bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4125533: Demographic Trends and Disparities in Mortality Related to Coexisting Heart Failure and Diabetes Mellitus Among Older Adults in the United States: A Large Database Analysis from 1999 to 2020
Authors: Goyal Aman , Saeed Humza , . Abdullah , Naeem Irum , Zafar Amna , Ahmad Bilal , Islam Taimur , Rizvi Syed Saaid , Kumari Nikita , Kirmani Syed Ghazi Ali , Mansoor Fatima , Hassan Amir , Raja Adarsh , Bansal Kamna
Published: November 2024

Background:
In the United States, over 38 million people have diabetes mellitus (DM) and more than 6 million have heart failure (HF). DM and HF often coexist, and each condition independently increases the likelihood of developing the other. Approximately 40% of individuals with HF also have DM, and this prevalence is even higher among older adults and hospitalized patients. While there has been concern regarding the increasing burden of disease for both conditions individually over the last decade, a comprehensive examination of mortality trends associated with their coexistence has not been thoroughly explored.

Methods:
This study analyzed death certificates from the CDC WONDER database, specifically focusing on mortality caused by the simultaneous presence of HF and DM among individuals aged 75 years and older. The data covers the period from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, and race/ethnicity.

Results:
Between 1999 and 2020, a total of 663,016 deaths were reported in patients with coexisting HF and DM. Overall, AAMR increased from 154.1 to 186.1 per 100,000 population between 1999 and 2020, with an initial increase from 1999 to 2005 (APC: 0.80; 95% CI: -0.17 to 2.94), a significant decline from 2005 to 2011 (APC: -2.82; 95% confidence interval (CI): -5.47 to – 1.71), a subsequent increase from 2011 to 2018 (APC: 0.61; 95% CI: -0.59 to 2.18), and finally a steep increase from 2018 to 2020 (APC: 11.30; 95% CI: 6.98 to 14.11). Gender-based analysis revealed that older men had consistently higher AAMRs than older women (Men: 185; 95% CI: 184.3 to 185.6; vs Women: 135.4; 95% CI: 135 to 135.8). Furthermore, we found that AAMRs were the highest among non-Hispanic American Indian or Alaska natives (214.4; 95% CI: 207.5 to 221.4) followed by non-Hispanic African Americans (179.9; 95% CI: 178.5 to 181.4), Hispanics (159.5; 95% CI: 158 to 161.1), non-Hispanic White (152.9; 95% CI: 152.5 to 153.3), and non-Hispanic Asian or Pacific Islander populations (104.1; 95% CI 102.4 to 105.8) (Figure 1).

Conclusion:
The mortality rate due to coexisting HF and DM has increased in the elderly population over the past decade. Males and non-Hispanic American Indians or Alaskan Natives had the highest AAMRs in our study.
Abstract 4125606: Systolic Blood Pressure During Sleep Determined by Pulse Transit Time Predicts Worsening Heart Failure in Patients with Heart Failure
Authors: Ohashi Naoto , Yoshihisa Akiomi , Sato Yu , Takeishi Ryohei , Sekine Toranosuke , Nishiura Kazuto , Ogawara Ryo , Ichimura Shohei , Kimishima Yusuke , Yokokawa Tetsuro , Miura Shunsuke , Misaka Tomofumi , Sato Takamasa , Oikawa Masayoshi , Kobayashi Atsushi , Yamaki Takayoshi , Nakazato Kazuhiko , Takeishi Yasuchika
Published: November 2024

Introduction:
Intensive blood pressure (BP) lowering therapy is associated with lower rates of major adverse cardiac and cerebrovascular events in the general population. On the other hand, lower daytime systolic BP (SBP) is associated with higher mortality in patients with heart failure (HF). However, prognostic impact of SBP during sleep was unclear in patients with HF.

Methods and Results:
We measured continuous SBP during sleep non-invasively by pulse transit time in 379 patients with HF (median age 71, male 53.6%). Beat-to-beat SBP was calculated based on pulse transit time, which was defined as the travel time from the R-wave of electrocardiogram to the pulse wave at the finger detected by plethysmography. Mean values of SBP during sleep were used in the present study. The primary endpoint was hospitalization for worsening HF. The patients were divided into three groups based on the tertiles of SBP during sleep: High SBP group (median SBP 138 mmHg, n = 127), Middle SBP group (median SBP 117 mmHg, n = 127), and Low SBP group (median SBP 100 mmHg, n = 125). The Low SBP group showed the youngest age (High, Middle, and Low groups; 73, 73, 68 years, P < 0.001). Levels of B-type natriuretic peptide (207.7, 216.7, and 407.2 pg/mL, P = 0.039) and estimated glomerular filtration rate (52.6, 54.0, and 57.1 mL/min/1.73 m
2
, P = 0.041) were the highest in the Low SBP group. During the follow-up period of median 1,083 days after SBP measurement, 66 patients experienced hospitalization for worsening HF. Kaplan-Meier analysis revealed that primary endpoint occurred most frequently in the Low SBP group (
Figure
). Multivariable Cox proportional hazard analysis showed that the lowest SBP tertile was associated with the primary endpoint compared to the highest SBP tertile (hazard ratio 2.546, 95% confidence interval 1.257–5.158, P = 0.009).

Conclusion:
Low SBP during sleep was associated with hospitalization for HF in patients with HF.
Abstract 4125940: Hypertensive Disorders During Pregnancy: Patient Perspectives on Care, Barriers, and a Path Forward
Authors: Rasmusson Kismet , Poll Justin , May Heidi , Anderson Angela , Hesterberg Kirstin , Graham Kaley , Petersen Sheralee , jiricko audrey , Campbell Amy , Dizon-Townson Donna
Published: November 2024

Background:
The future risk of cardiovascular disease (CVD) after a diagnosis of hypertensive disorders of pregnancy (HDP) is well established. Blood pressure (BP) assessment and management after delivery is one essential part of downstream risk mitigation of future CVD. This requires intentional follow-up by clinicians and understanding by patients. We sought the perspectives of patients regarding solutions to barriers for health care interventions and self-care support after a HDP diagnosis.

Methods:
Phone interviews were conducted three to six months following a delivery from a random sample of women diagnosed with HDP, determined by ICD-10 codes. Interview questions were designed by a multidisciplinary team that included those who specialize in women’s CVD health and pregnancy. Interviews were conducted by a senior qualitative researcher. Questions aimed to discover health care and self-care steps taken following HDP diagnosis, reasons why these were not started or used consistently, education recalled, and areas for improvement.

Results:
A total of 20 women were interviewed from ages 21-42 (20-29, n=10; 30-39, n=8; and 40-42, n= 2) among 9 different hospitals (1 quaternary, 3 tertiary care hospitals, and 5 small-medium-rural community hospitals). Of the respondents, 50% were diagnosed during their third trimester, 25% in their second trimester, 20% in their first trimester, and 5% within a week after delivery. A total of 8 (40%) of the women were induced early given HDP concerns. Table 1 describes health care and self-care steps taken for HDP during and after pregnancy. If health care and/or self-care for HDP did not start or did not continue beyond the fourth trimester (>12-weeks post-delivery), reasons included BP stabilized or returned to normal, the clinician ‘wasn’t concerned’, and/or they didn’t have a history of a hypertension diagnosis. Table 2 lists suggested areas from those interviewed for improving support to women with HDP.

Conclusion:
This study suggests a high prevalence of unclear education with low patient recall and incomplete follow-up after delivery among women with HDP, with health care support and self-care diminishing after the fourth trimester. Understanding the perspectives of women with HDP and its associated risk factors can help in developing effective clinician and patient education and clinical pathways to reduce barriers for long-term care and CVD risk mitigation.
Abstract 4126158: Persistence to once weekly GLP-1 RAs is associated with lower risk of MI, stroke, and 2-point MACE among patients with T2D and ASCVD in the real world.
Authors: Dunn Tyler , Zhu Yong , Gronroos Noelle , Xie Lin , Noone Josh , Sargent Andrew , Gamble Cory , Billings Liana
Published: November 2024

Introduction:
Studies have shown the reduction of CV events in patients with T2D treated with GLP-1 RAs. However, little is known about how persistent use of GLP-1 RA therapy affects CV outcomes in patients with T2D and ASCVD. The objective of this study was to estimate the association between persistent use of once weekly (OW) GLP-1 RAs and 2-point MACE and its components (MI, stroke) in patients with T2D and ASCVD in a real-world setting.

Methods:
Adult patients with T2D and ASCVD with ≥1 pharmacy claim for OW GLP-1 RAs during Jan 2018-Nov 2022 were identified in the Optum Research Database. The date of the first OW GLP-1 RA claim was defined as the index date. Patients were followed until a CV event occurred or censored. Discontinuation was defined as a ≥60-day gap in supply of OW GLP-1 RAs. All patients were required to be persistent for ≥3 months of follow-up to allow titration of the therapy. CV events of interest include 2-point MACE, MI and stroke. Kaplan-Meier analyses were used to examine risk of CV events by persistent status within 6, 12, or 18 months of follow-up. Cox proportional hazards models with time-varying exposures were used to assess associations between persistent status and MACE, with persistent status of patients updated for each day of follow-up, adjusting for demographic and baseline clinical characteristics.

Results:
Among a total of 29516 patients, the median follow up duration was 412 days, median persistence was 254 days, and 63.9% of patients (n=18849) were persistent throughout their variable follow up period. Kaplan-Meier analyses indicated risk of 2-point MACE, MI, and stroke was significantly lower in patients who were persistent within 6, 12 or 18 months of follow-up compared to patients who discontinued within 6, 12 or 18 months of follow-up (all p<0.05); longer persistence led to a qualitatively greater risk reduction. Adjusted hazard ratio (95% confidence interval) from Cox regression with time-varying persistence status during the full variable follow up in all patients for risk of 2-point MACE, MI, and stroke associated with persistent use of OW GLP-1 RAs was 0.70 (0.63-0.77), 0.71 (0.62-0.81), and 0.67 (0.57-0.78), respectively.

Conclusions:
Patients with T2D and ASCVD who were persistent with OW GLP-1 RAs had a lower risk of 2-point MACE, MI, and stroke than those who discontinued the therapy in real-world clinical practice. Longer persistence of OW GLP-1 RAs appeared to provide greater CV benefits.
Abstract 4126628: Worse Cardiac Structure and Function is Associated with Decline in Multiple Domains of Cognitive Function: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Dehghan Arshama , Bartholdy Katja , Giugni Fernando , Claggett Brian , Hajjar Ihab , Mosley Thomas , Palta Priya , Shah Amil
Published: November 2024

Background:
Cognitive impairment is cross-sectionally associated with worse cardiac structure/function. However, limited data exist regarding cardiac structure/function and longitudinal changes in cognitive function.

Objective:
Determine the association of cardiac structure and function with longitudinal changes in cognitive performance in late life.

Methods:
Among HF- and dementia-free participants in the community-based ARIC study who attended the 5th study visit (V5; 2011-2013), underwent protocol echocardiography, and completed a neurocognitive test battery at both V5 and study Visit 6 (V6; 2015-17), we assessed associations of cardiac structure and function measures with changes in both domain-specific and global cognitive scores between V5 and V6 using multivariable linear regression. Models were initially adjusted for demographics and education level, with additional models further adjusting for cardiovascular risk factors and disease at both V5 and V6. The neuropsychological test battery consisted of 10 neuropsychological tests that covered 3 domains of cognitive function: memory, executive functioning, and language. Factor scores were constructed for each cognitive domain, and their average represented a global composite score.

Results:
Among 2,988 included participants, mean age was 74±5 years, 60% were female, 20% reported Black race, and mean LVEF was 66±6%. Over a mean of 4.9±0.6 years (the V5 to V6 interval), raw scores declined for all neuropsychological tests. In fully adjusted models, worse diastolic function (larger LAVi) and LV remodeling (greater LV mass index) were associated with decline in executive function. Lower LVEF was associated with decline in language function, while worse LV longitudinal strain – a more sensitive measure of systolic dysfunction – was associated with decline in executive function, language function, and global cognition performance (all p<0.05; Table).

Conclusion:
Subclinical LV remodeling and dysfunction is associated with greater declines in cognitive function over 5 years in late life. Differential associations were observed by cognitive domains, with executive function decline most uniformly associated with impairments in cardiac structure/function.
Abstract 4127345: National Cohort Study on Hypertensive Disorders of Pregnancy Among Women with Congenital Heart Disease: Insights from Multiple Centers
Authors: Zhang Qian , Zhu Fang , Zhu Chunfeng , Ma Ruixiang , Miao Huixian , chen huiwen
Published: November 2024

Background:
Hypertensive disorders of pregnancy (HDP) are among the primary reasons for maternal and perinatal deaths globally. Encompassing chronic hypertension, pregnancy induced hypertension (PIH), and preeclampsia, HDP are among the most frequent complications encountered during pregnancy. Considering the emerging congenital heart disease (CHD) population globally, research on HDP in pregnancies with CHD is urgently needed.

Methods:
Outcomes for 2220 pregnant women with CHD were evaluated retrospectively from 1993 to 2016 and prospectively from 2017 to 2019 from 7 tertiary hospitals. Maternal death, cardiac complications, obstetric and offspring complications of completed pregnancies and their demographics, cardiac characteristics, and comorbidities were collected. To identify the risk factors for HDP, univariate and multivariate analysis were performed through logistic regression.

Results:
Of 2220 completed pregnancies with CHD from 7 tertiary institutions, 77 women had PIH, and 76 women had preeclampsia. The main CHD diagnosis of patients with PIH was shunt lesion (including ASD, VSD, and PDA), left heart abnormality (including AS/AI, BAV, and COA), and single ventricle (SV). The main CHD diagnosis of patients with preeclampsia was shunt lesion (including ASD, VSD, and PDA), left heart abnormality (including AS/AI and MS/MI), and right heart abnormality (including TOF, PS/PAS/PI, DORV and DCRV).

In parturients with PIH, the mortality and incidence of heart failure were 2.60% and 15.58%, respectively. In parturients with preeclampsia, the mortality and incidence of heart failure were 6.58% and 23.68%, respectively. Pregnancies with HDP had a significantly higher incidence of adverse maternal and offspring events than pregnancies without HDP.

Independent risk factors for HDP included multiple gestation, use of medically assisted reproduction, having elevated brain natriuretic peptide (BNP) level, delayed first ANC visit, and absence of strict antenatal supervision.

Conclusion:
In summary, the presence of HDP in women with CHD significantly increased the risk of mortality and morbidity for both the mother and the child, particularly in cases involving preeclampsia.
Abstract 4127891: Value of Left Ventricular and Left Atrial Strains in Loeffler Endocarditis and Hypereosinophilic Syndrome
Authors: Okushi Yuichiro , Reeder Matthew , LoPresti Vega Saberio , Grimm Richard , Griffin Brian , Xu Bo
Published: November 2024

Background:
Hypereosinophilic syndrome (HES) is a rare disease that causes organ damage and thrombosis due to sustained eosinophilia of the blood or tissues. Loeffler endocarditis (LE) is defined as cardiac involvement in the setting of HES. There are limited data on the diagnostic and prognostic impact of strain imaging on LE.

Methods:
A single-center retrospective cohort study was performed. Patients with eosinophilia between January 2000 and January 2023 were identified. We included patients who met the current diagnostic criteria for HES and underwent echocardiography prior to treatment. LE was defined as the presence of eosinophils in the myocardium by an endomyocardial biopsy, endocardial thickening, or left ventricular thrombus due to HES. We evaluated the composite events defined as CV death and stroke at diagnosis and during follow-up.

Results:
Of 1,664 patients with eosinophilia, 34 patients with HES were included (10 with LE and 24 without LE). In the entire cohort, the mean age was 57 ± 16 years and 41% were male. The median follow-up duration was 85 months (25th -75th percentile: 41-145 months). The composite events occurred in 6 patients. Left ventricular ejection fraction (LVEF) was similar in both groups (60% vs. 61%, p = 0.691). Patients with LE had significantly lower left ventricular global longitudinal strain (LV-GLS) (-9.7% vs. -15.5%, p = 0.001), left atrial (LA) reservoir strain (21.0% vs. 32.1%, p = 0.021) and LA conduit strain (-9.7% vs. -19.2%, p <0.001), compared to patients without LE. There were no significant differences in LA booster strain (-11.3% vs. -12.8%, p = 0.606) and right ventricular free wall strain (-17.5% vs. -23.4%, p = 0.083). All LE patients and half of non-LE patients had LV-GLS worse than -16 %. There was a significant difference in the compsoite events for patients with LV-GLS worse than -16% (28.6% vs. 0.0%, p = 0.049).

Conclusions:
LE was associated with significantly worse LV-GLS and left atrial strain compared to patients without LE. Worse LV-GLS was associated with a higher frequency of the composite events.
Abstract 4128189: CD44 Knockdown Attenuates the Abnormal Cellular Phenotype of BMPR2-Deficient Primary Human Pulmonary Artery Endothelial Cells
Authors: Siddique Md Abdul Hai , Chen Li-Yuan , Awad Keytam S. , Wang Shuibang , Danner Robert , Elinoff Jason
Published: November 2024

Background:
BMPR2
gene silencing in primary human pulmonary artery endothelial cells (PAECs) produces a proliferative, hypermigratory PAH-like cellular phenotype. Genome-wide expression profiling in
BMPR2
-silenced cells uncovered
CD44
, a cancer stem cell marker associated with tumor progression and metastasis, among the top upregulated transcripts. Therapeutic strategies that block CD44 or reduce its expression are currently in various stages of development for cancer. Thus, mechanistic studies investigating the contribution of CD44 to vascular remodeling in PAH may reveal new therapeutic targets.

Hypothesis:
Upregulation of CD44 contributes to the abnormal phenotype of BMPR2-deficient PAECs and thus may contribute to vascular remodeling in PAH.

Aims:
Determine the effect of
CD44
-silencing on gene expression and cell proliferation in BMPR2-deficient PAECs.

Methods:
Commercially available primary, human PAECs were transfected with scrambled control (siCTRL) or gene specific siRNA(s). PAH patient-derived (N=24) and failed donor-derived (N=11) PAECs were obtained from the PHBI. mRNA and protein expression were determined by quantitative RT-PCR and Western blotting, respectively. Cell proliferation was assessed by BrdU incorporation 96h after siRNA transfection. Data was analyzed using t-tests or ANOVA with post hoc pairwise comparisons.

Results:
Consistent with our previous findings, CD44 protein expression was increased 4-fold in
BMPR2
-silenced PAECs 48h following siRNA transfection (P<0.0001 vs siCTRL; N=10 unique donors). Genes involved in endothelial-mesenchymal transition and cell proliferation were also increased in
BMPR2
-silenced PAECs including
HMGA1
,
ID1
,
SNAI1,
and
SNAI2
(P<0.01 for all vs siCTRL; N=5 independent experiments) and co-silencing
CD44
attenuated their upregulation (P<0.05 for all vs siBMPR2 alone). Importantly, CD44 knockdown reduced PAEC proliferation in the absence (P=0.01 vs siCTRL) and presence of BMPR2 deficiency (P=0.002 vs siBMPR2 alone). Like
BMPR2
-silenced PAECs,
CD44
mRNA levels were higher in PAH patient-derived versus failed donor control PAECs (P=0.07).

Conclusions:
CD44 knockdown corrected aberrant gene expression associated with endothelial-mesenchymal transition and reduced cellular proliferation in BMPR2-deficient PAECs. Thus, endothelial CD44 upregulation may contribute to pathologic vascular remodeling in PAH and represents an unexplored therapeutic target.
Abstract 4128369: Inpatient Mortality After Catheter Ablation for Atrial Fibrillation Among Heart Failure Patients: A 6-Year Nationwide Analysis
Authors: Abood Zaid , Jan M. Fuad , Ashraf Muddasir , Allaqaband Suhail , Ghafoor Asad , Mortada M. Eyman , Bhatia Atul , Tajik A. Jamil , Jahangir Arshad
Published: November 2024

Background:
Significant advancements have been made in the safety of catheter ablation for atrial fibrillation (AF) over the past decade. However, large-scale data regarding inpatient mortality among heart failure (HF) patients (HF with reduced ejection fraction [HFrEF] and HF with preserved ejection fraction [HFpEF]) who undergo AF ablation are lacking.

Aim:
To compare mortality rates and trends between patients with HF (HF group) and without HF (non-HF group) following AF catheter ablation.

Methods:
The National Inpatient Sample was utilized from January 2015 to December 2020 to identify the study population using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. The primary outcome was in-hospital mortality for patients with and without HF undergoing ablation for AF, and the secondary outcome was mortality in patients with HFrEF compared with those with HFpEF.

Results:
We evaluated 142,860 patients hospitalized for AF who underwent catheter ablation. Of these, 42.2% (n=60,334) had HF (29% HFrEF; 71% HFpEF). The HF cohort was older (69.7 years) and predominantly male (61.3%) compared with non-HF (66.7 years, P<.001 and 55.7%, P<0.00, respectively). Overall mortality in the HF group was 3-fold higher (1.6% vs 0.5%, P<.001). Within the HF group, mortality in HFrEF was 1.8 times higher than in HFpEF (2.4% vs 1.3%, P<.001). Over the study period, mortality rates declined in the HF cohort (Fig. 1A), both in HFrEF (from 4.1% to 2.2%, P=.012) and HFpEF (from 2.7% to 1.3%, P=.006) (Fig 1B). In non-HF, mortality rates remained relatively unchanged during the study period (from 1.4% to 1.6%, P=.344).

Conclusion:
Overall mortality following AF ablation is relatively low. Despite the higher mortality observed in patients with HF, the overall rate declined in both HFrEF and HFpEF over the study period. This reduction in mortality may reflect improvements in HF treatment and ablation techniques. Further research is needed to elaborate on the factors contributing to these trends and to develop targeted interventions to reduce mortality in this high-risk population.
Abstract 4128457: Trends in Hypertension-Related Mortality Among Younger Adults in the United States From 1999-2021
Authors: Maniya Muhammad Talha , Siddiqi Ahmed , Ali Kumail Mustafa , Salman Ali , Raja Adarsh , Khan Laibah , Siddiqi Tariq Jamal , Hall Michael
Published: November 2024

Background:
The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated.

Aim:
We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S.

Methods:
Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region.

Results:
Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0).
Figure 1.

Conclusion:
Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.
Abstract 4128519: Performance of a Popular Large Language Model in Answering Cardiovascular Related Queries: A Systematic Review and Pooled-Analysis
Authors: Kassab Joseph , El Hajjar Abdel Hadi , Haroun Elio , Kanj Mohamed , Sarraju Ashish , Laffin Luke , Kapadia Samir , Harb Serge
Published: November 2024

Background:
The integration of large language models (LLMs) such as ChatGPT into healthcare can have significant implications for patient education and clinical decision-making.

Aims:
This systematic review and pooled analysis aim to evaluate the accuracy of ChatGPT 3.5 and 4 in answering simple queries across cardiovascular (CV) medicine disciplines.

Methods:
Literature searches were conducted in PubMed, Embase, and Cochrane Central in May 2024. Keywords included “ChatGPT”, “LLMs”, and “Chat-based artificial intelligence models”. Cross-sectional, peer-reviewed studies published in 2023 and 2024 investigating ChatGPT’s performance in CV medicine-related queries (Table/Figure) were extracted and included. All queries were evaluated by expert physicians in the corresponding fields within each study (and not by our readjudication), and a standardized grading system was employed for pooled analysis using an "accurate" and "inaccurate" grading scale for each answer.

Results:
Out of 127 identified and screened peer-reviewed studies, fourteen studies involving 542 CV-related queries were included. Pooled analysis revealed an overall accuracy of 84.5% (458/542) (95% CI [81.5, 87.6]). Stratification by model (ChatGPT-4 vs. ChatGPT-3.5) did not show a significant difference in accuracy (p=0.32). Furthermore, no significant differences in accuracies were seen between answers in 2023 and 2024 (p=0.07). The accuracies across the various topics were statistically comparable, except in the field of cardio-oncology, which showed significantly lower accuracy at 68% (p=0.02). Detailed performances per topic are included in the table and figure.

Conclusion:
ChatGPT demonstrated consistently high accuracy in answering CV-related queries with no significant differences across model versions or years. These results support the potential use of online-chat based LLMs as an informational tool in cardiology.
Abstract 4128919: A Study Using Team Based Hypertension Care Focused on Black Patients to Inform a Future Randomized Trial
Authors: Manandhar Srista , Chhetri Sunit , Sutton Danielle , Saha Animita , Kaur Suneet , Brown Josh , Moore Justin , Callahan Kate , Williamson Jeff , Taylor Yhenneko , Bosworth Hayden , Pokharel Yashashwi
Published: November 2024

Background:
Current telemedicine programs to manage hypertension are less effective in Black patients perhaps due to insufficient support for self-care skills and social needs. We describe a tailored program for Black patients emphasizing self-management support and social needs to inform future studies.

Method:
We piloted a 12-week telemedicine intervention comprising home blood pressure (BP) guided pharmacotherapy, frequent self-management support and social support using pharmacist, nurses, community health workers (CHW) and social workers (SW) among 20 patients in 2 clinics. At enrollment, we trained patients to use a BP monitor and a telemonitoring app that transmits BP real-time via a smartphone and provided a pill box to facilitate medication adherence. We asked patients to measure BP at least once daily and used 6 weeks average to guide pharmacotherapy. Trained nurses helped patients achieve self-care goals and provided 8-12 self-management support calls discussing hypertension, medication adherence, diet, physical activity, weight management, sleep, and BP measurement techniques. SWs and CHWs provided social support to address social needs such as food, transportation, and housing, and also offered home visits.

Result:
Eighteen patients completed the study of which 15 were Black, 2 White, and 1 Korean (9 were women). Mean age was 61.7 ± 11.8 years. Patients measured BP 10 ± 8.6 times/week and completed 8.3 ± 2.5 self-management calls. Over 12 weeks, SBP/DBP decreased by 16.5 ± 26.2/10.2 ± 18.5 mmHg without safety events (Table). There were 1.1 ± 0.8 (range 0-3) medication adjustments (dose or medication changes) per patient. Patients had 8 minor technical difficulties that were promptly resolved. 17 patients used pill boxes to improve medication adherence.

Conclusion:
Our tailored telemedicine program to manage hypertension is feasible among Black patients and offer valuable insights for future research.
Abstract 4129075: Racial and Ethnic Differences in Semaglutide Prescriptions in the Veterans Affairs Healthcare System
Authors: Tisdale Rebecca , Beyene Tariku , Tang Wilson , Sandhu Alexander , Heidenreich Paul , Asch Steven , Yong Celina
Published: November 2024

Introduction:
Recent advances in obesity treatment added incretin-based injectables like semaglutide to treatments ranging from lifestyle modification to bariatric surgery. While the burden of obesity in the United States is high and disproportionately affects minoritized individuals, obesity interventions may not be equitably distributed. Insurance coverage is often cited as a barrier to accessing novel treatments.

Research Question:
Do inequities in semaglutide use among patients with obesity persist without insurance barriers to care?

Goals:
Characterize the role of race and ethnicity in the receipt of semaglutide among Veterans with obesity.

Methods:
Among VA patients with BMI ≥27 from 2018-2023, we used a hierarchical multivariable mixed effects logistic regression model to evaluate the association between race and ethnicity (White, Non-Hispanic Black, Hispanic, Asian/Native Hawaiian/Pacific Islander, American Indian/Alaska Native) and receipt of semaglutide prescriptions. We adjusted for age, gender, diabetes status, Charlson Comorbidity Index, education, and urbanicity, with a random effect for diagnosis year.

Results:
Among Veterans with BMI ≥27 (n=2,423,070), 38.8% had Class I obesity (BMI 30-34.9), 18.2% had Class II obesity (BMI 35-39.9), and 9.8% had Class III obesity (BMI>40), with differences by race and ethnicity (p<0.01). Across the cohort, 184,690 (7.6%) received at least one prescription for semaglutide during the study period. Higher severity of obesity was associated with odds of semaglutide prescription (Figure). Compared to White Non-Hispanic patients, Black and Hispanic/Latino Veterans were less likely to receive a semaglutide prescription, with adjusted odds ratios (AOR) of 0.63 (95% confidence interval [CI]): 0.60-0.68) and 0.81 (95% CI: 0.74-0.90), respectively. Receipt of a semaglutide prescription was also highly associated with diabetes status, with an AOR of 35.2 (95% CI 32.5-38.0) for those with a diagnosis of diabetes compared to those without.

Conclusions:
Racial and ethnic minority Veterans with obesity are less likely to receive prescriptions for semaglutide in VA, suggesting that challenges to equitable obesity care are more complex than financial coverage alone.
Abstract 4129533: Phenotypes and clinical outcome of heart failure with preserved ejection fraction (HFpEF) patients in China: Findings from the Chinese Cardiovascular Association Database-Heart Failure Center Registry
Authors: Yuan Shuai , Xie Zhonglei , Cui Xiaotong , Zhou Jingmin , Ge Junbo
Published: November 2024

Background:
Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome with 5 phenotypes. We aimed to evaluate the clinical outcome of HFpEF patients with various phenotypes in China.

Methods and Results:
Data from the Chinese Cardiovascular Association (CCA) Database-HF Center Registry between January 2017 and December 2021 were analyzed, 51,466 hospitalized HFpEF patients with 1-year follow-up results were included in this analysis. The patients were categorized into five phenotypes based on published phenotyping method. Clinical characteristics and 1-year outcome and related risk factors of HFpEF patients with various phenotypes were explored. Results demonstrated significant differences in baseline characteristics and clinical outcomes among the phenotypes, patients with phenotype-3 (right heart and pulmonary-related HFpEF), phenotype-4 (valvular- and rhythm-related HFpEF) and phenotype-5 (extracardiac disease-related HFpEF) exhibited high incidence of adverse outcomes. Phenotype-3 and -4 exhibited high risk of heart failure rehospitalization, whereas phenotype-5 showed high cardiovascular mortality. The independent prognostic risk factors varied across different phenotypes as well.

Conclusion:
One-year outcome differs among HFpEF patients with various phenotyping. Future studies are warranted to validate if personalized treatment strategies based on HFpEF phenotypes could improve the individual outcome of HFpEF patients, especially for phenotype-3, -4 and -5 HFpEF patients.

Keywords:
Heart failure with preserved ejection fraction, phenotype, prognosis, population study, risk factors.
Abstract 4129675: Effective Transcatheter Intracoronary Delivery of mRNA-Lipid Nanoparticle Targeting on The Heart
Authors: Handa Kazuma , Kawamura Masashi , Sasai Masao , Matsuzaki Takashi , Harada Akima , Miki Kenji , Fujimura Lisa , Saito Shunsuke , Tsuneda Ryo , Fujishiro Anri , Hirano Kunio , Miyagawa Shigeru
Published: November 2024

Introduction:
mRNA has great potential to provide new medical innovations in the treatment of heart failure. Lipid nanoparticles (LNPs) are an established and effective mRNA delivery system. However, effectively delivering LNPs to the heart remains a significant challenge. We evaluated the efficacy of transcatheter intracoronary (IC) administration compared to intravenous (IV) and intramyocardial (IM) administration as methods for delivering.

Methods:
Normal rabbits were used to examine each route of administration. Fluorescence (ATTO 700)-labeled LNP encapsulating Firefly Luciferase (FLuc) mRNA (25 ug/kg) were used to confirm the in vivo mRNA-LNP dynamics. The LNP accumulation and FLuc expression were verified using an in vivo imaging system (IVIS) 4 hours post-administration, followed by immunohistochemical analysis. The same experiments were conducted in an ischemia-reperfusion (I/R) model.

Results:
In the normal model, IVIS spectrum data showed that LNPs accumulated in the order of IM, IC and IV groups, with FLuc expression significantly higher in the IC group than in the IV group and comparable to the IM group (A). Histological analysis revealed that FLuc-expressing cells were mainly found in troponin T-positive cardiomyocytes at the injection site in the IM group and throughout the heart in the IC group (B). In the I/R model, LNP accumulation and FLuc expression were increased in the IV group compared to the normal model, whereas, in the IC and IM groups LNP accumulation and FLuc expression levels were similar to those in the normal model (C). Histological analysis revealed more FLuc-expressing cells in the infarcted area in all groups, but higher FLuc expression was observed in remote areas in the IC group (D).

Conclusions:
IC administration effectively delivered mRNA-LNPs not only to the damaged area but also to the remote area (non-damaged area) in the diseased heart, suggesting a safe and useful method for delivery to a wider range of cardiomyocytes in the heart.
Abstract 4129733: Glucagon-like Peptide 1 Receptor Agonists Effect on Low-Density Lipoprotein Cholesterol and Total Cholesterol Levels Independent of Weight Reduction: A Meta-analysis and Meta-regression of Placebo-controlled Randomized Controlled Trials
Authors: Rivera Frederick , Chin Marielle Nicole , Ruyeras Jade Monica Marie , Salva Wailea Faye , Menghrajani Rajiv Hans , Desai Drashti , Choi Sarang , MANGUBAT GERARD FRANCIS
Published: November 2024

Background:
The impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on lipid components is unclear. The objective of this study was to measure the lipid-lowering effect of GLP-1RAs.

Methods:
A thorough database search was performed to identify placebo-controlled randomized controlled trials (RCTs) on GLP-1RA therapy through January 2023. From these trials, data was extracted and a robust statistical analysis was performed using a random effects model to determine outcomes with weighted mean difference (MD) in milligrams per deciliter (mg/dL) and 95% confidence intervals (CIs). The primary outcome was the mean difference in low-density lipoprotein cholesterol (LDL-C). Secondary outcomes were mean differences in total cholesterol (TC), triglycerides, high-density lipoprotein-C (HLD-C), and very low-density lipoprotein-C (VLDL-C). To account for covariates, subgroup analyses and meta-regression were performed.

Results:
A total of 33 studies were included in the final meta-analysis carried out between 2008 and 2023, which were conducted in 26 countries. Of the 5,918 participants, the study population comprised 2,603 (44%) males and 3,315 (56%) females, aged between 33.7 and 65.9 years. GLP-1RAs significantly reduced LDL-C compared to placebo (MD -2.93, 95% CI (-5.01, -0.85), P=0.01). Treatment effect was consistent regardless of duration of treatment;12 weeks or less MD: -5.39, 95% CI (-10.36, -0.42), P=0.03 vs >12 weeks MD: -2.39, 95% CI (-4.70, -0.007), P=0.04, P interaction 0.28). In our analysis, GLP-1RA reduced TC by ~7 mg/dl. There was no significant reduction in triglycerides (MD = -7.19, 95% CI (- 15.01, 0.62], P=0.07) and VLDL-C ~4 mg/dl (MD = -3.99, 95%, CI (-8.73, 0.75), P=0.10). Furthermore, GLP-1RA did not increase HDL-C (MD = -0.12, 95% CI (-0.73, 0.49], P=0.69. Regression analysis determined that weight loss did not affect the treatment effect on LDL-C (tau2=28.38, I2=99.83, R2=0.0, p=0.67), and total cholesterol (tau2=93.6, I2=99.86, R2=0.0, p=0.92).

Conclusion:
Patients on GLP-1RA experienced modest LDL-C and TC lowering compared to placebo. GLP-1RA did not decrease triglycerides and VLDL-C. GLP-1RA did not increase HDL-C.
Abstract 4130314: High sodium, low potassium diet is associated with incident cardiovascular disease among US Hispanic/Latino adults: results from the Hispanic Community Health Study/Study of Latinos.
Authors: Tremblay Julien , Swift Samuel , Rundek Tatjana , Sotres-Alvarez Daniela , Raij Leopoldo , Van Horn Linda , Daviglus Martha , Castaneda Sheila , Zeki Al Hazzouri Adina , Franceschini Nora , Wassertheil-Smoller Sylvia , Elfassy Tali
Published: November 2024

Background:
Diets high in sodium and low in potassium are associated with increased blood pressure level but associations with cardiovascular disease (CVD) remain controversial. Few studies have evaluated this relationship among Hispanic/Latino adults.

Objective:
To assess whether dietary sodium and potassium are associated with incident CVD among diverse US Hispanics/Latino adults.

Methods:
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a cohort of 16,415 self-identifying Hispanic/Latino adults aged 18-74 four US urban communities in 2008-2011 (visit 1; V1). V1 included a comprehensive examination with in-person measurement of health information and interviewer administered questionnaires. Dietary sodium (mg/day) and potassium (mg/day) intakes were assessed from the average of two 24-hour dietary recall surveys administered by bilingual registered dietitians. CVD events occurring from V1 through 2019 were adjudicated by an expert panel of clinicians. We used Poisson regression to determine the association (incidence rate ratio, IRR) between sodium, potassium, and the sodium-to-potassium ratio, with CVD, using time to CVD as an offset. Models accounted for HCHS/SOL complex survey design and were adjusted for demographic, including Hispanic/Latino background, socioeconomic, and behavioral factors along with energy consumption, body mass index, cholesterol, and family history of CVD.

Results:
Among 15,291 participants without self-reported CVD at V1, mean age was 40 years, with 53% female. Mean daily intakes of sodium and potassium were 3,040 mg/day and 2,422 mg/day, respectively. Molar ratio of sodium to potassium was 1.33. Over 9.7 years of follow-up, there were 311 CVD events (2.0 events per 1,000 person years, 95% CI: 1.6, 2.5). In adjusted models, nutrients were associated with increased risk of CVD: by 17% for each 1g/day increment of sodium (IRR: 1.17, 95% CI: 1.03, 1.33); by 29% for each 1g/day decrement of potassium (IRR: 1.29, 95% CI: 1.01, 1.64); and by 112% for each 0.5 molar increment of sodium to potassium ratio (IRR: 2.12, 95% CI: 1.13, 4.11).

Conclusions:
In a large diverse sample of Hispanic/Latino adults, high dietary sodium and low dietary potassium were independently associated with an increased risk of CVD. Results underscore the importance of intensifying public health interventions to improve nutrient quality, by reducing dietary sodium and increasing dietary potassium consumption as a means of preventing CVD.
Abstract 4130756: Two Leads are All We Need: Optimizing Choice of Electrocardiogram Leads for Artificial Intelligence-based Based Detection of Left Ventricular Systolic Dysfunction
Authors: Nakayama Masamitsu , Yagi Ryuichiro , Deo Rahul , Macrae Calum , Goto Shinichi
Published: November 2024

Introduction:
Artificial intelligence (AI) models built with convolutional neural networks (CNN) accurately detect left ventricular systolic dysfunction (LVSD) from 12-lead electrocardiogram (ECG). While AI models can also detect LVSD from 1-lead (but with lower accuracy), the optimal numbers and combinations of the leads remain unclear.

Aims:
To identify the optimal numbers and combinations of ECG leads for detecting LVSD.

Methods:
A total of 75,033 ECGs recorded within 14 days of an echocardiogram were collected. The data was randomly divided into derivation, validation, and test sets in a 5:2:3 ratio without patient overlap. The same split was used throughout the study. While all available ECGs were included in derivation and validation sets, the test set included 1 ECG per patient closest to the echocardiogram. CNN models were trained to detect LVSD, defined as left ventricular ejection fraction <40%, using all possible combinations of 1-, 2-, and 3-lead extracted from 12-lead ECG. The final model for each lead combination was chosen according to the area under the receiver operating curve (AUROC) on the validation set across the 20 epochs. The models were trained 4 times to evaluate the variance caused by initialization vectors.

Results:
The 12-lead model showed AUROC of 0.893 (95%CI, 0.887-0.899). Multiple models trained with 2-lead achieved similar performance, with aVR-V4 displaying the highest AUROC (0.892; 95%CI, 0.889-0.895), followed by I-V4 (0.889; 95%CI, 0.883-0.895) and I-II (0.888; 95%CI, 0.884-0.893). The results were similar for 3-lead (aVR-aVL-V4: AUROC 0.895; 95%CI, 0.893-0.897, I-aVR-V4: 0.892; 95%CI, 0.889-0.896, and I-II-V4: 0.891; 95%CI, 0.886-0.895). The choice of leads greatly affected the performance. For the 1-lead models, aVR showed the highest AUROC (0.876; 95%CI, 0.873-0.879), but III only achieved an AUROC of (0.766; 95%CI, 0.761-0.772). The combinations, including a chest lead and a limb lead (especially aVR), tend to achieve higher performance (Fig 1).

Conclusion:
A combination of 2-lead was sufficient to achieve comparable accuracy as the 12-lead for the AI model to detect LVSD. Wearable devices collecting a combination of a limb and a chest lead may enhance the detection of LVSD.
Abstract 4131381: Comparison of Dietary Macronutrient Interventions for Weight and Cardiovascular Risk Factor Reduction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trial
Authors: Ali Eman , Latif Fakhar , Ali Kumail Mustafa , Perswani Prinka , Janjua Hamza , Ansari Yusra , Vipparthy Sharath , Ali Farman , Siddiqi Tariq Jamal , Hall Michael
Published: November 2024

Background:
Dietary interventions play a crucial role in weight management and reducing cardiovascular risk factors. Our study aims to compare the effectiveness of four dietary macronutrient interventions on weight loss and cardiovascular (CV) risk factor reduction through a systematic review and network meta-analysis.

Methods:
We conducted a comprehensive literature search on PubMed, Scopus, Embase, and Cochrane Library up till May 2024 to identify randomized controlled trials (RCTs) comparing four macronutrient dietary interventions including Mediterranean Diet (MD), Keto, Dietary Approaches to Stop Hypertension (DASH), and Intermittent Fasting (IF) with study period ≥ 6 months or 24 weeks. The primary outcomes of interest were weight loss, systolic blood pressure (SBP), Diastolic blood pressure (DBP), Body Mass Index (BMI), High density lipoprotein (HDL), Low density Lipoprotein (LDL), cholesterol levels and C-reactive protein (CRP) levels. Outcomes were reported as standard mean difference (SMD).

Results:
Our analysis identified 50 studies enrolling 5368 patients (MD=3554; DASH=838; Keto=206; IF=770). Regarding BP outcome, MD and DASH had significant reduction in SBP and DBP respectively (MD [SBP]: -0.76 mmHg vs DASH [DBP]: -1.92 mmHg) respectively. In contrast, IF showed a significant rise in SBP (0.87). MD participants also had significant weight loss (-1.06 kg) and a moderate decrease in BMI (-0.79) when compared with other diets. Furthermore, IF, keto, and MD showed moderate increase in HDL levels (0.61, 0.77 and 0.33) respectively. In contrast, DASH resulted in a moderate decline in HDL levels (-0.92). IF and MD resulted in modest decline in LDL levels (-0.45 and -0.42) respectively. In contrast, Keto demonstrated non-significant rise in LDL (0.35). DASH showed a significant decrease in triglycerides (-3.02). Lastly, MD demonstrated a significant reduction in CRP (-0.89).

Conclusions:
MD and DASH were superior to other dietary interventions in terms of weight loss and CV risk factors. Further research is required to tailor specific types of dietary interventions and assess their long-term efficacy on weight loss and CV risk reduction.