bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144738: Change in Valve Function During Pediatric Heart Transplant Graft Rejection May Shed Light on Immunosuppressive Strategies for Partial Heart Transplantation
Authors: Gearhart Addison , Dafflisio Gianna , Lipsitz Stuart , Emani Sitaram , Singh Tajinder
Published: November 2024

Introduction:
Partial heart transplant (HT), the transplantation of living/growing heart valve implants, has emerged as a novel solution for children with complex CHD and semilunar valve dysfunction. Management of immune suppression following partial HT is unclear, and may be aided by understanding how valve function changes during full HT graft rejection.

Aims:
To compare semilunar and atrioventricular (AV) valvular function before and during biopsy-proven rejection by echocardiogram imaging in pediatric HT recipients.

Methods:
Single institution retrospective study including all pediatric HT recipients during 2005-2023 with biopsy diagnosed rejection, a preceding biopsy with no rejection (baseline), and available echo within 24 hours of each biopsy. All echos were reviewed by a pediatric imaging cardiologist to qualitatively grade valvular and ventricular function. Change in valvar/ventricular function was assessed by McNemar’s and Fischer’s exact tests.

Results:
The cohort comprised 87 patients (43.7% female, mean age 14.2 years [SD +/-6.5], 60% with acute cellular rejection and 40% with antibody mediated rejection, median time between baseline and rejection diagnostic biopsy/echo pairs 6.5 months [SD +/-3.9]). At baseline, 99% of patients had no/mildly depressed left and right ventricular systolic function. During rejection 18%(17) patients had progressed to moderate or greater LV dysfunction and 15%(13) had moderate or greater RV dysfunction (p-value <0.001 for both). There were no instances of aortic, pulmonary, mitral, or tricuspid stenosis. No patients had more than trivial aortic regurgitation (AR) at baseline or during rejection. At baseline 1%(1) of patients had mild PR versus 6%(5) during rejection (p=0.103). The proportion of those with mild or greater MR increased from 17% at baseline to 39% during rejection (p=0.0003). Worse MR during rejection was seen in a higher proportion of those who developed > mild LV dysfunction during rejection compared to those who did not (82% vs. 22%, p<0.001). Those with mild or more TR increased from 39% to 52% during rejection (p=0.068).

Conclusion:
There was no significant semilunar valve dysfunction during graft rejection in pediatric HT recipients using contemporary immune suppression. This suggests that less immunosuppression may be sufficient to preserve the longevity of semilunar valve transplants. Mitral valve dysfunction was worse during rejection, but was related to LV dysfunction and warrants further study.
Abstract 4144742: Outcomes of a modified Frozen Elephant Trunk technique with debranch first in acute and chronic aortic arch disease
Authors: Montella Antonio Pio , d'oria veronica , Miele Mario , Masiello Paolo , Mastrogiovanni Generoso , Rubino Antonino Salvatore , de santo luca , De Feo Marisa , Iesu Severino
Published: November 2024

Introduction:
Although Frozen Elephant Trunk has emerged as a valuable technique in aortic arch pathology it is still burdened by a high mortality and morbidity rate due to the technical complexity and clinical and anatomical substrates.

Research Questions:
Evaluation of early hard outcomes in a surgical approach encompassing the following : 1) central cannulation of the right subclavian artery or the right axillary artery; 2) debranch-first approach (selective cannulation of left common carotid artery with single 8-mm dacron graft and the left subclavian artery for cerebral perfusion with single 10-mm dacron graft); 3) central venous cannulation of right atrium; 4) use of a home-made 4-branched perfusion circuit for extracorporeal circulation; 5) brachiocephalic artery clamping at 26–28°C and beginning of selective antegrade perfusion. The aortic arch is opened and the distal stent graft of the hybrid prosthesis is released into the descending thoracic aorta. The strengthened collar of the prosthesis is sutured to the aorta, and, after cannulation of the fourth lateral branch, systemic perfusion is resumed. The anastomosis between the hybrid prosthesis and sino-tubular junction is then completed and the cross-clamp is released. The prosthesis-elongated supra-aortic vessels are then termino-terminally re-anastomosed to the corresponding branches of the hybrid prosthesis.

Methods:
Retrospective analysis of a prospectively collected database including 167 patients referred for FET (55 %acute aortic dissections, 14.5% chronic aortic dissections, and 30.5% extended aneurysms, 67% males, 9.2% diabetes mellitus, 72% arterial hypertension, 8.2% chronic renal failure, 12% peripheral vasculopathy, 3% bicuspid aortic valve, 11.9% redo)

Results:
The average cardio-pulmonary bypass time, crossclamp time, cerebral and visceral perfusion time is 192, 102, 29 and 12 minutes, respectively. In-hospital mortality occurred in 16% (44% due to respiratory failure), spinal cord injury in 2.8% and stroke in 3.5% of patients.

Conclusion:
Debranch-first technique and cerebral protection through the trivascular perfusion strategy appear safe and effective in the treatment of complex arch pathology.
Abstract 4144749: Evolving Trends and Outcomes of P2Y12 Inhibitor Pretreatment in Non-ST-Elevation Acute Coronary Syndrome in the United States: Insights from the NCDR Chest Pain-MI Registry
Authors: Ueyama Hiroki , kennedy kevin , Rymer Jennifer , Sandhu Alexander , Kuno Toshiki , Masoudi Frederick , Spertus John , Kohsaka Shun
Published: November 2024

Background:
Although high rates of P2Y12 inhibitor pretreatment for non-ST-elevation acute coronary syndrome (NSTE-ACS) have been reported, contemporary practice pattern in the U.S. are not well studied.

Objectives:
To investigate the temporal trends, variability, and clinical outcomes of P2Y12 inhibitor pretreatment in NSTE-ACS across U.S.

Methods:
Consecutive patients that underwent early invasive strategy for NSTE-ACS (coronary angiogram ≤ 24 hours of arrival) in National Cardiovascular Data Registry (NCDR) Chest Pain-Myocardial Infarction (MI) registry was analyzed. Initially, a time-trend analysis was conducted on the complete cohort from January 1, 2013, to March 31, 2023. Subsequently, a more recent cohort (January 1, 2019, to March 31, 2023), with a complete set of variables, was used to construct a hierarchical regression model to quantify variability in the use of pretreatment among institutions and hospital regions. For this contemporary cohort, instrumental variable analysis was performed to compare in-hospital outcomes between patients who received pretreatment and those who did not.

Results:
Use of P2Y12 inhibitor pretreatment has decreased from 24.8% in 2013Q1 to 12.4% in 2023Q3. Among the contemporary cohort of 110,148 patients (2019-23; mean age, 63.9 [SD 12.5] years; 33.0% female), 17,509 (15.9%) received pretreatment. Significant variability in P2Y12 inhibitor pretreatment was observed (range: 0-100%): hierarchical regression model demonstrated that two identical patients would have more than a three-fold difference in the odds of pretreatment by changing institution or hospital region (OR 3.63; 95% CI, 3.51-3.74 and 3.21; 95% CI, 2.90-3.54, respectively). Instrumental variable analysis demonstrated no significant differences in in-hospital all-cause death (1.5% vs 1.7%; p=0.071), recurrent MI (0.56% vs 0.57%; p=0.98), or major bleeding (2.7% vs 2.8%; p=0.98) between the two groups. However, in patients who underwent coronary artery bypass surgery, pretreatment was associated with a longer length of stay (11.2 ± 5.1 days vs 9.8 ± 5.0 days; p < 0.001).

Conclusions:
Within the nationwide registry in the U.S., we observed a significant variability in the use of P2Y12 inhibitor pretreatment among NSTE-ACS patients in the U.S. Given the lack of clear advantages and the potential for prolonged hospital stays, our findings highlight the importance of efforts to improve standardization.
Abstract 4144762: Fear of Recurrence in Acute Myocardial Infarction Survivors
Authors: Zvonar Sarah , Reyes Andrew Thomas , Benning Stephen , Kawi Jennifer , Serafica Reimund
Published: November 2024

Background:
Each year, millions of people worldwide experience cardiovascular events, including acute myocardial infarctions (AMIs). Surviving an AMI can result in psychological sequelae, including negative illness perceptions, fear of recurrence, and perceived stress, that may interfere with survivors’ recovery, individually influencing their physical, emotional, and cognitive outcomes. Though influential, little is known about the individual relationships between these variables in persons who have experienced an AMI.

Purpose: This study examined the relationships between illness perceptions, fear of recurrence, and perceived stress in AMI survivors. Also examined were predictors of fear of recurrence and perceived stress, changes in fear of recurrence over time, and effects of anxiety or depression.

Methods:
We used a repeated measures descriptive design to evaluate relationships with the brief illness perception questionnaire, the fear of progression questionnaire, perceived stress scale, and the depression, anxiety, and stress scale (N =171). Additionally, we examined the relationship between participant demographics and modifiable risk factors such as diet, exercise, and smoking. Our hypotheses were tested via multiple linear regression and mediation modeling.

Results:
Fear of recurrence was a significant mediator of the relationship between illness perceptions and perceived stress in AMI survivors [
F
(2,168) =43.31,

R
2

=0.34,
p
<0.001]. Fear of recurrence did not decrease over time (M=68.45, SD=21.72), and was still a significant mediator of illness perceptions and perceived stress, after controlling for depression and anxiety [B = 0.09, SE = 0.05,
t
(166) = 2.03,
p
= 0.044]. The regression models identified age and race as significant predictors of fear of recurrence. Alcoholic beverage intake was a significant predictor of both fear of recurrence and perceived stress.

Conclusions:
Providers should be aware that fear of recurrence is a separate symptom from anxiety and/or depression and should be evaluated separately. Fear of recurrence and the relationships with illness perceptions and perceived stress suggest that psychological sequelae may interfere with adaptive coping and health behaviors and should be further explored.

Keywords: Fear of Recurrence, Acute myocardial infarction, illness perception, perceived stress
Abstract 4144790: Impact of Prolonged PR Interval on Recurrence of Atrial Fibrillation after Catheter Ablation: A Systematic Review and Meta-analysis with Reconstructed Time-to-Event Data.
Authors: Amin Ahmed Mazen , Manasrah AlMothana , Modi Karnav , Khassawneh Abdo-rahman
Published: November 2024

Background:
A prolonged PR interval has been demonstrated as a predictor of increased risk for incident atrial fibrillation (AF), coronary artery disease, heart failure, and pacemaker implantation.

Purpose:
We aim to investigate the impact of prolonged PR interval > 200 ms on AF recurrence after catheter ablation.

Methods:
We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through May 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1.

Results:
With the inclusion of four studies, our cohort comprised a total of 2,790 patients. Regarding pair-wise meta-analysis, PR interval > 200 ms was significantly associated with an increased incidence of AF recurrence compared to PR interval ≤ 200 ms (RR: 1.50 with 95% CI [1.33, 1.70], P< 0.01). Regarding adjusted prognostic meta-analysis, PR interval > 200 ms was significantly associated with a 92% increase in the risk of AF recurrence compared to PR interval ≤ 200 ms (HR: 1.92 with 95% CI [1.61, 2.30], P< 0.01). Our reconstructed Kaplan Meier showed that a PR interval > 200 ms was significantly associated with a 65% increase in the risk of AF recurrence compared to a PR interval ≤ 200 ms (HR: 1.65 with 95% CI [1.42, 1.92], P< 0.00001) over 120 months follow-up.

Conclusion:
Our meta-analysis concluded that a prolonged PR interval greater than 200 ms is a significant predictor of AF recurrence after catheter ablation, reflecting atrial remodeling, and since the PR interval can be easily measured by a surface 12-lead ECG, patients with a prolonged PR interval may require additional treatment strategies.
Abstract 4144793: Pulmonary Thromboendarterectomy in a Developing Country: Clinical and Hemodynamic Outcomes and Predictors of Hospital Mortality
Authors: Campos Frederico Thadeu , Bernardes Rodrigo , MARINO MARCOS , Marino Roberto Luiz , Guimaraes Virginia , Junior Carlos Alberto , Andrade Susan , Leucas Paula , Nascimento Bruno
Published: November 2024

Introduction:
Pulmonary thromboendarterectomy (PTE) is the definitive therapy for chronic thromboembolic pulmonary hypertension (CTEPH). Outcomes are highly dependent on local expertise and volume. We aimed to describe clinical and hemodynamic outcomes of patients with CTEPH undergoing PTE in a developing country, and to assess predictors of mortality.

Methods:
Single-center observational study, with prospective data collection of consecutive patients with symptomatic CTEPH who underwent PTE in a high-volume PH center in Brazil. Clinical and demographic variables were systematically collected by the Pneumology team. Hemodynamic data were collected in the right heart catheterization, prior to PTA, and in the post-procedural Swan-Ganz monitoring. Echocardiography (echo) was performed pre procedure and in the earliest available follow-up. Hemodynamic variables of interest were invasive mean pulmonary artery mean pressure (PAPm), cardiac index (CI) and pulmonary vascular resistance (PVR), and systolic pulmonary artery pressure (SPAP) on echo, compared pre and post-surgery. The outcome of interest was in-hospital mortality, and significant predictors in bivariate analysis were included in multivariate regression models.

Results:
At total 64 patients underwent CTEPH, 37 (58%) women, mean age of 51±14 (range 23-78) years. All but 13 patients had documented acute pulmonary embolism, and 13 (20%) had deep vein thrombosis. Functional class was NYHA 3 or 4 in 38 (59%) cases, and mean NT-ProBNP was 1182±1642pg/ml. Compared to baseline, PAPm (51.9 ± 17.0 vs. 28.5 ± 8,6 mmHg, p<0.001), PVR (11.5 ± 5.3 vs. 4.7 ± 3.7 UWood, p<0.001) and SPAP (87.4 ± 22.1 vs. 57.5 ± 18.5 mmHg, p<0.001) decreased significantly in the post-procedural evaluation, with a parallel increase in CI (2.4±1.0 vs. 3.0±0.7 L/min/m
2
, p=0.039). In the late port-surgical echo, SPAP remained similarly low (54.1 ± 22.1 mmHg, p=0.46). In-hospital mortality occurred in 11 (17.2%) individuals, and the most frequent non-fatal complication was infection (N=5). Patients who died were more frequently women, had higher NT-ProBNP levels and higher post-operative PVR. The only independent predictor of mortality among the available variables was female sex: OR=9.6 (95% CI 1.5 – 80.7), p=0.03, in the age-adjusted model.

Conclusion:
PTE resulted in significant and long-standing hemodynamic improvement among patients with CTEPH. The growing multidisciplinary experience tend to improve hard clinical outcomes.
Abstract 4144801: Risk Assessment for Cardiac Adverse Events with Bruton’s Tyrosine Kinase Inhibitors in Patients with Mantle Cell Lymphoma
Authors: Ali Abdelrahman , Ynalvez Leslie , Song Juhee , Koutroumpakis Efstratios , Ali Hyeon-Ju , Khalaf Shaden , MENDOZA KEILA , Yusuf Syed , Palaskas Nicolas , Iliescu Cezar , Jain Preetesh , Deswal Anita
Published: November 2024

Introduction:
Bruton’s tyrosine kinase inhibitors (BTKi) have significantly advanced treatment of mantle cell lymphoma (MCL). This study evaluates the incidence and risk factors for cardiovascular adverse events (CVAEs) in MCL patients receiving BTKi, correlating CVAEs with risk stratification by the European Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS).

Methods:
In this retrospective study, demographic and clinical variables, and CVAEs were extracted from clinical records of MCL patients treated with BTKi. Patients were stratified into low, medium, high, and very high-risk groups using the HFA/ICOS tool. Exposure time, from BTKi initiation to 90 days post-treatment, was expressed per 100 person-years. The incidence rate (IR) of CVAEs included palpitations, arrhythmias, blood pressure medication initiation, heart failure, coronary artery disease, stroke, CVAE-related hospitalizations, bleeding, and death. Cox regression models analyzed the association of clinical and demographic characteristics with CVAEs.

Results:
We included 298 patients (85% untreated, 15% relapsed MCL), median age 65.6 years (IQR 57.6-71.5), predominantly White males (92%, 79%). Comorbidities at BTKi initiation included hypertension (44%), hyperlipidemia (37%), diabetes (11%), and history of atrial fibrillation (AF, 8%), with 2% having AF at therapy initiation. Median left ventricular ejection fraction was 60% (IQR 57-63) and the left atrial volume index 24.6 ml/m
2
(IQR 19.0-30.3). Ibrutinib was used in 60% and second-generation BTKis in 40%. Over a median BTKi exposure of 1 year (range 0.06-8.34), 99 subjects experienced AEs with an IR of 20.8 per 100 person-years. HFA/ICOS low-risk patients had the lowest IR (16.7/100 person-years, 95% CI 6.1-32.5), and the very high-risk group the highest IR (31.9/100 person-years, 95% CI 19.2-47.8). Seventeen patients (5.7%) developed new-onset AF, 7.2% on Ibrutinib and 4.3% on second-generation BTKi. Independent predictors of CVAEs included a history of AF (HR 1.80, 95% CI 1.01-3.22; p=0.047) and prior BTKi exposure within 90 days (HR 3.67, 95% CI 1.77-7.59; p<0.001).

Conclusions:
Patients with a history of AF were at higher risk for CVAEs when treated with BTKi for MCL. The HFA/ICOS risk tool identified MCL patients at the highest risk for CVAEs with BTKi, highlighting the need for tailored monitoring strategies to optimize patient care and resource utilization.
Abstract 4144860: Sleep Duration as a Potential Modifiable Risk Factor in the Management of Clinical Depression among Patients with Cardiovascular Disease
Authors: Abbasi-Kangevari Mohsen , Jaka Sanobar , Shah Tanmik , Anzai Nicole , El-Shahawy Omar
Published: November 2024

Background:
Sleep duration has emerged as a potential modifiable risk factor influencing both cardiovascular disease (CVD) and mental health outcomes. This study aimed to assess the prevalence of clinical depression among participants with CVD, examine sleep duration, and assess the association between sleep duration and clinical depression.

Methods:
We used data from six waves of the Behavioral Risk Factor Surveillance System (BRFSS) with available sleep assessments (2013, 2014, 2016, 2018, 2020, 2022). We restricted the analyses for people reporting having CVD, with the final analytical sample including 319,470 adults. We used two sets of guidelines to categorize sleep based on its duration: A) normative (7-9 hours), short (<7 hours), and long (≥9 hours); and B) Inadequate sleep (<6 hours/day) versus adequate (≥6 hours/day). Weighted multivariate logistic regression was used to assess the association of clinical depression with sleep duration among people with CVD.

Results:
Participants were mostly male (55.3%) and white (69.4%). Among the whole sample (N=319,470), 85,547 (28.5%) were diagnosed with clinical depression. Regarding sleep duration, 179,407 (54.1%) participants reported normative duration, 110,921 (38.9%) participants reported short duration, and 21,932 (7%) reported long duration. When examining sleep adequacy, 208,549 (61.9%) were classified as having adequate sleep, while 110,921 (38.1%) had inadequate sleep. Compared to those with normative sleep duration, both, participants with short and long sleep duration were more likely to have clinical depression (Adjusted Odds Ratio (aOR) =1.5, p<.001; aOR=1.7, p<.001 respectively). Additionally, participants with inadequate sleep were more likely to have clinical depression (aOR=1.37, p<.001) compared to those with adequate sleep.

Conclusion:
Regardless of the guidelines followed to categorize healthy sleep duration (whether 6 or 7 hours/day for adults) there was a significant association between insufficient sleep and clinical depression among people with CVD. Interventions aimed at improving sleep duration could play a vital role in the mental health wellbeing of individuals with CVD. This vulnerable population, having dual burden of clinical depression and CVD were more likely to experience inadequate sleep that may lead to poor treatment outcomes. Further research is needed to quantify the impact of sleep duration and outcomes on the co-morbidity of CVD and depression.
Abstract 4144863: Impact of Phone Outreach and In-Person Education on Blood Pressure Control in Black Patients with Severe Hypertension at a Federally Qualified Health Center (FQHC)
Authors: Ashar Perisa , Allen Jada , Gupta Rohan , Haque Huda , Johnson Camryn , Metz Caroline , Nguyen Jennifer , Sai Ashna , Tharakan Anna , Wang Eric , Wang Velda , Yoon Elliot , Burnette Marcie , Biola Holly , Granger Bradi
Published: November 2024

Introduction:
Black Americans are 30% more likely to have hypertension (HTN), and they experience 4-5 times greater HTN-related mortality as compared to White Americans. Despite the higher risk, Black patients have lower blood pressure (BP) control than White patients. These disparities can be addressed through improved engagement and self-monitoring of BP (SMBP).

Hypothesis: We hypothesize that telephonic outreach with in-person educational interventions will promote BP control in Black patients with HTN.

Methods:
We conducted a pre-post single cohort study targeting minority patients with uncontrolled HTN (systolic BP [SBP] > 160 mmHg and/or diastolic BP [DBP] > 100 mmHg) in an FQHC. Trained students conducted telephone outreach to bring HTN awareness to 291 patients. In-person classes provided education about lifestyle modifications (exercise, nutrition, and medication compliance), distributed BP cuffs, and taught patients SMBP. Patient engagement, interest in classes, BP recordings before and after telephonic outreach, and in-person class attendance were analyzed.

Results:
From 291 patients, 149 (51.2%) were reached (Figure 1). Among patients who engaged with the entire call (n=137, 91.9%), 71 (77.2%) expressed interest in attending classes. Significant reductions in SBP (170.47 mmHg to 139.94 mmHg, p<0.001) and DBP (97.15 mmHg to 83.21 mmHg, p<0.001) were observed post-telephonic outreach (n=34) (Figure 2). Of the 24 patients who attended in-person classes, 12 (50%) responded to telephonic outreach and demonstrated increased continuity with follow-up primary care visits. During their first class, 18 (75%) patients did not own a BP cuff.

Conclusions:
Telephonic engagement is associated with improved BP and greater class attendance, but barriers to in-person attendance remain. Providing BP monitors and integrating digital education resources could improve engagement and outcomes for high-risk Black patients.
Abstract 4144897: Complex Pathogenesis and Clinical Presentations of Pediatric Infectious Endocarditis in the Modern Era
Authors: Rosenberger Paul , Tsuda Takeshi , Kakavand Bahram , Bhat Abdul , Tadeo Danilo
Published: November 2024

Background:
Infective endocarditis (IE) can induce serious acute and chronic impacts on the cardiovascular system in children. Congenital heart disease (CHD) is a common predisposing factor, but IE can occur without CHD, suggesting its complex pathogenesis.

Methods:
A retrospective chart review was performed for patients with an admission diagnosis of IE. Demographic data, clinical manifestations, isolated organisms, treatment, and outcomes were studied.

Results:
A total of 76 IE cases were divided into unrepaired CHD (13), repaired CHD (31), and non-CHD (32) (Table 1). There was no significant difference in age or sex between the three groups. Although a majority of the patients presented with nonspecific symptoms, a high incidence of thromboembolic events was noted in the Non-CHD group. Five patients with repaired CHD had DiGeorge syndrome. Overall,
Staphylococcus aureus (S. aureus)
was the most common organism; a high incidence of methicillin-resistant
S. aureus
was noted only in the Non-CHD group. Surgical intervention and hospitalization days were comparable between the groups. Recurrence was noted only in 2 cases. In 13 patients with thromboembolic events at presentation, vegetations were identified in the right (7), left (2), and both (2) sides of the heart (Table 2). Embolic events were noted as pulmonary embolism (5), arthritis/osteomyelitis (5), stroke (2), liver abscess (1), and renal embolism (1). Two patients developed an embolism in both pulmonary and systemic circulation. There were 5 total deaths, 3 of which occurred in the Non-CHD group. Two of these deaths in the Non-CHD group were directly attributable to embolic strokes from IE.

Conclusions:
Distinct clinical pictures of IE were identified with and without underlying CHD. The IE without CHD was characterized by a high incidence of thromboembolic events and mortality rate. The pathogenesis and clinical presentation of IE has become more diverse due to more advanced and comprehensive medical treatment.
Abstract 4144926: Central Sleep Apnea with Ticagrelor in Patients with Coronary Syndrome; A Meta-Analysis.
Authors: Shrestha Abhigan , Mainali Nischal , Rajak Kripa , Goyal Aman , Acharya Bimarsh , Yadav Randhir
Published: November 2024

Background:
Sleep apnea is characterized by cessation of breathing during sleep. It is often prevalent among patients with cardiovascular disorders. Ticagrelor, an anti-platelet drug, can have significant implications on the health of a patient. It is suspected to have potential impacts on sleep including sleep apnea. However, the extent of the association between ticagrelor and sleep apnea is unclear.

Hypothesis:
This meta-analysis evaluates the association between ticagrelor and the association of sleep apnea compared to placebo.

Method:
We systematically searched for relevant articles published until March 2024, on PubMed, Google Scholar and Embase. Odds ratios (OR) were pooled using the random-effects DerSimonian-Laird model, and a p-value of <0.05 was considered statistically significant.

Result:
A total of four observational studies were included in the analysis.

The use of ticagrelor was associated with increased odds of sleep apnea [OR 4.16, (95% CI: 2.63-5.70), I
2
=0.00% p=0.00] with statistical significance.

Conclusion:
The use of ticagrelor is associated with a significant increase in the risk of sleep apnea compared to placebo. Thus, there should be careful consideration of the risk of sleep apnea when prescribing ticagrelor. Despite these findings, further large-scale studies are warranted to justify these results in larger sample sizes.
Abstract 4144961: Validation of Right Ventricle and Pulmonary Artery Decoupling via Non-Invasive and Invasive Measurements in Pulmonary Arterial Hypertension: Significance and Considerations for Early Detection and Prognostic Stratification
Authors: Hiraide Takahiro , Tsuruta Hikaru , Murata Mitsushige , Ieda Masaki
Published: November 2024

Backgrounds:
The ratio of tricuspid annular plane systolic excursion over the estimated pulmonary artery systolic pressure (TAPSE/PASP) has shown as a parameter of coupling between right ventricle and pulmonary artery. Despite its importance, the accuracy of estimating PASP in echocardiography and the diagnostic/prognostic value of TAPSE/PASP are not fully understood.

Methods:
We examined 697 pairs of right heart catheterization and echocardiography performed in 264 patients who were suspected to have pulmonary arterial hypertension (PAH). We excluded the data of echocardiogram with no TR (n = 6). The correlation of PASP measured by right heart catheterization and echocardiography was analyzed according to the severity of tricuspid regurgitation (TR). The accuracies of predicting the presence of PAH by TAPSE/PASP were examined by receiver operating characteristic (ROC) curve analysis. The severity of TAPSE/PASP was categorized in three groups according to the current guideline (low: < 0.19, intermediate: 0.19 - 0.31, high: > 0.31 mm/mmHg), and the association between TAPSE/PASP and composite prognosis of cardiovascular death or lung transplantation was evaluated by Kaplan-Meier analysis.

Results:
At baseline, median age was 57 [interquartile range: 42, 71], 188 (71.2%) of the patients were female, median TRPG was 50.7 [35.0, 69.3] mmHg, median TAPSE was 18.0 [14.9, 23.0] mm, and median mean PAP was 34 [21, 46] mmHg. Trivial TR was identified in 159 (23.0%) echocardiography, and PASP was likely to be underestimated in patients with trivial TR (panel A). TAPSE/sPAP was inversely correlated with pulmonary vascular resistance (panel B), and ROC curve analysis demonstrated that TAPSE/PASP 0.55 was the best threshold in predicting the presence of PAH, but the threshold was higher in trivial TR (panel C). The Kaplan-Meier analysis demonstrated that patients whose TAPSE/PASP were under 0.19 mm/mmHg had significant worse prognosis in contemporary intensive treatment of pulmonary vasodilators (panel D).

Conclusions:
PASP measured by echocardiography is an accurate noninvasive parameter to estimate the hemodynamics and prognosis in patients with PAH. Since the trivial TR may underestimate the PASP, presence of other echocardiographic signs of PAH should be evaluated especially in patients with trivial TR.
Abstract 4144988: Association of Neutrophil-Lymphocyte Ratio with All-Cause Mortality and Cardiovascular Mortality in Patients Receiving Peritoneal Dialysis: A Systematic Review and Meta-Analysis
Authors: Mourad Denise , Damarlapally Nanush , Vempati Roopeessh , Vasudevan Srivatsa Surya , Banda Prathibha , Polamarasetty Harshavardhan , Khan Afrasayab , Mathur Gaurav , Desai Rupak
Published: November 2024

Background:
The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker predicting cardiovascular mortality (CVM) and all-cause mortality (ACM) among the general population. We aim to investigate this association in patients who underwent peritoneal dialysis (PD).

Methods:
We systematically reviewed articles from PubMed, Google Scholar, and Scopus until May 2024 on the association of ACM and CVM in patients with NLR following PD. We used a fixed effects model, 95% confidence intervals (CI), and I
2
statistics to pool unadjusted and adjusted hazard ratios (HR) and measure heterogeneity. Leave-one-out sensitivity analysis was employed to study how each study alters the overall effect of the studies. Multivariate meta-regression was utilized to identify influencing confounding factors. Quality assessment of the studies was done through the Joanna Briggs Institute (JBI) tool. For all results, a P value < 0.05 was considered significant.

Results:
Out of 160 articles screened, seven studies spanning from 2011 to 2023 with 4,350 patients, a mean age of 49.9 ± 15, and a median follow-up of four years were included in our meta-analysis. We found that higher NLR (>2.88) was significantly associated with ACM (aHR: 1.09, 95% CI: 1.05–1.12, p<0.0001) (Fig. 1a) and CVM (aHR: 1.08, 95% CI: 1.03–1.13, p=0.002) (Fig.1b) in patients following PD. Sensitivity analysis showed no variations, indicating that no single study influenced the overall results. JBI tool scores revealed low bias among the studies. Multivariate meta-regression revealed a significant relationship between age and ACM outcomes (Coefficient: 0.14, 95% CI: 0.001–0.2905, p=0.04) (Fig.1d).

Conclusion:
Our meta-analysis identifies a significant association between higher NLR (>2.88) and outcomes such as ACM and CVM. This association can help prevent deaths in the older population and encourage proper utilization of the elderly resources. Additionally, age was a significant potential confounder for ACM in patients who are receiving PD. Thus, caution should be taken when predicting mortality in the elderly population.
Abstract 4145033: Trends in-hospital mortality and 90-day outcomes in cardiac implantable electronic device management amongst patients with and without ERSD, a national analysis
Authors: Anand Reddy Maligireddy , Golemi Lolita , Rojulpote Chaitanya , Frick William , Ghosh Somshukla , Siebert Jason , Khan Ali , Saraf Rabya , Patil Shivaraj , Lin Chien-Jung , Mikhalkova Deana , Ierovante Nicholas , Mar Philip
Published: November 2024

Background:
Cardiac implantable electronic device (CIED) infections pose risks, with outcomes potentially influenced by underlying comorbidities such as end-stage renal disease (ESRD).

Objective:
To evaluate the differences in clinical outcomes of CIED-infection management between patients with and without ESRD.

Methods:
From 2016 to 2020, we employed the National Readmission Database to identify patients ≥18 years of age who were admitted with CIED-related infections. CIED/lead extraction was defined as a composite of extraction of device, with or without revision or replacement in index hospitalization. Patients were stratified based on ESRD status.

Results:
Patients with ESRD had a higher rate of mortality in index hospitalization than no-ESRD (14.82%, vs 5.95%, p<0.001). CIED-related infection was the leading cause of readmission in both groups (40.7% vs 79.5%). 90-day readmission mortality (6.5% vs. 3.7%, p=0.458) and hospital readmission rates (1.09% vs 1.46%, p=289) were comparable between ESRD vs no- ESRD patients. ESRD patients had longer length of stay (29.5 vs. 16.8 days, p<0.001) and higher total charges ($559185 vs. $317353, p<0.001). Over a 5-year period, CIED extraction rates remained unchanged, with no improvement in its associated mortality (p=0.805).

Conclusion:
CIED-related infections in ESRD patients have nearly a 3-fold increase in mortality during index hospitalization but no significant differences were observed during a 90-day mortality.
Abstract 4145070: Genetic and Family Analysis of Probands with Peripartum Cardiomyopathy and Dilated Cardiomyopathy and Their First-Degree Relatives
Authors: Kransdorf Evan , Jain Rashmi , Kinnamon Daniel , Jordan Elizabeth , Ni Hanyu , Hershberger Ray
Published: November 2024

Introduction:
Peripartum cardiomyopathy (PPCM) presents as left ventricular systolic dysfunction (LVSD) during pregnancy or the post-partum interval. The underlying cause of PPCM remains incompletely defined, with hypotheses suggesting either pregnancy-related environmental (e.g., hormonal, hemodynamic) cause or genetic cause similar to dilated cardiomyopathy (DCM).

Hypothesis:
If PPCM results principally from pregnancy-related environmental cause, then first-degree relatives (FDRs) of women with PPCM will have lower risk of DCM than FDRs of women with DCM because they cannot share this risk. Conversely, if DCM genetics underlies both PPCM and DCM, then FDRs of women with PPCM or DCM are equally likely to share these genetic factors and will have comparable risks.

Aims:
In female probands with PPCM or DCM from the DCM Precision Medicine Study, evaluate proband DCM-relevant rare variant genetics; in their FDRs, compare the age-specific cumulative risk of DCM, LVSD, or LV enlargement [LVE].

Methods:
Of 452 female probands with DCM, 72 met criteria for PPCM; all underwent exome sequencing and analysis of rare variants in 36 DCM genes. Their 665 FDRs were assessed for DCM, LVSD, or LVE. Hierarchical logit models were used to describe the distribution of the most deleterious variant identified (none, variant of uncertain significance, or pathogenic/likely pathogenic) in probands. For FDRs, binary data on the presence or absence of DCM, LVSD, or LVE at enrollment were used to model age-specific cumulative risk in a Weibull proportional hazards model. Models accounted for site heterogeneity and, in FDRs, intrafamilial correlation.

Results:
The odds of finding a DCM-relevant rare variant were comparable between female probands with PPCM and DCM (OR=1.07, 95% CI: 0.37-3.11, p=0.90) adjusting for ancestry, ethnicity, and diagnosis age. DCM-relevant rare variants of PPCM probands were similar to those of DCM probands for ClinGen gene evidence category (p=0.55) and variant predicted impact (loss-of-function, missense, or other; p=0.90). Age-specific cumulative risk of DCM, LVSD, or LVE was not different among FDRs of women with PPCM or DCM (HR=0.96, 95% CI: 0.59-1.57, p=0.87) adjusting for proband ancestry and diagnosis age and FDR sex.

Conclusion:
Data from female probands indicate that PPCM and DCM have a similar rare variant genetic basis. FDRs of both PPCM and DCM probands show similar risks of DCM, LVSD, or LVE, further supporting an underlying genetic cause for PPCM.
Abstract 4145114: Novel Sonothrombolysis Approach to Left Circumflex Thrombus
Authors: Brush Kelli , Kalkur Roshni , Shah Kajal , Helisch Armin , Rothstein Eric
Published: November 2024

Sonothrombolysis, the use of ultrasound waves to augment thrombolysis, has been reported in prior limited studies as an adjunctive therapy in the management of acute myocardial infarct (MI) during percutaneous coronary intervention (PCI). By facilitating the dissolution of thrombi and improving microvascular perfusion, sonothrombolysis offers a potential strategy to enhance the efficacy of PCI and improve clinical outcomes. We present a case report utilizing a novel sonothrombolysis approach with successful application of ultrasound contrast directly to the coronary vasculature to reduce thrombus burden in a left circumflex lesion.

Case:
A 78 year old male presented with ventricular tachycardia and NSTEMI. After stabilization he underwent a left heart catheterization which demonstrated thrombus in the mid left circumflex. Distal flow was decreased, TIMI grade 2. Intravascular ultrasound&optical coherence tomography was used for visualization of thrombus, no atherosclerosis or significant calcification was seen. Mechanical thrombectomy was performed with significant residual thrombus. Sonothrombolysis was performed with ultrasound enhancing agent injected directly intracoronary through a guide catheter and high mechanical index pulses applied via echo probe. There was marked reduction in thrombus burden and TIMI 3 flow.

Discussion:
Despite advancements in PCI techniques, achieving optimal myocardial reperfusion remains a challenge in patients with MI, particularly those with extensive thrombotic burden. Traditional thrombolytic agents have limitations, including incomplete thrombus dissolution and delayed reperfusion. Sonothrombolysis utilizing an ultrasound enhancing agent adminsitered intravascularly with echo probe delivering high mechanical index pulses has emerged as a novel approach to address these limitations. This is the first reported case with direct application of ultrasound contrast to the coronaries via guide catheter for sonothrombolysis in the setting of an NSTEMI. There have been prior reports of pre-procedural sonothrombolysis delivered to peripheral vasculature in STEMI cases which had limited evidence demonstrating improvement in post MI outcomes. This case report contributes to the growing body of literature by providing insights into the clinical application and efficacy of sonothrombolysis in the management of MI during PCI.
Abstract 4145118: The Association Between Obstructive Sleep Apnea and Major Adverse Limb Events in Patients with Peripheral Arterial Disease
Authors: Ahmed Omair , Haseeb Shahan , Singh Harjinder , Qureshi Muhammad Ahmad , Munir Shafia , Aneni Ehimen
Published: November 2024

Background:
Obstructive Sleep Apnea (OSA) is the most common sleep related disorder and shares common pathophysiological mechanisms with Peripheral Arterial Disease (PAD). Studies exploring the influence of OSA on PAD have largely focused on subclinical markers of PAD such as ankle brachial indices and pulse wave velocities. We sought to investigate the association of OSA with Major Adverse Limb Events (MALE) in patients with PAD.

Methods:
National Inpatient Sample 2018-2020 was utilized for this analysis. MALE was the primary outcome, defined as a composite of Acute Limb Ischemia, Limb Revascularization (either percutaneous or surgical), limb amputation and All-Cause mortality. ICD-10 codes were utilized to identify the diagnoses of choice. Propensity score matching was performed between the 2 groups of OSA and no OSA using the caliper match method for the variables, Age, Gender, Stroke, Obesity, Hypertension, Anemia, Coagulopathy, ESRD, Diabetes, Chronic Pulmonary Disease, Congestive Heart Failure, Cardiac Arrythmias and Valvular Heart Disease. Weighted samples were utilized and p<0.05 was considered statistically significant.

Results:
Our sample consisted of 1,947,125 patients with PAD with a mean age of 74 (57-91) and 56% were male. Patients with OSA had higher incidence of hypertension, diabetes, congestive heart failure, obesity and pulmonary circulation disorders compared to those without OSA and similar rates of ESRD, valvular heart disease and cardiac arrythmias (Table). On unadjusted analysis, patients with OSA had lower odds of composite outcome of MALE (OR: 0.65 p<0.05) which persisted after propensity matching (OR: 0.68 p<0.05) (Table). The incidence of myocardial infarction was the same between the two groups.

Conclusion:
Patients with OSA had lower rates of MALE compared to patients without OSA in PAD cases. It remains unclear if this paradoxical effect is due to biological factors such as intermittent nocturnal hypoxia promoting angiogenesis or is the result of unmeasured confounders such as OSA severity, positive airway pressure therapy and healthier lifestyle habits. Nonetheless, our findings highlight the need for well-designed prospective studies to further investigate this relationship.
Abstract 4145140: Wenckebach conduction from ventricular endocardium to epicardium induced by class Ic I
Na
blockers: implications for mechanical dysfunction and arrhythmias
Authors: Gao Yuan , Qi Datun , Zhao Wenping , Liu Tong , Zhu Mingjun , Gao Chuanyu , Yan Gan-Xin
Published: November 2024

Background:
It is known that the Class Ic antiarrhythmic drugs exhibit strong use-dependent blockade of fast sodium current (I
Na
) due to their slow dissociation kinetics from the sodium channel. Clinically, Class Ic I
Na
blockers are linked to increased mortality in patients with coronary artery disease or ventricular systolic dysfunction. However, the mechanisms by which Class Ic I
Na
blockers influence ventricular conduction and mechanical function, thereby contributing to increased mortality, have not been well studied. We hypothesized that Class Ic I
Na
blockers may transition conduction of normal ventricular myocytes from an "all-or-none" pattern to Wenckebach or decremental conduction, features typically associated with slow response action potentials (APs). This change could markedly alter ventricular electrophysiology and mechanical function.

Methods:
APs, with ECG and contractility, were recorded concurrently from ventricular epicardium (Epi) and endocardium (Endo) in the isolated arterially perfused rabbit ventricular wedge in control and in presence of flecainide, a class Ic I
Na
blocker, at 10 microM. The preparations were paced from Endo at basic cycle lengths (BCL) ranging from 300 to 1000 ms.

Results:
Pacing from a BCL of 1000 ms down to BCLs of 300 to 600 ms resulted in decremental conduction between the ventricular Endo and Epi during pacing rate acceleration or Wenckebach conduction at a constant rapid pacing rate in the presence of flecainide. This unique conduction (Figure 1) was observed in 8 of 8 preparations under flecainide perfusion versus 0 of 8 in the control perfusion (p<0.01). Decremental and Wenckebach conduction was always associated with reduced and dyssynchronous contraction. Additionally, flecainide blunted or even reversed physiologically positive staircase response of contractility (Figure 2). Notably, 2 to 1 conduction and paroxysmal conduction block between the Endo and Epi occurred in 4 of 8 (Figure 3). On the other hand, conduction delay between the ventricular Endo and Epi also promoted echo beats and non-sustained ventricular tachycardia via a reentrant mechanism.

Conclusions:
Flecainide due to its strong use-dependent blockage of I
Na
has a capability to transition ventricular fast response APs to slow response APs, leading to Wenckebach or decremental conduction. This conduction not only reduces ventricular contraction but also induces dyssynchrony. Intraventricular conduction block also promotes reentrant arrhythmias.
Abstract 4145151: In-Flight Sudden Cardiac Arrest and Automated External Defibrillator Use
Authors: Bassi Mario , Kuchtaruk Matthew , Jiang Nathan , Sartor Cameron , Baranchuk Adrian
Published: November 2024

Background:
In-flight cardiac arrest (IFCA) is unique due to restricted access to equipment, healthcare providers, and isolated location in the air. This review aimed to explore the complexities surrounding IFCA on commercial flights, including the prevalence, incidence, and risk factors of IFCA and the effectiveness of automated external defibrillators (AED).

Methods/Results:
A narrative review of the literature was conducted on MEDLINE, PubMed, EMBASE, and Google Scholar. Literature searches were completed with Medical Subject Headings (MeSH), Emtree terminology, and appropriate keywords. The applied terms included “sudden cardiac arrest” OR “sudden cardiac death” OR “cardiac arrest, out of hospital” OR “cardiopulmonary resuscitation” OR “defibrillators” and a combination of “aircraft” OR “aviation”.

IFCA accounts for approximately 0.3% of all in-flight emergencies yet is responsible for up to 86% of all in-flight deaths. The most recent literature shows an overall survival rate from IFCA of 44%; with shockable and non-shockable rhythm survival at 53% and 35%, respectively.
Table 1
summarizes reports of IFCA incidence and survival. The most impactful risk factors for IFCA included male sex (79%) and past cardiac history (48.5%). Age was not found to be a significant predictor of IFCA. Thought to be due to in-flight immobility and venous stasis, pulmonary embolisms are reportedly responsible for 2% of IFCA.

AEDs have been mandated on all commercial flights with at least 1 trained attendant in the US since 2004, however, they are only recommended in many parts of the world. A study analyzing the emergency medical equipment of European airlines showed that only 65% have provided an AED for their aircraft. Studies have shown a survival of IFCA to hospital admission of up to 36% in patients that received a shock from an AED compared to 6% without an AED. Even in non-shockable rhythms, 76% of AED applications were used for monitoring purposes and assisted with ongoing treatment.

Conclusion:
IFCA remains a rare yet highly fatal event that is associated with male sex, past cardiac history, and pulmonary embolism risk. Availability of AEDs and trained personnel are critical factors to treat patients presenting with IFCA.