bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144205: Diagnostic accuracy of artificial intelligence-based electrocardiogram algorithm to predict heart failure with reduced ejection fraction: a systematic review and meta-analysis
Authors: Carvalho Ferreira Andre , Antunes Vanio do Livramento Junior , Guida Camila , Vergara Ferraz de Souza Luciana , Defante Maria Luiza Rodrigues , Bulhoes Elisio , Begic Edin , Aziri Buena , Mazetto Roberto , Monteiro Sarah , Garcez Luanna , Benitez Maria
Published: November 2024

INTRODUCTION:
AI-based EKG has shown good accuracy for diagnosing heart failure. However, due to the heterogeneity of studies regarding cutoff points, its precision for specifically detecting heart failure with reduced ejection fraction (LVEF <40%) is not yet well established.

Research question:
What it is the sensitivity and specificity of artificial-based electrocardiogram to diagnose heart failure with low ejection fraction(cut-off of 40%)

Aims: We conducted a meta-analysis and systematic review to evaluate the accuracy of artificial intelligence electrocardiograms in predicting an ejection fraction below 40%.

METHODS:
We searched PubMed, Embase and Cochrane Library for studies evaluating the performance of AI EKGs in diagnosing HFrEF. We computed true positives, true negatives, false positives and false negatives events to estimate pooled sensitivity, specificity and area under the curve, using R software version 4.3.1, under a random-effects model.

RESULTS:
We identified 8 studies,including 136151 patients with a paired artificial intelligence enabled electrocardiogram with an echocardiography. 9349(6.8%) patients had an ejection fraction below 40% according to the echocardiogram.

The AI-ECG data yielded areas under the receiver operator of, sensitivity of 0.861(0.815-0.897), and specificity of 0.874(0.834-0.905) , and area under the curve of 0.929(0.876-0.949).

Mean/median age ranged from 60±9 to 67.8±14.4 years.

CONCLUSIONS:
In this systematic review and meta-analysis, the use of electrocardiogram-based artificial intelligence models demonstrated high sensitivity and specificity for the diagnosis of heart failure with an ejection fraction below 40%
Abstract 4144227: Sustained Moderate to Vigorous Physical Activity Modifies the Association Between Body Weight Changes and Survival in Stroke Patients
Authors: Jae Sae Young , Cho Dong-Hyuk , Choi Jimi , Gwon Jun Gyo
Published: November 2024

Background:
The relationship between body weight changes and survival after stroke diagnosis is complex and influenced by various factors. While higher levels of physical activity (PA) are known to improve post-stroke outcomes, it remains unclear whether PA status can impact the association between body weight changes and survival in stroke patients. This study tested the hypothesis that sustained moderate to vigorous physical activity (MVPA) modifies the association between body weight changes and all-cause and cardiovascular mortality in stroke survivors.

Methods:
This retrospective study followed 32,905 ischemic stroke patients registered with the National Health Insurance Service. Body mass index (BMI) and PA were measured for three years prior to and two years following stroke diagnosis. Changes in BMI were classified as BMI loss, BMI stable, and BMI gain, while changes in MVPA were classified as persistently inactive, MVPA initiation, MVPA quitting, or MVPA continuation. Outcomes included all-cause mortality (ACM) and cardiovascular mortality (CVM).

Results:
During a median follow-up of 6 years, we identified 4,379 cases of ACM and 1,349 cases of CVM. In adjusted models compared with the stable BMI-inactive, the hazard ratios (HRs) indicated a higher risk of ACM (HR 1.68, 95% CI 1.42-1.98) and CVM (HR 1.74, 95% CI 1.30-2.33) in the BMI loss-inactive, and a higher risk of ACM (HR 1.66, 95% CI 1.40-1.96) and CVM (HR 1.89, 95% CI 1.40-2.54) in the BMI loss-MVPA quitting. However, these risks were not observed in the BMI loss-MVPA continuation (HR 1.00, 95% CI 0.85-1.18 for ACM; HR 0.96, 95% CI 0.72-1.29 for CVM). Conversely, the BMI gain-MVPA continuation had a lower risk of ACM (HR 0.72, 95% CI 0.61-0.85) and CVM (HR 0.74, 95% CI 0.54-1.00), but this was not observed in the BMI gain-inactive (HR 0.95, 95% CI 0.79-1.15 for ACM; HR 0.89, 95% CI 0.64-1.24 for CVM), compared with the stable BMI-inactive.

Conclusions:
Sustained MVPA significantly modifies the association between body weight changes and survival in ischemic stroke survivors. Body weight loss combined with inactive increases the risk of death, whereas continued MVPA mitigates these risks. Body weight gain with ongoing MVPA is associated with lower mortality risks. These findings highlight the importance of sustained PA in improving survival outcomes post-stroke and suggest that PA plays a crucial role in modulating the obesity paradox in stroke patients.
Abstract 4144236: Assessing Trends in Disability-Adjusted Life Years (DALYs) and Age-Adjusted Mortality Rates (AAMR) of Ischemic Heart Disease: A Comparative Analysis of the United States and Global Burden of Disease
Authors: Buhadur Ali Muhammad Khan , Shahzaib Muhammad , Qureshi Muhammad Ahmad , AMMAR UR RAHMAN MOHAMMAD , Munir Luqman , Khalid Amna , Hayat Malik Saad , Shoaib Muhammad Mukarram
Published: November 2024

Introduction:
Ischemic heart disease (IHD) is characterized by reduced blood flow to the heart muscle due to narrowing or blockage of the coronary arteries. This leads to chest pain, shortness of breath, and can result in heart attacks.

Objectives:
This study aims to analyze and compare trends in disability-adjusted life years (DALYs) and age-adjusted mortality rates (AAMR) due to IHD in the United States and globally, while also focusing on risk factors like high systolic blood pressure, high LDL cholesterol levels and smoking from 1991 to 2021.

Methods:
We gathered data estimates on AAMR and DALYs related to risk factors in the United States and globally, including gender-specific data, from 1991 - 2021 using the Global Burden of Diseases, Injuries, and Risk Factors (GBD) database. We computed age-adjusted rates per 100,000 individuals and determined the annual percent change (APC) with a 95% confidence interval. Trends over this period were analyzed using the Joinpoint Regression Program.

Results:
The analysis revealed declining trends of DALYs and AAMR in both America and globally although the negative trend has been steeper in United States for both DALYs (AAPC -2.62) and AAMR (AAPC -2.70) as compared to DALYs (AAPC 1.10) and AAMR (AAPC 1.21) globally. Conversely, the trend associated with high systolic blood pressure, high LDL cholesterol and smoking as risk factors showed declining pattern with DALYs AAPC of -3.26, -3.20 and -3.50 respectively and AAMR’s AAPC of -3.29, -3.45 and -3.62 respectively across the US while the global AAPC values for DALYs were -1.17, -1.24, -1.72 respectively and for AAMR were -1.33, -.45, 1.74 respectively. The DALYs and AAMR for males and females across the US and globally showed similar declining trends with the trend being steeper in the US than globally. In the US, the AAPC values for DALYs for males and females were -2.6 and -2.7 and for mortality rates, AAPC were -2.7 and -2.9 respectively. While for males and females globally these values were -0.96 and -1.32 respectively for DALYs and -1.07 and -1.49 respectively for mortality rates.

Conclusions:
The data shows a steeper decline in DALYs and AAMR in the US compared to global trends. This decline is particularly evident for high systolic blood pressure, high LDL cholesterol, and smoking and is consistent across both males and females, indicating significant improvements in public health outcomes in the United States relative to global averages.
Abstract 4144239: The Relationship Between Endothelial Function and Tissue Characterization After Drug-coated Balloon for De-novo Coronary Lesion
Authors: Kawai Tsutomu , Asai Mitsutoshi , Morita Takashi , Kawasaki Masato , Kikuchi Atsushi , Kondo Takumi , Seo Masahiro , Nakamura Jun , Fujita Takeshi , Yamada Takahisa , Fukunami Masatake
Published: November 2024

Background:
The previous our study showed that vasomotion may be better preserved after drug-coated balloon (DCB) treatment than after stenting. However, there is no information available on the relationship between endothelial function and tissue characterization after DCB treatment.

Aims:
The purpose of this study was to investigate the relationship between endothelial function and tissue characterization after DCB for de-novo coronary lesion.

Methods:
We prospectively studied 19 patients who underwent acetylcholine provocation test and intravascular imaging at 8-month after DCB treatment. To evaluate endothelial-dependent vasomotion, the mean lumen diameter of the distal segment, beginning 5 mm and ending 15 mm distal to the edge of the treated segment, was quantitatively measured by angiography during the acetylcholine provocation test. Tissue characterization was assessed with integrated backscatter intravascular ultrasound (IB-IVUS).

Results:
There was a positive correlation between endothelial-dependent vasomotion and the proportion of lipid plaque in treated segments (r
2
=0.610, p=0.009). On the other hand, there were negative correlations between endothelial-dependent vasomotion and the proportion of dense fibrous or calcified plaque in treated segments (r
2
=-0.709, p=0.001, r
2
=-0.773, p<0.001).

Conclusion:
Endothelial-dependent vasomotion was better preserved in lipid-rich lesions than in dense fibrous or calcified lesions, suggesting that endothelial function could be more impaired in lesions with advanced atherosclerosis after DCB treatment.
Abstract 4144240: Weight gain and the risk of sudden cardiac death in coronary artery disease
Authors: Hannula Maria , Holmstrom Lauri , Tulppo Mikko , Hookana Ida , Perkiomaki Juha , Huikuri Heikki , Junttila Juhani
Published: November 2024

Background:
Obesity increases the risk of sudden cardiac death (SCD) in the general population, but in patients with CAD, obesity has been associated with a smaller risk of death. This ‘obesity paradox’ is confounded by several factors and the association between weight gain and the risk of SCD in CAD is unclear.

Aim:
We aimed to investigate the effect of weight gain on the risk of SCD in a prospective cohort of CAD patients.

Methods:
We have prospectively enrolled 1,946 patients with CAD (mean age 66.9±8.6, 68% male), with a mean follow-up of 8.7±2.2years. Weight was measured at baseline and at 5 years and was classified into 3 groups: 1) -5%< weight change <+5% (reference group), 2) weight gain >5%, and 3) weight loss >5%. The primary endpoint was SCD or resuscitation from sudden cardiac arrest. Non-sudden cardiac death and non-cardiac death were secondary endpoints. Statistical analysis was performed with Cox regression and was adjusted for age, sex, baseline BMI, type 2 diabetes, kidney function (eGFR), and left ventricle ejection fraction.

Results:
A total of 1,053 subjects had weight measured at baseline and at 5 years. Thirteen percent (13%) gained weight >5% and 19% lost weight >5% in 5 years. During a mean follow-up of 2.1±0.7 years after the second weight measurement, SCDs/SCAs occurred in 18 patients. Weight gain was associated with an increased risk of SCD (HR 3.54, 95% CI 1.17-10.67; p=0.03), but not with non-cardiac death (HR 2.01, 95% CI 0.97-4.19; p=0.06) or non-sudden cardiac death (no events). Weight loss was associated with an increased risk of non-sudden cardiac death (HR 2.74, 95% CI 1.07-6.97; p=0.04) and non-cardiac death (HR 2.60, 95% CI 1.40-4.81; p=0.002) but not with SCD (HR 1.73, 95% CI 0.51-5.86; p=0.38).

Conclusions:
Weight gain was associated with an increased risk of SCD but not with other modes of death. Patients with stable weight had the best prognosis. These results suggest that weight changes may have a special effect on CAD trajectory and further studies are warranted to investigate the role of weight gain on SCD risk.
Abstract 4144253: Sotagliflozin Reduces Contractile Work In Human Living Myocardial Slices
Authors: TAICHMAN REBECCA , Smolyak Julia , Bedi Kenneth , Patel Sapna , Margulies Kenneth , Day Sharlene , Lee Benjamin
Published: November 2024

Introduction:
Sodium glucose co-transporter inhibitors (SGLTi) are a class of medication with clinical benefit in heart failure regardless of subgroup. It has been postulated that SGLTi may have direct effects on the heart in addition to known systemic effects. One potential cardioprotective mechanism of SGLTi is through direct modulation of cardiac tissue mechanics, which few studies have investigated. New tissue slice platforms offer the potential to test impact of compounds on contractility but have not been fully validated. We sought first to establish the ability for human living myocardial slices (LMS) to recapitulate known disease-related and drug-related effects on biomimetic work loop parameters. We then assessed whether SGLTi directly and acutely affect LMS contractility.

Methods:
Vibratome-generated 300µm-thick slices of left ventricular tissue from non-failing donor hearts (N=10), failing hearts (N=4), and hypertrophic cardiomyopathy (HCM) septal myectomy tissue (N=7) were adhered to 8x8mm anchors and mounted onto the IonOptix Cardiac Slice System. We generated force-length work loops at varying preloads (4-16% strain) and afterloads (25-75% active force). Drug (sotagliflozin 10µM, isoproterenol 5µM, mavacamten 1µM) or vehicle (DMSO) was washed in and work loops were repeated.

Results:
HCM slices performed more work at baseline compared to nonfailing slices. Across groups, slices demonstrated an increase in total work in response to isoproterenol (known positive inotrope) and a decrease in total work in response to mavacamten (known negative inotrope). Sotagliflozin significantly reduced total work done by slices at a given load.

Conclusions:
We developed a rigorous and reproducible methodology for phenotyping contractile behavior, including biomimetic work loops, in freshly prepared human LMS at multiple preloads and afterloads. SGLTi acutely and directly reduced the total work performed in human myocardial tissue. Future work is focused on the mechanisms by which SGLTi directly impact contractility.
Abstract 4144260: Diversity is Essential in Cardiovascular Medicine and Subspecialties: A Comprehensive Report of Gender, Racial, and Ethnic Representation among Cardiovascular Fellows from 2005 to 2022
Authors: Obeidat Omar , Abughazaleh Saeed , Tarawneh Mohammad , Akhter Nausheen , tong ann
Published: November 2024

Introduction:
The diversity of the healthcare workforce is essential for equitable and effective patient care. This comprehensive report analyzes the representation trends among cardiovascular fellows in the US over an 18-year period, focusing on gender, racial, and ethnic representation.

Methods:
Utilizing data from the National Graduate Medical Education Census, this study analyzes trends in representation across gender, race, and ethnicity among cardiovascular medicine fellows. It examines the expansion of cardiology programs and fellow positions in specialties, assessing the evolution of diversity between 2005 and 2022 using J point trend analysis software.

Results:
Growth Trends in Cardiology Specialties (2005-2022): Cardiology exhibited significant growth, with an AAPC of 2.6% for programs and 2.0-3.2% for fellow positions. IC showed an AAPC of 2.0% for programs and 2.8% for fellow positions. EP had a lower AAPC for programs (1.7%) but a higher rate for fellow positions (5.2%).

Gender Disparities: Women constituted 22% in CVM, 12.3% in EP, and 11% in IC. Despite these disparities, there was a promising increase in the representation of women over time, with a higher AAPC for women compared to men, indicating a shift towards greater gender diversity.

Racial and Ethnic Composition and Trends: White and Asian fellows accounted for over 70% of the total, while Black and Hispanic fellows made up less than 12%. The representation of White fellows decreased significantly, while Black fellows showed a significant increase in CVM. Hispanic fellows did not exhibit a significant increase and even showed a decrease in IC.

Medical School Backgrounds: USMDs comprised the majority of fellows, but DOs displayed the highest growth rate, particularly in EP (AAPC of 7.9%). IMGs had the highest AAPC in IC at 4%.

Conclusion:
Our analysis revealed continued racial and gender disparities in the cardiology specialty. This report calls for concerted efforts from academic institutions, healthcare organizations, and policymakers to implement effective strategies for diversity and inclusion, reflecting the aim of creating a workforce that mirrors the diversity of the population it serves.
Abstract 4144266: Transcription factor LITAF orchestrates pericyte-mediated vascular inflammation via modulation of protein trafficking pathways in pulmonary hypertension
Authors: Chelladurai Prakash , Condon David , Agarwal Stuti , Mitra Ankita , Shamskhou Kian , Nathan Abinaya , Sweatt Andrew , Chakraborty Ananya , Zamanian Roham , Yuan Ke , Dejesus Vinicio
Published: November 2024

Introduction:
Vascular inflammation is a major component in the pathogenesis of pulmonary arterial hypertension (PAH). Inflammatory mediators initiate a pro-inflammatory state in capillary-resident pericytes resulting in dysfunctional endothelial-pericyte interactions, reduced pericyte coverage, and microvessel loss in severe PAH. However, molecular mechanisms driving excessive proinflammatory responses in pericytes remain elusive.

Hypothesis:
Lipopolysaccharide-induced tumor necrosis factor (TNF)-α factor (
LITAF
) perpetuates pro-inflammatory state in pericytes that consequently exacerbate tissue inflammation, reduces pericyte coverage, compromises vascular integrity leading to loss of microvasculature in PAH.

Methods:
Transcriptomic and mechanistic studies were conducted on isolated human pericytes from healthy donors and patients with PAH. Impact of
LITAF
ablation and overexpression on the secretion of proinflammatory mediators was assessed using cytokine arrays, and protein interactions using mass-spectrometry. Pericyte-specific
Litaf
deletion was generated using NG2-CreERT2 and
Litaf
flox/flox
transgenic mouse lines
.

Results:
LITAF transcription and protein levels are significantly elevated in PAH pericytes, which correlated with the increased levels of cytokines including TNFα and monocyte chemoattractant protein-1 (MCP1) as compared to healthy pericytes. Comparatively, PAH pericytes exhibited rapid stabilization and increased nuclear translocation of LITAF and MCP1 upon exposure to cytokines (TNFα, IL1β, IL6). LITAF proteins also colocalized to late endosomes and lysosomes. Secretome analysis from PAH pericytes confirmed increased LITAF and MCP1 secretion, and coregulation of ALG-2-Interacting Protein-X (ALIX), which is a bona fide marker of exosomes. Our observations confirm the positive feedback loop between TNFα signalling in the transcriptional activation of
LITAF
promoter, and the function of LITAF as a proinflammatory transcription factor in the regulation of
TNFA
transcription. Pericyte-specific
LITAF
deletion protects against development of chronic hypoxia-induced PH via reduction in the serum levels of proinflammatory cytokines, inflammatory cell infiltration, capillary loss, and vascular remodeling
in vivo
.

Conclusions:
LITAF activation mediates pro-inflammatory state in pericytes via regulation of endolysosomal and secretory pathways that amplifies pro-inflammatory mediator release, endothelial dysfunction, and vascular inflammation in PAH.
Abstract 4144289: Left atrial appendage isolation in catheter ablation of atrial fibrillation: An updated systematic review and meta-analysis.
Authors: Mohamed Ahmed , Elesawy Mahmoud , Afify Raneem , Ramadan Shrouk , Desouki Mariam , Elnady Mohamed , Mohamed Elshafey Shams Mahmoud , Elkhayat Ibrahim , Elbenawi Hossam , Arafa Amr Ossama Gaber , Abdelaziz Ahmed
Published: November 2024

Introduction:
Atrial fibrillation is the most encountered arrhythmia in clinical settings, with an estimate of 6 million cases in the United States. A growing amount of evidence has been supporting the role of left atrial appendage in left sided atrial fibrillation with conflict results. We aim in this study to provide a more in-depth guide for optimal left sided atrial fibrillation ablation strategy.

Methods:
We searched PubMed, Web of Science, Cochrane and Scopus for published studies until May 2024. We included relevant studies that compared the left atrial appendage electrical isolation versus the standard ablation and reported our outcomes of interest. The main outcomes of the study were the recurrence of atrial arrhythmia and the incidence of stroke or transient ischemic attack during the follow-up period. Data were pooled as Mean difference (MD) or risk ratio (RR) with their 95% CI using a fixed-effect model.

Results:
Eleven studies with 3040 patients were included in the final analysis. Left atrial appendage electrical isolation was associated with a significant reduction in atrial arrhythmia recurrence compared to the standard ablation alone (OR: 0.41, 95% CI: 0.35 to 0.48). However, it was also associated with a significant increase in stroke or transient ischemic attack incidence (OR: 1.48, 95% CI: 1.09 to 3.12).

Conclusion:
Left atrial appendage electrical isolation led to a significantly lower atrial arrhythmia recurrence, but this was achieved with an increased risk of stroke and transient ischemic attack incidence during the follow-up period.
Abstract 4144326: Mid-Term Outcomes of Surgical Resection of Pediatric Cardiac Fibroma and Modified Ventricular Reconstruction Procedure
Authors: Dou Zheng , Li Shoujun
Published: November 2024

Introduction:
Primary cardiac fibroma (CF) was the second most common type of cardiac tumor, with surgical resection being the optimal strategy. However, as the tumor grew, a larger tumor also presented challenges during surgery. Particularly when compared to adults, children have smaller ventricles and thinner ventricular walls. The integrity of the ventricular wall decreased after the resection of large occupation, leading to reduced ventricular function or complications such as ventricular aneurysms. This study presents a single-center retrospective review of pediatric CF cases in our hospital, and presented the outcomes of our modified ventricular reconstruction procedure.

Methods:
We retrospectively reviewed pediatric patients under the age of 14 underwent CF resection and modified ventricular reconstruction procedure from January 2018 to December 2023, excluding metastatic cardiac tumors. 2 steps were performed during modified ventricular reconstruction procedure. Step 1: interventricular septum reconstruction. For larger defects, two pericardial stripes were used to clamp the defect on both sides of the endocardium and then running sutured, while primary closure for smaller ones. Step 2: free wall reconstruction. Two pericardial stripes were used to clamp resection margin on ventricular free wall and then running sutured.

Results:
10 (58.9%) boys and 7 girls were included in this study, with a median age at surgery of 28.8 (7.8, 48.3) months and a median body weight of 13.0 (8.9, 15.3) kg. 7 patients had a tumor index (TI, the longest diameter of the cardiac tumor divided by the body surface area) greater than 10, with one patient reaching an exaggerated value of 22.1. During a median follow-up period of 17.4 months, no deaths, left ventricular failure, malignant arrhythmias, tumor recurrence were observed in the other patients.

Conclusion:
Our modified ventricular reconstruction procedure has proven successful. It has changed the fate of young patients with large tumors who would have otherwise needed heart transplants, offering high suture strength and reducing postoperative complications. Moreover, its relatively straightforward surgical approach facilitates learning and implementation in different centers.
Abstract 4144359: Performance of Pooled Cohort Equations and the AHA Predicting Risk of cardiovascular EVENTs Equations Among Multiracial Asian and Pacific Islander People
Authors: Bacong Adrian , Frankland Timothy , Li Jiang , Daida Yihe , Fortmann Stephen , Palaniappan Latha
Published: November 2024

Introduction:
The AHA Predicting Risk of cardiovascular EVENTs (PREVENT) Equations were introduced as a race-neutral alternative to the Pooled Cohort Equations (PCE) for predicting risk of ASCVD and heart failure. Although the equations have performed well among single-race groups, it is unknown if the PREVENT equations will perform better than PCE for multiracial individuals, a growing demographic population in the United States.

Research Question:
Do the PREVENT Equations perform better than the PCE among multiracial Asian and Pacific Islander (API) populations in predicting incident ASCVD?

Methods:
Using electronic health data from the Cardiovascular Disease Among Asians and Pacific Islanders Study, we examined individuals with complete data for all inputs necessary for both PCE and PREVENT from a large healthcare system in Hawaii (n = 27,784). We included individuals without ASCVD prior to entry and examined follow up for 5 years total. We examined 12 race and ethnic groups, including four multiracial groups: “Asian + White”, “Pacific Islander + White”, “Pacific Islander + Asian”, “Pacific Islander + Asian + White”. We evaluated the performance of PCE and PREVENT by calculating C-statistics with 95% Confidence Intervals (CI).

Results:
The performance of the PCE and PREVENT equations among the full sample was 0.6831 and 0.6813, respectively, reflecting similar moderate performance across both equations. PCE and PREVENT performance was similar among multiracial API groups (Table). However, there was heterogeneity in discriminative performance by group. PCE performance was worst among “Asian + White” individuals (0.65; [95% CI: 0.58, 0.72]) and best among “Pacific Islander + Asian” individuals (0.76; [95% CI: 0.69, 0.8288). Similar trends were seen in PREVENT; performance was worst among “Asian + White” individuals (0.65 [95% CI: 0.58, 0.72]) and was best among “Pacific Islander + Asian” individuals (0.71; [95% CI: 0.64, 0.78]).

Conclusions:
The base PREVENT Equations had comparable performance to PCE among multiracial Asian and Pacific Islander groups. Additional work is needed to better evaluate the performance of CVD risk equations among multiracial individuals and other emerging populations.
Abstract 4144416: Long-Term Cumulative LDL-C Exposure and ASCVD Events in Young Adults with CAC=0: Insights from the CARDIA Study
Authors: Peng Allison , Razavi Alexander , Bimal Tia , Rubin Maya , Allen Norrina , Wilkins John , Sperling Laurence , Rana Jamal , Whelton Seamus , Blaha Michael , Blumenthal Roger , Gianos Eugenia
Published: November 2024

Introduction

Cumulative exposure to LDL-C over time is independently associated with incident atherosclerotic cardiovascular disease (ASCVD), while the absence of coronary artery calcium (CAC) is associated with a low risk of ASCVD events regardless of baseline LDL-C. Whether cumulative LDL-C exposure influences clinical risk stratification in individuals with CAC=0 is unknown.

Objectives:
To assess whether cumulative LDL-C exposure in young adults with CAC=0 was associated with incident ASCVD events or future conversion to CAC>0.

Methods:
This analysis included Coronary Artery Risk Development in Young Adults (CARDIA) participants who underwent CAC scans at year 15 (Y15) (n=3043) or Y25 (n=3189) with measures of LDL-C from Y0 (baseline), 2, 5, 7, 10, 15, 20, 25, 30, and 35. Of those with CAC measured at Y15 and Y25, 2734 (89.9%) and 2282 (71.6%) had CAC=0, respectively. Cumulative LDL-C exposure was calculated using area under the curve (LDL-AUC) for three different time intervals: Y0-15, Y0-25, and Y15-25. Univariate and multivariate Cox regression models (adjusted for age, sex, race, and traditional ASCVD risk factors) were used to determine the association of LDL-AUC (per 100 mg/dL x years) with incident fatal and non-fatal ASCVD events with mean follow-up time 19.1 years after Y15 and 9.7 years after Y25. Logistic regression was used to measure the association of LDL-AUC with conversion from CAC=0 to CAC>0.

Results:
Of those with CAC=0 at Y15 (58% female, mean age 40 years) and Y25 (65% female, mean age 50 years), the event rate was 2.8 and 3.0 per 1000 person-years, respectively. After multivariate adjustment, LDL-AUC
[Y0-15]
in individuals with CAC=0 at Y15 was not associated with a significant increase in risk for ASCVD events (HR 1.01, 95% CI: 0.97-1.05). LDL-AUC
[Y0-25]
was associated with a significantly increased risk for ASCVD events after multivariate adjustment in those with persistent CAC=0 at Y25 (HR 1.05, 95% CI: 1.01-1.09). There was a significant association between LDL-AUC
[Y15-25]
and conversion from CAC=0 at Y15 to CAC>0 at Y25 (OR 1.10, 95% CI: 1.05-1.14).

Conclusions:
In young adults with CAC=0, long-term cumulative exposure to LDL-C remains independently associated with a significant increase in ASCVD events and development of future CAC. While the risk of cardiovascular events is low for those with CAC=0, risk is detectable over longer exposure to greater cumulative LDL-C, confirming the continued importance of long-term LDL-C control.
Abstract 4144458: Cardiometabolic Risk during the Venezuelan Humanitarian Crisis: Insights from the EVESCAM Study on Crisis Indicators.
Authors: Nieto-Martinez Ramfis , De Oliveira Gomes Diana , Gonzalez Rivas Juan , Ugel Eunice , DURAN Maritza , Marulanda Maria , Franceschi-Jimenez Luis , mechanick Jeffrey , Danaei Goodarz
Published: November 2024

Introduction:
Social vulnerability is linked to increased cardiovascular morbimortality. Venezuela faces a severe humanitarian crisis –rated 4.2/5 on the INFORM Severity Index-, marked by hyperinflation, healthcare collapse, and mass migration (>7.2 million by 2023), with poverty escalating from 48% in 2014 to 96.2% by 2020. This study aims to examine the association between crisis indicators—food insecurity, stressful life events (SLEs), and family separation—and cardiometabolic risk factors (CMRF).

Methods:
This analysis uses follow-up data (2018-2020) from 1,257 individuals in the Venezuelan Study of Cardiometabolic Health (EVESCAM,2014-2017). The distribution of CMRF (adiposity, dysglycemia, dyslipidemia, anxiety/depression symptoms, diet, physical activity, alcohol intake, and smoking) by three crisis indicators (food insecurity, SLEs—including financial difficulties, accidents, family deaths, health issues, and violence—and family separation) was analyzed. Logistic regression determined the associations.

Results:
Table 1 illustrates the relationship between crisis indicators and CMRF. Food insecurity was prevalent in 60.2% of participants, especially those with low SES, and was associated with higher odds of being underweight (OR:2.0[1.1-3.6]), anxiety (OR:2.9[2.3-3.7]), depression (OR=3.2[2.5-4.1]), and reduced fruit/vegetable intake. SLEs affected 67.2% of participants, linked to higher odds of diabetes (OR:1.6[1.1-2.3]), anxiety (OR: 2.2[1.7- 2.9]), depression (OR: 2.0[1.5- 2.6]), and poor dietary habits. Family separation, with a prevalence of 49.2%, was more common in older adults and females and linked to depression (OR: 1.4[1.1- 1.8]), low adherence to the Mediterranean diet, high triglycerides (OR:1.3[1.01-1.7]), and high risk of a fatal cardiovascular event (OR: 1.6 [1.1 – 2.5]).

Conclusion:
The Venezuelan humanitarian crisis has severely impacted adults, with high prevalence rates of food insecurity, SLEs, and family separation, while increasing CMRF, especially among vulnerable groups. Food insecurity rates in Venezuela were aligned with crisis-hit countries like Yemen. This study underscores the urgent need for targeted interventions to support the most affected populations.
Abstract 4144462: Prevalence and Risk Factors of Peripheral Artery Disease Identified by Multimodalities in Hispanics
Authors: Salameh Maya , Liu Hairong , Ballew Shoshana , Martinez-Amezcua Pablo , Schrack Jennifer , Garcia-Bedoya Olga , Talavera Gregory , Daviglus Martha , Sotres-Alvarez Daniela , Gonzalez Franklyn , Allison Matthew , Kaplan Robert , Matsushita Kuni
Published: November 2024

Introduction:
The prevalence of peripheral artery disease (PAD) has been assessed with the ankle-brachial index (ABI), but some studies have raised concerns about its sensitivity.

Aims:
Using data from a community-based cohort study, the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we estimated the prevalence of PAD in US Hispanics using the toe-brachial index (TBI), pulse volume recordings (PVR), continuous Doppler waveforms, and post-exercise ABI, in addition to resting ABI. We also explored the associations of known risk factors with PAD identified by these methods.

Methods:
The HCHS/SOL sampled Hispanics/Latinos from four US regions (CA, IL, FL, and NY). During its third visit, participants aged ≥45 years were invited for a comprehensive evaluation of PAD. PAD was defined as having at least one of the following: 1) resting ABI ≤0.9; 2) post-exercise (heel-raise) drop in ABI ≥20% or drop in ankle blood pressure ≥30 mmHg; or 3) abnormality in at least two of TBI (≤0.6), PVR (mild or greater abnormality), and continuous Doppler waveforms (monophasic/nonpulsatile in either dorsalis pedis or posterior tibial artery or biphasic without good acceleration in both arteries). Certified technicians conducted the measurements using a vascular diagnostic instrument (the Unetixs MultiLab Series II). Major cardiovascular risk factors were measured according to the standard protocol in HCHS/SOL.

Results:
Among 3,130 participants (mean age 62.9 years, 2121 female [67.8%]), the prevalence of PAD was 4.1% with only resting ABI ≤0.9 but 17.8% considering all modalities. The prevalence of PAD exceeded 22% in participants aged 65+ (Figure) and was similar between men and women. PAD prevalence was significantly higher in Cubans, Puerto Ricans, and Central Americans compared to Mexicans (Figure). The higher prevalence in these ethnic groups remained consistent even after adjusting for traditional risk factors. Among traditional risk factors, smoking, diabetes, and systolic blood pressure were robustly associated with the presence of PAD.

Conclusion:
In this cohort of US Hispanics/Latinos, the prevalence of PAD is substantially higher when multiple modalities are used to detect PAD. Disparities in the prevalence of PAD across ethnic groups in Hispanics could not be explained by traditional risk factors and should be further investigated.
Abstract 4144490: Impact of Transient Conduction Disturbances on Long-term Outcomes Following Transcatheter Aortic Valve Implantation
Authors: okita shogo , Kitahara Hideki , Matsuura Kaoru , Matsumiya Goro , Kobayashi Yoshio
Published: November 2024

Background:
Conduction disturbances (CD) following transcatheter aortic valve implantation (TAVI) are well known as one of the important predictors of poor post-TAVI prognosis. Although persistent CD are evidently associated with poor prognosis, data on transient CD are limited. The aim of this study was to investigate the prognostic impact of transient CD on long-term clinical outcomes after TAVI.

Methods:
Patients with severe aortic stenosis (AS) undergoing TAVI between February 2017 and October 2022 were retrospectively enrolled. CD were defined as any of the following: 2nd- or 3rd-degree atrioventricular block, right or left bundle branch block, and intraventricular CD with QRS duration ≥120 ms. Transient CD were defined as CD that appeared after TAVI but improved either before discharge or within 7 days. Persistent CD were defined as CD that appeared after TAVI and presented at hospital discharge or >7 days after TAVI. The primary endpoint was cardiovascular adverse events (CAE) after discharge, defined as a composite of cardiovascular death, heart failure hospitalization, and new pacemaker implantation.

Results:
Of 412 enrolled patients, transient CD occurred in 81 patients (19.7%), persistent CD in 72 patients (17.5%), and no CD in 259 patients (62.9%). In comparison between the transient and no CD groups, membranous septum length was significantly shorter in the transient CD group (5.0 mm vs. 6.1 mm, p=0.005). For a maximum of 2,000 days follow-up (the median follow-up period was 569 days), the transient CD group showed a significantly higher incidence of CAE compared with the no CD group (18.5% vs. 9.3%, p=0.012) (Figure). Although there was no significant difference in cardiovascular mortality (11.1% vs. 8.5%, p=0.48), the incidence of heart failure hospitalization tended to be higher in the transient CD group (6.2% vs. 2.3%, p=0.091), and new pacemaker implantation was more frequent in the transient CD group (4.9% vs. 0.0%, p<0.001) compared with the no CD group.

Conclusions:
Post-TAVI transient CD were associated with a higher risk of long-term adverse events. Even though CD were transient and no longer present at discharge, careful outpatient follow-up may be necessary after TAVI.
Abstract 4144532: Bivalirudin Reduces Major Bleeding And Cardiovascular Mortality in MI patients Undergoing PCI Compared to Unfractionated Heparin.
Authors: Sharma Anubhuti , Sharma Arundhati , Daid Simranpreet Singh , Sanghvi Urja , Dantuluri Sahitya , Syed Saif , Senthil Velmurugan Isha , seelam Laxmi Priya , Aryal Saurav , Panjiyar Binay
Published: November 2024

Background:
Antithrombotic regimens play a pivotal role in averting complications and ischemic incidents post-percutaneous coronary intervention (PCI) in MI (myocardial infarction) patients. Bivalirudin stands as a viable alternative to unfractionated heparin in this cohort, demonstrating the efficacy and safety profiles.

Aim:
We aimed to compare the efficacy and safety of bivalirudin versus unfractionated heparin in post-percutaneous coronary intervention (PCI) in MI (myocardial infarction) patients.

Research Question :
What is the efficacy and safety of Bivalirudin compared to unfractionated heparin in patients with MI undergoing PCI, specifically in terms of major bleeding, cardiovascular mortality, and other major adverse cardiovascular events?

Methods:
We systematically searched PubMed, including MEDLINE, Embase, Cochrane Library, Google Scholar, ClinicalTrials.gov, and EBSCOhost/CINAHL, from January 1, 2000, through May 29, 2024, for randomized controlled trials (RCTs) that evaluated Bivalirudin versus unfractionated heparin and with a study population of patients with MI undergoing PCI. Data extraction was done using a spreadsheet, and data analysis was done using RevMan 5.4.1 for meta-analysis. The primary efficacy and safety endpoints were major bleeding, major cardiovascular events, cardiovascular mortality, all-cause mortality, myocardial infarction, stent thrombosis, and stroke.

Results:
Our analysis included 11 RCTs, encompassing a total of 40,919 participants. When compared with unfractionated heparin, bivalirudin was associated with a significant reduction in major bleeding events (RR 0.66 [0.55 to 0.80]; p < 0.0001) and cardiovascular mortality (RR 0.79 [0.67 to 0.92]; p < 0.003). However, there were no significant differences between Bivalirudin and unfractionated heparin in terms of major adverse cardiovascular events (RR 1.02 [0.91 to 1.13]; p = 0.76), all-cause mortality (RR 0.89 [0.78 to 1.01]; p = 0.08), MI (RR 0.99 [0.85 to 1.15]; p = 0.90), stent thrombosis (RR 1.12 [0.53 to 2.40]; p = 0.76), or stroke (RR 0.96 [0.73 to 1.26]; p = 0.75).

Conclusion:
Our meta-analysis indicates that in patients with MI undergoing PCI, Bivalirudin is associated with lower rates of major bleeding and cardiovascular mortality compared to unfractionated heparin. However, there were no significant differences observed in major adverse cardiovascular events, all-cause mortality, MI, stroke, or stent thrombosis between the two treatment groups.
Abstract 4144620: Outcomes with Drug-Coated Balloon Versus Drug-Eluting Stents for De-Novo Coronary Artery Disease: A Meta-Analysis
Authors: Jain Hritvik , Odat Ramez , Pervez Neha , Goyal Aman , Jain Jyoti , Patel Nandan , Yadav Ashish , Shah Janhvi , Jha Jagriti , Passey Siddhant
Published: November 2024

Background:
Drug-eluting balloons (DEB) are promising alternatives to drug-eluting stents (DES) for managing de novo coronary artery disease (CAD). Given the scarcity of available data, our objective was to evaluate the outcomes of DES versus DEB in CAD patients.

Methods:
Databases such as PubMed, Embase, Cochrane Library, and Google Scholar were searched to identify studies comparing clinical outcomes between DCB and DES in de novo CAD patients. Using a random-effects model, pooled estimates of the mean difference (MD) and odds ratio (OR) were calculated along the 95% confidence intervals (CI), with statistical significance set at p<0.05.

Results:
The pooled analysis included 19 studies with 3643 de-novo CAD patients (1588: DCB; 2055: DES). DCB was associated with a significantly lower mean lumen diameter at follow-up [MD: -0.27; 95% CI: -0.40, -0.15; p<0.0001] than DES. No statistically significant differences in mean in-stent late lumen loss [MD: 0.14; 95% CI: 0.00, 0.28], cardiovascular mortality [OR: 1.10; 95% CI: 0.57, 2.12], all-cause mortality [OR: 0.79; 95% CI: 0.45, 1.37], myocardial infarction [OR: 0.67; 95% CI: 0.41, 1.10], major adverse cardiovascular events [OR: 1.06; 95% CI: 0.67, 1.68], target lesion revascularization [OR: 1.32; 95% CI: 0.88, 2.00], and stent thrombosis [OR: 0.89; 95% CI: 0.39, 2.05] were noted.

Conclusion:
While the DCB group exhibited a notable decrease in the minimum lumen diameter during follow-up compared to the DES group, no statistically significant differences were observed in other outcomes. Further studies with larger sample sizes are required to confirm this comparison.
Abstract 4144639: Electrocardiographic Right Ventricular Hypertrophy As a Predictor of Mortality in Mitral Transcatheter Edge-to-Edge Repair
Authors: Wangmang Felix , Richards Donald , Dhillon Manvir , Torbati Tina , Shechter Alon , Kaewkes Danon , Patel Vivek , Koren Ofir , Skaf Sabah , Makar Moody , Chakravarty Tarun , Makkar Raj , Mirocha James , Siegel Robert , Chonde Meshe , Chyu Kuang-Yuh
Published: November 2024

Background:
M-TEER is an option for patients with severe mitral regurgitation (MR). Long-standing severe MR may lead to RVH; however, the clinical significance of RVH on ECG in patients undergoing M-TEER in relation to mortality is not known.

Methods:
A single-center, observational, prospective cohort of 443 adults with severe MR and a representative ECG from within 12 months prior to procedure date who underwent M-TEER between January 2018 and July 2020 was analyzed. Patients were assessed for paced rhythm (n=109), RAD only (n=28), and RVH (n=23) diagnosed by expert consensus. The rest of patients (n=283) served as control group. All-cause in-hospital mortality was evaluated as the primary outcome using log binomial regression models. The secondary outcome was one-year mortality calculated with multivariate Cox regression models.

Results:
The prevalence of electrocardiographic RVH is low (5.2%). RVH was associated with increased in-hospital mortality (RR 6.15, 95% CI 1.64-23.01, p 0.007, Table 1). A total of 71 (16%) patients experienced a one-year mortality (Figure). Several variables including RVH, RAD, a history of smoking, and prior cardiogenic shock were identified as each having association with one-year mortality. A multivariable analysis adjusting for these covariates demonstrated that RVH still was associated with increased one-year mortality (HR 2.53, 95% CI 1.06-6.03, p 0.036, Table 2). Paced rhythm on ECG was not associated with in-hospital mortality or at one-year.

Conclusions:
Electrocardiographic RVH is associated with an increased risk of in-hospital and 365-day mortality in patients with severe MR undergoing M-TEER.
Abstract 4144697: Cardiac outcomes with different types of Heart Failure in Polycythemia vera: Analysis from National Inpatient Sample
Authors: Modi Karnav , Mahadevia Himil , Modi Ronak , Bavishi Shriya , Vodnala Deepthi , Khumri Taiyeb , ASIF TALAL
Published: November 2024

Background:
Previous studies have shown poor outcomes in Polycythemia vera (PV) patients (pts) with comorbid heart failure (HF). Given lack of data, we studied the role of systolic heart failure (SHF), and diastolic heart failure (DHF), with and without acute exacerbation in PV pts from a national database.

Methods:
Using National Inpatient Sample 2019-21, we identified all pts with PV. They were further reclassified into 4 different study populations depending on type of HF. This included MM pts with and without acute SHF, chronic SHF, acute DHF, and chronic DHF. In each study population, we excluded those with any other type of comorbid HF. Outcomes were compared using Pearson’s chi-square test and multivariate regression analysis.

Results:
65780 had PV. Among them 5.2% (n=3425) had only acute SHF, 4.2% (n=2750) had chronic SHF, 6.6% (n=4315) had acute DHF, and 5.9% (n=3895) had chronic DHF. Those with acute SHF had significantly higher odds of mortality (adjusted odds ratio (aOR) 1.7, p=0.002), cardiogenic shock (CS) (aOR 6.6, p<0.001), acute myocardial infarction (MI) (aOR 4.2, p<0.001), and similar odds of cardiac arrest (CA) (aOR 1.6, p=0.116). Those with chronic SHF had similar odds of mortality (aOR 0.8, p=0.237), CS (aOR 1.3, p=0.472), acute MI (aOR 0.7, p=0.07) and CA (aOR 0.7, p=0.455). Similarly, those with acute DHF had similar odds of mortality (aOR 0.9, p=0.5), CS (aOR 1.1, p=0.745), acute MI (aOR 1.3, p=0.069) and CA (aOR 0.9, p=0.878). Those with chronic DHF also had similar odds of mortality (aOR 0.9, p=0.444), and CA (aOR 1.4, p=0.301), and lower odds of CS (aOR 0.3, p=0.039), and acute MI (aOR 0.6, p=0.001). Please refer Table 1 for rates of complication (Pearson’s chi-square).

Conclusion:
Among different types of HF in PV pts, acute SHF is associated with higher odds of mortality and even significantly higher odds of cardiac complication like CS (560%), acute MI (320%). All other types of HF including chronic SHF, acute DHF and chronic DHF showed similar odds of mortality and similar or even lower (for chronic DHF) odds of cardiac complications. This data helps guide timing for cardiology consultation and need for care escalation depending on HF type in PV.