bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4140714: Prevalence and Outcomes of Percutaneous Coronary Intervention in Patients With and Without Bipolar Disorder: A National Inpatient Sample Analysis
Authors: Khan Arshan , Atluri Ramtej , Alkehef Yazan , alsheikh omer , Mesih Nancy , Hassan Sohail
Published: November 2024

Background:
Severe mental disorders (SMIs) such as bipolar disorder are associated with a reduced life expectancy of up to two decades, with cardiovascular disease as the leading cause of death. Post-acute coronary syndrome, SMI patients, including bipolar disorder, often face poor prognosis and lower percutaneous coronary intervention (PCI) rates. We aimed to assess PCI prevalence and outcomes in patients with bipolar disorder.

Methods:
We analyzed the National Inpatient Sample data from 2016-2019, identifying 4,483,509 hospitalized adults with myocardial infarction (MI). These hospitalizations were further stratified based on the presence or absence of bipolar disorder using ICD-10 codes. A multivariate regression model was used to adjust for confounders and analyze the variables.

Results:
Out of 142,420,378 hospitalizations, 4,483,509 (3.15%) were identified with MI. Among those with MI, 1,221,030 (27.24%) underwent PCI. PCI rates were higher among MI patients without bipolar disorder compared to those with bipolar disorder (27.4% vs. 20%; p<0.001). Figure 1 depicts the Forest plot for multivariate analysis of complications. The length of stay (LOS) in patients with bipolar disorder was 0.24 days longer (p=0.02) on univariate analysis. However, on multivariate analysis, adjusted for patient demographics, comorbidities, and hospital characteristics, the difference in LOS was not statistically significant. Similarly, when adjusted for these variables, bipolar disorder patients who underwent PCI had no statistical difference in terms of mortality (adjusted odds ratio [AOR] 1.03; CI 0.79-1.34; p=0.81) and In-stent stenosis (ISR) (AOR 1.14; CI 0.95-1.37; p=0.13). Although bipolar disorder patients incurred slightly higher total hospitalization costs ($116,931 vs. $116,381 for those without bipolar disorder), this difference was not statistically significant (p = 0.812).

Conclusion:
Our study reveals a significant healthcare disparity: despite comparable outcomes in mortality, in-stent stenosis, and other complications, individuals with bipolar disorder are less likely to undergo PCI following MI. These findings underscore the need for targeted interventions to ensure equitable healthcare access for all patients.
Abstract 4140727: Genetic Insights into Chronic Thromboembolic Pulmonary Hypertension: Uncovering Immune Mechanisms in the Chinese Population
Authors: duo mengjie , Zou Bingzhang , Zhang Zhu , Zhai Zhenguo , Wang Chen
Published: November 2024

Background:
Current genomics studies on chronic thromboembolic pulmonary hypertension (CTEPH) have primarily focused on European populations, with limited research conducted on East Asian populations. Although CTEPH is considered a complication of acute pulmonary thromboembolism (PTE), 25% of CTEPH have no prior history of PTE.

Aim:
This study aimed to uncover the genetic basis of CTEPH and identify susceptibility loci and genes from the Chinese population, seeking to understand the shared and distinct genetic mechanisms between CTEPH and PTE.

Methods:
The discovery cohort enrolled 412 CTEPH and 2000 controls for whole genome sequencing. Genome-wide association analysis (GWAS) and gene annotation were performed for common variants (MAF>5%) to identify susceptibility gene. The heritability of CTEPH was calculated using LDSC. Additionally, burden test was performed in rare variants (MAF<1%) to identify candidate genes. Bulk and single-cell transcriptome analyses were performed on PEA tissues from CTEPH and controls. Method scPagwas was used to integrate GWAS and transcriptomics data.

Results:
A total of 1379 SNPs reached genome-wide significance (P<5×10
-8
), and 217 risk loci were identified after Clumping. LDSC estimated a heritability of 0.1217 for CTEPH. FUMA and TWAS analysis mapped 708 susceptibility genes, of which 95 genes were suggested by both common and rare variants. Several CTEPH susceptibility genes, including
CYP27C1, PROC, F2, LRP4, MPHOSPH9, SBNO1, EDEM2, PROCR,
and
ABO
, have been previously reported to be associated with VTE. However, only
ABO, F2
, and
HLA-DRA
overlap with CTEPH susceptibility genes identified in European populations. The scPagwas indicated that monocyte-macrophage trait correlation scores were highest in the single cell profiles of CTEPH. The differentially expressed genes from transcriptomics and susceptibility genes, identified five key genes:
SLC11A1, SLCO2B1, RILPL2, HCK
, and
CTSS
.
SLC11A1
is primarily distributed in monocytes and macrophages and regulates multiple immune inflammation processes, including reactive oxygen species and interleukin production, and T cell differentiation. Disease-related pathways encompass the complement coagulation pathway, Th cell differentiation, and various autoimmune diseases.

Conclusion:
CTEPH is influenced by genetic factors. Multiomics data suggest that abnormal immune responses mediated by high
SCL11A1
expression in monocytes and macrophages may be a key mechanism in the development of CTEPH.
Abstract 4140735: Associations Between Smoking Status and Sleep Health among South Korean Adolescents
Authors: Cho Nagyeong , Cho Sung-il
Published: November 2024

Background:
Cigarette smoking has been linked to sleep problems in both adults and adolescents. Some recent studies suggest dual users of conventional cigarettes (CC) and e-cigarettes (EC) may be more likely to experience sleep problems compared to CC-only users. Given the shorter sleep duration observed among South Korean adolescents compared to their global peers, this study investigates the relationship between smoking status and sleep health in Korean adolescents aged 13-18.

Methods:
We analyzed data from the 16th to 19th Korea Youth Risk Behavior Survey, a cross-sectional annual survey of health risk behaviors among Korean middle and high school students conducted from 2020 to 2023. The sample included 195,636 participants who reported sleep duration and satisfaction. Participants were categorized into five groups based on tobacco use: non-users, former users, current CC-only users, current EC or heated-tobacco product (HTP)-only users, and current dual users (CC+EC or CC+HTP). Sleep health was assessed using self-reported questionnaires on sleep duration during weekdays and overall sleep satisfaction: ‘<7 hours&Insufficient’, ‘≥7h&Insufficient’, ‘<7h&Sufficient’, and ‘≥7h&Sufficient’. Adolescents categorized as experiencing ‘Short (<7 hours)&Insufficient’ sleep were considered to have the poorest sleep health. We conducted a multinomial logistic regression analysis to explore the association between sleep health and smoking status. Covariates adjusted for the analysis included gender, grade, year, economic status, residential status, academic achievement, self-rated health, perceived stress, and smartphone use.

Results:
Of 195,636 adolescents, 41.2% of girls and 27.6% of boys experienced ‘Short&Insufficient’ sleep. Current dual users of CC and EC or HTP had the highest prevalence (52.7%) of experiencing ‘Short&Insufficient’ sleep compared to other smoking groups. Compared to non-users, the odds ratio (OR) for ‘Short&Insufficient’ sleep was significantly highest in the current dual users (OR 2.37, 95% CI 2.10-2.67). Current CC-only users, current EC or HTPs-only users, and former users had ORs of 2.08 (95% CI 1.85-2.34), 1.74 (95% CI 1.34-2.25), and 1.77 (95% CI 1.50-2.10), respectively.

Conclusions:
Our findings suggest that current smoking and dual use of tobacco products are associated with poor sleep health among Korean adolescents. Implementing smoking cessation programs may contribute to better sleep quality in this population.
Abstract 4140743: Impact of Frailty on In-Hospital Outcomes in Leadless Pacemaker Implantation (LPI)
Authors: Naeem Nauman , Ukrani Hina , Joshi Akshay , Karki Roshan , Rao Mohan , Mohammed Moghniuddin
Published: November 2024

Background:
Frailty is linked to adverse clinical outcomes across various patient and procedural cohorts. Leadless pacing has recently emerged as a promising therapy; however, little is known regarding its utilization and outcomes.

Aim:
To assess the association between frailty and hospital outcomes in patients undergoing leadless pacemaker implantation (LPI).

Methods:
We conducted a retrospective cohort study using the National Inpatient Sample to identify patients aged at least 18 years who underwent LPI between 2016 and 2020. Patients with a history of cardiac implantable electronic devices or procedures, including ablation, percutaneous coronary intervention, coronary artery bypass surgery, and valvular intervention, were excluded. A total of 21,210 patients were included and divided into three groups based on the Hospital Frailty Risk Score (HFRS): low risk (HFRS <5, n=7540), intermediate risk (HFRS 5-15, n=12010), and high risk (HFRS >15, n=1660). All analyses were performed using R, and the adjusted odds ratio (aOR) was determined using multivariate logistic regression analysis.

Results:
Overall, 64.4% of patients were at intermediate or high risk of frailty. The most common comorbidities in the high-risk group were diabetes (40.7%), congestive heart failure (53.3%), renal failure (55.4%), and hypertension (84.0%). Patients at intermediate or high risk of frailty had a higher risk of in-hospital mortality compared to the low-risk group (adjusted odds ratio 5.44 [95% CI, 3.20-9.25] for HFRS 5-15, and 7.07 [95% CI, 3.68-13.58] for HFRS >15). The most common complications were acute kidney injury and bleeding, with aOR of 2.77 [95% CI, 2.39-3.21] in the intermediate group and 5.21 [95% CI, 3.95-6.86] in the high-risk group. The length of hospital stay (16.39 vs. 4.5 days) and discharge to a nursing facility (58.7% vs. 12%) were also higher in the high-risk group compared to the low-risk group..

Conclusion:
Frailty is associated with an increased risk of mortality and complications in patients undergoing LPI and can be used for prognostication and informed decision-making with patients.
Abstract 4140751: “A silent death: Right heart clot in transit” Acute sub-massive pulmonary embolism
Authors: Udoh Kubiat , POTTABATHINI RAHUL
Published: November 2024

An 84-year-old male with a history of prostate cancer not on chemotherapy presented to the ED with complaints of shortness of breath worse on exertion ongoing for 1 week accompanied by generalized malaise. On arrival, his troponins were elevated 373, elevated BNP 934. He was requiring supplemental oxygen and an initial bedside cardiac ultrasound was unremarkable. On day 3 of hospitalization, he experienced a syncopal episode and had acute worsening of hypoxemia that prompted a CT angiography of the chest which revealed bilateral, large clot burden pulmonary emboli with proximal thrombus in both the right and left main pulmonary arteries. He was administered a therapeutic dose of low-molecular weight heparin and transferred to the ICU. Despite his large clot burden, there was absence of obstructive shock.

Transthoracic Echocardiogram and bilateral duplex venous ultrasound were obtained to evaluate for right heart strain and clot burden. TTE showed a clot in transit between the right atrium and ventricle, a severely dilated RV with reduced RV systolic function. Extensive clot burden in bilateral lower extremities was visualized on ultrasound. Cardiology was consulted. The risk and benefits of catheter-based aspiration thrombectomy versus thrombolytics (peripheral versus catheter directed) versus surgical thrombectomy versus anticoagulation alone were discussed. Given his high risk of in-hospital mortality, age and frailty, shared-decision making to proceed with anticoagulation alone was decided. Unfortunately, on day 8 of hospitalization, he became bradycardic with no recordable blood pressures, and went into pulseless electrical activity soon after with an eventual demise.

In this clinical case, we discussed sub-massive pulmonary embolism (PE) complicated by a right heart clot-in-transit presenting insidiously. Acute sub-massive pulmonary embolism is defined as intermediate risk PE associated with right ventricular dysfunction without hemodynamic instability. Right heart clot in transit is a rare complication of PE and is associated with a high mortality rate of 20-30%. Anticoagulation is the 1st line treatment for sub-massive PE but definite therapy regarding the management of right heart clot in transit is still debated: CATHETER-BASED INTERVENTION versus SURGICAL THROMBECTOMY as none is thought to be superior. Indication for either therapy centers on hemodynamic compromise which is assessed on a case-by-case basis based on the clinician’s judgement.
Abstract 4140774: Pharmaceutically Manufactured Cannabidiol Demonstrates Clinically Relevant Reductions in Pericarditis Pain and C-Reactive Protein in Patients with Recurrent Pericarditis – the MAvERIC-Pilot Study
Authors: Luis Sushil , Klein Allan , Cremer Paul , Abbate Antonio , Salik Jonathan , Thomas Georgia , Haider Syed Waqas , Hagerty Tracy , Lin David , Waggoner Thomas , Nicholls Stephen , Parker Andrea , Hamer Andrew
Published: November 2024

Background:
Recurrent pericarditis results from inflammasome activation and is associated with significant morbidity. Cannabidiol has been shown to block numerous inflammasome signaling pathways, including reducing transcription of pro-IL-1β and NLRP3, and inhibiting secretion of IL-1β and IL-6.

Aim:
To assess the impact of oral pharmaceutically manufactured (P-)cannabidiol in recurrent pericarditis patients (pts).

Methods:
Adult pts (≥18 years) with symptomatic, recurrent pericarditis (≥2 recurrences) were eligible for this open-label, multicenter study. Eligible pts had pericarditis chest pain with a numerical rating scale (NRS) pain score ≥4 within 7 days prior to enrollment, together with either elevated (≥1.0 mg/dL) C-reactive protein (CRP) within the prior 7 days or prior pericardial late gadolinium enhancement (LGE) on cardiac imaging. Pts had to be on chronic treatment with NSAIDs, colchicine or corticosteroids (any combination) with stable baseline (BL) doses. Oral P-cannabidiol was uptitrated to 10 mg/kg twice daily (BID), or maximum tolerated dose. The primary efficacy endpoint was improvement in NRS pain score at week 8 (WK8). A secondary efficacy endpoint among pts with elevated BL CRP was the percentage of pts with CRP normalization (≤0.5 mg/dL) at WK8.

Results:
27 pts, mean age of 53 years (range 24-77), 18 of female sex, with a median of 3 prior pericarditis episodes were enrolled. CRP was ≥1.0 mg/dL in 10 pts (37%) at BL. Prior evidence of LGE was present in 21 pts (78%). At BL, 41% of pts were receiving corticosteroid therapy. The highest tolerated study medication dose was BID 10 mg/kg in 20 pts (74.1%), 7.5 mg/kg in 4 pts (14.8%), and 5 mg/kg in 3 pts (11.1%). All 27 pts (100%) completed the WK8 visit. Mean NRS score decreased by 3.7, from 5.8 at BL to 2.1 at WK8. In those with CRP elevation at BL, CRP normalized in 8 pts (80%) by WK8, with mean CRP decreasing from 5.71 to 0.31 mg/dL. Study medication was discontinued due to AEs in 2 pts (7.4%). 24 pts (89%) tolerated P-cannabidiol with a treatment response and proceeded into the 18-week extension period (EP) where background therapy is weaned.

Conclusions:
Among pts with symptomatic pericarditis recurrence, oral administration of P-cannabidiol led to a clinically relevant reduction in pericarditis chest pain (measured by NRS score) and in CRP. P-cannabidiol was shown to be safe and generally well tolerated, with the majority of pts reaching the target dose and continuing into the study EP.
Abstract 4140786: The Outcomes of Takotsubo Cardiomyopathy Patients with Psychiatric Disorders: A Global Retrospective Analysis using TriNetX
Authors: Devakumar Sahana , Anuforo Anderson , Gupta Nikita , Ochani Rohan Kumar , Hanif Muhammad , Liu Kan , Taub Cynthia
Published: November 2024

Background:
High prevalence of psychiatric disorders (PD) is seen in Takotsubo cardiomyopathy (TC). Existing literature presents conflicting results but often identifies worse outcomes in patients with PD who develop TC. Primary limitations of those studies were relatively small sample sizes and insufficient matching for confounders. Therefore, we used a global database to determine differences in outcomes in TC patients with and without PD.

Methods:
We queried the TriNeTX Global collaborative network for adults diagnosed with TC between 2013 and 2023. We excluded patients with confounding diagnoses occurring 5 days before or after TC diagnosis and created two cohorts based on PD diagnosis. ICD-10 codes for PD included were: psychotic, mood and anxiety disorders. Propensity score matching (PSM) was conducted for over 50 covariates. After PSM, logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals. The primary endpoints were all-cause mortality, 4-point MACE and ICU admissions at 30 days, 90 days and 1 year. Acute appendicitis was used as a falsification endpoint.

Result:
The sample population had 10864 patients in the cohort with diagnosed TC and PD (Cohort 1) and 11,997 patients with TC without PD (Cohort 2). Before propensity score matching (PSM), Cohort 1 had significantly increased odds of ICU admissions (OR 1.32, 95%CI, 1.22-1.43) and 4-point MACE (OR 1.34, 95%CI, 1.26-1.44) but not all-cause mortality (OR 0.98, 95%CI, 0.88-1.09) at 30 days [Table 1]. After propensity score matching (PSM), both cohorts had 7,074 patients. Analysis post-PSM showed Cohort 1 had significantly lower odds of all primary outcomes compared to Cohort 2 at 30 days: All-cause mortality (OR 0.75; 95%CI, 0.66-0.86), 4 point MACE (OR 0.86; 95%CI, 0.79-0.94), and ICU admission (OR 0.88; 95%CI 0.80-0.97). These lower odds persisted at 90 days and 1 year.

Conclusion:
After extensive propensity score matching to eliminate confounders, there are reduced odds of 4-point MACE, all-cause mortality, cardiogenic shock and cardiac arrest in TC with PD cohort suggesting that patients with PD and TC have better cardiovascular outcomes if appropriately matched to a cohort with similar baseline characteristics.
Abstract 4140789: Clinical Impact of Utilization of Circulatory Assist Pump Cathter as Bridge to Cardiovascular Surgery for Preoperative Cardiogenic Shock -J-PVAD registry study-
Authors: Domae Keitaro , Mishima Takehito , Okoshi Yuki , Suzuki Shuhei , Onishi Ryo , Okubo Yuka , Okamoto Takeshi , Tsuchida Masanori
Published: November 2024

Background:
Cardiogenic shock in the perioperative period of cardiovascular (CV) surgery is a major challenge that worsens the prognosis and jeopardizes of treatment opportunities. Recently, the preoperative use of circulatory assist pump catheter (Impella) has been reported as a bridge to CV surgery in patients presenting with cardiogenic shock. However, the clinical impact has not been fully investigated.

Aims:
In this study, we aimed to investigate the safety and efficacy of utilization of Impella for preoperative cardiogenic shock as a bridge to CV surgery using the national database of Japanese Registry for Percutaneous Ventricular Assist Devices (J-PVAD).

Methods:
We selected and analyzed 102 patients with cardiogenic shock who utilized Impella before CV surgery from J-PVAD registry database from 2020 to 2021. The average age was 70.2 years, the etiologies were ischemic in 94 cases (92.2%), valvular disease in 8 cases (7.8%). The median time from onset to Impella support was 2.5 hours, the lactate level before insertion was 5.8±4.9 mmol/l, and LVEF was 37.7±14.6%. The devices used were Impella alone in 72 case (CP/2.5 in 66, 5.0 in 6) and combination of ECMO in 30 cases.

Results:
The detail of CV surgery was CABG alone in 43 cases, VSP repair in 27 cases, MV surgery in 25 cases and repair of LV rupture in 7cases. The mean duration of Impella support was 6.7 days, with 79 patients (77.5%) weaning off Impella, 21 patients (20.5%) dying during support, and 2 patients (2.0%) converting to durable LVAD. Bleeding events were observed in 26 patients (25.4%). Hemolysis in 10 patients and lower extremity ischemia in 5 patients, all of whom were CP cases. Post-weaning mortality was observed in 25 cases, and in-hospital mortality in 46 cases (45.1%). Freedom from all cause death at 30-day was 68.8% with no significant difference between ECPELLA and Impella alone (Log rank p=0.38).

Conclusions:
The clinical outcomes of bridge to CV surgery using Impella for preoperative cardiogenic shock from J-PVAD registry demonstrated acceptable postoperative weaning rate, however several cases of post-weaning mortality were observed, suggesting that appropriate protocol of weaning the device and prevention of complication is mandatory to improve outcomes.
Abstract 4140795: Pregnancy Outcomes in Women with Cardiovascular Disease: A Retrospective Cohort Study from Kaiser Permanente Northern California
Authors: Partani Ekta , Shi Carol , Stram Douglas , McDonald Marisa , Triplett Cynthia , Ting Jennifer , Stephenson Megan , Joshi Nikhil , Pursnani Seema
Published: November 2024

Background:
Cardiovascular disease (CVD) remains a leading cause of maternal mortality in the United States, comprising 26.5% of pregnancy-related deaths.

Objective:
We aim to evaluate trends in CVD during pregnancy and maternal, obstetric, and fetal outcomes in pregnant women with CVD in the Kaiser Permanente Northern California (KPNC) integrated healthcare system.

Methods:
This is a retrospective cohort study of adult KPNC members with moderate or greater valvular heart disease, cardiomyopathy, congenital heart disease, or ischemic heart disease during pregnancy from 2010-2021. Bivariate analyses and multivariable logistic regression were used to evaluate associations between demographic and clinical risk factors and maternal outcomes in pregnant patients with CVD.

Results:
Of 320,902 pregnancies, 763 (0.24%) were identified with clinically significant CVD. The prevalence of CVD increased from 0.19% to 0.24% over the decade, predominantly due to an increase in prevalence of women with congenital heart disease. Mean gestational age at delivery was 36.7 weeks with 19.5% experiencing preterm delivery. Cesarean section, pre-eclampsia or eclampsia, and postpartum hemorrhage rates were 29.5%, 20.8%, and 13.1%, respectively. Fetal loss beyond the first trimester occurred in 7.1% pregnancies.

Adverse maternal cardiac outcomes occurred in 12.6% of patients with clinically significant CVD, with the most common outcome being hospitalizations for congestive heart failure. Age, diabetes, parity, BMI, prior heart failure, prior CVD, lower LVEF, and systemic valvular regurgitation were significant predictors of adverse maternal events.

Conclusions:
The incidence of CVD during pregnancy increased between 2010-2021, largely driven by an increase in pregnancies among women with congenital heart disease. Rates of adverse maternal cardiac outcomes, pregnancy loss greater than 20 weeks, and maternal mortality in this cohort were similar to those previously reported in other large registries. High rates of pre-eclampsia or eclampsia and postpartum hemorrhage were noted in this cohort. Understanding risk factors for adverse outcomes in a contemporary, diverse setting can help refine cardio-obstetric risk assessment and preconception counseling.
Abstract 4140800: Clinical Outcomes in Peripartum Cardiomyopathy Complicated by Cardiogenic Shock: A Retrospective Multi-Center Cohort Study
Authors: Parcha Vibhu , Scheinuk John , Josey Gina , Hyder Syed , Hasnie Usman , Saleh Ahmed , Hasnie Ammar , Sinkey Rachel , Cribbs Marc , Joly Joanna , McElwee Samuel , Clarkson Stephen
Published: November 2024

Introduction:
Peripartum cardiomyopathy (PPCM) is the leading cause of late postpartum pregnancy-related death and often precipitates acute heart failure and cardiogenic shock. Limited contemporary data exists on long-term outcomes among PPCM patients who develop cardiogenic shock (PPCM-CS), especially those who require extra-corporeal membrane oxygenation (ECMO).

Methods:
This retrospective cohort study identified patients with PPCM-CS from January 2012-January 2024, using EHR-based data from academic medical centers across the US (TriNetX, Inc.). The primary outcome was all-cause mortality over a 180-day follow-up period. Secondary outcomes included acute kidney injury (AKI), new-onset atrial fibrillation (AF), ventricular tachycardia/fibrillation (VT/VF), mechanical circulatory support (MCS), and heart transplantation (HT). The outcomes were reported in the overall population and among those requiring ECMO support.

Results:
We identified 856 females (mean age 36 ± 12 years; 41% White, 41% Black individuals) with PPCM-CS (
Table
). During a mean follow-up of 144 ± 63 days, all-cause mortality occurred in 17.9%. There were high incidences of AKI (53.7%), AF (19.4%), and VT/VF (29.3%) (
Fig 1
). 8.1% of patients successfully underwent HT. There was substantial MCS use, with percutaneous ventricular assist device (pVAD) used in 8.7% and intra-aortic balloon pump (IABP) used in 11.0%. Among those requiring ECMO (N=97, 11.3%), there was high all-cause mortality (26.8%). The concomitant use of pVAD and IABP was 14.4% and 15.5%, respectively. 14.4% of ECMO-supported patients underwent successful HT.

Conclusion:
This study provides insights into long-term clinical outcomes among patients with PPCM-CS, highlights those requiring ECMO support. Further investigation is needed for early disease recognition and to establish optimal utilization of MCS to improve outcomes in PPCM-CS.
Abstract 4140834: The Use of Angiotensin Receptor Blockers Decreased Three-Year and Five-Year Mortality in a VA Population with Ascending Thoracic Aortic Aneurysms
Authors: Kailash Vidur , Tu Sally , Zamirpour Siavash , Pace William , Boskovski Marko , Ge Liang , Tseng Elaine
Published: November 2024

Background:
The incidence of ascending thoracic aortic aneurysms (aTAA) is approximately 5-10/100000 individuals/year. Estimates of acute rupture or dissection range from 1.6-4/100000 individuals/year with a mortality rate for untreated dissection up to 50% within 48 hours. Current guidelines recommend surgical intervention for aTAAs ≥ 55mm in diameter. Risk factors that contribute to aTAA growth and mortality include diabetes, age, and smoking history however, not much investigation has been done to evaluate protective factors.

Objective:
To evaluate clinical factors that reduce three-year and five-year all-cause mortality in a veteran population who have dilated ascending aortas or ascending thoracic aortic aneurysms (aTAA) and who did not undergo repair within three or five years.

Methods:
We conducted a cohort study of 887 patients followed for aTAA (diameter ≥ 4.0cm) at a Veterans Affairs hospital. Patients who died of any cause before repair within 3 or 5 years of aTAA identification or had 3 or 5 years of follow-up without repair were further analyzed. 57 pertinent factors (including social, genetic, cardiac risk factors, aneurysm size, medications, etc.) were evaluated in univariate logistic regression models of three and five-year all-cause mortality. Variables with univariate p<0.2 were combined in a multivariate logistic regression model. P<0.05 was considered statistically significant.

Results:
In the 3-year model, 392 had ≥3 years follow-up without aTAA surgical repair. 35 out of 392 patients (8.9%) died within 3 years. The only statistically significant variable that reduced mortality was history of angiotensin receptor blocker (ARB) use (OR 0.24, p=0.042). In the 5-year model, 274 had ≥5 years follow-up without aTAA surgical repair. 68 out of 274 patients (24.8%) died within 5 years. Similarly, history of ARB use (OR 0.22, p=0.003) was the only pertinent variable. For both models, the results were independent of age, history of diabetes, valve disease, CHF, and stroke.

Conclusion:
Among modifiable risk factors, at both 3 and 5 years, history of ARB was associated with reduced mortality (13% mortality compared to 27% at 5 years) and should be further investigated.
Abstract 4140839: Mitral Transcatheter Edge-to-Edge Repair to Treat Systolic Anterior Motion of the Mitral Valve and a Flail Posterior Mitral Leaflet: One Clip, Two Solutions
Authors: Ravindra Krishna , Anderson Ella , Morford Reagan , Moore Ashley , Kaddaha Firas , Tavaf-Motamen Houman , Kanda Brinder
Published: November 2024

Description of Case:
An 83-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM) with systolic anterior motion (SAM) of the mitral valve presented to the Emergency Department with several weeks of progressively worsening dyspnea and was found to have acute hypoxemic respiratory failure. The patient was started on bilevel positive airway pressure and underwent aggressive diuresis. Transesophageal echocardiogram showed moderate aortic stenosis, HOCM with SAM of the mitral valve, a large P2 flail segment of the mitral apparatus with ruptured cords, and significant pulmonary vein flow reversal. Percutaneous transcatheter edge-to-edge repair (TEER) was pursued with intraoperative transesophageal echocardiograpic images demonstrating an excellent result with resultant mild mitral regurgitation and a mean transmitral diastolic gradient of 5-6 mmHg. Hemodynamic measurements at this time showed resolution of prior left ventricular outflow tract gradient (from 86 mmHg to 25 mmHg).

Discussion:
This report highlights a unique case in which a patient with known HOCM with SAM of the mitral valve developed concomitant severe mitral regurgitation from a flail posterior leaflet, leading to acute hypoxemic respiratory failure that was repaired with TEER. Current nonpharmacologic interventions for HOCM include alcohol septal ablation/myectomy, though both of these are not without their own risks. Though the use of TEER has been approved for patients with symptomatic severe mitral regurgitation who are deemed inoperable or at high surgical risk with a life expectancy > 1 year, small studies have also reported the use of TEER in patients with HOCM for symptom improvement who were not candidates for septal reduction therapy. This case builds on prior reports supporting TEER as an option for patients with medication-refractory HOCM who are not candidates for surgical intervention, also highlighting that it can be done concomitantly to treat acute degenerative valvulopathies.
Abstract 4140853: Gender Differences in Cardiovascular Mortality Among Patients with Immune Mediated Diseases: A 22-Year Analysis
Authors: Motairek Issam , Abdulhai Farah , Badwan Osamah , Calcagno Tess , Issa Rochell , Tabaja Chadi , Al-Dalakta Astefanos , Arab Sammy , Mirzai Saeid , Husni Elaine , wassif heba
Published: November 2024

Introduction:
Cardiovascular disease (CVD) poses a significant mortality risk for patients with immune mediated diseases (IMIDs) due to systemic inflammation. However, true population-based cardiovascular mortality data are lacking for this group, particularly with respect to gender disparities. This study examines gender disparities in CVD mortality over 22 years in this high-risk population.

Methods:
Using CDC Multiple Cause of Death files (1999-2020), we identified CVD deaths (ICD-10 I00-I99) with underlying IMIDs (ICD-10 M05.0-M13, M30-M35) in the United States. Age-adjusted mortality rates were computed annually. Linear regression and t-tests assessed trends and gender differences, with significance at p < 0.01.

Results:
We analyzed 127,149 deaths. Age-adjusted mortality rates for females decreased from 4.2/100,000 in 1999 to 1.8/100,000 in 2020 (p < 0.01). For males, rates declined from 2.9/100,000 to 1.4/100,000 (p < 0.01). Gender differences were statistically significant (p < 0.01), with females exhibiting consistently higher mortality rates. (Figure)

Conclusions:
Despite overall declines in CV mortality, females with IMIDs face higher CVD mortality, indicating a need for gender-specific interventions. Continuous efforts are vital to address these disparities and enhance cardiovascular health outcomes.
Abstract 4140887: Impact of Advanced Lung Cancer Inflammation Index on All-Cause Mortality Among Patients With Heart Failure: A Meta-analysis with Reconstructed Time-to-Event Data
Authors: Amin Ahmed Mazen , Ghaly Ramy , Elbenawi Hossam , Khan Ubaid , Ewis Abdelrahman , S M Elshaer Khaled , Abuelazm Mohamed , Abdelazeem Basel , Patel Brijesh
Published: November 2024

Background:
Heart failure (HF) is associated with systemic inflammation and hypercatabolic syndrome, impacting body metabolism. The advanced lung cancer inflammation index (ALI) is a novel inflammatory and nutritional biomarker.

Purpose: We aimed to investigate the prognostic role of ALI in patients with HF.

Methods:
We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through March 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1. This meta-analysis was registered at PROSPERO (CRD42024535227).

Results:
We included four studies with 2,247 patients. In the pair-wise meta-analysis, ALI ≤ 25 was significantly associated with an increased incidence of all-cause mortality compared with ALI > 25 (risk ratio [RR] 1.73, 95% confidence interval [CI] 1.36-2.21, P< 0.01). On the adjusted prognostic meta-analysis, higher ALI (>25) was significantly associated with a reduction in the incidence of all-cause mortality (hazards ratio [HR] 0.45, 95% CI 0.35-0.58, P< 0.01). The reconstructed Kaplan Meier showed that ALI > 25 was significantly associated with a 56% reduction in the incidence of all-cause mortality compared with ALI ≤ 25 (HR 0.44, 95% CI 0.38-0.50, P< 0.000001).

Conclusion:
Among patients with HF, a low ALI was associated with a higher incidence of all-cause mortality rate than those with a high ALI. These findings suggest that ALI can be used for prognostic stratification and aid clinical decision-making in HF management.
Abstract 4140906: Cardiovascular Prognosis in Patients with Diabetes Mellitus Mediated by the Functional Post-revascularization Level
Authors: Zheng Zhihao
Published: November 2024

Background and Aims:
Functional complete revascularization (FCR) subsequent to percutaneous coronary intervention (PCI), as assessed by the residual functional SYNTAX score (rFSS), has been correlated with enhanced prognostic outcomes. This study sought to comprehensively apprehend the adverse cardiovascular prognosis within diabetic cohorts, determining what extent the association of diabetes with clinical outcomes is explained by functional revascularization.

Methods:
A total of 1,555 patients with available post-PCI quantitative flow ratio (QFR) were included, whose data were collected from PANDA III trial (Figure 1). FCR was defined as rFSS = 0, while anatomic complete revascularization (ACR) was defined as residual SYNTAX score (rSS) = 0. Firstly, we determined the ACR and FCR among DM and non-DM cohorts. Second, multiple cox regression was used to screen for potential mediating variables. Finally, we used structural equation modeling to analysis whether FCR explained the relationship between DM and the risk of 2-year rates of major adverse cardiac events (MACE).

Results:
Patients with DM had a significant lower percentage of FCR (71.9% vs 80.2%, P<0.001), however ACR was not (38.68 vs 42.21, P=0.265, Figure 2). Multiple cox regression revealed that DM was associated with MACE (P=0.007), but not after adding FCR to the model (P=0.05), suggesting a mediation effect. Structural equation modeling analysis revealed a significant indirect effect of DM on MACE through FCR (P=0.006, Mediated (%) =27.3,Figure 3), suggesting a partial mediation effect.

Conclusion:
The degree of functional revascularization emerges as a central mechanism pivotal in elucidating the association between DM and the risk of MACE.
Abstract 4140940: Re-adjudication and Contemporary Classification of Myocardial Injury Events in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Tomar Shubham , Lidani Karita , Decker Matthew , Trainor Patrick , Johnson Craig , Heckbert Susan , McClelland Robyn , Blaha Michael , Nasir Khurram , DeFilippis Andrew
Published: November 2024

Background:
The 4th Universal Definition of Myocardial Injury (UDMI) recognizes several categories of myocardial injury, including acute myocardial infarction (MI) which is further sub-classified into five types. However, data on these different types of myocardial injury and their risk factors is limited.

Methods:
In the MESA study of 6814 participants, 15905 clinical events were identified over the first 14 years, 4079 of which meet MESA criteria for physician adjudication for a possible cardiovascular event. Herein, we developed a standardized data format and a REDCap tool with an interactive robust logic algorithm to re-adjudicate all 4079 cases for the presence and classification of all 9 types of myocardial injury as defined by the 4
th
UDMI. Adjudication process as shown in
Figure 1
. The prevalence of myocardial injury types was evaluated using descriptive statistics, and adjudicator agreement was assessed using Cohen’s kappa (κ) statistics and percent agreement.

Results:
Out of 4079 events, adjudication is completed on 2282, of which 15% classified into subtypes of myocardial injury. Adjudication was achieved for 91% of the events in phase 1, 7% in phase 2, 2% in phase 3. The overall agreement between two adjudicators for the presence of myocardial injury was 91% (κ: 0.67), but the agreement for the specific subtype was 53% (κ: 0.38). The most common events were Type 1 MI (N= 114), followed by Type 2 MI (N= 95), and Acute non-ischemic myocardial injury (N= 85) (
Figure 2
). Compared to the original MESA adjudication for the presence of MI, 97% (N= 72) of probable MI and 8% (N= 174) of no MI were reclassified into five and six types of myocardial injury events respectively.

Conclusion:
This study highlights the complexities in identifying subtypes of myocardial injury based on current definition. This study provides a novel dataset to explore diverse correlations with these myocardial injury subtypes.
Abstract 4140984: Palliative Care Interventions Effect on Quality of Life and Symptoms in Patients with Heart Failure: An Updated Systemic Review and Meta-analysis
Authors: Almaadawy Omar , Mabrouk Manar , Elnady Mohamed , Ibrahim Rahma AbdElfattah , Hassan Abdul Rhman , Eldaidamouni Ahmed , Allam Salma , Elzahaby Amr , Darwish Moaz , Alrawi Aya , Ahmed Mustafa
Published: November 2024

Introduction:
Heart failure (HF) is a prevalent medical condition, affecting approximately 6.7 million Americans. Patients with HF frequently experience comorbidities such as depression and anxiety, which can lead to diminished quality of life. According to the World Health Organization (WHO), palliative care may be beneficial for these patients in addressing their complex physical, mental, and social needs. Therefore, an assessment of palliative care involvement in HF patients is warranted to determine its impact on improving quality of life, alleviating symptoms such as dyspnea, depression, and anxiety.

Hypothesis:
The aim is to assess the impact of palliative care interventions on the quality of life, dyspnea, anxiety, and depression in patients with HF.

Methods:
A systematic review and meta-analysis were conducted on clinical trials retrieved from Scopus, Cochrane, PubMed, Embase, and Web of Science databases from their inception until March 2024. Studies reporting on the impact of palliative care interventions on the quality of life of patients with HF were included. The primary outcome was the effect on quality of life, while the effects on dyspnea, depression, and anxiety were secondary outcomes. Data from the studies were pooled using RevMan V5.4, and changes in the mean difference from baseline and confidence intervals (CI) were calculated for each outcome.

Results:
The meta-analysis included eleven studies, predominantly randomized controlled trials, with a total of 1662 participants, 812 of whom received palliative care interventions. The analysis revealed a significant improvement in the mean change from baseline within the intervention group compared to usual care. Specifically, the quality of life showed a mean difference change from the baseline of 1.35 (95% CI: 0.88 to 1.82), anxiety improved with a mean difference change from baseline of 0.30 (95% CI: 0.03 to 0.58), and dyspnea showed a mean difference change from baseline of 1.0 (95% CI: 0.74 to 1.26). However, there was no significant difference in the mean change from baseline for depression between both groups.

Conclusion:
Palliative care interventions are associated with significant improvements in quality of life, anxiety, and dyspnea in patients with heart failure compared to usual care. However, there is no significant impact on depression. These findings support the integration of palliative care into the management of heart failure patients to enhance their overall well-being.
Abstract 4141004: Efficacy of calf neuromuscular electrical stimulation program on maximal walking distance in peripheral artery disease patients: results of the ELECTROPAD randomized controlled trial.
Authors: Mahe Guillaume , Chanteau Adrien , Jehannin Pierre , Mimassi Mary Lynn , Donnelly Alan , Talbot Marjolaine , Hoffmann Clement , Henni Samir , Le Pabic Estelle , Bura Alessandra , Kaladji Adrien , Laneelle Damien , Le faucheur Alexis
Published: November 2024

Introduction:
Lower extremity peripheral artery disease (PAD) can lead to walking impairment. To date, no clear clinical indication can be drawn regarding the efficacy of neuromuscular electrical stimulation (NMES) for the management of impaired walking function in patients with PAD. The ELECTROPAD study aimed to investigate the efficacy of NMES program on maximal walking distance (MWD) in patients with PAD.

Methods:
In this multicenter trial (NCT03795103), PAD patients with a maximal treadmill walking distance ≤300 m were randomized in the NMES or control group. The NMES program consisted of a 12-week program of NEMS sessions at the calf-muscle level, 2-3 h/day, 5 days/week. The primary outcome of the study was the change in treadmill MWD at 12 weeks. Main secondary outcomes included changes in the treadmill pain-free walking distance (PFWD) and 6 min total walking distance (6MWD). Results are reported in median [IQR]. Mann-Whitney Wilcoxon or Student t tests were used for comparisons.

Results:
Between 2019 and 2022, 73 patients were randomized and 63 with a mean age of 63 ± 9 years old were analyzed. Baseline treadmill MWD was 131[108;166]m and 130[98;213]m (p=0.85) in the control and NMES groups, respectively. The change of treadmill MWD was greater in the NMES group compared to the control group (58[18;139]m vs 19[3;55]m; p=0.026). The change of PFWD was not different between the NMES and control groups (23[2;48]m vs 10[-2;30]m; p=0.209). The change of 6MWD was greater in the NMES group compared to the control group (29[3;54]m vs 2[-14;30]m; p=0.019).

Conclusion:
A 12-week NMES program significantly improves treadmill and 6-minute walking performance in PAD patients. NMES could be considered as a complementary therapeutic option for PAD patients.
Abstract 4141021: Association of Cardiovascular Health by Life’s Essential 8 with Subsequent Coronary Artery Calcification: A Prospective Cohort Study
Authors: an hyoeun , Jeon Jooeun , Lee Hyeok-Hee , Shim Jee-Seon , Kim Hyeon Chang , Lee Hokyou
Published: November 2024

Introduction:
“Life’s Essential 8” (LE8) is an updated construct for measuring cardiovascular health (CVH). We hypothesized that a higher CVH score by LE8 is associated with a lower risk of subsequent coronary artery calcification (CAC>0) among middle-aged Koreans.

Methods:
The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) study is a community-based prospective cohort study conducted in Seoul, Korea, including 1,269 healthy participants with a baseline visit in 2013-2018 and a follow-up visit in 2022-2023. The baseline CVH score was calculated as the average of 8 metrics: diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure, each scaled from 0 to 100 points, according to the AHA’s LE8 definition. The CVH scores of 80 to 100 were classified as “high”, 50 to <80 as “moderate”, and 0 to <50 as “low” CVH group. The main outcome was CAC>0 at the follow-up visit. The association of baseline CVH score with the outcome was evaluated based on odds ratios (OR) and 95% confidence intervals (CI) using multivariable logistic regression models.

Results:
At baseline, the median age of the participants was 55 years, and 65.5% were female. After a median follow-up of 7 years, 519 (40.9%) participants had CAC>0. The proportion of CAC>0 at follow-up was 65.3% in the low CVH group, 40.6% in the moderate CVH group, and 31.0% in the high CVH group (Figure A). Using the low CVH group as the reference, the multivariable-adjusted OR (95% CI) for follow-up CAC>0 was 0.37 (0.25-0.55) in the moderate CVH group and 0.24 (0.15-0.38) in the high CVH group. Higher baseline CVH scores were log-linearly associated with lower odds of follow-up CAC>0 (Figure B). Each 10-point higher baseline CVH score was associated with a 27% lower odds of CAC>0 at follow-up (OR, 0.73; 95% CI, 0.66-0.82). The association was consistent across pre-specified subgroups and sensitivity analyses.

Conclusions:
Higher CVH by LE8 score was associated with a lower risk of developing CAC>0 among healthy middle-aged Koreans, suggesting the importance of promoting ideal CVH for the prevention of cardiovascular disease.
Abstract 4141041: Impact of atrial cardiomyopathy on early rhythm control therapy
Authors: Goette Andreas , Albring Antje , Schotten Ulrich , Willems Stephan , Borof Katrin , Eckardt Lars , Zapf Antonia , Crijns Harry , Camm Alan , Breithardt Guenter , Kirchhof Paulus
Published: November 2024

Background:
Whether the presence and extent of atrial cardiomyopathy (AtCM) has an impact on effectiveness of early rhythm control (ERC) in patients with atrial fibrillation (AF) is not known.

Method:
In this prespecified subanalysis of the EAST-AFNET 4 trial, the effects of ERC on outcome were compared between AF patients with different stages of AtCM. AtCM was determined by atrial size, PR interval in the surface ECG, and brain natriuretic peptide concentrations (NTproBNP). Associations between AtCM and the primary outcomes (cardiovascular death, stroke, hospitalization for heart failure and acute coronary syndromes; ACS) were compared over a mean follow-up of 5.1 years.

Results:
The EAST-AFNET 4 trial included a total of 2,789 patients. For this analysis, 1,395 patients on ERC and 1,394 on usual care (UC) were included. Left atrial (LA) size varied substantially in the overall study population (largest LA size up to 8.6 cm) without a significant difference between ERC and UC at baseline (mean ERC 4.4 ± 0.8 cm vs. UC 4.4 ± 0.9 cm; p=ns). PR intervals (ERC: 176
±
32ms vs. UC 178
±
37ms) and NTproBNP concentrations (mean ERC 772 ± 1,268 pg/mL vs. UC 825 ± 1,135 pg/mL; p=ns) were comparable between the two randomized groups. Larger left atrial diameters were related to occurrence of first primary outcome (HR per SD 1.26; 1.12-1.43; p<0.001) and recurrence of AF (HR per SD 1.19; 1.09-1.29; p<0.001). Similarly, higher NTproBNP concentrations were associated with the first primary outcome (HR per SD 1.81; 1.53-2.15; p<0.001) and with AF recurrence (HR per SD 1.53; 1.37-1.7; p<0.01). ERC reduced the first primary outcome during a 5.1 years follow-up (ERC HR 0.69;0.54-0.9; p=0.005), regardless of the degree of AtCM.

Conclusion:
In patients with recently diagnosed AF, recurrent AF and cardiovascular events are more common in the presence of atrial cardiomyopathy. Early rhythm control is effective regardless of the degree of AtCM in AF patients.