bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4140585: Shifting in the settings of stroke fatalities during the COVID-19 pandemic
Authors: Pham Hoang Nhat , Shrourou Farah , Olson April , Alabagi Abdulla , Habib Adam , Terrani Kristina , Beshai Rafail , Elias Tony , Ramzi Ibrahim , Singh Amitoj , Lee Kwan
Published: November 2024

Introduction:
Stroke-related mortality poses significant challenges in the US. Increased at-home deaths since COVID-19 pandemic prompted changes in the provision of end-of-life care.

Question:
What were the settings of stroke deaths in the US during COVID-19 pandemic?

Methods:
Decedent-level mortality data from death certificates in CDC repository were obtained for the year 2020 (pandemic) and 2019 (comparison). Demographic data include age, sex, race/ethnicity, education, marital status, and place of stroke death, including inpatient, outpatient/emergency room (ER), hospice/nursing facilities (H/NF), and at-home. Multivariable logistic regression models assessed demographic impact on stroke mortality by place-of-death, yielding odds ratios (OR) with significance threshold of p<0.05.

Results:
A total of 5,400 and 5,712 stroke-related deaths occurred in 2019 and 2020, respectively. During COVID-19, decedents >65 years were more likely to die in H/NF (OR 10.05, p<0.001) but less likely in outpatient/ER (OR 0.32, p<0.001) or at home (OR 0.57, p=0.007) compared to those <35 years. High education level did not significantly influence the place of death than having high school diploma or less (p>0.05). Males were more likely to die at home (OR 1.38, p<0.001) but less likely as inpatient (OR 0.79, p<0.001) than females. Hispanic decedents had a higher likelihood of inpatient death (OR 1.22, p=0.041) but less likely to die in H/NF (OR 0.55, p<0.001) compared to non-Hispanic decedents. Compared to White decedents, Black decedents were more likely to die in outpatient/ER (OR 1.44, p=0.018), while American Indian decedents were more likely to die as inpatient (OR 3.12, p=0.005). Asian/Pacific Islander decedents had a higher chance of inpatient death (OR 1.47, p=0.002) but a lower likelihood of dying in H/NF (OR 0.61, p=0.010). Married decedents were more likely than singles to die as inpatient (OR 1.37, p=0.001) or in outpatient/ER (OR 1.99, p<0.001), but less likely to die in H/NF (OR 0.61, p=0.002) or at home (OR 0.56, p<0.001).

Conclusion:
Our analysis revealed the influence of demographics on the settings of stroke fatalities during the COVID-19 pandemic. Further investigation is needed to determine contributing factors.
Abstract 4140588: Temporal Variation in Out-of-Pocket Costs for Guideline-Directed Medical Therapy Among Patients with Heart Failure
Authors: Gunn Alexander , Pendyal Akshay , Mentz Robert , Sinaiko Anna , Sloan Caroline
Published: November 2024

Background:
Patients with HF average >$4000/year in out-of-pocket (OOP) costs for their care, including GDMT. High OOP costs lead to nonadherence and poor outcomes. The OOP costs of GDMT often fluctuate over the course of the year due to deductibles and other variable cost-sharing requirements. Poor understanding of these changes present a barrier to cost-conscious treatment decisions.

Objective:
To characterize fluctuations in OOP GDMT costs over the course of the year for patients with HF.

Methods:
We used electronic health record and real-time prescription benefit (RTPB) data to conduct a retrospective analysis of insured adults (Medicare, Medicaid, or private) with a diagnosis of HF at a large academic system in Jan 2021-Dec 2023. We described RTPB-estimated 30-day OOP costs of all 4 major HF drug classes. We compared OOP costs at end-of-year (Oct-Dec) vs beginning-of-year (Jan-March) using Kruskal-Wallis test. An ordinary least-squares model was used to assess differences after adjustment for age, sex, race, and comorbidities.

Results:
Of 2965 patients with HF, 86% were enrolled in Medicare, 10% in private insurance, and 4% in Medicaid. Among patients with private insurance, median 30-day OOP costs for ARNi were $9.54 (IQR $0.00-$28.81) in Oct-Dec and increased seven-fold to $71.14 (IQR $26.68-$115.99) in Jan-March (p=0.03) (
Figure
). SGLT2i costs increased from $0.00 (IQR $0.00-$21.58) in Oct-Dec to $35.57 (IQR $28.81-$115.61) in Jan-March (p<0.001). For patients with Medicare, 30-day OOP costs for ARNi increased from $35.40 (IQR $2.00-$68.65) in Oct-Dec to $41.80 (IQR $10.89-$84.08) in Jan-March (p<0.001), while no differences were noted for SGLT2i. Costs varied minimally for patients with Medicaid and for medications with generic options available, regardless of payor type. In an adjusted model, between-period differences persisted for those with private insurance (ARNi $49.99, 95% CI 11.27-88.71, p=0.01; SGLT2i $23.63, 95% CI 3.10-44.16, p=0.02).

Conclusion:
Among patients with HF, OOP costs for 30 days of GDMT varied significantly over the course of a year, especially for patients with private insurance. The largest variations were for patented drug classes (ARNi and SGLT2i). These findings can inform cost-conscious treatment decisions for clinicians and patients.
Abstract 4140589: The Impact of Ischemic Conditioning on Corticomotor and Behavioral Outcomes in Chronic Stroke Survivors: A Pilot Trial
Authors: Cummings Mark , Madhavan Sangeetha
Published: November 2024

Introduction:
Ischemic conditioning (IC), a procedure where the limb is exposed to recurrent bouts of blood flow occlusion followed by reperfusion, is clinically relevant for stroke rehabilitation as a neuromodulatory adjunct. Similar modalities (i.e., ischemic nerve block) revealed that peripheral blood flow restriction initiated neuroplastic changes in the motor cortex. Yet, this is unconfirmed with IC.

Aims:
To quantify changes in corticomotor excitability (CME) and transcallosal inhibition (TCI) of the paretic and nonparetic tibialis anterior (TA) muscle representations alongside changes in motor performance after one session of IC compared to sham ischemic conditioning (sham-IC), and aerobic exercise.

Methods:
Fifteen chronic stroke survivors will participate in three sessions: one involving IC, one involving sham-IC, and one involving aerobic exercise, with a one-week washout period between sessions. During the IC and sham-IC sessions, participants will undergo three 10-minute cycles, totaling 30 minutes. Each cycle will consist of 5 minutes of occlusion with cuff pressure set at either 225mmHg (IC) or 25mmHg (sham-IC), followed by 5 minutes of reperfusion with cuff pressure set at 0mmHg. The aerobic exercise session will involve 30 minutes of moderate-intensity recumbent stepper cycling. Before (pre), after (post) and 30 minutes after (post-30) each intervention, CME and TCI will be assessed using transcranial magnetic stimulation in addition to paretic ankle strength and reaction time (RT).

Results:
Pilot data from five males (mean ± SD: age = 62.4 ± 9.9 years; years since stroke = 8.4 ± 4.6) showed that after IC, CME increased by 31% (post) and 15% (post-30) and TCI increased by 12% (post) and 13% (post-30). After aerobic exercise, CME decreased by 8% (post) and increased by 5% (post-30) whereas TCI increased by 14% (post) and 16% (post-30). Sham-IC had negligible results. Strength improved by 19% (post) and 25% (post-30) following IC and by 16% (post) and 15% (post-30) following aerobic exercise. RT increased by 11% after IC but only by 2% after exercise and <1% after sham-IC.

Conclusion:
Initial results reveal IC is superior to sham-IC and aerobic exercise for enhancing motor and neurophysiological outcomes in chronic stroke. We expect to confirm these results with full data collection.
Abstract 4140628: Guideline-Directed Medical Therapy Rates in Patients with Human Immunodeficiency Virus and Heart Failure with Reduced Ejection Fraction
Authors: Zhang Suyu , Patel Krishan , Gangavelli Apoorva , Steinberg Rebecca , Wang Jeffrey , Morris Alanna , Okoh Alexis
Published: November 2024

Introduction:
Human immunodeficiency virus (HIV) infection increases the risk of heart failure, particularly Heart Failure with Reduced Ejection Fraction (HFrEF). Guideline-directed medical therapy (GDMT), including beta-blockers (BB), renin-angiotensin system inhibitors (RASi), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i), has been shown to decrease morbidity and mortality in patients with HFrEF.

Hypothesis:
Lower GDMT prescription rates would be associated with higher 30-day readmission or mortality rates in patients with HIV and HFrEF

Aims:
To assess GDMT prescription rates and their impact on short-term morbidity and mortality in patients with HIV and HFrEF.

Methods:
Patients diagnosed with HIV and HFrEF who were admitted with acute heart failure within Emory Healthcare from 2010 to 2020 were identified using ICD codes. Diagnoses were confirmed by physician review. Baseline demographics, CD4 count, viral load (VL), prescriptions for GDMT and antiretroviral medications at the time of admission were assessed. A simple GDMT score was created, assigning 1 point for each medication prescribed (0-3, excluding SGLT2i given the study timeframe). Multivariable logistic regression was used to determine the association of the GDMT score with 30-day readmission or death, adjusting for age, sex, race, hypertension, diabetes, estimated glomerular filtration rate (eGFR), and VL.

Results:
The study included 161 patients (mean age 56 years, 22.9% women, 86.3% Black, 55% with VL <200 copies/ml). Of these, 96 (59.6%) were prescribed BB, 82 (50.9%) RASi, and 18 (11.1%) MRA. This distribution resulted in 38 patients (26.7%) with a GDMT score of 0, 62 patients (43.7%) with a score of 1, 49 patients (34.5%) with a score of 2, and 12 patients (8.5%) with a score of 3. During the 30-day follow-up period, 22 patients (13.7%) were re-hospitalized or died. After adjusting for risk factors, a higher GDMT score was associated with a lower risk of 30-day readmission or death (OR 0.24, CI 0.06 – 0.88, p = 0.032). Male sex was also associated with a lower risk of this endpoint (p = 0.045).

Conclusion:
GDMT is under-prescribed in patients with HIV and HFrEF. Lower rates of GDMT prescription are associated with worse short-term outcomes in this population. Further efforts are required to ascertain reasons for under-prescription in these comorbid patients and to improve adherence to GDMT guidelines to enhance patient outcomes.
Abstract 4140643: Real World Evidence on Health Care Resources Utilization and Economic Burden of Arrhythmias in Patients with Diabetes and COPD.
Authors: Russo Pierantonio , Nathan Ramaa , Pfefer Daniel , Kamdar Shilpa , Wright Brent
Published: November 2024

Introduction:
We studied the healthcare resource utilization (HCRU) and medical costs of managing arrhythmias inT2D and COPD, and the impact of EKG screening on the rate of hospitalization and ER visits.

Hypothesis:
Arrhythmias in T2D and COPD generate high costs. Screening with EKG monitoring devices may be associated with a reduced rate of hospitalization and ER visits for arrhythmias.

Methods:
A retrospective claims analysis using the Merative MarketScan and the Symphony Integrated Dataverse databases. We identified patients > 18 years with claims for T2D or COPD or both T2D and COPD (T2D+COPD) and assigned them into groups:

Target:
patients without prior history of arrythmias, followed by arrythmias claims.

Control:
patients with either of the conditions, but without arrhythmias claims.

Target and control were matched 1:1 on demographic, year of first episode of arrhythmia, risk (ECI, DSI, Gold criteria). HCRU and medical cost drivers over 24 months were analyzed. HCRU of patients with arrythmia screened with EKG monitoring devices was compared to that of not screened patients.

Results:
Target group and control group included the same number of patients.213,226 T2D: 47,851 COPD; 31,571T2D/COPD. Atrial fibrillation was the most reported arrhythmia in the target cohort, followed by SVT.

Hospitalizations/1000/year were: 584/205 (T2D target/control); 650/311(COPD target/control); 844/402 (T2D+COPD).

The ER days/1000 /year and the 30 days readmissionfor the target patients were nearly twice as high than for the control.

Total cost of care per patient / year was significantly higher for all target patients compared to control (T2D $34,171/ $18,687; COPD $ 37,719/$25,656; T2D COPD $46,484/ $30,802). The per patient / year cost of hospitalization was higher in the target patient's vs control (T2D $28,316/$19,439; COPD $25,098/$17,906; T2D COPD $28,694/$19,352). ER cost per patient/year was 35%-50% higher in the target cohort.

Hospitalizations/1000 /month of patients screened with monitor devices was significantly lower than a 1:1 matched control cohort not using monitoring devices (T2D 64/215; COPD 69/198; 93/276). ER visits/1000/year were up to 50% lower in patients screened with monitoring devices.

Conclusions:
Arrhythmias significantly increase HCRU and total cost for T2D and COPD, particularly in patients requiring ER visits and hospitalization. Early detection with monitoring devices, could reduce the utilization of acute care and associated costs.
Abstract 4140645: Simultaneous Electro-Dynamic Stimulation Accelerates Maturation of Engineered Cardiac Tissue from Human Induced Pluripotent Stem Cells
Authors: Maihemuti Wusiman , Murata Kozue , Abulaiti Mosha , Masumoto Hidetoshi
Published: November 2024

BACKGROUND:
Electrical and dynamic stimulation are commonly used to enhance the maturation of engineered cardiac tissue (ECT) derived from induced pluripotent stem cells (iPSCs), reflecting the physiological environment of the heart. Electrical stimulation mimics natural bioelectrical signals, while dynamic stimulation replicates mechanical forces. However, the potential synergistic effects of combining electrical and dynamic stimulation simultaneously on ECT maturation have not been thoroughly investigated.

HYPOTHESIS:
We hypothesized that simultaneous electro-dynamic stimulation would enhance the maturation and function of the ECT more effectively than either stimulus alone
.

Methods:
ECTs were created by co-culturing human iPSC-derived cardiovascular cells with Collagen I and Matrigel for 2 weeks. This was followed by a comparative analysis of four groups: no stimulation, dynamic stimulation, electrical stimulation (3 volts), and simultaneous electro-dynamic stimulation. For simultaneous stimulation, a specially designed sensor generated electrical pulses timed with dynamic mechanical stimulation. The physical training regimen lasted 2 weeks for all groups. The functionality of the ECTs was assessed using a video-based system to measure contractile capacity, and a flux analyzer to evaluate calcium indicators. Histological assessments examined structural maturation.

RESULTS:
During protocol optimization, the 30rpm dynamic culture significantly enhanced the cardiomyocyte (CM) component of the ECTs compared to the 60rpm group, highlighting the importance of dynamic stimulation frequency on tissue development. Simultaneous electro-dynamic stimulation significantly increased the CM component of ECT (control vs simultaneous stimulation: 16.1 ± 5.2 % vs 43.5 ± 12.1 %, P= 0.0009), elevated TNNT2 mRNA expression levels, and enhanced calcium transient capacity. Additionally, ECTs subjected to simultaneous stimulation exhibited a positive force-frequency relationship in contractility and an elevation in peak calcium flux, indicative of advanced tissue maturation. Moreover, simultaneous stimulation promoted vascular network formation within the ECTs, suggesting improved structural organization.

CONCLUSION:
Simultaneous electro-dynamic stimulation creates ECTs with superior functional and structural properties compared to electrical or dynamic stimulation alone. Simultaneous stimulation protocols are crucial for developing effective cardiac tissue engineering strategies.
Abstract 4140673: Prognostic Value of Renal Function Biomarkers in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis
Authors: Parhizkar Roudsari Peyvand , Behnoush Amir Hossein , Moradi Ali , Sadaf Salehi , Keykhaei Mohammad , Hosseini Kaveh , Gomes Edward , Malhi Jasmine , Chew Christopher , Tajdini Masih
Published: November 2024

Background:
Considering the high prevalence and comparable five-year mortality rates of heart failure with preserved ejection fraction (HFpEF) to heart failure with reduced ejection fraction (HFrEF), and the inconsistent results regarding prognostic biomarkers for HFpEF, we aim to systematically review studies evaluating the prognostic role of common kidney function markers in HFpEF.

Methods:
Following PRISMA guidelines, a systematic search was performed in online databases from inception to March 2024. Studies that primarily assessed the association of blood urea nitrogen (BUN), uric acid (UA), creatinine (Cr), estimated glomerular filtration rate (eGFR), and cystatin-C with HFpEF outcomes were included. A random-effects meta-analysis was conducted to pool the hazard ratios (HRs) and their 95% confidence intervals (CIs) for a 1-unit increase in markers or higher levels versus lower levels for the incidence of adverse events, including all-cause mortality, HF readmission, cardiac mortality, and composite outcomes.

Results:
Out of 2491 reviewed studies, 80 were included. A significant correlation between BUN levels and HFpEF outcomes, mainly HF readmission and all-cause mortality, was found. The meta-analysis showed that a 1-unit increase in BUN was linked to a higher hazard of these events (HR 1.02, 95% CI 1.01 to 1.03, P = 0.0003). A 1-unit increase in UA resulted in a higher incidence of adverse events (HR 1.13, 95% CI 1.05 to 1.21, P = 0.0005). Higher serum Cr levels were linked to increased all-cause mortality, with a 1-unit increase in Cr leading to a higher incidence of adverse events (HR 1.17, 95% CI 1.06 to 1.29, P = 0.0017). Higher eGFR values were associated with lower mortality and hospitalization (HR 0.99, 95% CI 0.98 to 0.99, P < 0.0001). The predictive value of cystatin-C was also demonstrated, with its increased levels correlating with higher mortality and readmission, showing a higher hazard ratio (compared to others) of 1.43 (95% CI 1.21 to 1.75, P < 0.0001). It appears that among continuous variables, cystatin-C works better to predict adverse outcomes in HFpEF (figure).

Conclusion:
Renal function biomarkers play a significant role in predicting HFpEF outcomes, aiding in better risk assessment and patient management.
Abstract 4140687: Characterization of the Near-Field Bipolar Voltage Substrate Using a Novel Automated Peak Frequency Algorithm in Patients Undergoing Catheter Ablation of Postinfarction Ventricular Tachycardia
Authors: Nimmagadda Manojna , Korzon Monica , Younis Arwa , Lee Justin , Higuchi Koji , Sroubek Jakub , Chung Roy , Kanj Mohamed , Nakhla Shady , Saliba Walid , Bhargava Mandeep , Wazni Oussama , Nakagawa Hiroshi , Hussein Ayman , Santangeli Pasquale
Published: November 2024

Background:
Ventricular tachycardia (VT) substrate characterization in patients with ischemic cardiomyopathy (ICM) utilizing conventional peak-to-peak bipolar voltage mapping is limited by preferential automatic annotation of large amplitude far-field electrograms (EGMs).

Objective:
To investigate the role of a novel peak frequency (PF) software that prioritizes annotation of the near-field high-frequency component of bipolar EGMs as compared to standard bipolar voltage mapping (Std-Bip) for postinfarction substrate characterization.

Methods:
We studied 23 patients (age 67.2±9.4 years, 95.7% male, LVEF 37.4±14.6%) undergoing catheter ablation of postinfarction VT (34.8% anterior infarction, 73.9% inferior infarction). High-density endocardial substrate maps were created in sinus rhythm (43.5%) or right ventricular pacing (56.5%) using a 16-electrode mapping catheter (HD grid, Abbott, IL). The peak-to-peak bipolar voltage of collected EGMs was analyzed in Std-Bip configuration and after applying the PF software.

Results:
A total of 105,815 Std-Bip and PF EGMs were analyzed. Overall, 30.6% Std-Bip EGMs had a voltage 0.5-1.5 mV and 39% a voltage <0.5 mV. After applying the PF software, 26.3% PF EGMs had a voltage 0.5-1.5 mV and 48.4% a voltage <0.5 mV (p<0.01 for comparison,
Figure
). The PF software reclassified an average of 8.9% (range 3.1% to 21.9%) Std-Bip EGMs to a voltage <0.5 mV and an average 3.5% (range -7.9% to 13.5%) Std-Bip EGMs to a voltage 0.5-1.5 mV. This resulted in an average increase in LV surface area subtending low voltage (<1.5 mV) EGMs of 3.9±0.03%.

Conclusions:
Postinfarction substrate mapping with a PF annotation algorithm significantly improves identification of low voltage bipolar EGMs compared to Std-Bip mapping.
Abstract 4140707: The Examination of Expression Patterns, Underlying Mechanisms, Diagnostic Accuracy, and Potential AI-Driven Drug Development Approaches for Ferroptosis-Related Genes in Heart Failure via Single-Cell and Bulk RNA Sequencing Analyses
Authors: Liu Zeye , Jiang Hong , Zhang Fengwen , Ouyang Wenbin , Wang Shouzheng , Xia Ruibing , Li Yakun , Shi Yi , Pan Xiangbin
Published: November 2024

Introduction:
Heart failure is a significant concern for public health, particularly among the elderly demographic. In this study, we aimed to investigate the molecular underpinnings of heart failure, focusing on ferroptosis-related genes.

Purpose:
Our objective was to analyze unicellular RNA sequencing data derived from patients with heart failure and healthy controls. We sought to identify common ferroptosis-related genes and explore their potential as therapeutic targets for heart failure treatment.

Methods:
We analyzed unicellular RNA sequencing data from 200,615 cells, encompassing samples from four heart failure patients and two healthy controls. Initially, we curated a set of 388 ferroptosis-related genes from the FerrDB Database. Subsequently, we identified commonly shared significant ferroptosis-related genes by intersecting these with genes differentially expressed in the cell clusters using bulk RNAseq data. We also utilized data from the DGIdb to explore potential therapeutic drugs targeting these identified genes. Molecular docking and artificial intelligence-based IC50 prediction were employed to assess the efficacy of these drugs in mitigating heart failure.

Results:
Among the identified ferroptosis-related genes, ALOX5 and PLIN2 emerged as common candidates, both enriched in monocytes and dendritic cells. Interaction analysis revealed 51 drug categories interacting with ALOX5, along with 10 corresponding transcription factors. These genes exhibited robust discrimination ability in independent datasets, with an AUC of 0.915. Compounds exhibiting the strongest binding affinity with the ALOX5 protein were evaluated, demonstrating an affinity of 10.4 kcal/mol. Furthermore, a compound IC50 prediction system based on 42 machine learning models was developed, showing promising correlation coefficients up to 0.723 (P<0.05).

Conclusions:
Our research indicates ferroptosis may contribute to heart failure progression via ALOX5 and PLIN2 gene dysregulation in monocytes and dendritic cells, highlighting their therapeutic potential. Our study also emphasizes the value of computational approaches in drug discovery and personalized heart failure treatments.
Abstract 4140771: Utility of Non-obstructive General Angioscopy-Derived Plaque Evaluation and LDL Cholesterol Levels in Identifying CCs from High-Risk Plaques in the Aorta
Authors: Tanaka Yudai , Kojima Keisuke , Hotsubo Yuta , Nakajima Yuki , MIGITA SHOHEI , Mizobuchi Saki , Fukumoto Katsunori , Arai Riku , Ebuchi Yasunari , Morikawa Tomoyuki , Mineki Takashi , Sudo Mitsumasa , Kitano Daisuke , Okumura Yasuo
Published: November 2024

Introduction:
Severe atherosclerosis of the aorta poses a significant risk of embolism to peripheral organs. Non-obstructive general angioscopy (NOGA) offers detailed observation of atherosclerosis in the aorta. Cholesterol crystals (CCs) can disperse into the blood from ruptured plaques (RPs) and cause inflammation. However, the relationship between LDL cholesterol levels and the detection rate of CCs from RPs has not been fully elucidated.

Aims:
This study aims to evaluate the utility of NOGA in identifying high-risk aortic plaques for CCs detection and to examine the influence of LDL cholesterol levels on this detection rate.

Methods:
We investigated 105 consecutive patients with coronary artery disease who underwent NOGA between September 2021 and November 2023. Blood samples were taken from a total of 248 NOGA-derived atheromatous plaques in the infrarenal abdominal aorta. The presence of CCs was assessed using polarized light microscopy and the filter paper rinse method. The CCs detection rates were analyzed by stratifying patients based on LDL cholesterol levels (divided at 100 mg/dL) and the presence of RPs.

Results:
The mean age was 67 years; 82.9% were male, 41.0% had diabetes, 99.1% had dyslipidemia, and 78.1% had hypertension. RPs accounted for 52.8％ of the sampling sites, thrombi for 13.3%, yellow plaque for 21.0%, and ulcer and fissure for 12.9%. The overall CCs detection rate was 22.6% (n = 56/248). The detection rates were 1.7% (n = 2/117) in plaques without RPs and 41.2% (n = 54/131) in plaques with RPs (p < 0.001). Among those with LDL levels < 100 mg/dL, the detection rate was 19.3% (n = 41/213), whereas it was 42.9% (n = 15/35) in those with LDL levels ≥ 100 mg/dL (p = 0.039). Specifically, the detection rates were 1.9% (n = 2/104) in plaques without RPs and LDL < 100 mg/dL, 9.1% (n = 1/11) in plaques without RPs and LDL ≥ 100 mg/dL, 36.8% (n = 39/106) in plaques with RPs and LDL < 100 mg/dL, and 58.3% (n = 14/24) in plaques with RPs and LDL ≥ 100 mg/dL (p < 0.001).

Conclusions:
Identifying plaque types using NOGA, combined with LDL cholesterol levels, is useful for detecting high-risk aortic plaques prone to CCs. The combination significantly enhances the predictive capability for CCs detection.
Abstract 4140782: Machine Learning of ECG Waveforms for Outcomes After Left Bundle Branch Area Pacing in Heart Failure
Authors: Bilchick Kenneth , Bivona Derek , Patlatzoglou Konstantinos , Ng Fu Siong , Ellenbogen Kenneth , Pillai Ajay
Published: November 2024

Introduction:
Although left bundle branch area pacing (LBBAP) has become a popular approach to physiologic pacing in heart failure (HF), there is still substantial uncertainty regarding ECG predictors of favorable outcomes with this approach. We have shown that machine learning (ML) with functional principal component decomposition (FPCD) generates accurate predictors of outcomes for cardiac resynchronization therapy (CRT), but its effectiveness for LBBAP in HF is unknown.

Research Question:
How does ML with FPCD applied to 12-lead ECG QRS waveforms predict improvement in the LVEF with LBBAP in HF patients compared with standard ECG criteria for selective LBBAP?

Aims:
The aims were to determine which FPCD lead parameters from 12-lead ECGs before and after LBBAP in HF were associated with improvement in LV function post-pacing and how these predictors compared with known ECG and clinical predictors.

Methods:
12-lead ECGs in paper format were digitized, and FPCD was applied to the QRS waveforms before and after LBBAP in patients with LVEF ≤ 40% and ≥ 80% LBBAP. Logistic regression with the least absolute shrinkage and selection operator (LASSO) (Figure 1) was used to identify the ECG leads with the best FPCD predictors, and these predictors were compared with the commonly used R-wave peak time (RWPT) in lead V6 and other clinical parameters.

Results:
In 25 patients (40% female), the median baseline QRS duration was 156 ms (IQR 116 to 170 ms) and the median baseline LVEF was 33% (IQR 28 to 35%). In this cohort, 40% of patients had an absolute LVEF improvement of at least 15% with LBBAP. The ECG leads with the best FPCD parameters to identify patients with a 15% increase in the LVEF after LBBAP were lead III post-pacing and lead aVF pre-pacing (area under the receiver operating characteristic curve [AUROC] for model = 0.88, p=0.003) (Figure 2). The RWPT in V6 (3 V pacing output) had an AUROC of 0.60 for this outcome (p=0.63), and the difference in QRS duration before and after LBBAP had an AUROC of 0.58 (p=0.34). The model with the first FPCD weight for lead III post-pacing and ischemic cardiomyopathy (ICM) had an AUROC of 0.86 (0.0025) (Figure 3).

Conclusion:
Machine learning applied to ECG waveforms using FPCD was more effective in identifying LV functional improvement with LBBAP in HF compared with known ECG and clinical parameters. This approach could have an important impact for prognostication, therapy selection, and optimization during the LBBAP procedure.
Abstract 4140796: Association Between the Severity of Coronary Artery Stenosis with the Minimum Responsive Dose of Intracoronary Acetylcholine Provocation Test
Authors: Rha Seung-Woon , Ahn Woo Jin , hyun sujin , Cha Jinah , Choi Se Yeon , Choi Byoung Geol , Sinurat Markz , Park Soohyung , Choi Cheol Ung , Park Chang Gyu , Oh Dong
Published: November 2024

BACKGROUND:
Coronary artery spasm (CAS) is a cause of variant angina and is typically diagnosed by intracoronary acetylcholine (ACH) provocation test. Investigations regarding association between the severity of coronary artery stenosis and the minimum responsive dose of ACH required for provocation is limited.

METHODS:
In this study, 3,915 patients who underwent the acetylcholine (ACH) provocation test and showed CAS between October 2004 and December 2022 were enrolled. Significant CAS was defined as temporary narrowing of ≥70% during the ACH test. Patients were divided into three groups, based on the minimum responsive dose of ACH: A1 group (20ug, n=227), A2 group (50ug, n=1,366) and A3 group (100ug, n=2,322).

RESULTS:
In patients who were documented with positive intracoronary ACH provocation test, 5.8% responded at the lowest dose (20ug), 34.9% responded at the medium doses (50ug) and 59.3% responded only at the highest dose of ACH (100ug). The baseline characteristics of the patients among the 3 groups were similar, demonstrating no significant difference in the prevalence of hypertension, diabetes mellitus, and dyslipidemia. However, patients who responded at lower dose showed higher proportion of smokers (A1 37.9% vs. A2 35.7% vs. A3 31.0%, p=0.004). A1 group demonstrated the highest proportion of severe stenosis (63.0%), followed by A2 group (60.1%) and A3 group (47.4%) (Figure 1).

CONCLUSION:
In patients with chest pain with positive intracoronary ACH provocation test, severe stenotic lesions were found to be more frequent and more susceptible in patients who responded at lower doses of ACH.
Abstract 4140852: Total Burden of Posttraumatic Stress Disorder on Incident Cardiovascular Disease Among Women Veterans
Authors: Ebrahimi Ramin , dennis paul , Alvarez Carlos , beckham jean , Shroyer Annie , Sumner Jennifer
Published: November 2024

Introduction:
Posttraumatic stress disorder (PTSD) is an independent cardiovascular disease (CVD) risk factor with high prevalence in women, particularly women veterans (WV). While the impact of PTSD on ischemic heart disease (IHD) and stroke has been well established, its impact on a comprehensive set of CVD outcomes has not been studied in WV, a growing population at high risk for CVD in the U.S. The goal of this project was to investigate the impact of PTSD on a comprehensive set of CVD conditions in WV.

Methods:
National Veterans Health Affairs (VHA) electronic health records were used to identify all women who visited any VAs from 1/1/2000 to 12/31/2019. PTSD and CVD were identified based on International Classification of Disease versions 9 and 10 diagnoses ( 1 inpatient or 2 outpatient encounter documentations). Incident CVD outcomes included first onset of IHD, stroke, cardiomyopathy/heart failure (HF), pulmonary arterial hypertension/pulmonary hypertension (PH), atrial flutter/fibrillation (AF), peripheral arterial disease (PAD), venous thromboembolism (VTE), and aortic stenosis (AS). Propensity score matching and Cox survival analyses were performed to assess associations of PTSD with incident CVD outcomes.

Results:
We identified 622,312 WV, with 140,210 (22.53%) with PTSD. After 1:1 matching, 202,896 patients were included in the final analysis. WV had a mean age of 39.1 years, and the mean [MOU1] follow-up was 5.72 years. Table 1 reveals the association of PTSD with an incident CVD composite and the different component outcomes individually.

Conclusion:
In a large sample of WV, we demonstrate significant and clinically relevant associations of PTSD with a comprehensive set of incident CVD outcomes. The potential association with some of the specific outcomes warrant further investigation. Maybe more of a call to action for PTSD screening and treatment to potentially offset CVD risk instead?
Abstract 4140872: Causes of 30-Day Readmissions Following Permanent Pacemaker Implantation in Dialysis-Dependent End-Stage Renal Disease Patients: Analysis of the National Readmission Database 2020
Authors: Jha Vivek , Teaima Taha , Gajjar Rohan , Aryal Badri , Quevedo Ramirez Andres , Karki Sadichhya , Jha Supriya
Published: November 2024

Background:
Permanent Pacemaker (PPM) implantation is recognized as a class I indication treatment for patients with high-grade Atrioventricular (AV) blocks, infra-Hisian conduction blocks, and symptomatic sinus node diseases such as sinus bradycardia. There remains a scarcity of data regarding the impact of dialysis-dependent End-Stage Renal Disease (ESRD) on PPM implantation outcomes, particularly in terms of readmission rates. We aim to evaluate short-term readmissions in dialysis-dependent ESRD patients post-PPM placement, utilizing data from the National Readmission Database (NRD).

Methods:
The NRD for the year 2020 was used to identify dialysis-dependent ESRD adults who underwent PPM implantation, employing ICD-10 CM and PCS codes. We focused on outcomes including 30-day readmission rates, length of stay (LOS), total hospital charge (THC), and predictors of readmissions. Both multivariate and univariate logistic and linear regression analyses were employed to assess outcomes and adjust for potential confounders.

Results:
Out of 2,497 dialysis-dependent ESRD patients who underwent PPM implantation, 2,353 were discharged alive. Within 30 days of discharge, 540 (22.9%) patients were readmitted. Those readmitted had a longer LOS and higher comorbidity burden but were similar in age, sex, hospital characteristics, and household income status compared to those not readmitted. Readmissions incurred an additional average THC of $103,599 and an average LOS of 7.3 days. The top five causes of readmissions were hypertensive heart disease with heart failure (11.3%), sepsis (9.9%), fluid overload (2.4%), hypoglycemia without coma in type II diabetes mellitus (2.0%), and non-rheumatic aortic valve stenosis (1.7%).

Conclusion:
This analysis reveals that 22.9% of dialysis-dependent ESRD patients who underwent PPM implantation were readmitted within 30 days, resulting in extended LOS and increased THC. These readmissions negatively impact patient outcomes and exacerbate the burden on healthcare resources. Optimizing the management plans for this patient group is crucial to enhancing outcomes and using healthcare resources more effectively.
Abstract 4140884:
Cardiovascular Stroke Nursing Best Abstract Award:
Digital Health-Based Interventions Improve Healthy Behaviors, Weight Loss, and Psychological Well-Being in Older Adults at Risk for Cardiovascular Diseas
Authors: Candelaria Dion , Reyes Andrew Thomas , Serafica Reimund , Hildebrand Janett , Cacciata Marysol , Sta. Maria Axel , Lee Jung-Ah , Stromberg Anna , Evangelista Lorraine
Published: November 2024

Background:
Evidence on the use of digital health technologies by older adults is growing. However, the impact of these technologies in health promotion and disease prevention among older adults at risk for cardiovascular disease is not fully explored.

Aims:
This study aimed to compare the effect of two digital health technology-based interventions on engagement in healthy behaviors, weight loss, and psychological well-being over time (baseline [pre-intervention] to three months [post-intervention] to six months [long-term]) and explore outcome predictors.

Methods:
This randomized, longitudinal study examined the intermediate (three months) and long-term (six months) effects of two digital health technologies,
Get FIT
vs.
Get FIT+
. Over 12 weeks,
Get FIT
participants (n = 24) received one face-to-face counseling session on healthy food and exercise, an activity tracker (Fitbit Charge), and access to a nutrition app (MyFitnessPal app). The
Get FIt+
group (n = 30) received all the same components as
Get FIT
, plus weekly personalized text messages to motivate and encourage them to meet their goals. General Linear Models were used for analysis.

Results:
Fifty-four older adults (mean age 65.6 ± 5.8 years, 60% women, 65.5% Hispanic) were randomly assigned into the two groups.
Table 1
shows the group comparisons between
Get FIT
vs.
Get FIT+
in terms of healthy behaviors, weight loss, and psychological well-being outcomes at the three time-points. At six months, the group assignment was associated with greater weight loss, higher physical activity levels, reduced calorie intake, and lower depression scores. Being Hispanic was associated with higher weight, whereas being non-Hispanic and higher education with higher levels of depression.

Conclusion:
Digital health technologies increased the adoption of healthy behaviors, weight loss, and better psychological well-being over time, with greater improvements observed in the
Get FIT+
group. Likewise,
Get FIT+
participants sustained these improvements in the long term. A large randomized clinical trial is needed to evaluate the efficacy of both interventions in older adults at risk for cardiovascular disease.
Abstract 4140901: Compression-Only or Standard Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Ehsan Muhammad , Sandhu Arshbeer Singh , Maan Muhammad Arslan Arif , OBI OGECHUKWU , Hervir Oliver , Abdelnour Mark , fattahi Mansoureh , Gandhi Nayan , Mohamed Abuelgasim , Yadav Ratan Pal , Shah Jassim
Published: November 2024

Background:
This meta-analysis aims to compare chest compression-only cardiopulmonary resuscitation (CO-CPR) with standard CPR (sCPR), which includes mouth-to-mouth ventilation, as potential strategies for managing out-of-hospital cardiac arrest (OHCA).

Methods:
We systematically searched various databases and registries such as MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov to retrieve relevant studies. We used the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0) to assess the risk of bias in included studies. Revman 5.4 was used to pool dichotomous outcomes under a random effects model.

Results:
A total of 4 RCTs were included in our meta-analysis. Our results indicate that CO-CPR was associated with a significantly increased survival to hospital discharge compared to sCPR (RR 1.22, 95% CI: 1.01 to 1.46) with minimal heterogeneity (I
2
= 0%). No significant difference was observed between the two groups regarding 1-day survival (RR 1.07, 95% CI: 0.94 to 1.23), survival to hospital admission with a good neurological outcome (CPC 1 or 2) (RR 1.10, 95% CI: 0.80 to 1.51), return of spontaneous circulation (RR 1.05, 95% CI: 0.95 to 1.17), and survival to hospital admission (RR 1.08, 95% CI: 0.93 to 1.25).

Conclusion:
This meta-analysis found that chest compression-only CPR (CO-CPR) significantly improves survival to hospital discharge compared to standard CPR for managing OHCA while yielding comparable results for other resuscitation outcomes.
Abstract 4140902: Association Between the Severity of Coronary Artery Stenosis with the Minimum Responsive Dose of Intracoronary Ergonovine Provocation Test
Authors: Rha Seung-Woon , Ahn Woo Jin , hyun sujin , Cha Jinah , Choi Se Yeon , Choi Byoung Geol , Sinurat Markz , Park Soohyung , Choi Cheol Ung , Park Chang Gyu , Oh Dong
Published: November 2024

BACKGROUND:
Coronary artery spasm (CAS) is a cause of variant angina and is typically diagnosed by intracoronary provocation test. Investigations regarding association between the burden of coronary artery stenosis and the minimum responsive dose of ergonovine (ERG) required for provocation is limited.

METHODS:
In this study, 356 patients who underwent the ergonovine (ERG) provocation test and showed CAS between October 2004 and December 2022 were enrolled. Significant CAS was defined as temporary narrowing of ≥70% during the ERG test. Patients were divided into three groups, based on the minimum responsive dose of ERG: E1 group (20ug, n=13), E2 group (40ug, n=53) and E3 group (80ug, n=290).

RESULTS:
In patients who were documented with positive intracoronary ERG provocation test, 3.7% responded at the lowest dose (20ug), 14.9% responded at the medium dose (40ug) and 81.5% responded only at the highest dose of ERG (80ug). The baseline characteristics of the patients among the 3 groups were similar, demonstrating no significant difference in the prevalence of hypertension, diabetes mellitus, and dyslipidemia. However, patients who responded at E2 dose showed higher proportion of smokers than E3 dose (E2 34.0% vs. E3 25.9%, p=0.043). E1 group demonstrated the highest proportion of severe stenosis (92.3%), followed by E2 group (90.6%) and E3 group (71.4%) (Figure 1). In addition, incidence of focal CAS and multi-vessel CAS were higher among those who responded to lower doses (focal CAS: 23.1% vs. 20.8% vs. 10.0%; multi-vessel CAS: 61.5% vs.50.9% vs. 36.6%).

CONCLUSION:
In patients with chest pain with positive intracoronary ERG provocation test, higher burden of stenotic lesions was found to be more frequent and more susceptible in patients who responded at lower doses of ERG.
Abstract 4140926: Transcatheter Closure of a Large Left Main Coronary Artery to Superior Vena Cava Fistula Revealed by Symptomatic Tachyarrhythmia
Authors: Harirforoosh Sarah , Morchi Raveendra , Morchi Gira , Bryan Theodore , Patel Pranav , Rochon-Duck Michael , Naqvi Ali , Frangieh Antonio
Published: November 2024

Introduction:
Coronary artery fistulas are rare congenital anomalies that are usually incidentally discovered on cardiac imaging or coronary angiography. We present an extremely rare case of a large left main coronary artery (LMCA)/left circumflex artery (LCX) fistula to the superior vena cava (SVC) successfully managed by transcatheter closure through coil embolization.

Case Presentation:
A 63-year-old male competitive bodybuilder, with no prior cardiac history, presented with lightheadedness and wide complex tachyarrhythmia at a heart rate over 240 beats per minute in the field, requiring two defibrillator shocks. His subsequent EKG demonstrated diffuse ST depressions. Coronary angiography revealed a large tortuous coronary fistula from the LMCA/LCX emptying into the SVC. Transthoracic echocardiogram showed a left ventricular (LV) ejection fraction of 56% and lateral LV wall hypokinesis. Cardiac MRI demonstrated an enlarged right ventricle without delayed myocardial enhancement. Given right sided enlargement and concerns for coronary steal, decision was made to intervene. The patient declined sternotomy to preserve his active lifestyle. Thus, a nonsurgical multi-disciplinary approach was planned for fistula closure. Vascular plug placement was attempted through retrograde venous and antegrade coronary wiring but was unsuccessful due to a narrow and fenestrated single fistula ostium opening and long and tortuous fistula length. From the coronary side, stasis was achieved in the fistula through embolization using 12 microcoils. An electrophysiology study was performed, and the patient’s arrhythmia was consistent with ventricular tachycardia. A subcutaneous implantable defibrillator was inserted for secondary prevention.

Discussion:
This patient’s uniquely late presentation and resulting unstable arrhythmia, cardiac chamber enlargement and ischemia emphasizes the importance of identifying indications for fistula closure. Pre-procedure planning with various imaging modalities and collaboration of multiple specialties allows for productive discussion of both surgical and interventional options.

Conclusion:
A multidisciplinary heart team is essential in successfully treating complex arteriovenous malformations.
Abstract 4140978: DOT1L mediates diabetic vascular remodeling by promoting insulin-induced phenotypic conversion of VSMCs through the NOTCH1-related pathway
Authors: Yang Jian , Zhang Jing , Wu Di
Published: November 2024

Introduction:
The transformation of vascular smooth muscle cells (VSMCs) from contractile to synthetic is an important step in diabetic vascular remodeling. DOT1L, the only lysine methyltransferase at the H3K79me locus, has not been fully elucidated in diabetic vascular remodeling, and DOT1L-based methods may be critical in discovering phenotypic transformation of VSMCs to improve clinical outcomes in patients with diabetic cardiovascular disease.

Hypothesis:
Whether DOT1L promotes the phenotypic transformation of VSMCs and further affects diabetic vascular remodeling.

Methods:
Primary VSMCs were extracted from the thoracic aorta of healthy, SPF-free male rats. DOT1L was up-regulated or down-regulated in vitro by lentivirus infection with VSMCs, followed by an insulin stimulation. VSMCs phenotype was assessed by EdU, flow cytometry, scratch assay, Transwell chamber assay, western blot; In addition, the mechanism of DOT1L on insulin-induced phenotypic transformation of VSMCs was explored. SD rats were fed with high glucose and high fat for 4 weeks, and were given a single intraperitoneal injection of low-dose (30 mg) STZ to establish a diabetes model. After 2 weeks of continuous high-glucose and high-fat feeding, a carotid balloon injury model was established, and then lentivirus was injected into the injured artery segment to overexpress or knock down DOT1L in vivo, and the role and mechanism of diabetic VSMCs phenotype were evaluated by immunohistochemistry and western blot.

Results:
After 24 hours of stimulation with 100 nmol/L insulin, the expressions of VSMCs synthesized phenotype OPN, proliferative phenotype PCNA, migration phenotype MMP2 and MMP9 increased, the expression of α-SMA decreased, and proliferation and migration occurred. Down-regulation of DOT1L can inhibit the conversion of insulin-induced VSMCs from contractile to synthetic and improve diabetic vascular remodeling. Mechanistically, overexpression of DOT1L promotes the activation of JAG1/NOTCH1 signaling pathway, promotes the expression of synthetic phenotypic proteins, and inhibits the expression of contractile phenotypic proteins, which ultimately promotes the transformation of VSMCs from contractile to synthetic in diabetic environment.

Conclusions:
Down-regulation of DOT1L can inhibit the activation of JAG1/NOTCH1 signaling pathway, thereby inhibiting the phenotypic transformation of VSMCs and improving diabetic vascular remodeling.