bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147019:
Role of Fractional Excretion of Uric Acid as a Predictor of Cardio-renal Syndrome in Acute Decompensated Heart Failure Patients: An Observational Study
Authors: Kunal Shekhar , Shah Bhushan , kathuria sanjeev , KUMAR SUNIL
Published: November 2024

Cardio-renal syndrome (CRS) is a growing health, economical, and societal problem.The diagnosis and treatment of patients with acute decompensated heart failure (ADHF) especially complicated with CRS are challenging and hence, we aimed to determine the prevalence of CRS in ADHF patients and also determine the role of fractional excretion of uric acid (FeUa) in prediction of CRS in patients with ADHF.

Methods:
In this hospital-based, observational study, a total of sixty-five patients with ADHF and who met the inclusion criteria were recruited and their demographic details were recorded. Blood samples were collected, and various laboratory parameters were measured at day-1, day-3, and day-7. The fractional excretion of sodium (FeNa) and FeUa were calculated.

Results:
The mean age of participants was 52.32 ± 14.04 years, and 67.69 % were males. The prevalence of CRS in ADHF patients was noted to be 18.46 %. At baseline, the B-type natriuretic peptide (BNP) level for the enrolled patients was observed to be 8690.06 ± 6181.32 pg/ml. The serum creatinine and serum uric acid elevated as the day of hospitalization increased, and the maximum was observed at day-7 i.e., 1.35 ± 0.54 mg/ml and 11.08 ± 15.83 mg/ml, respectively. Declining trend in the FeNa (%) was noted, and the values at day-1, at day-3, and at day-7 were 1.25 ± 1.18, 1.01 ± 1.08, and 0.80 ± 0.79, respectively. The FeUa (%) value increased at day-3 from 5.60 ± 7.47 to 6.95 ± 7.43. However, decrease FeUa value was observed at day-7 (5.78 ± 5.63 %). On receiver operative curve analysis, FeUa served to be a negative predictor of CRS in ADHF patients with an area under the curve of 0.489.

Conclusion:
The FeUa seems to be a negative predictor of CRS in patients hospitalized with ADHF. However, multi-parametric techniques and biomarkers which are available for investigating cardiovascular diseases and kidney diseases may offer opportunities for the evaluation of CRS.
Abstract 4147026: Predicting coronary artery disease using an exome-based estimate of KIV-2 repeat count in the Lp(a) gene
Authors: Telis Natalie , Dai Hang , Wyman Dana , White Simon , Khuder Basil , Tanudjaja Francisco , Washington Nicole , Lee William , Cirulli Elizabeth , Luo Shishi
Published: November 2024

Introduction:
Lipoprotein a (Lp(a)) levels are an often unmeasured predictor of future risk of cardiovascular disease. Unlike LDL, HDL, and triglycerides, Lp(a) levels are believed to be genetically determined; they are not altered by lipid-lowering medications or dietary changes, and are consistent over a lifetime, making them a potential early-life predictor of adult morbidity. However, genetic predictors of Lp(a) are challenging to design. Repeats of the kringle IV subtype 2 domain (KIV-2) contribute significantly but are extremely challenging to quantify via next-generation sequencing; this variability is particularly impactful in non-European ancestries.

Methods:
We analyzed ~110K individuals with paired clinical and exome sequencing data from six medical centers. We developed a coverage-based method to determine KIV-2 repeat counts. We validated that these counts associated with clinical Lp(a) measurements derived from the course of care (n = 2039 individuals). We calculated an expected Lp(a) in units of nmol/L using a genetic risk score (GRS) based on 43 variants in the Lp(a) gene. We identified instances of CAD via ICD9CM, ICD10CM and SNOMED terms present in the medical record.

Results:
Adding the number of KIV-2 repeats to the GRS substantially improved prediction of clinical Lp(a) measurements, for example improving the r-squared for non-Europeans five-fold (from 0.05 to 0.22). Individuals with fewer than 15 estimated KIV-2 repeats and a high GRS-predicted Lp(a) (high risk group) have a mean measured Lp(a) of that is 10-fold that of those in the lowest category of GRS-predicted Lp(a) (low risk group). In the full cohort, most of whom had not been measured for Lp(a), we find that relative to the low risk group, the high risk individuals are 1.6x more likely to have CAD.

Conclusion:
Lp(a) is a potentially useful biomarker with consistency over a lifetime and implications for future cardiovascular morbidity. We developed a method for estimating the number of KIV-2 repeats, a challenging component of genetic prediction of Lp(a). This estimate can be used in combination with a GRS to predict Lp(a), especially in individuals with non-European ancestry where GRS-based estimates fall short. The final prediction is associated with increased risk of CAD.
Abstract 4147064: Retrospective study shows pharmacogenomic testing could reduce adverse events associated with clopidogrel use by 38%
Authors: Washington Nicole , Telis Natalie , Judge Daniel , Pawloski Pamala , Grzymski Joseph , Chahal Anwar , Hajek Catherine , Kruisselbrink Teresa , Cirulli Elizabeth
Published: November 2024

Introduction:
In recent years, genetic interactions with drugs have been demonstrated to alter drug metabolism. Efforts such as PharmGKB and the Clinical Pharmacogenomics Implementation Consortium (CPIC) have developed recommendations to alter the use of several commonly prescribed drugs based on patient genotype. However, most prescriptions are still given without pharmacogenomic testing.

Objective:
Demonstrate the real world implications of the use of pharmacogenomic testing through a retrospective study of clopidogrel prescriptions given without testing.

Methods:
We analyzed ~100K individuals with paired medical records and clinical grade exome sequencing data, from population health studies administered at multiple medical centers. We genotyped all individuals for CYP2C19 star alleles. We identified daily dosage of clopidogrel by processing the freetext prescription “sig” field with GPT-4. Then, we identified all instances of individuals with at least one prescription that is not in concordance with the CPIC clopidogrel use guidelines based on their CYP2C19 genotype (Bousman et al. 2023). We identified instances of thrombosis using a comprehensive codeset based on the medical records.

Results:
25% of individuals with a calculable daily dose of clopidogrel have a mismatch between the recommended clopidogrel dosage guideline based on their CYP2C19 genotype and their prescribed dose. 12% of these mismatched individuals are poor metabolizers (PM), who should not use clopidogrel at all. The remaining 88% are intermediate metabolizers (IM). PMs and IMs receiving clopidogrel are much more likely to experience thrombosis than other metabolizers. 25% of PMs experienced thrombosis after the initiation of clopidogrel, with 40% of these occurring in the first two months (vs normal metabolizers, binomial p-value = 0.001).

Conclusions:
As expected from a lack of testing and a high population frequency of pharmacogenomic variants, many patients are prescribed doses of clopidogrel that are too high given their subsequently derived pharmacogenomic information. There is at least a 38% excess of adverse events (as measured by thrombosis) in this group. At minimum, this testing could prevent 1 thrombosis event per every ~30 people prescribed clopidogrel, demonstrating tangible benefits of population-based pharmacogenomic testing.
Abstract 4147103: Role Of Inflammation in Coronary Microvascular Function in Acute Coronary Syndromes
Authors: Gabaldon Badiola Alvaro , Fernandez Ana I , Gutierrez Enrique , Sanz Ricardo , Martin de Miguel Irene , Fernandez Aviles Francisco , Fernandez-Castillo Marta , Elizaga Jaime , Correa Rafael , Bermejo Javier
Published: November 2024

Introduction:
CD4+ Th cells and related cytokines play a predominant role in the proinflammatory response in acute coronary syndrome (ACS). However, there is limited information on the relationship between inflammation and coronary microvascular dysfunction in ACS.

Hypothesis:
There is an interplay between inflammation and coronary microvascular disfunction in ACS.

Methods:
Coronary flow reserve as measured by Doppler flow velocity in response to adenosine (CFR) and in response to acetylcholine (endothelial CFR) was assessed in non-culprit arteries in patients with ACS. Correlation analyses with Th cell populations and plasma-related cytokines were performed.

Results:
A total of 26 patients diagnosed with ACS were studied (NCT03434483), with a median age of 55 years (IQR 19.8), and 96.2% were male. At presentation, 19.2% of patients had unstable angina, 42.3% had NSTEMI, and 38.5% had STEMI. There was a negative correlation between CFR (Figure 1) and Th1 cells (R -0.39, p = 0.047) and positive with IL-4 (R 0.5, p = 0.021). When analysing endothelial CFR (Figure 2), there was a positive correlation with Th17 cells (R 0.59, p = 0.016), Th1/Th17 cells (R 0.59, p = 0.015), MMP1 (R 0.6, p = 0.041), CCL2 (R 0.64, p = 0.024) and LTA (R 0.65, p = 0.022) cytokines and negative with CSF3 (R -0.61, p = 0.035).

Conclusions:
The study highlights the complex interactions between inflammation and coronary microvascular function in the setting of ACS. CFR seems to improve with lower levels of inflammation, but correlations with Th17 and Th1/Th17 seem to indicate the opposite in regards to endothelial CFR. The correlations with MMPs should be further explored as they are known to be directly involved in endothelial function.
Abstract 4147106: Maternal Nativity and Adverse Pregnancy Outcomes Stratified by Maternal Race/Ethnicity: Insights from the National Vital Statistics System
Authors: Mehta Adhya , Satti Danish Iltaf , Boyer Theresa , Yanek Lisa , Kwapong Yaa , Bhansali Rebekah , Hays Allison , Minhas Anum
Published: November 2024

Background:
Adverse pregnancy outcomes (APOs) are a major cause of maternal morbidity and mortality, with significant variations in APOs prevalence among racial and ethnic groups. The US has rising immigration rates. Currently, studies with national representation are limited to detect the association of nativity with APOs.

Objective:
To determine the association between maternal nativity and APOs across maternal race and ethnicity groups in the US.

Methods:
We conducted a nationwide, cross-sectional study using data from the National Vital Statistics System natality files, encompassing all live births in the US from 2016 to 2022 among individuals aged 15 - 44 years. Maternal nativity was classified as non–US-born vs US-born. The outcomes of interest (APOs) included gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and pre-term birth (PTB). Multivariable logistic regression was used to determine the association between maternal nativity and APOs, stratified by race and ethnicity, including Asian, Black, Hispanic, White, or other (individuals who selected other race or more than one race).

Results:
24,366,281 birthing individuals were included. Non-US-born individuals had lower prevalence odds ratio of HDP (adjusted prevalence odds ratio (aPOR) 0.689 [95% CI 0.686-0.692]) and PTB (aPOR 0.922 [95% CI 0.919-0.925]) compared to US-born individuals, which was consistent across the majority of race and ethnicity groups (
Figure 1, 2 &3
). However, non-US-born individuals experienced significantly higher POR for GDM (aPOR 1.70 [95% CI 1.69-1.70]) (
Figure 1, 2 &3
).

Conclusions:
Individuals born outside the US have higher odds of GDM, but lower odds for HDP and PTB. Findings suggest that APO risk may be environmentally influenced beyond genetic ancestry, with different risk factors geographically across the world.
Abstract 4147113: Temporal Trends in Transcatheter Aortic Valve Implantation Outcomes: A Six-Year Analysis from the National Inpatient Sample (2016-2021)
Authors: Agrawal Siddharth , Patel Yug , Raval Maharshi , Sanghvi Labdhi , Siddiq Sajid
Published: November 2024

Background:
Transcatheter Aortic Valve Implantation (TAVI) is a rapidly evolving procedure with significant implications for patient outcomes. Understanding trends in TAVI outcomes over time can help identify areas for improvement and guide clinical practice. This study aims to analyze trends in mortality, procedural complications, length of stay (LOS), and total charges for TAVI patients from 2016 to 2021.

Methods:
We performed a trend analysis of TAVI procedures using data from the National Inpatient Sample (NIS) from 2016 to 2021. Outcomes assessed included in-hospital mortality, transfusion rates, permanent pacemaker (PPM) insertion, postprocedure shock, prosthetic valve dysfunction, intraprocedure stroke, LOS, and total hospital charges. The P-trend test was used to determine statistical significance over the six-year period.

Results:
A total of TAVI procedures were analyzed from 2016 to 2021. In-hospital mortality decreased significantly from 1.76% in 2016 to 1.06% in 2021 (P-trend <0.001). Transfusion rates declined from 7.60% in 2016 to 3.90% in 2021 (P-trend <0.001). The incidence of PPM insertion dropped from 8.59% in 2016 to 5.50% in 2021 (P-trend <0.001). Postprocedure shock rates decreased from 2.71% in 2016 to 2.00% in 2021 (P-trend = 0.007). Prosthetic valve dysfunction rates declined from 1.81% in 2016 to 1.27% in 2021 (P-trend = 0.012). Intraprocedure stroke rates showed a non-significant downward trend, decreasing from 2.20% in 2016 to 1.82% in 2021 (P-trend = 0.168). Mean LOS for TAVI patients decreased significantly from 5.077 days in 2016 to 3.21 days in 2021 (P-trend <0.001). Total hospital charges showed a significant downward trend from $261,883 in 2016 to $225,805 in 2021 (P-trend <0.001).

Conclusions:
The analysis of TAVI outcomes from 2016 to 2021 demonstrates significant improvements in several key areas, including reductions in in-hospital mortality, transfusion rates, PPM insertion, postprocedure shock, prosthetic valve dysfunction, LOS, and total hospital charges. These findings highlight advancements in TAVI technology and procedural techniques over time. Continued monitoring of TAVI outcomes is essential to maintain and enhance the quality of care for patients undergoing this procedure.
Abstract 4147132: Impact of Cannabis Use Disorder on Major Adverse Cardiovascular Events in Hospitalized Young Female Patients with Established Cardiovascular Disease Risk: A Nationwide Analysis from 2016-2020
Authors: Krishnakumar Manaswini , Pinnamaneni Monitha , Amin Juhi , Mody Shefali , Mellacheruvu Sai Priyanka , Sawhney Aanchal , Desai Rupak
Published: November 2024

Introduction:
Cannabis use disorder (CUD) has been associated with major adverse cardiac events (MACE). Additionally, preexisting cardiovascular disease (CVD) poses a major threat to young female patients, but the impact of CUD on MACE remains largely unexplored.

Methodology:
A retrospective cohort study was undertaken, utilizing data from the National Inpatient Sample dataset spanning from 2016 to 2020. Female patients aged 18-45 years with CVD risk factors (Hypertension, Diabetes Mellitus, Hyperlipidemia, Obesity) were divided into two groups: those with cannabis use disorder (CUD+) and those without (CUD-). Demographic characteristics, comorbidities, and MACE (myocardial infarction (MI), atrial fibrillation (AF), venous thromboembolism (VTE), cardiac arrest (CA), stroke, and all-cause mortality) were explored. Multivariable regression analysis was performed for all the outcomes reported under MACE.

Results:
Of the 7,245,508 hospitalized young females with CVD risk factors, 3.5% had CUD. CUD+ group was younger (31 vs. 33 years), had more Black patients (37.2 vs. 25.1%) and were more likely to be using Medicaid (59.2 vs. 42.4%). Comorbidities such as complicated diabetes (19.6 vs 13%), smoking (29.4 vs 15.7%), chronic pulmonary disease (22.4 vs 15.2%), drug abuse (64.1 vs 3.7%), alcohol use (10.1 vs 1.8%), and cocaine use (9.2 vs 0.7%) had higher prevalence in CUD+ group (p<0.001). Higher prevalence of MI, CA, and stroke in the CUD+ group, and secondary outcomes showed lower cost of hospitalization, similar length of stay, and a higher number of patient transfers to intermediate care facilities. Multivariable analysis showed that CUD was associated with higher odds of stroke (aOR 1.20) and lower odds for VTE, CA and AF.

Conclusion:
Young female patients with CUD and established CVD risk factors present a unique clinical profile. While CUD seems to lower the odds of certain cardiovascular events, it significantly heightens the risk of stroke. This further increases the necessity for interventions and healthcare policies aimed at this specific population.
Abstract 4147138: Cardiovascular and Bleeding Outcomes of Proton-Pump Inhibitor and Clopidogrel Co-therapy after Percutaneous Intervention: A Meta-Analysis
Authors: Haider Mobeen , Hamza Mohammad , Singh Sahib , Mir junaid , Javed Nismat , Khalid Yousra , Sattar Yasar , Subramaniam Parameshwari Subanandhini , Sengodan Prasanna
Published: November 2024

Introduction:
Clinical studies have shown conflicting results regarding the effect of proton pump inhibitors (PPIs) on the antiplatelet action of clopidogrel in coronary artery disease (CAD) patients. We conducted a meta-analysis to evaluate cardiovascular, gastrointestinal, and mortality outcomes in 6 months of concurrent use of these medications.

Methods:
We searched PubMed and Embase, screened 1071 articles, and included seven articles meeting our inclusion criteria: randomized control trials comparing the PPI group to the control group (no PPI) in patients on clopidogrel with CAD for six months. The outcomes of interest were major adverse cardiovascular events (MACE), myocardial infarction (MI), heart failure (HF), arrhythmia, bleeding, all-cause death, and cardiovascular (CV) death. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. We assessed heterogeneity between studies and p-value was assigned to <0.05 for statistical significance.

Results:
Seven studies with a total of 5146 patients (PPI group: 2585, No-PPI: 2561). Our analysis shows that use of PPI with clopidogrel is associated with less bleeding outcomes (RR: 0.30, CI:0.19-0.49; p-value:<0.0001). Table 1. Our analysis showed no difference with regard to myocardial infarction (RR: 0.96; CI: 0.51-1.79, p-value:0.897), major cardiovascular events (RR: 0.99; CI: 0.74-1.32, p-value: 0.944), the onset of heart failure (RR: 0.78; CI: 0.27-2.25, p-value: 0.643), arrhythmias (RR: 0.86; CI: 0.30-2.43, p-value: 0.775), cardiovascular mortality (RR: 0.78; CI: 0.29-2.07, p-value: 0.623), and all-cause mortality (RR: 0.77; CI: 0.39-1.51, p-value: 0.451). Figure 1.

Conclusions:
In patients taking clopidogrel, proton pump inhibitors are associated with decreased bleeding outcomes. Our study showed no difference in terms of cardiovascular and mortality outcomes. Further randomized controlled trials are needed to evaluate these results.
Abstract 4147144: Evaluating a Team-Based Telemedicine Hypertension Management Program to Address Inequities in Hypertension Care Among Black Patients
Authors: Chhetri Sunit , Manandhar Srista , Kramer Justin , Bosworth Hayden , Moore Justin , Diamantidis Clarissa , Taylor Yhenneko , Pokharel Yashashwi
Published: November 2024

Background:
Although superior to clinic-based care, existing telemedicine programs to manage hypertension are less effective in Black patients. Programs’ insufficient support of Black patients’ self-care skills and social needs may hinder their effectiveness. We piloted a 12-week, team-based telemedicine intervention by pharmacists, nurses, community health workers (CHW), and social workers (SW) emphasizing frequent and tailored self-care support and social support.

Methods:
We conducted semi-structured interviews with Black patients with hypertension (N=15) and clinic key players (N=16; 5 providers, 1 pharmacist, 4 nurses, 1 nurse manager, 1 administrative manager, 2 CHWs, 2 SWs) from two clinics in North Carolina to evaluate the program’s potential at improving hypertension care among Black patients. The Exploration, Preparation, Implementation, and Sustainment and Health Equity Implementation frameworks guided the interview. We used inductive and deductive coding strategies to identify emergent themes during the thematic analysis. We considered equity-related constructs about culture, social context, medical mistrust, health literacy, and clinic and health system-related factors and comfort using technology for healthcare.

Results:
At baseline, 12 (80%) patients felt comfortable using technology for healthcare, while 3 (20%) felt somewhat uncomfortable. Eight patients (53.3%) reported feeling confident filling out medical forms, while 7 (46.7%) noted being sometimes or occasionally confident. Medical mistrust score was 2.47 ± 0.62 (range 1-4; higher score, more mistrust with providers and health care system). Five health equity-related themes emerged from the interviews. Both patients and key players expressed (1) satisfaction with program-related clinical encounters and felt that the program (2) may improve trust, (3) is likely to treat Black patients fairly, (4) emphasizes the importance of patient-provider racial concordance, and (5) addresses social needs extending beyond housing (Table).

Conclusion:
Our team-based telemedicine program may improve equity for hypertension care among Black patients. If shown to be clinically effective, our program has the potential to improve hypertension control in this population.
Abstract 4147145: Short Dual Antiplatelet Therapy Followed by P2Y12 Inhibitor Monotherapy versus 1-Year Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials
Authors: Joseph Meghna , Murali Krishna Mrinal , Ezenna Chidubem , Pereira Vinicius , Jenil Franco Ancy , Goldsweig Andrew
Published: November 2024

Introduction:
Current guidelines recommend dual antiplatelet therapy (DAPT) for 6 months for stable ischemic heart disease and 12 months for acute coronary syndrome following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. However, long-term DAPT is associated with increased bleeding risk.

Objective:
To compare short DAPT (≤3 months) followed by P2Y12 inhibitor (P2Y12i) monotherapy until 12 months vs. standard DAPT for 12 months in patients undergoing PCI with DES.

Methods:
We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing short DAPT followed by P2Y12i monotherapy vs. 12-month DAPT following PCI. The co-primary outcomes were composite major adverse cardiovascular/cerebrovascular events (MACCE) and net adverse clinical events (NACE; MACCE + bleeding events) at 12 months post-PCI. Secondary outcomes were major and any bleeding, myocardial infarction (MI), stroke, stent thrombosis, all-cause and cardiovascular mortality, and target vessel revascularization (TVR) at 12 months post-PCI.

Results:
The systematic review identified 8 randomized controlled trials including 39,782 patients (short DAPT n=19,877, 49.96%). MACCE (RR 0.88; 95%CI 0.78-0.98; p=0.023; I
2
=0%) and NACE (RR 0.75; 95%CI 0.65-0.86; p<0.001; I
2
=56%) at 12 months were significantly lower with short DAPT than 12-month DAPT. Major (RR 0.52; 95%CI 0.37-0.72; p<0.001; I
2
=63%) and any bleeding (RR 0.55; 95%CI 0.42-0.73; p<0.001; I
2
=80%) were also significantly lower with short DAPT. MI, stroke, stent thrombosis, all-cause and cardiovascular mortality, and TVR at 12 months did not differ significantly between short and 12-month DAPT.

Conclusion:
Short DAPT for ≤3 months followed by P2Y12i monotherapy after PCI with DES was associated with decreased MACCE, NACE, and bleeding without differences in other outcomes. Short DAPT should be considered for high-bleeding risk patients.
Abstract 4147150:

Geographic, Gender,&Racial Trends in Mortality Due to Coronary Artery Disease in Hypertensive Adults Aged 25 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis
Authors: Naveed Muhammad Abdullah , Ali Ahila , Neppala Sivaram , Omer Rehan Muhammad , KASHAN MUHAMMAD , Azeem Bazil , Iqbal Rabia , Ansari Huzaifa , Chigurupati Himaja Dutt , Paul Timir
Published: November 2024

Background:
Coronary artery disease (CAD) in patients with hypertension is a significant health concern among adults in the United States. This study investigates trends and demographic disparities in mortality rates due to CAD in hypertensive patients aged 25 and older from 1999 to 2020.

Methods:
The CDC WONDER database's mortality data from 1999 to 2020 was used for a retrospective analysis. Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) were used to evaluate trends and calculate age-adjusted mortality rates (AAMRs) per 100,000 people. The year, sex, race/ethnicity, and geographic regions were used to stratify the data.

Results:
Between 1999 and 2020, CAD in hypertension caused 1,512,89 medical facilities, accounting for 37.9% of all deaths. With an AAPC of 1.88 (95% CI: -0.81 to 4.36, p = 0.118), the overall AAMR grew from 7.7 in 1999 to 36.0 in 2020. There was a notable increase between 1999 and 2001 (APC: 30.07, p = 0.040) and a minor growth between 2001 and 2020 (APC: 0.85, p = 0.030). Adult men had higher AAMRs than women (men: 40.2; women: 25.2), with increases for both sexes [Men: AAPC: 4.75, p = 0.002; Women: AAPC: 2.70, p = 0.058]. AAMRs varied significantly by race, highest among Black individuals (39.9), followed by Whites (31.4), American Indians (30.4), Hispanics (27.7), and Asians (21.3). The AAMR increased for all races from 1999 to 2020, most notably in American Indians (AAPC: 4.91, p = 0.004). AAMRs varied by state, from 16.4 in Utah to 51.4 in West Virginia. The Midwest had the greatest regional death rate (33.6), followed by the West (31.1), Northeast (31.0), and South (30.9). Nonmetropolitan areas had higher AAMRs than metropolitan areas (34.7 vs. 31.0), with a greater increase in nonmetropolitan areas (AAPC: 6.22, p < 0.000001).

Conclusion:
This analysis reveals significant demographic and geographic disparities in mortality rates due to CAD in hypertensive adults in the U.S. The AAMR has increased fivefold over the past two decades, particularly among certain racial groups and geographical regions. These findings underscore the urgent need for targeted interventions and equitable healthcare access to mitigate these disparities and improve outcomes.
Abstract 4147172: Targeting Percent Impedance Drop May Improve Atrial Fibrillation Ablation Success
Authors: Adewumi Joseph , Cerbin Lucasz , Murphy Rachel , Sabzwari Syed Rafay Ali , Varela Daniel , Saqi Bilal , Ashur Carmel , Grubb Alex , Padalia Kishan , Barrett Christopher , Von Alvensleben Johannes , Tumolo Alexis , Garg Lohit , Aleong Ryan , Rosenberg Michael , Varosy Paul , Tzou Wendy , Zipse Matthew , Sandhu Amneet
Published: November 2024

Background:
Contemporary power-modulated radiofrequency (RF) ablation prioritizes power, force and time as variables impacting lesion formation. Targeting specific impedance values remains less well defined but may be important due its effect on current delivery.

Objective:
To characterize 1) baseline unipolar RF impedances at PV ostia, and 2) the impact of baseline impedance (BI) and impedance change on procedure success.

Methods:
We reviewed one hundred and seventy-five consecutive patients with paroxysmal or persistent atrial fibrillation (AF) undergoing first time RF ablation at our institution between 2020-2021, to accommodate at least one year of follow-up. Two Megadyne impedance patches were placed on the flank of all patients in a standard fashion. BI was measured at PV ostia under intracardiac echocardiography imaging and averaged across all sites. Patients were stratified into low and high impedance groups relative to the median.

Results:
Patients with higher BI were slightly younger with larger BMI (p = 0.0001). Mean BI varied by anatomical site, with the roof, ridge, and posterior wall having higher BIs than anterior and inferior regions (125.7 ohms vs 122.8 ohms, p = 0.017). Regions with low BI had higher mean current values achieved (599 mA vs 559 mA, P = 0.000013). There was no significant difference in the BI between groups regarding one year recurrence or first pass isolation. However, the most frequent region requiring additional ablation was the right posterior wall, and there the percent impedance drop was the lowest at 4.87%.

Conclusion:
Baseline pulmonary vein impedances are higher at the roof, ridge, and posterior wall. To achieve similar first pass isolation rates, these regions had larger absolute impedance drops resulting in similar percent impedance change. The region associated with worst first pass isolation rates had percent impedance drop <5%. Targeting percent rather than absolute impedance drop may improve atrial fibrillation success.
Abstract 4147178: A Rare Case of Loeffler Endocarditis and Intracardiac Thrombus in the setting of FIP1L1-PDGFRA Mutation
Authors: Shaik Aleesha , Pankayatselvan Varayini , Mazar Michael , Bokhoor Pooya
Published: November 2024

Background:
Loeffler endocarditis is a rare and clinically challenging presentation of hypereosinophilic syndrome (HES). Early detection and treatment are critical for this disease that otherwise carries a high risk of morbidity and mortality. We present a complex case of a patient with HES and sequelae.

Case:
A 41-year-old male with history of asthma presented with cough, dyspnea on exertion, orthopnea, and right arm pain. He noted a 15-pound weight loss in the past few months. In addition to right upper superficial vein thrombus, he was initially diagnosed with pneumonia, but labs were concerning for significant leukocytosis (WBC 54.23 10
3
/uL) and hypereosinophilia (45%), as well as anemia and thrombocytopenia. Cardiology was consulted for evidence of cardiac involvement with high sensitivity troponin 480 ng/L and BNP 399 pg/mL. Transthoracic echocardiography and cardiac MRI showed mild apical biventricular dilatation with moderate apical hypokinesis. There was nonenhancing T2 hypointense eccentric signal in both apices, suggestive of organized thrombus. Circumferential mid-cavity subendocardial delayed enhancement in the left ventricle and right ventricular apex was noted. Systolic function was preserved, but there were signs of pulmonary arterial hypertension. These findings were consistent with Loeffler endocarditis. He underwent bone marrow biopsy, which confirmed diagnosis of FIP1L1-PDGFRA+ HES.

The presence of the FIP1L1-PDGFRA mutation is correlated with an increased risk of cardiac involvement in patients with HES and is also associated with worse prognosis. Following an interdisciplinary discussion between the hematology, rheumatology, and cardiology teams, he was started on imatinib, methylprednisolone followed by prednisone taper, and apixaban. His symptoms and blood counts have since drastically improved, and he is being monitored closely for resolution of the thrombi and for any signs of heart failure.

Conclusion:
HES complicated by Loeffler endocarditis is a unique presentation of infiltrative disease causing inflammatory, thrombotic, and fibrotic cardiac sequelae. It can portend deadly complications, including valvular involvement, thromboembolic events, and heart failure. A high clinical suspicion is required due to the multitude of possible symptom presentations. Multimodality imaging and interdisciplinary management with early accurate diagnosis and treatment are necessary to slow disease progression and reduce morbidity risk.
Abstract 4147211: Machine Learning Models for Predicting In-Hospital Mortality in Acute Aortic Dissection Patients with Malperfusion
Authors: Zhang Yanda , Xing Hang , Wang Ting , Zhang Bo , Yuan Jing , Wang Long
Published: November 2024

Introduction:
Acute aortic dissection (AAD) remains a critical cardiovascular emergency with high in-hospital mortality, especially in patients with malperfusion syndromes. Accurate prediction of in-hospital mortality in these patients is crucial for improving clinical decision-making and patient outcomes. This study evaluates the performance of various machine learning (ML) models in predicting in-hospital mortality among AAD patients with malperfusion.

Methods:
The study included 451 acute aortic dissection with malperfusion from Henan Provincial Chest Hospital from August 2020 to September 2023. The dataset included demographic, clinical, laboratory results, and treatment strategies. Multiple ML models were developed and validated, including k-Nearest Neighbor (KNN) and Extreme Gradient Boosting Machine (XGB). Model performance was assessed using sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC-ROC).

Results:
Our results demonstrated that the XGB model achieved the higher AUC-ROC (0.75, 95% CI: 0.73, 0.78), indicating excellent discriminative ability. KNN model showed lower AUC-ROC (0.66, 95% CI: 0.63, 0.68) but robust performance.

Conclusions:
XGB models offered promising tools for predicting in-hospital mortality in AAD patients with malperfusion. These models can assist clinicians in identifying high-risk patients and tailoring treatment strategies to improve survival outcomes.
Abstract 4147214: Association of Intensity of E-cigarette Use with Heart Rate in Daily Life in Young Adults using a Text-Messaging Partnered with Mobile Health Monitoring Platform
Authors: Javanmardi Elmira , Kadel Rabindra , Barger Kathryn , Minetti Erika , Hoover Rachel , Gallagher Jacqueline , Manoochehri Arash Niusha , Weisbrod Robert , Keith Rachel , Hamburg Naomi
Published: November 2024

Background:
Electronic Cigarettes (e-cig) are popular among young adults raising questions about the cardiovascular health impacts. In research settings, acute e-cig use leads to transient heart rate (HR) elevation. We evaluated how e-cig use intensity relates to HR during daily living using a text-messaging program partnered with continuous HR monitoring.

Methods:
We enrolled healthy young people (age 18-24) sole e-cig users and non-user controls in a text-messaging based program that assessed self-reported e-cig use intensity (vape sessions and puff count) over 5 two-hour time windows spanning awake period over 2 days. HR was collected using Fitbit and aligned to the text-messaging windows. We compared information collected about use intensity (vape sessions and puff number) to HR measures in two models: linear regression associations at a per person level over the total wake time and a repeated measures analysis based on individual time windows accounting for clustering by participant using compound symmetry.

Results:
In the 78 participants, mean age 21±2 years was similar in e-cig users (N=59, 47% women, 39% Asian, 7% Black, 9% Hispanic) and non-users (N=19, 61% women, 28% Asian, 22% Black, 6% Hispanic). At baseline e-cig users reported high intensity of use: 26±6 days/month, 16±20 vape sessions/day, 6±5 puffs/session. Over the 2-day monitoring period, total vape sessions reported was 23±26 and total puff 77±68 measured per participant and 2.4±4 vape sessions and 8.1±13.3 puffs per 2 hour window. In the per participant analysis, both higher number of vape sessions and puff counts were associated with higher average HR (β=0.08±0.03, P=0.01 and β=0.03±0.01, P=0.003) but not maximum or minimum HR. In the repeated-measures per window analysis, vape sessions and puff counts were associated with higher average HR (β=0.89±0.14, P<0.0001 and β=0.29±0.05, P<0.0001) as well as maximum HR (β=1.1±0.18, P<0.0001 and β=0.33±0.05, P<0.0001) and minimum HR (β=0.70±0.13, P<0.0001 and β=0.20±0.04, P<0.0001), providing temporal evidence linking variability in vaping intensity measures and HR measures.

Conclusion:
Our findings using an innovative mobile health platform suggest that the intensity of e-cig use is associated with higher HR during daily living in young people. Further investigation is needed to link short term hemodynamic impact of e-cig use to long-term health impacts.
Abstract 4147221: Surface Engineering Enhances the Therapeutic Potential of Systemically Delivered Extracellular Vesicles Following Acute Myocardial Infarction
Authors: Tarvirdizadeh Touba , Mentkowski Kyle , Manzanero Cody , Eagler Lisa , Potekar Gayatri , Lang Jennifer
Published: November 2024

Background:
Cardiomyocyte (CM) cell death is a sentinel event in the development of cardiomyopathy. It contributes to additional myocyte dysregulation, generating a positive-feedback loop which potentiates the evolution of heart disease. Accordingly, CMs represent an important therapeutic target in modulating the pathogenesis of cardiac disease. While extracellular vesicles derived from cardiosphere-derived cells (CDC-EVs) have emerged as therapeutic vectors for cardiovascular disease, their potential is limited by their biodistribution and necessity for direct intramyocardial injection. We hypothesized that CDC-derived EVs engineered to express a CM-specific binding peptide (CMP-EVs) with improved cardiac targeting would result in enhanced therapeutic efficacy when administered intravenously post-myocardial infarction (MI).

Methods:
Mice with acute MI underwent both intramyocardial and intravenous (IV) delivery of unmodified CDC-EVs, CMP-EVs and vehicle control in a double-blind study. Left ventricular ejection fraction (LVEF) was assessed by echo at 2- and 28-days post-MI and tissue samples processed for assessment of EV biodistribution and histological endpoints.

Results:
Mice treated with IV delivered CMP-EVs demonstrated a significant improvement in LVEF (57% ± 2% vs. 47% ± 3%) and a significant reduction in remote zone cardiomyocyte apoptosis (0.6 ± 0.2% vs. 1.9 ± 0.4%) when compared with IV delivered non-targeted EVs at 28-days post-MI (n=6-8 mice per group, mean± SEM, p<0.05, one-way ANOVA followed by Tukey’s post-hoc test).

Conclusions:
Systemic administration of CMP-EVs enhances their ability to augment systolic function following acute MI when delivered via systemic route, demonstrating a strategy to optimize therapeutic EV delivery post-MI. This approach also facilitates repeated dosing which may be advantageous as a treatment strategy for several cardiovascular diseases.
Abstract 4147235: Sex Differences in Psychosocial Factors and Angina in Patients with Chronic Coronary Disease
Authors: Hausvater Anais , Anthopolos Rebecca , Seltzer Alexa , Spruill Tanya , Peteiro Jesus , Lopez-sendon Jose , Celutkiene Jelena , Sidhu Mandeep , Demchenko Elena , Beleslin Branko , Kedev Sasko , Grodzinsky Anna , Spertus John , Fleg Jerome , Maron David , Hochman Judith , Reynolds Harmony
Published: November 2024

Background:
Sex differences in angina frequency and health status have been previously described in patients with chronic coronary disease (CCD), with women more severely affected despite lesser coronary artery disease (CAD) severity. Psychosocial factors, such as perceived stress and depression, are associated with increased angina and are more common in women and in those with ischemia and no obstructive coronary artery disease (INOCA). We examined whether perceived stress and depressive symptoms mediate sex differences in angina severity among patients with CCD, and whether this relationship differs between those with CAD vs. INOCA.

Methods:
The association between sex, stress (Perceived Stress Scale-4) and depressive symptoms (Patient Health Questionnaire-8) and angina-specific health status (Seattle Angina Questionnaire, SAQ) at enrollment and changes over 1 year in North American ISCHEMIA participants and in the CIAO-ISCHEMIA study (INOCA) were compared using linear regression.

Results:
Among 1,626 participants (N=1,439 CAD and N=187 INOCA) with available SAQ, PSS-4 and PHQ-8 data, women had worse SAQ-7 summary scores than men in both CAD and INOCA cohorts (Table). Higher stress and depressive symptoms were associated with worse angina in both CAD and INOCA cohorts. Given consistency of results, cohorts were pooled for multivariable analysis. Female sex, PSS-4 score and PHQ-8 score were each independently associated with lower SAQ scores, (female vs. male difference -5.12 points, 95% CI -7.21, -3.02, p=0.001; PSS-4 -0.78 per point, 95% CI -1.06, -0.50, p=0.001; PHQ-8 -1.38 per point, 95% CI -1.58, -1.18, p=0.001) but CAD vs. INOCA was not and the effects were similar by sex.

Conclusions:
Women, with both CAD and INOCA, had worse angina and angina-related health status than men. High stress and depressive symptoms were each independently associated without a significant interaction by sex, and regardless of presence of obstructive CAD. Therefore, stress and depression levels are not a central explanation for worse health status in women than men with CAD or INOCA.
Abstract 4147241: Association of angiogenic biomarkers in the third trimester of pregnancy with future body mass index trajectories
Authors: Pabon Maria , Cantonwine David , Claggett Brian , Anwer Tooba , DI CARLI MARCELO , Solomon Scott , McElrath Thomas , Honigberg Michael
Published: November 2024

Background:
Prior studies suggest that angiogenic markers measured during pregnancy may be associated with higher future systolic blood pressure. Furthermore, prior work suggests postpartum body mass index (BMI) influences progression to chronic hypertension among women who experience hypertensive disorders of pregnancy. However, no studies to date have investigated the relationship between levels of angiogenic markers during pregnancy and the future development of obesity among non-obese pregnant women.

Methods:
We included participants in a longitudinal pregnancy biorepository at Brigham and Women’s Hospital (Boston, MA) who had available levels of sFlt-1 (soluble fms-like tyrosine kinase receptor-1) and PlGF (placental growth factor) measured in the third trimester and who continued to follow with primary care in one of the Mass General Brigham institutions up to December 2019, with available covariate and outcome data. We excluded participants with a pre-pregnancy history of obesity (BMI ≥30 kg/m
2
). The ratio of sFlt-1/PlGF in the third trimester was examined by tertiles. Adjusted mixed effects models were used to test group differences in BMI trends during follow-up.

Results:
Among 590 participants included, the mean (SD) first-trimester BMI was 24 (3) kg/m
2
, and the mean age at delivery was 32 (6) years. Maternal age at delivery and first-trimester BMI were similar across sFlt-1/PlGF tertiles, but participants in the higher tertiles tended to have a slightly lower gestational age at delivery (
Table 1
). During a median follow-up of 9 years, 173 participants (29%) developed obesity during follow-up. Participants in the second and third tertiles had steeper increases in BMI (+0.22 and +0.24 kg/m
2
, respectively) compared to those in the first tertile (+0.18 kg/m
2
; p<0.001 for both comparisons) after adjustment for first trimester BMI, race and parity.

Conclusions:
Among participants without a history of pre-pregnancy obesity, higher levels of third-trimester sFlt-1/PlGF ratio were associated with higher BMI during follow-up. Angiogenic marker levels during pregnancy, which are now available and used clinically, may enable opportunistic risk stratification for future cardiometabolic disease.
Abstract 4147276: Gender-specific characteristics and in-hospital outcomes of active smokers with STEMI: contemporary data from the FRENCHIE cohort.
Authors: Zeller Marianne , Bouleti Claire , Cottin Yves , Steg Philippe , Rousseau Alexandra , Lebal Soufiane , Chague Frederic , Cayla Guillaume , Angoulvant Denis , coste pierre , Mesnier Jules , Lemesle Gilles , Simon Tabassome , Danchin Nicolas
Published: November 2024

Background:
Although the number of women who smoke is growing among patients with ST-segment elevation myocardial infarction (STEMI), this population is poorly documented.

Aim:
Using a French nationwide MI cohort, we aimed to analyze gender-specific characteristics and hospital outcomes of active smokers hospitalized for acute STEMI.

Methods:
The French Cohort of Myocardial Infarction Evaluation (FRENCHIE) is a large ongoing AMI cohort, collecting data from all patients hospitalized for AMI within 48 h of symptom onset in 21 French centers. STEMI patients admitted from 2019 to 2022 were analyzed. Smoking status was self-declared. Past or never smokers were excluded from the analysis. Combined in-hospital events included death or ventricular fibrillation (VF).

Results:
Among the 9258 STEMI patients, 3761 (40.6%) were current smokers, of whom 702(18.7%) were women. Women were in average 4 years older than men (57.9 ± 11.0 vs 54.3 ± 10.0 y, p<.0001), and had higher rates of cardiovascular (CV) risk factors including hypertension (p<.0001), familial history of CAD (p=0.02), obesity (p=0.001), and co-morbidities such as respiratory failure (p=0.001) or systemic auto-immune diseases (p<.0001). However, they were 3 times less likely to use illicit drugs (p<.0001). The rate of peripheral artery disease was similar for both genders, while history of CAD was lower in women (8.5% vs 12.4%, p=0.004). Their left ventricular ejection fraction was higher (49.3 ± 10.6% vs 47.8 ± 10.7 %, p=0.002). Chest pain was the most prevalent symptom in both genders, but women more frequently exhibited atypical chest pain (12.5% vs. 7.5%, p<.0001). Additionally, syncope was almost twice more common in women (6.4 vs. 3.6%, p=0.0007). Although the difference was not significant, there was a trend toward higher mortality or VF in women (5.6 vs. 4.3%, p=0.1671), which persisted after adjustment for confounding factors (OR(95%CI): 1.46 (0.94 ; 2.27), p=0.0940).

Conclusion:
Our contemporary findings in smokers with STEMI showed that women present with specific characteristics including an older age, an elevated burden of CV risk factors and more atypical chest pain or syncope. The rate of death or FV in women who smoke was higher than their male counterpart, although not reaching significance.

FRENCHIE was supported in part by the RHU iVASC grant ANR-16-RHUS-00010 from the French National Research Agency (ANR) as part of the Investissements d’Avenir program.
Abstract 4147325: Electronic Health Alerts to Improve Mortality and Medication Adherence in Heart Failure Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Khan Ubaid , Iltaf Arej , Amin Ahmed Mazen , Ayyad Mohammed , Imran Muhammad , ranabhat chet , Abuelazm Mohamed
Published: November 2024

Background:
Heart failure (HF) patients are frequently re-hospitalized shortly after discharge. Telemonitoring and electronic health alert follow-up may reduce the mortality and hospitalization in HF patients following discharge.

Methodology:
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, Scopus, Embase, and CENTRAL until May 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using RevMan v 5.4.

Results:
We included seven RCTs with a total of 6,820 patients. The patients who received electronic alerts were at lower risk of all-cause mortality than those who received usual care [RR: 0.64 with 95% CI (0.45, 0.92, P = 0.01). However, there was no difference in all-cause hospitalization [RR: 0.66 with 95% CI (0.22, 1.98), P = 0.46) between the two groups. Additionally, electronic alert led to a significant increase in the addition of mineralocorticoid antagonist (MRA) in treatment compared to usual care [RR: 1.77 with 95% CI (1.48, 2.11), P < 0.00001) but there was no difference in addition of all class guidelines directed medical therapy (GDMT) [RR: 1.23 with 95% CI (1.00, 1.52), P = 0.05) between the two groups.

Conclusion:
An electronic health alert was associated with a significant reduction in all-cause mortality and the addition of MRA. Still, there was no difference in all-cause hospitalization and the addition of all-class GDMT.