bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Transrectal Ultrasound Five‐Grade Scoring System and Multiparametric MRI PI‐RADS Score for Risk Prediction Modeling of Prostate Cancer and Clinically Significant Prostate Cancer in the PSA Gray Zone
Authors: Dong Qi , Tong Zhen , Xia Jianguo , Yang Wenqi , Liu Guiqin , Wu Guangyu , Xie Shaowei , Li Hongli
Published: November 2024

Purpose: This study aims to develop and validate predictive nomograms for prostate cancer (PCa) and clinically significant PCa (csPCa) in prostate‐specific antigen (PSA) gray zone of 4−10 ng/mL, utilizing transrectal ultrasound five‐grade scoring system (TRUS‐5), prostate imaging reporting and data system (PI‐RADS) score based on multiparametric magnetic resonance imaging (mpMRI) and clinical parameters.

Method: A retrospective analysis was conducted on a cohort of 383 patients with elevated PSA levels in the gray zone who underwent initial TRUS‐guided 12‐core prostate biopsy between January 2018 and December 2020. Multivariate logistic regression analyses were utilized to identify independent predictors for PCa and csPCa and to establish predictive nomograms. The diagnostic performance, calibration ability, and clinical usefulness of each model were assessed through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA), respectively.

Results: Two diagnostic nomograms were developed based on five risk factors (age, free/total PSA [(f/t) PSA] ratio, prostate volume [PV], TRUS‐5, and PI‐RADS score) to predict PCa and five risk factors (PSA, (f/t) PSA, PV, TRUS‐5, and PI‐RADS score) for csPCa of PSA gray zone patients. The TRUS‐5/PI‐RADS combined model demonstrated higher area under the curves (AUCs) (0.865 for PCa and 0.910 for csPCa) compared to the models based on PI‐RADS score or TRUS‐5 (p  < 0.05), as well as the greater net benefits across a wide range of threshold probabilities for PSA gray zone patients.

Conclusion: The current study presented valuable TRUS‐5/PI‐RADS combined nomograms for predicting PCa or csPCa in patients within the PSA gray zone, which may serve as useful tools for the clinical management of PCa and csPCa.
Prevalence and Associated Factors of Anemia Among Pregnant Women Attending Antenatal Care at Mizan Aman General Hospital, Bench Maji Zone, Southwest, Ethiopia
Authors: Tegegne Kaleab Tesfaye , Abeje Seblework , Tegegne Eleni Tesfaye , Tessema Mekibib Kassa , Wudu Tadele Kassahun
Published: November 2024

Background: Anemia is one of the most common nutritional deficiency disorders affecting pregnant women; its prevalence in developed countries is 14% and in developing countries 51%. It is therefore important to understand the prevalence and associated factors of anemia in our study area. This will encourage antenatal caregivers to identify and treat anemia early in pregnancy.

Objective: Therefore, the study’s goal was to determine the prevalence of anemia and its contributing factors among pregnant women receiving prenatal care.

Methods: Between April 2021 and May 2021, 295 pregnant women attending prenatal care participated in a cross‐sectional facility‐based study. Epidata software was used to enter the data, which were then exported to SPSS software for Windows version 23 for analysis. To determine the factors contributing to anemia in pregnant women, descriptive statistics collected with the study were performed together with bivariable logistic regression and the log‐binomial model.

Results: Among the 295 study participants, 24.7% were anemic. Out of these, most were mild types 78.1%. Illiterate pregnant women (ARR 2.89; 95% CI: 1.76–6.43, p value = 0.037), with no iron‐containing food intake per day (ARR 1.74; 95% CI: 1.59–1.95, p value = 0.01), and infected with malaria (ARR 1.58; 95% CI: 1.76–2.53, p value = 0.03) had higher odds of being anemic, compared to their counterpart. Gestational age of the first (ARR 0.21; 95% CI: 0.03–0.98, p value = 0.01), and second (ARR 0.8; 95% CI: 0.43–0.96, p value = 0.013) trimester has lower odds of being anemic compared to their counterpart.

Conclusion: Anemia in pregnant women is found to be a moderate public health issue in the research location. It is strongly and independently impacted by malaria infection and iron‐containing meal consumption. Reducing the prevalence of anemia is made possible by improved iron‐containing meal consumption. In addition, it is strongly advised that pregnant women receive education and should take iron supplements during pregnancy visits.
Supplementary Figure S.21 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.21
Supplementary Figure S.20 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.20
Supplementary Figure S.13 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.13
Supplementary Figure S.1 from Mathematical Modeling Unveils Optimization Strategies for Targeted Radionuclide Therapy of Blood Cancers
Authors: Kuznetsov Maxim , Adhikarla Vikram , Caserta Enrico , Wang Xiuli , Shively John E. , Pichiorri Flavia , Rockne Russell C.
Published: November 2024

Supplementary Figure S.1
Identification of Risk Factors Associated with Metabolic Dysfunction-Associated Steatotic Liver Disease in Psoriatic Patients
Authors: Küçük Kirley , Moreno Christophe , Nijmi Hassane , Daoud Mathieu , Mintoff Dillon , Willaert Fabienne , Benhadou Farida
Published: November 2024

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common cause of chronic liver disease. Patients suffering from psoriasis are at an increased risk of developing MASLD. Psoriasis and MASLD share a pro-inflammatory cytokine milieu; however, it is still unclear whether these conditions are related through shared metainflammatory processes or shared comorbidities such as obesity, diabetes, insulin resistance, and metabolic syndrome. The aim of our study was to better characterize the anthropometric and metabolic profile of psoriatic patients with MASLD. Methods: We conducted a prospective, single-center, cross-sectional study between June 2014 and August 2017. Recruitment was restricted to adult patients with psoriasis. Blood analysis, liver ultrasonography, and a FibroScan were performed. Blood investigations, baseline anthropometric measurements, and components of fatty liver disease (hepatic ultrasound, FibroScan) were assessed. Results: A total of 100 patients were recruited, of which, 43% (65.1% men, n = 28) were diagnosed with MASLD. The mean BMI was significantly higher in MASLD than in non-MASLD (27.7 kg/m2 vs. 30.1 kg/m2, p =< 0.001). The mean waist circumference in MASLD patients was significantly higher than in non-MASLD patients (105.6 cm vs. 97.2 cm, p = 0.005). There was no significant difference between the mean age of both patient groups (50.4 vs. 47.3 years, p = 0.26). Psoriatic arthritis was more prevalent in MASLD than in the non-MASLD group (14.3% vs. 1.8%, p = 0.004). Biochemical analysis revealed significantly higher C-peptide level in patients with MASLD compared with patients without MASLD (2.5 vs. 1.6 ng/mL, p = 0.036). Moreover, MASLD patients were found to have a lower HDL level and higher glycemia, triglyceridemia, cholesterol, and LDL levels than non-MASLD patients. A total of 16.3% of patients with MASLD had fibrosis stage ranging from F2 to F4 based on liver stiffness measurement compared with only 10.6% of patients without MASLD. Discussion: We identified parameters which were more prevalent in patients with psoriasis having MASLD, specifically a high BMI, elevated triglyceride levels, decreased HDL levels, and an elevated level of C-peptide. Patients with psoriasis and MASLD were more likely to suffer from comorbid psoriatic arthritis, despite having similar psoriasis disease severity as measured by PASI. Conclusion: This study highlights the importance of screening patients with psoriasis for MASLD to prevent the progression to liver fibrosis.
Comparative Efficacy and Safety of Anesthetic and Sedative Regimens for Endoscopic Retrograde Cholangiopancreatography: A Network Meta-Analysis
Authors: Liu Yufang , Xiao Jifeng , Chen Tian , Shi Dongdong , Qiao Yan , Liao Xingzhi
Published: November 2024

Introduction: This study evaluates the efficacy and safety of various anesthetic and sedative regimens for endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods: A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios. Results: 42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR <0.01), dexmedetomidine plus fentanyl (RR <0.01), propofol plus nalbuphine (RR = 0.01), Mg sulfate plus propofol (RR = 0.01), and propofol plus fentanyl (RR = 0.02) showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR = 0.01), propofol plus oxycodone (RR = 0.09), and dexmedetomidine plus fentanyl (RR = 0.2) exhibited lower rates of adverse events compared to propofol. Conclusion: This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures.
No Calidoscópio da Diplomacia: Formação da Monarquia Constitucional e Reconhecimento da Independência e do Império do Brasil de 1822 a 1827
Authors: Santos Guilherme de Paula Costa
Published: November 2024

As negociações diplomáticas para o reconhecimento da Independência e do Império do Brasil constituem o tema central deste livro. Fruto de uma tese de doutoramento, a obra busca compreender as tratativas diplomáticas em torno da independência a partir das vicissitudes e fragilidades políticas vivenciadas pelo governo de D. Pedro i no Rio de Janeiro. Pela confrontação de fontes diplomáticas produzidas em diferentes partes do Atlântico — Rio de Janeiro, Lisboa e Londres — a obra delineia a difícil trilha percorrida pelos agentes do gabinete D. Pedro na Europa que buscavam a todo custo o reconhecimento internacional do governo do Rio. Entretanto, questões discutidas nas mesas internacionais apresentaram-se muitas vezes como rastilho de pólvora nos debates políticos do Brasil. Abolição do tráfico de escravos e possibilidade de uma Monarquia dual, entre outros temas, motivaram disputas e dissenções em torno do governo que se formava ao redor de D. Pedro no Rio de Janeiro. Nesse jogo em que se cruzam proposições externas com desafios e divisões políticas internas, o livro lança luz na atuação do gabinete do Rio de Janeiro ao longo da década de 1820. Na busca por obter o reconhecimento internacional e, assim, enquadrar-se plenamente nas trocas reguladas pelo livre mercado, o governo de D. Pedro i assumiu compromissos, desrespeitou acordos e agiu isoladamente em muitas ocasiões. Das questões internacionais, portanto, é possível acompanhar os dilemas, as lutas, as dificuldades e as contradições da ação política liberal que pautou a construção do Estado Nacional brasileiro no início do século xix. Guilherme de Paula Costa Santos é bacharel e licenciado em História pela Universidade de São Paulo e dedica-se aos estudos sobre história do Império do Brasil. Atualmente também é professor de ensino superior e na educação básica.
Abstract 4138847: Home Blood Pressure Reductions With Zilebesiran In Patients With Mild-To-Moderate Hypertension Are Consistent With Ambulatory And Office Blood Pressure Reductions In The KARDIA-1 Study
Authors: Zappe Dion , Saxena Manish , Desai Akshay , Nweke Chinedu , Basile Jan , Carr George , Chauhan Rajvir , Zee Tiffany , Goyal Nitender , Bakris George
Published: November 2024

Background:
Zilebesiran is an investigational subcutaneous (SC) RNA interference therapeutic targeting hepatic angiotensinogen synthesis. In the Phase 2 KARDIA-1 study (NCT04936035), changes in blood pressure (BP) were assessed with different zilebesiran dosing regimens as monotherapy in patients with mild-to-moderate hypertension, and clinically significant reductions in ambulatory and office systolic BP (SBP) were observed throughout the 6-month treatment period. In this analysis, we report time-adjusted changes in SBP, a measure of weighted average BP over time, assessed by three modalities: ambulatory, office, and weekly home BP monitoring.

Method:
Adults with daytime mean ambulatory SBP of 135–160 mmHg were randomized equally to zilebesiran (150 mg, 300 mg, or 600 mg once every 6 months, or 300 mg once every 3 months [Q3M]) or placebo SC Q3M. Secondary and post hoc analyses included calculation of time-adjusted change in SBP from baseline through Month 3 and through Month 6 for ambulatory (24-hour mean and daytime), office, and home BP assessments. Rescue antihypertensive medication was permitted between Months 3 and 5.

Results:
KARDIA-1 included 377 patients (24.7% Black, 55.7% men, mean age 56.8 years). Time-adjusted least squares mean changes in SBP (mmHg) from baseline through Month 3 for different zilebesiran doses ranged from −5.5 to –9.0 for 24-hour mean ambulatory, −5.7 to –9.2 for daytime mean ambulatory, −9.1 to −10.9 for office, and −8.3 to −9.9 for home BP assessments, compared to −0.6 to 5.6 for placebo across the different modalities (Table). Time-adjusted reductions from baseline in SBP were sustained up to Month 6. Additional measures of BP control through Month 6, including percentage of time in target range, will be presented.

Conclusion:
Clinically significant time-adjusted reductions observed with self-assessed home BP following treatment with zilebesiran were consistent with ambulatory and office BP reductions, indicating that self-monitoring of BP control with zilebesiran is viable outside of the clinical visit setting. Weekly home BP measurements demonstrated consistent reductions in SBP, highlighting the potential of zilebesiran for providing sustained BP control.
Abstract 4139106: Prevalence and Prognostic Significance of Coronary Microvascular Dysfunction in Diabetic Heart Failure With Preserved Ejection Fraction Using Quantitative Perfusion Cardiac Magnetic Resonance
Authors: Yang Yang , Zeng Mu , Yu Bilian
Published: November 2024

Background:
The pathophysiological and clinical significance of coronary microvascular dysfunction in patients with diabetes mellitus and heart failure with preserved ejection fraction (HFpEF) remains uncertain.

Research Questions: We aimed to use cardiac magnetic resonance to quantify coronary microvascular function, explore the relationship between perfusion and fibrosis, and assess the impact of coronary microvascular function on long-term clinical outcomes.

Methods:
In a prospective, observational study, patients with type 2 diabetes (T2DM) and heart failure were recruited alongside control subjects. All participants underwent clinical assessment and cardiac magnetic resonance, which included T1 mapping, extracellular volume mapping, as well as measurement of myocardial blood flow at rest and during maximal hyperaemia. The primary endpoint was defined as the composite outcome of death or hospitalization with a cardiovascular cause.

Results:
A total of 65 control individuals and 443 patients with T2DM were screened. Of 167 T2DM patients in the final analysis, 55 (32.9%) patients were categorized as HFpEF, 70 (41.9%) as heart failure with ejection fraction less than 50% (DM-non-HFpEF), and 42 (25.1%) as control subjects with no heart failure (DM-control). Patients with DM-HFpEF exhibited a comparatively diminished myocardial perfusion reserve (MPR) in comparison to the other three cohorts (all P<0.05). Coronary microvascular function (defined as MPR <2.0) was present in 81.82% of patients with DM-HFpEF. MPR was associated with cardiac troponin T levels (r =-0.3687; P<0.0001) and diffuse fibrosis (extracellular volume: r =-0.5941; P<0.0001). In all participants, during a mean follow-up of 284 days, there were 47 composite events. MPR demonstrated independent predictability of clinical outcomes even adjusting for clinical, blood, and imaging parameters. Patients with lower MPR (cutoff point, 1.95) exhibited a higher risk of adverse outcomes compared with patients with higher MPR (P=0.0001).

Conclusions:
In symptomatic patients with T2DM, a high prevalence of impaired MPR was observed specifically in individuals with HFpEF. MPR was associated with makers of myocardial injury and fibrosis and was predictive of adverse clinical outcomes. These findings could help identify high-risk patients, leading to more intensive treatment.
Abstract 4139203: Anatomical Variations in Coronary Arteries and Implications in Spontaneous Coronary Artery Dissection
Authors: Gabaldon Badiola Alvaro , Kir Devika , Tweet Marysia , Donisan Teodora , Alfonso Fernando , Prasad Abhiram , Gulati Rajiv
Published: November 2024

Introduction:
Spontaneous coronary artery dissection (SCAD) is a poorly understood cause of acute coronary syndrome (ACS), predominantly affecting young women and frequently related to acute stressors. It has been suggested that stress induced cardiomyopathy can cause dissection via mechanical distortion of the vessel at wall-motion hinge points. Whether specific coronary anatomic configurations also predispose to distortion and hence SCAD remains unknown.

Hypothesis:
Patients with left anterior descending (LAD) SCAD have a higher frequency of a “wrap around” (type IV - perfuses >25% of the inferior wall) LAD.

Methods:
Coronary angiograms of patients in the Mayo Clinic SCAD Registry were reviewed. Patients from functional angiogram registry with similar characteristics were used as controls. Patients with an LAD SCAD were compared to patients who never had an LAD SCAD. For identifying predictors of LAD SCAD, patients who never had an LAD SCAD were compared to patients that had an LAD SCAD as a recurrent event, but not as the initial presentation.

Results:
A total of 456 patients with SCAD (46±6 years; 96% women) were included. The control group consisted of 178 patients (44±7 years, 97% women). Type IV LAD was more common in the SCAD cohort (Figure 1), and patients in the LAD SCAD group had a higher proportion of type IV LAD when compared to non-LAD SCAD (47.6% vs 23.0% p < 0.001). Bifurcation involvement was also more frequent (48.6 vs 25.8%, p <0.001).

Individual predictors of an LAD SCAD during follow-up were diagnosis of hypertension, peripartum SCAD, involvement of a bifurcation and type IV LAD. After multivariate analysis, only bifurcation involvement (OR 2.49, p = 0.01) and type IV LAD (OR 2.26, p = 0.02) remained as predictors of LAD SCAD during follow-up.

In patients in whom the PDA perfused the apex (LAD I and II), PDA was more likely to be involved by SCAD (OR 6.17, p<0.001). There were no other differences in coronary distribution after stratifying by LAD types.

Conclusions:
Type IV LAD variant is more common in patients with LAD SCAD. This finding suggests that coronary anatomic variants predispose to SCAD and lend further support to the mechanical distortion hypothesis.
Abstract 4139206: Design of Heart-2: a phase 1b clinical trial of VERVE-102, an
in vivo
base editing medicine delivered by a GalNAc-LNP and targeting
PCSK9
to durably lower LDL cholesterol
Authors: Vafai Scott , Karsten Verena , Jensen Chelsey , Falzone Richard , Lister Troy , Stolz Leslie , Khera Amit , Kathiresan Sekar , Bellinger Andrew , Fiedorek Fred
Published: November 2024

Introduction:
Maintaining LDL-C at goal levels is critical in populations at high risk for cardiovascular events, including people with heterozygous familial hypercholesterolemia (HeFH) and/or premature coronary artery disease (CAD). Despite multiple approved LDL-C lowering therapies for these populations, most patients are not at guideline-directed treatment goal.
In vivo
base editing to inactivate hepatic
PCSK9
has the potential to provide lifelong LDL-C lowering after a single course of treatment. Success of the base editing approach is contingent on safe and effective hepatocyte delivery and precise, consistent
PCSK9
editing.

Aim:
We set out to develop a base editing medicine to inactivate
PCSK9
with broad utility across diverse genetic backgrounds. Here we describe the investigational therapy, VERVE-102, and the design of the ongoing, phase 1b Heart-2 trial.

Approach:
VERVE-102 consists of an mRNA encoding an adenine base editor and guide RNA (gRNA) targeting
PCSK9
packaged in a novel, proprietary GalNAc lipid nanoparticle (LNP). VERVE-102 creates a precise A-to-G DNA edit to introduce a premature stop codon and thereby inactivate
PCSK9
in hepatocytes. In a DNA sequence analysis of 784,318 individuals from diverse ancestries, the 20 base-pair sequence targeted by the gRNA was identical in 99.97% of individuals. LNP delivery to hepatocytes
in vivo
occurs through either endogenous LDL receptor (LDLR) uptake or GalNAc-mediated endocytosis via the asialoglycoprotein receptor (ASGPR) and as such, may address the LDLR deficiency seen in a fraction of patients with HeFH. Heart-2 is a single ascending dose trial of VERVE-102 in males and females aged 18–65 with HeFH and/or premature CAD who require additional LDL-C lowering despite maximally tolerated oral lipid-lowering therapies. Participants receive a single intravenous infusion of VERVE-102 with 3 to 9 participants per dose cohort. The primary endpoint is safety and tolerability. Secondary endpoints include pharmacokinetics of VERVE-102 and changes from baseline in blood PCSK9 and LDL-C.

Discussion:
VERVE-102 was designed to access hepatocytes via either LDLR- or ASGPR-mediated uptake to enable robust LNP delivery and subsequent
PCSK9
editing. Consistency of the gRNA target site suggests that potential therapeutic benefits should apply broadly across ancestries. The ongoing Heart-2 clinical trial is intended to support selection of a safe and effective dose for future clinical investigation of VERVE-102.
Abstract 4139285: Awareness of Myocardial Infarction and Stroke Symptoms Among Asian American Adults: Insights from the National Health Interview Survey 2014 and 2017
Authors: Patel Nehal P. , Le Austin D. , Kawaleet Yanal B. , Dodani Sunita
Published: November 2024

Introduction:
Stroke and Myocardial Infarction (MI) are the leading causes of death in the United States. Awareness of symptoms is vital for early recognition and prompt treatment, which can significantly improve health outcomes. This study examines MI and stroke symptom awareness among Asian American adults, a group with limited prevalence estimates on this critical health metric.

Hypothesis:
There is variability in MI and stroke symptom awareness among Asian American subgroups, influenced by sociodemographic factors such as age, nativity, education, and income.

Methods:
We conducted a secondary analysis using data from the 2014 and 2017 National Health Interview Survey. Our sample included 2,832 Asian adults, categorized into self-identified ethnic groups: Asian Indian, Chinese, Filipino, and "Other Asian" (an aggregate category including Japanese, Korean, Vietnamese, and others due to low sample sizes). We assessed awareness of MI and stroke symptoms and the prevalence of recognizing 9-1-1 as the appropriate subsequent action using the Rao-Scott chi-square test to account for the complex survey design.

Results:
The study sample consisted of 2,832 adults (46.7 % male, 53.3% female, mean age 44.6 years [SD: 16.5 years]). Ethnic distribution was 22.0% Asian Indian, 22.5% Chinese, 20.8% Filipino, and 34.7% Other Asians. Significant disparities in symptom awareness were found among subgroups. Filipino adults exhibited the highest awareness of all five stroke symptoms (68%, 95% CI: 63%-73%) compared to Chinese (62%, 95% CI: 57%-67%), Asian Indian (53%, 95% CI: 48%-58%), and Other Asian adults (59%, 95% CI: 57%-61%). Similarly, Filipino adults also had the highest awareness of MI symptoms (51%, 95% CI: 45%-56%), compared to Asian Indian (37%, 95% CI: 32%-42%), Chinese (30%, 95% CI: 25%-34%), and Other Asian adults (30%, 95% CI: 27%-34%) (
Figure).

Conclusion:
There is significant heterogeneity in MI and stroke symptom awareness among Asian American adults. Filipino adults demonstrated the highest levels of knowledge regarding subsequent actions. The study underscores the need for targeted public health interventions to enhance MI and stroke symptom awareness, particularly focusing on subgroups with lower awareness.
Abstract 4139332: Patient-Clinician Communication and Cardiovascular Outcomes: An Analysis of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), 2008-2019
Authors: Slavin Samuel , Daviglus Martha , Garcia-Bedoya Olga , Mossavar-Rahmani Yasmin , Perreira Krista , Wassertheil-Smoller Sylvia , Ramos Alberto , Sotres-Alvarez Daniela , Telzak Andrew , Mittleman Murray
Published: November 2024

Background:
Strong patient-clinician communication may improve health outcomes for marginalized populations, including Hispanic/Latino individuals.

Objective:
We assessed the association between patient-clinician communication and cardiovascular (CV) events or death in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Methods:
HCHS/SOL is a longitudinal cohort study of individuals aged 18-74 who identified as Hispanic/Latino at 4 U.S. sites. Participants' ratings of communication with clinicians during the year before enrollment were used to generate a communication score. The primary outcome was the composite of myocardial infarction (MI), heart failure events (HF), stroke, and all-cause mortality. The secondary outcomes included the primary outcome components. The association between the baseline communication score and outcomes of interest was assessed with Cox proportional hazards models adjusting for possible confounders. We also used multivariable linear regression to assess the cross-sectional association between communication and AHA Life’s Essential 8 (LE8), a measure of CV risk factors. All analyses accounted for the complex survey design.

Results:
Our sample included 10,527 individuals without prior CV events and at least one medical encounter in the year before enrollment. The median age at enrollment was 41 years (IQR 29, 53), 59% were female, and 71% perceived high-quality communication with clinicians. The mean follow-up time was 9.4 years. High-quality communication was associated with the following results in our adjusted analyses: composite outcome (aHR 0.71, 95% CI 0.49, 1.02, p = 0.066), CV events (aHR 0.79, 95% CI 0.41, 1.51, p = 0.47), all-cause mortality (aHR 0.53, 95% CI 0.35, 0.80, p < 0.01).

Conclusions:
High-quality patient-clinician communication was associated with a non-significant trend toward a lower rate of CV events and death, driven by a significant association with lower all-cause mortality.
Abstract 4139384: Retrospective Review of the Safety and Effectiveness of a Low Carbohydrate Ketogenic Diet in Overweight or Obese Patients with Heart Failure
Authors: Moseley Garrett , Harrington Josephine , Westman Eric , Yancy William
Published: November 2024

Background:
Recent evidence suggests a therapeutic role for ketosis in patients with heart failure (HF). However, little is known regarding the safety and effectiveness of a low carbohydrate ketogenic diet (LCKD) in patients with overweight or obesity and HF.

Purpose:
To examine the safety and effectiveness of a LCKD in patients with overweight or obesity and HF.

Methods:
A retrospective review from 2006-2024 was conducted of all patients with overweight or obesity and HF who followed a LCKD with clinical oversight for at least one year in a university health system. Changes in metabolic outcomes, echocardiographic measures, and medication use were assessed. Heart failure hospitalization (HFH) rates and rate ratios (RR) and all-cause mortality rates were calculated and stratified by HF classification.

Results:
A total of 125 patients met inclusion criteria, including 59 patients with HF with reduced ejection fraction (HFrEF) and 66 patients with HF with preserved ejection fraction (HFpEF). Patients lost a median (interquartile range) of 11.2 kg (-19.5, 4.4;
p
<0.0001) of body weight, and patients who adhered more strictly to the diet lost a larger percentage of body weight (
p
=0.0011). Aspartate amino-transferase and alanine amino-transferase levels decreased by a median (interquartile range) of 2.0 IU/L (-6.0, 2.5;
p
<0.05) and 3.0 IU/L (-8.8, 2.0;
p
<0.01), respectively, in patients with HFpEF. There were no significant changes in total cholesterol or LDL-C levels. Patients with type 2 diabetes significantly decreased their insulin dose while following a ketogenic diet (
p
<0.006). There were no significant changes in left ventricular ejection fraction, but the rate of HFH decreased significantly among all patients combined and patients with HFpEF while following the diet (RR=0.5; 95% CI: 0.4, 0.9 and RR=0.5; 95% CI: 0.3, 0.9; respectively) and decreased nonsignificantly among patients with HFrEF (RR=0.6; 95% CI: 0.3, 1.1). The overall all-cause mortality rate was 3.2 per 100 person-years of follow-up (95% CI: 1.0, 5.3).

Conclusion:
A LCKD among patients with overweight or obesity and HF appears safe and effective for weight loss, with a potential additional benefit for improving metabolic markers and the rate of HFH.
Abstract 4139419: US National Trends in left atrial appendage occlusion volume and open payments to operators
Authors: Kolomaya Alexander , Zenger Brian , Ranjan Ravi , Bunch Thomas , Steinberg Benjamin
Published: November 2024

Background:
Left atrial appendage occlusion (LAAO) was first performed among Medicare beneficiaries in 2017 and has grown rapidly in popularity. Payments from device manufacturers to physicians have been shown to correlate with other procedures, which are now publicly available. We report trends of LAAO in Medicare patients, and the relationship between procedure volume and manufacturer payment.

Methods:
We linked Medicare procedural data with Open Payments data via NPI number and identified physicians performing ≥ 1 LAAO between 2017 and 2021. Baseline physician information, including sex, operating location, and specialty, was extracted from CMS registries. Payment data were highly skewed, and winsorized at the 95
th
percentile and compared to procedural volume.

Results:
The number of LAAO procedures increased from 6069 procedures in 2017 to 29083 in 2021 and 15.695 to 79.994 per 100,000 beneficiaries nationally. Across states, the median rate of implants 46.151 (IQR 33.765 – 62.271) per 100,000 beneficiaries, with Nebraska having the highest rate at 255.269 per 100,000 beneficiaries
(Figure 1).
The number of operators implanting LAAO devices increased from 286 (97.6% male) to 1003 (96.6% male). Roughly 49% of operators are licensed as electrophysiologists and 47% as interventional cardiologists. Total payments to physicians varied widely (median $ 3179.12, IQR 1703.16 – 9000.42) with >99% of operators receiving compensation from the LAAO device company; there is no clear relationship between compensation from the manufacturer and LAAO volume (r
2
=0.132) (
Figure 2
).

Conclusions:
LAAO has seen dramatic growth in volume of procedures and operators nationally, with substantial regional variation. While almost all LAAO operators received compensation from the primary LAAO device company, there is no correlation between payment amount and procedural volume.
Abstract 4139613: Orthotopic Heart Transplant in a Patient with Chronic Lymphocytic Leukemia: Challenges in Management
Authors: Radakrishnan Ankitha , Sharma Apurva , oloomi mehdi , Trivieri Maria Giovanna , love barry , Benza Raymond
Published: November 2024

Description of Case:
A 67-year-old female with a long-standing history of chronic lymphocytic leukemia (CLL, stage 0) on surveillance protocol, end stage heritable cardiomyopathy (titin mutation positive) with ejection fraction 15% and severe mitral regurgitation was referred to our center for advanced therapy evaluation. On evaluation, right heart catheterization showed normal filling pressures but decreased cardiac index (RA 4, PCWP 8, CI 1.6), so she was started on milrinone and listed for transplant as UNOS status 4 exception after extensive discussion regarding advanced therapies in the setting of her low-grade malignancy with favorable outcome. She underwent orthoptic heart transplantation (OHT) with DCD donor and ex-vivo perfusion. The preoperative total leukocytes count was 71,700/μl with mild anemia but no thrombocytopenia. Retrospective crossmatch was notable for flow cytometry crossmatch positive but CDC negative. The post-operative course was significant for an increase in total leukocyte count to 110,000/μl in absence of fever or infective source but was complicated with SVC stenosis at anastomotic site and thrombosis of the SVC and innominate vein necessitating thrombectomy and stent placement in the SVC. She also had bilateral pleural effusions for which she had bilateral chest tubes for three weeks post-transplant. Standard immunosuppression without induction was given and graft function was preserved with biopsies negative for rejection.

Discussion:
This case describes a successful OHT in a patient with long-standing chronic lymphocytic leukemia with a favorable outcome. OHT is the most effective therapy for end-stage heart disease, however historically cancer patients were considered ineligible for this therapy, given the increased risk with post-transplant immunosuppression. Though literature is limited, it is suggested that a careful selection of patients may have favorable outcome with slightly increased risk of cancer. These patients are at increased risk of infections and complications related to immunosuppression, which may exacerbate the immunocompromised state and potential rapid progression of underlying malignancy. Hematologic malignancies increase thromboembolism risk, as seen with this patient. A multi-disciplinary team approach involving oncology and infectious disease is integral for optimizing care in this complex population.
Abstract 4141165: Long-Term Contemporary Outcomes of the Ross Procedure
Authors: bouhout ismail , Chauvette Vincent , Notenboom Maximiliaan Lukas , Poirier Nancy , Demers Philippe , El-Hamamsy Ismail
Published: November 2024

Background:
Current evidence supports the use of the Ross procedure (pulmonary autograft) in adults with aortic valve disease.

Aims:
To examine the ten-year clinical and echocardiographic outcomes following the Ross procedure using a tailored approach.

Methods:
This prospective cohort included 455 consecutive adults (333 male [73.1%]) with a median age of 50.0 years (IQR, 40.0-57.0) undergoing a Ross procedure at a single center. Patients with aortic aneurysms (37.4%), previous cardiac surgery (15.2%) and active endocarditis (5.7%) were included. The predominant lesion was aortic stenosis (AS) in 379 patients (83.3%) and aortic insufficiency (AI) in 76 patients (16.7%). The study period ranged from February 1, 2011, to December 31, 2019. Primary endpoints were cumulative incidence of any, autograft, or homograft reintervention, and time-related valve function (AI grades 0-4). The secondary endpoint was ten-year survival among Ross patients compared with that in the age- and sex-matched Canadian population. Median clinical follow-up was 6.0 years (maximum 13 years). Follow-up was 90% complete for clinical and 87% complete for echo follow-up.

Results:
Operative mortality was 0.4% (n=2). Both patients were operated among the first 100 cases. At 10 years, cumulative incidence of any aortic and/or pulmonary reintervention was 5.0% (95% CI, 2.3-9.4%); autograft reintervention 1.5% (0.5-3.4%); and homograft reintervention 3.4% (1.9-5.7%). In patients with preoperative AS, cumulative incidence of autograft reintervention was 1.8% at 10 years (0.6-4.1%), versus 0% in patients with preoperative AI (p=0.6) (
Figure 1
). At 10 years, cumulative incidence of AI grade >2 was 2.0% (0.9-4.2%), and did not differ between patients with preoperative AS or AI (p=0.9) (
Figure 1
). Ten-year survival was 96.5% (95% CI, 94.7-98.7%), translating to a relative survival of 100% (99.4-100%) compared to the matched general population.

Conclusion:
This study demonstrates that using a tailored surgical approach and contemporary perioperative management strategies, the Ross procedure is associated with excellent long-term valve function and freedom from reintervention in an all-comer adult patient population. Moreover, it translates into restored late survival, mimicking the general population. These results further support the notion that, in reference centers, the Ross procedure should be considered in adults needing valve replacement.
Abstract 4144700: Short Term Effect of His bundle pacing on Myocardial Fatty Acid Metabolism, Perfusion and Function.
Authors: Fujita Takeshi , Kawasaki Masato , Yamada Takahisa , Asai Mitsutoshi , Morita Takashi , Kikuchi Atsushi , Kondo Takumi , Kawai Tsutomu , Seo Masahiro , Nakamura Jun , Oshita Takuya , Kokubu Yuki , Fukuda Yuto , furuta yuzo , Yoshida Motoshi , Oyama Fumiya , Noda Kenji , Yagi Ryota , Fukunami Masatake
Published: November 2024

Background:
Long term right ventricular apex pacing has been reported to affect myocardial metabolism and perfusion to lead to impaired left ventricular function. However, there is little information available on the effect on fatty acid metabolism, myocardial perfusion and function in RV septal or His bundle pacing.

Methods and Results:
We studied 94 patients (mean age 77±11 years, male 40%, AV block 71%) admitted for pacemaker implantation in our prospective cohort study, excluding patients with coronary artery disease who had past histories of coronary arterial revascularization and severe stenosis in coronary CT or coronary angiography. Forty-five patients had right ventricular apex pacing (RVA; n=10) or right ventricular septal pacing (RVS; n=35), 17 had selective or non-selective His bundle pacing (HIS) and, as a control, 32 had right atrial pacing (RA). The patients underwent 123I-β-methyl-P-iodophenyl-pentadecanoic acid (BMIPP) SPECT imaging and Tc-99m- methoxyisobutylisonitrile (MIBI) SPECT imaging between 3 months and 1 year after implantation. The uptakes of both tracers were displayed on a polar map, which was divided into 17 segments. Regional tracer activity at each segment was quantified as %uptake. Left ventricular ejection fraction (LVEF) was also obtained in MIBI imaging.

There were no significant differences in baseline characteristics such as age, gender, or underlying heart disease between the four groups. LVEF in MIBI rest imaging in RVA group was significantly lower than RA group (58.3±2.1% vs 64.9±1.2%, p=0.013), while there was no significant difference in LVEF among RVS, HIS and RA groups, with non-significantly (p=0.25) lower LVEF in RVS (62.5±1.1%) than HIS (65.3±1.6%) groups. The average of BMIPP %uptake in 17 segments significantly correlated with LVEF (r=-0.259, p=0.01). BMIPP and MIBI (stress and rest) %uptake were significantly lower in RVA group and RVS group than RA group in the septal or anterolateral area. Especially, BMIPP %uptake in RVA group was significantly lower at the broad area. On the other hand, BMIPP and MIBI (stress and rest) %uptake in HIS group were almost similar to those in RA group.

Conclusion:
His bundle pacing, but not RV septal pacing, maintains myocardial metabolism, perfusion and function.
Abstract 4145350: Association of Zip Code and Incidence of Driveline Infection in Patients with Left Ventricular Assist Devices (LVADs): Do social determinants of health impact outcomes in LVAD recipients?
Authors: Ramesh Ashvita , Pico Ana , Coglianese Erin
Published: November 2024

Introduction:
Driveline infection (DLI) is common after left ventricular assist device (LVAD) implantation and is associated with high morbidity/mortality. Socioeconomic status (SES) is a well-validated risk factor for poor outcomes among patients with heart failure, but its influence on adverse events in patients post-LVAD is poorly understood and may be overestimated. The primary aim of this study was to determine the association between markers of SES and DLI in LVAD recipients.

Methods:
We conducted a single-center retrospective study of patients who received durable LVAD implants from January 2016 to November 2023. The Distressed Communities Index (DCI), a validated measure of SES, was generated using home zip codes. Baseline patient demographics, insurance, pre-implant device data, and pre-implant laboratory data were also collected. Variables associated with DLI were analyzed with regression and Cox proportional hazard models.

Results:
Of 159 included patients, 23% were found to have at least one DLI. Patients were categorized as prosperous (29%), comfortable (21%), mid-tier (24%), at-risk (18%), and distressed (8%) based on their DCI, with baseline variables similar across DCI groups. Hispanic ethnicity (17% v 7%, p=0.016) and higher pre-implant BMI (mean 27.5 v 25.6, p=0.017) were associated with DLI (Table 1). While the absolute number of days with LVAD was found to be predictive of DLI (HR 0.998, 95% CI: 0.997-0.999, p=0.001), DCI was not found to be predictive of DLI (HR 1.179 95% CI: 0.918-1.514, p=0.196). Of note, BMI was not predictive (HR 0.983, 95% CI: 0.937-1.031, p=0.475).

Conclusion:
In this single center population, SES did not independently predict DLI after LVAD implantation. Our study is consistent with the current body of literature in demonstrating that there are no variables consistently associated with DLI, though no study thus far has evaluated SES. This is a key finding, as SES may factor in the assessment of candidacy for LVAD and concern for complications. This may inappropriately bias against LVAD implantation in patients who live in distressed communities. Further studies are necessary to evaluate if DCI impacts other adverse outcomes post LVAD.
Abstract 4145351: Wearable-Echo-FM: An ECG-Echo Foundation Model for Single Lead Electrocardiography
Authors: Knight Elizabeth , Oikonomou Evangelos , Aminorroaya Arya , Khera Rohan
Published: November 2024

Background:
Single-lead electrocardiograms (ECGs) are widely available on wearable and portable devices and can be leveraged as screening tools for structural heart disorders (SHDs) with novel deep learning ECG applications. However, scope of model development is limited by the need for large numbers of labeled examples. We present a novel approach to encode unstructured echocardiographic information on 1-lead ECGs to enable the design of wearable-adapted artificial intelligence (AI)-ECG models with efficient development for detecting SHDs.

Methods:
We linked 274057 unique ECGs from 77378 patients with reports of echocardiograms done within 30 days across a large, diverse health system (2015-2019). We extracted lead I ECG signals that are typically acquired on wearable devices. We defined 2 discrete encoders, a convolutional neural network (CNN) for ECGs and a RoBERTa-based text encoder for echocardiographic reports. We applied contrastive pre-training for 200 epochs to learn a shared signal-text embedding. In a transfer learning experiment involving an age- and sex-matched training pool of temporally-distinct ECGs all from 2019-2023, we trained sequentially smaller amounts to detect LVEF<40%, LVDD (left ventricular diastolic dysfunction), and a composite measure of LVEF<40%, moderate or severe aortic stenosis, aortic regurgitation, mitral regurgitation, and/or severe LVH (IVSd ≥15 mm) using our Wearable-Echo-FM pre-trained versus standard single-lead ECG CNN model. We examined the performance of these models on the same test set.

Results:
There were a total of 11923 patients (1 ECG per patient, age, 65.3±17.2 2016 (17%) women) in the test set. For models trained on 100% data, the Wearable-Echo-FM model achieved AUROCs comparable to a standard CNN for LVEF < 40% (0.894 vs 0.884), LVDD (0.849 vs 0.843) and a composite of SHDs (AUROC of 0.887 vs 0.869) in the test set. In few-shot learning experiments that only used 0.5% of the training data (~1000 ECGs), the pre-trained model achieved an AUROC of 0.855 vs. 0.548 for the standard model for LVEF < 40%, 0.819 vs. 0.582 for LVDD, and 0.863 vs. 0.496 for the composite SHD.

Conclusions:
We propose an ECG-Echo foundation model that learns shared embeddings between 1-lead ECGs and complex structural cardiac phenotypes recorded on unstructured echocardiographic reports. Our approach enhances the efficiency of developing AI algorithms for SHD screening on wearable and portable devices.
Abstract 4145376: Carbon Monoxide-Induced Atrial Fibrillation: Unveiling the Cardiovascular Spectrum Through a Case Report and Systematic Review of Reported Cases.
Authors: Alqudah Qusai , Obeidat Omar , Hammad Munther , Al-Ani Hashim
Published: November 2024

Background:
Carbon monoxide (CO) poisoning is a significant public health threat, with emerging attention on its cardiovascular consequences such as myocardial injury, heart failure, and arrhythmias. Notably, atrial fibrillation (AF) has been sporadically reported, suggesting a potential link between CO exposure and cardiac dysrhythmias.

Case Report:
A 72-year-old female with hypothyroidism and IBS presented to the emergency department with sudden gait imbalance, dizziness, and an occipital headache. Her ECG showed new-onset atrial fibrillation, with subsequent unremarkable echocardiography and brain imaging. Remarkably, her husband exhibited similar symptoms and both had recently been camping. Suspecting CO poisoning, carboxyhemoglobin was tested and found to be 2.9%, with no methemoglobinemia. The patient spontaneously converted to normal sinus rhythm during hospitalization and maintained it during hospitalization without hyperbaric oxygen therapy.

Systematic Review of Case Reports: We identified seven cases of carbon monoxide-induced atrial fibrillation from 45 citations. Patients were mostly male (57.14%), aged 21 to 82, and presented with diverse symptoms, primarily headache (57.1%) and nausea (57.1%). Rapid ventricular response occurred in 85.7% of cases, none with a prior history of atrial fibrillation. Most (85.7%) returned to normal sinus rhythm upon discharge, and 71.4% maintained it on follow-up. Normobaric oxygen therapy was given in 57.1% of cases, and hyperbaric oxygen in 42.9%. Most patients (85.7%) had no known cardiovascular disease.

Discussion:
Despite being underexplored, evidence suggests a notable escalation in dysrhythmia risk, particularly in patients with pre-existing cardiovascular conditions, following acute CO poisoning. Potential mechanisms for CO-induced dysrhythmias include the strong binding of CO to hemoglobin, resulting in hypoxia-induced myocardial changes, and molecular alterations affecting cardiac voltage-gated channels.

Conclusion:
While the association between acute CO poisoning and dysrhythmias warrants further investigation, emerging evidence underscores the necessity of raising awareness among healthcare providers regarding the potential cardiovascular consequences of CO exposure.