bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145158: CD38 Activation by Disturbed Flow (d-flow) Promotes Endothelial Cell (EC) Senescence-Associated Stemness (SAS) through Glutaminolysis Enhanced by Pyruvate Dehydrogenase (PDH) Inhibition, Leading to Atherothrombosis
Authors: Kotla Sivareddy , Lee Jonghae , Osborn Abigail , Pathania Rajneesh , Chen Weiqing , Samanthapudi Venkata Subrahman K , Mejia Gilbert , Hoang Oanh , Ko Kyung Ae , Ostos Mendoza Keila Carolina , Chau Khanh , LE NHAT TU , Schadler Keri , Burks Jared K , Seeley Erin , Lorenzi Philip , Brookes Paul , Martin James , Wang Guangyu , Chini Eduardo , Abe Junichi
Published: November 2024

Background:
D-flow’s impact on metabolic reprogramming, particularly glycolysis, needs reevaluation due to its conflicting role in atherosclerosis. We show that d-flow reduces LATS1/2 expression, leading to both EC proliferation and senescence. However, the exact molecular mechanisms remain elusive.

Methods: We utilized EC-specific Lats1
+/-
/Lats2
-/-
knockout (LATS1/2-EKO) mice in a partial left carotid ligation (PLCL) model under hypercholesterolemia with AAV-PCSK9 injection to mimic d-flow. Anti-CD38 antibody (Ab68) and IgG2a control were administered intraperitoneally every 5 days at a dose of 5 mg/kg starting one day before PLCL. Plaque characterization was performed using imaging mass cytometry and sequential immunofluorescence (COMET
TM
), integrating spatial metabolite data from Bruker timsTOF Flex Mass Spectrometer, and spatial single-cell metabolite data via the Visiopharm platform.

Results:
EC LATS1/2 depletion induced a unique atherothrombosis lesion with induced EC proliferation and senescence-associated secretory phenotype (SASP). Utilizing spatial single-cell metabolomics, we cataloged 134 distinct metabolites within the ECs. Subsequent overrepresentation analysis revealed that pathways related to glutamate and the citric acid cycle were enhanced in LATS1/2-EKO mice. Specifically, CD38-dependent downregulation of the pyruvate dehydrogenase (PDH) substrate lipoamide decreased PDH enzymatic activity, linking to CD38 to senescence induction. This inhibition led to a metabolic shift towards YAP-dependent glutaminolysis, and upregulated the citric acid cycle. The use of a glutaminase 1 inhibitor (CB-839) significantly curtailed senescence-associated stemness (SAS), underscoring the pivotal role of CD38 in driving glutaminolysis that contributes to d-flow-induced SAS. Moreover, the application of Ab68 but not IgG2a control decreased atherothrombosis formation following PLCL in LATS1/2-EKO mice. However, the effectiveness of Ab68 in attenuating atherosclerosis in wild-type mice was less pronounced.

Conclusions:
In the presence of d-flow, upregulated CD38, resulting from reduced LATS1/2 expression, triggers EC responses characterized by increased glutaminolysis and the emergence of an EC SAS phenotype. These processes play a crucial role in a unique form of atherothrombosis. Additionally, CD38’s impact on reducing PDH activity, along with YAP and CD38-mediated enhancement of glutaminolysis, constitutes critical pathways for inducing EC SAS by d-flow.
Abstract 4145162: Empagliflozin Effect on Left Cardiac Parameters in Acute Coronary Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Eljadid Ghaith , Rakab Mohamed , Mansour Ahmed , Abdelglel Mohamed Yasmeen , Abbas Ahmed , Almosilhy Nereen , Abdrabou Noura , Sabe alerab Ameerh dana , Khaled Ahmed , Goufa Elarbi , Elbataa Ahmed , Aboeldahab Heba , A. Ibrahim Ahmed , elsayed emara Ahmed gaber elsayed
Published: November 2024

Background:
Acute coronary syndrome (ACS) poses a significant global health burden despite advancements in its management. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, primarily used in type 2 diabetes mellitus (T2DM), have gained recent consideration as potential agents for ACS management due to their cardiovascular benefits beyond glycemic control. This study aimed to assess the effects of empagliflozin on left cardiac parameters in ACS patients.

Methods:
PubMed, Cochrane, Scopus, and Web of Science were searched thoroughly to identify relevant randomized controlled trials (RCTs) until June 1st, 2024. Continuous data were pooled using mean difference (MD) with a 95% confidence interval (CI) using R (Version 4.3).

Results:
Four RCTs involving 701 patients were included. Compared to placebo, empagliflozin significantly reduced left ventricular end-systolic volume index (LVESVi) (MD: -2.38, 95% CI: -3.95 to -0.80, p = 0.0032), left ventricular mass index (LVMi) (MD: -2.76, 95% CI: -4.95 to -0.56, p = 0.0137), and left ventricular filling pressure (E/e') (MD: -0.59, 95% CI: -1.07 to -0.10, p = 0.0189). However, empagliflozin treatment did not yield a statistically significant change in left ventricular ejection fraction (LVEF) (MD: 1.21, 95% CI: -0.05 to 2.48, p = 0.0603), nor a significant change in left ventricular end-diastolic volume (LVEDV) (MD: -4.49, 95% CI: -14.24 to 5.26, p = 0.37), left ventricular end-systolic volume (LVESV) (MD: -5.19, 95% CI: -10.77 to 0.39, p = 0.0682), and left ventricular end-diastolic volume index (LVEDVi) (MD: -2.20, 95% CI: -4.59 to 0.19, p = 0.0718).

Conclusion:
Empagliflozin provides favorable effects on left cardiac structural parameters in ACS patients, as it was associated with reduced LVESVi, LVMi, and E/e'. This suggests a potential role for SGLT2 inhibitors as adjunctive therapy in ACS management, warranting further investigation into their mechanisms and long-term clinical outcomes.
Abstract 4145216: Association of Neutrophil-Lymphocyte Ratio With Cardiovascular Mortality and All-cause Mortality in Patients Receiving Chronic Hemodialysis: A Systematic Review and Meta-analysis
Authors: Vempati Roopeessh , Damarlapally Nanush , Vasudevan Srivatsa Surya , Banda Prathibha , Mourad Denise , Polamarasetty Harshavardhan , Mathur Gaurav , Khan Afrasayab , Desai Rupak
Published: November 2024

Background:
The neutrophil-lymphocyte ratio (NLR) has been proposed as a potential prognostic marker for mortality outcomes in various conditions, yet its association with chronic hemodialysis (HD) remains underexplored. We aim to study its utility by conducting a meta-analysis of this specific population.

Methods:
We conducted a comprehensive systematic search from PubMed, Google Scholar, and Scopus to identify studies showing the association between NLR and mortality outcomes in patients with chronic HD. Random-effects model with 95% confidence intervals (CI) were employed to pool adjusted hazard ratios (aHRs) and odds ratios (OR), I
2
statistics for evaluating heterogeneity for all-cause mortality (ACM) and cardiovascular mortality (CVM) outcomes. Leave-one-out sensitivity analysis and meta-regression analyses assessed changes in overall effects and identified confounders, respectively. The Joanna Briggs Institute (JBI) tool was used to assess the quality of the studies.

Results:
Out of 180 articles analyzed, nineteen studies comprising 9,047 patients with a mean age of 59.5 ± 5.86 years and a mean follow-up duration of 46.7 months were included in our meta-analysis. The majority of the sample had a smoking history, hypertension, diabetes, and cerebrovascular diseases. Our meta-analysis revealed a significant association between higher NLR (>2.5) and increased risks of both ACM (aHR: 1.24, 95% CI: 1.13-1.36, P < 0.0001) (Figure 1a) and CVM (aHR: 1.23, 95% CI: 1.02-1.49, P = 0.03). (Figure 1b) Studies reporting outcomes in OR also reported similar findings for ACM (OR: 4.58, 95% CI: 1.73 - 12.1, p = 0.002) (Figure 1c) and CVM (OR: 1.11, 95% CI: 1.01 - 1.23, p = 0.03). Sensitivity analysis revealed no variations. The pooled AUC was 0.711 (95% CI: 0.63 - 0.80, p < 0.0001). JBI tool revealed higher scores indicating higher quality studies. Meta-regression analysis did not identify significant associations between NLR and confounding variables such as age. (Figure 1d)

Conclusion:
This meta-analysis strongly concludes that NLR (>2.5) is significantly associated with ACM and CVM in patients with chronic HD and can be useful in planning for the prevention of mortality-related strategies.
Abstract 4145239: Perinuclear puncta concentrate newly synthesized SERCA2a, Na,K-ATPase, and Phospholemman before cardiomyocyte-wide distribution
Authors: Aonuma Kazuhiro , Guo Jin , Cala Steven , Chen Zhenhui
Published: November 2024

Introduction:
Distribution of newly synthesized proteins is vital for the maintenance of healthy cardiomyocytes (CMs), but is poorly understood. We previously reported that multiple newly made sarcoplasmic reticulum (SR) proteins first concentrated in the perinuclear endoplasmic reticulum (ER) puncta of CM, before their transition to transversely oriented SR z-tubules (zSR), aligned with T-tubules (TTs) (the NEST pathway). We now study the initial trafficking steps of newly made sarcolemma (SL) proteins Na, K-ATPase (NKA) and its phosphoprotein regulator phospholemman (PLM), which we recently reported to have a unique uneven steady state distribution to lateral, transverse SL TTs, and intercalated discs (IDs), key to cardiac conduction.

Hypothesis:
Newly synthesized SL proteins sort through NEST pathway in CMs.

Methods:
Confocal immunofluorescence assay was performed on adult rat CMs 12-48h post infected with adenoviruses encoding dog isoform of NKA-Flag, PLM (dPLM) ± SR protein dSERCA2a (> 10 CMs at each condition), as indicated by corresponding affinity purified
dog–specific
monoclonal antibodies, which do not detect endogenous rat proteins.

Results:
Fig. A, newly made NKA-Flag proteins were concentrated in a
punctate
pattern within perinuclear ER at ~2µm intervals (18h, NE), and then spread distally from perinuclear ER puncta into zSR 24h post infection (zSR). Fig. B, Dual immunostaining also showed overlapping fluorescence of dPLM and co-expressed dSERCA2a in these perinuclear ER puncta and into zSR. Thus, morphologically, the same pathways were initially used for the trafficking of newly made SR protein SERCA2a, SL proteins dPLM and NKA. dPLM and NKA ultimately diverge from SERCA2a to localize to IDs, which occurs at 24 h and 30 h post infection, respectively. Anti-dPLM B8 and anti-Flag fluorescence intensity ratios of ID/TT were 2.6 ± 0.1 and 2.2 ± 0.5 at 30 h post infection, respectively, paralleling its steady state distribution in heart tissue.

Conclusions:
Newly made SL proteins PLM and NKA co-localize with SR protein SERCA2a in a series of organized perinuclear ER puncta, revealing a key CM-specific trafficking step that appears to “presort” SR and membrane proteins by aligning their transport with zSR.
Abstract 4145254: Effects Of Semaglutide On Safety Outcomes In Patients With Type 2 Diabetes Mellitus And High Cardiovascular Risk: A Meta-Analysis Of Randomized Controlled Trials And Systematic Review
Authors: Cruz Akabane Maria Antonia , Mazetto Roberto , RIBEIRO Iury , Cavalcante Douglas , Barbosa Imara
Published: November 2024

Background:
The efficacy of semaglutide, a glucagon-like peptide-1 receptor agonist, has been studied in patients with type 2 diabetes mellitus (T2DM) who also have advanced chronic kidney disease (CKD) and/or established cardiovascular disease. These conditions pose a high cardiovascular risk. However, the impact of semaglutide on safety outcomes and the incidence of adverse effects in this population remains unclear.

Hypothesis:
The use of semaglutide is associated with a higher incidence of gastrointestinal adverse events and specific safety concerns such as severe hypoglycemia and retinopathy.

Aims:
This study aimed to evaluate the impact of semaglutide on safety outcomes in high-risk cardiovascular patients with T2DM.

Methods:
PubMed, Embase, and Cochrane Central databases were systematically searched in May 2024 for randomized controlled trials (RCTs) that compared semaglutide (oral and subcutaneous) to placebo in adult patients with T2DM with CKD and/or established cardiovascular disease and reported the safety outcomes of (1) gastrointestinal disorder; (2) acute pancreatitis; (2) severe hypoglycemia; (3) retinopathy; (4) acute kidney failure and (5) malignant neoplasm. A systematic review and meta-analysis of the findings were performed using RStudio version 2024.04.0. Heterogeneity was examined with the Cochran Q test and I2 statistics.

Results:
We included 3 RCTs in the final analysis, with a total of 10.013 participants, of whom 5.006 (49.99%) were on semaglutide. Semaglutide was associated with a significant increase in the incidence of gastrointestinal disorders compared with placebo (OR 2.00; 95% CI 1.07-3.77; p= 0.031; figure 1A). Severe hypoglycemia (OR 1.10; 95% CI 0.92-1.31; p=0.31; figure 1B), acute kidney failure (OR 0.93; 95% CI 0.78-1.10; p= 0.402), acute pancreatitis (OR 0.92; 95% CI 0.49-1.71; p= 0.792), retinopathy (OR 1.17; 95% CI 0.91, 1.50; p=0.225) and malignant neoplasm (OR 1.02; 95% CI 0.85-1.24; p=0.809) were not significantly different between groups.

Conclusion:
In high cardiovascular risk T2DM patients, semaglutide was associated with a higher incidence of gastrointestinal disorders as compared with placebo.
Abstract 4145256: Urban Greenspace Exposure, Stress, and Cardiovascular Function.
Authors: Stopforth Cameron , Simpson Anna , Willis Sean , Smith Ted , Bhatnagar Aruni , Keith Rachel
Published: November 2024

Introduction:
Healthy urban environments are essential for improving cardiovascular health. Although exposure to wild green surroundings has been shown to have positive effects on mental and physical health, the effect of urban greenspaces on cardiovascular function and stress remain unclear.

Research Question:
Does being in an urban park decrease stress and autonomic tone as reflected by heart rate variability (HRV).

Methods:
We invited healthy adults (n=41; age 25-70 years) to participate in a cross-over panel study. They were randomly assigned to start in either a typical urban park or an adjacent urban space, spending 20min sitting and 20min walking. Self-reported distress and State-Trait Anxiety Index (STAI) scales were assessed before and after exposure. Paired
t
-test was used to compare stress levels by site, and the effect size was calculated using regression analysis after adjusting for the level of starting distress. ECG recordings were acquired for the duration of the visit. HRV epochs of 5 min at the end of sitting or walking period and 40 min for the entire study were analyzed and compared using paired
t
-test.

Results:
Pre-exposure distress and STAI summed scores were similar for the park and built spaces, but the level of distress was lower after visiting the park compared with built space (19.6±15.0 vs. 24.1±12.1; p=0.05). STAI scores were decreased after visiting the park, but not the built space (-5.4±8.2 vs. 0.8±6.8; p=0.003). When adjusted for the starting levels of distress, the summed STAI score after visiting the park was reduced by 6 (-10.34, -2.11), but no change for the built site. The standard deviation of NN intervals (SDNN) was higher in the park than the urban site (41.7 vs. 37.3; p=0.03) and the HR was lower (78 vs. 81; p=0.01) across the entire study epoch (40min). There was no significant change during the seated portion of visits, but across the walking portion, the values of SDNN were higher in greenspace (32.2 vs. 27.0; p= 0.01) and HR was lower (87 vs 84; p=0.02). Other HRV indices were not significantly affected.

Conclusion:
Visiting an urban park, but not a built environment, led to a decrease in self-reported distress, and a relative shift in the autonomic nervous system towards parasympathetic dominance. Although the relationship between changes in stress and HRV remain unclear, access to greenspaces may be an important factor in maintaining and enhancing cardiovascular health in urban environments.
Abstract 4145273: Utilization and Efficacy of an Automated Transthoracic Echocardiographic Report Data Extraction
Authors: Praveen Nischal , Shah Anish , Hill Michael , Tofovic David
Published: November 2024

Background:
Extraction of unstructured and semi-structured medical data is a key prerequisite for the application of bioinformatics. Portability, scalability, and protection of health information remain key problems in data analytics in medicine that cannot easily be solved using machine learning techniques alone, highlighting the importance of multi-faceted approaches.

Research Question / Hypothesis:
Can rule-based algorithms reliably and identify and extract transthoracic echocardiographic (TTE) report findings for use in a data analytics pipeline?

Methods:
Deidentified adult TTE reports were obtained between 09/14/2020 to 03/30/2023 within a single urban academic healthcare system. A rule-based algorithm was developed using derivatives of regular expressions in R to capture chamber parameters, cardiac function, and valvular disease. The accuracy was evaluated in a subset of manually adjudicated reports by study cardiologists.

Results:
Of the 1000 reports obtained, we were able to extract 23079 (78.4%) populated data points out of 29423 maximal data points for 37 variables. Out of 803 manually verified NA data points, 743 (92.5%) were accurate. The mean net accuracy of all variables was 99.8% (see Table 1). Continuous data points showed 100% accuracy. Modes of failure for data extraction were in categorical variables (7.5% of the 23 features), with the most common being in left atrial size (n=6), mitral valve structure (n=5), aortic valve structure (n=13), tricuspid valve structure (n=2) and right ventricular function (n= 7). All other categorical variables showed 93.6% mean accuracy of NA data points.

Conclusions:
A rule-based algorithm is effective at converting cardiologist-read TTE reports into datasets ready for use data analytics. Moving forward, it would be important to test this tool on metrics of speed, cluster computing and scalability.
Abstract 4145315: Are We Including Everybody? A Systematic Review On Reporting Of Transgender and Gender-Expansive Populations in Cardiovascular Clinical Trials
Authors: Yamparala Aishwarya , Joshi Amir , Fernandez Warren , parajuli Shreyash , Bansal Kannu , Ahmad Tariq , Desai Nihar
Published: November 2024

BACKGROUND:
Transgender and gender expansive (TGE) people constitute a vulnerable population with added cardiovascular risk and frequently experience health inequalities and obstacles to care. However, they are nonetheless underreported and underrepresented in clinical trials. We aim to understand inclusion and representation of TGE population in clinical research by examining the volume and caliber of reporting in certain disciplines of CV clinical trials.

METHODS:
A systematic review of clinical trials from January 2020 to March 2024 was conducted across 4 cardiovascular areas (heart failure, stroke, dyslipidemia, electrophysiology) using ClinicalTrials.gov focusing on the inclusion and reporting of TGE populations in the United States with published results. Trials were evaluated for explicit mention of TGE participants, use of gender-inclusive language, and provision of disaggregated data by gender identity. Equity metrics, such as the proportion of trials including TGE participants were calculated.

RESULTS:
A total of 32,583 participants were included(Table).We collected reporting of populations for sex and gender descriptions, as well as the inclusion and exclusion criteria. Almost all studies reported sex or gender as a single outcome variable. We inferred this to denote sex unless it was specified otherwise. All studies reported sex, with women representing 54% of all participants. Women represented the minority of study participants in stroke (39%), dyslipidemia (45%), and electrophysiology (37%) clinical trials, but majority of participants in heart failure trials (64%). Gender identity, including the option “other”, was reported in only 3 trials (4.1%), of which 2 were heart failure and 1 was a dyslipidemia trial. Most trials had pregnant women, lactating women, and age <18 years as exclusion criteria, and had adults aged >18 years as the inclusion criteria.

CONCLUSION:
Our findings confirm that there is still a lack of commitment in current clinical trials to the Sex and Gender Equity in Research guidelines. The impact of the differences in this population can never be fully understood unless gender identification data is carefully gathered. Current national guidelines mandate that in randomized clinical trials, gender should be fully reported and that gender-inclusive language be used appropriately. To properly represent and care for these populations, future cardiology studies should adhere to the Sex and Gender Equity in Research principles.
Abstract 4145329: Automated Detection of ST-elevation Myocardial Infarction in High-Acuity Settings Using Artificial Intelligence Applied to Images of 12-lead Electrocardiograms
Authors: Dhingra Lovedeep , Biswas Dhruva , Khunte Akshay , Sangha Veer , Shankar Sumukh , Aminorroaya Arya , Khera Rohan
Published: November 2024

Background:
The diagnosis of suspected ST-elevation myocardial infarction (STEMI) requires electrocardiograms (ECGs) done in emergent settings across the world. Despite access to ECG machines, the expertise of clinicians reading them is scarce. Automated reads are often inaccurate. We sought to address this challenge by developing an AI-enabled approach for automated cardiologist-level diagnosis from photos of 12-lead ECGs.

Methods:
We identified patients undergoing ECGs in a large, diverse US health system (2015-2023). We used self-supervised pretraining to develop a convolutional neural network to first detect ECG features without any diagnostic flags, designed to enhance the efficiency of training a STEMI-specific model. To ensure the model learned the signature for STEMI independent of other ECG features, each STEMI ECG (cases defined by reads by cardiologists) was matched to 10 ECGs of those without STEMI (controls) but of the same age, sex, and with the same set of conduction and rhythm abnormalities on their ECGs. To mimic variations in ECG formats in real-world clinical settings, the training ECGs were randomly plotted using any of 2880 unique formats, with variations in lead layouts, background colors, label fonts, grid, and signal line widths. The model was evaluated on a held-out set of ECG images from patients presenting to the emergency (ED) with chest pain.

Results:
The model development set included 49,995 ECGs from 39,697 individuals (age 65 years [IQR, 52-76], 18,926 [48%] women, 5941 [15%] Black). The test set included 7551 patients who had presented to the ED with chest pain (1 ECG/individual, median age 50 years [IQR, 34-62], 4063 [54%] women, 1661 [22%] Black). Of these, 104 (1.4%) had STEMI. The model achieved an AUROC of 0.95 (95% CI, 0.93-0.96) and AUPRC of 0.21 (0.15-0.28), with a sensitivity of 90.3% (84.0-95.8) and specificity of 87.7% (87.0-88.4). The model performance was consistent among demographic subgroups of age (AUROC 0.95-0.97), sex (AUROC 0.93-0.97), and race/ethnicity (AUROC 0.95-0.96).

Conclusion:
We have developed an AI algorithm that can diagnose STEMI on photos of ECGs with high accuracy, potentially enabling the triaging of patients in low-resource settings by offering accurate diagnosis at the point of care. The reliance on ECG images across formats and layouts ensures its use without changing ECG acquisition or related infrastructure.
Abstract 4145340: Health System Variability in Lipid Management for Patients with Atherosclerotic Cardiovascular Disease: An Analysis from Cv-MOBIUS
Authors: Shah Nishant , Shrader Peter , Shoji Satoshi , Martin Seth , Fernandez Soledad , Chamberlain Alanna , Arnold Jonathan , Shapiro Michael , Effron Mark , Chrischilles Elizabeth , Allred Clint , Priest Elisa , Syed Mahanaz , Kirchner H Lester , Leja Monika , Ahmad Zahid , Kalich Bethany , Dhalwani Nafeesa , Jones Laney , Wojcik Cezary , Peterson Eric , Navar Ann Marie
Published: November 2024

Background:
Nationally, many ASCVD patients fail to achieve an LDL-C <70 mg/dL, and uptake of both statin and non-statin therapies is low. The degree to which this varies across health systems is less clear.

Methods:
A cross sectional analysis was performed where lipid levels and lipid lowering therapies (LLT) were assessed using electronic health record data in patients with a previous diagnosis of ASCVD. The data was obtained across 14 US healthcare systems between 1/1/2021-12/31/2022. Proportions of patients with an active prescription of any statin, high intensity statin, ezetimibe, PCSK9i, and combination therapy (two or more agents) within 395 days of the most recent LDL-C value (index date) was evaluated overall and by participating site. Additionally, the proportion of patients with an LDL-C <70 mg/dL at the index date was also assessed.

Results:
Across 14 health systems, 1,118,623 patients with ASCVD were identified (median 61,840 per health system, range 8,161-182,315). Overall, 675,776 (60.4%) had an LDL-C level in the past year (range 39.1% - 70.8%). Of those with a lipid level, achievement of LDL-C <70 mg/dL ranged from 34.6-47.2%. In total, 42.6% were on any statin, 20.1% were on a high intensity statin, 4.3% on ezetimibe, and 1.2% on a PCSK9i. Only 2.9% were on combination therapy of a statin with ezetimibe or a PCSK9i. Variability was seen across health systems in utilization of each of these therapies, however even in the highest performing health systems, LLT uptake and achievement of LDL-C < 70mg/dL remained low (
Figure).

Conclusion:
Variability in utilization of LLT in ASCVD patients between health systems suggests that system-level factors may impact achieving guideline-based LDL-C goals. Despite the variability, the highest proportion of patients achieving an LDL-C <70mg/dL remained under 50% indicating the need for aggressive implementation efforts.
Abstract 4145360: Same-Day Discharge Following Catheter Ablation of Atrial Fibrillation in the United States
Authors: Sandhu Amneet , Qin Li , Minges Karl , Zimmerman Sarah , Borne Ryan , Polsinelli Vincenzo , Ho Michael , Hsu Jonathan , Al-Khatib Sana , Freeman James , Bradley Steven , Rao Sunil , Hernandez Adrian , Tzou Wendy , Varosy Paul , Hess Paul
Published: November 2024

Introduction:
Patients undergoing atrial fibrillation (AF) ablation have historically been hospitalized overnight or longer post-procedure. We conducted this study to characterize national rates of same-day discharge, associated clinical factors, variation across hospitals and in-hospital outcomes.

Methods:
The NCDR AF Ablation Registry was used to identify all index procedures from January 1
st
, 2016, to June 30
th
, 2023. Patients were stratified by post-procedure disposition into 3 cohorts: (1) same-day discharge, (2) overnight hospitalization (
<
1-day) or (3) >1-day hospitalization. Rates of same-day discharge, associated clinical factors, hospital-level variation and unadjusted post-procedural complication rates were analyzed.

Results:
Among 139,391 patients who underwent index AF ablation across 197 hospitals in the US, 51622 (37.0%) were discharged the same-day, 78220 (56.1%) hospitalized overnight and 9549 (6.9%) hospitalized for >1-day post-procedure. Shown in Figure 1, the rate of same-day discharge increased from 0.99% (Quarter 1 of 2016) to 62.3% (Q2 2023), p<0.0001 for trend, with a sharp rise in Q1 of 2020 and corresponding decline in those hospitalized overnight (83.3% in Q1 2016 to 32.9% Q2 2023, p<0.0001 for trend). The quarter during which AF ablation procedure was conducted was associated with same-day discharge (OR 1.26, 95% CI 1.256-1.264, Figure 2). In contrast, Black race (OR 0.71, 95% CI 0.65-0.78), persistent AF classification (OR 0.85, 95% CI 0.82-0.88) and prior non-AF catheter ablation (OR 0.89, 95% CI 0.85-0.93) favored overnight hospitalization. Variation in same-day discharge across hospitals was significant (MOR 4.12, 95% CI 3.48-4.79). Aggregate major and overall in-hospital complication rates were 0.70% and 2.13%, respectively. In comparison, major and overall complication rates were 0.03% and 0.19% for same-day discharge and 0.24% and 0.98% for overnight hospitalization.

Conclusion:
Rates of same-day discharge following AF ablation increased over time and surpassed overnight hospitalization by Q1 2021. Those with paroxysmal AF and fewer comorbid conditions were more likely to undergo same-day discharge with substantial variation across hospitals. Peri-procedural complication rates of those undergoing same day discharge were comparable to overnight hospitalization. With substantial growth in same-day discharge and development of outpatient or ambulatory procedural centers, our findings may assist future procedural policy development.
Abstract 4145382: Sex Differences in Clinical Outcomes Among Patients with Myocarditis Complicated by Cardiogenic Shock: A Retrospective Multi-Center Cohort Study
Authors: Josey Gina , Parcha Vibhu , Scheinuk John , Hasnie Usman , Saleh Ahmed , Hasnie Ammar , McElwee Samuel , Clarkson Stephen
Published: November 2024

Introduction:
Myocarditis is more commonly reported among young males and may be complicated by cardiogenic shock. Animal models and clinical studies demonstrate that myocardial fibrosis after myocarditis disproportionately impacts males. There is limited contemporary data on sex-specific clinical outcomes among patients with myocarditis complicated by cardiogenic shock.

Methods:
This retrospective cohort study used an EHR-based data platform from large academic medical centers across the United States (TriNetX, Inc.) to identify patients diagnosed with cardiogenic shock secondary to myocarditis between January 2012 and January 2024. Baseline demographics, clinical characteristics, medication use, and outcomes were defined using standardized ICD codes. The primary study outcome was all-cause mortality at 6 months. Secondary outcomes included cardiac arrest, acute kidney injury (AKI), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF). The study population was stratified based on sex. Propensity score matching (1:1), incorporating demographic factors, comorbidities, and medication usage, was employed to compare the risk of primary and secondary outcomes between groups.

Results:
We identified 3,048 individuals (1,857 males, 60.9%) with myocarditis complicated by cardiogenic shock. After propensity-score matching, there were 1,072 individuals in each group (
Table
). Females had a higher risk of all-cause mortality (HR: 1.27, 95%CI: 1.06-1.52), but a lower risk of AKI (HR: 0.83, 95% CI: 0.74-0.92) and VT/VF (HR: 0.74, 95%CI: 0.60-0.92). The risks of atrial fibrillation (HR: 0.88, 95% CI: 0.70-1.09) and cardiac arrest (HR: 1.04, 95% CI: 0.85-1.27) were similar between the two groups.

Conclusion:
Significant sex-based differences in clinical outcomes exist among patients with myocarditis complicated by cardiogenic shock. Further studies are warranted to investigate the pathophysiological basis of the higher risk of all-cause mortality, and lower risk of AKI and ventricular arrhythmias among females with myocarditis complicated by cardiogenic shock compared with males.
Abstract 4145414: Not just children: A case of Incomplete Kawasaki Disease with shock in a Black adult
Authors: Gonuguntla Akhilesh , Hyder Syed , Parcha Vibhu , Santana Heriberto
Published: November 2024

Background:
Kawasaki disease (KD) is a systemic vasculitis that is rare and underdiagnosed in adults given its atypical presentation, especially in non-Asian patients. Incomplete KD is characterized by less than 4 of the classic clinical findings of mucocutaneous inflammation and is more common in adults. Kawasaki shock syndrome (KSS) is a rare complication that has features of both cardiogenic and vasoplegic shock.

Case:
A 48-year-old Black male was admitted for subjective fevers, abdominal pain, cervical adenopathy, and jaundice. Labs include WBC count 13320/cmm with 85% neutrophils, total bilirubin 13.1 mg/dL, direct bilirubin 9.3 mg/dL, AST 64 U/L, ALT 191 U/L, ALP 143 U/L, GGT 201 U/L, and urinalysis with pyuria. Microbiological workup and abdominal imaging were unremarkable. Subsequently, he developed chest pain with hypotension, diffuse ST elevations on ECG, and hsTropI of 638 ng/L. Cardiac catheterization revealed no obstructive CAD but elevated filling pressures with cardiac index of 1.8 L/min/m2, suggestive of myopericarditis with cardiogenic shock. IABP was inserted. TTE revealed EF of 20-25% with global hypokinesis, reduced RV systolic function, mild MR, and mild pericardial effusion. Significant labs include ESR 102 mm/hr, CRP 22 mg/L, ferritin 775 ng/mL, albumin 2.3 gm/dL, hemoglobin 9.3 gm/dL, and platelets 703000/cmm. High-dose aspirin and colchicine were given with significant improvement. IABP was removed 2 days post-placement. Cardiac MRI at 1-week post admission revealed reduced LV systolic function and diffuse pericardial enhancement. Aspirin, colchicine, and GDMT were prescribed at discharge. At 2-week follow-up, symptoms had resolved with normalization of labs. Clinical findings, lab abnormalities, and resolution with high-dose aspirin were suggestive of incomplete KD. The patient was subsequently lost to follow-up.

Discussion:
Incomplete KD should be considered in an adult patient with myopericarditis and evidence of severe systemic inflammation when all classic findings are not present as current criteria are intended for children. Cervical adenopathy and hepatitis are more common in adults while coronary artery aneurysms are rarer. Early mechanical support in KSS may be beneficial.
Abstract 4145425: Patient-Facing Smartphone Application for Perioperative Cardiothoracic Surgery Care Improves Readmission Rates and Patient Satisfaction
Authors: Vargas Ian , Brinn Maria , Morsli Hakim
Published: November 2024

Introduction:
Smartphone applications increasingly are utilized to enhance patient education for optimal implementation of care plans to improve overall outcomes. We demonstrate the use of an app with instructions and built-in reminders for patients in the peri-operative phase of cardiothoracic surgery to reduce readmission rates and improve patient satisfaction.

Hypothesis:
We postulated that patients undergoing cardiothoracic procedures who used a smartphone application pre and post-procedure would demonstrate improved outcomes compared to non-users, including reduced 90 day rates of hospital readmission, wound complications, or post-op thoracentesis, as well as demonstrate enhanced patient satisfaction.

Methods:
We prospectively enrolled patients in the pre-operative phase undergoing cardiothoracic procedures including coronary artery bypass graft (CABG), valvular replacement, or patent foramen ovale closure, who either downloaded or declined the app. Patients were tracked for successful registration and use of the app. Post-operative outcomes including readmissions, wound complications, and need for thoracentesis were tracked for 90 days. Patients were also administered an in-person satisfaction survey at 14 days post-op with responses recorded.

Results:
App users (n=392) and non-users (n=334) with median age 67 years underwent cardiothoracic surgery between May 29, 2023 and February 2, 2024. Among app users, 23 experienced 90-day readmission compared to 49 non-users (5.9% vs 14.7%, p=<0.0001). Subsequent results are similarly sequenced. No difference was observed between wound complications (3.83% vs 3.29%, p=0.700) or post-op thoracentesis (3.1% vs 1.9%, p=0.275). App users reported increased satisfaction on a five-point scale with preparation for surgery (4.9 vs 4.5, p=0.0031), surgeon communication post-op (5.0 vs 4.9, p=0.0033), preparation for recovery (4.8 vs 4.5, p=0.0291), and overall experience (5.0 vs 4.8, p=0.0130).

Conclusion:
We demonstrated smartphone application catalyzed patient engagement throughout peri-operative experience of cardiothoracic surgery resulted in significantly reduced 90-day readmissions and improved patient satisfaction. Extension of app usage to similar clinical contexts may lead to like outcomes.
Abstract 4145433: The Association of PREVENT-HF Risk Estimates with Subclinical (Stage B) HF and Clinical Implications for HF Risk: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Grant Jelani , Zhang Sui , Khan Sadiya , Ozkan Bige , NAMBI VIJAY , Pandey Ambarish , Blumenthal Roger , Ballantyne Christie , Selvin Elizabeth , Matsushita Kuni , Shah Amil , Coresh Joe , Ndumele Chiadi
Published: November 2024

Background:
PREVENT-HF is a risk prediction tool recently developed by the AHA to estimate heart failure (HF) risk. The association of PREVENT-HF with measures of subclinical HF (stage B HF), and the clinical implications of subclinical HF measures within PREVENT-HF categories are undefined.

Methods:
We performed a prospective analysis of 2,716 ARIC participants <80 years of age without prevalent HF or atherosclerotic cardiovascular disease who attended Visit 5 (2011-2013). We grouped participants into PREVENT-HF 10-year risk categories (<7.5%; ≥ 7.5 to < 10%; ≥ 10 to < 15%; ≥ 15 to < 20%; and ≥ 20%). We identified stage B HF based on elevated cardiac biomarkers (N-terminal pro B-type natriuretic peptide ≥125 pg/mL or high sensitivity troponin T ≥22 ng/L for men and ≥14 ng/L for women) and/or abnormal cardiac function or structure on echocardiography (echo). We assessed the prevalence of subclinical HF within each PREVENT-HF category. We calculated HF incidence rates (IRs) within each PREVENT-HF category and assessed HF IRs for those with elevated cardiac biomarkers alone, abnormal echo alone, both abnormal or neither.

Results:
The mean age was 74 years, with 63% women and 22% Black adults and with 16%, 18%, 33%, 19% and 13% in PREVENT-HF 10-year risk categories of <7.5%; ≥ 7.5 to < 10%; ≥ 10 to < 15%; ≥ 15 to < 20%; and ≥ 20%, respectively. Higher PREVENT-HF estimated risk was associated with subclinical HF with the highest frequency of combination of both abnormal biomarkers + abnormal echo in 37% with PREVENT-HF ≥ 20%. Higher PREVENT-HF score was associated with a stepwise increase in HF IRs (Figure). Individuals with PREVENT-HF <10% had relatively low IRs for HF even in the presence of abnormal biomarkers + echo. In participants with higher PREVENT-HF scores, the presence of abnormal biomarkers + echo identified a subgroup at very high HF risk (IRs of 37 and 51 per 1000 person-years in those with PREVENT-HF ≥15 to < 20% and ≥20%, respectively), while the absence of abnormal biomarkers or echo identified a lower risk group.

Conclusion:
Stage B HF improves HF risk stratification in those with higher PREVENT-HF estimates but provides limited utility for absolute HF risk stratification in those with PREVENT-HF <10%.
Abstract 4145435: Diagnostic Accuracy of Non-Invasive Assessments for Detecting Cardiac Transplant Rejection: A Meta-Analysis
Authors: Han Donghee , Shah Kunal , Kim In-Cheol , Stern Lily , Kransdorf Evan , Chang David , Hamilton Michele , Nikolova Andriana , Kittleson Michelle , Patel Jignesh , Berman Daniel , Kobashigawa Jon
Published: November 2024

Background:
After heart transplantation, endomyocardial biopsy (EMBx) is the standard diagnostic modality for acute rejection (AR). However, EMBx is invasive with some limitations to conventional histological interpretation. Non-invasive assessments, such as cardiac magnetic resonance Imaging (MRI) and donor-derived cell-free DNA (dd-cfDNA) assays, have emerged as viable methods for diagnosing acute rejection. This study aims to assess the diagnostic performance of cardiac MRI and dd-cfDNA for evaluating acute cardiac transplant rejection.

Method

PubMed and Web of Science were searched for relevant publications reporting on the use of dd-cfDNA or cardiac MRI for the detection of acute cardiac transplant rejection defined as acute cellular rejection (ACR) and/or antibody-mediated rejection (AMR), with EMBx as the reference standard. Pooled sensitivity, specificity, and hierarchical modeling-based summary receiver-operating characteristic (sROC) curves were calculated.

Results:
Out of 725 screened papers, 23 studies were included (10 studies with cardiac MRI and 13 studies with dd-cfDNA). Five studies considered only ACR as a rejection criterion, while eighteen studies included both ACR and AMR. The sensitivity and specificity for detecting acute transplant rejection were 0.68 (95% CI: 0.58-0.77) and 0.82 (95% CI: 0.74-0.88) for dd-cfDNA, and 0.79 (95% CI: 0.66-0.88) and 0.72 (95% CI: 0.62-0.81) for cardiac MRI. The areas under the hierarchical modeling-based sROC curves were 0.82 (95% CI: 0.78-0.85) for dd-cfDNA and 0.82 (95% CI: 0.79-0.85) for cardiac MRI. While there was no significant difference in the sROC between dd-cfDNA and cardiac MRI (p = 0.959), cardiac MRI had significantly higher sensitivity (p < 0.001) and dd-cfDNA had significantly higher specificity (p = 0.001) (
Figure
)

Conclusion:
dd-cfDNA and cardiac MRI demonstrated comparable high diagnostic accuracy for acute cardiac transplant rejection. Given the high sensitivity of cardiac MRI and the high specificity of dd-cfDNA, combining these two non-invasive modalities may provide an effective screening strategy to detect acute cardiac transplant rejection and reduce the need of EMBx.
Abstract 4145439: Cardiac Arrest Associated with Thyrotoxicosis: A Systematic Review
Authors: Ahmed Ashraf , Badheeb Mohamed , Abid Shaun , Malaguez Webber Fabricio , Sethi Samdish , Adefuye Mayowa , Vangipuram Deepak , Gonciulea Anda , Zarich Stuart , Buller Gregory
Published: November 2024

Introduction:
Thyrotoxicosis is a systemic condition caused by the effects of elevated levels of thyroid hormones. The cardiovascular manifestations of thyrotoxicosis range from sinus tachycardia and atrial fibrillation to heart failure. The incidence of malignant arrhythmias and cardiac arrest associated with thyrotoxicosis is not well known, and much of the current literature regarding this is limited to case reports. This study conducts a systematic review of the literature to identify patient demographics and outcomes where thyrotoxicosis manifests as cardiac arrest.

Methodology:
A systematic literature review was conducted by searching three different databases, Embase, PubMed, and Scopus from inception to January 5th, 2024, to identify and review case reports regarding patients with thyrotoxicosis who had a cardiac arrest.

Results:
We identified 98 patients with thyrotoxicosis manifested as cardiac arrest. The mean age was 40 ±15 years, and 62% were female. Most were previously healthy and had no history of a thyroid disorder (60%). Of the patients with preexisting hyperthyroidism, around 50% had Graves' disease. Notably, around 90% of these patients had no history of heart disease. The overall mortality was 23.5% (table 1).

Conclusion:
Thyrotoxicosis should be considered when an otherwise healthy patient presents with a cardiac arrest in the third or fourth decade of life. The outcome in these patients seems to be favorable, with more than three-quarters of patients in our study having survived the event.
Abstract 4145450: Trends in Heart Failure Mortality Among Adults with Chronic Ischemic Heart Disease in the United States from 1999 to 2020
Authors: Qazi Shurjeel , Majid Muhammad , Ali Syed Hassaan , Ansari Huzaifa , Qazi Sana , Khan Muhammad , Agrawal Ankit , Saraswati Ushasi , Amsterdam Ezra , Klein Allan
Published: November 2024

Introduction:
The previous literature identifies chronic ischemic heart disease (CIHD) as a major contributor to heart failure (HF), accelerating its progression due to reduced coronary perfusion and decreased myocardial contractility. Significant disparities in mortality rates persist despite advancements in treatment,. This study characterizes trends in mortality across various demographics in the US.

Methods:
CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to identify HF-related mortality in patients with underlying CIHD from 1999-2020. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to calculate annual percentage change (APC).

Results:
A total of 2,165,216 deaths occurred in patients with CIHD due to HF from 1999-2020 (AAMR = 37.3, 95% CI: 37.3-37.4). AAMR decreased from 51.8 in 1999 to 31.9 in 2012, then increased to 35.1 in 2020 (APC: 5.1). Increased mortality rates were observed in males (AAMR = 49.8) compared to females (AAMR = 24.4) (Figure, Panel A). AAMRs were highest in Non-Hispanic (NH) Whites (38.5, 95% CI: 38.5–38.6), followed by NH blacks (32.0, 95% CI: 31.8-32.1), NH American Indian/Alaska Native (28.8, 95% CI: 28.3–29.5) and Hispanics (26.6, 95% CI: 26.6–26.7). NH Asian/Pacific Islanders had the lowest mortality rates (17.3, 95% CI: 17.1–17.5) (Figure, Panel B). We observed that mortality rates were highest in the Midwest region (40.1, 95% CI: 39.9 – 40.1). The West region reported mortality rates of 37.3 (95% CI: 37.2 – 37.4), followed closely by the South region (AAMR = 36.3, 95% CI: 36.3 – 36.4) while the Northeast reported the lowest mortality rate (AAMR = 35.7, 95% CI: 35.6 – 35.8). (Figure, Panel C). Rural areas had higher mortality rates than urban areas (Rural: 44.5, 95% CI: 44.3–44.7; Urban: 33.9, 95% CI: 33.8–34).

Conclusion:
Despite recent improvements, HF-CIHD-related mortality has shown a rise in recent years. AAMR increased among men, NHW, NHB, NH-API, Hispanics, the Midwest region, and rural areas. These results emphasize the necessity for focused interventions and strategic allocation of healthcare resources to address these disparities and enhance outcomes for vulnerable populations.
Abstract 4145470: Long-Term Association of Metabolic Dysfunction-Associated Steatotic Liver Disease With Cardiac Failure, Arrhythmias, and Arrest
Authors: Nogueira Alleh , Tramujas Lucas , Carvalho Pedro , Felix Nicole , de Barros e Silva Pedro , Moura Filipe
Published: November 2024

Background:
The novel concept of metabolic dysfunction-associated steatotic liver disease (MASLD) emerged to facilitate diagnosis and emphasize the underlying pathophysiology. However, research validating its prognostic significance, especially for nonatherosclerotic outcomes, is lacking.

Hypothesis:
MASLD is associated with an increased risk of cardiovascular disease.

Aim:
To determine the prognostic impact of MASLD on cardiac failure, arrhythmias, arrest, key atherosclerotic cardiovascular outcomes, and all-cause mortality.

Methods:
In this nationwide retrospective cohort study involving 61 centers, a total of 17,073,511 adults evaluated from 2014 to 2024 were categorized into MASLD and two control groups differing on metabolic dysfunction status. We adjusted for traditional cardiovascular risk factors using propensity score matching with a greedy nearest-neighbor algorithm and 0.1-caliper for pooled standardized mean differences. Cox regressions were used to compare all-cause mortality and cardiovascular outcomes between MASLD and reference groups.

Results:
After a 10-year follow-up, patients with MASLD exhibited greater risks for atrial fibrillation (HR, 1.53; 95% CI, 1.51–1.56), atrial flutter (HR, 1.85; 95% CI, 1.78–1.91), ventricular tachycardia (HR, 2.04; 95% CI, 1.97–2.11), ventricular fibrillation/flutter (HR, 2.18; 95% CI, 2.00–2.37), cardiac arrest (HR, 2.64; 95% CI, 2.53–2.78), heart failure with preserved ejection fraction (HR, 2.69; 95% CI, 2.63–2.74), heart failure with reduced ejection fraction (HFrEF), ischemic heart diseases, stroke, and all-cause mortality compared with patients without metabolic dysfunction. Comparisons between MASLD and metabolic dysfunction yielded significant associations for increased risk with MASLD, except for HFrEF.

Conclusion:
MASLD is a strong independent risk factor for mortality, nonatherosclerotic, and atherosclerotic cardiovascular outcomes.