bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4142159: Impact of Tricuspid Regurgitation on Readmission Outcomes in Patients with Heart Failure – United States Population-Based Survey Analysis
Authors: Yousuf Muhammad , Fatima Noor , Almani Muhammad Usman
Published: November 2024

Background:
Tricuspid regurgitation (TR) is a common occurrence in patients with heart failure (HF), and its role in disease progression has gained attention in recent years. While TR can worsen the clinical outcomes in HF patients, its impact on gender, racial and socioeconomic factors remains largely unexplored. With growing evidence supporting the role of percutaneous interventions for the treatment of significant TR, understanding these disparities is more crucial than ever.

Methods:
Data was extracted from the National Readmission 2016 - 2020 Database. We used ICD-10 code I50 to identify the patients primarily admitted for HF and subdivided the cohort into two groups based on presence or absence of TR using the ICD-10 codes I36.1 and I07.1. We performed multivariable Poisson regression analysis to determine hazard ratio of 90-day HF-specific readmission in HF patients with and without TR. Subgroup analyses were performed based on (1) gender, (2) age, (3) insurance status, (4) location and teaching status of admitting hospital, and (5) patients’ household neighborhood income quartile. All the analyses were adjusted for age, gender, insurance status, Charlson co-morbidity index and hospital characteristics. STATA 16 software was used for the analysis.

Results:
Among 971,368 HF patients, 83987 (9.03%) patients without TR and 3988 (9.66%) patients with TR had a 90-day HF-specific readmission. HF patients with TR were 9% more likely to have HF-specific readmission in 90-days (HR: 1.09, 95% CI 1.03 – 1.15, p = 0.002). In the subgroup analysis, female patients (HR: 1.16, 95% CI 1.07 – 1.25, p < 0.001), patients with age > 40 years of age (HR: 1.09, 95% CI 1.03 – 1.15, p = 0.002), patients with Medicare insurance (HR: 1.09, 95% CI 1.03 – 1.16, p = 0.005), patients admitted to urban non-teaching (HR: 1.12, 95% CI 1.01 – 1.23, p = 0.024) and urban teaching hospitals (HR: 1.08, 95% CI 1.01 – 1.15, p = 0.027) and the patients belonging to the lowest (HR: 1.11, 95% CI 1.01 – 1.22, p = 0.026) and the highest household neighborhood income quartiles (HR: 1.23, 95% CI 1.08 – 1.40, p = 0.002) had higher risk of 90-day HF-specific readmission as shown in
Figure 1.

Conclusion:
In our adjusted population-based survey analysis, we observed significant gender, socioeconomic and hospital-based disparities in readmission outcomes of HF patients with TR compared to those without TR.
Abstract 4142194: Comparative Characteristics and Outcomes of Primary Compared to Glycogen Storage Disease-Associated Hypertrophic Cardiomyopathy
Authors: Desai Spandan , Roma Nicholas , Pattoli Megan , Durkin Matthew , Henstenburg Brian , Magid Lindsey , Yellapu Vikas , Miller Luke , Shirani Jamshid
Published: November 2024

Background:
Glycogen storage disease (GSD), characterized by defects in carbohydrate metabolism, may result in left ventricular hypertrophy (GSD-CM) that mimics primary hypertrophic cardiomyopathy (HCM). Differentiation of GSD-CM and HCM relies mostly on genetic testing. We aimed to evaluate differences in demographics, comorbidities and in-hospital outcomes of GSD-CM compared to HCM.

Methods:
National Inpatient Sample 2016-2021 was used to identify adults with GSD-CM and HCM using appropriate ICD codes. Logistic regression was applied to compare in-hospital outcomes.

Results:
From 2016-2021, 110 GSD-CM and 333,685 HCM adults were admitted. Most common admitting or principal diagnoses in the GSD-CM group were acute on chronic heart failure (23.8%) and pneumonia (14.3%). In comparison to HCM, GSD-CM cases were younger (44.3 -vs- 66 years), more likely to be males (66.7% -vs- 44.1%, p<0.001) and less likely to be caucasians (40.0% -vs- 67.6%, p<0.001). Most common causes of GSD were observed to be Pompe disease (50 cases) and von Gierke disease (25 cases). As shown in Table 1, despite GSD-CM cases having lower proportions of comorbidities including hypertension, diabetes mellitus, coronary artery disease, hyperlipidemia, and chronic kidney disease, GSD-CM had a longer length of stay (LOS) as compared to HCM (12.9 -vs- 5.9 days, p<0.001). GSD-CM also had a higher total hospital cost compared to HCM ($261,167 -vs- 87,246) and higher rates of in hospital complications such as mortality (4.8%-vs-3.5%, p=0.037), cardiogenic shock (9.5% -vs- 2.6%, p<0.001) and need for heart transplant (9.5% -vs- 0.2%, p=0.041).

Conclusion:
This retrospective database analysis comparing GSD-CM with HCM was indicative of higher prevalence amongst younger males and resulted in higher mortality, higher in-hospital complication rate, prolonged LOS, and increased total cost of hospitalization. While the overall proportion of GSD-CM compared to other cardiomyopathies remains low, this particular subset of patients warrants further study to better understand long-term outcomes.
Abstract 4142210: Stroke Risk in Patients with Cardioversion of Newly Diagnosed Persistent Atrial Fibrillation with and without Transesophageal Echocardiogram for Left Atrial and Left Atrial Appendage Thrombus Assessment
Authors: Dinchman Kenan , Bashour Marla , Liu Benjamin , Karim Saima
Published: November 2024

The importance of transesophageal echocardiogram (TEE) to exclude left atrial (LA) and left atrial appendage (LAA) thrombus prior to cardioversion for atrial fibrillation (AF) has been debated in patients who are anticoagulated prior to cardioversion. Despite comprehensive anticoagulation protocols, discrepancies in pharmacologic responses due to patient-specific factors such as adherence to anticoagulation, renal function, and genetics suggest that imaging studies may still be critical for patient safety. Although anticoagulation prior to cardioversion is thought to be adequate to prevent thromboembolic disease after cardioversion, there are studies to suggest imaging is always associated with lower incidence of stroke (Palla, et al., 2023). This study evaluates the impact of TEE before cardioversion on stroke reduction in a contemporary cohort of patients with persistent AF, regardless of adequate anticoagulation time.

Question:
Do patients with newly diagnosed persistent AF who receive a TEE prior to cardioversion have lower incidence of transient ischemic attack /ischemic stroke compared to those who are anticoagulated for at least four weeks without interruption and cardioverted without thrombus exclusion?

Method:
This single-center, retrospective observational study involved 454 patients (>18 years) with newly diagnosed persistent AF undergoing cardioversion. Patients were divided into two groups: those who underwent TEE before cardioversion (n=382) and those who did not receive TEE after a four-week period of uninterrupted anticoagulation. Primary outcomes measured were the incidence of stroke within one-year post-cardioversion. Secondary outcome was mortality.

Results:
The incidence of stroke was significantly lower in the TEE group, with a hazard ratio of 0.1358 (95% CI 0.06531-0.2824; p < 0.0001). Mortality rates within a year did not differ significantly between the two groups. There was no significant difference in age, race, CHADS2VASc score, INR, GFR and platelet count between the two groups based on multivariate analysis.

Discussion:
TEE prior to cardioversion in patients with newly diagnosed persistent AF significantly reduces the risk of stroke compared to cardioversion after anticoagulation alone. In aligning with the results found in earlier trials such as ACUTE and AFFIRM, this study supports the paradigm that pre-cardioversion imaging to rule out LA/LAA thrombus could be beneficial even amongst patients who have been adequately anticoagulated.
Abstract 4142312: 90-Day Readmission Rates, Predictors, and Causes of Readmission After Placement of Left Atrial Appendage Occlusion Device in Patients With history of different malignancies: National Readmission Database analysis
Authors: Quevedo Ramirez Andres , Teaima Taha , Jha Vivek , Ibarra Joshua , Soon-Shiong Raquel , Gomez Valencia Javier
Published: November 2024

Introduction:
Patients with cancer have a higher risk for both arterial and venous thromboembolism. Furthermore, this population subset has an increased risk of bleeding when treated with anticoagulation. Left atrial appendage occlusion devices (LAAODs) have emerged as an alternative to oral anticoagulation in patients at high risk for bleeding events. There is a paucity of data regarding the efficacy of LAAODs in cancer patients. In our study, we investigated the readmission rates, predictors, and causes of readmission after LAAODs placement in patients with underlying malignancy.

Methods:
The National Readmission Database for 2016, 2018, and 2020 was queried to identify hospitalized adults for LAAOD placement with a history of cancer. Multivariate logistic and linear regression analyses were used to adjust for possible confounders.

Results:
A total of 566 patients were hospitalized for LAAOD placement and had a history of different malignancies with 563 discharged alive. Within 90 days from discharge, 141 patients (25%) were readmitted. Exacerbation of Congestive heart failure (CHF) (7.9%), Sepsis (6.7%), Lower GI bleeding (4.3%), Iron deficiency anemia (3.8%), unspecified gastrointestinal hemorrhage (3.1%), and paroxysmal Atrial fibrillation (2.6 %) were most common causes of readmissions. Independent predictors of readmission included female sex (aOR 1.68, 95% CI: 1.07 – 2.63, P=0.022), acute kidney injury (aOR 4.6, 95% CI: 1.5-8.4, P=0.008), and anemia (aOR 1.71, 95% CI: 1.08-2.7, P=0.023).

Conclusion:
Predictors of readmission included female sex, anemia, and acute kidney injury during index admission. The most common causes of readmission included Exacerbation of CHF, Sepsis, Lower GI bleeding, and Iron deficiency anemia. Addressing readmission causes and predictors is needed to prevent such a high rate of readmissions after LAAODs placement in cancer patients.
Abstract 4142323: Access to Lipid-Lowering Therapies is Limited by Payer Coverage Restrictions and High Out-of-Pocket Costs on Medicare Prescription Drug Plans
Authors: Young Grant , Bansal Kannu , Riello Ralph , Faridi Kamil , Clark Katherine , Desai Nihar
Published: November 2024

Introduction/Background:
There is an urgent need to improve lipid control as one in four adults in the United States has elevated low-density lipoprotein cholesterol (LDL-C). Many non-statin lipid-lowering therapies such as ezetimibe, pro-protein convertase subtilisin-kexin type 9 inhibitors (PCSK9i), bempedoic acid, and icosapent ethyl are recommended for LDL-C and cardiovascular risk reduction, but usage remains suboptimal. Proposed barriers include payer restrictions and patient costs, but the extent of these issues for Medicare beneficiaries in the contemporary period is poorly defined.

Research Questions/Hypotheses:
To what extent do Medicare Prescription Drug Plans provide coverage or use payer management strategies to restrict access to lipid-lowering medications? What are the patient out-of-pocket expenses for these therapies?

Methods/Approach:
Plan coverage, payer restrictions, and annual out-of-pocket costs were extracted from Medicare Prescription Drug Plan files from July-September 2023. Medications studied included generic atorvastatin, rosuvastatin, and ezetimibe as well as brand-name PCSK9i, bempedoic acid, and icosapent ethyl.

Results/Data:
Among 4,754 plans, coverage of lipid-lowering therapies varied widely. Generic atorvastatin, rosuvastatin, and ezetimibe were universally covered, while branded therapies such as alirocumab and bempedoic acid were covered by only one-half and one-third of plans, respectively. Nearly all plans providing coverage placed non-generic medications in high cost-sharing tiers and required prior authorization for alirocumab (96% of plans), evolocumab (94% of plans), and bempedoic acid (93% of plans). Median annual out-of-pocket costs ranged from $71 to $147 for generic statins and ezetimibe, while patient expenses for all branded lipid-lowering therapies exceeded $1,000.

Conclusions:
Lack of coverage, widespread prior authorization requirements, and high out-of-pocket costs jeopardize access to non-generic lipid-lowering medications, and likely contribute to their low utilization in the mitigation of cardiovascular disease risk. Some cost toxicity for patients may be alleviated by the Inflation Reduction Act and additional Medicare negotiations on drug pricing, however addressing the barriers of limited coverage and payer restrictions will be paramount to improve use of these therapies.
Abstract 4142334: 90 days readmission rates, predictors, and causes of readmission in heart failure patients with history of irradiation: nationwide retrospective analysis
Authors: Teaima Taha , Quevedo Ramirez Andres , Jha Vivek , Ibarra Joshua , Soon-Shiong Raquel , Gomez Valencia Javier
Published: November 2024

Introduction:
Radiation therapy (RT) is an important part of treatment strategies in cancer patients, but it carries multiple significant cardiovascular risks. Data regarding the effects of RT in heart failure patients is limited. In our study, we investigated the readmission rates, predictors, and causes of readmission in heart failure patients with a history of RT.

Methods:
The National Readmission Database for 2018 and 2020 was queried to identify hospitalized adults with Congestive heart failure (CHF) and a history of RT. Multivariate logistic and linear regression analyses were used to adjust for possible confounders.

Results:
A total of 2,607 patients were hospitalized for acute exacerbation of congestive heart failure and had a history of RT with 2,497 discharged alive. Within 90 days from discharge, 874 (35%) were readmitted. Exacerbation of CHF with a history of CKD or hypertension (27%), Sepsis (6.6%), Pneumonia (3.1%), and acute kidney injury (2.3%) were the most common causes of readmissions. Independent predictors of readmission included presence of anemia (aOR 1.46, 95% CI: 1.1 - 1.92, P=0.007), discharge against medical advice (aOR 2.9, 95% CI: 1.07-7.97, P=0.03), and presence of atrial flutter/Fibrillation (aOR 1.36, 95% CI: 1.03-1.81, P=0.03).

Conclusion:
Predictors of readmission included discharge against medical advice, anemia, and atrial flutter/ Fibrillation. The most common causes of readmission included Exacerbation of CHF, Sepsis, Pneumonia, and acute kidney injury. Addressing readmission causes and predictors is needed to prevent such a high rate of readmission.
Abstract 4142335: Performance of a Protein Language Model for Variant Annotation in Cardiac Disease
Authors: Hochstadt Aviram , Barbahya Chirag , Aizer Anthony , Bernstein Scott , Cerrone Marina , Garber Leonid , Holmes Douglas , Knotts Robert , Kushnir Alex , Martin Jacob , Park David , Spinelli Michael , Chinitz Larry , Jankelson Lior
Published: November 2024

Introduction:
Genetic testing is a cornerstone in the assessment of many cardiac diseases. However, variants are frequently classified as Variants of Unknown Significance (VUS), limiting the utility of testing.

Recently, the DeepMind group (Google, USA) developed AlphaMissense, a unique Artificial Intelligence (AI) based model, based on language model principles for the prediction of missense variant pathogenicity.

Objective:
To report on the performance of AlphaMissense, accessed by VarCardio, an open web-based variant annotation engine, in a real-world cardiovascular genetics center.

Methods:
All genetic variants from an inherited arrhythmia program were examined using AlphaMissense via VarCard.io and compared to the ClinVar variant classification system, as well as another variant classification platform (Franklin by Genoox). The
mutation reclassification rate and genotype-phenotype concordance were examined for all variants in the study.

Results:
We included 266 patients with heritable cardiac diseases, harboring 339 missense variants. Of those, 230 (67.8%) were classified by ClinVar as either VUS or non-classified. Using VarCard.io, 198 VUSs (86.1%, CI 80.9-90.3%) were reclassified to either Likely Pathgenic (LP) or Likely benign (LB). The reclassification rate was significantly higher for VarCard.io than for Franklin (86.1% vs 34.8%, p<0.001).

Genotype-Phenotype concordance was highly aligned using VarCard.io predictions, at 95.9% (CI 92.8-97.9%) concordance rate. For 109 variants classified as Pathogenic, LP, Benign or LB by ClinVar, concordance with VarCard.io was high (90.5%).

Conclusion:
AlphaMissense, accessed via VarCard.io, may be a highly efficient tool for cardiac genetic variant interpretation. The engine's notable performance in assessing variants that are classified as VUS in ClinVar, demonstrates its potential to enhance cardiac genetic testing.
Abstract 4142337: Takotsubo Syndrome During the COVID-19 Pandemic
Authors: Chang Amanda , Wang Yi , Phillips Joseph , Liu Kan
Published: November 2024

Background:
We previously demonstrated a significantly increased inpatient mortality of COVID-19 infection-induced male Takotsubo (TTS) patients during the early pandemic period. Since then, our management of COVID-19 prevention and treatment have evolved significantly, reducing both hospitalization and mortality rates. With these advancements, we have analyzed the clinical characteristics and outcomes of reported COVD-19-associated TTS patients since the initial pandemic.

Research Question:
What are the clinical characteristics and mortality outcomes of COVID-19-associated TTS patients especially in the context of improved prevention and treatment?

Aims:
To identify clinical characteristics and outcome correlates in patients with COVID-19-associated TTS.

Methods:
We completed a systematic review of 191 patients with TTS from 95 published case reports, 13 case series, and 4 observational cross-sectional/cohort studies published from April 1, 2020 to May 1, 2024 (PubMed). We performed clustering analysis using the clinical, imaging, and inpatient mortality data of 78 patients, which categorized groups of patients based on how closely associated or similar they are relative to other groups. Following this, we applied feature analysis to identify which features contributed the most to the clustering results.

Results:
Of all TTS cases, the mean age was 64.2±16.1 with 32.9% males. A total of 122 (63.9%) had COVID-19 infection, 21 (11.0%) had COVID-19 vaccination, and 50 (26.2%) patients had other triggers (2 patients had both COVID-19 infection and a non-infectious trigger). In-hospital mortality was 28.6% (16 of 56) for males and 13.2% (15 of 114) for females (p-value = 0.01). There was no association between COVID-19 vaccine administration and in-hospital mortality (0%, 0 of 21). There were notable differences in the clinical and demographic characteristics of TTS patients before and after September 2021 based on clustering analysis. Feature analysis indicated that COVID-19-induced TTS strongly correlated with in-hospital mortality and long-term adverse outcome in male patients.

Conclusion:
More male TTS patients were found during the pandemic than is expected of the traditional TTS archetype. A triad of “male, COVID-19 infection and TTS” appears to predict higher inpatient mortality. Compared to our prior study, inpatient mortality rates for TTS COVID patients have declined for all groups. Vaccine-induced TTS is associated with a benign clinical phenotype.
Abstract 4142338: Atrial mechanical remodeling could be predictable for newly developed atrial fibrillation in patients with embolic stroke with undetermined source
Authors: Kwon Hee-Jin , KANG KI-WOON , Kim Minsu , Sun Byung Joo , Kim Jun Hyung
Published: November 2024

Background:
Atrial fibrillation (AF) has been known as a main cause of embolic stroke. Well-chosen candidate to be anticoagulated should be critical for secondary prevention in patients with embolic stroke with undetermined source (ESUS). Atrial mechanical remodeling presenting cardiomyopathy could lead to not only occur atrial fibrillation but also increase risk of thromboembolism.

Objective:
To investigate association of LA strain, and newly detected AF in patients with ESUS.

Methods:
A total of 45 patients diagnosed ESUS with implantable loop recorder (ILR) who were prospectively enrolled and clinically followed for newly developed AF for secondary prevention in the 3 referral centers. Transthoracic echocardiography including LA strain analysis were performed.

Results:
11 patients (24%) among all (mean age 67 years, 58% male) have developed newly AF and others have maintained sinus rhythm within 2 years. The mean age, proportion of hypertension and diabetes were similar between sinus rhythm and newly AF patients. LA diameter (36.3 ± 6.6 mm vs. 39.3 ± 6.0 mm) and E of E’ (11.0 ± 4.5 mm vs. 9.2 ± 1.1 mm) were also similar between two group. Even though peak and pump LA strain in the newly AF were lower than those in sinus rhythm without statistically significance (24.7 ± 6.4 vs. 22.3 ± 8.8 and 10.8 ± 3.8 vs. 9.2 ± 4.9). Pump LA strain (cut-off value9.1) was significantly associated with developing newly AF during follow-up (hazard ratio=4.8, 1.27-18.3, p=0.02)

Conclusion:
Our data demonstrated that the pump LA strain was significantly associated with developing newly AF in the ESUS. This result suggests that atrial mechanical remodeling could be predictable for newly developed AF in patients with ESUS
Abstract 4142343: My AI Ate My Homework: Measuring ChatGPT Performance on the American College of Cardiology Self-Assessment Program
Authors: Hossain Afif , Shaikh Anam , hossain sarah , Shaikh Amina , Thomas Renjit
Published: November 2024

Background:
Artificial intelligence (AI) is a rapidly growing field with promising utility in health care. ChatGPT is a language learning model by OpenAI trained on extensive data to comprehend and answer a variety of questions, commands, and prompts. Despite the promise AI offers, there are still glaring deficiencies.

Methods:
310 questions from the American College of Cardiology Self-Assessment Program (ACCSAP) question bank were queried. 50% of questions from each of the following sections were randomly selected: coronary artery disease, arrhythmias, valvular disease, vascular disease, systemic hypertension and hypotension, pericardial disease, systemic disorders affecting the circulatory system, congenital heart disease, heart failure and cardiomyopathy, and pulmonary circulation. Questions were fed into ChatGPT Legacy 3.5 version with and without answer choices and the accuracy of its responses were recorded. Statistical analysis was performed using Microsoft Excel statistical package.

Results:
Human respondents were 77.86% accurate +/- 16.01% with an IQR of 21.08% on average. Without answer choice prompting, ChatGPT was correct 57.93% and inconclusive 7.77% of the time. When prompted with answer choices, ChatGPT was correct only 20.91% and inconclusive 14.55% of the time. Additionally, an average of 55.47% +/- 35.55% of human respondents with an IQR of 73.19% selected the same answer choice as ChatGPT. Finally, on a scale of 1 to 5, with 1 being the most picked and 5 being the least picked, human respondents selected the same response as ChatGPT an average of 1.66 out of 5. 30.32% or 94 of the 310 questions contained images in the question stem. Only 0.65% or 2 out of the 310 questions contained images in the answer choices.

Conclusion:
To our knowledge, the performance of ChatGPT in the field of cardiology board preparation is limited. Our analysis shows that while AI software has become increasingly more comprehensive, progress is still needed to accurately answer complex medical questions.
Abstract 4142349: Multidisciplinary Approach to Definitive Management of Chylopericardium with Percutaneous Thoracic Duct Embolization
Authors: Ardeshna Nelish , Thakker Janki , Rana Natasha , Derbas Laith , Arslan Bulent , Soble Jeffrey , Jolly Neeraj , Attanasio Steve
Published: November 2024

Background:
Conservative management of chylopericardium with pericardiocentesis, TPN, and octreotide has a high rate of recurrence. On the other hand, surgical management is invasive and can also result in treatment failure as well. Percutaneous approach has rarely been studied in this population.

Case:
A 26-year-old female was admitted for recurrent idiopathic chylopericardium after failing management with pericardiocentesis. On presentation, echocardiogram demonstrated a 5.4 cm pericardial effusion without hemodynamic compromise. Fluid studies showed turbid white fluid with a triglyceride level of 1,622 mg/dL. A pericardial window was performed, and patient was started on octreotide with fat-free diet. However, high chylous output continued for one week. After multidisciplinary discussion with cardiology, thoracic surgery, radiology, and interventional radiology, a nuclear medicine lymphangiogram was completed. This demonstrated a focal area of intense tracer activity at the level of pulmonary trunk. Subsequent lymphangiogram showed dilated lymphatic channels with reflux and stasis in this area. The thoracic duct was successfully embolized. Chylous output significantly decreased, and patient was discharged. An echo at one month follow-up showed complete resolution of pericardial effusion.

Discussion:
Although the clinical presentation was consistent with chylopericardium, management was complicated after patient failed treatment with several approaches. At this stage, invasive surgery to ligate the thoracic duct versus continued drainage in the outpatient setting was being considered. A collaborative approach guided the right imaging modality and therapeutic intervention to definitively manage chylopericardium efficiently without significant morbidity. Furthermore, it suggested that percutaneous thoracic duct embolization may be a viable treatment option for recurrent idiopathic chylopericardium refractory to conventional management.

Conclusion:
A multidisciplinary approach with nuclear medicine testing and percutaneous intervention can be an effective approach to certain cases of idiopathic chylopericardium.
Abstract 4142363: Pattern-Recognition Receptor-Associated Thromboinflammatory Transcript Changes in Platelets and Leukocytes
Authors: Core Jason , Corkrey Heather , Rade Jeffrey , Finberg Robert , Wang Jennifer , Tanriverdi Kahraman , Freedman Jane , Koupenova Milka
Published: November 2024

Background:
Increased risk of thrombotic outcomes has been observed during respiratory infections. This phenomenon likely involves platelet-leukocyte crosstalk via pattern recognition receptors (PRRs), including Toll-like receptors (TLR), Retinoic acid-inducible gene I-like receptors (RLR) and cGAS.

Purpose:
We studied correlations between PRRs and select pro-thrombotic/procoagulant transcripts (ITGA2B, GP1BA, GP9, GP5, GP6, PF4, PF4V1, F13A1, SELP, SERPING1) in platelets and leukocytes of COVID19 (α-δ variants) patients; and determined if those correlations were present in blood from patients with 3 respiratory infections (COVID19, Influenza, Tuberculosis-TB).

Methods:
RNA sequencing data of platelets and leukocytes isolated from COVID19 patients (n=10) and non-infected controls (n=15) was generated using AmpliSeq. Whole blood RNAseq was obtained from public databases for COVID19 (GSE217948), influenza (GSE161731), and TB patients (0m-peak infection, GSE181143). Transcripts with significantly greater mean expression in infected patients versus the respective control were assessed for positive correlations with PRRs using Spearman’s correlation coefficients. Data was analyzed in R.

Results:
Platelets and leukocytes showed distinct patterns of the top five highest expressed PRRs, based on BaseMean (Platelets: TLR9>DDX58>IFIH1>CGAS>TLR4, Leukocytes: TLR4>IFIH1>DDX58>TLR8>TLR2). PRR that were significantly increased in COVID19 platelets versus controls were DDX58 (p=0.017) and IFIH1 (p=0.005); in leukocytes only IFIH1 (p=0.015) showed significant difference. The only overlapping correlation between a PRR and transcript in the two cell populations was TLR1 with F13A1 (platelets, R=0.56, p=0.04; leukocytes, R=0.56, p=0.02). In COVID19 platelets, TLR9 correlated with GP1Ba (R=0.62, p=0.002); DDX58 correlated with GP9 and PF4; and IFIH1 correlated with GP9 and GP6. In COVID19 leukocytes, IFIH1 and DDX58 correlated with SERPING1. In whole blood RNAseq analysis of all 3 infections, only DDX58 and TLR1 uniformly associated with PF4 and F13A1, respectively. Surprisingly, correlations between PRRs and the listed transcripts overlapped predominantly between COVID19 and acute TB, but not with influenza.

Conclusion:
Platelets and leukocytes show distinct patterns of PRR expression and correlations with pro-thrombotic/procoagulant transcripts. Whole blood correlations between PRRs and thrombotic transcripts in COVID19 infection demonstrate more overlap with TB than influenza.
Abstract 4142393: Long-Term Outcomes of Septal Myectomy and Concomitant Aortic Valve Replacement at a Primary Academic Center
Authors: So Preston , Patel Mrinal , Iyengar Amit , Weingarten Noah , Dominic Jessica , Belec Andrew , Ho Joyce , Wilson Rachel , Meldrum Danika , Seiberlich Melissa , Atluri Pavan
Published: November 2024

Background:
Aortic stenosis (AS) and septal hypertrophy are significant causes of left ventricular outflow tract obstruction (LVOTO). When both are present, the severity of LVOTO increases. For symptomatic patients, the treatment involves relieving both sources of obstruction through aortic valve replacement (AVR) and septal myectomy. AVR is associated with symptomatic improvement and better long-term outcomes in valvular causes of LVOTO. However, the long-term outcomes of AVR combined with septal myectomy in patients with coexisting septal hypertrophy and AS are not well studied.

Aims:
This study aims to assess the long-term outcomes, associated risk factors, and prognostic indicators in patients with left ventricular outflow tract obstruction who underwent aortic valve replacement and concomitant septal myectomy.

Methods:
We identified a retrospective cohort of 82 patients who underwent aortic valve replacement and concomitant septal myectomy for symptomatic LVOTO at the University of Pennsylvania between 2007 and 2021. We assessed preoperative and postoperative symptoms, electrocardiograms, echocardiograms, operative data, follow-up data, and mortality.

Results:
The mean age of the cohort was 68.2 ± 15.1 years (range 19 to 88). Of the patients, 52% underwent AVR and concomitant myectomy only, while 48% underwent AVR, myectomy, and additional cardiac procedures. Postoperatively, the mean IVSd/PWd ratio was significantly reduced (Figure 1, p<0.01). Atrial fibrillation occurred in 45% of patients, and complete heart block occurred in 30%, but neither was associated with increased mortality (Figure 2, all p>0.05). The survival rates at 5 and 10 years post-operation were 74.6% and 44.8%, respectively. Additional cardiac procedures, alongside AVR and septal myectomy, did not increase mortality. Postoperative NYHA classifications at follow-up were markedly improved (Figure 3).

Conclusion:
Patients with symptomatic LVOTO who underwent AVR with concomitant septal myectomy have long-term symptomatic improvement. Postoperative arrhythmias are common sequelae but are not associated with increased mortality.
Abstract 4142413: Left-Sided and Right-Sided Composite Advanced Hemodynamic Metrics for Prognostication in Heart Failure
Authors: Obaoye Joanna , Randazzo Michael , Kanelidis Anthony , Cochran Matthew , Acosta Mary , Sipiora Justin , Poonawalla Maria , Siddiqi Umar , Hoang Ryan , Belkin Mark , Grinstein Jonathan
Published: November 2024

A complete invasive hemodynamic assessment, including both standard and advanced hemodynamic parameters improves risk stratification in patients with heart failure. Specifically, the novel advanced hemodynamic parameters, aortic pulsatility index (API) and cardiac power output (CPO), have shown robust prognostic potential in patients with cardiogenic shock and advanced heart failure. However, the incremental benefit of a simultaneous utilization of composite advanced hemodynamic parameters across the spectrum of left- and right- sided dysfunction currently remains unknown.

We performed a retrospective study of all patients with heart failure undergoing isolated right heart catheterization at our institution from 2013 to 2019. API, pulmonary artery pulsatility index (PAPI), as well as right and left ventricular CPO (RV-CPO, LV-CPO, respectively) were measured; RV CPO = (mPAP - RAP) * CO / 451. The primary outcome was freedom from left ventricular assist device (LVAD), orthotopic heart transplant (HT), and death at 24 months. Kaplan-Meier analyses were conducted based on previously determined cutpoints from receiver operator characteristic curve analysis.

A total of 709 patients were included (60 ± 14 years, 46% women, and 40% ischemic cardiomyopathy). There were 297 (42%) primary events in this cohort over 24 months: 46 LVAD, 38 HT, and 213 deaths. The left-sided parameters (API and LV-CPO) proved the primary drivers of the diversion in outcomes in all analyses (p <0.05). RV-CPO showed additional risk stratification when combined with either API or LV-CPO analyses, but only in patients with normal-range values (i.e. API ≥1.45 and LV CPO ≥0.64, p<0.05). No other composite markers showed prognostic significance (Figure).

Prognosis at 24 months for patients with heart failure was most sensitive to left-sided advanced hemodynamic parameters (i.e. API and LV-CPO), though RV-CPO, a right sided parameter, provided some additional prognostic benefit in those with a normal left-sided parameter.
Abstract 4142430: Feasibility of Coronary Allograft Vasculopathy Assessment Using Cardiac Stress Magnetic Resonance Imaging with Fully Quantitative Myocardial Blood Flow
Authors: O'Hara Meaghan , Wang Haonan , Minga Iva , Huang Sherry , Tang Maxine , Wang Shuo , Kim Gene , Belkin Mark , Slivnick Jeremy , Lang Roberto , Patel Amit , Patel Hena
Published: November 2024

Background:
Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality following heart transplantation (OHT). Noninvasive methods to detect CAV and risk stratify OHT patients are needed. The value of fully quantitative stress cardiac magnetic resonance imaging has been recently validated and may be a promising technique for OHT surveillance. We aimed to evaluate the feasibility of quantitative stress CMR after OHT.

Methods:
We enrolled asymptomatic OHT recipients without coronary artery disease to undergo regadenoson stress CMR (1.5T GE HealthCare) with cine imaging, tissue mapping, and late gadolinium enhancement (LGE) imaging for routine CAV surveillance. Using the dual sequence technique, quantitative perfusion values were determined using Fermi deconvolution. Myocardial perfusion reserve (MPR) was calculated as the ratio of stress to rest myocardial blood flow (MBF).

Results:
Fifty-three subjects (mean age 47.06 ± 17.14 years) were included. OHT recipients (n=11, mean 6.77 ± 4.34 years post-transplant) were compared with healthy controls (n=43). No life-threatening adverse events, brief or prolonged atrioventricular block or other arrhythmias occurred with regadenoson. Coronary angiography was performed in 9 OHT patients before CMR, with an average of 1.99 ± 2.05 years between studies. No visual inducible ischemia was reported. Post OHT, rest MBF was significantly higher (1.69 ± 0.52 mL/g/min vs 1.01 ± 0.24 mL/g/min, p=0.004) and stress MBF was lower (2.33 ± 0.69 mL/g/min vs 2.95 ± 0.88 mL/g/min, p=0.02) compared to controls. MPR was significantly lower in OHT recipients compared to controls (1.46 ± 0.51 vs 3.11 ± 1.12, p<0.001), and remained lower when corrected for rate pressure product (1.23± 0.32 vs 3.94 ± 1.5, p<0.001) (Figure 1).

Conclusions:
Regadenoson stress perfusion CMR is safe and feasible in OHT recipients. We observed reduced coronary microvascular function (higher resting MBF, lower MPR) post OHT, despite normal perfusion on visual inspection. In addition to cardiac structure, function, and myocardial tissue characterization, quantitative assessment of MPR by CMR may have incremental value over qualitative assessment of ischemia and should be evaluated in future studies.
Abstract 4142449: The Impact of a Closed Unit Model on Cardiac Intensive Care Unit Outcomes: A Before-After Study
Authors: Hinkamp Colin , Nardi Matthew , Senussi Mourad
Published: November 2024

Background:
The ‘closed unit model’ is increasingly being adopted as a model for providing critical care to cardiac patients in contemporary intensive care units (ICU), where patients are under the direct care of an intensivist-led primary team. Many data demonstrates improved outcomes in various other intensive care settings, but few data exist in the context of cardiology intensive care. We aim to assess the clinical implications of adopting a closed unit model in our cardiac intensive care unit (CICU) across a variety of parameters.

Hypothesis:
Adoption of a closed unit model will result in improvement in mortality rate, ICU length of stay (LOS), and spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) compliance.

Methods:
We performed a before—after retrospective comparison of patients admitted to the CICU at our tertiary care hospital after adoption of a closed unit model on 1 January. The study period was the first 3 months after adoption of the closed model, with the 3-months preceding adoption of the closed model serving as the comparison group. Mortality, SAT and SBT rates were compared using the Chi-squared test and median CICU LOS was compared using the Wilcoxon rank-sum test.

Results:
751 individual patients were admitted to the CICU and analyzed (380 before vs 371 after adoption). The mortality rate significantly improved (10% vs 6.7%; p=<0.01; Figure 1). Despite this, there was no significant change in median LOS (2.7 days [IQR 1.11-5.73] vs 2.5, [IQR 1.16-6.14]; p=0.54). There was also a significant improvement in SAT (66.8% vs. 73.6%; p=<0.01) and SBT rates (90.3% vs. 94.6%; p=<0.01; Figure 1).

Conclusions:
Adoption of a closed unit model resulted in a statistically significant improvement in CICU mortality and daily SAT and SBT compliance, although surprisingly there was no improvement in LOS. These findings suggest that our transition to a closed unit model enhanced our patient's outcomes likely through promoting improved adherence to evidence-based critical care principles. Further study is needed to explore the factors contributing to the unchanged LOS and to better evaluate the long-term impact of a closed unit model on outcomes and resource utilization in cardiac ICUs.
Abstract 4142484: Mechanism of miR-203a-3p regulating the proliferation and migration of PASMCs through PIK3CA/PI3K/Akt pathway in PAH
Authors: Zhu Tengteng
Published: November 2024

Background:
Pulmonary arterial hypertension (PAH) is characterized by an elevation in pulmonary vascular resistance and arterial pressure, culminating in right ventricular failure and mortality. Excessive proliferation and accumulation of pulmonary artery smooth muscle cells (PASMCs), driven by aberrant gene expression, stand as hallmark pathologies of PAH. Among the regulatory elements implicated in this process, microRNAs (miRNAs) such as miR-203a-3p are crucial, influencing cellular proliferation and migration. Nevertheless, the precise role and mechanisms through which miR-203a-3p modulates PAH pathophysiology remain poorly defined.

Objective:
This study seeks to elucidate the expression patterns and functional roles of miR-203a-3p in idiopathic pulmonary arterial hypertension (IPAH) and in rodent models of PAH, with an emphasis on understanding the underlying molecular mechanisms.

Methods:
Expression levels of miR-203a-3p were quantified in plasma from IPAH patients and healthy controls via RT-qPCR at the Second Xiangya Hospital. Rodent models of PAH were generated using either Monocrotaline (MCT) or Su5416 in conjunction with chronic hypoxia. MiR-203a-3p expression in plasma and lung tissue was evaluated at predetermined intervals. Additionally, the effects of miR-203a-3p overexpression on primary PASMC functions were assessed, and therapeutic potential was explored through administration of an adeno-associated virus vector encoding miR-203a-3p prior to model induction.

Results:
Significantly reduced levels of miR-203a-3p were observed in both IPAH patients and PAH-model rats compared to healthy controls, correlating inversely with indicators of disease progression. Overexpression of miR-203a-3p inhibited PASMC proliferation and migration and attenuated disease phenotypes in experimental models. Molecular analysis revealed that miR-203a-3p directly targets PIK3CA, influencing the PI3K/Akt signaling pathway, a critical mediator of PASMC function.

Conclusion:
The downregulation of miR-203a-3p in IPAH and its regulatory impact on PASMC behavior via the PIK3CA/PI3K/Akt pathway highlight its potential utility as a biomarker and therapeutic target in PAH. These findings provide a foundation for further investigations into the therapeutic benefits of miR-203a-3p in the clinical management of PAH, supporting its development as a novel therapeutic strategy.
Abstract 4142521: A Heart Transplant Patient’s Mysterious Illness: A Diagnostic Odyssey
Authors: Alkalbani Mutaz , Nayer Hassan , COCHRANE ADAM , Saeed Ibrahim , Psotka Mitchell , Rollins Allman , Kennedy Jamie , Blumer Vanessa
Published: November 2024

A 60-year-old male patient underwent orthotopic heart transplant for non-ischemic cardiomyopathy three years ago. Recently, he has been followed closely in transplant clinic for persistently elevated donor-derived cell-free DNA; endomyocardial biopsy was negative for allograft rejection. Cardiac MRI showed a global increase in T1 signal with normal T2 suggestive of nonspecific myocardial injury. He later presented with fever and diarrhea. Physical examination revealed pale conjunctivae, non-edematous extremities, and no jugular venous distension. Leukocyte count was 10.1 x10
3
/uL, hemoglobin 14 g/dL, platelets 407 x10
3
/uL, creatinine 1.2 mg/dL, AST 53 U/L, ALT 50 U/L, total bilirubin 0.7 mg/dL. Infectious disease workup was positive for norovirus, which was managed conservatively. He returned a week later with sudden right-sided weakness, confusion, and recurrent fever. Brain MRI was negative for acute pathology. Leukocyte count was elevated in the cerebral spinal fluid. No other etiology could be identified. Eventually, microbial cell-free DNA test was positive for toxoplasma gondii. Follow-up endomyocardial biopsy with hematoxylin and eosin stain confirmed diagnosis of toxoplasmosis. He was started on sulfadiazine, pyrimethamine, and folinic acid for six weeks. Follow up biopsy one month later was negative for toxoplasma gondii. Toxoplasmosis can be reactivated in immunocompromised individuals. Cardiac involvement is rare but can lead to myocarditis, pericarditis, or arrhythmias. Post-transplant toxoplasmosis is often due to transmission from the allograft rather than reactivation. Endomyocardial biopsy with special staining can help differentiate between infection and allograft rejection. Microbial cell-free DNA testing can also help isolate rare infectious etiologies, especially when other serum markers are inconclusive. This case illustrates: (1) the importance of differential diagnosis in post-transplant patients and the benefit of microbial cell-free DNA testing, (2) the need to consider various diagnoses in cases of elevated donor-derived cell-free DNA, (3) the necessity for increased awareness of Toxoplasma gondii infection in transplant patients with compatible symptoms, and (4) the crucial role of a multidisciplinary approach in delivering high-quality care in complex cases.
Abstract 4142557: Relationship between levels of nitric oxide (NO) concentration and flow-mediated vasodilatation test (FMD) in endothelial dysfunction development in overweight pregnant women with chronic hypertension.
Authors: Sadulloeva Mokhinur
Published: November 2024

Background:
In Central Asia, hypertension accounts for 14.5% of all maternal deathsThe problem of assessing endothelial dysfunction in women with hypertensive disorders during pregnancy are one of the early predictors of cardiovascular events.

Objective:
to determine the relationship between endothelial dysfunction and levels of nitric oxide (NO) concentration and flow-mediated vasodilatation (FMD) in overweight pregnant women with CHT.

Methods:
The study included 55 pregnant women of the I-II gestation period, divided into 2 groups. First group (n=34) included healthy pregnant women (healthy group). Second group (n=24) consisted of pregnant women with chronic hypertension/CHT. A physical examination was performed, heart rate was assessed, blood pressure was measured according to Korotkov method, body mass index (BMI) was calculated. Endothelial function was analyzed using a flow-mediated dilation (FMD) test by using ultrasound system Simens Acuson X700 and the level of nitric oxide (NO) concentration. NO level, which was determined by amount the main stable metabolites NO2 - and NO3 - were assessed by P.P. Golikov method. Results are presented as mean±SD. Statistical processing was carried out using the Statistica 13.0 program. P < 0.05 was considered statistically significant.

Results:
It was revealed that there was no significant difference in the age of women (27±3.4 in 1 group vs 29±4.5 in 2 group, P = 0.0658) and number of pregnancies between groups (3.3±1.2 in 1 group vs 3.2±1.6 in 2 group, P = 0.7920). The average level of blood pressure in the group with CHT amounted to systolic blood pressure (SBP) of 153.83±16.43 mmHg. vs 102.72±10.42 mmHg in group 1 (P <0.0001), according to diastolic blood pressure (DBP) 96.16±7.62 mmHg. vs 64.77±5.9 mmHg. in 1st group (P <0.0001). Heart rate in group 1 was 89.8±12.2 beats/min and in group 2 93.5±13.8 beats/min (P=0.22). At the same time, 23 pregnant women (95.8%) with CHT were overweight, of which 15(62.5%) were women with obesity of the I and II degree. In the healthy group, there were only 7 women (16%) who were overweight, and no obese women were identified. The mean value of FMD for 1 group was 6.2±3.5% vs 4.82±1.02 (P <0.0001), meanwhile NO – 8.8±0.281 µmol/l in group 1 vs NO – 13.7±0.517 µmol\l (P <0.0001).

Conclusion:
In conclusion, FMD measured by using an ultrasound system and determination of the blood serum NO level is associated with early diastolic dysfunction in overweight pregnant women with CHT.