bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147882: Multiple Arterial Graft Use: Sustained Quality Improvement Following a Targeted Assessment and Programmatic Intervention
Authors: Chinedozi Ifeanyi , Daskam Maria , Briscoe Jessica , Kumar Nivedita , Darby Zachary , Sangalang Janelle , Kang Jin Kook , Kpuska Vesa , Behrens Kim , Lawton Jennifer
Published: November 2024

Introduction/Background:
Multiple arterial grafting (MAG) provides superior outcomes compared to single arterial grafting in coronary artery bypass graft (CABG) patients. Studies and meta-analyses demonstrate MAG's association with improved survival, reduced major adverse cardiac events, and lower repeat revascularization rates. Despite strong evidence and guidelines, MAG utilization remains low nationally, ranging from 4-11%. Surgeons cite concerns such as advanced age, diabetes, and high body mass index (BMI) for not employing MAG. An educational and quality improvement initiative raised MAG usage from 11% to over 30% at one academic institution. This study reassesses MAG adoption trends and barriers three years later at the same institution.

Research Question/Hypothesis:
We investigated whether the increased adoption of MAG after a quality improvement initiative was sustained three years later. We hypothesized that MAG utilization would remain elevated due to the lasting impact of initial educational efforts, though some barriers might persist.

Methods/Approach:
We assessed MAG utilization and surgeons' reasons for not using MAG in isolated CABG procedures with two or more grafts over a four-month period. This evaluation aimed to determine if the previous quality improvement initiative's adoption of MAG was sustained post-implementation. The study analyzed MAG use frequency and surgeons' justifications for alternative methods, including patient outcomes, surgeon preferences, and institutional practices.

Results:
A total of 92 patients were included, with MAG used in 28 cases (30.4%). The MAG use rate three years earlier following the quality initiative was 30.5%. Predominant reasons for not using MAG were age > 65 (29.9%), diabetes (18.8%), BMI ≥35 (14.1%), and non-critical disease (9.4%), similar to concerns from three years prior: age >75 (30.8%), diabetes (23.1%), and BMI > 35 (22.9%) (Figure 1).

Conclusions:
The sustained adoption rate of MAG among cardiac surgeons at one institution highlights the complexities of changing surgical practices, even with targeted educational efforts. Continuous support and educational initiatives led by surgeon-champions are crucial for enhancing long-term adoption of evidence-based practices like MAG, ultimately improving patient care. Dedicated mentoring and regular training updates significantly influence the integration of advanced surgical techniques into routine practice, advancing patient treatment quality.
Abstract 4147907: Validation of PAINESD Score to Predict Outcomes of Catheter ablation of Structural Ventricular Tachycardia
Authors: Woelber Tiffany , Futela Pragyat , Arunachalam Karikalan Suganya , Poddar Aastha , Heybati Kiyan , pradeep aishwarya , Prasitlumkum Narut , Amin Hina , Deshmukh Abhishek , Kowlgi Gurukripa
Published: November 2024

Background:
PAINESD score was established as a predictor of periprocedural acute hemodynamic instability, long-term mortality and heart failure among patients undergoing catheter ablation for ventricular tachycardia (VT-CA).

Objective:
To assess the validity of PAINESD score and compare outcomes of high-risk patients undergoing catheter ablation for ventricular tachycardia (VT) with and without mechanical circulatory support (MCS) use during procedure.

Methods:
We conducted an observational dual-center study of consecutive patients with SHD undergoing VT-CA over a decade (2012-2022). The PAINESD score, based on 7 variables (COPD, age >60 years, general anesthesia, ischemic cardiomyopathy, NYHA class III or IV, ejection fraction <25%, VT storm, and diabetes mellitus), was calculated and categorized into low risk (<10), intermediate risk (10-16), and high risk (>16) as previously reported. Two survival analyses were performed to compare outcomes between different groups: one using all-cause mortality or heart transplant as the event, and another using recurrent or repeat ablation as the event. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios for each PAINESD category and to determine the hazard ratio for the use of MCS among high-risk patients.

Results:
We found that between 2012 to 2022, 559 ablations were performed on 441 patients. There were 296 (53%), 182 (32.6%) and 81(14.5%) patients in low, medium, and high risk. Using low risk as reference, aHR for medium risk was 2.1 (1.24-3.7; p=0.006) and for high risk was 4.6(2.54-8.3; p <0.001).

Among patients with high PAINESD score (n=81), 5 patients (6.2%) required MCS (Intra-arterial balloon pump (IABP)=1, ECMO only=1, ECMO+IABP=1, bypass=2). 4/5 (80%) patients on MCS stayed on them post procedure, except one patient on IABP. In this cohort, there was no difference between patients with and without MCS in primary outcome [aHR= 1.6 (0.48-5.4); p=0.43] and in secondary OUTCOME [1.29 (0.3-5.5; p=0.735)].

Conclusion:
PAINESD was a significant predictor of mortality or heart failure, but it did not help in prediction of recurrence of VT, or repeat VT-CA.
Abstract 4147916: Limitations of Brain Natriuretic Peptide in Detecting Early Stage Heart Failure
Authors: Rinderknecht Derek , Chiu W. Brian , Krupa Joanna , Jerdonek Christopher , Cook Kendra , Jin Weiwei
Published: November 2024

Introduction:
Brain natriuretic peptide (BNP) is commonly used for the diagnosis and management of heart failure (HF), as its presence strongly predicts cardiovascular events and risk of death. Detecting HF early has a substantial impact on quality of life and outcomes. Measurement of left ventricular end diastolic pressure (LVEDP) is the gold standard method for diagnosing HF, including early stage HF in the absence of signs and symptoms. BNP has been proposed as another means to screen for early stage HF, specifically in high-risk patients. Here, we compare BNP to elevated LVEDP across a range of LVEDP values to assess its ability to detect HF early.

Methods:
The dataset (154 subjects, 66 +/- 10 yrs of age and above; 64% male) consists of patients referred for coronary angiography and left heart catheterization for clinical indications inclusive of direct measurement of LVEDP. LVEDP was measured using high-fidelity Millar Mikro-tip pressure catheters. BNP was measured during the same visit. Mean LVEDP thresholds from 15 mmHg to 25 mmHg were analyzed. The sensitivities and specificities of BNP thresholds of 35 pg/ml and 100 pg/ml were assessed.

Results:
The receiver operating characteristic (ROC) curves with the area under the curve (AUC) for the classification models are shown in Fig. 1. AUC appears to increase linearly with the level of measured BNP, displaying only good performance (> 80%) when LVEDP is substantially elevated (AUC = 81%, at 25 mmHg). At a BNP decision threshold of 35 pg/ml (Ambulatory, AHA algorithm for suspected HF) the ROC curves for an LVEDPs >15 mmHg and >25 mmHg yield sensitivities of 74% and 92% and specificities of 47% and 41%, respectively. At a BNP decision threshold of 100 pg/ml (Hospitalized/Decompensated) the ROC curves for LVEDPs >15 mmHg and >25 mmHg yield sensitivities of 43% and 75% and specificities of 74% and 71%, respectively.

Conclusion:
While BNP is adept at identifying patients already exhibiting signs and symptoms of HF, these results suggest the diagnostic utility of BNP may be limited in detecting early stage HF.
Abstract 4147920: Optimal Approach to Generate Patient-Level Decision from Study-Level Predictions Using a Multimodal Deep Learning Model for Detecting Transthyretin Cardiac Amyloidosis
Authors: Finer Joshua , Haggerty Chris , Jing Linyuan , Jain Sneha , Einstein Andrew , Maurer Matthew , Raghunath Sushravya , Rocha Daniel , Elias Pierre , Poterucha Timothy
Published: November 2024

Background:
Transthyretin cardiac amyloidosis (ATTR-CA) is an underdiagnosed cause of heart failure and early disease detection is essential for improving outcomes. We previously developed a multimodal deep learning model, named ATTRact-Net, leveraging electrocardiogram (ECG) and echocardiogram data that can identify patients with ATTR-CA. Patients at risk for ATTR-CA often have multiple ECGs and echos available for analysis, leading to many different risk predictions by AI models. There is little evidence on how to go from study-level prediction to patient-level decision. We studied varying methods to integrate multiple ECG/echo pair predictions to maximize model performance in the detection of ATTR-CA. We hypothesized that retaining the patient-level mean risk across the prior 2 years would improve model performance compared to using maximum predicted risk.

Methods and Results:
ATTRact-Net was originally trained on 799 patients with 22,344 ECG/echo pairs completed within 2 years of PYP scan. Previously published performance of the model showed an AUROC of 0.83 in internal testing. For this study, a new test set composed of an outside hospital not used for training, had 422 patients with 12,387 pairs and ATTR-CA prevalence of 23%.

In this new hospital’s population, we tested model performance using four patient-level aggregation methods (mean, median, max, and no aggregation) for integrating predictions across multiple ECG/echo pairs. Performance was compared based on the area under the receiver operating characteristic curve (AUROC), Diagnostic Odds Ratio (DOR), and F1 score using the Youden index as the optimal threshold.

In the external validation dataset, the model achieved AUROCs of 0.78 (max), 0.82 (mean), 0.82 (median) and 0.82 (none) shown in Figure 1A. Mean and median aggregation outperformed both max and no aggregation by F1-score and DOR (Figure 1B).

Conclusion:
For a multimodal AI model detecting ATTR-CA, aggregating ECG/echo risk predictions using mean or median from the prior 2 years considerably improved diagnostic yield compared to using patient’s maximum score or no aggregation. A prospective clinical trial is underway using this strategy for early diagnosis of ATTR-CA across our healthcare system.
Abstract 4147936: Comparative Analysis of the 30-Year Survival after Primary Transplant Versus Reconstructive Surgery for Hypoplastic Left Heart Syndrome
Authors: Shi Caroline , Yang Yanxu , Kochilas Lazaros
Published: November 2024

Background:
Reconstructive surgery for hypoplastic left heart syndrome (HLHS) starts with the Norwood procedure in early infancy. Primary transplant is an alternative strategy that has shown superior outcomes to reconstructive surgery in some patients with left heart obstructive lesions. This study compares the 30-year survival of HLHS following primary transplant vs. reconstructive surgery.

Methods:
Using data from the Pediatric Cardiac Care Consortium (PCCC), a large US-based registry for congenital heart surgeries, we included patients operated at <6 mos old performing both Norwood and primary transplant for HLHS between 1987 and 2003. Deaths were tracked through 2022 by the US National Death Index. Kaplan-Meier curves and extended Cox regression models were used for survival comparison after adjusting for sex, race and birth era. We also performed subgroup analysis by birth era (early: 1987-1996 vs. late: 1997-2003).

Results:
Of 573 patients (males 61%) from 13 PCCC centers, 97 (17%) had a primary transplant. Patients with reconstructive surgery were younger at operation, less likely to be White, and more likely born in the late era. In-hospital survival was higher for primary transplant (79 % vs. 56%, p<0.01) with the advantage remaining significant after adjustment (aOR 0.36; 95%CI: 0.21-0.62, p<0.01). Over a median follow-up of 21.1 years (IQR 1.5, 25.3), 149 deaths occurred post-discharge. No significant difference was found between primary transplant vs. reconstructive surgery in the 30-year post-discharge survival (58.6% vs. 48.7%, p=0.07), although there was a trend towards significance after adjustment (aHR 0.68, 95% CI 0.45-1.05, p=0.08). During early era, primary transplant had 60% decreased hazard of death (aHR 0.40, 95%CI 0.23-0.72, p<0.01) compared to reconstructive surgery, while no difference was found in the late era (aHR 0.99, 95% CI 0.50-1.97, p=0.98) (Figure).

Conclusion:
Primary transplant for HLHS was associated with improved 30-year survival. However, this improvement reached significance only in the early era suggesting improved outcomes with reconstructive procedures in recent years. Further analysis beyond survival is needed to elucidate the relative outcomes of these two strategies.
Abstract 4147967: Increased Mortality Risk in Masquerading STEMI Presentations Compared with True STEMI Patients
Authors: Fathieh Sina , Tran Tu Hao , Faour Amir , Dang Viet , Pahn Reece , Long Mitchell , Tam Gladys , Juergens Craig , Xu James , French John
Published: November 2024

Background:
Prehospital identification of STEMI reduces time to reperfusion by timely primary PCI or fibrinolytic therapy. We previously reported that 40-50% of prehospital ECG transmissions were so-called ‘masquerading STEMI’ defined as ECGs meeting Glasgow algorithm (GA) criteria for STEMI but not meeting STEMI criteria on adjudication using the 4th Universal Definition of MI (4UDMI). We set out to determine late mortality of patients with these presentations.

Methods:
From June 2010 to October 2021, 2,992 patients at Liverpool Hospital in Sydney met GA criteria for STEMI via prehospital ECG and were classified as confirmed or masquerading STEMI per 4UDMI. Mortality risk between the two groups was compared using a Kaplan-Meier plot and further assessed using the Cox regression model, which was also used to further assess the mortality predictive value of patient baseline characteristics in the masquerading group.

Results:
Patients presenting with masquerading STEMI had a hazard ratio (HR) of 2.28 (CI=1.79-2.91, p<0.001) compared with true STEMI for all-cause mortality (figure). Amongst patient characteristics in the masquerading STEMI group, age (HR=1.06[1.05-1.07]), history of stroke (HR=1.42[1.00-2.04]), CKD (HR=1.97[1.47-2.64]) and diabetes (HR=1.49[1.13-1.95]) were positively correlated with increased mortality risk while dyslipidaemia was associated with a lower risk (HR=0.64[0.48-0.86]), potentially confounded by unmeasured statin-therapy.

Conclusions:
Patients presenting with masquerading STEMI have a higher risk of mortality compared to true STEMI patients, highlighting need to better charcterise these patients, and develop therapies and/or interventions that may improve outcomes.
Abstract 4147980: Barriers and Facilitators to Clinician Engagement in an Implementation Science-Informed Digital Health Intervention for Depression Treatment in Patients with Coronary Heart Disease
Authors: Kim Kain , Ospina Nohora , Diamond Meredith , Flores Samantha , Mizhquiri Barbecho Jennifer , Moise Nathalie
Published: November 2024

Introduction:
Nearly 1 in 5 coronary heart disease (CHD) patients experience depression, an independent risk factor for major adverse cardiovascular events. Yet, depression remains undertreated in CHD patients, and few existing implementation strategies address gaps in AHA depression treatment guidelines. Although digital health interventions may help provide patient preference-driven treatment and support, provider perceptions of these tools are poorly understood.

Methods:
From 2019 to 2024, we randomized 12 Columbia University Medical Center affiliated primary care and cardiology clinics to timing of a multi-level intervention, which includes problem-solving meetings for mental health social workers (MHSW), cardiologist/PCP (provider) education, and integration of a psychoeducation, activation, and treatment digital selection tool (“iHeart”). We previously found pre-post improvements in provider referral/prescribing rates (25 vs. 40%). Informed by the Consolidated Framework for Implementation Research 2.0, we conducted 1:1 interviews on treatment barriers and iHeart tool/digital health acceptability with 2-3 providers/MHSW/administrators per clinic in the post-implementation phase. We conducted thematic analyses, incorporating a data-driven inductive approach.

Results:
To date, 10 clinics completed the post implementation phase, and 20 clinicians consented to interviews. Key themes included 1. dissatisfaction with current depression screening and referral practices 2. Poor integration of digital therapeutics into existing clinic resource hubs, 3. Competing time and priorities and 4. Digital literacy in older, non-English speaking, or low-income patients limits uptake. For specific iHeart feedback, barriers included needing integration into the pre-visit screening workflow and confidentiality concerns. However, providers felt it would streamline the burdensome referral process and improve overall patient communication on mental health issues. For future stages, providers recommended clarifying tool integration infrastructure (e.g. for individual providers or entire clinic), engaging patient family members, and incorporating a navigation team component to orient patients with technological or literacy barriers.

Conclusion:
A multi-level digital health implementation strategy may help address existing clinician barriers to depression treatment in individuals with CHD. Future studies will examine impact on patient symptoms, management patterns, and treatment uptake.
Abstract 4147981: Enhanced Subclinical CAD Risk Prediction Using Lp(a): the BioHEART-CT Study
Authors: Fathieh Sina , Gray Michael Patrick , Vernon Stephen , Tang Owen , Grieve Stuart , Figtree Gemma
Published: November 2024

Background:
Lipoprotein(a) (Lp(a)) is now recognised as a key cardiovascular risk factor. Genetically determined and stable throughout adulthood, Lp(a) increases thrombotic risk and promotes atherosclerosis. Doubling Lp(a) levels raises cardiovascular disease risk by 22%. We aimed to evaluate the potential of Lp(a) to predict subclinical coronary artery disease in a well-characterised CCTA cohort, where early plaque detection may guide personalised treatment.

Method and Results:
1,718 participants from the BioHEART-CT cohort were included in this analysis, who presented for a CCTA for suspected CAD without a prior history of myocardial injury or revascularisation between 2015 and 2021. CAD burden was assessed using coronary artery calcium scores and Gensini scores. Lp(a) levels were measured using ELISA.

We evaluated the ability of Lp(a) to reclassify patients into correct CAD risk prediction categories: <10% low risk, 10-30% moderate risk, and >30% high risk. Logistic regression, adjusting for age, sex, hypertension, diabetes, hypercholesterolemia, and smoking status, revealed a net reclassification index (NRI) of 16% (p=0.001) and an integrated discrimination improvement (IDI) of 0.0046 (p=0.03), indicating accurate reclassification of one in 20 patients. In clinically actionable CAD (calcium score ≥100) cases, 26% were correctly reclassified from low to intermediate risk, 21% from intermediate to high risk, and only 2% were incorrectly reclassified. For non-clinically actionable CAD, 10% shifted from high to intermediate risk, 5% from intermediate to low risk, while 14% and 6% were misclassified into higher and intermediate-risk groups, respectively.

Conclusion:
Consideration of Lp(a) can potentially triage patients otherwise considered low risk for imaging to identify and treat atherosclerosis. It serves as an important screening biomarker with the potential to serve as an important non-invasive tool to identify vulnerable CAD patients who are currently underdiagnosed, such as patients without standard modifiable cardiovascular risk factors (SMuRFs).
Abstract 4148019: Shear Stress Affects Human Aortic Endothelial Heparan Sulfate Expression Response to Inflammatory Stimulus
Authors: Mathews Rick , McCarty Owen , Hinds Monica
Published: November 2024

Background:
Heparan sulfate (HS) proteoglycans act as mechanosensors on endothelial cells (ECs), regulating EC morphology and function. HS expression is affected by culture under static or dynamic conditions. HS response to inflammatory stimulus under both conditions is not well characterized. This study investigated HS expression on human aortic ECs (HAECs) under static and arterial flow conditions.

Hypothesis:
Inflammation modeled by TNFa significantly decreases HS epitope on HAECs under both static and arterial flow conditions.

Aims:
To establish the effect of TNFa on HS expression in HAECs.

Methods:
Passages 4 through 8 HAECs (ATCC) were cultured to confluence in endothelial growth medium (Vasculife) in Ibitreat µ-Slide 8 well high chambered coverslip slides or Ibitreat µ-Slide VI 0.4 flow channel slides. Cells were treated with TNFa at 100 ng/mL for 3 hours under static conditions or conditioned with 10 dyn/ cm2 of shear stress for 24 hours and then treated with TNFa at the same concentration added to the circulating media for 3 hours. HAECs were fixed in 2% paraformaldehyde/ 0.1% glutaraldehyde for 30 minutes followed by blocking with 2% goat serum for 30 minutes, both at room temperature. Primary antibody to the 10E4 HS epitope was incubated at 4°C overnight (1:100; 10E4 epitope, AMS Biotechnology, USA) followed by incubation in Alexa Fluor 488 goat anti-mouse secondary antibody (1:300, Molecular Probes, USA) for 1 hour at room temperature. HAECs nuclei were stained using 4′,6-diamidino-2-phenylindole and immersed in phosphate buffered saline for confocal imaging using a laser scanning microscope (Zeiss, LSM 880, 20X).

Results:
TNFa significantly (p < 0.05) increased HS expression in HAEC monolayers treated under static conditions compared to untreated control and heparinase III treated HAECs (Figure 1A). HAEC monolayers conditioned under arterial shear stress expressed significantly (p < 0.05, ANOVA with Tukey’s post-hoc) higher HS levels compared to baseline static controls; however, flow conditioned HAECs did not show any difference in HS expression under untreated compared to TNFa conditions (Figure 1B).

Conclusion:
These data indicate that fluid shear stress may program endothelial cells to significantly alter their HS expression and response to inflammatory stimuli.
Abstract 4148020: Circulating Extracellular Vesicles-Mediated Cardiotoxicity: A Novel Mechanism Exacerbating Heart Failure in Chronic Kidney Disease
Authors: Li Xisheng , Raisinghani Nikhil , Gallinat Alex , zhang shihong , Phan Anh , yoon seonghun , La Salvia Sabrina , Sachs David , Dogra Navneet , Erdbruegger Uta , Sahoo Susmita
Published: November 2024

Background:
More than 50% of deaths in advanced chronic kidney disease (CKD) are attributed to cardiovascular disease (CVD). The degree of heart failure (HF) correlates with severity of CKD. Clinical observations suggest that kidney-derived factors contribute to the development of HF in CKD, independent of the known co-morbidities such as hypertension and hyperglycemia. However, to date, no kidney-specific risk factor that triggers early damage to the heart has been identified, primarily due to a paucity of studies in patients with reno-cardiac disease. Here, we investigate the role of circulating extracellular vesicles (EVs) from CKD patients in pathological communication from the kidney to the heart, causing cardiotoxicity, impair cardiac function and leading to HF.

Methods and Results:
We isolated the plasma EVs from patients with CKD (hCKD-EVs) and healthy control (hCtr-EVs) and assayed for their cardiotoxicity both in vitro (human AC16 and rat primary cardiomyocytes (CMs) in culture) and in vivo (intramyocardial injection to Nod-Scid mice). hCKD-EVs significantly induced apoptosis in cultured CMs and in injected mice hearts and impaired the contractility of CMs, compared with hCtr-EVs. We also established an adenine-induced CKD mouse model that developed HF with reduced cardiac function. In line with hCKD-plasma EVs, kidney-derived EVs from CKD mice (mCKD-kidney EVs) induced cardiotoxicity both in vitro and in vivo. Moreover, decreasing the circulating EVs in CKD mice using an inhibitor of EV-biogenesis, GW4869, significantly improved the cardiac function in CKD mice. Small RNA sequencing and qPCR analysis revealed several highly expressed miRNAs in both human and mouse CKD-EVs, which are associated with CM apoptosis. MiRNA mimics treated to AC16 CMs induced their apoptosis, confirming the cardiotoxic function of miRNAs. To demonstrate the renal origin of these CKD-EV-miRNAs, we quantified the levels of corresponding endogenous primary miRNAs. We detected that several CKD-EV-miRNAs are originating from the kidney tissues and specific kidney cells, such as PTCs and podocytes in CKD mice.

Conclusion:
Our studies establish that both human and mouse CKD EVs are cardiotoxic and impair cardiac function. CKD-EVs carry pro-apoptotic miRNAs and are key contributors to humoral cardiotoxicity in CKD patients. Thus, they have the potential to serve as biomarkers for early diagnosis of and novel therapeutics for chronic reno-cardiac disease.
Abstract 4148033: Deep Learning Enabled Electrocardiogram Aimed to Detect Coronary Artery Disease to Predict Atherosclerotic Cardiovascular Events in the Community
Authors: Medina-Inojosa Jose , Mangold Kathryn , Awasthi Samir , Medina-Inojosa Betsy , McCully Robert , Lerman Amir , Attia Zachi , Friedman Paul , Lopez-Jimenez Francisco
Published: November 2024

Background:
We previously developed deep-learning algorithms that identify coronary artery disease (CAD) risk based on (i) coronary artery calcium (CAC), (ii) obstructive CAD by angiography, and (iii) left ventricular akinesis in ≥1 segment by echocardiogram, using a 12-lead electrocardiogram (CAD ECG-AI). We tested the hypothesis that those with increased probability of CAD by CAD ECG-AI algorithms will have an increased risk of atherosclerotic cardiovascular disease (ASCVD) events and would refine the AHA Predicting Risk of Cardiovascular Disease Events (PREVENT
TM
) equations’ predictive capabilities.

Methods:
We assessed a group of consecutive patients who sought primary care in Olmsted County, MN, between 1997 and 2003. Passive follow-up was conducted using the Rochester Epidemiology Project's record linkage system. Patients included met the same criteria of the original PREVENT
TM
equations. The probability output of each CAD ECG-AI algorithm was used to predict ASCVD (fatal and non-fatal myocardial infarction and ischemic stroke) and ASCVD-Plus [further including percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and all-cause mortality]. Events were validated in duplicate. Cox proportional hazard models adjusted for age, sex, and risk factors while modeling each CAD ECG-AI algorithm as an individual and additive predictor
(see footnote).
PREVENT
TM
risk categories stratified analysis to evaluate the effect of the CAD ECG-AI models on predicted ASCVD risk.

Results:
We included 21,193 patients, with mean ± SD age 51.6 ± 12.0, 54% women and 95% white. After 14.2±12.4 years follow-up, 1,351 (6.4%) developed ASCVD, and 2,808 (13.2%) had ASCVD-Plus. The risk of ASCVD and ASCVD-Plus increased with positivity for the CAD ECG-AI algorithms after adjustments for age, sex, and PREVENT
TM
equations factors, all
p
for trend <0.001 (data not shown). In additive analyses, the risk of ASCVD and ASCVD-Plus increased with increased CAD ECG-AI factors, all
p
for trend <0.001 (
Fig. A-B
). Furthermore, the CAD ECG-AI algorithm enhanced the predictive capabilities of PREVENT
TM
equations across most risk subgroups (
Fig. C-E
).

Conclusions:
The deep-learning CAD ECG-AI algorithms displayed an independent and additive association with long-term ASCVD and ASCVD-Plus events in the community and improved the PREVENT
TM
predicted ASCVD risk. The CAD ECG-AI algorithms could help identify individuals at risk in primary prevention of cardiovascular events.
Abstract 4148058: Coordination Index Guides Synchronous Non-Blood Contacting Support of the Failing Heart
Authors: Schmitt Benjamin , Anstadt Mark
Published: November 2024

Introduction:
Direct mechanical ventricular actuation (DMVA) is a non-blood contacting biventricular support device that uniquely augments diastolic pump function and promotes early recovery of the failing heart. Investigations demonstrate DMVA improves intraventricular dyssynchrony while supporting the failing heart suggesting an effect similar to that of cardiac resynchronization therapy. Optimizing intraventricular synchrony may be dependent on timing device augmentation with the underlying heart rhythm.

Hypothesis:
The purpose of this study was to test the hypothesis that a coordination index can be used to optimize synchronous DMVA support of the failing heart.

Methods:
Canine (n=9) were instrumented and subjected to repeated periods of ventricular fibrillation (VF) to achieve progressive worsening of ischemic heart failure (HF). DMVA returned the circulation during VF and provided support during HF. DMVA support was initiated using pre-determined pressure/flow profiles based on heart size. DMVA pneumatic drive were tailored to optimize LV pump function using intra-cardiac ECHO imaging. DMVA cycle rates were adjusted between 110-130 bpm to most closely match the underlying native heart rate determined during periodic device removal. Hemodynamics and drive pneumatics were simultaneously recorded using 10 s data acquisitions. The coordination index (CI), a metric for synchrony of peaks was used to analyze the results (see table). Aortic flow waveforms were evaluated for the number of peaks during each DMVA compression. Failure to elicit a pressure or flow response (skipped cycles) was also identified. The CI indices were divided into 5 equal quantiles to characterize synchrony from best (Group 1) thru worst (Group 5). One-way ANOVA with post-hoc Tukey’s HSD was used to assess statistical differences (p<0.05) for all comparisons.

Results:
Five groups of equally distributed CI quantiles were grouped from superior to inferior synchrony (Table). Periods of ventricular pacing was suggested evidenced by near-zero CI computations during DMVA support. Improved synchrony correlated with peak systolic and +dP/dt drive drive pneumatics. Lower CI was also linked to absence of skipped cycles. CI during VF support was consistently near-zero.

Conclusions:
CI can guide optimal synchronous DMVA support of the failing heart. Future studies will determine if optimizing synchronous support improves intraventricular synchrony and facilitates cardiac recovery.
Abstract 4148106: Hemophilia and Cardiovascular disease in the United States: Prevalence, Risk factors, and outcomes.
Authors: Nzeako Tochukwu , Adeniran Olayemi , Wang Jen-Chin
Published: November 2024

Background:
Hemophilia is a rare X-linked recessive inherited bleeding disorder. Owing to improved management, the life expectancy of patients with hemophilia has increased significantly and predisposes them to risk of cardiovascular diseases and thrombotic events. However, studies on cardiovascular risk factors and outcomes in patients with hemophilia are limited.

Aims:
Therefore, the present study aimed to examine the prevalence of cardiovascular disease, the risk factors, and the outcomes in patients with hemophilia.

Methods:
The study identified all adult males with a primary and secondary diagnosis of hemophilia in the National Inpatient Sample (NIS) database from 2018 – 2020. The overall study population was compared to the general population, non-hemophilia. The primary outcome was to estimate the prevalence of cardiovascular risk factors in patients with hemophilia compared to the general population. The secondary outcomes comprise the odds of adverse events, including myocardial infarction, ischemic stroke, transient ischemic attack (TIA), occlusive atherosclerotic disease, percutaneous coronary intervention, and coronary artery bypass graft (CABG)., We conducted a multivariate logistic regression to estimate the odds of the outcomes

Results:
Out of the total 7,377,811 adult male study population, 11,291 (0.2%) had hemophilia, and 7,377,811 (99.8%) with non-hemophilia. The hemophilia cohort was slightly older (63.2[16.8] vs. 61.5[17.4]) and was also more likely to have diabetes mellitus, hyperlipidemia, chronic lung disease, chronic kidney disease, chronic liver disease, BMI ≥ 25, anemia, metastatic cancer, and atrial fibrillation. In the adjusted models, patients with hemophilia had higher odds of myocardial infarction (OR 2.62, 95% CI: 2.47 – 2.77), ischemic stroke (OR 2.71, 95% CI: 2.53 – 2.89), TIA (OR 10.44, 95% CI: 9.40 – 11.60), occlusive atherosclerotic disease (OR 2.31, 95% CI: 2.08 – 2.56), PCI (OR 5.31, 95% CI: 4.86 – 5.80), and CABG (OR 7.62, 95% CI: 6.97 – 8.33).

Conclusions:
Our study found that patients with hemophilia had a higher prevalence of cardiovascular risk factors and adverse events compared to males without hemophilia in the United States. Further research is to identify potential ex-specific risk factors that predispose to worse cardiovascular outcomes among patients with hemophilia.
Abstract 4148110: Trends in Critical Limb Ischaemia Related Mortality in Patients Aged 55 and Older in the United States: Insights from the CDC WONDER Database
Authors: Naveed Muhammad Abdullah , Azeem Bazil , Ahmed Faizan , Abdul Basit Salman , sattar yasar
Published: November 2024

Background:
Critical Limb Ischaemia (CLI) is a concerning medical emergency condition with notable mortality among older adults. This study highlights the trends and demographic disparities in mortality rates due to CLI in patients aged 55 and older in the United States from 1999 to 2020.

Aim:
This study aimed to evaluate patterns and geographical variations in mortality associated with CLI among adults in the United States.

Methods:
Death certificates from CDC WONDER database from1999 to 2020 were analyzed to investigate mortality related to CLI among adults. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, stratified by year, sex, race/ethnicity, and geographical regions.

Results:
CLI caused a concerning 620,205 deaths among US adults aged 55+ between 1999 and 2020, primarily in hospitals (42%). The overall AAMR for CLI-related deaths showed decline from 51.6 in 1999 to 40.1 in 2020, with an AAPC of -1.51 (95% CI: -1.75 to -1.25, p < 0.000001). The AAMR experienced a steeper decrease from 1999 to 2011 (APC: -3.31, p < 0.000001), followed by a slight increase from 2011 to 2020 (APC: 0.94, p = 0.031174). Men had higher AAMRs than women, though both sexes experienced reductions (men: 48.3; women: 32.6). The AAMR for men decreased from 64.9 in 1999 to 42.8 in 2011, increasing to 50.1 by 2020. For women, the AAMR decreased from 42.9 in 1999 to 28.3 in 2014, followed by a slight increase to 32.3 by 2020. Racial/ethnic disparities were apparent, with Black individuals having the highest AAMRs (58.7), followed by Whites (39.0), American Indians/Alaska Natives (38.0), Hispanics (28.5), and Asians/Pacific Islanders (13.8). All racial groups experienced decreases in AAMRs. Geographically, AAMRs varied from 20.4 in Utah to 53.2 in Ohio. The highest mortality noted in the Midwestern region (AAMR: 43). Nonmetropolitan areas unveiled higher AAMRs than metropolitan areas (nonmetropolitan: 43.5; metropolitan: 38.2). Both regions showed a decrease in AAMRs from 1999 to 2020 (metropolitan AAPC: -1.36, p < 0.000001; nonmetropolitan AAPC: -0.81, p = 0.001399).

Conclusion:
Our analysis highlights significant demographic and geographic differences in older adult mortality due to CLI in the U.S. Continued decreases over time but recent upturn in mortality rates emphasizes need for focused interventions to close these gaps and to improve population health outcomes for affected populations.
Abstract 4148118: Causes of Thirty Day Readmission Following ICD Placement in Heart Failure Patient with Amyloidosis
Authors: Jha Vivek , Aryal Badri , Teaima Taha , Quevedo Ramirez Andres , AZIZ IMRAN , Gajjar Rohan
Published: November 2024

Background and Objectives:
Data regarding readmission rate following ICD placement in heart failure patients with Cardiac amyloidosis are scare. We attempted to study 30-day readmission rate following ICD placement in these patients and the common causes of readmission.

Methods:
We utilized the Nationwide Readmission Database from 2016 to 2020 and included patients more than 18 years of age who were admitted for placement of Implantable Cardiac Defibrillator (ICD) and had secondary diagnosis of heart failure and amyloidosis. We used International Classification of Disease, Tenth Revision, Clinical Modification (ICD10 CM) codes to identify patients. The primary outcome was the 30-day readmission rate, and secondary outcomes were mortality rates, and common reasons for readmission.

Results:
We identified a total of 457 patients who underwent placement of ICD and had heart failure with amyloidosis, among which mean age was 69 years and 25.42% were females. The 30-day readmission rate was 19.50%. Mortality rate was higher in readmitted patients (7.12%) as compared to index admission (3.82%). Most common causes of readmission were hypertension and heart failure with CKD stage 1 to 4(22%), hypertensive heart disease with heart failure (8.35%), hypertensive heart disease with CKD 5 or ESRD (7.58%), Acute Kidney Injury (5.94%), Non-specific chest pain (5.56%), Organ specific amyloidosis (5.43%), Cellulitis (3.68%), Acute on chronic systolic heart failure (3.56%), and Acute systolic heart failure (3.17%)

Conclusion:
The thirty-day readmission rate was 19.50% and most common cause of readmission was hypertension and heart failure with CKD. Improvement of management strategies is needed to address these causes and improve patient outcomes.
Abstract 4148151: Device Extraction Improves Survival in ESRD Patients with CIED Infections
Authors: Byer Stefano , Alzahrani Ashraf , Farjo Peter , Powers Edward , xDominicx xPaarix
Published: November 2024

Introduction:
Patients with end-stage renal disease (ESRD) are prone to cardiovascular implantable electronic device (CIED) infections with a reported 12-month infection rate of 1%, portending an all-cause mortality rate up to 35%. Complete device extraction reduces reinfection and mortality, but is complex and carries high risks, especially for ESRD patients. Here we compare outcomes in infected CIED extraction in the ESRD population.

Methods:
This study utilized data from the TriNetX research network. We included adults with a history of ESRD and CIED infection. Patients were stratified by device extraction, and those with a history of renal transplant were excluded. Propensity score matching was performed, with outcomes of interest: mortality, all-cause admission, sepsis or bacteremia, and 30-day complications.

Results:
In the ESRD population, we identified 271 patients who underwent extraction for infected CIED and 623 who did not undergo extraction. CIED extraction was associated with improved survival at one year (65.7% vs 57.3%, p=0.047). The survival benefit was evident at 30 days (91.6% vs 85.8%, p=0.03). No appreciable difference in freedom from admission (30.6% vs. 32.1%, p=0.875) or from sepsis or bacteremia (44.9 vs. 44.8%, p=0.130) at one year. At 30 days, there was no difference in development of pericardial effusion or tamponade (95.7% in vs. 98%, p=0.069), respiratory failure (75.9% vs. 73.4%, p=0.529), or red blood cell transfusion (94% vs. 90.1%, p=0.153). In the extraction group, freedom from cardiac surgery at 30 days was 88.1%, with 11.6% of patients requiring open lead extraction.

Conclusion:
In ESRD patients with CIED infections, device extraction is associated with a significant reduction in all-cause mortality at one year without increasing the risk of all-cause admission, sepsis or bacteremia, or 30-day complications. These findings support considering device extraction in this high-risk population to improve survival outcomes. Further research is needed to optimize management strategies and address the challenges specific to ESRD patients with CIED infections.
Abstract 4148156: A Comparison of Characteristics and Outcomes in Patients with and without Adult Congenital Heart Disease Undergoing Catheter Ablation for Ventricular Tachycardia
Authors: Futela Pragyat , Poddar Aastha , Kowlgi Gurukripa
Published: November 2024

Background:
Patients with adult congenital heart disease (ACHD) form a unique subset of patients with complex ventricular tachycardia (VT).

Objective:
To evaluate the clinical and procedural characteristics and outcomes of patients with congenital heart disease who present for VT ablation.

Methods:
A single-center, retrospective study of patients undergoing VT ablation was conducted. The primary composite outcome was recurrent monomorphic VT, and repeat ablation.

Results:
Out of 508 procedures for ventricular tachycardia ablation, 37 were performed in ACHD patients. These patients were younger compared to the non-ACHD subtype.(Table 1). Out of 26 patients with congenital heart disease, a majority had a diagnosis of tetralogy of Fallot (57.6%) and 69% had 2-3 prior open-heart surgeries, including ventriculotomy (53.8%), ventricular septal defect repair (65.3%), and pulmonary valve replacement (57.6%) (Table2). They had a higher mean LVEF,and lower burden of comorbidities including hypertension, chronic kidney disease, and myocardial infarction compared to their non-ACHD counterparts and had been on fewer antiarrhythmics at baseline. ACHD patients were less likely to require epicardial access, but the requirement for induction meds was higher, and energy delivery times were longer. There were no significant differences in the VT characteristics and mapping techniques between the two groups. There were no significant differences in outcomes including complications, and time to recurrence, and a Kaplan-Meier analysis showed no significant difference in VT free survival when ACHD patients were compared to patients without ACHD (Figure 3). After adjusting for age, sex and comorbidities, ACHD was not a predictor of having VT recurrence or repeat ablation (aHR =1.1 (0.7-1.9), p=0.6)

Conclusion:
VT ablation in patients with ACHD is safe, and as effective as ablation in non-ACHD patients. Procedure times tend to be longer owing to a more challenging substrate.
Abstract 4148181: Neutrophil and Leucocyte Ratio and LDL to HDL ratios as predictors of Hemorrhagic transformation in ischemic stroke patients : A systematic review
Authors: Kumar Harendra , Sharma Vagisha , Sharma Saurabh
Published: November 2024

Background:
Following an ischemic stroke, a serious complication known as hemorrhagic transformation (HT) might jeopardize patient outcomes. Inflammatory indicators, such as the neutrophil-to-leukocyte ratio (NRR), and lipid markers, such as the low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio, have been investigated as HT predictors. Recent research has delved further into the predictive significance of these biomarkers for ischemic stroke outcomes.

Objectives:
To systematically review the literature on the predictive value of NLR and LDL to HDL ratios for HT in ischemic stroke patients, incorporating recent findings that enhance our understanding of these biomarkers.

Methods:
A detailed search of electronic databases was conducted to gather studies focusing on NLR and LDL to HDL ratios as predictors for HT in ischemic stroke. The selection process followed strict inclusion criteria, and the quality of studies was rigorously assessed.

Results:
The paper discusses new findings that emphasize the impact LDL and NLR play in influencing HDL ratios and, hence, HT prediction. Following an ischemic stroke, an increased incidence of HT, especially parenchymal hematoma (PH), has been associated with greater NLR. A high neutrophil-to-HDL ratio (NHR) has also been identified as a possible predictor of poor prognosis in ischemic stroke, underscoring its significance in predicting HT. Furthermore, the LDL-to-HDL ratio has been connected to long-term clinical outcomes like death and recurrent myocardial infarction, which may be associated with HT risk.

Conclusions:
In individuals with ischemic stroke, NLR and LDL-to-HDL ratios are potential HT indicators. The addition of current data underscores the potential of these ratios not just as HT indicators but also as markers for broader stroke-related effects. More studies are needed to validate these results and provide consistent recommendations for their use in clinical practice.
Abstract 4148199: Enhanced Diagnostic Value of High Sensitivity Troponin I After Indexation for Myocardial Mass, Renal Function and Age: the BioHEART-CT Study
Authors: Fathieh Sina , Gray Michael Patrick , Murtagh Gillian , Tang Owen , Vernon Stephen , Grieve Stuart , Figtree Gemma
Published: November 2024

Background:
Atherosclerotic coronary artery disease (CAD) often goes undetected until acute myocardial infarction (AMI). High-sensitivity troponin (hs-cTn) assays, known for diagnosing acute coronary syndrome, are being explored for detecting subclinical CAD. Studies suggest hs-cTn's potential in identifying coronary atherosclerosis, indicating its value in early CAD screening.

Method and Results:
This study used the BioHEART-CT cohort (2015-2021) of 2,000 adults undergoing CCTA for known or suspected CAD, excluding those with prior cardiomyopathy, MI, or coronary revascularization. CAD severity was assessed using CACS and Gensini scores. Myocardial mass was estimated via automated segmentation. Hs-cTnI was measured using Abbott ARCHITECT i1000 and Beckman Access 2 assays.

We examined the association between hs-cTnI levels and the extent of myocardial involvement. Hs-cTnI significantly correlated with the total number of coronary artery segments containing detectable plaque (ρs = 0.25; p < 0.001; Figure 1). Additionally, Spearman’s correlation of segment location and stenosis degree with hs-cTnI indicated a stronger association in the proximal segments.

We examined the potential improvement of the association of hs-cTnI with clinically actionable CAD by incorporating myocardial mass (affecting baseline hs-cTnI release) and estimated glomerular filtration rate (eGFR) into the model. Using PLS with GLM regression, we projected hs-cTnI, age, eGFR, and myocardial mass into a latent feature. This improved detection of clinically actionable CAD, yielding an AUC of 0.79 and 0.80 in the participants without standard CAD risk factors. Using echocardiographic LV mass data (available for 362 patients), the AUC improved to 0.75 overall and 0.76 for SMuRF-less patients (Figure 2).

Conclusion:
Baseline serum hs-cTnI may indicate underlying subclinical CAD. The predictive value of troponin can be further enhanced by considering the effect of myocardial mass, renal function, and age.