bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4141513: Effect of Dapagliflozin on Cardiovascular Outcome in Patients With Acute Myocardial Infarction; a Systematic Review and Meta-analysis
Authors: Shrestha Abhigan , Afroze Tanzina , Shrestha Sajina , Jaiswal Vikash , Kadariya Suman , Goyal Aman , Edara Ravi Sankar Reddy
Published: November 2024

Background:
The beneficial effect of SGLT-2 inhibitors in managing type 2 diabetes mellitus and heart failure with reduced ejection fraction has already been established. However, the outcomes of dapagliflozin on cardiovascular events in patients with acute myocardial infarction are not well studied.

Hypothesis:
Our study aims to investigate the effect of dapagliflozin in reducing cardiovascular events among patients with acute myocardial infarction.

Methods:
A systematic search was conducted using multiple electronic databases from inception until March 2024 using the appropriate Mesh terms, “ dapagliflozin,” “SGLT 2 inhibitors,” “acute myocardial infarction,” “heart failure,” “major cardiovascular events,” “all-cause mortality.” We used the random effect model to calculate the pooled relative risk and their corresponding confidence interval. A p-value of <0.05 was considered statistically significant.

Results:
A meta-analysis was conducted using 5 studies that included 9321 patients (Dapagliflozin: 4404 and Placebo: 4917) with a mean age of 62.46 and 63.26 years respectively. Out of these, four studies included DM with heart failure patients and one study without DM and Heart failure patients. The average follow-up was 21.5 years. Pooled analysis showed that dapagliflozin is associated with a lower risk of acute kidney injury (RR 0.52, 95%CI: 0.12-0.92 p<0.001). However, no statistically significant difference was noticed in reducing all-cause mortality rate (RR 0.73, 95% CI 0.32-1.14, p=0.09), major cardiovascular events (RR, 0.73, 95% CI 0.44-1.02, p=0.27), cardiovascular mortality rate (RR 0.95, 95% CI 0.70-1.20, p=0.54), stroke (RR 0.80, 95% CI 0.50-1.09, p=0.69), and serious adverse events (RR 1.00, 95%CI: 0.88-1.13, p=0.95).

Conclusion:
Dapagliflozin was associated with a lower risk of acute kidney injury. However, the risk of major cardiovascular events, and cardiovascular mortality rate were comparable between both groups of patients.
Abstract 4141516: Cross-species single-cell RNA sequencing reveals divergent phenotypes and activation states of adaptive immunity in human carotid and experimental murine atherosclerosis
Authors: Horstmann Hauke , Anto-Michel Nathaly , Sheng Xia , Winkels Holger , Hilgendorf Ingo , Gerhardt Teresa , Zernecke Alma , Kohl Peter , Foks Amanda , Westermann Dirk , Zirlik Andreas , Wolf Dennis
Published: November 2024

Background and Aims:
The distinct functions of immune cells in atherosclerosis have been mostly defined by preclinical mouse studies. Contrastingly, the immune cell composition of human atherosclerotic plaques and their contribution to disease progression is only poorly understood. It remains uncertain whether genetic animal models allow for valuable translational approaches.

Methods and Results:
Single cell RNA-sequencing (scRNA-seq) was performed to define the immune cell landscape in human carotid atherosclerotic plaques. The human immune cell repertoire demonstrated an unexpectedly high heterogeneity and was dominated by cells of the T-cell lineage, a finding confirmed by immunohistochemistry. Bioinformatical integration with 7 mouse scRNA-seq data sets from adventitial and atherosclerotic vascular tissue revealed a total of 51 identities of cell types and differentiation states, of which some were only poorly conserved between species and exclusively found in humans. Locations, frequencies, and transcriptional programs of immune cells in mouse models did not resemble the immune cell landscape in human carotid atherosclerosis. In contrast to standard mouse models of atherosclerosis, human plaque leukocytes were dominated by several T-cell phenotypes with transcriptional hallmarks of T-cell activation and memory formation, T-cell receptor-, and pro-inflammatory signaling. Only mice at the age of 22 months partially resembled the activated T-cell phenotype. In a validation cohort of 43 patients undergoing carotid endarterectomy, the abundance of activated immune cell subsets in the plaque defined by multi-color flow cytometry associated with the extend of clinical atherosclerosis.

Conclusions:
Integrative scRNA-seq reveals a substantial difference in the immune cell composition of murine and human carotid atherosclerosis – a finding that questions the translational value of standard mouse models for adaptive immune cell studies. Clinical associations suggest a specific role for T-cell driven (auto-) immunity in human plaque formation and -instability.
Abstract 4141522: VTRNA 2-1 Promoter Methylation and HDL as Predictors of Excess Weight Loss After Bariatric Surgery: The Influence of Maternal Nutrition
Authors: Huang Yi-Chun , Wang Chao-Yung , Tsai Ming-lung
Published: November 2024

Background:
Maternal nutritional status and periconceptional environmental conditions have been previously linked to the methylation of the vtRNA 2-1 promoter. Bariatric surgery is an effective treatment for morbid obesity, with most patients achieving significant weight control within 1-2 years post-surgery. However, some patients do not experience the desired weight loss. The clinical correlation between the methylation of the vtRNA 2-1 promoter and postoperative outcomes in obese patients remains unclear. This study aims to elucidate the relationship between the methylation of the vtRNA 2-1 promoter and the effectiveness of bariatric surgery.

Hypothesis:
The degree of methylation of the vtRNA 2-1 promoter is related to excess weight loss (EWL) after bariatric surgery.

Methods:
The OCEAN registry (Obesity and Clock for Elegant AgiNg) is a prospective cohort study collecting data from 2011 to 2017, including 381 obese patients, 179 of whom underwent bariatric surgery. Quantitative pyrosequencing was performed on all patients. Postoperative weight and EWL were tracked and recorded at 3, 6, 12, and 24 months. Statistical analyses were conducted using SPSS.26.

Results:
The degree of methylation of the vtRNA 2-1 promoter shows a bimodal distribution. Compared to the normal group from the Taiwan Biobank, the methylation distribution between the two groups differs significantly. Patients were categorized into hypomethylation (≤10%), intermediate-methylation (10-40%), and hypermethylation (≥40%) groups. Statistics indicate that hypermethylation is associated with higher EWL at one year (p=0 .047) and two years (p=0.04) post-surgery compared to the hypomethylation group. In the linear regression model, after controlling for variables including age, creatinine, cholesterol, TG, LDL, AC sugar and HbA1c, our analysis revealed a positive correlation between HDL and one year EWL.

Conclusion:
Obese patients who have hypermethylation of the vtRNA 2-1 promoter demonstrate improved EWL one and two years following bariatric surgery. Given the previous links between the methylation of the vtRNA 2-1 promoter and maternal nutritional status, these findings suggest that early life nutritional factors may influence the effectiveness of bariatric surgery outcomes. Further comprehensive and long-term studies are needed to confirm the methylation of the vtRNA 2-1 promoter as a viable indicator for predicting bariatric surgery outcomes and improving cardiovascular health.
Abstract 4141523: Human-Centered Design to Tailor Telehealth Cardiac Rehabilitation to Diverse Populations: The MCNAIR Study
Authors: Oanesa Rae Denise , Atluri Namratha , Z Ali Yehia , Khoury Shireen , Lageza Vanessa , McNair Patricia , Merritt Greg , Mishra Sonali , Forman Daniel , Spaulding Erin , Brewer LaPrincess , Golbus Jessica , Martin Seth , Nallamothu Brahmajee , Beatty Alexis
Published: November 2024

Background:
Delivering cardiac rehabilitation (CR) by telehealth may increase participation and promote equitable access to CR. Our objective was to tailor a patient-centered telehealth CR program to diverse populations.

Methods:
We recruited participants with varying CR experience (e.g. attended >1 session, did not attend CR, and caregivers) between January and September 2023 from four US academic medical centers. Participants engaged in human-centered design sessions on CR perspectives and a proposed telehealth CR program. Sessions were qualitatively analyzed using rapid template analysis with pre-selected behavioral science constructs and other emergent codes. Based on participant feedback, we iteratively revised the telehealth CR program and created an implementation toolkit.

Results:
Among 21 participants (76% ≥65 years, 50% female, 60% non-Hispanic White; 90% attended >1 session, 10% caregiver of a CR participant, 5% prefer not to answer), CR was overall regarded as valuable. Benefits included accountability, confidence, and feeling better. Social support was appreciated from family, friends, program co-participants, and CR staff. Participants emphasized the importance of early goal setting, accountability, and program individualization. Participants thought that using technology for telehealth CR could be helpful for accountability, facilitating relationships, and convenience. However, some participants had concerns about safety, especially at the start of their telehealth program, and desired checks such as a monitoring device or observation of exercise over video. Through human-centered design, safety protocols and technology training were developed, which participants thought addressed their concerns about participating in telehealth CR. The implementation toolkit informed by human-centered design included a participant journey, safety plan, home exercise plan for use during and after CR, and scripts for technology training and telehealth visits. Selected quotes are presented in Figure 1.

Conclusions:
We developed a patient-centered telehealth CR program and implementation toolkit. Future research will test the comparative effectiveness of in-person and telehealth CR on patient-centered outcomes.
Abstract 4141541: Disparities in Achieving LDL-C Goals After Revascularization in a Diverse Real-World Cohort
Authors: Greenberg Garred , Lorenzatti Daniel , Filtz Annalisa , Jaspan Vita , Park Christine , Kalich Bethany , Kathe Niranjan , DiPalo Katherine , Browne Constance , Lipsitz Evan , Forest Stephen , Scotti Andrea , Latib Azeem , Garcia Mario , Rodriguez Carlos , Gulati Martha , Slipczuk Leandro
Published: November 2024

Background:
Guidelines and large clinical trials support the cardiovascular benefits of low-density lipoprotein cholesterol (LDL-C) testing and treatment with lipid-lowering therapies (LLT).

Research Questions:
What characteristics influence attainment of guideline recommended LDL-C goals in patients undergoing coronary (CAD) or peripheral arterial (PAD) revascularization?

Goals:
We analyzed the rates of LDL-C testing within 6 months and LDL-C goal attainment (<70 mg/dL) in a cohort of patients undergoing CAD or PAD revascularization.

Methods:
We retrospectively analyzed 8,172 patients from a large health network who underwent percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or peripheral artery revascularization from 2018-2023. Patients without follow-up LDL-C testing >30 days after revascularization were excluded. The associations between clinical variables and LDL-C goal attainment were assessed with logistic regression analysis.

Results:
Only about half of the patients (4,319) had LDL-C tests >30 days after their revascularization and were included in the analysis. The median age was 68 years, 2,729 (63%) were male, 1,848 (43%) were Hispanic, 928 (21%) were non-Hispanic Black and 663 (15%) were non-Hispanic White. Overall, 3,373 (78%) patients underwent PCI, 857 (20%) CABG, and 89 (2%) PAD revascularization. Median time to follow-up testing was 11 months
(Panel A).
Those with earlier follow-up testing, <6 months (35%), had higher utilization of high-intensity statins, ezetimibe, and PCSK9 inhibitors. A follow-up LDL-C <70 mg/dL was achieved in 2,259 (52%) patients with 1,294 (30%) having LDL-C <55 mg/dL
(Panel B).
Female sex, non-Hispanic Black race/ethnicity, presence of obesity and longer time to LDL-C testing were independently associated with a lower likelihood of achieving LDL-C <70 mg/dL after multivariable adjustment
(Panel C)
.

Conclusions:
LDL-C testing and guideline recommended goal attainment were low and female, non-Hispanic Black patients and those with obesity were less likely to reach optimal LDL-C values. Future preventive efforts must focus on efficiently standardizing and implementing an approach to LDL-C testing and lowering after revascularization.
Abstract 4141547: Dietary Branched Chain Amino Acids Modify Post-Infarct Cardiac Remodeling and Function in the Murine Heart
Authors: Nguyen Daniel , Wells Collin , Taylor Madison , Brittian Kenneth , Brainard Robert , Hill Bradford
Published: November 2024

Introduction:
Branched chain amino acids (BCAAs) are essential amino acids that are elevated in the failing heart and that have been linked with cardiovascular disease risk. Yet, it remains unclear how BCAAs influence the heart after injury. In this study, we examined in mice whether dietary alterations of BCAA levels influences cardiac structure and function after myocardial infarction (MI).

Methods and Results:
To assess whether altering dietary BCAA levels would impact circulating BCAA concentrations, mice were fed a low (1/3×), normal (1×), or high (2×) BCAA diet over a 7-day period. The low and high BCAA diets were matched for macronutrient content, nitrogen content, and caloric density. We found that mice fed the low BCAA diet had >2-fold lower circulating BCAA concentrations when compared with normal and high BCAA diet feeding strategies (n=8/group; p<0.05); notably, the high BCAA diet did not further increase BCAA levels over the normal chow diet. To investigate the impact of dietary BCAAs on cardiac remodeling and function after MI, male and female mice were fed either the low or high BCAA diet for 2 wk prior to MI and for 4 wk after MI. Although body weight (BW) or heart mass (HW/TL) were not different in female mice fed the custom diets, male mice fed the high BCAA diet had higher BW and HW/TL than those on the low BCAA diet (n = 7–10/group; p<0.05). Echocardiography prior to MI (baseline) and at 2- and 4-wk post-MI revealed that the low BCAA diet preserved stroke volume (SV) and cardiac output (CO), whereas mice fed a high BCAA diet showed progressive decreases in SV and CO, which reached statistical significance by 4 wk post-MI (p<0.05). Structural analysis further demonstrated higher LV mass in mice fed the high BCAA diet compared with the low BCAA diet (n = 7–10/group; p<0.05). Although no differences in cardiac fibrosis or cardiomyocyte cross-sectional area were found between the dietary groups, male mice fed the high BCAA diet showed longer cardiomyocytes and higher capillary density compared with the low BCAA gorup (n = 6-10/group; p<0.05).

Conclusions:
These preclinical results demonstrate that dietary BCAA levels influence cardiac structure and function after MI and suggest that a diet low in BCAAs minimizes deleterious remodeling, especially in male mice.
Abstract 4141555: Impact of multiple cardiovascular events on mortality and bleeding risks in Asian acute coronary syndrome patients: a nationwide population-based cohort study
Authors: Chen Chih-Wei , Lin Yi-cheng , Chang Chia-Li , Huang Chun-Yao , Shao Yu-Hsuan , Hsu Chien-Yi
Published: November 2024

Introduction:
Patients with acute coronary syndrome (ACS) face significant risks of recurrent cardiovascular (CV) events and bleeding complications. These bleeding risks are particularly pronounced in Asian populations, who may have a higher predisposition to bleeding complications due to genetic and physiological factors. This study aims to compare the long-term outcomes and characteristics of ACS patients who experienced only a single ACS event with those who had multiple CV events.

Methods:
Utilizing Taiwan's National Health Insurance Research Database, this retrospective cohort study categorized patients into single-event and multiple-event groups based on the occurrence of major adverse cardiovascular events within two years after index ACS. In this cohort study, 28,535 patients were considered. After 1:2 matching by age, sex, and interval between the first and second CV events, the final cohorts included 8,720 patients in the multiple-event group and 17,368 in the single-event group.

Results:
The multiple-event group had higher rates of comorbidities, including hypertension, prior coronary artery disease, heart failure, stroke, atrial fibrillation, peripheral vascular disease, and chronic kidney disease. Over a 5-year period, the multiple-event group exhibited higher all-cause mortality (34.1% vs. 24.6%, p < 0.0001) and CV mortality (11.4% vs. 6.2%, p < 0.0001) compared to the single-event group. Non-CV deaths (22.7% vs. 18.3%, p < 0.0001) and major bleeding events (7.8% vs. 1.6%, p < 0.0001) were also more frequent in the multiple-event group, as were minor bleeding events (34.4% vs. 7.2%, p < 0.0001). Additionally, we found that compared to the single-event group, which showed a significant decrease in major bleeding events after one month from the index ACS, the multiple-event group continued to have a higher rate of major bleeding events within three months following the index ACS. A previous major bleeding event in the multiple-event group was linked to earlier subsequent CV events, with each day preceding of the major bleeding advancing the CV event onset by 1.0044 days.

Conclusion:
ACS patients with multiple CV events have higher rates of all-cause mortality, CV mortality, and major bleeding compared to the single-event group. However, major bleeding events may be associated with subsequent CV events, highlighting the importance of implementing a tailored antiplatelet strategy in Asian populations.
Abstract 4141561: Impact of Snowfall on Emergency Medical System and In-hospital Mortality in Patients with Acute Coronary Syndrome
Authors: Mori Yuki , Nagai Toshiyuki , Takenaka Sakae , Saiin Kohei , Takahashi Akinori , Mizuguchi Yoshifumi , Konishi Takao , Yamazaki Seiji , Kamigaki Mitsunori , Hotta Daisuke , Kawahatsu Kandoh , Fujita Tsutomu , Yamashita Takehiro , Anzai Toshihisa , Makino Takao
Published: November 2024

Background:
Acute coronary syndrome (ACS) requires rapid transportation by the emergency medical system (EMS) and emergent percutaneous coronary intervention (PCI). In snowy areas, traffic conditions due to snowfall may delay EMS transport times and increase short term mortality of ACS. However, there is a paucity of data showing how snowfall affects the EMS and clinical outcomes in patients with ACS. We sought to investigate the impact of snowfall on the EMS transport time and in-hospital mortality in patients with ACS.

Methods:
We examined 2,387 consecutive ACS patients who were transported via EMS to 29 acute cardiac care facilities in Sapporo city (fifth largest in Japan) between April 2013 and March 2023. The patients were divided into two groups according to hospital arrival at snowy or non-snowy day.

Results:
The median age was 68 years, 1,754 (74.6%) patients were male, and 34.9%, 70.1%, and 69.2% had diabetes mellitus, hypertension, and dyslipidemia, respectively. There were no significant differences in gender, Killip classification, blood pressure, heart rate, or laboratory findings between the groups. Patients in snowy day group had longer time from EMS call to hospital arrival than those in non-snowy day group (33 [26–40] vs 29 [24–36] min,
P
<0.001). Quantity of snowfall was associated with a delayed time from EMS call to hospital (
Figure
). The proportion of emergent PCI and door-to-balloon time were similar between the groups. In-hospital death occurred in 125 patients (5.3%). The proportion of in-hospital death was higher in snowy day group compared to non-snowy day group (4.6% vs. 7.3%,
P
= 0.011). The snowfall was independently associated with a higher incidence of in-hospital death (
Table
).

Conclusions:
The snowfall was significantly associated with prolonged transfer time in EMS and higher in-hospital mortality in patients with ACS. These findings are relevant for developing traffic obstacles prevention strategies and ensuring timely treatment.
Abstract 4141570: In-hospital cumulative exposure of inflammation reflect the prognosis of patients with myocardial infarction with nonobstructive coronary artery disease
Authors: Huang Sizhuang , Yu Mengyue , Fang Yanwen , Liang Hanyang
Published: November 2024

Background:
Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is a special syndrome with clear evidence of myocardial ischemia, but no clear stenosis of coronary artery imaging sign. Inflammation is closely related to the prognosis of such diseases. This study focuses on the correlation between cumulative exposure of inflammation during the hospital stay period and the prognosis of MINOCA patients.

Methods:
This study was a single-center, prospective cohort study. Patients who underwent coronary angiography and diagnosed with MINOCA in Fuwai Hospital from January 2015 to December 2019 and met the inclusion criteria were enrolled. We mainly explored the correlation between the in-hospital cumulative exposure of inflammation (calculated as the area under the highly sensitive CRP(mg/L)-time(days) curve) and long-time outcomes of MINOCA.Patients had their blood hsCRP levels tested at least twice during their hospital stay. Kaplan-Meier analyses and Cox regression analyses were performed to evaluated survival rate of patients and hazard ratio during a 77.2-month follow-up. ROC analyses were also adapted in this study to detect the best cut-off value for

Results:
A total of 890 MINOCA patients were enrolled, including 148 (16.6%) with major adverse cardiovascular events (MACEs). Patients in higher quartile group of cumulative exposure to inflammation had an apparently higher rate of MACE during the follow-up time. After adjusted for multiple clinically relevant variables, higher cumulative exposure of inflammation was still associated with an increased risk of MACE (HR=1.79; 95% CI: 1.08-2.92 P<0.001). Moreover, AUC of hsCRP(mg/L)-time(days) had an AUC of 0.72 for MACE prediction with the best cut-off value of 6.36mg*L
-1
*d, higher than that of peak hsCRP (AUC 0.64).

Conclusions:
Inflammation is closely related to the development of disease and adverse events in patients with MINOCA. Cumulative exposure of inflammation during the hospital stay period have better predictive value than single peak-hsCRP index. Routine assessment of hsCRP and AUC of hsCRP-time data may help this specific population benefit from the prognostic information or even guiding the timely initiation of anti-inflammatory treatment.
Abstract 4141584: Associations of the Glasgow Prognostic Score with Adverse Outcomes in Patients with Acute Coronary Syndrome and Atrial Fibrillation
Authors: Liang Hanyang , Han Zhang , Shao XingHui , Wang Juan , Wu Shuang , Lyu Si-qi , Xu Wei , YANG YANMIN
Published: November 2024

Introduction:
Glasgow Prognostic Score (GPS), including c-reactive protein and albumin, has been used to assess inflammatory status in many diseases. The aim of this study was to evaluate the associations of GPS on prognosis in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF).

Methods:
We conducted a prospective observational study and consecutively recruited 1153 patients with AF combined with ACS. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs). Three multivariable adjusted Cox proportional hazards models were performed to evaluate the associations between GPS and endpoints.

Results:
Patients were divided into 3 groups: GPS=0 (c-reactive protein≤10mg/L and albumin ≥35g/L, n=812), GPS=1 (c-reactive protein >10mg/L or albumin <35g/L, n=264), GPS=2 (c-reactive protein >10mg/L and albumin <35g/L, n=77). During a median follow-up of 34.0 months, log-rank analysis showed that higher GPS was associated with decreased overall survival (P<0.001, Figure 1A) and a higher incidence of MACCEs (P<0.001, Figure 1B). After adjustment for confounders including demographics, comorbidities, and treatments, multivariable Cox models showed that GPS=1 was independently associated with increased risk of all-cause mortality and MACCEs (Table 1).

Conclusions:
Hypoalbuminemia or elevated c-reactive protein is independently associated with worse prognosis in patients with ACS and AF, suggesting that inflammatory status plays an important role in the prognostic assessment of ACS patients with AF.
Abstract 4141614: Reducing the Risks of Complex Pediatric Cardiovascular Surgery using Glucagon-Like Peptide 1 Peptides
Authors: Lao Robert , Kobayashi Yasuyuki , Stanisic Anamaria , Hui Wei , Deng Mimi , Kadowaki Sachiko , Siraj M. Ahsan , Lamba Manya , Li Jing , Friedberg Mark , Husain Mansoor , Honjo Osami
Published: November 2024

Background:
Children with critical congenital heart disease (CHD) often require complex open-heart surgery with long aortic cross-clamp times (XC). Despite refinement in cardioplegia, ventricular dysfunction due to inadequate myocardial protection remains a major clinical challenge. Glucagon-like peptide-1 (GLP-1) has proven cardioprotective properties. This study characterizes the mechanisms of injury of long XC and investigates cardioprotective properties of GLP-1(28-36), a naturally occurring fragment of GLP-1.

Method&Results:
A pediatric surgical model of cardiopulmonary bypass and long XC was developed in 4-5 wk-old Yorkshire pigs. Pigs were subjected to 90-min XC (modelling common CHD repair, e.g. Tetralogy of Fallot) or 180-min XC (modelling complex CHD repair, e.g. corrected transposition). After 90-min XC [n=8], analysis of cardiac function at baseline vs. 2-h post-bypass revealed reduced ejection fraction (55±6% vs. 28±4%; P<0.001) and global longitudinal strain (-11.5±1.5% vs. -6.8±1.2%; P<0.001). Levels of arterial lactate (0.6±0.1 vs. 3.9±0.8 mmol/L; P<0.001), myeloperoxidase (MPO: 39±4 vs. 124±28 ng/mL; P<0.001) and cardiac Troponin-I (cTnI: 0.01±0.01 vs. 4.8±0.6 ng/mL; P<0.001) indicate metabolic- and oxidative-stress and cardiomyocyte injury. Markedly reduced survival after 180- vs. 90-min XC (37.5% vs. 100% survival; n=8/group, P<0.05) was accompanied by more profound cardiac dysfunction, metabolic- and oxidative-stress, and cardiomyocyte injury in pigs surviving 180-min XC. Untargeted plasma metabolomics reveal XC time-dependent signatures (
Figure 1
). Adding GLP-1(28-36) vs. control SCRAM(28-36) [30nM; n=8/group] to cardioplegia during 90-min XC caused longer time to first heart beat following XC (165±21 vs. 59±7 sec; P<0.001), with markedly reduced oxidative stress (MPO: 74±19 vs. 131±30 ng/mL; P<0.01) and cardiomyocyte injury (cTnI: 1.9±0.4 vs. 5.1±0.7 ng/mL; P<0.001).

Conclusions:
In a new model of long XC designed to simulate pediatric surgical repair of common and complex CHD, we demonstrate time-dependent cardiac dysfunction correlating with metabolic- and oxidative-stress and cardiomyocyte injury. Treatment with GLP-1(28-36) reduced injury and may mediate this by inducing hibernation.
Abstract 4141624: The inadequacy of Physician’s Knowledge of Iron Deficiency Anemia in Heart Failure
Authors: Bess Olva , Tung George , Toral Lama Alejandro
Published: November 2024

Introduction:
It is estimated that about 30% of patients with heart failure (HF) have iron deficiency anemia that can be masked as chronic normocytic anemia or functional anemia. Currently, the ACC/AHA 2022 heart failure guidelines give IV Iron replacement a Class IIa recommendation. However, many physicians who are regularly involved in the management of HF patients do not assess for or adequately treat iron deficiency anemia in these patients. This project seeks to identify the gaps in physicians’ knowledge on iron deficiency anemia and HF.

Method:
Over a 2-week period, a 9-item questionnaire was given to a total of 52 Internal Medicine physicians: 9 attendings, 27 residents (2nd and 3rd year) and 16 interns (1st year residents) chosen by convenience sampling. The participants at that time, were regularly involved in the care of patients with HF at a Brooklyn inter-city community Hospital. Data was collected and analyzed using IBM SPSS version 29 data analysis software.

Results:
All 52 participants completed the survey. When asked if all stages and classification of heart failure can be affected by iron deficiency anemia, 81.3% of interns vs 100% of both residents and attendings answered yes. However, only 18.8% of interns, 22.2% of residents and 11.1% of attendings test every patient with HFrEF <40% for iron deficiency anemia. Even though over 90% of the physicians had managed patients admitted for HF within the prior 2 weeks. Remarkably, 81.3% of interns, 59.3% of residents and 44.4% of attendings were aware that anemia in HF is an independent predictor of worsening mortality and morbidity. Iron deficiency anemia in HF diagnostic criteria of Ferritin < 100µg/L or ferritin between 100-299 µg/L with transferrin saturation < 20%, was known by 31% of interns, 40.7% of residents and 56.6% of attendings. None of the interns while 11.1% of both residents and attendings knew the recommendation of IV ferric carboxymaltose as treatment for iron deficiency anemia in HF. Responses to Stages and classification were significant at P value of 0.028.

Conclusion:
Iron deficiency anemia in HF is common, however physicians, both within and post training, are unaware of the management of iron deficiency anemia according to the 2022 heart failure guidelines. the study's statistical power can be improved with increased participants. More physician education is needed on Iron Deficiency anemia and Heart Failure with aim of improving patient care.
Abstract 4141627: Not The Corona You Wish For After a Successful Atrial Fibrillation Ablation!
Authors: Krayem Hussein , Shaikh Rafae , HENDRIX MACK , Huizar Jose , Tan Alex , Ellenbogen Kenneth , KASZALA KAROLY
Published: November 2024

Background:
Corona mortis artery or ring of death, is a common variant (25-30%) vascular anastomosis between the obturator artery and inferior epigastric or external iliac artery. However, injury to this vessel during EP procedures has not been described. We present a case of an inguinal hematoma secondary to arteriovenous fistula(AVF) and pseudoaneurysm of the corona mortis artery due to puncture injury during atrial fibrillation(AF) ablation.

Case:
A 71-year-old male underwent pulmonary vein isolation for persistent AF. The right femoral vein was accessed using ultrasound guidance and 3 sheaths were placed after which intravenous heparin was administered. At the end of the case, protamine was given for heparin and a figure of 8 suture was placed after sheath removal. Six hours post procedure, a soft 2.5 cm right groin hematoma was noted, that was treated conservatively with manual pressure and pressure dressing overnight. The patient was discharged home next day but returned one week later with continued groin pain and swelling. Examination revealed a moderate groin hematoma, ecchymosis and a loud right femoral bruit. Duplex ultrasound demonstrated a fistula between the right external iliac artery and vein with potential pseudoaneurysm at the fistula site. CT angiogram of the abdomen and pelvis showed a pseudoaneurysm of a distal branch of the external iliac artery arising from the inferior epigastric artery and an AVF (Fig 1a). Selective arteriogram was performed via left groin access, which confirmed the above findings as a result of injury to the corona mortis (Fig 1b). Coil embolectomy of the right inferior epigastric artery and the obturator branch up to the respective origins was performed with resolution of the fistula (Fig 1c). The patient was discharged home and oral anticoagulation therapy was restarted 24 hours later. He recovered well with no further sequelae.

Discussion:
The corona mortis artery is a common vascular variant which may be a source of bleeding complications during groin injury or during vascular groin access. Familiarity with this variant allows its consideration in the differential diagnosis of post procedural groin hematoma which ensures rapid diagnosis and appropriate management.
Abstract 4141636: Ventricular Arrhythmia Risk in Repaired Tetralogy of Fallot: Implications of Prior Pulmonic Valve Interventions
Authors: Sonderman Mark , Johnson Bryce , Bevan Graham , McDonagh Rosemary , Pistner Andrew , Krieger Eric , Akoum Nazem , Chatterjee Neal , Robinson Melissa , Nazer Babak
Published: November 2024

Background:
Ventricular tachycardia (VT) is common in adult patients with repaired Tetralogy of Fallot (rTOF). The majority of VT originates from 1 of 5 arrhythmogenic slowly conducting anatomic isthmuses (SCAI) that exist between non-conducting anatomic and surgical borders. Catheter and surgical ablation of spontaneous VT, as well as of inducible VT at time of risk stratification electrophysiologic study (EPS), frequently target SCAI. The effects of prior pulmonary valve (PV) interventions on the prevalence of SCAI is unknown.

Aims:
We sought to quantitate differences in the prevalence of SCAI and VT inducibility based on prior PV interventions. This may help identify patients more or less likely to benefit from risk stratification EPS.

Methods:
We compared patients with rTOF who underwent EPS with electroanatomic mapping for either clinical history of spontaneous VT (n=22) or risk stratification (n=60). Patients were divided in 4 groups based on presence of: RV-PA conduit, prior surgical PV replacement, prior transcatheter PV replacement, or no PV intervention after initial repair. We described the presence of SCAI, VT inducibility prior to ablation, and rates of ablation success among patients in these groups.

Results:
SCAI were more frequently identified in patients undergoing VT ablation than risk stratification (91% vs 53%, p=0.004). Among risk stratification patients, SCAI were present in 37% of patients with prior PV interventions versus 66% of patients without (p=0.04). Prior RV-PA conduit and surgical PV replacement frequently had dense, inexcitable scar in isthmuses 2-4, but SCAI were still present in 36% of these patients even without a history of VT. There was no significant difference in incidence of pre-ablation VT inducibility (7% vs 15%, p=0.60) or SCAI ablation success (87% vs 96%, p=0.47) between patients with prior PV interventions and those without.

Conclusion:
Compared with patients with no prior PV interventions, those with prior interventions were less likely to have SCAI due to pre-existing scar in isthmuses 2-4, but SCAI still remained frequent and was ablated successfully at a similar rate. The presence of prior PV interventions should not influence the decision to pursue risk stratification EPS.
Abstract 4141657: Lipoprotein Apheresis improves HDL Proteomics and reduces the risk of Aortic Stenosis in patients with elevated Lipoprotein(a) levels and Familial Hypercholesterolemia
Authors: Moriarty Patrick , Safarova Maya
Published: November 2024

Background:
The prevalence of calcific valve stenosis (CAVS) in familial hypercholesterolemia (FH) is 30-40%. Eleveated Lp(a) levels independently promotes faster progression of CAVS. Low HDL particles (HDL-P), increase apoC3 and serum amyloid A (SAA)-bound HDL are associated with long-term incidence and progression of CAVS.

Aim:
Dextran-sulfate-adsorption lipoprotein-apheresis (LA), the only LA device available in the United States, reduces LDL-C and Lp(a) by an average of 60%-80% via binding positive-charged apolipoprotein B to a negative-changed environment. Despite the negative charge of HDL-C, it is acutely reduced by 10%-20%. However, the total HDL-P number, as measured by nuclear magnetic resonance testing, is increased by an average of 16% following LA therapy. We hypothesized that regular LA may improve cardiovascular outcomes and slow the progression of CAVS via its effects on HDL functionality and Lp(a) levels.

Methods:
This case series describes 39 Caucasian patients (mean age 61 years, 70% female, 80% statin intolerant) with FH and/or elevated Lp(a) (Liposorber LA-15, Kaneka) over a mean treatment period of 4.8 years, as compared to an average of 5.3 years pre-treatment. Pre-treatment LDL-C and Lp(a) levels were 144 mg/dL (range, 35-314) and 167 nmol/L (range 2-530). HDL proteomic analysis was performed to identify numerous proteins and lipids segregated into distinct subclasses. Major adverse cardiovascular events were defined as: MI=myocardial event, PCI=percutaneous cornary intervention, CABG=coronary artery bypass surgery, TIA=transient ischemic attack, CAVS=calcific artic stenosis.

Results:
LA therapy reduced mean LDL-C to an average of 40 mg/dL and Lp(a) to 24nmol/L, while total HDL-C was lowered by 14%. Extra small and small-sized HDL-P was reduced by 42% and 20%, respectively (P<0.001). Medium-sized HDL-P increased by 12% (P<0.001). We observed significant modifications in the HDL-bound proteins (Table 1). There was an 88% reduction in major adverse cardiovascular events, with no patient developing CAVS (Table 2).

Conclusions:
In patients with FH and/or elevated Lp(a) with established ASCVD, LA effectively lowered the incidence rate of cardiovascular events. LA selectively reduced pro-inflammatory apoC3- and SAA-bound HDL and increased HDL-P, potentially explaining the lack of development and progression of CAVS in patients with elevated Lp(a). This observation merits further investigation with a dedicated controlled clinical study.
Abstract 4141695: Empagliflozin reduces both infarct size and no-reflow in a rat experimental myocardial ischemia/reperfusion model
Authors: Dai Wangde , Carreno Juan , Pahlevan Niema , Alavi Rashid , Chavez Jesus , Kloner Robert
Published: November 2024

Background:
Whether acute administration of empagliflozin (EMPA)
,
a sodium glucose cotransporter-2 could reduce myocardial infarct size is controversial. Its effect on no-reflow is unknown. We determined whether intravenous administration of EMPA at 10 min before coronary occlusion combined with 1 min prior to reperfusion, could limit myocardial infarct (MI) size and the no-reflow phenomenon compared to chronic therapy in a standardized rat model.

Methods:
Male SD rats were randomized into 3 groups (n = 13 in each group): (1) Control group: rats were fed diet without EMPA; (2) Acute treatment group: EMPA was given intravenously through the jugular vein at 10 minutes prior to coronary artery occlusion (10 mg/kg) and repeated at one minute prior to reperfusion; (3) Chronic treatment group: EMPA was administrated to the rats by food (20 mg/kg) for 7 days before myocardial ischemia. The coronary artery occlusion was maintained for 30 minutes followed by 3 hours of reperfusion.

Results:
The ischemic risk area (blue dye technique) was comparable among the 3 groups. MI size (Triphenyl tetrazolium staining) as percent of risk zone was significantly reduced in both acute EMPA treated group (46.9 ± 2.0%) and chronic EMPA group (48.8 ± 5.8%) compared to the control group (70.0 ± 2.6%; p = 0.005, figure A). No-reflow size (thioflavin S technique) as percent of risk zone was significantly smaller in the acute EMPA treated group (36.3 ± 3.3%) and chronic EMPA group (33.9 ± 4.3%) compared to the control group (53.4 ± 3.3%; p = 0.012, figure B).

Conclusions:
Both acute and chronic EMPA treatment significantly reduced infarct size. We showed for the first time that EMPA reduced no-reflow in an acute rat myocardial ischemia/reperfusion model.
Abstract 4141710: Artificial Intelligence Guided Stress Perfusion Cardiac Magnetic Resonance Versus Standard-Of-Care in Stable Chest Pain Syndromes
Authors: Reis Marques Isabela , Daibes Marianna , Bernhard Benedikt , Jerosch-Herold Michael , Heydari Bobak , Addy Okai , Powell Lori , Santos Juan , Hu Bob , Kwong Raymond
Published: November 2024

Background:
Stress perfusion CMR has excellent diagnostic and prognostic values in assessing chest pain syndromes. AI-guided methods may overcome complex scanning and increase clinical adaptation of stress CMR.

Aim:
To assess the benefits of AI-guided stress perfusion CMR.

Methods:
Consecutive patients with stable chest pain underwent stress CMR using either a standard scanning method (SOC) or an AI-assist (AIA) machine learning protocol to automate scan planning, plane prescription, sequence tuning, and image reconstruction. Scan duration, the ratio of scan preparation time over the entire scan duration, and scan quality using a 5-point scale were compared between AIA and SOC. Cox regression models were constructed to associate evidence of ischemia on stress CMR, by either scanning method, with composite endpoints including cardiovascular death, non-fatal MI, unstable angina hospitalization, and late CABG. A second composite endpoint included the performance of additional cardiac imaging tests (stress imaging and CCTA) and invasive coronary procedures after CMR.

Results:
Among 594 patients (62.8 ± 14 years), 29% underwent stress CMR with AIA. 26% had stress-perfusion ischemia, and 39% had LGE present. AIA stress CMR had lower scan duration (median 44.0 [IQR 40-47] vs. 52.5 min [IQR 46-60]; p<0.001), lower preparation time ratio (median 0.11 [IQR 0.09-0.15] vs. 0.21 [IQR 0.16-0.31], p<0.001) and a higher mean image quality score (mean 4.2±0.7 vs. 3.9±0.6; p<0.001) compared to SOC. There was a trend to a lower risk of experiencing the clinical composite endpoint and a lower need to undergo subsequent noninvasive testing among the AIA group (log-rank p=0.33 and p=0.08). Among the 152 patients with ischemia present, the incidence of invasive referral and performance of coronary revascularization within 90 days were not different.

Conclusions:
In this non-randomized observational cohort, AIA significantly improved stress CMR scan duration, preparation time ratio, and image quality compared to SOC.
Abstract 4141733: Impact of Achilles Tendon Thickening on the Long-Term Clinical Outcomes of Acute Coronary Syndrome Patients with Intensive Lipid-lowering Therapy Following Percutaneous Coronary Intervention
Authors: Fujii Subaru , NAKAO SHO , Ishihara Takayuki , Masuda Masaharu , Okamoto Shin , Nanto Kiyonori , Tsujimura Takuya , Matsuda Yasuhiro , Hata Yosuke , Uematsu Hiroyuki , Kusuda Masaya , Ariyasu Wataru , Ooka Hirotaka , Kudo Satoshi , MATSUBARA HAYA , Muroya Ryo , Mano Toshiaki
Published: November 2024

Background:
Lipid-lowering therapy (LLT) is a primary means of secondary prevention in patients with acute coronary syndrome (ACS) and the current guidelines recommend maximum tolerated statin and ezetimibe as LLT. Achilles tendon thickening (ATT) is one of the criteria for the diagnosis of familial hypercholesterolemia, which can sometimes be accompanied by ACS. However, the impact of ATT on the prognosis after ACS under the intensive LLT remains unclear.

Hypothesis:
ACS patients with ATT would have worse prognosis even with receiving intensive LLT.

Aims:
The aim of the current study was to compare the long-term prognosis of ACS patients with and without ATT.

Methods:
We retrospectively analyzed 218 patients who underwent successful percutaneous coronary intervention for ACS and received the intensive LLT with maximum tolerated doses of statins and ezetimibe at our hospital from September 2017 to May 2023. Thickness of Achilles tendon was measured on radiography, and ATT was defined as Achilles tendon ≥8.0 mm in males and ≥7.5 mm in females. The cumulative incidence of 5-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction, target vessel revascularization, and stent thrombosis, was estimated by the log-rank test and was compared between the patients with and without ATT. Hazard ratio (HR) and 95% confidence interval (CI) of ATT for MACE were estimated through a multivariable Cox model.

Results:
ATT was found in 58 patients (26.6%). The proportion of low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL was significantly lower in patients with ATT (45% vs. 77%, p<0.001). The 5-year cumulative incidence of MACE was significantly higher in patients with ATT than those without ATT (22.2% vs. 7.6%, p=0.021, Figure). Multivariate analysis showed ATT significantly impacted on the incidence of MACE (HR 3.13, 95% CI 1.18-8.31, p=0.022).

Conclusions:
ATT was associated with lower achievement rate of target LDL-C level and worse long-term clinical outcomes in patients with ACS receiving intensive LLT, which suggests more intensive lipid management including the introduction for proprotein convertase subtilisin/kexin type 9 inhibitor in patients with ATT.
Abstract 4141748: Association of Cumulative Cardiovascular Health Score Through Young Adulthood With Cardiovascular-Kidney Outcomes in Midlife
Authors: Lee Hokyou , Lee Hyeok-Hee , Kim Eun Jin , Jhee Jong Hyun , Kim Hyeon Chang
Published: November 2024

Introduction:
Little is known about cumulative cardiovascular health (CVH) measures and associated health outcomes. This gap, together with the AHA’s recent focus on cardiovascular-kidney-metabolic interactions, led to the hypothesis that greater cumulative CVH (cumCVH), through young adulthood, is associated with a lower combined risk of cardiovascular and kidney events in midlife.

Methods:
This study included 241,924 participants from the 2012-2014 Korean National Health Insurance general health screening without prior cardiovascular disease (CVD) or chronic kidney disease (CKD) at index age 40. Each participant had ≥3 examination visits: Y0 (age 30), Y10 (age 40), and ≥1 in between (median, 8 visits total). We calculated a 10-year cumCVH score as the area under the CVH score curve from age 30 to 40, using the AHA’s “Life’s Essential 8” construct (0 to 100 points per visit; cumCVH 0 to 1000 point-years; Fig A). The primary outcome was a composite of CVD events (myocardial infarction, ischemic stroke, heart failure, or death from CVD) or kidney events (high-risk CKD, kidney replacement therapy, or death from kidney disease).

Results:
Over a median follow-up of 9.2 years, 3560 cardiovascular-kidney events occurred. Participants with a higher cumCVH score by age 40 had a lower cumulative incidence of cardiovascular-kidney events in the following decade (Fig B). After adjustment, every 10 point-years of cumCVH score (i.e., 1 year lived with 10-point greater CVH) was associated with a 5.1% lower risk of cardiovascular-kidney events after age 40 (Fig C). Every 100 point-years of cumCVH score (i.e., 10 years lived with 10-point greater CVH) was associated with a 41% lower risk of cardiovascular-kidney events. The associations were similar for secondary cardiovascular-kidney outcomes (Fig D) and remained significant when adjusted for the slope of CVH change or the midlife CVH score, both of which were independently associated with the outcomes.

Conclusions:
Greater cumulative CVH through young adulthood was associated with a lower combined risk of cardiovascular-kidney events in midlife. The results underscore the importance of maintaining better early-life CVH for the prevention of cardiovascular and kidney diseases.