bluuebunny/crossref_metadata_2025 huggingface dataset:
НОВЕЛИ ЧИННОГО ЗАКОНОДАВСТВА У СФЕРІ ГРОМАДСЬКОГО ЗДОРОВ’Я
Authors: Калинюк Н. М. , Галіян А. В.
Published: December 2023

Мета: дослідження актуальних нормативних нововведень та нормотворчої діяльності у сфері громадського здоров’я.

Матеріали і методи. У статті проведено аналіз чинних нормативно-правових актів. Застосовано такий комплекс методів: теоретичного аналізу, порівняння, обґрунтування, узагальнення, систематизації теоретичного та практичного матеріалу, формулювання і систематизації висновків.

Результати. Проаналізовано чинні нормативно-правові акти, що дають можливість систематизувати аргументацію різних підходів до розуміння сутності та взаємозв’язку понять «здоров’я», «громадське здоров’я» та «система громадського здоров’я». Запропоновано проведення нормотворчої діяльності з питань сфери громадського здоров’я через призму оперативних функцій системи громадського здоров’я. З’ясовано, що Україна є прихильником позиції впровадження сучасних міжнародних та регіональних стандартів із метою забезпечення розвитку системи громадського здоров’я. Законодавчим підґрунтям розвитку системи громадського здоров’я в Україні слід вважати ст. 426 гл. 22 «Громадське здоров’я» Угоди про асоціацію, де визначено співробітництво сторін у галузі охорони здоров’я задля підвищення рівня безпеки людини та захисту її здоров’я з інтеграцією України в європейські стандарти охорони здоров’я. Доведено, що новели законодавства у напрямку подолання туберкульозу осучаснюють нашу стратегію відповідно до міжнародних стандартів. Здійснений аналіз міжнародних, регіональних та національних стандартів у сфері громадського здоров’я формує невирішену на сучасному етапі соціально-економічного, культурного і духовного розвитку суспільства суперечність із пошуку найкращих заходів забезпечення системи громадського здоров’я. Аналіз нормотворчої роботи уповноважених органів із метою забезпечення належного функціонування системи громадського здоров’я вказує на їх системний підхід.

Висновки. Доведено необхідність застосування системного підходу в нормотворчій діяльності з питань регулювання правовідносин, що виникають у сфері громадського здоров’я. Обґрунтовано доцільність подальших наукових розробок із питань вдосконалення правового регулювання системи громадського здоров’я та доцільності їх вивчення та аналізу у поєднанні з нормопроєктною діяльністю в цій сфері.
ОЦІНКА СИСТЕМИ ЗВОРОТНОЇ РЕАКЦІЇ ЗАБЕЗПЕЧЕННЯ ПОСТУРАЛЬНОГО БАЛАНСУ У ПАЦІЄНТІВ ІЗ МІННО-ВИБУХОВОЮ ТРАВМОЮ
Authors: Завіднюк Ю. В. , Бакалюк Т. Г. , Цвях А. І. , Копитчак І. Р. , Грубар Ю. О. , Денефіль О. В.
Published: December 2023

Мета: оцінити вплив фізичної терапії на основні компоненти забезпечення постурального балансу у пацієнтів із мінно-вибуховою травмою.

Матеріали і методи. Дослідження проводилися на стабілоплатформі з біологічним зворотним зв’язком TYMO (Tyromotion). Обстежено 20 пацієнтів, котрі отримали поранення нижніх кінцівок із порушенням цілісності кісткової тканини. Діагностика проводилася на етапі вертикалізації пацієнта та можливості осьового навантаження ураженої кінцівки. Оцінка співвідношення впливу на постуральний баланс зорового, вестибулярного та соматосенсорного компонентів проводилася перед початком двотижневої рабілітаційної програми (включала мобілізацію суглобів та м’яких тканин; відновлення амплітуди рухів; кінезотерапію; терапію порушених функцій балансу; відновлення патерну ходи; корекцію елементів моторної активності; медичне терапевтичне тренування; механотерапію; інструментальні методи мобілізації м’яких тканин; терапію порушених функцій балансу із застосуванням стабілоплатформи) та після її закінчення.

Результати. При оцінці компонент зворотної реакції у пацієнтів із мінно-вибуховою травмою до лікування виявлено, що у них переважав соматосенсорний компонент, який перевищував вестибулярний компонент на 22,7 % (p<0,05), а візуальний компонент – на 35,2 % (p<0,001). Візуальний компонент виявився найменшим.

Після лікування відмічено достовірне зменшення соматосенсорного компонента на 10,1 % (р<0,001), достовірне зростання візуального компонента на 6,6 % (р<0,01) і зростання вестибулярного – на 6,3 % (p>0,05), яке виявилося статистичго недостовірним. У пацієнтів переважав соматосенсорний компонент, який перевищував вестибулярний компонент на 3,8 % (p>0,05), а візуальний компонент – на 14,1 % (p<0,02). Візуальний компонент був меншим, ніж вестибулярний, на 9,9 % (p<0,05).

Висновки. Мінно-вибухова травма спричинює розлади постурального балансу, що відображається дисбалансом у розподілі компонент зворотної реакції: зростає вклад соматосенсорного компонента, зменшується – візуального. Лікування приводить до зменшення вкладу соматосенсорного компонента. Оптимальним методом для моніторингу лікувального ефекту медичної реабілітації при дисфункції опорно-рухового апарату виявилася стабілометрія.
ВИКОРИСТАННЯ СИМУЛЯЦІЙНИХ МЕТОДІВ НАВЧАННЯ У ВИВЧЕННІ ДИСЦИПЛІНИ «АКУШЕРСТВО ТА ГІНЕКОЛОГІЯ»
Authors: Моцюк Ю. Б. , Остафійчук С. О. , Басюга І. О.
Published: December 2023

Симуляція в медичній освіті – сучасна технологія навчання та оцінки практичних навичок, умінь і знань, заснована на реалістичному моделюванні, імітації клінічної ситуації або окремо взятої фізіологічної системи, для чого можуть використовуватися біологічні, механічні, електронні та віртуальні (комп’ютерні) моделі. Метою роботи було проведення аналізу сучасних можливостей організації симуляційного навчання при вивченні дисципліни «Акушерство та гінекологія» в умовах симуляційного центру. Симуляційне навчання є ефективним інструментом для вдосконалення теоретичних і клінічних навичок і дозволяє студентам розвивати ключові клінічні компетенції, особливо ті, яких важко досягти під час стажування або в умовах з обмеженим досвідом навчання, спілкування, командну роботу та критичне мислення.
Для опрацювання практичних навичок, окрім медичного обладнання, можливе використання сучасних електронних підручників, навчальних посібників, анатомічних моделей, фантомів – тренажерів практичних навичок, манекенів, палат інтенсивної терапії. Отже, симуляційний досвід забезпечує ефективний підхід до викладання та навчання, оскільки дозволяє студентам стати активними та повністю залученими в безпечному та контрольованому середовищі.
Для повноцінного оволодіння практичної майстерності навчальні посібники повинні максимально реалістично імітувати патологічний стан пацієнта та клінічну ситуацію. За цих умов дії майбутнього лікаря виконуються в ситуації, що імітує реальну, з використанням спеціальних засобів. З метою забезпечення впровадження новітніх інтерактивних технологій навчання у медичному закладі вищої освіти створюються симуляційні центри, в умовах яких відбувається відтворення реального процесу діяльності лікаря, що дозволяє у студентів систематизувати теоретичні знання та сформувати необхідні професійні вміння командної роботи. Симуляції також приносять користь викладачам, надаючи їм кращу можливість оцінювати студентів у безпечному середовищі.
СИНДРОМ ВИГОРАННЯ СТУДЕНТІВ-МЕДИКІВ ПІД ЧАС ВІЙНИ ТА ЧИННИКИ, ЯКІ ЙОГО ВИЗНАЧАЮТЬ
Authors: Шульгай А. Г. , Федчишин Н. О. , Шульгай О. М.
Published: December 2023

Повномасштабна російська агресія вплинула на психоемоційний стан населення, а особливо постраждала від війни українська молодь. Втрата близьких людей, розлука з рідними, фінансові труднощі, невпевненість у завтрашньому дні, зміни освітнього середовища, постійні загрози життю і здоров’ю, які пов’язані з воєнними діями, ракетним бомбардуванням, негативно впливають на психічне здоров’я. Учасники навчального процесу долають випробування війни: вимушені перерви під час занять, перехід на дистанційну чи змішану форму навчання, відключення електроенергії. Повномасштабна війна погіршила доступ до освіти та поглибила освітню нерівність, негативно вплинула на якість навчального процесу та успішність студентів і емоційний стан студентів та викладачів. Такі психоемоційні переживання призвели до збільшення поширеності професійного вигорання серед студентів-медиків. 
Метою даного дослідження було вивчити поширеність синдрому вигорання серед студентів медичного факультету Тернопільського національного медичного університету та пов’язаних із ним чинників під час російсько-української війни.
Серед студентів-медиків було проведено онлайн-дослідження. Вигорання оцінювалося за допомогою інструменту Maslach Burnout Inventory-Student Survey. Порівняння частотних показників між групами проводилося із використанням критерію хі­квадрат (χ2) Пірсона. Порівняння кількісних показників груп спостереження проводили за допомогою визначення t-критерію Стьюдента. Логістичний регресійний аналіз використовували для оцінки прогностичного зв’язку між професійним вигоранням і пов’язаними факторами. 
У цьому дослідженні проаналізовано 776 студентів-медиків із середнім віком (22,03±1,8) року. За результатами проведеного дослідження встановлено, що високий рівень емоційного виснаження відзначили 50,1 % студентів, деперсоналізації – 53,1 %, а зниження особистих досягнень – 38,1 %.
Незалежний вплив на розвиток професійного вигорання має період навчання, який пов’язаний із курсом доклінічних чи клінічних дисциплін (exp(B)= 0,452, 95 % ДІ = 0,141–0,763, p = 0,001), а також вік студентів (exp(B) = 0,104, 95 % ДІ = 0,059–0,167, p-значення = 0,03).
З метою зменшення вираженості проявів синдрому вигорання необхідно застосувати практичні та успішні методи подолання або розробити ефективну стратегію для мінімізації рівня вигорання серед студентів-медиків під час війни.
Colonialismo, plantation e Antropoceno: o controle sobre corpos e territórios
Authors: Wedig Josiane Carine , Ramos João Daniel Dorneles
Published: December 2023

Neste ensaio, apresentamos uma análise sobre as transformações provocadas nas agriculturas do Holoceno pela plantation. A partir do colonialismo, foram instituídos processos que produziram alterações devastadoras no planeta, destruindo espaços-tempos de refúgios para pessoas e outros seres, o que ocasionou o Antropoceno – período que remete às mutações geológicas decorrentes da ação humana. Como contraponto a esse modelo extrativista de corpos e territórios, discutiremos a agroecologia enquanto correlação de práticas, movimentos sociais e ciências que conectam modos de existência e conhecimentos ancestrais dos povos da terra, criando possibilidades de ressurgências multiespécies frente às catástrofes.
Manuel Correia de Andrade: em pequenos textos, o mundo
Authors: Buitoni Dulcilia Helena Schroeder
Published: December 2023

A seção Documentação abre espaço para originais de textos do geógrafo Manuel Correia de Andrade e para imagens de livros de sua biblioteca. São documentos que fazem parte do imenso acervo doado ao Instituto de Estudos Brasileiros, acervo esse que está em processo de higienização e catalogação. Foram selecionados trechos que mostram como esse intelectual articulava pesquisa, cultura e contexto político e social. Aparecem temas como desenvolvimento, pobreza, questões ambientais, corrupção e pensamento decolonial – pioneirismo, pois esse conceito ainda não havia se introduzido nos meios acadêmicos brasileiros.
Abstract 11310: T Helper 1 Lymphocytes Promote Diastolic Dysfunction and Fibrosis in a Non-Hypertensive Angiotensin II Mouse Model of Heart Failure
Authors: Kim Michelle M , Mezzaroma Eleonora , Martinez Naya Nadia , Mauro Adolfo G , Alcaide Pilar , Abbate Antonio , Toldo Stefano A
Published: December 2023

Introduction:
Angiotensin (Ang) II induces cardiac fibrosis and diastolic dysfunction, also in absence of hypertension (HTN). We found that a non-HTN AngII infusion fails to induce dysfunction and fibrosis in T cell receptor α deficient mice (

Tcrα
-/-

, bereft of T cells).

Hypothesis:
Since T helper 1 (Th1) lymphocytes promote adverse remodeling in models of heart failure (HF), we hypothesized that Th1 cells are sufficient to induce diastolic dysfunction and fibrosis in a non-HTN AngII model.

Methods:
Naïve CD4+ cells were isolated from wild type (WT) mice lymph nodes (LNs) and spleens (MACS columns) and differentiated into Th1 cells over 7 days using plates coated with anti-CD3 antibody (5 μg/ml) plus IL-12 (10 ng/ml) and anti-IL-4 (1 μg/ml) and from day 4, IL-2 (20 ng/ml). Adoptive transfer (AT) of 10
7
Th1 cells/500 μl PBS, naïve CD4+ cells, or PBS alone was performed into

Tcrα
-/-

mice (3-11 months old, N=8-16/group) implanted with AngII (0.2 μg/kg/day) osmotic pumps for 4 wks. AT was repeated two weeks later. LV dimensions, ejection fraction (EF), and diastolic function (isovolumetric relaxation time - IRT) were measured with Doppler echocardiography. LV end-diastolic pressure (EDP) and peak systolic pressure (PSP) were measured with a Millar catheter. Heart slides were stained with picrosirius red to measure interstitial fibrosis.

Results:
All groups had similar LV dimensions, EF, and PSP (not shown). AT of naïve CD4+ cells or PBS did not increase the IRT vs baseline (7.3±0.9 vs 7.6±0.6 and 9.9±0.7 vs 8.8±0.7 ms). AT of Th1 cells significantly increased the IRT (15.6±0.9 vs 9.0±0.7 ms, all p<0.0001). EDP was significantly higher in Th1 mice (11.5±0.8 mmHg) vs naïve CD4+ mice (4.6±0.8 mmHg) or PBS (5.2±0.6 mmHg) (all p<0.0001). Interstitial fibrosis in Th1 mice (1.4±0.2%) was significantly higher than in naïve CD4+ mice (0.7±0.1%) or PBS (0.8±0.1%) (all p<0.001).

Conclusions:
Th1 cells are sufficient to induce diastolic dysfunction and fibrosis in a non-HTN AngII HF mouse model.
Abstract 11415: Integrative Metabolomics Differentiate Coronary Artery Disease, Peripheral Artery Disease, and Venous Thromboembolism Risks
Authors: Lee Jiwoo , Gilliland Thomas , Koyama Satoshi , Nakao Tetsushi , Dron Jacqueline S , Lannery Kim , Wong Megan , Peloso Gina , Hornsby Whitney , Natarajan Pradeep
Published: December 2023

Rationale:
Venous and arterial cardiovascular conditions, such as venous thromboembolism (VTE), coronary artery disease (CAD), and peripheral arterial disease (PAD), are genetically correlated. Interrogating distinct and overlapping mechanisms may shed new light on disease mechanisms.

Objective:
In this study, we aimed to: identify and compare (1) epidemiologic and (2) causal, genetic relationships between metabolites and CAD, PAD, and VTE.

Methods:
We used metabolomic data from 95,402 individuals in the UK Biobank, excluding individuals with prevalent cardiovascular disease. Logistic regression models adjusted for age, sex, genotyping array, first five principal components of ancestry, and statin use estimated the epidemiologic associations of 249 metabolites with incident CAD, PAD, or VTE. Bidirectional two-sample Mendelian randomization (MR) estimated the causal effects between metabolites and cardiovascular phenotypes using genome-wide association summary statistics for metabolites (N = 118,466 from UK Biobank), CAD (N = 184,305 from CARDIoGRAMplusC4D 2015), PAD (N = 243,060 from Million Veterans Project) and VTE (N = 650,119 from Million Veterans Project). Multivariable MR (MVMR) was further performed in subsequent analyses.

Results:
We found that 194, 111, and 69 metabolites were epidemiologically associated (P < 0.001) with CAD, PAD, and VTE, respectively. Metabolomic profiles exhibited variable similarity between disease pairs: CAD and PAD (N = 100, R
2
= 0.499), CAD and VTE (N = 68, R
2
= 0.455), and PAD and VTE (N = 54 shared associations, R
2
= 0.752). MR revealed 28 metabolites that increased risk for both CAD and PAD and 2 metabolites that increased risk for CAD but decreased risk for VTE. Despite strong epidemiologic overlap, no metabolites had a shared genetic relationship between PAD and VTE. MVMR revealed several metabolites with shared causal effects on CAD and PAD related to cholesterol content within very-low-density lipoprotein particles.

Conclusions:
While common arterial and venous conditions are associated with overlapping metabolomic profiles, MR prioritized the role of remnant cholesterol in arterial diseases but not venous thrombosis.
Abstract 11419: Combination of Right Ventricular Global Longitudinal Strain and Conventional Echocardiographic Parameter Carries Improved Prognostic Value in Submassive Pulmonary Embolism
Authors: Eguchi Shunsuke , Orihara Yoshiyuki , Eguchi Ayumi , Pfeiffer Michael , Peterson Brandon , Ruzieh Mohammed , Gao Zhaohui , Boehmer John , Gorcsan John , Wilson Ryan
Published: December 2023

Introduction and Hypothesis:
Right ventricular (RV) dysfunction has been identified as a prognostic marker for adverse clinical events in patients with submassive pulmonary embolism (PE). We hypothesized that combination of right-sided strain analysis and conventional parameters can further risk stratify patients at high risk for mortality.

Methods:
Retrospective cohort study of patients with submassive PE between 2010 and 2018. The primary outcome was all-cause mortality at 30 days. Echocardiographic parameters including right to left ventricular end-diastolic diameter ratio (RV/LV ratio), RV global longitudinal strain (RVGLS), RV free wall strain and right atrium strain were compared between survivors and non-survivors. Multivariable analysis and receiver operator characteristic (ROC) curves analysis were used to demonstrate the predictive value of baseline measurements.

Results:
251 patients were analyzed. Overall mortality rate at 30 days was 12.4 %. Multivariable analysis revealed RV/LV ratio was an independent predictor of 30-day mortality in conventional parameters, and RVGLS was also an independent predictor among the three strain parameters. ROC curves indicated that the best cutoff values for RVGLS and RV/LV ratio to predict mortality were 17.7 % and 1.03. When the 230 patients with measurable RVGLS and RV/LV ratio were divided into four groups using both cutoff values, patients with both high RVGLS and low RV/LV ratio had the lowest mortality (1.0 % at 30 days; n = 99) while patients with both low RVGLS and high RV/LV ratio had the highest mortality (46.2 % at 30 days; n = 39). Kaplan-Meier curves depicted the significantly different prognosis among the four groups (p < 0.001. Figure).

Conclusions:
The combination of RVGLS and RV/LV ratio can help further risk stratify patients with submassive PE. This may identify patients at highest risk of mortality and ultimately alter treatment pathways.
Abstract 11430: A Bad Break: Cardiogenic Shock Complicated by an Intracardiac Foreign Body
Authors: Hendrix Andrew , Li Kevin , Chang Josh , Sukhija Rishi , Das Manisha
Published: December 2023

Introduction:
We report a case of cardiogenic shock complicated by an intracardiac foreign body. This is a rare occurrence during a dangerous cardiovascular disease process which necessitated urgent multidisciplinary management.

Case:
A 54-year-old female with a history of hypertensive cardiomyopathy and breast cancer was not improving during a hospitalization for acutely decompensated CHF and atrial flutter with RVR. Right heart catheterization demonstrated cardiogenic shock, with a foreign body noted in the right atrium favored to be a fragment of the left subclavian port catheter also seen on fluoroscopy. This object was present on admission imaging but likely mistaken as external artifact. Coronary angiography revealed severe multi-vessel CAD. A multidisciplinary team discussed the timing and modality of foreign body removal, electing to prioritize hemodynamic optimization before intervention. Once stable, the patient underwent successful endovascular removal of the catheter fragment with immediate improvement of her heart rhythm. She remained in sinus rhythm until discharge home in stable condition.

Discussion:
This episode of cardiogenic shock may have been precipitated by an arrhythmogenic intracardiac foreign body. However, medication non-adherence and severe CAD on angiography suggested a multifactorial etiology, justifying a delay in the removal of the foreign body until shock had resolved. Additionally, the catheter fragment present on admission imaging should have been identified earlier as a contributing factor. Timely recognition and removal of the fragment may have prevented the hemodynamic decompensation of the patient.

Conclusion:
This case demonstrates the efficacy of delaying the removal of an intracardiac foreign body in favor of hemodynamic optimization in patients with cardiogenic shock, while obviating the need for maintaining a broad differential when determining the underlying etiology of decompensated heart failure.
Abstract 11450: The Association of Care Fragmentation on Limb Outcomes After Endovascular PAD Procedures Requiring Reintervention
Authors: Alabi Olamide , Zheng Xinyan , Duwayri Yazan , Mao Jialin , MASSARWEH NADER
Published: December 2023

Introduction:
Several policies exist that incentivize improved care coordination. Reintervention care fragmentation (when a patient requires a reintervention at another facility that is different than the index facility) for peripheral artery disease (PAD) has not been well-characterized. The intent of this work is to explore the frequency, characteristics, and differences in outcomes for patients when a vascular reintervention occurs at a non-index facility.

Methods:
National cohort of adults over age 65 who underwent an endovascular procedure for PAD within the Vascular Quality Initiative between January 1, 2010 to December 31, 2018 and had subsequent vascular reintervention. Data was linked to Medicare claims and American Hospital Association. We excluded emergency procedures, those performed for aneurysm, and those performed in an office-based setting. The primary outcomes were 90-day and 180-day amputation. Covariates of interest included sociodemographic, anatomic, procedural, and facility-level characteristics. Mixed effect logistic regression models (clustered at the facility-level) were used to determine the association between reintervention at an index versus non-index facility and the outcomes of interest.

Results:
Among 4,470 patients who underwent a vascular reintervention after an index endovascular procedure for PAD, 18.1% had their reintervention performed at a non-index facility. There were no differences noted by sex or level of community distress among those who went to the index facility versus a non-index facility for their vascular reintervention. Compared to those who had their reintervention at an index facility, vascular reintervention at a non-index facility was associated with significantly higher likelihood of major amputation (90-d amputation: Odds Ratio (OR) 1.61 [95% Confidence Interval (CI) 1.08-2.39]; 180-day amputation: OR 1.75 [95% CI 1.14-2.70]).

Conclusions:
Care fragmentation for patients who require vascular reintervention after an index endovascular PAD procedure is associated with higher risk of amputation. Additional work is needed to better understand which patients are at greatest risk for care fragmentation and how to better coordinate care in the post-procedural setting.
Abstract 11451: Development and Validation of the CANHEART Population-Based Laboratory Prediction Models for Atherosclerotic Cardiovascular Disease
Authors: Sud Maneesh , Sivaswamy Atul , Austin Peter , Hester Robert J , Naimark David , Farkouh Michael E , Lee Douglas , Roifman Idan , Thanassoulis George , Tu Karen , Udell Jacob A , Wijeysundera Harindra C , Ko Dennis T
Published: December 2023

Background:
The use of atherosclerotic cardiovascular disease (ASCVD) prediction models is suboptimal in clinical practice partly because of the need to gather history, physical and laboratory measures. Automation of risk assessment using only demographic and laboratory results may overcome this limitation. Our objective was to develop and validate sex-specific prediction models for ASCVD using age and routine laboratory tests and compare their performance to the Pooled Cohort Equations (PCEs).

Methods:
Models were derived and internally validated in Ontario residents aged 40 to 75 years without cardiovascular disease who had outpatient laboratory testing from April 1, 2009 to December 31, 2015. Estimates of the 5-year risk of ASCVD (myocardial infarction, stroke, death from ischemic heart or cerebrovascular disease) were obtained from Fine-Gray models that included age, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hemoglobin, mean corpuscular volume, platelets, leukocytes, estimated glomerular filtration rate, and glucose as predictors. Models were externally validated in a primary care cohort assembled from electronic medical record data and compared with the PCEs.

Results:
Sex-specific models were developed and internally validated in 2,160,497 women and 1,833,147 men. They were well calibrated with less than 2% relative difference between mean predicted and observed risk. The C-statistic was 0.77 in women and 0.72 in men. External validation in 31,697 primary care patients demonstrated less than 15% relative and less than 0.3% absolute difference in mean predicted and observed risks (
Figure
). The C-statistics for the lab models were 0.72 for both sexes and were not significantly different from the C-statistics for the PCEs in women (p=0.18 for difference) or men (p=0.35).

Conclusions:
We developed and validated the CANHEART Lab Models that predict ASCVD with similar accuracy to more complex models such as the PCEs.
Abstract 11574: Clinical Changes and Predictors of Health Status in Patients With Atrial Fibrillation
Authors: Miyama Hiroshi , Ikemura Nobuhiro , Kimura Takehiro , Katsumata Yoshinori , Nishiyama Takahiko , Himeno Yukihiro , Yano Shuhei , Yamashita Shuhei , Yamaoka Kouki , Ibe Susumu , Sekine Otoya , Ueda Ikuko , Kohsaka Shun , Takatsuki Seiji
Published: December 2023

Background:
Recent clinical trials have shown the health status benefit of rhythm control, including catheter ablation (CA) over rate control for patients with atrial fibrillation (AF). However, the trials show population-averaged benefits, which complicates clinical interpretation; in reality, some patients may not benefit or even experience worsening health status after treatment. This study aimed to examine changes in patients' health status and identify predictors in a multicenter outpatient registry (KiCS-AF).

Methods:
KiCS-AF was a multicenter, prospective registry of patients with newly diagnosed AF collecting baseline and 1-year patient-reported health status. We examined changes in the Atrial Fibrillation Effect on QualiTy-of-life overall summary (AFEQT-OS) score over 1 year across different treatment strategies in patients with paroxysmal or persistent AF. We defined clinically important improvement and deterioration of health status as ≥5 points increase and decrease in AFEQT-OS score and no change as -5 to 5 points based on previous reports.

Results:
Overall, 1,960 patients were enrolled in this study, with mean AFEQT-OS scores of 76.7±17.7 and 85.4±14.8 at baseline and 1-year follow-up, respectively. The majority of patients (53.9%) experienced a clinically important improvement in health status, albeit a substantial number of patients experienced no change (28.7%) or worsening health status (17.4%). The proportion of patients with no change or worsening health status differed by treatment strategy (59.9%, 53.9%, and 32.0% in the rate control, antiarrhythmic drugs, and CA groups, respectively). After adjustment for baseline characteristics and AFEQT-OS scores, preserved baseline health status, older age (≥65 years), female sex, heart failure, and coronary artery disease were independent predictors of worsening health status in the overall cohort and the CA subgroup.

Conclusion:
In contemporary practice, a large proportion of patients showed improvement in health status, while a considerable number of patients experienced worsening or no change after intervention. Patient-centered care is essential to prevent the worsening of health status even after CA in high cardiovascular-risk, elderly, and female populations.
Abstract 11589: Late Complications After Interrupted Aortic Arch Repair
Authors: Keaney John F , Asnes Jeremy , Assi Roland , Pastor Tony
Published: December 2023

Description of Case:
A 38-year-old man with known type B interrupted aortic arch (IAA), bicuspid aortic valve, and a complex surgical history (including IAA repair with an ascending-descending aortic conduit, later conduit graft revision, and left pulmonary artery [LPA] stent) presented after many years of loss to follow-up and was found to have hypertensive urgency. Echocardiogram showed turbulent flow in the proximal descending aorta concerning for arch obstruction. Computed tomography angiography (CTA) (Fig. 1 A–C) showed: narrowed proximal graft anastomosis, dilation of the aortic root and ascending aorta, a large pseudoaneurysm arising from the distal graft anastomosis, and LPA stenosis due to compression from the descending aorta.

Following improved hypertension, the patient underwent placement of a left carotid-subclavian bypass graft followed by thoracic endovascular aortic repair (TEVAR) with an endograft positioned across the distal aortic jump graft suture line. CTA one month postoperatively (Fig. 1 D–F) confirmed exclusion of the pseudoaneurysm.

Discussion:
Type B IAA is considered the most common subtype of IAA among cases diagnosed in infancy, though recent data regarding IAA epidemiology are scarce. IAA is associated with other congenital abnormalities, such as ventricular septal defect (VSD), LV outflow tract abnormalities, and 22q11 deletion syndrome. Additional surgical aortic arch procedures in these patients are not uncommon, perhaps especially among patients who required reintervention for LV outflow tract obstruction. While most studies examining long-term outcomes after IAA repair have not commented specifically on late risk of aneurysm or pseudoaneurysm, such findings have been described in the literature. Additionally, use of polytetrafluoroethylene material in arch repair and arch repair by a method other than direct anastomosis—such as were seen in our patient—have been observed to be risk factors for late reintervention.
Abstract 11591: Mechanism of Finerenone-Induced Vasorelaxation in Arteries From Human Visceral Adipose Tissue
Authors: SCHINZARI Francesca , De Stefano Alessandro , Vizioli Giuseppina , Tesauro Manfredi , Cardillo Carmine
Published: December 2023

Introduction:
Inadequate perfusion has emerged as a main determinant of adipose tissue (AT) dysfunction in obesity, sparking interest about possible ways to improve it. Among several mechanisms, mineralcorticoid receptor (MR) signaling has been shown to play a key role in the cross-talk between AT and the vasculature.

Hypothesis:
This study, therefore, tested the vasoactive properties of finerenone, a nonsteroidal MR antagonist, in arteries harvested from human AT.

Methods:
Small arteries (<1 mm in diameter) were isolated from visceral AT and studied ex vivo in a wire myograph. After vessels had been contracted, changes in vascular tone were determined under different experimental conditions.

Results:
Finerenone elicited a concentration-dependent relaxation in arteries of obese individuals contracted with the thromboxane A2 analogue U46619 (n=9; P<0001 vs. baseline); the steroidal MR antagonist potassium canrenoate, by contrast, did not induce any vasorelaxation (n=3; P>0.05). The relaxing effect of finerenone on U46619-induced constriction was not different in arteries from lean (n=3) and obese subjects (P=0.155). Mechanistically, the vasorelaxing response to finerenone was not influenced by pre-incubation with the nitric oxide (NO) synthase inhibitor L-NAME (n=4; P=0.19 vs. saline), hence ruling out an involvement of NO. Interestingly, finerenone was also able to relax arteries contracted with endothelin-1 (n=7; P<0.001) or with high-K
+
solution (n=4; P<0001), as well as those contracted with the L-type Ca
2+
-channel agonist BayK8644 (n=5; P=0.007); similarly, the calcium-channel blocker nifedipine induced relaxation of arteries contracted with BayK8644 (n=3; P<0.001).

Conclusions:
Finerenone induces NO-independent vasorelaxation in arterioles from human visceral AT, likely through antagonism of L-type Ca2
+
-channels. This finding identifies a novel action of finerenone to improve AT perfusion, thereby potentially expanding the emerging observations about the cardiovascular benefits of this agent.
Abstract 11601: Does Artificial Intelligence Dream of Elevated Natriuretic Peptide in Chest Radiography?
Authors: Kagawa Eisuke , Kato Masaya , Oda Noboru , Kunita Eiji , Nagai Michiaki , YAMANE AYA , Matsui Shogo , Yoshitomi Yuki , Ishida Shunsuke , Kurimoto Genki , Dote Keigo
Published: December 2023

Introduction:
Heart failure pandemic is a medical issue, and its diagnosis can be challenging.

Hypothesis:
To assess the hypothesis that the artificial intelligence (AI) model for predicting elevated brain natriuretic peptide (BNP) levels from chest X-ray images has sufficient performance and could improve the diagnostic performance of human.

Methods:
Patients who underwent chest radiography and BNP testing on the same day were enrolled in this study. The chest X-ray images were labeled based on plasma BNP levels >= 200 pg/mL. We trained models that predicted the label, and the final ensemble model was constructed. Humans were trained and tested to predict labels, followed by the same test, referring to the prediction of the AI model. Diagnostic performance was assessed.

Results:
Among the 1607 patients, 10103 chest X-ray images and BNP values were collected. We assembled 31 models as the final model with an accuracy of 0.855, precision of 0.873, recall of 0.827, receiver-operating-characteristics area-under-curve (AUC) of 0.929, and precision-recall AUC of 0.934. The accuracy of the testing by 35 individuals significantly improved from 0.708±0.049 to 0.829±0.069 (P < 0.001) with AI assistance. The accuracy of the experts was higher than that of non-experts (0.692±0.042 vs. 0.728±0.051, P = 0.030); however, with the AI assistance, the accuracy of the non-experts was rather higher than that of the experts (0.851±0.074 vs. 0.803±0.054, P = 0.033).

Conclusions:
The AI model can predict elevated BNP levels from chest X-ray images and could improve the diagnostic performance of humans.
Abstract 11629: Prognostic Impact of Geriatric Nutritional Risk Index After Endovascular Treatment With Lower Extremity Artery Disease
Authors: Satake Akinori , Ando Hirohiko , niwa toru , SHIMODA MASAHIRO , Suzuki Akihiro , Nakano Yusuke , Amano Tetsuya
Published: December 2023

Introduction:
The number of patients with lower extremity artery disease (LEAD) continues to increase. Moreover, the volume of endovascular treatment (EVT) increases accordingly. On the other hand, malnutrition of LEAD patients is underestimated despite nutritional factors are potentially a correctable parameter. Geriatric nutritional risk index (GNRI), calculated from serum albumin and the components of the body mass index, is a simple nutritional screening method. However, it is not well known whether GNRI before EVT affects the prognosis of LEAD patients.

Objective:
We investigated whether GNRI before EVT affects the prognosis of LEAD patients

Methods:
This study was a single-center, retrospective analysis. Between January 2010 and December 2022, consecutive 130 patients underwent the first EVT for LEAD at our hospital. The patients were divided into two groups based on the median GNRI: GNRI ≥ 91 group (n = 68) and GNRI < 91 group (n = 62). The primary endpoint was all-cause death, and the secondary endpoints were major amputation and target lesion revascularization (TLR) after EVT.

Results:
During the follow-up, 67 patients died after EVT. All-cause mortality was significantly higher in GNRI<91 group (P < 0.001). However, major amputation and target lesion revascularization rates were not significantly different between the two groups.

Conclusions:
The GNRI before EVT was independently associated with mortality in patients with LEAD
Abstract 11632: Altered Autonomic Balance Linked to Arrhythmogenicity in Chronic Myocardial Infarction Ovine Model
Authors: Kulkarni Kanchan , Pallares-Lupon Nestor , Poigai Arunachalam Shivaram , Bernus Olivier , Walton Richard
Published: December 2023

Background:
Increased sympathetic drive resulting in decreased heart rate variability (HRV), has been linked to cardiovascular diseases such as heart failure and myocardial infarction (MI). Dynamic electrophysiological changes due to acute ischemia and chronic MI are known to be pro-arrhythmic.

Objective:
Evaluate the changes in autonomic tone resulting from substrate remodeling during the development of chronic MI in an in-vivo ovine model.

Methods:
ECG recordings were collected at baseline, post occlusion and 6 weeks post MI, in young adult sheep (n=16). Time domain, frequency domain and non-linear measures of HRV were evaluated from 10 minutes of ECG data at the 3 time points. RR interval, heart rate, SDRR (standard deviation of the RR intervals), RMSSD (root mean square of successive differences between normal heartbeats), QTc interval, pNN
50
, LF/HF ratio and SD1/SD2 ratio were calculated and compared between baseline, post acute coronary artery occlusion and after 6 weeks of chronic MI. 24-hour telemetry was also performed in an ambulatory animal for 6 weeks to monitor the progression of alterations in the T-wave morphology or duration, i.e. T-wave alternans, a known marker of ventricular tachyarrhythmias, with chronic MI.

Results:
Chronic MI led to significantly decreased RR interval (Fig.1A) and increased heart rate (Fig.1B), along with a significant prolongation of the QTc interval (Fig.1C). Significant rise was also observed in the SDRR (Fig1D) and LF/HF ratio (Fig1E) indicating a shift towards increased sympathetic tone and reduced parasympathetic drive. In addition to the autonomic changes, a significant rise in T-wave alternans burden (Fig1F) and localized action potential alternans inducibility was observed with progression of MI indicating increased arrhythmogenicity.

Conclusion:
Skewed autonomic balance is evident in chronic MI and may be closely linked to increased arrhythmogenicity.
Abstract 11635: Device and Formulation Optimization for MK2 Inhibition and Restenosis Prevention at Sites of Peripheral Angioplasty
Authors: Tierney William , Yu Fang , Ma Jackey , Cheung-flynn Joyce , Keech Megan , Brasuell Jordan , Chang Devin , Brophy Colleen , Duvall Craig
Published: December 2023

Introduction:
Peripheral angioplasty often fails due to intimal hyperplasia (IH), where contractile smooth muscle cells (SMCs) de-differentiate into proliferative, migratory, and pro-inflammatory synthetic SMCs, leading to restenosis. We have formerly shown that potentiation of an MK2 inhibitory peptide (MK2i) via delivery with poly(propyl acrylic acid) (PPAA) can block SMC phenotype switching and neointima formation in a transplant model. This work develops strategies for targeted in vivo MK2i+PPAA delivery to the site of angioplasty.

Hypothesis:
MK2i+PPAA can be effectively delivered into and retained within the arterial wall using either convective delivery or a coated angioplasty balloon.

Methods:
These studies have utilized isolated rat aortae as a model tissue. Aortae were balloon damaged and subjected to convective or coated balloon treatment. Delivery and retention of MK2i was determined with confocal microscopy and flow cytometry. MK2i activity was measured using IHC and western blots for pCREB, a downstream substrate of MK2.

Results:
Convective delivery studies have shown substantial MK2i delivery into the vascular wall, with pre-formed MK2i nanopolyplexes (NPs) having significantly more cell uptake than free MK2i or sequentially delivered PPAA and MK2i. Additionally, we have created a method for layered coating of MK2i+PPAA onto an angioplasty balloon that shows rapid release and successful arterial wall delivery. In efficacy studies, convective delivery of MK2i-NPs and balloon delivery of MK2i+PPAA with 50 mg/mL lactosucrose excipient significantly decreased levels of pCREB downstream of MK2 after balloon damage. Ongoing studies show that both delivery strategies block cellular proliferation in balloon damaged arteries after 7d in a flow loop bioreactor.

Conclusions:
Convective and coated balloon delivery show promise as strategies for on-target delivery of MK2i+PPAA to peripheral arteries after angioplasty to prevent restenosis.
Abstract 11685: Effects of Pectus Excavatum Surgical Repair on Cardiac Volumes and Systolic Function as Assessed by 3D Transesophageal Echocardiography
Authors: FARINA JUAN M , Mandale Deepa R , Jaroszewski Dawn E , Aly Mohamed R , Botros Michael M , Moosavi Ryan S , Narayanasamy Hemalatha , Larsen Carolyn M , Chaliki Hari P , Majdalany David , freeman william , Alsidawi Said , Lester Steven J , Ayoub Chadi , Wilansky Susan , Arsanjani Reza , Naqvi Tasneem Z
Published: December 2023

Introduction:
The consequences of external cardiovascular compression and cardiac displacement from pectus excavatum (PEx) are debated. The complex geometry of the right (RV) and left ventricle (LV) along with distortion from the extrinsic chest deformity pose significant limitations to reliable assessment of LV and RV volumes and function using transthoracic 2D-echocardiography in this population.

Hypothesis:
A 3D-echocardiography approach can reliably assess the effects of external cardiac compression and the benefits of surgical correction on RV and LV function in PEx patients.

Methods:
Adult patients undergoing minimally invasive repair of PEx between Oct-2021 and Feb-2023 were included in this prospective study. Intraoperative transesophageal (TEE) 6 beat full volume video loops incorporating LV and RV were captured and compared before and after surgical correction of the PEx. TomTec Software® was used for offline 3D/4D reconstruction (
Figure 1
shows changes in 3D RV and LV shape pre- and post-surgery).

Result:
The study included 102 patients (mean age of 32.1 ±11.8 years; Haller index 4.9 ±2.5; 60.8% males). Post PEx repair, there was a significant (p<0.001) increase in the 3D RV volumes, RV ejection fraction (EF), RV stroke volume and RV strain (
Figure 1
). Additionally, there was a significant improvement in 3D LVEF, 3D LV strain (longitudinal and circumferential), LV twist, and torsion (
Figure 1
).

Conclusion:
In this PEx cohort, 3D/4D TEE imaging demonstrated significant increases in RV volumes and in RV and LV systolic function after surgical repair. These findings support the negative cardiovascular consequences of PEx compression and benefits of surgical repair.
Abstract 11686: Aortic Stenosis is Independently Associated With Smoking, Diabetes Mellitus, Hypertension, Hyperlipidemia, Renal Disease, COPD, and Caucasian Ethnicity in Addition to Advanced Age, Rheumatic Fever, and Bicuspid Aortic Valve
Authors: Timmerman Brandon , Hashemzadeh Mehrtash , Movahed Mohammad Reza
Published: December 2023

Hypothesis:
Aortic valve stenosis is known to be associated with age, rheumatic fever, and bicuspid aortic valve but its association with other cardiovascular risk factors is less known. The purpose of this study was to investigate any association between aortic stenosis and other common cardiovascular risk factors.

Method:
The large Nationwide Inpatient Sample database was utilized to study these associations using uni- and multivariate analyses. Data was extracted from the first available database that used ICD-10 codes specifically coding aortic stenosis alone, which occurred in the year 2016.

Results:
In the database of patients over age of 40, a significant association was identified between aortic stenosis and smoking (OR: 1.12, CI 1.1 - 1.15, P < 0.001), diabetes mellitus (OR: 1.19, CI 1.17 - 1.21, P < 0.001), hypertension (OR: 1.36, CI 1.33 - 1.39, P < 0.001), hyperlipidemia (OR: 1.47, CI 1.44 - 1.49, P < 0.001), renal disease (OR: 1.46, CI 1.43 - 1.48, P < 0.001), chronic obstructive lung disease (COPD) (OR: 1.16, CI 1.14 - 1.18, P < 0.001), obesity (OR: 1.35, CI 1.32 - 1.39, P < 0.001), and Caucasian race (OR: 1.47, CI 1.42 - 1.52, P < 0.001), in addition to known factors such as age, rheumatic disease and bicuspid aortic valve.

Conclusion:
Based on this large database study, we found a new association of aortic valve stenosis with race and many cardiovascular risk factors such as smoking, renal disease, COPD, Caucasian race, and obesity. The role of these new risk factors in the pathogenesis of aortic stenosis warrants further investigation.
Abstract 11698: Torsades de Aortique Pustule: A Case of Aortic Abscess Leading to 2:1 AV Block and Torsades de Pointes
Authors: Matthews Benjamin , Marak Martin , Doppalapudi Harish
Published: December 2023

Introduction:
Endocarditis of the aortic valve has a propensity to create A-V conduction disturbances in up to 10% of cases. Torsades de pointes (TdP) is polymorphic ventricular tachycardia in the setting of prolonged QT interval and bradycardia that is typically preceded by a short-long-short sequence of ventricular activation. We present a case of infective endocarditis with aortic root abscess leading to acute 2:1 A-V conduction and culminating in TdP.

Case Summary:
A 30-year-old male with history of IV drug use and bioprosthetic aortic valve repair presented with pleuritic chest pain, nausea and vomiting. He was febrile and tachycardic with a systolic murmur at the right upper sternal border. Initial electrocardiogram showed sinus rhythm with no conduction abnormalities.
A
Transthoracic echocardiography showed a large aortic valve vegetation with an abscess cavity.
E
Blood cultures grew Streptococcus oralis. Two days later, he developed VT/VF arrest requiring external defibrillation. Preceding ECGs and telemetry showed sinus tachycardia with new left bundle branch block and prolonged QTc.
B
This progressed to 2:1 AV block
C
with abrupt transition to relative bradycardia and ventricular ectopy leading to short-long-short ventricular intervals and subsequent TdP.
D
A temporary pacemaker was placed, and he underwent an aortic root reconstruction with valve replacement.

Discussion:
While both the etiology of TdP and aortic root abscesses leading to conduction system disease are well described, this case exhibits the real time progression of aortic abscess involvement. The patient presented with a normal QRS morphology. During hospitalization, he developed new LBBB, and the appropriate sinus tachycardia then deteriorated into 2:1 AV conduction leading to relative bradycardia. This abrupt transition with QTc prolongation sets up the nidus for ventricular ectopy (due to early after depolarizations) with salvos of short-long-short sequences causing TdP.