bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4138294: Medicare Utilization and Associated Spending on Icosapent Ethyl
Authors: Parajuli Shreyash , Majmundar Vidit , Pandey Priya , Venkataramana Raju Arvind kumar , Yukselen Zeynep , Hadley Michelle
Published: November 2024

Introduction:
In 2019, Icosapent Ethyl became the first US Food and Drug Administration (FDA) approved medication for reducing cardiovascular risk beyond cholesterol-lowering therapy in high-risk patients. It was approved specifically as an adjunct to maximal tolerated statin therapy to reduce cardiovascular risk in adult patients with elevated triglyceride (TG) levels. The National Lipid Association now has a Class I recommendation for the use of icosapent ethyl (4 g/d) to reduce cardiovascular risk in patients with TG > 150 mg/dl.

Methods:
We analyzed available data from Medicare Part D prescription drug events published from the year 2018 to 2022. All data were de-identified and made publicly available. All costs were adjusted for inflation and represented in 2022 US dollars.

Results:
The number of Medicare Part D beneficiaries prescribed Icosapent Ethyl increased from 141,336 to 303,971 (215%) between 2018 and 2022 (Fig. A) and the number of claims increased from 704,334 to 1,527,133 (216%) (Fig. B). The total spending increased from $278 million to $787 million (282%) within the same timeframe (Fig. C). The average spending per claim has increased from $396 to $515 (130%) (Fig. D) and the average spending per beneficiary has also increased from $1976 to $2591 (131%) (Fig. E) between 2018 and 2022.

Discussion:
We observed a marked increase in the use of icosapent ethyl from 2018 to 2022. We can see a sharp rise of 187% in beneficiaries from 2018 to 2019 following FDA approval. The total number of claims and total spending also increased by 181% and 200%, respectively, from 2018 to 2019. The average spending per claim and average spending per beneficiary has increased from 2018 to 2022. It also demonstrates the cost burden to Medicare with the use of such lipid-lowering agents. Many Medicare plans include icosapent ethyl as a Tier 4 drug, which is the second most expensive drug tier.

Limitations:
The pattern of data used may not be generalizable to other payer demographics. Policy changes can affect the comparability of data over different periods.

Conclusion:
Our data highlights the increasing use of icosapent ethyl as a cardiovascular risk-reduction medication in the Medicare population. There has been a steady increase in the number of claims and beneficiaries since the approval of icosapent ethyl with an increase in average spending from 2018 to 2022.
Abstract 4138306: Impact of Early Menopause and Hormonal Replacement Therapy on Aortic Stenosis Progressio
Authors: Abdoun Kathia , Tastet Lionel , Bedard Elisabeth , Arsenault Marie , Pibarot Philippe , Clavel Marie-Annick
Published: November 2024

Background:
Early menopause is associated with an increased risk of cardiovascular disease and mortality in women. The present study aimed to examine the impact of early menopause and hormonal replacement therapy (HRT) on the progression of aortic stenosis (AS).

Methods:
Thirty-three postmenopausal women (mean age 65 ± 10 years) with mild or moderate AS prospectively recruited in the PROGRESSA study (NCT01679431) were included in this sub-analysis. All patients underwent multidetector computed tomography and Doppler-echocardiography at least twice during follow-up to assess both anatomic and hemodynamic AS severity, based on aortic valve calcification (AVC), mean pressure gradient (MG), and aortic valve area indexed to body surface area (AVA). Annualized changes in AVC, MG and AVAi were calculated between baseline and the last follow-up.

Results:
Over a median follow-up of 2 [1-4] years, early menopausal women had a faster progression rate of AVC, MG, and AVAi compared to other women: (100[58-130] vs. 23[2-71] AU/year, p=0.03); (2.37[0.82-3.61] vs. 0.31[0.01-1.78] mmHg/year, p=0.04); and (-0.12[-0.23-0.002] vs. -0.004[-0.07-0.08] cm
2
/m
2
/year, p=0.08) respectively. In multivariate analysis adjusted for age, AS severity at baseline, and comorbidities, early menopause remained significantly associated with faster AVC progression (p=0.003). Moreover, after comprehensive adjustment, women who received HRT (45%) had a slower progression rate of AVC (20[10-42] AU/year vs. 62[2-100], adjusted p=0.04).

Conclusion:
Early menopause is associated with faster progression of AS, both anatomically and hemodynamically. However, the use of HRT is associated with slower progression of AS. Integrating female-specific risk factors, particularly menopausal history and hormonal therapy status, into the clinical management of AS could enhance patient care.
Abstract 4138380: Cardiac protection of hiPSC-CMs loaded chitosan cardiac patch in myocardial infarcted swine
Authors: Zheng Zilong , Li Yichen , Tang Weijie , Chen Wangping , Yang Jinfu , Fan Chengming
Published: November 2024

Background:
The low grafting rate of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) following direct injection into the myocardium limits the efficacy of cardiac repair after myocardial infarction (MI). Chitosan-based scaffolds have emerged as functional biomaterials for designing delivery systems in cardiac therapies. This study aimed to enhance the potency of cardiac repair using a hiPSC-CMs loaded chitosan cardiac muscle patch (hCCMP).

Methods:
The patches were fabricated using chitosan. Characterization of the chitosan patches involved assessing their swelling rate and porosity. The biocompatibility of the hCCMP was analyzed through scanning electron microscopy (SEM) and the CCK8 assay. 16 Yorkshire swine (15-20 kg, 45-50 days of age) were randomly divided into 4 groups (n=4 per group): Sham, MI without further intervention, MI with an empty patch (without hiPSC-CMs), and MI with hCCMP implantation. One and four weeks post-MI, heart function, Infarction size, myocardial perfusion and metabolism were evaluated via cardiac PET-MRI. Engraftment was assessed through human cardiac troponin T staining. Histological analysis including left ventricular anterior wall thickness, cardiac remodeling, angiogenesis, arterialization, and apoptosis in the infarct border area were analyzed using immunofluorescence.

Results:
SEM showed that the chitosan patch had regular pore size and good 3D structure; porosity was about (96.7±0.37)%. On day3, the patch swelling rate was about (715±64.55)%. SEM, CCK8 assay showed a normal cells growth in the chitosan patch. The hiPSC-CMs grafted well with chitosan patch delivery systems and was associated with significantly improvement in LV function, infarction size, angiogenesis and cardiomyocyte apoptosis in pigs 4 weeks after MI.

Conclusions:
The 3D chitosan cardiac patch with hiPSC-CMs loaded can enhance the potency of cardiac repair in pigs after MI and present a novel and promising therapic strategy.
Abstract 4138487: A Novel Technique in Managing Equipment Entrapment: A Complicated Case of Aortic Valvuloplasty Balloon Rupture and Detachment
Authors: ABDELSALAM MAHMOUD , Ezaldin Shady , Abu-Halimah Shadi , Han Richard
Published: November 2024

Introduction:
A 79-year-old male patient with a history of surgical AVR presented with severe bioprosthetic aortic stenosis requiring valve-in-valve TAVR. The plan was to place an Evolut CoreValve after intentionally fracturing the basal ring of his surgical valve. Through an 18F sheath, a 25mm x 4.5cm True balloon was advanced to the surgical valve over a Lunderquist wire. However, the balloon ruptured immediately after fracturing the valve ring.

Decision making:
Efforts were made to remove the ruptured True balloon while maintaining the position of the wire, but attempts to withdraw it through the 18F sheath were unsuccessful due to resistance at the distal tip of the sheath. Subsequently, the proximal portion of the balloon catheter was partially detached and removed.

An exchange was made to a 22F Gore DrySeal sheath, but again, efforts to withdraw the ruptured balloon were unsuccessful (Figure 1). Various snares were employed, but all attempts to manipulate the balloon into the sheath were ineffective. The ruptured balloon remained in the abdominal aorta and eventually detached from the hypotube.

The 22F sheath was then exchanged for a 20F Inari Protrieve sheath. Two Supracore wires were then inserted through the sheath, with one designated for snare delivery and the other for maintaining vessel access. A Tulip snare was guided over one Supracore wire to the descending thoracic aorta, where the snare was opened and the Lunderquist wire was captured at the junction between the stiff and soft parts of the wire (Figure 2). The snared wire and ruptured balloon were retracted into the exposed Nitinol cone of the Inari sheath, successfully engulfing the balloon and compressing it (Figure 3). The sheath, wire, balloon, and snare were then removed as a unit while the wire access was maintained.

A new 22F Gore DrySeal sheath was inserted. Inspection confirmed the complete removal of all components of the ruptured True balloon and the catheter. The procedure concluded with the successful deployment of a 29mm Evolut pro CoreValve. The patient made an uneventful recovery and was discharged home the following day.

Conclusion:
The Inari Protrieve sheath proved valuable in this case of complicated intravascular equipment entrapment. The soft, funnel-shaped nitinol cone aided in capturing and compressing the bulky ruptured balloon, obviating the need for a surgical cutdown.
Abstract 4138519: A Scoping Review Exploring Cardiovascular Risk and Health Metrics and Cancer Prediction
Authors: Kim Ji-Eun , Henriquez Santos Gretell , Kumar Sant , Livinski Alicia , Vo Jacqueline , Joo Jungnam , Shearer Joe , Hashemian Maryam , Roger Veronique
Published: November 2024

Introduction:
Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. Since they share risk factors, it is plausible that CVD risk scores and cardiovascular health (CVH) metrics could also be used to predict cancer.

Research Question:
What is the relationship between established CVD risk scores and CVH metrics and the incidence of cancer?

Methods:
A librarian searched four databases (Embase, PubMed, Scopus, Web of Science: Core) in February 2024 without language restriction. Using Covidence, two reviewers independently screened the titles, abstracts, and full texts of the retrieved articles based on the inclusion criteria (prospective observational studies, adults aged ≥18 years, reported incidence of any type of cancer as an outcome, and used at least one CVD risk score or CVH metric as an exposure). A third reviewer resolved conflicts. The characteristics of the studies retained after screening and the summary estimates of the associations were extracted using Excel.

Results:
Of the 4,165 records screened, 13 studies (reporting 14 CVD or CVH metrics) were included. The heterogeneity in the scales (comparison group) precluded a meta-analysis. Four studies evaluated CVD risk scores (Atherosclerotic Cardiovascular Disease [ASCVD], Framingham Risk Score, Systematic Coronary Risk Evaluation), and 10 reported CVH metrics (American Heart Association [AHA] Life’s Simple 7, AHA Life’s Essential 8). Sample size ranged from 1,880 to 342,226, with median follow-up from 8.1 to 29.6 years. Most of the studies included more women than men (61.5%) and mean age ranged from 44.8 to 72 years. The majority of studies included all cancer types (71.4%), including breast, lung, colorectal, and prostate cancer subtypes, and the total number of cancer events ranged from 387 to 11,643. Studies utilizing CVD risk scores consistently reported that individuals with a higher CVD risk, developed any type of cancer, with hazard ratios (HRs) ranging from 1.02 to 3.71, and studies employing CVH metrics generally indicated an ideal CVH is associated with a lower cancer risk, with HRs ranging from 0.49 to 0.95.

Conclusion:
Despite heterogeneity in CVD risk metrics and cancer subtypes, most studies reported that higher CVD risk scores or worse CVH metrics may increase future cancer risk. More rigorous studies are needed focusing on specific CVD risk metrics and cancer types of cancer to produce evidence suitable for a meta-analysis.
Abstract 4138547: The A Body Shape Index and Type 2 Diabetes are Mutually Independent Predictors of Cardiovascular Events in Patients With Established Coronary Artery Disease
Authors: Plattner Thomas , Larcher Barbara , Mader Arthur , Vonbank Alexander , Leiherer Andreas , Muendlein Axel , Drexel Heinz , Saely Christoph H
Published: November 2024

The A Body Shape index (ABSI) is a validated measure of visceral adiposity that is calculated based on waist circumference, height and BMI. Its power to predict cardiovascular events in patients with coronary artery disease (CAD) is unclear and is addressed in the present study.

We prospectively recorded cardiovascular events in a cohort of 938 patients with CAD over a mean follow-up time of 8.1±4.2 years.

At baseline, the ABSI was higher in patients with type 2 diabetes (T2DM; n=308) than in those who did not have diabetes (8.4±0.6 vs. 8.3±0.5; p=0.032). Prospectively, the ABSI significantly predicted the incidence of cardiovascular events (n=389) after adjustment for age, gender, smoking, hypertension, LDL cholesterol, HDL cholesterol, and T2DM (standardized adjusted HRs 1.12 [1.03-1.22]; p=0.009, respectively). T2DM in turn also significantly predicted cardiovascular events in this model with a HR of 1.23 [1.02-1.49]; p=0.034 after adjustment for ABSI.

We conclude that ABSI and T2DM are mutually independent risk factors for cardiovascular events in patients with established CAD.
Abstract 4138552: Prevalence, Complications, and Outcomes of Cardiogenic Shock in Breast Cancer Patients; A Population Based Study
Authors: Bajwa Ahmad Taimoor , Iqbal Rabia , Jafar Amina , Linn Hnin Nadi , Sanka Sujana , Gollamudi Sindhu , Gaddam Mrunanjali , Mallick Abbas
Published: November 2024

Background:
Cardiovascular disease and cancer are the leading causes of mortality in developed countries. Recent evidence suggests that these conditions share common underlying factors, such as inflammation and oxidative stress. However, there is a lack of data on the association between cardiogenic shock and cancer.

Purpose:
Our study aimed to investigate the prevalence and outcomes of cardiogenic shock in patients with a history of breast cancer.

Methods:
We conducted a retrospective analysis of data from the National Inpatient Sample Database (2018-2020) to identify patients with a primary diagnosis of breast cancer. We employed the International Classification of Diseases (ICD-10) diagnostic criteria. Our analysis focused on the impact of cardiogenic shock on mortality, morbidity, and resource utilization. We used chi-square tests for categorical variables and t-tests for continuous variables.

Results:
Our analysis identified 516,125 breast cancer patients admitted between 2018 and 2020, with 11.3% experiencing cardiogenic shock. The mean age of these patients was 64 years, with 1.2% males and 98.8% females. The mortality rate among patients with cardiogenic shock was 11.8%, which was significantly higher than the 4.1% mortality rate in those without cardiogenic shock (OR 1.9, CI 1.5-2.4, p-value <0.05). Patients with cardiogenic shock were more likely to experience arrhythmias (OR 1.2, CI 1.13-1.4, p-value <0.05) cardiac arrest (OR 2.1, CI 1.3-2.9, p-value <0.05), acute kidney injury (OR 2.2, CI 2.1-2.3, p-value <0.05), and systemic inflammatory response syndrome (SIRS) (OR 2.8, CI 2.5-3, p-value < 0.05). These complications were associated with increased hospitalization costs, with patients with cardiogenic shock incurring $77,185 in costs compared to $64,300 for those without cardiogenic shock (p-value 0.00).

Conclusion:
Our study highlights the significant prevalence of cardiogenic shock in patients with breast cancer (11.3%) and its association with increased mortality rates. These findings highlights the importance of immediate management of cardiogenic shock to prevent adverse outcomes and emphasize the need for close monitoring and early intervention to minimize the risk of related complications. Multidisciplinary cooperation between cardiologists, intensivists, and oncologists is crucial during these critical situations.
Abstract 4138564: Fitbit-Measured Physical Activity Is Inversely Associated With Incident Atrial Fibrillation Among All Of Us Participants
Authors: Barua Souptik , Upadhyay Dhairya , Surapaneni Aditya , Grams Morgan , Heffron Sean
Published: November 2024

Background:
Studies show that moderate to vigorous physical activity (MVPA) reduces atrial fibrillation (AF) risk. However, these studies used subjective questionnaires or short-term (<1 week) accelerometry assessments.

Objective:
This study investigated the link between MVPA levels and AF incidence using long-term (1-year) accelerometry data from the NIH All of Us Fitbit database.

Methods:
The study included All of Us participants who agreed to share electronic health record (EHR) and Fitbit data between January 1, 2016 to July 1, 2022. Among participants without an existing diagnosis of AF, the average weekly minutes of MVPA over the first year of Fitbit use was computed. Incident AF events were identified using validated ICD-10 codes in a five-year follow-up period. The risk of incident AF was evaluated using Cox proportional hazards regression models, for both MVPA as a continuous and a categorical variable (<30, 30-150,151-300, and >300 minutes MVPA per week; aligned with WHO guidelines). Covariates included age, sex, race/ethnicity, BMI, smoking status, and diagnoses of hypertension and diabetes. In a subset of participants with whole genome data, we evaluated if the association between MVPA and AF incidence varied by a participant’s AF genetic risk score (GRS)

Results:
6086 participants (mean age 50 years, 71% female, 83% White) had EHR and at least 1 year of Fitbit data. Over the 1-year MVPA assessment period, participants had 41±12 weeks of complete data and a median 202 [241] minutes of MVPA per week. 55 participants (0.9%) experienced incident AF in the five-year follow-up period. In adjusted analysis, every additional hour of MVPA was associated with an 11% reduced risk of AF (HR = 0.89 [0.81,0.98], p = 0.02). There was a step-wise reduction in risk of AF by MVPA category with <30 min/week as the reference: 30-150 (HR = 0.62 [0.24,1.6], p = 0.31), 151-300 (HR = 0.40 [0.15,1.07], p = 0.07), and >300 (HR = 0.35 [0.13,0.95], p = 0.04) (
Figure 1
). These associations also held after adjusting for GRS.

Conclusion:
Higher amounts of objectively measured MVPA were inversely associated with risk of incident AF, independent of clinical and genetic risk factors.
Abstract 4138589: Prognostic implications of Biventricular systolic and diastolic strain in diabetes without coronary artery diseases.
Authors: Matshela Mamotabo
Published: November 2024

Background:
2D-speckle-tracking echocardiography (2D-STE) has emerged as useful to assess subclinical myocardial dysfunction, however its utility in diabetes milletus (DM) has been limited to the evaluation of left ventricular (LV) longitudinal systolic function.

Aim:
To assess the differences and prognostic implications of left (LV) and right (RV)ventricular systolic and diastolic strain parameters in DM.

Methods:
Of the initial 1721 DM patients screened for this study only 513 consecutive patients with DM were eligible and retrospectively enrolled, and 2D-STE strain (longitudinal, circumferential and radial) parameters assessed on the 2D-TTE images. All patients were prospectively followed for development of new outcome/cardiac events which included hospitalization for acute HF, CVS-related death, heart transplantation, and also diabetic complications. The 2D-STE analysis was used to measure the peak LV (longitudinal, radial and circumferential) and RV (longitudinal and radial) strain parameters. The long-term outcomes were evaluated for all-cause CVS outcomes and recurrent hospitalization.

Results:
For the 513 eligible patients [mean age: 51±8; 62 % male sex], 263 reached the combined endpoint during a mean follow-up of 1.4±0.6years. Conventional TTE was performed in all subjects and reviewed. Both LV and RV strain parameters were significantly impaired compared to normal standard references (p<.0001), where RV was more impaired than LV strain parameters. Th
e best performance parameters predictive of CVS events were RV systolic and diastolic strain than global LV longitudinal systolic and diastolic strain.
The strongest association between the degree of myocardial dysfunction and CVS risk was more evident for RV strain (free wall > global strain) and lesser extend to LV strain. More myocardial strain impairments were demonstrated in those with higher left atrial volume index, impaired diastolic function, lower strain values ( LV, RV), and reduced tricuspid annular plane systolic excursion, p<.001). RV strain and to a lesser extend LV strain impairment were independent predictors of combined outcomes after multiple adjustments using different models.

Conclusion:
Patients with Diabetes, RV and LV strain parameters are stronger (RV>LV strain) predictors of outcome than other conventional parameters and should be included for regular clinical screening DM patients as these parameters provide a stronger prognostic stratification
Abstract 4138601: Comparison Between Mono VS Dual VS Triple Antiplatelet Therapy In Patients With Ischemic Heart Disease Undergoing PCI, A Network Meta-Analysis.
Authors: Al-Shammari Ali Saad , Ibrahim Ahmed , Shalabi Laila , Almansouri Naiela , Tarek Hasan Mohammed , Kanagala Sai Gautham , Islam M Rafiqul , Alsawadi Razan , Al Sakini Ahmed , Hassan Ibrahim , A. Nada Sara , Al-Wssawi Ameer
Published: November 2024

Background:
Antiplatelets are important in ischemic heart disease(IHD) patients. We aim to research the efficacy and safety of single(SAPT), dual(DAPT), and triple(TAPT) antiplatelet approaches in IHD patients undergoing PCI.

Methods:
A systematic review was conducted until April 1st, 2024, and a network meta-analysis using the Netmeta package in R studio 4.3.3 was performed. Primary outcomes were cardiac death, myocardial infarction(MI), stent thrombosis, stroke, and major bleeding(BARC 3-5). A sensitivity analysis was done to explain variables with high heterogeneity.

Results:
From 25 studies, a total of 65115 patients were included in the analysis. For cardiac death, 17 studies showed TAPT had a lower risk than DAPT compared to SAPT [RR = 0.74; 95%CI (0.40 to 1.35); p-value = 0.33], [RR = 1.01, 95%CI (0.84 to 1.19); p-value = 0.87] respectively. The heterogeneity was insignificant(I2=0%; p-value=0.58. For MI, 23 studies found TAPT had a lower risk than DAPT compared to SAPT [RR = 0.77; 95%CI (0.51 to 1.16); p-value = 0.2047], [RR = 0.81, 95%CI (0.64 to 1.03); p-value = 0.0850] respectively. The heterogeneity was significant (I2 = 53%). For stent thrombosis, 17 studies showed DAPT had a lower risk than TAPT compared to SAPT [RR = 0.74; 95%CI (0.45 to 1.21); p-value = 0.2284], [RR = 0.84, 95%CI (0.27 to 2.59); p-value = 0.7630] respectively. The heterogeneity in this comparison was significant. For stroke, 17 studies showed DAPT had a lower risk than TAPT for stroke in comparison to SAPT [RR = 0.91; 95%CI (0.75 to 1.10); p-value = 0.3209], and [RR = 0.87, 95%CI (0.43 to 1.76); p-value=0.6937], respectively. The heterogeneity was insignificant(I2=0%; p-value=0.8165). For Major bleeding(BARC 3-5), 15 studies showed DAPT had a lower risk than TAPT in comparison to SAPT[RR = 1.43; 95%CI (1.09 to 1.88); p-value = 0.0107], [RR = 2.78, 95%CI (0.90 to 4.78); p-value = 0.0852] respectively. The heterogeneity was significant(I2 = 49.5%).

Conclusion:
Personalized treatment approaches that consider the benefits and risks of different antiplatelet strategies are crucial for optimal patient management of IHD.
Abstract 4138611: Impact of SGLT-2 Inhibitor Use on Atrial Fibrillation Incidence Following Heart Failure Hospitalization
Authors: Fretz Thomas , Tanawuttiwat Tanyanan , Ilonze Onyedika , Das Mithilesh
Published: November 2024

Introduction:
The development of atrial fibrillation (AF) in patients with heart failure (HF) is associated with increased morbidity and mortality. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated cardiovascular benefit in patients with both preserved and reduced ejection fractions. Meta analysis of prospective trials suggest reduced incidence and burden of atrial fibrillation in patients taking SGLT-2 inhibitors, though this has not been specifically addressed in prospective trials.

Hypothesis:
SGLT-2 inhibitors reduce the incidence of atrial fibrillation in patients with heart failure.

Aim:
The goal of the study is to assess the impact of SGLT-2 inhibitor on the incidence of atrial fibrillation following heart failure hospitalization.

Methods:
The study included consecutive patients who were admitted to an academic tertiary care center over a 3 year time period with a primary diagnosis of heart failure exacerbation and no prior diagnosis of AF. The primary outcome was development of AF within 12 months after hospitalization. Demographic, comorbidity, echocardiographic data, and medications were obtained. Cox-regression analysis was performed to identify the predictors of new-onset AF after HF hospitalization.

Results:
Among the 3,953 patients included in our study, 704 (17.8%) patients were prescribed SGLT-2 inhibitors. Of those taking SGLT-2 inhibitors, 559 (79.4%) patients had diabetes. SGLT-2 inhibitor use is associated with significant reduction of AF at one year (
p<0.001; RR 0.65; 95% CI: 0.51-.81
). This finding was consistent across patients with reduced ejection fractions (EF<50%) (
p=0.001; RR 0.56; 95% CI: 0.40-.80
) and preserved ejection fraction (EF>50%)(
p=0.001; RR 0.58; 95% CI: 0.42-0.80
).

Conclusion:
In patients with reduced ejection fraction and preserved ejection fraction heart failure, use of an SGLT-2 inhibitor is associated with a statistically significant lower risk of new-onset atrial fibrillation at one year following HF hospitalization.
Abstract 4138624: Looking Beyond Respirophasic Ventricular Interdependence: A Case Report of Constrictive Pericarditis Masquerading as Cirrhosis
Authors: Shan Rongzi , Share Michael , Ayoub Walid , Lee Andrew , Kwan Alan
Published: November 2024

Case Presentation:
A 67-year-old man with recurrent pleural effusions and concern for cirrhosis was referred for liver transplant. Pleural fluid was transudative by Light’s criteria with a high total protein level of 3.5 g/dL, which made hepatic hydrothorax unlikely. Liver biopsy confirmed congestive hepatopathy without advanced fibrosis. Transthoracic echocardiogram showed left ventricular (LV) ejection fraction 55%, right ventricular (RV) systolic pressure 35 mmHg, normal mitral annular tissue doppler velocities, and early diastolic septal bounce. Right and left heart catheterization showed prominent X and Y descent, elevated and equalized diastolic pressures, but no respiratory discordance in the LV-RV pressure gradient. As etiology of these findings were unclear, he underwent aggressive diuresis and hemodialysis, but repeat right heart catheterization showed persistently elevated right and left filling pressures. Cardiac MRI had no evidence of myocardial or pericardial inflammation/edema but showed pericardial thickening (7.9 mm) and septal bounce. There was no inspiratory septal shift, but the large pleural effusion appeared to limit diaphragm excursion. Given lack of respirophasic ventricular interdependence and thickened pericardium on MRI, CT was ordered, showing pericardial calcifications. Diagnosis of constrictive pericarditis was made, and patient underwent complete pericardiectomy. Pathology confirmed calcified and thick pericardium without acute inflammation. Post-operatively, patient developed RV failure, but recovered with inotrope support and was discharged with improvement in congestive symptoms.

Discussion:
Constrictive pericarditis classically exhibits respirophasic ventricular interdependence, but large pleural effusions may decrease respiratory variation in intrathoracic pressures, blunting this response. Normal mitral annulus tissue doppler velocities and lack of infiltrative process on cardiac MRI made restrictive cardiomyopathy unlikely. In the absence of respirophasic changes on multimodality testing, constriction can be diagnosed with other supportive features such as diastolic septal bounce, rapid Y descent, diastolic pressure equalization, and pericardial thickening and calcifications.
Abstract 4138686: Impact of Ejection Fraction on Incidence of Atrial Fibrillation Following Admission for Heart Failure
Authors: Fretz Thomas , Fortna Sarah , Ilonze Onyedika , Tanawuttiwat Tanyanan , Das Mithilesh
Published: November 2024

Introduction:
Though the prevalence of atrial fibrillation (AF) is similar amongst heart failure (HF) with reduced, mildly reduced, and preserved ejection fractions, population-level data suggests a modestly increased prevalence in patients with HFpEF compared to those HFrEF. The development of atrial fibrillation is associated with increased risk of stroke, hospitalization, and cardiovascular death in all types of heart failure, though some data suggests morbidity and mortality is worse amongst those with HFpEF. Whether ejection fraction plays a role in development of AF following a HF hospitalization is unclear.

Hypothesis:
We hypothesized incidence of AF following heart failure hospitalization is increased in patients with preserved ejection fractions.

Aim:
The goal of this study is to assess the impact of ejection fraction on development of new atrial fibrillation following heart failure exacerbation.

Methods:
Patients admitted to an academic tertiary care hospital with a primary diagnosis of HF without a previous diagnosis of AF were identified and followed for up to one year for this retrospective study. Demographic, comorbidity, medications, and echocardiography of these patients were obtained from the medical record and analyzed. Consistent with the American Heart Association heart failure guidelines, we defined HFrEF as an EF less than 40%, HFmrEF as an EF between 40-50%, and HFpEF as an EF greater than 50%. This data was analyzed on SPSS using cox-regression and Kaplan-Meier survival analysis.

Results:
Of the 3,953 patients included in our study, 22.2% had HFrEF, 13.5% had HFmrEF, and 64.3% had HFpEF. At the end of one year 23.5% of those with HFrEF, 20.1% of those with HFmrEF, and 15.9% of those with HFpEF, developed atrial fibrillation. The difference in AF incidence was noted to be statistically significantly lower in HFpEF compared to HFrEF (p<0.001) and HFmrEF (p=0.019). The difference between HFmrEF and HFrEF did not reach statistical significance (p=0.144).

Conclusion:
In patients without atrial fibrillation, a reduced ejection fraction is associated with an increased incidence of atrial fibrillation one year following a hospitalization for heart failure compared to a preserved ejection fraction.
Abstract 4138698: Association of ALDH2*2 Variant with Increased HDL-Cholesterol Levels in East Asian Populations
Authors: Zhang Ruina , Purkayastha Subhanik , Malkani Kabir , Heffron Sean
Published: November 2024

Background:
Mitochondrial aldehyde dehydrogenase 2 (ALDH2) is responsible for acetaldehyde metabolism with alcohol consumption. ALDH2 deficiency is a common enzymopathy – afflicting ~540 million East Asians. The ALDH2*2 variant, a missense mutation, significantly decreases enzyme activity. Recent studies suggest a potential link between ALDH2 deficiency and increased cardiovascular disease (CVD) risk. High-Density Lipoprotein cholesterol (HDL-C) is inversely associated with CVD and is known to increase with alcohol consumption. However, the impact of ALDH2*2 on HDL-C levels in East Asians remain unclear.

Methods:
Using the NIH
All of Us
cohort, we assessed HDL-C levels and reported alcohol consumption habits (never, < once/week, > once/week) at enrollment, as well as ALDH2 variant status among East Asian participants. Differences in HDL-C values were analyzed with Mann-Whitney U-tests.

Results:
Among 3,289 US Asian adults (age 46.8 ± 16.1 years; 58.8% female), median HDL-C was 54mg/dL [IQR 45, 67]. Of these, 2809 (85.4%) had wildtype ALDH2, and 480 (14.6%) had ALDH2*2
.
Individuals with ALDH2*2 reported lower alcohol consumption (Figure A) but exhibited higher HDL-C levels (p=0.0002). The association was similar regardless of sex (Figure B).

Conclusion:
The ALDH2*2 variant is associated with higher HDL-C levels, despite lower alcohol consumption, indicating a possible independent influence on HDL-C levels. In the context of previous studies linking ALDH2 deficiency to adverse CVD outcomes, this suggests that ALDH2 may have a role independent of HDL-C levels, or it could affect HDL function rather than the HDL-C level itself.
Abstract 4138718: Teen Pregnancy and Risk of Premature Major Adverse Cardiovascular Events
Authors: Agboola Olayinka , Satti Danish Iltaf , Mehta Adhya , Javed Zulqarnain , Epps Kelly , Honigberg Michael , Sarma Amy , Scott Nandita , Harrington Colleen , Saad Antonio , Spitz Jared , Sharma Garima
Published: November 2024

Introduction:
Teen pregnancy (TP), defined as pregnancy between 10 and 19 years, is associated with adverse pregnancy outcomes and perpetuates socioeconomic disadvantage, but the impact in later life is not well studied. We investigated the association of TP with premature major adverse cardiovascular events (PMACE)

Methods:
We used data from the National Health and Nutrition Examination Survey 1999–2018. Surveys were linked with the National Death Index to ascertain mortality records. Only adult females aged 20 years and older were included in the analysis. Participants were divided into 3 groups based on age at their first life birth: 19 or younger (TP), 20 and above (non-TP), and nulliparous women (NP). TP was ascertained by age at first life birth ≤ 19 years, and PMACE was defined as any self-reported diagnosis of coronary artery disease, stroke, heart failure, or all-cause mortality occurring before age 65. We assessed the association between these groups and PMACE using univariate and multivariate logistic regression models.

Result:
Among 19,737 (weighted frequency of 83,450,668) adult females, 24.2% had a history of TP, 54.3% had a history of non-TP and 21.5% were NP. Compared with NP females, females with TP had a higher odd of PMACE with an unadjusted odd ratio of 3.75 (95%CI, 2.80 - 5.01) versus 2.07 (1.55 – 2.75) among non-TP. Adjusting for age, race, alcohol use, smoking, and social determinants of health factors such as income, educational status, insurance status, and food insecurity, TP remained independently associated with higher odds of PMACE with an adjusted odd ratio of 1.66 (95%CI, 1.19 – 2.30); p=0.003, but this association was not statistically significant among non-TP females with aOR 1.32 (0.95 – 1.84); p=0.10.

Conclusion:
Teen pregnancy was associated with higher likelihood of PMACE. This association may be indicative of the enduring impact of social determinants of health factors associated with teen pregnancy into adulthood.
Abstract 4138721: Outcomes of Coronary Revascularization in Patients with Contemporaneous Abdominal Organ Transplant
Authors: Zamirpour Siavash , Zhang Justin , Tseng Elaine , Soni Krishan , Boskovski Marko
Published: November 2024

Background:
Clinical evaluation surrounding liver and kidney transplantation may reveal obstructive coronary artery disease (CAD). However, little is known about outcomes after revascularization in this population. Our aim was to examine coronary artery bypass grafting (CABG) and percutaneous intervention (PCI) in peri-transplant patients compared to the general CABG/PCI populations.

Methods:
We conducted a matched retrospective cohort study between 2014-2022 at a single academic center. Matching was done by optimal full matching of a logistic regression-based propensity score adjusting for age, chronic kidney disease, diabetes, tobacco use, chronic lung disease, hypertension, prior myocardial infarction, and valvular disease. Covariate balance was assessed as standardized mean difference <0.2. The primary outcome was a composite of in-hospital death, stroke, and myocardial infarction, and a key secondary outcome was incident arrhythmia.

Results:
The study population comprised 2655 patients: 24 CABG/transplant (median age, 64 [IQR, 59-66]; 4 female [17%]), 1037 CABG/non-transplant (age, 66 [59-73]; 190 female [18%]), 27 PCI/transplant (age, 62 [IQR, 55-67]; 6 female [22%]), and 1567 PCI/non-transplant (age, 70 [IQR, 60-78]; 399 female [25%]). CABG/PCI preceded transplant by a median 321/324 days, respectively, and followed transplant by a median 461/36 days, respectively. For the primary outcome in CABG patients, there were no events in the transplant group and an estimated potential outcome in 6.5% of the matched non-transplant group (marginal RR, <0.001; p<0.001). For the primary outcome in PCI patients, there were no events in the transplant group and an estimated potential outcome in 2.4% of the matched non-transplant group (marginal RR, <0.001; p<0.001). For incident arrhythmia in CABG patients, the estimated potential outcome was 12% and 17.5% in the transplant and matched non-transplant groups, respectively (marginal RR, 0.98; 95% CI, 0.37-2.6; p=0.97). For incident arrhythmia in PCI patients, the estimated potential outcome was <0.001% and 3.6% in the transplant and matched non-transplant groups, respectively (marginal RR, 0.89; 95% CI, 0.12-6.5; p=0.91).

Conclusions:
Patients with contemporaneous abdominal organ transplant undergoing coronary revascularization suffered no in-hospital mortality, stroke, or myocardial infarction, and were not at greater risk of incident arrhythmia than similar non-transplant patients.
Abstract 4138733: Predictive Value of Serum Vasoactive Intestinal Peptide for Low-Voltage Areas in Atrial Fibrillation
Authors: Nishino Kotaro , Temma Taro , Kawakami Kei , Kawasaki Masahiro , Shimano Kintaro , Saito Shota , koya jiro , Tatsuta Daishiro , Natsui Hiroyuki , Koizumi Takuya , Kadosaka Takahide , Koya Taro , Nakao Motoki , Watanabe Masaya , Anzai Toshihisa
Published: November 2024

Introduction:
Identifying low-voltage areas (LVAs) within left atrium (LA) is crucial for predicting atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Animal studies have shown that the parasympathetic neurotransmitter vasoactive intestinal peptide (VIP) affects atrial electrophysiological remodeling.

Hypothesis:
Thus, we hypothesized that elevated serum VIP levels might contribute to the development of LVAs and that serum VIP concentrations could serve as a biomarker for LVA presence in AF patients.

Aims:
The aim of this study is to investigate the relationship between the blood levels of VIP and the presence of LVAs in AF patients with electroanatomical mapping (EAM).

Methods:
We conducted an observational, prospective cross-sectional study on AF patients undergoing PVI between 2021 and 2023. Blood samples for VIP were collected before atrial septal puncture, and EAM was performed using CARTO 3® before PVI. VIP concentrations were measured using an enzyme-linked immunosorbent assay kit. Patients were divided into two groups based on LVA presence (≥5% or <5%) as determined by EAM.

Results:
Among the 108 patients, 51 (47%) had LVA. VIP levels were significantly higher in patients with LVA compared to those without (median [interquartile range]: 335.1 [274.1-456.5] pg/mL vs. 247.7 [196.1-294.0] pg/mL, p<0.001). No difference was observed in VIP levels by LVA sites. Multivariate logistic regression identified VIP and sex as independent predictors of LVA (per 50 pg/mL, odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.13-1.83, p<0.001, OR: 4.67, 95% CI: 1.69-12.89, p=0.002, respectively). Females with high VIP had lower conduction velocity compared to other groups. (low VIP male: 0.9 [0.6-1.0] m/s, high VIP male: 0.9 [0.7-1.1] m/s, low VIP female: 0.8 [0.7-1.0] m/s, high VIP female: 0.7 [0.3-0.8] m/s, p=0.013). Incorporating VIP levels (≥288 pg/mL) into an existing predictive score (age ≥65 years, female, and LA volume index ≥57 mL/m
2
) significantly improved LVA detection (area under the curve: 0.784 vs. 0.707, p<0.001).

Conclusions:
Serum VIP levels are higher in patients with LVAs, and VIP is a reliable predictor of LVA presence. Incorporating VIP levels into existing predictive models enhances the power for identifying LVAs in AF patients. Serum VIP measurement could be valuable for detecting LVAs, improving risk stratification, and tailoring strategies in AF management.
Abstract 4138757: Lipid-Lowering Therapy Intensification and Low-Density Lipoprotein Cholesterol Testing Following a Major Cardiovascular Event or Procedure in Adult Patients in the United States
Authors: Jin Ran , Oliveira Thiago , Jones Jenna , Ma Jifeng , Kouznetsova Maria , Sugumaran Rajkumar
Published: November 2024

Background:
Optimizing lipid-lowering therapy (LLT) use is foundational to reduce atherosclerotic cardiovascular disease (ASCVD) risk, especially among patients who have already experienced an ASCVD event. This study aimed to evaluate the patterns of LLT intensification and LDL-C testing within 12 months following an ASCVD event in US patients.

Methods:
Adults who experienced an ASCVD event (acute coronary syndrome, coronary revascularization, stable angina, ischemic stroke, transient ischemic attack, or peripheral arterial disease) between January 1, 2016 and December 31, 2022 in the IQVIA Longitudinal Access and Adjudication Data were included. The first instance of LLT intensification after the event was defined as an increase from a low-moderate to high intensity statin, or the initiation of statins, ezetimibe, PCSK9i, or bempedoic acid in addition to a baseline LLT regimen that did not include these medications. Baseline medication use was defined during 6 months before the ASCVD event.

Results:
Among 6,028,573 patients who had an eligible ASCVD event (mean age: 63.6 years, 51.5% male), 53.9% were not taking any LLT and 43.2% were taking statins only (low-moderate intensity: 26.7%; high intensity: 16.4%) during baseline. Within 1, 3, and 12 months after the event, 16.3%, 21.3%, and 30.0% of patients intensified LLT, respectively. Among patients who intensified LLT within 12 months (n= 1,820,246), the most commonly observed intensification was from no LLT use at baseline to low-moderate (29.0%) or high-intensity statins (43.5%), followed by intensification from low-moderate to high-intensity statins (20.3%). LDL-C values at baseline were available in a subset of 10.7% of patients, with the median being 95 mg/dL (78.9% ≥70 mg/dL). LDL-C values were observed in 17.7% of patients within 12 months after the ASCVD event, with the median being 84 mg/dL (68.3% ≥70 mg/dL).

Conclusions:
Within 12 months after an ASCVD event, only about one-third of patients intensified LLT and two-thirds did not achieve guideline-recommended LDL-C levels. The results highlight a missed opportunity to reduce recurrent ASCVD events. Future effort is warranted to address the clinical inertia that may be contributing to this unmet need.
Abstract 4138792: A Case of Right Coronary Artery Chronic Total Occlusion in a Transplanted Heart: To Stent or Not to Stent?
Authors: Krayem Hussein , Cooke Richard , Abouzaki Nayef , Kutkut Issa
Published: November 2024

Background:
Cardiac Allograft Vasculopathy (CAV) is commonly seen in transplanted hearts. Due to the absence of innervation, many transplanted patients have no symptoms despite extensive disease. This poses a challenge in deciding when to perform coronary interventions. We present a case of significant CAV on surveillance angiogram that posed a challenge in management.

Case:
A 67-year-old female presented for her fifth surveillance coronary angiography nine and a half years after her heart transplant. The angiogram revealed ostial right coronary artery (RCA) chronic total occlusion (CTO) with left-to-right collaterals as well as diffuse irregularities in the left anterior descending (LAD) and left circumflex arteries. The patient was asymptomatic and two years prior to that, her angiogram revealed no significant disease. Biopsies for the past nine years showed no evidence of allograft rejection. She was subsequently referred for coronary intervention.

Due to concern of CTO being a sign of rapidly progressing CAV, it was decided to undergo revascularization of the RCA. Antegrade approach was performed with guidance from contralateral injections. Three overlapping drug-eluting stents were deployed proximally-distally using intravascular ultrasound guidance. Surveillance angiography nine months later showed patent RCA stents with no significant disease otherwise. Eighteen months later, angiography demonstrated CTO of the mid LAD and patent RCA stents with mild in-stent restenosis in the most distal RCA stent. The patient remained asymptomatic.

Discussion:
CAV develops in fifty percent of transplanted hearts within 10 years and requires close surveillance. In this case, revascularization of the RCA CTO resulted in maintaining graft function for at least two additional years as the development of LAD CTO may have resulted in graft failure had the RCA CTO not been intervened upon. CTO revascularization in CAV has the potential to prolong graft viability and delay the need for re-transplantation. Further studies related to CTO revascularization, especially in asymptomatic transplanted patients, are needed to understand the impact on morbidity and mortality in this patient population.
Abstract 4138813: The Use of Direct Oral Anticoagulants for Valvular Atrial Fibrillation in Central Australia
Authors: Sawant Sonia , Freedman Gabrielle , Terrett Sally , Garcia Ana , Khandkar Chinmay , Sivashanmugarajah Anosh , Baumann Angus
Published: November 2024

Background:
In developed countries, valvular atrial fibrillation (vAF) in the setting of rheumatic heart disease (RHD) disproportionately impacts minority groups. In Australia, Indigenous Australians account for 92% of cases despite only representing 3.8% of the population. Studies to date, such as the INVICTUS trial, support the use of Vitamin K antagonists (VKAs) over direct oral anticoagulants (DOACs) in vAF. However, this assumes consistent adherence and regular clinic follow up. Reduced access to monitoring and dispensing clinics in Central Australia remains a challenge in the provision of VKAs and the use of DOACs may address this.

Hypothesis:
DOACs may be comparably effective with VKAs in preventing major adverse cardiac and cerebrovascular events (MACCE) in a real-world vAF population.

Aim:
To conduct a real-world retrospective observational study examining rates of MACCE for patients on VKAs or DOACs for vAF in Central Australia over a five-year period.

Methods:
The Northern Territory RHD Register was accessed to identify patients with RHD and vAF in January 2019. Demographic and five-year outcome data (until January 2024) were collected. The primary outcome was MACCE, a composite of ischaemic stroke, systemic embolism, non-fatal myocardial infarction, cardiovascular death and all-cause mortality. The primary safety endpoint was major bleeding. Statistical analyses were conducted as both intention-to-treat (ITT) based on initial anticoagulation and as-treated (AT) based on anticoagulation prior to MACCE or trial endpoint, each excluding patients without anticoagulation.

Results:
61 patients were included. The mean age was 61.9 ± 13.9 years and 68.9% were female. At baseline, 65.6% received VKA, 14.8% DOAC and 19.7% were not anticoagulated. 30.6% of patients crossed over from the ITT analysis, with a non-significant trend favouring switch to DOAC (11 vs 0, p=0.09). In the ITT analysis (n=49), there was no significant difference in MACCE (25.0% vs 22.2%, p=0.86) or major bleeding (20.0% vs 11.1%, p=0.53) between VKA and DOAC groups. In the AT analysis (n=51), there was no significant difference in MACCE (27.3% vs 16.7%, p=0.39) or major bleeding (18.2% vs 22.2%, p=0.73) between VKA and DOAC groups.

Conclusion:
Over a five-year period, there was a trend towards use of DOACs over VKAs in vAF. This study demonstrates that DOACs may be as effective as VKAs for reducing MACCE in a real-world vAF population however further investigation is required.