bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4119303: The New Strait-Jacket Designed for Endovascular Therapy Reduces the First Reperfusion Time of Emergency Thrombectomy for Stroke
Authors: Mei Bin , Xie Fei , Xie Fei , He Yi , Chen Fang , Feng Xia , Wang Ziying , Mei Jing
Published: November 2024

Introduction:
Conscious sedation during cerebrovascular interventional surgery can shorten the time of vascular recanalization and bring significant benefits to patients, but patients are often difficult to cooperate, which affects the operation of interventional surgery. This study aims to develop a novel cerebral vascular intervention strait-jacket and explore its safety and effectiveness in emergency cerebral vascular intervention surgery.

Methods:
Using the convenient sampling method, patients with acute large artery occlusion stroke who underwent emergency mechanical thrombectomy in Zhongnan Hospital of Wuhan University from September 2018 to March 2021 were selected as the research objects. The control group was treated with conventional restraint belt, and the experimental group was treated with new cerebrovascular interventional surgery strait-jacket. The first reperfusion time, total operation time, modified Rankin score (mRS) at 30 days, intraoperative limb prolapse rate, average surgical cost, and safety indicators were compared between the two groups. The t test, Mann-Whitney U test or Fisher exact test were used for comparison between groups according to the data type. A p<0.05 indicated statistical significance.

Results:
The new type of cerebrovascular interventional surgical strait-jacket developed in this study are shown in Figure 1, which have been patented and transformed into products. A total of 140 patients were included for mechanical thrombectomy, randomly divided into an experimental group (n=69) and a control group (n=71). Using the new strait-jacket significantly shortened the first reperfusion time (43.5±13.7 vs 50.7±15.7, P=0.039) and the total operation time (81.1±12.6 vs 93.2±21.1, P=0.027). There was a significant decrease in limb dislodgement rate (0% vs 35.2%, P<0.001) and a noticeable reduction in average surgical cost (76315±12400 vs 81462±14142 P=0.040) by using the strait-jacket. In terms of safety performance, using the strait-jacket significantly lower rates of skin redness than the control group (8.7% vs 42.3%, P<0.001).

Conclusion:
The new type of cerebrovascular interventional surgical strait-jacket is safe, which can effectively shorten the operation time, reduce the rate of intraoperative limb prolapse and the average operation cost, and can bring good social benefits.
Abstract 4119327: Tyrosine Kinase Inhibitor and Their Cardiotoxic Profile in the African American Population at a Community Safety Net Hospital
Authors: Chandora Kapil , Azees Ridwan , Gundroo Hafsa , Green Carey , Chandora Akshay
Published: November 2024

Intro:
Tyrosine Kinase inhibitors (TKI) have been an effective treatment option for multiple cancer types. Unfortunately, TKIs have shown to have off-target Kinase binding to cardiac tissue. The examination of these cardiotoxic side effects have not been sufficiently explored in minority populations and studies such as DASISION and ENESTnd with high NAA homogeneous demographics reflect this issue. AA tend to have higher rates of HTN and HF at baseline, so further evaluation of TKI cardiotoxicity in this population is warranted.

Methods:
A total of 181 patients (pts) charts were reviewed in this study, who were exposed to either Ibrutinib, Imatinib and Sorafenib. First, Patients’ demographic data, such as age, gender, race, malignancy type were obtained along with their corresponding exposure to TKIs discussed above. Next, each patient (pt) chart was examined for any cardiotoxic etiologies after starting a TKI, such as arrhythmias, new- onset heart failure (nOHF) , cardiac arrest (CA), and Myocardial infarction (MI). Echocardiography reports were examined for Ejection fraction ( EF). In summary, this is an observational study looking at Cardiotoxicity secondary to TKI use in the AA population.

Results:
This study's demographics consisted of 149 AA and 32 NAA (non- african american), with the average age of 64.2, and had 128 males and 53 females. A total of 89 pts were on imatinib, 57 on Ibrutinib, 35 on sorafenib. In our population, 64 pts received cardiac echography while on TKIs, with 9 of them demonstrating nOHF. In terms of cardiac arrhythmias, a total of 67 pts experienced this while on TKI, with about 34% (51/149) of AA compared to 50% (16/32) of NAA. A total of 18 pts in the study required hospital management as a sequelae of their cardiotoxicity.

Conclusion:
There were a few trends that diverged from most studies regarding cardiotoxicity associated with TKIs in our study. When looking at individual items, such as rate of Atrial Fibrillation (AF), seen commonly in patients on Ibrutinib, our rate seen is 4.6% which is lower compared to earlier pooled homogenous population studies (6-7%). Earlier clinical trials of Sorafenib had a 2 % rate of HF in mostly homogenous NAA populations, and our study had 0% rate in total. Overall, several cardiotoxicity trends seen with the TKIs in this observational study warrant need for future studies to enable improved cardiac surveillance strategies post treatment in heterogeneous populations.
Abstract 4119635: The Effect of Exercise Training on Apolipoproteins: A Trial Sequence Meta-Analysis.
Authors: Smart Neil , van der Touw Tom
Published: November 2024

Background:
The role of lipoprotein sub-units in the development of CVD not as well understood as for the standard lipid profile. We conducted a systematic review and meta-analysis of the effect of Exercise training (ExTr) effect on common lipid sub-units.

Methods:
We conducted a systematic search for randomized, controlled trials of ExTr versus sedentary controls that reported lipid sub-units Apo AI, Apo AII, Apo B, HDL-2, HDL-3 and Lp(a) up until January 31, 2024.

Results:
We included 24 included studies with 27 intervention groups, with a total of 1,429 participants, 775 ExTr and 654 control. We found significant favourable anti-atherogenic changes in Apo A1; MD 5.96 mg/dL 95% CI (3.63, 8.30); Apo B; MD -0.11 mg/dL (-0.19, -0.04); HDL-2; MD 1.28 mg/dL 95% CI (0.28, 2.28). Our TSA analysis showed that futility was achieved for Apo A1, but not for Apo B and HDL-2. The minimal clinically important differences (MCID) for Apo A1, Apo B and HDL-2 were 0.76 mg/dL, 0.02 mg/dL and 0.26 mg/DL respectively, meaning ExTr is capable of adequately achieving clinical significance for these 3 outcomes. Analyses of Apo A2, Lp(a)and HDL-3 were not significant and these TSA analyses failed to show futility.

Conclusion:
ExTr produces significant improvements in ApoA1, Apo B and HDL-2, with the MCID achieved and evidence of futility reached for all three of these outcomes. The effect of ExTr on Apo A2, Lp(a)and HDL-3 is unclear as futility has not been reached. ExTr changes observed in Apo AI are similar in size to those from statin trials that were associated with an 11% reduction in CV events.
Abstract 4119869: Automatic assignment of CAD-RADS categories in coronary CTA reports using large language model
Authors: Wang Yuli , Hsu Wen-Chi , Dai Yuwei , Shi Victoria , Lin Gigin , Bai Harrison , Lin Cheng Ting
Published: November 2024

Background:
The effectiveness of different large language models (LLM) in extracting important information from CT angiography (CTA) radiology reports is unknown.

Purpose:
The Coronary Artery Disease-Reporting and Data System (CAD-RADS) is a standardized reporting system for CTA that categorizes the severity of coronary artery disease to aid in clinical decision-making. To evaluate the agreement between human readers and LLMs in assigning CAD-RADS categories based on CTA reports.

Materials and Methods:
This retrospective study analyzed reports from patients who underwent coronary CTA for screening or diagnosis at Johns Hopkins Hospital. Reports with CAD-RADS 0–5 findings were collected from Jan. 2020 to Oct. 2023. Initially, 6,212 CTA reports were retrieved. After excluding non-organized reports and retaining only those with CAD-RADS scores, 590 reports remained. Board-certified radiologists and three large language models (GPT-3.5, GPT-4, and Llama3) assigned CAD-RADS categories based on the original radiologists' findings. Two radiologists reviewed the CAD scores, with only one discrepancy in the 590 reports, indicating high inter-agreement. Agreement between human readers and LLMs for CAD-RADS categories was assessed using the Gwet agreement coefficient (AC1 value). Frequencies of changes in CAD-RADS category assignments that could potentially affect clinical management (CAD-RADS 0-2 vs. 3-5) were calculated and compared. Typically, CAD-RADS 0-2 indicates mild disease leading to conservative management, while CAD-RADS 3-5 denotes further testing or disease requiring aggressive intervention to prevent adverse cardiovascular events.

Results:
Among 590 reports, agreement between original and reviewing radiologists was almost perfect (AC1 = 0.985). Good agreement was also found between original radiologists and Llama3, GPT-3.5, and GPT-4 (AC1 = 0.861, 0.907, 0.941, respectively). Differences in CAD-RADS category upgrades/downgrades potentially affecting clinical management were observed: 0 of 590 (0%) for human readers, 56 of 590 (9.4%) for Llama3, 33 of 590 (5.5%) for GPT-3.5, and 23 of 590 (3.9%) for GPT-4 upgrading CAD-RADs; 8 of 590 (1.4%) for human readers, 19 of 590 (3.2%) for Llama3, 22 of 590 (3.7%) for GPT-3.5, and 12 of 590 (2.0%) for GPT-4 downgrading RAD-CADs.

Conclusion:
LLMs showed good agreement with human readers in assigning CAD-RADS categories on CTA reports. However, they were more likely to upgrade CAD-RADS category when compared to radiologists.
Abstract 4119874: Cost Effectiveness Analysis of Surgical Strategies Versus Medical Management for Rheumatic Heart Disease in Rwanda
Authors: Mlambo Vongai Christine , Wang Songnan , Musoni Maurice , Rando Hannah , Ingabire Lambert , Patton-Bolman Ceeya , Bolman Ralph , Bendavid Eran , Lin Yihan
Published: November 2024

Background:
One third of the Rheumatic Heart Disease (RHD) burden is in sub-Saharan Africa. Without valve surgery, 17% of patients die. However, surgery is often deemed too expensive in this region despite the lack of cost-effectiveness analyses to support this assumption.

Aim:
Assess the cost-effectiveness of surgical strategies for RHD performed in Rwanda.

Methods:
We built a Markov model to simulate the progression of patients through different health states. We compared mechanical valve replacement, bioprosthetic valve replacement, and valve repair to medical management for patients with severe RHD. Probabilities of transitioning into different health states were derived from regional published studies. Micro-costing data was obtained from the cardiac surgery program to calculate total costs for each health state. Health effects were measured in quality-adjusted life years (QALYs) from the 2019 Global Burden of Disease Study. Sensitivity analysis was performed to account for model uncertainty. We used a willingness-to-pay threshold of three times the GDP per capita of Rwanda (USD$769).

Results:
All surgical strategies extended life expectancy compared to medical management, which only offered 5.05 QALYs. Mechanical valve replacement surgery was cost-effective with 11.31 QALYs for a lifetime cost of USD$10,721. The incremental cost effectiveness ratio compared to medical management was USD$1,596/QALY, which is below the willingness to pay threshold. Decreasing the initial cost of surgery and probability of long term stroke increased cost-effectiveness. Although bioprosthetic valve replacement and repair provided 6.43 and 5.70 additional QALYs compared to medical management, they had higher lifetime costs than mechanical valve replacement ($19,789.21, $22,477.27). As a result, they were not cost-effective. In the sensitivity analysis, they became cost effective if valve degeneration rates were 11% in 2 years from a baseline of 26% for repair, and 8% in 2 years from baseline of 14% for bioprosthetic valves.

Conclusion:
This study challenges the prevailing assumption that surgery is not cost-effective in Sub-Saharan Africa. Mechanical valve replacement surgery was most cost-effective. Watchful waiting with medical management is inexpensive but carries an average life expectancy of 5 years. Identifying cost-saving opportunities for mechanical valve replacement surgery and enhancing anticoagulation monitoring can make it even more economically favorable.
Abstract 4119926: Inadequate calorie and macronutrient intake in a population with congestive heart failure in a non-cardiovascular tertiary hospital.
Authors: Godinez Flores Tania , Barron Clemente , Payró Gerardo , CASTILLO MARTINEZ LILIA
Published: November 2024

Introduction:
Chronic Heart Failure (HF) is a clinical syndrome that as a consequence of the compensatory mechanisms to maintain an adequate level of perfusion, causes dyspnea, peripheral edema, fatigue, lack of appetite, changes in body weight, cachexia, sarcopenia, among others. The presence of these signs and symptoms, with other factors such as restrictions on salt and water consumption, early satiety, and poor mobility, producing changes in the patient's nutritional status that can indirectly increase the risk of inadequate dietary intake, which over a prolonged period will lead to the development of nutritional deficiencies.

Objective:
To analyze the dietary intake of energy, macronutrients, and micronutrients of patients with chronic HF in outpatient care.

Methods:
Cross-sectional study, including 75 outpatients with HF, who attended a Heart Failure Clinic. Data collection on dietary intake was obtained using a multi-step 24-hour recall. The ESHA Food Processor program was used to calculate the energy, macronutrient, and micronutrient intake. The presence of congestion was evaluated by bioelectrical impedance vectorial analysis and VEXUS.

Results:
The baseline characteristics of the population are shown in Table 1. Of the total population, 34% presented with deficient caloric intake, and the subjects who presented congestion also ingested significant fewer calories compared with those who do not present congestion (p= 0.031). Only 15% of patients had an adequate protein intake that resulted in lower NYHA class; among those subjects with a deficient protein intake, 72% had congestion measured by VExUS or bioelectrical impedance. For the sodium intake in the subjects' diet, 45% exceeded the recommendation stated in the guidelines of less than 2,400 mg of sodium per day which was not statistically significant (p=0.077).

Discussion and Conclusions:
The inadequate intake of calorie or macronutrients in patients with CHF led the patients to more congestion and higher NYHA class, this provide a perspective on the importance of adequate nutritional advice by an expert in the area, which is also essential to improve the clinical course of heart failure. Likewise, future studies are deeded to investigate whether this poor dietary intake is inversely related to some clinical manifestations such as congestion, suggesting that improving these conditions could positively impact patients' volume status and improve functional class.
Abstract 4120140: Catastrophic Bioprosthetic Aortic Valve Thrombosis: An Unappreciated Complication of Veno-Arterial Extracorporeal Membrane Oxygenation Support in Cardiogenic Shock
Authors: O'Hara Patrick , Truby Lauren , Goral Montana , Kim Han , Malensek Paris , Beaini Hadi , Patel Ravi , Jawaid Anas , Hussain Fizza , Heid Christopher , Lahsaei Peiman , Farr Maryjane , Garg Sonia , Araj Faris
Published: November 2024

Description of Case:
A 56-year-old male with a history of cardiac sarcoidosis with biventricular systolic heart failure (HF) and a bioprosthetic aortic valve presented with acute decompensated HF. Progressive cardiogenic shock and hemodynamic instability ensued, requiring urgent bedside placement of an intra-aortic balloon pump (IABP) which provided only marginal hemodynamic support. After extensive multidisciplinary discussion, emergent cannulation for veno-arterial ECMO (VA-ECMO) was performed at the bedside as a bridge-to-decision for advanced HF therapies. The IABP was left in place for LV venting. Within 72 hours, extensive bilateral pulmonary opacities had developed. It was later realized that true LV ejection (as evidenced by aortic pulsatility on the arterial line) was not present and had been masked by pseudo-pulsatility provided by IABP inflations and deflations. Compared to an echocardiogram done 7 days prior to VA-ECMO cannulation, the bioprosthetic leaflets were no longer opening, thrombosis of the AV had occurred, and thrombus formation along the ECMO venous drainage cannula was noted. Failure to achieve LV venting culminated in complete thrombosis of the entire LV and LA and the patient ultimately expired.

Discussion:
Bioprosthetic valve thrombosis is a lesser-known complication of VA-ECMO support, with most reports involving bioprosthetic valves in the mitral position. Indeed, bioprosthetic valve thrombosis occurs at a higher rate than native valve thrombosis during VA-ECMO support. However, bioprosthetic AV thrombosis is an extremely rare complication of VA-ECMO support and arguably results in a more catastrophic scenario as most traditional approaches to LV unloading are contraindicated. The optimal LV unloading strategy for these patients (IABP, Impella, surgical apical unloading, etc) is unknown. Data from large retrospective analyses have demonstrated extremely poor outcomes when prosthetic valve thrombosis occurs, and it is thus critical to prevent this complication from developing. In contrast to IABP counter-pulsation, the benefit of upfront transvalvular LV venting with an Impella device safeguards the presence of a direct LV vent in the event of bioprosthetic AV thrombosis and eliminates the false reassurance of IABP pseudo-pulsatility. Further studies are needed to better elucidate the optimal LV unloading strategy in patients with bioprosthetic valves, particularly in the aortic position.
Abstract 4120196: Temporal Trends and Predictors of Cardiac Biomarker Testing in the Emergency Department, 2014-2021
Authors: Watson Nathan , Wasfy Jason , Baugh Christopher , Januzzi James , Secemsky Eric , McCarthy Cian
Published: November 2024

Background:
Presenting symptoms risk stratify patients presenting to the Emergency Department (ED) to determine their likelihood of having a myocardial infarction (MI) and need for cardiac biomarker testing. Since the 2014 AHA/ACC non-ST segment elevation MI (NSTEMI) guideline, little is known regarding cardiac biomarker testing trends in the United States.

Methods:
We analyzed data from the National Hospital Ambulatory Medical Care Survey for consecutive adult ED visits between 2014 and 2021 in the United States. The primary outcome was the proportion of ED visits where cardiac biomarker testing occurred. Subgroup analysis was performed for visits with chest pain, non-chest pain anginal equivalents, and non-anginal symptoms. Survey-weighted multivariable logistic regression was used to generate adjusted odds ratios (aOR) to assess predictors of cardiac biomarker utilization.

Results:
In total, 87,965 ED visits were sampled, representing a weighted total of 644,531,395 visits. Cardiac biomarker testing occurred in 7.21% of all ED visits (95% CI, 6.27%-8.29%) and increased over time (Figure,
P
=0.03 for trend). When stratified by symptoms, utilization of testing mainly increased among patients with non-chest pain anginal equivalents (Figure,
P
=0.02 for trend). Cardiac biomarker testing was most frequently used for patients with chest pain (34.9%) and non-chest pain anginal equivalents (39.3%). Nonetheless, 25.8% of patients who underwent testing had no chest pain or anginal equivalents. Cardiac biomarker testing was more frequent among patients with older age (aOR 1.03 per year, 95% CI 1.03-1.04), tachycardia (aOR 1.26, 95% CI 1.13-1.41), tachypnea (aOR 1.71, 95% CI 1.47-1.98), history of heart failure (aOR 1.33, 95% CI 1.15-1.54), prior venous thromboembolism (aOR 1.43, 95% CI 1.12-1.83), and those treated in a rural setting (aOR 1.63, 95% CI 1.14-2.32).

Conclusion:
Cardiac biomarker testing in the ED has increased over time, mostly attributed to increased utilization among patients with a low pre-test probability of MI. Notably, 25% of individuals who underwent cardiac biomarker testing had no chest pain or anginal-equivalent symptoms. More judicious utilization of cardiac biomarker testing may be needed.
Abstract 4120623: Sphingosine Kinase 1 Is Integral For Elastin Deficiency-induced Arterial Hypermuscularization
Authors: Saito Junichi , Dave Jui , Kabir Inamul , xGallardo-Vara xEunate , Hla Timothy , Greif Daniel
Published: November 2024

Introduction:
Defective elastic lamellae and smooth muscle cell (SMC) accumulation are characteristics of diverse obstructive arterial diseases (e.g., atherosclerosis, pulmonary hypertension, and supravalvular aortic stenosis [SVAS]) as well as physiological closure of the ductus arteriosus (DA). Mechanistic links between defective elastin and SMC proliferation are not well elucidated.

Methods:
Immunostaining for proliferation marker Ki67 was performed on wild-type (WT) and

Eln
(-/-)

mouse aortas at embryonic day (E) 13.5 and E15.5 because elastin (ELN) is expressed in the mouse aorta from E14. Bulk RNA-seq was conducted on mouse aortic SMCs isolated from WT or

Eln
(-/-)

embryos at E15.5. As sphingosine kinase 1 (SPHK1) was found as a highly promising candidate, its expression was evaluated in human SVAS patient aortas and in mouse

Eln
(-/-)

aortas and WT DA. S1P receptor 1 (S1PR1) activity was assessed in aortic SMCs from

S1pr1
(knock-in/knock-in)
, H2B-GFP

mice. Genetic deletion of
Sphk1
in SMCs was performed on the elastin mutant background. Pharmacological SPHK1 inhibition was evaluated on both elastin mutants and WT embryos. Regulatory mechanisms of SPHK1 were assessed by mRNA stability assay and TRANSFAC database analysis.

Results:
SMC hyperproliferation was first observed in

Eln
(-/-)

aorta at E15.5, prior to morphological differences. Bulk RNA-seq revealed that Sphk1 is the most upregulated transcript in

Eln
(-/-)

aortic SMCs at E15.5. Reduced ELN increases SPHK1 levels in SMCs of human patient aortas and mouse aorta and DA. S1PR1 expression and activity are increased by elastin insufficiency. SMC
Sphk1
deletion attenuates SMC proliferation and muscularization in the elastin-defective aorta, leading to extended viability of

Eln
(-/-)

mice. Similarly, pharmacological SPHK1 inhibition ameliorates elastin aortopathy but leads to patent DA in WT mice. mRNA stability assay indicated Sphk1 is upregulated by enhanced transcription. TRANSFAC and bulk RNA-seq data suggested that transcription factor early growth response 1 (Egr1) induces Sphk1 transcription. Indeed, EGR1 was upregulated in elastin mutant aortas and DA.

Conclusions:
Elastin deficiency upregulates SPHK1 transcription, leading to SMC proliferation and hypermuscularization in elastin aortopathy as well as during physiological DA closure. Inhibiting SPHK1 is a promising therapeutic strategy for elastin aortopathy and for select congenital heart diseases in which patent DA maintains circulation.
Abstract 4120670: Pericoronary Adipose Tissue Inflammation as a Marker of Increased Coronary Plaque Burden in Patients With Chronic Coronary Artery Disease With Zero Calcium Score
Authors: Otsuka Kenichiro , Yamaura Hiroki , Fujisawa Naoki , Ishikawa Hirotoshi , Hojo Kana , Matsumoto Kotaro , Okamoto Akihiro , Yamaguchi Tomohiro , Kagawa Shunsuke , Shimada Takenobu , Shibata Atsushi , Ito Asahiro , Yamazaki Takanori , Fukuda Daiju
Published: November 2024

Background:
Dysfunctional or excess adiposity plays pivotal role in the development of coronary atherosclerosis. It remains unclear whether pericoroanry adipose tissue (PCAT) inflammation is associated with increased coronary plaque burden in its early stage of atherosclerosis, independent of traditional coronary risks or cardiovascular-kidney metabolic health.

Purpose:
To investigate the association of PCAT inflammation with coronary plaque burden in patients with newly suspected with chronic coronary artery disease (CAD) and zero calcium score who underwent coronary computed tomography angiography (CCTA).

Methods:
This retrospective CCTA study consists of 294 chronic CAD patients with zero calcium score (59 years, male 51 %). Chronic CAD was defined as stable condition with presence of increased non-calcified plaque burden on CCTA (Figure 1A-D). PCAT attenuation (PCATA) was assessed by fat attenuation index in the major three coronary arteries (right coronary artery, RCA; left anterior descending artery; LAD, and left circumflex coronary artery, LCX)(Figure 1C and D). Multivariable analysis using linear regression model was performed to determine independent predictors of increased %PV by adjusting for traditional coronary risks, metabolic risks, and chronic kidney disease (CKD). Hisayama Risk Score (HRS) was calculated to estimate 10-year cardiovascular risks.

Results:
Mean %plaque volume (PV) and PCATA-RCA was 44±4.0％ and -77±8.8 HU. %PV was correlated with age (p<0.05), systolic blood pressure (p<0.05), non-HDL cholesterol (p<0.05), Hisayama risk score (p<0.05, Figure 2), PCATA-RCA (p<0.001, Figure 3), PCATA-LAD (p<0.001), and LCX-PCATA (p<0.001). In a multivariable linear regression model adjusting for age, sex, hypertension, diabetes, dyslipidemia, and current smoking (model 1), PCATA-RCA was independently associated with %PV [beta, 0.17; 95% confidential interval (CI) 0.115-0.217, p < 0.001]. In a model adjusting for age, sex, metabolic syndrome, body mass index ≥23kg/mm
2
, and CKD (model 2), PCATA-RCA (beta, 0.18; 95% CI 0.128-0.232, p<0.001) and high-risk HRS (beta, 3.1; 95% CI 1.35−4.87, p<0.001) were independently associated with %PV. Similarly, independent associations of PCATA in LAD and LCX with %PV was observed.

Conclusion:
This study demonstrates that PCATA is a robust marker related to increased burden of coronary atherosclerosis even in the early stage of atherosclerosis as defined by zero coronary artery calcium score.
Abstract 4120785: Differential Cardiovascular Impact of ω-3 Fatty Acid in Patients at High Cardiovascular Risk in Asians versus non-Asians: Sub-analysis of the STRENGTH Randomized Clinical Trial
Authors: Wang Tom Kai Ming , Nicholls Stephen , St John Julie , Wolski Kathy , Nissen Steven
Published: November 2024

Background:
Racial differences in lipid and cardiovascular risk profiles are well-established including for Asians. The STRENGTH trial found that ω-3 carboxylic acid (CA) formulation of eicosapentaenoic acid and docosahexaenoic acid did not result in significant changes in cardiovascular event rates compared with corn oil in statin-treated patients at high cardiovascular risk, however drug efficacy may vary by race. We evaluated and compared the cardiovascular treatment effect of ω-3 CA between Asians and non-Asians in this sub-analysis of the STRENGTH trial.

Methods:
The STRENGTH trial was a double-blinded 1:1 randomized controlled trial of 13,078 high cardiovascular risk patients enrolled during 10/30/2014-6/14/2017 at 675 centers. Efficacy of ω-3 CA for Asians (n=1,355) and non-Asians (n=11,723) and interactions between race and treatment effect were assessed. The primary endpoint is a composite of cardiovascular death, non-fatal myocardial infarction, stroke, coronary revascularization and unstable angina hospitalizations.

Results:
Key differences in baseline characteristics include Asians having significantly higher prevalence of men, secondary prevention, and lower total cholesterol, LDL, apoB100, and hsCRP. In Asians, ω-3 CA was associated with significantly lower primary endpoint during follow-up, with 81/698 events [Kaplan-Meier (KM) Estimate: 14.8%] in the ω-3 CA group, 103/657 events (KM Estimate: 20.4%) in the corn oil group, and hazard ratio (HR) 0.72, 95% CI 0.54-0.96, P=0.026 (Figure A). In non-Asians, there was not a significant difference in primary endpoint rates between the two groups, with 704/5841 events (KM Estimate: 15.6%) in the ω-3 CA group, 692/5882 events (KM Estimate: 15.9%) in the corn oil group, and HR 1.03 95% CI 0.93-1.14, P=0.60 (Figure B). There were significant interactions between race (Asian versus non-Asian) and treatment group for the primary endpoint (P=0.021) and non-fatal stroke (P=0.016) and remained significant after adjusting for other covariates.

Conclusion:
ω-3 CA was associated with significant reduction in major adverse cardiovascular events compared with corn oil in Asians but not in non-Asian patients with high cardiovascular risk. Further research is necessary to elucidate the mechanisms for potentially beneficial effects of ω-3 CA unique to Asian race.
Abstract 4120854: Case Report: Elevated HDL in Familial Hyper-Alpha-Lipoproteinemia: Atheroprotective or Atherogenic?
Authors: Manji Zahra , Mahoney Jenna , Mehta Samir , sutera myrna , Meng Stephen
Published: November 2024

Introduction:
Familial hyper-alpha-lipoproteinemia (HALP) is a heterogenous genetic lipid disorder that is found in only 8% of the population and manifests as elevated HDL levels above the 90
th
percentile. HALP is due to mutations in various genes including cholesteryl ester transfer protein (CETP), hepatic lipase, or apolipoprotein C-III (APOC3). While epidemiological studies have noted an inverse relationship between high HDL and the development of coronary artery disease, recent data have shown a lack of causal atheroprotective effects. We present a case of a patient with significantly elevated HDL and peripheral vascular disease.

Case Description:
Patient is a 64-year-old female with past medical history of peripheral artery disease with occlusion of the left femoral artery and popliteal arteries status post angioplasty, hypertension, type 2 diabetes, alcohol use, and CKD Stage 4 who presented to the advanced lipid clinic for management of elevated lipoproteins. Patient’s laboratory data was significant for total cholesterol (TC) of 375 mg/dL, a high-density lipoprotein (HDL) of >200 mg/dL, triglycerides (TG) of 66 mg/dL, and a low-density lipoprotein (LDL) of 175 mg/dL. Further testing revealed elevated apolipoprotein A-I of 231 mg/dL. Patient was subsequently initiated on a high intensity statin with improvement in her lipid panel with a TC of 247 mg/dL, HDL of 133 mg/dL, TG of 50 mg/dL, and LDL of 106 mg/dL, with plan for further uptitration of lipid therapy to target LDL <70 mg/dL.

Discussion:
CETP exchanges cholesteryl esters from HDL for TG, making HDL smaller and more TG-rich. Studies have shown that
in vitro
addition of CETP and hepatic lipase, which hydrolyzes phospholipids and TG, into CETP-deficient patients led to the development of very small HDL particles that were able to remove cholesterol from lipid laden macrophages. Conversely, larger HDL molecules seen in CETP-deficient patients did not have such anti-atherogenic properties. In addition to recognizing HALP in the setting of elevated HDL, it is also important to exclude secondary causes of elevated HDL, such as primary biliary cirrhosis and high-dose niacin. Genetic testing should also be considered.
Abstract 4120898: Assessment of Subclinical Atherosclerosis in Psoriasis Patients Using Echocardiographic Coronary Flow Parameters: A Systematic Review and Meta-Analysis
Authors: Jain Hritvik , Odat Ramez , Goyal Aman , Jain Jyoti , Ahmed Mushood , Patel Nandan , Passey Siddhant , Gole Shrey
Published: November 2024

Background:
Chronic inflammatory diseases are associated with a higher risk for atherosclerosis and adverse cardiovascular events. Psoriasis is a systemic inflammatory condition that significantly increases coronary artery disease risk. Subclinical atherosclerosis can be estimated by echocardiographic parameters like coronary flow velocity reserve (CFVR), diastolic peak flow velocity (DPFV), and hyperemic DPFV. Limited literature investigates these parameters in psoriasis, with inconsistent results.

Methods:
We systematically searched the major bibliographic databases including PubMed, Embase, Cochrane Library, and Google Scholar from inception to 7th May 2024 to retrieve relevant studies. The outcomes were pooled using the inverse variance random-effects model, and the results were presented as standardized mean difference (SMD) with the corresponding 95% confidence interval (CI).

Results:
4 studies with 557 participants (281: psoriasis and 276: controls) were included. The mean age of the psoriasis group was 44.7 ± 7.7 years and of the control group was 45.2 ± 5.9 years. Psoriasis patients had a significantly lower CFVR [SMD: -0.71; 95% CI: -0.97, -0.45; p<0.00001] and hyperemic DPFV [SMD: -0.71; 95% CI: -1.30, -0.12; p=0.02] compared to healthy controls. However, the difference between baseline DPFV was insignificant between the two groups [SMD: 0.20; 95% CI: -0.92, 1.32; p=0.73].

Conclusion:
This study demonstrates that psoriasis is associated with coronary microvascular disease as measured by significantly lower CFVR and hyperemic DPFV. These results suggest that impaired myocardial perfusion in psoriasis patients may be an early manifestation of cardiac involvement. Hence, early risk stratification in psoriasis patients is crucial. Further large, randomized trials are essential to corroborate the results of this meta-analysis.
Abstract 4120912: Non-Alcoholic Fatty Liver Disease is Associated with Coronary Flow Reserve Impairment: A Pilot Meta-Analysis
Authors: Jain Hritvik , Jain Jyoti , Odat Ramez , Goyal Aman , Ahmed Mushood , Patel Nandan , Marsool Mohammed Dheyaa Marsool , Jha Jagriti , Passey Siddhant
Published: November 2024

Background:
Non-alcoholic fatty liver disease (NAFLD) is estimated to affect approximately 25% of the global population. Significant epidemiological data links NAFLD to an increased risk of coronary artery disease. Both, coronary artery disease and NAFLD are linked to underlying insulin resistance and inflammation as drivers of the disease. Coronary flow reserve parameters including coronary flow reserve velocity (CFRV), baseline diastolic peak flow velocity (DPFV), and hyperemic DPFV are non-invasive markers of coronary microvascular circulation. The existing literature contains conflicting findings for these parameters in NAFLD patients.

Aim:
This meta-analysis aimed to compare CFRV, baseline DPFV, and hyperemic DPFV in between NAFLD patients and healthy controls.

Methods:
A comprehensive systematic search was conducted on PubMed, Embase, Cochrane Library, and Google Scholar from inception until 8th May 2024 to identify relevant studies. We pooled the standardized mean differences (SMD) with the 95% confidence intervals (CI) using the inverse variance random-effects model. A p-value of less than 0.05 was considered statistically significant.

Results:
We included 4 studies with 1139 participants (226: NAFLD and 913: controls). The mean age in the NAFLD group was 54.55 ± 7.62 years and in the control group was 54.2 ± 7.6 years. NAFLD was associated with a significantly lower CFRV [SMD: -0.77; 95% CI: -1.19, -0.36; p<0.0002] and hyperemic DPFV [SMD: -0.73; 95% CI: -1.03, -0.44; p<0.00001] compared to the controls. NAFLD demonstrated a statistically insignificant trend towards reduction in the baseline DPFV [SMD: -0.09; 95% CI: -0.38, 0.19; p=0.52] as compared to healthy controls.

Conclusion:
NAFLD patients are at a higher risk of coronary microvascular dysfunction as demonstrated by reduced CFRV and hyperemic DPFV. The presence of abnormal coronary flow reserve in NAFLD patients provides insights into the higher rates of cardiovascular disease in these patients. Early aggressive targeted interventions towards impaired coronary flow reserve in NAFLD subjects may lead to improvement in clinical outcomes.
Abstract 4120929: Silent Myocardial Infarctions in Women with Ischemic Sudden Cardiac Death
Authors: Hookana Ida , Eskuri Anette , Holmstrom Lauri , Pakanen Lasse , Tikkanen Jani , Perkiomaki Juha , Huikuri Heikki , Vahatalo Juha , Junttila Juhani
Published: November 2024

Background:
Sudden cardiac death (SCD) is a significant mode of death in both sexes, with most cases attributed to coronary artery disease (CAD). In women, ischemic SCD seems to occur more often without previously diagnosed CAD, but the prevalence and characteristics of silent myocardial infarctions (SMI) in women are not known.

Aim:
This study aimed to investigate the prevalence and characteristics of women with silent myocardial infarction (SMI) and ischemic SCD.

Methods:
The Fingesture study consists of 5,869 autopsy-verified SCD cases (21.1% women) in Northern Finland 1998-2017. In this study, we investigated women with ischemic SCD without previous CAD diagnosis (N=660). SMI was defined as a myocardial infarction (MI) scar at autopsy in the absence of CAD history in medical records. As a control group, we used women with ischemic SCD without MI scar and previous CAD diagnosis. Coronary artery stenosis, myocardial fibrosis, and MI scars were evaluated through macroscopic assessment during autopsy, with further histological verification for myocardial fibrosis and MI scars.

Results:
Among 660 ischemic SCD subjects without prior CAD diagnosis, 220 (33.3%) had SMI. Women with SMI were older compared to those without SMI (73.4 vs. 71.4 years in subjects without SMI, p=0.03), and SMIs became more prevalent with advancing age (+4.4% per decade, p<0.01). Women with SMI had higher heart weight (411 vs. 386 g in subjects without SMI, p<0.01) and a higher prevalence of left ventricular hypertrophy (LVH) (73.6% vs. 64.5% in subjects without SMI, p=0.02). The average body mass index was 27.1 kg/m
2
in subjects with SMI and 27.6 kg/m
2
in subjects without SMI (p=0.34). Subjects with SMI were more likely to have severe coronary artery stenosis with >90% occlusion (37.3% vs. 22.5% in subjects without SMI, p<0.01). Severe (15.0% vs. 3.0% in subjects without SMI, p<0.01) and moderate (69.1% vs. 39.4% in subjects without SMI, p<0.01) degrees of myocardial fibrosis were more prominent among subjects with SMI.

Conclusions:
One-third of ischemic SCD cases without prior CAD diagnosis in women had findings of SMI at autopsy. Women with SMI were slightly older and exhibited more severe coronary disease, LVH and myocardial fibrosis at autopsy. These findings underscore the importance of earlier diagnosis and treatment of CAD in SCD prevention in women.
Abstract 4120990: Classification of Echocardiography Videos Using TimeSformer for Detecting Incipient Heart Failure in Asymptomatic Patients with Normal Ejection Fraction and Patients with Heart Failure
Authors: Adhyapak Srilakshmi , Menon Prahlad
Published: November 2024

Background:
Recent advancements have seen deep learning models help differentiate echocardiography images of patients with heart failure with preserved ejection fraction (HFpEF) from normal controls. Our aim was to develop a model capable of detecting early signs of heart failure in asymptomatic patients with a normal ejection fraction.

Methods:
We employed the TimeSformer, a video transformer model that classifies video data using a novel attention-based mechanism. This self-attention mechanism that diverges from traditional convolutional neural networks (CNNs). It focuses on relevant parts of the video across both space and time, split into spatial attention, which processes each frame individually, and temporal attention, which integrates information across different frames. The training and validation of the TimeSformer model were conducted on the same dataset of echocardiography videos from 50 normal controls and 50 patients diagnosed with HFpEF, employing 5-fold cross-validation to ensure robust performance evaluation.

Results:
The TimeSformer model effectively identified HFpEF in patients, as all diagnosed with HFpEF were flagged as abnormal. The echocardiography assessment, along with NT pro BNP levels, supported the diagnoses, with patients showing NT pro BNP levels of 1016±32 pg/ml. Conversely, 46 out of 50 normal controls were correctly identified, with their NT pro BNP levels averaging 52±12 pg/ml. These controls remained asymptomatic.

Conclusions:
The TimeSformer model demonstrated capability in identifying subtle deviations indicative of incipient heart failure in videos of normal controls, despite normal NT pro BNP levels. This suggests potential for early detection of heart failure in asymptomatic individuals. Further longitudinal studies are necessary to determine whether individuals identified as abnormal develop heart failure symptoms subsequently.
Abstract 4121104: Fish Oil-Derived N-3 Very-Long-Chain Polyunsaturated Fatty Acids Improve Retinal Function in Aged Mice
Authors: Kun Julia , Yang Zhihong , Pryor Milton , Ibarguen Sophia , Yamazaki Isao , Yamaguchi Hideaki , Xie Hairui , Swaroop Anand , Remaley Alan
Published: November 2024

Introduction:
Epidemiological studies and clinical trials have revealed cardiometabolic benefits associated with dietary fish oil-derived omega-3 polyunsaturated fatty acids, particularly EPA and DHA. Omega-3 very-long-chain polyunsaturated fatty acids (VLCPUFA), synthesized
in vivo
by very-long-chain fatty acid elongase (ELOVL), e.g. ELOVL2 and 4, have recently garnered interest for their role in eye and cardiometabolic diseases. In our previous study, aging mice fed a VLCPUFA-rich diet for 8 weeks exhibited lowered plasma lipid levels, and repeated gavage of VLCPUFA in young mice resulted in improved retinal function. However, it is largely not known if VLCPUFA intake for a short term in aged mice would also improve retinal function and have beneficial effects in cardiometabolic risk factors.

Hypothesis:
We hypothesized that VLCPUFA may delay or rescue age-related vision loss by supplementing the products of ELOVL2, which decrease in quantity with age. We also hypothesize that short-term VLCPUFA intake may also confer favorable cardiometabolic benefits.

Aims:
We aimed to evaluate the effects of exogenous VLCPUFA on visual function and lipoprotein profiles in aged mice.

Methods:
Sixteen-month-old mice received a daily oral gavage of C24-28-rich VLCPUFA-oil (80 mg/kg BW) or an Intralipid vehicle for 15 consecutive days (n=8). The electroretinogram (ERG) instrument used was a UTAS E-3000 with gold corneal and stainless-steel scalp electrodes. Fast Protein Liquid Chromatography was performed using pooled plasma.

Results:
Consumption of VLCPUFA for 15 days increased scotopic a- (p < 0.05 at −5, 0, 5, 10, and 15 dB) and b-wave (p < 0.05 at 0 and 5 dB, p = 0.08 at 10 dB) amplitudes on ERG in both male and female mice compared with control. Although photopic ERG results did not exhibit statistically significant differences, likely due to low sample size, the overall results were consistent with those in our previous studies in young mice. We report no statistically significant difference in the composition of pro-atherogenic VLDL and LDL fractions due to VLCPUFA gavage. Increasing the duration and samples size in future gavage studies may be critical to determine the effects of VLCPUFA on eye and cardiovascular risk factors.

Conclusions:
This study revealed that a short-term oral administration of VLCPUFA was effective in improving ERG response overall, but not lipoprotein profiles.
Abstract 4121215: Efficacy and Safety of Empagliflozin in Patients with Acute Myocardial Infarction: A meta-analysis of randomized controlled trials
Authors: OBI OGECHUKWU
Published: November 2024

Background:
Empagliflozin is a sodium glucose co-transporter 2 inhibitor that improves cardiovascular outcomes in patients with type 2 diabetes mellitus, chronic kidney disease and heart failure. Less is known about the efficacy and safety of empagliflozin in patients after acute myocardial infarction.

Methods:
PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) that reported the outcomes of interets including all-cause mortality, death from cardiovascular causes, hospitalization due to heart failure etc. Risks ratios (RR) or mean difference (MD) and their 95% confidence intervals (CIs) were computed with the use of random-effect model. Heterogeneity was examined with I
2
statistics.

Results:
We included 12 RCT articles consisting of 23,178 patients that received empagliflozin after acute myocardial infarction were considered. Empagliflozin was associated with significantly reduced incidence of all-cause mortality (RR 0.72; 95% CI [0.61, 0.85]; P < 0.0001; 5.9% vs 7.4%), death from cardiovascular causes (RR 0.66; 95% CI [0.52, 0.83]; P = 0.0004; 4.0% vs 5.4%), and hospitalization for heart failure (RR 0.66; 95% CI [0.58, 0.76]; P < 0.00001; 3.2% vs 4.7%), acute kidney injury (RR 0.52; 95% CI [0.31, 0.86]; P = 0.01), acute renal failure (RR 0.71; 95% CI [0.55, 0.91]; P = 0.008), adverse events leading to discontinuation (RR 0.89; 95% CI [0.80, 0.99]; P = 0.03), systolic blood pressure (MD -8.59; 95% CI [-13.26, -3.93], P = 0.0003), and thromboembolic events (RR 0.51; 95% CI [0.28, 0.92]; P = 0.03) compared to placebo.

However, there was no significant difference between groups with respect to fatal or nonfatal stroke (RR 1.15; 95% CI [0.91, 1.46]; P = 0.23), adverse events leading to lower limb amputation (RR 1.11; 95% CI [0.62, 1.99]; P = 0.73), estimated glomerular filtration rate (MD 0.45; 95% CI [-0.20, 1.10]; P = 0.17), diastolic blood pressure (MD -2.53; 95% CI [-5.40, 0.34]; P = 0.08), body weight (MD -1.04; 95% CI [-4.08, 1.99]; P = 0.50), urinary tract infection (MD 1.04; 95% CI [0.92, 1.17]; P = 0.55), NT- proBNP (MD -115.93; 95% CI [-271.52, 39.66]; P = 0.14), glycated hemoglobin (MD -0.10; 95% CI [-0.41, 0.22]; P = 0.55), and hypoglycemia (RR 0.98; 95% CI [0.89, 1.08]; P = 0.70).

Conclusion:
Our findings suggest that empagliflozin has superior efficacy and safety compared to placebo for the treatment of patients with acute myocardial infarction with no impact on UTI, eGFR, NT-proBNP, and hypoglycemia.