bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145568: DOACs versus Aspirin for Secondary Prevention of Stroke after ESUS: An Updated Systematic Review and Meta-analysis of Randomized Clinical Trials
Authors: Da Silva Izael , Queiroz Ivo , Souza Freire Camila Veronica , Daibes Marianna , Barbosa Lucas , Maia Jose , Evangelista André , Mota Diandro
Published: November 2024

Background:
Embolic stroke of undetermined source (ESUS) is a nonlacunar ischemic stroke with no clear cause, having a 4%-5% annual recurrence rate. The potential benefits of direct oral anticoagulants (DOACs) relative to aspirin in patients with ESUS remain unclear.

Objective:
We aimed to perform a systematic review and meta-analysis to determine the efficacy of the DOACs in secondary prevention for patients with ESUS compared with aspirin.

Methods:
MEDLINE, Embase, Cochrane, and ClinicalTrias.gov were searched for RCTs comparing DOACs versus aspirin for secondary stroke prevention after ESUS. We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review (PRISMA) and Cochrane guidelines. Statistical analysis was performed using R software 4.3.2. A random-effects model was employed to measure mean differences and hazard ratios (HR) with 95% confidence intervals (CI).

Results:
We included 4 RCTs comprising 13,970 patients. The median age was 67 years (IQR 65.5-68.2), 61% were male, 76% had hypertension, and 51% had diabetes. DOACs were administered to 50% of the participants. No significant difference was found between groups for stroke recurrence [RR 0.95 (95% CI 0.8-1.11) p=0.52; I
2
=0%]. Death from any cause [HR 1.11 (95% CI 0.87-1.42) p=0.38; I
2
=0%], cardiovascular death [HR 1.08 (95% CI 0.61-1.94) p=0.77; I
2
=18%] and myocardial infarction [HR 0.92 (95% CI 0.54-1.54) p=0.76; I
2
=16%] were also similar between groups. However, there was a significant increase in clinically relevant non-major bleeding for patients treated with DOACs [HR 1.53 (95% CI 1.22-1.92) p<0.001; I
2
=9%].

Conclusion:
In patients with ESUS, DOACs were not superior to aspirin for the secondary prevention of stroke. However, there was a significant increase in clinically relevant non-major bleeding among patients treated with DOACs. These findings suggest that aspirin remains a viable option for secondary prevention in ESUS patients.
Abstract 4145595: Relationship status is associated with sex differences in social and health-seeking behaviors among heart failure patients
Authors: Leyba Katarina , Kao David
Published: November 2024

Background:
Evidence from observational cohort studies suggests that lifelong unmarried status is associated with worse outcomes in men but not women. The reasons for these sex differences is poorly understood.

Purpose:
Identify sex differences in health-seeking behaviors according to relationship status that correspond to sex differences in clinical outcomes

Methods:
Data from study visits reporting multiple social and health-seeking behaviors were obtained from the Atherosclerosis Risk in Communities (ARIC, year 23) study, Multiethnic Study of Atherosclerosis (MESA, year 10) and Framingham Heart Study Offspring (FHS, year 40) were pooled and harmonized. Behaviors including recent doctor visits, medication compliance, activity and caloric intake were summarized by relationship status and sex. Behaviors found to be different between relationship groups were then analyzed for association with all-cause mortality using Cox proportional hazards analysis.

Results:
There were 2653 subjects with incident HF, of whom 1479 were married, 208 were divorced, 78 were never married, 33 were separated, and 784 were widowed. Never-married status was associated significantly higher risk of all-cause mortality in men (HR 1.83 [1.11-3.04, p=0.019]), but not women (HR 0.75 [95% CI 0.44-1.27]). Compared with unmarried men, married men had significantly better medication adherence (Morisky score, 44% vs. 25%, p=0.003), emotional support (ESSI5 16.7±3.8 vs. 13.8±4.3, p<0.001), and social support (Berkman Social Network Questionnaire 26.6±6.3 vs. 22.9±6.4, p<0.001), whereas there were no differences in these metrics between married and unmarried women. Of these, the higher ESSI and BSNQ indices were both associated with reduced all-cause mortality, whereas the Morisky score was not.

Conclusion:
Married men experience significantly more social and emotional support than unmarried men, whereas women do not. Personal support systems may be an important contributor to the relationship between unmarried status and HF outcomes in men.
Abstract 4145601: Prevalence and Distribution of Retinal and Deep Learning-Based Versus Actual Coronary Artery Calcium Scores: A Large South Korean Population Aged 21-90 Years
Authors: Cho Yunnie , Rim Tyler Hyungtaek , Choi Beom-hee , Jung Gyouchul , Lee Chan Joo , Park Sung Ha , Kim Hyeonmin , Seo Chanyang , Thakur Sahil , Tan Yong Yu , Wong Tien , Cheng Ching-Yu , Generoso Giuliano , Correa Fabiano Ronaldo , Bensenor Isabela , Bittencourt Marcio , Cho Jun Hwan
Published: November 2024

Introduction:
Reti-CVD, a novel cardiovascular risk stratification tool derived from deep learning and retinal photography, offers a promising alternative to CT scan-measured Coronary Artery Calcium (CAC) scores in predicting cardiovascular events. This study investigates the profile of Reti-CVD scores using data from three medical centers in South Korea: GC iMED Gangbuk&Gangnam branches and Philip Medical Center.

Hypothesis:
Reti-CVD scores can effectively stratify cardiovascular risk across different age groups and genders and correlate with actual CAC scores, demonstrating their utility as predictive markers for cardiovascular risk.

Methods:
Data from 598,831 retinal images from Philip Medical Center and 74,859 from GC iMED Gangbuk&Gangnam branches were analyzed for Reti-CVD. The overall dataset consists of 45,858 individuals aged 21-90 years. The distribution of Reti-CVD and CAC scores across various age groups, segmented into ten-year increments, was examined. For 4,685 individuals with available follow-up data, longitudinal changes in Reti-CVD scores over an approximate two-year period were assessed using Pearson’s correlation analysis.

Results:
In both Reti-CVD and CAC distributions, each age group exhibited distinct score ranges, with increasing cardiovascular risk as age increased, as shown in Figures 1 and 2. Men had consistently higher scores, indicating gender differences. The longitudinal study further revealed a significant positive correlation between baseline and follow-up Reti-CVD scores (Correlation Coefficient: 0.158, p-value < 2.2e-16).

Discussion:
Reti-CVD score analysis in relation to age and gender exhibited similar trends to CAC scores, offering insights into cardiovascular risk profiles and enabling percentile assessments within specific gender and age groups. The correlation between baseline and follow-up scores emphasizes Reti-CVD's potential as a longitudinal cardiovascular risk marker, suggesting the need for closer monitoring and intervention strategies for those with higher initial scores.
Abstract 4145632: Impact of Anemia on the Prediction of Galectin-3 for Cause-specific Mortality in Patients With Suspected or Known Coronary Artery Disease: The ANOX Study
Authors: Wada Hiromichi , Suzuki Masahiro , Matsuda Morihiro , Ajiro Yoichi , Shinozaki Tsuyoshi , Sakagami Satoru , Yonezawa Kazuya , shimizu masatoshi , Funada Junichi , Takenaka Takashi , Morita Yukiko , Nakamura Toshihiro , Fujimoto Kazuteru , Matsubara Hiromi , Kato Toru , Unoki Takashi , Takagi Daisuke , Wada Kyohma , Wada Miyaka , Nakayama Takumi , Maeda Yuka , Masunaga Nobutoyo , Ishii Mitsuru , Kotani Kazuhiko , Abe Mitsuru , Akao Masaharu , Hasegawa Koji
Published: November 2024

Background:
High circulating levels of galectin-3 are associated with all-cause and cardiovascular (CV) mortality in patients with coronary artery disease (CAD). However, the impact of anemia on the prediction of galectin-3 with cause-specific mortality in patients with suspected or known CAD is unknown.

Methods:
Serum levels of galectin-3 were measured in 2,418 patients with suspected or known CAD undergoing elective coronary angiography. The outcomes were all-cause death, CV death, and non-CV death. Patients were divided into 2 groups according to the presence (n=882) or absence (n=1,536) of anemia, and followed up over a 6-year period.

Results:
During the follow-up, 329 anemic and 207 non-anemic patients died of any cause, 116 anemic and 50 non-anemic patients died of CV diseases, and 187 anemic and 139 non-anemic patients died of non-CV diseases. After adjustment for potential clinical confounders and established CV biomarkers, log-transformed (Ln-) galectin-3 levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.23; 95% confidence interval [CI], 1.10–1.37) and non-CV death (HR, 1.30; 95% CI, 1.13–1.50), but not with CV death (HR, 1.16; 95% CI, 0.95–1.41) in the entire cohort; significantly associated with all-cause death (HR, 1.20; 95% CI, 1.03–1.41) and non-CV death (HR, 1.49; 95% CI, 1.20–1.85), but not with CV death (HR, 0.95; 95% CI, 0.72–1.24), in anemic patients; and significantly associated with all-cause death (HR, 1.33; 95% CI, 1.13–1.57) and CV death (HR, 1.19; 95% CI, 1.00–1.42), but not with non-CV death (HR, 1.17; 95% CI, 0.95–1.43), in non-anemic patients. We also evaluated the incremental predictive performance of galectin-3 by calculating continuous net reclassification improvement, and integrated discrimination improvement metrics. The addition of Ln-galectin-3 levels to the model with potential clinical confounders and established CV biomarkers further improved the prediction of all-cause death and non-CV death, but not that of CV death, in the entire cohort and in anemic patients, and the prediction of all-cause death and CV death, but not that of non-CV death, in non-anemic patients.

Conclusions:
In patients with suspected or known CAD, distinct differences were observed between anemic and non-anemic patients, in the prediction for cause-specific mortality by galectin-3 levels, which independently predicted non-CV mortality in anemic patients and CV mortality in non-anemic patients.
Abstract 4145634: Clinical Outcomes of Catheter Ablation for Atrial Fibrillation in Younger Adults: A Systematic Review and Meta-Analysis
Authors: Rathore Sawai Singh , Farrukh Ameer , Yao Sem Josue Nsanh , Vidaurre Corrales Vanessa , Wint Zario , Al Shyyab Ibrahim , Goyal Aman , Jain Hritvik , Kumar Ashish
Published: November 2024

Background:
Catheter ablation has been increasingly used for managing atrial fibrillation (AF), to restore and maintain normal sinus rhythm. Despite its widespread use, it is unclear if there are differences in clinical outcomes, particularly in maintaining rhythm control and safety outcomes, between younger and older adults undergoing catheter ablation. The objective of this meta-analysis was to compare the outcomes following catheter ablation in younger and older adults.

Methods:
A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using random effect models, mantel-Haenszel odds ratios and associated 95% confidence intervals were calculated to report the overall effect size. The primary endpoints were AF/atrial tachycardia (AT) recurrence and re-ablation requirement. Secondary outcomes included in-hospital complications such as stroke/TIA, cardiac tamponade/pericardial effusion, and vascular complications such as bleeding, hematoma, AV fistula, and femoral pseudoaneurysm. The young adult group varied between studies, ranging from under 30 years to under 45 years.

Results:
Data from 10 articles, with a sample size of about 126,141 AF patients, were considered. Our analysis indicated that catheter ablation for AF in the younger age group was linked to reduced odds of AF/AT reoccurrence (OR: 0.60; 95% CI: 0.44 to 0.83; p=0.002) and a decreased need for re-ablation after the index procedure (OR: 0.72; 95% CI: 0.53 to 0.97; p=0.03). Furthermore, catheter ablation in younger adults was found to be associated with a lower risk of in-hospital procedural complications like stroke/TIA (OR: 0.59; 95% CI: 0.43 to 0.80; p=0.0008) and cardiac tamponade/pericardial effusion (OR: 0.53; 95% CI: 0.42 to 0.68; p<0.0001). There was no difference between the two groups concerning vascular complications during the procedure (OR: 0.60; 95% CI: 0.28 to 1.27; p=0.18).

Conclusion:
This meta-analysis demonstrates that younger adults undergoing catheter ablation for atrial fibrillation reported significantly better clinical outcomes than older adults.
Abstract 4145652: Complete Versus Incomplete Revascularization Strategy in Myocardial Infarction and Multivessel Coronary Artery Disease in ≥65-Year-Old Patients: A Meta-Analysis.
Authors: Banga Akshat , Rathore Sawai Singh , Mautong Hans , Sah Biki , Gurav Jaiprakash , Talaei Fahimeh , Farrukh Ameer , Bansal Vikas
Published: November 2024

Background:
Invasive management strategies for myocardial infarction (MI) and multivessel coronary artery disease (MV-CAD) include complete revascularization (successful revascularization of all coronary artery lesions or segments ≥1.5 mm in diameter with ≥50% diameter stenosis) and incomplete revascularization (including culprit-only revascularization). However, non-culprit lesion management strategy in elderly patients remains ambiguous due to a lack of representation of this cohort in randomized trials (RCTs) and higher cardiovascular complication risks.

Methods:
We performed a meta-analysis comparing clinical outcomes of elderly individuals (age ≥65 years) with MI and MV-CAD submitted to complete vs. incomplete (including culprit-only) percutaneous coronary intervention (PCI). The outcomes of interest were all-cause death, cardiovascular mortality, recurrent MI, and any revascularization. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model.

Results:
Thirteen studies (3 RCTs, 1 post hoc analysis of previous RCT, and 9 observational studies) with a total of 12,289 patients were included. Complete revascularization (CR) was performed in 5,232 patients, while 7,057 patients underwent incomplete revascularization (IR). The mean age was 80.46 years for CR and 80.73 years for IR and the mean durations of follow-ups ranged from 12-78 months. As compared to IR, the CR group was associated with significantly lower risk of all-cause mortality (OR 0.59, 95% CI 0.49 to 0.71, p<0.0001) (Figure 1), cardiovascular mortality (OR 0.56, 95% CI 0.40 to 0.77, p=0.0005), recurrent MI (OR 0.62, 95% CI .47 to 0.81, p=0.0005) (Figure 2), and any revascularization (OR 0.47, 95% CI 0.26 to 0.86, p=0.01).

Conclusion:
Among elderly patients with MI and MV-CAD, CR is associated with a lower risk of all-cause mortality, cardiovascular mortality, recurrent MI, and any revascularization.
Abstract 4145690: Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Diabetes: A Systematic Review and Meta-Analysis
Authors: Rathore Sawai Singh , Al Shyyab Ibrahim , Farrukh Ameer , aneis hamam , Yao Sem Josue Nsanh , Vidaurre Corrales Vanessa , Wint Zario , Kumar Ashish
Published: November 2024

Background:
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular benefits beyond glycemic control, including potential anti-arrhythmic effects. The impact of SGLT2 inhibitors on atrial fibrillation (AF) recurrence following catheter ablation in diabetic patients is an area of emerging interest. The purpose of this meta-analysis was to evaluate the impact of SGLT2 inhibitors on AF recurrence following catheter ablation in patients with diabetes.

Methods:
A comprehensive literature search was carried out using PubMed, Embase, and Google Scholar databases for the studies comparing SGLT2 inhibitors with other antidiabetic drugs in AF patients undergoing catheter ablation. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Statistical significance was set at p < 0.05. Egger's regression test and Begg-Mazumdar's rank test were used to assess publication bias. The primary endpoint was the reoccurrence of atrial fibrillation after catheter ablation during the follow-up period, which varied between studies and ranged from 12 to 33 months.

Results:
The analysis included six studies, involving a sample size of around 5,765 AF patients. Our study reported that the use of SGLT2 inhibitors in diabetic patients undergoing catheter ablation for AF was associated with lower odds of AF reoccurrence (OR: 0.46; 95% CI: 0.32 to 0.65; p<0.0001) compared with other antidiabetic medications. This outcome has moderately associated heterogeneity, with I2 of 59%. Egger's regression test and Begg-Mazumdar's rank test showed no evidence of publication bias (p > 0.05).

Conclusion:
The use of SGLT2 inhibitors was associated with improved outcomes post-catheter ablation for AF diabetic patients. Further large-scale, randomized controlled trials are warranted to confirm these findings and elucidate the underlying mechanisms.
Abstract 4145692: Patient Autonomy and Statin Therapy Adherence (PASTA) Trial
Authors: Haq Ayman , Aldujeli Ali , Zaliaduonyte Diana , Miedema Michael
Published: November 2024

Introduction:
Adherence to statin therapy is suboptimal in the primary prevention population, despite extensive data regarding efficacy and safety.

Hypothesis:
Introducing autonomy in the decision-making process will increase statin adherence and reduce perceived side effects.

Goals:
Compare six-month rate of statin adherence and perceived side effects in patients who initially decline atorvastatin, between those given reassurance and those offered a supplement trial prior to statin therapy.

Methods:
Patients > 40 years without a history of ASCVD at a moderate ASCVD risk who decline statin therapy underwent block randomization. The control group was provided education and reassurance regarding the statin therapy and prescribed 30mg atorvastatin. The intervention group was offered a trial of red yeast rice extract 20mg and a goal LDL-C 100 mg/dL. After 2 months those not at the goal LDL-C were then prescribed 30mg atorvastatin (Figure 1). The primary endpoint was the number of monthly pharmacy refills at 6 months. The secondary endpoints were rates of self-reported myalgias, fatigue, mental fog, and gastrointestinal upset at 6 months. The Wilcoxon rank sum test and the Chi-square test was used to assess the primary and secondary endpoints, respectively.

Results:
The final analysis included 276 patients; baseline demographics, labs and lipid profiles were similar between the two groups. Statin prescriptions filled was higher in the intervention group (Figure 2). The intervention group had lower rates of fatigue and mental fog, but not myalgias or gastrointestinal upset (Figure 3).

Conclusion:
Introducing autonomy in the decision-making process improved adherence to atorvastatin therapy and reduced the rate of perceived side effects.
Abstract 4145703: Sickle Cell Disease is Associated with Increased Readmission Rates in Patients Admitted with Acute Coronary Syndromes
Authors: Mahmud Arif , Leiva Orly , Loftspring Ethan , Osei Miriam , Bangalore Sripal , Rao Sunil
Published: November 2024

Introduction:
Acute coronary syndrome (ACS) is a leading cause of cardiovascular (CV) death. Sickle cell disease (SCD) is the most common inherited blood disorder in the United States and is associated with coronary microvascular dysfunction and impaired myocardial perfusion reserve. However, data on post-ACS outcomes in patients with SCD are scarce.

Methods:
Patients admitted with ACS from 2014-2020 with and without SCD were identified using the National Readmissions Database. In-hospital outcomes were death, major bleeding, stroke or arterial thromboembolism, and venous thromboembolism (VTE). Ninety-day readmission outcomes were CV-related, heart failure (HF) related, bleeding-related, and all-cause. Multivariable logistic or Cox proportional hazards were utilized with age, sex, chronic kidney disease, prior MI, prior stroke, prior VTE, pulmonary hypertension, STEMI, cardiogenic shock, revascularization, anemia, mechanical circulatory support use, hospital size and teaching status in addition to social factors as co-variables.

Results:
A total of 2,190,358 patients with ACS were included, of whom 1,471 (0.067%) had SCD. After multivariable adjustment, there was no difference in in-hospital mortality (OR 0.92; 95% CI 0.68-1.26) or major bleeding (OR 1.03; 95% CI 0.82-1.28) between patients with and without SCD. There was no significant difference in 90-day CV-related (HR 1.11; 95% CI 0.94-1.3) or bleeding-related (HR 0.86; 95% CI 0.49-1.52) readmissions between patients with and without SCD. However, SCD was associated with a higher rate of HF-related (HR 1.25; 95% CI, 1.04-1.52) and all-cause 90-day readmissions (HR 1.17; 95% CI, 1.04-1.32).

Conclusion:
Among patients admitted with ACS, SCD was not associated with increased risk of in-hospital outcomes though there was an association of increased HF-related and all-cause 90-day readmissions with SCD. Further investigation is needed to better characterize and improve outcomes of patients with SCD and ACS.
Abstract 4145774: Clinical Outcomes Following Transcatheter Edge-to-Edge Mitral Valve Repair in Cancer Survivors: A Systematic Review and Meta-Analysis
Authors: Costa Thomaz , Felix Nicole , Clemente Mariana , Costa Bruno , Lima Neiberg , Guha Avirup , Silva Guilherme
Published: November 2024

Introduction:
Little is known about the outcomes of cancer survivors versus patients without a history of cancer undergoing Transcatheter Edge-to-Edge Mitral Valve Repair (TEER) for mitral regurgitation (MR). Moreover, recent publications retrieved conflicting results on the safety and efficacy of TEER in cancer survivors.

Hypothesis:
Performing TEER in cancer survivors produces similar outcomes when compared to patients with no history of cancer.

Aims:
Conduct a systematic review and meta-analysis to evaluate clinical outcomes after TEER for MR in patients with versus without a history of cancer.

Methods:
From inception to December 2023, we systematically searched PubMed, Web of Science, and Embase for studies comparing the safety and efficacy of TEER for MR in cancer survivors versus in patients without a history of cancer. Outcomes of interest were 30-day and 1-year all-cause mortality, incidence of post-procedural MR grade ≥ 3, post-procedural stroke, and 30-day readmissions. Statistical analyses were performed using R software version 4.3.2. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints.

Results:
We included six observational studies comprising 25,334 patients, of whom 6.1% were cancer survivors. Cancer survivors and controls had comparable rates of 30-day all-cause mortality (OR 1.15; 95% CI 0.55 to 2.39; p=0.71), 1-year all-cause mortality (OR 1.61; 95% CI 0.93 to 2.79; p=0.09), post-procedure severe MR (OR 1.49; 95% CI 0.67 to 3.30; p=0.33), post-procedural stroke (OR 1.25; 95% CI 0.47 to 3.27; p=0.66), and 30-day readmission (OR 1.16; 95% CI 0.92 to 1.46; p=0.19).

Conclusion:
This meta-analysis suggests that cancer survivors with symptomatic MR have similar outcomes after TEER as compared with patients who do not have a history of cancer. Future multicenter studies are warranted to confirm and expand these findings in larger populations and with multivariable-adjusted analysis.
Abstract 4145779: Proteomic Insights into High-Fat Diet's Impact on Chronic Myocardial Ischemia in a Swine Model
Authors: Harris Dwight , Stone Christopher , Broadwin Mark , Malhotra Akshay , Melendez-Martinez Gabriela , Sabe Sharif , Abid Ruhul , Sellke Frank
Published: November 2024

Introduction:
The effect of obesogenic diet on the outcomes of coronary artery disease are controversial with some clinical studies suggesting a paradoxical favorable effect of obesity. We seek to better understand the effects of high-fat diet on chronic myocardial ischemia using a swine model of chronic myocardial ischemia and Proteomic Analysis.

Methods:
Twenty 6-week-old Yorkshire swine received 5 weeks of normal diet (n=9, ND) or high-fat diet (n=11, HFD) prior to the placement of an ameroid constrictor on the left coronary circumflex artery to induce chronic myocardial ischemia. The swine continued ND or HFD for seven weeks after the procedure. At that time, the swine underwent terminal harvest with functional measurement and tissue collection for proteomic analysis.

Results:
There was a significant increase in ejection fraction, tau, myocardial perfusion, and PRSW in the HFD compared to ND (all p<0.05). There was no change in cardiac output (p=0.73). Proteomic analysis identified a total of 2,782 proteins. The HFD ischemic myocardium had 430 significantly increased and 105 significantly decreased proteins. The HFD non-ischemic group had 251 significantly increased and 94 significantly decreased proteins. Pathway analysis of the ischemic myocardium showed increases in pathways related to fatty acid metabolism and amino acid metabolism and decreases in pathways related to cytoskeletal structure in the HFD compared to ND. Pathway analysis of the non-ischemic myocardium also showed increases in pathways related to fatty acid metabolism and decreases in pathways related to cytoskeletal structure in the HFD compared to ND.

Conclusions:
HFD results in paradoxical increases in cardiac perfusion and function in the setting of chronic myocardial ischemia. This was accompanied by an increase in fatty acid metabolism and amino acid metabolism in both the ischemic and non-ischemic myocardium in the HFD compared to ND. There were decreases in several pathways related to cytoskeletal organization in the HFD compared to ND. This suggests that a high-fat diet may initially increase cardiac function through altered metabolism, but deteriorations in cytoskeletal structure may help explain longer-term complications.
Abstract 4145908: Early Pregnancy Blood Pressure Trajectory Predicts Diagnosis of Hypertensive Disorders of Pregnancy: an External Validation Study
Authors: Sheehan Megan , Zhao Manyun , Alexeeff Stacey , Sun Baiyang , Gunderson Erica , Levine Lisa , Chen Jinbo , Lewey Jennifer
Published: November 2024

Background:
Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and contribute to cardiovascular disease later in life. Early identification of patients at highest risk of HDP may improve targeting of preventive therapies. Prior work within the Kaiser Permanente Northern California (KPNC) cohort demonstrated that early pregnancy blood pressure trajectories (BPT) improved HDP prediction compared to clinical factors alone. Our objective is to assess the performance of BPT models in a racially diverse patient population.

Methods:
We identified patients within Penn Medicine with a delivery from 2012-2020 and ≥3 outpatient BP measurements between 0 to 20 weeks gestation. Patients with pre-existing hypertension (HTN) or serious medical conditions were excluded. Covariates were obtained from the electronic medical record (EMR). Each patient was assigned one of six BPT groups based on KPNC latent class growth models. The primary outcome of HDP diagnosis, including preeclampsia and gestational HTN, was identified using ICD codes. Multivariable logistic regression was used to model the relationship between patient factors and HDP diagnosis. Predictive models were compared using the C-statistic.

Results:
Among 26,430 patients, the mean age was 30.8 years, 23% had Medicaid insurance, and 32% identified as Black. Overall, 22% of patients developed HDP and incidence varied by BPT group (Figure). After adjusting for age, race/ethnicity, parity, BMI, and diabetes, the moderate-stable group (aOR 5.42, 95% CI 3.7-8.3) and the elevated-stable group (aOR 10.2, 95% CI 6.9-15.8) had the strongest associations with HDP compared to the ultra-low-declining group. The prediction model including patient factors and BPT groups had better discrimination for HDP compared to patient factors alone (C-statistic 0.71 vs 0.66). Overall, models including BPT groups performed similarly to those from the KPNC cohort.

Conclusions:
Compared to the KPNC cohort, the Penn cohort had higher prevalence of patients with HDP, who identified as Black and had Medicaid insurance. Despite these differences, early pregnancy BPT groups demonstrated a similar improvement in HDP prediction compared to patient risk factors alone.
Abstract 4145948: Rare Case of Left-Dominant Arrhythmogenic Cardiomyopathy with Gene Mutations in DSP and MYBPC3
Authors: Sattouf Zafer , Ali Bilal , Patel Dev , Datla Sanjana
Published: November 2024

Background:
Mutations in desmoplakin gene (DSP) are associated with arrhythmogenic cardiomyopathy (ARVC). Myosin-binding protein C gene (MYBPC3) is a sarcomere gene and is associated with hypertrophic cardiomyopathy (HCM). The expression of both of these genes has only been reported twice in the literature. It remains unclear whether the expression of both mutation carries a more severe phenotype than carrying on of the mutations only.

Case Description:
A 21-year-old female with history of sustained ventricular fibrillation (VT) at age 18, VT arrest at age 20,dilated cardiomyopathy with LVEF 30-35% and subcutaneous ICD, who was admitted after multiple ICD defibrillations. Device interrogation demonstrated 23 monomorphic VT episodes treated with 44 shocks by the ICD. Coronary angiogram demonstrated non-obstructive coronary arteries. Patient underwent VT ablation, complicated by incessant VT from LV summit which was eliminated during procedure. Cardiac MRI demonstrated RVEF 33%, regional dyskinesis in the sub-tricuspid area and RV outflow tract. cMRI also demonstrated subepicardial late gadolinium enhancement at the level of the mid antero/infero lateral walls with extension into the apicolateral wall and mid inferoseptal territory. These findings heightened suspicion for left ventricle fatty infiltration. However, endomyocardial biopsy negative for inflammation or granuloma, no fibrosis, negative iron and amyloid staining. Left-dominant arrhythmogenic cardiomyopathy was diagnosed based on cMRI findings, LV systolic dysfunction, and arrhythmia of LV origin. Subcutaneous ICD was explanted and replaced with a dual chamber ICD. Patient was discharged on Mexiletine and GDMT for HFrEF. Genetics testing later revealed rare co-occurance of two genetic mutations including MYBPC3 and DSP.

Discussion:
The presentation of both DSP and MYBPC3 mutations in patients diagnosed with ARVC has only been reported twice in the literature and a is an extremely rare phenomenon. There is currently no sufficient understanding of the genotype-phenotype correlation of DSP and MYBPC3 mutations in the clinical expression of their associated inherited cardiac diseases. Therefore, more research need to investigate this phenomena and to study whether the co-presence of both of these two mutations is associated with a more severe phenotypic expression of HCM and ARVC.
Abstract 4145955: In An Experimental Type 2 Diabetes Mellitus Model Induced With Streptozotocin, The Combined Use of Finerenone and Exenatide Reduced Inflammation and Oxidative Stress In The Heart and Kidney Tissues and Improved The Health of The Heart
Authors: gunek emirhan , Aydin Elif , Koldemir Gunduz Meliha , Kaymak Gullu , Kocak Ayse
Published: November 2024

Introduction:
Cardiovascular problems are the primary cause of morbidity and death in people with diabetes mellitus.The whole nature of diabetic cardiomyopathy(DCM) is yet unknown.In order to investigate the pathogenesis of DCM and find possible treatment targets,animal models have proven invaluable.It has been common practice to create experimental models of type 2 diabetes(T2DM) using streptozotocin (STZ).Finerenone(F) is a selective mineralocorticoid receptor antagonist and reduces cardiovascular and adverse renal outcomes in diabetes.Exenatide(E) has been approved by the FDA to improve glycemic control in T2DM.

Aim:
The aim of this study is to investigate the possible cardiorenal protective effects of potential heart failure and chronic kidney injury associated with T2DM and to assess the potential therapeutic roles of Finerenone and Exenatide.To understand the interactions on cardiorenal outcomes of heart failure and diabetes and to effectively manage these two conditions.

Methodology:
Wistar
male rats with streptozotocin-induced T2DM were used.Five different groups were established as 1)Control,2)STZ,3)STZ+F,4)STZ+E,5)STZ+F+E groups.

During the 21-day experiment, blood glucose concentrations were measured in all animal experimental groups.

The kidney, heart tissues, and blood serum were collected. Serum urea and creatinine were exanimated.Total antioxidant status(TAS) and total oxidant status(TOS) were examined from blood serum,kidney,heart tissues by spectrophotometric assays. Kidney, heart tissues and blood IL-6, IL-1β, TNF-α gene expressions were examined by qPCR. Cardiac troponin T(cTnT) and troponin I(cTnI) gene expressions were examined by qPCR.p-STAT3 and p-NRF2 protein expressions in heart tissue were assessed by western blotting.

Results:
Serum urea and creatinine were significantly lower in STZ+E+F group than control group. TAS were significantly higher in STZ+E+F group than control group in serum,heart and kidney tissues.

TOS, IL-1β, IL-6, and TNF-α gene expressions were lower in STZ+E+F groups than control group significantly in serum, heart and kidney tissues.cTnT and cTnI gene expressions and p-STAT3 and p-NRF2 protein expressions were lower in STZ+E+F groups than control group significantly in heart tissues.

Conclusion:
This study demonstrates the potential beneficial effects of Finerenone and Exenatide on cardiorenal complications in T2DM. Evaluation of these drugs in treatment strategies and further clinical trials are recommended.
Abstract 4145961: Assessing Short- and Long-Term Prognoses In Minor Stroke Patients With Nonvalvular Atrial Fibrillation
Authors: Maqsood Hamza , Younus Shifa , Khan Muhammad , Awais Muhammad , Hussain Alamdar , khaliq muhammad , Saleem Hamza , Zafar Shahzad
Published: November 2024

Introduction:
Approximately 20% of ischemic strokes are linked to a cardioembolic source, with 80% of cardioembolic strokes being attributed to atrial fibrillation. This study aimed to investigate the impact of non-valvular atrial fibrillation (NVAF) on mortality and recurrent stroke following a minor stroke event, considering AF as the most prevalent sustained cardiac rhythm disorder associated with stroke.

Methods and Materials:
Consecutive patients experiencing minor acute ischemic stroke (NIHSS<5) underwent a thorough assessment, including transesophageal echocardiography and prolonged electrocardiography monitoring, before enrollment. Two subgroups were formed based on the diagnosis of NVAF. Clinical outcomes, encompassing all-cause mortality, cardiovascular death, recurrent ischemic stroke, and recurrent hemorrhagic stroke, were recorded. The association between NVAF and clinical outcomes was determined using Cox proportional hazards models.

Results:
Our study comprised a total of 6,190 patients, among whom 440 (7.1%) had NVAF, with a mean age of 63.4 years. In multivariate analyses, NVAF was associated with 12-month cardiovascular mortality (hazards ratio [HR] = 5.32, 95% CI 1.58 - 13.53). There was no discrepancy in the in-hospital ischemic stroke recurrence rate between the two groups (hazards ratio [HR] = 0.58, 95% CI 0.21 - 1.26). However, patients with NVAF exhibited a lower rate of recurrent ischemic stroke at medium- (3 months and 6 months) and long-term (12 months) follow-up (hazards ratio [HR] = 0.28, 95% CI, 0.19 - 0.74 at 3 months; 0.51, 95% CI 0.31–0.93 at 6 months; 0.62, 95% CI 0.29 - 0.90 at 12 months, respectively) compared to those without NVAF.

Conclusion:
In our study, patients with minor stroke and NVAF faced an elevated risk of cardiovascular death but experienced a reduced rate of recurrent ischemic stroke compared to those without NVAF over the following year post-stroke. This underscores the need for tailored guidelines for this patient cohort.
Abstract 4145964: Association of Echocardiographic Traits with Deep Neural Network-Predicted Age from ECGs
Authors: Eromosele Oseiwe , Gogineni Neha , Tseng Sabatine Matthew , Brant Luisa , Ribeiro Antonio , Ribeiro Antonio , Ouyang David , Cheng Susan , Ramachandran Vasan , Benjamin Emelia , Lin Honghuang
Published: November 2024

Background:
Electrographic age (ECG-age), obtained by the estimation of age through deep neural networks, has been useful in predicting cardiovascular outcomes. Given the wide availability of echocardiograms and known associations of metrics with age, we sought to amplify the applicability of ECG-age, by exploring the association of echocardiographic traits with ECG-age.

Research Questions/Hypothesis:
We hypothesized that accelerated aging is associated with adverse cardiac remodelling measured by echocardiography. Conversely, decelerated aging is associated with improved levels of these echocardiographic traits.

Goals/Aims:
We aimed to ascertain the association of echocardiographic characteristics with ECG-age in the Framingham Heart Study (FHS).

Methods/Approach:
We obtained echocardiographic data and studied seven echocardiographic traits, including mean peak velocity E/A - ratio of early to late peak velocities, mean diastolic velocity time integral, left ventricular (LV) wall thickening, left atrial diameter, aortic root diameter LV fractional shortening, and LVmass. The predicted ECG-age was adjusted for chronological age, and the Δage was defined as the difference between the adjusted predicted ECG-age and chronological age. Participants were classified into accelerated, normal, or decelerated aging based on their Δage being within, higher, or lower than the mean absolute error. The association of each echocardiographic trait with Δage was tested using linear regression models, adjusting for age, sex, and cohort. In the secondary analysis, participants were classified into age groups using logistic regression models and adjusted for the same covariates as above.

Results/Data:
Our study included 9077 participants from the FHS (mean age 50±15 years, 53.6% women). The mean absolute Δage was 6.3 years. Accelerated aging was associated with increased LV wall thickness, left atrial diameter, aortic root diameter, and LV mass. Similarly, decelerated aging was associated with decreased LV wall thickness, left atrial diameter, aortic root diameter, and LV mass.

Conclusion(s):
Our study provides insight into the anatomical and functional factors underlying ECG-age. Both accelerated and decelerated aging assessed by ECG-age are associated with cardiac remodeling measured by echocardiography, and found changes in LV wall thickness, left atrial diameter, aortic root diameter, and LV mass that correlates with ECG-age.
Abstract 4145971: Characteristics and in-hospital outcomes of Illicit drug users in the FRENCHIE acute coronary syndrome cohort
Authors: Boccara Franck , Bouleti Claire , Steg Philippe , Rousseau Alexandra , Lebal Soufiane , Henry Patrick , Pezel Theo , DILLINGER Jean Guillaume , Cottin Yves , Cayla Guillaume , Angoulvant Denis , coste pierre , Lemesle Gilles , Simon Tabassome , Danchin Nicolas
Published: November 2024

Background:
The prevalence and prognosis of illicit drug use (IDU) in the setting of acute coronary syndrome (ACS) are poorly documented.

Aim:
This study aimed to assess the prevalence of drug use and its potential impact on in-hospital outcomes after ACS.

Methods:
The multicenter prospective FRENCHIE cohort of ACS evaluated the prevalence of self-declared drug use and its impact on patients’ characteristics and in-hospital outcomes. The composite endpoint of in-hospital outcomes included death, need for intensive care unit, cardiac arrest, sustained ventricular tachycardia, stroke, or stent thrombosis, which was assessed according to drug use status.

Results:
Between March 2019 and December 2022, 16,265 ACS patients (53% STEMI) were included in the cohort, with a mean age of 64 ± 13 years, 76% male. IDU was reported by 3% (n=482) of patients. Cannabis and cocaine were the most prevalent drugs, with 438 (91%) and 57 (12%) patients declaring use, respectively. Polydrug use was reported in 51 (11%) patients.

IDUsers were significantly younger than non-drug users (47±10 vs 64±13 years; P<0.0001), more frequently male (91% vs 76%) with fewer traditional cardiovascular risk factors (diabetes, hypertension, dyslipidemia, obesity), and comorbidities (Heart failure, chronic kidney disease, stroke, coronary artery disease). STEMI was more prevalent in IDUsers than in non-users (73% vs 56%;P<0.0001) and initial left ventricular ejection fraction (LVEF) < 40% was more frequent (17.3% vs 13.6%, p= 0.02). The proportion of normal coronary angiogram was similar in both groups, as was patients’ presentation (STEMI (1.7% vs 1.0%) or NSTEMI (6.9% vs 5.2%)). The composite in-hospital outcome endpoint rate was similar in both groups (8.7% vs 8.7%, p=0.98). However, in-hospital cardiac arrest (ventricular fibrillation) was twice as high in the IDU group (3.7% vs 1.9%;P<0.006). In multivariate analysis, a history of diabetes, high blood pressure, and an older age were significantly associated with in-hospital outcomes.

Conclusion:
In this large contemporary registry, 3% of ACS patients reported IDU, representing the largest population of drug users with ACS studied to date. Despite being much younger, IDUsers had an intra-hospital prognosis comparable to the non-IDU group, with a higher prevalence of decreased LVEF and ventricular fibrillation. Whether the long-term prognosis differs remains to be evaluated.
Abstract 4145983: Non-Invasive Optical Brain Pulse Monitoring In High-Risk Cardiac Surgery
Authors: Teo Elliot , Petautschnig Sigrid , Dixon Barry
Published: November 2024

Background:
Early detection and intervention of stroke have been shown to significantly reduce the burden of stroke-related disability and healthcare costs. The challenge, however, is that early detection is limited by currently available monitoring technologies. Non-invasive optical brain pulse monitoring (OBPM) offers bilateral, continuous measurement of brain pulse waveforms, from which cerebral oxygen saturation (StO
2
%), intracranial pressure (ICP), and brain compliance can be derived. The use of OBPM in high-risk cardiac surgery may enable real-time identification of cerebral events and allow for early intervention.

Aims:
To observe and characterise the OBPM signal changes in cardiac surgery patients during the perioperative period.

Methods:
Eight patients aged between 59 and 85 underwent coronary artery bypass graft procedures with OBPM measurements taken pre-, intra-, and post-operatively for up to 12 hours. Three patients had simultaneous procedures: one mitral valve repair and one left atrial appendage ligation.

Results:
Cardiopulmonary bypass time ranged from 68 to 151 minutes, with 53 to 120 minutes of cross-clamp time. Seven patients underwent continuous flow bypass, and one underwent pulsatile flow bypass. No OBPM device-related adverse events were reported during the study. The OBPM showed distinct waveforms pre-, intra-, and post-operatively, with unique signals during pulsatile and continuous bypass. One patient experienced two intraoperative cardiac arrests, with the OBPM demonstrating signatures of significant cerebral hypoxia during both episodes. Three patients showed reduced brain compliance intraoperatively, which normalized before sternal closure. Six episodes across two patients of transient reduction in cerebral oxygen saturation (<10%) were identified.

Conclusion:
OBPM successfully identified distinct waveform patterns and provided indications of cerebral hypoxia during cardiac arrest, and changes in brain compliance in patients undergoing high-risk cardiac surgery with no device-related adverse events.

Continuous, non-invasive optical brain pulse monitoring is a safe and effective tool in the perioperative management of high-risk cardiac surgery patients. The benefits of early detection and informed clinical decision-making will significantly impact both clinical and economic value for healthcare stakeholders.
Abstract 4145988: Individual- and Community-level Socioeconomic Differences in Use of GLP-1 Receptor Agonists in Diabetes
Authors: Chaudhary Richard , Decker Sergio , Song Yang , Khan Sadiya , Ndumele Chiadi , Kazi Dhruv
Published: November 2024

Introduction:
Cardiovascular-kidney-metabolic (CKM) syndrome disproportionately affects individuals with adverse social determinants of health (SDOH). While glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve outcomes in CKM syndrome, inequitable access (e.g., coverage, supply constraints) may worsen health disparities in CKM syndrome.

Aims:
To characterize the association of individual- and community-level SDOH with GLP-1RA use among Medicare beneficiaries with diabetes.

Methods:
Cross-sectional study using 100% Medicare claims linked with the Social Vulnerability Index and the US Department of Agriculture Rural-Urban Commuting Area Codes. We evaluated Medicare Advantage and fee-for-service beneficiaries ≥65 years with diabetes enrolled in Part D in 2021 (last year available). Filled prescriptions for GLP-1RAs were identified using National Drug Codes. Baseline characteristics were compared using standardized mean differences. Associations between SDOH (self-identified race and ethnicity, insurance status, social vulnerability index, median household income, rurality, US census region) and GLP-1RA use was evaluated using multivariate logistic regression adjusted for age, sex, and clinical characteristics.

Results:
Of 13,429,963 adults with diabetes included in the analysis, mean age was 77y and 54.6% were female. During the 1-year study period, 8.5% (475,719) filled ≥1 GLP-1RA prescriptions and were more likely to be younger, have obesity and chronic kidney disease. After adjustment, race and ethnicity were associated with GLP-1 RA use (Compared with non-Hispanic pregnancy: Black race, OR 0.74 (95% CI: 0.73– 0.75); Asian American race, OR 0.80 (0.78– 0.81); Native American, OR, 1.56 (1.50 –1.62); and Hispanic ethnicity 0.91 (0.89–0.93). Medicare Advantage enrollees had lower odds of use than fee-for-service Medicare: OR, 1.18 (1.17 – 1.19). Dual enrollee status, higher median household income, rurality, and higher social vulnerability were associated with greater use.

Conclusions:
There is substantial variability in the use of GLP-1RAs by individual-level and community-level SDOH factors. Determining the drivers of differential access is urgently needed to enhance equitable use.