bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4116285: Safety and Efficacy of Early Direct Oral Anticoagulants Versus Low Molecular Weight Heparin in Patients with Ischemic Stroke and Immobility: A Multi-National Database Study
Authors: Chang Kyle , Nareddy Suhas , Hambach Bryce , Prucnal Christiana , Hernandez Elvin , Sovory Lisa
Published: November 2024

Background:
Low molecular weight heparin (LMWH) is the preferred anticoagulant for venous thromboembolism (VTE) prophylaxis in patients with ischemic stroke and reduced mobility. However, some patients may have indications for early direct oral anticoagulants (DOACs) and are continued on this therapy rather than transitioning to LMWH. Whether outcomes differ between these groups is unknown. We compared the safety and efficacy of early DOACs versus LMWH from a large retrospective database.

Methods:
Patients within the TriNetX Research Network receiving either DOACs or LMWH within 72 hours of ischemic stroke and a Modified Rankin Scale of 4-5 were included. A 1:1 propensity score matching analysis was performed using 27 covariables including demographic information, comorbidities, and medications. Chi-square and independent
t
-tests were used in bivariable analyses. Outcomes were all-cause mortality, VTE, intracranial and extracranial hemorrhage at 30 and 90 days.

Results:
Of 5,492 propensity-matched patients, mean age was 73±13, and 43% were male. Mortality in the DOAC group was significantly lower than in the LMWH group at 30 days (RR=0.59, 95% CI: 0.51-0.69) and 90 days (RR=0.63, 95% CI: 0.56-0.71). Risk of VTE was not significantly different at 30 days (RR=0.80, 95% CI: 0.43-1.50) or 90 days (RR=0.74, 95% CI: 0.45-1.22). Risk of intracranial hemorrhage was not significantly different at 30 days (RR=0.81, 95% CI: 0.36-1.80) or 90 days (RR=0.62, 95% CI: 0.34-1.15).

Conclusions:
In patients with acute ischemic stroke and reduced mobility, early use of DOACs was associated with lower mortality compared to early use of LMWH.
Abstract 4116410: A Novel Deep Learning Approach for Prediction of Right Heart Failure After Left Ventricular Assist Device Implantation using Pulmonary Artery Pressure Tracings
Authors: Lamicq Melissa , Buchanan Cole , Lateef Azalfa , Atteya Miriam , Houston Brian , Tedford Ryan , Wehbe Ramsey
Published: November 2024

Introduction:
Left ventricular assist device (LVAD) offers a lifeline for advanced heart failure patients, but ~30% experience post-operative right heart failure (RHF) with significant morbidity and mortality. Current methods for predicting RHF risk have limited accuracy. This study is the first of its kind to explore the feasibility of using a convolutional neural network (CNN) deep learning model with pulmonary artery pressure (PAP) tracings acquired during pre-operative hemodynamic assessment to identify patients at risk for early RHF.

Methods:
A CNN model was pre-trained on PAP tracings from the MIMIC-III Waveform Database to leverage transferable knowledge and improve model performance. The model learned general features and temporal relationships in hemodynamic tracing morphology for RHF prediction. It was then adapted for classification by modifying the output layers. Post-LVAD RHF was definitively adjudicated for each instance included from our 246 patient single center LVAD database. RHF was adjudicated using the 2020 Academic Research Consortium defintion. The database included 205 non-RHF instances and 41 RHF instances. We developed a novel signal processing method utilizing computer vision to extract PAP waveform data from pre-operative right heart catheterization reports. Data was reviewed to ensure accurate pressure tracing representation. SMOTE-ENN (synthetic oversampling) and class weighting addressed dataset imbalance during training to enhance model generalizability and RHF prediction accuracy.

Results:
The model achieved strong performance in classifying RHF from non-RHF outcomes, as evidenced by consistent AUC scores of 0.87 and 0.85 on validation and unseen test data, respectively. These findings indicate the potential for hemodynamic tracings to predict RHF after LVAD implantation. Notably, the model maintained its performance on unseen data, highlighting its generalizability.

Conclusions:
This study explored the feasibility of using a deep learning model for RHF risk stratification in patients with LVADs. The model, pre-trained on PAP tracings, achieved promising classification performance assessed by AUC. Further validation with larger, more diverse datasets will refine model performance and enhance generalizability for clinical application. Leveraging hemodynamic tracings within a deep learning framework holds promise for improved clinical outcome prediction.
Abstract 4116425: " Navigating High-Risk Terrain: Clinical Outcomes of Percutaneous Coronary Intervention (PCI) in Breast Cancer Patients - A National Inpatient Sample Analysis "
Authors: Kavarthapu Anusha , Tantry Bhuvana , Patel Nishant , Kamani Prahasith , Sekandlapuram Rohit , Upadhya Gautham , Rotatori Francesco
Published: November 2024

Background:
Breast cancer is the most prevalent malignancy affecting women globally and is one of the leading causes of cancer-related deaths. Cardiovascular disease (CVD) holds the highest mortality rate among women. However, the prognosis of percutaneous coronary intervention (PCI) patients with underlying breast cancer has not been well-studied.

Methods:
The National Inpatient Sample (NIS) 2017-2020 database was used to identify PCI patients with ICD-10 codes for a retrospective analysis. PCI patients were then divided into those with and without underlying breast cancer. Multivariable logistic regression was performed for composite post-PCI outcomes analyses.

Results:
Among 2,815,610 patients admitted for PCI, 3,935 had breast cancer. Patients with underlying breast cancer experienced worse post-PCI outcomes, including a higher risk of major bleeding (OR, 3.7; 95% CI, 2.9 - 4.8; P < .001) and post-PCI cardiac arrest (OR, 8.003; 95% CI, 5.39 - 11.8). The need for devices such as Impella and IABP was also higher in the breast cancer subpopulation compared to those without (OR, 6.8; 95% CI, 5.7 - 8.0) and (OR, 8.4; 95% CI, 7.44 - 9.668), respectively. Although the incidence of stroke was higher in the subpopulation, intra/post-PCI stroke was lower.

Breast cancer patients undergoing PCI showed no significant difference in hospitalization charges or length of stay.

Conclusions:
In conclusion, our study sheds light on the intricate relationship between breast cancer and percutaneous coronary intervention (PCI) outcomes. These findings underscore the importance of tailored care and close monitoring for breast cancer patients undergoing PCI.
Abstract 4116975: Safety signals with SGLT2 inhibitor use in diabetic males with erythrocytosis, but not in females: Findings from the CANVAS Program and CREDENCE trial
Authors: Doi Yohei , Hamano Takayuki , Isaka Yoshitaka
Published: November 2024

Backgrounds:
Mediation analyses have shown that an increase in hematocrit (Hct) levels significantly contributes to the cardiorenal benefits of SGLT2 inhibitors (SGLT2i). However, given the link between erythrocytosis and poor prognosis, concerns remain about whether SGLT2i-induced erythropoiesis in patients with erythrocytosis may increase thromboembolic events (TE) including myocardial infarction (MI).

Methods:
We conducted a pooled analysis utilizing individual participant data from the CANVAS Program and the CREDENCE trial, both aimed to evaluate the efficacy and safety of canagliflozin versus placebo in diabetic patients. The primary outcome was a composite of MI, stroke, or any other TE. Sex-specific Cox analyses were performed to assess effect modifications by baseline Hct levels, treated as categorical (anemia, normal, and erythrocytosis) or continuous variable.

Results:
Of the participants for whom baseline Hct values were available (98.5% [14,321/14,543]), 35% were female. Canagliflozin significantly increased the percentage of erythrocytosis from baseline to 1 year in males (5.6% to 16.9%) and females (1.9% to 5.2%), unlike placebo. Overall, canagliflozin did not alter the risk of the primary outcome for either male (HR 0.97; 95% CI, 0.86–1.10) or female (HR 0.95; 95% CI, 0.78–1.15). In males, baseline Hct levels modified treatment effect on the primary outcome, whether treated as categorical or continuous variables (Pinteraction <0.05), with benefits in anemic patients and harm in those with erythrocytosis (Figure). Meanwhile, no effect modifications were noted in females. In analyses for each component of the primary outcome, canagliflozin consistently reduced the risk of MI, stroke, and any TE in anemic male patients (HR 0.53, 0.49, and 0.71, respectively). However, mixed results were observed in those with erythrocytosis (HR 1.77, 0.62, and 1.11, respectively), suggesting detrimental effects on the primary outcome in these patients were primarily driven by MI. No heterogeneity by Hct was found for heart failure hospitalization or kidney outcome in both sexes.

Conclusion:
Canagliflozin may pose a safety concern regarding the risk of TE in diabetic male patients with erythrocytosis.
Abstract 4116981: Sex- and Racial/Ethnic Mortality Trends Across Separate Time Periods Following Hospitalization for Acute Myocardial Infarction
Authors: Tran Matthew , Luo Qian , Moghtaderi Ali , Kini Vinay
Published: November 2024

Intro:
Mortality for patients hospitalized with acute myocardial infarction (AMI) has improved over time, but sex- and racial/ethnic disparities remain. Whether disparities have changed over specific time periods following hospitalization is poorly understood.

Aim:
To assess mortality trends across separate time periods following incident AMI hospitalization by sex and race.

Methods:
Using Medicare fee-for-service data covering all patients with incident AMI hospitalizations from 2008 to 2018, we examined unadjusted mortality rates by sex and race/ethnicity for the following time periods: acute (in-hospital), post-acute (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), and long term (1-3 years after discharge). Each period was considered separately (i.e., patients who died during one period were not counted in later periods).

Results:
We identified 768,084 patients hospitalized with incident AMI (mean age 81 years, 48% male, 87% White) between 2008-2018. Figures 1 and 2 show annual mortality rates and trends. From 2008-2018, men and women had similar in-hospital and post-acute mortality, but women had persistently higher short- and long-term mortality compared to men. In 2008, Black patients had higher mortality rates compared to White patients for every period studied. In-hospital mortality rates were similar by 2018 but remained higher for Black patients for every other time period.

Conclusions:
For incident AMI patients, mortality rates have improved across subgroups through 3 years after discharge. However, women have had persistently higher mortality rates 1-3 years following hospitalization compared to men, while Black patients have had persistently higher mortality rates 30 days – 3 years following hospitalization compared to White patients. These results suggest that opportunities to reduce sex- and race-based AMI disparities might be particularly effective in longitudinal outpatient care following hospital discharge.
Abstract 4117032: Investigating the natural history and risk factors underlying deterioration in early-stage hypertrophic cardiomyopathy: findings from SOLENOID
Authors: Bradlow William , Elgui Kevin , Ducret Valerie , Trichelair Paul , Chevalier Philippe , Ripoll Tomas , Fudim Marat , Patel Manesh , Deleforge Aurelie , Guichard Ninon , Jaeger Alexandre , Micsinai Balan Mariann , Simon Antoine , Sehnert Amy , TOUZOT Maxime , Bastien Arnaud , Charron Philippe
Published: November 2024

Background:
Understanding the natural history and factors contributing to heterogeneous outcomes in patients with early-stage hypertrophic cardiomyopathy (HCM) is crucial to improving patient management.

Aim:
Utilizing a real-world data cohort spanning multiple centers, we described the natural history of early-stage HCM patients and identified risk factors for disease progression.

Methods:
SOLENOID is an observational study conducted in five academic centers (two in France, UK, Spain and the US). Inclusion criteria were patients with confirmed HCM seen between 2010 and 2022 in NYHA class I, or in “early stage” NYHA class II (defined by an NT-pro BNP<300 pg/ml, resting or provoked LVOT<50 mmHg, LAVi<35 ml/m2, E/e’<14, without a history of atrial fibrillation (AF), and not on HCM-specific therapy).

The endpoint was a composite of NYHA class worsening, new onset of AF and cardiovascular hospitalization. To identify risk factors, univariate analyses were conducted in each center, and then aggregated through a meta-analysis.

Results:
A total of 1044 patients were included with a median follow-up of 3.9 years (IQR 1.5-7.0). The mean age was 53±16 years, with 30% females and 42% of NYHA I were treated with beta-blockers. Genetic tests in 57% of patients revealed mutations, primarily in MYBPC3 (29%) and MYH7 (12%).

During follow-up, the composite endpoint has an incidence of 27% and 41% at 3 and 5 years. The main contributor was NYHA class worsening with an incidence of 24% and 35% at 3 and 5 years. AF at inclusion (log-HR=1.56, p<0.001), baseline level of NT-proBNP (log-HR=0.75, p<0.001) and age at inclusion (log-HR=0.24, p=0.005) were the main predictors of the composite endpoint.

Conclusion:
Nearly 30% of the early-stage HCM patients experienced disease progression within a 3 year follow-up period, highlighting a medical unmet need. Further studies are needed to assess whether the population characterized by elevated NT-proBNP, or pre-existing AF at inclusion, may benefit from more intensive surveillance and, in future HCM-specific therapy.
Abstract 4117365: Effect Of Renal Denervation In Combination With Cardiac Ablation On The Recurrence Of Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Zavaleta Corvera Carlos , Dominguez-Herido Caroline , Mamani-Condori Zulema , Chavez-Cano Joaquin , BUSTAMANTE ORDOÑEZ MARINA ATENA , Ccoyllo Mayhuasca Alexis , Campos-Ramos Ruth , Caballero-Alvarado Jose
Published: November 2024

Background:
Atrial fibrillation(AF) is the most common cardiac arrhythmia, affecting millions globally. Despite various treatments, recurrence remains high, especially among those with drug-resistant hypertension.

Aim:
To evaluate the efficacy of combining Renal Denervation and Cardiac Ablation compared to Cardiac Ablation Alone in reducing AF recurrence.

Methods:
A systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines, A search for randomized controlled clinical trials was carried out in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ScienceDirect until March 2024. Specifically, about adult patients aged 18 years and above diagnosed with AF and drug-resistant hypertension undergoing renal denervation and or cardiac ablation. The primary outcome was the recurrence of AF. The secondary outcomes were effects on systolic blood pressure, diastolic blood pressure, cardiovascular structural changes, glomerular filtration rate (eGFR). In addition, periprocedural events and major complication events. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI). For continuous variables, the results were shown considering the mean difference (MD) and standard deviation with 95% CI.

Results:
From 409 studies identified, 8 studies and 695 patients were included. Meta-analysis showed a significant reduction in atrial fibrillation recurrence with the combination therapy (HR 0.66 [95% CI=0.55 – 0.79], p=0.00001). Blood pressure outcomes were superior in the combination group, with reductions in both systolic (MD = -9.66 mmHg [95% CI: -13.89, -5.42], p=0.00001) and diastolic pressures (MD = -7.09 mmHg [95% CI: -13.67, -0.50], p=0.003). Cardiovascular structural changes, such as left atrial size (RR 2.85 [95% CI: 2.13, 3.81], p=0.00001) and interventricular septal thickness (MD = -1.15 [95% CI: -1.85, -0.44], p=0.003), also favored the combination therapy. Kidney function, measured by eGFR was better preserved (MD = -10.34 [95% CI: -13.39, -7.28], p<0.00001).

Conclusion:
The combination of RDN and CA is more effective than CA alone in reducing the recurrence of AF, with additional benefits in blood pressure control, cardiovascular structural improvements, and renal function preservation.
Abstract 4117772: Age-Related Differences in Aortic Valve Calcium Progression and the Risk for Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis
Authors: Marrero Natalie , Jha Kunal , Grant Jelani , Razavi Alexander , Budoff Matthew , Shah Sanjiv , Blumenthal Roger , Post Wendy , Shaw Leslee , Thanassoulis George , Rotter Jerome , Blaha Michael , Whelton Seamus
Published: November 2024

Background:
Aortic valve calcium (AVC) is strongly associated with an increased risk for severe aortic stenosis (AS). The prevalence of AVC increases with age affecting 40-50% of individuals ≥80 years. The impact of age on the progression of AVC and its association with incident AS remains unknown.

Methods:
Our study included 6,810 participants (52.9% women) free of cardiovascular disease between ages 45 and 84 from the Multi-Ethnic Study of Atherosclerosis. AVC was measured using non-contrast cardiac CT at Visit 1. Progression was calculated as the change in AVC divided by years between CT scans with up to 10 years between scans. Long term incident AS was adjudicated using medical chart review and echocardiogram data from Visit 6 with a median follow up of 16 years. Multivariable adjusted 1) linear regression was used to examine AVC progression and 2) multivariable adjusted Cox proportional hazards ratios (HR) were used to examine the association of AVC with incident AS.

Results:
The prevalence of AVC >0 was 4.9% among participants <65 and 23.2% for those ≥65 years old. Among participants with AVC >0, the median AVC was 34.1 (IQR 13-1,113) for participants <65 versus 69.0 (IQR 23-2,453) for participants ≥65. Participants <65 years and ≥65 years had no significant difference in median annualized AVC progression within the baseline AVC categories of 1-99 (10 versus 12 AU/year, p=0.303) and AVC >100 (50 versus 47 AU/year, p=0.846) (
Figure 1
). Overall, linear regression models showed older age was associated with greater AVC progression (p=0.001), but after additional adjustment for baseline AVC, the association became non-significant (p=0.134). AVC >0 was associated with significantly increased risk of incident AS for both younger (HR 13.37; 95% CI 5.67-31.52) and older participants (HR 10.59, 95% CI 6.77-16.56).

Conclusion:
We observed a similar progression of AVC for younger versus older persons after adjusting for baseline AVC burden. Additionally, AVC >0 independently conferred at least a ten-fold higher risk for severe AS among both younger and older participants. These findings demonstrate that the AVC progression is primarily associated with baseline AVC burden and that AVC is a strong marker of risk for severe AS for both younger and older persons.
Abstract 4117856: Effects of a Nurse-led Common-sense Model of Self-regulation-Based Heart Failure Self-care Program on Patient Outcomes: A Randomized Controlled Trial
Authors: HUANG Zehao , Chair Sek Ying
Published: November 2024

Introduction:
Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results.

Aims:
To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF.

Methods:
A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes.

Results:
138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2.

Conclusion:
Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.
Abstract 4117927: Prevalence of Obstructive Sleep Apnea Among Consecutive Patients with Atrial Fibrillation Using WatchPAT Home Sleep Testing: A Prospective Cohort Study
Authors: Mills Eric , Cassidy Michael , Im KyungAh , Sofer Tamar , Tadros Thomas , Zei Paul , Sauer William , Romero Jorge , Martin David , Antman Elliott , Javaheri Sogol
Published: November 2024

Background:
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and health system costs. Obstructive sleep apnea (OSA) is a highly prevalent condition affecting more than one third of the global adult population and, among patients with comorbid AF, contributes to poor AF related quality of life. However, the prevalence of undiagnosed OSA in the general AF population is unknown.

Methods:
In this pragmatic, phase IV prospective cohort study, we performed sleep testing on consecutively enrolled ambulatory AF patients for OSA using a cloud-based disposable home sleep test (the WatchPAT system). The primary outcome of our study was the prevalence of undiagnosed mild (5≤AHI<15) or moderate/severe (AHI≥15) OSA in the general AF population. A prespecified power analysis supports 80% power to detect a <5% difference in OSA prevalence compared to the general population (defined by AHI cut-offs of ≥5 or ≥15).

Results:
We performed sleep testing in 180 AF patients. Enrollment concluded early after a prespecified interim power analysis showed a larger than predicted difference of OSA prevalence between AF patients and the general population. Among the patients tested, 126 (70.4%) had paroxysmal AF, and 53 (29.6%) had persistent/long standing persistent AF. None had previous sleep testing. Our results show that the prevalence of OSA was 83.3% by AHI≥5 and 47.2% had moderate/severe OSA (AHI≥15). Patients with persistent or long standing persistent AF demonstrated even higher rates of OSA with 51 (96.3%) testing positive for OSA (AHI≥5) and 35 (64.2%) with moderate/severe OSA (AHI≥15). Conversely, standardized OSA screening instruments (Stop-BANG questionnaire or Epworth Sleepiness Scale) were poorly predictive of OSA in AF patients (AUC 0.66 and AUC 0.44, respectively).

Conclusions:
Undiagnosed OSA is highly prevalent in the general AF population. Our results demonstrate that OSA prevalence in AF patients exceeds that in the general population with a high degree of confidence. Widely used clinical prediction instruments cannot effectively be used to guide sleep testing decisions in AF patients. Our results suggest routine OSA testing should be performed in the comprehensive evaluation of all AF patients.
Abstract 4118122: Effect of Beta Blockers on Exercise Capacity, Diastolic Function, and Quality of Life in Patients with Heart Failure with Preserved Ejection Fraction
Authors: Weigel Frank , Smith Sakima
Published: November 2024

Introduction:
In recent landmark HFpEF trials, 75-80% of patients are taking beta blockers (BB) without clear evidence of clinical or symptomatic benefit. Patients with HFpEF commonly have comorbidities that have been classically managed with BB (AF, CAD, HTN), though the utility of this medication class for these conditions is being reconsidered. It remains unclear what impact BB use, in patients with HFpEF, has on exercise capacity, diastolic function, and quality of life.

Hypothesis:
We hypothesized that BB use is associated with worse exercise capacity, diastolic function, and quality of life in HFpEF patients.

Methods:
This retrospective cohort study was completed using deidentified patient data from the INDIE-HFpEF and RELAX clinical trials (two trials of HFpEF patients). Patients were divided into two groups based on BB use at trial enrollment. The primary outcomes were exercise capacity, diastolic function, and quality of life at baseline evaluation. A multivariate logistic regression model was used to assess for statistically significant differences after controlling for potentially confounding variables including age, sex, BMI, AF, prior MI, COPD, DM, HTN, serum creatinine, and NYHA functional class.

Results:
A total of 320 patients were included in this analysis, with 230 on BB (72%). Baseline demographics are shown in Table 1. Patients studied were older (68 years old), white (90%), obese (average BMI 34 kg/m
2
) individuals with an average LVEF of 61%. Outcomes and multivariate linear regression results are shown in Table 2. After controlling for potential confounding variables, there were no differences in baseline exercise capacity [peak VO2 (mL/kg/min): 12.1 vs 13.2, P=0.233], diastolic function [average E/e’: 14 vs 12, P=0.125; LAVI (mL/m
2
): 42 vs 37, P = 0.665; peak TR velocity (m/s): 2.8 vs 2.7, P = 0.165; PASP (mmHg): 41 vs 36, P = 0.357], quality of life [KCCQ: 54 vs 58, P = 0.206; MLHFQ 43 vs 46, P = 0.762], or NT-proBNP (633 vs 342; pg/mL, P = 0.208) in HFpEF patients on BB compared to those not on BB.

Conclusion:
There was no association with BB use and worse exercise capacity, diastolic function, or quality of life in HFpEF patients. This may be due to heterogenous treatment effects, with differing impact of BB based upon the underlying pathophysiology of unique HFpEF phenotypes. To definitively determine the impact of BB use in patients with HFpEF, both on clinical outcomes and symptoms, randomized controlled trials are necessary.
Abstract 4118402: National Burden, Trends, and Racial Disparities in Cardiovascular Mortality Among Incarcerated Individuals in the United States from 2000-2019
Authors: Eberly Lauren , Shultz Kaitlyn , Nathan Ashwin , Turecamo Sarah , Kishore Sanjay , Hayden Margaret , Khatana Sameed Ahmed
Published: November 2024

Background:
Cardiovascular disease is the leading cause of death in the U.S. Mass incarceration is a national public health issue, with the US having the highest incarceration rate in the world. However, there is a paucity of data on cardiovascular mortality among incarcerated individuals, or how the racialization of mass incarceration contributes to cardiovascular health inequities. The aim of this study was to evaluate the burden of cardiovascular mortality, trends in cardiovascular deaths, as well as racial differences in cardiovascular death and receipt of care among those incarcerated in U.S. state prisons from 2001-2019.

Methods:
We utilized the database “Mortality in Correctional Institutions: ICD-10 Diagnosis Codes for Natural Deaths Occurring in State Prison or Local Jail Custody, 2000-2019” from the United States Bureau of Justice Statistics. This database collects inmate death records from each of the nation’s 50 state prison systems. We extracted all deaths related to cardiovascular causes to evaluate the epidemiology of individuals with cardiovascular death, trends in cardiovascular death rates, and differences between racial groups.

Results:
From 2000-2019, there were a total of 18227 (28.0%) deaths secondary to cardiovascular causes among those incarcerated in US state prisons. The rate of CV death increased from 71.3 per 100,000 persons in 2001 to 94 per 100,000 persons in 2019. Black individuals who died while incarcerated had higher rates of death related to a cardiovascular cause than White individuals (30.9% vs. 27.8%, p<0.0001). Black individuals had higher rates of death due to ischemic heart disease (23.2% vs 21.9%) and hypertensive-related cardiovascular deaths (3.71% vs. 2.96%) as compared to white counterparts (p<0.001). Black incarcerated individuals who died from a cardiovascular cause were less likely to be evaluated by a medical provider in prison (78.6% vs. 81.9%; p<0.0001), were less likely to have a diagnostic test performed (65.3% vs. 69%, p<0.0001), were less likely to receive medications (68.1% vs 72.6%, p<0.001), as well as treatment other than medications (49.1% vs 52.8%, p <0.0001) for the condition which caused death as compared to White counterparts.

Conclusions:
Deaths due to cardiovascular causes are high among patients incarcerated in US state prisons. Combined with decarceral efforts to address mass incarceration, strategies to ensure quality and equitable cardiovascular care for this population are needed.
Abstract 4118641: Trend, Survival, and Disparity Analysis of Heart Transplantation in a Single Large Transplant Center
Authors: KC ANIL , Sanghavi Devang , Bhattacharyya Anirban , Patel Parag , Pham Si , Guru Pramod , Chaudhary Sanjay
Published: November 2024

Background:
In the landscape of organ transplantation, heart transplantation stands as a life-saving procedure for patients with end-stage heart failure. Comprehensive analyses of transplant programs are imperative to optimize outcomes and understand the complexities.

Hypothesis:
This study hypothesizes that an increasing trend of heart transplant service and short-term mechanical circulatory support (STMCS) is the bridge to transplant; the UNOS (United Network for Organ Sharing) guideline positively impacts STMCS utilization. Even with the standard of care, there might be a disparity in receiving care in terms of gender and race.

Goal/ Aims:
By examining this center's collective experience, this research provides valuable insights into the evolving landscape of heart transplantation, ultimately contributing to advancements in patient care and transplant policy.

Methods:
This retrospective cohort study includes heart transplant patients in a single large transplant center. For statistical analysis, Cox regression, Mann-Whitney test, Kruskal Wallis, and Chi-Square test were used in IBM SPSS 25.

Result:

Trends:
This retrospective study covering 2010 to 2022 comprehensively analyzed 1513 heart transplant patients. The cohort consisted of 1071 (70.78%) males and 442 (29.21%) females, 31.9% were bridged through STMCS. 76.7% of Caucasian and 16.1% were African American.The mean utilization of STMCS was 20.08% before the UNOS policy change, increasing to 53.81% after that (p < 0.001).

Disparity Analysis:
There was a statistically significant difference in STMCS utilization between white and black patients (p= 0.008) but no difference in between obese and non-obese cohorts (P=0.362).Wait time was similar among the genders (p=0.161) and different races (p=0.302).

Survival Analysis:
There is a significant survival discrepancy between patients bridged through MCS and those without STMCS(p< 0.001). However, yearly trend analysis showed an evolving survival trajectory favoring STMCS users. There are statistically significant survival differences among whites and blacks (P =0.008) but similar among the genders (p=0.589).

Summary:
The study reveals significant changes in the trend of transplants regarding STMCS utilization since the UNOS guideline. There are substantial differences in survival between STMCS vs. non-STMCS groups and among the races.There was a significant difference in STMCS utilization among the races.
Abstract 4118671: Extreme ambient temperatures increase the risk of congenital heart disease mortality: insights from the national mortality surveillance system of China
Authors: He Qiyu , Dou Zheng , Liu Yuze , Li Shoujun
Published: November 2024

Background:
Climate change is intricately linked to human health, and the cardiovascular system is particularly susceptible to suboptimal temperatures, causing premature mortality. Extensive research has confirmed a robust link between non-optimal temperatures and most cardiovascular diseases; however, limited focus has been given to investigating the association between non-optimal temperatures and mortality related to congenital heart disease (CHD), one of the most prevalent cardiovascular diseases among children.

Research question:
Do extreme temperatures increase the risk of CHD mortality?

Aims:
We aimed to investigate the association between CHD mortality and ambient temperatures.

Methods:
Based on the national mortality surveillance system of China, we applied a two stage, individual level, time-stratified case-crossover design to investigate the association between CHD mortality and ambient temperatures from 2013 to 2021, with different thresholds of events. After estimation within each province of China, we pooled all the estimations using meta-analytic method. Sensitivity analyses and subgroup analyses were used to explore the stability and vulnerable population.

Results:
From 2013 to 2021, a total of 32168 CHD deaths were recorded. Neonates and adults constituted the primary age groups among all CHD-related deaths, with a majority of patients being male (55.2%). Cold temperatures exhibited a significant association with the risk of CHD mortality, while no significant association was observed with heat temperatures (Figure 1). Cold extremes made a significant contribution to CHD mortality in most defined events, with the highest contribution observed in P5_5d (indicating temperatures below the 5th percentile lasting for 5 days; odd ratio [OR]: 1.15, 95% CI: 1.03 to 1.29) (Figure 2). In comparison to male patients, female patients appeared to be more vulnerable to cold extremes, with ORs ranging from 1.08 (95% CI: 1.01 to 1.16) for P10_1d to 1.20 (95% CI: 1.01 to 1.43) for P5_5d.

Conclusion:
Extreme cold temperatures significantly increase the risk of CHD mortality. This is the first study performed to explore the relationship between ambient temperatures and CHD mortality, and it may suggest policy-adjustment in healthcare of CHD population.
Abstract 4118804: Use and Clinical Outcomes Associated with Urgent versus Elective Catheter Ablation of Atrial Fibrillation in the United States
Authors: Polsinelli Vincenzo , Qin Li , Minges Karl , Freeman James , Al-Khatib Sana , Bradley Steven , Ho Michael , Tzou Wendy , Varosy Paul , Hess Paul , Sandhu Amneet
Published: November 2024

Introduction:
Catheter ablation of atrial fibrillation (AF) is an increasingly important evidence-based treatment option for select patients. Although typically performed as an outpatient elective procedure, the use and clinical outcomes of AF ablation pursued urgently among inpatients have not been adequately characterized.

Hypothesis:
Rate of urgent AF ablation, defined as an AF ablation procedure pursued among inpatients hospitalized for a non-procedural indication, has increased over time, and may be associated with worse outcomes.

Aims:
To describe the use and outcomes of urgent versus elective AF ablation.

Methods:
Using the NCDR AFib Ablation Registry, patients who underwent AF ablation from 1/1/2016 to 6/30/2023 were stratified according to whether AF ablation was urgent or elective. Logistic regression models were fitted to determine patient and hospital-level factors associated with use of urgent AF ablation. Cochrane-Armitage tests were used to test for trends over time. Unadjusted and adjusted in-hospital event rates were reported.

Results:
Among 140,051 patients, 2,714 (1.9%) underwent urgent inpatient AF ablation and 137,337 (98.1%) elective ablation. Compared with the elective cohort, those undergoing urgent ablation had higher rates of co-morbid conditions including: diabetes (30.6% vs. 20.4%, P<0.0001), coronary artery disease (30.8% vs. 22.7%, P<0.0001), and heart failure (47.1% vs 20.8%, P<0.0001). Urgent AF ablation was more often used among patients of Black race (OR 1.68; 95% CI: 1.41 – 2.0) and those with AF at the time of the procedure (OR 1.73; 95% CI: 1.36 – 2.20). Higher hospital procedural volume of AF ablations ([per 100 cases] OR 1.22; 95% CI: 1.20 – 1.25) was also associated with higher odds of urgent AF ablation. The use of urgent AF ablation increased from 0.5% in 2016, to 2.0% in 2023 (P<0.0001). Unadjusted event rates for AF-related complications were significantly higher for the urgent cohort (Figure). The adjusted rate of any procedure-related complication was significantly higher in the urgent cohort (urgent 4.9% vs. elective 2.4%, P<0.0001).

Conclusions:
The rate of urgent inpatient AF ablation has increased over time. Compared with elective AF ablation, after adjustment for patient risk factors, urgent AF ablation is associated with significantly higher rates of procedural complications. Use of urgent, inpatient AF ablation should be carefully considered within clinical contexts and offered to select patients.
Abstract 4118949: Factors Influencing Left Ventricular Function Recovery Following Left Ventricular Assist Device Implantation in Pediatric Dilated Cardiomyopathy: Insights from Single-Cell RNA Sequencing Analysis
Authors: Kugo Yosuke , Kawamura Takuji , Harada Akima , Watanabe Takuji , Kido Takashi , Taira Masaki , Miyagawa Shigeru
Published: November 2024

Background and Objective:
Heart transplantation is a recognized treatment for pediatric severe heart failure, but long-term issues necessitate alternative treatments. Some dilated cardiomyopathy (DCM) cases show left ventricular function recovery after LVAD implantation. This occurrence could lead to new treatments, but mechanisms are unclear. This study explores preoperative molecular factors interacting with LVAD's effects using single-cell transcriptomics on clinical samples.

Methods:
Twenty-five pediatric DCM patients underwent Berlin Heart EXCOR (BHE) implantation at our institution since 2013. Those with left ventricular ejection fraction (LVEF) improving by >20% were in the Recovery group (R), others in Non-Recovery (NR). Single-cell RNA-sequence was performed on myocardial tissue from six patients (three per group). Differential gene expression and pathway analysis were conducted for each cell type. Findings were validated by comparing them with histological evaluation or clinical examination in all 25 cases.

Results:
R: 10 patients; NR: 15. R's weight was 6.3 kg, NR's 9.9 kg (p=0.049); LVEF: R 23%, NR 16.5% (p=0.61). In pseudobulk analysis of cardiomyocytes, upregulated genes in R included NPPB, MYL7, PCDH9. KEGG analysis indicated activation of Tight Junction and ECM receptor pathways in R. In fibroblasts, major extracellular matrix proteins were higher in R, GSL gene expression in NR. Plasma Brain Natriuretic Peptide (BNP) at BHE implantation was significantly higher in R; 2913 [1836-3990 (95% CI)] vs 1278 [667-1888] pg/ml (Image1,2). No differences in tissue fibrosis rates were found between the groups.

Conclusion:
Alterations in gene expression patterns in some cell clusters, including cardiomyocytes, may contribute to left ventricular function recovery post-BHE implantation in pediatric DCM patients. Plasma BNP levels correlated with gene expression alterations, suggesting both a potentially protective effect on cardiomyocytes and a useful marker of LV functional recovery. Further validation of these candidate genes may elucidate intracellular molecular mechanisms.
Abstract 4118993: β1 Adrenergic Receptor Autoantibodies Promote Heart Failure Though Activation of Prostaglandin E2 Receptor EP1/Phosphodiesterase 4B Pathway
Authors: Cao Ning , Qiu Hui , Li Hongwei
Published: November 2024

Background:
β1 adrenergic receptor (β1-AR) autoantibodies (β1-AA) can cause heart failure (HF) through activating of β1-AR; However, β-AR antagonists cannot completely reverse the cardiac injury induced by β1-AA and improve the survival rate of patients with β1-AA-positive HF. However, the β1-AR-independent mechanisms of heart failure induced by β1-AA are unclear.

Methods:
Proteomics of mice hearts was used to identify the specific changed proteins induced by β1-AA. The expression of phosphodiesterase 4B (PDE4B) was detected by western blot in neonatal mice mouse cardiomyocytes (NMCMs) and heart tissues. The binding proteins with β1-AA were enriched by immunoprecipitation (IP) and identified by mass spectrum. The interaction between β1-AA and prostaglandin E2 Receptor EP1 was detected by co-IP and surface plasmon resonance. The cardiac function and cardiac remodeling of PDE4B transgenic (TG) mice and EP1 knockout (KO) mice.

Results:
Firstly, PDE4B was changed the most proteins induced by β1-AA compared to β1 adrenergic receptor dobutamine. Moreover, the decrease of PDE4B induced by β1-AA cannot be reversed by metoprolol in vivo and in vitro. Secondly, the cAMP/PKA pathway and cardiac injury/dysfunction induced by β1-AA were inhibited after activation of PDE4B or PDE4B-TG in vivo and in vitro. Thirdly, β1-AA can bind with EP1 and activate Gq/IP3 pathway. The activation effect was abolished by EP1 antagonist. Lastly, blocked EP1 or EP1-KO will reverse the decreased PDE4B and cardiac injury/dysfunction induced by β1-AA.

Conclusions:
Our work reveals that β1-AA can activate of EP1/PDE4B pathway to result in heart failure.
Abstract 4119146: Pulmonary Artery Enlargement Predicts Mortality in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Replacement.
Authors: Adamopoulos Dionysios , Gkotsoulia Christina , Muller Hajo , Vallee Jean-Paul , Crowe Lindsey , Deux Jean-Francois , Mauler-Wittwer Sarah , Lador Frederic , Mach Francois , Noble Stephane
Published: November 2024

Background:
Pulmonary hypertension is associated with extensive remodeling of the pulmonary tree, with key finding the enlargement of the pulmonary artery (PA). Although the independent predictive value of the pulmonary hypertension in patients undergoing transcatheter aortic valve replacement for severe aortic stenosis has been clearly demonstrated, data about the potential predictive value of the pre-interventional PA enlargement on mortality are scarce.

Research questions:
The aim of the present study was to assess the prognostic significance of the pre-interventional PA enlargement, assessed by cardiac CT scan, in patients undergoing transcatheter aortic valve replacement for severe aortic stenosis.

Methods:
We conducted a retrospective study and recruited 337 patients with aortic stenosis, who underwent a right heart catheterization and a cardiac CT scan before the transcatheter aortic valve replacement. The cohort was divided in two groups according to the presence of an enlarged PA (PA
e
), (main PA axial diameter ≥ 29 mm for males and ≥ 27 mm for females, n=192, mean age 83±6 years, 41% males) or not (PA
n
), ( n=145, mean age 84±6 years, 46% males). The primary endpoint was all-cause mortality at 1 year.

Results:
Globally, a strong correlation between invasive mean PA pressure and main PA axial diameter was noted (Pearson r=0.393, p<0 .001). Compared to the PA
n
group, patients with enlarged PA exhibited higher 1 year mortality rates (hazard ratio 2.51, 95% CI: 1.1-6.04, p=0.027). The prognostic significance was even stronger after indexing the PA to the ascending aorta diameter (hazard ratio 3.82, 95% CI: 1.86-7.87, p<0.001, figure 1).

Conclusions:
Pre interventional PA enlargement, is strongly associated with 1-year all-cause mortality in patients undergoing transcatheter aortic valve. This may pave the way for a more precise non-invasive risk stratification in patients with severe aortic stenosis.
Abstract 4119187: Association of CMR derived Global Longitudinal Strain with adverse Outcomes in Arrhythmogenic Cardiomyopathy.
Authors: Bahbah Ali , Zishiri Edwin , Fukui Miho , Schmidt Stephanie , Cavalcante Joao , Witt Dawn , Berger Justin , Bennett Mosi , Sengupta Jay
Published: November 2024

Background:
Arrhythmogenic cardiomyopathy (ACM) is associated with high risk of ventricular arrhythmias (VA) and heart failure (HF). Different predictive models and diagnostic criteria include parameters related to myocardial structural abnormalities and right ventricular (RV) ejection fraction (EF). Nevertheless, the value of global longitudinal strain (GLS) ascertained from cardiac magnetic resonance (CMR) for risk-stratification in the context of ACM is unknown.

Aim:
We aim to study the association of low CMR-derived GLS with adverse outcomes in ACM patients.

Methods:
This was a retrospective cohort study of ACM patients seen at a single quaternary center. ACM diagnosis followed the modified 2010 ARVC modified task force criteria. Primary outcome was a composite of life-threatening VAs, heart transplant or HF hospitalization during follow up. We excluded patients who suffered events prior to diagnosis, and those with missing or inadequate CMR protocol. Imaging parameters were acquired by CMR including EF, GLS, and late gadolinium enhancement (LGE).

Results:
A total of 82 patients with suspected ACM were included, with a median age of 40 years, and 43 (52.4%) were females. Most common reason of initial visit was family history of genetic cardiomyopathy in 46 (56%), while 16 (20%) patients visited our clinic due to history of syncope. Out of 60 patients who had genetic testing, 21 (35%) had mutations of DSP gene. Left ventricular involvement (non-ischemic LV-LGE by CMR) was present in 42 (56.8%) out of 74 patients who had CMR with gadolinium. Median LVEF was 62% (56, 66), and RVEF of 53% (48, 59), both by CMR. Median LVGLS was -17.01% (-14.71, -18.43), while median RVGLS was -20.5% (-18.3, -24.4). A total of 15 (18%) patients suffered the composite endpoint during an average follow up period of 8 years. Patients who suffered the composite endpoint had significantly lower mean LVGLS (-15.04% vs -16.70%, p= 0.048), and lower average RVGLS (-18.45% vs -21.33%, p=0.035) compared to patients free from the adverse outcome. Meanwhile there was no significant difference in LVEF (60.13% vs 61.18%, p=0.67), nor in RVEF (49.13% vs 54.01%, p=0.065) between the two groups.

Conclusion:
Lower GLS was significantly associated with VAs and HF hospitalizations in our patient population. CMR derived GLS can be used as an important prognostic parameter of adverse outcomes in patients with suspected ACM. Especially in those with LV involvement and high genetic predisposition as our cohort.