bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144161: The impact of atrial fibrillation on no-reflow phenomenon in acute coronary syndrome patients following percutaneous coronary intervention: A meta-analysis of the current literature
Authors: Cinar Tufan , Erdem Almina , Pham Hoang Nhat , Saylik Faysal , cicek Vedat , Pay Levent , Khachatryan Aleksan , alejandro joel , Korucu Berke Cenktug , Hayiroglu Mert
Published: November 2024

Background:
Percutaneous coronary intervention (PCI) is a cornerstone in the management of acute coronary syndrome (ACS) patients. Despite technological advancements, the occurrence of no-reflow phenomenon remains a significant concern among ACS patients. Atrial fibrillation (AF) is a common arrhythmia associated with cardiovascular events. We conducted a meta-analysis to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI.

Methods:
Relative risk (RR) with a 95% confidence interval (95%CI) served as the summary measure in our meta-analysis using the random-effects model to estimate the summary effect. The primary outcome is to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. We assigned I2 > 50% as an indicator of statistical heterogeneity. P value <0.05 was considered significant. Data analysis was conducted using SPSS v.25. A comprehensive literature search was performed identifying relevant studies published up to January 2024 from October 2001 from PubMed, Google Scholar, Scopus databases. Studies reporting the baseline AF and no-reflow in ACS patients post-PCI were included. Case reports, duplicate studies, reviews and metaanalysis were excluded. Data screening and analysis were conducted independently by two reviewers.

Results:
The meta-analysis included 10 studies comprising a total of 11079 ACS patients who underwent PCI. No reflow developed in 2442 of these patients. In total, 653 patients had baseline AF and 10426 patients had not AF. No-reflow developed in 243 of the patients with baseline AF. Also, no-reflow developed in 2199 of the patients with non-AF. Our findings revealed a statistically significant association between AF and increased incidence of no-reflow in ACS patients following PCI (RR: 1.5 Cl %95) (p < 0.05). There was moderate statistical heterogeneity across the studies that evaluated no-reflow outcomes (I2= 61%)

Conclusion:
In this meta-analysis, we provide evidence suggesting that the presence of AF may have a deleterious effect on the development of no-reflow phenomenon in ACS patients following PCI. AF may have deleterious effects on the coronary microvasculature. Further research is warranted to elucidate the underlying mechanisms and to determine the clinical implications of these observations.
Abstract 4144170: Association of loneliness and social isolation with incident atrial fibrillation: a population-based cohort study using the UK Biobank
Authors: Zeng Zhiwei , Zhang Yingyi , Wang Peng , Chen Runze , li xi , Zheng Zhe
Published: November 2024

Background:
The role of socio-psychological factors, such as loneliness and social isolation has gained increasing attention, especially in a post-COVID world. However, their related evidence on atrial fibrillation (AF) is scarce.

Aims:
We sought to assess whether loneliness and social isolation are associated with the risk of incident AF, and which behavioral factors serve as the mediators in such association.

Methods:
Using data from the UK Biobank, we included the participants free of AF at baseline, and categorized them into three-level loneliness and social isolation scales by self-reported questionnaires, respectively. After adjusting for potential confounders, the hazard ratios (HRs) with 95% confidence interval (CI) of incident AF were estimated by Cox proportional hazard models. The mediating effects of behavioral factors (including current smoking, excess alcohol use, insufficient physical activity, unhealthy diet, sleep deprivation, and obesity) were assessed using a 2-stage regression method for survival data.

Results:
Among 459,282 participants (mean age of 56.4 years, 55.0% female), 25,406 incident AF cases were documented during a median follow-up period of 12.1 years. In the fully adjusted models, compared with participants with the lowest loneliness scale (zero), participants with the highest loneliness scale of 2 had a significantly higher risk of incident AF (HR 1.21 [95% CI 1.15-1.27]. However, those with social isolation scale of ≥2 had only mild additional risk, with marginal significance (HR 1.06 [95% CI 1.02-1.10]. The association between loneliness and risk of AF was significantly modified by sex (P for interaction=0.029), with female participants suffering from the more detrimental effect of loneliness. Obesity, current smoking, and sleep deprivation were the top three mediators, with a mediated proportion of 20.3%, 8.4%, and 7.6%, respectively.

Conclusions:
Loneliness was independently associated with a higher risk of incident AF, which was mediated by unhealthy behaviors.
Abstract 4144181: Sociodemographic and Clinical Correlates of Right Ventricular Structure and Function, and Serial Change among Hispanics/Latinos: The Echocardiographic Study of Latinos (ECHO-SOL)
Authors: Cedeno Juan , Duran Luciano Priscilla , Zamora Cristian , Yuan Yawen , April-Sanders Ayana , Kansal Mayank , Hurwitz Barry , Talavera Gregory , Kaplan Robert , Shah Sanjiv , Daviglus Martha , Gonzalez Franklyn , Rodriguez Carlos
Published: November 2024

Introduction:
The role of the right ventricle (RV) in influencing clinical outcomes and overall survival is well established. However,RV serial change over time and the influence of sociodemographic and clinical factors on RV structure/function remains understudied, especially among Hispanics/Latinos.

Methods:
ECHO-SOL comprehensively assessed RV structure and function in Hispanic/Latino 1643 adults at baseline (visit 1 2011-2014) and 4.3 years later (visit 2 2015-2019). RV
functional parameters
included were RV peak S’ velocity (PsV), fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE);
structural parameters
: RV systolic (RVSA) and diastolic (RVDA) area; and
hemodynamic parameters:
maximal tricuspid pressure gradient (TR max PG), velocity time integral (VTI). Regression models were employed to assess the association of sociodemographic factors with RV structure/function at baseline. Marginal models were used to estimate RV change between visits. All analyses were weighted to account for complex survey design.

Results:
At baseline, 41.5% were female, mean age 56.38±0.39 years. Increasing age was associated with worse RV systolic function, evidenced by functional parameters (lower TAPSE, S’ velocity) but lower RVDA. Females had worse RV structure/function (greater RVDA and decreased FAC) but better RV longitudinal shortening (greater TAPSE, PsV). Higher BMI was related to worse RV functional (decreased FAC) and structural parameters (greater RVDA). Higher income (>75K) correlated with better RV longitudinal shortening (PsV). First generation immigrants had worse RV structure with higher RVDA. (
Table 1a)
RV structure and function worsened over time (
Table 1b
), as evidenced by an change in all parameters: increased RV size (greater RVSA, RVDA), impaired systolic function (lower FAC) and longitudinal shortening (lower TAPSE,PsV), along with impaired stroke volume (lower TR max PG,VTI).

Conclusion:
Among Hispanic/Latinos, different sociodemographic and clinical factors were associated with RV morphology and function. Overall, RV structure and function worsened over time, suggesting that sociodemographic factors may play an important role in the decline of RV parameters in this population.
Abstract 4144186: Can Noninvasive Evaluation of Right Atrial Pressure by Internal Jugular Vein Imaging Complement Inferior Vena Cava Imaging?
Authors: Murugesan Lakshmi , Htay Yan Naung , Kasi Sakthi , manova angelena , Prabhakaran Shakthi , Victor Varun , Gopalakrishnan Prabhakaran
Published: November 2024

Background:
Right atrial pressure (RAP) is estimated noninvasively by sonographic evaluation of inferior vena cava (IVC) size and collapsibility. We evaluated a new internal jugular vein (IJV) based approach for RAP estimation.

Methods:
Sixty-nine patients underwent right heart catheterization and sonographic evaluation of IVC and right IJV. Both IVC long axis (LA) –

IVC(LA)

and short axis (SA) -

IVC(SA)

images were analyzed for RAP. SA images of right IJV were obtained at the clavicular level at 0°and clavicular and mandibular levels at 45°&90° (60° if the patient is unable to sit upright) (Figure 1). Cine images were recorded during free breathing, sniff, and valsalva maneuvers at each location, in each posture. IJV was classified as distended (D), pulsatile (P), or collapsed (C). Models were developed to grade noninvasive RAP (niRAP) based on IJV classification in these images –

IJV(c)

and combined IJV&IVC imaging –

IJV+IVC

(Figure 2). A simple model

IJV(s)

using only 45° posture was also analyzed. The invasive RAP (iRAP) was categorized as 3 (<5 mm Hg), 8 (5-10 mm Hg), and 15 (>10 mm Hg) and compared with the niRAP from

IJV(c)

,

IJV(s)

,

IVC(LA)

,

IVC(SA)

and

IJV+IVC

.

Results:

IVC(LA)

was nondiagnostic in 3 patients and

IVC(SA)

in 8 patients. In comparison, both

IJV(c)

and

IJV(s)

were diagnostic in all patients. The correct niRAP category was identified in more patients by IJV (c-54%, s-54%) than by IVC imaging (LA-39%, SA-46%).

IVC(SA)

performed better than the traditional

IVC(LA)

. While both

IJV(c)

and

IJV(s)

had an overall similar performance,

IJV(c)

was better when iRAP>10 and the

IJV(s)

was better when iRAP ≤10. Combined

IJV+IVC

identified RAP category correctly in most patients (64% overall, 84% if iRAP >10) (Table 1).

Discussion:

While IJV was diagnostic in all patients, IVC imaging was nondiagnostic in some. IJV correctly identified the RAP category more often than IVC and combined IJV and IVC had the best performance. IJV imaging was easier to perform and more comfortable for patients. A simpler 45° only evaluation of IJV had a performance similar to comprehensive IJV imaging. While

IVC(SA)

was nondiagnostic in more patients, its classification was more accurate than

IVC(LA)

.

Conclusion:
Sonographic imaging of IJV is potentially better than IVC imaging in noninvasive evaluation of RAP. Combined IJV and IVC imaging is better than IJV or IVC alone. When IVC only imaging is done, short axis or biplane imaging is preferable to long axis alone.
Abstract 4144202: Association of Elevated Lipoprotein(a) Levels with Adverse Outcomes in Patients with Stable Angina Undergoing Stent-less PCI with Paclitaxel-coated Balloon
Authors: Takahashi Tomonori , Wakatsuki Tetsuzo , Saijo Yoshihiro , Kawabata Yutaka , Ueno Rie , Kadota Muneyuki , Hara Tomoya , Matsuura Tomomi , Ise Takayuki , Yamaguchi Koji , Yagi Shusuke , Yamada Hirotsugu , Soeki Takeshi , Sata Masataka
Published: November 2024

[Background]:
Evidence on the long-term prognosis of stent-less percutaneous coronary intervention (PCI) using paclitaxel-coated balloons (PBCs) is becoming established, however some prognostic indicators remain unexplored. Recently, elevated blood lipoprotein(a) levels are gaining attention as an independent risk factor for the development of atherosclerosis. We hypothesized that elevated lipoprotein(a) levels would also adversely affect the outcome of stent-less PCI.

[Object]:
The aim of this study is to investigate the association between lipoprotein(a) levels and outcomes after stent-less PCI.

[Methods]:
In this single-center retrospective study, patients with stable angina undergoing stent-less PCI with PCBs in de novo lesions at our institution were included between October 2016 and September 2022. We classified all patients into three groups according to lipoprotein(a) tertiles and performed a Cox proportional hazards analysis. The primary endpoint was a composite outcome of cardiovascular death, major bleeding, myocardial infarction, and target lesion revascularization.

[Results]:
A total of 207 patients were included, including a mean age of 70±11 years and 75% male. The median lipoprotein(a) level was 12.4 nmol/L (IQR 4.8-21.4 nmol/L). During a median follow-up of 18 months, the composite outcome was observed in 37 patients (17.9%). Patients with the highest lipoprotein(a) group (≧18.4 nmol/L) had a 4-fold higher risk than those with the lowest group (<7.1 nmol/L) (adjusted hazard ratio: 3.98[1.46-10.83],p=0.02).

[Conclusions]
: Patients with high lipoprotein(a) levels may have an unfavorable outcome compared to those with low levels undergoing stent-less PCI with PCBs.
Abstract 4144219: Safety and Efficacy of Rechallenging Immune Checkpoint Inhibitors After Discontinuation Due to Immune-Associated Myocarditis in Cancer Patients
Authors: Zhang Jian , Han Mengxiao , Li Zheng , Wang Yan , Cheng Leilei
Published: November 2024

Background:
Immune checkpoint inhibitor-associated myocarditis (ICIAM), a highly fatal immune-related adverse event (irAE) in cancer patients receiving immune checkpoint blockade (ICB) therapy, necessitates immediate termination of ICB once diagnosed.

Research Questions:
However, no studies have yet explored how to safely and effectively rechallenge ICB for long-term tumor control.

Aims:
To investigate the clinical course, treatment, and prognosis of patients with ICIAM undergoing ICB rechallenge (ICBR).

Methods:
This study retrospectively evaluated consecutive patients admitted to Zhongshan Hospital with clinically diagnosed ICIAM according to the 2022 European Society of Cardiology (ESC) guidelines from January 2020 to April 2022. Clinical, biological, imaging, treatment, and prognostic data were collected. Patients were grouped based on the recurrence of irAE following ICBR.

Results:
A total of 23 ICIAM patients (64.39 ± 9.40 years) who underwent ICBR were included. According to the Common Terminology Criteria for Adverse Events (CTCAE), myocarditis grades were: 11 patients (47.83%) with grade 1, 5 patients (21.74%) with grade 2, and 7 patients (30.43%) with grade 3. The median initial cardiac troponin T (cTnT) was 0.072 ng/ml (IQR, 0.037-0.096). Fourteen patients (60.87%) were administered glucocorticosteroids (GC). Twelve patients (52.17%) reported a recurrence of irAE following ICBR, including elevated cTnT (58.33%), pneumonia (16.67%), enteritis (8.33%), thyroiditis (8.33%), hypocortisolism (8.33%), and hemophagocytic syndrome (8.33%). A higher proportion of patients who developed irAEs following ICBR were administered GC (75% vs. 45.45%, p<0.001). The median progression-free survival (mPFS) was 8.5 months (95% CI: 6, NA) after ICBR.

Conclusions:
Rechallenging immunotherapy for patients with ICIAM was relatively safe and controllable, despite the potential recurrence of non-fatal irAEs. Additionally, patients often achieved better tumor control after ICBR, indicating that ICBR can be a viable option for maintaining long-term tumor management.
Abstract 4144258: Clinical value of bioactive adrenomedullin and proenkephalin A in patients with left ventricular assist devices
Authors: Zayat Rachad , Dogan Leyla , Bergmann Deborah , Hill Aileen , Shoaib Mohammed , Haneya Assad , Kolashov Alish , Khattab Mohammad , Spillner Jan , Goetzenich Andreas , Stoppe Christian
Published: November 2024

Introduction:
In an acute heart failure setting, proenkephalin A 119–159 (penKid) has emerged as a promising prognostic marker for predicting acute kidney injury (AKI) while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion.

Research questions:
This raises the question of whether they can serve as predictive indicators for risk assessment in patients receiving left ventricular assist device (LVAD) implantation.

Aims:
we aimed to study whether pre- and postoperative bio-ADM and penKid levels could predict clinical outcomes in LVAD patients.

Methods:
This observational study prospectively enrolled patients who were undergoing LVAD implantation. Routine laboratory, Plasma levels of PenKid and bio-ADM were assessed at five-time intervals, spanning from pre-induction of anesthesia to 48 hours postoperatively. clinical data and patient outcomes were recorded, with a particular emphasis on right heart failure (RHF) and AKI.

Results:
In 20 patients undergoing LVAD implantation, the bio-ADM levels increased and the penKid levels decreased significantly over time. Preoperative PenKid was a predictor of postoperative AKI (OR: 1.04, 95%-CI: 1.0-1.09;
p
=0.035). Bio-ADM was a predictor of postoperative RHF (OR: 1.10, 95%-CI: 1.01-1.20;
p
=0.025) and early mortality (OR: 1.02, 95%-CI: 1.0-1.03;
p
=0.039). In the ROC analysis bio-ADM as a predictor of post-LVAD RHF had an area under the curve (AUC) of 0.83. Adding bio-ADM to accepted clinical scores for post-LVAD RHF prediction (CRITT-Score and RV-Michigan score) the AUC reached 0.93.

Preoperative bio-ADM was also a useful predictor of early mortality and added prognostic value to the HeartMateII risk score and EuroSCOREII reaching an AUC of 0.96.

Conclusion:
In the present study, the biomarkers penKid and bio-ADM correlated with clinically significant patient outcomes after LVAD implantation, such as AKI and RHF. Adding Bio-ADM to well-established risk scores increased the prognostic value in the prediction of RHF. Preoperative penKid is a helpful marker to predict post-LVAD AKI.
Abstract 4144267: Time Trends in Major Adverse Cardiovascular Events-Related Outcomes After Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis on Sex Differences
Authors: Shojaei Shayan , Mousavi Asma , Soleimani Hamidreza , Takaloo Fatemeh , Parhizkar Roudsari Peyvand , Salabat Dorsa , Shahmohamady Amirreza , Mehrani Mehdi , Seilani Parisa , Ashraf Haleh , Nelson John , Thachil Rosy , Iskander Fady , Khan Safi , Nasir Khurram , Hosseini Kaveh
Published: November 2024

Background:
Percutaneous coronary intervention (PCI) is considered procedure of choice in patients with acute coronary syndrome (ACS). However, whether outcomes of PCI differ by sex remains uncertain.

Hypothesis:
This systematic review and meta-analysis aims to evaluate potential sex-related differences in major adverse cardiovascular events (MACE) after PCI among ACS patients in different timeframes.

Methods:
We conducted a systematic search of Pubmed, Embase, Cochrane, and ClinicalTrials databases to identify relevant randomized controlled trials with ACS patients undergoing PCI. The primary outcome of our article was study defined MACE components (all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, and need for revascularization). We evaluated Our outcomes in different timeframes, short-term (within 1 month after PCI), mid-term (1 month to 1 year), and long-term (>1 year). We used a random-effects model to estimate risk ratios (RR) and 95% confidence intervals (CI). Egger’s test and funnel plots were used to assess publication bias.

Results:
Among 32 trials (78,846 patients; 59,491 men and 19,355 women), at short-term, PCI was associated with higher risk of all-cause mortality (RR=2.51, 95% CI 1.70; 3.71), MI (RR=1.33, 95% CI 1.00; 1.77), and stroke (RR=4.35, 95% CI 1.35; 14.04) in women compared with men. Concerning mid-term outcomes, the male group exhibited significantly lower risk of all-cause mortality, cardiovascular mortality, MI, and stroke compared to women group (RR=1.44, 95% CI 1.21; 1.72), (RR=1.29, 95% CI 1.00; 1.66), (RR=1.16, 95% CI 1.04; 1.28), and (RR=1.49, 95% CI 1.15; 1.93), respectively. Eventually, In the long-term, women were found to have a higher risk of both all-cause mortality (RR=1.27, 95% CI 1.16; 1.40) and cardiovascular mortality (RR=1.26, 95% CI 1.08; 1.48) compared to men. However, in terms of the need for revascularization, men had a higher risk compared to women (RR=0.87, 95% CI 0.77; 0.98).

Conclusion:
In the meta-analysis of PCI related trials in ACS patients, women have a higher risk of cardiovascular events compared to men in different timeframes.
Abstract 4144283: A Novel EMR-Based Algorithm with the Virtual Echocardiography Screening Tool (VEST) to Screen Patients for Pulmonary Arterial Hypertension
Authors: Narowska Gabriela , Anand suneesh , Gangireddy Chethan , Enevoldsen John , Keane Martin , Edmundowicz Daniel , Forfia Paul , Vaidya Anjali
Published: November 2024

Introduction:
Pulmonary arterial hypertension (PAH) remains an underrecognized, fatal disease. Limited awareness, non-specific symptoms, and late referral to accredited PH centers all contribute to an overall poor prognosis. The previously validated Virtual Echocardiography Screening Tool (VEST) uses 3 routine transthoracic echocardiogram (TTE) parameters (left atrial size, transmitral E:e’ and systolic interventricular septal flattening) to recognize a high PAH likelihood. A positive VEST score has been shown to have 80% sensitivity and 76% specificity for PAH hemodynamics, while a VEST score of +3 has 92.7% specificity for PAH hemodynamics with a positive predictive value of 88.0%.

Aim:
We aimed to implement a novel algorithm via our electronic medical record (EMR) as an automated VEST calculator to identify patients with a high likelihood of PAH.

Methods:
An automated EMR VEST calculator was applied retrospectively to 4,952 patients who underwent TTE with TR velocity >/= 2.9 m/s at an accredited PH center from 12/2021-8/2023. Automated EMR VEST scores were validated by comparison to 60 manually scored echocardiograms. Those with VEST score of +3 (highest risk for PAH) underwent chart review to identify whether they were seen by a PH specialist.

Results:
There was 100% correlation between the automated EMR VEST scores and the manual results.

Of the 4,952 patients, 1,655 had a positive automated EMR VEST score, and 355 had a score of +3, predicting the highest likelihood of PAH and warranting urgent referral to an accredited PH center. Of those patients with a +3 score, 103 (29.0%) were never seen by a PH specialist (Fig 1).

Conclusion:
VEST is a validated, noninvasive and accessible screening tool for identification of patients with a high likelihood of PAH likely to benefit from early referral to a PH center. We present a novel, accurate, and automated EMR algorithm for determination of the VEST score to prompt urgent referral for PH expert evaluation and timely initiation of complex medical therapies. These findings highlight the potential of future artificial intelligence and machine-learning applications for improved recognition of life-threatening PAH.
Abstract 4144303: Long-Term Blood Pressure Variability is Associated With Risk for Sudden Cardiac Death: Cardiovascular Lifetime Risk Pooling Project (LRPP)
Authors: Patel Ritam , Ning Hongyan , Wilkins John , Lloyd-Jones Donald
Published: November 2024

Background:
Higher blood-pressure variability (BPV) across multiple visits has been associated with greater risk for mortality and adverse cardiovascular and neurocognitive outcomes. However, no studies have examined associations of BPV with sudden cardiac death (SCD), a leading mechanism of death among adults.

Methods:
We used individual-level participant (ppt) data from 5 cohorts that are included in the LRPP dataset, (CARDIA, ARIC, Framingham Original and Offspring, and CHS), using baseline visits from the 1980s-2000s. We included ppts aged 40-80 years with at least 3 blood pressure (BP) measurements. Visit-to-visit BPV was quantified over 15 years using the standard deviation (SD) across all visits or the average real variability (ARV; average absolute difference between successive BP measurements, also taking the order of the BP measurements into account). SCD was adjudicated by each cohort using standardized definitions. Cox models (adjusted for covariates) were assessed to examine associations of BPV measures with SCD.

Results:
There were 23,499 ppts (mean age 52.7±8.7 years, 55.3% women, 16.9% Black) followed for 15 years for BPV data and then for 10.3±6.6 years for SCD; 484 ppts (2.1%) experienced SCD. The mean SD and ARV were 11.1±6.3 and 11.9±7.3 mm Hg for systolic BP, 6.4±3.5 and 7.0±4.0 mm Hg for diastolic BP, and 7.0±3.9 and 7.8±4.6 mmHg for mean arterial pressure (MAP), respectively. After adjustment for age, sex, and race, each 1 mm Hg greater SD or ARV in MAP was associated with 9% (95% CI, 7-11%) or 6% (95% CI, 5-8%) higher hazards for SCD, respectively (Table). Associations of BPV with SCD were partially attenuated but remained significant after adjustment for other risk factors, baseline BP, and change in BP from baseline to end of observation. The pattern of results was overall similar for MAP, systolic BP, and diastolic BP. Ppts in the highest vs lowest quartiles of BPV were at approximately 50% higher adjusted risk for SCD (Table).

Conclusions:
Long-term BPV in middle age is associated with SCD, even after adjusting for underlying BP change with age and other risk factors. BPV may be useful as a marker to identify individuals in the general population at higher risk for sudden death.
Abstract 4144315: Impact of Smartphone-based Atrial Fibrillation Burden (SMURDEN) on Quality-of-Life Improvement; Insights from DECAAF II
Authors: bidaoui ghassan , Lim Chanho , Tirado Polo Francisco , Bsoul Mayana , Assaf Ala' , Younes Hadi , Chouman Nour , Feng Han , Liu Yingshuo , Jia Yishi , Hassan Abboud , Tsakiris Eli , Abi-Rached Joe , Hui Yanpei , Ademi Besim , Mekhael Mario , Noujaim Charbel , Rao Swati , Kreidieh Omar , donnellan eoin , Pandey Amitabh , Marrouche Nassir
Published: November 2024

Background:
While numerous studies and clinical trials utilize smartphone based 30-second electrocardiogram (ECG) strips to assess the outcome of AF treatment, the direct association of AF burden with the quality of life (QoL) is yet to be established.

Purpose:
To discover the influence of smartphone-based AF Burden on QoL and symptom improvement after catheter ablation.

Methods:
We study the AF burden collected from the DECAAF II trial. The trial consists of persistent AF patients who provided daily single-lead ECG strips after ablation. We defined AF burden as the ratio of days with AF detected to the number of days with submitted ECG strips. A total number of 230,892 single-lead ECG strips were submitted. The AFSS and SF-36 questionnaires were administered pre-ablation, at 3 months, and at 12 months post-ablation. Our analyses include all patients with AF burden and completed questionnaires and those who had arrhythmia recurrence. With the two groups, we assessed the associations amongst AF burden, AFSS symptom severity score improvement, and SF-36 improvement through multiple linear regression analysis, controlling for possible confounders.

Results:
507 persistent AF patients with a mean of 62 ±9 met our inclusion criteria. Patients submitted ECG strips on most days each month throughout the follow-up period, suggesting high compliance as shown. AFSS symptom score was 12±8 at baseline and improved by 7±8 points on average. AF burden was 19%±7 in the follow-up period. After controlling for age, sex, comorbidities, baseline AFSS score, and left atrial volume, AF burden was found to be inversely associated with AFSS symptom score improvement (beta=-5.201 p=<0.001). This association was also significant in patients who recurred (Beta=-3.45 p=0.04). Similarly, AF burden was associated with improved functional status through SF-36 after ablation even after controlling for all the aforementioned factors including baseline SF-36(Beta= 20.641, p-value= <0.001). These results highlight the importance of AF burden as a measure of treatment success compared to the binary outcome of recurrence.

Conclusion:
Smartphone-based AF burden adversely affects symptom severity and functional status improvement after ablation in persistent AF patients even in patients who had a recurrence, highlighting to need to incorporate it in our definition of ablation success.
Abstract 4144347: Evaluating Hospital Volume Based Outcomes on Catheter Ablation for Atrial Fibrillation; A National Registry Study
Authors: Bouza Sean , Wahood Waseem , Curry Bryan , Lal Kunal
Published: November 2024

Introduction:
Catheter ablation is a common treatment of atrial fibrillation (AFib). However, the relationship between hospital procedural volume and patient outcomes remains unclear. This study aims to investigate whether the volume of catheter ablation procedures performed for AFib at a hospital influences patient outcomes. It is hypothesized that hospitals with higher procedure volumes will demonstrate superior outcomes due to staff expertise, protocols, and resource allocation.

Methods:
National Inpatient Sample (NIS) was queried from 2005 to 2020 for admissions involving catheter ablation for atrial fibrillation. Hospitals were divided into tertiles based on their volume of catheter ablation. Multivariable, Hierarchical logistic regression was utilized to assess risk factors of in-hospital mortality, discharge other than home (DOTH), and vascular complications. Negative binomial regression was utilized to assess factors of total charge and length of stay (LOS) of the two higher volume tertiles, to the first, lowest volume, tertile.

Results:
A total of 534,097 admissions were identified;182,354 (34.1%) in the lowest tertile, 178,525 (33.4%) in the 2nd tertile and 173,219 (32.4%) in the 3rd and highest tertile. Those in the 2nd and 3rd tertiles had similar odds of in-hospital mortality compared to the first tertile (2nd: OR: 1.05, p=0.62; 3rd: OR: 0.86, p=0.17). Those in the 2nd and 3rd tertiles had lower odds of DOTH compared to the first tertile (2nd: 0.85, p<0.001; 3rd: OR: 0.75, p<0.001). Those in the 2nd tertile had similar odds of vascular complications compared to the first tertile (OR: 0.87, p=0.16), while those in the 3rd tertile had lower odds of vascular complications (OR: 0.71, p=0.001). Compared to the first tertile, those in the 2nd and 3rd tertiles were associated with lower average LOS by 9.7% (p<0.001) and 20.4% (p<0.001), respectively. There was no difference in total charge among the 2nd and 3rd tertiles compared to the first tertile (2nd: Coef: -1.9%, p=0.17; 3rd: Coef: 0.9%, p=0.69).

Conclusions:
Higher hospital volumes for catheter ablation procedures may be associated with lower odds of DOTH and vascular complications as well as lower average LOS. However, in-hospital mortality and total charge was comparable among the three tertiles. Further research is needed to fully understand the relationship between hospital catheter ablation volume and patient outcomes, including postoperative management and discharge planning.
Abstract 4144353: Evaluating Electrocardiographic Predictors of Left Ventricular Ejection Fraction Decline after Conduction System Pacing: Using Time-to-notch in Lead I
Authors: Chiou Tommy , Treger Jeremy , Gampa Amulya , Roy Dipayon , Aziz Zaid , Beaser Andrew , Yeshwant Srinath , Ozcan Cevher , Upadhyay Gaurav
Published: November 2024

Background:
While conduction system pacing (CSP) has shown promise in mitigating the risk of pacemaker-induced cardiomyopathy compared to traditional right ventricular pacing, some patients undergoing CSP may experience declines in left ventricular ejection fraction (LVEF). We aimed to identify ECG predictors of LVEF decline after left bundle branch area pacing (LBBAP) or deep septal pacing (DSP).

Methods:
Consecutive patients undergoing LBBAP or DSP at a single center who had baseline LVEF >35%, follow-up echocardiogram at least 90 days post-implant, >20% ventricular pacing, and no coronary intervention during follow-up were retrospectively studied. Post-implant ECGs were analyzed for LBBAP capture (delayed RV activation with RSR’ pattern in V
1
or QRS duration <120 msec) or DSP (all others), V6 R wave peak time (<75 msec if narrow QRS or RBBB, <85 msec if LBBB), lead I time to notch >75 msec, and RS/rS pattern in V6. Primary outcome was absolute LVEF decline ≥15%.

Results:
A total of 67 patients met inclusion criteria with mean age 73 years, 45% female, 63% African American, 34% CAD, 18% cardiomyopathy, and 60% median LVEF (IQR 52-68%) at baseline. LBBAP was achieved in 39 (58%) and DSP in 28 (42%). Median pacing at follow-up was 99% over median follow-up of 15.6 (IQR 8-23) months. No differences were noted with respect to demographics, clinical comorbidities, or LBBAP vs DSP among patients with and without LVEF decline ≥15% (Table). Among ECG predictors, notch time in Lead I >75 msec was significant on univariate logistic regression analysis (OR 4.431, 95% CI 1.11-17.72, p=0.035, Figure) and with multivariate adjustment for age, baseline LVEF, history of cardiomyopathy or CAD.

Conclusion:
Lead I notch time >75 msec on post-implant paced ECG was associated with LVEF decline at follow up, albeit with broad confidence intervals. These findings suggest utility in evaluating paced QRS patterns after CSP to identify patients at risk for pacemaker-induced cardiomyopathy.
Abstract 4144360: Neurohormonal therapies at baseline and follow-up and survival in patients with wild-type transthyretin cardiac amyloidosis
Authors: Aimo Alberto , Tini Giacomo , Vergaro Giuseppe , Milani Paolo , Zampieri Mattia , Caponetti Angelo , Fabris Francesca , Foli Andrea , Mazzoni Carlotta , Gagliardi Christian , Longhi Simone , Saturi Giulia , Serenelli Matteo , Fabbri Gioele , De Michieli Laura , Palmiero Giuseppe , Ciliberti Giuseppe , Carigi Samuela , Mandoli Giulia , Rella Valeria , Mussinelli Roberta , Cameli Matteo , Marzo Francesca , Limongelli Giuseppe , Cipriani Alberto , Perlini Stefano , Obici Laura , Perfetto Federico , Sinagra Gianfranco , Merlo Marco , Musumeci Beatrice , Biagini Elena , Cappelli Francesco , Palladini Giovanni , Emdin Michele , Canepa Marco
Published: November 2024

Background:
Transthyretin cardiac amyloidosis (ATTR-CA) typically manifests with heart failure (HF). Discontinuing beta-blockers and avoiding angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) in patients with ATTR-CA has been recommended.

Methods:
We investigated the prescription of neurohormonal therapies and their relationship with all-cause mortality in a multicenter cohort.

Results:
Patients (n=926) had a median age of 79 years (interquartile range 74-83), 90% were men, 17% had a left ventricular ejection fraction (LVEF) ≤40%, and 27% were in New York Heart Association (NYHA) class III/IV. At diagnosis, 60% of patients were on beta-blockers, 58% on ACEi/ARB/ARNI, and 35% on MRA. Patients on beta-blockers had more often NYHA class III/IV, a greater burden of comorbidities, and lower LVEF, and those on ACEi/ARB/ARNI had more comorbidities. Nonetheless, the survival of patients on beta-blockers or ACEi/ARB/ARNI was not significantly shorter over a 2.5-year follow-up (1.6-3.8) (p=0.577 and p=0.977, respectively), and patients on both drugs had not a worse outcome than those not receiving any neurohormonal drug (p=0.575). During the entire follow-up, the number of neurohormonal drugs remained unchanged in 54%, decreased in 27%, and increased in 19%. Patients with a number of neurohormonal drugs either unchanged or increased had a lower risk of mortality (odds ratio 0.71, 95% confidence interval 0.53-0.95, p=0.023).

Conclusions:
ATTRwt-CA patients on beta-blockers or ACEi/ARB/ARNI at diagnosis did not have a shorter survival. Beta-blockers were discontinued less often than ACEi/ARB/ARNI. There was no sign of better outcomes in patients discontinuing these therapies, or worse outcomes in those starting them.
Abstract 4144377: L-2-hydroxyglutarate Attenuates the Accumulation of Long Chain Acylcarnitines in Myocardial Ischemia
Authors: Vigder Niv , He Huamei , Tumanov Sergey , Watermeyer Georgia , Mulhern Ryan , Cordwell Stuart , Loscalzo Joseph
Published: November 2024

Mammalian cells have several adaptive mechanisms to counteract the adverse effects of metabolic and redox stress induced by ischemia. Hypoxia, a hallmark of ischemia, results in the selective reduction of the tricarboxylic acid cycle metabolite, α-ketoglutarate, to the
L
-(
S
)-enantiomer of 2-hydroxyglutarate (L2HG) in several cell types. L2HG protects hypoxic cells by buffering increases in the NADH/NAD
+
redox couple and inhibiting mitochondrial electron transport. In addition, the accumulation of L2HG induced by genetic knockout of L2HG dehydrogenase (L2HGDH), the only known enzyme capable of oxidizing L2HG back to α-ketoglutarate, protects mice against myocardial injury during ischemia. This protection by L2HG manifests as decreased myocardial infarct size and improved cardiac function, owing partly to a metabolic shift in carbon flux from glycolysis towards the pentose phosphate pathway. However, myocardial ischemia also leads to perturbations in fatty acid metabolism as manifest by accumulation of acylcarnitines and acyl-CoA’s. It remains unclear as to whether or not L2HG accumulation affects fatty acid metabolic homeostasis during myocardial ischemia. Here, we induced L2HG accumulation by homozygous deletion of the
l2hgdh
gene in male mice (

l2hgdh
-/-

; n=12). Hearts isolated from these mice and their wild-type littermates (
l2hgdh
+/+
; n=13) were subjected to
ex vivo
Langendorff perfusion at coronary perfusion pressure of 80 mmHg for 30 min with (ischemic group) or without (control group) subsequent perfusion at ~10% pressure for 90 min. Using liquid chromatography tandem mass spectrometry (LC-MS/MS)-based nontargeted lipidomics, we identified several species of long chain acylcarnitines that accumulated by ischemia in hearts obtained from
L2HGDH
+/+
mice [linoleoyl carnitine, palmitoyl carnitine, and hydroxy-linoleoyl carnitine increased by 13.2-fold (p=4.2 x 10
-6
), 10.7-fold (p=1.7 x 10
-6
), and 10.0-fold (p=5.8 x 10
-6
), respectively]. Interestingly, however, this accumulation was attenuated substantially in ischemic hearts obtained from

L2HGDH
-/-

mice [hydroxy-linoleoyl carnitine, palmitoyl carnitine, and linoleoyl carnitine were downregulated by 62.6% (p=0.034), 54.2% (p=0.018), and 35.4% (p=0.054) in ischemic hearts from

L2HGDH
-/-

mice when compared to

L2HGD
+/+

littermates]. Overall, these findings highlight a novel and potentially important role for L2HG in restoring the perturbations in fatty acid metabolism induced by myocardial ischemia.
Abstract 4144421: Factors Associated with Delay Presentation of Acute Ischemic Stroke to Emergency Department in Oman
Authors: AL Hadabi Fatma , AL Hadhrami Mohammed , Al Saidi Ahmed , AttaUllah Raheela , Alshahri Muna , AL-Hashmi Amal
Published: November 2024

Abstract

Background:
Stroke is a leading cause of death and disability worldwide and a significant burden on healthcare systems globally. Despite the effectiveness of tissue plasminogen activator (tPA) within 4.5 hours of the onset of acute ischemic stroke (IS), many patients arrive at the emergency department beyond the window to perform intravenous thrombolysis.

Study objectives:
This study investigated factors contributing to the delayed presentation of acute patients with stroke to emergency departments across governorate hospitals in Oman and assessed neurological function at 90 days using the Modified Rankin Scale.

Methods:
A prospective observational cohort multi-center study was conducted involving 512 participants with acute ischemic stroke symptoms who arrived at the emergency departments more than 4.5 hours after symptom onset. Data were collected using questionnaires administered to participants or their relatives to identify reasons for delayed arrival. Key variables included socio-demographic characteristics, symptom type, mode of arrival, and follow-up outcomes. Statistical analysis was performed to assess associations between these variables and participant outcomes.

Results:
The mean age of the participants was 61.96 years, with a majority being male (65.2%) and Omani nationals (81.3%). The most common symptoms were upper limb weakness (67.8%), lower limb weakness (60.4%), and inability to speak (56.7%). The primary mode of transfer to the hospital was by a relative (62.3%). Significant findings included; Delayed Arrival: Confusion, falls, and facial weakness were associated with the fastest median arrival times, while memory loss, loss of facial sensation, and abnormal eye movements were associated with the longest delays. Reasons for Delay: Common reasons for delay included lack of awareness of stroke symptoms (36.7%), believing symptoms would self-resolve (29.7%), and not knowing the importance of timely hospital arrival (31.9%). Outcomes: At 90 days, 36.3% had mild disability, 50.0% had moderate to severe disability, and 13.7% had died.

Conclusion:
Delayed hospital arrival in participants with stroke is influenced by various factors, including symptom type, mode of arrival, and socio-demographic characteristics. Enhancing public awareness about stroke symptoms and the importance of timely medical intervention could improve outcomes. This study provides valuable insights for improving stroke management and patient education in Oman.
Abstract 4144431: Machine Learning to Differentiate Myocardial Infarction with Obstructive versus Non-Obstructive Coronary Artery Disease
Authors: Patel Shubh , Deng Jiawen , Fung Marinda , Rubin Barry , Wang Bo , Anderson Todd , Subasri Vallijah
Published: November 2024

Background:
Myocardial infarction (MI) can occur with or without coronary artery disease, classified as myocardial infarction with non-obstructive coronary artery disease (MINOCA) and MI with obstructive coronary artery disease (MICAD), respectively. Differentiating between these conditions is important as they require potentially different diagnostic and therapeutic approaches. No pre-test probability score currently exists to aid in this differentiation. This study aims to develop and validate machine learning (ML) models to predict whether a patient with suspected MI has MINOCA or MICAD.

Methods:
Data from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database, including patients who underwent their first cardiac catheterization for chest pain or an anginal equivalent from 2002 to 2017, was used. We analyzed a cohort of 53,348 patients suspected of having myocardial infarction. For machine learning model development, 20 demographic and clinical features were selected using the Boruta algorithm. The dataset was divided into training (80%) and testing (20%) sets. Model performance was evaluated using 5-fold cross-validation, and the area under the receiver operating characteristic curve (AUROC) was the primary metric for model evaluation.

Results:
Among the five machine learning models trained, the XGBoost model showed superior performance, achieving an AUROC of 0.76 [95% CI: 0.76–0.77] and an accuracy of 0.86 during internal validation. Logistic regression achieved an AUROC of 0.74 [95% CI: 0.74–0.74]. Calibration of the XGBoost model was assessed via a calibration plot, which showed good agreement between predicted probabilities and observed event probabilities, with a Brier score of 0.10.

Conclusions:
The developed ML models demonstrated moderate accuracy for predicting MICAD versus MINOCA using clinically relevant features. Implementing such models in clinical practice could guide alternative diagnostic approaches for patients with suspected MINOCA.
Abstract 4144459: Sex Differences in Lipid Measurement, LDL-C Goal Attainment, and Prescribing Practices
Authors: Vartak Natasha , Weintraub Spencer , Huang Xueqi , Ong Caroline , Fishbein Joanna , Parikh Nisha , Rosen Stacey , Gianos Eugenia
Published: November 2024

Background:
ASCVD is the leading cause of death in women worldwide. Historically, lipid lowering therapy (LLT) and LDL-C goal attainment have been suboptimal in women.

Aim:
We aim to investigate sex differences in lipid measurement, LDL-C goal attainment, and prescribing practices within our health system.

Methods:
We performed a retrospective chart review of adult patients with lipid panels performed between 2022 and 2023 in a large health system. We abstracted demographics, comorbidities, lipid levels, LLT, and prescriptions from the electronic health records. Optimal LDL-C was defined as <70 mg/dL for high-risk patients with ASCVD and <100 mg/dL for the rest of the population.

Results:
Among 364,021 patients, 57% were female, 60% were White, 10% Black, 6% Asian, 14% Other, and 10% unknown; 12% were Hispanic or Latino with ASCVD noted in 7% of women and 13% of men. Mean LDL-C was 108 mg/dL ± 35 in women vs. 102 mg/dL ± 37 in men. Overall optimal LDL-C was achieved in 41% of women vs. 47% of men; 31% women vs. 47% men with ASCVD achieved goal LDL-C. LDL-C was ordered primarily by primary care (74% and 69%) and cardiology (12% and 17%), in men and women respectively, compared to other specialties.

Statins were most often prescribed by primary care (61%) and cardiology (31%). Cardiology prescribed more frequently to men compared to women (55% vs. 45%); primary care prescribed more often to women compared to men (53% vs. 47%). Non-statin prescriptions were more common by cardiology (57%) and primary care (34%). Overall, men were more frequently prescribed statins than women (33% vs 26%) and amongst ASCVD patients, men had higher prescriptions rates of high intensity statins compared to women (31% vs. 24%) (Figure 1A-D). Results were statistically significant (p<0.01) for all comparisons between men and women.

Conclusions:
In our study, women had higher mean LDL-C and suboptimal LDL-C levels compared to men. Women with ASCVD were less frequently prescribed high intensity statins. Most LDL-C orders and statin prescriptions were by primary care, but women experienced treatment disparities even when treated by cardiologists, highlighting the need for increased awareness and education around sex disparities in lipid management.
Abstract 4144467: Associations between High-density Lipoprotein Cholesterol Efflux and Brain Health
Authors: Giacona John , Wang Jijia , Zhang Rong , Kelley Brendan , Hajjar Ihab , Thomas Binu , Lacritz Laura , Yu Fang , de Lemos James , Rohatgi Anand , Vongpatanasin Wanpen
Published: November 2024

Previous studies have linked plasma levels of high-density lipoprotein cholesterol (HDL-C) with impaired cognitive function. However, few studies have investigated the associations between plasma HDL functionality and brain structure and function. Thus, our study aimed to elucidate the associations between plasma HDL measures and brain structure/function in a multiethnic cohort of middle-aged adults.

Accordingly, we conducted a cross-sectional study in 1,826 adults (mean age 51.0±9.7 years, 58% female, 47% Black adults) without preexisting cardiovascular disease or stroke who participated in the Dallas Heart Study to determine associations between HDL measures and brain structure/function. Whole brain white matter hyperintensities (WMH) and grey matter volume (GMV) was measured using a 3-T MRI scanner and normalized to total cranial volume (TCV), and the Montreal Cognitive Assessment (MoCA) was used to measure cognition. HDL cholesterol efflux capacity (HDL-CEC) was assessed using fluorescence-labeled cholesterol efflux from J774 macrophages and was expressed in arbitrary units. HDL particle measures were assessed using NMR spectroscopy. Adjusted multivariable linear regression models were performed with standardized beta estimates reported.

Higher HDL-CEC and small HDL particles (HDL-P) were positively associated with GMV/TCV after adjustment for relevant risk factors (β=0.078 [95% CI: 0.029, 0.126],
Figure
, and β=0.063 [95% CI: 0.014, 0.111], respectively, all p<0.05). Conversely, there were no associations between HDL measures and WMH or MoCA after adjustment (all p>0.05). Associations of HDL-CEC and small HDL-P with GMV were not modified by race/ethnicity or ApoE-ε4 status.

In conclusion, higher HDL function and small HDL-P were associated with higher GMV after adjustment for traditional risk factors and were not modified by race/ethnicity or ApoE-ε4 carrier status. As such, these findings suggest that better HDL functionality is linked with larger brain GM volume in middle-aged adults. Since GMV loss has been linked to the development of mild cognitive impairment (MCI) and conversion of MCI to Alzheimer's disease, our study may have implications for prevention of age-related decline in cognitive function.