bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12153: Prevalence and Prognostic Implications of Worsening Renal Function After Acute Myocardial Infarction
Authors: Song Pil-Sang , Jeong Jin-Ok
Published: December 2023

Introduction:
Limited data exist on the association between longitudinal changes in renal function and long-term clinical outcomes in patients who survive acute myocardial infarction (AMI) events.

Hypothesis:
We sought to investigate the relationship between worsening renal function (WRF) at one-year follow-up and clinical outcomes at three years after AMI.

Methods:
We analyzed data from 13,104 patients enrolled in the national AMI registry from November 2011 to December 2015. Patients with all-cause death, recurrent myocardial infarction (re-MI), and re-hospitalization for heart failure (rHHF) at one-year follow-up after AMI were excluded. A total of 6,235 patients were extracted and divided into WRF and non-WRF groups. WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline to one-year follow-up. The primary outcome was three-year major adverse cardiac events (MACE), a composite of all-cause death, re-MI, and rHHF.

Results:
On average, a -1.5 ml/min/1.73 m
2
/year rate of decline in eGFR was exhibited, and 575 (9.2%) patients exhibited WRF at one-year follow-up. After multiple adjustments, WRF at one-year follow-up was independently associated with increased risks of MACEs (adjusted hazard ratio: 1.498, 95% confidence interval: 1.113-2.016,
P
=0.01), all-cause death, and re-MI at three-year follow-up (Figure 1). Older age, female, diabetes, hypertension, non-ST segment elevation AMI, anterior AMI, anemia, left ventricular ejection fraction <35%, and baseline eGFR <30 ml/min/1.73 m
2
were identified as independent predictors of WRF after AMI.

Conclusions:
WRF at one-year follow-up after AMI intuitively seems like a risk marker indicating multiple comorbidities. Monitoring serum creatinine in patients at one-year follow-up after AMI may help to identify those who are at the highest risk and guide effective long-term therapeutics.
Abstract 12157: Underutilization of Revascularization Procedures Among Patients Living With HIV Admitted to the US Hospitals With Acute Myocardial Infarction and Factors Associated With Higher Odds of Receiving Revascularization: A Cross-Sectional Study
Authors: Shoar Saeed , Chaudhary Ashok , Asadi Sadegh
Published: December 2023

Introduction:
Despite significant improvements in the prevention and treatment of infection with the human immunodeficiency virus (HIV), people living with HIV (PLWH) suffer cardiovascular diseases to a more extent than HIV-negative patients.

Research Question:
Is there a disparity in the demographics and socioeconomic status of hospitalized PLWH with AMI, who undergo revascularization compared to those who do not?

Methods:
Data pertinent to admission cases with AMI was analyzed from the National Inpatient Sample registry between 2016 and 2019 to determine differences in the frequency and outcomes of revascularization (percutaneous or surgical) between PLWH and HIV-negative counterparts and identify factors associated with higher odds of undergoing revascularization.

Results:
The frequency of revascularization was significantly lower among PLWH with AMI than HIV-negative patients. The difference was more substantial for PCI than for CABG (Fig.1). Younger age, male gender, White race, residential of a zip code with higher income quartile or smaller metropolitan regions, private insurance or self-paid status, and hospitalization in the Western states were all associated with a higher likelihood of undergoing revascularization (Table1). Although total hospital charges were significantly higher for PLWH and AMI who underwent revascularization compared to those who did not, the length of hospital stay was significantly shorter.

Conclusions:
There is a significant disparity in revascularization approaches between HIV-positive and HIV-negative patients hospitalized with acute myocardial infarction.
Abstract 12167: Cardiac-Specific Knockout of Myosin Phosphatase Targeting Subunit 2 Prevents Cardiac Fibrosis in a Connective Tissue Growth Factor-Dependent Manner in Mineralocorticoid Receptor-Related Hypertension Mice
Authors: Ye Zhe , Okamoto Ryuji , Ito Hiromasa , Ito Rie , Moriwaki Keishi , Ida Mizuki , Kimena Lupiya , Ali Yusuf , Gomez-Sanchez Celso E , Ito Masaaki , Dohi Kaoru
Published: December 2023

Introduction:
Myosin phosphatase targeting subunit 2 (MYPT2) is an important subunit of cardiac myosin light chain phosphatase (MLCP), which plays a crucial role in regulating the phosphorylation of MLC (p-MLC). Recent research has shown that cardiac MLCP plays an important role in cardiac fibrosis as a target of Rho kinase and protein kinase G. However, it is unclear how the loss of MYPT2 affects cardiac function and fibrosis.

Methods:
After the knockdown of MYPT2, HL-1 cells (murine cardiomyocytes) were incubated with aldosterone (ALDO) for 24h. Cardiac specific MYPT2 knockout (c-MYPT2
-/-
) mice were generated using the Cre lox system (αMHCMerCreMer; MYPT2
f/f
). Mineralocorticoid receptor (MR)-related hypertension mice were induced by the subcutaneous infusion of ALDO and 8% NaCl food for 4 weeks after uninephrectomy.

Results:
In HL-1 cells, ALDO increased connective tissue growth factor (CTGF) and MYPT2 and decreased the p-MLC in a dose-dependent manner. Knockdown of MYPT2 decreased CTGF. In mice model, the MYPT2 expression in the heart from MYPT2
-/-
mice was decreased to less than 30% compared with MYPT2
+/+
mice. Heart rate, blood pressure, and cardiac systolic function were normal in c-MYPT2
-/-
mice. Type 1 phosphatase catalytic subunit β was decreased and p-MLC was increased in c-MYPT2
-/-
mice. Blood pressure elevation and left ventricular hypertrophy were observed in both MR-related hypertension mice, while no difference in heart size and the nuclear localization of MR in cardiomyocytes. However, ejection fraction and fractional shortening in echocardiography were higher in c-MYPT2
-/-
than in MYPT2
+/+
in MR-related hypertension mice. After treatment of ALDO for 28 days, both global radial and longitudinal strain (GRS and DLS) were reduced in both c-MYPT2
-/-
and MYPT2
+/+
mice, but the reduction in systolic and diastolic GRS and GLS strain rates were prevented in c-MYPT2
-/-
mice compared with MYPT2
+/+
mice. Histopathology revealed fibrosis degree in c-MYPT2
-/-
mice was lower than MYPT2
+/+
mice with decreased CTGF and increased p-MLC.

Conclusions:
Cardiac-specific deletion of MYPT2 resulted in a decrease of MLCP and an increase of p-MLC. MYPT2 deletion can prevent cardiac fibrosis and dysfunction in a MR-related hypertension model.
Abstract 12225: The Association of Intensive Blood Pressure Therapy to Mortality in Older Adults After an Injurious Fall. Geriatric Insights From SPRINT
Authors: Ogarro Maziyah , Ashok Arjun , Damluji Abdulla , Goyal Parag , Rich Michael W , Forman Daniel E , Solomon Matthew , Rana Jamal S , Krishnaswami Ashok , Kwak Min Ji
Published: December 2023

Introduction:
The primary finding of the Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive (IT, <120 mmHg) compared to standard (<140 mmHg) blood pressure (BP) treatment on an index serious adverse event (SAE), injurious falls, was similar. However, mortality after the index fall has not been well studied. We hypothesized that the occurrence of falls may be associated with reduced mortality benefits.

Methods:
Using the publicly available SPRINT dataset we analyzed the association of IT on the primary outcome of all-cause mortality and the secondary outcome of non-cardiovascular (CV) mortality as a function of falls.

Results:
Among 9,361 SPRINT participants, 7.1% (n=666) had a fall. Falls were more likely in older adults (p<0.0001), among women (45.9% vs 34.8%), and those with baseline cardiovascular disease (20.3% vs 16.4%). Among those who fell, 7.8% (52/666) died which was 14.2% of all deaths in SPRINT (52/365). In those who fell, mortality increased with age (p<0.0001) and was highest in those ≥ 80 years (13.7%,
Figure
).

For all-cause mortality-

Falls independently and significantly were associated with increased risk

(HR 1.41,1.04-1.91, p=0.03
)

while IT significantly decreased the risk

(HR 0.73, 0.60-0.91, p=0.004)

. The joint effect (IT+Fall) demonstrated a non-significant increased risk

(HR 1.03, 0.56-1.88, p
int
=0.92). For non-CV mortality-

Falls independently and significantly were associated with increased risk

(HR 1.63, 1.16-2.29, p=0.005)

while IT did not significantly lower risk

(HR 0.81, 0.63-1.03, p=0.09)

. The joint effect (IT+Fall) demonstrated a non-significant increased risk

(HR 1.21, 0.63-2.35, p
int
=0.56).

Conclusions:
Our findings suggest that current reporting of potential harm of the treatment effects of IT, measured by the index SAE, may underrepresent true risk and overstate treatment benefits.
Abstract 12237: All-Cause and Cause-Specific 30-day Readmission After Left Ventricular Assist Device Implantation: Comparing the HeartMate 3 vs Pre-HeartMate 3 Eras
Authors: Almani Muhammad U , Aliyev Nijat , Qudrat Ullah Muhammad , Khan Mohammad S , Greene Stephen J
Published: December 2023

Introduction:
In recent years, the HeartMate 3 (HM3) has become the most commonly implanted left ventricular assist device (LVAD) for patients with end-stage HF in the United States. We assessed 30-day readmission rates and leading causes of readmission for patients newly receiving an LVAD in the pre-HM3 era compared to the HM3 era.

Methods:
Using the Nationwide Readmission Database (NRD), all adult admissions (age ≥18) with LVAD implantation from October 2015 - December 2020 were identified. Admissions were excluded if the patient had: died while inpatient, missing data for age, sex, or mortality, transferred to another acute care facility or December admission. Multivariable Cox regression analysis with all-cause and cause-specific readmission within 30 days as the ‘failure event’ and time from index hospitalization discharge to failure event as the ‘time to failure event’ was analyzed. Based on the timing of initial FDA approval of HM3, the study period was divided into two eras: 2015-2017 was defined as the pre-HM3 era and 2019-2020 as the HM3 era. The year 2018 was deemed the transition period and excluded from the analysis.

Results:
Among 13,867 hospitalizations for LVAD implantations, 57.6% of index hospitalizations were during the pre-HM3 era (mean age= 56 years, men= 77.2%), and 42.4% were during the HM3 era (mean age= 56 years, men= 76.6%). Hazards of 30-day all-cause readmissions were similar in the two eras
(Figure 1 Panel A)
. LVAD implantation in the HM3 era was associated with lower risks of 30-day readmission with a gastrointestinal (GI) bleed or pump thrombosis and a higher risk of 30-day readmission with an acute kidney injury (AKI) compared to the pre-HM3 era (
Figure 1 Panel B).

Conclusion:
There was no significant difference in risk of 30-day all-cause readmission after LVAD implantation in the HM 3 and Pre-HM 3 eras. However, implant in the HM3 era was associated with lower risk of readmission with GI bleed and pump thrombosis and higher risk of readmission with AKI.
Abstract 12247: The Effect of Angiotensin Receptor-Neprilysin Inhibitor With Sodium-Glucose Cotransporter 2 Inhibitor versus Angiotensin Receptor-Neprilysin Inhibitor Without Sodium-Glucose Cotransporter 2 Inhibitor on Heart Failure Outcomes in Patients With Heart Failure With Reduced Ejection Fraction
Authors: KOMMU SHARATH
Published: December 2023

Background:
Angiotensin receptor-neprilysin inhibitor (ARNI) improves heart failure outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Similarly, sodium-glucose cotransporter 2 (SGLT2) inhibitors have also shown significant beneficial effects in this patient population. It is unclear if adding SGLT2 inhibitors to patients already using ARNI-containing regimen will have additional benefits in improving heart failure outcomes in patients with HFrEF.

Methods:
PubMed and MEDLINE search was performed using the search words – ARNI, SGLT2 inhibitor, and heart failure. Among the studies identified, we looked for randomized controlled, prospective, and retrospective studies on HFrEF that included patient groups using ARNI with SGLT2 inhibitors and ARNI without SGLT2 inhibitors and had heart failure outcomes. We identified three studies and performed a meta-analysis.

Results:
A total of 671 patients in the treatment group and 808 patients in the placebo group are included in our meta-analysis. The heart failure outcome analyzed is the composite of hospitalization for heart failure and cardiovascular death. Among the patients using ARNI without SGLT2 inhibitors, the outcome occurred in a total of 215 out of 808 patients (26.61%). In comparison, it occurred in 114 out of 671 patients (16.99%) among those who are on both ARNI and SGLT2 inhibitors. This study shows that there is a significant improvement in this heart failure outcome in patients with HFrEF taking an SGLT2 inhibitor and ARNI-containing regimen compared to those taking ARNI without an SGLT2 inhibitor with a relative risk (RR) of 0.67 and 95% confidence interval (CI) of 0.55 to 0.83 (p=0.0001).

Conclusion:
Though ARNI and SGLT2 inhibitors individually are known to improve heart failure outcomes, adding an SGLT2 inhibitor to ARNI significantly improves the heart failure outcome of the composite of hospitalization for heart failure and cardiovascular death in patients with HFrEF.
Abstract 12269: The Association Between Measurements of Obesity and Accelerated Aging Estimated by Artificial Intelligence ECG
Authors: Bianchettin Rosana G , Medina-Inojosa Jose R , Attia Zachi , Medina-Inojosa Betsy , De Leon Andrea , Mangold Kathryn , Sheffeh Mohammad Ali , Johnson Lynne , Friedman Paul , Lopez-Jimenez Francisco
Published: December 2023

Introduction:
The effect of obesity on physiologic aging has not been completely established. We previously developed an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm that predicts age and determines that the difference between AI-ECG age and chronological age (Age-Gap) may reflect accelerated aging, as it is associated with increased total and cardiovascular (CV) mortality.

Hypothesis:
Obesity is associated with an increased Age-Gap reflecting morbidity and accelerated aging.

Methods:
We included adults undergoing a wellness evaluation including, body fat percentage (BF%) determination by air displacement plethysmography (Bod-Pod®) and a 12-lead ECG within 2 years. We excluded those with coronary artery disease, congestive heart failure, stroke or being underweight defined as having a BMI<18.5 kg/m2. Logistic regression models tested the association between obesity by BMI (≥30 kg/m2) or BF% quartiles (≥35% for men and ≥25 in women) and being older by AI-ECG.

Results:
We included 1295 subjects (70% women), mean chronological age 46.7 ± 13.1 years. Mean Age-gap positive difference compared to those with BMI<25 was 1.39, 2.06 and 2.83 for those with BMI 25-29.9, 30-34.9, and >35 respectively (p<0.05). In the BF% group, Age-gap difference compared to those in the 1st quartile was 0.008, 0.37 and 1.52 for those in the 2nd, 3rd, and 4th quartile (p<0.05). Those>3 years older by ECG were more likely to have obesity by BMI and BF%, see figure.

Conclusions:
Obesity, either by BMI or BF%, is associated with increased physiologic age as measured by AI-ECG, highlighting the importance of obesity as a health threat.
Abstract 12292: Lipid-Lowering Therapy and LDL-C Control for Primary Prevention in Persons With Diabetes Across 90 Health Systems in the United States
Authors: Decicco Emily , Peterson Eric D , Gupta Anand , Gillard Kristin , Sarnes Evelyn , Navar Ann Marie M
Published: December 2023

Background:
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in persons with type 2 diabetes, and national guidelines recommend statin therapy for primary prevention of ASCVD in persons with type 2 diabetes (T2DM).

Aim:
To evaluate the degree of utilization of appropriate intensity statin therapy for primary prevention in patients with T2DM in community practice.

Methods:
We evaluated lipid-lowering therapy (LLT) and LDL-cholesterol (LDL-C) levels in patients aged 40–75 years with T2DM but without atherosclerotic cardiovascular disease (ASCVD), across 90 health systems in the United States participating in an EHR-derived dataset, Cerner Real World Data at baseline and one year follow-up. Multivariable logistic regression was used to evaluate factors associated with guideline-recommended (moderate- to high-intensity) statin therapy use.

Results:
We identified 241,232 patients with T2DM (58.1% on appropriate statin, 7.0% on low-intensity statin, and 34.9% on no statin. Predictors of appropriate statin therapy included retinopathy (adjusted odds ratio [aOR], 1.26; 95% CI, 1.15–1.38), hypertension [aOR 1.52 (1.43-1.61)], and stage 3 chronic kidney disease [CKD; aOR 1.14(1.07–1.21]. Women (aOR, 0.85, 95% CI, 0.82-0.87), and those with rheumatoid arthritis [aOR, 0.79 (0.71–0.87)], psoriasis [aOR, 0.85 (0.75–0.96)], and hepatitis C [aOR, 0.4 (0.39–0.46)] had reduced odds of appropriate statin treatment. Utilization of ezetimibe was rare (2.0%). LDL-C control was suboptimal (36.9% and 27.9% had LDL-cholesterol ≥100 mg/dL and <70 mg/dL, respectively). Therapy uptitration was infrequent; at one-year only 65.3% of patients were on appropriate statin intensity (Figure).

Conclusions:
Increased efforts are needed to improve primary prevention of ASCVD in adults with T2DM, particularly among women and those with risk-enhancing inflammatory conditions.
Abstract 12298: Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Rheumatic Mitral Valve Disease
Authors: Agarwal Siddharth , Munir Bilal , Sharma Vagisha , Patel Harsh P , Krishan Satyam , payne joshua E , Desimone Christopher V , Deshmukh Abhishek , Stavrakis Stavros , Jackman Warren M , Po Sunny S , Asad Zain Ul Abideen U
Published: December 2023

Introduction:
There is a lack of data on procedural safety and outcomes in patients with rheumatic mitral valve disease (RMVD) undergoing atrial fibrillation (AF) ablation.

Hypothesis:
We hypothesized that the presence of RMVD may affect the outcomes of patients undergoing AF ablation and tested this hypothesis using data from a large, nationally representative sample of the US population.

Methods:
The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients with RMVD were then identified by using ICD-10 CM codes. A multivariable logistic regression model was used to adjust for confounders.

Results:
Our cohort included 50,728 weighted AF ablation procedures, of which 3,500 (6.9%) patients had RMVD. Patients with RMVD were older at the time of catheter ablation, with a significantly higher percentage of females, less likely to have paroxysmal AF, and had a higher burden of comorbidities including congestive heart failure, renal failure, and hypertension. On multivariable analysis, the presence of RMVD was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.28; 95% confidence interval [CI]: 1.12-1.47; p<0.01) with no difference in the odds of in-hospital mortality or other periprocedural outcomes. Also, RMVD was associated with longer length of stay (adjusted mean difference: +1.06; 95% CI: +0.67 - +1.45; p<0.01) days and lower odds of routine home discharge (aOR:0.77; 95% CI: 0.69-0.87; p<0.01). There was no difference in the odds of 30-day or 180-day all-cause, AF-related, or atrial flutter-related readmissions in patients with RMVD vs. no RMVD (Figure 1).

Conclusion:
In conclusion, patients with RMVD undergoing AF ablation have higher odds of periprocedural cardiovascular complications with similar odds of 30-day and 180-day all-cause and AF-related readmissions
Abstract 12324: Current Trends in Anticoagulation, Referral and Utilization of Procedures for Rhythm Control for Atrial Fibrillation
Authors: Karim Saima , Lewis William R , Bolen Shari , Sehgal Ashwini R , Einstadter Douglas
Published: December 2023

Introduction:
Atrial fibrillation (AF) can reduce quality of life and cause thromboembolic events, heart failure and death. Prior studies have identified disparities in the treatment of AF based on sex, race, and ethnicity.

Hypothesis:
There will be disparities in procedures for rhythm control (RC) based on sex, race and ethnicity.

Methods:
Cohorts of patients with new AF from 2016 to 2021 were identified with 1 year follow up to identify referrals, anticoagulant prescription, and procedures for RC. We calculated the proportion of patients with each outcome overall stratified by sex and race/ethnicity. We used logistic regression to compare outcomes across sex and race/ethnicity after adjustment for confounding variables.

Results:
We identified 2,919 patients with a new onset AF. The mean age: 68 years, 53% were male, 66% had Medicare, 69% self-identified as White, 23% as Black, and 3% as Hispanic. There was no difference in referral rates between men and women. Compared to White patients, Black and Hispanic patients were more likely to be referred to Cardiology and more likely to complete a visit. Prescription of anticoagulants was high (83%) and did not differ between men and women (84% vs. 82%, p = 0.65). Compared to White patients, Black and Hispanic patients were more likely to receive a prescription for anticoagulation (86% and 88% vs. 81%, p = 0.006). Women were significantly less likely to receive cardioversion or ablation compared to men (17% vs. 25%, p < 0.001). Similarly, Blacks and Hispanics were significantly less likely to receive procedures compared to Whites (17% vs. 23%, p = 0.01).

Conclusions:
Despite equal attendance at Cardiology visits, women and Black or Hispanic patients were significantly less likely to receive cardioversion or ablation compared to men and Whites respectively.
Abstract 12344: Effect of Valved versus Non-Valved Conduits in Norwood Procedure on Ventricular Size and Function in Stage I Palliation for Hypoplastic Left Heart Syndrome
Authors: Linder Alexandra N , Beqaj Halil , Goldshtrom Nimrod , Shah Amee , Goldstone Andrew B , Kalfa David , DiLorenzo Michael P
Published: December 2023

Background:
Mortality in the interstage period remains high in hypoplastic left heart syndrome (HLHS) after introduction of the right ventricle (RV) to pulmonary artery conduit to the Norwood procedure. Prior studies have not shown long term survival benefit with conduits, possibly due to regurgitation and volume load, which may cause decreased RV function. Valved conduits (VC) were introduced more recently to address these limitations.

Hypothesis:
The goal of the study was to assess differences in RV size and function during the interstage period between patients undergoing Norwood procedure with valved versus non-valved conduits (NVC). We hypothesized that patients with VC would have smaller increases in RV size and improved function compared to those with NVC.

Methods:
Twenty-five consecutive neonates with HLHS who underwent Norwood procedure with VC were compared to 25 consecutive neonates who underwent Norwood with NVC from 2013 and 2022. Primary outcomes were RV size measured by end diastolic area (EDA) on 4-chamber images and function measured by RV fractional area change and global longitudinal strain.

Results:
Most patients with VC (96%) did not develop more than mild conduit regurgitation. There was no difference in EDA increase one month post op between groups, but there was a significantly smaller increase in EDA pre-Glenn compared to baseline in the VC group (Table 1). Functional measures were not significantly different during follow up. There was no difference in interstage cardiac events or mortality.

Conclusions:
Patients with VC at time of Norwood had smaller increases in ventricular size compared to those with NVC, but there were no differences in functional parameters during follow up. It is possible decreased volume load will have a beneficial long term effect on the immature myocardium of infants with HLHS. Larger studies are needed to further examine the hemodynamic benefits of VC in the interstage period and throughout the stages of palliation.
Abstract 12348: Targeted Degradation of Topoisomerase 2b by Dexrazoxane for Prevention of Doxorubicin-Induced Cardiotoxicity: Dose and Time Course Study in Human
Authors: Chang Hui-Ming , Hsu Jinn-Yuan , Chen Jim , Yeh Edward T
Published: December 2023

Introduction:
Doxorubicin is known to induce cardiotoxicity through topoisomerase 2b (Top2b), whereas doxorubicin poisons topoisomerase 2a (Top2a) to kill cancer cells. When Top2b was genetically deleted in the cardiomyocytes of adult mice, doxorubicin-induced cardiomyopathy was prevented. Pharmacological degradation of Top2b by dexrazoxane can also prevent doxorubicin-induced cardiotoxicity in mice. However, it is not known whether dexrazoxane can induce degradation of Top2b in human.

Hypothesis:
Targeted degradation of Top2b by dexrazoxane can be achieved in humans.

Methods:
Top2b protein level in peripheral blood mononuclear cells (PBMC) were assessed serially after intravenous dexrazoxane infusion in human volunteers. The effectiveness of dexrazoxane on Top2b degradation and the time course of Top2b degradation were determined. Blood was drawn before dexrazoxane infusion, hourly after infusion up to 12 hours, at 24 hours, and at 48 hours. PBMCs were isolated using SepMate tube and fractionated into nuclear and cytosolic fractions. The nuclear fractions were used in Western blot analysis. Immunoblotting was carried out with rabbit anti-Top2b, anti-Top2a, or anti-Lamin B1 antibodies, followed by Peroxidase AffiniPure goat anti-rabbit IgG. The ratio of the intensity of the Top2b and Lamin B1 bands were normalized by setting the pre-ratio to 1.

Results:
One hour after dexrazoxane infusion, Top2b level in leukocytes was reduced to 14%-21% of baseline. Dexrazoxane-induced degradation of Top2b persisted for up to 12 hours and returned to baseline 24 hours after dexrazoxane infusion. Importantly, Top2a level did not vary significantly following dexrazoxane infusion. There were no serious adverse reactions in all participants.

Conclusions:
Human PBMC can be used as a surrogate to follow Top2b degradation. Degradation of Top2b can be achieved with dexrazoxane dose as low as 100 mg/M
2
(one-fifth of the current FDA recommended dose when used in conjunction with doxorubicin). Thus, early dexrazoxane followed by delayed-administration of doxorubicin can be studied as a new strategy to prevent doxorubicin-induced cardiotoxicity by depleting Top2b. Moreover, dexrazoxane did not affect Top2a, thus preserving doxorubicin’s efficacy.
Abstract 12350: The Impact of an Electronic Best Practice Advisory on Patients’ Physical Activity and Cardiovascular Risk Profile
Authors: McCarthy Margaret M , Szerencsy Adam , Fletcher Jason , Melkus Gail D , Vorderstrasse Allison , Katz Stuart
Published: December 2023

Background:
Regular physical activity (PA) is one of eight components of cardiovascular health and it is associated with numerous benefits including a lower risk of CVD. Promoting PA to sedentary patients in primary care can result in significant improvements in PA. The aims of this study were to implement a PA counseling intervention using an electronic best practice advisory (BPA), in a preventive cardiology clinic, and to assess changes in PA and CVD risk factors in a sample of patients enrolled in 12 weeks of PA monitoring.

Methods:
Patients were assessed with the 3-question (days/minutes/intensity) physical activity vital sign (PAVS) via their electronic patient portal prior to an office visit. Those who self-reported less than 50% of current PA recommendations prompted a BPA to their cardiologist to counsel them on improving their PA. Patients were then offered participation in remote patient monitoring wearing a Fitbit for 12 weeks. Blood pressure, waist circumference, lipids, BMI, PA (using the PAVS and Fitbit step-counts) and the six-minute walk test (for cardiorespiratory fitness) were measured at baseline and 12 weeks. Paired
t
-tests assessed for changes in these CVD risk factors from baseline to 12 weeks. We calculated the percent of participants who achieved a clinically important difference of 25 meters in the six-minute walk test.

Results:
The enrolled sample (n=59) were primarily female (51%), White adults (76%) with a mean age of 61.13±11.6 years. There was significant improvement in moderate-to-vigorous PA as self-reported by the PAVS (43±86 vs. 114±157, p=.005). There was no significant difference between week 2 step counts (baseline) and week 12 (p=.07). There was significant improvement in the distance covered (in meters) during the six-minute walk test (469±108 vs. 494±132, p=.0034) and 23 participants (42%) improved at least 25 meters. There were also significant differences in total cholesterol (163±51 mg/dl at baseline vs. 148±45mg/dl at 12 weeks; p=.0.02). No other improvements in CVD risk factors were noted.

Conclusion:
Patients who reported low PA and triggered a BPA for PA counseling had improvements in some, but not all, CVD risk factors. Additional counseling may be needed to improve and maintain PA levels in patients at risk of CVD.
Abstract 12375: Performance of Echocardiographic Measures of Right Ventricular Assessment Against Cardiac MRI in Pulmonary Hypertension - Results From the PVDOMICS Cohort
Authors: Goff Zackary D , Ali Ambreen F , Larive Armand B , Kendrick Cynthia , Kwon Deborah H , Park Margaret , Yu Shilin , Frantz Robert , Jellis Christine L ,   the PVDOMICS Study Group
Published: December 2023

Introduction:
Assessment of right ventricular (RV) size and function by echo is challenging due to complex RV anatomy and requires integration of multiple measurements. We sought to compare accuracy of echo measures of RV size and function with cardiac MRI (CMR) in pulmonary hypertension (PH).

Methods:
We included patients with PH from the PVDOMICS Study who underwent both echo and CMR. Echo measures of RV size (basal dimension, area, 3D volume) and function (fractional area change [FAC], 3D RV ejection fraction [EF], RV global longitudinal strain [GLS], S’, TAPSE, Tei index) were compared to CMR derived RV volumes and RVEF. Agreement was assessed using Bland-Altman (BA) plots and Lin’s concordance correlation coefficients (ρ
c
). Predictive trends were evaluated using linear regression.

Results:
The cohort included 446 subjects (58 ± 15 yrs, 36% male). Echo measures of RV size showed poor agreement with CMR, but substantial linear associations, when comparing CMR end diastolic volume (EDV) with: echo basal dimension (ρ
c
= 0.002; β = 60, R
2
= 0.47), end-diastolic area (ρ
c
= 0.04, β = 6.4, R
2
= 0.64), and 3D EDV (bias = 106, limits of agreement [LOA]: -14.1 to 225); and also when comparing CMR end-systolic volume (ESV) with: end-systolic area (ρ
c
= 0.08; β = 6.8, R
2
= 0.74) and 3D ESV (bias = 67.3, LOA: -31.8 to 166). Select echo measures of RV function demonstrated better agreement with CMR RVEF including: 3D RVEF (bias -0.23, LOA -17.9 to 17.5) and FAC (ρ
c
= 0.55; β = 0.89, R
2
= 0.50). Others exhibited modest or poor agreement including: RV GLS (ρ
c
= 0.11; β = -1.5, R
2
= 0.40), along with S’, TAPSE, and Tei index (ρ
c
≤ 0.02; R
2
≤ 0.19 for all). [Figure]

Discussion:
In this largest comparison of echo vs CMR measures of RV assessment in PH, echo measures of RV size agreed poorly with CMR, especially at larger RV volumes. RV functional assessment was best with echo 3D RVEF and FAC, which should be preferentially used for echo RV functional assessment. Consider CMR for more accurate volume assessment of RV size.
Abstract 12377: Differing Response to Left Bundle Branch Area Pacing versus Biventricular Pacing for Cardiac Resynchronization According to Septal Scar Burden Among Nonischemic Cardiomyopathy Patients
Authors: Chen Zhongli , Ma Xuan , Chen Keping
Published: December 2023

Introduction:
Whether left bundle branch area pacing (LBBAP) have similar benefit compared with biventricular pacing (BVP) for cardiac resynchronization therapy (CRT) in nonischemic cardiomyopathy (NICM) with different septal scar burden is still unknown.

Hypothesis:
We hypothesize that a higher septal scar burden might attenuate the relative benefits of LBBAP versus BVP.

Aims:
This study aims to assess the effect of the septal scar on the response to LBBAP and BVP for CRT.

Methods:
We retrospectively included nonischemic cardiomyopathy (NICM) patients with wide QRS complex and CRT indications who underwent pre-procedure cardiac magnetic resonance (CMR) examination and received either BVP or LBBAP. Late gadolinium enhancement (LGE) was analyzed for scar quantification. CRT response was defined as an absolute increase of≥ 5% in left ventricular ejection fraction (LVEF) at 6 months follow-up.

Results:
A total of 147 patients were included. Fifty-one patients (34.7%) had LBBAP, and 96 (65.3%) had BVP. As septal LGE extent increased, LVEF improvement at 6-month follow-up gradually decreased in the BVP group whereas dropped sharply in the LBBAP group. The nonlinear inverse relationship between the relative benefit of LBBAP versus BVP for response and septal LGE extent, as well as cut-off points (4.4%, 13.3%) of septal LGE extent, were determined using a restricted cubic spline model. Among patients with low septal scar extent (<4.4%), LBBAP was associated with higher response odds than BVP [Odds Ratio (OR) 3.87,95% confidence interval (CI): 0.99-15.17,p=0.052]. In the medium septal scar extent (4.4%-13.3%) group, response odds did not differ between LBBAP and BVP (OR 2.00,95%CI: 0.41-9.74, p=0.391). Among patients with high septal scar extent (>13.3%), BVP was associated with higher response odds (OR 0.12, 95%CI: 0.03-0.54, p=0.006).

Conclusions:
Response to LBBAP and BVP among NICM patients might be impacted by septal scar burden.
Abstract 12428: Small Apolipoprotein(a) Isoform Size is a Predictor of Postoperative Patency Following Peripheral Arterial Revascularization
Authors: Pavlyha Marianna , Hunter Madeleine D , Li Yihao , Matveyenko Anastasiya , Cherukuri Srinivas P , Patel Virendra I , Morrissey Nicholas , Bajakian Danielle , Nowygrod Roman , Reyes-Soffer Gissette
Published: December 2023

Introduction:
High Lp(a) is associated with adverse limb events in patients undergoing lower extremity (LE) revascularization. Lp(a) levels are genetically pre-determined, with
LPA
gene encoding for two apo(a) isoforms whose variations in size are driven by the number of kringle IV type 2 repeats. We examined the role of apo(a) size in LE revascularization outcomes.

Methods:
25 subjects with symptomatic PAD, Rutherford stage 4 or less underwent open or endovascular LE revascularization (age 66.7±9.7 years; F=12, M=13; Black=8, Hispanic=5, and White=12). Pre- and post-operative medical history, self-reported symptoms, ABIs, and LE ultrasounds were obtained. Plasma Lp(a), apoB100, lipid panel, and pro-inflammatory markers (IL-6, IL-18, hsCRP, TNFa) were assayed preoperatively. Isoform size was estimated using gel electrophoresis and weighted isoform size (
wIS
) calculated based on % isoform expression. Firth logistic regression was used to examine the relationship between
wIS
and procedural outcomes: symptoms (better/worse), patency of treated lesion(s) in the postoperative period (<1 month), change in ABI, and re-intervention <6 months. We controlled for age, sex, smoking, statin and antiplatelet use.

Results:
Median plasma Lp(a) level was 108 (44, 301) nmol/L. The mean apoB100 level was 168.0±65.8 mg/dl. As expected, plasma Lp(a) levels were inversely correlated with
wIS
(R2 = 0.20; p=0.00001). Interestingly, plasma Lp(a) levels and w
IS
were not associated with any of the measured plasma pro-inflammatory markers. However, small apo(a)
wIS
was associated with occlusion of the treated lesion(s) in the postoperative period [OR=2.32 (95% CI 1.08 to 4.9, p= 0.03)]. The relationship of small apo(a)
wIS
with re-intervention was not as strong [OR=1.59 (95% CI 0.97 to 2.62), p=0.07)]. We observed no association between
wIS
with patient reported symptoms or change in ABI.

Conclusions:
Subjects with small apo(a) isoform sizes undergoing peripheral arterial revascularization may be more likely to experience occlusion in the perioperative period and/or require re-intervention. Further studies identifying the mechanism and possible relationship of these findings to detrimental long-term peripheral vascular outcomes are warranted.
Abstract 12429: Potential Impact of Eliminating Physical Activity Activities Among the United States Adults
Authors: Tamura Kosuke , Martinez Marie F , Moniruzzaman Mohammad , deng Yangyang , Chin Kevin L , Weatherwax Colleen , Bartsch Sarah , Velmurugan Kavya , Heneghan Jessie , Scannell Sheryl , Lee Bruce
Published: December 2023

Introduction:
Disparities in physical activity levels among adults have been a significant and growing concern in the United States (US) for the past few decades, disproportionately impacting minority populations. Yet, demonstrating and quantifying the potential benefits of eliminating these disparities is challenging as traditional statistics cannot simultaneously account for changes to physical activity levels, subsequent health-related factors, and socioeconomic measures.

Aims:
This study developed an agent-based model (ABM) to simulate the elimination of physical activity disparities among race/ethnic groups in the US. adults (ages 18-30), and determine the lifetime health and economic impact.

Methods:
We developed a computational simulation model representing US adults ages 18-30, their physical activity and subsequent weight changes over time, and the lifetime physical health outcomes and the associated costs. We simulated Black and Hispanic Americans getting the same physical activity levels as White Americans.

Results:
Eliminating disparities/achieving parity in physical activity among adults such that the same proportion of Black and Hispanic Americans are meeting the physical activity guidelines as White Americans could reduce overweight/obesity prevalence by 1.13% (95% confidence interval [CI]: 1.13%-1.14%) among Black and Hispanic Americans, resulting in approximately 203,000 fewer cases of overweight/obesity (95% CI: 202,000-204,000). Additionally, this could avert 65,000 (95% CI: 64,800-65,200) cases of weight-related diseases (i.e., coronary heart disease, cancer, and diabetes) and gain 249,000 (95% CI: 249,000-250,000) quality-adjusted life years (QALYs). This translates to savings of $3.94 billion (95% CI: $3.93-$3.95 billion) and $5.43 billion (95% CI: $5.41-$5.46 billion) from direct medical costs and productivity losses averted, respectively, due to improvements in physical health.

Conclusions:
These cost savings represent what could be invested to reduce physical activity disparities and still break even, which can give decision-makers a sense of how to prioritize achieving equity in physical activity levels in US adults.
Abstract 12466: Targeted Quantitative Plasma Metabolomics Identifies Metabolite Signatures That Distinguish Heart Failure With Reduced and Preserved Ejection Fraction
Authors: Naeem Fawaz , Leone Teresa , Petucci Christopher , Groarke John D , Bennett Donald , Mancuso Jessica , Tzameli Iphigenia , Roth Flach Rachel J , Rader Daniel J , Kelly Daniel P
Published: December 2023

Background:
Despite recent advances, heart failure (HF) remains a high burden disease and is largely treated with a “one-size-fits-all” approach. Two phenotypes are recognized: HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). To develop HF disease-specific approaches to define and guide treatment, distinguishing biomarkers are needed.

Methods:
We conducted quantitative, targeted LC/MS plasma metabolomics on 787 samples collected by the Penn Medicine BioBank from patients with HFrEF (n=219), HFpEF (n=357), and matched non-failing Controls (n=211). Sample collection time from last meal was not controlled. A total of 97 metabolites were analyzed, comprising 30 amino acids, 8 organic acids, and 59 acylcarnitines classified by carbon length.

Results:
3-hydroxybutyrate (3-HBA) was uniquely and significantly elevated in the HFrEF group [mean +/- SEM: HFpEF, 108.7(+/-7.15); HFrEF, 148.0(+/-12.4); Control, 86.29(+/-8.01);
p
<.0001]. The 3-HBA metabolite C4-OH butyryl-carnitine also showed a similar HFrEF-specific pattern. Consistent with previous studies, long/very-long chain acylcarnitines were elevated in the HFrEF group to a much greater extent than the HFpEF group compared to Controls. Branched-chain amino acid (BCAA) levels were not different across the groups; however, acylcarnitine species indicative of BCAA degradation, including C04 Isobutyryl, C04-DC Methylmalonyl, C04-DC Succinyl, and C05 2-Methylbutyryl, were significantly elevated in both HF groups compared to Controls. Lastly, we found that the amino acid, asymmetric dimethylarginine, which promotes endothelial dysfunction and vasoconstriction, was uniquely elevated in the HFpEF cohort [mean +/- SEM: HFpEF, 1.236(+/- .019); HFrEF, 1.105(+/- .027); Control, 1.077(+/- .022);
p
< .0001].

Conclusions:
Taken together, these results identify plasma metabolite signatures that potentially distinguish between HFrEF and HFpEF and suggest patterns of metabolic re-programming in extra-cardiac tissue in the context of heart failure. Future studies will be necessary to define the utility of these metabolites as biosignatures to help guide therapeutics and to identify the underlying physiology responsible for these observations.
Abstract 12473: Majority of Technetium-99m Pyrophosphate Scans for the Evaluation of Transthyretin Cardiac Amyloidosis Are Ordered Without Appropriate Paraprotein Evaluation
Authors: Yan Crystal L , Rivera Nina , hoffman james
Published: December 2023

Background:
Guidelines recommend the use of technetium-99 m pyrophosphate (PYP) scanning after light chain amyloidosis has been ruled out via laboratory testing. Yet lack of execution of this condition significantly hinders the real-world value of PYP scanning to diagnose transthyretin amyloidosis.

Objective:
The aim of this study was to evaluate the prevalence and consequences of inappropriate PYP scanning at an academic, tertiary care center.

Methods:
We performed a retrospective study of all PYP scans ordered at our institution from January 2018 to March 2023. Categorical variables were determined as frequencies and percentages. Continuous variables were determined as means and standard deviations.

Results:
269 PYP scan orders were identified from 228 distinct patients. Mean age was 67.04 years, 51.2% of patients were female, 66.5% were White, and 47.7% were Hispanic. 52 PYP scans (19.3%) should not have been ordered given positive paraprotein results. 145 PYP scans (53.9%) should not have been ordered given lack of any paraprotein results. Only 9 scans (3.3%) were ordered after negative serum free light chain, serum protein electrophoresis, and serum immunofixation results. Up to seven patients (3.1%) did not receive appropriate paraprotein evaluation prior to tafamidis initiation and thus may have been erroneously treated, representing potential unnecessary healthcare costs to not only the patient, but also the healthcare system. There were no temporal trends for scans performed with zero, three, or positive paraprotein results (
Figure
).

Conclusions:
Most patients did not undergo complete serum monoclonal protein testing prior to PYP scan ordering. Many patients underwent PYP scanning despite positive serum monoclonal protein test results. Increased awareness and education among physicians regarding paraprotein evaluation prior to PYP scanning is still needed to prevent misdiagnosis, delayed diagnosis, and unnecessary healthcare costs.
Abstract 12488: Oral Anticoagulation for New Onset Post-Operative Atrial Fibrillation After Combined Coronary Artery Bypass Grafting and Valve Surgery is Not Associated With Improved Outcomes
Authors: Tejpal Ambika , Lee Joshua G , Fang Jiming , Jeong Irene , Ouzounian Maral , Atzema Clare , Austin Peter , Ha Andrew C
Published: December 2023

Introduction:
Post-operative atrial fibrillation (POAF) after cardiac surgery is common and is associated with increased risk of stroke and death. The incidence of POAF is highest among patients who undergo combined CABG and valve surgery, at 40-60%. The risks and benefits of oral anticoagulation (OAC) in this high-risk population are not well established.

Research Question:
Among patients with POAF after combined CABG and valve surgery, what is the association between OAC use and clinical outcomes?

Methods:
From a population-based registry in Ontario, Canada, we identified consecutive patients >65 years of age who developed POAF after combined CABG and left-sided, non-mechanical valve surgery from Oct/08-Mar/18. The exposure of interest was OAC prescription within 90 days after hospital discharge. Outcomes included death, cardiovascular death, stroke, MI, thromboembolism, and bleeding. Follow-up began at 90 days after discharge and continued for 24 months. Outcomes were analyzed using inverse probability of treatment weighting using the propensity score. Statistical measures of association were reported as hazard ratios with 95% confidence intervals.

Results:
Among 4,836 patients who had combined CABG/valve surgery, 1,939 (40.1%) developed POAF and these patients had a higher rate of death (HR 1.31, 95% CI 1.01-1.68 P=0.04). OAC was prescribed in 1,153 (59.5%) patients (86% warfarin and 14% DOAC). The use of OAC was not associated with a lower rate of death, stroke/MI/thromboembolism, or cardiovascular death but was associated with an increased rate of bleeding (HR 1.62, 95% CI 1.00-2.61, P=0.048).

Conclusion:
Among patients with POAF after combined CABG/valve surgery, use of warfarin or DOAC did not improve ischemic cardiovascular outcomes or survival and was associated with higher rates of bleeding. Randomized control trials are needed to define the risk and benefit of OAC use in this high-risk population. Until then, routine use of OAC is not recommended.