bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 13629: Increased Rate of High Risk Cardiac Outcomes in Patients With Cardiac Sarcoidosis Without Underlying Coronary Artery Disease: Analysis of the National Inpatient Sample From 2015-2019
Authors: Singireddy Shreyas , Ibrahim Sammudeen , Chawla Raghav , Allihien Saint-Martin , Andanamala Haripriya , Brar Mandeep , Markson Favour , Ummidi Asha , Kesiena Onoriode
Published: December 2023

Introduction:
Sarcoidosis is a systemic disease characterized by deposition of noncaseating granulomas. It commonly involves the lungs but can also affect other organs such as the heart. In terms of cardiac sarcoidosis, it is still a relatively under diagnosed illness with its clinical manifestations often being variable and nonspecific thus making the diagnosis challenging. There is a need to further investigate the burden of high-risk cardiac outcomes in patients with underlying sarcoidosis with cardiac involvement to further understand the extent of disease progression in this group.

Methods:
In this study, the National Inpatient Sample (NIS) was queried for the years 2015 Q4-2019. Our cohort of interest included patients with Sarcoidosis, more specifically, those with cardiac involvement. Patients with underlying coronary artery disease and its equivalents were excluded from the study. Multivariate logistic with linear regression analysis was used to adjust for confounders.

Results:
After excluding patients with coronary artery disease (CAD) equivalents, the final number of patients included in the study was 8,722,809. Out of which, 54,537 had sarcoidosis with a total of 918 having a diagnosis of cardiac sarcoidosis (CS). Patients with CS were more likely to be males and be younger than 65 (p<0.001). African American race was the predominant population affected in both cohorts (p<0.001). The CS group had higher rates of underlying congestive heart failure but were overall less likely to have underlying connective tissue disease, chronic pulmonary disease, and diabetes (p<0.001). In terms of cardiac outcomes, they had higher rates of Cardiac Arrest (2.2% vs 0.7%, p<0.001), Atrial Fibrillation (24.5% vs 10.4%, p<0.001), Ventricular Tachycardia (36.6% vs 2.0%, p<0.001), AV Block Type 3 (10.3% vs 0.7%, p<0.001) and Heart Failure [systolic HF (54.6% vs 6.6%, p<0.001), diastolic HF (20.9% vs 12.3%, p<0.001)].

Conclusions:
We demonstrate with the results of this study that patients with cardiac sarcoidosis had higher rates of major arrhythmias, conduction defects, and cardiac arrest. Understanding these associations may help in earlier clinical diagnosis and possibly improved outcomes with targeted therapies.
Abstract 13640: Baseline Kidney Function and the Effects of Dapagliflozin on Health Status in Heart Failure: A Pooled Patient-Level Analysis From DFEINE-HF and PRESERVED-HF
Authors: Ambrosy Andrew P , Sauer Andrew J , Patel Shachi , Windsor Sheryl , Borlaug Barry A , Husain Mansoor , Inzucchi Silvio E , Kitzman Dalane W , McGuire Darren K , Shah Sanjiv J , Sharma Kavita , Umpierrez Guillermo , Kosiborod Mikhail N
Published: December 2023

Background:
Sodium-glucose co-transport-2 (SGLT2) inhibitors have been shown to reduce clinical events and improve health status (symptoms, function, and quality of life) in patients with HF across the range of EF. Baseline kidney dysfunction is common in HF, complicates HF management, and is strongly linked to worse health status.

Aim:
The study objective was to assess whether the treatment effects of dapagliflozin on health status vary based on baseline eGFR.

Methods:
Patient-level data were pooled from the DEFINE-HF (N = 263 participants with EF
<
40%) and PRESERVED-HF trials (N = 324 participants with EF
>
45%). Both were double-blind, randomized trials of dapagliflozin vs. placebo, enrolling participants with NYHA class II or higher and elevated natriuretic peptides. The primary endpoint for this analysis was Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CCS) at 12 weeks. Interaction of dapagliflozin effects on KCCQ-CCS by baseline eGFR (mL/min/1.73m
2
) was assessed as categorical (i.e., eGFR <60 vs.
>
60) and continuous variables.

Results:
Across both trials there were 583 (99.3%) participants with available baseline eGFR. The median (25
th
, 75
th
) eGFR was 59 (46,77). Dapagliflozin improved KCCQ-CSS at 12 weeks (placebo-adjusted difference, +5.0 points, 95% Confidence Interval [CI] 2.6-7.5; p-value <0.001), and this was consistent in participants with an eGFR
>
60 (+6.0 points, 95% CI 2.4-9.7; p=0.001) and <60 (+4.1 points, 95% CI 0.5-7.7; p=0.025) (p-interaction = 0.46). The benefits of dapagliflozin on KCCQ-CSS were robust across eGFR when modeled continuously (p-interaction = 0.46) (
Figure
). There was no heterogeneity of treatment effects when analyzing other KCCQ domains based on eGFR categorically or continuously (all p-interaction = NS).

Conclusion:
Treatment with dapagliflozin for 12 weeks led to significant and consistent improvements in health-related quality of life in patients with HF across a wide range of eGFRs.
Abstract 13658: Cholesterol Content of Lipoprotein Particles and Progression of Coronary Artery Calcification From Different Methods in ELSA-Brasil Study - A Metabolomic Approach
Authors: Tebar William , Meneghini Vandrize , Generoso Giuliano , Pereira Alexandre , Bittencourt Marcio , Santos Itamar S , Lotufo Paulo A , Bensenor Isabela M
Published: December 2023

Background:
Cholesterol content (CC) of lipoprotein particles is heterogeneous according to size and type.

Research Question:
The association of CC with carotid artery calcium (CAC) progression in different subclasses is not established.

Aim:
To analyze the association between CC of lipoprotein particles and CAC progression in ELSA-Brasil cohort study.

Methods:
Data from 883 participants (50.5±7.3 years, 50.7% women) without cardiovascular disease and statin use were analyzed. The CC in mmol/l was assessed by high-throughput proton Nuclear Magnetic Resonance metabolomics platform in 14 subclasses according to type and size at baseline. A 5-year CAC progression was assessed by computed tomography and calculated by log transformed, square root transformed and by methods of Hokanson and of Berry. The association of CC with CAC progression was analyzed by generalized linear models adjusted by sociodemographic (age, sex, race, education, health insurance), lifestyle (physical activity, alcohol consumption, smoking), comorbidities (hypertension, diabetes, obesity and total cholesterol ≥200mg/dL) and further adjusted by particle concentration.

Results:
A total of 15.6% of sample (n=138) presented a positive follow-up CAC score. The CC of medium VLDL, IDL, and LDL (large, medium and small) was associated with CAC progression by Berry method - Table 1. However, only the CC in medium VLDL (β=3.059 [95%CI: 0.040; 6.078], p=0.047) and large LDL (β=1.007 [95%CI: 0.342; 1.673], p=0.003) remained associated after adjustment for particle concentration. The CC of small HDL was associated with CAC progression by square root method (β=13.427 [95%CI: 0.487; 26.367], p=0.042), but lost significance after adjustment for particle concentration.

Conclusions:
The CC of medium VLDL and large LDL was associated with CAC progression by Berry method, beyond sociodemographic, lifestyle, comorbidities and particle concentration in a subsample of ELSA-Brasil participants.
Abstract 13664: Relationship Between Vascular Inflammation Assessed by 18FDG-PET/CT and Coronary Calcification in Patients With Lung Cancer
Authors: Hayashi Misayo , Matsumoto Jun , Watanabe Takatomo , Okura Hiroyuki
Published: December 2023

Background:
As the prognosis of lung cancer (LK) has improved over the years, atherosclerotic cardiovascular disease may affect the prognosis of LK. Previous studies have shown that vascular inflammation assessed by 18FDG-PET/CT and coronary artery calcification (CAC) assessed by chest CT can predict cardiovascular events.

Objective:
This study aimed to evaluate the relationship between vascular inflammation on 18FDG-PET/CT and CAC in patients with LK.

Methods:
Ninety-nine patients with LK who underwent both chest CT and 18FDG-PET/CT were included in this study. Vascular inflammation was assessed by 18FDG-PET/CT. Target-to-background ratio (TBR) was measured in 8 major arteries and was used as a marker of vascular inflammation. Agatston score was measured using chest CT images and was used as a marker of CAC.

Results:
The mean age was 70 years old (61 male). The median TBR was 1.39 (IQR: 1.33-1.43). Using a median value of TBR, patients were divided into 2 groups, high TBR group (≧1.39, n=50) and the low TBR group (<1.39, n=49). High TBR group had more male gender (72% vs. 51%, p=0.03), was significantly older (71 (67-74)vs. 62(57-70)years, p<0.001), and had diabetes (p=0.03). In contrast, the history of hypertension (p=0.993), dyslipidemia (p=0.622) and smoking(p=0.113) were similar between the groups. Agatston score was significantly higher in the high TBR group than in the low TBR group (168±338 vs. 56±97, p=0.005).

Conclusion:
Patients with lung cancer patients with high vascular inflammation had significantly higher Agatston score, suggesting an association between vascular inflammation and advanced coronary atherosclerosis. The impact of vascular inflammation and/or coronary calcification on the prognosis of LK needs further investigation.
Abstract 13665: Clinical Outcomes and Predictors of Residual Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Kim Kitae , Sano Madoka , Ooka Junichi , Murai Ryosuke , Toyota Toshiaki , Okada Taiji , Sasaki Yasuhiro , Taniguchi Tomohiko , Kobori Atsushi , Ehara Natsuhiko , Kinoshita Makoto , Furukawa Yutaka
Published: December 2023

Background:
Although transcatheter aortic valve replacement (TAVR) improves pulmonary hypertension (PH) secondary to aortic stenosis (AS), PH can remain after TAVR. We sought to investigate the outcomes and predictors of residual PH after TAVR.

Methods:
A total of 491 consecutive patients underwent TAVR between 2014 and 2023 at our institution. After excluding patients without baseline or postoperative transthoracic echocardiography, we stratified 483 patients according to baseline and postprocedural PH estimated by systolic pulmonary artery pressure >36 mmHg as follows: no PH group (n=285), improved PH group (n=87), residual PH group (n=111). Outcome measures were the composite of cardiac death and heart failure (HF) hospitalization. Logistic regression analysis was used to identify the predictors of residual PH. Variables included in the model were age, atrial fibrillation (AF), left ventricular ejection fraction, left atrial dilatation, moderate/severe mitral regurgitation, moderate/severe tricuspid regurgitation (TR).

Results:
The mean age was 83.6±5.4 years, and 314 (65%) were female. Patients in residual PH group were more likely to have AF, higher left atrial volume index, moderate/severe MR, and moderate/severe TR, compared with patients in no PH group. Compared with no PH group, the cumulative incidence of the composite of cardiac death and HF hospitalization were comparable in improved PH group (6.1% vs. 10.5 at 2 years, P=0.3), but significantly higher in residual PH group (6.1% vs. 20.6% at 2 years, P=0.002) (Figure). Multivariable logistic regression analysis showed that AF (Odds ratio [OR] 1.91, 95% confidence interval [CI] 1.09-3.32), moderate/severe TR (OR 4.09, 95% CI 2.30-7.28) were independently associated with residual PH.

Conclusions:
Among patients undergoing TAVR, residual PH were associated with increased risk of adverse cardiac events. AF, moderate or severe TR were independent predictors of residual PH after TAVR.
Abstract 13666: Pooled Prevalence of Anemia and Its Concerning Disparities in Type 2 Myocardial Infarction Hospitalized Patients - A Global Systematic Review and Meta-Analysis
Authors: Guddeti Ananth V , Podduturi Pavan Vihar R , Allala Manoj R , Shah Hem , Shah Viraj , Damera Abhiram Rao , Thakkar Kamya U , Senapati Sidhartha G , Chauhan Shaylika , Desai Rupak
Published: December 2023

Background:
Anemia in Type 2 Myocardial Infarction (T2MI) related hospitalizations has been linked to higher one year mortality along with other causes of hemodynamic stress. We conducted the first ever meta analysis to evaluate the overall global prevalence of Anemia among patients with T2MI with differences by subgroups.

Methods:
PUBMED, SCOPUS and Google Scholar Databases were systematically reviewed to find studies through January 2023 ascertaining prevalence of Anemia in T2MI. Binary Random Effects models were used to estimate the pooled prevalence and subgroup analysis of anemia in T2MI. Heterogeneity was assessed using I
2
statistics. Leave-One-Out sensitivity analysis was also performed.

Results:
A total of 16 cohorts with 28,629 patients, hospitalized with T2MI (Mean Age 74; SD13) revealed a 23.3% [95% CI 17.8% - 28.8%, I
2
-98.61%, P<0.001] pooled prevalence of Anemia and a Mean Hb level of 121; SD - 25 in g/L. The prevalence of Anemia was higher among T2MI cohorts with younger Mean Age [Mean <70 vs >70 Years; 24.6% (95% CI 14.1% - 34.1%) vs 21.4% (95% CI 15.6 - 27.2%)]; smaller sample size [ n<500 vs n>500; 26.6% (95% CI 18.4% - 34.8%) vs 18.6% (95%CI 10.4% - 26.8%)]; prospective studies [Prospective vs Retrospective; 26.1% (95%CI 17.4% - 34.7%) vs 18.7% (95%CI 12.7% - 24.7%)] and single center studies [Single Center vs Multi Center; 24.9% (95%CI 17.5% - 32.2%) vs 21.4% (95%CI 12.7% - 30.1%)]. The prevalence of Anemia in T2MI related hospitalizations was also higher in studies from Asia [36.2% (95%CI 24.6% - 47.7%)], Europe [21.9% (95% CI 14.1% - 29.7%)] and Multinational [21.1% (95%CI 11.9%-30.2%)] as compared to North America [16.4% (95%CI 8% - 24.8%)].

Conclusions:
The pooled prevalence of Anemia in this worldwide meta analysis of T2MI hospitalized patients was 23.3% with wide variance among subgroups. Further studies should focus on scrutinizing the outcomes and devastating complications of Anemic patients with T2MI among various populations universally.
Abstract 13676: Characteristics and Outcomes of Patients With Clinically Significant Valvular Heart Disease and Cardiogenic Shock Admitted to Cardiac Intensive Care Units
Authors: Carnicelli Anthony P , Miller Elliott , Chonde Meshe , Berg David , Palazzolo Michael , Aliyev Nijat , Bohula Erin A , Hamilton Madeleine , Keane Ryan , Kusner Jonathan , Loriaux Daniel , Newby L Kristin K , Patolia Harsh , Pierce Jacob , Van Diepen Sean , Katz Jason N , Morrow David
Published: December 2023

Introduction:
Little is known about the characteristics & outcomes of patients (pts) with significant valvular heart disease (VHD) and cardiogenic shock (CS). In addition, differences between pts with CS due to VHD vs VHD as “bystander” to CS have not been described.

Methods:
The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America coordinated by the TIMI Study Group. Participating centers capture all CICU admissions for 2 months annually. Pts with CS and significant VHD were classified as having CS due to VHD or CS with concomitant VHD not felt to be the cause of CS. Admissions from 2017 - 2021 were analyzed.

Results:
Of 3,974 CICU admissions with CS, 165 (4.2%) had CS due to VHD and 769 (19.4%) had CS with concomitant VHD. Pts with CS due to VHD were older (71 vs 67 y), less commonly had a hx of HF (47.3% vs 73.1%), & more commonly had LVEF>50% on admission (51.5% vs 16.8%); p<0.001 for all. Resource use varied significantly (Fig). Nearly 1/3 of pts (30.3%) with CS due to VHD underwent surgical/transcatheter valve procedures during CICU admission, contrasting with those with CS and concomitant VHD (13.5%; p<0.001). In-hospital mortality was similar between the 2 VHD groups (39.4% vs 33.8%, p=0.17). In-hospital mortality for allcomers with CS and VHD (concomitant or causative) was higher than in those with CS and no VHD (34.8% vs 29.7%; p=0.003), including adjusted for age, sex, SOFA score, and pre-CICU cardiac arrest (aOR 1.23; 1.03-1.47). Mortality was numerically lower in pts undergoing a valve procedure (23.4% died; 16% with CS due to VHD, 26.9% with CS and concomitant VHD; p=0.13), compared to pts who did not (37.1% overall; 49.6% & 34.9%, respectively; p=0.003).

Conclusions:
Although VHD is the primary cause of CS in a minority of pts, the presence of significant VHD is associated with higher mortality. In contemporary CICUs, procedural intervention is undertaken in ~1/3 of cases and mortality was numerically lower in pts who underwent valve procedures.
Abstract 13678: Initial Decline in Estimated Glomerular Filtration Rate After Initiation of Dapagliflozin in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: Insights From DELIVER
Authors: Mc Causland Finnian R , Claggett Brian , Vaduganathan Muthiah , Desai Akshay S , Jhund Pardeep S , Vardeny Orly , Fang James C , de Boer Rudolf A , Docherty Kieran , Hernandez Adrian F , Inzucchi Silvio E , Kosiborod Mikhail N , Lam Carolyn S , Martinez Felipe , Saraiva Jose F , McGrath Martina , Shah Sanjiv J , Verma Subodh , Langkilde Anna Maria , Petersson Magnus , McMurray John J , Solomon Scott
Published: December 2023

Introduction:
Among patients with heart failure with reduced ejection fraction, an initial eGFR decline >10% with dapagliflozin was associated with a lower risk of cardiovascular (CV) outcomes and slowing of kidney function decline, compared with a similar decline among those on placebo. We examined these associations in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF).

Methods:
In this prespecified analysis of DELIVER, the frequency of initial eGFR decline (baseline to month 1) was compared between dapagliflozin vs. placebo. Cox models (adjusted for baseline eGFR, age, sex, race, BMI, hypertension, left ventricular ejection fraction, log-transformed NT-proBNP, systolic blood pressure (SBP), ACEi or ARB use, MRA use, and change in SBP from baseline to month 1) were fit to estimate the association of initial >10% eGFR decline with CV (CV death or heart failure event) and kidney (≥50% eGFR decline, eGFR <15 ml/min/1.73m
2
or dialysis, death from renal causes) outcomes, landmarked at month 1, stratified by baseline diabetes.

Results:
The median [IQR] initial change in eGFR was -1 [-6, +5] and -4 [-9, +1] ml/min/1.73m
2
with placebo and dapagliflozin, respectively (difference 3 ml/min/1.73m
2
; P<0.001). Patients randomized to dapagliflozin were more likely to develop an initial eGFR decline >10%, vs. placebo (odds ratio 1.9; 95%CI 1.7, 2.1). An initial eGFR decline >10% was associated with a higher risk of the CV outcome among those randomized to placebo (adjusted hazard ratio [aHR] 1.31; 95%CI 1.08, 1.59), but not to dapagliflozin (aHR 0.93; 95%CI 0.77, 1.13; P
interaction
=0.01;
Fig. 1
). In the dapagliflozin group, an initial eGFR decline >10% was not associated with adverse kidney outcomes (aHR 0.94; 95%CI 0.49, 1.82).

Conclusions:
Among patients with HFmrEF/HFpEF in DELIVER, an initial eGFR decline >10% (vs. ≤10%) was not associated with a higher risk of cardiovascular or kidney events, among those assigned to dapagliflozin.
Abstract 13680: Assessing the Role of Phosphodiesterase-5 Inhibitors in the Management of Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis
Authors: Elfaituri Muhammed K , Alzubi Alhasan Saleh , Khaled Ala , BenGhatnsh Ahmed , Faraj Hazem Abdelkarem A , Msherghi Ahmed
Published: December 2023

Introduction:
The advent of left ventricular assist device (LVAD) therapy revolutionized the management of severe heart failure. Right ventricular failure (RVF) remains a principal cause of mortality among these patients. Previous reports suggest phosphodiesterase-5 inhibitors (PDE-5is) can decrease pulmonary pressure, enhance ventricular function, and lower the risk of thrombosis and stroke. Nonetheless, certain studies present conflicting data, indicating potential increases in bleeding and mortality among patients using PDE-5is.

Hypothesis:
This study aimed to assess the outcomes of LVAD patients who were administered PDE-5is.

Methods:
A comprehensive search of PubMed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature was conducted until January 2022. We included studies that directly compared outcomes of LVAD patients who used PDE-5is versus those who did not. Primary outcomes focused on postoperative RVF and all-cause mortality, while secondary outcomes included stroke, gastrointestinal bleeding, and pump thrombosis. The statistical analysis was performed using "R" statistical computing software (version 4), utilizing the metafor and meta packages.

Results:
Eight studies encompassing 3035 PDE-5i users and 3023 non-users were included in our analysis. PDE-5i use was not significantly associated with postoperative RVF (RR: 0.84; 95% CI 0.58-1.21, P=0.35; I2 = 83.2%). Similarly, there was no significant correlation between PDE-5i use and all-cause mortality (RR: 0.99; 95% CI 0.96-1.02, P=0.75; I2 = 0%), pump thrombosis (RR: 0.66; 95% CI 0.61-0.72, P=0.45; I2 = 0%), stroke (RR: 0.96; 95% CI 0.84-1.08, P=0.58; I2 = 0%), or gastrointestinal bleeding (RR: 1.13; 95% CI 0.77-1.67, P=0.65; I2 = 0%).

Conclusions:
Our analysis suggests that PDE-5i use is not associated with increased adverse outcomes such as bleeding, stroke, thrombosis, or all-cause mortality in LVAD patients. However, given the heterogeneity of the included studies and a lack of robust evidence supporting PDE-5i use, high-quality randomized controlled trials are needed to assess the potential benefits, efficacy, and safety of PDE-5is in reducing RVF, thrombosis, and all-cause mortality in LVAD patients.
Abstract 13683: Deciphering the Effects of Quercetin on Blood Pressure: A Systematic Review and Meta-Analysis
Authors: Elfaituri Muhammed K , Alzubi Alhasan Saleh , Khaled Taha , Faraj Hazem Abdelkarem A , BenGhatnsh Ahmed , Msherghi Ahmed
Published: December 2023

Introduction:
Hypertension, a key driver of global cardiovascular diseases, has prompted interest in nutritional solutions like dietary supplements for managing blood pressure. The flavonoid quercetin, found in fruits and vegetables, has garnered attention for potential antihypertensive effects, although research on quercetin supplementation's impact on blood pressure has yielded varied outcomes.

Hypothesis:
This study aims to assess Quercetin supplementation's effects on blood pressure to comprehend its potential role in hypertension management.

Methods:
A systematic search was conducted across PubMed, Cochrane Library, Embase, and Scopus databases until December 2022 to include studies on the effects of Quercetin supplementation on blood pressure. The Mean Difference in Blood Pressure was used as the pooled effect size to compare the impact of Quercetin on patients, calculated with a random-effects model in R (version 4.0.3) using the metafor and meta packages. The I2 statistic was employed to evaluate heterogeneity.

Results:
The meta-analysis included ten studies with 743 participants, with 372 and 371 in the Quercetin and placebo/control groups, respectively. Quercetin supplementation in patients diagnosed with hypertension led to a statistically significant reduction in systolic blood pressure (MD: -3.19 mmHg; 95% CI: -4.41 to -1.99, P<0.01, I2=73%). However, the reduction in diastolic blood pressure was not statistically significant (MD: -2.65 mmHg; 95% CI: -6.79 to 1.51, P=0.21, I2=98%). In individuals with normal blood pressure, quercetin supplementation resulted in a significant reduction in systolic blood pressure (MD: -2.97 mmHg; 95% CI: -4.72 to -1.22, P<0.01, I2=74%), while its effect on diastolic blood pressure was not significant (MD: -2.99 mmHg; 95% CI: -10.18 to 4.21, P=0.42, I2=99%).

Conclusions:
The results indicate that quercetin supplementation notably lowers systolic blood pressure in hypertensive and normotensive individuals, but its impact on diastolic blood pressure is insignificant. These findings hint at Quercetin's potential as an auxiliary treatment for systolic hypertension, with a need for more high-quality, randomized controlled trials to determine its optimal dosage and duration.
Abstract 13692: Incidence, Recurrence, and Ethnicity Specific Risk Factors for Premature Coronary Artery Disease in South Asians and Europeans
Authors: Kang Mehima , Malhi Navraj , Huang Kate , Vikulova Diana , Pimstone Simon , Brunham Liam R
Published: December 2023

Introduction:
Premature coronary artery disease (CAD) incidence is increasing globally. South Asians (SA) have a disproportionately high burden of atherosclerotic cardiovascular disease (ASCVD). However, the effect of SA ethnicity on the risk of recurrent events in patients with premature CAD has not been prospectively evaluated.

Methods:
Patients in the SAVEBC and UK biobank (UKB) registries were enrolled and stratified by ethnicity and presence of premature CAD. The co-primary outcomes were to compare proportion of premature CAD and the incidence of recurrent ASVCD events. Secondary exploratory outcomes included describing demographic, physical, biochemical variables between cohorts.

Results:
11,136 patients were included, 1,129 (143 SA; 21%) were from SAVEBC and 10,007 (400 SA; 4.0%) from UKB. There was a higher proportion of premature CAD in SA compared to Caucasians in UKB (5.2% vs. 2.0%, p < 0.001). Similarly, SA were overrepresented in SAVEBC (21% of cohort vs. 7.9% of British Columbia population). SA compared to Caucasians with premature CAD had increased prevalence of diabetes (SAVEBC: 20.1% vs 13.8%, p=0.08; UKB: 37.5% vs 18.0%, p<0.001), and lower mean HDL cholesterol (SAVEBC: 1.4±0.4 vs 1.5±0.4, p=0.21; UKB: 1.1±0.3 vs 1.2±0.3, p<0.001). SA had more diffuse disease reflected by more coronary segments affected (4.9±3.0 vs. 4.1±2.6, p=0.05), and a trend towards more affected coronary vessels compared to Caucasians (1.31±1.4 vs. 0.61±0.91, p=0.14). SA had greater incidence of recurrent ASCVD vs. Caucasians (4.19 vs. 3.08 events per 100 P-Y; incidence rate ratio p-value < 0.001). SA had higher risk of recurrent ASCVD events (HR 1.35, 95% CI 1.13,1.61, p<0.001). SA ethnicity remained a predictor of recurrent events on adjusted COX regression (HR 1.24, 95% CI 1.03,1.48, p=0.02).

Conclusion:
Using two prospective registries, SA had a higher proportion of premature CAD and recurrent cardiovascular events with shorter time to recurrent events. Some risk may be explained by adverse cardiometabolic profiles, however significant risk mechanisms are yet to be elucidated. Understanding the unique mechanisms of cardiovascular risk in SA is critical to appropriately identify high-risk individuals and initiate contemporary preventative therapies.
Abstract 13694: Impact of an Interdisciplinary Heart Failure Clinic on Achieving Guideline-Directed Medical Therapy in the Community
Authors: Bregier Jessica , Cheuvront Jessica , Spence Rowan , Krupski Rebekah , Yoder Virginia , Pisano Mary Ellen , Choy-Ames Maryann , Reeves Gordon R
Published: December 2023

Background:
Guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) is underutilized despite proven benefits. Strategies to implement GDMT are needed, especially in the era of sodium-glucose cotransporter-2 inhibitors (SGLT2is).

Research Question:
What is the impact of embedded interdisciplinary heart failure (HF) clinics on HFrEF GDMT prescribing within community cardiology practices?

Goal:
Compare GDMT prescribing for HFrEF patients followed in community cardiology practices with or without the added support of embedded interdisciplinary HF clinics.

Methods:
This retrospective chart review of four community-based cardiology practices in North Carolina identified 2,121 patients ≥ 18 years old with a diagnosis of HFrEF (EF ≤ 40%) who had encounters from January 1 to December 31, 2022. Patients were categorized based on whether their encounters included an HF clinic provider. Patients seen in HF clinic also had access to embedded clinical pharmacists and centralized social work support. Chi square test of independence was used to assess differences between groups.

Results:
Significantly more patients who attended HF clinic (n=1050) compared to those receiving usual care alone (n=1071) were female (36% vs 30%, p<0.01), African American (39% vs 30%, p<0.01), and had systolic BP < 100 mmHg (12% vs 7%, p<0.01). Mean age (67.8 ± 2.4 years), rates of potassium > 5 mEq/L (10%), and rates of GFR < 30 mL/min/1.73m
2
(12%) were similar between groups. HF clinic patients had significantly higher rates of angiotensin receptor/neprilysin inhibitors (ARNis) (72% vs 46%, p<0.01), ACEi/ARB/ARNis combined (86% vs 77%, p<0.01), SGLT2is (61% vs 20%, p<0.01), and mineralocorticoid receptor antagonists (45% vs 32%, p<0.01) prescribed compared to usual care alone. HF beta blocker prescribing was similar between groups (88% vs 89%, p=NS).

Conclusion:
Patients receiving care in interdisciplinary HF clinics within community cardiology practices had significantly higher rates of HFrEF GDMT prescribing for 3 of the 4 drug classes. Specialized HF clinics can provide patients additional support and resources to achieve GDMT.
Abstract 13706: Determinants of Right Ventricular Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial Experience
Authors: Lu Henri , Inciardi Riccardo M , Abanda Martin , Shah Amil M , Cikes Maja , Claggett Brian , Prasad Narayana , Lam Carolyn S , Redfield Margaret M , McMurray John J , Solomon Scott , Hegde Sheila , Skali Hicham
Published: December 2023

Introduction:
Right ventricular dysfunction (RVD) is a major prognostic factor in patients with heart failure with preserved ejection fraction (HFpEF), however determinants of RVD in HFpEF are not well described. Although sex-specific mechanisms have been incriminated in the development of HFpEF, it is unclear whether this is also true for RVD.

Goals:
(1) Assess the prevalence of RVD (defined as a tricuspid annular plane systolic excursion [TAPSE] <1.7 cm, a fractional area change [FAC] <35% or a RV free wall longitudinal strain [RVFWLS] <20%, absolute value) in patients with HFpEF; (2) identify determinants of RVD, overall and according to sex, in patients with HFpEF.

Methods:
We used data from patients enrolled in the echocardiographic sub-study of the PARAGON-HF trial with adequate image quality (N=809, 53% women, mean age 74±8 years). Determinants of RVD, in the whole study population and according to sex, were identified using a multivariable logistic regression model.

Results:
There were 461 patients (57%) with RVD. After multivariable adjustment, RVD was cross-sectionally associated with a history of atrial fibrillation of flutter (AFF), older age, higher heart rate, greater LV mean wall thickness and higher NT-proBNP values. Systolic blood pressure and LV global longitudinal strain (absolute value) showed an inverse association (
Figure
). These results were consistent between men and women, except for AFF and LV mean wall thickness, which were associated with a greater likelihood of RVD in men (OR 2.46, 95%CI 1.33-4.56, OR 1.61, 95%CI 1.18-2.21 respectively) but not in women (OR 0.99, 95%CI 0.58-1.68, OR 0.90 95%CI 0.69-1.17 respectively, p-values for interaction=0.028 and 0.006).

Conclusions:
RVD was highly prevalent in our study population. Determinants of RVD included AFF, LV remodeling and systolic impairment, and increased NT-proBNP levels. Differences between men and women suggest gender-specific mechanisms in the development of RVD in HFpEF.
Abstract 13711: Clonal Hematopoiesis Driven by
TET2
and
ASXL1
but Not
DNMT3A
is Associated With Interleukin 6 Levels, Cardiac Biomarkers, Cardiac Remodeling, and Risk of Atrial Fibrillation
Authors: Saadatagah Seyedmohammad , Naderian Mohammadreza , Uddin Md Mesbah , Dikilitas Ozan , Schuermans Art , Niroula Abhishek , Selvin Elizabeth , Hoogeveen Ron C , Matsushita Kuni , NAMBI VIJAY , Yu Bing , Chen Lin Y , Bick Alexander G , Ebert Benjamin L , Honigberg Michael C , Li Na , Shah Amil M , Natarajan Pradeep , Kullo Iftikhar J , Ballantyne Christie M
Published: December 2023

Introduction:
Aging and inflammation are associated with risk of atrial fibrillation (AF), to which clonal hematopoiesis of indeterminate potential (CHIP) may contribute. We investigated whether CHIP was associated with AF, inflammatory and cardiac biomarkers and cardiac structural changes.

Methods:
We ascertained CHIP (variant allele frequency, VAF ≥2%) in the Atherosclerosis Risk in Community Study (ARIC visit-5, n = 4,131) and the UK Biobank (UKBB, n = 195,851) participants. Using multivariable Cox regression models, we studied the association of CHIP and the top three implicated genes (i.e.,
DNMT3A
,
TET2
,
ASXL1
) with incident AF and conducted a meta-analysis on both cohorts. We also ascertained high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL6), IL18, high-sensitivity troponin T and I (hs-TnT and hs-TnI), NT-proBNP, and echocardiography indices in ARIC. We first standardized the natural log of all markers (st-ln) and used the adjusted quantile regression to compare the median in those with and without CHIP.

Results:
In ARIC, the mean ± SD age was 75.8 ± 5.2 years, 41% were men, 23% were Black, 25% had CHIP, and 11.6% had large CHIP (VAF ≥10%). These measures in UKBB were 56.4 ± 8.1 years, 45%, 2%, 5.8%, and 2.6%, respectively. In the meta-analysis, compared to those without CHIP, the hazard ratios (95% confidence interval) for AF were 1.12 (1.01 - 1.25,
P
=0.035), 1.31 (1.07 - 1.60,
P
=0.009), and 1.48 (1.05 - 2.08,
P
=0.026) for Large-CHIP, Large-
TET2,
and Large-
ASXL1
, respectively. hs-CRP and IL18 levels were similar in those with and without CHIP as well as gene-specific subgroups. Large-
TET2
and
ASXL1
were associated with higher IL6, which was separately associated with AF. Additionally, Large-
ASXL1
was associated with increased left ventricle mass index and NT-proBNP (coefficients in
Figure 1
).

Conclusion:
Large
TET2
and
ASXL1
but not
DNMT3A
CHIP is associated with higher IL6 levels, indices of cardiac remodeling, and an increased risk of AF.
Abstract 13715: Catheter-Based Therapies in High-Risk Pulmonary Embolism: Outcomes From a Tertiary Referral Center
Authors: Al Soueidy Amine , Miller Gregory , Hussain Shawana , rachoin jean-sebastien , Hunter Krystal , Iliadis Elias A
Published: December 2023

Introduction:
Prompt and effective treatment of pulmonary embolism (PE) is essential to prevent morbidity and mortality. We aim to evaluate and compare the effectiveness of two FDA-approved catheter-based therapies (CBT) for acute high-risk PE: ultrasound-assisted catheter-directed thrombolysis EKOS (EKOS Corporation, Bothell, WA) and Penumbra Indigo aspiration thrombectomy (Penumbra Inc., Alameda, CA, USA).

Methods:
Patients with acute high-risk submassive or massive PE who underwent CBTs between 09/2014 and 08/2022 at our institution were identified. The primary efficacy outcome was the change in the echocardiographic RV/LV diameter ratio within 48 to 72h of procedure.

Results:
A total of 189 patients underwent EKOS (n=119) or Penumbra (n=70) for submassive (n=175) and massive (n=14) PE (Table). Both groups had similar demographics and clinical characteristics except for prior DVT. Mean age was 60.6±14.3 years old and 55.6% were male. The RV/LV ratio showed significant improvement post intervention, with 21.2% decrease in the EKOS group (EG) and 35.6% in the Penumbra group (PG). The PG had a greater decrease in RV/LV (median change 0.396 (IQR, 0.347) vs. 0.207 (IQR, 0.306), p<0.001). In the cohort, 25 adverse events were reported (13.2%). The rate of complications did not differ between the 2 groups, with 15.1% in EG and 10% in PG. In terms of bleeding complications, GUSTO moderate bleeding was observed in 8 cases (5 in EG and 3 in PG), while severe bleeding was observed in 3 (2 in EG and 1 in PG), including 1 intracranial hemorrhage in the PG. ICU admissions were higher in the PG (p<0.001), but median hospital and ICU stays were comparable. No significant difference was found in the rate of in-hospital mortality (2.5% in EG, 4.3% in PG, p=0.672).

Conclusion:
Both CBT options are promising for treating submassive PE, with efficacy outcomes favoring Penumbra thrombectomy. Longer follow-up and randomized controlled trials are needed for definitive conclusions.
Abstract 13720: Global Burden, Trends, and Attributable Risk Factors for Ischemic Heart Disease, 1990~2019: A Systemic Analysis of the Global Burden of Disease Study 2019
Authors: Xiao Yichao , Jiang Shali , Ji Shuting , Li Nini , Ni Wenrui , Liu Qiming , Zhou Shenghua
Published: December 2023

Background:
As the primary culprit for nearly half of global cardiovascular deaths, ischemic heart disease (IHD) exerts a significant medical and economic toll, particularly on low- and middle-income countries. The rise in IHD incidence and mortality from 1990 to 2019 necessitates revising analyses and developing effective IHD strategies.

Research Questions:
To categorize IHD incidence, mortality, and Disability-Adjusted Life Years by country, sex, age, and Sociodemographic Index (SDI) from 1990-2019. To identify key risk factors and establish a model predicting IHD incidence till 2044.Aims: To assess global IHD incidence, dissect disease burden distribution, identify central risk factors, and forecast incidence trends.

Methods:
Leveraging the Global Burden of Disease (GBD) database for global population and IHD data from 1990 to 2019, we explored regional, gender, age attributes, and IHD temporal progression. We utilized a joinpoint model and an age-period-cohort model to decipher IHD incidence trends, scrutinized primary IHD risk factors, and predicted global IHD incidence till 2044.

Results:
Global age-standardized IHD incidence decreased from 316 (95% UI 282-352) in 1990 to 262 (95% UI 233-293) in 2019, primarily due to high SDI and high-middle SDI regions. Men had higher IHD incidence across all ages, notably between 35-74. Diet remained the leading risk factor from 1990 to 2019. Projections suggest a steady global IHD incidence similar to 2019 levels by 2044.

Conclusions:
Future trends indicate the IHD burden will concentrate in middle or lower SDI regions, with stable global IHD incidence over the next two decades. Joint initiatives to mitigate IHD's burden are vital, demanding specific policies and interventions. The GBD database is instrumental for health priority strategies. Collective efforts can lead us towards sustainable development and improved global health.
Abstract 13751: Clinical Characteristics With High Extracellular Volume Fraction in Patients Who Performed Cardiac Computed Tomography Angiography for the Purpose of Evaluating Coronary Arteries
Authors: OGUNI TETSUYA , Naoto Kuyama , Takashio Seiji , Kidoh Masafumi , Oda Seitaro , Tsujita Kenichi
Published: December 2023

Background:
Cardiac computed tomography angiography (CCTA) is useful for the evaluation of anatomical coronary artery lesions. Recently, extracellular volume fraction by computed tomography (ECV
CT
) have become possible by imaging the delay phase after coronary CT angiography. ECV
CT
has been reported to be useful for detailed examination and prognosis prediction after therapeutic intervention of cardiomyopathy. Cardiac amyloidosis is known as a cardiomyopathy with noticeable increased ECV, and cardiac amyloidosis should be suspected in patients with high ECV. The aim of this study was to evaluate clinical characteristics of high ECV
CT
and incidental detection of cardiac amyloidosis in patients who underwent CCTA for the purpose of evaluation of coronary arteries.

Methods and Results:
We examined consecutive 875 patients (mean age; 74.3 ± 7.1 years, men; 64%) who underwent CCCA in men aged ≥ 60 years and women aged ≥ 70 years. ECV
CT
quantification was performed with pre-contrast and post-contrast delayed phase CT images with the subtraction-derived method. Mean ECV
CT
was 29.7 ± 5.2%, and a total of 109 patients (12.3%) had ECV
CT
≥ 35%. The patients with ECV
CT
≥ 35% were significantly older (75.8±8.1 years vs. 74.1±6.9 years; P=0.038) and male dominant 75.4% vs 63.1%; P=0.007). Increased of high-sensitivity cardiac troponin T and B-type natriuretic peptide levels, left ventricular diastolic diameter, left ventricular thickness, impaired left ventricular ejection fraction, and E/e’ were significantly associated with ECV
CT
≥ 35%. The prevalence of cardiac amyloidosis was estimated to be at least 1.7% (15/875) in entire study patients and 14.2% (15/106) in patients with ECV
CT
≥ 35%. In these cases, increased ECV
CT
was a clue of the diagnosis of cardiac amyloidosis.

Conclusion:
CCTA was useful not only for evaluation of coronary arteries but also for evaluation of myocardial properties by ECV
CT
. Elevated ECV
CT
was associated with elevated cardiac biomarkers and structural changes of myocardium. There is an incidental diagnosis of cardiac amyloidosis in approximately 1.7% of cases underwent CCTA for the purpose of coronary artery evaluation detected by increased ECV
CT
.
Abstract 13760: Systematic Review and Meta-Analysis of Clinical Outcomes in Cardiac Sarcoidosis: A Comprehensive Review
Authors: Seo Jiyoung , Shao Daming , Mangeshkar Shaunak , Nazarenko Natalia , Esagian Stepan , Nagraj Sanjana , Kharawala Amrin , Choi Hansol , Palaiodimos Leonidas , Kokkinidis Damianos
Published: December 2023

Introduction:
Cardiac sarcoidosis (CS), often overlooked due to its myriad and non-specific presentation, is mainly understood through small studies.

Hypothesis:
What comprehensive evidence exists regarding the cumulative clinical outcomes in CS patients?

Methods:
A literature search in PubMed and EMBASE was conducted until September 8, 2022. Data from Kaplan-Meier curves were reconstructed using WebPlotDigitizer, with subsequent analysis was conducted via Cox proportional hazards models and non-parametric methods.

Results:
We reviewed 183 studies with 29,830 CS-diagnosed patients, and CS predominantly affected middle-aged, White, and Black individuals, with data primarily derived from Europe, North America, and Japan. The prevalent arrhythmias were ventricular arrhythmias (25%) and conduction block (low-degree, 21%; high-degree, 15%). Steroids were the primary treatment, with implantable cardioverter-defibrillators (ICD) used in 20% of cases
(Image 1)
. Survival meta-analysis showed that immunosuppressants significantly lower mortality risk in CS patients (HR: 0.52, 95% CI: 0.38-0.7, p < 0.0001) compared with the general CS population. ICD implanted for primary prevention in CS patients was associated with lower risk of inappropriate ICD therapy compared with ICD for secondary prevention (HR: 0.29, 95% CI: 0.19-0.44, p < 0.0001). Post-transplant survival was superior in CS patients than non-CS patients (HR: 0.58, 95% CI: 0.46-0.72, p < 0.0001)
(Image 2)
.

Conclusions:
This study is the first to provide comprehensive outcomes in CS patients. We encourage global research efforts to include underrepresented population in order to better understand CS.
Abstract 13765: ECG Signal Quality Assessments of Real-Time Single-Lead Wearable SmartPatch and 12-Lead ECG
Authors: Im Sung I , Su Hyun BAE , Cho sung phil
Published: December 2023

Introduction:
There is an increasing clinical interest using wearable single-lead ECG sensors for continuous cardiac monitoring.

Hypothesis:
However, there is limited to qualify the reliability of those. The purpose of this study is to assess ECG signal quality assessments of real-time wearable SmartPatch (HiCardi Plus) compared to 12-lead ECG.

Methods:
To analyze the similarity between the standard 12-Lead ECG and HiCardi Plus signals, 31 subjects were simultaneously acquired with SmartPatch (HiCardi Plus) and 12-Lead ECG. The 12-lead ECG equipment used in this experiment is IntelliVue Patient Monitor MX700 (Philips)

Results:
It was found that even if the distance between electrodes was short, the ECG signal measured from the electrode pair located diagonal (direction of the electrical axis of the heart) and vertical direction with chest had a very high correlation with the standard 12-lead ECG signal and was sufficient for diagnosis

Conclusions:
Our device (HiCardi Plus) has substantial equivalence with standard 12-Lead ECG, in terms of QRS-complex detection and arrhythmia classification in the intended use condition.
Abstract 13786: Early Mortality Following Transcatheter Edge-to-Edge Repair of Mitral Regurgitation
Authors: Yeo Yong Hao , Tan Min Choon , Ang Qi Xuan , San Boon Jian , Thong Jia Yean , Lee Justin , Lee Kwan S
Published: December 2023

Background:
While transcatheter edge-to-edge repair (TEER) is increasingly used, data on risk stratification for predicting early mortality after TEER are scarce.

Objective:
This study aimed to assess early mortality and analyze the predicting factor of early mortality among patients who underwent TEER.

Methods:
Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who had TEER between January 2017 and November 2020. We categorized the cohort into two groups depending on the occurrence of early mortality (death within 30 days after the procedure). Based on the ICD-10, we identified the trend of early mortality after TEER and further analyzed the predictors of early mortality.

Results:
15,931 patients who had TEER were included in this study; 292 (1.8%) with early mortality and 15,639 (98.2%) without. There was a decreasing trend in early mortality from 1.9% in 2017 to 1.7% in 2020, but it was insignificant (p=0.18). In multivariable analysis, the independent predictors for early mortality were chronic kidney disease not requiring dialysis (adjusted odds ratio [aOR]: 1.57; 95% confidence interval [CI]: 1.11-2.22, p=0.01), end-stage renal disease (aOR: 2.34; CI: 1.44-3.79, p<0.01), chronic liver disease (aOR: 4.90; CI: 3.29-7.29, p<0.01), coagulation disorder (aOR: 3.42; CI: 2.32-5.03, p<0.01) and heart failure (aOR: 2.90; CI: 1.39-6.03, p=0.01). Among those who died during 30-day readmission following TEER, the most common cardiac cause and non-cardiac-cause of readmission were heart failure (18.2%) and infection (26.6%), respectively.

Conclusion:
The early mortality following TEER was low at 1.8%. The independent predictors of early mortality were chronic kidney disease (including end-stage renal disease), chronic liver disease, coagulation disorder, and heart failure.

Figure
Hazard Curves for Early Mortality after TEER Stratified by Clinical Predictors of Early Mortality.