bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4141001: Pulsed field ablation of recurrent atrial tachyarrhythmias after prior thermal ablations
Authors: Bai Rong , Shen Caijie , Chou Tsai-Lin , Eng Mischa , Dai Yi , Martinez Jake , Katrapati Praneeth , Zawaneh Michael , Weiss Peter , Tung Roderick , Su Wilber
Published: November 2024

Background:
Pulsed field ablation (PFA) has emerged as a safe and effective alternative to thermal ablation modalities for treatment of paroxysmal and persistent AF in a de novo procedure.

Research Questions:
Since the FaraPulse system (Boston Scientific) was approved by FDA, no data was reported on whether PFA can be used in redo procedures.

Aims:
We reported our initial experience with PFA in patients with recurrent atrial tachyarrhythmias (ATs) who failed at least one thermal ablation of AF.

Methods:
Consecutive patients receiving redo ablation using PFA (FaraPulse) for recurrent ATs were enrolled. ICE and fluoroscopy were used to guide the placement of FaraWave catheter. Voltage and activation mapping of LA were performed in all patients before ablation using Orion high density mapping catheter and Rhythmia system. Ablation strategy included PV re-isolation as needed, LA posterior wall (PW) isolation if low voltage zone was identified, and ablation of any organized ATs. Procedural endpoints were PVs and LAPW isolation, non-inducibility for ATs and bidirectional block for linear ablation.

Results:
15 patients (12 male; age 66.3±10.3 years) were included. The median number of prior RF ablations was 2; 2 patients also received one cryoballoon ablation. Patients presented with persistent (80%) AF or paroxysmal (20%) AF with/without documented organized ATs. By using PFA, LAPW isolation was performed and achieved in all patients, while 11 (73.3%) patients required reisolation of at least one PV (
Figure
). Organized ATs were present/induced in 7 (46.7%) patients including 3 peri-mitral AFL, 3 LA roof-dependent AFL, 3 CTI AFL and 3 atrial tachycardias from LA roof, LA septum and RA roof respectively. RF ablation was required in 2 patients (2/7, 28.5%) to eliminate CTI AFL. Per case total PFA applications number were 48.7±24.4 (46, 22-90); total fluoroscopy time was 6.8±5.6 mins. No major peri-procedural complication was observed except for one case (90 PFA applications) of hemolysis and acute renal failure that completely recovered.

Conclusion:
PFA of recurrent ATs after failed thermal ablation is feasible and safe acutely if limited the applications. The long-term outcome of this strategy warrants further investigation.
Abstract 4141011: Less Coronary Artery Disease Motivating Intervention Among Out-of-Hospital Cardiac Arrest With Increased Refractoriness
Authors: Frykler Abazi Lis , Bohm Felix , Witt Nils , Jonsson Martin , Riva Gabriel , Elfwen Ludvig , Hollenberg Jacob
Published: November 2024

Background:
Significant coronary artery disease has been suggested as the main cause of the refractory state among patients with out-of-hospital cardiac arrest (OHCA) and initial ventricular fibrillation (VF).

Research Question/Hypothesis:
The aim of this study was to describe the coronary angiography findings in relation to degree of treatment refractoriness, measured as the number of shocks, among patients with shockable OHCA in Sweden.

We hypothesized that increasing number of shocks was associated with an increased prevalence of coronary artery disease (CAD) and more frequent percutaneous coronary intervention (PCI).

Methods:
All patients with primary VF OHCA in Sweden between January 1, 2010, and December 31, 2019, who underwent coronary angiography, were included using three national registries. Patients were divided according to the number of delivered defibrillations and subgrouped according to presence of STEMI on ECG. Coronary angiography findings of acute occlusions, PCI performed, chronic total occlusions as well as multivessel disease were described in relation to level of refractoriness.

Results:
In total, 3369 patients were included. Among them 67%/N=2270 required 1-3 defibrillations, 23%/N=758 4-6, 7%/N=222 7-9 and 4%/N=119 ≥10 defibrillations. There was no significant difference regarding acute coronary occlusions between the groups. The proportion of patients receiving PCI decreased with increased number of shocks (67%/N=1525 for 1-3 shocks, 58%/N=435for 4-6 shocks, 54%/N119 for 7-9 shocks and 55%/N=65 for ≥10 shocks). This was true for both subgroups with or without STEMI. Survival and neurological function decreased in accordance with increased need of defibrillations (74% to 35%; p=<0,001), a clear difference that was unaffected when adding coronary angiography findings as well as PCI in an adjusted multivariable model.

Conclusions:
In this comprehensive study including all VF OHCA undergoing coronary angiography in Sweden, patients with an increased number of defibrillations have less coronary artery disease motivating PCI in relation to those receiving fewer defibrillations.
Abstract 4141018: Association of HDL-2b and HDL-3 with severe coronary stenosis in acute myocardial infarction patients: effects of age, gender, and comorbidities
Authors: Wang Bin , LI DONG , Geng Yu , Wang Yujie , Cao Han , Tang Mingkun , Lv Changhua , Lv Tingting , Xue Yajun , Zhang Ping
Published: November 2024

Background:
It is unclear if the novel, functionally unidentified HDL cholesterol subtypes HDL-2b and HDL-3 can be used to predict acute myocardial infarction (AMI).

Methods:
This cross-sectional study comprised 1,200 hospitalized patients with AMI identified using ICD-9 coding. The Gensini score was used to assess stenosis severity, defining patients as severe (score ≥50) or mild to moderate (score <50). Differences between groups were determined using one-way analysis of variance or nonparametric testing for continuous variables and chi-square tests for categorical variables. The relationship between HDL-2b, HDL-3, and severe coronary stenosis was investigated using restricted cubic splines (RCS) and logistic regression, with adjustments for age, gender, hypertension, diabetes, stroke, and kidney disease. Each of the covariates listed above was subjected to subgroup analyses. Based on the literature-reported cutoff of 18%, HDL-2b (%) was classified into a new variable, the HDL-2b group (HDL-2b ≥ 18% vs. HDL-2b < 18%).

Results:
558 (46.5%) mild to moderate and 642 (53.5%) severe groups differed by HDL-3 (P=0.032) and HDL-2b group (P=0.019), but not by the above covariates or HDL-2b (P=0.324). RCS models revealed strong relationships between severe coronary stenosis and HDL-2b and HDL-3. To predict severe coronary stenosis, the odds ratio (OR) for HDL-3 was 0.98 (95% CI: 0.97-1.00, P=0.010), and for HDL-2b group, the OR was 0.67 (95% CI: 0.50-0.91, P=0.010). HDL-2b, as a continuous variable, had no statistically significant connection with severe coronary stenosis. HDL-3 significantly predicted severe coronary stenosis in subgroups of aged <65 years, females, those with hypertension, without stroke, and without kidney disease (Figure 1). The HDL-2b group was significant in the subgroups aged ≥65 years, males, with hypertension, without stroke, and without kidney disease for the prediction of severe coronary stenosis (Figure 1).

Conclusions:
HDL-2b (%) values less than 18 and a drop in HDL-3 in AMI patients are associated with significant severe coronary stenosis, with differences identified among subgroups based on age, gender, and comorbidities.
Abstract 4141025: Interleukin-22 Prevents Right Ventricular Remodeling and Tricuspid Regurgitation during Pressure Overload through a Unique Mechanism
Authors: Shibao Kodai , Yasukawa Hideo , Akagaki Daiki , Okabe Kota , Yanai Toshiyuki , Kanako Shima , Yamamoto Mai , Fukumoto Yoshihiro
Published: November 2024

Introduction:
Right ventricle (RV) remodeling is associated with prognosis in patients with RV failure. Interleukin-22 (IL-22) is a member of the IL-10 cytokine family, play roles in tissue protection and wound repair. We have previously shown that IL-22 plays an important role in left ventricular remodeling after acute myocardial infarction; however, the role of IL-22 in the development of RV remodeling remains elusive.

Hypothesis:
IL-22 would inhibit the development of RV remodeling during pressure overload.

Methods:
Pulmonary artery banding (PAB) is performed by placing a 6-0 suture around the pulmonary artery over a 24 G needle in wild type mice (C57BL/6J) and IL-22 knockout mice (IL-22 KO). Only mice with moderate pulmonary artery stenosis (peak pressure gradient across the pulmonary band> 25 mmHg at 1 week after surgery by echo Doppler) were included in the study protocol. Four weeks after PAB, RV function was measured by echocardiography and transcriptome analysis was performed on mRNA samples isolated from the RV and differentially expressed genes were identified by EdgeR (p<0.05). Survival confirmation of mice with moderate pulmonary artery stenosis was also performed up to 56 days.

Results:
IL-22 KO mice had significantly higher 56-day mortality rate compared with WT mice after PAC (p<0.01). Four weeks after PAB, IL-22 KO mice showed markedly increased RV weight (IL-22 KO mice vs. wild-type mice; RV/LV+IVS: 0.48±0.05 vs 0.40±0.02, P=0.002). IL-22 KO mice exhibited significant RV enlargement and RV dysfunction 4 weeks after PAB. (RVEDV: 10±2.3mm2 vs 12.9±3.1mm2, P=0.005, FAC: 35.2±7.8% vs 23±6.0%, P<0.001). Four weeks after PAB, the frequency of tricuspid regurgitation (TR) in IL-22 KO mice was significantly higher than that in wild type mice (100% vs 30%, P=0.004).Transcriptome analysis showed that genes related to extracellular matrix (ECM) organization, including collagen formation, which are involved in fibrosis during RV failure, were less upregulated in Il-22 KO mice after PAB, in contrast to the echo results of reduced RV function. Interestingly, genes related to elastic fiber formation, such as Fbn1 and Eln, were particularly less elevated in Il-22 KO mice compared to WT mice after PAB.

Conclusions:
These results suggest that IL-22 may play a prophylactic role in RV remodeling and tricuspid regurgitation development during pressure overload through a unique mechanism.
Abstract 4141030: Real-world treatment patterns of mavacamten and associated background therapies in patients with obstructive hypertrophic cardiomyopathy (HCM) in the United States
Authors: Masri Ahmad , Maksabedian Hernandez Ervant , Schuler Patricia , Wang Yan , Gao Weihua , Wu Aozhou , Han Xu
Published: November 2024

Background:
There are limited data on the treatment patterns of mavacamten and background therapies in real-world patients with obstructive HCM.

Aims:
To describe posology, discontinuation, adherence to mavacamten, and the use of HCM background therapies in real-world patients.

Methods:
This was a retrospective cohort study of adult patients using the Symphony Integrated Dataverse from Apr 28, 2022 to Jan 18, 2024. Patients were included if they had ≥ 1 approved claim for mavacamten and had continuous claims activity during the 12 months (baseline) before the first claim (index date). The stable dose (defined as the dose used for 6 months consecutively), discontinuation (defined as a treatment gap ≥ 95 days without restarting), and adherence (measured as proportion of days covered [PDC]) were described for mavacamten. The use of background therapies (beta blockers, calcium channel blockers and disopyramide) was described at index and during the follow-up.

Results:
A total of 1867 patients (mean ± SD age 64.7 ± 12.2 years, 63.1% female, median [interquartile range, IQR] follow-up 219 [107, 346] days) were included (
Table
). Among patients with ≥ 6 (n = 993), ≥ 9 (n = 640), and ≥12 (n = 394) months of treatment, 67.3%, 86.1%, and 93.7% reached stable dose, respectively. Among patients who reached stable dose (n = 691, median [IQR] treatment duration 345 [270, 435] days), 54.8% did not require any dose adjustment, and 33.0% required only one adjustment from treatment initiation. The most commonly used stable dose was 5 mg (49.6%), followed by 2.5 mg (25.0%), 10 mg (20.5%) and 15 mg (4.8%). The discontinuation rate for mavacamten was 10.8% and 8.7% among patients with ≥1 and ≥2 claims, respectively. Mean PDC for mavacamten was 93.7 ± 9.1%. Overall, 25% of patients did not have any claim for background therapy at index. For the remaining patients (n = 1401), 11.6% discontinued and 15.1% down titrated the index HCM background therapy.

Conclusions:
The vast majority of patients treated with mavacamten reached stable dose with no or only one dose adjustment. Discontinuation rate was 8.7-10.8% and adherence to mavacamten was high. A substantial proportion of patients discontinued or down titrated HCM background therapy.
Abstract 4141061: Predicting Mortality Risk In patients With Heart Failure Using Respiratory Polygraphy And Esophageal Pressure During Sleep
Authors: Nahoui Hamza , Schirmer Henrik , Hrubos-Stroem Harald
Published: November 2024

Background:
Expansion of thorax and abdomen during normal respiration generates negative intrathoracic pressure that affects organs like the heart and esophagus. Upper airway collapse during sleep increases respiratory effort. Measuring esophageal pressure (PES) is the gold standard for estimating this effort.

Heart failure is highly associated with obstructive sleep apnea (OSA). Abrupt swing in thoracic pressure and nocturnal hypoxemia during apnea are two mechanisms that can lead to heart failure.

Hypothesis:
PES and traditional sleep metrics: apnea hypopnea index (AHI), oxygen desaturation index (ODI), and mean-spO2 are associated with increased mortality risk in patients with heart failure and OSA.

Methods:
174 patients with heart failure identified in the local heart failure registry in Akershus university hospital. All patients underwent respiratory polygraphy and esophageal manometry during sleep. Observation time 2003-2024.

AHI, ODI, mean-spO2 and sleeping time with elevated esophageal pressure above different cmH2O, PES, were measured. Initial proBNP were also analyzed. Cox proportional hazard models were used to analyze the risk. Results were adjusted to age, sex, body mass index (BMI), and comorbidities.

Results:
Mean age 66 years (SD 12.019). 34 (20%) of observed cases were females. 70 (40%) patients died during observation time. Mean time to event (death) from first proBNP 3,5 years. Mean time to event from baseline polygraphy 8,2 years.

First proBNP predicted all-cause mortality (HR 1.108 [95% CI 1.052-1.167], p<0,001). AHI>15, ODI and mean-spO2 during sleep predicted all-cause mortality, but not sleep time with elevated esophageal pressure above 15 cmH2O. Sleep time with higher pressure degrees (above 80 cm H2O) did predict mortality.

Adding first proBNP to our prediction model did not affect the predictive value of mean-spO2 (HR 0.828 [95% CI 0.752 -0.912], p<0.001), or sleep time with PES above 80 cmH2O (HR 1.127 [95% CI 1.003-1.1.265], p 0.043).

Conclusion:
Nocturnal mean-spO2, and PES above 80 cmH2o predicted mortality in patients with heart failure and sleep apnea independent of first proBNP values.

Our results might explain why treatment with positive airway pressure is more effective in patients with severe OSA, and that oxygen therapy during sleep could represent a treatment choice for patients with HF and OSA.

Sleep studies may offer prognostic value for heart failure patients several years before first proBNP is obtained.
Abstract 4141082: Effects of lactate production caused by acetylcholine provocation tests on ketone bodies concentration in coronary artery spasm.
Authors: Ikebe Sou , Ishii Masanobu , Otsuka Yasuhiro , Arima Yuichiro , Matsuzawa Yasushi , Yamamoto Eiichiro , Tsujita Kenichi
Published: November 2024

Background:
Lactate measurement during acetylcholine (ACh) provocation tests can indicate the presence or absence of myocardial ischemia. Despite ACh-provoked spasm, including epicardial coronary artery spasm (CSA) and microvascular spasm (MVS), lactate production from coronary circulation is not observed in some cases. This may be attributable to the severity of myocardial ischemia. The relationship between lactate production due to coronary spasms and myocardial metabolism is not fully understood.

Hypothesis:
We hypothesized that there was a significant difference of ketone bodies concentration between patients with and without lactate production in ACh-provoked spasm patients.

Method:
This retrospective analysis included 81 CSA or MVS patients (excluding myocardial infarction) diagnosed by ACh provocation test from May 2018 to February 2024. During the test, blood sample was collected from aortic root (Ao) and coronary sinus (CS) before and after ACh provocation, in order to measure lactate and ketone bodies, such as acetoacetic acid (AcAc) and 3-hydroxybutyric acid (3-OHBA). The patients were categorized into two groups based on lactate production during ACh provocation test. Lactate extraction ratio was calculated as follows: lactate extraction (%) = {([lactate concentration at Ao] – [lactate concentration at CS]) / [lactate concentration at Ao]} x 100. Ketone bodies concentration from Ao was used before ACh provocation.

Results:
During ACh provocation test, 63 patients had lactate production, and 18 did not. The patients with lactate production had significantly higher concentration of ketone bodies (235.0 [IQR: 120.7-426.4] vs 90.5 [IQR: 62.2-286.7] mmol/L, p value = 0.007), AcAc (87.5 [IQR: 48.9-124.7] vs 44.9 [IQR: 29.8-88.8] mmol/L, p value = 0.006), and 3-OHBA (147.4 [IQR: 70.0-290.9] vs 51.0 [IQR: 35.1-197.4] mmol/L, p value = 0.006). Multiple logistic regression analysis adjusted for brain natriuretic peptide showed that ketone bodies (p = 0.048) and AcAc (p = 0.035) were associated with lactate production, but 3-OHBA (p value = 0.053) was not.

Conclusion:
This study showed that CSA or MVS patients with lactate production during ACh provocation tests have higher levels of ketone bodies concentration. These results implied that there was the differential severity of myocardial ischemia caused by ACh provocation, and that severity might affect the ketone metabolism in myocardium.
Abstract 4141112: Identifying Gaps in Screening&Treatment for Peripheral Artery Disease (Pad): A Survey on Provider Knowledge, Attitudes, and Practices
Authors: Jones Keith , Karambe Akshat , Sadik Kay , Hernandez Brisa
Published: November 2024

Background:
It is estimated that Peripheral Artery Disease (PAD) affects between 8.5 and 12 million Americans and its prevalence among adults over 40 years of age is increasing. PAD disproportionately affects Black Americans who, at any age, are twice as likely to experience PAD as their white counterparts but are less likely to be screened and benefit from early diagnosis and treatment.

Research Questions/Hypothesis:
Despite the high prevalence of PAD and the importance of early intervention, screening for PAD remains limited and/or underutilized particularly in primary care settings where most cases of PAD can be identified. This study sought to understand provider knowledge of PAD, associated risk factors, treatment, understanding of disparities in PAD and barriers and facilitators of PAD screening. It was hypothesized that limited resources, lack of awareness on the part of providers and patients, limitations of training in vascular medicine, and other issues are contributing to PAD morbidity and mortality, particularly among Black and Hispanic populations.

Methods:
Because no current PAD survey was found in the literature, a survey for providers to determine their knowledge, attitude, and beliefs about PAD and the importance and process of PAD screening for patients at risk was developed. The survey was administered to CommonSpirit Health providers in Sacramento, CA between December 2023- January 2024. Specialties engaged in the survey (N=145) included primary care, endocrine, nephrology, cardiology and podiatry providers.

Results:
Response rate was 21%. Of those responding, primary care was the specialty most represented(69%). A total of 65% of respondents identified medical treatment of risk factors as the primary way to treat PAD, 32% rated their knowledge of risk reduction therapies in PAD as below average, and 88% of respondents were either somewhat or not familiar with racial disparities in PAD. 24% of respondents identified the ‘lack of knowledge of PAD management guidelines’ as the most important barrier to their patients with PAD not receiving risk reduction therapies.

Conclusions:
Initial survey of providers identifies lack of knowledge as a key indicator of PAD screening practices, including knowledge on racial disparities in PAD. These identified gaps can inform targeted interventions to improve screening, early detection and treatment of PAD.
Abstract 4141135: Right atrial functional reserve and liver stiffness after complete repair of tetralogy of Fallot
Authors: Chik Wing Ki Bosco , Chan Kwok-lap , Chow Pak-cheong , Yu Kwong Man , Chan Yumi Yuk-ting , Cheung Yiu-Fai
Published: November 2024

BACKGROUND:
Right atrial (RA) dysfunction related to right ventricular (RV) function has been reported in patients with repaired TOF. Increased liver stiffness in these patients has also been reported. Whether RA function worsens under exercise stress, and its relationship with worsened liver stiffness is unknown.

HYPOTHESIS:
In patients after TOF repair, RA functional reserve during exercise stress is reduced and correlated with raised liver stiffness and RV dysfunction.

METHODS:
19 patients (8 male) aged 17.92 ± 3.81 at 16.06 ± 3.98 years after repair and 25 controls (16 male, aged 19.99 ± 1.67 years) were studied. RA mechanics was assessed by speckle-tracking echocardiography (STE) at rest and during bicycle exercise, with quantification of positive, negative, and total strain, and strain rates at ventricular systole (aSRs), early diastole (aSRed), and atrial contraction (aSRac). RAFR is calculated as (Change in RA total strain x [1-1/ baseline RA total strain]). Biventricular (RV, LV) function were quantified using Doppler interrogation and STE. Hepatic shear wave velocity (c) and tissue elasticity (E) were measured using shear wave elastography.

RESULTS:
At rest, patients had lower RA positive, negative and total strain, aSRs and aSRed than control subjects (all p<0.001). RAFR were lower in patients than controls (p<0.05). Hepatic shear wave velocity and tissue elasticity were higher in patients than controls (both p<0.003). Compared with controls, patients had lower RA strains, aSRs, aSRed and aSRac during exercise (all p<0.001). No significant difference in hepatic stiffness indices were found between patients and control subjects at exercise (both p>0.05). RAFR correlated negatively with baseline hepatic shear wave velocity and tissue elasticity (both p<0.001). RAFR tended to correlate with pulmonary regurgitation severity (p=0.06), and correlated with RV function, such as exercise RV strain rate at late diastole (SRa), exercise transtricuspid early (E) and late (A) inflow velocities during exercise, and resting RV systolic strain (all p<0.05). Multivariate analyses revealed that RV and LV systolic strain, and RV strain rate at early diastole (SRe) are predictors of right atrial total strain at exercise and RAFR, whilst RV SRa is also a predictor of exercise RA total strain (all P<0.05).

CONCLUSIONS:
In young adults after TOF repair, right atrial function reserve is impaired, and is associated with increased liver stiffness and RV dysfunction.
Abstract 4141157: Associations Between In Vitro Fertilization and Cardiovascular Outcomes in the United States
Authors: Thakker Ravi , Saxena Ritika , Harmouch Wissam , Albaeni Aiham , Khalife Wissam , Gulati Martha , El Haddad Danielle , Gaalema Diann , Jneid Hani
Published: November 2024

Introduction:
Use of in vitro fertilization (IVF), assisted reproductive technology to treat infertility, has risen recently. However, research to date is inconclusive if IVF is associated with increase in cardiovascular disease. We therefore performed a large retrospective study, identifying major adverse cardiovascular and cerebrovascular (MACCE) events in those undergoing IVF. We hypothesize IVF to be associated with an increase in MACCE.

Aims:
To determine the association between IVF and MACCE.

Method:
We utilized the TriNetX database (64 healthcare organizations in the United States (US)) to identify women ≥18 years of age who had an IVF-assisted pregnancy. Primary outcomes included overall mortality, acute myocardial infarction (AMI), stroke, peripartum cardiomyopathy, cardiogenic shock, and arrhythmias from index of IVF therapy up to 5 years. We also performed a 1:1 propensity matched analysis of our cohort on 12 characteristics: hypertension, hyperlipidemia, heart failure, atrial fibrillation/flutter, diabetes mellitus, chronic kidney disease, cerebrovascular disease, peripheral vascular disease, body mass index, alcohol abuse, nicotine dependence, and social determinants of health.

Results:
A total of 35,468 patients met criteria for analysis. Mean age at index was 33.9±5.6 years in the IVF cohort vs 29.4±7.9 years in the non-IVF cohort. The predominant race undergoing IVF were White (71.3%) followed by Asian (5.7%), and Black (5.7%). IVF use was predominant in the Midwest US (44%), followed by the South (25%), West (16 %), and Northeast (14%). There were no statistically significant differences across the 12 baseline characteristics in the matched cohorts. IVF-assisted pregnancy was associated with a decrease in AMI (0.43% vs 0.63%, Risk Ratio (RR) 0.69 (0.56, 0.84)), stroke (0.95% vs 1.83%, RR 0.51 (0.45, 0.59), peripartum cardiomyopathy (0.05% vs 0.18%, RR 0.25 (0.15, 0.44)), and arrythmias (0.93% vs 1.44%, RR 0.65 (0.56, 0.74)). There were no statistically significant differences between cohorts in overall mortality (0.80% vs 0.87%, RR 0.93 (0.79, 1.09)) and cardiogenic shock (0.03% vs 0.03%. RR 1 (0.42, 2.40)).

Conclusion:
In this large retrospective study of IVF-assisted pregnancy, we found that IVF was not associated with an increase in MACCE. Geographical and racial differences exist in the utilization of IVF in the US which further need investigation, especially socioeconomic status, which may account for the findings in our study.
Abstract 4141168: CD 34+ Cell Therapy is Associated With Improved Myocardial Perfusion in Heart Failure With Preserved Ejection Fraction
Authors: Poglajen Gregor , Zbačnik Rok , Frljak Sabina , Zemljic Gregor , Cerar Andraz , Vrtovec Bojan
Published: November 2024

Background:
In HFpEF patients transendocardial CD34+ cell therapy was shown to improve systolic and diastolic properties of the myocardium. However, the underlying mechanisms remain poorly defined.

Aim:
As coronary microvascular dysfunction is thought to represent a central pathophysiological mechanism of HFpEF, we sought to evaluate the potential correlation between CD34+ cell therapy and myocardial perfusion in HFpEF patients.

Methods:
We performed a cardiac MRI (cMRI)-based subanalysis of a prospective pilot study that investigated clinical effects of transendocardial CD34+ cell therapy in HFpEF patients. All patients underwent transendocardial autologous CD34+ cell transplantation using electroanatomical mapping system targeting areas of local mechanical diastolic delay >50 ms. At baseline and 6 months we performed clinical, biochemical, echocardiographic and cMRI evaluation. A 17-segment model was used for cMRI segmental perfusion analysis, which was assessed using gadolinium contrast and a first pass perfusion approach. We analyzed segmental myocardial perfusion using cMRI segmental perfusion data normalized to baseline blood pool (BP) AUC for each patient.

Results:
Of 12 patients 2 (17%) were female and the average age was 68±6 years. 6 (100%) patients had a history of hypertension, 2 (17%) had diabetes and 3 (33%) had hyperlipidemia. We found no differences between baseline and follow-up in creatinine (99±28 μmol/L vs. 100±29 μmol/L; P=0.91), bilirubin (18±10 mmol/L vs. 15±5 mmol/L; P=0.33), and NT-proBNP (1581±1079 pg/mL vs. 1437±902 pg/mL; P=0.74) serum levels. Left ventricular systolic function also remained unchanged (LVEF; 62±8% vs. 63±8%; P=0.75 and GLS;-13.3±1.9% vs. -13.5±2.4%; P=0.86). However, left ventricular diastolic function significantly improved at 6 months (E/e'; 17.6±3.6 vs. 12.5±2.0; P=0.002). When performing myocardial segmental analysis, we found significantly higher myocardial viability in injected (N=54) than in noninjected (N=45) electroanatomical segments (15.3±3.8 mV vs. 11.3±4.5 mV; P=0.00001). Moreover, at 6 months myocardial perfusion was significantly improved in 89 injected corresponding cMRI segments, but it remained unchanged in 103 noninjected segments (111±44% vs. 97±21%; P=0.004).

Conclusion:
In HFpEF patients, CD34+ cell therapy may be associated with an increase in myocardial perfusion of the target myocardium, which may result in beneficial echocardiographic and clinical benefits observed in this patient cohort.
Abstract 4141178: Papillary fibroelastomas: clinical presentation, anatomical characteristics, and bleeding rates in those undergoing surgical and conservative management
Authors: Saleh Hassan , Khaleel Ibrahim , Korn Morgan , Alameh Saleem , Sarkisov Mitchell , Dils Anthony , McNamara David
Published: November 2024

Papillary fibroelastomas (PFEs) are benign cardiac tumors, most commonly arising on left sided heart valves but have been reported on non-valvular structures. Histologically, PFEs are comprised of throngs of an avascular mucopolysaccharide core with an overlying layer of endothelial cells. While PFEs carry no inherent malignant potential, the risk of embolization poses a unique challenge to clinicians.

Case series exist describing the anatomical characteristics of PFEs, though as echocardiography has become more ubiquitous and imaging quality has dramatically improved, little contemporary data exists on the patient characteristics, management techniques employed, and outcomes. Our objective was to describe a quaternary center’s experience with PFEs.

A single quaternary center, retrospective case review of patients with a diagnosis of cardiac tumor between Janurary 1 2008 and Janurary 30 2024, using ICD codes D15.1 and I42.4, resulted in 410 patients. Using chart review, 80 of the 410 patients had a suspected diagnosis of PFE based on TEE or TTE characteristics. We then performed a retrospective analysis of the 80 patients.

Of the 80 patients, 47 underwent surgical resection, 5 roboticly, with no evidence of PFE on subsequent TTE. The median age at time of diagnosis was 67.7 +/- 13.8 years. 35 patients had a diagnosis of stroke any time prior to PFE identification. The most common indication for the diagnostic echocardiogram was arterial emboli. Valvular PFEs were commonly found on the upstream aspect of valves (55.9%) and most commonly located on the aortic valve (63.8%). Of the 27 patients with a diagnosis of stroke and PFE size data, 20 had a PFE >/= 5 mm. In the non-surgical group 7 were on P2Y12 inhibitor or therapeutic anticoagulation for the indication of PFE. Within 3 years there was 1 mortality in the surgical group and 6 in the non-surgical group. In the non-surgical group 15.2% were hospitalized for bleeding at 3 years verse 6.25% in the surgical group.

While PFEs have been previously characterized in case series, there remains a scarcity of literature on their clinical presentation and management techniques. This single center case series demonstrates an association between PFEs and arterial embolic events with low three-year mortality. There may be a relation to PFE size and stroke as stroke was more common in those with a PFE >/= 5mm. Additional studies evaluating PFE characteristics and treatment strategies are necessary to guide PFE management.
Abstract 4141182: Extreme Heat and Atrial Fibrillation in Patients with Implanted Devices
Authors: alahmad barrak , Noone Michael , Strohmeyer Claire , Oyekunle Taofik , Koutrakis Petros , Mela Theofanie
Published: November 2024

Background:
Atrial fibrillation (AF) is becoming more prevalent both in the US and globally, with its incidence rising at an alarming rate. While this rise can be partly explained by enhanced surveillance, an aging population, or increase in traditional risk factors, it is also prudent to start examining the role of emerging environmental risk factors like extreme heat driven by climate change.

Methods:
Data from the Medtronic Product Surveillance Registry for all patients in the US who underwent a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) device implant from 2016 to 2023. For each patient, we extracted the first arrhythmic episode of AF detected on the device. These episodes were matched with hourly ambient temperature recordings from the nearest station in their respective town/city. In a case-crossover design, we created multiple control hours within the same individual that matched the episode hour by time of day, day of the week, month, and year. Conditional logistic models were then pooled across all climate zones in the US to obtain the dose-response relationship between outdoor heat and AF episodes, allowing for non-linearity. In an additional analysis, we limited episodes to those lasting 30 minutes or longer.

Results:
A total of 2,313 individuals with atrial arrhythmic events were analyzed. We found fewer AF episodes in the early morning hours (12am-7am) compared to normal working hours (8am-5pm) (p<0.001). We found fewer AF episodes occurring on Saturday and Sunday compared to weekdays (p<0.001). Pooled across all regions in the US, compared to locally optimal temperatures (those associated with least odds; between 5°C to 8°C), the odds ratios of AF events when outdoor temperatures were 39°C, 40°C, and 41°C were 2.66 (95% CI: 1.57 – 4.54), 2.87 (95% CI: 1.57 – 5.22), and 3.09 (95% CI: 1.58 – 6.01), respectively. Lagging temperature exposure did not improve the models. Restricting to episodes longer than 30 minutes showed similar results.

Conclusion:
We observed a dose-response relationship between rising outdoor temperatures and increased AF events with doubling to tripling of odds when temperatures reach extreme hot levels. This study highlights the urgent need to consider emerging environmental factors, such as climate change-induced heat, in managing and preventing AF.
Abstract 4141224: Prognostic Value of Serum Glycated Albumin in Acute Coronary Syndrome Patients Without Standard Modifiable Cardiovascular Risk Factors
Authors: Zhang Xiaoming , Du Yu , Zhou Yujie
Published: November 2024

Background:
Glycated albumin (GA) has been demonstrated to be associated with adverse outcomes in patients with acute coronary syndrome (ACS). However, as a specific subgroup of ACS, a significant proportion of patients with ACS without standard modifiable cardiovascular risk factors (SMuRFs) are currently being identified. The prognostic value of serum GA for adverse events in such patients remains unexplored.

Aims:
This study aims to evaluate the prognostic value of GA in predicting adverse outcomes in patients with ACS without SMuRFs.

Methods:
This study involved 1,140 consecutive patients who were diagnosed with ACS without SMuRFs at the Beijing Anzhen Hospital between May 2018 and December 2020 and underwent coronary angiography. Each patient was followed up for a period of 35–66 months after discharge. The primary endpoint of this study was major adverse cardiovascular and cerebrovascular events (MACCEs) that included all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, and ischemia-driven revascularization.

Results:
The average age of the study participants was 59.55 ± 10.98 years, and men accounted for 61.8%. The average GA level was 14.37 ± 2.42. The median follow-up duration was 48.3 months, during which 220 cases (19.3%) experienced MACCEs. In the fully adjusted model, with GA as a continuous variable, the hazard ratio (HR) for MACCEs in the high GA group was 1.069 (95% confidence interval (CI): 1.008, 1.133), the HR for ischemia-driven revascularization was 1.095 (95% CI: 1.021, 1.175), and the HR for all-cause mortality was 1.155 (95% CI: 1.021, 1.306), all with P values less than 0.05. Similarly, when GA was considered as a categorical variable, in the fully adjusted model, GA was associated with MACCEs, ischemia-driven revascularization, and all-cause mortality, with P values all less than 0.05. The restricted cubic spline curve showed that the relationship between GA and MACCEs was linear (p for non-linear = 0.079; p for overall association = 0.026). Furthermore, GA levels were correlated with poor prognosis in the subgroups of patients.

Conclusion:
Serum GA might be an independent predictor of all-cause death, ischemia-driven revascularization, and MACCEs in patients with ACS without SMuRFs.
Abstract 4141269: Prescriber Implementation of Guideline-Directed Medical Therapy Remains Poor in the Peripheral Artery Disease Population
Authors: Minnick Caroline , Stutsrim Ashlee , Williams Timothy , Downey William , Edwards Matthew , Goldman Matthew
Published: November 2024

Background:
Peripheral Artery Disease (PAD) is one of the most prevalent forms of cardiovascular disease, with many progressing to CV morbidity/death. Adherence to guideline-directed optimal medical therapy (OMT) in PAD is vital. This study evaluated adherence to prescribing OMT in patients with PAD.

Methods:
A retrospective study of 3,471 patients with PAD between 2017 and 2022 undergoing vascular laboratory imaging was performed. OMT was defined by 2016 AHA guidelines. Adherence to guidelines was denoted by active prescriptions for antiplatelet and statin therapy. Presence of high-intensity OMT (HIOMT) was defined as prescriptions for an antiplatelet and high-intensity statin. Prevalence and incidence (change to OMT /HIOMT within 60 days of index vascular laboratory visit) of OMT were evaluated. Multivariable models were created evaluating predictors of OMT and HIOMT prevalence and incidence.

Results:
OMT prevalence was 45.3% while HIOMT prevalence was 23.6% at the time of index vascular laboratory. Incident OMT was 24.3% while incident HIOMT was 11.2% within 60 days. Age, min/max ABI, insurance status, smoking status, and comorbidities were associated with prevalent OMT/HIOMT (table 1). Age, gender, min/max ABI, smoking status, and HgbA1c were associated with incident HIOMT (table 2). In multivariable models, incident HIOMT was less likely in women (OR 0.7; 0.52-0.91) whereas lower ABIs were predictive of HIOMT (OR 0.6; 0.51-0.72).

Conclusions:
Despite clear guidelines regarding OMT in patients with atherosclerotic cardiovascular disease, in this real-world study of guideline directed prescription management of PAD, adherence to OMT remains low, especially for HIOMT. Predictors of incident HIOMT include lower ABI while females were less likely to be on HIOMT. Given the high prevalence of PAD, heterogeneity of caregivers, widespread availability of screening, this population should be targeted for better adherence to HIOMT to prevent CV morbidity and death.
Abstract 4141292: Neo-Sinus Washout Time Following Transcatheter Aortic Valve Replacement and Hemodynamic Outcomes
Authors: Kathavarayan Ramu Shivabalan , Isogai Toshiaki , Beotra Saksham , Kapadia Vishwum , Thakore Nikita , Agrawal Ankit , Shekhar Shashank , Majeed-Saidan Maryam Muhammad Ali , Prasad Rohan , Bansal Agam , Abushouk Abdelrahman , Iskandar Odette , Tereshchenko Larisa , Reed Grant , Puri Rishi , Yun James , Harb Serge , Miyasaka Rhonda , Popovic Zoran , Krishnaswamy Amar , Kapadia Samir
Published: November 2024

Background:
Leaflet thrombosis and associated transcatheter heart valve (THV) dysfunction are major concerns in managing transcatheter aortic valve replacement (TAVR) recipients. Prolonged neo-sinus contrast washout time (NWT) may increase the risk of hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, leading to early valve degeneration. This study aims to assess the association between NWT measured in-vivo and hemodynamic outcomes in patients undergoing TAVR.

Methods:
In this retrospective cohort study, NWT was obtained from aortograms using computer vision algorithm in 2256 patients (mean [SD] age 79 [9] years; 40% female) who underwent TAVR at our center between 2016 and 2020. NWT was stratified into terciles (T1: <1.33 s, T2: 1.33-2.08 s, T3: >2.08 s) and adjusted for heart rate (HR). Hemodynamic assessments focused on transvalvular aortic mean and peak gradients post-TAVR, with evaluations at 30-day and 1-year follow-ups. The association between NWT and HALT presence was also studied. Unpaired t test was used to compare the gradients between terciles at different time points. Mann-Whitney test was used to compare NWT between HALT and no HALT.

Results:
At the 30-day follow-up, the transvalvular aortic mean gradient was higher in T3 compared to T1 (12.61 [5.07] mm Hg vs. 11.98 [4.75] mm Hg, p=0.03). At the 1-year follow-up, patients with 29 mm valves in T3 had higher mean gradients than those in T1 (11.13 [4.35] mm Hg vs. 9.65 [3.85] mm Hg, p=0.04). Patients with 30-day HALT exhibited significantly greater NWT (z=-2.06, p=0.04).

Conclusion:
Prolonged NWT measured in-vivo is associated with elevated transvalvular aortic mean gradients at both 30-day and 1-year follow-ups post-TAVR. Moreover, patients with HALT had higher NWT. NWT can help identify patients at risk of valve deterioration and HALT at an early stage, guiding post-procedural pharmacotherapy.
Abstract 4141296: Dietary Sodium Intake and The Gut Microbiome: A Pilot Study in COSMOS
Authors: Zhu Haidong , Dong Yanbin , Li Jun , Hamaya Rikuta , Lee Kyu Ha , Manson JoAnn , Sesso Howard
Published: November 2024

Background:
Recent animal studies connect high sodium intake to the gut-immune axis and highlight the gut microbiome as a potential therapeutic target to counteract salt-sensitive conditions and hypertension. However, the relationship between sodium intake on the gut-immune axis in humans is largely unknown. We previously showed that dietary sodium reduction increased circulating levels of gut-produced short-chain fatty acids (SCFAs), in persons with untreated hypertension. Therefore, we examined whether dietary sodium intake is associated with gut microbial taxonomic features.

Methods:
The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a recently completed randomized, double-blind, placebo-controlled, 2x2 factorial trial of a multivitamin and cocoa extract supplement (containing 500 mg/d flavanols, including 80 mg/day (-)-epicatechin) in 21,442 older adults. Dietary intake was assessed by a validated Food Frequency Questionnaires at baseline and year 2. We previously conducted a deep shotgun metagenomic sequencing in a pilot study of 30 COSMOS participants using fecal samples collected at baseline and year 2 to explore whether the interventions affected gut microbial composition and function. We leveraged available taxonomic profiling data and analyzed the association between energy-adjusted sodium intake and microbial features at baseline.

Results:
We did not observe significant associations between sodium intake and alpha diversity parameters including Shannon Diversity Index and Inverse Simpson Index (
P
>0.05). The PERMANOVA analysis showed that sodium intake was significantly associated with the overall taxonomic beta diversity (Bray-Curtis dissimilarity) (R
2
= 0.067, p=0.031), suggesting 6.7% of the variation in beta diversity was explained by sodium intake. The Spearman’s rank-order correlation test showed several nominally significant associations (P<0.05) between sodium intake and taxonomic features (4 Family, 6 Genus, 15 Species, 16 Strains, 18 Pathways). At genus level,
Bacteroides
was associated with sodium intake (r=0.566, p=0.0037). A superpathway of
geranylgeranyldiphosphatevbiosynthesis I
(r=-0.527, p=0.0076) was associated with sodium intake, which play key roles in signaling pathways, cytoskeletal regulation, intracellular transport, and cell proliferation.

Summary:
This pilot study suggests that dietary sodium intake may be related to beta diversity and some microbial taxa or pathways. Large studies are warranted.
Abstract 4141300: Sympathetic Response to Dynamic Exercise Predicts the Exercise Capacity of Patients with Heart Failure with Preserved Ejection Fraction
Authors: Badrov Mark , Tobushi Tomoyuki , Notarius Catherine , Keys Evan , Nardone Massimo , Cherney David , Mak Susanna , Floras John
Published: November 2024

Background:
In heart failure, sympathetic excess and exercise intolerance impair quality of life. In HFrEF, muscle sympathetic nerve activity (MSNA) is augmented at rest and in response to exercise, of which the latter relates inversely to peak oxygen uptake (VO
2peak
).

Aims:
To determine, in HFpEF: 1) if resting MSNA is elevated, independent of its accompanying comorbidities; and 2) if MSNA responses to exercise are also increased and relate inversely to exercise capacity.

Methods:
In 13 HFpEF patients (70±6 yrs; LVEF: 63±6%; NTproBNP: 658±610 pg/ml), 17 co-morbid controls (CMC; 67±8 yrs), matched for medication and presence of comorbidities, and 18 healthy controls (HC; 65±8 yrs), we measured, in the seated position, heart rate, blood pressure, and MSNA (microneurography) during: i) 7 min baseline; ii) 2 min isometric (IHG; 40% maximal voluntary contraction [MVC]) or rhythmic handgrip (RHG; 50% and 30% MVC) exercise, followed by 2 min post-HG ischemia (PHGI); and iii) 4 min 1-leg cycling (2 min each at mild and moderate intensity). VO
2peak
was obtained by open circuit spirometry.

Results:
Resting MSNA was higher in HFpEF (48±14 bursts/min) vs. CMC (36±9 bursts/min; P=0.02) and HC (34±12 bursts/min; P<0.01). In HFpEF, relative VO
2peak
(16±5 ml/kg/min) was lower vs. CMC (25±7 ml/kg/min; P=0.02) and HC (29±9 ml/kg/min; P<0.001). During HG, MSNA responses were similar in magnitude in all groups (P<0.05), resulting in higher absolute values in HFpEF vs. CMC and HC during HG and PHGI at 40% IHG (P<0.05) and HG only at 50% and 30% RHG (P<0.05). During cycling, MSNA decreased during mild (−4±4 bursts/min; P=0.01) and moderate (−8±6 bursts/min; P<0.001) cycling in HC, was unchanged during mild (+1±6 bursts/min; P=0.42) and moderate (+2±8 bursts/min; P=0.28) cycling in CMC, yet increased in HFpEF during both mild (+8±8 bursts/min; P<0.001) and moderate (+9±10 bursts/min; P<0.001) cycling. In HFpEF, the change in MSNA elicited by moderate cycling related inversely to relative VO
2peak
(R
2
=0.51; P<0.01). No such relationship existed in either CMC or HC (P>0.05).

Conclusion:
In contrast to comorbidity-matched controls, HFpEF patients exhibit augmented MSNA at rest and during exercise. As with HFrEF, the magnitude of such ‘paradoxical’ sympathoexcitation during dynamic exercise related inversely to exercise capacity, observations consistent with the concept of a peripheral neurogenic, vasoconstrictor limit on exercise in all with heart failure, regardless of LVEF.