bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145387: Cardiac Myosin inhibitors in patients with Symptomatic Hypertrophic Cardiomyopathy: An updated Systematic review and Meta-analysis of randomized trials.
Authors: Prata Alonzo , Katsuyama Eric , Coan Ana Carolina , Fernandes Julia , Scardini Pedro Gabriel , Fukunaga Christian , Falco Neto Wilson , Petri Santos Pinheiro Rafael , Andrade Naieli , Dantas Brígido Alexandra Regia
Published: November 2024

Background:
Current therapeutic options for relieving symptoms in hypertrophic cardiomyopathy (HCM) predominantly involve invasive interventions. In contrast, cardiac myosin inhibitors (CMI), such as aficamten and mavacamten, represent a promising pharmacological alternative to alleviate left ventricular outflow tract obstruction. However, there is limited data regarding the efficacy of this therapy.

Methods:
We searched Pubmed, Cochrane, and Embase databases for randomized controlled trials (RCT) comparing CMI with placebo among symptomatic HCM patients. Key outcomes assessed included: (1) improvement in at least one New York Heart Association (NYHA) functional class, (2) enhancement in the Kansas City Cardiomyopathy Questionnaire - Clinical Summary Score (KCCQ-CSS), and (3) change in N-terminal pro b-type Natriuretic Peptide (NT-proBNP) levels. Statistical analyses were performed using R Studio 4.3.2.

Results:
Six RCTs were included, involving 826 patients, of whom 443 (53.6%) were assigned to the CMI group. The majority of participants were male (57%), with a mean age of 57.9 years and a mean follow-up duration of 21 weeks. In the pooled analysis, CMI was associated with a significant improvement of at least one NYHA functional class (RR 2.21; 95% CI 1.75, 2.80; p<0.001; Fig 1) and KCCQ-CSS (MD 7.18; 95% CI 4.64, 9.72; p<0.01; Fig 2A). Moreover, CMI also reduced NT-proBNP levels (MR 0.22; 95% CI 0.17, 0.29; p<0.01, Fig 2B).

Conclusion:
This meta-analysis highlights the potential of CMI as a promising pharmacological therapy for managing symptomatic HCM, with significant improvements in NYHA functional class, quality of life and NT-proBNP levels.
Abstract 4145408: The Unexpected Heart Stopper: A Case of Ketamine-Induced Stress Cardiomyopathy Requiring Mechanical Circulatory Support
Authors: Hyder Syed , Gonuguntla Akhilesh , Parcha Vibhu , McElwee Samuel
Published: November 2024

Background:
Stress cardiomyopathy (SCM) is rarely triggered by ketamine and seldom leads to cardiogenic shock. Ketamine-induced catecholaminergic surge can lead to myocardial stunning with transient ischemia and subsequent reversible heart failure. Mechanical circulatory support can be successfully leveraged in SCM-associated cardiogenic shock while awaiting myocardial recovery.

Case Presentation:
A 28-year-old female with chronic pain was admitted for failure to thrive secondary to opioid-induced gastroparesis. The patient was weaned off opiates while on ketamine over 4 days. After halting ketamine, the patient had a cardiac arrest with eventual return of spontaneous circulation. After being extubated, she developed chest pain, hypotension, and ventricular tachycardia with anterolateral ST elevations, troponin leak, and lactic acidosis. TTE revealed an EF <20% with severe mid-distal LV dysfunction with preserved basal segments, concerning for SCM. Cardiac catheterization revealed clear coronaries but elevated filling pressures and reduced cardiac index, requiring mechanical circulatory support by IABP and, eventually, VA-ECMO. By 1-week post-arrest, IABP was removed and the patient was decannulated off VA-ECMO. TTE at 1-week post-arrest showed an EF of 45-50% with moderate global hypokinesis. MRI at 1-month post-arrest revealed a normal heart with no abnormal myocardial edema, fatty infiltration, perfusion abnormalities, or scarring. TTE at 1-month post-arrest revealed an EF of 55-60% without wall motion abnormalities. Subcutaneous ICD did not reveal any events on follow-up.

Conclusion:
With the rise of ketamine use in pain management, the recognition of rare cardiac complications like SCM should be an important consideration even in patients without underlying cardiac risk factors. Early recognition of shock and initiation of mechanical circulatory support may lead to more favorable outcomes. Increased awareness and prompt intervention can significantly impact a patient’s recovery and prognosis in ketamine-induced SCM.
Abstract 4145497: Pump-Assisted Vein Dilation for Arteriovenous Fistula Creation – Translation of the Amplifi Vein Dilation System from Bench to Bedside
Authors: Treffalls Rebecca , Shenoy Surendra , Ebner Adrian , Macedo Mark , De Peralta Erdie , Richardson Scott , Fritterer Mimi , Mani Krishnil , brown michael , Tansley Geoffrey Douglas , Franano Nicholas , Muller Paul , Morrison Jonathan
Published: November 2024

Background:
Autologous arteriovenous fistulas (AVF) are the preferred choice for hemodialysis access due to their longevity, lower complication rates, and mortality benefit. Their use is limited by vein size and necessary maturation period, excluding up to a third of patients. A novel solution to this problem is pump-assisted vein dilation (PAVD), where the vein is “pre-matured” using a miniatured centrifugal pump that draws blood from a central vein, delivering it into the recipient vein (e.g., cephalic) under pressure. The aim of this study is to report the initial safety studies in sheep and a first-in-human (FIH) pilot study as a prelude to a phase 2 clinical study.

Methods:
Preclinical Study:
Three anesthetized male sheep (50-70 kg) underwent cephalic PAVD using the Amplifi Vein Dilation System for 7 days (mean). These subjects and two control animals (no-PAVD) underwent brachiocephalic AVF creation and observation for 6 weeks, with weekly surveillance fistulagrams and duplex ultrasound (U/S). AVFs were then explanted for histological analysis.

Clinical Study:
Ten patients were recruited for a phase 1 study. They underwent cephalic PAVD for 7 days (mean), followed by brachiocephalic AVF creation and surveillance at 2 and 6 wks. Data on vein diameter and flow rates of the AVF were collected, as well as safety data on complications such as bleeding, infection, and embolism.

Results:
Preclinical Study:
PAVD increased mean±SD vein diameter (mm) from 4.5±1.0 to 8.4±1.0 (p=0.005); leading to greater cephalic vein diameter at the time of AVF creation in the PAVD group vs no-PAVD (8.2±1.3 vs. 3.3±0.7; p<0.05). After 6 wks of maturation, mean vein diameter was still greater in the PAVD group compared to no-PAVD (12.8±2.8 vs. 8.4±0.7; p<0.05). Mean flow increased at 41 mL/min/day versus control animals at 5.2 mL/min/day.

Clinical Study:
All subjects saw an increase in vein diameter with PAVD at baseline vs. at 6 wks (2.3±0.5 vs. 5.2±0.7; p<0.05), as well as mean flows (mL/min) (285±30 vs. 724±149). There were no Amplifi-related or procedure-related serious adverse events.

Conclusion:
The translation of PAVD for AVF creation from bench-to-bedside provides safety and efficacy data on a novel solution that can increase the availability of autologous AVFs in patients excluded due to size criteria. The Amplifi vein dilation system can effectively and rapidly dilate peripheral veins without stimulating neointimal hyperplasia. PAVD should be explored in a phase 2 clinical study.
Abstract 4145524: Artificial Intelligence-Based Screening for Blood Pressure Phenotypes of White-coat and Masked Hypertension in Outpatient Settings
Authors: HUNG MING HUI , Chen Chun-Hung , Tseng Yu-Hsuan , Huang Chin-Chou
Published: November 2024

Introduction:
White-coat hypertension (WCH) and masked hypertension (MH) complicate accurate blood pressure (BP) monitoring. While ambulatory BP monitoring (ABPM) is effective, its high cost and limited availability are significant barriers.

Hypothesis:
We hypothesized that a machine learning (ML) model using clinical data from a single outpatient visit could accurately predict WCH and MH.

Aims:
This study aimed to develop and validate ML-based prediction models for WCH and MH using accessible clinical data to improve diagnostic efficiency and accessibility.

Methods:
We enrolled patients from two hypertension cohorts, after excluding those with incomplete data. Patients were classified by office BP and ABPM readings per American Heart Association guidelines. ML models, including Multi-layer Perceptron （MLP）, Support Vector Machine (SVM), and Tabular Prior-Data Fitted Network (Tab-PFN), were developed. Input parameters included demographic data (age, gender, height, weight, smoker), and office BP (OBP) and heart rate measurements. Principal Component Analysis (PCA), kernel PCA (kPCA), or t-distributed stochastic neighbor embedding (t-SNE) were used to improve class separability.

Results:
The study population comprised 1481 participants with a mean age of 47.6 years (SD 13.6), 65% of whom were male and 20.1% were smokers. OBP measurements showed a mean systolic BP (SBP) of 128.7 mmHg (SD 15.4) and a mean diastolic BP (DBP) of 84.2 mmHg (SD 11.6). ABPM showed a mean 24-hour systolic BP of 122.5 mmHg (SD 11.8) and diastolic BP of 79.3 mmHg (SD 10.1). The inclusion of demographic and OBP data, along with advanced resampling and dimensionality reduction techniques, significantly improved the model’s predictive ability. The final TabPFN model achieved the best performance with recall, precision, F1 score, and accuracy of 0.747, 0.931, 0.829, and 0.807 for WCH, and 0.713, 0.954, 0.816, and 0.907 for MH.

Conclusion:
Our ML-based model effectively predicts WCH and MH using accessible clinical data, offering a cost-effective alternative before applying ABPM.
Abstract 4145609: The Cardiac Conundrum of Cannabis: A Case of Junctional Bradycardia Triggered by Cannabis Use
Authors: Jyothi Ramachandran Nair Devi Parvathy , SHAH SMIT , Singh Aniruddha
Published: November 2024

Introduction:
Cannabis has been increasingly used as a recreational drug. Its cardiovascular effects depend on several factors, including the exact composition, route of administration, dose, and duration of use. Here we report a case of cannabis induced junctional bradycardia in a patient with cardiovascular comorbidities.

Case description:
A 68-year-old male with history of chronic systolic heart failure, coronary artery disease, diabetes, hypertension and chronic kidney disease was referred to the hospital from outpatient clinic for bradycardia with heart rate 25-35. Patient did not report any symptoms and was hemodynamically stable. He was euvolemic on physical exam. Electrocardiogram (ECG) and telemetry revealed junctional bradycardia with heart rate in 30s and sinus pauses (5-7 seconds). Initial laboratory analysis was unremarkable. He was admitted for further workup of bradycardia. His home medications included metoprolol succinate 25mg daily which was held given bradycardia. Urine drug screen was positive for cannabis. Patient endorsed that he had recently started smoking marijuana to help him with sleep and anxiety. Echocardiogram was unchanged from baseline. He was monitored on telemetry and the heart rate improved to 60-70s in about 24-48 hours without any other intervention. The temporal relationship between cannabis initiation and spontaneous resolution of bradycardia favored a potential causal link for cannabis- induced mechanism for the junctional bradycardia. Patient was resumed on metoprolol prior to discharge and tolerated it well without any bradycardic episodes establishing further that this was not iatrogenic bradycardia. He was counseled to abstain from cannabis use.

Conclusion:
At low to moderate doses, cannabis can lead to a surge in sympathetic activity causing tachycardia and hypertension, while parasympathetic activity is predominant at higher doses, causing bradycardia and hypotension. Understanding these nuanced effects is crucial for clinicians when evaluating patients especially those with pre-existing cardiovascular conditions. Guidelines should be refined for safer use as the landscape of cannabis legislation evolves.
Abstract 4145617: Racial Disparities in Management and Outcomes of Acute Myocardial Infarction and Non-Acute Myocardial Infarction Related Cardiogenic Shock: An Analysis of the National Inpatient Sample Database
Authors: Desai Anushka , Minhas Anum , Rahman Faisal
Published: November 2024

Background:
Cardiogenic shock (CS) has high morbidity and mortality rates. There is limited understanding of race differences in the management and outcomes of CS.

Methods:
We queried the US National Inpatient Sample database (years 2016-2021) for CS hospitalizations in adults and categorized them by presence of acute myocardial infarction (AMI) on admission. Using multivariable logistic regression modeling, we adjusted for age, sex, income, insurance, comorbidities, and prior cardiac interventions and compared racial differences in use of and time to interventions, inpatient mortality, and cardiac arrest during hospitalization for AMI-CS and non-MI-CS.

Results:
Out of a total 1,012,050 weighted hospitalizations for CS, 60% involved non-MI-CS, while 40% were AMI-CS. Among AMI-CS hospitalizations, Black patients were less likely to receive IABP (aOR: 0.87, 95%CI: 0.82-0.93), pLVAD (aOR: 0.79, 95%CI: 0.72-0.86), PCI (aOR: 0.79, 95%CI: 0.75-0.84), and CABG (aOR: 0.77, 95%CI: 0.71-0.83), than White patients (all p<0.001). For non-MI-CS hospitalizations, Black patients were less likely to receive PCI (aOR: 0.58, 95%CI: 0.50-0.67), CABG (aOR: 0.55, 95%CI: 0.50-0.60), and invasive mechanical ventilation (aOR: 0.91, 95%CI: 0.87-0.94) and were more likely to receive right heart catheterization (aOR: 1.27, 95%CI: 1.21-1.33) and LVAD (aOR: 1.39, 95%CI: 1.25-1.54) when compared to White patients (all p<0.001). In both types of CS, treatment of Hispanic, Asian, and Native American patients was largely comparable to that of White patients. Regardless of CS type, Black patients were more likely to have cardiac arrest during hospitalization. Race was not seen to impact likelihood of inpatient mortality or early treatment within 24 hours in either non-MI-CS or AMI-CS hospitalizations.

Conclusions:
Differential management of CS by race is most notable between Black and White patients with Black patients being less likely to receive most treatments. Inpatient mortality rates remain comparable across race and ethnicity groups. Future studies should further investigate the clinical impact of racial differences in management and assess survival based on time to procedure and length of stay.
Abstract 4145650: Development and Validation of a Pediatric Cardiology-Specific Large Language Model Chat Interface using Retrieval Augmented Generation
Authors: Aly Doaa , Aquino Liliam , Haligheri Geetha , Elmeleegy khaled
Published: November 2024

Introduction:
Generative Pretrained Transformers (GPTs) utilize extensively pre-trained large language models (LLMs) to generate text that resembles human language. Commercially available GPTs are not optimized for medical use and are prone to generating hallucinatory information. Retrieval-augmented generation (RAG) is a novel technology that allows embedding of customized knowledge bases for more enhanced performance of GPTs in specific domains. We aimed to validate the performance of a novel RAG empowered specialized GPT in Pediatric Cardiology.

Methods:
We developed "PedheartVersa," a pediatric cardiac disease-specific GPT, by using our institution's HIPAA-compliant text embedding and LLM platform, "Versa Chat". We conducted RAG on a custom knowledge base which we generated from 6 recent pediatric and fetal cardiology textbooks and 30 AHA/ACC guideline statements (Fig1). We applied prompt engineering through zero shot, few shot and chain of thought learning. We evaluated the performance of PedsheartVersa by comparing its outputs for 75 deidentified real-life fetal, pediatric and ACHD cases to those of trainees, OpenAI's ChatGPT 4, and Meta AI 2. Outputs were rated by expert pediatric Cardiologists on a detailed rubric (scientific consensus, reading comprehension, knowledge depth, reasoning, citation, hallucination, bias, and likelihood of harm).

Results:
94% of the tested cases were correctly answered by PedsheartVersa vs 78% by trainees, 84% by ChatGPT 4 and 76% by Meta AI,
P=
0.027(Fig 2). PedsheartVersa had significantly less demographic bias and likelihood of harm, and higher reading comprehension, reasoning, and depth of knowledge scores than trainees and rest of commercial unspecialized GPTs (Fig 2).

Conclusion:
Our novel customized GPT demonstrated high performance on a wide range of pediatric cardiology-based problems. This lays a groundwork for future applications of customized models in pediatric cardiology education, training and overall decision making.
Abstract 4145694: Dilated Cardiomyopathy Mortality: A Nationwide Cross-Sectional Analysis
Authors: Sainbayar Enkhtsogt , Pham Hoang Nhat , Ibrahim Ramzi , Alabagi Abdulla , Olson April , Thien Ha Le Duc , Tran Phillip
Published: November 2024

Introduction:
Dilated cardiomyopathy (DCM) is associated with a significant mortality risk, with untreated cases showing a five-year survival rate of just 50%. However, there is a scarcity of data on how DCM-related mortality rates have changed over time.

Goals:
How have temporal trends and demographic disparities in DCM mortality evolved in the United States over time?

Methods:
Mortality/demographic data (i.e. sex, race, ethnicity, and area of residence) in adults in the US spanning from 1999-2020 were sourced from the CDC-WONDER database, using ICD-10 code I42.0. Age-adjusted mortality rates (AAMR) per 1,000,000 population were standardized to the 2000 US population. Temporal trends in mortality were assessed using log-linear regression, with results expressed as the average annual percentage change (AAPC).

Results:
A total of 168,702 DCM deaths were recorded between 1999-2020. DCM-related AAMR declined from 34.00 [95% CI, 33.31-34.69] in 1999 to 17.17 [16.74-17.59] in 2020, with AAPC -3.47%, p<0.001. Higher mortality was observed in males (AAMR 33.94 [33.74-34.15]) than females (AAMR 14.68 [14.56-14.80]), in non-Hispanic populations (AAMR 24.06 [23.94-24.18]) compared to their Hispanic counterparts (AAMR 16.68 [16.35-17.01]), and in rural regions (AAMR 23.31 [23.03-23.59]) compared to urban regions (AAMR 23.31 [23.19-23.44]). Black populations (AAMR 41.89 [41.42-42.36]) and residents of the Midwestern US region (AAMR 26.14 [25.89-26.39]) experienced the highest mortality rates.

Conclusions:
DCM-related mortality halved between 1999 and 2020. However, the burden of mortality disproportionately affected males and Black populations. Further research is essential to uncover the underlying factors contributing to these disparities.
Abstract 4145760: Impact of the liver fibrosis scoring on prognosis after coronary artery bypass grafting in patients with prediabetes or diabetes
Authors: Li Zhongchen , Zeng Juntong , Chen Runze , Zheng Zhe
Published: November 2024

Background:
Previous studies have suggested a strong association of liver fibrosis scores with cardiovascular outcomes in patients with different cardiovascular diseases, especially in people with abnormal glucose metabolism. However, the prognostic implication of liver fibrosis scores in patients with prediabetes or diabetes undergoing coronary artery bypass grafting (CABG) has not been investigated yet.

Purpose:
This study aimed to investigate the impact of liver fibrosis, assessed by the Fibrosis-4 (FIB-4) index on clinical outcomes following CABG in patients with prediabetes or diabetes.

Methods:
Adult patients with stable coronary artery disease and prediabetes or diabetes undergoing isolated CABG from a large prospective registry-based cohort between January 2013 and December 2018 at our center were consecutively included. Patients with missing detailed data, hepatitis B/C virus infection, autoimmune hepatitis, hereditary liver disease, secondary causes of fatty liver, drug-induced liver disease, active infections, or severe liver insufficiency were excluded. The primary outcome was all-cause death. The secondary outcome was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of all-cause death, myocardial infarction, cerebrovascular accidents, or repeat revascularization. Survival was summarized using Kaplan-Meier curves and compared by log-rank test, followed by multiple adjustments.

Results:
A total of 14,253 patients were included. According to clinical guidelines, a FIB-4 score of ≤1.3 is considered indicative of a low risk for liver fibrosis. Of all patients, 8,888 (47.9%) were identified as having a high FIB-4 (>1.3) level. During a median follow-up of 3.4 years, a high FIB-4 level was associated with an increased risk of all-cause death (adjusted hazard ratio [aHR]: 1.405, 95% confidence interval [95% CI]: 1.205-1.698, P＜0.001), as well as MACCEs (aHR: 1.142, 95% CI: 1.039-1.256, P=0.006).

Conclusion:
Almost half of the patients with prediabetes or diabetes undergoing CABG were exposed to high FIB-4, which might be associated with poor prognosis.
Abstract 4145764: Mitral Annular Calcification (MAC) and Stroke Risk: A Single Center Cohort Analysis of stroke outcomes across the spectrum of MAC Severity
Authors: Rosenzveig Akiva , Badwan Osamah , Alamer Mohammad , Gharaibeh Ahmad , Layoun Habib , Safdar Ahmad , Mirzai Saeid , Persits Ian , Skoza Warren , wassif heba
Published: November 2024

Background:
Stroke is one of the leading causes of long-term disability and mortality worldwide. Of ischemic stroke etiologies, cardio-embolism both causes more severe strokes and is responsible for an increasing share of the ischemic stroke etiologies in the developed world. Mitral annular calcification (MAC), chronic degeneration of the fibrous base of the mitral valve, has been implicated by association with increased stroke risk. However, there has been conflicting evidence regarding the causative relationship between MAC and stroke risk. Although the 2008 CHEST guidelines recommended antithrombotic therapy with aspirin to mitigate stroke risk, the updated 2012 CHEST guidelines question the role of antithrombotic therapy since stroke may be due to embolized calcific spicules. 2020 American College of Cardiology / American Heart Association guidelines do not make recommendations regarding stroke prevention in MAC. Our study sought to assess the association of MAC and its severity with stroke outcomes.

Hypothesis:
We hypothesize an association between MAC and stroke which increases with increasing MAC severity

Methods:
We retrospectively studied patients undergoing transthoracic echocardiography in a single center cohort from 2005 through 2017. MAC severity was determined based on documented echo reports. Multivariable cox regression analysis was used to assess for correlation with stroke and was adjusted for diabetes, hypertension, hyperlipidemia, infection, endocarditis, lupus, prior MI, mitral disease, OSA, PAD, and prosthetic valves.

Results:
The cohort included 2,837 patients. Of the full cohort, 393 had no MAC, 1686 had mild MAC, 537 with had moderate MAC, and 221 had severe MAC. Mean age (57.2 to 68.6) and female gender rates (49.4% to 71%) significantly increased with increasing MAC severity. At median follow up of 73 months (IQR 6.1,103.7) there were a total of 92 stroke events. Cox regression analysis found aHR of 1.45 (0.74-2.84, p=0.28), 1.16 (0.52-2.59, p=0.72), and 1.23 (0.44-3.44, p=0.69), for mild, moderate, and severe MAC, respectively, when compared to patients without MAC.

Conclusion:
In a large single center cohort, there was no association found between MAC and stroke outcomes, regardless of severity.
Abstract 4145862: Prognostication Of Cardioembolic Stroke Due To Underlying Atrial Fibrillation With Serum Troponin Levels
Authors: Maqsood Hamza , Hussain Alamdar , solanki siddhant , Furqan Muhammad , KARIMI MUHAMMAD SIDDIQUE , Younus Shifa , khaliq muhammad , Zafar Shahzad
Published: November 2024

Introduction:
The association between elevated levels of high-sensitivity cardiac troponin I (cTnI) and clinical outcomes in stroke patients has been documented. Nevertheless, the precise significance of cTnI and its potential as a biomarker in ischemic stroke (IS) remains unclear. Our study sought to evaluate the correlation between serum cTnI levels and early neurological deterioration (END) in individuals experiencing stroke related to atrial fibrillation (AF).

Methods and Materials:
In this multicentric study, we enrolled consecutive patients with stroke related to atrial fibrillation (AF) from 2020 to 2023. Exclusion criteria for this study comprised large vessel stenosis/occlusion and previously identified etiologies upon admission. All patients underwent a comprehensive etiological assessment. Early neurological deterioration (END) was defined as a rise in the NIHSS score of at least 2 points from baseline to the 48-hour assessment.

Results:
A total of 1611 patients with stroke related to atrial fibrillation (AF) were assessed. In the multivariable analysis, cTnI (odds ratio [OR] = 1.32, 95% confidence interval [CI] 0.96–1.62; P < 0.005) remained statistically significant after controlling for confounding factors. The initial NIHSS score (OR = 0.98, 95% CI 0.92–1.11; P < 0.005) showed a positive association with early neurological deterioration (END), whereas the utilization of anticoagulants (OR = 0.61, 95% CI 0.51–0.74; P < 0.001) and new oral anticoagulants (OR = 0.71, 95% CI 0.37–1.36; P < 0.005), exhibited a negative association.

Conclusion:
Our study concluded that troponin elevation in patients with AIS may be attributed to the cumulative impact of comorbidities alongside neurological status, thereby highlighting the prognostic importance of troponin assessment.
Abstract 4145962: Evaluating a Single-Lead, Mobile Electrocardiogram for Screening of Atrial Fibrillation in Patients with Obstructive Sleep Apnea
Authors: Mittal Ajay , Savu Victor , Patel Mansi , Kapadia Kevin , Segal Mark
Published: November 2024

Introduction:
Obstructive sleep apnea (OSA) affects nearly a billion adults worldwide, and is associated with an increased risk of coronary artery disease, heart attack, heart failure, and arrhythmias - notably atrial fibrillation (AF). Low cost, point of care mobile electrocardiograms (MobileECGs) record and detect heart rhythm abnormalities in 30 seconds. This study aims to assess the effectiveness of the KardiaMobile (AliveCor) MobileECG device as an AF screen in the OSA patient population.

Methods:
The MobileECG Sleep Study enrolled 500 adult University of Florida Health patients in an observational study between March 2021 and March 2024. After providing consent and completing a brief survey regarding pre-existing health conditions and overall sleep health, a trained research assistant performed the AF screening with the KardiaMobile ECG device. ECG readings were marked for previously undetected abnormalities (potential AF, tachycardia, bradycardia, etc.) and statistically analyzed to determine stroke risk using the CHA2DS2-VASc scoring system. CHA2DS2-VASc criteria includes congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female).

Results:
A total of 500 participants were enrolled over a 3 year period at University of Florida Health Sleep Center. Of which 276 (55.2%) were female and 224 (44.8%) were male, with a mean age of 56.34 (SD 15.74) and a mean weight of 222.50 (SD 63.25). Of those tested, 68 (13.6%) had irregular, previously undetected AF readings. Patients with irregular AF readings using the KardiaMobile ECG device had CHA2DS2-VASc scores of t(68) = 2.15, p = .042, d = 0.26 indicating an intermediate risk for stroke. Oral anticoagulation is recommended for a score of ≥ 2 if the patient has no contraindication. After prior 12-lead ECG data for patients is obtained the determinations will be compared to the KardiaMobile ECG readings using Cohen’s Kappa.

Conclusion:
MobileECGs offer a rapid, point of care screening tool for AF in an outpatient sleep clinic setting. Early detection of AF in the OSA patient population can result in improved outcomes and reduced instances of stroke events through anticoagulation therapy guided by CHA2DS2-VASc scores. Further research is necessary to understand the long term impact of surveillance AF screening in high risk patient populations on mortality and cost of healthcare.
Abstract 4145963: Mortality Trends of Pulmonary Hypertension and Congestive Heart Failure in the United States: A CDC WONDER Analysis
Authors: Rathore Azeem , Shaikh Safia , Nassar Sameh , Upreti Prakash , Basit Jawad , Bolaji Olayiwola , Alraies M Chadi
Published: November 2024

Introduction:
Pulmonary hypertension (PH) is a common comorbidity in congestive heart failure (CHF) patients. Despite studies showing the negative impact of PH on outcomes in CHF, temporal analyses of combined mortality trends are unknown.

Methods:
We queried the CDC WONDER database for PH (ICD-10: I27.0, I27.2, I27.8, I27.9) and CHF (ICD-10: 50.0, 50.1, 50.9) related deaths in ≥ 45-year-olds. Joinpoint regression analysis assessed annual percentage change (APC) trends for underlying and contributing causes of death. Age-adjusted mortality rates (AAMR) were computed and compared cumulatively across subpopulation demographics.

Results:
From 2012 to 2016, significant temporal changes were noted in PH and CHF as underlying causes (APC: 4.50% [95% CI: 2.50, 6.36]). Conversely, PH and CHF as contributing causes showed notable shifts from 1999 to 2012 (APC: -2.38% [95% CI: -2.72, -2.11]) and 2012 to 2020 (APC: 2.24% [95% CI: 1.65, 3.04]). Gender-specific analysis revealed higher AAMRs among males (313.7) than females (240.3) across this period. Race-specific analysis indicated higher AAMRs among Blacks than Whites and Asians (285.1, 273.8, and 122.6, respectively). Variation across major regions was statistically significant with the Midwest having the highest AAMR (296.3).

Conclusion:
PH and CHF are major contributors to mortality, with trends showing limited improvement across gender, race, and region. While PH and CHF were increasingly recognized as primary causes of death, their role as contributing factors in mortality is even more significant and has been rising more sharply. Targeted public health interventions are needed to address these disparities.
Abstract 4145973: Pemafibrate Provides Multiple Antiatherothrombotic Effects for Patients with Dyslipidemia Receiving Statin
Authors: Murakami Tatsuaki
Published: November 2024

Background:
Statin is thought to be highly effective against complex atherothrombogenic processes, but further therapies for the residual risk after statin have not been established.
Hypothesis:
We assessed hypothesis that treatment with pemafibrate, a selective peroxisome proliferator-activated receptor α (PPARα) modulator, inhibits atherothrombotic progression in patients with coronary artery disease and dyslipidemia receiving statin, one of the best possible antiatherosclerotic treatment.

Methods:
Thirty dyslipidemic patients with stable coronary artery disease were randomized to group-P where they received pemafibrate (0.2mg/day), or to group-C where they continued antidyslipidemic therapy without a fibrate for 3 months. We quantified flow-mediated endothelium-dependent dilation of right brachial artery after 5 minutes forearm occlusion (BFMD), and we also quantified intima-media thickness of brachial artery (BIMT) using high-resolution ultrasonography. Changes in BFMD, BIMT, and other serum variables were compared between the two study groups.

Results:
Group-P (n=20) manifested good compliance to the treatment with pemafibrate and improvements in clinical variables represented by triglycerides and D-dimer after medication of pemafibrate, while there were no improvements in group-C. BFMD (%) improved after medication in group-P (from 4.1±1.6 to 5.4±2.5, p<0.01) and BIMT (mm) decreased in group-L (from 0.33±0.10 to 0.30±0.11, p=0.03), while both remained unchanged in group-C (BFMD; from 4.0±2.1 to 3.9±1.8, p=0.58, BIMT; from 0.33±0.14 to 0.34±0.18, p=0.44). Changes of BFMD or BIMT in group-P did not correlate to those of triglycerides (FMD: r=0.18, p=0.62, BIMT: r=0.11, p=0.80).

Conclusion:
This study suggests that pemafibrate safely improves arterial function and inhibits progression of wall thickness independent of reversal for dyslipidemic status, and has novel potential benefit for residual risk management of atherothrombosis in dyslipidemics receiving statin.
Abstract 4145979: Rising Burden of Ischemic Heart Disease Attributable to High Fasting Plasma Glucose in the United States: A Three-Decade Trend Analysis (1990-2019)
Authors: Chokshi Anushka , Syed Saif , Waqas Muhammad , Shandilya Ashwinikumar , Bhalodia Paritaben , Lakkimsetti Mohit , AMIN VISHRANT , Venugopal Darshine , PATEL JUHI , DESAI HARDIK , sharma kamal
Published: November 2024

Introduction:
Ischemic heart disease (IHD), driven predominantly by modifiable risk factors such as high fasting plasma glucose (FPG), remains a leading cause of morbidity and mortality worldwide. In the United States, understanding the state-specific burden of IHD attributable to high FPG is critical for tailoring effective public health strategies.

Method:
Using Global Burden of Disease tool, we estimated Deaths, DALYs (disability adjusted life years), YLDs (years lived with disability) due to IHD attributable to FPG across the US by age, sex, year and location from 1990-2019.

Results:
Between 2010-2019, the annual percentage change (APC) showed a significant increase in deaths rose by 17% (95% Uncertainty Interval [UI]: 10-25%), DALYs by 19% (11-26%), and YLDs by 21% (12-30%). In terms of age-standardized mortality rates (ASMR), Vermont saw the largest increase at 9%, followed by South Dakota at 8%. Conversely, New York exhibited the most substantial decrease in ASMR, declining by 11%. The YLDs rate saw its most considerable rise in the District of Columbia, up by 12%, with Wyoming following at a 7% increase. In 2019, Oklahoma recorded the highest ASMR at 43.06 (25.18-67.9) cases per 100,000, whereas Mississippi had the highest YLDs rate at 786 (495-1160). Over the last three decades, older age groups experienced a heavier burden. A gender comparison revealed an increasing trend in females compared to males, with APC in deaths for males versus females at 32% vs. 37%, DALYs at 21% vs. 25%, and YLDs at 94% vs. 116% from 1990-2019.

Conclusion:
IHD attributable to high FPG accounted for 34.19% of all IHD deaths in 2019, underscoring the urgent need for public health policies that promote outdoor activities and regular exercise among youth, and discourage the consumption of processed foods to foster healthier lifestyles and mitigate this significant health burden.
Abstract 4146016: Trend-Analysis of Atrial Fibrillation and Atrial Flutter Related Mortality from 1999 to 2022: A CDC-Wonder Database Study
Authors: Ayyan Muhammad , Munir Luqman , Zahid Afra , Naveed Aiman , Ehsan Muhammad , Rehman Wajeeh , Dani Sourbha
Published: November 2024

Introduction:
Atrial Fibrillation is the most common arrhythmia, causing an irregular and rapid heart rate. This occurs due to electric and structural remodeling of the atria, which creates the rapidly discharging foci.

Aims:
This study aims to explore the national mortality trends resulting from Atrial Fibrillation and Flutter in the United States from 1999-2022 while also studying the discrepancies among the various socio- demographic groups.

Methods:
The death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiological Research (CDC Wonder) database were explored to investigate the Atrial fibrillation and flutter mortality from 1999 to 2022, focusing on the Age-Adjusted Mortality Rate (AAMR) per 1,000,000 individuals. We employed Joinpoint Regression Analysis to compute Annual Percent Changes (APC) with a 95% Confidence Interval. The data was further stratified into epidemiological groups of age, gender, ethnicity, and census region.

Results:
There was a steady rise in mortality from 1999 to 2017 (APC: 2.96), followed by a rapid surge in mortality trends from 2017 to 2022 (APC: 7.35). The mortality rate rose fairly equally among both genders over the years, with males having a slightly steeper incline (Male AAPC: 4.27, Female AAPC: 3.43). African Americans had the greatest number of deaths due to atrial fibrillation and flutter and the greatest rise was during recent years from 2017 to 2022 (APC: 9.64). The atrial fibrillation and flutter related mortality was the greatest among 25-34-year-olds, with the mortality decreasing among the older populations. All US Census regions had similar mortality rates and trends.

Conclusion:
This study reveals an overall rise in mortality associated with atrial fibrillation and flutter. It also highlighted disparities across gender, age, and geographic regions. These findings emphasize the need for further research and the development of targeted interventions to reduce mortality and alleviate the burden of this debilitating condition.
Abstract 4146024: Duration of Cardiopulmonary Resuscitation Enhances Prognostic Stratification in Cardiogenic Out-of-Hospital Cardiac Arrest
Authors: Numaga Miki , Abe Takuro , MIYOSHI KOTARO , Yoneyama Fumika , Kitagawa Kai , Hashimoto Junki , Ogata Madoka , Okuda Nozomiko , Kawahara Yuki , Tani Akihiro , Ando Toshiyuki , Komiyama Hideori , Ishihara Shiro , Jujo Kentaro
Published: November 2024

Background:
Despite advances in treatment strategies for out-of-hospital cardiac arrest (OHCA), prognosis remains poor. The MIRACLE2 score is an established prognostic predictor, but does not consider the duration of cardiopulmonary resuscitation (CPR), a critical determinant of outcomes. Stratifying risk at admission is crucial for guiding subsequent management decisions.

Aims:
To evaluate the prognostic value of CPR duration in patients with cardiogenic OHCA and assess its additive predictive utility beyond the MIRACLE2 score.

Methods:
We conducted a single-center, observational study (COEDO-CPA registry) of cardiogenic OHCA patients from 2018 to 2024. Receiver operating characteristic (ROC) analysis identified the optimal CPR duration cut-off for predicting 30-day mortality. We compared the predictive performance of MIRACLE2 score alone versus combined with CPR duration.

Results:
A total of 124 consecutive cardiogenic OHCA patients was ultimately analyzed, with an average age of 62.6 years; 87% were male, and the average MIRACLE2 score was 3.0. ROC analysis identified 35 minutes as the optimal CPR duration cut-off for 30-day mortality. Kaplan-Meier analysis revealed significantly higher mortality in patients with CPR duration >35 minutes (Log-rank p<0.001, Figure A). Multivariable Cox regression model showed CPR duration >35 minutes independently predicted mortality after adjusting for MIRACLE2 score (HR: 3.41, 95% CI: 1.82-6.39). Additionally, compared to MIRACLE2 score alone, combining MIRACLE2 score with CPR duration >35 minutes improved prediction of 30-day mortality (AUC: 0.81 vs. 0.78, p=0.005, Figure B).

Conclusion:
In cardiogenic OHCA patients, CPR duration >35 minutes independently stratified mortality risk and enhanced the accuracy of existing prognostic models like MIRACLE2 score. Incorporating CPR duration could improve risk assessment and guide management decisions in this high-risk population.
Abstract 4146065: Sex Differences in Clinical Profile and Outcomes of Infective Endocarditis: A Meta-Analysis
Authors: A. Hamad Yousef , Salim Heba , Alwadiya Huda , Siriya Woroud , Mansour Baraa , Alhadad Haya , Marouf Walid , Ayyad Mohammed , Saravanabavanandan Ragavendar , Al-Tawil Mohammed , Haneya Assad
Published: November 2024

Background:
Infective endocarditis (IE) presents significant morbidity and mortality, with potential sex differences in clinical profile and outcomes. This meta-analysis aims to compare the clinical profile and outcomes of IE between males and females.

Hypothesis:
The clinical profile and outcomes of IE differ between males and females.

Methods:
We conducted a meta-analysis comparing the clinical profile and outcomes of IE in males versus females. Twelve studies were retrieved from PubMed, EMBASE, SCOPUS, and Cochrane databases up to January 1, 2024, with 9 studies reporting on patients admitted for IE and 3 studies reporting on patients who underwent surgery for IE.

Results:
Our meta-analysis revealed notable sex differences in the incidence and complications of IE. Males exhibited a higher incidence of aortic valve IE (RR 1.57; 95% CI [1.31, 1.88]), surgical indications for IE (RR 1.38; [1.12, 1.70]), Streptococci infection (RR 1.36; [1.04, 1.77]), intracardiac abscess (RR 1.22; [1.05, 1.42]), and Enterococci IE (RR 1.44; [1.28, 1.61]). In contrast, females had a higher incidence of mitral valve IE (RR 0.79; [0.67, 0.94]) and a higher in-hospital mortality rate (RR 0.84; [0.74, 0.96]). There were no major sex differences in the occurrence of valve vegetation, tricuspid valve IE, embolization, or Staphylococcus IE. Male patients had a longer in-hospital stay, although this was only marginally significant (RR 3.15; [-0.16, 6.45]; p = 0.06). Among patients who received surgery for IE, male patients had significantly lower mortality rates (RR: 0.67; [0.59, 0.76]; p<0.01).

Conclusions:
Compared to females, males exhibit higher rates of aortic valve IE, IE-related surgical indications, intracardiac abscesses, streptococci IE, and enterococci IE. In contrast, females have higher rates of mitral valve IE and in-hospital mortality. Conversely, the incidence of stroke, embolization, and in-hospital stay duration is comparable between both sexes.
Abstract 4146080: Depolymerization of Myocyte Microtubules with Colchicine Normalizes Increased Left Ventricular Chamber Stiffness Induced by Brief Repetitive Pressure Overload
Authors: Graser Luke , Weil Brian , Canty John
Published: November 2024

Objective:
Swine subjected to brief (30-min) episodes of repetitive pressure overload (BRPO) exhibit increased left ventricular (LV) chamber stiffness in the absence of anatomic hypertrophy or increased interstitial fibrosis. We employed acute colchicine administration to determine the role of microtubule remodeling in this process.

Methods:
We used daily 30-minute infusions of phenylephrine (PE; 400µg/min, n=12) to induce BRPO. This raised LV systolic pressure from 102 ± 4 to 215 ± 14 mmHg and LVEDP from 12.5 ± 2.3 to 30.0 ± 1.8 mmHg. Serial LV chamber stiffness (ΔLVEDP / ΔLVEDV) was determined using echocardiography and LVEDP at rest and during PE-induced preload elevation (n=7). We assessed the contribution of microtubules to stiffness 1-hour after colchicine (1mg/kg iv).

Results:
Two-weeks of BRPO produced a significant increase in LV stiffness (Figure). Pathological analysis (n=5) demonstrated that this was associated with increased microtubule detyrosination (from 15.9 ± 1.7% to 21.9 ± 1.1% of myocyte area; p <0.05) but no increase in interstitial fibrosis (5.03 ± 0.33% vs. 4.99 ± 0.34%, p=0.95). Serial studies of LV chamber stiffness showed an increase from 0.43 ± 0.08 mmHg/mL at baseline to 0.86 ± 0.08 mmHg/mL after 2-weeks of BRPO (p<0.01). After colchicine, LV stiffness decreased to 0.54 ± 0.04 mmHg/mL (n=7, p<0.01) and was not significantly different from baseline values before BRPO.

Conclusions:
Acute depolymerization of microtubules with colchicine reduces the increased LV chamber stiffness after BRPO to near baseline levels. These data indicate that myocyte microtubular remodeling is a major determinant of LV chamber stiffness arising from BRPO and contributes to diastolic LV properties in this model, which may pose relevance in some forms of hypertensive HFpEF.
Abstract 4146082: Evolving Burden of Congenital Heart Anomalies in the United States and its Trend in the last three Decade: A Benchmarking Analysis
Authors: Bhalodia Paritaben , Suppala Praveena , Patel Lalitkumar , Patel Vishwesh , Rathod Urvashi , Vala Lovekumar , Nandania Parth Kumar , Modi Dhruvi , Patel Rutvij , Vummaneni Siri , DESAI HARDIK
Published: November 2024

Introduction:
Congenital Heart Anomalies (CHA) are the leading cause of deaths among all congenital birth defects (CBD) in the United States. This study represents the first-ever effort to estimate the burden of CHA nationwide over the past three decades, including the first two years of the COVID-19 pandemic.

Method:
Using Global Burden of Disease 2021 tool, we estimated incidence, prevalence, deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to CHA by age, sex, year and location across the US from 1990-2021. The results were presented in absolute counts and age-standardized rates (per 100,000).

Results:
The total prevalence of cases rose from 441,000 (95% Uncertainty Interval: 391,325-492,037) in 1990 to 527,452 (475,661-579,228) in 2021. Over the same period, the total percentage change (TPC) in deaths decreased by 56%, while YLDs increased by 11% (3-17%). The largest increase in TPC in incidence rates was observed in Wisconsin at 19% (6-37%), followed by a YLD rate increase in Delaware of 4% (7-15%). By age, individuals under 20 years experienced the highest death count at 1,551 (1,295-1,942), those aged 20-54 years observed 695 deaths (623-827), and those over 55 years saw 378 deaths (332-519) in 2021. In terms of gender, females showed a higher increase in TPC for YLDs compared to males (11% vs 10%), although both genders observed decreases in incidence and deaths.

Conclusion:
Deaths due to CHA accounted for 31% of all CBD in the US in 2021. Study findings reveal a notable decrease in mortality but an increase in disability years, reflecting advances in treatment alongside ongoing challenges in managing long-term health outcomes. This underscores the need for a dual approach in public health: enhancing preventive strategies and improving management for those affected. Coordinated efforts among healthcare providers, policymakers, and community health programs are essential to address these needs effectively.
Abstract 4146113: Clinical, Sociodemographic, Lifestyle, and Genetic Factors Associated with Worsening Heart Failure: Evidence from the UK Biobank
Authors: Hwang Taehyun , Yang Pil-sung , JANG EUNSUN , Kim Daehoon , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-Sun , Sung Jung-Hoon , Pak Hui-Nam , Lee Moon-Hyoung , JOUNG BOYOUNG
Published: November 2024

Background:
Heart failure (HF) is the leading cause of hospitalization and death.

Hypothesis:
This study examined the associations and clinical utilities of genetic, sociodemographic, lifestyle, laboratory, and clinical risk factors for worsening HF (WHF).

Methods:
Data were from 4,913 UK Biobank middle-aged adults with established HF at enrolment. WHF comprised HF admission, visit events of the emergency department due to acute congestive HF, and cardiovascular death. We performed Cox proportional hazard regression analyses to investigate the associations related to WHF after enrolment utilizing 24 variables encompassing sociodemographic, clinical, lifestyle, and laboratory data. To assess the impact of genetic factors, we additionally adjusted the polygenic risk score (PRS) for coronary artery disease (CAD).

Results:
Over a median follow-up of 11.5 [10.9-12.1] years, 411 (8.4%) WHF events occurred. Among the 24 variables, statistically significant hazard ratios were observed for 12 variables, with hypertension (2.20, 1.64-2.94), AF (1.99, 1.58-2.49), coronary heart disease (1.90, 1.51-2.40), and current smoking (1.77, 1.29-2.44), showing the highest hazard ratios, while female gender (0.47, 0.36-0.62) exhibited the smallest hazard ratio. After adjusting for CAD PRS, CAD PRS (HR 1.16, 1.05-1.28) showed significance in relation to WHF. In the WHF prediction model, the C index was 0.834 (0.816-0.851) with clinical variables, and it marginally increased to 0.847 (0.830-0.864) when all factors, including the genetic factor, were applied.

Conclusions:
Sociodemographic, clinical, laboratory, lifestyle, and genetic factors are each associated with worsening HF with male gender, hypertension, AF, CHD, diabetes, chronic obstructive pulmonary disease, low eGFR, low hemoglobin, high lipoprotein, cigarette smoking, no regular physical activity, and CAD PRS.