bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4139407: Association of Aortic Valve Calcium with Albuminuria: The Multi-Ethnic Study of Atherosclerosis
Authors: Abdollahi Ashkan , Sani Maryam , Shabani Mahsima , Scarpa Bruna , Blaha Michael , Wu Colin , Ambale-Venkatesh Bharath , Budoff Matthew , Strom Jordan , Rotter Jerome , Post Wendy , Blumenthal Roger , Bluemke David , Lima Joao AC , Whelton Seamus
Published: November 2024

Background:
Higher aortic valve calcium (AVC) burden is associated with an increased risk of cardiovascular disease (CVD) and non-CVD. Despite shared risk factors between AVC and chronic kidney disease (CKD), the association of AVC with incident albuminuria is unknown.

Methods:
We examined 5,464 MESA participants who had AVC quantified by cardiac CT at Visit 1 (2000-02), an eGFR of ≥60 mL/min/1.73 m
2
, a normal spot urine albumin to creatinine ratio (ACR) (<30 mg/g at baseline), and at least 1 follow up ACR measurement. AVC was analyzed as a log transformed variable, due to its right skewed distribution, and categorized as 0, 1-99, and ≥100. Incident albuminuria was defined as ACR ≥30 mg/g. We performed multivariable Cox proportional hazard regression along with mixed-effect linear regression models to examine the association of AVC with incidence, and progression of albuminuria per 5 years follow up, respectively. Models adjusted for baseline eGFR, sociodemographic and CVD risk factors, with further adjustment for coronary artery calcium (CAC), lipoprotein (a) (Lp[a]), and the APOE-ε4 genotype.

Results:
At MESA Visit 1, participants had a mean age 61.6±9.9 years, 2894 (53%) were women, and 616 (11%) had AVC > 0. During a median follow up of 14.2 years, 921 (17%) developed albuminuria. There was a significantly increased rate of incident albuminuria with higher AVC values (p < 0.001) (
Figure
). In multivariable adjusted models, a higher risk of incident albuminuria was observed when AVC was examined as a continuous variable (per log-unit [AVC+1]) HR 1.05;
p
= 0.03 and for participants with AVC ≥100 HR 1.43; (
p
= 0.02) compared to AVC=0, but not for participants with AVC 1-99 (HR 1.13;
p
= 0.29). A significant progression in log transformed ACR was observed for AVC as a continuous variable (β 0.03;
p
< 0.001) along with participants who had AVC 1-99 (β 0.13;
p
< 0.001), and AVC ≥100 (β 0.16;
p
= 0.001), compared to AVC=0. The associations between continuous AVC and incident albuminuria remained after further adjusting for CAC score (
p
= 0.04), Lp(a) (
p
= 0.03), and the APOE-ε4 genotype (
p
= 0.04). The signal was consistent for ACR progression after further adjusting for CAC score (
p
< 0.01), Lp (a) (
p
< 0.01), and the APOE-ε4 genotype (
p
< 0.01).

Conclusions:
In a multi-ethnic cohort of participants free of CVD and CKD at baseline, AVC was independently associated with a higher risk of incident albuminuria and progression of ACR.
Abstract 4139432: The Mixing Enigma? Does Interchanging Leads and Generators Still Cause Concern in the MRI? Could this be the Final Device Hurdle for Routine MRI Patients?
Authors: Biederman Robert , WILLIAMS RONALD , Boltralik Mark , Lombardi Richard , Shah Moneal , Doyle Mark
Published: November 2024

Background:
Over the last two decades substantial efforts have been aimed at improving acceptability of pacemakers and ICD's in the MRI scanner. Many labs have evaluated the construction, safety, efficacy, reproducibility and more recently, clinical impact value in such legacy devices. In conjunction, there has been extensive effort by the major vendors to develop safe MRI compatible devices. We believe that there remain few reasons for hesitation in more universal useage of any PM/ICD in the MRI bore. Yet, mixing vendor leads and generators remain a major hurdle considerably limiting contemporary MRI usage in
nearly
all MRI laboratories. Accordingly, we
Hypothesize:
mixed leads and generators have no distinct safety signal from common devices; whether CIED or non-CIED.

Methods:
We undertook a retrospective DB analysis to determine safety signals in those patients possessing mixed vendor leads and devices. Comparisons of impedance, amplitude, threshold and battery voltage and patient safety etc. were performed.

Results:
Patients from 5/2004 to 5/2024, representing 2008 pts with CIED (78%) and non-CIED (22%) underwent an MRI in a dedicated CMR Lab. The majority of the mixed cohort were obtained from the non-CIED cohort (>98%), having no need for generator replacement.

Accordingly, 12% of these underwent MRI to include: 76% neurologic, 7% orthopedic and 17% cardiac indications.

In safety signals comparisons between standard and mixed lead/generator implants, there were no differences in any implant parameters either pre-MRI or post-interrogation (p=NS). Similarly, there were no peri-MRI pt events reported in the 30d, 180d and 365 day post-MRI scan (p=NS). Importantly, especially for EP considerations, there were no added complications to interrogations.

Moreover, utilizing a similar approach to manipulation of MRI parameters for maximum safety intrinsic to dependent/non-dependent PM status was employed regardless of lead/generator configuration yielding no complications.

Conclusions:
Developing a similar approach to MRI scanning in those patients with mixed vendor lead/generator configurations yielded no difference in a multitude of safety, interrogation, devices and efficacy parameters implementing a similar device interrogation/programming strategy as in traditional devices. This reassurance derived from a large MRI lab suggests, despite inherent incompatibility concerns between vendors while in the magnetic field, suggests no such fears are truly warranted.
Abstract 4139440: A 3-Year, Pre-Trial, Real-world Data Analysis of Patients Enrolled in VICTORION-INITIATE: Insights Using Tokenization
Authors: Rodriguez Fatima , Wright R , Ross Elsie , Ali Yousuf , Kumar Biswajit , Han Guangyang , Cai Beilei , Abbas Cheryl , Ryan Amy , cosmatos irene , Desai Nihar
Published: November 2024

Background:
VICTORION-INITIATE (NCT04929249) showed significantly greater LDL-C lowering in patients (pts) with ASCVD with an inclisiran first (IF) strategy (adding inclisiran immediately on failure to achieve LDL-C <70 mg/dL on maximally tolerated statin therapy) vs usual care (UC). Tokenization can be leveraged to link clinical trial data to pt-level real-world data (RWD) to provide a comprehensive overview of the pt journey pre- and post-trial and enhance understanding of clinical trial and long-term pt outcomes.

Aim:
To utilize tokenization and linked RWD to characterize the pt journey pre-VICTORION-INITIATE enrollment.

Methods:
Eligible pts from VICTORION-INITIATE were deidentified and tokenized with unique IDs, allowing linking to RWD (EMR, claims, hospital, and lab records) to follow the pt journey in the 3-year pre-trial and 2-year post-trial periods. Here we present demographics, clinical characteristics, and lipid-lowering therapy (LLT) use of pts with linked pre-trial RWD.

Results:
Of 450 pts randomized, 383 (85.1%) were linked with pre-trial RWD (IF arm, n=193; UC arm, n=190); 26.9% were female, first available recorded mean (SD) age was 64 (9.36) years. Among the 74.2% (n=284) of pts with linked, pre-trial, lipid test RWD, mean (SD) earliest and latest LDL-C values were 100.1 mg/dL (35.70) and 99.3 mg/dL (30.06), respectively, for pts in the IF arm vs 97.3 mg/dL (40.43) and 97.8 mg/dL (27.60) for pts in the UC arm (
Table
). Overall, in the pre-trial period, LLT was dispensed/prescribed to 66.1% of pts, statins to 64.5%, ezetimibe to 4.4%, and PCSK9i to 4.4%. Of pts with ≥1 recorded ASCVD events in the pre-trial period (n=141), 53.2% and 68.8% had available LLT dispensing/prescription records pre- and post-event, respectively.

Conclusions:
In the 3 years pre-VICTORION-INITIATE, mean LDL-C levels were above recommended goals, non-statin LLT prescription was infrequent, and ~31% of pts with ≥1 recorded ASCVD event had no evidence of post-event LLT use, highlighting a need for more aggressive LDL-C management. Full data visibility for each pt is a limitation of this approach. Tokenization post-trial will allow for long-term evaluation of LLT practices.
Abstract 4139454: Patients with Atrial Fibrillation who Maintain Sinus Rhythm post Ablation Demonstrate Improved Left Atrial Blood Flow and Volume
Authors: Dushfunian David , Baraboo Justin , Maroun Anthony , Pradella Maurice , Lee Daniel , Greenland Philip , Passman Rod , Kim Daniel , Markl Michael
Published: November 2024

Introduction:
Atrial Fibrillation (AF) incidence increased by 30% over the past 20 years with 1 of 7 strokes attributed to AF. While catheter ablation (CA) is valuable at decreasing AF burden, its long-term effect on stroke risk is unknown. 4D flow MRI studies of AF patients have found reduced peak velocities and increased blood stasis in the left atrium (LA) and LA appendage (LAA), indicating AF-associated atrial flow impairment and increased thromboembolism risk.

Aim:
To explore, using 4D flow MRI, pre vs post-CA LA and LAA hemodynamics and volumes in patients with and without AF recurrence.

Methods:
We enrolled 60 AF patients who had baseline (pre-CA) and follow-up (post-CA) 4D-flow MRI scans. Success was defined as no recurrent AF > 30 sec on intermittent monitoring after a 3-month blanking period. 4D flow data analysis included pre-processing and LA/LAA manual 3D segmentation. The segmentations were used to calculate LA and LAA volumes as well as peak velocity and blood stasis (Figure 1).

Results:
Of the 60 patients (61.1 ± 12.3 years, 73% male), forty-five maintained SR while 15 had AF recurrence post-CA. One LAA was excluded from the analysis due to the presence of an artifact.

Mean LA stasis significantly decreased for both groups post-CA (success: 46 ± 17% to 41 ± 11% and failure: 40 ± 13% to 37 ± 12%, p <0.05). However, only the success group’s LAA peak velocity (36 ± 0.15 cm/s to 41.5 ± 0.09 cm/s, p <0.05) and LA volume (101 ± 39 ml to 89 ± 28 ml, p <0.05) changed significantly (Figure 2 A-C). Further, the change in LA stasis was strongly correlated (r=0.48, p <0.01) with the change in LA volume only in the success group (Figure 2D).

Conclusions:
Our results reinforce that SR maintenance post-CA is key for improved LA flow and geometry, indicating that reverse remodeling is taking place. The LAA velocity change in those with successful CA may confer reduced thrombotic risk, since thrombus formation is linked to a reduced LAA velocity.
Abstract 4139457: The Efficacy of Sacubitril-Valsartan in Congestive Heart Failure Patients Who Also Have End Stage Renal Disease
Authors: Kazi Usman , AL-Nasseri Abraheim , Mirabella Steven , Nerella Nishant , Pasupuleti Suman
Published: November 2024

Introduction:
The PARADIGM-HF trial demonstrated that angiotensin receptor-neprilysin inhibitor was superior to enalapril in reducing risks of death and hospitalization for heart failure; however, the trial excluded patients with a GFR <30mL/min/1.73m2. This poses limited data when treating patients with concomitant congestive heart failure (CHF) and end-stage renal disease (ESRD). We observe the effects of sacubitril-valsartan on all-cause mortality, acute kidney injury (AKI), ventilation requirements, hyperkalemia, and intensive care unit (ICU) admissions in patients with both CHF and ESRD.

Methods:
We conducted a multicenter retrospective cohort on patients diagnosed with CHF and ESRD (defined as a GFR below <15mL/min/1.73m2) from 01/01/2017 to 06/01/2023 across 16 West Florida hospitals. Patients receiving sacubitril-valsartan were compared to those not taking sacubitril-valsartan. Chi-square and binary logistic regression were used to predict the clinical outcomes of all-cause mortality, AKI, ventilation requirements, hyperkalemia, and ICU admissions between the two groups.

Results:
Among 18,116 patients with CHF and ESRD, 712 (3.9%) were taking sacubitril-valsartan and 17,406 (96.1%) were not taking sacubitril-valsartan. Among those taking sacubitril-valsartan compared to those who were not, similar likelihood was seen in terms of all-cause mortality (OR 1.04, 95% CI 0.74-1.47; p=0.8325), hyperkalemia (OR 0.88, 95% CI 0.73-1.05; p=0.1464), and ICU admissions (OR 0.86, 95% CI 0.73-1.02; p=0.0825). The likelihood of AKI was higher in patients taking sacubitril-valsartan compared to those who were not (OR 1.20, 95% CI 1.02-1.43; p=0.0330). There was a significantly less likelihood of ventilation requirement among those taking sacubitril-valsartan compared to those who were not (OR 0.79, 95% CI 0.67-0.92; p=0.003).

Conclusion:
In patients with concomitant CHF and ESRD, the odds of all-cause mortality, hyperkalemia, and ICU admissions were similar among patients taking sacubitril-valsartan compared to those who were not. Patients taking sacubitril-valsartan were less likely to require ventilation but more likely to develop AKI. Although these patients are more likely to develop AKI, this does not significantly impact mortality rate. This study highlights outcomes excluded in the PARADIGM-HF trial.
Abstract 4139509: Effect Of A Comprehensive Personalized Behavioral Intervention On Cardiovascular Event-free Survival And All-Cause Event-free Survival In Veterans With Diabetic Neuropathy - The PATRIOT Randomized Clinical Trial
Authors: Natarajan Sundar , Nicholson Andrew , Illenberger Nicholas , Kumar Preethi , Khamcha Magar Yunika , Haley Leah , Stroupe Kevin , Bigdeli Tim , Sharath Sherene , Kougias Panagiotis
Published: November 2024

Background:
The PATRIOT trial (2015-2021) tested a personalized behavioral intervention (PBI) to prevent diabetic foot lesions by targeting general and foot-specific diabetes care. From the hospitalizations and deaths in the trial, we evaluated if time to cardiovascular events (CVE) or all-cause events (ACE) differed between PBI and current best practice (CBP).

Methods:
Adults with diabetic neuropathy were recruited from two urban Veterans Affairs hospitals and randomly assigned in parallel to PBI or CBP. The PBI included monthly phone calls targeting general diabetes care (medication adherence, physical activity, diet) and foot-specific care. CBP calls focused on non-cardiovascular and non-diabetes care. Participants were followed for 1.5 years post randomization. Hospitalizations and deaths were assessed from medical record review and participant/family report. After examining if CVEs and ACEs differed between arms by logistic regression, we tested if time to CVEs or ACEs differed by arm, using Kaplan-Meier curves and Cox models. Further, to account for repeat events while evaluating PBI, we used negative binomial regression. We report all model estimates with 95% confidence intervals (CI).

Results:
We randomized 406 participants (203 per arm). Mean (SD) age was 67.8 (8.4) years in PBI and 68.0 (8.8) years in CBP. Both arms were similar in race, education, social support, and cardiovascular risk factors (all
P
> .05). There were 151 hospitalizations and 4 deaths. In total, 92 participants had at least one event and 31 had multiple events. The mean (variance) of ACEs was 0.37 (0.78). Most events (44) were CVEs (18 ischemic, 13 arrhythmic, 8 heart failure, and 5 vascular). The odds ratio for CVE in PBI vs. CBP was 0.29 (CI: 0.11, 0.67). There was longer time to CVE for PBI compared to CBP with the 1.5-year cumulative probability of CVE-free survival being 0.95 in PBI and 0.84 in CBP (log-rank
P
< 0.01). Controlling for age and race, the hazard ratio for CVE comparing PBI to CBP was 0.30 (CI: 0.13, 0.67). Incorporating repeat CVEs, the rate ratio comparing PBI to CBP was 0.30 (CI: 0.13, 0.67). For ACE, PBI was superior to CBP, consistent with all the CVE analyses.

Conclusions:
The PBI led to greater CVE-free and ACE-free survival. Such comprehensive interventions that target a specific outcome also holds promise for preventing other serious outcomes, probably through raised health consciousness and more healthful behaviors.

Registration:
NCT02356757
Abstract 4139537: An Emerging Epidemic: Obesity Related High Output Heart Failure
Authors: Singh Pooja , Wondmagegn Admasu , Lam Phillip
Published: November 2024

Introduction:
High output heart failure (HOHF) can be attributed to a wide array of diseases such as severe anemia, hyperthyroidism, arteriovenous fistulas, cirrhosis, chronic lung disease, and morbid obesity. Amongst the causes, obesity is the most common, accounting for 31% of those diagnosed with HOHF; however, there is limited data regarding this topic despite the increasing prevalence of obesity worldwide. We recount a unique case of HOHF in a young woman.

Case Description:
A 22-year-old woman with a history of class 3 obesity (body mass index 60.1 kg/m2) presented with shortness of breath for 3 weeks and new bilateral lower extremity edema. She was found to have newly reduced left ventricular function of 10-15% with severe dilation of the left ventricle and global hypokinesis. Her cardiac catheterization showed insignificant coronary artery disease. However, hemodynamics showed elevated filling pressures, a cardiac index of 4.6 L/min/m2 and output of 11.9 L/min, both measured by thermodilution; establishing a diagnosis of high output heart failure. The patient’s right ventricular biopsy returned and showed chronic cardiomyopathy, demonstrated by hypertrophied myocytes. Other etiologies of HOHF were ruled out with further workup, including arteriovenous shunting, thyroid disease, liver disease, and pulmonary pathologies. The etiology of her HOHF was ultimately attributed to severe obesity. After diuresis, the patient was discharged on guideline directed medical therapy, which included sacubitril-valsartan, metoprolol succinate, spironolactone, and empagliflozin. She was set to follow up with advanced heart failure and bariatric surgery.

Conclusion:
HOHF is due to unmet demands by the body, by increased oxygen consumption or by decrease systemic vascular resistance. The pathophysiology for HOHF due to obesity is not entirely understood, however there are several working hypotheses. The pathophysiology stems from obesity causing increased leptin, neprilysin, and decreased adiponectin; increased vasoactive adipokines increasing increased vasodilation; insulin resistance causing cardiac remodeling seen as impaired diastology with low ejection fractions. Treatment of HOHF due to morbid obesity is with bariatric surgery and lifestyle changes. However, given the role of active adipokines in this disease, future studies can aim to investigate intervening at this level to prevent severe consequences, as seen in our patient.
Abstract 4139549: Air Filtration-Associated Changes in Cardiometabolic Protein Markers: Exploratory Analysis within a Randomized Controlled Trial
Authors: Long Clarine , Schlamp Maria Florencia , Gordon Terry , Thorpe Lorna , Newman Jonathan , Wittkopp Sharine
Published: November 2024

Background:
Fine particulate matter air pollution (PM
2.5
) exposure is linked with increased risk of cardiovascular disease (CVD) events, increases in blood pressure and inflammation. By decreasing PM
2.5
concentrations, portable air cleaners (PACs) reduce PM
2.5
exposure and may mitigate inflammatory responses to exposure. We hypothesized that PAC use is associated with changes in serum concentrations of protein biomarkers associated with CVD risk.

Aim: We aimed to quantify changes in protein biomarkers after 4 weeks of PAC use to provide insights into the proteomic response to reduced PM
2.5
.

Methods:
We performed a randomized, double-blind, sham-controlled trial of PACs in 44 outpatient adults with stable HTN and no known CVD. Participants were randomly assigned to either the true PAC group or the sham PAC (placebo) group. Serum concentrations of 369 protein biomarkers associated with CVD risk were measured using the Olink Cardiometabolic Explore I panel before and after 4 weeks of PAC use. The associations between PAC use and changes in protein concentrations were analyzed using linear mixed-effects models, adjusting for age, sex and BMI.

Results:
Median (IQR) age of participants was 57.5 (51-68) years, 29 (66%) were female, and 21 (48%) had BMI > 30. The changes in expression of 7 protein biomarkers after air filtration differed significantly comparing true versus sham: SSC5D, F7, GH1, LEPR, TFPI, COL4A1, THPO (all p-values < 0.05 for interaction term). SSC5D and THPO were downregulated while the remainder were upregulated. PAC use may have beneficial effects on pathways associated with blood coagulation (increased F7 and TFPI, decreased THPO) and healing (increased LEPR, COL4A1, GH1) and innate immune response (decreased SSC5D). Though most of these have not been directly studied in relation to PM
2.5
, F7 has been shown to decrease with increased air pollution, concordant with our results.

Conclusions:
We showed significant effects of air filtration on serum concentrations of seven protein biomarkers linked with CVD. These results provide insight into potential mechanisms by which PAC use may reduce CVD risk.
Abstract 4139567: Relationship between Cardiac Implantable Electronic Devices and Tricuspid Regurgitation in the General Population
Authors: Bowman Hilary , Tang Janet , Thein Anna-Sophie , Dewland Thomas , Marcus Gregory
Published: November 2024

Introduction:
Case series suggest that cardiac implantable electronic devices (CIEDs) with right ventricular leads may tether the tricuspid valve, leading to clinically relevant tricuspid regurgitation (TR). However, the impact of these devices on tricuspid disease in the general population has not been investigated.

Methods:
Using California’s Department of Health Care Access and Information databases, a longitudinal Cox proportional-hazards analysis of adults who received care in an emergency department, hospital, or outpatient surgery facility from 1 January 2005 to 31 December 2020 was performed. Patients with prevalent TR, rheumatic or congenital heart disease, and endocarditis were excluded. Outcomes were (1) the development of TR and (2) tricuspid intervention.

Results:
Of 16,893,314 participants contributing 56,095,327 person years, there were 11,234 instances of TR. In the unadjusted analyses, CIED implantation was associated with a 13-fold higher risk of incident TR. After adjusting for age, sex, race and ethnicity, income, heart failure, atrial fibrillation, hypertension, pulmonary hypertension, coronary artery disease, chronic kidney disease, hyperlipidemia, diabetes mellitus, chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, alcohol use, cocaine use, methamphetamine use, opiate use, and tobacco use, patients with a CIED exhibited a 15% higher risk of TR (
Figure 1
). Heart failure, pulmonary hypertension, hypertension, and atrial fibrillation each exhibited larger magnitudes of risk for TR than having a CIED.

In the same population, 74 tricuspid valve interventions were identified. While a CIED was associated with a subsequent tricuspid intervention with HR 19.43 (p<0.0001) in the unadjusted model, this lost statistical significance after adjusting for the same covariates listed above (HR 1.3, p=0.34).

Conclusions:
Patients with a CIED experienced a higher risk of TR, although the magnitude of the hazard was smaller than other cardiovascular risk factors. While the point estimate favored a higher risk of requiring tricuspid interventions among those with CIEDs, statistical significance was lost after multivariable adjustment, likely due to a small number of outcomes.
Abstract 4139591: Characterization of cardiac allograft vasculopathy on serial coronary angiography of heart transplant patients
Authors: Huang Brian , Tello Ayala Jose Roberto , Abou-Karam Roukoz , Pomerantsev Eugene , Garasic Joseph , Mastoris Ioannis , Lewis Gregory , Fahed Akl
Published: November 2024

Background:
Cardiac allograft vasculopathy (CAV) continues to be a major source of morbidity and mortality in heart transplant patients. Serial coronary angiography is the recommended modality to monitor for CAV after heart transplant.

Research Question:
We aimed to characterize the incidence and distribution of CAV on coronary angiography in heart transplant patients.

Methods:
In a cohort of 465 patients who had undergone orthotopic heart transplant at a single center, we identified 2451 associated coronary angiograms. Coronary stenosis lesions were extracted to perform CAV grading on each angiogram following the International Society of Heart and Lung Transplantation (ISHLT) grading system. Kaplan-Meier curves were generated for CAV incidence across gender and race. McNemar tests for paired proportions were used to compare involvement of different coronary arteries.

Results:
Among 465 patients (age 53.8±12.6 years, 26.9% female, 75.9% white), the mean±SD follow-up time was 5.8±4.5 years, with 2451 associated coronary angiograms (5.3±4.2 angiograms per patient). Over the follow-up period, 156 (33.5%) patients experienced CAV with an average time after transplant for CAV diagnosis of 4.2±3.5 years. CAV incidence ranged from 9.0% at the first angiogram at around one year from the transplant date, to 24.5% at the 5th angiogram at around 5 years from the transplant date. Of those diagnosed with CAV, 12 (7.7%) underwent PCI at time of initial diagnosis and 44 (28.2%) underwent PCI during the total follow-up period. At time of diagnosis, 137 (87.8%) patients had ISHLT Grade I, 14 (9.0%) patients had Grade II, and 5 (3.2%) had Grade III CAV. There were significant differences in vessel involvement with CAV at time of diagnosis – 3.8% presented with left main (LM), 66.0% with left anterior descending (LAD), 27.6% with left circumflex (LCx), and 39.1% with right coronary artery (RCA) involvement, including the branches of each. There was markedly more main vessel (88.4%) compared to branch vessel (26.3%) CAV reported, likely due to limitations of coronary angiography in visualizing small vessel CAV. CAV incidence and severity was not significantly different across sex or race.

Conclusions:
Within a large transplant patient cohort, CAV incidence was high and mostly reported in main vessels with the LAD being the most involved. Further work could be done to optimize earlier and more effective detection of CAV.
Abstract 4139628: Postoperative Risk Stratification For Complex Congenital Heart Disease Based On Age-adjusted NT-proBNP
Authors: Shen Huayan , Zhou Zhou
Published: November 2024

Background:
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is extensively utilized in the prognosis of cardiovascular disease for adults, but its clinical significance for pediatric cardiology is poorly understood.

Objectives:
This study aimed to explore the prognostic value of age-adjusted NT-proBNP (zlog-proBNP) in pediatric patients with CCHD.

Methods:
This retrospective study included 2681 patients with CCHD (median age at surgery, 10.6 months; male, 59%), and the median follow-up time was 3.0 years (range, 1 day–6.2 years). The primary endpoint was death, and the composite events were death and unplanned cardiac reintervention. NT-proBNP level was measured within 24 h after surgery and transformed into zlog-proBNP.

Results:
NT-proBNP level increased to a median absolute value of 3970 (interquartile range [IQR], 1352–9095), and a median zlog-proBNP value of 3.83 (IQR, 2.93–4.44) on postoperative day 1, reaching its peak at approximately 12h. Compared with patients with low zlog-proBNP value (≤1.96), those with very high zlog-proBNP value (>5; hazard ratio [HR] for death, 9.78 [3.17-30.22,
p
<0.001]; HR for composite events, 3.64 [1.95-6.79,
p
<0.001]) had higher risk of death and composite events, followed by patients with high (>3.8 to ≤5; HR for death, 5.27 [1.79-15.53,
p
=0.003]; HR for composite events, 2.28 [1.29-4.03,
p
=0.004]) and moderate (>1.96 to ≤3.8; HR for death, 3.83 [1.31-11.17,
p
=0.014]; HR for composite events, 1.53 [0.87-2.69,
p
=0.139]) zlog-proBNP values.

Conclusions:
Zlog-proBNP demonstrates substantial prognostic significance in patients with CCHD, warranting particular clinical attention in those with a zlog-proBNP value >5.
Abstract 4139644: Unraveling the Impact of Giant Cell Myocarditis in Cardiogenic Shock: A Comprehensive Analysis of Incidence, Mortality, and Hospitalization Costs from the National Inpatient Sample (2016-2020)
Authors: Siraw Bekure , Nguyen Hong Thoai , Paudel Hemraj , Yasmeen Juveriya , Hussein Khalid , Bastola Satish , Somarouthu Kirthi , Medina-Inojosa Jose , Hussein Mohammed
Published: November 2024

Background:
Giant Cell Myocarditis (GCM), a rare and aggressive inflammatory heart disease characterized by infiltration of the myocardium by multinucleated giant cells and extensive inflammation, represents a clinical conundrum, particularly in patients with cardiogenic shock (CS). Despite its rarity, GCM's devastating impact necessitates thorough investigation. To address this gap, our study harnesses comprehensive data from the National Inpatient Sample (NIS), aiming to unravel the incidence and mortality patterns of GCM in the context of CS.

Methods:
Utilizing data from the NIS spanning from 2016 to 2020, we identified admissions for CS. Diagnosis of GCM was defined with an ICD-10 CM code of I40.1 in patients who have had endomyocardial biopsy (captured using ICD-10 PCS codes of 02BK0ZX, 02BK3ZX, 02BK4ZX, 02BL0ZX, 02BL3ZX, 02BL4ZX, and 02BL4ZZ) during the index hospitalization. Survey weights were used to compute national estimates. Sociodemographic variables, medical comorbidities, procedures performed during the hospitalization, and outcomes of index hospitalizations were coded using corresponding ICD-10 codes. Descriptive statistics were used to summarize the study population.

Results:
Between 2016 and 2020, there were 114 admissions for GCM in the context of CS. The five-year incidence of GCM among CS admissions was 0.015%. The cohort's mean age was 48.4 years (SD 15.7), with males comprising 58.8% of the population. Racial and Ethnic composition included 69% Whites, 10% Blacks, and 8% Hispanics. Notably, 95.6% of these admissions occurred in urban teaching hospitals. Pulmonary artery catheterization for hemodynamic monitoring was employed in 23.7% of the cases. Temporary mechanical circulatory support devices were utilized in 56.1% of the admissions, including intra-aortic balloon pump in 28.9%, percutaneous ventricular assist devices in 8.8%, and extracorporeal membrane oxygenation in 21.9% of cases. Additionally, 36.9% of the patients required mechanical ventilation, and 34.8% underwent heart transplantation. The overall mortality rate was 23.7%. The median length of hospital stay was 24.6 days (IQR 16.5), and the median hospitalization cost was $955,128 (IQR $794,708).

Conclusion:
GCM complicating CS poses a formidable challenge with high mortality rates, length of stay, and cost of hospitalization despite intensive care interventions, emphasizing the urgency for advanced treatment modalities and tailored management approaches.
Abstract 4139646: Disparities in Palliative Care Utilization Among Patients With Heart Failure and LVAD implantation: A Nationwide Comparative Analysis
Authors: Haddad Enad , Nugooru Sudeep , Shah Shreeja , Sevella Prerana , Ginnaram Shravya , Samara Kamel , Janga Sai Shilpitha , Watson Robert
Published: November 2024

Background:
Heart failure (HF) affects 6.7 million Americans and causes 500,000 deaths annually. Despite advancements in treatment, the 1-year mortality in advanced HF is 25-50%. Implantable left ventricular assist devices (LVAD) are critical for bridge-to-transplant or destination therapy, with 1-year and 2-year survival rates of 80% and 70%, respectively. At least 67% of LVAD patients have palliative care (PC) needs. However, PC involvement rates have been variable. The aim of this study is to measure the utilization of PC focusing on demographic disparities.

Methods:
Data was obtained from the National Inpatient Sample (NIS) 2021 database to identify patients with a principal diagnosis of HF (ICD I50.xx), secondary diagnoses of LVAD placement (Z45.2, Z95.811) and utilization of PC during encounter (Z51.5). Analysis was performed using SPSS statistical software.

Results:
Out of 5,688,355 adult hospitalizations in 2021, 1,048,573 patients were hospitalized with a primary diagnosis of HF. About 7.46% of HF patients received PC. Among these, patients over 75 years old, who constituted 44.4% of the cohort, accounted for 62.6% of PC involvement. PC consultation rates were similar between sexes. White patients made up 67.8% of the HF population but represented 73.6% of PC consultations, while other minority groups had a lower proportion of PC consultations.

LVADs were implanted in 0.09% of HF patients, with 69.5% between 50-74 years old. A significant gender disparity was noted; 76.6% of LVAD recipients were male, and 23.4% female.

PC was only involved in the care of 17.2% of LVAD patients. Age distribution of LVAD patients PC mirrored the overall LVAD cohort. Gender disparity persisted, with 80.4% of LVAD patients receiving PC being male, and 19.6% female. Racial disparities were less pronounced in this group.

Conclusion:
Despite proven benefits of PC involvement on the quality of life, psychological well being, and advanced care planning, specific guidelines in LVAD patients are yet to be established. This study underscores the need for more comprehensive guidelines promoting PC integration in the management of LVAD patients, and highlights demographic disparities in PC utilization among HF and LVAD patients.
Abstract 4139675: Short- and long-term impact of aspirin cessation in older adults: a target trial emulation.
Authors: Zhou Zhen , Webb Katherine , Nelson Mark , Woods Robyn , Ernst Michael , Wolfe Rory
Published: November 2024

Background:
The net benefit of aspirin cessation in older adults remains uncertain. This study aimed to use observational data to emulate a randomized trial of aspirin cessation versus continuation in older adults without cardiovascular disease (CVD).

Methods:
Post-hoc analysis using a target trial emulation framework (
Table 1
) applied to the immediate post-trial period (2017-2021) of a study of low-dose aspirin initiation in 19,114 adults aged 70 years and older (ASPREE; NCT01038583). Participants from Australia and US were included if they were free of CVD at the start of the post-trial intervention period (time zero, T0) and had been taking open-label or randomized aspirin immediately before T0 (
Fig 1A
). The two groups in the target trial were: aspirin cessation (participants who were taking randomized aspirin immediately before T0; assumed to have stopped at T0 as instructed) versus aspirin continuation (participants on open-label aspirin at T0 regardless of their randomized treatment; assumed to have continued at T0). The outcomes after T0 were incident CVD, major adverse cardiovascular events (MACE), all-cause mortality, and major bleeding during 3, 6, and 12 months (short-term), and 48 months (long-term) follow-up. Hazard ratios (HRs) comparing aspirin cessation to continuation were estimated from propensity-score (PS) adjusted Cox proportional-hazards regression models.

Results:
We included 6,103 CVD-free participants (cessation: 5,427, continuation: 676). Participant selection flow chart is presented in
Fig 1B
. Over both short- and long-term follow-up, aspirin cessation versus continuation was not associated with elevated risk of CVD, MACE and all-cause mortality (HRs, at 3 and 48 months respectively were, 1.23 and 0.73 for CVD; 1.11 and 0.84 for MACE; 0.23 and 0.79 for all-cause mortality, p >0.05) but cessation had a reduced risk of incident major bleeding events (HRs at 3 and 48 months, 0.16 and 0.63, p <0.05) (
Fig 1C
). Similar findings were seen for all outcomes at 6 and 12 months, except for a lowered risk of all-cause mortality in the cessation group at 12 months (
Fig 1C
).

Conclusions:
Our findings support the safety of deprescribing prophylactic aspirin used for primary prevention in older adults.
Abstract 4139706: A Systematic Review and Network Meta-Analysis of Metastatic Castrate-Resistant Prostate Cancer Therapy Cardiotoxicity Given Metastatic Hormone-Sensitive Prostate Cancer Treatment History
Authors: Aziz Moez , Molony Donald , Monlezun Dominique , Higgason Noel , Brunckhorst Oliver , Roland Jerry , Owen Christopher , Iacobucci Alexander Samuel , Galan Jacob , Swaby Justin , Deng Brett , Hartshorne Taylor , Desai Shubh , Zhang Allan , Xiao Daniel , Sanchez Darren , Imber Jared , Song Jeffrey , Rivas Alexis , Guhan Maya , Ranganath Shreyas , Jacob Jerril , Ziaolhagh Ali , Ali Abdelrahman , Yusuf Syed , Canfield Steven , Iliescu Cezar
Published: November 2024

Background and Aim:
For metastatic castrate-resistant prostate cancer (mCRPC), the European Association of Urology recommends multiple therapies as first-line. However, these recommendations do not account for additional cardiotoxicity of the therapies for prior stages of the disease, such as the metastatic hormone-sensitive prostate cancer (mHSPC) stage. We seek to adjudicate the cardiotoxicities of first-line mCRPC therapies assuming history of mHSPC treatment based on the five International Cardio-Oncology Society (IC-OS) cardiotoxicity domains: heart failure, myocarditis, vascular toxicity, hypertension, and arrhythmias.

Methods:
Ovid Medline, Elsevier Embase, and the Cochrane Library were searched for randomized clinical trials (RCTs) of mCRPC and mHSPC patients from inception until January 2024. Studies reporting at least one first-line therapy and effect size of at least one cardiotoxicity domain were included. Network meta-analyses with indirect treatment comparison with multivariate multi-level analysis were performed for each cardiotoxicity domain to estimate relative risk (RR) with 95% confidence intervals (CI) for mCRPC and mHSPC therapies. A Bayesian model was then constructed using the mHSPC network as a prior for informing the RRs and 95% CIs of mCRPC first-line therapies.

Results:
Network meta-analyses of mHSPC treatment cardiotoxicity, mCRPC treatment cardiotoxicity assuming no treatment history, and mCRPC treatment cardiotoxicity assuming prior mHSPC treatment are provided in Images 1-2. We did not find any studies assessing myocarditis. For patients with mHSPC treatment history, olaparib (OLA) plus androgen deprivation therapy (ADT) plus abiraterone with prednisone (AA+P) decreased hypertensive risk relative to ADT+AA+P (RR 0.20, 95% CI 0.16-0.26).

Conclusion:
OLA may offer a protective antihypertensive effect when superimposed on ADT+AA+P for mCRPC treatment after prior androgen deprivation from mHSPC therapy.
Abstract 4139730: Impact of Telemedicine on Access to Care for New Patients at an Academic Cardiovascular Center: An Analysis of Distance and Time to Visit
Authors: Tsung Sean , Zeng Yan Bo , Parameswaran Vijaya , Rodriguez Fatima , Hu Yue , Scheinker David , Kalwani Neil
Published: November 2024

Introduction:
Telemedicine allows patients to attend visits from a distance and has been linked to reduced clinic wait times. However, little is known about its impact on catchment area and scheduling efficiency for new patients. We assessed the association of new patient visit (NPV) modality with patient–clinic distance and time to visit (wait time from day of scheduling to day of visit) across patient demographics and pandemic phases.

Methods:
We extracted visit data at an academic cardiovascular center in Northern California from Jan 2017 to Nov 2023. We used linear models with fixed effects for clinician and patient characteristics to assess the association of NPV modality with distance and time to visit.

Results:
There were 8,104 and 3,566 NPVs in the mid-pandemic (Jan 2021–Mar 2022) and post-pandemic (Apr 2023 onwards) periods respectively, conducted by 141 clinicians. The proportion of visits conducted by telemedicine decreased from 58% to 40% from the mid- to post-pandemic periods. During the mid-pandemic period, NPVs conducted by telemedicine were more likely to fall outside the center’s pre-pandemic catchment area (100-mile radius) with an adjusted odds ratio of 1.06 (95% CI 1.03, 1.09). This effect did not change significantly post-pandemic, nor did it vary by sex, race, ethnicity, or public insurance status in either period.

Time to visit for telemedicine NPVs was 8 days shorter (95% CI 2, 14) during the mid-pandemic period, and 20 days shorter post-pandemic (95% CI 10, 29). During the post-pandemic period, those with Medicaid waited 28 fewer days (95% CI 16, 41) and those with Medicare waited 16 fewer days (95% CI 6, 25) when the modality was telemedicine, whereas those with private insurance saw a smaller reduction of 12 days (95% CI 3, 21).

Conclusions:
At this academic cardiovascular center, new patients seen via telemedicine were more likely to reside outside the center’s traditional catchment area and had shorter times to new cardiology visits. These effects persisted throughout and beyond the pandemic. Strategic implementation of telemedicine may allow cardiovascular practices to broaden their reach to new patients.
Abstract 4139743: Alfa-tubulin detyrosination causes mitochondrial dysfunction through suppression of Parkin-mediated mitophagy linking to heart failure with preserved ejection fraction
Authors: Miura Shunsuke , Sekine Toranosuke , Ogawara Ryo , Ichimura Shohei , Yokokawa Tetsuro , Misaka Tomofumi , Oikawa Masayoshi , Kobayashi Atsushi , Yamaki Takayoshi , Nakazato Kazuhiko , Ishida Takafumi , Takeishi Yasuchika
Published: November 2024

Background:
Alfa-tubulin detyrosination is one of the post-translational modifications of tubulin c-terminal tail, observed in failing cardiomyocytes. Tubulin is known to regulate mitochondrial function, however, the effects of detyrosinated α-tubulin on mitochondrial function remains unrevealed.

Methods and Results:
We tested the effects of α-tubulin detyrosination on mitochondrial function with tubulin tyrosine ligase knocked out (TTL KO) H9C2 and Vasohibin 1 overexpressed (VASH1 OE) H9C2 cells, which had high amounts of detyrosinated α-tubulin. Alfa-tubulin detyrosination reduced mitochondrial respiration and mitochondrial membrane potential. Moreover, we found mitophagy, evaluated with Mito-Keima fluorescence and LC3 lipidation, were suppressed in TTL KO and VASH1 OE cells. Mitochondria in detyrosinated α-tubulin increasing cells contained less ubiquitinated proteins, suggesting that α-tubulin detyrosination might inhibit Parkin-mediated mitophagy. Next, we overexpressed VASH1 in the mouse heart with AAV9 to validate the effects of detyrosinated α-tubulin on cardiac function. Cardiomyocyte-restricted overexpression of VASH1 led to heart failure with preserved ejection fraction (HFpEF) evidenced by prolonged isovolumic relaxation time and increased mitral E/E' ratio. Cardiac VASH1 OE mice also displayed a reduction in running distance during exercise exhaustion test. The VASH1 OE heart showed suppressed LC3 lipidation, suggesting decreased mitophagy.

Conclusion:
We demonstrated α-tubulin detyrosination reduces mitochondrial function through the inhibition of mitophagy, leading to HFpEF progression. Our study elucidates that α-tubulin detyrosination may act as a potential target for the novel therapy for HFpEF patients.
Abstract 4139762: Structural and Functional Changes in the Left Atrium Following Arteriovenous Fistula Placement
Authors: Daniel Zachary , Leso John , Musumeci John , Hongalgi Krishnakumar , Torosoff Mikhail
Published: November 2024

Background:
Arteriovenous fistula (AVF) remains the preferred method of vascular access in patients requiring long-term maintenance hemodialysis for end stage renal disease (ESRD). However, the AVF creates an acute left-to-right shunt, with the potential to cause high output heart failure.

RESEARCH QUESTIONS:
In patients with ESRD and AVF placement:

1) What is the effect of AVF on left atrial (LA) anatomy and function in patients with atrial fibrillation/atrial flutter (AF)?

2) What are the longitudinal effects of AVF placement on prevalence of AF?

Methods:
We retrospectively analyzed 179 consecutive ESRD patients who underwent AVF placement from 2008-2022 at a single tertiary academic center. Trans-thoracic or trans-esophageal echocardiograms were compared for each patient pre- and post-AVF placement. The median interval between echocardiograms was 2.3 years.

Results:
AF was noted in 19.0% of patients prior to AVF placement. An additional 11.2% of the overall cohort developed AF during the study period (59% interval increase). Patients with AF were older (p=0.002), had greater body surface area (p=0.037), and were more likely to have a history of diabetes (p=0.01), but otherwise there were no significant differences in baseline comorbidities.

AVF placement was associated with a significant increase in LA maximum volume in the overall cohort (70.0+/-32.2 mL post-AVF from 52.1+/-21.0 mL pre-AVF, p<0.001). In patients with AF, LA maximum volume was significantly larger post-AVF compared to those without AF (79.7+/-28.7 vs 60.8+/-26.8 mL, p=0.004). LA strain was significantly lower in patients with AF pre-AVF (42.8+/-11.7% vs 52.5+/-13.6%, p<0.001) and post-AVF (39.9+/-13.1% vs 49.9+/-14.4%, p<0.001). Incidence of newly reduced left ventricular ejection fraction post-AVF was 13% in patients with AF (7/54) compared to 6.4% (8/125, p=0.146) in those without.

Conclusion:
Patients who undergo AVF placement for ESRD are at significant risk for subsequent development of AF, with adverse hemodynamic consequences. Close monitoring of cardiac rhythm, anatomy, and function is warranted in the post-AVF cohort. Additional studies to examine optimal management of this vulnerable population are needed.
Abstract 4139858: Association Between the Amount of Feedback Received and the Adherence to Recommended Self-monitoring and Lifestyle Goals in a Weight Loss Clinical Trial
Authors: Sereika Susan , Bizhanova Zhadyra , Beatrice Britney , Cheng Jessica , Conroy Molly , Kariuki Jacob , Parmanto Bambang , Burke Lora
Published: November 2024

Introduction:
Self-monitoring (SM) lifestyle behaviors is the cornerstone of behavioral treatment for weight loss, but adherence declines. Mobile health (mHealth) tools can lessen the burden of SM and enable timely feedback (FB) to reinforce SM behaviors.

Hypothesis:
A greater number of FB messages received will be associated with better adherence to diet, physical activity (PA), and weight SM and study-prescribed diet and PA goals.

Aims:
To examine the association between adherence to diet, PA, and weight SM and calorie, fat and PA goals and the amount of FB received for participants assigned to the SM+FB arm in SMARTER, a 12-month mHealth weight loss clinical trial.

Methods:
We randomized 502 participants to either SM+FB or SM alone and asked them to self-monitor diet via the Fitbit app, PA via the Fitbit tracker and weight via a smart scale over 12 months. Participants recorded food intake and tracked PA daily and self-weighed at least weekly. Using SM data uploaded in real-time, the SM+FB group received 3 tailored FB messages daily on their study-designed smartphone app (daily for diet, every other day for PA, weekly for weight). We applied generalized linear mixed-effects modeling to examine the association between the number of FB messages opened and adherence to SM and to study-prescribed goals analyzed as a percentage or meeting the threshold and reported as the unstandardized regression coefficient (b) or odds ratio (OR) with 95% confidence interval (CI) and p-value.

Results:
The SM+FB group (n=251) was 84% white and 80% female with a mean age of 45.0±14.3 years and a mean BMI of 33.7±3.9 kg/m
2
. Over 12 months, the SM+FB group opened a mean 471.3±279.7 FB messages. While adherence to diet, PA, and weight SM and to diet (calorie and fat) and PA (weekly minutes) goals declined nonlinearly (p<.05) over 12 months, the number of FB messages received was positively associated with SM and goal adherence: daily diet SM (OR=2.61, 95%CI=[2.46, 2.76]; p<.001), daily PA SM (OR=3.04, [2.72, 3.40]; p<.001), weekly weight SM (b=2.03, [1.90, 2.16]; p<.001), daily calorie goals (b=2.21, [1.95, 2.47]; p<.001), daily fat goals (square root transformed) (b=0.17, [0.14, 0.19]; p<.001), and weekly PA goals (b=5.22, [3.49, 6.95]; p<.001).

Conclusion:
Providing feedback to participants reduced the decline in adherence to SM and lifestyle change goals; however, additional strategies are needed to enhance long-term engagement with mHealth tools and improve weight loss outcomes.