bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4122048: Disparities in Heart Failure-Related Mortality Among Reproductive-Aged Women in the United States from 1999 to 2019
Authors: Shah M Danial Ali , Malik Iram , Nkeangu Fomengia , Umar Muhammad Faiq , Sattar Zeeshan , Akhtar Khawaja Hassan , Haq Muhammad , Ameen Abdul A , Khan Mohammad
Published: November 2024

Introduction:
Heart failure (HF) majorly affects the elderly, but can also affect the younger population. This study aims to examine the trends of HF-related deaths among reproductive-aged women in the United States (US).

Method:
We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 codes I11, I13.0, I13.2, and I50 to find HF-related deaths among women aged 15-44 from 1999 to 2019. We examined demographic disparities in HF mortality rates over time, considering age, ethnicity, and geographic areas. Results were reported as age-adjusted mortality rate (AAMR) and 95% confidence interval (CI). Joinpoint regression assessed trend changes and annual percentage change (APC).

Results:
Between 1999 and 2019, a total of 43,683 women aged 15-44 died from HF in the US, with an AAMR of 3.5 per 100,000 (95% CI: 3.5-3.5). The AAMR increased from 2.6 in 1999 to 4.8 in 2019. Non-Hispanic Black women had the highest AAMR at 10.2, while Hispanics had the lowest at 1.8. Geographically, the South was the most affected region with an AAMR of 4.6, contributing to nearly half (48.9%) of all deaths. States including Massachusetts, Oregon, New Hampshire, and Minnesota had the lowest AAMRs. Rural areas showed a higher AAMR compared to urban areas (4.4 Vs. 3.3). The age group (35-44) accounted for the majority of deaths (73.7%).

Conclusion:
HF-related mortality among reproductive-aged women increased from 1999 to 2019, with the highest burden among non-Hispanic Black women and those in the Southern region. Enhancing access to care, particularly in rural areas, and implementing targeted prevention programs are vital to reducing mortality rates.
Abstract 4122134: Relationships between aortic valve area planimetry on four-dimensional cardiac computed tomography and survival following transcatheter aortic valve replacement
Authors: Arockiam Aro Daniela , Dong Tiffany , Haroun Elio , El Dahdah Joseph , Agrawal Ankit , Khurana Rishabh , Saraswati Ushasi , Bhalla Jaideep , Paul Aritra , Harb Serge , Popovic Zoran , Rodriguez L , Puri Rishi , Reed Grant , Krishnaswamy Amar , Griffin Brian , Kapadia Samir , Wang Tom Kai Ming
Published: November 2024

Background:
Aortic valve area planimetry (AVA
CT
) is feasible on four-dimensional computed tomography (4D-CT) for grading aortic stenosis severity, with superior spatial but inferior temporal resolution to echocardiography, however its prognostic utility is not well-established. We evaluated the prognostic value of AVA
CT
in patients with significant aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR).

Methods:
We studied 1035 native aortic valve stenosis patients (age 79.0±9.0 years, 429 (41.5%) women) undergoing TAVR during 2019-2020. AVA
CT
and indexed to body surface area (AVAi
CT
) were retrospectively measured on contrast-enhanced 4D-CT at peak systole, and standard statistical analyses performed to evaluate its associations with all-cause mortality during follow-up.

Results:
Mean AVA
CT
and AVAi
CT
were 1.02±0.21 cm
2
and 0.53±0.12 cm
2
/m
2
respectively, with 240 (23.2%) deaths during mean follow-up of 2.1±0.9 years. Areas under curves and optimal thresholds for identifying severe aortic stenosis (defined as AVA<1.0 cm
2
on echocardiography) were 0.78 and <1.10 cm
2
for AVA
CT
and 0.83 and <0.65 cm
2
/m
2
for AVAi
CT
. AVA
CT
and AVAi
CT
below these thresholds representing severe aortic stenosis were independently associated all-cause mortality during follow-up, with hazards ratios (95% confidence intervals) of 1.84 (1.34-2.53) and 2.38 (1.48-3.81) respectively in multivariable analyses. The Figure illustrates Kaplan-Meier survival curves for the cohort based on A) AVA
CT
and B) AVAi
CT
thresholds.

Conclusion:
Optimal thresholds of AVA
CT
(<1.10 cm
2
) and AVAi
CT
(<0.65 cm
2
/m
2
) were independently associated with worse survival in patients undergoing TAVR, indicating that AVA
CT
and AVAi
CT
as potentially useful additional imaging biomarkers in the diagnostic and prognostic evaluation of aortic stenosis patients.
Abstract 4122247: Impact of serum chloride levels for ventricular arrhythmias in patients with heart failure undergoing cardiac resynchronization therapy
Authors: Minami Yoshiaki , Suzuki Atsushi , ono manami , Shirotani Shota , Kikuchi Noriko , Hattori Hidetoshi , YAGISHITA DAIGO , Shoda Morio , Yamaguchi Junichi
Published: November 2024

Background:
As previous reports of ventricular arrhythmia (VA) as a prognostic marker of mortality in heart failure (HF) patients included those with implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices, little is known about the risk factors of VA among patients undergoing cardiac resynchronization therapy (CRT), especially those without previous VA. The prognostic role of electrolyte abnormalities has been highlighted in HF patients. This study evaluated the impact of serum chloride levels for VA and all-cause death in patients with HF who underwent CRT without VA before CRT implantation.

Methods:
From the retrospective cohort of 397 HF patients (age 63+/-13, male 74%) who undergoing CRT implantation between 2010 and 2020, this study enrolled 175 patients (82% implanted CRT with a defibrillator) without a previous history of VA (sustained ventricular tachycardia (VT) of ventricular fibrillation (VF)). We studied the impact of serum chloride levels before CRT implantation. The primary endpoint was defined as VA, VA with ICD therapy and sudden cardiac death. The secondary endpoint was all-cause mortality.

Results:
During median follow-up of 35 months, 53 patients (30%) experienced VA. Patients with VA had a tendency toward high LVESV (172ml vs. 150ml, p<0.09) and low left ventricular ejection fraction (26 vs. 29, p<0.09), and significantly reduced rate of angiotensin converting enzyme inhibitors or angiotensin receptor blockers (30% vs. 70%, p<0.05) at the time of CRT implantation. The rate of CRT responders was significantly higher in patients without VA than with VA (59% vs. 40%, p<0.05). The cut-off value of chloride for VA was determined to be 102mEq/l using receiver operating characteristic analysis. The patients with chloride ≤102mEq/l had significantly higher rates of VA (41% vs. 25%, log-rank p<0.05) and mortality (33% vs. 18%, log-rank p<0.05) (Figure). By multivariate cox analysis, the level of chloride had an independent predictive value of VA in patients with CRT (hazard ratio [HR] 1.08 per 1mEq/l decrease, 95% confidence interval [CI] 1.00-1.16, p<0.05) (Table).

Conclusions:
The chloride level had a predictive value for VA after CRT implantation in HF patients without previous VA. The management of electrolytes, including chloride, might be important for preventing fatal arrhythmia in patients with HF undergoing CRT implantation.
Abstract 4122389: Accumulation of Epicardial Adipose Tissue as a Marker of Diastolic Dysfunction in Patients With Preserved Left Ventricular Ejection Fraction Undergoing Coronary Computed Tomography Angiograph
Authors: Ishikawa Hirotoshi , Otsuka Kenichiro , Sugiyama Takatoshi , Yamaura Hiroki , Hojo Kana , Kawa Yoshinori , Shintani Ako , Ito Asahiro , Yamazaki Takanori , Kasayuki Noriaki , Fukuda Daiju
Published: November 2024

Background:
Left ventricular diastolic dysfunction (LVDD) plays a major role in the pathophysiology of progression to heart failure with preserved left ventricular (LV) ejection fraction (EF). Although epicardial adipose tissue (EAT) is attracting attention for the underlying pathophysiology, whether increased EAT and coronary plaque burden are associated with LVDD is unclear in patients with chronic coronary artery disease (CAD) and preserved LVEF.

Aims:
To investigate the association between LVDD and EAT accumulation in chronic CAD patients with preserved LVEF.

Methods:
We included three hundred fourteen chronic CAD and preserved LVEF patients without history of heart failure (mean age: 66±13 years; 48% female). Thoracic tissue doppler echocardiography (TTDE) analysis included LVDD parameters, including left atrial volume index (LAVI), e’, E/e’ and tricuspid regurgitation (TR) velocity. LVDD was defined according to the American Society of Echocardiography guidelines. Coronary computed tomographic angiography (CCTA) analysis included EAT volume index (EAVi), coronary artery calcium score (CACS), and coronary plaque volume (%PV). Patients were divided into three groups according to EAVi: Group A as normal (<68.1 ml/m
2
, n=127), group B as low (68.1-89.4 ml/m
2
, n=95), and group C as high EATVi (>89.4 ml/m
2
, n=92). Multivariable logistic regression analysis was performed to investigate the association between the clinical parameters, TTDE and CCTA findings, and the presence of LVDD.

Results:
Compared with Group A, group C was older and more frequently suffered from renal dysfunction. Among the three groups, we observed significant differences in LV mass index, e’, E/e’, and CACS. The EAVi correlated with each LVDD diagnostic component, including e’, E/e’, left atrial volume index (all p<0.05), except for tricuspid regurgitation velocity. A multivariate model showed that age [odds ratio (OR), 1.13; 95% CI, 1.06-1.20; p<0.001] and EAVi (OR, 1.03; 95%CI, 1.01-1.04; p<0.05) were independently associated with LVDD, even after adjusting for LV mass index (OR, 1.1; p < 0.05). There was no independent association of CACS or %PV with LVDD (Table).

Conclusion:
This study demonstrates that accumulation of EAT and LV mass index but not plaque volume were independent predictors of LVDD in chronic CAD patients with preserved LVEF. Further study is needed to investigate whether EAT predicts the development to heart failure in this population.
Abstract 4122650: 1-year comparison of quadruple therapy sequencing strategies for heart failure with reduced ejection fraction using an individual-based state-transition microsimulation model
Authors: Turgeon Ricky , Van Minh Tri , Loewen Peter , Hawkins Nathaniel , Sadatsafavi Mohsen , Zhang Wei , MacKay Kelly
Published: November 2024

Introduction:
Guidelines recommend quadruple therapy (angiotensin receptor blocker-neprilysin inhibitor [ARNI]), beta-blocker, mineralocorticoid receptor antagonist (MRA), and sodium-glucose co-transporter 2 inhibitor [SGLT2I]) as the cornerstone of heart failure (HF) with reduced ejection fraction (HFrEF) management. Yet, guidelines do not propose a specific order of initiation and titration (or “sequencing strategy”) of these agents, due to the absence of trial evidence.

Aims:
To model the 1-year efficacy and harms of proposed HFrEF quadruple therapy sequencing strategies using a microsimulation model.

Methods:
We conducted an individual-based state-transition microsimulation modeling study to compare the 1-year cumulative incidence of death, total HF hospitalization, and adverse events with 6 different HFrEF medication sequencing strategies (emulating 2 different traditional strategies, 2 two-drug combinations, a "cluster" strategy, and four-drug "simultaneous" strategy), each with two versions (weekly or biweekly medication adjustments), applied to treatment-naïve outpatients with HFrEF. We modeled death as an incidence at 1 year, and total HF hospitalization (first and recurrent events) and adverse events (bradycardia, hyperkalemia, hypotension, and renal impairment) as incidence rates per 100 patient-years.

Results:
At 1 year, an estimated 15.5% died without treatment compared to 6.9% with the traditional sequence adjusted biweekly, and 5.2-6.3% with other sequencing strategies. Similarly, the HF hospitalization rate decreased from 32.8 per 100 patient-years with no treatment to 11.1 per 100 patient-years traditional sequencing adjusted biweekly, and 6.9-9 per 100 patient-years with other strategies. The incidence rates of medication-related adverse events per 100 patient-years were: hypotension (5.8-6.9), renal impairment (4.6-6.0), bradycardia (2.9-3.2), and hyperkalemia (approximately 0.5).

Conclusions:
For treatment-naïve outpatients with HFrEF, pharmacotherapy sequencing strategies that started 2 to 4 medications on the first visit reduced the risk of death and hospitalization at 1 year compared to a traditional sequencing strategy. Weekly medication adjustments did not outperform biweekly adjustments when >=2 medications were started on the initial visit. These findings can inform clinicians and policymakers in developing HFrEF medication optimization programs with sequencing strategy protocols that fit the local practical context.
Abstract 4122694: The
ICAM1
p.K56M Variant and Risk of Heart Failure Among Individuals with Chronic Kidney Disease
Authors: Culler Kasen , Zelnick Leila , Mehta Rupal , Rodriguez de Sosa Giselle , Kansal Mayank , Rao Panduranga , Bhat Zeenat , Taliercio Jonathan , Horwitz Edward , Chen Jing , He Jiang , Shah Sanjiv , Isakova Tamara , Patel Ravi
Published: November 2024

Background:
Intercellular adhesion molecule-1 (ICAM-1) is a cell-surface protein that facilitates inflammation through leukocyte adhesion. Approximately 35% of African American individuals carry at least one copy of an
ICAM1
missense variant (rs5491; p.K56M), which has been associated with increased risk of heart failure with preserved ejection fraction (HFpEF). Individuals with chronic kidney disease (CKD) are at high risk for HF, but whether the risk of HFpEF conferred by rs5491 extends to individuals with prevalent CKD is unknown.

Hypothesis:
We hypothesized that in a CKD population, rs5491 is specifically associated with HFpEF, but not HF with reduced ejection fraction (HFrEF).

Methods:
In the Chronic Renal Insufficiency Cohort (CRIC), participants were enrolled based upon an estimated glomerular filtration rate (eGFR) of 20 to 70 mL/min/1.73m
2
. We estimated associations of rs5491 with incident HF and HF subtypes among African American individuals who were free from HF at baseline in CRIC. Models were adjusted for age, sex, systolic blood pressure, eGFR, body mass index, smoking, diabetes, C-reactive protein, the first 10 principal components of ancestry, and study site.

Results:
Among 1267 African American participants without HF at baseline (mean age 57±11 years, 51% female, mean eGFR 45±15 mL/min/1.73m
2
), 464 (37%) had at least one copy of rs5491. During a median follow-up of 10.3 years (IQR: 4.7 – 15.0 years), there were 309 incident overall HF hospitalizations (160 HFpEF, 111 HFrEF, and 38 HF with unknown EF). Each additional rs5491 allele was significantly associated with incident HFpEF (HR 1.35 [95% CI: 1.03-1.76], P=0.029; Figure). The rs5491 variant was not associated with incident overall HF (HR 1.14, 95% CI: 0.93-1.39, P = 0.20) or incident HFrEF (HR 0.76, 95% CI: 0.53-1.10, P=0.15).

Conclusion:
The
ICAM1
p.K56M variant specifically confers increased risk of incident HFpEF among individuals with CKD.
Abstract 4122717: An Epigenetic Drug, GSK126 Mitigates Endothelial to Mesenchymal Transition Attenuating Atherosclerosis in Diabetes
Authors: Aziz Misbah , Jandeleitdahm Karin , Khan Abdul Waheed
Published: November 2024

Background:
Endothelial to mesenchymal transition (EndMT) involves transformation of an endothelial to mesenchymal like cellular state. Recent studies implicate EndMT in atherosclerosis development. Diabetes is associated with both EndMT as well as accelerated atherosclerosis. Experimental evidence supports the use of epigenetic drugs that act on relevant epigenetic mechanisms to attenuate atherosclerosis. Recently, inhibition of a histone methyltransferase Enhancer of zest homolog 2 (EZH2) with GSK-126 attenuated atherosclerosis development. However, the role of EZH2 in induction of EndMT in diabetes induced atherosclerosis is not known.

Methods:
An
in-vitro
model of EndMT was generated using high glucose (HG) and TNF-α in human aortic endothelial cells (HAECs). EZH2 methyltransferase activity was inhibited using EZH2 specific inhibitor GSK-126. RNA sequencing was performed in this setting. EZH2 genetic knockdown (shRNA) in HAECs was also performed to validate role of EZH2 in EndMT. In addition, EZH2 mediated H3K27me3 and EndMT was assessed in atheroprone diabetic mouse model.

Results:
In HAECs, morphological changes as well as gene and protein expression confirmed TNF-α+HG induced EndMT, which was blunted by GSK-126. Elevated EZH2 mediated H3K27me3 activity by the TNF-α + HG stimulation was blunted with GSK-126 treatment. Furthermore, RNA sequencing identified several enriched pathways including AGE-RAGE signaling pathway in diabetic complications, focal adhesion, and leukocyte trans-endothelial migration directly relevant to EndMT and commonly deregulated in diabetic complications, which were rescued by EZH2 inhibition. Transcriptomic analysis showed that 242 genes including MMP2, NOS3 linked to EndMT were dysregulated. Interestingly, expression of 76 dysregulated genes in EndMT were rescued by GSK-126. EZH2 knockdown studies in HAECs also validated the role of EZH2 in EndMT. Furthermore, immunofluorescence staining identified elevated levels of H3K27me3 in the aortic endothelial layer of diabetic Apoe
-/-
mice. Co-localization of EndMT markers was observed in the endothelial layer of aortic sinus of diabetic Apoe
-/-
mice which was blunted with GSK-126 treatment.

Conclusion:
The study identified EZH2 inhibition as a novel therapeutic target in diabetes induced EndMT in atherosclerosis. These findings highlighted ongoing efforts to develop targeted therapies for diabetic patients who are at risk to develop cardiovascular disease.
Abstract 4122780: Muscle Quality Defines Sarcopenic Obesity in Older Adults In Association with Cardiac Function
Authors: Tan Sarah , WONG JIE JUN , Tan Glades , Tan Ru , Gao Fei , Teo Loon Yee , Ewe See Hooi , Lim Wee Shiong , Tan Hong Chang , Koh Angela
Published: November 2024

Background:
Obesity phenotypes are increasingly used to define cardiovascular diseases (CVD) risks. Age-related deteriorations in skeletal muscle function have ignited interest in the co-occurrence of sarcopenia and obesity in older adults. However, the traditional definition of sarcopenia (low appendicular skeletal mass [ASM] and handgrip strength [HGS]) may lead to underdiagnosis of sarcopenic obesity (SO) in overweight individuals (due to higher muscle mass). To address this enigma, we evaluated the use of muscle quality (MQ), as an alternative metric for SO, in association with cardiac function.

Methods:
Community older adults without CVD were prospectively annotated for skeletal mass, HGS and cardiac function via bioimpedance analysis, dynamometer, and simultaneous acquisition of echocardiography respectively. Sarcopenia was defined by low ASM and low HGS. Low MQ (HGS divided by upper body ASM) was defined by males<5.76kg/kg and females<5.475kg/kg. Aerobic capacity (VO2 max,ml/kg/min) was computed by a physical activity prediction model. Mitral early diastolic inflow velocity to early diastolic annular tissue velocity (E/e’) and early to late diastolic inflow velocity (E/A) ratios were recorded.

Results:
Overall, low MQ was prevalent (34.3%) in n=574 participants (59% females), but only 17.4% fulfilled sarcopenia diagnosis. Higher BMI correlated with higher ASM but lower MQ (Fig 1). Low MQ prevalence was higher in the obese compared to the non-obese (64.7% vs 30.2%, p<0.0001). Low MQ group was significantly older (69.0±10.4 vs 64.8±14.0 years, p<0.0001), had higher prevalence of dyslipidemia (49.2% vs 40.9% p=0.002) and hypertension (45.2% vs 39.3% p<0.0001) than the normal MQ group. The low MQ group had greater left ventricular mass (129±45 vs 114±44, grams, p<0.0001), left atrial volumes (37±14 vs 33±13, ml, p=0.001), and demonstrated a greater degree of diastolic dysfunction (lower E/A (0.89±0.28 vs 1.1±0.49, p<0.0001 and higher E/e’(8.63±2.42 vs 8.00±2.58, p=0.005), compared to the high MQ. VO2 max was lower in low MQ group (33±5.7 vs 36±6.7, p<0.0001). By regression, low MQ was associated with E/A (β=-0.119, adjusted p<0.0001) and VO2 max (β=-0.137, p<0.0001) (Table 1).

Conclusion:
Muscle quality is a useful metric of muscle function for sarcopenia in obese older adults. The associations between low MQ with diastolic dysfunction and reduced aerobic capacity corroborate the clinical impact of MQ as a defining metric of sarcopenia in obesity.
Abstract 4123501: Coronary Artery Calcium in Asymptomatic Arabs: Prevalence and Distribution
Authors: Alfaddagh Abdulhamied , El Mugharbil Ahmed , Yousef Altayyeb
Published: November 2024

Background:
Coronary artery calcification (CAC) is an established marker of subclinical atherosclerosis and predictor of cardiovascular events. Despite extensive research on CAC in various populations, data focusing on Arab populations, particularly asymptomatic individuals, is limited.

Methods:
We analyzed data from 2,739 asymptomatic self-referred Arabs included in the Kuwait Hospital Awareness Campaign for Early Detection of Atherosclerotic Coronary Artery Disease study. Traditional CVD risk factors were assessed, and ECG-gated cardiac CT imaging was used to measure using the Agatston method.

Results:
The mean±SD age of the sample was 48.4±9.8 and 41.8% were females. Kuwaitis comprised 61.6% of the sample, Egyptians 20.5%, and Levantines 16.4%. CAC was >0 in 32.3%, ≥100 in 11.5%, and ≥400 in 4% of the sample. CAC prevalence increased with age and was higher in Arab males with a 12 year earlier onset in males than females. The 50
th
, 75
th
, 90
th
and 95
th
percentiles of CAC for Arab females were, 0, 0, 39, and 167 and for males were 0, 25, 191, and 470, respectively. The presence of CAC was associated with traditional risk factors including diabetes, smoking, hypertension and LDL-C. Levantines and Kuwaitis had the highest prevalence of CAC and CVD risk factors; these groups were independently associated with higher CAC levels. In all age and sex subgroups except older males, the 75
th
percentiles of CAC were below 100. Therefore, a larger number of subjects were identified as high risk using the 75
th
age- and sex-specific CAC percentile than with CAC≥100 (19.3% vs 11.5%).

Conclusion:
This study provides comprehensive insights into subclinical atherosclerosis in asymptomatic Arabs, emphasizing the importance of early risk stratification for primary CVD prevention using CAC scoring. Our findings highlight that Arabs are not a homogeneous group with regards to prevalence of CVD risk factors and CAC. This study underscores the need to consider both absolute and age- and sex-specific CAC percentile values to inform primary prevention strategies in this predominantly young population.
Abstract 4123509: The Intersection of Race and Ethnicity, Social Determinants of Health, and Hypertension Prevalence: A Community-Level Analysis
Authors: Cajita Mia , Dunn Susan , Hernandez Rosalba , Doorenbos Ardith
Published: November 2024

Background:
Despite being one of the most diverse cities in the United States, Chicago is also notably segregated. The distinct separation among its 77 communities provides an opportunity to examine racial and ethnic segregation and the impact of social determinants of health (SDOH) on health outcomes.

Research Question:
How do race/ethnicity and SDOH influence hypertension (HTN) prevalence?

Aim:
To examine the relationships between race/ethnicity, SDOH, and HTN prevalence at the community level.

Methods:
This cross-sectional study used data from the Chicago Health Atlas collected between 2021 and 2022. The sample included data from all 77 Chicago communities and 2,738,956 of its residents. Two-step latent profile analyses were performed to classify each of the community according to the predominant race/ethnicity of its residents (Asian, Black, Hispanic, or White) and SDOH level (low, moderate, high), which was defined as how favorable the physical and social conditions are within the community and determined using 14 indicators (Table 1). Kruskal-Wallis tests were used to compare the prevalence of HTN among the communities by predominant race/ethnicity and SDOH level.

Results:
Among the 77 communities, 28 were predominantly Black, 27 were predominantly White, 21 were predominantly Hispanic, and 1 was predominantly Asian. HTN prevalence was highest in predominantly Black communities (39.9%), then the Asian community (35.8%), Hispanic communities (28.8%), and White communities (25.2%),
p
<.001. Based on the 14 SDOH indicators, 26 of the communities were classified as low SDOH (unfavorable conditions), 25 as moderate SDOH (moderately favorable), and 26 as high SDOH (favorable). HTN prevalence was highest in low SDOH communities (36.3%), followed by moderate SDOH communities (31.4%), and lowest in high SDOH communities (27.2%),
p
=.003.

Conclusions:
The findings highlight significant disparities in HTN prevalence across Chicago's communities, with higher rates observed in predominantly Black and low SDOH areas. These results underscore the need for targeted public health interventions to address the intersection of racial/ethnic segregation and SDOH.
Abstract 4123563: High Prevalence of Unrecognized Actionable Cardiac Arrhythmias in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease
Authors: Leavitt Jonas , Coleman Kristie , Dumchin Gregory , Kossack Andrew , Schwartz Jacob , Garcia Brenda , Wolf Elliot , Altschul Erica , Oks Margarita , Mina Bushra , Mountantonakis Stavros
Published: November 2024

Background:
Patients with chronic obstructive pulmonary disease (COPD) are at high risk for developing arrhythmias due to hypoxemia, right heart failure and use of beta-agonists inhalers. Symptoms related to arrhythmias can often be masked or confounded by symptoms related to COPD exacerbation and remain undiagnosed.

Objective:
To identify the incidence of actionable arrhythmias in patients with no prior cardiology follow-up and moderate–severe COPD with continuous monitoring.

Methods:
An automatic referral for electrophysiology (EP) consult was generated in patients with moderate-severe COPD if they answered yes to one of the following: palpitations, dizziness, abnormal ECG, near syncope. Upon consultation with EP specialist, implantation of loop reorder was discussed (ILR) with the patient. Patients were then monitored for 12 months via remote monitoring. Actionable arrhythmia was defined the arrhythmia that correlated with symptoms triggered by the patient, necessitated adjustment of medications (including initiation of anticoagulation), catheter ablation and implantation of implantable cardiac defibrillator (ICD) or permanent pacemaker (PPM).

Results:
Out of 62 patients referred 22 (35.5%) agreed to undergo ILR implantation. Of the 22 (50.0% female, 62 ± 9.5 years) patients implanted with an ILR, 15 (68.2%) had an actionable arrhythmia after a mean follow-up of 2.7± .3 months. These included 14 symptomatic events requiring medication adjustment (10 atrial tachycardias, 4 ventricular events), 7 cases of atrial fibrillation (requiring initiation of anticoagulation in all cases and catheter ablation in 1), 1 case of sinus node dysfunction requiring pacemaker implantation, and 1 episodes of sustained ventricular tachycardia requiring ICD implantation.

Conclusion:
Continuous monitoring had high yield in diagnosing significant arrhythmic events in patients with moderate-severe COPD. Awareness should be raised about the high arrhythmic risk of this population and the role of continuous monitoring should be sought in larger studies.
Abstract 4123804: Joint associations of sleep and daily step count with cardiometabolic health markers: a pooled analysis of the ProPASS consortium
Authors: Bian Angel , N Ahmadi Matthew , Biswas Raaj Kishore , Blodgett Joanna , Atkin Andrew , Chan Hsiu-Wen , Cruz Borja del Pozo , Suorsa Kristin , Bakker Esmee , Pulsford Richard , Mielke Gregore , Johansson Peter , Hettiarachchi Pasan , Koemel Nicholas , Thijssen Dick , Stenholm Sari , Mishra Gita , Teixeira Pinto Armando , Rangu Vegar , Sherar Lauren , Ekelund Ulf , Hughes Alun , Lee I-Min , Cistulli Peter , Holtermann Andreas , Koster Annemarie , Hamer Mark , Stamatakis Emmanuel
Published: November 2024

Background:
Poor sleep and physical inactivity are lifestyle-related behaviors that impact cardiometabolic health, but there is limited insight into their combined association with cardiometabolic markers.

Aims:
This study investigated the joint association of device-measured sleep patterns (regularity and duration) and daily step counts with cardiometabolic biomarkers.

Methods:
Harmonized individual participant data of 12,223 adults (mean±SD age:54.6±9.5 years; 54.8% female) from the pooled Prospective Physical Activity, Sitting and Sleep consortium (ProPASS), comprising six cohorts with thigh-worn accelerometry data were analysed. Sleep regularity was assessed using the validated Sleep Regularity Index (SRI, range 0-100), quantifying day-to-day sleep consistency. We used generalized linear models to examine cross-sectional joint associations between sleep patterns, regularity (SRI tertiles ≤75.8, low; 75.8-84.5, medium; >84.5, high) and duration (<7h, short; 7-8h, adequate; >8h, long), and daily step counts (step tertiles <8488, low; 8488-11601, medium; >11601, high steps/day) with a composite cardiometabolic health score and individual biomarkers, including BMI, waist circumference, total cholesterol, HDL cholesterol, triglycerides, and HbA1c.

Results:
Lower sleep regularity, deviation from adequate sleep, along with lower step counts were adversely associated with the composite cardiometabolic health risk score. Compared to optimal sleep patterns (SRI>84.5 or 7-8h/day) and high step groups, low sleep regularity and short sleep duration were separately associated with the least favourable composite cardiometabolic health (z-score [95%CI] 0.32 [0.28,0.37] and 0.25 [0.21,0.29], respectively) among participants with low volume of steps. Low sleep regularity and low daily steps were jointly associated with higher BMI (2.98 [2.67,3.29] kg/m
2
), waist circumference (8.61 [7.81,9.4] cm), total cholesterol (0.15 [0.08,0.23] mmol/L), and lower HDL levels (0.17 [0.14,0.2] mmol/L), regardless of sleep duration. For short/long sleep duration and low daily step count, such associations were only evident in BMI and waist circumference.

Conclusions:
Our findings suggest that the potential deleterious associations of irregular or inadequate sleep duration with cardiometabolic health outcomes may be exaggerated by lower daily step counts. Future studies should examine the prospective joint association of sleep patterns and physical activity on cardiometabolic health.
Abstract 4124267: Comparison of Right Ventricular Failure Prediction Models to Predict Right Ventricular Assist Device (RVAD) After HeartMate3 Implantation
Authors: Liu Zhiyu , Lee Dae Hyun , Lewellen Chase , Lee Jason , Wu Robby , Restrepo-Jaramillo Ricardo , Oliveira Guilherme , Rinde-Hoffman Debbie , Feliberti Jason , Mackie Benjamin , Dumitru Ioana
Published: November 2024

Introduction:
The requirement for right ventricular-assisted device (RVAD) implantation portends poor outcomes after left ventricular-assisted device (LVAD) implantation. We investigate RVF prediction models to help prediction of RV failure requiring RVAD implantation after centrifugal-flow LVAD HeartMate3 (HM3) placement.

Methods:
A total of 124 patients who underwent HM3 implantation at our institution from 2015-2023 were included in our analysis. We collected clinical variables used in EUROMACS RVF Risk Score (Circulation 2018), Utah Model (Am J Cardiology 2010), Michigan RVF Risk Score (JACC 2008), and CRITT (ATS 2013). Baseline scoring systems were compared with our cohort of patients with and without RVAD implantation after HM3 placement with ROC Area Under the Curve (AUC) statistical analysis. In addition, we investigated the pulmonary artery pulsatility index (PAPi) as a predictor for RV failure requiring RVAD.

Results:
There were 17 patients (13.7%) who underwent RVAD implantation after HM3 placement. Patients who required RVAD implant had worse survival (p = 0.037). The EUROMACS score differentiated those patients who required RVAD from those who did not (AUC: 0.66; 95% C.I: 0.51-0.81). In contrast, CRITT (AUC: 0.64; 95% C.I: 0.49-0.78), Michigan score (AUC: 0.37; 95% C.I: 0.25-0.51), and Utah (AUC: 0.53; 95% C.I: 0.40-0.68) scores did not differentiate those who required RVAD. PAPi was significantly lower in patients requiring RVAD (2.5±1.2 vs 3.9±3.0, p=0.001). Also, even as a single parameter, PAPi had an AUC of 0.63 (95% C.I: 0.50-0.76).

Conclusion:
RVAD implantation is associated with high early mortality. Existing RVF prediction models were not able to predict future RVAD requirements with high AUC, with the EUROMACS system having the only statistical significance. There is a lack of a strong predictive model for RV failure in HM3. Future efforts are needed to establish predictors for RV failure requiring RVAD implants in the HM3 population, especially utilizing novel hemodynamic markers such as PAPi.
Abstract 4124277: Resorcimoline, a Novel Free Radical Scavenger, Exhibits Cardioprotective Effects Following Coronary Ischemia-reperfusion Injury
Authors: Ueno Kazuhiro , Mulorz Joscha , Yoshimura Kenshi , Mori Kazuki , Kawashima Takayuki , Nishida Haruto , Higuchi Akihiro , Tokumaru Osamu , Miyamoto Shinji
Published: November 2024

Background:
Ischemic heart disease remains the leading cause of death worldwide. Early coronary revascularization is the most important treatment. Recent findings have revealed that reactive oxygen species (ROS) can lead to tissue damage following coronary artery revascularization, known as ischemia-reperfusion injury. In this study, we focused on a novel free radical scavenger, resorcimoline (RML). Last year, we reported the scavenging activity of RML
in vitro
against multiple ROS, confirmed by the electron spin resonance spectrometry.

Hypothesis:
Resorcimoline might reduce ROS damage in cardiomyocytes, thereby exerting cardioprotective effects following coronary ischemia-reperfusion injury.

Methods:
Nine-to-eleven-week-old male Wistar rats were subjected to acute myocardial ischemia induced by ligation of the left anterior descending coronary artery for 30 minutes. Rats received intravenous injections of RML at 6 mg/kg before the ligation release or saline as a control. The heart sections were double-stained at 24-hour reperfusion with Evans blue and triphenyltetrazolium chloride to assess the infarct area. Cardiac function was evaluated at 2-day and 7-day reperfusion with echocardiography. Myocardial fibrosis was assessed at 7-day reperfusion by Masson’s trichrome staining. Primary cultured rat cardiomyocytes were treated with 10 μM angiotensin II for 3.5 hours and then exposed to RML for 30 minutes. Cellular ROS assay kits were used to assess the levels of ROS in the cardiomyocytes.

Results:
Infarct size in RML-treated animals was significantly smaller than in control animals (41.8±19.4% vs. 60.8±12.9%, p=0.03, Fig. 1A). Apoptotic cells in the border zone were significantly reduced in RML-treated animals (32.0±11.7% vs. 55.1±16.9%, p=0.01, Fig. 1B). Troponin I level in RML-treated animals was significantly lower than in control animals (p=0.04, Fig. 1C). Ejection fraction in RML-treated animals was significantly preserved at 2-day reperfusion and 7-day reperfusion when compared to control animals (p=0.001, p=0.003, Fig. 2A). Myocardial fibrosis area in RML-treated animals was significantly smaller than in control animals (23.9±11.7% vs. 40.6±15.6%, p=0.01, Fig. 2B). RML significantly reduced angiotensin II-induced ROS in cardiomyocytes in a concentration-dependent manner (Fig. 3A,B,C).

Conclusion:
Resorcimoline exhibits cardioprotective effects following coronary ischemia-reperfusion injury by reducing the infarct size and ROS damage in cardiomyocytes.
Abstract 4124430: Calcinosis Cutis and Heart Failure---A Rare Manifestation Which Should Never Be Ignored!
Authors: Islam Sabeeh , Islam Rabia , Islam Hamza , Yousaf Hamza , Khan Arshan , Hanif Muhammad , Sbitli Taher , Singh Sumi
Published: November 2024

Introduction:
Heart failure can be a manifestation of underlying immune mediated myopathies like dermatomyositis/polymyositis which can present in broad range of clinical manifestations and sometimes dermatologic lesions can be the only manifestation of these underlying pathologies without typically involving the muscle weakness. Calcinosis cutis is the deposition of calcium salts in the skin and subcutaneous tissue. There are five subtypes of calcinosis cutis, dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis.

Case summary:
70-year-old female was evaluated for bilateral lower extremity swelling. Past medical history was significant for Graves’ disease, atrial fibrillation, mechanical aortic valve on warfarin, hypertension, hyperlipidemia, ascending aortic aneurysm. Work up showed BNP of 4700 pg/ml with normal cardiac enzymes. Transthoracic echocardiogram revealed newly reduced ejection fraction of 25—30% with severely dilated left ventricle. Patient refused cardiac catheterization. Nuclear stress test showed no evidence of ischemia. Patient was started on guideline directed medical therapy and biventricular Implantable cardioverter defibrillator device was placed as per cardiology recommendation. Six months later patient developed multiple calcinosis cutis lesions on abdominal wall requiring surgical excisions. Endocrine work up including PTH, serum Ca level was normal, however creatin kinase level was high normal (150 U/L). Serum aldolase was ordered which was found to be elevated(25U/L). Muscle biopsy was performed as per recommendations of rheumatology which was diagnostic of dermatomyositis. Patient was started on high dose steroids and methotrexate and eventually IV immunoglobulins as per rheumatology recommendation. Follow up echocardiogram revealed improved ejection fraction to 40--45% with resolution of any further lesion of calcinosis cutis afterwards.

Conclusion:
Cardiac involvement such as congestive heart failure can be a part of presentation of underlying untreated myopathies. Calcinosis cutis can be the only clinical manifestation of dermatomyositis affecting heart. Etiology of calcinosis cutis in patients with heart failure should be worked up properly. Dystrophic calcinosis cutis is the subtype associated with underlying autoimmune connective tissue diseases.
Abstract 4124446: Traditional Risk Factors, Cardiovascular Health, and Elevated Lipoprotein(a): The Multi-Ethnic Study of Atherosclerosis
Authors: Razavi Alexander , Reyes Mikaila , Wilkins John , Szklo Moyses , Tsai Michael , Whelton Seamus , Sperling Laurence , Tsimikas Sotirios , Bhatia Harpreet
Published: November 2024

Introduction:
One in five individuals have elevated lipoprotein(a) [Lp(a)], an inheritable risk factor that is causally associated with atherosclerotic cardiovascular disease (ASCVD). Whether individuals with elevated Lp(a) derive similar benefit from control of ASCVD risk factors has not been well-studied.

Hypothesis:
The magnitude of benefit associated with optimal cardiovascular health will be similar across the spectrum of Lp(a).

Aim:
To assess the association of traditional risk factor burden and Life’s Simple 7 (LS7) score with incident ASCVD across Lp(a) values.

Methods:
We studied 6,676 participants from the Multi-Ethnic Study of Atherosclerosis who underwent Lp(a) testing and were followed for incident ASCVD events (coronary heart disease and stroke). Elevated Lp(a) was defined as
>
50 mg/dL. As defined by the American Heart Association, LS7 metrics included smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and glucose. Multivariable Cox proportional hazards regression assessed the association of traditional risk factor burden and LS7 score (poor: 0-8, average: 9-10, optimal: 11-14) with incident ASCVD for individuals with and without elevated Lp(a) during a median follow-up of 17.7 years.

Results:
The mean age was 62.1 years, 53% were women, and 61% were non-white. The median Lp(a) was 17 mg/dL and 20% had Lp(a)
>
50 mg/dL. Individuals with Lp(a)
>
50 mg/dL had the highest burden of traditional risk factors except cigarette smoking. Compared to those with a poor LS7 score, those with an optimal LS7 score had a lower ASCVD risk that was significant for participants with Lp(a) <50 mg/dL (HR=0.37, 95% CI: 0.25-0.55), but borderline significant for participants with Lp(a)
>
50 mg/dL (HR=0.41, 95% CI: 0.16-1.02). Individuals with Lp(a)
>
50 mg/dL had the highest absolute event rates across all LS7 categories, and there was no significant interaction between Lp(a) and LS7 score on incident ASCVD (p-interaction=0.64,
Figure
).

Conclusions:
Participants with an optimal LS7 score had similar reduction in ASCVD risk regardless of their Lp(a) burden. These results emphasize the importance of a healthy lifestyle and ASCVD risk factor control among patients with elevated Lp(a).
Abstract 4124457: Socioeconomic Deprivation is Associated with Readmission Within One Year After Atrial Fibrillation Ablation
Authors: Brodeur Peter , Ferro Enrico , Maher Timothy , Yang Shu , Waks Jonathan , Tung Patricia , Saad Eduardo , d'Avila Andre , zimetbaum peter , Kramer Daniel , Yeh Robert , Locke Andrew
Published: November 2024

Introduction:
Gender and race have been shown to impact access and outcomes regarding rhythm control management such as atrial fibrillation (AF) ablation. We aimed to evaluate the role of the Area Deprivation Index (ADI), a validated metric that represents the social disadvantage of communities, to determine if socioeconomic disadvantage (SED) increases the risk of readmission within one year after AF ablation.

Methods:
Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Ambulatory Surgery and Services Databases in New York and Florida from 2016-2019 with follow-up into 2020 into the inpatient setting. These states were chosen due to availability for linkage of the 2020 ADI. International Classification of Diseases 10 and Current Procedural Terminology codes for AF and AF ablation were used. The risk of readmission was assessed using multivariable Cox proportional hazards with covariates age, sex, race, insurance, Charlson Comorbidity Index (0 vs ≥ 1 comorbidity), and ADI quartiles. ADI is scored 1-100 with higher scores representing more disadvantage.

Results:
14,078 patients met inclusion criteria. The readmission rate at one, three, and twelve months was 6.1%, 9.9%, and 20.9% respectively. The most common readmission diagnoses at twelve months were AF (22.8%), followed by symptoms such as chest pain, dyspnea, palpitations, and syncope (13%). In the adjusted model, older age, female sex, federal insurance, ≥ 1 Charlson comorbidity, and higher ADI had higher one-, three-, and twelve-month risks of readmission. Hispanic ethnicity had a higher risk of one month readmission.

Conclusion:
Readmission for AF after ablation is common at twelve months. Higher risk of readmission after AF ablation was observed with SED. Enhanced awareness and additional research regarding SED as a risk factor for readmission may help improve post-ablation AF outcomes and equitable access to cardiovascular care.
Abstract 4125026: Effect Of Pressure-Controlled Intermittent Coronary Sinus Occlusion On Echocardiographic Features In Patients With STEMI: A Systematic Review And Meta-Analysis With Trial Squential Analysis
Authors: Mouffokes Adel , Soliman Youssef , K. Awad Ahmed , Abdelazeem Basel
Published: November 2024

Introduction:
Primary percutaneous coronary intervention (pPCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, pPCI is still associated with poorer outcomes particularly left ventricular dysfunction. Pressure-controlled intermittent coronary sinus occlusion (PiCSO) is a novel therapeutic approach proposed to improve myocardial perfusion and its function in patients with STEMI. Therefore, we performed this meta-analysis to evaluate the effects of PiCSO on left ventricular function in STEMI patients.

Methods:
We performed a comprehensive search on PubMed, Scopus, and Web of Science. Our primary endpoints were left ventricular ejection fraction (LVEF%), left ventricular end diastolic volume (LVEDV), and left ventricular end systolic volume (LVESV). The secondary endpoint was infarct size. We performed Trial Squential Analysis (TSA), and we pooled our continuous data as mean difference (MD) and 95% confidence interval (CI) in the fixed effects model.

Results:
A total of four studies, with 335 patients, were included in the analysis. Our pooled analysis showed that PiCSO significantly increased LVEF% compared to pPCI (MD = 3.52, 95% CI [1.05, 6.00], P= 0.005). However, there was no significant difference between the two groups in terms of LVESV and LVEDV (MD = -1.1, 95% CI [-9.28, 7.08], P= 0.79; MD = -1.69, 95% CI [-9.14, 5.76], P= 0.66, respectively). With regard to infarct size, a significant reduction was observed in PiCSO group compared to pPCI (MD = -4.26, 95% CI [-7.39, -1.14], P= 0.007). The TSA curve crossed the conventional boundary for statistical significance, indicating that the available evidence reach the predetermined threshold.

Conclusions:
Our meta-analysis revealed that PiCSO could mitigate left ventricular dysfunction in STEMI patients by improving LVEF% and reducing infarct size. Nevertheless, PiCSO failed to show a positive impact on LVESV and LVEDV. Further large-scale studies are warranted to draw a definitive conclusion.
Abstract 4125059: Techniques and Outcomes of Atrial Fibrillation Ablation in Patients with Persistent Left Superior Vena Cava
Authors: Liao Ting-Wei Ernie , Xu Lingyu , Pourmousavi Khoshknab MirMilad , Peters Carli , Callans David , Marchlinski Francis , Schaller Robert , Frankel David , Luebbert Jeffrey , Guandalini Gustavo , Nazarian Saman
Published: November 2024

Introduction/Background:
Persistent Left Superior Vena Cava (PLSVC) presents unique challenges for atrial fibrillation (AF) ablation due to its arrhythmogenic potential and complex anatomical variations. Understanding tailored approaches and outcomes in patients with PLSVC and AF is essential for improving procedural success and safety.

Research Questions/Hypothesis:
This study aims to investigate the efficacy and outcomes of tailored ablation strategies in patients with PLSVC and AF.

Goals/Aims:
To evaluate the procedural safety, acute success, and AF recurrence rate post-ablation in patients with PLSVC, and to determine the optimal ablation strategies for this population.

Methods/Approach:
This retrospective cohort study included 16 patients with PLSVC who underwent 21 AF ablation procedures between August 1, 2008, and February 14, 2024, at the Hospital of the University of Pennsylvania. Procedures involved pre-ablation imaging, 3D electroanatomical mapping, pulmonary vein isolation (PVI), and targeted ablation strategies focusing on PLSVC-related triggers. The primary endpoints were procedural safety and AF recurrence post-ablation.

Results/Data:
The cohort's mean age was 51.9 ± 17.9 years, 31.2% of whom were female. Triggers from the PLSVC were identified in 66.7% of procedures. Tailored ablation strategies were employed to isolate PLSVC-left atrium/coronary sinus connections or directly target the induced triggers, with a success rate of 85% in achieving isolation or targeted ablation once triggers were induced. The recurrence rate of arrhythmia post-ablation was 58.3% in the patient-based analysis and 70.6% in the procedure-based analysis. No major complications occurred.

Conclusion(s):
This study highlights the significance of recognizing PLSVC as a potential source of AF triggers. The single procedure success rate is low compared to patients without PLSVC. Further studies are warranted to enhance outcomes in this challenging AF population.