bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145246: Regional Disparities in the Cardiology Workforce: Insights from the U.S. Bureau of Labor Statistics
Authors: Rathore Azeem , Younas Hafiz Muhammad Waqar , Hanna Daniel , kronen tara , Upreti Prakash , Mathur Pankaj , Kadariya Dinesh , Alraies M Chadi
Published: November 2024

Background:
Access to cardiology services remains a persistent challenge. Identifying regional disparities in the workforce can help inform healthcare policies toward equitable access of cardiologists.

Methods:
We conducted a cross-sectional analysis of the 2023 U.S. Bureau of Labor Statistics report, focusing on employment estimates, mean wages, and location quotients (LQs) for cardiologists. Data was aggregated at national, state, and metropolitan levels.

Results:
Nationally, 15,190 cardiologists were employed, with a mean annual wage of $421,330. Regional disparities in wages were apparent, with Northeastern states like New York ($402,840), New Jersey ($331,430), and Connecticut ($381,730) offering higher salaries while states like Utah ($267,030) and South Carolina ($287,360). The states with the highest LQs were Connecticut (2.47), Rhode Island (2.46), and Delaware (2.07) while Louisiana (0.16), South Carolina (0.22), and Utah (0.29) had the lowest LQS. Urban areas like Boston-Cambridge-Nashua, MA-NH (1.39) and New York-Newark-Jersey City, NY-NJ-PA (2.14) demonstrate robust demand, while regions like Cedar Rapids, IA (3.28) and Winchester, VA-WV (4.63) display concentrated demand despite lower employment figures.

Conclusion:
Significant regional gaps in cardiologist employment and compensation exist across the U.S., particularly pronounced in urban centers with advanced healthcare infrastructure. States with historically lower health outcomes, such as Mississippi and West Virginia, also had lower LQs highlighting the ongoing demand for specialized care, such as cardiology. States like Utah, which rank highly in many health outcomes, show low demand for cardiologists despite a low LQ, indicating a healthcare system meeting patient demands. By aligning healthcare resources with the specific needs of each region, policymakers can work toward achieving more equitable healthcare access and improved health outcomes nationwide.
Abstract 4145249: THE TWO-HIT HYPOTHESIS?: NEW ONEST SEVERE CARDIOMYOPATHY AND CARDIAC ARRYTHMIA IN A HIGH RISK PATIENT WITH NEUROGENIC ORTHOSTATIC HYPOTENSION ON DROXIDOPA
Authors: Htay Yan Naung , Victor Varun , Murugesan Lakshmi , Ri Thi , Annappah Dilanthy , Sikandar Billal , Qureshi Ataul , Koene Ryan
Published: November 2024

Introduction:
Droxidopa (DD) is the second FDA approved drug after midodrine for neurogenic orthostatic hypotension (nOH). Isaacon et al reported that 19 (5.4%) of total 350 patients on droxidopa had 25 cardiac events, most commonly atrial fibrillation in a mean duration of 363 days. Currently, limited long term cardiovascular safety data is available. We encountered a patient with nOH on DD, who developed symptomatic frequent premature ventricular contractions (PVCs) and severe cardiomyopathy (CM).

Case:
A 52-year-old woman with a long-standing nOH had persistent lightheadedness, dizziness, presyncope and hypotension despite midodrine, fludrocortisone, and non-pharmacological measures. Her past medical history was significant for nodular lymphocyte dominant Hodgkin lymphoma status post AVBD chemotherapy in 2001, with recurrence in 2012, which was treated with autologous stem cell transplantation.

Patient was switched to DD from midodrine for nOH and responded well. However, she developed frequent PVCs(13%), left bundle branch block(QRS 127 ms), with new onset CM approximately 2 years later. The ischemic work-up with coronary angiography was normal and cardiac MRI showed no late gadolinium enhancement. DD was stopped and patient was started on GDMT for HFrEF with subsequent improvement in PVC burden(1%). GDMT uptitration was limited due to hypotension. Without EF recovery up to 2 years, she received CRT-D placement.

Discussion:
CM after anthracycline therapy is rare after 5 years. Our patient’s last exposure to doxorubincin was 17 years before the onset of CM. Serial echocardiograms showed normal cardiac function over years. A potential association of developing takotsubo cardiomyopathy was suggested in patients on DD by Sato et al, the potential mechanism being the increased adrenergic drive. The rapid development of non-ischemic, non-infiltrative CM and cardiac arrythmia, which subsequently improved by stopping the DD, is alarming for DD’s potential side effect.

Conclusion:
Caution should be taken in prescribing DD in patients with nOH, who are at higher risk for development of cardiac arrythmia and cardiomyopathy. Further studies and data are needed in identifying or excluding the potential cardiovascular side effects.
Abstract 4145271: Systemic Lupus Erythematosus-Induced Libman-Sacks Endocarditis Complicated by Multiple Embolic Episodes and Atypical Secondary Valve Involvement
Authors: Roberts Jacob , Cho David
Published: November 2024

A 42-year-old female with SLE, lupus cerebritis with related seizure disorder, and mesenteric venous thrombosis on warfarin initially presented for syncope. Acute stroke workup was negative, and syncope was attributed to possible brief seizure. Six months later, the patient was evaluated by cardiology for hypertension diagnosed during hospitalization. She reported no further syncope, but exam revealed a 3/6 holosystolic murmur. Subsequent TTE identified severe MR with primary MV degeneration and LVEF >60%. A TEE confirmed severe MR with myxomatous MV leaflets and moderate-sized nonmobile vegetations attached to the atrial side of A2 and P2 of the MV. Subsequent infectious workup including serial blood cultures were negative. The patient was diagnosed with non-bacterial Libman-Sacks endocarditis (LSE). Given a lack of symptoms and plan to resume immunosuppressive therapy and continue her anticoagulation (AC), surgical intervention was initially deferred with close follow-up.

The patient continued to endorse worsening headaches and brain MRI revealed new chronic small ischemic strokes. One morning, the patient noted sudden aphasia and presented to the ED. Stroke workup revealed an acute ischemic stroke with total left M2 occlusion of her MCA, and she underwent thrombectomy. Cerebral angiogram further revealed FMD. Given ongoing embolic phenomena, likely from LSE, she underwent MVR with mechanical valve and LA appendage ligation and continued mycophenolate and warfarin. Two months postoperatively, the patient remained asymptomatic with normal prosthetic valve function and neurologic status. However, evaluation for extracranial FMD with CTA revealed interval development of PV vegetations. These lesions and moderate PR were confirmed on TTE.

Discussion:
While response to immunosuppressive therapy and AC has been reported to improve early-phase LSE, this patient continued to experience thromboembolic events resulting from LSE vegetations while on mycophenolate and warfarin. Despite continuing these therapies after MVR, she later developed PV vegetations and PR. Pulmonary valve involvement is rare in LSE, and development of new disease while on recommended medical therapy represents unusual disease progression.
Abstract 4145278: Higher Long-Term Variability In Metabolic Parameters From Childhood Is Associated With Poorer Midlife Cognitive Function: The Bogalusa Heart Study
Authors: Kang Soo Jung , De Anda-Duran Ileana , Gill Eunsun , Fernández Alonso Camilo , JIN XUANYI , Bazzano Lydia
Published: November 2024

Background:
Metabolic syndrome (MetS), a cluster of risk factors, has been linked to higher risk of dementia in older adults. However, the composite impact of long-term variability of metabolic parameters from childhood on midlife cognitive function is unclear.

Methods:
We studied 1145 midlife participants of the Bogalusa Heart Study (age at enrollment: 12.2 ± 5.4 years, follow-up: 36.1 ± 3.4 years, age at last exam (midlife): 48.3 ± 5.0 years, 60.9% women, 33.7% Black participants) with ≥3 measurements of metabolic parameters (systolic blood pressure (SBP), fasting blood glucose (FBG), triglyceride (TG), high density lipoprotein (HDL), and body mass index (BMI)) across follow-up. MetS was defined by the National Cholesterol Education Program guidelines, but using BMI >30 kg/m
2
for abdominal obesity. Long-term variability of SBP, FBG, TG, HDL, and BMI from childhood were measured as the residual standard deviation (RSD). Repeated measurements of each parameter were fitted in random-effect models to obtain individual growth curves. Using the growth curves, RSD was obtained as the SD of the difference between each observed and predicted parameter level. A composite variability score (range, 0-10) was defined by 1) assigning 0 points to the lowest tertile of RSD and 2 points to the highest tertile for each parameter, then 2) summing the points for all 5 parameters. Midlife cognitive function was measured by 8 neuropsychological (NP) tests. NP test results were categorized into 3 distinct NP profiles (optimal, average, mixed-low) using cluster analysis. Associations between the composite variability score and NP profiles were analyzed using multinomial logistic regression models, adjusting for education status. Sensitivity analysis excluding participants with MetS at midlife were also performed.

Results:
A total of 348 (30.4%) participants had MetS at midlife. The odds of having mixed-low cognitive function at midlife increased by 13.3% (OR 1.13, 95% CI 1.03, 1.24) for a 1-unit increase in the composite variability score, compared to optimal cognitive function, adjusted for education status. Sensitivity analysis showed consistent results in participants without MetS at midlife (OR 1.18, 95% CI 1.05, 1.33).

Conclusions:
A graded association was observed between composite long-term variability in metabolic parameters from childhood and poorer midlife cognitive function. Lowering variability of metabolic parameters may be beneficial to midlife cognitive function.
Abstract 4145308: Mechanical Circulatory Support in Cardiogenic Shock Secondary to Acute Myocardial Infarction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials
Authors: Neves Henrique Alexsander , Romaniello Gabriela , Collini Michelle , Reginato Pedro Henrique , Makita Luana Miyahira , Kojima Giovana Schlichta , da Rocha Guilherme , Amarilla Victor Galvani , Antunes Vanio do Livramento Junior , Lenci Marques Gustavo
Published: November 2024

Background:
Cardiogenic shock is a leading cause of mortality in acute myocardial infarction. The efficacy of mechanical circulatory support devices in reducing mortality is uncertain.

Research Question:
Which mechanical circulatory support device is associated with lower mortality and better safety outcomes in patients with cardiogenic shock?

Goals/Aims:
To compare different mechanical circulatory support devices in patients with cardiogenic shock.

Methods:
We conducted a systematic search of PubMed, Embase, and Cochrane Library databases up to April 2024 for randomized controlled trials (RCTs) involving mechanical circulatory support devices (e.g., Impella, ECMO, IABP, percutaneous ventricular assist device) reporting at least 30-day mortality or safety outcomes (bleeding, cerebrovascular events, sepsis). Two reviewers independently extracted data on mortality and safety outcomes. A frequentist network meta-analysis with random-effects models was used, calculating risk ratios (RR) with 95% confidence intervals (CI) and treatment ranking probabilities (P-SCORE).

Results:
Our systematic review and network meta-analysis included 15 RCTs, involving 1,927 patients, comprised of 77.6% of males with a mean age of 63.1 years, from Europe, North America, and Asia. No device reduced 30-day mortality. IABP had a lower risk of bleeding compared with Impella (RR 0.34; 95% CI 0.17-0.7), while ECMO had a higher bleeding risk compared with no support (RR 1.97; 95% CI 1.18-3.28). Regarding long-term mortality (30 + 180 days), ECMO showed a higher risk compared with Impella (RR 1.22; 95% CI 1.01-1.46). IABP led to fewer cerebrovascular events (RR 0.37; 95% CI 0.15-0.93) and sepsis (RR 0.54; 95% CI 0.35-0.83) compared with Impella. No significant differences were found in other comparisons.

Conclusion:
No mechanical circulatory support device significantly reduced 30-day mortality in patients with cardiogenic shock. IABP was associated with lower risks of bleeding, cerebrovascular events, and sepsis compared with Impella. ECMO showed a higher risk of bleeding compared with no support and higher long-term mortality compared with Impella. Further research should focus on identifying safer strategies and optimal patient profiles for these devices to improve outcomes.
Abstract 4145313: Efficacy of self-expandable versus balloon-expandable Transcatheter aortic valve replacement in severe aortic stenosis patients: A systematic review and meta-analysis of randomized control trials.
Authors: Scardini Pedro Gabriel , Prata Alonzo , Katsuyama Eric , Coan Ana Carolina , Fukunaga Christian , Falco Neto Wilson , Fernandes Julia , Petri Santos Pinheiro Rafael , Andrade Naieli , Gioli-Pereira Luciana
Published: November 2024

Background:
Transcatheter aortic valve replacement (TAVR) has become the primary treatment for severe aortic stenosis, surpassing surgery in multiple trials. However, there is limited evidence between self-expandable valves (SEV) and balloon-expandable valves (BEV). Therefore, we performed a systematic review and meta-analysis comparing the efficacy of SEV and BEV undergoing TAVR in severe aortic stenosis patients.

Methods:
We systematically searched Pubmed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing SEV and BEV in patients with severe aortic stenosis. Our primary endpoint was (1) All-cause mortality. Additionally, we reported the following secondary outcomes:(2) stroke, (3)all-cause mortality within 30 days, and (4) stroke within 30 days. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.

Results:
Our meta-analysis included six RCTs comprising 3488 patients, of whom 1617 subjects (46.3%) underwent SEV. The mean age was 81 years, and the mean follow-up was 2 years. In the pooled analysis, our results show no significant difference in all-cause mortality (RR: 0.95; CI 95%: 0.81,1.12; p= 0.56; Fig. 1A ) and stroke (RR:0.97; CI 95%: 0.72,1.32; p= 0.86; Fig. 2A) between SEV and BEV in patients with severe aortic stenosis undergoing TAVR. Our 30 days follow-up analysis also showed no significant change in all-cause mortality (RR: 1.74; CI 95%: 0.88,3.45; p= 0.11; Fig. 1B) and stroke (RR: 0.59; CI 95%: 0.17,1.98; p= 0.39; Fig. 2B).

Conclusion:
In this meta-analysis comparing SEV versus BEV in patients undergoing TAVR in patients with severe aortic stenosis, there was no significant difference between all-cause mortality and stroke. These findings were consistent in our 30-day follow-up subanalysis.
Abstract 4145337: Evaluating Complications And Healthcare Utilization Of Intravascular Ultrasound Guided Percutaneous Coronary Interventions: A Retrospective Observational Study
Authors: Thakkar Aditya , Gupta Soumya , Sanku Koushik , KOMMINENI SAI KARTHIK , Namburu Lalith , Kumar Dilpat , jbara manar , patel jeetendra
Published: November 2024

Background:
While using intravenous ultrasound(IVUS) during Percutaneous interventions(PCI) enhances lesion assessment, stent placement, and procedural precision, it may also potentially increase procedural costs and complications.

Research Question:
This study aims to evaluate the outcomes, complications, and healthcare utilization associated with IVUS-guided PCI.

Method:
We conducted our study utilizing data from the nationwide inpatient sample database from January 2016 to December 2020. The study cohort comprised 444,571 hospitalized patients who underwent PCI during their hospitalization. We compared the outcomes of interventions with the use of IVUS and those without. The primary outcome was inpatient mortality. Secondary outcomes were the length of stay, cost of hospitalization, in-hospital and procedural complications as well as the need for life-saving interventions.

Results:
Among 444,571 patients who underwent PCI, 37,482(8.4%) had IVUS used during their procedure. Among the study population, 67.3% were male, 75.4% were white, 9.5% were black and the remaining 15.1% comprised of other races. The average age of the population was 65.37 years. All outcomes in this study were adjusted for age, race, sex, and comorbidities using the Charlson comorbidity index.

Cases that utilized IVUS experienced a significant reduction in in-patient mortality. However, they did have an increased risk of acute renal failure and ventricular arrhythmias. There was also an increase in procedure-related complications like access site-related hematoma, access site-related infection, deep venous thrombosis, coronary artery dissection, and coronary artery aneurysm. They also had an increased need for interventions like dialysis, extra-corporeal membrane oxygenation, pressors, and blood transfusions. Additionally, this group also had a significantly higher length of stay (mean 5.2 days vs. 4.9 days, p<0.001), and cost of hospitalization ($134,914 vs. $117,411, p<0.001).

Conclusion:
Although IVUS-guided PCI is linked to an uptick in certain complications and overall healthcare costs, it concurrently shows a decrease in in-hospital mortality. This contrast paints a complex picture; the modest increase in risk is counterbalanced by a critical mortality benefit. Ultimately, the benefits of potentially improved survival rates may justify the use of IVUS in PCI, particularly in settings where precision and detailed assessment can significantly impact patient outcomes.
Abstract 4145342: GLP-1 Agonists are Associated with Fewer Unplanned Hospital Visits in Patients with Cardiovascular Disease and Comorbid Substance Use Disorder
Authors: Javed Jahanzeb , Spadaro Anthony , Cinevert Emillie , Simmons Benjamin , Gordon Emily , Gardin Julius
Published: November 2024

Background:
Improved outcomes related to the use of glucagon-like peptide 1 (GLP-1) agonists in patients with cardiovascular disease (CVD) have been well documented. Small studies have shown benefits of GLP-1 agonists in reducing substance use in patients with substance use disorders (SUDs). In patients with CVD, co-occurring SUDs are known to worsen outcomes. The use of GLP-1 agonists to improve outcomes related to both CVD and SUD could improve healthcare disparities in this marginalized population.

Hypothesis:
The use of GLP-1 agonists in patients with CVD and SUD could improve outcomes related to both disease processes.

Aim:
Our aim is to describe clinical outcomes in patients with CVD and SUD who were prescribed GLP-1 agonists.

Methods:
This is a single-center retrospective cohort study of patients with CVD and SUD on a GLP-1 agonist. As previous studies have shown that change in body mass index (BMI) correlates with adherence to GLP-1 agonists, we stratified subjects by change in BMI over a two-year study period. Using SPSS, we analyzed number of hospital visits and conducted frequency analyses by type of CVD, type of SUD, and change in BMI during our study period.

Results:
The study population consists of 81 patients on GLP-1 agonists who have SUD and CVD. BMI decreased in 55 patients (67.9%), increased in 24 patients (29.6%), and remained the same in 2 patients (2.5%). Correlation analysis was conducted between change in BMI and the number of hospital visits related to SUD and CVD, indicating positive correlation between change in BMI and reduction in hospital visits related to both SUD (r=0.136, p= 0.230) and CVD (r=0.142, p= 0.208). Subgroup analyses were also performed by specific SUD type; patients with cocaine, cannabinoid, or alcohol use disorders had decreased hospital visits related to CVD (p<0.05) while those with opioid or polysubstance use disorders did not (Table 1).

Conclusion:
GLP-1 agonists, previously established to reduce adverse CVD outcomes, may be especially beneficial in patients with both CVD and SUD. More research is needed to determine how to optimize the benefit from treatment with GLP-1 agonists in this vulnerable patient population.
Abstract 4145353: Sex Differences in Post-PCI Myocardial Injury and Long-Term All-Cause Mortality
Authors: Graves Claire , Talmor Nina , Kozloff Sam , Major Vincent , Shah Binita , Babaev Anvar , Razzouk Louai , Attubato Michael , Rao Sunil , Feit Frederick , Slater James , Smilowitz Nathaniel
Published: November 2024

Background:
Myocardial injury complicating percutaneous coronary intervention (PCI) is associated with mortality, but sex differences in outcomes are uncertain. We explored sex differences in the incidence and long-term outcomes of post-PCI myocardial injury (PPMI).

Methods:
Adults who underwent PCI at NYU between 2011-2020 were included in this retrospective analysis. Patients with ACS as the indication for PCI were excluded. PPMI was defined as a peak CKMB concentration >99% of the upper reference limit. The incidence of PPMI by sex was compared by Chi-square tests. Independent predictors of elevated CKMB post-PCI were evaluated with linear regression models in subgroups by sex. Cox proportional hazard models were generated to evaluate relationships between PPMI and all-cause mortality by sex.

Results:
Of 10,807 adults undergoing PCI, 24.9% (2,694) were female. Females were older than males at the time of PCI (68.9 vs. 65.8, p<0.001), more likely to have stage ≥3 CKD (30.3% vs. 23.9%, p<0.001), and had shorter target lesion lengths (mean 24.6mm ± 18.3 vs 28.1mm ± 20.5, p<0.001). PPMI was less common among females than males (14.1% vs. 17.7%, p<0.001). Among females, older age, longer lesion length, multivessel PCI, severe vessel calcification, and thrombectomy device use were independently associated with higher post-PCI CKMB concentrations. Among males, older age, longer lesion length, vessel calcification, and atherectomy device use were associated with higher post-PCI CKMB concentrations. Over 4.3 year mean follow-up, 131 (4.9%) females and 341 (4.2%) males died. Males with PPMI had a greater risk of long-term death than males without PPMI (p<0.001) (Figure 1), while in females PPMI was associated with a trend towards excess mortality that did not reach statistical significance (p=0.064). No significant sex interaction was observed in the association between PPMI and mortality (p=0.38).

Conclusions:
In this large, single-center experience, female patients had less extensive coronary artery disease and were less likely to develop PPMI than males. Myocardial injury was associated with higher long-term mortality overall and among males with no significant interactions between sex and mortality.
Abstract 4145354: Sex Differences in Body Composition of Heart Failure Patients and its Relationship with Exercise Performance
Authors: Yang Taeil , Lee Jooyeon , Kim Moojun , Oh Jaewon , Lee Chan Joo , Kang Seok-min
Published: November 2024

Introduction:
Bioelectrical impedance analysis (BIA) is a non-invasive method to assess body composition and fluid status. The aim of this study was to investigate the differences in body composition and exercise performance by HF type and sex.

Methods:
This study is a retrospective analysis of patients with HF who had left ventricular ejection fraction (LVEF) <50% in a single tertiary center from August 2020 to December 2022. A total of 302 patients underwent body composition assessment using BIA, and exercise capacity was measured with a 6-minute walk test (6MWT). The type of HF was divided into ischemic and non-ischemic HF (NIC-HF). Ischemic heart failure (IC-HF) was defined as the presence of a history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery.

Results:
The median age of the study participants was 64 [IQR: 54.3 - 72] years old, and 209 individuals (69%) were men. Among male patients, 78 (37%) had IC-HF and 131 (63%) had NIC-HF. Among female patients, 17 (18%) had IC-HF and 75 (82%) had NIC-HF.

There was no statistical difference in skeletal muscle mass, total muscle mass, body fat mass, and visceral fat area between the NIC-HF and the IC-HF groups in men. However, the IC-HF group had higher body mass index (27.5kg/m
2
vs 24.2kg/m
2
, p=0.009), body fat mass (p=0.002), and visceral fat area (p=0.002) than the NIC-HF group regardless of age, although there was no difference in total muscle mass (p=0.129) and body weight (64.3kg vs 58.4kg, p=0.07) in women.

The 6MWT did not show any differences by HF type in men. However, in women, the IC-HF group had a shorter 6MWT distance than the NIC-HF group (p=0.02). The increased visceral fat area showed an association with a shorter 6MWT distance in both women (p=0.004), regardless of age and type of HF.

Conclusion:
After adjustment for age, there were no statistical differences in body composition between the two HF groups in the males. Unlike men, women had lower exercise capacity in the IC-HF group than in the NIC-HF group, which may be partly explained by the relationship between the difference in visceral fat area and exercise capacity according to heart failure type in women.
Abstract 4145357: Detecting ST Elevation Myocardial Infarction on a Noisy Single Limb-lead ECG: An Artificial Intelligence-enabled Approach Adaptable to Portable Devices
Authors: Dhingra Lovedeep , Khunte Akshay , Shankar Sumukh , Khera Rohan
Published: November 2024

Background:
While wearable and portable devices recording 1-lead ECGs can potentially enable accessible cardiovascular disease detection, most capture a single limb lead (lead I) that is clinically insufficient to define STEMI. Moreover, the acquisition is noisy. We sought to evaluate if an artificial intelligence (AI) algorithm can detect STEMI and its subtypes based on location (anterior, inferior, lateral, posterior) from noisy 1-lead ECG tracings.

Methods:
We extracted lead I data from ECGs in patients at a large and diverse US health system (2015-2023) to train a multi-label convolutional neural network (CNN) for detecting STEMI and its different subtypes. To ensure that the CNN identified the STEMI signature independent of associated findings, every ECG with STEMI (case) in the training set was matched to 10 ECGs without STEMI (controls) but with the same age profile, sex, and other rhythm and conduction disorders. Each ECG recording was augmented with random Gaussian noise during training to mimic real-world noises of specific frequencies, including muscle tremors, electrode motion, and others. The model was evaluated in a held-out test set of lead I tracings from ECGs recorded during ED visits for patients with chest pain.

Results:
We used 49,995 lead I ECGs from 39,697 individuals (65 years [IQR, 52-76], 18,926 [48%] women, 5,941 [15%] Black) for model development. The held-out test set included one ECG each from 7551 patients, including 104 (1.4%) with STEMI (84 anterior, 103 inferior, 72 lateral, 7 posterior STEMI). The model achieved high discrimination (AUROC of 0.828 [95% CI, 0.777-0.875]) for detecting STEMI from lead I ECGs in the test set, with AUROCs of 0.734 (0.656-0.802) for anterior, 0.769 (0.726-0.818) for inferior, 0.849 (0.787-0.889) for lateral, and 0.747 (0.518-0.968) for posterior STEMI. Overall, the model had a sensitivity of 91.5% (85.6-96.9), and a specificity of 43.0% (41.8-43.9), with consistent performance among demographic subgroups.

Conclusion:
A noise-adapted AI model using only 1-lead ECG tracings was able to identify various subtypes of STEMI with moderate to high accuracy. Using portable ECG devices and smartwatches, an AI-ECG approach can enable first-line triaging in individuals with chest pain, facilitating early detection of STEMI in the community and high-acuity settings.
Abstract 4145358: Cardiovascular Outcomes of Glucagon-Like Peptide 1 Receptor Agonists in Patients with or without Diabetes Mellitus, A Meta-Analysis of Randomized Controlled Trials:
Authors: Khan Muhammad Aslam , Aafreen Asna , Bhatia Hitesh , Muhammad Anza , Bhattarai Shraddha , Akbar Usman , Adil Abid Nawaz Khan , Sharma Saurabh
Published: November 2024

Objectives:
Glucagon-like peptide 1 receptor agonists (GLP-1RA) have emerged as a class of antihyperglycemic agents that also reduce major adverse cardiovascular events (MACE), as proven by multiple recent randomized controlled trials (RCTs). This meta-analysis aims to present up-to-date evidence on the cardiovascular benefits of GLP-1 RA in patients with and without diabetes.

Methods:
After a detailed search of the PUBMED, COCHRANE, EMBASE and MEDLINE databases from their inception until May 2024, 12 RCTs comparing GLP-1 RA with placebo were included in this study. The outcomes of interest were MACE (composite of death from cardiovascular causes, myocardial infarction, and stroke), cardiovascular (CV) mortality, all-cause mortality, myocardial infarction (MI), heart failure (HF) hospitalizations, and the incidence of atrial flutter and atrial fibrillation. The results were reported as risk ratios (RR) with 95% confidence intervals (CI) using random effects model.

Results:
This study included 84,362 participants from 12 RCTs, with a median follow-up period of 12-60 months. Patients receiving GLP-1 RA showed significant reductions in MACE (RR: 0.86, 95% CI: 0.82-0.92, p=0.00001), all-cause mortality (RR: 0.87, 95% CI: 0.83-0.91, p=0.00001), CV mortality (RR: 0.86, 95% CI: 0.80-0.92, p=0.0001), MI (RR: 0.88, 95% CI: 0.80-0.96, p=0.006), and HF-related hospitalizations (RR: 0.85, 95% CI: 0.73-0.98, p=0.02) compared to those receiving placebo. No significant difference was observed in the incidence of atrial fibrillation or flutter between the two treatment groups.

Conclusion:
The use of GLP-1RA in patients, regardless of their diabetes mellitus status, reduces the incidence of MACE, MI, death, and HF-related hospitalization. These results further support the use of this class of medication in eligible patients.
Abstract 4145362: Sex Differences in Mortality Following ST-Elevation Myocardial Infarction between 2019-2023 : Insights from the Northern New England Cardiovascular Disease Study Group
Authors: Lin Isabelle , Gupta Tanush , LAHOUD Rony , Chaudry Hannah , Rothstein Eric , Lutz Daniel , Ross Cathy , Flynn James , Hassan Ansar , Devries James
Published: November 2024

Background:
Women have historically had higher mortality following STEMI than men. The difference in mortality is in part related to higher bleeding rates in women when compated to men. Little is known about the mortality differences in women versus men in the current era of radial first and other bleeding avoidance stategie for PCI.

Methods:
We queried in the NNE database to identofy all PCI cases between 2019 and 2023. From the dataset, patients who underwent PCI for an indication of STEMI were identified, and demographic as well as procedural variables were collected. Patients with shock prior to PCI were excluded. In-hosptial outcomes were assessed including bleeding and need for transfusion. Mortality was obtained from discharge vital status. Standard statisical methods were used to assess significance of differences, using STATA for calculations.

Results:
A total of 22,681 pateints were identified who underwent PCI between 2019 and 2023. Of these, 4,356 (19.2%) underwent PCI for STEMI and did not have shock. Of the patients with STEMI, 3,198 (73.4%) were men and 1,158 (26.6%) were women. When compared with men, women tended to be older, have smaller BSA, and similar BMI. Procedurally, the percent radial cases and IIBIIIA receptor inhibitor use were similar between men and women. In-hospital mortalty was 3.3% for women and 1.7% for men (p<0.01) during this time period. Bleeding rates and need for transfusion were not different between men and women (Table 1).

Conclusions:
Desipite similar rates of radial access and bleeding, women undergoing PCI for STEMI in Northern New England continue to have nearly double the mortality of men. More study is needed to understand these diferences and optmimize outcomes for women.
Abstract 4145402: The Role of Extracorporeal Membrane Oxygenation in Advanced Peripartum Cardiomyopathy Requiring Heart Transplant: A Case Report
Authors: Toledo-Elias Renata , Aguilar Regina , Figueroa Méndez Rodrigo , Manzur-Sandoval Daniel , Rojas-Velasco Gustavo
Published: November 2024

INTRODUCTION:
Peripartum cardiomyopathy (PPCM) is a form of systolic heart failure, which occurs late in pregnancy or within the first 5 months postpartum and it is the most common cause of death related to heart failure in pregnant women. To establish the diagnosis, other causes of heart failure must be ruled out and a left ventricular ejection fraction (LVEF) <45% must be present. Prognosis can range from complete recovery of the heart function to progressive deterioration with the need for mechanical circulatory support and heart transplant.

DESCRIPTION OF CASE:
We present the case of a 33-year-old woman with a 5-year history of PPCM. She was enrolled in the heart transplant program for progressive deterioration of cardiac function with an LVEF of 31%. The patient was admitted to the emergency department due to progressive dyspnoea and signs of low cardiac output and treatment for decompensated heart failure was established. Initially, she remained stable, however, on the fifth day of hospitalization the patient presented an event of monomorphic ventricular tachycardia and sudden hemodynamic deterioration. The diagnosis of cardiogenic shock was established, which was refractory to medical treatment, therefore an intra-aortic balloon pump was implanted and an extracorporeal membrane oxygenation (ECMO) system with veno-arterial configuration was placed.

After 4 days of ECMO assistance, the patient showed hemodynamic improvement, therefore vasopressor and inotropic support were gradually reduced and she was weaned off mechanical support. Afterwards, given the availability of an organ, a bicaval orthotopic heart transplant was performed without complications.

DISCUSSION:
Recovery rates of PPCM are typically high, however, there is an important percentage of patients who progress to cardiogenic shock with a mortality rate up to 50%. This highlights the importance of recognition and adequate treatment of PPCM and the early use of mechanical circulatory support if required as a bridge to recovery or heart transplantation.
Abstract 4145413: Factors Associated with Long Term Adverse Limb Events after Endovascular Revascularization: The Boston Femoral Artery Endovascular Revascularization Outcomes (FAROUT) study
Authors: Mandieka Edwin , Ohiomoba Ramael , Sobieszczyk Piotr , Eisenhauer Andrew , Todoran Thomas , KINLAY SCOTT
Published: November 2024

Background:
Patient, lesion, and procedural characteristics may impact the long-term risks of adverse limb outcomes differently after successful endovascular revascularization for lower extremity peripheral artery disease.

Objective:
To assess the relationships of patient, lesion, and procedural characteristics to the subsequent risk of major and minor adverse limb events over the decade after successful endovascular revascularization of the superficial femoral artery for chronic limb threatening ischemia (CLTI) or lifestyle limiting claudication.

Methods :
A retrospective cohort of patients who underwent endovascular revascularization between 2003-2011 were followed for a median of 9.3 (25-75%: 6.8, 11.1) years. Hazard ratios and 95% confidence intervals (HR, 95% CI) from Cox proportional hazards models assessed the risk of major adverse limb events (MALE) or minor revascularization, MALE alone, and minor revascularization alone.

Results:
There were 232 index limb revascularizations in 185 patients. Longer lesion length was associated with a higher risk of MALE or minor revascularization (HR=2.09, 95% CI=1.22, 3.60) and minor revascularization alone (HR=2.53, 95% CI=1.39, 4.61). Current smoking was linked with minor revascularization (HR=3.83, 95% CI=1.54, 9.56). CLTI was associated with MALE or minor revascularization (HR=1.89, 95% CI=1.09, 3.29), and MALE alone (HR=7.43, 95% CI=3.11, 17.79). Black race/ethnicity (HR=4.74, 95% CI=1.51, 14.9) and low density lipoprotein (LDL) >100 mg/dL (HR=2.76, 95% CI=1.20, 6.35) were linked to MALE alone.

Conclusion

Factors related to MALE differed from those related to minor revascularization. Lesion length and smoking were linked to minor revascularization, whereas CLTI, Black race/ethnicity and elevated LDL were linked to MALE.
Abstract 4145417: Insomnia Moderates the Relationship Between Psychological Distress and Obesity Risk in the American Heart Association Go Red for Women Strategically Focused Research Network
Authors: Benasi Giada , Makarem Nour , Cheng Bin , St-Onge Marie-Pierre , Aggarwal Brooke
Published: November 2024

Introduction:
Poor sleep is associated with adverse mental and cardiometabolic health outcomes. However, there are limited data on the interplay between insomnia and psychological distress domains and their influence on adiposity indicators among women.

Aims:
To evaluate associations of psychological distress domains with adiposity indicators and elucidate differences by insomnia status in a racially and ethnically diverse cohort of women.

Hypothesis:
We hypothesized that psychological distress would be associated with worse anthropometric indicators of adiposity and that insomnia would exacerbate these relations.

Methods:
This is a cross-sectional study of a community-based cohort of 237 women (69% racial/ethnic minority, 34.1±13.5y). Validated questionnaires assessed perceived stress (4-item Perceived Stress Scale), chronic stress (4-item Global Perceived Stress Scale), stressful life events exposure within the past year (8-item Life Events Checklist), and depression (2-item Patient Health Questionnaire). Insomnia was assessed using the validated Insomnia Severity Index, and BMI and waist circumference (WC) were measured by trained study personnel. Linear regression models adjusted for age and socioeconomic status examined associations of psychological distress with BMI and WC in the overall sample and by insomnia status.

Results:
There were no significant associations between psychological distress and anthropometric markers of adiposity in the overall sample. Although a statistically significant interaction between insomnia and stressful life events was observed (p-interaction<0.05), in stratified analyses, higher exposure to stressful life events was more strongly associated with higher BMI and WC among individuals with vs. without insomnia (BMI: β=1.17±0.97 vs. 0.05±0.26 and WC: β=1.23±0.75 vs. -0.07±0.25), but these associations were not significant (p>0.05). Notably, associations of chronic stress with BMI varied by insomnia status (p-interaction=0.052). Specifically, higher chronic stress was associated with lower BMI (β=-1.55±0.72, p=0.044) among individuals with insomnia, but null results were observed among those without insomnia (β=0.07±0.16, p=0.66).

Conclusions:
Insomnia may moderate the association of stress with adiposity indicators. These findings highlight the complexity of the relations between sleep disorders, stress, and obesity risk and warrant replication in a larger sample and among males.
Abstract 4145424: 30-Day Outcomes of Dual vs Triple Antithrombotic Therapy After PCI
Authors: Meeks William , Slone Sarah , Barringhaus Kurt
Published: November 2024

Introduction:
Dual therapy with clopidogrel and an anticoagulant has become the standard of care for patients on long-term anticoagulation following PCI. However, the impact of initial triple therapy and the selection of optimal P2Y12 inhibitor on ischemic and bleeding events is ambiguous during the first 30 days after PCI.

Aim:
Explore prescribing patterns and outcomes of patients discharged on dual therapy versus triple therapy post PCI.

Methods:
We performed a retrospective chart review of all patients receiving PCI at a single institution over a 12-month time frame who were discharged on an anticoagulant. The exposure variable was type of therapy (dual vs. triple) prescribed at discharge as well as anticoagulants and P2Y12 inhibitors prescribed. The outcome was any 30-day event defined as death, stent thrombosis, major bleeding events, and composites of ischemic and bleeding events. Differences were explored using Fisher’s exact test due to the low number of types of events.

Results:
The study included 124 patients. 41% patients were treated with immediate dual therapy, and 59% were discharged on triple therapy. A greater proportion of patients undergoing non-elective PCI received triple combination therapy (58% vs 31%; P=0.004; Table 1). There was no statistically significant difference in death or composite outcomes between groups (Table 2). Two stent thrombosis events occurred, both in patients receiving dual antithrombotic therapy with clopidogrel (
P=0.09
). No stent thrombosis events occurred in patients initially started on triple therapy or in patients receiving dual therapy utilizing a more potent P2Y12 inhibitor. Four major bleeding events were noted in patients on triple therapy, and 1 major bleeding event occurred in a patient on dual therapy (
P=0.31
; Table 2).

Conclusion:
In this retrospective analysis of patients, a trend toward higher albeit not statistically significant 30-day stent thrombosis event rate was noted in patients started on dual therapy using clopidogrel for P2Y12 inhibition. These findings should be cautiously interpreted, and analysis is ongoing in a larger dataset to better define the relationship between type of therapy and ischemic and bleeding events.
Abstract 4145444: GLP-1 Receptor Agonists And Clinical Events After Anthracycline-Based Chemotherapy: A Propensity Score-Matched Cohort Study
Authors: Felix Nicole , Tramujas Lucas , Costa Thomaz , Nogueira Alleh , de Barros e Silva Pedro
Published: November 2024

Introduction:
Anthracyclines are associated with cancer therapy-related cardiovascular dysfunction and heart failure (HF). The role of GLP-1 receptor agonists for patients with cancer undergoing anthracycline-based chemotherapy remains unknown.

Hypothesis:
GLP-1 receptor agonists are associated with reduced mortality and cardiovascular events after chemotherapy with anthracyclines.

Aims:
Evaluate the association between GLP-1-treated patients undergoing chemotherapy with anthracyclines and mortality and cardiovascular events.

Methods:
We conducted a retrospective cohort study of de-identified, aggregated data from 120 centers using the TriNetX Global Collaborative Network. Patients with ≥18 years old, a diagnosis of cancer, a history of use of anthracyclines, and either type 2 diabetes mellitus or overweight/obesity were included. We excluded patients with end-stage kidney disease, ischemic heart disease, or aortocoronary bypass graft. Patients were stratified according to treatment with GLP-1 receptor agonists or not and underwent propensity score matching. We compared HF exacerbation, hospitalizations or urgent emergency department visits, and all-cause mortality rates using Cox proportional hazard models over an 8-year follow-up.

Results:
After propensity score matching, 2,575 patients remained in each cohort. At 8 years, GLP-1 use was associated with significantly lower rates of HF exacerbation, defined as the need for diuretics, pulmonary edema, systolic and/or diastolic acute decompensated HF, or reaching a left ventricular ejection fraction <40% (HR 0.49; 95% CI 0.42–0.57; p<0.001; Fig. 1A). In addition, GLP-1 use was also associated with lower rates of hospitalizations or urgent emergency department visits (HR 0.45; 95% CI 0.35–0.58; p<0.001; Fig. 1B) and all-cause mortality (HR 0.43; 95% CI 0.38–0.49; p<0.001; Fig. 1C).

Conclusion:
In this propensity score-matched cohort study comprising 5,150 patients with obesity or type 2 diabetes mellitus undergoing chemotherapy with anthracyclines, the use of GLP-1 receptor agonists was associated with lower incidences of HF exacerbation, hospitalizations, and mortality.
Abstract 4145447: Impact of Acquired Thrombophillia on Inpatient Outcomes Among Hospitalized Patients With Acute Coronary Syndrome
Authors: Soji-Ayoade Demilade , Etuk Aniekeme , Olanipekun Olalekan , Akeju Abidemi , Rueda Carlos , Thompson Ellen
Published: November 2024

Introduction:
Acute Coronary Syndrome(ACS) is a disease entity that can have high mortality if other risk modifiying factors are inadequately controlled. In this study, we examined the effect of acquired thrombophillas like antiphospholipid syndrome, Heparin induced thrombocytopenia (HIIT) and Jak 2 Mutation on outcomes in inpatients hospitalized with ACS;all of which can be commonly associated with myocardial infarction and other arterial thombotic sequelae,

Methods:
Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS) collected between 2016 and 2020. Multivariate logistic and linear regression modelling was used to access the impact of acquired prothrombotic factors on inpatient outcomes among hospitalized patients with acute coronary syndrome.Our primary outcome of interest was in-hospital mortality. Secondary outcomes were length of stay and cost of hospitalization or total hospital charges.

Results:
Of the 2,389,836 hospitalizations with acute coronary syndrome, 32% had a diagnosis of an acquired prothrombotic factor. Among those with these acquired prothrombotic factors, 40% had a diagnosis of HIT, 25% had a diagnosis of APS and 35% had a diagnosis of JAK 2 mutation. In the adjusted analyses, patients who had acute coronary syndrome with a concurrent diagnosis of an acquired prothrombotic factor (AOR: 2.28; 95% CI: 1.84-3.99) had higher odds of mortality compared to those without an acquired prothrombotic factor. Length of stay (ß: 1.23; 95% CI: 1.01-1.76) was found to be longer among those with acquired prothrombotic factor relative to those without. Furthermore, having an acquired prothrombotic factor was associated with higher hospital charges (ß: 1281.22; 95% CI: 28.65-4364.98) compared to those without an acquired prothrombotic factor.

Conclusion:
Acquired thrombophilias are associated with increased in-hospital mortality , length of stay and cost of hospitalization. Further studies are needed to elucidate the predictors of higher mortality in these patients, which could be translated into clinical practice to further identify high risk patients