bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4142577: The impact of advanced liver fibrosis on recurrence following catheter radiofrequency ablation in atrial fibrillation patients
Authors: Wang Zhe , Zheng Shuwen , Chen Xiaojie , Chen Yingwei , Sun Yihong
Published: November 2024

Background:
Non-alcoholic fatty liver disease (NAFLD) is not only a predictor of new onset of atrial fibrillation (AF), but also a predictor of AF recurrence following catheter ablation. Advanced liver fibrosis increase susceptibility to AF in NAFLD population. However, the effect of liver fibrosis levels on AF recurrence after catheter ablation remains unclear in the general population. This study was conducted to explore the effect of liver fibrosis on AF recurrence after radiofrequency catheter ablation (RFCA).

Methods:
The study was a prospective observational cohort study that enrolled consecutive inpatients who underwent their first RFCA of AF from June 2021 to August 2022 at the China Japan Friendship hospital and the First Affiliated Hospital of Zhengzhou University. Liver stiffness measurement (LSM) was performed by VCTE in all enrolled patients before ablation. The study endpoint was recurrence after ablation. The predictive values of SHR for adverse events were assessed.

Results:
The study finally included 279 patients with AF. Multivariate Cox regression analysis showed that a high level of LSM value was an independent predictor of AF recurrence following ablation, both as a continuous and a categorical variable. Kaplan-Meier curve analysis revealed that a significant disparity inthe recurrence of AF following ablation among the three groups with different levels of LSM value (P value<0.001). Furthermore, restricted cubic spline showed an increasing risk of AF recurrence with increasing LSM values, based on an LSM value of 9.6 kPa as the reference point. Subgroup analyses revealed that a significant interaction between the presence or absence of NAFLD and the levels of LSM value on AF recurrence after ablation (P value for interaction=0.046). Kaplan-Meier curves showed that the rate of AF recurrence was significantly higher with LSM value≥6.9 kPa in NAFLD patients. Multivariate Cox regression analysis also demonstrated that NAFLD patients with LSM≥6.9 kPawere independent factors of higher risk of AF recurrence after RFCA.

Conclusions:
A high level of LSM value was a predictor for the risk of AF recurrence after the first RFCA, especially in patients with NAFLD. Therefore, LSM values may be a valuable marker for risk stratification of AF recurrence after RFCA.
Abstract 4142588: Increased macrophage activity in non-culprit plaques in patients with acute coronary syndrome and familial hypercholesterolemia
Authors: Iwaya Toshiyuki , Minami Yoshiyasu , Asakura Kiyoshi , Nagata Takako , Katamine Masahiro , Hashimoto Takuya , Ako Junya
Published: November 2024

Introduction:
Patients with familial hypercholesterolemia (FH) are at a very high risk of recurrent coronary events. However, the characteristics of non-culprit coronary plques in patients with FH remain unclear.

Hypothesis:
Patients with FH have a higher prevalence of vulnerable non-culprit coronary plaques compared to patients without FH.

Methods:
A total of 130 patients with acute coronary syndrome (ACS), who underwent optical coherence tomography (OCT) imaging of non-culprit plaques were included. The characteristics of non-culprit plaques were compared between patients with and without FH.

Results:
A total of 23 patients (8.9%) were clinically diagnosed with FH. The prevalence of macrophages (71.4 vs. 42.0%, p = 0.046) and layered plaques (78.6 vs. 37.8%, p = 0.008) was significantly higher in patients with FH than those without (Panel A) although the prevalence of non-culprit plaques (60.9 vs. 49.2%, p = 0.383) and the severity of stenosis was comparable between the groups (Panel B). The prevalence of plaques with a macrophage grade of 2 or higher (Semi-quantification of macrophages on OCT images: Panel C) was significantly higher in patients with FH than those without (42.9 vs. 16.0%, p = 0.021) (Panel D).

Conclusions:
Patients with FH had a higher prevalence of macrophages and layered plaque compared with those without FH in non-culprit plaques among patients with ACS. The present results further suggest the importance of FH diagnosis at the time of ACS event and the requirement of intense secondary prevention in patients concomitant with FH.
Abstract 4142590: Machine Learning Approaches for Predicting Cardiac Rehab Utilization in Patients with Cardiovascular Diseases
Authors: Tieliwaerdi Xiarepati , Manalo Kathryn , Shah Aaisha , Bilal Muhammad Ibraiz , Oehler Andrew
Published: November 2024

Background/purposes:
Cardiac rehabilitation (CR) is shown to reduce cardiovascular mortality and hospital re-admissions in patients with cardiovascular diseases. Despite its benefits, CR faces challenges with low participation rates: only 25% of eligible patients attend at least one session, and only 27% of those who participated complete the recommended 36 sessions. This study aims to predict non-attenders and incomplete-attenders in CR using machine learning (ML) algorithms to guide early interventions for improving adherence.

Methods:
This was a retrospective study of patients referred to CR at a single outpatient center from 2020-2023. The dataset was split into training and testing sets at a 7:3 ratio. Patient demographics, travel distance, medical comorbidities, referral indications and insurance type were used for prediction. We employed multiple ML algorithms including XGBoost, AdaBoost, random forest (RF), decision tree(DT). Those models were compared to traditional prediction models such as logistic regression (LR). Model performance was assessed using area under the curve(AUC) of the receiver operating characteristic (ROC) curve and mean absolute error (MAE) to measure the difference between predicted and actual completion sections.

Results:
Among 762 patients referred to CR, 16.1% (n=123) were non-attenders, 60.1% (n=458) were full attenders, and 23.8% (n=181) were incomplete attenders (Figure 1). The XGBoost model showed the best performance with an AUC of 0.72 (Figure 2), indicating a 72% chance of correctly predicting patients who are full attenders and those who are incomplete attenders or non-attenders. This was followed by RF, AdaBoost and DT models. LR had the poorest performance. The MAE was 8.2, indicating a significant error between predicted and actual sessions attended.

Conclusion:
ML models outperform LR in predicting patients with a low CR participation rate but are not precise in predicting the exact number of attended sessions.
Abstract 4142597: Prognostic Value of Different Definitions of Iron Deficiency in Light Chain Cardiac Amyloidosis Patients
Authors: Li Xinqing , Xin Anran , Huang Yan , Zhuang Xiaofeng , Zhao Xuemei , Wang Jinxi , Zhou Ping , Zhang Yuhui , Zhang Jian
Published: November 2024

Background:
Previous research on the iron deficiency (ID) of patients with light chain cardiac amyloidosis (AL-CA) has been limited.

Aims:
The purpose of this study was to investigate how different definitions of ID affect its prevalence and association with prognosis in patients with AL-CA.

Methods:
Consecutive patients diagnosed with AL-CA at Heart failure Center, Fuwai hospital between September 2017 and July 2023 with available iron status were included. ID was defined as (1) serum ferritin concentration of <100 ng/ml, or 100-299 ng/ml with transferrin saturation (TSAT) <20% (according to international guidelines on heart failure), (2) TSAT<20%, (3) serum iron <13 μmol/L. The primary outcome measure was all-cause mortality. Kaplan–Meier cumulative endpoint curves were used to compare groups. Cox proportional hazards models were used to estimate the effects of variables on the primary outcome.

Results:
Overall, 133 patients were included, and the prevalence of ID was 41.4%, 42.1% and 69.9% respectively depending on the definition used. ID defined by TSAT and serum iron was associated with increased risk of all-cause mortality (hazard ratio [HR] 2.25, 95% confidence interval [CI]: 1.41-3.60, and HR 2.26, 95% CI: 1.26-4.06), but the same association was not seen with the guideline definition of ID (HR 1.51, 95% CI: 0.945-2.42). In the multivariable model adjusting for age, gender, hemoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I (cTnI) and difference between involved and uninvolved free light chain (dFLC) levels, the predictive value of TSAT<20% remained (adjusted HR 2.15, 95% CI: 1.29-3.59).

Conclusions:
Different definitions of ID yield inconsistent results in terms of prevalence and prognosis. ID, as defined by TSAT<20%, emerged as an independent predictor of all-cause mortality in patients with AL-CA.
Abstract 4142605: Differences in Acute Myocardial Infarction and Heart Failure Cardiogenic Shock: Utilization of Temporary Mechanical Circulatory Support and Outcomes
Authors: Alhuneafat Laith , Ghanem Fares , Jabri Ahmad , Naser Abdallah , Bilal Muhammad Ibraiz , Al Akeel Mohannad , Basir Mir , Alexy Tamas , Elliott Andrea
Published: November 2024

Introduction:
Cardiogenic shock (CS) is marked by substantial morbidity and mortality. The two major CS etiologies include heart failure (HF) and acute myocardial infarction (AMI). The utilization trends of mechanical circulatory support (MCS) and their clinical outcomes are not well described.

Methods:
This study compares the rates of MCS utilization, factors associated with utilization, and clinical outcomes in patients who present with HF-CS and AMI-CS, using 2016-2020 National Inpatient Sample data.

Results:
The study included 329,280 patients, comprising 204,660 cases of AMI-CS and 124,620 of HF-CS. MCS utilization increased over the study period with variable degree among devices, and CS-phenotype. AMI-CS had higher intraaortic balloon pump (32.4% vs. 8.9%), extracorporeal membrane oxygenation (2.8% vs. 2.4%), and percutaneous ventricular assist device use (14.5% vs. 8.1%) compared to HF-CS (p<0.01). Factors linked to lower MCS use were female sex, age over 60 years, Black race, atrial fibrillation, chronic obstructive lung disease, diabetes mellitus, cirrhosis, previous stroke, or myocardial infarction. After adjusting for various factors, patients with HF-CS vs. AMI-CS had significantly fewer adverse outcomes, including inpatient death, stroke, tracheostomy, mechanical ventilation, and blood transfusion. However, HF-CS had higher odds of acute renal failure requiring dialysis. AMI-CS was associated with shorter hospital stays (8.8 vs. 15.0 days, p<0.001), lower charges ($251,580 vs. $294,792, p<0.001), and were less likely to discharge home.

Conclusion:
Despite the evolving trends in MCS utilization over time, CS patients still face high morbidity and mortality rates. The underlying shock etiology has a substantial impact on outcomes, with AMI cases demonstrating worse complications. This highlights the need for a personalized approach to CS management, considering not only etiology but also individual characteristics and comorbidities.
Abstract 4142607: Influence of Seasons on the Management and Outcomes of Pulmonary Embolism
Authors: Bansal Mridul , Mehta Aryan , Ahmad Khansa , Yalamanchili Sreeram , Subramanian Lakshmi , Abbott Jinnette , Vallabhajosyula Saraschandra
Published: November 2024

Background:
While previous studies have noted seasonal variation in acute cardiovascular conditions, such as higher myocardial infarction in the winter, there are limited data on the impact of seasonal variations in pulmonary embolism (PE) outcomes.

Methods:
All adult (greater than or equal to 18 years) non-elective admissions with a primary diagnosis of PE with available data on the month of admission were identified using the National Inpatient Sample (2016-2020). We stratified the seasons into spring (March-May), summer (June-August), fall (September-November), and winter (December-February). Outcomes of interest included in-hospital mortality, total hospitalization costs, hospital length of stay, and discharge disposition.

Results:
During 01/01/2016 to 12/31/2020, 903,254 PE admissions with were identified. Spring, summer, fall, and winter had 23.9%, 25.1%, 25.2%, and 25.5% admissions, respectively. Admissions during the four seasons were comparable on sex distribution. Spring had higher admissions of white race (spring 69.6%, summer 68.8%, fall 68.9%, winter 69.2%) whereas summer had highest black race admissions (spring 18.3%, summer 19.0%, fall 19.0%, winter 18.6%) and those in lowest socioeconomic quartile (spring 28.2%, summer 28.7%, fall 28.5%, winter 28.1%) (all
p
<0.05). Respiratory failure was the highest in winter (spring 26.2%, summer 25.7%, fall 26.4%, winter 26.8%), whereas renal failure (spring 13.4%, summer 13.7%, fall 14.2%, winter 13.9%) bleeding complications (spring 5.7%, summer 5.8%, fall 6.1%, winter 5.9%), were higher in fall (all p<0.05). Mechanical thrombectomy rates were highest in fall (spring 1.0%, summer 1.3%, fall 1.7%, winter 1.2%, p< 0.001), whereas systemic thrombolysis (spring 2.8%, summer 3.2%, fall 3.1%, winter 3.1%, p=0.02) was highest in the summer. Use of catheter directed therapies was comparable. There were no difference in-hospital mortality rates among seasons but winter had highest length of stay, lowest discharges to home, and fall had highest hospitalization costs.

Conclusion:
In this five-year study duration, despite some differences in organ failure and complication rates, there was no significant seasonal variation in the in-hospital mortality from PE. Winter months had the highest in-hospital resource utilization.
Abstract 4142609: Lifestyle associated-factors influencing serum LDL-C and HDL-C levels and RNA-seq analysis in monozygotic twins of Osaka University Twin Research Registry
Authors: Nishihara Sae , Koseki Masahiro , Tanaka Katsunao , Omatsu Takashi , Sawabe Hiroshi , Saga Ayami , Okada Takeshi , Higo Tomoaki , Nishida Makoto , Ueno Tomohiro , Sakata Yasushi , Watanabe Mikio , Group Osaka Twin Research
Published: November 2024

Introduction:
Lifestyle habits are considered to be significant determinants of serum lipoprotein concentration. There have been many studies on the factors affecting serum LDL cholesterol(LDL-C) or HDL cholesterol(HDL-C) levels, however, most studies have been conducted in unrelated individuals who had different genetic backgrounds, making it difficult to determine which factors affecting lipid profile might be genetic or environmental.

Research Questions:
Monozygotic(MZ) twins share almost the same genes, so we hypothesize that twin research may allow us to determine factors associated with lipid profile.

Aim:
The aim is to examine factors that affect LDL-C and HDL-C levels using data of monozygotic twins database including nutrition survey data, anthropometric and biochemical parameters and to identify genes whose expression levels changed in pairs with large within-pair difference of LDL-C or HDL-C.

Methods:
The database of 263 pairs of MZ twins in the Osaka University Twin Research Center was analyzed. 1. As for the dietary, smoking, exercise, and drinking habits, we confirmed their influences on LDL-C or HDL-C by Wilcoxon’s signed-rank test in the MZ pairs with the different lifestyle habits. 2. We performed a linear regression analysis of 263 pairs to identfy anthropometric and biochemical parameters(BMI, serum TG, TP and HbA1c etc) associated with the difference in LDL-C(ΔLDL-C) and HDL-C(ΔHDL-C). 3. RNA-seq data derived from peripheral blood mononuclear cells of 59 pairs were examined in the group of large ΔLDL-C or ΔHDL-C.

Result:
1. LDL-C increased with increased cholesterol intake(n=65 pairs, p<0.05). HDL-C decreased with smoking(n=15 pairs, p<0.05) and increased with exercise (n=23 pairs, p<0.005). 2. Linear regression analysis of 263 pairs showed that ΔLDL-C was significantly associated with age, ΔTG and ΔBMI, and ΔHDL-C was significantly associated with ΔBMI, ΔTG, ΔTP, and ΔLDL-C. 3. In the 20 pairs of larger ΔLDL-C or ΔHDL-C among the total 59 pairs, RNA-seq revealed that the expression of downstream genes of TLR4 and IFNG was suppressed due to increased HDL-C levels in the large difference of ΔHDL-C.

Conclusion:
Cholesterol intake, aging, and BMI are factors that affect serum LDL-C levels, and smoking, exercise, and BMI are factors that affects serum HDL-C levels in MZ twins. In addition, the subject who had lower HDL-C in twins showed more inflammatory gene expressions in peripheral blood mononuclear cells.
Abstract 4142625: Ultrasonic Evaluated Endothelial Dysfunction Highly Predicts Future Diabetic Evolution And Development Of Fatal Events
Authors: Murakami Tatsuaki
Published: November 2024

Introduction:
Although diabetes mellitus (DM) and endothelial dysfunction are thought to affect atherogenic processes, we know little about the clinical impact of endothelial dysfunction on evolutional mechanisms of DM.

Hypothesis:
This study assessed hypothesis that endothelial dysfunction accelerates diabetic evolution and adverse clinical events.

Methods:
Endothelial dysfunction was graded by reactive changes in lumen diameter of right brachial artery following transient forearm occlusion (FMD; flow-mediated endothelium-dependent vasodilation) in consecutive 518 patients with stable coronary artery disease using high-resolution ultrasonography.

The enrolled patients were categorized into 3 groups according to the values of FMD, and their glucose tolerance and adverse clinical events were followed-up for 36 months or more. We prospectively followed up diabetic evolution, which was defined as newly diagnosed DM by 75g-OGTT or new administration of an antidiabetic agent.

Results:
For a mean follow-up period of 60 months with 100% follow-up, the patients with severe endothelial dysfunction (FMD<4%; Group-L, n=174), more frequently manifested diabetic evolution [Group-L versus Group-M with mild endothelial dysfunction (4%≤FMD<8%, n=171) plus Group-H with preserved endothelial function (FMD 8% or more, n=173): 25 (14.4%) versus 12 (7.0%) plus 7(4.0%), p<0.001, by Kaplan-Meier analysis].

The patients in Group-L more frequently resulted in fatal events [Group-L versus Group-M plus Group-H: 15(8.6%) versus 4(2.3%) plus 2(1.2%), p<0.001].

HbA1c significantly elevated in Group-L (5.9±0.6 to 6.2±0.9, p=0.009) but not in Group-M or in Group-H.

Cox proportional hazard model analysis including clinical variables showed that severe endothelial dysfunction was a significant predictor for future diabetic evolution (hazard ratio=2.69, p=0.011) and all-causal death (hazard ratio=5.87, p=0.009).

Conclusions:
This is the first clinical ultrasonic vascular investigation demonstrating that endothelial dysfunction accelerates diabetic evolution and causes excess of fatal events and strategies based on practical status of endothelial dysfunction are required for metabolic and prognostic management.
Abstract 4142629: Trends in Ischemic Heart Disease-Associated Mortality in Individuals with Diabetes Mellitus Type II
Authors: Rahman Sara , Nofal Abdullah , Khurram Maheen
Published: November 2024

Introduction:
Over 9 million people are estimated to die annually due to Ischemic Heart Disease (IHD). It also serves as an inviolable risk factor for diabetes mellitus type II-related mortality. However, trends in IHD-related mortality tend to show disparities, which if addressed, can improve outcomes.

Research Question:
What are the trends in IHD-associated mortality in individuals with diabetes mellitus type II in the USA?

Goal:
Determining trends stratified by age, gender, race, geographical location, and metropolitan status in IHD-associated mortality in diabetic individuals.

Methodology:
The CDC Wonder database was used to extract crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 population from 1999 to 2020. Annual percentage change (APC) was determined using Joinpoint regression analysis to identify temporal trends.

Results:
The overall AAMR doubled from 1999 (AAMR: 6.61) to 2020 (AAMR: 12.50). It increased from 1999-2005 (APC: 3.67), followed by a decrease during 2005-2014 (APC: -1.09), and finally a steep incline till 2020; 2014-2018 (APC: 5.53) and 2018-2020 (APC: 12.70). Men had a higher AAMR than women, 11.57 versus 6.19. Older adults aged 85+ had the highest CMR (137). NH American Indians or Alaska Natives had the highest AAMR (12.01), followed by Hispanic or Latino (9.73), NH Black or African American (8.81), NH White (8.44), and NH Asian or Pacific Islander (6.69) populations. Stratified by census regions, the highest death rate was in the Midwestern region (AAMR: 10.07), followed by the Western, Southern, and Northeastern regions; AAMR: 9.74, 7.81, and 6.29, respectively. Among the states, West Virginia had the highest AAMR of 16.61, while Nevada had the lowest AAMR of 3.47. Non-metropolitan areas consistently showed higher rates (AAMR: 10.87).

Conclusions:
Rising trends were observed in IHD-related fatalities in type ll diabetes patients between 1999 and 2020. Amongst various groups, the highest AAMRs were found in those over 85 years, men, American Indians or Alaska Natives, and residents of the Midwest, West Virginia, and non-metropolitan areas. These findings can aid in developing targeted interventions and strategies to counter the alarming rise in mortality rates.
Abstract 4142660: Mast cell MRGPRX2 receptor-mediated neuroimmune interaction induces ventricular arrhythmias after acute myocardial infarction via the overactivation of cardiac sympathetic nerves system
Authors: Wang Changyi , Jiang Hong , Yu Lilei
Published: November 2024

Background:
Previous study has shown mast cell (MC) can modulate cardiac sympathetic nerve activity, associated with ventricular arrhythmias after myocardial infarction (MI). However, the key receptor that play a role in this remain unknown.

Hypothesis:
MRGPRX2 is a newly identified MC receptor that primarily mediates neuroimmune responses. We hypothesized it plays an important role in ventricular arrhythmias after MI.

Methods:
Cardiac sympathetic ganglion tissues and blood were collected from normal, acute MI and chronic MI models for preliminary detection of MRGPRX2 expression. Plasma of acute MI and normal coronary arteries patients was collected for the determination of relevant indices. Knockdown of MRGPRX2 in cardiac sympathetic nerve to explore its role and mechanisms in ventricular arrhythmias after acute MI.

Results:
In normal models, expression of MRGPRX2 and FcεRI receptors in cardiac sympathetic nervous were significantly higher than other common MC receptors. We found increased expression of MRGPRX2, corresponding ligand neuropeptide Y (NPY) and MC inflammatory factors in acute MI models. No similar trend was observed for IgE-FcεRI pathway. Clinical data showed serum MRGPRX2 levels were higher in acute MI group than in the control group [1.002 (0.675-1.301) vs. 0.661 (0.562-0.887),
P
<0.05], and were positively correlated with serum NPY and inflammatory factors levels. In acute MI models, knockdown of MRGPRX2 reduced the sympathetic indexes of heart rate variability and serum NPY, resulting in suppressed cardiac sympathetic activity. And it suppressed local inflammation and sympathetic remodeling. Moreover, it could improve ventricular electrophysiological stability, evidenced by the prolonged ventricular effective refractory period, elevated action potential duration, increased ventricular fibrillation threshold, consequently showing antiarrhythmic effects.

Conclusion:
MRGPRX2 receptor-mediated neuroimmune disorders induce ventricular arrhythmias after MI, suggesting that MRGPRX2 is a potential target for therapy.
Abstract 4142661: Comparative Analysis of ECG Processing Software Performance on Traditional vs Patch-Based Lead II Configurations
Authors: Deery Adrian , Dowie Danielle , Diven Jordan , Easlea Holly
Published: November 2024

Introduction:
Although ECG devices with non-conventional form factors, such as wearable patches, offer enhanced convenience and comfort for users, they can introduce variability in signal characteristics, posing challenges for clinicians and ECG analysis software. To ensure accuracy and support informed decision-making, ECG software must process even the most difficult signals effectively.

Aims:
To compare the signal characteristics of a standard lead II configuration with those of a modified lead II (MLII) patch configuration and to evaluate the differential impact of these configurations on the performance of ECG processing software.

Methods:
Five-minute ECGs were recorded on 43 adult participants (63% male, mean age: 34.5 ± 9.1 years) using Bittium Faros cardiac monitors in two configurations: i) standard Einthoven lead II with electrodes placed across the chest cavity, and ii) a MLII patch configuration with electrodes 10 cm apart on the upper left chest. Average QRS amplitudes for both configurations were compared, using a paired T-test to determine statistical significance. ECG signals were processed with HeartKey software, and the accuracy of QRS beat detection was calculated against manual annotations. Heart rate (HR) detection accuracy was assessed using Bland-Altman analysis.

Results:
The average QRS amplitude was significantly lower in the MLII patch configuration compared to the standard lead II configuration (2.3 ± 1.0 mV vs. 1.2 ± 0.7 mV,
p
<0.001), with 55% of participants showing a two-fold greater mean QRS amplitude in the standard configuration. Despite the reduced amplitude, HeartKey software achieved high QRS beat detection accuracy, with a mean sensitivity of >99.1% and a mean positive predictive value of >99.9% across both configurations. HR detection accuracy was high across both configurations, with an absolute mean HR difference of 0.4 bpm (95% CI: -0.5 bpm to 1.3 bpm) for the standard lead II and 0.24 bpm (95% CI: -1.4 bpm to 1.9 bpm) for the MLII patch configuration.

Conclusion(s):
Despite the notable decrease in QRS amplitude with the MLII patch configuration compared to the standard Lead II configuration, HeartKey software maintained high accuracy in detecting QRS beats and analysing heart rate.
Abstract 4142806: Multi-stage digital animation education improves negative mood in patients with atrial fibrillation catheter ablation during hospitalization
Authors: Shi Xiaoyu , Yu Lilei
Published: November 2024

Background:
Digital education for outpatient atrial fibrillation (AF) patients is gradually increasing. However, research on digital education for patients with atrial fibrillation catheter ablation (AFCA) is limited.

Objective:
Our aim is to develop a new multi-stage education model based on digital animation and to evaluate its effect on quality of life and negative mood in AFCA patients.

Methods:
This randomized, controlled clinical trial included 208 AF patients who underwent catheter ablation in the Department of Cardiology at Renmin Hospital of Wuhan University between January 2022 and August 2023. Patients were randomly assigned to the digital animation intervention group (n=104) and the usual care group (n=104). The primary outcome was the difference in the Quality of Life in patients with Atrial Fibrillation (AF-Qol-18) scores at 3 months. Secondary outcomes included differences in Medication Adherence Report Scale (MARS-5) score, self-rating anxiety scale (SAS) score, and self-rating depression scale (SDS) score at 3 months.

Results:
The main outcome of the study is the change in quality of life at 3 months after discharge from AFCA, secondary outcomes of the study were improvements in patients' anxiety, depression, and medication adherence. In the digital animation intervention group, the AF-Qol-18 score increased from 38.02 (SD 6.52) to 47.77 (SD 5.74), the MARS-5 score increased from 17.04 (SD 3.03) to 20.13 (SD 2.12), the SAS score decreased from 52.82 (SD 8.08) to 45.39 (SD 6.13), and the SDS score decreased from 54.12 (SD 6.13) to 45.47 (SD 5.94). In the usual care group, the AF-Qol-18 score increased from 36.97 (SD 7.00) to 45.31 (SD 5.71), the MARS-5 score increased from 17.14 (SD 3.01) to 18.47 (SD 2.79), the SAS score decreased from 51.83 (SD 7.74) to 47.31 (SD 5.87), and the SDS score decreased from 52.78 (SD 5.21) to 45.37 (SD 6.18).

Conclusions:
This educational model effectively improves postoperative anxiety, depression, medication adherence, and quality of life in patients at 3 months post-discharge.
Abstract 4142845: Efficacy of full petticoat TEVAR in Stanford type B aortic dissection with patent false lumen and computational fluid dynamics analysis of the remodeling mechanism
Authors: Yoshida Yukiyo , Sakakibara Kenji , Kaga Shigeaki , Nakajima Hiroyuki
Published: November 2024

Introduction:
Uncomplicated Stanford type B acute aortic dissection is traditionally managed with strict blood pressure control. However, many patients who survive the acute phase develop dissecting aortic aneurysms owing to false lumen expansion in the chronic phase.

Objectives:
This study investigated treatment strategies for Stanford type B aortic dissection, specifically comparing the outcomes of full provisional extension to induce complete attachment (PETTICOAT) thoracic endovascular aortic repair (TEVAR) with those of simple entry closure using TEVAR. This study aimed to elucidate the long-term results of full PETTICOAT TEVAR and the mechanisms underlying false lumen expansion or suppression through computational fluid dynamics analysis.

Methods:
This retrospective study included 22 patients diagnosed with Stanford type B aortic dissection: 12 in the full PETTICOAT group and 10 in the entry closure group. Computed tomography images were analyzed at various time points till four years postoperatively by measuring the aortic, true lumen, and false lumen diameters at four levels. Statistical analyses were performed using Welch's t-test, and statistical significance was defined as p < 0.05. Additionally, blood flow analysis was performed for one case from each group. We aimed to approximate solutions from the fluid equations, visualize blood flow, and compare hemodynamic parameters, namely wall shear stress and oscillatory shear index.

Results:
In the fourth postoperative year, there was a significant difference in aortic diameter (p = 0.012) and false lumen diameter (p = 0.001) at level 3 (diaphragm level of the descending aorta), and the full PETTICOAT group showed smaller values indicative of favorable remodeling. Blood flow analysis revealed elevated oscillatory shear index values in the false lumens of the entry closure group, suggesting a correlation with false lumen expansion.

Conclusions:
Full PETTICOAT TEVAR demonstrated positive long-term outcomes by reducing the false lumen and preventing aortic enlargement. This study provides insights into the underlying hemodynamic mechanisms, emphasizing the potential of computational fluid dynamics analysis in understanding aortic dissection treatment strategies.
Abstract 4142863: Patient and Clinician Perceptions of Barriers to and Facilitators of Equitable Oral Anticoagulation in Atrial Fibrillation: A National Qualitative Study
Authors: Essien Utibe , Boyer Taylor , Beyer Nicole , Hruska Kristina , Rodriguez Keri , Litam Terrence , Nguyen Valerie , Tang Jasmyn , Hamilton Alison , Hausmann Leslie
Published: November 2024

Introduction:
Atrial fibrillation (AF) is a common arrhythmia associated with ischemic stroke. Prior work shows that stroke-reducing oral anticoagulant (OAC) therapy is less commonly prescribed in minoritized racial/ethnic groups, but the drivers of these disparities are unclear.

Hypothesis:
We hypothesized that clinicians and patients would provide key themes to inform disparities in OAC prescribing.

Goals/Aims:
To identify barriers to and facilitators of equitable OAC prescribing.

Methods:
Using data from a cohort of patients with incident AF in the Veterans Health Administration (VA) from 2018-2021, we identified VA medical centers (N=21) with high vs. low rates of OAC prescribing and racial disparities (>10%) in prescribing. From these sites, we recruited 30 clinicians (PCPs, cardiologists, pharmacists) and 33 patients with AF (67% Black or Hispanic). We conducted 1:1 semi-structured interviews from 6/1/23-3/1/24. A primary and secondary analyst co-coded 20% of the interviews using negotiated consensus before coding the remaining interviews independently. Themes related to patient and structural-level barriers to and facilitators of equitable OAC use were identified using thematic analysis.

Results:
Clinicians identified patient-level barriers including knowledge of someone who had a negative anticoagulation experience, mistrust of the health system, and concerns about bleeding risk and side effects. Patients raised concerns about the OAC regimen or distrust of medications and a lack of information about OACs. Structural-level barriers identified by clinicians included perceptions that patients’ adverse social circumstances (e.g., homelessness) interfere with medication use, care fragmentation between VA and non-VA clinics, and AF care not being a top VA priority. Patients also identified distance to VA and poor coordination of care as barriers. All clinicians noted comfort prescribing OACs as a facilitator of equitable prescribing. Other facilitators included strong collaboration between clinicians and anticoagulation clinics, patient-clinician trust, and Veterans learning about the benefits of OAC.

Conclusion:
Clinicians and diverse patients with AF in VA identified several barriers to equitable prescribing of OAC, including adverse social determinants of health and care fragmentation. Strengthening physician-pharmacist collaboration, building trust with patients, and enhancing AF education are actionable strategies for eliminating disparities in OAC use.
Abstract 4142869: Heritable heart failure traits in mice undergoing early life stress
Authors: costantino sarah , Gorica Era , Mohammed Shafeeq , Manuella Francesca , Ambrosini Samuele , Boscardin Chiara , Ruschitzka Frank , Mansuy Isabelle M , Paneni Francesco
Published: November 2024

Introduction:
Adverse childhood experiences, also known as early life stress (ELS), are associated with increased risk of cardiovascular disease in later life, yet the underlying mechanisms remain elusive. Recent evidence indicates that parental life experiences can be transmitted to the offspring.

Aim:
To investigate the effects of ELS on cardiac structure and function in exposed parents and in their offspring, across 3 generations.

Methods:
We used ELS mouse model based on unpredictable separation of mouse pups (F1) from their mother (F0) each day for 3 hours from postnatal day 1 (PND1) to PND14 combined with dams exposure to an additional unpredictable stressor (forced swim in 18°C water for 5 minutes or 20-minute physical restraint in a tube) during separation. Control litters were raised normally. Echocardiography was performed at 6, 12 and 18 months in exposed animals (F0), their unexposed offspring (F1) and grand-offspring (F2). Both male and female mice were studied. Heart weight/tibia length was used to assess cardiac mass while Masson's Trichrome was employed to detect fibrosis. Lung congestion was assessed as lung wet/dry weight ratio. Single-cell RNA sequencing (scRNAseq) was performed in MSUS and control hearts. A 6-week environmental enrichment (EE) program (cages containing running wheels, maze) was employed to test the possible rescue of ELS effects in adult males and their offspring.

Results:
F1 MSUS mice displayed increased LV mass, impaired diastolic function (assessed by conventional and tissue Doppler analysis) myocardial fibrosis and lung congestion. Time-dependent worsening of cardiac performance was observed from 6 to 18 months, both in males and females. ScRNAseq unveiled dysregulation of transcriptional programs underlying inflammation and lipotoxicity in the cardiomyocyte and endothelial cell clusters. MSUS offsprings did not show changes of cardiac function at 6 months, however diastolic dysfunction and lung congestion were observed at 12 and 18 months. A similar impairment of cardiac function was observed in the MSUS grandoffspring (F3). Of interest, 6-week exposure to an environmental enrichment protocol was able to improve LV mass, diastolic function and lung congestion in 12 months-old MSUS mice.

Conclusions:
ELS induces a transgenerational transmission of cardiac phenotypic alterations which can be rescued by EE. Our results shed light on the potential role of ELS on heart failure development and potential mitigation strategies.
Abstract 4142998: Optimizing Transcatheter Aortic Valve Design to Mitigate Subclinical Leaflet Thrombosis
Authors: Qiu Dong , Azadani Ali
Published: November 2024

Introduction:
Subclinical leaflet thrombosis is an increasingly recognized complication in patients undergoing transcatheter aortic valve replacement (TAVR). Patients with hypoattenuated leaflet thickening (HALT) and reduced leaflet motion (RELM) have a higher incidence of strokes and transient ischemic attacks. Early clinical data suggested that HALT is more common in supra-annular than intra-annular transcatheter aortic valves (TAVs). It was postulated that intra-annular TAVs have a larger neo-sinus volume and are potentially at a higher risk of blood flow stagnation in the neo-sinus region than supra-annular devices. However, recent clinical data obtained from the Evolut Low-Risk trial and the PARTNER 3 Cardiac CT sub-study showed that the incidence of HALT was comparable between supra-annular Evolut R (30.9%) and intra-annular SAPIEN 3 (28%) devices at one year.

Hypothesis:
We hypothesized that TAV leaflet design plays a vital role in the initiation and growth of leaflet thrombosis.

Aim:
The study aimed to optimize the leaflet and frame geometry of TAVs to mitigate the risk of subclinical leaflet thrombosis using an interactive parametric design platform that streamlines the engineering design process.

Methods:
We developed an automated computational framework to optimize the design of TAV leaflets in ANSYS Workbench, aiming to minimize (i) blood stasis on the surface of the TAV leaflets and (ii) the peak stress experienced by the tissue. Seven design variables were defined to modify the leaflet geometry and valve position (Figure 1).

Results:
The design platform revealed a complex response of the design variables, underscoring the importance of numerical optimization to obtain an optimal valve geometry. A considerable reduction in the blood stasis and maximum in-plane principal stress (31%) was observed in comparison to commercially available TAVs.

Conclusions:
The simulation results revealed that the leaflet geometry plays a vital role in the degree of blood stasis on the surface of the TAV leaflets and the stress experienced by the tissue. The optimized TAV design could reduce the risk of subclinical leaflet thrombosis in patients undergoing TAVR.
Abstract 4143104: Atherosclerotic features of plaque instability are transmitted via gut microbial transplantation
Authors: Nieri Riccardo , Foglio Eleonora , De Maio Flavio , Severino Anna , Masucci Luca , D Aiello Alessia , Grimaldi Maria Chiara , Gervasoni Jacopo , Santoni Daniele , Pedicino Daniela , Russo Matteo , Liuzzo Giovanna , Limana Federica
Published: November 2024

Background:
Gut microbiota have been suggested as a causative agent of atherosclerosis mainly by converting dietary and endogenous molecules into active metabolites like the trimethylamine N-oxide (TMAO). Nevertheless, the relationship between gut microbiota and plaque features has not been well documented. In this study, we tested the hypothesis that gut microbial transplantation can transmit atherosclerotic plaque characteristics.

Methods and Results:
In a fecal microbiota transplantation mouse model, the colonization of gut microbiota from patients with acute coronary syndrome (ACS, n=9), chronic coronary syndrome (CCS, n=11) and control subjects (CTRL, n=8) was evaluated and plaque features of stability were assessed. Transplantation was performed into ApoE KO mice fed a diet containing 1% choline or a standard diet. Initially, resident intestinal microbes were suppressed using antibiotics, followed by the administration of fecal oral gavages from human donors over a period of 12 weeks. Firstly, a significant positive correlation was detected between TMAO serum levels assessed by UPLC-MS/MS system and atherosclerotic lesion formation measured by Oil Red O staining of aortic root cross-sections; however, no correlations were identified with plaque instability. Plaque composition was analyzed using necrotic core area and fibrous cap thickness as primary readouts of plaque vulnerability. Interestingly, microbiota from ACS patients significantly decreased plaque stability as showed by increased necrotic core and fibrous cap thinning. Further, it decreased α-SMA
+
cell population and increased MMP2 staining, indicating intraplaque metalloprotease activity.

Gut microbiota composition was evaluated using 16S rRNA sequencing of ApoE KO mice fecal samples. In ACS transplanted mice, 14 bacterial genera were positively associated with larger necrotic core and 6 bacterial genera with MMP2. In CCS transplanted mice, 6 bacterial genera showed negative correlations with necrotic core size and 2 bacterial genera positively correlated with α-SMA
+
cells.

Conclusions:
In conclusion, we identified bacteria significantly associated with the vulnerable plaque phenotype, which provides potential insights to modulate atherosclerotic plaque composition by influencing the gut microbiota.
Abstract 4143416: Optical Absorption Figure of Merit for Photoplethysmography-Based Cuffless Monitoring of Blood Pressure Varies Across a Diversity of Skin Tones in the Fitzpatrick Scale
Authors: Trawick Anna , Aumer Michael , LeBoeuf Steven , Ali Asif , Farooqui Sami , Delgado Yulissa , Reyes-Rivera Jonathan
Published: November 2024

Introduction:
Well-publicized studies have shown that photoplethysmography (PPG), a key technology for pulse oximeters and consumer wearables, may have limitations for users with darker skin tones. This study assessed the correlation between skin tone and figures of merit for PPG sensing in a multiwavelength, reflection-mode, fingertip-worn PPG device. The device measures optical signals on the underside of the hand, where melanin density is relatively low; thus, this study hypothesized that the figures of merit would show an insignificant correlation with skin tone.

Methods and Results:
A study at Houston Cardiology Consultants saw trained professionals tend to 174 participants (Table 1). Subjects wore a multiwavelength, reflection-mode, PPG-based fingertip sensor. Subject metadata, including skin tone, were collected manually. PPG datasets were analyzed by Valencell, Inc. using the company’s standard figures of merit: AC/DC ratio, Signal-to-Noise-And-Distortion (SINAD), and Relative Peak Ratio (RPR). SINAD and RPR represent motion-artifact resistance and hemodynamic consistency, respectively. The AC/DC ratio measures the strength of the pulsatile PPG waveform against unwanted optical scatter due to melanin and other skin chromophores. Using the Fitzpatrick Scale to quantify skin tone (Figure 1), its correlation with these figures of merit was assessed. No correlation was found between the Fitzpatrick value and SINAD or RPR across optical wavelengths. However, a strong correlation between the Fitzpatrick value and AC/DC ratio was observed for all wavelengths, with the green AC/DC ratio showing the highest correlation (Table 2).

Conclusion:
The observed disparity in AC/DC ratio with skin tone must be considered when developing PPG-based physiological monitors to ensure they operate effectively across all Fitzpatrick values, even when these monitors target skin regions with relatively low melanin density. Engineering approaches that rely solely on green wavelengths of light, the most commonly used in consumer wearables, will face greater challenges than those utilizing longer wavelengths.
Abstract 4143614: Clinical Features and Prognosis of FDG-avid Genetic Cardiomyopathies
Authors: Bevan Graham , Llamas Valle Yovani , Johnson Bryce , Cheng Richard , Nazer Babak
Published: November 2024

Introduction:
Cardiac
18
FDG-PET is frequently utilized to noninvasively diagnose inflammatory cardiomyopathies such as cardiac sarcoidosis (CS). Many patients are diagnosed with presumptive isolated CS based on cardiac
18
FDG-avidity and the Japanese Circulation Society (JCS) guidelines. However, individuals with genetic cardiomyopathies present similarly to CS, are often
18
FDG-avid, and may be misdiagnosed with isolated CS.

Aims:
Determine the prevalence of pathogenic or likely pathogenic variants (P/LP) in patients with
18
FDG-avid cardiomyopathy and evaluate how
18
FDG avidity may impact prognosis.

Methods:
This is a single center, retrospective analysis of patients who had undergone both cardiac
18
FDG-PET and commercial genetic testing with a comprehensive cardiomyopathy panel (Invitae). Patients with biopsy-proven extracardiac or CS were excluded. Group comparisons made using Chi-square. The composite endpoint of cardiac mortality, sustained VT, LVAD, heart transplant, and heart failure hospitalization was compared between groups using Cox Proportional Hazard’s Model.

Results:
Of 128 patients with both cardiac
18
FDG-PET and genetic testing, 112 patients (30% women; mean age 56) met our inclusion criteria.
18
FDG-avidity was present in 54 (48%), of which 9 (17%) had P/LP ([list genes here]). Of these 9, 5 (56%) met JCS diagnostic criteria for isolated CS, 4 were clinically diagnosed with CS, and 2 had been immunosuppressed prior to their genetic testing results. Baseline characteristics were similar between
18
FDG-avid and
18
FDG-negative patients with genetic cardiomyopathies (Figure 1). P/LP prevalence was significantly higher in the
18
FDG-negative group (13, 22%, p=0.01). LP/P variants were most commonly found in LMNA (n=10). Among patients with genetic cardiomyopathy, there was no significant difference in the composite endpoint between
18
FDG-avid and FDG-negative groups (Figure 1; HR 2.3 (95% CI: 0.7-7.2, p-value 0.17).

Conclusions:
Genetic cardiomyopathies are often mis-diagnosed as isolated CS based on
18
FDG-avidity, and genetic testing should be performed prior to diagnosing isolated CS. Larger, multi-center studies are needed to determine if
18
FDG-avidity predicts prognosis in genetic cardiomyopathies.