bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4134912: Geographic, Gender,&Racial Trends in Mortality Due to Coronary Artery Disease in Diabetes among Adults Aged 25 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis
Authors: Naveed Muhammad Abdullah , Ali Ahila , Neppala Sivaram , Omer Rehan Muhammad , Azeem Bazil , Iqbal Rabia , Chigurupati Himaja Dutt , Sattar Yasar , Paul Timir
Published: November 2024

Background:
Coronary artery disease (CAD) is a significant contributor to mortality among adults with diabetes mellitus (DM) in the United States. This study examines the patterns of CAD-related mortality in individuals aged 25 and above with DM, with a particular focus on geographic, gender, and racial/ethnic discrepancies from 1999 to 2020.

Methods:
The study analyzed death certificate information from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were computed per 100,000 individuals, categorized by year, gender, race/ethnicity, and geographic areas.

Results:
Between 1999 and 2020, CAD in individuals with DM resulted in 1,462,279 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (44.2%) and at home (29.3%). The overall age-AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95% CI: -1.29 to -0.77 p < 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p < 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p < 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in urban areas (AAPC: -1.22, p < 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629).

Conclusion:
The decrease in AAMRs for CAD among individuals with DM from 1999 to 2020 indicates improvements in healthcare management. However, the ongoing disparities based on race, gender, and geography call for targeted public health interventions to guarantee fair access to cardiovascular care. Additional endeavors are necessary to comprehend and alleviate the root causes of these inequalities.
Abstract 4134957: Survival and Cardiac Recovery in Pediatric Dilated Cardiomyopathy: A Long-term Cohort Study of Risk Factors, Prognosis, and Health Outcomes Followed into Adulthood
Authors: Navarro Jose , Jeewa Aamir , Fang Jiming , Lee Douglas , Jean-St-Michel Emilie
Published: November 2024

Background:
Dilated cardiomyopathy (DCM) is the most common cause of pediatric heart failure (HF), but there is limited literature on its long-term prognosis and treatment outcomes. We examined risk factors for long-term morbidity and mortality and outcomes of care in childhood-onset DCM.

Methods:
Electronic medical records from a tertiary care pediatric hospital (SickKids, Toronto, Canada) were used to retrospectively follow children ages 0–18 years with DCM from January 1, 2001 to July 1, 2017. Provincial healthcare administrative data was used to monitor outcomes recorded outside of SickKids, following patients during the same time period and into adulthood (age >18 years) until August 31, 2023. We compared DCM cases, with or without echocardiographic recovery (LVEDD z score < 2 and LVEF ≥ 55%), and controls matched on sex, age, and urban/rural residence on a range of health and health service outcomes. Primary outcomes included all-cause mortality, heart transplant (HT), and inpatient admission for HF. Among cases, Cox proportional hazards regression with backwards selection was used to identify demographic, disease, and treatment characteristics associated with each primary outcome, with candidate variables selected based on univariate analysis and clinical judgment.

Results:
We studied 156 patients with DCM and 780 controls for a median of 14.8 years. Median age at the end of follow-up was 16.2 years. Compared with controls, DCM cases had higher rates of all-cause death, HT, and HF admission (all
P
<0.001), as well as chronic kidney disease (
P
<0.001) and diabetes (
P
=0.002). Compared to cases with recovered DCM (n=53), non-recovered cases had higher rates of death, HT, and HF admission (all
P
<0.001). On multivariable analysis, beta blockers were associated with reduced mortality risk (HR 0.343, 95% CI 0.162–0.727). Using any HF medication (HR 0.205, 95% CI 0.102–0.412) and living in an urban versus a rural area (HR 0.166, 95% CI 0.048–0.573) decreased HT risk. Idiopathic (HR 4.16, 95% CI 1.42–12.2) or sarcomeric mutation-related (HR 9.86, 95% CI 2.30–42.3) DCM were associated with higher HT risk than myocarditis-related DCM.

Conclusions:
While childhood DCM is associated with long-term adverse health and increased health care utilization, patients who recover have improved morbidity and mortality. Treatment (e.g. medication or access to urban specialist care) was associated with lower mortality and HT risk in DCM.
Abstract 4134962: Association between Chronotype and Psychological Health in South Korean Adolescents
Authors: Seo Jinhee , Cho Sung-Il , Won Sung-Ho
Published: November 2024

Background:
Chronotype influences general health, with late chronotypes often linked to psychological problems. However, longitudinal studies on this topic are limited. This study assessed the association between chronotype and adolescent mental health, focusing on depression and somatic symptoms through cross-sectional and longitudinal analyses.

Methods:
This longitudinal study used data from the Korean Children and Youth Panel Survey (KCYPS), targeting middle school students aged 13. Participants were assessed annually over four years (2018-2021). Chronotype was determined by analyzing sleep onset and wake times. Depression and somatic symptoms were evaluated using preexisting questionnaires like the SCL-90. Multilevel linear regression analyses were conducted both concurrently and prospectively, with gender stratification. Covariates included sleep quality, physical activity, smartphone usage, breakfast and friendship.

Results:
The study included 1,882 students who completed all follow-ups. Students with a late chronotype, short sleep duration, and low sleep quality reported more mental health symptoms. Late chronotype was associated with higher levels of depression (β=0.062, p<.001) and somatic symptoms (β=0.056, p=.018) within the same year, and predicted somatic symptoms one year later (β=0.055, p=.019). For males, insufficient sleep worsened the effects of late chronotype on depression one year later (β=0.100, p=.042), and late chronotype predicted somatic symptoms one year later (β=0.072, p=.024). In females, late chronotype was associated with depression (β=0.061, p=.025) and somatic symptoms (β=0.075, p=.005) within the same year but did not predict future symptoms.

Conclusions:
Late chronotype negatively impacted depression and somatic symptoms and predicted future somatic symptoms. In females, late chronotype was related only to current mental health issues, whereas in males, it predicted future mental health problems, especially when combined with insufficient sleep. These findings highlight the impact of chronotype on adolescent mental health and suggest that its negative effects can be moderated by factors like sleep duration.
Abstract 4134974: SGLT2 Inhibitors Following Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
Authors: Defante Maria Luiza Rodrigues , X. Mendes Beatriz , Queiroz Ivo , Mazetto Roberto , Barbosa Lucas , Romeiro Pedro , Antunes Vanio , Bulhoes Elisio , Silva Catarina , Guida Camila
Published: November 2024

Background:
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits in various settings. However, their impact after myocardial infarction (MI) in patients without prior heart failure remains unclear. Therefore, we conducted a meta-analysis comparing SGLT2i to placebo in post-MI patients.

Methods:
We systematically searched Pubmed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing SGLT2i to placebo in post-MI patients. We calculated the Risk Ratio (RR) for binary outcomes and 95% confidence intervals (CI). Statistical analysis was performed using Review Manager 5.4. A random-effects model was used for all outcomes. Heterogeneity was examined with I2 statistics.

Results:
We included 3 RCTs comprising 11,065 patients in this meta-analysis, where 79.5% were male with a mean age of 61.9 years old. Two studies evaluated Empaglifozin and one Dapagliflozin. There was no statistically significant difference between groups in all-cause mortality (RR 1.05; 95% CI 0.78-1.41; p= 0.76; Figure 1A) and cardiovascular mortality (RR 1.04; 95% CI 0.84-1.29; p= 0.73; Figure 1B). There was a statistically significant reduction in the incidence of heart failure hospitalization in the SGLT2i group (RR 0.73; 95% CI 0.61-0.88; p< 0.01; Figure 1C).

Conclusion:
Our systematic review and meta-analysis found that SGLT2i significantly reduced the incidence of heart failure hospitalization in patients following MI, without significantly affecting all-cause or cardiovascular mortality.
Abstract 4135206: Patterns of Lifestyle Risk Behaviors for Cardiovascular Disease in Family Caregivers: A Latent Class Analysis
Authors: Ahn Soojung , Son Elisa H , Mogos Mulubrhan , Muchira James , Sheng Ying , Park Chorong , Lee Lena
Published: November 2024

Introduction:
Lifestyle risk behaviors for cardiovascular disease (CVD) often co-occur. However, little is known about their behavioral patterns among family caregivers, a population at high risk for CVD.

Aims:
To identify distinct latent classes of caregivers of lifestyle risk behaviors for CVD and to examine the individual characteristics associated with membership in the identified latent classes.

Methods:
This study included 643 unpaid family caregivers from the 2019 Health Information National Trends Survey 5 Cycle 3. The assessed lifestyle risk behaviors included cigarette use, non-abstinence from alcohol, low physical activity, long sedentary time, and low fruit and vegetable consumption. These behaviors were dichotomized based on established guidelines or cut-off points. Latent class analysis was performed to identify latent classes based on these lifestyle risk behaviors among caregivers. Subsequently, multinomial logistic regression was used to investigate socio-demographic, health-related, and caregiving characteristics associated with the latent class membership.

Results:
Three distinct classes were identified (mean age = 55±16 years; 59.3% female; 57.1% non-Hispanic white): “overall healthy, but non-abstainer” (Class 1, 17.1%; reference), “overall unhealthy” (Class 2, 64.1%), and “inactive, but healthy eaters” (Class 3, 18.8%). In unadjusted multinomial logistic regression models, caregivers reporting greater financial hardship (relative risk ratio [95% CI] = 2.5 [1.0-5.9]), higher psychological distress (3.7 [1.9-7.3]), poorer sleep quality (3.3 [1.6-6.8]), longer caregiving hours (2.1 [1.1-3.9]), and providing dementia care (2.3 [1.3-4.3]) were more likely to belong to Class 2, relative to Class 1. In the adjusted model including the significant characteristics above and controlling for age and gender, psychological distress (2.7 [1.2-5.9]) remained significant. No characteristics were significantly associated with membership in Class 3, relative to Class 1.

Conclusions:
Lifestyle risk behaviors for CVD among caregivers may cluster in distinct patterns that vary by individual characteristics. Caregivers experiencing psychological distress may be particularly at risk for engaging in lifestyle risk behaviors. Our novel findings underscore the importance of adaptive lifestyle modification interventions that target caregiver subgroups with different patterns of health behaviors to promote their cardiovascular health.
Abstract 4135259: Coronary Artery Anomalies Induce Myocardial Ischemia in Hypertrophic Cardiomyopathy
Authors: Miller Luke , Maddahi Yaniv , Roma Nicholas , Pattoli Megan , Shirani Jamshid
Published: November 2024

Background:
Myocardial ischemia is a frequent finding in hypertrophic cardiomyopathy (HCM) and is often attributed to microvascular disease, extravascular compressive forces, reduced coronary flow reserve, hemodynamic abnormalities, and concomitant atherosclerotic coronary artery disease (CAD). The potential contribution of congenital coronary artery anomaly (CCAA) to myocardial ischemia in HCM has not been systematically explored.

Research Question:
We aimed to evaluate the spectrum and potential contribution of CCAA to myocardial ischemia in HCM.

Methods:
From June 1991 to March 2023 a total of 35 CCAA were reported in 29 adults [age 18-87 (47.9±19.9; 59% male; 35% obstructive, 21% apical variant). Clinical data on presence or absence of myocardial ischemia, mode of therapy, and outcomes of the patients were reviewed.

Results:
The individual CCAAs were graphically reproduced [Figure] and were categorized based on the number of coronary ostia present in the aorta [single ostium (n=11; 38%); 2 ostia (n=13; 45%); 3 ostia (n=4; 14%); 4 ostia (n=1; 3%)]. The anomalous coronary artery was the left main in 6 (17%); left anterior descending in 6 (17%); left circumflex in 8 (23%); right in 14 (40%) or the ramus intermedius in 1 (3%). Two patients (7%) with apical variant HCM also had coronary artery fistulae in a non-anomalous coronary artery. Of all 29 patients who presented, 12 (41%) showed objective evidence of myocardial ischemia and of those, a total of 6 (50%) had an anomalous coronary artery coursing between the great vessels. In addition, 1 of 5 patients with sudden cardiac arrest had a high-risk coronary anomaly. Pharmacologic treatment was offered to 11 (38%) patients and 3 (10%) patients underwent coronary artery surgery (bypass grafting in 2 and unroofing in 1). Septal reduction therapy was performed in 8 (28%). Follow up data was available in 14 patients including 2 of the 3 who underwent surgical correction. Symptomatic improvement was noted in all 14.

Conclusion:
Congenital coronary artery anomalies may be present in patients with HCM and may contribute to myocardial ischemia. Treatment options depend on the type of anomaly and presence of objective evidence of myocardial ischemia.
Abstract 4135286: Comparative Efficacy of Intracardiac and Transesophageal Echocardiography in Left Atrial Appendage Occlusion: A Meta-Analysis of Clinical Outcomes
Authors: Nugooru Sudeep , Ginnaram Shravya , Sevella Prerana , Janga Chaitra , Haddad Enad , Shah Shreeja , Watson Robert
Published: November 2024

Background:
Left atrial appendage occlusion (LAAO) is essential for stroke prevention in patients with non-valvular atrial fibrillation where anticoagulation is contraindicated. Intracardiac Echocardiography (ICE) has been proven effective and safe for LAAO since 2011, yet adoption rates remain low, with only 2.2% of LAAOs guided by ICE between 2015 and 2019. Transesophageal Echocardiography (TEE), the current gold standard, and ICE differ significantly in operational dynamics and patient impacts, influencing procedural outcomes.

Objective:
This study aims to compare the efficacy and safety of ICE and TEE in facilitating LAAO, offering insights into their comparative clinical use.

Methods:
A systematic review and meta-analysis were conducted according to PRISMA guidelines. Searches were performed in MEDLINE/PubMed, OVID, and Scopus through December 2023, comparing ICE and TEE in LAAO. Inclusion criteria centered on studies reporting technical success, with secondary outcomes including length of stay (LOS), mortality, and adverse outcomes such as stroke, transient ischemic attacks (TIA), pericardial effusion, cardiac tamponade, device thrombosis, device embolization, and peri-device leaks. Data synthesis employed statistical methods utilizing R Studio.

Results:
Fourteen studies involving 4184 patients were included. The meta-analysis revealed no significant differences in technical success (OR 1.34, 95% CI: [0.76, 2.36]), LOS (OR 1.66, 95% CI: [0.80, 3.42]), or mortality (OR = 1.00, 95% CI: [0.50, 2.00]) between ICE and TEE. Similarly, non-significant differences were noted in stroke, TIA, pericardial effusion, and device leaks, with minimal heterogeneity (I
2
= 0%).

Conclusion:
ICE and TEE provide comparable clinical outcomes in LAAO, with no significant efficacy or safety differences. These results suggest that the choice between ICE and TEE should be based on procedural convenience, patient anatomy, and resource availability, rather than clinical outcomes alone. The equivalence in performance between these modalities allows for flexibility in clinical practice, ensuring that patient care can be customized to individual needs without compromising safety or effectiveness.
Abstract 4135311: Cryptogenic stroke associated with a double interatrial septum treated with surgical closure
Authors: Nabi Michelle , Jeha Jeannine , walker jennifer , Mahadevan Vaikom , Rastogi Ujjwal
Published: November 2024

Introduction:
A double atrium septum is a rare congenital anomaly characterized by a double-walled atrial septum with persistent interatrial space. This could be an asymptomatic presentation but also serve as a nidus of thromboembolic complications. We hereby present a case of a 57-year-old female with a cryptogenic stroke found to have a patent foramen ovale and double atrial septum.

Case Description:
A 57 year-old-female with a past medical history of hypertension presented with acute complaints of word-finding difficulty, left-sided neck pain and lightheadedness after a head strike while swimming. She was found to have a right-sided cerebellar stroke. A carotid artery ultrasound showed no evidence of atherosclerotic disease. Her lipid profile was normal. A transthoracic echocardiogram showed a patent foramen ovale with a positive bubble study revealing a large right to left shunt with Valsalva. A transesophageal echocardiogram confirmed a patent foramen ovale with an incidental finding of a double atrial septum with extreme redundancy of septal issue. The patient had a surgical closure of the interatrial septum and resection of the accessory interatrial septum tissue. She developed chronic post-sternotomy pain and subsequently had sternal wire removal.

Discussion:
A double atrial septum is a rare congenital anomaly seen as two parallel interatrial septa accompanied by a distinct echo-lucent midline space that expands during systole and contracts during diastole. It can happen embryologically by either the abnormal development of the septum secundum, resorption failure of the superior portion of the septum primum, or the persistence of the left venous valve of the sinus venosus. Typically, individuals with double atrial septum are asymptomatic, but they may encounter cardioembolic events due to the potential thrombi formation in the interatrial space. Communication between the septa increases the likelihood of such events. Unlike atrial fibrillation/flutter, there are currently no established criteria for initiating anticoagulation therapy for double atrial septum, primarily due to its rarity. Some options include antiplatelet agents, oral anticoagulation therapy, and percutaneous or surgical PFO closure. Surgical closure provides a permanent closure of the defect, thereby preventing future paradoxical emboli without the potential risks associated with long-term anticoagulation.
Abstract 4135327: Long-term Bleeding Events after Percutaneous Coronary Intervention in Patients with Malignancy with and without Anticoagulant Therapy
Authors: Otsuka Yasuhiro , Ishii Masanobu , Nakamura Taishi , Tsujita Kenichi , Fujita Hideo , Matoba Tetsuya , Kohro Takahide , Kabutoya Tomoyuki , Kario Kazuomi , Kiyosue Arihiro , Mizuno Yoshiko , Nakayama Masaharu , Miyamoto Yoshihiro , Sato Hisahiko , Nagai Ryozo
Published: November 2024

Background:
With the aging population, the prevalence of malignancies in patients undergoing percutaneous coronary intervention (PCI) is increasing. Active malignancy is increasingly recognized as a significant contributor to high bleeding risks. In cases where anticoagulant (AC) therapy is required, it becomes crucial to determine which is the optimal choice for cancer patients, direct oral anticoagulants (DOACs) or warfarin. The aim of this study was to investigate long-term bleeding events in patients with malignancy undergoing PCI.

Methods:
CLIDAS (Clinical Deep Data Accumulation System) is a multicenter database with 7 tertiary medical hospitals in Japan. This retrospective analysis using CLIDAS database included 6838 patients who underwent PCI during April 2014 and March 2020 and also who have completed 3-year follow-up were divided into two groups; No malignancy group (n=6155) and malignancy group (n=683). Malignancy was defined as patients with treatment history of malignancy. Furthermore, these patients were categorized into six groups based on the presence of malignancy and the type of AC therapy;
1)
No malignancy without AC (n=5369),
2)
No malignancy with DOAC (n=294),
3)
No malignancy with warfarin (n=492),
4)
Malignancy without AC (n=586),
5)
Malignancy with DOAC (n=44), and
6)
Malignancy with warfarin (n=53). The primary outcome was the incidence of bleeding events, defined according to the Global Use of Streptokinase and t-PA for Occluded Coronary Arteries classification of moderate and severe bleeding.

Results:
During the 3-year follow-up period, 260 (3.8%) patients experienced major bleeding events after PCI. Among these patients, 180 (3.4%) were in group 1, 9 (3.1%) in group 2, 33 (6.7%) in group 3, 27 (4.6%) in group 4, 2 (4.5%) in group 5, and 9 (17.0%) in group 6. Multivariate Cox regression analysis showed that patients in the malignancy group had a significantly higher rate of bleeding events (HR, 1.50; 95% CI, 1.03-2.18). Furthermore, only the malignancy with warfarin group showed a significantly higher rate of bleeding events compared to the no malignancy without AC group (HR, 4.03; 95% CI, 1.94-8.37).

Conclusions:
Patients with malignancies receiving warfarin were associated with a higher risk of bleeding events. DOACs may be a safer alternative to warfarin in reducing bleeding risk in this population.
Abstract 4135333: Peripheral Perfusion Index: Normative Values From Electronically Reported Critical Congenital Heart Disease Screenin
Authors: Donlon Tobias , Lohr Jamie , Lunos Scott , Pfister Katie , Pavan Amanda , Engel Melissa
Published: November 2024

Background:
Critical Congenital Heart Disease (CCHD) screening is performed in an effort to reduce morbidity and mortality associated with CCHD by facilitating early detection. This screening consists of pulse oximetry and is most effective at identification of cyanotic cardiac lesions, with less sensitivity for left sided obstructive lesions.

Research:
Question Peripheral perfusion index (PPI) is obtained from the plethysmographic signal of a pulse oximeter and represents the ratio of pulsatile to non-pulsatile blood flow. As such, it is a surrogate for peripheral perfusion at the site of measurement. PPI has been postulated to be an adjunctive screening method for low perfusion states in neonates, including left sided obstructive lesions. To date, reference ranges of PPI values in neonates have not been published in the United States. This project utilized electronically reported CCHD screening results to establish normative PPI data in healthy neonates.

Methods:
In Minnesota, CCHD screening results are electronically sent to the Minnesota Department of Health (MDH) and are cross referenced against the Minnesota Birth Information System, which tracks infants who are identified to have a congenital birth defect within the first year of life. These data were provided by the MDH for infants born in Minnesota from Jan 2017 through Dec 2022. Infants were included in the analysis if they did not have a known critical congenital heart defect, were born between 35 and 42 weeks gestation, and were 24-48 hours of life at time of screening.

Results:
PPI data from 11,179 cases were included in the analysis. Overall, there is a trend towards increasing PPI with gestational age. Pre-ductal PPI trended higher than post-ductal PPI. There was no difference between PPI in males and females.

Conclusions:
These data reflect trends identified in international data. This is the largest dataset to date of PPI in healthy neonates and the first in the United States. Future studies will compare neonates with left sided obstructive lesions against these normative data. If PPI is found to predict left sided obstructive lesions in neonates, there may be utility in use of PPI in CCHD screening to facilitate earlier detection of these lesions.
Abstract 4135338: Associations between plant-based diets and total mortality among Chinese older participants with cardiometabolic diseases: a prospective cohort study
Authors: Tan Bohao , Chen Pengfei , Wang Kang , Wei Cheng , Luo Fei , Tang Jianjun , Fang Zhen-fei , Liu Qiming , Hu Xinqun , Zhou Shenghua , Chen Zhangling
Published: November 2024

Background and Aims:
Plant-based diets have been associated with a lower risk of total mortality among generally health populations. However, the associations of plant-based diets with total mortality remain unclear among older people with cardiometabolic diseases, who have an elevated risk of mortality.

Methods:
We prospectively followed 4,485 participants (mean age: 84 years) from the China Prospective Longitudinal Survey of Health and Longevity (2006-2018), who had cardiometabolic disease in 2006. Dietary data were collected at baseline using a food-frequency questionnaire. Using these data, we created an overall plant-based diet index (PDI), in which plant-based foods received positive scores while animal foods (meat, fish and aquatic products, eggs, milk, animal fats) received reversed scores accordingly. We also created a healthful plant-based diet index (hPDI), where healthy plant-based foods (whole grains, vegetables, vegetable oils, fresh fruits, legumes, beans, garlic, nuts, tea) received positive scores, while less healthy plant-based foods (refined grains, pickles, sugar, preserved vegetables) and animal-based foods were given reversed scores. In addition, an unhealthful plant-based diet index (uPDI) was created by assigning positive scores to less healthy plant-based foods while reverse scores to healthy plant-based foods and animal-based foods. We used Cox proportional hazards regression to compute hazard ratios (HRs) and 95% CIs for total mortality, with adjustment for demographics, dietary and lifestyle factors, and medical history.

Results:
During a 12 years of follow-up, 2,881 deaths were recorded. A higher score from PDI and hPDI was associated with a lower risk total mortality among participants with cardiometabolic diseases (HR and 95% CI for extreme quintiles of PDIs: 0.85, 95% CI 0.75–0.96, P
trend
< 0.001; hPDI: 0.84 (0.74–0.94), P
trend
< 0.001). A higher uPDI score was associated with a higher total mortality among participants with cardiometabolic diseases (uPDI: 1.28 (1.13-1.47), P
trend
< 0.001). These results were consistent in subgroup analyses by age, sex, smoking status, alcohol consumption, education level, physical activity, and BMI.

Conclusion:
Our study suggests that among older Chinese participants with cardiometabolic diseases, adherence to an overall plant-based diet or a healthful plant-based diet, is associated with a lower total mortality, while an unhealthful plant-based diet was associated with a higher total mortality.
Abstract 4135360: Eosinophilic Myocarditis: An Atypical Presentation with a Labile Course: A Case Report
Authors: Li Shuojohn , Kochar Kirpal , Pierce Matthew
Published: November 2024

Case presentation:
A 64-year-old man presented with one day of chest pain. Initial evaluation showed elevated cardiac enzymes (CE) and normal eosinophil count. Electrocardiogram (EKG) was unremarkable. Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 40% and a moderate-large pericardial effusion with signs of tamponade. Pericardiocentesis was deferred due to the lack of a safe window. Left and right heart catheterization showed no occlusive disease or chamber pressure equalization. The patient developed worsening shock, raising suspicion for myocarditis and prompting an endomyocardial biopsy (EMB). He was placed on extracorporeal membrane oxygenation (ECMO) on day 3. The EMB resulted as eosinophilic myocarditis (EM), and high dose Methylprednisolone was started. He was decannulated from ECMO on day 10. Intra-operative transesophageal echocardiogram (TEE) post-decannulation showed a normal EF without segmental abnormalities. Three hours later, a rise in CEs was noted, and EKG showed ST elevations inferiorly. TTE showed a reduced EF with multiple segmental abnormalities concerning for myocardial infarction. A repeat coronary angiogram was unremarkable. Due to the residual pericardial effusion, the patient underwent a pericardial window draining 200 cc of serosanguinous fluid. Intra-operative TEE showed an EF of 20% with no improvement after drainage. He had a cardiac arrest during the procedure and was placed back on ECMO. High-dose steroids were resumed along with intravenous immunoglobulin. Despite interventions, the patient continued to deteriorate and he ultimately expired.

Discussion:
EM has high mortality and a variable course, often requiring EMB for diagnosis. As in our case, about 25% of cases present without peripheral eosinophilia. Pericardial effusion occurs in 34% of cases and tamponade in 6%. A distinct feature of this case is the decompensation associated with ST elevation and segmental abnormalities, thought initially to be myocardial infarction (MI), after an initial response to steroids. While the etiology of such decompensation is unclear, relapsing EM in the setting of tapering steroids is one explanation, as myocarditis and MI can share similar clinical features. Another explanation is cardiac tamponade, which has also been reported to mimic MI and myocarditis. Air embolism from ECMO decannulation is another possibility, though air embolisms may include cerebrovascular pathology, which was not observed.
Abstract 4135443: A Phase 1, Single Ascending Dose Study to Evaluate ALN-TTRsc04, a Next-Generation RNA Interference Therapeutic, in Healthy Participants for Potential Treatment of Transthyretin Amyloidosis
Authors: Murad Ali , Lasko Maxwell , Badri Prajakta , Jadhav Satyawan , Boyle Katherine , Li Juanjuan , Vest John , Taubel Jorg
Published: November 2024

Introduction:
Transthyretin amyloidosis (ATTR) is a progressive, debilitating, fatal disease caused by deposition of misfolded toxic transthyretin (TTR) amyloid fibrils in multiple organs and tissues. Major ATTR manifestations include polyneuropathy and cardiomyopathy. Ongoing amyloid deposition drives rapid progression of ATTR, leading to morbidity and mortality. ALN-TTRsc04 is an investigational small interfering RNA that targets hepatic
TTR
mRNA to reduce circulating TTR protein levels.

Hypothesis:
ALN-TTRsc04 rapidly knocks down serum TTR and is well tolerated.

Aims:
Describe safety, pharmacokinetics, and pharmacodynamics of single ascending ALN-TTRsc04 doses.

Methods:
This ongoing, Phase 1, randomized, double-blind, placebo-controlled study (NCT05661916) enrolled healthy adults (18–65 yrs; 18.0–30 kg/m
2
) sequentially included in 6 cohorts receiving subcutaneous single ascending doses of ALN-TTRsc04 (5, 25, 100, 300, 600, or 900 mg) or placebo (randomized 3:1). Urine and plasma concentrations were measured on Days 1–2 and 1–4, respectively; change from baseline (BL) in serum TTR and AEs will be assessed over 12 months.

Results:
Overall, 36 and 12 adults (of similar age/sex distribution) were randomized to 1 of the 6 ALN-TTRsc04 groups or placebo, respectively. ALN-TTRsc04 plasma concentrations declined below lower limit of quantification within 24–48 hrs; mean (SD) plasma half-life ranged from 4.5 (1.5) hrs (300 mg dose) to 7.6 (3.2) hrs (100 mg dose). ALN-TTRsc04 was minimally excreted by renal route (<20%) after 24 hrs. Rapid and sustained knockdown in serum TTR occurred following all ALN-TTRsc04 doses (
Figure
). Mean (SD) serum TTR was 236.2 (47.4) µg/mL and 290.1 (73.3) µg/mL at BL and 22.2 (1.8) µg/mL and 289.0 (59.1) µg/mL at Day 15, for ALN-TTRsc04 300 mg and placebo, respectively. Mean percent knockdown at Day 15 was 90.3% vs 1.8%, respectively. Robust mean serum TTR knockdown of >90% from BL was seen with ALN-TTRsc04 doses ≥300 mg at Day 29 and sustained until Day 90 (or Day 180 with 300 mg dose, 92.6% reduction).

Majority of AEs across doses were mild; none were considered related to treatment. No injection-site reactions or safety signals, including liver-related signals, were identified.

Conclusion:
A single ALN-TTRsc04 dose led to a rapid and sustained knockdown in serum TTR; a reduction >90% from BL was sustained until Day 180 with the 300 mg dose. All ALN-TTRsc04 doses have been well tolerated to date; data through 12 months will be assessed.
Abstract 4135480: Effect of Time Since Heart Failure Diagnosis or Hospitalization on the Cost-effectiveness of Dapagliflozin in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction
Authors: Bhatt Ankeet , De Boer Rudolf , Booth David , Davis Jason , Chen Jieling
Published: November 2024

Background:
Previous studies have shown dapagliflozin, a sodium-glucose co-transporter-2 inhibitor (SGLT2i), to be a cost-effective treatment option for patients with heart failure (HF) with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF) in multiple European settings.

Research question:
Is the cost-effectiveness of dapagliflozin treatment in HFpEF/HFmrEF modified by either the time since HFpEF/HFmrEF diagnosis or the time since the last hospitalization for heart failure (HHF) event?

Methods:
A Markov cohort transition model was built for the UK setting, informed by patient-level data from the randomized, placebo-controlled DELIVER trial. The patient population was subset according to categories of time since last HHF event (including no prior HHF) and time since HF diagnosis (further subset to those with no prior HHF). For each subgroup, disease evolution was characterized by transitions among health states defined by quartiles of the Kansas City Cardiomyopathy Questionnaire Total Symptom Scale. The risk of fatal (cardiovascular and non-cardiovascular) and non-fatal events of worsening HF were modelled, adjusting for baseline characteristics and time-updating health state. Incremental costs and quality-adjusted life-years (QALYs) were calculated for each subgroup to yield incremental cost-effectiveness ratios (ICERs).

Results:
The lowest ICERs were observed for subgroups with the shortest time from HF diagnosis (with and without prior HHF) or last HHF event (Figure 1). Across all subgroups, the calculated ICERs were below the UK willingness-to-pay (WTP) threshold of £20,000/QALY gained.

Conclusions:
In patients with HFpEF/HFmrEF, the cost-effectiveness of dapagliflozin improved (via lower ICERs) in the subgroups corresponding to earliest disease (least time since an HHF event or HF diagnosis) compared with groups of later disease and potentially delayed treatment initiation. These findings suggest early optimization of HF therapy with implementation of guideline-directed medical therapy, including SGLT2is, may improve economic value.
Abstract 4135534: Total and Regional Lung Volumes And Pulmonary Blood Flow In Repaired Tetralogy Of Fallot - Smaller Lungs And A Maldistribution of Flow
Authors: Fogel Mark , Whitehead Kevin , Biko David , Harris Matthew , Vaiyani Danish , Partington Sara , Mercer-Rosa Laura
Published: November 2024

Introduction:
Many pts with repaired tetralogy of Fallot (rTOF) are left with residual pulmonary regurgitation (PR) and poor exercise performance. Small studies in young children suggest that the total lung volume of rTOF pts are smaller than normal and may contribute to these sequelae. As exercise and cardiac performance are intimately related to lung function, it’s surprising that few rTOF studies have investigated cardiopulmonary interactions.

Aims:
To determine if regional and total lung volumes in rTOF pts are the same size as normals and if the larger amount of forward blood flow courses to the bigger lung. We hypothesized that this may not be the case.

Methods:
rTOF patients undergoing clinically indicated cardiac magnetic resonance (CMR) were evaluated for lung volumes using dark blood imaging (figure) and blood flow to the branch pulmonary arteries (bPA) using velocity mapping. Significance
<
P=0.05.

Results:
Eleven rTOF patients and 25 normal controls were studied.

Total control lung volume was significantly larger than those of rTOF.

Regional rTOF right and left lung volumes were smaller than their respective control lung volumes, barely missed statistical significance (table). In 6 rTOF pts with CMR prior to and after pulmonary valve replacement (PVR), lung volumes did not differ between the 2 timepoints (1034 vs 998 cc/m
2
respectively). Only 3/11 (27%) rTOF pts had the higher bPA flow coursing to the higher regional lung. The ratio of right bPA forward flow/right lung volume to left bPA forward flow/left lung volume ranged from 0.72-1.51 (ideal balanced flow to each lung would be 1), implying a maldistribution of flow.

Conclusion:
rTOF patients have smaller total lung volumes than controls with no change after PVR in our study. In addition, only a small proportion of rTOF patients have the larger amount of flow coursing to the larger lung.

The ratio of individual bPA flow to individual lung volume implies a maldistribution of pulmonary flow relative to the respective lung volume.

Our findings may have implications for timing of PVR, partially explaining PR and poor exercise performance. Flow limiters placed by cath or surgery may be able to redistribute the appropriate flow to regional lung fields.
Abstract 4135712: Mortality and Cardiovascular Complications Associated with Weight Loss Drugs among Breast Cancer Females Under Cardiotoxic Therapies: A Real-World Populational Study in the United States
Authors: LU Chuan , Liao Ting-Wei Ernie , Lee Gin-Yi , Hsieh Yi-Jin , Chen Sheng-Yin , Wei Cheng-Chung
Published: November 2024

Background:
Obesity is an adverse prognostic factor for breast cancer (BC). While liraglutide and semaglutide, derived from antidiabetic glucagon-like peptide-1 receptor agonists (GLP1RA), are established weight loss drugs known for their cardiovascular safety in the general obese population, their safety in BC patients undergoing cardiotoxic antineoplastic therapies remains less understood.

Objective:
To investigate the mortality and cardiovascular outcomes related to GLP1RA used for weight loss among the highly susceptible BC females.

Methods:
This retrospective cohort study was based on the TrinetX network, comprising real-time health records from over 60 US healthcare organizations. The study population included obese females (≥18 years old) who received at least three prescriptions of either exclusive GLP1RA (liraglutide or semaglutide) or non-GLP1RA weight loss drugs (phentermine, bupropion-naltrexone, orlistat) upon BC diagnosis between 01/01/2015 and 01/01/2022. The index date was the initiation of systemic anti-cancer treatment, including chemotherapy (anthracycline, taxane, or cyclophosphamide), and/or anti-HER2 agents (trastuzumab, pertuzumab, or lapatinib). We used 1:1 propensity score-matching (PSM) to balance demographics, BMI, comorbidities, concurrent medications for cardiovascular diseases and metabolic disorders, BC receptor status and prior treatment, and levels of serum cholesterol (LDL, HDL) and hemoglobin A1c. Cox regression models were applied to compute hazard ratios (HR) and 95% confidence intervals (CIs). Follow-up continued until 05/24/2024, or until adverse cardiovascular events or death occurred.

Results:
Among 380 PSM-balanced pairs, the GLP1RA group (mean age: 57.6±11) showed significantly lower risks of all-cause mortality (HR 0.593, 95% CI 0.457-0.77), acute heart failure (HR 0.496, 95% CI 0.286-0.859), angina pectoris (HR 0.566, 95% CI 0.343-0.936), and acute stroke (HR 0.661, 95% CI 0.46-0.951) than the non-GLP1RA group (mean age: 57.5±12). Otherwise, no significant difference was shown in acute myocardial infarction (HR 0.787, 95% CI 0.495-1.251), pulmonary hypertension (HR 0.777, 95% CI 0.55-1.099), or arrhythmias (HR 0.829, 95% CI 0.566-1.215).

Conclusion:
Compared to non-GLP1RA weight loss agents, GLP1RA offers better survival and cardiovascular protection for BC patients undergoing cardiotoxic therapies. Future studies are warranted to validate the safety of these weight loss drugs during the BC treatment continuum.
Abstract 4135723: Efficacy and Safety of Ticagrelor with Aspirin vs Ticagrelor Monotherapy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Moeed Abdul , Khan Adam , Memon Abdul Basit Jawed , Mushtaq Muhammad Ali , Munir Anfal , Mughal Aira , Ashfaq Ume Habiba , Munir Chaudhary Asharib , Mahfooz Arisha , Kumar Susheel , Abdul Rahman Aliyan , Khan Maryam , Bejugam Vishal Reddy , Siddiqui Abdul Hannan , Najeeb Hala , alam mahboob
Published: November 2024

Background:
Dual antiplatelet therapy (DAPT) consisting of ticagrelor, a P2Y
12
inhibitor, and aspirin, is the recommended treatment of acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI). However, recently ticagrelor monotherapy has been shown to preserve ischemic protection while reducing bleeding risk in ACS patients. We aimed to compare the clinical outcomes of DAPT and ticagrelor monotherapy in ACS patients undergoing PCI.

Methods:
MEDLINE, Scopus, and EMBASE were queried up to May 2024 for randomized controlled trials (RCTs) comparing ticagrelor monotherapy after 1 to 3 months of DAPT versus continued DAPT for 12 months in ACS patients. The primary outcomes were all-cause death, net adverse clinical events (NACE) and Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding. Key secondary endpoints included BARC 3 or 5 bleeding, myocardial infarction (MI), hemorrhagic and ischemic stroke, and target vessel revascularization (TVR). A random-effects meta-analysis was performed to derive risk ratios (RR) and corresponding 95% confidence intervals (CI).

Results:
Six RCTs including 28,526 patients, with a mean age of 63.5 years, were included. DAPT was associated with a significantly higher risk of all-cause death (RR: 1.32, 95% CI: 1.05-1.64, P=0.02), NACE (RR: 1.20, 95% CI: 1.01-1.42, P=0.04), and BARC 2, 3, or 5 bleeding (RR: 1.96, 95% CI: 1.71-2.26, P<0.00001) compared to monotherapy. DAPT significantly increased the risk of BARC 3 or 5 bleeding (RR: 2.06, 95% CI: 1.69-2.51, P<0.00001) however, no association was seen in myocardial infarction (RR: 1.01, 95% CI: 0.84-1.20, P=0.94). Conversely, DAPT resulted in a non-significant reduction in ischemic (RR: 0.94, 95% CI: 0.63-1.41, P=0.77) and hemorrhagic stroke (RR: 0.83, 95% CI: 0.36-1.95, P=0.67). Additionally, no significant association could be ascertained in TVR (RR: 1.18, 95% CI: 0.94-1.48, P=0.15).

Conclusion:
Our analysis highlights the elevated risks of all-cause death, NACE, and major bleeding with DAPT compared to monotherapy in ACS patients post-PCI, favoring the latter for safety. Future investigations should refine antiplatelet therapy durations and identify specific patient subsets for optimal DAPT utilization.
Abstract 4135791: Bleeding risk with non-vitamin K antagonist oral anticoagulants versus single antiplatelet therapy: A systematic review and meta-analysis of randomized controlled trials
Authors: Baskaran Geethan , Wang Michael , Razeghi Ghazal , Ma Richard , Park Louis , Tannu Manasi , Devereaux PJ , McIntyre William , Healey Jeff , Conen David
Published: November 2024

Background:
While non-vitamin K antagonist oral anticoagulants (NOACs) are more effective than single antiplatelets (mostly low-dose aspirin) at reducing stroke risk in patients with atrial fibrillation (AF), differences in bleeding risk between NOACs and single-dose antiplatelets across various populations remain unclear.

Aim:
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing bleeding outcomes of NOACs versus single antiplatelet therapy.

Methods:
We searched MEDLINE, EMBASE, and CENTRAL to June 2024 for RCTs that compared NOAC (therapeutic doses used for stroke prevention in AF patients) versus single antiplatelet therapy for a treatment duration of ≥3 months. For the meta-analyses, we used fixed-effects models and reported results as summary risk ratios (RRs). We used Risk of Bias 2 and GRADE to assess the quality and certainty of the evidence.

Results:
Eight RCTs with 26,194 participants were included. Mean follow-up time was 18 (±13) months. NOACs included in the studies were apixaban (4 studies), rivaroxaban (2 studies), and dabigatran (2 studies). All studies used low-dose aspirin as the comparator. When compared to aspirin, NOACs had a higher risk of major bleeding (326/13107 [2.5%] vs. 239/13087 [1.8%] events; RR 1.36 95% CI 1.15-1.60, I
2
=52%, 8 trials; high certainty) (Figure A), gastrointestinal bleeding (104/8803 [1.2%] vs. 74/8788 [0.8%] events; RR 1.39; 95%CI, 1.04-1.87; I
2
=0%; 5 trials; high certainty), and clinically relevant non-major bleeding (318/10397 [3.1%] vs. 230/10395 [2.2%] events; RR 1.38; 95%CI, 1.17-1.63; I
2
=16%; 5 trials; high certainty). There was no difference in the risk of intracranial hemorrhage (88/13107 [0.7%] vs. 84/13087 [0.6%] events; RR 1.04, 95%CI 0.78-1.41; I
2
=48%; 9 trials; high certainty) (Figure B) nor fatal bleeding (22/12412 [0.2%] vs. 28/12392 [0.2%] events; RR 0.78; 95%CI, 0.45-1.36; I
2
=8%; 6 trials; high certainty).

Conclusion:
When compared to aspirin, NOACs are associated with an increased risk of major bleeding and clinically relevant non-major bleeding, but not intracranial hemorrhage. These data are important to inform patients about the risks of antithrombotic treatment.