bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4140634: Instantaneous Classification of Myocardial No-Reflow Size from a Carotid Pressure Waveform: A Physics-Based Machine Learning Approach
Authors: Li Jiajun , Alavi Rashid , Dai Wangde , Matthews Ray , Kloner Robert , Pahlevan Niema
Published: November 2024

Introduction:
It was recently shown that the Intrinsic Frequency (IF) method, a systems approach for evaluating cardiovascular dynamics, combined with machine learning (ML) algorithms, instantaneously detects acute myocardial infarction (MI) or ischemia in rats (Alavi et al., European Heart Journal Open, 2023, PMID:37849787). Here, we aim to classify myocardial no-reflow size (NR) from carotid pressure waveforms using a hybrid physics-based ML approach.

Methods:
We used the standard occlusion/reperfusion MI rat model (Sprague Dawley; Female; n=88) and induced necrosis via a 30-minute proximal left coronary artery occlusion followed by 3 hours of reperfusion. IFs were computed from carotid pressure waveforms measured 2 hours post-reperfusion. NR sizes (i.e., mass percentage of no-reflow over total left ventricle (LV)) were determined via histopathology (visualized by non-fluorescent area which did not receive thioflavin-S, Fig.1), ranging from NR=0.8% to 38.8%. NR=15% was used as the classification cut-off for mild and severe NR size classes. A support vector machine (SVC) model was developed using IFs and diastolic pressure of n=66 rats. K-fold cross-validation (k=5) was used to prevent overfitting. Finally, the model was blindly tested on n=22 additional rats.

Results:
Our ML classifier model showed overall accuracy of 92% for all data when predicting the true class of NR, i.e., severe or mild (Fig.1). The model also showed a high accuracy of 73% using blind test rats.

Conclusions:
Our results suggest that a hybrid IF-based ML approach can determine the severity of no-reflow zone using a single arterial pressure waveform, independent of advanced imaging techniques. The no-reflow phenomenon is clinically significant (distinct from infarct size) as it is linked to LV microvascular damage, LV remodeling, and thus patient recovery after reperfusion. Since IFs can be measured remotely and noninvasively e.g., via smartphones or wearables, our approach has significant potential for instantaneous pre-hospital identification of patients at risk for outcomes post-MI (e.g., heart failure or mortality).
Abstract 4140639: Efficacy of Remote Patient Monitoring in Managing Hypertension in Federally Qualified Health Centers versus Primary Care Settings
Authors: Flanagan Craig , Colbert Brett , Davis Kevin , Smith Wesley
Published: November 2024

Background:
Remote patient monitoring (RPM) has proven highly effective in managing hypertension (HTN). A key strength of RPM lies in its ability to continuously monitor patients, especially those with limited access to traditional healthcare settings.

Hypothesis:
Do patients in Federally Qualified Health Centers (FQHCs) respond to RPM for HTN management as effectively as patients in traditional primary care settings (PC)?

Goals/Aims:
To compare the effectiveness of RPM between FQHC and traditional primary care populations. Specifically, we focused on patients who transmitted data at least 50% of the time, consistent with the CPT code for RPM billing, and who had been on the program for at least one year.

Methods:
Patients were equipped with cellular-enabled BP cuffs. Clinical staff met monthly with patients to review data and discuss lifestyle changes. Patients with an average SBP ≥140 mmHg or DBP ≥90 mmHg during the first 7 days, enrolled for ≥365 days, and transmitted data ≥50% of days, were analyzed. Data comparisons were made between the average of the first seven BP readings and the last seven BP readings.

Results/Data:
The PC group (n = 495) averaged 640 ± 280 days on the program, while FQHC patients (n = 429) averaged 599 ± 136 days. Both groups demonstrated significant improvements (p < 0.0001) with RPM. PC patients reduced SBP from 150.7 to 135.2 mmHg (-15.5), and FQHC patients improved from 152.3 to 134.9 mmHg (-17.4). Baseline and final SBP readings were not significantly different between groups. DBP also markedly improved (P < 0.0001): PC from 86.4 to 77.7 mmHg (-8.7 mmHg) and FQHC from 92.4 to 81.9 mmHg (-10.6 mmHg). FQHC patients had higher DBP at both baseline and study end (p < 0.0001). Surprisingly, FQHC patients experienced a greater improvement in mean arterial pressure (MAP) compared to PC patients (-11.1% vs. -9.9%; p < 0.05). Average transmission frequency was higher in PC patients (73.3%) compared to FQHC patients (70.3%; p < 0.01).

Conclusion:
RPM significantly improves HTN management, leading to substantial reductions in blood pressure and MAP in both FQHC and primary care populations. These findings support RPM as an effective tool for managing hypertension remotely and enhancing health equity, making it a valuable strategy in diverse healthcare settings.
Abstract 4140642: Comparative Analysis of Prodromal Symptoms in Head-Up Tilt Test vs. Spontaneous Vasovagal Syncope
Authors: Babaei Mohammadreza , Mehrani Mehdi , Tavolinejad Hamed , Bozorgi Ali , Sadeghian Saeed , Vasheghani Farahani Ali , Yadangi Somaye , Aminorroaya Arya , Tajdini Masih
Published: November 2024

Background:
The diagnosis of VVS largely relies on clinical history and simple diagnostic tools (e.g., electrocardiogram) to rule out dangerous differential diagnoses. However, using the head-up tilt test (HUTT) has become controversial among clinicians. This retrospective study aims to evaluate whether the prodromal symptoms experienced during HUTT are consistent with those experienced during spontaneous syncope.

Methods:
This study utilized data from the HUTT registry at the Syncope Unit of the tertiary Heart Center, focusing on adults aged 18 and older diagnosed with VVS. Diagnoses were based on clinical histories, physical examinations, and the latest syncope guidelines. Out of 1914 patients with HUTT results, 764 patients with positive tests were analyzed for mutual prodromal symptoms during HUTT and spontaneous syncope.

Results:
The McNemar test revealed significant differences for several symptoms, including palpitation (X2 = 30.59, P < 0.001), nausea (X2 = 16.13, P < 0.001), chest pain (X2 = 24.32, P < 0.001), abdominal discomfort (X2 = 22.33, P < 0.001), flushing (X2 = 10.87, P < 0.001), and aura (X2 = 19.86, P < 0.001), indicating discrepancies in the occurrence of these symptoms. Cohen's Kappa values ranged from 0.06 to 0.32, signifying slight to fair agreement. Specifically, diaphoresis (k = 0.32), palpitation (k = 0.27), and vertigo (k = 0.25) demonstrated fair agreement, whereas nausea, aura, chest pain, abdominal discomfort, and flushing exhibited slight agreement. Among the 640 patients who experienced prodrome during spontaneous syncope, 110 (17.19%) had no symptoms. Conversely, among the 123 patients who did not experience prodrome, 96 (78.05%) experienced at least one symptom during the tilt test (Figure).

Conclusion:
The assessment of prodromal symptoms during HUTT compared to spontaneous syncope showed significant differences for several symptoms and overall low levels of agreement. Also, tilt cannot differentiate patients with or without prodrome during their spontaneous spells.
Abstract 4140651: Effect of Statin Therapy on Cardiovascular Events in High-Risk Group Identified by a Coronary Artery Calcium-Trained Deep Learning Model Using Retinal Imaging: A Propensity Score-Matched Study from the UK Biobank
Authors: Cho Yunnie , Rim Tyler Hyungtaek , Lee Chan Joo , Park Sung Ha , Kim Hyeonmin , Seo Chanyang , Yu Marco , Thakur Sahil , Wong Tien , Cheng Ching Yu
Published: November 2024

Introduction:
Cardiovascular disease (CVD) remains the leading cause of mortality globally, necessitating improved risk stratification and preventive strategies. Reti-CVD, a deep learning model, predicts CVD risk by analyzing retinal images to detect subtle vascular changes indicative of coronary artery calcium presence. This study evaluates the efficacy of statin therapy in individuals identified as high-risk by Reti-CVD using propensity score matching and survival analysis.

Hypothesis:
Individuals with high Reti-CVD scores will benefit significantly from statin therapy, resulting in a reduced incidence of cardiovascular events compared to those not receiving statins.

Methods:
Data from the UK Biobank were utilized to perform 1:1 propensity score matching, comparing statin users and non-users. Matching was based on age, gender, race, BMI, systolic blood pressure, diastolic blood pressure, medication use for blood pressure, diabetes status, smoking status, alcohol consumption, and socioeconomic status. Within a cohort identified as high-risk by a deep learning model, survival analysis of a mean follow-up period of 9.83 years for CVD outcomes was conducted, with the hazard ratio calculated for statin users versus non-users.

Results:
In the unmatched cohort, significant differences were observed in several variables including age and gender between statin users (n=3,008) and non-users (n=42,373) as shown in Table 1. Post-matching, the cohort comprised 3,008 statin users and 3,008 non-users, with standardized mean differences significantly reduced for most variables. For the high Reti-CVD cohort, the hazard ratio for CVD outcomes in the statin group was 0.76 (95% CI: 0.50-1.14), indicating a 24% reduction in the risk of cardiovascular events compared to non-users. In comparison, the low to medium Reti-CVD cohort had a hazard ratio of 1.22 (95% CI: 0.90-1.68).

Discussion:
Findings suggest that individuals with high Reti-CVD scores likely benefit from statin therapy, as indicated by a trend towards reduced cardiovascular events. Reti-CVD shows potential in refining risk stratification for guiding statin therapy decisions. The integration of deep learning models like Reti-CVD in clinical practice could provide targeted interventions for high-risk populations.
Abstract 4140672: Integrated Bioinformatic Analysis of the Shared Molecular Mechanisms Between Osteoporosis and Aortic Stenosis
Authors: Yang Yuejiao , Tang Liang , He Yang , Zhu Zhaowei , huang yiyuan , Zhou Shenghua
Published: November 2024

Background:
osteoporosis (OP) and aortic stenosis (AS) are common in the elderly population, conferring a heavy world burden. Several epidemiological studies show a correlation between AS and OP independent of aging. However, the molecular and cellular mechanisms underlying stenotic calcification and OP remain poorly understood. Herein, this study aimed to identify crosstalk genes between OP and AS and potential mechanism.

Method:
AS and OP datasets were downloaded from the GEO database and were performed Weighted Gene Co-Expression Network Analysis (WGCNA) to get common key genes, and differential expression analysis to get common differentially expressed genes (DEGs). We also analyzed the protein–protein interactions (PPIs) of the common key genes and DEGs using the NetworkAnalyst online tool to find the intersection of correlated genes in OP and AS, the top 20 genes in each algorithm were selected as the candidate genes and the genes were calculated by more than six algorithms at the same time were chosen as candidate genes. We downloaded genes related to AS in the Comparative Toxicogenomics Database (CTD) to get the intersection with candidate genes as hub genes. The hub genes were certified in another OP dataset and AS dataset downloaded from GEO respectively.

Result:
665 common Genes from WGCNA, which were enriched in the myeloid leukocyte activation, secretory granule membrane, cell adhesion molecules.13 of them were screened as candidate genes by 12 prediction algorithms in the Cytoscape. 161 common DEGs were differentiated in another AS database and OP database, which were enriched in natural killer cell mediated immunity, collagen-containing extracellular.19 genes were recognized as candidate genes by Cytoscape in the same way. 15 hub genes were selected by intersecting with candidate genes and genes downloaded from CTD as hub genes, including CD226, CD247, CD38, CD4, CD96, FCGR2B, GNG2, GRB2, GAMB, HSD17B6, ITGB2, KSD17B6, ITGB2, KLRB1, NGF, PECAM1, SDC1. The transcription factors hub genes interaction network was constructed using TRRUST. Hub genes were certified in another AS and OP dataset. CD4, GZMB, SDC1 are upregulated remarkably in AS dataset, whereas SDC1 and ITGB2 are downregulated and GZMB is upregulated in OP dataset.

Conclusion:
GZMB, SDC1may be potential hub genes in AS and OP, through bioinformatic analysis, we identified potential biomarkers and therapeutic targets for AS and OP, providing a theoretical basis for future studies.
Abstract 4140688: Bioactive Oxylipins Predict Aortic Vascular Calcification Severity in Heart Failure with Preserved Ejection Fraction
Authors: Aradhyula Vaishnavi , Fares Anas , Vergis John , Dube Prabhatchandra , Sherafati Alborz , Kloster Alex , XKhatib-ShahidiX XBellaX , Elzanaty Ahmed , Sajdeya Omar , Manandhar Sareeta , Maddipati Krishna Rao , Brewster Pamela , Smith Robert , Haller Steven , Kennedy David , Khouri Samer , Gupta Rajesh
Published: November 2024

Background:
Aortic calcification has been significantly linked to the development of heart failure with preserved ejection fraction (HFpEF). Both HFpEF and aortic calcification are associated with inflammation, vascular dysfunction, and remodeling. Circulating polyunsaturated fatty acid oxidized lipids, or oxylipins, have been well described to initiate and resolve inflammation in cardiovascular disease. We questioned the role of these bioactive oxylipins in predicting aortic vascular calcification severity in HFpEF.

Hypothesis:
We hypothesize that oxylipins can predict and distinguish aortic vascular calcification severity in HFpEF patients.

Methods:
We collected venous blood samples during right heart catheterization from 57 HFpEF patients. We categorized patients by CT-based aortic vascular calcification severity: none (control; n=8), mild (<25%, n=14), moderate (26-50%, n=9), and severe (>50%, n=26). We measured 143 oxylipins in all study participants using mass spectrometry. Along with unpaired T-tests, machine learning analysis was used to determine oxylipin permutation importance and evaluate predictive accuracy for aortic vascular calcification severity.

Results:
Demographic variables showed no significant differences between groups. Pro-inflammatory TXB2 levels were elevated in severe aortic calcification vs control (p=0.036). This is further substantiated by increased 12(S)-HHTrE (a degradation product of TXA2) levels in severe aortic calcification vs control (p=0.0266). Anti-inflammatory 7(8)-EpDPE was also elevated in severe aortic calcification compared to control (p=0.0067). Finally, the inactivated anti-inflammatory 5,6 DiHETrE levels were higher in severe aortic calcification vs control (p=0.019). Out of 143 oxylipins, the 12-lipid panel of 5(S),15(S)-DiHETE, 5,6-DiHETrE, PGE2, 4-HDoHE, 15-keto PGE2, 11dh-2,3-dinor TXB2, iPF-VI, 19,20-DiHDoPE, 9(S)-HOTrE, 13,14dh-15k-PGE2, 5-oxoETE, and PD1 were the most significant predictors of severe (n=26) vs non-severe (none, mild, moderate; n=31) aortic vascular calcification, with 100% predictive accuracy.

Conclusion:
In HFpEF patients, aortic vascular calcification severity can be predicted with remarkable accuracy by a novel panel of circulating, bioactive venous oxylipins.
Abstract 4140698:

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UPPORT GROUPS (CAMPS) FOR PROPHYLAXIS ADHERENCE IN RHEUMATIC HEART DISEASE
Authors: De Loizaga Sarah , Pulle Jafesi , Okumu Atanas , Alepere Juliet , Nambogo Jane-Liz , Ndagire Emma , Kaudha Gloria , Ollberding Nicholas , Okello Emmy , Rwebembera Joselyn , Beaton Andrea
Published: November 2024

Background:
Secondary antibiotic prophylaxis (SAP) is the only intervention known to prevent rheumatic heart disease (RHD) progression, but non-adherence to SAP undermines most global RHD programs.

RESEARCH QUESTION:
We sought to determine whether enhanced SAP support administered through the public health system was feasible and a scalable model.

AIMS:
Determine the difference in 1-year SAP adherence rates of children with RHD in Uganda randomized to either Usual Care or Enhanced Support.

Explore differences in patient-reported outcomes including treatment satisfaction and health-related quality of life (HRQoL).

Methods:
We conducted a pragmatic randomized trial of two support strategies for SAP integrated into routine care in Eastern Uganda. Children ages 5 to 17 years with RHD were randomized to either
Usual Care
or
Enhanced Support
. Outcome measures at the end of 12 months included SAP adherence, health related quality of life, and treatment satisfaction. See Figure 1.

Results:
In total, 208 participants were included in the analysis (103 from Usual Care and 105 from Enhanced Support) from 11 participating health centers. Mean age between the groups was the same (13.2 years), with 62.1% and 54.3% female participants in Usual Care and Enhanced Support, respectively. Most participants had only mild disease, with only 11.7% in Usual Care and 8.6% in Enhanced Support having moderate/severe disease. Mean WAMI scores between the two groups were the same, 0.49.

After 12 months, mean adherence was 80.0% for those receiving Usual Care, compared to 98.2% for those receiving Enhanced Support (estimated mean difference 18.2% days of coverage; 95% CI 14.4; 22.1, p<0.001). Treatment satisfaction and HRQoL scores were not statistically significantly different between the groups.

Conclusion:
Although further research is needed to understand the minimum elements needed to achieve ideal SAP adherence and to understand implementation and dissemination at scale, the integration of community health workers into RHD supports may provide an effective and scalable model to improve outcomes for children with RHD in low-resource settings.
Abstract 4140722: Racial Disparity among the clinical outcomes in post Ablation Atrial Fibrillation patients: A Global Retrospective Study
Authors: Hanif Muhammad , Jaiswal Vikash , Bhandari Jenish , Ali Junaid , Akbar Usman , Devakumar Sahana , Sundas FNU , Yousaf Hamza , Khan Arshan , Ochani Rohan Kumar , Yasmin Farah , Islam Sabeeh , Singh Sumi , Jha Mayank , Chaudhuri Debanik
Published: November 2024

Background:
Racial disparities have been well described in cardiovascular disease. However, the impact of race on the outcomes post atrial fibrillation (AF) ablation is not well understood.

Objective:
This study aim to investigate the clinical outcomes post AF ablation among Black and White patients.

Method:
The TriNeTX Global Collaborative Network database was used to identify patients aged ≥18 years of age from January 2000 to April 2023 which included atrial fibrillation post-ablation patients. Patients were categorized into two groups, one with Black or African American race and another with White race groups. Both groups were followed for 12 months. We used the international Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify comorbidities, and ICD-10 Procedure coding system for procedures. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, BMI, smoking, hypertension, diabetes mellitus, chronic kidney disease, hemoglobin level and left ventricular ejection fraction. The primary outcome was all-cause mortality (ACM), while secondary outcomes were ischemic stroke, hemorrhagic stroke, acute myocardial infarction (AMI), MACE (composite of ACM, heart failure, AMI, and ischemic stroke) and heart failure (HF).

Result:
After 1:1 propensity score matching, the study cohort comprised 10, 335 Black patients and 10,335 White patients. The mean age of patients was comparable between both groups (65.2 and 64.9 years). Post ablation, Black patients were having a significantly higher risk of ACM (RR 1.131, 95% CI: 1.002-1.277), HF (RR 1.473, 95% CI: 1.290-1.683), AMI (RR 1.312, 95% CI: 1.117-1.342), and MACE (RR 1.416, 95% CI: 1.250-1.603) as compared with white population. However, the risk of ischemic stroke (RR 1.069, 95% CI: 0.878-1.301) and hemorrhagic stroke (RR 1.466, 95% CI: 0.908-2.369) were found comparable between Black and White patients post ablation.

Conclusion:
These findings suggest that Black patients post AF ablation were having a higher risk of mortality and MACE.
Abstract 4140752: Aspirin Use among Women at High-Risk for Pre-eclampsia in the United States
Authors: Pritchard Abiah , Zhang Cancan , Mukamal Kenneth
Published: November 2024

Background:
Pre-eclampsia is a major cause of maternal and neonatal morbidity and mortality and impacts 5-7% of pregnancies. Randomized trials have shown that aspirin reduces the risk of pre-eclampsia by 10-20%. In 2018, ACOG recommended the use of aspirin in high-risk women and “consideration” in those with moderate risk factors, which would newly include African American race. We sought to determine the proportion of women at risk for pre-eclampsia in the US receiving aspirin and how new guidelines impacted use.

Methods:
We used survey data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey conducted by the CDC of ambulatory health visits. We assessed visits of pregnant women from 2014-6 and 2018-9 and examined aspirin use according to pre-eclampsia risk status. High-risk includes those with hypertension, diabetes, or chronic kidney disease; medium-risk includes those with >=2 of the following: Black race, low socioeconomic status (identified by Medicaid enrollment), obesity, and age >=35. To determine if aspirin use was well-captured, we tested validity using coronary heart disease.

Results:
We identified 3,362 visits among pregnant women 2014-9, of which 8.3% occurred with high-risk women (Table 1). Aspirin use increased modestly at visits among low- and medium-risk women after guideline publication, to 1.7% (95% CI 0.5-3.9%) of visits in 2018-9. In contrast, aspirin use increased substantially at visits with high-risk women, though still remained low at 12.3% (95% CI 3.9-27%).

Conclusions:
Aspirin is an inexpensive and accessible intervention to reduce pre-eclampsia, a driver of adverse pregnancy outcomes and observed racial disparities. Aspirin use in moderate-risk women had minimal change over the time period, suggesting little immediate impact of the 2018 guidelines. Use in high-risk women increased significantly, but still remains low. Systematic efforts to ensure widespread and equitable use of this therapy are needed.
Abstract 4140758: Down-regulated Suv39h1 Alleviates Heart Aging by restoring mitochondrial autophagy through SIRT1-related pathways
Authors: Yang Jian , Liu Li
Published: November 2024

Introduction:
Cardiac aging is the main risk factor for cardiovascular disease, and the basis for maintaining cardiovascular system homeostasis and delaying cardiac aging is increasing mitophagy to promote the clearance of damaged mitochondria. Suv39h1 is a histone lysine methyltransferase closely associated with aging, but it is not yet clear whether Suv39h1 is associated with cardiac aging.

Hypothesis:
Whether downregulating Suv39h1 signaling improves cardiac aging, and if so to further explore underlying mechanism.

Methods:
H9C2 cardiomyocytes were stimulated with 0.1μmol doxorubicin for 24h to induce aging. Recombinant Suv39h1 lentivirus was infected with H9C2 cells to overexpress or knock down Suv39h1. The aging-associated phenotypes of cardiomyocytes was detected by western blot and β-galactosidase staining. Mitochondrial membrane potential was detected by JC-1 staining. The effect of Suv39h1 on aging phenotype was detected by β-galactosidase staining. Mitochondrial autophagy markers were detected by western blot.

Results:
Compared with the control group, the expression of aging marker P21 and positive staining of SA-β-gal were significantly increased in Doxorubicin induced subacute senescent cardiomyocytes. The expressions of Suv39h1 and H3K9me3 were also significantly increased in aging cardiomyocytes.Compared with sh-Con group, mitochondrial membrane potential of cardiomyocytes increased significantly in sh-Suv39h1group,indicating that down-regulated Suv39h1 reversed doxorubicin- induced mitochondrial membrane potential decline of cardiomyocytes. β-galactosidase staining showed that the positive rate of SA-β-gal in sh-Suv39h1 group was significantly lower than that in sh-Con group, indicating that cell senescence was inhibited. However, overexpression of Suv39h1 showed the opposite result.Mechanistically,down-regulation of Suv39h1 can relieve transcriptional inhibition of H3K9me3 on SIRT1, and promote mitochondrial autophagy through activation of Pink1/Parkin axis, delaying cardiac aging.

Conclusions:
Targeted down-regulation of Suv39h1 can relieve the transcriptional inhibition of H3K9me3 on SIRT1, promote myocardial mitochondrial autophagy and alleviate cardiac aging.
Abstract 4140767: MRI-Measured Myocardial Strain as a Predictor of Clinical Outcomes in Systemic RV.
Authors: Kajimoto Hidemi , Broberg Craig
Published: November 2024

Background:
Systemic RV dysfunction is a common concern in patients with d-Transposition of the great arteries (d-TGA) after atrial switch and congenitally corrected TGA (ccTGA). We investigated myocardial strain on MRI to predict clinical outcomes.

Methods:
We analyzed 50 MRI studies (33 d-TGA with atrial switch, 17 ccTGA, mean age 42 ± 13 years) after excluding studies with fewer than 30 phases or incomplete images. Feature-tracking of SSFP cine was retrospectively utilized to quantify radial, circumferential, and longitudinal strain in both 2 and 3 dimensions. Physiological class (PC) was determined by clinicians according to the 2018 AHA/ACC guidelines. Clinical events (e.g., change in PC, initiation or escalation of diuretics, mortality, arrhythmias, heart failure hospitalization) over a 5-year period were obtained through chart review.

Results:
Deterioration of PC was significantly associated with worsening of all strain measures (p ≤0.05 for each) except 3D global radial strain. RV ejection fraction (EF) was also significant (p ≤0.05). Importantly, in patients experiencing new clinical events within 5 years, baseline absolute values of global longitudinal strain (2D and 3D) were significantly worse (p ≤0.05 for both), whereas RVEF was not (Figure).

Conclusion:
MRI-measured global longitudinal strain holds promise as a prognostic indicator for clinical outcomes in adults with systemic RV dysfunction. These findings underscore its potential utility in risk stratification and guiding management decisions.
Abstract 4140772: Social Deprivation is Associated with Readmission After Percutaneous Left Atrial Appendage Closure
Authors: Brodeur Peter , Ferro Enrico , Maher Timothy , Yang Shu , Waks Jonathan , Tung Patricia , Saad Eduardo , d'Avila Andre , zimetbaum peter , Kramer Daniel , Yeh Robert , Locke Andrew
Published: November 2024

Introduction:
Gender and racial disparities have been shown to impact outcomes with percutaneous left atrial appendage closure (LAAC) though no studies have directly evaluated the role of socioeconomic disadvantage. The Social Deprivation Index (SDI) is a metric designed to quantify socioeconomic variation in health outcomes. We aimed to evaluate if SDI increases the risk of readmission within one year after LAAC in patients with atrial fibrillation (AF).

Methods:
Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York (NY) and Florida (FL) from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2018 SDI data. International Classification of Diseases 10 codes for AF and LAAC were used. The risk of readmission was assessed using multivariable Cox proportional hazards regression with covariates age, sex, race, insurance, Charlson Comorbidity Index (0 vs ≥ 1 comorbidity), and SDI deciles. SDI is scored 1-100 with higher scores representing more disadvantage.

Results:
7,786 patients underwent LAAC in NY and FL 2016-2019. The readmission rate at one, three, and twelve months was 10.1%, 21.5%, and 44%. The most common admitting diagnoses at readmission were dyspnea/chest pain (11.4%) and GI bleed (8.8%). Female sex, African American race, ≥ 1 Charlson comorbidity, and those with from areas with a higher SDI had a higher one-, three-, and twelve-month risk of readmission. Those with federal insurance had a higher three- and twelve-month risk of readmission.

Conclusion:
After adjustment, socioeconomic disadvantage was observed to place patients at higher risk of readmission within one year after LAAC. GI bleed remains a common complication post LAAC. Given the link between differential care and healthcare disparities, it is essential to raise awareness to ensure successful post-procedure management and equitable cardiovascular care.
Abstract 4140775: Efficacy of Colchicine in Stroke Prevention: A Meta-Analysis of Randomized Controlled Trials
Authors: Jain Hritvik , Jain Jyoti , Odat Ramez , Goyal Aman , Yasin Jehad , Patel Nandan , Yadav Ashish , Shah Janhvi , Jha Jagriti , Passey Siddhant
Published: November 2024

Background:
Stroke is the leading cause of neurological disability worldwide and contributes substantially to mortality. Colchicine is a microtubule inhibitor that has anti-inflammatory properties. In recent years, colchicine has been investigated as a potential therapeutic agent for reducing the risk of adverse cardiovascular events. Few studies have reported the risks of stroke with colchicine, with controversial results to date.

Aim:
This meta-analysis aimed to compare the efficacy of colchicine versus placebo for stroke prevention.

Methods:
We conducted a comprehensive systematic search of the major databases from inception until May 3, 2024, to identify randomized controlled trials (RCTs) comparing colchicine to placebo. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using an inverse-variance random-effects model. Statistical significance was set at p < 0.05.

Results:
We included 13 RCTs with 13629 patients (6823: Colchicine and 6806: Placebo). The mean age in the Colchicine group was 62.1 ± 9.4 years and in the placebo group was 62.4 ± 9.1 years. Colchicine was associated with a significantly lower risk of stroke [RR: 0.51; 95% CI: -0.32, 0.80; p=0.003] than placebo. However, the risk of all-cause mortality [RR: 1.01; 95% CI: 0.66, 1.54; p=0.97] was similar between the two groups.

Conclusion:
This study demonstrated the efficacy of colchicine in reducing the risk of stroke. However, colchicine did not reduce the risk of all-cause mortality. Future RCTs are required to investigate this risk reduction on a larger, multicenter scale.
Abstract 4140776: Pre-Existing Atrial Fibrillation and Mortality in Left Ventricular Assist Device Recipients
Authors: Castillo Rodriguez Beatriz , Uppalapati Lakshmi , Lynch Patrick , Maloof Alexandra , Badjatiya Anish , Segar Matthew , Molina Razavi Joanna , Rasekh Abdi , Saeed Mohammad , Razavi Mehdi , Civitello Andrew , Oberton Selby , Simpson Leo , Xie Lola , Nair Ajith , Chelu Mihail
Published: November 2024

Introduction:
Left Ventricular Assist Devices (LVADs) revolutionized the care of patients with advanced heart failure (AHF). Among AHF patients, atrial fibrillation (AF) is a common arrhythmia. Despite its prevalence, the impact of pre-existing AF on outcomes in post-LVAD recipients is poorly understood.

Hypothesis:
LVAD recipients with preexisting AF have higher all-cause mortality.

Methods:
This is a single-center, retrospective review of 573 LVAD recipients. Patients with LVADs implanted elsewhere, implants prior to 2011, implantation of an unconventional LVAD (e.g. artificial heart), and those with insufficient records were excluded. Univariate descriptive statistics and multivariate logistic&linear regression analyses of patient all-cause mortality, as appropriate, were performed using STATA. Significance was determined at alpha < 0.05.

Results:
Pre-implant AF was seen in 54% of LVAD recipients. Participants with AF were more likely to be male and older. They had higher rates of hyperlipidemia, prior stroke or TIA, prior CABG, pre-existing ICD at time of implant, and pre-LVAD sustained VT (Table 1). After a median follow-up time of approximately 2 years, 57% of patients died, 22% were transplanted, 9% were explanted, and 12% were lost to follow up. Irrespective of incidence of pre-LVAD AF, worse survival was seen in ischemic cardiomyopathy (HR 2.0 [1.5-2.7]), RV failure necessitating RVAD (HR 2.6 [1.9-3.6]), and pre-LVAD ICD shocks (HR 1.3 [1.0-1.7]). Pre-LVAD AF was associated with increased mortality (61% vs 47%, p= 0.001). This finding remained significant on multivariate analysis while controlling for other comorbidities (Table 2). Additionally, presence of AF was significantly associated with an increased occurrence of both post-implant VT (63% vs 43%, p <0.001) and post-implant RV failure necessitating RVAD (19% vs 10%, p< 0.001).

Conclusions:
A history of prior AF is associated with worse survival and higher incidence of complications following LVAD placement when compared to LVAD recipients without prior AF. This association is maintained even when controlling for possible confounders. However, this study is limited by its retrospective design, and further prospective randomized studies would better determine the impact of pre-implant AF on survival in LVAD recipients.
Abstract 4140791: Two-Year Clinical Outcomes of Patients with Critical Limb Ischemia versus Claudication in Femoropopliteal Artery Disease following Endovascular Therapy : An Analysis from K-VIS ELLA Registry
Authors: Rha Seung-Woon , Park Soohyung , Ahn Woo Jin , Cha Jinah , hyun sujin , Choi Se Yeon , Choi Byoung Geol , Sinurat Markz , Choi Cheol Ung , Park Chang Gyu , Oh Dong
Published: November 2024

Background:
Endovascular therapy (EVT) is a prevalent treatment option for femoropopliteal artery (FPA) disease, manifesting as critical limb ischemia (CLI) or intermittent claudication (IC). However, there is a lack of evidence regarding comparative outcomes between patients with CLI and IC following EVT in real-world settings.

Research Questions:
This study aimed to investigate the clinical outcomes of patients with native FPA disease, specifically comparing those with CLI and IC at 2 years following the EVT procedure from a real-world multicenter cohort.

Methods:
From K-VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases) multicenter registry cohort, a total of 1924 patients with FPA disease (CLI, n=812; IC, n=1112) between 2006 and 2021 were analyzed. The primary endpoint was target limb amputation or clinically driven (CD)-target extremity revascularization (TER) at 2 years post-procedure.

Results:
After Inverse Probability of Treatment Weighting (IPTTW), the incidence of the primary endpoint was significantly higher in the CLI group (HR 1.314; 95% CI [1.105-1.561]; p=0.002) compared to the IC group. The incidence of loss of clinical patency, major adverse limb events (MALEs), and all-cause death was also higher in CLI group (HR 1.312; 95% CI [1.157-1.488]; p<0.001). No significant differences were observed in the risk of repeated percutaneous transluminal angioplasty (PTA) (HR 1.014; 95% CI [0.833-1.234]; p=0.920). Treatment with drug-coated balloon (DCB) showed favorable outcomes for the primary endpoint in both groups compared to other treatment modalities, particularly in patients with IC [HR of 0.429 (CI: 0.25-0.734, p=0.002)].

Conclusions:
EVT for FPA disease in patients with CLI is associated with worse clinical outcomes compared to those with IC. Nevertheless, the risk of repeated PTA did not differ in both groups. The use of DCB shows promising results in both groups.
Abstract 4140802: Detection of subclinical carotid and femoral arterial disease in patients with prior percutaneous coronary intervention: Insights from the LAI-ACP study
Authors: Mahajan Kunal , Puri Raman , Sharma Jai Bharat , Himral Surender , Dsouza Savio , Patel Prashant , Chandel Pankaj , Kapoor Anuradha , Mohite Komal , Sandal Shivali
Published: November 2024

Background:
Poly-vascular disease, characterized by atherosclerosis in multiple vascular beds, significantly increases the risk of cardiovascular death, myocardial infarction, and stroke. The severity correlates with the number of affected regions. The Lipid Association of India classifies patients with poly-vascular disease in the extreme risk category and recommends a lower LDL cholesterol target (
<
30 mg/dl) compared to those with atherosclerosis in a single territory (<50 mg/dl).

Research Hypothesis:
Indian patients likely show a higher prevalence of poly-vascular disease, possibly explaining the aggressive atherosclerosis observed in Indian and South Asian populations.

Aim:
This study aimed to assess the prevalence of subclinical carotid and femoral artery disease in Indian patients with post-percutaneous coronary intervention (PCI).

Methods:
Post-PCI patients attending a cardiology outpatient clinic over eight months were enrolled. Exclusions were patients with prior ischemic stroke, vascular limb event and carotid or peripheral intervention. Femoral and carotid artery Doppler ultrasounds were performed for plaques. Plaque was defined as either intima-media thickness exceeding 1.5 mm or protruding into the lumen by at least 50% of the surrounding thickness.

Results:
A total of 357 patients (mean age 63.1±10.7 years; 80.9% male) were enrolled. Diabetes mellitus and hypertension were present in 33.3% and 53.8% of patients, respectively. A history of ACS was noted in 88.8% of participants. Double or triple vessel disease was observed in 75.6% of patients. Carotid and femoral plaques were detected in 78.4% and 65.2%, respectively, with both present in 56.3%, and either of them in 87.7%. Mean LDL-cholesterol was higher in patients with both carotid and femoral plaques than those without (57.23 ± 27.12 versus 54.49 ± 28.15 mg/dl, p<0.001). The majority (80.7%) were on combination LDL-cholesterol lowering treatment with high intensity statins plus ezetimibe or bempedoic acid.

Conclusion:
Indian patients with CAD and a history of PCI exhibit a high prevalence of diabetes, hypertension, and triple vessel disease. Poly-vascular disease was prevalent, with majority having either subclinical carotid or femoral artery disease. Given the high incidence of recurrent events in poly-vascular disease patients, cardiometabolic risk targets, especially the LDL-C targets for Indian patients, may need to be lower than Western guidelines suggest.
Abstract 4140810: Impact of Neutrophil on Ischemic Risk in Acute Coronary Syndrome Patients Across Different Low Density Lipoprotein Cholesterol Levels
Authors: Yan Kailun , Li Jiawen , Zhang Kexin , Liu Menglu , Yuan Jinqing , Zhao Xueyan
Published: November 2024

Background:
Inflammation is a significant residual risk factor for coronary artery disease. While intensive lipid-lowering therapy has reduced the prevalence of plaque rupture, plaque erosion in acute coronary syndrome (ACS) patients is increasing, with neutrophils playing a crucial role. It remains unclear whether varying low-density lipoprotein cholesterol (LDL-C) levels modify the relationship between neutrophil count and ischemic risk in ACS patients.

Aim:
To investigate the relationship between neutrophil counts and ischemic risk in ACS patients undergoing percutaneous coronary intervention (PCI) across different LDL-C levels.

Methods:
This large cohort study enrolled consecutive 10724 patients undergoing PCI at Fuwai Hospital (Peking Union Medical College) throughout the year of 2013. Patients were divided into subgroups according to baseline LDL-C levels, with cut-off points at 1.8mmol/L or 1.4mmol/L. The primary endpoint was major adverse cardiovascular event (MACE), and the secondary endpoint was revascularization.

Results:
Finally, 5717 ACS patients with PCI were included. The mean age was 58.43 ± 10.35 years, with 4399 (76.9%) being male. During the 5-year follow-up period, 1058 (18.5%) MACEs and 821 (14.4%) revascularizations were recorded. Restricted cubic spline analysis revealed a positive correlation between neutrophil and MACE and revascularizations only in patients with lower LDL-C levels (LDL-C <1.8 and LDL-C <1.4 mmol/L), but not in those with higher LDL-C levels (LDL-C ≥1.8 and LDL-C ≥1.4 mmol/L)
(Figure 1)
. Multivariate Cox regression analysis showed that in the LDL-C <1.8 mmol/L group, each unit increase in neutrophil count was associated with a 1.129 times higher risk of MACE (HR 1.129; 95% CI 1.046-1.219) and a 1.130 times higher risk of revascularizations (HR 1.130; 95% CI 1.031-1.238). Similar findings were observed in the LDL-C <1.4 mmol/L group, where higher neutrophil was independent risk factors for MACE (HR 1.222; 95% CI 1.063-1.404) and revascularizations (HR 1.274; 95% CI 1.078-1.506). However, in patients with higher LDL-C levels (LDL-C ≥1.8 and LDL-C ≥1.4 mmol/L), neutrophil counts were not associated with outcomes
(Table 1)
.

Conclusions：
High neutrophil counts are a significant risk factor for ischemic events in ACS patients with low LDL-C levels, highlighting the potential benefits of targeting neutrophils-related inflammatory pathway in the management of ACS patients with well-controlled LDL-C levels.
Abstract 4140819: Trends and Racial Disparities in Cardiovascular Deaths in Chronic Kidney Disease in the United States, 1999-2020
Authors: Agyekum Abena , Bonnah Godslove , Donaldy Webster , Djanie Stephen Nii-Ashie , Kumi Alex , Ottun Abdul-Rahaman , Adusei Poku Frank
Published: November 2024

Background:
Previous studies have shown that chronic kidney disease (CKD) is associated with increased cardiovascular disease (CVD) burden, but few studies have investigated trends in CVD deaths in CKD. We evaluated the temporal changes in the CVD-related age-adjusted mortality rate (AAMR) in CKD based on sex, race, rural-urban status, and census region from 1999-2020.

Methods:
This was a retrospective repeated cross-sectional analysis of national death certificate data from the CDC WONDER from 1999 to 2020. We included persons aged ≥25 years of age with CKD (ICD-10 code N18) as the underlying cause of death. We used ICD-10 codes I10-I178 to identify CVD-related deaths from the multiple cause-of-death dataset. We calculated the CVD-related AAMR in CKD per 100,000 population. The exposure variable was the year of death, and the outcome was the changes over time in CVD- related AAMR in CKD, stratified by sex, race, rural-urban status, and census region. We used the Mann-Whitney test and ANOVA for group comparisons as appropriate. Racial disparities were assessed with the Black-White AAMR ratio. Trends were evaluated with Joinpoint regression and expressed as average annual percentage change (AAPC) with 95% confidence interval (CI). P<0.05 defined statistical significance.

Results:
Of the 4.4 billion people, 260,679 with CKD had CVD-related deaths (AAMR 5.5). The AAMR was higher in males (7 vs 4.4 in females; P<0.001), Black people (12.6 vs 4.7 in White; P<0.001), and the Northeast and South census regions (AAMR 5.8). The AAMR did not differ by rural-urban status. From 1999 to 2020, the overall AAMR increased from 4.7 to 6.5 (AAPC 1.6%; CI: 1.4-1.8). Similarly, the AAMR increased significantly in males (AAPC 1.5%; CI: 1.2-1.7), females (AAPC 1.4%; CI: 1.1-1.6), rural areas (AAPC 2%; CI: 1.6-2.3), urban areas (AAPC 1.4%; CI: 1.1-1.7), White race (AAPC 1.9%; CI: 1.7-2.2) and across each of the four census regions. There was no significant change in Black race (AAPC 0.2%; CI: -0.04-0.5). The overall Black-White AAMR ratio was 2.8 and it declined from 3.4 to 2.4 (AAPC -1.7%; CI, -1.9, -1.5).

Conclusion:
CVD-related deaths increased in CKD patients over the last two decades. While racial disparities in CVD-related deaths persisted, they narrowed during the study period. These findings underscore the need to intensify CVD screening and multidisciplinary management in CKD patients. The reasons for the persistence of the racial disparity require further study.
Abstract 4140846: Racial Disparities in Low-Density Lipoprotein Cholesterol Control and Lipoprotein(a) Testing Among Young Adult Women with Severe Hyperlipidemia
Authors: Jowell Amanda , Cho So Mi , Andersen Christian , Yu Zhi , Natarajan Pradeep , Honigberg Michael , Harrington Colleen
Published: November 2024

Background:
Young adult women with severe hyperlipidemia (sHLD), or low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL, are less likely to achieve guideline-recommended LDL-C reduction than their male or older counterparts. Lipoprotein(a) [Lp(a)] can serve as a risk modifier of cardiovascular disease and may have some utility in risk-stratification in young populations.

Question:
Do LDL-C control and Lp(a) testing differ by race among young adult women?

Methods:
We used clinical registry data from seven Mass General Brigham hospitals/affiliated practices to identify young women (18-45 years) between 2005-2022 with a qualifying LDL-C ≥190 mg/dL. We used linear mixed models to assess longitudinal differences in LDL-C levels by self-identified race. We compared Lp(a) testing and statin initiation rates of these groups and examined whether LDL-C control differed according to Lp(a) testing.

Results:
Our study included 4,633 women with sHLD, mean (SD) age 35.7 (7.0) years at qualifying LDL-C and median (IQR) follow up 5.8 (9.4) years. Compared to White women, Black women had persistently higher LDL-C levels during follow-up (coefficient=6.4, p<0.001), and women who reported other/multiple racial categories (Other) had a non-significant trend of persistently higher LDL-C during follow-up (coefficient=2.8, p=0.08) [Figure]. Overall, 255 (5.7%) women recieved Lp(a) testing. Lp(a) testing was positively associated with 50% LDL-C reduction (p<0.001), and 8.8% Asian, 3.8% Black, 4.9% Other and 5.9% White women underwent Lp(a) testing (p=0.04). Mean (SD) age of statin initiation was 39.9 (8.2) years; 51.9% Asian, 65.6% Black, 59.3% Other and 56.2% White women received a statin prescription during follow-up (p<0.001).

Conclusions:
Young women with sHLD had persistently high LDL-C levels over time, and Black women experienced the highest LDL-C burden. Lp(a) testing was also low across all groups, with the lowest testing rates occurring in Black and Other populations, but was associated with improved LDL-C control. Statin initiation was low across all groups. These data highlight an urgent need for strategies to improve guideline-recommended preventive care in young women at high lifetime risk of cardiovascular disease.
Abstract 4140855: A Novel Tool for Evaluating Endothelial Function: Plethysmographic Flow-mediated Vasodilation (pFMD)
Authors: Kishimoto Shinji , Maruhashi Tatsuya , Kajikawa Masato , Mizobuchi Aya , Harada Takahiro , Yamaji Takayuki , Nakano Yukiko , Mohamad Yusoff Farina , Yada Tomohiko , Itarashiki Tomomasa , Higashi Yukihito
Published: November 2024

Background:
Measurement of flow-mediated vasodilation (FMD) in the brachial artery by using ultrasound is a well-established technique for evaluating endothelial function. To make the measurement quicker and easier than the measurements of conventional ultrasound FMD (uFMD), we have developed a novel noninvasive method, plethysmographic FMD (pFMD), to assess vascular response to reactive hyperemia in the brachial artery. The aim of this study was to determine the accuracy of measurement of pFMD in comparison to that of measurement of conventional uFMD.

Methods and results:
This study was a multi-center, cross-sectional study. We compared pFMD by a new device using cuff pressure and volume with conventional uFMD using ultrasound in 50 men (mean age, 41±9 years). pFMD significantly correlated with conventional uFMD (β=0.59, P<0.001). In Bland-Altman plot analysis of pFMD and conventional uFMD, the mean difference of pFMD and conventional uFMD was 0.78%, and limits of agreement (mean difference ±2 standard deviations of the difference) ranged from -4.53% to 6.11%.

Conclusions:
We demonstrated validity of the new method for measurement of pFMD, which has the capability to automate the assessment of endothelial function in a short period of time. Measurement of pFMD is easier than measurement of conventional uFMD and may have less artificial bias compared to that of conventional uFMD measurement.