bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145375: Examining Maternal and Fetal Outcomes Across Various Subtypes of Hypertension During Pregnancy
Authors: Alhuneafat Laith , Ghanem Fares , khan sana , Puttur Anushree , Nandy Sneha , Alrifai Nada , jabri Ahmad , Carlson Selma
Published: November 2024

Introduction:
Hypertension disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality worldwide. It can be categorized as chronic hypertension (CH), gestational hypertension (GHTN), preeclampsia (PRE), and chronic hypertension with superimposed preeclampsia (SPE).We aim to assess in-hospital maternal and fetal outcomes of women in each of these groups in comparison to normotensive controls.

Methods:
Study sample included women in the National Inpatient Sample dataset from 2016 to 2020 who were categorized into the 4 groups of HDP described above. They were compared to normotensive pregnancies for maternal and fetal outcomes using regression analysis after adjusting for age, race, C-section status, and comorbidities.

Results:
The study dataset from October 2015- December 2020 included 19,089,780 labor admissions with 2,771,809 patients affected by HDP. The HDP groups were distributed as follows: GHTN - 38%, PRE - 32%, SPE - 11%, and CHTN - 19%. Women with PRE, SPE, and CH had significantly higher rates of mortality, circulatory shock, peripartum cardiomyopathy, acute kidney injury, preterm labor, stillbirth, and cerebrovascular events compared to normotensive patients, while GHTN did not. Specifically, maternal mortality was highest in the SPE group (adjusted odds ratio [aOR] 3.16), followed by PRE (aOR 2.91) and CH (aOR 2.42). Additionally, all HDP groups had higher rates of small for gestational age and significant bleeding compared to normotensive patients.

Conclusions:
Pregnant patients with CH, PRE, and SPE experience various higher rates of adverse maternal and fetal outcomes when compared to normotensive patients. Future studies should examine the effect of early high-risk group identification on adverse outcomes in hypertension management.
Abstract 4145423: Antiphospholipid Antibodies and Risk of Atherosclerotic Cardiovascular Disease
Authors: Nogueira Alleh , Tramujas Lucas , Felix Nicole , Costa Thomaz , Carvalho Pedro
Published: November 2024

Background:
Antiphospholipid antibodies (aPL) trigger inflammation, vasculopathy, and thrombosis, sharing pathophysiological mechanisms with atherosclerosis. However, their association with incident cardiovascular events has not been defined and may impact predicting cardiovascular disease risk and guiding therapy intensity.

Hypothesis:
aPL predict the risk of all-cause mortality and cardiovascular disease in primary prevention, independent of traditional cardiovascular risk factors and their therapy.

Aim:
To determine the association between single-time-point measurement of aPL and atherosclerotic cardiovascular risk in a diverse population without established cardiovascular disease or antiphospholipid syndrome.

Methods:
This retrospective cohort study included patients from 2004 to 2024, measuring nine aPLs using solid plasma assays: anticardiolipin IgM, IgG, IgA; anti–β2-glycoprotein I IgM, IgG, IgA; and lupus anticoagulant IgM, IgG, IgA. Data were sourced from the TriNetX Global Collaborative Network, a centralized database of deidentified electronic medical records from 120 healthcare organizations. Eligible patients had aPL measurements and no history of cardiovascular disease or antiphospholipid syndrome. In accordance with the 2023 ACR/EULAR laboratory criteria, the group of interest was defined by the presence of high-positive aPL (>80 U), with individuals having negative aPL levels serving as the reference group. Associations between aPL and future cardiovascular events were assessed using Cox proportional hazards models, adjusted for known risk factors, medications, and multiple comparisons.

Results:
After nearest-neighbor matching for demographics, diagnoses, and medication use, there were 2,801 patients in each group. Over a median follow-up of 3.0 years, patients with high-positive aPL levels were at increased risk for the composite of all-cause mortality, cerebrovascular events, or coronary artery disease (HR 1.15 [95% CI 1.01–1.32]). These patients had higher risks for all-cause mortality (HR 1.25 [95% CI 1.03–1.51]) and cerebrovascular events (HR 1.30 [95% CI 1.02–1.65]), but not for coronary artery disease (P=0.76). The association with cerebrovascular events was primarily driven by stroke (HR 1.36 [95% CI 1.04–1.78]), but not transient ischemic attack (P=0.27).

Conclusion:
In this cohort study, a single measurement of high-positive aPL was an independent predictor of all-cause mortality and cardiovascular events, particularly stroke.
Abstract 4145440: Simultaneous Percutaneous Ventricular Septal Closure and Mitral Valve Repair in Postinfarction Ventricular Septal Rupture and Papillary Muscle Rupture Complicated by Cardiogenic Shock
Authors: Giverts Ilya , Naeem Azka , SHETTY VIJAY , Youdelman Benjamin
Published: November 2024

Introduction:
Post-infarction (post-MI) ventricular septal rupture (VSR) and papillary muscle rupture (PMR) are usually lethal complications of acute STEMI that have decreased in the fibrinolytic era and with rapid STEMI response teams. Delayed correction is preferred for recovery from MI and healing of the edges of the VSD but like emergent repair, delayed treatment is also associated with high mortality. We present a case of concomitant post-MI VSR and PMR successfully corrected by simultaneous percutaneous intervention.

Case presentation:
A 76-yo female with hypertension, obesity and asthma presented with progressively worsening dyspnea and mild substernal chest pain for 4 days. She appeared pale, diaphoretic, and hypoxic, with troponin of 22ng/mL and lactate of 9mmol/L. ECG showed Q waves with STE<1 mm in the inferior leads. A bedside EchoCG suggested possible VSR with a L-to-R shunt. Emergent angiography showed a 100% thrombotic occlusion of LCA and chronic 100% RCA occlusion. Right heart catheterization indicated elevated right-sided pressures with a stepwise increase in SaO2 from 45% the RA to 70% in the RV. She remained hemodynamically unstable requiring mechanical ventilatory and circulatory support with intra-aortic balloon pump (IABP) and vasopressors. Transthoracic EchoCG showed LVEF of 30% with akinetic inferior wall and RV, irregularly shaped 1 cm VSD in the mid-inferoseptum with a predominant L-to-R shunt, along with intramyocardial dissection, partially torn papillary muscle with severe MR. The patient was kept in ICU for 25 days with IAPM to allow for scarring of the VSD followed by percutaneous VSD closure with an Amplatzer device and mitral valve repair with a MitraClip. IABP was removed subsequently but the patient failed weaning process and ended up requiring tracheostomy. She was successfully discharged to a skilled nursing facility two months after admission.

Discussion:
Post-MI VSR and PMR usually fail conservative management while open heart surgery carries high risk. In our case VSR and PMR were corrected with a one-time percutaneous procedure.

Conclusion:
Percutaneous intervention seems a promising alternative even for combined post-MI mechanical complications.
Abstract 4145459: Lower Extremity Extracorporeal Distal Revascularization (LEEDR) as a Novel Approach to Limb Salvage with Prolonged Ischemia
Authors: Treffalls Rebecca , Rodrigues Diego , Price Colin , Jacobs Julia , Stonko David , DeMartino Randall , Walker Patrick , Morrison Jonathan
Published: November 2024

Background:
Acute limb ischemia (ALI) requires prompt revascularization to preserve the extremity and minimize the effects of systemic reperfusion. Once ALI is recognized, delays in revascularization are generally due to system issues (e.g., transfer) and there is a need for a method of temporary extremity perfusion to reduce warm ischemic time. Lower Extremity Extracorporeal Distal Revascularization (LEEDR) is a percutaneous technique that uses a pump and circuit to deliver oxygenated blood into a pedal artery.

Hypothesis:
Extracorporeal perfusion can improve survival from ALI.

Aims:
The aim of this study is to use a swine model of prolonged hindlimb ischemia to compare survival and functional outcomes of LEEDR versus control (warm ischemia).

Methods:
Anesthetized female Yorkshire swine (40-60kg) underwent hindlimb ischemia using endovascular balloon occlusion and were randomized to control (n=6) or LEEDR (n=6). Controls underwent 9 hours of ischemia. LEEDR animals underwent contralateral femoral and ipsilateral posterior tibial artery cannulation followed by 8 hours of extracorporeal perfusion into the ischemic limb. Subjects were revascularized by removing the endovascular balloons, restoring extremity blood flow, and undergoing a 4-hour critical care period before extubation and observation for 48 hours. Primary outcome was survival and secondary outcomes included functional extremity scores (Tarlov Gait Score), compartment pressures (mmHg) and biochemical markers of reperfusion.

Results:
Survival was higher in animals undergoing LEEDR (83% vs. 0%; p=0.001), with most control animals succumbing to acute lung injury. LEEDR animals had a higher functional gait score (5.9±0.3 vs. 2.5±0.7; p<0.001) and lower compartment pressure (8±2 vs. 28±4; p=0.002) compared to controls. Biochemically, the LEEDR group had lower potassium (4.5±0.3 vs. 5.3±0.4; p=0.001) and lactate (1.2±0.5 vs. 2.0±0.7; p<0.001) measurements compared to controls during reperfusion and recovery.

Conclusion:
LEEDR can effectively mitigate 8 hours of extremity ischemia in a swine model, reducing mortality from reperfusion, while improving functional gait score and eliminating compartment syndrome. This percutaneous approach to ALI opens a new field of extracorporeal limb salvage, which can temporize extremity perfusion improving outcomes in patients who have traditionally had limited options due to prolonged warm ischemia.
Abstract 4145480: Acute Pulmonary Edema in Peripartum Period: An Unusual Presentation of Takotsubo Cardiomyopathy
Authors: Sharma Chinmaya , Bhave Aditya , Bajaj Pratima , Dunlap Stephanie , Sharma Gyanendra
Published: November 2024

Introduction:
Acute respiratory distress in the peripartum period can occur from a variety of reasons including pulmonary or cardiac causes. Careful integration of the history, physical examination and imaging studies is crucial to make a definitive diagnosis.

Case presentation:
The patient is a 22-yr-old G1P0 African American woman with no significant medical history who had two unsuccessful external cephalic versions and required Cesarean section. Intraoperatively, she became dyspneic and hypoxic. She had labored breathing, tachycardia, scattered wheezes and hypotension. She had acute pulmonary edema, requiring endotracheal intubation. PA catheter placement revealed cardiac output of 3.7 L/min, Pulmonary artey pressure was 37/27 mmHg and SPO2 of 80% on 100% FiO2. Transthoracic echocardiogram (TTE) revealed moderately reduced left ventricular ejection fraction, (LVEF) 30-35% and moderate mitral regurgitation. She had preserved apical LV function with reduced contractility in the basal segments suggestive of reverse Takotsubo syndrome. RV size and function were normal, making significant pulmonary embolism less likely. CXR revealed interstitial edema. EKG had sinus tachycardia. Peak troponin I was 3.3ng/mL and Lactic acid 4.2 mmol/L. Patient received IV diuretic and inotropic support with Norepinephrine, Epinephrine and Milrinone. She was extubated after 2 days. TTE four days later revealed recovery of LVEF to 53%. Three weeks later, she was asymptomatic. Cardiac MRI showed normal LVEF 58% and no wall motion abnormalities.

Discussion:
The patient had acute pulmonary edema and systolic dysfunction
.
In the absence of chest pain or ST elevation on EKG, spontaneous coronary dissection was unlikely. Takotsubo cardiomyopathy (TMC) is an acute but transient cardiac dysfunction following significant physical or emotional stress. Attempted external cephalic version may have triggered TMC. It is important to distinguish between TCM and Peripartum cardiomyopathy (PPCM) in these patients as it may prevent the continuation of long term medical therapy for heart failure. PPCM has a more gradual onset. Quick normalization of her LV function strongly favors that she experienced Takotsubo, not Peripartum cardiomyopathy.

Conclusion:
Making an accurate diagnosis of Takotsubo cardiomyopathy by serial echocardiography to demonstrate quick improvement in LV function has long-term implications regarding future pregnancies and prognosis.
Abstract 4145488: Unique Presentation of Acute Massive Pulmonary Embolism as Complete Heart Block
Authors: Hussain Tasmeen , Chu Emily , Sayegh Hoda , Torelli Stefan , Keamy-Minor Emily , Witteles Ronald
Published: November 2024

Description of Case:
An 81-year-old man with left bundle branch block (LBBB) and recent inguinal hernia repair presented with 2 weeks of dizziness and shortness of breath. On presentation, sinus tachycardia was noted with a heart rate of 100 bpm. While in the emergency department, he acutely developed complete heart block, initially with a right bundle branch block (RBBB) pattern escape at a rate of 53 bpm. Gradually, the escape slowed to 20 bpm with vomiting and hypotension so an emergent transvenous pacer was placed; he was paced at VVI 80 bpm with improvement in status. Transthoracic echocardiogram exhibited McConnell’s sign (Figure 1) with severe RV enlargement, severely reduced RV systolic function and normal LV systolic function. Arterial line tracings fluctuated with inspiration/expiration consistent with a pulsus paradoxus pattern (Figure 2) without evidence of pericardial effusion. CT angiography of the chest showed emboli in the bilateral main pulmonary arteries. For treatment, the patient was started on a therapeutic heparin drip, transitioned later to therapeutic apixaban. He did continue to require intermittent pacing and so underwent dual-chamber permanent pacemaker placement on hospital day 3.

Discussion:
EKG findings in patients with pulmonary emboli can be variable. In one prospective cohort study of 246 consecutive patients suspected to have pulmonary embolism (PE), only tachycardia (p = 0.008) and incomplete right bundle branch block (p = 0.002) amongst 28 total EKG findings evaluated were associated with confirmed pulmonary embolism by imaging. Interestingly, new RBBB may be a sensitive and specific marker for massive PE. In 50 patients with proven pulmonary embolism, all 16 cases with new RBBB on EKG were noted to have massive trunk obstruction (no patients with peripheral PEs had new RBBB). In the several case reports we found of patients with prior/observed LBBB and PEs who subsequently developed CHB, PEs were notably large, described as either bilateral or saddle-shaped, suggesting an association of acquired RBBB with significant PE burden. The cause of new complete heart block should always be acutely sought; in patients with baseline LBBB, a new RBBB leading to complete heart block can occur with massive/submassive PE. Rapid identification and treatment are needed to limit mortality in this often hemodynamically unstable entity.
Abstract 4145506: Cardiac Myosin Inhibitors Improve Hemodynamics and Symptom Burden in Symptomatic Hypertrophic Cardiomyopathy: An Updated Meta-Analysis
Authors: Raheel Mahad , Goyal Akash , Smith Sakima , Patel Vaiibhav , Kahwash Rami , Lampert Brent , Bole Indra , Foreman Beth , Haas Garrie , Franco Veronica , hasan ayesha , Vallakati Ajay
Published: November 2024

Introduction:
Cardiac myosin inhibitors (CMI), including mavacamten and more recently aficamten, are emerging therapies in the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM) that facilitate ventricular relaxation by reducing myosin-actin crossbridge formations. We performed an updated, contemporary pooled analysis to study to study the clinical efficacy of CMI in patients with HCM.

Methods:
We searched PubMed database from its inception to May 25, 2024 using the search terms “mavacamten” or “aficamten” and “hypertrophic cardiomyopathy” for literature search. Random effects model with Mantel–Haenszel method was used to pool data. The following outcomes were analyzed: change in peak VO
2
, valsalva LVOT gradient, Kansas City Cardiomyopathy questionnaire (KCCQ) clinical summary scale (CSS), improvement in NYHA functional class (FC), and LVEF decline.

Results:
We identified five randomized controlled studies which compared CMI with placebo. Pooled analysis included 741 patients of whom 389 received either mavacamten or aficamten and 352 received placebo. Median follow up time was 24 weeks. When compared to placebo, CMI decreased valsalva LVOT gradient (mean difference -41.08 mmHg, 95% CI -48.41 – -33.75 mmHg, p<0.001), improved KCCQ CSS (mean difference 6.83, 95% CI 3.59-10.06, p<0.001), increased peak VO
2
(mean difference 1.19 mL/kg/min, 95% CI 0.21-2.17 mL/kg/min, p=0.02). Patients receiving CMIs were more likely to experience ≥1 NYHA FC improvement (RR 2.18, 95% CI 1.67-2.84, p<0.001) (Figure 1). CMIs were associated with a temporary decline in LVEF (RR 3.30, 95% CI 1.25-8.73, p=0.02). However, LVEF normalized in all patients with temporary decline by the end of follow-up.

Conclusion:
This is the largest pooled analysis assessing the efficacy of CMI in patients with HCM. Evidence from this analysis suggests that CMIs improved hemodynamic measures and symptom burden in patients with HCM.
Abstract 4145541: The Association Between Leisure Time Physical Activity and Atrial Fibrillation Risk
Authors: Varghese Achsah , Varghese Danny , Dalmacy Djhenne , Torres-Heisecke Raul , Radford Nina , Wright Beth , Pavlovic Andjelka , Shuval kerem , Leonard David , DeFina Laura , Berry Jarett
Published: November 2024

Background:
While physical activity (PA) is associated with a lower risk of atrial fibrillation (AF), prior studies have observed a higher prevalence of AF among athletes. Therefore, we sought to characterize the association between PA and the risk for AF in a large cohort of healthy adults with relatively high levels of self-reported leisure time PA levels.

Methods:
Individual participant data from the Cooper Center Longitudinal Study were linked to Medicare administrative claims files. PA volume (MET-min/wk), duration of moderate (< 6 METs), and duration of vigorous PA (≥ 6 METs) PA were measured by self-report at study entry. Other risk factors such as age, current smoking status, weekly alcohol consumption, BMI, blood glucose, systolic blood pressure, and cholesterol were measured using a standard approach. AF was identified using Medicare claims. A proportional hazards illness-death model was used to estimate hazard ratios for incident atrial fibrillation and multivariable-adjusted for all measured baseline covariates.PA was evaluated as an ordinal variable (< 500, 500-1499, 1500-3000, and ≥ 3,000 MET-min/week). In analyses for subtype of activity, moderate and vigorous activity were mutually adjusted and evaluated as a continuous covariate (per hour).

Results:
We included 26,549 participants (71.9% men, mean age 54 years at baseline), who received Medicare coverage from 1999 to 2019. After 195,343 person-years of Medicare follow-up time, we observed 3,939 cases of AF. Higher PA was associated with a modest increase in the risk for AF above 1,500 MET-min/week, but with less precision at PA above 3,000 MET-min/week (Figure 1). We also observed vigorous activity, but not moderate activity, was associated with higher risk of AF (Figure 2).

Conclusion:
After accounting for covariates, higher PA volume was associated with increased risk of AF at doses more than 3x the guideline-recommended amount. These associations appear to be more apparent for vigorous exercise intensity.
Abstract 4145543: ChatGPT-4 Improves Readability of Institutional Heart Failure Patient Education Materials
Authors: King Ryan , Samaan Jamil , Haquang Joseph , Bharani Vishnu , Ghashghaei Roxana
Published: November 2024

Introduction:
Heart failure consists of complex management involving lifestyle modifications such as daily weights, fluid and sodium restriction, and blood pressure monitoring placing additional responsibility on patients and caregivers. Successful adherence requires comprehensive counseling and understandable patient education materials (PEMs). Prior research has shown that many PEMs related to cardiovascular disease exceed the American Medical Association’s 5
th
-6
th
grade recommended reading level. The large language model (LLM) Chat Generative Pre-trained Transformer (ChatGPT) may be a useful adjunct resource for patients with heart failure to bridge this gap.

Research Question:
Can ChatGPT-4 improve heart failure institutional PEMs to meet the AMA’s recommended 5
th
-6
th
grade reading level while maintaining accuracy and comprehensiveness?

Methods:
There were 143 heart failure PEMs collected from the websites of the top 10 institutions listed on the 2022-2023 US News&World Report for “Best Hospitals for Cardiology, Heart&Vascular Surgery”. The PEMs of each institution were entered into ChatGPT-4 (Version updated 20 July 2023) preceded by the prompt “please explain the following in simpler terms”. The readability of the institutional PEM and ChatGPT prompted response were both assessed using
Textstat
library in Python and the
Textstat readability
package in R software. The accuracy and comprehensiveness of each response were also assessed by a board-certified cardiologist.

Results:
The average Flesch-Kincaid grade reading level was 10.3 (IQR: 7.9, 13.1) vs 7.3 (IQR: 6.1, 8.5) for institutional PEMs and ChatGPT responses (p< 0.001), respectively. There were 13/143 (9.1%) institutional PEMs meeting a 6
th
grade reading level which improved to 33/143 (23.1%) after prompting by ChatGPT-4. There was also a significant difference found for each readability metric assessed when comparing institutional PEMs with ChatGPT-4 responses (p<0.001). While improving readability, ChatGPT-4 maintained accuracy and comprehensiveness with no responses graded as less accurate or less comprehensive and 33/143 (23.1%) deemed more comprehensive than institutional PEMs.

Conclusion:
ChatGPT-4 significantly improved the readability metrics of heart failure PEMs. The model may be a promising adjunct resource in addition to care provided by a licensed healthcare professional for patients with heart failure leading to improved health literacy and potentially improved outcomes.
Abstract 4145549: All-Cause Mortality and Cardiovascular Outcomes with Glucagon-Like Peptide-1 Receptor Agonists in People with Type 2 Diabetes and Systolic Heart Failure
Authors: Vignarajah Aravinthan , Vigneswaramoorthy Nishanthi , Shah Gautam
Published: November 2024

Background:
There is an increasing prevalence of type 2 diabetes (T2D) and systolic heart failure. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are becoming popular in the management of T2D. Previous studies have demonstrated that GLP-1 RAs reduce major adverse cardiovascular events (MACE) in T2D patients compared to placebo. However, the impact of GLP-1 RAs on mortality and cardiovascular outcomes in patients with T2D and systolic heart failure remains uncertain.

Aim

This study examines the effects of GLP-1 RA on individuals with T2D and systolic heart failure, focusing on all-cause mortality, cardiovascular outcomes (including ischemic heart disease, acute myocardial infarction, heart failure exacerbations, stroke, peripheral vascular disease, chronic kidney disease), and all-cause hospitalization.

Methods:
The TriNetX research database was utilized to identify patients aged 18 years and older with T2D and systolic heart failure. Patients were classified into two groups: GLP-1 RA users and non-users. Propensity score matching (1:1) was conducted based on demographics, body mass index, comorbidities, glycated hemoglobin levels, and medications, resulting in a matched cohort of 23,873 patients. Outcomes analyzed included all-cause mortality, cardiovascular outcomes and all cause hospitalization. Survival analysis was performed using TriNetX software, estimating the probability of outcomes over 5 years from the index event and generating hazard ratios (HR), log-rank tests, and Kaplan-Meier survival curves.

Results:
The GLP-1 RA user group demonstrated a reduced hazard ratio (HR, 95% confidence interval) over 5 years compared with the control group for all-cause mortality (0.705, 0.675-0.736, P <0.001), composite of cardiovascular outcomes (0.94, 0.922-0.958, P<0.001), all cause hospitalization (0.809, 0.788-0.831, P <0.001) (Figure), acute myocardial infarction (0.822, 0.790-0.857, P <0.001), and heart failure exacerbation (0.962, 0.944-0.981, P <0.001). All other individual cardiovascular outcomes also showed significant risk reductions in favor of the GLP-1 RA cohort.

Conclusion:
In patients with type 2 diabetes and systolic heart failure, GLP-1 RA therapy significantly reduces mortality and cardiovascular events over a 5-year period, independent of body weight.
Abstract 4145557: Principal Strain Analysis by 3D Echocardiography Provides Novel Insights into Function and Prognostication in Single Left Ventricles.
Authors: Numata Ryusuke , Matsubara Daisuke , Sato Tomoyuki , Calderon-Anyosa Renzo , Wang Yan , Collia Dario , Pedrizzetti Gianni , Banerjee Anirban
Published: November 2024

Background:
Progressive systolic dysfunction is considered an important risk factor for Fontan failure. Previously we have shown that principal strain (PS) is a novel 3D concept that provides insights into 3D deformation of single right ventricle (SRV). In this study, we plan to apply the concept of PS in patients with single left ventricle (SLV).
Hypothesis:
PS may predict the risk of composite outcomes in post-Fontan patient with SLV.
Methods:
We prospectively enrolled 48 post-Fontan patients with SLV (median age: 12.4 years), 64 with SRV, and 102 age-matched controls (12.4 years). We performed 3D speckle-tracking echocardiography (3D-STE) to measure magnitude and direction of PS (PS angle), magnitude of secondary strain (SS), other conventional strains, which were described as absolute values, and LV volumetric indices. PS depicts both magnitude and direction of principal myocardial contraction, whereas SS defines a lower intensity strain in the perpendicular direction. SLV group included tricuspid atresia (41.7%), double inlet left ventricle (37.5%), and pulmonary atresia with intact ventricular septum (20.8%). A composite outcome, experienced by 10 patients in SLV group, comprised of any of the following: Fontan failure, take-down of the Fontan, and clinically significant arrhythmia.
Results:
In the SLV group, the magnitudes of PS and SS were reduced in most walls, except for the lateral wall compared to controls (global PS (GPS): 30.5 ± 3.2 vs. 34.6 ± 2.8%, global SS (GSS): 12.1 ± 3.0 vs. 15.7 ± 2.9 %, p < 0.001, respectively). All PS angles in SLV group had a significantly oblique orientation, except for lateral walls and were similar to those of SRV (global PS angle: 31.4 ± 6.7 vs. 33.0 ± 6.5 vs. 27.6 ± 5.6 degrees in SLV vs. SRV vs. controls, p<0.001, Figure 1). Among the 3D-STE indices, the magnitude of PS in the anterior wall was the best predictor of composite outcomes in SLV group (AUC: 0.734, cut off: 27.1%, Figure 2). There was an increased risk of the composite outcomes, even after adjusting for age and SpO
2
(OR: 0.69 [95% CI: 0.48 – 0.98]; P < 0.04, Table 1).
Conclusion:
PS analysis is a newly described method in children that provides not only the magnitude but also the angles of cardiac deformation. It may offer incremental value in predicting risk of composite outcomes in post-Fontan patients.
Abstract 4145565: A comparison of the efficacy of initial high energy versus initial low energy biphasic shocks for cardioversion of atrial fibrillation and atrial flutter – a real-life experience
Authors: Alampoondi Venkataramanan Sai Vikram , Vunnam Ramarao , Voruganti Dinesh , Tsai Shane
Published: November 2024

Background:
In patients with atrial fibrillation (AF), biphasic energy is superior to monophasic energy for cardioversion (CV). However, the optimal initial biphasic energy for CV is unknown. There are no studies in the US comparing the different biphasic energy levels.

Objective:
To compare the efficacy of initial high energy (IHE, 300-360J) versus initial low energy (ILE, ≤200J) biphasic shocks for CV of AF.

Methods:
Patients who received CVs at our institution for AF over a year were identified using the ICD-10 code. Patients who received internal CV, CV during other procedures, or CV for hemodynamic instability were excluded. Shocks were delivered using Lifepak® 20 through self-adhesive electrodes placed in an anteroposterior direction. Statistical analysis was performed using IBM® SPSS® Statistics software. The primary endpoint was conversion to sinus rhythm after the first shock (CSRF) and the secondary endpoint was conversion to sinus rhythm (SR) using multiple shocks.

Results:
A total of 594 patients were screened and 409 patients were included for final analysis. Results are shown in the table. Patients in the ILE group had lower BMI and lower rates of prior ablation. Patients in the IHE group had higher rates of CSRF (95.5% vs 87.6%, p=0.018). On subgroup analysis, higher rates of CSRF were observed with IHE even in patients with BMI>30 (97.4% vs 84.2%, p=0.019). More patients in the ILE group required multiple shocks. Even when multiple shocks were used, there was a higher rate of conversion to SR in IHE vs ILE (95.5% vs 92%, p=0.24). On multivariate analysis, the odds of CSRF were 6-fold higher with IHE after adjusting for sex, ejection fraction, prior ablation, obesity, and history of heart failure.

Conclusion:
Our study shows that IHE is better than ILE at converting AF into SR with the first shock. Even though the latest AF guidelines recommend 200J for initial cardioversion, select patients may benefit from >300J to avoid multiple shock attempts.
Abstract 4145614: Neuroimaging findings in adults with congenital heart disease: associations with demographic-clinical factors and neurocognition
Authors: Field Thalia , Dizonno Vanessa , Ratnaweera Namali , Sahragard Farnaz , Andrade Jason , LeComte Karen , Su Wayne , Gandhi Preet , Mangat Suneet , Grewal Jasmine
Published: November 2024

Background:
People with congenital heart disease (CHD) face developmental and acquired risks to their neurocognitive health. Mechanisms and clinical-neuroimaging correlates are not well-defined. We report baseline neuroimaging findings, their associations with demographic/clinical factors, and cognitive performance, from a longitudinal study of brain health in adult CHD (ACHD).

Methods:
Participants (n=99) aged >18y with moderate-severe complexity CHD were recruited from the ACHD referral centre for Western Canada. They underwent clinical review and had bloodwork, Holter, echocardiography MRI brain, cognitive testing (MoCA, NIH Toolbox [NIHTB]). Forward stepwise linear and logistic regression models were used to identify demographic/clinical factors that predicted MRI findings. Relationships between demographic/clinical factors with MRI findings, and MRI findings with cognition, were then explored with multivariable linear and logistic regression as appropriate.

Results:
Median(IQR) age 35y (29-40); 42% female.(Figure 1) CHD complexity (21% severe) was independently associated with lower total brain volume (TBV). TBV independently predicted cognitive performance (B[95%CI] for MoCA change/100mm3: 2.73x10
-3
[3.0x10
-4
- 5.1 x 10
-3
]; p=0.03; NIHTB 8.39x10
-3
[2.2x10
-3
- 1.46x10
-2
]; p=0.009).

History of dyslipidemia was independently associated with white matter hyperintensity (WMH) volume but not presence of WMH. Cerebral microbleeds (CMB, 60% of participants) and lacunes (16%) were independently associated with history and number of cardiopulmonary bypass surgeries. None of WMH, CMB or lacunes predicted cognitive performance.

Conclusions:
In this high-functioning cohort of mostly younger ACHD, neuroimaging abnormalities were common. TBV was independently associated with CHD severity. WMH were associated with dyslipidemia; CMB and lacunes with bypass. Only TBV predicted cognitive performance.

Acknowledging our modest cohort size with heterogenous CHD types, our results suggest that the pathophysiology impacting brain health reflects a combination of early- and later-life factors. Longitudinal studies may identify optimal preventative interventions and their timing; dyslipidemia may be a modifiable target.
Abstract 4145622: Fast Stress-Relaxing Hydrogels Modulate Transplanted Stem Cell Potency in the Ischemic Limb
Authors: Huang Ngan , Aravindan Sree , Hu Caroline , Chiang Gladys , Oropeza Beu , Huang Michelle , Heilshorn Sarah C
Published: November 2024

Introduction:
Endothelial cells (ECs) can improve blood perfusion in diseased blood vessels associated with peripheral artery disease, but direct injection of therapeutic cells significantly decreases their survival and functionality for angiogenesis. To address these limitations, we employed a class of mechanically tunable protein hydrogels to enhance the survival and angiogenic behavior of human induced pluripotent stem cell-derived ECs (iPSC-ECs).

Hypothesis:
We hypothesize that the optimal stress relaxing mechanical property of hydrogels will modulate iPSC-EC survival and function in a mouse model of hindlimb ischemia.

Materials&Methods:
Engineered hydrogels, termed elastin-like protein (ELP)-polyethylene glycol (PEG), consists of two components of a hydrazine-modified elastin-like protein (ELP-HYD) and an aldehyde- or benzaldehyde-modified, polyethylene glycol (PEG-ALD or PEG-BZA), which interact with each other through hydrazone dynamic covalent chemistry bonds to form ELP-PEG hydrogels. By varying the use of PEG-ALD or PEG-BZA, we created hydrogels with the same stiffness but at either fast or slow stress relaxation rates. The hydrogels were assessed by dynamic oscillatory rheology. Afterwards, 10
6
human iPSC-ECs were encapsulated within gels and injected into a mouse limb ischemia model to assess transplant cell viability and the ability to restore vascular perfusion to the ischemic limb.

Results and Discussion:
Although both hydrogels had a Young’s Modulus of 500 Pa, the stress relaxation rate of the PEG-BZA was 2.5h (slow), whereas that of PEG-ALD was within minutes (fast). When the iPSC-ECs were injected into the ischemic limb within either fast or slow-relaxing hydrogels or in saline, bioluminescence imaging of the luciferase-tagged iPSC-ECs showed higher cell survival within the fast-relaxing hydrogel over the course of the first 7 days. Blood perfusion recovery by laser Doppler similarly showed higher mean perfusion ratio when cells were delivered in the fast-relaxing hydrogel.

Conclusions:
ELP/PEG-ALD promotes iPSC-EC cell survival and perfusion recovery in the ischemic limb.
Abstract 4145636: Associaion Between Daily Steps And Calf Muscle Oxygen Saturation In Patients With Symptomatic Peripheral Artery Disease
Authors: Gardner Andrew , Montgomery Polly , Wang Ming , Wu Xue
Published: November 2024

Purposes:
We determined whether patients with peripheral artery disease (PAD) who walked at least 7,000 steps/day had better microvascular function, assessed by calf muscle oxygen saturation (StO
2
), and more favorable vascular biomarkers than patients who walked less than 7,000 steps/day. A secondary aim was to determine whether group differences in calf muscle StO
2
and vascular biomarkers persisted after adjusting for severity of PAD, and demographic and clinical characteristics.

Methods:
Five hundred and sixteen patients were assessed on daily ambulatory activity for one week with a step activity monitor, and were grouped according to whether they walked fewer than 7,000 steps/day (Group 1; n=306) or for 7,000 steps/day or greater (Group 2; n=210). Patients performed a standardized Gardner-Skinner graded treadmill test, and calf muscle StO
2
was continuously measured over the medial gastrocnemius muscle of the more symptomatic leg using near-infrared spectrometry. Additionally, patients had blood samples drawn for measurement of high-sensitivity C-reactive protein (HsCRP).

Results:
Exercise time to reach the minimum calf muscle StO
2
was significantly longer (p=0.025) in Group 2 (297±339 sec) than in Group 1 (210±232 sec). Additionally, HsCRP was significantly lower (p<0.001) in Group 2 (4.0±4.5 mg/L) than in Group 1 (6.8±10.7 mg/L). In multivariable linear regression models, exercise time to minimum calf muscle StO
2
was significantly associated with physical activity group status after adjusting for ankle/brachial index (Model 1) (p=0.032), and after adjusting for age, race, sex, education, and body mass index (Model 2) (p=0.044). HsCRP was significantly associated with physical activity group status after adjusting for Model 1 (p<0.001), Model 2 (p<0.001), and the two models combined (Model 3) (p<0.001).

Conclusions:
Walking at least 7,000 steps/day was associated with better microvascular function in the calf muscle during exercise and with lower vascular inflammation in patients with symptomatic PAD. The clinical significance is that community-based walking for at least 7,000 steps/day is a simple goal that is associated with more favorable vascular outcomes in patients with symptomatic PAD.
Abstract 4145671: Characteristics and Association of Cannabis Use on Cardiovascular Outcomes in patients hospitalized with Atrial Fibrillation: An NRD Propensity Matched Analysis
Authors: Brar Ajit , Ravi Soumiya , Chirumamilla Yashitha , Garg Ayushi , Omer Mohammed , Maharjan Nikky , Maini Shriya , Zreik Ali
Published: November 2024

Background:
Cannabis use is rapidly rising with its legalization across multiple regions of the USA. Recent literature has identified that Atrial Fibrillation is the most common arrhythmia identified in cannabis users. Further research is needed to elucidate the impact of cannabis use in patients with Atrial Fibrillation.

Aim:
We aim to study the difference in characteristics and outcomes in patients with Atrial Fibrillation based on cannabis use through the National Readmission Database(2016-2020).

Methods:
NRD database was used to identify patients with Atrial Fibrillation using ICD-10 codes. Patients were stratified into two groups based on history of cannabis dependence. Information was collected on patient demographics, comorbidities, and outcomes. Propensity score matching was performed to compare outcomes among AFib patients based on cannabis use.

Results:
12,394,481 patients with AFib were included in the analysis. Of these cannabis use was identified in 104,837 (0.84%) patients. The patients in the cannabis group were younger (60.2+- 0.03 yrs vs 75.16 +- 0.06 yrs), and had a higher prevalence of males (73.8% vs 52.9%) in comparison with the non cannabis group. Cannabis group had a higher rate of Obesity (20.98% vs 19.83), prior MI (12.04% vs 10.69), pulmonary disease (30.17% vs 26.61%) and liver disease (4.17% vs 2.33%) in comparison with the non-cannabis group. In the propensity matched analysis, cannabis group had a higher rate of myocardial infarction (5.59% vs 5.32%; p<0.001) and Acute Stroke (1.66% vs 1.64%, p<0.001). The cannabis group had a ra lower rate of in-hospital death (3.77% vs 4.74%, p<0.001), acute kidney injury (25.24% vs 25.93; p<0.001), heart failure (44.09% vs 46.34%; p<0.001), sudden cardiac arrest (0.88% vs 0.75%;p<0.001), mechanical circulatory device use(3.12% vs 3.5%;p<0.001), major adverse cardiovascular events (11.6% vs 12.13%;p<0.001) and net adverse events(59.55% vs 61.17%, p<0.001)

Discussion:
Group with Afib and Cannabis use displayed a lower mean age and lower prevalence of females in comparison with the non-cannabis group. Furthermore, unmatched outcome analysis showed a higher rate of AKI, MI, sudden cardiac death and MACE among cannabis users in comparison with non-cannabis users. In comparison, propensity score matched outcomes displayed higher rates of acute stroke and myocardial infarction. Understanding the relationship between cannabis use and atrial fibrillation is crucial for improving outcomes.
Abstract 4145682: Impact of Cardiac Sarcoidosis on Short-term Outcomes in Heart Transplant Patients
Authors: Rajotia Arush , Mohan Ayushi , Dhaliwal Jasninder , Sekhon Manraj , Mourkus Avronia , Ahmed Raheel , Ramphul Kamleshun , Singh Swaiman
Published: November 2024

Background:
Heart transplantation (HTx) is a life-saving procedure for patients with end-stage heart disease. Sarcoid myocarditis (SM) is a rare condition characterized by granulomatous inflammation of the myocardium. The mainstay of therapy is immunosuppression but the incidence of cardiac sarcoidosis leading to advanced heart failure is increasing. HTx is a valid option in such cases however post-HTx outcomes in sarcoid population have been poorly investigated.

Methods:
A retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2021 was conducted. Outcomes compared between sarcoid and non-sarcoid HTx groups were mortality, length of stay (LOS), hospital charges, transplant rejection and graft failure. Mann-Whitney U test was utilized to compare differences between non-parametric variables, while multivariable logistic regression was applied to adjust for confounders.

Results:
During our study period a total of 17,635 patients underwent HTx out of which 235 (0.013%) had HTx due to sarcoid myocarditis. Multivariable analysis revealed a comparable mortality between sarcoid and non-sarcoid HTx (Adjusted Mortality: aOR 1.35; CI 0.40-4.56; p=0.61). Median length of stay in sarcoid myocarditis group was 29[IQR19-55] vs 28[IQR16-50] p=0.57. Total hospitalization charges were also comparable 956,893[IQR 649,498-1,451,199] vs 800,898[IQR 533,047-1,349,074], p=0.18. There was no significant increase in transplant rejection (aOR 1.43; CI 0.64-3.20; p=0.37) or graft failure (aOR 1.92; CI 0.55- 6.70; p=0.30) in the sarcoid myocarditis group (Table 1, Table 2).

Conclusion:
Sarcoid myocarditis patients undergoing HTx showed comparable mortality, LOS, total hospital charges, transplant rejection, or graft failure rates to patients undergoing HTx for other causes.While these findings suggest that SM, while rare, does not adversely affect transplant outcomes, we strongly advocate for more studies to adjust for limitations.
Abstract 4145763: Unexpected Devastation: Streptococcus mitis Endocarditis Leading to Multisystem Crisis in a Healthy Young Adult
Authors: Offor Rita , Atere Muhammed , Nigussie Bisrat , Fotso Simo Stefanie Clinton , Graham-Hill Suzette
Published: November 2024

Case Description:
A 27-year-old woman from outside the United States, with no prior medical history, presented to the emergency room (ER) with fever and unresponsiveness. Upon arrival, she was found to have a basilar tip occlusion with multifocal posterior fossa infarcts. Imaging also revealed a subarachnoid hemorrhage, suspected to be secondary to a ruptured distal basilar aneurysm. The patient experienced associated seizures and acute hypoxic respiratory failure due to aspiration and bulbar weakness, necessitating an upgrade to the neuro-intensive care unit (ICU). Blood cultures drawn in the ER were positive for Streptococcus mitis/oralis. A transthoracic echocardiogram (TTE) showed a thickened mitral valve with a thick shaggy vegetation on the atrial side of the anterior mitral leaflet, as well as vegetation on the posterior leaflet and severe mitral regurgitation (MR). The patient was diagnosed with S. mitis mitral valve endocarditis. Due to the severity of her neurological and cardiac conditions, she was pending cardiothoracic (CT) intervention after stabilization in the neuro ICU.

Discussion:
Streptococcus mitis endocarditis is relatively rare and typically affects individuals with pre-existing valvular abnormalities or immunosuppression. In this case, the patient had no known predisposing factors, making the diagnosis more intriguing. The pathogenesis of S. mitis endocarditis involves bacterial adherence to damaged or abnormal heart valves, leading to the formation of vegetations composed of fibrin, platelets, and bacteria. These vegetations can embolize to various organs, causing infarctions and other complications as seen in this patient. The management of S. mitis endocarditis involves prolonged antibiotic therapy and, in some cases, surgical intervention to address valvular damage.

Conclusion:
This case highlights the severe and multifaceted complications that can arise from Streptococcus mitis endocarditis, even in young and previously healthy individuals. The combination of multifocal posterior fossa infarcts, subarachnoid hemorrhage, severe mitral regurgitation, and acute hypoxic respiratory failure presents a significant clinical challenge. Further studies are needed to better understand the pathophysiology and optimal management strategies for S. mitis endocarditis, particularly in patients without traditional risk factors.
Abstract 4145866: Changes in Left Ventricular Systolic Function in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Jensen Anne Marie , Yang Yimin , Lamberson Victoria , Claggett Brian , Skali Hicham , Matsushita Kuni , Lutsey Pamela , Butler Kenneth , Kitzman Dalane , Biering-Srensen Tor , Shah Amil
Published: November 2024

Introduction:
Aging is associated with changes in left ventricular (LV) structure and function, and with increasing incidence of heart failure. However, little is known about longitudinal changes in LV systolic function in late life.

Aim:
To quantify changes in systolic function in late life.

Methods:
Among 2,779 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study who underwent protocol echocardiography at study Visits 5 (2011-2013) and 7 (2018-2019), systolic function was assessed by LV ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS). Abnormal function was defined using previously published ARIC-based cut-offs. Longitudinal change in systolic measures and abnormal prevalence were assessed using paired t-test and McNemar’s test respectively. Predictors of each abnormal systolic function measure at Visit 7 were assessed using logistic regression models adjusted for that measure at Visit 5 in addition to systolic blood pressure, heart rate and rhythm during echo at both visits.

Results:
Mean age was 74±4 years at Visit 5 and 81±4 years at Visit 7, 57% were female, and 24% reported Black race. At Visit 5, mean LVEF was 65±6%, GLS 18±2%, and GCS 28±4%. Over a mean of 6.5 years, LVEF decreased by 2±7%, GLS decreased by 0.5±2.9%, and GCS decreased by 0.6±4.2% (
p
< 0.001). The prevalence of abnormal LVEF increased from 14% to 23%, abnormal GLS prevalence increased from 18% to 23%, and abnormal GCS increased from 11% to 13% (Figure). At Visit 5, predictors of the development of abnormal LVEF and GLS included older age, male sex, prevalent coronary artery disease (CHD), diabetes, and chronic kidney disease, while only male sex and CHD associated with the development of abnormal GCS. On echocardiography, lower systolic measures, higher LV mass index, larger left atrial volume, and lower e’ at Visit 5 were each associated with higher odds of abnormal LVEF, GLS and GCS at Visit 7.

Conclusions:
LV systolic function decreases on average over 6 years in late life. Worse measures of both systolic and diastolic function associate with the development of subsequent systolic dysfunction.