bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145873: Optimal Timing for Coronary Artery Bypass Grafting in NSTEMI Patients: A Retrospective Cohort Analysis of In-Hospital Mortality and Stroke Prevalence Over 2017 to 2021
Authors: Tran Viet Nghi , Nguyen Doan Ngoc Chau , Bilo Thanh , Pham Hoang Nhat , Hoang Phu Thoai , Nguyen Thach
Published: November 2024

Background:
Recent studies have suggested performing coronary artery bypass grafting (CABG) within 24 hours of acute myocardial infarction increases mortality risk. However, the ideal timing after the first day remains unclear. This study aims to suggest an optimal timing of CABG in NSTEMI patients using the large National Inpatient Sample (NIS) database over a 5-year period.

Methods:
This retrospective cohort study analyzed survey-weighted NIS data over 2017-2021, including adult-age admissions with NSTEMI as the principal diagnosis who underwent CABG without prior transfer from another hospital. Patients were categorized into eight groups based on days from admission to CABG (0, 1, 2, 3, 4, 5, 6, and ≥7 days). Baseline characteristics were compared across groups. Multivariate regression analysis adjusted for multiple confounders to assess the association between Time-to-CABG and in-hospital mortality and stroke prevalence.

Results:
Table 1 presents the baseline characteristics across the eight groups, encompassing 142,200 included admissions (mean age 65.24 years; 26.78% female).

In-Hospital Mortality:
The adjusted odds ratios (OR) were less than one for groups 1 through 7 compared to group 0, indicating that immediate CABG (day 0) is associated with higher mortality risk. While the reduced odds in the day 1 group were not statistically significant, substantial and statistically significant reductions in mortality were observed between days 2 and 5 (OR: 0.624 - 0.609; p<0.05). After day 5, the OR for mortality trended up, reaching 0.667 (p<0.05) on day 6 and 0.692 (p<0.05) for surgeries performed on day 7 or later.

Stroke Prevalence:
The adjusted ORs for stroke prevalence were significantly lower for groups 1 through 7 compared to the CABG within 24-hour group (all p-values <0.05). The lowest ORs were observed between days 2 and 4 (OR: 0.654 and 0.542, p<0.05, respectively). After day 4, the ORs increased, reaching 0.672 (p<0.05) for surgeries performed on day 5 and 0.609 (p<0.05) on day 7 and beyond.

Conclusion:
The mortality risk in NSTEMI patients remained higher if CABG was performed in the first 48 hours of admission (end of day 1) compared to later. This risk also increased if CABG was done after day 5. Combined with the possible risk of stroke being increased from day 5, we suggest the optimal time-to-CABG is between admission day 2 and day 4 in NSTEMI patients. Future prospective studies are warranted to confirm these findings and guide clinical practice.
Abstract 4145899: The Danger of Moderator Band Ectopy: A Case of Premature Ventricular Contraction induced Recurrent Ventricular Fibrillation
Authors: Krayem Hussein , Trongtorsak Angkawipa , Grandhi Gowtham , Kalahasty Gautham
Published: November 2024

Introduction:
Premature Ventricular Contractions (PVCs) are often a benign arrhythmia. However, those originating from the Purkinje system can result in fatal arrhythmias. One example is PVCs originating from the moderator band (MB) within the right ventricle (RV) of the heart. We present a case of PVCs originating from the MB triggering idiopathic ventricular fibrillation (VF) and electrical storm.

Case:
A previously healthy 49-year-old woman was admitted following a witnessed VF cardiac arrest. She had recurrent episodes of VF, initially treated with Amiodarone and Procainamide which failed to suppress the recurrent VF. She received 54 external defibrillations before a transvenous pacer (TVP) was placed to override the PVCs at a pacing rate of 110 bpm. Post-resuscitation ECGs revealed frequent PVCs originating from the RV free wall, potentially from the lateral part of MB (Figure 1). Quinidine was added to suppress the PVCs ultimately allowing removal of the TVP. Transthoracic Echocardiogram revealed normal cardiac function and a prominent MB. A cardiac MRI was performed showing no infiltrative disease or any other abnormalities. The patient underwent sympathectomy and defibrillator placement. Despite recurrent cardiac arrest, she had excellent neurologic recovery and was subsequently discharged on Quinidine.

Discussion:
MB extends from the septal wall to the base of the anterior papillary muscle in the RV, carrying Purkinje fibers(PF) from the right bundle branch as it exits the septum. Purkinje fibers have been shown to initiate arrhythmias by several mechanisms including enhanced automaticity, triggered activity and re-entry. In the genesis of PVCs, triggered activity is the likely mechanism. This can degenerate into VF in a structurally normal heart, hence the term “idiopathic VF”. Familiarity with this entity and ECG features of MB ectopy leads to timely management and may potentially prevent lethal arrhythmias in symptomatic patients with such PVCs. Further studies are required to fully understand the arrhythmogenic mechanisms and the optimal management approach for MB ectopy.
Abstract 4146312: Global Burden and Trend of Atrial Fibrillation and Flutter in the 27 European Union Countries from 1990-2021: A Systematic analysis for the Global Burden of Disease Study 2021
Authors: Patel Lalitkumar , Vummaneni Siri , Bhalodia Paritaben , Patel Rutvij , Daid Simranpreet Singh , Modi Dhruvi , John Jobby , Rathod Urvashi , Sharma Akhilesh , Kochhar Gunjan , DESAI HARDIK
Published: November 2024

Introduction:
Atrial Fibrillation (Afib) and Flutter ranks as the fifth leading cause of death among all cardiovascular diseases (CVD). Given the scarcity of consistent previous estimates, this study is the first to assess the burden of Afib and Flutter in the European Union (EU) over the past three decades, including the initial two years of the COVID-19 pandemic.

Methods:
Using global burden of disease study 2021 meta tool, we estimated prevalence, incidence, deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to Afib and Flutter by age, sex, year and location across the 27 EU countries from 1990-2021.

Results:
The total number of prevalence rose from 5 million (95% uncertainty interval: 3.9-6.4 million) in 1990 to 8.6 million (7.2-10.3 million) in 2021. The total percentage of change (TPC) in deaths increased by 130% (110%-143%), and YLDs by 69% (56%-84%) from 1990-2021. Austria saw the highest increase in age-standardized incidence rates (ASIR) at 83%, followed by Czechia at 50%. Sweden experienced the largest rise in mortality rates (ASMR) at 93%, with Estonia at 35%, and in YLD rates (ASYLDR), Austria led with a 90% increase followed by Sweden at 49%. In terms of age, individuals aged 55 and older recorded the highest death toll at 70,269 (57,793-77,019) and the highest incidence at 607,960 (397,686-868,122) in 2021. Regarding gender, males showed an increased TPC in overall burden compared to females, with males observing an increase and females a decreasing trend in ASIR (5% vs -7%), ASMR (7% vs -4%), and ASYLDR (7% vs -5%) from 1990-2021.

Conclusion:
Deaths due to Afib and Flutter accounted for 4.26% of all CVD in EU. The escalating prevalence and mortality rates of Afib and Flutter across the EU highlight an urgent need for comprehensive healthcare strategies. Effective management should focus on bolstering preventive measures, advancing diagnostic techniques, and enhancing patient care frameworks, particularly for the aging demographic most at risk. Strategic collaboration across sectors, including innovative public health initiatives and policy reinforcement, is essential to curb this growing trend and safeguard public health.
Abstract 4146316: Venous Remodeling and Occlusion Accompany Arterial Pathology in Patients with Chronic Limb Threatening Ischemia
Authors: Beach Jocelyn , Narula Navneet , Aikawa Elena , Marinho Lucas , Turner Mandy , Clift Cassandra , Morrison Alan , Narula Jagat , Pradhan Aruna
Published: November 2024

Background:
Chronic limb threatening ischemia (CLTI) is defined as the presence of peripheral artery disease (PAD) in combination with rest pain or tissue loss and represents advanced arterial occlusive disease. Little is known about associated venous pathology as prior pathologic reports were limited to evaluation of maximally diseased arterial lesions.

Objectives:
To characterize arterial and venous histopathology in patients with CLTI.

Methods:
Tissue containing peripheral arteries and veins from the femoropopliteal to distal tibial arteries was harvested from 10 patients who underwent amputation for CLTI (Fig 1). Vessels were sectioned at 0.5 cm intervals, and histopathologic features were catalogued across 535 arterial and 493 venous sections.

Results:
Consistent with PAD, atherosclerotic lesions were more prevalent in proximal than distal arteries; 81.8% (27/33) femoropopliteal sections compared to 26.6% (134/502) of tibial sections. Severe stenosis (>90%) was noted in 21.9% (117) of sections and was associated with atherosclerosis (pathological intimal thickening, fibroatheroma, fibrocalcific or fibro-osseous lesions) in 10.3% (12), luminal thrombi in 68.4% (80), or both in 21.4% (25) of arterial sections.

In all patients and in 99.0% (488/493) of venous sections, irrespective of the degree of arterial luminal stenosis, adjacent large (≥1000µm) and small diameter veins revealed marked thickening of the vessel wall comprised of fibrosis and smooth muscle hyperplasia (Fig 2). While large veins retained luminal patency, small veins exhibited severe luminal stenosis or obliteration. Venous thrombosis was uncommon, occurring in 3.0% (15/493) of sections.

Conclusions:
Venous remodeling with stenosis and occlusion is highly prevalent and coincides with arterial disease pathology in patients with CLTI. This novel finding of previously underappreciated and severely altered venous pathology suggests a possible additional mechanism for limb ischemia in CLTI.
Abstract 4147601: Associations between Accelerated Aging Phenotypes with Cancer-Specific and Cardiovascular-Specific Mortality in Long-Term Cancer Survivorship
Authors: Scheuermann Britton , Ade Carl
Published: November 2024

Background:
The consequences of cancer and anti-cancer treatments are often described as representing an “accelerated aging” phenotype. However, little is known about how the “accelerated aging” phenotype affects mortality risks in long-term cancer survivors.

Purpose:
To investigate the association between accelerated aging phenotype and cause-specific mortality in a sample of long-term cancer survivors

Methods:
Data for cancer survivors (CS) were extracted from the National Health and Nutrition Examination Survey between the years 1999-2010. Participants missing vital data and those diagnosed with multiple cancers, childhood cancers, cancer within the previous 5 years, or skin cancer were excluded. Mortality outcomes were collected from the National Death Index through December 2019. The Phenotype Age score was derived from blood biochemistry measures such as albumin, creatinine, and c-reactive protein. Accelerated Aging (AA) was defined as a Phenotype Age greater than the participants’ chronological age. CS were grouped by time since diagnosis: 5-10, 10-15, 15-20, and ≥20 years. Within each group, hazard ratios (HR) were derived from competing-risk hazard regression for the AA phenotype association with cancer-specific and cardiovascular-specific mortality. Regressions were modeled with participant age as the time-scale to account for the predictive nature of chronological age.

Results:
A total of 875 CS (65.6±12.9 years, 62% female, 31% non-white, 15.6±9.4 years from cancer diagnosis) were included. The most common cancer types were prostate (16%) and breast (21%) cancer. There were 107 cancer and 113 cardiovascular deaths over a 10.8±4.6 year follow-up. The AA phenotype was significantly associated with cardiovascular-specific mortality in each survivor group (all p<0.05). Conversely, the AA phenotype was only significantly associated with cancer-specific mortality in the 5-10 years of survivorship group (p=0.01). Results are displayed in Figure 1, along with cubic splines fit to the HR of each survivorship group.

Conclusions:
Present results suggest that the AA phenotype may demonstrate time-dependent associations with cancer-specific and cardiovascular-specific risks, two leading causes of death in CS.
Abstract 4147602: The Paradox Role of Sirtuin 6 In Coronary Microvascular Function under Metabolic Stress
Authors: Wang Yang , Enrick Molly , Gadd James , Nagy Blessing , Ogunmiluyi Iyanuoluwa , Yin Liya
Published: November 2024

Coronary microvascular dysfunction (CMD), which is associated with diabetic cardiomyopathy, Takotsubo cardiomyopathy, andheart failure with preserved ejection fraction (HFpEF), is understudied. CMD is characterized by impaired endothelial-dependent vasodilation, but detailed mechanisms have yet to be elucidated.

Nuclear Sirtuin 6 (SIRT6) plays essential roles in gene transcriptional, stress tolerance, DNA repair, inflammation, and aging. SIRT6 is strongly associated with cardiovascular pathologies, but how SIRT6 regulates endothelial metabolisms and homeostasis under metabolic stress and the underlying mechanism remains poorly understood. It might be because global Sirt6 knockout mice are perinatally lethal caused by hypoglycemia, suggesting the essential role of SIRT6 in glucose metabolism.

In our preliminary studies, we generated inducible global Sirt6 knockout mice by crossing with Sirt6 f/f mice with CAG-cre (Sirt6
f/f, CAG
), and mice were viable with normal glucose levels. However, they showed impaired endothelial-dependent dilation (EDD) and impaired coronary flow reserve (CFR), an index clinically used to diagnose CMD. It suggests that deletion of Sirt6 might cause EC dysfunction because Sirt6 is reported to protect EC from premature senescence and oxidative stress by sustaining high eNOS levels. Surprisingly, when we studied non-inducible Sirt6 endothelial-specific knockout (Sirt6
f/f, tie-2 cre
) and inducible Sirt6 endothelial-specific knockout (Sirt6 f/f,
Cdh5-cre/ERT2
) and wild-type (WT) mice, Sirt6
f/f, Tie-2
and Sirt6
f/f, Cadh5
mice do not phenocopy the inducible global SIRT6 knockout mice, they had normal EDD and CFR. When the mice were fed a high fat and high sugar (HFHS) diet, the Sirt6
f/f, Tie-2
and Sirt6
f/f, Cadh5
had impaired EDD, suggesting Sirt 6 functioned differently in the mice fed with chow diet or HFHS diet.

We hypothesize Sirt 6 deficiency causes coronary endothelial dysfunction and contributes to CMD; activating Sirt6 will ameliorate CMD. EDD was assessed using myography (DMT). Myocardial blood flow (MBF) was measured by Doppler. Our preliminary data show that the mediator of coronary vasodilation switched from NO to H
2
O
2
in the Sirt6 knockout mice with impaired EDD. Interestingly, when the mice fed on HFHS were treated with Sirt 6 activator MDL-800, the coronary microvascular function was improved, and the blood glucose level was decreased. The underlying mechanism and the pathways involved will be elucidated.
Abstract 4147608: Trends in Mortality and 30-Day Readmission Rates Among Heart Failure Patients Undergoing Cardiac Rehabilitation: A Nationwide Analysis from 2017 to 2020
Authors: Aiwuyo Henry , Jha Mayank , Perry Jamal , Akinti Oluwasegun , Ayinalem Yonael , Asfaw Yonathan , Nevolina Anna , Offor Rita , Nigussie Bisrat , Nnadi Ekenedilichukwu , Mitre Cristina
Published: November 2024

Background:
Heart failure (HF) is a significant public health concern, affecting approximately 6.2 million adults in the United States, with high mortality and readmission rates. Cardiac rehabilitation (CR) programs have been widely recognized as a crucial component of HF management, aiming to improve physical function, reduce symptoms, and enhance quality of life. Despite the established benefits of CR, there is a need to understand the trends in mortality and readmission rates among HF patients participating in these programs. We aim to analyze mortality and 30-day readmission rate trends among heart failure patients undergoing cardiac rehabilitation from 2017 to 2020 using NRD data.

Hypothesis:
We hypothesize a significant downward trend in mortality rates and significant yearly variation in 30-day readmission rates among heart failure patients undergoing cardiac rehabilitation.

Methods:
We analyzed NRD data from 2017 to 2020, including patients with ICD-10 codes I50 (heart failure) and Z5189 (cardiac rehabilitation). Trend analyses were performed using Ordinary Least Squares (OLS) regression for mortality rates and the Cochrane-Armitage test for binary data. Multivariate regression adjusted for age, sex, and comorbidities. Statistical analyses were conducted using STATA version 18.

Results:
From 2017 to 2020, annual mortality rates were 6.9% (95% CI: 0.95% to 12.85%), 5.5% (95% CI: 0.47% to 10.52%), 4.6% (95% CI: -0.51% to 9.68%), and 1.9% (95% CI: -1.90% to 5.74%), respectively. The mean age was 78 years, with 54% were female. OLS regression showed a significant downward trend in mortality (p = 0.025), while the Cochrane-Armitage test did not (p = 0.998). Multivariate regression also indicated a downward trend, though individual predictors were insignificant (p=0.576). For 30-day readmission rates from 2017 to 2020, annual margins were 21.5% (2017), 21.7% (2018), 18.0% (2019), and 34.3% (2020), showing significant yearly variation.

Conclusion:
Despite the varying range of 30-day readmission within the years of interest, there seems to be a significant downward trend in mortality for heart failure patients who underwent cardiac rehabilitation. Further studies are required to corroborate these findings as understanding CR program outcomes can help identify improvement areas, guide resource allocation, and inform healthcare policy decisions.
Abstract 4147609: Hypoalbuminemia as predictor of poor functional status in hospitalized patients with advanced heart failure
Authors: Ogg Galen , Cedeno Juan , Atienza Matthew , Ippolito Paul , Chandra Akhil , Pandya Vidish , Chavez Patricia , Eti Serife
Published: November 2024

Introduction:
Timely involvement of palliative care services for patients with advanced heart failure (HF) improves symptom burden, functional status, and resource utilization. The Karnofsky Performance Scale (KPS) is an objective tool used by palliative care specialists to assess physical ability and guide palliative interventions. Patients with lower KPS have poor outcomes, however evidence linking clinical parameters such as New York Heart Association (NYHA) class, ejection fraction (EF), and albumin with KPS remains limited.

Goals:
To identify clinical parameters associated with poor functional status in hospitalized patients with advanced HF

Methods:
Individuals with acute decompensated HF admitted between 2021-2023, ineligible for advanced cardiac therapies, and referred to palliative care were included. Data collected encompassed demographic variables, clinical parameters (NYHA classification, KPS, comorbidities, EF, Brain natriuretic peptide (BNP), albumin, creatinine), and palliative care interventions (family meetings, advanced care planning discussions). Bivariate and multivariate analyses, utilizing Kruskal-Wallis and chi-square tests along with adjusted regression models, were conducted using R to compare characteristics, with a low KPS (≤40) as the primary outcome.

Results:
A total of 97 individuals were included, with a mean age of 68 ± 17.7 years, 32 (33.0%) were female. Hypoalbuminemia was directly associated with KPS. Patients with albumin levels ≤3 g/dL were more likely to have KPS ≤40 (OR 2.6 [CI 1.03-6.7], p=0.04). NYHA class, EF, serum creatinine, and comorbid conditions (chronic kidney disease, stroke, chronic obstructive pulmonary disease, dementia) were not significantly associated with KPS. Those with lower KPS scores had higher utilization of palliative care services for family meetings, although did not differ significantly in advanced care planning status.

Conclusions:
In our analysis of hospitalized patients with advanced HF, hypoalbuminemia had the highest predictive value for low functional status. Low KPS score was associated with increased utilization of palliative care services and higher rates of inpatient mortality.
Abstract 4147614: Prevalence and Impact of Stroke In Young (18-44 Years) ACHD-Related Admissions by Median Household Income Quartiles: A 2019 National Inpatient Sample Analysis
Authors: Appala Pavana , Appala Nikhila , Bansal Prerna , Khanolkar Vidhi , Ghaffar Ammara , Mylavarapu Maneeth , Desai Rupak
Published: November 2024

Background:
The risk of stroke in Adult Congenital Heart Disease (ACHD) is well established. However, the prevalence and impact of stroke in young ACHD-related admissions stratified by median household income remain underexplored.

Methods:
The National Inpatient Sample (2019) was utilized to identify the rate of stroke admissions among young (18-44 years) ACHD patients. We also evaluated comorbidities and outcomes (all-cause mortality [ACM], length of stay [LOS], disposition,&charges) based on the median household income quartiles and compared two cohorts of lowest (0-25th percentile) and highest (75-100thpercentile) median household income (LMHI vs HMHI).

Results:
Of 41950 young (18-44 years) ACHD patients, 5360 patients had stroke (12.8%). Patients in the LMHI group were relatively older (median age 36 years vs 35 years) and had a greater proportion of males (53.8% vs 46.0%) when compared to patients in the HMHI group. Patients admitted with stroke were of greater proportion in the LMHI group (13.2% vs 12.1%) compared to the HMHI group. Comorbidities like alcohol abuse (4.7% vs. 2.3%), depression (9.8% vs. 7.0%), hypertension (13.0% vs. 5.6%), obesity (21.2% vs. 18%), drug abuse (12.3% vs 4.2%), and tobacco use disorder (30.4% vs 11.2%) were higher for LMHI when compared to HMHI. Regarding in-hospital outcomes, ACM (3.7 vs. 1.9%) and discharge to home (71.6 vs. 66.5) were higher with HMHI, whereas the LMHI cohort demonstrated fewer routine discharges, higher transfers to other facilities, and prolonged LOS (5 vs. 3 days, p<0.001). When adjusted for confounders, there were statistically higher odds of AIS in ACHD patients from the LMHI group vs. the HMHI group [aOR 1.33; 1.02-1.74; p=0.045]. However, no association of income quartile with overall stroke risk was observed.

Conclusion:
The prevalence of stroke is significantly higher in the LMHI group. When controlled for confounders, there was a higher risk of AIS without any impact on overall stroke. Furthermore, the lowermost income quartile was associated with fewer routine dispositions, and frequent transfers can further adversely increase healthcare inequalities and healthcare costs.
Abstract 4147618: Modality of Research Engagement Among Postpartum Women with Hypertension and High Health-Related Social Needs
Authors: Yarrington Christina , Parker Samantha , Ncube Collette , Agyemang Nana , Murray Mara
Published: November 2024

Introduction:
People of color and non-English speakers are underrepresented in research and disproportionately affected by health-related social needs (HRSNs). Research engagement can be particularly challenging after pregnancy as postpartum care attendance is low. We describe our experience with remote recruitment modalities in a such a population.

Methods:
The study population included all patients affected by hypertension during a pregnancy who delivered at a large safety-net hospital 1/2022-6/2023. These patients also engaged in 6 weeks of remote blood pressure monitoring postpartum. Patients were contacted between 6 weeks and 12 months post-delivery to complete an online survey regarding HRSNs and provide consent to link survey data to clinical data. The recruitment protocol included initial outreach via the electronic medical record (EMR) patient portal, if available, or else a hard copy letter via mail, followed by a series of text messages then phone calls. All communication was conducted in the patient’s primary language (English, Spanish, or Haitian Creole).

Results:
We recruited 148 (9.4%) of 1571 patients contacted. Respondents were 51% Black, 39% Latina, 26% White. Table illustrates the comparable rate of recruitment across languages, dominance of EMR as mode of engagement and an illustration of the high rate of complex HRSN among our participants. The most effective recruitment method was EMR communication (57% of total recruitment) followed by text messages (28%). Our Haitian Creole-speaking respondents had the highest rates of HRSN - possibly representing the Haitian migrant crisis affecting Boston in this time period - as well as the highest rate of engaging via EMR messaging. Other domains of HRSN were high among all language groups including trouble affording medication (11-23%) and heating/electric access (21-34%).

Conclusions:
A diverse postpartum population with a high prevalence of HRSNs is hard to engage in research. Despite presumed digital barriers, EMR and secure text were effective and secure methods of online survey recruitment. Future studies seeking to understand the intersection of health outcomes and HRSNs should consider adding recruitment with EMR to common texting strategies.
Abstract 4147625: Cardiometabolic Syndrome and Incident Alzheimer’s Disease: The Predicative Value of Age and CMS Using Cox and Machine Learning Models
Authors: Liu Longjian
Published: November 2024

Background:
Cardiometabolic syndrome (CMS) poses a significant public health concern. The study aimed to investigate the predictive value of age and CMS for incident Alzheimer’s disease (AD) in women aged≥50.

Methods:
A cohort of women aged 50-79 (
n
= 63,117) who participated in the Women’s Health Initiative Observational Study (WHIOS) in 1993-1998, without baseline AD and followed through to March 1, 2019, were analyzed. CMS was defined as having ≥3 of five CMS components: large waist circumference, HBP, elevated triglycerides, elevated glucose, and low HDL-cholesterol. AD was classified by physician-diagnoses of incident AD. Hazards ratios (HR) of AD risk associated with CMS by age were analyzed using Cox’s proportional hazards regression analysis. Machine learning (ML)-XGBoost and Lasso Cox models clustered individuals with low, mild, moderate, and severe risk of incident AD.

Results:
During a median follow-up of 20 years (range: 3.36 to 23.36 years), 8340 developed incident AD. The incident rate (95%CI) of AD was 8.6 (8.1-9.1) per 1000 person-years (PY) in women with CMS, and 7.0 (6.9-7.2) per 1000 PY in those without CMS (p<0.001). Multivariate Cox’s regression analysis indicated that women with CMS versus non-CMS had significantly higher risks of AD in those aged 50-59 [HR (95%CI): 1.37(1.12-1.68)], followed by in those aged 60-69 [1.26 (1.14-1.40)], but nonsignificant in those aged≥70 [1.00 (0.87-1.14)]. Elevated glucose concentration ranked as the top predictor for AD, followed by triglyceride and HBP. Four levels (low to severe) of AD risk were significantly clustered using ML-XGBoost and Lasso Cox models.

Conclusions:
Women aged 50-69 with CMS
vs
those without CMS had significantly higher relative risks of AD, but the risk was not significant in those aged≥70. The application of ML prediction models holds potential promise in the early identification of AD risk among U.S. adults.
Abstract 4147628: A Mixed Methods Analysis of Patient Knowledge in Peripheral Artery Disease
Authors: Reilly Margaret , Alagna Megan , Iroz Cassandra , Ho Emily , Hoel Andrew , Vavra Ashley , Lundberg Alexander , Ho Karen
Published: November 2024

Introduction:
Patient knowledge of lower extremity peripheral artery disease (PAD) is low compared to other cardiovascular diseases.

Research Questions/Hypothesis:
We hypothesize that demographic and socioeconomic factors impact patient knowledge of PAD.

Goals/Aims:
To obtain qualitative description of and identify factors associated with patient knowledge of PAD.

Methods/Approach:
We performed a convergent parallel mixed methods study of participants with an established PAD diagnosis. Participants completed an 87-item survey assessing demographics, awareness of PAD diagnosis, and PAD knowledge. Functional health literacy (FHL) was measured using the short Test of Functional Health Literacy Assessment. Multivariable linear regression was used to identify factors associated with PAD knowledge scores. Semi-structured interviews were used to describe understanding of PAD. Transcripts were analyzed with inductive and deductive coding, and a constant comparative approach was used to identify themes.

Results/Data:
There were 91 participants (77.2% response rate, 49.5% female, 29.7% Black, mean age 68.6 years). Most participants (51.7%) had chronic limb-threatening ischemia and 17.6% had a previous major amputation. While 21.3% had poor FHL and 24.4% were unaware of their PAD diagnosis, the average knowledge score was 79.1%. On bivariate analysis, non-White race, non-ambulatory status, poor FHL, lack of awareness of PAD diagnosis, and not knowing the chronicity of diagnosis were inversely associated with knowledge score. Multivariate linear regression showed that poor FHL, non-White race, and not knowing the chronicity of PAD diagnosis were independently associated with low PAD knowledge. Qualitative analysis of 22 participants revealed that patients have difficulty understanding the name “PAD”, confuse PAD with other comorbidities, and have incorrect beliefs about PAD despite high knowledge scores.

Conclusions:
Knowledge of PAD is associated with health literacy. However, patients have incorrect beliefs and difficulty understanding the terminology associated with PAD despite a high average knowledge score. Knowledge scores may not adequately reflect understanding. Future research will focus on optimizing patient education, identifying strategies to appropriately gauge patient understanding, and understanding the association between knowledge and behavior in PAD.
Abstract 4147633: Structural and Electrophysiological Cardiac Changes in Children with Osteogenesis Imperfecta (OI)
Authors: Sardesai Krish , Dayal Anuhya , Srivastava Tarak , Harrison Christopher , Lee Brian
Published: November 2024

Introduction:
Osteogenesis imperfecta (OI) is an inherited type 1 collagen disorder leading to bone fragility and increased fractures. Cardiovascular disease is the leading cause of death of adults with OI, but studies on cardiac changes from this collagen defect in children are sparse. We aim to fill this gap by assessing changes in EKG and echocardiogram (ECHO) variables in children with OI.

Hypothesis:
Children with OI will exhibit arrhythmogenic EKG changes and/or ECHO abnormalities which will precede changes that are documented in adults.

Methods:
53 children with OI receiving care at Children’s Mercy-Kansas City were identified via ICD-10 codes. 64 with Duchenne Muscular Dystrophy (DMD, expected cardiac abnormalities) and 55 with non-accidental trauma (NAT, no expected cardiac abnormalities) served as controls. We specifically compared the most recent EKG and ECHO metrics extracted from medical charts by Kruskal-Wallis testing.

Results:
EKG: Children with OI differed from both NAT and DMD. OI had shorter median PR intervals (p<0.001) plus longer median QRS (p<0.001) and QTc intervals (p=0.002) than NAT. DMD had the shortest PR and longest QRS and QTc (see Table).

Echo:
The three groups showed no difference in systolic/diastolic BP or LV thickness. However, OI differed from NAT and/or DMD in other metrics. OI had higher end diastolic volume (p<0.001), end systolic volume (p<0.001) and stroke volume (p<0.05) than NAT, but lower values than the DMD group. Similarly, OI children had higher LV mass and LV internal diastolic and systolic diameters than NAT, but lower than DMD (p<0.001). OI LVOT diameter and Aortic root diameter were lower than NAT, but not as low as DMD (p<0.05 and p<0.001, respectively).

Conclusion:
Children with OI exhibit EKG and ECHO abnormalities that are similar to but less severe than for DMD, a group in which cardiovascular abnormalities are well documented. These abnormalities may be predictive of arrythmia/sudden cardiac death and/or functional decline in heart function. Our data suggest that OI children could benefit from ongoing routine cardiology studies along with orthopedic/metabolic management. Future studies would assess effects of age and OI treatments on cardiac abnormalities.
Abstract 4147644: Regional Distribution and Overlap of Left Atrial Epicardial Adipose Tissue and Fibrosis
Authors: Kassar Ahmad , Telle Aashild , Chahine Yaacoub , Chamoun Nadia , Boyle Patrick , Akoum Nazem
Published: November 2024

Background:
Left atrial epicardial adipose tissue (LA-EAT) and fibrosis are implicated in the pathophysiology of the atrial fibrillation (AF) substrate.

Hypothesis:
The distribution of fibrosis and LA-EAT differs across various regions of the LA.

Aims:
Ascertain whether high fibrosis regions coincide with high EAT regions.

Identify specific anatomical regions in which LA-EAT and fibrosis tend to co-localize.

Methods:
LA-EAT was imaged using MRI Dixon sequences and images were segmented axially using the software contouring tools. LGE-MRI was used for LA fibrosis quantification and segmentation. The regions of fibrosis and fat were then co-registered with the atrial geometry and projected onto the left atrial shell. A universal atrial coordinates (UAC) approach was then used to systematically delineate anatomical LA regions in a manner independent of inter-individual variabilities in scale and shape. Specifically, the LA was divided into 10 regions (left and right versions of: posterior-inferior, posterior-superior, roof, anterior-superior, and anterior-inferior). Levene’s test and ANOVA were used to check for any statistically significant variability.

Results:
Nineteen patients were recruited (94% male; median age 72[62-74]; BMI 32.1±6.3; LA volume index 71.0±21.5mL/m
2
).LA fibrosis was highest in the left posterior superior segment, right anterior inferior, and left posterior inferior (39.3±16.2%,34.7±26.8%, and 25.7±20.9% respectively;F=1.9,p=0.15). LA-EAT was most prominent in the right anterior superior, left posterior inferior, and left anterior inferior segments (38.1±25.3%,35.6±18.4%,and 33.1±18.9% respectively; F=0.94, p= 0.39). Spatial co-localization of fat and fibrosis was highest in the left posterior inferior region (8.95±2.1%), followed by the left posterior superior, right anterior superior, and left anterior inferior region (7.9±2.1%,7.2±1.7%,and 6.3±1.6% respectively; F= 0.29, p=0.83 ).

Conclusion:
LA fibrosis and EAT have differing regional preponderances, impacting the AF substrate through infiltrative and paracrine effects. This fibro-fatty remodeling creates structural and conduction abnormalities, forming stable reentrant circuits and perpetuating AF by providing varied pathways and refractory periods.
Abstract 4148070: Clonal Hematopoeisis of Indeterminate Potential and Risk of Autopsy-defined Sudden Cardiac Death
Authors: Devine W. Patrick , Kinkead Brielle , Nakasuka Kosuke , Bick Alexander , Yee Matthew , Eik David , Moffatt Ellen , Tseng, MD Zian
Published: November 2024

Introduction:
Clonal hematopoiesis of indeterminate potential (CHIP) has been associated with an increased risk of coronary artery disease (CAD) and cardiovascular (CV) mortality. Whether CHIP may affect myocardium beyond promoting CAD, or its potential association with sudden cardiac death (SCD), the most feared manifestation of CV disease, is unknown.

Research Questions/Hypothesis:
We hypothesize that CHIP-mutant macrophages infiltrate the myocardium and are associated with autopsy-defined arrhythmic death.

Goals/Aims:
(1) determine rate of CHIP at time of death in an unselected, countywide study of all incident sudden deaths; (2) evaluate whether CHIP-mutant macrophages infiltrate into myocardium; and (3) evaluate potential association of CHIP with autopsy-confirmed arrhythmic causes among countywide sudden deaths

Methods/Approach:
We used autopsy to adjudicate arrhythmic from non-arrhythmic (PE, stroke, overdose, tamponade) causes in 1,148 sudden deaths and 141 trauma control deaths in San Francisco County from 2011-23. DNA was extracted from frozen blood samples collected at time of death from 399 consented cases. Sequencing of 22 CHIP-associated genes was performed to ~2000x mean target coverage. All pathogenic/likely pathogenic CHIP variants at >2% variant allele frequency (VAF) were considered CHIP+. DNA was then isolated from left ventricular (LV) tissue sampled at autopsy in all CHIP+ blood cases and sequenced as above.

Results:
Of 399 consented cases, 70 blood samples (17.5%) were CHIP+ (range 2%-39.6%; mean age 70.6 years vs. 58.1 years for CHIP-). The most frequent mutant genes were DNMT3A, TET2, and ASXL1. Proportion of arrhythmic causes among sudden deaths was similar for CHIP+ vs. CHIP- cases (36 of 70 [52%] vs. 171 of 329 [51%]). Sequencing of available LV tissue from 61 CHIP+ blood cases revealed 67% (n=41) harbored the same CHIP mutation identified in blood at >0.2% VAF (range 0.2%-4.3%). Proportion of arrhythmic causes among sudden deaths was significantly higher in cases where both blood and LV were CHIP+ (24 of 41 [58.5%] vs. 5 of 19 [26.3%] CHIP+ blood/CHIP- LV, p=0.02).

Conclusions:
Prevalence of CHIP positivity at sudden death is similar to published studies and correlated with age. CHIP+ status in myocardial tissue but not peripheral blood was associated with arrhythmic causes of sudden death, suggesting a direct tissue effect of CHIP-mutant macrophages.
Abstract 4148077: Heart Failure Mortality Between 1990 and 2020 by US State and Racial and Ethnic Group
Authors: Fleszar Laura , Dorsey Henry , Johnson Catherine , Roth Gregory
Published: November 2024

Introduction:
Heart failure (HF) mortality rates in the US appear to have increased in the past decade. It is unknown how these have changed in recent years by racial and ethnic groups within states.

Research Question:
To understand disparities in HF mortality patterns between 1990 and 2020

Aim:
To estimate the change in HF mortality rates between 1990 and 2020 for Hispanic, non-Hispanic Black, and non-Hispanic White males and females in each US state

Methods:
We used multiple cause of death records from the National Vital Statistics System and population data from the National Center for Health Statistics to estimate HF mortality from 1990 to 2020 by state, age group, sex, and racial and ethnic group. A binomial model was fit to the data using RegMod, a Bayesian extension of a generalized linear model which incorporated priors from a hierarchy and modeled year as a spline.

Results:
In 2020, we estimated 566230 (95% UI 566160 to 569740) deaths due to HF. Between 1990 and 2010, HF rates declined in general for all racial and ethnic groups across the US, but not consistently for all states (Figure). From 2010 to 2020, this trend reversed, with age-standardized mortality from HF increasing over this time period, but again this change was not consistent across states. Among the Hispanic population, mortality increased for all states except for Maine, with the largest change for both sexes in Oklahoma. For the non-Hispanic, Black group, mortality increased among all states, with the largest change for both sexes in Oklahoma and South Dakota. Among the non-Hispanic, White populations, mortality decreased for both sexes in District of Columbia, while the largest increases were in Oklahoma.

Conclusion:
Heart failure mortality increased in the past decade, with striking increases in specific locations by race and ethnic group. Identifying etiologies and drivers of increased HF deaths, including the role of new therapies for subsets of systolic function, could help target novel therapies to subpopulations at highest risk. Differences in trends by state and race and ethnicity groups provides important information for clinicians and policymakers interested in reducing mortality rates.
Abstract 4148083: Mechanism of Acute Mitral Regurgitation in Patients with Acute Coronary Syndrome As A Predictor Of Mortality
Authors: Neri Bale Raul Rodrigo , Amaro Palomo Eder Jonathan , Gonzalez Macedo Eder , Latapi Ruiz Esparza Ximena , Arias-Escarpulli Romeo , Garcia Villarejo Mariana , Santiago Hernández Alberto , Araiza Diego , Gopar-Nieto Rodrigo , Arias-Mendoza Alexandra
Published: November 2024

Introduction:
Mechanical complications after acute myocardial infarction (MI) have decreased in the context of readily available pPCI and other reperfusion therapies, however, many patients still cannot achieve adequate reperfusion status. Acute Mitral Regurgitation (AMR) is associated with worse clinical outcomes, and can be classified according to three main mechanisms; papillary muscle ischemia, papillary muscle rupture and left ventricular remodeling.

Data regarding AMR an association between disease mechanism and mortality is lacking.

Objective:
To assess the association between AMR mechanism and mortality

Methods:
We performed a retrospective cohort study and included patients who visited the ED in a Mexican National Institute due to ACS who also presented AMR from February 2006 through to October 2023.

A univariate Cox regression model was performed and adjusted by age and sex, and the only Killip-Kimball class (K-K) and Type of ACS at admission showed significance, which both persisted in individual adjusted multivariate analyses. A survival analysis with Kaplan-Meier curve was done.

Results:
We included 161 patients in the analysis. The frequency per AMR mechanism was 98 (60.4%) for ischemia of papillary muscle, 33 (20.3%) for papillary muscle rupture, and 30 (19.3%) for left ventricular remodeling.

The multivariate Cox regression models were done by subgroup analysis, by each different type of AMR mechanism. Ischemia of Papillary Muscle showed a significantly increased risk for mortality when analyzed by K-K (HR 1.48, 95% CI 1.01-2.17, p=0.045), but showed a decreased risk by ACS type (HR 0.39, 95% CI 0.18-0.82, p=0.014). Papillary Muscle Rupture was associated with increased risk for mortality in the model with K-K (HR 1.8, 95% CI 0.95-3.38, p=0.067) but not by ACS type. Left Ventricular Remodelling was not significantly associated with an increased risk in any model.

Conclusions:
In patients presenting AMR and ACS, there was an increased risk of mortality in the subgroup of patients with ischemic mitral regurgitation.
Abstract 4148085: Transfer to ‘Hub’ Hospitals and Outcomes in Cardiogenic Shock
Authors: Pawar Shubhadarshini , Bansal Kannu , Ton Van-Khue , Kanwar Manreet , Abbott Jinnette , Kapur Navin , Vallabhajosyula Saraschandra
Published: November 2024

Introduction:
Patients with cardiogenic shock (CS) have high mortality. Many CS patients present to non-tertiary care centers. Limited data exist on outcomes for patients transferred to “hub” CS centers for both acute myocardial infarction (AMI) and non-AMI etiologies. This study sought to compare the characteristics and outcomes of transferred CS patients compared to patients presenting to a hub center.

Methodology:
Adults (≥18 years) with a primary or secondary diagnosis of CS were identified from the National Readmissions Database (2016-2020) and stratified by transfer status. Overlap propensity score (PS) weighting was performed to assess the association between in-hospital mortality, length of stay (LOS) and transfer status.

Results:
Of 314,098 CS patients (AMICS 27%, non-AMICS 73%), 30,630 (9.8%) were transferred. Compared to non-transferred patients, transferred patients were on average younger (65 [interquartile range {IQR} 55-73] vs. 68 [IQR 58-77] years), more likely to be female (34% vs. 37%), less frequently with Medicare as primary payor (55% vs. 62%), and with higher comorbidity (Elixhauser index 8 [IQR 6-9] vs. 6 [IQR 5-8]) (all
p
<0.001). Transferred patients had higher rates of respiratory failure (70% vs. 64%), renal failure (71% vs. 60%), hepatic failure (25% vs. 17%), bleeding complications (28% vs. 17%), and arrhythmias (59% vs. 52%) (all
p
<0.001). Transferred patients were also more likely to undergo percutaneous coronary intervention (22% vs. 19%), coronary artery bypass grafting (13% vs. 8%), pulmonary artery catheter insertion (36% vs.16%), placement of intra-aortic balloon pump (25% vs.13%), percutaneous left ventricular assist device (13% vs. 7%), and extracorporeal membrane oxygenation (7% vs. 2%), receive invasive mechanical ventilation (3% vs. 2%), and undergo hemodialysis (17% vs. 11%) (all
p
<0.001). In-hospital mortality was significantly lower in transferred patients – 39% vs. 47.1%; unadjusted odds ratio 0.71 (95% confidence interval 0.70-0.73); adjusted PS weighting odds ratio 0.73 (95% confidence interval 0.71-0.76),
p
<0.001. Transferred patients had a longer median LOS (13 [IQR 7-22] vs. 6 [IQR 3-11] days,
p
<0.001).

Conclusion:
Transferred CS patients had higher use of cardiovascular procedures and organ support therapies and lower in-hospital mortality suggesting patients were appropriately selected for transfer.
Abstract Su801: Use of Large Language Models to Optimize Clinical Text Analysis for In-Hospital Cardiac Arrest Identification
Authors: Kaviyarasu Aarthi , Vurgun Ugurcan , Hwang Sy , Acevedo Ana , Abella Benjamin , Mowery Danielle , Mitchell Oscar
Published: November 2024

Introduction/Background:
In-hospital cardiac arrest (IHCA) is experienced by approximately 300,000 patients annually in the US. While individual care teams can readily identify IHCA at the bedside, the reporting of these events after the event often lacks consistency and poses a major challenge for hospitals across the US. Accurate and timely reporting of IHCA events is crucial for facilitating QI initiatives, such as CPR quality review, optimizing team performance, and benchmarking IHCA outcomes.

Hypothesis:
Large language models (LLMs) can be used to identify IHCA events at the patient encounter-level by analyzing targeted note types from the inpatient record with high performance.

Methods:
Adult (≥18 years old) inpatient encounters at the Hospital of the University of Pennsylvania from 06/2018 to 03/2022 with a reported clinical emergency were identified from a QI database. Discharge summaries and notes associated with the encounters of interest were extracted from the EHR and deidentified using a natural language processing tool. Notes were reviewed by research staff to ascertain true IHCA events. Positive IHCA was defined as the loss of pulses followed by the delivery of CPR. An LLM, GPT4 v. 32K-Chat, was employed on the Penn Medicine Microsoft Azure Databricks environment to compare zero- and few-shot prompting methods to identify IHCA. Model performance was measured using accuracy, precision, recall and F1 scores.

Results:
Manual chart review determined 96.8% and 3.2% of cases to be IHCA+ and IHCA-, respectively. A balanced pilot dataset of positive and negative cases was created and the accuracy values across strategically sampled note types was checked. Using zero-shot learning with Chain-of-Thought (COT) prompting, the LLM performed with an accuracy of 86%, precision of 77%, recall of 100%, and F1-score of 87%. Using three-shot learning with COT, the LLM performed with an accuracy of 90%, precision of 83%, recall of 100%, and F1-score of 91%.

Conclusions:
This study demonstrates the potential efficacy of leveraging LLMs to automatically classify IHCA from strategically sampled note types using both zero and few-shot learning approaches. In the future, we will implement temporal sampling of note types and refine model parameters such as output token size and temperature. These findings suggest that such technologies can be effective in real-world clinical settings, providing a scalable solution to improve patient outcomes and quality improvement efforts.