bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145483: Comparison of Micro Embolic Signals During Carotid Procedures in Patients With Diabetes Mellitus and Patients Without Diabetes Mellitus
Authors: Wiley Karlo , Anker Allison , Martinez Torres Ana , Kozdag Gold Guliz , Vivoni Alejandro , Sanina Cristina
Published: November 2024

Introduction:
The rate and significance of micro embolic events during carotid endarterectomy (CEA) and carotid artery stenting (CAS) remains unclear. We evaluated pre-procedural, intra-procedural, and post-procedural micro embolic signal (MES) rates in patients treated electively with CEA and transfemoral CAS with distal filter protection monitoring MES continuously with transcranial Doppler (TCD). The aims of the study were to determine if patients with diabetes mellitus (DM) had more MES than patients without DM during the procedures and if there were significant effects of the revascularizations on cognitive functions in the short term.

Methods:
Fifty-six patients (mean age 71±9 years; 35 male, 21 female) with significant carotid stenosis underwent successful TCD monitoring during the elective revascularization procedures [34 (61%) CEAs and 22 (39%) CASs]. 22 (39%) had DM when they were enrolled into the study. Ipsilateral MES were segregated into a total of 9 phases of pre-procedure, intra-procedure and post-procedure and the data were analyzed with IBM SPSS software. Cognitive functions were assessed with Mini Mental State Examination 2nd Edition questionnaire. The cognitive tests were administered within 1 day before and after the treatment.

Results:
There were no statistically significant differences in the MES rates in any stage of the procedures between the patients with DM and the patients without DM. There were also no differences in the Mini-Mental State Examination scores before and after the procedures between patients with DM and patients without DM.

Conclusion:
TCD recordings did not demonstrate any significant differences of MES rates during all phases of the carotid procedures between patients with DM and patients without DM. Interestingly, no difference was also found in cognitive function in pre and post procedure periods in both groups.
Abstract 4145487: Right Upper Pulmonary Vein Thrombi Differ Significantly from Right Lower Pulmonary Vein Thrombi due to a Lack of Extending Thrombi in the Left Atrium
Authors: Takeuchi Hidekazu
Published: November 2024

Background:
Pulmonary vein thrombi (PVTs) are common, and their prevalence is underestimated. Neutrophil extracellular traps (NETs) may initiate the formation of PVTs, and NETs are associated with many diseases, such as type 2 diabetes mellitus (T2DM), atherosclerosis and heart diseases. A study of the retrieved thrombi revealed that they had calcification, indicating that they were old. PVTs can release several types of particles, potentially ranging from microclots including NETs to large clots. We reported that standard-dose heparin-warfarin treatment ameliorated mild to moderate T2DM. Heparin might improve blood flow in the microvessels of most organs by destroying histones in NETs. Other NET-associated diseases might be ameliorated, so it is important to understand the traits of PVTs.

We reported several cases in which right lower pulmonary vein (RLPV) thrombi extended into the left atrium (LA). The reported shape of these extended thrombi is rod-like in many cases, as estimated using transesophageal echocardiography (TEE). Most of these thrombi cannot be detected using enhanced computed tomography (ECT). Whether LA thrombi extending from the right upper pulmonary vein (RUPV) are rod-like remains unclear.

Methods:
We examined thrombi in the RUPV in thirty-one patients with and type 2 diabetes mellitus (24 men and 7 women; age = 73.5 (+/- 8.9)-year-old; range: 50- to 88-year-old) using TEE and ECT.

Results:
None of the patients had rod-like LA thrombi extending from the RUPV in the LA. When we checked using TEE, six patients clearly had PVTs in the RUPV, in which thrombi were attached to the vessel wall and could not be detected using ECT. Thrombi extended into the LA, contacting the wall of the RUPV and the wall of the LA. Thrombi are difficult to visualize directly and are recognized as lacking in pulmonary vein blood flow. This study had two limitations. First, only thirty-one patients were included. If we check more patients, rod-like extending LA thrombi might exceptionally exist. The second was that there were several small white spot-like areas around the RUPV; however, we diagnosed them as having no thrombi. These spot-like areas might be thrombi.

Conclusions:
PVTs in the RUPV did not have rod-like extending thrombi in the LA. Attachments to the vessel wall were not rare, and they were detectable when using TEE but not ECT. The thrombi depicted by TEE were different from the thrombi depicted by ECT in some cases.
Abstract 4145503: The Trifecta of Female Gender, LVAD and Sensitization: A Case for Higher Priority Listing for Heart Transplant
Authors: Vaidya Gaurang , Ha Richard-Tien , Kidambi Sumanth , Nishime Erna , Parekh Hemal , Scoville David , Varr Brandon , Adatya Sirtaz
Published: November 2024

Background:
Highly sensitized recipients are expected to have higher wait-time for heart transplant, however, their sensitization status does not grant them higher priority.

Methods:
UNOS database was analyzed for adult heart transplant recipients from Oct 2018 to April 2024 with reported calculated panel reactive antibodies (cPRA). Retransplant and multiorgan transplant recipients were excluded.

Results:
Total 10801 recipients were identified. High cPRA (≥70% cPRA) group constituted only 5% of the listed patients. However, 13% of listed female recipients fell in this category (compared to <2% males, p <0.01). Higher cPRA recipients were more likely to have a durable LVAD (27% vs. 19%, p= 0.01). There was no difference in blood group O (p= 0.5), BMI (p=0.9) and dilated cardiomyopathy etiology (35% in both groups). High cPRA recipients were younger (51 vs. 53 years, p= 0.01). High cPRA group had significantly longer wait time (115 vs. 98 days, p= 0.04).

Rejection episodes requiring treatment in the first year were similar (11% in both). One-year survival was comparable (figure). In median follow-up period of 720 days, hospitalization for rejection (3% vs. 4%, p= 0.3), for infection (11% vs. 10%, p= 0.3) and coronary artery vasculopathy rates were similar (4% vs. 6%, p= 0.4).

Conclusion:
High cPRA patients tend to be females, resulting in a gender disadvantage. Additionally, LVAD can be a source of ongoing but temporary sensitization, which could improve with its removal during transplant surgery. But due to their high cPRA, these LVAD patients will wait longer than non-sensitized LVAD patients, due to a significantly smaller donor pool. A case is made to consider adding higher priority status for high cPRA patients to balance the disadvantage in donor pool, without any effect on post-transplant mortality.
Abstract 4145534: Impact of operation related myocardial infarction on the clinical outcome of patients undergoing coronary endarterectomy combined with coronary artery bypass grafting
Authors: Tiemuerniyazi Xieraili , Zhao Wei , Feng Wei
Published: November 2024

Background:
Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) is one of the last revascularization options for patients with diffuse coronary artery disease. However, concerns exist regarding the application of CE due to the increased perioperative risk, including operation related postoperative myocardial infarction (POMI). However, the impact of POMI on the later outcome is unknown.

Research question:
Does POMI influence the follow-up clinical outcome of patients undergoing CE+CABG?

Aims:
To evaluate the impact of POMI on the patient outcome after CE+CABG.

Methods:
Patients who underwent CE+CABG (excluding concomitant valvular or ventricular aneurysm surgery) between September 2008 and January 2024 were retrospectively enrolled. POMI was defined according to the Forth Universal Definition of Myocardial Infarction. Patients were divided into POMI and no POMI group. Propensity score matching (PSM) analysis with 1:4 ratio was performed to balance the potential baseline confounders. Kaplan-Meier analysis and log-rank test was performed to test the survival difference between the two groups. Cox regression analysis was used to calculate the hazard ratios (HR) and 95% confidence intervals (CI).The primary outcome was the follow-up overall survival, and the secondary outcome was the survival free of major adverse cardiovascular and cerebrovascular events (MACCE), composite of all-cause death, myocardial infarction, stroke and repeat revascularization.

Results:
A total of 859 patients met the inclusion criteria, including 52 in the POMI group and 807 in the no POMI group. The mean age was 61.1±9.0 years, and 78.5% of them were male. During a median follow-up of 13.1 [6.2, 37.7] months, 28 (3.3%) of the patients suffered from death, while 66 (7.7%) suffered from MACCE. The PSM resulted in pairing of 52 and 208 patients in the two groups. The survivals differed significantly between the two groups (
Figure 1A & B
). Cox regression analysis revealed that POMI was observed to be associated with decreased overall (HR: 5.28, 95% CI:1.42-19.67, P=0.013) and MACCE-free (HR: 4.51, 95% CI: 1.69-12.01, P=0.003), which was in line with the unmatched analysis (Overall survival: P=0.001, MACCE-free survival: P=0.001).

Conclusion:
POMI after CE+CABG might impair the survival outcomes of patients.
Abstract 4145582: Implications of a “Smart” Resuscitation Strategy to Identify Rhythm and Physiologic Phenotype During CPR
Authors: Kwok Heemun , Coult Jason , Blackwood Jennifer , King Julia , Kudenchuk Peter , Rea Thomas
Published: November 2024

Background:
Previously described algorithms evaluated defibrillator biosignals
during ongoing CPR
to characterize the underlying rhythm and its physiologic phenotype. We hypothesized that a “smart” resuscitation strategy incorporating these algorithms could reduce CPR interruptions and better align rescuer actions with patient-specific physiology.

Methods:
In a cohort study of ventricular fibrillation OHCA from 2017-2019, rescuer actions (rhythm analysis, shock delivery, pulse check and medication administration) were extracted from EMS, audio, and defibrillator recordings. Previously validated algorithms were combined to assess both cardiac rhythm and physiologic measures. The combined smart algorithm was compared to observed clinical practice with respect to rhythm accuracy and CPR interruption. The frequency of potentially misdirected drug therapy, defined as epinephrine use with >50% probability of spontaneous pulse or antiarrhythmic use with a predicted rhythm of asystole or bradycardia, was determined. Low vitality physiologic phenotype was defined as a shockable rhythm with low probability of post-shock ROSC or a non-shockable rhythm with low probability of a pulse during a clinical pulse check. Vitality phenotypes were compared with respect to post-shock ROSC following shock delivery and pulse prevalence during pulse checks.

Results:
: Of 390 VF-OHCA cases, median age was 64, and 46% survived to hospital discharge. There were a median of 5 rhythm analyses, 3 shocks, and 2 pulse checks per case. The smart strategy achieved comparable shock accuracy (95% sensitivity, 98% specificity) to observed care while decreasing the median CPR interruption from 12 to 6 seconds. Of 597 epinephrine doses, the algorithm identified 17% (n=99) with predicted probability of ROSC over 50%. Of 248 antiarrhythmic doses, the algorithm predicted the rhythm was asystole or bradycardic organized in 9% (n=23). Following 1334 VF shocks, post-shock ROSC differed by phenotype: 4% (9/217) with low vitality versus 22% (244/1117) with high vitality (p<0.01). During 1088 pulse checks, a pulse was present in 9/171 (5%) with low vitality compared to 325/917 (35%) with high vitality (p<0.01).

Conclusion
: A smart resuscitation strategy that assesses the specific rhythm and physiologic phenotype could positively affect hands-on time, medication administration, shock delivery, and pulse checks. It has the promise to improve OHCA survival but requires rigorous comparison to current protocols.
Abstract 4145608: Calibration and Discrimination of Cardiovascular Risk Scores in Women with Breast Cancer in the Women’s Health Initiative
Authors: Wadden Elena , Larson Joseph , Jung Su Yon , Nudy Matthew , Sun Yangbo , Manson JoAnn , Levy Wayne , Stefanick Marcia , Reding Kerryn , Barac Ana , Simon Michael , Vasbinder Alexi , Cheng Richard
Published: November 2024

Introduction:
Women with breast cancer (BC) are at increased risk for cardiovascular disease (CVD). Currently, there is no standardized approach to assess CVD risk in women with BC, despite recommendations for risk assessment. We estimated and compared the performance of established ASCVD risk scores (Framingham Risk Score [FRS], Atherosclerotic Cardiovascular Disease [ASCVD] Risk Estimator, and Life’s Essential 8 [LE8]) in a cohort of postmenopausal women with BC.

Methods:
Women who were diagnosed with BC (stage I-III) and free of CVD from the Women‘s Health Initiative were included in this study. The primary outcome was 10-year risk of ASCVD, defined as a composite of adjudicated coronary heart disease, myocardial infarction, or stroke. For each risk score, we examined calibration and discrimination. Calibration was assessed by calculating bias, slope, standard error of the estimate (SEE), and root mean square deviation (RMSD). Discordance was defined as the percent difference between expected and observed events. Discrimination was evaluated using the c-statistic. We reassessed calibration and discrimination after recalibrating the FRS and ASCVD scores.

Results:
In 6,946 participants (mean age BC diagnosis: 70 years; 89.7% White), the 10-year incidence of ASCVD was 8.6%. FRS underestimated ASCVD risk by 31.1%, whereas ASCVD and LE8 scores overestimated the risk by 53.7% and 9.3%, respectively (Hosmer-Lemeshow P<0.001 for all scores) (Figure). Discordance was consistent throughout the risk continuum for FRS and ASCVD. However, for LE8, discordance was minimal for those at moderate- to high- risk and overestimated in those at low-risk. The ASCVD risk score had the highest c-statistic of 0.76, compared to 0.62 and 0.71 for the FRS and LE8, respectively (Figure). After recalibration, the discordance for FRS and ASCVD was reduced where the FRS overestimated the risk by 3.7% and the ASCVD overestimated the risk by 37.3%. There were no changes in c-statistics.

Conclusions:
In this analysis, LE8 had the best calibration, whereas ASCVD had the best discrimination. The ASCVD risk score had a c-statistic of 0.76, suggesting it may be a practical tool to aid in 10-year CVD risk stratification in women with BC.
Abstract 4145626: Comparative Bleeding Risks Following Acute Myocardial Infarction: Clopidogrel and Ticagrelor, with Consideration for Clopidogrel Resistance
Authors: Gupta Nikita , Anuforo Anderson , Vaishnav Pratyaksh , Ochani Rohan Kumar , Harisingani Dr. Avi , Devakumar Sahana , Chaudhuri Debanik
Published: November 2024

Various studies have shown higher bleeding risks with ticagrelor in comparison to clopidogrel in acute myocardial infarction (AMI). The literature also reveals significant variability in Clopidogrel resistance and consequent efficacy in patients. Our study compares the post-AMI bleeding risks and outcomes of patients on Clopidogrel with confirmed inhibition of platelet aggregation via P2Y12 platelet reactivity assay, compared to Ticagrelor.

We queried the TriNeTX Global collaborative network for adults diagnosed with AMI between 01/01/08 to 12/31/23 and created two cohorts: one on Clopidogrel for at least one month post-AMI, after confirmed ADP-mediated P2Y12 inhibitor effect, and the second cohort was on Ticagrelor for at least one month post-AMI. We conducted propensity score matching(PSM) for around 35 variables, including race, age, sex, medications, and other comorbidities. Logistic regression was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) at one year. Upper Gastrointestinal (GI) bleeding and hemorrhagic stroke at one year were the primary outcomes. Secondary outcomes included 4-point major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of all-cause mortality, cardiac arrest, heart failure, and ischemic stroke.

The sample population had 1,460 post-AMI patients in the Clopidogrel cohort (Cohort 1) and 17,686 post-AMI patients on Ticagrelor (Cohort 2). After PSM both cohorts had 1,296 patients. The Clopidogrel cohort had significantly increased odds of upper GI bleeding (OR 1.656, 95% CI, 1.092-2.511) and hemorrhagic stroke (OR 2.119, 95% CI, 1.110 - 4.044) compared to Cohort 2 at one year. Among secondary outcomes, there was increased odds of heart failure (OR 1.565, 95%CI, 1.118-2.190), ischemic stroke (OR 1.745, 95%CI, 1.098 - 2.775), and 4-point MACCE (OR 1.549, 95%CI, 1.110 - 2.160) in the clopidogrel group compared to ticagrelor. There was no significance noticed in cardiac arrest and all cause-mortality.

In our study, post-AMI patients on Clopidogrel with confirmed in-vitro platelet aggregation effect had significantly higher odds of bleeding and MACCE than those on Ticagrelor. However, Ticagrelor use did not show any mortality benefit.
Abstract 4145628: Association Between Lipoprotein A Levels and Vulnerable Atherosclerotic Plaques: Meta-Analysis
Authors: Mahadevan Arankesh , Prabu Samyuktha , Dhananjaya Hemanth , Jog Himanshu , Patel Mansi , Gawde Rashmi , Goyal Ninia , Desai Rupak
Published: November 2024

Introduction:
Lipoprotein A (LpA), an inherited, soluble protein formed in the liver, may be useful as a risk stratification tool for atherosclerosis. Asymptomatic atherosclerosis with a high tendency to rupture is known as vulnerable plaques, which can be defined with common morphologies such as thin-cap fibro-atheroma with a thin layer of depleted smooth muscles (TCFA) or a lipid-rich (LR) plaque.

Hypothesis:
A high LpA level is associated with an increased risk of vulnerable plaques, defined as TCFA or LR plaque.

Methods:
A systematic search of PubMed, SCOPUS, and Embase databases was conducted to find and include relevant observational studies that compared LpA levels with two primary outcomes of plaque vulnerability, TCFA or lipid-rich plaques. A total of 196 studies were identified, 67 underwent initial screening, and 15 were assessed for full-text eligibility. The random effects model was used to pool binary outcomes as odds ratios (OR) with 95% confidence intervals (CI), and the results were presented on forest plots. Sensitivity analysis was performed using the leave-one-out method, and heterogeneity was identified using I2 statistics. Publication bias was assessed using the Luis Furuya-Kanamori (LFK) index.

Results:
A total of 6 studies were included in our analysis, comprising three retrospective cohort studies and three prospective cohort studies involving 806 patients, out of which 503 were defined as low LpA and 303 as high LpA. Our analysis revealed that high LpA levels were associated with greater odds for both TCFA (OR 2.61 95% CI:1.30-5.24, p<0.01) and LR plaques (OR 2.80 95% CI: 1.23-6.39, p=0.01). Leave-one sensitivity analysis confirmed the stability of our analysis. High heterogeneity values of I2=66% for TCFA and I2=76% for lipid-rich plaques (p<0.01) were observed. However, the LFK index suggested major asymmetry for both outcomes (TCFA: 2.01 and LR plaque: 2.9), indicating the potential of publication bias to confound our results.

Conclusions:
Our analysis, the first of its kind, reveals an association between higher LpA levels and plaque vulnerability.
Abstract 4145721: Diagnosing Hemorrhagic Myocardial Infarction with 3D Cardiac MRI Under 15 minutes
Authors: Zhang Xinheng , Guan Xingmin , Yang Hsin-jung , Huang Yuheng , Yoosefian Ghazal , Christodoulou Anthony , Li Debiao , Dharmakumar Rohan
Published: November 2024

Background:
Hemorrhagic myocardial infarction (hMI) has emerged as the most serious form of reperfusion injury in MI patients. Cardiac MRI (CMR) is the gold standard for characterizing hMI. Given the challenges in imaging these patients (difficulty with breath-holding and patient discomfort with long scans), we developed a free-breathing, non-ECG gated, motion-resolved whole LV 3D CMR to integrate multiple quantitative measurements to limit acquisitions to be within 15 min.

Method:
A free-running 3D Cartesian readout with IR preparation and multiple readouts were used to collect image data interleaved with subspace training data. Images were represented as a 6-way tensor with a combined spatial and 5 temporal dimensions and then were jointly reconstructed. The post-Gd acquisition was time-resolved to trace the Gd kinetics (last time point used to determine LGE). The time-resolved images were assigned to 15 bins (~1 min/bin) and the temporal coefficients were estimated from subspace training data.

Data Acquisition:
Canines with reperfused MIs were imaged at weeks 1 (n=12) and 8 (n=9), post MI. Reference 2D CINE, T2* and LGE images were acquired at diastole during end-expiration breath-holds.

Data Analysis:
Left Ventricle Ejection Fraction (LVEF), MI size and transmurality, microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) size were computed from conventional CINE, (Early Gadolinium Enhancement) EGE, LGE, T2*-weighted (T2*-w) images (TE=11.42 ms), respectively and compared with those determined using the proposed 3D method. Trichrome and Prussian Blue staining were used to validate MI and IMH, respectively.

Results:
Representative CINE, T2*-w and LGE images obtained using conventional and proposed methods are shown in Fig. 1A&B. There was excellent agreement in LVEF, IMH size, extent of MI (Fig. 1C-F), as well as early and late enhancement (Fig. 2) between the approaches.

Conclusion:
Accurate characterization of hMI can be performed under 15 minutes without gating. Patients studies are needed for clinical validation.
Abstract 4145759: Guideline Directed Medical Therapy and the Impact of Sex on Patient Reported and Clinical Outcomes in a Specialized Heart Failure Clinic
Authors: Ma Chen Hsiang , Qi Arthur , Gagnon Luke , Sadasivan Chandu , Oudit Gavin
Published: November 2024

Introduction:
Despite new advances in heart failure (HF) management, underutilization of guideline-directed medical therapy (GDMT) persists. In addition, contemporary data on GDMT utilization and whether sex differences exist is unclear. We aim to characterize GDMT use across HF subtypes, investigate sex-based disparities in utilization, and explore these impacts on patient quality of life markers and clinical outcomes.

Methods:
Patients with HF were enrolled in the heart function clinic (HFC) in Edmonton, Alberta, from Feb 2018 to Nov 2022. Medication records (renin-angiotensin system inhibitors [RAASi], angiotensin receptor neprilysin inhibitors [ARNI], β-blockers, mineralocorticoid inhibitors [MRA], sodium-glucose cotransporter 2 inhibitors [SGLT2i], and glucagon-like peptide 1 receptor agonist [GLP-1 RA]) over 3 years and clinical comorbidities using ICD-10 codes were obtained. We administered the Kansas City Cardiomyopathy Questionnaire Score (KCCQ-12) at enrolment and 6—or 12-month follow-ups, with changes ≥5 defined as clinically significant. We assessed the association between GDMT and sex to changes in KCCQ-12 scores and clinical outcomes.

Results:
Our HFC cohort of 1431 HF patients (median age 68, 29% female) included 52% with reduced (HFrEF), 20% with mildly reduced (HFmrEF), and 28% with preserved (HFpEF) ejection fraction. Median baseline KCCQ-12 score was 75 (IQR 33) and was similar between HF subtypes. ARNI, SGLT2i, and MRA use in HFpEF remains lower compared to HFrEF/HFmrEF (p<0.001), with gaps in treatment persisting over 3 years. Across HF subtypes, GDMT utilization rates were similar between sexes except for SGLT2i in HFmrEF (19.1% male vs. 7.5% female, p=0.02). Controlling for clinical covariates, RAASi (aHR 0.54, 95% CI 0.41-0.70), ARNI (aHR 0.58, 95% CI 0.43-0.80), GLP-1 RA (aHR 0.43, 95% CI 0.19-0.97), and females (aHR 0.72, 95% CI 0.58-0.91) were associated with lower all-cause mortality. ARNI use was also associated with improved follow-up KCCQ12 scores (aOR 1.57, 95% CI 1.00-2.45).

Conclusion:
Despite evidence of improved KCCQ-12 scores and reduced all-cause mortality, GDMT remains underutilized, particularly in HFpEF patients. While we found no sex-based disparities in GDMT utilization, females showed better clinical outcomes in our HF cohort. To improve patient outcomes, further research is needed to address barriers to implementing new GDMT across the heart failure spectrum.
Abstract 4145765: Interstate And Age Group Stratified Variability In The Incidence, Prevalence And Mortality Of Maternal Hypertensive Disorders In The United States: A 1990–2021 Analysis Using The Global Burden Of Disease Database
Authors: Majmundar Vidit , Parajuli Shreyash , Shah Aangi , Byer Marina , Colombo Rosario , Sancassani Rhea
Published: November 2024

Background:
The incidence burden of maternal hypertensive disorders has increased by 30% globally. This study analyzed the trends in prevalence and death rates from maternal hypertensive disorders across various states in the United States from 1990 to 2021.

Methods:
Using the Global Burden of Disease (GBD) database, we compared the following levels, stratified by state, between the beginning of 1990 and the end of 2021: hypertensive disorders of pregnancy, percentage prevalence change, mortality percentage change by age-standardized rates per 100,000 population, and age-stratified changes in the rate of incidence and mortality. The analysis was conducted using Microsoft Excel (16.7).

Results:
The analysis revealed notable interstate variability in the prevalence and death rates of maternal hypertensive disorders (Figure 1). Nevada exhibited the highest increase in prevalence (0.87%), followed by Hawaii (0.65%) and Idaho (0.54%). In contrast, Mississippi experienced the largest decrease in prevalence (-0.22%), followed by Louisiana (-0.20%) and Maine (-0.19%). Regarding death rates, the District of Columbia saw the most significant decrease (-0.67%), followed by New York (-0.45%) and New Jersey (-0.42%). Conversely, West Virginia had the highest increase in death rates (0.89%), followed by Alaska (0.52%) and Kentucky (0.51%). The analysis of Age stratified subgroups in each state showed the maximum increase in mortality change in the age group of 40–44 years, followed by 35–39 years, with West Virginia having the highest percentage change mortality rates (2.55%; age group 40–44 years) and District of Colombia showing a sharp decrease in the percentage mortality rates (-0.72%; age group 30-34 years). Incidence percentage changes showed similar patterns, with Virginia showing a (3.41%; 40–44 years), closely followed by New York (3.31%; 40–44 years).

Conclusion:
The data reveal significant disparities in both the prevalence and death rates of maternal hypertensive disorders across different states. Additionally, an increase in mortality and incidence rate changes of hypertension in pregnancy was observed in higher age groups, particularly among women aged 35–39 and 40–44. These findings highlight the need for tailored, state-specific public health strategies to effectively address targeted interventions for older age groups and mitigate the impact of maternal hypertensive disorders.
Abstract 4145777: Left Atrial Appendage Closure Device Outcomes Among Patients With Diagnosed Coagulable Disorders
Authors: Wei Chapman , Mustafa Ahmad , Velaga Saran Teja , Agarwal Alaukika , Shah Rina , Akhrass Philippe , Kowalski Marcin , Weinberg Mitchell , Parikh Valay
Published: November 2024

Background:
The literature regarding outcomes among patients with coagulopathy who had left atrial appendage occlusion (LAAO) device procedure is limited. This study evaluated the inpatient outcomes among patients that underwent LAAO with and without diagnosed coagulable disorders.

Methods:
Patients that underwent LAAO were collected from the National Inpatient Sample database 2016-2019. Patients were stratified by the presence of diagnosed coagulable disorders. Demographic and comorbidity data were collected. Bleeding events and inpatient mortality were assessed. Chi-square and binary logistic regression analyses were utilized. Factors with p<0.20 were used for the binary logistic regression models.

Results:
Among 12,280 patients, 538 (3.2%) had a diagnosed coagulable disorder. Patients with coagulable disorders were more male. They also had higher rates of cancer, chronic heart failure, anemia, chronic kidney disease, and chronic liver disease and lower rates of dyslipidemia and hypertension than patients without coagulable disorders. Regarding inpatient outcomes, see table 1. After performing logistic regression analysis, coagulable disorders were associated with increased rates of blood transfusion requirement, postoperative bleeding, hematuria, acute kidney injury, and mortality.

Conclusion:
Patients that underwent LAAO with coagulable disorders are associated with increased bleeding in 30 days/in the hospital except gastrointestinal bleeding. Similar risk of hemorrhagic stroke and ischemic stroke were present amongst both groups. Future long-term studies can be performed to corroborate these findings.
Abstract 4145783: Prevalence of Kidney Dysfunction and Hyperkalemia in a Specialized Heart Failure Clinic
Authors: Ma Chen Hsiang , Qi Arthur , Gagnon Luke , Vandermeer Ben , bello aminu , Oudit Gavin
Published: November 2024

Introduction:
Kidney dysfunction is highly comorbid in heart failure (HF) patients and contributes to suboptimal utilization of goal-directed medical therapy (GDMT). Worsening hyperkalemia is a common concern in GDMT implementation. We aimed to evaluate the prevalence of kidney dysfunction and rates of hyperkalemia in a specialized heart function clinic (HFC) cohort in Edmonton, Alberta, and characterize the impact of renal dysfunction on clinical outcomes.

Methods:
HF patients were enrolled in the HFC from Feb 2018 to Nov 2022. Outpatient serum creatinine measurements were used to estimate glomerular filtration rate (eGFR) using the 2021 CKD-EPI equation. Medication records (renin-angiotensin system inhibitors [RAASi], angiotensin receptor neprilysin inhibitors [ARNI], β-blockers, mineralocorticoid inhibitors [MRA], sodium-glucose cotransporter 2 inhibitors [SGLT2i]), laboratory results, and comorbidities using ICD-10 codes were obtained. Hyperkalemia events were defined as any serum potassium ≥5.5 mmol/L measured in a year. Adjusting for clinical covariates, we analyzed the association between GDMT use and hyperkalemia rates as well as between eGFR and all-cause mortality and hospitalization.

Results:
Our HFC cohort of 1401 patients (median age 68, 29% female) includes 54% with an eGFR ≥60, 37% with an eGFR from 30 to <60, and 9% with an eGFR <30. Prevalence of hyperkalemia increased with worsening renal function, from 9.1% in eGFR >60, 18.1% in eGFR 30-60, to 34.2% in eGFR <30 (p<0.001). After adjusting for baseline clinical characteristics, ARNI, RAASi, MRA, and SGLT2i uses were not associated with increased rates of hyperkalemia. Using eGFR ≥60 as a reference, all-cause mortality increased in eGFR 30-60 (aHR 1.58, 95% CI 1.23-2.02) and eGFR <30 (aHR 3.40, 95% CI 2.45-4.72). In addition, RAASi (aHR 0.57, 95% CI 0.43-0.74) and ARNI use (aHR 0.66, 95% CI 0.48-0.91) were associated with improved all-cause mortality. These results were similar across all-cause hospitalization.

Conclusion:
Although hyperkalemia is often viewed as a barrier to initiating and up-titrating GDMT, our results show no association between GDMT use and increased hyperkalemia rates. Given the high mortality and morbidity in patients with heart failure and renal dysfunction, further research on improving GDMT utilization and mitigating hyperkalemia in the context of worsening renal function is warranted.
Abstract 4145905: NLRP3 signaling in rodent and human right ventricular failure is sexually dimorphic and regulated by 17β-estradiol via estrogen receptor α
Authors: Sobrano Fais Rafael , Das Neves Palotta Erica , Kopf Katrina , Mora Massad Karina , Hoffer Christopher , Walts Avram , Cook Todd , Fisher Amanda , Frump Andrea , Givens Sophie , Bourgeois Alice , Woulfe KC , Savai Pullamsetti Soni , Boucherat Olivier , Ogle Brenda , Bonnet Sebastien , Lahm Tim
Published: November 2024

Introduction:
Estrogen receptor α (ERα) promotes cardioprotective signaling in right ventricle cardiomyocytes (RVCMs). NLRP3 inflammasome activation in macrophages contributes to RV failure (RVF) development in pulmonary hypertension (PH). However, NLRP3 signaling in RVCMs has not been studied. We hypothesized that NLRP3 inflammasome activation mediates RVCM contractile dysfunction and is attenuated by 17β-estradiol (E2) via ERα.

Methods:
RVs from male or female PH patients with RVF were assessed for NLRP3 activation by analyzing RNA-seq and proteomics data, plus staining for NLRP3 and its binding partner ASC. Male or female human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) were treated with endothelin-1 (ET1) ± E2. RVCMs were isolated from male or female monocrotaline (MCT) or pulmonary artery banding (PAB) rats. RVCMs were also isolated from healthy rats and treated with ET1 ± E2 in vitro. Male or female ERα loss-of-function mutant (ERα
mut
)] rats were employed to study effects of ERα. NLRP3 activation in RVCMs and iPSC-CMs was assessed by NLRP3-ASC colocalization and activation of downstream targets. RVCM contractility and cytosolic calcium (c-Ca
2+
) were evaluated via IONOPTIX system. P<0.05 was considered significant.

Results:
RNA-seq, proteomics, and immunofluorescence studies revealed that upregulation of NLRP3 activity and signaling in human RVF are more pronounced in males (p<0.05 for all comparisons). In male patients, NLRP3 activation was inversely correlated with cardiac index (p<0.05). In pilot studies, NLRP3 was more activated in male vs female ET1-treated iPSC-CMs. RVCMs from male, but not female, MCT- or PAB-rats demonstrated increased NLRP3-ASC colocalization (p<0.05). RVCMs treated with ET1 exhibited more NLRP3 activation and contractile dysfunction than female RVCMs (p<0.05). E2 treatment in male WT RVCMs reduced NLRP3-ASC co-localization and increased Ca
2+
dependent contractility (p<0.05). E2 treatment in male iPSC-CMs trended to prevent ET1-induced NLRP3 activation. E2’s inhibitory effects on NLRP3 activation, NLRP3-induced contractile dysfunction, and c-Ca
2+
in male WT RVCMs were abrogated in ERα
mut
RVCMs (p<0.05).

Conclusion:
NLRP3 activation in human and rat RVF as well as NLRP3-induced contractile dysfunction in human iPSC-CMs and rat RVCMs exhibit a male bias. E2, via ERα, prevents NLRP3 activation and NLRP3-induced contractile dysfunction. Inhibiting NLRP3 via E2-ERα may be a novel treatment strategy for RVF.
Abstract 4145934: Racial Disparities in Knowledge of Cardiovascular Disease by Chat-Based Artificial Intelligence Models
Authors: Eromosele Oseiwe , Ughagwu Kelechukwu , Johnson Ayodeji , Das Herlyne , Sobodu Temitope , Ouyang David
Published: November 2024

Background:
Patients and their families often explore the information available online for information about their health status. Dialogue-based artificial intelligence (AI) language models (ChatGPT, Perplexity, Bing AI and Google Bard AI) havebeen developed for complex questions and answers even while still constantly evolving. We sought to assess whether AI model had knowledge of cardiovascular disease (CVD) racial disparities, including disparities associated with CVD risk factors and associated diseases.

Methods:
To assess the responses of various AI models to topics in cardiovascular disease disparities, we created twelve questions, with each question having varying topics and patient demographics. Each question was input into 4 different AI models and was asked three times to assess for variability in responses, and the application closed after each attempt.

Results:
A total of 144 responses were tabulated from ChatGPT, Google Bard, Perplexity, and Bing AI answers to 12 questions in triplicate to assess for consistency. Most responses to the same prompt were consistent across different question-and-answer sessions. ChatGPT’s responses to 75% of the questions (9 out of 12 questions) were appropriate, 25% (3 out of 12 questions) were inappropriate and none were unreliable. Google Bard's responses to 91.7% of the questions (11 out of 12 questions) were appropriate, 8.3% (1 out of 12 questions) were inappropriate and none were unreliable. Perplexity responses to 66.7% of the questions (8 out of 12 questions) were appropriate, 25% (3 out of 12 questions) were inappropriate and 8.3% of the questions (1 out of 12 questions) were unreliable. Bing AI responses to 75% of the questions (9 out of 12 questions) were appropriate, 16.7% (2 out of 12 questions) were inappropriate and 8.3% of the questions (1 out of 12 questions) were unreliable. Of the 144 prompt entries into ChatGPT, Google Bard, Perplexity, and Bing AI; 122 (84.7%) were correct, 11 (7.64%) were hedge responses and could not be binarized into a correct or incorrect response, and 11 (7.64%) were incorrect.

Conclusion:
Our study showed that online chat-based AI models have a broad knowledge of CVD racial disparities, however persistent gaps in knowledge about minority groups. Given that these models might be used by the general public, caution should be advised in taking responses at face value.
Abstract 4145936: Ethnic differences in Body Mass Index Cut-off Values Associated with Cardiovascular Risks in South Asians Compared to White Population: A Systematic Review and Meta-analysis
Authors: Shahmohamadi Elnaz , Middeldorp Melissa , Ariyaratnam Jonathan , Jayakumar Mohanaraj , Fitzgerald John , Elliott Adrian , Sanders Prashanthan
Published: November 2024

Background:
BMI is a modifiable risk factor for stroke and heart disease. However, there is limited or no data on the association of BMI with adverse outcomes and the absence of data on Black, South Asian, and Arab populations. Thus, national, and global recommendations for BMI cutoffs to prevent obesity-related complications among minority populations are debatable.

Aims:
This review aimed to identify a holistic estimate of the optimal BMI cutoffs at which cardiovascular adverse outcomes could be predicted amongst south Asian populations.

Methods:
A systematic search was conducted in PubMed, Google Scholar, and Cochrane database to identify community-based studies that reported BMI cut-off values for individuals in South Asian countries from 2004 onward. To determine ethnicity-specific BMI cut-offs for obesity equivalent to the BMI threshold for obesity in White populations (≥30 kg/m
2
), a random-effects meta-analysis was performed for data associated with type 2 Diabetes. The pooled estimate of cut-off points was calculated, with studies weighted by the inverse variance of their individual estimates.

Results:
We included 7 studies, comprising a total of 143,380 participants from South Asian countries. The pooled estimate for the BMI cutoff associated with type 2 diabetes, equivalent to a BMI of 30.0 kg/m
2
in White populations, was 23.3 kg/m
2
(95% CI: 22.0-24.6). Summary receiver operating characteristic (SROC) curves were created using a linear regression model to summarize the studies' ROC curves. The highest Youden index indicated that the optimal BMI cut point for hypertension and dyslipidaemia among South Asian males was 23.3 kg/m
2
(95% CI: 22.2-24.6) and 24.3 kg/m
2
(95% CI: 21.2-27.4), respectively. For South Asian females, the optimal BMI cut point for hypertension was 24.0 kg/m
2
(95% CI: 22.9-25.2) and for dyslipidaemia was 24.7 kg/m
2
(95% CI: 23.0-25.9).

Conclusion:
Revisions to BMI cutoffs specific to different ethnicities are necessary to ensure that minority ethnic groups receive proper clinical monitoring. This will help enhance the prevention, early diagnosis, and timely management of cardiovascular risk factors.
Abstract 4145938: Intravascular Radioisotope Detection Catheter for Localization of High-Risk Plaques
Authors: Nakahara Takehiro , Fujimoto Shinichiro , Strauss Harry , Narula Jagat , Minamino Tohru , Daida Hiroyuki , Jinzaki Masahiro
Published: November 2024

Background:
Rupture-prone high-risk atheromatous plaques are characterized by large plaque and positively remodeled necrotic core volumes and thin fibrous caps with significantly inflammation by the cells of monocyte-macrophage origin. The plaque volumes and remodeling are relatively reliably identified by noninvasive and invasive imaging, however; the detection of coronary inflammation is not conveniently possible. We propose that development of a radioisotope (RI) catheter could help record quantitative uptake of specifically targeted radiotracers against inflammation. counting of be developed.

Methods:
We developed an RI catheter comprising scintillator and flexible optical fibers, with (sCath) and without (nsCath) shielding scintillator to obtain directionality and evaluated its utility in both
in vitro
and
ex vivo
experiments. For an
in vitro
study, the catheter was placed on
18
F point sources to measure the radioactivity counts. For
ex vivo
study, atherosclerotic lesions were induced in 6 rabbits balloon injury model. Rabbits received
18
F-fluorodeoxyglucose (FDG) and were sacrificed 2 hours later; the aortas were exposed, and RI catheter was pulled back every 1cm and counts measured the for 1 minute by nsCath, and right (sCath-R) and left (sCath-L) sided catheters. After 3 measurements, the artery was sectioned at 1cm and each segment was counted in an automatic well-type gamma-counter. Specimens were fixed overnight with 4% paraformaldehyde and serial sections were histologically analyzed and characterized immunohistochemically by anti-CD68 antibody for macrophage infiltration.

Results:
In vitro
study showed linear correlation between counts and
18
F souse dose until at 100kBq (R
2
=0.996). For
ex vivo
study, 71 sections were obtained from 6 rabbits, and the cpm from each catheter was correlated with counts from well counter. The counts of both sCath-R and -L demonstrated the highest correlation (nsCath: r=0.47, sCath-R: r=0.42, -L: r=0.53, sCath-R+L: r=0.54, p<0.01, respectively), and showed excellent agreement with ipsilateral CD68-positive areas, CD68-L&sCath-L: r=0.50, CD68-R&sCath-R=0.42, p<0.01). The average CD68 area correlated with sCath-R+L, but not with nsCath (av. CD68&sCath-R+L: r=0.44, p<0.01, CD68 average; nsCath: r=0.18, p=0.12).

Conclusions:
The Shielded RI catheter counts correlated with well counts and ipsilateral CD68-positive area and are potentially useful for the detection of inflammation in high-risk plaques.
Abstract 4146008: Association of Pre-operative Neutrophil to Lymphocyte Ratio (NLR) and Post-operative AKI in Patients Undergoing CABG: A Meta-Analysis
Authors: Patel Bhavin , Lapsiwala Boney , Jariwala Prayag , Suresh Aditya , Vanani Samir , Patel Shaurya , Rajani Aayushi , Desai Rupak
Published: November 2024

Objective:
Inflammation is associated with pathologies including post operative acute kidney injury (AKI). AKI is one of the common post operative conditions which prolongs hospitalization, intensive care unit stay and causes higher health costs and mortality. Pre-operative neutrophil to lymphocyte ratio (NLR) has predictive value for post-operative AKI after coronary artery bypass grafting (CABG). Hence, we aimed to evaluate the association of pre-operative NLR and post-operative AKI in patients undergoing CABG.

Methods:
A comprehensive literature review was conducted using PubMed, Google Scholar and SCOPUS databases from 2000 until 2024 using related keywords to identify studies reporting association of pre-operative NLR and post-operative AKI in patients undergoing CABG. The data was extracted and independently reviewed by four authors using standard forms. A random-effects model was used to calculate odds ratios (OR) and heterogeneity was assessed using I2 statistics. The sensitivity analysis was performed using the leave-one-out method.

Results:
Our final analysis included 6 retrospective studies which included 1757 patients with CABG. The mean age of the included patients was 64 years and 63.4% were males. Initial unadjusted analysis showed higher odds of post-operative AKI in patients having higher pre-operative NLR values with unadjusted OR 1.67, 95% CI 1.20-2.34, p <0.001 with high heterogeneity (I2=94.89%). After adjusting for baseline characteristics and comorbidities, odds for post-operative AKI increased to aOR 1.69, 95% CI 1.03-2.79, p <0.001 with high heterogeneity (I2=85.16%), which indicates stronger association after adjusting for confounders. Leave-one-out sensitivity analysis confirmed the robustness of these findings.

Conclusion:
Our meta-analysis suggests that higher pre-operative NLR is associated with 69% higher risk of post-operative AKI in patients undergoing CABG. This warrants more prospective studies to validate these findings. Moreover, better prediction of AKI can help to establish preventive measures to avoid adverse outcomes including the need for renal replacement therapy or hemodialysis in high-risk patients.
Abstract 4146019: Trends, Prevalence of Bradyarrhythmia and Pacemaker Implantation in Patients with Parkinson’s Disease.
Authors: Nzeako Tochukwu , Adeniran Olayemi , Singh Shreya , Kaur Saranjeet , Ukenenye Emmanuel , Wimmer Neil
Published: November 2024

Background:
Parkinson’s disease (PD) is one of the most common neurodegenerative disorders, affecting more than one million persons in the United States. Cardiovascular dysautonomia is a prominent dysfunction in PD, affecting the conduction system and causing bradyarrhythmia. However, no studies have assessed the prevalence and characteristics of bradyarrhythmia in patients with PD.

Research Question:
Is there an increased prevalence of bradyarrhythmia and pacemaker implantation in patients with PD?

Aims:
The study assessed the trends, prevalence, and risk factors of bradyarrhythmia and pacemaker implantation in PD patients.

Methods:
The National Inpatient Sample was utilized to identify patients' data with primary and secondary diagnoses of Parkinson’s disease (PD) in the United States from 2016 to 2020 using the International Classification of Disease, 10th Revision codes. Outcomes of interest included the trends and prevalence of bradyarrhythmia and pacemaker implantation in PD. We assessed potential predictors of bradyarrhythmia in patients with PD using a backward selection multivariable logistic regression.

Results:
A total of 333,242 patients with PD diagnosis were included (76.5 ± 15.2 years, 58.7% male, 80.1% white); of these, 5,092 (20.5%) had comorbid diagnoses of bradyarrhythmia, and 328,150 (79.5%) without bradyarrhythmia. The prevalence of bradyarrhythmia in patients with PD was 351.9 per 10,000 hospitalizations (3.5%). The trends of bradyarrhythmia showed a stable increase from 291.9 to 463.8 per 10,000 (AAPC 12.5%, CI: -0.2%, 26.8%). The overall prevalence of pacemaker implantation in patients with PD was 79.9 per 10,000 hospitalizations (0.8%). The overall trends of pacemaker implantation showed a stable decrease in patients with PD during 2016-2020, with an AAPC -0.9% (CI: -4.1% to 2.3%). Age≥ 65, male sex, comorbidities (atrial fibrillation, coronary artery disease, heart failure, hypertension, liver failure, obesity, peripheral vascular disease, renal failure) were associated with a higher likelihood of bradyarrhythmia in patients with PD.

Conclusions:
This study's findings revealed that the prevalence of bradyarrhythmia and subsequent pacemaker implantation in patients with PD remained relatively stable over the study period. The study provides the initial prevalence of bradyarrhythmia in patients with Parkinson’s disease. Further study is necessary to provide the characteristics and outcomes of bradyarrhythmia in PD.