bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147416: Racial Disparities in Periprocedural Outcomes and Mortality in Catheter Ablation of Atrial Fibrillation Among Congestive Heart Failure Patients in the United States: An Analysis from the National Inpatient Sample Database
Authors: Bhatia Hitesh , Rao Adishwar , Agrawal Siddharth , Khan Muhammad , Agrawal Akriti , Jayasree Rajendran Rakendu , Aafreen Asna , Parul . , Bhattarai Shraddha , Sharma Saurabh
Published: November 2024

Background:
Atrial Fibrillation (AF) and congestive heart failure (CHF) are intertwined disorders that contribute to cardiovascular morbidity and mortality. Arrhythmia burden is a key prognostic factor in patients with AF and CHF. Numerous studies have suggested that catheter ablation outperforms conventional therapies in improving clinical outcomes for these patients. This study aims to evaluate the racial disparities affecting periprocedural outcomes and mortality in CHF patients undergoing AF ablation.

Methods:
We searched the National Inpatient Sample (NIS) data from 2016 to 2021 using ICD-10 and ICD-10-PCS9 codes to look for patients with CHF who underwent ablation for AF and stratified the data on the basis of race, particularly African American(AA) and White American (WA) population. We used the Pearson Chi-Square test to analyze categorical variables and the Wilcoxon Rank Sum test for continuous variables to evaluate racial disparities in the periprocedural outcomes in patients undergoing ablation. Additionally, we also used a multivariate logistic regression analysis to compute adjusted odds ratios (aORs) for outcomes.

Results:
After analyzing NIS data from 2016 to 2021, among 7,803,487 patients admitted for AF and CHF, only 94,245 underwent ablation. Among those who underwent ablation, AA were admitted and received ablation at a younger age compared to WA (63.89 years versus 71.48 years). We found that AA patients experienced higher rates of HF exacerbation (91% vs 88.9%, p:0.006, ), cardiogenic shock (7.8% vs 5.6%, p<0.001), acute kidney injury (AKI) (38.7% vs 28.2%, p<0.001 ), and major adverse cardiovascular and cerebrovascular events (MACCE) (12.6% vs 9.9%, p<0.001 ) than WA patients. Additionally, multivariate analysis revealed AA had increased odds of HF exacerbation (aOR 1.40, 95% CI 1.16-1.70, p<0.001) and AKI (aOR 1.67, 95% CI 1.49-1.88, p<0.001) [Table 1]. Also, AA patients also had a longer length of stay (LOS) (> 7 days for 50.5% of AA versus 39.1% of WA p<0.001), utilized Medicaid more frequently (13.7% versus 4.3%, p<0.001), and incurred higher total charges (median charge of $174,604 versus $161,210, P: <0.01) compared to WA [Table 2].

Conclusion:
Racial disparities are evident in the periprocedural outcomes and mortality in CHF patients undergoing ablation for AF. More studies are needed to investigate these findings further and potentially help resolve the disparities.
Abstract 4147436: Cardiac Sarcoma Mimicking as Rheumatic Mitral Disease
Authors: Chirumamilla Sri Sai Kaumudi , Schaff Hartzell , Eleid Mackram , Pislaru Sorin
Published: November 2024

Description of Case:
A 40-year-old woman presented with a 3-month history of dyspnea. A murmur was found on examination. Echocardiography reported moderate mitral stenosis and regurgitation with diffuse thickening and calcification of the anterior mitral leaflet (Fig1.A), thought to be due to rheumatic disease. She had runs of supraventricular tachycardias not controlled with diltiazem. Her dyspnea progressively worsened; transesophageal echocardiography(TEE) showed severe mitral stenosis and mitral regurgitation (mean gradient 18 mmHg; Fig1.B) with a dense CW Doppler (Fig 1.C) and a mass on left atrial free wall. Cardiac MRI revealed diffuse left atrial thickening with delayed enhancement of the left atrium, left atrial appendage, and extending into the right upper and left inferior pulmonary veins. The mass was initially suspected to be a thrombus. She was placed on rivaroxaban and scheduled to undergo mitral valve replacement.

When she presented to our emergency department with dizziness she was found to have paroxysmal atrial fibrillation and pulmonary embolism. On admission she had an intermittent opening snap and a 1/6 mid-diastolic rumble with a 2/6 holosystolic murmur at the apex. Work-up for infectious disease and antiphospholipid syndrome was negative. NT-proBNP was mildly elevated. At surgery the mass invaded the mitral valve and the anterior, septal, and superior part of the left atrial lateral wall and could only be partially excised (Fig1.D). Pathology showed high-grade undifferentiated pleomorphic cardiac sarcoma.

Discussion:
This case highlights the diagnostic challenges associated with primary cardiac tumors masquerading as valvular pathology. The presentation included dyspnea, typical auscultation of mitral stenosis and features of stenosis on echocardiography. Presumptive diagnoses included rheumatic heart disease, calcific degeneration, infective endocarditis, and autoimmune processes; the atrial mass was initially thought to be a thrombus. A thorough, multidisciplinary approach to diagnosis, utilizing multimodality imaging techniques and ultimately tissue biopsy were required to make the correct diagnosis. Maintaining a broad differential when dealing with valvular masses is key, since relying solely on imaging findings may not suffice for definitive tissue diagnosis.
Abstract 4147438: Use of Impella RP Flex for Right Ventricular Failure (RVF): A Single Center Review
Authors: Heyer Marissa , Walters Patricia , Stewart Scott , Mody Kanika , Landers David , Batsides George , Dudiy Yuriy , Anderson Mark
Published: November 2024

Introduction/Background:
Right ventricular failure (RVF) is the inability of the RV to adequately perfuse pulmonary circulation and sufficiently fill the LV; it increases morbidity, mortality, and length of hospital stay. In critically ill patients, three main etiologies of RV failure are excessive preload, excessive afterload, and insufficient myocardial contractility. In addition to medical management, some patients at risk for refractory cardiogenic shock may require temporary mechanical circulatory support (TMCS).

Research Questions/Hypotheses:
The Impella RP flex (Abiomed, Danvers, MA) has provided an option for percutaneous RV support through the internal jugular vein and allows for early rehabilitation of complex cardiac patients.

Methods/Approach:
Consecutive cases at our center using the Impella RP flex were evaluated for hemodynamics and quality measures.

Research/Data:
Thirteen patients received RP flex support: 3 patients with pulmonary hypertension during mitral valve repair or replacement, 4 patients for prophylactic placement pre-LVAD, 3 patients with intraoperative placement during CABG, 2 patients with acute myocardial infarction, and 1 patient for salvage therapy. The average length of stay for our patients was 30.23 days; average duration of Impella support was 4.46 days.

Twelve patients required inotropic support with milrinone and 91.7% received epinephrine. Of the 12 patients who required vasodilators, 100% received inhaled nitric oxide and 50% received sildenafil. Four patients required sildenafil at the time of discharge (36.4%).

Internal jugular vein cannulation and intracorporeal support allows capable patients to participate in physical therapy early in the recovery process. Of our cohort, 30.77% of patients were successfully assisted out of bed to chair and 15.38% ambulated with assistance. All patients had pre- and post-creatinine levels collected, with an average pre-implantation creatinine level of 1.48 and post-explantation level of 1.76. The average pre-implantation lactic acid level was 4.75; only 11 patients had post-explantation lactic acid measurements collected, which averaged 3. Eleven patients were successfully discharged and no patients required home inotropes.

Conclusions:
The RP flex allows for RV unloading for patients requiring TMCS; it is best used early or prophylactically for patients who are otherwise high-risk for complications or who may require high-dose pressors and prolonged ICU level of care.
Abstract 4147450: Pulsed-field ablation versus thermal ablation for paroxysmal atrial fibrillation: A systematic review and meta-analysis
Authors: Cavalcante Douglas , Cruz Akabane Maria Antonia , Mazetto Roberto , RIBEIRO Iury , De Oliveira Fischer Bacca Caroline , Barbosa Imara
Published: November 2024

Introduction:
Conventional thermal ablation (TA) has been used to treat paroxysmal atrial fibrillation (AF) refractory to medical therapy. Despite this, the energy used to isolate the pulmonary veins can extend through the myocardium and adjacent tissues, causing complications. Pulsed-field ablation (PFA), which delivers high-voltage electric fields in microseconds, may limit this tissue damage outside the myocardium. However, the efficacy of pulsed-field ablation compared with conventional thermal ablation in this population remains uncertain.

Research Question:
What are the benefits of using PFA in patients with paroxysmal atrial fibrillation compared to AT

Objective:
The purpose of this study was to evaluate the efficacies and safety of PFA compared with TA in patients with paroxysmal atrial fibrillation

Methods:
PubMed, Embase, and Cochrane Central databases were systematically searched in May 2024 for studies that directly compared PFA and TA for the treatment of paroxysmal AF and reported safety or efficacy outcomes. We evaluated the following outcomes at ≥12 months of follow-up: (1) stroke, (2) arrhythmia recurrence and (3) redo procedures. Heterogeneity was assessed with I
2
statistics. Rstudio was used for statistical analysis.

Results:
We included 1,677 patients (734 male – 43.76%) from three studies. PFA was used to treat AF in 519 (30.94%) patients and thermal energy was used in 1.158 (69.05%) patients. There was no significant incidence of stroke after performing PFA compared to TA in the pooled population (OR 1.31; 95%CI 0.11-15.59; P = 0.832). As compared to thermal ablation, PFA demonstrated similar freedom from recurrent atrial fibrillation (OR 0.77; 95%CI 0.51- 1.18; P = 0.237). There were no statistically significant differences in redo procedures (OR 0.61; 95%CI 0.36- 1.03; P = 0.066).

Conclusion:
Compared to TA, PFA did not show significant differences in the occurrence of stroke after the procedure or in the recurrence of paroxysmal atrial fibrillation. Additionally, it was not associated with a lower rate of redo procedures.
Abstract 4147456: Serum and Glucocorticoid Regulated Kinase 1 (SGK1) Inhibition Induces Anti-Fibrotic and Anti-Inflammatory Responses: Relevance to Cardiac Fibrosis
Authors: Labit Delphine , Khalifa Maroua , Hewgill Shannon , Vidal Marc , Srinivasan Dinesh , Odink Debra , Das Saumya , Campeau Eric
Published: November 2024

Background:
Cardiac fibrosis is a condition characterized by deposition of extracellular matrix proteins and myofibroblasts, leading to scar formation, cardiac dysfunction and arrhythmogenesis. Various cardiometabolic stressors can promote fibrosis and scarring, including MI, hypertension, diabetes and obesity. Targeted therapy to prevent cardiac fibrosis is therefore an important unmet medical need. In a mouse model of obesity-related atrial fibrillation (AF), inhibition of SGK1 reduced markers of inflammation and fibrosis, suggesting SGK1 as a novel target. Several SGK1 inhibitors are being evaluated in clinical studies for the treatment of long QT syndrome, paroxysmal AF, and heart failure.

Hypothesis:
SGK1 activation is a significant driver of inflammation and fibrosis, and its inhibition may offer a new therapeutic strategy for treating fibrotic diseases, including those of the cardiovascular system.

Methods:
Primary hepatic stellate cells, lung fibroblasts, and proximal tubule cells were treated with TGFβ for 24-48 hours to induce fibrosis and measure the effects of SGK1 inhibition on markers of fibrosis (alpha SMA and collagen 1). Three, selective and potent, SGK1 inhibitors (SGK1-I 1,2,3) were tested in a BioMAP fibrosis panel at concentrations ranging from 0.3 to 10 µM. The fibrosis panel includes three systems that model TGFβ and TNFα driven myofibroblast differentiation during chronic inflammation and wound healing. Markers of fibrosis, tissue remodeling, myofibroblast activation, and inflammation were measured quantitatively. IC50s were determined using GraphPad Prism.

Results:
In primary human stellate cells, SGK1-I,1,2,3 inhibited αSMA and collagen 1 mRNAs with IC50s ranging from 0.1- 0.8 µM and 1.0-3.0 µM, respectively. In primary lung fibroblasts, treatment with SGK1-I reduced the mRNA and protein expression of αSMA. Treatment of cells from different tissues with TGFβ resulted in a 1.5-to-3.0-fold increase in SGK1 mRNA and protein and this was blocked by the TGFβ receptor inhibitor SB525334. SGK1 inhibitors displayed anti-inflammatory and anti-fibrotic properties in the BioMAP panel, with inhibition of IL-6, IL-8, MCP-1, and αSMA, collagen 1, and TIMP1 respectively.

Conclusion:
SGK1 is an important effector of TGFβ signaling. The development of SGK1 inhibitors may represent a new therapeutic strategy for treating fibrotic diseases. Additional studies are warranted to further evaluate novel SGK1 inhibitors in cardiac fibrosis
Abstract 4147460: Beat Heart failure rehospitalization!
Authors: Riya FNU , Sardone-Ponnappan Jennifer
Published: November 2024

Introduction:
Heart failure (HF) rehospitalization poses a significant burden on the healthcare system. Multiple factors contribute to multiple HF admissions, such as polypharmacy, non-compliance, and inadequate treatment. Studies have demonstrated a strong association between early follow-up with primary care or a cardiologist within seven days of discharge and reduced 30-day HF rehospitalization.

Research Question/Hypothesis:
A quality improvement (QI) study was conducted at a community hospital to decrease the HF rehospitalization rate. The study involved enrolling acute in chronic HF exacerbation patients and implementing early follow-up using a checklist for both in-person and telephonic visits.

Goals:
The study aimed to reduce the HF 30-day readmission rate to 10-12% from the community hospital's 18% average by focusing on early primary care follow-up within seven days of discharge and using a standardized American Heart Association (AHA) Target HF checklist at the time of follow-up.

Method:
The QI project employed a bundled intervention approach, incorporating patient education, scheduling post-discharge follow-up appointments, and utilizing a standard AHA checklist integrated into EPIC smartphrases for streamlined documentation during follow-up appointments. The project used Tableau to review the 30-day readmission rate.

Results:
Quality improvement measures were initiated at the community hospital in September 2023 to decrease the 30-day readmission rate. Monthly HF readmission rates from October 2023 to March 2024 in image 1 showed variation with significant peaks due to seasonal periodicity, peaking in January 2024. Despite variation, the project increased HF education resources, achieving 1-2 follow-up HF visits per week at the continuity clinic with increased checklist utilization.

Conclusion:
With the help of QI, we successfully increased the number of HF education books across all the nursing units on the telemetry floor. We addressed challenges in implementing the approach, focusing on improving education access, increasing staff awareness with interdisciplinary collaboration regarding discharge appointments, and creating awareness posters (as shown in images 2 and 3) in common workplaces.

Currently, the project aims to raise awareness among internal residents and familiarize them with the checklist and advanced HF therapy referrals. This is an ongoing QI project tracking the 30-day readmission rate with the implementation of a bundle intervention approach.
Abstract 4147468: Using Structured Queries versus Retrieval Augmented Generation Enabled GPT-4 to Phenotype Atherosclerotic Cardiovascular Disease
Authors: Unlu Ozan , Shin Jiyeon , Zelle David , Wagholikar Kavishwar , Hassan Shahzad , Chang Lee-Shing , Colling Caitlin , Gabovitch Dan , Oates Michael , Varugheese Matthew , Wang Fei , Mailly Charlotte , Scirica Benjamin , Aronson Samuel , Blood Alexander
Published: November 2024

Background:
Using Electronic Health Record (EHR) data to accurately phenotype patients for atherosclerotic cardiovascular disease (ASCVD) is crucial for clinical decision-making and research. Traditional methods using structured queries often lack specificity or sensitivity. We developed RECTIFIER, an AI-based clinical phenotyping tool. This study compares the performance metrics of structured queries against RECTIFIER in determining types of ASCVD.

Methods:
We conducted an analysis using EHR to compare the performance of structured queries with RECTIFIER for identifying various ASCVD types. The dataset included 998 patients with diabetes. Structured queries identified ASCVD types using ICD, CPT, and HCPCS codes, while RECTIFIER analyzed unstructured clinical notes within the previous year to identify the same components. Three expert clinicians adjudicated each ASCVD component by reviewing patients’ charts. Performance metrics, including sensitivity, specificity, and accuracy, were calculated for both methods.

Results:
Structured queries demonstrated similar or lower sensitivity in identifying ASCVD types compared to RECTIFIER (Figure). The sensitivity of structured queries to determine any ASCVD was significantly lower than that of RECTIFIER (Structured: 67.8%, RECTIFIER: 87.3%). Conversely, structured queries exhibited similar specificity with RECTIFIER except for greater performance in PCI and coronary revascularization which showed small but statistically significant differences (Structured: 100% and 95.1%, RECTIFIER: 98.1% and 90.1%, respectively).

Conclusion:
The higher sensitivity of RECTIFIER in identifying ASCVD components suggests its potential for improving patient phenotyping. However, the greater specificity of structured queries underscores its utility in specific procedural identification. An integrated approach, using RECTIFIER for general phenotyping and structured queries for procedure-specific components, may enhance the accuracy and efficiency of ASCVD identification. Future studies should explore optimized prompting strategies to further refine structured queries' performance and validate these findings in larger, diverse populations.
Abstract 4147488: Effects of Influenza Vaccination Among Patients With Myocardial Ischemia and Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Santos Charles Karel , Ramos Miranda Maria Clara , Barbosa Gabriel , Nogueira Thallys , da Silva Menezes Junior Antonio
Published: November 2024

Background:
Previous studies have shown that influenza vaccination (IV) may reduce the incidence of cardiovascular events in patients with cardiovascular disease. In this meta-analysis, we aimed to clarify the effects of IV in patients with myocardial ischemia (MI) and heart failure (HF).

Hypothesis:
The influenza vaccine reduces the incidence of major adverse cardiovascular events among patients with MI and HF.

Methods:
A comprehensive search was performed in PubMed, Cochrane Library, and Embase databases from inception up to march 2024. We included randomized clinical trials (RCTs) that assessed the effects of IV in patients with HF and MI, and reported outcomes of major adverse cardiovascular events (MACE), cardiovascular death, and all-cause death. Analyses were conducted using R software. Heterogeneity was assessed using the I2 statistic. A random-effects model was applied to calculate pooled Relative Risk (RR). A stratified analysis was performed to investigate ST-segment elevation myocardial infarction (STEMI) and non-STEMI subgroups. Sensitivity analysis was performed to explore heterogeneity. Confidence Interval (CI) was set at 95%.

Results:
We identified six RCTs comprising a total population of 9229 participants. Of these, 4100 were patients with MI, and 5129 were HF patients. Overall, MACE (RR 0.65; 95%CI 0.47-0.89; p=0.007; I2=75%) (Figure 1A) and cardiovascular death (RR 0.60; 95%CI 0.37-0.96; p=0.035; I2=62%) (Figure 1B) were significantly lower in group receiving IV compared to placebo/no treatment. No statistically significant difference was observed for all-cause death. In sensitivity analysis, after excluding HF patients, IV significantly decreased the risk of MACE (RR 0.57; 95%CI 0.43-0.76; p<0.001; I2=21%) (Figure 2A), cardiovascular death (RR 0.49; 95%CI 0.30-0.81; p=0.006; I2=24%) (Figure 2B), and all-cause death (RR 0.56; 95%CI 0.39-0.80; p=0.001; I2=0%). Consistent results were observed, with IV reducing the risk of MACE in the non-STEMI subgroup (RR 0.48; 95%CI 0.30-0.78; p=0.003; I2=24%). However, no significant difference was identified in the STEMI subgroup. Meta-regression showed impact of age and follow-up duration on treatment effect estimates.

Conclusion:
IV exhibited potential in reducing the risk of major cardiovascular events and cardiovascular mortality in patients with HF and MI. These findings reinforce the importance of the IV as a secondary prevention strategy for these populations.
Abstract 4147493: Association Between Diabetes and 5-year Mortality and Major Amputation Outcomes After Revascularization in Chronic Limb-threatening Ischemia
Authors: Callegari Santiago , Cleman Jacob , Rahman Mufti , Aggarwal Abhinav , Smolderen Kim , Mena-Hurtado Carlos , Romain Gaelle
Published: November 2024

Introduction:
Diabetes affects over 60% of patients with chronic limb-threatening ischemia (CLTI). The impact of diabetes mellitus (DM) in long-term outcomes after lower-extremity bypass (LEB) or peripheral vascular interventions (PVI) remains unclear. We aim to assess the association between DM and 5-year all-cause mortality and major amputation after LEB vs. PVI for CLTI.

Methods:
Patients with CLTI undergoing LEB or PVI between 2014-2019 were abstracted from the Vascular Quality Initiative registry and stratified by DM status. Mortality and major amputation outcomes were derived from Medicare claims data. Patients in LEB vs. PVI groups were 1:1 propensity matched based on 13 preprocedural variables. The 5-year cumulative incidence of mortality by revascularization group and DM status was assessed with Kaplan-Meier and the risk in patients with DM vs. no DM by revascularization group (i.e., interaction DM status*revascularization group) was tested using Cox proportional hazard regression model. The Aalen-Johansen method and Fine-Gray model assessed the 5-year cumulative incidence and interaction between DM status and revascularization accounting for the competing risk of mortality.

Results:
A total of 4,210 patients (mean age 70.9 ±10.9, 30.7% female) were included of whom patients with DM were 65.7% and 58.8% of the PVI and LEB groups, respectively. Mortality cumulative incidence at 5-years was higher for DM vs. no DM in PVI (65.9% vs 59.5%; p=0.022) and LEB (59.3% vs 50.4%; p=0.003), with non-significant interaction for DM status (p =0.616). Amputation risk at 5 years was higher for DM vs. no DM for PVI (29.0% vs 14.3%; p<0.001) and LEB (29.0% vs 16.3%; p<0.001), with non-significant interaction for DM status (p =0.744).

Conclusion:
Mortality and major amputation risk at 5 years after revascularization for CLTI was higher for patients with DM vs. no DM regardless of the type of revascularization, with 3 out of 5 patients deceased and 1 out of 3 with a major amputation at 5 years. Shared decision-making and life expectancy discussions are needed for planning a definitive revascularization strategy.
Abstract 4147498: Prognostic Significance of Echocardiographic Transaortic Flow Rate in Aortic Valve Stenosis: a Systematic Review and Meta-Analysis
Authors: Hatamnejad Mohammad Reza , Mombeini Hoda , Chichagi Fatemeh , Arbabi Mahta , Jamshidi Parnian , Sotoudehnia Setayesh , Sahafi bandary Maryam , Piroozkhah Moein
Published: November 2024

Background:
Echocardiographic evaluation of Aortic valve stenosis (AS) severity relies on aortic valve area, peak jet velocity, and mean transaortic gradient. In pursuit of improving accuracy, the transaortic flow rate (FR), defined as the ratio of stroke volume to systolic ejection time, has been introduced. However, its prognostic value in AS patients remains controversial.

Aim:
This study aims to systematically review the predictive value of FR in AS patients and provide quantitative pooled analysis results where applicable.
Methods:
A systematic search of PubMed/Medline, Embase, Scopus, Web of Science, and Cochrane was conducted for observational studies on AS patients published up to March 15, 2024. Studies were included if they assessed the clinical prognostic utility of FR with at least three months of follow-up. Pooled estimates and 95% CI for FR's hazard ratio (HR) in each binary outcome were calculated using a random effects model.

Results:
Nineteen studies with 9456 patients (mean age 75) underwent descriptive analysis, and 17 eligible studies were included in the meta-analysis. For predicting all-cause mortality, the pooled HR for low FR measured at rest (cut-off value 200-210 mL/s) was 1.32 (95% CI: 1.01–1.63, I2: 69%, p<0.05) (Figure 1. A). For FR measured during stress echocardiography, the pooled HR was higher at 1.58 (95% CI: 1.20–1.96, I2: 0%, p<0.05). Additionally, every 100 mL/s increase in FR significantly reduced all-cause mortality; the HR was 0.61 (95% CI: 0.47–0.75, I2: 47%) for FR measured at rest (Figure 1. B), and 0.61 (95% CI: 0.31–0.91, I2: 65%) for FR measured during stress echo. For the combined endpoint of mortality and hospitalization, the HRs were as follows: 2.54 (95% CI: -0.99–6.08, I2: 48%) and 2.57 (95% CI: 0.69–4.44, I2: 0%) for the low FR group at rest and during stress echo, respectively. For every 100 mL/s increase in FR, the HRs were 0.19 (95% CI: -0.19–0.58, I2: 61%) at rest and 0.36 (95% CI: 0.18–0.54, I2: 0%) during stress echo.

Conclusion:
FR is a prognostic marker for all-cause mortality in AS patients, indicating its potential for risk stratification. Incorporating FR into clinical assessments could help personalize follow-up and monitoring strategies.
Abstract 4147510: A novel methodology for simultaneous analysis of electrical activation parameters and myocardial fibrosis in patients with LBBB and indications to cardiac resynchronization therapy
Authors: Rimskaya Elena , Chmelevsky Mikhail , Aparina Olga , Bazhutina Anastasia , Budanova Margarita , Khamzin Svyatoslav , Stukalova Olga , Ternovoy Sergey , Golitsyn Sergey
Published: November 2024

Background:
Left ventricular (LV) myocardial fibrosis can be crucial for the electrical wave propagation and thus contribute to left bundle branch block (LBBB) formation. Using a novel specially developed technology we aimed to establish the role of fibrosis in activation parameters in patients with LBBB and indications to cardiac resynchronization therapy (CRT).

Materials and Methods:
15 patients (7 male, mean age 59.1±9.8 years) with LBBB underwent late gadolinium enhancement magnetic resonance imaging (LGE-MRI) and novel AI-based 12-lead ECG non-invasive electrical activation mapping (NIAM) prior to CRT onset. LGE-MRI was performed for the reconstruction of fibrosis 3D geometry and calculation of total fibrosis volume (totLVfvol), and LV transmural index (volFibInLV). In NIAM maps total activation time (totalAT), LV (totalLVAT), total LVAT on epicardial and endocardial surfaces (totLVATepi, totLVATendo) were estimated. LV 3D LGE-MRI and NIAM models were merged for semi-automatic segmentation in each patient followed by calculation in each of 17 segments epicardial segment total AT (ΔSegLVepi), endocardial segment total AT (ΔSegLVendo), total segment fibrosis (SegLVfvol) and transmural index (SegLVtransmInd). Latest activated zone segment (LAZ) location was determined.

Results:
Mean totLVfvol was 17.4[7.3;53,7] ml and it was not related to totalAT, totalLVAT, totLVATepi and totLVATendo (r=0.18, 0.02, 0.02, 0.52, p>0.05). In segment-by segment analysis fibrosis was variously distributed in LV but its most prominent amount was located in segments 2,3,8,9, 7,and 12. LAZ was typically located in 5
th
and 6
th
segment in 12 (80%) cases. Its displacement did not depend on the fibrosis in the target segment. Mean SegLVfvol was 3.27[0.53;8.06]ml, SegLVtransmInd was 0.18[0.04;0.42] whereas ΔSegLVepi was 55[42;66], ΔSegLVendo was 44[33;58]. Moderate positive association was revealed between ΔSegLVepi and SegLVfvol (r=0.37, p<0.001), and between SegLVfvol and ΔSegLVendo (r=0.31, p<0.001). Weak positive association between SegLVtransmInd and ΔSeg LVepi (r=0.27, p<0.001), and between SegLVtransmInd and ΔSegLVendo (r=0.211, p<0.001) was detected.

Conclusion:
Our results based on novel developed technology of simultaneous evaluation of LGE-MRI and NIAM 3D models have showed that in LBBB patients fibrosis being unevenly distributed in myocardium does not determine the totalAT and LVAT but its value can influence of local AT in segment-by-segment analysis
Abstract 4147522: Myofibroblast transition and loss of UCP2 in a rat model and a human pulmonary hypertension cohort underline right ventricular decompensation: potential value of a loss-of-function UCP2 SNP
Authors: Zhang Yongneng , Haromy Alois , Liu Yongsheng , Zhao Yuan Yuan , Breuils Bonnet Sandra , Bonnet Sebastien , Bowles Dawn , Sutendra Gopinath , Michelakis Evangelos
Published: November 2024

Backgrounds:
The mechanism driving the transition from compensated (cRVH) to decompensated right ventricular hypertrophy (dRVH) in pulmonary hypertension (PHT) is unknown. We hypothesized that a transition from cardiac fibroblasts (cFB) to cardiac myofibroblasts (cMFB) underlies this mechanism. Decreased mitochondrial calcium (mCa
++
) promotes cMFB differentiation (from cFB). Methylation of mCa
++
uptake 1 (MICU1) and lack of UCP2 (uncoupling protein 2, a component of the mCa
++
uniporter complex) decrease mCa
++
.

Methods/Results:
In the monocrotaline-rat PHT model, we separated cRVH from dRVH based on strict catheterization and echo criteria: dRVH had decreased cardiac output, increased right atrial pressure, decreased tricuspid annular plane systolic excursion (TAPSE) and increased RV end-diastolic diameter compared to cRVH. In isolated hearts, RV systolic pressure was lower in dRVH but in isolated cardiomyocytes (CM), contractility (sarcomere shortening) was not, pointing to a non-cardiomyocyte cause. The number of cMFB was not different between cRVH and Control, but dramatically increased in dRVH. Mitochondrial respiration was lower in dRVH cMFB than cRVH cFB. mCa
++
was progressively decreased from Control to cRVH to dRVH c(M)FB, while it was not different in CM. The MICU1 methyltransferase (PRMT1) levels and MICU1 methylation were increased but the expression of UCP2 was decreased from Control to cRVH to dRVH c(M)FB (but not CM). In a cohort of 60 patients with human RV tissues, dRVH (based on clinical criteria) had increased cMFBs compared to Control and cRVH. Cytoplasmic PRMT1 was increased and UCP2 was decreased from Control to cRVH to dRVH c(M)FB. UCP2 protein level correlated negatively with the presence of a loss-of-function SNP (rs659366) and positively with TAPSE. In a subgroup that had Echo and right heart catheterization data within 2 days, carriers of the UCP2 SNP had decreased TAPSE compared to non-carriers with similar mean PA pressure.

Conclusion:
Our data point to a change of cell identity (cFB to cMFB) in the RV as the basis of RV decompensation. UCP2 SNPs may be promising biomarkers for RV failure in PHT patients.
Abstract 4147528: Subclinical Cardiac Dysfunction and Circulating Markers of Brain Injury in Older Adults
Authors: Abe Temidayo , Tressel William , Bartz Traci , Gottdiener John , Kamel Hooman , Longstreth W , Shah Sanjiv , KIZER JORGE , Djousse Luc , Mukamal Kenneth
Published: November 2024

Introduction:
Dementia has been strongly linked with cardiovascular disease, but the relationship between cardiovascular disease and brain health at subclinical stages remains uncertain. We explored the relationships between subclinical cardiac dysfunction, defined by echocardiography and cardiac biomarkers, and novel neurobiomarkers associated with dementia in older adults.

Methods:
We included 962 Cardiovascular Health Study participants free of previous stroke, transient ischemic attack, atrial fibrillation, heart failure, or myocardial infarction. We analyzed cross-sectional associations with serum neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) using linear regression. Subclinical cardiac measures included echocardiographic left atrial reservoir strain, left ventricular average longitudinal strain, early diastolic strain rate of the left ventricle, decreased left ventricular ejection fraction, average E/e’, percent predicted left ventricular mass, and left atrial diameter and circulating N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT).

Results:
Among 844 participants with NT-proBNP/hs-cTnT values, hs-cTnT was significantly associated with NfL, even after mutual adjustment for NT-proBNP (β=0.24, 95% CI: (0.10, 0.40); p=0.001. NT-proBNP was also associated with NfL (β=0.005, 95% CI: (0.000, 0.010), p=0.04), although this association was modestly attenuated and not nominally significant after adjustment for hs-cTnT (β=0.004, 95% CI: (-0.001, 0.010), p=0.08). No significant associations were observed for either circulating marker with GFAP, nor were echocardiographic variables associated with NfL or GFAP.

Conclusions:
In older adults with no clinically identified cardiovascular disease, subclinical cardiac dysfunction identified through hs-cTnT and, to a lesser degree, NT-proBNP was linked to higher levels of NfL, a marker of brain injury. This novel insight suggests that long-term prevention of even subclinical cardiac disease could also lead to better brain health.
Abstract 4147548: Usefulness of Baseline NT-proBNP Non-Response Score and Health Status Measures in Assessing Treatment Responses in Heart Failure with Reduced Ejection Fraction
Authors: Chaikijurajai Thanat , Tang Wai Hong
Published: November 2024

Background:
The NT-proBNP nonresponse score (NNRS) previously derived from the PROTECT and BATTLESCARRED studies was proposed (Gaggin et al,
Congest Heart Fail
2013), with the goal to identify patients with chronic heart failure (HF) who would not likely to response to outpatient medical treatment.

Hypothesis:
The NNRS can be used with health status measures (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OSS]) for assessing treatment response and prognostication in patients with chronic HFrEF.

Aims:
To validate the prognostic value of NNRS in comparison with KCCQ-OSS.

Method:
Data on the GUIDE-IT trial were used to derive the NNRS based on 4 predictors and their integeric score (IS) including baseline NT-proBNP (< 1,000, 1,000-5,000, and > 5,000 pg/mL; IS = 0, 2, 3, respectively), heart rate < 60 beats per min (IS = 1), NYHA class III or IV (IS = 1), and history of atrial fibrillation (IS = 1). Multivariable logistic regression analysis was used to determine the predictive value of the NNRS and KCCQ-OSS greater than the median values for NT-proBNP response with adjustment for age, sex, body mass index, comorbidities, baseline creatinine and NT-proBNP levels. Kaplan-Meier curves and log rank test were used to assess survival from CV mortality or HF hospitalization across patients with high and low NNRS and KCCQ-OSS.

Results:
Among 877 patients (median NNRS=3 [IQR 2-4], and KCCQ-OSS=59 [IQR 40-75]), 252 (28.7%) patients had NT-proBNP >1,000 pg/mL at 12 months, and 321 (36.6%) patients had CV mortality or HF hospitalization during median follow up of 300 days. The NNRS and KCCQ-OSS correlated poorly (
Figure 1A
). After adjusting for covariates, higher NNRS (adjusted OR 1.99, 95% CI 1.02-3.90, P 0.044) and KCCQ-OSS (adjusted OR 2.14, 95% CI 1.33-3.45, P 0.002) were associated with a higher risk of lack of NT-proBNP response at 12 months. Both NNRS and KCCQ-OSS can be used complimentarily for prognostication (log rank P<0.001,
Figure 1B
).

Conclusions:
The NNRS and KCCQ-OSS were associated with persistently elevated NT-proBNP 12 months independently of baseline NT-proBNP levels and can be used complimentarily for prognostication in patients with HFrEF.
Abstract 4147561: Impact of Obstructive Sleep Apnea in Patients With Concomitant Heart Failure With Preserved Ejection Fraction; A Retrospective Population-Based Analysis
Authors: Alugba Gabriel , TABOWEI GODFREY , Gbegbaje Oghenetejiri , Ogedegbe Oboseh , Okorare Ovie , Adeyemi Boluwaduro , Ishola Folake , Oyeleye Oluwagbemiga , Nelson Favour , Evbayekha Endurance , Patel Dipal
Published: November 2024

Introduction:
Recent evidence from the literature has shown that obstructive sleep apnea (OSA) may contribute to worsening outcomes of patients with heart failure. However, most OSA studies were conducted in the HFrEF population. There remains scarce data on the impact of OSA in HFpEF hence, we aimed to study this population.

Methods:
We conducted a retrospective analysis of the 2020 National Inpatient Sample (NIS) database. Using the ICD-10 codes, we identified the codes for HFpEF and OSA. We adjusted for cofounders and used multivariate logistic regression model to analyze the odds ratio (adjusted odds ratio (aOR)) of our outcomes of interest.

Result:
There were 2,115,015 hospitalizations for HFpEF, and 18.1% (383,624) had a diagnosis of obstructive sleep apnea. The mean age was 69.5 years, with males having a prevalence of 51%. Of these, 74% were Caucasians, 17.26% were Blacks, and 5.24% were Hispanics. Following multivariate analysis, we found that HFpEF patients with OSA had significant odds of atrial fibrillation, adjusted odds ratio (aOR) 1.28(1.26 -1.31 p=0.000), coronary artery disease 1.23(1.20-1.26 p=0.000), obesity 3.49(3.41-3.57 p=0.000), diabetes mellitus 1.11(1.08-1.14 p=0.000), second-degree heart block 1.2(1.09-1.34 p=0.000), bifascicular heart block 1.08(1.02-1.14 p=0.003), defibrillator use 1.36 (1.04-1.77 p=0.026). However, OSA was not significantly associated with atrial flutter 1.03(0.99-1.06 p=0.13), third-degree heart block 1.07(0.99-1.15 p=0.072), ventricular tachycardia 1.01(0.95-1.07 p= 0.762).

Conclusion:
This analysis showed that HFpEF patients with OSA had higher likelihood of arrhythmias, and ischemic cardiac events. Lifestyle modifications including weight loss, healthy diet, and appropriate CPAP use should be encouraged in these patients.
Abstract 4147572: Sex, Adiposity-Related Anthropometrics, and Clinical Outcomes in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: A Participant-Level Pooled Analysis of Randomized Trials
Authors: Ostrominski John , Lassen Mats , Butt Jawad , Claggett Brian , Anand Inder , Desai Akshay , Jhund Pardeep , Lam Carolyn , Pfeffer Marc , Pitt Bertram , ZANNAD Faiez , Zile Michael , McMurray John , Solomon Scott , Vaduganathan Muthiah
Published: November 2024

Background:
Important sex-related differences in body composition exist and may influence the predictive utility of body mass index (BMI) in heart failure (HF) populations. However, whether sex modifies the association between BMI and other adiposity-related anthropometrics and outcomes in HF with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) has not been rigorously explored.

Methods:
In this participant-level pooled analysis of five international, multicenter, randomized-controlled trials enrolling adults HFmrEF/HFpEF, the association between sex and adiposity-related anthropometrics (BMI, waist circumference [WC], and waist-to-height ratio [WHtR]) and the primary composite outcome of time-to-first HF hospitalization or cardiovascular (CV) death was evaluated using multivariable adjusted Cox proportional hazards models (stratified by age, treatment, and trial) and restricted cubic splines.

Results:
Overall, BMI was available in 21,606 participants (mean age, 71±9 years; 83% White; mean BMI: 30±6 kg/m
2
), of whom 10,681 (49%) were female and 10,925 (51%) were male. WC was available in 7,854 participants. Female participants were more likely to be older, have higher BMI, WHtR, and left ventricular ejection fraction. Males had higher rates of the primary outcome compared with females across the BMI, WC, and WHtR spectra (
P
comparison
<0.01 for all), but higher BMI, WC, and WHtR were similarly associated with a higher rate of the primary outcome irrespective of sex (
Figure
). However, among those with BMI 18.5 to <25 kg/m
2
, WC was elevated in 8% of males, but 34% of females. Higher WC was associated with a higher rate of primary events (adjusted hazard ratio per 10 cm increase, 1.13, 95% CI 1.08-1.19;
P
<0.001) independent of BMI, with consistent findings by sex (
P
interaction
=0.25).

Conclusions:
In this participant-level pooled analysis of HFmrEF/HFpEF trials, higher BMI, WC, and WHtR were similarly associated with HF hospitalization or CV death in females and males. However, use of BMI alone disproportionately underestimated abdominal adiposity among females, stressing the importance of implementing additional anthropometrics to mitigate sex-based differences in risk stratification in the HF population.
Abstract 4147575: Outcomes of Utilizing Sodium Glucose Transporter Inhibitors Following Acute Myocardial Infarction: A Comprehensive Meta-Analysis
Authors: Suppah Mustafa , Desouki Mariam , Ali Mohammed , Mohamed Alaa , Keshk Menna , Moradi Ali , Saugstad Austin , Naik Hursh , Bellamkonda Pallavi , Alsidawi Said
Published: November 2024

Introduction:
Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. In the quest for improved therapeutic strategies, the addition of Sodium Glucose Transporter Inhibitors (SGLTis) to the treatment regimen has garnered considerable attention. This meta-analysis endeavors to shed light on the efficacy of SGLTis in short-term cardio-renal protection post-AMI. By synthesizing evidence from diverse studies.

Methods:
Adhering to the PRISMA guidelines, a meticulous systematic review and meta-analysis were conducted. Comprehensive literature searches across PubMed, Web of Science, Scopes, and Google Scholar were performed. Inclusion criteria comprised four Randomized Controlled Trials (RCTs), one retrospective cohort, and one observational study, investigating the effects of SGLTis versus placebo on AMI patients, irrespective of diabetic status. Our analysis included the following outcomes: acute kidney injury, all-cause death, cardiovascular mortality, cardiac death, composite of cardiovascular death/hospitalization for heart failure, and NT-proBNP levels.

Results:
Our analysis encompassed six scientific articles involving 7238 patients. SGLTIs exhibited a notable favorable effect solely on acute kidney injury (P value=0.001, 95% CI [0.46-0.82]). Conversely, no significant benefit was observed in other short-term outcomes, including all-cause death, cardiovascular mortality, cardiac death, composite of cardiovascular death/hospitalization for heart failure, and NT-proBNP levels. These results align with previous studies suggesting the renal protective effects of SGLTIs but highlight the need for further research to clarify their overall cardiovascular benefits in AMI patients.

Conclusion:
Incorporating SGLTis into the therapeutic armamentarium of AMI patients, irrespective of diabetic status, demonstrated a discernible advantage solely concerning acute kidney injury. However, no appreciable benefit was discerned across other assessed metrics. These findings underscore the need for further exploration and tailored therapeutic strategies in the management of post-AMI patients.
Abstract 4147580: Global and regional burden of alcohol-related hypertension from 1990 to 2021: An analysis of GBD study 2021
Authors: Hayat Malik Saad , Shaukat Muhammad Talha , Rehman Wania , Shahzaib Muhammad , Bhatti Muhammad Imaz , Rehman Aqeeb Ur , Mohsin Aleenah
Published: November 2024

Background and Aims:
Hypertension stands as the foremost preventable cause of premature mortality and is expected to have a global burden of up to 55%. Here we aim to examine the trends in age-standardized death rates (ASDR), years of life lost (YLL), and disability-adjusted life years (DALY) for alcoholic hypertension, pinpoint the vulnerable populations, and raise awareness about the global health burden of alcohol-related hypertension.

Methods:
Data on alcohol-related hypertension was extracted from the Global Burden of Diseases 2021 study, including ASDR, YLL, and DALY from 1990 to 2021. The dataset was globally divided and categorized by continents and World Bank income levels. Joinpoint regression was performed to determine annual percentage change (APC) and average annual percentage change (AAPC) from 1990 to 2021.

Results:
Globally, the age standardized death rates (ASDR) for alcohol-related hypertension had an overall decline from 1990-2021. In 1990, ASDR was 1.12 (95% UI 0.72-1.6) and it declined to 0.94 in 2021 (AAPC=-0.54; 95% CI -0.57 to -0.50). Although the overall trend is declining, some prominent spikes in mortality rate were observed, with the most prominent one seen from 2006-2010 (APC=1.38; 95% CI 1.04-1.82). Globally, the disability-adjusted life-years (DALYs) rate was 23.75 in 1990 and it decreased to 18.86 in 2021 (AAPC=-0.73; 95% CI -0.76 to -0.69). From 1990 to 2021, the age standardized years of life lost (YLL) showed a continuous drop with an AAPC of -0.78 (95% CI -0.81 to -0.75). In continent-wise analysis, North America and Europe had higher ASDRs while Asia and Africa had lower ASDRs. From 1990 to 2021, North America and Europe had AAPC of 0.44 (95% CI 0.36 to 0.53) and AAPC of 0.23 (95% CI 0.16 to 0.31) respectively. Conversely, the AAPCs for Africa and Asia showed significant decline and were -0.16 (95% CI -0.19 to -0.15) and -1.37 (95% CI -1.41 to -1.33) respectively. According to World Bank income levels, upper-middle income countries had declining death rates while lower-middle and lower-income countries had increasing death rates throughout.

Conclusion:
Alcohol-related hypertension remains a global health concern. While overall trends show a decline in mortality rates, spikes and variations across continents and income levels highlight the need for targeted interventions.