bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4131630: Comparative Outcomes of Left Atrial Appendage Occlusion Device Implantation in Atrial Fibrillation Patients with a Lower Stroke Risk
Authors: Nguyen Amanda , Zia khan Muhammad , Alruwaili Waleed , Agarwal Siddharth , balla sudarshan , Munir Bilal
Published: November 2024

Introduction:
Current guidelines recommend oral anticoagulation in atrial fibrillation (AF) patients with a CHA
2
DS
2
-VASc score ≥ 2 for stroke prevention. Left atrial appendage occlusion (LAAO) devices serve as alternatives to reduce stroke risk in select AF patients that are unable to tolerate long-term oral anticoagulation. However, Centers for Medicare&Medicaid Services reimburses left atrial appendage occlusion (LAAO) for patients with CHA
2
DS
2
-VASc score ≥ 3.

Objective:
To evaluate differences in outcomes and complications of LAAO therapy in AF patients with a CHA
2
DS
2
-VASc score of ≥ 3 versus < 3.

Methods:
National Inpatient Sample and International Classification of Diseases, 10th Revision codes were used to identify AF patients who underwent LAAO device implantation in the U.S. from 2016−2020. The study population was stratified by stroke risk into two groups, CHA
2
DS
2
-VASc ≥ 3 and < 3. Study endpoints assessed included procedural complications, inpatient outcomes and resource utilization. A multivariable logistic regression model was used to assess the independent association of CHA
2
DS
2
-VASc score with study outcomes.

Results:
A total of 73,795 and 15,500 LAAO devices were implanted in patients with CHA
2
DS
2
-VASc ≥ 3 and < 3, respectively. Compared to patients with CHA
2
DS
2
-VASc score of ≥ 3, patients with CHA
2
DS
2
-VASc < 3 had lower overall (6.9% vs 9.9%, P< 0.01) and major (4.5% vs 6.2%, P< 0.01) complications in the crude analysis. After multivariable adjustment for potential confounders, CHA
2
DS
2
-VASc < 3 was associated with lower overall complications (aOR 0.84, 95% CI 0.78 – 0.91), major complications (aOR 0.90, 95% CI 0.81-0.99) and cost of hospitalization (aOR 0.95, 95% CI 0.91-0.99).

Conclusions:
Patients with CHA
2
DS
2
-VASc < 3 had lower complications and hospitalization costs after LAAO device implantation than patients with CHA
2
DS
2
-VASc ≥ 3 . These data, if redemonstrated in a large randomized trial can have important clinical implications for stroke prevention in AF patients.
Abstract 4131796: Non-Contact Biometric System for Early Detection of Hypertension and Diabetes Using AI and RGB Imaging
Authors: Uchida Ryoko , Chen Ying , Hasumi Eriko , Fujiu Katsuhito
Published: November 2024

Introduction:
In recent years, the development of wearable devices and bioinformation analysis applications utilizing smartphone sensors has seen significant advancements. Despite these technological strides, their adoption and sustained use remain limited to health-conscious individuals. The general populace, particularly those indifferent to health management, stands to miss out on the potential benefits of wearable technologies due to a lack of engagement. This disconnect underscores the necessity for more accessible health monitoring solutions.

Research Questions and Goals:
This study aims to bridge the gap in health monitoring accessibility by introducing a system capable of non-invasive, non-contact acquisition of biometric information. Such a system seeks to democratize the early detection and prevention of diseases across various demographics.

Methods and Results:
A prospective cohort clinical study was conducted in a hospital setting with approximately 200 consenting patients and healthy controls. Images of the subjects' faces and hands were captured with a high-speed camera, and blood pressure measurements were taken simultaneously for correlation.

A machine learning algorithm was developed to analyze skin blood flow and spectral features from these images to identify potential diseases. The study specifically focused on early detection of hypertension and diabetes. Hypertension was categorized for individuals with systolic blood pressure ≥115 mmHg or diastolic blood pressure ≥75 mmHg. Diabetes was identified in subjects with HbA1c levels ≥6.5 or those previously diagnosed.

The algorithm's performance in detecting hypertension showed a 94.2% in alignment with the AHA guidelines for stage1 hypertension, based on pulse wave features. For a subset including 40% early hypertension cases, accuracy rates were 86.2% for 30-second data segments and 80.9% for 5-second segments.

For diabetes detection, the application of the algorithm to video data achieved a 75.3%, utilizing blood flow patterns as markers. Hypertension and diabetes were analyzed using different features.

Conclusions:
The integration of AI algorithms with video data analysis of skin and blood vessels demonstrates a promising avenue for the non-contact, early detection of hypertension and diabetes. This approach not only offers a viable non-contact monitoring technology, but also represents a significant leap towards inclusive, accessible health care prevention and management strategies.
Abstract 4132212: Trends in Atrial Fibrillation or Flutter Related Mortality Among Adults in the United States: Insights from CDC WONDER Database from 1999-2020
Authors: Qazi Shurjeel , Ahmad Eeman , Ashraf Danish Ali , Shaheen Fabeeha , Ahmad Tayyab , Afzal Maham , Anees Muhammad Hamza , Ahmad Bilal , Hassan Amir , Paryani Neha
Published: November 2024

Background:
Atrial fibrillation or flutter (Afib/AFL) incidence rates continue to rise and are linked to significant mortality, particularly in older populations. Our analysis examines Afib/AFL mortality trends across different demographics and regions in the U.S. from 1999 to 2020, highlighting the importance of understanding these patterns.

Aim:
To guide preventive measures that alleviate the impact of Afib/AFL and identify high-risk populations and regions, we sought to quantify trends associated with Afib/AFL related mortality in the U.S.

Methods:
We conducted a comprehensive search of death certificates from 1999-2020 using Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database focusing on Afib/AFL mortality in adults with ICD-10 codes I48. Gender, race, geographical and urban-rural parameters were investigated by calculating annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons using the Joinpoint Regression Program (Joinpoint V 4.9.0.0, National Cancer Institute).

Results:
A total of 2,581,488 deaths occurred in patients with Afib/AFL from 1999 to 2020. The AAMR displayed an abrupt rise from 2018 to 2020 (APC: 8.51; 95% CI: 4.84-10.47). Men consistently exhibited a higher AAMR (overall AAMR male: 79.4, 95% CI 79.3-79.6; female: 60.8, 95% CI 60.7-60.9). Non-metropolitan areas showed higher AAMRs than metropolitan areas (overall AAMR non-metropolitan areas: 74.9, 95% CI 74.7-75.1; metropolitan: 67.2, 95% CI 67.1-67.2). Disparities were also observed in AAMRs by region with the West region showing the highest mortality rate with a notable rise between 2010 and 2020 (APC: 3.70, 95% CI 3.30-5.37). Non-hispanic (NH) White population showed the highest mortality (overall AAMR: 74.2, 95% CI 74.1-74.3), followed by NH American Indian (AAMR: 50.3), NH Black (AAMR: 45.8), NH Asian (AAMR: 35.0) and Hispanic (AAMR: 37.9) populations.

Conclusion:
Mortality from Afib/AFL has risen from 1999 to 2020. Men, NH white populations, and residents in non-metropolitan areas and Western U.S. are at higher risk. Targeted interventions and strategic healthcare resource allocation are needed to address these disparities and improve outcomes.
Abstract 4132288: Associations Between Health-Related Social Needs and Cardiovascular Health Among US Adults
Authors: Zhang Zefeng , Jackson Sandra , Thompson-Paul Angela , Yin Xiaoping , Merritt Robert , Coronado Fatima
Published: November 2024

Background Unfavorable:
health-related social needs (HRSNs) have the potential to worsen health and wellbeing and drive health disparities. Its associations with cardiovascular health (CVH), assessed by Life’s Essential 8 (LE8), have not been comprehensively examined among US adults.

Research Questions/Hypothesis:
Whether unfavorable HRSNs are associated with worse CVH.

Goals/Aims:
To determine associations between unfavorable HRSNs and CVH in a large, diverse, nationally representative sample of US adults.

Methods:
We used the National Health and Nutrition Examination Survey 2011–March 2020 data for adults aged ≥20 years. We grouped LE8 scores as low (0–49), moderate (50–79), and high (80–100) CVH. We identified 8 unfavorable HRSNs: unemployed, low family poverty-to-income ratio, food insecurity, less than high school education, no healthcare access, no health insurance, no homeownership, and living alone. We assigned a value of 1 for the unfavorable status of each. The number of unfavorable HRSNs was summed and ranged from 0 to 8, with higher numbers indicating more unfavorable HRSNs. We categorized unfavorable HRSNs as none, 1–2, 3–4, and ≥5. We used multivariable linear and multinomial logistic regression to examine the association between HRSNs and CVH.

Results:
We included 14 947 participants (n=7340 male [49.3%]; mean [SE] age, 46.4 [0.35] years). Of those, 29.1% were categorized as having HRSNs 0, 40.4%; HRSNs 1–2, 21.5% HRSNs 3–4, and 9.0% HRSNs ≥5. The prevalence of low, moderate, and high CVH was 14.7%, 63.5%, and 21.8%, respectively. Every one-unit increase in unfavorable HRSNs was associated with 1.59 points lower LE8 scores (
P
<.001). Comparing participants with HRSNs values of 1–2, 3–4, and ≥5 to those with none, the fully adjusted prevalence ratios for low CVH were 1.42 (1.17–1.73), 2.11 (1.69–2.63), and 2.42 (1.90–3.08), respectively. The corresponding prevalence ratios for high CVH were 0.77 (0.68–0.87), 0.58 (0.49–0.67), and 0.46 (0.38–0.55). The associations were consistent across subgroups and in sensitivity analyses.

Conclusions:
A graded association exists between unfavorable HRSNs and higher prevalence of low CVH or lower prevalence of high CVH. Public health interventions targeting unfavorable HRSNs might reduce health disparities and promote CVH.
Abstract 4132291: Assessing the Efficacy of Preventive Percutaneous Coronary Intervention vs Optimal Medical Therapy for the Treatment of Vulnerable Plaque: A Meta-analysis
Authors: Mootz Nicholas , Rojulpote Chaitanya , Verma Divya , Harjai Kishore , Lin Chien-Jung
Published: November 2024

Introduction:
Rupture and thrombosis of lipid-rich atherosclerotic plaques (vulnerable plaques) contributes to majority of acute coronary syndrome (ACS). Current guidelines recommend optimal medical therapy (OMT) for stabilization of vulnerable plaques. Recent evidence of preventive percutaneous intervention (PCI) as a targeted treatment shows improvement in outcomes in these patients.

Hypothesis/Goals/Aims:
We aim to evaluate the efficacy of preventive percutaneous coronary intervention (PCI) compared to optimal medical therapy (OMT) for treatment of non-vulnerable plaque within five years of follow up from available selected randomized controlled trials (RCTs).

Methods:
PubMed, Cochrane, OVID, and NIH Clinical Trials were searched for RCTs evaluating preventive PCI compared to standard of care medical therapy. All trials reported primary common endpoints as death from cardiac cause and myocardial infarction (MI). Secondary outcomes included all-cause mortality, any revascularization, hospitalization for unstable and progressive angina, and composite death (any cause, MI, or any revascularization). Sub analyses for secondary outcomes were included if measured by RCT. A fixed effect model with Mantel-Haenszel statistical method was used to calculate risk ratios, Z scores, and a 95% confidence interval.

Results:
Ten RCTs (n=15955 patients) were included. Preventive PCI of vulnerable plaques revealed a significant benefit in lowering incidence of MI (RR: 0.86 [0.77, 0.86], p=0.01) and death from cardiac cause (RR: 0.73 [0.62, 0.86], p=0.004). Similarly, patients undergoing preventive PCI had a lower incidence of hospitalization for unstable or progressive angina (RR: 0.75 [0.62, 0.91], p<0.0001) and composite death (RR: 0.55 [0.46, 0.67], p<0.001). No difference was noted in all-cause mortality. Incidence of revascularization had a significant benefit with OMT therapy compared to preventive PCI (RR: 1.84 [1.75, 1.94], p<0.0001).

Conclusion:
Preventive PCI in vulnerable plaque demonstrates cardiovascular benefit as a result from lower incidence of MI, death from cardiac cause, composite death and fewer hospitalization for unstable or progressive angina.
Abstract 4132498: Hemodynamic and Clinical Outcomes with Balloon-Expandable Valves Versus Self-Expanding Valves in Patients with Small Aortic Annulus Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis of Randomized Controlled Trials and Propensity Score Matched Studies
Authors: Ahmed Mushood , Ahsan Areeba , Tariq Irra , Raja Mahnoor Farooq , Mahmood Asma , Tabassum Shehroze , Ramphul Kamleshun , Ahmad Adeel , Rahman Asad , Shahid Farhan , Ahmed Raheel
Published: November 2024

Background:
Transcatheter aortic valve implantation (TAVI) is thought to be more effective than surgery for patients with small aortic annulus (SAA), however, the comparative efficacy of different transcatheter heart valves (THVs) remains uncertain. The objective of this meta-analysis was to compare the effects of balloon-expandable valves (BEVs) and self-expanding valves (SEVs) on hemodynamic parameters and clinical outcomes in patients with SAA who underwent TAVI.

Methods:
A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception until May 2024 to identify eligible randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95% confidence intervals (CIs).

Results:
The analysis included 8 studies; 2 RCTs and 6 PSM studies, with a total of 2,180 patients with SAA. BEVs were associated with a smaller indexed effective orifice area (MD: -0.18, 95% CI: -0.31 to -0.05) and a higher transvalvular mean pressure gradient (MD: 5.23, 95% CI 3.44 to 7.02) than SEVs. The risk for prosthesis-patient mismatch (PPM) (RR= 1.82, 95% CI: 1.27 to 2.60) and severe PPM (RR= 2.77, 95% CI: 1.93 to 3.98) was significantly higher for patients receiving BEVs than those receiving SEVs. However, no significant difference was observed between BEVs and SEVs regarding the risk of paravalvular leak (RR= 0.98, 95% CI: 0.57 to 1.69) and the permanent pacemaker implantation (RR= 0.78, 95% CI: 0.50 to 1.23). Although patients receiving BEVs showed a slightly lower risk of major bleeding events (RR= 0.69, 95% CI: 0.49 to 0.99), BEVs were associated with a significantly increased risk of 1-year cardiovascular mortality (RR= 1.61, 95% CI: 1.05 to 2.47) compared to those receiving SEVs. However, no significant differences were observed between BEVs and SEVs regarding 30-day all-cause mortality (RR= 1.19, 95% CI: 0.57 to 2.49), 1-year all-cause mortality (RR= 1.17, 95% CI: 0.89 to 1.53), stroke rates (RR= 0.83, 95% CI: 0.52 to 1.31) and any vascular complication (RR= 1.13, 95% CI: 0.72 to 1.75).

Conclusion:
In patients with SAA, SEVs showed reduced risks of PPM and severe PPM compared to BEVs, along with a larger indexed effective orifice area. Moreover, SEVs were associated with a lower risk of 1-year cardiovascular mortality.
Abstract 4133324: Socioeconomic status, race, and ethnicity in management of pediatric SVT
Authors: Javalkar Karina , Sleeper Lynn , Newburger Jane , Dionne Audrey
Published: November 2024

Introduction:
Electrophysiology study and ablation (EPS) is often the preferred approach to management of supraventricular tachycardia (SVT) and/or ventricular pre-excitation (WPW) in older children/adolescents. There are inequities in arrhythmia management in adults, and in other areas of pediatric cardiology, but little is known about disparities in management of SVT in children.

Research question:
Do racial/ethnic and socioeconomic inequities affect referral for EPS in patients with SVT and/or WPW?

Methods:
This retrospective observational study utilized the Pediatric Health Information System of 49 children’s hospitals’ administrative data from 2016-2022. We included patients with SVT or WPW seen in the emergency department, admitted for observation, or inpatient. We excluded patients with congenital heart disease. The outcome was having a procedure code for EPS. The childhood opportunity index (COI, scale 1-100) based on zip code was used to measure socioeconomic status (SES).

Results:
Among 37,818 patients with primary diagnosis of SVT (27620, 73%) or WPW (10198, 27%), 9840 (26%) underwent EPS (Table 1). COI was higher in patients who underwent EPS than those who did not (median 59 [IQR 34,82] vs 57 [IQR 30,81]). In addition, time from initial visit with diagnosis of SVT/WPW to EPS was longer in patients with lower COI (beta= -0.026, p=0.007). Black (21.2%), Hispanic (23.8%), and American Indian (19.8%) patients were less likely to undergo EPS than White (26.5%) and Asian (28.31%) patients and those with other (28.4%) or unknown/missing (35.7%) race (p<0.001, Figure 1). In both subgroups of patients with SVT and WPW, EPS differed by race and COI, and higher COI predicted shorter time to EPS.

Conclusions:
In this hospital database of pediatric patients, we found disparities in use of EPS for the management of SVT and/or WPW. Patients of minoritized race/ethnicity and lower SES were less likely to undergo EPS.
Abstract 4134589: Evaluating risk factors of embolism in patients with cardiac myxoma: A systematic review and meta-analysis
Authors: Qureshi Muhammad Ahmad , Bakht Danyal , Ahmed Omair , Haseeb Shahan , Gupta Kartik , Baqal Omar , Hadeed khawar Mirza Muhammad , Amir Maaz , Ali Khawar , Hussain Muqaddas , Qureshi Ali Akram
Published: November 2024

Background:
Risk stratification for embolism in cardiac myxomas remains poorly explored.

Goals:
By this meta-analysis we studied the risk factors assicated with embolism among patients with cardiac myxoma.

Methods:
A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Google Scholar from their inception until January 2024. Statistical analyses were performed using Cochrane's RevMan 5.4 software. For each risk factor, the pooled odds ratio or mean difference was calculated along with the corresponding 95% confidence interval.

Results:
We included 18 studies in our analysis with a total population of 2601 out of which 525 patients (20.1%) had at least one episode of embolism. The pooled analyses showed that hypertension (p = 0.001), New York Heart Association I/II (p = 0.03), irregular tumor surface (p <0.00001), hyperlipidemia (p < 0.0001), coronary artery disease (p=0.01), high mean platelet volume (p=0.02), high tumor mobility (p<0.00001), were significantly associated with increased incidence of embolism. Female gender (p = 0.03) was the only risk factor associated with reduced risk. Other factors like smoking, atrial fibrillation, tumor size, age, body mass index (BMI), diabetes, left ventricular ejection fraction (LVEF), left atrial diameter (LAD) were not significantly associated with embolism (p > 0.05).

Conclusion:
Our study is the first to report significant pooled outcomes for gender, hyperlipidemia, coronary artery disease, mean platelet volume, and tumor mobility in the population discussed. Hypertension, New York Heart Association I/II, irregular tumor surface, hyperlipidemia, coronary artery disease, mean platelet volume and tumor mobility were significantly associated with high risk while female gender was associated with low risk of embolism. Patients with high-risk factors might benefit from early evaluation and definitive treatment (surgery).
Abstract 4134594: More than One Way to Catch a Fish: Micra Extraction Case Series
Authors: Davis Nathaniel , Prasitlumkum Narut , Mulpuru Siva , Asirvatham Samuel , Tan Nicholas
Published: November 2024

Description of Cases:
Case 1: A 72 year old male with atrial fibrillation (AF) and tachy-brady syndrome underwent Micra implantation. On post-procedure day 2, pacing thresholds were unacceptably elevated. A new Micra device was deployed; subsequently, a microsnare was placed through the Micra delivery catheter and the docking button of the old Micra was successfully snared (Figure A). The old Micra was then captured over the delivery catheter and removed from the body.

Case 2:
A 76 year old male underwent Micra implantation and AV node ablation for AF with persistent tachycardia. One month later, he presented with heart failure and interval decrease in ejection fraction from 66% to 33%. After biventricular leads were implanted, an Agilis catheter was advanced towards the Micra. The docking button was successfully snared with a gooseneck snare (Figure B), and the Micra was extracted with gentle traction.

Case 3:
A 76 year old male with complete heart block and longstanding persistent AF received a Micra. Nine months later, he presented with heart failure and interval decrease in ejection fraction from 55% to 25%. A defibrillator lead was implanted but no suitable CS branch was identified. The Aveir retrieval catheter was advanced and the Micra docking button was captured with the triloop snare (Figure C). The protective sleeve was advanced over the Micra and it was successfully removed. Subsequently, a left bundle area lead was placed.

Discussion:
Although uncommon, extraction of the tined leadless pacemaker (Micra) may be indicated at times. As rates of implantation continue to increase, establishing uniform procedures for extraction becomes increasingly important. These three cases highlight unique options for Micra extraction, and the feasibility of each approach. However, a dedicated tool and protocol would be ideal for patient safety and consistency. No complications occurred with the above cases.
Abstract 4134668: Title: Mandibular advancement device versus CPAP on cardiovascular health and quality of life in OSA a pre-specified 12 months follow up of outcomes
Authors: Ou Yi Hui , Colpani Juliana , Cheong Crystal , Loke Wei Qiang , Thant As Tar , Shih E Ching , Chan Siew-Pang , Chin Calvin , Kojodjojo Pipin , Chan Yan Yee Mark , Richards A , Cistulli Peter , Lee Ronald
Published: November 2024

Background:
Obstructive sleep apnoea (OSA) is a significant cause of hypertension. ACC/AHA Guidelines recommended screening and treatment of OSA in patients with hypertension; however, evidence comparing mandibular advancement devices (MAD) to continuous positive airway pressure (CPAP) on cardiovascular health is lacking. We present the complete 12 months follow-up data on the comparative effectiveness of MAD versus CPAP in ambulatory BP reduction, QoL, cardiac arrhythmia, and myocardial remodelling.

Method:
In a randomized, non-inferiority trial (margin 1.5 mmHg), 321 participants, aged over 40, with hypertension and high cardiovascular risk were recruited. Of these, 220 participants with OSA (apnoea–hypopnea index ≥15 events/h) were randomized to either MAD or CPAP (1:1). Pre-specified secondary outcomes include: ambulatory BP, quality of life (QoL) (sleep-specific: ESS, SAQLI, FOSQ; non-sleep-specific: SF-36, EQ-5D), ambulatory ECG monitoring, and cardiac MRI.

Results:
A total of 89 (80.9% of 110) participants from MAD, and 91 (82.7% of 110) participants from CPAP completed 12 months follow-up. The median daily usage was 5.5 hours for MAD and 4.9 hours for CPAP. The between-group difference in 24h mean BP from baseline to 12 months was - 0.57 mmHg (95% confidence interval: (-2.53 to 1.39, non-inferiority P < 0.001). Compared with the CPAP group, MAD group demonstrated a larger reduction in all the 24h with the most pronounced differences observed in the asleep BP parameters (Table 1). Both the MAD and CPAP improved QoL (Table 2). CPAP had greater improvement in FOSQ from sleep-specific questionnaires (P=0.038), and social QoL in SF-36 from non-sleep-specificl questionnaires (P=0.013). The ambulatory ECG monitoring (MAD: 2.8 ± 1.0 days, CPAP: 2.3 ± 1.1 days) showed no between-group differences in % atrial fibrillation(P=0.209), % ventricular ectopic isolated count (P=0.790) and % supraventricular ectopic isolated count (P= 0.333). The cardiac MRI sub-study (101 participants : MAD= 45, CPAP= 56) showed CPAP had greater improvement in right ventricular stroke volume (P=0.023) and MAD had greater improvement in circumferential strain favours the MAD group (P=0.015) (Table 3).

Conclusion:
At 12 months , MAD was non-inferior to CPAP for reducing 24h mean arterial BP. MAD showed greater reduction in 24h BPs, especially during asleep. While both the MAD and CPAP are effective in improving QoL, CPAP is more effective in improving FOSQ and social QoL (SF-36).
Abstract 4134851: Demographic and regional disparities in cerebrovascular disease mortality among adult patients with pre-existing atherosclerosis in the United States from 1999-2020
Authors: Qazi Shurjeel , Ansari Huzaifa , Samad Muhammad Ammar , Mahboob Eman , Qazii Sana , Ahmed Mushood , Ahmad Adeel , Rahman Asad , Ahmed Raheel
Published: November 2024

Introduction:
Atherosclerosis (ATH) is a major risk factor for cerebrovascular disease (CEVD), with persistent mortality disparities. Our study aims to identify vulnerable regions and demographics in the US adult population with pre-existing ATH at risk of CEVD.

Methods:
CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access National Vital Statistics System data from 1999 to 2020. ATH-related CEVD was identified using CEVD as the underlying cause of death and ATH as a contributing cause of death. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC).

Results:
A total of 325,408 CEVD occurred in patients with ATH from 1999 to 2020 (AAMR = 6.9, 95% CI: 6.8-7). Increased mortality rates were observed in males (AAMR = 6.3) as compared to females (AAMR = 5.1) (Figure, Panel A). AAMRs were highest in Non-Hispanic Whites [NHW] (5.7, 95% CI: 5.7 - 5.8), followed by non-Hispanic blacks [NHB] (5.5, 95% CI: 5.4 - 5.5), Hispanics (4.1, 95% CI: 4.0 - 4.1) and non-Hispanic American Indian/Alaska Native [NH-AIAN] (3.6, 95% CI: 3.4 - 3.8). Non-Hispanic Asian/Pacific Islander [NH-API] had the lowest mortality rates (3.4, 95% CI: 3.4 - 3.5). Region-wise analysis revealed that mortality rates were highest in the West (6.4, 95% CI: 6.3-6.4) and Midwest (6.2, 95% CI: 6.1-6.2). The South reported the rate of 5.5 (95% CI: 5.5-5.6), while the Northeast had the lowest rate (4.4, 95% CI: 4.3-4.4). Mortality rates were consistently higher in rural areas (6.1, 95% CI: 6.0-6.1) compared to urban areas (5.3, 95% CI: 5.3-5.4) throughout the study period. Overall AAMR rose from 9.0 in 1999 to 10.4 in 2001, then steadily declined before increasing to 3.6 from 2016 to 2020 (APC: 0.41). After an initial decline, AAMR increased in men (APC: 1.09) from 2016 and in women (APC: 5.09) from 2018. AAMR also increased among NH-API (APC: 8.9) and NHB (APC: 8.3) from 2018 onwards, and NHW (APC: 0.1) from 2016 (Figure, Panel B).

Conclusions:
Our study reveals significant mortality disparities from CEVD in patients with ATH, identifying males, NHW, and residents in the West and Midwest as particularly at increased risk. Rural areas consistently show higher mortality rates than urban areas. These findings highlight the need for targeted interventions and strategic provision of healthcare resources to improve outcomes for vulnerable populations.
Abstract 4134977: Utility of Coronary Artery Calcium Scoring in Low-Risk Patients: the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Davis Jonathan , Razavi Alexander , Ellberg Charlotte , Blaha Michael , Criqui Michael , Bhatia Harpreet
Published: November 2024

Introduction:
Coronary artery calcium (CAC) scoring is a powerful tool for atherosclerotic cardiovascular disease (ASCVD) risk assessment. Guidelines recommend consideration of CAC scoring in intermediate risk patients, but it’s utility in low and borderline risk patients is less clear.

Methods:
We used data from 2,894 participants from MESA with low (<5%) or borderline (5-<7.5%) 10-year ASCVD risk defined by the pooled cohort equations (PCE). We evaluated the association between CAC score and coronary heart disease (CHD) and ASCVD risk using multivariable adjusted Cox proportional hazard models. We also evaluated if the addition of CAC to the pooled cohort equations (PCE) improved risk prediction using Harrell’s C-index and net reclassification improvement (NRI).

Results/Data:
Mean age was 54.1 ± 5.8 years with 66.9% women. Among low-risk individuals, the ASCVD event rate was 3.3% with CAC=0, and 7.8% with CAC>0, and 4.7% vs. 11.4% among borderline-risk individuals. Natural-log transformed CAC score was associated with increased ASCVD risk in low-risk (HR 1.35, 95% CI 1.22-1.50) and borderline-risk (HR 1.29, 95% CI 1.15-1.45) individuals. Similar results were seen for CHD with higher HRs (
Table 1
). The addition of CAC to the PCE improved the C-index (SE) among low/borderline risk individuals from 0.620 (0.023) to 0.671 (0.024). Continuous NRI was also significant with the addition of CAC to the PCE in low/borderline risk (0.422, 95% CI 0.248-0.611). Greater improvement was seen for CHD (
Table 2
).

Conclusions:
The presence of CAC in low and borderline risk individuals is associated with increased ASCVD and CHD risk. The addition of CAC scoring to the PCE improved risk prediction in low and borderline risk individuals, suggesting potential clinical utility in this population.
Abstract 4135001: Right Ventricular Function and Right Ventricular-Pulmonary Arterial Adaptations in Aging Older Adults
Authors: Senthamil Selvan Vikneshwaren , WONG JIE JUN , ZHAO XIAODAN , Leng Shuang , Tan Glades , Loh Johnathan , Gao Fei , Tan Ru , Zhong Liang , Koh Angela
Published: November 2024

Background:
Compared to our understanding of left ventricular (LV) dysfunction in cardiac aging, there is far less depiction of right heart function, especially right ventricular (RV) remodelling in response to pulmonary arterial (PA) changes with aging. Given the importance of cardio-respiratory function in declining aerobic capacity with age, identifying sensitive metrics of RV function would complete our understanding of RV and RV-PA conduit adaptations in aging.

Methods:
Community older adults without cardiovascular disease underwent prospective cardiac magnetic resonance (CMR) imaging that measured RV volumes (RV end-diastolic volume, EDV; end-systolic volume, ESV), RV function (RV ejection fraction, RVEF; RV global longitudinal strain, GLS) and RV-PA coupling (end-systolic elastance to arterial elastance, computed as ratio of LV stroke volume, SV to RVESV). A RV-PA coupling threshold of >1.5 (based on prior literature) implies effective RV adaptation Aerobic capacity (VO
2
) was calculated. Multivariable regression adjusted for significant covariates.

Results:
We studied 251 participants (54.5% female, 70.78±9.07 years) with normal LV and RV function (mean LVEF, 65.13±7.51 %, RVEF, 64.25±6.98 %). RV-PA threshold of <1.5 defined poorer RV structure and function with lower RVEF (56.6 ± 3.95 vs. 67.5 ± 5.25, p < 0.001), RVGLS (28.13± 4.55 vs. 32.8 ± 5.1, p = 0.0065) and higher RVEDV index (73.2 ± 15.15 vs. 63.34 ± 12.03, p < 0.001), compared to those with RVPA > 1.5. Predictors of better RVGLS were female sex (β=0.189, adj. p=0.019), independent of systolic and diastolic blood pressure while predictors of RVESV were female sex (β=-0.433, adj. p<0.00), age (β=-0.195, adj. p<0.001) and body mass index (β=0.264, adj. p<0.001). Overall, women had better RVEF and RVGLS but lower RVSV and VO
2
(30.1±4,5 vs 37.7±5.1, ml/kg/min) compared to men (all p<0.001) (Table 1). Lower VO
2
among women compared to men was accompanied by higher RV-PA (2.1±0.7 vs 1.8±0.7, p<0.001). Female sex (β=0.233, 95% CI [0.158, 0.506, adj. p<0.001) was independently associated with RV-PA coupling on multivariable analyses.

Conclusions:
Novel CMR-derived right heart parameters defined RV function and RV adaptations as depicted by RV-PA interactions in older adults. Superior RV functions and RV-PA coupling in women may represent hemodynamic adaptations in women, despite lower aerobic capacities.
Abstract 4135023: Effect of mild hepatic impairment on the pharmacokinetics of pelacarsen
Authors: Yan Jing-He , Taylor Amanda , Clough Timothy , Burmeister-Getz Elise , Pazdirkova Marketa , Russo Cesare
Published: November 2024

Introduction:
Pelacarsen, a hepatocyte-directed, N-acetyl galactosamine (GalNAc
3
)–conjugated antisense oligonucleotide, reduces plasma lipoprotein(a) levels by inhibiting apolipoprotein(a) translation. Pelacarsen uptake is mediated by GalNAc
3
binding to the hepatocyte-specific asialoglycoprotein receptor.

Hypothesis:
It is unknown whether hepatic impairment (HI) impacts pelacarsen uptake and systemic exposure.

Aim:
This single-dose, open-label, parallel-group, Phase 1 study (NCT05026996) assessed the pharmacokinetics (PK), safety, and tolerability of a single 80 mg subcutaneous dose of pelacarsen in participants with mild HI compared to healthy controls (normal hepatic function).

Methods:
Eight adults with prior liver cirrhosis and mild HI (Child-Pugh Class A) were matched for sex, age, and body weight with nine healthy controls. PK parameters (C
max
, AUC
0-72,
AUC
last
, and AUC
inf
) were determined using non-compartmental methods. Log-transformed PK parameters were analyzed using a statistical model with group and matching covariates as fixed effects. Least-square geometric means for each group and geometric mean ratios between participants with mild HI and healthy controls were extracted. Safety was also assessed.

Results:
Pelacarsen C
max
, AUC
last,
and AUC
inf
were, on average, 7%, 37%, and 50% higher, respectively, in participants with mild HI versus matched controls. All 90% confidence intervals around the HI versus healthy control geometric mean ratios included 1 (
Table
). The ranges of all PK parameters and estimated half-lives were similar between groups. In participants with mild HI, pelacarsen exposure approached the same level as controls after eight hours post-dose (
Figure
). No serious adverse events occurred.

Conclusion(s):
In participants with mild HI, pelacarsen was well tolerated. Mild HI had no significant effect on pelacarsen C
max
. The non-statistically significant transient increase in AUC was within the exposure range tested in the first-in-human study.
Abstract 4135127: Traveling more than a 20-mile radius to a Heart Failure Center can affect the quality of Heart Failure Care.
Authors: Baksh Gladys , Ali Omaima , Haydo Michele , Velasco Claudia Mae , Reesor Heather
Published: November 2024

Introduction:
We recognized the profound importance of access to care among patients with heart failure (HF). The geographical location of HF centers may significantly impact health outcomes, especially for those with limited transportation. This social determinant of health (SDOH) aspect is critical in bridging the gap in achieving HF care.

Hypothesis/Methods:
This was a single-center observational study conducted at a tertiary heart failure center in central Pennsylvania. We assessed the impact of travel distance by comparing patients who travel within a 20-mile radius to those who travel beyond a 20-mile radius. A total of 322 patients were referred to the HF clinic and enrolled in a guideline-directed medical therapy (GDMT) optimization program. Data collected included distance to Hershey Medical Center (HMC), health insurance coverage, HF etiology, onset, and echocardiogram. The distance was calculated based on the patient’s zip code.

Results:
Among patients enrolled in the HF-GDMT program, 194 travel within 20 miles, and 128 travel beyond a 20-mile radius to HMC. The mean travel distance to HMC was 9.1 miles (within) and 40.9 miles beyond 20 miles. The majority of patients were 81.3% white, 67% male, and the average age was 64. Most patients had heart failure with reduced ejection fraction (HFrEF) at 92.9%, 63% nonischemic, and 57.5% new onset. The comorbidities in both groups were similar, including hypertension, hyperlipidemia, and coronary artery disease (CAD). When comparing both groups, those who traveled beyond the 20-mile radius to HMC had more chronic HF at 55.5% vs. 34% in patients who traveled within the 20-mile radius. Upon enrollment, most patients were on suboptimal doses of either 1 or 2 of the four pillars of GDMT for HFrEF.

Conclusions:
The findings of this study revealed that patients with HF who travel beyond a 20-mile radius to HMC are more likely to have chronic HF, suggesting a delay in seeking care. A delay in referral may affect the timely initiation of appropriate GDMT and will likely lead to worse health outcomes. This underscores the urgent need for interventions to address barriers like transportation to improve HF care, offering a potential avenue for better patient outcomes.
Abstract 4135239: Pausing Under Pressure: Ocular Hypertension as an Atypical Cause of Heart Block
Authors: Pietrini Nicholas , HYDER SYED , Hamilton David , Jasty Uma , Deshmukh Amrish
Published: November 2024

A 67-year-old male with a history of hypertension presented to the emergency department with abnormal cardiac monitor results. Prior to this, he was diagnosed with primary open-angle glaucoma by ophthalmology and underwent left-sided aqueous tube shunt placement, which was complicated by hypotony requiring revision and holding of all topical glaucoma medications. Concurrently, he was noted to have an irregular heart rhythm during a routine physical. In office ECG showed normal sinus rhythm, but subsequent 14-day continuous ECG monitor showed sinus bradycardia with nadir heart rate of 21 beats-per-minute and 114 ventricular pauses (longest 4.8 seconds) primarily due to second-degree atrioventricular (AV) block, Mobitz type 1, but also periods of high-grade AV block. He was sent to the emergency department for expedited pacemaker evaluation. On further review, heart block and ventricular pauses occurred exclusively over a 12-hour period that temporally coincided with a hospitalization for acute ocular hypertension following shunt revision. His intraocular pressure peaked at 56 mmHg (normal range 10-21 mmHg), then normalized to 21 mmHg after acetazolamide and anterior chamber paracentesis. Bradycardia resolved following ophthalmic intervention. Bradyarrhythmias were attributed to excess vagal tone from acute ocular hypertension via an atypical but recognized cause of the oculocardiac reflex, and pacemaker placement was avoided.

The oculocardiac reflex is a reflex bradycardia involving the trigeminal and vagus nerves. Cardiac effects are consistent with other vagally-mediated bradyarrhythmias, including sinus bradycardia, AV block, and even asystole. This reflex occurs commonly during traction on extraocular muscles during strabismus surgery, but can be seen in other orbital and ocular stimuli. To our knowledge, this is the first documented case of ocular hypertension leading to atrioventricular block through this mechanism. This case illustrates the importance of (1) clinical context of abnormal events during extended cardiac monitoring, (2) understanding the oculocardiac reflex as a cause of bradyarrhythmias, and (3) ruling out reversible medical causes of dysrhythmias prior to permanent device implantation.
Abstract 4135279: The Watchman Device needs to be Watched: A Case of Device Related Thrombus
Authors: Acharya Sameer , Fiema Bryan , akram ali , Depta Jeremiah
Published: November 2024

Introduction:
Left atrial appendage (LAA) harbors approximately 90% of thrombi in non-valvular atrial fibrillation (AF) for which an anticoagulant (AC) is indicated to prevent cardio-embolic stroke. Alternatively, the benefits of LAA occlusion (LAAO) devices to those patients who encounter life-threating bleeding with AC are also well established. However, the LAAO device comes with the risk of device related thrombus (DRT), which is a real challenge.

Case:
A 68 year-old-male with history of chronic AF on apixaban and recurrent ischemic and hemorrhagic stroke was evaluated for LAAO device placement procedure. Initially, when the patient was not taking AC, he had an ischemic stroke likely cardio-embolic source, which necessitated the initiation of apixaban. Unfortunately, while he was taking apixaban, he had a right thalamic bleed causing persistent left sided paresis. Subsequently, AC was held for 6 months and he underwent watchman device placement. He remained on apixaban for 45 days post procedure and was continued on aspirin only. After 10 months, on routine cardiac computerized tomographic arteriography (CTA), a large filling defect measuring 1.7 x 1.4 cm on the left atrial side of the watchman device was seen (Figure 1A) which was confirmed with transesophageal echocardiogram. Then, he was re-started on apixaban for a short period of time, which culminated him to have a right temporal bleed. After holding AC for 3 months, repeat CTA showed persistent filling defect suggestive of DRT (Figure 1B). Therefore, AC was permanently discontinued and patient was evaluated for DRT removal procedure. Utilizing a shared decision model, the option of mechanical thrombectomy with cerebral protection device (CPD) was chosen to mitigate the risk of embolic stroke. Post procedure, he was continued on apixaban 2.5 mg twice daily for 3 months and then aspirin forever. Subsequent surveillance CTA did not show DRT (Figures 1C and D). Patient has remained asymptomatic thereafter.

Conclusion:
3-7% of patients with Watchman device suffer from DRT. Life threatening bleeding from AC further complicates the management of such patients. Mechanical thrombectomy with CPD is an established procedure for the removal of intra-arterial or intravenous thrombus. However, the feasibility of the routine use of mechanical thrombectomy with CPD for persistent DRT in-patient like ours is yet to be studied in detail.
Abstract 4135289: Renal Blood Perfusion is Closely Related to Right Ventricular Volume Overload in Congestive Heart Failure
Authors: Liu Ruisi , Wang Yu , Zhao Qingzhen , Zhen Yuzhi , Li Lizhuo , Liu Chao , Li Yue
Published: November 2024

Background:
Cardiorenal syndrome (CRS) involves a bidirectional relationship where dysfunction in one organ exacerbates the other. A key factor in this interaction is the impact of right ventricular (RV) volume overload on renal blood flow, which is vital for the progression and management of heart failure (HF).

Objective:
This study aims to explore and quantify the relationship between right ventricular volume overload, i.e, echocardiographic assessments of right ventricular diameter (RVD), and the time-to-peak (TTP) of renal blood flow in patients with HF measured by 99mTc-DTPA renal scintigraphy.

Methods:
This single-center study included 304 stable, ambulatory HF patients admitted between October 2017 and August 2022. HF was diagnosed based on the 2016 ESC guidelines. Echocardiographic parameters, including RVD, and TTP of renal blood flow measured by 99mTc-DTPA renal scintigraphy, were collected. Statistical analysis was conducted using SPSS and R software, with Spearman correlation analysis used to assess the relationship between echocardiographic parameters and TTP.

Results:
The study showed there was a significant correlation between RVD and TTP (rs=0.535,
P
<0.001), indicating that RV volume overload is closely related to impaired renal perfusion. The median TTP among the study population was 27.25 seconds (IQR: 21-39 seconds). Corrected for body surface area (BSA), RVD was found to be significantly higher in patients with heart failure with reduced ejection fraction (HFrEF) compared to heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF) (HFrEF: 20.62 mm/m
2
, HFmrEF: 18.72 mm/m
2
, HFpEF: 18.09 mm/m
2
; p < 0.001). Furthermore, right atrial diameter (RAD) corrected for BSA (RAD/BSA) demonstrated the strongest correlation with TTP in the HFrEF subgroup (rs=0.602, p<0.001).

Conclusions:
Our findings highlight the significant impact of right ventricular volume overload on renal perfusion, providing valuable insights into the pathophysiology of CRS. These results suggest that therapeutic strategies aimed at reducing RV overload could enhance renal perfusion and improve overall outcomes in HF patients.
Abstract 4135434: Effect of early nutritional guidance for patients with acute myocardial infarction: A single center retrospective cohort study
Authors: Abe Hiroshi , Miyazaki Tetsuro , Yasuda Kentaro , Ishiwata Sayaki , Maki Masaaki , shimai ryousuke , Isogai Hiroyuki , Ozaki Dai , Nishiyama Hiroki , Takasu Kiyoshi , Takamura Kazuhisa , Tokano Takashi , Minamino Tohru
Published: November 2024

Introduction/Background:
Acute myocardial infarction (AMI) stands as a major global cause of mortality. Various intervention strategies, such as pre-hospital care, reperfusion therapies, pharmacological interventions, dietary modifications, and exercise therapies, have been researched to improve patient prognosis.

Research Question:
There remains a lack of evidence regarding the impact of early nutritionist-led dietary guidance on the prognosis of AMI patients.

Aim:
This study aimed to elucidate whether nutritional guidance by nutritionists who have national qualifications would improve the mortality and the primary composite endpoint (including acute decompensated heart failure, stroke, and acute coronary syndrome) of patients following an acute myocardial infarction.

Methods/Approach:
A retrospective cohort study enrolling 409 AMI patients who underwent emergency percutaneous coronary interventions between September 1, 2015, and October 31, 2023. Nutritionists guided 223 patients (54.5%) during hospitalization in this study. The nutritional guidance used in our study was also based on the definition of adequate caloric intake of 25–30 kcal per ideal body weight (kg). Under an appropriate total energy intake, a fat energy ratio of 20–25% and a carbohydrate energy ratio of 50–60% are recommended, with protein and lipid restrictions depending on the disease state.

Results/Data:
During a median follow-up of 39 months, 24 cases of all-cause mortality (5.9%) and 6 cases of cardiovascular mortality (1.5%) were recorded. Kaplan–Meier curves demonstrated significantly higher incidence rates of death and primary composite endpoints among patients without nutritional guidance during hospitalization. The multivariate Cox regression model revealed early nutritional guidance as a significant predictor for long-term mortality but not for primary composite endpoints. Furthermore, undernourished patients, defined as those with a geriatric nutritional risk index of 98 or less, showed a similar prognosis to those with good nutritional status after receiving nutritional guidance, indicating that nutritional guidance improves prognosis.

Conclusion:
Nutritionist-led dietary guidance for patients with AMI can potentially improve total mortality and is expected to be more effective in undernourished patients. Further research is warranted to explore the physiological impacts of improved diets resulting from such guidance and their effects on enhancing prognosis.