bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147327: Race and Ethnic Differences in Donor-Derived Cell-Free DNA and Gene Expression Profiling in Heart Transplant Recipients in a Negative Biopsy Cohort
Authors: Oren Daniel , Moeller Cathrine , Fernandez Valledor Andrea , Rahman Salwa , Rubinstein Gal , Baranowska Julia , lotan dor , DeFilippis Ersilia , Fried Justin , Yunis Adil , Raikhelkar Jayant , Clerkin Kevin , Peterson Stephen J , Parikh Manish , Latif Farhana , Sayer Gabriel , Uriel Nir
Published: November 2024

Introduction:
The Donor-Derived Cell-Free DNA-Outcomes AlloMap Registry (D-OAR) study has highlighted the significant capability of dd-cfDNA, showcasing a 97% negative predictive value (NPV) for identifying both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) at a dd-cfDNA threshold of 0.20%. This development has greatly enhanced the range of biomarkers available to clinicians, confirming dd-cfDNA as a reliable clinical biomarker for monitoring heart transplant (HT) recipients. Short and long-term outcomes for African American HT recipients are worse. Given these findings, our study aims to investigate baseline differences in the levels and positivity rates of dd-cfDNA stratified by race in a negative biopsy cohort.

Methods:
We conducted a single-center retrospective review of all HT recipients from 2019 to 2023 with at least one valid combined dd-cfDNA sample drawn between April 2019 and July 2023. Multiorgan transplant recipients and those without a paired biopsy result were excluded. A positive biopsy result was defined as >= ISHLT grade 1R/1B or pAMR>0. Dd-cfDNA (AlloSure, AS) result was considered positive if ≥0.12%, and as a sub-analysis using a threshold ≥0.20%. A positive peripheral GEP (pGEP, AlloMap, AM) test was defined as >30 in the first five months post-transplant and >34 afterward. Samples associated with a positive biopsy result were excluded. We further stratified our cohort based on race.

Results:
Of 643 paired dd-cfDNA/GEP samples from 227 patients, the median age was 55 years, and 27% were female. The cohort was stratified into four categories: 53% were white, 18.8% were AA, 20.4% were Hispanic/Latino, and 7.8% were of other races. We observed no baseline differences in the positive dd-cfDNA levels (p=0.39) and positivity rates of dd-cfDNA at a threshold of 0.12% and 0.20% (p=0.08, p=0.06) or GEP positivity rates (p=0.52) between the 4 race categories in our surveillance cohort (Figure 1). Further comparison of patients treated for rejection based on non-invasive monitoring did not reveal a difference.

Conclusions:
In our surveillance cohort, dd-cfDNA levels and positivity rates were not different between AA and white HT recipients. Further prospective randomized trials are needed to elucidate potential race-related differences in dd-cfDNA levels.
Abstract 4147337: The Aortic Inflammation Affects Long-Term Freedom From Reintervention After Bentall Procedure
Authors: Zanella Luca , Giacomo Murana , Baldovini Chiara , Di Marco Luca , Leone Alessandro , Pacini Davide
Published: November 2024

Background:
The impact of aortic inflammation on aortic surgery is still unclear.

Hypothesis:
The aortic inflammation affects the freedom from reintervention in the distal native aorta following the Bentall procedure.

Methods:
This is a retrospective observational study performed on the aortic histology of patients over 18 years old who underwent a Bentall procedure in a single centre, from 2000 to 2023. Variables included demographics, cardiovascular risk factors and ascending aorta diameter. The follow-up verified death or reintervention on the distal aorta. The relationship between the aortic inflammation and cardiovascular risk factors was tested with Logistic Regression, expressed as odds ratio (OR) and 95% confidence interval (CI95%). The Cox regression evaluated if inflammation was a significant predictor for survival and reintervention, expressed as hazard ratio (HR) and 95%CI. The Kaplan-Meier curves for the freedom from reintervention stratified by inflammation were compared with the Tarone-Ware test.

Results:
Data concerning 1327 patients was gathered: 61(4.6%) had aortic inflammation. The median follow-up was 4.3 years (Interquartile 1.5-8.1 years). The inflammation was associated with females (OR3.5 CI95% 1.9-6.2 p<0.01), age (OR1.1 CI95% 1.01-1.08 p=0.01), and increased ascending aorta diameter (OR1.1 CI95% 1.05-1.1 p<0.01), but not with aortic dissection (OR0.5 CI95% 0.2-1.1 p=0.08). Inflamed aorta did not increase mortality (HR1.4 CI95% 0.8-2.6 p=0.23). However, inflammation was the strongest risk factor for reintervention on the distal aorta (HR6.8 CI95% 3.1-15.2 p<0.01), independently from aortic dissection (HR3.2 CI95% 1.5-6.6 p<0.01), elevated ascending aorta diameter (HR1.1 CI95% 1.01-1.05 p=0.05), body max index (HR0.9 CI95% 0,84-0,97 p<0.01). The Kaplan-Meier curves confirmed that an inflamed aorta provided lower freedom from reintervention than one without inflammation (Figure 1, Tarone-Ware Test p<0.01).

Conclusions:
Aortic inflammation in patients treated with the Bentall procedure is associated with age, female, and increased ascending aorta diameter. Inflammation doesn’t affect survival after surgery. However, it strongly increases the risk of reintervention in the distal native aorta.
Abstract 4147346: Efficacy of OCT versus angiography in post-procedural lesions complications after percutaneous coronary intervention with drug-stent implementations: A systematic review and meta-analysis
Authors: Katsuyama Eric , Fukunaga Christian , Andrade Naieli , Petri Santos Pinheiro Rafael , Prata Alonzo , Scardini Pedro Gabriel , Coan Ana Carolina , Falco Neto Wilson , Fernandes Julia , Gioli-Pereira Luciana
Published: November 2024

Background:
Although recent studies have suggested the advantages of utilizing optical coherence tomography (OCT) for image guidance during percutaneous coronary intervention (PCI) with drug-eluting stent implantation over conventional angiography, the specific impact on post-procedural lesion complications has remained uncertain. To address this gap, we conducted an updated systematic review and meta-analysis focusing on post-procedural lesion complications associated with OCT-guided versus angiography-guided procedures in lesions undergoing PCI with drug-eluting stent implementation.

Methods:
We searched systematically through Pubmed, Embase, and Cochrane for randomized controlled trials(RCTs), which included lesions undergoing PCI and drug-stent deployment guided by OCTversus angiography. Our primary outcome of interest was (1) stent malposition under OCT analysis. We also included the following secondary outcome: (2) dissections under OCT analysis. We excluded studies that did not use OCT imaging to analyze post-procedure lesions. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model.

Results:
Five RCTs comprising 3,266 lesions undergoing OCT or Angio PCI-guided and drug stent implementation were included, of whom 1,549(48,34%) underwent OCT. The number of moderate-severe calcified lesions was 370 (11.33%). Our results show a significant association with decreased stent malposition risk in the OCT group, showed a significant decrease in post-procedure risk regarding stent malpositioning ( RR: 0.80; 95% CI: 0.75-0.84; P<0.001; Fig.1) compared to angiography. However, our findings did not detect any difference in dissection undergoing OCT post-procedure analysis (RR: 1.58; 95% CI: 0.31- 8.06; P=0.583; Fig.2)., compared to the angiography group.

Conclusion:
In this meta-analysis comparing OCT versus angiography in lesion complications post-procedure undergoing PCI and drug-stent implementation, the OCT group was associated with decreased stent malposition.
Abstract 4147366: At-Home Management of Patients with Heart Failure Demonstrates Few Emergency Department Transfers and High Patient Satisfaction
Authors: Daniels Brock , McGinnis Christina , Reading Meghan , Shafran Topaz Leah , Masterson Creber Ruth , Sharma Rahul
Published: November 2024

Background and Objective:
Mobile Integrated Health (MIH) interventions enable community paramedics to perform structured assessments, physical exams, and medication reconciliation, provide disease education, review follow-up instructions, and adjust medications or administer intravenous diuretics under the direction of the telehealth physician. MIH has been shown in other studies to reduce emergency department (ED) transfers and healthcare costs while maintaining high patient satisfaction. We aimed to assess ED transfer rates and satisfaction in our population of largely medically underserved patients living with heart failure (HF) managed at home by MIH.

Methods:
Patients at a large, urban, academic medical center were enrolled in MIH via clinician referral as needed. After receiving an MIH visit, patients were invited to complete anonymous satisfaction surveys via REDCap. Paramedics documented whether an MIH home visit resulted in an ED transfer. Descriptive statistics were performed to evaluate the survey response distribution percentage and calculate ED transfer rates.

Results:
Between January 2021 and March 2024, 2,678 MIH visits were conducted for heart failure patients in NYC, with some patients receiving multiple visits. Among these, 239 patients completed at least one survey; only the first was considered for analysis. The average age of respondents was 74.01 (SD 14.8). Patient satisfaction was high: over 90% of participants expressed satisfaction across domains of ease of technology use, self-management and preference for receiving care at home. The net promoter score (patients recommending MIH to others) was 9.56 out of 10 (SD 1.27). Only 67 visits (2.5%) resulted in immediate ED transport during an MIH visit.

Conclusions:
High patient satisfaction with MIH care management at home and low rate of immediate transfers to ED indicate effective at-home care. These findings support MIH as a viable model for improving healthcare delivery and patient outcomes in HF management.
Abstract 4147375: Temporal Patterns in Atrial Fibrillation and Flutter Mortality 1999-2022: A Racial Comparative Analysis in the United States
Authors: Qadadeh Ziad , Nadeem Bilawal , Abughazaleh Saeed , Al Nawaiseh Ahmad , Jahandideh Dariush
Published: November 2024

Background:
Atrial fibrillation is the most common cardiac arrhythmia in the United States. It is a tachyarrhythmia characterized by irregular electrical impulses in the atria. It poses a significant risk of stroke and is a major concern in cardiovascular health. Understanding mortality trends related to AF across racial groups is crucial for guiding targeted treatment strategies, particularly for marginalized populations.

Methods:
Data were obtained from the CDC WONDER database. Age-adjusted mortality rates for atrial fibrillation and flutter between 1999-2022 were calculated relative to the standard US population. Time trends were assessed using annual percentage change (APC) and average APC (AAPC), employing Joinpoint Regression Software (version 8.4.2, NCI). Monte Carlo permutation analysis was utilized to determine the most parsimonious trend.

Results:
In 2022, atrial fibrillation and flutter caused 28,932 deaths in the United States. Analyzing mortality trends from 1999 to 2022 across all racial groups revealed a significant increase in the average annual percentage change (AAPC) of 3.6% (95% CI 3.1-4.2, p <0.001), with mortality rates rising from 4.8 to 10.6 deaths per 100,000. Breakdown by race indicated AAPC increases of 4.0% among non-Hispanic whites, 3.9% among non-Hispanic blacks, and 3.7% among Hispanics.

Among non-Hispanic whites, two distinct periods of change were observed: an APC of 4.9% (95% CI 4.5-5.4, p <0.001) from 1999-2015 and an APC of 1.8% (95% CI 0.2-3.4, p <0.001) from 2015-2022. For non-Hispanic blacks, the mortality trend remained uniform, with an APC of 3.9% from 1999-2022. Hispanics displayed two join points: an APC of 4.6% (95% CI 4.0-5.3, p <0.001) from 1999-2016 and an APC of 1.1% (95% CI -2-4.3, p=0.5) from 2016-2022.

Conclusion:
In conclusion, our study highlights significant increases in mortality rates attributed to atrial fibrillation and flutter across all racial groups in the US from 1999 to 2022. Non-Hispanic whites exhibited a slowdown in the rate of increase between 2015 and 2022, contrasting with uniform trends among non-Hispanic blacks and fluctuating patterns among Hispanics. These findings emphasize the importance of tailored interventions to address racial disparities in mortality rates associated with atrial fibrillation and flutter, particularly targeting areas where trends deviate from the overall trajectory. Further research should explore the underlying cause for these observed disparities in outcome.
Abstract 4147387: Outcomes of Heart Failure with Preserved Ejection Fraction with GLP1RA plus SGLT2i vs SGLT2i alone: A Propensity-Matched Nationwide Cohort Study
Authors: Almas Talal , Al-Kindi Sadeer , Akbar Absam , Qureshi Amal , Perez Jaime Abraham , Grace Harper Elleson , Syed Saif , Alazazzi Hosam , Sullivan Claire , Neeland Ian , Deshmukh Abhishek , Anavekar Nandan
Published: November 2024

Introduction:
Metabolic pharmacotherapies [Glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium-glucose cotransporter type 2 inhibitors (SGLT2i)] have shown benefit in patients with heart failure and preserved ejection fraction (HFpEF). It remains unclear whether the two classes would have additive effects.

Methods:
We performed a retrospective study using a de-identified federated database with 89 contributing health care organizations (HCO), including over 126 million patients (TriNetX Research Network, Cambridge, MA; date of data access: May 23, 2024). TriNetX regularly aggregates clinical data directly from participating HCOs, and performs extensive data quality and accuracy assessment. While TriNetX obfuscates institutional information relating to participating HCOs, a typical HCO includes a large academic health center with inpatient, outpatient, and specialty care services. We identified all patients with a diagnosis of Heart failure with preserved ejection fraction (HFpEF, ICD-10: I50.3), and SGLT2i usage. We then categorized this patient population into two cohorts, including patients with concomitant GLP1RA use, and patients without GLP1RA use. For both cohorts, we collected data on patient demographics, and the outcomes of all-cause mortality, and all-cause hospitalization, occurring up to 10-years after the index diagnosis. We evaluated differences in outcome risk using hazards ratios and 95% confidence intervals.

Results:
Prior to propensity score matching, we identified 114,329 patients, with 7931 patients receiving SGLT2i +GLP1RA vs 106398 receiving SGLT2i-alone. Majority (55.7%) identified as white and 24.4% as African Americans and >90% of the patients had a diagnosis of type 2 diabetes mellitus. After propensity matching, the rate of all-cause hospitalization within the combination group was lower than SGLT2i group (29.6% vs 32.4%, HR 0.76 [0.73- 0.79], P<0.001). All-cause mortality for the combination group was 6.8% versus 10.6% within the SGLT2i-alone group (HR 0.52 [0.47-0.56], P<0.001)).

Conclusion:
In this propensity-matched cohort, patients with HFpEF receiving GLP1RA and SGLT2i had lower rates of hospitalizations and all-cause mortality compared with those receiving SGLT2i alone. Large randomized controlled trials are warranted to corroborate these findings.
Abstract 4147415: Return-to-Play for Athletes with Desmosomal Arrhythmogenic Cardiomyopathy: A Single Center Experience
Authors: Martinez Katherine , Bos Johan , Giudicessi John , Ackerman Michael
Published: November 2024

Background:
Current guidelines discourage athletes with a positive genetic test for arrhythmogenic cardiomyopathy (ACM) from participating in sports. The evidence that exercise may act as a disease-accelerator is most compelling for PKP2-mediated ACM. As such, shared decision making (SDM) and return-to-play (RTP) for athletes with ACM may be possible for some genotypes.

Objective:
To examine the management, RTP, outcomes, and evolution of phenotype among athletes with genotype positive ACM.

Methods:
A retrospective review of the electronic medical records was performed on all self-identified athletes with genotype positive ACM. They were evaluated, risk stratified, and treated in Mayo Clinic’s (MC) Windland Smith Rice Genetic Heart Rhythm Clinic.

Results:
Among the 621 patients with genotype-positive ACM, there were 38 athletes [16 females (42%); mean age at either clinical diagnosis or positive genetic test 28 ± 19 years; mean follow-up 4 ± 4 years] participating in sports at all levels. The majority, 21 (55%), had PKP2-ACM and 7 (18%) had DSP-ACM. Prior to their first MC evaluation, 15 athletes (39%) were engaged in long distance running, swimming, cycling, or triathlons. Seven athletes (18%) had a non-lethal breakthrough cardiac event (BCE) after diagnosis, but prior to MC evaluation. During 150+ athlete-years of follow-up, there have been no ACM-associated deaths, but 5 athletes (13%) experienced a non-lethal BCE. Twenty-two athletes (58%) were phenotype negative at time of first MC evaluation including 10 endurance athletes (45%). Of these, 3 (14%) converted to phenotype positive (average age at conversion 25 ± 15 years), while 7/16 (44%) phenotype positive athletes exhibited further disease progression (average age at progression 32 ± 18 years). For these 10 athletes who either converted or progressed, treatment intensification included an ablation in 4, ICD in 2, and a heart transplant in 2. Seven resumed athletic activity in some capacity after conversion/progression and a non-lethal BCE occurred in 3.

Conclusions:
This is the first single center cohort of patients with ACM being empowered to remain an athlete. In contrast to athletes with other genetic heart diseases (GHDs), these athletes have exhibited more cardiac events, although nonfatal, and higher rates of disease conversion/progression than our other GHDs. Further studies are needed to determine how to effectively and safely enable appropriate sports participation in genetically-mediated ACM
Abstract 4147445: Framingham risk and major adverse cardiovascular events among patients with hypertension ineligible for SPRINT
Authors: Petito Lucia , Huang Xiaoning , Jefferson Celeena , Vupputuri Suma , Lancki Nicola , Ahmad Faraz , Kazi Dhruv , Ndumele Chiadi , Allen Norrina , Persell Stephen , Shah Nilay , Lloyd-Jones Donald , Khan Sadiya
Published: November 2024

Background:
Among older adults with hypertension and increased risk of cardiovascular disease (CVD), the SPRINT trial demonstrated benefit of intensive BP-lowering. However, several categories of individuals who are at increased CVD risk were not included in SPRINT, including persons with diabetes, advanced chronic kidney disease [CKD], or younger than age 50 years.

Objectives:
In an integrated health system, we aimed to compare the cumulative incidence of major adverse cardiovascular events (MACE) among patients with hypertension who (1) met all eligibility criteria for SPRINT and met all inclusion criteria for SPRINT but were excluded due to (2) diabetes, (3) advanced CKD, or (4) age <50 years.

Methods:
In this retrospective analysis of electronic health records (EHR) from Kaiser Permanente Mid-Atlantic States between 2010-2018, we identified patients aged 18 years or older with a systolic BP 130-180mm Hg at increased risk of CVD as defined in SPRINT (Framingham predicted CVD risk>15%, prior CVD, or CKD with eGFR 20 to <60 mL/min/1.73m
2
). We compared MACE with Kaplan-Meier analysis among those who were (1) eligible for SPRINT, (2) with diabetes, (3) with stage 4 or 5 CKD (eGFR <20 mL/min/1.73m
2
not on dialysis), (4) or younger than 50 years.

Results:
In total, 104,757 individuals (47.3% female, 47.5% non-Hispanic Black) were identified with elevated BP and at increased CVD risk. Of these, 54.2% met all eligibility criteria for SPRINT, 32.2% had diabetes, 3.8% had advanced CKD, and 9.9% were aged 18-49y. At baseline, the 10-year Framingham CVD risk for each subgroup was: SPRINT-eligible: 24.2%; among those ineligible for SPRINT, those with diabetes: 32.2%; CKD: 25.0%; and adults aged 18-49 years: 18.8%. Over a median follow-up of 1.8 (IQR 0.9-3.8) years, the 3-year cumulative incidence of MACE (
FIGURE
) was SPRINT-eligible: 9.1% (95% CI 8.8-9.5%); among those ineligible for SPRINT, those with diabetes: 12.6% (12.1-13.0%); CKD: 18.8% (17.3-20.3%); and adults aged 18-49 years: 7.7% (7.0-8.4%).

Conclusions:
A large proportion of patients with hypertension in a diverse real-world sample were not eligible for SPRINT. However, CVD event rates were high in all groups, which suggests risk-based approaches to BP-lowering should be evaluated among those at increased CVD risk not included in SPRINT.
Abstract 4147459: Impact of Arrhythmias on Vascular Outcomes in Loeys-Dietz Syndrome
Authors: Saugstad Austin , Bcharah George , Ravi Srekar , Firth Christine , Wang Yuxiang , Osundiji Mayowa , Ayoub Chadi , Shamoun Fadi
Published: November 2024

Introduction/Background:
Loeys-Dietz syndrome (LDS) is a rare autosomal dominant aortic aneurysm syndrome characterized by arterial tortuosity resulting in arterial aneurysms and dissections, with unique craniofacial and skeletal features including bifid uvula, cleft palate and hypertelorism. While the presence of atrial fibrillation (Afib) and arrhythmias have been reported in LDS patients, limited investigation has been completed regarding the associated risk and severity of vascular complications in relationship to these arrhythmias1,2.

Research Questions/Hypothesis:
Are there any differences in vascular outcomes in patients with LDS when experiencing various forms of tachyarrhythmia?

Goals/Aims:
To evaluate the relationship between various types of arrhythmias and vascular outcomes in patients with LDS, including arterial dissection, stroke, revascularization, and death.

Methods/Approach:
A large sample of LDS patients (n=436) from a single tertiary referral center was assessed for ICD-10 diagnoses of arrhythmia and outcomes of interest. Arrhythmias assessed included Afib, atrial flutter (AFL), premature ventricular contractions (PVCs), and supraventricular tachycardia (SVT). Outcomes were arterial dissection, hemorrhagic and ischemic stroke, revascularization, and all-cause mortality.

Results/Data:
Our cohort (n=436) had an average age of 47 and was 57.8% female. A total of 26 patients had a documented history of tachyarrhythmia: 16 (3.4%) Afib, 2 (0.5%) AFL, 6 (1.4%) SVT, and 2 (0.5%) PVC. LDS patients with Afib were at significantly higher risk of arterial dissection (25% vs 6.0%, OR: 5.3, p<0.01), revascularization (18.8% vs 3.3%, OR: 8.1, p<0.01), stroke (25% vs 3.6%, OR: 9.0, p<0.001), and death (25% vs 4.3%, OR: 7.4, p<0.01) compared to those without a documented history of arrhythmia. Other arrhythmia types evaluated were not significant. Predictors of any arrhythmia type included hypertension (78% vs 31%, OR: 1.5, p<0.001) and heart failure (39% vs 5.0%, OR: 2.3, p<0.001).

Conclusion:
Although rare, Afib in LDS patients is associated with adverse vascular outcomes and mortality compared to those without a history of arrhythmia. Furthermore, the magnitude of increased risk is striking. Early identification and management of Afib in LDS patients may be critical in mitigating the risk of potential vascular complications.
Abstract 4147467: Combined Heart and Liver Transplantation in the Failing Fontan: Systematic Review and Single-arm Meta-analysis
Authors: Karlinski Vizentin Vanessa , Mesquita Cynthia , Ferreira Felix Iuri , Bulhoes Elisio , Antunes Vanio do Livramento Junior , Ameduri Rebecca , Johnson Jonathan
Published: November 2024

Background:
The Fontan procedure has transformed the management of congenital heart defects (CHD) characterized by single ventricle physiology, yet it predisposes individuals to Fontan-associated liver disease (FALD), potentially leading to end-stage liver disease (ESLD). Combined heart and liver transplantation (CHLT) emerges as a therapeutic option, but evidence on its efficacy, safety, and outcomes remains limited.

Objectives:
This systematic review and single-arm meta-analysis aims to comprehensively evaluate the literature on CHLT in Fontan patients, focusing on patient characteristics, perioperative outcomes, and post-transplant morbidity and mortality.

Methods:
A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted following PRISMA guidelines. Studies meeting the intervention of CHLT in Fontan patients were included and data were collected and synthesized using proportion meta-analysis techniques. Statistical analysis was carried out using R software.

Results:
Four studies met inclusion criteria, comprising 67 Fontan patients undergoing CHLT. All included studies were observational retrospective cohorts performed in the United States. One-year survival rate post-CHLT was 84% (95% CI 66%-94%), Figure 1A. Rates of liver and heart graft rejection were low 10% (95% CI 3%-33%) and 8% (95% CI 2%-31%), respectively, Figure 1B. Postoperative complications included acute kidney injury 72% (95% CI 46%-88%), temporary dialysis 31% (95% CI 14%-55%), neurologic events 14% (95% CI 5%-34%), infection 24% (95% CI 6%-63%), and unplanned medical procedures 41% (95% CI 24%-60%), Figure 1C.

Conclusion:
CHLT in Fontan patients demonstrates promising survival rates, but graft rejection and postoperative complications pose challenges. The rate of renal complications is particularly notable and requires further evaluation. Future research should prioritize comparative different management strategies and long-term follow-up to refine protocols and optimize outcomes.
Abstract 4147484: Association Between Protein Energy Malnutrition and Transplant Rejection in the Heart Transplant Population. A Retrospective Inpatient Database Analysis
Authors: Evbayekha Endurance , OMOIKE EUGENE , Alugba Gabriel , sajja jayadev , Younis Uthman , REISS CRAIG
Published: November 2024

Introduction:
Heart transplant (HT) is the gold standard for advanced heart failure, and the individuals burdened by advanced heart failure often have multiple comorbidities. Protein-energy malnutrition (PEM) is a common comorbidity and is frequently underdiagnosed. Previous studies examined the relationship between PEM and mortality in HT and found a positive association. However, the relationship between PEM and HT rejection, HT failure, and cardiac allograft vasculopathy (CAV) is scarce. Given that these complications also impact survival, we sought to explore the relationship.

Methods:
We identified all HT patients using ICD-10 codes from the 2016 to 2021 National Inpatient Sample database. Then, the PEM group was compared to the no-PEM group. We used Student’s Test and Pearson’s Chi-squared to analyze continuous and categorical variables. Then, multivariable logistic regression models were used to account for confounders and to predict the outcomes. The primary outcomes were HT rejection, HT failure, and CAV. The secondary outcomes were mortality, arrhythmias (composite of atrial and ventricular fibrillation and flutter, and supraventricular tachycardia), length of hospital stay, and cost of hospitalization. A 2-sided p-value was the statistical threshold for significance.

Results:
During the study period, 31,215 HT hospitalizations occurred, and 11.9% (3,700) had PEM. The median age for the PEM group was 65 years.

Compared to the no-PEM group, HT rejection 0.8 (0.4-1.5), HT failure 0.8 (0.3-2.1), and CAV 1.08 (0.6-1.9) did not differ between both groups, p>0.05, each.

The PEM group had a higher association with mortality 2.8 (2.1-3.6), arrhythmias 1.4 (1.07-1.8), longer LOS 8 vs. 4 days, and higher cost of hospitalization, $84,687 vs. $43,285, p<0.01 each.

Conclusion:
Among the heart transplant population, protein-energy malnutrition was not associated with transplant rejection, transplant failure, or CAV. However, protein-energy malnutrition was associated with mortality, arrhythmias, a longer hospital stay, and a higher cost of hospitalization.
Abstract 4147486: In-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy and Malnutrition: Analysis from the National Inpatient Sample
Authors: Gbegbaje Oghenetejiri , NELSON FAVOUR , Ezenna Chidubem , Alugba Gabriel , Okorare Ovie , Muhammad Haris , Gallimore Samantha , Patel Dipal , Saint Croix Garly , Goldsweig Andrew
Published: November 2024

Introduction:
Takotsubo, or stress cardiomyopathy, can result in substantial morbidity and mortality. Malnutrition can affect the prognosis of hospitalized patients.

Objective:
To compare Takotsubo cardiomyopathy outcomes between patients with severe protein-calorie and mild-moderate malnutrition.

Methods:
We queried the National Inpatient Sample (NIS) from 2016 to 2020 for adults hospitalized with Takotsubo cardiomyopathy and severe or mild-moderate protein-calorie malnutrition. The primary outcome was inpatient mortality. Secondary outcomes included cardiac arrest, cardiogenic shock, respiratory failure/mechanical ventilation, acute kidney injury, vasopressor use, palliative consult, length of stay (LOS), and total hospital charges (TOTCHG). Multivariate logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs).

Results:
Among 159,395 patients with Takotsubo cardiomyopathy, 10,638 had severe protein-calorie malnutrition, while 5,907 had mild-moderate malnutrition. Respectively, the groups had mean age 67 vs. 68 years, male sex 27.0% vs. 24.8%, and White race 76.5% vs. 78.6% (Table 1A). Compared to the mild-moderate malnutrition group, the severe malnutrition group had higher odds of in-hospital mortality [OR 1.53, CI (1.12-2.07), P=0.006], palliative consults [OR 1.74 CI (1.29-2.34) P<0.0001], longer LOS (15 vs. 13 days), and higher charges ($215,441 vs. $188,171) (Table 1B). Other outcomes showed no significant differences.

Conclusion:
In patients with Takotsubo cardiomyopathy, severe protein-calorie malnutrition significantly worsens clinical outcomes.
Abstract 4147489: POLA-R-CHP: Promising Results in DLBCL with Cardiac Involvement
Authors: Sharma Sneha , Goyal Akash , Addison Daniel , Potter Adam
Published: November 2024

Polatuzumab Vedotin is a novel antibody-drug conjugate that targets CD79b, a B-cell antigen receptor expressed in mature B-cell lymphomas such as Diffuse Large B-Cell Lymphoma (DLBCL)
1
. Yet, its effect on cardiac disease is unknown.

We present a case illustrating clinical outcome of a patient treated with Polatuzumab plus standard Rituximab, Vincristine and Prednisone (Pola-R-CHP) for metastatic DLBCL with profound cardiac involvement. She is a 56-year-old female who presented with pre-syncope associated with night sweats, myalgia and weight loss. On examination, a grade II/VI tricuspid regurgitation murmur was auscultated. CT showed chronic right lower lobe pulmonary embolism along with axillary and mediastinal lymphadenopathy. New findings of a mass protruding into the right atrium with thickening of right atrial and ventricular walls, a right atrial thrombus and small pericardial effusion were reported. Cardiac MRI characterized the mass to be partially vascularized with extension from right to left chambers encasing RCA and coronary sinus with diffuse interstitial expansion and inflammation (Image 1). Axillary lymph node biopsy was consistent with aggressive B cell lymphoma with positive CD19, CD20 and BCL2 markers. Hospital course was significant for polymorphic VT with degeneration into VFib arrest. ROSC was achieved after one round of ACLS. Multiple factors may have contributed to VT including myocardial inflammation, possible tumor induced RCA compression and prolonged QT. Amiodarone and anticoagulation were initiated and patient was discharged with a wearable cardiac defibrillator along with oncology and cardio-oncology referrals.

Traditionally, DLBCL is treated with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone), however up to 40% of patients develop refractory disease or have a relapse
1
. As in the recent POLARIX trial
1
, our patient underwent three cycles of novel regimen of Pola-R-CHP. Follow up PET showed dramatic response with metabolic remission (Image 3). Cardiac MRI showed reduction in RV tumor, RA thrombus and inflammatory burden with preserved LV and RV function (Image 2). No further arrhythmias were noted and the patient completed chemotherapy. This case highlights a positive outcome in a patient with aggressive DLBCL with cardiac metastasis treated with Polatuzumab based therapy.

References

1. Tilly H et al. Polatuzumab vedotin in previously untreated diffuse large B-Cell lymphoma.
NEJM
2022;386:351–363
Abstract 4147496: Lack of CD8 T Cells impacts cerebral perfusion and cognitive function without altering cerebral vascular reactivity
Authors: Pacella Jacopo , Pallante Fabio , Fardella Valentina , Migliaccio Agnese , Carnevale Daniela , Lembo Giuseppe , Carnevale Lorenzo
Published: November 2024

It is well known the role of CD8 T cells in the onset hypertension and associated injury. We and others have recently shown the role of CD8 in hypertensive cerebral vascular damage, mediated by the secretion of interferon gamma leading to capillary rarefaction in both cortex and white matter and loss of cognitive functions. Thus, our aim was to explore whether CD8 can exert a physiological role in the cerebral vasculature in absence of any cardiovascular challenge.

We assessed advanced neuroimaging and behavioural phenotyping in mice lacking CD8 T cells (CD8 KO) and matched wildtype controls (CD8 WT). We performed perfusion imaging of the brain by 7T MRI to evaluate the cerebral blood flow, Morris water maze (MWM) test and Novel Object Recognition (NOR) to evaluate learning and memory function. The reactivity of the middle cerebral artery (MCA) was also analyzed by pressure myography.

CD8 KO showed a slight but significant hypoperfusion in the cerebral cortex (Figure A, ANOVA F on genotype effect F=13.58, p=0.0042), paired with a slower learning capability shown at MWM (Figure B, ANOVA F on genotype effect F=8.561, p=0.0104), and worse recognition capabilities at NOR (Figure C, t=2.537, p=0.0442). To understand whether the impact of CD8 cells on CBF was associated with abnormal cerebral vascular tone we evaluated MCA myogenic tone, evidencing no differences between CD8 WT and KO mice (Figure D).

Our results shown that the presence of CD8 T cells is crucial for an adequate cerebral perfusion and such a condition realizes a cognitive dysfunction. This phenotype is independent of any cardiovascular challenge and of alteration of cerebral myogenic tone.
Abstract 4147505: A RETROSPECTIVE EVALUATION OF RESOURCE UTILIZATION AND OUTCOMES IN PATIENTS USING MOBILE ECG DEVICES FOLLOWING ABLATION FOR ATRIAL FIBRILLATION
Authors: Fairman Alix , Loh Alexander , Druml Lauren , Triplett Cynthia , Liu Taylor , Pursnani Seema
Published: November 2024

Background:
Mobile electrocardiogram (mECG) algorithms have been validated for early detection of atrial fibrillation (AF), with a potential for reduced arrhythmia-related healthcare utilization. In this study, we compare healthcare utilization metrics of mECG and non-mECG users who previously underwent AF ablation to provide insights about resource utilization during the COVID 19 pandemic.

Methods:
This is a retrospective study of patients with known AF who underwent ablation in 2020. We identified patients as having an mECG device through chart review of the electronic health record. Baseline demographic, clinical, and procedural characteristics were collected in addition to resource utilization outcomes 1-year pre- and post-ablation. COHORT: There were 322 patients who met study criteria, with n=144 being mECG users and n=178 being non-mECG users. The mECG and non-mECG user groups were comparable by age, sex, race, and clinical/echocardiographic factors (Table 1). There was a greater proportion of persistent AF in the non-mECG user group.

Results:
mECG users sent a significantly larger number of secure messages to their providers in both the pre- and post-ablation period (Figure 1). There were no statistically significant differences in outpatient provider visits, ED visits, or hospitalizations (Table 2). Success rates of ablation were comparable in both groups.

Discussion:
mECG users, compared to non-mECG users, sent more secure messages to providers both pre and post ablation, but mECG users did not have a reduction in provider, ED or hospital visits at 1 year post AF ablation. Given that utilization of a mECG device increased the number of communications with providers, more work should be done to develop workflows for clinicians to triage, manage and integrate mobile ECG data into clinical practice.

Key Takeaways:
Mobile ECG users sent significantly more messages to providers, without a reduction in provider, ED, or hospital visits. Integration of wearable device data into clinical care requires further understanding on the provider specific and systemic impacts on resource utilization.
Abstract 4147532: Left Ventricular Global Longitudinal Strain is Associated with Appropriate Implantable Cardioverter Defibrillator Shocks Independent of Left Ventricular Ejection Fraction
Authors: Soofi Muhammad , Burkman Gregory , Gonzalez Mario , Naccarelli Gerald , Maheshwari Ankit
Published: November 2024

Background:
Left ventricular ejection fraction (LVEF) <35% is the principal criterion to select patients for primary prevention of sudden cardiac death (SCD) from ventricular tachyarrhythmias (VTAs) with Implantable Cardioverter Defibrillator (ICDs). Unfortunately, many SCDs occur in people with LVEF >35% and many people with LVEF <35% are actually at low risk for VTAs and SCD. Thus, identification of novel risk factors for VTAs independent of LVEF is paramount. LV Global Longitudinal Strain (LVGLS) has been associated with adverse cardiovascular events and heart failure independent of LVEF.

Objective:
To evaluate the association between LVGLS and appropriate ICD shocks for VTAs.

Methods:
223 consecutive patients who had ICDs implanted for primary prevention of SCD at a tertiary care medical center (1/2016-12/2017) were retrospectively evaluated in 2024. Patients were excluded for inadequate transthoracic echocardiogram data (n=44) and follow-up <3 years (n=55). TTEs were retrospectively analyzed with speckle tracking to calculate LVGLS (TomTec; Unterschlessheim, Germany). Appropriate ICD shocks were physician adjudicated after review of ICD reports from the medical chart. Cox proportional hazards models and Kaplan-Meier survival analyses were used to evaluate the association between LVGLS and appropriate ICD therapies for VTAs. All statistics were completed in SPSS (Version 29.0.2.0 Armonk, NY: IBM Corp).

Results:
124 patients were included (52% with ischemic cardiomyopathy (ICM), 74% male, mean age 66.3 +/- 15.3 years) with a mean (standard deviation) follow-up time 5.6 (2.3) years. Increased (less negative) LVGLS was independently associated with appropriate ICD shocks in ICM patients. The association was attenuated after adjusting for LVEF when modeled as a continuous variable per 5% increase. When modeled as a categorical variable, LVGLS > -4.5% was associated with appropriate ICD shocks independent of LVEF, age, and gender. In patients with non-ischemic cardiomyopathy (NICM), LVGLS was not associated with appropriate ICD shocks. Interestingly, LVEF was not associated with appropriate ICD shocks patients in either ICM or NICM patients.

Conclusion:
If our findings are validated in larger cohorts, future studies should evaluate whether analysis of LVGLS can guide therapies such as implantation of primary prevention ICDs and/or prophylactic treatment in patients with ICDs to prevent VTAs and occurrence of ICD shocks.
Abstract 4147544: Incidence of Heart Failure Among Hispanic/Latino Individuals in the United States: Insights from the Hispanic Community Health Study/Study of Latinos
Authors: Nriagu Bede , Duran Luciano Priscilla , Pandey Ambarish , Daviglus Martha , Talavera Gregory , Kaplan Robert , Shah Sanjiv , Allison Matthew , KIZER JORGE , Hurwitz Barry , Chavez Patricia , Aviles-Santa Larissa , Solomon Scott , Cheng Susan , Shook-Sa Bonnie , Cai Jianwen , Gallo Linda , Rodriguez Carlos
Published: November 2024

Introduction:
Hispanic/Latino individuals are known to have higher traditional cardiovascular disease (CVD) risk factors compared to non-Hispanic Whites and Asians. However, inconsistencies and variability exist regarding the incidence of heart failure (HF) among Hispanics compared to other race/ethnic groups. We examined the incidence of HF in participants enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Methods:
The baseline HCHS/SOL population consisted of 16,415 participants enrolled between 2008 - 2011 and followed up for incident HF events through 2015 (mean follow up period of 5.8 years). A total of 1000 participants with pre-existing HF at baseline, or with missing information/response for baseline HF, socio-economic status (SES), CVD risk factors, and medication use were excluded. Outcome was ascertained via self-report of events at annual follow-up interviews. HF events were adjudicated by trained physicians who reviewed hospital records. HCHS/SOL participants were stratified into seven Hispanic/Latino heritage groups: Mexican, Dominican, Cuban, Puerto Rican, South or Central American, as well as more than one/other. Cox-proportional hazard regression models were used to calculate HRs for incident HF with Mexican Americans as the reference group and controlling for SES, CVD risk factors, and medication use.

Results:
A total of 15,415 participants [mean age 41 years, 52.2% Female) were included and 114 HF events (69 Males and 45 Females) were identified after 89,751 person-years follow up. The HF incidence rate was 94.6 per 100,000 persons-years. Hispanic/Latino individuals of Cuban background had the highest HF incidence rate (131.4 per 100,000 person-years) while those from Central American backgrounds had the lowest (42.8 per 100,000 person-years). Hispanic/Latino individuals of Cuban background [HR: 1.471 (95% C.I: 0.397,5.447)] and Dominican background [HR: 0.509 (95% C.I: 0.075, 3.429)] had the highest and lowest adjusted HR of incident HF compared to those of Mexican background.

Conclusion:
Among different Hispanic/Latino heritage groups, the incidence rate for HF was highest among those with Cuban background and lowest among those with a Central American background.
Abstract 4147550: Evaluating the Clinical Reasoning of GPT-4, Grok, and Gemini in Different Fields of Cardiology
Authors: Reyes-Rivera Jonathan , Castro Molina Alberto , Romero-Lorenzo Marco , ali sajid , Gibson Charles , Saucedo Jorge , Calandrelli Matias , García Cruz Edgar , Bahit Cecilia , Chi Gerald , Angulo Stephanie , moore michelle , Lopez-Quijano Juan M. , Samman Abdallah , Gordillo-Moscoso Antonio A. , Ali Asif
Published: November 2024

Introduction:
The use of Large Language Models (LLMs) in clinical practice seems increasingly possible, although comparative studies are needed to achieve standardization. GPT-4, Grok and Gemini are three commonly used LLMs. While these LLMs may exhibit some level of clinical reasoning, their performance could differ between them and between areas of cardiology.

Aim:
To evaluate the clinical reasoning of GPT-4, Grok and Gemini in distinct fields of cardiology.

Methods:
A total of 12 cases were selected from the AHA Circulation Journal, representing six cardiology areas: General Cardiology (GC), Interventional Cardiology (IC), Cardiac Imaging (CI), Electrophysiology (EP), Heart Failure (HF) and Congenital Heart Disease (CHD). Each area included two cases. We only provided the case presentation to the LLMs, ensuring they were unaware of the diagnosis and management. Four questions were asked with the following prompts: 1. What are the diagnostic steps?, 2. What is the most likely diagnosis?, 3. What is the differential diagnosis?, 4. What is the appropriate management?. The responses were systematically evaluated with a digital rubric through an international collaboration of 12 cardiologists from various institutions. Each cardiologist evaluated two cases in their area of expertise and was aware of the diagnosis and management. One-way ANOVA was used for analysis.

Results:
GPT-4 had a slightly best overall performance (Table 1) and the highest score in GC and CHD; Grok excelled in determining the management and was superior in CI, HF and IC; Gemini had the highest performance in EP, although these findings were not statistically significant (Table 2).

Conclusions:
This is one of the first studies comparing the clinical reasoning of LLMs in cardiology. Our results propose that GPT-4 has the best overall performance and Grok is superior indicating the management. More studies comparing LLMs are required for further standardization of their use.
Abstract 4147562: Traditional modifiable cardiovascular risk factors and the risk of future CHD in the general population: an attempt towards better understanding residual risk.
Authors: Arnold Natalie , Gossling Alina , Bay Benjamin , Blaum Christopher , Brunner Fabian , Zeller Tanja , Linneberg Allan , Soderberg Stefan , Iacoviello Licia , Sans Susana , Veronesi Giovanni , Grimsgaard Sameline , Kee Frank , Salomaa Veikko , Kuulasmaa Kari , Thorand Barbara , Blankenberg Stefan , Waldeyer Christoph , Koenig Wolfgang
Published: November 2024

Background:
Up to 20% of patients presenting with an acute coronary heart disease (CHD) event do not report any traditional modifiable cardiovascular risk factors (CVRFs) on admission. However, major predictors of CHD events in the absence of CVRFs are still unknown.

Aims:
To establish whether increased concentrations of emerging circulating biomarkers at baseline (hsCRP, cystatin C, fibrinogen, NT-proBNP and troponin I), might be associated with future CHD events in subjects from the general population, who demonstrated no traditional CVRFs (hypertension, diabetes mellitus, dyslipidemia, smoking) at time of enrollment.

Methods:
Overall 213,310 subjects (median age 50.6 yrs.; 57.0% males) from 21 European prospective population-based cohorts were included. All participants were free of CHD at baseline and were followed-up prospectively for incident CHD events. Subjects were characterized in accordance to CVRF burden into2not present" or having 1 or ≥2 CVRFs at baseline. Fine and Gray competing risk-adjusted models were performed for the association between biomarkers and future CHD events in an interaction with the CVRF groups.

Results:
Overall, 18.6% of subjects revealed no traditional CVRF at baseline (n=39,722). During a median follow-up of 13.95 years, 17,544 subjects developed an incident CHD event (event rate 20.0%). Of those, 532 events were among subjects, who were free of four traditional CVRFs at baseline (event rate 6.7%). Among all studied biomarkers, only fibrinogen was not associated with incident CHD among those without CVRFs, whereas the association between all remaining biomarkers and future events was found to be even more prominent in subjects without than in those with CVRFs. The corresponding sub-distribution Hazard Ratios (sHRs) with 95% CI were for hsCRP (<2 vs. ≥2 mg/L) 1.64 (1.22-2.19) in those without CVRFs vs. 1.37 (1.21-1.55)/1.24 (1.14-1.35) in those with 1 or ≥2 CVRFs, respectively; for cystatin C (<median vs. ≥median) the sHRs were 1.79 (1.29-2.47) vs 1.30 (1.13-1.50)/1.10 (0.98-1.22), for NT-proBNP (<90
th
pctl vs ≥90
th
pctl) 2.23 (1.40-3.56) vs. 1.42 (1.13-1.79)/1.50 (1.31-1.73) and for troponin I (<6 vs. ≥6 ng/L) 2.03 (1.40-2.95) vs. 1.24 (1.07-1.45)/1.24 (1.12-1.36), respectively.

Conclusion:
In the general population low event rates for incident CHD were found among CVRF-free subjects at baseline. Moreover, circulating biomarkers might substantially improve the prediction of future CHD events in this low-risk population.