bluuebunny/crossref_metadata_2025 huggingface dataset:
O bolsonarismo e a necropolítica: uma análise dos discursos de Jair Bolsonaro à luz do ensaio de Achille Mbembe
Authors: Leite Diogo Mendonça
Published: November 2024

O conceito de necropolítica, cunhado pelo pensador Joseph-Achille Mbembe, adquire crescente importância na discussão da violência estatal na contemporaneidade. No Brasil, essa tendência é expressa no debate acerca do bolsonarismo. Este estudo vai na esteira de diversos outros que encontraram sinais de alinhamento entre o governo de Jair Bolsonaro e a necropolítica, buscando agora comparar os discursos (entendidos aqui como pronunciamentos oficiais e extraoficiais gravados e/ou noticiados pela mídia) do político com preceitos centrais do ensaio Necropolítica: Biopoder, soberania, estado de exceção, política da morte, de Mbembe. São encontrados diversos pontos de contato, a saber: a utilização de um inimigo ficcional para criar exceção e emergência, a presença e o emprego do racismo como determinante do valor da vida e o alinhamento ao paradigma da colonização na questão indígena.
Abstract 4135265: When the Beat Drops: A Pilot Project for a Case-Based Resident’s Guide to Cardiovascular Care
Authors: Garber Rebecca , Mishra Satish
Published: November 2024

Residents care for patients with a vast array of cardiovascular (CV) diagnoses in settings ranging from primary care clinic to the cardiac intensive care unit. However, the resources available are mainly intended for advanced cardiology trainees. We created a resident-driven, case-based reference for residents to serve as a companion to traditional CV medicine educational resources.

Methods:
We surveyed residents, fellows, and cardiology attendings to identify topics within CV care for which residents are responsible. We recruited residents from multiple ACGME-accredited Internal Medicine residency programs to write a chapter on each identified topic that would be published on a central website. The chapters included a topic overview with key learning points, a case presentation, review questions, attending pearls, and high-yield articles for further reading. Chapters were reviewed for accuracy and completeness by cardiology fellows, pharmacologists, and attendings. The chapters were sent out to residents weekly via email and through social media platforms. Website analytics were used to track usage and monitor engagement. Each chapter concluded with a brief survey regarding learning gains, comprehension, and if the reader would recommend the resources to others.

Results:
A total of 52 cases were submitted by resident contributors from four residency programs. Topics included management of arrhythmias, structural heart disease, ischemia, cardiogenic shock, and post-procedure complications. Within the first two months of publication, the website was being accessed throughout 30+ states and 6 countries with more than 2,500 views and 1,500 unique visitors. Topics with high traffic included chapters regarding arrhythmias and post-procedural complications. The website was viewed throughout the entire day with no specific time pattern; however, there were significantly more views on days when each chapter was released via email and social media. Preliminary survey results show that residents and other trainees find this resource useful, and many want to get involved and help create more content.

Conclusion:
Our resident-created and cardiologist reviewed website is a unique resource created for residents caring for patients with CV disease. Using email and social media marketing has allowed this resource to be widely accessible to a large global audience. Survey feedback suggests the importance of this resource and need for continued CV resources for trainees.
Abstract 4135281: Bidirectional Associations of Chronic Kidney Disease and Heart Failure are Frequent and Associated with Higher Mortality: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Luo Shengyuan , Zhang Sui , Echouffo Justin , NAMBI VIJAY , Ballantyne Christie , Shah Amil , Minhas Anum , Matsushita Kuni , Grams Morgan , Selvin Elizabeth , Coresh Joe , Ndumele Chiadi
Published: November 2024

Background:
Chronic kidney disease (CKD) and heart failure (HF) are interrelated but the bidirectional associations between the two conditions are not completely understood.

Hypothesis:
Bidirectional associations between CKD and HF are common in ambulatory populations and have implications for survival.

Methods:
We conducted a prospective cohort study of 11595 participants who attended ARIC Visit 4 (1996-98) with data on prevalent CKD and HF status, with follow-up for incident events through 2021. We assessed the prospective association of prevalent CKD (defined as eGFR<60 ml/min per 1.73 m
2
or urine albumin-creatinine ratio of ≥30 mg/g) at Visit 4 with incident HF. We also assessed the association of prevalent HF at Visit 4 with incident CKD through 2019. Analyses accounted for mortality as a competing risk. We cross-categorized CKD and HF at Visit 4 and assessed prospective associations with mortality relative to those with neither condition.

Results:
The mean age in the study population was 63 years, with 56% women; and 23% Black adults. Among 1222 with prevalent CKD, 529 (43%) developed HF; among 433 with prevalent HF, 137 (31%) developed CKD. After multivariable adjustment, prevalent CKD (vs no CKD) was associated with incident HF (HR 1.87; 95% CI, 1.65–2.12;
Figure
). Prevalent HF (vs no HF) was also associated with incident CKD (HR 1.33; 95% CI, 1.09–1.62). The co-occurrence of prevalent CKD and HF was associated with greater mortality risk (HR, 2.07; 95% CI, 1.78–2.42) than prevalent CKD alone (HR, 1.47; 95% CI, 1.37–1.59) or prevalent HF alone (HR, 1.33; 95% CI, 1.18–1.50), when compared with neither condition (
p
interaction
<0.001).

Conclusions:
Bidirectional associations between CKD and HF are common in ambulatory populations. The co-existence of both CKD and HF is associated with higher mortality compared to either alone. There is a need to refine strategies to mitigate risk associated with bidirectional CKD and HF associations.
Abstract 4135318: Comparison of Right Ventricular Function Changes Between Volume Control and Pressure Support Ventilation Modes: A Prospective Study Using S' Prime Values
Authors: Yakkali Shreyas , Agarwal Raksheeth , Kushwaha Ankit , KRISHNAN ANKITA , Anand Dongre Yutika , ADAL BISRAT hUSSIEN , Gulani Perminder
Published: November 2024

Background:
This study assesses changes in right ventricular function by measuring S' values during the transition from volume control-assist control (VC-AC) to pressure support ventilation (PSV). Transitioning from VC-AC to PSV reduces the mean airway pressure (P mean) which causes a decrease in right ventricular afterload and also potentially improves venous return and right ventricular preload. PSV allows spontaneous breathing efforts, possibly increasing cardiac output. Thus, we expect a consistent increase in S' value when changing ventilator modes.

Methods:
This prospective observational study included ICU patients on invasive mechanical ventilation for over 24 hours. The clinical team decided when to switch from VC-AC to PSV. An average of three S' measurements was taken during VC-AC and within 10 minutes of transitioning to PSV. Sedation, vasopressor use, and Richmond Agitation-Sedation Scale scores were consistent throughout the measurements. The study was approved by the Albert Einstein College of Medicine IRB (#2023-15068)

Results:
Seventeen patients were included in the study, with an average age of 61.29 years (SD 11.39). Of these, 6 (35.3%) were female. The mean S' during VC-AC was 12.79 ± 4.52, and upon transitioning to PSV, it was 14.56 ± 3.89 (p-value 0.47). The intra-observer variability for S' was 5.3%. Of the seventeen patients, 5/17 (29%) showed an S' change of less than 5.3% and were deemed to have no significant variation; 7/17 (41%) experienced a significant decrease in S' (15.41% ± 7.29% SD), while the remaining 5/17 (29%) showed a significant increase (19.31 ± 13.23%).

Conclusion:
Our study demonstrates that transitioning from VC-AC to PSV results in variable changes in right ventricular systolic function, as indicated by S' values. Contrary to our expectations of a consistent increase, the interplay between S' values and ventilator mode changes appears to be non-linear, suggesting other factors may influence cardiopulmonary interactions in spontaneously breathing ventilated patients. These findings highlight the complexity of these interactions, underscoring the need for individualized patient management and paving the way for further research with a larger cohort.
Abstract 4135357: Activation of prostaglandin E receptor 4 attenuates pulmonary vascular remodeling and pulmonary hypertension in monocrotaline-exposed rats via non-inflammatory pathway
Authors: Kimuro Keiji , Yoshida Keimei , Izumi Ryo , Imabayashi Misaki , Masaki Kohei , Hosokawa Kazuya , Abe Kohtaro
Published: November 2024

Backgrounds:
The prostacyclin pathway plays a pivotal role in the treatment of pulmonary arterial hypertension (PAH). Meanwhile, there is evidence that the expression of IP, the target of prostacyclin, is scant in PAH patients, whereas the prostaglandin E receptor 4 (EP
4
) remains stable. EP
4
, similar to IP, exerts vasodilative effect via cAMP. In addition, an orally administrable selective EP
4
agonist, KAG-308, has shown to exert anti-inflammatory effect in patients with ulcerative colitis and the mouse with surgically induced osteoarthritis. However, the effect of KAG-308 on pulmonary vasculature of PAH remains unknown.

Hypothesis:
EP4 agonist ameliorates pulmonary vascular remodeling and pulmonary hypertension (PH).

Methods and Results:
We investigated the effects of KAG-308 on hemodynamics and pulmonary vascular remodeling in a monocrotaline (MCT)-exposed rat model of PH. Compared to normal rats, MCT-exposed rats had higher right ventricular systolic pressure (RVSP), total pulmonary vascular resistance index (TPRI) and RV hypertrophy, together with medial wall thickening and increased activation of nuclear factor kappa B (NFkB) and inflammatory cytokines in the lungs on day 21 after MCT injection. Chronic oral administration of KAG-308 (1 mg/kg, twice daily, by gavage, day 0 to 21) lowered RVSP (53.1 ± 9.3 vs 81.0±18.5 mmHg,
p
<0.01), TPRI (112.0 ± 16.6 vs 161.4 ± 37.0 mmHg/mL/min/g,
p
<0.05) and RV hypertrophy (0.47 ± 0.04 vs 0.57±0.10,
p
<0.05). Elastica van Gieson staining showed attenuation of medical wall thickening. Furthermore, KAG-308 significantly reduced NFkB activation and inflammatory cytokines such as
Il6
,
Mcp1
and
Il1b
in the lungs. In addition, chronic KAG-308 administration didn’t alter the level of cAMP in the lung, suggesting that the reduction of TPRI wasn’t the results of vasodilation. Interestingly, in human pulmonary artery smooth muscle cells (PASMCs) stimulated by TNFα 10ng/ml, pretreatment with KAG-308 significantly upregulated mRNA level of
Il6
(5.9±0.1vs 1.0±0.1,
p
<0.05), whereas downregulated
Ki67
(0.4±0.1 vs 1.0±0.2,
p
<0.05), suggesting anti-proliferative effect via non-inflammatory pathway.

Conclusions:
KAG-308 ameliorated pulmonary vascular remodeling and PH in MCT-exposed rat, whereas it didn’t show anti-inflammatory effect but anti-proliferative effect in human PASMCs. Although EP
4
agonist KAG-308 could be a potential therapeutic agent for the treatment of PAH, the mechanism of anti-proliferation remains to be elucidated.
Abstract 4135497: Model-informed dosing recommendations for digoxin in interstage single ventricle heart disease
Authors: Thompson Elizabeth , Gonzalez Ramirez Rodrigo , Kumar Karan , Allen Kiona , Benscoter Alexis , Hornik Chi , Del Grippo Erica , Anderson Brett , KHAN DANYAL , Suttner Denise , Costello John , Eghtesady Pirooz , Halnon Nancy , Hornik Christoph
Published: November 2024

Digoxin is commonly used in infants with single ventricle heart disease (SVD) and may decrease mortality in the interstage period. While labeled for the treatment of heart failure in infants, dosing recommendations do not account for alterations in drug disposition in SVD. We aimed to characterize digoxin pharmacokinetics (PK) in interstage infants with SVD.

Infants <3 months with SVD who received enteral digoxin per standard of care after stage 1 and prior to stage 2 palliation were included in this prospective, multicenter, open-label PK study. Preterm infants and those with creatinine >2mg/dL or on extracorporeal support at enrollment were excluded. PK samples were prospectively collected and digoxin plasma concentrations quantitated by HPLC/MS/MS assay validated per FDA guidance. Population PK analysis was performed in NONMEM. Effects of covariates on PK parameters were evaluated. Dosing simulations were conducted in a virtual cohort of infants with SVD that optimized dosing to achieve trough concentrations of 0.5-2 ng/mL, the label-endorsed reference range for heart failure.

Across 10 sites, 50 infants contributed 207 PK samples.
Table 1
shows cohort characteristics. A 2-compartment model with transit compartment absorption and linear elimination best described the data. Renal function and weight were significant covariates. Infants with SVD had lower apparent clearance than previously reported in infants without SVD. Current labeled dosing resulted in simulated exposures above the reference range (
Figure 1
). A new dosing regimen for infants with SVD is proposed.

Digoxin PK is altered in infants with SVD. Dosing should account for renal function, age, and weight.
Abstract 4135754: Prediction of Incident Atrial Fibrillation Using Handheld Single-Lead Electrocardiograms from the VITAL-AF Trial
Authors: Khurshid Shaan , Friedman Samuel , Al-Alusi Mostafa , Kany Shinwan , Anderson Christopher , Ho Jennifer , McManus David , Ashburner Jeffrey , Lubitz Steven , Atlas Steven , Maddah Mahnaz , Singer Daniel , Ellinor Patrick
Published: November 2024

Background:
Deep learning of 12-lead electrocardiograms (ECGs) can estimate future atrial fibrillation (AF) risk. Whether these models can be applied to single-lead ECGs (1L ECGs) from wearable or handheld devices is unknown.

Aim:
To apply a previously published deep learning model to estimate 2-year incident AF risk using handheld 1L ECGs obtained prospectively in a large AF screening trial.

Methods:
In the VITAL-AF trial (NCT03515057), over 16,000 primary care patients aged ≥65 years underwent AF screening with handheld 1L ECG. We applied our published deep learning model (ECG-AI) derived using single leads of over 450,000 standard 12-lead ECGs external to the VITAL-AF study (1L ECG-AI). We compared the performance of 1L ECG-AI to the validated CHARGE-AF clinical risk score and calculated net reclassification indices.

Results:
Among 15,694 individuals enrolled in VITAL-AF and without prevalent AF (age 74±7 years, 9,104 [58%] women), 1L ECG-AI discriminated 2-year incident AF (area under receiver operating characteristic curve [AUROC] 0.666 [95% CI 0.603-0.721]). With addition of age and sex (1L ECG-AI AS), 2-year AF discrimination (0.695 [0.637-0.742]) was comparable to the 11-component CHARGE-AF clinical risk score (0.679 [0.625-0.729]). Two-year AF incidence was markedly higher with 1L ECG-AI AS in the top 5% (8.0% [5.7-10.2]) vs bottom 5% (0.89% [0.23-0.55]). At a threshold of ≥3% estimated 2-year AF risk, AF incidence was progressively higher among patients at high risk according to neither model (1.5% [1.2-1.8]), one model (1L ECG-AI: 3.3% [2.3-4.2]; CHARGE-AF 3.4% [2.2-4.6]), and both models (5.8% [5.0-6.5]), implying that clinical risk and ECG-AI signals are complementary (
Figure
). Compared to screening all individuals at the guideline-based threshold of ≥65 years, 1L ECG-AI AS resulted in favorable net reclassification improvement (0.27 [0.22-0.32]).

Conclusion:
An ECG-AI algorithm developed using single leads of a 12-lead ECG combined with age and sex can discriminate AF risk using real-world handheld 1L ECGs with comparable performance to the CHARGE-AF score. 1L ECG-AI signals complement clinical risk factors. ECG-AI applied to 1L ECG may increase the reach and efficiency of AF screening.
Abstract 4135873: Time Course of Late Gadolinium Enhancement Intensity in Ventricular Myocardium after Proton Beam Irradiation in Swine
Authors: Koya Taro , Hirao Tatsuhiko , Deisher Amanda , Newman Laura , Kruse Jon , Shumway Dean , Merrell Kenneth , Packer Douglas , Siontis Konstantinos , Rettmann Maryam
Published: November 2024

Background:
Proton beam irradiation to the ventricular myocardium may enable non-invasive targeting of ventricular tachycardia. Previous work has demonstrated the feasibility of imaging ablation lesion with late gadolinium enhanced (LGE) cardiac magnetic resonance imaging (MRI).

Hypothesis:
We hypothesize that proton beam irradiation will lead to progressively increasing density of LGE corresponding to lesion formation during follow-up after treatment delivery.

Aim:
The aim of the current study was to determine the time course of LGE intensity in ventricular myocardium following proton beam therapy.

Methods:
Eleven swine were irradiated with 40 Gy proton beam in the anterior or lateral left ventricular (LV) followed by LGE cardiac MRI every 4 weeks for up to 24 weeks. After manual contouring of the endocardial and epicardial myocardium, a region of interest (ROI) in the area irradiated with 0-5 Gy was contoured (remote ROI). The mean and standard deviation (SD) of the signal intensity (SI) of the remote ROI were calculated. Light LGE was defined as voxels with SI > mean+2SD but < mean+3SD of the remote ROI, while voxels with SI > mean+3SD of the remote ROI were classified as having dense LGE. Voxels identified as bright due to image artifacts or noise were manually removed. The analysis was conducted in a fashion blinded to swine ID and time point after irradiation.

Results:
A total of 33 time points were analyzed (3.1 ± 1.4 MRI studies per swine).
Figure 1A
shows a representative time course of LGE in the same swine, progressing from diffuse light LGE at 8 weeks to dense LGE at 16-24 weeks.
Figure 1B
demonstrates the proportion of light versus dense LGE across timepoints in irradiated myocardial regions. At 8 weeks, light and dense LGE areas were evenly distributed. At 12 to 24 weeks, dense LGE increased to approximately 75%. The proportion of dense versus light LGE was significantly higher at 12, 16, and 24 weeks, as compared to 8 weeks.

Conclusion:
In ventricular myocardium, diffuse light LGE evident at 8 weeks progresses to denser LGE at 12-24 weeks following proton beam irradiation corresponding with lesion formation.
Abstract 4135899: Large-Scale Investigation on the Outcomes of Atrial Fibrillation Ablation in Liver Cirrhosis Patients
Authors: Ravi Soumiya , Brar Ajit , Garg Ayushi , Sohal Aalam
Published: November 2024

Background:
Catheter-based atrial fibrillation(AF) ablation is amongst the most commonly done EP procedures that have evolved over decades, improving patient outcomes and quality of life. Atrial fibrillation is seen in 5% of patients with cirrhosis and studies have shown AF in cirrhosis to be associated with increased mortality and adverse hospital outcomes.

Aim:
There is scarce literature on the outcomes of AF ablation in patients with cirrhosis. Our study aimed to study the safety and efficacy of catheter-based AF ablations in this population group and to ascertain if there is a difference compared to the general patient population.

Methods:
We used the Nationwide Inpatient Sample Database 2016-2020, the largest openly accessible inpatient healthcare database in the United States. Patients with a primary diagnosis of AF were identified using ICD-10 codes. We excluded patients with a secondary diagnosis of other arrhythmias, missing demographics, mortality, or age<18. The study population was divided into patients with and without cirrhosis. Information was collected regarding various patient demographic characteristics and comorbidities (comorbidity burden captured via Elixhauser Comorbidity Index). The primary endpoint was in-hospital mortality. The secondary endpoints were total complications, length of stay, and hospitalization charges.

Results:
A total of 23,905 patients underwent ablation, with 23,800 being non-cirrhotic, and only 105 presenting with cirrhosis. This signifies a relatively low proportion of cirrhotic patients undergoing ablation procedures, approximately 0.6% (105 out of a total of 17,600 cirrhotic patients). Additionally, the Elixhauser comorbidity index is significantly higher in cirrhotic patients (6.62) compared to non-cirrhotic patients (3.65) with a p-value <0.001, indicating a higher burden of comorbidities in the cirrhotic group. Patients with cirrhosis undergoing ablation procedures exhibit a notably higher risk of major bleeding compared to those without cirrhosis (14.3% vs. 4.06%, p-value = 0.02). Furthermore, the incidence of bleeding requiring transfusion is significantly elevated in cirrhotic patients (4.8%) in contrast to non-cirrhotic patients (0.2%) (p-value < 0.001).

Conclusion:
Although the risk of major bleeding is high, overall mortality and other complications are comparable to those without cirrhosis. We believe that this can be mitigated by carefully selecting the patients with cirrhosis for this procedure.
Abstract 4135938: Angiopoeitin-2 and Mortality in an End-Stage Renal Disease, Heart Failure Population
Authors: Robbin Vanessa , Bansal Vinod , Siddiqui Fakiha , Fareed Jawed , Syed Mushabbar
Published: November 2024

Introduction:
Angiopoeitin-2 (Ang2) is a vascular growth factor involved in regulating angiogenesis and endothelial remodeling. Higher Ang2 levels have been associated with mortality in the general population and among male hemodialysis patients, but its effects on concomitant heart failure with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD) are unknown.

Methods:
Plasma samples from 73 ESRD patients and 40 normal healthy patients (NHP) were analyzed for Ang2 concentrations using ELISA. Patient groups were stratified into those with or without HFrEF (EF < 50%). At two years following sample collection, the medical record was reviewed for mortality. The optimal cut-off value for Ang2 to predict all-cause mortality was 1715 pg/mL (AUC 0.706) based on the regression analysis. Statistical analyses included Mann–Whitney U tests, Cox proportional hazards model, and Log-rank (Mantel-Cox) test.

Results:
Multiple comorbidities were present; coronary artery disease 46%, diabetes 69%, hypertension 97%, and smoking 49%. Patients with one-year mortality had higher Ang2 (Figure 1). Ang2 levels above the optimal cut-off are associated with mortality, both within the entire ESRD sample and within the group with both ESRD and HFrEF (Figures 2-3). In the Cox proportional hazards analysis, Ang2 levels were associated with mortality within the larger ESRD sample (HR=1.001) but not in the group with ESRD and HFrEF.

Discussion:
Ang2 has potential as a biomarker for prognostication in patients with chronic disease given its association with mortality. Future research should be conducted with larger samples to evaluate if it has prognostic value in individuals with HFrEF without ESRD.
Abstract 4135984: Comparison of Immediate and Staged Complete Revascularization in STEMI Patients with Multivessel Disease: Meta-Analysis of Randomized Controlled Trial
Authors: Almizel Abdulrahman , Levett Jeremy , Zolotarova Tetiana , Eisenberg Mark
Published: November 2024

Background:
Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) frequently present with multivessel coronary artery disease (CAD) at the time of primary percutaneous coronary intervention (PCI). The optimal timing of complete revascularization (CR) in these cases remains a subject of ongoing debate.

Objective:
To assess major cardiovascular outcomes and procedural complications in STEMI patients with multivessel CAD undergoing immediate versus staged CR post index procedure.

Methods:
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate to staged CR in STEMI and multivessel CAD. Trials were identified via a systematic search of MEDLINE, Embase, and Cochrane Libraries from database inception to March 6, 2024. The data were analyzed using RevMan software.

Results:
Among five RCTs (n=1,415) the majority of participants were male, the weighted mean follow-up duration across studies was 15.6 months. Immediate versus staged CR showed no significant differences in MACE (13.3% vs 9.8%; RR: 1.07, 95% CI [0.62, 1.83]), all-cause mortality (3% vs 4.55%; RR: 0.70, 95% CI [0.41, 1.21]), or MI (4.5% vs 2.6%; RR: 1.43, 95% CI [0.58, 3.55]). However, the staged group had higher unplanned revascularization incidence (8.6% vs 4.4%; RR: 1.92, 95% CI [1.21, 3.04]).

Conclusion:
Staged revascularization in STEMI patients with multivessel CAD demonstrates comparable effectiveness to immediate revascularization but leads to a greater number of unplanned revascularization procedures, likely due to delayed intervention. The early implementation of staged PCI during the initial hospitalization phase may provide equivalent efficacy to immediate complete revascularization. Nonetheless, further research is necessary to corroborate these findings.
Abstract 4135993: Body Composition and Mortality Throughout the Reproductive Cycle: Findings from the Multi-Ethnic Study of Atherosclerosis
Authors: Liang Icy , Flynn Spencer , WATSON KAROL , Srikanthan Preethi , Horwich Tamara
Published: November 2024

Introduction:
Changes in body composition throughout the reproductive cycle accelerate during the 2 years following the final menstrual period (FMP), known as the menopausal transition (MT). During MT, an increase in fat mass (FM) and a decrease in fat free mass (FFM) are usually seen, but the relationship between these changes and cardiovascular events is not well understood. We aim to explore how FM and FFM are associated with cardiovascular events and total mortality across the reproductive cycle in participants of the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
This study included 3439 women from exam 1 of MESA. Outcomes of interest were either MACE (heart failure, myocardial infarction, coronary revascularization, cardiac arrest, or stroke) or all-cause mortality. Equations to determine FM and FFM at exam 1 were validated with the NHANES 2003 population and derived from regression models based on bioelectrical impedance analysis results at exam 5 and anthropometric and demographic measures. Women were divided into 3 groups based on time since FMP: reproductive phase (before FMP), MT phase (<2 years after FMP), and late menopause phase (>2 years after FMP). Adjusted Cox multivariate models assessed the association between FM, FFM and MACE or all-cause mortality.

Results:
Median follow-up time was 14.1 years. FM was associated with MACE in the late menopause group, whereas FFM was not associated with MACE (Table). With respect to all-cause mortality, FM had a positive association (HR=1.19, P=0.03) while FFM had a negative association (HR=0.68, P=0.04) in the MT phase. The late menopause group showed similar relationships between FM, FFM, and all-cause mortality. The reproductive group showed no significant associations (Table).

Conclusion:
In this cohort, FM is associated with a higher risk of mortality whereas FFM is associated with a lower risk. We observed these associations to be more pronounced during the MT, a time of accelerated body composition change. Our results suggest and will need further investigation to confirm that the MT may be a critical time in the female lifespan to initiate interventions which positively impact muscle mass with a view to improving survival.
Abstract 4136009: Adherence and Persistence to Guideline-Directed Medical Therapy in Patients with Heart Failure: A Systematic Review and Meta-Analysis
Authors: Moon Jungyeon , Chiang Erin , Rodriguez Albert , Ozaki Aya , Lee Douglas , Mody Freny , Udell Jacob , Jackevicius Cynthia
Published: November 2024

Introduction:
Since individual adherence/persistence studies for heart failure (HF) guideline-directed medical therapy (GDMT) have mainly focused on single classes or had limited sample sizes, providing inconclusive estimates, a comprehensive analysis is needed to understand the magnitude of the problem.

Hypothesis:
Adherence and persistence to HF GDMT are suboptimal and are associated with increased risks of HF admission and mortality.

Aims:
To generate estimates of real-world HF medication adherence and persistence and associated clinical outcomes.

Methods:
We conducted a systematic review and meta-analysis, searching PubMed, EMBASE, and CINAHL for observational studies on adherence and persistence in HF GDMT from inception to 9/25/23. We evaluated bias using the Newcastle-Ottawa Scale. Primary outcomes were adherence and persistence rates using a restricted maximum-likelihood model. Adherence was summarized as the mean proportion of days covered (PDC) and medication possession ratio (MPR), proportion of patients with good adherence (PDC/MPR≥80%), and persistence. Secondary outcomes were all-cause mortality and HF readmission with summary hazard ratios (HRs) and 95% confidence intervals (CI) estimated. Heterogeneity and publication bias were assessed using Cochran’s Q, I squared statistics, funnel plots, and Egger's tests, while subgroup analyses explored variations across studies.

Results:
The 48 studies included comprised 1,614,985 patients (mean age 71; 57% men). The overall mean PDC/MPR was 76%, with good adherence of 54%, and persistence rates of 60%. Renin-angiotensin-aldosterone system inhibitors had the highest mean PDC/MPR of 78%, good adherence of 56%, and persistence of 64%, while mineralocorticoid receptor antagonists (MRAs) had the lowest at 71%, 47%, and 49% respectively. Nonadherence/nonpersistence to GDMT was associated with a higher rate of mortality (HR 1.27 [95% CI 1.19–1.35]) and HF admission (HR 1.25 [95% CI 1.14-1.37]).

Conclusions:
Suboptimal adherence/persistence to HF GDMT is common, with only half of patients showing good adherence. Given the association with worse clinical outcomes, clinicians should prioritize identifying barriers to and addressing nonadherence/nonpersistence to HF GDMT, particularly with MRAs.
Abstract 4136040: Wearable Device-Measured Physical Activity and Incident Cardiovascular Diseases In Cancer Survivors
Authors: Jiang chengqing , Li ziang , Xu Haiyan , Wu Yongjian
Published: November 2024

Background:
Cardiovascular diseases (CVD) is the leading cause of non-cancer mortality among cancer survivors. Despite the known benefits of physical activity on cardiovascular health in the general population, evidence regarding post-diagnosis physical activity and CVD risk among cancer survivors is limited.

Objectives:
To explore the associations of wearable device-measured moderate-to-vigorous intensity physical activity (MVPA) with CVD risk in long-term cancer survivors.

Methods:
The retrospective analysis involved a prospective cohort of 6109 cancer survivors without CVD from the UK Biobank accelerometry subsample. Cancer diagnoses were obtained from national cancer registries (International Classification of Diseases-10 [ICD-10], C00-C97, except for non-melanoma skin cancer, in situ, and non-well-defined cancers), and participants were followed up through December 31, 2022. A machine-learning algorithm was utilized to categorize MVPA into four groups based on guideline-recommend MVPA duration (0-75 min/week, 75-150 min/week, 150-300 min/week, ≥300 min/week).

Results:
Over a median follow-up of 7.88 years, there were 539 incident CVD events, including 361 incident CAD events, 155 incident HF events, and 109 incident stroke events. A clear inverse linear dose-response relationship between MVPA volume and the incidence of CVD was observed (P for nonlinear=0.49), with no maximal threshold for the benefits. Adjusted CVD incidence rates (95% confidence intervals [CIs]) across MVPA groups (0-75 min/week, 75-150 min/week, 150-300 min/week, ≥300 min/week) were 15.30 (12.90, 18.10), 13.50 (11.00, 16.40), 12.00 (10.20, 14.10), and 9.86 (8.35, 11.60) per 1000 person-years, respectively. Adjusted hazard ratios (95% CI) for CVD, CAD, HF, and stroke in the highest MVPA group (≥300 min/week) compared with those with the lowest MVPA group (0-75 min/week) were 0.63 (0.49, 0.80), 0.68 (0.51, 0.91), 0.66 (0.42,1.06), 0.72 (0.42, 1.23), respectively.

Conclusions:
Findings from the UK Biobank study suggest that longer durations of MVPA are associated with reduced incident CVD risk in cancer survivors, particularly in CAD risk reduction, underscoring the potential for physical activity to serve as a key component in cardio-oncology care.
Abstract 4136180: Sex Differences in Cognition Related to Cerebral Small Vessel Disease Associated with Younger Age ofHypertension Diagnosis
Authors: Kaur Amanpreet , Behlouli Hassan , Rajah Natasha , Pilote Louise
Published: November 2024

Background:
There are sex differences in the effect of age at onset (AO) of hypertension onbrain structural changes later in life. This may differentially affect long-term cognition through cerebral smallvessel disease (CSVD) in females and males. However, whether and how the association between age ofhypertension diagnosis contributes to sex differences in cognitive decline related to CVSD later in life remainsunclear.

Objective:
Our objective was to examine sex differences in cognition in relation to brain structural changesexacerbated by CSVD caused by younger AO of hypertension.

Methods:
We used data from the UK Biobank to select participants with a known age of hypertensiondiagnosis who also had neuropsychological test scores for cognitive functions affected by CSVD i.e., memoryand executive function (n= 6095). We stratified data by sex and AO at baseline (2006-2010). Controlparticipants who did not have hypertension were chosen at random using propensity score matching. Principalcomponents analysis (PCA) was used to reduce the number of CSVD related cognitive function tests(measured at 2014 follow-up). We selected participants >65 years of age at the time of cognitive function teststo determine cognitive function later in life. This was followed by a sex disaggregated regression analysis totest for the effect of AO on cognitive functions identified from the PCA in females and males.

Results:
Our main outcomes were cognitive function tests in the domains of memory (working and visual-spatial) and executive function/processing speed. When compared to normotensive controls, cognitiveoutcomes differed by sex and age of hypertension diagnosis. Whereas females diagnosed at middle age (45-54 years) had worse outcomes in the working memory domain compared to controls, males diagnosed at olderage (>65 years) had worse outcomes compared to controls. Only females diagnosed with hypertension ateither younger age (< 35 years) or older age (>65 years) had worse outcomes in the executive visualdeclarative memory domain. We did not see any differences in the processing speed/executive functiondomain in either males or females.

Conclusions:
This study demonstrates distinctive characteristics of CSVD-related cognitive decline in malesand females based on the age of hypertension onset. Therefore, CSVD is a critical pathophysiologicalmechanism for sex differences in cognitive decline and may aid in identification of novel sex-specific therapy.
Abstract 4136181: Automated Personalized Modulation of the Sympathetic “fight-or-flight” Reflex
In Vivo
Using Implantable Microdevices for Enhancing Neurocardiac Function and Reducing Mortality Risk.
Authors: Kundu Dibyasankha , Hazra Debapriya , Mukherjee Shayani , Jones Steven , Dey Swati , DeMazumder Deeptankar
Published: November 2024

Background:
The sympathetic nervous system (SNS) is a critical regulator of cardiovascular function. Whereas acute SNS activation elicits positive inotropy and confers survival advantage, persistent SNS hyperactivity is maladaptive and can lead to arrhythmias, cardiac arrest and heart failure.

Hypothesis:
Automated optogenetic modulation of the sympathetic stress response
in vivo
enhances neurocardiac function while avoiding sympathetic hyperactivity-mediated pathological effects.

Methods:
In normal guinea pigs, we virally transduced excitatory and/or inhibitory channelrhodopsins to the stellate ganglia (SG), the primary sympathetic input to the heart. We studied
in situ
effects of graded activation of SG opsins (e.g., phasic vs tonic) on cardiac function (e.g., ECG, heart rate) with and without perfusing agents (e.g., β-blockers, antioxidants).
In vivo
studies used novel implanted µLED devices for wireless body signal streaming (e.g., ECG) and neurophotonic SG opsin modulation closed-loop to dynamic analyses of physiological demand versus ECG-based cardiac risk prediction.

Results:
Compared to baseline heart rate (218±16 bpm), pulsed activation of inhibitory opsins reduced heart rate by ~25% (156±12; delta=67±14 bpm; p<0.0003; N=5). Pulsed activation of excitatory opsins increased heart rate by ~30% (285±28; delta=65±19 bpm; p<0.0002; N=5). Interestingly, prolonged (>20 min) tonic excitation of the SG caused desensitization, possibly as an intrinsic safety mechanism. Whereas graded SG excitation or inhibition at different LED intensities elicited prompt changes in heart rate, repeated activation of excitatory opsins led to quick desensitization. Our ongoing studies are aimed at understanding how and when SG modulation can enhance cardiac function, trigger intrinsic cardioprotective mechanisms, or cause pathological effects.

Conclusion:
Automated neurophotonic optogenetic excitation or inhibition of the SG is a robust personalized strategy for modulating cardiovascular function. The ability to rapidly and accurately modulate the sympathetic stress reflex in a graded manner can lead to more timely, effective, and appropriate physiological responses while avoiding undesired pathophysiological responses.
Abstract 4136267: Racial and ethnic disparities in-hospital outcomes after out-of-hospital cardiac arrest: Insight from the United States national inpatient sample
Authors: Quevedo Ramirez Andres , Ibarra Joshua , Gajjar Rohan , Shaka Hafeez
Published: November 2024

Background:
Out-of-hospital cardiac arrest (OHCA) continues to have a high mortality with an overall survivability to hospital discharge of less than 10%. Increased bystander cardiopulmonary resuscitation has resulted in better survival after OHCA. Some studies have tackled sociodemographic characteristics and rates of survival, but these are mostly localized studies with varied results. We investigated racial disparities in in-hospital mortality and mechanical circulatory support (MCS) use in OHCA.

Methods:
Retrospective cohort study based on the 2019-2020 National Inpatient Sample database of the Healthcare Utilization Project. Our population included patients 18 years or older with out-of-hospital cardiac arrest (OHCA) identified using ICD-10 codes. The primary risk factors examined were race/ethnicity categorized into White, Black, and Hispanic. The primary outcome was in-hospital mortality among patients with OHCA. The secondary outcome was mechanical circulatory support (MCS) use. Left ventricular assist device (LVAD), extracorporeal membrane oxygenation (ECMO), and intra-aortic balloon pump (IABP) were identified as MCS. Multivariate regression analysis was used to estimate the odds ratio.

Results:
During the study period, 26,640 hospitalizations with OHCA were identified, of whom 67,4% were White, 22,9% were Black, and 9,7% were Hispanic. The mean (SD) age of patients with OHCA was 65.2 (16) years old, and Black patients well as Hispanic patients had lower mean age compared to White patients (63.1 vs 63 vs 66.3 years old, p<0.001). A total of 19,425 died (72.9%) and 0.9% needed MCS. Notably, more Hispanics needed MCS, compared to White and Black patients (1.7% vs 0.9% vs 0.4%, p=0.049). In the multivariate analysis, we did not find statistical significance among racial/ethnic groups regarding in-hospital mortality. However, Hispanic patients had higher odds of MCS (OR=2.4; CI 95% 1.05-5.55, p=0.039) compared to White patients. No statistical significance was found regarding the use of IABP or LVAD.

Conclusion:
Overall, in-hospital mortality was elevated. Moreover, our findings highlight significant racial disparities after OHCA regarding MCS use. More research is needed to identify factors of racial disparities to improve outcomes.
Abstract 4136285: Large-Scale Proteomics Identifies Novel Shared Biomarkers of Heart Failure and Cancer: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Yang Yimin , Ky Bonnie , Lamberson Victoria , Hoogeveen Ron , Ballantyne Christie , Ndumele Chiadi , Joshu Corinne , Coresh Josef , Platz Elizabeth , Selvin Elizabeth , Yu Bing , Shah Amil
Published: November 2024

Introduction:
There is a bidirectional relationship between cancer and cardiovascular disease risk. Identifying proteins associated with both cancer and heart failure (HF) may provide insight into common biological pathways underlying both conditions.

Methods:
Among 10,136 participants in the community-based ARIC cohort study who were free of HF and cancer at study visit 2 (1990-92) and had aptamer-based proteomics (SomaScan v4), we assessed the association of 4,955 plasma proteins with incident HF and with incident site-specific cancer ascertained by cancer registry linkage supplemented with medical records (lung, post-menopausal breast, prostate, colorectal, and hematologic) using multivariable Cox models adjusted for demographics, clinical characteristics, and social determinants of health. Two-sample cis-Mendelian randomization (
cis-
MR) was performed to evaluate potential causal effects of proteins on HF, left ventricular (LV) function, and site-specific cancer.

Results:
Mean age at baseline was 56±6; 54% were female; and 24% reported black race. Over a median follow-up of 10 [IQR 10, 10] years, there were 604 incident HF events and 1,207 incident cancers (169 lung, 85 hematologic, 105 colorectal, 206 breast, 288 prostate). Using a Bonferroni significance threshold (p < 1.0x10
-5
), 23 proteins were associated with both HF and lung cancer, 2 with HF and hematologic malignancy, 1 with HF and colorectal cancer, and none with HF and breast or prostate cancer. Six proteins remained significantly associated with both HF and lung cancer after further adjustment for pack-years of smoking (Figure). In
cis-
MR of these six proteins, ICAM5 and MMP12 showed potential causal effect on LV volume and lung adenocarcinoma, and PLAUR showed potential causal effect on HF and lung adenocarcinoma.

Conclusion:
Among various types of cancer, proteins associated with lung cancer showed the greatest overlap with proteins associated with HF, which was largely accounted for by smoking exposure. We uncovered a set of 6 plasma proteins associated with both incident HF and lung cancer after accounting for smoking. MR identified proteins with potential causal effects on both lung adenocarcinoma and LV size (ICAM5, MMP12) and HF (PLAUR).
Abstract 4136346: A Comparative Analysis of Esophageal Cooling for Preventing Esophageal Injury Post Atrial Fibrillation Catheter Ablation: A Systematic Review and Meta-analysis
Authors: Ibrahim Momen Mohamed , Al Hennawi Hussam , Tanas Yousef , Abourady Youmna , Sewedan Nourhan , Hashem Ahmed Magdy , Motawea Karam R.
Published: November 2024

Introduction:
Thermal injury following atrial fibrillation catheter ablation is a rare but fatal complication. We aim to assess the safety profile of different forms of esophageal cooling methods versus standards of care.

Methods:
We searched PubMed, Cochrane Library, Scopus, and Web of Science databases for randomized controlled trials and cohort studies comparing esophageal cooling to Luminal esophageal temperature (LET) monitoring regarding esophageal thermal lesions (ETL) post atrial fibrillation ablation. Case reports, case series, reviews, conference abstracts and animal studies were excluded. Review manager software (version 5.4) was used to perform the meta-analysis.

Results:
We included 10 studies with 25662 patients in total: 14515 patients in the esophageal cooling group and 11147 patients in the LET group. Overall esophageal lesion analysis demonstrated no statistically significant difference between the esophageal cooling group and LET (RR = 0.72, 95% CI = 0.35 to 1.49, p-value = 0.38). Subgroup analysis showed no statistically significant difference for mild/moderate lesions (RR = 1.52, 95% CI = 0.80 to 2.90, p-value = 0.20). However, the subgroup analysis showed a statistically significant association between esophageal cooling and decreased severity of esophageal lesions compared with LET (RR = 0.29, 95% CI = 0.12 to 0.71, p-value = 0.007). Regarding AF recurrence, the pooled analysis showed no statistically significant difference between esophageal cooling group and LET (RR = 1.24, 95% CI = 0.95 to 1.61, p-value = 0.11).

Conclusion:
In patients undergoing AF catheter ablation, the implementation of esophageal cooling showed statistical significance in decreasing the severity of esophageal lesions compared to the LET group. Also, esophageal cooling demonstrated non-inferiority in AF recurrence compared to LET. Future research should focus on assessing the long-term effects of esophageal cooling during AF catheter ablation.
Abstract 4136452: Acute Cardiac Function Change After Catheter Ablation of Ventricular Arrhythmias in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Davis Nathaniel , Ezzeddine Fatima , Sugrue Alan , Siontis Konstantinos , Kapa Suraj , Kowlgi Gurukripa , Giudicessi John , Bois John , Chang Ian C , Asirvatham Samuel , Friedman Paul , Killu Ammar
Published: November 2024

Introduction:
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterized by fibrofatty replacement of myocardial tissue, creating areas of electrical heterogeneity and increasing the risk of ventricular arrhythmias (VAs) and sudden cardiac death (SCD). Catheter ablation is commonly performed in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) for management of ventricular arrhythmias (VAs). Whether catheter ablation affects cardiac function post-procedurally is uncertain.

Research Question:
Does catheter ablation for ARVC result in acute change in cardiac function?

Goals/Aims:
To assess the impact of catheter ablation for VAs on cardiac function in the acute post-procedure setting.

Methods:
This retrospective study included patients with ARVC who underwent catheter ablation for VAs at Mayo Clinic. Cardiac function was assessed on pre- and post-procedure transthoracic echocardiograms (TTEs). Post-procedure TTEs were obtained within 4 weeks after the ablation procedure. Right ventricular (RV) enlargement and systolic dysfunction were evaluated as continuous variables (0=none, 1=mild, 2=mild-moderate, 3=moderate, 4=moderate-severe, 5=severe).

Results:
The study included 32 patients who underwent a total of 44 ablations. Mean age at the time of ablation was 49±16 years, and 24 (75%) were male. After a mean follow-up duration of 2.6±5.5 days, there was a significant worsening in mean RV dysfunction (1.6±1.5 to 2.0±1.4,
P
= 0.001). There were no significant changes in mean left ventricular ejection fraction (LVEF), left ventricular (LV) dimensions, and RV size. 6 (14%) patients had a >5% decline in LVEF, and 14 (32%) patients had worsening RV function. Transient inotropic support was required in 4 (9%) patients.

Conclusion(s):
This study is the first to assess the acute impact of catheter ablation for VAs on cardiac function in ARVC patients. These results underscore the importance of careful post-procedure monitoring and planning of the ablation target in these patients to avoid excessive ablation and therefore impairment in cardiac function.