bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9175: Clinical Significance of Resting Heart Rate on Exercise Capacity and Prognosis: Comparison Among Heart Failure Patients with Reduced, Preserved and Mid-Range Ejection Fraction
Authors: Sato Takamasa , Yoshihisa Akiomi , Ishida Takafumi , Takeishi Yasuchika
Published: April 2024

Introduction:
Resting heart rate (rHR) has a big influence on clinical outcomes and exercise capacity in patients with chronic heart failure (CHF). However, the association of rHR with exercise capacity and prognosis has not been fully elucidated in patients with heart failure with reduced, preserved and mid-range ejection fraction (HFrEF, HFpEF and HFmrEF).

Aims:
We aimed to determine the differences in the association of rHR with exercise capacity and prognosis in patients with HFrEF, HFpEF and HFmrEF.

Methods:
877 CHF patients with sinus rhythm (SR) were divided into four groups according to rHR (G1: rHR
<
60 /min, G2: 60<rHR
<
70 /min, G3: 70<rHR
<
80 /min and G4: rHR<80 /min) in HFrEF, HFpEF and HFmrEF, respectively. We compared the parameters of cardiopulmonary exercise testing and adverse cardiac event rates (cardiac death and re-hospitalizations for worsening heart failure) among HFrEF, HFpEF and HFmrEF.

Results:
Of 877 CHF patients, 388 were in HFrEF, 360 in HFpEF and 179 in HFmrEF. Patients with HFrEF were the youngest among three groups. Patients with HFrEF had the highest plasma BNP level and the lowest estimated glomerular filtration rate, followed by those with HFmrEF and HFpEF. Patients with HFrEF had the lowest peak oxygen consumption (PVO
2
) , heart rate reserve (HRR: [peak HR-rHR] / [predicted max HR-rHR]) and oxygen uptake efficiency slope (OUES) , and the highest minute ventilation and carbon dioxide production (VE/VCO
2
) slope, followed by those with HFmrEF and HFpEF. In HFrEF, patients with rHR from 70 to 80 /min had the highest PVO
2
and HRR and the lowest VE/VCO
2
slope. On the other hands, as rHR increased, adverse cardiac event rates increased. In HFpEF, patients with rHR less than 60 had the lowest PVO
2
, HRR and OUES, and the highest VE/VCO
2
slope and adverse cardiac event rates. In HFmrEF, patients with rHR less than 60 had the lowest PVO
2
, HRR and OUES and the highest VE/VCO
2
slope. In contrast, adverse cardiac event rate was not significant different in relation to rHR.

Conclusions:
rHR was associated with exercise capacity and clinical outcomes in patients with CHF and SR. However, influence of rHR on exercise capacity and adverse clinical outcomes were different among HFrEF, HFpEF and HFmrEF.
Abstract 9202: Sudden Cardiac Death and Icd Use in Rasopathy-Associated Hypertrophic Cardiomyopathy: An International Multi-Centre Study
Authors: Lynch Aine , Ahuja Sachin , Lafreniere-Roula Myriam , Zhao Vivian , Armstrong Kathryn , Aziz Pete , Benson Lee N , Butts Ryan J , Colan Steven D , Dragulescu Andreea , Gardin Letizia , Godown Justin , Henderson Heather T , Jean-st-michel Emilie M , Jeewa Aamir , Kantor Paul F , Kaufman Beth D , Beausejour-Ladouceur Virginie , Lal Ashwin K , Parent John J , Richmond Marc E , Russell Mark W , Balaji Seshadri , Stephenson Elizabeth A , Villa Chet , Whitehill Robert , Conway Jennifer , Howard Taylor , Nakano Stephanie J , Rosanno Joseph , Weintraub Robert G , Mital Seema
Published: April 2024

Introduction:
Sudden cardiac death (SCD) burden in RASopathy patients (pts) with hypertrophic cardiomyopathy (RAS-HCM) is not known. We compared SCD events and transplant-free survival in RAS versus primary HCM (P-HCM) pts.

Methods:
The international 22-center retrospective cohort study (PRIMaCY) included 190 pediatric RAS-HCM and 568 P-HCM pts. The primary outcome was 10-year freedom from SCD events (composite of SCD, resuscitated sudden cardiac arrest, and appropriate shock from a prophylactic ICD), estimated using Kaplan Meier method.

Results:
Of 190 RAS-HCM pts, 82% had Noonan syndrome. Age at diagnosis was lower in RAS-HCM vs P-HCM (0.9 vs 9.7 yrs, p<0.001). There was no difference in baseline LV posterior wall or septal thickness, but LVOT gradient was higher in RAS-HCM vs P-HCM (30 vs 13mmHg, p<0.001). However, frequency of myectomy was not different in RAS-HCM vs P-HCM (15.2% vs 16.7%, p=0.55). Eighteen RAS-HCM pts died (4 SCD, 2 bradycardic arrests, 5 heart failure, 3 respiratory failure, 2 other) with lower 10-year transplant-free survival in RAS-HCM vs P-HCM (84.2% vs 91.6%, p=0.026). Although 10-year cumulative proportion of SCD events was lower in RAS-HCM than P-HCM (5.4% vs 15.1% respectively, p<0.001) (Figure 1), the median age at event was not different (12yrs in RAS-HCM vs 15.2yrs in P-HCM). Of 5 RAS-HCM pts with a SCD event, 4 died and 1 received a secondary prevention ICD. An additional 10 pts received a prophylactic ICD with no appropriate shock during follow-up. The 10-year cumulative proportion of prophylactic ICD was lower at 6.3% in RAS-HCM vs 27.2% in P-HCM (p<0.001).

Conclusion:
Transplant-free survival was lower in RAS-HCM than P-HCM with mortality related primarily to non-SCD events. Of the RAS-HCM patients with SCD events, 4 died without an ICD highlighting the need for better risk prediction models for both SCD and heart failure mortality in this population.
Abstract 9203: Role of Artificial Intelligence and Utilisation of Deep Learning Methods in Screening for Subcutaneous Implantable Cardioverter Defibrillator Eligibility
Authors: ElRefai Mohamed , AbouelAsaad Mohamed , Roberts Paul
Published: April 2024

Introduction:
There is a Class I recommendation for S-ICD in patients with no pacing indication at a high risk of infection. S-ICD eligibility is assessed at pre-implant screening where ECG traces taken in multiple postures are used as a surrogate for S-ICD vectors. In HF patients undergoing diuresis, changes in electrolytes, and fluid shifts can cause changes in R and T waves amplitudes. Subsequently, T:R ratio - a major predictor of S-ICD eligibility - is dynamic.

Hypothesis:
We hypothesize that prolonged screening for S-ICD eligibility identifies HF patients with high probability of T wave oversensing (TWO) and inappropriate shocks that can otherwise be missed using current screening practices.

Methods:
We ran a prospective study where participants with structurally normal hearts and HF patients undergoing diuresis on clinical grounds were fitted with Holters®. The leads were placed to correspond to the 3 vectors of an S-ICD. We used a convolutional neural network-based model utilising phase space reconstruction matrix as a state-of-the-art tool to assess T:R ratios over 24 hours against eligibility cut-off of 1:3 based on the manufacturer screening tool.

Results:
A total of 21 patients (mean age 58.43 ± 18.92, 62% male) were enrolled (14 HF, 7 normal hearts). We found a significant difference in the mean and SD of the T/R ratios between both groups. Mean T/R ratio was 0.181 ± 0.084 and 0.104 ± 0.054, and SD was 0.093 ± 0.048 and 0.067 ± 0.036 in HF and normal heart groups, respectively. T/R ratio was above the eligibility threshold with medians of 4.68% (0- 64.6%) and 0.03 % (0 - 30.4%) in HF and normal heart groups, respectively. There was no difference in the mean, SD or median between leads within the same group.

Conclusions:
T:R ratio, a main determinant for S-ICD eligibility is higher and with more tendency to fluctuate in HF patients. We report an accurate method that utilises prolonged screening to select HF patients eligible for S-ICD with low probability of TWO and inappropriate shocks.
Abstract 9216: Fontaine Leads and Their Further Modifications in Arrhythmogenic Cardiomyopathy
Authors: Ali Muzaffar , Padmanabhan Deepak , Banavalikar Bharatraj , Kanjwal Khalil , Lone Ajaz A , Hafeez Imran , Rashid Aamir , Rather Hilal A , Shenthar Jayaprakash
Published: April 2024

Introduction:
Epsilon wave, one of the major criteria for the diagnosis of arrhythmogenic cardiomyopathy (ACM), is present in only 30% of ACM patients. Fontaine Leads have been shown to facilitate the visualization of Epsilon waves.

Hypothesis:
Modified Fontaine leads may help in better visualization of Epsilon waves in ACM patients than standard Fontaine leads.

Methods:
We prospectively enrolled ACM patients under our follow-up. Fontaine and the modified Fontaine EKGs were recorded (
Figure 1A
). The duration and amplitude of Epsilon waves, when present, were measured. Duration-amplitude product (DAP) was computed and compared.

Results:
EKGs of seventeen patients were available for analysis. Four patients (24%) had an Epsilon wave on a 12 lead EKG. Thirteen patients (76%) had Epsilon waves either on 12 lead EKG or Fontaine modification leads. These 13 patients (10 males and 3 females; mean age: 40.5 ±13 years) were included in the analysis. (
Table 1
) Epsilon waves were seen in 10 (77%) patients in Standard Fontaine Leads. In the rest of the modifications, Epsilon waves were seen in 85% (11), 77% (10), 80% (8), and 80% (8) in Right, Left, Right-Left, and Left-Right Fontaine leads, respectively. (
Table 1
) In only one patient (8%), the Standard Fontaine Epsilon wave had maximum DAP. Right, Left, Right-Left, and Left-Right Fontaine leads had maximum DAP in 5 (39%), 3 (23%), 2 (20%), and 3 (30%) patients, respectively.

Conclusions:
A modified Fontaine lead position may facilitate the Epsilon wave visualization in patients suffering from ACM when standard EKG and Fontaine lead EKGs fail to do so. A well-designed randomized study may be needed to evaluate the utility of modified Fontaine Leads in ACM.
Abstract 9297: Assessing Cardiovascular Health in Pediatric Hypertrophic Cardiomyopathy Using the CANHEART Index
Authors: Jeewa Aamir , Pidborochynski Tara , Power Alyssa , Remtulla Tharani Alliya , Balmer-Minnes Diana , DHILLON Santokh S , Vaujois Laurence , Dallaire Frederic , Carrier Virginie , Khoury Michael , Conway Jennifer
Published: April 2024

Introduction:
Pediatric hypertrophic cardiomyopathy (HCM) is associated with sudden death often resulting in restriction from strenuous physical activity and competitive sports. Restrictions may increase the risk of poor cardiovascular (CV) health.

Hypothesis:
CV health, as measured by the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index (https://www.cmaj.ca/content/cmaj/186/3/180.full.pdf) are lower in pediatric HCM compared to other Canadian children.

Methods:
Pediatric HCM patients between age 10 and 18 years were prospectively recruited at 5 Canadian sites and assessed using the CANHEART health index. The index uses four factors for the definition of ideal CV health: never smoked, body mass index (BMI), fruit and vegetable (veg) consumption
>
5 times/day and walking >60 minutes walking or 20 mins of running/jogging per day. Ideal health is defined by the presence of all four factors and poor health 0-2 factors.

Results:
There were 36 subjects enrolled in the study [27 males; median age 14.8 years (10-18); median BMI 24 (17-37)]. With regards to CANHEART health index results, 50% (n=18) were overweight/obese, 56% (n= 20) walked <60 minutes or ran/jogged <20 min per day, 70% consumed fruits/veg < 5 times/day and 94.4% had never smoked. The mean CANHEART index score was 2.19 (95
th
CI 1.87-2.52) compared to the previously reported for Canadian youths without HCM (2.49 95% CI 2.47-2.52). Ideal CV health was seen in 11.1% (n=5) of HCM patients with poor health in 66.7% (n=24) [See Table 1].

Conclusions:
A small percentage of pediatric HCM patients had ideal CV health as defined by the CANHEART index and the mean score was lower than previous reported in the CANHEART population study. These finding are predominantly driven by a lack of fruit/veg consumption, poor physical activity and BMI. CV profiling for pediatric HCM patients should be considered as part of the longitudinal care to help decrease the risk of premature CV disease in adulthood.
Abstract 9307: A Heart of Gold: A Case Report of Massive Pericardial Effusion Secondary to Cholesterol Pericarditis
Authors: Bockus Lee , Nakamura Kenta , Chen Michael A
Published: April 2024

A case of rare cholesterol pericarditis that developed over 12 years resulting in a massive pericardial effusion containing cholesterol crystals is described. A 41-year-old homeless man with history of polysubstance intravenous drug abuse and upper respiratory and soft-tissue infections presented with evidence of recurrent left lower extremity cellulitis, mild shortness of breath, and palpitations. Physical exam demonstrated soft-tissue infection, marked tachycardia and distant heart sounds on auscultation, and jugular venous distention. Unexpectedly, pulse-oximetry plethysmographic waveforms revealed pronounced respirophasic variability and pulsus paradoxus of 14 mmHg. Electrocardiogram demonstrated low voltage and electrical alternans. A transthoracic echocardiogram revealed a large pericardial effusion and findings consistent with tamponade physiology, such as elevated respiratory variation in mitral inflow velocity. Emergent pericardiocentesis yielded 3.6 L of fluid characterized by glittering, gold paint-like appearance and a cell count predominated by macrophages, leading to a provisional diagnosis of cholesterol pericarditis. This was confirmed by polarized light microscopy demonstrating cholesterol crystals. Retrospective review of prior emergency department visits revealed a 12-year development of the effusion, beginning with symptoms, imaging, and labs consistent with a presumably instigating viral respiratory illness. Over time, progressive enlargement and evidence of chronic pericarditis were demonstrated by chest x-ray and electrocardiography, while the effusion remained undiagnosed. Following improvement in his symptoms after pericardiocentesis, the patient deferred pericardial window and definitive surgical management with pericardiectomy. Given his high risk for recurrent cardiac tamponade, he was given clear return precautions and is now followed on an outpatient basis. The diverse etiologies of cholesterol pericarditis, such as hypothyroidism, tuberculosis, and rheumatoid arthritis, that guided the workup for this patient, and the pathophysiology of this disease and its treatment options, are reviewed.
Abstract 9310: Aortic Arch Shape After Coarctation Repair Predicts Exercise Capacity: A Multicenter Analysis
Authors: Mandell Jason G , Romanowicz Jennifer , Loke Yue-hin , Ikeda Nobuyuki , Pena Emily , Siddiqi Umar , Hibino Narutoshi , Alexander Mark E , Powell Andrew J , Olivieri Laura
Published: April 2024

Introduction:
Patients with coarctation of the aorta (CoA) have decreased exercise capacity despite successful repair with no anatomic obstruction. Altered aortic arch shape after surgical repair may increase resistance to flow and affect flow distribution. This study correlates parameters of aorta size and flow with exercise capacity after successful CoA repair.

Methods:
We retrospectively reviewed patients with repaired CoA at 4 centers who had cardiac magnetic resonance imaging (CMR) and an exercise stress test with respiratory exchange ratio ≥ 1.09 within 1 year. Patients with significant valve disease, outflow tract obstruction, or need for cardiac bypass outside of their arch repair were excluded. Aorta size mismatch (D
AAo
/D
DAo
), defined by the ratio of ascending (AAo) to proximal descending aorta (DAo) diameter, and DAo flow as a percentage of AAo flow, were measured from CMR. Each parameter was correlated with percent predicted peak oxygen consumption (VO2 max).

Results:
Forty-six patients (age 26 ± 8.4 years) with left ventricular ejection fraction (LVEF) > 52%, met inclusion criteria. Larger D
AAo
/D
DAo
and lower %DAo flow correlated significantly with lower VO2 max (Fig). Compared to those with normal VO2 max (n=25), patients with VO2 max <90% predicted (n=21) had a primary repair at an older age (p=0.03) and smaller DAo diameter/m
2
(p=0.04). There were no significant differences in prevalence of arch obstruction by echocardiogram, LVEF, hypertension, blood pressure gradient at rest or exercise, or AAo diameter/m
2
between groups.

Conclusions:
Aorta size mismatch, due to AAo dilation or small DAo, and associated decreased %DAo flow, correlate significantly with decreased exercise capacity after CoA repair in patients with normal left ventricular systolic function. CMR measurements of aorta geometry and flow can inform the definition of a successful repair and suggest that indications for re-intervention may not be limited to discrete re-coarctation.
Abstract 9339: Cardiac Fibroblasts Are Critically Involved in the Development of Heart Failure by Inducing Cardiomyocyte Senescence
Authors: Ko Toshiyuki , Nomura Seitaro , Fujita Kanna , Yamada Shintaro , Zhang Bo , Hatsuse Satoshi , Satoh Masahiro , Hatano Masaru , Morita Hiroyuki , Komuro Issei
Published: April 2024

Introduction:
Tissue fibrosis and cellular senescence are hallmarks of age-related diseases including heart failure, but it remains elusive whether there is a common pathway to induce both events. Besides, the clinical significance of the cellular senescence seen in heart failure also remains unclear.

Methods and Results:
Through single-cell RNA-seq, spatial transcriptomics, and genetic perturbation, we focused and elucidated the role of high-temperature requirement A serine peptidase 3 (Htra3) which is expressed specifically in cardiac fibroblast. We found that Htra3 governs the identity of quiescent cardiac fibroblasts through degradation of TGF-β. Expression of Htra3 was downregulated by pressure overload in cardiac fibroblasts. Htra3 deletion in the murine heart caused overactivation of TGF-β signalling which induced not only significant cardiac fibrosis, but also cardiomyocyte senescence through DNA damage accumulation by repressing DNA repair factors and activating NADPH oxidase Nox4. Overexpression of Htra3 in the murine heart inhibited TGF-β signalling and ameliorated cardiac dysfunction as well as fibrosis after pressure overload. Htra3-regulated spatio-temporal cardiac fibrosis and cardiomyocyte senescence were also observed specifically in infarct regions after myocardial infarction. Furthermore, the senescent transcriptional profile observed in Htra3 knock-out murine cardiomyocytes were also seen in the cardiomyocytes from end-stage heart failure patients. Integrative analyses of human single-cardiomyocyte transcriptome and plasma proteome revealed that IGFBP7, which is a cytokine downstream of TGF-β and secreted from senescent cardiomyocytes, was the most predictable marker of advanced heart failure.

Conclusions:
Htra3 is a critical regulator of cardiac fibrosis and also affects cardiomyocyte senescence through the intercellular signalling communication between cardiac fibroblasts and cardiomyocytes. Our findings highlight the previously unknown roles of cardiac fibroblasts in regulating cardiomyocyte senescence as well as cardiac fibrosis through the Htra3-TGF-β-IGFBP7 pathway, which would be a novel therapeutic target for heart failure.
Abstract 9386: Marfan Syndrome Mouse Model MgΔ
Lpn
Presents Alterations in Glomerular Architecture and Increased Renal Vascular Resistance. Losartan Treatment Attenuates These Phenotypes
Authors: Souza Rodrigo Barbosa , Reinhardt Dieter P. , Koh Ivan H , Pereira Lygia d
Published: April 2024

Introduction:
Previously, we have shown that mgΔ
lpn
murine Marfan syndrome (MFS) model with a fibrillin-1 disruption presents increased Metalloproteinase-9 (MMP-9) expression in the cilliary body in eye. MMP-9 has been related to microfibrils degradation. In this study, we examined the fibrillin-1 and MMP-9 distribution in the kidney and their influence on hemodynamics.

Hypothesis:
The alteration of fibrillin-1 impacts the glomerular architecture and modify renal hemodynamics.

Methods:
Female mice at 4 months of age were used: MFS mgΔ
lpn
mice (n=5); mgΔ
lpn
treated with losartan for 3 months (n=5); and control wild type mice (n=5). The glomerular structure of the kidney was examined by histology. The distribution and quantification of fibrillin-1 and MMP-9 were analyzed by immunofluorescence assay. Blood flow in the aorta and renal artery was monitored with the probe 2SB-T206 of the Transonic Systems, and the cortical micro-hemodynamic of the kidney was examined by SDF video-microscopy (Sidestream Dark Field Imaging).

Results:
The mgΔ
lpn
mice showed reduction of fibrillin-1 deposition and an increase in MMP-9 in the entire kidney tissue, including the glomerular structures. In histologic aspects, the glomerulus showed a reduction of the glomerular area, urinary space, and vascular pole area. The reduced glomerulus dimension possibly squeezes the arteriolar system with a subsequent increase of their vascular resistance. In addition, the cortical microvessels showed a significant reduction in blood flow, and there was an increase in the distribution of microvessels with diameters 6 to 8 μm. Blood flow analysis in the mgΔ
lpn
showed decreased artery renal flow but did not reveal a difference in aorta blood flow when compared to WT animals. These results indicate vascular resistance in the renal artery. Losartan therapy increased fibrillin-1 and decreased MMP-9 quantifications, improved the glomerulus structures and significantly increased the velocity of the microcirculation blood flow.

Conclusions:
Alterations in fibrillin-1 modify the glomerular structures and impair kidney hemodynamics. Losartan therapy minimized the renal phenotypes.
Abstract 9807: Sirt1 Ameliorates High Fat Diet-Induced Diastolic Heart Failure
Authors: Oka Shinichi , Zhai Peiyong , Sadoshima Junichi
Published: April 2024

Approximately half of heart failure patients are diagnosed with diastolic heart failure. Sirt1 is a protein deacetylase that inhibits cardiac fibrosis and diastolic dysfunction. We investigated how Sirt1 inhibits cardiac fibrosis and diastolic dysfunction using a high fat diet (HFD)-induced obesity model with cardiac-specific Sirt1 knockout (Sirt1cKO) and overexpression (Sirt1cTG) mice. In addition to diastolic dysfunction, HFD (3 months)-induced cardiac fibrosis was promoted in Sirt1cKO (Relative fibrosis: wild-type mice (WT) Normal Diet (ND): 1.0; WT HFD: 2.4; Sirt1cKO ND: 1.2; Sirt1cKO HFD: 6.2*, p<0.05 vs WT HFD) but inhibited in Sirt1cTG mice. Cardiomyocyte-specific gene expression analysis with Ribo-tag mice revealed that TGFβ1 mRNA is increased in Sirt1cKO mice during HFD consumption (relative TGFβ1 mRNA: WT ND: 1.0; WT HFD: 1.3; Sirt1cKO ND: 1.1; Sirt1cKO HFD: 1.9*, p<0.05 vs WT HFD). A TGFβ1 receptor inhibitor inhibited HFD-induced cardiac fibrosis and diastolic dysfunction in Sirt1cKO mice, suggesting that loss of Sirt1 promotes cardiac fibrosis and diastolic dysfunction partly though TGFβ1. ChIP-sequencing revealed that Sirt1 localized to the TGFβ1 promoter, overlapping with Smad binding elements. Co-immunoprecipitation assays showed that Sirt1 bound to Smad3 in the heart. Reporter gene assays showed that Sirt1 inhibited the TGFβ1 promoter activity through Smad3 (Relative activity: control 1.0; Sirt1 overexpression: 0.35; Sirt1 overexpression with Smad3 knockdown: 0.89*, p<0.05 vs Sirt1). DNA binding assays with the TGFβ1 promoter region showed that Sirt1 binds to the TGFβ1 promoter, which was inhibited by Smad3 knockdown (relative binding to TGFβ1 promoter: Control: 1.0; Smad3 knockdown: 0.45*, p<0.05 vs Control). Taken together, the data show that Sirt1 binds to the TGFβ1 promoter through Smad3, thereby suppressing TGFβ1 expression and subsequent cardiac fibrosis and diastolic dysfunction.
Abstract 9825: Stenotic Pulmonary Artery Reconstruction Using
in vivo
Tissue Engineered Vascular Grafts
Authors: Maeda Yoshinobu , Yamagishi Masaaki , Asada Satoshi , Hongu Hisayuki , Yamashita Eijiro , Nakatsuji Hiroki , Nagase Takashi , Nakai Rie , Kanda Keiichi , Inoue Tomoya , Yamanami Masashi , Yaku Hitoshi
Published: April 2024

Introduction:
We have applied
in vivo
tissue engineered vascular grafts (TEVGs) created in the patient's body for surgical reconstruction of the pulmonary artery (PA) as a substitute material for autologous pericardium. This study reports evaluations of PA reconstruction with
in vivo
TEVGs.

Methods:
Molds of
in vivo
TEVGs made of silicon tubes (outer diameter: 19Fr) were embedded into the subcutaneous spaces more than 6 months before the operation. Then,
in vivo
TEVGs created around the molds were harvested and used as patch materials to treat PA stenosis after the preparation period. Nine patients underwent mold embedding between July 2014 and February 2021. Two of the nine patients underwent mold re-embedding after harvesting the primary mold. Median age at mold embedding was 2.1 years (range, 1.2 to 5.0 years), median body weight was 10.2 kg (range, 7.3 to 15.4 kg), and median number of embedded molds per patient was 2 (range, 2 to 4).

Results:
The total number of molds embedded was 27, of which two were 35 mm long, nine were 40 mm long, four were 45 mm long, and 12 were 50 mm long.
In vivo
TEVGs were successfully harvested and autologously implanted for patch augmentation of stenotic PAs in six patients, and three patients are currently awaiting surgery. The median preparation period for creating
in vivo
TEVGs was 314 days (range, 180-1050 days). Median follow-up period after PA reconstruction was 16 months (range, 4 months to 6.1 years). Early mortality and late death did not occur. In addition,
in vivo
TEVG-related complications, including hemorrhage, aneurysmal change, degeneration and infection, were not observed. The mechanical properties were as follows: mean suture retention, 2.01 ± 0.26 N; and mean burst pressure, 2777 ± 246 mmHg.

Conclusions:
In vivo
TEVGs are safe for use in PA reconstruction and might be a useful alternative material to autologous pericardium in multistage surgery for congenital heart disease with hypoplastic pulmonary arteries.
Abstract 9837: A Blunted Nocturnal Blood Pressure Decline is Associated with Total and Cardiovascular Mortality
Authors: De La Sierra Alejandro , Williams Bryan , Gorostidi Manuel , Vinyoles Ernest , Segura Julian , Ruilope Luis M
Published: April 2024

Introduction:
A blunted nocturnal BP decline is associated with an increased cardiovascular risk. Nevertheless, patients with a blunted BP dip usually have high levels of nighttime BP, being both parameters clearly related. Thus, it is unclear if an abnormal dipping is deleterious
per se
or it merely reflects an elevated BP during sleep.

Hypothesis:
We aimed to assess the prognostic value of nocturnal BP decline, independently of the presence or not of nocturnal BP elevation.

Methods:
Vital status and death due to cardiovascular causes were obtained from death certificates in 59110 hypertensives, enrolled in the Spanish ABPM Registry between 2004 and 2014, and having a valid 24-h ABPM at entry. On the basis of BP data, patients were classified into 4 groups: Normal (<120 mmHg) night systolic BP (SBP) and normal (<0.9) systolic night-to-day ratio (NDR). Normal night SBP with elevated (≥0.9) NDR. Elevated (≥120 mmHg) night SBP with normal NDR and both elevated night SBP and NDR. Association between NDR, dipping status and groups combining night SBP and NDR with total and cardiovascular mortality were assessed by Cox models, adjusted for clinical confounders.

Results:
The total number of deaths were 2866 (978 of cardiovascular causes) during a median follow-up of 5 years. NDR predicted total mortality (HR for 1 SD change: 1.19; 95%CI: 1.15-1.23). Both patients with reduced dipping (HR: 1.28; 1.17-1.41) and risers (HR: 1.59; 1.42-1.77) had increased risk of total mortality, whereas extreme dippers (NDR<0.8) did not. With respect to patients with both normal night SBP and NDR, those with elevated NDR in the absence of elevated night SBP had increased risk of death (HR: 1.36; 1.19-1.55), as well as those with elevated night SBP and normal NDR (HR; 1.40; 1.21-1.62). Those combining both abnormalities had the highest risk (HR: 1.78; 1.60-1.98). Similar results were obtained for cardiovascular mortality.

Conclusions:
Abnormalities in the circadian dipping pattern are responsible for an increased risk of mortality, both total and cardiovascular. Increased mortality rates are observed in patients with a reduced nocturnal dip and, even more intensively, in those with a riser pattern. This abnormal dipping increases the risk of mortality even in the absence of BP elevation.
Abstract 9839: Correlates of Exercise Self-Care Behavior in Type 2 Diabetes Adults with and without Comorbid Heart Failure at a Tertiary Healthcare Setting in Ethiopia
Authors: Aga Fekadu , Dunbar Sandra B , Higgins Melinda , kebede tedla , Guteta Senbeta , Gary Rebecca
Published: April 2024

Introduction:
Exercise self-care behavior (ESCB) is recognized to improve glycemic control, cardiorespiratory fitness, and reduce cardiometabolic risk factors in persons with type 2 diabetes (T2D) and heart failure (HF).

Aim:
This study compared the demographic, clinical, and psychosocial correlates of ESCB in T2D adults with and without HF.

Methods:
This cross-sectional study recruited 210 T2D adults (105 with HF and 105 without HF) from Tikur Anbessa Specialized Referral Hospital in Ethiopia. The exercise subscale of the Summary of Diabetes Self-Care Activities (SDSCA) was used to measure ESCB. Correlational bivariate and stepwise logistic regression analyses were used to examine and compare correlates of ESCB. Variables included in the logistic regression model were: demographic (age, sex, marital status, occupation, living arrangement), clinical (body mass index [BMI], years since diagnosis of T2D, diabetes medication type, Ney York Heart Association [NYHA] classification, Charlson comorbidity index) and psychosocial (diabetes self-efficacy, depressive symptoms, and social support).

Results:
The participants mean age was 58.7±10.9 years while those with HF (61.6±10.5) were significantly older (
p
< 0.001) than those without HF (55.7±10.6). The percentage who exercised 5 days per week was significantly lower (
p
= 0.03) in comorbid HF participants (n = 41, 39.1%) compared to those without HF (n = 48, 45.7%). In T2D adults without HF, for each 1 kg/m
2
increase in BMI there was a 12% lower odds of ESCB (
p
= 0.028). In T2D adults with HF, a 1-year increase in age (
p
= 0.029) and a 1-unit increase in depressive symptom score (
p
= 0.009) independently predicted a 5.5% and 12.4% lower odds of performing ESCB, respectively. A 1 unit increase in diabetes self-efficacy score predicted a 24% higher of odds of ESCB (
p
= 0.01).

Conclusions:
Findings indicate that multimorbidity negatively influenced participation in ESCB in T2D. Studies that improve diabetes self-efficacy, address weight and depressive symptoms may be beneficial for enhancing ESCB in T2D patients with HF or other serious chronic conditions.
Abstract 9840: National Trends in Statin Use for Secondary Prevention in the Adult Cardio-Oncology Population from 2006 to 2017
Authors: Cheng Evaline , Yang Eric H , Ziaeian Boback
Published: April 2024

Introduction:
Adults with a history of cancer may have increased risk of atherosclerotic cardiovascular disease (ASCVD) from cancer therapies and shared modifiable risk factors. While cancer history is associated with disparities in other areas of cardiology care, recent trends of secondary cardiovascular prevention in the cardio-oncology population is understudied. We examined trends in statin use for secondary prevention of ASCVD in the U.S. adult population.

Hypothesis:
We hypothesized that cancer history is associated with decreased statin use, and this trend persists over time.

Methods:
This retrospective longitudinal study included adults over age 21 with ASCVD, defined as a history of coronary artery disease (CAD) or stroke. Demographics, medical conditions, and prescribed medications between January 2006 and December 2017 were obtained from the Medical Expenditure Panel Survey database. Multivariable logistic regressions examined associations between cancer history and statin use, adjusting for age, sex, calendar year, socioeconomic variables, and comorbidities.

Results:
Among 26,813 adults with ASCVD, 4040 participants (15.1%) also had a history of cancer, defined as the cardio-oncology group. The cardio-oncology group was older on average compared to adults with only ASCVD (mean [SE], 70.9 [0.4] years vs. 65.1 [0.2] years; P < 0.001). More adults in the cardio-oncology group also had a history of diabetes (33.9% vs. 30.6%, P = 0.01) or dyslipidemia (78.2% vs. 73.0%, P < 0.001) compared to those with only ASCVD. Between 2006-2007 and 2016-2017, age-adjusted rates of statin use decreased from 35.7% to 32.6% in the ASCVD only group. Across the cardio-oncology group, age-adjusted rates of statin use also decreased from 43.4% to 35.8% during this period. In multivariable adjusted analysis, cancer history was associated with decreased odds of statin use across the 12-year period (OR 0.86; 95% CI 0.76-0.98).

Conclusions:
Adults with a history of ASCVD and cancer were significantly less likely to use statins for secondary prevention despite higher prevalences of diabetes and dyslipidemia. This treatment gap persisted across the 12-year period, identifying a need for more cardiovascular preventive care in the cardio-oncology population.
Abstract 9842: An Implemented Medical Mockup Modelling for Personalised Medicine and Surgery
Authors: Roggeri Riccardo , Garzena Cristian , Silvestri Paolo , Parsafar Amir , Scalise Filippo , Vilasi Antonio , Gargani Luna , D'Angelo Gennaro , Torino Claudia
Published: April 2024

Introduction:
Virtual three-dimensional (3D) anatomical models can improve diagnostic and surgical medical procedures with a patient-specific approach. The advantage of these models, in opposition to CT scans or MRIs alone, is their unique ability to demonstrate anatomical spatial relationship with submillimetre accuracy.

Methods:
Starting from our platform Med3D VR Lab, we implemented, in the MMM project, a basic algorithm within a software, able to capture, from DICOM images (MRIs/CT scans), the cloud of points needed to build 3D images. Different areas of a tissue might have different radio-density levels. In these cases, we applied our patented algorithm to harmonize these values through a transformation matrix.

Results:
We created a VR Laboratory (via a supervised learned approach) to access the resulting 3D image. The user, by wearing a VR headset, can rotate and enlarge the heart’s model. By cutting the model with the scalpel tool, the user is able to see the interior of the 3D model. The sections of the heart are created according to the direction of the cut. Each section can be further cut into smaller sub-sections, and both sections and sub-sections can be saved for future use.

Conclusions:
We developed a software for the conversion of 2D cardiac images in 3D models, which can be further examined and sectioned in a VR environment. This technique could help cardiologists in refining diagnosis and surgeons in tailoring cardiac interventions on the basis of patients’ characteristics, thus reducing operating times and costs while also preventing possible complications in cardiac surgery- therefore allowing to precisely assess risks in advance. Moreover, our software, through the VR visor, allows patients to truly understand their clinical conditions, thus overcoming the drawbacks of expressing an informed consent based only on DICOM imaging: the patients themselves will be able to understand the risks and benefits of a given surgical operations or its alternatives.
Abstract 9862: Correlation of Lipoprotein(a) and Plaque Morphology in Very Young Acute Coronary Syndrome Patients Using Optical Coherence Tomography
Authors: sharma prachi , Nagar Saurabh , Chandra Sharad , Chaudhary Gaurav K , Jaiswal Vikash , Kumar Sharma Akhil , Bhandari Monika , Vishwakarma Pravesh , Pradhan Akshyaya , sethi rishi , Dwivedi Sudhanshu
Published: April 2024

Background:
Levels of lipoprotein (Lp) (a) are a useful marker for risk stratification of cardiovascular diseases. This genetic biomarker is suggestive of patient predisposition to an acute coronary event. Its correlation with the plaque morphology is yet to be explored with optical coherence tomography (OCT).

Aim:
To study the correlation of Lp(a) levels and plaque morphology in very young (<35 years) patients presenting with acute coronary syndrome(ACS).

Methods:
A prospective, single-centre, observational study was conducted at a tertiary-care centre. Very young patients with acute coronary syndrome and fit for OCT guided invasive coronary angiography were included. Lp(a) levels were compared between healthy controls and these very young ACS patients. Correlation of Lp(a) levels and plaque characteristics in very young ACS patients was done using OCT imaging.

Results:
A total of 80 subjects were enrolled in the study. Out of these 40 were very young ACS and 40 were age matched healthy controls. Mean levels of Lp(a) were 28.10±13.96 nmol/l and 61.20±55.88 nmol/l in healthy controls and very young patients with ACS respectively (p=0.022). In very young patients, plaque rupture and erosion were the mechanism of acute coronary syndrome in 67.5% and 32.5% patients, respectively. Among very young ACS patients, those with Lp(a) levels <75 nmol/l had a mean thin cap fibroatheroma thickness of 96.89±65.52 μm and those with Lp(a) levels ≥75 nmol/l had a mean thin cap fibroatheroma thickness of 67.85±53.80 μm (p=0.158).

Conclusion:
It was revealed that patients with higher Lp(a) levels had lesser thickness of fibrous cap on OCT imaging compared with lower levels of Lp(a). Lp(a) levels were

independently associated with ACS in very young (<35 years) patients, with plaque rupture being the commonest mechanism. Hence, we conclude that higher Lp(a) levels predispose to ACS at a very young age associated with lowering of fibrous cap thickness.
Abstract 9863: Cannabis Use is Associated with Elevated Atherosclerotic Cardiovascular Disease Risk Score
Authors: Skipina Travis M , Patel Nikhil , Upadhya Bharathi , Soliman Elsayed Z
Published: April 2024

Introduction:
Cannabis use has been linked to deleterious cardiovascular events including stroke and myocardial infarction in observational studies. However, to date, the association between cannabis use and composite cardiovascular risk has not been studied.

Hypothesis:
Cannabis use is associated with an elevated atherosclerotic cardiovascular disease risk (ASCVD) score.

Methods:
This analysis included 7,159 participants (age 37.8±12.4 years, 48.6% male, 61.5% Caucasian) from the National Health and Nutrition Examination Survey years 2011-2018. Cannabis use was defined by self-report. Participants with a history of stroke or myocardial infarction were excluded. ASCVD scores were classified by risk levels: low (<5.0%), borderline (5.0-7.4%), intermediate (7.5-19.9%), and high (≥20.0%). Multinomial logistic regression was used to examine the association between cannabis use and ASCVD risk category using low-risk ASCVD category as the reference level.

Results:
About 63.9% (n=4,573) of participants had ever used cannabis. Ever cannabis use was associated with 60% increased odds of high-risk ASCVD score [Odds Ratio (95% Confidence Interval): 1.60 (1.04-2.45), p-value=0.03]. Those reporting ≥2 uses per month had 79% increased odds of high-risk ASCVD score [Odds Ratio (95% Confidence Interval): 1.79 (1.10-2.92), p-value=0.02]. Those reporting ≥1 use per day had 87% increased odds of high-risk ASCVD score [Odds Ratio (95% Confidence Interval): 1.87 (1.16-3.01), p-value<0.001].

Conclusions:
Cannabis use is associated with elevated cardiovascular risk as evidenced by a positive association with ASCVD score. Patients who use cannabis should be counseled regarding their elevated risk for major cardiovascular events and appropriate risk reduction strategies should be implemented.
Abstract 9880: Microplastics Exposure Promotes Cardiovascular Disease Risk in Mice
Authors: Zhao Jingjing , Gomes Daniel C , Conklin Daniel , O'Toole Timothy E
Published: April 2024

Microplastics (MPs), particles with a diameter less than 5 mm, have become a common and abundant environmental pollutant. Prior studies suggested exposure to MPs induces oxidative stress and inflammation. As these outcomes also underlie cardiovascular disease (CVD), we sought to determine if ingestion of MPs promotes cardiovascular disease risk. Thus we supplied male C57BL/6J mice (13-weeks old, n=10 in each group) with normal drinking water or that containing two sizes of polystyrene (PS) beads (0.5 μm, 5 μm) at two different doses (0.1 μg/ml and 1 μg/ml) for 12 weeks. At intervals throughout this feeding time course and at termination, we measured several indices of pre-clinical CVD. Compared with control mice, we observed a statistically significant increase in body weight in those mice consuming the 0.5 μm polystyrene beads at a dose of 1 μg/ml as early as 3 weeks after initiation of treatment. This statistically significant increase in mice body weight was maintained after 9-(1.85 fold increase versus control group) and 12-weeks (2.02 fold increase versus control group) of consumption. Furthermore, this increase in body weight appeared to be due to an increase in fat mass. Dual-energy X-ray absorptiometry (DEXA) scan analysis showed that the percent body fat significantly increased in PS exposure groups (control: 13.78±0.17% versus 17.24±0.93% in mice consuming 0.5 μm PS particles at a dose of, 1 μg/ml). In the same group of mice, we also observed an increase in fasting blood glucose (1.46 fold), fasting plasma insulin (2.50 fold), and HOMA-IR scores (2.18 fold) after 12 weeks exposure. Consistently, after analysis of a gene expression array, we found altered expression of some genes regulating adipogenesis and white adipose browning in collected perivascular adipose tissue samples. An analysis of the gut microbiome also identified changes consistent with an increase in adiposity. Thus, our results suggest that polystyrene exposure promotes adiposity and insulin resistance and is a heretofore unrecognized risk factor for atherosclerosis development and CVD.
Abstract 9888: Ischemic Heart Disease and Type 2 Diabetes Complications Are Associated with Glycemic Variability Measured by Continuous Glucose Monitoring
Authors: Hertzberg Jeffrey K , Janer Ciara , Jhuang An-Ting , Santos Alix J , Kibanoff Nathan , Vojta Deneen , Wiegand Ben , Murillo Jaime
Published: April 2024

Introduction:
The management of type 2 diabetes mellitus (DM) has focused on achieving normal glucose levels in order to prevent cardiovascular disease (CVD) and other DM-related complications. Some have suggested that glucose variability (GV) may be associated with DM complications. Other studies, using manual glucose testing, failed to prove it. In our retrospective study using a large administrative database and thousands of patients wearing continuous glucose monitors (CGM), we evaluated the association between various glucose parameters and CVD and DM complications.

Methods:
Of 15,815 people enrolled in a T2DM program who ordered a CGM device, 58.2% actually used it. The final cohort had 4,530 CGM users with
>
30 days of CGM data within 90 days. Metrics included mean glucose and GV measures such as SD, IQ range, % coefficient of variation (%CV), mean amplitude of glycemic excursions (MAGE) and time in range. A multivariable regression analysis tested for the association between these metrics and the occurrence of CVD and DM complications based on claims from Jan 2016 through April 2021.

Results:
The mean age was 53, with a 1:1 gender ratio. Mean glucose level was 157 (SD
+
32). At least one CVD condition or DM complication (nephro-, retino-, neuropathy, skin ulcer/gangrene, circulatory problems) was present in 84% of subjects. The 2 most frequent were ischemic heart disease (IHD) in 15.7% and DM kidney disease in 9.5%. Subjects with IHD or DM complications had significantly higher mean glucose and GV measures (p<0.001). However, there was a 10-fold difference between a marker of variability (%CV) and the mean glucose level: for every % point increase in %CV there was a 7% increased likelihood of DM complications, compared with only a 0.7% increase for every additional 1 mg/dl of mean glucose.

Conclusions:
In a relatively young cohort of persons with T2DM wearing CGM, glycemic variability, as measured by %CV, was more strongly associated with IHD and diabetic complications than mean glucose level. This suggests that management of diabetes should focus more on glycemic variability than absolute glucose levels. Wider adoption of CGM may more effectively detect persons with high glycemic variability at risk for ischemic heart disease and other diabetic complications.
Abstract 9907: High-Power Short-Duration versus Standard-Power Standard-Duration Settings for Repeat Atrial Fibrillation Ablation
Authors: Junarta Joey , Dikdan Sean , Upadhyay Naman , Bodempudi Sairamya , Yakobi Michael Y , Frisch Daniel R
Published: April 2024

Introduction:
High-power short-duration (HPSD) ablation is a novel strategy using contact force-sensing catheters optimized for radiofrequency ablation for atrial fibrillation (AF). No study has directly compared HPSD versus standard-power standard-duration (SPSD) settings in patients presenting for repeat ablation with AF recurrence after initial ablation.

Methods:
We studied consecutive cases of patients with AF undergoing repeat ablation with SPSD or HPSD settings after their initial pulmonary vein isolation (PVI) with temperature controlled non-contact force, SPSD or HPSD settings between 6/23/14 to 3/4/20. Procedural data collected included radiofrequency ablation delivery time (RADT). Clinical data collected include sinus rhythm maintenance post-procedure.

Results:
A total of 61 patients were studied (36 SPSD, 25 HPSD). A total of 51 patients (83.6%) were found to have pulmonary vein reconnections necessitating repeat isolation, 10 patients (16.4%) had durable PVI and ablation targeted non-PV sources. RADT was shorter when comparing repeat ablation using HPSD compared to SPSD (22 vs 35 min; p=0.01). There was no difference in sinus rhythm maintenance by Kaplan-Meier survival analysis (log rank test p = 0.87), after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume index, CHA
2
DS
2
-VASc score, or left ventricular ejection fraction.

Conclusion:
We demonstrated that repeat AF ablation with HPSD reduced procedure times with similar sinus rhythm maintenance compared to SPSD in those presenting for repeat ablation.