bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145915: Postoperative Pericarditis after Cardiac Surgery in Adult Congenital Heart Disease
Authors: Khor Sinan , Mosca Ralph , Kumar TK , Weber Brittany , Small Adam , Halpern Dan , Garshick Michael
Published: November 2024

Background:
Advances in diagnosis and treatment have led to improved congenital heart disease (CHD) outcomes with more adults undergoing operations into adulthood. Cardiac surgery is associated with post-surgical inflammatory conditions including postoperative pericarditis that confer morbidity and are understudied in the adult CHD (ACHD) population.

Goals/Aims:
To evaluate the incidence and risk factors for developing postoperative pericarditis in ACHD surgical operations.

Methods:
This is a retrospective study of all adult patients with CHD who underwent cardiac surgery between 2015 and 2023 at a major New York medical center. Pericarditis diagnosis required 1) documentation of pericardial inflammation as meeting 2/4 criteria for acute pericarditis (chest pain, friction rub, non-localizing ST-elevations or PR depressions, and new/worsening pericardial effusion) and 2) treatment of pericarditis (NSAIDS, colchicine, steroids, IL-1 inhibition). Surgical data and lesion classification was collected.

Results/Data:
Out of 214 ACHD patients undergoing cardiac surgery (median age 36, IQR [26-53] years, 49% male [Table 1]), 47 patients (22%) developed postoperative pericarditis. The majority (>75%) of cases occurred within the first 7 days, with clinical resolution within 2-4 weeks. Four patients developed recurrent episodes of pericarditis, and no patients experienced clinical tamponade or required urgent pericardial drainage. Those who developed pericarditis were younger and more commonly Asian (33%) or African American (33%) compared to Hispanic (23%) or White (12%) (Table 1). Pericarditis occurred most frequently with shunt repairs (27/73, 37%, p<0.001) and aortic valve replacement (10/29, 34%, p=0.016). Those who underwent septal defect (ASD) repairs (24/61, 39%, p<0.001) with autologous pericardium (16/36, 44%, p=0.001) represented the highest risk group.

Conclusions:
Postoperative pericarditis develops in roughly one in five ACHD cardiac surgical cases, most frequently in those who required autologous patch repair, yet only rarely had long-lasting complications. Our study suggests the need to further understand the natural history, treatment, and prevention of pericarditis in those with ACHD requiring surgery.
Abstract 4145932: Real World Data From A Nationwide Survey: Current Approaches Post Acute Coronary Syndromes By Cardiologists
Authors: SABOURET Pierre , Santos Raul , Sharareh Ali , garban thierry , Cohen Serge , Parrens Eric , Villaceque Marc , Guedjmeynier Dominique , Lequeux Benoit , Hoffman Olivier , Dib Jean-Claude , Durand Philippe , Bernardi Marco , Spadafora Luigi , Asher Elad , Bhatt Deepak , Biondi-Zoccai Giuseppe , Banach Maciej , Amara Walid , Schiele Francois , Lellouche Nicolas , Dievart Francois
Published: November 2024

Background:
A new ESC guidelines in 2023, the International Lipid Expert Panel (ILEP) 2021 recommendations, and a subsequent statement by EAS have been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists.

Objective:
To determine the current approach and therapeutic strategies concerning lipid lowering treatments post-acute coronary syndromes in France.

Methods:
This national survey was performed during October and November 2023 in France with an online questionnaire on the websites of 2 national French Societies of Cardiologists.

Four mailings were sent to cardiologists to invite them to answer to the questionnaire. A total of 400 answers of cardiologists were collected during this 2-month period.

Results:
For ASCVD patients, cardiologists agreed with an LDL-C goal below 55 mg/dL (1.4 mmol/L) in 69%, below 70 mg/dL (1.8 mmol/L) in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL (1.8-2.5 mmol/L). An upfront lipid lowering combination strategy using fixed dose combination (FDC) of statins and ezetimibe was prescribed in less than 5% of patients, whereas high-intensity statins were prescribed in more than 90% of patients. No significant differences were observed in terms of sex of patients, geographical area, or strategies followed by male and female cardiologists (
p
> 0.05). A combination of statins and ezetimibe was prescribed only for a minority of patients, especially as an early upfront strategy. The use of PCSK9i remains marginal and the interval between the ACS and initiation of these medicines remains high.

Conclusion:
In this contemporary national survey, we report an excellent agreement of lipid goals in secondary prevention by cardiologists. Despite the declared consensus recommending a low LDL-C target in ACS patients, lipid lowering strategies are suboptimal, mainly consisting of high intensity statins. The lack of recommended use of ezetimibe and PCSK9i to lower LDL-C levels highlights the importance of better implementation of intensive and early upfront strategies to reduce recurrent ischemic events.
Abstract 4145943: Recidivism in the Cardiac Intensive Care Unit: Insights from the Multinational Critical Care Cardiology Trials Network
Authors: Katz Jason , Sinha Shashank , Alviar Carlos , Kontos Michael , Carnicelli Anthony , Daniels Lori , Pierce Matthew , Wang Jeffrey , Baird-Zars Vivian , Palazzolo Michael , Van Diepen Sean , Bohula Erin , Berg David , Morrow David
Published: November 2024

Background:
Intensive Care Unit (ICU) readmission, or recidivism, can lead to increased resource use, longer hospital length-of-stay (LOS), higher costs,&worse survival. Given the potential clinical&financial impact of recidivism, it may be a useful quality metric for unit-&hospital-level comparisons. No prior studies, however, have comprehensively explored recidivism – its potential causes or consequences – across Cardiac Intensive Care Units (CICUs).

Methods:
The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of advanced CICUs coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions were captured (n=16,705)&those with
>
1 readmission during the same hospitalization were identified. Multivariable logistic regression was used to determine baseline variables associated with recidivism, as well as the association of recidivism with in-hospital mortality.

Results:
A total of 1287 pts (7.7%) had CICU readmission. These pts were younger (p=0.015), had more diabetes (p=0.04), prior heart failure (HF)&chronic kidney disease (CKD) (p<0.001 for both), more frequently presented with decompensated HF or cardiogenic shock (p<0.001), were more often transferred from outside facilities (p<0.001), and had higher Sequential Organ Failure Assessment (SOFA) scores at presentation (p<0.001). Rates of CICU recidivism highly varied across institutions (
Fig-A
). Compared to those who were not readmitted, those readmitted to the CICU had greater critical care resource use during their 1
st
CICU stay (
Fig-B
), along with longer initial CICU LOS (2.8
vs
2.2d)&hospital LOS (20.4 vs 7.6d) (both p<0.001). Hospital mortality was 20.3% in those readmitted to the CICU compared to 4.5% in those without readmission (
Fig-C
); adjusted odds ratio 6.22 (95% CI 5.25-7.38, p<0.001). This remained statistically significant after adjustment for code status.

Conclusions:
CICU recidivism varies significantly across centers and is associated with numerous comorbidities, higher illness severity, and greater resource use. One of every 5 pts readmitted to the CICU died in the hospital. Recidivism should be measured in future CICU-based studies, and could help to assess quality of CICU care.
Abstract 4145945: Comparison of Catheter Ablation of Ventricular Tachycardia Between Ischemic and Non-ischemic Cardiomyopathy
Authors: Mir junaid , Al-Ahmad Majd , Nandu Nitish Singh , Al-Ahmad Anas , Basharat Anam , Basit Jawad , Alraies M Chadi
Published: November 2024

Background:
Ventricular Tachycardia (VT) is a common arrhythmia encountered in ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM). VT ablation is one of the treatment options of VT in ICM and NICM. There is scarcity of research comparing the outcomes of VT ablation in ICM and NICM.

Methods:
This is an analysis of the National Inpatient Sample of the years 2016 to 2020. We identified patients who were admitted for VT ablation using ICD-10-PCS codes. We divided the population into two groups by secondary diagnosis of ICM and NICM. The risk of mortality and in-hospital complications in the VT ablation/ICM group was compared to the VT ablation/NICM group using multivariate logistic regression analysis.

Results:
During 2016-2020, there were a total of 246240 patients who were admitted with for VT ablation, of which 28745(11.7%) patients had ICM while 58989 (23.95%) had NICM. After adjusting for demographics, VT ablation with NICM had lower odds of cardiogenic shock (aOR (adjusted odds ratio) 0.80; 95% CI 0.67–0.95 p =0.012), invasive mechanical ventilation (aOR 0.65; 95% CI 0.53–0.78p < 0.001), lower length of stay (LOS) (aMD (adjusted mean difference) - 0.42; 95% CI -0.7 – -0.14 days p= 0.003) but higher odds of arrhythmia other than VT (aOR 1.33; 95% CI 1.2 – 1.49 p<0.001), compared to VT ablation with ICM. (Figure 1)

Conclusion:
VT ablation in NICM has lower odds of cardiogenic shock, invasive mechanical ventilation, and lower LOS but higher odds of arrhythmia other than VT, compared to VT ablation in ICM. Further studies are needed to elucidate it further.
Abstract 4145958: Quantification of Sarcopenia in Chest Computed Tomography Prognosticates Cardiac Surgery Outcome
Authors: Nezafati Pouya , McFarlane Craig , Hebbard Lionel , Saxena Pankaj , Raman Jai
Published: November 2024

Background:
Sarcopenia is an objective and comprehensive marker of frailty and an important predictor of outcomes after cardiac surgery. Its utility is challenging due to difficulty in its assessment.

Hypothesis:
We hypothesize that sarcopenia defined as pectoralis major cross-sectional area (PMA) from CT Chest is a useful predictor of cardiac surgery outcomes.

Aim:
The aim of this study is to develop Gender Specific Cut-off Points for PMA as a marker for sarcopenia and to evaluate the associations between sarcopenia and post-operative cardiac surgery outcomes.

Methods:
This study includes 237 subjects with pre-operative CT Chest scans who underwent any Cardiac Surgery involving sternotomy from 2019 to 2023 at the Townsville University Hospital, Australia. The Pectoralis Major Muscle Area, Density and Thickness measurements were performed at the level of 4th thoracic vertebra in Axial view. The sarcopenia cut-off value was defined as the lowest sex-specific quartile in PMA. Intra and post-operative outcomes up to 30-days, were collected.

Results:
The Cut-off values for PMA were set at 1045mm
2
for males and 609mm
2
for females, with 59 subjects meeting the criteria for sarcopenia. Sarcopenic patients required longer hospitalization (10.8±6.93 vs 8.37±5.26 days; P=0.006), longer intubation and stay in ICU, and experienced more post-operative complications within the first 30 days after surgery (p=0.002). Post-operative mortality was similar in both groups.

Logistic regression analysis revealed that sarcopenia is associated with increased risk in days of extended hospital stays (OR=5.08, 95% CI: 2.35-10.96, p<0.001), ICU stays (OR=3.16, 95% CI:1.54-6.50, p<0.002),and intubation (OR=2.49, 95% CI:1.09-5.67, p=0.031). Moreover, the Receiver Operating Characteristic (ROC) analysis showed that muscle thickness displayed a higher degree of accuracy than density for assessment of sarcopenia and achieved a sensitivity of 80% and specificity of 70% at cut-off values of 12.2mm in males and 8.1mm in females, with an area under the curve (AUC) of 0.85.

Conclusion:
Patients undergoing cardiac surgery with pre-op CT Chest can be assessed for sarcopenia with PMA or simply thickness of pectoralis major muscle. Sarcopenia defined based on CT Chest PMA is a significant predictor of post-operative outcomes in cardiac surgery patients, including longer hospitalization, ICU stay, and intubation time, as well as increased risk of post-operative complications within the first 30 days after surgery.
Abstract 4145992: Mortality Trends of Chronic Obstructive Pulmonary Disease and Acute Myocardial Infarction in the United States
Authors: Rathore Azeem , Shaikh Safia , Nassar Sameh , Upreti Prakash , Bolaji Olayiwola , Bahar Yasemin , Alraies M Chadi
Published: November 2024

Introduction:
Given the overlap in their risk factors, investigating the combined mortality trends of both chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI) represents a crucial yet understudied area.

Methods:
Using the CDC WONDER database, we queried mortality records from 1999 to 2019 among COPD-related deaths (ICD-10: J40, J41, J42, J43, J44) and AMI-related deaths (ICD-10: I21) in ≥ 45-years-old. Joinpoint regression analysis was utilized to assess trends in annual percentage change (APC) for underlying and contributing causes of death. Age-adjusted mortality rates (AAMR) were computed and compared cumulatively across subpopulation demographics.

Results:
Between 1999 and 2007, COPD and AMI mortality as underlying causes showed a notable decline (APC: -4.71, 95% CI: -6.09, -3.45), with a continued decrease from 2007 to 2020 (APC: -2.28, 95% CI: -2.61, -1.57). Conversely, as contributing causes, COPD and AMI demonstrated a downward trend from 1999 to 2009 (APC: -3.09, 95% CI: -4.22, -2.45), followed by a slower decline from 2009 to 2018 (APC: -1.52, 95% CI: -3.3, -0.93), and a slight increase from 2018 to 2020 (APC: 2.05, 95% CI: -1.18, 3.75). Gender-specific analysis revealed consistently higher AAMRs among males (458.8) than females (295.5), while Whites consistently had the highest AAMR (377.6) and Asians the lowest (145.9). Urbanization level played a role, with non-metropolitan areas consistently exhibiting higher AAMR (478.5) compared to metropolitan areas (353.1), with the Midwest showing the highest AAMR (396.1).

Conclusion:
The decline in COPD and AMI-related mortality reflects the success of public health initiatives targeting smoking cessation, improved air quality regulations, and advancements in cardiovascular care. The uptick in mortality rates from 2018 to 2020 underscores the necessity for ongoing vigilance and targeted interventions, especially in addressing disparities related to gender, race, and urbanization.
Abstract 4146041: Spatiotemporal Stability of Dominant Frequency Sites in Atrial Fibrillation Using Digital Twin Technology and Clinical Outcomes of Catheter Ablation
Authors: Hwang Taehyun , Kwon Oh-Seok , LIM BYOUNGHYUN , Kim Moon-Hyun , Kim Daehoon , Park Je-Wook , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-Sun , JOUNG BOYOUNG , Lee Moon-Hyoung , Pak Hui-Nam
Published: November 2024

Background:
Although the dominant frequency (DF) may localize the reentrant drivers of atrial fibrillation (AF), its meandering nature makes it difficult to localize as an extra-pulmonary vein (extra-PV) target.

Hypothesis:
We explored and quantified the spatiotemporal stability of DF by sophisticated digital-twin maps and the association with the rhythm outcome of clinical AF catheter ablation (AFCA).

Methods:
We retrospectively examined the DF sites in the digital twin integrated by high-density electroanatomical maps (EAM) of 170 patients previously included in the CUVIA-AF2 trial (male 70.6%, 59.2±11.3 years old, 100% persistent AF). We monitored 34 seconds of virtual AF and analyzed DF sites in 10 different left atrial (LA) regions at 3 consecutive periods (6 seconds each after 16 seconds of induction and blanking periods). The spatiotemporal stability index (STSI) was calculated to quantify mean DF's spatial and temporal variability. During protocol-based rhythm follow-up, we assessed the atrial arrhythmia recurrence rate by dividing patients into two groups based on STSI 0.75.

Results:
During the simulation, 108 out of 170 (63.5%) patients recorded the mean DF in all consecutive periods. There were 26 (24.1%) patients in the stable DF group (STSI ≥0.75, Stable group) and 82 (75.9%) patients in the unstable DF group (STSI <0.75, Unstable group). Although the proportion of patients with hypertension (73.1 vs. 47.6%, p=0.041) was higher and left ventricular end-diastole diameter (51.3±3.9 vs. 49.0±4.4 mm, p=0.020) was larger in the stable DF group than in the unstable DF group, other parameters, including LA size, LA voltage, or AF ablation targets, did not differ between two groups. During the median 19 [15-22] months follow-up, the atrial arrhythmia recurrence rate of the Stable group is higher than that of the Unstable group (log-rank p=0.031, HR = 2.06, CI [1.06-4.01])

Conclusions:
We found that the temporally stable DF in EAM-integrated virtual AF, the potential extra-PV AF drivers, is a surrogate marker of the adverse rhythm outcome of AFCA. A prospective clinical trial targeting the spatiotemporally stable DF will be warranted.
Abstract 4146070:

A

rtificial intelligence for the prediction of all-cause mortality and readmission in heart failure: a meta-analysis of twenty studies
Authors: Gupta Aashray , Zaka Ammar , Mutahar Daud , Mustafiz Cecil , Gorcilov James , Abtahi Johayer , Kamalanathan Harish , Tan Sheryn , Hains Lewis , Sharma Prakriti , Sharma Srishti , Ragunath Priyyanca , Kovoor Joshua , Stretton Brandon , Mridha Naim , Bacchi Stephen
Published: November 2024

Background:
Accurate risk prediction of heart failure patients is essential for identifying high risk patients, developing targeted treatment strategies and prognostication. Existing traditional risk scores offer modest discriminative value, and rely on rigid predictor variables. A form of artificial intelligence, machine learning (ML) models provide alternate risk stratification that may improve predictive accuracy. This systematic review and meta-analysis compared machine learning models with traditional risk scores for predicting all-cause mortality and readmission in patients with heart failure.

Methods:
PubMed, EMBASE, Web of Science and Cochrane databases were searched until 1st May, 2024 for studies comparing ML models with traditional statistical methods for prediction of all-cause mortality and hospital re-admission following an index admission with CHF. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals between ML models and traditional methods in estimating the risk of all-cause mortality and hospital readmission at 30 days.

Results:
Twenty observational studies were included (558,233 patients). The summary C-statistic of the top-performing ML models for all-cause mortality was 0.76 (95% CI, 0.72-0.80), compared to traditional risk scores 0.71 (95% CI, 0.68-0.74). The difference in C-statistic between ML models and traditional methods was 0.05 (95% CI 0.04-0.06, p<0.05). Of all included studies, 6 models were externally validated. Calibration was inconsistently reported.

Conclusion:
ML models demonstrated superior discrimination of 30-day all-cause mortality and hospital readmission for heart failure patients when compared to traditional risk scores. Before integrating into clinical practice, further research is required to overcome methodological and validation limitations.
Abstract 4146083: The Restricted Fluid Intake Compared With Liberal Fluid Intake In Patients With Heart Failure – A Meta-Analysis
Authors: Bielecka-Dabrowa Agata , Banach Maciej , Jaiswal Vikash
Published: November 2024

Background:
Although fluid overload is inextricably linked to heart failure (HF), dehydration is also possible in HF patients. Maintaining euvolemia is the cornerstone of HF management. Physicians should find a balance between decongestion therapy and the risk of dehydration. In the absence of enough supportive evidence, the US and European guidelines for the diagnosis and treatment of acute and chronic HF provide only a general recommendation supporting fluid restriction (FR) for selected patients with symptomatic HF, without providing a level of evidence. Thus, we aimed to evaluate the risk of all-cause mortality, hospital readmissions, and change in BNP, sodium, potassium, creatinine, and perceived thirst in HF patients with FR vs liberal fluid intake.

Methods:
We performed a systematic literature search on PubMed, EMBASE, and Scopus for relevant randomized controlled trials (RCTs) from inception until May 2024. Risk ratios (RR), weighted mean differences (WMD), and 95% confidence intervals (CI) were pooled using a random-effect model.

Results:
A total of 8 RCTs with 767 patients (364 in the FR group and 403 in the non-FR group) were included in the study. The mean age of patients among FR and non-FR groups was 69.49 and 68.62 years, respectively. The mean follow-up duration was 95 days. Pooled analysis of primary and secondary outcomes showed that there are no statistically significant differences between FR and liberal fluid intake in the risk of HF hospital readmissions [RR, 0.64; 95%CI: 0.24-1.70; P=0.37], and all-cause mortality [RR, 0.62;95% CI: 0.31-1.25; P=0.18] (Figure 1). No significant difference in thirst was also observed [WMD: 2.94, 95% CI: -3.61 to 9.48, P=0.38]. For FR, BNP at follow-up showed a non-significant increasing trend (WMD: 21.34, 95% CI: -144.28 to 186.97, P=0.80). Sodium levels showed a non-significant increase in FR vs liberal fluid intake (WMD: 1.94, 95%CI: -1.10 to 4.99, P=0.21). Creatinine and potassium levels showed no significant differences at any time point.

Conclusion:
Fluid restriction does not significantly reduce the risk of HF rehospitalizations and all-cause mortality in HF patients. Further randomized controlled trials are warranted to confirm these findings and result in suitable recommendations and clinical practice changes.
Abstract 4146105: Diagnostic Yield in Relatives to Sudden Cardiac Death Patients – A 10-year Follow-Up Study
Authors: Groenholdt Christine , Hansen Benjamin , Folke Fredrik , Lauridsen Trine , Axelsson Anna , Winkel Bo , Bundgaard Henning , Tfelt-Hansen Jacob , Christensen Alex , Hansen Carolina
Published: November 2024

Introduction:
International guidelines recommend cardiogenetic screening of relatives to sudden cardiac death (SCD) patients suspected of having an inherited cardiac disease. However, little is known about the long-term diagnostic yield and risk of cardiac events among relatives. This information is crucial for designing appropriate follow-up strategies for relatives.

Aims:
To determine the 10-year diagnostic yield and frequency of clinical outcomes in referred families to patients with all cause-SCD.

Methods:
In this retrospective single-center study, we included consecutively referred families to patients with all cause-SCD from 1 January 2005 until 1 October 2018. Upon referral, the cause of death in the SCD proband was assessed through autopsy reports, genetic testing, and premortem medical records. First-degree relatives were screened following a standard protocol, and diagnostic yields were assessed after five and 10 years of follow-up. Furthermore, cardiac events (i.e. death due to cardiac cause, SCD, aborted SCD, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy) and relevant clinical outcomes in relatives were monitored.

Results:
A total of 686 relatives (304 families) were included, and mean age at follow-up was 45 years (47% males). The relatives were followed for a mean of 10.9 years during which 22 patients were lost to follow up. Screening over five years led to 73 relatives (49 families) being diagnosed, resulting in a diagnostic yield of 11%. After 10-years of follow-up, 82 relatives (56 families) were diagnosed, increasing the overall diagnostic yield to 12% with arrhythmogenic right ventricular cardiomyopathy being the most prevalent diagnosis. A total of 11 relatives experienced a cardiac event during follow-up, of whom 10 had a definite diagnosis.

Conclusion:
Over 10 years of follow-up, 82 (12%) relatives to patients with all cause-SCD were diagnosed with an inherited cardiac disease, primarily within the first five years. The majority of relatives who experienced a cardiac event during follow-up had a definite diagnosis. This underscores the importance of early detection and management of inherited cardiac diseases in the screening of SCD relatives.
Abstract 4146109: Genetic Mouse Models of Obesity may provide mechanistic insights into atrial myopathy and atrial fibrillation: Insights from
Mc4r
-KO Mice
Authors: Sridhar Arvind , DeSantiago Jaime , Arif Mahmud , Owais Asia , Barney Miles , Chen Hanna , Baskaran Abhinaya , Hong Liang , McCauley Mark , Darbar Dawood
Published: November 2024

Background:
Although a causal relationship between diet-induced obesity (DIO) and atrial fibrillation (AF) has been established, the underlying pathophysiological mechanisms in genetic obesity remain unclear. A high-fat diet (HFD) is used to generate DIO mice, but investigating genetic models of obesity may provide mechanistic insights into atrial myopathy, a precursor state of AF and stroke that is of increasing clinical and research interest.

Objective:
We used a genetic (melanocortin-4 receptor knockout,
Mc4r
-KO) mouse model of obesity to test the hypothesis that obesity-mediated atrial myopathy creates an electrophysiologic (EP) substrate for AF.

Method:
MC4R
mutations are the most common monogenic form of obesity in humans. Transesophageal rapid (TE) pacing, invasive electrophysiology studies, immunohistochemistry, western blotting of plasma membrane proteins, mitoSOX staining, and whole-cell patch clamping were performed to evaluate AF burden and analyze the molecular and whole-animal EP phenotype.

Results:
Mc4r
-KO mice were significantly heavier than wild-type lean controls (
Figure A
). AF burden was 257 ± 175 seconds in
Mc4r
-KO mice vs. 14.4 ± 29 seconds in control mice (P=XX;
Figure B-C
). Patch-clamping and optical mapping studies showed that
Mc4r
-KO mice displayed a shortened atrial action potential (APD) (data&P=) and reduced conduction velocity (
Figure D-F
).
Mc4r
-KO mice also displayed significantly reduced peak cardiac sodium current (I
Na
) and delayed rectifier potassium current (I
Kr
), but the L-type Ca
2+
current (I
Ca,L
) was unchanged, indicating that the atrial APD changes are mostly due to I
Na
modulation (
Figure G-H
).
Mc4r
-KO atrial myocytes showed increased MitoSOX staining, indicating elevated ROS production (
Figure J
). Notably, fibrosis was not increased in
Mc4r
-KO mice, suggesting AF susceptibility is primarily due to electrical remodeling (
Figure K
).

Conclusion:
Our study indicates that mice with genetic susceptibility to obesity are more prone to develop AF primarily through electrical remodeling, with minimal structural changes, differing from DIO mice. This risk is in part mediated by modulation of the cardiac Na
+
channel and increased oxidative stress. These findings may have important implications for the management of obesity-mediated AF in humans.
Abstract 4146116: Carotid body ablation reduces hypertension following long-term intermittent hypoxia by regulating brainstem glial cell activation
Authors: Iturriaga Rodrigo , Pereyra Katherine , Vicencio Sinay , Bernal Ignacio , Diaz-Jara Esteban , Del Rio Rodrigo
Published: November 2024

Introduction:
Sleep apnea is an independent risk factor for hypertension. Chronic intermittent hypoxia (CIH), a key feature of sleep apnea, is considered the main factor for the development of hypertension, which is attributed to sympathoexcitation. However, novel evidence shows that CIH enhanced CB chemosensory discharges triggering an increase in sympathetic outflow through neuronal activation in the nucleus of the solitary tract (NTS). This idea is supported by the fact that CB ablation abolish the hypertension and NTS neuroinflammation after 21 days of CIH even in the presence of CIH. However, whether CB mediate glial cell activation (well-known sentinels involved in brain inflammation) following long-term CIH remains unknown.

Hypothesis:
Accordingly, we propose that the maintenance of hypertension and glia cell activation within the NTS of mice exposed to long-term CIH, depends on the CB afferent discharge.

Methods:
We exposed male C57BL6 mice to CIH (5% FiO2, 12 times/h, 8 h/day) for 60 days. At 45 days of CIH, CBs were selectively denervated, and animals were kept in CIH for additional 15 days. At the end of the experiments, we measured arterial blood pressure (MABP), hypoxic ventilatory response (HVR) in awake mice and assessed astrocyte and microglia activity through morphological 3D reconstructions, and IL-1β, IL-6, and TNF-α gene expression in the NTS with real-time PCR.

Results:
CIH induces hypertension (MABP 83.5±1.4 vs. 95.0±2.2 mmHg; Sham vs CIH), enhances HVR (1.69±0.2 vs 4.3±0.9 VE/min; Sham vs. CIH), and change astrocytes morphology (N° of branches 13.0±0.7 vs 11.3±0.5; cable length 181.0±8.9 vs 148.1±1.5 pm, Sham vs CIH), and microglia arborization (N° of branches 196.1±8.4 vs 376.3±16.8; cable length 667.4±29.6 vs 1267±60.5 pm, Sham vs CIH). Remarkably, CB denervation (CIHd) normalized the hypertension (MABP 83.5±1.4 mmHg; CIHd), the enhanced HVR (1.63±0.43 VE/min; CIHd), reduced the increased IL-6 (1.2± 0.2 vs 0.4 ± 0.1, CIH vs CIHd), TNF-α (2.0±0.2 vs 1.1±0.2, CIH vs CIHd) but not IL-1β levels (3.0±0.4 CIH vs 2.6±0.5, CIH vs CIHd), and the changes observed in astrocytes (N° of branches 17.2±0.9, cable length 231.0±12.9) and microglia (N° of branches 126.2±13.3; cable length 126.2±1.3 CIHd).

Conclusions:
Present results suggest that CBs plays a critical role in the maintenance of high blood pressure and contribute to the inflammation in the NTS of mice exposed to long-term CIH. Supported by Fondecyt Grants 1211443 and 1220950.
Abstract 4146152: Young Onset Stroke in Young Asian American and Pacific Islanders and Associated In-hospital Mortality Using National Inpatient Sample 2016-2020
Authors: Patel Mansi , Prabu Samyuktha , Dhananjaya Hemanth , Jog Himanshu , Mahadevan Arankesh , Goyal Ninia , Gawde Rashmi , Desai Rupak
Published: November 2024

Background:
Exploring the risk of young-onset stroke (YOS) in Asian Americans and Pacific Islanders (AAPIs), our study helps fill a critical gap in medical literature. By identifying unique risk factors and trends, the findings can guide early identification and targeted interventions for young AAPI individuals at high risk of stroke.

Method:
AAPIs aged 18-44 with and without YOS hospitalization were retrospectively identified from the National Inpatient Sample (2016-2020). Study population, comorbidities, and outcomes were queried using ICD-10-CM codes. All-cause in-hospital mortality (ACIHM) was the primary outcome and secondary outcomes were measures of healthcare resource utilization. Multivariable regression analysis was performed to analyze cardiovascular disease risk (CVD) factors as predictors of YOS and associated all-cause in-hospital mortality (ACIHM). Linear-by-linear trend analysis was performed. Statistical significance was defined at p<0.05.

Result:
Of 1,629,064 young AAPIs hospitalized between 2016 and 2020, 9325 had YOS (0.6%), with an overall increasing prevalence year by year (0.5% in 2017 to 0.7% in 2020). Demographically, the YOS had a higher average age (38 vs. 32 years) and a male majority. YOS hospitalizations had the highest prevalence of comorbidities (hypertension, hyperlipidemia, obesity, diabetes mellitus, and smoking). Based on sex, females had an upward trend in YOS admissions (0.3% in 2016 to 0.4% in 2020) while nonsignificant in males. Trends in ACIHM were nonsignificant (p=0.279) overall, but by sex, it showed an overall decrease in males (11.1% in 2016 to 0.5% in 2020) and an overall increase in females (4.5% in 2016 to 11.5% in 2020).

ACIHM was higher in the YOS cohort (9.4% vs. 0.3%), with a longer stay (5 vs 2 days) and more expense (94,712 USD vs. 25,637 USD). Comorbidities of hypertension, both complicated and uncomplicated, hyperlipidemia, and peripheral vascular disease significantly predicted the odds of stroke by 7.14, 6.29, 1.85, and 5.94. Hyperlipidemia was protective against ACIHM in YOS hospitalizations (OR: 0.24 [0.13-0.43]).

Conclusion:
Young AAPIs have an increasing risk of YOS each year, with higher rates and odds seen with certain CVD risk factors.
Abstract 4146172: Gender Differences in Outcomes of Leukemia Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): An Analysis of National Inpatient Sample (NIS) Data from 2016-2021
Authors: Uttam Chandani Kanishka , Agrawal Siddharth , Raval Maharshi , Bhargava Sahil , Patel Yug , Siddiq Sajid
Published: November 2024

Background:
Transcatheter Aortic Valve Implantation (TAVI) is increasingly used to treat severe aortic stenosis in patients who are at high risk for conventional surgery. Patients with leukemia represent a unique subset, often presenting with additional comorbidities and a higher susceptibility to complications. Gender differences in clinical outcomes following TAVI in leukemia patients remain under-explored. Understanding these differences is crucial for optimizing patient care and improving procedural outcomes in this vulnerable population.

Methods:
A retrospective analysis using the National Inpatient Sample (NIS) data from 2016 to 2021 compared male and female leukemia patients undergoing TAVI. Multivariate logistic regression was utilized to analyze variables such as in-hospital mortality, transfusion requirements, bleeding, and other complications. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and statistical significance was determined by P-values.

Results:
The study included 2,175 male and 1,055 female leukemia patients undergoing TAVI. The majority of patients were White, with 91.92% of males and 92.12% of females. Black patients constituted 2.14% of the male and 2.46% of the female groups.The mean age of male patients was 79.25 years, while female patients were slightly older, with a mean age of 80.66 years. Total charges were comparable between genders, with males incurring $217,554.6 and females $224,248.3. The length of stay was also similar, with males staying an average of 3.48 days and females 3.82 days. Mortality was significantly higher in females compared to males, with an odds ratio (OR) of 8.824 (95% CI: 1.415-55.017, P=0.02). Females also had higher odds of requiring transfusions (OR=2.049, 95% CI: 1.052-3.989, P=0.035) and experiencing bleeding complications (OR=2.039, 95% CI: 1.17-3.555, P=0.012). Other complications, such as vascular injury, permanent pacemaker (PPM) insertion, arrhythmias, and respiratory failure, did not show significant gender differences.

Conclusion:
Female leukemia patients undergoing TAVI are at a significantly higher risk of mortality, requiring more transfusions, and experiencing increased bleeding compared to their male counterparts. These findings underscore the urgent need for gender-specific management strategies and further research to enhance outcomes for this high-risk population.
Abstract 4146180: HFpEF in Space: The Influence of Weightlessness on Cardiac Filling Pressure in Obese Heart Failure with Preserved Ejection Fraction
Authors: Manferdelli Giorgio , MacNamara James , Hearon Christopher , Shah Aman , Tayon Kevin , Pandey Ambarish , Sarma Satyam , Levine Benjamin
Published: November 2024

Introduction:
Heart failure with preserved ejection fraction (HFpEF) and obesity are often co-morbid, with obesity being associated with greater left ventricular (LV) filling pressures. Obesity may contribute to LV filling pressure by increasing external constraint due to the weight of the lungs and chest wall compressing the heart. The magnitude of the contribution of external constraint to LV filling pressure in HFpEF is unknown. We investigated the influence of chest weight on pulmonary artery systolic, diastolic, and mean pressures in two patients with obesity and HFpEF during acute exposure to weightlessness.

Methods:
One female (participant 1; age: 62 years; BMI: 41.2 kg/m
2
) and one male (participant 2; age: 72 years; BMI: 46.8 kg/m
2
) patient with HFpEF, obesity, and previously placed CardioMEMS device (Abbott), completed a parabolic flight consisting of repeated parabolas with ~30 seconds of 0G, and ~30 seconds of 1.8G, with level flying (1G) between sets (Figure 1A). Pulmonary artery systolic, diastolic and mean pressures were measured using a CardioMEMS console in the supine position and 10-second waveforms were recorded for analysis (Figure 1C). Spontaneous end-expiratory pressures were corrected for barometric pressure.

Results:
Pulmonary diastolic pressures during flight are shown in Figure 1B and 1C. Removal of gravity immediately and significantly decreased pulmonary pressures in both participant 1 (1.8G: 61/36 (46), 1G: 59±4/34±3 (45±3), 0G: 52±3/26±1 (37±2) mmHg) and participant 2 (1.8G: 41/27 (32), 1G: 38/24 (30), 0G: 29±1/15±1 (21±1) mmHg). The absolute change in pulmonary artery diastolic pressure from 1G to 0G was -8 mmHg and -9 mmHg, while between 1.8G and 0G was -10 mmHg and -12 mmHg for participant 1 and 2, respectively.

Conclusion:
Acute exposure to weightlessness profoundly reduced pulmonary artery pressures in patients with the obese phenotype of HFpEF. The magnitude of the decrease was greater than nitrates and left atrial shunt devices. Our results suggest that the weight of the lungs and chest wall contribute mechanically to LV filling pressures in HFpEF, and that weight loss may lower LV filling pressures by reducing external constraint.
Abstract 4146248: Statewide Burden of Lower Extremity Peripheral Arterial Disease in the United States from 1990-2021: A Benchmarking Systematic Analysis for the Global Burden of Disease Study 2021
Authors: gopi Anaswara , Giri Tapan , Haseeb Madiha , Syed Saif , Yadav Ratan Pal , Lakkimsetti Mohit , Shandilya Ashwinikumar , Bhalodia Paritaben , Islam Hamza , sharma kamal , AMIN VISHRANT , DESAI HARDIK
Published: November 2024

Introduction:
Lower Extremity Peripheral Arterial Disease (PAD) ranks as the leading cause of incidence among all cardiovascular diseases (CVD) in the United States. Due to a significant lack of data on the overall burden of PAD, this pioneering study investigates the trends of PAD over the past three decades in the US, including the initial two years of the COVID-19 pandemic.

Method:
We estimated prevalence, incidence, deaths, and disability-adjusted life years (DALYs) due to PAD by age, sex, year and location across the US from 1990-2021 using the global burden of disease 2021 methodology. Results were presented in absolute counts and age-standardized rate (per 100,000 person-years)

Results:
From 1990 to 2021, the overall prevalence of PAD in the US rose from 8.6 million (95% uncertainty interval: 7.4-10 million) to 14.9 million (13.4-16.6 million). The total percentage change (TPC) in deaths increased by 93% (82%-102%), and DALYs by 87% (79%-96%). Pennsylvania recorded the highest increase in age-standardized incidence rate (ASIR) at 3%, followed by Delaware at 2%. Kansas saw the highest death rate (ASMR) increase at 20%, with Kentucky close behind at 19%. The 65-69 age group had the highest incidence count at 265,188, while the 85-89 age group saw the most deaths at 1,827, and the 70-74 age group recorded the most DALYs at 36,772 in 2021. Males experienced a higher increase in TPC across incidence, deaths, and DALYs compared to females, with figures at 85% vs 56%, 104% vs 85%, and 99% vs 76%, respectively.

Conclusion:
While deaths due to Peripheral Arterial Disease (PAD) constituted only 1.22% of all cardiovascular-related fatalities in the US in 2021, the growing burden of the disease highlights a critical area for public health focus. Although mortality rates remain relatively low, the high incidence compared to other cardiovascular diseases suggests the need for targeted prevention and early intervention strategies. Strengthening awareness, improving diagnostics, and enhancing treatment accessibility can help mitigate the rising impact of PAD and improve cardiovascular health outcomes nationwide.
Abstract 4146276: Conduction Delay Characteristics in the Post-operative Course of the First Porcine-to-Human Cardiac Xenotransplant Recipient
Authors: Brilliant Justin , Haridas Devika , Griffith Bartley , Khan Ubaid , Khan Oneib , Parsirad Mahdokht , Ananthram Manjula , Hong-Zohlman Susie , Feller Erika , Grazioli Alison , Amara Richard , Shorofsky Stephen , Mohiuddin Muhammad , Dickfeld Timm
Published: November 2024

Background:
The first-ever genetically modified porcine-to-human cardiac xenotransplantation was performed in January 2022 at the University of Maryland, with the recipient surviving 60 days.

Aim:
Characterize trends in conduction delay observed over the 60-day post-operative course of the first-ever porcine-to-human cardiac xenotransplant recipient.

Methods:
Daily 12-lead ECGs were evaluated for presence and type of conduction delay. Over the post-operative period, 93 ECGs were obtained. ECGs that could not be assessed for conduction delay due to presence of significant artifact (2 ECGs) or paced rhythm (12 ECGs) were excluded from evaluation.

Results:
During the 60-day postoperative period, the xenotransplant exhibited alternating conduction block including nonspecific intraventricular conduction delay (NSIVCD), right bundle branch block (RBBB), incomplete RBBB, and left anterior fascicular block (LAFB). Nonspecific intraventricular conduction delay (NSIVCD) was observed on 6 days in total, occurring primarily within the first 9 post-operative days. After day 9, the conduction block alternated between bifascicular block with RBBB+LAFB, incomplete RBBB+LAFB, RBBB, and incomplete RBBB. The predominant pattern of conduction delay was bifascicular block with RBBB+LAFB, occurring over 32 days in this period. Presence of incomplete RBBB+LAFB was noted on 17 days in total. Isolated RBBB occurred on 2 days, and incomplete RBBB on 4 days. There was no evidence of high-grade atrioventricular block observed in this period.

Conclusion:
Ventricular conduction in the post-operative period of the first porcine-to-human xenotransplant was characterized by an alternating conduction block with NSIVCD in the early postoperative period (through day 9), followed by predominantly bifascicular block with RBBB and LAFB or incomplete RBBB and LAFB. Atrioventricular conduction remained largely intact without evidence of high-grade AV block nor dependence on back-up pacing during the majority of our patient’s post-operative course.
Abstract 4146277: Risk and Predictors of Hemorrhagic Complications in Extracorporeal Cardiopulmonary Resuscitation Patients: Insights from the SAVE-J 2 Registry
Authors: Sano Madoka , Toyota Toshiaki , Matsuoka Yoshinori , Watanabe Yusuke , Kohjitani Hirohiko , Azumi Yuta , Hayashi Hideyuki , Murai Ryosuke , Ooka Junichi , Sasaki Yasuhiro , Taniguchi Tomohiko , Kim Kitae , Kobori Atsushi , Ehara Natsuhiko , Kinoshita Makoto , Furukawa Yutaka
Published: November 2024

Introduction:
Extracorporeal cardiopulmonary resuscitation (E-CPR) is an emerging resuscitative therapy for patients with refractory cardiac arrests with various underlying conditions. However, hemorrhagic complications remain a significant challenge, adversely affecting patient outcomes.

Research Questions:
Risks and predictors of hemorrhagic complications in E-CPR patients may differ based on the causes of cardiac arrest.

Aims:
To compare the risks and predictors of hemorrhagic complications among the groups with different causes of cardiac arrest in patients undergoing E-CPR.

Methods:
The SAVE-J 2 registry is a multicenter registry of patients who underwent E-CPR for out-of-hospital cardiac arrest (OHCA) from 2013 to 2018. The patients were stratified into three groups based on the underlying causes of OHCA: endogenous cardiac, endogenous non-cardiac, and exogenous. The primary outcome was any bleeding, whereas the secondary outcomes included bleeding at cannulation sites and non-cannulation site bleeding. Pre-specified covariates were evaluated using the Cox proportional hazards model to identify the independent risk factors for bleeding.

Results:
Of the 2,070 patients who underwent E-CPR, 1,498 had endogenous cardiac causes, 344 had endogenous non-cardiac causes, and 228 had exogenous causes. The median follow-up among survivors was 35 days (interquartile range [IQR]: 21-55 days). Most of the bleeding events occurred within a week after E-CPR (median two days, [IQR: 1-8 days]). The 30-day cumulative incidence of any bleeding was significantly different among the three groups (endogenous-cardiac: 342 [26.1%]; endogenous-noncardiac: 47 [18.9%] and exogenous: 31 [15.1%], P<0.001). There was also significant difference among the three groups regarding puncture-related bleeding and non-puncture site bleeding (Figure). Multivariable analysis suggested that the potential risk-estimating variables for bleeding were different among the three groups.

Conclusions:
Hemorrhagic complication risks and predictors vary depending on causes of cardiac arrest in E-CPR patients. These findings highlight the need for individualized management strategies to mitigate bleeding risks and improve outcomes.
Abstract 4146342: Endothelial cells injured by hyperglycemia are rescued by P53 silenced bone marrow derived mesenchymal stromal cells (BM-MSC) derived secretome by improving cellular mitochondrial function.
Authors: Sen Sabyasachi , Nandula Seshagiri
Published: November 2024

Introduction:
Diabetes is associated with endothelial cell dysfunction. Studies have demonstrated that endothelial progenitor cells (EPCs) and mature endothelial cells (EC) are susceptible to apoptosis in hyperglycemic environment, however EPC start to undergo apoptosis within 48 hrs whereas ECs take upto 4 weeks. We in the past have shown that p53 gene silencing prevents EPC senescence in hyperglycemia and helps vascular regeneration. We have also shown that p53 silenced hematopoeitic CD34+ve EPC therapy helped tissue and vascular regeneration in hyperglycemia (25mmol). Our goal was to test whether conditioned media (CM) obtained from p53 silenced human stem cells (non-hematopoitic source) can also improve cell survival®eneration.

Methods:
We examined BM-MSCs and Adipose tissue MSCs (ADMSCs) derived CM to explore cell free therapeutics. Ad-human-P53 (TP53)-shRNA was used to silence P53 and Ad-scrambled-null-shRNA was used as control. To collect CM, the MSCs were cultured for 5 days, in serum-free media, followed by transduction with Ad-p53sh or Ad-null. After transduction, cells were cultured in 2% exosome free FBS media for only 48h and the collected supernatant was concentrated 10-fold to obtain the CM. Endothelial regeneration was tested following CM treatment on human endothelial cells (HECs) using endothelial wound healing assay kit (Cell Biolabs CBA-120-T). We compared CM obtained from null and p53sh BM-MSCs and ADMSCs on HEC , which was exposed to hyperglycemia for 2-3 weeks, using wound-healing assay (n=5).

Results:
Anti-apoptosis/ Proliferation capacity of the p53sh BMMSC-CM was 2.5-fold more compared to p53sh-ADMSC-CM. Post BM-MSC-CM treatment of hyperglycemia exposed endothelial cells, we noted a 4-fold increase in VEGFA mRNA expression and 2.2-fold increase mitochondrial-SOD (SOD2), compared to null transduced BMMSC derived CM. Other mitochondrial genes are being investigated and indicate a similar trend. Furthermore exosomes derived from p53 BMMSC-CM appear to have the protective effect on hyperglycemia exposed HEC vs non exosomal portion.

Conclusion:
p53sh-BMMSC-CM appears to have better anti-apototic effect compared to p53sh-ADMSC-CM. This finding allows us to generate relatively larger quantities of CM vs CM from p53sh EPCs. Cell-free CM or exosomes from CM obtained from p53sh BM-MSC cells may have a therapeutic role in treating vascular complications of diabetes with mitochondrial function improvement as a possible mechanism.