bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4146740: Procedure-related Ischemic Stroke in Atrial Fibrillation Ablation in a Contemporary Cohort at a Tertiary Care Center
Authors: El Hajjar Abdel Hadi , Tabaja Chadi , Younis Arwa , Gharaibeh Ahmad , Farwati Medhat , Al-Dalakta Astefanos , Motairek Issam , Saliba Walid , Bouscher Patricia , Baranowski Bryan , Kanj Mohamed , Nakhla Shady , Callahan Thomas , Nakagawa Hiroshi , Martin David , Bhargava Mandeep , Chung Mina , Sroubek Jakub , Lee Justin , Taigen Tyler , Wazni Oussama , Hussein Ayman
Published: November 2024

Background:
Ischemic stroke incidence after catheter ablation is historically reported at 0.2-0.3%. With advancements in catheter design, mapping, ablation techniques, and reduced ablation times, it is pertinent to reevaluate stroke incidence. We aim to determine the rates of procedural stroke in a contemporary patient series and characterize the clinical profiles associated with procedure-related Ischemic stroke.

Methods:
All patients undergoing AF ablation from 2013 to 2021 at our center were enrolled in a prospective registry for outcomes and procedural complications and an automated platform for patient reported outcomes (AF symptom severity score, QoL, AF burden). Peri-procedural anticoagulation was continued peri-procedurally with therapeutic INRs or holding one dose of apixaban or dabigatran the morning of the procedure. Patients who experienced an ablation-related ischemic stroke or transient ischemic attack (TIA) were identified and compared to the general population of patients undergoing ablation.

Results:
Of 7020 patients undergoing ablation, only 8 had an ischemic cerebrovascular event (0.11%, 5 strokes, 3 TIAs). The average age was similar in stroke patients (66 years) and the general cohort (65 years). The average CHA
2
DS
2
Vasc score was higher in the stroke group (2.6) compared to the general cohort (2.3), with larger left atrial diameter (4.5 cm vs. 4.2 cm) and a more frequent history of TIA (11% vs. 3.2%). AF burden was higher in stroke patients at baseline with higher AF frequency scores (8.8 vs 6.8) and higher AF duration scores (10 vs. 7.0 in controls). Other characteristics of patients with ischemic cerebrovascular events are summarized in table. All but one patient recovered without residual neurological deficits.

Conclusion:
In this contemporary cohort of patients undergoing ablation, procedural related ischemic stroke incidence was 0.11% and associated with higher CHA
2
DS
2
Vasc score, larger atria, and baseline AF burden. This suggests that stroke rate is lower in modern practice versus historical cohorts.
Abstract 4146756: Temporal Trends in Stroke-related Mortality in the United States for the Past 3 Decades
Authors: Abdulelah Zaid , Abdulelah Ahmed , Alayyat Ahmad , Al-Husni Dua' , AlQirem Lina , damlakhy Ahmad , Rahman Mansoor
Published: November 2024

Introduction:
Stroke is one of the leading causes of morbidity and mortality in the United States resulting in significant health and socioeconomic burden. Accordingly, examining the temporal trends of stroke is essential for the development of effective stroke management strategies and prevention.

Research Question:
Is there a change in stroke mortality trends in the United States over the past 3 decades?

Aim:
To investigate trends in stroke mortality in the United States over the past three decades, focusing on gender and age-specific variations.

Methods:
We analyzed the Global Burden of Diseases 2019 database for stroke mortality trends stratified by age and gender. Trends were expressed using annual percentage change (APC) and average APC (AAPC) calculated via Joinpoint Trend Analysis Software (v5.2.0, NCI).

Results:
A total of 4,968,927 stroke-related mortality were reported during the time period of 1990-2019. An overall decline in the stroke-related death has been identified, with females displaying a declining mortality from 1990 to 2019 with AAPC of -0.238 (95%CI: -0.291 to -0.183; p<0.001). Additionally. a declining mortality among all age groups has been identified, that is most significantly in the age group of under 50 years of age (AAPC -0.611, 95%CI: -0.655 to -0.565; p<0.001) followed by the 50-74 years of age ((AAPC -0.307, 95%CI: -0.332 to -0.277; p<0.001) and the 75 years and older group (AAPC -0.220, 95%CI: -0.283 to -0.1512; p<0.001).

Conclusion:
Temporal trends for the past 3 decades in the United States demonstrates a slightly reassuring decline in stroke mortality across the female gender and all age groups. However, more research is warranted to compare to global trends and identify the driving factors behind these trends in the United States.
Abstract 4146764: Arrhythmia and Left Ventricular Functional Recovery in Arrhythmic Myocarditis Following Immunosuppressive Therapy
Authors: Chelikam Nikhila , Katapadi Aashish , Darden Douglas , Gopinathannair Rakesh , Kabra Rajesh , Pothineni Naga Venkata , Atkins Donita , Lakkireddy Dhanunjaya
Published: November 2024

Introduction:
Treatment of myocarditis often revolves around symptomatic management until recovery. Immunosuppressive therapy (IST) is an option in a select group of patients but is poorly understood.

Research Questions:
Is there a benefit to IST in myocarditis?

Goals:
To evaluate the role of IST on ventricular arrhythmia burden and left ventricular ejection fraction (LVEF).

Methods:
The MAVERIC registry is a prospective, single-center, observational study of patients with a high burden of cardiac arrhythmias and suspected myocarditis. All enrolled patients underwent 18-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging. If positive, patients were managed with IST and guideline-directed therapy. IST consisted of 3 months of Methotrexate and Prednisone, and Folic Acid. A repeat FDG-PET was performed after IST. If persistent inflammation was seen, IST was repeated. We analyzed select baseline characteristics and outcomes.

Results:
Out of 431 total, 31% had evidence of active myocarditis on FDG-PET and underwent at least one cycle of IST. A further 33.8% underwent a second, 18.8% a third, and 12.0% a fourth cycle of IST for persistent symptoms or FDG-PET. Myocarditis resolved in 64% after one cycle, but 31% of all cases had a relapse requiring further IST. Though incidence of ventricular arrhythmias and LVEF was no different, those with four cycles had significantly higher PVC burden (9.5% vs. 7.0%, p<0.001). LVEF recovery was significant in all groups and greatest in those with multiple cycles of IST (Figure 1). There was no difference in arrhythmia recurrence or implantable cardioverter defibrillator (ICD) needs after treatment.

Conclusions:
Relapses of myocarditis are common. IST is an important adjunctive strategy in treating arrhythmic, FDG-PET-positive myocarditis and assist LVEF recovery and result in no difference in arrhythmias or ICD needs afterward.
Abstract 4146785: A Six-Year Analysis of In-Hospital Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Valve in patients with dementia: Insights from the National Inpatient Sample Data (2016-2021)
Authors: Agrawal Siddharth , Raval Maharshi , Shah Aalesh , Sanghvi Labdhi , Patel Yug , Siddiq Sajid
Published: November 2024

Background:
Dementia is a prevalent comorbidity in patients undergoing the transcatheter edge-to-edge repair (TEER) procedure of the mitral valve. This study compares outcomes of mitral valve TEER in patients with and without dementia, utilizing data from the National Inpatient Sample (2016-2021)

Methods:
We conducted a retrospective cohort study on 48,085 patients without dementia and 3,125 with dementia undergoing mitral valve TEER. Multivariate logistic regression was employed to compare outcomes, adjusting for potential confounders. Primary outcomes included mortality and major complications, while secondary outcomes encompassed specific procedural complications.

Results:
Patients with dementia were older (mean age: 80.896 vs. 76.69 years, p-value <0.001) and exhibited differences in gender distribution (male: 49.92% vs. 54.24%, female: 50.08% vs. 45.76%, p=0.0356).Patients with dementia had a longer LOS (coefficient: 1.64 days, 95% CI: 0.85-2.43, p<0.001) and higher total hospitalisation cost (coefficient: $19,868.97, 95% CI: $302.45-$39,435.49, p=0.047). Patients with dementia exhibited a higher prevalence of mortality (OR: 1.677, 95% CI: 1.049-2.68, p=0.031), bleeding (OR: 1.4807, 95% CI: 1.156-1.896, p=0.002), PPM insertion (OR: 3.351, 95% CI: 1.463-7.674, p=0.004), post-procedure shock (OR: 2.027, 95% CI: 1.478-2.779, p<0.001), intra-procedure stroke (OR: 1.971, 95% CI: 1.438-2.701, p<0.001), mechanical ventilation (OR: 3.088, 95% CI: 2.172-4.389, p<0.001), and cardiogenic shock (OR: 1.949, 95% CI: 1.418-2.678, p<0.001). Additionally, they had increased odds of sepsis (OR: 1.974, 95% CI: 1.125-3.466, p=0.018) and stroke (OR: 1.987, 95% CI: 1.007-3.923, p=0.048), as well as a higher likelihood of pleural effusion (OR: 2.167, 95% CI: 1.501-3.128, p<0.001). Odds of arrhythmia and post-procedure deep vein thrombosis did not significantly differ between groups.

Conclusion:
Patients with dementia undergoing mitral valve TEER procedure face elevated risks of mortality, bleeding, PPM insertion, post-operative shock, stroke, and other major complications compared to those without dementia. Clinicians should consider these heightened risks when evaluating the appropriateness of mitral valve TEER in dementia patients. Further research is warranted to explore strategies for risk mitigation in this population.
Abstract 4146799: Medical Applications of Artificial Intelligence: Coronary Artery Segmentation, Lesion Identification and Measurement in X-Ray Angiography
Authors: Raval Abhishek , Padariya Karan , Soni Pranay , Kapadiya Harsh , Raghvani Niraj
Published: November 2024

Background:
Coronary artery segmentation, Lesion Identification and Measurement (CASLIM) on XRA images on X-ray angiography (XRA) are performed by cardiologists.

Aims:
The study, CASLIM aims to develop an end-to-end deep learning framework with integrated conventional image processing methods that accurately performs those tasks on XRA images.

Methods:
In depth analysis and comparisons of the deep learning models UNet, UNet+, Attention UNet, Trans UNet, SwinUNet, and UNet3+ comprising of the training curve and validation curve plotted against the epochs were carried out. The testing scores are obtained from the results of trained models on around 80 full size images. The data is presented for validity of the UNet3+ model as compared to the others.

The performance of the proposed CASLIM analysis starts with the training results of the UNet3+ and other models for the coronary pixel segmentation. For UNet3+, patch sizes of 128*128 and 244*244 are studied to define the effect of patch sizes on performance. The model is trained on XRA images for accurate segmentation. (Image-1) Multiple image processing techniques are developed for lesion assessment. A dataset for training, validation and testing of the model is prepared by manual pixel annotation. Image processing algorithms are innovated to develop algorithms for catheter detection, its width measurement; subtract small arteries; thinning and pixel width measurement on binary mask images of arteries; detect, locate and quantify lesions. (Images-2,3) Experiments evaluated this method by comparing the lesion measurement results with the manually performed ones.

Results:
The dice score, 0.989; Structural Similarity Index Measurement (SSIM), 0.888; SSIM loss, 0.809 and Intersection Over Union, 0.979 of UNet3+ show its excellent performance and proximity to the ground truth in segmentation; overcoming the issues of intensity and position variations, noise and overlapping structures. The numerical testing performance report shows that the UNet3+ with a patch size of 128*128 performs the best. The lesion measurement by CASLIM shows a mean square error (MSE) value- 28.66 and an R squared (R2) value- 0.81 as compared to the manual process. The MSE- 69.91 and R2- 0.99 are obtained with the proposed method for lesion localization as compared to the manual process.

Conclusion:
The UNet3+ model has exceptional accuracy for precise segmentation. The CASLIM presents a promising solution for automated coronary lesion assessment accurately.
Abstract 4146812: Cardiac Comorbidities has worse outcomes in Multiple Myeloma patients; A retrospective Analysis
Authors: Iqbal Rabia , Bajwa Ahmad Taimoor , Jafar Amina , Linn Hnin Nadi
Published: November 2024

Background:
Multiple myeloma, a type of blood cancer characterized by recurring and remitting episodes, has historically been difficult to manage. While advancements in treatment have led to improved survival rates, they have also introduced new cardiac complications. Notably, many multiple myeloma patients already possess pre-existing cardiac risk factors. Unfortunately, there is limited information available on the prevalence of these risk factors, making it crucial to investigate this issue further to better understand and address the cardiac burden associated with this disease.

Methods:
We used the National Inpatient Sample Database (NIS) from 2017 to 2020 to identify patients with primary diagnosis of Multiple Myeloma (MM) using ICD-10 codes. Our analysis aimed to determine the prevalence of cardiac risk factors among MM patients and their impact on mortality. We used multivariable logistic and linear regression models to estimate the adjusted odds ratio (AOR) for the outcomes. A p-value of <0.05 was considered statistically significant

Results:
Analysis showed that a total of 690789 patients were admitted with multiple myeloma. Out of them, almost 68% of the patients had cardiac comorbidities. The mean age of the patients was 69 years. Males were in majority (55%) while female patients comprised 45% of the patients. Out of them, 23% of patients had coronary artery disease (CAD), 21% had congestive heart failure (CHF), 18% had atrial fibrillation, 3% had ventricular arrhythmias, 5% had non-rheumatic heart disease (NRHD), 3% had heart block and 0.08% of the patients had infective endocarditis. Among the patients, CHF (OR 1.5, p-value 0.00) , atrial fibrillation (OR 1.1, p-value 0.001), ventricular arrhythmias (OR 3.2, p-value 0.00) was associated with higher mortality risk in multiple myeloma patients. Other comorbidities, such as NRHS (OR 0.9, p-value 0.8) and CAD (OR 0.9, p-value 0.5) were associated with lower risk, although the result was not significant (p-value >0.05). Although endocarditis was associated with higher risk (OR 1.8, p-value 0.7), the result was also not significant.

Conclusion:
The prevalence of cardiac comorbidities in multiple myeloma (MM) patients is 68%, significantly increasing mortality risk. Conditions such as congestive heart failure, atrial fibrillation, and ventricular arrhythmias are particularly associated with higher mortality. The mortality was observed to be higher in the presence of cardiac risk factors.
Abstract 4146840: Findings From Learning Collaborative Listening Sessions Assessing The Operationalization Of Community-Clinical Linkages
Authors: Aguirre Diana , King Linda , Shine Kyna
Published: November 2024

Introduction/Background:
The American Heart Association’s National Hypertension Control Initiative (NHCI) collaborated with health care professionals and public health advocates to facilitate listening sessions for learning collaboratives (LCs) to discuss ways to address hypertension (HTN) through Clinical-Community Linkages (CCL) in five regions. CCLs have been recognized as essential for effective HTN control.

Research Questions/Hypothesis:
LC knowledge exchange sessions can play a crucial role in strengthening CCL by fostering relationships to address social determinants of health (SDoH) and enhancing HTN control collaborations in health care.

Methods/Approach:
From October 2023 to April 2024, the NHCI participated in HTN-focused LC listening sessions in 5 regions, utilizing CDC’s CCL approach to identify key stakeholders' engagement level. LC listening sessions facilitated knowledge exchange identifying recommendations for improving HTN. NHCI developed a 10-item assessment for data collection and conducted a thematic analysis.

Results/Data:
An estimated 210 community and clinical stakeholders participated in six LC listening sessions, five virtual and one in-person, providing insights for optimizing CCL for better HTN control. Findings highlighted five major barriers to implementing CCLs. Barriers that hindered CCL optimization include staffing shortages, low health literacy, lack of funding, an absence of leadership buy-in, and low patient engagement. One consistent insight that emerged as integral was incorporating Community Health Workers. Self-Measured Blood Pressure (SMBP) monitoring tools and the AMA MAP™ framework, along with capacity-building resources were deemed effective approaches. Building stakeholder relationships and addressing SDoH were frequently highlighted as good practices. The top three SDoH factors identified as influencing HTN control were nutrition security, transportation, and income.

Conclusion:
LC listening sessions allow for knowledge exchange providing insights on advancing and sustaining CCLs to improve HTN control. Innovative pathways for sustainable improvement and advancement of CCL consist of staff and patient education tools, training, capacity building, bi-directional referrals, and solution-oriented advocacy efforts.
Abstract 4146841: Unsupervised Agglomerative Cluster Phenotyping of Young Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
Authors: Maqsood Muhammad Haisum , Bou Chaaya Rody , Patel Kershaw , Samimi Sahar , Hatab Taha , Qamar Fatima , Kharsa Chloe , Goel Sachin , shah alpesh , Kleiman Neal , Khan Safi
Published: November 2024

Introduction:
Young patients with acute coronary syndrome (ACS) exhibit diverse demographic, clinical and angiographic characteristics.

Hypothesis:
We hypothesized that unsupervised machine learning (ML) can identify phenotypic clusters and predict the prognosis among young patients with ACS who undergo percutaneous coronary intervention (PCI).

Methods:
We used the Houston Methodist Young-ACS PCI registry (2010-2022) and performed agglomerative clustering to analyze demographic, clinical and angiographic variables among young patients (≤50 years) treated with PCI for ACS.

Results:
Among 633 patients, cluster analysis identified three distinct phenotypes.
Low risk
(n=273) exhibited lowest proportions of heart failure (HF: 10.3%) and peripheral arterial disease (PAD): 5.9%), normal left ventricular ejection fraction (LVEF) (median =0.60) and shorter median culprit vessel stent length (16 mm).
Moderate risk
(n=101) was characterized by moderate rates of diabetes (36.6%), hypertension (77.2%), prior myocardial infarction (16.8%) and prior PCI (18.8%).
High risk
(n=78) had highest proportion of diabetes (67.9%), hypertension (93.6%), HF (65.4%), PAD (17.9%), prior MI (41.0%), prior PCI (46.2%), the lowest median LVEF (0.3) and the most frequent use of mechanical circulatory device (5.1%). All-cause mortality differed significantly (
Figure
), with
high-risk
cluster showing a four-fold increase in all-cause mortality (HR: 4.50 [1.68-12.1]). There was no significant difference in mortality between
moderate
and
low-risk
clusters (HR: 1.52 [0.44-5.19]).

Conclusions:
Through unsupervised ML, we identified three distinct phenotypic clusters among young patients with ACS treated with PCI, each exhibiting varying degrees of comorbidity burden and allowing identification of patients with high mortality risk, thus underscoring the potential for phenotype-guided therapeutic approaches.
Abstract 4146872: Analysis of 30-Day Readmission Rates and Costs Post-Heart Transplant: A 12-Year Retrospective Study Using Nationwide Readmission Database(NRD) : 2010-2021
Authors: Pinninty Dheeraj , Mogga Phanidhar , Raol Karanrajsinh , Pillai Ashwin , Mudduluru prathyusha , Singh Kerry , Jedeon Zeina , Jaiswal Abhishek
Published: November 2024

Introduction:
Increased prevalence and incidence of heart failure has resulted in a significant rise in the number of patients progressing to advanced heart failure (AHF). Heart transplant improves morbidity and mortality in patients with heart failure refractory to medical therapy. We examined resource utilization as measured in 30-day readmission in a contemporary population utilizing the NRD database.

Aim:
We conducted a thorough analysis to identify trends in 30-day readmissions of HTs and analyze the associated costs.

Methods:
Using the National Readmission Database from 2010 to 2021, the study focused on new HT recipients. We evaluated various parameters, including readmission rates and the costs associated with 30-day readmissions. Patients aged <18 and those receiving HT and LVAD during the initial hospitalization were excluded from the study.

Results:
We identified 36,379 weighted index hospital admissions from January to December 2010 - 2021. The 30-day readmission rate fluctuated between 21% and 26% during this period, p—0.143 (Figure 1). There has been an upward trajectory in 30-day median readmission costs over the past decade, escalating from $13,027 in 2010 to $15,722 in 2021, with the highest readmission costs being $18,190 in 2020 (Figure 2).

Conclusion:
Over the last decade, 30-day readmissions among heart transplant recipients remain high in the US. Furthermore, associated costs continue to rise, and an unmet need remains to reduce the burden on healthcare resources. Despite some periods of improvement, the costs associated with readmission have increased by 20.69% since 2010. These findings underscore the need for targeted interventions to enhance post-transplant care, reduce readmission rates and manage costs more effectively.
Abstract 4146877: Percutaneous coronary intervention in cancer patients with chronic coronary artery disease is associated with lower major cardiovascular events
Authors: Pileggi Brunna , Franci Andre , Saretta Roberta , Baracioli Luciano , Drager Luciano , Kalil Filho Roberto
Published: November 2024

Background:
The interaction between cancer and coronary artery disease (CAD) is well established, primarily due to shared risk factors, chronic inflammation, and complications related to cancer therapies. Prior studies regarding percutaneous coronary intervention (PCI) in patients with chronic CAD have never demonstrated consistent reduction in hard endpoints. Nevertheless, cancer patients are frequently excluded or underrepresented in major clinical trials that address this matter.

Objectives:
To evaluate whether PCI in patients with chronic CAD and cancer could impact outcomes.

Methods:
Observational, retrospective cohort study with data from the TriNetX platform, an international research network database, which provides access to electronic medical records across large health care organizations. Inclusion criteria were age ≥18 years, diagnosis of chronic CAD and a concurrent cancer diagnosis within one year. Patients with acute coronary syndrome (ACS) and hematologic cancers were excluded. Participants were divided into two groups: 1) those who underwent PCI within this first year after the diagnosis of cancer and 2) those who did not receive intervention. The primary outcome was major adverse cardiovascular events (MACE), defined by all-cause mortality, non-fatal myocardial infarction, and non-fatal ischemic stroke over a five-year period. Propensity score matching was conducted using variables such as age, gender, types of cancer, hypertension, previous cerebrovascular disease, diabetes, dyslipidemia, tobacco use, left ventricular ejection fraction, and peripheral artery disease.

Results:
A total of 741,184 patients were included, 12,189 in group 1 and 728,995 in group 2. The mean age was 72±9 and 73±10 years, respectively. Most patients were men, and most common cancer sites were prostate, digestive system, urinary tract and lungs. The primary analysis showed a five-year incidence of MACE of 27.6% in group 1 vs 31.1% in group 2 [OR 0.86 (95% CI 0.81-0.88), p<0.0001]. After propensity score matching, the incidence of MACE was 27.6% vs 29.2% [OR 0.92 (95% CI 0.87-0.98), p=0.006]. Kaplan-Meier event-free survival curves before and after propensity matching are shown in the figure.

Conclusion:
PCI in patients with chronic CAD and cancer was associated with a lower incidence of MACE in 5 years in a large real-world international database. Randomized controlled trials including patients with cancer are urgently needed to further investigate these outcomes.
Abstract 4146878: The NADPH Oxidase 4 Plays a Vital Role for the Endothelium under Hypoxia and in the Absence of Protective Laminar Blood Flow
Authors: Brendel Heike , Mittag Jennifer , Hofmann Anja , Hempel Helene , Giebe Sindy , Diaba-Nuhoho Patrick , Wolk Steffen , Reeps Christian , Morawietz Henning , Brunssen Coy
Published: November 2024

Background:
Increasing evidence support a vasoprotective role of the major endothelial NADPH oxidase isoform 4 (NOX4). NOX4 is notably induced by hypoxia.

Research Question:
What is the functional role of NOX4 under hypoxic conditions in the vessel wall?

Aim:
We aimed to elucidate NOX4’s significance in endothelial and vascular function under hypoxia.

Methods:
Primary cultures of human endothelial cells were exposed to hypoxia of 1% O
2
. Internal mammary arteries were obtained from patients undergoing coronary artery bypass grafting surgery. Surgical specimens of the artery wall proximal to occlusion were obtained from patients with peripheral arterial disease. Human NOX4 was downregulated by lentiviral sh
NOX4
. Primary microvascular lung endothelial cells were isolated from wild-type and Nox4
-/-
mice. Vascular function was assessed under hypoxia in murine mesenteric arteries and aortas in a Mulvany myograph. Laminar flow was applied by cone-and-plate viscometer or ibidi pump system. NO was measured by Griess reaction, H
2
O
2
by Amplex Red Assay and gene expression by real-time PCR and Western blot.

Results:
Hypoxia significantly elevated NOX4 expression and activity in endothelial cells. Inhibition of prolyl hydroxylase domain (PHD) enzymes, which stabilize hypoxia-inducible factors (HIFs), increased
NOX4
expression even under normoxic conditions. In human hypoxia-prone vessels,
NOX4
expression strongly correlated with genes relevant for vascular function, such as prostaglandin I2 synthase (
PTGIS
). Endothelial function assessments under hypoxia revealed elevated contraction and endothelial dysfunction in both wild-type and Nox4
-/-
mice with Nox4
-/-
mice exhibiting the most severe alterations in endothelium-dependent vasodilation. Laminar shear stress attenuated the hypoxic response in endothelial cells, reducing HIF1a and
NOX4
expression while enhancing eNOS expression. NO synthase inhibition under combined hypoxia and laminar flow conditions upregulated
NOX4
. Furthermore,
NOX4
deletion affected PECAM1 expression and endothelial cell adhesion. Inhibition of NOX4 under combined hypoxia and laminar flow increased the number of endothelial cells not aligned in the direction of flow.

Conclusions:
Hypoxia-induced NOX4 ensures vasodilation in both conductive and resistant arteries. Laminar blood flow restores eNOS expression and mitigates the hypoxic response on NOX4. NOX4 deletion affects PECAM1 expression, reduces endothelial cell adhesion and alignment.
Abstract 4146894: Switching to Ticagrelor from clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: A meta-analysis of 4334 patients
Authors: Abdelaziz Ahmed , Desouki Mariam , Elshahat Ahmed , Hassan Atef , Helmi Ahmed , Mohamed Ahmed , Afify Raneem , Nasr Ahmed , Ali Ahmed Hamdy G. , Banour Sandi , Abdelazeem Basel
Published: November 2024

Introduction:
For patients undergoing fibrinolytic therapy for ST-elevation myocardial infarction (STEMI), The concurrent administration of aspirin and clopidogrel as dual antiplatelet therapy is the recommended standard of care for these patients. However, the efficacy and safety of switching to ticagrelor within 24 hours following fibrinolytic treatment compared to clopidogrel continuation is still a debate.

Purpose:
We aimed to compare ticagrelor and clopidogrel regarding the efficacy and safety outcomes in patients with STEMI receiving fibrinolytic therapy.

Methods:
We performed an extensive electronic search on PubMed, Scopus, Web of Science, and Cochrane Library from inception till February 2024. All randomized controlled trials (RCTs) that compared between ticagrelor and clopidogrel in the setting of STEMI were included. The primary endpoint was all-cause death. The secondary outcomes were myocardial infarction and Bleeding Academic Research Consortium classification (BARC) 1-2.

Results:
Four randomized controlled trials involving 4334 patients were included in the analysis. Ticagrelor showed higher rates of BARC 1-2 bleeding events compared to clopidogrel (OR= 1.68, 95% CI [ 1.22 to 2.31], P=0.002), with no significant difference regarding the incidence of all-cause death (OR= 0.89, 95% CI [ 0.61 to 1.31], P=0.56) or MI (OR= 0.76, 95% CI [ 0.42 to 1.35], P=0.35).

Conclusion:
Ticagrelor was associated with a higher incidence of bleeding events compared to clopidogrel, with no significant difference in other clinical outcomes. Switching to ticagrelor from clopidogrel might worsen the case regarding clinical outcomes. Large-volume RCTs should be implanted with longer follow-up to validate the current findings.
Abstract 4146902: Invasive versus Echocardiographic Hemodynamics in Two Genetically Modified Porcine to Human Cardiac Xenotransplants
Authors: Tang Alice , Mohiuddin Muhammad , Soares Cullen , Hong-Zohlman Susie , Tully Andrew , Galindo Javier , Dickfeld Timm , Barr Brian , Asadi Sadegh , Gupta Anuj , Grazioli Alison , Lankford Allison , Feller Erika , Griffith Bartley , Ananthram Manjula
Published: November 2024

Background:
Our institution performed two transgenic porcine to human cardiac xenotransplantations. There is limited data with the first cardiac xenograft suggesting echocardiographic assessment of the cardiac xenograft in humans correlates with invasive hemodynamic assessments. We investigated whether echocardiographic-derived hemodynamic indices would correlate with invasive measurements in both cardiac xenotransplants.

Methods:
Serial transthoracic echocardiography (TTE) and right heart catheterizations (RHC) were performed in the cardiac xenografts. Retrospective analysis of TTE and invasive hemodynamics were analyzed in both the first and second xenotransplant to assess correlation between various parameters. Invasive hemodynamic measures include right atrial pressure (RAP), pulmonary artery systolic and diastolic pressures (PASP, PADP), Fick cardiac output (CO), cardiac index (CI), right ventricular stroke work index (RVSWI), and cardiac power output (CPO). TTE measurements and calculations included: RAP, PASP calculated via tricuspid regurgitation velocity (TRV), PADP based on end diastolic pressure gradient, tricuspid annular plane systolic excursion (TAPSE), right ventricular outflow time-velocity integral (TVI RVOT), pulmonary vascular resistance (PVR) = [TRV/TVI RVOT x 10 + 0.16], CO, CI, CPO = [mean arterial pressure echo-derived CO / 451], and right ventricular stroke work index (RVCPI) = [4x(TRV)^2) x TAPSE], as a surrogate of RVSWI.

Results:
Pearson correlation using invasive measurements at the time of TTE for cardiac output showed a positive correlation of 0.69 (p = 0.06) with a trend towards significance. Pearson correlation of RVSWI and RVCPI demonstrated a significant positive correlation of 0.83 (p = 0.04).

Conclusions:
In the first two cardiac xenotransplants, there remains a positive correlation in hemodynamic markers between invasive and noninvasive measurements. Given the intense interest in cardiac xenotransplant, continued investigation in correlating noninvasive and invasive hemodynamic markers will provide real-time prognostic and clinical value for future research.
Abstract 4146910: Impact of Catheter Ablation on Atrial Fibrillation Outcomes in Various Cardiomyopathies: Findings from LGE-MRI Quantified Atrial Fibrosis Analysis
Authors: Kassar Ahmad , Chamoun Nadia , Chahine Yaacoub , Bockus Lee , Al Yasiri Hala , Hensley Tori , Akoum Nazem
Published: November 2024

Background:
Atrial fibrillation(AF) is the most prevalent arrhythmia in patients with cardiomyopathies(CMs) with and without left ventricular dysfunction. Catheter ablation is widely performed for rhythm control in these patients.

Hypothesis:
Patients with cardiomyopathies have an increased risk of AF recurrence after catheter ablation.

Aims:
Characterize the difference in AF recurrence following ablation in Hypertrophic(HCM), ischemic(ICM), and non-ischemic cardiomyopathy(NICM) patients.

Characterize the degree and distribution of left atrial(LA) fibrosis among the various CM groups.

Methods:
Patients undergoing their first catheter ablation for AF were included, assessed for left atrial fibrosis using pre-ablation late-gadolinium enhancement cardiac magnetic imaging(LGE-MRI), and followed for AF recurrence after pulmonary vein isolation, excluding those with prior ablations.

Results:
A total of 552 patients: 39(7%) HCM, 39(7%) ICM, 115(21%) NICM, and 359(65%) patients without CM were analyzed. Patients with HCM were younger(63±14 years) than other CM subtypes(76.2±8.7 and 68.4±30.8;p<0.001). There was a male predominance noticed across the different groups of cardiomyopathies, except for HCM patients, who had a higher percentage of females(41%vs15%vs22%;p<0.001). Patients with any CM had more LA fibrosis and a higher left atrial volume index(LAVI) compared to patients with no CM(19.1±7.5%vs16.5±6.9%;p=0.01 and 44.9±12.1vs40.8±8.8;p<0.001)respectively. HCM and ICM had higher LA fibrosis compared to NICM(21.3±8.7% and 21.9±9.1% respectively vs17.5±6.3;p=0.01). There was no significant difference in the regionality of fibrosis among the various groups. Multivariate analysis revealed that individuals with HCM had a three-fold increase in the risk of arrhythmia recurrence compared to individuals with no CM(HR=3.07,95%CI:2.06–4.58,p<0.001). Left atrial fibrosis and LAVI were also independently associated with an increased risk of recurrence(HR=1.03,95% CI:1.01–1.06,p=0.01 and HR=1.02,95% CI:1.01–1.03,p=0.01) respectively.

Conclusion:
HCM had a higher arrhythmia recurrence risk than other CM types in AF patients undergoing catheter ablation, with overall fibrosis and volume predicting recurrence despite similar fibrosis patterns.
Abstract 4146920:

Potential Effects of Preoperative Blood Transfusions on Cardiac Transplantation Patient’s Postoperative Condition
Authors: Gonipati Sneha , Kashem Abul , Toyoda Yoshiya
Published: November 2024

Introduction:
Perioperative anemia can cause a host of complications, such as renal injury, stroke, and mortality. However, the use of transfusions preoperatively also can cause various complications, such as an overload of fluids and the risk of infection. Learning if, and how much an effect transfusion has in cardiac surgery can lead to better decision-making to reduce postoperative complications.

Hypothesis:
The hypothesis tested was that there is a significant difference in postoperative outcomes between cardiac transplant patients who received a blood transfusion preoperatively and those who did not.

Methods:
The UNOS database was used to find adult patients who received a heart transplant between 2000 and 2023 (n = 51,325). The remaining individuals were split into groups that received preoperative blood products (n=10,873) or did not (n=40,452). Endpoints analyzed include mortality, length of stay, graft status, and acute rejection. Mortality was analyzed using a Kaplan-Meier curve and log-rank tests, and Cox proportional hazards were used to find risk factors. All analysis was done in JMP.

Results:
After analysis, it was found that there was a significant difference in length of stay (p<0.0001), graft status (p<0.0001), and acute rejection (p=0.0430), with transfusion patients having a longer LOS, and higher percentages of graft failure and acute rejection. The Kaplan-Meier curve shows a significant difference in mortality between the two groups (p<0.0001). Life support at registration also showed significant differences, with ECMO utilization (p<0.0001), ventilator utilization (p<0.0001), and IABP utilization (p<0.0001) having higher percentages with patients with preoperative transfusions. Cox regression results showed that there is an increased risk of mortality in patients who did not receive transfusions before transplant (p<0.0001).

Conclusion:
While there was an increase in postoperative complications with patients with preoperative transfusions, there also appears to be a correlation between the need for life support and the use of blood products preoperatively. This, along with the reduced risk of mortality from preoperative transfusion patients, shows the possibility that differences in outcomes relating to transfusions may be due to patient conditions before the surgery rather than transfusions alone.
Abstract 4146929: Comparison of Right Ventricular Dysfunction Following Catheter-Directed, Half-Dose, and Full-Dose Thrombolysis for Acute Pulmonary Embolism
Authors: Koura Simran , Mallery Quinn , Clarke Jacob , Greathouse Frances , Choi Myoung Hyun , Riya FNU , Bruno Elizabeth , Arora Punit , Malas Waddah , Shah Parth , Sutherland David , Kumar Amudha , Wroblewski Igor , Darki Amir
Published: November 2024

Introduction:
Systemic thrombolysis (ST) is the mainstay of treatment for acute massive pulmonary embolism (PE). Catheter directed therapy (CDT) has become more common in treatment of acute PE in patients with contraindications to ST. Half-dose ST (hdST) has also been utilized with similar efficacy and a lower risk of bleeding than full-dose ST (fdST). It is uncertain how right ventricular dysfunction (RVD) on transthoracic echocardiography (TTE) varies comparing all three modalities.

Research Question:
How does RVD on TTE imaging in acute PE vary based on the thrombolytic modality?

Methods:
We conducted a retrospective, multi-center cohort study using data from our institutional PE Response Team registry. TTE imaging was directly assessed to obtain parameters. Included patients were over 18 years old with TTE’s obtained after CDT, fdST, or hdST, excluding those missing key RVD parameters (TAPSE, S', RV ratio, RVOT VTI, RVOT notching, 60-60 sign). RVD was defined as threshold values met in two or more parameters. Between group univariate testing was performed using ANOVA, Student’s t-test, chi-squared, and Fisher’s exact test when appropriate for the entire cohort as well as specifically CDT vs. hdST.

Results:
The final cohort included 188 patients, with 163 undergoing CDT, 19 receiving hdST, and 6 receiving fdST. Patients with hdST had significantly higher RVOT VTI (13.8 ± 5.7 cm) compared to the CDT group (10.7 ± 4.5 cm, p=0.016). There were lower rates of RVD in the hdST group (26.3%) compared to CDT (39.3%, p=0.04). Bleeding rates were not statistically different across all three cohorts (p=0.78)

Conclusion:
Despite the higher severity of illness on presentation, patients treated with hdST had lower rates of RVD following treatment compared to those treated with CDT, without increased rates of bleeding. Further investigation is needed; however this study provides additional evidence supporting the safety of hdST in hospital systems lacking access to CDT.
Abstract 4146947: Obese adolescents supported with VADs have inferior post-transplant outcomes
Authors: Berger Justin , Mejia Erika , Sanderlin Rachel , zhang Xuemei , Mavroudis Constantine , O'Connor Matthew , DeWitt Aaron , Ahmed Humera , Rossano Joseph , Wittlieb-Weber Carol , Edwards Jonathan , Lin Kimberly , Joong Anna , Maeda Katsuhide , Edelson Jonathan
Published: November 2024

Background:
The prevalence of both obesity and the use of left ventricular assist devices (LVAD) is increasing in pediatrics, but what impact obesity has on post-heart transplant (HT) outcomes when using an LVAD as a bridge to transplant (BTT) is unknown.

Methods:
Retrospective cohort study of patients 12-18 years old in the UNOS database with a durable LVAD and listed for heart transplant (HT) between 7/1/2004-12/31/2021. Demographic and clinical variables were assessed. Patients were classified as overweight (BMI
≥
85-<95% percentile), Class I obesity (BMI
≥
95-<120% of the 95
th
%), and Class II/III obesity (
≥
120% of the 95
th
% or BMI
≥
35) at time of listing and transplant. The primary outcome was 1-year post-HT survival; additional outcomes included post-HT length of stay (LOS), rejection, and waitlist removal. A multivariable analysis was performed to identify the independent association of morbid obesity with 1-year post HT survival.

Results:
Of 539 adolescent BTT patients, 41% had a BMI
≥
85
th
percentile at time of listing: 76 were overweight, 84 were Class I, and 60 were Class II/III. Class II/III patients, compared to overweight, demonstrated a decrease in BMI between listing and transplant (△BMI -0.2, IQR -2.6–0.5 vs 0.0, IQR -0.5–2.6, p= 0.003) with similar improvement in functional status (27% vs 32-36%, p=0.37) and equivalent post-HT LOS (17 vs 15-17 days, p =0.09). However, these patients were more frequently inactivated (13% vs 4-7%, p=0.04). In adjusted analysis, the highest BMI cohort had lower likelihood of reaching HT (OR 0.65, 95% CI 0.48-0.88) and increased 1-year post-HT graft failure (OR 4.47, 95% CI 1.22-14.78) (Fig. 1A). The 5-year mortality of these patients was nearly twice that of other adolescents (29% vs 18%, p=0.06) (Fig. 1B).

Conclusions:
Class II/III obese adolescent VAD patients have an increased risk of waitlist inactivation and 1-year graft failure. Use of VADs and HT in obese adolescents may be reasonable (71% 5-year survival) if the team, patient, and family are aware of the higher risk profile. Given the socioeconomic contributions to obesity in children, further studies examining if obesity can be a modifiable risk factor in VAD and HT is critical.
Abstract 4146960: Social Determinants of Health Associated With Worse Hypertension Stage in Low-Middle Income Country
Authors: Rodriguez Szaszdi David Jose Javier , Satish Vikyath
Published: November 2024

Background:
Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD) and is the leading cause of morbidity and mortality globally, with a rise in prevalence in low and middle-income countries (LMIC). While HTN awareness, treatment, and control have increased in high-income countries (HIC), this increase is less marked in LMIC.

Objective:
To describe the characteristics of social determinants of health associated with HTN in LMIC rural areas.

Methods:
Data was obtained from a cluster-randomized trial in Guatemala, implemented in rural areas nationwide. Trained interviewers used standardized questionnaires and measurements to collect data. HTN stage was defined according to AHA’s 2018 guidelines. The chi-squared test compared sociodemographic characteristics between HTN stages I and II.

Results:
Data from 1580 hypertensive participants with blood pressure readings over 130/80 mmHg with or without anti-hypertensive treatment was analyzed. The median age was 63 years, with 72% women. Spanish (Guatemala’s official language) was spoken by 65%, and the illiteracy rate was 58%. Mayan ethnicity represented 43%. The proportion of people aware of their HTN diagnosis was 69%, but only 60% of them were on anti-hypertensives. Median systolic and diastolic blood pressure (BP) was 142.5 and 76.5 mmHg, respectively. Median BMI was 27.6 kg/m
2
. A statistically significant difference (p<0.05) was observed between HTN stages I and II in ethnicity (37% vs. 46% belonged to the Mayan Indigenous group), median age (61 vs. 64 years), Spanish language fluency (68% vs. 64%); literacy (46.3% vs. 39.6%); known HTN (74% vs. 66%); established anti-HTN treatment (69% vs. 54%); treatment adherence (76% vs 68%); and body mass index (28.1 vs 27.4 kg/m2).

Conclusions:
These results highlight significant disparities in the characteristics and management of hypertension among rural populations of LMIC. They emphasize the need for targeted interventions to improve hypertension control, specifically in rural areas, like enhancing access to healthcare, improving literacy and language proficiency, and addressing the specific needs of the Mayan indigenous population due to differing cultural habits and beliefs.
Abstract 4146970: Comparative Computational Modeling of Mitral Valve Translocation and Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation
Authors: Darby Zachary , Gammie James , Yao Jiang , Chinedozi Ifeanyi , Reginauld Shawn , Masterson Ashley , Rando Hannah , Kang Jin Kook , Briscoe Jessica , Battisti Tom , Quinn Rachael
Published: November 2024

Introduction/Background:
Secondary mitral valve regurgitation (SMR) results from left ventricular or left atrial remodeling. Conventional surgical repair with restrictive mitral annuloplasty has demonstrated poor durability in randomized trials. We have described a novel surgical approach, mitral valve translocation (MVT) in which a circumferential, frustum-shaped pericardial patch favorably improves the geometry of the mitral apparatus and abolishes MR. To gain a better understanding of MVT, we sought to compare it in a computational model of SMR vs Transcatheter edge-to-edge repair (TEER).

Research Questions/Hypothesis:
We sought to compare the effect of MVT to transcatheter edge to edge repair (TEER) on valvular function and hemodynamics using computational modeling.

Methods:
Using an adaptation of a 3D model developed from a patient specifc mitral valve apparatus model, simulations for TEER and MVT were conducted. Pre- and post-procedure hemodynamics including flow rates, pressures, and geometric measurements were extracted.

Results/Data:
Mitral valve (MV) pansystolic effective orifice area decreased by 72.6% for MVT and 66% for TEER (Table1), while MV minimal regurgitation area went from 25mm
2
in the native valve to 6mm
2
and 9mm
2
for MVT and TEER respectively. Left ventricular ejection fraction was reduced by 15.3% post-MVT and 11% post-TEER. Left atrial end-diastolic volume (EDV) decreased by 11.2% post-MVT and 8.8% post-TEER.

Transmitral pressure gradient decreased by 16.7% post-MVT but increased by 600% post-TEER. Left ventricular (LV) diastolic pressure decreased by 17.0% for MVT, compared to a 51.7% reduction for TEER. LV systolic pressure increased by 14.4% post-MVT and 13.2% post-TEER. Systolic pulmonary arterial pressure rose by 3.9% post-MVT and 4.7% post-TEER

Conclusion:
Both MVT and TEER effectively improved cardiac function in SMR, with MVT showing greater benefits in certain hemodynamic parameters. Future research will focus on developing patient-specific models to optimize surgical outcomes and explore new repair strategies.