bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4143756: Demographic Characteristics and Geographic Patterns of Atrial Fibrillation-Associated Mortality among Older Adults with Heart Failure in the United States (1999-2020)
Authors: Alim Ur Rahman Hafsah , Moeed Abdul , Hotwani Priya , Yasmin Farah , Ochani Rohan Kumar , Hanif Muhammad , Goyal Aman , Alraies M Chadi
Published: November 2024

Background:
Heart failure (HF) continues to pose a substantial threat to global mortality, exacerbated by the increasing prevalence of atrial fibrillation (AF) among the elderly population in the United States (US). Despite this, AF-related mortality in HF patients aged 65 and above remains understudied. This study aims to analyze the demographic and regional trends of AF-related mortality in the older adults with HF in the US.

Methods:
Utilizing death certificates from the CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) database spanning 1999 to 2020, AF-related mortality in HF patients aged ≥65 years was examined using ICD-10 (International Classification of Diseases 10th Revision) codes. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percentage change (APCs) with 95% confidence intervals (CI) were calculated. Mortality trends were analyzed by year, sex, race/ethnicity, and geographic region.

Results:
Between 1999 and 2020, 822,358 AF-related deaths occurred in HF patients aged ≥65 years. The overall AAMR was 88.4 (95% CI: 88.2 to 88.6). Males had higher AAMRs than females (overall AAMRs: 100 vs 80.6). Non-Hispanic (NH) white individuals exhibited the highest AAMR (96.3), followed by NH American Indian or Alaska Native (66.2), NH black or African American (54.2), Hispanic or Latino (46.9), and NH Asian or Pacific Islander (39.4). By census region, the highest AAMRs were in the West (100.8), Midwest (95.7), and Northeast (80.6), with the lowest in the South (80.5). Non-metropolitan areas showed higher AAMRs than metropolitan areas (103 vs 85.2). The top 90th percentile states included Washington, Vermont, Oregon, and Minnesota, with AAMRs nearly double those in the bottom 10th percentile states such as the District of Columbia, Florida, Nevada, and Hawaii.

Conclusion:
AF-related mortality trends among older HF patients increased from 1999-2020, with higher AAMRs observed in men, NH White individuals, Non-Metropolitan areas, and the Western region. Targeted strategies addressing precipitating events and further investigations are needed to overcome these trend disparities.
Abstract 4143765: Partial Cardiac Denervation To Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: A Randomized Controlled Trial
Authors: Yang Ziang , Tiemuerniyazi Xieraili , Xu Fei , Sun Yang , Yan Peng , Tian Liangxin , Han Chao , zhang yan , Pan Shiwei , Hu Zhan , Zhao Wei , Feng Wei
Published: November 2024

Background:
Postoperative atrial fibrillation (POAF) is commonly seen in patients undergoing coronary artery bypass grafting (CABG), increasing the risk of both short-term and long-term clinical adverse events. This study aimed to evaluate the effectiveness of partial cardiac denervation, which is achieved by cutting off the ligament of Marshall (LOM) and resecting the fat pad along the Waterston groove, on the prevention of POAF after CABG.

Methods:
In this single-center randomized controlled study, patients planned for isolated CABG were recruited during August 2022 and December 2023, then randomized into the intervention group (CABG + partial cardiac denervation) and the control group (CABG only) in a 1:1 pattern. All the participants were continuously monitored for the incidence of POAF through electrophysiologic device till day 6 after the operation, and invited to follow-up visits 30 days after discharge. The primary endpoint was the incidence of POAF, while the secondary endpoints were the safety and economics outcomes.

Results:
A total of 430 patients were enrolled (215 in the intervention vs. 215 in the control). The mean age was 61.9 ± 7.8 years, and 18.4% of them were female. Baseline characteristics were well balanced after ramdomizaiton. All participants underwent successful CABG and each one in the intervention group received scheduled partial cardiac denervation procedure. Compared with the control group, the 6-day incidence of POAF was significantly lower in the intervention group (18.1% vs. 31.6%, p=0.001). The time-to-event analysis also showed a significant reduction in the occurrence of POAF in the intervention group (hazard ratio: 0.53, 95% confidence interval: 0.36 to 0.79, p = 0.002). Similar effect was observed in the subgroup analysis. Safety assessments showed no difference between the two groups, for the incidence of need for blood transfusion, transferring to on-pump CABG, re-operation for postoperative bleeding, delayed epicardial effusion, critical arrhythmias other than atrial fibrillation and major adverse events in the 30-day follow up. The economic assessments showed that postoperative medical cost was reduced in the intervention group (p=0.050).

Conclusions:
Partial cardiac denervation through cutting off the LOM and resecting the fat pad along the Waterston groove, was an effective and safe procedure to reduce the occurrence of POAF after isolated CABG.
Abstract 4143792: Real-World Patterns of Statin Use, Titration, and Discontinuation Among a Racially Diverse Commercially-Insured Population
Authors: Zhang Pengyue , Alabre-Bonsu Alisha , Zhang Ping , Chiang ChienWei , Li Lang , Milks Michael
Published: November 2024

Introduction:
Statins remain the most evidence-supported and cost-effective medications to reduce atherogenic lipoprotein levels and atherosclerotic cardiovascular disease (ASCVD) risk. Among patients with ASCVD, high intensity statin treatment is indicated (e.g. atorvastatin 40-80 mg or rosuvastatin 20-40 mg daily). However, the effectiveness of statin therapy is limited by intolerance symptoms and other factors that lead to discontinuation or dose titration, some of which have been shown to vary in prevalence by race, gender, and certain comorbid conditions.

Hypothesis:
The propensity to discontinue or titrate new statin therapy varies by race, sex, and the starting statin agent-dose combination selected.

Aim:
Examine patterns of statin therapeutic persistence and titration among US commercial insurance or Medicare Advantage beneficiaries.

Methods:
New statin prescription episodes (n=1,859,442) were identified by a retrospective cohort design using the de-identified Optum Clinformatics® Data Mart Database (2007-2020). Included individuals were ≥45 years of age on the first day of enrollment and continuously enrolled for ≥3 years. The Indiana University IRB designated this study as exempt.

RESULTS: Discontinuation or titration of an initial statin prescription occurred in >70% of cases over 30 months. The incidence of dose increases or decreases varied by the statin agent and dose initially selected (Figure). Down-titration of rosuvastatin 40 mg/d and atorvastatin 80 mg/d varied based on racial group (Table).

Conclusions:
Statin dose adjustment and discontinuation are common following initial statin prescription. This observation from claims data implies that different choices of initial statin drug-dose combinations could result in variable likelihood of long-term treatment persistence. Cumulative LDL-C reduction over time, with likelihood of persistence as well as pharmacologic effect, should be considered with selection of an initial statin dose in ASCVD.
Abstract 4143806: Long-Term Risks of Cardiovascular Disease in the U.S. Population Based on the American Heart Association PREVENT Equations
Authors: Faridi Kamil , Malik Devesh , Essa Mohammed , Yang Huanhuan , Spatz Erica , Krumholz Harlan , Lu Yuan
Published: November 2024

Background:
The American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations were recently developed to estimate risk of cardiovascular disease (CVD). Long-term risks of cardiovascular disease based on the PREVENT equations in the U.S. population are unknown.

Methods:
Using data on adults aged 30-79 years from the National Health and Nutrition Examination Survey between 2011 and 2020, we determined long-term risks of total CVD (atherosclerotic cardiovascular disease or heart failure) based on the PREVENT equations. Age-standardized and survey-weighted risk prevalence was determined with further stratification by age group, sex, race and ethnicity.

Results:
The study population included 14,256 participants representing 160.6 million U.S. adults (mean [SD] age 51.9 [11.2] years, 49.2% women, 66.4% non-Hispanic white, 9.8% non-Hispanic black, 5.7% non-Hispanic Asian and 14.8% Hispanic). Among adults aged 30-79 years, 9.6% had existing CVD and 20.2% were CVD-free but had intermediate or high (≥7.5%) 10-year risk of CVD. The prevalence of CVD-free US adults with low or borderline (<7.5%), intermediate (7.5-19.9%) and high (≥20%) estimated 10-year CVD risk was 65.6%, 18.8%, and 4.3% for men and 74.7%, 14.3% and 2.8% for women, respectively. Among adults 45 years and older, men and Black or Hispanic adults were more likely to be at intermediate or high 10-year CVD risk (
Table
). Among adults 65-79 years, 28.9% had existing CVD and 64.3% were CVD-free but had intermediate or high 10-year risk. Among CVD-free adults 30-59 years, the median 30-year risk of CVD was 17.8% for men and 12.6% for women, respectively. Among all U.S. adults 30-59 years of age, 65.4% were CVD-free with an intermediate or high 30-year risk of CVD and 6.1% had existing CVD.

Conclusions:
Three in ten U.S. adults aged 30-79 years has an intermediate or high 10-year risk of CVD events, including more than 90% of adults over age 65. Nearly three in four middle-aged adults have an intermediate or high 30-year risk. Men, Black and Hispanic adults were generally higher risk. These findings emphasize the need for more intensive public health efforts to prevent cardiovascular disease in the U.S.
Abstract 4143888: Exploring the Perspectives and Journey of Patients Utilizing Left Ventricular Assist Devices as They Approach End-of-Life: A Cross-sectional Study
Authors: Thompson Jessica , Costelle Devan , Moser Debra
Published: November 2024

Background:
Over the past decade over 27,000 patients have been implanted with a left ventricular assist device (LVAD) for the treatment of advanced heart failure (HF). Technology has advanced greatly over this time with 1-year mortality rates around 14% for the newer devices. Up to 75% of the HF population is thought to have mild cognitive impairment, which is related to increased readmission rates and higher mortality. Guidelines provided by professional organizations encourage providers to discuss end-of-life situations with LVAD patients and their caregivers.

Purpose:
The purpose of this study was to explore the attitudes and experiences of patients with an LVAD related to end-of-life situations and pump exchanges, and to identify if mild cognitive impairment impacts end-of-life decision-making.

Methods:
A cross-sectional, correlational study design was used, with 30 LVAD patients completing an end-of-life questionnaire and a validated cognitive assessment instrument. Results: The average age of the participants was 57±16, 77% male, 90% identified as white, non-Hispanic, and 63% were labeled as destination therapy. Fifty-eight percent of the cohort had discussed end-of-life scenarios with a healthcare provider, and 60% had discussed what a pump exchange involved. Forty-four percent of the total cohort indicated they never wanted to have a conversation about end-of-life with their provider and 73% said they would have a pump exchange even if they were seriously ill and were dying of a terminal illness other than heart failure. Of the 29 patients who were able to complete the cognitive assessment, 79% met criteria for mild cognitive impairment. There were no differences in the experiences and attitudes regarding end-of-life between those with mild cognitive impairment, and those with normal cognition.

Conclusion:
Despite having higher mortality rates in the HF population, those with mild cognitive impairment had similar experiences and attitudes regarding end-of-life. There are still many misconceptions regarding decision-making related to the end-of-life and pump exchange for patients with an LVAD, and moving forward it is important to identify factors that may influence these decision-making processes.
Abstract 4143918: Differences in Outcomes in Spontaneous Coronary Artery Dissection vs. Type 1 Myocardial Infarction
Authors: Kodali Mouna , Essien Ekow , Nfor Tonga , Galazka Patrycja , Klinka Matthew , Kroboth Stacie , Boulware David , Peterson Michael , Kanani Jim , Walczak Sara , Gogineni Venkateswara , Allaqaband Suhail
Published: November 2024

Background:
Spontaneous coronary artery dissection (SCAD) is a non-iatrogenic dissection in the epicardial coronary arteries, not related to trauma or atherosclerosis. In SCAD, myocardial injury occurs due to luminal obstruction following intimal disruption or intramural hematoma. We aimed to determine the differences in outcomes associated with SCAD compared to Type 1 myocardial infarction (MI) in the Aurora Health Care community.

Methods:
A retrospective, matched cohort, multicenter community study was carried out on adult patients aged >18 years admitted to all Aurora Hospitals from January 2012 to December 2022. A total of 57 patients were diagnosed with SCAD during that period. The SCAD and Type 1 MI groups were matched by age and gender at a 1:5 ratio using a propensity score-based matching. Outcomes between the SCAD and Type 1 MI groups were compared using chi-squared tests or Fisher’s exact tests, and t-tests or nonparametric equivalents (Wilcoxon), and a time-to-event analysis.

Results:
SCAD patients who underwent conservative therapy were 87.7%. There were no significant differences in in-hospital outcomes between SCAD and Type 1 MI in measures such as cardiogenic shock, mortality rate, sudden cardiac death, ischemic stroke, hospital length of stay, and arrhythmias (AF, atrial flutter, supraventricular tachycardia, and ventricular fibrillation). In the long term, SCAD patients required less repeat coronary catheterization (7% vs. 24.6%, p=0.003) and PCI (1.8% vs. 11.2%, p=0.027) compared to the Type 1 MI group. Type 1 MI patients had a higher incidence of AF, atrial flutter, death, readmissions for heart failure, and diastolic and systolic function in the long term, but this was not statistically significant. Type 1 MI patients required loop diuretics in the long term (24.6% vs 10.5%, p 0.02).

Conclusion:
Type 1 MI patients exhibited poorer long-term prognoses characterized by a higher risk of heart failure, which likely increased the necessity for diuretics. Additionally, Type 1 MI patients showed a higher need for repeat coronary catheterization and PCI. Although SCAD and Type 1 MI present similarly as acute coronary syndrome, it is important to understand the differences in outcomes as the management of these two populations differ.
Abstract 4143942: Diabetes Education on Cardiovascular Disease Shows Improvements in Knowledge, Confidence, and Intent
Authors: McWeeny Patrick , Picou Kylie , Okeke Oge , Madhusudhan Divya , Crabill CarriAnne , Lippold Kaitlyn , Yuan Meg
Published: November 2024

Introduction:
Cardiovascular disease is the leading cause of death for people living with type 2 diabetes. Know Diabetes by Heart (KDBH) is a program jointly implemented by the American Heart Association (AHA) and the American Diabetes Association to reduce cardiovascular death, heart attack, heart failure and stroke in people living with type 2 diabetes. We aim to understand knowledge, confidence, and intent changes among program participants in lessons taught through community-based organizations (CBOs) and an online education module.

Methods:
The AHA collected pre-post data from persons with diabetes and caregivers present at diabetes education courses at participating CBOs and users who participated in the e-module on AHA’s website. Analysis utilized both summary statistics and paired Wilcoxon Signed-Rank testing for significance.

Results:
Participants at CBOs were generally female (73%), White (43.5%) or Black/African American (36%), non-Latinx (72%), and between 45-69 years old (48%). E-module participants were generally female (69%), White (63.7%), non-Latinx (87%), and between 55-74 years old (48%). After participating in the program, 91% of e-module participants were comfortable speaking with a health care professional about their diabetes and risk for heart disease, and 84% felt it was important to do so. Most participants in the education courses at CBOs were confident in speaking with a health care professional (85%), and in making lifestyle changes (84%) – 11-point improvements. Participants also indicated they were likely to speak with a health care professional about reducing their risk for heart disease and stroke at their next appointment (77%) – a 9-point improvement. None of these changes were statistically significant when pre- and post-tests were paired and analyzed.

Respondents scored very high on pre knowledge questions, leaving no room for statistically significant improvement. This may relate to the low difficulty level of predictable questions rather than proficient diabetes knowledge. Confidence and intent showed noticeable improvements over baseline testing.

Significance:
The KDBH program’s patient education resources improved persons with diabetes and caregivers’ confidence and intent to talk with their healthcare professional about the risk for cardiovascular disease and their diabetes care. One area for improvement is knowledge testing as the survey tools were unable to capture a knowledge level consistent with the literature.
Abstract 4143962: Lineage-specific iPSC derived smooth muscle cells predict mannose receptor C type 2 deficiency accelerates aortic root enlargement in Marfan syndrome mice via exacerbating collagen deposition
Authors: Kusadokoro Sho , Yokoyama Nobu , Kim Jennifer , Bolar Nikhita , Dalal Alex , Pedroza Albert , Gilles Casey , Puaala Anna Marie , Klinder Avani , Yamaguchi Atsushi , Fischbein Michael
Published: November 2024

Introduction:
Marfan Syndrome (MFS) is a genetic disorder characterized by aortic root aneurysm formation, with risk of dissection and rupture. Proteomic profiling on human Marfan iPSC-derived second heart field (SHF) SMCs revealed decreased Mannose Receptor 2 (MRC2) expression. Given MRC2's role in collagen homeostasis, its reduction is hypothesized to impair collagen turnover and compromise aortic wall integrity, worsening TAA development in MFS.

Methods:
In vitro assays were performed on iPSC-derived SMCs from the SHF and cardiac neural crest (cNC) from MFS patients and control. MRC2's impact on collagen dynamics was assessed via western blot following targeted MRC2 knockdown and overexpression using lenti-vector. In vivo, MRC2 conditional SMC-specific knockout mice on WT and MFS backgrounds were generated to explore collagen turnover and its influence on MFS pathology and for single-cell RNA (scRNA) sequencing.

Results:
MRC2 expression was significantly lower and COL1a1 levels significantly higher in SHF-derived SMCs from MFS patients compared to cNC-derived and control SHF SMCs. MRC2 knockdown in these cells significantly increased COL1A1 expression, which normalized upon MRC2 overexpression. Longitudinal echocardiographic analysis of SMC-specific Marfan MRC2 KO mice showed significantly larger aortic root diameters at 24 weeks versus control (MFS-MRC2 KO vs. MFS and WT: 2.62±0.27 mm vs. 2.36±0.25 mm, p<0.05 and 1.92±0.12, p<0.05). Histological evaluation revealed increased adventitial collagen in the aortic root of MFS-MRC2 KO mice. scRNA showed MRC2 was primarily expressed in modulated SMCs (modSMCs) and that modSMCs in MFS SMC-specific MRC2 KO versus MFS control had upregulation of pathways involved in translation at the synapse/cytoplasm, ossification and osteoblast differentiation, and peptidase activity. Overall SMC and fibroblast gene expression profiles were similar when MRC2 was knocked out, however, the majority of gene expression appeared to be influenced by the MFS mutation itself.

Conclusion:
The study highlights that MRC2 plays a crucial role in aortic wall collagen homeostasis, with its deficiency markedly exacerbating TAA progression in MFS mice.
Abstract 4143965: Reactive Oxygen Species Scavenging Reduces Complex Fractionated Atrial Electrograms (CFAEs) In Persistent Atrial Fibrillation Patients - A New Smart Mechanism Guided CFAE Targeting Approach in Atrial Fibrillation
Authors: Rottmann Markus , Knight Bradley , Passman Rod , Arora Rishi
Published: November 2024

Background:
It is known that oxidative stress (OS) and complex fractionated atrial electrograms play an important role in AF. However, the effect of reactive oxygen species (ROS) on complex fractionated atrial electrograms (CFAEs) in persistent atrial fibrillation patients remains unsettled. While previous CFAE ablation studies have mixed results, it is currently also unclear which types of CFAEs should be targeted with ablation during the clinical electrophysiological (EP) study.

Objective

We hypothesized that ROS are dynamically involved in the creation of a vulnerable substrate leading to overlying CFAEs and that regions of CFAEs that may reflect high OS are uniquely sensitive to acute ROS scavenging with N-acetylcysteine (NAC) in persistent AF patients.

Methods:
We performed in 5 patients with persistent AF high-density mapping in the left and right atrium (LA, RA) pre/post-NAC (intravenous, dose 100mg/kg) (Figure 1A) using the HD-grid catheter (EnSite, Abbott) (Figure 1B). We analyzed cycle length (CL) and dominant frequency (DF), organization index (OI), fractionation index (FI), and regions demonstrating >10% change in these parameters and CFAEs (definition EnSite) >50% change post-NAC.

Results:
NAC (Figure 2) affected AF electrogram measures in atrial sub-regions, increasing CL in the left lateral free wall, right atrial free wall, affecting DF/OI preferentially in the left atrial superior wall and CFAEs (Figure 3A, B) in the left atrial inferior wall (Figure 3C). Acute administration of NAC caused significantly greater percentage changes in CFAEs in the LA (165%) pre vs post-NAC compared to percentage changes in CL (40%), DF (33%), OI (37%) and FI (16%) (P=0.002) (Figure 3D). 35% of all CFAEs in the LA and 21% in the RA were sensitive (>50% change, P=0.02) to ROS scavenging.

Conclusion:
Acute administration of NAC organizes AF electrogram characteristics in subregions in the left and right atrium and has a greater effect on CFAEs in the left atrium compared to other established AF electrogram characteristics. About one third of all CFAEs are ROS dependent. These uniquely sensitive CFAE regions to ROS scavenging may constitute a new smart therapeutic target in patients with persistent AF.
Abstract 4143985: Post-acute Sequelae of COVID-19 (PASC) is Related to Endothelial Dysfunction and Elevated Asymmetric-dimethylarginine
Authors: Ali Mohamed , Phillips Shane , Layden Brian , Darbar Dawood , Mahmoud Abeer
Published: November 2024

Introduction:
Endothelial dysfunction can trigger the development and progression of cardiovascular disease. We hypothesize that cardiovascular PASC is induced by persistent endothelial dysfunction mediated via asymmetric-dimethylarginine (ADMA, the endogenous inhibitor of endothelial nitric oxide synthase). ADMA levels rise in response to viral infections, but it is usually degraded by the enzyme DDAH1, which is inhibited by chronic inflammation and oxidative stress. This study aims to determine whether cardiovascular PASC is associated with endothelial dysfunction and to clarify the role of ADMA in this relationship.

Methods:
We recruited subjects who had been previously infected and developed cardiovascular symptoms (PASC+), those who had been infected but did not have PASC (PASC-), and those who had never been infected (controls) (n=20 each). Groups were matched for age, sex, and BMI and underwent blood draws and fat biopsies. Vascular function was assessed
in-vivo
via ultrasound imaging and
ex-vivo
in fat-isolated arterioles.

Results:
Compared to PASC- and controls, PASC+ subjects exhibited 80% higher serum levels of ADMA and 40% reduced nitric oxide levels. DDAH1 activity was elevated in the PASC+, suggesting a compensatory mechanism for the elevated ADMA levels. However, PASC+ obese subjects exhibited substantially lower DDAH1 activity than non-obese subjects, which was associated with lower insulin sensitivity and higher ADMA levels. Compared to the other two groups, the PASC+ group exhibited lower brachial artery vasoreactivity, while nitroglycerin-induced dilation did not differ statistically, suggesting impaired endothelial function. In the PASC+ group, microvascular recruitment in response to reactive hyperemia was diminished, as was the ex vivo measured flow-induced arteriolar dilation and NO generation. Left ventricle (LV) dysfunction was observed in 80% of the PASC+ group, as opposed to 5% of the PASC- and controls. The LV ejection fraction and global longitudinal strain (GLS) were substantially reduced in the PASC+ group, which was correlated with higher ADMA, C-reactive protein, and troponin-1, as well as lower NO and vascular function. Obese PASC+ subjects had the highest ADMA and the lowest endothelial-dependent vasodilation and insulin sensitivity.

Conclusion:
Cardiovascular PASC symptoms are related to persistent endothelial dysfunction and elevated ADMA levels, which may be further exacerbated by obesity and reduced DDAH1 activity.
Abstract 4144010: Digital Health Intervention Yields Modest Improvements in Diet and Blood Pressure Among Adults with Hypertension
Authors: Miller Hailey , Askew Sandy , Berger Miriam , Yang Qing , Steinberg Dori , Bennett Gary
Published: November 2024

Background:
The Dietary Approaches to Stop Hypertension (DASH) diet is an evidence-based treatment for adults with hypertension and has health benefits for other cardiovascular disease risk factors. Yet, DASH has not been fully disseminated. Digital health solutions offer a promising approach to disseminate DASH. However, the efficacy of these approaches is unknown.

Aims:
To evaluate the efficacy of a digital health intervention on DASH adherence and blood pressure (BP) among adults with hypertension.

Methods:
Nourish was a 2-arm RCT to evaluate the efficacy of a 12-month digital health intervention, compared to attention control, among adults with hypertension. The intervention, delivered virtually, included skills training, goal setting, self-monitoring, personalized feedback, and dietitian coaching. The primary and secondary outcomes were 6-month changes in DASH adherence and BP, respectively. DASH scores ranged from 1 (lowest) -9 (highest). Outcomes were also assessed at 12 months to evaluate long term effect. We used linear mixed models to test the efficacy of the intervention on change in DASH score and BP. BP models adjusted for change in BP medications.

Results:
. Nourish randomized 301 adults: 150 to the intervention and 151 to attention control. The mean age of participants was 54.4 (SD=13.4) years. Most participants identified as female (65%); over half identified as white (53%); and 31% identified as Black. Change in DASH score was not significantly different between arms at 6 months (
M
diff
=0.02, 95% CI=-0.37,0.41), yet the intervention arm had a greater increase in DASH score, relative to attention control, at 12 months (
M
diff
=0.64, 95% CI=0.17,1.11). Mean SBP and DBP were significantly reduced in the intervention arm at 6-months compared to baseline (mean SBP change=-4.4 mm Hg, 95% CI=-6.6,-2.1; mean DBP change=-2.9, 95% CI:-4.3,-1.5). However, no significant between-group differences were found. Findings were similar at 12 months (
Table 1
).

Conclusions:
A 12-month digital health intervention led to modest improvements in DASH and BP among adults with hypertension. Further research is needed to elucidate the effectiveness of smartphone interventions to promote DASH.
Trial registration:
NCT03875768
Abstract 4144026: Association of anthropometric measurements and cardiometabolic risk in Mexican American children
Authors: Samuel Joyce , Lee Kyung Hyun , North Kari , Below Jennifer , Lee Miryoung , McCormick Joseph B , Fisher-hoch Susan
Published: November 2024

Background:
Guidelines recommend that pediatricians screen for cardiometabolic (CM) risk factors at certain thresholds of body mass index (BMI) percentile, with lipid screening after BMI exceeds the 85th%ile for age and sex, and glucose metabolism screening after BMI exceeds the 95%ile. We hypothesize that for Hispanic children, BMI may be an insufficiently sensitive harbinger of CM risk factors. Here we describe the CM profile of children and adolescents from an ethnically homogenous cohort of Mexican Americans with a high risk for CM disease and investigate whether some CM characteristics appear prior to usual BMI thresholds.

Methods:
We assessed children enrolled in the Cameron County Hispanic Cohort, one of the largest and most comprehensive prospective cohorts of Mexican Americans, with participants recruited from randomly selected households living on the Texas-Mexico border and followed every 2 to 5 years since 2014. Using data from the first visit, we describe the prevalence of individual CM risk factors and their clustering based on age, sex, family history, and obesity category.

Results:
Of 450 participants under 18 years old, the combined prevalence of overweight and obesity was 48.9%, with median age 12 years (range 8 to 17), 49% male, and 97.7% self-identifying as Hispanic/Latino, and no differences observed in demographic factors across weight status categories. Individual CM risk factors, including high triglycerides, low HDL-C level, abdominal obesity, insulin resistance (IR), or elevated BP, alone or in combination, were present in 59.8% of the sample. IR, the most prevalent risk factor, was present in 40.4% of the children, specifically in 76.0% of obese children, and 39.7% and 19.0% of overweight and normal/underweight children. Clustering of any 3 CM risk factors was more likely to occur with increasing weight status categories and occurred in 1.9% of normal weight, 13.7% of overweight, and 42.3% of obese children.

Conclusion:
In this cohort, abnormal glucose metabolism and dyslipidemia are present well before BMI percentiles exceed usual thresholds. We observed alarmingly high rates of insulin resistance among children who did not meet BMI criteria for obesity, in 40% of overweight and 19% of normal weight children. Reliance on the BMI as a trigger to screen for CM risk factors may be disadvantageous to some high-risk groups, including Mexican Americans.
Abstract 4144059: Predictors of Sudden Cardiac Arrest Presenting with Pulseless Electrical Activity
Authors: Chugh Harpriya , Reinier Kyndaron , Uy-Evanado Audrey , Sargsyan Arayik , Chugh Sumeet
Published: November 2024

Background:
The prevalence of sudden cardiac arrest (SCA) manifesting as pulseless electrical activity (PEA) has been rising, survival outcomes are poor and there are no known treatments. Little is known about the clinical profile of these individuals who present with PEA-SCA.

Hypothesis:
Individuals presenting with PEA-SCA have unique clinical profiles that can be determined from their lifetime clinical records and resting 12-lead ECG.

Methods:
From an ongoing prospective, population-based study of out-of-hospital SCA in the Northwestern US (catchment pop. ≈1 M, 2002-2020), we identified adults with PEA-SCA. Comparisons of lifetime medical records and resting 12-lead ECG closest and unrelated to the SCA event were made with a control group of which 70% had known coronary artery disease (CAD). The data archive was divided, a priori, into training and validation datasets. Prediction models were constructed using backwards stepwise logistic regression, with a p value of 0.05 to retain variables in the training dataset and applied to the validation dataset.

Results:
A total of 604 PEA-SCA cases (male 64%, age 72±14yr) and 1418 controls (male 68%, age 66±2yr) had medical history and ECG available. The full dataset was divided into training (67%) and validation (33%) subsets. A multivariable logistic regression model in the training dataset showed that cases were older, had higher odds of using anti-psychotic medications, and higher odds of stroke, heart failure, kidney disease, chronic obstructive pulmonary disease, seizure disorder, syncope, anemia and hyperthyroidism. ECG heart rate >75 bpm, Tpeak to Tend interval ≥90 ms and delayed QRS transition zone were also associated with higher risk of PEA SCA (Table). Cases had lower odds of hypothyroidism and myocardial infarction. The model displayed very good discrimination in the training dataset (C statistic 0.86 [0.836-0.88]) and was successfully validated (C statistic 0.81 [0.77-0.84]).

Conclusion:
A model that combined clinical profile with ECG variables showed very good discrimination for prediction of PEA-SCA vs. controls with CAD. These findings have implications for future investigations targeted at improving prevention and management of SCA presenting with PEA.
Abstract 4144093: Stent-Based Sensor System for Wirelessly Monitoring Arterial Stiffness and Restenosis
Authors: Herbert Robert
Published: November 2024

Introduction:
Implantable vascular electronics offer opportunities to improve patient monitoring and treatments. However, device manufacturability, alongside strict requirements of size, mechanics, and sensing capability, have hindered the development of implantable vascular sensors. Although stents are commonly used with over 3 million stents implanted in cardiovascular arteries every year, there have been minimal efforts to integrate sensing functionality with stents. A promising target for a stent-based electronic system is to monitor the progression of restenosis. Towards this, we report a stent-based sensor system utilizing an electronic stent and a soft sensor to wirelessly measure changes in arterial stiffness and monitor restenosis.

Methods:
A multi-step, rotational laser micromachining was developed to form an electronic stent with layers of stainless steel, polymer, gold, and parylene. Soft, capacitive sensors were printed with elastomer, polymer, and silver nanoparticles. Integrating a stent and sensor forms a passive, wireless sensor. An external loop antenna interrogates the implantable device to record a resonant frequency dependent on arterial strain. The device is evaluated in vitro with silicone models and ex vivo in an ovine coronary artery.

Results:
Figure 1a illustrates the device while the sensor and stent components are highlighted in Figures 1b and 1c. Capacitive strain sensor design was studied to achieve a gauge factor over 3 and the ability to measure strain changes as small as 0.15%. Stent design and fabrication strategies were developed to yield a stent that replicates conventional stent mechanics while offering wireless connectivity to an external antenna. Figure 1d shows the system before and after expansion with a balloon catheter. Once expanded, the device is operated via inductive coupling to wirelessly record changes in resonant frequency and measure changes in arterial strain or artery diameter (Figure 1e). Restenosis levels of 0% up to 90% were tested by thickening the artery wall along the length of the stent and are summarized in Figure 1f. Figure 1g shows the sensor implanted in the coronary artery of an ovine heart for ex vivo testing.

Conclusions:
We have demonstrated a vascular electronics system for the monitoring of arterial stiffness and restenosis. Collectively, our studies of vascular device fabrication and sensor design provide strategies to create vascular electronics for enhanced patient and disease monitoring.
Abstract 4144101: Variation in Vasoactive Treatments for Cardiogenic Shock: Insights from the Critical Care Cardiology Trials Network
Authors: Hamilton David , Shriver Jackson , Park Jeong-Gun , Michos Zoe , Ketcham Scott , Adie Sarah , Mathis Michael , Patel Siddharth , Morrow David , Thompson Andrea
Published: November 2024

Introduction:
The paucity of data to guide selection of specific vasoactive agents in patients with cardiogenic shock (CS) may lead to variability in practice patterns.

Hypothesis:
Variation in the utilization of inodilators to treat CS is associated with both institution- and patient-level factors.

Methods:
The Critical Care Cardiology Trials Network (CCCTN) is a multicenter network of tertiary CICUs in North America coordinated by the TIMI Study Group. This analysis cohort includes patients with CS from 2018-2023. Shock was defined as systolic blood pressure less than 90 mmHg with end-organ dysfunction ascribed to the hypotension. Shock type was classified by site investigators. Multivariable linear mixed-effect modeling was used to evaluate patient- and institutional-level variation associated with the use of inodilators treatment (milrinone, dobutamine).

Results:
A total of 3,282 patients from 37 CICUs were in the study cohort. The rate of utilization of specific vasoactive medications and MCS varied substantially across institutions (Fig 1). For inodilators, rates of dobutamine use varied by institution from 10% to 82%, while milrinone use varied from 6% to 71%. Patient-level variables that were associated with the use of inodilator treatment included male sex (OR 1.24 [95% CI 1.03-1.49]), history of heart failure (1.98 [1.61-2.43]), SCAI class D vs. B/C (1.35 [1.08-1.69]), and BiV failure vs. LV failure (1.59 [1.27-1.99). Variables less likely to be associated with inodilator use included age (0.97 [0.97-0.98] per year increase), cardiac arrest (0.34 [0.27-0.42]), and acute coronary syndrome presentation (0.72 [0.57-0.91]). MCS use within 36 hours of CICU admission and pulmonary hypertension were not associated with variability in inodilator use. In multivariable linear mixed-effect modeling, 45.9% of variation in inodilator use was attributed to patient-level factors and 21.8% of variation was attributed to the institution.

Conclusion:
There is substantial variation in vasoactive treatment and inodilator use related to patient- and institution-level factors. Such variability underscores the need for additional high-quality evidence to guide vasoactive treatment strategies in CS.
Abstract 4144108: Incorporating AI-enabled Left Atrial Volume Measurement from Coronary Artery Calcium Scans (AI-CAC) to CHA
2
DS
2
s-VASc Risk Score Improves Stroke Prediction in the Asymptomatic Population: The Multi-Ethnic Study of Atherosclerosis
Authors: Naghavi Morteza , Reeves Anthony , Atlas Kyle , Zhang Chenyu , Atlas Thomas , Henschke Claudia , Yankelevitz David , Budoff Matthew , FAN WENJUN , Yu Ruilin , Branch Andrea , Ma Ning , Roy Sion , Nasir Khurram , Molloi Sabee , Fayad Zahi , McConnell Michael , Kakadiaris Ioannis , Zulueta Javier , Maron David , Shah Prediman , Williams Kim , Abela george , Levy Daniel , Wong Nathan
Published: November 2024

Background:
The CHA
2
DS
2
-VASc risk score is a clinical tool for stroke prediction. It is mainly used in patients with atrial fibrillation (AF) but is also applied to the non-AF population. We previously reported that artificial intelligence (AI)-enabled left atrial (LA) volumetry from coronary artery calcium (CAC) scans (AI-CAC) predicts AF as early as one year and outperformed CHARGE-AF and NT-proBNP. In this report, we compare AI-CAC LA volumetry to the CHA
2
DS
2
-VASc risk score and evaluate the incremental value of incorporating AI-CAC LA volume to CHA
2
DS
2
-VASc for incident stroke prediction in the non-AF population.

Methods:
We applied the AutoChamber
TM
LA volumetry component of AI-CAC to CAC scans of 5830 people without AF (52.2% women, age 61.7±10.2 years) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) baseline (2000-2002). We used the 15-year outcomes data for incident stroke (ischemic and hemorrhagic) and assessed discrimination using the time-dependent area under the curve (AUC) between AI-CAC LA volume vs. CHA
2
DS
2
-VASc risk score. Notably, the CHA
2
DS
2
-VASc score in this non-AF population ranges from 0 to 5, whereas in the AF population it typically ranges from 0 to 9 points.

Results:
252 cases of stroke accrued over 15 years. The median and mean ± SD of CHA
2
DS
2
-VASc score at baseline were 1.0 and 1.58 ± 1.15, respectively. The cumulative incidence of stroke for the 95
th
percentile of AI-CAC LA volume (n=291) vs. CHA
2
DS
2
-VASc 4 or 5 points (n=364) was 13.0% and 13.7%, respectively. AI-CAC LA volume significantly improved the AUC of CHA
2
DS
2
-VASc for stroke prediction at 2-year follow-up (0.76 for CHA
2
DS
2
-VASc vs. 0.81 for CHA
2
DS
2
-VASc plus LA volume, p=0.03), 5-year follow-up (0.73 vs. 0.77, p=0.01), 10-year follow-up (0.70 vs. 0.75, p<0.0001) and 15- year follow-up (0.70 vs. 0.74, p<0.0001).

Conclusion:
In this multi-ethnic longitudinal cohort of people without AF, addition of LA volume significantly improved performance of the CHA
2
DS
2
-VASc risk score for stroke prediction from 2 to 15 years follow-up. Further studies are needed to evaluate the clinical utility of adding LA volume to CHA
2
DS
2
-VASc risk score in people with and without AF.
Abstract 4144115: Suppressed T cell Response to the ApoB-100 Antigen P210 In Stable ASCVD Patients Is Rescued By Nanoparticle-conjugated P210-PAM
Authors: Dimayuga Paul , Chyu Kuang-Yuh , Zhao Xiaoning , Zhou Jianchang , Wei Janet , Trac Noah , Cercek Bojan , Chung Eun Ji , Shah Prediman
Published: November 2024

Background:
The apoB-100 peptide P210 is an atherosclerosis-related antigen. P210 conjugated-nanoparticles (P210-PAM) are internalized by antigen-presenting cells to elicit T cell responses and reduce atherosclerosis in mice. However, if and how P210 modulates human T cell responses is not known. We investigated the intrinsic T cell response to P210 in both healthy and atherosclerotic cardiovascular disease (ASCVD) subjects.

Methods:
We evaluated the T cell response to unconjugated P210 or P210-PAM in PBMCs of healthy subjects (N=15) and stable ASCVD patients (N=27) using the Activation Induced Marker (AIM) assay, where a change of 1.5-fold relative to unstimulated cells is considered the activation threshold and a value of 1 considered no response. Under IRB approval, PBMCs from stable ASCVD patients were collected within 1 year of acute MI or stroke, or a diagnosis of peripheral artery disease (PAD). To investigate effects on innate cells, monocytes from healthy subjects were phenotyped by flow cytometry staining after stimulation with P210-PAM.

Results:
P210 significantly increased CD4+CD69+CD154+ T cells in healthy subjects compared to ASCVD patients (2.2±1.9 vs 0.8±0.6 fold-change; P=0.01) without affecting other T cell activation markers. In healthy subjects, CD4+CD69+CD154+ T cell response to P210-PAM stimulation was similar compared to P210 stimulation (1.5±0.7 vs 2.2±1.9 fold-change) but was significantly increased in ASCVD patients (1.8±1.8 vs 0.8±0.7 fold-change, respectively; P=0.02). CD4+CD134+CD137+ T cells were also significantly increased by P210-PAM compared to P210 in ASCVD patients (2.8±2.0 vs 1.9±1.8 fold-change; P<0.01) but not in control subjects. Monocyte-enriched PBMCs of healthy subjects (N=13) stimulated with P210-PAM significantly increased CD64+CD80+ cells (32.3±11.9% vs 3.1±2.8%; P<0.001), CD11b+CD209+ cells (3.7±2.2% vs 2.0±1.6%; P<0.01), CD14+CD16+ cells (13.9± 9.5% vs 0.9±0.8%; P<0.001) and CD14-CD16+ cells (37.3±18.7% vs 0.9±1.1%; P<0.001), with significantly reduced CD14+CD16- cells (16.9±14.6% vs 60.0±21.0%; P<0.001).

Conclusions:
CD4+ T cell response to P210 is impaired and can be rescued by P210-PAM in stable ASCVD patients. Such rescue may be mediated by P210-PAM provoking a shift in monocytes from classic inflammatory to non-classic anti-inflammatory phenotype. Our results support the dynamic existence of T cell response to P210 and the development of P210-PAM as potential immune-modulator therapy for human ASCVD.
Abstract 4144122: Genetic Modulation of Cytoglobin Expression Regulates Vascular Nitric Oxide Metabolism, Vascular Tone and Blood Pressure
Authors: Mahgoup Elsayed , Khaleel Sahar , Ewees Mohamed , Eid Mahmoud , Zweier Jay
Published: November 2024

Background:
The recently identified globin Cytoglobin (Cygb), in the presence of cellular reductases, has potent nitric oxide (NO) dioxygenase (NOD) activity and serves as the major pathway of O
2
-dependent NO metabolism in vascular smooth muscle. While genetic deletion of Cygb greatly decreases vascular NO metabolism, vessel tone and blood pressure (BP), the effects of increasing or partially decreasing Cygb expression are unknown.

Objective:
Therefore, we investigate how upregulating or downregulating Cygb expression affects NO metabolism, vessel relaxation and BP.

Methods:
Wild-type (WT),

Cygb
-/+

(HET),

Cygb
-/-

knockout (KO), and Cygb overexpressing (OE) mice were used to determine the effect of Cygb expression levels on NO metabolism and vascular function. Cygb levels were assayed by quantitative immunoblotting. NO diffusion across the aortic wall was measured by electrode. BP was measured by tail-cuff, and endothelial-dependent vasorelaxation by the concentration-dependent acetylecholine (Ach) response in phenylephrine-preconstricted aortic rings using a strain gauge myograph.

Results:
In HET mice Cygb levels were 50% of WT and in OE 500% of WT. NO diffusion flux across the aortic wall was greatly increased by the decrease/abolition of Cygb expression in HET and KO mice with 2.8 and 5.1-fold increase from WT, respectively (n= 5-7/grp,
p
<0.01 and
p
<0.001, respectively) (Fig. 1 A&B). However, in OE mice NO flux was 2.2-fold decreased (n=5-7/grp,
p
=0.05). Mean BP (MBP) was 29% decreased in KO and 22% in HET (n= 21/grp,
p
<0.01). In OE mice, MBP was 9% increased, compared to WT,
p
<0.05 (Fig. 1 C). In aortic vessels of Cygb KO and HET, there was a marked shift to the left in the Ach relaxation-response curve, with 50% relaxation seen at 0.34 nM or 8.6 nM Ach, respectively, compared to 154 nM in WT (n= 6/grp,
p
<0.0001). In contrast, a rightward shift was seen in Cygb OE vessels with 50% relaxation at 930 nM,
p
<0.0001).

Conclusion:
Changing Cygb expression levels alters NO diffusion through the vessel wall in turn modulating vascular tone and BP. Therefore, modulation of Cygb expression could serve as a novel approach for the regulation of vascular tone in the treatment of cardiovascular disease.