bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4138528: Clinical Characteristics of Five Different Endotypes from Coronary Reactivity Testing, and the Emergence of Sex Patterns in Coronary Microvascular Dysfunction
Authors: Namkoong Jenny , McCarthy Mary , Toleva Olga , Nield Lynne , Rinfret Stephane , Miner Steven
Published: November 2024

Background:
The common preconception is that non-obstructive coronary artery disease(NOCAD) predominantly affects females with little to no cardiac risk factors. However, it is unclear whether there is a significant difference in baseline characteristics between those with a positive vs negative coronary reactivity testing(CRT) result. Furthermore, CRT explores multiple pathophysiological mechanisms which make a positive result nuanced. This study identifies 5 different endotypes based on CRT results, aiming to identify phenotypic characteristics that correlate with these endotypes.

METHODS:
409 patients were included in a cohort study, representing all patients referred for CRT to a tertiary referral centre for NOCAD, between 2016-2024. Patients underwent protocol CRT of coronary flow reserve(CFR) and index of microvascular resistance(IMR) measurements following adenosine infusion(140mcg/kg/min) and bolus acetylcholine(100mcg).

Results were compared by positive vs negative CRT, normal vs abnormal CFR/IMR, and by 5 different endotypes identified from CRT result combinations.

RESULTS:
There was no significant difference in clinical characteristics between the positive vs negative CRT result groups.

However, with further stratification, there were significant sex differences and cardiac risk profile differences in CFR and IMR results. There was a greater proportion of females in the abnormal (low) CFR group(p<0.001), and higher burden of cardiac risk factors in the abnormal (high) IMR group(p<0.001). The highest burden of cardiac risk factors was seen in the 'Traditional Coronary Microvascular Dysfunction (CMD)' endotype, defined as those with abnormal(low) CFR and abnormal(high) IMR. The 'Functional CMD' endotype was characterised by younger females, whilst the 'Compensated CMD' and 'Coronary spasm' endotype showed no sex difference. The normal CFR and normal IMR endotype reflected the referred population(Figure 1).

CONCLUSION:
There is an emergence of clinical phenotypes according to the five coronary reactivity testing endotypes. Lower CFR appears to be a more “female pattern” of microvascular dysfunction. Endotypes reflect underlying pathology and may provide mechanistic explanations for sex differences in the microvascular dysfunction types of NOCAD, whilst explaining the lack of sex differences in other types. Further detailed understanding of CRT endotypes will allow us to understand the mechanistic differences in cardiovascular outcomes between males and females.
Abstract 4138529: Acute Coronary Syndrome in a Patient with Situs Inversus Totalis
Authors: Balani Prachi , Sharma Nitish , Ray Ayita , Sarraf Rahul , Roumia Mazen , Angelis Dimitrios
Published: November 2024

INTRODUCTION:
Situs inversus totalis (SIT) occurs in 1 in 8000 births. 0.04% of cases involve ACS, posing a clinical challenge. We present a case of NSTE-ACS in a patient with SIT, where a universal diagnostic catheter was used to engage the coronary arteries.

CASE PRESENTATION:
51-year-old Caucasian male with situs inversus totalis presented with worsening right-sided chest&right arm pain after shoveling snow. Initial examination was benign, but the EKG showed features of dextrocardia with T wave inversions in V2-V6. Laboratory results showed elevated CKMB (119.2)&up-trending troponin T 1.260 ng/ml. He was started on a Heparin drip and 81 mg of Aspirin with a plan for urgent cardiac catheterization.

A coronary angiogram from the right radial with a 6 French Tiger Radial Catheter in the right anterior projection (RAO) 30 degrees showed minor luminal irregularities in the RCA, and 90% stenosis in the LAD. RCA was enganged anticlockwise and LCA clockwise.

A 6 French XB 3.5 guide catheter was used to engage the LCA system, and the mid-LAD was stented. DAPT including Aspirin and Ticagrelor, was initiated. A TTE showed an EF of 25-30% with severe anterior, apical, and septal wall hypokinesis. The patient was discharged home with GDMT for coronary artery disease.

DISCUSSION:
CAD in dextrocardia can be challenging, requiring reversed limb and precordial leads and a right-sided ECG to show the extent of MI. Failure to recognize dextrocardia can lead to underestimating or missing MI. Typical findings include global negativity in lead I, positively deflected QRS in aVR, negative P-wave in lead II, reverse R-wave progression in precordial leads, and right-axis deviation. Our patient's EKG revealed polarity reversal in leads I and aVL, QS and rS patterns in precordial leads, and positive polarity in aVR, suggesting dextrocardia with T wave inversions, prompting further workup.

Engaging the coronary arteries is challenging. We used a Tiger radial catheter with a reverse torque technique: anticlockwise for the RCA and clockwise for the LCA. Both arteries were engaged in the right anterior oblique view at 30 degrees. The cranial and caudal angulation remained the same, but the standard left anterior oblique view was switched with the right anterior oblique view and vice versa. The double inversion technique is useful during interventions when dealing with unfamiliar anatomy. It is not well-established whether dextrocardia is a risk factor for myocardial infarction.
Abstract 4138555: The ApoB/LDL-C Ratio Predicts Cardiovascular Events in Coronary Artery Disease Patients Independently of Type 2 Diabetes Status
Authors: Larcher Barbara , Plattner Thomas , Mader Arthur , Vonbank Alexander , Leiherer Andreas , Muendlein Axel , Drexel Heinz , Saely Christoph H
Published: November 2024

A high ApoB/LDL-C ratio reflects small LDL particle size which like type 2 diabetes (T2DM) is associated with insulin resistance. Whether the ApoB/LDL-C ratio and the presence of T2DM are mutually independent predictors of cardiovascular events is unclear and is addressed in the present study.

We enrolled a large high-risk cohort of 1200 patients with coronary artery disease. T2DM was diagnosed according to current ADA guidelines. Prospectively, cardiovascular events were recorded over a mean follow-up period of 10.5±4.9 years.

At baseline, the ApoB/LDL-C ratio was significantly higher in patients with T2DM (n=422) than in subjects who did not have T2DM (0.81±0.18 vs. 0.74±0.15 p<0.001). During follow-up, 662 patients suffered cardiovascular events. The Apo B/LDL-C ratio predicted cardiovascular events in univariate analysis (HR=1.11 [1.03-1.20] p= 0.006), and the event rate was higher in patients with than in those without T2DM (62.2% vs. 52.3%; p=0.001). In a multivariate adjusted Cox regression model both the ApoB/LDL-C ratio and T2DM significantly predicted cardiovascular events in a mutually independent manner, with standardized adjusted HRs of 1.11 [1.03-1.20]; p=0.008 and 1.39 [1.18- 1.64]; p<0.001, respectively.

We conclude that in subjects with coronary artery disease the ApoB/LDL-C and T2DM are mutually independent predictors of cardiovascular events.
Abstract 4138578: NICE-Support program effectively improves symptom and psychological distress in patients with heart failure
Authors: Liao Hui-Ya , Chiou Ai-Fu
Published: November 2024

Background:
Patients with heart failure may suffer from symptom distress, affecting their overall quality of life and psychological well-being including depression. Limited researches focused on the effects of intervention on symptoms and psychological distress for patients with heart failure.

Research Hypothesis:
Nutritional education and exercise intervention can significantly improve symptoms and psychological distress in patients with heart failure.

Aims:
To investigate the effectiveness of the Nutrition Instruction Combined Exercise and Support program (NICE-Support) on symptom and psychological distress in patients with heart failure.

Methods:
This randomized controlled trial recruited 240 patients with heart failure from two medical centers in Taiwan by convenience sampling. Participants were divided into two subgroups based on participation in the "Post-Acute Care Integration Program (PAC)." Each group was randomly assigned to the experimental group and control group, including PAC, PAC+NICE, N-PAC, and N-PAC+NICE groups. The experimental group received a 12-week NICE-Support intervention, encompassing nursing instruction, nutritional counseling, exercise, and support. The control group followed routine hospital care. Data were collected through a structured questionnaire, including basic information, the Heart Failure Symptom Distress Scale, Hospital Anxiety and Depression Scale at baseline, 4, 12, and 24 weeks after enrollment. Data were analyzed using SPSS 24, including descriptive, t-tests, one-way ANOVA, Pearson correlation coefficients, chi-square tests, and generalized estimating equations.

Results:
The overall symptom distress score was 45.02 (SD = 13.50). Anxiety and depression were reported in 23.8% and 30.9% patients, with the mean anxiety and depression score of 5.01 (SD = 4.50) and 5.98 (SD = 4.16), respectively. Compared with the N-PAC control group, the PAC+NICE group and N-PAC+NICE group exhibited significant greater improvements in symptom distress at 4, 12, and 24 weeks post-intervention, while the N-PAC+NICE group showed statistically significant greater improvement in anxiety at 12 and 24 weeks.

Conclusion:
The NICE-Support program effectively improves symptom and psychological distress in patients with heart failure and could implement in patients with heart failure.
Abstract 4138583: Incidence and Outcomes of Heparin-Induced Thrombocytopenia Among Patients Undergoing Left Ventricular Assist Device Implantation
Authors: Agyeman Walter , Kumi Alex , Donaldy Webster , Ntow Mark Anthony , Sivasubramanian Barath Prashanth , Addo Basilio , Murrow Jonathan
Published: November 2024

Background:
Left Ventricular Assist Devices (LVAD) are being increasingly used as a bridge to transplant and destination therapy for advanced (stage D) heart failure. Heparin-induced thrombocytopenia (HIT) increases the risk of thromboembolic and bleeding events. HIT is also a well-known complication in patients undergoing LVAD implantation. This study examines the incidence and impact of HIT on outcomes in LVAD implants using a nationwide database from 2016 to 2020.

Methods:
We queried the National Inpatient Sample database for 2016-2020 to identify all adults ≥ 18 who underwent LVAD insertion using ICD 10 codes. LVAD recipients were dichotomized into two cohorts by the presence of HIT. Our primary outcome was in-hospital mortality. Secondary outcomes included vascular complications, acute kidney injury (AKI), length of stay, and total cost. Outcomes were adjusted for demographic variables, hospital-level characteristics, and comorbidities using regression analysis.

Results:
A total of 19975 (95% CI: 18328 - 21622) hospitalization records for LVAD insertion were identified, out of which HIT occurred in 1.8%. There were significant differences in AKI requiring dialysis, (p < 0.03) cardiogenic shock, (p<0.01), mechanical ventilation (p<0.01), pulmonary embolism (PE) (p< 0.001) and acute deep vein thrombosis (DVT) (p< 0.001) which occurred more in HIT. In-hospital mortality was not significantly associated with HIT (adjusted odds ratio [aOR] 1.49, 95% CI :0.73-3.04, p value 0.28). Older age (aOR 1.02; 95% CI: 1.01-1.02) was associated with mortality after LVAD insertion. AKI, ischemic stroke, hemorrhagic stroke, acute coronary syndrome, arterial dissection, cardiogenic shock, and mechanical ventilation were significantly associated with in-hospital mortality. Our analysis did not show any differences in the incidence of vascular complications, stroke, intraoperative bleeding, blood transfusions and AKI between the HIT and non-HIT group. The HIT group stayed longer in the hospital 39 days (95% CI: 36- 38) vs 37 days (95% CI: 35- 44) and incurred higher total hospital cost of $1,101,638 vs. $1,245,616) although this was not statistically significant.

Conclusion:
Among US hospitalized patients undergoing LVAD implants, HIT was significantly associated with a higher risk of AKI requiring dialysis, PE, acute DVT, cardiogenic shock and need for mechanical ventilation. It was however not associated with a higher risk of in-hospital mortality.
Abstract 4138604: Impact of GLP-1 Agonist on the Incidence of Atrial Fibrillation in Obese Patients Following Heart Failure Hospitalization
Authors: Fretz Thomas , Tanawuttiwat Tanyanan , Ilonze Onyedika , Das Mithilesh
Published: November 2024

Introduction:
Atrial fibrillation (AF) in patients with heart failure (HF) is associated with increased morbidity and mortality. Glucagon-like peptide-1 (GLP-1) agonists have been shown to reduce cardiovascular risk in patients with obesity and diabetes, respectively. Meta-analysis of prospective trials looking at GLP-1 agonist use on the incidence of AF suggest benefit in patients with diabetes but is of unclear benefit in this regard for patients with obesity.

Hypothesis:
GLP-1 agonists reduce atrial fibrillation incidence in patients with diabetes and obesity.

Aims:
The goal of the study is to assess the effects of GLP-1 agonist on incidence of new AF in patients with obesity and diabetes following heart failure hospitalization.

Methods:
The study included consecutive patients who were admitted to an academic tertiary care center over three years with a primary diagnosis of heart failure exacerbation and no prior diagnosis of AF. The primary outcome was incidence of AF within 12 months after hospitalization. Demographic, comorbidity, echocardiography, and medications were obtained. Cox-regression analysis was performed to identify the predictors of new-onset AF following HF hospitalization.

Results:
Of the patients included in our study, 1668 (42.9%) have a BMI greater than or equal to 30, 574 (14.5%) have BMI greater than or equal to 40, and 2300 (58.2%) have diabetes mellitus. GLP-1 use is associated with a significantly lower incidence of AF at one year in obese patients (p=0.042; RR 0.73; 95% CI: 0.54-.99) (Figure), while in non-obese individuals, GLP-1 receptor agonist was not associated with a decreased incidence of AF (p=0.674; RR 1.08; 95% CI: 0.76-1.53). In patients with diabetes, GLP-1 receptor agonist use did not reach statistical significance for reduced AF incidence following heart failure hospitalization (
p=0.091; RR 0.80; 95% CI 0.62-1.04
).

Conclusion:
GLP-1 receptor agonist use is associated with a statistically significant reduction of incidence of new atrial fibrillation at one year following hospitalization for heart failure in obese patients.
Abstract 4138609: Patient Care Experience Worsens After Private Equity Acquisition of US Hospitals: Implications for Cardiovascular Outcomes
Authors: Bhatla Anjali , Bartlett Victoria , Liu Michael , Zheng ZhaoNian , Wadhera Rishi
Published: November 2024

Background:
Patient care experience is strongly associated with outcomes among individuals with cardiovascular disease. There is growing concern that the recent and precipitous rise in private equity acquisitions of US hospitals may worsen patient-centered care, and ultimately, cardiovascular outcomes. However, little is known about how private equity acquisitions of hospitals impact patient care experience.

Research Question:
To evaluate whether the acquisition of US hospitals by private equity firms was associated with changes in measures of patient-reported experience compared with matched control hospitals (not acquired by private equity) between 2007-2019.

Methods:
This cohort study identified 74 US acute care hospitals newly acquired by private equity firms and 298 matched control (non-acquired) hospitals from 2007 to 2019. CMS Hospital Compare files were used to obtain patient experience measure scores for each hospital from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) survey results. A quasi-experimental difference-in-differences design was used to evaluate changes in patient experience measures at private-equity acquired hospitals compared with matched control hospitals 3 years before vs 3 years after acquisition.

Results:
The percentage of patients rating hospitals as a 9 or 10 out of 10 at private equity acquired hospitals and control hospitals is shown in the
Figure.
There was a differential decrease in patient ratings (of 9 or 10 out of 10) at hospitals acquired by private equity firms compared with control hospitals (-2.4 percentage points [95% CI -3.9, -0.9]). A similar trend was seen in the percentage of patients that would definitely recommend the hospital, with a differential decrease at private equity-acquired hospitals relative to control hospitals (-2.2 percentage points [95% CI -3.6, -0.7]). For both measures, the relative decrease in patient care experience at private equity hospitals compared with control hospitals steadily grew with each subsequent year after acquisition.

Conclusion:
In this national study, patient-reported care experience worsened after private equity acquisition of US hospitals, which has important implications for cardiovascular care and outcomes.
Abstract 4138622: Cardiac Rhabdomyosarcoma: An Updated Review of the English Literature From 1980 Through 2023
Authors: Adusei Poku Frank , Biney Bernice , Mensah Samuel , Oppong-Twum Sandra , Aghasili Chukwuemeka , Ampadu Joshua Oppong , Baygani Shawyon , Akamah Joseph
Published: November 2024

Cardiac Rhabdomyosarcoma (CR) is a rare malignant neoplasm of the heart occurring in all age groups and genders. It can arise anywhere in the heart with varied clinical presentation. Available data on CR are mainly from case reports and series that are limited by small sizes. The purpose of this study was to characterize the epidemiology, presentation, management, hospital course, and outcomes of CR published in the English literature from 1980-2023.

Methods:
We reviewed and included all published case reports with a diagnosis of CR in adult patients (age >18 years) on PubMed and Google Scholar using the keywords “primary cardiac tumor” and “cardiac rhabdomyosarcoma”. Data was extracted onto an Excel spreadsheet for analysis and the outcomes of interest were demographics, clinical presentation, diagnostic modalities, management, complications, and outcomes. We used descriptive statistics to analyze the data.

Results:
Among a total of 97 patients from 19 countries included in this study, 54% were males and the median age was 49 years (range 18-80). The main symptoms were dyspnea (37.1%), palpitations (23.7%), chest pains (16.5%) and syncope (6.5%). Hypotension or heart failure and arrhythmias were present in 10.3% and 9.3%, respectively and 5.2% had pericardial effusion. In addition to those with metastatic tumors, 22.7% had chronic co-morbidities. The majority of the cases were primary tumors (85.6%), and the remainder were (14.4%). All patients had at least one imaging modality including echocardiography (89%) and CT/MRI (84%). The commonest sites of cardiac involvement were the left atrium (35%), right atrium (33%), right ventricle (20%), and left ventricle (12%). Approximately 68% involved a single cardiac site while 32% involved multiple sites. Among the patients, 96% underwent surgery while 33% and 25% had chemotherapy and 25% radiotherapy, respectively. The median length of hospital stay was 11 days (range, 2-68 days), and mortality was recorded in 79.3% (77/97) of the patients. The median survival time was reported in 42 patients, and it was 6 months (range, 0-36 months).

Conclusion:
Cardiac rhabdomyosarcoma is a rare and aggressive malignant neoplasm. Most cases are primary tumors with poor outcomes such as a very short median survival time and a very high mortality rate despite the combination of surgery, chemotherapy, and radiotherapy. This calls for further research into the early diagnosis and optimal management strategies to improve outcomes.
Abstract 4138639: Exploring advanced therapeutic approaches for atherosclerosis: Targeting efferocytosis and EndoMT with a focus on the CD47
Authors: Singh Bandana , Cui Kui , Wang Beibei , Peng Qianman , Zhu Bo , EISA-BEYGI SHAHRAM , Wu Hao , Wang Donghai , Wong Scot , Cowan Douglas , Chen Hong
Published: November 2024

Background:
The anti-phagocytic molecule CD47 is upregulated in the atherosclerotic plaques of patients with cerebrovascular disease; however, the molecular mechanisms responsible for the development and progression of atherosclerotic lesions have not been fully established. In this study, we postulate how endothelial-specific CD47 promotes endothelial-to-mesenchymal transition (EndoMT) in potentiating atherosclerosis and assess the efficacy of the development of novel therapeutic interventions for cardiovascular disease.

Methods:
Using single-cell RNA sequencing (scRNA-seq), combined with molecular, cellular, and biochemical analyses, we investigated the role of endothelial CD47 in stimulating EndoMT using knock-out in ApoE-/- atherosclerotic mouse models.

Results:
ScRNA-seq revealed that CD47 promotes EndoMT, and the loss of endothelial CD47 inhibits EndoMT marker expression as well as transforming growth factor-beta signaling
in vitro
and atherosclerotic mice, which is associated with smaller lesions in
Apoe-/-
mouse model. In endothelial cells, CD47 hinders efferocytosis of senescent ECs and represses macrophage’s efferocytotic capacity to propel arterial inflammation and atherogenesis. Mechanistically, the interaction between CD47 and efferocytic receptor MerTK exacerbates inflammation by inhibiting the process of efferocytosis in endothelial cells and macrophages under atherogenic conditions. In response to atherogenic stimuli, endothelial CD47 upregulates the endocytic adaptor protein epsin, causing fibroblast growth factor receptor-1 (FGFR1) signal attenuation that upregulates TGF-β signaling and promoting EndoMT and potentiating atherosclerosis.

Conclusion:
We conclude that endothelial CD47 potentiates EndoMT during atherogenesis by increasing TGF-β signaling through FGFR1 internalization and degradation and targeted manipulating CD47 expression with precision nanomedicine offering a novel approach for mitigating cardiovascular disease.
Abstract 4138640: Learning Curve for Left Bundle Branch Area Pacing Lead Implantation
Authors: Clark Maci , Zerr Hannah , Ose Benjamin , Fritz David , Trupp Caroline , Gupta Amulya , Shahab Ahmed , Noheria Amit , Sheldon Seth
Published: November 2024

Background:
Left bundle branch area pacing (LBBAP) has shown promising outcomes at experienced centers, but less is known about the learning curve with new adoption of LBBAP. We conducted a retrospective analysis (2020-2023) of the learning curve for LBBAP at our center.

Methods:
Procedural success and complications in adult patients undergoing LBBAP by operators with >5-years’ experience in device implantation were compared between operators’ experience ≤10th (LBBAP
inexp
) vs. >10th (LBBAP
exp
) LBBAP implant. Successful LBBAP was defined as left ventricular activation time (LVAT) ≤80 ms.

Results:
Seven operators implanted LBBAP in 288 patients (age 73±11 years, 38% women): 68 (24%) in LBBAP
inexp
vs. 220 (76%) patients in LBBAP
exp
groups with similar baseline characteristics (all p >0.05). The median number of implants per operator was 22 (range 8-83).
Table 1
shows the procedural characteristics and ECG results. Post-implant LVAT ≤80 ms was less frequent in LBBAP
inexp
compared to LBBAP
exp
(56.9% vs 72.4%, p=0.04,
Figure 1
). There were no differences in paced QRS duration ≤130 ms (75.9% vs. 76.1 %, p=1.0) or operator self-identified success (85% vs. 91%, p=0.2). With new single-/dual-chamber device implants, there was no difference in implant duration (103.4±31.8 vs. 101.6±38.5 minutes, p=0.3) but there was longer fluoroscopy in LBBAP
inexp
(12.6±10.1 vs. 8.2±8.0 minutes, p<0.0001,
Figure 1
). The average number of attempts at LBBAP was lower in LBBAP
inexp
vs. LBBAP
exp
(2.0 ± 1.5 vs. 2.9 ± 2.9, p=0.03). There was no difference in complications between the 2 groups (
Table 2
).

Conclusion:
Operators use less fluoroscopy, make more attempts at LBBAP and more frequently achieve LVAT ≤80 ms after their first 10 implants.
Abstract 4138714: Implementation of the KDIGO Guidelines to Prevent Cardiac Surgery Associated Acute Kidney Injury in Patients with Heart Failure With Preserved Ejection Fraction Undergoing Coronary Artery Bypass Grafting
Authors: Zhang Heng , Han Jiawei , Zeng Juntong , Su Xiaoting , Zhou Hongyan , Liu Sheng , Zheng Zhe
Published: November 2024

Backgrounds:
The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommended the initiation of multiple supportive measures in patients at high risk for cardiac surgery associated acute kidney injury (CSA-AKI). Heart failure with preserved ejection fraction (HFpEF) was known as a critical risk factor for CSA-AKI.

Purpose:
Our study was designed to assess the effectiveness of KDIGO guidelines and the risk of CSA-AKI following coronary artery bypass grafting (CABG) among patients with HFpEF.

Methods:
This retrospective cohort study included 7420 patients undergoing CABG from 2019 to 2022, including 1960 patients with pre-operative HFpEF and 5460 patients without pre-operative HF as comparison. Implementation of the KDIGO guidelines consists of 6 measures in the first 72 hours after surgery, including avoidance of nephrotoxic agents, discontinuation of ACEi and ARB, implementation of advanced hemodynamic monitoring, avoidance of hyperglycemia, optimization of hemodynamics, and intensified monitoring of renal function. The primary outcome was in-hospital postoperative AKI according to the KDIGO criteria.

Results:
Among the included patients with HFpEF, 125 (6.4%) patients were classified as fully implementing the KDIGO guidelines. For the primary outcome, implementation of guidelines was associated with a significantly decreased risk of CSA-AKI (46.4% vs. 62.0%; OR, 0.591 [95% CI, 0.407-0.857]; p = 0.006). Meanwhile, implementation of guidelines had a greater preventive effect on CSA-AKI for HFpEF patients compared with non-HF patients (OR, 0.921 [95% CI, 0.759-1.118]; p = 0.405). Noticeably, we found that avoidance of hyperglycemia (OR, 0.737 [95% CI, 0.591-0.920]; p = 0.007) and optimization of hemodynamics (OR, 0.638 [95% CI, 0.508-0.802]; p < 0.001) were associated with lower incidence of CSA-AKI.

Conclusions:
Despite a lack of adherence to the KDIGO guidelines in patients undergoing CABG, implementation of the guidelines was found to be associated with a significantly lower risk of CSA-AKI for patients with HFpEF. Among the measures in the guidelines, avoidance of hyperglycemia and optimization of hemodynamics had stronger preventive effects for CSA-AKI.
Abstract 4138716: A novel Urocortin-2 analog COR-1167 corrects cardiac and renal dysfunction on top of Empagliflozin in a rat model of acute decompensated heart failure
Authors: Stephan Yohan , Corruble Clement , Charrier Lucie , NICOL Lionel , Kowala Mark , Ozoux Marie-Laure , Lawson Francesca , Janiak Philip , Mulder Paul
Published: November 2024

Introduction:
Urocortin-2 (UCN-2) is a peptide belonging to the corticotropin-releasing factor family that has cardiovascular, renal, metabolic and anti-inflammatory actions and improves cardiac function in human heart failure (HF) and cardiorenal dysfunction in chronic HF models. However, UCN-2 has a short half-life and intravenous delivery limits its therapeutic use. COR-1167 was discovered as a stable UCN-2 analog with qd pharmacological effects when injected subcutaneously.

Hypothesis:
Whether COR-1167 exerts chronic cardiorenal protection in Acute Decompensated HF (ADHF) is unknown, and in particular on background of SGLT2 inhibition, therefore both treatments were tested in a rat model of ADHF.

Methods:
Rats had coronary artery ligation to induce MI and a reduced ejection fraction phenotype. Three months later, rats were treated with vehicle or Empagliflozin (Empa) at 10 mg/kg/day PO. One month after starting Empa, two acute decompensation events were induced by administrating NaCl solution (1.8 g/kg, PO) on Day 0 and Day 14. Empa treated ADHF rats received vehicle or COR-1167 (3 µg/kg/day) by SC injections starting at 12 hours after the first decompensation and all treatments continued for 14 days. The groups were ADHF, ADHF + Empa and ADHF + Empa + COR-1167 (n=7-10/group). Left ventricular (LV) hemodynamics (cardiac catheters), cardiac output (echocardiography) and LV tissue perfusion (magnetic resonance imaging), cardiac mitochondrial coupling and ATP production (Seahorse) were measured 1 day after the second decompensation, while urine volume (uVol) and urine Na
+
excretion (uNa
+
) collected from metabolic cages were analyzed 7 days after the first decompensation.

Results:
Compared to ADHF control rats, Empa treatment had no effect on systolic blood pressure (SBP), cardiac output (CO), LV end systolic pressure volume relationship (LVESPVR), LV end diastolic pressure volume relationship (LVEDPR), mitochondrial coupling and ATP production, but it increased myocardial perfusion, uVol and uNa
+
excretion. Compared to ADHF + Empa rats, COR-1167 treatment increased SBP, CO, LVESPVR, myocardial perfusion, mitochondrial coupling and ATP production, uVol, uNa
+
, while decreasing LVEDPVR.

Conclusion:
In the setting of ADHF, significant cardiorenal benefits and decongestion occurred when COR-1167 was administered on top of an SGLT2 inhibitor.
Abstract 4138722: Large Language Model based multi-agent Transcatheter Aortic Valve Implantation team to augment multidisciplinary meetings - proof of concept.
Authors: Tran Hao , Joseph Viren , Al-Falahi Zaidon , Dharmadmajan Anoop , Shaw Elizabeth , Xu Aaron , Akrawi Daniel , Juergens Craig , French Bruce , Wilson Michael , Otton James , Scalia Greg , Naguib Badie Tamer , Kay Sharon , Guo Yi , Tran Tu Tak , Chang Anthony , Lo Sidney
Published: November 2024

Introduction:
Multidisciplinary team (MDT) discussions are integral to Transcatheter Aortic Valve Implantation (TAVI) decision making. Large language model (LLM) ubiquity and low-code no-code platforms have enabled clinician lead solution development. Specialised chatbots or ‘agents’ have evolved into multi-agent systems that can personify human collaboration. We assess the performance of an artificial intelligence (AI) multi-agent TAVI MDT.

Methods:
Four de-identified TAVI cases from two metropolitan Australian hospitals were assessed by a mock human TAVI MDT (h-MDT) and an AI multi-agent TAVI MDT (ai-MDT). The ai-MDT was created with Agentflow within Flowise AITM and had a hierarchical multi-agent architecture suited to complex reasoning required for TAVI MDT simulation (figure). LLM limitations necessitated the ai-MDT rely on imaging reports rather than clinical images. The h-MDT and ai-MDT consisted of similar team members. Outputs from the h-MDT and ai-MDT was adjudicated by a panel of four blinded TAVI doctors that determined if output was human vs AI and assigned a SMIC score (4-12, 4=good, 12=poor) that assessed structure, missing information, incorrect information and clinical utility. Time durations for h-MDT and ai-MDT were recorded.

Results:
Adjudicators differentiated human vs. AI output 100% of the time and ai-MDT output had better SMIC scores than h-MDT (U-stat 213, p=0.0011). ai-MDT outperformed h-MDT in the domains of structure, missing information and clinical utility but was not statistically different in the incorrect information domain (U-stat 132, p=0.88). The average time for each case in h-MDT was 15 minutes and 45 seconds compared to 97 seconds for ai-MDT.

Conclusion:
This demonstrates the potential of using LLM based multi-agent systems as a clinical adjunct in highly specialized multidisciplinary clinical meetings. AI responses were superior for structure, clinical utility and missing information and non-inferior for incorrect information compared to humans, which highlights that hallucinations remain an issue with generative AI. Time was saved but image interpretation still requires human input, for now. Cognitive AI continues to require human supervision for implementation.
Abstract 4138788: Outcomes of Percutaneous Coronary Interventions Following Transcatheter Aortic Valve Replacement: Insights from the National Cardiovascular Data Registry (NCDR) CathPCI Registry
Authors: Lalani Christina , Sharma Ravi , Sevilla-Cazes Jonathan , kennedy kevin , Butala Neel , Secemsky Eric , Pinto Duane , Poulin Marie-France , Laham Roger , Kolte Dhaval , Cohen David , Yeh Robert
Published: November 2024

Background:
Although transcatheter aortic valve replacement (TAVR) devices can impair coronary access, there are limited real-world data on rates of percutaneous coronary intervention (PCI) and PCI outcomes in post-TAVR patients.

Research Question:
How often do patients who undergo TAVR develop coronary events, and do they have different procedural characteristics or rates of adverse events when undergoing PCI compared to patients without a TAVR?

Methods:
We used CMS claims data for the Medicare fee-for-service population to evaluate the incidence of PCI after TAVR between 2011-2017. Then, using data from the NCDR CathPCI Registry linked with Medicare claims, we compared procedural characteristics and PCI outcomes between patients with a history of TAVR vs. propensity-matched patients who did not have a history of TAVR.

Results:
Of the 52,780 Medicare fee-for-service patients who underwent TAVR between 2011-2017, the incidence of acute myocardial infarction (AMI) was 10.6% and of PCI was 5.4% at five years. Among those patients, 5.6% had a PCI in the three months preceding their TAVR. After propensity-score matching, the procedural success rates for PCI were similar between patients with vs. without a history of TAVR. However, in the propensity-matched comparison, PCI in post-TAVR patients required greater fluoroscopic time (21.9 vs 17.7 mins, p<0.001) and was associated with a greater incidence of post-procedural stroke (0.8% vs 0.4%, p=0.02) and bleeding (5.1% vs 2.9%, p < 0.001). At three-year follow-up post-PCI, there were no differences in the rates of AMI between patients with vs. without a history of TAVR (HR: 1.22, 95% C.I.: 0.97, 1.54, p=0.08). However, patients with prior TAVR were more likely to have repeat PCI in the three years following their index procedure (HR: 1.38, 95% C.I.: 1.12, 1.73, p=0.003).

Conclusion:
Among Medicare fee-for-service patients, one in 20 patients undergoing TAVR subsequently underwent PCI within 5 years. Although the rates of procedural success were similar, patients with a history of TAVR who underwent PCI had longer fluoroscopic times, more frequent in-hospital adverse events, and a higher likelihood of a repeat PCI compared with matched patients without a history of TAVR.
Abstract 4138793: Impact of diabetes mellitus on the severity and long-term outcomes of chronic thromboembolic pulmonary hypertension: a retrospective cohort study
Authors: Gao Luyang , zhang sicheng , Li Xin , Li Sicong , zhao qing , Yang Tao , Zeng Qixian , Huang Zhihua , Duan Anqi , Wang Yijia , Zhao Zhihui , Luo Qin , Liu Zhihong
Published: November 2024

Background:
Previous studies have indicated that diabetes mellitus (DM) is linked to the severity and mortality of both pulmonary thromboembolism and pulmonary arterial hypertension. But the relationships between diabetes and chronic thromboembolic pulmonary hypertension (CTEPH) have not been discussed. This study aims to investigate the relationships of DM with disease severity and clinical worsening events in patients with CTEPH.

Methods:
We analysed data of patients with CTEPH from the National Center for Cardiovascular Diseases in China between January 1, 2013 and August 31, 2023. A 2-group propensity score matching was conducted to adjust for differences between CTEPH patients with and without DM, employing a 1:1 pairing algorithm. The association between DM and long-term adverse outcomes was appraised utilizing multivariable Cox regression models. Subgroup analyses, predicated on age, sex, World Health Organization functional class (WHO-FC) and body mass index, were carried out to evaluated interaction effects.

Results:
In total, 489 consecutive CTEPH patients were included in the study, with 25.97% diagnosed with DM. Subsequent matched analysis comprised 127 patients with DM and 127 without DM. CTEPH patients with DM exhibited inferior WHO-FC as well as cardiac index, elevated N-terminal pro–brain natriuretic peptide levels, pericardial effusion, tricuspid annular plane systolic excursion / systolic pulmonary arterial pressure ratio and pulmonary vascular resistance. After adjusting for confounding factors, DM remained independently associated with adverse outcomes in patients with CTEPH. In addition, further subgroup analyses disclosed a more robust association in patients without overweight or obesity.

Conclusions:
DM correlates with heightened severity of CTEPH and serves as an autonomous predictor of long-term prognosis in CTEPH. Moreover, this correlation is more pronounced in individuals devoid of overweight or obesity.
Abstract 4138799: SGK1 inhibition shortens action potential duration in LQT3 mice and LQT2 rabbits via inhibition of late sodium current
Authors: Barbieri Miriam , Casini Simona , Louradour Julien , de Waal Tanja M. , Sager Philip , Das Saumya , Wilde Arthur , Odening Katja , Remme Carol Ann
Published: November 2024

Background:
Serum and glucocorticoid regulated kinase 1 (SGK1) activation during pathological conditions has been shown to increase late sodium current, prolong action potential duration (APD), and induce ventricular arrhythmias, thus recapitulating a long QT syndrome (LQTS) phenotype. Hence, pharmacological SGK1 inhibition may be a novel therapeutic approach in inherited LQTS.

Aim:
We aimed to investigate potential effects of SGK1 inhibition in animal models of different LQTS subtypes, and the potential involvement of late I
Na
inhibition.

Methods:
Cardiomyocytes (CMs) isolated from wild-type (WT) and LQT3 mice (
Scn5a
-1798insD) as well as from WT, LQT1 (
KCNQ1
-Y315S) and LQT2 (
KCNH2
-G628S) rabbits, were incubated for 3-5 hours with SGK1-inhibitor (SGK1-inh, 300 nM-3 μM) or DMSO (vehicle). Patch-clamp experiments were performed to assess AP properties, short-term variability (STV) of APD and late I
Na
.

Result:
SGK1-inh incubation significantly shortened the prolonged APD
90
in LQT3 CMs by 23% and in LQT2 CMs by 25% (restoring them towards the WT level), without affecting other AP properties. In contrast, in WT and LQT1 CMs, no effect of SGK1-inh on APD
90
was observed. Furthermore, short-term-variability (STV) of APD, a measure of pro-arrhythmia, was pathologically increased in LQT3 (5.6±0.2 ms vs WT 2.7±0.3 ms, p<0.05) and LQT2 (14.7±2.8 ms vs WT 5.9 ±1.1 ms, p < 0.0001), but not in LQT1. SGK1-Inh markedly reduced STV in LQT3 (to 2.9±0.1 ms) and LQT2 CMs (to 7.2± 1.2 ms), but had no effect in WT and LQT1 CMs. While enhanced late I
Na
was previously demonstrated in LQT3 CMs, we now also observed increased late I
Na
in LQT2 CMs as compared to WT (-0.14 ± 0.02 pA/pF vs WT -0.08 ± 0.02 pA/pF, p < 0.005), but not in LQT1 CMs. SGK1-Inh significantly reduced late I
Na
in LQT3 (by 32%) and LQT2 CMs (by 43%), but not in LQT1 CMs, confirming that SGK1-inh directly targets late I
Na
.

Conclusion:
SGK1-inhibition exerts a beneficial APD-shortening and anti-arrhythmic effect in LQT3 and LQT2 by reducing the enhanced late I
Na
associated with these LQTS genetic subtypes. These findings furthermore underscore the contribution of increased late I
Na
to the LQT2 phenotype.
Abstract 4138840: Hybrid Convergent Procedure as a ‘Bail Out’ Strategy In Patients with Atrial Fibrillation Resistant To Catheter Ablation
Authors: Spring Remy , Playford Emma , Eranki Aditya , Joshi Pragnesh , Playford David , Weerasooriya Rukshen
Published: November 2024

Introduction:
Atrial fibrillation (AF) is a common and symptomatic arrhythmia which can be resistant to conventional endocardial catheter ablation. The Hybrid Convergent procedure, combining initial surgical AF ablation with a concurrent or staged endocardial catheter-based component, offers a potential solution for refractory cases. While effective as a de novo treatment for persistent AF, outcomes of this procedure in patients who failed prior catheter ablation remains uncertain. Our aim was to evaluate its efficacy and safety in this patient group.

Methods:
We conducted a single-center retrospective cohort study involving consecutive patients selected for the Hybrid Convergent procedure between May 2019 and October 2022 at a single center in Perth, Western Australia. Eligible patients had symptomatic AF and failed prior catheter ablation and antiarrhythmic drugs. The primary outcome was single procedure freedom from atrial arrhythmias, on or off antiarrhythmic drugs at 12 months. Overall follow-up freedom from AF, 12-month AF burden, complications and reinterventions were also recorded.

Results:
Sixty-two patients underwent both stages of the Hybrid Convergent procedure. All received concomitant thoracoscopic left atrial appendage exclusion. Of these, 46 (74.2%) were male, 27 (45.3%) had paroxysmal AF, and 15 (24.2%) had implantable loop recorders (ILRs). The mean duration since AF diagnosis was 9.5±7.1 years, with a median of 3 prior catheter ablations for AF. The median follow-up was 25.9 (13-48) months. After 12 months, 36 (62.9%) patients remained free from any atrial arrhythmia (figure 1). At this time point, 47 (75.8%) patients had an atrial arrhythmia burden of less than 5%. For the overall follow-up period, 32 (51.6%) patients maintained freedom from any atrial arrhythmia. Among patients with ILRs, the 12 month atrial arrhythmia free survival was 36.6%, compared with 64.4% in those without ILRs. Nine patients required repeat catheter ablation. There was one major complication.

Conclusions:
Our initial experience with the Hybrid Convergent procedure demonstrates sustained effectiveness and safety for patients with paroxysmal or persistent AF who have previously failed catheter ablation strategies.
Abstract 4138935: Lp(a) and LDL-Cholesterol Interaction Association with Aortic Valve Calcium and Severe Aortic Stenosis
Authors: Chew Christopher , Marrero Natalie , Jha Kunal , Razavi Alexander , Dzaye Omar , Budoff Matthew , Rotter Jerome , Blumenthal Roger , Bhatia Harpreet , Tsimikas Sotirios , Blaha Michael , Whelton Seamus
Published: November 2024

Introduction:
Calcific aortic valve disease (CAVD) is the most common valvular disorder with aortic valve calcification (AVC) as a principal underlying mechanism. Low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] are risk factors for AVC and aortic stenosis (AS). However, whether an interaction between LDL-C and Lp(a) exists in CAVD is not well studied, which may have implications for trials investigating novel Lp(a) lowering therapies.

Methods:
Cardiac computed tomography (CT) was used to quantify AVC in participants free of known cardiovascular disease at Multi-Ethnic Study of Atherosclerosis (MESA) Visit 1 and subsequent visits. Incident severe AS was adjudicated through chart review of hospital visits and echocardiogram data. Participants were categorized into four groups based on the cutpoints of LDL-C 160mg/dL and Lp(a) 50mg/dL. We examined the association of the four LDL-C and Lp(a) groups with incident AVC and incident severe AS using multivariable adjusted Cox Hazard models. We also tested for the presence of a multiplicative interaction between LDL-C and Lp(a).

Results:
In this analysis, 6,603 participants were included. The mean age of participants was 62 years old and 52% were women. Incident AVC occurred among 416 participants and during a median follow-up time of 17 years, 84 participants developed severe AS. At baseline, AVC >0 was present in 11.9% of participants with LDL-C <160mg/dL and Lp(a) <50mg/dL compared to 21.6% participants with LDL-C ≥160mg/dL and Lp(a) ≥50mg/dL (p=<0.01). Compared to participants with LDL-C <160 mg/dL and Lp(a) <50mg/dL, those with LDL-C ≥160 and Lp(a) ≥50 mg/dL had a 2.3-fold higher risk for incident AVC [HR 2.27 (1.34-2.85)] (
Table 1)
. There was a statistically significant multiplicative interaction between Lp(a) and LDL-C as continuous variables for both incident AVC (p=0.002) and severe AS (p=0.036).

Conclusion:
Participants with both an elevated LDL-C and Lp(a) had the highest risk for incident AVC. There was a significant interaction between LDL-C and Lp(a) for both incident AVC and incident AS. Thus, individuals with elevated LDL-C and Lp(a) may be most likely to benefit from novel Lp(a) lowering therapies and/or combined LDL-C and Lp(a) lowering.
Abstract 4139022: Targeting Aurora Kinase B Improves Vascular Remodeling in Pulmonary Arterial Hypertension
Authors: Lemay Sarah-Eve , Mougin Manon , Sauvaget Melanie , Reem EL-Kabbout , Valasarajan Chanil , Yamamoto Keiko , Martineau Sandra , Pelletier Andreanne , Grobs Yann , Bourgeois Alice , Romanet Charlotte , Breuils Bonnet Sandra , Montesinos Monica , Lu Min , Chen Huidong , Theberge Charlie , Potus Francois , Savai Pullamsetti Soni , Provencher Steeve , Bonnet Sebastien , Boucherat Olivier
Published: November 2024

Introduction:
Pulmonary arterial hypertension (PAH) is a progressive and fatal disease characterized by pulmonary artery (PA) remodeling. Extensive proliferation of PA smooth muscle cells (PASMCs) is perhaps the most important feature of PAH accounting for vascular remodeling for which current treatments have limited efficacy.

Methods and Results:
To discover novel actionable targets involved in vascular remodeling, we performed a comparative RNA-sequencing analysis between control and PAH-PASMCs, and next enriched our experiment with two publicly available datasets conducted on comparable cell lines. After merging the three datasets, 136 genes were found to overlap, of which 126 and 10 were up- and down-regulated in PAH-PASMCs, respectively. A connectivity map analysis using SigCom Library of Integrated Network-based Cellular Signatures was performed on the commonly upregulated genes and identified an aurora kinase B (AURKB) inhibitor as the top reverser drug of PAH-PASMCs gene signature. In this regard, aurora kinase B (AURKB), known to play a critical role in the onset and progression of mitosis, was present among the overlapping upregulated genes in PAH-PASMCs. Further experiments revealed that FOXM1 positively regulates AURKB expression. Pharmacological (Barasertib) and molecular (siRNA) inhibition of AURKB reduced PAH-PASMC proliferation (EDU incorporation, Ki67 labeling&WB PLK1), survival (TUNEL assay,&WB Survivin) and was associated with mitotic defects. Acquisition of a senescence-like phenotype was observed in PAH-PASMCs that escaped apoptosis following AURKB inhibition (SA-βGal, p21, p53, SASP…). Barasertib treatment significantly improved pulmonary vascular remodeling and hemodynamics in MCT and Su/Hx rats with established PAH (RHC&EVG) and resulted in a marked increase in p21 in small PAs. Similar effects were also observed in human precision-cut lung slices isolated from PAH patients. Finally, the combination of Barasertib with the p21 attenuator UC2288 was more effective in reducing vascular remodeling in Su/Hx rats than either drug alone (EVG, RHC, echocardiography).

Conclusion:
Our research identified AURKB as a novel therapeutic target and suggests that combining anti-remodeling drugs with senotherapeutics may be more effective in counteracting vascular remodeling in PAH.