bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144486: Early versus Delayed Left Atrial Appendage Occlusion After Left Atrial Appendage Electrical Isolation
Authors: ZOU FENGWEI , La Fazia Vincenzo Mirco , Freilich Michael , Ammirati Giuseppe , Ventrella Nicoletta , Cedeno Serna Juan , Marazzato Jacopo , Lin Aung , Zhang Xiaodong , Mohanty Sanghamitra , Natale Andrea , Di biase Luigi
Published: November 2024

Background:
Atrial fibrillation (AF) causes significantly increased risk of stroke and patients often need to be on lifelong anticoagulation. Left atrial appendage occlusion (LAAO) device is an alternative approach to prevent strokes in patients who cannot tolerate anticoagulation. Patients undergoing LAA electrical isolation (LAAEI) as part of their ablation strategy are at increased risk of stroke due to the loss of LAA contractility. In patients with prior LAAEI, the optimum timing of LAAO is unknown.

Objective:
The aim of this study is to investigate whether early versus delayed LAAO impacts risk of stroke in patients with prior LAAEI adherent to anticoagulation.

Methods:
Patients who received both LAAEI and LAAO were included in this analysis. Demographics, co-morbidities, anticoagulation adherence, timing between LAAEI and LAAO, and occurrence of stroke between LAAEI and LAAO were summarized. Patients who received LAAO ≤6 month of LAAEI were designated as the early group, and those >6 month the late group.

Results:
A total of 171 patients were included in this study with 135 in the early group and 36 in the late group and all patients were adherent to oral anticoagulation. Patients in the early vs late group had similar age (69.8 vs 70.7 yr), BMI (28.8 vs 27.3 kg/m
2
), CHA
2
DS
2
-VAS
C
score (2.19 vs 1.83), left ventricular ejection fraction (57.9% vs 57.9%), diabetes (88.9% vs 87.4%), LAA maximum orifice width (18.1 vs 18.5 mm) and percentage of paroxysmal AF (25.0% vs 25.9%). Patients in the early group were more likely to be male but did not reach statistical significance (83.3% vs 71.8%, p=0.161). During a mean follow up duration of 18.6 ± 5.5 months after LAAEI, no stroke events occurred in either group between the date of LAAEI and date of LAAO.

Conclusion:
Delayed LAAO after >6 month of LAAEI is not associated with increased risk of stroke compared to early LAAO (≤6 month) in patients adherent with oral anticoagulation. Delayed occlusion allows for the opportunity to confirm LAAEI and reisolate if needed as the effectiveness and technical difficulty of LAA ablation significantly increases after LAAO.
Abstract 4144537: Recurrent Myocarditis and Ventricular Arrhythmias Associated with Vascular Endothelial Growth Factor Inhibitor Use and Rechallenge
Authors: Roberts Jacob , Garcia Lizette , Yang Eric , Do Duc , Aksoy Olcay , Salavati Ali , Khakpour Houman , Chmielowski Bartosz , Stein-Merlob Ashley
Published: November 2024

Introduction:
Vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI) therapy has been associated with cardiotoxicity, particularly hypertension. Cardiomyopathy and ventricular arrhythmias (VA) have rarely been reported.

Case Report:
A 51-year-old male with metastatic sarcoma on pazopanib, a VEGFR-TKI, for the past 4 years presented with 1 month of increasing palpitations and lightheadedness leading to a fall. On arrival, telemetry showed paroxysmal AF with RVR rates to 120 bpm followed by incessant runs of NSVT with rates 200-240 bpm. Initial labs included BNP 191 pg/mL and HS troponin-I 6 ng/L (<5 ng/L). Lidocaine infusion, amiodarone infusion, and metoprolol were required to reduce NSVT burden. Initial TTE revealed LVEF of 30-35% from baseline 55-60%. Coronary angiography showed no significant CAD. Cardiac MRI was negative for LGE or metastatic involvement. Cardiac PET-CT revealed moderate diffuse FDG uptake with focal enhancement suggestive of an inflammatory process. Pazopanib was stopped and the patient started on GDMT and prednisone taper for treatment of myocarditis.

At 2 months follow up, TTE revealed LVEF improved to 45-50% and ambulatory rhythm monitoring showed rare PVCs and few NSVT episodes. Repeat cardiac PET-CT revealed resolution of myocardial inflammation.

Due to sarcoma progression, the patient started on regorafenib, another VEGFR-TKI, 3 months after initial hospitalization. About 3 weeks later, he presented with frequent NSVT which required lidocaine and amiodarone infusions for arrhythmia control. Repeat cardiac PET demonstrated myocarditis recurrence. He received intravenous pulse dose steroids followed by prednisone taper and was transitioned to oral mexiletine and amiodarone with resolution of VA. Review of ambulatory rhythm monitoring 1 week following regorafenib initiation already showed 20.6% burden of ventricular ectopy and >8000 NSVT episodes.

Discussion:
This patient had an unusual, delayed presentation of VEGFR-TKI induced myocarditis presenting with significant VA. Although TKI induced myocarditis is rare and the mechanism is not well understood, recurrence of myocarditis in this case with an alternative agent indicates a possible medication-class effect.
Abstract 4144621: Intensive Risk Factor Modification for Secondary Prevention of Ischemic Stroke – a Feasibility Study
Authors: Fitzgerald John , Shahmohamadi Elnaz , Emami Mehrdad , Middeldorp Melissa , Jayakumar Mohanaraj , Elliott Adrian , Gallagher Celine , Kleinig Timothy , Sanders Prashanthan
Published: November 2024

Background:
Secondary prevention targets for embolic stroke or transient ischemic attack (TIA) are clearly described in guidelines, but many patients do not achieve consistent follow-up or adequate cardiovascular risk factor control.

Aim:
This study evaluated the feasibility of an intensive risk factor modification clinic model following embolic stroke compared to usual care.

Methods:
Eligible participants 18 to 85 years old with embolic stroke were randomly allocated to 3-monthly physician-led multi-disciplinary risk factor clinic (RFC) review or to standard follow-up for up to 3 years. Lifestyle and cardiovascular risk factors were evaluated including hypertension, hyperlipidemia, diabetes or impaired fasting glucose, physical activity, obesity, sleep apnea, alcohol and tobacco use. In the RFC group, structured advice and medication titration were provided to achieve the secondary prevention targets for each risk factor in accordance with stroke guidelines.

Results:
A total of 140 participants were enrolled (39% female, mean age 71±9 years), at 100±70 days post embolic stroke. Mean follow-up was 545±264 days. Risk factor clinic intervention was associated with greater likelihood of control to target for blood pressure, low density lipoprotein cholesterol (LDL-C) and achievement of target exercise volume. Average percentage weight change in participants with a body mass index (BMI) >27kg/m
2
was 7.5±5.4% in the treatment group compared with 1.3±4.9% in the control group (p<0.001). Differences in blood sugar control, alcohol intake and tobacco use did not reach statistical significance. Moderate or severe sleep apnea was diagnosed in 37% of those tested, with 50% acceptance of continuous positive airways pressure. Achievement of all risk factors to target including a BMI ≤27kg/m
2
(47% versus 0%) was significantly more likely in the risk factor intervention group, compared to the control group.

Conclusions:
The structured risk factor modification in this study was feasible and led to greater risk factor control than standard follow-up. Adopting this approach routinely following embolic stroke has the potential to reduce cardiovascular adverse outcomes and should now be tested in a large, randomized trial.
Abstract 4144624: Clinical Outcomes of Postoperative Atrial Fibrillation Following Non-Cardiovascular Procedures: A Three-Year Study
Authors: Thangjui Sittinun , Abdelazeem Basel , Al Hajji Mohamed , Perkowski Gregory , Watson HangYu , Santer Matthew , Thyagaturu Harshith , balla sudarshan , Arora Sandeep
Published: November 2024

Background:
Postoperative atrial fibrillation (AF) is common, often brief, and may recur, with some studies reporting a recurrence rate lower than 30% at one year. The initiation of anticoagulation (AC) in these patients, particularly those at lower stroke risk, remains debatable due to insufficient evidence. This study aims to assess outcomes in postoperative non-cardiovascular procedures with acute AF, focusing on patients at lower stroke risk, comparing those treated with and without AC.

Method:
Using the TriNetX database, we identified patients aged 18 to 64 years with new-onset AF following non-cardiovascular procedures, excluding those with a history of stroke or other indications for anticoagulation. Patients were divided into AC and Non-AC groups based on AC initiation within two weeks of AF onset, then followed for three years. Propensity score matching (PSM) balanced confounders between groups. Thromboembolic and bleeding outcomes were assessed.

Results:
Among 10,108 patients, 734 (7%) received anticoagulation within two weeks of postop AF. After PSM, mean ages were 53.7±7.6 years for the AC group and 54.2±7.17 years for the Non-AC group. At 3 years, the incidence of composite thromboembolic events did not significantly differ between AC and Non-AC groups (5.8% vs. 4.1%, OR 0.70 (95% CI: 0.43-1.14)). Most thromboembolic events occurred within one month of AF onset. There were no significant differences in the composite of intracranial bleeding, gastrointestinal bleeding, retroperitoneal bleeding, or need for blood transfusion between the AC and Non-AC groups at 3 years (OR 1.04 (95% CI 0.72-1.50)).

Conclusion:
At three years, there is no significant difference in thromboembolic and bleeding outcomes in patients undergoing non-cardiovascular procedures who develop new-onset AF. Further randomized controlled trial is needed to determine the necessity of anticoagulation in this patient population.
Abstract 4144631: Angiographic and Clinical Outcomes with Drug-Coated Balloon Versus Drug-Eluting Stents for In-Stent Restenosis: A Meta-Analysis
Authors: Jain Hritvik , Odat Ramez , Pervez Neha , Goyal Aman , Jain Jyoti , Patel Nandan , Yadav Ashish , Shah Janhvi , Jha Jagriti , Passey Siddhant
Published: November 2024

Background:
The rate of in-stent restenosis (ISR) in clinical practice is approximately 5-10% after 5 years of percutaneous coronary intervention for coronary artery disease. ISR is associated with a high risk of adverse events. The current literature comparing drug-eluting stents (DES) to drug-eluting balloons (DEB) for ISR has yielded divergent results, prompting this meta-analysis.

Methods:
A comprehensive systematic literature review was conducted across major electronic databases, from inception to May 20, 2024. The search was aimed at identifying studies that compared DCB with DES for ISR. Using an inverse-variance random-effects model, we pooled odds ratios (OR) and mean differences (MD) with their respective 95% confidence intervals (CI). Statistical significance was set at p<0.05.

Results:
Twelve studies encompassing 2362 patients with CAD (1250: DCB and 1112: DES) were included. Pooled analysis demonstrated that DCB was associated with a significantly lower mean lumen diameter at follow-up [MD: -0.17; 95% CI: -0.27, -0.07; p<0.001] than DES. However, there was no statistically significant difference in mean in-stent late lumen loss [MD: -0.06; 95% CI: -0.16, 0.04], cardiovascular mortality [OR: 0.74; 95% CI: 0.36, 1.51], all-cause mortality [OR: 0.78; 95% CI: 0.45, 1.35], myocardial infarction [OR: 0.75; 95% CI: 0.48, 1.18], major adverse cardiovascular events [OR: 1.16; 95% CI: 0.85, 1.58], target lesion revascularization [OR: 1.52; 95% CI: 0.99, 2.32], and stent thrombosis [OR: 0.84; 95% CI: 0.27, 2.58].

Conclusion:
ISR treatment with DCB was associated with a lower minimum lumen diameter at follow-up than DES. No significant differences were noted in the other outcomes. Additional appropriately powered trials with larger patient populations are necessary to confirm our findings.
Abstract 4144636: Novel Technique for Impella Sheath Explantation Through Antegrade Wiring via Contralateral Access: A Gateway to Preventing Clot Embolization
Authors: Obeidat Liyan , Ayyad Asem , Al-suraimi Anas , jabri Ahmad , Villablanca Pedro , Alqarqaz Mohammad
Published: November 2024

Introduction:
Mechanical Circulatory Support (MCS) is increasingly used in patients with cardiogenic shock (CS) or compromised hemodynamics during high-risk percutaneous coronary or structural interventions. Safe removal of large-bore MCS devices and closure of arteriotomy sites are crucial to prevent bleeding and vascular complications. Clot formation within intra-arterial sheaths post-MCS implantation poses a risk of thromboembolic complications, necessitating innovative approaches for safe removal.

Case presentation:
We present a 69-year-old male with a history of multivessel coronary artery disease (CAD), who was admitted with CS due to non-ST-segment elevation myocardial infarction (NSTEMI) requiring Impella CP device implantation. He later demonstrated hemodynamic stability with a heart rate ranging from 70 to 80 beats per minute and a mean arterial pressure (MAP) ranging from 75 to 80 mmHg, with the Impella set at power level 8 (P8). He underwent successful weaning from Impella support per protocol and was subsequently brought to the cardiac catheterization laboratory (CCL) for device explantation. The procedure began with the standard technique; however, upon inspection of the sheath following device removal, a sizable clot was visualized. To prevent embolization, we avoided standard retrograde wiring and instead, a Glide Advantage wire was threaded to the Impella sheath in an antegrade fashion via a contralateral access. A balloon was inflated within the sheath for dry field closure. Subsequently, the balloon and sheath were pulled together, extracting the clot in the process.

Discussion:
MCS utilization has risen, necessitating meticulous approaches to arterial access and device removal to mitigate bleeding and vascular complications. In our case, our primary concern revolved around the risk of embolization stemming from the sizable clot observed within the Impella sheath post-device removal when using the standard retrograde technique. This situation posed the potential for serious consequences, including acute limb ischemia, organ ischemia, or cerebrovascular accidents. Consequently, we needed to devise a novel technique for sheath explantation that would ensure safety and effectiveness. Our approach, employing the contralateral access and advancing the wire antegradely, provided a secure alternative, averting the severe consequences associated with clot embolization.
Abstract 4144651: Association Between Pre-Existing Chronic Total Occlusion and Post-TAVR Pacemaker Implantation: A Retrospective Propensity Matched Analysis
Authors: Haseeb Shahan , Ansari Umair , Munir Shafia , Lee Sang , Chan Marvyn , Goldbarg Seth
Published: November 2024

Introduction:
Post-transcatheter aortic valve replacement (TAVR) pacemaker (PPM) implantation is a known complication. Chronic total occlusion (CTO) of coronary arteries is common in TAVR patients and is a marker of advanced coronary calcification. Its influence on the requirement for PPM post-TAVR remains unclear. We investigated the association between pre-existing CTO and the incidence of PPM post-TAVR.

Methods:
A retrospective cohort study was conducted using the National Inpatient Sample database from 2018-2020 with 205,565 patients who underwent TAVR. Propensity score matching was utilized to create a matched cohort of patients with and without CTO, balancing key variables such as age, sex, elective procedure status, and comorbid conditions (heart failure, arrhythmias, pulmonary circulation disorders, peripheral vascular disorders, and complicated diabetes). Outcomes measured included the requirement for PPM implantation post-TAVR, in-hospital mortality, and major adverse cardiac events (MACE). Weighted samples were utilized and p-value <0.05 was considered significant.

Results:
The unmatched analysis included 3,495 patients with CTO and 202,070 without CTO. Patients with CTO were likely to have comorbidities such as heart failure, arrhythmias, and complicated diabetes (Table 1). Unmatched results showed a higher incidence of PPM implantation in patients with CTO (9.2%) compared to those without CTO (7.1%) (p<0.05). Propensity score matching yielded a cohort of 6,930 patients. In the matched analysis, the incidence of PPM implantation was 9.2% in patients with CTO and 6.5% in those without CTO (p=0.06). Logistic regression analysis in the matched cohort demonstrated that CTO was associated with increased odds of PPM implantation post-TAVR (OR 1.47, 95% CI 0.99-2.18, p=0.06). In-hospital mortality and MACE did not differ significantly between the two groups.

Conclusion:
We conclude that pre-existing CTO may be associated with a higher incidence of PPM implantation after TAVR, although the difference was not statistically significant. Further research is needed to validate these findings and explore the mechanisms involved.
Abstract 4144666: Outcomes of Ventricular Tachycardia Ablation Among Patients with Chronic Kidney Disease: Insights from the National Inpatient Sample Database 2018-2021
Authors: Sheffeh Mohammad Ali , Sheffeh Judy , Baqal Omar , Waqas Shamaiza , Vuppuluri Naveen , Cieslak Robert , Zahwe Firas , Kawa Anthony , Collins-Hamel Benjamin
Published: November 2024

Background:
There is limited data on the safety and efficacy of ventricular tachycardia (VT) ablation in patients with chronic kidney disease (CKD). We examined the outcomes of patients with CKD undergoing VT ablation in a nationally representative cohort of patients.

Methods:
The National Inpatient Sample Database (NIS) was analyzed from 2018 to 2021 to identify patients ≥18 years old with VT undergoing ablation. Patients with atrial fibrillation, atrial flutter, supraventricular tachycardia, or pre-excitation syndrome were excluded. Patients were divided into those with CKD and without CKD. A multivariable logistic regression model was utilized to assess the association of CKD with in-hospital mortality and outcomes after adjusting for confounders.

Results:
Our cohort included 1608 VT ablation procedures, of which 428 (27%) were performed on CKD patients. Mean age was 63 (±13) years, 318 (19%) were female, and 1194 (74%) were White. 1475 (92%) of the procedures were done at an urban teaching hospital, and 1240 (77%) at a private non-profit hospital. On multivariable analysis, CKD was associated with significantly higher odds of death (adjusted odds ration [aOR]: 3.43; 95% confidence interval [CI]: 1.79-6.5; p=0.0002), acute decompensated heart failure (aOR: 3.1; 95% CI 2.24-4.56; p<.0001), bleeding (aOR: 1.53; 95% CI1.02-2.28; p<.03), and acute kidney injury (aOR: 4.49; 95% CI3.42-5.9; p<.0001). There was no difference in the odds of acute myocardial infarction, stroke, cardiogenic shock, vasopressor use, mechanical ventilation, and pericardial tamponade or pericardial procedures
Figure
.

Conclusion:
Patients with CKD undergoing VT ablation have an increased risk of mortality and adverse in-hospital outcomes when compared to patients without CKD. These hypothesis-generating findings need validation in future prospective studies for optimal pre-procedural risk stratification.
Abstract 4144669: Hospital-at-Home Digital Health Testing in Underserved versus the General Population
Authors: Navara Rachita , Corsi Douglas , Rathore Azeem , Ashary Mohammed Ali , Devgun Jasneet , Malcolm Katherine , Cheung Christopher , Dopierala Maria , Chen Devon , Hsieh Yi-Ting , Samikanu Luke Bharane , Ozkan Ecem , Pallod Aditi , Bolaji Olayiwola , Ouedraogo Faizal , Markson Favour , Joel Ronal , Patel Kunj
Published: November 2024

Background:
Racial and socioeconomic disparities in healthcare access are well-documented. Minority and rural populations face barriers and often have limited access to healthcare services and facilities. Digital health solutions can help bridge these gaps. Previous studies examining digital health usage patterns have reported mixed findings, with some showing lower adoption among minority/underserved groups and others finding no significant differences compared to the general population.

Hypothesis:
Minority and rural patients would participate in the digital health intervention at similar rates as non-minority, affluent patients when provided with equal access to cardiologist and device training.

Aims:
To analyze the variance in usage of digital health products between underserved and general patient populations.

Methods:
The 5,000-patient clinic serves a population of underserved minority and affluent non-minority patients. All patients were offered cellular-enabled blood pressure cuffs and weight scales that transmitted data automatically to a physician portal as part of routine care. Patients consented to have their data used for research and were instructed to use these devices > 4 times per week for six months, with periodic reminders from clinic staff. Patient participation was tracked, and digital records were analyzed.

Results:
Demographic information of enrolled patients (n=18) is reported (Figure 1). There was an overall 90% retention rate throughout the six-month study period, including 90% retention from African American patients, 87.5% from indigent patients, and 100% from both rural and inner-city residents.

Conclusion:
With a modest sample size, this data suggested that minority and rural populations may participate in digital health and remote patient monitoring interventions at the same rate as the general population of patients. This study supports the growing potential of digital health to improve healthcare access for minority and rural communities.
Abstract 4144671: Safety and Efficacy of Aortic Cross-Clamp for Thrombosed Acute Type A Aortic Dissection
Authors: Nakahara Yoshinori , Iwakura Tomohiro , Marui Akira
Published: November 2024

Introduction/Background:
Clamping the ascending aorta in acute type A aortic dissection (aTAAD) surgery is an important technique that facilitates proximal procedures such as reinforcement and root replacement during systemic cooling and reduces extracorporeal circulation time. However, in case of aTAAD with thrombosed false lumen, clamping the aorta may lead to serious thromboembolism such as ischemic stroke

Research Questions/Hypothesis:
We sought to compare the safety and the efficacy of cross-clamp of the ascending aorta with thrombosed and patent false lumen of aTAAD.

Methods/Approach:
From January 2004 to December 2023, a total of 1550 patients with aTAAD underwent emergent surgery at our institution. Among them, 1404 (91%) patients underwent aortic cross-clamp during systemic cooling. The completeness of the cross-cramp was 99.9%. They were divided into 2 groups based on the false lumen status in the ascending aorta: thrombosed (group T, n=399 [28%]) and patent (group P, n=1005 [72%]). After propensity score matching, 389 patients in each group were matched.

Results/Data:
After matching, there were no significant differences in age and male gender ratio between the groups. (Table 1A) Preoperative shock state and malperfusion were also similar. The cannulation site did not differ between the groups (Femoral artery: 79% vs. 84% for group T vs. P,
P
= 0.11; Subclavian artery: 12% vs. 8.0%,
P
= 0.12). There were no significant differences in the incidence of ischemic stroke (5.4% vs. 6.2% for group T vs. P,
P
= 0.65), 30-day mortality ( 2.1 vs. 4.1% for group T vs. P,
P
= 0.10 ), and spinal cord injury (1.3 vs. 1.0% for group T vs, P,
P
= 1.00), respectively. (Table 1 B）Logistic regression model revealed that thrombosed type dissection was not an independent risk factor for ischemic stroke (odds ratio 1.13, 95% confidence interval 0.66–1.92;
P
= 0.66).

Conclusions:
Cross-clamp of the ascending aorta in aTAAD surgery was very useful in that the proximal procedures could be performed during systemic cooling. Notably, in patients with thrombosed false lumen, the procedure could be performed safely without increasing the risk of cerebral complications.
Abstract 4144676: Leveraging AI to Identify ECG Indicators of Ventricular Dysfunction
Authors: Makimoto Hisaki , Okatani Takayuki , Suganuma Masanori , Kabutoya Tomoyuki , Kohro Takahide , Ogata Yukiyo , Harada Kenji , Bejinariu Alexandru , Rana Obaida , Makimoto Asuka , Kelm Malte , Kario Kazuomi
Published: November 2024

Introduction:
Recent studies have demonstrated that artificial intelligence can effectively identify ventricular dysfunction using electrocardiograms (ECGs). However, the specific ECG waveforms indicative of left ventricular dysfunction remain poorly understood. This study aims to identify the ECG leads and segments that most accurately signal left ventricular dysfunction.

Methods:
We utilized ECG and echocardiography datasets comprising 17,422 cases from Japan and Germany. Convolutional neural networks with ten layers were developed to detect left ventricular ejection fractions below 50%. The models were trained and validated through 4-fold cross-validation using the Japanese dataset. The performance of the models was evaluated and compared among various ECG configurations (3-second strips, single-beat, and adjacent 2-beat overlay) and ECG segments (PQRST, QRST, P, QRS, PQRS). In addition to internal validation using Japanese data not employed during training, external validation was conducted with the German dataset.

Results:
Models based on 2-beat ECGs significantly outperformed the other models. Models with single-beat ECGs showed at least equivalent to superior performance compared to the 3-second models in both internal and external validations (AUC 0.908±0.001, 0.863±0.001 vs 0.826±0.016, respectively for 2-beat, single-beat, and 3-second models, P<0.0001, external validation). Employing single-beat models, our analysis found that limb leads, particularly leads I and aVR, were more indicative of left ventricular dysfunction. Furthermore, within the single-beat ECGs, the segments from QRS to T-wave were most revealing, while the addition of P segments significantly augmented the models’ performance (
Fig.1
).

Conclusions:
This study confirms that using ECG segments from the P to the T-wave is more effective for assessing ventricular dysfunction than 3-second ECG strips, with performance further enhanced by multiple heartbeats. Notably, signals indicating ventricular dysfunction were predominantly distributed within the QRS to T-wave segments, while the P-segment also showed some significance. The concentration of dysfunction signals varied by lead, with leads I and aVR providing higher diagnostic utility. Further research is needed to identify specific ECG signals or waveforms for ECG-based diagnostics of ventricular dysfunction.
Abstract 4144695: Comparative cardiovascular efficacy of empagliflozin and dapagliflozin in patients with type 2 diabetes: A systematic review and meta-analysis
Authors: Samad Muhammad Ammar , Mahboob Eman , Ahmed Mushood , Farooqui Sabeeh , Tahir Ali Shaikh , Akhtar Shanzay , Ahmad Adeel , Rahman Asad , Jain Hritvik , Ahmed Raheel
Published: November 2024

Background:
The favorable safety profile of sodium-glucose cotransporter 2 (SGLT2) inhibitors, notably empagliflozin and dapagliflozin, make them a suitable treatment option for type 2 diabetes mellitus (T2DM). However, their comparative efficacy and cardiovascular (CV) benefits still remain unclear. This meta-analysis aims to compare the CV outcomes between Dapagliflozin and Empagliflozin in T2DM patients, exploring their varying effectiveness.

Methods:
A comprehensive search of electronic databases, PubMed, Embase, and Google Scholar was conducted from inception till May 2024. The study was conducted adhering to the PRISMA guidelines. Following a thorough screening and quality assessment, primary outcomes including major adverse cardiovascular events (MACE), cardiovascular (CV) mortality, and all-cause death along with secondary outcomes including stroke, myocardial infarction (MI), and heart failure (HF), were extracted. The random effects model was used to pool the odds ratio (OR) along with the corresponding 95% confidence intervals (CIs) for all outcomes. A p-value of less than 0.05 was considered statistically significant.

Results:
We pooled 6 studies with a total of 172,293 participants. The evaluation of pool results showed a significant association between the use of empagliflozin and dapagliflozin for reducing CV mortality (OR 1.15, 95 % CI 1.01- 1.30; p=0.04) and MACE (OR 1.15, 95 % CI 1.01- 1.30; p=0.04). However, we found no statistically significant difference between the two drugs for reducing MI (OR 1.04, 95 % CI 0.90- 1.19; p=0.59), Stroke (OR 0.92, 95 % CI 0.76- 1.11; p=0.40), HF (OR 1.30, 95 % CI 0.93- 1.81; p=0.13) and all-cause death (OR 1.33, 95 % CI 0.46- 3.88; p=0.60). After running the sensitivity analysis, a statistically significant result was observed between use of empagliflozin and dapagliflozin for HF (OR 1.47, 95 % CI 1.13- 1.90; p=0.004).

Conclusion:
The use of dapagliflozin significantly reduces CV mortality and MACE when compared with empagliflozin. However, the incidence of MI, stroke, HF, and all-cause death is comparable across the two groups. Our results should be considered hypothesis generating and evidence from large-scale multi-centric randomized controlled trials (RCTs) is required to reach a definitive conclusion
Abstract 4144701: Characterizing Pulmonary Artery Growth in Single Ventricle Patients Palliated through Fontan Procedure
Authors: Medina Cathlyn , Carmon Philip , Foote Henry , Fleming Gregory , Chamberlain Reid
Published: November 2024

Introduction:
Pulmonary artery (PA) size influences risks for complications in patients with Fontan physiology. Optimal strategies to augment PA growth over the course of single ventricle surgical palliations are not well understood.

Hypothesis:
In single ventricle surgical palliations, PA growth will be concentrated in periods of pulsatile blood flow.

Aim:
Describe PA growth through early childhood in patients with Fontan palliation.

Methods:
Retrospective, single-center study of Fontan patients between 1998-2022. Absolute PA diameters (right+left PA) and Nakata index (NI) were measured by angiogram and growth compared at three intervals: pre-Glenn, pre-Fontan, and 5yrs post-Fontan. Post-Glenn, pulsatile blood flow was defined as native antegrade flow (with or without PA band) or systemic shunt (surgical or ductal stent). Multivariable linear regression assessed predictors of PA size 5yrs post-Fontan.

Results:
In 195 patients, hypoplastic left heart syndrome was most common (60/195, 32%). Passive PA flow at Glenn occurred in 164/195(84%). Median age at Fontan was 38 (33,46) months. Absolute PA size increased during both pre-Glenn to pre-Fontan interval (p<0.001) and pre-Fontan to 5yrs post-Fontan interval (p<0.001), but relative growth by NI decreased after Glenn (p<0.001) with no further change post-Fontan (p=0.29). Overall PA and LPA growth velocity was significantly higher in pulsatile than passive Glenn patients (2.0 mm/yr [1.3, 2.7] v 0.7 mm/yr [0.1, 1.7], p=0.01 and 1.0 mm/yr [0.5, 1.5] v 0.2 mm/yr [-0.4, 0.5], p=0.009 respectively, Figure 1). In multivariable analysis, post-Fontan PA size was significantly associated with pre-Fontan size (0.3 mm/mm [0.1, 0.6], p=0.02) but not cardiac diagnosis (p=0.67), initial Stage I surgical type (p=0.10), or use of stent angioplasty (p=0.28).

Conclusions:
Through single ventricle surgical palliations, absolute PA size increases, while growth velocity remains stable after Glenn. Post-Fontan PA size is primarily driven by pre-Fontan PA size suggesting importance of efforts to improve PA growth during Glenn period. Maintaining pulsatile flow during Glenn represents a viable strategy to augment PA growth and preferentially improve left PA growth through Fontan.
Abstract 4144717: SGLT2 Inhibitors and Diabetic Retinopathy: Reducing Surgical Interventions and Vision Loss
Authors: Akbar Usman , Umer Ahmed Muaaz , Shafique Nouman , Muhibullah Fnu , Akbar Ayesha , Naveed Muhammad Abdullah , Ahmed Faizan , Khan Muhammad Aslam , Sohail Hadia , Cheshire Michael
Published: November 2024

Background:
Sodium-glucose co-transporter-2 (SGLT-2) inhibitors extend their utility beyond glycemic control in type 2 diabetes mellitus (T2DM) by demonstrating cardiovascular risk reduction, heart failure protection, and attenuation of chronic kidney disease progression. Additionally, SGLT-2 inhibitors may confer ancillary benefits in reducing the risk of diabetic retinopathy (DR). This study evaluates the impact of SGLT2 inhibitors on DR outcomes in a matched cohort of T2DM patients.

Methods:
Utilizing data from the US Collaborative Network, we assessed the effects of SGLT2 inhibitors on DR in 97,495 propensity score-matched pairs using the TriNetX analytics platform. Comparative analyses between treated and untreated cohorts were conducted, including risk differences, odds ratios (OR), risk ratios (RR), and p-values. Evaluated outcomes encompassed surgical interventions requiring laser photocoagulation, anti-VEGF injection utilization, and incidence of vision loss.

Results:
In terms of surgical interventions (retinal excision and repair, and vitreous drainage), the SGLT2 inhibitor cohort exhibited a significant risk reduction, evidenced by a risk difference of -0.000 (95% CI: -0.001 to -0.000, p=0.027), RR of 0.790 (95% CI: 0.640 to 0.974), and OR of 0.789 (95% CI: 0.640 to 0.974). No significant difference was observed for laser photocoagulation (Risk Difference: 0.000, 95% CI: -0.000 to 0.000, p=1.000). Similarly, anti-VEGF injection outcomes did not differ significantly despite a risk difference of -0.002 (95% CI: -0.003 to -0.001, p=0.002). The analysis revealed a substantial protective effect against vision loss in the SGLT2-treated patients, with a risk difference of -0.010 (95% CI: -0.012 to -0.008, p<0.000), RR of 0.793 (95% CI: 0.759 to 0.829), and OR of 0.785 (95% CI: 0.750 to 0.822).

Conclusion:
Our findings indicate that SGLT2 inhibitors significantly decrease the necessity for surgical interventions and the risk of vision loss in patients with DR. The lack of significant differences in laser photocoagulation and anti-VEGF injection outcomes suggests targeted benefits of SGLT2 inhibitors. These results underscore the potential role of SGLT2 inhibitors as a valuable component in the management strategy for diabetic retinopathy.
Abstract 4144731: Trends in Rheumatic Heart Disease Mortality in India (2010-2021) and Projections to 2030
Authors: Ramphul Kamleshun , SINGH GURJOT , Goswami Kanishka , Sekhon Manraj , Rajotia Arush , Aggarwal Shruti , Sombans Shaheen , Dhaliwal Jasninder
Published: November 2024

Introduction:
In 2021, India reported an estimated 166,017 deaths related to Rheumatic Heart Disease (RHD). Since 2010, the Indian government has implemented various initiatives to reduce this burden. The Indian Council of Medical Research (ICMR) launched the "Jai Vigyan Mission Mode Project," focusing on raising awareness, early detection, treatment, and infrastructure strengthening. The National Programme for Prevention&Control of Cancer, Diabetes, Cardiovascular Diseases&Stroke (NPCDCS) and Rashtriya Bal Swasthya Karyakram (RBSK) programs have established NCD clinics and cardiac care units, conducted health education campaigns, and trained medical staff for RHD prevention and control. Key initiatives include using RHD registers, regular penicillin prophylaxis, and promoting early diagnosis and treatment. The development of the low-cost Sree Chitra Valve has also increased treatment affordability. This study aims to evaluate the impact of these government efforts on reducing RHD-related mortality in India.

Methods:
Data from the Global Health Data Exchange (GHDx) for the 2021 Global Burden of Disease was analyzed to assess the global burden of RHD cases from India and the death rates per 100,000 population between 2010 and 2021 and predictive models adopted for estimates till 2030.

Results:
Between 2010 and 2014, the global mortality linked to RHD from India increased from 45.23% to 46.94%, then decreased gradually to 44.47% in 2021. Our predictive model estimates that India will contribute around 40.96% of global RHD deaths by 2030. Initially, the age-standardized RHD death rate per 100,000 population was lower among females than males, but it rose higher than males from 2013 onwards. A continuous reduction in the rate was observed in females from 2013 to 2021. Meanwhile, a declining trend was seen among males and combined (male + female) over the study period. By 2030, the overall death rate per 100,000 population is estimated to reach 9.23 (95% CI 7.24-11.22)(Figure 1).

Conclusion:
Our study confirms the downward trend of RHD mortality rates in India, likely linked to the multiple health initiatives. This highlights the need for sustained public health efforts to continue reducing RHD mortality.
Abstract 4144751: Relationship between abnormal conduction area detected by isochronal late activation mapping in sinus rhythm and arrhythmogenicity of atrial fibrillation
Authors: Watanabe Tomonori , Okuyama Takafumi , Watanabe Hiroaki , Kamioka Masashi , Makimoto Hisaki , Yokota Ayako , Komori Takahiro , Kabutoya Tomoyuki , Imai Yasushi , Kario Kazuomi
Published: November 2024

Background:
The arrhythmogenic substrate in atrial myocardium could contribute the trigger of atrial fibrillation (AF) except pulmonary vein (PV). This study was conducted to investigate the arrhythmogenic substrate using an isochronal late activation mapping (ILAM) related with the trigger of AF.

Methods:
Forty-five AF patients (age 65±9 years old,35 Males,17 non-paroxysmal AF,11 patients with 2
nd
-session procedure) who underwent the catheter ablation for AF were enrolled. The high-density activation mapping of left atrium (LA) was obtained by in sinus rhythm or atrial pacing with a cycle length of 600ms. ILAM was retrospectively constructed and deceleration zone was defined as abnormal conduction area with ≥3 isochrones within a 1cm radius along with a discontinuity of conduction zone. Relationship between the AF arrhythmogenicity and ILAM deceleration zone was investigated.

Results:
Patients with non-paroxysmal AF has larger number of ILAM deceleration zone in LA than those with paroxysmal AF (median [interquartile], 4.0[2.5-7.5] vs.0[0-5], p=0.028).

Of all, 15 patients had a trigger of AF except pulmonary vein (non-PV foci) in the LA (10: posterior wall, 6: anterior wall, 2: septum, 1: roof). Patients with non-PV foci had a larger number of ILAM deceleration zone in LA than those without (median [interquartile], 6.0[4.0-8.0] vs.0[0-4], p<0.001). Furthermore, 15 patients with non-PV foci had 35 deceleration zones in sinus rhythm, 26 of them were associated with non-PV foci. On the other hand, of total 87 deceleration zones in all patients, 61 deceleration zones had no contribution to the non-PV foci.

Conclusion:
ILAM deceleration zone with ≥3 isochrones within a 1cm radius along with a discontinuity of conduction zone obtained in sinus rhythm may be useful to assess the atrial myocardial arrhythmogenic substrate related with non-PV foci.
Abstract 4144765: Delayed Management in the Borderline Left Heart Provides Additional Insight Into the Left Heart Potential
Authors: York Emitt , Eckersley Luke , Haberer Kim , McBrien Angela , Hornberger Lisa
Published: November 2024

Introduction:
Prediction of successful biventricular outcome following a fetal diagnosis of borderline left heart (BLH) can be challenging. A postnatal algorithm of delaying interventional decisions to allow for optimized left heart preload and consequent growth was therefore developed. We review our experience, examining changes in left heart dimensions and clinical outcomes using this algorithm.

Methods:
We identified all fetal BLH cases encountered in our institution from 9/2008-4/2024 with neonatal management and a repeat postnatal preintervention echo available. BLH was defined as a left ventricular (LV) end diastolic dimension(LVEDd) and/or mitral valve(MV) diameter (4 chamber) z score of <-2 at last fetal echo. Pre and postnatal medical records were reviewed. Z-scores of LVEDd, MV and aortic valve(AoV) diameters and LV end diastolic volume indexed to body surface area(LVEDVi)), and left/right heart ratios were compared between initial neonatal echo and either last echo before intervention or at
<
6 weeks in those without intervention. Findings were also compared between those with vs without a successful biventricular(BiV) outcome.

Results:
Forty-eight fetuses with a BLH were included. Mean gestational age at last fetal echo was 35.2±2.4 weeks and at birth 38.3±2.0 weeks, and birth weight was 3.0±0.7Kg. Successful BiV outcome occurred in 43(90%), 35 following neonatal intervention (31 with coarctation/arch repair +/- ventricular septal defect), whereas, 5(10%) required single ventricle(SV) palliation (Norwood in 4, transplant with failed BiV repair in 1). Findings at initial (day 1) and repeat echo (BiV 13.8±12.9 and SV 6.4±5.1 days) are presented in the table. Initial MV and AoV diameters and left/right valve ratios were greater and there was a significant increase in size with time for LVEDd, MV and AoV in the BiV compared to the SV group (Table, Figure). When comparing only BiV neonates with surgical intervention who had a similar interval to 2
nd
study as SV neonates (6.7 ±3.7days), significant increase in LVEDd and MV size occurred in BiV but not SV neonates. All but 1 BiV infant (noncardiac death at 5 months), survived with mean age at last follow-up of 6.0±4.4years.

Conclusions:
Delayed decision making confers valuable data about the left heart potential in the BLH newborn. Smaller initial MV and AoV and little or no change in LVED and MV dimensions may be useful in identifying those who should undergo SV palliation.
Abstract 4144767: Long-term effect of beta-blockers after acute myocardial infarction in patients with preserved ejection fraction: A systematic review and meta-analysis
Authors: R.C. Clemente Mariana , Lopes Lucca , Bittar Vinicius , Navalha Denilsa , Almeidinha Lara , Diaz Braiana , Bortoletto Mussolini Maria Carolina , Gomez Victor , Ponte Farias Ana Gabriela , Fernandes Amanda
Published: November 2024

Background:
The efficacy of beta-blockers (BB) in patients with heart failure and reduced ejection fraction (EF) is well established. In fact, current guidelines widely recommend BB use after myocardial infarction (MI). However, the effects of long-term BB therapy in patients with acute myocardial infarction (AMI) and preserved EF remains uncertain.

Hypothesis:
The use of BB after AMI improves long-term outcomes in patients with preserved EF.

Aims:
To compare the long-term effects of BB with non-BB post AMI in patients with preserved EF.

Methods:
PubMed, Embase, and Cochrane Library were systematically searched from inception to May 2024 to identify studies comparing BB with no BB use after AMI in patients with preserved EF (>50%), with a minimum follow-up of 1 year. We pooled hazard ratios (HR) with 95% confidence intervals (CI) to preserve time-to-event data in the pooled analysis. Statistical analyses were performed using R software version 4.3.1.

Results:
We included two randomized controlled trials and eight cohorts comprising 25,357 patients, of whom 47% received BB and 52% were men. Mean age of patients ranged from 58 to 66.2 years. Follow-up ranged from 1 to 5.2 years. There were no significant differences between groups in all-cause mortality (HR 0.86; 95% CI 0.68-1.08; p=0.20; Figure 1A), myocardial infarction (HR 1.02; 95% CI 0.84-1.24; p=0.86; Figure 1B), or hospitalization for heart failure (HR 1.06; 95% CI 0.78-1.43; p=0.71; Figure 1C). However, when performed a leave-one-out sensitivity analysis in all-cause mortality we saw significant results favoring the use of BB after omitting each study.

Conclusion:
In this meta-analysis, there were no significant differences in all-cause mortality, myocardial infarction, or hospitalization for heart failure when comparing long-term use of BB with no BB use after AMI in patients with preserved EF. Further trials are needed to clarify the role of BB in this setting.
Abstract 4144779: Cardiac Tamponade And Constrictive Effusive Pericarditis Caused By Metastatic High-Grade Follicular-Derived Thyroid Carcinoma
Authors: Achuthanandan Supraja , Tamazyan Vahagn , Naeem Azka , Harutyunyan Hakob , Munoz Martinez Alejandro , Sadiq Adnan , Hollander Gerald
Published: November 2024

Case Presentation:
A 76-year-old male, non-smoker, with history of HLD and NIDDM, presented with several weeks of dyspnea and cough, unresponsive to outpatient treatments. He was normotensive and found to have new onset atrial fibrillation at a rate of 110bpm and pulsus paradoxus with a difference of 15mmHg. CT chest showed a 2.2cm thyroid nodule along with a pericardial effusion (PE), confirmed to be tamponade on TTE (Fig.1). A TTE showed resolution of tamponade after the pericardial window (Fig.2). Pericardial fluid cytology was positive for malignant cells. Patient was discharged, had an outpatient PET CT which showed uptake in the thyroid, pericardial region&right supraclavicular lymph node (LN). The patient developed symptoms of heart failure, prompting his 2nd visit to the hospital after 3 weeks. A repeat TTE showed a small PE with effusive-constrictive physiology (Fig.3). He was started on high dose steroids and diuresed as tolerated, but his symptoms did not improve. He underwent thyroid nodule and right supraclavicular LN biopsy, which revealed high grade follicular thyroid carcinoma (FTC). His course was complicated by multiorgan failure, prompting transfer to another facility for pericardiectomy; during which he was found to have extensive tumor infiltration into the myocardium; he then went into shock and passed away shortly after.

Discussion:
Effusive-constrictive pericarditis (ECP) is a rare clinical condition characterized by PE with constrictive physiology1. Hancock defined ECP as a pathophysiological form of cardiac compression due to a constricted visceral pericardium and PE, with the hallmark sign of persistently elevated right atrial pressure despite removal of pericardial fluid2. ECP can rarely be caused by malignancies, attributing 5% of cases2. FTC is a well-differentiated thyroid malignancy that typically metastasizes to distant sites such as the lungs and bones, but pericardial involvement is extremely rare. To date, there has been one reported case of PE caused by FTC, but the PE did not reaccumulate, possibly due to early recognition and radiation therapy3. To our best knowledge, this case report represents the first documented case of ECP caused by FTC. Our case demonstrates the complexity of diagnosing/managing it, which underscores the need for a multidisciplinary approach and comprehensive diagnostic evaluation in patients with PE, especially when associated with malignancies that rarely metastasize to the pericardium.