bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4141974: Impact of Timing of Pacemaker Reimplantation Following Transvenous Lead Removal of Infected Cardiac Implantable Electronic Devices on Hospital Outcomes
Authors: Ang Qi Xuan , Tan Min Choon , Yeo Yong Hao , Rattanawong Pattara , Sorajja Dan , Scott Luis , Cha Yong-mei , Russo Andrea , Lee Justin
Published: November 2024

Background:
The optimal timing of pacemaker reimplantation following transvenous lead removal (TLR) of infected cardiac implantable electronic device (CIED) remains unclear.

Objective:
Our study aimed to assess the impact of timing to pacemaker reimplantation after TLR of infected CIED on hospital outcomes.

Method:
Using the Nationwide Readmissions Database, patients aged ≥18 years who underwent new pacemaker implantation with percutaneous approach following TLR of infected CIED from 2017 to 2020 were identified. The study population was stratified based on the timing of pacemaker reimplantation following TLR of infected CIED: early (<5 days) vs delayed (≥5 days). Weighted-propensity-score matched conditional multivariable logistic regressions were performed to determine the impact of the timing on various outcomes.

Results:
In our study, 469 (66.9%) patients received early device reimplantation, and 232 (33.1%) patients received delayed device reimplantation (≥5 days). Post-procedurally, patients in the delayed group had a higher risk of prolonged hospital stay (95% CI OR: 42.37 (6.36 – 282.11); p<0.01) and non-home discharge (95% CI OR: 2.00 (1.35 – 2.95), p<0.01). There was no significant difference between both groups in the early mortality, 30-day readmission, and procedural complications.

Conclusion:
Our study suggests that time-to-device reimplantation from TLR of infected CIED did not affect the overall short-term in-hospital outcomes. However, delayed device reimplantation was associated with a higher rate of prolonged hospital stay and non-home discharge.
Abstract 4141987: Bionanomatrix coated flow diverters promote faster endothelialization and occlusion of brain aneurysms
Authors: Sherwood Jennifer , Hwang Patrick , Brott Brigitta , Kadirvel Ram , Kallmes David F , Jun Ho-wook
Published: November 2024

Introduction:
Intracranial aneurysms are associated with local degradation of the vessel wall resulting in the formation of a blood-filled sac. Approximately 6 million people are estimated to have intercranial saccular aneurysms in the US alone. Most aneurysms remain undetected until rupture, resulting in hemorrhage which carries a high mortality rate (>50%). Flow diverters are placed across the aneurysm neck to divert blood flow away from the sac, preventing rupture once occluded. However, flow diverters carry significant risk for thromboembolism, which is a major cause of morbidity. The elevated risk of thromboembolism is likely due to endothelial injury of the parent artery at the neck of the aneurysm. We hypothesize that the bionanomatrix can promote faster endothelialization and aneurysm occlusion thereby reducing the risk of thromboembolism after flow diverter treatment.

Methods:
The bionanomatrix is composed of peptide amphiphiles containing endothelial cell adhesive ligand (YIGSR) and a nitric oxide (NO) donor (KKKKK), both components critical for recruiting and retaining endothelial cells on the device. The NO releasing bionanomatrix was coated onto the flow diverters using ultrasonic spray coating, and the NO effects on endothelial cell (EC) and smooth muscle cell (SMC) proliferation on the coated devices was assessed,
in vitro,
using calcien-AM staining. For the
in vivo
study, an elastase-induced rabbit aneurysm model was created. The bionanomatrix coated and uncoated flow diverters were implanted into the rabbit aneurysm model for 4 weeks. The coated and uncoated flow diverters were then analyzed for endothelialization, smooth muscle cell proliferation, and aneurysm occlusion by angiography, gross image, and immunohistochemistry analyses.

Results:
In vitro
, the bionanomatrix coated flow diverters significantly enhanced endothelial cell proliferation as well as reduced smooth muscle cell proliferation on the flow diverters compared to the uncoated device.
In vivo,
after 4 weeks, the bionanomatrix coated flow diverters demonstrated enhanced neck coverage, more complete endothelialization, and reduced smooth muscle thickness on the coated flow diverters compared to the uncoated devices as seen by gross image analysis and histology.

Conclusions:
The bionanomatrix coated flow diverters can successfully promote faster endothelialization and brain aneurysm occlusion which is critical for reducing the risk of thromboembolism after neurointervention.
Abstract 4141988: The Power Duo: Combining LA Volume Index and Strain to predict AF Recurrence after ablation
Authors: Kulthamrongsri Narathorn , FARINA JUAN , Mandale Deepa , El Masry Hicham
Published: November 2024

Background:
Catheter ablation (CA) is an effective treatment for atrial fibrillation (AF), but many patients experience recurrence post-intervention. Evaluating left atrial strain (LAS) to measure LA reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct) could help predict AF recurrence, especially in patients with no evident signs of severe LA myopathy.

Goal:
This study aims to assess the prognostic value of pre-ablation LAS in both paroxysmal AF (paAF) and persistent AF(peAF) in patients with no evident signs of severe LA myopathy.

Methods:
This retrospective study encompassed AF patients who underwent their first CA procedure at Mayo Clinic Arizona from October 2018 to February 2022 and had a LAVI <40 ml/m2 and LVEF >55%. Transthoracic echocardiography parameters, including the three LAS phases, were collected using TOMTEC software on the closest date before the CA procedure. Receiver operating characteristic (ROC) curve analysis was used to evaluate the capability of LAS to detect patients with AF recurrence after CA from those without recurrence.

Results:
Out of 335 AF patients who underwent CA during the study period, 40 cases had LAVI <40 ml/m2 and LVEF >55% (72.5% male; mean age 69.2 ± 8 years). Of these, 15% (6/40) experienced recurrence, while 85% (34/40) maintained sinus rhythm. The mean values of LASr, LAScd, and LASct for all patients were 16.82, 11.23, and 6.87, respectively. ROC analysis indicated that the area under the curve (AUC) for LASr, LAScd, and LASct was 0.582, 0.502, and 0.710, respectively. (Graph 1A, Table 1A) LASct was the only parameter associated with AF recurrence (AUC: 0.71). Additionally, we developed a novel marker termed LAVI-LASct by combining LAVI and LASct values, which demonstrated improved discrimination with an ROC value of 0.74 (Graph 1B).

Conclusions:
LASct demonstrated predictive capability for AF recurrence in patients with no severe LA dilation and preserved LVEF, potentially due to its ability to detect early atrial dysfunction preceding visible structural changes or myocardial pathology. The addition of LAVI values provided better discrimination for the ROC model. Further research is needed to confirm the clinical relevance of LAS in AF patients undergoing ablation.
Abstract 4141989: Utilization rates of SGLT2 inhibitors and GLP-1 receptor agonists remain significantly lower than those for other cardioprotective medications: Results from a retrospective, cross-sectional study at a large academic medical center
Authors: Ling Andrew , Mawson Thomas , Tiwari Gaurav , Tram Thanh , Yankama Tuyen , Rubin Rochelle , Silva George , Jonas Zachary , Ward Charlotte , Moran Sara , Quadir Juweria , Chaudhary Richard , Qian Frank , Chen Zsu-Zsu , Benson Mark
Published: November 2024

Background:
Specific sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) significantly improve outcomes in patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) or heart failure. Contemporary data regarding utilization rates of these medications remain limited.

Hypothesis:
Utilization rates of SGLT2i/GLP-1RA remain low, especially among cardiology providers.

Aim:
Characterize utilization rates of SGLT2i/GLP-1RA in a large academic medical center (AMC).

Methods:
We developed algorithms to query electronic health records from Beth Israel Deaconess Medical Center to identify 18-74 year-old patients with either T2D and ASCVD (cohort 1) or patients with heart failure with reduced or preserved ejection fraction (HFrEF/HFpEF, cohort 2) who qualified for SGLT2i or GLP-1RA therapy between 1/1/21-12/31/22 according to 2020 ACC Expert Consensus Decision Pathway and 2021 ADA Standards of Care guidelines. Positive predictive values (PPV) for each algorithm were calculated following manual review of 150 randomly-selected charts from each cohort. Comparisons were performed using Fisher’s exact test.

Results:
We identified 1,022 patients with T2D and ASCVD (PPV 87.9%) who qualified for SGLT2i and/or GLP-1RA therapy and 2,070 patients with HFrEF or HFpEF (PPV 84.7%) who qualified for SGLT2i therapy. In contrast to utilization rates of statins (89.8%), significantly fewer patients with T2D and ASCVD had received a prescription for a SGLT2i (35.9%, P<0.001), GLP-1RA (39.3%, P<0.001), or either medication (54.6%, P<0.001) any time before 12/31/22. Similarly, compared to utilization rates of ACE inhibitors or ARBs (70.4%), significantly fewer patients with HFrEF/HFpEF had received a prescription for a SGLT2i (30.3%, P<0.001). Cardiology providers were the top prescribers for SGLT2i in patients with HFrEF/HFpEF (48.7% of prescriptions). However, cardiology providers prescribed significantly fewer SGLT2i or GLP-1RA for patients with T2D and ASCVD (8.6% of prescriptions) compared to primary care providers (49.4%, P<0.001).

Conclusions:
Within a single AMC, utilization rates of SGLT2i and GLP-1RA remain significantly lower than those for other cardioprotective medications. Our data suggest a possible opportunity for cardiology providers to improve utilization of SGLT2i and GLP-1RA. Further study is needed to more broadly characterize these findings.
Abstract 4141993: Artificial Intelligence ECG Analysis More Accurately Identifies Epicardial versus Endocardial Ventricular Tachycardia and Pacing Compared with Visual Criteria
Authors: Dreessens Erin , Oliver Kendall , Fox Sutton , Sung Kevin , Aldaas Omar , Han Frederick , Hoffmayer Kurt , Hsu Jonathan , Raissi Farshad , Feld Gregory , McCulloch Andrew , Villongco Christopher , Ho Gordon , Krummen David
Published: November 2024

Background:
Accurate prediction of whether a ventricular tachycardia (VT) source or critical isthmus is epicardial may facilitate efficient and effective catheter ablation. Prior visual criteria have been described but performance may vary depending upon region.

Hypothesis:
We hypothesized that an artificial intelligence (AI) algorithm would provide more accurate identification of epicardial versus endocardial sources distributed throughout the left ventricle (LV) compared with visual analysis.

Aims:
We endeavored to assess the performance of a novel AI algorithm in separating epicardial and endocardial VT and pacing sources compared with 7 previously published ECG criteria.

Methods:
Patients with LV VT or pacing were enrolled. Episodes were grouped as either LV-endocardial or non-LV-endocardial (i.e., epicardial) according to site of successful ablation or location of the pacing electrode. 12-lead ECG data was analyzed using the AI algorithm to predict source location and accuracy was computed. For comparison, accuracy of 7 previously described visual ECG criteria was assessed.

Results:
A total of 136 arrhythmia or pacing episodes from 72 patients (mean age 66±14 y, 32% female, EF 39±16%) were analyzed, evenly distributed between epicardial (n=68, 50%) and endocardial (n=68) sources. Episodes were localized to all 17 AHA LV segments. Algorithm accuracy was 91.1% (124 of 136 episodes), exceeded the best performing visual ECG criteria (shortest precordial rS >121 msec; 62.5%; 85 of 136 episodes; P<0.001). Algorithm sensitivity was 0.971 [95% CI: 0.898 - 0.996] and specificity was 0.853 [95% CI: 0.746 - 0.927]. Figure A shows an example ECG from a 73-year-old patient undergoing epicardial pacing at the inferior left ventricular apex. Figures B, C, and D show orthogonal views of the local normal vector (blue) and the electrical activation vector (red), consistent with an epicardial origin.

Conclusions:
The AI algorithm provided improved accuracy versus visual ECG criteria. Future studies are required to assess whether such information improves procedural efficiency.
Abstract 4141994: Targeted Atrial Fibrillation Screening in Older Adults: A Secondary Analysis of the VITAL-AF Trial
Authors: Shah Sachin , Iyer Jay , Agha Leila , Chang Yuchiao , Atlas Steven , Ashburner Jeffrey , McManus David , Ellinor Patrick , Lubitz Steven , Singer Daniel
Published: November 2024

Background:
Screening trials for atrial fibrillation (AF) have produced mixed results; however, it is unclear if there is a subset of individuals for whom screening would be effective. Identifying such a subgroup would support targeted screening.

Methods:
We conducted a secondary analysis of VITAL-AF (NCT03515057), a randomized trial of one-time, single-lead ECG screening during primary care visits. We tested two approaches to identify a subgroup that would benefit from screening (i.e., heterogenous screening effects). First, we use a potential outcomes framework to develop an effect-based model. Specifically, we predicted the likelihood of AF diagnosis under both screening and usual care conditions using LASSO, a penalized regression method. The difference between these probabilities was the predicted screening effect. Second, we used the CHARGE-AF score, a validated AF risk model. We used interaction testing to determine if the observed diagnosis rates in the screening and control arms were statistically different when stratified by decile of the predicted screening effect and predicted AF risk.

Results:
Baseline characteristics were similar between the screening (n=15187) and usual care (n=15078) groups (mean age 74 years, 59% female). On average, screening did not significantly increase the AF diagnosis rate (2.55 vs. 2.30 per 100 person-years, rate difference 0.24, 95%CI -0.18 to 0.67). Patients in the highest decile of predicted screening efficacy (n=3026, 10%) experienced a large and statistically significant increase in AF diagnosis rates due to screening (6.5 vs. 3.06 per 100 person-years, rate difference 3.45, 95%CI 1.62 to 5.28; interaction p-value 0.038) (
Figure 1
). In this group, the mean age was 84 years and 68% were female. Participants in the highest decile of AF risk using the CHARGE-AF score did not have a statistically significant increase in AF diagnosis rates due to screening (
Figure 2
). Predicted screening effectiveness and predicted AF risk were poorly correlated (Spearman coefficient 0.13).

Conclusions:
One-time screening may increase AF diagnoses in a subgroup of older adults with the largest predicted screening effect. In contrast, predicted AF risk was a poor proxy for predicted screening efficacy. These data caution against the assumption that high AF risk is necessarily correlated with high screening efficacy. Prospective studies are needed to validate whether AF screening is effective in the subgroup identified in this study.
Abstract 4142006: Small Wearable Tissue Oximeter to Evaluate Microvascular Function in Chronic Heart Failure Patients
Authors: Roumengous Thibault , Wallner Josephine , Tariq Aimen , Griffin Brian , Boutwell R. Casey , Harkins Douglas
Published: November 2024

Background:
Although microcirculatory function is known to be affected by chronic heart failure (HF), the lack of available sensing technology has limited its investigation. A noninvasive wearable tissue oximeter using near-infrared spectroscopy (NIRS) was developed to measure microcirculatory adaptation during cardiovascular stressors such as vascular occlusion testing (VOT) and mild activity such as a six-minute walk test (6MWT) as a step toward remote monitoring of HF patients during daily activities.

Hypothesis:
We aimed to assess microvascular responses using tissue oximetry on relevant body sites to further characterize HF patients based on their disease stage.
Methods:
Patients (n=20, F=3, NYHA Class I-III) completed a single visit to the clinic (approximately 30 min each). NIRSense devices were placed on the patient’s dominant arm, thigh, and sternum using a custom adhesive patch. Tissue oxygenation (StO2) and reperfusion slopes were independently calculated from sensor signals (Figure 1, B, D).

Results:
Mean VOT reperfusion slopes were 0.083526 +/- 0.114388 (NYHA I), 0.079975 +/- 0.43068 (NYHA II), and 0.064203 +/- 0.159261 (NYHA III). During 6MWT, Mean StO2 was 86.6% +/- 0.1% at baseline (sternum) and 83.1% +/- 0.2% at baseline (thigh). Percent change over the initial 100s of the 6MWT was 5.3 +/- 0.674% (NYHA I), 3.35 +/- 0.745% (NYHA II), 2.67 +/- 1.8% (NYHA III) for sternum and 2.45 +/- 4.28%, 2.94 +/- 2.12%, 2.5 +/- 1.19% for thigh. Reperfusion slopes were lower in the more severe NYHA class (Figure 1, C). StO2 during the 6MWT showed larger decrease after the first 100s in the more severe NYHA class (Figure 1, E). Three patients were excluded from VOT (only) analyses due to poor signal quality.

Conclusion:
We were able to measure tissue oxygenation kinetics during cardiovascular stressors in chronic HF population. NIRS-based tissue oximetry, particularly during VOT, can characterize microvascular function and differentiate patients based on HF stage. Data collection is still ongoing to enable statistical analyses. Continuous tissue oximetry has potential as a prognosis tool, and remote monitoring during daily activities may allow early detection and intervention in HF and pre-HF populations.
Abstract 4142028: An Intensive Lifestyle Intervention Improves Cardiovascular Health Outcomes in Patients with Type-2 Diabetes
Authors: Tripathi Pramod , Kathrikolly Thejas , Sul Lidiya , Lee Matthew , Nanjundappa aravinda , Kapadia Samir , Kadam Nidhi
Published: November 2024

Background:
Type 2 diabetes (T2D) is associated with an elevated risk of cardiovascular (CV) complications, including hypertension, dyslipidemia, obesity, and inflammation. Addressing CV risk factors is crucial for reducing morbidity and mortality in affected individuals. Integrated lifestyle interventions have emerged as promising strategies for managing T2D and its associated CV risks, emphasizing the importance of dietary modifications, physical activity, and stress management in improving health outcomes

Research Aim
This study evaluated the impact of an intensive lifestyle intervention (ILI) on both traditional and non-traditional cardiovascular risk factors in patients with type 2 diabetes (T2D)

Methods:
This retrospective study of 6028 patients diagnosed with T2D (≥18 years), who enrollled in a one-year online ILI program at Freedom from Diabetes Clinic, Pune, India between January 2021 and December 2022. The intervention included a personalized plant-based diet, exercise regimen, stress management, and medical support. Baseline and endline data on CV risk factors, socio-demographics, anthropometry, and medical history were extracted. The primary outcome was an improvement in the CV profile.

Results:
The mean age of the study population was 51.7±10.4 years (64% male) with a mean diabetes duration of 10.9±7.6 years. At baseline, the majority (67.7%) were on glucose-lowering medication; 39.9% and 51.9% were on anti-hypertensives and statins, respectively. Despite being on medication, 70.2% had poor glycemic control (HbA1c>7%); while dyslipidemia (triglycerides ≥150 mg/dl), obesity (≥25 kg/m2), and hypertension (≥140/90 mmHg) affected 38.8%, 56.3%, and 18.7% of the patients, respectively. Following intervention, there was significant improvement in HbA1c (-17.1%) and weight (-5.3%) (p<0.05). Significant improvements in traditional CV risk factors such as obesity (decreased to 43.2%) and dyslipidemia (decreased to 30.1%) were observed (p<0.05). Moreover, there was significant improvement in non-traditional risk factors (p<0.05), including urine microalbumin (≥25 µg/ml; decreased from 17.8% to 12.9%), CRP (1–10 mg/dl; decreased from 57.7.3% to 56.5%), and postprandial hyperglycemia (>140 mg/dl; decreased from 65.7% to 48.7%).

Conclusion:
The ILI program showed significant improvements in CV risk factors and glycemic parameters among patients with T2D highlighting the impact of a comprehensive approach to managing CV risks associated with T2D.
Abstract 4142030: A Polygenic Score to Identify Risk of Incident Stroke and Benefit from Primary Prevention Statin Therapy
Authors: McClintick Daniel , Kamanu Frederick , Melloni Giorgio , Sabatine Marc , Ruff Christian , Ridker Paul , Chasman Daniel , Marston Nicholas
Published: November 2024

Background:
Primary prevention statin use has been shown to significantly reduce the incidence of stroke, however, clinical risk scores for statin eligibility do not predict stroke specifically. A polygenic risk score (PRS) for stroke is a tool that may help identify individuals at greatest risk of stroke and most likely to benefit from statin therapy.

Methods:
We performed a prospective cohort study using genotyped individuals from a large primary prevention RCT (JUPITER), which tested rosuvastatin 20 mg daily vs placebo. We applied the validated GIGASTROKE PRS categorized by quintiles: low (Q1), moderate (Q2-Q4) or high risk (Q5). The primary outcome was occurrence of all-cause stroke. PRS risk was modeled per 1-SD and hazard ratios calculated for the moderate and high-risk groups relative to low risk. Formal testing of treatment interaction for rosuvastatin and PRS was performed.

Results:
Of 8,749 patients with genetic data (32% male, mean age 66), the median LDL-C was 110 mg/dL and hsCRP was 4.05 mg/L. During 4 years of follow up, 44 patients suffered a stroke. The PRS was strongly associated with risk of incident stroke (
Fig, A
). Compared to those at low genetic risk, the absolute risk of stroke was more than 2-fold greater in the moderate group (HR: 2.10, 0.78-5.67) and nearly 4-fold greater in the high-risk group (HR: 3.72, 1.27-10.88, p-trend =0.011). In this genetic cohort, rosuvastatin reduced the risk of stroke by 61% (HR: 0.39, 0.20-0.76, p=0.006). The relative risk reductions with rosuvastatin were 37% (HR 0.63, 0.11-3.77), 63% (HR 0.37, 0.16-0.88), and 68% (HR 0.32, 0.09-1.17) in low, moderate, and high-risk groups, respectively. The absolute risk reductions with rosuvastatin were 0.13% (-0.38-0.63), 0.46% (0.08-0.84), and 0.76% (-0.03-1.56) (
Fig, B)
. Rosuvastatin in the high-risk subgroup reduced the incidence of stroke to the level of the low-risk subgroup receiving placebo (0.35%).

Conclusion:
A PRS can identify primary prevention patients with a 2 to 4-fold increased risk of stroke, which appears to be largely offset with statin therapy. As the use of PRSs increase in clinical practice, it may be a useful tool to help guide statin initiation for primary stroke prevention.
Abstract 4142036: Association of smoking status with incident heart failure among patients with chronic kidney disease: Insights from CRIC
Authors: Castro Valentina , Waikar Sushrut , Mc Causland Finnian
Published: November 2024

Introduction:
Smoking is a well-known risk factor for atherosclerotic cardiovascular disease and kidney failure among patients with chronic kidney disease (CKD). However, the association of former and current smoking status (vs. never) with incident heart failure (HF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) among patients with CKD warrants further exploration.

Methods:
Using data from participants of the Chronic Renal Insufficiency Cohort, without a history of HF, we used Cox regression models to estimate the association of smoking status (never, former, current) with incident HF. We also fit linear regression models to explore the association of smoking status with log-transformed NT-proBNP. Models were adjusted for demographics, comorbid disease, medications, systolic blood pressure, and socioeconomic variables (including income, education, marital status, illicit drug use, and alcohol use).

Results:
Of the 5,083 included participants, 2,423 (48%) were never smokers, 2,030 (40%) were former smokers, and 630 (12%) were current smokers. Over a median follow-up of 6.7 years, there were 664 HF events. In adjusted analyses, compared with never smokers, the risk for future HF events was non-significantly higher for former smokers (HR 1.10; 0.89, 1.35), but significantly higher for current smokers (HR 1.68; 95%CI 1.26, 2.24; Table 1). Similarly, compared with never smoking, former smoking was non-significantly associated with NT-proBNP (-3%; 95%CI -12, +6%), while current smoking was associated with higher NT-proBNP (+24%; 95%CI +9%, +42%).

Conclusion:
Current smoking status, but not former smoking, is associated with higher NT-proBNP and a higher risk of incident heart failure among patients with CKD. Enhanced public health efforts to promote smoking cessation among patients with CKD may be relevant to prevention of HF.
Abstract 4142041: Re-evaluating the Use of Race/Ethnicity in the MESA Risk Score
Authors: White Quinn , Hansen Spencer , McClelland Robyn , Johnson Craig , Murphy Brittany , DeFilippis Andrew , Post Wendy
Published: November 2024

Background:
The Multi-Ethnic Study of Atherosclerosis (MESA) Risk Score is used to predict 10-year coronary heart disease (CHD) risk based on traditional risk factors and coronary artery calcium (CAC). Discussions around the potential for equity consequences when using race/ethnicity as a predictor in models for clinical decision-making have prompted other risk scores, such as the PREVENT score, to no longer include race/ethnicity. To this end, we developed a revised score omitting race/ethnicity and compared its performance to the original MESA score.

Methods:
MESA is a longitudinal multi-ethnic observational cohort study of 6,814 participants, who were aged 45 to 84 and did not have prevalent cardiovascular disease upon study entry in 2000-2002. Model development was done using regularized Cox regression. The regularization process had two stages. The first used LASSO regression for variable selection, where we considered age, CAC, total and HDL cholesterol, systolic blood pressure (SBP), sex, diabetes, family history of heart disease, hypertensive medication, current smoking, and lipid-lowering medication use. Interactions were considered between the variables age, sex, and CAC with all other predictors; anti-hypertensive medications with SBP; and lipid-lowering medications with total cholesterol. The second stage involved ridge regression to mitigate over-fitting. We then compared the calibration and discrimination of the model including race/ethnicity to that of the model that did not.

Results:
The updated model excluding race/ethnicity included the same main effects, but several interactions were also selected in the LASSO step. When comparing the performance of the models including race/ethnicity to those excluding it, no significant differences were found. For example, there was no significant difference in AUC between the model excluding race/ethnicity and that including it, with a difference of 0.00323 (95% bootstrap CI: -0.000715 to 0.00717). Harrell’s C-statistic was comparable between the models, at 0.800 in the model without race/ethnicity and 0.797 in that including it. Other metrics revealed a similar picture, where calibration and discrimination did not differ the inclusion of race/ethnicity.

Conclusions:
We developed a MESA risk score model that does not use race/ethnicity as a risk factor that performs similarly to the risk score model including race/ethnicity. This risk score will be made publicly available for clinical CHD risk prediction.
Abstract 4142044: The prognostic value of criteria for diagnosis of Immune Checkpoint Inhibitor Related Myocarditis: a comparison of the Bonaca et.al. criteria and European Society of Cardiology (ESC)-International Cardio-Oncology Society (ICOS) guidelines
Authors: Pereyra Milagros , FARINA JUAN , Mahmoud Ahmed K. , Scalia Isabel , Tagle-Cornell Maria Cecilia , Kenyon Courtney , Abbas Mohammed Tiseer , Baba Nima , Herrmann Joerg , Arsanjani Reza , Ayoub Chadi
Published: November 2024

Background:
Myocarditis is a dreaded complication of immune-checkpoint inhibitor (ICI) therapy but challenging to diagnose. There are no published data comparing the two leading diagnostic criteria for ICI myocarditis and their association with cardiovascular events.

Methods:
Patients treated with ICI and cardiac Troponin (cTnT) measurements thereafter at a tertiary institution from 2011 to 2022 were identified. Charts were reviewed for ICI-related myocarditis according to the Bonaca et. al criteria and the ESC-ICOS guideline criteria. A propensity matched control group was identified of patients treated with ICI but without developing myocarditis. Medical records were reviewed for baseline characteristics and long-term outcomes, including cardiac death, MACE (myocardial infarction, TIA/stroke, new heart failure diagnosis), and arrhythmias (V-tach, A-fib, complete heart block).

Results:
A total of 59 patients were identified as having a diagnosis of ICI-related myocarditis per Bonaca criteria (16 having definite, 13 probable and 30 possible myocarditis), and 47 met the ESC-ICOS guideline criteria. Mean age was 73.1±10.2 years, 60.1% were male, median follow-up was 2.5 years. ICI-related myocarditis as diagnosed by both diagnostic criteria had prognostic value for cardiac death (HR 13.94, 95%CI 1.84-105.64, p=0.011 per Bonaca, HR 6.22, 95%CI 1.77-21.88, p=0.004 per ESC-ICOS), MACE, (HR 3.17, 95%CI 1.34-7.47, p=0.008 per Bonaca, HR 2.97, 95%CI 1.37-6.45, p=0.006 per ESC-ICOS), and arrhythmias (HR 1.93, 95%CI 1.10-3.38, p=0.022 per Bonaca, HR 2.09, 95%CI 1.21-3.60, p<0.001 per ESC-ICOS), (Figures 1 and 2). There was no significant difference for cardiac death (AUC 0.75 for Bonaca, AUC 0.74 for ESC, p=0.765) or MACE (AUC 0.66 for Bonaca, AUC 0.66 for ESC, p=0.916) when both criteria were compared with each other.

Conclusion:
The ESC-ICOS criteria were more restrictive than the Bonaca criteria for the diagnosis of ICI-related myocarditis but similar in terms of prognostic value.
Abstract 4142072: Prevalence of Cardiovascular Risk Factors in Pediatric Patients in a Large Rural Health System
Authors: Benziger Catherine , Asche Stephen , Allen Clayton , Freitag Laura , Holland Claire , Harry Melissa , Schultz Brandon , Ekstrom Heidi , Essien Inih , Muthineni Abhilash , Thirumalai Vijayakumar , Vo Phuong , Kromrey Kay , Ronkainen Elizabeth , Saman Daniel , Oconnor Patrick , Kharbanda Elyse
Published: November 2024

Introduction:
Cardiovascular (CV) disease risk factors in rural areas are influenced by behavioral, environmental and social factors. Risk factors begin in childhood and contribute to increased morbidity and mortality in adults.

Research Questions:
What is the difference in burden of CV risk factors among pediatric patients by rural and urban residences?

Aims:
To describe the CV risk factors among patients 6-17 years of age by rural and urban dwelling in a large, rural health system.

Methods:
Descriptive cohort study of patients aged 6-17 years in the PedsBP study, a pragmatic, cluster-randomized study in 44 Essentia Health (MN, WI, ND) primary care clinics (3 pediatric, 41 family medicine, 73% rural). Patients were included who had an ambulatory clinic visit and blood pressure measurement at time of index visit and were seen from 8/1/2022-7/31/2023. Patients were separated into groups based on rural vs urban residence (rural urban commuting code [RUCA] 4-10 were considered rural). Primary outcomes include the number of CV risk factors (out of 5): hypertension, obesity, pre-diabetes or diabetes mellitus, hyperlipidemia (all based on problem list, labs and vital signs), and current tobacco smoking or passive smoke exposure (self-reported).

Results:
Among 33,160 (50.4% female, mean age 11.6 years, SD=3.5 years) eligible patients,18,348 (55.3%) were from a rural residence. The most common CV risk factor was obesity (Rural N=3,888; 21.2%; Urban N=2,890; 19.5%), followed by current smoking/passive smoking (Rural N=3,341;18.2%; Urban N=2,201; 14.9%), hyperlipidemia (Rural N=548; 3.0%; Urban N=750; 5.1%), hypertension (Rural N=415, 2.3%; Urban N=357; 2.4%), and diabetes (or pre-diabetes) (Rural N=215; 1.2%; Urban N=225; 1.5%). Patients in rural areas were more likely to have ≥1 CV risk factors than patients in urban areas (36.1% vs. 33.6%, p<0.001). However, patients in rural and urban areas did not differ in their likelihood of having ≥2 CV risk factors (8.5% vs. 8.1%, p=0.22).

Conclusions:
1 in 12 children and adolescents have ≥2 CV risk factors. Obesity and smoking are the most prevalent factors. Differences between rural and urban youth varied by risk factor.
Abstract 4142104: Ischemic Stroke and TIA Incidence in Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement: A Comparative Systematic Review and Meta-analysis
Authors: Patel Palak , Karmani Vikash Kumar , Oza Jaykumar
Published: November 2024

Objective:
This systematic review and meta-analysis aimed to compare the incidence of ischemic stroke and Transient ischemic attack (TIA) post-transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in intermediate or high surgical risk patients with aortic stenosis, as this assessment may influence the choice of intervention.

Methods:
In accordance with PRISMA guidelines, we conducted a comprehensive search of PubMed, Google Scholar, and Cochrane CENTRAL databases from inception to December 2023 to identify trials and observational studies comparing the incidence of stroke and TIA after 30 days and 1-year post-TAVR vs SAVR from their inception through December 2023. Odds ratios (ORs) with 95% confidence intervals (CIs) for each study, employing a random-effects model for data synthesis irrespective of heterogeneity, were utilized as measures of outcomes. Heterogeneity was assessed using I2 statistics. All statistical analyses were conducted using Review Manager (Rev Man, Version 5.4; The Cochrane Collaboration, Copenhagen, Denmark).

Results:
After screening of 4549 articles, eight randomized controlled trial studies consisting of 5 randomized controlled trials and three observational studies with a total of 6879 patients were included in this meta-analysis; six studies comparing 30-day stroke incidence, no significant difference was found between TAVR and SAVR (OR 0.83, 95% CI 0.59 to 1.17, p=0.30, I2 3%). Seven studies showed that TAVR patients had a similar 1-year stroke risk to SAVR patients (OR 0.92, 95% CI 0.64 to 1.33, p=0.67, I2 52%). In the TIA case, there was no evidence of a significant difference between TAVR and SAVR in the risk of having a transient ischemic attack within 30 days following surgery (OR 0.93, 95% CI 0.24 to 3.63, p=0.92, I2 52%), although There was a greater 1-year risk of having a transient ischemic attack in the TAVR group compared to the SAVR group, OR 1.15 (95% CI 0.72 to 1.82, p=0.56, I2 0%), however, this was not a statistically significant difference.

Conclusion:
Our meta-analysis showed no significant differences in either ischemic stroke or TIA occurrences within 30 days and 1-year post TAVR and post SAVR in intermediate or high surgical risk patients.
Abstract 4142105: Impact of Supraventricular Tachycardia on Pregnancy Outcomes
Authors: Ardehali Arya , Kiess Marla , Rychel Valerie , Barlow Amanda , Oakes Jennifer , Deyell Marc , Grewal Jasmine
Published: November 2024

Background:
Paroxysmal supraventricular tachycardia (PSVT) is one of the most common arrhythmias among pregnant women, in part due to the maternal physiological changes that occur during pregnancy. However, studies investigating the risk of new-onset and pre-existing PSVT in pregnancy, and the associated adverse maternal and fetal/neonatal outcomes are lacking.

Research Questions:
This study aimed to determine: 1) the proportion of women presenting with new-onset PSVT in pregnancy; 2) the impact of prior PSVT history on episode severity and management during pregnancy; and 3) the rate of adverse maternal and fetal/neonatal events among women with PSVT in pregnancy.

Methods:
Prospective case-control study: 77 consecutive pregnancies in 75 women referred to the St. Paul’s Hospital Cardiac Obstetric Clinic between January 2010 and January 2022 secondary to findings consistent with or a history of atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT) PSVT without documented structural heart disease. Maternal cardiac, obstetric, and fetal/neonatal adverse events were compared to a control group consisting of 57 women with low risk, normal pregnancies and no cardiac diagnosis.

Results:
Among the PSVT cohort (n=77), 63 (82%) pregnancies had a prior diagnosis of PSVT and 18% were new-onset in pregnancy. Sixty-eight percent of those with a prior PSVT diagnosis had recurrence in pregnancy. Those with a more recent history (within 5 years of pregnancy) were more likely to experience PSVT during pregnancy compared to those with a more remote history (81% vs. 31%, p<0.001). Similarly, they experienced a higher frequency of PSVT during pregnancy and increased rates of chemical cardioversion (38% vs. 12%, p=0.05). There was a higher rate of adverse obstetrical events in the PSVT group vs. controls (8% vs. 0%, p=0.03), however this is likely due to higher prevalence of obstetric risk factors among the PSVT cohort. Adverse fetal/neonatal events were similar between the PSVT group vs. controls (17% vs. 19%, p=0.72).

Conclusions:
PSVT events were safely managed in pregnancy with no major adverse cardiac events and similar fetal/neonatal outcomes as healthy controls. However, recurrence and burden of PSVT during pregnancy is frequent and leads to management complexities among those with a history of PSVT, reinforcing the need for pre-pregnancy counselling and catheter ablation for definitive management of PSVT prior to pregnancy.
Abstract 4142114: Significant Reduction in Left Atrial Epicardial Adipose Tissue Following Catheter Ablation for Atrial Fibrillation
Authors: Chamoun Nadia , Chahine Yaacoub , Kassar Ahmad , Al Yasiri Hala , Hensley Tori , Akoum Nazem
Published: November 2024

Background:
Atrial fibrillation (AF) is closely associated with obesity, and epicardial adipose tissue (EAT) has been proposed as a possible promoter of fibrosis and predictor of AF recurrence post-ablation. The impact of ablation on left atrial (LA) EAT, as well as that of LAEAT on ablation-induced scarring, have not been explored. Our aim was to assess changes in LAEAT volume following ablation and the association of LAEAT with ablation-induced scarring and AF recurrence.

Methods:
This is a single-center observational study of AF patients undergoing their first catheter ablation at the University of Washington. Cardiac MRIs were done pre- and post-ablation. LGE-MRI and Dixon sequences were used to assess ablation-induced scarring and LAEAT (
Panel A
). 3D atrial models of fibrosis and ablation-induced scar with superimposed EAT were created (
Panel B
). Patients were followed prospectively for AF recurrence.

Results:
We included 14 patients, aged 68 (60-74) years, 64% male, and 71% with paroxysmal AF. Radiofrequency ablation was performed in 8 (57%) patients and cryoballoon ablation in 6 (43%) for pulmonary vein isolation. Median BMI was 27.2kg/m2 and left atrial volume (LAV) was 115.65 ml. LAEAT decreased from 35.47ml (28.6-53.9) to 19.37ml (11.48-30.65) post-ablation (p<0.001) (
Panel C
), despite minimal BMI change (median change 0.5kg/m
2
, p=0.07) (
Panel D
). The reduction was higher in persistent AF patients compared to paroxysmal (35.61ml vs. 14.46ml, p=0.016). LAEAT reduction was correlated with pre-ablation LAV (r=0.675, p=0.008), LA fibrosis (r=0.82, p<0.001), and BMI (r=0.815, p<0.001); and post-ablation LAV (r=0.676, p=0.011), and BMI (r=0.798, p<0.001). There was no correlation between LAEAT reduction and ablation-induced scarring. AF recurred in 9 patients (64.2%). Pre- and post-ablation LAEAT trended higher in those with recurrence compared to those without (42.72mL vs. 34.87ml, p=0.11 and 26.09ml vs. 13.85ml, p=0.11). LAEAT reduction relative to pre-ablation LAEAT was similar between groups.

Conclusion:
AF ablation was associated with a significant decrease in LAEAT. LAEAT did not affect ablation-induced scarring. The mechanisms and potential implications of these findings require further investigation.
Abstract 4142129: The Role of Neutrophil to Lymphocyte Ratio and Right Ventricular Dysfunction in Indonesian Patients with COVID-19
Authors: Agarwal Raksheeth , Muliawan Hary , Nugraha Raka , Priyonugroho Gatut , Hertine Siti , Wicaksono Sony Hilal , Almazini Prima , Zamroni Dian
Published: November 2024

Background:
The clinical impact of neutrophil to lymphocyte ratio (NLR) and right ventricular (RV) dysfunction on clinical outcomes in COVID-19 have not been studied in the often-underrepresented Indonesian population.

Aim:
To investigate the role of NLR and RV dysfunction in Indonesian patients hospitalized for COVID-19.

Methods:
A retrospective cohort study was conducted at a COVID-19 referral hospital in Indonesia. We included all adult patients hospitalized with COVID-19 between April 2020 – April 2021 who had transthoracic echocardiography (TTE) during admission. Clinical data were extracted from electronic medical records. TTE variables were defined according to the American Society of Echocardiography criteria. All statistical analyses were conducted using the SPSS software. This study was approved by the IRB at Universitas Indonesia (#2022-01-135).

Results:
A total of 488 patients were included – 29 with and 459 without RV dysfunction. The mean age of the population was 54.8 (SD ± 13.5), and 42% were females. Receiver operating curve analysis and Youden’s J statistics were used to determine the optimal NLR cut-off (Figure 1). An NLR > 4.79 was considered elevated, and had a sensitivity of 70.6% and a specificity of 80.6% in predicting severe - critical COVID-19. A high NLR (OR: 3.38, P = 0.02) and LV systolic dysfunction (OR: 9.76, P < 0.01) were independently associated with RV dysfunction. In multivariate cox regression analysis, older age (HR: 1.02, P = 0.01), obesity (HR: 1.85, P < 0.01), chronic kidney disease (HR: 1.69, P = 0.01), high NLR (HR: 2.75, P < 0.01), and RV dysfunction (HR: 2.07, P = 0.02) increased the risk of 30-day mortality.

Conclusions:
In Indonesian patients hospitalized with COVID-19, A high NLR is predictive of severe – critical COVID-19 and is associated with RV dysfunction. A high NLR at admission and RV dysfunction independently increase the risk of 30-day mortality in hospitalized Indonesian adults with COVID-19.
Abstract 4142134: Temporal Trends in Implantation of Cardiac Electronic Devices Following Septal Reduction Therapy in Obstructive Hypertrophic Cardiomyopathy
Authors: Desai Spandan , Roma Nicholas , Pattoli Megan , Shah Kashyap , Shadman Shahrad , Amaratunga Eluwana , Magid Lindsey , Shirani Jamshid
Published: November 2024

Background:
Septal reduction therapy (SRT) options for obstructive hypertrophic cardiomyopathy (oHCM) include surgical myectomy (SM) and alcohol septal ablation (ASA). A significant proportion of these SRTs also concurrently receive an implantable cardioverter defibrillator (ICD). We aimed to compare recent temporal trends and outcomes in this SRT subset.

Methods:
National Inpatient Sample 2016-2021 was queried to identify adults with oHCM using appropriate ICD codes and procedure codes were obtained for SM with ICD placement and ASA with ICD placement respectively. Logistic regression was applied to compare in-hospital outcomes.

Results:
Between 2016-2021, there were 420 cases with SM and ICD placement and 185 cases with ASA and ICD placement. Cases with ASA with ICD were older (64.3 -vs- 52.4 years), more likely to be females (58.3% -vs- 40.3%, p=0.041). The proportion of annual SM with ICD placement rates continued to decrease from 2016 and 2021 (Table 1). In comparison to this, there was an increase in ASA with ICD placement rates each year. During the study period, a majority of ASA with ICD occurred in the northeast while the majority of SM with ICD occurred in the midwest. More than 90% of SRTs were performed at large urban teaching centers. ASA with ICD cases had a higher proportion of SRT complications including development of complete heart block (62.2% -vs- 41.7%, p<0.001) but lower incidence of ventricular fibrillation (2.7% -vs-9.5%, p=0.003). ASA with ICD cases had a shorter length of stay (6.6 -vs- 10.9 days) and less total hospitalization cost ($240,792 -vs- $314,359). For both groups, major complications were uncommon and remained unchanged throughout this study period.

Conclusion:
Analysis of SRT groups in this retrospective database of hospital admissions was indicative of an overall decline in SM with ICD procedures from 2016 to 2021. Further analysis is needed to understand the impact of this trend on long term outcomes of oHCM patients.
Abstract 4142149: A 10 Year Report on Fontan Candidacy
Authors: Adamson Marissa , John Mohan , Nayi Pranay , Deshpande Shriprasad , Ferguson Matthew , Maher Kevin , Chai Paul , Beshish Asaad
Published: November 2024

Background:
As patients progress through the single ventricle palliation, changing hemodynamics and non-cardiac conditions can prevent completion of Fontan. We sought to determine the incidence of completion of Fontan at our institution and to investigate the reasons for non-Fontan candidacy.

Methods:
Institutional database was queried to identify patients who underwent single ventricle palliation from 2010 to 2020. Patients who underwent stage 2 palliation were included for analysis. The primary outcome of interest was reason for non-Fontan candidacy or reason for delayed Fontan.

Results:
526 patients who reached stage 2 single ventricle palliation were analyzed. 378 (71.9%) underwent Fontan procedure or were referred for Fontan before the age of 4-years-old at our center at the time of the study (Figure 1). 19 patients died prior to the typical age of Fontan and 38 were lost to follow up. Of the remaining 91 patients, 21 (23.1%) had a 1.5 or 2 ventricle repair, 12 (13.2%) had a Fontan at another center, and 29 (32%) had a late Fontan. Most patients with late Fontan were due to provider practice variation (22), whereas there were only 3 patients with medical conditions delaying pre-Fontan testing, and 4 patients had a Kawashima. Only 3 patients out of the 12 who had Fontan at another center were for second opinions, whereas the remainder either moved or had surgery at another center due to family preference. Reasons for non-Fontan candidacy were divided into cardiac and respiratory sources. Cardiac reasons included severely depressed ventricular function (12), diastolic dysfunction (2), atrioventricular valve stenosis or regurgitation (7), and pulmonary vein stenosis (3). Respiratory conditions leading to non-Fontan candidacy included severe OSA (1), pulmonary arterial malformation (1), and pneumonectomy (2). There are 17 patients in the non-candidacy group who had a heart transplant or were listed for transplant at the time of the study. No patient in our study was deemed not a candidate for Fontan after stage 2 palliation for developmental delay or syndrome.

Discussion:
This study demonstrates that the reasons for non-Fontan candidacy after completion of stage 2 palliation are broadly due to hemodynamic and respiratory condition, with many patients who are not candidates developing severe ventricular dysfunction after stage 2. There is a subset of patients who either move, are lost to follow up, or are delayed due to provider practice variation.