bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4142243: Efficacy of Radiation Protective Shields on Operator Radiation Exposure During Cardiac Interventions: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Authors: Elsaeidy Ahmed Saad , Almohtasib Yazan , Abuelazm Mohamed , Amin Ahmed Mazen , Almahdy Mohamed Ahmed , Altobaishat Obieda , Abdelhalem Ahmed , Imran Muhammad , Abdelazeem Basel
Published: November 2024

Background:
The cumulative exposure to X-ray radiation during cardiac intervention can indeed pose various health risks. This meta-analysis aims to compare radiation protective shields (drapes and X-ray shields) versus conventional safety measures (lead apron) on the operator’s procedural radiation exposure during cardiac interventions.

Methods:
A systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. We used the random-effects model to report continuous outcomes using mean difference (MD) with a 95% confidence interval (CI).

Results:
We included 16 RCTs with 3370 patients. Radiation shields were significantly associated with low total operator radiation dose (MD: -7.3, 95%CI [-11.9, -2.7], P< 0.01) with no significant difference between both arms regarding chest radiation dose (MD: -20.7, 95%CI [-48.9, 7.6], P= 0.15) and thyroid radiation dose (MD: -15.4, 95%CI [-32.4, 1.7], P= 0.08).

Also, shields were significantly associated with low air kerma (MD: -46.4, 95%CI [-87.3, -5.5], P= 0.03) and low fluoroscopy duration (MD: -0.3, 95%CI [-0.6, -0.04], P= 0.02). However, there was no difference between both arms regarding the total procedure time (MD: -0.7, 95%CI [-3.1, 1.6], P= 0.54), contrast volume (MD: -3.2, 95%CI [-10.2, 3.7], P= 0.36), and dose area product (MD: 628.4, 95% CI [-3466.9, 4723.8], P= 0.76). Also, we found no differences between drape and shields subgroups in all outcomes.

Conclusion:
Radiation protection shields significantly reduced the total radiation dose exposure and air kerma. Also, shields are associated with lower fluoroscopy duration, insignificant lower procedure time, and contrast volume.
Abstract 4142244: Complete Versus Culprit Only Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction Patients with Chronic Total Occlusion in Non-Infarct Related Artery: A Systematic Review and Meta-Analysis
Authors: Khan Laibah , Paryani Neha , Khan Muhammad , Mohiuddin Neha , Fatima Saba , Ehsan Naija , Butt Tooba Shaukat , Usman Muhammad
Published: November 2024

Background:
Multivessel coronary artery disease has a higher risk of adverse cardiovascular outcomes. Although patients presenting with STEMI usually undergo revascularization of the infarct-related artery only (i.e. cuplrit only percutaneous coronary intervention or CO-PCI), recent trials suggest improved outcomes with complete PCI of all arteries with chronic total occlusion (CTO).

Aim:
To meta-analyze data from randomized controlled trials comparing the impact of complete versus CO-PCI in STEMI patients with CTO in the non-infarct related artery (non-IRA).

Methods:
We conducted a comprehensive search of Medline, EMBASE, and Scopus up till May 2024, to identify studies comparing the clinical outcomes between CO-PCI versus complete PCI in patients with STEMI accompanied by CTO in the non-IRA. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) along with corresponding 95% confidence intervals (CIs), with a significant p value < 0.05. Outcomes of interest include all-cause and cardiac mortality, myocardial infarction and stroke.

Results:
Our search strategy yielded 16 eligible studies (complete PCI, n= 7,982; CO-PCI, n= 7,753). Complete PCI significantly reduced all-cause mortality in comparison to CO-PCI (RR=0.64 [0.49, 0.84]; p=0.002). Complete PCI was also associated with a significant reduction in cardiac death (RR: 0.54 [0.41 - 0.72]; p<0.0001), and myocardial infarction (RR=0.72 [0.60 - 0.86]; p=0.0003), compared with CO-PCI. However, there was no significant difference in stroke risk 1.10 [0.78-1.54; p=0.60]. The forest plots are illustrated in
Figure 1.

Conclusion:
In STEMI patients with chronic total occlusion in the non-infarct related artery, complete PCI may yield superior outcomes compared with CO-PCI.
Abstract 4142248: Pulmonary Artery Pressure Monitor is Associated with Improved Outcomes in the Octogenarian-plus Age Group
Authors: Mitchell Ashley , Siddique Talha , Panza Gregory , Jaiswal Abhishek , Scatola Andrew
Published: November 2024

Background:
Pulmonary artery pressure monitoring with an implantable device (PAPM) improves heart failure hospitalizations (HFH) in patients with symptomatic heart failure. This device has been previously validated in clinical trials among participants with a mean age of 69 years and a maximum age of 78 but not in the octogenarian-plus age group (≥80).

Methods:
We retrospectively evaluated 277 heart failure (HF) patients who had a PAPM device placed between 1/1/19 and 10/31/22, with at least 1 yr follow up and compared outcomes between patients aged <80yr (n=218) vs aged ≥80yr (n=59). Continuous data were compared with independent samples t-test and categorical data were compared using chi-square or Fisher’s exact test. Multivariable logistic regression was used to further examine post-PAPM outcomes while adjusting for covariates.

Results:
Patients in the <80yr group were aged 65.6 ± 10.6yr and 51% were male&in the ≥80yr group were aged 84.5 ± 3.8yr and 67% were male. Patient characteristics are outlined in table 1. Post-PAPM outcomes between groups are presented in Table 2. HF readmission within 30 days was significantly less in the ≥80yr group compared to the <80yr group (P=.001). HFH at 1yr was not significantly different between groups. Need for inotrope within 1yr was significantly lower in the ≥80yr group compared to the <80yr group (P=.006). Mortality within 30d of PAPM implant was not significantly different between the two groups. Results did not change after adjusting for relevant covariates.

Conclusion:
To our knowledge, this study is the first of its kind to show that octogenarian-plus individuals had less 30d HFH and less need for inotropes within 1yr post-PAPM implant compared to those <80yr. There was no difference in mortality between groups. These results indicate that the use a PAPM device in the octogenarian-plus demographic is safe and effective and warrants a prospective clinical trial.
Abstract 4142252: Impact of Diagnosis to Ablation Time on Recurrence of Atrial Fibrillation and Clinical Outcomes after Catheter Ablation: A Systematic Review and Meta-analysis with Reconstructed Time-to-Event Data.
Authors: Amin Ahmed Mazen , Elbenawi Hossam , Khan Ubaid , Almaadawy Omar , Turkmani Mustafa , Abdelmottaleb Wael , Essa Mohammed , Abuelazm Mohamed , Abdelazeem Basel , Asad Zain Ul Abideen , Deshmukh Abhishek , Desimone Christopher
Published: November 2024

Background:
Current clinical guidelines emphasize the significance of rhythm control with catheter ablation but lack guidance on the timing after diagnosing atrial fibrillation (AF).

Purpose:
We aim to investigate the latest evidence on the impact of diagnosis to ablation time (DAT) on AF recurrence, all-cause mortality, stroke, and heart failure (HF) after AF catheter ablation.

Methods:
We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through February 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1. PROSPERO ID: CRD42024525542.

Results:
With the inclusion of 22 studies, our cohort comprised a total of 42,101 patients. Regarding pair-wise meta-analysis, shorter DAT was significantly associated with a decreased incidence of AF recurrence across paroxysmal and persistent AF subgroups. Moreover, DAT ≤ one year was significantly associated with a decreased incidence of all-cause mortality (RR: 0.73 with 95% CI [0.59, 0.92], P< 0.01) with a trend toward lowering the risk of stroke (RR: 0.80 with 95% CI [0.62, 1.03], P= 0.08). However, there was no significant difference between DAT ≤ one year and DAT > one year in HF. Regarding adjusted prognostic meta-analysis, longer DAT was significantly associated with an increased risk of AF recurrence (P < 0.01). Our reconstructed Kaplan Meier showed that DAT > one year was significantly associated with a 50% increase in the risk of AF recurrence compared to DAT ≤ one year (HR: 1.50 with 95% CI [1.42, 1.58], P< 0.00001) over 60 months follow-up.

Conclusion:
Our meta-analysis strongly underscores the critical importance of a short DAT in significantly reducing AF recurrence and all-cause mortality, with a trend toward lowering stroke risk, though no significant impact on HF was observed. Early ablation proves beneficial not only for patients with paroxysmal AF but also for those with persistent AF. These findings suggest that minimizing DAT can markedly improve AF outcomes, warranting further investigation to optimize treatment strategies.
Abstract 4142264: De-escalation of Dual Antiplatelet Therapy by Changing Ticagrelor to Clopidogrel Versus Ticagrelor Monotherapy in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention
Authors: Li Yi-Heng , Hsieh I-Chang , Lin Hui-Wen , Lin Sheng-Hsiang
Published: November 2024

Background:
Two de-escalation options of dual antiplatelet therapy (DAPT) have been proposed to mitigate bleeding risk in patients (pts) with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), including maintaining DAPT but reducing its intensity by changing potent P2Y12 inhibitor (P2Y12i) to clopidogrel or discontinuation of DAPT by using P2Y12i monotherapy. Our study aims to evaluate the use of de-escalation therapies after discharge in AMI pts undergoing PCI and compare the clinical outcomes of the two de-escalation options.

Methods and Results:
In the Taiwan National Health Insurance Research Database, we included adult pts (≥ 18 yrs) who received PCI for AMI and survived to discharge with DAPT. Pts who need oral anticoagulant were excluded. From 2011 to 2021, 58989 pts (mean age 61.9±13.2 yrs, male 81.4%) were included. After 2016, >70% pts were treated with aspirin plus ticagrelor (A+T) at discharge. In A+T users (n=28698), de-escalation for any reason occurred in 52.2% during follow-up. Among de-escalation therapy, aspirin plus clopidogrel (A+C, 55.8%) and ticagrelor monotherapy (T mono, 15.5%) were most commonly used in the first 6 mo. The mean duration from discharge to de-escalation to T mono vs. A+C was 52.5±69.3 vs. 68.4±70.7 days (p<0.01). Multivariable logistic regression analysis showed that multi-vessel PCI and bleeding risk at baseline were more likely to receive T mono than A+C. We used inverse probability of treatment weighting (IPTW) to balance all differences and compared the outcomes after de-escalating to T mono vs. A+C (reference) with Cox proportional hazards analysis. Among pts with multi-vessel PCI, the composite ischemic outcome (cardiovascular death, recurrent MI and ischemic stroke) (HR 0.73, 95% CI 0.50-1.05) and the composite major bleeding outcome (major gastrointestinal bleeding and intracerebral hemorrhage) (HR 0.97, 95% CI 0.46-2.06) were similar between the groups. Among pts with bleeding risk (at least 1 ARC-HBR risk factor), the composite ischemic outcome was similar (HR 1.05, 95% CI 0.76-1.44) and the composite major bleeding outcome was also similar (HR 1.78, 95% CI 0.91-3.50).

Conclusions:
In pts with AMI undergoing PCI initially received A+T, de-escalation was common after discharge. The clinical outcomes were similar after de-escalating to T mono vs. A+C in pts with multi-vessel PCI or bleeding risk. Further randomized trial is needed to confirm our finding.
Abstract 4142266: Long-term Outcomes and Predictors of Recurrence in Atrial Arrhythmia Ablations Post-Fontan Procedure: A Retrospective Analysis
Authors: Kharidia Khush , Tan Weiyi , Patel Nimesh
Published: November 2024

Introduction:
Supraventricular tachycardia (SVT) is common and poorly tolerated in patients who have undergone Fontan procedure. Recurrence rates after catheter ablation in these patients are high. Recent data on the outcomes of SVT ablation and the predictors of recurrence in this population is lacking.

Objective:
Our study aimed to characterize clinical variables in patients with a Fontan undergoing EP ablation, investigate long-term outcomes, and determine factors that are associated with recurrence.

Methods: Charts of patients who had undergone Fontan procedure and underwent SVT ablation between January 1, 1995, and October 1, 2023, at a tertiary care center were reviewed. Demographic, clinical, and outcome variables over 5 years were compared between patients with and without SVT recurrence.

Results:
Mean age of 25 patients (56% male) at time of SVT ablation was 31.5 ± 7.2 years. Ablation success rate was 92%. Recurrence occurred in 12 (48%) patients, with 7 (28%) requiring repeat ablations repeat within 5 years. Rate of recurrence did not differ between those who had the procedure before or after 2018. During the 5-year follow up period, 13 (59%) patients with follow up had cardiovascular (CV) hospitalization and 1 patient died. Atrial Tachycardia (70%) and Typical Atrial Flutter (65%) were the most common SVTs ablated. A trans-baffle puncture during the ablation was performed in 6 (23%) patients. Tricuspid atresia and elevated BNP levels were associated with increased risk of SVT recurrence (Table).

Conclusion:
Recurrence and cardiac hospitalization rates after SVT ablation in this population remain high. This study underscores the need for risk stratification in patients with Fontan physiology undergoing SVT ablation and informs future research directions for enhancing ablation outcomes.
Abstract 4142294: Anticoagulation for the Prevention of Stroke Recurrence in Embolic Stroke of Undetermined Source: a meta-analysis
Authors: Chi Kuan Yu , Song Junmin , El Zarif Talal , Varrias Dimitrios , Ntaios George , Chang Yu-Cheng , Chiang Cho Han , Gershon Adam , Borkowski Pawel , Nanna, MD, FACC Michele , Nanna Michael
Published: November 2024

Background:
The 2021 AHA/ASA stroke guideline highlighted the importance of identifying clinical factors to discern patients with embolic stroke of undetermined source (ESUS) who may benefit from anticoagulation as a key area for future investigation.

Research Question:
Which subsets of patients with ESUS potentially benefit from anticoagulation for secondary prevention?

Aims:
To identify potential subsets of ESUS who may benefit from direct oral anticoagulants (DOAC).

Methods:
Electronic databases were searched from January 1
st
, 2014 to May 10
th
, 2024 to identify randomized controlled trials (RCTs) comparing DOACs and aspirin for secondary prevention after ESUS. The efficacy outcome was comparative ischemic stroke recurrence between DOACs and aspirin. The safety outcome was major bleeding.Random-effects meta-analysis using restricted maximum likelihood method was performed, with a prespecified subgroup analysis based on participants with evidence of patent foramen ovale (PFO) and with signs of, or risk factors for atrial cardiopathy.

Results:
We identified four RCTs including 13,970 participants. Overall, DOAC did not lead to a significant reduction in the unselected ESUS population (RR, 0.92; 95% CI, 0.80 to 1.05; I
2
= 0%; Figure A). In patients with signs of or risk factors for atrial cardiopathy, there was a significant 16% reduction in recurrent ischemic stroke with DOAC (RR, 0.84; 95% CI, 0.70 to 0.99; I
2
= 0%; Figure A). Notably, a significant 36% reduction in stroke recurrence was observed in the subgroup using criteria more specific to atrial pathology for signs of atrial cardiopathy (RR, 0.64; 95% CI, 0.43 to 0.97; I
2
= 25%; Figure A). Conversely, no difference was noted in the subgroup using cardiac biomarkers criteria for signs of atrial cardiopathy (RR, 1.05; 95% CI, 0.78 to 1.43; I
2
= 0%; Figure A). The risk of major bleeding outside ICH was significantly higher with DOACs than with aspirin (RR, 1.63; 95% CI, 1.08 to 2.47; I
2
= 0%; Figure B).

Conclusions:
The use of DOAC was associated with a significantly lower risk of ischemic stroke recurrence in patients with ESUS presenting with signs of or risk factors for atrial cardiopathy, especially in those meeting criteria more specific to atrial pathology.
Abstract 4142309: Development of novel 3D
in vivo
tracking of myofibroblasts and fibrosis with panoramic optical mapping after murine myocardial infarction
Authors: Guttipatti Pavithran , Saadallah Najla , Ji Ruiping , Wan Elaine
Published: November 2024

Background:
Myocardial infarction (MI) initiates an injury response that triggers fibroblast to myofibroblast cell transition and pathological fibrosis, a substrate for arrhythmogenesis. However, there are no methods to image in-vivo development of fibrosis continuously in the murine model other than cardiac MRI which is costly and time-consuming.

Objectives:
We aimed to develop a novel 3D method to track myofibroblast activity in the heart
in vivo
and correlate with electrophysiological changes using optical mapping.

Methods:
Mice with the alpha-Smooth Muscle Actin (α-SMA) promoter for expression of the red fluorescent protein DsRed were used to label myofibroblasts. MI was induced by left anterior descending artery ligation in α-SMA-RFP (n=4) and control C57BL/6 mice (n=5). RFP fluorescence was monitored over time using a PerkinElmer® In Vivo Imaging System (IVIS) before and after MI. 3D IVIS imaging with micro-computed tomography (CT) of 3D cardiac structure was then performed. Ex-vivo heart imaging of RFP followed by 3D panoramic optical mapping of electrical activation via Di-4-ANEPPS was performed and action potential duration (APD) maps generated.

Results:
After MI α-SMA-RFP mice demonstrate strong myofibroblast RFP signal localized above the heart on IVIS imaging at varying time points from 9 days to 3 months after MI. Myofibroblast RFP signal is not present before MI, and is also absent in control C57 mice. Ex-vivo imaging of hearts confirms myofibroblast RFP signal correlates with the site of infarction as well as increased APD. In α-SMA-RFP mice myofibroblast RFP intensity at the fibrotic infarct site is significantly greater than non-infarcted sites (mean difference 52.9 ± 13.2, p = 0.0088). Control C57 hearts do not demonstrate preferential RFP signal at infarct sites (mean difference -3.28 ± 2.99, p = 0.29). Furthermore, 3D IVIS imaging with CT co-registration demonstrates the localization of RFP signal in space near the heart.

Conclusion:
IVIS imaging of α-SMA-RFP is able to track myofibroblast activity in living mice up to three months after MI, and can be combined with optical mapping to study electrophysiology (APD, phase, activation maps). This novel approach can offer a method to monitor myofibroblast dynamics in disease states and test treatments that reduce the pathologic myofibroblast persistence that leads to fibrosis, scarring and arrhythmogenesis.
Abstract 4142376: Impact of Atrial Fibrillation on Outcomes in Patients with Esophageal Cancer Receiving Neoadjuvant Chemoradiation
Authors: Sivamurugan Aravinthasamy , Grewal Udhayvir
Published: November 2024

Limited data indicate an elevated risk of atrial fibrillation (AF) after neoadjuvant chemoradiation in esophageal cancer however the role of AF as an independent predictor of outcomes post-esophagectomy remains under-studied. We sought to the impact of AF on overall outcomes of patients undergoing neoadjuvant chemoradiation and esophagectomy, with or without adjuvant nivolumab.

The global TriNetX database was used to identify patients (based on ICD-10 codes) with esophageal squamous cell carcinoma or adenocarcinoma who received neoadjuvant chemoradiation with carboplatin and paclitaxel and subsequently underwent esophagectomy between 2009 and 2024. Patients who received adjuvant nivolumab were analyzed separately. Patients who developed AF were compared with patients who did not using propensity score matching (PSM) based on age, race, BMI, and multiple comorbidities. Outcomes over a 5-year period were mortality, ischemic stroke, and use of anticoagulation. Odds ratios with 95% confidence intervals were generated with generalized linear mixed modeling and a p value of <0.05 was considered statistically significant.

A total of 1007 patients were identified, of these 186 (18.5%) developed AF after esophagectomy. PSM yielded 94 pairs for patients without adjuvant nivolumab. In this group, mortality was not significantly higher in patients with AF [OR=1.409 (0.793-2.504), p=0.242]. Incidence of stroke was equivalent between patients with and without AF [OR=1 (0.396-2.528), p = 1], despite significantly higher use of anticoagulation in the AF group [OR= 2.004 (1.071-3.749), p<0.028]. PSM for patients receiving adjuvant nivolumab yielded 68 pairs. In this cohort, AF was not associated with a significant difference in mortality [1.86 (0.843, 3.870), p = 0.126]. Incidence of stroke was significantly higher in patients with AF [Risk difference = 0.147 (0.063, 0.231) p = 0.0001], however anticoagulation use was not significantly higher in the AF group [1.944 (0.862, 4.384), p = 0.106].

The current analysis highlights a high incidence of AF after neoadjuvant chemoradiation in esophageal cancer. However, despite rigorous vetting with PSM, we found no difference in mortality associated with AF both among patients who received or did not receive adjuvant nivolumab. Diligent use of anticoagulation is required among patients with AF post-esophagectomy due to an increased risk of stroke. These findings merit confirmation in a large prospective cohort.
Abstract 4142424: The impact of the stress hyperglycemia ratio on adverse prognosis in patients with chronic thromboembolic pulmonary hypertension
Authors: Wang Yijia , Xin Li , Huang Zhihua , Duan Anqi , zhang sicheng , Gao Luyang , Li Sicong , Zhao Zhihui , zhao qing , Luo Qin , Liu Zhihong
Published: November 2024

Background:
Risk assessment for chronic thromboembolic pulmonary hypertension (CTEPH) remain challenging. Stress hyperglycemia represents the regulation of glucose metabolism in response to stress. Meanwhile, stress hyperglycemia ratio (SHR) is recently found to reflect true acute hyperglycemic status. However, the relationship between SHR and adverse prognosis is uncertain. This study aimed to investigate the prognostic value of SHR in CTEPH patients.

Methods:
A total of 451 CTEPH patients with available baseline SHR measurement were enrolled between February 2014 to July 2023 at Fuwai hospital. The predictive values of SHR for adverse events were assessed.

Results:
During a median follow-up of 21 months, 89 (19.7%) CTEPH patients experienced adverse clinical outcomes. Kaplan-Meier curve analysis revealed that the cumulative adverse event rates were significant higher in the SHR≥0.747 with CTEPH patients, compared with patients in the SHR<0.747. The multivariable analysis revealed that high level of SHR, whether as a continuous variable or categorical variable, were independent risk factor for adverse events after adjusting various confounding factors. Restricted cubic spline also revealed a correlation between SHR and the risk of adverse events after adjusted clinical risk factors (
p
value for non-linearity=0.871). Furthermore, when incorporating SHR into the baseline risk model, a significant improvement in the predictive ability for adverse prognosis was noted in CTEPH patients, as evidenced by the C-statistic rising from 0.690 to 0.711 (
p
value=0.037). Significant enhancements in continuous net reclassification improvement, and integrated discrimination improvement were also observed as a result of incorporating the SHR into the baseline risk model (
p
value <0.05).

Conclusions:
The high level of SHR was independently associated with long-term adverse prognosis risk in CTEPH patients. The integration of SHR into the baseline risk model may have improved the accuracy in predicting the risk of adverse prognosis. Our findings support the utility of SHR as a reliable indicator for clinical outcome risk stratification of CTEPH patients in the real world. Further research is needed to explore whether interventions targeting SHR can improve the clinical outcomes for patients with CTEPH.
Abstract 4142444: The Effect of Left Atrial Filling Pressure on Exercise Arterial Oxygenation in HFpEF: Does the V-wave matter?
Authors: Huang Le , Macnamara James , Brazile Tiffany , Balmain Bryce , Tomlinson Andrew , Hearon Christopher , Babb Tony , Levine Benjamin , Sarma Satyam
Published: November 2024

Background:
Left atrial (LA) myopathy is common in patients with heart failure with preserved ejection fraction (HFpEF) and is characterized by decreased LA compliance, pulmonary vascular dysfunction, and decreased survival. However, the mechanistic relationship between these variables are unclear. It has been thought pulmonary capillary wedge pressure (PCWP), particularly the v-wave which is directly transmitted backwards into the pulmonary circulation, contributes to worsened pulmonary vascular function through disruption of lung diffusion of oxygen. Though efforts to reduce PCWP, such as with interatrial shunt devices, have not improved outcomes. We hypothesized that HFpEF patients with greater v-wave amplitudes would have worse pulmonary gas exchange assessed by lower arterial partial pressure of oxygen (PaO2) but that reductions in the v-wave amplitude would not improve arterial gas exchange.

Methods:
Patients with HFpEF underwent upright invasive hemodynamic exercise testing with right heart and radial arterial catheterizations. PCWP tracings and arterial blood gases were obtained during rest and submaximal 20W exercise without (control: con) and with nitroglycerin (NTG) on a semi-recumbent cycle. V-wave peaks were measured manually by two observers (blinded).

Results:
In 40 patients with HFpEF, mean v-wave amplitudes at rest were 9.9 ± 4.4 mmHg (con) and 9.4 ± 4.0 mmHg (NTG; p=0.33) and during 20W exercise were 27 ± 15 mmHg (con) and 22 ± 9.9 mmHg (NTG; p=0.018). PaO2 at rest was 86 ± 12 mmHg (con) and 82 ± 10 mmHg (NTG) and during 20W exercise was 85 ± 13 mmHg for both control and NTG. PaO2 was negatively correlated with v-wave amplitude across all conditions (figure) but increases in v-wave amplitude from rest to 20W exercise did not correlate with changes in PaO2 under either condition (control: p = 0.49, R^2 = 0.013; NTG: p = 0.55, R^2 = 0.0093). Similarly, reductions in v-wave with NTG did not improve PaO2 at rest or with 20W exercise.

Conclusions:
While higher v-wave amplitudes correlated with a lower PaO2, changes in v-wave amplitude, whether via increases through exercise or decreases with NTG, had no effect on arterial oxygenation. These results suggest that elevated v-waves may not play a role in decreasing PaO2.
Abstract 4142494: Prediction Of Atrial Fibrillation From Beat-To-Beat Correlations During Normal Rhythm
Authors: Rasanen Esa , Pukkila Teemu , Molkkari Matti
Published: November 2024

Background:
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, affecting over 59 million individuals worldwide. Even wearable heart rate monitors can detect ongoing AF episodes, but none of the devices are able to assess the susceptibility to impending episodes. The prediction of AF episodes during normal rhythm would significantly improve the early treatment of AF.

Research Hypothesis:
Heart diseases are known to affect the short- and long-range correlations in beat-to-beat intervals, i.e., RR interval (RRI) time series. The hypothesis is that persistent alterations remain in the RRI correlations even outside of AF episodes. The study examines whether the RRI correlations can indicate the susceptibility to AF during normal rhythm.

Methods:
We analyze the correlations in RRIs with detrended fluctuation analysis (DFA). We enhance the analysis with its dynamical (DDFA) variant, which assesses time-dependent correlations over several ranges of scale. We attempt to discriminate the AF population with varying ratios of AF episodes (from <20% to >99%) from healthy controls by their RRI correlations with XGBoost classifier.

Data and results:
The data consist of long ECG recordings of 274 healthy controls and 84 patients with AF from Physionet and THEW datasets. The data is split into subclasses according to the relative time of the recording spent in AF: (a) >99% (N=34), (b) 20-99% (N=24), (c) <20% (N=26). The classification according to DDFA calculations leads to the following results in each subclass for sensitivity and specificity, respectively: (a) 94% and 97%; (b) 88% and 94%; (c) 73% and 96%. Figure 1 illustrates the differences in DDFA results between each of the studied subclasses and healthy controls. There is significant qualitative similarity between the subclasses (a-c) compared to the healthy controls in (d), especially at high heart rates. We confirmed that a small ratio of AF episodes in the data, such as in subclass (c), does not impair the DDFA results.

Conclusions:
The RRI correlations in the AF population show marked deviation from healthy controls even outside of AF episodes. A significant portion of the AF cases could be isolated outside the episodes with excellent specificity, paving the way for practical early screening without overflowing the healthcare system with false positives.
Abstract 4142510: Impact of Stress Hyperglycemia Ratio on Heart Failure and Atherosclerotic Cardiovascular Events After Acute Myocardial Infarction
Authors: okita shogo , Saito Yuichi , Kitahara Hideki , Kobayashi Yoshio
Published: November 2024

Background:
An acute hyperglycemic status is reportedly associated with poor prognosis in patients with acute cardiovascular diseases. Although the stress hyperglycemia ratio (SHR) is a novel index to accurately represent the hyperglycemic condition on admission, relations between SHR and clinical outcomes are not fully evaluated in a setting of acute myocardial infarction (MI).

Methods:
This retrospective, multicenter registry study included 2,386 patients with acute MI undergoing percutaneous coronary intervention. SHR was calculated as a blood glucose level on admission divided by the estimated average glucose derived from a glycated hemoglobin level. The co-primary endpoints of this study included heart failure (HF)-related events (a composite of all-cause death and worsening and hospitalized HF) and major atherosclerotic cardiovascular events (MACE) (a composite of all-cause death, recurrent MI, and ischemic stroke), during the index hospitalization and after discharge.

Results:
Of the 2,386 patients, 890 (37.3%) had diabetes, and the median SHR was 1.17 [0.99, 1.45]. HF events and MACE occurred in 680 (28.5%) and 233 (9.8%) during hospitalization. SHR was identified as a factor significantly associated with both in-hospital HF events (adjusted odds ratio 1.65, 95% confidence interval 1.18-2.29, p=0.003) and MACE (adjusted odds ratio 1.50, 95% confidence interval 1.10-2.03, p=0.009). Among 2,017 patients who survived to discharge and had follow-up information, 195 (9.7%) and 214 (10.6%) experienced HF events and MACE during the median of 536 days after discharge. Patients with the high SHR (>1.45, 4th quartile) had an increased risk of HF events than those with SHR ≤1.45, while the incidence of MACE after discharge did not differ significantly between the two groups (Figure). The multivariable analysis confirmed the association of SHR with long-term HF events.

Conclusions:
In patients with acute MI, SHR was predictive of in-hospital outcomes including HF events and MACE, while after discharge, the higher SHR was associated with a higher HF risk but not with MACE. Further studies are needed to elucidate the underlying mechanisms and potential incremental benefit of SHR in stratifying patient risks after MI.
Abstract 4142562: Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery – MeDCaP Phase I Trial
Authors: Henmi Soichiro , Kobayashi Kumi , Zurakowski David , Staffa Steven , Fulton Kenneth , Datar Anushree , Tanna Jay , McCann Chase , Nuszkowski Mark , Deutsch Nina , Schlatterer Sarah , Donofrio Mary , Hoq Fahmida , Hanley Patrick , Wernovsky Gil , D'UDEKEM YVES , Deshpande Shriprasad , Bollard Catherine , Ishibashi Nobuyuki
Published: November 2024

Introduction/Background:
Neurodevelopmental impairment is a challenge for many children with complex congenital heart disease who undergo surgical intervention with cardiopulmonary bypass during the early postnatal period.

Research Questions/Hypothesis:
We hypothesized that bone marrow-derived mesenchymal stromal cell (BM-MSC) delivery through cardiopulmonary bypass (CPB) will improve neurodevelopmental outcome and post-operative course.

Goals/Aims:
The primary goal of this single-center, dose-escalation phase 1 trial was to assess the safety/feasibility and determine the maximum tolerated dose (MTD) of BM-MSC treatment.

Methods/Approach:
Inclusion criteria of the phase 1 trial were neonates/infants (ages ≤ 6 months) who underwent scheduled two-ventricle repair without arch reconstruction. Dose escalation was guided by a modified continual reassessment method at four dose levels (1-40x10^6 cells/kg). Dose limiting toxicity was assessed for 45 days after BM-MSC delivery. Secondary endpoints before discharge were compared with a historical cohort (n=222) by inverse probability of treatment weighting (IPTW) using the propensity score to balance the groups.

Results/Data:
Seventeen patients were enrolled from July 2020 to June 2023 (ventricular septal defect, n=9; tetralogy of Fallot, n=7; transposition of the great arteries, n=1; male, n=10). There were 3 serious adverse events all of which were related to cardiac surgery and not the BM-MSC product (junctional ectopic tachycardia, n=2; diaphragm paresis, n=1). Among 50 total events, there were no adverse events related to BM-MSCs. The BM-MSC dose was successfully escalated to the planned MTD (40x10^6 cells/kg), demonstrating safety and feasibility of this therapeutic delivery strategy. Consistent with results indicating little interference on CPB functions, electron microscopy studies showed no BM-MSC adherence on the CPB filter mesh at the MTD. Multivariable analyses with IPTW identified a reduction of CO2 and lactate levels in MeDCaP cases. We observed differences in white blood cell, monocyte, and platelet numbers between the two groups, suggesting possible interaction between endogenous blood cells and applied BM-MSCs.

Conclusions:
We confirmed the safety and feasibility of BM-MSC treatment during CPB at the proposed MTD level. Successful design and completion of a future phase 2 trial is needed to determine efficacy.
Abstract 4142612: External validation of CHIP score in patients undergoing in patients undergoing percutaneous coronary intervention in a large-scale Chinese cohort
Authors: Zeng Guyu , Yuan Jinqing
Published: November 2024

Background:
The CHIP score, developed from the BCIS (British Cardiovascular Intervention Society) database, predicts adverse in-hospital MACCE (major adverse cardiovascular and cerebrovascular events). However, its long-term prognostic value in Asian population remains unclear. This study aims to externally validate the CHIP score in a large Chinese cohort.

Methods:
We included 10,445 patients undergoing percutaneous coronary intervention (PCI), stratified into four groups based on the CHIP score (0, 1-2, 3-4, ≥5). The primary endpoint was 5-year MACCE, defined as a composite of all-cause mortality, myocardial infarction, and stroke. Secondary endpoints included the individual components of 5-year MACCE.

Results:
Higher CHIP scores were associated with significantly higher 5-year MACCE risk compared to a score of 0 (score 1-2: HR 1.31, 95% CI 1.15-1.49; score 3-4: HR 1.95, 95% CI 1.62-2.35; score ≥5: HR 3.81, 95% CI 2.93-4.96). This trend was consistent for 5-year all-cause mortality, myocardial infarction, and stroke. The discrimination ability of the CHIP score for 5-year MACCE risk was modest (C-statistics: 0.57, 95% CI: 0.55-0.59). For secondary endpoints, the discrimination for 5-year mortality risk was the highest (C-statistics: 0.61, 95% CI: 0.58-0.64). The Hosmer-Lemeshow goodness-of-fit test P values were all <0.05 for all endpoints.

Conclusions:
The CHIP score demonstrates a modest ability to predict 5-year MACCE and its individual components in a large Chinese cohort undergoing PCI. While it shows a clear trend of increasing risk with higher scores, further refinement and validation are needed to improve its predictive accuracy in this population.
Abstract 4142622: Circulating biomarkers of collagen type-I degradation are associated with risk of mortality after ST-elevated myocardial infarction.
Authors: Martin Emily , Angeli Elisavet , Laursen Clara , Genovese Federica , Karsdal Morten , Frydland Martin , Moller Jacob , Hassager Christian
Published: November 2024

Introduction:
Extracellular matrix (ECM) remodelling is a critical consequence of ST-elevated myocardial infarction (STEMI). Type-I collagen (COL1) is the main constituent of the myocardium, and its’ degradation could result in destabilisation of the cardiac tissue and increase the risk of adverse events.

Aim:
We sought to quantify circulating peptides reflecting COL1 degradation in STEMI patients.

Methods:
COL1 degradation was measured using two enzyme-linked immunosorbent assays (ELISA) targeting MMP-generated fragments of COL1 (C1M and C1SIG) in plasma of 1,464 patients admitted with STEMI from the PREDICT-CS study (72.7% male, median age: 63.5) (Rigshospitalet, Denmark). Survival analysis and Cox proportional hazard analysis were used to determine the association the biomarker to mortality within 1-year of STEMI.

Results:
C1M and C1SIG were lowly correlated (R = 0.204, p < 0.0001). Patients with circulating levels of C1M and C1SIG above the median at a higher mortality risk at 1-year post-admission, compared to those with biomarker levels below the median (C1M: p = 0.0006, C1SIG: p < 0.0001, Log-rank test). Univariate Cox proportional regression analysis showed a 90% increase in risk of death per doubling of C1M and a 120% increased risk of death per doubling of C1SIG over 1-year (C1M: HR 1.9 [1.6-2.4], C1SIG: HR 2.2 [1.6-3.0], both: p <0.001). In Model 1 (adjusment for age, sex, hypercholesterolemia, blood pressure, diabetes, and smoking), C1M and C1SIG retained the association with risk of mortality (C1M: HR 1.6 [1.2-2.0], C1SIG: HR 2.2 [1.5-3.1], both: p <0.001). In Model 2, including Model 1 and the cardiac and inflammatory markers MR pro-adrenomedullin, Copeptin, proANP, ST2 and CRP, C1SIG, but not C1M, continued to remain an independent predictor of mortality over 1-year (HR 1.9 [1.2-3.0], p <0.001 for C1SIG; HR 1.4 [0.9-1.9], p = 0.109 for C1M).

Conclusion:
Circulating levels of C1M and C1SIG showed a significant and independent association with risk of mortality in STEMI patients after 1 year, in a multivariate model based on the Framingham Score. The association was retained for C1SIG after adjustment for markers of cardiac injury and inflammation. Assessing acute ECM processing in STEMI patients using COL1 biomarkers could be beneficial for predicting mortality and identifying a patient-subset at increased risk of long-term outcome.
Abstract 4142632: Identifying the Impact of Systolic Dysfunction on CKD Risk in HFpEF Patients
Authors: Nishimura Thiago , Damiani Lucas , Shinzato Mariane , Santos Natasha , da Silva Farias Eduardo , Shiguematsu Victor , Batista Fernanda , Feres Lara , Damiani Bruna , Delamain Tacianne , Nishida Gustavo , Samaan Farid , Feres Fausto , Franchini Kleber
Published: November 2024

Introduction:
Chronic kidney disease (CKD) is a critical comorbidity in heart failure with preserved ejection fraction (HFpEF), often linked to congestion due to elevated filling pressures. However, the role of subtle systolic dysfunction in CKD remains to be elucidated. This study aimed to investigate the predictive power of left ventricular systolic function for CKD in patients with HFpEF, using advanced machine learning (ML) techniques.

Methods:
We analyzed data from 497 patients referred to a specialized HFpEF clinic. Using machine learning models (Random Forest, XGBoost, Logistic Regression, Decision Tree), we assessed traditional risk factors (sex, age, hypertension, obesity, diabetes, and smoking) and renal function markers (eGFR and UACR) to estimate the risk of HFpEF based on the HFA-PEFF scoring system. Echocardiography-derived variables were used to predict CKD, defined as an eGFR <60 ml/min/1.73 m
2
. SHapley Additive exPlanations (SHAP) provided insights into model predictions.

Results:
The study population consisted primarily of women (67%) with an average age of 62 ± 12 years, increased BMI (33 ± 7 kg/m
2
), and prevalent hypertension (79%), dyslipidemia (71%), and type 2 diabetes (38%). The logistic regression model that incorporated traditional risk factors and renal markers achieved an AUROC of 0.80 ± 0.07, indicating significant impacts of lower eGFR and higher UACR on the risk of HFpEF (Panel A). The Random Forest model, which included variables derived from echocardiography, achieved the highest accuracy (AUROC 0.96 ± 0.02). Key systolic predictors of lower eGFR included reductions in tissue Doppler S wave and stroke volume index, as well as impaired left ventricular diastolic function (increases in E/e’ ratio) and elevated estimated pulmonary artery pressure (TRV - tricuspid regurgitation peak velocity) (Panel B).

Conclusion:
This study identifies subtle systolic dysfunction, along with impaired diastolic function and increased pulmonary arterial pressure, as significant predictors of CKD in HFpEF. Our findings highlight the potential of advanced ML techniques to better understand the disease mechanisms. Early detection of these impairments can improve risk stratification and guide targeted interventions in the management of HFpEF.
Abstract 4142703: Characteristics and Transplant Outcomes of Patients with End Stage Hypertrophic Cardiomyopathy Stratified By Genotype
Authors: Austin Melissa , Agarwalla Anjali , Zitelny Edan , Owens Anjali , Reza Nosheen
Published: November 2024

Introduction:
Harboring a likely pathogenic/pathogenic (LP/P) sarcomeric genetic variant has been shown to be a predictor of developing hypertrophic cardiomyopathy (HCM) with systolic dysfunction. There are limited data describing the associations between genotype and clinical outcomes of patients with end stage HCM.

Methods:
All patients with HCM who underwent both genetic testing and heart transplantation (HT) between 2011 and 2023 at a quaternary care center were included. Baseline characteristics, peri-HT management and outcomes were compared between patients with or without LP/P variants for HCM using summary statistics and survival analysis.

Results:
Between 2011 and 2023, 38 patients with HCM were transplanted. Of these 38, 29 patients underwent genetic testing, and LP/P variants thought to be casual for HCM were identified in 20 (Gene+) (Table 1). Female patients composed 40% of the Gene+ cohort compared to 89% of the gene-negative (Gene-) cohort (p=0.04). The majority of LP/P variants were in
MYH7
(7/20) and
MYBPC3
(5/20). Pre-transplant cardiometabolic comorbidities were prevalent in both groups. Pre-transplant LVEFs were not significantly different (47% [IQR 34.0, 57.5] in Gene+; 55% [IQR 42.0, 60.0] in Gene-; p=0.23). Pre-transplant medication management and bridge to transplant strategies were similar between the two groups. NYHA Class at time of HT was higher in the Gene+ cohort (p=0.04), though a similar percentage of patients in both cohorts were upgraded to higher UNOS statuses while on the waitlist. Survival at 30, 90 and 180-days after HT (Figure) and incidence of rejection during the year following HT were similar in both cohorts (Table 2).

Conclusion:
Further investigation is needed to elucidate the impact of genotype on outcomes in end stage HCM.
Abstract 4142809: Artificial Intelligence Enabled Prediction of Future Structural Heart Disease and Cardiovascular Risk from Single-lead Electrocardiograms
Authors: Dhingra Lovedeep , Aminorroaya Arya , Pedroso Camargos Aline , Khunte Akshay , Sangha Veer , Brant Luisa , Barreto Sandhi , Ribeiro Antonio Luiz , Krumholz Harlan , Oikonomou Evangelos , Khera Rohan
Published: November 2024

Background:
Portable devices capable of recording single-lead electrocardiograms (ECGs) can enable large-scale community-based cardiovascular risk assessment. We developed a noise-adapted ensemble deep learning algorithm for lead I ECGs as the sole input and predicted the risk of major adverse cardiovascular events (MACE) and development of new-onset structural heart disorders (SHDs) across multinational cohorts, spanning a US health system and community-based cohorts in UK and Brazil.

Methods:
We included adults with outpatient ECGs in Yale New Haven Health System (YNHHS) and population-based cohorts of UK Biobank (UKB) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Among individuals with ECGs without cardiomyopathy or heart failure at baseline, we isolated lead I ECGs and deployed a noise-adapted AI-ECG model trained to identify cross-sectional SHD (LV ejection fraction < 40%, moderate/severe left-sided valve disease, severe LV hypertrophy [IVSd > 15mm and LV diastolic dysfunction]). Across cohorts, we evaluated the association of the baseline AI-ECG probability with risk of MACE using adjusted Cox proportional hazard models and assessed discrimination using Harrel’s c-statistic. In YNHHS, among those with serial echocardiograms, we evaluated the risk of new-onset SHD.

Results:
There were 169,381 patients with outpatient ECGs at YNHHS (age 55 years [IQR, 40-68], 98023 women [58%]), 42,741 UKB participants (65 years [59-71], 21,795 women [52%]), and 13,454 ELSA-Brasil participants (56 years [41-69], 7,348 women [55%]) with baseline ECGs. A total of 12,483 patients had MACE and 8595 developed SHD in YNHHS over 4.5 years (2.6-6.6). In UKB and ELSA-Brasil, 768 and 388 participants had MACE over 3.1 years (2.1-4.5) and 4.2 years (3.7-4.5), respectively. Each 0.1 increment in the model output portended a 15-35% higher hazard of MACE across cohorts, independent of age, sex, and comorbidities (aHR: YNHHS 1.20 [1.19-1.21], UKB 1.15 [1.09-1.20], ELSA-Brasil 1.35 [1.28-1.44]). Among patients with serial echocardiograms in YNHHS, a positive AI-ECG screen portended a 2-fold higher risk of new-onset SHD (aHR: 2.09 [1.98-2.20]).

Conclusions:
In geographically and clinically distinct cohorts, a noise-adapted AI model with lead I ECGs as the only input defined the risk of MACE and new-onset SHD. This represents a scalable strategy that can use portable and wearable devices with ECG capabilities for cardiovascular risk stratification in the community.