bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4139617: Cardiovascular disease prevention and control interventions: a review of state of implementation science and implication for sub-Saharan Africa
Authors: Hategeka Celestin
Published: November 2024

Background:
As the burden of cardiovascular diseases (CVD) in sub-Saharan Africa (SSA) rises, context-specific evidence on how to successfully scale proven CVD prevention and control interventions is urgently needed.

Objective:
To assess the current state of implementation science on priority CVD prevention and control interventions provided within health systems in low- and middle-income countries (LMICs).

Methods:
EMBASE and MEDLINE databases were searched from 1990 through 2021 to identify implementation science studies on the World Health Organization priority CVD control interventions provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Extracted data were synthesized narratively using descriptive statistics. Subgroup analysis was performed to describe the available context-specific evidence in SSA.

Results:
Of the unique records screened for inclusion, 103 eligible studies evaluated 145 priority CVD prevention and control interventions implemented in 38 countries. Of these studies, only 8% were conducted in SSA and focused on 15 interventions. Prevention interventions accounted for 18% overall and 8% in SSA, screening for 12% overall and 23% in SSA, and treatment for 70% overall and 69% in SSA. The implementation strategies were not specified well enough. Feasibility was the most studied implementation outcome whereas sustainability was the least studied. Most studies used quantitative methods and weak study designs. Most studies reported funding (77%), with international funding being the predominant source. Most studies were pilot (86% overall vs 92% in SSA) and targeted the micro level of health system (73% vs 92% in SSA).

Conclusions:
Implementation research on CVD in LMICs has risen steadily over the last few decades; however, major gaps in the science persists especially in SSA. Future studies should prioritize implementation at scale, target higher levels health systems and test sustainability of CVD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
Abstract 4139619: Longitudinal Assessment Using a Mobile Text-Messaging Based Platform Demonstrates High Rates of Transitions in Dual Users of Electronic and Combustible Cigarettes
Authors: Burns Madeleine , Minetti Erika , Palmisano Joseph , Hoover Rachel , Bhatnagar Aruni , Robertson Rose , Keith Rachel , Hamburg Naomi
Published: November 2024

Background/Aims:
The increasing use of electronic cigarettes (e-cigs) has resulted in complex tobacco use patterns that may change with time within individuals. We developed a mobile platform to capture use patterns and transitions over time in young adults.

Methods:
Individuals 18-45 years old in the Cardiovascular Injury Due to Tobacco Use (CITU 2.0) study completed a detailed baseline questionnaire followed by enrollment in a text message-based mobile platform (Agile Health, Inc) that collected self-reported tobacco use patterns and transitions over 24 months. Baseline use patterns (sole e-cig use, sole combustible cigarette use, dual use, and non-use) and transitions (changing from one use group to another) monthly until last follow-up are reported. Models were used to predict likelihood of non-use (no tobacco products) or non-combustible use (sole e-cig or non-use) at follow-up.

Results:
264 individuals were enrolled at baseline: 87 sole e-cig users, 46 sole combustible users, 91 dual users, and 40 non-users. On monthly follow-ups, the dual use pattern was associated with the highest rate of cumulative transitions, 3 by 6 months, compared to 1 for sole e-cig use. By last follow-up, 65% of the dual use pattern transitioned compared to relatively stable use in the sole e-cig and combustible cigarette use groups (Figure). Rate of uptake of combustible cigarette use in sole e-cig users was low (6%).

In logistic regression models, compared to combustible cigarette users, dual users were more likely to make a transition (OR 5.9, p<0.0001), but not sole e-cig users (OR 1.7, p=0.2). Neither group of e-cig users had a higher rate of transition to non-use than combustible cigarette users (dual use OR 1.2, p=0.7, sole e-cig OR 2.1, p=0.1). However, rates of non-combustible use at follow-up were higher in both sole e-cig (OR 55.5, p<0.0001) and dual users (OR 3.2, p=0.006).

Conclusions:
Frequent longitudinal assessment of tobacco use patterns revealed important details regarding rates of transitions with highest levels amongst dual users of e-cig and combustible cigarettes. Rates of transition to non-use were low across all tobacco product users, with higher rates of transition to non-combustible use amongst dual users when compared to combustible users. Future studies will be important to understand methods to enhance tobacco product cessation amongst all use groups.
Abstract 4139639: Clinical Outcomes after Ventricular Tachycardia Ablation With or Without Induction
Authors: Freedman Benjamin , Yang Shu , Waks Jonathan , Locke Andrew , Maher Timothy , d'Avila Andre
Published: November 2024

Introduction:
Substrate mapping may offer a safer alternative to VT mapping by avoiding prolonged episodes of VT during catheter ablation. However, VT induction to gauge procedural efficacy is still routinely attempted following substrate ablation, thereby exposing patients to potentially unnecessary hemodynamic risk.

Objective:
To assess the feasibility and efficacy of VT ablation without any attempted VT induction.

Methods:
Patients with ICDs who underwent VT ablation between August 2020 and May 2023 were assessed retrospectively. Ablation and induction strategies were at the operators’ discretion. Patients with or without attempted VT induction were compared with respect to 6-month VT burden reduction using univariable linear regression; and the 1-year incidence of recurrent VT, heart transplant or death using multivariable Cox regression.

Results:
Eighty-nine consecutive patients (median age 68 years, 89% male, 51% infarct-related cardiomyopathy, mean LVEF 38%) were followed for a median of 16 months after VT ablation. VT induction was attempted in 63% of patients. The median (IQR) reduction in VT burden was similar in the induction and non-induction groups (96% [0%, 100%] vs. 100% [93%, 100%], p = 0.20). There was no difference between induction and non-induction groups in the 1-year incidence of recurrent VT, heart transplant or death (62% vs. 42%, HR 1.26, 95% CI 0.61-2.62, p=0.54) after adjusting for cardiomyopathy type, VT storm, pre-ablation cardiac CT/MRI, baseline creatinine, pre-ablation VT burden and the presence of NYHA Class III-IV heart failure symptoms.

Conclusion:
In a single-center study of 89 consecutive VT ablations, a non-induction strategy was equally effective to an induction strategy in reducing 6-month VT burden and 1-year risk of VT recurrence, transplant or death. Our findings suggest that VT induction, recognized as a risk factor for hemodynamic compromise, may be avoided in some patients without sacrificing procedural efficacy.
Abstract 4139643: Variability of Ventricular Repolarization: Lessons Learned from Comparing Animal Xenotransplantations and First Human Genetically Modified Cardiac Xenotransplantation
Authors: Brilliant Justin , Khan Ubaid , Griffith Bartley , Khan Oneib , Parsirad Mahdokht , Tully Andrew , Ananthram Manjula , Hong-Zohlman Susie , Feller Erika , Grazioli Alison , Amara Richard , Shorofsky Stephen , Singh Avneesh , Mohiuddin Muhammad , Dickfeld Timm
Published: November 2024

Background:
The worldwide first genetically modified porcine-to-human cardiac xenotransplant (xeno) in 2022 showed a markedly prolonged ventricular repolarization during the 60-day survival raising concerns for ventricular arrhythmias. Longitudinal QTc intervals in 16 porcine-to-baboon cardiac xenos performed at the University of Maryland from 2017-2022 were compared to the human measurements.

Aim:
Compare the variability in repolarization between human and simian recipients of genetically modified porcine xenos.

Methods:
Daily 12-lead ECGs of the human recipient were compared with long-term recordings of implanted monitors in the baboons.

Results:
The first human xenotransplant patient showed longer repolarization compared to the cohort of 16 baboons with porcine xenos (QTc 570±58ms [range 438-698ms] vs QTc 432±89ms [range 288-627ms]; p<0.01). When dividing 16 baboons into 4 groups from shortest to longest mean QTc intervals (361±34ms vs 399±37ms vs 481±36ms vs 542±38ms; p<0.01 for shortest vs longest QTc quartile), no group approached the mean QTc of the human (p<0.01). However, when compared to the baboon with the longest QTc and similar survival (69 vs 60 days), the QTc intervals were closer approximated (547±37ms [range 474-627ms]; p=0.03) and did not significantly differ after the initial 20 post-operative days (human 551±52ms vs baboon 559±33ms, p=0.38).

Conclusion:
While the first human xeno showed prolonged repolarization, the baboon cohort demonstrated significant variability of repolarization duration. QTc prolongation of similar magnitude was observed in the baboon with longest repolarization with comparable follow up. Therefore, the prolonged QTc in the single human xeno may either represent the different physiological response in human environment or an outlier similar to the baboon with the longest QTc. A larger human cohort will help answer this question and further assess the potential arrhythmic risk of xenotransplantation.
Abstract 4139654: Effects of Exercising Sports on Cardiovascular Health among Youth Athletes: Basketball, Baseball, Football and Soccer
Authors: Qiu Grace , Kim Seong Kyu , Corsi Douglas , Masood Imran , Hajduczok Alexander , Osler Brian , Johnson Drew , Langstaff Renee , Shipon David
Published: November 2024

Introduction:
The impact of exercise on the adult heart has been well studied and associated with better cardiovascular health. However, the exercise-induced physiological adaptations of the youth athlete's heart are not well understood.

Research Questions/Hypothesis:
Cardiac screening data will differ significantly based on which sport a youth athlete plays.

Goals/Aims:
To assess the impacts of different sports on youth athletes' cardiovascular health.

Methods:
The HeartBytes National Youth Database produced by Simon’s Heart was used for this study. The database contains demographics, exercise-related symptoms, ECG data obtained during Simon’s Heart PPEs, and data on various types of sports that athletes participate in. To investigate the effects of each specific sport, we excluded those playing multiple sports from the data set, and employed a propensity score match method to control the confounding influences of race, sex, and exercise intensity. This study used an odds ratio statistic and p-value of 5% criterion to evaluate associations between specific sports and cardiovascular risk factors.

Results:
Of the 7425 athletes in the HeartBytes database, the majority were male (60.6%) and White (83.1%). The mean BMI was 21.4 with SD 4.6. The median age was 15.0 years old with an interquartile range 13.5-16.5. There were 279, 120, 179, 552 athletes playing basketball, baseball, football, and soccer only respectively.

Athletes playing basketball had higher odds of exertional symptoms of feeling easily tired (p=0.017), ECG abnormalities (p=0.032), and T wave inversion (p=0.017), but lower odds of ADHD (p=0.03).

Athletes playing baseball had higher odds of asthma (p=0.02) and T wave inversion (p=0.046) if exercising less than 5 hours/week, and higher odds of murmurs (p=0.023) and exertional syncope (p=0.04) if exercising more than 10 hours/week.

Athletes playing football had higher odds of obesity (p<0.0001), hypercholesterolemia (p=0.048), and diabetes (p=0.037) if exercising more than 10 hours/week.

Athletes playing soccer had higher odds of voltage ECG left and right ventricle hypertrophy respectively (p<0.01), but lower odds of obesity (p<0.001).

Conclusion:
All sports showed significant impact on youth athletes' health. Further studies are required to understand the physiological adaptations of youth athlete heart.
Abstract 4139659: Ostial versus Crossover Stenting for Ostial Left Anterior Descending Artery Lesions: A Systematic Review and Meta-Analysis
Authors: Desai Parth , Suffredini John , Koh Stephanie , Bk Anupama , Khalid Umair , Kayani Waleed , Jia Xiaoming
Published: November 2024

Introduction:
Significant coronary atherosclerotic lesions that involve the ostium of the left anterior descending (LAD) artery (Medina 0,1,0) pose unique challenges. The two main techniques used for percutaneous coronary intervention (PCI) of ostial LAD lesions are ostial stenting (OS) and crossover stenting (CS), in which a stent is deployed across the lesion extending from the left main (LM) artery into the LAD. Several observational studies have compared the efficacy of the two techniques, but the results have been mixed with respect to clinical outcomes.

Research Question:
Is there a difference in efficacy between CS and OS in ostial LAD lesions based on pooled data from existing studies?

Methods:
A systematic review was performed for studies comparing CS and OS techniques with respect to long-term outcomes (≥1 year). We used the Mantel-Haenszel random effects model to compute relative risk (RR) with 95% confidence intervals (CI) comparing rates of major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) between groups using the CS and OS techniques. In the secondary analysis, we included only studies with a high proportion (>50%) of intravascular ultrasound (IVUS) use in the CS group, given guideline recommendations of intravascular imaging in LM stenting.

Results:
We included 1448 patients across eight studies. In the primary meta-analysis, there was no significant association between the stenting technique and MACE (RR 0.72, 95% CI 0.38-1.39), all-cause mortality (RR 0.88, 95% CI 0.34-2.33), MI (RR 0.73, 95% CI 0.36-1.48), and TLR (RR 0.62, 95% CI 0.38-1.01). CS was favored with respect to ST (RR 0.34, 95% CI 0.13-0.93, p=0.04). There was significant heterogeneity between studies. In the secondary analysis, CS was favored with respect to MACE (RR 0.56, 95% CI 0.34-0.94, p=0.03) when including only studies that employed a high percentage of IVUS use in LM stenting. No significant differences were found with respect to all-cause mortality, MI, TLR, or ST.

Conclusion:
Based on our study, CS and OS appeared similar with respect to MACE, death, MI, and TLR, though there was significant heterogeneity across studies. CS did appear to be associated with lower ST. Moreover, CS was more favorable with a lower risk for MACE when IVUS was used more frequently, suggesting the importance of intravascular imaging in ostial LAD PCI.
Abstract 4139663: Impact of Catheter Ablation for Atrial Fibrillation on Clinical Outcomes in Hypertrophic Cardiomyopathy: Findings from the REVEAL-HCM Study
Authors: Koyama Kentaro , Tokita Yukichi , Ishihara Kakeru , Matsuda Junya , Kubota Yoshiaki , imori yoichi , Iwasaki Yuki , Shimizu Wataru , Kitaoka Hiroaki , Sakata Yasushi , Dohi Kaoru , Kato Takao , Matsushima Shouji , Takano Hitoshi , Asai Kuniya , Izumi Chisato
Published: November 2024

Background:
Atrial fibrillation (AF) is the most common arrhythmia associated with hypertrophic cardiomyopathy (HCM), and patients with HCM complicated by AF are known to have a poor prognosis. Although many studies have reported the efficacy of catheter ablation (CA) for AF in various events, a few have shown its efficacy in HCM patients. Moreover, no large-scale, long-term follow-up studies have been conducted. Therefore, we performed a subgroup analysis of the REVEAL-HCM study to evaluate the long-term efficacy of CA for AF in HCM patients.

Methods:
The REVEAL-HCM study was a retrospective, multicenter, observational longitudinal cohort study that enrolled 3611 consecutive HCM patients aged ≥ 16 years at 23 centers in Japan between January 2006 and December 2018. Of these, patients who either had a medical history of AF or developed AF during the study period were included, excluding those previously treated with CA for AF. Patients were divided into two groups based on whether they received CA post-enrollment. The primary outcome measured was a composite of all-cause death, heart failure hospitalization, and thromboembolism, while the secondary outcomes assessed each of these events individually.

Results:
Among 1131 HCM patients with AF (67±12 years, 472 females), CA was performed in 284 patients (25%). During a median follow-up of 4.4 years, 455 composite events were observed. Univariate Cox regression analysis showed significantly fewer composite events in the CA group compared to the No-CA group (hazard ratio [HR]: 0.30; 95% confidence interval [CI]: 0.23-0.41; P < 0.001) (Figure). Multivariate Cox regression analysis also demonstrated a significant reduction in composite events (HR: 0.35; 95% CI: 0.25-0.49; P < 0.001). Multivariate Cox regression analysis of the secondary outcomes also revealed significantly fewer events in the CA group for all-cause death (HR: 0.58; 95% CI: 0.34-0.99; P = 0.044), heart failure hospitalization (HR: 0.33; 95% CI: 0.21-0.50; P < 0.001) and thromboembolism (HR: 0.23; 95% CI: 0.10-0.49; P < 0.001).

Conclusion:
Our study suggests that CA for AF may reduce major clinical events in HCM patients.
Abstract 4139665: Effects of Various Caffeine Drinks on the Cardiovascular Health of Youth Athletes
Authors: Qiu Grace , Kim Seong Kyu , Corsi Douglas , Masood Imran , Hajduczok Alexander , Osler Brian , Johnson Drew , Langstaff Renee , Shipon David
Published: November 2024

Introduction:
Caffeine has been associated with both positive and negative impacts on adult athletes. However, the effects of caffeine on youth athletes have not been clearly established.

Hypothesis:
Cardiac screening findings will vary by caffeine intake.

Aims:
To assess the impact of different types of caffeinated drinks on youth athletes.

Methods:
The HeartBytes National Youth Database produced by Simon’s Heart was used for this study. The database contains demographics, exercise-related symptoms, ECG data obtained during Simon’s Heart PPEs, and self-reported data on caffeine intake for soda, energy drinks, tea, and coffee. To investigate the effects of specific caffeinated drinks, we excluded those consuming multiple caffeine drink types from the data set and used propensity score matching to control for confounding variables of race, sex, and exercise intensity. An odds ratio statistic and p-value of 5% criterion were used to evaluate the correlation between caffeine and cardiovascular risk factors.

Results:
Of the 7425 athletes in the database, the majority were male (60.6%) and White (83.1%). The mean BMI was 21.4 (SD 4.6). The median age was 15.0 years old (IQR 13.5-16.5). Of 1864 athletes taking caffeine drinks, 685, 43, 617, 246 drank only soda, energy drinks, tea, and coffee respectively. Athletes drinking soda had higher odds of diabetes (p=0.041), ADHD (p<0.0001), anxiety or depression (p=0.004) and obesity (p=0.018), but lower odds of asthma (p=0.011) if exercising more than 10 hours/week. Athletes drinking energy drinks had higher odds of hypercholesterolemia (p=0.021) if exercising less than 5 hours/week, and higher odds of murmur if exercising more than 10 hours/week. Athletes drinking tea had higher odds of hypertension (p=0.043), exertional dyspnea (p=0.019), ECG right ventricle hypertrophy (p=0.021), and higher odds of ECG nonspecific ST wave abnormality (p=0.04) if exercising more than 10 hours/week. Athletes drinking coffee had higher odds of exertional syncope (p=0.001), and higher odds of ECG T wave inversion (p=0.038) if exercising more than 10 hours/week.

Conclusion:
Overall, both tea and coffee drinkers were at higher risk of ECG abnormalities, with higher risk of hypertension and exertional dyspnea in tea drinkers. Coffee drinkers also had higher risk of exertional syncope. Soda drinkers were at higher risk of diabetes and obesity. Further studies are needed to delineate long-term effects of caffeine consumption on youth athletes.
Abstract 4139669: Evaluating Gender-Based Differences in Outcomes of Premature Coronary Artery
Authors: Khan Abdul Wali , Aleena Sayyeda , Modi Karnav , Ali Zafar , ASIF TALAL
Published: November 2024

Background:
Premature coronary artery disease (CAD) is an important cause of morbidity and mortality amongst the younger patient population and presents unique clinical challenges. Our study aims at evaluating gender and age-based differences in the presentation and outcomes among younger patients with premature CAD.

Methods:
Using the National Readmission Database, we identified patients admitted between 2016 and 2019 with a primary diagnosis of acute myocardial infarction (AMI). We focused our analysis on premature CAD, defined as males aged less than 45 and females aged less than 55 at, the time of the AMI diagnosis. We investigated potential differences in the type of AMI presentations, interventions received, and mortality rates among these premature AMI patients.

Results:
A total of 225,948 patients with premature CAD were identified, comprising 89,608 males and 136,340 females. ST-segment elevation myocardial infarction (STEMI) was a more common presentation among the younger population compared to older cohorts (33% vs. 26%, p<0.001). Importantly, males exhibited a higher incidence of STEMI than females (40% vs. 28%, p <0.001). Females with premature CAD were significantly less likely to undergo PCI compared to males (52% vs. 62%, p <0.001), even after adjusting for STEMI (OR 0.77, p<0.001). Additionally, female patients demonstrated higher mortality rates than males (2% vs. 1.6%, p <0.001), persisting even after age adjustment (OR 1.15, p 0.017). No significant differences in the length of stay, incidence of cardiogenic shock, and implantable cardioverter defibrillator placement were noted between males and females.

Conclusion:
Our study showed that STEMI was more common in younger patients presenting with AMI. Males had higher STEMI rates, but females were less likely to undergo PCI after adjusting for STEMI. Females also had higher inpatient mortality. These findings highlight disparities that warrant further investigation to address potential gaps in care for young female AMI patients.
Abstract 4139677: A rare case of ventriculobronchial fistula caused by an epicardial defibrillator patch
Authors: Alampoondi Venkataramanan Sai Vikram , Windle John
Published: November 2024

Background:
Epicardial patch defibrillators (EPDs) were commonly implanted in the 1990s for secondary prevention of sudden cardiac death. Despite being largely obsolete, some EPDs remain in patients and can cause late complications. This case highlights such a scenario.

Case:
A 75-year-old female with a history of cardiac arrest 30 years ago presented with shortness of breath and left leg swelling. She had idiopathic ventricular fibrillation in 1992, treated with an EPD (Picture 1A), later replaced by a transvenous ICD.

She was diagnosed with left femoral deep venous thrombosis and bilateral pulmonary embolism and started on therapeutic anticoagulation. She experienced massive hemoptysis, leading to respiratory and cardiac arrest, but was resuscitated. A CT angiogram showed no active bleeding but noted the EPD was close to the lower lobe of the left lung. Upper gastrointestinal endoscopy showed no active bleeding. Bronchoscopy revealed clots in the left lower lobe. Despite empiric bronchial artery embolization, hemoptysis persisted. A repeat bronchoscopy showed reaccumulation of clots. A repeat CT angiogram indicated contrast extension into the ventricular myocardium near the EPD but no lung spillage suggestive of pseudoaneurysm (Picture 1B).

She was transferred to our institution for further evaluation. A coronary angiogram revealed normal arteries, while a left ventriculogram revealed contrast extravasation through the lateral wall (Picture 1C). An urgent surgery revealed two EPDs: anterior and lateral. The lateral EPD had eroded into the ventricle, creating a ventriculo bronchial fistula (Picture 1D). The lateral EPD was removed (Picture 1E); the anterior EPD was left in place (Picture 1F). The ventricular defect was debrided and repaired. Postoperative recovery was successful, with no further hemoptysis, and the patient was discharged to a rehabilitation facility.

Discussion:
EPDs are no longer used due to high failure rates and complications like scar formation and constrictive pericarditis. However, patients with EPDs from the 1990s may present with delayed complications. Accurate diagnosis using multimodality imaging and early management is crucial to reduce morbidity and mortality.
Abstract 4139688: Empagliflozin versus Placebo in Patients with Cardiovascular Disease and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Authors: Raja Adarsh , Ahmed Muhammad , Asghar Muhammad Sohaib , Alim Ur Rahman Hafsah , Raja Sandesh
Published: November 2024

Background:
Historically, patients with type 2 diabetes mellitus (T2DM) and concurrent cardiovascular disease (CVD) have been managed through multifactorial interventions, including lifestyle modifications. Recently, empagliflozin, a potent sodium-glucose cotransporter 2 inhibitor (SGLT2i), has emerged as a novel antidiabetic agent demonstrating significant improvements in cardiovascular outcomes.

Aim:
To conduct a meta-analysis comparing empagliflozin with placebo in patients with T2DM and concomitant CVD.

Methods:
We performed a thorough literature search of PubMed, EMBASE, and the Cochrane Library up to May 2024 to identify studies comparing empagliflozin with placebo in patients with T2DM and concomitant CVD. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes and standard mean difference (SMD) or mean differences (MD) for continuous outcomes, each accompanied by 95% confidence intervals (CIs). Due to varying units of measurement for HbA1c that were not interconvertible, SMD was employed. Conversely, MD was used for the analysis of other continuous outcomes.

Results:
16 studies fulfilled the inclusion criteria. Empagliflozin significantly reduced HbA1c (SMD: -1.33 [-2.28, -0.38]; p=0.006;
Figure
) and cardiac mortality (RR= 0.62 [0.50, 0.78]; p<0.0001), in comparison to placebo. Empagliflozin was also associated with a significantly greater reduction in systolic blood pressure (MD: -5.22 [-7.97, -2.47]; p=0.0002) and diastolic blood pressure (MD: -3.31 [-5.76, -0.85]; p= 0.008). However, empagliflozin was associated with a significantly greater risk of genital infections (RR=3.66 [2.69, 5.00]; p<0.00001).

Conclusion:
In individuals diagnosed with T2DM and CVD, the use of empagliflozin could lead to improved clinical results.
Abstract 4139704: Coronary Artery Air Embolism During Left Heart Catheterization: A Rare Yet Potentially Fatal Complication
Authors: Siddiqui Arsalan , Yee Brianna , DiCaro Michael , Lee Ki , Lei KaChon , Ahsan Chowdhury
Published: November 2024

Coronary artery air embolism is a rare yet potentially fatal complication of interventional cardiac procedures, presenting from asymptomatic to cardiac arrest. There are no established guidelines for its management, and the focus is on primary prevention. Here, we present a case of iatrogenic coronary artery air embolism during an elective left heart catheterization (LHC).

A 61-year-old male with mitral valve prolapse underwent preoperative LHC which showed a stenotic left anterior descending artery and normal right coronary artery (RCA). On the following left ventriculogram, significant inferior wall hypokinesis was observed, and the patient developed acute chest pain, ST elevations, and complete heart block (Figure 1a). Suspecting new RCA pathology, reevaluation revealed multiple air emboli and Thrombolysis In Myocardial Infarction (TIMI) grade 1 flow (Figure 1b). The RCA was flushed multiple times with heparinized saline, resolving the air emboli and restoring TIMI grade 3 flow (Figure 1c). At the procedure's end, the patient was pain-free and in sinus rhythm. A repeat transthoracic echocardiogram showed normal ventricular function without regional wall motion abnormalities. The patient was discharged without further complications.

Coronary air embolism can occur iatrogenically and is inversely correlated with operator experience. Prevention through proper technique is crucial: catheters should be adequately aspirated, all connections tightened, and the catheter should be tested distal to the aortic cusp to prevent emboli occurrence. Although there are no established guidelines, management includes administering 100% oxygen, intracoronary saline boluses, or breaking down emboli with a guidewire.

In our case, the sudden onset hypokinesis of the inferior wall with complete heart block in a confirmed normal RCA raised suspicion for new RCA pathology. Immediate heparinized saline allowed for air emboli dissociation as a more immediate intervention than 100% oxygen and did not involve intravascular manipulation which could result in dissection. Our case highlights the importance of early detection of rapidly changing pathology and stresses meticulous technique for testing equipment as a prevention method.
Abstract 4139725: Minimal Radiation Use for Aortic Valvuloplasty During Pregnancy
Authors: Li Angela , Ghantous Eihab , Thangathurai Jenica , Lin Jeannette , Aboulhosn Jamil
Published: November 2024

Introduction:
Valvular heart disease affects approximately 1% of pregnant women, with left-sided obstructive lesions such as severe symptomatic aortic stenosis (AS) carrying the highest risk. In AS patients of childbearing age, 95% have bicuspid aortic valve (BAV). For preconception intervention, percutaneous balloon aortic valvuloplasty (PBAV) is often favored over surgical valve replacement. This decision becomes more nuanced when a symptomatic patient is pregnant, as we need to weigh the benefits of relieving obstruction with the risks of fetal radiation exposure.

Description of Case:
32 year old female with BAV presented pregnant at 10 weeks gestation with new symptomatic severe AS, mean gradient 49 mmHg, aortic valve area (AVA) 0.72 cm2. She reported dyspnea with minimal exertion and an episode of presyncope. After multidisciplinary meeting between congenital cardiology, obstetrics and cardiac anesthesia, decision was made to pursue PBAV. At 17 weeks gestation, she was placed under general anesthesia, after which a TEE was performed for aortic annulus sizing. A 10 Fr x 80 cm sheath was placed in the left femoral artery for catheter and wire exchange without need for fluoroscopy. Under TEE guidance, we crossed the stenotic valve via retrograde approach. Based on measured annulus size, we advanced a 20 mm VIDA balloon across the aortic valve and inflated the balloon to nominal volume with simultaneous rapid pacing. There was mild-moderate AS with moderate aortic regurgitation after PBAV, AVA 1.27 cm2. Total radiation exposure was 5 mGy with maximum collimation, low fluoroscopy frame rates and use of "fluoro-store". Patient tolerated procedure well without complications and was seen in follow up visit with significantly improved exercise capacity.

Discussion:
Studies have shown that interventions should be avoided during the first trimester of pregnancy when there is highest risk of fetal radiosensitivity, and to limit radiation exposure dose to less than 50 mGy. Our case demonstrates that transcatheter interventions can be safely performed during early second trimester of pregnancy with minimal radiation exposure and optimal results, with the use of multimodality imaging guidance and good radiation safety habits. It should be noted that any intervention can still pose a non-negligible risk to mother and fetus and should only be performed in symptomatic patients refractory to medical therapy, with consensus by a multidisciplinary cardio-obstetrics team.
Abstract 4139740: Left Atrial Strain and Genotype Associated with Clinical Outcomes in Genetic Hypertrophic Cardiomyopathy
Authors: Park Jin-Sun , Hong Kimberly , Kelso Cody , Nair Pooja , Prabhakar Apurv , Adler Eric
Published: November 2024

Background:
Genetic cardiomyopathies (CMP) are a group of inherited diseases that can lead to heart failure and sudden cardiac death. Hypertrophic CMP (HCMP) is a common genetic disorder. Despite the knowledge about the different causal genes, the relationship between individual genotypes and phenotypes is incomplete. Using the myocardial strain measurement, the relationship between individual genotypes and phenotypes could be evaluated.

Methods:
We consecutively enrolled 183 patients (123 males, 63 ± 19 year-old) with HCMP who underwent genetic testing. All patients were divided into three groups: gene (-) group, sarcomeric gene (+) group and non-sarcomeric gene (+) group. Echocardiographic images were reviewed and used to calculate myocardial strain. The data of clinical outcomes were obtained and analyzed according to the genotypes and myocardial strain. The primary composite end point of major cardiac adverse events (MACEs), consisting of left ventricular dysfunction (LVD) development, heart failure development, lethal arrhythmias and all-cause death, was analyzed.

Results:
Myocardial stains, including global LV longitudinal strain, LA strain and RV strain, were not statistically different among the groups. MACE-free survival rate in the gene (-) group was significantly lower than in other groups (log-rank
p
<0.001). LA conduit strain was significantly related with lethal arrhythmia. Univariable regression for LA conduit strain and lethal arrhythmias showed an odds ratio of 1.137 (95% CI, 1.008–1.283) with
p
=0.037. For receiver operating characteristic analysis, the areas under the curve for LA conduit strain was 0.716 (
p
=0.009). An absolute LA conduit strain cutoff of 10.0% yielded a sensitivity rate of 67% and specificity rate of 66%. The lethal arrhythmias-free survival rate in the group with LA conduit strain lower than 10.0% was significantly lower than in the other group (log-rank
p
=0.024).

Conclusion:
The genotype-positive patients with HCMP have worse clinical outcomes. The LA conduit strain was related to lethal arrhythmias in HCMP.
Abstract 4139790: Efficacy and Safety of Omecamtiv Mecarbil in Heart Failure with Reduced Ejection Fraction According to Age: the GALACTIC-HF Trial
Authors: Lu Henri , Claggett Brian , Felker Gary , McMurray John , Teerlink John , Metra Marco , Heitner Stephen , Diaz Rafael , Malik Fady , Vaduganathan Muthiah , Solomon Scott
Published: November 2024

Background:
Older age is associated with a high prevalence of comorbidities and worse cardiovascular (CV) outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Omecamtiv mecarbil (OM), a selective cardiac myosin activator, is relatively hemodynamically neutral with no known extra-cardiac effects, and thus may be well-tolerated in older individuals with comorbidities (e.g., low blood pressure or renal dysfunction). The safety profile and clinical benefits of OM across the age spectrum remain uncertain.

Purpose:
To assess the CV outcomes, treatment response and tolerability to OM according to age, in patients enrolled in the GALACTIC-HF trial.

Methods:
GALACTIC-HF was a randomized, double-blind clinical trial testing OM vs placebo in patients with symptomatic HF. Key eligibility criteria included an age between 18 and 85 years, elevated natriuretic peptides and a left ventricular ejection fraction (LVEF) ≤35%. We examined the treatment effect of OM vs placebo for the primary endpoint of CV death or first HF event (hospitalization or urgent visit for HF), in the overall population and severe HF subgroup (LVEF≤30%, New York Heart Association [NYHA] Class III/IV, HF hospitalization within 6 months), as well as safety outcomes according to predefined age groups (<65 or ≥65).

Results:
A total of 8,232 patients (age 64.5±11.4 years, 54.5% ≥65 years, 21% women) were included. The rate of the primary outcome was 21.4 per 100py in age <65 years and 28.8 per 100py in age ≥65 years. The treatment effect of OM for the primary outcome (hazard ratio [HR] 0.92; 95% confidence interval [CI] 0.86-0.99; p=0.025) was consistent in age groups (P
interaction
=0.73,
Figure 1 Panel A
) and irrespective of age as a continuous variable (P
interaction
=0.19), after adjustment for treatment interactions with known modifiers of the effects of OM (LVEF and baseline atrial fibrillation status). In patients with severe HF, OM significantly reduced the risk of the primary outcome in both age <65 years (HR 0.77; 95% CI 0.64-0.92) and age ≥65 years (HR 0.83; 95% CI 0.71-0.97; P
interaction
=0.72,
Figure 1 Panel B
). The safety profile of OM was consistent irrespective of age (P
interaction
>0.05 for all,
Table 1
).

Conclusions:
In GALACTIC-HF, older individuals were well-represented and faced higher risks of CV events. Treatment with OM was safe irrespective of age, and reduced the risk of CV death or first HF event across the age spectrum, especially in those with severe HF.
Abstract 4139791: A short version of HFD/L-NAME mouse model enabling time-effective proof of concept studies to evaluate drugs targeting the cardiometabolic and mild hypertension associated HFpEF phenotype.
Authors: Assaly Rana , Dubroca Caroline , Waget Aurelie , Perrier Kevin , SULPICE Thierry
Published: November 2024

Intro:
Drug Development for Heart failure with Preserved Ejection Fraction (HFpEF) is a major challenge facing cardiovascular research due to its complex pathophysiology and existence of comorbidities, leading to recognize distinct HFpEF phenogroups. Animal model development should consider this heterogeneity and each model capturing features of specific phenogroups.

Hypothesis:
We established a 2-hit model consistent with one of the leading phenogroups, the cardiometabolic and mild hypertension associated HFpEF, by combining a high fat diet to trigger obesity/metabolic syndrome and L-NAME to induce mild hypertension (HFD/L-NAME). We evaluated the presence of HFpEF hallmark and corroborated our data with literature. Empagliflozin (EMPA), the clinical benchmark, was used to confirm the relevance of the model.

Methods:
To induce obesity/metabolic syndrome, mild and HFpEF, C57BL6N mice were fed HFD (60% Kcal from fat) and water with L-NAME (0.5g/l) for 8 weeks. Control mice (Ctrl) were fed normal chow and water. At 5weeks, mice were randomized based on E/A ratio and ejection fraction and were treated QD for 3weeks with vehicle or EMPA (10mg/kg). Then, treadmill exercise tolerance test was performed, cardiac geometry, systolic and diastolic function were evaluated by echocardiography and heart and lungs were harvested. Longitudinal blood pressure was evaluated by tail cuff.

Results:
Compared with Ctrl, HFD/L-NAME mice showed cardiac remodeling, preserved systolic function and moderate diastolic dysfunction characterized by inverted or pseudonormal profiles and higher filling pressure (E/A=1.2±0.04 E’/A’=1.1±0.02 E/E’=16.4±0.6 in HFD/L-NAME vs E/A=1.4 ± 0.02 E’/A’=1.3±0.01 E/E’=14.4±0.4 in Ctrl). HFD/L-NAME mice showed altered exercise capacity (p<0.05 for running distance and time vs. Ctrl). Cardiac hypertrophy was confirmed by increased heart weight (p<0.01 vs. Ctrl). Consistent with elevated filling pressure, lung weight was increased in HFD/L-NAME mice (p<0.01 vs. Ctrl), indicative of pulmonary congestion. Mean blood pressure was consistently increased in HFD/L-NAME mice (p<0.05 vs. Ctrl). EMPA had positive outcome on cardiac remodeling in terms of left ventricle hypertrophy and enlargement (p<0.05 vs. Ctrl) and alleviated diastolic dysfunction.

Conclusion:
The 8-week HFD diet/L-NAME captures several aspects of patients suffering from moderate HFpEF associated to obesity/metabolic syndrome and mild hypertension allowing cost and time effective POC studies.
Abstract 4139810: Acute Bilateral Breast Swelling as a Rare Manifestation of Heart Failure Exacerbation: A Case Report
Authors: Mohyeldin Moiud , Anto Anandu , Hossain Muhammad
Published: November 2024

Background:
Bilateral breast swelling is a rare and often overlooked presentation of congestive heart failure (CHF) exacerbation. It can mimic other conditions like cellulitis or malignancy, posing a diagnostic challenge. Recognizing this unusual manifestation is crucial for timely diagnosis and appropriate management.

Case Presentation:
A 77-year-old female presented with acute onset bilateral breast enlargement, tenderness, and erythema, along with symptoms of CHF exacerbation including dyspnea, orthopnea, and lower extremity edema. Physical examination revealed markedly enlarged, tender breasts. Imaging studies including mammography (Figure 1: Right and left craniocaudal views; Figure 2: Right and left mediolateral oblique views) and breast ultrasound showed diffuse skin and subcutaneous edema without evidence of infection or malignancy. Echocardiography confirmed reduced ejection fraction and diastolic dysfunction. Skin biopsy findings were consistent with CHF-related changes. The patient's symptoms improved with diuresis and optimization of guideline-directed medical therapy for heart failure.

Conclusion:
This case highlights breast edema as a rare manifestation of CHF exacerbation that clinicians should be aware of. It can mimic inflammatory breast disorders or malignancy, leading to delayed diagnosis. A high index of suspicion in patients with cardiovascular disease and close collaboration between specialties are key for accurate diagnosis. Treatment involves managing the underlying CHF with diuretics, medical therapy, and supportive measures. Prompt recognition can help alleviate symptoms, prevent complications, and improve patient outcomes.
Abstract 4139825: Impact of Non-Culprit Chronic Total Occlusion in Patients with Infarct-Related Cardiogenic Shock: Results from the RESCUE Registry
Authors: Kim Min Chul , Ahn Youngkeun , Choi Ki Hong , Yang Jeong Hoon , Gwon Hyeon-Cheol , Ahn Chul-Min , Yu Cheolwoong , Chun Woojung , Bae Jang-whan , Kwon Sung Uk , Lee Wang Soo , Jeong Jin-Ok , Park Sang-Don , Lim Seong-Hoon
Published: November 2024

Background:
About 25% of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) have chronic total occlusion (CTO) at non-culprit artery. However, the prognostic impact of CTO in these patients is still unclear.

Aims:
We aimed to investigate the impact of CTO at non-culprit artery on 1-year mortality in patients with AMI-CS using the multicenter registry of cardiogenic shock.

Methods:
A total of 1,247 patients presented with cardiogenic shock (CS) were enrolled in the SMART-RESCUE registry between January 2014 and December 2018. After exclusion of non-ischemic cause shock, ischemic cardiomyopathy, failed or no revascularization, vasospasm, and patients undergoing coronary artery bypass surgery, 695 patients underwent percutaneous coronary intervention (PCI). Among these, we analyzed 536 patients with multivessel disease (MVD) according to the presence of CTO at non-culprit artery. The study endpoint was a 1-year all-cause mortality. We also examined the incidence of 1-year cardiac death, and in-hospital death or renal replacement therapy (RRT).

Results:
A 141 patients (26.3%) of study population had CTO lesion at non-culprit artery. The CTO group had more patients with diabetes mellitus, and lesser patients with ST-elevation myocardial infarction. Although initial left ventricular ejection fraction was lower in CTO group (28.5 vs. 34.1%, P=0.005), initial systolic blood pressure (73.8 vs. 73.2 mmHg, P=0.822) and the level of lactate (6.6 vs. 6.4 mmol/L, P=0.804) were similar in both groups. Venoarterial extracorporeal membrane oxygenation was applied in 206 patients (38.4%), and its use rate was comparable in 2 groups (40.4 vs. 37.7%, P=0.571). Pre- (32.9 vs. 22.9, P <0.001) and post-PCI SYNTAX score (16.7 vs. 5.3, P <0.001) was significantly higher in CTO group. In CTO group, 53 patients (37.6%) had CTO at left main or left anterior descending artery, and only 19 patients (13.5%) in CTO group received PCI for CTO. In multivariate analysis, all-cause mortality at 1-year was significantly higher in CTO group (51.8 vs. 40.5%, hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.09-1.90, P=0.011). The incidences of 1-year cardiac death (45.4 vs. 32.4%, HR 1.55, 95% CI 1.15-2.10, P=0.004) and in-hospital death or RRT (46.8 vs. 36.5%, P=0.031) were also higher in CTO group.

Conclusions:
Non-culprit CTO lesion was associated with higher 1-year mortality in patients with AMI-CS and multivessel disease.
Abstract 4139834: Pulse Pressure in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: A Pooled Participant-Level Analysis of 4 Large-Scale Trials
Authors: Lu Henri , Kondo Toru , Claggett Brian , Vaduganathan Muthiah , Neuen Brendon , Beldhuis Iris , Jhund Pardeep , Mc Causland Finnian , Anand Inder , Pfeffer Marc , Pitt Bertram , Zannad Faiez , Zile Michael , McMurray John , Solomon Scott , Desai Akshay
Published: November 2024

Background:
Pulse pressure (PP), a marker of aortic stiffness, is associated with risk for mortality and cardiovascular (CV) events, but these associations have not been extensively explored in patients with heart failure (HF). We examined the association between PP and CV outcomes in a pooled dataset of 4 large, well-characterized cohorts of patients with HF with moderately reduced (mrEF) or preserved EF (pEF).

Methods:
I-PRESERVE, TOPCAT, PARAGON-HF and DELIVER were global, multicenter, randomized clinical trials testing irbesartan, spironolactone, sacubitril/valsartan and dapagliflozin respectively, against either a placebo or an active control (valsartan in PARAGON-HF), in patients with HF and a LVEF >40% (in DELIVER) or ≥45% (in the other trials). Predictors of higher PP were identified using forward stepwise regression analysis. The relationship between baseline continuous PP and the incidence rates (IR) of first HF hospitalization (HFH) or CV death was analyzed with restricted cubic splines. To assess the prognostic significance of incorporating systolic blood pressure (SBP) along with PP, we categorized patients into 4 groups based on median values of PP and SBP.

Results:
A total of 18,627 patients (age 71±9 years, 49% men, PP 55±14 mmHg, SBP 131±15 mmHg) were included. Over a median follow-up of 2.9 years, 3,852 patients experienced a first HFH or CV death event (7.4 events per 100py). Predictors of higher PP values included higher SBP, older age, female sex, Asian race, higher EF, use of diuretics, higher N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and diabetes. Conversely, factors associated with lower PP included atrial fibrillation, higher heart rate, worse New York Heart Association (NYHA) Functional Class, use of beta-blockers, and higher estimated glomerular filtration rate. After adjusting for predictors of PP and other relevant variables, higher PP was associated with a higher risk for HFH or CV death. This relationship was nonlinear (p<0.001), with risk increasing markedly at higher PP values (
Figure 1
). After multivariable adjustment, higher PP was associated with higher CV risk regardless of baseline SBP, compared to lower PP and lower SBP (
Figure 2
).

Conclusions:
Our analysis of a pooled dataset from 4 clinical trials including patients with HFmrEF or pEF suggests that PP was an independent predictor of CV events in this population, regardless of baseline SBP.