bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4138333: Childhood Oral Health Associates with the Incidence of Ischemic Heart Disease, Myocardial Infarction and Ischemic Stroke in Adulthood
Authors: Nygaard Nikoline , Eriksen Anne , Ängquist Lars , Belstrom Daniel , Stankevic Evelina , Torben Hansen , Olsen Anja , DAiuto Francesco , Markvart Merete
Published: November 2024

Introduction:
Cardiovascular disease remains a considerable source of years of life lost. Thus, identification of possible risk factors and prevention strategies continues to be important. In adults, oral diseases are associated with the risk of cardiovascular disease, including ischemic heart disease (IHD), myocardial infarction (MI) and ischemic stroke (IS). Few studies have examined the effect of oral health in childhood on the risk of cardiovascular disease in adulthood, thus overlooking a potentially important avenue of early detection of high-risk individuals.

Hypothesis:
We hypothesize that poor childhood oral health is associated with IHD, MI, and IS in adulthood.

Methods:
Using nationwide Danish registry data from the National Child Odontology Register, National Patient Register, and the Central Person Register we followed individuals born between 1963 and 1972. Follow-up started in 1995 or by age 30 (whichever occurred last), and ended in 2018, where study participants were aged 46 to 56. Using Cox-proportional hazards modelling we examined the association of childhood oral health, defined as the highest registered level of dental caries and gingivitis for any one individual, with the occurrence of IHD, MI, and IS in adulthood. The highest achieved level of education between ages 25 and 30 was used as Cox-strata.

Results:
The study consisted of n = 569.057 individuals, 51.2% male, 48.8% female. The incidence of IHD was 26% (1.17; 1.86) higher in females with high levels of caries in childhood compared to those with low-level caries, 19% (1.08; 1.40) higher in males. Severe caries in childhood was associated with a 58% (1.19; 2.09) higher incidence of MI in females, 19% (1.01;1.42) higher in males, and a 45% (1.19; 1.78) higher incidence of IS, 52% (1.27; 1.81) in males. Females had a 52% (1.19; 1.94) higher incidence of MI, and males a 32% (1.15; 1.52) higher incidence of IS, if they had high levels of gingivitis as children (table 1).

Conclusion:
Poor oral health in childhood is associated with an increased incidence of IHD, MI, and IS, pointing to a potential new avenue for early identification of and prevention amongst high-risk individuals.
Abstract 4138350: Candidemia in Patients with Left Ventricular Assist Device-A Case Series
Authors: Johnson Adedoyin , Sama Jacob , Eltayeb A.A Abdalla , Rao Roopa , Schenkelberg Laurie , Ilonze Onyedika
Published: November 2024

Introduction:
Candidemia is rare but associated, have significant morbidity and mortality. Outcomes are not well-characterized in patients with left ventricular assist devices (LVADs). With an increasing number of patients living with LVADs, we sought to characterize risk factors to help optimize outcomes for this high-risk population.

Methods:
We retrospectively reviewed records of 97 patients who underwent LVAD implant between January 2012 to May 2024 at Indiana University Health, Indianapolis Indiana. Demographic and clinical data were extracted. Candidemia was defined as a positive blood culture with candida species.

Result:
We identified three patients with candidemia, with an overall attack rate of 3.09%. All patients had a HeartMate III (HM3) at the time of infection. The mean age of patients was 40.3 years (Range 29.0 – 58.0 years) and mean BMI was 35.7 kg/m
2
(Range, 30.0 – 42.0 kg/m
2
). One patient grew
Candida auris
and
Candida tropicana,
the other patient grew
Candida auris
and the third patient grew
Candida globrata.
All patients had an automatic implantable cardiac defibrillation, a peripherally inserted central catheter line, and right heart failure. Two patients had driveline infections (one fungal, one bacterial) while one patient developed LVAD endocarditis with a right ventricular outflow tract vegetation. Two patients had persistently positive blood cultures despite treatment with a multi-drug anti-fungal regimen (Flucytosine, Amphotericin B and micafungin) and expired. The third patient initially cleared her blood cultures after treatment with IV micafungin only but was re-admitted with muti-organ failure and expired. Summarily, all patients with candidemia died with a mortality rate of 100%. None of the patients were candidates for heart transplantation. Average survival from the time of diagnosis of candidemia was 5 months (Range 1.0 – 11.0 months). RHF, chronic DL infection and high BMI were associated with candidemia in our series.

Conclusion:
Candidemia in LVAD patients, while less common than bacterial infections, carry high mortality without cardiac transplantation (100% mortality in our cohort). Its rare occurrence makes it challenging to identify reversible risk factors, leading to poor survival. Multicenter registries are needed to fully elucidate these risk factors and determine effective treatment strategies.
Abstract 4138355: Machine Learning for Prediction of All-Cause Mortality in Acute Coronary Syndrome
Authors: Gupta Aashray , Zaka Ammar , Mustafiz Cecil , Mutahar Daud , Parvez Razeen , Stretton Brandon , Kovoor Joshua , Mridha Naim , Ramponi Fabio , Chan Justin , Gould Paul , Sivagangabalan Gopal , Zaman Sarah , Thiagalingam Aravinda , Chow Clara , Kovoor Pramesh , Bacchi Stephen , Bennetts Jayme , Maddern Guy
Published: November 2024

Background:
Acute coronary syndrome (ACS) remains one of the leading causes of death globally. Accurate and reliable mortality risk prediction of ACS patients is essential for developing targeted treatment strategies. Existing traditional models offer moderate discriminative value, and do not incorporate contemporary predictors of ACS prognosis. Machine learning (ML) models have emerged as an alternate method that may offer improved risk assessment. This study aims to compare machine learning models with traditional risk scores for predicting all-cause mortality in patients with ACS.

Methods:
PubMed, EMBASE, Web of Science and Cochrane databases were searched until 1
st
November 2023 for studies comparing ML models with traditional statistical methods for event prediction of ACS patients. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals between ML models and traditional methods in estimating the risk of all-cause mortality.

Results:
Ten studies were included (239627 patients). The summary C-statistic of all ML models across all endpoints was 0.89 (95% CI, 0.86-0.92), compared to traditional methods 0.82 (95% CI, 0.79-0.85). The difference in C-statistic between all ML models and traditional methods was 0.07 (p<0.05). Three models undertook external validation, and calibration was inconsistently reported.

Conclusion:
ML models demonstrated superior discrimination of all-cause mortality for ACS patients compared to traditional risk scores. Despite outperforming well-established prognostic tools such as the GRACE and TIMI scores, current clinical applications of ML approaches remain uncertain, particularly in view of the methodological limitations of existing studies and the need for greater model validation.
Abstract 4138373: Machine learning identifies clinically distinct phenotypes in patients with aortic regurgitation.
Authors: Deb Brototo , Scott Christopher , Michelena Hector , Pislaru Sorin , Nkomo Vuyisile , Kane Garvan , Crestanello Juan , Pellikka Patricia , Anand Vidhu
Published: November 2024

Background:
Aortic regurgitation (AR) is a prevalent valve disease with a long latent period to symptoms. Recent data has suggested the role of novel markers of myocardial overload in assessing onset of decompensation.

Method:
We sought to evaluate the role of unsupervised cluster analyses in identifying different clinical clusters, including clinical status, and a large number of echocardiographic variables including left ventricular (LV) volumes, and their association with mortality. Patients with ≥moderate-severe chronic AR identified using echocardiography at Mayo Clinic, Rochester were retrospectively analyzed. Primary outcome was all-cause mortality censored at aortic valve surgery/last follow-up. Uniform Manifold Approximation and Projection (UMAP) with
K
-means algorithm was used to cluster patients using clinical and, echocardiographic variables at the time of presentation. Missing data were imputed with the Multiple Imputation by Chained Equations (MICE) method. A supervised approach trained on the training set was used to find cluster membership in a hold-out validation set. Log-rank tests were used to assess differences in mortality rates between the clusters, both in the training and validation sets.

Results:
Three distinct clusters were identified among 1100 patients (log-rank
P
for survival <0.001). Cluster 1 (n=337), which included younger males with severe AR but fewer symptoms, showed the best survival, 75.6% (69.5, 82.3). Cluster 2 (n=235), older and more females with elevated filling pressures, showed intermediate survival of 64.2 % (56.8, 72.5). Cluster 3 (n=253), characterized by severe symptomatic AR, demonstrated the lowest survival of 45.3 % (34.4, 59.8) at 5 years. Similar clusters were formed in the internal validation cohort.

Conclusion:
Distinct clusters with variable echocardiographic features and mortality differences exist within patients with chronic ≥moderate-severe AR. Recognizing these clusters can refine individual risk stratification and clinical decision-making after verification in future prospective studies.
Abstract 4138376: A Machine Learning Approach to Predict Percutaneous Coronary Intervention in Patients with Critical Illness and Signs of Myocardial Injury
Authors: Mueller Joshua , Stepanova Daria , Chidambaram Vignesh , Nakarmi Ukash , Al'Aref Subhi
Published: November 2024

Background:
Critically ill patients frequently experience multi-organ dysfunction and unstable vital signs, increasing their risk of myocardial injury and elevated serum troponin levels. Myocardial injury from oxygen supply-demand mismatch, whether due to systemic disease or obstructive coronary artery disease (CAD), often leads to patients undergoing an invasive coronary angiogram (ICA) and potentially percutaneous coronary intervention (PCI) if obstructive CAD is identified. However, this procedure carries significant risks for critically ill patients. To address this challenge, we aimed to develop a machine learning (ML) model to predict the need for PCI in critically ill patients with myocardial injury.

Methods:
The study cohort included critically ill patients with elevated serum troponin levels who underwent ICA during their hospitalization at a single institution from 2012 to 2022. We defined critical illness as a life-threatening condition requiring intensive support for vital sign instability. Patients with atherothrombosis identified during ICA were excluded from the study, focusing only on patients with type 2 MI. We utilized Matplotlib to analyze patient data, including demographics, lab results, vital signs, and comorbidities. We then used XGBoost, a supervised ML algorithm, for binary classification tasks. An ensemble of decision trees was employed, with gradient boosting to correct errors from previous trees. XGBoost iteratively adjusted predictions, creating a model to predict which patients required PCI.

Results:
Out of 765 patients, 173 (22.6%) underwent PCI. The cohort had a mean age of 60.5 ± 13.5 years, with 41.7% being female. The ML model accurately identified non-PCI candidates at 75% and PCI candidates at 64%, achieving an overall accuracy of 73%. The three most important features identified by the model were a history of diabetes, diastolic heart failure, and whether the patient received a blood transfusion during hospitalization.

Conclusion:
A ML approach using XGBoost demonstrated moderate accuracy in predicting the need for PCI in critically ill patients with signs of myocardial injury. This prediction holds clinical significance due to the heightened risks associated with ICA in these patients. Given that PCI occurred in only 22.6% of the cohort, future models should include a higher proportion of patients who underwent PCI to improve the robustness and true positive accuracy of the model.
Abstract 4138386: Deep Learning-Enabled Assessment of Right Ventricular Function Using 2D Echocardiograms Improves 1-Year Mortality Prediction in Patients with Severe Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair
Authors: Lachmann Mark , Fortmeier Vera , Stolz Lukas , Tokodi Marton , Yuasa Shinsuke , Mayr N. Patrick , Joner Michael , Xhepa Erion , Laugwitz Karl-Ludwig , hausleiter jorg , Rudolph Volker , Trenkwalder Teresa
Published: November 2024

Background:
Right ventricular (RV) function has a well-established prognostic role in patients with severe mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (TEER) and is typically assessed using echocardiography-measured tricuspid annular plane systolic excursion (TAPSE). Recently, a deep learning model has been proposed that accurately predicts RV ejection fraction (RVEF) from 2D echocardiographic videos, with similar diagnostic accuracy as 3D imaging.

Aims:
This study aimed to evaluate the prognostic utility of the deep learning-predicted RVEF values in patients with severe MR undergoing TEER.

Methods:
This multicenter registry study analyzed the associations between the predicted RVEF values and 1-year mortality in patients with severe MR undergoing TEER. To predict RVEF, 2D apical four-chamber view videos from preprocedural transthoracic echocardiographic studies were exported and processed by a rigorously validated deep learning model.

Results:
From 1,366 patients undergoing TEER between 2017 and 2023, good-quality 2D apical four-chamber view videos could be retrieved for 1,154 patients (84.5%). Survival at one year after TEER was 84.7%. The predicted RVEF values ranged from 26.6% to 64.0% and correlated only modestly with TAPSE (Pearson correlation coefficient R: 0.33;
p
-value: <0.001). Importantly, predicted RVEF levels were superior to TAPSE levels in predicting 1-year mortality after TEER (area under the curve: 0.687 vs. 0.625;
p
-value: 0.029). Furthermore, Kaplan-Meier survival analysis revealed that patients with preserved RV function (defined as a predicted RVEF of ≥45%) had significantly better 1-year survival rates than patients with reduced RV function (92.1% [95% CI: 89.5-94.7%] vs. 80.3% [95% CI: 77.4-83.3%], respectively, hazard ratio for 1-year mortality: 2.67,
p
-value: <0.001).

Conclusion:
Deep learning-enabled assessment of RV function using standard 2D echocardiographic videos can refine the prognostication of patients with severe MR undergoing TEER. Thus, it can be used to screen for patients with RV dysfunction who might benefit from intensified follow-up care.
Abstract 4138388: Lipoprotein(a): Real-world Impact of Assay Change
Authors: Jeevanathan Janeni , Blom Sigrid , Olsen Thomas , Holven Kirsten , Arnesen Erik , Trydal Torleif , Nordestgaard Borge , Sovershaev Michael , Chen Ying , Retterstol Kjetil , Christensen Jacob
Published: November 2024

Background and aims:
Different assays have been used to analyze lipoprotein(a) over time, and the need for standardization of Lp(a) assays is well-known. Nonetheless, the impact of the use of different assays for clinical decision making and risk stratification of individuals is understudied. We aimed to investigate how transitioning between Lp(a) assays at a large central laboratory affected the proportion of individuals with Lp(a) result above clinical thresholds.

Methods:
We studied nationwide clinical laboratory data from Norway including 185,493 individuals between 18-50 years of age with 272,463 Lp(a) measurements between 2000-2019. Lp(a) was analyzed in non-frozen serum samples using immunoturbidimetric methods from Roche Tina-quant assay (generation 1) in 2000–2009 (N individuals = 75,221) and Siemens LPA assay (N individuals = 123,824) in 2009-2019 in mg/dL units. Because some lipid-lowering drugs can modestly alter plasma Lp(a), the data material was restricted to individuals <50 years due to a low use of medication in this age group.

Results:
The Roche assay detected 35% more individuals with Lp(a) > 50 mg/dL than the Siemens assay in the total population. In individuals that had measurements analyzed by both Roche and Siemens assays (N = 13,494), the Roche assay detected 40% more individuals with Lp(a) > 50 mg/dL than the Siemens assay (25%, N = 3,373 vs. 18%, N = 2,475), and 70% more individuals with Lp(a) >85 mg/dL than the Siemens assay (11%, N = 1,478 vs. 6.5%, N = 881).

Conclusion:
The choice of Lp(a) immunoassay can influence interpretation of Lp(a) results and decisions, particularly in individuals approaching clinically relevant Lp(a) thresholds.
Abstract 4138397: Gender Difference in Prevalence and Survival of Pulmonary Hypertension: A Prospective Cohort Study of 502,173 UK Biobank Participants
Authors: Zhu Fang , Zhang Qian
Published: November 2024

Background:
Research into pulmonary hypertension (PH) reveals significant sex-based disparities in long-term survival rates. Notably, women, despite being more susceptible to PH, often experience better survival outcomes than men—a phenomenon possibly linked to the "estrogen paradox." This study leverages the comprehensive UK Biobank to examine the role of sex in influencing these outcomes. By exploring differences in PH incidence and survival rates across genders, our research aims to provide a deeper understanding of the mechanisms at play and inform more effective, gender-specific analysis.

Methods:
This prospective cohort study utilized data from the UK Biobank, with baseline assessment between 2006 and 2010 and follow-up until November 30, 2023, for England and Scotland, and May 31, 2022, for Wales. Through diagnostic codes, medical records, and imaging studies, 3,296 PH cases and 497,580 cases without PH were identified . We followed them for the mortality rates over a period of 10 years. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazards models to assess sex-specific survival differences, adjusting for confounders like age, BMI, ethnic, menopause, smoking status, and comorbidities.

Results:
During 7,978,349 person-years of follow-up, of 502,173 participants in this prospective cohort, 3,296 were diagnosed with PH, while 497,580 did not receive the PH diagnosis. The prevalence of PH in the male cohort and the female cohort were 0.76% (1743 of 228,991 men) and 0.57% (1553 of 273,182 women), respectively, with significant difference between the two groups (p<0.001). In the PH cohort, the mortality rates of patients were 47.06%. In the male patients with PH, the mortality rate was significantly higher than the female PH patients (51.78% vs. 41.53%, p<0.001). After stratifying women into menopause and no-menopause group, Kaplan-Meier curves showed that even the age of male group was significantly younger than the menopause group (p<0.001), the male still had worse survival situation.

Conclusion:
To conclude, the prevalence of PH in the male participants was significantly higher than the female participants. While the mortality rate in the male participants was also significantly higher than the female participants.
Abstract 4138433: Prevalence, Clinical Characteristics, and Outcomes in Heart Failure with Improved Ejection Fraction by Chronological Age
Authors: Srikanth Kishan , Lee Keane , Parikh Rishi , Ambrosy Andrew , Tan Thida , Hamilton Steven , Vardeny Orly , Krishnaswami Ashok , Ku Ivy , Vasti Elena , Sandhu Alexander , Go Alan , Adatya Sirtaz , Bhatt Ankeet
Published: November 2024

Background:
HF incidence increases with age. Modern treatments have led to more patients recovering LVEF, classified as HF with improved ejection fraction (HFimpEF). However, the age-related epidemiology and prognosis of HFimpEF remain unclear.

Hypothesis: Compared to younger patients, older patients will have lower rates of HFimpEF after incident HFrEF and higher rates of HF-related morbidity and mortality.

Aims:
To describe the clinical characteristics and outcomes in HFimpEF across the age spectrum within a healthcare delivery system in the US.

Methods:
We identified adults ≥18 years with incident HFrEF (LVEF≤40%) between 2013-2018 within Kaiser Permanente Northern California (KPNC), a healthcare system serving 4.5 million members. HFimpEF was defined as baseline LVEF <40% with subsequent >10% improvement to >40%. HFimpEF incidence was assessed by baseline age categories (<50, 50-64, 65-79, ≥80 years [yrs]). Rates of worsening HF (WHF) events (i.e. HF-related hospitalization, ED, or outpatient visits) were compared between HFimpEF and persistent HFrEF patients across age using Cox proportional hazards models adjusted for sex and EF at the time of incident HFrEF, including potential interaction by age modeled continuously (cubic splines with 3 knots).

Data:
Among 12,639 adults with incident HFrEF, 33% experienced HFimpEF, with lower rates at older ages: 42% (<50 yrs), 41% (50-64 yrs), 35% (65-79 yrs) and 18% (≥80 yrs). Among patients with HFimpEF alive at 1-year post-HFrEF (N=9954), WHF incidence (per 100 p-y) remained high (10.7) in younger (<50 yrs) patients and increased by age: 14.5 (50-64 yrs), 21.6 (65-79 yrs), and 33.7 (≥80 yrs)(P <0.001 for trend; Figure, Panel A). Patients with HFimpEF, compared to those with persistent HFrEF, had lower adjusted rates of WHF across the spectrum of age (pinteraction by age < 0.001; Figure, Panel B).

Conclusion:
HFimpEF is common within a year of incident HFrEF, more prevalent in younger patients, and is associated with significant residual clinical risk. Compared to persistent HFrEF, improvements in LVEF are associated with a lower risk of WHF or death. Additional research is needed to understand HF symptom burden and medical therapy use in this population.
Abstract 4138473: Detailed Lipoprotein Profiling in Assessing Coronary Calcium Score Progression and Atherosclerotic Risk
Authors: Stephanus Andrea , Ramalho Sergio Henrique Rodolpho , Bittencourt Marcio , Bensenor Isabela , J Blaha Michael , Toth Peter , Jones Steven , Santos Raul , Lotufo Paulo , Carvalho Luiz Sergio , Campos-Staffico Alessandra
Published: November 2024

Background:
Coronary calcium scoring (CCS) evaluates atherosclerotic burden and cardiovascular risk, correlating with coronary artery disease (CAD) severity. Advances in Nuclear Magnetic Resonance (
1
H-NMR) spectroscopy for lipoprotein fraction analysis highlight precise atherogenic lipid parameter estimation. Enhanced lipid testing, including sub-fractionation assays, improves risk assessment and identifies new biochemical markers for CAD burden.

Hypothesis:
Specific lipid fractions and subfractions are significantly associated with CCS progression, serving as biochemical markers of CAD progression.

Aim:
To evaluate the association between lipid fractions and subfractions with CCS progression, aiming to improve CAD risk stratification.

Methods:
This study used data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CCS progression was any positive change in CCS values over 5 years. High-field
1
H-NMR spectroscopy assessed lipoprotein fractions and subfractions, including plasma concentration, particle size, cholesterol, and triglyceride content. Descriptive and inferential statistics compared baseline characteristics. Multivariable binary logistic regression models, both unadjusted and propensity score-adjusted, assessed associations between plasma levels of lipoprotein fractions and CCS progression. Statistical significance was set at p <0.05.

Results/Data:
In this study of 2,986 participants, 1,008 (33.8%) experienced CCS progression over 5 years. Significant associations were found between plasma lipoprotein fractions and CCS progression. Large, medium, and very small TRLP (89-37 and 29-24 nm) were linked to increased CCS risk, while small TRLP (36-30 nm) had an inverse association. Small cLDLP (20.4-19 nm) were directly associated with CCS progression, while medium and large cLDLP (23-20.5 nm) were inversely associated. Small cHDLP (7.4-8.0 nm) increased CCS risk, whereas medium to large cHDLP (8.1-13.0 nm) had an inverse association. Specific HDL subspecies (H7P to H3P, 12.0-8.7 nm) were inversely associated with CCS progression, while H2P and H1P (7.8-7.4 nm) increased CCS risk. TRLZ (30-100 nm) levels were positively associated with CCS progression, whereas LDLZ (19-22.5 nm) and HDLZ (7.1-13 nm) were inversely associated.

Conclusion(s):
Plasma levels of specific lipoprotein fractions and subfractions are associated with CCS progression, providing insights into the complexity of lipoprotein characteristics in CAD.
Abstract 4138475: Comparative Outcomes of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement in Patients with Right Heart Failure: Insights from Nationwide Readmission Database
Authors: Kansakar Sajog , Shrestha Dhan , Shtembari Jurgen , Sharma Nava , Pant Kailash , Moskovits Norbert , SHETTY VIJAY , Dahal Khagendra , Mattumpuram Jishanth , Katz Daniel
Published: November 2024

Background:
The annual number of transcatheter aortic valve implantation (TAVI) performed has surpassed that of surgical aortic valve replacement (SAVR) as its use expands to patient populations not included in initial clinical trials. However, in patients with Right Heart Failure (RHF), the outcomes of TAVI and SAVR remain unclear.

Methods:
We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2021. Using ICD-10 codes, we identified all adult admissions for TAVI and SAVR with the presence of RHF. The primary outcome was in-hospital mortality. Secondary outcomes included in-hospital complications, 30-day readmission rate, length of stay, and total hospitalization charges.

Results:
The study included 3,712 adult patients with RHF, of which 1,386 (37.3%) underwent TAVI and 2,326 (62.7%) underwent SAVR. Compared to SAVR patients, TAVI patients were older (63 years vs. 76 years, p<0.01) and had a higher burden of peripheral vascular disease, chronic liver disease, and coagulopathy, while SAVR patients had a higher burden of hypertension, diabetes mellitus, coronary artery disease, left heart failure, chronic lung disease, smoking, malignancy, and anemia. On multivariable analysis, compared to TAVI, SAVR was associated with higher odds of mortality (26.6% vs. 9.3%, p<0.01), mechanical circulatory support use (41.5% vs. 9.22%, p<0.01), respiratory failure (34.2% vs. 10.2%, p<0.01), acute kidney injury (58.1% vs. 37.7%, p<0.01), and need for blood transfusion (31.4% vs. 11.0%, p<0.01). There was no difference in 30-day readmission (13.8% vs. 14.3%, p=0.51) and permanent pacemaker implantation (7.0% vs. 8.7%, p=0.33). SAVR was associated with a longer median hospital stay (14 days vs. 8 days, p<0.01) and higher hospitalization charges ($406,826 vs $265,303, p<0.01). When compared to patients wihout RHF, the presence of RHF predicted higher in-hospital mortality for both TAVI (9.3% vs. 1.2%, p<0.01) as well as SAVR (26.6% vs. 3.7%, p<0.01).

Conclusions:
From 2018 to 2021, more RHF patients underwent SAVR (62.7%) than TAVI (37.3%), but SAVR was associated with worse short-term outcomes, including higher in-hospital mortality, in-hospital complications, and healthcare resource utilization.
Abstract 4138477: Small Vessels, Big Challenges: Clinical and Demographic Correlates of Failure to Respond to Optimal Medical Therapy in Patients with Microvascular Angina
Authors: Karwa Diya , Virdi Avraj , Kinnaird Tim , Gallagher Sean , Aldalati Omar , Davies Rhodri , Zaidi Abbas , Wheeler Richard , OCallaghan Peter , Yousef Zaheer , Farooq Vasim
Published: November 2024

Background:
Microvascular angina (MVA), resulting from coronary microvascular dysfunction, affects 40-50% of patients with exertional chest pain or dyspnea and a normal coronary angiogram. This condition significantly impairs quality of life and elevates the risk of major cardiac events, including myocardial infarction, stroke and death. MVA is classified as 'structural' (coronary flow reserve [CFR] <2.5&index of microcirculatory resistance [IMR] >25) or 'functional' (CFR <2.5&IMR <25). Current treatments are empirical, necessitating further investigation.

Methods:
This single-centre, retrospective study conducted in South Wales from 2019-24 examined MVA cases confirmed via national electronic health records. The Canadian Cardiovascular Society (CCS) angina grade was assessed at diagnosis and post optimal medical therapy (OMT) during clinic visits. Ordinal logistic regression was used to identify independent correlates of higher CCS grade, considering baseline LDL, age, diffuse epicardial disease, sex, hypertension, kidney function, smoking status and HbA1c levels as covariates.

Results:
Among 64 identified MVA cases (median age 69 yrs, IQR 61.3-77.8; 68.8% male), 81.3% had structural MVA, 6.3% functional MVA and 12.5% mixed disease. Coronary vessel testing was performed on 1, 2 or 3 vessels in 29.7% (n=19), 53.1% (n=34; 21 positive [+ve] in 2 vessels, 13 +ve in 1 vessel) and 17.2% (n=11; 5 +ve in 3 vessels, 5 +ve in 2 vessels, 1 +ve in 1 vessel) of cases, respectively. The LAD was most commonly affected vessel (82.8%). At diagnosis, 79.7% had CCS grade III or higher (Fig 1). Post OMT, 45.3% achieved CCS grade 0-I, 31.8% CCS grade II and 15.6% remained at CCS grade III (refractory angina). Medications included ranolazine (84.4%), beta-blockers (70.3%) and calcium channel blockers (28.1%). Ordinal logistic regression analysis (X
2
=0.27, p=0.033) identified baseline LDL (95% CI [0.16, 1.26]; p=0.011), age (95% CI [-0.12, -0.001]; p=0.045), diffuse epicardial disease (95% CI [0.016, 2.13]; p=0.047) and male sex (95% CI [0.066, 2.36]; p=0.038) as independent correlates of higher CCS grade, signifying poor response to OMT.

Conclusion:
MVA manifests regionally, underscoring the need for multi-territory testing. Although tailored OMT proved effective for many, 15.6% of patients continued to experience refractory symptoms (CCS grade III). This highlights the necessity for alternative therapeutic strategies to improve patient outcomes in this challenging condition.
Abstract 4138482: The burden of ischemic heart disease, hypertension, diabetes mellitus, and obesity among older Latino and Chinese adults with and without limited English proficiency
Authors: Shin Edward , Gordon Nancy , Njuguna Veronica , Naidu Anika , Rana Jamal , Lo Joan
Published: November 2024

Background:
An estimated 15% of Latinos and 34% of Chinese in the US have limited English proficiency (LEP). However, there is limited information on whether ischemic heart disease (IHD) and its risk factors (hypertension, HTN; diabetes mellitus, DM; and obesity) vary by LEP vs. non-LEP status in these ethnic groups. This information may be valuable for targeting healthcare interventions.

METHODS:
This cross-sectional study used data for Latino (79,588 men, 85,560 women), and Chinese (25,944 men, 32,586 women) adults aged 50-79 years who were members of a northern California health plan in 2018-2019. Age, sex, language preference, obesity (BMI ≥30 for Latino and ≥27.5 kg/m2 for Chinese), and IHD, HTN, and DM diagnoses were abstracted from electronic health records. LEP was defined as Spanish/Chinese vs. English (non-LEP) language preference. Prevalence was compared by LEP status within age-sex groups. Modified Poisson regression was used to estimate age-adjusted prevalence ratios.

RESULTS:
Among Latino men aged 50-64 (57,835, 39% LEP) and 65-79 (21,753, 30% LEP) and Chinese men aged 50-64 (14,751, 42% LEP) and 65-79 (11,193, 40.3% LEP) years, IHD prevalence was lower in LEP vs. non-LEP (Latino: 3.5% vs. 6.0% and 13.8% vs. 19.0%; Chinese: 3.6% vs. 5.8% and 11.9% vs. 14.5%). Similar trends were observed in women, but IHD prevalence was much lower. Among Latino and Chinese men, HTN and obesity prevalence was lower, but DM was similar. For women, HTN was similar, but DM was higher in LEP Latina (age 50-79) and Chinese adults (age 65-79), while obesity was lower in LEP Chinese but not Latina adults. Differences remained after adjusting for age (aPR).

CONCLUSION:
The burden of IHD, HTN, and obesity is similar or lower among LEP vs. non-LEP Latino and Chinese adults, while the burden of DM is higher for LEP vs. non-LEP Latina and Chinese women. These findings suggest that while DM prevalence is already high, acculturation is associated with higher risk of developing some chronic CVD conditions, underscoring the need for targeted healthcare interventions. Further research is needed to explore mechanisms driving these disparities and to develop culturally appropriate strategies to improve health outcomes.
Abstract 4138491: Association of histologic findings with long-term outcomes in symptomatic obstructive hypertrophic cardiomyopathy patients undergoing surgical myectomy
Authors: Jadam Shada , Gaballa Andrew , Alashi Alaa , Xu Bo , Thamilarasan Maran , Rodriguez E , Tan Carmela , Ospina Susan , Smedira Nicholas , Popovic Zoran , Desai Milind
Published: November 2024

Background:
In hypertrophic cardiomyopathy (HCM), histologic findings like myocyte hypertrophy&disarray, interstitial fibrosis (IF)&small intramural coronary arteriole dysplasia (SICAD) account for the left ventricular hypertrophy, diastolic dysfunction, arrhythmogenicityµvascular ischemia.

Objectives:
To evaluate the association between histology&outcomes in obstructive HCM (oHCM) patients undergoing surgical myectomy (SM).

Methods:
This was an observational study of 1722 symptomatic oHCM patients (mean age 56±14 years, 948 [55%] men) who underwent SM at a tertiary care center between 2005-18. Baseline clinical data was collected. The SM specimen was analyzed for presence&severity of a) myocyte hypertrophy b) myocyte disarray c) IF&d) SICAD. Histologic findings were graded as 0-3 (none, mild, moderate,&severe)&a score from 0-12 was calculated. Primary endpoint was a composite of death, appropriate defibrillator discharge or cardiac transplantation during follow-up.

Results:
896 (52%) were in New York Heart Association (NYHA) class III/IV, 457 (21%) had exertional syncope, 727 (42%) had ≥1 sudden death risk factor&409 (24%) had atrial fibrillation (AF). Moderate&severe histologic findings were distributed as follows: myocyte hypertrophy (1341 [78%]), disarray (237 [14%]), IF (448 [26%])&SICAD (258 [15%]). The mean total histologic score was 5.1±1.4. At 5.1±5.2 years, there were 352 (20%) primary events (317 [18%] deaths). On spline analysis (Figure 1A), a total histology score of ≥ 6 was associated with primary events. On Kaplan-Meier analysis (Figure 1B), patients with a histology score ≥ 6 had greater events vs. those with a score <6 (147/598 [25%] vs. 205/1124 [18%], log-rank p-value 0.002). On multivariable Cox analysis, age (for 10-year increase, Hazard ratio or HR 1.49 [95% confidence interval or CI 1.35-1.65], p<0.001), NYHA Class III/IV (HR 1.58 [95% CI -1.25-2.01], p<0.001), AF (HR 1.65 [95% CI 1.30-2.10], p<0.001)&histology score ≥6 (HR 1.24 [95% CI 1.03-1.54], p=0.03) were independently associated with higher primary events.

Conclusions:
In symptomatic oHCM patients undergoing SM, a higher histologic score was independently associated with long-term outcomes.
Abstract 4138497: Incidence and predictors of recurrent pericarditis in systemic lupus erythematosus
Authors: Kim Yoo Jin , Lovell Jana , Diab Alaa , Magder Laurence , Goldman Daniel , Petri Michelle , Fava Andrea , Adamo Luigi
Published: November 2024

BACKGROUND/PURPOSE:
Pericarditis is the most common cardiac manifestation of systemic lupus erythematosus (SLE). In the general population, pericarditis commonly recurs (~30%), likely due to immune-mediated mechanisms. Given the broad immune dysregulation that drives the pathogenesis of SLE, we sought to identify the frequency and risk factors for the recurrence of pericarditis in this unique population.

METHODS:
Retrospective cohort study of SLE patients enrolled between 1988 and 2023 at a tertiary medical center. The SELENA revision of the SLE Disease Activity Index was used to define pericarditis, and all follow-up clinical encounters were examined after the first reported episode. Recurrent pericarditis was defined as that occurring at least 6 weeks after the first recorded episode of pericarditis. Statistical significance was defined as a p-value of <0.05, and a pooled logistic regression was used to estimate odds ratios for risk factors.

Results:
Of 2931 patients in the cohort, 590 patients had a history of pericarditis. During a median follow-up of 7 years (IQR: 3 – 14), 20% (n=120) of patients experienced recurrent pericarditis (Table 1). The majority (51%) experienced only one recurrence, whereas 49% of patients had ≥2 recurrences. Several demographic, clinical, serologic, and treatment characteristics were associated with recurrence in the univariate analysis (Table 2). We performed a multivariate analysis using variables of statistical significance (P <0.05) and found that independent predictors of recurrence included younger age (≥60 years vs. <40, RR 0.11 (0.04, 0.32),
P
<.001), treatment with prednisone ( ≥20 vs. 0 mg, RR 1.99 (1.17, 3.40),
P
= 0.012), active SLE disease (SLEDAI ≥3 vs. 0, RR 1.55 (1.21, 2.00),
P
<.001), and time from initial episode (3-10 years vs. <1, RR 0.32 (0.20, 0.52),
P
<.001) (Figure 1).

CONCLUSION:
Recurrence of pericarditis in SLE is common (20%) and more likely to occur within one year of onset. Younger patients and those with higher lupus activity are at greater risk of recurrence. As in the general population, oral prednisone is independently associated with a higher chance of recurrence in SLE patients, with a dose-dependent effect. These findings set the basis for future studies to define optimal treatment for recurrent pericarditis in SLE patients and indicate that oral corticosteroids should be avoided when treating pericarditis.
Abstract 4138498: Sex Differences in Plasma Acylcarnitines in Patients with STEMI undergoing Primary PCI
Authors: Namkoong Jenny , Stamenkovic Aleksandra , Surendran Arun , Ravandi Amir
Published: November 2024

Background:
Rapid coronary reperfusion using primary PCI is the corner stone therapy for patients presenting with STEMI that restores blood flow and limits infarct size. But paradoxically, the reperfusion process itself can induce additional myocardial injury. Females have increased rates of cardiovascular death compared with males following MI, and it is unclear whether this is related to differences in presentation or reperfusion injury. Given these differences, we aim to better understand the sex differences in the lipidome shift post PCI.

METHODS&RESULTS:
126 patients(97 males, 29 females) undergoing PCI for STEMI in a tertiary centre underwent venous blood sampling and semi-targeted Liquid Chromatography Tandem Mass Spectrometry(LC/MS/MS) to determine 291 lipid species. Samples were taken pre-PCI(T0), and 2 hours post PCI(T1) with successful reperfusion.

Each lipid class and species were compared between males and females at each time point using statistical analysis, to determine the similarities and differences in plasma lipidome shifts in ACS between sexes.

Whilst most lipid classes decrease following reperfusion in STEMI (T0 vs T1), Acylcarnitines increase (20%, adjusted p=0.003) in both sexes. There is a clear sex difference with a greater increase in females (39% increase, adjusted p=0.03), as compared with males (13% increase, adjusted p=0.048). In both sexes this is primarily driven by OctadecanoylCarnitine (C8), which is a medium-chained acylcarnitine.

Notably, there was no significant difference in C8 between the sexes in the control group, nor the pre-PCI group(adjusted p=0.48, at T0). At T0, total free fatty acids(FFA) and total phosphatidylinositol were significantly elevated in females compared with males(adjusted p=0.012, p=0.018 respectively).

Conclusion:
Our analysis suggests there are differences in lipidomics shift between males and females in response to myocardial reperfusion. The higher levels of circulating FFA in ischemic females pre-PCI(T0), followed by a parallel increase of acylcarnitine with reperfusion(T0vsT1), suggest differences between the sexes in myocardial metabolic response to reperfusion injury. C8 has been associated with elevated risk of cardiovascular death in stable CAD, but its clinical impact during reperfusion is still unknown. Detailed understanding of sex specific lipidomics shifts during reperfusion injury will allow us to better understand the mechanistic differences in clinical outcome between males and females.
Abstract 4138514: From Treatment to Trigger: A Case of Atomoxetine-Induced Brugada Pattern
Authors: ABDELSALAM MAHMOUD , Elsayed Omar , Ezaldin Shady , Ahmed Maram , Gharib Elie
Published: November 2024

Introduction:
Brugada syndrome is an inherited cardiac disorder characterized by specific ECG patterns, notably the coved-type ST-segment elevation in the right precordial leads (V1-V3), leading to an increased risk of sudden cardiac death. This condition often stems from mutations in the SCN5A gene, which impair cardiac sodium channel function. The manifestation of Brugada Pattern, showing typical ECG findings without clinical criteria like sudden cardiac arrest or syncope, is significant. We highlight a case where atomoxetine, a selective norepinephrine reuptake inhibitor used for ADHD, unveiled a type 1 Brugada pattern.

Case Presentation:
A 26-year-old male with a history of ADHD on atomoxetine only presented to the emergency department with sudden substernal chest pain radiating to his left arm. His initial ECG showed right bundle branch block and type 1 Brugada pattern (Figure.1). Despite normal troponin levels and a negative coronary CT angiography, the patient's ECG abnormalities raised concerns. With no personal or familial history of arrhythmia or SCD and no other medications, atomoxetine was suspected as the trigger. Upon discontinuation, the patient's ECG type 1 Brugada pattern resolved (Figure. 2), and he remained asymptomatic with a normal Holter monitor at a 1-month follow-up.

Discussion:
Brugada syndrome is marked by dynamic ECG abnormalities, which can surface due to triggers like fever, certain medications, and electrolyte imbalances. Atomoxetine, an ADHD treatment and selective norepinephrine reuptake inhibitor, affects the human cardiac sodium channel (hNav1.5), encoded by the SCN5A gene. This interaction can disrupt heart action potentials, leading to conditions like long QT syndrome and Brugada pattern, by slowing cardiomyocyte depolarization and conduction. Its effect on hNav1.5 resembles that of antidepressants like Fluoxetine, increasing the risk of Brugada pattern. In our case, a patient's type 1 Brugada pattern, with no underlying heart disease or family history, pointed to atomoxetine as the cause. Discontinuing the drug resolved the ECG abnormalities.

Conclusion:
This case emphasizes the importance of assessing cardiovascular risk before prescribing atomoxetine, especially in individuals at risk for cardiac sodium channel dysfunctions. Immediate intervention and monitoring are critical to prevent severe arrhythmias.
Abstract 4138516: Effects of Serious Mental Illness on Transcatheter Aortic Valve Replacement (TAVR) Outcomes and Access
Authors: Brown Danielle , Rosenthal J. Walker , Szeto Wilson , Lewey Jennifer , Sharpe James , Kelz Rachel
Published: November 2024

Introduction:
Serious mental illness (SMI) is associated with higher risk of immediate procedural complications after transcatheter aortic valve replacement (TAVR), including myocardial infarction, major bleeding, and acute renal failure. There is limited data on the impact of SMI on in-hospital mortality and 30-day readmissions. We aimed to evaluate access to and outcomes after TAVR for patients with SMI compared to those without SMI.

Methods:
We performed a retrospective cohort study of adults aged ≥18 years who received TAVR with a primary diagnosis of aortic stenosis using the Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery and Services Database in FL, MD, VT, UT, and WI (2016-2019). SMI was defined using ICD-10 codes for schizophrenia spectrum, mood, or anxiety disorders. Primary outcomes include in-hospital mortality, 30-day readmission, length of stay, and routine discharge. The secondary outcome was access type (elective vs. urgent/emergent). Multivariable logistic and negative binomial regression models with adjustment for patient demographics, co-morbidities, and hospital characteristics were used to examine outcomes.

Results:
Of 21,905 patients who underwent TAVR for aortic stenosis, 2,954 (13.5%) patients had SMI. Overall, 16,762 (76.5%) of patients had elective procedures. Patients with SMI were more likely to be female (59% vs. 41%, p<0.001) and have 3+ co-morbidities (91% vs. 77%, p<0.001) but had similar income quartile distribution (p=0.18), home-to-hospital distance (p=0.09), and clinically similar hospital TAVR volume over the study period (435 vs. 430, p=0.01). After adjustment for potential confounders, access to and outcomes of TAVR differed significantly by SMI status (See Table).

Conclusions:
SMI patients had increased odds of emergent access to TAVR. After TAVR, SMI patients had longer length of stay and were less likely to be discharged to home. These findings suggest increased discharge planning may be required for patients with SMI after TAVR and highlight the need for additional investigation into barriers to elective TAVR in this vulnerable population.
Abstract 4138517: Role of Coronary Computed Tomographic Angiography in Patients with Discordant Findings on Exercise Stress Echocardiography
Authors: Olivieri Nicholas , Okon Natalia , Genev Ivo , Swamy Samantha , Baig Mirza , Kinno Menhel , Syed Mushabbar
Published: November 2024

Background:
Exercise stress echocardiography is routinely used for risk stratification and diagnosis of myocardial ischemia in low-to-intermediate risk patients with suspected coronary artery disease (CAD). Discrepancies between exercise electrocardiography (EKG) and echocardiography (ECHO) are common in clinical practice. Prior literature suggests that patients with discordant stress test results generally have worse outcomes, though the extent of epicardial atherosclerotic disease remains unclear. Coronary computed tomographic angiography (CTA) has gained a class I recommendation for the assessment of atherosclerotic burden per ACC/AHA chest pain guidelines. Using non-invasive fractional flow reserve (CT-FFR), the functional significance of lesions can also be assessed. This study investigates the incidence and burden of CAD in patients with discordant exercise echocardiography findings.

Methods:
Patients aged 18 or older who had exercise echocardiography followed by CTA from January 1, 2013, to January 31, 2023, were retrospectively enrolled in this study and categorized into two discordant result groups: EKG+/ECHO- or EKG-/ECHO+. Those who failed to achieve the target heart rate or had a paced rhythm/left bundle branch block on baseline EKG were excluded. CTA findings were classified as no CAD, non-obstructive CAD (<50% stenosis), obstructive CAD (≥50% stenosis), and obstructive CAD with FFR+ (<0.75).

Results:
The study included 198 patients, the majority female (56.0%), with a mean age of 61 ±10 years. Among them, 159 (80.3%) were EKG+/ECHO- and 39 (19.7%) were EKG-/ECHO+ (Table 1). In the EKG+/ECHO- group, 55 (34.6%) had no CAD, 48 (30.2%) had non-obstructive CAD, and 56 (35.2%) had obstructive CAD, out of which 19 (33.9%) were FFR+. In the EKG-/ECHO+ group, 13 (33.3%) had no CAD, 17 (43.6%) had non-obstructive CAD, and 9 (23.2%) had obstructive CAD of which 3 (33.3%) was FFR+. There was no statistically significant difference in the degree of CAD between the two cohorts.

Conclusions:
The majority of patients with discordant results on exercise echocardiography were found to have CAD. There was no significant difference in the degree of disease between the EKG+/ECHO- or EKG-/ECHO+ groups. Overall, discordant results on exercise echocardiography should not be discounted and warrant further evaluation. CTA provides important information that can impact the diagnosis and further medical management of patients with chest pain and suspected CAD.