bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4141290: The Role of Automated External Defibrillator Use in the Out-of-Hospital Cardiac Arrest Survival Rate and Outcome: A Systematic Review
Authors: Elhussain Mohamed , Ahmed Fatima , Mustafa Nafisa , Mohammed Doaa , Berkiah Ibrahim , Alnaeim Namariq , Ali Ragda , Mohyeldeen Noura , Ahamed Hassan , Elataya Fatima , Abdelrahman Nadir
Published: November 2024

Background:
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with prompt defibrillation being crucial for improving survival rates. Public access defibrillators (PADs) offer a means for rapid intervention outside hospital settings. This systematic review evaluates the effectiveness of PADs in OHCA scenarios.

Method:
A systematic review was conducted following PRISMA guidelines. Global studies from 2000 onwards assessing bystander and emergency medical service (EMS) interventions during OHCA, particularly focusing on AED usage, were included. Data synthesis and quality assessment were performed using established frameworks, including Covidence for screening and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) framework for risk of bias assessment.

Results:
Thirty studies met inclusion criteria. PAD deployment significantly improved survival outcomes, with better results observed in public settings compared to private residences. Bystander-initiated defibrillation correlated with higher survival rates and improved neurological outcomes. School and airport settings demonstrated particularly favorable outcomes due to AED accessibility and trained personnel. The combination of CPR and AED use by bystanders markedly increased survival chances compared to EMS intervention. The difference in survival rates between bystander-initiated defibrillation and EMS intervention ranged from 5% to 42%. Regarding neurological outcomes, the difference between bystander-initiated defibrillation and EMS intervention ranged from 16.4% to 34%.

Discussion:
The review underscores the critical role of immediate bystander response and PAD accessibility in OHCA survival. Strategic AED placement in high-risk areas and widespread CPR training are essential for enhancing outcomes. Challenges include variable data collection methods and limited benefits in certain OHCA scenarios.

Conclusion:
Bystander interventions, including CPR and AED usage, significantly increase OHCA survival rates. Promoting widespread CPR training, strategic AED placement, and continuous outcome monitoring are vital for improving OHCA outcomes. Further research is warranted to address challenges and optimize intervention strategies.
Abstract 4141293: Prognostic Significance of Exercise-Induced Ventricular Arrhythmia Patterns in
PKP2
-Mediated Arrhythmogenic Cardiomyopathy
Authors: Castrichini Matteo , Neves Raquel , Garmany Ramin , Allison Thomas , Ackerman Michael , Giudicessi John
Published: November 2024

Background:
Although exercise stress testing (EST) has shown to unmask latent electrical substrates in
PKP2
-mediated arrhythmogenic cardiomyopathy (ACM), the prognostic role of EST-induced ventricular arrhythmia (VA) patterns in PKP2-ACM patients is unclear.

Objective:
To examine the exercise-induced VA patterns observed during EST in PKP2-ACM patients and explore their correlation with major VA outcomes.

Methods:
We retrospectively analyzed 621 patients with either genotype-positive ACM or genotype-positive dilated cardiomyopathy evaluated between 01/2015 and 04/2024 to identify those with a disease-causative variant in
PKP2
(N = 108). After exclusion of 38 PKP2-ACM patients without EST data, demographic and electrocardiographic data was extracted from the electronic medical record. The arrhythmic burden [premature ventricular contractions (PVCs), PVCs in bigeminy, PVC couplets, non-sustained VT (NSVT), sustained VT, ventricular fibrillation (VF), and PVCs/minute] during each EST phase (baseline, peak, active and passive recovery) were reviewed and correlated with major VA outcomes [sudden cardiac arrest (SCA), sustained VT, and appropriate implantable cardioverter-defibrillator (ICD) shocks].

Results:
A total of 186 exercise tests from 70/108 (65%) PKP2-ACM patients (mean age 36 ± 20 years, 40 % male) were analyzed. The presence and burden of PVCs occurring singly, bigeminy, couplets. and NSVT were more prevalent during the recovery phase, specifically the passive recovery phase (
Table
). PKP2-ACM patients with structural disease (64%) were more likely to have an increased VA burden during recovery than those without structural disease [28/45 (62%) vs 4/25 (16%); p<0.001]. Interestingly, the presence of an increased arrhythmic burden (worsening PVCs/min or complex PVCs) during the recovery was associated with major VA over a median follow-up of 47 months (HR 8.576 [1.015-72.449]; p= 0.019).

Conclusion:
Increased arrhythmic burden during the recovery phase (late > early) is associated with an increased risk of major VAs in PKP2-ACM. Further studies are needed to understand if this observation extends to other ACM genotypes and whether EST-induced VA patterns can be used to assess therapeutic efficacy in PKP2-ACM.
Abstract 4141318: AI-Powered Smartphone Application for Detection of Left Ventricular Systolic Dysfunction using 12-Lead ECG
Authors: Demolder Anthony , Herman Robert , Vavrik Boris , Martonak Michal , Boza Vladimir , Herman Martin , Paluš Timotej , Kresnakova Viera , Bahyl Jakub , Iring Andrej , Bartunek Jozef , Vanderheyden Marc , Heggermont Ward , Penicka Martin
Published: November 2024

Background:
Though echocardiography is the cornerstone of cardiac function assessment in specialized practice, there is a lack of point-of-care tools for immediate evaluation of left ventricular ejection fraction (LVEF) in current practice facilitating the early identification of patients at risk for heart failure who may benefit from further echocardiographic evaluation.

Aims:
To develop and validate artificial intelligence (AI) models to identify reduced LVEF from a single 12-lead ECG using a smartphone application.

Methods:
We sourced all ECGs and transthoracic echocardiograms (TTEs) recorded between 2011 and 2021. ECGs were paired with TTEs conducted within a 24-hour window and were randomly divided into the model development dataset (50%) and validation dataset (50%). Two AI-ECG models were created: one to detect LVEF ≤40% and another for LVEF <50%, following the AHA definition of heart failure. These models were coupled with smartphone-based ECG digitization technology. Performance metrics included area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1-score.

Results:
A total of 1,205,370 ECGs and 291,433 TTEs were collected and paired, resulting in 109,809 ECG-TTE pairs from 56,236 unique patients. The validation dataset consisted of 25,510 distinct TTE-ECG pairs (25,510 patients). Prevalence of LVEF≤40% and LVEF<50% was 5.4% and 7.9% respectively. The LVEF≤40% model demonstrated an AUC of 0.963 (95% CI: 0.959-0.966), sensitivity 0.924 (95% CI: 0.91-0.937), specificity 0.887 (95% CI: 0.883-0.891), and F1-score of 0.474 (95% CI: 0.457-0.490). PPV and NPV were 0.318 (95% CI: 0.304-0.333) and 0.995 (95% CI: 0.994-0.996) respectively. Performance of the LVEF <50% model shows an AUC of 0.952 (95% CI: 0.947-0.956), with a slightly lower sensitivity of 0.899 (95% CI: 0.886-0.912), specificity of 0.875 (95% CI: 0.871-0.879), PPV of 0.382 (95% CI: 0.368-0.395), NPV of 0.99 (95% CI: 0.989-0.992), and F1-score of 0.536 (0.521-0.55).

Conclusion:
The smartphone-integrated AI model can reliably detect reduced LVEF from standard 12-lead ECGs. Our findings suggest these single 12 lead-ECG based models could serve as a point-of-care screening tool to identify such patients benefiting from further echocardiographic evaluation and consequent management acceleration.
Abstract 4141335: Modification Effect of Flu-like Illness on the Genetic Association of Dilated Cardiomyopathy
Authors: Ni Hanyu , Cao Jinwen , Kinnamon Daniel , Jordan Elizabeth , Hershberger Ray
Published: November 2024

Background and Aims:
Previous studies have speculated that a viral infection may act as a trigger in the development of idiopathic dilated cardiomyopathy (DCM) among people genetically at risk. This study aimed to describe the frequency of DCM patients who experienced a flu-like illness prior to the diagnosis and examine if this experience modifies the association of DCM with carrying DCM-relevant genetic variants.

Methods:
We analyzed data from the DCM Precision Medicine Study conducted between June 2016 and April 2021. Medical history including flu-like illness prior to DCM diagnosis was obtained from patient interview and medical record review. Exome sequencing identified DCM-related rare variants [pathogenic (P), likely pathogenic (LP), or uncertain significance (VUS)] and common variants via GWAS. Logistic mixed models with a case-only design were used to examine if flu-like illness modified the association between DCM and genetic risk. After imputation using the TOPMed Imputation Server, Firth logistic regression was used to examine if flu-like illness modified the association of DCM with each of 13,443,192 common autosomal variants (minor allele frequency >=1%).

Results:
Of 1,164 patients with DCM, 351 (30.2%) reported episodes of flu-like illness proximal to their DCM diagnosis. The percent with a history of flu-like illness was higher among those aged <45 than those aged
>
45 (35.2% vs. 27.4%, P=0.004) and among ever smokers than non-smokers (32.4% vs. 28.2%, P=0.04), but did not differ by other demographics, clinical comorbidities, or seasons. The percent with a history of flu-like illness by variant classification was 29.9% for LP/P, 29.6% for VUS only, and 30.1% for no LP/P/VUS. The odds ratio for an interaction between a history of flu-like illness and presence of any P, LP or VUS variants was 1.0 (95% CI: 0.7-1.3). A genome-wide significant association between rs2102158 and flu-like illness (p=1.1*10^-8) was identified at chromosome 3q24.

Conclusions:
We did not find evidence that a flu-like illness modified the association of DCM with DCM-relevant rare variants; however, our GWAS analysis suggested that flu-like illness may modify the effect of a common variant on the odds of DCM.
Abstract 4141352: Can quantifiable aortic or coronary artery calcifications in the standard of care baseline CT or PET-CT scan of patients with Hodgkin or non-Hodgkin lymphoma serve as a predictor of Major Adverse Cardiovascular Events?
Authors: GOMEZ ARDILA MARIA F. , Daryanani Andres , GARZON JUAN , Tellez Garcia Eduardo , Witzig Thomas E , Habermann Thomas , Cerhan James , Foley Thomas , Villarraga Hector
Published: November 2024

Background:
Major adverse cardiovascular events (MACE), including myocardial infarction, acute coronary syndrome, ischemic heart disease requiring revascularization, stroke, and heart failure, have been documented as significant contributors to mortality in cancer survivors. Coronary artery calcium (CAC) can predict MACE in non-cancer populations, while calcium in the aorta (CA) has not been evaluated as a prognostic marker. Every patient diagnosed with cancer undergoes a standard-of-care Positron Emission Tomography-Computed Tomography (PET-CT) or a chest CT before the initiation of chemotherapy.

Hypothesis:
To determine whether the CAC or CA of patients with Hodgkin's or non-Hodgkin's lymphoma, derived from standard-of-care PET-CT/chest CT, can predict the incidence of MACE.

Methods:
Patients treated with anthracycline-based chemotherapy, diagnosed and followed from January 1, 2013, through June 30, 2023, were included. Patients who did not undergo a PET-CT or CT, and/or developed MACE before treatment initiation were excluded. Univariate and multivariate adjusted Cox regression models were employed to assess whether the presence of CAC, CA, or CAC-CA was associated with the development of MACE. Calcium was retrospectively quantified using TeraRecon software (Durham NC) and categorized as: 0, 1-99, and >100. Outcome analyses was estimated using the Kaplan-Meier method.

Results:
326 patients were included, mean age of 55 years (range: 52-60), predominantly male 201 (61%) and white 314 (96%), CAC was found in 89 patients and CA in 140. In the univariate regression model, a statistically significant association was found with values >100 for CA, CAC and CAC-CA with the risk of MACE. (Fig 1a/b/c). CAC equal to 0 demonstrated a significant protective effect against MACE. (Fig 1a). In the multivariable analysis, these associations persisted even after adjusting for comorbidities. (Table 1).

Conclusion:
CAC, CA and CAC/CA >100 in the standard-of-care CT/PET CT are predictors of MACE in lymphoma patients undergoing anthracycline treatment, a CAC equal to 0 has protective effect, these relationships remained statistically significant after adjusting for comorbidities.
Abstract 4141353: Predictors of Coronary Artery Calcium Distribution in Older Adults Aged ≥ 75: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Gami Abhishek , Zou Siyu , Dardari Zeina , Dudum Ramzi , Mok Yejin , Budoff Matthew , Lutsey Pamela , Howard Candace , Couper David , Matsushita Kuni , Blaha Michael
Published: November 2024

Background:
Coronary artery calcium (CAC) is commonly measured using the Agatston score. Prior work has shown that inclusion of measures of CAC distribution, such as the number of coronary vessels with involved CAC and the relative distribution of CAC burden across different vessels, may improve cardiovascular risk prediction. However, the long-term predictors of CAC distribution at older age have not yet been explored.

Aims:
We aimed to characterize the patterns of distribution of CAC in adults ≥ 75 years and identify risk factors associated with a more diffuse CAC distribution.

Methods:
Time-weighted average exposure to traditional cardiovascular risk factors (e.g., blood pressure, LDL-C, HDL-C, BMI) was calculated over a 30-year period, using ARIC data from Visit 1 (1987-1989) to Visit 7 (2018-2019). ARIC conducted cardiac CT at Visit 7, and the CAC “diffusivity index” was calculated as 1 - (CAC in most affected vessel/total CAC). Participants with a diffusivity index >75
th
percentile were classified as having a diffuse CAC phenotype. Multivariable logistic regression was used to quantify the associations between time-averaged risk factors and diffuse CAC phenotype. Ordinal logistic regression was used to identify predictors of the number of coronary vessels with any CAC (0-4 [including left main]).

Results:
Of 2,143 participants (62% female, mean age 49 at Visit 1 and 80 at Visit 7), the mean diffusivity index was 0.28 (SD 0.23). In adjusted models, SBP ≥140 mmHg and HDL <35 mg/dL were associated with diffuse plaque phenotype. Other predictors included ever smoking (OR 1.52, 1.22-1.91), male sex (OR 2.12, 1.67-2.70), and limited education (OR 1.49, 1.03-2.14) (
Table 1
). SBP ≥140 mmHg (ordinal OR 2.06, 1.44-2.96), LDL ≥160 mg/dL (OR 2.28, 1.35-3.90), HDL <35 mg/dL (OR 2.78, 1.96-3.95), BMI ≥30 kg/m
2
(OR 1.54, 1.02-2.32), ever smoking (1.47, 1.24-1.73), and limited education (OR 1.35, 1.00-1.80) were associated with increasing number of vessels with CAC.

Conclusion:
Traditional risk factors such as hypertension or low HDL-C are strong graded risk factors of a more diffuse CAC phenotype in older adults age >75. Men, individuals with a smoking history, and those with limited education also had more diffuse CAC.
Abstract 4141361: Aging, Lifestyle, and Diet Quality in a Black Heart Failure Population
Authors: Davis Erica , Dunbar Sandra , Higgins Melinda , Ferranti Erin , Butts Brittany
Published: November 2024

Introduction:
Black adults with heart failure (HF) have issues with dietary preferences that warrant further study to achieve optimal self- and culturally-congruent care. Greater knowledge of dietary patterns and behaviors is essential to understanding barriers with improving diet quality. Aging in Black populations with HF may also affect diet, inflammation, and lifestyle choices. Metabolites like trimethylamine N-oxide (TMAO) are linked to inflammation which contributes to deterioration in HF, especially with renal involvement. More research is needed to ascertain the impact of diet quality, lifestyle factors, and inflammatory biomarkers in this population.

Research Question:
What factors are associated with diet quality,TMAO, and lifestyles in Black adults with HF?

Methods:
Thirty-one participants were recruited from a cardiac center (mean age 57 years, 65% women). Measures included age, diet quality (Healthy Eating Index [HEI]); lifestyle factors (Lifestyle Score [LIS] from smoking, alcohol, activity, body mass index [BMI]); comorbidities (Charlson Comorbidity Index [CCI]]; creatinine measures, and TMAO. Analyses included descriptive, correlational, and inferential statistics.

Results:
HEI score (range:47-87; mean 64
+
10) out of a possible ideal score of 100, was positively correlated with age (r=.368, p=.054). TMAO level (mean 6.3
+
0.7) was negatively correlated with LIS (r= -.470, p=.008). The mean LIS was 2
+
0.9 and the mean for CCI was 3
+
2. There was a positive correlation with age and comorbidities (r= .423, p=.018). A multiple regression model with creatinine levels and LIS as predictors of TMAO accounted for 16.6% of the variance (F(2,27)=3.89, p=.033). LIS was the key predictor related to TMAO levels. T-tests were performed for each component of the LIS variable and notably TMAO concentrations of those who consumed alcohol were lower than those who did not (mean difference 0.41 ± 0.18, p=.026, d=0.66).

Conclusion:
Black persons with HF have a high number of comorbidities with increasing age. The greater the age in this sample, the higher the HEI diet quality score. However, HEI scores were in the range for needing improvement. The LIS in relation to TMAO has a counterintuitive result but suggests that BMI, smoking, exercise ability, and alcohol use may influence metabolite levels that are linked to the diet. Findings suggest that diet quality is a strong intervention target for older Black adults with HF, especially for those with high comorbidities.
Abstract 4141367: Telemonitoring as a Strategy to Reduce Mortality and Hospitalizations in Heart Failure: A Systematic Review
Authors: Gupta Umang , Meda Venkata Sai Abhilash , Adhikari Ashok , Tadigotla Chandana , Gaddam Ashwith Reddy , Vaghamashi Yogeshkumar , Panjiyar Binay
Published: November 2024

Background:
Heart failure (HF) is a chronic condition with high morbidity and mortality rates, and is known to pose a significant burden on the healthcare system. Telemonitoring, an innovative approach using remote monitoring of patients' health data, has emerged as a potential solution to enhance HF management and improve patient outcomes.

Research Question:
This systematic review investigates whether telemonitoring interventions improve heart failure outcomes compared to standard care.

Aim:
We aim to synthesize the current evidence on the impact of telemonitoring on all-cause mortality, cardiovascular mortality, heart failure-related hospitalization, and health-related quality of life in patients with heart failure.

Methods:
We conducted a thorough search of electronic databases, including PubMed, Cochrane Library, Google Scholar, and PLOS Medicine, to identify relevant randomized controlled trials (RCTs) and systematic reviews/meta-analyses (SRs/MAs) evaluating telemonitoring interventions in heart failure. Studies were selected based on pre-defined criteria. A review of the literature and risk of bias assessment was performed independently by four reviewers.

Results:
Out of 16,778 articles reviewed, eight were chosen for this study, comprising 3 SRs/MAs and 5 RCTs. The findings suggest that using telemonitoring interventions, such as structured telephone support, mobile health interventions, and medication support, significantly reduces deaths and hospitalizations in heart failure patients compared to standard care. Longer telemonitoring duration (≥12 months) significantly lowered hospitalization rates.

Conclusions:
This systematic review suggests that telemonitoring may be associated with improved heart failure outcomes, including reduced mortality and hospitalization rates. However, further research is needed to explore telemonitoring interventions' long-term effects and cost-effectiveness in heart failure management.
Abstract 4141368: Increasing handgrip strength in patients with cardiovascular diseases is associated with improving ejection fraction in the longitudinal study
Authors: Ojima Satoko , Kubozono Takuro , Yamaguchi Satoshi , Kawasoe Shin , Ohishi Mitsuru
Published: November 2024

Background:
Weakness of muscle strength is one of the indicators of frailty. Moreover, frailty is associated with the prognosis of cardiovascular disease (CVD). However, no reports examine the association between improving ejection fraction (EF) and handgrip strength (HGS) in the longitudinal study.

Purpose:
To investigate the factors related to handgrip muscle strength in patients with CVD

Methods:
We recruited 133 patients with CVD who all performed HGS and echocardiography twice on the first and second visit. Furthermore, we measured blood samples such as brain natriuretic peptide (BNP) and haemoglobin (Hb) twice on the first and second visit as well.

We applied to investigate factors such as the newly presented anaemia, ΔBNP(second visit-first visit), ΔHGS (second visit-first visit), Δleft ventricular end-diastolic diameter (Dd) (second visit-first visit). Two types of assessment were used for EF improvement. One is improving ΔEF, defined as an increase from the baseline. The other is improving ΔEF
>
10%, defined as a 10% increase from the baseline.

Results:
The average follow-up period was 1.5±1.1 years. EF, BNP, and HGS baseline data were 50±19 %, 128±178 pg/mL, and 28.6±10.2 kg, respectively. In multivariate logistic regression analysis adjusted for age and sex, increasing HGS and decreasing Dd were independent risk factors for improving ΔEF
>
10% (increasing HGS: OR 3.69 CI 1.32-10.3, p=0.013; decreasing Dd: OR 3.76 CI 1.41-10.0, p=0.008). Moreover, in multivariate logistic regression analysis adjusted for age and sex, increasing HGS was only an independent factor for improvingΔEF (OR 2.31 CI 1.05-5.07, p=0.038).

Conclusions:
In patients with CVD, improving ΔEF
>
10% was associated with decreased Dd and increasing HGS. Furthermore, improving ΔEF was associated with increasing HGS. Increased handgrip strength was a significant factor in EF improvement.
Abstract 4141371: Comparing predictors of atrial fibrillation recurrence following
de novo
versus repeat catheter ablation
Authors: Brahier Mark , Schwennesen Hannah , Vista Andrew , Friedman Daniel , Piccini Jonathan
Published: November 2024

Background:
Approximately 1 of 5 catheter ablations for atrial fibrillation (AF) are repeat procedures. Despite this, little is known about risk factors for recurrence in patients undergoing
repeat
ablation compared with those undergoing
de novo
ablation.

Objective:
To compare predictors of AF recurrence following
de novo
and
repeat
catheter ablation.

Methods:
To compare AF recurrence between those with and without prior ablation, we conducted a retrospective cohort study of patients undergoing catheter ablation for treatment of symptomatic and drug-refractory AF. In this analysis, early recurrence was defined as 30 seconds of AF, atrial flutter, or atrial tachycardia within a 3-month blanking period, while late recurrence was defined as recurrent arrhythmia at >3 months. Multivariable Cox proportional hazard regression analysis was used to identify independent factors associated with recurrence.

Results:
Among 659 patients, 487 (mean age 63.3 +/- 10.1 years, 33% female, CHA2DS2-VASc 2.8 +/- 1.8, 62% paroxysmal) underwent
de novo
ablation and 172 (mean age 65.1 +/- 10.0 years, 34% female, CHA2DS2-VASc 3.1 +/- 1.9, 60% paroxysmal) underwent
repeat
ablation with average follow up of 24.4+/-18.4 months. Multivariable modeling revealed that left atrial volume index (LAVi) [HR 1.015, p<0.0001], body mass index (BMI) [HR 1.025, p=0.043], and early recurrence [HR 2.496, p<0.0001] were predictive of late recurrence in the
de novo
ablation cohort, compared to LAVi [HR 1.014, p=0.006] and early recurrence [HR 2.053, p=0.001] in the
repeat
ablation cohort. Age, sex, AF type (paroxysmal vs non-paroxysmal), obstructive sleep apnea, heart failure, CHA2DS2-VASc scores, and energy source (cryoballoon vs radiofrequency) were not predictive of recurrence in either cohort (p>0.05). There was a trend towards higher probability of recurrence following
repeat
ablation (log-rank p=0.052).

Conclusion:
Predictors of late AF recurrence following
de novo
and
repeat
catheter ablation are similar at >2 years follow-up. The left atrial volume index and early recurrence are the strongest predictors of late recurrence.
Abstract 4141403: Age-, Sex- and/or Ethnic- specific disparities; Biventricular systolic and diastolic strain, and biomarker, prognostic implications in Acute Tuberculous Pericarditis.
Authors: Matshela Mamotabo
Published: November 2024

Background:
Two-dimensional speckle tracking echocardiographic (2D-STE) strain analysis is modern and inovatively useful in overcoming technical echocardiographic limitations. To-date no larger studies have assessed sub-clinical myocardial mechanics in acute tuberculous pericarditis (ATBP) and age/sex/ethnic differences, and synergistic-prognostic association of these parameters with patients' outcomes (survival).

Aim:
To assess the prognostic relation between age/sex/ethnitic differences with right (RV) and left (LV) ventricular systolic and diastolic strain (and other parameters/biomarkers) with outcome ATBP and preserved LV function.

Methods and results:
A total of 362 (mean age 37years, LVEF 56%, 57% males) consecutive patients with ATBP were enrolled and subseguently had 2D-STE strain analysis performed on their the 2D-TTE images. Sex, age and ethnic differences were assessd and all were prospectively followed for new CVS events
including new onset acute heart failure or deterioration in LV function, hospitalization for HF, CVS-related death, recurrent effusion or tamponade
.

The LV and RV longitudinal strain parameters were assessed using the 2D-STE. Of the 362 patients eligible for the study, 142 developed 84 new CVS-related events during a mean follow-up of 12 ±6 months. The RV free-wall, global RV and LV systolic and diastolic strain parameters, elevated NT Pro-BNP and troponins, RV fractional area change, low TAPSE, LV end-diastolic volume, LA volume index, moderate TR, and mPASP > 40mmHg were independently predictive of combined outcomes (p <.0001). ATBP demonstrated impaired RV>LV strain parameters and best performance predictive of CVS events was greatest for RV compared with LV strain. There was a stronger association between the degree of RV dysfunction and risk of CVS events for RV free wall- and global systolic and diastolic strain parameters and biomarker compared with LV strain parameters.
Male sex, older age (at least 42years) and black etnicity were further independent risk factors of outcomes.

Conclusion:
Patients with ATBP and normal LVEF, and myocardial mechanical dysfunction in addition to elevated biomarkers were stronger predictors of outcome more so for those with RV dysfuntion than other conventional and LV mechanical parameters. Male sex, older age and black ethnicity provided additional independent risk of outcomes in ATBP,
providing stronger prognostic stratification.
Abstract 4141419: Predictors of Mortality and Hospitalization in Heart Failure with Preserved Ejection Fraction with Low NT-proBNP Levels
Authors: Tajdini Masih , Jani Vivek , Tanacli Radu , Keykhaei Mohammad , Hahn Virginia , Sharma Kavita
Published: November 2024

Introduction:
Many patients with heart failure with preserved ejection fraction (HFpEF) have relatively low natriuretic peptide (NP) levels, often related to obesity. The predictors of mortality and hospitalization (CV outcomes) within HFpEF patients with low NT-proBNP levels remain unclear. In this study, we examined these predictors, comparing HFpEF with low NT-proBNP (HFpEF-LoBNP) and high NT-proBNP (HFpEF-HiBNP) groups.

Methods:
Patients from the Johns Hopkins HFpEF Clinic (July 2014 - May 2024) were categorized into HFpEF-LoBNP (<125 pg/mL) and HFpEF-HiBNP (≥125 pg/mL) groups. Diagnosis relied on clinical findings, standard echocardiography, and right heart catheterization when available. Group differences were analyzed using Chi-square or Mann-Whitney U tests. Cox models examined associations with CV outcomes, and Kaplan-Meier analysis assessed the combined factor impact on outcomes. Analyses compared within each BNP level category (HFpEF-LoBNP and HFpEF-HiBNP) those who experienced CV outcomes versus those who did not.

Results:
A total of 378 HFpEF patients were included, categorized as HFpEF-LoBNP (107 patients) and HFpEF-HiBNP (271 patients), with a median follow-up period of 36 months. Within the HFpEF-LoBNP group (mean age 59.5 years, 68% female), 26 (24.3%) experienced CV outcomes. HFpEF-LoBNP patients with CV outcomes had higher diabetes prevalence, HbA1c, RA pressure, PA systolic pressure, RV systolic pressure, PA diastolic pressure, PCWP, PVR, and lower albumin (Figure A) compared to HFpEF-LoBNP patients without CV outcomes. No significant differences were found in other characteristics. Within the HFpEF-HiBNP group (mean age 68.2 years, 59.4% female), 98 (36.2%) experienced CV outcomes. HFpEF-HiBNP patients with CV outcome were more likely to be on β-blocker therapy, had a higher E/e' ratio, NT-proBNP, cystatin C, uric acid, RV systolic pressure, PA systolic and diastolic pressures, PCWP, PVR, and lower albumin compared to those without CV outcomes (Figure B). There were no notable differences in other characteristics. Kaplan-Meier graphs showed poorer outcomes with an increasing number of factors in each subgroup (Figures C&D).

Conclusion:
NT-proBNP is linked to HF prognosis but often low in HFpEF. HFpEF-LoBNP patients still face high CV outcomes. Predictors of CV outcomes in HFpEF-LoBNP, similar to HFpEF-HiBNP, include higher pulmonary pressures. Alternative prognosis markers, like hemodynamic testing, are needed for HFpEF-LoBNP patients.
Abstract 4141421: Soluble adenylyl cyclase prevents cardiac rupture and adverse ventricular remodeling after myocardial infarction.
Authors: Siraj M. Ahsan , Lao Robert , Momen Abdul , Zarrin Khat Dorrin , Husain Mansoor
Published: November 2024

Background:
The ubiquitous second messenger cyclic adenosine monophosphate (cAMP) plays a key role in post-myocardial infarction [MI] remodeling, influencing apoptosis, inflammation, fibrosis and metabolism. Unlike transmembrane activators of cAMP,
soluble
adenylyl cyclase (sAC) represents a unique source of intracellular and mitochondrial cAMP, and metabolic sensor due to its ability to regulate oxidative metabolism and cell survival. However, a role for sAC in post-MI remodeling was not known.

Methods and Results:
Permanent LAD ligation was used to induce experimental MI in 10-12 wk old sAC knockout (

sAC
-/-

) mice and wild-type littermates (

sAC
+/+

) [
n
=26-31/group]. Compared to wild-type,

sAC
-/-

mice had more cardiac rupture events (17/26
vs.
13/31) and reduced survival at 28-d post-MI (35
vs.
58%, P<0.05). Echocardiography showed more cardiac dysfunction in

sAC
-/-

mice (LVEF: 20±4
vs.
28±4%, P<0.05). Heart to body weight ratio was higher in

sAC
-/-

mice (9.1±1.5
vs.
7.7±0.3 mg/g, P<0.05
)
with no differences in lung to body weight [n=15/group]. Importantly, no structural or functional cardiac differences were found between sham-operated

sAC
-/-

and

sAC
+/+

mice [n=6 each]. To elucidate underlying mechanisms, we assayed infarct size, hemodynamics, inflammation and fibrosis at 3-d post-MI, a time point that precedes cardiac rupture (
n
=10 each). Sections stained with 2,3,5-triphenyltetrazolium chloride reveal larger infarcts in

sAC
-/-

mice (43±2
vs.
37±2%, P<0.05). Pressure-volume loops show lower LVEF (31±1%
vs.
34±1%, P<0.05), cardiac output (21,634±825
vs.
25,515±612 µl/min, P<0.01), and stroke volume (39±1
vs.
46±1 µl, P<0.001) in

sAC
-/-

mice. Luminex® multiplex assay for cytokines and chemokines revealed higher serum TNFα (14±1.6
vs.
8.4±1 pg/ml), CCL5/RANTES (66.6±7.2
vs.
36.3±5 pg/ml) and MCP-1 (81.8±15
vs.
50±11.4 pg/ml) levels in

sAC
-/-
vs.

sAC
+/+

mice (P<0.05 for all comparisons), with no differences in IL-6, IL-1β, INF-γ, GM-CSF, G-CSF, IL-10, IL-12 and TGF-β. Finally, Masson’s trichrome staining demonstrated no differences in interstitial or perivascular fibrosis in

sAC
-/-
vs.

sAC
+/+

hearts.

Conclusion:
In an experimental mouse model of MI, sAC prevents cardiac rupture and adverse cardiac remodeling by reducing infarct size, improving cardiac function and limiting specific inflammatory cytokines. Further studies are needed to define which cell-types expressing sAC mediate these findings.
Abstract 4141426: Electronic Health Record-Integrated Platform for Patients with Severe Hypercholesterolemia and Familial Hypercholesterolemia Reveals Opportunities for Quality Improvement in a Large Healthcare System
Authors: Ingle Tanvi , Moon Jessica , Carter Spencer , Schneider Ruth , Ahmad Zahid , Basit Mujeeb , Khera Amit
Published: November 2024

Background:
Familial Hypercholesterolemia (FH) is a genetic predisposition to high LDL-C levels and premature atherosclerotic cardiovascular disease (ASCVD) that remains underdiagnosed and undertreated. We developed a patient registry within the EPIC (Epic Systems Corp., Verona, WI) electronic health record (EHR) system to identify patients who have severe hypercholesterolemia or FH. We illustrate how our platform reveals gaps in treatment and outcomes for these patients across a large academic medical center.

Methods:
We extracted health information for all living, adult patients from UT Southwestern Medical Center who have ever had an LDL-C >= 190 mg/dL or an FH diagnosis (ICD-10 E78.01) from our FH patient registry. Patients with only laboratory data and no other meaningful encounter or treatment data were omitted from the cohort. We characterized LDL-C levels across the patient cohort and determined the proportion who had seen cardiology or endocrinology, had an FH diagnosis, and received LDL-C lowering therapy. We further analyzed how many patients achieved LDL-C levels at goal (defined as LDL-C < 70 mg/dL for patients with ASCVD or LDL-C < 100 mg/dL for all others in the cohort). Data were extracted from EPIC’s Clarity reporting database.

Results:
Of the 7026 patients included in our study, the median age was 62 years, 64.5% were female, 56.7% were white, 16.3% had an unknown/declined race, 9.7% were Hispanic, and 14.2% had an unknown/declined ethnicity. The highest LDL-C among the cohort averaged 216.4 (±43) mg/dL. The most recent LDL-C values recorded averaged 158.5 (± 63.7) mg/dL. We found 6.7% of the cohort had an FH diagnosis, 38.1% were seen by cardiology or endocrinology, and 66.6% were prescribed an LDL-C lowering therapy (63.1% any statin, 53% high intensity statin, and 11.8% a non-statin therapy). Additionally, only 19.1% of those receiving treatment achieved LDL-C levels at goal.

Conclusion:
We showcased how an EHR-integrated patient registry can provide rapid insights into the status of FH and severe hypercholesterolemia care at an institution while also elucidating opportunities for targeted intervention. Since EPIC is the most prevalent EHR system in the United States, our methodology can be readily adopted to improve care of patients with severe hypercholesterolemia and FH on a national scale.
Abstract 4141427: Refining the risk of all-cause death at mid-term in pulmonary embolism using four-cardiac chambers myocardial strain analysis
Authors: Soulat-Dufour Laurie , Evain Isaure , LANG Sylvie , GERARD Manon , EDERHY Stephane , Chauvet-Droit Marion , Capderou Elodie , Arnaud Camille , Le Bos Pierre Antoine , Fagnen Pauline , Benoudiba Campanini Lucas , Boccara Franck , Cohen Ariel
Published: November 2024

Introduction:
In acute pulmonary embolism (PE), right ventricular (RV) remodeling and hemodynamic involvement using echocardiography data are associated with in-hospital prognosis. The impact on mid-term outcome of right atrial (RA), RV, left ventricle (LV), and left atrial (LA) involvement using myocardial deformation analysis is poorly evaluated.

Hypothesis:
We hypothesized that acute PE had a global impact on 4-heart cavities geometry and functions.

Aims:
We sought to evaluate the prognostic value at mid-term of myocardial strain of the 4-cardiac cavities in patients with acute PE.

Methods:
We retrospectively analyzed 488 patients hospitalized for acute PE. LV, LA, RA and RV strains were measured using speckle tracking transthoracic echocardiography (TTE) at admission. Primary outcome was mid-term all-cause mortality.

Results:
During a median follow-up of 3.6 (2.7-4.7) years, all-cause death occurred in 93 patients. At baseline, patients with the highest severity of PE, based on ESC risk score determination, had significantly lower LA (reservoir, conduit, contractile), RA (reservoir, conduit), LV (global, GLS) and RV (free wall) longitudinal strains (Figure 1). The optimal strain thresholds associated with mortality are displayed in Table 1: -19.1% for LV and RV, +36.4% for LA reservoir strain, +16.6% for LA conduit strain, +27.5% for RA reservoir strain, +16.0% for RA conduit strain. Kaplan Meier curves for cumulative hazards for all-cause death using strain parameters showed significant difference of survival according to LV GLS, RV free wall strain, LA and RA reservoir strains, LA and RA conduit strains (Figure 2).

Conclusion:
Beyond RV cavity remodeling and dysfunction, PE induces acute alteration of the 4-cardiac chambers strains. Strain analysis appears as an interesting tool in addition to conventional echocardiographic parameters to assess heart cavities dysfunction and predict mid-term outcome.
Abstract 4141518: Disparities in Associations Between Migraine and Cardiovascular Events: A Cross Sectional Cohort Study in the Veterans Health Administration
Authors: Seng Elizabeth , Schwartz Alexandra , Lipton Richard , Ezzti Ali , Sico Jason
Published: November 2024

The extent to which migraine is associated with cardiovascular events may differ across age, gender, racial and ethnic subgroups.

The current study uses the migraine cohort from the Headache Centers of Excellence VHA Headache Cohort. Migraine cases include veterans who had an International Classification of Disease-9/10 code of migraine in the VHA electronic health record between 2008-2023. Controls had no headache ever coded in their VHA electronic health record, and were matched on age, gender, race, ethnicity, and point of care the year of cohort entry (defined as the first year in which headache was diagnosed for the migraine group). Baseline cardiovascular events were extracted from the VHA electronic health record using validated algorithms from 6 months prior to cohort entry to 12 months following cohort entry. Separate logistic regression models evaluated the relationship between migraine vs. matched control and each cardiovascular outcome separately in the following subgroups: gender (men and women), age (18-49 and 50+), race (White and Black), and ethnicity (Non-Hispanic and Hispanic).

The cohort included 668,968 individuals with migraine and 1,337,937 non-headache controls. Overall, subgroup analyses found the strongest relationships between migraine (vs. matched control) and cardiovascular outcomes in younger adults (aged 18-49): ischemic stroke OR = 3.62, 95% CI = 3.33, 3.94; transient ischemic attack OR = 9.0, 95% CI = 7.65, 10.54; Notably, migraine was associated with higher odds of hemorrhagic stroke for younger adults (OR = 4.30, 95% CI =3.27, 5.66), but lower odds of hemorrhagic stroke in adults aged 50+ (OR = 0.28, 95% CI = 0.25, 0.31). An exception is acute myocardial infarction (MI), where the strongest relationship betwen migraine and acute MI was observed in adults aged 50+ (OR = 1.69, 95% CI = 1.57 1.83). Migraine (vs. matched control) was associated with slightly higher odds of heart failure among White patients (OR = 1.28, 95% CI = 1.23, 0.86), but slightly lower odds of heart failure among Black patients (OR = 0.92, 95% CI = 0.86, 0.9. ORs for cardiovascular events were relatively similar (e.g., within 1.0 OR) across gender, racial and ethnic groups.

This study shows that age is a particularly important factor in understanding the relationship between migraine and cardiovascular events.
Abstract 4141524: Patient education in cardiovascular disease in Sub-Saharan Africa: the “Heart School” pilot project at IPMS/Cheikh Anta Diop University of Dakar, Senegal
Authors: Ngaide Aliou Alassane , GAYE Ngone , Kane Abdoul
Published: November 2024

Background:
Patient education is a core component of cardiac rehabilitation program and a part of the consensus statement for Cardiac rehabilitation delivery model for low resource settings. To our knowledge, there is little to no evidence regarding cardiac patient education implementation in sub–Saharan Africa, despite all the benefits and the urgent need for prevention in our settings.

Purpose:
To describe a patient education (PE) pilot project named “the Heart School” at Cheikh Anta Diop University of Dakar.

Methods:
In this cross sectional study were included 45 patients addressed for a patient education program. Patient education was delivered on weekly one-on-one sessions. Content of the educational program is shown in figure 1. Progression was assessed through self-evaluation scales with scores ranging from 0 to 10 administered before and after the program. Data analysis was performed with SPSS version 18 with a level of significance set at p<0.05.

Results::
Coronary artery disease was the primary indication in 87% of cases. At the end of the program, there was a significant improvement in knowledge of the disease (4.5 vs. 7.4; p <0.001) and its treatment (4.7 vs. 6.8; p <0.001), as well as good practices of physical activity (4.5 vs. 7; p <0.001), cardioprotective diet (4.2 vs. 7; p <0.001) and motivation to change lifestyle (5.6 vs. 7.8; p <0.001).

Conclusion:
Results from this pilot project were promising. However long-term follow up is necessary to better assess the sustainability of these results.
Abstract 4141549: The Diagnostic Utility of the Longitudinal Myocardial Blood Flow Gradient is Dependent on the Magnitude of the Hyperemic Stimulus in Swine with an Epicardial Coronary Stenosis
Authors: Fees Alex , Palka Beth , Canty John , Weil Brian
Published: November 2024

Introduction:
The hyperemic longitudinal myocardial blood flow (MBF) gradient (i.e., hyperemic MBF from the base to the apex of the left ventricle) has been proposed as an emerging non-invasive index to identify hemodynamically significant epicardial coronary artery disease (CAD). However, whether the utility of this parameter is influenced by the magnitude of the hyperemic stimulus has not been studied. Accordingly, we measured the longitudinal MBF gradient at rest and during submaximal and maximal adenosine (ADO)-induced hyperemia in swine with a fixed epicardial coronary stenosis.

Methods:
Swine (n=11) were chronically instrumented with a fixed LAD stenosis (89±3%). Regional MBF was assessed with fluorescent microspheres at rest and during submaximal (150 or 300 µg/kg/min) and maximal (900 µg/kg/min) ADO vasodilation, with concomitant phenylephrine (8±3 µg/kg/min) during maximal ADO to avoid hypotension. Coronary flow reserve (CFR) was calculated as the quotient of MBF during ADO divided by MBF at rest and the longitudinal MBF gradient was calculated as the difference in absolute MBF between the base and apex of full-thickness myocardium in LAD (ischemic) and PDA (non-ischemic) perfusion territories.

Results:
ADO elicited a dose-dependent increase in MBF that was blunted in the LAD perfusion territory vs. the PDA perfusion territory, such that a dose of at least 300 µg/kg/min was necessary to identify a significant regional difference in CFR (
Figure A
). The longitudinal MBF gradient was negligible in the normally perfused region of the left ventricle at rest and across all ADO doses. In contrast, an abnormal decrease in the longitudinal MBF gradient was evident In the LAD perfusion territory, but only when ADO was given at a dose of at least 300 µg/kg/min (
Figure B
).

Conclusion:
These results demonstrate that a proximal LAD stenosis leads to an abnormal decrease in the base-to-apex perfusion gradient during ADO hyperemia in swine. However, the reduction in the longitudinal MBF gradient is not evident at relatively low doses of ADO, suggesting that the diagnostic utility of this parameter is dependent on the magnitude of the hyperemic stimulus.
Abstract 4141571: Association of Ambient Air Pollution with Pulmonary Hemodynamics and Long-term Survival in Patients with Pulmonary Arterial Hypertension: A Multi-center Cohort Study in China
Authors: zhang sicheng , Gao Luyang , Li Sicong , Luo Manqing , Xi Qunying , Lin Ping , Zhao Zhihui , zhao qing , Yang Tao , Zeng Qixian , Huang Zhihua , Li Xin , Duan Anqi , Wang Yijia , Luo Qin , Guo Yan-Song , Liu Zhihong
Published: November 2024

Background:
Although ambient air pollution exposure has been linked with increased mortality in many cardiovascular or pulmonary diseases, its relationship with pulmonary arterial hypertension (PAH) is still unknown. The present study aims to investigate the association of ambient particulate matter (PM) exposure with pulmonary hemodynamics and long-term survival in patients with PAH in China.

Methods:
This retrospective multi-center cohort study included 1511 participants who underwent invasive right heart catheterization and were eventually diagnosed with PAH from January 2014 to December 2020. The primary outcome was transplant-free survival from the time of diagnosis. The association of PM
2.5
and PM
10
with all-cause death or lung transplantation was assessed by fitting Cox proportional risk models. Generalized linear models were used to examine the relationship between PM exposure and pulmonary hemodynamic severity at baseline. Restricted cubic splines were used to describe exposure-response curves. Mediation analysis with bootstrap method was used to explore whether potential variables mediated the associations.

Results:
During a median follow-up of 36.7 months, all-cause death or lung transplantation occurred in 149 patients. Per 10 µg/m
3
increase of PM
2.5
and PM
10
were associated with 14.5% and 7.9% increased risk of primary outcomes adjusting for potential confounding variables, respectively. PM
2.5
and PM
10
were associated with European Society of Cardiology risk stratification and with pulmonary hemodynamics at baseline, in particular pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP), cardiac index, and mixed venous oxygen saturation (S
V
O
2
). Effect of PM may be mediated in part by impaired glucolipid metabolism and inflammation-associated lymphocyte.

Conclusions:
Particulate matter exposure was associated with disease severity and pulmonary hemodynamics at baseline in patients with PAH, and higher chronic exposure to PM
2.5
and PM
10
independently predicted shorter transplant-free survival.