bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14946: Sex Differences in Growth Differentiation Factor-15 and Association With Acute Myocardial Infarction and Death at 90 Days in Emergency Department Patients Presenting With Acute Chest Pain and Normal Troponin Levels
Authors: Bhandari Nipun , Tran Nam K , Allen Brandon R , Christenson Robert H , Nowak Richard M , Wilkerson Richard G , Madsen Troy E , Weaver Michael T , Yi Fan , Mahler Simon A , Mumma Bryn
Published: December 2023

Introduction:
Growth differentiation factor (GDF)-15, a novel biomarker of cardiac stress, has been recently studied as a tool in predicting cardiovascular outcomes in patients with acute chest pain, when compared against high-sensitivity troponin T (hs-TnT). However, GDF-15 is not approved for cardiac indications in the United States, with limited nationwide data evaluating subpopulations by key demographic and clinical characteristics.

Hypothesis:
GDF-15 levels demonstrate sex-specific differences and serve as an independent predictor of 90-day acute myocardial infarction (MI) and all-cause death in patients presenting to the emergency department (ED) with acute chest pain and normal hs-TnT levels.

Methods:
This study was a secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) trial, which prospectively enrolled adults ≥ 21 years presenting to eight EDs in the US with suspected acute MI over a twenty-month period. Blood sampling was performed at presentation, with hs-TnT and GDF-15 assays performed at a central laboratory. The outcomes of interest were the composite of acute MI and all-cause death at 90 days. Multiple logistic regression models were fitted for timepoint with multiple independent variables including the following: age, sex, ischemic electrocardiogram, hs-TnT, GDF-15, and creatinine.

Results:
We studied 1,428 patients; median age was 58 years and 54% (765) were male. The composite outcome of acute MI or death occurred in 3% (37) at 90 days. In multivariable regression models in patients with baseline normal hs-TnT levels, GDF-15 was associated with acute MI or all-cause death at 90 days (Odds Ratio 1.03, 95% Confidence Interval 1.01-1.05). Median GDF-15 levels were 1266 pg/mL in males (25th percentile-75th percentile, 914-2038 pg/mL), and 1504 pg/mL in females (25th percentile-75th percentile, 987-2197 pg/mL).

Conclusions:
Among adult ED patients presenting with acute chest pain with normal troponin levels, the novel biomarker GDF-15 was independently associated with 90-day acute MI or death, with higher median GDF-15 levels in females compared to males. These data suggest a role for GDF-15 in short-term cardiac risk stratification.
Abstract 14960: Coronary Artery Calcium Distribution Patterns Are Independently Predictive of Adverse Cardiovascular Events: Observations From the Dallas Heart Study
Authors: Parsa Shyon , Khera Amit , Joshi Parag H , Kay Fernando , Rohatgi Anand
Published: December 2023

Introduction:
The coronary artery calcium (CAC) diffusivity index (DI) may improve risk stratification for those with Agatston CAC > 0 in older individuals. We aimed to assess whether the distribution of CAC would improve risk prediction of cardiovascular (CV) events beyond the traditional Agatston CAC score in a younger population.

Methods:
Among Dallas Heart Study 2 (DHS2) participants with Agatston CAC > 0 and no history of CVD (35% of entire cohort), we studied 1013 participants with CAC DI at DHS2. The raw CAC DI was calculated as 1 - (CAC in most affected vessel/total CAC) and categorized into concentrated (<25th%), standard (25-75th%), and diffuse (>75th%) patterns. Multivariable Cox proportional hazards regression and C statistics were calculated for coronary events (CHD) and all CVD, and all-cause mortality. Models were adjusted for total Agatston score, race, gender, BSA, smoking history, diabetes, and statin use.

Results:
Mean age of the DHS2 study cohort was 55 ± 9.4 years (48% women, 45% Black). The median follow up was 9 ± 2.5 years (55 CHD, 97 CVD, and 120 all-cause mortality events)
(Figure, A)
. CAC DI was modestly correlated with Agatston CAC (Spearman rho = 0.60, p<0.01). In models adjusted for total Agatston score, risk factors, and demographics, compared with a concentrated pattern, a diffuse CAC pattern was associated with incident CHD (HR [95%CI]: 5.32 [1.68-16.86]); CVD (HR [95%CI]: 3.21 [1.66-6.21]), and all-cause mortality (HR [95%CI]: 2.02 [1.18-3.47]
(Figure, B)
. Findings were similar for continuous CAC DI. Addition of continuous CAC DI to adjusted models including Agatston CAC improved the C-statistic for CHD (0.79 to 0.81, p<0.01) and CVD (0.71 to 0.73, p<0.01).

Conclusions:
Beyond the validated Agatston score, higher CAC DI at baseline improves risk prediction of incident CHD and CVD events in a younger population-based cohort. Further studies are warranted to evaluate the clinical utility of assessing distribution patterns of CAC.
Abstract 15139: Applying an Artificial Intelligence-Enabled Electrocardiographic System for Reducing Mortality: A Pragmatic Randomized Clinical Trial
Authors: LIN CHIN , Lin Chin-Sheng , Liu Wei-Ting
Published: December 2023

Introduction:
The early identification of high-risk patients for sequent intensive care is a significant challenge.

Hypothesis:
We aimed to evaluate the outcome of an artificial intelligence (AI)-enabled electrocardiogram (ECG) in identifying patients at high risk of mortality.

Methods:
In this single-blind, patient-level randomized controlled trial (NCT05118035), we recruited 39 attending physicians and their patients from emergency and inpatient departments. The AI-ECG intervention involved an AI report in electronic health records and an active warning message to physicians for high-risk patients. Primary endpoint was 90-day all-cause mortality. Secondary analyses included medical behavior changes and causes of death.

Results:
Data from 15,965 patients (8,001 intervention; 7,964 control) with a mean age of 61±18 years were included. The intervention group had a significantly reduced cumulative proportion of death (HR: 0.83, 95% CI: 0.70-0.99) compared to the control group (3.6% vs. 4.3%). High-risk cases (709 intervention; 688 control) identified by AI-ECG showed a 31% reduction in mortality (16.0% in intervention arm vs. 23.0% in control arm, HR: 0.69, 95% CI: 0.53-0.90; p for interaction = 0.026). The intervention group with high-risk ECGs received more intensive care, arrhythmia interventions, echocardiographic and electrolyte examinations, contributing to a significant reduction in cardiac death (0.2% in intervention arm vs. 2.4% in control arm, HR: 0.07, 95% CI: 0.01-0.56).

Conclusions:
AI-ECG effectively identifies high-risk patients, facilitating intensive care and resulting in reduced all-cause mortality.
Abstract 15210: Qualitative Stress Perfusion American Heart Association Plot and Outcome Prediction Using Artificial Intelligence
Authors: Alskaf Ebraham , Scannell Cian , Suinesiaputra Avan , Crawley Richard , Young Alistair , Perera Divaka , Chiribiri Amedeo
Published: December 2023

Introduction:
Stress perfusion cardiac magnetic resonance (CMR) is a guidelines-backed non-invasive test for the assessment of coronary artery disease (CAD), and its prognostic value is well validated. However, image interpretation requires a high level of expertise. Furthermore, the direct relationship between image pixels and outcome is not well understood.

Hypothesis:
Qualitative stress perfusion map based on American Heart Association (AHA) segmentation and direct linkage with outcome can be achieved using artificial intelligence.

Methods:
Retrospective CMR data collection was performed in one center between 2011 and 2021. Cases with death events were identified. Mean time to event was considered as a follow-up period, and cases without events and with shorter duration from CMR to collection date were excluded. Stress perfusion images were selected from 3 left ventricular (LV) levels: basal, mid and apical. Clinical CMR reports with binary AHA perfusion values were available. Six convolutional neural networks (CNNs) were trained to predict AHA segments values for each level and merged into four CNNs for the apical level. Perfusion, scar image pixels and clinical data were transformed into features, and a hybrid CNN (HNN) was trained to predict mortality. Training, validation, and test split was 70%, 15%, and 15%, respectively. Evaluation metrics included area under curve (AUC).

Results:
Total number of cases included for AHA plot classification were 2139 (6417 perfusion images). The average AUC for AHA perfusion classifiers was 61%, an example with correct predictions is presented. Follow-up period was calculated at 999 days. Total number of cases included for HNN development was 1294. HNN achieved high prediction value with AUC of 81%.

Conclusions:
Qualitative AHA stress perfusion map was feasible using artificial intelligence. Outcome prediction with HNN was a powerful new approach for risk stratifying patients with known or suspected CAD.
Abstract 15246: Myocardial Deformation for Prediction of Major Arrhythmic Events in Patients With Non-Ischemic Cardiomyopathy and Primary Prevention Implantable Cardioverter Defibrillators
Authors: Ghanbari Fahime , Cirillo Julia , Rodriguez Jennifer , Yue Jennifer , Kramer Daniel B , Morales Manuel A , Ngo Long , Manning Warren J , Nezafat Reza
Published: December 2023

Introduction:
Sudden cardiac death is a major cause of mortality in patients with non-ischemic cardiomyopathy (NICM). Implantable cardioverter-defibrillator (ICD) is an established prophylactic measure. But, optimal identification of patients with greatest likelihood of benefiting poses ongoing challenges.

Objective:
To assess the prognostic value of myocardial deformation for predicting ICD intervention while accounting for competing mortality risk.

Methods:
180 NICM patients eligible for primary prevention ICD underwent cardiac magnetic resonance (CMR). Myocardial strains (left ventricular radial, circumferential, longitudinal; left atrial; and right ventricular free wall longitudinal strain (RV GLS)) were measured via CVI42 feature tracking. In a multivariable Fine-Gray competing risk model, incremental values of strains were assessed, adding to a baseline model based on clinical features and late gadolinium enhancement (LGE). The primary endpoint was ventricular tachycardia/fibrillation treated with ICD intervention, including shocks or anti-tachycardia pacing.

Results:
159 patients with ICD (117 male; 54 ± 13 years) were included for final analysis (follow-up: 1176±960 days; median: 896). 26 patients met the primary endpoint. RV GLS showed a statistically significant difference between patients with and without events (-12.5% ± 5 vs -16.4% ± 5.5, p = 0.001). Univariate analyses revealed that LGE and RV GLS were significantly associated with outcome, even after accounting for competing risk (LGE: HR=3.69, 95% CI=1.28-10.62; RV GLS: HR=2.04, 95% CI=1.30-3.22). Adding RV GLS to the baseline model improved its prognostic value, with a c statistic improvement from 0.678 to 0.730. RV GLS hazard ratio remained significant in multivariate analysis after accounting for competing risk (HR=1.73, 95% CI=1.12-2.66) (Table 1).

Conclusions:
In NICM, RV GLS provides additional predictive value above LGE and clinical features for ICD intervention.
Abstract 15318: A Dene- and Drug-Eluting Peripheral Stent Using a Baculovirus-Eluting PVA Hydrogel Coating
Authors: Schaly Sabrina J , Prakash Satya
Published: December 2023

Introduction:
Over 20 % of people over 60 have peripheral artery disease (PAD), the narrowing of peripheral arteries due to atherosclerosis. More recent data suggests a surge in PAD in younger people (affecting up to 4 % of people). Atherosclerosis is complex, initially involving fat deposition and endothelial cell dysfunction, leading to inflammation, hyperproliferation of cells, plaque development, and calcification. This can lead to significant pain, discomfort, limb ischemia, stroke, and increases the risk of major cardiovascular events such as myocardial infarction and coronary artery disease. Often a bare-metal or drug-eluting stent will force the artery open. These stents are highly effective but come with complications such as restenosis, thrombosis, and enhanced endothelial dysfunction leading to patency as low as 60 % one-year post-implantation.

Hypothesis:
A gene- and drug-eluting hydrogel stent coating can promote endothelial recovery while the long-term drug elution prevents restenosis and inflammation, improving the clinical outcome of PAD (Figure 1).
Methods & results:
The gene encoding nitric oxide had been cloned into a baculovirus, a highly efficient and safe gene delivery vector to arterial cells. Nitric oxide inhibits smooth muscle cell proliferation, promotes endothelial cell proliferation, promotes angiogenesis, and prevents reactive oxygen species production within the diseased artery. The 10-day gene elution has the potential to leave behind a healthy endothelial lining, and the 100-day Everolimus drug elution can prevent restenosis and inflammation. Moreover, the gene- and drug-eluting stent is stable during crimping and expansion, has a high tensile strength, is non-cytotoxic, and is anti-thrombotic by preventing platelet adhesion.

Conclusion:
Overall, the novel stent exhibits beneficial mechanical and cellular properties with the potential to mitigate current stenting complications using dual gene and drug therapy.
Abstract 15329: Echocardiographic Assessment of Cardiac Function in Preterm Miniature Pigs Supported With a Pumped Artificial Placenta
Authors: Kuehle Henriette , Chow Jessica S , Cho Steven K , Charest-Pekeski Alex J , Lee Fu-Tsuen , Aujla Tanroop , Floh Alejandro , McVey Mark J , Estrada Marvin , Crawford Lean Lynn , Mroczek Dariusz , Saini Brahmdeep , Lim Jessie Mei , Moir Olivia J , Darby Jack R , Morrison Janna L , Haller Christoph , Sun Liqun , Seed Mike
Published: December 2023

Introduction:
Preterm birth is the leading cause of infant mortality and morbidity. Artificial placenta (AP) technology aims to support premature fetal piglets in an environment simulating intrauterine physiology to maintain fetal circulation and improve outcomes and survival.

Hypothesis:
We sought to understand the fetal cardiovascular physiology and mode of cardiac failure associated with a pumped extracorporeal membrane oxygenation circuit connected to the fetal circulation.

Methods:
Following umbilical cannulation, connection to a centrifugal pump and neonatal oxygenator and transition of preterm Yucatan miniature piglets to a fluid-filled biobag, echocardiographic studies measured ventricular function and fluid status including Dopplers, and strain analysis both prenatally and while maintained on the AP circuit.

Results:
AP fetuses (n=13; GA 102±4d; 616±139g; survival 46.4±46.8h) were tachycardic and hypertensive with supraphysiologic circuit flows initially. Strain analysis revealed significantly reduced RV strain rate within the first five hours of AP support compared to paired prenatal measurements
(p=0.005)
. Fetuses supported for <24h had significantly lower overall RV global longitudinal strain
(p=0.001)
than those surviving >24h. M-mode imaging revealed progressive cardiac hypertrophy with an increase in interventricular septum
(p=0.03)
and LV free
(p=0.04)
wall thickness from first to last measurements. Doppler measurements showed elevated peak flow velocity patterns in the MCA and reductions in MCA-PI from start to end of support
(p=0.04)
as well as compared to unpaired prenatal controls
(p=0.03, p=0.001)
. Imaging findings included ascites, skin edema, and dilated hepatic veins.

Conclusions:
AP fetuses exhibited signs of excessive volume and pressure loading resulting in impaired contractility, including supraphysiologic umbilical flows, reduced RV strain and strain rate, and evidence of elevated filling pressures. Myocardial hypertrophy and changes in cerebral perfusion indicated adaptation to increased afterload, potentially affecting cardiovascular and cerebrovascular development and leading to fetal deterioration. Further advancements in AP technology are necessary before clinical translation.
Abstract 15333: The Addressing Hypertension Care in Africa (ADHINCRA) Study: A Multi-Level Nurse-Led, Mobile-Health Enhanced Intervention to Improve Hypertension Control in Ghana
Authors: Commodore-Mensah Yvonne , Turkson-Ocran Ruth-Alma N , Foti Kathryn , Dennison Himmelfarb Cheryl R , Carson Kathryn , Appiah Lambert T , Nyamekye Gideon , Mobula-Shufelt Linda , Cooper Lisa A , SARFO FRED S
Published: December 2023

Background:
Ghana, is experiencing silent epidemics of hypertension (HTN) and cardiovascular disease (CVD). There is a dire need to implement multilevel strategies to improve HTN control in Ghana. The Addressing Hypertension Care in Africa (ADHINCRA) Study sought to test the feasibility of a multilevel, nurse-led, mobile-health enhanced intervention to improve HTN control in Ghana.

Methods:
Using a cluster-randomized controlled pilot trial design, we enrolled 4 hospitals in Kumasi, Ghana and recruited 240 patients with uncontrolled HTN, defined as systolic blood pressure (BP) ≥140 mm Hg. Two hospitals were randomized to the intervention and 2 to the enhanced usual care (UC) arm. Patients in the intervention arm received nurse-led task-shifting, a mobile health application and home BP monitoring. The intervention was administered for six months, after which it was withdrawn and patients were followed for 6 more months. The enhanced UC arm received usual care, plus short text messages on health. The primary outcome was change in BP control status at 6 and 12 months. We used general linear models to examine the probability of BP control, accounting for clustering within hospitals.

Results:
The mean age was 53 ± 9.7 years, 51% were women. After 6 months, BP control improved in the intervention arm (57.0%, 95% CI 56.8% to 57.1%) versus 18.1%, 95% CI 16.9% to 19.3%, for the UC arm), with a between-group difference of 38.9% (95% CI 37.7% to 40.1%; p<0.001). After 12 months, BP control improved in the intervention arm (80.5%, 95% CI 65.5% to 95.4%) versus 24.2%, 95% CI 10% to 38.5%, for the UC arm), with a between-group difference of 56.2% (95% CI 35.6% to 76.8%; p<0.001). (
Figure)

Conclusion:
A multi-level intervention nurse-led, mobile-health enhanced intervention was associated with greater BP control than enhanced UC among patients with HTN in Ghana. A larger scale study is warranted to support future scale-up of the ADHINCRA Study.
Abstract 15372: The Lewis Lead
Authors: Elhadi Mohamed , Adel Fadi W , Killu Ammar M
Published: December 2023

The Lewis lead is a modified ECG configuration that can enhance the amplitude of the atrial electrical activity and is useful when the atrial activity cannot be discerned in the standard ECG. The configuration involves applying the right arm electrode on the manubrium, left arm electrode to the 5th intercostal space on the right sternal border, left leg electrode over the right lower costal margin and right leg electrode in the standard position. The ECG is then interpreted in lead I and II. Herein we present a case where the Lewis lead aided in the diagnosis of complete heart block with underlying atrial fibrillation.

Case Presentation:
A 75 year old female with severe tricuspid regurgitation was admitted for tricuspid valve replacement. She had previous paroxysmal atrial fibrillation status post pulmonary vein isolation. The preoperative ECG revealed normal sinus rhythm. Postoperatively, ECG demonstrated a narrow complex ventricular rhythm at 70 beats per minute. No atrial activity could be clearly discerned (Image 1). The epicardial atrial wire placed intraoperatively was not functioning, therefore atrial electrogram could not be obtained. It was unclear from repeat ECGs if there was sinus arrest or atrial fibrillation in the atria. The Lewis lead was then utilized and revealed underlying atrial fibrillation (Image 1); together, this was consistent with atrial fibrillation and complete heart block with a junctional escape rhythm. The rhythm did not recover and there was progressive conduction system disease with widening of the QRS and episodes of severe bradycardia. She underwent pacemaker implantation.

Discussion:
By utilizing the Lewis lead we were able to establish the atrial rhythm and differentiate between atrial fibrillation and sinus arrest. The Lewis lead can also help narrow the differential for wide complex tachycardia by magnifying the p wave, thus making it easier to detect ventriculoatrial dissociation, a hallmark feature of ventricular tachycardia.
Abstract 15427: Lipoprotein(a) Proteomic Signatures and Links to Metabolic Pathways
Authors: Matienzo Nelsa , Matveyenko Anastasiya , Soni Rajesh , Reyes-Soffer Gissette , Aikawa Masanori , Singh Sasha A
Published: December 2023

Introduction:
High levels of Lp(a) are positively associated with the development of ASCVD. The pathways regulating levels and links to disease are not clear. Lipoprotein(a) has two main proteins: apolipoprotein(a) [apo(a)] and apolipoporoteinB100 (apoB100).The aim of this study was to describe additional proteins on Lp(a) and links to pathways that may drive disease mechanisms.

Methods:
We analyzed plasma from 10 healthy volunteers, mean age 47 ±13 years, 50% female (5 Blacks, 3 Hispanics, 2 Whites). Lp(a) was isolated via immunoprecipitation (IP). Two distinct proteome analyses were compared: in-gel versus in-solution digestion of immunoprecipitated Lp(a), in two independent laboratories. Proteins that were identified with at least 3 unique peptides, and present in every IP sample were considered. Biological networks were generated based on protein abundance using the STRING database.

Results:
There were 55 proteins identified in every IP sample via in-gel preparation and 92 proteins met the same criteria via in-solution preparation. We found 26 proteins overlapping between the two methods (Table 1A). Apo(a) and apoB100 met the strict criteria we set forth, showing that we successfully immunoprecipitated Lp(a) from plasma. The top gene ontology biological processes and networks associated with the Lp(a) proteome are presented on Table 1B and Figure 1, respectively.

Conclusions:
Lp(a) proteome analysis via two platforms provides pathways that can increase our understanding of Lp(a) links to disease mechanisms. Further studies of these protein-protein interactions and their pathways can lead to enhanced understanding of Lp(a) links to ASCVD and other diseases.
Abstract 15447: The Association of Maternal Statin Use During Pregnancy to Perinatal Outcomes
Authors: May Heidi T , Le Viet T , Bair Tami L , Muhlestein Joseph B , Knowlton Kirk U , Ronnow Brianna S , Knight Stacey , Anderson Jeffrey L
Published: December 2023

Introduction:
Statins are used to treat those with hyperlipidemia and at high risk for a cardiovascular event, including women of childbearing potential. Traditionally, statins have been contraindicated during pregnancy because of a theoretical risk of teratogenicity. The FDA removed the black box warning for usage during pregnancy in 2021and recent observational studies have reported a relatively safe profile of statin use during pregnancy. However, ongoing evidence is needed because of the small samples and limited data available. Therefore, the objective of this study is to report perinatal outcomes of statin use during pregnancy.

Methods:
Patients taking a statin while pregnant were matched 1:10 to non-statin pregnant patients by age (±1 years), date of delivery (±2 years), hypertension, diabetes, and smoking history. All patients were
>
18 years of age and received prenatal and delivery care between 1997 and 2021 at Intermountain Health, a system of 24 hospitals and 215 clinics in Utah, Idaho, and Nevada. Data for this study utilized electronic health records stored in Intermountain’s data warehouse.

Results:
A total of 57 statin-user pregnancies were well-matched to 570 non-statin user pregnancies (Table 1). No significant differences were found between the groups for miscarriage, pre-term delivery, preclampsia/eclampsia, and congenital anomalies (Table 2). Mean length of statin use prior to pregnancy was 1.3±2.5 years. Among those without miscarriages, 59.6% discontinued statin use, with a mean length of use while pregnant before discontinuation being 5 months.

Conclusions:
This study suggests that statin use while pregnant may be safe with no congenital anomalies being found. However, ongoing surveillance is needed because of the small sample size of statin users that can make it difficult to detect associations.
Abstract 15501: Effects of Vericiguat on Right Ventricular Function in Chronic Heart Failure Patients
Authors: Poglajen Gregor , Frljak Sabina , Zorz Neza , Bajec Tine , Cerar Andraz , Zemljic Gregor , Okrajsek Renata , SEBESTJEN Miran , Vrtovec Bojan
Published: December 2023

Introduction:
Despite the beneficial clinical effects of vericiguat in chronic heart failure, the potential effects of vericiguat therapy on right ventricular (RV) function remain poorly defined.

Hypothesis:
We sought to evaluate the effects of vericiguat on RV function in chronic heart failure patients.

Methods:
We performed a prospective non-randomized single center study enrolling 24 consecutive HFrEF outpatients who were receiving stable heart failure therapy for at least 3 months. All patients received vericiguat 2,5 mg qd at baseline and up-titration was performed on a bi-weekly basis to the target dose of 10 mg qd. At baseline and at 3 month follow-up all patients underwent clinical, biochemical and echocardiographic evaluation. Improved RV function was defined as any improvement in TAPSE between baseline and 3 months.

Results:
During follow-up we observed a significant overall improvement of TAPSE (18.5±4.2 mm vs. 21.3±4.7 mm; P=0.03) and TR gradient (35±10 mmHg vs. 29±8 mmHg; P=0.04). RV function improved in 17 patients (70%; Group A) and remained unchanged in 7 (30%) patients (Group B). At baseline, the two groups did not differ in gender (male; 100% in Group A vs. 90% in Group B; P=0.37), age (64±9 years vs. 61±9 years; P=0.59), NYHA class (2.9±0.5 vs. 3.1± 0.3; P=0.39), or heart failure etiology (ishemic: 64% vs. 71%; P=0.76). Heart failure therapy was also comparable: ARNI (94% vs. 100%; P=0.53), beta blockers (94% vs. 100%; P=0.53), MRA (100% vs. 100%), SGLT2i (100% vs. 86%; P=0.12) and loop diuretics (59% vs. 57%; P=0.94). We found no differences in baseline LVEF (30±6% vs. 29±4%; P=0.73), LVOT VTI (15±3 cm vs. 14±5 cm; P=0.34), LVEDV (219±51 mL vs. 197±56 mL; P=0.39), TAPSE (17±3 mm vs. 18±3; P=0.68), RVIDd (39±4 mm vs. 38±3 mm; P=0.58) and TR gradient (34±8 mmHg vs. 38±11 mmHg; P=0.38). Both groups received similar doses of vericiguat (8.5±2.8 mg in Group A vs. 6.8±2.9 mg in Group B; P=0.19). Compared to Group B, we found significantly lower baseline NT-proBNP serum levels in Group A (1888±1973 pg/mL vs. 6373±5465 pg/mL; P=0.009).

Conclusions:
Vericiguat therapy may be associated with improved RV function in chronic heart failure patients. The effects appear to be particulary pronounced in patients with lower NT-proBNP levels.
Abstract 15635: Sex Differences in the Effect of Nocturnal Hypoxia on Right Ventricular Myocardial Blood Flow
Authors: Kapadia Sohum , Malczewska Magdalena , Feher Attila , deKemp Robert , KLEIN RAN , Yaggi Henry K , Miller Edward J , Sinusas Albert J , Thorn Stephanie , Aneni Ehimen
Published: December 2023

Introduction:
Nocturnal hypoxia is common in patients with obstructive sleep apnea (OSA). However, it is unclear how nocturnal hypoxia affects the structure and function of the right ventricle (RV), and if there are sex differences in the impact of nocturnal hypoxia on RV dysfunction. We examined the sex-specific relationship between nocturnal hypoxia, as measured as T90% (time asleep with <90% oxygen saturation), and RV myocardial blood flow (MBF) and myocardial flow reserve (MFR).

Methods:
RV MBF and MFR were examined for 78 patients who had a cardiac PET stress test and a sleep test between 2015 to 2019. MBF was analyzed using FlowQuant software (Ottawa, Canada). MFR was defined as the ratio of stress to rest MBF. We categorized reduced RV MFR as < 2.3 (corresponding to the median value) and nocturnal hypoxia as T90 ≥ 8%.

Results:
The mean (± SD) age was 63 ± 10 years. Most patients (83%) were obese (BMI ≥ 30kg/m3). Fifty-one patients (63%) were female. Although not statistically significant, the median RV MFR was higher among females (2.4 vs. 2.2, p = 0.158). RV MFR was higher among those without nocturnal hypoxia compared to those with nocturnal hypoxia (2.4 vs. 2.0, p = 0.023). Among females, the median RV MFR was higher among those without significant nocturnal hypoxia (2.5 vs. 1.8, p = 0.004), while males showed no relationship (2.2 vs. 2.2, p = 0.696; see table for details). In age and BMI adjusted logistic regression analysis, patients with nocturnal hypoxia were 3X as likely to have reduced RV MFR (OR = 3.2, 95% CI: 1.1 - 9.3) and there was a significant statistical interaction by sex (p = 0.046).

Conclusions:
These findings suggest that nocturnal hypoxia is associated with a reduction in RV MFR, more prominently among females. Future studies should focus on elucidating the pathophysiologic implications of our findings and understanding the biologic processes that account for the sex differences observed.
Abstract 15640: Long Term Event-Free Survival in Patients With Ischemic and Non-Ischemic Cardiomyopathy up to Thirteen Years Following Cell-Based Therapy: Results From the Hyperion Observational Cohort
Authors: Saltzman Russell G , Sundin Andrew , caceres lina V , Tovar Jairo A , Garzon Ana Maria , Cabreja-Castillo Maria , Jayaweera Dushyantha , Khan Aisha , Schulman Ivonne H , Mitrani Raul D , Hare Joshua M
Published: December 2023

Introduction:
The long-term clinical outcomes of cell-based therapies to treat ischemic (ICM) and non-ischemic dilated cardiomyopathy (NIDCM) are unknown. We therefore prospectively followed patients (pts) with ICM/NICDM treated by targeted transcatheter endocardial mesenchymal stromal cell (MSC) injections (TESI).

Methods:
Of the 155 pts enrolled in prior MSC TESI studies, 111 were eligible to be contacted. Of these, 47 (42%) agreed to participate and have periodic follow-up assessments (Cardiac MRI/CT, 6MWT, labs, PE, EKG, and MLHFq) for up to 13 years following their index procedure. Time-to-event information was captured from all 155 former participants. Endpoints included event-free survival, changes in left ventricular ejection fraction (EF), and ventricular remodeling. Clinical endpoint events were defined as the composite of: Death (all-cause mortality), Left Ventricular Assist Device (LVAD) placement, or Heart Transplant. Descriptive statistics were used to classify the sample, and Kaplan-Meier survival analysis was generated to examine time-to-event trends.

Results:
There were 134 men and 21 women, mean age 60.0±11.0 years, including 121 (78%) with ICM, and 34 (22%) with NIDCM. In pts with ICM, mean EF at baseline was 31 %±10.8% and after 1 year was 32.6%±11.8% (P=0.08). In pts with NIDCM baseline EF was 27%±10% and increased to 34%±13% after 1 year (P=0.002). Overall, 40% of pts had a decrease in LVEF, 26% had <5% increase, 34% had a ≥5% increase, and 17% had a ≥10% increase in LVEF after 1 year. Increases of ≥5% LVEF post-therapy were associated with longer event-free survival in NIDCM (OR: 2.57; 95% CI: 0.6, 11.1) but not ICM (OR: 1.25; 95% CI: 0.4, 3.6). Conversely, reductions in LVEDV were associated with longer event-free survival in ICM (OR: 7.23; 95% CI: 1.9, 27.1) but not NIDCM (OR: 1.88; 95% CI: 0.4, 10.0).

Conclusion:
In this long-term observational cohort analysis, improvement of EF and/or reduction in LVEDV was associated with survival benefits among pts with NIDCM and ICM respectively. Future studies are needed with placebo controls to determine which pts are most likely to respond to MSC therapy.

Clinical Trial Registration:
URL: http://www.clinicaltrials.gov.; Unique ID: NCT03071835.
Abstract 15644: A Systematic Review and Meta-Analysis Exploring Impact of Beta-Blocker Therapy on Long Term Mortality in Takotsubo Cardiomyopathy
Authors: Ahsan Muhammad Junaid , Ahmad Soban , Yousaf Amman , Dvalishvili Mariam , Khan Behram A , Ahsan Muhammad Z , Naeem Ammad , Qavi Ahmed H , Sigurdsson Gardar , Goldsweig Andrew M
Published: December 2023

Introduction:
Conflicting data exist regarding the effects of beta-blocker (BB) therapy on long-term survival in Takotsubo cardiomyopathy (TC). This study aims to address this gap by examining the potential impact of BB therapy on long-term mortality in patients with TC.

Methods:
We searched Pubmed (MEDLINE), Google Scholar, and EMBASE for relevant studies from inception to May 18
th
, 2023. We included observational studies reporting the impact of BB use on all-cause mortality during long-term follow-up in patients with TC. Hazard ratios (HRs) of all-cause mortality with their 95% confidence interval (CI) for beta-blocker use were extracted. Study-specific estimates were pooled using an inverse-variance, random-effects model.

Results:
We identified seven eligible studies enrolling 3,446 patients with TC with a mean follow-up duration of up to 5.8 years. The primary meta-analysis for long-term all-cause mortality combining all HRs showed significant long-term mortality reduction with BB use (HR=0.62; 95%CI [0.50-0.79], P<0.0001, I
2
=10%). Similarly, pooled analysis of adjusted HRs for long-term all-cause mortality demonstrated improved survival with BB therapy (HR=0.61; 95%CI [0.43-0.88], P=0.008, I
2
=33%) (Figure 1).

Conclusions:
Observational data suggest that the use of BB therapy is associated with a significant improvement in long-term survival in patients with TC. Randomized control trials should be performed to evaluate this effect further.
Abstract 15680: Serum High-Sensitivity C-reactive Protein Levels Throughout Early Adulthood and Subclinical Atherosclerosis in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Ramesh Ashvita , Ning Hongyan , Allen Norrina B , Harty Mary J , Lloyd-Jones Donald M
Published: December 2023

Introduction:
Single measures of high sensitivity C-reactive protein (hs-CRP) have been associated with atherosclerosis. However, trajectories of hs-CRP through young adulthood and their associations with mid-life coronary artery calcification (CAC) are poorly characterized.

Methods:
We examined longitudinal data from 4681 participants in the CARDIA study, including men and women aged 18-30 years at baseline followed for 25 years. We included participants with >3 hs-CRP measurements and a CAC score measured at year 25. We also examined cardiovascular (CV) risk factor trajectories through young adulthood in parallel with hs-CRP. Multivariable logistic regression models were used to assess association between hs-CRP trajectories and CAC >0 status at year 25.

Results:
We identified 5 discrete trajectories in hs-CRP from young adulthood to middle age according to measured hs-CRP levels and time course: low-stable (56%, n=1364), low-early rise (18%, n=432), low-late rise (7%, n=155), elevated-stable (6%, n=136), and elevated-decline (13%, n=308) (Figure 1). Compared with the low-stable group, trajectories with early, but not later elevations of hs-CRP levels had significantly higher odds of CAC score > 0 at year 25. Odds ratios (OR; adjusted for age, sex, race and education) were 1.71 (95% CI, 1.11-2.64) for the elevated-stable group and 1.98 (1.49-2.65) for elevated-decline group. After adjustment for all CV risk factors, only the elevated-decline group retained significance (OR 1.46, 1.06-2.02). Trajectories of CV risk factors, especially BMI, through young adulthood were highly correlated with hs-CRP trajectories, and attenuated associations of hs-CRP with CAC.

Conclusions:
Trajectories with early elevations in hs-CRP in young adulthood are associated with mid-life CAC. CV risk factor trajectories correlate with hs-CRP over time, suggesting that hs-CRP trajectory may integrate data from other risk factors and provide information about CAC risk.
Abstract 15757: Racial Disparities in Acute Respiratory Failure Incidence During Hypertensive Emergencies
Authors: Seok Minji , Muhyieddeen Amer , Gulati Martha
Published: December 2023

Introduction:
One of the most frequent complications of hypertensive emergency is pulmonary edema, which can ultimately lead to requiring mechanical ventilation because of respiratory failure. Additionally, epidemiologic studies have observed that certain races are disproportionately affected by hypertensive emergency. This analysis aimed to assess if race was also associated with increased likelihood of requiring mechanical ventilation during hypertensive emergencies.

Methods:
Using the 2020 National Inpatient Sample data, we identified patients admitted due to hypertensive emergencies. We excluded admissions for primary acute hypoxic respiratory failure necessitating invasive mechanical ventilation. To explore potential relationships, we employed logistic and linear regression analyses, accounting for potential confounders. We deemed the results as statistically significant when the 2-tailed p-value was <0.05.

Results:
In 2020, among 1,221,535 hypertensive emergency hospital admissions, 124,200 (10.2%) involved patients needing mechanical ventilation due to respiratory failure. After adjusting for factors such as age, gender, hospital attributes, insurance, income, and Elixhauser comorbidities, Black and Asian/Pacific Islander patients exhibited higher likelihoods of requiring mechanical ventilation due to respiratory failure. Compared to White patients, the adjusted odds ratios were 1.06 (95% CI 1.05-1.12) for Black patients and 1.18 (95% CI 1.06-1.32) for Asian/Pacific Islander patients.

Conclusions:
We have demonstrated that there are racial disparities associated with development of acute hypoxic respiratory failure in the setting of hypertensive emergencies. Further research needs to be undertaken to identify if these racial differences are due to differences in blood pressure control or if clinical management differs by race in the acute hospitalization contributing to adverse outcomes.
Abstract 15808: Sodium Glucose Co-Transporter-2 Inhibitors and Clinical Outcomes in Cancer Patients Treated With Anthracyclines
Authors: Fath Ayman R , Aglan Mostafa , Aglan Amro , Kabbani Mahmoud , Eldaly Abdullah , Trakhtenbroit Anatole , Otchere Prince
Published: December 2023

Background:
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been proven to improve clinical outcomes in heart failure (HF). However, there remains a paucity of data on the potential cardioprotective impact of SGLT2i in cancer patients receiving anthracyclines.

Aim:
To evaluate if SGLT2i use is associated with improved outcomes in anthracycline-treated cancer patients.

Methods:
Using TriNetX Global Research Network from 2013 to 2021, patients diagnosed with cancer and receiving anthracycline therapy were identified and categorized into those who were taking SGLT2i versus those who were not. A 1:1 propensity score matching was used to control for baseline characteristics between the two groups. Patients were followed for 2 years. The primary endpoint was all-cause mortality and secondary endpoints were new-onset HF, acute HF exacerbation, myocardial infarction, new-onset atrial fibrillation/flutter, and all-cause hospitalization.

Results:
A total of 82,369 anthracycline-treated cancer patients were identified. After propensity score matching application, 1,412 patients were included in our analysis (706 patients in each group). Patients on SGLT2i had lower rates of all-cause mortality (OR: 0.7 [95% CI: 0.56, 0.88]; P=0.002), acute HF exacerbation (OR: 0.64 [95% CI: 0.41-1]; P=0.048), and new-onset atrial fibrillation/flutter (OR: 0.52 [95% CI: 0.33, 0.8]; P=0.003) compared to those not on SGLT2i. The incidence of myocardial infarction, new-onset HF, and all-cause hospitalization were similar between the two groups (Figure).

Conclusion:
Among cancer patients receiving anthracyclines, SGLT2i were associated with lower rates of mortality, acute HF exacerbations, and new-onset atrial fibrillation/flutter and similar rates of myocardial infarction, new-onset HF, and hospitalization.
Abstract 15845: Unraveling Postoperative Atrial Fibrillation at the Single-Cell Level
Authors: Tiwari Sameeksha , DeLaughter Daniel , Yazdani Azam , Gorham Joshua , Aranki Sary , pesce Lorenzo , Seidman Christine E , Seidman Jonathan G , Stranger Barbara , Muehlschlegel Danny J
Published: December 2023

Background:
Postoperative atrial fibrillation (poAF) is one of the most common complications after cardiac surgery. It increases the length of stay in the ICU and hospital, increases the risk of stroke, and leads to death. Several clinical factors, including age, obesity, and co-occurring conditions such as prior atrial fibrillation, hypertension, kidney disease, etc., are associated with poAF. We hypothesize that the atrial transcriptome differs between patients who remain in sinus rhythm following surgery and those who develop poAF, allowing the identification of genes, pathways, and cell types necessary for the understanding and treatment of poAF.

Methods:
Single-cell RNA sequencing (scRNA-seq) was performed to gain insights into the heterogeneous cell populations of the left atrium. It provided an in-depth view of the variability in the cellular response to poAF through the molecular changes within cells, allowing for identifying biomarkers and therapeutic targets. Changes in gene expression associated with poAF were modeled, including batch, sex, age, atrial size, and history of atrial fibrillation and covariates.

Results:
sc-RNA-seq data of thirty-one human left atrium samples were analyzed. The samples included 14 females and 17 males aged 35-86 years. Cell clusters were identified after the quality check, preprocessing, and normalization. Nine distinct cell types were identified, including atrial cardiomyocytes, fibroblasts, endothelial cells, smooth muscle cells, adipocytes, pericytes, myeloid, lymphoid, and neuronal cells. The atrial cardiomyocytes and fibroblasts were the most abundant identified cell types. The enrichment of these cell types and significant changes in many marker genes in the disease condition suggest their crucial role in their response to the disease.

Conclusion:
The comprehensive analysis revealed distinct gene expression patterns and cellular heterogeneity. It provided valuable insights into the cellular landscape and transcriptional alterations in poAF. By shedding light on the molecular mechanisms, the findings pave the way for developing targeted interventions to mitigate the impact of poAF.
Abstract 15854: Pulmonary Arterial Waveform Analysis and Supervised Machine Learning Predicts Outcomes in Heart Failure: An Analysis of the CHAMPION Trial
Authors: Kearney Katherine , Padayachee Alexander , Adji Audrey , Lau Edmund , Hayward Christopher S
Published: December 2023

Introduction:
Pulmonary artery (PA) pressure monitors have been shown to prevent hospitalizations in heart failure patients using mean pressure values. PA waveform analysis offers an overall assessment of right ventricular load that combines resistance and compliance.

Hypothesis:
We hypothesised that clinical outcomes can be predicted from PA waveform analyses from patients with an implanted PA monitor.

Methods:
The CHAMPION trial database was analysed. Information about the demographics and data collection methods for this cohort have been published previously. All waveforms were analysed automatically using Python. Tau or RC time, respiratory rate, respiratory range, P asymptote, mean pulmonary arterial pressure (mPAP), diastolic pulmonary arterial pressure (dPAP) and systolic pulmonary arterial pressure (sPAP) were derived from the raw waveforms. Tau and P asymptote were calculated using phase plane analysis. Outcomes of hospitalization or mortality were adjudicated as part of the original trial. Statistics were performed in R. A decision tree statistical approach using the XGBoost algorithm was used. Contribution to the model was assessed using Shapley Additive Explanations (SHAP) values. The dataset was split into 70% train and 30% test sets.

Results:
296,948 PA pressure traces from 547 patients were analysed. 3 patients had insufficient quality of trace to analyse. There were 1340 outcome events throughout the follow up period, median 664 days.

The trained algorithm was able to predict clinical outcomes in the test dataset with 100% accuracy. The most significant contributors according the mean SHAP value were RC time (SHAP = 1.1), respiratory range (SHAP = 1.1) and heart rate (SHAP = 1.1).

Conclusions:
Detailed analysis of the PA waveform from PA pressure monitors is feasible and yields clinically relevant information. A supervised machine learning algorithm trained on this data can accurately predict hospitalization or mortality events in heart failure patients.
Abstract 15941: Efficacy of Frozen Elephant Trunk for Acute Type A Aortic Dissection
Authors: Tsumaru Shinichi , Shimamoto Takeshi
Published: December 2023

Objectives:
There are various treatment strategies for acute type A aortic dissection (ATAAD). In our department, total arch replacement (TAR) using the Frozen Elephant Trunk (FET) is the standard technique for DeBakey type I, which has a patent false lumen, and we assessed the outcomes and postoperative complications.

Methods:
Of 71 consecutive patients who underwent surgical treatment for ATAAD at our department from October 2020 to May 2023, 42 patients were included, excluding 29 patients whose the descending aorta was thrombosed or not dissected.

Results:
Age 64±11 years, 30 male patients (71.4%). Preoperatively, cardiac tamponade was observed in 5 cases, malperfusion in 5 cases of head, 2 cases of coronary artery, 3 cases of celiac artery, 3 cases of superior mesenteric artery, 13 cases of renal artery, and 13 cases of lower limbs. The surgical procedures were ascending aortic replacement (AAR) in 6 cases (14.2%), partial arch replacement (PAR) in 2 cases (4.8%), TAR in 5 cases (11.9%), and TAR with FET in 29 cases (69.0%). The mean operation time was 304±70 minutes, the mean cardiopulmonary bypass time 168±45 minutes, the mean cardiac arrest time 100±26 minutes, the mean circulatory arrest time 42±8 minutes, and the mean minimum bladder temperature 26.1±1.4°C. There was no hospital death, and complications included new stroke in 2 patients (4.8%). The residual dissection was AAR5/6 (83.3%), PAR1/2 (50.0%), TAR5/5 (100%), and TAR with FET24/29 (82.8%), of which AAR5/5 (100%), PAR1/1 (100%), TAR2/5 (40.0%), and TAR with FET1/24 (4.2%) had residual dissection in the proximal descending aorta. There were 3 deaths (meningitis, cerebral hemorrhage, gastrointestinal hemorrhage) with a mean follow-up of 8.9±6.7 months. The only additional treatment was preemptive TEVAR in 1 case (2.4%) for residual dissection of proximal descending aorta of TAR with FET. There was no case of stent induced new entry.

Conclusions:
We consider the early results for ATAAD to be favorable. Furthermore, TAR with FET promotes good thrombosis and remodeling down to the proximal descending level, suggesting that FET may contribute to improved outcomes during follow-up period. Further clinical research on mid-term outcomes is needed.