bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147568: Sociodemographic Disparities Associated with Stress, Cardiovascular Disease, and Cancer Outcomes in the
All of Us
Research Program
Authors: Cousin Lakeshia , He Ruina , Roach Keesha , Hill Mandy , Sutton Arnethea
Published: November 2024

Introduction:
Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality worldwide. Increasing evidence suggests that sociodemographic factors such as race, ethnicity, income, education, and stress levels significantly influence the prevalence and outcomes of these diseases. The
All of Us
Research Program provides a unique opportunity to explore these disparities across a diverse U.S. population. This study aims to examine how sociodemographic disparities are associated with stress, CVD, and cancer outcomes. We hypothesize that higher perceived stress levels, lower income, lower education levels, and minority race/ethnicity groups are associated with higher incidences of CVD and cancer.

Methods:
Data from 55,505
All of Us
Research program participants were analyzed. Key variables included age, race, ethnicity, education, household income, perceived stress level, and history of CVD and cancer. Descriptive statistics were used to summarize participant demographics. Multivariate logistic regression models were employed to examine the associations between sociodemographic factors and the outcomes of interest (CVD and cancer).

Results:
Older participants had a higher prevalence of both CVD (mean age: 60.8 vs. 50.5, p < 0.001) and cancer (mean age: 63.6 vs. 51.7, p < 0.001). Black/African Americans had a higher incidence of CVD (21.3% vs. 78.7%, p < 0.001), while Whites had a higher prevalence of cancer (5.3% vs. 94.7%, p < 0.001). Lower income and higher stress levels were also associated with higher CVD incidence (<$25k: 20.1% vs. 79.9%, p < 0.001; high stress: 15.0% vs. 85.0%, p < 0.001). Multivariate logistic regression showed significant predictors for CVD, including age (OR = 1.05), Black race (adjusted OR = 1.18), and high stress (adjusted OR = 1.27). For cancer, significant predictors were age (OR = 1.06), Hispanic ethnicity (OR = 0.53), and moderate stress (adjusted OR = 1.12).

Conclusion:
The study highlights significant sociodemographic disparities in the incidence of CVD and cancer. Older age, Black/African American race, lower income, and higher perceived stress levels were associated with higher odds of CVD. For cancer, older age, White race, and higher income were significant predictors. Perceived stress level plays a crucial role in mediating these associations, underscoring the need for targeted interventions to address these disparities in high-risk populations.
Abstract 4147578: Temporal Trends in Stroke-related Mortality in Canada Over the Past 30 Years
Authors: Alayyat Ahmad , Abdulelah Zaid , Abdulelah Ahmed , Rahman Mansoor , Al-Husni Dua' , damlakhy Ahmad , abdulelah Hussein , Diaz Jesus , Al Balbissi Kais
Published: November 2024

Introduction:
Stroke is among the leading global health burdens worldwide due to the resultant morbidity and mortality. Accordingly, thorough evaluation of the temporal trends in stroke-related mortality in Canada is mandatory to effectively tackle the associated global and socioeconomic burden.

Research Question:
Are there temporal trends in stroke-related mortality in Canada during the last 3 decades?

Aim:
To evaluate the temporal trends in stroke-related mortality in Canada over the past 3 decades.

Methods:
Mortality trends of stroke in Canada have been evaluated by initially retrieving data from Global Burden of Diseases 2019 database. JoinPoint Analysis software was utilized to calculate the Annual Percentage Change (APC) and the Average Annual Percentage Change (AAPC).

Results:
There was a total of 1,269,854 stroke-related death reported during the period of 1990-2019. There is an overall decline in stroke-related death, with females displaying a higher decline in mortality from 1990 to 2019 with AAPC of -1.00 (95%CI: - 1.04 to -0.96; p<0.001) than males (AAPC -0.68 95%CI: -0.73 to -0.62; p<0.001). Additionally. There is a declining mortality among all age groups, most significantly in the group of 50-74 years of age (AAPC -1.23, 95%CI: -1.31 to -1.15; p<0.001) followed by the 75 years and older age group (AAPC -1.20, 95%CI: -1.27 to -1.12; p<0.001), while the group of the 15-49 year old had the smallest decrease in mortality (AAPC - 0.97, 95%CI: -1.16 to -0.72; p<0.001).

Conclusion:
A noticeable decline in the stroke-related mortality across both genders and all age groups in Canada has been demonstrated across the past 30 years. Comparison of these trends with other international and global trends is warranted to identify the factors associated with this decline.
Abstract 4147587: Missed Opportunities To Optimize Lipid-lowering Therapy Following Revascularization In Patients With ASCVD
Authors: Ayers Hannah , Groo Vicki , Hellenbart Erika , Dwyer Kaluzna Stephanie , Alaraj Ali , Tofovic David , Duckett Melissa , DiDomenico Robert
Published: November 2024

Introduction:
Although attainment of LDL-C levels < 70 mg/dl with lipid lowering therapy (LLT) is associated with decreased rates of ASCVD events, up to 58% of patients have LDL-C > 70 mg/dL one year after coronary revascularization and <50% have their LLT intensified.

Research Questions:
Following revascularization for ASCVD, how often do clinicians have the opportunity to obtain follow-up lipid profiles and intensify LLT?

Goals:
Evaluate the number of ambulatory care (AC) visits at which follow-up lipid profiles and/or LLT intensification failed to occur (e.g., missed opportunity) following revascularization in patients with ASCVD.

Methods:
We report a retrospective cohort study evaluating lipid management following revascularization for ASCVD of the coronary, cerebral, or peripheral arteries between July 2021 – July 2022. Patients were identified from procedure lists. Exclusion criteria included baseline LDL-C < 70 mg/dl, triglycerides > 500 mg/dl, dialysis dependence, and no follow-up care within 6 months of revascularization. The number of AC visits with a provider and LLT intensification following revascularization were compared between patients with a follow-up lipid panel versus those without within 15 months post-revascularization. Logistic regression was performed to identify characteristics associated with obtaining a follow-up lipid profile.

Results:
Of the 159 patients included, 69 (43%) had a follow-up lipid panel for evaluation at an average of 162±115 days after revascularization; 35 (22% of the entire cohort) achieved an LDL <70 mg/dL. Patients with a follow-up lipid panel had significantly more AC visits and had higher rates of LLT intensification than those without follow-up lipids (Figure). Among the 90 patients without follow-up lipid profiles, there were a total of 363 missed opportunities to reassess lipids. Follow-up with either cardiology (OR 5.8 [95% CI 1.4-24.2]) or primary care (OR 4.1 [95% CI 1.8-9.3]) and diabetes (OR 2.7 [95% CI 1.2-5.9]) were positively associated with follow-up lipids; follow-up with vascular surgery (OR 0.2 [95% CI 0.0-0.9]), and heart failure (OR 0.2 [95% CI 0.1-0.8]) or CKD (OR 0.4 [95% CI 0.2-1.0]) were negatively associated with follow-up lipid panels.

Conclusion:
Post-revascularization care of high-risk ASCVD patients is suboptimal; we identified many missed opportunities to reassess lipids and intensify LLT.
Abstract 4147597: Venoarterial Extracorporeal Membrane Oxygenation With and Without Left Ventricular Unloading in Patients With Cardiac Arrest
Authors: Mohamoud Abdilahi , abdallah nadhem , Ismayl Mahmoud , Wardhere Abdirahman , Goldsweig Andrew
Published: November 2024

Background:
Extracorporeal cardiopulmonary resuscitation (ECPR) using venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a promising strategy for refractory cardiac arrest. However, the role of left ventricular (LV) unloading during ECPR remains uncertain.

Methods:
We queried the United States National Inpatient Sample (2016-2021) to identify adult patients with out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) who received ECPR. Patients were stratified based on the use of either VA-ECMO only or VA-ECMO with intra-aortic balloon pump (IABP) or VA-ECMO with Impella (ECPELLA) for ventricular unloading. Multivariable logistic regression was used to compare in-hospital outcomes between the groups.

Results:
Among 6,915 patients receiving ECPR, VA-ECMO alone was used in 5,145 (74.4%), VA-ECMO-IABP in 809 (11.7%), and ECPELLA in 961 (13.9%). The LV unloading groups more frequently presented with ventricular tachycardia/fibrillation (61.1% and 72.4% vs. 43.9%, both p<0.01), while the VA-ECMO only group more often presented with pulseless electrical activity/asystole (56.1% vs. 38.9% and 27.6%, both p<0.01). In IHCA patients, ECPELLA was associated with 50% lower odds of in-hospital mortality compared to VA-ECMO alone (adjusted odds ratio [aOR] 0.50, 95% CI 0.31-0.81, p<0.01). No significant difference was found in OHCA patients. VA-ECMO-IABP was not associated with a mortality benefit vs. VA-ECMO alone in either OHCA or IHCA (Figure 1). Cardiovascular complications were significantly higher in both LV unloading groups compared to the VA-ECMO only group in OHCA subgroup (90% and 95% vs. 73.3%, both p<0.01) while IHCA subgroup only showed higher significant rates in ECPELLA compared to VA-ECMO alone (89.3% vs. 81%, p=0.04) (Figure 2). After adjustment for potential confounders, VA-ECMO-IABP (aOR 2.79, 95% CI 1.02-7.60, p=0.04) and ECPELLA (aOR 6.92, 95% CI 2.09-22.94, p<0.01) were associated with significantly higher odds of cardiovascular complications compared to VA-ECMO alone among OHCA patients, but not among IHCA patient. There were no statistically significant differences in neurologic, renal, and hematologic complications between the three groups in either OHCA or IHCA patients (Figure 3).

Conclusion:
In this nationwide study, LV unloading with ECPELLA was associated with improved survival in IHCA patients but not in OHCA patients compared to VA-ECMO alone. The addition of IABP to VA-ECMO was not associated with a mortality benefit.
Abstract 4147673: Outcome of Impella vs. Other Temporary Mechanical Circulatory Support Devices in Acute Myocardial Infarction Patients with Cardiogenic Shock: A Bayesian Network Meta-Analysis
Authors: Oli Prakash , Shrestha Dhan , Lamichhane Sandesh , Subedi Subash , Shrestha Swikriti , Kansakar Sajog , Shtembari Jurgen , Dawadi Sagun , Katz Daniel
Published: November 2024

Background:
Cardiogenic shock (CS) affects up to 10% of hospitalized patients with acute myocardial infarction (AMI), leading to over 30% mortality despite treatment. In patients with AMI-CS refractory to vasopressors and inotropes, temporary mechanical circulatory support (MCS) devices have been used to provide hemodynamic support. Recently, Impella demonstrated significant mortality benefit in AMI-CS in the DanGer shock trial. However, it has not demonstrated such benefit over other devices, such as IABP and ECMO in other trials (ISAR-Shock, IMPRESS in Severe Shock, IMPELLA-STIC). Here we performed this network meta-analysis of all available studies including the DanGer shock trial comparing Impella with other MCS devices in AMI-CS patients.

Method:
We performed a Bayesian network meta-analysis to synthesize direct and indirect evidence from relevant studies published until April 2024 using PubMed, Embase, and Scopus databases comparing Impella with other strategies for treating AMI-CS patients. The primary outcome was a short-term mortality defined as in-hospital or 30-day mortality. This study is registered with PROSPERO, and data analysis was performed using the “BUGSnet” package in R.

Result:
Out of 7,211 studies, 17 were deemed eligible. These included five RCTs and 12 observational studies, encompassing 16,654 patients with AMI-CS assigned to 3 different MSC interventions: Impella, IABP, and ECMO in 9 different combinations or alone. Based on SUCRA value, IABP was the most effective strategy in regard to short-term mortality (73.46), long-term mortality (75.59), major bleeding (66.4), renal replacement therapy (73.02); Impella along with IABP for stroke (95.24), ischemic stroke (99.68), device-related bleeding (90.22), MI (94.38); ECMO for hemolysis (91.66); standard of care for peripheral ischemic complications (88.66), sepsis (78.71). In sub-analysis using the RCTs only, Impella was ranked best for short-term mortality (74.53).

Conclusion:
Based on the findings of this network meta-analysis, IABP could potentially provide both short-term and long-term mortality benefits, as well as reduce the risk of bleeding. Meanwhile, combining it with Impella could potentially reduce the risk of cerebral ischemia.
Abstract 4147680: Epidemiology of Disease State Transitions Among Patients with New-Onset Heart Failure with Preserved Ejection Fraction
Authors: Keshvani Neil , Rabiei Shireen , Tao Kayla , Shimoni Or , Pandey Ambarish
Published: November 2024

Introduction:
The presentation of new-onset HFpEF varies among older adults, from progressive exercise intolerance in outpatients to acute HF hospitalization (HFH). The natural history of HFpEF based on its clinical presentation at the time of diagnosis (outpatient vs. HFH) is not well-characterized.

Methods:
Patients with new-onset HFpEF were identified in the Optum database from 2016-2022. Patients were grouped into 4 strata based on their clinical presentation at time of diagnosis (outpatient vs. HFH) and subsequent transition in disease state (subsequent HFH, yes vs. no). The predictors of progression in disease state (outpatient to first HFH to repeat HFH) and risk of mortality associated with each disease state transition were assessed using adjusted Cox models.

Results:
99,370 patients (age 73.5y, 11.2% Black) were included, of which 38.6% were outpatient-diagnosed and 41.4% following an HFH. Patients with HFH-based HFpEF diagnosis (vs. outpatient) were younger, had lower burden of comorbidities, and had earlier follow-up with PCP or HF cardiologist following diagnosis (12 [IQR 4-59] vs.15 [4-72] days; p <0.001). 42.6% of outpatient-diagnosed HFpEF progressed to a subsequent HFH event, while 55.3% with HFH-based HFpEF diagnosis had a subsequent HFH (median time to event: 363 days[IQR 106-790] vs. 162 [IQR 34-505]days, p<0.001). In adjusted analyses, patients with outpatient diagnosis without subsequent HFH had the highest 12-month survival (88%), followed by inpatient-diagnosed patients with HFH (82%). Patients with HFH-based HFpEF diagnosis without subsequent HFH had the lowest 12-month survival (74%,
Table
). Significant predictors of HFH in the outpatient-diagnosed group included older age, worse kidney disease, and prior right heart cath. Significant predictors of rehospitalization included older age, higher blood pressure, obesity, worse kidney disease, and prior PCI (
Table
).

Conclusion:
1/3
rd
of patients with HFpEF are outpatient-diagnosed, of which 42% progress to have an HFH within 1 year of diagnosis. Progressive disease state transitions from an outpatient setting to HFH is more common among older patients with a higher burden of comorbidities and is associated with a higher risk of mortality.
Abstract 4147683: The Impact of Midodrine on Heart Failure Outcomes: Emergency Visits, Mortality, and Complications
Authors: Akbar Usman , Umer Ahmed Muaaz , Muhibullah Fnu , Rehman Mohammad , Akbar Ayesha , Rehman Urooj , Lohana Abhi , Kumar Besham , Sajjad Ribal , Cheshire Michael
Published: November 2024

Background:
Midodrine, an FDA-approved peripheral alpha1-adrenergic agonist for treating orthostatic hypotension, is also used off-label to manage hypotension in patients with advanced heart failure (HF). Hypotension, whether due to HF itself or as a side effect of its treatment, often restricts the optimization of medical therapy in these patients. By increasing baseline blood pressure, midodrine can enhance the tolerance of HF medications, potentially improving patient outcomes. The use of midodrine is limited due to the risk of supine hypertension, making it crucial to investigate its effects in this patient population.

Methods:
This study utilized data from the US Collaborative Network, focusing on heart failure patients with a Left Ventricular Ejection Fraction (LVEF) of less than 50%. It compared outcomes between patients treated with midodrine (22,178 patients) and those not treated (376,686 patients). After Propensity Score Matching (PSM), each group consisted of 21,893 matched patients. The outcomes measured included emergency department visits, mortality, shock, and CHF exacerbation, aiming to assess the impact of midodrine on these aspects of heart failure management.

Results:
Midodrine treatment was associated with significant improvements in key outcomes for heart failure patients: it reduced emergency department visits (OR: 0.68, 95% CI: 0.57-0.81, p<0.001), lowered mortality rates (OR: 0.75, 95% CI: 0.65-0.87, p<0.001), decreased occurrences of shock (OR: 0.59, 95% CI: 0.46-0.76, p<0.001), and mitigated CHF exacerbation (OR: 0.82, 95% CI: 0.74-0.91, p<0.001), underscoring the potential benefits of midodrine in managing heart failure.

Conclusion:
The study demonstrates that midodrine treatment in heart failure patients significantly reduces emergency department visits, mortality, shock, and CHF exacerbation, highlighting its potential as a beneficial off-label option. These findings suggest an important role for midodrine in enhancing the management and outcomes of patients with advanced heart failure.
Abstract 4147691: Sex-specific Thresholds for Energy Loss Index to Predict Survival in Paradoxical Low Flow Low Gradient Severe Aortic Stenosis
Authors: Dahan Shani , Bach Rasmus , Namasivayam Mayooran , Tran Nathanael , Levine Robert , Hung Judy , Dal-Bianco Jacob
Published: November 2024

Background:
The prognosis of patients with paradoxical low flow, low gradient, severe aortic stenosis (LFLGAS) is variable, necessitating improved risk stratification. Although this entity is more common in women, the impact of sex on outcomes remains unclear. Energy loss index (ELI), which accounts for aortic root size in estimating the severity of aortic valve stenosis, may enhance risk prediction in LFLGAS. This study aims to investigate sex-based ELI prognostic value in patients with paradoxical LFLGAS.

Methods:
This study analyzed clinical, echocardiographic, and outcome data collected in 294 patients with paradoxical LFLGAS, with AVA<1 cm
2
, mean transaortic gradient<40mmHg, preserved left ventricular ejection fraction (LVEF>50%) and low flow state, defined as transvalvular flow rate (Q)<210 ml/sec. ELI was calculated using the formula ELI= [AVA x Aa / (Aa - AVA)] / BSA, where Aa is the cross-sectional area of the aorta at the level of the ascending aorta and BSA is the body surface area. Spline curve graphs and maximally selected rank statistics (maxstat package in R) were used to determine optimal sex-specific thresholds.

Results:
Optimal ELI thresholds were identified for men (0.43 cm
2
/m
2
, n=102) and women (0.39 cm
2
/m
2
, n=192). After adjusting for clinically relevant risk factors (age, LVEF, diabetes mellitus, hypertension), a lower ELI was independently associated with an increased composite outcome of mortality and need for aortic valve replacement for both women [HR 2.88 (95% CI 1.85-4.54), p<0.001] and men [HR 2.63 (95% CI 1.61-4.35), p<0.001], whereas the more commonly used threshold for ELI (0.6 cm
2
/m
2
) was not predictive.

Conclusion:
In the challenging landscape of paradoxical low flow, low gradient, severe aortic stenosis, our results suggest that using sex-specific energy loss index thresholds is a promising strategy for risk stratification, and better than the more commonly used threshold.
Abstract 4147702: Identifying Sex-Specific Risk Profiles in Patients with Non-ischemic Cardiomyopathy: A Cardiac MRI Study
Authors: Rizkallah Diane , Korkerdsup Theerawat , Ammoury Carl , Bodi Kashyap , Wu Yanjun , Wang Tom Kai Ming , Calcagno Tess , Tang Wai Hong , Chen David , Nguyen Christopher , Wang Xiaofeng , Kwon Deborah
Published: November 2024

Introduction:
Sex-based differences in cardiac remodeling have been identified in patients with non-ischemic cardiomyopathy (NICM). There is conflicting data regarding sex differences in outcomes in these patients, which may be related to heterogenous risk profiles. We sought to assess sex specific modulators of risk, based on assessment with cardiac magnetic resonance (CMR) imaging.

Methods:
We conducted a retrospective analysis of patients with NICM who underwent cardiac MRI between 2001 and 2017. The primary endpoint was a composite outcome of death, heart transplant, heart failure admission and LVAD. The study cohort was divided into male and female subgroups, and univariate cox regression was performed to evaluate differential risk factor profiles.

Results:
We evaluated 634 patients: 255 females (40.3%) and 377 males (59.7%), see fig 1(A) for baseline demographic characteristics and CMR parameters. On Kaplan-Meier analysis, outcomes were similar in males and females (p=0.662). On Cox regression, hypertension (HR: 1.91 [CI 1.22-3.0];
p=0.005
), diabetes (HR: 3.17 [CI 1.94-5.18];
p<0.001
) and LGE (HR: 1.11 [CI 1.01-1.21];
p=0.030
) were associated with adverse outcomes in females only. While LA ejection fraction (LAEF) (HR 0.87 [CI 0.82 - 0.93];
p<0.001
) and eGFR (HR 0.88 [CI 0.80-0.95];
p=0.002
) were associated with adverse outcomes in males only, see fig 2, left atrial volume index (LAVi) and LA reservoir strain were associated with the composite outcome in both males and females.

Conclusion:
Despite similar outcomes in men and women with NICM, we found significant differences in the modulators of risk and cardiac structure and function based on sex. Notably, LGE and diabetes were unique predictors of risk in females, despite similar prevalence. On the other hand, LAEF and renal function were uniquely predictive of adverse outcomes in males. Further work is needed to elucidate sex specific biologic mechanisms of risk to better characterize sex specific phenotypes.
Abstract 4147746: External Validation of Supraventricular Tachycardia and Accelerated Junctional Rhythm Risk Prediction Models in Pediatric Congenital Heart Surgery
Authors: Giorgio Thomas , Feins Eric , Kheir John , Gauvreau Kimberlee , Dionne Audrey
Published: November 2024

Background:
Tachyarrhythmias are a complication of congenital heart disease (CHD) surgery associated with significant morbidity and mortality. Risk scores to predict supraventricular tachycardia (SVT) and accelerated junctional rhythm/junctional ectopic tachycardia (AJR/JET) were previously published, but their performance not evaluated.

Objective:
To validate risk prediction scores for post-operative SVT and AJR/JET in an external cohort.

Methods:
Prospective cohort of children 0-18 years undergoing surgery for CHD from 2020-2023. In-hospital telemetry and 12-lead ECGs were reviewed daily for the presence of arrhythmia. C-statistic and Hosmer-Lemeshow tests were used to quantify discrimination and calibration of the model.

Results:
From 1190 surgeries in 1109 patients (54% male, age 1.71 [IQR 0.3, 6.5] years), SVT occurred in 124 (10%) and AJR/JET in 68 (6%). The observed risk of arrhythmia was significantly higher in the prospective validation cohort than the retrospective cohort. Patients in the prospective cohort were older, more likely to have heterotaxy syndrome and with longer and more complex surgeries than the retrospective cohorts. The model accurately predicted the risk of SVT with a C-statistics of 0.76 [95% CI 0.72, 0.80] and AJR/JET with a C-statistics of 0.63 [95% CI 0.55, 0.70] for AJR/JET. However, the model was not well calibrated with Hosmer-Lemeshow p-value <0.001.

Conclusion:
Risk prediction scores for post-operative arrhythmia created on retrospective cohort did not perform well in a prospective validation study. Arrhythmia outcomes were significantly higher with prospective review of telemetry than reported with diagnostic and complication codes in a retrospective cohort.
Abstract 4147765: A Refractory Case of Prinzmetal’s Angina Treated with VATS Sympathectomy
Authors: Qureshi Natasha , Vashistha Kirtivardhan , Ali Syed , Omar Ali , Kanei Yumiko
Published: November 2024

Case Description:
A 74-year-old male with hypertension, hyperlipidemia, coronary artery disease status post PCI, paroxysmal atrial fibrillation, and coronary vasospasm presented with recurrent episodes of chest pain at rest described as substernal, pressure like, 10/10 lasting for a few minutes. The patient was hemodynamically stable upon presentation but had an event of pulseless ventricular tachycardia (VT) requiring shock x 2 (Image 1). The patient was stabilized, and an emergent left heart catheterization showed stable obstructive CAD with diffuse coronary vasospasm responsive to intracoronary nitrates (Image 2). The patient was transferred to the intensive care unit for further management. He had multiple prior presentations for chest pain, with one complicated by a transient hemodynamically unstable high grade AV block (Image 1). Prior work up was also consistent with coronary vasospasm despite being optimally managed on nitrates and calcium channel blockers. Despite medical management the patient had a refractory course with recurrent symptoms.

Clinical Decision Making:
As it was believed that symptoms were likely driven by high sympathetic tone, the patient was intubated and sedated for sympathetic drive suppression. After a multidisciplinary meeting with cardiothoracic surgery and electrophysiology, a decision was made to go for video assisted thoracoscopic surgery (VATS) which was performed successfully. The patient was extubated, had no recurrence of symptoms after, and was offered an implantable-cardioverter defibrillator at discharge for secondary prevention.

Discussion:
Coronary vasospasm can be life threatening due to transient and acute ischemia driven myocardial injury or arrhythmias. This case highlights the role of VATS sympathectomy in managing severe cases of vasospastic angina that are unresponsive to conventional treatments. Further studies are required to establish the efficacy and safety of this procedure in broader patient populations.
Abstract 4147767: Advanced Machine Learning Models for Classifying Transthyretin Amyloidosis in Clinical Settings
Authors: Verma Anurag , Hsu Po Ya , Kripke Colleen , HOWARD WILLIAM , Sirugo Giorgio , Myes Kelly
Published: November 2024

Introduction:
Early and accurate classification of transthyretin amyloidosis (ATTR) is crucial for improving patient outcomes. However, nonspecific symptoms and heterogeneous disease variations have made ATTR diagnosis challenging. Leveraging advancements in machine learning (ML) and large language models (LLMs), this study aims to enhance diagnostic accuracy by analyzing electronic health records (EHRs) data.

Hypothesis:
Can the integration of innovative feature formulation and large language models improve the performance of ML models in diagnosing ATTR using EHR data?

Goals/Aims:
Our primary goal was to develop a robust ML model that classifies the presence of ATTR in patients with high precision for clinical implementation. We aimed to utilize advanced feature formulation techniques and LLMs to capture complex patterns in patients’ EHR data.

Methods:
A cohort of 1,158,426 patients from University of Pennsylvania Health System was retrospectively analyzed, of whom 261 ATTR patients and 52,200 patients sharing at least one comorbidity were selected for ML model training. Appropriate data engineering was conducted to handle missing values and feature construction. We innovated EHR feature formulation, which incorporated clinical, demographic, and patient history data. Moreover, we integrated an LLM to extract meaningful patterns and context from unstructured data. Various ML algorithms were evaluated, with hyperparameter tuning performed to optimize model performance.

Results:
The developed model demonstrated a performance of F1 score 0.6, along with a precision of 74% and sensitivity 51% and an area under the precision-recall curve (AUPRC) of 0.5. These results highlight the model's potential in reliably classifying ATTR. The next step involves the clinical evaluation of patients, including recalling patients for technetium scan and ATTR genetic testing to confirm the diagnosis.

Conclusion(s):
Our study demonstrates that the integration of innovative feature formulation and large language models can substantially enhance the performance of machine learning models in predicting ATTR. This approach not only enhances diagnosis rate but also provides a scalable solution for clinical implementation. Further investigation by clinicians will validate the model's effectiveness in a real-world setting, potentially transforming ATTR diagnosis and patient management.
Abstract 4147768: Demographic Variations in Ischemic heart disease-related Mortality of Breast Cancer
Authors: Maharjan Nikky , Karki Bibek , Belbase Samjhana , Lamichhane Bikal , Brar Ajit
Published: November 2024

Methods:
Data were collected using Surveillance, Epidemiology, and End Results, SEERS at 8.4.2 database using Incidence-Based Mortality. The analysis included 17 SEER Registries and data from 2000 to 2020. Selection criteria included malignant breast cancer cases with known ages. Age-adjusted rates were displaced as cases per 100,000, standardized to the 2000 US Standard Population and confidence intervals (95% using Tiwari modification), and standard errors were calculated.

Results:
Our study included a total of 25,027 breast cancer cases related to ischemic heart disease. The ischemic heart disease-related incidence-based mortality for breast cancer was 1.4 per 100,000 populations. When stratified by gender, the rate was significantly lower among males (0.1) compared to females (2.3). Ischemic heart disease related death also exhibited racial disparities, higher in Black individuals (1.7), compared to White (1.5), American Indian/Alaska Native individuals (0.7) and Asian or Pacific Islanders (0.7). Temporal trends, spanning from 2000 to 2019 in five-year intervals, revealed a consistent decline in ischemic heart disease-related mortality rates, with rates dropping from 0.7 in 2000-2004 to 0.1 in 2015-2019. Incidence-based mortality, ischemic heart disease-related mortality rates were influenced by household income, with rates decreasing as income levels rose. The rates were highest for those with incomes below $35,000 (1.7) and lowest for those earning above $75,000 (1.3).

Discussion:
The findings of our study shed light on the socioeconomic factors associated with ischemic heart disease-related mortality of breast cancer. The observed variations in incidence-based mortality rates among genders and racial groups emphasize the complex interplay of biological and sociodemographic factors. Temporal trends reveal declining mortality rates signify potential improvements in healthcare interventions and early detection. The association between higher household income and lower mortality rates suggests a socio-economic dimension in breast cancer outcomes. Notably, the lower ischemic heart disease-related mortality rates in breast cancer underscore the importance of understanding and addressing treatment-related cardiovascular risks. These insights underscore the need for integrated healthcare strategies that consider both breast cancer and cardiovascular health, aiming to provide comprehensive care for affected individuals.
Abstract 4147770: TAVR versus SAVR for Severe Aortic Stenosis in the Low and Intermediate Surgical Risk Population: A Meta-Analysis of Randomized Controlled Trials
Authors: Murali Krishna Mrinal , Joseph Meghna , Ezenna Chidubem , Pereira Vinicius , Goldsweig Andrew
Published: November 2024

Background:
Randomized control trials (RCTs) have compared transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis (AS) at low-intermediate surgical risk.

Objective:
To compare TAVR vs. SAVR for AS in low-intermediate surgical risk patients.

Methods:
We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing TAVR with SAVR for AS in low-intermediate surgical risk. Outcomes included composite death or stroke, death, stroke, myocardial infarction (MI), cardiac death, new atrial fibrillation (AF), new pacemaker implantation, acute kidney injury (AKI), bleeding, major vascular complications, endocarditis, aortic valve reintervention, and rehospitalization at 1 year. Random effects models were used to generate risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I
2
statistics.

Results:
The systematic review identified 8 RCTs including 9,239 patients (TAVR n=4,695, 50.8%). Death or stroke (RR 0.78; 95%CI 0.62-0.98; p=0.033; I
2
=52%), cardiac death (RR 0.79; 95%CI 0.63-0.98; p=0.029; I
2
=1%), bleeding (RR 0.39; 95%CI 0.25-0.60; p<0.001; I
2
=94%), new AF (RR 0.28; 95%CI 0.20-0.40; p<0.001; I
2
=83%), and AKI (RR 0.50; 95%CI 0.35-0.70; p<0.001; I
2
=0%) were lower with TAVR. New pacemaker implantation (RR 2.25; 95%CI 1.50-3.39; p<0.001; I
2
=86%) and aortic valve reintervention (RR 1.95; 95%CI 1.19-3.20; p=0.008; I
2
=0%) were higher with TAVR. Death, stroke, MI, major vascular complications, endocarditis, and rehospitalization were comparable.

Conclusion:
In low-intermediate surgical risk patients, TAVR carries a lower risk of major adverse outcomes than SAVR.
Abstract 4147797: Clinical Correlations with Longitudinal Echocardiography and Global Longitudinal Strain in the First and Second Genetically Modified Porcine to Human Cardiac Xenotransplantation
Authors: Leventhal Sarah , Mohiuddin Muhammad , Ananthram Manjula , Tully Andrew , Galindo Javier , Dickfeld Timm , Grazioli Alison , Lankford Allison , Hicks Albert , Barr Brian , Gupta Anuj , Feller Erika , Griffith Bartley , Hong-Zohlman Susie
Published: November 2024

Background:
Our institution performed the first and second genetically modified porcine cardiac xenotransplantation in a human in the world. Our laboratory performed serial and longitudinal transthoracic echocardiograms (TTE) with global longitudinal strain (GLS) for both patients for clinical surveillance and to identify any evidence of xenograft failure. For both recipients, marked myocardial hypertrophy with worsening GLS were noted at the time of graft failure.

Study Aim:
The aim of this study is to identify noninvasive measurements which may help predict early graft failure and mortality in cardiac xenotransplantation. We hypothesize that a ratio of papillary muscle measurement (PPM) to end diastolic diameter (EDD) measured on TTE with GLS may predict xenotransplant graft failure and mortality.

Methods:
Echocardiographic measurements were made in both xenotransplanted patients, which included PPM, EDD, and GLS. Serial echocardiographic measurements and ratios were subsequently compared to endomyocardial biopsies (EMBx) and clinical correlation, including terminal graft failure and death.

Results:
From post-operative day (POD) 1 of xenotransplant to end-of-life for both recipients, PPM thickness increased by 84.5% (CI 78.8-95.2%) while EDD decreased by 40.2% (CI 20.3-64.1%). For the first recipient, PPM/EDD progressively increased from 0.23 (POD 1) to 0.57 (POD 58), when the xenotransplant terminally failed from a restrictive myopathy (LVEF 55%, GLS -7.7) confirmed by EMBx. For the second recipient, PPM/EDD progressively increased from 0.26 (POD 1) to 1.00 (POD 40) (Figure 1), when the graft terminally failed due to combined systolic and diastolic dysfunction (LVEF 25%, GLS -7.6), also confirmed by EMBx. For both xenografts, the global longitudinal strain (GLS) worsened (more positive) by an average of 42.3% (CI 42.2 - 42.4%) when the PPM/EDD ratio reached between 0.5 and 0.6.

Conclusion:
Increased ratio of PPM to EDD is associated with worsening GLS, cardiac xenotransplant graft failure, and recipient mortality. TTE with GLS provided real-time clinical and noninvasive histological correlation in the first and second transgenic cardiac xenotransplants. Given the interest in cardiac xenotransplantation, serial noninvasive measurements identifying early graft failure will be important for future monitoring and management.
Abstract 4147863: Temporal Trends and Regional Disparities in Ischemic Heart Disease Mortality Across the Americas: A Two-Decade Analysis from the PAHO Database
Authors: Khalid Noman , Haider Safee Ullah , Abdullah Muhammad , Asghar Saad , Awais Abeer Bin , Muhammad Ameer , Hassan Muhammad , Afzal Muhammad Adil , Shamoon Yezin , Michael Patrick , Vasudev Rahul , shamoon fayez
Published: November 2024

Background:
Ischemic heart disease (IHD) affects over 120 million people and is the leading cause of death globally. Our study aims to assess the trends in IHD-related mortality in the regions of the Americas.

Research Questions/Hypothesis:
Has IHD-related mortality decreased from 2000 to 2019 in all regions of the Americas?

Aims:
Analyze differences in IHD-related mortality in different regions of the Americas.

Methods:
We analyzed the Pan American Health Organization (PAHO) database for IHD-related mortality rates in 2000, 2010, and 2019. The age-standardized mortality rates per 100,000 population were extracted, and trends were analyzed by gender and region.

Results:
The IHD-related mortality was consistently higher in males as compared to females in the last 2 decades. The mortality rate decreased in males in all regions from 2000 to 2019 apart from the Mexico, Central America and Latin Caribbean region where it increased from 115.12 in 2000 to 119.50 in 2019.The greatest decrease in IHD-related mortality in males was seen in the North America region from 164.49 in 2000 to 93.73 in 2019. This opposite trend was seen in females where mortality decreased in all regions from 2000 to 2019.

Conclusion:
The sociodemographic and temporal trends highlighted by this study need to be further investigated, and targeted policy measures are required to reduce the disparities in IHD-related mortality.
Abstract 4147872: Self-Expanding versus Balloon-Expandable Transcatheter Aortic Valve Implantation in Patients With Small Aortic Annulus: An Updated Systematic Review And Meta-Analysis
Authors: Mariz Ferreira Passos Bárbara , Curi David , Capuchinho Scalioni Galvao Lorhayne Kerley , Costa Esteves Almuinha Salles Joao Pedro , Zamora Fernanda , Filippini Filippe , Pimenta Nicole , Felix de Farias Santos Ana Clara
Published: November 2024

Introduction:
Both self-expanding (SEV) and balloon-expandable (BEV) valves are used in transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) and small aortic annulus (SAA). This updated meta-analysis compares the efficacy and safety of SEV versus BEV in TAVI for these patients.

Hypothesis:
This study investigates whether SEV valves are hemodynamically and clinically superior to BEV valves in patients with small aortic annulus.

Methods:
PubMed, SCOPUS, and Cochrane Central databases were systematically searched for randomized and observational studies comparing SEV and BEV in TAVI for SAA patients. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model for clinical outcomes (all-cause mortality, stroke, permanent pacemaker implantation [PPI]) and hemodynamic parameters (mean gradient [MG], indexed effective orifice area [iEOA], moderate to severe prosthesis-patient mismatch [PPM], and paravalvular leak [PVL]).

Results:
A total of 21 studies involving 6,515 patients (58.4% treated with SEV) were included. SEV valves were associated with lower all-cause mortality (OR 0.75; 95% CI 0.60-0.95; p=0.014), lower MG (OR -4.44; 95% CI -5.48-3.39; p<0.01), higher iEOA (OR 0.23; 95% CI 0.13-0.23; p<0.01), and less moderate to severe PPM (OR 0.31; 95% CI 0.22-0.45; p<0.001). However, SEV valves had higher rates of PPI (OR 1.35; 95% CI 1.01-1.80; p=0.042) and PVL (OR 2.69; 95% CI 1.58-4.57; p<0.001). Stroke rates were not significantly different between the groups.

Conclusion:
In patients with severe AS and SAA, TAVI with SEV valves showed better outcomes in all-cause mortality, MG, iEOA, and moderate to severe PPM. However, BEV valves had advantages in lower PPI and PVL rates. These findings should be interpreted cautiously due to the predominance of observational studies and varying valve types and generations used.
Abstract 4147885: Aortic Growth Mapping to Examine Genotype-Phenotype Correlations in Heritable Thoracic Aortic Disease and Variants of Unknown Significance
Authors: Campello Carlos Alberto , Ramesh Vedika , Marway Prabhvir , Hofmann Bowman Marion , Aatre Rajani , Burris Nicholas
Published: November 2024

Introduction:
Methods to define genotype-phenotype correlations are needed to advance precision medicine in heritable thoracic aortic disease (HTAD), particularly for variants of unknown significance (VUS), where evidence is sparse. Vascular deformation mapping (VDM) - an image analysis tool - provides accurate, three-dimensional (3D) aortic growth mapping, to better define disease severity and phenotypes.

Research Question:
Does the extent of 3D aortic growth mapping vary among patients evaluated for HTAD according to their genetic test results?

Methods:
We included adults undergoing genetic testing for HTAD with at least 2 CT angiograms spanning ≥2 year interval. VDM quantified the 3D thoracic aortic growth over the longest interval.

Results:
We analyzed 122 patients (imaging follow-up 5.0 years ± 3.2), a median age of 62.5 years (range: 26-87), 33.6% females, 50% with a history of aneurysm and/or dissection in first-degree relatives, 32% with prior ascending aortic replacement (AAR). Genetic testing results were pathogenic/likely pathogenic (P/LP) in 17%, negative or benign/likely benign (B/LB) in 59%, and VUS in 46%. Among those with negative genetic testing, 80% had no growth by VDM. Among P/LP patients, 65% had at least one affected segment (6% showing growth without AAR; 24% with prior AAR; 35% with growth beyond AAR). Among VUS patients, 44% exhibited no aortic growth and 56% demonstrated aortic growth by VDM (30% with growth and native aorta; 26% with growth beyond the prior AAR). During follow-up, 10 VUS mutations were re-classified as B/LB or P/LP and VDM growth severity assessments were concordant with the re-classified category in 6 (60%). Among those with growth of the native aorta distal to AAR, 50% showed growth at non-dilated (<30 mm) diameters.

Conclusion:
HTAD presents with variable aortic enlargement patterns that are effectively characterized by VDM, providing an avenue for patient-specific risk assessment and decision-making, especially for VUS cases.
Abstract 4147910: 22q11 Deletion Syndrome: A Potenitial Risk Factor For Left Pulmonary Artery Hypoplasia and Need For Intervention in Patients With Congeital Heart Disease
Authors: Oliver Shannon , Ward Cameron
Published: November 2024

Background:
Individuals with 22q11 deletion syndrome have a mutation in the TBX1 gene which is associated with the formation of cardiac outflow tracts. Animal studies have shown that mice with TBX1 gene mutations have smaller left pulmonary arteries compared to wild type mice, defined by a reduced left pulmonary artery (LPA) to right pulmonary artery (RPA) ratio. A single study has shown this translates to humans with 22q11 and structurally normal hearts. We sought to determine if this is also true for patients with congenital heart disease and whether this finding has clinically significant links with reference to the need for increased intervention upon the LPA.

Method:
We performed a retrospective analysis of patients at our centre who underwent surgical repair of Tetralogy of Fallot, Truncus Arteriosus or Interrupted Aortic Arch between 2007 and 2022, with follow up to 2023. 134 patients were identified and were divided into two groups, those with 22q11 deletion syndrome (19 patients) and the control group (115 patients). The LPA to RPA ratio on initial and most recent echocardiogram, intervention on the LPA at initial surgery and subsequent reintervention on the LPA were compared between the two groups.

Results:
The 22q11 deletion and control group had a similar mean age at time of study 6.9±3.4 versus 5.9±3.8 years. Tetralogy of Fallot was overrepresented in the control group compared to the 22q11 deletion group (87.8% versus 42.1%). Patients with 22q11 deletion had a reduced LPA to RPA ratio compared to the control group on both the initial (0.84±0.17 versus 1.03±0.18; p<0.001) and most recent (0.76±0.17 versus 1.03±0.27, p=0.002) echocardiogram. Patients with 22q11 were more likely to have intervention on the LPA in their initial surgery compared to the control group (36% versus 8.7%, p = 0.003). There was no statistical differences between rates of LPA reintervention between the 22q11 deletion group and the control group (26% versus 10.7%; p=0.070).

Conclusion:
Patients with 22q11 deletion syndrome are more likely to have reduced LPA to RPA ratio and need intervention on the LPA at the initial surgery, despite Tetralogy of Fallot (the only of the three lesions known to be associated with LPA stenosis) being over represented in the control group. The most recent echocardiogram showed a reduced LPA to RPA ratio in the 22q11 group, so we suspect that whilst we demonstrated no difference in rates of reintervention, this could change with longer follow up.
Abstract 4147915: Title: Cardiovascular Events Associated with Endothelin Receptor Antagonists: A Pharmacovigilance Analysis of Bosentan and Ambrisentan
Authors: Rathore Azeem , Jonna Sadhana , Hanna Daniel , Verghese Dhiran , Muller Laura , Sierra Juan , Navas Elsy , Mirsaeidi Mehdi
Published: November 2024

Introduction:
Endothelin receptor antagonists (ERAs) are the mainstay therapy for pulmonary arterial hypertension (PAH). However, there is limited data on cardiac adverse drug events (ADEs) associated with ERA medications. We performed a pharmacovigilance study comparing bosentan and ambrisentan using the FDA Adverse Event Reporting System (FAERS) data.

Methods:
Cardiac ADE data for bosentan and ambrisentan from January 1, 2004, to December 31, 2023, in the FAERS database were retrieved. Disproportionality analysis was performed by calculating the reporting odds ratio (ROR) aligned with p-values. The following cardiac ADEs were included: atrial fibrillation (AF), right ventricular failure (RVF), and cardiac arrest (CA).

Results:
For adults ≥ 18 years, a total of 12,058 cardiac ADEs were reported for both bosentan (38%) and ambrisentan (62%). Among the selected cardiac ADEs, AF was more frequently reported with bosentan (ROR 3.99, 95% CI: 3.62-4.40) than ambrisentan (ROR 1.91, 95% CI: 1.77-2.07). RVF showed a significantly higher ROR for bosentan (73.60, 95% CI: 66.68-81.25) than ambrisentan (23.11, 95% CI: 20.99-25.46). CA was also more commonly associated with bosentan (ROR 2.25, 95% CI: 1.98-2.55) than with ambrisentan (ROR 0.69, 95% CI: 0.61-0.78), with all comparisons showing p-values < 0.001.

Conclusion:
Our study identifies a significantly higher frequency of cardiac ADEs, particularly AF, RVF, and CA, in patients treated with bosentan compared to ambrisentan. This finding corroborates previous literature that has suggested differential safety profiles among ERAs, emphasizing the need for vigilant cardiac monitoring. Clinicians should integrate these insights into their practice, potentially favoring ambrisentan in patients with elevated cardiac risk, thus optimizing the management of PAH and improving patient outcomes.