bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147215: Cardiac Magnetic Resonance Imaging vs Positron Emission Tomography in the Assessment of Viability in Ischemic Cardiomyopathy. The Alternative Imaging Modalities in Heart Failure (AIM-HF) Clinical Trial
Authors: Tavoosi Anahita , Paterson David , Omeara Eileen , White James , Larose Eric , Knuuti Juhani , Wiefels Christiane , Chow Benjamin , Chen Li , Garrard Linda , Kandolin Riina , Guo Ann , deKemp Robert , Wells George , Beanlands Rob , Mielniczuk Lisa
Published: November 2024

Background:
Patients with ischemic heart failure (IHF) often undergo myocardial viability assessment to help determine the appropriate treatment strategy, whether revascularization or medical therapy. However, there is a lack of evidence regarding the optimal imaging modality for this purpose. The present study aimed to compare the clinical outcomes of IHF patients undergoing cardiac magnetic resonance (CMR) versus positron emission tomography (PET) for myocardial viability assessment.

Methods:
We enrolled patients >18 years with IHF and ejection fraction (EF)
<
45% needing viability assessment. Exclusions included those with cardiac devices, significant medical conditions, recent ST segment myocardial infarction (<4 weeks), unsuitability for revascularization, or needing emergency revascularization/valve surgery. Patients were randomized to PET or CMR for viability detection. The primary endpoint was the composite of cardiac death, myocardial infarction, cardiac arrest, or cardiac re-hospitalization. Secondary endpoints evaluated the effect of imaging strategies on each composite component, including cardiac death.

Results:
Total of 116 patients were randomized to either the CMR group (n=60) or the PET group (n=56) at sites where both modalities were available. There were no significant differences between the CMR and PET groups in terms of average age (63.7±9.6 vs. 63.9±10.2), prevalence of male patients (90% vs. 89%), or NYHA class III or IV (40% vs. 38%). The mean EF was 25.5±7.9 in the CMR and 26.6±8.3 in the PET group, with a standardized difference of 0.264.Over a median (IQR) of 25.0 (15.3,29.6) months, the cumulative incidence rate (CIR) for the primary endpoint was 25.0% for CMR and 32.6% for PET (HR 0.74,CI 0.37-1.49,p=0.402).The CIR for cardiac death was 13.9% for CMR vs. 13.2% for PET (HR 1.12 (0.41,3.06,p=0.822)).(Fig.1)

Conclusion:
The result of this randomized cohort showed that among IHF patients who required a definition of viability, there were no significant differences in the incidence of important cardiac endpoints when either CMR or PET were used. Larger randomized clinical trials should be considered to confirm the current results.
Abstract 4147319: Anti-inflammatory Agents and their Effect on Cardiovascular Disease: A Comprehensive Review of Literature
Authors: Malik Hamza , Harmouch Wissam , mai steven , Salehin Salman , Gilani Syed
Published: November 2024

Introduction:
Historically, the pathogenesis of atherosclerotic disease has been characterized as an inflammatory process that drives the formation, progression, and rupture of plaques. Despite the recognized role of the immune response, current guidelines primarily emphasize statin and non-statin lipid lowering agents for the prevention of atherosclerotic disease. However, the utilization of anti-inflammatory agents and their effects on inflammation with respect to the attenuation of atherosclerosis has been recently highlighted in the literature.

Aim:
We aimed to investigate the role of immunomodulating agents in the prevention of atherosclerotic disease by means of a systematic review.

Methods:
We conducted a systematic search of MEDLINE, Cochrane, and Scopus databases through June 2024, for randomized control trials (RCTs) that assessed immunomodulating agents on outcomes of cardiovascular disease (CVD). Keywords included "anti-inflammatory therapy”, “immunomodulator therapy”, and “atherosclerotic disease”. Inclusion criteria involved participants aged 19 years and older with CVD and studies that assessed major adverse cardiovascular events (MACE), or atherosclerotic biomarkers.

Results:
Five RCTs were included in our systematic review, including CANTOS, COLCOT, LoDoCo2, RESCUE, and CIRT. Two RCT's evaluated immunomodulating agents, including the CANTOS trial which assessed canakinumab, an IL-1β inhibitor and the RESCUE trial which assessed ziltivekimab, an IL-6 inhibitor. The COLCOT and LoDoCo2 trials assessed colchicine while CIRT assessed methotrexate. All trials assessed the primary endpoint of MACE, except the RESCUE trial. The primary endpoint for the RESCUE trial was the percent change in high sensitivity CRP. All trials, except CIRT had statistically significant reductions in their primary endpoints.

Conclusion:
The advancements in targeted immune therapies offer promising new avenues in cardiovascular medicine. Our systematic review of RCTs suggests that anti-inflammatory agents have a beneficial role in the reduction of cardiovascular events and the progression of CVD in patients with atherosclerotic disease. While the majority of the included RCTs support the use of these agents, the heterogeneity in the individual studies emphasize the need for further research to investigate the role of immunomodulating agents on CVD outcomes.
Abstract 4147391: Cardiovascular Outcomes among Giant Cell Myocarditis compared with cardiac sarcoidosis: A Propensity score matched analysis
Authors: Jaiswal Vikash , Hanif Muhammad , Jaiswal Akash , Akhlaq Hira , Wajid Zarghoona , Danisha FNU , Ang Song Peng , Sundas FNU , Shrestha Abhigan , Rajak Kripa
Published: November 2024

Background:
Giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare inflammatory diseases of the myocardium with poor prognosis. Cardiovascular outcomes among both the disease have not been well studied with limited literature.

Objective:
This study aims to investigate the cardiovascular outcomes among patients with GCM and CS.

Method:
We queried the TriNeTX Global Collaborative Network for adult patients with Giant cell myocarditis and Cardiac sarcoidosis between January 2000 to May 2023 and created two groups: one with Giant cell myocarditis and second with Cardiac Sarcoidosis. Both the groups were followed for 6 months and 12 months. Propensity score matched analysis (PSM) was done for age, gender, race, BMI, hypertension, diabetes mellitus, chronic kidney disease, hemoglobin level, low-density lipoproteins level, left ventricular ejection fraction and various drugs including beta blockers, ACEi, ARBi, and statins. The primary outcome was all-cause mortality (ACM), while secondary outcomes were heart failure, heart transplant, ventricular tachycardia (VT), AV nodal block, and atrial flutter and fibrillations.

Result:
After PSM, amongst the 4804 patients (2402 patients in each group), the mean age of patients was 57.1 and 57.6 years in GCM and CS groups respectively. PSM analysis showed that primary outcomes i.e., ACM was significantly higher in GCM both after 6 months (RR, 2.332 (95% CI: 1.645-3.305), P<0.001) and 1 year follow up (RR, 1.547 (95% CI: 1.209-1.981), P<0.001) as compared with CS group. However, secondary outcomes i.e., Heart failure at 6 month (RR 0.668, 95% CI: 0.523-0.854), P=0.001), and at 1 year (RR 0.604, 95% CI: 0.498-0.733), P<0.001), VT at 6 months (RR 0.342, 95% CI: 0.254-0.461), P<0.001), and at 1 year (RR 0.328, 95% CI: 0.257-0.419), P<0.001), AV nodal block at 6 month (RR 0.454, 95% CI: 0.336-0.613), P<0.001), and at 1 year (RR 0.437, 95% CI: 0.342-0.557), P<0.001), and atrial flutter and fibrillation at 6 months (RR 0.674, 95% CI: 0.484-0.942), P=0.020), and at 1 year (RR 0.592, 95% CI: 0.457-0.767), P<0.001) were found significantly lower in GCM group as compared with CS. On the other hand, heart transplant incidence was comparable between both the groups.

Conclusion:
These findings suggest that giant cell myocarditis patients were having high risk of mortality and lower risk of heart failure, ventricular tachycardia, AV nodal block, and atrial flutter and fibrillation compared with cardiac sarcoidosis.
Abstract 4147434: Efficacy and Safety of Tirofiban for the Management of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)
Authors: Ayyan Muhammad , Ahmad Adeel , Fuadah Samratul , showkat wasid bin , Bullecer Dorothy , Taikadan Thahsin , Mutyala Sarika , Mohammed Cara , Hussein Abimbola , de Lima Loiola Julie Anne , Chy Mary Gabrielle Te
Published: November 2024

Background:
Tirofiban is a GP IIb/IIIa inhibitor, an anti-platelet drug that is used after ischemic episodes like stroke or acute coronary syndromes. We are assessing the safety and efficacy of the drug in patients who have suffered an acute ischemic stroke.

Methods:
A comprehensive search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to April 2024 yielded randomized controlled trials (RCTs) comparing Tirofiban and control in patients with acute ischemic stroke. We assessed the risk of bias using the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0). We analyzed the outcomes using RevMan 5.4, with risk ratio (RR) as the effect measure.

Results:
A total of eight RCTs with 3678 patients were included in our meta-analysis. According to our meta-analysis, the Tirofiban group was associated with a statistically significant increase in the patients showing functional independence at 90 days, measured by patients with Modified Rankin Score (mRS) of 0-2 (RR 1.14; CI = 1.05-1.25; I
2
= 38%). We found no difference between the two groups regarding excellent outcome (mRS score 0-1) at 90 days (RR 1.15; CI = 0.99-1.33; I
2
= 51%) and mortality (RR 0.86; CI = 0.50-1.46; I
2
= 56%). The tirofiban group did not increase the incidence of both intracranial hemorrhage (ICH) (RR 1.23; CI = 1.04-1.46; I
2
= 0%) and symptomatic ICH (RR 1.41; CI = 0.93-2.14; I
2
= 0%).

Conclusion:
According to our analysis of acute ischemic stroke patients, Tirofiban increased the number of patients with functional independence with no increase in adverse events as compared to the control group. Large-scale RCTs are needed to better ascertain the role of Tirofiban in acute ischemic stroke.
Abstract 4147439: Accuracy of Rule-based Natural Language Processing Models for Identification of Pulmonary Embolism
Authors: RASHEDI SINA , Krishnathasan Darsiya , Khairani Candrika , Bejjani Antoine , Lo Ying-Chih , Zarghami Mehrdad , Mahajan Shiwani , Caraballo Cesar , jimenez ceja jose victor , Jimenez David , Monreal Manuel , Secemsky Eric , Klok Erik , Hunsaker Andetta , Aghayev Ayaz , Muriel Alfonso , Hussain Mohamad , Appah-Sampong Abena , Aneja Sanjay , MOJIBIAN HAMID , Goldhaber Samuel , Wang Liqin , Zhou Li , Krumholz Harlan , Piazza Gregory , Bikdeli Behnood
Published: November 2024

Background:
Some rule-based natural language processing (NLP) tools can identify pulmonary embolism (PE) from imaging reports. The external validity of these tools remains to be determined.

Methods:
We evaluated data for hospitalized patients from the Mass General Brigham (MGB) Health System (2016-2021). The NLP algorithms developed by Verma et al. and Johnson et al. were implemented on radiology reports to identify PE among 1,712 patients (mean age 60.6 years, 52.3% female). Previously, these two models had demonstrated high diagnostic accuracy for PE internally within the derivation cohorts (Figure). Manual chart review by two independent physicians using pre-specified criteria was set as the reference standard. Weighted estimates were determined based on the total number of hospitalizations at MGB (n=381,642).

Results:
The prevalence of PE in the weighted sample was 2.0% (7,708/ 381,642). The weighted estimates indicated high sensitivity (77.7% and 88.1%) and specificity (98.0% and 97.2%) but low positive predictive values (44.3% and 39.7%) for the models by Verma et al. and Johnson et al. (Figure). The most frequent reason for false positive findings was the inability of the tools to properly detect negation (such as “no PE”) from the radiology reports. Most false negative findings were related to the patients diagnosed with PE at another hospital and transferred to MGB; subsequently, they did not have an available imaging report from the index hospitalization. Therefore, the NLP algorithms led to false negative results (Figure).

Conclusions:
The rule-based NLP models showed high sensitivity and specificity for PE detection. However, they resulted in low positive predictive value in external validation, contrary to the derivation cohorts, limiting their utilization. Modifying the existing NLP tools and using large language models should be considered in upcoming studies to improve the positive predictive value.
Abstract 4147473: Development of Pre-clinical Models of Coronary Microvascular Disease
Authors: Kumar Mansi , Conlon Donna , Stentz Dale , Metzler Scott , Guerraty Marie
Published: November 2024

Coronary microvascular disease (CMVD), or disease of the coronary pre-arterioles, arterioles, and capillaries, accounts for 30-50% of ischemic heart disease. Progress in the field requires preclinical models to assess the coronary microvasculature. There are several risk factors for CMVD including age, metabolic syndrome, and hypercholesterolemia. Here, we evaluate the effect of these risk factors on coronary microvascular function in mice.

Male and female C57BL/6 mice aged 12-42 weeks (n=29) were treated with 45% high fat diet (HFD) for six months or aged > 9 months. Apolipoprotein E knockout (ApoE-/-) was used to induce hypercholesterolemia as a second risk factor. To assess coronary microvascular function, we measured the intramyocardial blood volume (IMBV) under hyperemic (2.5% isoflurane) and basal (1.25% isoflurane) conditions, as previously reported. Briefly, we labeled red blood cells using pyrophosphate and Technetium 99m-pertechnatate and imaged the heart using µ-SPECT (MI Labs). Coronary microvascular function is reflected by the percent change in intramyocardial activity concentration between rest and stress conditions or
△
IMBV. Outliers were removed based on Grubbs method (a=0.1) and groups were compared using Student's T test.
p
<0.05 was considered significant (Prism 9.3.1).

Mice fed HFD had a 0.75-fold change in
△
IMBV (23% ± 3.4 vs. 17% ± 2.4, p=0.03). Aging had a similar reduction in
△
IMBV, 0.73-fold change (17% ± 2.7, p=0.01). We saw no sex-based difference in
△
IMBV in our HFD and aged cohorts (18% vs 19%, 17% vs. 19%, p=0.79, p=0.74
,
respectively), consistent with human cardiac perfusion PET imaging data. Exposure to two cardiovascular risk factors, ApoE-/- and HFD (0.48-fold change) or ApoE-/- and aging (0.54-fold change) additionally decreased
△
IMBV (11% ± 2.3, p<0.01, 12% ± 2.6, p<0.01, respectively). Of note, ApoE-/- mice on a HFD had no evidence of obstructive epicardial coronary artery disease on histology.

We evaluated coronary microvascular function in various mouse models using u-SPECT-based imaging methods and commercially available tracer. Exposure to cardiovascular risk factors induced CMVD, and the degree of CMVD was worse when two cardiovascular insults were used. Further studies using preclinical mouse models of CMVD may be helpful in assessing the effects of therapies and interventions.
Abstract 4147504: Efficacy and Safety of Vorapaxar in Patients with Peripheral Arterial Disease: A Meta-Analysis of Randomized Controlled Trials
Authors: Dogan Muhammed Melih , Tanriverdi Lokman Hekim
Published: November 2024

Introduction:
Vorapaxar is an inhibitor of protease-activated receptor-1 (PAR1) and primarily blocks thrombin mediated platelet activation. There are discrepancies in the literature regarding whether vorapaxar alleviates ischemic outcomes and increases bleeding in patients with peripheral arterial disease (PAD).

Purpose:
The aim of this study is to evaluate the efficacy and safety of Vorapaxar in patients with PAD.

Methods:
A comprehensive literature search of Cochrane CENTRAL, PubMed, Ovid Medline, and Web of Science databases was conducted. Randomized controlled trials (RCTs) comparing Vorapaxar in patients with PAD were included. Primary efficacy outcome was defined as hospitalization for acute limb ischemia, while primary safety outcome was assessed for severe bleeding events according to GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) trial. Summary effect measures of the primary outcomes were obtained by pooling the data with an inverse variance–weighted random-effects model. Statistical analyses were performed with “meta” package in R (version 4.3.2).

Results:
Three unique RCTs involving 4825 patients were included in the analysis. Vorapaxar was associated with a significantly less rate of hospitalization for acute limb ischemia (Risk Ratio [RR] 0.57, 95% Confidence Interval (CI) 0.39 to 0.83, I
2
: 0%) and significantly less requirement of peripheral revascularization (RR 0.85, 95% CI 0.76 to 0.97, I
2
: 0%) compared to placebo. Furthermore, no significant differences were observed between Vorapaxar and placebo groups in fatal bleeding (RR 1.00, 95% CI 0.38 to 2.66, I
2
: 0), severe bleeding according to GUSTO trial (RR 1.38, 95% CI 0.84 to 2.27, I
2
: 0%), and lower extremity amputation (RR 0.53, 95% CI 0.17 to 1.67, I
2
: 0%).

Conclusion:
In patients with PAD, Vorapaxar significantly reduces hospitalizations due to acute limb ischemia and the need for peripheral revascularizations compared to placebo. However, it does not have a significant effect on the need for lower extremity amputations. In terms of safety, Vorapaxar does not lead to fatal or severe bleedings compared to placebo. Therefore, Vorapaxar should remain one of the treatment options for patients with PAD.
Abstract 4147593: Improving Pediatric Heart Failure 30-Day Readmission Rates
Authors: Ambrose Anna , Butler Loreitha , Carrington Sydney , Dubke Curtis , Handley Tamara , Hicks Felicia , Butts Ryan
Published: November 2024

Introduction:
Pediatric heart failure (HF) 30-Day readmission rates are high (~20%) and contribute to resource utilization.

Methods:
A quality improvement project was initiated with the aim to reduce the pediatric HF 30-day readmission rate from above 20% to below 10% through utilization of four primary key drivers; Family directed self-care through variable diuretic dosing, early HF hospitalization follow-up, obtaining guideline directed medical therapy, and addressing iron deficiency in the hospital. Patients 18 years of age and younger admitted to the hospital with symptomatic systolic or combined (systolic and diastolic) HF were included. HF patients that were discharged after transplant or with ventricular assist device support were excluded. Electronic Health Record (EHR)-based interventions, including implementation of a HF discharge checklist, were used to deliver care and track key datapoints.

Results:
Since implementing the project on January 1, 2023, the HF 30-day readmission rate within our facility improved from 22% to 10%. The percentage of patients discharged with variable diuretic dosing plans is currently 50%. Patients discharged on at least three of five classes of HF medications increased from 75% to 80%. The percentage of patients that received early HF hospitalization follow-up decreased. Patients with iron assessed during their HF admission increased from 25% to 80%, and those with iron deficiency who received appropriate treatment increased from 75% to 100%.

Summary:
Pediatric HF 30-day readmission rates can be improved through EHR-based interventions using evidence-based adult heart failure practices. This was achieved despite the heterogeneity and lack of randomized trials in pediatric HF. Continuing efforts will focus on improving early HF hospitalization follow-up.
Abstract 4147887:
Cardiopulmonary Best Abstract Award:
Mitochondrial Dysfunction in Right Ventricular Cardiomyocytes Drives Ceramide-Mediated Lipotoxicity in Pulmonary Arterial Hypertension
Authors: Niihori Maki , James Joel , Lawal Odunayo , Rafikov Ruslan , Rafikova Olga
Published: November 2024

Introduction:
Pulmonary arterial hypertension (PAH) is a progressive and fatal disease with unmet medical needs. Patient outcomes primarily depend on the ability of the right ventricle (RV) to maintain adequate function, yet no therapy preventing RV dysfunction is currently available. Previous studies have demonstrated that patients with PAH exhibit an impaired fatty acid (FA) metabolism and RV steatosis. Furthermore, this RV lipotoxicity was associated with a substantial accumulation of the cardiotoxic sphingolipid ceramide. In this study, we utilized a novel rat model of severe mitochondrial dysfunction (MD) induced by humanized G206C mutation in the NFU1 protein to investigate the role of MD in the RV FA metabolism.

Hypothesis:
We hypothesized that MD severely impairs FA metabolism, leading to the upregulated synthesis of cardiotoxic ceramides.

Methods:
The RV functional analysis and mitochondrial respiration were assessed in the NFU1
G206C
rats with a developed PAH phenotype and age-matched wild types (WTs). The FFA transporter expression level and cardiac lipotoxicity markers were compared in the isolated RV and left ventricle (LV) cardiomyocytes (CMs). To address the role of ceramides, we investigated the protective capacity of the inhibitor of dihydroceramide desaturase-1 (DES1), catalyzing the final step in the
de novo
ceramide synthesis.

Results:
RV but not LV CMs showed impaired mitochondrial respiration in NFU1
G206C
rats. Consistent with findings in PAH patients, these changes were associated with a significant RV steatosis and an increase in the expression of free FA transporter, CD36, and DES1, both observed explicitly in NFU1
G206C
RV CMs. Treatment with a DES1 inhibitor (DES1i, 2.5 mg/kg i.p., every other day for 4 weeks) attenuated the PAH phenotype in NFU1
G206C
rats (RV systolic pressure: WTs vs. NFU1
G206C
vs. NFU1
G206C
+DES1i; 23.8 ± 1.3 vs. 32.7 ± 3.7 vs. 27.1 ± 1.3 mmHg, p < 0.001 (ANOVA), N=5:), by inhibiting RV hypertrophy (Fulton Index: 0.27 ± 0.01 vs. 0.30 ± 0.01 vs. 0.27 ± 0.01, p < 0.05 (ANOVA), N=5) and improving mitochondrial function in CMs.

Conclusion:
MD is a significant contributor to RV dysfunction, lipotoxicity, and enhanced ceramide synthesis. The protective effect of DES1 inhibition underscores the therapeutic potential of targeting ceramide pathways in PAH.
Abstract 4147913: Factors Associated with Activation to Perform Self-care among Rural Caregivers of Patients with Chronic Diseases and the Association of Activation to Perform Self-care with Adherence to Cardiovascular Disease Risk Reduction Measures
Authors: Hammash Muna , Lennie Terry , Biddle Martha , Chung Misook , Moser Debra
Published: November 2024

Introduction:
Caregivers are at high risk of cardiovascular disease (CVD), depression, and mortality compared to non- caregivers. Patient activation- one's knowledge, skills and confidence to manage their own health-is associated with improved self-management behaviors for several chronic conditions. Studies exploring patient activation among rural caregivers of patients with chronic diseases are lacking.

Aims:
To determine 1) demographic, socio-economic, and psychological characteristics associated with activation in rural caregivers, and 2) association between activation and reported adherence to recommended CVD risk reduction measures and affective symptoms in rural caregivers of patients with chronic diseases.

Method:
In this cross-sectional study, 277 rural caregivers were included (mean age 54 ± 14 years; 76% were female; and 70% were married). We measured sociodemographic factors using a standardized survey, activation using patient activation measure (PAM), caregiver burden using the Zarit Burden Interview, social support using the Medical Outcomes Study Social Support Survey, depression using the Patient Health Questionnaire-9, anxiety using the Brief Symptom Inventory– Anxiety subscale, and adherence to recommended CVD risk reduction measures using the Medical Outcomes Study (MOS) Specific Adherence Scale. Hierarchical regression analysis was performed.

Results:
In this study, patient activation was high (mean PAM 69 ± 26). Caregivers who reported low activation had significantly poorer social support, more depressive symptoms, higher anxiety level, and scored higher on food insecurity (
p
<.05). High patient activation was associated with better adherence to recommended CVD risk reduction measures (
β
= 0.17;
p
<.01), less depressive symptoms (
β
= -0.2;
p
<.001), lower anxiety level (
β
= -0.23;
p
<.001), and lower caregiver burden (
β
= -0.15;
p
<.01) compared to those with the lowest scores.

Conclusion:
In rural caregivers, higher activation was associated with better adherence to health behavior recommendations and favorable self-reported outcomes. Greater attention should be given to patient activation and psychosocial factors to reduce CVD risk in this population.
Abstract 4147929: Life Essentials 8 scores among Women by Race and Ethnicity in the National and Health Survey 2013-2020
Authors: Washington India , Olusola-Bello Mojisola , Akubo Chelsea , Tomiwa Tosin , Adeleye Khadijat , Dugbartey Janice , Metlock Faith , Turkson-Ocran Ruth-Alma , Commodore-Mensah Yvonne , Ogungbe Bunmi
Published: November 2024

Introduction:
Although the American Heart Association's Life's Essential 8 (LE8) score has been used to assess cardiovascular health in various populations, there has been a lack of focus on minoritized women and the unique intersectional identities that may influence risk factors for cardiovascular disease.

Objectives:
This study aims to assess differences in LE8 scores by race and ethnicity among women ages 18 and older.

Methods:
We analyzed cross-sectional data of women aged 18 years and older from the National Health and Nutrition Examination Survey (NHANES) 2013-2020. LE8 composite scores were computed from diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, blood glucose, lipids; scored between 0-100 points. The outcome, composite LE8 score, was categorized into quartiles very low (0-2.5), low (2.5-5), moderate (5-7.5) and high (7.5-10). Survey-weighted multinomial regression models were used to derive the relative risk ratio to assess the association between race and ethnicity categories and LE8 quartiles, adjusting for age, income, education, marital status, insurance, employment, and pregnancy history.

Results:
We included a sample of 9,848 women (corresponding to a weighed sample of 97,759,359 women), mean age 49(±17) years; 72% White, 13% Hispanic, 11% Black, and 3% Asian. Compared to Non-Hispanic White women, Hispanic women had higher relative risk ratios of being in very low (RRR = 2.53, 95% CI: 1.55, 4.12), low (RRR = 2.13, 95% CI: 1.30, 3.49), moderate (RRR = 2.03, 95% CI: 1.20, 3.43) LE8 scores quartiles. Similarly, Non-Hispanic Black women had higher relative risk ratios of being in the very low (RRR = 3.04, 95% CI: 1.81, 5.11), low (RRR = 2.25, 95% CI: 1.28, 3.95) LE8 score quartiles. Non-Hispanic Asian women had higher relative risk ratios of being in the low (RRR = 2.02, 95% CI: 1.23, 3.32) LE8 score quartiles, compared to Non-Hispanic White women (Figure).

Conclusion:
Black and Hispanic women are exposed to more cardiovascular health risk factors based on LE8 metrics. There is a need for increased LE8-focused interventions among Black and Hispanic women to bridge the significant cardiovascular health disparities.
Abstract 4147988: The association between E-cigarette use and atrial fibrillation in the All of Us Study: A prospective study
Authors: Mensah Samuel , Bene-Alhasan Yakubu , Acquah Isaac , Osei Albert , Koskina Lida , Mesubi Olurotimi
Published: November 2024

Introduction:
E-cigarette use, promoted as an alternative to traditional cigarette smoking, may have long-term clinical cardiovascular effects, including arrhythmias that have not yet been studied. Even though mouse models have shown significantly increased susceptibility to atrial fibrillation and ventricular tachycardia in rats exposed to e-cigs, there are no extensive human studies that investigate the association between e-cigarette use and atrial fibrillation in the US population. We sought to determine if e-cigarette use is associated with incident atrial fibrillation.

Methods:
This study was a longitudinal prospective study of participants enrolled in the NIH-sponsored ‘All of Us’ research study program. We excluded participants without electronic health records (EHR) and those with a diagnosis of Atrial fibrillation/flutter at baseline. We identified participants who had e-cigarette use at baseline using the Population Assessment of Tobacco and Health-styled questionnaire. We analyzed the association between both current and former e-cigarette use and incident atrial fibrillation using the Cox proportional hazards model adjusting for age, sex, race, ethnicity, income, education, alcohol use, diabetes mellitus, hypertension, dyslipidemia, BMI and other tobacco products (smokeless tobacco, cigar, hookah, and cigarette).

Results:
Of the 144, 743 participants eligible for the study at baseline, there were 2191 events of atrial fibrillation identified with a median follow-up time of 46 months. The mean age was 52 years; 21% were Blacks, 72.0% were White, and 3.5% were Asian. 2.6 % were of Hispanic ethnicity. 3.8%, 12.0%, and 84.2% were current, former, and never users of electronic cigarettes. Current and former use of e-cigarettes was not associated with incident atrial fibrillation after adjusting for confounders [aHR for current users= 0.77, 95%CI 0.52-1.12; for former users= 1.06, 95%CI 0.87 - 1.29]

Conclusion:
We did not find an association between e-cigarette use and incident atrial fibrillation or flutter. Further studies are needed in different populations to corroborate our findings.
Abstract 4148026: Multi-Venous Compression Syndromes Are Characterized by Preload Failure and Dysautonomia
Authors: Pandey Arvind , Abdou Magda , Gerhard-Herman Marie , Menard Matthew , Systrom David
Published: November 2024

Introduction:
Multi-venous compression syndromes pose diagnostic and management dilemmas due to uncertainties in both etiology and clinical course. Clinical thresholds for surgical intervention are unclear, and systemic symptoms beyond the anatomic sites of compression are common, including exertional dyspnea, intermittent tachycardia, and fatigue. We hypothesize that multi-venous compression syndromes may represent a manifestation of autonomic dysfunction with impaired venous return to the right heart (preload failure physiology).

Methods:
Consecutive patients presenting to the Vascular Medicine clinic, Vascular Surgery clinic, or the vascular ultrasound laboratory at Brigham and Women’s Hospital from November 1, 2021 to May 1, 2024 with evidence of multi-vein compressions were retrospectively included in this cohort. Venous compressions evaluated were thoracic outlet syndrome, popliteal entrapment, left common iliac vein compression, and left renal vein compression. Data were analyzed from autonomic function testing and invasive cardiopulmonary exercise testing (iCPET) performed for clinical indications.

Results:
A total of 16 patients presented with imaging-confirmed multi-vein compressions. The average (standard deviation) number of compressed sites were 4 (2). Eleven patients (69%) had clinical symptoms of dysautonomia. Five patients (31%) underwent autonomic function testing; all had an abnormal result, most commonly manifesting as reduced orthostatic cerebral blood flow velocity. Seven patients (44%) underwent iCPET; the average right atrial pressure at peak upright exercise was abnormally low at 1 mmHg (1.5 mmHg) with a range of 0-4 mmHg. Four out of 7 patients had accompanying peak oxygen consumption less than 80% of predicted. Seven patients (44%) underwent surgery for at least one compression; the most common procedure was left common iliac vein stenting. Two patients with dysautonomia underwent venous decompression and reported no significant change in overall symptoms. Nine patients with dysautonomia were managed conservatively with medical therapy (salt/water repletion, oral pyridostigmine, beta blocker, midodrine, and/or compression garments). Eight of these patients reported improved functional status after at least 6 months.

Conclusions:
Patients with multi-vein compressions are enriched for autonomic dysfunction and preload failure. Medical therapy can improve overall functional status without requiring surgical intervention.
Abstract 4148050: Correlates of DASH adherence among Adults with Hypertension in the 2013- 2020 National Health and Nutrition Examination Survey
Authors: Olusola-Bello Mojisola , Dugbartey Janice , Adeleye Khadijat , Akubo Chelsea , Sullivan Valerie , freeman jennifer , Turkson-Ocran Ruth-Alma , Ogungbe Oluwabunmi
Published: November 2024

Introduction:
Dietary Approaches to Stop Hypertension (DASH) dietary pattern is an effective non-pharmacologic approach to hypertension management. Several factors may influence DASH adherence, hence, we aimed to assess correlates of DASH adherence among adults with hypertension.

Methods:
We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013 –2020. The outcome, DASH score was calculated from dietary intake data (fruit and vegetables, fish, whole grains, sugar-sweetened beverages, and sodium) from ≥95th percentile (top/ideal diet) to 1st–24th percentile (bottom/least ideal quartile). Weighted generalized linear models were fitted to examine the correlates between DASH adherence and adult food security, age, gender, race and ethnicity, education, poverty income ratio (PIR), marital status, employment, insurance, supplemental nutrition assistance program (SNAP) receipt.

Results:
Among a sample of 3303 adults with hypertension; mean age 48 (±)18 years, 52% female; mean DASH score was 26 (±3) points. Key correlates of higher DASH diet adherence in adults with hypertension were full individual food security (β = 0.61, 95% CI: 0.10, 1.13), being Hispanic (β = 1.17, 95% CI: 0.57, 1.77) or Asian (β = 2.06, 95% CI: 1.23, 2.88) compared to Whites, older age (β = 0.05, 95% CI: 0.03, 0.07), female sex (β = 0.65, 95% CI: 0.11, 1.19), college education or higher (β = 1.58, 95% CI: 0.80, 2.36), and being married (β = 0.41, 95% CI: 0.07, 0.75). A higher poverty income ratio of 1-1.99 compared to <1 was also associated with better DASH adherence (β = 0.53, 95% CI: 0.19, 0.87).

Conclusions:
Adherence to the DASH diet among adults with hypertension in the U.S. varies based on ethnicity, individual food security, marital status, and gender. To improve adherence, targeted support should be provided, addressing the unique needs and circumstances of these different groups.
Abstract 4148059: Impact of Chronic Kidney Disease on Incidence of Atrial Fibrillation Following Heart Failure Exacerbation
Authors: Fretz Thomas , Fortna Sarah , Tanawuttiwat Tanyanan , Ilonze Onyedika , Das Mithilesh
Published: November 2024

Introduction:
Chronic kidney disease (CKD) is associated with increased morbidity and mortality in patients with heart failure (HF). Patients with HF have a high prevalence of CKD, affecting 50% or more of those with either preserved or reduced ejection fraction HF. Both heart failure and chronic kidney disease are associated with an increased incidence of atrial fibrillation (AF). However, the impact of chronic kidney disease on the incidence of AF in the heart failure population is incompletely understood.

Hypothesis:
Patients with a history of CKD have a higher risk of developing AF following HF hospitalization.

Aims:
Our goal with this study was to examine whether chronic kidney disease impacts the development of AF following HF hospitalization.

Methods:
This retrospective study included consecutive patients who were admitted to an academic tertiary care center over a 3 year time period with a primary diagnosis of heart failure exacerbation and no prior diagnosis of AF. The primary outcome was an incident of AF within 12 months after hospitalization. Demographic, comorbidity, echocardiographic data, and medications were obtained. Cox-regression analysis was performed to identify the predictors of new atrial fibrillation following heart failure hospitalization.

Results:
A total of 2,087 patients with CKD and 1,866 patients without CKD were identified and included in our study. Of those with a previous diagnosis of CKD, 22.7% developed AF at one year, whereas this occurred in 13.2% of those without previous diagnosis of CKD. This difference was statistically significant after controlling for age and comorbidities (
p<0.001; RR 1.62; 95% CI 1.37-1.90)
(Figure).

Conclusion:
A previous diagnosis of chronic kidney disease is a predictor of development of new atrial fibrillation at one year following heart failure hospitalization.
Abstract 4148114: Sequential Radial Artery Grafting Safely and Efficiently Increases Multi Arterial Grafting in Patients Undergoing Coronary Artery Bypass Grafting: A Propensity Score Analysis of Operative Outcomes
Authors: Chinedozi Ifeanyi , Mathews Jonathan , Lee Anson , Larson Emily , Sangalang Janelle , Kumar Nivedita , Wang Hanghang , Kang Jin Kook , Darby Zachary , Kachroo Puja , Lawton Jennifer
Published: November 2024

Introduction/Background:
Use of the radial artery (RA) is associated with better clinical outcomes compared to the saphenous vein during coronary artery bypass grafting (CABG) and is strongly endorsed by society guidelines. While the safety of using the RA as a sequential T-graft from the internal mammary artery is established, evidence on the safety and efficiency of sequential radial artery grafts directly from the aorta is limited.

Research Questions/Hypotheses:
The use of a sequential radial artery originating on the aorta is safe and efficient and is associated with an increase in the number of arterial grafts used in patients undergoing CABG.
Goals/Aims:
To evaluate the safety and efficiency of using the radial artery in a sequential approach directly from the aorta during CABG.

Methods:
STS database analysis of patients undergoing isolated CABG with ≥1 RA by one surgeon at two centers (2001-2022). Patients with sequential vs. non-sequential RA grafting were compared. Primary outcomes included CPB and cross-clamp time, total number of arterial grafts, and incomplete revascularization. Secondary outcomes were 30-day mortality, reoperation, stroke, renal failure, sepsis, ICU length of stay, and deep sternal wound infection. Statistical methods included Mann-Whitney U test, Chi-Square test, and Optimal Matching Propensity Score analysis (1:3 ratio).

Results:
Of 503 patients who received an RA graft, 129 (25.6%) were sequential. Before matching, significant differences were noted in median age, BMI, CPB and cross-clamp (XC) time, and elective status between groups. Sequential RA use was associated with a higher median number of arterial grafts and total grafts (3 vs 2, and 4 vs 3, respectively, p<0.001 for both). Following propensity score matching (SMD <0.1, n=125 sequential and 370 non-sequential), baseline characteristics were similar. Matched patients with sequential RA and ≥5 grafts had significantly shorter median CPB and cross-clamp time (142 [135–161] vs. 164 [164–164] min, and 113 [107–122] vs. 137 [124–137] min, p<0.001 for both), higher number of arterial grafts and total arterial grafting (p<0.001 for both), and lower rates of incomplete revascularization (17/125 vs. 83/370, p=0.046). No differences were observed in clinical outcomes between matched groups.
Abstract Or105: Preparing paramedics for patient- and family-centered resuscitation using an ABCD framework
Authors: Tennyson Carolina , Oliver John , Jooste Karen , Maxin Jeff
Published: November 2024

Introduction:
Data around Family Presence During Resuscitation (FPDR) and the Family Facilitator role are rapidly evolving in inpatient care settings. Yet, there is little formal preparation available for pre-hospital clinicians. A large Canadian paramedic group identified this gap in preparation for FPDR and requested practical, practice-changing education for their clinicians.

This project aimed to develop and deliver virtual education regarding patient- and family-centered care using current FPDR evidence and foundational care theories. Additionally, we aimed to evaluate the learner's baseline knowledge, comprehension of the content, and perspective of the framework’s application to practice.

Methods:
Three interprofessional resuscitation experts used current FPDR evidence and theories to develop the ABCD framework. The purpose of this simple schema is to provide memorable mental cues to prepare resuscitation team members for patient- and family-centered care during cardiac arrest. The ABCD tool emphasizes (A) Awareness of the family facilitator role and needs of the family, (B) Being Present emotionally and physically, (C) Connecting patients and family to the team and other resources, and (D) Debriefing and, in the case that ROSC is not achieved, leading a Pause to recognize the life lost. This framework was introduced during an hour-long pilot session for 75 Paramedics in a large Canadian province. The learning objectives included (1) identifying ways to be emotionally present, (2) communicating effectively with families during and after cardiac arrest care, and (3) recognizing the benefits of real-time reflection and team debriefing. An online survey was used to evaluate the impact of this virtual education on the participants' confidence in their communication skills and caring for family members during resuscitation.

Results:
Exposure to the ABCD framework positively influenced the confidence with which paramedics responded to families during resuscitation. Attendees responded positively to case studies; many said they felt strongly that they could lead a Pause in the case of patient death and planned to do so. At 3 months post-education, most respondents had already applied the content to their clinical practice.

Conclusion:
The ABCD framework demonstrates potential to prepare interprofessional learners to provide patient- and family-centered care during resuscitation, and this work represents a first step to validating the framework’s content.
Abstract Or106: Automated cardiac arrest detection incorporated in a wristband: First experience with spontaneous cardiac arrest detection
Authors: Edgar Roos , Scholte Niels , Ebrahimkheil Kambiz , Brouwer Marc , Beukema Rypko , Mafi-Rad Masih , Vernooy Kevin , Yap Sing , Ronner Eelko , Van Mieghem Nicolas , Boersma Eric , Cetinyurek-Yavuz Aysun , Stas Peter , Royen Niels , Bonnes Judith
Published: November 2024

Introduction:
Survival from out-of-hospital cardiac arrest depends on immediate recognition and early cardiopulmonary resuscitation. Especially for unwitnessed cardiac arrest, survival chances are poor due to delays in receiving help. Automated cardiac arrest detection using wearables could facilitate early help. In the DETECT-1 study, an algorithm for circulatory arrest detection was developed using wrist-derived photoplethysmography (PPG) from patients with induced circulatory arrest, yielding 98% sensitivity. Next step is the validation of this algorithm in spontaneous cardiac arrest events.

Goal:
This study presents the first experience with the PPG algorithm for cardiac arrest detection in hospitalized patients with spontaneous cardiac arrest.

Methods:
The study population consisted of patients who underwent transcatheter aortic valve implantation (TAVI) complicated by an episode of cardiac arrest, and patients admitted to the intensive care unit (ICU) in whom life sustaining treatment was withdrawn, while wearing the PPG wristband. Continuous ECG, arterial blood pressure data, and/or procedural logs were used as reference standard. The developed PPG algorithm for cardiac arrest detection was used to study sensitivity for cardiac arrest detection. Additionally, the mean arterial pressure (MAP) and pulse pressure, determined from the arterial blood pressure at the time of the algorithm’s cardiac arrest alarm, were analyzed.

Results:
A cardiac arrest occurred in 15 patients (9 TAVI patients and 6 ICU patients), of whom 2 had ventricular fibrillation, 11 pulseless electrical activity (Figure 1), and 2 asystole. Cardiac arrest was successfully detected in 14 out of the 15 patients, yielding a sensitivity of 93% (95% CI 66-100%). The false negative alarm was related to noisy PPG signal resulting from the immediate resuscitative interventions of the medical team. PPG data were identified as cardiac arrest at a median MAP of 37 mmHg (IQR 26-55 mmHg) and a median pulse pressure of 16 mmHg (IQR 6-18 mmHg). There were no false positive cardiac arrest alarms.

Conclusion:
The PPG algorithm successfully detected all but one cardiac arrests, which holds promise for future implementation of wristband-based cardiac arrest detection. Moreover, there were no false positive alarms. As a the next step, the PPG algorithm needs to be validated in a larger sample of cardiac arrest events and potential false positive alarms need to be studied thoroughly during daily life use.
Abstract Or109: Systemic Nicotinamide Mononucleotide Administration for Post-cardiac Arrest Brain Injury
Authors: Kaito Daiki , Tamura Tomoyoshi , Suzuki Sayuri , Oonishi Ryutaro , Homma Koichiro , Sasaki Junichi
Published: November 2024

Background:
Nicotinamide mononucleotide (NMN), a precursor of nicotinamide adenine dinucleotide (NAD
+
), has been shown to increase NAD
+
levels, reduce inflammation, and improve short-term survival in a rodent model of hemorrhagic shock. NAD
+
levels decrease after cardiac arrest (CA), but the effect of NMN on outcomes after CA remains undefined.

Hypothesis:
NMN administration increases NAD
+
content in the brain, reduces systemic inflammation, and improves outcomes after CA.

Aims:
This study aimed to investigate the effects of systemic NMN administration on neurological function, survival, and systemic inflammation after CA.

Methods:
In a murine model of CA, asystole was induced using potassium chloride. After 10 minutes of CA, mice were resuscitated with continuous epinephrine injections. Mice were randomly assigned to the NMN group (60 mg/kg body weight i.p.) or the control group (normal saline i.p.) 1.5 minutes after the return of spontaneous circulation (ROSC). The same treatment was repeated at 24 and 48 hours after CA. Neurological function score (on a scale from 0 to 12) at 48 hours post-CA and 7-day survival were compared between the NMN and control groups. Brain NAD
+
levels were measured 30 minutes post-ROSC. Plasma cytokine levels (IL-6 and TNF-α) were measured 2 hours post-ROSC.

Results:
Brain NAD
+
levels significantly increased 30 minutes post-ROSC in the NMN group compared to the control group (186 ± 15 pg/mg tissue and 131 ± 14 pg/mg tissue, respectively; P=0.02). NMN significantly improved neurological function score at 48 hours post-CA (NMN group median 12 [9–12] vs. control group 8 [4–11]; P=0.03). Moreover, NMN improved survival rate up to 7 days post-CA (NMN group 61.1% [11/18] vs. control group 22.2% [4/18]; P=0.03). Mean arterial pressure tended to be higher in the NMN group, although the difference was not significant (NMN group 113.8 ± 2.1 mmHg vs. control group 107.8 ± 2.9 mmHg; P=0.08). NMN showed a trend toward decreased IL-6 (NMN group 52.7 ± 14.3 pg/ml vs. control group 114.6 ± 33.3 pg/ml; P=0.15) and TNF-α (NMN group 6.9 ± 1.2 pg/ml vs. control group 11.7 ± 2.3 pg/ml; P=0.12).

Conclusions:
Systemic administration of NMN post-CA increased brain NAD
+
levels and improved neurological function and survival. NMN also showed a trend toward reduced systemic inflammation. NMN is a promising approach to improve outcomes after CA.