bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14147: Septal Longitudinal Strain Predicts Long-Term Mortality in Patients With Acute Pulmonary Embolism
Authors: Bjerregaard Caroline L , Rasmussen Sif M , Shabib Ali , Toender Niels , Fritz-Hansen Thomas , Biering-Sørensen Tor , Olsen Flemming J
Published: June 2023

Background
Acute pulmonary embolism (PE) is associated with an increased risk of short- and long-term mortality. Since interventricular septal systolic function contributes to a third of right ventricular (RV) cardiac output, we sought to investigate the potential value of septal strain in PE.

Methods
This was a retrospective cohort study of patients admitted with acute pulmonary embolism. Patients underwent echocardiography during admission and included left ventricular (LV) speckle tracking, by which global longitudinal strain (GLS) and regional strain were acquired. Multivariable adjustments were made for age, sex, simplified PE index (sPESI), abnormal cardiac biomarkers (troponin or proBNP) and RV systolic function. The endpoint was all-cause death.

Results
The cohort consisted of 186 patients (mean age 68 years, 54% men), of whom 49 (26%) died during a median follow up of 3.5 years (IQR: 2.9-6.7 years). All LV systolic measures were univariable predictors of death (LVEF: HR: 1.04 (1.02-1.06), per 1% decrease; GLS: HR: 1.15 (1.07-1.22), per 1% absolute decrease; septal strain: HR: 1.15 (1.08-1.23), per 1% absolute decrease] (figure). RV systolic function was also associated with death [TAPSE: HR: 1.06 (1.01-1.12), per 1mm decrease). After multivariable adjustments, only septal strain remained significantly associated with outcome (HR: 1.09 (1.01-1.19), p=0.029, per 1% absolute decrease).

Furthermore, septal strain significantly increased C-statistics when added to a base model of sPESI score, abnormal biomarkers and presence of hypotension (base model C-stat: 0.76; base model and septal strain C-stat: 0.83, p for increment = 0.006).

Conclusion
Septal strain is associated with death in acute PE and provides prognostic information beyond conventional risk assessment.
Abstract 14155: Concomitant Use of Creatine Kinase MB and High-Sensitivity Troponin: What is the Cost?
Authors: Mills Joshua , Yu Hoi-Ying , Van Enkevort Erin , Hoffman Samantha , Matsumura Martin , Voyce Stephen J
Published: June 2023

Introduction:
AHA/ACC guidelines recommend the use of serial high sensitivity troponin (hs-Tn) assays to assess for cardiac injury
1
and addition of CK-MB adds no benefit. However, in the clinical setting, CK-MB assays continues to be ordered concomitantly with hs-Tn in evaluation of suspected myocardial injury/infarction. We performed this study to determine whether the addition of CK-MB to hs-Tn alters diagnostic or therapeutic decisions and to determine its effect on patient outcomes. The financial aspects of this practice were also analyzed

Methods:
We performed a retrospective review of patients in the Geisinger Health care system from 2018 through 2021. Those having both a CK-MB and a hs-Tn drawn within 24 hours were included. Test results were categorized as concordant or discordant. Patient demographics, clinical profiles, medications and rates of diagnostic cardiac catheterization and subsequent PCI and primary admission and discharge diagnosis were collected from the EMR and analyzed. We used Medicare reimbursement data for estimates of financial impact.

Results:
A total of 18,727 unique patients had a CK-MB and hs-Tn performed within a 24-hour window. Of these, 49.1% (9,149) had concordant values and 50.9% (9,533) had discordant values. Of those with discordant results, 8,801 (92.3%) patients had abnormal hs-Tn result but normal CK-MB. Abnormal CK-MB with a normal hs-Tn was resulted in 840 patients (8.8%). There was a total of 42,276 CK-MB determinations during our study timeframe which averages out to 2.3 CK-MB/patient. Medicare reimbursement for CKMB is $11.55.

Conclusions:
This 3-year study demonstrates clinicians still frequently ordered CKMB in patients with concomitant hs-Tn determinations and 49.1%% results are concordant with hs-Tn results yielding no additional clinical information versus use of hs-Tn alone. The cost of this practice is estimated at $239,749.31 for the study period. Data on patients with discordant results and impact on decision process and cost is under analysis and will be available for presentation.
Abstract 14182: A Missense Mutation in Ryanodine Receptor 2 Leads to Structural Remodeling of the Heart and Cardiac Arrhythmia in a Rabbit Model
Authors: Zheng Jingjing , Dooge Holly , Valdivia Hector , Alvarado Francisco
Published: June 2023

Ryanodine receptor 2 (RyR2) is the Ca
2+
release channel of sarcoplasmic reticulum that provides the majority of Ca
2+
necessary for contractions of the heart. RyR2 mutations are linked to catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited arrhythmogenic disorder with normal heart structure. There are reports suggesting that RyR2 mutations can also lead to structural heart disease, notably arrhythmogenic right ventricular cardiomyopathy (ARVC); however, additional research is required to support this association. We generated a rabbit model carrying the missense mutation RyR2-V2475F, linked to CPVT in humans. Heterozygous (V2475F
+/-
) rabbits show a CPVT-like syndrome and display arrhythmia under pharmacological stress. Homozygotes (V2475F
+/+
) show a stronger phenotype, with 37% of the animals (13/35) experiencing sudden death at 22.5±3.8 weeks old during regular housing. Remarkably, gross examination of V2475F
+/+
hearts showed significant structural remodeling, characterized by fibrous infiltrations and thinning of the right ventricle with or without left ventricle involvement. This phenotype is reminiscent of ARVC. Lead II ECG obtained in conscious rabbits by telemetry showed that V2475F
+/+
animals have significant bradycardia (144.6±11.1 bpm) with prolonged QT interval (QTc: 180.4±8.2 ms, n=6) compared to WT (HR: 224.9±4.2 bpm, p=0.04; QTc: 157.4±5.3 ms, p=0.02, n=5). After subcutaneous injection of 0.5 mg/kg of isoproterenol, WT rabbits showed the expected positive chronotropic response (HR, 367±10 bpm, n=3) while V2475F
+/+
animals developed bouts of ventricular tachycardia. Mild emotional stress applied by transporting the animal around the laboratory, also induced ventricular arrhythmia in 100% (5/5) V2475F
+/+
rabbits, while WT littermates were unaffected. RyR2-V2475F expressed in a rabbit model triggers remarkably different phenotypes based on the zygosity of the animals, ranging from a purely arrhythmogenic syndrome (CPVT) in V2475F
+/-
animals to severe structural disease compatible with ARVC in V2475F
+/+
rabbits. The RyR2-V2475F rabbit model is therefore an excellent model to dissect the intersection of arrhythmic and structural phenotypes due to RyR2 dysfunction.
Abstract 14194: Risk Factors of Hypokalemia and Hyperkalemia in Hypertensive Emergency
Authors: Tan Jia Wei , Parekh Jay , Nketiah Sarpong Kwabena Sefah , Jang Sun-Joo , Sethi Samdish , Polisetty Lakshmi , Gogna Arjun
Published: June 2023

Introduction:
Potassium disorders are common among hypertensive patients. There is a paucity of data on the prevalence and risk factors of dyskalemia in patients with hypertensive emergency.

Hypothesis:
We sought to investigate the prevalence and risk factors of potassium disorders in patients presenting with hypertensive emergency.

Methods:
A retrospective, cross-sectional study was employed by retrieving electronic medical records (EMR) of patients with a diagnosis of hypertensive emergency admitted from September 2016–December 2021 under Yale New Haven Health system. Hypertensive emergency patients were identified using the International Classification of Diseases, Tenth Edition (ICD-10) diagnosis. We selected patients who carried the diagnosis code of hypertensive emergency (I16.1) and at least 1 additional diagnosis for concurrent end organ damage (EOD). We manually examined all the electronic medical record (EMR) (n = 2664) to assure the correct establishment of diagnosis and removed 345 patients who are hypertensive urgency misclassified as hypertensive emergency. Hypokalemia is defined as serum potassium <3.5 mg/dL and hyperkalemia is defined as >5.5 mg/dL.

Results:
Among a total of 2,319 patients included in the study, 1,157(49.9%) were women and 1162(50.1%) were men. The mean age of the patients was 67.3 years. We have941(40.6%) African Americans, , 1048( 45.2%) Caucasian, and the rest of 240 (14.2%) are either Asians or unspecified. Average systolic blood pressure on presentation was 193 mmHg and average diastolic blood pressure was 106 mmHg. 143 (6.2%) patients had hyperkalemia and 260 (11.2%) patients had hypokalemia. After multivariable adjustment, older age, lower serum bicarbonate, elevated serum sodium and elevated serum creatinine were independently associated with hyperkalemia, and younger age, African American, higher serum bicarbonate, lower serum sodium, and lower serum creatinine were independently associated with hypokalemia.

Conclusions:
We identify a potential clinical phenotype of hypertensive emergency patients who present with potassium disorder. The risk for hypo- and hyperkalemia in hypertensive emergency can be stratified with common laboratory results and socio-demographic variable.
Abstract 14205: WAVES - The Lucile Packard Children's Hospital Open-Access Pediatric Physiological Waveforms Dataset
Authors: Dhillon Gurpreet S , Miller Daniel R , Bambos Nicholas , Shin Andrew , Scheinker David
Published: June 2023

Introduction:
Research repositories of adult physiological waveform (PW) data facilitate clinical and methodological advances. Models trained on adult data do not generalize well to pediatric groups. No large, open repository of pediatric PW data is available for research.

Methods:
PW and vital sign data were downloaded from bedside patient monitoring systems at an academic pediatric hospital from 06/2008-01/2017, de-identified, cleaned, organized, and stored on a research platform managed by Stanford University. Algorithms to process data for deep learning applications were designed, validated, and uploaded to the research platform.

Results:
WAVES is a single-institution dataset comprising 9 years of high-frequency PW data. WAVES consists of 10.6 million hours of 1 to 20 concurrent types of high-frequency PWs (Table 1). Approximately 1.5 million PW samples were collected over 50,364 unique hospital encounters across various specialized and general units (Table 2). Initial work demonstrated the suitability of the data for training deep learning models by accurately detecting hypotension with data only from electrocardiogram, plethysmography, and respiration waveforms.

Conclusions:
WAVES is currently the largest pediatric-focused PW dataset available for open-access research and the second largest repository of correlated multi-channel PW data. The WAVES database can enable improvements in pediatric clinical care through machine learning research on PWs from a variety of hospitalized pediatric patients and could facilitate the development of methodological and clinical innovation in the field of pediatric care.
Abstract 14206: Cross-Sectional, Exploratory Assessment of Biomarkers in Patients With Decompensated Heart Failure and Underlying Coronary Artery Disease (abide-hf)
Authors: Alleman RIck K , McGrew Frank A , Kotha Jayaprakash , Angiolillo Dominick J , Jefferies John L , Jennings Lisa K
Published: June 2023

Introduction:
Heart failure (HF) is a key contributor to high mortality and economic burden associated with cardiovascular diseases. Understanding the factors responsible for accelerated HF progression due to comorbid conditions is important in HF management.

Hypothesis:
The hypothesis of this study was that specific biomarkers related to thrombosis, inflammation, cardiac injury, and remodeling in patients with reduced ejection fraction (HFrEF) and coronary artery disease (CAD) may inform disease progression and aid in evaluating therapeutic efficacy.

Methods:
This study was a cross-sectional, exploratory assessment of biomarkers related to thrombosis, inflammation, and cardiac injury/remodeling in decompensated heart failure patients with reduced ejection fraction and underlying CAD. Symptomatic HF patients (n=74) with reduced left ventricular ejection fraction (LVEF ≤40%, HF ≥3 months) and significant underlying CAD as evidenced by previous myocardial infarction, prior coronary artery bypass graft, 50% coronary stenosis of one or more arteries, and history of percutaneous coronary intervention with or without stenting were enrolled in the study, and age-matched healthy subjects (n=20) were enrolled for comparative analysis of biomarkers.

Results:
Significant differences between HF+CAD and Controls were observed for thrombosis biomarkers (TM,
p
=0.0002, TGA [lag time,
p
=0.003; endogenous thrombin potential
p
=0.048], inflammatory biomarkers (CD62P,
p
=0.006; hsCRP,
p=
0.0064; S100β,
p
=0.0004), and cardiac injury/remodeling (GDF-15,
p
=0.0002; NTproBNP,
p
<0.0001).

Conclusions:
Elevated levels of hsCRP and GDF-15 demonstrate heightened systemic inflammation in HF and CAD, and support the hypothesis that targeting inflammation may provide additional treatment options for this patient population. A novel finding of this study was that S100β, previously identified to play a role in maladaptive compensatory mechanisms, was higher in HF+CAD patients and correlated with multiple biomarkers including, CD62P, NTproBNP, and TM. (ClinicalTrials.gov Identifier: NCT03551756).
Abstract 14215: Higher Social Vulnerability is Associated With Lower Self-Care Monitoring in African Immigrants With Chronic Disease
Authors: Osokpo Onome H , Iroegbu Christin , Huang Liming , Lewis Lisa M , Hirschman Karen , Naylor Mary D , Riegel Barbara J
Published: June 2023

Background:
Self-care is important in chronic illness management. While known that social determinants of health or social vulnerability (SV) influence health outcomes, little is known about the influence of SV on self-care and less is known about how SV influences self-care among African immigrants with chronic Cardiovascular disease (CVD). Therefore, we examined the relationship between individual-level SV and self-care in this population.

Method:
Self-identified African immigrants with symptomatic chronic CVD, over age 35 years, who spoke and understood English were enrolled in this descriptive, cross-sectional study (n=128). Individual SV scores were calculated based on gender, marital status, education, English proficiency (speaking and understanding), race, income, employment, living condition, immigration status, health insurance, and healthcare access; possible SV 0-12. Higher scores, higher social vulnerability. Self Care of Chronic Illness Inventory measured self-care maintenance, monitoring, and management (scores standardized 0-100, ≥70 adequate self-care). Multivariable linear regression was used to assess the association of SV with self-care, adjusting for age and duration of US residency.

Results:
The sample was mostly older adults (56±11 years), 68% men, 70% married, 82% college educated, 89% living with family or others, with a long duration of residency (16±11 years). Most common illnesses were hypertension (48%) and/or diabetes (20%). Self-care scores were adequate (maintenance=78.7, monitoring=79.3, management=73.9). SV score (3.49±2.03). Higher SV was associated with lower self-care monitoring (p=0.04) but not with self-care maintenance or management.

Conclusion:
Self-care monitoring was the only dimension of self-care associated with SV. African immigrants who feel more socially vulnerable may focus on monitoring to avoid needing acute care. Culturally tailored interventions focused on self-care monitoring may help this population follow a reliable method in detecting significant changes in signs and symptoms.
Abstract 14223: Lifetime Smoking Behaviors, Frequency of Worship and Systolic Blood Pressure in the Metabolic Syndrome Outcome (MetSO) Cohort Study
Authors: Blanc Judite , Oliveira Bruno , Rogers April , Sanchez Alfonso Ana , Seixas Azizi A , Jean-Louis Girardin
Published: June 2023

Introduction:
Research has shown faith-based intervention can influence a net reduction of 5.8 millimeters of mercury in systolic blood pressure
1
. This study examined the relationships between lifetime smoking behaviors and systolic blood pressure (BP) in a diverse sample of Blacks residing in New York City and whether this relationship is moderated by frequency of visit to place of worship.

Method:
The present study utilized data from the MetSO study, an NIH-funded cohort study of blacks with metabolic syndrome (MetS). A total of 1035 were screened for MetS in the MetSO registry. The average age of the sample was 62±14 years (range: 20-97); 71% were female, and all were of the black race/ethnicity. Seventy-one percent reported finishing high school, and 43% reported annual income <10K. Patients were diagnosed with MetS using standard criteria articulated in the joint interim statement for harmonizing the MetS. Data was gathered on demographics, health behaviors and religious practices. Participants were asked about their smoking habits and alcohol consumption, as well as their religious practices. Correlation matrix and multilinear regression analysis were conducted to explore associations between smoking behaviors and blood pressure level. Interaction effects between smoking behaviors and potential moderators (frequency of visits to place of worship) were conducted to examine which category was at greater risk of higher systolic blood pressure.

Results:
Surprisingly, lifetime smoking habits were positively correlated with frequency of visit to place of worship (r =.41; p=.000) and emerged as the strongest independent predictor of systolic BP [β =.084(SE=1.068); p< 0.001], after adjustment for age, employment and daily alcohol consumption. The association between lifetime smoking habits and systolic BP was moderated by the frequency of visits to place of worship [B(SE)=.098 (.150); p< 0.001].

Conclusions:
Results of our study suggest that frequency of visit to place of worship is linked with lifetime smoking habits, which may have significant impact on systolic blood pressure among diverse older Blacks.
Abstract 14224: Patient Differences in Prescription Patterns for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors When More Intensive Therapy is Needed
Authors: Effron Mark B , Kakkar Anjali , Desrosiers Greg , Velasco-Gonzalez Cruz , Cooper-dehoff Rhonda M
Published: June 2023

Introduction:
Statins are the cornerstone therapy to lower low density lipoprotein cholesterol (LDL) but not all patients (pts) tolerate statins or reach LDL goal reduction with statin therapy. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) potently reduce LDL and demonstrate reduction of cardiovascular (CV) events compared to placebo. Despite this, prescribing rates of PCSK9i are low.

Hypothesis:
This study aims to identify patient factors associated with PCSK9i prescriptions.

Methods:
Pts with a prior CV event or diabetes with LDL >70 mg/dL on maximally tolerated statins or statin intolerant were identified using PCORnet clinical data marts (CDM) from REACHnet and OneFlorida. Pt demographics, co-morbidities, CV risk factors, 10-year ASCVD risk, and non-lipid lowering and lipid lowering drugs were provided in aggregate by the CDM. Categorical Baseline demographic and clinical characteristics differences were assessed by exact χ-square tests for categorical variables and Welsh t-tests for continuous variables. Unadjusted odds ratios (95% confidence intervals) were calculated to determine significance of the association.

Results:
Out of 464,664 pts, 0.3% received PCSK9i. Blacks had 21% lower odds of being prescribed PCSK9i as compared to whites. Non-Hispanics had 130% higher odds of being prescribed PCSK9i compared to Hispanics. Medicare pts had 44% higher odds of being prescribed PCSK9i than those with commercial insurance (Table). The presence of certain cardiac risk factors, such as MI and peripheral vascular disease, showed higher rates of PCSK9i prescription. Diabetes without known CV disease had the lowest odds of being prescribed PCSK9i.

Conclusions:
PCSK9i were rarely used. Higher CV risk appears to be a driver for use while it appears there is a bias in use based on race and ethnicity. Further analysis is needed to determine the interrelation of factors that limit prescription of PCSK9i and developing strategies to overcome them.
Abstract 14229: Utilization of Calcium Scores to Predict TAVR Outcomes in Paradoxical Severe Aortic Stenosis
Authors: Cipriano Ralph , Kapoor Mehak , Corrigan Andrew , Grinberg Gregory , Aladi Stanley , Islam Shahidul , Schwartz Richard , Salhab Khaled , Schubach Scott , Marzo Kevin , Ray Beevash
Published: June 2023

Introduction:
In patients with severe symptomatic (Stage D) aortic stenosis (AS), the disease is subcategorized based on the gradient, flow and left ventricular ejection fraction (LVEF). Stage D3 reflects low-flow, low-gradient severe AS with normal LVEF (paradoxical low-flow severe AS [PLFLG AS]. Current guidelines suggest measurement of a Computed Tomography (CT) derived calcium score of the native valve is helpful for management. Furthermore, calcium score can provide prognostic information for transcatheter aortic valve replacement (TAVR) in the general AS population. However, whether CT-derived calcium scores can predict major adverse cardiovascular events (MACE) in PLFLG AS patients undergoing TAVR has not been examined.

Methods:
We retrospectively investigated post-TAVR outcomes at 1 year, in patients echocardiographically characterized as PLFLG AS at our center between Jan. 2017 and Dec. 2020. Continuous variables were assessed for normality using the Kolmogorov-Smirnov test, histogram, and Q-Q plot. Logistic regression models were used to assess if calcium scores were associated with outcomes, and statistical significance was assumed if p<0.05.

Results:
:
A total of 85 patients were included in the analysis. The baseline pre- and immediately post TAVR data are described in Table 1. In our cohort, 16 had MACE (18.8%) at 1 year. Calcium score as a predictor of MACE (odds ratio (OR): 0.99; p=0.93), death (OR: 0.99; p=0.79), stroke (OR 1.01; p=0.90), myocardial infarction (OR 0.97; p=0.63), and post-TAVR paravalvular aortic regurgitation (OR 1.02; p=0.47) did not reach statistical significance.

Conclusions:
In our cohort, CT-derived calcium scores did not predict MACE events or post-TAVR paravalvular aortic regurgitation in PLFLG AS. The study had several limitations: it is a single center retrospective study with a small sample size, potentially leading to recording bias.
Abstract 14253: Distance to Cardiac Rehabilitation is Associated With Participation and Completion
Authors: Guduguntla Vinay , Hou Hechuan , Likosky Donald S , Pagani Francis D , McCullough Jeffrey , KETEYIAN Steven J , Sukul Devraj , Thompson Mike P
Published: June 2023

Background:
Despite the known benefits for patients undergoing coronary revascularization, cardiac rehabilitation (CR) use remains low, with few studies evaluating geographic barriers to care. In this analysis, we examined geographic access (i.e. distance) to a CR facility and its relationship to CR participation and completion.

Methods:
A cohort of 414,730 Medicare beneficiaries with coronary revascularization were identified from 2016-2018. Geographic access was defined as the presence of a CR facility within the beneficiary’s home zip code (yes vs. no) and the distance to the nearest CR facility: within the same zip code (0 miles), 0-10 miles, 10-20 miles, 20+ miles. We then used claims data to determine any CR participation within one year of discharge and completion of the full CR program (36 sessions). Multivariable logistic regression was used to identify the relationships, adjusting for patient factors.

Results:
A total of 155,872 (37.6%) beneficiaries participated in CR during the study period, with 45,591 (29.3%) completing 36 sessions. Nearly a quarter of beneficiaries had a CR facility located within their residential zip code (23.7%), with the majority of beneficiaries having a CR facility within 10 miles of the center of their home zip code (
Table 1).
Beneficiaries without a CR facility in their zip code were more likely to be younger in age, men, non-white race categories, dual eligible for Medicare/Medicaid, and increasingly comorbid. Adjusting for patient factors, increasing distance category was associated with an absolute reduction in CR participation and completion
(Table 1)
.

Conclusions:
Distance to the nearest CR facility is an important predictor of CR participation and completion, with overall use declining as distance increased. Interventions to address geographic barriers, such as transportation programs or virtual/hybrid CR, may be necessary to improve CR participation in areas with limited facility access.
Abstract 14265: Proteomic Discovery of Molecular Pathways in Patients With Biopsy-Proven Myocarditis
Authors: Kim Eui-Soon , Jang Donggi , Kyoung Yeonju , Kim Jeesoo , Lee Seonhwa , Kim In-cheol , Kim Jong-Seo , Youn Jong-Chan
Published: June 2023

Introduction:
Myocarditis is an inflammatory disease of the myocardium that results in injury to the cardiac myocytes. However, there is a lack of research focusing on its immune reaction. Also, most studies have been done through analysis of peripheral blood. Here, we aimed to identify proteome-based immunopathogenesis in patients with biopsy-proven myocarditis.

Methods:
Comparative proteomic analysis of right ventricle biopsy specimens was performed from six patients with myocarditis and four controls (normal endomyocardial biopsy specimens from one-year surveillance of heart transplant recipients) by tandem mass tag combined with liquid chromatography-mass spectrometry. Based on the results of protein expression, cell fractions were calculated using CIBERSORTx and Gene ontology (GO), and ingenuity pathway analysis was conducted to address immune features and related molecular mechanisms in myocarditis.

Results:
In total, 720 up-regulated proteins were screened. The top 10 GO terms in up-regulated proteins were mostly related to immune response. Also, the T follicular helper (Tfh) cells and plasma cell fractions were significantly increased in myocarditis. The ingenuity pathways analysis showed that the pathway for activation and immune response of immune cells included signaling of interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) with other mediators including interferon regulatory factor (IRF) 1,5, 7 and signal transducer and activator of transcription 1 (STAT1).

Conclusions:
From mass spectrometry protein analysis, we revealed that Tfh cells and plasma cells play a major role in the development of immune response in myocarditis. Also, TNF-driven interferon response via STAT1 and IRFs can be the main pathways for B cell activation by Tfh cells. Further studies are necessary to validate whether these proteins correlate with the clinical characteristics or can be used as biomarkers for myocarditis.
Abstract 14268: Prognostic Value of Clinical and Echocardiographic Factors in Atrial Functional Tricuspid Regurgitation
Authors: Fava Agostina M , Nakhla Michael , Hajj Ali Adel , Akintoye Emmanuel , Akyuz Kevser , Popovic Zoran B , Gillinov A M , Pettersson Gosta B , Griffin Brian P , Desai Milind Y , Wang Tom Kai Ming K
Published: June 2023

Introduction:
Atrial functional tricuspid regurgitation (AFTR) is an increasingly recognized and prevalent clinical entity associated with adverse outcomes.

Hypothesis:
We evaluated the clinical and echocardiographic features of AFTR and those associated with poor prognosis.

Methods:
Consecutive patients with at least moderate-to-severe and isolated AFTR during 14 years were studied, and clinical and echocardiographic parameters including that for TR and the right heart were analyzed. Multivariable and receiver-operative characteristics analyses were performed to identify predictors and their thresholds for all-cause mortality during follow-up.

Results:
Amongst 155 AFTR patients (age 73±15, female 83%), 58(37%) were symptomatic, and 80 (52%) had atrial fibrillation. There were 77 (49%) deaths over a mean follow-up of 3.9±3.3 years. Multivariable analyses results are shown in the Table 1, were symptoms, right atrial strain and right ventricular systolic pressure (RVSP) were independently associated with mortality during follow-up with hazards ratios (95% confidence intervals, P-values) of 3.27 (1.18-9.04, P=0.022), 0.95 per 1% increase (0.92-0.98, P=0.01), and 1.05 per 1 mmHg increase (1.01-1.09, P=0.003). Area under curve (95% confidence interval) and optimal thresholds for the most important echocardiographic parameters to predict mortality were RVSP 0.80 (0.74-0.92) >44 mmHg, right atrial strain 0.73 (0.62-0.84)
<
+21%, and right ventricular free wall longitudinal strain 0.69 (0.57-0.81)
>
-18%.

Conclusions:
Significant AFTR is associated with adverse prognosis, therefore accurate diagnosis is critical. The key predictors of mortality include symptoms, reduced right atrial strain and higher RVSP, and their presence may prompt more aggressive medical and procedural therapies in AFTR patients that warrants further research.
Abstract 14275: Sex Disparity of Cardiovascular Risk in Organisation for Economic Co-Operation and Development Countries (OECD): Finding the “Real Difference” Between Males and Females
Authors: Bhattaram Rohan , Bhayani Siddharth , Vidovich Mladen I
Published: June 2023

Background:
The differences in cardiovascular risk between males and females has been well established and the real difference (utilizing the natural log function) has been used to describe sex differences in incidents like motor vehicle accident rates. However, the “real difference” has not been applied to cardiovascular outcomes previously. The purpose of this study was to apply the “real difference” to cardiovascular death rates while evaluating the relationship between the “real difference” and established economic markers.

Methods:
OECD Statistics, a freely available online database, was accessed for data retrieval. Male and female cardiovascular death statistics (per 100,000) in all 38 OECD countries were acquired from the freely available online database, OECD Statistics. The real difference was calculated using Ln(Male CVD Rate) - Ln(Female CVD). A multivariate analysis was run to establish the relationships between different economic markers and the calculated “real difference”.

Results:
Mexico was found to have the smallest real difference at 0.211 while France had the largest real difference at 0.542. Figure 1 demonstrates the variation between real and raw difference for each country. Multi-variate analysis revealed a significant effect on real difference (
F
(32)=4.185, p<0.01) with 40% (R
2
=0.395) of the variation explained by the following factors- Estimated Female Earned Income (US$ PPP), Life Expectancy Gap, % of Women of Total Employment, Wage Gap, and Government Representation of Women.

Discussion:
The results of the multi-variate analysis demonstrate that sex disparities in cardiovascular death is related to the combined effects of multiple economic factors. The real difference is a valuable metric for assessing sex disparities and further studies should be conducted to further elucidate and account for the difference in CV mortality in different countries.
Abstract 14277: Comparison of Three Vascular Closure Devices for Vascular Access Closure After Cardiac Electrophysiology Procedures
Authors: Gianni Carola , Chafizadeh Thomas , Della Rocca Domenico G , Mohanty Sanghamitra , Al-Ahmad Amin , Burkhardt J D , Gallinghouse G J , Horton Rodney P , Hranitzky Patrick M , Sanchez Javier E , Natale Andrea
Published: June 2023

Introduction:
Vascular closure devices are commonly used for EP procedures to achieve rapid hemostasis. Different devices using different mechanisms of action are available, but the potential contribution of each type to the incidence of vascular complications is not clear.

Methods:
This is a single center, prospective study in which 138 contemporaneous patients undergoing EP procedures were categorized according to the vascular closure device type used: Vascade (collagen plug, n=57), Perclose (suture, n=41), and SiteSeal (external compression, n=40). The primary endpoint was access-related major vascular complications. Secondary endpoints included time to ambulation and delayed access-site bleeding requiring additional manual pressure.

Results
Mean age and BMI 68±11 years and 29.7±6.2 Kg/m
2
, 46 (33%) were female, 121 (88%) were on uninterrupted antithrombotic therapy (71% OAC, 14% OAC/APLT, 3% APLT). Femoral vein access was obtained in all, bilaterally in 113 (82%), with a mean of 3±1 access sites per patient and a sheath size ranging from 6- to 23-Fr. Femoral arterial access was obtained in 14 (10%), once per patient, with a sheath size ranging from 5- to 8-Fr.

There were no arterial access complications. On the venous side, hematomas occurred in 3/57 (5%) of the Vascade group, 1/41 (2%) of the Perclose group, and 0/40 (0%) of the SiteSeal group (p=ns for all comparisons). Delayed access-site bleeding occurred in 5/57 (9%) of the Vascade group, 5/41 (12%) of the Perclose group, and 7/40 (18%) of the SiteSeal group (p=ns for all comparisons). Time to ambulation was comparable between groups (minutes: 139±51 Vascade, 137±34 Perclose, 123±11 SiteSeal, p=ns).

Conclusion

Vascade, Perclose, and SiteSeal are comparable in term of vascular complications and time to ambulation for patients undergoing EP procedures.
Abstract 14286: Comparison of Enteric Coated Aspirin With Plain Aspirin on Effectiveness and Safety in the ADAPTABLE Trial
Authors: Effron Mark B , Sleem Amber , Stebbins Amanda , Wruck Lisa M , Gravel Guillaume , Muñoz Daniel , Re Richard N , gupta Kamal , Pepine Carl , Jain Sandeep , Girotra Saket , Whittle Jeffrey , Benziger Catherine , Farrehi Peter M , Knowlton Kirk U , Polonsky Tamar S , Roe Matthew T , Rothman Russell T , Harrington Robert A , Jones William S , Hernandez Adrian F
Published: June 2023

Introduction:
Many clinicians recommend enteric coated aspirin (EC-ASA) to decrease gastrointestinal bleeding (GIB) in secondary cardiovascular (CV) protection even though studies suggest decreased platelet inhibition with EC-ASA compared to uncoated “plain” formulations (P-ASA). ADAPTABLE was a large, pragmatic study, showing no difference in ischemic events or bleeding between 81-mg and 325-mg ASA and provides a large population to assess effectiveness and safety of EC-ASA versus P-ASA in CV patients.

Methods:
Participants (pts) from ADAPTABLE were re-grouped according to type and dose of reported ASA use at baseline. The primary effectiveness endpoint was the composite of myocardial infarction (MI), stroke, or death from any cause and the primary safety endpoint was major bleeding events (hospitalization for a bleeding event with use of a blood product or intracranial hemorrhage) analyzed between groups by ASA type and within groups by dose using multivariable Cox proportional hazards.

Results:
15,076 pts were randomized to 81-mg or 325 -mg ASA were followed for a median of 26.2 months of whom 10,678 reported ASA type at baseline. Of pts reporting ASA type used, 69% used EC-ASA and were slightly older, more likely to be in the 81-mg cohort, be nonsmokers, have slightly more coronary artery disease, and have a slightly lower prior MI rate (Table). No other significant differences between the 2 cohorts were noted. There was no significant difference in the effectiveness or safety outcomes between the EC-ASA and P-ASA cohorts (Table). Within EC-ASA and P-ASA, ASA dose had no effect on effectiveness (interaction p = 0.41) or safety (interaction p = 0.07).

Conclusion:
Enteric coating did not significantly affect the primary effectiveness or safety endpoints in ADAPTABLE, regardless of ASA dose. More research is needed to confirm whether enteric coated aspirin formulations or newer formulations will improve ischemic and bleeding outcomes in patients with CV disease.
Abstract 14293: Sex Differences in Cytokine and Chemokine Expression in an Experimental AAA Rodent Model
Authors: Zaghloul Mohamed , Elizondo-Benedetto Santiago , Arif Batool , Sastriques Dunlop Sergio , Gropler Robert J , Liu Yongjian , Zayed Mohamed
Published: June 2023

Introduction:
Abdominal aortic aneurysms (AAAs) are a multifactorial disease process that results from a series of biomolecular processes. AAAs are more prevalent in men; however, women are at greater risk of rupture. Despite continued investigation, the mechanisms of sex disparities in AAA remain unknown.

Hypothesis
We hypothesize that male and female rats will have different inflammatory cytokine and chemokine expression in AAA tissue.

Methods:
Male and female Sprague-Dawley rats underwent intraluminal infrarenal abdominal aortic exposure to elastase to induce AAA. Rats were administered daily β-aminopropionitrile to promote AAA rupture.
In vivo
aortic diameters were evaluated using ultrasound (12MHz) at day 7 and 14 post-AAA induction. PET imaging with
64
Cu-DOTA-ECL1i (a selective radio-marker for C-C chemokine receptor type 2; CCR2), AAA tissue zymography and cytokine array were performed at day 6 and 14 to evaluate CCR2, matrix metalloproteinases (MMP), chemokine, and cytokine content.

Results:
Male rats developed larger AAAs at day 7 and 14 compared to female rats (p<0.0001; Figure 1A), but AAA rupture rate was similar between sexes. At day 6, AAA cytokine arrays demonstrated Rantes, IFN-y, and IL-17A were higher in males (p<0.01; Figure 1B-D). However, MCP-1, IL-6, IL-10, IL-18, IL-1B, and TNF-α were similar between groups (Figure 1E-J). Interestingly, at day 14, females showed significantly higher MCP-1, IL-6, and IL-10 (p<0.05; Figure 1E-G). PET imaging demonstrated that males had higher CCR2 uptake at day 14 (p<0.05; Figure 1K). AAA zymography demonstrated equivalent levels of total MMP-9, pro-MMP 9, and active MMP-9 between groups (Figure 1L-O).

Conclusion
Our findings demonstrated that inflammatory cytokines and chemokines are differentially expressed in AAA tissue - particularly CCR2 which is higher in males. This provides sex-specific AAA tissue targets for diagnostic molecular imaging and potential future immune-modulation strategies.
Abstract 14299: In-Hospital Outcomes of Patients With Obstructive Sleep Apnea Undergoing Atrial Septal Defect Repair
Authors: Kaur Sukhpreet , Ebner Bertrand , Dangl Michael , Albosta michael , Ergui Ian , Inestroza Karla , Hernandez Rafael J , Vergara-Sanchez Carlos , Maning Jennifer , VINCENT LOUIS , Grant Jelani , Colombo Rosario , de Marchena Eduardo
Published: June 2023

Introduction:
There is emerging new evidence of an association of atrial septal defects (ASD) with hypoxic conditions such as obstructive sleep apnea (OSA). In this study, we determined in-hospital outcomes of patients with OSA undergoing percutaneous ASD repair (ASDR).

Methods:
The National Inpatient Sample Database was queried from 2011-2019 for relevant ICD-9 and -10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with and without a history of OSA with a primary diagnosis of ASD who underwent ASDR (Surgical or percutaneous) on the index admission. Logistic-regression was performed to adjust for pre-specified co-variable for different outcomes. p-value was considered significant when <0.001.

Results:
We identified a weighted sample of 132,221 patients (≥18 years old) with a primary diagnosis of ASD, out of whom 10.9% (14,457) had ASDR. Of patients who underwent ASDR, 11.2% (1,615) carried a diagnosis of OSA. Baseline characteristics are shown in Table 1. There was no statistically significant difference in all-cause mortality between patients who underwent ASDR, with and without OSA (2.7% vs 2.7%). After adjusting for potential confounders, there was no statistical difference between both groups’ in-hospital outcomes such as total cost, length of stay, acute renal failure, stroke rate, vascular or pericardial complications.

Conclusions:
Although patients with OSA who underwent ASD repair have higher co-morbidities, they were not at higher risk for inpatient complications post-procedure and there was no difference in mortality noted. Prospective studies are needed to further investigate the effect of ASDR in OSA patients.
Abstract 14300: Arterial Stiffness is Associated With Intermediate-Term Home Blood Pressure Variability: The Electronic Framingham Heart Study
Authors: Wang Xuzhi , Zhang Yuankai , Pathiravasan Chathurangi H , Lin Honghuang , Borrelli Belinda , Spartano Nicole L , Benjamin Emelia J , McManus David D , Larson Martin , Ramachandran Vasan S , Hamburg Naomi M , Murabito JoAnne , Liu Chunyu , Mitchell Gary F
Published: June 2023

Introduction:
Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies examined associations between arterial stiffness and digital home BPV over an intermediate time span.

Objective:
We investigated if antecedent arterial stiffness was associated with home BPV among participants in the electronic Framingham Heart Study (eFHS). We hypothesize that higher arterial stiffness predicts higher intermediate-term home BPV over one-year follow-up.

Methods:
At an FHS research exam (2016-2019), participants underwent arterial tonometry to acquire mean arterial pressure (MAP) and measures of arterial stiffness (carotid femoral pulse wave velocity, CFPWV; forward pressure wave amplitude, FWA) and wave reflection (reflection coefficient, RC). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly. Participants with < 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with home average real variability (ARV) of systolic (SBP) and diastolic (DBP) BP adjusting for covariates. We obtained ARV as an average of the absolute differences of consecutive BP measurements. ARV considers not only the dispersion of the BP readings around the mean, but also the order of BP readings. We used p<0.05 for significance.

Results:
Among 857 eFHS participants (mean age 54 years, 59% women, mean BP 119/76, 47% hypertension, mean ARV of DBP 5.50, mean ARV of SBP 8.61), higher FWA and RC were associated with higher ARV of SBP (
Table
). Higher CFPWV was associated with lower ARV of DBP (
Table
).

Conclusion:
In eFHS, higher FWA and RC were associated with higher intermediate-term home BPV of SBP while higher CFPWV was associated with blunted BPV of DBP. Our findings suggest that higher aortic stiffness and wave reflection may affect day-to-day modulation of blood pressure in a home-based setting.
Abstract 14303: Disparities in Mechanical Circulatory Support Utilization in Patients With End Stage Heart Failure
Authors: Gharbin John , Brgdar Ahmed , Winful Adwoa B , Alebna Pamela , Yi Jin , Balogun Abimbola , Mehrotra Prafulla P
Published: June 2023

Despite optimum guideline directed medical therapy, one-year mortality rate of patients with end stage heart failure exceeds 50%. The use of mechanical circulatory support (MCS) has been shown to improve the overall quality of life in patients with advance stage heart failure. Studies have explored disparities in clinical outcome of patients undergoing mechanical circulatory support for acute myocardial infarction and cardiogenic shock. Data on sex-specific, racial, and socioeconomic disparities in patients with end stage heart failure requiring MCS as a bridge-to-transplant or destination therapy is limited. Using the most recent National Inpatient Sample database, we hypothesized that disparities found among other patient populations also exist in patients with end stage heart failure needing MCS.

In our study, 1.5% of patients with end stage heart failure underwent MCS with a mean age of 55±16 yrs. Females accounted for 20.7% (20.69% vs 79.3%,
p
=0.002). Patients who received MCS had lower comorbities; Diabetes (38.8% vs 43.5%,
p
=0.308), COPD (8.6% vs 24.9%,
p
<0.001), CKD (47.4% vs 63.1%,
p
=0.001), and Hyperlipidemia (43.1% vs 47.5%,
p
=0.347). Among patients with end stage heart failure, mean charlson index by race were 4.4 vs 4.6 vs 4.5 for Whites, Blacks, and Hispanics respectively,
p
=0.008. After controlling for age, comorbities, charlson index, insurance types, household income and place of residence, compared to Whites, Blacks and Hispanic with end stage heart failure were significantly less likely to undergo MCS (Blacks: aOR=0.50, 95% CI: 0.29-0.87,
p
=0.014) (Hispanics: aOR=0.68, 95% CI: 1.48,
p
=0.337). Females compared to males also had lower odds of receiving MCS in end stage heart failure (aOR=0.56, 95% CI: 0.34-0.92,
p
=0.021).

We observed patients with end stage heart failure who received MCS were younger and had less comorbidities. After controlling for age, comorbidities and potential confounders, the odds of females and minority patients with end stage heart failure receiving MCS was about half. These findings underscore the importance of addressing social determinants of health in minority populations. Further implementation studies are required to help bridge the health equity gap in patients with end stage heart failure.
Abstract 14310: Patient Reported Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Chronic Kidney Disease
Authors: Farwati Medhat , Johnson Brett , amin mustapha , Farwati Amr , Turkmani Mustafa , Nakagawa Hiroshi , Saliba Walid I , Tarakji Khaldoun , Diab Mohamed , Kuroda Shunsuke , Kanj Mohamed H , Dresing Thomas J , Callahan Thomas D , Bhargava Mandeep , Baranowski Bryan , Rickard John , Cantillon Daniel J , Tchou Patrick , Wazni Oussama M , Hussein Ayman
Published: June 2023

Introduction:
Increasingly, catheter ablation for atrial fibrillation (AF) has been utilized for rhythm control and to improve quality of life (QoL). Data are limited on patient-centered ablation outcomes in individuals with chronic kidney disease (CKD).

Objective:
To examine clinical outcomes and QoL following AF ablation in CKD patients from a large patient-reported outcomes (PRO) database.

Methods:
All patients undergoing AF ablation (2013-2016) at our center were enrolled and assessed for outcomes using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). This analysis captured data at 1- and 3-year follow-up. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min using the 2021 CKD-EPI equation. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL assessment. In addition, data were collected on clinical improvement by patient report, AF burden, and healthcare utilization.

Results:
A total of 488 patients were identified (66% male, mean age 68.5, 56.2% persistent AF). QoL was significantly improved from baseline median (IQR) AFSSS of 14 (6-19.5) to 3 (0-9) at 1-year and 4 (0-9.5) at 3-year; P≤0.0001 for both. About 90% of patients reported improvement in their overall AF-related symptoms both at 1- and 3-year follow up. The proportion of patients in AF at the time of completion of the baseline survey was 51.2%, and this decreased to 6.2% at 1-year and 9.7% at 3-year follow up (P<0.0001 for both). AF burden was significantly reduced at 1-year and 3-year including frequency and duration of episodes (P<0.05 for both), with associated decrease in ER visits and hospitalizations; P<0.0001 for all comparisons. The proportion of patients on antiarrhythmics decreased from 61.8% at baseline to 35.6% and 22.7% at 1-year and 3-year, respectively (P<0.0001 for both).

Conclusions:
In a large AF-specific PRO system, catheter ablation for AF was associated with a significant improvement of QoL in most patients with CKD; with a decrease in AF burden and healthcare utilization.