bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18020: An Analysis of Retraction Studies in the Cardiology in Last 2 Decades
Authors: Sharma Akash , Karavadi Vidusha , Suresh Harshini , Singh Priyali , Walia Parteek , Balasubramanian Sowntappan , Venkatesh U
Published: December 2023

Background:
False information might harm patients and increase medical care costs. For accurate and rapid scientific advancement and clinical care, the integrity of published biomedical literature is essential. Hence, we analyzed the retracted studies in cardiology.

Methodology:
We adhere to the STROBE checklist. This cross-sectional study utilized PubMed and Embase databases to identify retracted publications from 2002-2022. The articles are retrieved for the detailed analysis of various characteristics, including year of publication, article type, causes of retraction, impact factor, number of citations, and author country. The statistical analysis was done by using R statistical software. Fischer t-test and 2-sample t-test were used to compare the two groups. Mann-Kendall Trend Test was used to know the trend of various variables. P-value <0.05 was considered significant.

Results:
The search yielded 979 articles. Randomized controlled studies, experimental studies, and case-control studies are major retracted study designs. Authors from China have the highest number of retracted studies (36.1%), followed by the USA (22.4%) and Japan (4%). The most common cause of retraction is mistakes and honest errors (24.51%); and duplicate data (17.78%). From 2002 to 2022, there has been an insignificant increase in the number of retracted studies with a significant decrease in the impact factor of journals, number of citations, and time to retraction. In the first decade(FD, 2003-2012) and second decade (SD, 2013-2023), males (68.2% in the FD and 66.9% in SD) had higher retraction. In the FD, USA's first authors had the highest retractions (32.5%), while in the SD, it was for Chinese authors (46%). In the SD, retracted publications had fewer citations than in the FD (mean difference (MD) -96.37, 95% CI -142.12 to -50.62, p-value <0.001). Also, the SD publications have less time for retractions (MD -9.12, 95%CI -15.52 to -2.71, p-value<0.005).

Conclusion:
The trend of retracting publications in cardiovascular diseases is increasing. The retracted studies are still cited, but there is a decreasing trend.
Abstract 18037: Left Bundle Branch Area versus Biventricular Pacing in Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis
Authors: Rivera Andre , Mesadri Gewehr Douglas , Nascimento Barbara , Oliveira Vinicius M , da Silva Menezes Junior Antonio
Published: December 2023

Introduction:
Cardiac resynchronization therapy (CRT) through biventricular pacing (BVP) is the standard treatment for heart failure with reduced ejection fraction (HFrEF) and left bundle-branch block (LBBB). Left bundle-branch area pacing (LBBAP) has emerged as a potentially more effective approach. However, its superiority over BVP remains unclear.

Hypothesis:
Is LBBAP more effective and safer than BVP for CRT in patients with HFrEF?

Methods:
We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) or observational studies that reported adjusted effect estimates (i.e propensity score-matched populations or multivariate analysis), comparing the efficacy and safety of LBBAP versus BVP. We applied the random-effects model to calculate adjusted hazard ratio (aHR) and mean difference (aMD), with the corresponding 95% confidence interval. Heterogeneity was assessed using I
2
statistics. Statistical analysis was performed using R version 4.2.1.

Results:
Our analysis included 7 studies, yielding 2,743 patients, of whom 1,164 (42.4%) were assigned to LBBAP group. Compared with BVP, LBBAP was associated with a significant reduction of the composite of overall mortality and heart failure hospitalizations (aHR 0.67; 95% CI 0.56-0.80; I
2
=0%; p<0.001; Figure 1A). Additionally, LBBAP demonstrated a significant increase in LVEF (aMD 5.77%; 95% CI 2.94-8.60; I
2
=68%; p<0.001; Figure 1B) and shortening of QRS duration (aMD -25.71 ms; 95% CI -35.87 to -15.55; I
2
=0%; p<0.001; Figure 2A) compared with BVP. Sub-analysis of patients with LBBB also demonstrated a significant reduction of the composite of overall mortality and heart failure hospitalizations (aHR 0.64; 95% CI 0.49 to 0.85; I
2
=0%; p<0.001; Figure 2B) in LBBAP.

Conclusions:
This meta-analysis of RCTs and multivariable adjusted studies suggests that LBBAP is superior to BVP in patients with HFrEF undergoing CRT for both electrophysiological and clinical outcomes.
Abstract 18049: Mathematical Modeling Predicts Treatment Efficacy in Transthyretin Cardiac Amyloidosis
Authors: Stein-Merlob Ashley F , Jin Lihua , Garfinkel Alan
Published: December 2023

Introduction:
Increased recognition of transthyretin cardiac amyloidosis (ATTR-CA) led to the development of treatments with different therapeutic targets. Optimal patient selection, treatment choice, timing and duration remain unclear. We evaluated the efficacy and timing of common and emerging ATTR-CA treatments with a mathematical model based on therapeutic mechanisms.

Methods:
We developed a system of ordinary differential equations describing transthyretin amyloid (ATTR) deposition and myocardial clearance by clusterin (Figure 1A,B). Published data and equilibrium analyses determined parameters for initial maximal ATTR density. Mechanisms of four therapies were modeled and simulated at varying levels of efficacy. Complete success of the mechanism defines 100% efficacy, i.e. full stabilization of tetramer. Expected clinical efficacy (ECE) is based on studies of clinical doses. Minimum effective clearance (MEC) is the theoretical efficacy required to reduce ATTR fibrils below the threshold for complete clearance.

Results:
All treatments reduced ATTR fibril density, correlating with efficacy (Fig 1C). At ECE, only NI006 demonstrated complete clearance of ATTR fibrils. With other current treatment strategies, amyloid density will be lowered but never cleared. The secondary mechanism of diflusinil did not change equilibrium behavior compared to tafamidis. MEC values and time to clearance at MEC were lowest for NI006 (14.7%; 65 days) and doxycycline (16.1%; 36 months). Tetramer stabilization required almost complete efficacy (99.3%) and about a decade (119 months) for tetramer clearance.

Conclusion:
This mathematical model predicts ATTR clearance by four distinct mechanisms of action. The novel anti-ATTR antibody NI006 is a promising treatment with predicted faster onset and higher effectiveness for clearance of ATTR fibrils from the myocardium. This model can evaluate future treatment strategies and therapeutic targets.
Abstract 18088: Survival After Ventricular Tachycardia Onset in Left Ventricular Assist Device Recipients
Authors: Lynch Patrick T , Maloof Alexandra , Rasekh Abdi , Nair Ajith , Colombowala Ilyas , Molina Razavi Joanna Esther , Badjatiya Anish , Chelu Mihail G
Published: December 2023

Introduction:
Left Ventricular Assist Devices (LVADs) revolutionized the care of patients with heart failure. However, the burden of ventricular tachycardia (VT) increases after LVAD insertion. The role of ablation in treating VT in LVAD recipients is unclear.

Hypothesis:
The incidence of VT following LVAD insertion is associated with worse survival, but this association is ameliorated by VT ablation.

Methods:
This is a single-center retrospective review of 549 LVAD recipients. LVADs implanted elsewhere, LVADs prior to 2011, and patients with inadequate follow up were excluded. Endpoints were transplantation, explantation, and last date of follow up. Event failure was defined as patient death. Cox and Kaplan-Meier survival analysis was performed with STATA and reported as hazard ratio with 95% confidence interval (HR [95% CI]).

Results:
Pre-LVAD VT was seen in 52% of patients: 33% had a prior ICD shock and 12% had a prior VT ablation. At study conclusion, 57% had died, 22% were transplanted, 9% were explanted, and 12% remained alive. Regardless of VT incidence, worse survival was seen in ischemic cardiomyopathy (HR 2.0 [1.5-2.7]), RV failure necessitating RVAD (HR 2.6 [1.9-3.6]), and pre-LVAD ICD shocks (HR 1.3 [1.0-1.7]). While post-LVAD VT overall was not associated with worse survival (HR 1.1 [0.8-1.3]), VT within 1 year of LVAD insertion demonstrated worse survival (HR 1.9 [1.3-2.6]; Figure 1). Incremental years between LVAD insertion and VT onset improved survival (HR 0.8 [0.7-0.9]). Among those with post-LVAD VT, ablation was not associated with a survival difference (IRR 0.9 [0.6-1.4]) regardless of the timing of ablation or VT onset.

Conclusions:
The incidence of VT within 1 year of LVAD insertion is associated with worse survival. However, mortality was not improved by VT ablation. This study is limited by its retrospective design, and further prospective studies would better determine the impact of VT ablation on survival in LVAD recipients.
Abstract 18142: A Silent Heart Break: An Uncommon Case of Silent Mitral Valve Perforation Secondary to Infective Endocarditis
Authors: agyingi chris M , Bess Olva , Gubran Ahmed , Alsillak Mohammed , Cohen Ronny , Tabot Antoine
Published: December 2023

Introduction:
Infective Endocarditis (IE) is an endocardial surface infection of the heart which may lead to valve damage and if severe, this may even lead to valve perforation which can cause significant regurgitation and cardiac function compromise. We present an uncommon case of IE complicated by mitral valve perforation.

Case presentation:
A 46-year old male with AIDS and polysubstance use was brought to the ED from a shelter after exhibiting erratic behavior with confusion. On exam, he was febrile and tachycardic. Lab data pertinent for lacticaemia and leukocytosis. Blood cultures grew Streptococcus Pneumoniae. MRI Brain was unremarkable. Echocardiography was unremarkable. Antibiotic was initiated leading to marked improvement in patient’s mental status. Despite clinical improvement, days into hospital course, a new holosystolic murmur was audible with left axillary radiation necessitating a repeat echocardiogram which revealed moderate-to-severe mitral eccentric jet regurgitation concerning for anterior leaflet perforation. He remained euvolemic without symptoms of heart failure and was subsequently transferred to a tertiary facility where a mitral valve surgery replacement was scheduled.

Discussion:
Most patients with infective endocarditis have no preceding valvular abnormality. This case is unusual as there was valvular perforation with no evidence of valvular involvement on prior imaging which could possibly be as a result of invasive streptococcus pneumonia IE potentially coexisting with bacterial meningitis which carries a high mortality rate. Invasive streptococcus pneumonia is an unusual cause of IE since wide availability of antibiotics and vaccines. This case reminds us of the need of thorough physical exam and sequential imaging in such immunocompromised patient groups.

Conclusions:
A high suspicion for mitral valve perforation should be maintained in patients with invasive streptococcus pneumoniae and new cardiac murmur.
Abstract 18143: Sudden Death in Heart Failure (HF) With Preserved Ejection Fraction: Clinical Profile and Role of Atrial Fibrillation (AF) and HF NYHA Class
Authors: Nagarakanti Rangadham , Slee April , Saksena Sanjeev
Published: December 2023

Introduction:
Clinical risk factors for sudden death(SD) in patients with HFpEF have not been hitherto well characterized nor is the impact of concomitant atrial fibrillation (AF) on SD risk in HFpEF defined.

Methods:
We evaluated 1765 HFpEF subjects from the TOPCAT Americas trial to identify potential clinical markers for SD risk. We also examined the role of AF presentation, comparing pts in sinus rhythm (SR, n=1319) to pts in AF at study entry with two different AF presentations (Any AF or AF on baseline ECG) during a mean follow up period of 2.9 years.

Results:
AF on baseline ECG was independently associated with excess CV mortality (HR 1.46, 95% CI 1.10-1.95, P = 0.009). SD occurred in 77 pts (4.4%) of all HFpEF subjects. 20 SD victims had concomitant AF on baseline ECG (26 % of all SD). SD events were significantly more frequent in males (p=.002), in black or other minority ethnicity (vs. white; p<0.001), diabetics (p=0.024), lower eGFR (p=0.035) and vascular disease (p=0.044). Multivariate Cox analysis identified significant increased SD risk in people with reduced eGFR (HR 0.98, CI: 0.97 to 1.00, p=0.005), reduced risk in females (HR 0.40, 95% CI 0.24,0.65, p<0.001) and increased risk in smokers (HR: 2.16, 95% CI: 1.03 to 4.54, p=0.042). In unmatched or propensity score matched cohorts, neither Any AF or AF on ECG was independently associated with increased SD risk (Figure; p>0.2). SD risk was also similar in early and advanced NYHA class HF.

Conclusions:
1. SD risk in HFpEF is influenced by gender, race, lifestyle and systemic comorbidities. 2. In contrast to HF with reduced EF, SD risk is not impacted by concomitant AF, its presentation or HF NYHA class.
Abstract 18157: Temporal Trends in Sex-Related Risk of Cardiac Events in Children With Congenital Long-QT Syndrome
Authors: Goldenberg Ido , Goldenberg Ilan , Zareba Wojciech , Kutyifa Valentina , McNitt Scott , Schuger Claudio D , Steinberg Martin , Steinberg John , Younis Arwa , Aktas Mehmet K
Published: December 2023

Introduction:
Unexplained male predominance during childhood until puberty is observed in long-QT syndrome (LQTS). As cardiac events in LQTS have been linked to the degree of physical activity, we hypothesized that the sex differential previously described may be attenuated by temporal trends in the level of activity in males and females with LQTS during childhood.

Methods:
The study population comprised 1,356 patients from the Rochester LQTS Registry with LQTS Types 1, 2, or 3 (genetically confirmed or retrospectively identified phenotype positive family members of a genotype positive subject) with follow-up from birth through 14 years. Based on their year of birth, patients were divided into 3 groups by vicennium: 1960-1979, 1980-1999, and 2000-2021. The primary endpoint was a CE defined as nonfatal cardiac arrest, unexplained sudden death, appropriate implantable cardioverter defibrillator shock, or syncope. The age-related incidence of a first CE in each vicennium, with birth used as the time of origin, was determined by the Kaplan-Meier method. The hazard ratio (HR) of experiencing a first CE by sex was calculated using multivariate Cox-regression analysis.

Results:
In the 1960-1979 cohort the incidence of first CE at age 14 was 28% versus (vs) 14% in boys vs girls, respectively (p<0.001 for the overall difference during follow-up [Figure left panel]). This difference was attenuated in the 1980-1999 cohort as the incidence was 30% vs 25% in boys vs girls, respectively (p=0.150 for the overall difference during follow-up [Figure center panel]). In the 2000-2021 cohort, event rates were lower and the incidence of a CE was similar in both boys and girls (18%; Figure right panel). The HRs for boys vs girls were 2.31 (p<0.001), 1.07 (p=0.684), and 0.95 (p=0.880) in the first, second, and third vicennium, respectively.

Conclusions:
The strength of sex as a risk factor for cardiac events appears attenuated in contemporary populations of children with LQTS.
Abstract 18188: Positron Emission Tomography Has Robust Negative Predictive Value for Development of Clinically Significant Cardiac Allograft Vasculopathy Over Time
Authors: Prasad Nikil , Clerkin Kevin
Published: December 2023

Introduction:
Cardiac allograft vasculopathy (CAV) affects >50% of OHT recipients by 10 years and is a leading cause of mortality. Standard CAV screening is via invasive coronary angiography (ICA). Recently it has been shown that PET with myocardial blood flow (PET/MBF) has excellent diagnostic ability for CAV, however, its prognostic value is not known.

Hypothesis:
CAV assessment by PET/MBF can prognosticate lack of significant angiographic progression of CAV over meaningful time scales.

Methods:
A retrospective analysis of 206 OHT recipients who underwent a PET/CT between ICAs was performed. CAV progression over time was assessed using intra-patient sequences of 1) baseline ICA, 2) interval PET, and 3) subsequent ICA. PET CAV grades were determined using the algorithm in Table 1. For each interval, NPV of CAV development was calculated.

Results:
Intervals between ICAs of 600, 800, 1000, and 1200 days were included with 77, 114, 106, and 22 patients respectively. Sequences were analyzed if the PET fell within middle third of interval. For development of ISHLT CAV 2/3 on subsequent ICA, PET CAV 0/1 had an NPV of 0.91, 0.94, 0.91, and 0.86 at each respective time point. For development of meaningful ISHLT CAV (presence of ≥ 30% vessel stenosis) on subsequent ICA, PET CAV 0/1 had an NPV of 0.80, 0.85, 0.85, 0.8 respectively (Figure 1).

Conclusions:
Non-invasive CAV assessment by PET/MBF provides robust NPV for development of varying degrees of clinically significant CAV over intervals up to 4 years. PET may be used as an adjunct to ICA for CAV screening and is a viable alternative among those with reasonable risk profiles. Prospective studies are needed to determine optimal interval lengths.
Abstract 18192: Sleep Apnea and Incident Atrial Fibrillation : Implications for Targeted Screening
Authors: Deb Brototo , Vasireddi Sunil K , bhatia neal , Rogers Albert J , Perino Alexander C , Narayan Sanjiv M
Published: December 2023

Introduction:
In younger individuals, the factors contributing to atrial fibrillation (AF) and ischemic stroke are not entirely understood. Despite the frequent coexistence of obstructive sleep apnea (OSA) and AF, current guidelines do not advise routine screening for either condition.

Hypothesis:
OSA may be an independent predictor of AF in younger adults

Methods:
We mined electronic health records of patients aged 20-50 Y who have had >=2 visits within Stanford Healthcare System during the period of 2008 to 2022. Our primary endpoint was incident AF. A comprehensive list of risk factors was mined as covariates. Time-varying covariate survival analysis was done to relate the covariates to the primary endpoint. Analysis was performed in R.

Results:
From a total population of approximately 1.3 million patients aged between 20 and 50 years, we identified 541168 individuals. Among them, 66088 (12.2%) had OSA. During the follow-up, 5060 young adults (67 per 100,000 person-years) developed new AF. In the multivariable adjusted time-varying analysis, apart from previously reported cardiovascular and demographic risk factors, sleep apnea [aHR:1.13 (1.06,1.20)], CKD [aHR:1.91 (1.22,1.44)], cancer [aHR:1.12, (1.04,1.20)], chronic liver disease [aHR:1.13, (1.05,1.21)] were independent risk factors of AF (Fig 1a). Although risk portended by sleep apnea may be slightly lower than some CHADS2VASC factors, sleep apnea is much more prevalent than them, which may support the benefit for screening in this young population (Fig 1b).

Conclusions:
In a cohort of over half a million adults aged between 20 and 50, sleep apnea significantly and independently predicts incident AF, which may have implications in screening and treatment strategies for younger patients.
Abstract 18213: Predictors of Left Atrial Appendage Occlusion Device-Related Thrombus
Authors: Morgan Ethan , Baghdadi Sarah , Smith Ross , Tabak Carine , Parikh Riya , Bajaj Matthew , Enders Robert , Uhlich Cody , Baer Jacob , Jiwani Sania , Harvey Christopher , GUNASEKARAN PRASAD , Hockstad Eric , Dendi Raghuveer , Reddy Madhu , Noheria Amit
Published: December 2023

Background:
Left atrial appendage (LAA) occlusion (LAAO) is preformed to prevent LAA thrombus and cardioembolic stroke in patients with atrial fibrillation (AF). There is however up to 4% risk of device related thrombus (DRT) on the left atrial (LA) side of LAAO device that is a cause for stroke. Predicting which patients are at high risk of DRT would enable more aggressive anticoagulation strategies and closer surveillance to prevent stroke post LAAO.

Objective:
To develop a risk score to predict DRT.

Methods:
From the LAAO registry at University of Kansas Medical Center we identified 26 patients with DRT. We chose 3 controls per case at random from other LAAO recipients without DRT. Predictor variables were obtained from transesophageal echocardiogram (TEE) reports and images, transthoracic echocardiogram reports and detailed clinical chart review. LAAO device depth was measured from the center of the device to the peak of the left atrial ridge in 45° TEE view.

Results:
We analyzed 26 DRT patients (age 77.7±9.7 yr, 34.6% female) and 78 controls. Univariate predictors of DRT included history of venous thromboembolism (VTE, 23.1% vs 5.1%, P=0.01), presence of spontaneous LA echocontrast (SEC) on TEE (26.9% vs 7.7%, p=0.02), implant depth >2 cm (34.6% vs 12.8%, p=0.02) and rhythm at implant being AF (50.0 % vs 11.5%, p=0.0001). Using a multivariate model with these variables we devised a risk score with 1 point each factor except 2 points for AF rhythm. A total score of ≥3 had odds ratio 13.6 (95% CI 3.8-48.4, p<0.0001) of DRT (see Tables).

Discussion:
We present a DRT risk score comprising history of VTE, LA SEC, implant depth >2 cm (1 point each) and AF rhythm (2 points). Score of ≥3 identified patients at high risk of DRT. This score needs to be validated in an independent dataset.
Abstract 18236: Enhancing Predictive Accuracy of H2FPEF Score in Suspected HFpEF by Incorporating Left Atrial Reservoir Strain
Authors: Shinzato Mariane , Santos Natasha , Cancellier Renato , Nishida Gustavo , Moriya Henrique Takachi , Maduro Yuri , Assef Jorge , Botelho Roberto , Hossri Carlos , Feres Fausto , Franchini Kleber , Hortegal Renato
Published: December 2023

Introduction:
Diagnosing HFpEF can be challenging, but the H
2
FPEF score is a valuable tool for clinical decision-making. Atrial fibrillation (AF) plays a significant role in this score, creating challenges for diagnosis in patients without AF or with paroxysmal AF. Left atrial reservoir strain (LArS) has emerged as a promising indicator for both AF and HFpEF. This study explores how incorporating LArS can enhance the predictive ability of the H
2
FPEF score for exercise capacity in outpatients with suspected HFpEF.

Methods:
This cross-sectional study has a sample size of 283 patients with suspected HFpEF. We collected clinical and echocardiographic data and compared LArS values across different H
2
FPEF score categories. Additionally, we analyzed a subgroup of 129 patients who underwent a Cardiopulmonary Exercise Test (CPET) to evaluate the effectiveness of the H
2
FPEF score and LArS in predicting Peak VO
2
. To further comprehend the contribution of each feature in the performance of the H
2
FPEF score, we used Shapley Additive Explanations (SHAP) analysis.

Results:
Most patients were female (63%), age of 60 (±12) years and LVEF of 60 (±5.2)%. Patients with low scores had a LArS of 32.6 (± 6.8)%, while those with moderate and high scores had probabilities of 26(± 8.2)% and 16 (±8.2)%, respectively (p<0.001). The H
2
FPEF score demonstrated an AUC of 0.74 (95% CI: 0.64-0.84) in predicting peak VO
2
, whereas LArS exhibited an AUC of 0.71 (95% CI: 0.62-0.80). Incorporating LArS into the score improved its performance, resulting in an AUC of 0.82 (95% CI: 0.75-0.89). The SHAP analysis revealed that LArS had a significant impact as the most important feature (Figure 1), while the importance of the atrial fibrillation criterion decreased significantly.

Conclusions:
Our findings show that integrating LArS improves the diagnostic performance of the H
2
FPEF score and offers a valuable alternative to the AF criterion within the H
2
FPEF algorithm.
Abstract 18245: ViTrack™ : A Computer Vision Technology for Continuous Blood Pressure and Advanced Cardio Hemodynamics
Authors: Thanikachalam Mohan , Boverman Greg , Rajamanickam Gokul Prasath , Aleiferis Stamatios , Huang Brendan , Wong José
Published: December 2023

Introduction:
There is an unmet need for a wearable device for accurate and continuous non-invasive blood pressure (BP) and other cardio-hemodynamic parameters in real-world situations.

Methods:
To address the need, we have developed ViTrack™, a wrist wearable optomechanical sensor capable of 3D contact sensing at the microscale. ViTrack, based on a fundamentally new method, utilizes pressure-dependent spatiotemporal skin displacement to directly measure beat-to-beat SBP and DBP. ViTrack also measures heart rate and respiratory parameters, and advanced hemodynamic parameters. In real-world settings, patient activities such as body or arm movements introduce motion artifacts that interfere with BP measurement. To address this, ViTrack’s 3D imaging system has been enhanced with advanced computer vision and AI/ML techniques to ensure precise and consistent measurements, regardless of patient movement or wrist position relative to the heart (hydrostatic pressure change).

Methods:
We have built a minimum viable product. Animal studies (n = 12) showed that the device correlates well (R2 value = 0.958) with invasive arterial pressure (IAP). In outpatient settings, in more than 120 subjects, both male and female, with a wide range of BP (86-180 SBP; 60-110 DBP), when compared to the auscultatory method, ViTrack measures BP in accordance with FDA standards (Association for the Advancement of Medical Instrumentation [AAMI] standard: mean offset < 5mmHg; standard deviation <8 mmHg). Subsequently, in unconstrained patients (n=14), we compared the ViTrack continuously over 2 hours against IAP in real-life ICU conditions. The arm with ViTrack was unconstrained, while the opposite arm was constrained because of the IAP line. With the implementation of the computer vision and AI/ML algorithms, when beat-to-beat measures were averaged across 20 seconds and compared to IAP, ViTrack demonstrated excellent accuracy for both DBP (mean error = -1.37 mmHg [SD = 3.8 mmHg]) and SBP (mean error = -2.69 mmHg [SD = 5.99 mmHg]).

Conclusions:
Studies show that ViTrack, a wearable device, can accurately and continuously measure BP in real-world settings. The technology could disrupt the way we measure and manage BP. A multi-center trial is further validating the technology.
Abstract 18252: Comparison of an Artificial Intelligence Heart Failure Detection Model and Clinical Prediction Models in Patients With Heart Failure With Preserved Ejection Fraction (HFPEF)
Authors: Akerman Ashley P , Al-Roub Nora , Angell-James Constance , Thompson Rasheed , Bosque Lorenzo , Hawkes Will , Piotrowska Hania , Leeson Paul , woodward gary , Upton Ross , Strom Jordan B
Published: December 2023

Background:
An artificial intelligence (AI) model to diagnose heart failure (HF) with preserved ejection fraction (HFpEF) based on deep learning of echocardiographic (TTE) images could improve under-recognition of disease. However, the diagnostic accuracy in high-risk patients, compared to existing clinical prediction models, remains uncertain.

Methods:
In this retrospective case-control study, we identified patients who received routine TTE at Beth Israel Deaconess Medical Center, Harvard Medical School. Cases were defined by presence of ICD-10 codes for HF (I50.X), LVEF≥50%, and grade II or III diastolic dysfunction. Controls were defined by absence of HF within 1 year of the index TTE. The discriminatory performance of an AI HFpEF model (EchoGo Heart Failure, Ultromics Ltd.) was compared to the clinical H2FPEF score.

Results:
Both cases (n=213, 75±12 years, 53% female, 29.4±7.1 kg/m2) and controls (n=226, 75±13 years, 54% female, 27.0±5.6 kg/m2) were high-risk for HFpEF, with high rates of hypertension, atrial fibrillation, diabetes, coronary artery, kidney, and pulmonary disease. The H2FPEF score demonstrated high sensitivity (mean [95% CI]; 97.3% [94.3, 100%]) and modest specificity (38.1% [25.9, 55.9%]). The AI HFpEF model had similar sensitivity (88.8% [84.0, 93.4%]) and slightly improved specificity (55.6% [47.7, 64.0%]). In the 265 patients (60.4%) with non-diagnostic H2FPEF scores, the AI HFpEF model successfully classified 144 patients as probable HFpEF (
Figure
). The H2FPEF score identified 31 (54.5%) whereas the AI HFpEF model identified 45 (78.9%) HFpEF patients who were hospitalized within 1 year of the TTE.

Conclusions:
An AI model to detect HFpEF improves upon identification of HFpEF amongst high-risk individuals, thus potentially improving the capacity to identify patients who might benefit from treatment.
Abstract 18270: Interagency Registry for Mechanically Assisted Circulatory Support Profile is Associated With Outcomes in Patients With an Impella 5.5 Ventricular Assist Device
Authors: Maigrot Jean-Luc A , Starling Randall C , Soltesz Edward G , Smedira Nicholas G , Tong Michael , Unai Shinya , Bhat Pavan , Moros David , Blackstone Eugene H , Weiss Aaron J
Published: December 2023

Introduction:
The Impella 5.5 left ventricular assist device (LVAD) can provide temporary mechanical circulatory support (MCS) in select patients with advanced heart failure (HF). The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile provides a standardized grading system for advanced HF patients receiving MCS, ranging from most (1) to least severe (7).

Hypothesis:
The INTERMACS profile is associated with outcomes in patients supported with an Impella 5.5 LVAD.

Methods:
From 2019-2022, retrospective review of perioperative characteristics, INTERMACS profile and outcomes in patients supported with an Impella 5.5.

Results:
When stratified by INTERMACS profile, there were 63 patients (28%) in profile 1, 73 (32%) in profile 2, 20 (8.8%) in profile 3, 72 (32%) in profiles 4-7. Indication for Impella 5.5 implant was primarily cardiogenic shock due to chronic HF (81; 52%), acute MI (33; 21%) or postcardiotomy (22; 14%) in profiles 1-3 and Impella 5.5-assisted cardiac interventions (cardiac surgery, VT ablation, PCI) (68; 94%) in profile 4-7 (p<0.01). Composite freedom from death, durable LVAD, or heart transplant occurred for 63 (41%) profile 1-3 and 66 (92%) profile 4-7 patients (p<0.01).

Conclusions:
Patients with advanced INTERMACS profiles (1-3) primarily underwent Impella 5.5 implant for chronic HF, postcardiotomy, or acute MI cardiogenic shock, whereas patients in profiles 4-7 primarily underwent Impella 5.5-assisted cardiac interventions. Patients with advanced profiles were more often transitioned to durable LVAD or heart transplant, however, also had higher rates of mortality.
Abstract 18289: A Real-World Analysis Of New-Onset Heart Failure After Anterior Wall ST-Elevation Acute Myocardial Infarction
Authors: Van Tassell Benjamin W , Talasaz Azita , Abbate Antonio , Ziegelaar Brian , Redlich Garry
Published: December 2023

Introduction:
The one-year incidence of heart failure (HF) after anterior wall ST-elevation acute myocardial infarction (STEMI) remains difficult to determine due to inconsistencies in definitions.

Aims:
Evaluate the 1-year incidence of HF after anterior wall STEMI in a real-world data set using a variety of potential definition criteria.

Methods:
A retrospective cohort study of anonymized patient data was accessed through a federated health research network (TriNetX LLC) of 56 US healthcare organizations (US Collaborative Network). Patients were identified based upon ICD-10 criteria for anterior wall STEMI during the 10-year period from 2013-2022 and the absence of pre-specified signs or symptoms of HF. One-year incidence was calculated as 1 minus Kaplan-Meier survival at 12 months after anterior wall STEMI. The analysis utilized 5 different types of definition criteria for HF. Univariate Cox proportional hazards ratio was calculated to compare risk associated with potential risk factors.

Results:
A total of 34,395 patients from the US Collaborative Network met eligibility criteria and were included in the analysis. One year incidence of HF based upon each definition criteria is summarized in table 1 and figure 1. Age ≥65 years, Black race, low density lipoprotein ≥100 mg/dL, elevated hemoglobin A1c, and BMI ≥35 kg/m
2
were also associated with increased risk of HF.

Conclusions:
Patients with anterior wall STEMI continue to be at high risk for new onset HF. In the absence of structured, prospective, systematically adjudicated diagnostic criteria, composite definitions are more likely to yield accurate estimates of HF incidence.
Abstract 18296: Insights From the LURIC Study: Decoding the Peripheral Immune Cell Composition in Atherosclerosis Through Single Cell RNA-Sequencing
Authors: Horstmann Hauke , Anto-Michel Nathaly , Hansen Sophie , Westermann Dirk , Maerz Winfried , Zirlik Andreas , Wolf Dennis
Published: December 2023

Introduction:
Atherosclerosis and its clinical sequelae, myocardial infarction and stroke, represent the main causes of death worldwide. Although preclinical evidence has suggested the existence of a sustained inflammatory and immune response driving disease and complications, the extend of cellular alterations in human atherosclerosis remains enigmatic.

Hypothesis:
Here, we employ single cell RNA-sequencing (scRNA-seq) on peripheral blood mononucleated cells (PBMCs) in a well-defined cardiovascular risk cohort from the Ludwigshafen Risk and Cardiovascular Health (LURIC) trial to define changes in the immune cell landscape in atherosclerotic patients

Methods:
Of 3317 patients enrolled in the LURIC trial, we selected individuals with stable coronary-artery disease (CAD) (n=31) and healthy patients (no CAD) (n=16) by propensity score matching, adjusted for CRP, NT-proBNP, Troponin T, LDL-C, and Cystatin-C, in a case-control design. scRNA-seq was performed by droplet sequencing on PBMCs stored in liquid nitrogen. Individual data sets were integrated and changes between healthy individuals and patients with CAD were evaluated on numeric and transcriptional levels.

Results:
We identified several regulated leukocyte populations that were differentially regulated between both conditions. Interestingly, small cell populations like Tregs (>1.4-fold more), platelets (>10-fold more), stem cells (>3-fold more), and proliferating cells (>2-fold-more) were significantly increased in PBMCs from patients suffering from CAD. On the contrary, naïve B cell and T cell populations were considerably overrepresented in healthy control patients (>1.4-fold more). Pathway analyses of distinct clusters in patients with CAD revealed increased signalling for cellular exhaustion, response to stress, and leukocyte activation, which strikingly resembles the underlying pathology in atherosclerosis.

Conclusions:
Employing scRNAseq, we demonstrate that atherosclerosis is associated with a profound change in the circulating immune cell landscape even in the absence of measurable differences in inflammatory biomarkers. These findings propose the usage of scRNAseq for the discovery of outcome-relevant cellular biomarkers in the future.
Abstract 18298: 10-Year Trends of In-Hospital Outcomes of Patients That Underwent Percutaneous Coronary Intervention for Cardiogenic Shock Complicating Acute Coronary Syndrome
Authors: Ohata Takanori , Kohsaka Shun , Nakamaru Ryo , Shiraishi Yasuyuki , Ueda Ikuko , Kuno Toshiki , Kodaira Masaki , Ono Tomohiko , Numasawa Yohei , Noma Shigetaka , Ieda Masaki
Published: December 2023

Background:
Cardiogenic shock complicating acute coronary syndrome (CS-ACS) is a life-threatening condition and percutaneous coronary intervention (PCI) remains a fundamental approach in its management. In recent years, notable advancements have emerged, including the utilization of mechanical circulatory support (MCS) devices and an enhanced understanding of patient selection for PCI. This study aims to assess the temporal trends in patient background and outcomes of patients who underwent PCI for CS-ACS.

Methods:
The Keio interhospital Cardiovascular Studies (KiCS)-PCI registry prospectively collects approximately 200 variables, which were defined in accordance with the National Cardiovascular Data Registry (NCDR), from the major teaching hospitals in Tokyo metropolitan area in Japan. Between 2009 and 2019, 24,671 consecutive cases were registered, 10,053 patients (40.7%) undergoing PCI for ACS, of which 870 patients (8.5%) had CS-ACS. We stratified CS-ACS patients into 4-time frame groups (T1: 2009-2011, T2: 2012-2013, T3: 2014-2016, and T4: 2017-2019), and examined the temporal trends in patient risk profiles using the NCDR score (ranging 0-100, reflecting predicted mortality rates). Additionally, we assessed the incidence and types of employed MCS as well as the in-hospital mortality rate.

Results:
During the study period, the proportion of CS-ACS remained stable, accounting for 8.0% in T1 to 8.2% in T4 of ACS-related PCI cases. The calculated NCDR risk score demonstrated minimal variation, ranging from 70.6 in T1 to 70.1 in T4. There was a notable decrease in the utilization of MCS (66.5% in T1 to 56.7% in T4), mainly driven by a reduction in the use of intra-aortic balloon pump (70.3% to 55.0%, p for trend<0.001), with a increase in the concomitant use of veno-arterial-extracorporeal membrane oxygenation (27.6% to 36.2%, p for trend<0.001). However, the in-hospital mortality rate for CS-ACS patients remained persistently high at 30%.

Conclusion:
Over the past decade, there have been notable changes in the peri-procedural management of CS-ACS, albeit no significant improvements in patient outcomes was observed. The result calls for additional efforts to enhance their management.
Abstract 18302: Impact of Guideline-Directed Statin Intervention in Secondary Prevention Patients Stratified by Diabetes Status
Authors: Mulukutla Saarang S , Zhu Jianhui , Thoma Floyd W , MARROQUIN Oscar C , Nasir Khurram , Gianos Eugenia , Saeed Anum
Published: December 2023

Background:
The 2018 ACC/AHA Cholesterol guidelines recommend that patients with diabetes and known ASCVD should be prescribed high-intensity statin therapy. We analyzed statin use and associated ASCVD outcomes in patients with diabetes and ASCVD across a healthcare network.

Methods:
Using EMR data, statin utilization was analyzed on patients with established ASCVD (CAD, ischemic stroke, TIA and PAD) stratified by diabetes status. Statin use was divided as: (1)
no statin
, (2)
less than guideline-directed statin intensity
(<GDSI), and GDSI. Cox regression models were used to assess HRs and incidence rate per 1000-person years for secondary ASCVD outcomes (MI, ischemic stroke/TIA and all-cause death) in the population.

Results:
Over a median follow up of 6 years, out of 38,309 secondary prevention patients, 34.3% had diabetes. Over 30% of patients in both groups received no statin or <GDSI. Patients with diabetes and no statin use had higher incidence of MI (107 vs 37 per 1000PY), stroke (44 vs 17) and death (122 vs 45) than those on GDSI. In comparison to GDSI, patients receiving <GDSI or no statin were at significantly higher risk for all adverse outcomes in a graded manner (Table).

Conclusions:
In a contemporary real-world practice, there is an underutilization of GDSI amongst patients with known ASCVD with or without diabetes. Patients with diabetes suffer worse consequences as a result of this underuse. Efforts to ensure guideline implementation and optimal statin use can curtail burden of future ASCVD events.
Abstract 18308: Effective Atomic Number and Electron Density Number in the Infarcted Myocardium Were Significantly Lower Than Normal Group and Non-Infarcted Myocardium Using the Latest Spectral CT
Authors: Funabashi Nobusada , Akaza Shin , Shukuya Atsushi , Asano Hiroki
Published: December 2023

Introduction:
Spectral CT with a dual layer detector can be used to acquire new parameters, such as effective atomic (EAN) and electron density number (EDN). Hypothesis: The EAN and EDN obtained from the latest spectral CT with a dual-layer detector in infarcted myocardium were lower than the myocardial in the normal group and non-infarcted myocardia of patients with previous myocardial infarction (MI).

Methods:
This retrospective study comprised two groups of patients: those with previous MI (MI group; n = 20; mean age, 73±7 years) and those with clinically suspected coronary artery diseases, no significant stenosis in the coronary arteries, and a normal ECG (normal group; n = 146; age 55±14 years). All patients underwent cardiac spectral CT (7500; Philips) with a dual-layer detector. The EAN and EDN were measured in the interventricular septum (IVS), left ventricle (LV) anterior wall of the (LVAW), and LV lateral wall (LVLW) within a 1.0 mm2 circle at the LV inflow level in axial images during the non-contrast phase and early phase (with a contrast agent).

Results:
During the non-contrast phase, the EAN in the infarcted myocardium was significantly lower than those in the normal group (P < 0.01) and the non-infarcted myocardia in the MI group (P < 0.05). During the early phase, the EAN in the infarcted myocardium was also significantly lower than those in the normal group (P < 0.01) and the non-infarcted myocardia in the MI group (P < 0.05). During both phases, the EDN in the infarcted myocardium was significantly lower than those in the normal group (P < 0.01) and the non-infarcted myocardia in the MI group (P < 0.05).

Conclusion:
During both phases, the EAN and EDN in the infarcted myocardium were significantly lower than those in the normal group and the non-infarcted myocardia in the MI group. Using this novel CT approach and the data from the non-contrast phase may aid in detecting abnormal characteristics (such as reduced blood flow, fibrotic changes, or inflammation) in the myocardium.
Abstract 18319: Regional Disparities in the Cardiovascular Deaths Among Sarcoidosis Patients: A CDC-Wonder Database Analysis From 2005-2020
Authors: Faisaluddin Mohammed , V Nair Ambica , Osama Muhammad , Patel Harsh P , Thakkar Samarthkumar , Alweis Richard , Hedge Shruti , Dani Sourbha , Iqbal Uzma , Feitell Scott , Kassi Mahwash
Published: December 2023

Background:
Sarcoidosis can manifest as “Cardiovascular Death (CVD)” in undiagnosed patients. Regional Impact and Disparities In CVDs among sarcoidosis have not been identified.

Methods:
We analyzed data from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database from January 2005, to December 2020. All deaths related to CVS were included from 4 different regions. Data for deaths related to sarcoidosis and CVD were obtained by querying “Sarcoidosis” using ICD 10th Revision code “D86”. Rates per year for trends and disparities were calculated using cumulative CVD.

Results:
A total of 8211 CVD from 2005-2020 were identified among sarcoid patients- 1666, (20.2%) in north east, 1,697 (20.64%) in midwest, 3,684 (44.81%) in south and 1,164, (14.15%) in west . The CVDs occurred mostly in the ages(55-74) in the northeast, (45-74) in the Midwest, (35-84) in the south and (45-84) in the west. Incidence of cardiovascular death among females with sarcoid was greater than males in all regions .(12.03% vs 8.25% in northeast , 12.65% vs 8.02% in midwest , 8.12 %vs 6.05% in west , 27.13%v/s 17.73% in south ). The South showed a significantly higher population of blacks suffering from CVD (31.3% blacks vs 12.61% whites) whereas in other regions , the rates were comparable. The most common cause of CV death was found to be cardiac arrest (28.8 %) in the north east, cardiomyopathy(27.09%) in the midwest , cardiac arrhythmias (17.13%) in the west and conduction disorders (52.17%) in the south. An increasing trend of CVD was recorded in the south with an increase in rates from 42.5% in 2005 to 45% in 2020.

Conclusion:
Incidence of CVD related to sarcoidosis is highest in the south and females had higher mortality in all regions. Pulmonary hypertension, cardiac arrest and CHF were the major causes of CVD.
Abstract 18328: A National Survey to Identify the Inequality in the Career Development Between Male and Female Cardiologists in Japan
Authors: Shimbo Mai , Nishizaki Fumie , Fukue Noriko , Matsumoto Chisa , Noma Satsuki , Ohno-Urabe Satoko , Kamiya Chizuko A , Kanki Sachiko , Ide Tomomi , Izawa Hideo , Taniguchi Tatsunori , Nakayama Atsuko , Kobayashi Yoshio
Published: December 2023

Background:
Equality of training opportunities and job satisfaction are not well studied among Japanese cardiologists, especially among female cardiologists in the invasive subspecialties.

Methods:
We investigated the career development of cardiologists using a questionnaire sent by e-mail to 14,798 cardiologists belonging to the JCS in September 2022. Feelings of equality in training opportunities and job satisfaction were assessed by examining cardiologists' age, gender and subspecialty. These feelings were compared between male and female cardiologists. Invasive treatment subspecialties included ischemia, arrhythmia, surgery, structural heart disease and emergency.

Results:
Responses were received from 2,566 cardiologists (17.3%). Female cardiologists (n = 624) were underrepresented in ischemia, cardiac surgery and emergency compared to male cardiologists (n = 1,942) (13.0% vs 29.5%, 2.4% vs 6.2%, 1.0% vs 3.2%, 1.4% vs 2.6%, respectively). Female cardiologists perceived more inequality in training opportunities than male cardiologists (44.1 vs. 33.9%, p=0.0001) and were less satisfied with their work than male cardiologists (71.3 vs 80.8%, p=0.0001). In the invasive subspecialties, female cardiologists felt more inequality than male cardiologists (50.0 vs 36.2%, p<0.001) and were less satisfied with their work than male cardiologists (74.0 vs 81.7%, p=0.001). Although male cardiologists in invasive subspecialties did not feel significantly more unequal and dissatisfied than those in non-invasive subspecialties (p=0.063, p=0.758, respectively), female cardiologists in invasive subspecialties felt more unequal and dissatisfied than those in non-invasive subspecialties (p=0.015, p=0.040, respectively). In invasive subspecialties, cardiologists with family care responsibilities were less satisfied with their work than cardiologists without those responsibilities (84.0% vs. 79.0%, p=0.039).

Conclusions:
Female cardiologists felt more inequality and dissatisfaction in career development than male cardiologists, especially in invasive subspecialties. Diverse workplaces can promote equality in training opportunities and job satisfaction for both female and male cardiologists.