bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4136498: Analysis of Cardiovascular Events in Cancer Survivors: A Comparative Study of Solid Tumors and Hematologic Malignancies at a Tertiary Cardiovascular Center
Authors: Amaro Palomo Eder Jonathan , Latapi Ruiz Esparza Ximena , Adib Gracia Anna Elisa , Garate Togo Javier , Sierra Lara Martinez Jorge Daniel , Hernandez Pastrana Sarai , Gonzalez Macedo Eder , Santiago Hernández Alberto , Neri Bale Raul Rodrigo , Cortes Flores Claudia Galilea , Diaz Braiana , Araiza Diego , Arias-Mendoza Alexandra , MARTINEZ RIOS MARCO ANTONIO
Published: November 2024

Background:
Cardiovascular disease (CVD) and cancer represent the leading contributors of death worldwide. Although advancements in antineoplastic therapies have notably enhanced prognoses, CVD now emerges as the primary cause of mortality in this population.

Ojective:
To assess the occurrence of CVD in cancer survivors and investigate disparities based on their previous cancer diagnosis, categorized into solid tumors or hematological malignancies.

Methods:
A cross-sectional study was conducted, including adult oncology survivors who had previously undergone oncological treatment and were referred to our center between 2010 and 2023 due to the presentation of major adverse cardiovascular events (MACE). They were categorized into two groups: those with hematological cancer and those with solid tumors. We used Chi2 test to assess differences between categorical variables and the Wilcoxon rank-sum test to evaluate differences in continuous parameters. Statistical analysis was performed using R 4.0 and StataMP 14.1.

Results:
A total of 214 oncological patients were included (median age: 69 [IQR: 55-80], women: 53%), comprising 164 (76.6%) with solid tumors and 50 (23.4%) with hematological cancer. Baseline characteristics were mostly similar between the groups (Table 1), with diabetes being more prevalent in patients with solid tumors (26% vs 12%, p=0.036). The prevalence of heart failure was predominantly NYHA I and II in solid tumors and NYHA III in hematological cancer (p=0.002) (Table 2). The incidence of coronary artery disease (CAD) was the most common MACE in solid tumors (39% vs 34%), but this was not statistically significant (p=0.04). In hematological cancer, the most frequent MACE was myocardial dysfunction, showing a significant difference (46% vs 24%, p=0.002). Similarly, valvular heart disease (VHD) appeared more frequently in this group (38% vs 20%, p=0.01). The remaining MACEs did not show significant differences, nor did the count of MACEs upon hospital arrival.

Conclusion:
Myocardial dysfunction and VHD exhibited a higher incidence in hematological cancer compared to solid tumors. Conversely, the incidence of CAD was higher in the solid tumor group; however, similar to the occurrence of other MACEs, there was no significant difference between the two groups. These findings could emphasize the importance of closely monitoring specific cancer types to enhance prevention strategies but still need further analysis to also determine the exact etiologies.
Abstract 4136501: Machine Learning Uncovers the Contribution of Rare Genetic Variants and Enhances Risk Prediction for Coronary Artery Disease in the Japanese Population
Authors: IEKI Hirotaka , Ito Kaoru , Zhang Sai , Koyama Satoshi , Miyazawa Kazuo , YOSHIDA HIROKI , Kurosawa Ryo , Enzan Nobuyuki , Ozaki Kouichi , Onouchi Yoshihiro , Kamatani Yoichiro , Terao Chikashi , Snyder Michael , Komuro Issei
Published: November 2024

Background:
Genome-wide association studies (GWASs) have enhanced our understanding of the genetic basis of coronary artery disease (CAD), and polygenic risk scores (PRSs) have facilitated the assessment of genetic risk. However, these methods predominantly focus on common variants due to statistical power, potentially leaving rare variants insufficiently analyzed and thus limiting the predictive performance of PRS.

Methods:
We conducted whole genome sequencing (WGS) of 1,752 Japanese early-onset myocardial infarction (MI) patients and 3,019 controls from Biobank Japan (BBJ). We performed case-control association studies including GWAS and gene-based tests, as well as a novel machine learning-based framework. In this framework, we developed a penalized regression model to predict the CAD status from genome-wide rare nonsynonymous variants. The model identified the minimal set of most distinguishing features (genes) and generated a rare variant-based risk score (RVS). The RVS was evaluated on an independent validation WGS cohort of 200 cases and 824 controls. We also derived a PRS based on CAD-GWAS (25,668 CAD cases vs 141,667 controls from BBJ) to compare the properties and performance between the RVS and PRS.

Results:
In the case-control studies, only two common variants in chromosome 12 were identified in GWAS, with no genes in gene-based analysis (SKAT-O), suggesting the challenges in rare variant analysis. On the other hand, our machine-learning framework identified 59 CAD-related genes, including
LDLR
, a causal gene of familial hypercholesteremia. Functional analyses revealed that various biological pathways, including lipid metabolism, immune system, and vessel development, are involved in CAD. For the genetic risk prediction, RVS significantly predicted CAD (area under the curve [AUC], 0.58; p=0.001, pseudo-R
2
, 0.051; p=7.92*10
-9
). RVS was significantly associated with LDL cholesterol levels and coagulation function (Pearson’s r, 0.21; p=4.5*10
-5
and 0.10; p=0.03, respectively) and MI patients with high RVS (top 5%) showed higher cardiovascular mortality rate (p=0.03, log-rank test), highlighting the clinical importance of RVS. Finally, the combined risk score (CRS) of RVS and PRS significantly improved CAD prediction compared to PRS (AUC, 0.66 (CRS) vs 0.61 (PRS); p=0.007, pseudo-R
2
, 0.093 (CRS) vs 0.040 (PRS); p=0.0018,
Figure
).

Conclusions:
Our machine learning framework successfully characterized rare variants and enhanced genetic risk prediction in CAD.
Abstract 4136516: Intraventricular pseudoaneurysm: A diagnosis with high mortality that demands a good eye
Authors: Beauti Wisam , Biondi Nicholas , Nabavizadeh Pooneh , hong michael , Hitchins Janki , Pisati Maanas , Dovtchinova-Crowly Anissiia
Published: November 2024

Traumatic left ventricular (LV) pseudoaneurysms (PSA) are rare, life-threatening complications of blunt chest trauma and the management is heavily reliant on early identification and diagnosis.

A healthy 55-year-old female presented after blunt chest trauma from a car accident. Bedside echocardiogram revealed a mid-septal LV discontinuity with myocardial outpouching. Lab work was significant for high sensitivity troponin of 22,000 ng/L which peaked at 24,000 in 5 hours. ECG revealed normal sinus rhythm with a QRS duration of 102ms. No ventricular ectopy was detected. Transthoracic echocardiograph (TTE) using echo contrast agent and computed tomography (CT) scan confirmed the intraventricular pseudoaneurysm (Fig 1-A&B).

A transesophageal echocardiogram (TEE) showed an intact PSA at 3.7 x 2.5 cm LV PSA with a 5mm neck extending from the mid septum superiorly into the right ventricle (RV) with no Doppler evidence of rupture or shunt (Fig 2). With cardiology and cardiac surgery shared decision making, conservative therapy was elected in the setting of polytrauma and hemodynamic stability. Serial TTEs showed stable size and appearance of the PSA during her month long hospitalization.

Cardiac magnetic resonance imaging (cMRI) 7 months later showed significant improvement in the PSA size to 0.3 cm
2
and extensive myocardial remodeling (Fig 1-C).

LV septal PSA is rare following blunt chest trauma, and it confers a considerable risk of rupture with the highest risk occurring within 3 months of formation. Untreated PSA presents with risks including thromboembolism, infection, and arrhythmia. Multimodal cardiac imaging is paramount for diagnosis and surveillance. There are no guidelines for serial monitoring in hemodynamically stable patients and an individualized approach should be taken. In this patient TTE, TEE, and CT imaging modalities were utilized. Our patient progressed without complication following conservative management with shrinking and scarring of the aneurysm characterized by the cMRI.
Abstract 4136561: Music therapy for postprocedural pain in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials
Authors: Barbosa Lucas , Araujo Beatriz , Almiron Giulia , Queiroz Ivo , Parriao Victor Dante , de Oliveira Vieira Daniela
Published: November 2024

Background:
Patients undergoing cardiac surgeries often experience significant levels of pain and anxiety, which can impair effective recovery. Music therapy has been proposed as a non-pharmacological intervention to alleviate these symptoms. This meta-analysis aimed to evaluate the effectiveness of music therapy in patients undergoing cardiac surgeries.

Methods:
We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing music therapy in patients undergoing cardiac surgeries. We pooled mean differences (MD), and standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of pain, and conducted a subgroup analysis to compare heart and respiratory rate between children and adults. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses.

Results:
Our meta-analysis included 20 RCTs comprising 1379 patients, of whom 715 (51.9%) were randomized to music therapy. Compared with control, music significantly reduced postoperative pain (SMD -0.59; 95% CI: -0.76 to -0.41; p<0.05; Figure A), and anxiety (SMD -0.59; 95% CI: -0.74 to -0.44; p<0.05; Figure B). There was a significant difference between groups in heart rate (MD -5.68 bpm; 95% CI: -9.73 to -1.63; p<0.05), overall there was an important subgroup interaction between children and adults (p=0.01). In children, music therapy reduced the respiratory rate (MD -5.98 ipm; 95% CI: -6.71 to -5.25) compared to control, whereas in adults, no significant differences were observed among these groups, overall, there was a significant subgroup interaction (p<0.01). For the primary endpoint, TSA suggested a low risk of type 1 error, therefore these results may be conclusive.

Conclusion:
In patients undergoing cardiac surgery, music therapy reduced postoperative pain, anxiety, heart rate, and respiratory rate.
Abstract 4136563: In-Hospital Outcomes of Percutaneous Versus Surgical Mitral Valve Repair in Patients With COPD
Authors: Yarlagadda Chetan , Rodriguez Esteban , Ugarov Michael , Ebner Bertrand , Colombo Rosario , Spilias Nikolaos
Published: November 2024

Background:
Percutaneous mitral valve repair has been increasingly utilized for the treatment of mitral valve disease in the recent years, although surgical mitral valve repair and/or replacement remains the preferred therapy, especially for primary mitral regurgitation. Chronic obstructive pulmonary disease (COPD) is a common comorbidity that can adversely affect outcomes of cardiac procedures. While COPD is an independent predictor of adverse outcomes after surgical mitral valve repair, its effects on percutaneous mitral valve repair is not well-defined.

Methods:
Using National Inpatient Sample data from 2011 to 2019, we conducted a retrospective study of adult patients with COPD who underwent surgical or percutaneous mitral valve repair, using ICD-9 and ICD-10 codes. We excluded patients with surgical mitral valve replacement. Patient baseline characteristics and in-hospital outcomes were compared and adjusted for covariates to investigate outcomes using a logistic regression model. Statistical significance was determined with a p-value of <0.001.

Results:
A total of 18,050 patients with COPD were included. Of these, 10,308 (57.1%) underwent surgical mitral valve repair and 7,742 (42.9%) underwent percutaneous mitral valve repair. The percutaneous cohort had a higher prevalence of heart failure, previous myocardial infarction, pulmonary hypertension, chronic kidney disease, and diabetes, while the surgical cohort had a higher prevalence of obesity and atrial tachyarrhythmias. Percutaneous repair was associated with lower rates of mortality, intraoperative complications, postoperative shock, acute coronary syndrome, and transfusions. Upon logistic regression, percutaneous repair was associated with lower rates of mortality (OR 0.28; 99% CI [0.19-0.40]), acute kidney injury (OR 0.38; 99% CI [0.33-0.44]), pneumothorax (OR 0.14; 99% CI [0.09-0.22]), vascular complications (OR 0.40; 99% CI [0.26-0.62]), and infection (OR 0.54; 99% CI [0.39-0.73]; p<0.001 for all groups).

Conclusions:
In patients with COPD, percutaneous mitral valve repair is associated with lower mortality and procedural complications compared to surgical repair. The presence of COPD should be taken into consideration when deciding treatment strategy for patients with mitral valve disease.
Abstract 4136566: Primary Pericardial Mesothelioma: Diagnostic dilemma and rapid decline
Authors: Hamilton Steven , Ting Jennifer , Colicci Steven , So-rosillo Rosendo , LaPunzina Paul , Ren Xiushui
Published: November 2024

Description of case:
A 33-year-old man with no medical history or environment exposures, presented with dyspnea, nausea, and vomiting. He was tachycardic, with jugular venous distension, pulsus paradoxus, low voltage QRS and echocardiogram (TTE) showed a large pericardial effusion with ventricular interdependence. He underwent pericardiocentesis with negative fluid studies, including cytology. Two months later he represented with dyspnea and pleuritic chest pain, was diagnosed with pericarditis, and found to have recurrent pericardial effusion without tamponade. He was treated with aspirin and colchicine and discharged, with surveillance TTE showing a stable pericardial effusion but with significant adhesions and constrictive physiology (confirmed on right heart catheterization). Negative QuantiFERON was obtained and Anakinra started. Two months later he remained symptomatic with new pleural effusions and was sent for positron emission tomography scan which revealed diffuse intensely hypermetabolic pericardial thickening/fluid, up to 3.8 cm in maximal thickness and increased uptake in mediastinal nodes. Next, a cardiac MRI showed extensive circumferential thickening of the pericardial space approximately 2.5 cm in thickness. Both the visceral and parietal pericardium exhibited extensive scattered delayed hyperenhancement. Subsequent pericardial biopsy showed markedly fibrotic pericardium and pathology showed biphasic malignant pericardial mesothelioma. Immunosuppressive medications were stopped, and he underwent thoracentesis. After multidisciplinary discussions, he was started on nivolumab every two weeks and ipilimumab with a plan for surgery based on response to therapy. However, progressive symptoms and worsening constriction physiology led to palliative consultation and comfort care transition, with him dying shortly after.

Discussion:
Recurrent pericarditis and pericardial effusion, along with negative typical pericardial fluid studies, raised suspicion for a non-benign etiology. Multimodality imaging was employed and led to a pericardial biopsy. Constrictive pericarditis is an uncommon presentation of primary pericardial mesothelioma. Biphasic mesotheliomas from pleural or peritoneal origins are normally treated with systemic therapy with preference for combined immunotherapy. Primary pericardial mesothelioma is associated with a late presentation and high mortality rate, with surgery, if able to be done early appearing to be the recommended approach.
Abstract 4136581: Shared Genetic Burden of Ischemic and Non-Ischemic Dilated Cardiomyopathy
Authors: Cao Louie , Rushakoff Joshua , Zhang Zijun , Williamson Ian , Karlstaedt Anja , Kittleson Michelle , Czer Lawrence , Kransdorf Evan
Published: November 2024

Introduction:
Ischemic dilated cardiomyopathy (IDCM) is defined as DCM caused by severe stenosis of one or more coronary arteries. Patients with non-ischemic dilated cardiomyopathy (NIDCM) have normal coronary arteries and may possess rare disease-causing variants in cardiac proteins such as
TTN
. However, IDCM and NIDCM share echocardiographic and pathologic features, possibly suggesting a shared etiology.

Hypothesis:
There is a similar prevalence of pathogenic (P)/likely pathogenic (LP) variants in patients with IDCM compared to patients with NIDCM.

Aims:
We compared the prevalence of P/LP genetic variants in DCM-associated genes in a cohort of patients with NIDCM or IDCM who received a heart transplant.

Methods:
We conducted a retrospective cohort study of patients who received a heart transplant between May 2017 and October 2023 at Cedars Sinai Medical Center in Los Angeles, CA. All subjects had LVEF ≤ 50% and LVEDD ≥ 95
th
percentile for sex and height. Whole exome sequencing was performed on explanted heart tissue. We assessed for rare variants (minor allele frequency <0.1%) in genes with a definite, strong, or moderate rating in the ClinGen DCM Gene Curation Expert Panel. Variant pathogenicity was interpreted using the American College of Genetics and Genomics criteria for DCM. Ischemic cardiomyopathy was defined by the Felker criteria (Felker et al.,
JACC
2002).

Results:
We included 60 subjects: 16 with IDCM and 44 with NIDCM. There was no difference in LVEF or LVEDD between groups (TABLE). 2/16 (12.5%) patients with IDCM carried a P/LP variant, both of which were in
TTN
. 11/44 (25.0%) patients with NIDCM carried a P/LP variant: 6 in
TTN
and 1 each in
FLNC, ILK, LMNA, MYH7
, and
RBM20
. The prevalence of
TTN
variants in each group was similar (12.5% in IDCM vs. 13.6% in NIDCM) and higher than the expected frequency in the general population (0.2%). There was no significant difference in the prevalence of P/LP variants between the groups (chi-squared p-value 0.493, Bayes factor 0.45).

Conclusion:
Patients with IDCM exhibited a similar prevalence of P/LP variants to NIDCM patients, which suggests a shared genetic burden. If further studies confirm our findings, genetic testing for individuals with IDCM may be warranted.
Abstract 4136598: Osteochondrogenic transdifferentiation of vascular smooth muscle cells and microenvironmental dynamics in medial arterial calcification at single-cell resolution
Authors: Nakao Yasuhisa , Sakaue Tomohisa , Shirai Manabu , Inoue Katsuji , Ikeda Shuntaro , Yamaguchi Osamu
Published: November 2024

Background:
Medial arterial calcification (MAC) significantly contributes to cardiovascular mortality, yet effective treatments remain limited due to unclear molecular mechanisms. This study aimed to develop a mouse model of MAC using O-ring-induced transverse aortic constriction (OTAC) and to elucidate key genes, pathways, and cellular interactions involved in MAC formation through lineage tracing and single-cell RNA sequencing (scRNA-seq).

Methods:
An OTAC mouse model was established to replicate MAC. Adult C57BL/6J male mice underwent OTAC, and subsequent analyses were conducted at various time points. Histological and immunohistochemical assessments were performed to monitor changes in vascular smooth muscle cells (VSMCs). Lineage tracing was utilized to verify the origin of osteochondrogenic VSMCs. Furthermore, scRNA-seq was employed to capture dynamic changes in VSMCs and other cell types contributing to MAC development.

Results:
The OTAC model successfully induced osteochondrogenic transdifferentiation of VSMCs, leading to MAC. Immunohistochemical analysis demonstrated time-dependent decreases in α-SMA expression and increases in SOX9 and RUNX2 expression. Lineage tracing using Myh11CreERT2;ROSA26-EGFP mice confirmed that osteochondrogenic VSMCs originated from contractile VSMCs. scRNA-seq identified osteochondrogenic VSMCs and revealed dynamic changes in surrounding cells, including macrophages and fibroblasts, which were implicated in calcification-related and inflammatory processes.

Conclusion:
The OTAC method effectively mimicked human MAC pathology, offering comprehensive insights into the microenvironmental dynamics of MAC progression at the single-cell level. This model serves as a robust platform for future research on therapeutic interventions.
Abstract 4136614: The design of novel therapeutics that target the L-type calcium channel to prevent hypertrophic cardiomyopathy
Authors: Hool Livia , Er Teagan , Reinke Daniel , Francis Alice , Solomon Tanya , Viola Helena , Cserne Szappanos Henrietta , Richworth Caitlyn , Vu Khanh , Jenkins Cathy , Camacho Londono Juan , Ponnuswamy Padmapriya , McFarlane Ciaran , Van Petegem Filip
Published: November 2024

Background:
Hypertrophic cardiomyopathy (HCM) is an inherited autosomal dominant disease of the sarcomere. Pathogenic features include ventricular hypertrophy, increased myofilament calcium sensitivity, myocardial fibrosis, and diastolic dysfunction. At the level of the myocyte there is cytoskeletal disarray, hypercontractility and altered mitochondrial function. Mitochondrial dysfunction is considered to be a key driver in HCM pathology.

Research question:
We previously demonstrated that the L-type Ca
2+
channel plays a role in the development of HCM facilitated by a structural-functional communication with mitochondria that can be regulated via the alpha interaction domain (AID) of the channel. In search of a preventative HCM therapy, we explored the efficacy of amino acid peptide variants that correspond to the AID of the cardiac L-type Ca
2+
channel.

Methods and Results:
Consistent with
in silico predictions
, competition binding assays confirmed that 4 variant peptides bound with higher affinity to the beta subunit than the AID peptide.
In vitro
studies confirmed that 3 of the 4 peptides could decrease the characteristic hypermetabolic state in myocytes isolated from a murine model of human HCM (
cTnI-G203S
).
In vivo
treatment of
cTnI-G203S
mice with peptide variants prevented the development of HCM and the development of fibrosis, in the absence of alterations in blood pressure, or kidney and liver function or changes in behaviour. Of note, the peptide variants also significantly improved contractile function. Similar effects were measured in

αMHC
403/+

mice expressing the
MYH6
mutation.

Conclusions:
Here we describe a first in class therapy that uniquely targets the L-type Ca
2+
channel to modify mitochondrial function and prevent hypertrophic cardiomyopathy. The peptides may be effective for treatment of HCM broadly because the mechanism of action involves the modification of mitochondrial function and impaired energy metabolism that is a common characteristic and driver of the pathology.
Abstract 4136627: Development of a biomarker to predict refractory cases in Kawasaki disease patients -towards the development of diagnostic kit-
Authors: Yoshikane Yukako , Fukazawa Ryuji , MAKOTO WATANABE , Takeda Atsuhito , Takatsuki Shinichi , Hirono Keiichi , Kato Taichi , Ikeda Kazuyuki , Kobayashi Naho , Suda Kenji , Nagata Hazumu , Imanaka-Yoshida Kyoko
Published: November 2024

Introduction:
Kawasaki disease (KD), which is the most common multisystem vasculitis with unknown causes in childhood, causes coronary artery lesions (CALs). Treatment with a high dose of intravenous immunoglobulin (IVIG) is the most effective therapy for the acute phase of KD. However, some very severe cases need several additional treatments and are at risk for CALs. Several scoring systems that have tried to predict IVIG-resistant patients failed in multiethnic populations.

Aims:
To develop the most effective biomarker for predicting refractory cases and determine the cut-off value for the development of the diagnostic kit.

Methods:
Multicenter, prospective, observational study was conducted at 49 hospitals in Japan between September 2017 and December 2023. The subjects consisted of 1310 KD patients, including Group 1 (n=50); treatment-resistant cases that required additional treatment of 3rd line or more (defined as refractory cases), and Group 2 (n=1260); cases that completed the treatment with 1st or 2nd line. Tenascin C (TN-C), Pentraxin 3 (PTX3), and Procalcitonin (PCT) values, which were selected by systematic review and a pilot study, were measured before initial treatment in each group. The cut-off value of the biomarker, which had the highest area under the curve (AUC), was determined.

Results:
All three biomarker values were significantly higher in Group 1 than Group 2 (p<0.01). Median [Interquartile range] in Group 1 vs Group 2 and AUC were PTX3; 44.6 [32.3-67.9] vs 12.2 [6.9-26.9]ng/ml, AUC=0.83, PCT; 4.3 [1.9-7.8] vs 0.6 [0.2-1.9]ng/ml, AUC=0.81, TN-C; 182 [122-222] vs 123 [94-163]ng/ml, AUC=0.71. PTX3 showed the highest AUC with the cut-off value of 31.7ng/ml [95% confidence interval; 31.7-34.9]. Group 1 could be predicted by PTX3 with the sensitivity of 80%, the specificity of 82%, the positive predictive value of 13% and the negative predictive value of 99%.

Conclusions:
It may be possible to predict refractory KD cases with high sensitivity and specificity by PTX3 value before initial treatment, and possibly develop a diagnostic kit using PTX3 value for prediction of refractory cases.
Abstract 4136632: Impact of Postoperative Atrial Fibrillation on Long-term Clinical Outcomes in Patients after Coronary Artery Bypass Grafting
Authors: Kuroda Yuki , Shiomi Hiroki , Morimoto Takeshi , Hirao Shingo , Tsubota Hideki , Matsuo Takehiko , Uehara Kyokun , Esaki Jiro , Shimamoto Takeshi , Kanemitsu Hideo , Tsuneyoshi Hiroshi , Kanemitsu Naoki , Iwakura Atsushi , Tamura Nobushige , Furukawa Yutaka , Kadota Kazushige , Ando Kenji , Ohno Nobuhisa , Komiya Tatsuhiko , Kimura Takeshi , Minatoya Kenji
Published: November 2024

Background:
The impact of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) on long-term clinical outcomes has not been adequately evaluated yet.

Methods:
Among consecutive 14927 patients who underwent their first coronary revascularization in the CREDO-Kyoto PCI/CABG Registry Cohort-3 (2011-2013), the study population consisted of 1483 patients who underwent CABG after excluding those with prior AF. POAF was defined as newly documented AF during hospitalization for CABG. The primary outcome measure was all-cause death after discharge. The median clinical follow-up was 5.7 (interquartile range, 4.4-6.6) years.

Results:
POAF was observed in 337 patients (23%). Multivariable logistic regression analysis indicated that age >=75 years (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.24-2.10; P<0.001) and cardiopulmonary bypass (CPB) use (OR, 1.40; 95%CI, 1.09-1.79; P=0.01) were independent predictors of POAF. Of the 1400 patients discharged alive among the study population, the POAF group included more older patients, patients with prior stroke, and patients prescribed beta-blockers and oral anticoagulants than the non-POAF group. The cumulative 5-year incidence of all-cause death was 15.9% in the POAF group and 13.0% in the non-POAF group (Log-rank P=0.38). After adjusting for confounders, the adjusted risk for all-cause death was almost neutral (adjusted HR, 0.96; 95%CI, 0.70-1.31; P=0.81). The cumulative 5-year incidence of stroke was significantly higher in the POAF group than in the non-POAF group (8.0% versus 4.2%; Log-rank P=0.02), and the adjusted risk of stroke in the POAF group relative to the non-POAF group tended to be higher (adjusted HR: 1.58, 95%CI, 0.99-2.53; P=0.057). However, the cumulative 5-year incidence of major bleeding was significantly higher in the POAF group than in the non-POAF group (14.6% versus 10.7%; Log-rank P=0.01). Even after adjusting for confounders, the excess risk of major bleeding in the POAF group was significant (adjusted HR, 1.42; 95%CI, 1.01-2.00; P=0.041).

Conclusions:
Advanced age and CPB use were associated with POAF occurrence. POAF was not associated with long-term mortality after discharge. However, it tended to be associated with a higher risk for stroke and was associated with a significantly higher risk for major bleeding. Further study would be needed to clarify the appropriate management of POAF after CABG.
Abstract 4136643: Automated cardiac arrest detection using a photoplethysmography wristband: Evaluation of the time to detection of the circulatory arrest event
Authors: Edgar Roos , Scholte Niels , Ebrahimkheil Kambiz , Brouwer Marc , Beukema Rypko , Mafi-Rad Masih , Vernooy Kevin , Yap Sing , Ronner Eelko , Van Mieghem Nicolas , Boersma Eric , Cetinyurek-Yavuz Aysun , Stas Peter , Royen Niels , Bonnes Judith
Published: November 2024

Introduction:
Out-of-hospital cardiac arrest survival depends on immediate recognition and early cardiopulmonary resuscitation. For victims of unwitnessed cardiac arrest, accounting for 30-50% of cases worldwide, survival chances are dismal as help often comes too late. Automated cardiac arrest detection and alarming would offer a solution to shorten treatment delays. Within the DETECT project, a wristband with the functionality of automated cardiac arrest detection is developed. During the DETECT-1 study, we developed a photoplethysmography (PPG) algorithm to detect circulatory arrest in patients with induced circulatory arrest.

Research question:
In this sub analysis of the DETECT-1 study, we aim to study the delay between the actual circulatory arrest and the algorithms’ cardiac arrest alarm.

Methods:
Patients undergoing circulatory arrest induction during transcatheter aortic valve implantation (TAVI), subcutaneous ICD (S-ICD) implantation or ventricular tachycardia (VT) ablation wore a PPG wristband. Continuous ECG and arterial blood pressure data were collected as reference standard. PPG data were used to develop a circulatory arrest detection algorithm in three training iterations and one validation. Time to detection was defined as the difference between the algorithm’s cardiac arrest alarm and the circulatory arrest annotated based on the arterial blood pressure data.

Results:
The validation set consisted of 86 patients (77 TAVI, 3 S-ICD, 6 VT ablation) with 97 induced circulatory arrest events of which 95 were correctly identified by the algorithm (sensitivity 97% [95% CI 90-100%]). The median time to circulatory arrest detection was -1 second (IQR -2 – 0). In total, 50 (53%) events were detected before the annotated time (median; -1 sec), 33 (35%) events were detected at t=0, and 12 (13%) events were detected after the annotation (median; +2 sec). A total of 65 (68%) induced circulatory arrest events were detected within one second before and after the annotated start time of the circulatory arrest. Return of PPG pulsations were detected in all patients, with a median of 4 seconds (IQR 3 – 7) after pulsations returned (Figure 1 and 2). There were no differences in detection time between the three subgroups.

Conclusion:
The PPG algorithm detects the induced circulatory arrest events directly when blood pressure lowers. Further research is needed to validate the circulatory arrest detection algorithm and detection interval in spontaneous cardiac arrest.
Abstract 4136701: A combined approach of cardiac magnetic resonance and CardioMEMS to assess right ventricular dysfunction during exercise in HFpEF-PH
Authors: Bekhuis Youri , Janssens Stefan , Droogne Walter , Rosseel Thomas , Barrios Leticia , Verwerft Jan , Timmermans Philippe , Trenson Sander , Dresselaers Tom , Bogaert Jan , La Gerche Andre , Claessen Guido
Published: November 2024

Background:
Right ventricular dysfunction (RVD) is common in patients with heart failure with preserved ejection fraction (HFpEF) and is associated with shortened life expectancy. Early identification of these at-risk patients could facilitate the initiation of future treatments. Evaluating the RV during exercise has proven to enhance the diagnostic accuracy in revealing RVD that is not detectable at rest. The CardioMEMS device has emerged as a non-invasive tool to remotely monitor pulmonary artery pressures (PAP) and enable early identification of clinical worsening.

Research Questions:
Using a hybrid approach of combined real-time CMR-derived volume measurements with CardioMEMS-derived PAP measurements, we aimed to identify RVD during exercise which is not detectible at rest in a population of patients with HFpEF and pulmonary hypertension (PH).

Methods:
In this prospective cohort study, we used a hybrid approach of two consecutive exercise tests in HFpEF patients (
Figure 1
). First, PAP were measured using the CardioMEMS signal on a supine bike at rest, and 25%, 50%, and 75% of peak power output determined previously on an upright cycle ergometer. Subsequently, volumes were derived by CMR at rest and during exercise at 25% and 50% of peak power output. The RV end-systolic pressure-volume relationship (RVESPVR), a surrogate of RV contractility, was calculated as mean PAP divided by RV end-systolic volume. RV contractile reserve, as a marker of RVD during exercise, was calculated as the ratio of peak exercise to resting RVESPVR, with values < 2.0 indicating impairment.

Results:
Fourteen patients with HFpEF-PH were included (age 76.6±6.9 years, 57% women). Eleven (79%) had impaired RV contractile reserve during exercise (
Table 1
). Although not significant, RVESPVR at rest tended to be better in the group with RVD during exercise (0.47±0.17 vs 0.27±0.03; P=0.070). Peak VO
2
was significantly reduced in patients with RVD during exercise (13.1±2.0 vs. 18.6±6.4%; P<0.021).

Conclusion:
A new hybrid approach combining cardiac MRI and CardioMEMS is feasible during exercise in HFpEF patients and identifies RVD in approximately eighty percent of patients with HFpEF and elevated mPAP at inclusion. Evaluation of RV contractility at rest showed a discordant trend, pointing out the need to test the RV during exercise. Further research is needed to determine if this approach can predict progression of RVD over time and serve as a risk stratification tool for these patients.
Abstract 4136704: Comparison of Early Clinical Outcomes with Balloon-Expanding Valves Versus Self-Expanding Valves in Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials
Authors: Jain Hritvik , Odat Ramez , Goyal Aman , Jain Jyoti , Rathore Sawai Singh , Jha Mayank , Patel Nandan , Passey Siddhant , Saleem Maryam , Suleiman Hassan
Published: November 2024

Background:
Transcatheter aortic valve replacement (TAVR) is an effective percutaneous intervention in patients with severe aortic stenosis, particularly in those with contraindications for surgical repair. Currently, two types of aortic valves are used in clinical practice: balloon-expanding valves (BEV) and self-expanding valves (SEV). The current data comparing early (30-day) clinical outcomes of BEV to SEV in patients with severe aortic stenosis undergoing TAVR are inconsistent.

Methods:
A systematic literature search spanning PubMed, Embase, Cochrane, and Scopus databases was conducted to retrieve randomized controlled trials (RCTs) comparing balloon-expanding valves to self-expanding valves in patients undergoing TAVR. The DerSimonian and Laird random-effects model was used to pool the odds ratios (OR) with 95% confidence intervals. Statistical significance was set at p<0.05.

Results:
This meta-analysis included five RCTs with 2190 severe aortic stenosis patients (1097 in the BEV group and 3621 in the SEV group). BEV-TAVR was associated with a significantly lower risk of 30-day new permanent pacemaker (PPM) implantation [OR: 0.67; 95% CI: 0.48, 0.93; p=0.02] and 30-day re-hospitalization for heart failure [OR: 0.20; 95% CI: 0.04, 0.96; p=0.04] compared to SEV-TAVR. The risks of 30-day mortality, 30-day cardiac mortality, 30-day all-cause stroke, 30-day myocardial infarction, 30-day life-threatening bleeding, 30-day vascular complications, 30-day acute kidney injury, and 30-day repeat procedures for valve-related dysfunction were comparable between the two groups.

Conclusion:
TAVR in patients with severe aortic stenosis using BEV is advantageous over SEV in terms of 30-day new PPM implantation and 30-day rehospitalization for heart failure, with comparable risks for other outcomes. These findings underscore the safety and efficacy of newer generation valves, including Sapien 3 and EvolutPro, in TAVR. The choice of prosthetic aortic valve is dependent on individual anatomy and operator preference. Further RCTs are warranted to evaluate other newer-generation valves with varying severities of aortic stenosis.
Abstract 4136721: Reducing the Use of Transesophageal Echocardiogram Prior to Cardioversion Using Machine Learning
Authors: Meisel Emily , Frechette Reece , Kramer Ethan , Bai Chen , Nassereddin Ali , Smoot Madeline , Edwards Emily , Kurup Varsha , Naccarelli Gerald , Naik Dhaval , Mardini Mamoun , Ruzieh Mohammed
Published: November 2024

Introduction/Background:
Direct current cardioversion (DCC) is used to terminate atrial fibrillation and atrial flutter. Due to increased stroke risk post DCC, a transesophageal echocardiogram (TEE) is performed in selected patients to rule out left atrial appendage thrombus (LAAT) prior to DCC. The prevalence of LAAT is around 2.5% in the era of direct oral anticoagulants. This is a large proportion of patients with no LAAT on TEE and calls for strategies to improve patient selections for TEE before DCC.

Research Questions/Hypothesis:
In this study we aimed to determine if the use of machine learning could accurately predict the presence of LAAT among patients with nonvalvular atrial fibrillation and atrial flutter.

Methods/Approach:
We collected demographic, comorbid, and transthoracic echocardiographic data on 795 patients who underwent TEE prior to DCC for nonvalvular atrial fibrillation and atrial flutter. We developed and validated an explainable machine learning model using the eXtreme Gradient Boosting algorithm with 5x5 nested cross-validation. The algorithm used 37 variables to predict the probability of LAAT.

Results/Data:
The prevalence of LAAT in our cohort was 11.3%. Our model achieved an area under the curve (AUC) of 0.79 in predicting LAAT, figure 1A. In comparison, CHA2DS2-VASc score performed poorly in our cohort with an AUC of 0.48, figure 1B. The ranking of variables most strongly predictive of LAAT is shown in figure 1C, with left ventricle ejection fraction as the most instrumental.

Patients were categorized into 10 groups based on the percentile of their predicted probability of having a thrombus. A lower percentile (e.g., 10%) indicates a lower probability of having a thrombus. By utilizing a cutoff point of 0.16, which includes 10.0% of the patients, we can exclude the presence of thrombus with 100% certainty.

Conclusion:
Machine learning, compared to traditional risk scores, offers enhanced predictive model for identifying LAAT and provides better guidance for TEE and anticoagulation therapy before DCC.
Abstract 4136755: Associations of Pulmonary Hypertension and Lung Cancer: A Prospective Cohort Study of Half a Million UK Biobank Participants
Authors: Zhu Fang , Zhang Qian , Luo Qingquan
Published: November 2024

Background:
Pulmonary hypertension (PH) and lung cancer (LC) are both significant public health issues with substantial morbidity and mortality. Recent studies suggest potential associations between pulmonary vascular diseases and LC due to shared risk factors and pathophysiological mechanisms, yet comprehensive research in large populations is scarce.

Methods:
This prospective cohort study utilized data from the UK Biobank, with baseline assessment between 2006 and 2010 and follow-up until November 30, 2023, for England and Scotland, and May 31, 2022, for Wales. We included 6,425 participants with LC, identified using linked cancer registry data, and followed them for the incidence of PH over a period of 10 years. We adjusted for potential confounders including age, ethnics, sex, smoking status, BMI, and histologic subtypes of LC. Statistical analyses were performed using Time-dependent Cox proportional hazards models to estimate the associations between PH and LC.

Results:
Of 502,173 participants in this prospective cohort, 6,425 were diagnosed with LC, while 494,451 did not receive the LC diagnosis. The prevalence of PH in the LC cohort and the no-LC cohort were 0.64% (1,494 of 3,142 women [47.55%]) and 2.40% (59 of 154 women [38.31%]), respectively, with significant difference between the two groups (p<0.001). In the LC cohort, the mortality rates of patients without PH and with PH were 69.18% and 77.92% (p=0.020). Among the patients diagnosed with LC and PH, 33.12% were diagnosed with LC after PH (PH-LC), while 66.88% were diagnosed with LC before PH (LC-PH). And the mortality rates of the PH-LC group and the LC-PH group were 78.43% and 77.67%, respectively, with no significant difference between the two groups (p=0.915). Time-dependent Cox regression analysis showed that PH shows an increasing trend in risk (5th year HR: 3.22, 95% CI: 2.09-4.99, p-value < 0.001), highlighting its significant impact on LC long-term prognosis.

Conclusion:
To conclude, the presence of PH significantly increased the risk of mortality in participants with LC, especially for the long-term LC survivors. And certain percentage of patients were diagnosed with LC before PH, but they had no significant difference between the patients with LC after PH.
Abstract 4136758: Apabetalone: evaluating cardiovascular and safety outcomes in meta-analysis
Authors: Tanriverdi Lokman Hekim , Dogan Muhammed Melih , Bytyci Ibadete , Penson PEter , Toth Peter , Banach Maciej
Published: November 2024

Background:
Epigenetic mechanisms play a pivotal role in the transcriptional programs associated with cardiovascular disease (CVD). Apabetalone, an orally available inhibitor of BET proteins that serve as key epigenetic readers, and modulating gene expression - holds promise as a therapeutic intervention in CVD management. Understanding its efficacy and tolerability is crucial for delineating its potential impact on disease progression and patient outcomes.

Purpose:
This systematic review and meta-analysis aimed to assess the impact of apabetalone in patients with cardiovascular disease.

Methods:
The meta-analysis was registered with PROSPERO (CRD42023423298). Databases searched included Cochrane CENTRAL, PubMed, Ovid Medline, and Web of Science. Three unique RCTs with total of 2897 patients were included, with trial durations ranging from 12 to 124 weeks. Primary outcomes assessed were all-cause mortality and non-fatal myocardial infarction (MI). Data analysis was performed using the inverse variance common effect model. Subgroup analyses were conducted based on the presence of atherosclerotic cardiovascular disease (ASCVD) or its increased risk.

Results:
Among the primary outcomes, no significant effects of apabetalone were observed on all-cause mortality (RR 0.88, 95% CI 0.63 to 1.23) or non-fatal MI (RR 0.83, 95% CI 0.62 to 1.11). Apabetalone demonstrated favorable effects on increasing Apo A1 (SMD 0.20, 95% CI 0.04 to 0.35) and HDL (SMD 0.29, 95% CI 0.09 to 0.49). However, no significant effects were observed for changes in Apo B, LDL, non-HDL, total cholesterol. Subgroup analysis did not reveal any significant differences in outcomes. Significant effects were noted in secondary outcomes. Apabetalone showed a significant increase in adverse events (AEs) leading to withdrawal (RR 1.61, 95% CI 1.21 to 2.15) and ALT and AST increases greater than three times the normal value (RR 4.50, 95% CI 2.73 to 7.41).

Conclusion:
Our meta-analysis highlights the significant impact of apabetalone on certain lipid parameters and adverse events. However, it did not demonstrate significant effects on all-cause mortality or non-fatal MI. Further well-designed and reported RCTs were warranted to elucidate the clinical implications of apabetalone in selected group of patients that might benefit the most from apabetalone that may also improve cardiovascular disease management.
Abstract 4136776: Prognostic Value of Resting Heart Rate and Heart Rate Variability in the 12-lead Electrocardiogram: Mortality Data From the CODE Nationwide Database
Authors: Moraes Diego , Nascimento Bruno , Paixao Gabriela , Rodrigues Gomes Paulo , Pires Magda , Ribeiro Antonio
Published: November 2024

Introduction:
Resting Heart Rate (HR) and Heart Rate Variability (HRV) reflect autonomic control, and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a cohort from a nationwide telemedicine network.

Methods:
We assessed unique ECGs recorded from patients ≥16 years-old, from the tele-ECG database of the Telehealth Network of Minas Gerais, Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Self-informed data were collected: sex, age, risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities (myocardial infarction, Chronic Obstructive Pulmonary Disease, and Chagas disease). Outcomes of interest were all-cause and cardiovascular mortality, assessed by ICD codes reported in death certificates, through linkage with the Mortality Information System. Cox regression was applied to evaluate the association between HR and HRV and the outcomes, in 4 models: 1. Unadjusted; 2. Adjusted for sex and age; 3. Model 2 + risk factors + clinical comorbidities; 4. Model 3 + HRV or HR, respectively.

Results:
At total 992.611 individuals were included, median age of 55 years, 60% women. In 6 years, there were 33.292 deaths (3,37%), 21% due to cardiovascular causes. Patients who died had higher prevalence of all risk factors and comorbidities, as well as higher HR: 76 (IQR 66-87) vs. 74 (IQR 65-83) bpm, p<0.001 and lower HRV: 84 (IQR 51-127) vs. 114 (IQR 74-153), p<0.001. After adjustments (model 4), all HR quartiles were independently associated a progressively increased risk of all-cause mortality, being 88% higher for the 4
th
quartile (HR=1.88 (95%CI 1.77–1.89). Similarly, the 1
st
and 2
nd
HRV quartiles remained associated with increased all-cause mortality (1
st
quartile HR=1.42 (95%CI 1.37–1.47) in the final model. For cardiovascular mortality, HR was also an independent predictor, with a progressively higher risk, with a 77% increase (HR=1.77 95%CI 1.65–1.91) in the 4
th
quartile. HRV was also an independent predictor of cardiovascular death, with a 33% risk increase (HR=1.33, 95%CI 1.23–1.44) for the 1
st
quartile. Male gender, age, and all risk factors and comorbidities were also independent predictors of all-cause and cardiovascular mortality.

Conclusions:
In a large cohort of Brazilian adults, baseline HR and HRV were independent predictors of all-cause and cardiovascular mortality, after adjustment for clinical variables and autonomic indexes.