bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144305: Comparison of Transradial Versus Transfemoral Access in Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
Authors: Fatima Laveeza , Ahmed Mushood , Zulfiqar Eeshal , Tariq Muhammad Daoud , Hurjkaliani Sonia , Mushtaq Fiza , Ahmad Adeel , Rahman Asad , Ahmed Raheel
Published: November 2024

Background and Purpose:
Transfemoral access (TFA) has been the standard for neuro-interventional procedures, but it carries risks such as pseudoaneurysm formation and arterial occlusion. Transradial access (TRA) is a newer alternative that may reduce these complications. This study aims to compare the clinical outcomes of TRA versus TFA in mechanical thrombectomy (MT) for acute ischemic stroke (AIS).

Methods:
A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases searched included PubMed/MEDLINE, Cochrane Library, and Google Scholar up to April 7, 2024. A random-effects model was used for analysis, and study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias (RoB 2) tool.

Results:
The search identified 1389 records, and 13 studies (12 observational, 1 RCT) with 4803 patients (TRA: 855, TFA: 3948) were included. TRA showed no significant difference in successful recanalization (TICI 2b-3) compared to TFA [RR: 0.98; 95% CI: 0.94 – 1.03]. Complete recanalization (TICI 3) was also similar [RR: 1.08; 95% CI: 0.96 – 1.21]. Fluoroscopy time, reported by four studies, showed no significant difference [RR: -1.76; 95% CI: -7.54 – 4.02]. Hospital stay duration from three studies was comparable [MD: -0.52; 95% CI: -1.25 – 0.21]. The access-to-perfusion time reported by ten studies showed no significant difference [MD: -1.70; 95% CI: -8.11 – 4.72]. The mean number of passes from eight studies showed no significant difference [MD: 0.10; 95% CI: -0.06 – 0.27].

Procedural complications were lower in the TRA group but not statistically significant [6.09% vs. 8.77%, RR: 0.71; 95% CI: 0.46 – 1.09]. TRA had significantly fewer access site complications [RR: 0.23; 95% CI: 0.08 – 0.62]. Symptomatic intracranial hemorrhage from seven studies showed no significant difference [RR: 1.0; 95% CI: 0.72 – 1.38]. NIHSS score at discharge showed no significant difference [MD: 1.31; 95% CI: -2.14 – 4.76]. In-hospital mortality from two studies showed no significant difference [RR: 0.56; 95% CI: 0.26 – 1.20]. Ninety-day mortality from three studies showed no significant difference [RR: 1.15; 95% CI: 0.98 – 1.36].

Conclusion:
TRA is as effective as TFA for MT in AIS and significantly reduces the risk of access site complications. Further large-scale RCTs are warranted to confirm these findings and refine the clinical guidelines for optimal access strategy in neuro-interventional procedures.
Abstract 4144306: Relation Between Periprocedural Acute Myocardial Infarction And Coronary Microcirculation In Elective Percutaneous Coronary Intervention
Authors: Jallad Pedro , Maksud Danilo Maksud , Alves Bruno , Calderon Jean Carlos , GODINHO ROGER , Pileggi Brunna , Lopes Neuza , Gowdak Luis Henrique , Abizaid Alexandre , CAMPOS CARLOS
Published: November 2024

Background:
Coronary microvascular dysfunction in patients with stable coronary artery disease (CAD) predicts worse long-term clinical outcomes. Whether the dynamic changes of the microcirculation during elective percutaneous coronary intervention (PCI) might be associated with the occurrence of periprocedural acute myocardial infarction (pMI) is still unknown.

Objective:
In this study we aimed to investigate the impact of pre and post-PCI angiographic-derived index of microcirculatory resistance (AMR), coronary flow velocity ratio (CFVR) and μFR on periprocedure myocardial infarction (pMI).

Methods:
Between June 2021 and December 2023, patients with CAD who underwent elective PCI at a tertiary hospital in Brazil, were considered for inclusion; patients with side branch occlusion were excluded. All eligible patients underwent microcirculation analysis using AngioPlus Core (Shanghai Pulse Medical Technology Inc). The primary outcome was the incidence of pMI, as defined by the Fourth universal Definition (4thU) and by the Society for Cardiovascular Angiograph&Interventions (SCAI) criterias.

Results:
330 patients were included into the analysis. Figure 1 (A-D) shows the behavior of epicardial pressure and flow and, the microvascular resistance according to the occurrence of pMI. Dynamic changes in coronary microcirculation, lead to differences between the delta of μFR, AMR and CFVR pre and post-PCI, which are correlated with pMI in patients undergoing elective PCI. The best parameter to predict pMI was delta AMR (4thU AUC 0.64; SCAI AUC 0.68; Figure 1A). Patients who developed pMI, presented significantly higher values of delta μFR (4thU p< 0.001; SCAI p 0.04; Figure 1B) and delta AMR (4thU p < 0.001; SCAI p = 0.005; Figure 1C). There is a tendency for CFVR to decrease in pMI population, as seen in delta CFVR value (4thU p = 0.03; SCAI p = 0.007; Figure 1D).

Conclusion:
Computational angiographic-derived indexes were able to identify patients with pMI undergoing elective PCI irrespective of the pMI definition. These indexes have potential utility in clinical practice for patient’s risk stratification.
Abstract 4144308: Re-Exploration of the Pulmonary Resistance-Compliance Relationship: a Universal Time Constant and Hyperbolic Fit?
Authors: Hungerford Sara , Adji Audrey , Kempton Hannah , Kapur Navin , Burkhoff Daniel
Published: November 2024

Background:
Pulmonary vascular resistance (PVR) and arterial compliance (PAC) represent the two major hemodynamic determinants of PA load, and their interdependence (the PVR-PAC relationship), critical to our understanding of RV-PA coupling. Previously, it has been reported that the two are physiologically linked through an inverse hyperbolic relationship, such that any rise in PVR is followed by an inverse reduction in PAC, and vice versa. Recent modelling has questioned the 'physiological correctedness' of this relationship as both share stroke volume (SV) in their determination. Accordingly, we sought to re-explore the PVR-PAC relationship, comparing PAC
clinical
with a new, modified area under the curve method, termed PAC
pcwp.

Methods:
PAC
clinical
was calculated as the ratio of SV to PA
PP
. For PAC
pcwp
, the time constant was estimated as:

τ = (A-dt*PCWP)/(P
1
-P
2
)

, where
A
is the integral over the time period from t
1
to t
2
of the pressure wave,
dt
is the time difference between

P
1

and

P
2

,
PCWP
is the mean post capillary wedge pressure,

P
1

is the arterial pressure at t
1
and

P
2

the arterial pressure at t
2
. Once
τ
was determined, PAC
pcwp
was measured as the
τ/PVR
ratio.

Results:
Hemodynamic data from 79-patients with dyspnoea who underwent sequential right heart catheterisation/cardiac magnetic resonance for investigation of PH were analysed (24 pre-capillary PH, 25 post-capillary, 17 combined and 13 controls). PAC
pcwp
values were significantly higher than PAC
clinical
(5.5±4.0 vs 3.4±1.6 mL/mmHg; P<0.01), with a non-signifcant increase in
τ
amongst subjects with PH (Figure 1a). Whereas PVR demonstrated a strong inverse hyperbolic correlation with PAC
clinical
(R
2
-0.77, P<0.01), it did not with PAC
pcwp
(R
2
-0.09, P=0.59; Figure 1b) where there was significant random scatter at lower PVR values. Compared with data in those with a PCWP <15mmHg, the relationship was predictably shift downward in an almost parallel manner for PVR-PAC
clinical
but not so PVR-PAC
pcwp
(Figure 1c&d).

Conclusions:
Although these observations may seem trivial at first, they bring into question the invariability of (i) a constant R-C time product and (ii) a hyperbolic resistance-compliance relationship, signalling the potential for greater fluctuations in PAC for any given change in PVR. Reconsideration of PAC determination using the PAC
pcwp
method in those with a low PVR and/or PA
M
(i.e., at the steep end of the PVR-PAC curve) may be the key to unlocking the prognostic utility of this index.
Abstract 4144319: Socioeconomic and Geographic Factors Associated with Reduced Prenatal Diagnosis of Significant Congenital Heart Disease at a Single Regional Institution
Authors: Ittleman Benjamin , Howard Waylon , Virk Kathryn , Brown Nicholas , Bhat Aarti , Caris Elizabeth , Conwell Jeff , Edwards Lindsay , Lewin Mark , Pinto Nelangi , Studer Matthew , Young Luciana , Arya Bhawna
Published: November 2024

Background:
Prenatal diagnosis (PND) of congenital heart disease (CHD) is associated with lower preoperative mortality and improved perinatal outcomes. Socioeconomic (SE) and geographic disparities impact PND of CHD in the United States. However, the relationship of these disparities and PND along with postnatal outcomes have not been previously studied in the Northwestern United States, a large geographic catchment area with significant SE and access-to-care variability.

Hypothesis:
Greater SE disadvantage, defined by higher Area Deprivation Index (ADI), as well as non-white race, Hispanic ethnicity and increased distance from our regional surgical center are associated with lower rates of PND of CHD.

Aims:
To evaluate the association of SE and geographic variables and PND of CHD in a cardiac center with a unique catchment area. Also to compared post-operative outcomes between those diagnosed prenatally and postnatally.

Methods: A Retrospective cross-sectional study of all patients with CHD requiring surgical intervention <6 months of age between 2014-202 at a single institution, serving 6 states, in the Northwestern United States was performed. Medical records, prenatal, and surgical databases provided demographic, diagnosis, and outcomes data. Race, ethnicity, ADI and address data were collected from first hospitalization or prenatal record depending on timing of diagnosis.

Results:
705 patients met inclusion criteria; 511 prenatally diagnosed and 194 postnatally. Higher (more disadvantaged) State ADI (p<0.001), non-white race (p=0.03), Hispanic ethnicity (p<0.002) and increased distance from surgical center (p<0.001) were associated with lower rates of prenatal diagnosis. No significant difference in post-surgical variables between prenatally and postnatally diagnosed patients was found.

Conclusion:
In a large regional catchment area serviced by a single surgical center, non-white race, Hispanic ethnicity, higher state ADI and distance from regional surgical center were associated with decreased rates of PND of significant CHD. This study provides a framework for developing strategies to improve accessibility to comprehensive prenatal care for underserved communities.
Abstract 4144321: Catheter Ablation Outperforms Medical Therapy in Management of Persistent Atrial Fibrillation: Enhanced Cardiac Function, Reduced Mortality, and Lower Hospitalizationion Rates
Authors: Sharma Anubhuti , Sharma Arundhati , Daid Simranpreet Singh , Senthil Velmurugan Isha , seelam Laxmi Priya , Aryal Saurav , Sanghvi Urja , Dantuluri Sahitya , Syed Saif , Panjiyar Binay
Published: November 2024

Background:
Persistent atrial fibrillation (AF) presents a significant management challenge, particularly in patients with concurrent heart failure. The effectiveness of catheter ablation compared to medical therapy for these patients remains under debate.

Aim:
This meta-analysis aims to evaluate the outcomes of catheter ablation versus medical therapy for managing persistent AF.

Research Question:
How does catheter ablation compare to medical therapy in managing persistent AF considering outcomes like arrhythmia recurrence, hospitalizations, cardiac function, exercise capacity, and mortality?

Methods:
We performed a meta-analysis of randomized controlled trials (RCTs) comparing catheter ablation with medical therapy in patients with persistent AF. Data sources included PubMed, Embase, Cochrane Library, Clinicaltrial.gov, Google Scholar, and CINAHL/EBSCOHOST, with studies selected based on predefined inclusion criteria. Primary outcomes assessed were recurrence of atrial arrhythmias, hospitalizations, changes in left ventricular ejection fraction (LVEF), changes in 6-minute walk test (6MWT) distance, and all-cause mortality. The data extraction was done using a spreadsheet, and the data analysis was done using RevMan 5.4.1: for meta-analysis

Results:
A total of 10 RCTs involving 1812 patients were included in the analysis. Compared to medical therapy, catheter ablation significantly reduced the recurrence of atrial arrhythmias (risk ratio [RR] = 0.43, 95% confidence interval [CI]: 0.29-0.63, P < 0.0001). Hospitalization rates due to heart failure were also lower in the ablation group (RR = 0.57, 95% CI: 0.44-0.73, P < 0.001). Improvements in LVEF were observed with a mean difference (MD) of 5.98% (95% CI: 3.81% to 8.15%, P < 0.00001). The performance on the 6MWT was better in the catheter ablation group, with an MD of 28.83 meters (95% CI: 8.61 to 49.05 meters, P = 0.005). Additionally, catheter ablation was associated with a reduction in all-cause mortality (RR = 0.60, 95% CI: 0.45-0.80, P = 0.00006).

Conclusion:
This meta-analysis demonstrates that catheter ablation is superior to medical therapy in managing persistent atrial fibrillation. Catheter ablation offers significant benefits in reducing atrial arrhythmia recurrence, lowering hospitalization rates, improving cardiac function and exercise capacity, and reducing mortality. These findings support the consideration of catheter ablation as a preferred treatment strategy for patients with persistent AF.
Abstract 4144337: Temporal Trends of Permanent Pacemaker Implantation With Transcatheter Aortic Valve Replacement in the United States 2016 - 2023
Authors: Mehta Chirag , Bhargout Mohamed , Ahmad Khansa , Elkaryoni Ahmed , Imran Hafiz , Abbott Jinnette , Sharaf Barry , Gordon Paul , Saad Marwan
Published: November 2024

Background:
Permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR) is associated with adverse outcomes and cost. Whether the incidence and timing of PPMI has changed with the advent of newer device iterations and implantation techniques is unknown.

Methods:
This contemporary analysis queried the Vizient Database to identify patients who underwent TAVR from January 2016 to November 2023. The primary outcome was the trend of PPMI within 30 days of TAVR (i.e., during index admission, or readmission for PPMI within 30 days) over the study years. Linear trend test was used for trend analyses.

Results:
Of 253,100 TAVR patients, 24,797 (9.8%) received a PPMI within 30 days. Compared to the non-PPMI group, patients in the PPMI group were of similar age, but were more likely male and White, and had a higher burden of comorbidities. Over the study period, the rate of 30-day post-TAVR PPMI ranged from a low of 13.6% in 2017 to a high of 16.6% in 2023, with an overall increase in trend (p=0.04). With respect to timing of PPMI, the rate of PPMI during index TAVR admission remained similar (p=0.19), while the rate of 30-day readmission for PPMI increased (p<0.001). In tandem, there was a significant trend of shorter hospital length of stay (p< 0.001) across the study period.

Conclusion:
Despite advancements in TAVR and expansion to lower risk patients during the time period examined, the rate of PPMI within 30 days of TAVR increased, mainly driven by an increase in PPMI after the index hospitalization. Further study is needed to understand the reasons for the observed trends.
Abstract 4144340: Attributing Ischemic Heart Disease Patients to Physicians: An Assessment of Claims-based Accountable Care Organization Attribution Methods
Authors: Magid David , Luo Qian , Moghtaderi Ali , Klasco Richard , Kini Vinay
Published: November 2024

Background:
Accountable care organizations (ACOs) often assess provider care quality by using attribution algorithms to determine the provider most responsible for a patient’s care. However, patients with ischemic heart disease (IHD) may receive care from more than one physician, and secondary prevention for IHD is often provided by both primary care physicians (PCPs) and cardiologists.

Aim:
To assess the performance of two commonly used claims-based ACO attribution methods for identifying the provider responsible for managing IHD-related outpatient care for patients in the year following incident acute myocardial infarction (AMI).

Methods:
Retrospective analysis of Medicare claims data for 491,391 AMI patients who survived for at least 1-year. Assignment of responsibility was made to the physician who saw the patient for the 1) plurality of PCP visits (PCP-method) or 2) plurality of PCP or cardiologist visits (PCP-Cardiologist method). For each method we assessed a) the proportion of patients that could be attributed to a physician, and b) how often the attributed physician and non-attributed physicians provided IHD care. IHD visits were identified using a previously validated list of IHD diagnosis codes.

Results:
The PCP-method attributed 352,261 patients (72%) and the PCP-Cardiologist method attributed 396,618 patients (81%) to a physician. The PCP-method attributed physician did not see the patient for an IHD visit in 38% of cases and did not provide the plurality of IHD visits in 67% of cases. The PCP-cardiologist method attributed physician did not see the patient for an IHD visit in 30% of cases and did not provide the plurality of IHD visits in 35% of cases. Overall, the proportion of IHD visits provided by other, non-attributed physicians was 69% for the PCP-method and 39% for the PCP-Cardiologist method.

Conclusions:
Patients with IHD often obtain care from multiple physicians. Commonly used ACO attribution methods to identify a single physician responsible for a patient’s IHD care results in a significant number of patients being unattributed. Attribution methods that focus on visit frequency alone often attribute patients to physicians that do not provide any IHD care or less than a plurality of IHD care. Multi-attribution methods which attribute patients to more than one physician and consider both visit frequency and clinical context could result in a more appropriate appraisal and distribution of the responsibility of IHD care.
Abstract 4144351: Association of Blood Pressure Time in Target Range with Outcomes Among NIH "All of Us” Cohort
Authors: Agarwal Neel , St John Julie , Laffin Luke
Published: November 2024

Novel means to account for BP fluctuations are being scrutinized to assess longitudinal control, including BP time in target range (TTR) assessment. TTR quantifies the percentage of time a patient’s BP is in the desired range. The present analysis sought to determine the relationship between BP TTR and long-term outcomes among participants in the NIH “All of Us” cohort.

Systolic and diastolic BP TTR are differentially associated with long-term outcomes among low-risk primary prevention participants compared to high-risk primary, as well as secondary prevention participants.

“All of Us” is an 800,000 participant cohort that is followed longitudinally and collects demographics, adverse events, medications, procedures, and laboratory and clinical measurements. A participant’s systolic BP was noted to be in target range if it was between 110-130 mm Hg and diastolic BP was in target range if it was between 70-80 mmHg. TTR was calculated via traditional and Rosendaal linear interpolation (RLI) methods. Participants were grouped into high and low-risk primary and secondary prevention groups and sorted into four groups based on the percentage of TTR: <25%, 25–50%, 50-75%, or ≥75%. Descriptive statistics, hazard ratios, and survival curves were generated to assess the association between TTR and a composite outcome of major adverse cardiovascular events and all-cause mortality.

156,183 participants had at least 4 BP readings and were analyzed. The cohort had a mean systolic BP of 125 mm Hg and diastolic BP of 74 mm Hg. Among secondary prevention patients, a lower risk of the composite outcome was seen among individuals with ≥75% systolic TTR compared with <25% using the traditional (HR 0.48, CI(0.28, 0.81), p=0.006) and RLI (HR 0.49, CI(0.28, 0.87), p=0.014). In high-risk primary prevention participants, higher systolic BP TTR by RLI was associated with decreased risk and in low-risk primary prevention participants, higher systolic BP TTR by the traditional method was associated with decreased risk. Survival curves corroborated this trend (Figure). Diastolic BP TTR analysis demonstrated similar associations.

Systolic and diastolic BP TTR predict long-term cardiovascular and all-cause mortality among the “All of Us” cohort.
Abstract 4144380: Association Between an Atrial Fibrillation Polygenic Risk Score and Incident Atrial Fibrillation
Authors: Peigh Graham , Mulford Ashley , Shi Zhuqing , Tran Huy , Wei Jun , Ashworth Annabelle , Xu Jianfeng , Sanders Alan , Arman Qamar , Wasserlauf Jeremiah
Published: November 2024

Background:
Prior population-based cohort studies demonstrate that an atrial fibrillation (AF)-specific polygenic risk score (AF-PRS) is an independent predictor of incident AF. Further data on the performance of the AF-PRS in a real-world population may inform AF screening techniques in high-risk patients.

Objective:
The objective of the current study is to evaluate the association between an AF-PRS and incidence of AF in a real-world cohort.

Methods:
Data from the Endeavor Health Genomic Health Initiative (GHI), utilizing DNA from blood samples of consenting patients, were analyzed. All participants in the GHI with complete genetic information (low pass whole genome sequencing with imputation) and without an existing diagnosis of AF (per ICD-10 codes) were included and followed through a censoring date of 7/21/2023. AF-PRS (PGS002756) was calculated for each patient. A high-risk AF-PRS was defined as 1.5x relative risk for AF based on the UK biobank, which corresponds to the 13
th
percentile of risk. Multivariate analyses were completed to determine associations between this AF-PRS and outcome variables.

Results:
There were 15,803 patients in the GHI (53.7yrs [52.4-53.9], 34.3% male) followed for a median of 8 years. Among them, 2,206 (14.0%) had a high-risk AF-PRS. Those with high-risk AF-PRS were less likely to be male, had a higher BMI, and a greater percentage of family history of AF (Table). A high AF-PRS risk, compared to low AF-PRS risk, was associated with greater incidence of AF (HR 1.89 [1.55-2.31], p<0.001) after adjusting for age at recruitment, gender, and genetic background (top 10 ancestry principal components) (Fig 1). Those with a high-risk AF-PRS also had a younger age at AF diagnosis (Fig 2).

Conclusions:
In a real-world cohort of patients with complete genetic sequencing, a high-risk, compared to low-risk, AF-PRS was associated with greater incidence of AF and younger age at AF diagnosis. The findings, along with other risk factors, could provide a rationale for screening measures in selected patients at increased risk of developing AF.
Abstract 4144385: Advanced Cardiac MRI Parameters Phenomapping to Predict Outcomes in Patients with Nonischemic Cardiomyopathy
Authors: Ammoury Carl , Wu Yanjun , Korkerdsup Theerawat , Wang Tom Kai Ming , Rizkallah Diane , Bodi Kashyap , Calcagno Tess , Chen David , Nguyen Christopher , Tang Wai Hong , Wang Xiaofeng , Kwon Deborah
Published: November 2024

Background:
Non-ischemic cardiomyopathy is a classification that includes several heterogenous phenotypes. Derivation of distinct phenotypes may enable improved risk stratification. Comprehensive functional, morphologic, and substrate assessment of the myocardium can be leveraged to derive distinct phenogroups through unsupervised latent class/cluster analysis but requires accurate and reproducible imaging biomarkers. We sought to evaluate the impact of cardiac magnetic resonance (CMR) imaging parameters to derive distinct phenotypes in NICM patients.

Methods:
Consecutive NICM patients referred to CMR between 2001 and 2017 were evaluated. Latent Class Analysis (LCA) was performed to identify phenotypes enriched by comprehensive CMR assessment. The primary endpoint was death, heart transplant, or left ventricular assist device implantation. Kaplan–Meier survival curves were estimated, and differences between phenotypic groups were assessed by the log-rank test. Decision tree modeling was used to predict the latent class membership. LCA and Decision tree analysis were completely blinded to the clinical outcomes.

Results:
A total of 458 patients were identified (53.2 ± 15.7 years, 40.7% females), with 83 primary events. LCA identified 3 distinct clusters of patients, with significant differences in overall outcome (p<0.0001, Figure 1A). Principal component analysis demonstrated 3 well demarcated clusters. Weighted variable analysis demonstrates the variable importance for determining phenogroup status (Figure 1B). Decision tree analysis (Figure 1C) demonstrated high accuracy (0.89) to predict LCA phenogroup status.

Conclusion:
CMR enriched phenomapping identified 3 distinct NICM phenogroups associated with significant differential risk profiles, with advanced CMR measures including comprehensive myocardial strain assessment being important imaging parameters used for phenogroup stratification. Decision tree analysis provided an accurate, simplified, and explainable method to enable a novel approach for patient selection. Future studies are needed to determine if distinct phenogroups are associated with differential treatment response to various interventions.
Abstract 4144386: Obstructive Sleep Apnea does not Affect Atrial Remodeling and Ablation Success in Persistent Atrial Fibrillation Patients: Insights from DECAAF II
Authors: bidaoui ghassan , Feng Han , Bsoul Mayana , Assaf Ala' , Younes Hadi , Chouman Nour , Tirado Polo Francisco , Liu Yingshuo , Jia Yishi , Lim Chanho , Hassan Abboud , Tsakiris Eli , Abi-Rached Joe , Hui Yanpei , Ademi Besim , Mekhael Mario , Noujaim Charbel , Rao Swati , Kreidieh Omar , donnellan eoin , Pandey Amitabh , Marrouche Nassir
Published: November 2024

Background:
Previous literature suggests that Obstructive sleep apnea (OSA) increases atrial fibrillation (AF) recurrence after catheter ablation, but its impact on atrial remodeling has not been investigated.

Objective:
The study assesses the impact of OSA and continuous positive airway pressure (CPAP) on atrial remodeling, AF burden, arrhythmia recurrence, QoL improvement.

Methods:
The study population consists of patients with persistent AF with late-gadolinium enhancement (LGE) MRI before and after undergoing catheter ablation from the DECAAF II trial. We compared a subgroup with OSA with the rest of the cohort. The three study outcomes were measured with the following: arrhythmia recurrence and AF Burden based on single-lead smartphone-based daily electrocardiogram (ECG) strips, and SF36 questionnaires (baseline, 3-month, 12 month). Survival analysis of arrhythmia recurrence was performed using cox regression analysis, controlling for confounders.

Results:
The study population consists of 815 patients. We compared 84 OSA patients with the remaining 731 non-OSA population. Amongst OSA patients 29 patients were treated with CPAP. Baseline characteristics including baseline fibrosis (18.8 vs 18.86; p=0.9426), left atrial volume index (LAVI) (62.4 mm
3
vs 62.6 mm
3
p=0.95), and comorbidities were not different between OSA and non-OSA patients except for body mass index (30.9 vs 35.1; p<0.001). OSA patients had more lateral fibrosis compared to non-OSA patients (2.6 vs 2.18; p=0.002). Both groups demonstrated equivalent LAVI decrease (9.5 mm
3
vs 9.57 mm
3
; p=0.975), QoL improvement (11.8 vs 8.23; p=0.116), AF burden (14.8%vs 14.2% p-value=0.8222), and time-to-recurrence (p= 0.15). OSA is not associated in this cohort of persistent AF with ablation failure even after controlling for age, sex, body mass index (BMI), CPAP use, baseline fibrosis, and LAVI.

Conclusion:
Catheter ablation for AF results in similar improvements in atrial remodeling, QoL, AF burden, and arrhythmia recurrence for both OSA and non-OSA patients, irrespective of CPAP treatment.
Abstract 4144389: Obstructive Sleep Apnea is Associated with Ablation Failure in Paroxysmal Atrial Fibrillation Patients Only: Insights from a left atrial MRI Database
Authors: bidaoui ghassan , Younes Hadi , Feng Han , Bsoul Mayana , Assaf Ala' , Chouman Nour , Tirado Polo Francisco , Liu Yingshuo , Jia Yishi , Lim Chanho , Hassan Abboud , Hui Yanpei , Tsakiris Eli , Abi-Rached Joe , Ademi Besim , Noujaim Charbel , Rao Swati , Kreidieh Omar , donnellan eoin , Pandey Amitabh , Marrouche Nassir
Published: November 2024

Background:
Obstructive sleep apnea (OSA) may influence the outcomes of catheter ablation in atrial fibrillation (AF) patients, but its impact at different stages of AF is not well understood.

Objective:
This study aims to evaluate whether OSA influences catheter ablation outcomes differently in patients with paroxysmal AF compared to those with persistent AF.

Methods:
We included AF patients with and without obstructive sleep apnea (OSA) in a late gadolinium enhancement (LGE) MRI database of patients who underwent catheter ablation. Our study population was stratified based on the type of AF: paroxysmal or persistent. Patients were followed for 24 months post-ablation, with a 3-month blanking period. To analyze time-to-AF recurrence, we used Kaplan-Meier curve along with the log-rank test to compare recurrence rates between patients with and without OSA in both AF types. Additionally, we used Cox regression analysis to adjust for potential confounders.

Results:
324 patients with paroxysmal AF (mean age: 64.5) and 512 patients with persistent AF (mean age: 65.2) were included. The left atrial (LA) volume was similar between OSA and non-OSA patients in both the paroxysmal AF cohort (83.1 mm3 vs. 83.6 mm3; p=0.73) and the persistent AF cohort (115 mm3 vs. 119 mm3; p=0.37). Patients with OSA exhibited a higher prevalence of comorbidities, including congestive heart failure (CHF), coronary artery disease, obesity, and diabetes, compared to non-OSA patients (p<0.05). After adjusting for these comorbidities, OSA was significantly associated with a higher rate of AF recurrence following ablation in paroxysmal AF patients (HR=2.249; p<0.001). However, OSA did not significantly impact ablation outcomes in persistent AF patients (HR=1.014; p=0.836).

Conclusion:
OSA significantly impacts the success of catheter ablation in patients with paroxysmal atrial fibrillation (AF), leading to higher rates of AF recurrence. However, this association was not observed in patients with persistent AF.
Abstract 4144401: Hypertension and Incident Cardiovascular Events following Thoracic Radiotherapy
Authors: McCrohan Megan , Patel Prem , Busby Tyren , Holtman Adia , Siefker Anna , Wade Elizabeth , Jin Ning , Merritt Robert , Diaz Dayssy , Ghazi Sanam , Ferdousi Mussammat , Ruz Patrick , Reddy Sohil , Miller Eric , Addison Daniel
Published: November 2024

Introduction:
Radiation therapy (RT) is associated with high efficacy in treating thoracic malignancies. However, it has been linked to potentially limiting cardiotoxicity, including anecdotal reports of profound hypertension (HTN). Yet, the long-term incidence and implications of HTN development after RT is unknown.

Aims:
We aimed to define the relation between RT and HTN development in patients with lung and esophageal cancers, as well as the association of RT with major adverse cardiac event (MACE) and overall survival.

Methods:
From a large cohort of consecutive esophageal and lung cancer patients treated with thoracic RT from 2007-2019, we assessed the incidence and outcomes of incident (new) or worsened HTN [systolic blood pressure (SBP) ≥130mmHg] after RT initiation. Secondary outcomes were MACE (heart failure, myocardial infarction, stroke, arrhythmia and sudden death) and overall survival by RT dose. Differences in outcomes by HTN status were also evaluated via landmark analysis, excluding those with undiagnosed HTN. Observed new HTN rates were compared to Framingham predicted rates, and absolute excess risks were estimated. Multivariate regression was used to define the relation between clinical and RT measures (including cardiac and aorta substructure dose) and outcomes.

Results:
Overall, 439 RT-treated patients (238 esophageal; 201 lung; 66.7% male; mean age 63.2 years; 57.9% baseline HTN) were identified. Most (67.4%) had advanced T3-4 disease. Over a median follow-up of 23 months, 262 (59.7%) developed new or worsened HTN; median SBP increase of 8 mmHg. In landmark analysis, the cumulative incidence of new or worsened HTN by 1 year was 48.0% and 68.5%, respectively. Using the JNC 8 cutoff of ≥140/90 mmHg, the new HTN rate was 19.1% at 1 year, translating to a 1.7-fold higher rate than the Framingham predicted rate (RR 1.72,
P
<0.0001). In multivariate models, RT dose consistently associated with new or worsened HTN development (
P
<0.05). Similarly, beyond age, only RT-dose (aorta max dose, mean dose, V60; whole heart, left atrium, left ventricle, right atrium V60; right ventricle max dose, mean dose, V50, V60) consistently associated with MACE (
P
<0.05 for all). In multivariate analysis, new HTN remained associated with improved overall survival (HR: 0.75,
P
<0.001), even after accounting for surgical resection and disease-related factors.

Conclusion:
In patients with lung and esophageal cancers, RT increases HTN risk even within 1-year of treatment.
Abstract 4144404: Efficacy of Mavacamten on Echocardiographic Parameters and Cardiac Biomarkers in Hypertrophic Cardiomyopathy Patients: A Systematic Review and Meta-Analysis
Authors: Otmani Zina , Abdrabou Noura , Ayman Elsayed Hazem , Diaa Hindawi Mahmoud , K. Awad Ahmed
Published: November 2024

Introduction:
Mavacamten, a cardiac myosin inhibitor, distinguishes from other pharmacological interventions by addressing not only symptomatic treatment but also targeting the underlying pathophysiological mechanisms in Hypertrophic Cardiomyopathy (HCM). Therefore, we aimed in our meta-analysis to evaluate the impact of mavacamten on echocardiographic parameters and cardiac biomarkers in HCM patients.

Methods:
We searched different databases such as PubMed, SCOPUS, WOS, and Cochrane from inception until February 20, 2023, for any randomized controlled trials (RCTs) that compare mavacamten to placebo in HCM patients and report the echocardiographic parameters. Our outcomes of interest were diastolic function parameters [lateral and septal early diastolic mitral annular velocity (lateral e’ and septal e’), lateral and septal ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity of the septum (E/e’ lateral and septal ratio)], left ventricular parameters [left ventricular ejection fraction (LVEF) and left ventricular outflow tract (LVOT) valsalva gradient ], as well as cardiac biomarkers [NT-proBNP and troponin]. We used the mean difference (MD) for continuous outcomes with the corresponding 95% confidence interval (CI).

Results:
Four RCTs with a total of 503 patients were included. Mavacamten led to a significant improvement in lateral e’ and septal e’, (MD=1.43, 95% CI [1.06, 1.79]), (MD=0.78, 95% CI [0.51, 1.05]) respectively compared to placebo. Furthermore, mavacamten was superior to placebo in reducing E/e’ lateral ratio, (MD=-3.05, 95% CI [-5.05, -1.05]) E/e' septal ratio (MD=-3.38, 95% CI [-4.50, -2.25]), LVEF, and LVOT valsalva gradient, (MD=-3.52, 95% CI [-4.76, -2.27]), (MD=-51.02, 95% CI [-69.66, -32.38]), respectively. Regarding to cardiac biomarkers, mavacamten demonstrated substantial efficacy in reducing NT-proBNP (MD=-557.14, 95% CI [-685.59, -428.68]), and troponin (MD=-8.47, 95% CI [-12.73, -4.21]).

Conclusion:
Our meta-analysis reveals that mavacamten significantly enhanced echocardiographic outcomes for diastolic function and left ventricular parameters. Also, mavacamten led to a significant reduction in cardiac biomarkers.
Abstract 4144425: Identification and Management Practices of MINOCA at a Tertiary Care Center
Authors: Manalo Kathryn , Tieliwaerdi Xiarepati , Arrigo Alexis , Pulipati Yochitha , Khetrapal Sanchaya , Oehler Andrew
Published: November 2024

Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is an ischemic cause of chest pain with normal appearing coronary vessels on angiography. The prognosis for these patients is extremely dependent on etiology highlighting the importance for appropriate evaluation. Currently, several imaging modalities have been useful in diagnostic workup, however no diagnostic guidelines have been developed. As a result, many patients are likely not getting proper evaluation. The study's main objective is to observe practice variations in the diagnostic evaluation for patients meeting criteria for MINOCA.

A review of electronic medical records of patients presenting to a tertiary care center between Jan 2018 – Dec 2022 for chest pain who were referred for left heart catheterization was performed. Patients with prior history of obstructive CAD, whose imaging evaluation uncovered obstructive stenosis or had stenosis >50% as measured on LHC were excluded. Next, patients diagnosed with a nonischemic cause of hospital presentation were excluded. Examples of nonischemic etiologies include stress induced cardiomyopathy, myocarditis and pulmonary embolism. Data regarding medical management and follow-up imaging were collected.

A total of 2,763 patients were reviewed. Among them, 168 patients met the exclusion criteria. Approximately 60% (n=101) of patients were female with an average age of 60 years. Medical management with aspirin (n=123), DAPT (n=22), beta-blocker (n=98), calcium channel blocker (n=58), statin (n=130), anti-anginal therapy (n=55), diuretics (n=47), and ACEi/ARB (n=69) were observed. Additional imaging was seen in only 26% of patients. The imaging modalities used were cardiac MRI (cMRI), fractional flow reserve (FFR) and intravascular ultrasound (IVUS). The most common imaging modality was cMRI (n=35), followed by FFR (n=8) and IVUS (n=1).

MINOCA was identified in 6% of patients presenting with AMI and was primarily comprised of women, which is consistent with other reported figures. Our data demonstrates that nearly 75% of these patients were placed on medical therapy without further evaluation. MINOCA is a diagnosis with multiple pathophysiological etiologies that requires thorough workup including additional imaging for complete evaluation. This study demonstrates the importance of considering MINOCA as a potential diagnosis in patients presenting with AMI and the need for guidelines on its evaluation.
Abstract 4144428: Gender Differences In Leadless Pacemaker Placement Clinical Outcomes: Analysis Of Nationwide Readmission Database
Authors: Akhlaq Hira , Udongwo Ndausung , Adeniyi Adeyinka , Alam Haroon , Ahmed Mariam , Arcidiacono Anne Marie , Klei Lauren , Ghali Jalal , Heaton Joseph
Published: November 2024

Background:
Leadless pacemaker implantation (LPI) is common among patients with sick sinus syndrome (SSS) or atrioventricular block (AVB). Our study explores 30-day readmission rates (30-dr) following LPI for SSS and AVB, comparing outcomes between male and female patients.

Methods:
Using the Nationwide Readmissions Database, we conducted a retrospective analysis of patients who underwent LPI for SSS, and second or third-degree AVB between 2017 and 2021. Our study cohort was stratified by gender. The primary outcome was 30-dr, while secondary outcomes included inpatient mortality, length of stay (LOS), complications, and total hospital charge (THC).

Results:
Among the 17,759 patients meeting the inclusion criteria, 54.1% (n = 9,613) were males and 45.9% (n = 8,146) were females, with a mean age of 76.4 ± 12.6 years. The mean age was 75.5 ± 12.4 years for males and 77.4 ± 12.6 years for females (adjusted Wald test, p < 0.01).

Logistic regression analysis revealed that females had higher odds of readmission (OR 1.21, 95% CI 1.06 - 1.39, p < 0.01) compared to males. However, inpatient mortality and LOS did not differ significantly between the two groups (p > 0.05, all). In addition, males had a higher rate of complications leading to hemodialysis and the use of mechanical ventilators (p < 0.05, all), while women had higher complications in pericardial effusions and tamponade (p < 0.05, all). The mean THC was higher in males ($50,589 vs 47,681), compared to females (adjusted Wald test, p = 0.02).

Conclusion:
Our study revealed that female patients have a higher risk for 30-dr after LPI for SSS and AVB,. While the difference between two groups was not significant for inpatient mortality and LOS, the males had higher THC. Moreover, the nature of complications differed between males and females as well. This highlights the need for tailored interventions to minimize readmissions in this patient population.
Abstract 4144440: Where We Work Correlates with Whether We Receive Cardiorespiratory Preventive Care Services
Authors: Kuo Wan-Chin , Lally Bridget , Luo Dian , Brown Roger
Published: November 2024

Background:
More than 20% of Americans do not regularly receive cholesterol screening and flu shots, the two important preventive services for cardiorespiratory self-care. Uncontrolled dyslipidemia leads to cardiovascular diseases (CVD), the leading cause of death and disability among American workers, while influenza contributes to health-related workplace absenteeism. Despite the loss of productivity in workers due to cardiorespiratory illness, only a few studies examined occupational disparities in cardiorespiratory preventive care services. This study aimed to examine the association between occupational characteristics and the utilization of cholesterol screening and flu shots.

Methods:
The Health and Retirement Study (HRS) is a longitudinal survey of middle-aged and older adults in the U.S. This study focused on 3,222 participants in the HRS from 2004 to 2018, representing the past and current working population. Respondents who did not report cholesterol screening, influenza vaccination, or job information, passed away by 2019, never worked for pay, or had CVD/stroke were excluded from the analysis. Occupation was coded based on the U.S. Census 2000 and configured into five groups: (1) management/science, (2) social services, (3) general services, (4) health services, and (5) industrial workers. Job characteristics, including psychological and physical strains at work, ergonomic risk, lifting of heavy loads, and job stability, were based on self-reported questions. The multivariable logistic and ordered logistic regression models were used for analysis.

Results:
Compared to the management/science workers, industrial and general services workers were less likely to have optimal cholesterol screening and influenza vaccination. For cholesterol screening behaviors, frequent heavy lifting at work (p=0.010), lower job mental strain (p=0.004), and lower job stability (p=0.025) were associated with a lower likelihood of optimal cholesterol screening, after the adjustment for demographic and health covariates. For flu-shot intake, higher job physical strain (p<0.001) and lower job stability (p=0.002) were associated with a lower likelihood of optimal influenza vaccination.

Conclusion:
Findings highlight the underutilization of cholesterol screening and flu shots among industrial workers and general services workers. Multi-level stakeholder engagement is warranted to gauge the return on investment and sustainability of preventive health programs at workplaces.
Abstract 4144446: Efficacy and Safety of Empagliflozin after Acute Myocardial Infarction: A Systematic Review and Meta Analysis
Authors: Otmani Zina , Yassin Mazen Negmeldin Aly , Ayman Elsayed Hazem , Alahmed Farouq , Al Zoubi Bashar M. , Hany Mohammed Omar , Belakhdar Abdelbassat , K. Awad Ahmed
Published: November 2024

Introduction:
Empagliflozin, a sodium–glucose co-transporter-2 (SGLT-2) inhibitor, improves cardiovascular outcomes in patients with heart failure (HF) with or without diabetes mellitus. However, limited data is available regarding its impact after acute myocardial infarction (AMI). Therefore, we aimed in our meta-analysis to evaluate the safety and efficacy of empagliflozin after AMI.

Methods:
We searched PubMed, Scopus, Cochrane Library, and Web of Science from inception to April 19th, 2024, to identify any Randomized Controlled trials (RCTs) that compare empagliflozin to placebo after AMI. The safety outcomes were presented as short term cardiovascular mortality, all-cause mortality, hospitalization for heart failure (HF), and any adverse events. The efficacy outcomes were reported as NT-proBNP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and LDL-c. Dichotomous outcomes were pooled in the form of risk ratio (RR), and continuous outcomes in form of mean difference (MD), with the corresponding 95% confidence intervals (CI).

Results:
Ten RCTs with a total of 10,697 patients were included. Empagliflozin was associated with significant lower risk of cardiovascular mortality (RR = 0.57, 95% CI [0.46, 0.71]), all cause mortality, and hospitalization for heart failure, (RR=0.64, 95% CI [0.53, 0.79]), (RR = 0.67, 95% CI [0.58, 0.79]), respectively. Furthermore, empagliflozin demonstrated a significant reduction in both NT-proBNP (MD = -161.26, 95% CI [-294.58, -27.93]) and SBP (MD= -8.59, 95% CI [-13.26, -3.93]). However, there is no difference between the two groups in terms of any adverse events, diastolic blood pressure, and LDL-c, (RR=0.98, 95% CI [0.95, 1.02]), (MD = -2.55, 95% CI [-5.31,0.20]), (MD=1.67, 95% CI [-6.11, 9.46]), respectively.

Conclusion:
Our meta analysis reveals that empagliflozin significantly reduce all major cardiovascular outcomes after AMI such as cardiovascular mortality and hospitalization due to heart failure. Moreover, empagliflozin effectively lowers NT-proBNP levels and SBP with no superiority in terms of adverse events, diastolic blood pressure and LDL-c.
Abstract 4144461: The Impact of Vitamin D Status on Driveline Infections and Cerebral Vascular Accidents in Patients Undergoing Left Ventricular Assist Device Implantation
Authors: Borman Wesley , Landrigan Luke , guglin maya
Published: November 2024

Introduction:
Left ventricular assist devices (LVADs) have become an increasingly common treatment option for patients with advanced heart failure, serving as either a bridge to transplantation or destination therapy. Despite major advancements in the field of mechanical circulatory support, cerebral vascular accidents (CVA) and driveline infections (DLI) continue to have a detrimental impact on morbidity and mortality.

Research Question:
Is there a higher incidence of DLI and CVA in vitamin D deficient patients that are undergoing LVAD implantation?

Goals/Aims:
We aimed to evaluate vitamin D deficiency as a potential risk factor for DLI and CVA in patients undergoing LVAD implantation.

Methods:
We performed a retrospective chart review of patients that underwent LVAD implantation at our institution from 2010 to 2022. Patients with vitamin D levels measured within 90 days of implantation were classified into either vitamin D sufficient (
>
30 ng/ml) or deficient (<30 ng/ml). The Kaplan-Meier method estimated 18-month freedom of DLI and CVA. The Cox proportional hazards model estimated the effect of deficiency on DLI/CVA risk. Baseline characteristics were recorded (table 1), and a multivariate cox model corrected for differences. Patients who were transplanted or expired were censored at their last clinic visit.

Results:
The study included 134 patients (mean age 53 +/- 13.23, 71.8% male), with 92 in the deficient group and 42 in the sufficient group. During the study period, 36 patients (27.5%) underwent transplant or expired, and there were 32 DLI and 7 CVA events. DLI-free survival was significantly higher in the sufficient group (90.5% vs. 69.6%, log rank p = 0.014). Patients in the sufficient group were found to be significantly older, but no other significant differences were found (Table 1). The unadjusted and age-adjusted hazard ratios for DLI were 3.430 (95% CI: 1.203 – 9.782, p = 0.021) and 3.190 (95% CI: 1.111 – 9.160, p = 0.031) respectively. No difference in CVA incidence was observed.

Conclusion:
Our findings support vitamin D deficiency as a potential modifiable risk factor for DLI, warranting further research to establish causality and assess the impact of vitamin D repletion on infection rates. Vitamin D levels did not appear to influence CVA incidence.