bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145454: Clinical and Hemodynamic Predictors of Stabilization and Associated Complications in Patients with Cardiogenic Shock Supported with Impella 5.5
Authors: Blumer Vanessa , Abraham Jacob , Li Borui , Kanwar Manreet , Garan Reshad , Sinha Shashank , Hernandez-Montfort Jaime , Burkhoff Daniel , Kapur Navin
Published: November 2024

Background:
Despite widespread use of the Impella 5.5 to support patients with cardiogenic shock (CS), the identification of patient profiles that benefit the most from this intervention remains a challenge. Understanding the clinical and hemodynamic characteristics associated with successful outcomes is crucial for optimizing patient selection and management.

Methods:
Using data from a comprehensive registry of 508 patients, we evaluated clinical stabilization among those receiving Impella 5.5 for CS. Clinical stabilization was defined as weaning from the Impella 5.5 without escalation to additional mechanical circulatory support and discharge from the hospital alive, or bridging to durable heart replacement therapy (HT or LVAD) without further escalation of support.

Results:
Of the 508 patients analyzed, 30.7%(N=156) achieved clinical stabilization. The mean age of the cohort was 58.4±12.6 years, with 83.7% being male. Heart failure-related cardiogenic shock (HF-CS) was present in 69.5% of the patients. No significant demographic differences were observed between the stabilization and deterioration groups (p>0.05). Patients who stabilized were more likely to have HF-CS (p<0.001) and lower incidence of out-of-hospital cardiac arrest (OHCA)(p<0.001). Higher pulmonary artery pressure (mPAP, p=0.02) and pulmonary capillary wedge pressure (PCWP, p<0.001) were significant predictors of stabilization. The presence of implantable cardioverter-defibrillators (ICDs) was more common in stabilized patients (p=0.01). Major complications such as stroke (stabilization:3.8%, deterioration:6.1%, p=0.3), limb ischemia (stabilization:1.9%, deterioration:7.4%, p=0.02), and bleeding requiring surgery (stabilization:7.7%, deterioration:12.8%, p=0.09) were observed. Notably, bleeding requiring transfusion was significantly higher in the deterioration group (41.5% vs. 30.1%,p=0.02). The median duration from Impella 5.5 insertion to heart recovery or discharge was 15.1 days (IQR:7.7-29.1 days).

Conclusions:
Among patients with CS supported with the Impella 5.5, those with HF-CS, higher pulmonary pressures, and the presence of ICDs are more likely to achieve clinical stabilization. Significant complications, including bleeding and limb ischemia, remain a concern and require careful management. This study highlights the importance of detailed pre-implant hemodynamic assessment and suggests that targeted management strategies based on these predictors could improve patient outcomes.
Abstract 4145460: Takotsubo syndrome and sports: a systematic review
Authors: Li Pengyang , Lu Xiaojia , Li Chenlin , Teng Catherine , Shi Ao , Wang Bin
Published: November 2024

Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction and a presentation resembling that of acute myocardial infarction. An increasing number of studies has shown physical stress as a trigger for TTS. Here, we comprehensively reviewed the literature and examined the available evidence for TTS patients triggered by sports. After searching PubMed, Embase, Web of Science and Scopus databases, two investigators independently reviewed 837 studies published through July 24, 2023. Of these studies, 21 met the inclusion criteria (n = 23 patients), including 9 patients with exercise stress test, 14 patients with daily physical activity. In Sports-trigger TTS patients, the most common TTS symptom was dyspnea (69.57%), followed by chest pain (52.17%) and diaphoresis (13.04%). The most common type of TTS was apical, accounting for 69.57% of cases, followed by the midventricular (21.74%) and basal (8.70%) types. The overall mortality rate for Sports-trigger TTS patients was 0.00%. Exercise stress test (39.13%), swimming (21.74%) and diving (21.74%) are the most frequently identified physical activity triggers of TTS. Sports is a potential etiology of TTS patients, rare but it is associated with excellent prognosis. Furthermore, the diagnosis of TTS must be considered in patients with typical symptom after sports. Future prospective studies are needed to establish appropriate guidelines for avoiding TTS during sports and the appropriate exercise prescription for Sports-trigger TTS patients to recovery.
Abstract 4145465: A Bridge from Sweet to Sour: A Case of Recurrent Myocardial Stunning in Diabetic Ketoacidosis
Authors: Satish Vikyath , Maliha Maisha , Chi Kuan Yu , Sunil Kumar Sriram , Borkowski Pawel , Vyas Rhea , Rodriguez Szaszdi David Jose Javier , Kharawala Amrin , Seo Jiyoung , Pargaonkar Sumant , Slipczuk Leandro , Schenone Aldo
Published: November 2024

Background:
Myocardial bridging (MB) is a common congenital anomaly wherein a coronary artery segment takes an intramyocardial course. While often benign, MB may be associated with myocardial ischemia/stunning (MS), acute coronary syndromes (ACS), or even sudden cardiac death during periods of increased cardiac demand.

Case presentation:
A 47-year-old male with a history of type 1 diabetes mellitus was admitted to the Intensive Care Unit for diabetic ketoacidosis (DKA). He complained of epigastric pain with an electrocardiogram showing transient ST-elevation in the anterior and inferior leads. Cardiac troponin showed an upward trend with a peak of 0.202 ug/L and an elevated NT-proBNP of 5,014 pg/mL. A transthoracic echocardiogram (TTE) revealed left ventricular systolic dysfunction (LVEF 40%) with akinesis of the mid to apical anterior and septal walls, consistent with the left anterior descending (LAD) artery territory. Emergent left heart catheterization (LHC) revealed patent coronary arteries with severe mid-LAD MB with TIMI 3 flow. He was managed conservatively with guideline-directed medical therapy for heart failure, and subsequent TTE nine months later showed normalization of LV wall motion (LVEF 65%). Five months later, the patient was readmitted for DKA with elevated troponin. A repeat TTE demonstrated LV systolic dysfunction (LVEF 35%) with wall motion abnormalities (WMA) mirroring the initial presentation.

Discussion:
Our patient presented with recurrent episodes of ACS/MS complicated by LV systolic dysfunction along the LAD territory during periods of DKA, a known stressor for myocardial ischemia. The absence of obstructive coronary atherosclerosis on LHC, coupled with severe mid-LAD MB, suggests that the MB was the likely culprit for recurrent ACS/MS. Although stress cardiomyopathy was considered a differential diagnosis, this was less likely given the uncharacteristic pattern of WMA sparing the apical lateral and inferior walls as opposed to apical ballooning and the presence of an alternative diagnosis.

Conclusion:
This unique case underscores the importance of recognizing MB as a rare but potential cause of ACS/MS and LV dysfunction in patients with precipitating stressors such as DKA.
Abstract 4145471: Global And Regional Burden Of Alcoholic Cardiomyopathy From 1980 To 2021: An Analysis Of Global Burden Of Disease (GBD) Study 2021
Authors: Rehman Wania , Shaukat Muhammad Talha , Rehman Aqeeb Ur , Mohsin Aleenah , Rahman Saad Ur , Abbott Jinnette , Nanda Navin
Published: November 2024

Background:
Alcoholic cardiomyopathy (ACM) is induced by chronic alcohol consumption and is a predominant cause of non ischemic dilated cardiomyopathy. Here we evaluate the trends of ACM from 1980 to 2021, while focusing on locoregional variations which will help identify the areas with the highest disease burden and guide future investigation into underlying causes.

Methods:
Data extraction from the Global Burden of Diseases (GBD) study encompassed age-standardized death rates (ASDR), Years of Lost Life (YLL), and disability-adjusted life years (DALYs). The dataset was globally stratified by continent and by World Bank income classification. Joinpoint Regression was employed to determine average annual percentage changes (AAPC).

Results:
Globally, the prevalence of alcoholic cardiomyopathy decreased from 1990 to 2021, with an AAPC of -0.80 (95% CI -0.82 to -0.78). However, the ASDR had a fluctuating trend from 1980 to 2021. Intermittent spikes in ASDRs could be observed, with the most prominent ones seen from 1991 to 1994 (Annual Percentage Change =9.71; 95% CI 6.1-11.3) and 2002 to 2005 (Annual Percentage Change =12.54; 95% CI 9.2-14.4). Overall, however, the global ASDR decreased from 1980 (ASDR=1.3) to 2021 (ASDR=0.7) with an AAPC of -1.48 (95% CI - 1.5 to -1.3). Similarly, disability-adjusted life years (DALYs) and age-standardized Years of Lost Life (YLL) also declined over this period [(AAPC=-1.03; 95% CI -1.25 to -0.82) and AAPC= -1.14 (95% CI -1.26 to -1.03) respectively]. In continent-wise analysis, North America and Europe had higher ASDRs, while Asia and Africa had lower ASDRs throughout the analysis. It was observed that irrespective of ASDRs, all continents independently had a decreasing trend in alcoholic cardiomyopathy mortality. According to world bank income levels, low- and lower- middle-income countries had higher death rates than high- and upper-middle income countries.

Conclusions:
Global trends in alcoholic cardiomyopathy (ACM) from 1980 to 2021 reveal fluctuating mortality rates, with substantial intermittent surges. Despite declining DALYs and prevalence, low-income and lower-middle-income nations have persistently high death rates which underscores the need for targeted interventions to address this concerning disparity.
Abstract 4145478: When a Cutie Takes Your Breath Away: A Case of Cutibacterium Acne-induced Pericardial Effusion
Authors: Wasef Natale , Benjamin Patrick , Stys Adam
Published: November 2024

Introduction:
Pericarditis is an inflammation of the pericardium, a thin sac-like membrane surrounding the heart, which can progress to life threatening cardiac tamponade. It can be caused by infections (viral, bacterial, fungal, or parasitic), autoimmune conditions, injuries, or underlying medical conditions. Common symptoms include chest pain, fever, shortness of breath, and fatigue. In the case presented, the patient suffered from a severe form of pericarditis caused by a rare infectious etiology, leading to the development of cardiac tamponade.

Case Summary:
A 29-year-old female with type II diabetes and hypothyroidism presented with a week of shortness of breath, chest pain, lightheadedness, and loss of consciousness. Workup showed WBC (20.6), CRP (283), and ESR (85). Echocardiogram revealed a large pericardial effusion with right ventricular collapse, indicating cardiac tamponade. She underwent pericardiocentesis, draining 400 ml of exudative fluid. Unfortunately, the effusion rapidly re-accumulated, requiring a pericardial window procedure with drainage of fibrinous, loculated fluid over 2 days, improving her symptoms. She was discharged on colchicine and NSAIDs, however she returned 5 days later with recurrent symptoms and fever. The culture of the previous fluid showed Cutibacterium acne. Histopathology of pericardial biopsy revealed fibrinoid pericarditis. She was treated with ceftriaxone, and transitioned to doxycycline for 14 days, along with 14 days of ibuprofen and 3 months of colchicine. At 3-month follow-up, she was asymptomatic with no effusion recurrence.

Conclusion::
As bacterial pericarditis cases rise, the initial work-up should include investigating bacterial etiology. This raises the question of antibiotic coverage for patients presenting with pericardial effusion until bacterial etiology is excluded and also advocate for elective pericardiocentesis in bacterial effusions without tamponade physiology.
Abstract 4145490: Direct Oral Anticoagulants versus Low Molecular Weight Heparins for Prevention of VTE in Active Malignancy: Insights from a Pooled Analysis of RCTs
Authors: Alam Mustafa
Published: November 2024

Background:
Cancer is well known to cause a pro-thrombotic state, however, the pharmacologic therapy for prevention of Venous Thromboembolism (VTE) remains under contention. Direct Oral Anticoagulants (DOACs) and Low Molecular Weight Heparins (LMWHs) remain the mainstay treatment to prevent VTE in active malignancy. The purpose of this pooled analysis is to clarify the safety and efficacy of DOACs and LMWHs in the prevention of VTE and the risk of bleeding.

Methods:
A systematic search of MEDLINE was conducted using PRISMA guidelines using the search terms “DOAC”, “VTE”, “LMWH” and “Cancer OR Malignancy”. Studies were only included if they were prospective and randomized with a control group. Clinical characteristics of patients and outcomes were aggregated according to the Cochrane Manual. A random effects model using clinical events as dichotomous variables and was utilized to calculate Odds Ratios with 95% confidence intervals. Revman 5.3 was used to aggregate outcomes and statistics.

Results:
A total of 3880 patients were included in this analysis. Solid organ tumors remained the most enrolled malignancies included in the trials, with gastrointestinal malignancies being the most common. Apixaban, Rivaroxaban, Edoxaban, and Dalteparin were compared in these trials. There was a significant reduction in VTE in favor of the DOACs (OR: 0.64 [0.49, 0.82], P=0.0004). There was no significant difference in major bleeding between DOACs and LMWH (OR: 1.22 [0.80, 1.86], P= 0.36). There was a significant increase in Clinically Relevant Non-Major Bleeding in the DOAC group (OR: 1.68 [1.3, 2.17], P<0.0001). There was no significant difference in All Cause Death (OR: 1.02 [0.88, 1.18], P=0.78).

Conclusion:
DOACs significantly reduced VTE as compared to LMWHs at the expense of an increase in Clinically relevant Non-Major Bleeding. Shared decision making should be utilized with the patient to balance the risks of VTE versus bleeding. Further trials are needed to confirm the safety and efficacy of anticoagulation with differing types of malignancies to guide VTE treatment.
Abstract 4145495: Arrhythmia Risk in Healthy Young Adults Who Co-use Electronic Cigarettes&Cannabis
Authors: FONG REECE , Sanchez Joshua , Lopez Samuel , Zhao Kevin , Cooper Ziva , Gornbein Jeffrey , Middlekauff Holly
Published: November 2024

Background:
Tobacco cigarette (TCIG) smoking is the most prevalent modifiable risk factor for cardiovascular (CV) disease, including sudden arrhythmic death. Although TCIG smoking among current young adults has never been lower, cannabis smoking and co-use of cannabis and electronic cigarettes (ECIG) now approaches 50%. The arrhythmia risk associated with cannabis smoking and potential amplification of risk through co-use with ECIGs remain largely unknown.

Purpose:
To test the hypothesis that arrhythmia risk as estimated by abnormal ventricular repolarization is increased in people who smoke cannabis and amplified by ECIG co-use.

Methods:
Three groups were assessed in a parallel group comparison study: 1) chronic (≥ 1 year) ECIG and inhaled cannabis co-users, 2) chronic exclusive cannabis smokers, and 3) control non-users. Participants were healthy adults aged 21-30 who do not smoke TCIGs. Participants fasted and abstained from ECIGs, cannabis, caffeine, and exercise for 8 hours before the study. Blood pressure (BP) and heart rate (HR) were recorded, followed by 12-lead ECG recordings for 5 minutes in supine position. ECG recordings were then analyzed for T(peak-end) (Tp-e) interval as well as Tp-e/QT and Tp-e/QTc ratios as a measure of ventricular repolarization and predictors of arrhythmia risk.

Results:
A total of 134 participants were enrolled (49 Controls, 59 Exclusive Cannabis, 26 ECIG/Cannabis Co-users). Subgroups did not differ by sex (54% F), age (24.1±2.9 y), BP, or HR. The Tp-e interval was significantly shorter in the cannabis/ECIG co-users compared to both exclusive cannabis smokers and control non-users (Figure panel A). Overall, ventricular repolarization tended to be shorter in co-users compared to both other groups (Figure panels B&C).

Conclusion:
In otherwise healthy young people, chronic cannabis/ECIG co-use impacts ventricular repolarization in the direction not typically associated with increased arrhythmia risk. The clinical implications of Tp-e shortening in co-users require further investigation. Additionally, these outcomes only provide a glimpse of the implications of cannabis and ECIG co-use, and other outcomes of CV risk warrant investigation.
Abstract 4145507: Impact of Angiotensin-I-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Carotid Plaque Composition Assessed By MRI
Authors: Wiley Karlo , Anker Allison , Martinez Torres Ana , Kozdag Gold Guliz , Vivoni Alejandro , Sanina Cristina
Published: November 2024

Background:
Carotid artery stenosis is a well-established risk factor for ischemic stroke, contributing to 10-20% of strokes or transient ischemic attacks. Currently, MRI is the gold standard in carotid plaque imaging due to its high resolution and high sensitivity for identifying intraplaque hemorrhage, ulceration, lipid-rich necrotic core, and inflammation. The purpose of the study is to determine the effects of Angiotensin-I-converting enzyme inhibitors(ACEIs) and Angiotensin receptor blockers (ARBs) on carotid plaque characteristics.

Methods:
Before elective carotid revascularization 30 patients (mean age 72±8 years; 16 males, 14 females) underwent 3-T MRI. After localization of the carotid bifurcation using phase contrast imaging, Time-of-Flight, 3D T1 weighting, transverse T1 and T2 weightings and proton density sequences were acquired. The different plaque components: lipid core, intraplaque hemorrhage, calcification and the characterization of the fibrous cap were assessed. 16 patients were on ACEIs or ARBs.

Results:
MRI demonstrated that although 25% of patients who were on ACEIs or ARBs had lipid-rich necrotic core, 71% of patients who were not on ACEIs or ARBs had lipid-rich necrotic core. While 9 (90%) males who were not on ACEIs or ARBs had lipid rich necrotic core, 1 (25%) female who was not on ACEIs or ARBs had lipid rich necrotic core, p=0.015. There was no gender difference for lipid rich necrotic core in patients who were on ACEIs or ARB.

Conclusion:
This study demonstrated that patients receiving ACEIs or ARBs had less lipid rich necrotic core in the carotid plaques compared to patients not receiving ACEIs or ARBs. Additionally, patients with lipid-rich necrotic core who were not on ACEIs or ARBs were mostly males.
Abstract 4145513: Substrate Characterization and Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Non-Ischemic Dilated Cardiomyopathy and Isolated Apical Scar
Authors: Liao Yi Wen Becky , Baranowski Bryan , Bhargava Mandeep , Callahan Thomas , Chung Mina , Courson Jeff , Dresing Thomas , Higuchi Koji , Hight Nolan , Hussein Ayman , Kanj Mohamed , Kochar Arshneel , Koeth Robert , Lee Justin , Martin David , Mayuga Kenneth , Nakhla Shady , Rickard John , Saliba Walid , Sroubek Jakub , Taigen Tyler , Varma Niraj , Wazni Oussama , Santangeli Pasquale
Published: November 2024

Background:
Patients with non-ischemic dilated cardiomyopathy (NIDCM) and ventricular tachycardia (VT) typically have a basal perivalvular substrate with predominant antero-septal or infero-lateral distribution. Isolated apical substrate responsible for VT in NIDCM has not been previously characterized.

Objectives:
The purpose of this study is to characterize the prevalence, characteristics and catheter ablation outcomes of NIDCM with isolated apical VT substrate.

Methods:
Patients with NIDCM and VT from an isolated apical scar were identified from a prospective registry of consecutive patients with NIDCM undergoing VT ablation between 2018 and 2023. Isolated apical scar was defined as apical abnormal bipolar low voltage area (LVA, <1.5 mV for the endocardium, <1.0 mV for the epicardium with abnormal electrograms) demonstrated to participate in VT with activation, entrainment and/or pace mapping in the absence of abnormal electroanatomic substrate in other LV segments. Patients with hypertrophic cardiomyopathy were excluded.

Results:
Out of 208 patients with NIDCM and VT undergoing catheter ablation during the study period, 5 (2.4%; age 52±10 years, LVEF 37±12%) had isolated apical substrate and underwent a total of 8 ablation procedures (2 endocardial, 6 endo-epicardial). One patient had isolated apical scar on pre-procedural cardiac MRI. All patients had both endocardial and epicardial scar identified. At the end of the procedure, non-inducibility of any VTs was achieved in all cases. After a median follow-up of 11 months (range 6-14 months) after the last procedure, there were no deaths and all patients remained free from recurrent VT.

Conclusion:
In patients with NIDCM, isolated apical VT substrate is rare. Endo-epicardial catheter ablation is typically needed in these patients and is associated with good VT control over follow-up.
Abstract 4145520: Comparison of Percutaneous Coronary Intervention vs Coronary Artery Bypass Graft for Left Main Coronary Artery Disease in Patients with Prior Cerebrovascular Disease: A Systematic Review and Meta-analysis
Authors: Qazi Shurjeel , Majid Muhammad , Ali Syed Hassaan , Ansari Huzaifa , Qazi Sana , Asghar Muhammad Sohaib , Bhalla Jaideep Singh , Amsterdam Ezra , Klein Allan
Published: November 2024

Background:
The previous literature reports similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disease (CEVD) in such patients. Thus, our aim is to compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing either PCI or CABG.

Methods:
A comprehensive search of electronic databases, PubMed, SCOPUS, and Cochrane Central was conducted from their inception till May 2024. Outcomes of interest included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), Myocardial Infarction (MI), and risk of stroke in patients undergoing either PCI or CABG for LMCAD. Data were pooled and analyzed using a random effects model and presented as hazard ratios (HR) along with their 95% confidence intervals (CI). Heterogeneity was quantified using the I(2) index.

Results:
We included three studies in our analysis (n = 5,732). Our analysis demonstrated that in patients with prior CEVD, PCI lead to significantly increased risk of MACCE (HR = 2.56, 95% CI:[1.23, 5.37], p = 0.01] and MI (HR = 2.97, 95% CI: [1.72, 5.13], p< 0.01). While an elevated risk of all-cause mortality (HR: 1.35, 95% CI: [0.92, 1.98]; p = 0.12) and repeat stroke (HR: 1.67, 95% CI: [0.81, 3.42], p = 0.16) was observed, these were comparable across procedures. Similarly, an elevated but comparable risk of repeat revascularization was observed between the two procedures (HR: 3.44, 95% CI: [0.50, 23.60]; p = 0.21).

Conclusion:
Our results show that PCI significantly elevates the risk of MACCE and MI in patients with prior CEVD compared to CABG. However, risks of all-cause mortality, repeat stroke, and revascularization were comparable. The increased risk of adverse CV events in CEVD patients may be due to co-morbidities like hypertension, smoking, diabetes, peripheral vascular disease, renal insufficiency, inflammation, and hypercoagulability. We recommend including prior CEVD in pre-operative assessments for revascularization and developing novel strategies for patients with LMCAD and prior CEVD.
Abstract 4145538: Components of the Environmental Justice Index are Associated with Hypertension in Adolescents: Analysis of PEDSnet Data
Authors: Baker-Smith Carissa , Zhang Zugui , Falkner Bonita , Akins Robert
Published: November 2024

Introduction:
The Environmental Justice Index (EJI) uses data from the U.S. Census Bureau, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention to rank the cumulative impact of environmental injustice on health for every Census tract. Cross-sectional studies in adults identify an association between cumulative environmental burden and hypertension (HTN) in adults. The aim of this study is to examine the relationship between environmental injustice exposure, using the EJI, and HTN in youth.

Hypothesis:
Greater cumulative exposure to environmental toxins is significantly associated with HTN status in adolescents, adjusting for other demographic and socioeconomic factors.

Methods:
Using PEDSnet (a PCORI-funded aggregate of pediatric health data) data from 2009 to 2019 and geocoded EJI, we modeled the relationship between HTN and components of the EJI, adjusted for area deprivation index (ADI; scaled 1-100) terciles (ADI < 25 = best/low, 25-52, > 52 = worst/high); where ADI of 52 represents the upper quartile ADI for the state of Delaware. The HTN status of each youth, 13 to 17 years of age, was classified into three levels: Normal: SBP ≤ 120 + DBP < 80; Elevated: SBP 120-129 + DBP < 80; and HTN: SBP ≥ 130 or DBP ≥ 80. Multinomial logistic regression was used to analyze HTN status as the outcome and EJI index components and other covariables as predictors.

Results:
Among the 122,177 youth, 51% were female, 58% were non-Hispanic white, and 22% were non-Hispanic Black. Twenty-four percent lived in neighborhoods with ADI < 25, and 35% lived in neighborhoods with ADI
>
52. Female sex and private/other insurance were associated with lower odds of HTN and elevated BP (ref= normal BP). Compared to ADI < 25, ADI > 52 was associated with 35% and 21% greater odds of having HTN or elevated BP, respectively. For each unit increase in the Air Toxins Respiratory Hazard Index, the odds of having HTN vs. normal BP was 2.83 times higher, and the odds of having elevated BP vs. normal BP was 1.81 times higher. For each unit increase in the Air Toxics Cancer Risk or Lead Paint Index, the odds of having HTN vs. normal BP was significantly higher (Table).

Conclusions:
Environmental toxin exposure is associated with greater odds of HTN in adolescents. Analysis of HTN and environmental injustice is an important step toward reducing HTN burden, beginning in youth.
Abstract 4145615: Impact of Acute Coronary Syndrome on Hospitalization Outcomes in Young Adults with Substance Use Disorder: A Nationwide Analysis (2016-2020)
Authors: Subramanian Lakshmi , Srikanth Sashwath , Devaprasad Nikitha , Liu Jinye , Podduturi Pavan Vihar Reddy , Shan Zoofi , Jindal Urmi , Patel Divyank , Desai Rupak
Published: November 2024

Background:
Substance use disorder (SUD) is increasingly prevalent among young adults, often leading to severe cardiovascular complications. The specific impact of acute coronary syndrome (ACS) on young adults with SUD is not well-documented. We aimed to investigate the impact of ACS on young adults with SUD by comparing demographics, comorbidities, and in-hospital outcomes between those with and without ACS.

Methods:
We used the 2020 National Inpatient Sample (NIS) database to identify hospitalizations of young adults (18-44 years) with SUD and categorized them into those with and without ACS using ICD-10 codes. We compared demographics, comorbidities, all-cause mortality (ACM), and cardiogenic shock between the two groups. Multivariable regression analysis was performed to compare outcomes.

Results:
A total of 4,132,379 weighted hospitalizations of young adults with SUD were included in our study, of which 0.7% (n=30,955) had ACS. The population in the ACS group was older (median age 37 years vs. 32 years), more often had males (71.5% vs. 52.2%) and blacks (26.3% vs. 20.6%), and less often consisted of whites (56.7% vs 64.5%) compared to the no-ACS group. The ACS group had higher rates of hyperlipidemia, hypertension, diabetes, obesity, and peripheral vascular disease compared to the no-ACS group. Interestingly, tobacco and alcohol use disorders were more common in the no-ACS group (Table 1). The ACS group was also associated with higher hospital costs. Patients with ACS suffered significantly higher odds of ACM (aOR 10.16, 95% CI 8.96-11.53) as compared to those without ACS. Over the five years from 2016 to 2020, the rates of ACS admissions among young adults with SUD remained largely unchanged. (all p<0.001).

Conclusion:
In this large nationwide analysis, ACS was associated with a significantly higher risk of ACM in young adults with SUD. Further research is essential to validate this data and develop effective strategies to improve outcomes for this vulnerable population.
Abstract 4145631: A Rare Case of Sequential Impella Mechanical Failures due to Infective Endocarditis Vegetations
Authors: Sawalski Cathryn , Seu Michelle , Darki Amir
Published: November 2024

Description of Case:
A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chest pain and found to have ST elevations. Urgent angiography revealed complete occlusion with thrombus of the proximal left anterior descending (LAD) coronary artery. The patient underwent aspiration thrombectomy, followed by intracoronary vasodilators, without improvement of flow. Due to ongoing shock despite initial mechanical support, the patient was escalated to an Impella CP device after a transthoracic echo confirmed no left ventricle thrombus. Once stabilized, intravascular ultrasound showed significant thrombus and plaque in the LAD. This was treated with a drug-eluting stent, but TIMI 3 flow was not achieved. The patient was placed on an integrilin drip with plans to reevaluate in 24 hours. While preparing for transport to the cardiac ICU, the Impella device malfunctioned, and function could not be restored. With ongoing hemodynamic collapse, a second Impella device was placed, but it malfunctioned almost immediately, and the patient suffered a pulseless electrical activity arrest. Advanced Cardiac Life Support was initiated, but the patient ultimately expired. Abiomed's investigation following the case identified an unknown biological material obstructing both Impella devices. In light of a leukocytosis of 14,000 and a recent urine sample positive for E. coli, there is a high suspicion that the patient suffered from recurrent infective endocarditis causing septic embolization and subsequent Impella device failure from aspiration of bacterial vegetations.

Discussion:
This is the first known reported case of Impella device failure resulting from the aspiration of vegetation in a patient with infective endocarditis of a bioprosthetic aortic valve. The case highlights the challenges of diagnosing endocarditis in bioprosthetic valves and emphasizes the importance of transesophageal echo in cases with high clinical suspicion. Additionally, considering the recent FDA recall of Impella devices in patients who have had transcatheter aortic valve replacement (TAVR) procedures due to the risk of motor damage after contact with TAVR stents, this case calls attention to a need for further research of the use and safety of Impella devices in patients with non-native aortic valves.
Abstract 4145649: Proteomics Characteristics of Patients with Acute Coronary Syndrome
Authors: Liu Yiying , Huang Rong
Published: November 2024

Background:
Acute coronary syndrome (ACS) remains a significant cause of morbidity and mortality worldwide, with its molecular characteristics at the protein level still poorly understood. This study aims to elucidate the proteomic signatures of ACS patients using a comprehensive proteomic approach.

Methods:
182 ACS patients and 62 age and gender-matched healthy controls (HC) were randomly selected from our longitudinal multi-omic ACS cohort. Circulating proteins levels were measured with the Olink-Explore 3072 panel. Spearman correlation was used to examine the associations between proteins and clinical variables. Differential expression of proteins was analyzed using Benjamini-Hochberg-corrected T-tests.

Results:
Firstly, we screened proteins associated with clinical characteristics such as age, BMI and lipid profiles. As shown in figure 1, we identified several protein biomarkers associated with aging such as Elastin (ELN), Prokineticin 1 (PROK1), or exhibited gender-specific variations such as Kunitz Type 3 (SPINT3), and Insulin Like 3 (INSL3) in both healthy subjects and ACS patients. Proteins such as SSCD4 were significantly associated with BMI and lipids, suggesting a potential role in regulating lipid homeostasis. Then we analyzed the differential proteomic characteristics in ACS patients compared to HC patients and identified 1361 proteins with differential expression (false discovery rate, q<0.05 for all). We subsequently conducted a pathway enrichment analysis on the differential proteins. We found pathways involved in regulation of cardiac muscle function, interleukin signaling, and regulation of the neuro-inflammatory response were upregulated while pathways related to the regulation of vascular-associated smooth muscle cell proliferation and platelet activation were downregulated.

Conclusion:
Our study demonstrates the efficacy of plasma proteomics in discerning demographic variations and elucidating the proteomic landscape of ACS patients. The significant differential protein expression observed underlines the value of a comprehensive proteomic approach in advancing our understanding of ACS pathophysiology and potentially facilitating the discovery of novel biomarkers.
Abstract 4145658: Early Prediction of Inpatient Worsening Heart Failure Using Machine Learning
Authors: Gangavelli Apoorva , Steinberg Rebecca , Olakunle Oreoluwa , Okoh Alexis , Wang Jeffrey
Published: November 2024

Background:
In patients with acute heart failure (AHF), worsening heart failure (WHF) predicts mortality, prolonged length of stay and readmission. We aimed to create a predictive model to identify predictors of intensive care unit (ICU) transfer as a proxy for WHF.

Methods:
We developed and evaluated retrospectively a machine learning model based on the LASSO algorithm to predict ICU transfer. The algorithm was trained on 11 years of data (from 2010-2020) collected from a large regional healthcare system. We included patients admitted with acute HF, an admission BNP value >100, and excluded direct ICU admissions. The input variables include demographics, vital signs, laboratory values, pre-existing diagnoses, and treatment teams. Model performance was evaluated AUROC.

Results:
Of 19,351 patients with an index AHF hospitalization, 5,829 (30.1%) required ICU transfer. These patients were younger (70 ± 15 vs 73 ± 16 yrs, p<0.001), more likely to be male (54% vs 51%, p<0.001), and be White (52% vs 40%, p<0.001). These patients had higher rates of 30-day mortality (17% vs 6%, p<0.001), 30-day readmission (11% vs 8%, p<0.001), and a longer median length of stay (12 [7, 20] vs 4 [3, 7] days, p<0.001). Model performance on training and validation datasets yielded AUC=0.78 and AUC=0.78, respectively. Internal medicine primary teams predicted lowest odds of ICU transfer (OR: 0.17 [95% CI: 0.15 - 0.18], p<0.001), while atrial fibrillation predicted highest odds of ICU transfer (1.72 [95% CI: 1.59 - 1.88], p<0.001) (Fig).

Conclusion:
WHF during index hospitalization was associated with worse 30-day outcomes and longer length of stay. Our model has excellent risk prediction for worsening HF defined by ICU transfer during HF hospitalization.
Abstract 4145660: Limitations of the Generalizability of Semaglutide Trials Evaluating CV Outcomes
Authors: Shi Ivy , Yeh Robert , Khan Sadiya , Ndumele Chiadi , Hennessy Susan , Penko Joanne , Kazi Dhruv
Published: November 2024

Introduction:
In the SUSTAIN-6, SELECT, and FLOW clinical trials, semaglutide improved CV outcomes for primary and secondary prevention among those with poor cardiovascular-kidney-metabolic (CKM) health. However, whether trial participants are representative of the treatment-eligible U.S. population is uncertain.

Research Question:
How well do the SUSTAIN-6, SELECT, and FLOW trial populations each represent their respective treatment-eligible U.S. populations?

Methods:
We identified U.S. adults eligible for semaglutide by applying key inclusion and exclusion criteria of the SUSTAIN-6, SELECT, and FLOW trials to the 2015 to March 2020 cycles of the National Health and Nutrition Examination Survey (NHANES). We compared baseline demographic and clinical characteristics of treatment-eligible NHANES populations (“real-world”) with those of their corresponding clinical trial populations using standardized mean differences (SMD). An absolute SMD ≥ 0.10 represents an imbalance in a given demographic or clinical characteristic between the trial and U.S. population.

Results:
Across the 3 trials, 39 of the 50 characteristics had an absolute SMD value ≥ 0.10 (Table). Trial participants were younger (SMD < -0.2) than the real-world populations. Women were significantly underrepresented in the SELECT and FLOW trials (SMD < -0.2). Self-reported race/ethnicity representation was imbalanced in all studies, with underrepresentation of Black (SMD < -0.2) individuals and Hispanic individuals in FLOW (SMD = -0.11). Trial subjects had higher diastolic blood pressure and HgbA1C. The greatest imbalance was that SELECT enrolled a lower proportion of patients with a history of stroke compared with the real-world population (a subgroup in which semaglutide showed equivocal CV benefit).

Conclusion:
Of the three semaglutide CV outcome trials that have been published, all were not representative of the treatment-eligible U.S. population. The underrepresentation of women and Black and Hispanic individuals is notable because of the disproportionate burden of poor CKM health in these groups. Evaluation of semaglutide in representative, diverse US populations is needed to examine safety, effectiveness, and cost-effectiveness in the real-world.
Abstract 4145678: Enhanced Cardiovascular Risk Prediction of Calcium Scoring Computed Tomography Scans by Incorporating Pericardial Fat Characteristics: A Machine Learning Gradient Boost Analysis of Data Derived from a Deep Learning Segmentation Model of a Community-Based Cohort
Authors: Mahmoudi Elham , Lopez-Jimenez Francisco , Medina Betsy , Medina-Inojosa Jose , Erickson Bradley
Published: November 2024

Introduction:
Calcium scoring computed tomography (CAC) is a widely available and inexpensive modality of screening for atherosclerosis. This study aims to improve the predictive value of CAC by incorporating pericardial fat characteristics in a CatBoost model.

Methods:
A sample of 7,000 non-contrast clinically indicated CAC scans were randomly selected from a cohort of consecutive Olmsted County MN residents. Known history of atherosclerotic cardiovascular disease or impaired images were excluded. A pericardial fat segmentation model, trained on 191 images of the same dataset with a dice similarity score of 94%, was applied to 6,194 CT scans; Volume and mean Hounsfield unit (mHU) of the output masks were added to age at imaging, radiologist-measured calcium score, male gender, diabetes, and smoking (Figure 1). A 70,20 and 10% split was used to produce the training, validation and test set, respectively. Features were inputted to CatBoost classifier, as the best model tested, to predict four outcomes: acute coronary syndrome (ACS), heart failure (HF), ischemic stroke, and all-cause mortality. Model was evaluated by area under the ROC curve (AUC) on the unseen test set.

Results:
Mean age was 55.2 (8.8), 55.2 (8.8) and 54.8 (8.5) years in the training, validation and test sets, respectively, and 65%, 67% and 66% of the populations were male. The mean AUC, obtained through bootstrapping with 100 iterations, was 0.81 [0.77-0.85], 0.86 [0.60-0.92], 0.80 [0.73-0.87] and 0.87 [0.81-0.91] for HF, ACS, stroke and death, respectively; The same analysis excluding pericardial fat measurements showed a 3% reduction in the AUC for all of the investigated outcomes (Figure 2).

Conclusion:
Our study presents a robust risk prediction model for ACS, HF, stroke, and mortality based on CAC scans. The improved performance of the model by incorporating pericardial fat characteristics, highlights the potentials of deep learning in timely inexpensive risk prediction in large populations.
Abstract 4145685: Battling Cardiogenic Shock: A Comparative Study of In-Hospital Outcomes for left ventricular assist devices (LVADs) vs. intra-aortic balloon pump (IABP)
Authors: TABOWEI GODFREY , Gonzalez Laura , Ukenenye Emmanuel , Alugba Gabriel , Ogedegbe Oboseh , Lodhi Shahmeer , Tesfaye Meron , Matute Carlos , Enakpene Evbu
Published: November 2024

Introduction:
Cardiogenic shock (CS), with a mortality rate of 30% to 50%, is a severe condition marked by the heart's inability to supply sufficient blood to meet the body's needs, which demands timely and effective intervention. Historically, the intra-aortic balloon pump (IABP) was the primary support device, but the use of left ventricular assist devices (LVADs) has increased. This study compared outcomes between CS patients treated with newer LVADs (CSLVAD) and older IABPs (CSIABP).

Methods:
This retrospective cohort study used the 2020 National Inpatient Sample (NIS) database to identify cardiogenic shock (CS) hospitalizations using ICD–10 codes. Our primary outcomes were in-hospital mortality, length of stay (LOS), total hospital charges (TOTCHG), and postprocedural complications among patients treated with LVADs and IABPs.

Results:
Out of 195,254 patients with cardiogenic shock, 2,609 received LVADs, and 21,169 received IABPs. The average age was 64.8 years for CSIABP patients and 54.8 years for CSLVAD patients. Males predominated in both groups (70.5% CSIABP, 75% CSLVAD). More Black patients received LVADs (33%) compared to IABPs (13%).

Mortality was 23% in the CSIABP group versus 8% in the CSLVAD group. After adjusting for confounders, the CSLVAD group had statistically significant 62% lower odds of mortality (P=0.00, CL=0.25–0.57). The average LOS was longer in the CSLVAD group (39.4 days) compared to the CSIABP group (13.4 days), with a statistically adjusted increase of 20.1 days in the CSLVAD group (P=0.00, CL=17.6-22.6). The average TOTCHG was higher in the CSLVAD group ($1,265,731) compared to the CSIABP group ($399,160), with a statistically significant increase of $869,550 (P=0.00, CL=732,536-1,006,564).

For cardiovascular outcomes, there was a 79% and 40% decrease in the odds of hypertension and CAD in the CSLVAD group(P=<0.05). Interestingly, there were increased odds of CKD, anaemia, ventricular tachycardia, hypothyroidism, postprocedural complications, supraventricular tachycardia, and atrial fibrillation in the CSLVAD group(P=<0.05).

Conclusion:
Patients treated with LVADs for cardiogenic shock had significantly lower mortality but higher LOS and TOTCHG compared to those treated with IABPs. Despite reduced odds of hypertension and CAD, the LVAD group had higher incidences of various complications (CKD, anaemia, ventricular tachycardia, hypothyroidism, postprocedural complications, supraventricular tachycardia, and atrial fibrillation).
Abstract 4145698: Temporal Trends in Survival and Hospitalizations in Transthyretin Cardiac Amyloidosis with and without LV Systolic Dysfunction
Authors: Kar Ronit , Azhar Abdullah , Medoff Brent , Satyavolu Bharadwaj , Soman Prem
Published: November 2024

Background:
The impact of left ventricular systolic dysfunction on survival and hospitalizations in patients with transthyretin cardiomyopathy (ATTR-CM) remains underexplored.

Methods:
Patients with confirmed ATTR-CM were categorized into HFrEF (LVEF < 50%) and HFpEF (LVEF ≥ 50%) groups. Regression models identified predictors of reduced ejection fraction. Kaplan-Meier survival analysis, multivariable Cox proportional hazards models, and time-varying Cox models were used to assess survival and heart failure (HF) hospitalization rates.

Results:
132 patients with ATTR-CM were enrolled between 2015 and 2020 and followed for 4 years. Of these, 57 (43%) had HFrEF and 47% were on Tafamidis. Logistic regression showed no association between clinical characteristics and HFrEF status. Kaplan-Meier analysis showed no significant difference in HF hospitalization rates between HFrEF and HFpEF patients (58% vs 44%, respectively, p=0.110). When examining mortality, unadjusted Kaplan-Meier analysis showed a trend towards higher mortality in HFrEF patients compared to HFpEF patients. (p=0.066). Multivariable Cox analysis revealed that, after controlling for Tafamidis use (39% and 52% in HFrEF and HFpEF, respectively), HFrEF was associated with a higher risk of mortality compared to HFpEF (HR 1.99 [1.056–3.746], p=0.017). Additionally, time-varying Cox modeling indicated that HFrEF significantly predicted early mortality (p<0.0001), with the impact of HFrEF on mortality diminishing over time due to a significant interaction term between HFrEF and time (p<0.0001).

Conclusion:
In ATTR-CM patients, the risk of mortality of HFrEF patients compared to HFpEF patients is higher initially and equalizes with time, with no difference in HF hospitalization. The mechanism underlying this intriguing trend needs further study.
Abstract 4145701: The Impact of Mechanical Circulatory Support on Vasoactive Inotropic Score in Patients with Cardiogenic Shock
Authors: Dhillon Manvir , Richards Donald , Wangmang Felix , Torbati Tina , Botting Patrick , Chyu Kuang-Yuh , Ebinger Joseph , Chonde Meshe
Published: November 2024

Background:
The Vasoactive-Inotropic Score (VIS) quantifies vasopressor and inotropic use in cardiogenic shock (CS), with higher VIS indicating greater severity and mortality. This study examines VIS changes within 48 hours post-Mechanical Circulatory Support (MCS) implementation and their correlation with mortality.

Methods:
We retrospectively analyzed 2,261 CS patients admitted from Jan 1, 2013, to Dec 31, 2023. Primary outcome is the mean change in VIS score at designated time intervals in the 48 hours after receiving MCS or medical treatment alone. A multivariable Cox proportional hazard regression model was used to evaluate the independent relationship between VIS change and in-hospital mortality.

Results:
Patients were categorized into the strategy they received in the first 72 hours of shock onset: medical treatment (n=2044) IABP (n=146), Impella (n=33), or ECMO (n=39). A total of 534 patient died within the index hospitalization. A decrease in the change of the mean VIS score was observed at various time intervals within the first 48 hours (Figure 1). The mean change in VIS score incorporates patients who had a decrease, no change or increase in score in the first 48 hours. Therefore, a hazard ratio <1 in a Cox model would indicate that a more negative mean VIS values correlates with lower mortality. A multivariable Cox model assessing for in-patient mortality incorporated the strategies that patients received (medical treatment, IABP, etc.), age, gender, race medical history, left ventricular ejection fraction, serum creatinine, lactate > 4.5 or pH < 7.2. Our model suggests that a decreased need in the vasoactive medication requiring in the first 48hrs is associated with a reduction in mortality (Figure 2).

Conclusion:
All device strategies effectively reduce VIS within 48 hours. The change in mean VIS score within the first 48 hours is independently associated with lower mortality, regardless of the strategy patients received, their past medical history or other clinical covariates.