bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4128549: Feasibility and Acceptability of a Combined Contingency Management and Problem-Solving Therapy Intervention to Enhance Alcohol Abstinence: A Pilot Single-Arm Mixed Methods Randomized Controlled Trial
Authors: HALLI HAN HAGAR , Lee Sangeun , Shin Joy , Adomah Ruth , Rospenda Kathleen
Published: November 2024

Introduction/Background:
It is crucial to develop and implement innovative behavior-change therapies that specifically target young adults with alcohol use disorder, as the prevalence of this issue is on the rise, and it has serious long-term health consequences.

Research Questions/Hypothesis:
How does the newly developed Contingency Management and Problem-Solving Therapy (CM-PST) intervention impact the levels of alcohol misuse or abstinence in young adults at follow-up compared to baseline.Young adults who receive the newly developed CM-PST will have lower levels of alcohol misuse or abstain from alcohol.

Goals/Aims:
We aimed to examine the feasibility, acceptability, and efficacy of an integrated behavior therapy of CM-PST for young adults with alcohol use disorder.

Methods/Approach:
This mixed methods study employed a single-arm design with post-intervention and 12-week follow-up assessments. Young adults aged 18-24 were recruited from July 2023 to May 2024. Participants underwent the newly developed integrated CM-PST intervention for 8 weeks. The assessment of feasibility was conducted by evaluating the rates of recruitment and retention, and adherence to the intervention. Acceptability was assessed by analyzing participants’ feedback and engagement data. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and the 90-day Timeline Follow back (TLFB) at baseline and 12 weeks after the intervention. Furthermore, they participated in a twice daily breathalyzer test, post-intervention interview and completed a client satisfaction scale questionnaire.

Results:
A total of 28 participants were recruited, with 71.43% (20/28) completing all the study procedures. Adherence to the CM-PST was 100%, indicating strong engagement. Participant feedback highlighted the influence of CM on behavior and decision-making and the efficacy of PST in addressing life challenges as well. Alcohol consumption at 12 weeks was significantly lower than those at baseline (
t
=3.042,
p
=.007). Overall, the newly developed intervention was well-received, and 95% of participants indicated that the interventions were acceptable.

Conclusions:
This study showed that the integrated CM-PST intervention to promote alcohol abstinence and reduce alcohol related problems is both feasible and acceptable. Study findings indicated that the intervention has potential as a supplementary care for individuals seeking support in reducing alcohol consumption.
Abstract 4128599: Facility-level Variation Underlying Low Inferior Vena Cava Filter Retrieval in the United States
Authors: Trivedi Premal , Carey Evan , Wang Lei , Mierau Savannah , Lindrooth Richard , Lindquist Jonathan , Ryu Robert , Ho Michael
Published: November 2024

Background:
Inferior vena cava (IVC) filters are commonly implanted in patients with venous thromboembolism (VTE) who are unable to receive anticoagulation, to protect against clot migration to the heart. With prolonged implantation, IVC filters are associated with complications: device fracture, migration, penetration into adjacent organs and worsened VTE. Two Federal Drug Administration advisories and multi-society guidelines have emphasized the importance of timely retrieval but national retrieval rates remain low (<30%).

Aims:
To quantify hospital-level variation in IVC filter retrieval
,
describe time-based retrieval rates and examine factors associated with retrieval.

Methods:
IVC Filter implantation for all patients >= 18 years was identified in the 2016-2020 inpatient and outpatient 100% limited data set Medicare files using claims codes. Hospital information for the implanting facility was cross-linked from the American Hospital Association and Healthcare Cost Report Information System files, including identifying information, teaching status, census location, operating margin and % uncompensated care. IVC filter retrieval rates and time to retrieval from implantation was calculated. Bayesian hospital profiling methods were used to quantify 1-year retrieval rate for all U.S. facilities, adjusting for patient factors – demographics, diagnostic indications and comorbidities.

Results:
Among Medicare beneficiaries, there were 140,481 IVC Filter implantations across 2,850 facilities. Excluding patients who died within 90 days of implantation (25.7%), retrieval rates at 3 months, 1 year and anytime were 7.9%, 18.7% and 20.0% respectively. IVC Filter retrieval within 1 year varied significantly at the facility-level, from 0-100%
.
Focusing on facilities with at least 13 IVC filter implantations each year (top 25%ile volume), 1-year retrieval ranged from 0 to 74.5%. Higher 1-year retrieval was seen among higher implantation volume (12.4% bottom quartile, 20.5% top quartile), teaching (21.1% teaching vs. 16.9% nonteaching) and non-safety net (21.1% low uncompensated care, 15.0% high uncompensated care) hospitals. Retrieval rates did not vary significantly by hospital operating margin or rurality.

Conclusion(s):
There is low overall IVC filter retrieval in the United States with large underlying facility-level variation. Focused examination of high-performing facilities could yield insights on how to improve device retrieval nationally.
Abstract 4128698: Mental Health and Sleep Quality as Determinants of Physical Activity Levels in Depressed Rural Patients with Coronary Heart Disease
Authors: Cha Geunyeong , Kang JungHee , Lin Chin-Yen , Heebner Nicholas , Wu Jia-Rong , Biddle Martha , Chung Misook , Thapa Ashmita , Lennie Terry , Moser Debra
Published: November 2024

Background:
Disparities in coronary heart disease (CHD) and other chronic related conditions, such as poor sleep quality and psychological distress, have been observed in rural areas. Both conditions can negatively affect disease progression, possibly through their impact on physical activity. The relationships, however, among sleep quality, psychological distress, and physical activity among depressed rural CHD patients have not been examined.

Purpose:
The purpose of this study was to determine the association of sleep quality (i.e., sleep fragmentation [frequent sleep interruption] and nocturnal/sleep movement [increased rates of movement, ‘tossing and turning’ during sleep]) and psychological distress (i.e., anxiety and perceived stress) with levels of physical activity (i.e., sedentary, light, and moderate to vigorous) in depressed rural patients with CHD.

Methods:
A total of 142 depressed rural CHD patients (aged 57.0±11.9 years, 97% White) completed surveys on demographic characteristics, anxiety (Brief Symptom Inventory), and stress (Perceived Stress Scale-4). Participants also wore accelerometer activity monitors for seven days (ActiGraph GT9X Link) to capture physical activity levels and sleep quality. Three different hierarchical regression models were conducted to predict each level of physical activity (sedentary, light, and moderate-vigorous) with predictor variables entered in blocks. Block 1 included demographic variables (i.e., age, sex, marital status, employment status). Block 2 included sleep quality measures, and Block 3 included psychological distress.

Results:
Participants spent 466±126.0 min/day while awake being sedentary, 483±119.9 min/day in light activity, and 90±65.9 min/day in moderate to vigorous activity. We found that stress was significantly associated with greater sedentary time (B = 6.56, p = .043) and less time in light activity (B = -7.99, p = .024). Nocturnal/sleep movement was significantly associated with increased sedentary time (B = 3.14, p < .001) and decreased time in light (B = -5.29, p =.002) and moderate-vigorous activity (B = -2.58, p = .003). Anxiety was not associated with physical activity.

Conclusions:
Poor sleep quality and greater perceived stress are associated with a more sedentary lifestyle, a major risk factor for CHD. Addressing both stress and sleep management may play a role in reducing CHD risks associated with inactivity among depressed rural patients with CHD.
Abstract 4129453: Comparing Cardiovascular Outcomes in Patients with Lyme Disease and Babesiosis: A Retrospective Cohort Study
Authors: George Riya , Varadarajan Shruti , Chang Joshua , Sood Aditya , Pierce Matthew
Published: November 2024

Intro:
In the U.S, Lyme disease and Babesiosis are among the four most common tick-borne illnesses, with an annual average of 36,000 and 2200 cases respectively from 2016-2019. Both have cardiac involvement; 1% of lyme disease cases result in lyme carditis, while babesiosis is associated with arrhythmias and heart failure. Little research has explored the comparative risk of developing cardiac complications between the two. This study investigates cardiovascular complications in cases of Lyme and Babesiosis.

Methods:
We conducted a retrospective cohort study utilizing data from the TriNetX database and the US Collaborative Network, which together cover 60 healthcare organizations providing real-world electronic health records. We included all individuals diagnosed with either Lyme disease (Cohort A, pre-match n = 317368/post-match n = 4115 ) or babesiosis (Cohort B, pre-match n=4173/post-match n = 4115), identified using ICD-10-CM codes. Patients under 18 years of age, diagnosed with both diseases, or with incomplete follow-up data were excluded. We employed propensity score matching to adjust for age, race, sex, and other clinical parameters to compare the two cohorts equitably. We focused on 4 key outcomes over a 5-year period: arrhythmias, the need for PPM implantation, ACS and HF, utilizing both risk analysis and Kaplan-Meier survival analysis.

Results:
Interestingly, patients with babesia exhibited a greater likelihood of developing HF (OR: 1.279, 95% CI (1.073,1.524)). The development of arrhythmias between the two groups was not statistically significant with an OR of 1.013 (95% CI (0.837, 1.227)). The need for PPM implantation was not statistically significant between the two groups with an OR of 1.269 (95% CI (0.785, 2.052)). The risk of developing ACS was not statistically significant with an OR of 1.103 (95% CI (0.838, 1.451)) .

Conclusion/Discussion:
Our findings indicate that patients with babesiosis have a higher likelihood of developing HF compared to those with lyme disease. Surprisingly, there were no significant differences in the rates of arrhythmias or pacemaker implantations between the two cohorts. These results suggest that while overall cardiovascular risks are comparable between the groups, the increased risk of HF in babesiosis needs to be further explored.
Abstract 4129729: Relationship Between Inflammatory Biomarkers and Quality of Life in Black Adults Living with Heart Failure: A Pilot Study
Authors: Herring Christopher , Madariaga Andrea , Davis Erica , Higgins Melinda , Morris Alanna , Dunbar Sandra , Butts Brittany
Published: November 2024

Introduction:
Heart failure (HF) impacts quality of life considerably, with inflammatory biomarkers potentially playing a significant role in this relationship. The purpose of this study is to examine the relationship between NYHA Class, inflammatory biomarkers, and quality of life in Black adults living with HF.

Methods:
Black adults living with HF (N=41) were enrolled in this study. NYHA Class was extracted from the medical record. Health-related quality of life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 23-item questionnaire that quantifies physical function, symptoms, social function, and health-related quality of life in HF. Scores are transformed to a range of 0-100, with higher scores reflecting better health status. One-way ANOVA and correlation analyses were used to assess associations between NYHA class, inflammatory biomarkers (XO activity, IL-1β, IL-15, and CCL-19), and KCCQ scores.

Results:
Participants were 57±11 years of age and 66% female, with mean LVEF 33±14%. NYHA Class ranged from I (20%) to IV (12%), with the majority of participants in Class II (34%) and III (22%). Mean KCCQ Clinical Summary Score was 85± 21. NYHA Class I had significantly lower scores on the KCCQ Clinical Summary Score compared to Class III and IV (p < .001, η
2
= 0.54), KCCQ Physical Limitation compared to Class II, III, and IV (p < .001, η
2
= 0.53), and KCCQ Symptom Frequency compared to Class IV (p = .001, η
2
= 0.39). The KCCQ Clinical Summary Score was negatively associated with XO activity (r = -0.440, p = .046), IL-1β (r = -0.407, p = .043), IL-15 (r = -0.427, p = .033), and CCL-19 (r = -0.559, p = .004). Similar negative associations were observed for the KCCQ subscales.

Conclusion:
The negative association between XO activity and health-related quality of life (KCCQ) in individuals with HF highlights the potential impact of oxidative stress on these patients' subjective well-being and functional status. Understanding this relationship could underscore the importance of mitigating oxidative stress pathways to improve the overall quality of life and symptom burden experienced by individuals with HF. The KCCQ and subscales were also negatively associated with markers of inflammation, highlighting the potential impact of systemic inflammatory processes on subjective well-being and functional status in persons with HF. Targeting inflammatory pathways may improve quality of life and mitigate the burden of symptoms in HF.
Abstract 4129974: Increased Expression of Histone Deacetylases-2 and -6 in Left Ventricular Myocardium of Dogs with Chronic Heart Failure
Authors: Gupta Ramesh , Szekely Kristina , Kalabat Sean , Lanfear David , Sabbah Hani
Published: November 2024

Background:
Histone deacetylases (HDACs) -2 and -6 are localized in the nucleus and cytoplasm of cells and have been implicated in the development of left ventricular (LV) hypertrophy, cardiac interstitial fibrosis, inflammation and worsening of LV systolic and diastolic function thus contributing to progressive worsening of heart failure (HF) with reduced ejection fraction (HFrEF) as well as HF with preserved ejection fraction (HFpEF). There is considerable interest in the application of small molecules that inhibit the activity of HDAC proteins in HF in the hope of fostering clinical benefit.

Purpose:
In the present study we examined the expression of HDAC-2 and -6 in LV tissue from normal (NL) dogs and dogs with chronic HF (LVEF <35%) produced by multiple sequential intracoronary microembolizations.

Methods:
Studies were performed in LV tissue from 7 NL dogs and 7 HF dogs. HDAC-2 and -6 protein levels were determined by Western blotting in the lysate of homogenate and 9000g supernatant (cytosolic) fractions prepared from powder of approximately 200 mg frozen LV tissue. After determining the protein by Lowry method, approximately 30 μg homogenate and 15 μg supernatant for HDAC-2 and 8 μg protein for both homogenate and supernatant for HDAC-6 were separated on 4%-20% SDS-PAGE and transferred on PVDF membrane. Band intensities were quantified in densitometric units (du). All data were normalized to glyceraldehyde-3-phosphate dehydrogenase (GAPDH).

Results:
HDAC-2 proteins levels normalized to GAPDH were higher in the cytosol (0.59 ± 0.10 vs. 0.17 ± 0.04, p<0.05 vs. NL) and homogenate (0.75 ± 0.12 vs. 0.55 ± 0.10, not statistically significant) of LV tissue of dogs with HF compared to NL dogs. HDAC-6 protein levels were higher in the homogenate (2.54 ± 0.36 vs. 0.57 ± 0.19, p<0.05 vs. NL) and the cytosol (0.96 ± 0.15 vs. 0.78 ± 0.13, not statistically significant) of LV tissue of dogs with HF compared to NL dogs.

Conclusions:
These findings indicate upregulation of protein levels of HDAC-2 and -6 isoforms in LV myocardium of dogs with chronic HF. These abnormalities are likely to contribute to worsening HF. Selective inhibition of HDAC-2 and -6 represents a potential therapeutic approach for the treatment of both HFrEF and HFpEF.
Abstract 4130072: Prognostic Impact of Renal Microcirculatory Dysfunction in Heart Failure Assessed by the Advanced Doppler technique, Superb Microvascular Imaging
Authors: Kayama Kiyomi , Kikuchi Shohei , Sugimoto Tadafumi , Seo Yoshihiro
Published: November 2024

Aims:
The significance of cardio-renal interactions in heart failure (HF) prognosis has become increasingly evident, yet there are no established methods to assess them. To address this issue, we propose a novel approach using Superb Microvascular Imaging (SMI), an ultrasound method that that enables detailed visualization of microvascular flow, to assess renal microcirculation.

Methods:
We retrospectively analyzed 78 patients who underwent renal ultrasonography using SMI from October 2020 to May 2023. We measured changes over time of Vascular Index (VI), which quantifies the blood flow signal area in the region of interest on the SMI image (Figure 1). Key measurements included Maximum VI (Max.VI), Minimum VI (Min.VI), and the cyclic variation of VI, calculated as the intrarenal perfusion index (IRPI) = (Max.VI - Min.VI) / Max.VI within one cardiac cycle. The primary endpoint of this study was a composite event (CE), defined as a composite of all-cause death and unplanned hospitalization for worsening HF.

Results:
During a mean follow-up period of 1.6±0.8 years, 13 of 78 patients (17%) experienced a CE. Compared with patients without CE, those with CE had significantly lower Max.VI (0.28±0.15 vs 0.46±0.18, p=0.002) and Min.VI (0.10±0.12 vs 0.22±0.14, p=0.007), and IRPI was significantly higher in the event group (0.68±0.19 vs 0.55±0.17, p=0.018). In univariable Cox regression analyses, Max.VI (HR 0.35, 95%CI 0.17-0.71, p=0.004), Min.VI (HR 0.28, 95%CI 0.10-0.75, p=0.012), IRPI (HR 1.97, 95%CI 1.11-3.51, p=0.021), creatinine (Cr) (HR 1.67, 95%CI 1.26-2.21, p<0.001) and estimated right atrial pressure by echocardiography (eRAP) (HR 4.22, 95%CI 1.42-12.5, p<0.001) were significantly associated with CE. In multivariable Cox regression analyses, Min.VI remained significantly associated with CE in the model adjusted for Cr (HR 0.35, 95%CI: 0.13-0.92, p=0.033), and in the model adjusted for eRAP (HR 0.11, 95%CI: 0.11-0.82, p=0.019). ROC curve analysis showed that, although not statistically significant, the predictive power of Min.VI was superior to that of Cr and eRAP (Figure 2). Stratifying patients by a Min.VI cut-off value of 0.08, determined through ROC analysis, showed that those with Min.VI < 0.08 had a significantly poorer prognosis (log-rank p<0.001) (Figure 3).

Conclusion:
The use of Superb Microvascular Imaging to assess renal circulation provides new insights into the prognosis of HF and allows risk stratification beyond conventional markers.
Abstract 4130368: Outcomes of Patients with Critical Limb Ischemia and Chronic Kidney Disease: A National Perspective
Authors: Rivera Frederick , Aparece John Paul , Ruyeras Jade Monica Marie , Menghrajani Rajiv Hans , Honorio Emily Grace , Dwivedi Alok , Puentespina Rachel Anne , Bantayan Nathan Ross , Choi Sarang , Desai Drashti , MANGUBAT GERARD FRANCIS , Lerma Edgar , Collado Fareed Moses , Ong Kenneth , vijayaraghavan krishnaswami , Kazory Amir
Published: November 2024

Background:
Studies exploring the relationship between peripheral arterial disease (PAD), critical limb ischemia (CLI), and chronic kidney disease (CKD) and its effect on in-hospital outcomes are limited.

Objectives:
We aimed to analyze the outcomes of patients with CKD and PAD who are admitted for CLI.

Methods:
We utilized the National Inpatient Sample (NIS) to capture hospitalizations for CLI from 2016-2020 and then identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accident, major bleeding, vasopressor requirement, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay (LOS), and total hospital charges. Multivariable logistic regression was performed to adjust for covariates.

Results:
A total of 441,245 patients with CLI were identified, of which 122,370 (27.7%) reported concomitant CKD. Patients with CKD had a higher in-patient mortality (OR 1.68, CI, 1.17-1.68, p < 0.001), vascular complications (OR 1.31, 95% CI, 1.17-1.48, p<0.001), acute kidney injury requiring hemodialysis (OR 3.17, 95% CI, 2.64-3.80, p< 0.001) and major bleeding (OR 1.12, 95% CI 1.05-1.19, p<0.001). Patients with CKD underwent conservative (31.08% vs 36.73%, p<0.0001) and invasive procedures (14.73% vs 23.55%, p<0.0001) less often. PAD-CLI with CKD was associated with major (20.54% vs. 16.17%, OR 1.04; p<0.0001) and minor (26.87% vs. 19.53%, OR 1.2, p<0.0001) amputations more often.

Conclusion:
Patients admitted for PAD-CLI with concomitant CKD have significantly higher in-hospital mortality as compared to patients without CKD. Moreover, patients with CKD and PAD-CLI are less likely to receive revascularization and more likely to undergo amputation
Abstract 4130622: Neonatal Outcomes of Hypertensive Women Across US Races: 2016-2022
Authors: Usman Muhammad Shariq , Salman Ali , Khan Muhammad , Aisha Eliza , Naz Sabina , Faisal Sarah , Khan Iqra , Arif Muhammad Hammad , Janjua Hamza , Khan Ayesha Ali , Afzal Ahson , Siddiqi Tariq Jamal , Hall Michael
Published: November 2024

Background:
Maternal hypertension, a major pregnancy complication, can adversely affect newborn health. We aim to evaluate the racial and ethnic disparities in neonatal outcomes among hypertensive pregnant women in the United States.

Methods:
Using data from the CDC WONDER Natality database, we conducted a retrospective cohort study focusing on live births to hypertensive mothers from 2016 to 2022. Neonatal outcomes, including NICU admissions, low birth weight, infant mortality, and assisted ventilation, were analyzed by calculating rates [95% CIs] per 1000 live births across maternal racial/ethnic groups and the US Census Bureau's regional classification: Northeast, Midwest, South, and West.

Results:
We analyzed 2,336,679 live births to hypertensive women (23% pre-pregnancy; 77% gestational). This cohort comprised: 0.2% infants born to Native Hawaiian/other Pacific Islander women (NH/PI), 0.9% to American Indian/Alaska Native women (AI/AN), 3.8% to Asian American women (AA), 19.6% to Hispanic/Latino women (H/L), 20.0% to Black/African American women (BA), and 55.4% to White American women (WA). Infant mortality rates were highest in BA (3.6 [3.5, 3.8]), followed by AA (2.1 [1.8, 2.4]), AI/AN (2.1 [1.6, 2.7]), H/L (1.9 [1.8, 2.0]), NH/PI (1.9 [1.0, 3.3]), and lowest in WA (1.5 [1.4, 1.6]). Similarly, NICU admission rates were highest in BA (217.2 [216.1, 218.4]) and lowest in WA (156 [155.4, 156.6]). Assisted ventilation rates were highest in NH/PI (131.8 [123.4, 140.7]) and lowest in AA (87.8 [86.0, 89.7]). Low birth weight rates were highest in BA (235.1 [233.9, 236.3]) and lowest in WA (121.8 [121.2, 122.4]). The Midwest had the highest rates for NICU admissions in NH/PI (254.2 [217.2, 295.2]), assisted ventilation in AI/AN (143.8 [133.2, 155.1]), and mortality in BA (4.1 [3.7, 4.5]). The South had the highest rate of low birth weight for BA (244.4 [242.9, 246.0]).

Conclusion:
Significant racial and regional disparities exist in neonatal outcomes among hypertensive women in the US. BA mothers consistently experienced the poorest outcomes, while WA mothers had the best. Further research is crucial to understand the reasons behind these disparities and develop targeted interventions for high-risk populations.
Abstract 4131424: Exercise Stress Perfusion Cardiac MRI in Pediatric Patients with Coronary Anomalies
Authors: Carter Elizabeth , Moore Rebecca , Harris Matthew , Brothers Julie
Published: November 2024

Introduction:
Anomalous aortic origin of a coronary artery (AAOCA) can result in sudden cardiac death in the young and risk stratification is challenging. Though dobutamine stress cardiac MRI (DS-CMR) is feasible in pediatric patients, exercise stress CMR (ES-CMR) has lower rates of adverse events, higher diagnostic accuracy, and the ability to better reflect the physiologic changes occurring with exercise. No studies have evaluated ES-CMR in the pediatric population. We aim to describe our institution’s experience with ES-CMR using supine bicycle ergometry in patients with AAOCA.

Methods:
We retrospectively reviewed the medical records of AAOCA patients who underwent ES-CMR at our institution between 2011 and 2024 for demographic, clinical presentation, cardiopulmonary exercise test (CPET) and ES-CMR data. The exercise-based portion of the CMR consisted of supine cycle ergometry utilizing a ramp protocol, immediately after which perfusion imaging was performed. We used descriptive statistics for data analysis.

Results:
Of 38 patients who underwent ES-CMR, the median age was 16 years (range 13-24) and 68% were male. Diagnoses included anomalous right coronary artery (N=28), anomalous left coronary artery (N=8), and single coronary artery (N=1 single right, N=1 single left). Median maximal heart rate (HR) during ES-CMR was 160 bpm (range 130-190, median 80% predicted) with a median maximal HR during patients’ most recent CPET of 187 bpm (range 160-203, median 97% predicted). No patients had perfusion defects at rest or with exercise stress, or evidence of myocardial scarring. There were no adverse events.

Discussion:
We demonstrate for the first time the use of ES-CMR in a cohort of pediatric and young adult patients with AAOCA. ES-CMR can provide a unique modality to assess for ischemia at rest and stress as a means of risk stratification and simulate physiologic changes occurring with exercise stress in a single study. Although maximum heart rates during supine cycle ergometry are lower than those reached during CPET, they are similar to those reached during DS-CMR. ES-CMR can be a helpful and safe diagnostic tool in patients with AAOCA.
Abstract 4131439: Routine Social Isolation Screening Among Adults with Cardiovascular Disease: A Survival Analysis
Authors: Galper Kathleen , Nudy Matthew , SINOWAY Lawrence , Brignone Emily
Published: November 2024

Background:
Evidence linking social isolation to cardiovascular disease morbidity and mortality has grown in recent years. Still, information on how this may manifest in real world settings and its implications for screening practices is limited. In 2019, our large national integrated health care system implemented screening for social isolation as part of a broader universal social risk assessment. This repository of screening data was joined to administrative claims to test these associations in real world data and explore differences by demographic and medical factors.

Methods:
Social isolation responses recorded from 2019-2022 were included for a cohort of adult health plan members with documented atherosclerotic cardiovascular disease (ASCVD). We selected a single random assessment for each member and retained any other responses for sensitivity analyses. Cohort members had at least 10 months of enrollment surrounding assessment date for use as the baseline period and were followed for 365 days. We used cox proportional hazards regression with right censoring for coverage gaps to estimate the risk of all-cause mortality conferred by social isolation. We used Poisson regression to model the rate of inpatient stays.

Results:
There were 881 deaths among 7,484 members (18% of those with social isolation; 11% of those without). The isolated group skewed less male (54% vs. 65%, p <0.001) and older (68.4 [SD 12.7] vs. 67.5 [SD 12.6] years, p <0.05) than those not isolated. At baseline, the isolated group had higher rates of mean inpatient stays (2.3 [SD 1.9] vs. 1.9 [SD 1.6], p <0.001), ED visits (1.2 [SD 1.9] vs. 0.9 [SD 1.6], p < 0.001), and smoking (50% vs. 44%, p < 0.05), and a higher mean Charlson Comorbidity Index (CCI) (3.6 [SD 2.6] vs. 3.0 [SD 2.4], p < 0.001). Adjusted survival models suggested an independent 33% increase in all-cause mortality risk among those screening positive for social isolation (1.33 HR 95% CI 1.10, 1.62). Adjusted Poisson models found a similar increase in inpatient stays (1.36 IRR 95% CI 1.14, 1.62).

Conclusions:
Our findings corroborate the association between social isolation and morbidity and mortality among those with known ASCVD. The effect for social isolation was similar in magnitude to clinical comorbidities and smoking, suggesting that routine screening for social isolation may provide valuable information for assessing and managing the risk of death among patients with ASCVD.
Abstract 4131460: Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and Renal Insufficiency
Authors: Strom Jordan , Bertolet Marnie , Herbert Brandon , Malik Shahbaz , Lemesle Gilles , Madan Mina , Steg Philippe , Traverse Jay , White Harvey , Alsweiler Caroline , Gupta Rajesh , Ritt Luiz Eduardo , MENEGUS MARK , Alexander John , Lopes Renato , Chaitman Bernard , Carson Jeffrey
Published: November 2024

Background:
Chronic kidney disease (CKD) is associated with risk of myocardial infarction (MI) and anemia. Among patients with CKD and anemia who experience MI, it remains uncertain if a liberal transfusion threshold (LTT) strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (RTT, Hgb 7-8 g/dL) strategy.

Objectives:
To evaluate outcomes of those with CKD randomized to RTT vs. LTT in the Myocardial Ischemia and Transfusion (MINT) trial (NCT02981407).

Methods:
Among 3,495 MINT participants with non-missing creatinine (99.7%), we compared the baseline characteristics and outcomes at 30 days post-randomization of those individuals without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.73 m
2
(N = 999), CKD with eGFR < 30 mL/min/1.73 m
2
(N = 802), and CKD requiring dialysis (N = 415), both overall and by randomized transfusion strategy. Interaction terms for eGFR category by treatment assignment on each outcome were assessed.

Results:
Individuals with CKD compared to those without CKD more frequently presented with NSTEMI (all p < 0.001) and had a greater risk of all-cause death, recurrent MI, rehospitalization, and heart failure (all p < 0.05). Compared to a liberal transfusion strategy, a restrictive strategy among non-dialysis dependent individuals with an eGFR < 30 mL/min/1.73 m
2
was associated with an increased risk of death/recurrent MI (
Figure 1
) and unplanned rehospitalization (
Figure 2
). Among individuals with an eGFR 30-60 mL/min/1.73 m
2
, a restrictive strategy was associated with an increased risk of cardiac death (
Figure 1
). No eGFR category by treatment assignment interaction terms were significant.

Conclusions:
In this prespecified analysis, individuals with CKD were at greater risk of death, recurrent MI, heart failure, and unplanned rehospitalization at 30 days post-randomization than those without CKD. In individuals with CKD, a restrictive transfusion strategy was associated with increased risk of adverse outcomes.
Abstract 4131486: Cardiovascular Mortality in Children and Young Adults: Trends and Demographic Differences in the United States, 1999 to 2021
Authors: Saqib Scheryar , Maniya Muhammad Talha , Shafiq Aimen , Siddiqi Ahmed , Ali Kumail Mustafa , Salman Ali , Raja Adarsh , Khan Laibah , Siddiqi Tariq Jamal , Hall Michael
Published: November 2024

Background:
Cardiovascular disease (CVD) mortality in the U.S. younger population is on the rise. However, limited data is available on CVD-related mortality trends in this population.

Aim:
This study aimed to assess the temporal trends and demographic differences in CVD-related mortality among the U.S. youth.

Methods:
The CDC WONDER dataset was analyzed from 1999-2021 for CVD-related mortality in children and young adults (age <25 years). Socio-demographic data including gender, race/ethnicity, urbanization status and census region was acquired. Age adjusted mortality rates (AAMR) per 100,000 persons and annual percent changes (APCs) with 95% confidence interval (CIs) were calculated.

Results:
Between 1999-2021, a total 54,283 CVD-related deaths occurred among the youth in the U.S. The overall AAMR declined from 1999-2008 (APC, -1.15 [-3.4 to 0.53]), followed by sharp decrease from 2008-2012 (APC, -3.28 [-4.68 to 0.86]). The AAMR continued to decrease steadily from 2012 to 2019 (APC: -1.20, [-3.76 to -0.06]), followed by a sharp increase in from 2019 to 2021, (APC, 3.03 [-0.66 to 5.12]). Males consistently had higher AAMRs than females from 1999 (AAMR males: 2.99 vs females: 2.3) to 2021 (AAMR males: 2.39 vs females: 1.74). Non-Hispanic (NH) Black or African Americans had the highest AAMR in 2020 (3.68), followed by NH Whites (1.71), Hispanic or Latinos (1.59), and Asian and Pacific Islanders (1.2). AAMRs also showed significant variations across different regions (overall AAMR West 1.81; Northeast 1.93; Midwest 2.3; South 2.69). Metropolitan areas (2.23) consistently had lower mortality rates than nonmetropolitan areas (2.59).

Conclusion:
Our analysis revealed that CVD-related mortality in the youth declined from 1999-2019, followed by an increase in 2020 to 2021. Highest mortality rates were seen in males, Black or African Americans, Western region of the U.S, and nonmetropolitan areas. Tailored interventions are necessitated to decrease the burden of CVD-related mortality in these demographics among children and young adults in the United States.
Abstract 4131618: Association between Clinical Characteristics and Telomere Length - Factor Analysis of Mixed Data (FAMD)-based Cluster Analysis
Authors: Osadnik Tadeusz , Banach Maciej , Goc Anna , Boniewska-Bernacka Ewa , Panczyszyn Anna , Lejawa Mateusz , Strzelczyk Joanna , Pawlas Natalia , Krystek Karol , Gierlotka Marek , Golawski Marcin , Osadnik Kamila , Fronczek Martyna , Gach Agnieszka , Jozwiak Jacek
Published: November 2024

Introduction:
Telomere length is a marker of cellular aging and is correlated with various cardiovascular risk factors.

Aim:
To assess the association between clinical characteristics of patients and telomere length in an unselected cohort of patients under the care of primary care physicians.

Methods:
The LIPIDOGEN study was carried out in the primary care 2015. Patients recruited to LIPIDOGEN cohort (n=1788) were a random subset of patients of LIPIDOGRAM 2015 (n=13,724) study. Patients for LIPIDOGRAM2015/LIPIDOGEN study were recruited in all 16 administrative regions in Poland. Each patient was asked to fill the questionnaire on risk factors, chronic, treatment and lifestyle and also had saliva secured for DNA analyses. Factor Analysis for Mixed Data (FAMD) based cluster analysis was utilized to discern groups of patients with similar clinical profiles and correlate them with relative telomere length (rTL). RTL was measured using quantitative polymerase chain reaction.

Results:
DNA quality was sufficient for further analyses in 1606 patients. After outlier exclusion, 1,342 patients (59.3% female, mean age 50.2 years) were analyzed. FAMD revealed two distinct clinical characteristic patterns, explaining 41.6% of the total variance in the clinical variables. The first pattern, correlated with male gender and a higher prevalence of MetS, hypertension, diabetes, obesity, greater waist circumference, elevated non-HDL-C and remnant-C levels, was linked to shorter rTL (r = -0.13, p < 0.001). The second pattern, characterized mainly by lipid parameters, showed no significant association with comorbidities or rTL (r = -0.04, p = 0.14).

Conclusions:
Pattern of clinical characteristics marked by classical cardiovascular risk factors, is inversely related to telomere length, underlining the potential role of metabolic disturbances in cellular aging. The second lipid-centric pattern without significant comorbidities was not associated with telomere length.
Abstract 4131736: Myocardial Work in Patients with Systemic Arterial Hypertension: Correlation with Left Ventricular Mass and Aortic Strain Lidia Capotosto
1,2
, Enrico Mangieri
2
, Gaetano Tanzilli
2
, Giuseppe Placanica
2
, Attilio Placanica
2
, Fabio Miraldi
2
, Antonio Vitarelli
1,21
Department of Echocardiography, Cardiodiagnostica CS, Rome, Italy,
2
Department of Cardiology and Cardiac Surgery, Sapienza University, Rome, Italy
Authors: Capotosto Lidia , Mangieri Enrico , Tanzilli Gaetano , Placanica Giuseppe , Placanica Attilio , Miraldi Fabio , Vitarelli Antonio
Published: November 2024

Background:
Myocardial work (MW) is a new echocardiography-based diagnostic tool, which allows to quantify left ventricular performance based on pressure-strain loops and has been validated against invasively derived pressure-volume measurements. The purpose of the present study was to analyze whether systemic arterial hypertension is associated with abnormal left ventricular (LV) function assessed by myocardial work and how these changes are related to left ventricular hypertrophy (LVH) and aortic strain.

Methods:
We examined 86 hypertensive (mean age, 66±14 years, 51% male) and 86 sex- and age-matched healthy controls (mean age, 64±15 years, 53% male). Hypertensive patients were divided into two groups: patients without LVH (group-A) and patients with LVH (group-B, LVMI>115g/m2 men, LVMI>95g/m2 women). All of them had preserved LV ejection fraction. Global LV longitudinal strain (GLS) was calculated by speckle tracking echocardiography. The following indices of MW were assessed: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Corrected circumferential aortic strain (Ao-S) was calculated in the ascending aorta by two-dimensional speckle tracking echocardiography as global aortic strain /pulse pressure. Data analysis was performed offline (GE EchoPAC).

Results:
GWI and GCW were increased in group-A compared to controls (p<0.05) and decreased in group-B (p=0.04). GWW was increased in group-A(p=0.02) and group-B(p<0.001). GWE was decreased in group-A(p<0.01) and group-B(p<0.005). There was a positive correlation between GWE and Ao-S(r=0.51,p=0.03). GWE was independently associated with GLS(β=0.26,p=0.034), LV mass(β=0.31,p=0.02) and Ao-S(β=0.37,p=0.01) in the whole hypertensive population. At the receiver operating characteristic (ROC) analysis, optimal cutoff values of GWI, GLS, Ao-S, GWE and (GWE+Ao-S) discriminating LV hypertrophy were 0.7329, 0.7613, 0.8011, 0.8442 and 0.8986, respectively.

Conclusions:
Decreased GWE in systemic hypertension was related to aortic strain and occurred even in the absence of LV hypertrophy. Additional assessment of aortic strain improved the ability of myocardial work variables to differentiate patients with LVH, patients without LVH, and control subjects.
Abstract 4131838: Heart’s Deception: A Venous Villain Hiding in the Heart
Authors: Haloot Justin , Khalid Umair , Liu Jing
Published: November 2024

A 66-year-old male presented with 5 months of worsening left flank and lower back pain. Three weeks prior to this presentation, he was seen at an outside facility where he was found to have a left renal mass that was not further worked up. CT Abdomen and Pelvis showed an enhancing heterogenous lesion at the left superior renal pole, left adrenal gland lesion, and a pulmonary artery filling defect. This defect, along with concern for metastasis, led to a CT chest angiogram that reported small left upper and lower lobe pulmonary emboli. A transthoracic echocardiogram (TTE) was ordered and showed a linear highly mobile mass in the right atrium that was intermittently protruding into the right ventricle and into the main pulmonary artery through the pulmonic valve. There was no visible evidence of tumor extension of the renal mass into the inferior vena cava. Based on this, the highest differential was a clot-in-transit. After collaboration with the pulmonary embolism response team and echo team, the patient underwent aspiration thrombectomy via AngioVac system with transesophageal echocardiography (TEE) guidance. Most of the mass was removed, but there was a residual small portion adherent to the superior vena cava that was not amenable to aspiration. Grossly, the removed mass did not have the classic appearance of thrombus. The specimen was sent to pathology and returned as poorly differentiated carcinoma with spindle cell pattern positive for PAX8, CK7, CD10, pancytokeratin, and vimentin concerning for renal cell carcinoma. Post procedural transthoracic echo found to have new basal septal globular mass with vascularity seen on echo contrast imaging concerning for vascular involvement consistent with myocardial metastatic invasion. Cardiac magnetic resonance imaging could have aided in more precise tissue characterization to differentiate between clot or tumor prior to aspiration thrombectomy. This case demonstrates the significance of a detailed history and physical exam, use of multimodality imaging, and multidisciplinary collaboration to manage a rare cardiac condition.
Abstract 4131951: The Safety Profile Of Inclisiran In Patients With Dyslipidemia And Intermediate To High Atherosclerotic Cardiovascular Disease Risk: A Systematic Review And Meta-Analysis
Authors: Maliha Maisha , Satish Vikyath , Chi Kuan Yu , Sunil Kumar Sriram , Kharawala Amrin , Duarte Gustavo , Mangeshkar Shaunak , Borkowski Pawel , Osabutey Anita , GAshi Eleonora , Behuria Supreeti
Published: November 2024

Introduction:
Inclisiran is a novel drug that employs ribonucleic acid (RNA) interference to lower levels of the proprotein convertase subtilisin/kexin type 9 (PCSK9) protein, thereby improving the clearance of low-density lipoprotein (LDL) cholesterol from the bloodstream. It is given through subcutaneous injections at specified intervals and significantly reduces LDL cholesterol levels in patients with dyslipidemia and with intermediate to high risk of atherosclerotic cardiovascular disease (ASCVD).

Goal:
We aim to evaluate the safety of the use of inclisiran in patients with dyslipidemia and intermediate to high ASCVD risk.

Methods:
Three electronic databases of MEDLINE, Web of Science, and Embase were searched from inception to May 5th 2024 to identify relevant randomized controlled trials (RCTs) comparing safety profiles of inclisiran versus the control group . The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiovascular events (MACE), injection-site reaction and all treatment-emergent adverse events (TEAE). The effect estimates of outcomes were assessed using risk ratio (RR) with a 95% confidence interval (CI). Random-effects meta-analysis was conducted using the restricted maximum likelihood method given the inter-study variance was inevitable. The subgroup analysis was performed based on different dosing regimens.

Results:
We included 7 RCTs enrolling 4790 patients (63.8 ± 9.7 years, 66.8 % males) who received inclisiran. Compared to the control group, the use of inclisiran did not yield a significant effect on all-cause mortality (RR, 0.92; 95% CI, 0.54 to 1.54; I
2
= 0%), MACE (RR, 0.98; 95% CI, 0.82 to 1.17; I
2
= 0%), and TEAE (RR, 1.76; 95% CI, 0.74 to 4.15; I
2
= 74%). However, inclisiran use significantly increased injection-site reaction (RR, 7.08; 95% CI, 3.42 to 14.64; I
2
= 27%). Results are illustrated in the accompanying figure.

Conclusions:
Inclisiran use significantly increased injection-site reaction, with no increase in mortality and TEAE. Further trials are required to comprehensively assess the safety of inclisiran in the management of dyslipidemia in patients with ASCVD risk.
Abstract 4132217: Comorbidities Associated with One Year Mortality and Hospital Readmission After Ventricular Tachycardia Ablation
Authors: Brodeur Peter , Ferro Enrico , Maher Timothy , Yang Shu , Waks Jonathan , Tung Patricia , Saad Eduardo , d'Avila Andre , zimetbaum peter , Kramer Daniel , Yeh Robert , Locke Andrew
Published: November 2024

Introduction:
Many studies have evaluated outcomes after ventricular tachycardia (VT) ablation though few studies have evaluated outcomes past thirty days. This study aimed to determine which comorbidities are associated with one-year readmissions and mortality after VT ablation, including socioeconomic disadvantage (SED) via the Area Deprivation Index (ADI).

Methods:
Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York and Florida from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2020 ADI (1-100, higher scores representing more disadvantage). International Classification of Diseases 10 codes for VT and VT ablation were used. Patients undergoing pacemaker placement or with other arrhythmias were excluded. The risk of readmission and mortality was assessed using Cox proportional hazards first in an unadjusted fashion for each comorbidity in the Charlson Comorbidity Index. In addition to demographic variables, only significant variables from the unadjusted analysis were included in the final adjusted multivariable models.

Results:
1,798 patients met inclusion criteria. The readmission and mortality rates at one, three, and twelve months were 18.5%, 27.4%, 41.4% and 3.5%, 4.1%, 6.5%, respectively. Common diagnoses for readmission were VT (24.8%) and dyspnea/chest pain (10.7%). After adjustment, African American race, federal insurance, heart failure (CHF), vascular disease, renal disease (CKD), severe liver disease (SLD), and higher ADI were associated with increased risk for twelve-month readmissions. Federal insurance, CHF, cerebrovascular disease, dementia, peptic ulcer disease, CKD, and SLD were associated with increased risk for twelve-month mortality.

Conclusion:
CHF and CKD increased the risk of readmission and mortality. Recurrent VT was the most common cause of readmission. Patients of SED are at increased risk of readmissions within one year.
Abstract 4132409: Caspase-4/11 promotes a high-fat diet and chronic kidney disease-accelerated vascular inflammation via caspase-4/11-IL-1b two-tier trained immunity
Authors: Lu Yifan , Sun Yu , Saaoud Fatma , Shao Ying , xu keman , Yang Xiao-feng
Published: November 2024

Introduction:
Chronic kidney disease (CKD) is a common inflammatory disease affecting >15% of the adult population and 50% of all patients with advanced/end stages (4 to 5) of CKD have cardiovascular disease.

Research Questions:
How multiple disease risk factors interplay to accelerate vascular inflammation in CKD.

Aim:
To determine whether hyperlipidemia and CKD have a synergy in accelerating vascular inflammation via trained immunity (TI).

Methods:
we performed aortic pathological analysis and RNA-sequencing in high-fat diet (HFD)-fed 5/6 nephrectomy CKD (HFD+CKD) mice.

Results:
1)
HFD+CKD increases aortic cytosolic lipopolysaccharide (LPS) levels, caspase-11 (casp11) activation, and 998 gene expressions of TI pathways in the aorta (first-tier TI mechanism);
2)
Casp11
—/—
decreases aortic neointima hyperplasia, aortic recruitment of macrophages, and casp11-gasdermin D-mediated cytokine secretion;
3)
Casp11
—/—
decreases N-terminal gasdermin D (N-GSDMD) membrane expression on aortic endothelial cells and aortic IL-1b levels;
4)
LPS transfection into human aortic endothelial cells results in casp4 (human)/casp11 (mouse) activation and increases N-GSDMD membrane expression;
5)
IL-1b serves as the
second-tier mechanism underlying
HFD+CKD-promoted TI.

Conclusion:
Hyperlipidemia and CKD accelerate vascular inflammation by promoting two-tier trained immunity