bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144136: Assessing the Efficacy and Safety of Olezarsen in Lowering Triglyceride Levels: A Systematic Review and Meta-Analysis
Authors: Shahzad Zoha , Ijaz Osama , Rao Asad Gul , Rasool Warda , Wani Shariq Ahmad , Rauf Faateh , ilmaguook Badr , Khan Arslan Ahmed , Bhatti Ali Hanif , Batool Asma
Published: November 2024

Background:
Elevated fasting serum triglyceride (TG) levels are linked to an increased risk of cardiovascular disease. Olezarsen is an inhibitor of apolipoprotein C3 (apo-C3) production with a potential to decrease TG levels and thereby, reduce the risk of cardiovascular disease.

Research Question:
Is olezarsen efficacious and safe in reducing the TG levels?

Aim:
This meta-analysis aims to evaluate the efficacy and safety of olezarsen in patients with hypertriglyceridemia.

Methods:
A literature search was carried out on Medline, Embase, Google Scholar, Cochrane CENTRAL, Scopus, and clinicaltrials.gov. Only randomized controlled trials (RCTs), including adult patients with hypertriglyceridemia and treated with olezarsen, were included. The primary outcome assessed was the mean change in the level of TG, whereas the secondary outcomes were changes in the apo-C3, apo-B48, and non-HDL cholesterol levels at the end of the 6-month follow-up period. Various adverse events were also assessed. Review Manager 5.4 was used to calculate standardized mean differences (SMD) with 95% confidence intervals (95% CIs) using a random effects model.

Results:
Three RCTs involving 334 patients in total, with 248 receiving olezarsen and 86 receiving placebo, were included. The analysis revealed that at the end of the follow up period, there was a significant change in the levels of TG (SMD -52.04, 95%CI: -64.55 to -39.52; p<0.00001; I
2
=72%), apo-C3 (SMD -69.84, 95%CI: -76.82 to -62.86; p<0.00001; I
2
=33%), apo-B48 (SMD -14.50, 95%CI: -21.29 to -7.71; p<0.00001; I
2
=8%) and non-HDL cholesterol (SMD -21.54, 95%CI: -27.96 to -15.12; p<0.00001; I
2
=0%). Olezarsen was not associated with any adverse event as demonstrated by the pooled analysis of adverse events. Meta-regression showed that no outcomes were significantly associated with age and BMI as covariates.

Conclusion:
A significant reduction was noted in TG, apoC-III, apo-B48, and non-HDLC levels, indicating a significant effect of olezarsen on these parameters. Additionally, olezarsen exhibited no significant side effects, making this medication comparatively safe. More research may be warranted to validate these findings and explore the drug's impact on cardiovascular outcomes.
Abstract 4144165: Transcatheter mitral valve repair demonstrates lower early mortality rates and lower rates of adverse events compared to surgical mitral valve repair among patients with mitral regurgitation: an updated systematic review and meta-analysis
Authors: Elfaituri Ahmed , Alzubi Alhasan Saleh , Faraj Hazem Abdelkarem , Khaled Ala , Elfaituri Muhammed
Published: November 2024

Introduction:
Transcatheter mitral valve repair (TMVR) has recently emerged as a therapy option for patients with severe mitral regurgitation (MR) deemed unsuitable for traditional cardiac surgery. In contrast to surgical mitral valve replacement (SMVr), its effectiveness is uncertain. Therefore, there is a need to assess safety, mortality, and morbidity.

Hypothesis:
To compare the mortality and morbidity of TMVR intervention versus SMVr in patients with MR.

Methods:
Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature were searched in May 2022. We only included studies that reported the outcomes of patients undergoing TMVR intervention compared to SMVr for MR, either secondary or primary. The primary outcome was early mortality and major adverse cardiac events (MACE). The secondary outcomes were reoperation rate, long-term survival, and complications. Statistical analysis was performed using R 4.0.3

Results:
Eleven studies comprising 10,627 patients (5307 TMVR and 5320 SMVr) were included in the analysis. In early mortality, the results showed TMVR has a significantly lower mortality rate than SMVr (RR: 0.84; 95% CI, 0.43-1.63; P < 0.01; I2 = 47.8%). MACE was significantly lower in TMVR than SMVr (RR: 0.52; 95% CI, 0.22-1.22; P < 0.01; I2 = 45.1%). Acute kidney injury (AKI) was significantly lower in TMVR compared to SMVr (RR: 0.76; 95% CI, 0. 34-1.67; P < 0.01; I2 = 75.1%). Although not significant, TMVR associatedwith higher rates of reoperation (RR: 2.46; 95% CI, 1.31-4.61; P = 0.53; I2 = 0%). TMVR was associated with non-significant lower rates of bleeding complications and the needs for transfusion (RR: 0.23; 95% CI, 0.20-0.28; P = 0.56; I2 = 0%). However, in long survival outcome, TMVR showed significant higher non-survival rate to SMVr (HR: 1.37; 95% CI, 0.85-2.23; P < 0.01; I2 = 26.1%).

Conclusions:
TMVR showed significantly lower early mortality, MACE, andAKI than SMVr. Long survival outcomes showed a negative trend for TMVR compared to SMVr in a few included studies. Therefore, TMVR can be a safe and effective approach for mitral valve regurgitation with lower early mortality and morbidity when compared to surgical management. However, there is a need for longitudinal studies on long-term outcomes.
Abstract 4144216: Have Gender-Specific Outcomes After STEMI Improved? – A Meta-Analysis of the Past Decade
Authors: Hariyanto Jesslyn , Hardi Catherine Jillian , Setiawan Jessica Anastasia , Ng Sunanto
Published: November 2024

Background:
Over the past decade, research has focused on gender disparities in cardiovascular outcomes. Historically, women have had higher mortality rates and worse outcomes after STEMI compared to men. This study aims to investigate if advancements in interventional cardiology and pre-hospital and in-hospital care have improved outcomes for women over 10 years.

Methods:
PubMed, Scopus and Cochrane were reviewed for cohort studies and registries from 2014-2024 comparing male and female STEMI patients, focusing on mortality, reinfarction, heart failure, stroke, and stent thrombosis. In-hospital and 1-year outcomes were assessed. Statistical analysis used Review Manager and I^2 for heterogeneity with a random-effects model.

Results:
We found 28 studies from 39 countries, with 39% female participants. T2DM was prevalent for 33.2% of males and 36.9% of females, with 32.2% of males and 21.3% of females being smokers. Both genders had an equal history (50%) of previous MI, PCI, and CABG. Primary PCI was performed in a majority (73%) of male patients compared to 62% of female patients; while thrombolysis was received by 73.1% of males and 61.5% of females.

For in-hospital outcomes, women have a higher all-cause mortality risk (RR = 1.77, 95% CI: 1.65-1.91), consistent in 2014-2018 (RR = 1.75, 95% CI: 1.49-2.05) and 2019-2024 (RR = 1.79, 95% CI: 1.63-1.96; P = 0.81) Women have higher risks of stroke (RR = 1.64, 95% CI: 1.34-2.02) and heart failure (RR = 1.50, 95% CI: 1.31-1.70) No significant differences were found in reinfarction (RR = 1.19, 95% CI: 0.82-1.74) or stent thrombosis (RR = 1.05, 95% CI: 0.53-2.07)

At 1 year, women have a significantly higher all-cause mortality risk (RR = 1.94, 95% CI: 1.48-2.53), observed in both 2014-2018 (RR = 1.77, 95% CI: 1.26-2.50) and 2019-2024 (RR = 1.98, 95% CI: 1.45-2.72; P = 0.64) Women also face higher cardiovascular mortality (RR = 2.45, 95% CI: 1.11-5.40) and stroke risk, (RR = 1.85, 95% CI: 1.43-2.39) with no significant difference in reinfarction risk (RR = 0.96, 95% CI: 0.53-1.73)

Conclusion:
Women with STEMI still face higher risks of in-hospital and 1-year all-cause mortality, stroke, and heart failure compared to men, indicating insufficient improvement in outcomes. There were no significant differences in reinfarction and stent thrombosis. It is important for future efforts to focus on understanding these disparities to improve outcomes for women.
Abstract 4144217: Ruling-out Left Main Stem Stenosis By Clinical And Stress-ECG Variables: The MASTER Case-Control Multicenter Study
Authors: De Carlo Marco , Fornili Marco , Baglietto Laura , Berti Sergio , Carmisciano Luca , De Caterina Alberto , Fabozzo Simona , Lanza Gaetano Antonio , Mancini Nastasia , Massacesi Cristiano , Neglia Danilo , Pastore Maria Concetta , Patti Giuseppe , Tremamunno Saverio , Vizzari Giampiero , Weintraub William , Temporelli Pierluigi , De Caterina Raffaele
Published: November 2024

Background:
The ISCHEMIA trial questioned revascularization in chronic coronary syndrome (CCS) patients, but excluding subjects with left main (LM) coronary artery disease (CAD). A widely available diagnostic method excluding LMCAD would expand the implementation of an initial noninvasive strategy.

Objective:
Assessing the ability of excluding LMCAD through clinical and ECG stress testing (EST) variables in patients undergoing coronary angiography (CAG) for CCS.

Methods:
In a multicenter retrospective case-control study we evaluated CCS subjects undergoing CAG after a maximal EST.
Cases
were patients with angiographic ≥50% LM stenosis or ≥70% stenoses of both proximal left anterior descending and proximal circumflex arteries; we matched them with similar patients without LMCAD (
Controls)
in a 1:3 ratio. Models were internally validated through logistic regressions.

Results:
219
Cases
were matched with 554
Controls
. The c-statistic was 0.80 (optimism-adjusted: 0.73). Assuming LMCAD prevalence of 5% and a misclassification cost ratio of 1:100 (ratio of the cost of performing CAG in a subject without LMCAD to the cost of not performing CAG in a patient with LMCAD), the negative predictive value was 98.6%, correctly classifying 84.5% of
Cases
. CAG could be spared in 57.0% of subjects, missing one LMCAD diagnosis every 70 CAGs spared in patients without LMCAD (
Figure
).

Conclusions:
Among patients with CCS, LMCAD can be predicted with
acceptable
diagnostic accuracy and
a very high
negative predictive value through a model based on clinical and EST parameters, allowing an initial noninvasive management of most patients able to perform an EST, reducing the costs of routine coronary imaging. Such results should enlarge the applicability of the ISCHEMIA results when coronary computed tomography angiography, used in ISCHEMIA, is not available, limiting the referral to invasive CAG.
Abstract 4144252: Associations of Dietary Zinc Intake with Cardiovascular Disease and Mortality: Results from the Prospective Urban and Rural Epidemiology (PURE-China) Study
Authors: Li Xiaocong , Cai Qiujing , Huang Yilin , Wang Biyan , Li Wei
Published: November 2024

Background:
Zinc is an essential trace element that can affect cardiovascular health through a variety of pathways including influencing vascular endothelial cell stability and signaling processes. Dietary intake is the main source of zinc in humans. Epidemiologic studies on the association between dietary zinc and cardiovascular disease remain scarce, especially in China.

Aims:
To investigate the associations of dietary zinc intake with the risk of cardiovascular disease and mortality in Chinese adults.

Methods:
Based on the Prospective Urban and Rural Epidemiology in China (PURE-China) study, we included people aged 35-70 years from 12 provinces in China. The daily dietary intake was recorded by a semi-quantitative food frequency questionnaire designed for Chinese people, and the daily dietary zinc intake was obtained based on the nutrient content of each food provided in the Chinese Food Composition Table (2002). Cox frailty proportional hazards models were developed to evaluate the association between dietary zinc intake with mortality and major cardiovascular diseases.

Results:
A total of 41 310 participants were included in the study after excluding participants with incomplete information, cardiovascular disease at baseline, and no follow-up information. The mean dietary zinc intake was 14.07±6.10 mg/d and the median level was 12.98mg/d. After 11.9 years of follow-up, 3 209 (7.8%) developed new cardiovascular diseases, 5.3% (2 170) died during follow-up, 714 (1.7%) died from cardiovascular diseases and 4 594 (11.1%) had a composite endpoint event. Compared with those in the second quartile of dietary zinc intake, those in the fourth quartile had a higher risk of all-cause mortality (HR[95%CI]: 1.20 [1.01-1.44]), stroke (HR[95%CI]: 1.25 [1.05-1.48)), and composite outcomes (HR[95%CI]:1.17 [1.03-1.32]). Those in the fourth quartile had a higher risk of major cardiovascular disease (HR[95% CI]:1.17 [1.03-1.32]) compared with those in the first quartile of dietary zinc intake.

Conclusions:
Excessive dietary zinc intake in the Chinese population may be associated with an elevated risk of cardiovascular disease and death. Further studies should be conducted to clarify the upper limit of dietary zinc intake.
Abstract 4144382: Covering or Encircling the Fibrotic Substrate in the Left Atrium: Does it Matter? Insights from DECAAF II
Authors: bidaoui ghassan , Feng Han , Bsoul Mayana , Assaf Ala' , Younes Hadi , Chouman Nour , Tirado Polo Francisco , Liu Yingshuo , Jia Yishi , Lim Chanho , Hassan Abboud , Tsakiris Eli , Abi-Rached Joe , Hui Yanpei , Ademi Besim , Mekhael Mario , Noujaim Charbel , Rao Swati , Kreidieh Omar , Pandey Amitabh , donnellan eoin , Marrouche Nassir
Published: November 2024

Background:
Left atrial fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). The optimal way to target atrial fibrosis has not been determined still.

Purpose:
The aim of this study is to determine whether left atrial fibrosis, as detected by late gadolinium enhancement MRI (LGE-MRI), should be covered, encircled, or both, in addition to PVI, to improve ablation success in patients with persistent AF.

Methods:
We conducted an analysis of DECAAF II participants who were randomized to the PVI plus MRI-guided atrial fibrosis ablation arm. These patients underwent late-gadolinium enhancement MRI (LGE-MRI) before and after AF ablation. Left atrial ablation lesions were collected from intra-procedural electro-anatomical maps and were superposed on 3D left atrial MRI images of fibrosis. We divided the patients into three groups based on whether atrial fibrosis was covered, encircled, or both. After ablation, patients were instructed to provide single-lead smartphone-based ECG strips once daily and following symptoms based on which AF burden and recurrence after ablation was assessed. Uni- and multivariable regression models were developed to assess the association of the technique used with time-to-atrial arrhythmia recurrence.

Results:
393 patients were included in our analyses. At baseline, patients were similar in comorbidity burden, age, sex, and left atrial volume. However, baseline fibrosis was different amongst the groups (19% vs 18% vs 20%; p-value=0.02). LA volume decrease was higher when atrial fibrosis was both encircled and covered simultaneously (31 mm3 vs 21 mm3 vs 23 mm3; p= 0.006). The primary outcome of atrial arrhythmia recurrence was similar among all the groups as shown in figure A (p=0.17). Even after controlling for possible confounders such as age, body mass index, sex, comorbidities, left atrial volume index, and baseline fibrosis, the technique used to target atrial fibrosis was not associated with recurrence (p=0.07). Moreover, AF burden in the follow-up period was not different across the patient groups as shown in figure B (p=0.63).

Conclusion:
Among patients with persistent AF, neither covering nor encircling atrial fibrosis in addition to PVI affected atrial arrhythmia recurrence after catheter ablation. More studies should be done to optimize atrial fibrosis targeting and modification.
Abstract 4144387: The Prognostic Role of Glucagon-like Peptide-1 Receptor Agonist in Transthyretin Amyloid Cardiomyopathy
Authors: Chi Kuan Yu , Borkowski Pawel , Song Junmin , Chang Yu , Chiang Cho Han , Nanna, MD, FACC Michele , Sikand Nikhil , Gallegos Cesia , Samsky Marc , Nanna Michael
Published: November 2024

Background:
Guideline-directed medical therapy (GDMTs) for heart failure is often poorly tolerated in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) and has unclear efficacy. Contrasting with GDMTs, glucagon-like peptide-1 receptor agonist (GLP1a) does not affect cardiovascular hemodynamics in patients with restrictive physiology.

Research Question:
What is the association between GLP1a treatment and survival outcomes in patients with ATTR-CM?

Aims:
To examine the prognostic role of GLP1a in patients with ATTR-CM.

Methods:
We used the TriNetX Global Collaborative Network database to conduct a retrospective propensity-score matching (PSM) study including adult patients with ATTR-CM, identified through tafamidis records, between September 1, 2019, and January 1, 2024. GLP1a users were defined as those having at least one prescription for GLP1a after the first dispense of tafamidis. GLP1a non-users were those who had no GLP1a prescription in the database but had at least one ambulatory visit after the first tafamidis prescription. The index date for study follow-up was set as the first GLP1a dispense for users and the first ambulatory visit after the first tafamidis prescription for non-users. The primary endpoint was heart failure (HF) hospitalization. The secondary endpoint was all-cause mortality. Incident gastrointestinal bleeding was set as a falsification endpoint. Cox proportional hazard ratios (HR) were calculated to compare study endpoints occurring within two years of the index date between two arms.

Results:
Of 5,241 ATTR-CM patients treated with tafamidis, 98 GLP1a users were matched to 98 nonusers. Before PSM, the mean BMI (33.4 vs 27.1) and the prevalence of type 2 diabetes (79.0% vs 19.0%) were higher in GLP1a users. After PSM, key covariates were balanced between the two cohorts
(Table 1A)
. The use of GLP1a was associated with a significant reduction in HF hospitalization (HR, 95% CI, 0.52; 0.28 to 0.96)
(Table 1B),
compared with non-users. There was no significant difference in all-cause mortality (HR, 95% CI, 0.73; 0.36 to 1.47) and the falsification endpoint between the two groups
(Table 1B)
.

Conclusions:
In ATTR-CM, GLP1a use was associated with a significant reduction in HF hospitalization.
Abstract 4144410: Mechanical Complications in Hemorrhagic Myocardial Infarction: Insights from Wall Strain Index Ratio for Predicting Cardiac Rupture (MIRON-STRAIN)
Authors: Vora Keyur , Huo Huaibi , Kumar Andreas , Dharmakumar Rohan
Published: November 2024

Background:
Mechanical complications following Myocardial Infarction (MI), such as ventricular rupture, significantly impact patient morbidity and mortality. Reperfused MI characterized by intramyocardial hemorrhage (hMI), has been identified to be the most severe form of myocardial injury. However, whether hMI portends a higher risk for mechanical complications is not known. The Wall Strain Index (WSI) Ratio, which is a measure of myocardial deformation and one that has been previously validated for cardiac rupture, is a desirable biomarker for examining the potential mechanical differences in strain development in hMI vs. non-hMI.

Research Question:
Do patients with hMIs have a higher radial and circumferential Wall Strain Index (WSI) Ratio compared to patients without hMI?

Methods:
We performed a retrospective cohort study (MIRON-STRAIN, NCT06450912) in mechanically revascularized STEMI patients (n=181) who underwent CMR (cine, T2* and LGE) approximately 2 days after PCI. WSI Ratio was computed using the 2D-strain module in CVI
42
(circumferential&longitudinal). Parametric statistics was performed using Shapiro-Wilk test and non-parametric statistics was performed using Mann-Whitney U test.

Results:
Patients with hMI (n=104) showed significantly higher radial and circumferential WSI Ratios compared to non-hMI patients. The radial WSI Ratio was approximately 58% higher in hMI relative to non-hMI patients (1.36±0.72 in hMI vs. 0.86±0.55 in non-hMI (p<0.001)). The circumferential WSI Ratio was 103% higher in hMI patients compared to those with non-hMI (1.22±0.87 in hMI vs. 0.60±0.44 in non-hMI (p<0.001)). Median and IQR values for radial and circumferential WSI ratios showed significant differences, indicating the development of higher myocardial stress in hMI. Additional findings in hMI included higher LV EDV (122.08±33.22 ml vs. 100.78±31.92 ml, p<0.001), and Infarct Size (%LV, 38.69±14.27% vs. 16.20±12.11%, p<0.001).

Conclusion:
The Wall Strain Index Ratio is significantly elevated in hMI patients, indicating hMI patients carry a significant risk for mechanical complications. Our findings suggest that WSI Ratio can serve as a valuable biomarker for enabling timely and targeted monitoring and critical care.
Abstract 4144434: Cardiac Amyloidosis: Hidden in Plain Sight
Authors: Jamal Hera , LaLoggia Michael , Moshman Rachel , Powell Maura , Kulkarni Vivek
Published: November 2024

Introduction:
Cardiac amyloidosis (CA) is the most common cause of restrictive cardiomyopathy (CM). CA is most often due to deposition of transthyretin (ATTR-CM). ATTR-CM is prevalent in 10-14% of patients diagnosed with heart failure with preserved ejection fraction (EF > 50%) (HFpEF). Despite clinical advancements and increased awareness, CA remains under-detected.

Questions:
Are patients admitted with HFpEF being adequately screened for CA? Will an educational intervention and implementation of an electronic order set for CA improve screening rates?

Goals:
Identify screening rates for CA, and improve comfort level recognizing and screening for CA at a tertiary care institution.

Methods:
A retrospective review was conducted of patients admitted to an academic tertiary care hospital in New Jersey from 1/1/22-6/30/22 with a diagnosis of HFpEF. Data collected included previous diagnosis of CA, presence and results of a technetium-99m pyrophosphate (PYP) scan, serum and urine tests for monoclonal proteins (including electrophoresis with immunofixation and free kappa/lambda light chains ratio).

An educational intervention was then provided to internal medicine (IM) residents regarding CA pathophysiology and screening (topics detailed in Figure 1). Pre- and post-intervention surveys were administered. Results were analyzed for significance with a paired t-test.

Results:
Of 498 patients admitted with HFpEF, only 23 (4.6%) were screened for a diagnosis of CA. Of those screened, only 14 (60%) received all appropriate diagnostic testing. The most often omitted test was the PYP scan in 30% of patients. IM residents reported modest comfort with CA screening before the intervention and a significant improvement after the intervention (Figure 1).

Conclusion:
Screening for CA in patients admitted with HFpEF is limited. An educational intervention significantly improved resident comfort level regarding screening for CA. Based on these findings, an electronic order set was created for comprehensive screening of CA; post-intervention screening rates will be assessed in the future.
Abstract 4144485: Gender Disparities in In-Hospital Outcomes After Out-of-Hospital Cardiac Arrest: Insight from the United States National Inpatient Sample
Authors: Malkani Sharan , Quevedo Ramirez Andres , Bello Jeremiah , Shaka Hafeez
Published: November 2024

Background:
Out-of-hospital cardiac arrest (OHCA) is a critical emergency with a high mortality rate, necessitating immediate intensive medical intervention, which may include advanced therapies such as mechanical circulatory support (MCS). Despite advances and organized protocols, outcomes remain poor due to various factors, including gender. While gender disparities in cardiovascular health well-documented, their impact on OHCA outcomes, particularly in-hospital mortality and MCS use, remains unclear. This study investigates these disparities using the 2019-2020 National Inpatient Sample database, aiming to identify gender differences in outcomes and improve management of OHCA patients.

Methods:
We conducted a retrospective cohort study based on the 2019-2020 NIS database of the Healthcare Utilization Project. Our population included patients 18 years or older with OHCA as the primary diagnosis, identified using ICD-10 codes. The primary risk factors examined was gender, classified into male and female. The primary outcome was in-hospital mortality among patients with OHCA. The secondary outcome was mechanical circulatory support (MCS) use. Left ventricular assist device (LVAD), extracorporeal membrane oxygenation (ECMO), and intra-aortic balloon pump (IABP) were identified as MCS. Multivariate regression analysis was used to estimate the odds ratio.

Results:
During the study period, 26,640 hospitalizations with OHCA were identified, of whom 57.1% were male. The mean (SD) age of patients with OHCA was 65.2 (16) years old, and male patients had lower mean age compared to female patients (64.6 vs 66 years old, p<0.001). A total of 19,425 died (72.9%) and 0.9% needed MCS. Notably, more females died compared to male subset (74.6 vs 71.7%, p<0.001). Although not significant, MCS use was 1.1% in males and 0.67% in females. In the multivariate analysis, we did not find statistical significance among genders regarding in-hospital mortality and MCS use.

Conclusion:
Our findings reveal a higher in-hospital mortality rate among female patients following OHCA. However, the multivariate analysis did not show statistically significant gender differences regarding in-hospital mortality or the use of MCS. This suggests that factors other than gender are critical in determining these outcomes. Further research is essential to identify these factors and develop targeted interventions to enhance survival rates for all OHCA patients.
Abstract 4144488: 4-5 Years Outcomes of Left Atrial Appendage Closure vs. Oral Anticoagulants in Atrial Fibrillation: A Systematic Review and Meta-Analysis:
Authors: Khan Muhammad Aslam , Muhammad Anza , Shafique Nouman , Bhatia Hitesh , Aafreen Asna , Adil Abid Nawaz Khan , Akbar Usman , Khan Alamzaib , Haider Muhammad Adnan , Haider Taimoor , Bhattarai Shraddha , Afzal Hafsa , Khan Bilal
Published: November 2024

Background:
Oral anticoagulants (OAC) including Vitamin K antagonists such as warfarin and direct oral anticoagulants like Apixaban, Rivaroxaban, and Edoxaban, have long been the standard treatment for stroke prevention in patients with atrial fibrillation (AF). However, they increase the risk of bleeding, making them unsuitable for certain patient populations, particularly those with a personal history of bleeding, elderly individuals prone to falls or those with high-risk occupation with safety hazards. In cases of non-valvular AF, where thrombi typically form in the left atrial appendage, mechanical left atrial appendage closure (LAAC) has come out as an alternative for selected patients. Numerous studies have shown that LAAC is comparable to OAC in preventing strokes while significantly reducing major bleeding events. This meta-analysis aims to compare the 4–5-year outcomes of these two treatment strategies in non-valvular AF.

Methods:
4 studies (3 randomized controlled trials and 1 observational study) comparing the 4–5-year outcomes of LAAC versus OAC in patients with AF were included in this meta-analysis. These studies were identified after a thorough search of PUBMED, COCHRANE, and MEDLINE databases from inception till May 2024. The outcomes of interest were MACE (composite of stroke, embolism, and death), ischemic stroke, major bleeding episodes, cardiovascular (CV) deaths, and all-cause death. The results were reported as Risk Ratio (RR) with 95% confidence intervals (CI), using a random effects model.

Results:
6,012 patients were identified from the 4 studies. After a median follow-up of 4–5 years, LAAC was associated with a clinically significant reduction in MACE (RR: 0.76, 95% CI: 0.61-0.94, p=0.01), all-cause mortality (RR: 0.77, 95% CI: 0.62-0.96, p=0.02), and CV mortality (RR: 0.64, 95% CI: 0.45-0.90, p=0.01). Additionally, a significant reduction in major bleeding episodes (RR: 0.63, 95% CI: 0.44-0.91, p=0.01) was also noted between the two treatment strategies favoring LAAC treatment group. There was no significant difference in the incidence of ischemic stroke (RR: 1.07, 95% CI: 0.62-1.85, p=0.80) between the two groups.

Conclusion:
Over a median follow-up of 4-5 years, LAAC was found to be as effective as OAC in preventing ischemic strokes, while also showing lower incidence of MACE, all-cause, CV mortality and major bleeding episodes. More RCTs are needed to further assess the long-term outcomes between the two strategies.
Abstract 4144539: A Heart-pounding Case of Cardiomyopathy in Pregnancy
Authors: Tran Linh , Everitt Ian , Vaught Arthur , Barth Andreas , Minhas Anum
Published: November 2024

Introduction:
Pregnancy-induced cardiomyopathy is typically idiopathic, with no predisposing condition identified. In some cases, women with pre-existing genetic mutations may initially present with cardiomyopathy in pregnancy.

Case:
A 30-year-old G2P1001 woman presented to Labor&Delivery with frequent palpitations, dyspnea on exertion, and reduced exercise tolerance in the third trimester. Her previous pregnancy was complicated by frequent premature ventricular contractions (PVCs) but otherwise unremarkable. She had a family history of early-onset atrial fibrillation in her mother and a maternal cousin with pregnancy-induced arrhythmias. ECGs and telemetry demonstrated significant ectopy (bigeminy, non-sustained ventricular tachycardia) and atrial arrhythmias including supraventricular tachycardia, atrial tachycardia, and atrial fibrillation (Figure 1). Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 20-25%, reduced from 50% 2 weeks prior. Ectopy was associated with reduced fetal heart rate variability suggestive of fetal malperfusion, for which an urgent C-section was performed at 38 weeks and 6 days. Following delivery, she was started on amiodarone, metoprolol, and spironolactone, as part of guideline-directed medical therapy. Subsequent TTEs showed improvement in EF to 30-35% at 2 days and 45-50% at 4 weeks postpartum. Cardiac MRI showed no evidence of fibrosis or inflammation. Given her maternal family history of arrhythmic events, genetic testing was pursued. Genetic testing revealed a pathogenic SCN5A variant (c.638G>A (p.Gly213Asp)).

Discussion:
SCN5A variants are associated with dilated cardiomyopathy, conduction disorder, and arrhythmias. It is a rare variant of pregnancy-induced cardiomyopathy. This case highlights the value of genetic testing in patients with significant arrhythmia burden and cardiomyopathy in pregnancy and a family history of cardiomyopathy and arrhythmias. For pregnant women with genetic variants predisposing to arrhythmias and cardiomyopathy, comprehensive longitudinal, multidisciplinary care is essential at a referral center with Cardio-Obstetrics expertise and an Inherited Heart Disease Clinic.
Abstract 4144618: Mitral regurgitation quantification by Cardiac Magnetic Resonance; Does the approach matter?
Authors: Alnaimat Saed , Doyle Mark , Radhakrishnan Anita , Shah Moneal , Farah Victor , raina Amresh , Biederman Robert
Published: November 2024

Introduction/Background:
Quantification of mitral regurgitation (MR) by CMR is performed indirectly by subtracting the aortic forward flow (measured by phase velocity mapping) from the left ventricular stroke volume (LVSV, measured by 3D EDV-ESV). However, 3D volumetric analysis of the LV can be performed by either including papillary muscles in the blood pool “Contour Method” or as part of myocardium “Blood Volume Method”. While both methods are considered acceptable to the Society for Cardiovascular Magnetic Resonance 2020 Guideline, using either method has a significant impact on the calculated LVSV, which in turn affects the calculated mitral regurgitant fraction (MRfr). Moreover, no universal cutoff for MR grading by CMR has been established yet.

Research Questions/Hypothesis:
We sought to validate which method (Blood Volume or Contour) should be used to quantify MR by comparing the calculated MR grade by CMR (assessed by MRfr) to MR grade by echocardiography (none, trace, mild, moderate, or severe).

Methods/Approach:
This is a single-center retrospective analysis. CMR studies were analyzed using Medis Suite (Version 4.0.50.2) Software. Each patient was analyzed twice; initially using Contour Method then Blood Volume Method.

Results/Data:
A total of 100 patients with various grades of MR were included. 83% of patients had a transthoracic echocardiogram (TTE) while 17% had a transesophageal echocardiogram (TEE). 94% of patients had their echocardiogram performed within 6 months of CMR, and 80% performed within 3 months of CMR.

We found that the Contour Method tends to over-estimate the severity of MR, especially in patients with small ventricles

(Figure 1)

and in patients with milder grades of MR (less than moderate). This is because Contour Method yields a higher SV than Blood Volume Method. When compared to echocardiographic grades of MR, Blood Volume Method has a much better performance in quantifying MR severity (Kappa 0.89) than Contour Method (Kappa 0.44,

Figure 2

). Based on Blood Volume method, we suggest cutoffs of MR grading by CMR as listed in

Table 1

.

Conclusions:
In this study, we present evidence that papillary muscles and trabeculations should be excluded from the blood pool in routine volumetric analysis for accurate assessment of LV stroke volume. This practice is not firmly established by current guidelines. We also present evidence-based reference ranges of mitral regurgitation grades according to the mitral regurgitant fraction calculated by CMR.
Abstract 4144650: Stereotactic Radioablation for Septal Ventricular Tachycardia
Authors: Magnocavallo Michele , Marchesano Domenico , Polselli Marco , Di Renzi Paolo , Grimaldi Gianmarco , Cauti Filippo Maria , Borrazzo Cristian , El Gawhary Randa , Bisignani Antonio , Castelluccia Alessandra , Rossi Pietro , Gentile PierCarlo , Bianchi Stefano
Published: November 2024

Background:
Intramural septal substrate represents a major challenge in patients undergoing Ventricular Tachycardia (VT) ablation because the septal thickness could make difficult for radiofrequency to achieve transmural lesions. Although novel approaches have been proposed to treat septal VT, about half of patients experienced VT recurrence and the risk of peri-procedural complications including Atrioventricular Block (AVB) remained high. Stereotactic Arrhythmia Ablation (STAR) was introduced to treat VT refractory to catheter ablation nevertheless no data are available in the setting of septal VT.

Objectives:
to evaluate the arrhythmic burden in patients with septal VT treated with Magnetic Resonance Imaging guided STAR (MRgSTAR).

Methods:
We enrolled consecutive patients with septal VT substrate. The therapy target was achieved combining anatomical/functional and electrophysiological data (Fig. 1). Patients were treated with a single fraction of 25Gy adopting MRgSTAR (Fig. 2). All patients were clinically followed-up and all implantable cardiac device were remote monitored. The efficacy outcome included recurrences of any sustained VT beyond the 6-weeks blanking-period after MRgSTAR. The safety outcome was the incidence of adverse events and AVB.

Results:
We included 11 patients with septal substrate VT [median age:68yrs (IQR:64.5–78yrs); 100% male]. Clinical presentation was electrical storm in 81.8% of patients. No complications occurred after MRgSTAR and six (54.5%) patients were discharged the same day of treatment. During a mean follow-up of 12±6 months, the efficacy outcome occurred in three (27.3%) cases. A significative reduction of Implantable Cardioverter Defibrillator (ICD) therapy (23.6 before MRgSTAR vs 1.7 after MRgSTAR, p-value:<0.001) was observed (Fig. 3). Left ventricular ejection fraction increased significantly after treatment [38%(IQR:33.5-42%) before MRgSTAR vs 43.8%(IQR:35–47%) after MRgSTAR; p-value:0.04]. No adverse effects were observed in ICD system performance, lead thresholds, or lead impedances at any point after treatment. In the seven patients with preserved AV conduction, no AVB or left/right branch block were reported after STAR. No difference in the percentage of ventricular pacing was described before and after STAR [3.5% (IQR:2.75-4%) before STAR vs 4.5% (IQR: 3.25–5.5%) after STAR; p-value: 0.24].

Conclusions:
MRgSTAR represents a safe and effective strategy for the treatment of septal VT.
Abstract 4144674: Left Versus Right Ventricular Pacing during TAVR and Balloon Aortic Valvuloplasty: A Systematic Review and Meta-Analysis
Authors: Khalefa Basma , Ayyad Mohammed , Albandak Maram , Ayyad Alaa , Negmeldin Aly Yassin Mazen , Gardezi Syed Karam , K. Awad Ahmed
Published: November 2024

Introduction:
While right ventricular pacing (RVP) is the conventional temporary pacing modality used for transcatheter aortic valve replacement (TAVR), this approach possesses inherent risks and procedural challenges. We aim to assess and compare safety and efficacy of left ventricular pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV).

Methods:
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted in four databases from inception to December 15
th
, 2023. We included observational studies and clinical trials comparing LVP with RVP during TAVR and BAV procedures. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes, while continuous outcomes were reported in form of mean difference (MD).

Results:
Five studies involving 830 patients with RVP and 1577 with LVP were included. Short-term mortality was significantly higher in the RVP group (RR 2.32, 95% CI: [1.37-3.93], P = 0.002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI: [1.11-4.32], P = 0.02). Subgroup analysis of the TAVR studies only revealed similar trends with higher short-term mortality in the RVP group (RR 1.99, 95% CI: [1.13-3.51], P-value = 0.02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95% CI: [0.90, 1.78], P<0.001) and reduced procedure duration (MD = 7.75 min, 95% CI: [5.08, 10.41], P<0.00001) compared to RVP. New pacemaker implantation was higher in the RVP group (RR 2.23, 95% CI: [1.14, 4.39], P = 0.02). Major vascular complications (RR 1.78, 95% CI: [0.86-3.70], P-value = 0.12), Cerebrovascular accidents (RR 1.67, 95% CI: [0.78-3.57], p-value = 0.18) and all bleeding (RR 0.95, 95% CI: [0.51-1.76], p-value = 0.86) were all comparable between both groups.

Conclusion:
Left ventricular pacing is a plausible alternative to RV pacing in patients undergoing TAVR or valvuloplasty, particularly in the absence of high-grade conduction disturbances. LV pacing has demonstrated superior outcomes with lower short-term mortality rates, lower incidence of cardiac tamponade, and pacemaker implantation. On the other hand, RV pacing could be the preferred modality of treatment if baseline conduction abnormalities are present.
Abstract 4144722: Electrophysiological Effects of Transcutaneous Vagal Nerve Stimulation in Humans
Authors: Olarte Neal , Nguyen Heajung , Krokhaleva Yuliya , Khakpour Houman , Do Duc , Hayase Justin , Stavrakis Stavros , Vaseghi Marmar
Published: November 2024

Background:
Cervical vagus nerve activation has been shown to have significant cardiac hemodynamic and electrophysiological effects. Transcutaneous vagal nerve stimulation (tVNS) has been reported to benefit patients with atrial fibrillation, though the potential electrophysiological effects of tVNS beyond the atrium remain unclear.

Aims:
The purpose of this study was to evaluate the electrophysiological effects of tVNS in patients with structurally normal hearts.

Methods:
Patients with structurally normal hearts undergoing electrophysiology study for supraventricular tachycardia were recruited and randomized to low-level stimulation of the right or left tragus (1 mA below discomfort threshold personalized for each patient pre-procedure, 20 Hz, 250 µs). After completion of ablation, hemodynamic and electrophysiologic parameters were measured before, during 30 min of tVNS, and at approximately 15 min after tVNS had ended. Variables were compared using one-way ANOVA, and if significant, paired comparisons were performed using the paired Student’s t-test.

Results:
Eighteen patients were randomized and 16 (mean age 47.0±16.1 years; 50% female) underwent the full protocol (9 right and 7 left). TVNS reduced systolic blood pressure (SBP) and was associated with significant increases in RR interval, atrial and atrioventricular nodal refractory periods (AVNERP), atrio-His (AH) interval, atrioventricular nodal Wenckebach cycle length (AVWBCL), and ventriculoatrial block cycle (VABCL) length (figure). There were no significant differences in sinus node recovery time (SNRT), His-ventricular (HV) interval, and ventricular refractory periods (VERP); 15 min post-tVNS, significant differences were still observed in SBP, RR interval, AERP, and AVWBCL, suggesting neural memory, though the effects on AVNERP and VABCL had diminished.

Conclusions:
TVNS is associated with measurable increases in the conduction time of the AV node and AV nodal and atrial, but not ventricular, refractory periods. Increases in AERP and AV nodal effects may explain the benefit of tVNS observed in atrial fibrillation and may potentially be leveraged to slow or terminate AV nodal dependent supraventricular tachycardias.
Abstract 4144725: Frequency of Occurrence of, and Risk Factors for, Thromboembolism Before and After Cardiac Surgery in Children with Surgical Congenital Heart Disease: A Case-Control Study
Authors: Kiskaddon Amy , Stock Arabela , Pham Danh , Tinling Heather , Frank Shannon , Miles Alyssa , Quintessenza James , Goldenberg Neil
Published: November 2024

Background:
Thromboembolism (TE) is a common complication in pediatric congenital heart disease (CHD) requiring cardiac surgery. Data describing the frequency, timing, and factors associated with TE and TE recurrence are limited.

Aim:
To describe frequency, occurrence, and risk factors for, TE before and after cardiac surgery in children with surgical CHD. The secondary aim was to determine frequency of TE recurrence.

Methods:
A single-center retrospective study (10/2020-11/2023). Patients <18 years of age with radiologically confirmed TE either within 12 months before or after cardiac surgery were compared with randomly selected patients without TE (1:2 ratio). Data included age, CHD diagnosis/surgery type, hemodynamics, hematologic indices, near-infrared spectroscopy (NIRS), infection, respiratory status, length of stay, mortality, timing/location of incident/recurrent TEs. Descriptive and inferential (Mann-Whitney U for continuous, Chi-square for categorical variables) statistics were utilized.

Results:
Among 302 patients, 45(15%) developed a TE: 16(35.6%) within 12 months before and 29(64.4%) within 12 months after cardiac surgery. TE types were: 11(24.4%) arterial, 32(71.1%) venous, and 2(4.5%) intracardiac. In univariate analyses, age <12 months (p=0.01), single-ventricle (p=0.03), intra-cardiac lines (p=0.02), cardiac-catheterization (p<.001), mechanical ventilation (p<.001), infection (p=<.001), mechanical circulatory support (p=.003), lower cerebral NIRS (p<.001), lower somatic NIRS (p<.001), and higher heart rate (p<.001) were associated with TE. Age <30 days (p<.001), mechanical ventilation (p<.001), and infection (p=.03) were associated with TE before surgery. Single-ventricle (p=0.003), central-venous/intracardiac lines (p=0.04), cardiac-catheterization (p<.001), mechanical ventilation (p<.001), infection (p=.03), lower cerebral NIRS (p<.001), lower somatic NIRS (p<.001), higher heart rate (p<.001) and post-op LOS (p<.001) were associated with TE after surgery. Patients with TE had a longer median (IQR) post-op LOS 20[8-48] vs. 6[4-12] days, p<.001, and higher mortality (11%vs.2.2%,p=0.04). Recurrent TE occurred in 10(22.2%).

Conclusions:
In children with CHD, the frequency of occurrence of TE before/after surgery and TE recurrence is high. Putative risk factors for the development of TE have been identified and should be further evaluated in multivariable models via future collaborative studies.
Abstract 4144730: Combining novel lipid biomarkers with deep learning algorithms to develop an initial non-invasive screening approach for ruling out obstructive coronary artery disease
Authors: KARAGIANNIDIS EFSTRATIOS , Papazoglou Andreas , Mouskeftara Thomai , Deda Olga , Liapikos Theodoros , Panteris Eleftherios , Fyntanidou Barbara , Fragakis Nikolaos , Theodoridis George , Gika Helen , Giannakoulas George
Published: November 2024

Background:
A personalized, non-invasive assessment approach for evaluating the risk of obstructive coronary artery disease (CAD) is crucial for patients with an intermediate or low clinical likelihood of CAD before undergoing invasive coronary angiography (ICA). This method allows clinicians to effectively rule out the presence of obstructive CAD without the need for ICA or to determine if a referral for ICA is warranted. Emerging lipidomics biomarkers may be valuable in this process. However, technological challenges in detecting structurally similar lipids and the requirement for advanced computational tools have so far impeded the clinical application of lipidomics research.

Hypothesis:
Our study aims to develop an innovative non-invasive diagnostic test utilizing novel lipidomics biomarkers, potentially revolutionizing current risk classification schemes for CAD.

Methods:
In this post-hoc analysis of the CorLipid trial (NCT04580173), we employed extreme gradient boosting (XGBoost) machine learning to assess the predictive power of a lipidomics panel for obstructive CAD risk. Liquid chromatography-mass spectrometry analyzed lipid profiles from 146 individuals undergoing ICA. SYNTAX Score (SS) was used to define obstructive CAD as SS>0 versus non-obstructive CAD (SS=0).

Results:
Of the 146 participants (25% female, mean age: 61 ±11 years old), 55% had obstructive CAD (SS>0). Lipidome changes [phosphatidylinositols, (lyso-)phosphatidylethanolamine, (lyso-)phosphatidylcholine, triglycerides, diglycerides, and sphingomyelins] were investigated to identify lipids potentially associated with the phenotype and complexity of CAD. Using this information, 290 quantified serum lipid species were utilized to develop an XGBoost algorithm with 17 serum biomarkers ( consisting of sphingolipids, glycerophospholipids, triacylglycerols, galectin-3, glucose, low-density lipoprotein, and lactate dehydrogenase) with very good discriminative ability [ROC AUC: 0.875 (95%CI: 0.867-0.883)], excellent sensitivity (100%) but moderate specificity (62.1%) for the prediction of obstructive CAD.

Conclusions:
These findings indicate that a deep-learning-based non-invasive diagnostic test, using lipidomics serum biomarkers, could reliably rule-out obstructive CAD without necessitating ICA. To enhance generalizability, these results should be validated in larger and similar cohorts. Further research, particularly leveraging machine learning, is promising for refining risk stratification.