bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144471: Addition of Malignancy into the CHADS2/CHADS2VASc Score: Better prediction of stroke risk in cancer patients with atrial fibrillation.
Authors: Majeed Zoha , Issa Rochell , Safdar Ahmad , Prasad Rohan , Collier Patrick , Agdamag Arianne Clare , Kaelber David , Sadler Diego , Khorana Alok , Kanj Mohamed , Moudgil Rohit
Published: November 2024

Introduction:
The CHADS2 and CHADS2VASc scoring systems are used to determine thromboprophylaxis indication in patients with atrial fibrillation (AF). While these scoring systems include multiple independent risk factors for the development of ischemic stroke, their overall predictive performance is poor when applied to cancer populations.

Research Question:
To identify whether cancer serves as an independent risk factor for ischemic stroke in AF.
Methods:
TriNetX, a global health research database, was utilized to identify AF patients with and without malignancy from 2015 to 2022, excluding patients with prior cerebrovascular disease. Propensity score matching was conducted to control for demographic variables, heart failure, type 2 diabetes, hypertension and anticoagulation. Propensity matching yielded two cohorts consisting of 45,339 patients each. Risk and survival analyses were then run at 3 months, 6 months, 1 year, and 5 years after the index event. The primary outcome was stroke and secondary outcomes were mortality and major bleeding events.

Results:
At 3 months, our study showed that the incidence of stroke was higher in patients with AF and malignancy when compared to AF alone, with an odds ratio (OR) of 2.773 (p < 0.001). A Kaplan-Meier curve analysis revealed a hazard ratio (HR) of 2.683 with a confidence interval of 2.564-2.807. These results were consistent at the 6-month, 1-year and 5-year intervals, with an OR of 2.737, 2.685 and 2.167, respectively (p-value <0.001), and an HR of 2.659, 2.628 and 2.267, respectively. The results also revealed higher rates of mortality among the AF and malignancy cohort, along with elevated major bleeding events across all intervals.

Conclusion:
Patients with malignancy had a significantly higher risk of stroke compared to patients without malignancy, despite controlling for other CHADS2 and CHADS2VASc variables. This defines malignancy as an independent risk factor with an HR of at least 2 across all intervals. Additionally, there was a higher incidence of mortality in patients with AF and malignancy. However, this cohort also had higher rates of major bleeding. Therefore, future studies should investigate incorporating malignancy into the CHADS2VASc score.
Abstract 4144473: Effect of Obesity on Cardiovascular Remodeling and Aerobic Capacity in Adults with Coarctation of Aorta
Authors: Hsu Andrea , Ali Ahmed , Karnakoti Snigdha , Egbe Alexander
Published: November 2024

Background:
We hypothesized that patients with coarctation of aorta (COA) and obesity would have more advanced cardiovascular remodeling and impaired aerobic capacity compared to COA patients without obesity. The purpose of this study was to assess the relationship between obesity, cardiovascular remodeling, and aerobic capacity in adults with repaired COA.

Methods:
The study comprised of 3 groups: (1) Obese COA group (n=177) (COA patients with body mass index [BMI] >30 kg/m2); (2) Non-obese COA group (n=572) (COA patients with BMI ≤30 kg/m2); (3) Control group (n=59) (subjects without structural heart disease and BMI ≤30 kg/m2). Cardiovascular remodeling was assessed using the following indices: (1) Arterial stiffness - total arterial compliance index (TACI). (2) Left ventricular hypertrophy - LV mass (LVM) and relative wall thickness (RWT). (3) LV diastolic function - Doppler-derived estimated LV end-diastolic pressure (LVEDP) and Tau. (4) Right ventricular-pulmonary artery coupling - RV free wall strain and right ventricle systolic pressure (RVFW/RVSP). Aerobic capacity was assessed using predicted peak oxygen consumption (VO2).

Results:
The obese COA group had higher LVM, RWT, LVEDP, and Tau, well as lower RVFWS/RVSP, TACI and peak VO2 compared to non-obese COA group and controls. There was a correlation between BMI and LVM (r=0.39, p<0.001), RWT (r=0.47, p<0.001), estimated LVEDP (r=0.43, p<0.001), tau (r=0.22, p=0.008), RVFWS/RVSP (r=- 0.24, p<0.001), and predicted peak VO2 (r= -0.48, p<0.001).

Conclusions:
These findings underscore the cardiovascular implications of obesity in the setting of COA, and provide opportunities for interventions to address obesity and improve outcomes in the COA population.
Abstract 4144475: Predictors of progression to left ventricular systolic dysfunction in hypertrophic cardiomyopathy patients with borderline left ventricular systolic function
Authors: Lee Hyun-Jung , Park Sang-Shin , Galimkhan Nurjanar , Gwak Seo-Yeon , Kim Kyu , Cho Iksung , Shim Chi Young , Ha Jong-Won , Hong Geu-Ru
Published: November 2024

Background:
In patients with hypertrophic cardiomyopathy (HCM), borderline left ventricular (LV) ejection fraction (LVEF) was reported to be a significant risk factor for developing LV systolic dysfunction (LVSD), which is associated with poor prognosis. However, the natural history of patients with borderline LVEF and risk factors for progression to overt LVSD are incompletely characterized.

Methods:
HCM patients who had two or more echocardiography exams between 2005 and 2023 and a borderline LVEF of 50–59% on the initial exam were included. Patients who progressed to LVSD during follow-up were compared with patients with preserved LV systolic function.

Results:
Among 2,282 HCM patients evaluated, 145 patients (6.4%) with borderline LVEF at baseline were included (median age 61, IQR 51-72; male 67%). Compared to patients with normal LVEF (≥60%), patients with borderline LVEF had more atrial fibrillation (AF) (16% vs. 38%), less obstructive physiology (18% vs. 6.2%), larger left atrial (LA) size, and lower LV global longitudinal strain (LV-GLS) (-16.1 vs. -13.7%) and LA reservoir strain (LARS) (27.7% vs. 21.7%) (all p<0.001).

During median follow-up of 6.5 [IQR 3.2–10.9] years, 30 patients (21%) progressed to LVSD. Patients who progressed to LVSD were younger (55 vs. 64 years, p<0.001), had less hypertension, lower LVEF (55% vs. 57%, p<0.001), larger LV and LA dimensions, and higher ESC sudden cardiac death risk scores (2.1% vs. 1.4%, p<0.001) compared to patients with preserved LVEF. They also had lower baseline LARS (18.2% vs 22.6%, p=0.028) and LA contraction strain (9.3% vs. 12.2%, p=0.011), while there were no differences in LV-GLS and LA conduction strain. On multivariable Cox regression analysis, independent predictors of LVSD progression were identified as younger age (HR 0.82, 95% CI 0.70–0.97, p=0.017, per 5 years), lower LVEF (HR 0.80, 95% CI 0.71–0.91, p<0.001), larger LV end-diastolic dimension (HR 1.17, 95% CI 1.06–1.30, p=0.002), and lower LARS (HR 0.94, 95% CI 0.89–0.98, p=0.011).

Conclusions:
Among HCM patients with borderline LVEF, 21% progressed to overt LVSD. Younger age, lower LVEF, larger LV size and lower LA strain at baseline predicted the development of LVSD.
Abstract 4144478: Atrial Fibrillation Recurrence in Patients with Left Atrial Appendage Occlusion with or without Previously Confirmed Left Atrial Appendage Electrical Isolation
Authors: ZOU FENGWEI , Freilich Michael , Ammirati Giuseppe , Ventrella Nicoletta , Cedeno Serna Juan , Marazzato Jacopo , Lin Aung , Zhang Xiaodong , La Fazia Vincenzo Mirco , Mohanty Sanghamitra , Natale Andrea , Di biase Luigi
Published: November 2024

Background:
Atrial fibrillation (AF) is one of the most common supraventricular arrhythmias in the general population and imposes significant risk for cerebral vascular events. Catheter ablation is one of the most effective approaches to achieve and maintain sinus rhythm. Left atrial appendage (LAA) is a common arrhythmogenic site for AF and targeting LAA for ablation has been proven to reduce AF recurrence. Nevertheless, LAA electrical isolation (LAAEI) is only performed in certain practices and in patients who have previously received a LAA occlusive (LAAO) device, LAAEI is difficult to achieve after the LAA is occluded.

Objective:
The aim of this study is to investigate whether confirmed LAAEI prior to LAAO device implantation has an impact on AF recurrence.

Methods:
Patients who received LAAO were included in this analysis. Demographics, co-morbidities, previous ablations, recurrence of AF or atrial arrhythmias, follow up duration and whether patients had confirmed LAAEI either through LAA ablation or electroanatomical mapping during ablation prior to LAAO implantation were summarized. Kaplan-Meier survival analysis for freedom from atrial arrhythmia recurrence was performed.

Results:
A total of 613 patients were included in the study period and 63.6% were male. Among them 214 (34.9%) had confirmed LAAEI while 399 (65.1%) did not prior to implantation of LAAO device. Compared to patients without LAAEI, patients in the confirmed LAAEI group were more likely to have persistent and longstanding persistent AF (69.2% vs 46.6%), had higher percentage of diabetes (56.1% vs 40.3%) and heart failure (66.4% vs 33.3%) but were more likely to be male (72.9% vs 58.6%) and younger (70 vs 75 years old). At mean follow up period of 13 +/- 7.3 months, patients in the confirmed LAAEI group had 90.7% freedom from atrial arrhythmia recurrence compared to 81.5% in the no LAAEI group (P<0.001).

Conclusion:
LAAEI prior to LAAO is associated with significantly reduced risk of AF recurrence after device implantation. LAAEI should be considered before LAAO in patients with LAA substrate given technical difficulty in LAAEI after LAAO.
Abstract 4144534: Sex Differences in Onset of New Cognitive or Psychological Complaints Following Acute Coronary Syndrome in Older Adults
Authors: Priyadarshni Shivani , Saxena Ritika , Jneid Hani , Gaalema Diann
Published: November 2024

Background:
Anxiety, depression, and cognitive changes are common adverse outcomes after acute coronary syndromes (ACS). These challenges also predict increased risk of adverse cardiac outcomes. While it is known that females have higher rates of psychological symptoms generally, data on sex differences in onset following an acute cardiac event are scarce, especially among older adults.

Goal:
Our goal was to determine if sex differences exist in mental health and cognitive outcomes after acute coronary syndrome in older adults.

Hypothesis:
Females are more likely to have new psychological and cognitive issues within one year of ACS compared to male patients.

Methods:
We conducted a retrospective analysis using Texas Medicare claims data from 2017-2020. The study population consisted of those 65 and older, diagnosed with ACS (either STEMI or NSTEMI). Eligible participants had continuous enrollment in Medicare Part A and B for at least one year before and after the index event, were not part of any Health Maintenance Organization, and had no prior diagnosis of the outcomes of interest (anxiety, depression, amnesia, and dementia). Data were extracted on demographic characteristics, clinical variables, and intervention (i.e. PCI/CABG). Descriptive statistics were used to summarize the data.

Results:
Our study included 56,325 patients (23,911, 42.4% female), 13,078 with STEMI and 43,247 with NSTEMI. In STEMI and NSTEMI patients respectively, the prevalence of onset of the following outcomes was significantly higher among females compared to males: anxiety (14.8% vs. 9.3%; 16.2% vs. 11.3%), depression (11.5% vs. 7.9%; 14.1% vs. 9.9%), and dementia/Alzheimer's (2.5% vs. 1.7%; 3.5% vs. 2.5%). No differences were observed in amnesia by sex. Differences by sex persisted by treatment type for anxiety and depression (Table). Additionally, rates of new diagnoses were higher across sexes for CABG compared to PCI.

Conclusion:
Significant sex differences exist in cognitive and mental health outcomes after ACS. Females are more likely to have worse outcomes following ACS as compared to men. Additionally, across sexes, psychological outcomes are worse following CABG as compared to PCI.
Abstract 4144536: Predicting Intramyocardial Hemorrhage Following Reperfusion Therapy for Acute MI with Coronary Biomarkers and Hemodynamic Modeling
Authors: Gruionu Gabriel , Vora Keyur , Youssef Khalid , Dharmakumar Rohan
Published: November 2024

Introduction:
Emergency PCI has reduced immediate death in STEMI patients. However, reperfusion therapy can cause intramyocardial hemorrhage (IMH) in 40% of STEMI patients and has emerged as a major predictor of adverse CV events. The mechanisms contributing to the development of IMH, however, are not understood.

Research Hypothesis:
We hypothesize that hemodynamic forces (pressure variation and blood flow redistribution) influenced by the topological organization of coronary vasculature plays a major role in IMH development.

Goal:
We tested our hypothesis by developing a computational model of the coronary vasculature to determine patient-specific coronary network topology biomarkers and hemodynamics associated with IMH.

Methods:
Pre- and post-PCI coronary angiograms from STEMI patients (n=17) were stratified into 4 groups (IMH:H; Collaterals: C): H-/C+; H+/C-, H-/C-, and H+/C+). T2* MRI was used to identify IMH. Vascular topology and hemodynamics of the main branches of LCx and LAD and associated collaterals (if present) were determined. Computational model used input pressure of 100mmHg, 40mmHg threshold for IMH in microvasculature, and pressure-flow relationships.

Results:
A higher density of vessels on angiograms in the H-/C+ group (91±15) vs H+/C- (47±19) with smaller vessel diameters (1.2±0.2mm (H-/C+) vs 1.6±0.4mm (H+/C-)) of shorter length (7.4±1.1mm vs 11±3.5mm) were observed. There were more 3
rd
or 4
th
order arterioles (41±6.7 vs. 21±8) with smaller diameters (0.72±0.6 vs. 0.9±0.2mm) in H-/C+ vs H+/C-. The Junctional Exponent (JE, a coronary network biomarker) was significantly lower in the H-/C+ vs other groups in pre-PCI (1.48±0.1 vs 1.74±0.02 H+/C- p=0.021; 1.79±0.12 H-/C- p=0.021; 1.6±0.12 H+/C+ p=0.008) and post PCI (1.44±0.11 vs 1.87±0.19 H+/C- p=0.02; 1.64±0.07 H-/C- p=0.04) except H+/C+ (1.58±0.11 H+/C- p=0.46) suggesting hemodynamically efficient branching structure in the H-/C+ group. Hemodynamic simulations indicated that prior to PCI, collaterals provide some tissue perfusion to the MI area whereas, after PCI, collaterals play minimal role in flow redistribution. Mean segment pressure was lower in the H-/C+ vs. H+/C- groups (55.6±4.2 vs. 60.8±7.7mmHg, p=0.41) whereas the terminal arterial flows were not different (p=0.94).

Conclusions:
Our early findings support the notion that coronary network topology influences hemodynamic factors and contributes to the development of hemorrhagic MI.
Abstract 4144601: Predictive Significance of Nutritional Status Assessment with the Prognostic Nutritional Index in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Kanzaki Hideaki , Kurashima Shinichi , Irie Yuki , Okada Atsushi , Amaki Makoto , Takagi Kensuke , Kawamoto Naonori , Fukushima Satsuki , Kitai Takeshi , Izumi Chisato
Published: November 2024

Background:
Nutritional impairment significantly affects physical and cognitive functions, immune response, recovery, and quality of life in the elderly. However, the impact of malnutrition on the prognosis of patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear.

Objective:
The aim of this study was to investigate whether additional assessment of nutritional status is meaningful in predicting the prognosis of patients undergoing TAVR.

Methods and Results:
A total of 654 consecutive patients (mean age 83 ± 6 years, 65% female) who underwent TAVR were included. Nutritional status was evaluated at baseline using the prognostic nutritional index (PNI), calculated as follows: [10 × serum albumin (g/dL)] + [0.005 × total lymphocyte count (/mm
3
)]. The primary endpoint of this study was all-cause mortality, with a median follow-up period of 3.4 years. Kaplan–Meier analysis showed that patients with severe malnutrition, defined as a PNI of <40, had higher mortality rates (log-rank test, P <0.001). Cox multivariate analysis found that PNI was an independent prognostic factor. Furthermore, the Harrell’s C-statistic of the multivariate analysis for predicting mortality improved from 0.666 to 0.715 (P = 0.002) when PNI was added. Cubic spline analysis revealed that a PNI of less than 40 was associated with a steep increase in the hazard ratio for mortality.

Conclusion:
Evaluating nutritional status in patients undergoing TAVR provides additional information for predicting clinical outcomes, with PNI being a useful predictive indicator.
Abstract 4144603: Artificial Intelligence Tool Accurately Predicts Occlusion Myocardial Infarction And May Reduce False-Positive Cath Lab Activations
Authors: Harris Samantha , BROWN FREDRICK , May Adam , Bach Richard
Published: November 2024

Introduction:
An early and accurate diagnosis of occlusion myocardial infarction (OMI) by an electrocardiogram (ECG) is critical for prompt catheterization lab activation (CLA) for primary percutaneous coronary intervention (PCI).

Objective:
To evaluate the predictive accuracy of a new mobile application, utilizing an artificial intelligence (AI) deep learning algorithm, for distinguishing cases of OMI from non-OMI among actual Emergency Department (ED) patients assessed for potential CLA.

Methods: We conducted a retrospective analysis of adult patients assessed for potential CLA in the ED at Barnes Jewish Hospital, St. Louis, MO, from August 22, 2023 to April 6, 2024. Patients arriving post-cardiac arrest were excluded. The ECG obtained immediately prior to each CLA was re-analyzed using a mobile device application with the OMI ECG AI algorithm, known as the Queen of Hearts (QoH) model. Each ECG was then categorized as either OMI or non-OMI. Coronary angiograms were reviewed blinded to the ECG results.

Results:
Out of 102 CLAs, 57 patients were accepted for emergent coronary angiography. The QoH model predicted 54 patients (52.9%) as having an OMI. Patients predicted to have an OMI were more likely to be accepted for coronary angiography (94% vs. 17%), have primary PCI performed (85% vs. 2.1%), and have acute coronary thrombosis detected (74.1% vs. 0.0%) on coronary angiography compared to non-OMI patients. All 46 patients fulfilling STEMI ECG criteria were correctly identified as having an OMI. Two patients predicted to have OMI without STEMI ECG criteria were found to have acute coronary occlusion. Patients with OMI had higher peak high-sensitivity troponin values. Among the 55 patients predicted to have non-OMI, 41 of 45 (91.1%) were not accepted for emergent coronary angiography and 6 of 10 (60.0%) patients accepted for emergent coronary angiography did not have obstructive coronary artery disease.

Conclusions:
The AI-based QoH model was highly predictive of OMI confirmed at coronary angiography. Implementation of this model may help clinicians identify the risk of OMI in patients triggering a CLA, and utilization of the AI-model could have led to potential reduction of false-positive CLAs.
Abstract 4144604: Evaluating the Risk of Cardiomyopathy in Breast Cancer Patients: A National Cohort Study
Authors: Obeidat Omar , Ismail Mohamed , Al-Ani Hashim , Daise Mohd , Alqudah Qusai , Tarawneh Mohammad , Abughazaleh Saeed , tong ann
Published: November 2024

Introduction:
Breast cancer and cardiovascular disease are significant global health concerns for women. Our study is a significant advancement in understanding cardiomyopathy risks associated with breast cancer in the U.S. population. Unlike previous studies focusing mainly on treatment-related cardiomyopathy, our research identifies risks across various cardiomyopathy subtypes in breast cancer patients. This novel approach reveals the intricate relationship between different cardiomyopathies and breast cancer, filling a crucial gap in existing medical research. Moreover, by considering racial disparities, our study offers vital insights into the differential health impacts on diverse demographic groups, enhancing our knowledge of the interplay between these medical fields.

Methodology:
The research was conducted as a retrospective cohort analysis using data from the National Inpatient Sample (NIS) spanning 2016 to 2019. It targeted female patients over 18 with a diagnosis of breast cancer, carcinoma in situ, or a personal history of breast cancer. Case identification relied on ICD-10 codes. A pivotal aspect of the methodology was implementing propensity score matching to ensure balanced comparison groups, considering variables like age, race, hypertension, and diabetes. Statistical analysis involved logistic regression, Chi-Square tests, and T-tests, executed using 9.4 SAS software.

Results:
The study compared 589,940 breast cancer patients with an equal number of controls, matched demographically. Comorbidity prevalence was similar in both groups, with slight variations in myocardial infarction and heart failure history. Breast cancer patients exhibited a higher prevalence of cardiomyopathy (4.0% vs. 3.2%), with an increased adjusted odds ratio (OR) especially for dilated, restrictive, and drug-related cardiomyopathies. Interestingly, they had lower odds of obstructive and hypertrophic cardiomyopathy. Racial disparities were evident, with Black patients facing higher risks for most cardiomyopathies, while Hispanic and Asian or Pacific Islander patients showed varied risks. Similar patterns were observed in the control group.

Conclusion:
The findings highlight a significant link between breast cancer and an elevated risk of cardiomyopathy, advocating for the integration of cardiovascular monitoring into breast cancer management.
Abstract 4144617: Disparities in Mortality Following Stroke with Atrial Fibrillation Among Older Adults in the United States: A CDC WONDER Database Analysis
Authors: Shah M Danial Ali , Umar Muhammad Faiq , Malik Iram , Nkeangu Fomengia , Sattar Zeeshan , Rahman Saad Ur , Jafry Ali , Lak Hassan Mehmood , Awan Uqba , Ameen Abdul A , Khan Mohammad
Published: November 2024

Introduction:
Over the past two decades, treatment advances for atrial fibrillation (AF) and stroke have improved overall survival (OS). However, a significant proportion of the population still faces high mortality, suggesting an uneven distribution of improvements. This study analyzes mortality after stroke in older adults with AF in the United States (US), highlighting disparities and trends.

Method:
A retrospective analysis was conducted using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 code I48, I63.1, I63.2, I63.4, I63.5, I63.8, I63.9, I64, I69.4, to find stroke-related deaths among people diagnosed with AF, aged ≥65 years old from 1999 to 2019. We examined demographic disparities in mortality rates by age, gender, race, geographic region, rural/urban classification, and place of death. Results were reported as age-adjusted mortality rates (AAMR) with 95% confidence intervals (CI). Joinpoint regression assessed trend changes and average annual percentage change (AAPC).

Results:
Between 1999 and 2019, 398,571 individuals aged 65 and older died from AF and stroke in the US, with an AAMR of 45.6 per 100,000 (95% CI: 45.5-45.8). The AAMR declined from 47.0 in 1999 to 45.7 in 2019. Mortality rates showed disparities: females had a higher AAMR than males (46.4 vs. 43.4), non-Hispanics higher than Hispanics (46.7 vs. 27.9), and Whites higher than Blacks (48.5 vs. 32.8). The West was the most affected region (53.9), while the Northeast was the least affected (42.1). State variations were most pronounced in Vermont and Oregon (84.9 and 78.6) and lowest in Louisiana and Nevada (28.3 and 27.0). Rural areas had higher AAMR than urban areas (51.1 vs. 44.4). Most deaths occurred in inpatient settings (39.3%), followed by nursing homes (32.6%). The age group 85 years and older accounted for the majority of deaths (56.5%).

Conclusions:
Overall mortality due to stroke and AF has decreased, yet disparities persist. Focused action is needed to mitigate these deaths. Expanding access to healthcare in rural areas and promoting stroke prevention programs are vital for improving survival rates.
Abstract 4144649: Severity of Tricuspid Regurgitation and Its Impact on Long-Term Clinical Outcomes in Heart Failure: A Meta-Analysis of 456,353 Patients
Authors: Singh Sachin , Mohammed Adil , Kanagala Ramya S D , Danish Ali , Vala Lovekumar , Dhadhal Riya , Mathew Joanne , Ahmed Hafeezuddin , Kanthala Neha , Vyas Ankit , ghantasala paritharsh , Al-Sabbagh Ihsan , Desai Rupak
Published: November 2024

Introduction:
Tricuspid regurgitation (TR) can have detrimental effects on heart failure (HF) patients clinically, and there is growing evidence supporting this association. We aim to study the impact of the severity of TR on the long-term outcomes in patients with HF.

Methods:
We systematically screened PubMed, SCOPUS, and Google Scholar databases up to May 2024 using appropriate keywords. The outcomes studied included 1-year mortality, 2-year mortality, HF hospitalizations, cardiovascular deaths, and composite events (HF hospitalization and mortality). The majority of studies included Journal of the American Society of Echocardiography 2017 guidelines to assess the severity of TR. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a binary random effects model. Heterogeneity was assessed using I2 statistics, and a leave-one-out analysis was performed. A p-value of <0.05 was considered significant.

Results:
A total of 10 studies with 456,353 HF patients were included. The mean age of the included population was 71.2 years, with 59.4% of male participants having a median follow-up of 2 years. Severe TR showed a significant association with higher odds of 1-year mortality (OR=1.25 [1.02-1.52], p=0.03; I2=78.15%), 2-year mortality (OR=1.63 [1.28-2.09], p<0.01; I2=0%), HF hospitalization (OR=1.39 [1.14-1.71], p<0.01; I2=61.58%), and composite events (OR=1.44 [1.10-1.88], p<0.01; I2=73.46%). However, it showed no association with cardiovascular deaths (OR=1.35 [0.82-2.24], p=0.24; I2=78.31%). Upon performing a leave-one-out sensitivity analysis, we found that excluding Adamo's study changed the overall OR to 1.34 (95% CI: 1.29, 1.39), indicating its influence on the estimate. The narrower CI and increased OR suggest Adamo's study has a relatively lower effect on overall mortality risk compared to the pooled effect of the other studies.

Conclusion:
Severe TR is associated with a higher risk of 1-year and 2-year mortality, HF hospitalizations, and composite events among heart failure patients. Therefore, HF patients with comorbid TR should be promptly screened and managed, as increasing severity is linked to a higher risk of adverse outcomes.
Abstract 4144657: Is Changing Climate Affecting the Risk of Acute Coronary Syndrome-related Hospitalizations and Outcomes of Young Adults During Summer Months in the United States?
Authors: Singh Sachin , Danish Ali , Vala Lovekumar , Dhadhal Riya , Kanthala Neha , Mylavarapu Maneeth , Mohammed Adil , Ahmed Hafeezuddin , Mathew Joanne , Imtiaz Hassaan , Vyas Ankit , Desai Rupak
Published: November 2024

Introduction:
Seasonal variations, particularly cold weather, can increase the risk of acute coronary syndrome, as evidenced by various studies over the years. On the other hand, hot weather can cause dehydration, electrolyte imbalances, and thermoregulatory strain on the heart, leading to adverse cardiac events. In recent years with rising concerns about global warming, we aim to study the impact of climate changes during the summer on outcomes among people hospitalized with ACS.

Methods:
We used the National Inpatient Sample from 2016 to 2020 to identify young adults hospitalized with ACS using appropriate ICD-10 codes. Patients were categorized into two cohorts: summer (hospitalizations during June, July, and August) and non-summer (hospitalizations during other months). The outcomes studied were ACS hospitalizations and in-hospital mortality. Pearson chi-square tests and the Mann-Whitney U test were used for cohort comparisons.

Results:
Of 230,555 ACS hospitalizations, 26.2% (n=60,340) occurred during the summer months, with a median age of 40 years. White individuals had higher hospitalization rates compared to others (57.8% vs. 58%), and those from lower socioeconomic statuses had higher ACS hospitalizations in both cohorts (37.5% vs. 38.1%). Comorbidities like hypertension, diabetes, and hyperlipidemia were lower in the summer cohort (all p<0.001). The rates of in-hospital death were higher in the summer cohort compared to the non-summer cohort (4.7% vs. 4.5%, p=0.019). However, logistic analysis showed no significant association between summer climate and ACS hospitalizations (OR 1.02, 95% CI 0.99-1.04, p=0.178) or all-cause mortality (OR 1.04, 95% CI 0.94-1.06, p=0.446), irrespective of region or gender.

Conclusion:
While in-hospital mortality rates were higher during the summer months, there was no significant association between summer climate and the incidence of ACS or all-cause mortality, regardless of region or gender, when adjusted for confounding factors.
Abstract 4144673: 1-Year Outcomes After Cardioversion With and Without Anticoagulation in Patients With Left Atrial Appendage Occlusion: A Propensity-Matched Analysis
Authors: Thangjui Sittinun , Trongtorsak Angkawipa , Kewcharoen Jakrin , Thyagaturu Harshith , Watson HangYu , Mensah Samuel , balla sudarshan , Navaravong Leenhapong
Published: November 2024

Background:
Left atrial appendage occlusion (LAAO) is an alternative primary stroke prevention strategy for patients with atrial fibrillation (AF) who cannot tolerate anticoagulation (AC). Following LAAO implantation, patients typically undergo testing after 45 days to confirm successful occlusion and potentially discontinue AC. Some patients with LAAO may require cardioversion (CVN) due to recurrent AF. However, data is limited on whether post-CVN management in these patients should mirror that of patients without LAAO. Therefore, we report the outcomes of patients with LAAO who underwent CVN and were empirically treated with or without AC post-CVN.

Methods:
Using the TriNetX database, we identified patients aged ≥ 18 years who had LAAO, underwent CVN, and were not on AC prior to the procedure. Patients were included if they received AC for at least 4 weeks after CVN (AC group) or did not receive AC (Non-AC group). Propensity score matching was performed to adjust for confounders between the two groups. Thromboembolic and bleeding outcomes were assessed at 1 year post-CVN.

Results:
Among 1,086 patients, 84 (7.7%) received anticoagulation after CVN. After propensity score matching, 158 patients (79 in each group) were included, with a mean age of 71.8 ± 11.3 years (49% female) in the AC group and 70.6 ± 12.5 years (39% female) in the Non-AC group. At 1 year, the incidence of composite thromboembolic events was similar between the AC and Non-AC groups (12.7% vs. 12.7%; OR = 1.00, 95% CI: 0.39-2.55). Most thromboembolic events occurred within 2 weeks post-CVN. There were no significant differences in the composite outcomes of intracranial bleeding, gastrointestinal bleeding, or need for blood transfusion between the AC and Non-AC groups at 1 year (OR = 0.86, 95% CI: 0.30-2.25).

Conclusion:
Data suggest that most patients with LAAO do not receive AC after CVN. Additionally, the use of anticoagulation post-CVN in patients with LAAO did not statistically reduce thromboembolic events nor increase bleeding risk.
Abstract 4144690: Impact of Apolipoprotein A-1 Infusion on Coronary Atherosclerosis Post-Acute Coronary Syndrome: A Network Meta-Analysis of randomized controlled trials.
Authors: Rath Shree , Saad Mohamed , Rasool Warda , Hassan Hossam , Saeed Fatima , Alabide Arwa , Hakim Diaa
Published: November 2024

Background:
High-density lipoproteins (HDLs) have various potentially beneficial circulatory effects. Apolipoprotein A-1, one of the HDL mimetics, has been shown in several studies to slow the progression of atherosclerosis after an acute coronary syndrome (ACS) event.

Aim:
To evaluate the comparative efficacy of Apo A1 on Total Atheroma Volume (TAV), Percent Atheroma Volume (PAV), and changes in these parameters.

Methods:
We systematically searched articles in PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase published up to June 2024. Eligible randomized controlled trials (RCTs) enrolled adults who received Apo A1 infusion, compared to placebo, within 2 weeks of an ACS event (defined as unstable angina, non-ST or ST-segment elevation myocardial infarction) or with at least one narrowing of ≥20% on coronary angiography at baseline. Apo A1 infusion preparations evaluated include ETC-216, CER-001, CSL-111, and MDCO-216. Network meta-analysis was performed.

Results:
A total of 5 RCTs were included in our analysis. Outcomes evaluated include PAV, TAV (measured by intravascular ultrasonography catheter), and changes in these values from baseline to follow-up. For changes in PAV, only ETC-216 45 mg was statistically significant (MD: -12.74, [-20.70; -4.78]). All other regimens were statistically insignificant: ETC-216 15 mg, ETC-216 15 and 45 mg combined, CER-001 3 mg, CER-001 6 mg, CER-001 12 mg, MDCO-216 20 mg, and CSL-111 40 or 80 mg. In addition, changes in TAV showed no significant treatment effects. PAV was lowest at follow-up in the CER-001 3 mg (MD: -1.68, [-4.73; 1.38]) and MDCO-216 20 mg (MD: 1.00, [-3.64; 5.64]) groups; all other ETC-216 and CER-001 regimens were insignificant. For TAV, only MDCO-216 20 mg (MD: -10.00, [-39.58; 19.58]) and CER-001 3 mg (MD: -2.47, [-19.84; 14.90]) showed insignificant treatment effects, while all ETC-216 regimens had no beneficial effect.

Conclusion:
Our analysis concludes that ETC-216, 45 mg showed a significant reduction in PAV. Other regimens were insignificant in their effect on atheroma reduction. This analysis highlights the need for further clinical trials to explore this regimen for enhancing responses in ACS patients.
Abstract 4144705: Risk of Cardiovascular Disease in Giant Cell Arteritis: Systematic Review and Meta-analysis
Authors: Rathore Sawai Singh , Allam Sanjana , Jeswani Bijay , Manoj Swetha , Patel Tirath , Syed Saif , Goyal Aman
Published: November 2024

Background:
Giant cell arteritis (GCA) is a chronic inflammatory condition associated with a significantly increased risk of various cardiovascular and thromboembolic events. Existing studies show that there may be an increased risk of cardiovascular disease in GCA, but the results are inconsistent. This meta-analysis aims to quantify the association between GCA and the risk of various cardiovascular outcomes, providing a comprehensive evaluation of the cardiovascular burden in patients with GCA.

Methods:
A comprehensive literature search was carried out using several databases. Studies were included based on predefined eligibility criteria. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to assess publication bias. The endpoint included any cardiovascular events, myocardial infarction (MI), coronary artery disease (CAD), aortic aneurysm/dissection, peripheral artery disease (PAD), stroke, and venous thromboembolism.

Results:
The meta-analysis included 14 studies with a combined sample size of 609,954 patients, where the mean age was 73.8 years and 72.2% were female. Patients with GCA had significantly higher odds of experiencing any cardiovascular event (OR = 1.81, 95% CI = 1.55 to 2.15), MI (OR = 1.63, 95% CI = 1.34 to 1.97), CAD (OR = 1.51, 95% CI = 1.09 to 2.08), aortic aneurysm/dissection (OR = 1.95, 95% CI = 1.55 to 2.46), PAD (OR = 2.02, 95% CI = 1.69 to 2.41), stroke (OR = 1.52, 95% CI = 1.25 to 1.84), venous thromboembolism (OR = 1.92, 95% CI = 1.73 to 2.12), deep vein thrombosis (OR = 2.09, 95% CI = 1.50 to 2.91) and pulmonary embolism (OR = 2.45, 95% CI = 1.38 to 4.36). The heterogeneity of the outcomes ranged from low to high across different analyses. No publication bias was evident in the analysis.

Conclusion:
The meta-analysis highlights the critical need for vigilant cardiovascular monitoring and proactive management strategies in GCA patients. Further research is needed to identify specific factors that contribute to cardiovascular complications in these patients.
Abstract 4144740: Characteristics and Natural History of Early ATTR Cardiac Amyloid Infiltration
Authors: Porcari Aldostefano , Razvi Yousuf , Cappelli Francesco , Nitsche Christian , Serenelli Matteo , Longhi Simone , Sinigiani Giulio , Cipriani Alberto , Aimo Alberto , Allegro Valentina , Tomasoni Daniela , zampieri Mattia , Cantone Anna , Masri Ahmad , Urey Marcus , Ioannou Adam , Petrie Aviva , Gustafsson Finn , Whelan Carol , Emdin Michele , Metra Marco , sinagra Gianfranco , Lachmann Helen , Wechalekar Ashutosh , Hawkins Philip , Gillmore Julian , Fontana Marianna
Published: November 2024

Background:
Patients with transthyretin (ATTR) cardiac amyloid infiltration are increasingly diagnosed at earlier disease stages with no heart failure (HF) symptoms and a wide range of cardiac amyloid infiltration.

Aim:
The aim of the study was to characterize the natural history and long-term outcomes of patients with ATTR cardiac amyloid infiltration and no HF symptoms.

Methods:
Data of consecutive patients at 12 international centres for amyloidosis (2008-2023) were analysed. Asymptomatic ATTR cardiac amyloid infiltration was defined as absence of HF and diuretic therapy, monoclonal gammopathy with evidence of cardiac uptake on bone scintigraphy (Perugini grade 1 to 3).

Results:
The study comprised 660 patients with ATTR cardiac amyloid infiltration and no HF symptoms (74.1±9.7 years, 87% male, 21.5% hereditary ATTR amyloidosis), 81.5% (n=538) with Perugini grade 2 and 3, and 18.5% (n=122) with Perugini grade 1. The number of new diagnoses progressively increased over time, from 27 in 2008-2011 to 350 in 2020-2023. Perugini 2 and 3 patients exhibited significant cardiac functional and structural abnormalities, in keeping with ATTR cardiomyopathy, whilst Perugini grade 1 patients generally had normal cardiac structure and function. At 3 years, the rate of cardiovascular (CV) events in the overall population was elevated and consistently higher in Perugini grade 2 and 3 compared to grade 1 (development of symptomatic HF [50% vs 23%], diuretic initiation and NT-proBNP progression [32.5% vs 12.6%], HF hospitalization [6.6% vs 0%] and unplanned CV hospitalization [16.7% vs 4%]) (Figure 1). Over 38 months (IQR 22-61), the death rate was high, and similar in Perugini grade 1 vs 2 and 3 (5.0 vs 4.5 deaths per 100 patient-years), however Perugini grade 2 and 3 patients had a 3-fold higher risk of CV mortality (hazard ratio [HR] 3.0 [95%CI 1.19-7.56], p=0.020) compared to Perugini grade 1 (Figure 2).

Conclusions:
Asymptomatic ATTR cardiac amyloid infiltration is increasingly common and encompasses a wide spectrum of disease severity. The Perugini grade enables potential characterization of patients into clinical profiles with varying disease progression and risks of CV and non-CV mortality. In the absence of randomized trials, these data may inform clinicians regarding the use of disease-modifying treatment in patients with asymptomatic ATTR cardiac amyloid infiltration.
Abstract 4144752: Endothelial and microvascular dysfunction in adults with congenital heart disease: a systematic review and meta-analysis
Authors: Baroutidou Amalia , Dimitroulas Theodoros , Arvanitaki Alexandra , Grantza Triantafyllia , Otountzidis Nikolaos , Farmakis Ioannis , Kamperidis Vasileios , Ziakas Antonios , Giannakoulas George
Published: November 2024

Background:
Adults with congenital heart disease (ACHD) are lifelong at high risk for premature cardiovascular events and life-threatening complications, suggestive of early or accelerated cardiovascular disease. Endothelial and microvascular dysfunction as well as arterial stiffness play a key role in the emergence and progression of cardiovascular complications. As vascular dysfunction may precede the occurrence of adverse events, early identification of endothelial damage markers in ACHD is crucial.

Aim:
This is the first systematic review and meta-analysis of studies investigating the endothelial and microvascular function in ACHD patients versus healthy controls.

Methods:
We systematically searched four major electronic databases (PubMed, CENTRAL, Scopus, Web of Science), ClinicalTrials.gov and grey literature. We included studies evaluating endothelial and microvascular function with any semi- or non-invasive method in adult patients with and without ACHD. Studies exploring arterial stiffness indices were also investigated.

Results:
In total, 31 studies (1118 ACHD patients, 794 controls) were included in this systematic review. Branchial arterial endothelium-dependent (assessed via flow-mediated dilatation, FMD) and -independent vasodilation (assessed via nitroglycerine-mediated dilatation, NMD) were impaired in ACHD patients versus controls (mean difference [MD] -2.5, 95% confidence intervals [CI] -3.7; -1.3 and MD -3.9, 95%CI -6.8; -1.0, respectively). Microvascular dysfunction was also evident; significantly lower reactive hyperemia index and peripheral arterial tonometry (PAT) ratio were found in ACHD patients compared with controls (MD −0.26, 95%CI −0.48; −0.04 and MD −0.26, 95%CI −0.5; −0.4, respectively). Regarding arterial stiffness, pooled analysis revealed non-significant differences in pulse wave velocity between the study groups (standardized MD 0.2, 95%CI -0.2; 0.6). However, augmentation index was significantly higher in ACHD (standardized MD 1.6, 95%CI 0.8; 2.4).

Conclusions:
ACHD patients have impaired endothelial and microvascular function and increased arterial stiffness, factors that may be responsible for the increased adverse cardiovascular events in this population.
Abstract 4144754: Comparing Combined Pneumococcal and Influenza Vaccines to Influenza Vaccine Alone in Coronary Artery Disease Patients: A Propensity Matched Analysis
Authors: Jaiswal Vikash , Hanif Muhammad , Jaiswal Akash , Sundas FNU , Danisha FNU , Deb Novonil , Bytyci Ibadete
Published: November 2024

Background:
Pneumococcal and influenza vaccination have shown cardioprotective effects by reducing adverse cardiovascular events among high-risk patients. However, the effectiveness of combined pneumococcal and influenza vaccinations compared to influenza vaccination alone in patients with coronary artery disease (CAD) has not been thoroughly established to date.

Objective:
This study aims to investigate the cardiovascular events in patients with CAD following combined pneumococcal and influenza vaccination compared to influenza vaccination alone.

Method:
The TriNeTX US Collaborative Network research database was used to identify patients aged ≥18 years of age from January 2005 to April 2021. Patients were divided into two groups, one with pneumococcal and influenza vaccination and a control group with influenza vaccination only. Patients were followed for one year. Propensity score-matched analysis (1:1, Figure 1) was conducted based on age, sex, race, body mass index, hypertension, diabetes mellitus, and chronic kidney disease. The main outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, myocardial infarction, heart failure and ischemic stroke. Secondary outcomes included all-cause mortality, acute myocardial infarction, heart failure and ischemic stroke.

Results:
After propensity score matching, the study cohort comprised 132,646 patients in the pneumococcal and influenza vaccination group and 132,646 patients in the influenza alone group. The mean age of patients was 79.2 years. Patients who received pneumococcal and influenza vaccinations had a significantly lower risk of MACE (RR, 0.925 (95%CI: 0.896-0.955),
P<
0.001), all-cause mortality (RR, 0.947 (95%CI: 0.916-0.979),
P=
0.001), acute myocardial infarction (RR, 0.946 (95%CI: 0.897-0.997),
P=
0.039), and heart failure (RR, 0.937 (95%CI: 0.903-0.973),
P=
0.001) when compared with CAD patients with influenza vaccine alone. However, the risk of ischemic stroke was comparable between both groups (RR, 0.943 (95%CI: 0.893-1.004),
P
=0.067).

Conclusions:
In patients with coronary artery disease, those who received both pneumococcal and influenza vaccinations showed significantly lower risk of MACE and all-cause mortality compared to those who received only influenza vaccine.
Abstract 4144763: Impact of Anemia on Clinical Outcomes in Atrial Fibrillation Patients on Oral Anticoagulants: A Systematic Review and Meta-analysis.
Authors: Amin Ahmed Mazen , Odat Ramez , Manasrah AlMothana , Elgebaly Mohamed , Al-Shammari Ali , Nakhla Michael , Ayman Dina , Ali Mohamed Ahmed , Hageen Ahmed Wael , Helmi Ahmed , Abuelazm Mohamed , Abdelazeem Basel
Published: November 2024

Background:
Anemia is frequently observed as a comorbidity in atrial fibrillation (AF) and is associated with poor clinical outcomes.

Purpose:
We aim to investigate the impact of anemia on clinical outcomes in AF Patients on oral anticoagulants.

Methods:
We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through March 2024 and conducted a prognostic systematic review and meta-analysis. All analyses were performed using R V. 4.3.1.

Results:
With the inclusion of 23 studies, our cohort comprised a total of 286,781 patients. Anemia was significantly associated with an 86% increase in the risk of major bleeding (HR: 1.86 with 95% CI [1.61, 2.14], P< 0.01), a 25% increase in the risk of intracranial hemorrhage (HR: 1.25 with 95% CI [1.02, 1.54], P= 0.03), a 92% increase in the risk of gastrointestinal bleeding (HR: 1.92 with 95% CI [1.68, 2.19], P< 0.01), and a 91% increase in the risk of all-cause mortality (HR: 1.91 with 95% CI [1.46, 2.51], P< 0.01). However, Anemia did not significantly affect the risk of stroke, TIA, or systemic embolism (HR: 1.07 with 95% CI [0.93, 1.22], P= 0.36).

Conclusion:
Anemia was significantly associated with an increased risk of major bleeding, intracerebral hemorrhage, gastrointestinal bleeding, and all-cause mortality without impacting stroke, TIA, or systemic embolism. Further research is warranted to compare the effects of DOACs and vitamin K antagonists. Clinically, it is imperative to closely monitor the anemic status of patients due to these elevated risks.