bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4139873: Isolated Tricuspid Replacement versus Repair among Medicare Beneficiaries
Authors: Shimoda Tomonari , Ueyama Hiroki , Miyamoto Yoshihisa , Watanabe Atsuyuki , Gotanda Hiroshi , Elmariah Sammy , Yokoyama Yujiro , Fukuhara Shinichi , Kaneko Tsuyoshi , Kuno Toshiki , Tsugawa Yusuke
Published: November 2024

Background:
Evidence is limited regarding mid-term outcomes following isolated tricuspid operations for tricuspid regurgitation at the population level.

Objective:
This study aimed to compare the mid-term outcomes following isolated tricuspid valve replacement versus repair using contemporary data.

Methods:
We analyzed the national data on Medicare beneficiaries aged ≥65 who underwent isolated tricuspid valve replacement or repair between January 2016 and December 2020. The primary outcome was mid-term (up to 3 years) all-cause mortality. The secondary outcomes included mid-term major adverse cardiovascular events (MACE) and heart failure hospitalizations, as well as in-hospital permanent pacemaker implantation rates. MACE comprised all-cause mortality, heart failure hospitalization, stroke, and tricuspid reoperations. A propensity score-matching analysis was conducted to compare the two groups.

Results:
A total of 1,693 patients were included (replacement= 655 patients, repair= 1,038 patients). In the matched cohort (597 patients in each group), the overall mortality and MACE were 40% and 47% at 3 years, respectively. Tricuspid valve replacement was associated with similar all-cause mortality in comparison to repair (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.95-1.39; P=0.15). Similarly, the rates of MACE and heart failure hospitalizations were similar (adjusted HR, 1.10; 95% CI, 0.93-1.32, P=0.27; subdistribution HR, 1.07, 95% CI, 0.75-1.54, P=0.69, respectively) between these two procedures. Patients undergoing replacement required permanent pacemaker implantations more frequently (25.4% vs. 12.4%; P<0.001).

Conclusions:
Isolated surgical tricuspid valve replacement was associated with similar clinical outcomes compared to repair, except for permanent pacemaker implantation rates. The overall high mid-term mortality and morbidity with either treatment highlight the need for better options and further research to optimize the indication and timing of intervention.
Abstract 4139875: Trends in Comorbid Diabetes Mellitus and Heart Failure-Related Mortality Among Older Adults: Demographic and Regional Analysis from CDC WONDER - 1999 to 2019
Authors: Ejaz Arooba , Ahmad Adeel , Salman Madiha , Khan Naima , Alim Ur Rahman Hafsah , Raja Sandesh , Ali Eman , Hameed Ishaque , Rehman Wajeeh , Shaikh Asim
Published: November 2024

Background and Purpose:
Older adults in the United States face worsening trends in the incidence and prevalence of comorbid diabetes mellitus (DM) and heart failure (HF). This study aimed to examine the trends in DM and HF-related mortality among adults ≥65 years in the United States.

Methods:
The Multiple Cause-of-Death data using CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) were analyzed for DM and HF-related deaths from 1999 to 2019 in adults ≥65 years. Age-adjusted mortality rates (AAMRs) per 100,000 population were determined and stratified by year, sex, race/ethnicity, and geographic region. Joinpoint regression was used to analyze trends in AAMRs using annual percent change (APC).

Results:
A total of 842,785 deaths occurred among older adults in the United States related to comorbid HF and DM. The overall AAMR for deaths due to comorbid DM and HF in older adults was 97.4. The AAMRs remained stable between 1999 and 2005. From 2005 to 2009, AAMRs steadily declined at an APC of -3.41 (95% CI: -4.75 to -0.52). Following a period of stability from 2009 to 2014, AAMRs increased at an APC of 2.80 (95% CI: 1.97 to 4.68) till 2019. Men (116.2) had consistently higher AAMRs than older women (84.8) throughout the study period. Upon stratification by race and ethnicity, AAMRs were observed to be highest in non-Hispanic (NH) American Indian or Alaska Native (144.1), followed by NH Black or African American (124.4), Hispanic or Latino (100.5), NH White (95.3), and NH Asian or Pacific Islander (62.0) populations. Non-metropolitan areas had higher AAMRs for comorbid HF and DM than metropolitan areas, with overall AAMRs of 126.9 and 90.9, respectively. States that fell into the top 90
th
percentile included Kentucky, Mississippi, Oklahoma, Oregon, Vermont, and West Virginia, which had twice the AAMRs than states that fell into the bottom 10
th
percentile, including Arizona, Florida, Hawaii, Massachusetts, Nevada, and New York.

Conclusion:
Our analysis revealed a concerning rise in mortality related to comorbid DM and HF in U.S. adults ≥ 65 years old since 2014. Men, NH American Indian and Alaska Native populations, and residents of non-metropolitan areas displayed the highest AAMRs. Future efforts focusing on improved risk assessment and the adoption of therapeutic therapies are needed for the effective management of patients with comorbid DM and HF to help alleviate the mortality burden.
Abstract 4139879: Impact of Catheter Contact Angle on the Relationship between Contact Force and Local Impedance Change with the Novel Diamond-embedded Temperature-controlled Ablation Catheter in a Porcine Experimental Model
Authors: Ogiso Sho , Fukaya Hidehira , Ogawa Emiyu , Mori Hitoshi , Masuda Yuya , Yazaki Yuto , Murayama Yusuke , Daiki Saito , Arakawa Yuki , Kobayashi Shuhei , Nakamura Hironori , Ishizue Naruya , Kishihara Jun , Niwano Shinichi , Oikawa Jun , Ako Junya
Published: November 2024

Background:
The DiamondTemp
TM
(DT) catheter enables precise temperature-controlled ablation. However, the DT catheter lacks contact force measurement capabilities. This study investigated the impact of catheter contact angle on the relationship between contact force and local impedance change in a porcine experimental model.

Hypothesis:
We hypothesized that a correlation between contact force and local impedance would differ in different contact angles of the DT catheter.

Aims:
To evaluate the impact of different contact angles (30°, 45°, 90°) of the DT catheter on the relationship between the contact force and local impedance change.

Methods:
We used freshly sacrificed porcine hearts and set them in the circulated water pool. The contact force (5, 10, and 30 grams) and catheter contact angles (30°, 45°, and 90°) were changed in each set (n = 13 each). Local impedance was measured, and the correlation with contact force was assessed using Spearman's rank correlation coefficient.

Results:
Strong correlations were found between local impedance rise and contact force at catheter contact angles of 90° (Spearman’s rank correlation coefficient: 0.70, p <0.001) and 45° (0.60, p <0.001). However, there was no correlation between catheter contact force and local impedance rise at 30° (0.31, p = 0.057).

Conclusion:
Local impedance rise of the DT catheter was correlated with contact force at the catheter contact angle of 90° and 45°; however, it became insignificant at 30°, suggesting that local impedance could not be utilized to speculate contact force in the shallower catheter contact angles.
Abstract 4139880: Trends in Atrial Fibrillation Related Mortality in Coronary Artery Disease Patients Aged 65 and Older in the United States: Insights from the CDC WONDER Database
Authors: Naveed Muhammad Abdullah , Ali Ahila , Iqbal Rabia , Azeem Bazil , Omer Rehan Muhammad , Akbar Usman , sattar yasar , Gonuguntla Karthik , Khan Muhammad , Asad Zain Ul Abideen , balla sudarshan , Munir Bilal
Published: November 2024

Background:
Patients with Coronary Artery Disease are at an increased risk of Atrial Fibrillation related mortality via various mechanisms like Ischemia, Atrial stretch and remodeling, but largely as side effects of treatments. Thus, AF in patients with CAD is a critical health concern among older adults (65+) in the United States. Our CDC analysis focuses on unraveling mortality trends among patients grappling with both conditions from 1999 to 2020.

Methods:
A retrospective analysis was conducted using national mortality data from the multiple causes of death files in the CDC WONDER database from 1999 to 2020, employing ICD codes I48 for AF and I25.1 for CAD. Age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for the total population, stratified by gender, race, urban/rural metro status, and census region. Annual Percent Change (APC) was calculated using the Joinpoint regression software.

Results:
A total of 564,952 AF-related deaths among older adults aged 65+ with CAD occurred in the U.S. between 1999 and 2020. Majorly occurred in medical facilities (36.5%). The overall AAMR for AF in CAD-related deaths increased from 49.7 per 100,000 in 1999 to 84.4 in 2020, with an AAPC of 2.52 (95% CI: 2.29 to 2.76, p < 0.000001). A moderate rise in AAMR from 1999 to 2016 (APC: 1.75, p < 0.000001), then significant surge from 2016 to 2020 (APC: 5.88, p < 0.000001). Men had higher AAMRs than Women (83.8 vs 46.6), with a more pronounced increase in men (AAPC: 3.44, p < 0.000001) compared to women (AAPC: 1.23, p < 0.000001). Racially, White population had the highest AAMRs (67.1), followed by American Indians or Alaska Natives (41.9), Hispanics (33.7), Blacks (32.2), and Asians (28.1). All racial groups saw significant increases in AAMRs, most notably among American Indians or Alaska Natives (AAPC: 4.64). Geographically, AAMRs varied, with Rhode Island having the highest (103.5) and Nevada the lowest (29.7). The Midwest had the highest regional AAMR (65.1), while nonmetropolitan areas exhibited higher AAMRs than metropolitan areas, both showing overall increase throughout study (3.34 vs 2.23).

Conclusion:
This analysis reveals increasing trends and demographic disparities in mortality rates due to AF in CAD patients among older adults in the U.S. The recent surge in mortality rates highlights the need for targeted interventions to address these disparities and improve health outcomes for this vulnerable population.
Abstract 4139892: Trends in ACS-Related Mortality in Older Adults in the United States from 1999 to 2020: An Analysis of Gender, Race/Ethnicity, and Geographic Disparities
Authors: Khan Naima , Salman Madiha , Ejaz Arooba , Azeem Bazil , Zubair M. Mujeeb , Ali Eman , Cheema Huzaifa Ahmad , Ahmad Adeel , Rehman Wajeeh , Shaikh Asim , Dani Sourbha
Published: November 2024

Background and Purpose:
Specific populations of older adults in the United States are experiencing worsening trends in the incidence and prevalence of acute coronary syndrome (ACS). This study examined trends in ACS-related mortality among older adults in the United States.

Methods:
The CDC-WONDER (Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research) database was used to track deaths due to ACS in adults aged ≥ 65 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population were determined and stratified by year, sex, race/ethnicity, and geographic region. Joinpoint regression was used to analyze trends in AAMRs using annual percent change (APC).

Results:
Altogether, 3,017,769 deaths occurred due to ACS and the overall ACS-related AAMR was 327.5 from 1999 to 2020. Following an initial period of rapid decrease in mortality rates from 1999 to 2011 (APC: -5.98; 95% CI: -6.40 to -5.65), the rate of decline halved from 2011 to 2020 (APC: -3.02; 95% CI: -3.62 to -2.19). Men had consistently higher AAMRs (410.6) than women (267.8). In racial and ethnic groups, the Non-Hispanic (NH) Black or African American population had both the highest total AAMR (374.4) and was one of the two ethnicities that displayed increasing trends from 2018-2020 (APC: 4.74; 95% CI: 0.30 to 7.10). The second ethnic group with increasing trends was Hispanic or Latino (2018-2020 APC: 9.27; 95% CI: 3.22 to 13.16). Significant geographic disparities were observed, with nonmetropolitan areas having consistently higher AAMRs (433.5) than metropolitan areas (304.1). States in the top 90th percentile (District of Arkansas, Kentucky, Mississippi, Missouri, South Dakota, and Tennessee) had almost double the AAMRs than states in the bottom 10th percentile (Alaska, Colorado, Hawaii, Minnesota, Montana, and Nevada).

Conclusion:
Despite an overall decrease in mortality, the deceleration of decline since 2011is concerning. Men, NH Black/African American populations, and residents of nonmetropolitan areas displayed the highest burden of ACS-related mortality. Focused strategies are required to prevent and manage ACS in older adults to mitigate the rising levels of ACS-related mortality.
Abstract 4139905: Trends and Regional Variations in Chronic Ischemic Heart Disease and Lung Cancer-Related Mortality among American Adults: Insights from Retrospective CDC-Wonder Analysis
Authors: Ali Eman , Alim Ur Rahman Hafsah , Salman Madiha , Fahim Muhammad Ahmed Ali , Shaikh Asim , ahmed jawad , Hameed Ishaque , Yasmin Farah , Cheema Huzaifa Ahmad , Ahmad Adeel
Published: November 2024

Introduction:
Lung cancer remains the leading cause of malignancy-related mortality in the US. When concomitant Chronic Ischemic Heart Disease (CIHD) exists, morbidity and mortality in these patients is severely worsened. However, empirical evidence on shared mortality burden remains understudied. Therefore, we aim to retrospectively analyze mortality trends among American adults with concomitant lung cancer and CIHD.

Methods:
Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database, using ICD-10 codes was retrieved for patients aged ≥ 45 years between 1999-2020. Age-adjusted mortality rates (AAMRs), per 100,000 people, and Annual Percentage Change (APCs) along with their respective 95% CIs were also calculated. Data was stratified according to year, sex, race, and geographical distribution.

Results:
Lung cancer with comorbid CIHD in adults aged ≥ 45 years resulted in 214,785 deaths, with an overall AAMR 8.4 (95% CI: 8.3 to 8.4). The AAMRs remained relatively stable from 1999-2005 (APC: -0.8352; 95% CI: -1.9139 to 1.5413) succeeded by periods of significant decrease from 2005-2010 (APC: -2.3654; 95% CI: -5.5832 to -0.6062) and 2010-2017 (APC: -4.7159; 95% CI: -7.6110 to -3.6000). However, another period of stability was noted between 2017-2020 (APC: 0.8579; 95% CI: -2.1682 to 5.2231). In 1999, men had triple the mortality rate when compared with women (AAMR: 17.8 vs 5.7), which non-significantly declined in 2020 (AAMR:13.3 vs 4) respectively. Non-Hispanic (NH) Whites had highest AAMR (9.3), followed by NH American Indian or Alaskan Native (7.3), NH Black or African American (6.8), Hispanic or Latino (3.3) and lastly NH Asian or Pacific Islander (3.2). Furthermore, AAMRs also varied significantly in census regions, with the highest ratios being observed in the Midwest (9.6), followed by the Northeast (8.8), South (8.4) and lastly the West (6.8). Additionally, non-metropolitan areas were found to have comparably higher AAMRs than metropolitan areas (10.3 vs 8). States in the top 90th percentile such as West Virginia, Kentucky, Vermont, Ohio and Rhode Island had nearly triple the AAMRs when compared with states in the lower 10th percentile including Utah, Nevada, Arizona, New Mexico and Hawaii.

Conclusion:
Mortality rates declined among American adults, with highest AAMRs being observed in men, NH Whites, residents of the Midwest and non-metropolitan patient populations.
Abstract 4139909: Rural and Urban Patterns of Monitoring of Implanted Cardiac Devices in the US
Authors: Zeitler Emily , Zhou Weiping , Creager Mark , O'Malley James
Published: November 2024

Background:
Along with in-person (IP) monitoring, remote monitoring (RM) is recommended for patients with a cardiac implantable electronic device (CIED) to improve clinical outcomes.

Hypothesis:
Rurality will adversely impact the delivery of both RM and IP monitoring as part of comprehensive CIED care.

Aims:
To define and compare CIED monitoring patterns among patients with a CIED in rural and urban geographies.

Methods:
All Medicare fee-for-service beneficiaries (2011-2021) with history of CIED implantation were included based on relevant CPT codes. Demographic characteristics were reported by implant year and stratified by rurality based on beneficiary rural-urban commuting area code. All IP and RM events in the year following implant were tabulated based on CPT and ICD-9/10 procedure codes and similarly stratified by geography.

Results:
Approximately 23% of the de novo CIED implants (approximately 150,000/year) were among patients living in rural areas. The mean age was 79-80 years across the study period and was slightly higher (<1 yr difference) in the urban group; the proportion of men was similar in each group (~57%). Comorbidity was high in both geographic strata throughout the study period, including hypertension (~94%), ischemic heart disease (~80%) and heart failure (~65%). In the year following implant, the proportion of patients with ≥1 IP monitoring event was stable and consistently greater among the urban than rural cohort (~81% vs ~78% in 2019) until 2020 when the proportion fell for both groups (75% vs 72%, respectively) (Figure). The proportion of patients with ≥1 RM event rose substantially over the study period (from 22% to 51% in the urban group and 28% to 50% in the rural group).

Conclusions:
Dramatic improvements in RM were observed among Medicare beneficiaries with a CIED in the last decade. Patients in rural areas were historically more likely to undergo RM than their urban counterparts, but this gap narrowed and equalized over time. By 2020, a decline in IP monitoring was accompanied by an increase of growth in RM in both urban and rural areas, possibly reflecting effects of the COVID pandemic on CIED care access.
Abstract 4139918: Myocardial Transcriptomics Differentiates Decompensated, Compensated, and Healthy Right Ventricular Samples in End Stage Heart Failure
Authors: Garry Jonah , Davogustto Giovanni , Agrawal Vineet , Brittain Evan
Published: November 2024

Introduction:
Myocardial transcriptional changes in the right ventricle (RV) during stress and failure are poorly understood. We hypothesized that myocardial transcriptomic signatures would differ among decompensated (d-RV), compensated (c-RV), and healthy RV (h-RV) myocardium.

Methods:
We obtained RV free-wall myocardial samples from pts undergoing transplant for end-stage HF (n=33). Control samples were obtained from unused donor hearts. We defined d-RV by pulmonary arterial pulsatility index </= 2.0 (10/33, 30%). We performed RNA-seq using the Illumina NovaSeq6000 with pair-wise differential gene expression using DESeq2 (FDR <0.05) and Gene Set Enrichment Analysis (GSEA) using WebGestalt to identify differentially regulated pathways (FDR <0.1).

Results:
Controls (n=8) were 44 years [IQR 39-57] and 50% male. HF pts were 53 years [44-61], 63% male, 13 ischemic and 22 non-ischemic, with median LVEF 21% (IQR 16-28%). Principal component analysis demonstrated distinct expression for h-RV vs c-RV and d-RV, but poorly differentiated between c-RV and d-RV (
Figure 1A
). Volcano plots for pairwise comparisons with differentially expressed genes (DEGs) are displayed in
Figure 1B-D
. Notable upregulated genes in d-RV and c-RV vs h-RV included NPPA, NPPB, and MYH6. Of the 4171 DEGs of d-RV vs h-RV, 3625 were also identified comparing c-RV vs h-RV. There were 39 DEGs differentiating d-RV vs c-RV. GSEA identified increased transcription of immune pathways, metabolism, and protein synthesis related pathways in c-RV and d-RV vs h-RV
(Figure 2A
). c-RV vs d-RV featured increased protein synthesis and decreased immune system and catabolism related pathways (
Figure 2B
).

Conclusions:
The RV response to stress in end-stage HF features transcriptional increases in immune pathways and protein synthesis along with metabolic changes in fatty acid synthesis, insulin signaling, and steroid biosynthesis. These findings warrant further mechanistic investigation of the implicated pathways.
Abstract 4139922: Differential Impact of Functional Autoantibodies Against Angiotensin II Receptor Type 1 and Endothelin-1 Receptor Type A on Microvascular Obstruction and Adverse Cardiovascular Events According to Infarct Size
Authors: Civieri Giovanni , Martini Marika , Tansella Donatella , Bernava Giacomo , Masiero Giulia , Meynardi Nicola , Perazzolo Marra Martina , Vadori Marta , Iop Laura , Cozzi Emanuele , Iliceto Sabino , Tona Francesco
Published: November 2024

Introduction:
autoantibodies (AAs) activating angiotensin II receptor type 1 (AT1R-AAs) and endothelin-1 receptor type A (ETAR-AAs) are associated with microvascular obstruction (MVO) and major adverse cardiovascular events (MACE) after ST-elevation myocardial infarction (STEMI).

Hypothesis:
we hypothesized that the effect of AT1R-AAs and ETAR-AAs on MVO and MACE is stronger in patients with smaller infarct extension. Indeed, while larger infarcts are expected to face more MVO and worse prognosis, AT1R-AAs and ETAR-AAs could explain the quote of STEMI patients with smaller infarct sizes and poor outcomes.

Methods:
we studied STEMI patients treated with primary PCI between February 2021 and April 2024 at Padua University Hospital (
Fig A)
. Blood samples for AAs level measurements were obtained within 12 h of admission. Patients were defined as seronegative, single, or double seropositive according to the AT1R-AA and ETAR-AA seropositivity (>10 U/mL). Cardiac magnetic resonance (CMR) was performed within 30 days after STEMI. Telephonic interviews and medical record revisions were performed to investigate MACE (death, myocardial reinfarction, and hospitalization for HF). Smaller or larger infarct was defined using the median infarct size in the MVO analysis and the median peak troponin level in the MACE analysis.

Results:
56 patients (median age 58 yrs, 82% males) underwent CMR. The degree of seropositivity was associated with the prevalence of MVO in patients with a smaller infarct size (p=0.047), but not in those with a larger infarct size (p=0.129) (
Fig B)
. A total of 174 patients (median age 61 yrs, 84% males) were investigated for incident MACE. Compared to seronegativity, double seropositivity was associated with a significantly higher risk of MACE in patients with a smaller (p=0.035), but not a larger (p=0.265), infarct extension (
Fig C).
The results were confirmed after adjusting for age and infarct-related artery.

Conclusions:
the degree of autoantibody seropositivity was strongly correlated with MVO and MACE in patients with smaller infarct sizes, suggesting that AT1R-AAs and ETAR-AAs could play a relevant role in patients who, despite relatively small infarcts, face the adverse complications of STEMI.
Abstract 4139936: Effectively Communicating the Seriousness of High Cholesterol at Diagnosis to Improve Shared Decision-Making and Adherence: Findings from the Patient-Led “Insights from Patients Living with Elevated Cholesterol” (IPEC) Study
Authors: Johnson Neil , Vandigo Joe , De Carvalho Fernanda , Gorre Celina , Hall Tanya , Hennessy Susan , Kazi Dhruv , Kotseva Kornelia , Petrie Patsy , Kelly David , Oehrlein Elisabeth
Published: November 2024

Background:
Shared decision-making aims to improve health outcomes by empowering patients to make informed decisions with their healthcare providers. While decision aids guide treatment choices, they may not help providers effectively communicate the importance of treatment and the risks of non-adherence. We explored patient perspectives on shared decision-making and communication of CVD risks upon diagnosis with elevated LDL-C, a significant risk factor for CVD.

Aims:
To learn from people with high cholesterol about their experiences, decisions, and perspectives on being diagnosed and living with high LDL-C, including awareness of the association between high LDL-C and other risk factors for heart disease and stroke.

Methods:
The design and interpretation of this cross-sectional, qualitative study were guided by a global multi-disciplinary steering committee. Fifty people with confirmed high LDL-C in Brazil, Australia, and the United States participated in 60-minute interviews between November 2023-March 2024. Half were required to have an ASCVD-related hospitalization. Interview transcripts were thematically analyzed.

Results:
Table 1 describes participant characteristics. During their high-LDL-C diagnosis encounter, participants often described being overwhelmed by multiple concurrent diagnoses, unfamiliar medical terms, and concerns about elevated cardiac risk. Most participants stated that their primary source of information, upon diagnosis and throughout their experiences with high LDL-C, is their HCP. Some described underestimating cardiac risks if treatment plans included lifestyle changes only or if discussions focused primarily on comorbidities. Reflecting on time between diagnosis and an ASCVD event, many participants acknowledged they had not taken their care plan as seriously as they should have. Participants offered messages and suggestions for communicating effectively with others with high LDL-C at diagnosis and regularly after diagnosis (see Table 2).

Conclusions:
Findings highlight an opportunity to improve cardiovascular care by overcoming indifference towards high LDL-C. Effective communication by healthcare providers at diagnosis and beyond, such as emphasizing the severity of high cholesterol and providing a realistic care plan, is crucial.
Abstract 4139942: Trends in Thromboembolic Events Related Mortality in Atrial Fibrillation Patients Aged 65 and Older in the United States: Insights from the CDC WONDER Database
Authors: Naveed Muhammad Abdullah , Ali Ahila , Iqbal Rabia , Omer Rehan Muhammad , Azeem Bazil , Akbar Usman , Gonuguntla Karthik , sattar yasar , Khan Muhammad , Asad Zain Ul Abideen , Munir Bilal , balla sudarshan
Published: November 2024

Background:
Thromboembolic events in atrial fibrillation (AF) patients represent a significant health concern among older adults in the United States. This study investigates trends and demographic disparities in mortality rates due to thromboembolic events in AF patients aged 65 and older from 1999 to 2020.

Methods:
Utilizing the CDC WONDER database from 1999-2020, this retrospective analysis focused on ICD code I48 for AF and related stroke codes (I26, I63, I74, and I82). Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and trends were assessed using Average Annual Percentage Change (AAPC) and Annual Percent Change (APC). Data were stratified by year, sex, race/ethnicity, and geographical regions.

Results:
Between 1999 and 2020, thromboembolic events in AF accounted for 422,525 deaths among adults aged 65+ in the U.S., primarily occurring in medical facilities (45.0%). The overall AAMR for thromboembolic events in AF-related deaths increased from 47.3 in 1999 to 49.1 in 2020, with an AAPC of -0.15 (95% CI: -0.37 to 0.07, p = 0.169). A significant decline occurred from 1999 to 2006 (APC: -1.45; 95% CI: -3.22 to -0.63, p < 0.000001), followed by a mild rise from 2006 to 2020 (APC: 0.50; 95% CI: 0.25 to 0.88, p = 0.013). Older women exhibited higher AAMRs compared to older men (women: 46.4; men: 43.5). Among racial/ethnic groups, White patients had the highest AAMRs (48.7), followed by Black population (33.5), American Indians (30.1), Asians (28.8), and Hispanics (27.3). All racial groups saw significant increases in AAMRs except Asian population, who experienced a slight decrease. The highest AAPC was observed in Blacks (1.46; 95% CI: 0.94 to 1.84, p < 0.000001). AAMRs varied by state, ranging from 29.2 in Nevada to 83.9 in Vermont. The Western region had the highest average AAMR (52.0). Nonmetropolitan areas had higher AAMRs than metropolitan areas (51.6 vs. 44.4).

Conclusion:
This analysis reveals stable yet slightly increasing mortality rates for thromboembolic events in AF among older adults in the U.S. over the past two decades, highlighting ongoing public health concerns. Addressing disparities and improving healthcare access for vulnerable populations are crucial to reducing these mortality rates and improving health outcomes.
Abstract 4139970: Low-Dose Apixaban Safety and Efficacy in Patients with Atrial Fibrillation Who Have Gastrointestinal Bleed; A Nationwide Cohort Study
Authors: Faris Carol , Ayoub Mark
Published: November 2024

Introduction:
Anticoagulation (AC) is the mainstay of thromboprophylaxis for stroke prevention in atrial fibrillation (AF) and is recommended. Gastrointestinal bleeding (GIB) is a common complication with varied severity and often poses a challenge for cardiologists and gastroenterologists. The decision of whether to continue anticoagulation, when to resume and at what dose is often the challenge. Our study assesses the safety and efficacy of low-dose apixaban compared to a full-dose in patients with AF who had GIB over the course of 5 years.

Methods:
We queried the US Collaborative Network (which contains 63 healthcare organizations) of TriNetX deidentified research database. Patients with atrial fibrillation who have history of gastrointestinal bleed who received apixaban were identified and divided into two cohorts; patients on low dose of 2.5mg and those on full dose of 5mg. We excluded patients with serum creatinine ≥ 1.5 mg/dL and patients with body weight ≤ 132 lbs.

Two well-matched cohorts were created using a 1:1 propensity-score matching (PSM) model using patients’ baseline characteristics and comorbidities. PSM components were age, gender, race, PPI use, anti-platelets, hypertension, coronary artery disease, heart failure, COPD, and CKD. We compared the risk of stroke, GIB, and mortality in 5 years.

Results:
A total of 19,427 patients with UGIB who have AFIB received oral apixaban were identified. Of those, 19% (n=3,701) were on low dose of 2.5mg and 81% (n=15,726) were on full dose of 5mg of apixaban. After PSM, each cohort included 3,701 patients. There was no statistically significant difference in the risk of stroke in 5 years between the patients on low dose compared to those on full dose (10.9% vs 11.9%, p=0.3). However, patients on low dose had a statistically significant lower risk of GIB compared to those on full dose (30.4% vs 35.3%, p<0.0001). Mortality rates were not different between patients on low dose compared to full dose (21.8% vs 20.4%, p=0.13).

Conclusion:
The use of low-dose (2.5mg) apixaban in patients with GIB who have AF decreases the risk of GIB without significantly affecting the rate of stroke or mortality when compared to full-dose of 5mg. The use of a low-dose apixaban is safer and as efficacious as full-dose in patients with GIB who have AF.
Abstract 4139975: Field of View of Atrial Electrodes by Endocardial and Epicardial Computer Mapping
Authors: Rodrigo Miguel , Ruiperez-Campillo Samuel , Narayan Sanjiv
Published: November 2024

Background:
Mapping atrial fibrillation (AF) electrograms at each position on a multipolar catheter is complicated by the impact of far-field signals from colliding and chaotic wavelets. The actual field of view of unipolar and bipolar electrodes of different sizes and separations is undefined, yet may substantially impact recorded AF maps.

Hypothesis:
We tested the hypothesis that the field of view (antenna) of EGMs can be defined based on the size of electrode, their spacing, and tissue characteristics including conduction velocity using biophysical models of active myocardial tissue.

Methods:
We modeled conduction in atrial tissue of size 30 x 30 x 3 mm, to estimate the region around clinical Advisor
TM
HDGrid (Abbott), Octaray
TM
or Optrell
TM
(Biosense-Webster) multipolar catheters. We tested various 1 mm electrode configurations, separated by 2 mm, 5 mm and 10 mm. Using models discretized into 100,000 and 100 nodes, we varied conduction velocities and propagation directions to simulate myocardial propagation (fig. A). The EGM was constructed using the electric potential transfer equation between the tissue and the electrode, discretized for each tissue node to evaluate individual contributions of atrial regions to unipolar and bipolar EGMs. We defined the spatial near field as regions contributing
>
30% of signal amplitude.

Results:
Transverse recording antenna varied substantially with bipolar configuration. In Figure B, the unipolar electrode recorded near field activity within a 3D ellipsoid of radius 8 mm across-tissue and 2.7 mm transmurally with a 1.9 endo-to-epicardial amplitude ratio. Bipolar electrodes showed directional antennas for near field, aligned with the propagation direction (fig. C) with radii of 1.7, 5.7 and 8.3 mm for 2, 5, and 10 mm spacing, respectively (fig. C). Bipolar electrodes showed less transmural variability in near field antenna (range 2-2.7 mm), which was similar to unipolar (fig. D).

Conclusions:
Current generation multipolar catheters may record apparently “near field” signals in relatively large ellipsoids/spheres of radius 1.7 to ~8 mm. This may substantially impact signal fidelity when the same wave is not present throughout this volume, such as in AF or ventricular fibrillation, and may impact noise detection for atrial and ventricular tachycardia. Signal processing techniques are required to improve near field signal detection.
Abstract 4139985: The impact of severity of right atrial dyssynchrony on mortality in patients with submassive pulmonary embolism
Authors: Orihara Yoshiyuki , Eguchi Shunsuke , Eguchi Ayumi , Pfeiffer Michael , Peterson Brandon , Ruzieh Mohammed , Boehmer John , Gorcsan John , Wilson Ryan
Published: November 2024

Background:
Right atrial (RA) function contributes 15 - 30% to right ventricular stroke volume. However, limited studies have evaluated RA function in the setting of submassive pulmonary embolism (PE). We investigated whether the severity of right atrial dyssynchrony was associated with short-term mortality in patients with submassive PE.

Methods:
We performed a retrospective cohort study of 251 patient with submassive PE. Strain analysis was applied retroactively using TomTec software. 201 patients had images sufficient for RA strain analysis. RA dyssynchrony was defined as absolute max opposing wall delay (maxOWD) which was the time interval between peak lateral and septal wall strain in RA (Figure1) The primary outcome was 30-day all-cause mortality. The severity of dyssynchrony was defined according to max OWD and divided into four groups; no delay, first tertile (mild), second tertile (moderate), and third tertiles (severe).

Results:
The patient groups were defined as follows: no delay (0 ms; n = 40), first tertile/mild delay (> 0 ms, ≤ 4.49 ms; n = 52), second tertile/moderate delay (> 4.49 ms, ≤ 13.1 ms; n = 51), and third tertile/severe delay (> 13.1 ms; n = 52). Of 201 patients, 23 patients (11 %) died within 30 days after diagnosis. Kaplan-Meier curves showed significant difference among the four groups (p < 0.001). Additionally, there were significant differences between no delay and moderate delay groups (p = 0.0321) and between moderate and severe delay groups (p=0.010). (Figure2) Moreover, patients with severe RA dyssynchrony had 7.3 times higher risk of 30-day mortality compared to patients in other groups (p < 0.001).

Conclusions:
The severity of RA dyssynchrony on presentation was associated with mortality in patients with submassive PE. Assessment of RA dyssynchrony on presentation could risk stratify patients with submassive PE.
Abstract 4139994: Deep-learning Assisted ECG-based Emergent Cathlab Activation: First Prospective Implementation of a Smartphone-based System
Authors: Herman Robert , Lauwers Rinaldo , Pletnickx David , Meyers Harvey , Smith Stephen , Kisova Timea , Demolder Anthony , Herman Peter , Grendova Radka , Beles Monika , Perl Leor , Nelis Olivier , Barbato Emanuele , Bartunek Jozef , Schelfaut Dan
Published: November 2024

Introduction:
Standard ST-segment elevation myocardial infarction (STEMI) pathways misidentify up to 50% of patients with an acutely occluded culprit coronary artery (OMI) with false positive emergent cathlab activations in up to 35% of cases. Recently, an artificial intelligence (AI) electrocardiogram (ECG) model outperformed standard of care in detecting OMI in international retrospective cohorts.

Hypothesis:
We sought to prospectively evaluate the rule-in performance of an AI ECG model in a large tertiary care STEMI network compared to ECG machine readings of STEMI and AI-assisted emergency physicians.

Methods:
An AI model trained to detect acute coronary occlusion regardless of ST elevation was implemented using smartphones in a tertiary care STEMI network consisting of 1 hub hospital, 1 spoke center, and 2 emergency medical service crews (EMS) (Fig 1A). Outcomes of all patients presenting with atraumatic chest pain during a 10-week period between January and March 2024 were adjudicated using ECG, laboratory, and angiographic chart review and classified based on the presence of OMI.

Results:
A total of 731 consecutive patients (68% male) with atraumatic chest pain were included; 142 patients were hospitalized of whom 23 (16%) met the primary outcome of OMI. The AI model showed a significantly higher sensitivity detecting OMI as compared to ECG machine (95.7% vs. 47.8%, p<0.001, Fig 1B) at comparable specificity (95% vs. 96%, respectively) with overall superior predictive accuracy (Chi-squared=8.1; p=0.004). The AI model correctly identified 15 cases that the ECG machine misclassified (80% were false negatives by ECG machine). All AI false positives were patients post recent myocardial infarction or angioplasty. Sensitivity of AI-assisted emergency physicians interpreting OMI was 78.2% indicating potential instances of AI underutilization.

Conclusions:
This first prospective performance evaluation in a large all-comer atraumatic chest pain cohort indicates high accuracy of unbiased, AI-powered ECG detecting acute coronary occlusion. The findings suggest its potential to improve ACS patient outcomes through timely referral for invasive management in a real-world clinical setting.
Abstract 4139998: New-onset atrial fibrillation following coronary artery bypass graft surgery: A systematic review
Authors: Gandhi Darshan , Prakash Atul , Patel Gaurav , Vaz Clint , Garcia Risk Ariadna , Guragain Ashish
Published: November 2024

Background:
Post coronary artery bypass surgery atrial fibrillation (Post-CABG AF) was reported to have variable incidence ranging from 10 to 40% and also noted to have a significant risk of stroke and all-cause mortality. This systematic review evaluated the incidence and adverse outcomes of post-CABG AF.

Methods:
The search period was from 1 January 2010 to September 30, 2023. We conducted a literature search in PubMed of English language, peer-reviewed manuscripts. We included observational and experimental studies among patients who underwent CABG and developed new-onset atrial fibrillation. We analyzed the overall incidence of new-onset AF, 30-day mortality, and adverse outcomes, including cerebrovascular accidents.

Results:
Thirty-two manuscripts, including findings from two randomized controlled trials conducted among patients with post-CABG new onset atrial fibrillation were reviewed, comprising of 150,788 patients. Of these, 39,327 (26%) developed new-onset post-CABG AF. The median age of patients with new onset post-CABG is 67.5 (IQR 66-69) years, with 52.5% males. The average incidence of cerebrovascular accidents calculated from four manuscripts was 6.26% and 3.38% among patients with and without new-onset AF post-CABG, respectively, with RR 1.92 (95% CI 1.69 - 2.18). Four studies described 30 days of mortality risk, which averaged at 3.05% and 1.46% among patients with and without new-onset AF post-CABG, respectively, with RR 2.08 (95% CI 1.77,2.45).

Conclusion:
This systematic analysis shows a higher incidence of post-CABG new-onset AF, along with a significant increase in 30-day mortality risk and incidence of cerebrovascular accident when compared to patients who did not develop new-onset AF postoperatively. We propose further studies on determining solutions for post-CABG AF.
Abstract 4140003: Impact of Long-Term Blood Pressure Variability on Adverse Cardiovascular Outcomes in High- and Low-Risk Populations
Authors: Krohn Lynne , Zappe Dion , Hoffing Rachel , Holleman Aaron , LoGerfo Philip , Plekan Mollie , Akle Serrano Sebastian , Ward Lucas , Nioi Paul , Williams Bryan , Deaton Aimee , Tu Ho-Chou
Published: November 2024

Background:
Hypertension is a major preventable risk factor for cardiovascular (CV) disease. Emerging evidence suggests that in addition to blood pressure (BP) levels, controlling the consistency of BP is a key determinant of clinical outcomes. We aimed to assess the effects of consistency of BP control on adverse CV and renal outcomes using two metrics: long-term variability of systolic BP (LT-BPV) and the degree at which BP control is achieved, known as cumulative systolic BP load (CBPL).

Methods:
We collected clinic systolic BP (SBP) measurements from UK Biobank primary care records in those diagnosed with hypertension (N=39,816), chronic kidney disease (CKD, N=8,062), and neither of these (N=17,702), including a per-participant mean of 21 SBP values over 6 years. Instances of the primary outcome, 4-point major adverse cardiovascular events (MACE; stroke, acute myocardial infarction, heart failure hospitalization, and cardiovascular-related death), were collected from hospital records. Per-standard deviation (SD) and per-quartile hazard ratios (HR) were used to estimate LT-BPV, CBPL, and mean SBP separately using adjusted Cox regression. Sensitivity analyses were used to determine the independence of BP consistency effects from mean BP levels.

Results:
In those with hypertension, each per-SD increase in LT-BPV was associated with increased risk for MACE (HR=1.12, p=4.4E-11), specifically CV-related death, stroke, and HF hospitalization. LT-BPV effect estimates were strongest in those with controlled SBP and the strongest predictors for all events in those without high-risk comorbidities (coronary artery disease, CKD, peripheral vascular disease, and diabetes). CBPL was similarly associated with MACE (HR=1.13, p=8.1E-13), specifically stroke and acute myocardial infarction, but not with fatal events or HF. In those with CKD, both LT-BPV and CBPL were associated with progression to renal failure (HR=1.31-1.33, p<6.8E-11), but only LT-BPV was associated with MACE and mortality. CBPL showed a J-shaped mortality distribution in all populations, whereas LT-BPV consistently showed a stepwise increase in fatalities across quartiles.

Conclusions:
LT-BPV was a robust predictor of adverse CV outcomes across all populations, especially in typically “lower-risk” populations where the need for preventative measures would not usually account for LT-BPV. Our study indicates the importance of controlling the consistency of BP to optimize protection against CV events.
Abstract 4140006: Risk of Acute Ischemic Stroke with Early Versus Late Initiation of Mechanical Circulatory Support in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Propensity-Matched Analysis
Authors: Yan Rui , Cong Guangzhi , Jia Shaobin , Ma Xueping , Shi Bo , Ye Congyan , Fu Shizhe , Wang Kairu , Li Haowei , He Baotong , He Zefeng , GITANGAZA Israel , Rehman Abdul
Published: November 2024

Background:
Mechanical circulatory support (MCS) devices have been widely used for managing acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, their use additionally elevates acute ischemic stroke (AIS) risk. There is insufficient data on the risk of AIS associated with early versus late initiation of MCS in AMI-CS cases.

Aims:
This study aimed to assess the timing of MCS initiation associated with the risk of AIS in patients with AMI-CS.

Methods:
A retrospective of the National Inpatient Sample data analysis (January 2016–December 2020) identified AMI-CS hospitalizations: categorized into early MCS initiation (<48 h) and late MCS initiation (>48 h). The primary outcome was AIS; the secondary outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, major bleeding, and blood transfusion. The outcomes were compared using logistic multivariate regression and 1:1 propensity score-matching analyses between the groups.

Results:
From 2016 to 2020, the use of IABP decreased from 35.89% to 30.21%, whereas Impella use increased from 8.49% to 15.27% and ECMO use increased from 2.05% to 2.90%
.
The incidence of AIS in patients with AMI-CS receiving MCS remained stable over the study period; 3.55% in 2016 and 4.54% in 2020 (P trend = 0.277). Among 78,405 weighted patients with AMI-CS receiving MCS, 82.77% (n=64,895) and 17.23% (n=13,510) underwent early and late MCS initiation, respectively. The patients with late MCS initiation had higher risks of AIS (5.74% vs. 3.60%; adjusted odds ratio [aOR] 1.46; 95% confidence interval [CI], 1.19-1.79; p<0.001), AKI (61.73% vs. 50.40%; aOR, 1.41; 95%CI 1.27-1.55; p<0.001), and major bleeding (43.19% vs. 29.72%; aOR, 1.12; 95%CI 1.01-1.23; p=0.028). A propensity-matched cohort, adjusted for risk factors indicated that late MCS initiation remained associated with increased risks of AIS (aOR, 1.39; 95%CI 1.08-1.78; p=0.010), AKI (aOR, 1.37; 95%CI 1.23-1.53; p<0.001), and major bleeding (aOR, 1.14; 95%CI 1.02-1.28; p=0.027). Furthermore, subgroup analysis revealed that an AMI-CS hospitalization with late MCS was consistently associated with a high AIS risk among all subgroups.

Conclusions:
Among patients with AMI-CS, late initiation of MCS was associated with increased risks of AIS, AKI, and major bleeding. Further studies are needed to decipher the optimal timing of MCS initiation to improve outcomes in this critically ill population.