bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4140163: Initial Experience with Mini-Crush Versus Double Kissing Crush in Bifurcation Percutaneous Coronary Intervention: Insights from PROGRESS-BIFURCATION registry
Authors: Carvalho Pedro , Strepkos Dimitrios , Rempakos Athanasios , Alexandrou Michaella , Mutlu Deniz , Al-Ogaili Ahmed , Kultursay Barkin , karagoz ali , Krestyaninov Oleg , Khelimskii Dmitrii , Uluganyan Mahmut , soylu korhan , Yildirim Ufuk , Mastrodemos Olga , Rangan Bavana , Jalli Sandeep , Voudris Konstantinos , Burke M Nicholas , Sandoval Yader , Brilakis Emmanouil
Published: November 2024

Background:
There is limited data on use of the mini-crush technique in two-stent bifurcation percutaneous coronary intervention (PCI).

Methods:
This retrospective, observational, cohort study was performed across 6 centers in the United States, Russia, and Turkey between 2013-2024, as part of the Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992). We evaluated procedural characteristics of patients who underwent bifurcation stenting using the mini-crush technique and compared it with those who were treated with double kissing (DK) crush.

Results:
Of 1,138 PCIs involving 1,499 lesions, 46 (4.04%) were performed using the mini-crush technique and 147 lesions (12.91%) using the DK crush technique. Baseline characteristics of the patients were similar in both groups. There was no difference between mini-crush versus DK-crush in technical success (100.0% versus 98.6%; p=0.99), procedural success (95.1% versus 97.1%, p=0.62), procedural complications (10.9% versus 14.7%, p=0.51), or in-hospital major adverse cardiovascular events (MACE) (6.5% versus 5.7%, p=0.73). In contrast, mini-crush technique was associated with shorter procedure time (79.00 vs 116.50 minutes; p<0.001; Figure 1A), fluoroscopy time (23.50 vs 30.35 minutes, p=0.002; Figure 1A), and lower contrast volume (150 versus 109 milliliters; p<0.001; Figure 1B), and air kerma radiation dose (1.11 vs 1.71 gray; p=0.024; Figure 1C).

Conclusion:
In patients undergoing PCI for bifurcation lesions, the mini-crush technique had similar rates of procedural complications and in-hospital MACE as compared with the DK crush technique but required less contrast volume, fluoroscopy time, radiation dose, and procedural time.
Abstract 4140169: Neonatal Electroencephalogram Alpha:Delta changes precede neurologic injury during Antegrade Cerebral Perfusion and Deep Hypothermic Circulatory Arrest
Authors: Orie Gabrielle , Swartz Michael , Duncan Aubrey , Seltzer Laurie , Yoshitake Shuichi , Alfieris George
Published: November 2024

Background:
Although neurologic injury commonly occurs following neonatal aortic arch reconstruction, the mechanism(s) are poorly understood. A decrease or inter-hemispheric difference in the electroencephalogram (EEG) Alpha:Delta ratio (A:D) precedes cerebral ischemia during antegrade cerebral perfusion (ACP). However, it is unknown if A:D changes precede neurologic injury during deep hypothermic circulatory arrest (DHCA). We hypothesized during DHCA, the A:D would decrease and that a significant A:D inter-hemispheric difference would precede neurologic injury.

Methods:
Neonates requiring aortic arch reconstruction underwent simultaneous quantitative EEG monitoring. Left vs. right hemispheric, anterior, and posterior A:Ds were recorded at baseline, arterial cannulation, cooling, ACP vs. DHCA, and the rewarming phases of the operation. Left vs. right A:D differences > 25% were considered significant for ischemia and the cumulative duration of a significant A:D inter-hemispheric difference was calculated. Post-operative neurologic injury was defined as either stroke or seizure.

Results:
From 86 neonates, 16.2 % (14) required DHCA and 83.8 % (72) ACP. There were no significant differences in the pre-operative demographics or baseline A:Ds between groups. Although the A:Ds remained similar during ACP, after 15 minutes the hemispheric A:Ds decreased significantly during DHCA (Figure 1). Eleven neonates (ACP-7 vs. DHCA-4) developed neurologic injury. The duration of an anterior A:D inter-hemispheric difference > 25% was significantly greater within neonates that developed neurologic injury (25 {IQR:0,65 minutes} vs. 5 {IQR: 0, 15 minutes}; p<0.001). Multivariate analysis demonstrated that the duration of an anterior A:D difference > 25% was independently associated with neurologic injury using either ACP or DHCA (Odds Ratio:1.081, 95% CI: 1.025, 1.141; p-value=0.004).

Conclusion:
Unlike ACP, the A:D decreased significantly during DHCA. During either DHCA or ACP, a significant anterior inter-hemispheric A:D difference was independently associated with neurologic injury and suggests the importance of quantifying the A:D during neonatal arch reconstruction.
Abstract 4140185: The Burden Of Substance Abuse And Mental Health Disorders In Patients Admitted With Stress Cardiomyopathy
Authors: Ellauzi Rama , Hamza Izhan , Kalaiger Mukhtadir , Sheikh Muhammad Dawood Amir , Cuellar Servando , Ortega Isaiah , Chatila Khaled
Published: November 2024

Introduction:
Several studies have linked mental health disorders and substance abuse as risk factors for stress cardiomyopathy (SC). However, the true burden of these disorders amongst patients with stress cardiomyopathy remains unknown.

Methods:
We used the 2016-2020 National Inpatient Sample database to identify hospitalizations for SC who underwent diagnostic catheterization. We assessed the proportion of patients diagnosed with a substance abuse or mental health disorder. Subsequently, the association of these disorders in SC compared to patients admitted for myocardial infarction (MI) was assessed using the chi-square test.

Results:
From 2016 to 2020, there were 33,075 hospitalizations for stress cardiomyopathy who were diagnosed by cardiac catheterization. Of these patients, 5,920 (17.9 %) had depression, 8,500 (25.7 %) had anxiety, 1058 (3.2 %) had severe stress reactions, and 16,372 (49.5 %) were diagnosed with a mental health disorder. 9,955 (30.1 %) were smokers, 5,358 (16.2%) abused hallucinogens, 5,457 (16.5 %) abused cocaine, 5,457 (16.5%) abused sedatives, 6,019 (18.2 %) abused cannabis, 5,920 (17.9%) abused opioids, 6,416 (19.4 %) abused alcohol. Subsequently, the association of stress cardiomyopathy with mental and substance abuse disorder was compared with patients admitted with myocardial infarction See Table 1.

Conclusion:
Mental health and substance abuse disorders are common in patients diagnosed with SC. These disorders are more commonly present in SC compared to MI. Further research is needed to assess the significance of these findings.
Abstract 4140198: Impact of Non-ST-segment elevation Myocardial Infarction on outcomes of Diabetic Ketoacidosis in Hospitalized Patients: A National Inpatient Sample Analysis
Authors: Patel Nishant , Iyer Ishwari , Kavarthapu Anusha , Kamani Prahasith , Sanka Sujana , Vachhani Bhavyakumar , Linn Hnin Nadi , Nanavaty Dhairya , Singh Sohrab , Ramireddy Keerthi , Devarakonda Pradeep Kumar , Ayala-Rodriguez Cesar , Reddy Sarath
Published: November 2024

Introduction:
Diabetes Mellitus (DM) has a broad spectrum of complications and is one of the leading 5 causes of hospital admissions in the US. Decompensated DM is associated with high mortality in hospitalized patients. Cardiac ischemia and related events are proposed to be increasingly prevalent in hospitalized patients with decompensated diabetes. Numerous studies and reports have suggested that elevation in troponin levels is associated with high mortality in such patients. Notably, there have only been a few studies that assessed the prevalence of NSTEMI (Non-ST segment elevation myocardial infarction) and its effect on outcomes in patients hospitalized with Diabetes ketoacidosis (DKA).

Methods:
We aimed to compare the outcomes of DKA in hospitalized adults (age >18 years) with NSTMI with those without NSTEMI using the National Inpatient Sample (NIS) database from 2018 to 2020. NIS is the largest publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays.

Results:
There were a total of 1113295 hospitalizations identified with a diagnosis of DKA. Of these, 9860 (0.88%) patients had NSTEMI. The mean age of this subpopulation was 38.71 years. Among these patients, 48.59% were female, and 58.40% were male. We attempted to assess the impact of NSTEMI on the occurrence of complications such as cardiac arrest, acute renal failure (ARF), Acute liver failure (ALF), Acute heart failure (Acute HF), and acute respiratory failure in patients admitted with DKA. The results of this analysis are depicted in the table below. The cost of hospitalization for DKA with NSTEMI was $35878 higher and the length of stay was 50% longer compared to the patients with DKA without NSTEMI. The Odds ratio for mortality was 2.84 for patients with NSTEMI.

Conclusions:
Our analysis suggests that the occurrence of NSTEMI negatively impacts outcomes in DKA patients. The occurrence of primary outcomes assessed in this study (Cardiac arrest, ARF, ALF, Acute HF, and Acute respiratory failure) was significantly higher in DKA patients with concomitant diagnosis of NSTEMI. NSTEMI also increased the cost burden on hospitalizations for DKA.
Abstract 4141434: Real-World Improvement of Cardiometabolic Risk Factors by Treating Obesity at Scale
Authors: Boyd Kim , Medeiros Kaelen , Ryan Donna
Published: November 2024

Intro:
Obesity is a critical risk factor for cardiometabolic disease. A growing body of clinical trial data shows GLP-1 receptor agonist medications (GLP-1s) are not only effective in treating obesity but also demonstrate significant impact on the reduction of cardiovascular risk. Yet current models of care have not been able to reach the >200 million Americans who meet criteria for obesity treatment. To improve access to evidence-based treatment, we established a virtual metabolic health company to provide medically-supervised obesity treatment at scale.

Research Question:
This real-world evaluation examines the impact of a virtual health program on weight and related cardiometabolic markers.

Methods:
Data were analyzed for individuals who completed at least 12 months (mos) in the core program and for a subset who continued to 24 mos. Obesity treatment involved GLP-1s combined with a proprietary intensive lifestyle intervention delivered with virtual coaching. Weights were submitted via cellular connected scale. Waist circumference, metabolic labs, and patient-completed surveys were analyzed at baseline and 12 mos.

Results:
The cohort included 6,766 patients, a subset with structured lab data from a larger population of 16,098 patients who had completed 12 mos in the commercial program. Average weight loss at 12 mos was -16.5% (n=5,932) and -17.8% at 24 os (n=1,171). Improvement was observed for all collected metabolic markers: waist circumference, AST/ALT, lipids, HbA1c, insulin, hs-CRP. Specifically for cardiovascular labs, 12 mos results showed improvement in HDL in 56.3% (n= 3,090), in LDL for 64.8% (n=3,066), in hs-CRP for 82.9% (n=2,446). Of n=825 with abnormal A1c at baseline, 77.1% achieve A1c <5.7%. Average reduction in waist circumference was -5.9 inches (n=3,682). Positive changes were also seen for patient-reported outcomes (PROs).

Discussion:
In the context of significant obesity and cardiovascular results for GLP-1s in clinical trials, it is important to gather data on the efficacy of approaches to scale treatment in the real world since factors such as medication shortages, gaps in insurance coverage, and challenges with adherence occur with treatment outside of clinical trials. Results from 6,766 patients in a virtual metabolic health program available in 50 states and DC demonstrate clinically significant and sustained weight loss through 24 mos, with improvement in associated key cardiometabolic risk markers, health behaviors, and PROs.
Abstract 4141438: Predictors of Left Atrial Low Voltage Areas Were Different among Age Groups in Patients with Atrial Fibrillation Ablation
Authors: Ooka Hirotaka , Matsuda Yasuhiro , Masuda Masaharu , Okamoto Shin , Ishihara Takayuki , Nanto Kiyonori , Tsujimura Takuya , Hata Yosuke , Uematsu Hiroyuki , NAKAO SHO , Kusuda Masaya , Ariyasu Wataru , Kudo Satoshi , Fujii Subaru , Mano Toshiaki
Published: November 2024

Background:
Catheter ablation is a well-established treatment for atrial fibrillation (AF). Left atrial low-voltage areas (LVAs) is associated with atrial remodeling following the progression of atrial cardiomyopathy, and poor rhythm outcome after catheter ablation. However, the predictors of LVAs presence have not been fully elucidated in different age groups.

Purpose:
The purpose of this study was to investigate predictors of the prevalence of LVAs in different age groups.

Methods:
1,488 (age, 69 ± 10 years; female, 501 [34%]) consecutive patients who underwent initial ablation were included. Age groups were divided into three groups, namely <60 years old (younger age, n=272), 60-75 years old (intermediate age, n=864), ≥75 years old (older age, n=352). The definition of LVAs was areas with a bipolar voltage of <0.5 mV covering ≥5 cm2 of left atrial surface. Multivariate logistic regression analysis was performed to investigate the clinical predictors of LVAs.

Results:
Of 1,488 patients, LVAs existed in 352 (24%) patients. In the younger age group, C-reactive protein (odds ratio [OR], 4.5; [95% confidence interval {CI}: 1.5-13], p = 0.006) and previous history of heart failure (OR, 5.6; [95% CI: 1.2-26], p = 0.027) were the independent predictors of LVAs. In the intermediate age group, female (OR, 3.8; [95% CI: 2.6-5.7], p < 0.001), persistent AF (OR, 2.6; [95% CI: 1.7-4.1], p < 0.001), lower body mass index (OR, 0.93; [95% CI: 0.88-0.98], p = 0.004), lower hemoglobin (OR, 0.81; [95% CI: 0.72-0.93], p = 0.002), C-reactive protein (OR, 1.4; [95% CI: 1.0 1-2.0], p = 0.047), diabetes mellitus (OR, 1.8; [95% CI: 1.1-2,8], p = 0.01), left atrial diameter (OR, 1.04; [95% CI: 1.01-1.1], p = 0.007) were the independent predictors of LVAs. In the older age group, female (OR, 2.3; [95% CI: 1.4-3.7], p = 0.01), persistent AF (OR, 3.1; [95% CI: 1.8-5.2], p < 0.001) and lower hemoglobin (OR, 0.83; [95% CI: 0.71-0.97], p = 0.017) were the independent predictors of LVAs.

Conclusion:
In patients with atrial fibrillation ablation, the independent predictors of LVAs were different among age groups.
Abstract 4141445: Long-Term Predictive Value of 4D Flow MRI in Bicuspid Aortic Valve Patients: A 10-Year Assessment for Aortic Surgery Risk
Authors: Dehadrai Aniket , Maroun Anthony , Johnson Ethan , Berhane Haben , Dushfunian David , Allen Bradley , Markl Michael
Published: November 2024

Introduction:
Bicuspid aortic valve (BAV) is associated with progressive ascending aorta (AAo) dilation, often leading to aneurysms, dissections, and ruptures. Thus, current guidelines recommend preventive surgery for AAo dilation. Recent 4D flow MRI studies show that BAV morphology causes abnormal transvalvular flow patterns, increasing wall shear stress (WSS), a trigger of aortic growth. Further studies have delineated areas of abnormally high WSS by comparing to estimates of matched controls, and show promise in detecting risk for aortic growth. However, since the long-term prognostic significance of this marker is unclear, we aimed to quantify WSS in BAV patients to assess its value in predicting the need for aortic surgery up to 10 years post-4D flow MRI acquisition.

Methods:
BAV patients without prior surgical intervention scanned before April 1, 2014 were identified. Using medical records, patients were categorized as ‘operated’ if they underwent aortic surgery post-scan and ‘non-operated’ if they were surgery-free for at least 10 years post-scan. 4D flow MRIs were processed with an AI pipeline, including 3D segmentation of the aorta, followed by peak velocity (PV) and WSS quantification in the AAo (Fig. 1A-C). Patient-specific WSS heatmaps were computed relative to a map based on the WSS of 10 or more sex and age-matched controls. Relative areas of elevated WSS in the AAo were then calculated (Fig. 1D-F).

Results:
115 patients were included, with 73 non-operated (age: 42.5±11.5y, 49M) and 42 operated patients (age: 53.5±12.1y, 34M). The mean baseline mid-AAo diameters for non-operated and operated patients were 3.8±0.6 cm and 4.1±0.5 cm, respectively. Among operated patients, the mean scan to surgery time was 5.7±3.3y. All three 4D flow metrics were significantly higher in operated compared to non-operated patients: PV: 2.6±0.6 vs. 1.7±0.4 m/s (p<0.01); WSS: 2.2±0.5 vs. 1.6±0.4 Pa (p<0.01); relative area of high WSS on heatmaps: 31±12 vs. 15±13% (p<0.01).

Conclusions:
4D flow MRI parameters provide long-term predictive value in BAV patients, as elevated peak velocity, wall shear stress, and relative area of high wall shear stress on heatmaps are associated with subsequent aortic surgery within 10 years post-scan.
Abstract 4141457: Forms of Childhood Maltreatment and Subclinical Cardiovascular Disease Risk in Black men and women
Authors: Spikes Telisa , Thorpe Roland , Michopoulos Vasiliki , Wharton Whitney , Dunbar Sandra , Pelkmans Jordan , Harris Latesha , Mehta Puja , Pemu Priscilla , Taylor Herman , Quyyumi Arshed
Published: November 2024

Background:
Exposure to specific forms of childhood maltreatment have been associated with cardiovascular disease (CVD) risk factors and CVD events in adulthood. Heterogenous experiences of childhood maltreatment across race and sex exist, yet there is little evidence regarding these relationships and CVD risk in Black populations.

Aims:
To investigate the association between various forms of childhood maltreatment (emotional, general, physical, and sexual abuse) and surrogate markers of vascular dysfunction and test whether sex modify these associations.

Methods:
Forms of childhood maltreatment and indices of vascular function were assessed in a cohort of healthy Black adults without known CVD (n=404) from a large metropolitan southeastern city. Childhood maltreatment was assessed using the Early Trauma Inventory short form (ETISR-SF) consisting of physical, sexual, emotional, and general domains. A trauma severity index score was calculated by summing the indexes for each of the four domains. Higher scores are indicative of higher traumatic life events before age 18 years. Outcomes of central augmentation index (cAIx) corrected for a heart rate of 75 bpm and carotid femoral pulse wave velocity (CfPWV) were measured as indices of wave reflections and arterial stiffness using applanation tonometry (Sphygmocor Inc.), and central pulse pressure (CPP) was calculated as the difference between the aortic systolic and diastolic blood pressures. Associations between each domain and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models.

Results:
Mean age of the cohort was 53
+
10.3 years, 61% women. Exposure to emotional [
b
= -1.5%, 95%CI: -2.7,-0.3] and physical abuse [
b
= -1.3%, 95%CI: -2.5,-0.2] was associated with cAIx overall but not CPP or CfPWV after adjusting for sociodemographic, clinical factors, health behaviors, and depressive symptoms. Significant emotional abuseXsex (
P=
0.014) and physical abuseXsex (
P=<
0.001) interactions were identified for cAIx. Among women, physical abuse was associated with higher cAIx [
b
=1.5%, 95%CI: 0.6, 2.4] and among men emotional [
b
=-1.6%, 95%CI: -3.2, -0.0] and physical [
b
=-1.7%, 95%CI: -3.1, -0.3] abuse was associated with lower cAIx.

Conclusions:
Exposure to emotional and physical abuse as children was associated with vascular dysfunction; moreover, exposure to physical abuse among women and not men have adverse clinical implications for CVD risk and prospects for enhanced preventive care.
Abstract 4141475: Prognostic Impact of Acute Kidney Injury Following Repair of Stanford Type A Aortic Dissection: A Systematic Review and Meta-Analysis
Authors: Goyal Aman , Maheshwari Surabhi , Abbasi Haleema Qayyum , Mashkoor Yusra , Jain Hritvik , Tariq Muhammad Daoud , Shamim Urooj , Changez Mah I Kan
Published: November 2024

Background:
Acute Kidney Injury (AKI) is a multifactorial complication following repair of Stanford Type A aortic dissection (TAAD) with an alarmingly high incidence, varying from 20 to 77%. Postoperative AKI following life-threatening disease tends to be much more complex. However, the exact role of postprocedural AKI in the prognosis of patients undergoing TAAD repair has not been elucidated.

Aims:
This meta-analysis aimed to evaluate the prognostic significance of postprocedural AKI in patients undergoing TAAD repair.

Methods:
A literature search was conducted using PubMed, EMBASE, and SCOPUS databases. The primary endpoint was 30-day mortality with several secondary endpoints. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using Review Manager software. Statistical significance was set at p <0.05. Random-effects meta-analyses were performed for all outcomes.

Results:
Our analysis included 21 studies comprising 10396 patients. Patients with AKI exhibited a significantly higher risk of 30-day mortality (RR=3.98; 95% CI: 3.04-5.22; p<0.00001;

I
2

=57%), stroke (RR= 2.05; 95% CI: 1.68-2.50; p<0.00001;

I
2

=32%), dialysis requirement (RR= 32.9; 95% CI: 10.39-104.24; p<0.00001;

I
2

=90%) (Figure 1), cardiovascular complications (RR= 2.85; 95% CI: 1.65-4.92; p<0.0002;

I
2

=85%), sepsis (RR= 4.92; 95% CI: 2.62-9.24; p<0.00001;

I
2

=64%), and re-exploration for bleeding (RR=2.46; 95%CI: 1.79-3.39; p<0.00001;

I
2

=58%) compared to those without AKI (Figure 2).

Conclusion:
Patients with AKI demonstrated a significantly increased risk of mortality, stroke, need for dialysis, sepsis, postoperative cardiovascular complications, and re-exploration for bleeding. Further prospective studies are required to better understand the prevention strategies and long-term effects on prognosis of AKI post-repair for TAAD.
Abstract 4141480: Gender differences in bifurcation percutaneous coronary interventions: Update from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION)
Authors: Alexandrou Michaella , Strepkos Dimitrios , Rempakos Athanasios , Mutlu Deniz , Carvalho Pedro , Krestyaninov Oleg , Khelimskii Dmitrii , Kultursay Barkin , karagoz ali , Yildirim Ufuk , soylu korhan , Uluganyan Mahmut , Mastrodemos Olga , Rangan Bavana , Jalli Sandeep , Al-Ogaili Ahmed , Voudris Konstantinos , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil
Published: November 2024

Background:
Gender differences on short and long-term outcomes following bifurcation percutaneous coronary intervention (PCI) have received limited study.

Research Questions:
To examine gender differences in outcomes of bifurcation PCI.

Methods:
We examined the angiographic, procedural characteristics, and outcomes of 1084 bifurcation PCIs (1076 patients) performed at five centers between 2013-2024 from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION).

Results:
Women represented 25.19% of the entire study population. They were older (68.37±12.34 vs 66.09±11.54; p=0.001), less likely to be currently smokers (13.7% vs 20.4%; p=0.014), with higher left ventricular ejection fraction (%) (55.46±13.27 vs 53.16±12.55; p<0.001) and lower baseline creatinine (0.85 vs 1.00; p<0.001). Lesion characteristics were mostly similar, with slightly lower proximal and distal main vessel diameter in women. Their proximal main vessel was more likely to be left anterior descending artery (46.5% vs 39.4%; p=0.030) and less likely to be right coronary artery (10.3% vs 16.1%; p=0.030), compared to men. Technical success was similar (94.5% vs 94.6%; p=0.952), while procedural success was lower (89.6% vs 94.1%; p=0.011). In-hospital major adverse cardiac events (MACE) were more common in women (8.5% vs 4.2%; p=0.007), which presented with increased in-hospital mortality (4.1% vs 0.6%; p<0.001), stroke (1.8% vs 0.1%; p=0.005) and bleeding (1.8% vs 0.2%; p=0.013). Their PCIs required equal procedure time, but lower fluoroscopy time, contrast volume and air kerma radiation dose. Female gender was independently associated with higher in-hospital major adverse cardiac events (MACE) (odds ratio (OR) 2.21; 95%CI 1.23-3.95; p=0.008) and lower procedural success (OR 0.56; 95%CI 0.32-1.00; p=0.044). Follow-up data were available for 733 patients (68.12%). The incidence of follow-up MACE was significantly higher in women (hazard ratio (HR) 1.36; 95%CI 1.02-1.81; p=0.038), while on adjusted mixed Cox proportional hazards analysis female gender was associated with higher follow-up MACE (HR 1.58; 95%CI 1.08-2.30; p=0.018). The incidence of follow-up mortality was similar between genders (HR 1.17; 95%CI 0.78-1.77; p=0.45).

Conclusions:
Bifurcation PCI can be accomplished with high technical success in women, but higher in-hospital and follow-up MACE, compared to men.
Abstract 4141481: Outcomes of the upfront two stent strategies for bifurcation percutaneous coronary interventions: Insights from PROGRESS-BIFURCATION registry
Authors: Mutlu Deniz , Rempakos Athanasios , Strepkos Dimitrios , Alexandrou Michaella , Carvalho Pedro , Al-Ogaili Ahmed , Kultursay Barkin , karagoz ali , Krestyaninov Oleg , Khelimskii Dmitrii , Uluganyan Mahmut , soylu korhan , Yildirim Ufuk , Mastrodemos Olga , Rangan Bavana , Jalli Sandeep , Voudris Konstantinos , Sandoval Yader , Burke M Nicholas , Brilakis Emmanouil
Published: November 2024

Background:
Upfront two-stent techniques are often used in bifurcation percutaneous coronary interventions (PCI), but there is controversy about optimal strategy selection.

Methods:
We examined the clinical, angiographic characteristics, and long-term outcomes of 206 bifurcation PCIs using the double kissing (DK) crush or the culotte techniques in 192 patients between 2014-2023 from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (NCT05100992). For the long-term outcomes adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated using the mixed effects Cox proportional hazards model.

Results:
DK crush was more commonly used (70.4%). Patients in the culotte group had similar baseline characteristics with the DK crush group. Lesions treated with culotte were more likely to be in the left anterior descending (54.1% vs. 35.9%, p<0.001) and circumflex arteries (21.3% vs. 9.0%, p<0.001), had smaller proximal (3.50 [3.00, 3.75] vs. 3.50 [3.30, 4.00] mm, p=0.032) and distal (3.00 [2.75, 3.00] vs. 3.00 [3.00, 3.50] mm, p=0.047) main vessel diameters, and were less likely to have severe calcification (6.6% vs. 32.4%, p<0.001). Technical success (96.7% vs. 98.6%, p=0.583), procedural success (93.1% vs. 93.9%, p=0.758), and in-hospital major adverse cardiovascular events (MACE) (3.4% vs. 6.1%, p=0.726) were similar in both groups. During a mean follow-up of 38-month, 32 (28.3%) patients experienced MACE. On multivariable analysis, culotte was associated with similar MACE (aHR 1.19; 95%CI 0.78-1.80; p=0.680), mortality (aHR 1.11; 95%CI 0.68-1.79; p=0.810), and target vessel PCI revascularization (aHR 0.58; 95%CI 0.30-1.13; p=0.460) compared with DK crush (Figure).

Conclusions:
Bifurcation PCI with DK crush and culotte had similarly high technical and procedural success, low in-hospital MACE, and long-term outcomes.
Abstract 4141497: Left ventricular diastolic function by echocardiography is related to extracellular volume and is an independent predictor of mortality in patients with aortic regurgitation
Authors: Lababidi Hossam , Malahfji Maan , Graviss Edward , Shah Dipan , Nagueh Sherif
Published: November 2024

Background:
Cardiac catheterization along with cardiac biopsy studies have shown the presence of abnormally increased left ventricular (LV) chamber stiffness in patients with severe aortic regurgitation (AR) and its significant correlation with interstitial fibrosis. LV diastolic dysfunction (DD) is associated with increased mortality in several patient populations. However, there is a paucity of data on the association of DD with mortality in patients with AR.

Hypotheses:
1 - LV DD is related to extracellular volume (ECV), imaging marker of interstitial fibrosis, by cardiac magnetic resonance imaging (CMR)

2 - LV DD by echocardiography is associated with mortality in patients with AR

Methods:
We studied patients with moderate or greater AR who underwent echocardiographic and CMR imaging within 12 months. We excluded patients with concomitant valve disease, prior valve intervention, cardiomyopathy deemed unrelated to AR, congenital heart disease and terminal conditions. The primary outcome was all-cause death. CMR was used to obtain LV volumes, EF and mass, AR severity, scar extent by delayed hyperenhancement, and ECV. DD was assessed by comprehensive echocardiography.

Results:
The study included 323 patients. Mean age was 61.9 ± 16.0 years and 22% were female. Median follow-up was 3.8 years, during which 65 patients died and 172 had aortic valve replacement. Median LV EF was 56 (47-65) %, AR volume on CMR was 40 (30-61) mL, and AR fraction was 40 (33-47) %. ECV progressively increased with higher grades of LV DD (Figure 1).

Table 1 shows the univariate associations with mortality in the study. On multivariable analysis based on the Lasso variable selection process, Euroscore, Charlson comorbidity index, DD grade, and RAP were associated with total mortality.

Conclusion:
ECV by CMR progressively increases with higher grades of DD by echocardiography, and DD is independently associated with mortality in patients with AR.
Abstract 4142768: Association Between Right Ventricular-Pulmonary Arterial Coupling and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction
Authors: Sherafati Alborz , Kloster Alex , Manandhar Sareeta , Fares Anas , Aradhyula Vaishnavi , Dube Prabhatchandra , Elzanaty Ahmed , Sajdeya Omar , XKhatib-ShahidiX XBellaX , dragomirescu catalin , Brewster Pamela , Kennedy David , Gupta Rajesh , Khouri Samer
Published: November 2024

Introduction:
Right ventricle (RV)-pulmonary artery (PA) coupling reflects functional adaptation of RV to afterload. Impaired RV-PA coupling is associated with worse outcomes in patients with pulmonary hypertension. However, the association between RV-PA coupling and outcomes in patients with heart failure with preserved ejection fraction (HFpEF) is not well established.

Objective:
To assess the association between RV-PA coupling and outcomes in patients with HFpEF and determine an optimal cutpoint of the TAPSE/RVSP ratio for prediction of adverse events.

Methods:
Participants with a diagnosis of HFpEF were enrolled at the University of Toledo Medical Center from March 2012 and were followed until August 2023. The ratio of tricuspid annular plain systolic excursion (TAPSE) to right ventricular systolic pressure (RVSP) on echocardiogram was used as a measure of RV-PA coupling. The primary endpoint was death or heart failure hospitalization. ROC analysis was performed to determine an optimal cutpoint point for TAPSE/RVSP. Cox proportional hazards regression model was used to assess the association between TAPSE/RVSP and outcomes.

Results:
83 participants (age 68.69 ± 10.72, 67.5% female) with HFpEF and available echocardiogram data were enrolled in the study. The median TAPSE/RVSP was 0.41. Death or heart failure hospitalization occurred in 51 (56.6%) individuals. Using ROC curve analysis, we identified the optimal cutpoint of TAPSE/RVSP of 0.31 which had a sensitivity of 57% and specificity of 88% for predicting mortality (AUC 0.756, 0.622-0.889). TAPSE/RVSP less than 0.31 was associated with higher risk of death or heart failure (HF) hospitalization (HR=2.61, CI=1.28-5.33, p= 0.008), death (HR=3.40, CI=1.34-8.64, p= 0.01), and HF hospitalization (HR=2.45, CI=1.06-5.68, p= 0.03).

Conclusion:
Worse RV-PA coupling was associated with worse outcomes in individuals with HFpEF. The TAPSE/RVSP cutpoint of <0.31 had a good specificity for prediction of adverse events including death or HF hospitalization.
Abstract 4142796: Hospital Admission Rates for Peripartum Cardiomyopathy Follow Influenza Seasonal Peaks
Authors: Pattoli Megan , Desai Spandan , Roma Nicholas , Miller Luke , Amaratunga Eluwana , Field Patrick , Shirani Jamshid
Published: November 2024

Background:
Peripartum cardiomyopathy (PPCM) is defined as a dilated form of cardiomyopathy that occurs within the last month of pregnancy and up to 5 months postpartum. Previous studies have shown that PPCM more often occurs in the Southern United States compared to other geographic locations. Although the etiology of PPCM is likely multifactorial, viral infections may account for up to a third of those cases. We aimed to examine the association of PPCM to active influenza infection in the Southern United States.

Methods:
National Inpatient Sample 2016-2021 was queried to identify women admitted with PPCM with (group A) and without (group B) concurrent influenza infection in the Southern United States.

Results:
A total of 13540 women were admitted with PPCM, of whom 3511 (35%) had concurrent influenza infection. Group A PPCM followed a seasonal pattern with peak incidence in winter (62%) followed by spring (25%), fall (13%) and summer (0) [p<0.001]. Group A was older (mean age 33.6 -vs- 31.9), more often obese (16.8% -vs- 11.2%, p=0.011), had a smoking history (38.2% -vs- 26.1%, p<0.001), had higher Charlson comorbidity severity indexes (25.3% -vs- 17.2%, p=0.020), and had longer length of stay (6.1 -vs- 5.5). Group A also had higher rates of preexisting hypertension (15.3% -vs- 13.1%, p=0.011) and depression (18.8% -vs- 8.6%, p<0.001, OR 0.125 p-0.285), but similar rates of preeclampsia. In hospital mortality was not statistically significantly different between the two groups (1.8 -vs- 1.6%, p=0.067).

Conclusion:
PPCM appears to follow a seasonal trend in incidence similar to influenza in the Southern United States. Influenza infection may account for some cases of PPCM in that region and may be associated with adverse in-hospital outcomes.
Abstract 4142798: Differences in Clinical presentation in Spontaneous Coronary Artery Dissection vs. Type 1 Myocardial Infarction
Authors: Kodali Mouna , Essien Ekow , Nfor Tonga , Allaqaband Suhail , Klinka Matthew , Kroboth Stacie , Boulware David , Peterson Michael , Kanani Jim , Walczak Sara , Gogineni Venkateswara , Galazka Patrycja
Published: November 2024

Background:
Spontaneous coronary artery dissection (SCAD) refers to the nontraumatic, non-iatrogenic, and nonatherosclerotic separation of the coronary artery wall leading to acute coronary syndrome. This condition predominantly affects women with minimal or no traditional cardiac risk factors. We aimed to determine the differences in clinical presentation between SCAD and Type 1 myocardial infarction (MI) in the Aurora Health Care community.

Methods:
A retrospective, matched cohort, multicenter community study was carried out on adult patients aged >18 years admitted to all Aurora Hospitals from January 2012 to December 2022. A total of 57 patients were diagnosed with SCAD during that period. SCAD group and Type 1 MI group were matched by age and gender at a 1:5 ratio using a propensity score-based matching. Outcomes between the SCAD and the Type 1 MI groups were compared using chi-squared tests or Fisher’s exact tests, and t-tests or nonparametric equivalents (Wilcoxon).

Results:
A higher percentage of Type 1 MI patients presented as NSTEMI compared to SCAD patients (70% vs. 59.6%, p=0.028). Although not statistically significant, SCAD patients had a higher occurrence of STEMI than Type 1 MI patients (42.1% vs. 32.6%, p=0.169).

On admission, SCAD patients had a higher maximum troponin (12,000 vs. 3,550, p=0.012). Type 1 MI patients had higher HgbA1C (6 vs. 5.4, p=0.0008). Both patients had similar LDL levels, but Type 1 MI had lower HDL levels (44 vs. 48, p=0.024). ESR, CRP, and D-dimer levels showed no significant difference. LV ejection fraction was 53% in both groups, and the LV global longitudinal strain was similar. The Type 1 MI group exhibited higher grades of diastolic dysfunction (Grade 2 and Grade 3) and mitral valve disease. E/e was higher in Type 1 MI compared to SCAD (11.5 vs 8.8, p <0.0001). Type 2 SCAD was most prevalent at presentation, with the most frequently affected artery being LAD (47.4%) and the most frequently affected branch vessel being obtuse marginal (36.4%). The most common location was distal (59.6%), followed by mid (22.8%), with the diameter of the vessel involved mostly between 2-3.5 mm.

Conclusion:
This study observed that although more SCAD patients presented as STEMI with higher troponins, Type 1 MI patients were sicker overall. These differences in clinical findings can aid in diagnosis as the management of these two populations differ.
Abstract 4143217: Gender Disparities in Clinical Outcomes Following Transcatheter Aortic Valve Replacement: Insights from the National Inpatient Sample
Authors: Odo Chinenye , Awoyemi Toluwalase , Ogunniyi Kayode , Daniel Emmanuel , Ogunmola Isaac , Odoh Ikenna , Barriga Guzman Rocio , Jaamour Dania , Nriagu Valentine
Published: November 2024

Background:
Transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis, offering a less invasive alternative to surgical valve replacement, particularly for high-risk patients. While TAVR has demonstrated efficacy and safety in various patient populations, there is growing recognition of gender-specific differences in clinical outcomes post-procedure.Understanding gender-related variations in TAVR outcomes is crucial for optimizing patient care and ensuring equitable access to this life-saving therapy.

Methods:
Using the National Inpatient Sample (2017-2020), we analyzed the characteristics and comorbidities of male and female patients undergoing TAVR. We then assessed the incidence of clinical outcomes between genders, including in-hospital mortality, mechanical ventilation, length of stay, hospital charges, vasopressor requirement, heart block, pacemaker insertion, stroke, acute kidney injury (AKI), vascular complications, and discharge disposition. Multivariate analysis was performed to evaluate mortality risk among congestive heart failure (CHF) patients.

Results:
Among 234,860 total admissions, females comprised 44.5% (104,365) of the population. Females were slightly older (mean age 79.4 vs. 78.5 years, p < 0.001) and had a lower mean Charlson Comorbidity Index (2.8 vs. 3.1, p < 0.001) compared to males. After adjusting for confounding factors, females had a higher odds ratio for in-hospital mortality (OR 1.48, 95% CI 1.37-1.60, p < 0.001), mechanical ventilation (OR 1.14, 95% CI 1.07-1.20, p < 0.001), stroke (OR 1.55, 95% CI 1.46-1.65, p < 0.001), and vascular complications (OR 1.24, 95% CI 1.19-1.31, p < 0.001). Length of stay (mean difference 0.37 days, 95% CI 0.32-0.42, p < 0.001) and hospital charges (mean difference $3,795, 95% CI 2,488-5,102, p < 0.001) were also significantly higher in females (p < 0.001 for both).

Conclusion:
The divergent clinical profile and poorer outcomes observed among females undergoing TAVR, characterized by elevated in-hospital mortality, stroke, and vascular complications compared to males, may emphasize the need for gender-specific approaches in TAVR management.
Abstract 4143224: Feasibility of Left Atrial Appendage Occlusion with Dual-Seal Technology without Pre-Procedural CT: Early Single-Center Experience
Authors: SIDDIQUI Usman , Khanani Aqeel
Published: November 2024

Background:
Left Atrial Appendage (LAA) Occlusion with Amulet has shown promising results in achieving complete closure with minimal periprocedural leak. Amulet’s dual-sealed technology and numerous sizing options provide versatility for different LAA morphologies. Pre-procedural CT is routinely recommended for pre-procedural planning. However, this brings risks including use of contrast, risk of renal failure, radiation exposure, and patient inconvenience. Here, we share initial results of our Amulet implantation protocol without pre-procedural CT: 83 cases were reviewed; number of devices used, procedural time, periprocedural bleeding complications, success in coming off oral anticoagulation, and incidences of stroke and embolism were followed.

Methods:
We followed 83 AF patients who underwent LAA closure with Amulet, implanted with intraprocedural TEE, intracardiac left atrial echocardiography, and intraprocedural angiography. Pre-procedural CT was not used. Patients were followed to assess safety and efficacy of this protocol. Safety endpoints included rates of procedural and bleeding complications. Efficacy endpoints included rates of stroke and embolism, and number of devices used.

Results:
All 83 procedures were successfully completed with no perioperative procedural complications and no documented leaks on follow-up TEE. Patients had early ambulation with closure. On average, 1.14 devices were used per case: 88% of cases required 1 device, and nine cases required 2 devices; one case required 4 devices to fit as patient was noted to have an interrupted IVC, requiring implantation via right IJV. There were no cases of stroke or embolism following implantation, and all patients were safely able to come off oral anticoagulation.

Conclusions:
Results demonstrate that Amulet with its dual-sealed technology can be effectively and safely implanted without pre-procedural CT. No perioperative complications were observed. 88% of cases closed with single device usage. No post-procedure leaks were noted on follow-up TEE. Safety endpoints revealed minimal adverse events, with 2 cases of late pericardial effusion managed without long-term consequences. This protocol demonstrated high efficacy, as all patients were successfully able to come off oral anticoagulation with no reported strokes or embolic events. Intraprocedural TEE, intracardiac left atrial echocardiography, and intraprocedural angiography are typically appropriate for periprocedural sizing of the device.
Abstract 4143227: Incidence of Hemorrhagic Stroke in Hypertrophic Cardiomyopathy
Authors: Schultz Thomas , Choi Jennifer , Hasik Julia , Sharma Abhinav
Published: November 2024

Background:
Individuals with hypertrophic cardiomyopathy (HCM) have an elevated risk of ischemic stroke, primarily driven by the increased risk of atrial fibrillation (AF) development in this patient population. This risk remains elevated regardless of CHADS2VASC score; thus, anticoagulation is recommended for all HCM patients with AF. Given the known association between anticoagulant medications and hemorrhagic events, there is likely an assumed risk of hemorrhagic stroke in these individuals. Currently, the incidence of hemorrhagic stroke in HCM and its relationship to AF and anticoagulation has not been well-established in the literature. The goal of this study was to establish the presence of and risk factors for hemorrhagic stroke in individuals with HCM.

Methods:
A retrospective review of all HCM patients ages 18 and older in our institution’s health system was performed from 2019-2023. ICD 10 codes were used to identify individuals with hemorrhagic stroke. Patient charts were reviewed for additional data including demographics, comorbid conditions, anticoagulant prescription, and other inciting factors prior to the hemorrhagic event.

Results:
The study cohort comprised 343 HCM patients, of which 47.1% were female and 72.7% were Caucasian. Concurrently, 30% (n=103) had a diagnosis of AF. The overall incidence of hemorrhagic stroke was 2.9% (5.8%, n=6 in those with AF vs 1.7%, n=4 in those without AF); furthermore, AF was associated with a non-statistically significant increased risk of hemorrhagic stroke (RR = 3.36, 95% CI 0.97-11.7). Anticoagulant use at the time of hemorrhagic event was observed in 4 individuals (67%) with AF and 1 individual (25%) without AF. Head trauma and falls were frequently observed as precipitating events prior to hospital admission for hemorrhagic stroke, occurring in 83% (n = 5) of patients with AF and 50% (n = 2) of those without AF.

Conclusions:
While ischemic stroke and anticoagulant use are commonly studied in those with HCM, the incidence of hemorrhagic stroke in this population is not negligible. Risk of hemorrhagic events in HCM appears largely influenced by anticoagulant use, particularly in those with concurrent AF, and by head trauma. Given the known benefits of anticoagulation on ischemic stroke risk in the HCM population, appropriate counseling and careful attention to individual patient factors may be warranted in the administration of anticoagulants.
Abstract 4143228: Uncovering Hidden Disparities in Surgical Mortality among Texas Medicaid-Insured Infants with Critical Congenital Heart Disease
Authors: Heims-Waldron Danielle , Marengo Lisa , Shumate Charles , Lopez Keila
Published: November 2024

Background:
Data shows that publicly insured patients with critical congenital heart disease (CCHD) have higher surgical mortality than privately insured patients. However, little is known about disparities within Medicaid-insured cohorts. We hypothesized that disparities in surgical mortality exist within the Medicaid population, with the highest mortality being among the most socially vulnerable patients.

Methods:
We conducted a retrospective cohort study using Texas Birth Defects Registry records of infants with CCHD born 2010-2014 who underwent cardiac surgery <1 year old (CCHDs). Patients with CCHD as defined by the Centers for Disease Control or ductal dependent anatomy were included, and records for study inclusion were reviewed by a pediatric cardiologist. Cases were linked with death certificates and the Medicaid database, and Medicaid patients were stratified into Primary (PM) and Secondary (SM) cohorts. The PM cohort was comprised of patients with the highest scores (most socioeconomically vulnerable) based on the census tract derived Social Vulnerability Index (SVI). The primary predictor was race/ethnicity and primary outcome was infant mortality. Descriptive sociodemographics were analyzed using chi-square. Infant mortality was analyzed using stratified univariable Cox Proportional-Hazards models.

Results:
We identified 2525 infants with CCHD
S
, of whom 14.5% had PM and 56.9% had SM. The Medicaid-cohort had more single ventricle, chromosomal, and extracardiac defects than the Non-Medicaid (NM) cohort (p<0.0001). Compared to the SM cohort, CCHD
S
infants with PM were more likely to be born preterm, and be born to mothers who are non-White, have < a high school education (p<0.0001, respectively), and who drove further to surgical facility (p<0.005). Cox regression showed no racial/ethnic mortality disparities in the PM cohort. In the SM cohort, infant mortality was 2.2x higher among Black patients (HR 2.21, CI 1.41-3.45). In the NM cohort, Hispanic patients had nearly 2x (HR 1.93, CI 1.12-3.33) and Black patients had 3x (HR 3.01, CI 1.42-5.96) higher risk of infant mortality than White CCHDs infants.

Conclusions:
We completed one of the largest analyses of Medicaid-insured CCHD
S
infants using a novel SVI stratification. Despite worse SVI, racial/ethnic disparities in CCHD
S
mortality were not observed among PM-insured patients. Future database work should include stratified Medicaid populations to accurately interpret outcomes in patients with CCHD.