bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4124675: Deep Learning Screening of Cardiac MRIs Uncovers Undiagnosed Hypertrophic Cardiomyopathy in the UK BioBank
Authors: Kaur Dhamanpreet , Shad Rohan , Zakka Cyril , Fong Robyn , Pogatchnik Brian , Filice Ross , MONGAN JOHN , Kallianos Kimberly , Khandwala Nishith , Eng David , Ferrari Victor , de Feria Alejandro , Acker Michael , Hiesinger William
Published: November 2024

Introduction:
The prevalence of hypertrophic cardiomyopathy (HCM) in the UK Biobank based on ICD-10 codes (.07%) is lower than global estimates of disease prevalence (0.2 - 0.5%). Prior studies using this data have remarked on the limitations of findings given likely underdiagnosis. The availability of cardiac MRI scans on a fraction of the participants offers an opportunity to identify missed diagnoses.

Aims:
This study seeks to utilize a generalizable deep learning model to detect likely cases of undiagnosed hypertrophic cardiomyopathy from cardiac MRIs in the UK Biobank.

Methods:
The foundational model was trained on a multi-institutional dataset of 14,073 cardiac MRIs via a self-supervised contrastive learning approach that sought to minimize the divergence between scans and their associated radiology reports. The pre-trained model was fine-tuned to diagnose hypertrophic cardiomyopathy on a distinct cohort of 4,870 MRIs with 368 cases of HCM, achieving an AUC of 0.94. The fine-tuned model was applied to the UK Biobank cardiac MRI dataset to ascertain predicted probabilities of HCM. Cases exceeding a threshold of 95% – correlating to the top 0.5% of cases (expected specificity of 97% and sensitivity of 60%) – were screened in for manual reading. In a blinded fashion, a board-certified radiologist was tasked with diagnosing HCM on a sample of cases composed of high and low predicted probabilities.

Results:
Of the 43,017 patients with cardiac MRIs, only 9 (.02%) had an ICD diagnosis of HCM. 266 cardiac MRIs were manually reviewed: 216 had greater than 95% predicted probability of HCM; 50 negative controls were randomly selected amongst cases with predicted probability less than 10%. The radiologist concurred with an HCM diagnosis for 115 cases (sensitivity 53%, specificity 98%), 112 of which were previously undiagnosed. The prevalence of hypertension and aortic stenosis did not significantly differ between the cohort of true positives (69.2%) and false positives (76.6%). The corrected prevalence of HCM in the UK BioBank MRI cohort is estimated at 0.28%.

Conclusions:
The findings of this study illustrate the remarkable ability of a generalizable deep learning model to detect undiagnosed cases of a rare disease process from cardiac MRIs. This is an important milestone that may allow for widespread screening of hypertrophic cardiomyopathy while minimizing demand for radiologist labor, and thereby allow patients to reap the substantial benefits of earlier treatment.
Abstract 4124690: Effect of Colchicine on the Perivascular Inflammation Index of Coronary Computerized Tomography Angiogram: COPIX trial
Authors: Barbosa Camila , Serrano Carlos , PITTA FABIO GRUNSPUN , Lima Eduardo , RACHED FABIANA HANNA , Martins Eduardo
Published: November 2024

Inflammation is an important pillar of atherogenesis in coronary disease. Studies have documented the prognostic power of measuring the attenuation of coronary perivascular adipose tissue (PVAT) and its good correlation as an early inflammatory biomarker in the atherogenesis process. Colchicine, a medication with well-documented anti-inflammatory action and with an impact on reducing cardiovascular outcomes, may influence reducing FAI (Fat Attenuation index) assessed by coronary tomography angiography. This study aims to evaluate the effect of colchicine in reducing coronary inflammation after 12 months of using the medication. Methods: Single- center, randomized, prospective, open, ongoing study, carried out at the Heart Institute of the University of São Paulo (InCor HCFMUSP). Forty patients with documentation of FAI ≥ 70 HU in the right coronary artery (RCA) and/or left descending artery (LAD) were randomized to receive colchicine 0.5 mg/day for a period of 12 months. The primary outcome was the quantification of FAI in both therapeutic groups (colchicine and control) after a 12-month follow-up. As a secondary outcome, we evaluated the variation in total atheroma volume, calcium score, progression or regression of high plaque findings, variation low attenuation plaque volume and clinical outcomes. Results: Forty patients were included between May 2021 to April 2023, of which 22 were in the Colchicine group and 18 in the Control group. As a primary outcome, no FAI improvement in RCA and LAD was documented after a 12-month follow-up. In the Colchicine group, the mean FAI in initial LAD of −70.37 ± 7.1 HU improved to −72.90 ± 6.2 HU, but without statistical significance (p = 0.82) and Control group −69,13 ± 7,7 HU to −71,73 ± 6,3 HU (p= 0,64). FAI RCA from − 67.69 ± 5.4 HU to −71.23 ± 4.7 HU, without significance (p = 0.10) in Colchicine group and – 65,48 ± 5,5 HU to −69,08 ± 7,8 HU (p = 0,19) in control group. Conclusion: To date, a total of 40 patients have been randomized. In this interim analysis, with 50% of the sample already undergoing control coronary CT angiography, no association was observed with the use of colchicine and improvement in coronary inflammation after 12 months of using the medication.
Abstract 4124839: Does Anticoagulation Status Before LAA Thrombus Detection Influence Stroke Risk?
Authors: Kagawa Eisuke , Hidaka Takayuki , Kunita Eiji , YAMANE AYA , Matsui Shogo , Kanegawa Munehiro , Kato Masaya
Published: November 2024

Introduction:
Thrombus in the left atrial appendage (LAA) is known to be one of the risk factors for ischemic stroke, and after the detection of LAA thrombus, anticoagulation therapy is usually administered. However, the role of anticoagulation therapy before the detection of LAA thrombus in the prognosis is still unclear.

Hypothesis:
We assessed the hypothesis that the anticoagulation status at the time of LAA thrombus detection with transesophageal echocardiography (TEE) affects the future incidence of ischemic stroke.

Methods:
Patients who underwent TEE and were found to have LAA thrombus were included. Patients were divided into two groups based on their anticoagulation status before TEE. To exclude strokes that might occur due to the detected LAA thrombus itself, landmark analysis was performed by excluding patients who had a stroke or died within 30 days after detection of the LAA thrombus. The difference in the 7-year cumulative incidence of ischemic stroke was assessed using the Gray-test. Fine-Gray proportional hazard regression was utilized to assess the impact of anticoagulation status on ischemic stroke.

Results:
Among 183 patients detected with LAA thrombus, 15 suffered ischemic stroke or death within 30 days of detection, and 168 patients were included in this study. Of these, 58 patients were treated with anticoagulation therapy before the index detection of LAA thrombus (PreAC group). Patients in the PreAC group were older (median 76 years [interquartile range 51-88 years] vs. 74 years [38-89 years], P = 0.032) than those in the non-PreAC group. The rates of CHA2DS2-VASc score ≥ 2 (93% vs. 89%, P = 0.582), male sex (64% vs. 70%, P = 0.488), and history of atrial fibrillation (98% vs. 95%, P = 0.667) were similar between the two groups. The cumulative ischemic stroke rate was higher in the PreAC group than in the non-PreAC group (P = 0.048, Figure). Even after adjusting for CHA2DS2-VASc score, anticoagulation therapy before detection of LAA thrombus was significantly associated with the cumulative incidence of ischemic stroke (P = 0.049).

Conclusions:
Anticoagulation status before the detection of LAA thrombus is a determinant of a higher incidence of ischemic stroke. The background mechanisms suggesting a tendency toward thrombus generation even when treated with anticoagulation are proposed.
Abstract 4125076: Catheter Ablation Alone Versus Catheter Ablation With Combined Percutaneous Left Atrial Appendage Closure For Atrial Fibrillation: A Systematic Review and Meta-analysis
Authors: Junarta Joey , Siddiqui Muhammad , Abaza Ehab , Zhang Peter , Roshandel Aarash , Barbhaiya Chirag , Jankelson Lior , Park David , Chinitz Larry , Aizer Anthony
Published: November 2024

Background:
Combined catheter ablation (CA) with left atrial appendage closure (LAAC) may produce comprehensive treatment for atrial fibrillation (AF) whereby rhythm control is achieved and stroke risk is reduced without the need for chronic oral anticoagulation. However, the efficacy and safety of this strategy is still controversial.

Aim:
To investigate the efficacy and safety of a combined CA with LAAC approach to treat AF in patients moderate-to-high-risk for bleeding.

Methods:
This meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the Modified Newcastle-Ottawa scale and Cochrane risk of bias tool. Eligible studies reported outcomes in patients with AF who underwent combined CA and LAAC versus CA alone. Studies performing CA without pulmonary vein isolation were excluded.

Results:
Eight studies comprising 1878 patients were included (2 RCT, 6 observational). Pooled results showed no difference in arrhythmia recurrence (risk ratio [RR] 1.05; 95% confidence interval [CI] 0.84-1.30), stroke or systemic embolism (RR 0.71; 95% CI 0.26-1.94), total procedure time (mean difference 31.45 minutes; 95% CI -5.91-68.81), or major periprocedural complications (RR 1.28; 95% CI 0.28-5.89) when comparing combined CA and LAAC versus CA alone.

Conclusion:
Combined CA with LAAC for AF is associated with similar rates of arrhythmia free survival, stroke, major periprocedural complications, and procedure time when compared to CA alone. A combined strategy may be as safe and efficacious for patients moderate-to-high-risk for bleeding events to negate the need for chronic oral anticoagulation.
Abstract 4125188: Cardiac Specific Biomarkers of Progression in Duchenne Muscular Dystrophy Detected Using Aptamer-Based Proteomics
Authors: Naguib Mark , Tamaroff Jaclyn , Burnette William , Harris Rachel , Xu Meng , Slaughter James , Markham Larry , Soslow Jonathan
Published: November 2024

Background:
Duchenne muscular dystrophy (DMD) is an X-linked, progressive neuromuscular disorder characterized by cardiac and skeletal myopathy. The cardiac and skeletal muscle manifestations have different ages of onset and rates of progression, suggesting variability in the pathophysiology of dystrophin loss within the respective muscle groups.

Hypothesis:
We hypothesized that proteomics with comprehensive clinical phenotyping would identify novel biomarkers that correlate with cardiac but not skeletal disease progression in boys with DMD.

Methods:
This single-center cohort study of 56 DMD subjects performed cardiac magnetic resonance (CMR), including left ventricular ejection fraction (LVEF), late gadolinium enhancement (LGE), and myocardial circumferential strain (ECC). Fifty-one subjects underwent quantitative muscle testing, and 33 underwent actigraphy (MSK indices). Aptamer-based technology (SomaScan, SomaLogic, Boulder, CO) evaluated 1128 proteins in plasma sampled at the time of CMR. Correlations between serum protein levels and cardiac or MSK indices were tested using Benjamini-Hochberg corrected p-values (q-values).

Results:
The mean age of DMD subjects was 15.5 years old +/- 4.30. Twenty-six subjects had left ventricular dysfunction (LVEF <55%), 45 subjects had LGE, and 45 were non-ambulatory. Of 1128 proteins analyzed, 208 demonstrated a significant correlation for cardiac but not MSK indices (Figure 1). Figure 2 lists the 20 proteins with the strongest correlations, which included biomarkers of inflammation, calcium regulation in myocytes, and cell adhesion.

Conclusion:
We detected 208 novel proteins that correlate with cardiac-specific DMD disease progression. These proteins provide a better understanding of the underlying differences of cardiac disease, compared to MSK disease in DMD and provide clues to potential cardiac therapeutic options.
Abstract 4125252: Pre-Hematopoietic Stem Cell Transplantation Echocardiographic Indices and Post-Transplant Cardiovascular Outcomes
Authors: Kalathoor Sujay , Vasbinder Alexi , Catalan Tonimarie , Machado Kristen , Ismail Anis , Hutten Christina , Pizzo Ian , Huang Yiyuan , Blakely Pennelope , Banerjee Mousumi , Leja Monika , Hayek Salim
Published: November 2024

Introduction:
Hematopoietic stem cell transplantation (HSCT) is associated with adverse cardiovascular (CV) events including the development of heart failure (HF) and arrythmias. While transthoracic echocardiogram (TTE) is routinely obtained prior to HSCT, its role in predicting the incidence of HSCT related CV events is poorly understood.

Methods:
We used data from the Cardiovascular Registry in Bone Marrow Transplantation (CARE-BMT) study, a multicenter observational study of adult patients (aged ≥18 years) who underwent autologous/allogeneic HSCT for malignant or nonmalignant bone marrow disorders at the University of Michigan Health System (UMHS) and Rush University Medical Center from 2008-2019. In this analysis, we included patients from UMHS with a baseline TTE. Data on pre-HSCT TTE parameters and post-HSCT CV outcomes were collected through manual chart review. Left ventricular (LV) function and dimensions were categorized into normal, mildly abnormal, and moderately/severely abnormal based on American Society of Echocardiography guidelines. The primary outcomes were new-onset HF and atrial fibrillation/flutter post-HSCT. Analyses were conducted using a Fine-Gray model adjusted for the pre-HSCT CARE-BMT CV risk score.

Results:
Of the 2071 patients (mean age at HSCT 55.5
+
12.9 years; 59.5% male) with a pre-HSCT TTE (median 25 days pre-HSCT), 116 (5.6%) and 128 (6.2%) patients experienced HF and atrial fibrillation/flutter, respectively, over a median period of 2.2 years. Greater abnormalities in left ventricular internal diameter at end-diastole (LVIDd) and end-systole (LVIDs) were linearly associated with a higher risk of HF (P-trend 0.018 and 0.004, respectively) (Table). Similarly, moderately/severely abnormal LVIDd was associated with a 2.41-fold (95% CI: 1.07, 5.43) increase in risk of atrial fibrillation/flutter (Table). Pre-HSCT ejection fraction (EF) was not associated with either endpoint.

Conclusion:
LV dilation, even when mild, was notably associated with increased risk of developing new HF or atrial arrythmias post-HSCT, regardless of EF. Whether evidence of LV dilation should prompt the initiation of guideline directed medical therapy to minimize the risk of incident HF warrants further study.
Abstract 4125493: Is There an Obesity Paradox for Cardiovascular Outcomes in Patients Undergoing Transcatheter Edge-to-Edge Repair? A Pilot Meta-Analysis
Authors: Goyal Aman , Maheshwari Surabhi , Jain Hritvik , Khan Rozi , Abbasi Haleema Qayyum , Sulaiman Samia , Puttaswamy Darshan , MAHALWAR GAURANGA
Published: November 2024

Background:
The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an 'obesity paradox' exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI.

Methodology:
We conducted a systematic literature search using major databases to identify studies investigating the association between baseline BMI status and post-procedural outcomes in patients undergoing TEER. Patients were categorized into four BMI groups: underweight (BMI < 18.5 kg/m
2
), normal weight (BMI 18.5-24.9 kg/m
2
), overweight (BMI 25-29.9 kg/m
2
), and obese (BMI ≥ 30 kg/m
2
). The endpoints included were the risk of in-hospital mortality, myocardial infarction, and stroke. Data were pooled using Review Manager with a random-effects model. Risk ratios (RRs) with their 95% confidence intervals (CIs) were used as the effect measure. Statistical significance was set at p<0.05.

Results:
Our study included a total of six observational studies, encompassing 7,627 obese and 74,820 non-obese patients. The outcome of in-hospital mortality revealed no significant difference between the two groups (RR: 0.85; 95% CI: 0.57, 1.27; p=0.43). Subgroup analysis showed a trend towards higher in-hospital mortality risk for underweight patients compared to overweight (RR: 1.48; 95% CI: 1.11, 1.95; p=0.007) and obese patients (RR: 1.40; 95% CI: 1.02, 1.92; p=0.04). The comparison between underweight and normal-weight patients did not reach statistical significance (RR: 1.18; 95% CI: 0.91, 1.55; p=0.22).

Additionally, the risk of myocardial infarction (RR: 1.10; 95% CI: 0.77, 1.58; p=0.59) and stroke (RR: 0.43; 95% CI: 0.13, 1.42; p=0.17) did not differ significantly between obese and non-obese patients.

Conclusions:
Our study found no significant difference in in-hospital mortality between obese and non-obese patients. However, underweight patients had a higher mortality risk compared to both overweight and obese patients. While myocardial infarction rates were similar across all groups, there was a non-significant trend suggesting a potentially lower risk of stroke in obese patients. These findings warrant further prospective studies to provide robust evidence.
Abstract 4125528: Interleukin-6-Modulated Inflammation Augments Deep Vein Thrombosis Organization in Mice
Authors: Achyar Arinal Chairul , Hara Tetsuya , Adinata Aditya , Hirata Ken-Ichi , Emoto Noriaki
Published: November 2024

Background:
A disorganized thrombus jeopardizes its stability, leading to an augmented risk of fatal acute complications following deep vein thrombosis (DVT). One of its plausible causes is impaired immune cell responses. While the importance of the cytokine interleukin-6 (IL-6) in immune responses is well established, its action towards DVT organization is poorly elucidated. Accordingly, we aimed to investigate the role of IL-6 in the acute immunoinflammatory orchestration of DVT organization in vivo.

Methods and Results:
We performed total ligation of the infrarenal inferior vena cava (IVC) in 8–12-week-old male C57BL/6J mice a day after starting continuous, subcutaneous mini-osmotic pump infusion of recombinant IL-6 (rIL-6; 1.2 µg/day, n = 21) or vehicle (n = 21), after which DVT pathology was examined. Exogenous IL-6 administration significantly decreased DVT mass at day 2 (16.6±1.9 vs. 23.0±0.9 mg/cm; p<0.01) and day 4 (16.2±1.6 vs. 21.4±0.8 mg/cm; p<0.05) compared to vehicle-treated mice. Intriguingly, rIL-6-treated mice’s DVT exhibited distal tropism of a macroscopically white lesion with abundant neutrophils and platelet accumulation, indicating enhanced DVT organization (Figures A–B). Quantitative polymerase chain reaction (qPCR) analysis revealed the distal edge upregulation of leukocyte chemoattractants, leukocyte-platelet interaction markers, and extracellular matrix regulator genes, confirming that the IL-6-driven inflammatory response was linked to augmented DVT organization. Spatiotemporally, real-time intravital imaging on stasis- and irradiation-induced saphenous vein thrombosis among intraperitoneal rIL-6 (0.3 µg/mouse)-treated mice demonstrated marked acute leukocyte and platelet recruitment with subsequent aggregation to the distal edge of the thrombus (Figures C–D), which consequently yielded an enhanced thrombus resolution at the distal edge.

Conclusions:
Our findings suggest that IL-6-driven inflammation results in distal tropism of leukocyte-platelet infiltration, which is important for modulating thrombus organization and subsequent DVT amelioration. This study presents a novel insight into the immunothrombosis process, with potential clinical implications for DVT.
Abstract 4125581: Association Between Life’s Essential 8 and Premature Atherosclerotic Cardiovascular Disease: A Cross-sectional Study Among Young Adults in the United States
Authors: Han Yitao , Chen Yuxiong , Fan Zhongjie
Published: November 2024

Background:
Among patients presenting with atherosclerotic cardiovascular disease (ASCVD), the proportion of young individuals has increased in recent years. Life’s Essential 8 (LE8), containing two domains of health behaviors and health factors, is an updated monitoring measurement of cardiovascular health by assessing 8 modifiable risk factors.

Objective:
The objective of this study is to investigate the potential relationship between the LE8 score and a history of premature ASCVD among young adults residing in the United States.

Methods:
This population-based cross-sectional study utilized data from the National Health and Nutrition Examination Survey spanning 2005 to 2018, focusing specifically on adults aged 20 to 45. LE8 score was measured and categorized into low (0-49), moderate (50-79), and high (80-100) levels (Figure 1). Premature ASCVD status was determined by interviews conducted at enrollment, encompassing a self-reported composite disease history of coronary heart disease, angina pectoris, heart attack, and stroke. Following descriptive statistics, weighted multivariable logistic regression and restricted cubic spline models were employed to evaluate the associations between the LE8 score and premature ASCVD. Additionally, subscale and subgroup analysis were developed.

Results:
Among 17,499 participants, 9846 were eligible for analysis (weighted mean age, 32.7 years; male, 50.3%), and 167 had premature ASCVD history (weighted percentage, 1.46%). The weighted mean LE8 score of the study population was 71.99 (0.3). Following the adjustment for potential confounders, individuals with higher LE8 scores exhibited a reduced risk of developing premature ASCVD (Table 1). A nonlinear relationship was observed and similar patterns were also identified in the association of health behaviors and health factors scores with premature ASCVD (Figure 2). This inverse association was consistently observed across various subgroups, including sex, age strata, ethnicity, education, and income levels, with no significant interactions identified.

Conclusions:
The LE8 score and its subscale scores exhibited a negative, nonlinear association with premature ASCVD. Maintaining a healthy lifestyle and controlling modifiable risk factors are crucial in preventing premature ASCVD in the younger demographic. Further studies, encompassing prospective cohorts, are needed to confirm this finding.
Abstract 4125999: Elderly patients with HF with reduced ejection fraction and renal failure: are SGLT2i a good option?
Authors: Balaguer German jorge , CORTES GARCIA MARCELINO , Rodriguez Lopez Carlos , Romero Otero Jose Maria , Esteban Chapel Jose Antonio , Nieto Roca Luis , Taibo Urquia Mikel , Pello Lazaro Ana Maria , Tunon Jose
Published: November 2024

SGLT-2 receptor inhibitors (SGLT-2i) have been shown to reduce cardiovascular mortality and hospitalisations for heart failure (HF) in patients with HF with reduced ejection fraction (HFrEF) and to have a nephroprotective role in patients with chronic kidney disease (CKD). However, the available evidence in patients older than 75 years and with CKD is limited.

We conducted a retrospective, single-centre study including patients aged >75 years diagnosed with HFrEF (defined as ejection fraction <40%), CKD (eGFR <60mL/min) and with an indication for treatment with SGLT-2i for HF between November 2019 and November 2022. Clinical, analytical, electrocardiographic and echocardiographic variables were collected.

A total of 173 patients were included with a mean follow-up of 31.6 months (SD ±13.2). Mean age 84.7 years (SD ±4.9), 66.5% were male, 85.5% were hypertensive, 34.7% diabetic and 39.3% dyslipidaemic. Peripheral vascular disease was present in 11.6%. Mean glomerular filtration rate was 45.9 mL/min and only 2.3% were on haemodialysis. LVEF at inclusion was 29.5% (SD ±7.9), with 53.1% being of ischaemic aetiology and the most frequent functional class being NYHA II (53.2%). Thirty-seven percent had atrial fibrillation and 34.1% had complete left bundle branch block. At the end of follow-up 80.3% were on beta-blockers, 48.6% on ACE inhibitors, 37.6% on aldosterone antagonists, 23.7% on ARNI and only 11% on SGLT-2i.

Survival analysis was performed using Cox logistic regression (multivariate analysis), where SGLT-2i was shown to be the only protective factor for all-cause mortality (HR 0.3 [0.1-0.9]). Male sex (HR 2.2 [1.3-3.9]) and diabetes (HR 1.6 [1.0-2.6]) were associated with higher mortality. The attached figure (figure 1) shows the Kaplan-Meier survival curves for total mortality in those patients with and without SGLT-2i (p log-rank 0.05).

In our population, SGLT2i showed a significant reduction in total mortality in patients older than 75 years, with HFrEF and CKD. However, the treatment rate in this subgroup of patients is very low. Further implementation of SGLT2i treatment in this type of patient could be of significant clinical and prognostic benefit.
Abstract 4126463: The Relationship Between Hope and Hopelessness in Adults with an Acute Cardiac Event
Authors: Dunn Susan , Tintle Nathan , Rivera Eleanor , Devon Holli
Published: November 2024

Introduction:
Hope has been positively associated with behavior change in individuals screened for cardiovascular risk, and negatively associated with fatal ischemic heart disease (IHD). Hopelessness is associated with increased risk of mortality or nonfatal myocardial infarction in patients with IHD, and negatively associated with physical activity outcomes. Hope and hopelessness are sometimes considered to be ends of a continuum, yet the relationship between hope and hopelessness is not commonly examined in IHD patients.

Aim:
To determine the relationship between the State-Trait Hopelessness Scale (STHS) and Snyder Adult State and Adult Trait Hope Scales in a sample of patients with IHD.

Hypotheses:
1) There would be an inverse relationship between hopelessness and hope as measured by the scales and 2) discriminant validity of the instruments would be confirmed.

Methods:
A total of 156 participants were enrolled as part of a 3-group randomized controlled trial testing an intervention to promote physical activity and reduce hopelessness. Data were collected two weeks after hospital discharge. Correlations and partial correlations were computed for all combinations of scales. Principal component analysis (PCA) was conducted on hope and hopelessness scales.

Results:
A total of 106 participants (68%) had moderate or high trait hope, and 92 (59%) had moderate or high state. Moderate or severe hopelessness was reported by 93 participants (59.6%) for state hopelessness and 108 participants (69.2%) for trait. There were moderately strong negative correlations (r=-0.54 to -0.66, p=<0.001) between the total STHS and the Snyder Hope scales for both full and short versions of the STHS. Correlations were virtually unchanged when adjusted for age, sex, cardiac diagnosis, and marital status (r=-0.5 to -0.63, p<0.001) indicating that as hopelessness increases, hope decreases. PCA revealed 4 factors that explained 64.7% of the variance in scores while demonstrating conceptual distinctions between the STHS and Snyder Hope scales.

Conclusions:
As hypothesized, as hopelessness increased, hope decreased; however, we found a proportion of patients with hopelessness who still expressed hope for the future. Discriminant validity was supported by inverse correlations and factor analyses indicating conceptual distinctions between the two instruments. Interventions to reduce hopelessness for patients with IHD may be successful since hope and hopelessness are not mutually exclusive.
Abstract 4126581: COVID-19 Impacted Septal Reduction Therapies in Hypertrophic Cardiomyopathy
Authors: Desai Spandan , Roma Nicholas , Pattoli Megan , Durkin Matthew , Shah Kashyap , Amaratunga Eluwana , Magid Lindsey , Yellapu Vikas , Shirani Jamshid
Published: November 2024

Background:
Coronavirus Disease-19 (COVID-19) pandemic had a significant impact on emergent and elective treatment strategies in patients with cardiovascular disease. We aimed to examine the impact of COVID-19 on septal reduction therapy (SRT) in hypertrophic cardiomyopathy (HCM).

Methods:
National Inpatient Sample 2019-2021 was queried to identify patients with HCM and SRT using appropriate ICD codes. Temporal trends for SRT were obtained before and after COVID-19 outset.

Results:
There was a significant decline in the number of SRT from 2019 to 2020 (1505 vs. 1180, p<0.001) with partial recovery in 2021 (1250 vs. 1180, p<0.001). Geographic differences existed with differential decrease in number of SM in midwestern and Western Unites States. In addition, the proportion of patients who underwent surgical myectomy (SM) decreased in 2020 (44.6 vs. 48.7%, p=0.008) in favor of alcohol septal ablation (ASA). Patients undergoing SRT in 2020 had higher prevalence of heart failure (39.5 vs. 29%, p=0.002). In-hospital complication rates for cardiogenic shock, bleeding requiring transfusion, acute kidney injury and admission to the critical care unit were higher in 2020 compared to 2019. Hospital length of stay (LOS) was not significantly different however there was an overall increase in LOS in septal myectomy group from 2019 to 2021 (9.1 vs. 10 days, p=0.028). The overall proportion of comorbidities and other in-hospital complications remain unchanged during this study period.

Conclusions:
Our data indicates that COVID-19 resulted in a significant decrease in total number of SRTs and a shift from surgical to percutaneous septal reduction therapy. Partial recovery of procedure numbers were noted in the year following the pandemic outset.
Abstract 4126672: Clinical Predictors and Outcomes of Catheter-Directed Therapies in Patients with Intermediate-Risk Central Pulmonary Embolism
Authors: Cantu Martinez Omar , Martinez Manzano Jose Manuel , Jara-Tantoco Mikaela Nikkola , Prendergast Alexander , Jarrett Simone , Briseno Mara , Planchart Maria , Tito Sahana , Malin John , Byfield Karecia , Geller Andrew , Isaacs Evan , Musri Maria Carolina , Wattoo Ammaar , Azmaiparashvili Zurab , Lo Kevin Bryan
Published: November 2024

Background:
The management of intermediate-risk pulmonary embolism (PE) is unclear. The use of catheter-directed therapies (CDTs) in these patients has increased. However, their selection is not standardized, and outcomes of CDT compared to anticoagulation alone (ACA) are limited.

Research Question:
What are the clinical predictors of using CDT and their outcomes compared to ACA?

Methods:
Single center, 11-year, retrospective study of patients with intermediate-risk central PE. We stratified data by CDT use vs. ACA. We used the simplified pulmonary embolism severity index (sPESI) and right ventricular (RV) dysfunction as surrogates of PE severity and the VTE-BLEED score for baseline bleeding risk. We looked for predictors of CDT use and bleeding complications on multivariate logistic regression analyses.

Results:
Of 490 patients identified, 110 (22%) underwent CDT (Figure 1, Table 1). Higher BMI (OR 1.04, 95% CI 1.01-1.06; p=0.002), prior venous thromboembolism (VTE) episodes (OR=1.92, 95% CI 1.05-3.50; p=0.032), saddle PE (OR=3.42, 95% CI 2.00-5.85; p<0.0001), RV dysfunction (OR=6.93, 95% CI 3.53-13.57; p<0.0001), and creatinine elevation (OR=1.36, 95% CI 1.13-1.64; p=0.001) were independently associated with CTD use (Table 2). After adjusting for PE severity and bleeding risk, CDT was independently associated with bleeding complications (OR=3.77, 95% CI 1.74-8.15; p=0.001) (Table 3). The overall in-hospital mortality was low (3%, n=13).

Conclusions:
Higher BMI, prior VTE, saddle PE, RV dysfunction, and creatinine elevation were independently associated with CDT use. The CDT group had more major bleeding without mortality difference compared to ACA. Further studies are needed to standardize the use of CDT in intermediate-risk PE.
Abstract 4126893: Feasibility and Acceptability of a Nurse-Pharmacist Post-Discharge Telehealth Model of Care for Heart Failure Patients
Authors: Bennetts Joshua , Robson Cameron , Weismantel-Savage Aisha , Mani Julie , Williams Trent , Sverdlov Aaron , Ngo Doan
Published: November 2024

Background:
Suboptimal medication management is common in patients with heart failure (HF), particularly during transitions-of-care. To date, there are few studies assessing the feasibility of a nurse-pharmacist post-discharge telehealth service for medication optimisation in patients with HF. We performed a feasibility study to determine service uptake and acceptability, and ability to identify medication-related issues for HF patients as they transition from hospital to home.

Methods:
HF patients were referred to an existing post-discharge telehealth service and offered medication reconciliation and education in addition to their usual care; a service we termed ‘MedRec’ (MR). Primary outcomes were feasibility, measured through recruitment and successful MR completion, and acceptability, measured by an investigator-developed survey. Secondary outcomes were medication-related issues detected during MR.

Results:
A total of 100 HF patients were offered a post-discharge MR. Mean age of patients was 68.5 ±14.2 years, and mostly male sex (62%). Pharmacist MRs were requested by 80% of patients. In total 62 MRs (77.5%) were performed; 9 patients declined MR during follow-up and an additional 9 patients were uncontactable. Mean time to MR following nurse referral was 10.98 ±9.74 days. Drug-related toxicity or adverse effect presentation was identified in 25 (40.3%) MR recipients at the time of consultation and subsequently required general practitioner follow-up. Medication compliance issues were detected by the pharmacist in 13 (20.9%) patients; forgotten doses being the most common concern. Undertreated medical conditions, such as symptomatic HF and chronic pain, were identified in 12 (19.3%) MR recipients. Medications prescribed without any apparent indication were found in 8 (12.9%) patients. Drug or disease management information was requested by 35 (56.4%) MR recipients. A total of 35 (56.5%) post-MR surveys were successfully completed. All participants who completed a post-MR survey agreed that a post-discharge telehealth MR was an acceptable form of education provision. Engagement with a pharmacist MR was perceived to ease anxiety associated with understanding medication-related changes and empowered greater medication self-management.

Conclusions:
A post-discharge nurse-pharmacist telehealth service is a feasible and acceptable model of care. Inclusion of a routine MR post-discharge may be an effective means of maintaining continuity of care for HF patients.
Abstract 4126950: Program Evaluation of a Team-Based Telemedicine Hypertension Intervention by Patients
Authors: Chhetri Sunit , Manandhar Srista , Kramer Justin , Seals Austin , Sutton Danielle , Saha Animita , Kaur Suneet , Callahan Kate , Williamson Jeff , Taylor Yhenneko , Bosworth Hayden , Moore Justin , Pokharel Yashashwi
Published: November 2024

Background:
We pilot tested a 12-week, team-based, telemedicine hypertension management intervention tailored for patients with greater social needs. Our study included home blood pressure (BP) guided pharmacotherapy, frequent self-management support, and social support by pharmacists, nurses, community health workers and social workers. Twenty patients, including 17 Black patients, from 2 clinics in NC participated. We conducted program evaluation to inform future research.

Methods:
After program completion, we conducted semi-structured interviews and administered validated surveys for program evaluation. We used Exploration, Preparation, Implementation, and Sustainment and Health Equity Implementation Frameworks to guide our study design. We utilized inductive and deductive coding methods, with thematic analysis to organize emergent themes. We used descriptive statistics to summarize survey results. We triangulated themes from interviews with survey results during analysis/results interpretation using concurrent embedded mixed methods (Qual + quant) for convergence/complementarity.

Results:
Nineteen patients completed the interviews and 18 completed the surveys. A patient withdrew from the study. Several themes emerged around acceptability, appropriateness, feasibility, and patient centeredness about the program (Table). Patients’ perceptions that the program was acceptable and measuring BP at home was easy were most salient. Program was found to be highly patient centered.

Conclusions:
Patients found our team-based telemedicine intervention acceptable, appropriate, feasible, and patient centered. The tailored telemedicine program holds promise for adoption by patients with greater social needs.
Abstract 4127413: High-normal Blood Pressure (130-139/85-89mmHg) is Associated with an Increased Risk of Mortality
Authors: Li Zhiwei , Liu Mengmeng , chen bowang , wu yuelin , jia hui , geng ruirui , zhang xiaoyan , yang yang , cui jianlan , lu jiapeng , li xi , zhang weili
Published: November 2024

Background:
The relationship between high-normal blood pressure (BP) and mortality lacks high-quality evidence based on large population cohort. The aim of this study was to comprehensively investigate the association of high-normal BP and its trajectory with all-cause and cause-specific mortality.

Methods:
In a community-based population cohort from the China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART) project, 3,598,940 participants aged 35-75 years with baseline BP were included. High-normal BP was defined as a systolic blood pressure (SBP) of 130-139 mmHg and/or a diastolic blood pressure (DBP) of 85-89 mmHg at baseline. Four trajectories of BP change were identified in 105,894 participants included in the study, who had more than 2 follow-up BP measurements, using latent mixture modeling. Among them, high-normal-increasing was defined as an increase in SBP from 130-139 at baseline to over 140 at the last follow-up.

Findings:
Compared with the optimal BP group (SBP < 120 mmHg and DBP < 80 mmHg, [18.1%]), participants with high-normal BP (18.7%) had a 4% increase in all-cause mortality risk (hazard ratio [HR] 1.04, 95% confidence interval [CI]: 1.01-1.07) and a 28% increase in CVD mortality risk (HR 1.28, 95% CI: 1.21-1.34), with the greatest increase in mortality risk observed from hemorrhagic stroke (HR 1.75, 95% CI: 1.55-1.98). Among BP trajectories, compared with participants with optimal-stable BP (25.3%), those with high-normal-increasing BP (3.5%) had a 25% increase in all-cause mortality risk (HR 1.25, 95% CI: 1.00-1.54) and a 67% increase in CVD mortality risk (HR 1.66, 95% CI: 1.21-2.30), with the greatest increase in mortality risk also observed from hemorrhagic stroke (HR 3.15, 95% CI: 1.38-7.20). In our study cohort, approximately 0.7% and 1.3% of all-cause mortality was attributable to the high-normal BP at baseline and high-normal-increasing BP trajectory, respectively.

Interpretation:
Individuals presenting high-normal BP at baseline or high-normal-increasing BP trajectory afterward exhibited a significantly elevated mortality risk, which is most pronounced for hemorrhagic stroke. Early management of BP in patients with high-normal BP is crucial for the prevention and treatment of hypertension.
Abstract 4127513: Cardiopulmonary long-term effects 6, 18 and 30 months after severe covid-19 infection
Authors: Niebauer Julia , Iscel Ahmet , Schedl Sarah , Capelle Christophe , Kahr Michael , Schamilow Simon , Faltas John , Srdits Marc , Lichtenauer Michael , Zoufaly Alexander , Valenta Rosmarie , Charwat-Resl Silvia , Krestan Christian , Hitzl Wolfgang , Wenisch Christoph , Bonderman Diana
Published: November 2024

Background:
SARS-CoV-2 infection affects the cardiopulmonary system in both the acute and long-term phase. This study aimed to comprehensively assess symptoms and potential long-term impairments 6, 18 and 30 months in patients previously hospitalized for severe Covid-19 infection.

Methods:
This prospective registry included patients hospitalized for PCR-confirmed Covid-19 infection. Approximately 6 months post-discharge, follow-up examination included patient history, clinical examination, echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a comprehensive laboratory panel. Patients with pathologic findings during the first visit underwent a second (at 18 months) and third (at 30 months) follow-up examination. Those without pathologic findings or who refused further medical examinations were contacted via phone to inquire about symptoms.

Results:
Between July 2020 and April 2022, 200 patients (91% general ward, 9% intensive care unit) were recruited. Due to dropouts, the second visit was conducted in 170 patients, and the third visit in 139 (74 in person, 65 via telephone). Long Covid criteria were fulfilled by 73% at 6 months, 52% at 18 months and 49% at 30 months post-discharge, with fatigue being the most common symptom (Figure 1). Echocardiography at 6 months showed impaired left ventricular function in 15 patients, with normalization in 80% at 18 months and further 66% at 30 months (Figure 2). cMRI revealed pericardial effusions in 28 patients at 6 months, which resolved in 47% at 18 months and in further 60% at 30 months. Signs of peri- or myocarditis were present in 7 patients at 6 months and were resolved in all 4 patients who attended control studies at 18 months. Chest CT scans at 6 months identified post-infectious residues in 41 patients, with full recovery in 20% at 18 months without further normalization after 30 months.

The length of in-hospital stay was identified as a significant predictor for persisting Long Covid 6 months after discharge (95% CI: 1.005 - 1.12, p=0.03).

Conclusion:
While the prevalence of Long Covid decreased over time, a significant symptom burden persisted at 6, 18 and even 30 months after severe Covid-19 infection. Structural and functional abnormalities were less frequent compared to reported symptoms, posing a challenge in substantiating the causes of these symptoms.
Abstract 4127931: Chronic Steroid Use is Associated with Increased Readmission Rates in Patients Admitted with Acute Coronary Syndromes
Authors: Loftspring Ethan , Leiva Orly , Mahmud Arif , Bangalore Sripal , Rao Sunil
Published: November 2024

Introduction:
Acute coronary syndrome (ACS) is associated with significant morbidity and mortality. Management of ACS includes percutaneous coronary intervention (PCI) and requires the use of antithrombotic therapy, which increases bleeding risk. Chronic steroid use (CSU) is common for many diseases and is also associated with bleeding risk and impaired wound healing. However, data on outcomes of patients with CSU and AMI are sparse.

Methods:
Patients admitted for ACS and managed with PCI from 2014 to 2020 with and without CSU were identified using the National Readmissions Database (NRD). In-hospital outcomes include death, arterial thrombosis (composite of ischemic stroke and arterial thromboembolism), and major bleeding (composite of gastrointestinal, intracranial, or post-procedure bleeding or transfusion). Ninety-day readmission outcomes were cardiovascular (CV)-related, bleeding-related and all-cause. Multivariable logistic or Cox proportional hazards were utilized.

Results:
A total of 1,087,357 patients with ACS were included, of whom, 9,864 (0.9%) had CSU. After multivariable adjustment, there was no significant difference in in-hospital mortality (3.1% vs 3.2%; OR 1.09, 95% CI 0.93-1.26) or risk of arterial thrombosis (3.3% vs 2.8%; OR 0.91, 95% CI 0.81-1.02) between patients with and without CSU. CSU was associated with an increased risk of major bleeding events (8.3% vs 6.0%; OR 1.15, 95% CI 1.06-1.25). CSU was associated with a higher risk of CV-related (10.7% vs 7.5%; HR 1.10, 95% CI 1.02-1.18), bleeding-related (2.3% vs 1.2%; HR 1.28, 95% CI 1.09-1.51), and all-cause 90-day readmissions (23.9% vs 14.9%; HR 1.28, 95% CI, 1.22-1.34).

Conclusion:
Among patients admitted with ACS who underwent PCI, CSU was associated with increased risk of bleeding during index hospitalization and readmissions for bleeding. Furthermore, CSU was associated with increased risk of 90-day CV and all-cause readmission. Further studies are needed to better characterize this risk.
Abstract 4127990: Inactive Matrix Gla Protein and Cardiovascular Outcomes: the Multi-Ethnic Study of Atherosclerosis
Authors: Berlot Ashley , Fu Xueyan , Shea Kyla , Tracy Russell , Budoff Matthew , Kim Ryung , Naveed Mahim , Booth Sarah , KIZER JORGE , Bortnick Anna
Published: November 2024

Background:
Matrix Gla protein (MGP) inhibits arterial calcification. Higher inactive MGP, dephosphorylated-uncarboxylated (dp-ucMGP), is positively associated with vascular calcification, possibly portending cardiovascular events. The objective was to determine the association of dp-ucMGP with incident cardiovascular disease (CVD) events and mortality in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
MESA is a cohort study of 45-84 year-old individuals enrolled between 2000-02 with adjudicated outcomes through 2019. Dp-ucMGP was measured at baseline in n=2663 participants with cardiac computed tomography at Exams 1 (2000-02) and 5 (2010-12). Using age-stratified Cox proportional hazard models, adjusted for sex, race-ethnicity, body mass index, systolic blood pressure, statin use, anti-hypertensive medication use, smoking status, physical activity, alcohol use, diabetes, high density lipoprotein, low density lipoprotein, triglycerides, phosphate, and estimated glomerular filtration rate, we determined the association of dp-ucMGP with risk of all CVD (mean follow-up 16
+
4 years), hard CVD (17
+
3 years), hard CHD (17
+
3 years), and all-cause mortality (18
+
2 years).

Results:
The youngest age quartile (45-53-years-old) with higher dp-ucMGP levels (520-2934 pmol/L) had an increased risk of all CVD (HR 3.01 [95% CI 1.56, 5.80], p=0.001), hard CVD (HR 2.78 [95% CI 1.29, 6.02], p=0.009), hard CHD (HR 3.37 [95% CI 1.29, 8.81], p=0.013) and all-cause mortality (HR 2.69 [95% CI 1.06, 6.79], p=0.037) compared to dp-ucMGP levels between 150-519 pmol/L in maximally adjusted models. There was no relationship with any outcomes for the other age quartiles (Table).

Conclusions:
Middle aged individuals with elevated dp-ucMGP levels (
>
520 pmol/L) had an increased risk of incident CVD, CHD, and all-cause mortality.