bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4139079: Procedural Volume and Outcomes After Septal Reduction Therapies in Hypertrophic Obstructive Cardiomyopathy
Authors: Patel Nirav , Shetty Naman , Gaonkar Mokshad , Shahid Abdulla , Divekar Girija , Pampana Akhil , Vekariya Nehal , Peng Li , Ahmed Mustafa , Arora Garima , Arora Pankaj
Published: November 2024

Background:
Septal myectomy (SM) and alcohol septal ablation (ASA) are preferred modalities for individuals with symptomatic obstructive hypertrophic cardiomyopathy (HCM). Apart from patient-level factors, operator and hospital volume play a role in determining clinical outcomes in patients undergoing septal reduction therapies. However, contemporary data on the influence of operator and hospital volume on clinical outcomes are lacking.

Methods:
This retrospective study used nationwide data from the Vizient
®
from 2016-2022. The appropriate ICD-10 diagnosis/procedure codes were used to identify patients with HCM who underwent SM and ASA. Based on operator and hospital volumes, the cohort was stratified into low-, medium-, and high-volume based on tertiles of annualized procedures. The outcomes of interest were 30-day mortality and 90-day readmissions. Multivariable-adjusted logistic and Cox models were used to assess the association of outcomes with operator and hospital volumes.

Results:
Among 5,725 HCM patients included in this study, 3,990(69.7%) and 1,735(31.3%) underwent SM and ASA, respectively. Among those who underwent SM, low-(OR
adj
:1.86;95%CI:1.11–3.15) and medium-(OR
adj
:1.93;95%CI:1.05–3.55) volume operators were associated with higher odds of mortality compared with high-volume operators.(
Table
) Similarly, medium-volume hospitals had higher odds of mortality post-SM compared with high-volume hospitals (OR
adj
:2.29;95%CI:1.32–3.99).(
Table
) Moreover, low-volume operators (HR
adj
:1.51;95%CI:1.22-1.88) and hospitals (HR
adj
:1.60;95%CI:1.14-2.23) were associated with greater risk for readmission compared with their high-volume counterparts for SM.(
Figure
) Among those who underwent ASA, low-(OR
adj
:2.99;95%CI:1.15-7.75) and medium-(OR
adj
:3.86;95%CI:1.30–11.46) operator volume was associated with higher odds for mortality compared with high-volume operators.(
Table
) Compared with high-volume operators, the risk of readmission was similar to low-volume operators (HR
adj
:1.31;95%CI:0.96-1.77).(
Figure
) However, hospital volume was not associated with mortality and readmission for ASA.

Conclusions:
Low operator and hospital volumes for septal reduction therapies were associated with higher postoperative morbidity and mortality compared with their high-volume counterparts. The current study highlights the need to refer HCM patients requiring septal reduction therapies to high-volume centers with experienced operators who have expertise in performing these procedures.
Abstract 4139209: Racial/Ethnic Disparities in Outcomes of Post-Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
Authors: Pawar Shubhadarshini , Ganduboina Rohit , Dutta Palak , Gulati Shipra , Ranka Sagar
Published: November 2024

Background:
There has been growing awareness and recognition of discrepant health outcomes based on ethnic and racial background in patients undergoing cardiovascular procedures. Transcatheter aortic valve procedures has become the primary treatment for aortic stenosis and is currently the standard of care. Despite widespread adoption of TAVR, African Americans (AA) have continued to remain underrepresented and typically suffer poorer outcomes. Thus, we conducted a systematic review and meta-analysis to compare TAVR outcomes between AA and non-AA populations.

Methodology:
We systematically searched all electronic databases (PubMed, EMBASE, Scopus, Web of science) from inception until May 25
th
, 2024. A pooled analysis of data from observational studies and randomized controlled trials reporting post-TAVR outcomes based on racial background were included. The key endpoints evaluated were in-hospital mortality, post-procedure myocardial infarction (MI), pacemaker placement, in-hospital stroke, vascular complications, major bleeding, acute kidney injury (AKI). We used the I2 statistic to assess heterogeneity among studies using the Random-Effects model, with significance set at I2 > 50%. All analysis was carried out using R version 4.3.2.

Results:
The meta-analysis of eleven observational studies, involving 953,892 TAVR patients [912,301 (95.64%) Caucasians and 41,591 (4.36%) AAs], showed a statistically significant higher risk of post-procedure pacemaker placement (OR 1.08, 95% CI: 0.77-1.51, p=<0.001, I2=99%) for Caucasians compared to AAs. In secondary outcomes, AAs had significant higher risk of in-hospital stroke (OR 0.83, 95% CI: 0.67-1.02, p <0.01, I2=90%), major bleeding (OR:0.89, 95% CI: 0.77-1.02, p <0.01, I2=74%), AKI (OR: 0.77, 95%CI:0.67-0.88, P=0.04, I2=59%) compared to Caucasians. However, no significant differences were found for in-hospital mortality, MI, vascular complications as mentioned in Figure 1-3.

Conclusion:
The current study suggests a worse clinical outcome for AA undergoing TAVR. Further studies are needed to evaluate the factors responsible for the discrepancy and implementing mitigation strategies.
Abstract 4139227: Exercise Right Ventricular-Pulmonary Arterial Coupling predicts long-term Functional Outcome in Patients undergoing Surgery for Secondary Ischemic Mitral Regurgitation.
Authors: Fino Carlo , BELLAVIA DIEGO , D'Alonzo Michele , Merlo Maurizio , Bruno Vito Domenico , Caputo Massimo , Magne Julien , terzi amedeo , SENNI MICHELE , Bichi Samuele , Simon Caterina , Sciatti Edoardo , Maccarana Agnese , Marchetto Giovanni , iacovoni attilio , Pibarot Philippe
Published: November 2024

Background:
The treatment of secondary ischemic mitral regurgitation is challenging and predictors of functional and clinical outcome are pivotal in order to define the best therapeutic strategy. In these patients there is growing evidence that assessing the right ventricular (RV)-pulmonary arterial (PA) coupling during exercise has additive diagnostic and prognostic value.

To date, no data are available as regard the exercise assessment of the RV- PA coupling in patients undergoing surgery for ischemic mitral regurgitation

Research Question:
in patients with ischemic mitral regurgitation the evaluation of the exercise RV-PA coupling could play a crucial role for patients selection and prognosis

Aim:
to test resting and exercise echocardiographic predictors of functional capacity and clinical outcome in patients referred to surgery

Methods:
A 6-minute walking test and exercise stress echo performed at preoperative baseline, at 1 year and at median FU of 6 years (IQR: 3.70; range: 4.5– 8) on 50 patients (age: 67 ± 8 year; EF: 35 ± 5%), undergoing surgery by valve replacement or repair. Generalized linear mixed models were used to evaluate the predictive value of preoperative echocardiographic parameters on the longitudinal distribution of the 6-MWT.

Results:
Preoperative exercise tricuspid annular plane systolic excursion (TAPSE)/ pulmonary artery systolic pressure (PASP) ratio showed the strongest correlation with long-term six-minute walking test (r=0.81, p< 0.01) (Figure 1).The receiver operating characteristic analysis found that a preoperative exercise TAPSE/PASP < 0.34 predicted the lowest quartile of six-minute walking test at long-term (sensitivity: 79%; specificity: 100%) (Figure 2) and a composite clinical outcome of heart failure and death for any cause (PPV 91.3%, NPV 100%).

On multivariable analysis TAPSE (Estimates:4.05; SE:0.90; p < 0.01) and TAPSE/PASP ratio (Estimates:106.9; SE: 31.54, p <0.01) were significantly associated with better long-term six-minute walking test (Table 1)

Conclusions:
A preoperative exercise TAPSE/PAPS < 0.34 predicts a poor six-minute walking test performance and an higher likelihood of clinical adverse events over time. In patients with secondary ischemic mitral regurgitation the exercise RV-PA coupling could add value in order to improve risk stratification. These findings need to be comfirmed by larger studies
Abstract 4139236: Artificial Intelligence–Electrocardiography to Predict Incident Atrial Fibrillation and Survival Following Kidney Transplant
Authors: FARINA JUAN , Scalia Isabel , Pereyra Milagros , Awad Kamal , Baba Ali Nima , Mahmoud Ahmed K. , Abbas Mohammed Tiseer , Alsidawi Said , Steidley D Eric , El Masry Hicham , Sorajja Dan , Ayoub Chadi , Mour Girish , Arsanjani Reza
Published: November 2024

Background:
New-onset atrial fibrillation (AF) is common among kidney transplant (KTx) recipients and is associated with reduced patient survival. Predictors of AF after KTx are not well understood, although AF can be associated with traditional and non-traditional risk factors. While artificial intelligence-enabled electrocardiography (AI-ECG) has shown promise in predicting incident AF, its predictive and prognostic implications in the KTx population have not yet been evaluated.

Hypothesis:
AI-ECG can predict new-onset AF and carries prognostic implications in patients undergoing KTx.

Aims:
To evaluate the clinical implications of applying AI-ECG to the preoperative ECGs of recipients of a KTx.

Methods:
Patients without a history of AF who underwent KTx at three referral centers between 2011 and 2021, with at least one preoperative ECG, were included in this retrospective study. Preoperative ECGs were analyzed using a previously developed AI-ECG algorithm to estimate the probabilities of new-onset AF. Based on these probabilities, patients were categorized into two groups: high and low probability of incident AF. The optimal cut-off value for the AI-ECG tool was determined using ROC analysis. The incidence of new-onset AF and mortality at 5 years post KTx were compared between these two groups using univariate and multivariate Cox regression analyses.

Results:
In total, 6246 patients were included (mean age 52.9 ±14.3 years, 58.7% males). A pre-transplant AI-ECG probability of AF >10% was identified as the most accurate cutoff point to distinguish between patients at low risk and high risk of incident AF (ROC = 0.72). The study found that a preoperative AI-ECG high risk of AF demonstrated not only a strong association with new-onset AF (HR 2.54, 95%CI 2.02-3.19, p<0.001 on multivariable analysis,
Figure 1A
) but was also associated with an increased risk of mortality both on univariate (HR 2.73, 95%CI 2.34-3.18, p<0.001) and multivariate (HR 1.57, 95%CI 1.29-1.91, p<0.001 ) analysis at 5-year follow-up (
Figure 1B
).

Conclusion:
The application of AI-ECG to a single widely available test may help assess the risk of new-onset AF and mortality in patients undergoing KTx. Accurate risk stratification may identify a high-risk subgroup of transplant recipients who can benefit from closer AF monitoring, risk factor modification, and early management.
Abstract 4139241: The Triple Medical Therapy Prevented Post-infarction Cardiac Rupture via Inhibiting MMPs Over-activation and Macrophage-induced Cardiac Fibroblasts Ferroptosis Through TRAF6/NF-κB/C/EBPβ Down-regulation mediated by different microRNAs.
Authors: TANG Ruijie , ZHANG Lili , Yang Yuejin
Published: November 2024

Background:
Percutaneous coronary intervention has significantly improved the prognosis of STEMI, though there is still the risk of fetal mechanical complications, particularly cardiac rupture(CR), which remains an international clinical problem unresolved.

Hypothesis:
We hypothesized that the combined triple medical therapy(
ANT
) with
A
torvastatin,
N
icorandil and Chinese patent medicine
T
ongxinluo(TXL) could be effective in post-infarction CR precautions via significantly inhibiting macrophage activation and secondary ferroptosis of cardiac fibroblasts(CFs) through TRAF6/NF-κB/C/EBPβ pathway.

Methods:
The 14-day survival and CR rates of AMI mice treated with Atorvastatin, Nicorandil and Tongxinluo, singly or in dual and triple combination, were all compared via the Kaplan-Meier curves. Then the inflammation level and infarct region were measured via ELISA, immunoblot and histopathology. Sequentially immunoprecipitation, luciferase report gene and transcriptome sequencing were introduced to understand the role of the TRAF6/NF-κB/C/EBPβ pathway and its upstream micro-RNAs in CR prevention. Further,
in-vitro
experiments were performed to demonstrate the crosstalk between macrophages activation and CFs ferroptosis in CR prevention.

Results:
Among all therapies involved, the triple combined ANT therapy supremely reduced the incidence of post-infarction CR (from 26.7% to 10.0%) and the mortality of AMI (from 30.0% to 13.3%), during which macrophages reduced most nuclear NF-κB p65 and C/EPBβ by nearly 70% simultaneously through miR215-5p-, miR122-5p-, miR-299b-3p-mediated TRAF6 inhibition, with 50%+ MMP9 cut and more extracellular matrix remaining, especially collagens, Syndecan-1, Laminin and Agrin. And, with the ANT administration, only 20% macrophages remained in peri-infarct areas, accompanied by the lowest serum inflammatory level. Furthermore, CF ferroptosis alleviated most, evidenced by the 4-fold GPX4 and 3-fold FSP-1 up-regulation. Two independent anti-ferroptotic system, GPX4 and FSP-1, worked equally in the nicorandil effect on CF survival, however, with GPX4 or FSP-1 overwhelmingly underlying atorvastatin or Tongxinluo protection against CF ferroptosis respectively.

Conclusions:
Our results indicated the ANT combination upmost alleviated the excessive excitation of M1 macrophages and its induced CF ferroptosis via prohibiting TRAF6-mediated NF-κB and C/EBPβ translocation, and facilitated myocardial repair to prevent post-infarction cardiac rupture onset.
Abstract 4139274: Implications of Electrocardiographic-Based Artificial Intelligence on Patients with Exercise-Induced Cardiomyopathy
Authors: Figueiral Marta , Fazzini Luca , Cao Jenny Jia Ling , Hubers Scott , Scott Christopher , McCully Robert , Castrichini Matteo , Mohananey Akanksha , Ghazal Rachad , Wang Min , Wang Li , Gulati Rajiv , Montisci Roberta , Pellikka Patricia , Pereira Naveen
Published: November 2024

Background:
Electrocardiography-based artificial intelligence (AI-ECG) validated models that detect cardiac disease are increasingly being applied in clinical practice. The utility of such tools to detect insidious cardiac disease in patients with normal baseline left ventricular ejection fraction (LVEF) who paradoxically develop reduced LVEF during exercise stress echocardiography (ESE), and do not have coronary artery disease (CAD) or hypertension, is unknown.

Hypothesis:
AI-ECG is useful to diagnose insidious cardiac disease and predict clinical outcomes in patients with exercise-induced cardiomyopathy.

Aims:
To assess the utility of AI ECG in patients with exercise-induced cardiomyopathy.

Methods:
Among all ESE performed between January 2003 and December 2022, patients without a hypertensive response to exercise and without CAD (confirmed by coronary angiography within 90 days after ESE), with resting LVEF ≥50% and a paradoxical ≥5% LVEF decrease during ESE were identified. A previously validated AI-ECG algorithm that predicts atrial fibrillation (AF), reduced LVEF, and cardiac amyloidosis (CA) was applied to the baseline ECG closest to the time of ESE. The predicted probability of AF, reduced LVEF, and CA if above the published thresholds, was determined.

Results:
There were 134 patients with exercise-induced cardiomyopathy who were identified. The mean age of this cohort was 66±10 years, 76% were women and 16% had AF at baseline. Mean LVEF was 58±4% at rest and 43±4% at peak stress. The median follow-up period was 6.8 years (IQR 3.0-12.2). Among patients without a baseline history of AF (n=112), AI-ECG identified 29% with a significant probability of AF, which was associated with a subsequent AF diagnosis at univariable analysis (HR 2.505, 95%CI 1.016-6.177, p=0.046). There were 10 patients with an AI-ECG prediction of reduced LVEF among whom 3 were subsequently hospitalized with HF. AI-ECG was positive for CA in 8 and 3 amongst these had subsequent HF hospitalizations (Table).

Conclusions:
Baseline AI-ECG may help predict subsequent AF and diagnose preclinical amyloid cardiomyopathy in patients who by resting echocardiography do not seem to have cardiac disease but with exercise develop reduced LVEF.
Abstract 4139277: Activation of the Histamine-3 Receptor Prevents Cardiac Fibrosis and Diastolic Dysfunction by Opposing a Profibrotic Cardiac Fibroblast Phenotype through Inhibition of cAMP Signaling
Authors: Connery Heather , Herrnreiter Anja , Campbell William , Widiapradja Alexander , Levick Scott
Published: November 2024

Introduction:
Cardiac fibrosis is a major contributor to adverse cardiac remodeling that underlies heart failure. Previously, we identified the presence of the histamine-3 receptor (H
3
R) in the left ventricle (LV), including on fibroblasts, and demonstrated that exogenous H
3
R activation with imetit reduced cardiac fibrosis in angiotensin II (Ang II)-infused mice.

Objective:
We sought to determine the extent to which activation of H
3
R improved diastolic function, and to identify cellular mechanisms by which H
3
R opposes a profibrotic cardiac fibroblast phenotype.

Methods:
Eight-week-old male C57/B6 mice received saline or Ang II (1500 ng/kg/d) via osmotic pump for 7 days. Separate saline or Ang II mice also received subcutaneous injections of imetit (40 mg/kg/d). LV function was assessed by pressure-volume catheter. TruPath assay was used to identify H
3
R-induced G proteins in HEK293T cells. For signaling studies, primary LV fibroblasts were isolated from C57/B6 mice and treated with TGF-β1 (30 ng/mL) as a profibrotic stimulus, together with imetit (300 nM). Collagen release and cell migration were assessed for fibroblast phenotype. The cAMP/PKA/CREB signaling pathway was also assessed.

Results:
LV end-diastolic pressure was increased in Ang II mice (p<0.03 vs Saline). This was prevented by imetit (p<0.02 vs Ang II). There was also a trend towards an increase in
tau
, a measure of LV stiffness, in Ang II mice that was normalized by imetit. Cardiac fibrosis occurred in Ang II mice (p<0.0001 vs Saline), which was normalized by imetit (p<0.0001 vs Ang II). In cardiac fibroblasts, TGF-β1 increased collagen I release, with this being inhibited by imetit (TGF-β1 594.1±59.97 vs TGF-β1+Imetit 274±38.2 ng/mg, p<0.0001). TGF-β1 inhibited fibroblast migration, with imetit restoring a normal migratory response (p<0.003 vs TGF-β1). H
3
R activation induced the Gα
i
subunit in HEK293T cells, which would suggest inhibition of cAMP. Consistent with this, imetit significantly decreased both pPKA/PKA and pCREB/CREB ratios in cardiac fibroblasts following TGF-β1. The cAMP pathway inhibitor cAMPs-Rp reduced TGF-β1 induced collagen production and restored the cell migratory response lost due to TGF-β1.

Conclusions:
Activation of H
3
R improves diastolic function in part by preventing cardiac fibrosis. This antifibrotic effect can be at least partially attributed to inhibition of a profibrotic cardiac fibroblast phenotype, likely through Gα
i
inhibiting the cAMP/PKA/CREB signaling axis.
Abstract 4139306: Digital engagement with a patient smartphone app and text messaging is associated with increased compliance in patients undergoing long-term continuous ambulatory cardiac monitoring
Authors: Battisti Anthony , Raley Joshua , Fan Alice , Pinkerton Relana , Mead Hardwin , Turakhia Mintu
Published: November 2024

Introduction:
Although home-based diagnostics have dramatically reshaped care delivery, greater patient activation could affect compliance. For home enrollment and activation (HE) of long-term continuous ambulatory cardiac monitoring (LTCM) devices, patients must receive the device by mail, self-apply the patch, wear it for up to 14 days, and return by mail for ECG interpretation. We developed two direct-to-patient digital interventions and evaluated association of use of these to compliance outcomes after US-wide implementation.

Methods:
MyZio® is an optional smartphone app (iOS&Android) for patients for use with Zio® LTCM (iRhythm Technologies, Inc; San Francisco, CA) that tracks shipping status, enables registration, provides educational content and instruction on application/activation/wear, notifies users of remaining wear time and gives return reminders. Patients with a mobile number may also opt-in to short messages services (SMS) text notifications. Opt-in patients receive texts regarding delivery, application/wear, billing information, device return and prompts to download MyZio.

We evaluated patient compliance (activation, wear, and device return) in all patients shipped Zio LTCM with HE between Oct 1 and Apr 3, 2024; the period after launch of MyZio version 2.0. We calculated return rates, stratified by use of one or both digital interventions. Odds ratios were calculated and the Chi Square test was used to report associated p-values compared to the reference (no intervention).

Results:
The distribution of the use of digital tools and compliance outcomes in 169,131 patients are shown in Table 1. Compliance was lowest (74.6%) when both the app and text messaging were not used. App use was associated with the highest gains in compliance, largely irrespective of concomitant text messaging. Opting into SMS text was associated with compliance improvement but was inferior to app use.

Conclusion:
In patch-based ECG LTCM, a dedicated patient app and SMS texting were associated with improved device return rates, although the app had a stronger effect. These data support the use of patient digital health interventions in home-based diagnostics and underscore the importance of post-implementation evaluation of outcomes.
Abstract 4139353:

Geographic, Gender,&Racial Trends in Mortality Due to Coronary Artery Disease in Obesity among Adults Aged 25 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis
Authors: Naveed Muhammad Abdullah , Alboushi Aldabagh Mohammad , Ali Ahila , Ahmed Faizan , Omer Rehan Muhammad , Iqbal Rabia , Azeem Bazil , Cheema Mustafa Sajjad , sattar yasar
Published: November 2024

Background:
Coronary Artery Disease (CAD) in obese population is the most common cause of mortality worldwide. This study examines the variation in cardiovascular mortality rates due to CAD in obese adults aged 25 and above from 1999 to 2020.

Methods:
We performed a retrospective cohort study using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database from 1999 to 2020. We calculated age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) per 100,000 persons. The information was categorized based on year, gender, ethnicity, and geographic area.

Results:
Between 1999 and 2020, CAD in obesity accounted for 102,434 deaths among adults (≥25 years) in the United States. Majority of deaths occurred in medical facilities (49.0%), followed by decedents' homes (36.8%). The overall AAMR for CAD in obesity-related deaths increased from 1.5 in 1999 to 3.3 in 2020, with an AAPC of 3.46 (95% CI: 2.83 to 3.92, p < 0.000001). Men exhibited higher AAMRs compared to women (men: 2.7; women: 1.6), with significant increases for both sex. The increase was more prominent in men (AAPC: 4.34, 95% CI: 3.73 to 4.83, p < 0.000001). Racial/ethnic disparities were evident, with American Indian or Alaska Native individuals having the highest AAMR (2.9), followed by Black or African American (2.4), White (2.3), Hispanic or Latino (1.3), and Asian or Pacific Islander (0.5). All racial groups experienced an increase in AAMR from 1999 to 2020, most pronounced in American Indian or Alaska Native individuals (AAPC: 5.06, 95% CI: 2.90 to 8.64, p < 0.000001). Geographically, AAMRs ranged from 1.0 in Alabama to 4.3 in North Dakota, with the Midwestern region having the highest mortality (AAMR: 2.6). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (nonmetropolitan: 2.8; metropolitan: 2.0). (Figure 1)

Conclusion:
This study highlights significant demographic disparities in mortality rates due to CAD in obesity among adults aged 25 and older. Despite an overall increase in mortality rates, the significant rise in recent years, particularly among certain racial groups and geographical regions, emphasize the need for targeted interventions and equal healthcare access to improve outcomes for affected populations.
Abstract 4139408: Lipoprotein(a) levels in Polish population based on the STAR-Lp(a) cohort study. Prevalence, patient’s population, and risk factors.
Authors: Burzynska Monika , Jankowski Piotr , Babicki Mateusz , Banach Maciej , Chudzik Michal
Published: November 2024

Background:
Elevated Lipoprotein(a) [Lp(a)] is independently associated with increased cardiovascular disease (CVD) risk.

Purpose:
The study aimed to evaluate the Lp(a) levels in Polish population and determine the association between socio-demographic and health-related variables and elevated Lp(a).

Methods:
The analysis was conducted among 2475 outpatient primary prevention patients (69.7% - women). The median age was 66.0 years ±20 years. Lp(a) levels were assessed in groups: <30 mg/dL (<75 nmol/l) (normal level) and >30 mg/dL (75-125 nmol/l) (elevated level). Statistical analysis was performed using STATISTICA 13.1. Qualitative variables were analyzed using descriptive statistics. The chi-square test was used to assess the relationship between quantitative variables. The Mann-Whitney test was used in the case of qualitative. Pearson's correlation coefficient was used to measure correlation. Multivariate logistic regression models were built to determine the effect of factors on the probability of elevated Lp(a) level. P<0.05 was judged as significant.

Results:
Lp(a) >30 mg/dL was recorded in 21.5% of patients (Fig. 1). The average age of patients with Lp(a)>30 was significantly higher (67 years ±17 vs. 65 years ± 20; p=0.008). A significant relationship was observed between the level of Lp(a) and the presence of selected comorbidities, i.e., hypertension, hyperlipidemia and atrial fibrillation (AF). The share of people with these disorders was higher in patients with elevated Lp(a) by 5.8; 6.6 and 1.7 pp. respectively. People suffering from migraines less frequently had Lp(a)>30 (5.6% vs 8.6%, p=0.025). Among patients with elevated Lp(a), there were significantly higher average levels of total cholesterol (TC), LDL cholesterol, non-HDL cholesterol, and hemoglobin A1C (HbA1C) (p=0.003; p=0.0004, p=0.003, p=0.021). A positive significant correlation was observed between the Lp(a) and the glucose level, both in patients with elevated Lp(a) level (r=0.19, p<0.001) (Fig. 2A). An analogous relationship was noted for Lp(A) and HbA1C (r=0.24; p<0.001) (Fig. 2B). In the regression model the factors determining the presence of elevated Lp(a)>30 included: AF (OR 1.99; 95CI: 1.091-3.629), diagnosed hyperlipemia (OR =1.414; 95 CI – 1.084-1.843) HbA1C>8 (OR=1.180; 95CI – 1.028-1.355), TC>250 mg/dl (OR=1.005; 95CI: 1.003-1.008), migraine (OR=0.539; 95CI - 0.306-0.950).

Conclusion:
Assessment of Lp(a) may be useful in taking effective management to reduce CVD risk.
Abstract 4139418: Self-monitoring of Home Blood Pressures Identifies a High Prevalence of White Coat and Masked Hypertension in Cardiac Rehabilitation Patients
Authors: Yang Jady , Andrade Humberto , Diaz Alexandra , Ramirez Anthony , Borromeo Taliyah , Grubbs John , Lopez Javier
Published: November 2024

Introduction:
Hypertension (HTN) is a highly prevalent risk factor that is targeted for the risk reduction and recovery of patients attending cardiac rehabilitation (CR) after a CV event. Self-measured home blood pressure monitoring (SM-BPs) is becoming a main approach for BP management, but how SM-BPs relate to BPs measured during in-center CR participation (CR-BPs) has not been previously reported.

Objective:
To compare concordance between SM-BPs and CR-BPs during the rehabilitation of high-risk CV patients.

Methods:
We studied 143 CR patients with SM-BPs in addition to CR-BPs. Patients were classified as having HTN if their starting BP in CR ≥130/80 (average of first 3 sessions). The prevalence of white coat (WC) and masked HTN were determined based on concomitant home BP readings. Concordance of SM-BP and CR-BP trajectories over time was determined using a linear mixed-effects model in 90 patients (63%) who had at least 2 weeks of concomitant measurements.

Results:
Of the 90 included patients (65±12 (SD) years, 33% female, 34% non-White), 77%, 41%, 24%, 23%, 37% and 22% had a history of HTN, any tobacco use, DMT2, HF, CAD, and PVD, respectively. Of the 30% of patients with high CR-BP initially, 17 (63%) were found to have WC HTN and 8% of normotensive patients had masked HTN (Figure 1, panel A). Twenty-nine patients (32%) had statistically significant discordance between SM-BPs and CR-BPs throughout CR participation (p < 0.05; Figure 1, panel B).

Conclusion:
To the best of our knowledge, this case series represents the 1st report of concomitant SM-BP and CR-BP trajectories over time. We identified white coat HTN (63%) among hypertensive patients and masked uncontrolled HTN (8%) among normotensive patients. Masked HTN may contribute to missing a prevention target whereas WC HTN may contribute to medical overtreatment of BP while adopting healthy lifestyle modifications. Not surprisingly, BP readings changed over time and 32% of patients had significant discordance between home and center, which could inform rational therapies in CR if recognized in a timely manner. We propose that SM-BPs should be rigorously and systematically measured during CR to further guide BP management in high-risk CV patients.
Abstract 4139425: Timing of Percutaneous Coronary Intervention for Non-infarct-related Coronary Artery in Patients with Acute Myocardial Infarction and Multivessel Disease: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials
Authors: Toyota Toshiaki , Nakamura Kanna , Sano Madoka , Azumi Yuta , Hideyuki Hayashi , Murai Ryosuke , Ooka Junichi , Sasaki Yasuhiro , Taniguchi Tomohiko , Kim Kitae , Kobori Atsushi , Ehara Natsuhiko , Kinoshita Makoto , Furukawa Yutaka
Published: November 2024

Introduction:
Although prior reports suggest that percutaneous coronary intervention (PCI) of non-infarct-related artery (NIRA) in patients with acute myocardial infarction (AMI) and multivessel disease improves clinical outcomes, the optimal timing for NIRA-PCI remains debated.

Research Questions:
When is the preferred timing to perform NIRA-PCI after infarct-related-artery (IRA)- PCI?

Aims:
We aimed to compare the clinical outcomes based on PCI strategies classified by the timing of NIRA-PCI in AMI patients with multivessel disease.

Methods:
We performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) evaluating clinical outcomes to compare PCI strategies for multivessel disease in AMI patients until September 2023. The primary outcome measure was all-cause death, while the secondary outcomes included myocardial infarction, stroke, coronary revascularization, and bleeding.

Results:
We included 22 RCTs (N=13,093) comparing the IRA only-PCI and NIRA-PCI strategies. Immediate NIRA-PCI strategy was defined as performing NIRA-PCI after IRA-PCI without delay. Staged NIRA-PCI strategies were categorized into three groups based on the protocol-defined or treated timing for NIRA-PCI from the IRA-PCI: within one week (Staged_Within1W), one week to one month (Staged_1Wto1M), and after one month (Staged_After1M). Compared with IRA-only PCI, Staged_Within1W had significantly lower risks for all-cause death, myocardial infarction, and coronary revascularization. The immediate PCI strategy relative to IRA-only PCI favored for myocardial infarction and coronary revascularization; however, there was no significant difference for all-cause death. Although Staged_1Wto1M or Staged_After1M showed trends similar to Staged_Within1W, all outcome measures had no significant difference. The risk for bleeding or stroke was comparable among the four strategies.

Conclusions:
This meta-analysis demonstrated a consistent benefit of the NIRA-PCI strategies relative to IRA-only PCI strategy in patients with AMI and multivessel disease. Among the NIRA-PCI strategies, NIRA-PCI within one week appeared the most preferred strategy in patients with AMI and multivessel disease.
Abstract 4139444: Benign Metastasizing Leiomyoma: A Challenging Case with Multifocal Involvement in the Heart, Liver, and Uterus
Authors: Vu Huong , Bui Hanh , Huynh Hai , Vo Duc , Minh Le Huu Nhat , Nguyen Hien
Published: November 2024

Case Presentation:
A 39-year-old Southeast Asian female presented with fatigue and exertional dyspnea. She underwent a myomectomy four years ago. Examination showed vital signs within normal limits, except for an SpO2 of 87%. Blood tests indicated microcytic hypochromic anemia and elevated D-Dimer levels of 1479 ng/mL.

A transthoracic echocardiogram revealed a large mass occupying almost the entire right atrium, extending into the inferior vena cava. A CT scan showed a large, low attenuation, and minimally enhanced mass extending from the right atrium into the inferior vena cava and right hepatic vein, possibly invading segments VII-VIII of the liver (Figure 1). Abdominal CT and MR images revealed multiple degenerating uterine fibroids, bilateral dilated uterine tubes, and mild right hydronephrosis (Figure 2).

The patient underwent surgical removal of the cardiac mass under general anesthesia with extracorporeal circulation and hypothermia. Pathological examination confirmed a benign tumor characterized by bundles of smooth muscle cells (Figure 3). Immunohistochemical staining with Actin (+), Progesterone receptor (+), Desmin (+), Ki67 (+) was consistent with a diagnosis of benign metastasizing leiomyoma (BML) of the heart. Subsequently, elective hysterectomy and bilateral salpingo-oophorectomy were performed.

Discussion:
Although rare, uterine leiomyoma can exhibit metastatic behavior, disseminating to extraneous anatomical sites. BML should be considered in the differential diagnosis when patients present with an atypical cardiac mass and have a history of uterine leiomyoma, myomectomy, or hysterectomy.

BML of the heart is an exceptionally rare condition, predominantly affecting middle-aged women who have undergone hysterectomy or myomectomy. While BML commonly occurs in pre-menopausal patients and shares a potentially similar mechanism with endometriosis, as indicated by its response to estrogen-blocking agents, the occurrence of BML in post-menopausal women suggests the involvement of other contributing factors.

Multiple imaging modalities play a significant role in the diagnosis and preparation for surgical management.
Abstract 4139471: Engineering Human-Induced Pluripotent Stem Cells Overexpressing Ferritin for In Vivo Graft Tracking via Magnetic Resonance Imaging
Authors: Son Yura , Li Pengsheng , Ortega Dakota , Qiu Huiliang , Prachyl Hannah , Yang Ming , Zhu Wuqiang
Published: November 2024

Heart disease continues to be the leading cause of death globally, even with the development and implementation of numerous pharmacological and surgical treatments. Transplanting cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CMs) shows potential for repairing heart damage. However, tracking and quantifying these cells after transplantation in large animals remains challenging. This study aimed to develop a hiPSC line that overexpresses ferritin heavy chain (FHC) to enable tracking of transplanted hiPSC-CMs via magnetic resonance imaging (MRI). Using the CRISPR/dCas9 activation system, we increased FHC expression in hiPSCs and hiPSC-CMs. Both mRNA and protein levels of FHC were significantly elevated following transfection. Cell viability was unaffected by iron chloride concentrations between 0 μM and 2000 μM. hiPSCs and hiPSC-CMs overexpressing FHC (hiPSC-FHC
OE
and hiPSC-CM-FHC
OE
) showed enhanced iron chloride uptake without changes in their electrophysiological properties compared to control hiPSC-CMs. Additionally, hiPSC-CM-FHCOE cells provided strong contrast and lower T
2
* values, indicating their effectiveness for cardiac MRI. When hiPSC-CM-FHCOE cells were injected into mouse hearts and imaged three days later, MRI revealed distinct signals from these cells with lower T
2
* values and rapid signal decay. Overall, endogenous FHC labeling in hiPSC-CMs could significantly improve the precision of cardiac MRI, marking a crucial advancement in assessing the success of hiPSC-CM transplantation in large animal models and enhancing cardiac regenerative therapies.
Abstract 4139545: Impact of Catheter Ablation(CA) in patients with Heart failure with preserved ejection fraction(HFpEF) : A meta-analysis of RCTs
Authors: Addo Basilio , Ibrahim Sammudeen , Agyeman Walter , Boakye Tanoh Desmond , Amoateng Richard , Osman Abdul-Fatawu
Published: November 2024

Introduction:
CA has been shown to be superior to medical management in improving mortality and hospitalization in patients with heart failure with reduced ejection fraction. However, literature concerning the benefit of CA in patients with HFpEF are scarce. There have been some non-randomized clinical trials which have attempted to bridge the gap. Therefore, we conducted a systematic review and meta-analysis of RCTs focusing on the impact of catheter ablation in patients with HFpEF.

Objective:
To systematically review and perform a meta-analysis by comparing the outcomes of CA versus medical therapy in patients with HFpEF, focusing on all-cause mortality, cardiovascular mortality, all- cause hospitalizations and cardiovascular hospitalizations.

Methods:
We conducted a systematic search on PubMed, Cochrane library, Scopus database, and Web of Science using the appropriate search strategy through to April 2024. Only English original RCTs that compared CA with medical management were included for data extraction. The outcomes of interest were as follows- All-cause mortality, Cardiovascular mortality, all- cause hospitalizations and cardiovascular hospitalizations.

Results:
Four RCTs which included a total of 1620 patients (796 in the intervention group and 824 patients in the medical management group). Follow up duration ranged between (24 – 72 months). Improvement in Heart failure hospitalizations or events was seen in the CA group as compared with the medical management group (OR: 0.57, 95% CI 0.43-0.77, P= 0.0002). There was also a reduction in All- cause hospitalizations in the CA group with an OR of 0.67, 95% CI 0.44-0.82, p=0.005. With regards to cardiovascular mortality and all cause mortality in the CA group the OR was 0.74, 95% CI 0.40-1.35, P= 0.59 and 0.68, 95% CI 0.46-1.03, P= 0.07 respectively. These were found not to be statistically significant.

Conclusion:
Using CA in patients with atrial fibrillation and HFpEF showed a statistically significant reduction of heart failure hospitalizations and all cause hospitalizations. Despite the trend towards CA, cardiovascular mortality and all cause mortality were found not to be statistically significant when comparing catheter ablation and medical management. This is the largest meta-analysis in this sub-population till date. With the advent of pulsed field ablation, it will also be intriguing to see how those results contrast CA in atrial fibrillation management in patients with HFpEF.
Abstract 4139569: The Importance of Family-Focused Care In The Evaluation of Children with Aortic Dilation
Authors: Schwartz Bradley , Starr Lois , Cratsenberg Drew , Yetman Angela
Published: November 2024

Background:
Most connective tissue disorders (CTD) that cause aortic dilation (AoD) are hereditary. Children suspected of CTD may be referred to a pediatric cardiology or genetics clinic (PC) where the focus of care is on the child. While recommendations for screening of adult family members may be made, it is not typically performed on-site leading to potential gaps in care. We sought to evaluate the impact of a family-focused cardiovascular genetics (CVG) clinic on outcomes and to compare the impact of such a clinic to PC in preventing premature adverse aortic events (AE) in patients and family members.

Methods:
A retrospective records review of all pediatric (age < 21 years) encounters for CTD performed during the current era of genetic testing was conducted. Patients were included if AoD was identified. Location of initial clinic visit (PC vs. CVG) was noted. Children referred for a family history of known AoD were excluded. Recommendation for-, completion of-&results of- family screening were noted. Preventable adverse events, defined as AoD-related death/dissection in an undiagnosed proband or family member occurring after initial clinic encounter were recorded. Screening practices&outcomes were compared between clinic types.

Results:
Of 154 children who met inclusion criteria with a mean age of 11.1 (+/- 9.3) years, initial evaluation was performed in PC in 94 (61%)&CVG in 60 (39%) patients. Screening was recommended in 37 (39%) vs. 60 (100%) families seen in PC vs. CVG clinic (p<0.00001) and was completed in 23/37 (70%) referred by PC (average of 2.1 (+/- 1.2) family members screened), vs 53/60 (88%) in CVG (average of 3.8 (+/- 5.9) family members screened) (p=.002). Of the 47 screened in PC, 30 (64%) were found to have AoD or the same pathogenic mutation as the proband, compared to 99 (43%) of 230 family members in CVG clinic. Preventable AE occurred in 4 (4%) probands and 30 (31%) families seen in PC compared to 0 probands and 6 (10%) families in CVG (p=.38 for probands, p=.002 for families). Of the 154 families, pathogenic variants in
FBN1
[77],
TGFBR1
[5],
TGFBR2
[9],
Col3A1
[4],
SMAD3
[6], and other genes [25] were identified as the source of AoD. Gene negative hereditary thoracic aortic aneurysm disease was suspected in 22 (14.3%).

Conclusion:
When a child is diagnosed with a hereditary aortopathy, whole family screening is essential to preventing AE. Clinics offering family-based care facilitate timely diagnosis in other family members.
Abstract 4139587: Age at First Diagnosis of Atrial Fibrillation and Longitudinal Cognitive Decline
Authors: Wang Yujie , Wang Bin , Cao Han , Tang Mingkun , Yao Chen , Zhang Ping , LI DONG
Published: November 2024

Introduction:
Evidence is limited to suggest possible associations between the age at first diagnosis of AF and cognitive decline. The two main goals of this study were: 1) to examine if a younger age at which AF onset occurs is linked to a higher rate of longitudinal cognitive decline; and 2) to ascertain whether AF duration may have a cumulative effect on cognitive decline over time.

Methods:
We retrospectively analyzed the Atherosclerosis Risk in Communities Study (ARIC) data from 1990 to 2013. Three cognitive tests were utilized to evaluate cognitive function: the Delayed Word Recall Test (DWRT), the Digit Symbol Substitution Test (DSST), and the Word Fluency Test (WFT). We divided participants into AF onset age groups (≤55, 56-65, and >65 years old) and used follow-up data to investigate the impact of AF onset age on 14-year cognitive deterioration. We also used data from all previous visits to visit 4 to classify AF duration. The association was estimated using the Generalized Estimating Equations (GEE) model.

Results:
Table 1 demonstrates the effect of varying the AF onset age and duration on the estimated cognitive change over 14 years of follow-up using our linear models. Participants who experienced their first episode of AF before age 65 showed a significantly higher loss in global cognitive Z score, the DWRT, but not in the DSST (after adjustments) or the WFT. Notably, participants with AF durations longer than 6 years exhibited a larger reduction in overall cognitive Z score, the DWRT, and the DSST. However, only AF durations over 9 years were significantly linked with the WFT. We also found no evidence that physical activities, smoking status, or alcohol consumption were additional risk factors for long-term cognitive impairment.

Conclusion:
Our investigation of cognitive decline across 14 years in patients in the ARIC cohort found that earlier onset of AF was linked with faster longitudinal cognitive deterioration. Furthermore, a longer AF illness history was linked to a higher rate of cognitive decline. However, when examining various cognitive scores, the age of onset and disease duration had slightly varied effects.
Abstract 4139651: Cardiac Rehabilitation Following Thoracic Aortic Dissection Surgery: A Multi-Center Retrospective Study
Authors: Heybati Kiyan , Ochal Domenic , Poudel Keshav , Zuberi Eric , Tayon Kevin , Dineen Elizabeth , Taylor Bryan , Farres Sam , Landolfo Kevin , Shapiro Brian
Published: November 2024

Background:
Despite expert opinion recommending patient-tailored cardiac rehabilitation (CR) after acute aortic dissection, both patient participation in CR and the associated risk factor modification after CR following aortic dissection repair are poorly understood.

Objectives:
To describe the characteristics of patients referred to CR, as well as the enrollment rate and outcomes of those referred to CR following thoracic aortic dissection.

Methods:
We reviewed electronic health records of adults (≥18) discharged alive following thoracic aortic dissection surgery across the Mayo Clinic Enterprise (01/01/2020-11/15/2022) with follow-up to 05/15/2024 (IRB #24-001141). Data are presented using summary statistics.

Results:
During the study period, 85 patients were included (median [IQR] age: 65 [50-75] years; 40% female;
Table 1
). Across 84% (N=71) who were referred to CR at discharge, 55% (N=39) enrolled. In those patients referred versus not referred to CR, the prevalence of type A dissection (75% vs. 43%), end-organ involvement (27% vs. 0%), and underlying CAD (54% vs. 21%) were greater while current tobacco use (9% vs. 29%) was lower. Of those enrolled at Mayo Clinic (N=16), CR was started 35 (28-65) days following surgery. These patients completed 21 (13-30) CR sessions at an exercise intensity of 59% (50-65%) maximum predicted heart rate. CR was discontinued in 44% (N=7) due to non-cardiac reasons (
Table 2
). Of the 9 patients who completed CR, general health status (Dartmouth index: 19 [17-21] vs. 26 [22-34]), depressive symptoms (PHQ-9: 1 [0-1] vs. 4 [1-4]), and exercise capacity (6MWT: 214 [196-244] vs. 384 [305-597] meters) improved (
Table 2
). There were no reported complications or deaths, with stable aortic sizes reported at 18 months.

Conclusions:
CR improves functional capacity and well-being without complications in patients after thoracic aortic dissection surgery. Further investigation is needed to better assess CR efficacy and usage in this population.