bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145103: Reduced Penetrance and Variable Expression of Dilated Cardiomyopathy Associated with Homozygous Truncating Variants of
NRAP
Gene
Authors: Alqahtani Aisha , Tulbah Sahar , Alruwaili Nadiah , alkorashy Maarab , ALBERT BROTONS DIMPNA CALILA , Zarroug Samah , Al-Hassnan Zuhair
Published: November 2024

Dilated cardiomyopathy (DCM) is a clinical condition with tremendous diversity of etiology. In familial forms of DCM, there has been a compelling evidence of immense genetic heterogeneity that implicate various mechanisms. Recently, biallelic loss-of-function (LOF) variants in the nebulin-related-anchoring protein (
NRAP
) gene have been reported in an ultra-rare form of DCM inherited recessively.

In this study, we sought to describe the clinical and genetic spectrum associated with
NRAP
variants in our highly consanguineous population. Genetic analysis with whole exome sequencing, conducted on consecutively recruited cases of DCM, identified 13 consanguineous families with 6 different LOF variants in
NRAP
. Segregation analysis detected 25 homozygous and 25 heterozygous individuals. Interestingly, only 18 of the 25 homozygous cases were symptomatic with a remarkable variability of age of onset (9 months to 47 years, median 5 years), of whom 9 cases died with a median age of death of 3 years (range: 9 months to 13 years). None of the heterozygous individuals was clinically symptomatic. Of note, 3 homozygous cases underwent heart transplantation at the ages of 8, 11, and 14 years who are alive with a follow up of 6 years, 3 years, and 3 months respectively.

Our work illustrates a notable clinical variability of DCM associated with
NRAP
LOF variants. This observation suggests an underling complex mechanism of
NRAP
-related DCM that deviates from simple mendelian inheritance and plausibly implicates modifiers. The reduced penetrance and variable expression underscore the need of exercising precaution when counseling individuals and families found to have
NRAP
variants.
Abstract 4145119: Implementation and Evaluation of a Life’s Essential 8 Risk Factor Screening Tool in a Public HIV Clinic in Tanzania
Authors: Roberts Nicholas , Manyangu Gloria , Kisigo Godfrey , Willkens Megan , Desderius Bernard , Peck Robert
Published: November 2024

Background:
The burden of cardiovascular disease (CVD) is increasing among people with HIV (PWH) in sub-Saharan Africa. Integrating CVD screening into routine HIV care represents an opportunity to diagnose CVD at an earlier stage in a potentially high-risk population.

Research questions
Is integrating CVD risk factor screening feasible and sustainable in a public HIV clinic in Mwanza, Tanzania? What is the magnitude of CVD risk of the general adult PWH population? What is the unmet need for blood pressure (BP) and diabetes management?

Methods:
We adapted the AHA Life’s Essential 8 (LE8) into a rapid questionnaire that was administered to every PWH in a large public adult HIV clinic. Questions included demographics; LE8 risk factors (BMI, diet, physical activity, sleep, and smoking); and the hypertension and diabetes continuum of care. Every patient had their BP measured; BP was measured two additional times for those with an initial BP >140/90 mmHg. We administered random blood glucose screening to anyone with a high BP, obese BMI, current smoking, or history of diabetes. Implementation and effectiveness were evaluated using the RE-AIM framework.

Results:
In 3 months, 1072 PWH were screened at least once. Mean age was 50 years and 72% were female. On average, PWH had a nutritious diet and received adequate physical activity per AHA guidelines. The prevalence of hypertension was 34%; the continuum of care is shown in Figure 1. Of those screened, 21% had diabetes or pre-diabetes. Evaluation via the RE-AIM framework is shown in Table 1. Successes included the reach and effectiveness of screening in only 3 months. Adoption was the biggest challenge due to staffing and supply constraints. The intervention was feasible, implemented with fidelity, and is ongoing.

Conclusions:
Integrating CVD risk screening into routine HIV care in a busy Tanzanian clinic was feasible and demonstrated a high magnitude of undiagnosed and untreated hypertension among the general PWH population.
Abstract 4145126: Catheter Ablation of Atrial Arrhythmias in Patients with Cardiac Amyloidosis
Authors: Diep Brian , Kewcharoen Jakrin , Garg Jalaj
Published: November 2024

Background:
Cardiac amyloidosis is an infiltrative disease that is associated with various atrial arrhythmias (AA). Data on the efficacy and safety of catheter ablation (CA) in this population is scarce, thus, we evaluated it in patients with cardiac amyloidosis.

Methods:
We performed a systematic review by searching for studies in all major databases. Random effect model was used to assess pooled incidence of outcomes with a 95% confidence interval (CI). Outcomes included 1) Freedom from AA; 2) Procedural complications (including pericardial effusion, cardiogenic shock and major bleeding); 3) Stroke during follow-up; 4) Cardiovascular hospitalization; 5) All-cause mortality.

Results:
7 studies were included in the meta-analysis comprised 376 patients (mean age 71.24.9, 71% male, 95% atrial fibrillation (AF), 2% atrial flutter (AFL), <1% atrial tachycardia (AT), <1% AF/AFL, 3% AF/AT, 86% transthyretin amyloid). During a mean follow-up period of 29.6 months, freedom from AA was 42% (CI: 22-62%). Procedural complications, stroke during follow-up, cardiovascular hospitalization and all-cause mortality occurred in 3% (CI: 0-9%), 1% (CI: 0-2%), 10% (CI: 2-18%) and 17% (CI: 7-27), respectively (Figure).

Conclusions:
CA for AA in patients with cardiac amyloidosis is safe, despite high recurrence rates. Due to significant comorbidities in these patients, further studies are needed to evaluate for optimal treatment strategy for AA in patient with cardiac amyloidosis.
Abstract 4145127: Sex Differences in Everyday Mood States and its Association with Autonomic Physiology
Authors: Shah Amit , She Hua , elon lisa , Li Qiao , Roberts Tatum , Stefanos Lewam , Haddad George , Gupta Shishir , Tarlapally Nitya , Lampert Rachel , Raggi Paolo , Pearce Brad , Quyyumi Arshed , Sameni Reza , Lewis Tene , Sullivan Samaah , Bremner J Douglas , Clifford Gari , Vaccarino Viola
Published: November 2024

Background:
Although CHD incidence is low amongst young and middle-aged women, those who have premature MI are at a high risk of mortality. Greater psychosocial exposures and mental health comorbidities in women may play a role. We hypothesize that women age ≤ 60 years with recent MI have a higher burden of everyday negative psychological experiences, and that these are associated with greater real-time cardiac autonomic dysfunction compared with men.

Methods:
We examined real-time mood and autonomic function in 239 participants aged ≤ 60 years with an MI within 8 months. We performed smartphone-based ecological momentary assessments of stressful events and negative mood states (anger, anxiety, distress, loneliness, and sadness) at 3 random points throughout the day for one week. Participants simultaneously wore a Holter monitor to measure autonomic function. Our primary exposure was the average negative mood intensity (rated 0 to 10) throughout the week, and our primary outcome was reduced deceleration capacity of heart rate (DC) during sedentary periods as a measure of lower vagal activity. Other measures of dysautonomia included lower high (HF) and low frequency (LF) heart rate variability (HRV). We used multivariable linear regression models to adjust for potential confounders.

Results:
The mean age was 52 years, 51% were black, and 36% were women; 76% of women reported at least one stressful event in the week of monitoring, vs. 64% of men (p=0.04). Women reported more negative mood than men by 0.39 units (p=0.02) on average. DC, averaged across the week, was 12% lower, LF HRV was 41% lower, and HF HRV was 34% lower in women than in men. As the weekly average of negative mood increased, the weekly average of DC declined in women only (Figure). After adjusting for age, current smoking, diabetes, and beta-blocker use, each 2-point increase in the negative mood score was associated with a 12% (95% CI: 6.12%-17.88%) lower DC in women only. Similar findings were observed for HF and LF HRV.

Conclusions:
Young and middle-aged post-MI women reported more real-time negative psychological states, which were associated with worse autonomic function compared to men with early MI. Resting autonomic function was also lower in women. Negative mood in daily life has disproportionate impact on cardiac autonomic regulation among women. Psychophysiological mechanisms are important in the examination of sex-based disparities in CHD pathophysiology and outcome.
Abstract 4145147: Prescription of Sodium-glucose cotransporter-2 inhibitors and Glucagon-like peptide-1 receptor agonists among Veterans with diabetes and cardiovascular disease
Authors: Qaisrani Fatima , Wu Jingyi , Eberly Lauren , Khatana Sameed Ahmed
Published: November 2024

Background:
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor (GLP-1) agonists (GLP-1a) improve cardiovascular (CV) health outcomes among individuals with type 2 diabetes and CV disease. US military Veterans have a higher prevalence of both diabetes and CV disease than the general population. Understanding what rates of SGLT2i and GLP-1a prescription are in this population is important for identifying strategies to improve CV outcomes.

Methods:
Using data from the Veterans Affairs Corporate Data Warehouse data, we identified all Veterans with type 2 diabetes and at least one of the following conditions – coronary artery disease, peripheral arterial disease, cerebrovascular disease/stroke, or congestive heart failure (either reduced or preserved ejection fraction). The study population was limited to people with active care with a primary care, cardiology, or endocrinology provider. We then examined trends in prescription of SGLT2i and GLP-1a from 2017 to 2022. Prescription rates among subgroups of gender and race were also evaluated. Differences between groups were compared using Chi-squared tests.

Results:
A total of 826,590 Veterans with both diabetes and CV disease were identified. Prescription rates of SGLT2i increased from 1.6% in 2017 to 22.3% in 2022 while GLP-1a rates increased from 2.0% to 12.0%. As of 2022, prescription rates of SGLT2i were similar between men and women (22.2% vs. 22.8%) while rates for GLP-1a were lower among men (11.8% vs. 18.6%, p<0.001). Among race subgroups, prescription rates were similar, but Black Veterans had the lowest rates for both categories of medications compared to white Veterans: 22.1% vs. 22.4%, p=0.03 for SGLT2i and 10.6% vs. 12.4%, p<0.001 for GLP-1a.

Conclusions:
Although prescription rates of SGLT2i or GLP-1a among Veterans with diabetes and CV disease have rose considerably between 2017 and 2022, as of 2022, a substantial proportion of Veterans with diabetes and CV disease were yet to be prescribed SGLT2i or GLP-1a. There also existed some disparities based on gender and race in prescription rates. Identifying, and removing, barriers towards prescribing these medications is crucial for improving the CV health of Veterans.
Abstract 4145148: The Hypertrophic Cardiomyopathy Associated Junctophilin-2 E169K Variant Disrupts Mitofusin-2 Binding and Elicits a Pathological Cellular Response to Metabolic Stress
Authors: Kim Minwoo , Hartweck Lynn , Moon Ryan , Raveendran Rashmi , Prins Kurt
Published: November 2024

Introduction:
Junctophilin-2 (JPH2) plays essential roles in multiple cardiac processes including calcium handling, t-tubule structure, and gene regulation. We recently showed JPH2 also has a mitochondrial role as it binds the mitochondrial protein mitofusin-2 (MFN2) and modulates mitochondrial metabolic function. However, the impacts of JPH2 disease-causing variants on MFN2 binding and subsequent cellular responses to metabolic stressors are unknown.

Methods:
Disease-associated variants in the MFN2 binding domain of JPH2 were engineered and recombinantly expressed in E. coli cells. Purified proteins were then subjected to pulldown experiments to assess MFN2 protein binding. Alphafold3 modeled how MFN2 and JPH2 and JPH2 E169K mutants interacted in the presence or absence of fatty acids. Wildtype JPH2 or JPH2 E169K expression was directed by a doxycycline inducible promoter after being cloned into the AAVS1 locus in JPH2 knockout iPSC-cardiomyocytes. In vitro metabolic stress was induced by incubating iPSC-CM with 150 μM oleate, 150 μM palmitate, and 500 μM carnitine overnight. Super resolution confocal microscopy visualized mitochondria integrity, nuclei shape and size, and lipid droplet accumulation and morphology.

Results:
In pulldown experiments, the JPH2 E169K mutation disrupted MFN2 binding. Alphafold3-based modeling showed JPH2 E169K disrupted the interaction between the two proteins when modeled with or without lipids (A-D). Control, wild type JPH2, and JPH2 E169K iPSC-CM displayed divergent responses to in vitro metabolic stress. JPH2 E169K cells exhibited pathological mitochondrial network changes characterized by a lower mitochondrial footprint and less network branches (E-G). In addition, the JPH2 E169K iPSC-CM accumulated significantly more lipid droplets in the cytoplasm and the nucleus, and the JPH2 E169K lipid droplets were significantly larger than the other cell types (H-K). Finally, the accumulation of lipid droplets impacted nuclear morphology as the JPH2 E169K cells had nuclear hypertrophy and nuclei were more ellipse-shaped (L-N).

Conclusion:
The JPH2 E169K variant disrupts MFN2 binding, which results in heightened metabolic stress characterized by lipid droplet accumulation and mitochondrial and nuclear morphological changes. These results implicate a new pathophysiological mechanism for how the JPH2 E169K mutation causes cardiac dysfunction.
Abstract 4145154: A Pilot Study of Post-Discharge Atrial Fibrillation Using a Novel Mobile Electrocardiography Monitoring Device
Authors: Iribarne Alexander , Patel Nirav , D'Alessandro David , DiMaio John , Bhavnani Sanjeev , Badhwar Vinay , Sengupta Partho , Johnson Linda , Gajewska-Dendek Elzbieta , Kramer Robert , Moquete Ellen , Hupf Jonathan , Duncan Prezley , Mihelis Efstathia , Borger Michael , Muir Andrew , Starnes Vaughn , Edegran Albin , Fenton Kathleen , Taddei-Peters Wendy , Moskowitz Alan , OGara Patrick , Gelijns Annetine , Alexander John , Gillinov A , Bagiella Emilia
Published: November 2024

Introduction:
Post-operative atrial fibrillation (AF) is the most common arrhythmic complication after CABG. Following inpatient treatment, data on the frequency and duration of recurrent AF after hospital discharge remain sparse.

Research Question:
Do patients who experience in-hospital post-operative AF have recurrent arrhythmias in the 30 days post discharge?

Goals:
To characterize the burden of AF after hospital discharge using a wearable telemetry device.

Methods:
Patients enrolled in the CTSN PACeS trial were eligible for this sub-study. PACeS is a randomized trial of anticoagulation versus no-anticoagulation in patients with new-onset post-operative AF. Eligibility criteria include patients with new onset AF defined as AF > lasting 60 minutes or recurrent AF episodes within 7 days after CABG and before hospital discharge. All patients in this sub-study wore a 3-lead mobile telemetry device upon hospital discharge that provided continuous beat-to-beat data for 30 days. For this analysis, an AF event was counted if it was at least 30 seconds in duration.

Results:
Forty-six patients participated in this sub-study. The mean age was 68.8 years, 21.7% were women, 78.3% White and 11% Hispanic. The mean and median device wear times were 23 and 29 days, respectively. The average total available analytic time (i.e., total time of interpretable electrocardiographic signal) was 20.3±3.3 hours/day. At least one episode of AF post-discharge was detected in 38 (82.6%) of patients. Among these, the median number of days in which patients had an episode of AF was 6. The mean duration of time in AF was 1.6±1.7 hours/day and the overall percent time in AF was 7.5%. Most patients (78.3%, n=36) had AF for <10% of the recording time. Nearly all AF events occurred within the first two weeks post discharge (Figure).

Conclusions:
In this telemetry study, patients who developed postoperative AF within 7 days of CABG were found to have a modest burden of post discharge AF episodes, most frequently within the first 2 weeks. These preliminary data should be verified in larger prospective studies, and may help inform anti-thrombotic and other management decisions for patients who develop AF following CABG surgery.
Abstract 4145163: Postprocedural Anticoagulation Following Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Clinical Outcomes
Authors: Oliveira Vinicius , Gaban Natalia , SILVA ARIADNE , Lopes Lucca , Alves Alencar Pedro Lucas , Duarte Lima Ana Paula , Oliveira Izadora , Graner Moreira Humberto
Published: November 2024

Background:
The use of procedural anticoagulation during primary percutaneous coronary intervention (PCI) is well established and has been shown to improve clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Despite its widespread application in clinical settings, the necessity and efficacy of postprocedural anticoagulation (PPA) remain contentious. Thus, this is the first meta-analysis to assess the efficacy and safety of PPA after PCI for the management of STEMI.

Methods:
A comprehensive search of PubMed, Cochrane, and Embase databases was conducted to identify studies comparing the clinical outcomes between PPA administration and control (placebo or no anticoagulant infusion) following PCI for STEMI treatment. Statistical analyses were performed using RevMan version 5.4.1, employing a random-effects model to calculate odds ratios (ORs) and their 95% confidence intervals (CIs).

Results:
A total of four studies comprising 45,066 patients were included (2 RCTs and 2 non-randomized studies), of which 30,925 (68.6%) received PPA. Among the included patients, 35,770 (79.4%) were female. Compared to the control group, PPA did not significantly reduce all-cause mortality (OR 0.82; 95% CI 0.49 – 1.36; P=0.44), cardiac death (OR 0.81; 95% CI 0.49 – 1.33; P=0.41), and major adverse cardiovascular events (MACE) (OR 0.97; 95% CI 0.64 – 1.47; P=0.88; Figure 1A). Moreover, the odds of stent thrombosis (OR 1.24; 95% CI 0.92 – 1.68; P=0.15), myocardial infarction (OR 1.03; 95% CI 0.79 – 1.36; P= 0.81) and stroke (OR 0.95; 95% CI 0.41 – 2.20; P=0.90) did not differ between the groups. However, patients receiving PPA were associated with higher odds of TIMI major/minor bleeding (OR 1.49; 95% CI 1.20 – 1.84; P<0.01; Figure 1B).

Conclusions:
This meta-analysis reveals no significant differences in the odds of all-cause mortality, cardiac death, MACE, stent thrombosis, myocardial infarction and stroke between PPA and control following PCI for the management of STEMI. However, PPA was associated with higher odds of TIMI major/minor bleeding when compared to control. Further randomized controlled trials are warranted to corroborate these findings.
Abstract 4145168: Incidence and Associations of Normal QRS vs Right Bundle Branch Block in Ebstein's Anomaly
Authors: Havangi Prakash Shisheer , Poddar Aastha , Connolly Heidi , Egbe Alexander , Madhavan Malini
Published: November 2024

Introduction:
Ebstein's anomaly (EA) is associated with ECG signature of right bundle branch block (RBBB). Patients with EA also have high incidence of accessory pathways (AP) and it has been hypothesized that the absence of RBBB on ECG may be associated with a higher prevalence of AP. This study aims to assess the prevalence of RBBB in patients with EA and examine the correlation between its absence and the presence of AP.

Methods:
Adults (age>18 years) with EA, identified using the Mayo Adult Congenital Heart Disease registry, were divided into 3 groups based on the QRS morphology of their first ECG. Those with prior AP ablation were excluded. The demographic characteristics, baseline ECG data, echocardiographic parameters and EP study data were retrospectively collected and compared between the three groups using Chi-square or ANOVA test as appropriate.

Results:
Of 596 patients with EA, 358(60.06%) patients had a RBBB, bifascicular block or an incomplete RBBB (group1) ; 18 (3.02%) patients had either a LBBB , ventricular pre-excitation, isolated left anterior or posterior fascicular block (group 2); and 220 (36.92%) patients had normal QRS (group 3). The characteristics of these groups are compared in the table. Patients with RBBB had larger RV size, reduced RV systolic function and higher likelihood of tricuspid valve surgery. EP study was performed in 51 (14%), 3 (17%) and 51 (23%) patients in groups 1, 2,and 3 respectively. One or more APs were noted in 11/51 (22%) and 14/51 (30%) patients with RBBB and normal QRS respectively (p=0.18). Additionally, in patients who did not undergo an EP study, supraventricular tachycardia was documented in 39/307 (13%), 2/15(13%) and 13/169 patients (8%) in group 1,2 and 3 respectively during followup .

Conclusion:
In a large cohort of adults with EA in a tertiary referral center, greater than one-third of patients had a normal QRS complex without RBBB. However, EP study did not reveal a significant difference in the prevalence of accessory pathways between patients with and without RBBB. In EA, the absence of RBBB may not increase the risk of an underlying accessory pathway.
Abstract 4145176: Prices for Transcatheter Aortic Valve Repair Vary Significantly by US Insurance Company
Authors: Wei Chen , Paranjpe Ishan , Sharma Pranav , Song Nancy , Schulman Kevin , Sandhu Alexander
Published: November 2024

Background:
Transcatheter aortic valve replacement (TAVR) is a crucial procedure for managing aortic stenosis (AS). Despite its widespread adoption, substantial price differences exist between hospitals and insurance companies. This study aims to analyze these variations across major insurers using new pricing data.

Hypothesis:
We hypothesize significant variation in TAVR prices across insurance plans, influenced by plan type and hospital characteristics.

Methods:
TAVR prices for Diagnosis Related Group (DRG) code 267 (TAVR without major cardiac complications) were analyzed using the Turquoise Health database. Prices from Aetna, Blue Cross Blue Shield, Cigna, Humana, Medicare, and United Healthcare were compared across HMO/Managed Care, Medicare Advantage, Medicaid, and Other plan types. Outliers beyond the 95th and below the 5th percentiles were excluded.

Results:
The median commercial price for TAVR was $71,312, about 1.88 times the Medicare rate. In comparison, the median cash price was $78,000. List prices were the highest, with a median of $166,714 and a substantial standard deviation of $83,534. Price variation between hospitals (2.6 times) was greater than within hospitals (2.0 times). Geographic differences significantly influenced prices, with median TAVR prices ranging from $54,915 in New England to $105,538 in the Pacific region (Fig 1A). Aetna had the highest median TAVR price at $84,190, with a standard deviation of $53,186. Medicare had the lowest median price at $37,865 and the least variability, with a standard deviation of $7,566. HMO/Managed Care plans showed the highest prices and variability, with an average median price of $78,725 and a standard deviation of $54,082 (Fig 1B). Medicare Advantage plans had substantially lower rates, with an average median price of $38,044 and a standard deviation of $14,890.

Conclusion:
This study highlights substantial TAVR price variation across major insurers and plan types. Aetna had the highest prices and variability, particularly in HMO/Managed Care plans, while Medicare Advantage plans had lower prices and variability compared to HMO/Managed Care plans. These findings emphasize the need for greater transparency and standardization in TAVR pricing to reduce disparities and control healthcare costs.
Abstract 4145182: Decadal Shifts in Metabolic Risk Factors Associated Ischemic Heart Disease Mortality Trends: Insights from Global Burden of Disease Study 1990-2021
Authors: Nadeem Bilawal , Saeed Muhammad Subhan , Qadadeh Ziad , Abughazaleh Saeed , Fatima Amel , Jahandideh Dariush
Published: November 2024

Background:
Ischemic heart disease (IHD) continues to be a major contributor to global mortality. Metabolic risk factors are known to be the leading drivers of IHD burden. Our study aims to explain the trends in Metabolic Risk Factors (MRF) associated IHD mortality by utilizing Global Burden of Disease Study data spanning over three decades from 1990 to 2021.

Method:
MRF associated IHD mortality rates in the United States from 1990 to 2021 were sourced from the Global Burden of Diseases 2021 database. Monte Carlo permutation analysis utilizing JointPoint Regression Software (version 4.9.0.1, NCI) was employed to estimate the time trends, using annual percentage change (APC) and average annual percentage change (AAPC) metrics. Initially, these trends were assessed for the overall population. Analysis was then stratified by gender, evaluating age-adjusted rates separately for males and females. Further stratification involved, assessing age-specific trends within two distinct age groups: younger adults (20-54 years) and older adults (>55 years).

Results:
A statistically significant decline in overall mortality was noted, with a moderate decline occurring during the decade 1990 to 2001 (APC= -2.2, p<0.000001), the most substantial decrease during the decade 2001 to 2010 (APC = -4.91, p < 0.000001), and the least decline from 2010 to 2021 (APC = -1.64, p < 0.000001). There was no statistically significant difference in mortality trends between males and females (AAPC difference= -0.14, p = 0.1177). Age-specific analysis revealed a significantly greater decline in mortality among older adults (AAPC = -2.80, p < 0.000001) compared to younger adults (AAPC = -1.32, p < 0.000001).

Conclusion:
Significant decline in metabolic risk factors associated IHD mortality from 1990 to 2021 could be attributed to improved medical interventions and public health strategies, particularly during the decade of 2001 to 2010. The subsequent slower decline from 2010 to 2021 suggests potential limitations in the reach or efficacy of these interventions over time. These findings underscore the need for continued focus on age-specific interventions and public health strategies to further reduce metabolic risk factors associated IHD mortality.
Abstract 4145207: A Comparison Between Global Longitudinal Strain (GLS) Derived with CMR Feature-Tracking (CMR-FT) and 2D Speckle-Tracking Echocardiography (2D-STE) to Monitor Cancer Therapy-Related Cardiac Dysfunction (CTRCD)
Authors: Kar Julia , Cohen Michael , Revere Cherie , McQuiston Samuel , Malozzi Christopher
Published: November 2024

Left ventricular global longitudinal strain (GLS) is a critical imaging biomarker for monitoring cancer therapy-related cardiac dysfunction (CTRCD) in patients treated with chemotherapy. This prospective study investigated the interchangeability between GLS monitored with cardiovascular magnetic resonance feature-tracking (CMR-FT) and 2D speckle-tracking echocardiography (2D-STE) in breast cancer patients who received antineoplastic chemotherapy. At baseline and 3- and 6-month follow-ups after chemotherapy initiation, LV images were acquired on 34 breast cancer patients with 2D echocardiography, Steady State Free Precession (SSFP) MRI, and Displacement Encoding with Stimulated Echoes (DENSE) MRI as reference (Fig. 1). For 3D strains, the DENSE images were analyzed with automated Artificial Intelligence pipelines, SSFP images with SegmentCMR, and the echocardiographic images with EchoPAC. The latter two are vendor tools. Tests of equivalence, with two-one-sided t-tests (TOST) for statistical inferences of a large effect, were conducted between pairs of the DENSE, 2D-STE, and CMR-FT data; the interaction between time and modalities was tested with 2-way repeated ANOVA (RANOVA). The results showed TOST effect sizes larger than the equivalence bounds at all time points between GLS analyzed with CMR-FT and 2D-STE (CMR-FT mean = -16.0±1.9 %, 2D-STE mean = -15.1 ± 3.3%, Equiv. bounds, [-1.6%, 1.6%], 95% CI, [0.3%, 1.8%], p = 0.05 at 3-months), and DENSE and 2D-STE (DENSE mean = -15.9 ± 1.7%, 2D-STE mean = -15.1 ± 3.3%, Equiv. bounds, [-1.5%, 1.5%], 95% CI, [0.0%, 1.8%], p = 0.1 at 3-months), but not between DENSE and CMR-FT (DENSE mean = -15.9 ± 1.7%, CMR-FT mean = -16.0 ± 1.9%, Equiv. bounds, [-1.6%, 1.6%], 95% CI, [-1.3%, 1.5%], p < 0.001 at 3-months). Pairwise comparison from the RANOVA methodology*time interaction showed differences between CMR-FT and 2D-STE-derived GLS (ΔGLS = -0.9%, 95% CI, [-1.7%, -0.1%,], p = 0.03), and DENSE and 2D-STE-derived GLS (ΔGLS = -0.8%, 95% CI, [-1.9%, -0.1%], p = 0.04) but not between DENSE and CMR-FT (ΔGLS = 0.1%, 95% CI, [-0.1%, 0.4%], p = 0.33) at 3-months and also baseline. Statistically, the significant differences between the CMR-FT and 2D-STE results show that the two methodologies should not be used interchangeably for GLS evaluation in CTCRD, and further large-scale studies are required to establish the most suitable methodology.
Abstract 4145229: Outcomes among hospitalized patients with stress-induced cardiomyopathy and concomitant Coronavirus Disease 2019 (COVID-19) infection: Insight from the US National Inpatient Sample
Authors: Malin John , Casipit Bruce Adrian , Wattanachayakul Phuuwadith , Khan Rasha , Idowu Abiodun , Isaacs Evan , Geller Andrew , Casipit Carlo Gabriel , Amanullah Aman
Published: November 2024

Background:
Stress-induced cardiomyopathy (CM) is a form of acute transient left ventricular dysfunction triggered by underlying physiological stress which often leads to increased morbidity and mortality. Coronavirus disease 2019 (COVID-19) is thought to cause stress-induced CM due to overwhelming systemic inflammation. There is paucity of data regarding the impact of COVID-19 on in-hospital outcomes of patients with stress-induced CM. The purpose of this study is to investigate in-hospital outcomes, including mortality and cardiogenic shock, of patients with concomitant COVID-19 and stress-induced CM.

Methods:
We queried the 2020 USA National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified hospitalized adult patients ≥ 18 years old with stress-induced CM and concomitant COVID-19 using ICD-10 CM codes. We used a survey multivariable logistic and linear regression analysis to calculate adjusted odds ratios (aORs) for outcomes of interest. A p value of <0.05 was considered statistically significant.

Results:
A total of 30,705 hospitalized patients with stress-induced CM were identified in 2020, of which 2.41% had concomitant COVID-19. The overall in-hospital mortality rate among patients with stress-induced CM was 10.15%. Among those with concomitant COVID-19, the mortality rate was significantly higher to 39.86% (P=0.00). Using a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, concomitant COVID-19 among patients with stress-induced CM was associated with increased risk for in-hospital mortality (aOR 5.50; p=0.00), development of CS (aOR 2.40; p=0.00) and AKI (aOR 1.84; p=0.00), use of MV (aOR 3.88; p=0.00), and longer LOS (aOR 4.93; p=0.00). (See table 1)

Conclusion:
Our analysis showed that concomitant COVID-19 among hospitalized patients with stress-induced CM increased the risk for in-hospital mortality, risk for the development of CS and AKI, utilization of MV, and longer LOS, but was not significantly associated with the utilization of RRT. This highlights the potential for COVID-19 as a predictor for worse outcomes among hospitalized patients with stress-induced CM.
Abstract 4145236: Predictors of Mortality Among Hospitalized Patients with Acute Myocardial Infarction by Systemic Lupus Erythematosus Diagnosis
Authors: Etuk Aniekeme , George Louisa , Jackson Inimfon , Badr Salem
Published: November 2024

Introduction:
Studies have reported on the prevalence, and associations between acute myocardial infarction (AMI) and systemic lupus erythematosus (SLE), but there is limited data on the predictors of mortality and whether these differ among patients with a diagnosis of SLE. We examined the factors associated with mortality among hospitalized patients with a diagnosis of AMI with or without SLE.

Hypothesis:
Patient and hospital associated factors can predict mortality among hospitalized patients with AMI and these predictors differ by SLE diagnosis

Methods:
The National Inpatient Sample (NIS) data collected from 2016 – 2020 was utilized to conduct retrospective cohort analyses. Multivariate logistic regression models were used to examine the factors associated with mortality among hospitalized patients with AMI by SLE diagnosis.

Results:
Among SLE patients with a diagnosis of AMI, being female (AOR: 1.53; 95% CI: 1.02-1.86) and 65 years and above (AOR: 1.65; 95% CI: 1.20-2.74) was associated with higher odds of mortality compared to being male and younger than 65 years. Elective admission (AOR: 0.59; 95% CI: 0.39-0.85) was associated with lower risk of mortality relative to non-elective admission. Of note, non-Hispanic blacks (AOR: 0.68; 95% CI: 0.39-0.98) had lower odds of mortality than non-Hispanic whites. Patients with length of stay greater than 5 days (AOR: 1.75; 95% CI: 1.18-2.59) were more likely to die than those with hospital stay 5 days or less. Higher comorbidity scores were also associated with higher odds of mortality. Among patients without SLE, non-Hispanic blacks (AOR: 1.68; 95% CI: 1.07–2.48) reported higher mortality compared to their non-Hispanic white counterparts. Additionally, being on private insurance (AOR: 0.75; 95% CI: 0.32–0.99) was associated with lower odds of mortality relative to Medicare insurance.

Conclusion:
Our study highlights patients and hospital related factors that can predict mortality among patients hospitalized with AMI by SLE. Further studies are needed to explore these factors as it will help physicians identify patients that need closer monitoring.
Abstract 4145242: Beta-Blocker Efficacy in Acute Myocardial Infarction: A Machine Learning Approach using the KAMIR-NIH Dataset
Authors: Rha Seung-Woon , Cha Jinah , Ahn Woo Jin , hyun sujin , Choi Se Yeon , Choi Byoung Geol , Sinurat Markz , Park Soohyung , Choi Cheol Ung , Park Chang Gyu , Oh Dong Joo
Published: November 2024

Background:
Acute myocardial infarction (AMI) is a critical global health issue requiring effective secondary prevention strategies. Current guidelines advocate for beta-blockers (BB) in STEMI and NSTEMI cases due to their mortality benefits. However, these guidelines often overlook individual patient variability, necessitating personalized treatment approaches. This study aims to develop a machine learning (ML) model to predict individualized mortality in AMI patients and evaluate the relative benefits of BB across diverse patient profiles to enhance clinical outcomes.

Methods:
We analyzed 12,599 AMI patients in the Korea AMI Registry (KAMIR)-National Institutes of Health (NIH) dataset. Patients were randomly divided into a training set (n = 8,467) and a testing set (n = 4,132) by a 2:1 ratio. Patients were categorized into four quartiles based on Mortality Risk Differences determined by our ML model, indicating increasing benefits from BB therapy. Quartiles Q1 and Q2 (Low-Risk group) showed smaller differences in mortality risks, while Q3 and Q4 (High-Risk group) showed larger benefits.

Results:
Among various ML models, Binary GLM Logistic Regression performed best, achieving an AUC of 0.8428. Our evaluations focused on patients with anemia, those aged over 65, eGFR below 60 and eGFR below 90. These factors were selected because they demonstrated the greatest information gain according to the 'information gain attribute evaluation' in the high-risk group. when analyzing the total test group within these groups, there was a noticeable survival advantage for patients in the BB group compared to those not on BB. (p = 0.009, p < 0.001, p = 0.003, p < 0.001). However, there was no significant difference noted among the groups within the low-risk group.

Conclusion:
This study highlights the potential of ML to enhance personalized medicine in AMI management, particularly in optimizing BB treatment. By utilizing detailed patient data, our model facilitates more personalized treatments that are specifically aligned with individual patient needs, thereby improving clinical outcomes. This approach not only enhances the effectiveness of interventions but also embodies the principles of precision medicine, adapting treatment strategies to optimally suit each patient's unique clinical profile.
Abstract 4145247: Optimal threshold of donor-derived cell-free DNA for detection of cardiac transplant rejection: a meta-analysis
Authors: Shah Kunal , Han Donghee , Kim In-Cheol , Stern Lily , Kransdorf Evan , Chang David , Hamilton Michele , Nikolova Andriana , Kittleson Michelle , Patel Jignesh , Berman Daniel , Kobashigawa Jon
Published: November 2024

Background:
Plasma donor-derived cell-free DNA (dd-cfDNA) has emerged as a biomarker for acute heart transplant rejection as a potential adjunct to endomyocardial biopsy (EMBx). However, an established threshold for dd-cfDNA in acute cardiac transplant rejection is lacking, with prior studies employing different study specific thresholds. This meta-analysis aims to assess the overall diagnostic accuracy of dd-cfDNA across various cutoffs and provide an optimal threshold.

Method:
PubMed and Web of Science were searched for relevant publications reporting on the use of dd-cfDNA for the detection of acute cardiac transplant rejection defined as acute cellular rejection (ACR) and/or antibody-mediated rejection (AMR), with EMBx as the reference standard. Pooled sensitivity and specificity were estimated across different thresholds of dd-cfDNA across studies. The optimal dd-cfDNA threshold was estimated by specificity and 1-sensitivity in each data point pooled with fractional polynomial models, maximizing the Youden index between these models.

Results:
Out of 247 screened papers, 13 studies were included, comprising 12,017 samples from 3,723 patients. Twelve studies used both ACR and AMR and one study used only ACR for the definition of transplant rejection. The thresholds of dd-cfDNA varied across studies, ranging from 0.1 to 0.35 (Figure A). The overall pooled sensitivity and specificity for detecting acute transplant rejection were 0.68 (95% CI: 0.58-0.77) and 0.82 (95% CI: 0.74-0.88) respectively. The areas under the hierarchical modeling-based summary receiver-operating characteristics (sROC) curves were 0.82 (95% CI: 0.78-0.85). Specificity increased with higher thresholds while sensitivity decreased (Figure A and B). The optimal dd-cfDNA threshold derived from combining all included studies was 0.218.

Conclusion:
Dd-cfDNA assay demonstrates high diagnostic accuracy for acute cardiac transplant rejection, particularly notable for its high specificity. However, there exists significant inconsistency in dd-cfDNA thresholds across studies. Increasing the threshold leads to a trade-off between increased specificity and decreased sensitivity. A cutoff of 0.22 may be considered for dd-cfDNA screening for heart transplant rejection.
Abstract 4145263: A Novel Multivariate Scoring System for Diagnosing Post-Myocardial Infarction Pericarditis Following Percutaneous Coronary Intervention
Authors: Bolaji Olayiwola , Omoru Okiemute , Upreti Prakash , Echari Blanche , Shoar Saeed , Basit Jawad , Alraies M Chadi
Published: November 2024

Introduction:
Post-myocardial infarction (MI) pericarditis, particularly after percutaneous coronary intervention (PCI), presents with distinct clinical, laboratory, and electrocardiographic features. Despite its unique presentation, no dedicated diagnostic tools exist for this condition in the post-PCI setting, highlighting the need for a tailored approach. This study aims to develop and validate the first comprehensive clinical scoring system specifically designed to accurately diagnose post-MI pericarditis following PCI, utilizing data available at admission.

Methods:
In this diagnostic case-control study, we compared 60 patients with confirmed post-PCI pericarditis (verified by echocardiography) from our PCI Registry with 120 control patients with various diagnoses from our hospital database. We evaluated 26 potential predictors, including clinical characteristics, chest pain descriptors, and additional diagnostic tests. Independent predictors for the scoring model were identified using stepwise logistic regression.

Results:
Among the 17 initial variables associated with pericarditis, five independent predictors were identified: age, chest pain exacerbation with thoracic movement, rising troponin levels, diffuse ST-segment elevation, and C-reactive protein levels. These predictors were incorporated into a scoring system based on their regression coefficients. The model demonstrated excellent discrimination, with a C-statistic of 0.97 (95% CI: 0.93-1.0). A score above 6 points yielded a sensitivity of 95% (95% CI: 85-100) and specificity of 86% (95% CI: 78-93), with positive and negative likelihood ratios of 7.2 (95% CI: 4.2-12) and 0.05 (95% CI: 0.01-0.2), respectively, Figure 1.

Conclusion:
We have developed the first multivariate scoring system specifically designed to identify post-MI pericarditis in patients undergoing PCI. Its promising accuracy has the potential to enhance early recognition, streamline diagnostic processes, and ultimately improve patient outcomes.
Abstract 4145275: Demonstrating Pulmonary Hypertension Reversibility Before Heart Transplantation: A Novel Bedside Technique Using Postural Change
Authors: Patel Ravi , Goral Montana , hardin elizabeth , Kim Han Wool , Malensek Paris , Beaini Hadi , O'Hara Patrick , Jawaid Anas , Hussain Fizza , Araj Faris
Published: November 2024

Introduction:
Pre-transplant pulmonary hypertension (PH) increases the risk of post-heart transplant right ventricular failure and as a result, morbidity, and mortality. Irreversible pulmonary hypertension is a contraindication to heart-only transplantation. Invasive and non-invasive methods to show PH reversibility include temporary and durable mechanical circulatory support (MCS), pulmonary vasodilators, diuretics, and inotropes. We herein describe a novel bedside technique to show PH reversibility and discuss its potential implications.

Case:
A 58-year-old female with advanced nonischemic cardiomyopathy was evaluated for heart transplant. There was no history of diabetes or dysautonomia. Supine right heart catheterization showed significant PH with the following data: PA 70/37 mmHg (48 mmHg); PCWP 25 mmHg; CO 4.03 L/min; PVR 5.7 WU. Diuretic therapy and sodium nitroprusside (SNP) were started, however due to hypotension SNP was stopped, and milrinone was initiated. Incidentally, we noticed that while seated in a chair her pulmonary hemodynamics dramatically improved without additional intervention: BP 111/73 (85) mmHg; PA 36/20 (25 mmHg); CO 3.91L/min. Once back in the supine position, the PA pressures returned to baseline. The findings were reproducible (Figure).

Management:
The patient continued IV diuretic and milrinone. SNP was not reintroduced, and IABP unloading was avoided as we felt reassured that the postural change in PA pressure was equivalent to vasodilator associated PH reversibility and identified a favorable phenotype for transplant. The patient underwent heart transplant and did not require an RVAD, or prolonged inotrope wean.

Conclusion:
To our knowledge this is the first case to describe the utility and predictive value of postural reversibility in PH in heart transplant. This is a simple bedside technique that can be performed at no extra cost using gravity to change cardiac loading conditions and may be as effective as more expensive and invasive treatments. Implications include the use of lower body negative pressure (LBNP) to prevent PH while supine during sleep or in bed. LBNP decreases venous return, leading to reduced preload and afterload, and thus reduces PH and in theory may avoid the need for durable MCS to treat PH in those needing heart transplant. We encourage further studies to determine the cost-effectiveness, clinical utility, and predictability of this novel technique for both RV failure post heart transplant and post-LVAD.
Abstract 4145277: The Utility of the Modified Shock Index (MSI) in Risk Stratification of Patients with STEMI
Authors: Jnani Jack , Weintraub Spencer , George Riya , Impastato Brandon , Kamel Maikel , Sood Aditya , Hsieh Ji-Cheng , Srivastava Shreya , Tsai Andrew , Alboucai Jack , Bulsara Kishen , Cheng Austin , Griffin Matthew , Alvarez Villela Miguel , Pierce Matthew
Published: November 2024

Introduction:
The Modified Shock Index (MSI) is easily calculated from a patient’s vital signs on admission. There have been small studies that suggest that MSI can be helpful to risk stratify patients with STEMI.

Methods:
We collected retrospective data on 760 patients admitted with STEMI at our quaternary academic medical center from 2018-2022. The MSI was computed as the heart rate divided by the mean arterial pressure collected on initial admission. We defined two cohorts: one with an MSI value of greater than or equal to 0.93 and one with MSI<0.93 based on prior literature on the topic (Abreu et al, 2018). Vasopressors included norepinephrine, neo-synephrine, and vasopressin while inotropes included milrinone and dobutamine. We utilized multivariable logistic regression to compare our two cohorts and adjusted for collinearity.

Results:
In a univariate analysis, female sex (OR 1.95, 95% CI 1.32-2.87, p=0.0007), diabetes (OR 1.75, 1.21-2.54, p= 0.003), post-COVID era (OR 1.52, 1.06 to 2.21, p=0.025), and reduced ejection fraction (OR 0.98, 0.96 to 0.99, p= 0.0008) were associated with elevated MSI. In a multivariate analysis, an MSI>= 0.93 was associated with over 6x increased need of vasopressors during admission (OR 6.12, 3.32-11.47, p<0.0001) and almost 6x increased use of inotropes (OR 5.76, 2.54-13.44, p<0.0001). An elevated MSI was also associated with 5.5x increased need for mechanical ventilation (OR 5.45, 2.91-10.41, p<0.0001), 5.7x increased need for temporary mechanical circulatory support (tMCS) (OR 5.68, 3.18-10.30, p<0.0001) and 2x increased risk of LV thrombus development (OR 2.23, 1.1-4.4, p= 0.02). An elevated MSI was also associated with 2.5x increased risk of CICU length of stay (LOS) > 3 days (OR 2.51, 1.37-4.6, p=0.0003) and over 3x increased risk of hospital LOS greater than 1 week (OR 3.1, 1.7-5.7, p=0.0003).

Conclusions:
At our center, an MSI greater than or equal to 0.93 was significantly associated with the use of vasoactive agents, mechanical ventilation and tMCS. An elevated MSI was also associated with prolonged CICU and hospital LOS. MSI is a simple yet informative tool to risk stratify STEMI patients and help determine their initial level of care.