bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4141921: Hydration to prevent acute kidney injury after pulsed field ablation: importance of timing and fluids amount
Authors: La Fazia Vincenzo Mirco , Mohanty Sanghamitra , Torlapati Prem Geeta , gianni carola , Della Rocca Domenico , Bode Weeranun , Gallinghouse Joseph , Al-Ahmad Amin , Di biase Luigi , Natale Andrea
Published: November 2024

Previous studies have highlighted the risk of acute kidney injury (AKI) development, underlining the need for strategies to mitigate this complication.

We analyzed 208 consecutive patients who underwent pulsed field ablation (PFA) for post-FDA approval. All patients received pulmonary vein isolation. Ablation of extra-PV sites was performed per the operator’s choice, with no contrast agents . Serum creatinine was measured in all patients at baseline and 24 after ablation.

The aim of our study was to evaluate the impact of hydration timing and the amount of fluids on incidence of AKI in patients undergoing PFA.

Group means for continuous variables were compared using the Student t-test. Categorical variables were compared using the Chi-square test. A ROC analysis was done to evaluate the predictive model of PFA applications to evaluate AKI. All tests were two-tailed and conducted at an α level of 0.05.

We divided patients into two groups:
Group 1
(n=102) received either one liter of saline pre-procedure or one liter pre-procedure followed by a liter post-procedure;
Group 2
(n=106) was preemptively hydrated with two liters of saline before the procedure, followed by additional 500cc if the patient had received more than 100 PF applications. Baseline Characteristics of population are described in
Fig.1a
.

In the comparative analysis of the two groups, there was no significant difference regarding the number of PFA applications administered.

None of the patients in Group 2 experienced AKI, while Group 1 AKI occurred in 9 patients. (0/106 vs 9/102, p-value=0.0034).

The ROC analysis yielded an area under the curve of 0.709 ± 0.107 with a 95% confidence interval ranging from 0.498 to 0.919 (p-value=0.035). An optimal PF application cutoff point of 105.50 was determined, associating a higher probability of AKI with PFA applications exceeding this threshold (sensitivity:0.667, specificity:0.735, Youden's index:0.402) (
Fig.1b
).

Among the 9 patients who developed AKI, we observed that 7 received more than 100PF applications; the remaining 2 patients, each with baseline stage 3 chronic kidney disease and prior episodes of AKI following surgeries, received 54 and 50PF applications, respectively.

In this series of patients, pre-procedural hydration with two liters of fluids eliminated the risk of AKI even in patients who received a high number of PFA applications.
Abstract 4141922: Development of prediction models in heart failure lacks quality: a systematic review
Authors: Bergstedt Seth , Cravero Ellen , Feldewerd Katianna , Walser-Kuntz Evan , Willett Andrew , Stanberry Larissa
Published: November 2024

Advances in modeling methodology and increased democratization of software led to rapid increase in novel prediction models. In clinical research, these models proclaim novel predictors, promise superior accuracy and meaningful improvements in patient outcomes. Developing an accurate prediction model requires rigorous methodology with great attention to study design and conduct. Failure to adhere leads to prediction bias and may result in harmful decisions.

We conducted a systematic review of research articles in heart failure listed in PubMed 2018 – 2023 and presented by their authors as developing prediction models, either diagnostic or prognostic. The study variables were selected based on PROBAST and TRIPOD (Table 1). These were summarized and the study conducts were evaluated against the gold standard of prediction modeling per PROBAST and TRIPOD. For each study, we calculated the optimal sample size, i.e. the minimal size required for at least 5% prediction accuracy and 90% shrinkage in parameters. Sentiment analysis was performed to estimate the prevalence of promotional language in the abstract corpus.

From 6,429 studies, 212 studies were presented as developing prediction models. Of those, 83 (39%) were truly about developing prediction models (TPM) and the rest were impostors, i.e. inferential models misrepresented as predictive.

Mostly, TPMs were prognostic, modeled binary outcomes, and employed machine-learning methods (Table 1). Commonly, essential data volume summaries were lacking and handling of missing data was inadequate. The deficit in the number of samples in model training was 1499 (-316, 3866) samples with 52(71%) studies below the optimal size.

Model validation or testing was not performed in 30% of the studies. Discrimination statistics were reported often in testing but not in validation. The calibration was rarely assessed at either phase. Thirty (36%) studies had enough information to implement risk score calculations. The sentiment analysis showed increased use of hype words in both TPMs and impostors relative to 2020-rates in Millar et al (2022).

Most TPM studies exhibit poor design, insufficient sample size, mishandling of missing data, and inadequate model evaluation. These deficiencies result in biased risk estimates, degrade the performance in external data limiting generalizability and clinical utility of the developed models. Excessive use of hype can be misleading and may impede objective evaluation by the readers.
Abstract 4141938: Effect of Menopausal Status on Cardiovascular Responses to Exercise
Authors: Cifci Gizem , Bruhn Eric , Kauss Marissa , Armour Sarah , Curry Timothy , Talbott Katie , Bissen Thomas , Miller Sophie , Smith Joshua
Published: November 2024

Introduction:
An elevated blood pressure (mean arterial pressure, MAP) response to exercise is an independent predictor of hypertension (HTN) development. HTN is highly prevalent in postmenopausal females. Postmenopausal, compared to premenopausal, females have a higher MAP at rest and during exercise primarily due to higher systemic vascular resistance (SVR). Studies using small muscle mass exercise have suggested that postmenopausal females have augmented increases in MAP from rest to exercise. However, it is unclear if postmenopausal females have augmented MAP responses from rest to exercise during whole-body exercise. Hypothesis: We hypothesized that postmenopausal females would have greater increases in MAP and smaller decreases in SVR from rest to peak exercise than premenopausal females.

Methods:
Normotensive premenopausal (n=16; age: 30±7 yrs; BMI: 23±4 kg/m
2
) and postmenopausal (n=14; age: 57±7 yrs; BMI: 27±4 kg/m
2
) female participants performed an incremental cycling test until task failure. Blood pressure was measured by manual sphygmomanometry, cardiac output (Q) via open-circuit acetylene wash-in technique, and SVR was calculated. Data are reported at rest and peak oxygen uptake (VO
2
). Data are also reported as % change from rest to VO
2
peak.

Results:
Postmenopausal females had higher MAP and SVR at rest and at VO
2
peak than premenopausal females (all, p<0.05). Postmenopausal, compared to premenopausal, females had lower Q at VO
2
peak commensurate with the lower achieved VO
2
peak (p<0.01). Resting MAP was positively related to MAP at VO
2
peak in postmenopausal females (r=0.85, p<0.01), but not premenopausal females (p=0.22). % change in MAP from rest to VO
2
peak was not different between groups (Post: 18±8 vs. Pre: 18±9%) (p=0.94). However, postmenopausal females had smaller % decreases in SVR from rest to VO
2
peak (Post: -44±7 vs. Pre: -54±8%) and smaller % increases in Q compared to premenopausal females (Post: 113±31 vs. Pre: 162±50%) (both, p<0.01).

Conclusion:
Our findings indicate that postmenopausal and premenopausal females have similar increases in MAP from rest to VO
2
peak; however, the mechanisms contributing to the MAP response differed by menopausal status. Postmenopausal females relied on smaller decreases in SVR, whereas premenopausal females had greater increases in Q. These findings provide important insight into the mechanisms contributing to the clinically relevant higher MAP response during exercise in postmenopausal females.
Abstract 4141940: Outcomes in Middle Eastern Atrial Fibrillation Patients with Prior Ischemic Stroke/Systemic Embolism: Findings from the JoFib Study
Authors: Al-Nusair Jowan , Al-Nusair Mohammed , Alrabadi Nasr
Published: November 2024

Objective:
Examine the sociodemographic and clinical profiles of Middle Eastern patients with atrial fibrillation (AF) who have a history of prior ischemic stroke or systemic embolism (SSE) and compare the risk of adverse events between AF patients from the Middle East with and without a history of SSE.

Methods:
The study population was drawn from the JoFib study, a multicenter, nationwide, prospective registry of AF patients from the Middle East. Patients with a history of prior hemorrhagic stroke were excluded from this analysis. The remaining patients were divided into two groups based on their history of prior SSE to compare baseline sociodemographic and clinical characteristics and the one-year risk of all-cause death, cardiovascular death, non-cardiovascular death, SSE, and major bleeding between AF patients with and without prior SSE. Multivariable Cox proportional hazards models and Fine-Gray sub-distribution hazards models were used to adjust for confounding factors. Additionally, multivariable logistic regression models were applied to compare the secondary outcome of clinically relevant non-major bleeding (CRNMB) between the two groups.

Results:
The study included 2,003 AF patients, divided into two groups: 318 patients (15.9%) with a history of prior SSE and 1,685 patients (84.1%) without. Patients with prior SSE were older than those without (45.3% vs. 30.4%, p<0.001). Compared to the no prior SSE group, those with prior SSE were less symptomatic (61.3% vs. 72.8%, p<0.001), had higher rates of diabetes (49.1% vs. 42.4%, p=0.03) and dyslipidemia (51.9% vs. 43.6%, p=0.007), and were less often obese (34.0% vs. 42.2%, p=0.009). Rhythm-control strategies were used less frequently in the prior SSE group (16.0% vs. 22.0%, p=0.02), while antithrombotic medications were more commonly used, including anticoagulants (89.0% vs. 80.7%, p<0.001) and antiplatelets (48.4% vs. 37.6%, p<0.001). The prior SSE group had a higher risk of all-cause death (aHR 1.64, 95% CI 1.21-2.22), cardiovascular death (adjusted subhazard ratio [aSHR] 1.50, 95% CI 1.04-2.16), non-cardiovascular death (1.76, 95% CI 1.00-3.08), and SSE (3.05, 95% CI 1.83-5.07). However, a history of prior SSE did not significantly affect the rates of major bleeding (0.67, 95% CI 0.27-1.65) or clinically relevant non-major bleeding (CRNMB) (AOR 0.79, 95% CI 0.47-1.33).

Conclusion:
AF patients with a history of prior SSE face a higher risk of adverse events compared to those without prior SSE.
Abstract 4141963: Patient Perspectives of Genetic Testing in Adult Congenital Heart Disease
Authors: Onorato Angela , Vannatta Kathryn , Texter Karen , Spayde Katherine , Gosselin Rachel , CHAUDHARI BIMAL , Kistler Isaac , Garg Vidu , Mah May Ling
Published: November 2024

Background:
Long-term survival of patients with congenital heart disease (CHD) has increased significantly in the past 40 years, resulting in the largest adult congenital heart disease (ACHD) population in history. Pathologic genetic variation significantly contributes to development, heritability, and outcomes of CHD. International guidelines for genetic testing in syndromic, familial, and complex CHD requiring intervention were published in the last decade and did not address the ACHD population, who was diagnosed well before this era. Perceptions of ACHD patients regarding genetic testing are unknown.

Aims:
Assess the proportion of ACHD patients that have received genetic testing compared to those that would be considered for testing based on current recommendations. Assess interest and perceived risks and benefits of genetic testing and how these are impacted by clinical and family factors.

Methods:
Single center prospective cohort survey of consecutive ACHD patients 18 years or older seen in outpatient clinics over a 5-month period.

Results:
Data were provided by 124 survey respondents, 48.4% female with median age 29.1 years (IQR 23.1-37.8). A majority of respondents (68.3%) have children or plan to have children. Few respondents (10.5%) report prior genetic testing. The majority desire genetic testing (65.3%), while only 8.1% would not choose to have testing performed. Respondents mostly believe testing should occur either during infancy (36.1%) or in adulthood before having children (29.5%). Personal and family health considerations were among the most important motivating factors for consideration of genetic testing, while financial factors were not as prioritized, as shown in Figure 1. Few respondents felt genetic testing would have a negative impact on their mental health (4.2%); the majority felt there would be a positive (53.3%) or neutral (42.5%) effect.

Conclusions:
Many ACHD patients would have received genetic testing if born in the current era, but very few have been offered such testing given a lack of recommendations in the ACHD population. Broadening genetic evaluation for the adult CHD population should be considered given patient interest and current pediatric CHD recommendations.
Abstract 4141975: Feasibility of Using Wearables to Obtain High-Fidelity ECG Signals for Cardiovascular Disease Screening in Palestinian Refugees in Jordan
Authors: Atoum Hadeel , Ji Rui Qi , Abu-Hananneh Mutaz , Alduraidi Hamzah , Alshraideh Jafar , Sejdic Ervin , Al-Zaiti Salah
Published: November 2024

Background:
Refugee populations often experience high rates of cardiovascular disease (CVD). Factors such as significant physiological stress, trauma, limited access to healthcare, substance abuse, and poor lifestyle choices contribute to disease progression and an increased incidence of cardiovascular events. We sought to evaluate the feasibility of using wearables to obtain high-fidelity ECG signals for CVD screening in refugees in Jordan.

Methods:
This observational cross-sectional study involved outpatients at one of four regional United Nations’ primary care clinics for Palestinian refugee in Jordan. Research assistants collected health histories from consented patients and recorded a 30-second, 6-lead ECG using a handheld, Bluetooth-enabled, wearable device (KardiaMobile 6L, AliveCor Inc., Mountain View, CA, USA). The digital ECG signals were stored on the Bluetooth-synced mobile device and then exported to a cloud server for offline analysis. The raw ECG recordings were preprocessed, and a single median beat was calculated per lead. Waveforms were segmented, and duration and amplitude measures were determined using a previously validated custom algorithm (University of Pittsburgh, PA, USA). All ECG recordings were reviewed by an independent physician.

Result:
The sample included 31 patients (age 52±13, 64% Females). Risk factors were prevalent in this group, including hypertension (74%), high cholesterol (65%), diabetes (64%), in-camp living (33%), and smoking (30%). Figure 1 shows the population-averaged median beat with 99% CI distribution of this sample. Mean QRS duration was 95±23 ms (range 53−150) and QTc interval was 403±53 (range 267−513). Most patients were in normal sinus rhythm (84%), and remaining patients were in atrial fibrillation or flutter (16%). Other clinically significant abnormalities included non-specific ST-T changes (9.7%), left bundle branch block (1.6%), and LVH with left ventricular strain (1.6%).

Conclusion:
This pilot study demonstrated that it is feasible to obtain high fidelity ECG signals using wearables to screen for CVD in refugees. Such affordable, noninvasive, point-of-care screening tools could enable early diagnosis and treatment in these patients.
Abstract 4141978: Surveying Healthcare Professionals' Awareness and Management of Inflammation as a Residual Cardiovascular Risk Factor.
Authors: Banach Maciej , Surma Stanislaw , Alnouri Fahad , Mancini G B John , Vinereanu Dragos , Gouni-Berthold Ioanna , Reiner Zeljko , SABOURET Pierre , Latkovskis Gustavs , Postadzhiyan Arman , Moriarty Patrick , Vohnout Branislav , Jozwiak Jacek , Shapiro Michael , Wong Nathan
Published: November 2024

Introduction:
Inflammation is a recognized residual CVD risk factor. However, the knowledge, diagnosis, and management of inflammation-related CVD risk among healthcare professionals (HCPs) remain scarce.

Methods:
The survey, consisting of 20 questions dedicated to HCPs, was developed by the International Lipid Expert Panel (ILEP). It was launched in March 2024 and promoted through websites, SoMe channels, and newsletters. Many questions allowed for multiple responses. The questionnaire is ongoing and available at the ILEP webpage.

Results:
We collected 264 responses within 3 months (64.4% males; 50.8% between 40-59 yrs.), mostly from physicians (72.7%, of which 49.6% were cardiologists, and 16.3% internal medicine specialists), but also researchers (6.8%) and academics (6.4%). HCPs from 50 countries participated in the survey. The highest response rates were from Poland: 26.9%, USA: 17.4%, Greece and Romania (4.5% for both). Only 43.4% of responders routinely measure hsCRP for CVD risk stratification, and only 20% had possibilities to measure both CRP, hsCRP, and IL-6. 28% knew the difference between CRP and hsCRP tests, and only 54.9% knew the approved hsCRP ranges to stratify CVD risk. 47.7% of the respondents recognized CRP as a causal risk factor of CVD, with only every 5
th
recognizing IL-6 (
Fig.1
). 71.2% of HCPs accepted statins, colchicine, and bempedoic acid as available therapies that might effectively reduce hsCRP elevated levels (
Fig.1&2
); 11% suggested that one should only reduce general CVD risk. Besides having rather general knowledge of the anti-inflammatory role of statins or colchicine, there are still 23.1% and 39.8% of responders that recognized anti-inflammatory properties of ezetimibe and PCSK9 modulators, respectively (
Fig.2
). A lot of inconsistency exists on the knowledge of the potential anti-inflammatory role of natural products, with the highest number of responses indicating curcumin and omega-3 acids (61.4% for both) (
Fig.1
). In the case of elevated hsCRP, 74.2% of HCPs recommended intensification of lifestyle changes and background CVD therapies, while 9.8% suggested using nutraceuticals, and 6.8% were prone to just monitoring the patients (
Fig.2
).

Conclusions:
There is a significant gap in knowledge regarding the diagnosis, biomarkers, and management of inflammation in CVD risk stratification. Enhanced education for medical students, physicians, and patients is crucial before targeted therapies become widely available.
Abstract 4142002: Peak Frequency Analysis Distinguishes Nearfield from Farfield Signals During Atrial Fibrillation Ablation
Authors: Ting Peter , Barbhaiya Chirag , Jankelson Lior , Holmes Douglas , Kushnir Alexander , Knotts Robert , Yang Felix , Bernstein Scott , Park David , Chinitz Larry , Aizer Anthony
Published: November 2024

Background:
The failure to distinguish nearfield and farfield signals is a common reason for ablation failure. Peak frequency (PF) analysis of electrograms is hypothesized to distinguish nearfield from farfield cardiac signals, although in vivo proof is lacking.

Hypothesis:
Using electrically isolated pulmonary vein (PV) tissue for analysis, PF will distinguish nearfield from farfield electrograms during atrial fibrillation (AF) ablation, identifying successful PV isolation and validating PF as a predictor of catheter proximity to electrical signals (nearfield versus farfield).

Methods:
We created a cohort of twenty patients with paroxysmal AF undergoing wide area circumferential PV isolation between July 2023 and January 2024. Left atrial and PV maps of PF (EnSite OT Near Field, Abbott, Inc) were generated before (Figure A) and after (Figure B) each PV isolation attempt and if dissociated potentials were present. The highest PF in each PV was selected in each PF map. PV electrograms were defined as farfield or nearfield based on the presence or absence of exit and entrance block. PV electrograms of dissociated potentials were considered nearfield. In the first 10 patients, a cutoff value was selected to predict nearfield versus farfield signals. The performance of this cutoff was assessed in the remaining 10 patients. If the PF remained elevated after PV isolation, pacing maneuvers were used to identify the source of the signal.

Results:
PF was lower in isolated PVs compared to connected PVs or dissociated potentials within PVs (Figure C). In the derivation cohort, a PF of 300 Hz had 93.2% (95% CI 81.3% - 98.6%) sensitivity and 100% (95% CI 95.0% - 100.0%) specificity for identifying the signal as farfield. In the validation cohort, this cutoff was associated with 90.0% (95% CI 76.3% to 97.2%) sensitivity and 100.0% (95% CI 93.6% to 100.0%) specificity. All farfield signals with a PF over 300 Hz were SVC signals detected in the right superior PV.

Conclusions:
PF distinguishes nearfield PV from farfield left atrial signals during AF ablation. PF analysis improves the recognition of PV isolation. Future studies modifying mapping and ablation strategies by utilizing PF as a tool to define nearfield versus farfield should be pursued to improve ablation outcomes.
Abstract 4142004: Predicting Cardiovascular Disease Events Using Uncalibrated Non-invasive Carotid Pressure Wave Components from Spectral Regression Learning
Authors: Aghilinejad Arian , Tamborini Alessio , Gharib Morteza
Published: November 2024

Introduction:
Pressure wave separation is a powerful tool for investigating wave phenomena in the cardiovascular system. However, its clinical application has been limited by the need for concurrent measurements of pressure and flow waveforms. Moreover, its predictive value for cardiovascular disease (CVD) remains unclear.

Aim:
This study aims to assess the performance of pressure wave components for CVD event prediction using single uncalibrated, non-invasive carotid pressure waveforms.

Methods:
The sample for this study is drawn from the Framingham Heart Study and includes tonometry recordings of carotid pressure waveforms for participants free of CVD at baseline (N=5110; mean age 47 years, 55% women). A recent machine Learning methodology for pressure-only wave separation, called spectral regression learning method (
Eur. Heart J. Open
, 2024: oeae040) is applied to decompose the pressure waveform into forward and backward wave components. The pressure wave index, defined as the ratio of the peak backward wave to the sum of the peak forward and backward wave amplitudes, is computed in a testing population (N=1567) blinded to all stages of the regression learning development. Cox proportional hazards regression models and Kaplan-Meier analysis are used in this testing population to relate the pressure wave index to the first incident CVD event (166 cases) over a median follow-up of 9.6 years.

Results:
The method-derived pressure wave index from uncalibrated carotid pressure waveforms is associated with incident CVD, adjusted for age and sex (model 1; hazard ratio, 0.66 [95% CI, 0.57–0.76] per SD; p<0.005), or adjusted for age, sex, brachial mean blood pressure, total cholesterol, high-density lipoprotein cholesterol, diabetes, and smoking (model 2; hazard ratio, 0.70 [95% CI, 0.59–0.83] per SD; p<0.005). A lower pressure wave index is associated with an increased risk of CVD events (cumulative event trajectories from Kaplan-Meier analysis are shown in Fig. 1).

Conclusion:
Our results demonstrate that the proposed uncalibrated carotid pressure wave index, which can be acquired using affordable non-invasive devices like wearable electronics, is an indicator of vascular health and cardiovascular disease risk.
Abstract 4142010: The Evolving Risk of Infective Endocarditis after Transcatheter Aortic Valve Replacement
Authors: Alabbadi Sundos , Rodes-Cabau Josep , Gelijns Annetine , Moskowitz Alan , Doenst Torsten , Chikwe Jo , Toyoda Nana , Itagaki Shinobu , Krane Prof. Dr. med. Markus , Makkar Raj , Bagiella Emilia , Akowuah Enoch , Deshpande Ranjit , Bleiziffer Sabine , Bandettini Wiphada , Akhter Shahab , OGara Patrick , Iribarne Alexander , Egorova Natalia
Published: November 2024

Introduction
Prosthetic valve endocarditis is a rare complication of aortic valve intervention, associated with high mortality and morbidity. There has been widespread growth in transcatheter aortic valve replacement (TAVR) use over the past decade including expansion to lower-risk and younger patients. Data on trends in incidence and outcomes of infective endocarditis (IE) after TAVR are sparse.

Research Question
With TAVR expansion, have there been any changes in the incidence of IE and 30-day surgical intervention and mortality, 2013-2022?

Methods:
Using Medicare data, we analyzed 280,073 TAVR patients. Joinpoint regression was used to evaluate IE incidence, reported as annual percent change (APC). Adjusted Cox models were used to evaluate associations between IE incidence and procedure year, patient characteristics, and 30-day outcomes.

Results:
IE incidence after TAVR decreased from 13.9/1000 person-years in 2013 to 10.6/1000 p-y in 2017 (APC=-7.7% [CI -12.2- -4.5%],p=0.01) and then was unchanged through 2022 (APC=0.9% [-0.3- 3.1%],p=0.23). Figure 1 depicts risk factors associated with post-TAVR IE. The reduction in non-elective procedures was associated with declining IE rates (p<0.001). After developing IE post TAVR, the 30-day risk-adjusted surgical intervention rate was 3.6% [3.1-4.1%].

In more recent years, patients were more likely to undergo such intervention within 30 days of IE diagnosis (sub-distribution HR (sHR):1.20 [1.12-1.29],p<0.001). Older IE patients (sHR:0.61[0.55-0.67],p<0.001), those on dialysis (sHR:0.48 [0.27-0.86],p=0.01) and those with permanent pacemakers (sHR:0.56 [0.34-0.93],p=0.03) were less likely to undergo intervention. The 30-day mortality risk of patient experiencing IE was 17.6% [16.8-18.5%] and remained similar across years.

Conclusion:
In Medicare patients, the adjusted risk of IE after TAVR declined over time, which may relate to increasing experience with TAVR, procedural technique, and declining rates of non-elective interventions. Patients with IE were more likely to undergo surgical intervention over time, especially younger and lower surgical risk patients. Mortality rates remained high and did not change, emphasizing the need for more research on management practices.
Abstract 4142011: HFpEF risk assessment using H
2
FpEF score in community-dwelling young Hispanic adults
Authors: Kim Andrew , XMusfeeX XFadiX , Patnaik Soumya , Lee Miryoung , Molina Emma , McPherson David , McCormick Joseph B , Fisher-hoch Susan , Laing Susan
Published: November 2024

Heart failure with preserved ejection fraction (HFpEF) prevalence has increased with the global increase in cardiometabolic risk factors and yet, diagnosis remains underrecognized in the community with concomitant undertreatment. H
2
FpEF scoring is a validated tool for dyspnea evaluation but has potential to identify individuals with increased HFpEF risk in larger patient populations. Hispanics are known to have a high prevalence of cardiometabolic risk factors, specifically obesity, hypertension and diabetes, which predispose to HFpEF. As HFpEF is often considered a disease of the elderly, this study aimed to determine HFpEF risk and define demographic and clinical covariates associated with this risk, in community-dwelling young Hispanic adults.

Methods:
Demographic, cardiometabolic biomarkers and echocardiographic data were obtained in 1285 participants (66% females, mean age 53±15 years) without any cardiovascular disease history from a sample of the Cameron County Hispanic Cohort. Those with left ventricular systolic dysfunction (n=30) were excluded. H
2
FpEF scoring was performed, and the sample was divided into low risk (0-2 points) or intermediate-high risk (3-7 points). Analysis focused on those ≤60 years of age and multivariate logistic regression analyses were conducted.

Results:
Intermediate-high risk H
2
FpEF score was seen in 43% (n=555) of the sample. Among those ≤60 years of age (n=852, mean age 45±12 years), one third (33%) were at intermediate-high risk for HFpEF based on the H
2
FpEF scoring tool. Those classified with increased HFpEF risk were slightly older (mean difference of 5 years), had larger waist circumference, had higher fasting blood glucose and more insulin resistance, and were more likely to have dyslipidemia, diabetes and the metabolic syndrome. After adjusting for covariates, among young Hispanics, age [OR=1.06 (1.01-1.11)] and the metabolic syndrome [OR=2.57 (1.06-6.36)] remained significantly associated with odds of having increased H
2
FpEF score.

Discussion:
We showed that a large proportion of community-dwelling Hispanics in our cohort have increased HFpEF risk, which is consistent with the demonstrated underdiagnosis of HFpEF in other ethnic groups. In young Hispanics, metabolic syndrome is significantly associated with a higher H
2
FpEF score regardless of BMI. Defining elevated HFpEF risk in young adults may be relevant for prevention and early intervention, specifically targeting cardiometabolic risk control in young Hispanics.
Abstract 4142012: Ectasias of Multiple Coronary Arteries and a Coronary Cameral Fistula Between Right Coronary Artery and Coronary Sinus
Authors: Sung Shijun , Gray Hannah
Published: November 2024

Case Description:
A 59-year-old male with history of hypertension, diabetes, Hashimoto’s thyroiditis presented with new, progressive shortness of breath. No murmur or extra heart sound were heard, and the lung sounds were normal. Exam was notable for significant lower extremity edema.

Echocardiography showed reduced LVEF of 30%, and cardiac catheterization found hemodynamically significant shunt with Qp:Qs of 1.47:1. Coronary angiography revealed a tortuous and extremely aneurysmal RCA, as well as multivessel coronary artery disease (mvCAD) involving LAD, D1, LCx, OM1. Notably, the LAD had multiple aneurysmal segments and areas of eccentric stenosis upto 90%.

Multislice CT angiography further characterized the RCA, which extends to the coronary sinus (CS) distally forming a coronary cameral fistula (CCF). Cardiac MRI did not show significant ischemic findings.

The patient received medical therapy consisting of antiplatelet agents, high dose statin, beta blocker and ACE inhibitor, as well as diuretics. Patient underwent surgical closure of fistula and a 2-vessel coronary artery bypass graft surgery, with a LIMA pedicle graft to the LAD, and SV graft to the LCx.

Postoperatively, patient was continued on medical therapy with improvement of symptoms. At the time of discharge, LV systolic function improved to 39% and there were no findings concerning for coronary artery thrombosis or fistula repair failure. Patient was planned to gradually start cardiac rehab.

Discussion:
CCF is a rare anomalous connection between coronary arteries and a cardiac chamber or other major blood vessels of the heart. CCF can be congenital or acquired and has many variations. It is often clinically silent. However some patients can develop heart failure, angina, and arrhythmia due to significant intracardiac shunt or coronary steal phenomenon. In this case presentation, it is likely that his heart failure was caused by the significant left to right shunt due to the fistula. He had concomitant ischemic cardiomyopathy in the setting of severe mvCAD, however the notable ectasia of LAD suggests there is a underlying disease that also affected RCA, leading to formation of the CCF.

In addition to diagnostic coronary angiogram, advances in noninvasive cardiac imaging allow further identification and characterization of these fistulae. Surgical approach was appropriate in this patient given the findings complex mvCAD and the CCF with significant hemodynamic shunt.
Abstract 4142032: Hospital Discharge Education For Heart Failure Patients Delivered by Conversational Agent Technology Improves Patient Experience and Is Preferred to a Doctor or Nurse
Authors: Mohammadi Abbas , Barney Jamie , Jahan Sultana , Rathi Deepu , Chengat Vipindas , Hodder Henry , jack brian , Spaccavento Leo , Akhondi Hossein
Published: November 2024

Introduction:
. The hospital discharge process is non-standardized and contributes to post-discharge adverse events, re-hospitalization and high cost. To address this, we developed the Re-Engineered Discharge (RED) program designed to provide high quality discharge education, shown to lower readmission rates and improve patient satisfaction. Integrating digital technologies could facilitate its implementation into hospital workflow.

Methods:
We designed “MayaRED”, a digital conversational agent that simulates face-to-face human interactions through personalized, conversational dialogue to deliver discharge education. MayaRED employs the “teach-back” method to document patient understanding. Upon completion, a report documents what was taught by MayaRED and understood by the patient. Participants were asked to complete a survey regarding their perceptions of the acceptability and usefulness of MayaRED. Participants were matched to controls subjects to evaluate the comparative effectiveness.

Results:
HF patients (N=18) using MayaRED averaged 69 years, 13,003 pg/ml pro-BNP, 42% ejection fraction and 3 mg/dl creatinine were compared to 17 matched controls. On a 1 to 7 point Likert scale (1=strongly disagree; 7=strongly agree), patients using MayaRED reported that they had “their questions answered” (mean 6.47 vs. 4.76; P<.0001), “understood their follow-up appointments” (6.73 vs. 5.59; P<.0001), “understood their medicines” (6.87 vs 4.59; P<.0001), and understood “how to care for themselves at home” (6.07 vs 4.65; P<.0001) (Figure 1). Intervention patients reported that they trust MayaRED (6.80), “are likely to follow Maya’s advice” (6.66), and are “confident in Maya’s ability to help me” (6.66). When asked “If you were hospitalized again at SVH, would you like to interact with Maya again?,” all patients responded “yes”. When asked “would you rather have the nurse/doctor or Maya give you your information about your discharge, all 18 responded MayaRED (Figure 2). Preliminary data show the 30 day all-cause readmission rate for those receiving MayaRED was 16.6% vs 29% for controls.

Conclusion:
The MayaRED conversational agent system is well-accepted by HF patients, demonstrating its feasibility as a tool for delivering discharge education. These findings support the continued implementation and rigorous testing of MayaRED in diverse clinical settings.
Abstract 4142037: Age Differences in Patients with Ischemia and Nonobstructive Coronary Arteries
Authors: Kostantinis Spyridon , Garcia Castro Gabriel , Latif Nida , Cigarroa Natasha , Kunnirickal Steffne , Odanovic Natalija , Shah Samit
Published: November 2024

Introduction:
Ischemia and nonobstructive coronary arteries (INOCA) is increasingly recognized and encompasses vasomotor disorders such as coronary microvascular dysfunction (CMD) and vasospastic angina (VA). The prevalence of atherosclerotic coronary artery disease increases with age, but the age at the time of diagnosis in patients with INOCA is not well described.

Methods:
From 2017 to 2024, 221 patients with INOCA underwent invasive coronary physiologic assessment including vasoreactivity testing with acetylcholine provocation, guidewire-based assessment of coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and fractional flow reserve (FFR). Age cut-off of 60 years was selected to create two groups of adequate size.

Results:
Mean age was 57.7 ± 10.8 years and 158 (71.5%) were females. Older INOCA patients (>60 years old) had higher rates of hypertension and obstructive sleep apnea, but similar rates of hyperlipidemia, diabetes, depression, anxiety, and active smoking compared to younger patients (<60 years old). There were significant differences in medical therapy at baseline with older patients being more likely to receive statin (69.7% vs 54.9%, p=0.024), ACEi/ARB (35.4% vs. 22.1%, p=0.029), or β-blockers (50.5% vs. 35.3%, p=0.022). Increasing age was associated with progressive decrease in CFR (rho=-0.21; R
2
= 0.04; p<0.001), and a progressive increase in IMR (rho=0.35; R
2
= 0.12; p=0.002) (Figure 1). Older INOCA patients had higher rates of CMD (38.4% vs. 21.3%; p=0.005), and myocardial bridging was more frequent in younger patients (14.8% vs. 5.1%; p=0.015) (Figure 2).

Conclusion:
In our study sample, increasing age was associated with a reduction in CFR and increase in IMR. Older INOCA patients were more likely to have CMD and less likely to have myocardial bridging compared to younger patients.
Abstract 4142070: Single Ventricle Palliation Pathways: Patient Characteristics and Outcomes
Authors: Kuntz Michael , Staffa Steven , Valencia Eleonore , Nasr Viviane
Published: November 2024

Introduction:
The choice between conventional surgical (SP) and hybrid (HP) stage 1 palliation for single ventricle heart disease remains debated. Pulmonary artery banding and prostaglandins followed by delayed surgical stage 1 (DSP) remains another option. HP is proposed for high-risk patients. We aimed to describe index hospitalization outcomes for patients undergoing these 3 pathways. We hypothesized that patients undergoing HP and DSP have more comorbid conditions, higher morbidity, and longer length of stay (LOS).

Methods:
Using the Pediatric Health Information System data, January 2016 – August 2023, we analyzed the characteristics and index hospitalization outcomes for patients with single ventricle disease undergoing SP, HP, and DSP.

Results:
Our final cohort included 1,872 patients (1,573 SP; 176 HP; 123 DSP). Prematurity was most common (45.5%) in the DSP compared to the HP (27.8%) and SP (9.5%) groups (P<0.001); the rate of small for gestational age birth (SGA, <2.5 kg) was similarly distributed. Non-cardiac comorbidities were most prevalent in DSP (neurologic, gastrointestinal, need home technology) and HP (respiratory). LOS (days) was highest for DSP (median 130, IQR:69–195) compared to HP (median 61, IQR:37–139) and SP (median 45, IQR:29–80)(P<0.001). Disposition varied (P<0.001), with in-hospital mortality highest among HP (25.6%) compared to DSP (13.8%) and SP (11.3%); the rate of index hospitalization heart transplant was 8.5% for HP, DSP 0.8%, and SP 0.9%.

Among patients born prematurely or SGA, LOS was longest for DSP (median 143, IQR:88–216) followed by HP (median 72, IQR:52–139) and SP (median 59, IQR:36–124)(P<0.001). Disposition also varied (P=0.004), with higher in-hospital mortality among HP (35.9%) compared to DSP (16.9%) and SP (19.9%); transplant was highest among HP (4.7%) compared to DSP (0%) and SP (0.8%).

Adjusted total costs per hospital day did not vary significantly.

Conclusions:
Patients undergoing DSP and HP are more often premature or SGA. Patients undergoing HP are most likely to have index hospitalization mortality or transplant. While recognizing the limitations of administrative databases, our data does describe the current utilization trend and outcomes for SP, HP, and DSP.
Abstract 4142075: From GPT-4 to GPT-4o: Progress and Challenges in ECG Interpretation
Authors: Pandya Vidish , Ge Alan , Ramineni Shreya , Danilov Alexandrina , Kirdar Faisal , Di biase Luigi , Ferrick Kevin , krumerman andrew
Published: November 2024

Background:
With the increasing popularity of large language models (LLM), the use of artificial intelligence (AI) for medical diagnostics has garnered significant attention. One area of particular interest is the application of LLMs in the interpretation of electrocardiograms (ECGs). Traditional ECG machines, such as those by General Electric (GE), use established algorithms for analysis. This study explores the potential of AI, specifically OpenAI’s GPT-4 and its latest iteration, GPT-4o, as an aide in interpreting ECGs.

Objective:
To evaluate the improved capability of GPT-4o in interpreting ECGs, comparing its performance against GE’s algorithm and previous iteration GPT-4, with a focus on identifying both improvements and remaining limitations.

Methods:
A total of 25 randomly selected ECGs representing both normal and abnormal findings were analyzed using GPT-4o. We prompted GPT-4o to comment on clinically relevant ECG findings, including rate, rhythm, QRS axis, intervals, chamber enlargement, and signs of ischemia. We compared the interpretations of GPT-4o against the GE machine and an older version of ChatGPT, examining diagnostic accuracy, consistency, and reliability.

Results:
GPT-4o showed marked improvements in detecting critical diagnoses compared to older versions. It successfully identified 4 STEMIs and all ventricular tachycardias (VT) missed by its predecessor. However, GPT-4o continued to struggle with atrial arrhythmias, missing 2 cases of atrial fibrillation, 1 atrial flutter, and 1 supraventricular tachycardia. Interestingly, GPT-4o exhibited a higher tendency to classify nonspecific ST segment and T wave changes as ischemia. Notable limitations included the quality of ECGs, with some having poor baselines, and the resolution of uploaded images.

Conclusion:
The rapid improvement in ECG interpretation, especially in detecting critical diagnoses previously missed, is very promising for AI and ChatCPT. GPT-4o shows significant advancements over its predecessor, particularly in identifying STEMIs and VTs. However, it still struggles with atrial arrhythmias and tends to overdiagnose ischemic changes, indicating the need for further refinement. While AI advancements are promising, more development is necessary before such technologies can be safely integrated into routine ECG interpretation. Future research should focus on enhancing AI's ability to detect a broader range of arrhythmias and improving efficiency in cardiology diagnostics.
Abstract 4142085: Exercise Pulmonary Vascular Mechanics and cardiac MRI prospective study to define Low vs. High-risk HFpEF phenotypes with Right Ventricular Failure in HFpEF
Authors: Raza Farhan , Lechuga Christopher , Garcia-Arango Mariana , Chen Yimin , Sahai Aditya , Tu Wanxin , Park Yeonhee , Chesler Naomi
Published: November 2024

Background:
Highly precise definition of high-risk features associated with HFpEF may guide targeted treatments and inform biological studies. The aim of this two-step study is to 1) define a high risk HFpEF cluster with unsupervised machine learning approach using cardiac magnetic resonance (CMR), 2) define novel pulmonary vascular mechanics at rest and with exercise in low- vs. high-risk phenotypes. Vascular mechanics defines vessel- and cardiac cycle-specific flow dynamics in pulmonary circulation.

Methods:
48 HFpEF participants underwent CMR and invasive cardiopulmonary exercise testing. With unsupervised K-means clustering analyses using CMR data, two specific clusters were identified with different survival outcomes at 12-months (mortality and heart failure hospitalizations): HR=5.4 (CI:1.7-17.4), log-rank p<0.01. Within this cohort (n=48), additional flow data (right ventricular outflow tract pulse wave doppler) was acquired in 13 participants at rest and 25 watts exercise, to obtain simultaneous pressure (pulmonary artery)-flow data for vascular mechanics analyses in time domain.

Results:
Features of low- (n=32) and high-risk (n=16) clusters are summarized in Table. High-risk cluster displayed decreased right ventricular ejection fraction and worse biventricular longitudinal strain. Among wave mechanics, characteristic impedance (proximal pulmonary artery stiffness) and backward decompression wave (pulmonary vascular reflections in diastole) were elevated in high-risk HFpEF phenotype.

Conclusions:
We report a high-risk HFpEF phenotype with reduced RV ejection fraction and biventricular strain, indicating myocardial limitations. Vascular mechanics revealed proximal pulmonary artery stiffness and increased wave reflections in diastole as key features in high-risk HFpEF, indicating pulmonary vascular limitations. These multimodal methods reveal that mechanism of RV failure in HFpEF likely involves both pulmonary vascular and intrinsic myocardial abnormalities.
Abstract 4142086: Efficacy And Safety Of Inhaled Nitric Oxide In Pediatric Cardiac Surgery: A Systematic Review And Meta-Analysis
Authors: Ramadan Abdelraouf , Elrosasy Amr , Ali Ahmed , Mahmoud Nour-Aldeen , Eid Hassan , Kamel Menna , Abd al-azim Hadeer , Chamay Salomon , Ghimire Manoj , Nassar Sameh
Published: November 2024

Background:
Congenital heart diseases affect one in every 100 live births. Surgical intervention is necessary for almost half of these cases, with a significant proportion requiring surgery within the first year after birth. This meta-analysis aims to evaluate the efficacy and safety of inhaled nitric oxide (iNO), selective pulmonary vasodilator, particularly its impact on perioperative clinical outcomes such as low cardiac output syndrome (LCOS), duration of mechanical ventilation, blood and fresh frozen plasma (FFP) transfusion, ICU stay, and hospital stay.

Methods:
We conducted a comprehensive search of PubMed, Scopus, WOS, and Cochrane databases for relevant studies from inception to April 1, 2024. We included randomized controlled trials (RCTs) comparing iNO with placebo or standard care in pediatric patients undergoing cardiopulmonary bypass. Data extraction and quality assessment were performed according to PRISMA guidelines and Cochrane's risk of bias tool. Mean differences (MD) and their 95% confidence intervals (CI) were calculated using OpenMeta [Analyst].

Results:
We included six RCTs in our meta-analysis. Our analysis showed that iNO significantly reduced the duration of mechanical ventilation (MD = -5.733, 95% CI [-10.494; -0.972]). However, no significant differences were observed between the iNO group and the control group for hospital stay, ICU stay, or incidence of LCOS. Safety outcomes showed no significant differences in blood or platelet transfusion rates, though iNO was associated with statistically significant lower FFP transfusion (MD = -5.199, 95% CI [-8.032; -2.366]).

Conclusion:
our review and meta-analysis highlights the potential benefits of iNO in reducing ventilation time and FFP transfusion in pediatric patients undergoing cardiac surger, while also emphasizing the need for further research to conclusively determine its impact on other clinical outcomes and safety parameters.