bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4139023: Clinical Outcomes and Hemodynamic Findings Following Transcatheter Aortic Valve Replacement with a Balloon-Expandable Valve in Patients with Small and Non-Small Annulus
Authors: Besir Besir , Majeed-Saidan Maryam Muhammad Ali , Rajendran Judah , Lomaia Tamari , Kathavarayan Ramu Shivabalan , Iskandar Odette , Yun James , Harb Serge , Miyasaka Rhonda , Reed Grant , Puri Rishi , Krishnaswamy Amar , Kapadia Samir
Published: November 2024

Background:
Patients with a small aortic annulus are at risk for worse hemodynamic performance after transcatheter aortic valve replacement (TAVR). There is a debate on whether they have worse clinical outcomes compared to patients with a non-small annulus.

Hypothesis:
Patients with a small annulus have worse hemodynamic and clinical outcomes post-TAVR than those with a non-small annulus.

Aims:
To explore the hemodynamic and clinical outcomes following TAVR in patients with a small annulus compared to those with a non-small annulus.

Methods:
This is a retrospective cohort of patients >18 years of age who underwent TAVR at Cleveland Clinic between 2016 and 2020. Patients were classified into 2 groups according to the annular size assessed by contrast-enhanced computed tomography or cardiac magnetic resonance: small (area ≤430 mm
2
), and non-small annulus (>430 mm
2
). Patients who underwent TAVR with a self-expanding valve and those with annular sizing using transesophageal echocardiography were excluded. Clinical outcomes included overall mortality, and heart failure rehospitalization at 3 years using Cox regression, in addition to ischemic stroke, and permanent pacemaker (PPM) implantation. Echocardiographic outcomes included moderate to severe paravalvular leak (PVL), aortic valve (AV) mean gradient, and dimensionless valve index (DVI), with up to 3 years of follow-up.

Results:
A total of 2630 patients underwent TAVR between 2016 and 2020. The study included 2122 patients, of which, 782 (37%) had a small annulus. Patients with a small annulus had significantly higher AV mean gradients and lower DVI at all follow-up intervals. However, there was no difference in clinical outcomes between the 2 groups. The hazard ratio [HR] for mortality was 0.89 (p-value= 0.328), and for heart failure rehospitalization was 1.06 (p-value= 0.712) (reference is non-small annulus). The incidence of moderate to severe PVL was not significantly different between the 2 groups at any of the follow-up intervals (Figure 1).

Conclusions:
Patients with a small annulus had higher AV mean gradients post-TAVR than those with a non-small annulus. However, there was no significant difference in clinical outcomes or PVL between the 2 populations.
Abstract 4139204: Impact of Myocardial Injury Assessment in Emergency Department on Disposition Distribution and Time to Disposition
Authors: Landry Alexander , Michael Kirolos , Lidani Karita , Palmer Benjamin , Tomar Shubham , Xu Meng , Libre Michael , Sexton Mitchell , Wrenn Jesse , DeFilippis Andrew
Published: November 2024

Background:
Emergency department (ED) overcrowding is a significant healthcare challenge that continues to strain medical facilities internationally. The need to assess myocardial injury in the ED is thought to be common, accounting for greater than 13 million visits annually. Therefore, we sought to assess the frequency and impact of myocardial injury assessment on the intermediates to ED overcrowding – ED disposition distribution and time to disposition – at an urban ED.

Methods:
In this single-center, retrospective cohort study from February 1, 2023, to January 31, 2024, the disposition distribution and median time to disposition were recorded for ED patient encounters. The study population was divided into encounters resulting in ED assessment for myocardial injury with conventional troponin measurement (ED-Tn group) and all other encounters without ED assessment for myocardial injury (control group). Pearson test was used for analyzing disposition distribution and Wilcoxon test for comparing time to disposition between the two defined groups.

Results:
66,984 patient encounters resulted in a disposition of discharge or admission during the study period. 15,918 (23.8%) were categorized into ED-Tn group, while 51,066 (76.2%) were categorized into control group. The ED-Tn group had a significantly lower discharge frequency of 51% compared to the control group with 59.1% (p<0.001). The median time to disposition was significantly higher for the ED Tn group at 212 minutes (IQR = 124, 325) compared to the control group at 184 minutes (IQR = 95, 313; p<0.001). When considering only those patients who were discharged from the ED, the difference in median time to disposition was even more pronounced for the ED-Tn group at 226 minutes (IQR = 139, 340) compared to the control group at 178 minutes (IQR = 86, 311; p<0.001).

Conclusions:
In an urban ED, myocardial injury assessments comprised a quarter of all ED evaluations, linked to increased admission and extended time to disposition for these patients. Implementing high-sensitivity troponin could improve efficiency of ED assessment for myocardial injury and alleviate overcrowding, given the resource-intensive and time-intensive nature of these assessments.
Abstract 4139212: Long Term Outcomes of Patients with Hypoplastic Left Heart Syndrome and Left Ventricle-Coronary Artery Fistula
Authors: Kobayashi Ryan , Brown Kaylah , Gauvreau Kimberlee , Valencia Ele , Kaza Aditya , Boscamp Nicholas , Stack Kathryn , Singh Tajinder
Published: November 2024

Introduction:
Hypoplastic left heart syndrome (HLHS) with mitral stenosis/aortic atresia (MS/AA) is associated with worse outcomes compared to other anatomic variants. It is unclear whether this is related to left ventricle-coronary artery (LV-CA) fistula.

Research Question:
We sought to compare outcomes for patients with HLHS (MS/AA) with and without LV-CA fistula.

Methods:
Retrospective cohort study of patients with HLHS (MS/AA) who underwent stage 1 palliation at Boston Children’s Hospital 2008-2023. Presence of LV-CA fistula was defined by angiography.

Results:
Among 91 patients, 58 (64%) had LV-CA fistula and 33 (36%) did not. LV-CA fistula was diagnosed prior to initial palliation in 31 (53%) patients. Birth weight (BW) and gestational age (GA) were similar between groups. Mean postnatal echocardiogram ascending aorta diameter z-score was -4.29 ± 0.74 and was similar between groups. In total, 67 (75%) of patients underwent surgical stage 1 palliation and 22 (25%) underwent hybrid palliation; hybrid palliation was more common in the fistula group (36% vs 6%, p=0.007). Transplant-free survival at 1 year was 63% (95% confidence interval [CI]: 49%, 74%) and 79% (95% CI: 61%, 89%) in those with and without fistula, respectively. There was a trend towards shorter time to death or transplant in patients with LV-CA fistula than for those without (Figure 1, p=0.083). In univariate analysis, lower GA (↓1 week; HR 1.34, 95% CI 1.18, 1.51), lower BW (↓0.5 kg; HR 1.69, 95% CI 1.28, 2.23), and initial hybrid palliation (HR 3.55, 95% CI 1.82, 6.94) were associated with an increased hazard of death/transplant (all p<0.001). After adjusting for either GA or BW, there was still a trend towards shorter time to death/transplant in children with LV-CA fistula which was not statistically significant (p=0.09, p=0.13, respectively).

Conclusions:
Mortality remains high for children with HLHS (MS/AA) and there is a trend toward worse transplant-free survival for those with LV-CA fistula.
Abstract 4139238: A Multi-Population-First Approach Leveraging UK Biobank (UKBB) and All of Us (AoU) Datasets Reveals Higher Cardiomyopathy Variant Burden in Individuals with Myocarditis
Authors: Gurumoorthi Manasa , Hesse Kerrick , Asatryan Babken , Shah Ravi , Sharaf Dabbagh Ghaith , Wolfe Rachel , Shyam Sundar Vijay , Mohiddin Saidi , Aung Nay , Khanji Mohammed , Munroe Patricia , Petersen Steffen , Landstrom Andrew , Chahal Anwar
Published: November 2024

Intro:
Myocarditis is an inflammatory cardiac condition that may progress to dilated (DCM) or arrhythmic (ACM) cardiomyopathy. Prior cohort studies indicate genetic factors significantly influence myocarditis susceptibility and outcomes; yet, this has not been studied at a population level, which holds potential for clinical risk prediction.

Objective:
To investigate DCM and ACM gene variant burden and clinical consequences by a multi-population approach encompassing diverse genetic ancestries.

Methods:
Individuals with exome sequencing (ES) in UKBB and AoU were included, and poor-quality samples excluded. Individuals with myocarditis were identified by ICD code and compared with myocarditis-neg population. Cardiomyopathy (CM) genes in ClinGen DCM- and ARVC-associated genes with at least moderate evidence of disease causality were included and filtered by our previously published variant pipeline and ClinVar 2* criteria for pathogenic/likely pathogenic (P/LP). Cardiac phenotype and CM variant burden were analyzed by chi-squared analysis.

Results:
200,580 individuals in UKBB and 230,013 in AoU had ES. 137 in UKBB and 284 in AoU had myocarditis. Myocarditis cohorts in both populations had increased phenotypic burden of CM, ventricular arrhythmia, and HF vs myocarditis-neg. Myocarditis-pos showed increased CM (16.8% vs 0.2%); VA (10.9% vs 0.9%) and HF (32.8% vs 3.1%) in UKBB (p<0.001). Similarly in AoU, 44.5% of myocarditis-pos had CM (vs 2.8%); 22.3% had VA (vs 1.6%), and 55.8% had HF (vs 5.8%) when compared to myocarditis-neg. UKBB had increased DCM and ACM variant burden in myocarditis-pos cohort: 9.5% (5) with DCM ClinVar 2* P/LP and 3.6% (5) with ACM ClinVar 2* P/LP compared to 0.3% (561) and 0.3% (578) in myocarditis-neg (p<0.001). Increased burden of DCM P/LPs by our peer-reviewed pipeline was noted in AoU myocarditis-pos (9.8%, 28) compared to AoU myocarditis-neg (6.2%, p=0.02). ACM variants were not significantly overrepresented in myocarditis cohort in AoU (p=0.4) but was underpowered to note significance by ClinVar2* P/LP.

Conclusions:
This study highlights a substantial burden of DCM and ACM variants in individuals with myocarditis, particularly in UKBB. The differential significance in AoU may represent diverse genetic ancestries and differences in recruitment methods. Future analyses include determining variant burden by outcome and genetic-ancestry based variant analysis to elucidate genetic risk myocarditis susceptibility and disease progression.
Abstract 4139239: Validation of ICD-10-CM diagnosis codes for heart failure classification within an integrated US administrative claims and electronic medical record (EMR) database
Authors: Barron John , Venkataraman Malvika , Teng Chia-Chen , Vojjala Shiva , Power Thomas , Willey Vincent
Published: November 2024

Objective:
Identification of individuals with reduced or preserved ejection fraction heart failure (HFrEF/HFpEF) within claims data is typically based on ICD-10-CM diagnosis codes that use systolic and diastolic HF (SHF/DHF) nomenclature. The objective of this study was to assess the performance characteristics of using ICD-10-CM diagnostic codes from claims data for HFrEF and HFpEF classification relative to a reference standard using EF results or clinician documentation within an integrated claims/EMR database.

Methods:
EMR data from the Healthcare Integrated Research Database (HIRD®) were searched to identify patients with EF assessment between 01/01/2016 and 01/31/2023. HFrEF was defined as EF ≤ 40% or documented reduced EF, while HFpEF was defined as EF ≥ 50% or documented preserved/normal EF. The most recent EF assessment date or EMR entry date (if EF assessment date not available) was set as the index date. Claims submitted from 7 days to 6 months post index date were then reviewed to identify SHF and DHF diagnoses as well as comorbid conditions. Analyses were performed to determine sensitivity, specificity, and positive/negative predictive values (PPV/NPV), accuracy and F1 scores of the claims-based algorithm, with a sensitivity analysis performed using the subset of patients with a known EF assessment date available.

Results:
A total of 45,272 patients had EF assessment in the EMR data with either a SHF or DHF diagnoses in the claims data. Mean (SD) age was 71.7 (12.7) years, 51.2% were male. The most common comorbidities of interest included hypertension (89.5%), dyslipidemia (71.9%), atrial fibrillation (45.9%), type 2 diabetes (43.7%), and chronic kidney disease (39.6%). Counts by heart failure classification and algorithm performance characteristics are in Table 1. Sensitivity analyses for those with known EF assessment dates showed similar results.

Conclusions:
Overall performance of the claims-based algorithm was good to very good, although EF data integrated with claims data can improve HF classification. Future claims-based algorithm development could also incorporate treatments and comorbidities to improve performance.
Abstract 4139303: Temporal Trends in Cardiovascular Risk Factors and Cardiovascular Disease among Middle Eastern Immigrants in the National Health Interview Survey 2004-2018
Authors: Kawaleet Yanal B. , Le Austin D. , Patel Nehal P. , Dodani Sunita
Published: November 2024

Introduction:
Historically, Middle-Eastern (ME) immigrants have been aggregated with Non-Hispanic White (NHW) individuals, masking disparities in cardiovascular diseases (CVD). This study analyzes yearly data from 2004-2018 to assess changes in the prevalence of CVD and the American Heart Association’s (AHA) Life’s Essential 8 (LE8) risk factors among ME immigrants.

Hypothesis:
Trends in CVD and LE8 risk factors from 2004-2018 will differ between ME immigrants and NHW adults.

Methods:
We used sample adult data limited to ME immigrant and US-born NHW adults ≥18 years of age in the National Health Interview Survey, a nationally representative household US survey for years 2004-2018. The study assessed the prevalence of CVD (heart attack, angina pectoris, coronary heart disease, other heart conditions, or stroke) and LE8 risk factors: insufficient physical activity (PA), nicotine exposure, sleep duration, obesity, physician-diagnosed high cholesterol, diabetes, and hypertension. Survey-weighted, multivariable logistic regression controlling for age, sex, family income-poverty-ratio, marital status, and years in the US was used to model the linear relationship between survey year and the prevalence of CVD and risk factors.

Results:
Our study sample included 534,278 adults (93.2% NHW&6.8% ME immigrants), representing 179,176,566 adults living in the US (mean age= 45.9 years, [SD=18.9]) with 51% being female. Trends for NHW adults showed decreases in CVD, insufficient PA, and nicotine exposure, but increases in sleep duration, obesity, high cholesterol, diabetes, and hypertension (Table). For ME immigrants, no significant changes were observed over time for most risk factors (p>0.05). However, each year was associated with lower odds of insufficient PA and higher odds of hypertension prevalence.

Conclusion:
Between 2004-2018, NHW adults had varying trends in CVD and LE8 risk factors whereas ME immigrant adults experienced a similar decrease only in insufficient physical activity prevalence and a greater increase in hypertension prevalence. Future research should focus on sustaining increases in physical activity and addressing hypertension in ME immigrant populations.
Abstract 4139369: Estimating PPCM Prevalence in the US Reveals Striking Differences by Race and Ethnicity, Income, and Chronic Comorbidities
Authors: Pathak Ishaan , Vaughan Adam , Kuklina Elena , Busacker Ashley , Wright Janet , Hollier Lisa , Coronado Fatima
Published: November 2024

Introduction:
Peripartum cardiomyopathy (PPCM) is cardiomyopathy of unknown etiology occurring in pregnant people shortly before or following delivery. Cardiovascular diseases are a large contributor to maternal morbidity in the US. We estimated PPCM prevalence to understand its contribution to this burden.

Methods:
We used National Inpatient Sample (NIS) data, a nationally representative sample of US hospital discharge records, from 2010-2020. We identified PPCM and deliveries among people aged 15-55 years using ICD and DRG codes. We excluded discharges missing age and race or ethnicity (n=512,639), and those with other cardiomyopathy codes (n=1010), leaving 7,820,420 delivery discharges. Using NIS survey weights, we calculated PPCM prevalence by age, race and ethnicity, comorbidities, and neighborhood income and adjusted prevalence ratios (aPR) using Poisson regression.

Results:
After weighting, our analytic set represented 38,672,513 delivery discharges and 41,182 PPCM cases. The overall PPCM prevalence was 109.4 (95% CI: 106.0-112.7) cases per 100,000 delivery discharges (Figure). Overall, PPCM prevalence remained steady from 2010-2020, but increased with advancing maternal age and decreasing neighborhood income. The prevalence in the lowest income quartile was more than double that of the highest income quartile (aPR: 2.4, 95% CI: 2.2-2.6). Compared to non-Hispanic (NH) White people, NH Black people had the highest prevalence (aPR: 3.7, 95% CI: 3.4-3.9), followed by Native American people (aPR: 1.9, 95% CI: 1.5-2.4). Hispanic and NH Asian people both had an aPR of 0.7 (95% CI: 0.6-0.8). Compared to those with no comorbidities, PPCM prevalence was significantly higher among those with certain comorbidities, notably diabetes (aPR: 5.6, 95% CI: 5.1-6.1) and chronic hypertension (aPR: 17.1, 95% CI: 16.0-18.2).

Discussion:
PPCM prevalence presents significant racial and ethnic, and economic disparities. The higher PPCM prevalence among those with diabetes and hypertension emphasizes the need to strengthen management of chronic conditions. Intensification of efforts to address root causes of these disparities and to enhance cardiovascular health before and during pregnancy may be needed.
Abstract 4139467: Application and Outcomes of Coronary Atherectomy in Patients with Acute Coronary Syndrome: A Report from the Nationwide J-PCI Registry
Authors: Aikawa Tadao , Mori Yuichiro , Kohsaka Shun , Matsue Yuya , Kuno Toshiki , Yamaji Kyohei , Ozaki Dai , Tokano Takashi , Kozuma Ken , Minamino Tohru
Published: November 2024

Introduction:
Acute coronary syndrome (ACS) has been generally considered a relative contraindication to coronary atherectomy.

Aims:
The objective of this study was to investigate the temporal trends and hospital variability in the use of coronary atherectomy and its outcomes among patients undergoing percutaneous coronary intervention (PCI) for ACS from a nationwide PCI registry in Japan.

Methods:
First, we analyzed the temporal trend in the use of rotational atherectomy (RA) and orbital atherectomy (OA) during PCI for ACS patients between 2014 and 2022 (822,237 PCIs from 1,269 hospitals). Next, we assessed the outcomes of the patients who underwent RA for ACS between 2019 and 2022 (7,421 patients across 662 hospitals). The primary outcome was in-hospital mortality after PCI. Patient outcomes associated with hospital PCI volumes and the device policy change on coronary atherectomy in Japan in 2020, which allowed operators to perform coronary atherectomy without on-site surgical backup, were also evaluated.

Results:
The rate of RA for ACS was low at 2.0% in the overall cohort (16,264/822,237 PCIs); the rate slightly increased from 1.9% in 2014-2019 to 2.1% in 2020-2022 (after the device policy change). The rate of PCI with OA for ACS was also low at 0.8% in 2021-2022 (1,404/185,141 PCIs). Increasing the complexity of baseline characteristics, including advanced age, diabetes, chronic kidney disease, dialysis, peripheral arterial disease, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, cardiac arrest within 24 h, cardiogenic shock within 24 h, three-vessel disease, and mechanical circulatory support during PCI was significantly associated with increased in-hospital mortality after PCI with RA in ACS patients (P<0.05 for all). Annual hospital PCI volumes (odds ratio, 0.937; 95% CI, 0.653-1.361; P=0.729 for high- vs. low-volume hospitals) and newcomer facilities starting RA after the device policy change (odds ratio, 0.987; 95% CI, 0.651-1.361; P=0.951) were not significantly associated with in-hospital outcomes after RA for ACS.

Conclusions:
The present study using a nationwide multicenter PCI registry showed that the overall rate of PCI with coronary atherectomy for ACS was low but slightly increased after the device policy change in Japan. Hospital PCI volumes and newly accredited facilities on coronary atherectomy after the device policy change were not associated with in-hospital outcomes after RA for ACS.
Abstract 4139473: Deep Learning Model for Identification of Patients with Acute Heart failure using electrocardiogram in Emergency Room
Authors: Jung-Joon Cha , Moon Jose , Kim Jong-ho , Hong Soon Jun , Yu Cheolwoong , Kim Yong , Kim Eung Ju , Joo Hyung Joon
Published: November 2024

Background:
Acute heart failure (AHF) poses significant diagnostic challenges in emergency room (ER) settings due to its varied clinical presentations and the limitations of traditional diagnostic methods. This study aims to develop and evaluate a deep learning model that uses electrocardiogram (ECG) data to enhance the identification of AHF in ER patients.

Methods:
In this retrospective cohort study, we analyzed ECG data from 19,285 patients who visited the ERs of three hospitals between 2016 and 2020. Among the patients, 9,119 patients with available left ventricular ejection fraction and NT-proBNP levels, who were diagnosed with AHF were included. We extracted morphological and clinical parameters from the ECG data to train and validate four machine learning models: a baseline linear regression and more advanced models including XGBoost, Light GBM, and CatBoost.

Results:
The CatBoost algorithm outperformed other models, showing superior AUROC and AUPRC diagnostic accuracy across both internal (0.89±0.01 and 0.89±0.01) and external validation datasets (0.90 and 0.89). In addition, the model demonstrated high metrics in accuracy, precision, recall, and f1-score, indicating robust performance in the identification of AHF.

Conclusion:
The developed machine learning model significantly enhances the detection of AHF in ER patients using conventional 12-lead ECGs combined with clinical data. These findings suggest that ECGs, a commonplace tool in ERs, can effectively screen for AHF.
Abstract 4139494: Impact of Statins on Major Adverse Cardiovascular Events in Lung Cancer Patients Treated with Chest Radiation
Authors: OBOMANU ELVIS , Adebolu Olayinka , Idowu Abiodun , Okwuosa Tochi
Published: November 2024

Introduction:
Chest radiation has been well-documented to predispose to major adverse cardiac events (MACE). However, preventing radiation-induced adverse cardiac events is still a research gap. There is limited data assessing the preventive value of statins in cardiovascular outcomes and mortality in chest radiation-treated cancer patients. This study aimed to bridge the knowledge gap.

Methods:
Retrospective propensity-matched analysis of lung cancer patients aged 30-75 years treated with chest radiation in the TriNetX database. Patients were divided into statin users (started within 3 months before or after radiation exposure) and non-users, and a 1:1 nearest-neighbor propensity-score matching was used to reduce cofounders. We calculated adjusted odds ratios (aOR) for outcomes and performed a 5-year follow-up Kaplan-Meier survival analysis using R software.

Result:
Both cohorts consisted of 448 patients each, and they were balanced in terms of demographics, comorbidities, and baseline medications (Table 1). The statin cohorts were followed for a median of 591 days, while the non-statin groups were followed for 549 days. At follow up, the incidence of MACE (a composite of all-cause mortality, heart failure, myocardial infarction, and cerebrovascular accident) was significantly higher in the statin cohort compared to the non-statin cohort (21.4% vs 0.4%, aOR: 7.36, 95%CI: 4.26-12.73, P<0.001). The survival probability was also significantly 6-fold lower in the statin cohort compared to the non-statin cohort (HR: 6.21, 95% CI (3.66 – 10.54), Log-Rank Test p<0.001) (fig 1).

Conclusion:
Among lung cancer patients, statin use around the time of chest radiation was associated with higher MACE and lower survival compared with non-statin users. Future prospective studies are needed to better assess the effects of statins on cardiovascular outcomes for patients with cancer receiving chest radiation.
Abstract 4139504: Associations Between Changes in Maximum Daily Atrial Fibrillation Duration, Ischemic Stroke and Mortality among Patients with Cardiac Implantable Electronic Devices
Authors: Peigh Graham , Koehler Jodi , Majumder Shubha , Cho Yong , Landman Sean , Sarkar Shantanu , Ziegler Paul , Passman Rod
Published: November 2024

Background:
Atrial fibrillation (AF) outcomes are strongly associated with continuous measures of AF burden.

Objectives:
To assess the association between changes in maximum daily AF duration (MDAFD) and the combined endpoint of ischemic stroke and mortality among patients with cardiac implantable electronic devices (CIEDs) capable of continuous AF detection.

Methods:
The Optum
®
de-identified electronic health record (EHR) (2007-2021) was linked with the Medtronic CareLink
®
heart rhythm database for this study. CIED patients with healthcare activity recorded in the EHR
>
12 months pre- and
>
6 months post-CIED implant were included, excluding those with oral anticoagulation (OAC) prescription. MDAFD was assessed during the first 30 days post-implant (baseline period) and the 30 days prior to censoring or an event. Associations between change in MDAFD and the combined endpoint were evaluated, adjusting for the individual components of CHA
2
DS
2
-VASc, baseline MDAFD category and chronic kidney disease (CKD).

Results:
Of 26,400 patients (68±13 years; 60% male; follow-up 2.6±1.6 years) analyzed, 2,544 (9.6%) had AF during baseline. In all patients, increased (vs. stable or decreased) MDAFD in follow-up was associated with a higher adjusted rate of stroke and mortality (HR 1.80 [1.61-2.01]). There was no association between decreased MDAFD in follow-up and the combined endpoint. Subgroup analysis by baseline MDAFD category demonstrated that increased MDAFD in follow up was associated with a greater risk of stroke or mortality among patients with no AF at baseline, and decreased MDAFD in follow-up was associated with a lower adjusted risk of stroke or mortality among patients with baseline MDAFD 1hour-<5.5hours and 5.5hours-<23.5hours (Figure).

Conclusions:
Results from the present study suggest that progression from low burden AF is associated with negative outcomes, and that there may be threshold effects of baseline AF duration that benefit from enhanced rhythm control. These data encourage continued monitoring of AF duration over time to enhance risk stratification and further inform treatment efforts.
Abstract 4139506: Comparative Analysis of 30-Day Surgical Outcomes: Univalvular vs. Multivalvular Procedures in Contemporary Practice
Authors: Tessari Fernanda , Rosa Vitor , Nazzetta Daniella , Lopes Mariana , Vicente Pereira Lipari Layara Fernanda , CAMPOS CARLOS , Andrade Camila , de Souza Giovanna , Ferola Laura Beatriz , SAMPAIO Roney , Tarasoutchi Flavio
Published: November 2024

Introduction:
Data on multivalvular surgery are heterogeneous, not contemporary, and are underrepresented from low-income countries where rheumatic disease is prevalent

Objectives:
To compare clinical, epidemiological data, and surgical outcomes between patients undergoing surgery for one vs. 2 or more concomitant valve diseases.

Methods:
Patients in the INCORVALV Registry were divided into groups based on the number of valves treated in the same procedure: univalvular vs. multivalvular (2 or more). Outcomes were evaluated at 30 days.

Results:
Of 459 patients, 400 had single-valve and 59 had multivalve surgery, with only 1 having 3-valve surgery. Groups were similar in age (55±16 vs. 55±15 years, p=0.98), male sex (49.3% vs. 52.5%, p=0.74), NYHA class III or IV (66.7% vs. 76%, p=0.08) and comorbidities such as hypertension (59.6% vs 54.2%, p=0.57) and diabetes (18% vs 22%, p=0.57). Multivalvular patients had higher pulmonary arterial pressure (47.7±19.4 vs. 59.2±19.6 mmHg, p<0.01) and lower creatinine clearance (72.7±33.4 vs. 62.4±25.4 mL/min, p=0.03). In the univalvular group, aortic valve replacement (45.4%) and mitral valve replacement (34.9%) predominated, while in the multivalvular group, aortic valve replacement occurred in 69.5%, mitral valve replacement in 50.8%, mitral valve repair in 42.4%, and tricuspid valve repair in 16.9% of patients. Cardiopulmonary bypass time (101.9±38.1 vs. 139.6±55.3 min, p<0.01) and cross-clamp time (79.3±31.3 vs. 115.2±51.7 min, p<0.01) were higher in the multivalvular group. However, there was no difference in 30-day mortality (12.8% vs. 22.0%, p=0.08), cardiovascular mortality (10.5% vs. 18.6%, p=1.00), stroke (1.3% vs. 3.4%, p=0.23), major bleeding (9.2% vs. 15.5%, p=0.21), surgical site infection (9.2% vs. 8.6%, p=1.00), need for reoperation (8.1% vs. 10.2%, p=0.61) or 30-day hospitalization (5.0% vs 1.7%, p=0.50). Multivalvular surgery was not a predictor of 30-day mortality (HR:1.50, 95% CI 0.611-3.68, p=0.38). Predictors were: diabetes (HR:2.56, 95% CI 1.21-5.43, p=0.01), mitral valve replacement (HR:3.01, 95% CI 1.46-6.19, p<0.01), left ventricular ejection fraction (HR:0.96, 95% CI 0.93-0.99, p<0.01) and creatinine clearance (HR:0.96, 95% CI 0.95-0.98, p<0.01).

Conclusion:
Multivalvular surgery presents a comparable risk to univalvular surgery, despite older studies. This is likely due to advancements in surgical techniques and a predominance of younger patients, many with rheumatic etiology.
Abstract 4139524: Impact of Internet Use on Knowledge of Clinical Trials: An Analysis Using the Health Information National Trends Survey (HINTS) Dataset
Authors: Hussain Zaib , Michos Erin , Miller Hailey , Dennison Himmelfarb Cheryl , Sheikhattari Payam , Barsha Rifath Ara Alam , Plante Timothy
Published: November 2024

Background:
Clinical trial (CT) participation is paramount for the advancement of medical knowledge and clinical practice. However, there are significant gaps in the literature surrounding effective CT engagement, particularly for increasing CT awareness and knowledge. We seek to bridge these gaps by assessing the role internet use plays in improving access to health information, knowledge of, and participation in CTs.

Objective:
To examine the association between internet use and CT knowledge among US adults and the modalities adults seek to access the internet.

Methods:
We used HINTS 5, Cycle 4, a cross-sectional, nationally representative survey of American adults aged ≥18 years [range: 18–104 years] to conduct this analysis. Participants self-reported the use of internet and knowledge of CTs (none or little vs. higher knowledge). Multivariate logistic regression was used to estimate relative odds of higher knowledge of CTs (outcome) by internet use (exposure) in models adjusting for demographic, health-related, and socioeconomic factors. The analysis was stratified by different modalities of internet use to explore variations in knowledge acquisition. Analyses applied sample weights.

Results:
Among a weighted sample of 249,896,898 participants (mean [SD] age 47 [20.2] years, 50% women), 86% used the internet, and 10% reported higher CT knowledge. As shown in the figure, there were significantly greater odds of CT knowledge among adults using the internet in partially adjusted models. In fully adjusted models, this was no longer significant (OR 1.76, 95% CI 0.83-3.74). In analyses stratified by internet modalities, both mobile phone and home-based internet use were positively associated with higher knowledge about CT (OR=4.77, 95% CI=1.26-18.0).

Conclusions:
Mobile phone and home-based internet use show significant association with higher knowledge of CTs among adults. This underscores the importance of employing online platforms to engage potential participants. Investing in internet-based recruitment strategies could significantly augment the efficacy of CT recruitment efforts. Furthermore, a wider net should be cast for CT recruitment to ensure non-users of the internet get equitable access to information.
Abstract 4139533: Epigenetic Factors Predict Incident Heart Failure with Preserved Ejection Fraction
Authors: Sun Yan , Linchangco Gregorio , Hui Qin , Rahafrooz Maryam , Gaziano J Michael , Wilson Peter , Phillips Lawrence , Joseph Jacob
Published: November 2024

Background:
Heart failure (HF) is a life-threatening aging-related syndrome with growing impact on the global population. It is estimated that >8 million adults in the US will be living with HF by 2030. HF with preserved EF (HFpEF), defined by an ejection fraction ≥50%, frequently has delayed diagnosis and limited treatment options. HFpEF progression can be affected by both gene and environment via different molecular pathways, which can be assessed by epigenetic factors measured by DNA methylation (DNAm).

Methods:
The DNAm levels of peripheral blood cells at enrollment into the Million Veteran Program (MVP) were profiled using the Illumina’s EPIC array. After excluding samples with low quality or discordant sex, and merging with the phenotypic data, the multi-ancestry (~70%, 24%, 5.4%, and 0.6% are European, African, Hispanic, and Asian Americans, respectively) epigenetic association study in the MVP included 1658 with incident HFpEF and 33926 controls without any record of HF. Incident HFpEF was defined as the presence of a diagnostic code for HF after enrollment into MVP and a measured left ventricle ejection fraction ≥50% within 90 days of first appearance of HF diagnosis code. For each DNAm site, the association with HFpEF was examined in a multiple regression model adjusted for age, sex, race/ethnicity, calculated cell type proportions, and potential batch effects. Epigenome-wide significance (EWS) threshold (p<6.6×10
-8
) corrected for multiple testing was used to identify DNAm sites associated with incident HFpEF.

Results:
We identified 106 EWS DNAm sites associated with incident HFpEF across 22 chromosomes, including the most significant DNAm in chromosomes 9 (
AQP3
, p=2.50×10
-27
), 17 (
SOCS3
, p=3.39×10
-26
), 19 (
SBNO2
, p=2.64×10
-25
), 6 (
FGD2
, p =1.49×10
-24
), and 18 (
NDUFV2
, p=1.57×10
-24
). Most of the identified DNAm (92 out of 106, 86.8%) showed negative association with incident HFpEF. After additional adjustment for body mass index and diabetes status, the associations of 54 and 47 DNAm sites remained EWS with incident HFpEF. DNAm age (years) predicts incident HFpEF (OR 1.045, 95% CI 1.039-1.052, p=6.52×10
-14
) independently from chronological age.

Conclusion:
The significant epigenetic associations with incident HFpEF suggest the crucial role of epigenetic regulation in the pathogenesis of HFpEF. These findings may lead to novel targets for treatment and prevention which could eventually reduce the burden of HFpEF among the growing aging population.
Abstract 4139536: Incidence of Severe QT Prolongation and the Assoicated Risk of Ventricular Arrhythmias and Sudden Cardiac Death in Patients Taking Antipsychotics or Antidepressants
Authors: Wang Chun-Li , Wu Victor , Huang Yu-Tung , Chang Shang-hung
Published: November 2024

Background:
Limited data exist on the incidence of severe QT prolongation (SQTP) in patients using antipsychotics or antidepressants and the associated risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD).

Aims:
This study aimed to investigate the incidence, risk factors, and outcomes of SQTP in patients using antipsychotics or antidepressants.

Methods:
Electronic medical records from a multicenter healthcare system in Taiwan were analyzed to identify patients using antipsychotics or antidepressants with baseline and follow-up electrocardiograms. SQTP was defined as a corrected QT interval exceeding 500 ms post-treatment or an increase of >60 ms compared to baseline. Risk factors for SQTP development and associated risks of VA and SCD were assessed using multivariate logistic regression.

Results:
Following antipsychotic use (n = 28,892) and antidepressant use (n = 14,634), mean corrected QT interval increases were +7.7 ± 39.0 ms and +6.7 ± 36.1 ms, respectively. Over 10% of patients using haloperidol, amisulpride, olanzapine, quetiapine, or risperidone experienced SQTP. Antipsychotics with a known or conditional risk of torsades de pointes and antidepressants with a known risk of torsades de pointes had a higher likelihood of SQTP compared to alprazolam control. Risk factors for SQTP included age >65 years, electrolyte imbalances, renal insufficiency, amiodarone use, left ventricular ejection fraction <50%, and the use of drugs with known torsades de pointes risk. In antipsychotic users, SQTP was significantly associated with increased risks of VA (odds ratio 2.91; 95% CI 2.29–3.70) and SCD (odds ratio 2.16; 95% CI 1.50–3.12). Similarly, in antidepressant users, SQTP was significantly linked to VA risks (odds ratio 2.78; 95% CI 1.63–4.74). Subgroup analyses for females and patients aged 18-50 years yielded consistent results.

Conclusions:
Over 10% of patients on certain antipsychotics experienced SQTP, often with related risk factors. SQTP was significantly associated with elevated risks of VA and SCD in antipsychotic users, and increased VA risk in antidepressant users. Clinicians should be alert to SQTP in patients taking antipsychotics or antidepressants.
Abstract 4139552: High-dimensional single-cell antibody-sequencing (AbSeq) analysis reveals age-associated myeloid cell subsets in coronary artery disease
Authors: Komaravolu Ravi , Chatterjee Nandini , Durant Christopher , Wu Runpei , McSkimming Chantel , Drago Fabrizio , Taylor Angela , McNamara Coleen , Miller Yury , Ley Klaus , Alimadadi Ahmad , Hedrick Catherine
Published: November 2024

Introduction:
Aging is strongly associated with increased vascular inflammation, particularly in individuals over 65. Given that the development of coronary artery disease (CAD) is positively correlated with age-related inflammation, the precise distribution of myeloid subsets across different ages and CAD severity remains unclear.

Objective:
To investigate the influence of aging on myeloid heterogeneity using peripheral blood samples from the Coronary Assessment in Virginia (CAVA) cohort.

Methods:
PBMC samples from CAVA subjects (older ≥65, younger ≤64) were analyzed using AbSeq-based high-dimensional analysis. The Gensini score assessed CAD severity (high_CAD >32, low_CAD ≤ 6). Our analysis included 61 subjects in total, 33 older (18 high_CAD) and 28 younger (14 high_CAD). We examined age-wise associations across myeloid subsets.

Results:
We identified six major myeloid clusters: classical monocytes (cMo), intermediate monocytes (iMo), non-classical monocytes (nMo), plasmacytoid dendritic cells (pDC), conventional dendritic cells (cDC), and DC3. In all major clusters identified, the proportion of cMos (>75%) was consistently higher across all age groups. Although no significant differences were noted in frequencies of major myeloid populations with age, further analysis revealed significant age-related changes in subclusters. A notable decrease was observed in the cMo_CD33
hi
CD9
hi
(p=0.043) subsets in older individuals. Ingenuity Pathway Analysis of genes associated with this cluster indicated activation of IL-4, and IL-13 signaling pathways. In older subjects with high_CAD, significant decreases were identified in two specific CXCR3
+
subsets, cMo_CD14
lo
CD33
lo
CXCR3
+
(p=0.0001) and cMo_CCR6
+
CXCR3
+
(p=0.006) compared to those with low_CAD. Gensini correlation analysis in the older population also revealed a significant negative association with two cMo_CXCR3
+
subsets. Within myeloid-specific genes in the older population, positive correlations with Gensini scores were observed for
Ctsa, Flt3, Ncf1, Cd38, and C1Qb
. Conversely,
Nr4a1
,
Cxcl1, Cxcl2, Cxcl8
,
Cd83
, and
Dusp2
showed negative correlations. We observed an increase in cMo_TLR4
lo
(p=0.02) and a decrease in cMo_CD33
hi
CD9
hi
(p=0.006) in younger populations with high_CAD compared to low_CAD.

Conclusion:
Our finding highlights age-related changes in myeloid populations and their association with increased cardiovascular risk, suggesting potential targets for therapeutic intervention.
Abstract 4139554: Overview of Direct Oral Anticoagulation Trends in the North Bronx: Patient and Systemic Factors Contributing to Medication Nonadherence
Authors: Khasnavis Sujoy , Davis Nichola , Leiderman Ephraim
Published: November 2024

Introduction:
Anticoagulation nonadherence has historically been attributed to myriad factors in patient populations worldwide. While direct oral anticoagulants (DOACs) have demonstrated advantages such as less routine monitoring and fewer interactions with other medications over other anticoagulant classes, nonadherence persists and the underlying contributors vary by geography. The goal of this retrospective review was to highlight on the patient and systemic characteristics associated with DOAC nonadherence in the North Bronx.

Methods:
This review used records between 2017-2024 from two major hospital centers in the North Bronx. Patients receiving outpatient primary care and active DOAC therapy were included in the analysis. Adherence and nonadherence groups were determined based on prescription fill status and MD documentation of medication intake patterns. The groups were compared in the categories of age, gender, race, ethnicity, insurance type, diagnosis, pharmacy type, employment status, comorbidity burden, outpatient medications, primary language, and zip code. Chi square analysis was done between the categories and outcomes as well as between categories. A p value of < 0.05 was deemed significant.

Results:
The cohort had 863 patients with nonadherence of 24.9%. The adherent group's mean age was higher than that of the nonadherent (70.3 years vs 66.8 years, p < 0.005). Females were more adherent than males (79.0% vs 70.5%, p < 0.005). The adherent group was also more likely to be receiving DOAC from a retail pharmacy than from a hospital pharmacy (81.7% vs 59.9%, p < 0.005). The nonadherent group was more likely to be insured under medicaid (69.3% vs 63.0%, p < 0.005) and to be taking fewer than 10 outpatient medications (62.3% vs 54.0%, p < 0.05). English was the primary language of more patients in the nonadherent group (78.6% vs 65.7%, p < 0.005).

Conclusion:
DOAC nonadherence in the North Bronx correlates with patient age, gender, pharmacy type, insurance type, number of outpatient medications, and primary language. Nonadherence does not correlate with comorbidity burden, diagnosis, or zip code. Associations with race/ethnicity and employment status were uncertain and warrant further study.
Abstract 4139610: A Curious Complete Heart Block with Carfilzomib
Authors: Shah Mohammed , Rahman Naveed , Al-Mohamad Talal , Batra Sejal , Vyas Apurva
Published: November 2024

Carfilizomib is a proteasome inhibitor used in the treatment of multiple myeloma. The incidence of arrhythmias according to one pooled analysis was 13.3%, mostly linked to mild supraventricular arrhythmias. We present a case of carfilzomib-induced complete heart block (CHB).

A 66-year-old male with a history of restrictive lung disease on 2 liters (L) oxygen, moderate aortic stenosis and multiple myeloma presented with shortness of breath and mild chest discomfort that started earlier that day. His most recent chemotherapy with carfilzomib, cyclophosphamide, and dexamethasone was 3 days prior to arrival. Oxygen requirements increased to 15L. Laboratory findings showed elevated high sensitivity troponins (600s), elevated brain natriuretic peptide (800), creatinine of 1.86 above baseline of 0.9. Chest x-ray revealed pulmonary edema. Initial electrocardiogram (EKG 1) showed 2nd degree, type 1 atrioventricular block, which was new compared to a prior EKG. Subsequent EKGs showed alternating bundle branch blocks with LBBB and RBBB (EKG 2) that progressed to eventual complete heart block (EKG 3). Echocardiogram revealed an ejection fraction of 55-59% without wall motion abnormalities and unchanged valve pathologies.

The patient was treated for acute heart failure with diuretics and fluid restriction. Cardiac catheterization was deferred as he did not have classic anginal symptoms. Oncology recommended discontinuation of carfilzomib. Electrophysiology recommended implantation of a permanent pacemaker (PPM) due to persistent complete heart block, which he successfully underwent, improving his symptoms.

The general arrhythmogenic effects of carfilzomib are established, however there is limited data on the specific types of arrhythmias. This case suggests that carfilzomib can result in CHB. Additional monitoring or early discontinuation of carfilzomib should be considered to prevent severe conduction abnormalities resulting in morbidity and potential mortality. Further research is necessary to elucidate underlying mechanisms and risk factors associated with carfilzomib-induced conduction abnormalities and whether they resolve with discontinuation of the medication.
Abstract 4139631: Long Sleep Duration is Associated with an Increased Risk of Stroke
Authors: Thiravetyan Ben , Prasitsumrit Vitchapong , Sodsri Tulaton , Numwong Terasut , Wonghanchai Sireethorn , Xanthavanij Nutchapon , Pangkanon Watsachon , Kulthamrongsri Narathorn , Vathesatogkit Prin
Published: November 2024

Background:
Several studies have explored the association between sleep duration and cardiovascular outcomes, but the results have been contradictory. Additionally, there are limited studies conducted within the Asian population.

Goal:
This study aims to assess the relationship between sleep duration and cardiovascular outcomes in the Asian population.

Methods:
This cross-sectional study used data from a survey of employees at the Electricity Generating Authority of Thailand (EGAT). Baseline demographics, sleep history, and the presence of cardiovascular diseases were collected in 2012. Self-reported usual sleep and wake times were used to calculate sleep duration. Participants were categorized into 3 groups based on sleep duration: short (< 6 hours), normal (6-8 hours), and long (> 8 hours). Logistic regression analysis was used to assess the association between sleep duration and cardiovascular outcomes, with the normal sleep duration group as a reference. Adjustments were made for variables as shown in the table.

Results:
Among 1571 participants enrolled, 6%, 77%, and 17% were categorized into the short, normal, and long sleep duration groups, respectively. The mean (SD) age was 69 (4.6) years, and 73% were male, consistent across all groups. The median (IQR) sleep duration was 5 (4.5-5.0) hours, 7 (6.5-8.0) hours, and 9 (8.5-9.5) hours for the short, normal, and long sleep duration groups. Among these three groups, participants in the long sleep duration group had higher levels of HbA1C (p=0.049) and triglyceride (p=0.005), but a lower level of HDL cholesterol (p=0.003). Multiple logistic regression analysis demonstrated that long sleep duration was significantly associated with stroke, with an odd ratio (OR) of 3.25 (95% CI 1.27-8.36), and showed a non-significant trend towards a higher risk of coronary heart disease. We found no significant association between short sleep duration and cardiovascular outcomes.

Conclusion:
Long sleep duration is associated with an increased risk of cardiovascular diseases, especially stroke. Additional studies with larger sample sizes are needed to investigate the effects of short sleep duration.