bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4146369: Association of Midlife Systemic Inflammatory Markers and Interval Change with Cognition: Insights from the HeartSCORE Study
Authors: Abdoun Khaled , Swanson Justin , Reis Steven , Saeed Anum
Published: November 2024

Introduction:
Systemic inflammation may be associated with risk for neuroinflammation and cognitive decline. We investigated the association of midlife inflammatory markers and their 1-year change with Montreal Cognitive Evaluation (MoCA) score in a longitudinal cohort.

Methods:
In the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study, baseline serum levels of high-sensitivity c-reactive protein (hs-CRP|), interleukin-6 (IL-6), CD40L, and intercellular adhesion molecule-1 (ICAM-1) were measured, along with their one-year changes (delta). Using linear regression, association of inflammatory biomarkers and interval change with MoCA scores taken 10-12 years later, were examined in models adjusted for traditional risk factors (age, sex, race, smoking, smoking, triglycerides, high density lipoprotein and total cholesterol, systolic and diastolic blood pressure, hypertension, diabetes, metabolic syndrome, antihypertensive use, statin use, and aspirin use). Model 2 added the one-year change in each biomarker.

Results:
Among 673 participants (mean age [SD]: 59 [6.8] years), 63.9% were women and 31.6% were self-reported Black. While univariate modelling showed an inverse association of IL-6 with MoCA; this was not significant when adjusted for covariates. Baseline ICAM levels had a significant inverse association with MoCA scores [β: -0.47 (-0.93 --0.02) p<0.05] in fully adjusted models (Table). One year change in these markers did not show any statistically significant association with MoCA scores.

Conclusion:
Midlife ICAM, known to initiate neuro and systemic inflammatory responses, may be an early risk marker for cognitive impairment. Future studies can examine the mechanisms of ICAM and its role in inflammatory cascade and neurocognitive decline.
Abstract 4146419: Maternal Gestational Diabetes Leads to Disturbed Fetal Vascular Function and Increased LOX-1 Expression
Authors: Hengst Clara , Villar Ballesteros Maria de Leyre , Brendel Heike , Carstens Philine Sophie , Effenberger Deborah , Mittag Jennifer , Giebe Sindy , Fruehauf Alexander , Birdir Cahit , Taylor Paul , Morawietz Henning
Published: November 2024

Introduction/Background:
Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and a major risk factor for endothelial dysfunction and cardiovascular diseases in later life. The underlying pathophysiology is not well-understood. An important mediator of endothelial dysfunction and atherosclerosis is the lectin-like receptor for oxidized low-density lipoprotein, LOX-1.

Research Question/Hypothesis:
We hypothesize that maternal GDM leads to impaired fetal vascular function and increased endothelial LOX-1 expression.

Goals/Aim:
Our aim is a better understanding of the impact of maternal GDM on fetal vascular function and LOX-1 as potential mediator of endothelial dysfunction.

Methods/Approach:
We obtained maternal and fetal vessels of mature human placentas from normoglycemic mothers (n=32) and patients with insulin-treated GDM (iGDM) (n=8) or diet-treated GDM (dGDM) (n=8). Groups were defined by oral glucose tolerance test and clinical data of mothers and newborns. Vascular function of fetal vessels from mothers with iGDM, dGDM, or normoglycemic controls was analyzed by Mulvany Myograph. Gene expression was quantified by real-time PCR in RNA from fetal vessels of cotyledone base and maternal spiral arteries of patients.

Results/Data:
Birth weight to placenta weight-ratio showed a significantly reduced placenta efficiency in the iGDM group (
P
<0.0016), but not in the dGDM group, compared to control. We observed a significant reduction of insulin-mediated vasodilatation in fetal arterial vessels of the chorionic plate from iGDM (
P
<0.0003) and dGDM patients (
P
<0.0421), compared to control. NO synthase inhibition significantly reduced insulin-dependent vasorelaxation in the control, but not GDM groups. This was independent of eNOS mRNA expression. We could show a significant LOX-1 overexpression in fetal placental vessels of iGDM patients, compared to normoglycemic mothers. In addition, the mitochondrial uncoupling protein 2 (UCP2) was elevated in fetal vessels of iGDM mothers compared to control. This supports a fetal compensatory mechanism in response to impaired vascular function in spiral arteries of the mother.

Conclusions:
In conclusion, the endothelial function of the fetus is more severely affected by maternal iGDM, compared to dGDM. Furthermore, iGDM might have an adverse effect on placenta efficiency. The LOX-1 receptor could be a promising therapeutic target in the treatment of vascular dysfunction in GDM.
Abstract 4146441: Non-invasive Algorithmic Hemodynamic Measurements Using Wearable Cloth-based Nanotechnology: Alternative to Invasive Right Heart Catheterization
Authors: Isath Ameesh , Khan Shazli , Kanwal Arjun , Gregory Vasiliki , Shyam Kumar Prashanth , Ramasamy Mouli , Varadan Venk , Zimmerman John , Varadan Vijay , gass alan
Published: November 2024

Background:
SimpleSense (Nanowear, New York, NY) is an FDA-cleared artificial intelligence (AI) based wearable diagnostic platform with multiparametric monitoring including 2-leads of ECG, thoracic impedance, heart sounds, blood pressure, posture and activity (Fig. 1 A). We explored the correlation between SimpleSense-derived and invasive hemodynamics (HD) parameters during right heart catheterization (RHC). The SimpleSense parameters assessed included amplitudes and width of heart sounds S1 and S2, ECG amplitudes, R to S1 and S2 times (Fig. 1 B), and pulse ejection period (PEP). PEP is a surrogate measurement that combines the pre-ejection period and left ventricular ejection time (Fig. 1 C).

Methods:
A single-center prospective feasibility study was conducted after IRB approval. Adult patients >18 yrs undergoing RHC were screened and enrolled after informed consent (NCT05629533). SimpleSense recorded data on the patients throughout the RHC procedure. We performed an exploratory analysis to identify potential correlations between the SimpleSense data and HD parameters utilizing maching learning.

Results:
Data from 11 subjects (8 Males, age:64.3 ± 10.23 yrs.) included 39 thermodilution cardiac outputs (CO) and 11 pulmonary artery pressures (PAP). The mean ± SD values of CO, cardiac index (CI), Systolic PAP, Diastolic PAP, and mean PAP were 4.4±1.9 l/min, 2.19±0.96 L/min/m
2
, 37.27±17.32 mmHg, 12.09±5.03 mmHg, and 22.72±8.42 mmHg respectively. Multiple SimpleSense derived data show statistically significant correlations with HD parameters (Fig. 2). The PEP metric exhibited the highest correlation with mean PAP and systolic PAP.

Conclusion:
The results highlight SimpleSense’s potential as a non-invasive AI tool that could revolutionize management by offering a reliable alternative to traditional invasive RHC. With further validation, SimpleSense may provide continuous, real-time hemodynamic information, significantly enhancing patient care and outcomes.
Abstract 4146448: Real-world Outcomes of Nicotine Replacement Therapy in Acute Coronary Syndrome
Authors: Dhaliwal Jasninder , Sekhon Manraj , Rajotia Arush , Ramphul Kamleshun , Singh Swaiman
Published: November 2024

Introduction:
Acute Coronary Syndrome (ACS) is a major global health issue, with smoking as a significant modifiable risk factor. Smoking cessation reduces recurrent coronary events, making it crucial in ACS management. Current protocols recommend smoking cessation education during hospitalization and referral to smoking cessation or outpatient cardiac rehabilitation programs, where nicotine replacement therapy (NRT) and bupropion are available. NRT, including patches, gum, and lozenges, helps alleviate withdrawal symptoms by providing a controlled nicotine dose.

Hypothesis:
We hypothesize that cautious initiation of NRT during hospitalization benefits ACS patients, with the benefits outweighing the risks. This study seeks to provide clarity and contribute to evidence-based guidelines for ACS management.

Methods:
In this retrospective cohort study, data were gathered from the TriNetX database. The study compared two cohorts: 122,198 patients who received NRT and were hospitalized for acute myocardial infarction (AMI) or unstable angina (UA), and 160,387 patients who did not receive NRT but were admitted for the same conditions. The follow-up period began on the day of the index event and continued for 30 days. Cardiovascular outcomes were compared between propensity score-matched patients with and without NRT.

Results:
Patients receiving NRT had a reduced risk of several cardiovascular outcomes compared to those who did not receive NRT, including atrial fibrillation and flutter (RR [95% CI]=0.822[0.792-0.854, p<0.01]) and ventricular fibrillation and flutter (RR [95% CI]=0.715[0.654-0.781, p<0.01]). The risk of death was also reduced (RR [95% CI]=0.701[0.678-0.726, p<0.01]). Hospital readmissions were less frequent in the NRT group (RR [95% CI]= 0.960[0.955-0.965, p<0.01]). Additionally, the risk of cardiac arrest was lower (RR [95% CI]= 0.698[0.660-0.738, p<0.01]), and supraventricular tachycardia (SVT) was less common (RR [95% CI]= 0.883[0.827-0.942, p<0.01]). These results highlight the potential benefits of NRT in reducing the risk of various cardiac events following AMI or UA.

Conclusions:
The cautious initiation of NRT during hospitalization can benefit ACS patients where the benefits outweigh the risks. This study aims to provide clarity and contribute to evidence-based guidelines for ACS management.
Abstract 4146473: Regional Differences in the Impact of Rurality on Ischemic Stroke Hospitalization Among Fee-for-Service Medicare Beneficiaries
Authors: Rabah Abdullah , Dalmacy Djhenne , Quadri Fayz , Kanneganti Nitin , Tiruneh Yordanos , Berry Jarett
Published: November 2024

Background:
Stroke presents a significant burden to the health care system of the United States. Previous research has shown a higher rate of stroke mortality in rural compared to urban areas. Rural communities are highly heterogeneous, and less is known about the variation in stroke across rural communities. Therefore, we sought to examine the association between rurality and hospitalization for acute ischemic stroke across rural vs urban zip codes among US census geographic regions.

Methods:
We included fee-for-service Medicare beneficiaries with prevalent hypertension and/or diabetes followed from 2017 to 2021. Participants were categorized at the residential zip code level into metropolitan, micropolitan, small towns, and rural areas using Rural Urban Commuting Area Codes. Census geographic regions were categorized at the state level into Northeast, South, Midwest, and West. First hospitalization for ischemic stroke or TIA were identified using algorithms from Medicare claims. The association between rurality and stroke hospitalization was estimated in age, race, and sex adjusted models. Additional models were stratified according to census region.

Results:
We included 25,915,862 participants (age 73; 45% male; 97.6% hypertension; 41.6% diabetes; 75.5% metropolitan). Hypertension prevalence was similar across RUCA codes (98%) but diabetes prevalence was slightly lower (42% vs. 39%, metropolitan vs. rural zip codes). After a mean follow-up of 3.8 years, we observed 832,567 first stroke hospitalizations. The south had a higher event rate compared to all other regions (8.79 vs. 8.17 per 1,000 person-years). In multivariable-adjusted models, compared to metropolitan zip codes, stroke risk was similar across micropolitan and small town areas but lower among rural areas. A different pattern of results was observed across geographic regions, with a higher risk for stroke across categories of rural areas in the south but not in other geographic regions (see Table).

Conclusion:
The impact of rurality on stroke risk varies by geographic region, with a higher risk for stroke among rural zip codes in the south but not in other geographic regions. Further research is needed to characterize the causes of the variability in stroke risk across rural communities.
Abstract 4146475: Impact of Cancer on Atherosclerotic Burden and Coronary Anatomical Complexity in the Presence of Acute Coronary Syndromes: A Comparative Analysis from the BRAVADO Registry
Authors: Seleme Vinicius , Pileggi Brunna , Costa Isabela , Branco Carlos , Itala Rizk Stephanie , Lopes Maria Antonieta , Borges Diego Carter , Campos Rodrigo , de Brito Junior Fabio , GODINHO ROGER , Faillance Bruno , PRECOMA DALTON BERTOLIM , Ribeiro Marcelo , Seabra Garcez Juliane , Kalil Filho Roberto , Abizaid Alexandre , Abrahao Hajjar Ludhmila , CAMPOS CARLOS
Published: November 2024

Background:
The interaction between cancer and coronary artery disease (CAD) significantly impacts cardiovascular outcomes and disease progression. However, the impact of cancer on atherosclerotic plaque burden and coronary lesion complexity in acute coronary syndrome (ACS) have not yet been studied.

Objective:
The aim of this study is to correlates the presence of cancer e atherosclerotic plaque burden

Methods:
This is a multicenter, ambispective, observational study, based on the analysis of coronary angiographies. Data was collected between September 2016 to December 2022. Patients were categorized into three study groups: ACSC (ACS with a history of cancer), ACSNC (ACS without a history of cancer), and CCAD (chronic coronary artery disease). Patients with ACS were consecutively included while those with CCAD were randomly included. Propensity score matching between ACSC and ACSNC groups was performed.

Results:
618 patients were included, and 3,752 coronary lesions were analyzed. The mean age of the patients was 68 years, with more than 74% diagnosed with hypertension. The most common types of cancer were prostate, hematological, and colorectal cancer (
Figure 1
). Patients with acute presentations had more eccentric and ulcerated lesions, with lumen obstructions greater than 90%, involving bifurcations and resulting in worse SYNTAX and Leaman scores compared to chronic coronary artery disease (p values < 0.01 for all). Post-matching, 234 ACSC and ACSNC patients were compared, revealing heightened atherosclerotic burden in ACSC, evidenced by elevated SYNTAX scores and complex lesions (p < 0.01). This group also showed a higher prevalence of complex lesions in the proximal thirds of the vessels, with statistical correlation (p = 0.003), as shown on
Figure 2
.

Conclusion:
Cancer was associated with a greater atherosclerotic burden and greater complexity of coronary lesions in patients with ACS when compared to those without history of cancer. These findings underscore the impact of cancer on exacerbating cardiovascular complexity in ACS individuals, emphasizing the need for comprehensive management strategies in this population.
Abstract 4146478: Women with Acute Heart Failure Have Lower Intracardiac Pressures than Men Despite Similar Symptoms, Physical Findings, and Biomarkers
Authors: Gupta Prerna , Kao David
Published: November 2024

Background:
Sex differences in physiology and presentation have been well established across the heart failure (HF) spectrum. Sex differences in presentations of acute decompensated heart failure (ADHF) have not yet been well described.

Hypothesis:
Women hospitalized with ADHF present with different hemodynamic profiles than men.

Methods:
Through the NHLBI BioLINCC resource, we obtained publicly available data via the NHLBI BioLINCC resource for the ESCAPE trial, which evaluated the potential benefit of pulmonary artery catheterization (PAC) in managing ADHF. We compared \ characteristics at enrollment between men and women with respect to symptoms, physical exam, biomarkers, imaging, and hemodynamics.

Results:
Women were more likely than men to be non-white (52% vs. 36%, p=0.02) with a non-ischemic etiology (69% vs. 44%, p<0.001). Women had a worse Minnesota Living with Heart Failure physical subscore (34.6±5 vs. 32.6±6.7, p=0.008) and more physical signs of congestion (10.7±2.3 and 10.1±2.5, p=0.03). On PAC, right atrial pressure (11.1±5.8 v. 13.0±5.8 mm Hg, p=0.08), mean PA pressure (35±10 v. 38±11 mm Hg, p=0.03), pulmonary capillary wedge (22±8 vs. 25±8 mm Hg,p=0.07) were all significantly lower or trended lower in women despite similar cardiac index, and mixed venous oxygen saturations between men and women (
Image 1
). Echocardiographic correlates including right and left atrial area, mitral inflow deceleration time (161±74 vs. 138±50 ms, p=0.04) and estimated right atrial pressure (40% vs. 60% > 15 mm Hg, p=0.02) were concordant with PAC findings and consistent with lower intracardiac filling pressures in women (
Image 2
).

Conclusions:
Despite similar physical and symptomatic features on presentation, women with ADHF appear to have lower intracardiac filling pressures. This suggests that women may develop increasing symptoms with less absolute fluid retention, which could have implications for ambulatory monitoring of HF for impending decompensation.
Abstract 4146480: Implementation and Evaluation of an Electronic Health Record Rule-Based System to Identify Heart Failure Patients Eligible for Guideline-Directed Medical Therapy
Authors: Hassan Shahzad , Subramaniam Samantha , Kumar Sanjay , Unlu Ozan , Zelle David , Ostrominski John , Nichols Hunter , McPartlin Marian , Twinning Megan , Collins Emma , Figueroa Christian , Ruggiero Ryan , Fridley Echo , Varugheese Matthew , Gabovitch Dan , Cannon Christopher , Desai Akshay , Blood Alexander , Scirica Benjamin , Wagholikar Kavishwar
Published: November 2024

Background:
Despite well-established benefits on morbidity and mortality, implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) population remains suboptimal. Quality improvement interventions to improve GDMT uptake often necessitate labor-intensive manual chart reviews to identify eligible patients. To automate this process, we implemented and evaluated a Rule-Based System (RBS) designed to identify HF patients eligible for remote medication optimization program.

Methods:
To identify symptomatic HF patients for enrollment in our Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure (COPILOT-HF), an RBS was hierarchically developed to first identify HF patients meeting program criteria (Figure 1A), then exclude those with contraindications or at increased risk of adverse drug reactions. The RBS processed structured data from electronic health records (EHR) from Mass General Brigham’s enterprise data warehouse to compile a list of potentially eligible patients as per program criteria. This list was then reviewed by program staff, who manually verified patient eligibility.

Results:
A total of 5,460 patients were identified by the RBS as potentially eligible, of whom 1,754 (32.1%) were confirmed as eligible on manual chart review with positive predictive value of 47.3%. Among the false positives, 25% did not meet the program criteria for symptomatic HF, 12.4% with LVEF
>
50% were already on SGLT2i, 11.0% were too medically complex for our program, 9.8% did not have a recorded echocardiogram within 2 years, 6.6% were receiving anticancer therapies, 4.0% had outside cardiologist, 3.9% with LVEF <50% were either on GDMT or intolerant and 23.3% had other reasons for exclusion (Figure 1B).

Discussion:
These findings suggest that RBS may be a useful tool for modeling and applying guideline logic in comparison to the traditional method of querying institutional health record repositories. While the RBS demonstrated acceptable performance in mass screening for remote GDMT optimization program, future efforts should focus on improving coding and integrating the natural language processing tool for processing of clinical notes to enhance screening accuracy and efficiency.
Abstract 4146485: Clinical Validation of an AI-enabled ECG Holter Analysis Platform
Authors: Kennedy Alan
Published: November 2024

Introduction:
The analysis of Holter ECG recordings on a large scale typically demands substantial clinical resources. This investigation aimed to evaluate whether an artificial intelligence (AI)-powered Holter analysis platform could interpret ambulatory ECG recordings with comparable accuracy to that of a board-certified cardiologist.

Methods:
A total of 328 30-second ECG rhythm strips were analysed from continuous 14-day ECG patch recordings. The recordings underwent independent analysis by the AI platform (PulseAI, Belfast, United Kingdom), six individual cardiologists, and a consensus panel of three cardiologists which served as the gold standard. The presence or absence of five predetermined cardiac arrhythmias were evaluated: atrial fibrillation/flutter (AFIB), ventricular bigeminy, ventricular trigeminy, ventricular tachycardia (VT), and high-grade atrioventricular block (AVB).

Results:
The comparison between the AI platform's interpretation and that of individual cardiologists revealed no statistically significant differences in sensitivity and specificity (McNemar's Test, p>0.05). For AFIB, the sensitivity was 0.76 for the AI platform compared to 0.74 for individual cardiologists, with specificities of 0.97 and 0.94, respectively. Similarly, for AVB, the sensitivity was 0.85 for the AI platform and 0.83 for individual cardiologists, with specificities of 0.99 for both. For VT, the sensitivity was 0.71 for the AI platform and 0.78 for individual cardiologists, with specificities of 0.98 and 0.99, respectively. For ventricular bigeminy and ventricular trigeminy, the AI platform demonstrated sensitivities of 0.82 and 0.85, respectively, compared to 0.81 and 0.79 for individual cardiologists, with specificities of 0.99 for all comparisons.

Conclusions:
These results suggest that use of an AI-based platform for Holter ECG analysis can provide rapid ECG interpretation from ambulatory ECG monitors at levels equivalent to those of a board-certified cardiologist. Implementation of this AI-platform could facilitate precise, scalable, and consistent arrhythmia analysis when monitoring patients for arrhythmias.
Abstract 4146487: Prediction of New-onset Structural Heart Disease and Cardiovascular Risk Using Ensemble Deep Learning Applied to Electrocardiographic Images
Authors: Dhingra Lovedeep , Aminorroaya Arya , Pedroso Camargos Aline , Sangha Veer , Brant Luisa , Barreto Sandhi , Ribeiro Antonio Luiz , Krumholz Harlan , Oikonomou Evangelos , Khera Rohan
Published: November 2024

Background:
Despite the availability of effective pharmacological and procedural interventions, risk stratification strategies for structural heart disorders (SHDs) remain elusive. We developed an ensemble deep learning model for ECG images that predicts the development of future SHD and the risk of major adverse cardiovascular events (MACE).

Methods:
In Yale New Haven Health System (YNHHS), UK Biobank (UKB), and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we included adults without baseline cardiomyopathy or heart failure. In YNHHS, where serial echocardiogram data were available, we identified the first transthoracic echocardiogram (TTE) with SHD (LVEF < 40%, moderate-to-severe left valve diseases, or severe LVH [IVSd > 15mm and LV diastolic dysfunction]). Across all cohorts, we followed individuals till the first MACE (HF/acute MI/stroke/all-cause death). We developed an ensemble convolutional neural network model that detects cross-sectional SHD from images of ECGs. We assessed the association of this model’s output probability with future risk of SHD or MACE using adjusted Cox models and discrimination using Harrel’s c-statistic.

Results:
Among 213,652 YNHHS patients, 11,695 developed SHD and 21,929 had MACE over 4.5 years (IQR 2.5-6.6). In UKB and ELSA-Brasil, among 42,147 and 13,454 people, 768 and 338 had MACE over 3.1 (2.1-4.5) and 4.2 (3.7-4.5) years. In YNHHS, a positive AI-ECG screen portended 2.5-fold higher risk of developing SHD (age-, sex-adjusted HR: YNHHS, 2.46 [95% CI, 2.35-2.57]) in those with serial TTEs. The association was consistent after accounting for comorbidities (aHR: 2.42 [2.32-2.54]) and the competing risk of death (aHR: 2.27 [2.17-2.38]). In YNHHS, model discrimination for new-onset SHD was 0.811 (0.807-0.814). Across cohorts, a positive AI-ECG screen portended a significantly higher risk of MACE (aHR: YNHHS, 1.86 [1.80-1.93]; UKB, 2.00 [1.62-2.46]; ELSA-Brasil, 3.01 [2.16-4.20]). Model discrimination for MACE was 0.763 (0.760-0.766) in YNHHS, 0.667 (0.646-0.688) in UKB, and 0.723 (0.695-0.751) in ELSA-Brasil.

Conclusion:
Across multinational cohorts, an ensemble AI model applied to a 12-lead ECG image identified those at elevated risk of SHD and MACE. This approach represents a digital biomarker to enable scalable cardiovascular risk stratification using ECG printouts or digital images, especially in low-resource settings.
Abstract 4146499: Commercial Pricing of Percutaneous Coronary Intervention in The United States
Authors: Wei Chen , Paranjpe Ishan , Sharma Pranav , Song Nancy , lan roy , Sahu Maitreyi , Dieleman Joseph , Schulman Kevin , Sandhu Alexander
Published: November 2024

Background:
The 2021 Price Transparency Final Rule required hospitals to publicly disclose commercial prices for all medical services. Using data made available by this legislation, we investigated variation in inpatient prices for percutaneous coronary intervention (PCI).

Hypothesis:
We hypothesized that there would be substantial differences in commercial prices between and within hospitals and that this variation would be associated with factors such as market competitiveness rather than patient outcomes.

Methods:
PCI hospitalization prices (MS-DRG 247-251) were obtained from Turquoise Health and linked to hospital characteristics. The association between price and hospital factors such as the Herfindahl–Hirschman index (HHI) for market competitiveness was evaluated using linear models. We also included hospital acute myocardial infarction (AMI) specific mortality and readmission rates made publicly available by Medicare.

Results:
Median commercial prices (N = 523 hospitals) were 1.7-1.9x higher than Medicare rates (Fig 1A). Self-pay prices were 2.4-3.0x higher. There was strong price correlation across DRG codes (Fig 1B). Across hospitals, the 90th percentile price was >2.5x the 10th percentile price. Within hospitals, the 90th percentile price was 1.7-2.1x the 10th percentile price. Prices varied greatly by region, with the Pacific being the most expensive and Midwest the least. For PCI with drug-eluting stents (DRG 246-247), teaching hospitals had higher prices than non-teaching hospitals (95% CI: +$4,000-5,000) whereas investor-owned hospitals had lower prices (95% CI: -$6,000-$9,000). Higher prices were not linked to hospital readmission and mortality statistics for AMI. On a system level, less competitive markets had significantly higher markups over Medicare rates (Fig 1C).

Conclusion:
Prices for PCI hospitalization vary significantly within and between hospitals and appear associated with hospital and system-level characteristics.
Abstract 4146510: Meaningful Clinical Changes Following Endovascular or Surgical Revascularization from the Patients’ Perspective: A Health Status Responder Analysis with BEST-CLI Trial Data
Authors: Smolderen Kim , FARBER Alik , Menard Matthew , Rosenfield Kenneth , Strong Michael , Doros Gheorghe , Romain Gaelle , Cleman Jacob , Scierka Lindsey , Goodney Philip , Mena-Hurtado Carlos
Published: November 2024

Background:
Chronic limb threatening ischemia (CLTI) is a condition that profoundly impacts individuals’ health status. As attempts are made to improve perfusion and promote limb salvage, the overall goal of CLTI disease management is also to make people feel better as reflected by their health status (symptoms, functioning, quality of life) evaluations. It is unknown how many individuals with CLTI rate their health status as meaningfully changed following endovascular or surgical revascularization 1 year after the procedure.

Methods:
Secondary data analyses as a pooled cohort of the endovascular and surgical arms for the Best Endovascular versus Best Surgical Therapy in Patients with CLI (BEST-CLI) trial was conducted. Patients were recruited from 150 international sites, during 2014-2019 and completed the generic Short Form-12, EQ-5D, and the peripheral artery disease (PAD)-specific Vascuqol prior randomization and at 1 year following randomization. Using distribution-based thresholds (0.5 standard deviation of baseline health status scores) for determining a minimally clinically important difference, a descriptive analysis was performed to rate 1-year health status responses as improved, remained the same, or worsened.

Results:
A total of 1,533 patients were included, (71.9% male, mean age 66.9 ± 9.7 years). For patients’ overall physical health status (SF-12 PCS, EQ-5D Index), between 50.1-57.9% rated themselves as improved. For overall mental status (SF-12 MCS), only 39.1-44.8% rated themselves as improved. MCID improvement rates for generic health status did not differ by treatment arm (P-values >.05). When looking at PAD-specific health status, 76.2-76.8% made clinically relevant improvements (endo vs. surgical, P-value 0.823) (
Figure
).

Conclusion:
The majority of individuals with CLTI achieve clinically meaningful PAD-specific health status improvements at 1 year, regardless of type of revascularization strategy. When it relates to their overall health status, less than ½ experience improvements, especially for their mental health status, 1 in 5 actually experiences worsening. Health status rehabilitation goals following CLTI revascularization may need to be broadened to not only include lower-limb related health status, but also aim to improve overall health status with integrated disease management approaches.
Abstract 4146514: Safety and Contemporary Trends of Left Atrial Appendage Occlusion in Patients 85 Years and Older versus Less Than 85 Years
Authors: Barrera Nelson I , Chamay Salomon , Jou Katerina , Cerrud-Rodriguez Roberto , Gallegos Koyner Francisco , Di biase Luigi
Published: November 2024

Background:
There is a relative lack of comparative effectiveness research on the safety profile of left atrial appendage occlusion devices (LAAO) in patients ≥ over 85 years of age.

Hypothesis:
We hypothesize that patients who underwent LAAO older than 85 years will have similar odds of mortality and post-procedure complications when compared with younger patients.

Aim:
We aim to examine the safety of the in-hospital mortality and immediate complications of patients ≥85 years who underwent LAAO compared to those < 85 years.

Methods:
Patients undergoing LAAO from 2016-2021 were queried from the National Inpatient Sample. Using propensity score matching, patients were matched into two cohorts based on age ( ≥85 years and <85 years) in a 1:1 fashion using the ≥85 cohort as the dependent variable. In-patient mortality, post-procedure complications, and LAAO placement trends were compared using logistic regression models.

The total complication outcome summarizes pericardial, cardiac, pulmonary, vascular, renal, neurologic, and infectious complications.

Results:
136,075 patients underwent LAAO; each group included 19,015 patients. The overall mean age for the older group was 87.2 ± 1.0 years vs. 74.2 ± 5.1 years for the younger cohort. There were no associations between the two cohorts in in-patient mortality and total complications (aOR 1.40; 95% CI 0.44-4.42;
p=
0.57) and (aOR 0.89; 95% CI: 0.79-1.01;
p=
0.07). There was no significant difference in major circulatory events (aOR 0.85; 95% CI 0.75-1.01), but the odds of bleeding requiring transfusion were higher in the older cohort compared to the younger cohort (aOR 2.19; 95% CI 1.10-4.37). Overall, total complications and major cardiac, vascular, circulatory, renal, and neurologic complications were not statistically significantly different between cohorts. There was a significant increase in LAAO placement from 2016 to 2021 in both cohorts [>85
(p=
0.04);<85
(p=
0.02)]

Conclusion:
In the 2016-2021 National Inpatient Sample, patients who underwent LAAO aged ≥85 had comparable inpatient mortality and post-procedure complications to younger patients. These results contribute to the growing body of evidence supporting the safety of LAAO in elderly patients aged 85 and above.
Abstract 4146540: Clinical characteristics and mortality outcomes in a multi-ethnic cohort of Asian patients with myocarditis
Authors: Rolles May Li , Teo Yao Hao , Wong Raymond , Poh Kian Keong , Yeo Tiong-Cheng , Lin Weiqin , Kong William , Sia Ching-Hui
Published: November 2024

Background:
Myocarditis is an inflammatory disease of the myocardium associated with numerous adverse outcomes such as arrhythmias, heart failure, cardiac arrest as well as death. Clinical characteristics and mortality outcome data in myocarditis specific to Asian patients is limited.

Research Question:
To evaluate characteristics and mortality outcome amongst a multi-ethnic cohort of Asian patients diagnosed with myocarditis.

Methods:
This retrospective, single-center cohort study involved consecutive patients diagnosed with myocarditis between 2010 and 2021 in a tertiary academic center. Patient respective clinical profile, diagnostic results and outcomes were detailed. Categorical variables were compared between mortality groups using the chi-squared test, and continuous variables with t-tests or Mann-Whitney U tests.

Results:
A total of 203 patients (mean age 41.8, 40.9% female) diagnosed with myocarditis were included in the study. The prevalence of fulminant myocarditis, acute non-fulminant myocarditis and chronic inflammatory cardiomyopathy in this cohort was 31%, 67.2% and 5.5% respectively. Over a mean follow up period of 4.7 years (SD 3.5), the all-cause mortality was 17.7% (36 patients) (p=<0.001). The mortality was higher amongst female patients as compared to male patients (21.6% vs 15%; p=0.299) and the mean age was higher amongst patients that suffered from all-cause mortality (48.14 vs 40.43; p=0.036). In terms of aetiology, viral myocarditis constituted the highest proportion overall (n=100; 49%) as well as within the mortality group (n=15; 41%). The overall prevalence of chronic kidney disease, hypertension and diabetes mellitus was 5.4%, 31.5%, and 15.8% respectively. In comparison to the survival group, the mortality group had a higher prevalence of chronic kidney disease (30.6% vs 12.6%; p=0.015), hypertension (47.2% vs 28.1%; p=0.042) and diabetes mellitus (16.7% vs 3.0%; p=0.004). In terms of medication usage, compared to the survival group, the mortality group had higher usage of B-blocker (13.9% vs 5.4%; p=0.144), ACE-i/ARB (13.9% vs 10.8%; p=0.807), statin therapy (22% vs 7.2%; p=0.015), anti-diabetic medications (25% vs 12%; p=0.078),and single/dual anti-platelet therapy (13.9% vs 4.8%; p=0.1).

Conclusions:
In a multi-ethnic Asian population, increased age, female gender, hypertension, chronic kidney disease, and diabetes mellitus were associated with worse outcomes.
Abstract 4146586: NT-proBNP: A Potential Diagnostic Tool for Left Ventricular Hypertrophy in Patients with Chronic Kidney Disease in a Tertiary Hospital In Sub-Saharan Africa
Authors: Penda Sena , DZUDIE Anastase , Fouda Hermine , Ebene Romain , Halle Marie Patrice
Published: November 2024

Introduction:
Left ventricular hypertrophy (LVH) is a prognostic marker for cardiovascular events in patients with chronic kidney disease (CKD). Detecting LVH is a desirable goal in the management of CKD patients, but ECG has a limited performance and echocardiography is not always available nor is it cost-effective. NT-proBNP is a biomarker released in the setting of LVH, easily measurable but has been shown to also increase with declining kidney function. We aimed to assess the diagnostic value of NT-proBNP for LVH in CKD patients.

Research Question:
What is the diagnostic utility of NT-proBNP for left ventricular hypertrophy in CKD patients without kidney replacement therapy at the Douala General Hospital, Cameroon, Africa?

Material and Methods:
We conducted a cross-sectional analytical study at the Douala General Hospital, Cameroon between January and May 2022; 57 patients with CKD stage 2-5 without kidney replacement therapy were matched to 52 healthy control patients by age and gender. Both groups underwent NT-proBNP measurement using enzyme-linked fluorescence with Vidas, Biomerieux® equipment and a transthoracic echocardiography. Left ventricular mass index (LVMI) was assessed in accordance with American Society of Echocardiography guidelines. The correlation between LVMI and NT-proBNP was assessed, the specificity, sensitivity, negative and positive predictive values were calculated.

Results:
Overall we included 109 patients in our study. Median (IQR) age of CKD patients was 64 (51-70) years and 41 (72%) of CKD patients were male. In CKD patients, median NT-proBNP of 222 pg/ml (118 – 737) was significantly higher than in non-CKD patients, 29 pg/ml (19.5 – 53), p<0.001. Median NT-proBNP increased with CKD stage (p=0.006). In CKD patients left ventricular mass index (LVMI) and LVH frequency increased across NT-proBNP quartiles, p=0.015 and 0.031 respectively. LVMI correlated positively with NT-proBNP (r=0.36, p=0.006) in CKD patients. At a cut-off of 483.5 pg/ml, NT-proBNP area under the curve was 0.75 (0.59 – 0.91) 95 CI, with a specificity of 83%, sensitivity of 75%, positive predictive value of 63% and negative predictive value of 90% for LVH.

Conclusion:
NT-proBNP is moderately sensitive and highly specific for diagnosing LVH in patients with CKD. NT-proBNP may be used for LVH diagnosis, further studies are warranted to confirm its contribution for cardiovascular risk stratification of patients with CKD.
Abstract 4146591: Burden of Premature Ventricular Complexes is Unrelated to Prediction of Cardiomyopathy
Authors: Slaven Sarah , Garg Lohit , Healy Christina , Tumolo Alexis , Tzou Wendy , Barrett Christopher , Cerbin Lukasz , Zipse Matthew , Sandhu Amneet , Varosy Paul , Sabzwari Syed Rafay Ali , Rosenberg Michael
Published: November 2024

Background:
Premature ventricular complexes (PVCs) are commonly seen on cardiac monitoring. Several studies have suggested that frequent PVCs can directly cause cardiomyopathy. Understanding why only certain patients with PVCs develop cardiomyopathy remains a challenge. The current guidelines suggest a cutoff of 10% burden to indicate risk; other studies have suggested thresholds as low as 4% and as high as 24%. In this observational study, we aim to evaluate the association between PVC burden and cardiomyopathy in a larger population than assessed previously.

Methods:
We performed a cross-sectional analysis of >35K ambulatory monitors obtained on patients seen across the health system from April 22, 2017 and February 20, 2023. Subjects were included if they had ≥24 hours of monitoring, a PVC burden of ≥5%, and a transthoracic echocardiogram (TTE) performed within 3 months before or after monitoring. The presence of cardiomyopathy was defined as left ventricular ejection fraction (LVEF) <50%. Clinical factors including comorbidities and relevant medications were included if they were in the patient’s chart at the time of the monitor.

Results:
The population included a total of 1451 patients, with age 68.2±14.5 years, female sex in 39.6%, and main indications of PVCs (20.3%), palpitations (15.0%), paroxysmal AF (8.1%), and bradycardia (5.9%). The average PVC burden was 12.4 ±7.4% (5% - 43.4%). Of 746 subjects with a TTE, the mean LVEF was 55.6 ± 9.2% (25% - 76.8%), with 171 subjects (22.9%) having an LVEF <50%. We identified no significant association between PVC burden and LVEF (p = 0.78), nor with PVC burden and depressed LVEF (p = 0.13), with or without adjustment for risk factors. We also failed to identify a significant trend in PVC burden and EF (p=0.75), and a cutoff of 20% was not associated with an increase in depressed LVEF (OR 1.3, 95%CI 0.87 – 2.0, p = 0.20).

Conclusions:
In this analysis, we found no association between PVC burden and LV function, and could not validate the clinical cutoff of 20% as being a higher risk. These findings suggest that additional patient or PVC characteristics contributing to the development of PVC-induced cardiomyopathy have yet to be fully defined.
Abstract 4146624: Computational Fluid Dynamics-Based Investigation and Development of an Axial-Flow Ventricular Assist Device Incorporating a Toroidal Blade Geometry for Improved Hemodynamics
Authors: Siddiqi Mohammed Usmaan , Bonde Pramod
Published: November 2024

Introduction:
Ventricular assist devices (VADs) present great promise as both bridge-to-transplant and destination therapies for patients with end-stage heart failure. However, complications – such as hemolysis, thrombosis, degradation of the von Willebrand factor, and gastrointestinal bleeding – stand in the way of their widespread application. High levels of wall shear stress resulting from poor hemodynamics within the bladed flow domain are primarily responsible. Computational fluid dynamics (CFD) software was used to model the hemodynamic performance of a novel VAD with a looped, toroidal blade design intended to reduce secondary flow effects at the blade tip – and provide detailed insight into the internal flow structures, leading to the shear stress levels within.

Research Questions:
Does the elimination of the open blade tip suppress tip recirculation and improve hemodynamics? What are the implications for wall shear stress in such a device, and how can we optimize the geometry as to improve pump performance, while minimizing shear stress?

Methods:
The toroidal impeller geometry file was imported into a computer aided design (CAD) software, and the generic scanned design file (STL) was converted to a 3D CAD surface model, from which the flow domain was subsequently extracted. The model was exported to a CFD software, and simulations were subsequently run to assess pump performance and impeller hemodynamics with respect to the wall shear stress parameter.

Results:
The VAD achieved an integrated pressure output equivalent to 108.84mmHg at the preliminary target flow rate of 0.5kg/s. The pressure is in the ideal range for supporting left ventricular pumping function. The efficiency of the VAD was calculated to be about 27%, which is reasonable for a VAD micromachine. There were regions of shear stress shown to be above the hemolytic threshold of 400 Pa, however.

Conclusions:
This toroidal impeller shows promise, which can be harnessed by applying heuristic, aerodynamic design methods to improve its hemodynamics. That is, further analysis, tuning, and optimization of the blade are necessary to enhance the operating efficiency of the VAD and minimize shear stress levels – specifically, optimization of the blade geometry for more balanced work distribution and reducing profile losses, as well as optimizing the size envelope of the device, currently 25mm in diameter.
Abstract 4146630: Thyroid Hormone Supplementation for Heart Donors: a Systematic Review and Meta-analysis
Authors: Fernandes Julia , Petri Santos Pinheiro Rafael , Katsuyama Eric , Fukunaga Christian , Andrade Naieli , Prata Alonzo , Coan Ana Carolina , Scardini Pedro Gabriel , Falco Neto Wilson , Gioli-Pereira Luciana , Lopes Balsalobre Trevizan Lígia
Published: November 2024

Background:
Thyroid hormone (TH) supplementation is a well-known guideline recommendation for eligible donors of heart transplantation. However, few research data demonstrated a benefit of this therapy, and some suggest higher rates of graft failure. Therefore, we aim to expand on previous literature through a systematic review and meta-analysis comparing TH therapy to placebo in potential heart transplant donors.

Methods:
We systematically searched Embase, Pubmed and Cochrane for randomized controlled trials (RCT) and observational studies comparing TH therapy to placebo in heart donors. We focused on the following outcomes: (1) receptor graft complications; (2) all-cause mortality; and (3) retransplantation. A subgroup analysis was performed according to graft complications: (1) dysfunction; (2) failure; (3) loss; and (4) survival.

Results:
We included six studies, of which 2 were RCTs. A total of 16,452 were analyzed, of whom 10,573 (64.3%) underwent TH supplementation. The follow-up period ranged from 30 days to 10 years. The included subjects were mostly male (69.1%), with a mean age of 30.6 years. In the pooled analysis, we found no significant difference between groups in graft complications (Figure 1;RR 0.94; 95% CI 0.52-1.69; p=0.83), all-cause mortality (RR 1.13; 95% CI 0.64-2.00; p=0.67), and retransplantation rates (RR 1.21; 95%CI 0.64-2.26; p=0.55). Subgroup analysis of graft complications demonstrated similar results between groups (p=0.29).

Conclusion:
In our meta-analysis of heart transplant donors, TH therapy was associated with similar rates of all-cause mortality, graft complications and retransplantation rates compared to the placebo group. It is important that further studies be conducted to reassess the guidelines regarding the use of TH in eligible heart transplant donors.
Abstract 4146636: Intensive Hypertension Management and Incident Heart Failure Risk for Blacks versus Non-Blacks: Insights From SPRINT
Authors: Hammonds Racquel , Kazibwe Richard , Gabani Mohanad , Mirzai Saeid , Herrington David , Shapiro Michael
Published: November 2024

Background:
Despite advances in blood pressure (BP) management, Black individuals continue to have disparate rates of uncontrolled hypertension and its sequelae, including heart failure (HF). The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated lower risk of cardiovascular diseases (CVD), including HF, among high-risk, hypertensive adults randomized to intensive (systolic BP [SBP] target <120 mmHg) vs. standard (SBP target <140 mmHg) BP control.

Research Question:
We asked if Black hypertensive adults in SPRINT had a higher risk of developing HF compared to non-Black adults and if intensive BP control reduced this risk.

Aim:
We aimed to highlight the disproportionate risk of HF in Black vs. non-Black individuals and the need for more intensive BP control in this population.

Methods:
The SPRINT participants were categorized by race into Black and non-Black groups, the latter incorporating non-Hispanic Whites, Hispanics, Indians, Hawaiians, Asians, and others.

Cox proportional hazards regression models assessed the risk of incident HF adjusted for potential confounders, including age, sex, body mass index, subclinical CVD, smoking, SBP, number of anti-hypertensives, total cholesterol, aspirin use, statin use, estimated glomerular filtration rate, and BP treatment arm. Interaction testing assessed whether the effect of the BP treatment arm on incident HF risk differed by race. ARR was calculated as the difference in incident HF rates between the standard and intensive BP control groups for each racial group.

Results:
Of the 9,361 SPRINT participants, 31% identified as Black and 69% non-Black. Fully adjusted Cox regression analysis revealed increased risk of incidental HF among Black vs. non-Black participants (HR 1.45, 95% CI 1.05-2.00, p=0.002). There was no significant interaction between race and BP treatment arm for incident HF (p=0.79). Similar non-significant risk reduction with intensive vs. standard BP control was seen for Black (HR 0.78, 95% CI 0.47-1.31, p=0.35) and non-Black (HR 0.80, 95% CI 0.58-1.10, p=0.17) participants; however, ARR in incident HF was greater in Black (4.2%) vs. non-Black (3.1%) participants.

Conclusion:
Black participants had a higher risk for incident HF than non-Black participants. Despite similar relative risk reduction with intensive BP control by race, Black participants had higher ARR than non-Black participants, indicating potentially higher benefits with intensive BP control in Black individuals.