bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144529: Cardiac Allograft Hypertrophy (CAH) at 6 Months Post Transplant Is a Prognostic Marker of Long-Term Outcomes: Are We Missing a Simple Biomarker?
Authors: Patel Khush , Nandakumar Varshni , Ranka Rajul , Torre-Amione Guillermo , Bhimaraj Arvind
Published: November 2024

Introduction:
Cardiac hypertrophy is a known adverse prognostic marker in various non-transplant pathologies. In heart transplant patients, due to many confounders, it has been controversial on the relevance and timing of cardiac hypertrophy as an adverse remodeling vs acute injury pattern in an immunologically hostile environment. Previous studies have shown prognostication of hypertrophy on echocardiogram at 1-year post-heart transplant.

Research Questions:
Does cardiac hypertrophy within a year after transplant have long-term prognostic implications?

Methods:
We collected relevant clinical variables for all heart transplants using EPIC EHR’s Clarity database. Hypertrophy was defined based on LV Mass Indexed to body surface area where LV Mass = 0.8 x (1.04 x (((LVIDD + IVSd + PWd)
3
- LVIDD
3
))) + 0.6. Relative Wall Thickness was defined as RWT = 2 x PWd / LVIDD. We used a rule-based natural language processing program validated by correlation with manual readings by trained cardiologists (r=0.96, p=0.007) to abstract echo variables.

Results:
Inclusion criteria were heart transplants performed from 2015 to 2023 at our center, with an echocardiogram closest to 6 months (+/- 1 month). Ten percent (n=33) showed hypertrophy on echocardiograms at 6 months (Table 1). Of these, 20 (61%) had mild, 3 (9%) severe, and 10 (30%) moderate hypertrophy. Of 33 patients, 28 (85%) had concentric, and 5 (15%) had eccentric hypertrophy. Patients with hypertrophy at 6 months had significantly worse survival at 5 years (p=0.01) and 10 years (p=0.05) compared to patients without hypertrophy (Fig 1). Survival at 5 and 10 years was not statistically different for patients with hypertrophy at 3 months (5 yrs p=0.17, 10 yrs p=0.06), 12 months (5 yrs p=0.38, 10 yrs p=0.30), and 18 months (5 yrs p=0.15, 10 yrs p=0.08) compared to those without hypertrophy.

Conclusion:
Cardiac hypertrophy on echocardiogram at 6 months predicts adverse long-term survival, while other time points did not.
Abstract 4144549: Proof of Concept of a Novel Culinary Medicine Service Line to Address Diet-Related Cardiovascular Disease Risk Factors
Authors: Wong Willis , Agrawal Amulya , Khine Tin , Siler Milette , Albin Jaclyn
Published: November 2024

Background:
Poor diet has emerged as a top contributor to cardiovascular disease (CVD) in the United States. Evidence-based dietary strategies have been shown to decrease CVD risk by addressing comorbid conditions such as hypertension and diabetes, and there is a growing demand for practical nutrition guidance from health providers. However, implementation of nutrition support in healthcare settings remains limited due to lack of time, expertise, and reimbursement, necessitating creative interprofessional collaboration. Culinary Medicine (CM) combines medical nutrition education with culinary literacy and holds promise to address these challenges. Our study reports on the cascade implementation of a 3-prong CM service line which includes a CM eConsult, 1:1 CM specialty clinic, and shared medical appointment (group visit) in a teaching kitchen at a large, academic medical center from 2021 to 2024.

Methods:
A CM-specific eConsult was designed and launched on August 1
st
2021 utilizing existing eConsult workflows in the electronic health record. Next, an in-person, interprofessional CM specialty clinic launched at a community-based satellite clinic December 4
th
2022 open to referrals from physicians and patients. In April 2024, established patients in the CM clinic were invited to participate in six, biweekly cooking classes billed as shared medical appointments. A Microsoft PowerBI dashboard was developed to track patient demographics, referrals and participation, associated diagnoses, and billing data for the service line for continuous quality improvement.

Results:
In the first year of eConsults, 25 eConsults were completed with 19 (76%) reimbursed by insurance. In the first year from launch of the CM specialty clinic, 96 patients completed initial visits with a 100% insurance collections rate. In the recent launch of shared medical appointments, the initial cohort included 17 unique patients with 58% completing at least 4 of 6 classes. Referrals to the CM clinic included hypertension, hyperlipidemia, coronary artery disease, and type 2 diabetes as the top 4 associated diagnoses.

Conclusions:
We demonstrated proof-of-concept of a novel CM service line as an interprofessional, financially sustainable preventive strategy to target patients with diet-sensitive CVD risk factors such as diabetes, hypertension, and obesity. Future study will investigate the impact on biomarkers of CVD health for patients served by the CM service line.
Abstract 4144552: Difference in Characteristics and Outcomes of Atrial Fibrillation patients based on type of Heart Failure: An NRD Propensity Matched Analysis
Authors: Brar Ajit , Ravi Soumiya , Garg Ayushi , Chirumamilla Yashitha , Omer Mohammed , Maharjan Nikky , Maini Shriya , Alkotob Luay
Published: November 2024

Background:
Heart Failure(HF) significantly deteriorates outcomes in patients with Atrial Fibrillation. Heart Failure with Preserved Ejection Fraction(HFpEF) and Atrial Fibrillation(AFib) share common disease progression pathways and are gradually increasing in prevalence.

Aim:
We aim to study the variation in characteristics and outcomes based on type of heart failure in patients with AFib using the National Readmission Database(2016-2020).

Methods:
NRD database was used to identify patients with Atrial Fibrillation using ICD-10 codes. Patients were stratified into two groups based on the presence of systolic dysfunction and diastolic dysfunction. Patients with combined systolic and diastolic dysfunction were excluded. Information was collected on patient demographics, comorbidities, and outcomes. Propensity score matching was performed to compare outcomes among AFib patients with HFrEF and HFpEF.

Results:
A total of 6,673,080 patients with AFib and isolated systolic or isolated diastolic dysfunction were included in the analysis. 3,914,695(58.66%) had HFpEF and 2,758,385 (41.34%%) had HFrEF. In the HFpEF group 57.8% were females in comparison with 33.12% females in the HFrEF group. HFpEF group had a higher rate of hypertension (84.9% vs 82%, p<0.001), OSA(19.35 vs 14.9, p<0.001), immunocompromised status (0.06 vs 0.04%, p<0.001), hypothyroidism(23.7% vs 18.47%,P<0.001), Anemia(10.1% vs 7.95%, p<0.001), Pneumonia (13.51%) and Pulmonary disease(37.34% vs 30.98%) as compared to the HFrEF group. In the propensity matched analysis, HFpEF group had lower in-hospital death (5.26% vs 6.59%, p<0.001), acute kidney injury (33.19% vs 38.92%; p<0.001), stroke (0.99% vs 1.71%), cardiogenic shock (1.02% vs 3.29%; p<0.001), Myocardial infarction (3.60% vs 7.65%; p<0.001), sudden cardiac arrest (1.95% vs 2.62%;p<0.001), mechanical circulatory device use(0.16% vs 0.77%;p<0.001) and major adverse cardiovascular event(9.79% vs 16.06%;p<0.001).

Discussion:
In Afib patients with HFpEF, yearly admissions were higher in comparison to the HFrEF group. Furthermore, we found a higher prevalence of hypertension, obesity, OSA, pulmonary disease, pneumonia, immunocompromised status, hypothyroidism, and anemia in comparison with the HFrEF group. However, mortality rate in HFpEF group and MACE were lower. At present, there are no definite therapies for patients with HFpEF that have displayed a clear mortality benefit highlighting the need for further inquiry.
Abstract 4144553: Fully Automated Machine Learning Based Echocardiographic Assessment of Global Longitudinal Strain in Breast Cancer Patients Receiving Cardiotoxic Chemotherapy
Authors: Patel Romil , Hussain Kifah , Sanagala Thriveni , Robin Jason , Karagodin Ilya
Published: November 2024

Background:
Global longitudinal strain (GLS) is considered the most sensitive echocardiographic marker for detecting cardiotoxicity and subclinical changes in cardiac function in patients receiving cardiotoxic therapies. Despite literature that has shown less inter-observer variability for GLS compared to left ventricular ejection fraction, there remains significant variability in GLS measurement across observers and vendors. US2.AI is a novel, machine learning-based artificial intelligence (AI) algorithm for automated echocardiographic interpretation. We aim to demonstrate the feasibility of AI-based GLS assessment and hypothesize that AI-based GLS measurement is more reproducible compared to human-based measurement

Methods:
A total of 27 transthoracic echocardiograms were selected at random from a population of female cardio-oncology breast cancer patients and were run through the US2.AI algorithm twice to calculate GLS. The same echocardiograms were then analyzed by two board-certified cardiologists in a blinded fashion to calculate GLS using QLAB software (Philips). The two methods of GLS measurement (AI versus humans) were compared using linear regression, as assessed by the Pearson correlation coefficient. Reproducibility for each method was assessed using the intra-class correlation coefficient (ICC).

Results:
A total of 27 studies were analyzed with a mean age of 55.6 ± 11.3 and all patients were female. The feasibility of US2.AI for the assessment of GLS was demonstrated with a strong correlation between AI-based and human reads (r = 0.80, p < 0.00001). The reproducibility of AI-based GLS assessment was superior to that of human readers as assessed by an ICC of 1.0 versus 0.52, respectively.

Conclusion:
AI-based assessment of GLS was shown to be both feasible and more reproducible compared to expert human readers in a population of breast cancer patients receiving cardiotoxic chemotherapy. Given the important clinical implications of GLS in cardio-oncology patients, more widespread implementation of AI-based strain assessment has the potential to significantly improve the reproducibility of GLS measurement in this unique patient population.
Abstract 4144555: Atrial Fibrillation Catheter Ablation among Patients with Mediastinal Radiation; Insight from The National Inpatient Database (2015-2020)
Authors: Osama Muhammad , Naeem Nauman , ahmed asmaa , Jawaid Hafsa , Rehman Saif ur , Chuprun Dmitry , Rao Mohan
Published: November 2024

Introduction/Background:
Radiation therapy (RT) is one of the most common treatment modalities for mediastinal cancers. RT has multiple adverse cardiovascular effects and it has been identified as an independent risk factor for atrial fibrillation (AF). The efficacy of catheter ablation in AF is well established, however there is limited data on procedural safety and outcomes in patients with mediastinal cancers and history of radiation

Methods:
The National Inpatient Sample (NIS) was analyzed from 2015-2020 to identify admissions for AF catheter ablation among patients with previous history of mediastinal radiation exposure using the 10-PCS (International Classification of Diseases, procedure coding system) codes. Baseline characteristics were compared between the two groups and multivariate logistic regression was used to analyze hospitalization outcomes.

Results:
We identified 257,240 admissions for AF catheter ablation of which 1720 patients (0.67%) had a history of mediastinal radiation exposure. In the adjusted analysis, the odds of in-hospital mortality (aOR 0.639, 95% CI 0.34-1.20, p 0.1637), major complications (aOR 0.876, 95% CI 0.73-1.05, p 0.1443), any gastrointestinal or hematological complication (aOR 0.853, 95% CI 0.63-1.15, p 0.3017), renal complications (aOR 1.017, 95% CI 0.88-1.18, p 0.0509) were similar in both cohorts. The odds of any cardiovascular complication (aOR 0.825, 95% CI 0.70-0.97, p 0.0208) was lower and odds of any pulmonary complication (aOR 1.433, 95% CI 1.27-1.62, p<.001) was higher in the mediastinal radiation cohort.

Conclusion:
AF catheter ablation in patients with history of mediastinal radiation is a safe treatment modality. It is not associated with higher in-hospital mortality or cardiac complications in a nationwide registry.
Abstract 4144566: Building CPR/AED Confidence through Community Volunteer Prevention Screening Sessions: The Impact of the Eric Paredes Save A Life Foundation
Authors: Goel Kunal , Baradarian Jacob , Legg Maureen , Paredes Rhina , Rogers John
Published: November 2024

Introduction:
Sudden cardiac arrest (SCA) remains a leading cause of death among young individuals, often occurring without prior symptoms. Public confidence in recognizing SCA warning signs, understanding risk factors, and using cardiopulmonary resuscitation (CPR) and Automated External Defibrillators (AEDs) is generally low. The Eric Paredes Save A Life Foundation addresses this gap by offering free cardiac screenings and educational sessions. This abstract evaluates the foundation's impact on participants' confidence in these critical areas.

Goals:
The primary objectives were to enhance participants' confidence in identifying SCA warning signs and risk factors, performing CPR, using AEDs during cardiac emergencies, and communicating youth heart health concerns to healthcare providers.

Methods:
Volunteer-led prevention screening sessions were conducted, incorporating educational components on SCA warning signs, risk factors, and hands-only CPR and AED training. Post-session surveys were administered to 1,123 participants to assess their confidence levels in these areas.

Results:
The screening sessions significantly increased participants' confidence. Specifically, 96% of participants reported heightened confidence in recognizing SCA warning signs and understanding risk factors. Additionally, 94% felt more assured in discussing youth heart health with providers. Confidence in performing CPR during a cardiac emergency rose to 92%, while confidence in using an AED reached 89%. These results demonstrate the effectiveness of the sessions in empowering individuals with essential life-saving skills.

Conclusions:
The Eric Paredes Save A Life Foundation's prevention screening sessions are highly effective in improving participants' confidence in recognizing SCA warning signs, understanding risk factors, and using CPR and AEDs. The substantial increase in confidence levels underscores the importance of community-based education and training programs in reducing SCA-related fatalities among youth. These findings support the need for ongoing and expanded initiatives to further enhance public health outcomes and preparedness for cardiac emergencies.
Abstract 4144583: Beyond Acute Rejection Screening Following Pediatric Heart Transplant: In Patients Negative for Rejection, Elevated Donor-Derived Cell-Free DNA is Associated with Cardiac Allograft Vasculopathy (CAV) and Donor Specific Antibodies (DSA)
Authors: Olsen Benjamin , Cole Jason , Auerbach Scott , Simpson Kathleen , Everitt Melanie
Published: November 2024

Donor-derived cell-free DNA (dd-cfDNA) has been increasingly used to detect acute rejection (AR). We aimed to compare our institutional dd-cfDNA results to previously published adult and pediatric dd-cfDNA AR cutoffs. We also hypothesized that in the absence of AR, elevated dd-cfDNA would be associated with CAV and positive DSA.

Patients (pt) < 18 years at transplant with
>
1 dd-cfDNA between 2021-2023 were included. Using dd-cfDNA levels from this cohort, sensitivity, specificity, NPV, and PPV were calculated. False positives and false negatives (FN) were determined using published dd-cfDNA thresholds. AR was defined as decision-to-treat with increased immunosuppression, which was independent of dd-cfDNA in our cohort. In pt without AR,
t
-test was used to compare the means of dd-cfDNA levels in pt with and without DSA. χ
2
testing was then performed to evaluate the association between dd-cfDNA levels above and below 0.2% and the presence/absence of DSA and CAV. DSA was defined as allele-specific DSA identified by single antigen bead with mean fluorescence intensity >1000, and CAV as any disease by angiography.

There were 379 samples among 163 pt, a median of 2 samples per pt, and 32 samples obtained at time of AR. Performance of dd-cfDNA in our cohort vs published dd-cfDNA thresholds is shown in Table 1. The FN rate ranged from 16 to 37% as the dd-cfDNA threshold increased. Mean dd-cfDNA was higher in patients with positive DSA versus those without (0.83% vs 0.19%, p<0.001). In patients that did not meet AR criteria, dd-cfDNA levels
>
0.2% were associated with a higher prevalence of positive DSA (n=66) (48% vs 13%, p<0.001), and trended towards a higher prevalence of CAV (n=20) (15% vs 11%, p=0.08).

Dd-cfDNA had high sensitivity and NPV for AR but the FN rate using published dd-cfDNA cutoffs was high in our validation cohort. The clinical utility of dd-cfDNA may extend beyond AR screening given increased frequency of DSA and CAV in pt with elevated levels that are negative for AR. We speculate that monitoring intra-pt dd-cfDNA variability will reduce the FN rate when screening for AR in addition to enhancing its clinical utility when monitoring for CAV and DSA.
Abstract 4144585: Association of renal function with mortality and heart failure hospitalization rates after Transcatheter Mitral Valve Edge to Edge Repair
Authors: Abuzeid Wael , Sacoransky Ethan , Czarnecki Andrew , Ke Danny Yu Jia , Teng Carolyn , Dave Prasham , osten mark , Zile Brigita , Wang Xuesong , Shuvy Mony , Cantor Warren , Mehta Shamir , Fam Neil , Abdel-Qadir Husam
Published: November 2024

Background:
Transcatheter edge to edge repair (TEER) is an established treatment for patients with symptomatic severe functional MR on optimal medical therapy or severe symptomatic primary MR and high surgical risk. Renal dysfunction is associated with adverse outcomes but the threshold at which risks rise are uncertain.

Aim

To determine the association of estimated glomerular filtration rate (eGFR) with adverse outcomes in patients undergoing TEER for severe symptomatic mitral regurgitation (MR) in Ontario, Canada.

Methods:
This was a population-based retrospective cohort study using linked administrative datasets of patients who underwent TEER in Ontario, Canada, between 2011 and 2023. The key exposure was eGFR, which was modeled using restricted cubic splines. Outcomes were 1-year mortality, cardiovascular mortality (CV) and heart failure hospitalization (HF). Cause-specific hazards regression was used to model the association between eGFR and outcomes, utilizing eGFR 30ml/min/1.73m2 as the reference value.

Results:
We studied 2076 patients, of whom 294 (14.2%) had eGFR <30ml/min/1.73m2 and 841 (40.5%) had eGFR 30-60ml/min/1.73m2. The incidence at one year was 16.8% for all-cause mortality, 11% for CV mortality and 14.2% for HF hospitalizations. The Figure illustrates that the predicted incidence of adverse outcomes increases with lower eGFR, with subtle differences in patterns of change in risk at lower eGFR levels such that all-cause mortality and CV mortality begin to rise rapidly at eGFR values ≤30ml/min/1.73m2, while HF hospitalization increases linearly at eGFR ≤50ml/min/1.73m2.

Conclusions:
There was a progressive increase in all-cause, CV mortality and HF hospitalization after TEER for patients with lower eGFR, particularly those with values <30 ml/min/1.73m2. This data can inform patient discussions and guide post-procedural follow-up.
Abstract 4144597: Cardiovascular Health Among Youth with Neurodevelopmental Disability: Analysis of National Survey of Children's Health (NSCH) – 2021
Authors: Baker-Smith Carissa , Zhang Zugui , Robson Shannon , Patterson Freda , Brewer Benjamin , Tsai Jung-Mei , Bhat Anjana
Published: November 2024

Introduction:
The National Survey of Children's Health (NSCH) provides data for key measures of child health and well-being. The aim of this study is to characterize the cardiovascular health (CVH) status of youth with neurodevelopmental disabilities (NDD) compared to those without neurodevelopmental disabilities (non-NDD).

Hypothesis:
Youth with NDD are more likely to have poor CVH status compared to non-NDD youth.

Methods:
We compared the odds of poor CVH status in youth with NDD vs non-NDD, using 2021 NSCH data, according to a modified AHA Life’s Essential 8 (LE8) scoring system. Participants were identified as having NDD based on the Diagnostic and Statistical Manual of Mental Disorders and diagnosis of an intellectual, communication, autism spectrum, attention-deficit/hyperactivity, specific learning, or neurodevelopmental motor disorder, including Tic disorder. The CVH status of each youth was scored according to a modified LE8 score- range 0 to 100 points, with higher scores indicating good health. Individual scores were generated for sleep (sleep duration), smoking (smoking/exposure), diabetes mellitus (yes/no), obesity (BMI percentile), heart condition (yes/no), and dyslipidemia (yes/no). A composite CVH score was generated using scores for sleep, smoking, diabetes mellitus, and obesity. Logistic regression was used to analyze the relationship between NDD and CVH status. Propensity score techniques were applied to address the potential selection bias between NDD and non-NDD.

Results:
12,134 youth, 3 to 17 years of age, were identified as having NDD and 44,960 without. Compared to those with NDD, non-NDD participants were less likely to have age-inappropriate sleep duration (63.4 vs. 55.3,
p <0.0001
), smoking/exposure (94.5 vs. 90.7,
p<0.0001
), diabetes mellitus (95.2 vs. 90.2,
p <0.0001
), obesity (80.0 vs. 73.2,
p <0.0001
), a heart condition (95.4 vs. 93.8,
p=0.021
), or dyslipidemia (98.1 vs. 95,
p<0.0001
). Overall CVH status was (93.9 vs. 91.0,
p<0.0001
) among non-NDD vs NDD participants. NDD participants had a greater odds of having a heart condition (OR=1.91, 95% CI: 1.51-2.42) and poor CVH status (OR=1.53, 95% CI: 1.45-1.62). Propensity score matching showed similar results.

Conclusions:
Neurodevelopmental disability is associated with poorer CVH status in youth. Efforts to improve CVH status in youth should include greater focus on youth with NDD.
Abstract 4145812: Cardiovascular MRI-Derived Cardiac Age Acceleration is Associated with Shortened Leukocyte Telomere Length But Not Clonal Hematopoiesis of Indeterminate Potential
Authors: Brundage James , Barrios Joshua , Tison Geoffrey , Pirruccello James
Published: November 2024

Introduction:
Cardiac structure and function typically decline with age. Abnormal acceleration of this decline, known as cardiac age acceleration, can be estimated from MRI using deep learning. Both general and cardiac-specific mechanisms may contribute to cardiac aging. Longer telomere length in circulating leukocytes, which indicates greater cellular capacity for replication, has been associated with a lower risk of heart failure and more favorable cardiac structure and function Recent data have also suggested that longer telomeres contribute to risk of clonal hematopoiesis of indeterminate potential (CHIP), which has been linked to increased risk of atherosclerosis, heart failure and arrhythmia. Here we studied whether telomere length or CHIP status are associated with deep learning derived cardiac age acceleration.

Methods:
We developed a deep learning model to estimate cardiac age acceleration in 70,805 UK Biobank participants from the cardiovascular MRI (four-chamber long axis view). Of these, we identified leukocyte telomere length (LTL) in 61,554 and were able to evaluate CHIP in 61,636. In an additional 372,465 participants unrelated to those with imaging, a genome-wide association study (GWAS) was conducted for LTL, and a GWAS of cardiac age acceleration was conducted in those with imaging; using these, a two-sample Mendelian randomization (MR) was performed to identify putatively causal relationships.

Results:
In the 61,636 participants with both CHIP and cardiac age acceleration measurements, CHIP was not associated with cardiac age acceleration regardless of driver gene (p=0.79). In contrast, cardiac age acceleration was associated with a shorter LTL (Beta=-0.025 SD, p=5.4E-10). Shorter LTL was causally associated with cardiac age acceleration (Beta=-0.10, p=0.047).

Conclusions:
These data suggest that general aging mechanisms conferred by shortening telomeres may contribute to the age-associated structural and functional decline of the heart as observed with MRI. In comparison, the relationship between CHIP and cardiovascular risk may not manifest in ways that cause apparent cardiac age acceleration.
Abstract 4145822: The Enigma of Chest Pain: Rare Presentation of ALCAPA Syndrome in a Young Adult
Authors: Kumar Baban , Sbitli Taher , Islam Sabeeh , Singh Ashu , Haniff Shaniza , Shive Gowda Ashwin , Abbas Adam , Parashar Akash
Published: November 2024

Introduction:
Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital anomaly(incidence:1 in 300,000 live births) typically presenting during infancy. Adult presentations are even rarer due to a high mortality rate of nearly 90% in the first year of life without surgical intervention. This report examines an adult patient with exercise-induced chest pain who received a delayed diagnosis of ALCAPA via multimodal imaging.

Case Summary:
A 21-year-old male presented to the emergency department(ED) with severe retrosternal chest pain radiating to both shoulders and arms, which began during exercise 30 minutes prior. He had a history of similar, milder episodes during exercise, previously treated as musculoskeletal pain and gastroesophageal reflux disease in the ED. His medical, social, and family histories were unremarkable. Physical examination revealed a soft, continuous murmur along the left sternal border. During this visit, An EKG done showed sinus tachycardia at 110 bpm and deep T-wave inversions in the anterolateral leads, a dynamic ST-T changes from his baseline.Serial Cardiac biomarkers and a lipid profile were within normal ranges. Initially managed for acute coronary syndrome-unstable angina with antithrombotic therapy, beta-blockers, and nitrates, he underwent urgent coronary angiography. This revealed a dilated right coronary artery (RCA) with retrograde flow to the left coronary artery (LCA) into the main pulmonary artery (PA) via collaterals, with no evidence of atherosclerosis (Figure 1).Echocardiography (Figure 2) and coronary CT angiography (Figure 3) confirmed the diagnosis of ALCAPA. The patient underwent successful surgical repair with aortic reimplantation of the LCA and was discharged in good health.

Discussion:
In adult ALCAPA patients, good collateral circulation may develop; however, myocardial ischemia can occur due to the "coronary steal phenomenon" and poor collateral flow regulation, leading to angina, arrhythmias, and sudden cardiac death. ALCAPA should be considered a differential diagnosis in adults presenting with exercise intolerance, as most sudden cardiac death cases occur by the fourth decade. A high index of clinical suspicion and a multimodality imaging approach is essential for the early diagnosis of this rare coronary anomaly, underscoring the critical role of early surgical intervention in preventing catastrophic, life-threatening events.
Abstract 4145834: Comparison of 30-Day Outcomes of TAVR vs. SAVR in Patients with Prior CABG: A Meta-Analysis
Authors: Qureshi Muhammad Ahmad , Haseeb Shahan , Bakht Danyal , Amir Maaz , Hussain Muqaddas , Ahmed Omair , Rehman Aqeeb Ur , Ahmed Hafsa , Ansari Umair , Munir Shafia , Zulqarnain Muhammad , Qureshi Ali Akram
Published: November 2024

Introduction:
Managing severe aortic stenosis in patients with a history of coronary artery bypass grafting (CABG) is challenging. Traditionally, surgical aortic valve replacement (SAVR) was the standard treatment, but transcatheter aortic valve replacement (TAVR) offers a less invasive alternative. This meta-analysis compares the 30-day outcomes of TAVR versus SAVR in patients with prior CABG.

Methods:
A systematic review and meta-analysis were conducted according to PRISMA guidelines. Studies comparing TAVR and SAVR in patients with prior CABG were included. The primary outcomes were 30-day (cardiovascular) CV mortality, all-cause mortality, stroke, and myocardial infarction. Heterogeneity was assessed using the Chi-squared test and I-squared statistic. P value <0.05 was considered statistically significant.

Results:
Nine studies with a total of 8,487 patients were included for the 30-day outcomes. The pooled odds ratio (OR) for 30-day CV mortality was 1.00 (95% CI: 0.48-2.06), with no significant difference between TAVR and SAVR (p=0.99). For 30-day all-cause mortality, the pooled OR was 0.75 (95% CI: 0.51-1.10), also showing no significant difference between TAVR and SAVR (p=0.14). The pooled OR for 30-day myocardial infarction was 0.34 (95% CI: 0.09-1.27), indicating no significant difference between TAVR and SAVR (p=0.11). However, the pooled OR for 30-day stroke was 0.67 (95% CI: 0.50-0.90), showing a significantly lower incidence with TAVR compared to SAVR (p=0.007). Detailed results in Figure 1.

Conclusion:
In patients with a history of CABG, TAVR appears to have comparable 30-day outcomes to SAVR in terms of CV mortality, all-cause mortality, and myocardial infarction. However, TAVR is associated with a significantly lower incidence of 30-day stroke. These findings suggest that TAVR may be a safer option in the short term for this high-risk patient population. Further research is needed to confirm these results in larger, randomized controlled trials.
Abstract 4145842: The Incidence, Predictors and Impact of 30-day Readmission of Takotsubo Cardiomyopathy Hospitalization: A Retrospective Nationwide Analysis
Authors: Nebuwa Chikodili , Bolaji Olayiwola , Mohammad Hazique , Umoudoh Uwakmfonabasi , Mandal Dipesh , Lohana Sameer
Published: November 2024

Objective:
This study aimed to describe the recent readmission and mortality rates of unplanned 30-day all cause readmission after takotsubo cardiomyopathy hospitalization.

Methods:
We conducted an analysis of the 2020 Nationwide Readmission Database. Using the ICD-10 code, we identified hospitalizations for takotsubo cardiomyopathy. We excluded hospitalizations for age<18years and planned or elective readmissions. To compare baseline characteristics between readmissions and index hospitalizations, Pearson χ2 tests were employed. We utilized multivariate Cox regression analyses to identify independent predictors of readmissions.

Results:
A total of 7554 patients were hospitalized for index admission for takotsubo cardiomyopathy, and 633 of them were readmitted. The 30-day all-cause readmission rate was 8.5% while specific takotsubo readmission rate was 0.4%. The mortality rate in the index admission was 1.9% and 5.5% in readmitted patients. The mean age of index admission was 67.6years vs 70.7 years in readmission, about 89.0% were female in index admission vs 85.0% in readmission cohorts. The most common reasons for readmission were hypertensive heart disease with heart failure, hypertensive heart disease and chronic kidney disease with heart failure, takotsubo syndrome, sepsis, NSTEMI, COPD exacerbation, acute kidney failure, pneumonia, atrial fibrillation. Readmissions had more acute kidney injury (20.6% vs 11.3%, p-value <0.001) and atrial fibrillation (23.0% vs 13.0%, p <0.001) compared to the index admission, however the index admission had more ventricular tachycardia (4.6% versus 1.8%, p=0.02) compared to readmission cohorts. Readmission had longer length of hospital stay (4.9 days vs 3.7 days, p< 0.001), but less mean total hospital charge of (US$51039 vs US$60617, P =0.008). Older age, acute renal failure, pulmonary disease, coronary dissection, longer length of hospital stays and transfer to rehabilitation facility after discharge were identified as statistically significant predictors of readmissions.

Conclusion:
About one in twelve patients hospitalized with takotsubo cardiomyopathy were readmitted within 30days. Readmissions had a higher mortality rate; acute renal failure, pulmonary disease, coronary dissection were notable reasons for readmission. Understanding the predictors for readmission highlighted in this study would enable clinicians implement preventive strategies to improve the rate of takotsubo cardiomyopathy readmission
Abstract 4145845: The Impacts of Albumin Levels on Clinical Outcomes in Patients in the Coronary Care Unit
Authors: Lu Yu-Yu , Huang Chin-Chou
Published: November 2024

Background:
Hypoalbuminemia is frequently observed in critically ill patients, yet its significance regarding short-term mortality among these patients remains uncertain. We aimed to investigate the impact of albumin levels and their changes on clinical outcomes among patients who were admitted to intensive care units due to cardiac causes.

Methods:
This is a retrospective, single-center, cohort study. Consecutive patients admitted to coronary care unit (CCU) were enrolled between January 2011 and December 2020. Serum albumin levels were obtained upon CCU admission and tracked for changes. Clinical outcomes were defined as 30-day mortality.

Results:
A total of 4,004 patients were enrolled. Among them, 1,129 (28.2%) had acute coronary syndrome, 1,915 (47.8%) had coronary artery disease, 1,039 (25.9%) had arrhythmia, and 1,825 (45.6%) had heart failure. There were 643 deaths and 3,361 survivors within 30 days. When comparing to survivors, those who died within 30 days had lower initial albumin levels (3.2 ± 0.9 vs. 3.4 ± 0.8, P < 0.001) and albumin level reduction (-0.1 ± 0.9 vs. 0.0 ± 0.9, P = 0.005). Cox regression multivariate analysis indicated that higher initial albumin levels (HR, 0.638; 95% CI, 0.538 – 0.756, P < 0.001) and increase in albumin levels (HR, 0.638; 95% CI, 0.541 – 0.752, P < 0.001) were independently associated with lower 30-day mortality rates.

Conclusions:
Higher initial albumin levels and increase in albumin levels were linked to better clinical outcomes in patients admitted to CCU.
Abstract 4145861: Systemic Sclerosis is Associated with Sub-Clinical Abnormalities in Myocardial Energetics, Perfusion and Increased Fibrosis
Authors: Soo Chin Yit , Jex Nicholas , Di Donato Stefano , Thornton Lucy Elizabeth , Kakkar Vishal , Bixio Riccardo , Tomoaia Raluca , Anderton Thomas , Lwin May , Kamani Christel , Chowdhary Amrit , Thirunavukarasu Sharmaine , Procter Henry , Kotha Sindhoora , Giannoudi Marilena , Levelt Eylem , Bissell Lesley-Anne , Delgado Francesco , Plein Sven
Published: November 2024

Background:
Primary cardiac involvement in systemic sclerosis (SSc) is heterogenous, poorly defined and associated with significant cardiac morbidity and mortality. The underlying mechanism is not well understood but may include the impact of coronary microvascular dysfunction and myocardial inflammation. Myocardial cellular metabolic alterations in SSc are yet to be established.

Aims:
Using
31
Phosphorous magnetic resonance spectroscopy (
31
P MRS) and cardiovascular magnetic resonance (CMR), we aimed to establish if myocardial energetics, measured as phosphocreatine (PCr) /ATP ratio, and quantitative myocardial perfusion were reduced in individuals with SSc compared to healthy volunteers (HV).

Methods:
A total of 35 age and sex matched participants were recruited (25 SSc, 10 HV). All subjects underwent
31
P MRS and comprehensive CMR protocol including volumetric analysis, quantitative myocardial perfusion and T1 mapping.

Results:
Table-1 shows clinical and CMR /
31
P MRS data. Bi-ventricular volumes, systolic function and left atrial function were similar in both groups. NT-Pro BNP and myocardial extra cellular volume (ECV) were significantly increased in SSc. Both PCr/ATP and myocardial perfusion reserve (MPR) were significantly reduced in SSc compared with controls. The disease activity as measured by the European Scleroderma Trials and Research group (EUSTAR) activity index did not correlate with either NTproBNP (P=0.79), PCr/ATP (P=0.35) or MPR (P=0.6).

Conclusions:
In addition to validating our previous observations of reduced perfusion and increased myocardial fibrosis in SSc, we have demonstrated for the first time significant reductions in myocardial energetics in patients with SSc. These findings provide further valuable insight into the pathogenesis of primary myocardial disease in SSc.
Abstract 4145880: Incidence and Outcomes of Acute Myocardial Infarction (AMI) in Hematological Malignancy Patients: Systematic review and Meta-analysis
Authors: Rathore Sawai Singh , Farrukh Ameer , Yao Sem Josue Nsanh , Al Shyyab Ibrahim , Vidaurre Corrales Vanessa , Wint Zario , Jain Hritvik , Goyal Aman , Kumar Ashish
Published: November 2024

Background:
Patients with hematological malignancies may face increased cardiovascular risks, including acute myocardial infarction (AMI). This systematic review and meta-analysis aims to evaluate the incidence and outcomes of AMI in patients with hematological malignancies compared with the general population.

Methods:
A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs). The inverse variance method with DerSimonian–Laird (DL) of Tau2 was used to calculate standardized mean differences (SMDs) with CIs. Statistical significance was set at p < 0.05. The primary endpoint was the incidence of AMI, while secondary outcomes included in-hospital mortality, length of hospital stay, likelihood of undergoing invasive procedures, total hospital costs, bleeding events, and stroke outcomes.

Results:
Twenty-six articles, including approximately 6.33 million patients with hematological malignancies, were included in the meta-analysis. Hematological malignancies were not associated with an increased incidence of AMI compared with the general population (OR = 0.91; 95% CI 0.80 to 1.03; p<0.001). AMI in hematological malignancies was associated with an increased risk of in-hospital mortality (OR = 1.71; 95% CI 1.57 to 1.86; p<0.001), bleeding event (OR = 1.30; 95% CI 1.12 to 1.60; p<0.001), and stroke (OR = 1.24; 95% CI 1.09 to 1.42) compared with AMI in the general population. Patients admitted due to AMI in hematologic malignancies also experienced an increased length of stay (SMD = 0.25; 95% CI 0.20 to 0.28; p<0.001) compared with AMI in the general population. There was no significant difference between the two groups in terms of the likelihood of undergoing invasive procedures (OR = 0.62; 95% CI 0.56 to 0.69) or total hospital expenditure (SMD = 0.09; 95% CI -0.01 to 0.19).

Conclusion:
While hematological malignancies do not appear to increase the incidence of acute myocardial infarction (AMI), patients who experience AMI episodes are at higher odds of in-hospital complications.
Abstract 4145884: Left ventricular 3D-sphericity is associated with 92 genetic loci
Authors: Pirruccello James
Published: November 2024

Introduction:
Left ventricular (LV) sphericity is a measure of the degree to which the LV blood pool resembles a sphere. Analyses of cardiovascular magnetic resonance imaging (MRI) in the MESA cohort have shown that LV sphericity is an important mode of variation in cardiac structure that is associated with ischemia, heart failure, and atrial fibrillation. A recent genome-wide association study (GWAS) of a two-dimensional estimate of sphericity in 38,000 UK Biobank participants identified 4 genetic loci (near PDZRN3, HLA, PLN, and ANGPT1). Genetic contributions to three-dimensional (3D) sphericity remain unknown.

Aims:
To measure 3D sphericity from cardiovascular MRI at scale and characterize the genetic contributions to 3D sphericity.

Methods:
Deep learning models were constructed to perform semantic segmentation in the short- and long-axis view from cardiovascular MRI in UK Biobank. These models were applied to all participants with MRI. Poisson surface reconstruction was used to build 3D meshes of the left ventricle. Sphericity was estimated at end-systole and end-diastole as the area of a perfect sphere with the same volume as the left ventricle, divided by the estimated surface area from the mesh. Heritability was estimated with ldsc; GWAS was conducted with REGENIE.

Results:
Sphericity was estimated in 68,978 individuals, of whom 3,096 were excluded due to atrial fibrillation or atrial dysfunction, and 2,686 were excluded during genetic quality control; 63,196 participants were included in the GWAS. Ldsc heritability was 29.7% for sphericity in diastole and 26.0% for sphericity in systole. 49 genetic loci were associated with 3D sphericity in diastole as were 64 in systole (92 distinct loci). 46 of these loci were unique to sphericity and not found for other LV traits, including loci near the genes encoding calsequestrin 2, troponin T2, palladin, supervillin, and angiopoietins 1 and 2. Shared loci included those near RXFP4, encoding a relaxin-family peptide receptor, and MICU2 (previously implicated in cardiac relaxation).

Conclusion:
Left ventricular sphericity is heritable, with genetic underpinnings distinct from standard LV measurements.
Abstract 4145889: Association between Pulmonary Artery Elastance and all cause mortality in patients with Heart Failure: A Meta-Analysis
Authors: Mellacheruvu Sai Priyanka , Nagarajan Jai Sivanandan , Vasudevan Srivatsa Surya , Pingili Adhvithi , Mohnani Priyanka , Kaur Shreyjit , Adompreh-Fia Kokou Selom , Sivakumar Thiruvikram , Pendem Harini , Rizvi Bisharah
Published: November 2024

Background:
Pulmonary Artery Elastance (PAE) is an echocardiographic value commonly calculated in Heart Failure (HF) patients. It is presumed to be associated with mortality and adverse outcomes. We aim to evaluate pulmonary artery elastance (PAE) as a predictor of all-cause mortality in heart failure (HF) patients

Methods:
A comprehensive literature review was conducted on PubMed and Google Scholar from inception till May 2024 for articles relevant to the mortality outcomes in HF patients with respect to pulmonary arterial elastance as one of their predictors. Data were extracted independently by four different reviewers. We used a fixed-effects model meta-analysis model to evaluate and pool the outcomes in association with PAE and all-cause mortality. Further assessment of the outcomes was performed by sensitivity analysis with a one-study removal method and meta-regression analysis.

Results:
Out of 63 studies, 4 studies with 759 patients were included in our meta-analysis. Mean age ranged from 54 to 65 years. We found there was a statistically significant association between pulmonary artery elastance and all-cause mortality (OR: 1.12, 1.06 - 1.19, p < 0.0001] (Figure 1a). Sensitivity analysis with one-study removal showed overall effects in the meta-analysis still lean towards supporting PAE as the predictor for ACM (Figure 1b). Meta-regression analysis with age (Figure 1c), sex and other supportive variables did not show statistically significant associated confounders.

Conclusion:
This meta-analysis establishes a significant association between elevated PAE and increased risk for all-cause mortality in HF patients. These results suggest PAE could be a strong predictor for all-cause mortality in HF patients. Further research is needed to provide a more comprehensive understanding of the predictive value of PAE for HF patients. The association between PAE and mortality could provide significant insights that could influence clinical practice and improve patient outcomes in HF.
Abstract 4145896: Terminal Rhythm of the Worldwide First Genetically Modified Porcine-to-Human Xenotransplantation
Authors: Brilliant Justin , Parsirad Mahdokht , Griffith Bartley , Khan Oneib , Khan Ubaid , Ananthram Manjula , Hong-Zohlman Susie , Feller Erika , Grazioli Alison , Amara Richard , Shorofsky Stephen , Mohiuddin Muhammad , Dickfeld Timm
Published: November 2024

Background:
The worldwide first genetically modified porcine-to-human cardiac xenotransplantation was successfully performed in January 2022 at the University of Maryland with the recipient surviving 60 days.

Aim:
Assess the ECG parameters and cardiac rhythm during the death of the worldwide first porcine-to-human xenotransplant.

Methods:
Continuous 6-lead ECG telemetry was used to analyze ECG parameters and cardiac rhythm during the final 9 minutes after withdrawal of life support.

Results:
At the time of withdrawal (W), the patient was in sinus rhythm (70bpm, PR interval 280ms, right bundle branch block (RBBB) with QRS 140ms, QT 400ms; Figure). PR prolongation up to 360ms with loss of P wave was noted at W+2:55min. Irregular junctional rhythm with blocked PACs and bradycardia (23 bpm) occurred around W+3:25min. At that time, widening of RBBB to 160ms with non-specific repolarization abnormalities and QT prolongation were observed. At W+4:30min, increasing pauses of up to 8.5s with mild QRS axis shift occurred. At W+6min, asystole (up to 20s) with rare PVCs from the left anterolateral LV base were seen. Final rhythm at W+6min consisted of ventricular escape beats from the infero-basal LV before electrical activity ceased at W+6:45min. No other atrial or ventricular arrhythmias were noted.

Conclusion:
The porcine-to-human cardiac xenotransplant showed a terminal rhythm of bradycardia, sinus arrest, and junctional and ventricular escape beats. This is consistent with ischemia-related failure of impulse generation, slowing intra-atrial/AV-conduction delay, and failure of impulse propagation. Notably, no tachyarrhythmias were seen despite ectopic atrial and ventricular beats with prolongation of depolarization and repolarization. This is similar to traditional terminal rhythms observed in humans and does not suggest unexpected arrhythmic proclivities between pig myocardium and the human environment (“pig heart in human body”).