bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4140684: Global burden, regional inequality, and age discrepancy of developmental intellectual disorder attributable to congenital heart anomalies, 1990 - 2021, a systematic analysis for the Global Burden of Disease Study 2021
Authors: Lin Xinjie , He Qiyu , Ma Kai
Published: November 2024

Introduction:
The success of cardiac surgical techniques and progress of interventional therapies prolonged the life expectancy patients with congenital heart anomalies (CHA). Reduction of mortality and extension of lifespan exacerbated the burden of non-fatal comorbidities. Developmental intellectual disability (DID) is the most substantial non-fatal comorbidities of pediatric patients with CHA. However, no epidemiological study describe the global burden of DID attributable to CHA (DID-CHA).

Research Question:
What was the global burden, regional inequality, and age specific discrepancy of DID-CHA?

Goal:
The aim of this study is to address the gap of lacking epidemiological data of global burden, regional inequality, and age discrepancy of DID-CHA.

Methods:
This was a secondary analysis study by utilizing impairment data of GBD study 2021. Data was collected from the website of Institute for Health Metrics and Evaluation (IHME, query tool:
https://ghdx.healthdata.org/gbd-2021
). The prevalence, disability adjusted life years (DALYs), and their calculayted annual percentage changes (EAPC) across global, both sexes, seven regions, five SDI regions, and 204 countries and territories from 1990 to 2021 were investigated.

Results:
In 2021, the global number of DID-CHA cases was 1.05 million (95% UI: 0.83 to 1.24 million) with an age-standardized prevalence rates of 15.71 per 100,000 (95% UI: 12.36 to 18.58). From 1990 to 2021, the EAPC of prevalence was -0.15 (95% CI: -0.16 to -0.13). Regional inequality of disease burden of DID-CHA remained prevalent worldwide. Pediatric population, especially neonates and infants, had a more substatial disease burden of DID-CHA compared to adults aged over 20 years.

Conclusions:
This is the first study that thoroughly describe the global prevalence, regional inequality, and age discrepancy of the burden on DID-CHA, by utilizing the public data of GBD 2021. DID-CHD is believed to be a progressive issues for the whole-life management of CHD. Future efforts on resource allocation for neurodevelopmental disability in population with CHD should be comparable with the expenditure in reducing CHD mortality. Persistent regional socioeconomic disparities will definitely move to impact the discrepant burden of DID-CHA. Increasing socioeconomic resources aimed at improving DID-CHA outcomes should prioritize in neonate and infants with CHA, as they represent the most critically affected age groups.
Abstract 4140686: Comparison of Short-Term Outcomes after Lower Extremity Bypass versus Peripheral Vascular Intervention in Patients with Chronic Limb-Threatening Ischemia and Diabetes Mellitus
Authors: Aggarwal Abhinav , Romain Gaelle , Callegari Santiago , Cleman Jacob , Smolderen Kim , Mena-Hurtado Carlos
Published: November 2024

Background:
Comorbid diabetes mellitus (DM) is associated with worse outcomes in patients with chronic limb-threatening ischemia (CLTI). Both lower extremity bypass (LEB) and peripheral vascular interventions (PVI) have demonstrated improved outcomes in peripheral artery disease (PAD). However, comparative effectiveness data for LEB versus PVI in patients with CLTI and DM is limited.

Objective:
This study aimed to evaluate and compare 30-day and 90-day (1) all-cause mortality, and (2) major amputation rates among patients with CLTI and comorbid DM undergoing LEB versus PVI.

Methods:
Patients undergoing LEB and PVI were identified from the Vascular Quality Initiative registry, linked with Medicare claims outcomes data. Propensity scores were generated using 12 variables, and a 1:1 matching method was employed. The 30-day and 90-day mortality risks for LEB versus PVI were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models, incorporating interaction terms for DM. For amputation outcomes, cumulative incidence functions and Fine-Gray competing risks models were employed, with interaction terms for DM included.

Results:
Among 4,210 patients undergoing LEB or PVI (2,105 in each group), the mean age was 70.9 ± 10.9 years, with 69.3% being male and 76.4% white. DM was present in 62.3% (2,662 patients). In patients with DM, 30-day all-cause mortality rates were comparable between the LEB and PVI groups (2.1% vs. 2.6%; log-rank p-value=0.844). However, LEB was associated with significantly lower 90-day all-cause mortality rates compared to PVI (5.1% vs. 7.6%; log-rank p-value=0.013). Additionally, LEB was associated with a lower risk of 30-day major amputation rates compared to PVI (2.7% vs. 4.2%; p=0.049), though no significant difference was observed in 90-day major amputation rates (9.4% vs. 10.9%; p=0.196).

Conclusion:
Among patients with CLTI and comorbid DM, LEB was associated with a lower risk of 30-day major amputation rates and 90-day all-cause mortality compared to PVI. These findings provide contemporary insights into the management of CLTI in diabetic patients, supporting informed shared decision-making for those often considered high-risk for surgical intervention.
Abstract 4140711: Efficacy and Safety of Sodium-Glucose Co-transporter-2 Inhibitors in Acute Heart Failure: A Meta-Analysis of Randomized Controlled Trials
Authors: Sevella Prerana , Rallabhandi Sai Sri Harsha , Nugooru Sudeep , Ginnaram Shravya , Janga Chaitra , Amrutha Karanam , Watson Robert
Published: November 2024

Background:
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated benefits in chronic heart failure. Their efficacy in acute decompensated heart failure (ADHF) is not well established, warranting further investigation. This meta-analysis evaluates the impact of SGLT2i (empagliflozin, dapagliflozin, and sotagliflozin) on patients with ADHF.

Methods:
A systematic review and meta-analysis were conducted following PRISMA guidelines. Relevant studies were sourced from MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials up to May 2024. Six studies met the inclusion criteria: Cox et al. (2024), Abdelrahman et al. (2023), Voors et al. (2022), Ibrahim et al. (2020), Dammam et al. (2020), and Bhatt et al. (2020). Three studies used dapagliflozin, two used empagliflozin, and one used sotagliflozin. Outcomes included all-cause mortality, heart failure [HF] events, HF readmissions, and major adverse events. Data analysis was performed using Microsoft Excel and R/R Studio [Version 4.4.0]. A risk ratio (RR) with 95% confidence intervals (CI) was calculated using both fixed and random effects models to assess heterogeneity.

Results:
A total of 5-6 studies were included for each outcome, with total sample sizes ranging from 2146 to 2246 participants. For all-cause mortality, the fixed effect model indicated a significant reduction by 25% (RR = 0.750, 95% CI [0.570, 0.987]), whereas the random effects model did not (RR = 0.750, 95% CI [0.524, 1.072]), with low heterogeneity. SGLT2i significantly reduced heart failure events or exacerbations in both models with a 34% reduction (RR = 0.660, 95% CI [0.577, 0.755] for fixed effect and RR = 0.660, 95% CI [0.514, 0.848] for random effects), with very low heterogeneity. Heart failure readmissions showed a significant reduction in the fixed effect model (RR = 0.757, 95% CI [0.625, 0.917]) but not in the random effects model (RR = 0.765, 95% CI [0.484, 1.208]), with moderate heterogeneity. Major adverse events showed no significant reduction in either model.

Conclusion:
SGLT2i significantly reduces heart failure events and potential readmissions in ADHF patients. The impact on all-cause mortality and major adverse events is less clear. These findings support the use of SGLT2i in heart failure management, although further research is needed to confirm benefits and identify optimal patient subgroups. Low to moderate heterogeneity supports the robustness of the results across diverse populations.
Abstract 4140731: Trends, Outcomes and Predictors of Mortality in Patients with Myeloproliferative Neoplasms Undergoing Percutaneous Coronary Intervention: Insights from National Database
Authors: Ang Song Peng , Chia Jia Ee , Krittanawong Chayakrit , Misra Kanchan , Jaiswal Vikash , Song David , Usman Mohammed Haris , Piana Robert , Mukherjee Debabrata
Published: November 2024

Introduction:
Myeloproliferative neoplasms (MPN) are stem cell disorders that include include polycythemia vera (PV), essential thrombocythemia (ET), chronic myeloid leukemia (CML), primary myelofibrosis (PMF), chronic neutrophilic leukemia, and less well defined entities such as chronic eosinophilic leukemia. MPN are associated with an increased cardiovascular risk including acute coronary syndrome. However, there is a lack of comprehensive data regarding the rate of coronary revascularization, as well as the in-hospital characteristics and outcomes for MPN patients.

Objective:
We aimed to evaluate the temporal trends and outcomes of percutaneous coronary intervention (PCI) among patients with MPN.

Methods:
The National Inpatient Sample database from 2016 to 2020 was queried to identify all PCI hospitalizations. Temporal trends and outcomes of patients with and without MPN following PCI were described. Propensity score matching (PSM) was implemented to compare outcomes between MPN and non-MPN groups.

Results:
Our study included 2,237,210 PCI hospitalizations with 7,560 (0.27%) patients having MPN. Throughout the study period, the prevalence of MPN among PCI admissions remained stable (p-value for trend = 0.12). Within the MPN subgroup, ET was the predominant condition (53.2%), followed by PV (24.2%), CML (19.6%) and PMF (3.0%), with no significant temporal variation in the distribution of these subtypes. Patients with MPN had higher prevalence of cardiovascular comorbidities than non-MPN patients. Following propensity score matching, MPNs were significantly associated with an higher risk of blood transfusions (OR: 1.66, 95% CI: 1.22-2.24, p=0.001) and AKI (OR: 1.39, 95% CI: 1.17-1.65, p<0.001). In contrast, the risk of in-hospital mortality (OR: 1.18, 95% CI: 0.83-1.69, p=0.354 and bleeding (OR: 1.43, 95% CI: 0.90-2.27, p=0.127) did not significantly differ between the two groups.

Conclusion:
Our study demonstrated that while the prevalence of MPN among patients undergoing PCI remained stable, those with MPN faced higher risks of bleeding, blood transfusion and acute kidney injury. Further research is warranted to explore the underlying reasons for these increased risks and to improve outcomes in this high risk group.
Abstract 4140745: Efficacy and Safety of Impella, Venoarterial Extracorporeal Membrane Oxygenation, and Intra-aortic Balloon Pump in Acute Myocardial Infarction- related Cardiogenic Shock: A Systematic Review and Network Meta-Analysis
Authors: Al Hennawi Hussam , Sabri Muhammad , Khan Muhammad Khuzzaim , Bedi Angad , Jennifer Mazzoni Clifford
Published: November 2024

Introduction:
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is being increasingly utilized for cardiogenic shock (CS). We compare the outcomes of using isolated mechanical circulatory support (MCS) versus Impella or intra-aortic baloon pump (IABP) for left ventricular unloading (LVU) in the context of VA-ECMO.

Methods:
We searched for Impella, VA-ECMO, and IABP utilization in acute myocardial infarction (MI) related cardiogenic shock. Primary outcomes included 30-day and 12-month mortality rates, major bleeding, and limb ischemia. Secondary outcomes were occurrence of major adverse cardiovascular events (MACE) and stroke. Data analysis utilized frequentist network meta-analysis with random-effects models, calculating odds ratios (OR) and 95% confidence intervals (CI).

Results:
We identified 22 studies, including 4 randomized controlled trials (RCTs) and 18 observational studies, involving a total of 79,149 participants. The average follow-up duration for these studies was 11 months, and the mean age of the included patients was 63 years. Regarding the 30-day mortality rate, IABP alone demonstrated a significant reduction compared to Impella and VA-ECMO [OR 0.54, 95% CI 0.40 to 0.72]. On the other hand, Impella alone exhibited the lowest 12-month mortality rate [OR 0.66, 95% CI 0.51 to 0.85]. Regarding complications, IABP showed a significantly lower risk of major bleeding [OR 0.29, 95% CI 0.14 to 0.61] and limb ischemia [OR 0.14, 95% CI 0.04 to 0.47] when compared to VA-ECMO and Impella. However, no significant difference was observed in the occurrence of stroke and MACE between Impella and IABP. Furthermore, there was no significant difference in the 30-day or 12-month mortality rate when VA-ECMO was combined with IABP or Impella.

Conclusion:
Impella offers significant long-term survival benefits, while IABP excels in short-term survival outcomes and reduces bleeding and thrombotic events with no significant difference in stroke and MACE risk.
Abstract 4140763: A Case of Clozapine-Induced Myocarditis: An Under-described Side Effect
Authors: Ibrahim Rand , Clearo Kellie
Published: November 2024

Case Descripton:
A 34-year-old male with Schizophrenia was transferred from inpatient Psychiatry unit for chest tightness, fevers andtachycardia after testing positive for COVID-19. Further history revealed antipsychotics had been recently adjusted with the addition of Clozapine 1 month prior to presentation.

On presentation, he was febrile (39.1°C) and tachycardic to the 146 in sinus tachycardiac on EKG and Telemetry. He was euvolemic on exam with tachycardia but no murmurs or discernable friction rub.

Labs revealed no leukocytosis but an elevated C-reactive protein (CRP) 168mg/L, high-sensitivity troponin (474ng/L) and brain-natriuretic peptide (BNP, 176 pg/mL, no baseline value). Otherwise, TSH, ANA and RF were normal. Repeat Respiratory Viral Panel, respiratory biofire and blood cultures were unrevealing. Imaging (CXR and Chest CTA) were normal. TTE showed normal function and small pericardial effusion. Cardiac MRI was limited by inability to tolerate the scan but reported preserved biventricular function. The home facility was contacted and reported initial COVID testing was expired and invalid. Psychiatry was consulted for suspected clozapine-induced myocarditis and recommending holding Clozapine while resuming Risperdione.

The patient reported subjective improvement in symptoms and return to baseline. Feversdefervesced and tachycardiac resolved.

Discussion:
Rare (0.06%-3.88% reported incidence) and not well-described, Clozapine-induced myocarditis can be a challenging entity to identify. In the literature, it is defined as having elevated CRP or detectable troponin and at least 1 sign or symptom of myocarditis, in the absence of alternative plausible etiologies. Symtoms typically onset between 1-4 weeks of medication initiation. Mortality can range between 10-30%. The acute history of symptoms, elevation in CRP and troponin shortly after medication initiation suggested a diagnosis of clozapine-induced myocarditis. The absence of reduction in systolic function and indeterminant MRI are nocompelling against clozapine-induced myocarditis in lieu of other more plausible diagnoses. Early cessation and symtpomatic managemnt is standard therapy.

Conclusion:
Clozapine-induced Myocarditis is an entity not well-described but carries a significant mortality risk. Perhaps cardiac-monitoring guidelines must be implemented in addition to the currently adopted montiroing for agranylocytosis with clozapine.
Abstract 4140781: Impact of Tricuspid Regurgitation on In-hospital Mortality in Patients with Heart Failure – United States Population-Based Survey Analysis
Authors: Yousuf Muhammad , Fatima Noor , Almani Muhammad Usman
Published: November 2024

Background:
Tricuspid regurgitation (TR) is a common occurrence in patients with heart failure (HF), and its role in disease progression has gained attention in recent years. While TR can worsen the clinical outcomes in HF patients, its impact on gender, racial and socioeconomic factors remains largely unexplored. With growing evidence supporting the role of percutaneous interventions for the treatment of significant TR, understanding these disparities is more crucial than ever.

Methods:
Data was extracted from the National Inpatient Sample 2016 - 2020 Database. We used ICD-10 code I50 to identify the patients primarily admitted for HF and subdivided the cohort into two groups based on presence or absence of TR using the ICD-10 codes I36.1 and I07.1. We performed multivariable Logistic regression analysis to determine odds of in-hospital mortality in HF patients with and without TR. Subgroup analyses were performed based on (1) gender, (2) age, (3) race, (4) insurance status, (5) location and teaching status of admitting hospital, and (6) patients’ household neighborhood income quartile. All the analyses were adjusted for age, gender, insurance status, Charlson co-morbidity index (CCI) and hospital characteristics. STATA 16 software was used for analysis.

Results:
Mean age of HF patients with TR was 71.3 years, mean CCI was 3.4 and 55.8% were women. In-contrast, mean age of HF patients without TR was 70.7 years, mean CCI was 3.5 and 47.5% were women. Among 1,365,529 HF patients, 41177 (3.15%) patients without TR and 1965 (3.37%) patients with TR died during the hospitalization. There was no difference in overall in-hospital mortality of HF patients with and without TR (OR: 1.04, 95% CI 0.94 – 1.16, p = 0.442). However, in subgroup analysis African Americans (OR: 1.70, 95% CI 1.31 – 2.19, p < 0.001), patients with Medicaid insurance (OR: 1.96, 95% CI 1.43 – 2.68, p < 0.001) and patients belonging to the lowest neighborhood income quartile (OR: 1.29, 95% CI 1.07 – 1.55, p = 0.008) had higher risk of in-hospital mortality as shown in
Figure 1.

Conclusion:
In our population-based survey analysis, we observed significant racial and socioeconomic disparities in clinical outcomes of HF patients with TR compared to those without TR. Among HF patients with TR, African Americans, patients with Medicaid insurance and patients belonging to lowest neighborhood income quartile had higher risk of in-hospital mortality compared to those without TR.
Abstract 4140798: Genome-Wide Association Studies (GWAS) of Angiotensinogen Levels in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Lidani Karita , Tomar Shubham , Mousavi Hossein , Buscaglia Robert , Landry Alexander , Michael Kirolos , Dupuis Leonie , Michos Erin , Morgan Erin , Guo Xiuqing , Rotter Jerome , Tsimikas Sotirios , Trainor Patrick , DeFilippis Andrew
Published: November 2024

Background:
The renin angiotensin aldosterone system (RAAS) is crucial for circulatory homeostasis and multiple cardiovascular diseases. Despite research on key RAAS components, resulting in multiple therapeutics, the role of angiotensinogen, the sole substrate, remains less understood. We sought to elucidate the relationship between circulating angiotensinogen levels and single nucleotide polymorphisms (SNPs) in a multi-ethnic cohort study.

Methods:
Genome-wide association analyses of plasma angiotensinogen levels were conducted in 4,899 MESA participants (self-identified as White, n=1,868; Hispanic, n=1,115; Black, n=1,283; and Chinese, n=633). Plasma angiotensinogen levels were measured at the baseline using an enzyme-linked immunoassay. Linear models were adjusted for age, sex, comorbidities, and sex hormones, along with top principal components to account for population structure. Furthermore, we conducted conditional analysis identifying SNPs meeting genome-wide significance for population-specific associations conditioned on the lead SNP in each race/ethnicity.

Results:
We identified 115 SNPs associated with angiotensinogen levels (p< 5×10
−8
), including the lead SNP rs4762 (Thr174Met) in exon 2 (β=-0.159, p=1.51E
-100
) and SNP rs5050 (A-20C) in the promoter region (β=-0.109, p=2.26E
-69
) within the
AGT
gene. Strong Linkage Disequilibrium [LD (r
2
>0.8)] was observed between rs4762 and rs35837081 for White, Black, and Hispanic ethnicities. Conversely, this level of LD was noted between rs4762 and rs3789657 specifically within Chinese. The LD between rs4762 and rs5050 was higher for White (r
2
=0.65), followed by Chinese (r
2
=0.56), Hispanic (r
2
=0.55), and Black (r
2
=0.29). Conditioned on rs4762 in the White population, we identified four secondary signals associated with angiotensinogen including rs2493151 (β=0.053, p=4.08E
-9
), implicated in transcription factor binding. Measured angiotensinogen levels were 9.7%, 12.8%, and 17.3% lower in Black, Hispanic, and Chinese, respectively, compared to White participants.

Conclusions:
These findings extend angiotensinogen research, highlighting the SNPs rs4762 and rs5050 as the key variants associated with angiotensinogen levels, both previously linked to hypertension.
Abstract 4140803: Vasomotion in human arteries and its ion channelbased on regulations: 10 years study
Authors: Young Chul kim
Published: November 2024

Vasomotion is the oscillation of vascular tone which gives rise to flow motion of blood into an organ. As is well known, spontaneous contractile organs such as heart, GI, and genitourinary tract produce rhythmic contraction. It imposes or removes pressure on their vessels alternatively for exchange of many substances. It was first described over 150 years ago, however the physiological mechanism and pathophysiological implications are not well understood. This study aimed to elucidate underlying mechanisms and physiological function of vasomotion in human arteries. Conventional contractile force measurement, immunohistochemistry, and Western blotting were employed to study human left gastric artery (HLGA) and uterine arteries (HUA). RESULTS: Circular muscle of HLGA and/or HUA produced sustained tonic contraction by high K
+
(50mM) which was blocked by 2µM nifedipine. Stepwise stretch and high K produced nerve-independent spontaneous contraction (vasomotion) (around 45 % of tested tissues). Vasomotion was also produced by application of Bayk 8644, 5-HT, prostagrandins, oxytocin. It was blocked by nifedipine (2µM) and blockers of intracellular Ca
2+
stores. Inhibitors of Ca
2+
-activated Cl
-
channels (DIDS and/or niflumic acid) and ATP-sensitive K
+
(K
ATP
) channels inhibited vasomotion reversibly. Metabolic inhibition by sodium cyanide (NaCN) and several neuropeptides also regulated vasomotion in K
ATP
channel-sensitive and -insensitive manner. In Next step, we identified TMEM16A Ca
2+
-activated Cl
-
channels and subunits of K
ATP
channels (Kir 6.1/6.2 and sulfonylurea receptor 2B (SUR2B)), and c-
Kit
positivity by Western blot. Fianally, we also foud regulation of vasomotion by other second messengers in HLGA and muscle specific events too. We conclude that vasomotion is sensitive to TMEM16A Ca
2+
-activated Cl
-
channels and metabolic changes in human gastric and uterine arteries. Vasomotion might play an important role in the regulation of microcirculation dynamics even in pacemaker-related autonomic contractile organs in humans.
Abstract 4140868: Perceptions about Diversity, Equity, and Inclusion among Cardiovascular Fellows-in-Training
Authors: Duqueney Estherland , DeFilippis Ersilia , Goyal Amit , Kaur Gurleen , Julien Howard , Eberly Lauren
Published: November 2024

Background:
Efforts to promote diversity, equity, and inclusion (DEI) within cardiology have been proposed and implemented to varying degrees. However, the perceptions of cardiovascular (CV) fellows-in-training (FIT) have not been characterized. Therefore, we sought to gauge the experiences of CV FIT at their institutions and the extent to which DEI is valued and embraced as a core mission.

Methods:
We conducted a nationwide survey of CV FIT from May to June 2021, utilizing the CardioNerds platform to recruit participants. The 25-question survey assessed FIT perceptions of diversity, institutional prioritization of DEI efforts, and the commitment to anti-racism as part of the fellowship curriculum on a Likert scale from 1 to 5, supplemented by open-ended questions with free-text responses. The authors reviewed narrative comments to identify common themes.

Results:
A total of 101 fellows-in-training (39.2% female, 37.6% as Asian, 13% as Black, 9% as Hispanic/Latinx; and 36% as international medical graduates) responded to our survey. The majority (67%) of respondents believed that health equity was valued by their program, and most (65%) considered diversity and health equity as priorities of their programs. While 58% of all respondents felt there were physicians in leadership positions who looked like them, 92% of Black FIT disagreed. Respondents highlighted strengths of their institutions including a diverse existing workforce and institutional commitment to DEI. However, suggestions for improvement focused on formal equity training, community outreach opportunities, and recruitment of underrepresented in medicine faculty in leadership positions.

Conclusion:
CV FIT recognize that DEI is valued by their institutions and training programs, but persistent challenges remain. Black CV FIT did not feel adequately represented in leadership, highlighting a need for more Black representation in faculty leadership. FIT desire formal cardiovascular equity training and community outreach opportunities, indicating a need for standardized health equity and antiracist curricula in cardiology programs.
Abstract 4140882: Peak Stroke Incidence Following Left Atrial Appendage Closure
Authors: Weaver Chayce
Published: November 2024

Introduction:
Atrial fibrillation (A fib) is the most common arrhythmia affecting 1-2% of the general population. A fib is a well-established risk factor for ischemic strokes. In patients with nonvalvular A fib, the majority of embolic strokes are caused by thrombi development in the left atrial appendage. Systemic anticoagulation (AC) is effective in reducing stroke risk in patients with A fib. However, bleeding complications and medication nonadherence are barriers to effective AC. In these patients, left atrial appendage occlusion (LAAO) act as a form of nonpharmacologic treatment.

Methods:
We completed a retrospective descriptive study evaluating patients with a fib undergoing either open left atrial appendage closure or percutaneous occlusion. Patients were selected from the HCA database (Jan 2021-Jul 2023). ICD 10 codes were used to identify patients with documented a fib. Procedure ICD codes were used to identify patients that underwent percutaneous LAAO. Patients with documented STEMI, left ventricular thrombus, mechanical mitral or aortic valve replacement were excluded. 5,661 underwent percutaneous closure. Stroke readmissions were evaluated at 45, 90, and 180 days. Chi-square was used to evaluate for statistically significant differences.

Results:
Of the 5,661 patients 40 developed a stroke within 45 days, 38 within 90 days, and 26 within 180 days (P=.19) The average patient age was 76.1 years with STD 7.86. There were 2438 females and 3223 males.

Discussion:
Stroke occurrence was similar by day 90 as day 45. There was no statistical difference in stroke by day 180; however, the trend suggests a larger drop off in stroke readmission rates after day 90. Perhaps with a larger study, a significant effect may be detected. Currently AC is only recommended for 60 days post procedure. With clinical significance, future studies may be warranted to evaluate bleeding incidence during post procedure AC and the utility of extending therapy to 90 days.
Abstract 4140889: Preclinical study of human induced pluripotent stem cell-derived endothelial cells for peripheral artery disease
Authors: Lee Shin-Jeong , Oh Jee Eun , Kim Yonghak , Sohn Dongchan , Jung Cholomi , Kim Sangsung , Bae Jung Yoon , Kim Hyun Ok , Choi Donghoon , Yoon Young-sup
Published: November 2024

Background:
Peripheral artery disease (PAD) affects approximately 230 million people globally and chronic limb-threatening ischemia (CLTI) can lead to limb amputation. Human induced pluripotent stem cell-derived endothelial cells (hiPSC-ECs) offer a promising source for PAD treatment. However, to date, regulatory criteria for the clinical application of hiPSC-ECs have not been established yet, and there have been no reports on preclinical studies involving hiPSC-ECs. This study aims to address this gap by investigating the feasibility, safety, and efficacy of clinical-grade hiPSC-ECs through a preclinical proof-of-concept analysis.

Methods and Results:
Clinical-grade hiPSC lines were established from the blood of three PAD patients using episomal plasmids. Their pluripotency was confirmed by assessing their expression of pluripotency markers through qRT-PCR and immunostaining, as well as their pluripotency in a teratoma assay. Furthermore, PAD-hiPSCs exhibited normal karyotypes. Subsequently, we differentiated PAD-hiPSCs into ECs, all of which displayed a cobble-stone EC morphology and expressed EC markers as confirmed by qRT-PCR and immunostaining. PAD-hiPSC-derived ECs also expressed CDH5 at a minimum of 98.4 ± 0.2% and VWF at 94.4 ± 1.3% by flow cytometry. PAD-hiPSC-ECs maintained their normal karyotypes and copy number variation across the genome, as determined by CGH array. Additionally, they exhibited endothelial characteristics such as tube formation in Matrigel and intracellular nitric oxide production. Administration of PAD-hiPSC-ECs into ischemic hindlimbs of both female and male mice led to improved blood flow recovery (~3.3 fold), reduced risk of limb loss (~8.8 ± 0.6%), and increased vascular density (~2.7 fold) compared to control groups. These engrafted hiPSC-ECs exhibited vessel-forming capacities, thereby contributing to neovascularization. More importantly, we evaluated the toxicity, biodistribution, and tumorigenic potential of these cells in immunodeficient nude mice over one year. The results demonstrated non-detection of tumorigenic cells in twelve organs and adverse events. With all the data, the use of hiPSC-ECs was approved for a clinical trial to treat PAD.

Conclusions:
Our preclinical proof-of-concept findings demonstrate, for the first time, the clinical compatibility of hiPSC-ECs derived from patients for autologous cell therapy for PAD. Our study further suggests regulatory guidance for the clinical development of hiPSC-ECs.
Abstract 4140908: ST Elevation Myocardial Infarction in the Setting of Severe Ectasia and Aneurysm of the Left Anterior Descending Coronary Artery.
Authors: Ugwendum Derek , Atere Muhammed , Arrey Agbor Divine B , Tindoy Merschelle , Farid Meena , Aboah Taylor Akua , Upadhya Gautham , Rotatori Francesco , Galligan Sean , Castillo Ricardo , Grodman Richard
Published: November 2024

Background:
Coronary artery aneurysm seen in patients undergoing coronary angiography is an uncommon disorder with poorly understood pathophysiology. Patients have variable clinical presentations and often poor long-term outcomes. Management of these patients still pose a clinical dilemma given there are no standardized treatment guidelines

Description of case and discussion:
A 44-year-old male with a significant past medical history of hypertension, diabetes mellitus, and hyperlipidemia presented in the emergency room (ER) for acute onset chest pain. His pain was retro-sternal, non-radiating, and pressure-like in nature. Pain was initially rated as 2/10 intensity which progressed to 9/10 later in the day with associated diaphoresis. He took acetaminophen which provided no relief. His electrocardiogram (EKG) showed ST elevation in the inferior and lateral leads. Initial troponin was negative. The cardiac catheterization laboratory was activated and the patient was administered loading doses of Aspirin, ticagrelor and a bolus of intravenous (IV) heparin.

An emergent left heart catheterization and coronary angiogram was performed which revealed a 100% thrombotic occlusion of the mid LAD as well as severe ectasia of the proximal vessel. There was mild ectasia of the left circumflex and right coronary arteries without any significant stenosis. There were no collaterals to the distal LAD consistent with an acute presentation. At the level of the occlusion (mid LAD), there was an aneurysm measuring up to 10 mm in diameter by angiography. Intravenous eptifibatide was administered with the continuation of IV heparin. The thrombotic occlusion was managed medically with a plan to repeat angiography in 24-48 hours. Transthoracic echocardiography revealed a preserved left ejection fraction at about 55-60% with mild hypokinesis of the apex. Repeated angiography in 48 hours revealed a mostly patent LAD with diffuse TIMI 2 flow and sub occluded distal LAD at the apex. He was discharged home with dual antiplatelet therapy, a statin, and a beta blocker. Two weeks later he was seen on outpatient setting and his medications were transitioned to Rivaroxaban and clopidogrel

Conclusion:
Large LAD aneurysms are not common and they carry long term complications which includes thrombosis (as seen in our patient), fistula formation, and rupture. Management of this condition is still challenging as there are no standardized management guidelines.
Abstract 4140910: New-onset Atrial Fibrillation and Associated Long-Term Cardiovascular Morbidity and Mortality in Patients with Type 2 Diabetes Mellitus; A Meta-analysis of 16 million patients.
Authors: Shrestha Abhigan , Afroze Tanzina , Jaiswal Vikash , Edara Ravi Sankar Reddy , Goyal Aman , Kadariya Suman , Basnyat Soney
Published: November 2024

Background:
Patients with type 2 diabetes mellitus (T2DM) often develop atrial fibrillation. Nevertheless, its incidence and long-term cardiovascular outcomes in newly diagnosed atrial fibrillation in patients with T2DM are still unclear.

Hypothesis:
We aim to investigate the association between new-onset AF and the risks of atherosclerotic cardiovascular disease (ASCVD); heart failure (HF), stroke, and all-cause mortality among patients with T2DM.

Methods:
A systematic search was conducted using multiple electronic databases from inception until March 2024 using the appropriate Mesh terms, “atrial fibrillation,” “diabetes mellitus,” “stroke,” “heart failure,” and “all-cause mortality.” We used the random effect model to calculate the pooled relative risk and their corresponding confidence interval. A p-value of <0.05 was considered statistically significant.

Results:
A meta-analysis was piloted using 12 studies. Of these, 10 studies studied DM patients versus non-diabetic (6442051 versus 9572901), and two studies compared atrial fibrillation versus non-atrial fibrillation in DM patients (1521 versus 17560) with a mean follow-up of 9.9 years. Pooled analysis showed that patients with T2DM are more likely to develop AF compared to nondiabetic patients (OR: 1.41, 95%CI: 1.18-1.64, p<0.001). Furthermore, patients with type 2 DM with new-onset atrial fibrillation have an increased of developing HF (OR 3.67, 95% CI 3.07-4.27, p<0.001), stroke (OR 1.79, 95% CI 1.40-2.18, p<0.001), and all-cause mortality (OR 1.70, 95% 1.42-1.98, p<0.001).

Conclusion:
This study reveals that patients with type 2 DM are at increased risk of developing atrial fibrillation compared to nondiabetic patients. Long-term cardiovascular morbidity, such as heart failure, stroke, and all-cause mortality, are also high in patients with type 2 DM with new-onset atrial fibrillation.
Abstract 4140936: Global, Regional, and National Trends in Atrial Fibrillation/Flutter Among Overweight and Obese Individuals: A Comparative Analysis of Gender, Age, and Risk Factors (1990-2019)
Authors: Xiao Yichao , Kang Yujie , Lan Zehao , Lv Zhaohua , Liu Qiming , Zhou Shenghua
Published: November 2024

Background:
Atrial fibrillation/flutter (AF/AFL) significantly contributes to global cardiac morbidity and mortality. Understanding its epidemiological trends is crucial for devising effective health interventions.

Objective:
This study aimed to elucidate the global burden of AF/AFL among overweight and obese individuals from 1990 to 2019, exploring variations in mortality, disability-adjusted life years (DALYs), and risk factor prevalence across 204 countries, as per the Global Burden of Disease Study 2019 (GBD 2019).

Methods:
Utilizing GBD 2019 data, this observational study assessed age-standardized mortality and DALY rates for AF/AFL. The analysis emphasized demographic variations (age, sex), socioeconomic disparities (as indexed by the sociodemographic index, SDI), and major modifiable risk factors such as hypertension, obesity, and lifestyle choices.

Results:
This study revealed a significant global increase in AF/AFL-related mortality, exceeding 63,000 deaths in 2019—an increase of 2.42% since 1990. DALYs exhibited a parallel upward trajectory. Notably, the AF/AFL burden increase was more pronounced in regions with lower SDIs, indicating marked health outcome disparities. A high body mass index (BMI) was identified as a predominant modifiable risk factor, highlighting the increasing impact of lifestyle-related health challenges. Moreover, mortality rate disparities were evident across different sex and age groups, with the highest rates among women and individuals aged 85-89 years.

Conclusion:
The increasing global burden of AF/AFL, especially associated with higher BMI, necessitates immediate public health interventions. These findings underscore the urgency for targeted preventive strategies focusing on lifestyle modifications and enhanced healthcare access, particularly in lower-SDI regions and among vulnerable populations.
Abstract 4140963: Major Adverse Cardiovascular Events in Patients with Chronic Atrial and Intestinal Dysrhythmia Syndrome: A Nationwide Analysis
Authors: Perry Jamal , Balaji Adarsh , Sinclair Sherlon , Ozbay Mustafa , poluyi Charles , Duodu Esther , Ukenenye Emmanuel , Akinti Oluwasegun , Nevolina Anna , Aiwuyo Henry , Gunsburg Moshe
Published: November 2024

Introduction:
Chronic Atrial and Intestinal Dysrhythmia Syndrome (CAIDS) is a rare but intriguing pathology caused by simultaneous arrhythmias impacting both the cardiovascular and gastrointestinal systems. Due to the rarity of the condition, the research remains largely unexplored. As such, the primary focus of this study is to unravel cardiovascular risk within this syndrome.

Hypothesis:
Patients hospitalized with CAIDS experience a high burden of major adverse cardiovascular events (MACE).

Aim:
While there is no well-understood etiology for this condition, We aim to analyze data on MACE in patients with CAID to gain insight into their cardiovascular risk.

Methods:
We queried the National Inpatient Sample (NIS) between 2016 and 2020, searching for adult patients hospitalized for CAIDS using ICD-10 codes. The primary outcomes were MACE and inpatient mortality. Propensity scores were used to match patients with CAIDS who experienced MACE and those who did not. Multivariate and univariate logistic regressions were applied for outcomes, adjusting for age and gender. A p-value of <0.05 was considered significant. Stata 18 was used for analysis.

Results:
The mean age of the cohort experiencing CAIDS was 76.42 years (95% CI: 75.30-77.54), with a slightly higher proportion of males (63.64%) compared to females (36.36%). The average length of stay for patients with CAIDS was 8.37 days (95% CI: 7.60-9.14).

The in-hospital mortality rate for patients with CAIDS was 3.39% (OR 1.02, p = 0.965, 95% CI: 0.51-2.00). Additionally, 3.12% of patients with CAIDS experienced cardiac arrest (OR 3.87, p < 0.001, 95% CI: 1.87-7.99). STEMI was observed in 1.30% of patients with CAIDS (OR 2.65, p = 0.068, 95% CI: 0.93-7.54). Cardiogenic shock was present in 0.52% of patients with CAIDS (OR 12.66, p < 0.05, 95% CI: 1.14-139.94). Heart failure occurred in 36.88% of patients with CAIDS (OR 4.16, p < 0.001, 95% CI: 3.09-5.60), and stroke was present in 10.65% (OR 2.89, p < 0.001, 95% CI: 1.96-4.26). Dilated Cardiomyopathy occurred in 5.2% (OR 5.7, p < 0.001, 95% CI: 3.06 -10.68)

Conclusion:
Patients with CAIDS face significant risks, with elevated rates of MACE such as cardiac arrest, cardiogenic shock, dilated cardiomyopathy, heart failure, and stroke, although STEMI and in-hospital mortality were not statistically significant.This underscores the critical importance of vigilance in monitoring and managing these patients to mitigate such outcomes.
Abstract 4140970: Association Between Prescription Fill Rates and Adverse Outcomes within an mHealth Clinical Trial Designed to Improve Medication Adherence
Authors: Asmuth Mallette , Hosokawa Patrick , Allen Larry , Peterson Pamela , Plomondon Mary , Caputo Sandy Lisa , Vaughn Shawni , Waughtal Joy , Marrs Joel , Orlando Steven , Saseen Joseph , Blankenhorn Richard , Bull Sheana , Ho Michael
Published: November 2024

Background:
Medication nonadherence is associated with adverse outcomes in observational studies. However, whether that association persists in a clinical trial designed to improve adherence is uncertain.

Question:
We describe factors associated with low adherence among patients enrolled in a mHealth intervention utilizing text messages to improve cardiovascular (CV) medication refills. The relationship between adherence and adverse outcomes was then assessed.

Methods:
The NUDGE study was a pragmatic clinical trial randomizing patients to usual care versus different types of text messages (generic, behavioral nudge, behavioral nudge plus an AI chatbot) to improve refill rates when patients had a 7-day delay in a CV medication refill. For the current analysis, the primary exposure of low adherence was determined from pharmacy data and was defined as a proportion of days covered by medication (PDC, as calculated by prescription fill data) ≤0.80 in the first 3 months after enrollment. Adverse outcomes were defined as time to emergency department visit, hospitalization or death. The association between low adherence and adverse outcomes was evaluated using Cox proportional hazards models.

Results:
Of the 9268 patients enrolled in the study with prescription fill data, the median PDC was 0.74 (0.19-0.96, 25%-75% percentile). Patients with low adherence comprised 53.5% of the cohort. In this clinical trial, all 3 text messaging intervention arms increased refill adherence at similar rates (~5%) at 3-months compared to usual care. In multivariable analyses, low adherence in the first 3 months was associated with adverse outcomes (HR 1.13; 95% CI 1.06-1.19) regardless of study arm enrollment.

Conclusion:
Among patients enrolled in a randomized clinical trial to improve medication refill adherence, low adherence remains common and was associated with adverse outcomes. While this mHealth intervention increased CV medication refills, additional solutions are needed to improve medication adherence.
Abstract 4140983: LVEF by echocardiogram does not correlate with findings on advanced cardiac imaging in cardiac sarcoidosis patients
Authors: Feldhus Konner , Barkes Briana , Maier Lisa , Swigris Jeffrey , Sung Raphael
Published: November 2024

Background:
Sarcoidosis is a systemic non-caseating granulomatous disease that can involve numerous organs, classically lung and lymph node. Patients with cardiac involvement typically have poorer outcomes, with left ventricular ejection fraction (LVEF) predicting mortality. There is little contemporary data evaluating the relationship of baseline LVEF at time of active cardiac sarcoidosis (CS) involvement or change in LVEF over time in patients with abnormal cardiac positron emission tomography (CPET) or cardiac magnetic resonance (CMR).

Hypothesis:
Abnormal CPET or CMR findings suggestive of CS will be associated with concurrently lower LVEF, as well as progressive decline in LVEF over long-term follow-up in those with CS.

Methods:
At a major sarcoidosis referral center, a retrospective analysis was performed on 1,901 biopsy-proven sarcoidosis patients and 358 probable CS patients by 2014 HRS Expert Consensus on Diagnosis. All echocardiograms, CPET, and CMR data were compiled. LVEF at time of positive and negative CMR and CPET within 6 months of each other, as well as LVEF change on long-term follow-up were analyzed by t-test and Tukey’s Studentized Range Test.

Results:
CPET and CMR positive findings did not correlate with lower LVEF at time of abnormal findings. Over an average of 4.98 years (range 0.25 to 11.68 years), LVEF by echocardiogram did not significantly change in patients with positive, negative, or discordant CPET/CMR imaging.

Conclusions:
Structural abnormalities by echocardiogram do not correlate with positive or negative CPET/CMR and are of little utility in early detection of cardiac sarcoidosis. These data suggest that combined CPET/CMR protocols increase the sensitivity of identifying early cardiac involvement of sarcoidosis. A normal echocardiogram should not be reassuring to the clinician against possible cardiac involvement of sarcoidosis.
Abstract 4141008: A Rare Case of Epicardial Cavernous Hemangioma with Coexisting Severe Mitral Regurgitation
Authors: Abdallah Ala , Sutton Jenna , Houshmand Nazanin , Gupta Neelesh , Ahsan Chowdhury
Published: November 2024

Background:
Primary cardiac tumors are rare, occurring in 0.001% - 0.03% of the general population, most discovered at autopsy. Approximately 75% of these tumors are benign, of which 2% represent cardiac hemangiomas. While most cardiac tumors are silent, devastating clinical symptoms have been documented including cardiac tamponade, arrhythmia, stroke and death. Such presentations may manifest at any age and are related to the tumor’s size and location.

Case Description:
A 68-year-old male with a history of OSA was referred to cardiology by his primary care provider after an incidental finding of left ventricular hypertrophy on EKG. Examination was significant for a grade III late systolic murmur. Echocardiography revealed severe mitral regurgitation, mitral valve (MV) prolapse and an epicardial mass suggestive of a tumor. Cardiac CT demonstrated an epicardial tumor of the left atrial appendage, uplifting the left main coronary artery, displacing the proximal LAD and first diagonal branch (Diag)

(figure 1).

Cardiac catheterization ruled out significant CAD, but identified tumor blush from the Diag

(Figure 2a).

Surgical intervention, including MV repair, was successful. Resection of the mass required extrication from the Diag, the proximal LAD and 1st septal branches, which was performed without compromise of coronary vessels. Pathology confirmed a diagnosis of epicardial cavernous hemangioma

(Figure 2b).

Patient is doing well 1 year post intervention.

Discussion:
This case illustrates the diagnostic and therapeutic challenges of primary cardiac tumors. As with our patient, cardiac tumors are often found incidentally. However, surgical resection is recommended as the consequences of tumor growth and/or invasion into surrounding structures is unpredictable and poses a significant morbidity and mortality risk. Comprehensive imaging and an interdisciplinary collaboration between medical and surgical personnel is essential for timely diagnosis and appropriate treatment planning.