bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4142395: Lipid Trends of Adults Who Participate in Hybrid Cardiac Rehabilitation
Authors: Gao Yumin , Ding Jie , Kim Chang , Spaulding Erin , Isakadze Nino , Stewart Kerry , Broderick Ashley , Bush Alexandra , MacFarlane Zane , Nimbalkar Mansi , Desai Anushka , Mathews Lena , Marvel Francoise , Garcia-Garcia Hector , Martin Seth
Published: November 2024

Background:
Hybrid cardiac rehabilitation (HCR) is an emerging approach to increase participation in cardiac rehabilitation, which targets improvements in functional status and broader risk factor modification including lipid management. However, long-term lipid control trends of patients engaging in HCR remain unexplored.

Methods:
Using data from a quality improvement program initiated during COVID-19, we conducted a retrospective analysis of 68 adults eligible for HCR from Jan 2021 to Feb 2023 at the Johns Hopkins Health System (Baltimore, MD), utilizing the Corrie digital health platform. This multi-component platform combines expert knowledge with gamified education and virtual coaching to deliver HCR. Patients hospitalized for cardiovascular events qualifying for HCR were recruited for a pilot study of a randomized controlled trial (mTECH REHAB; NCT05238103). We modeled trends in low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and triglycerides via mixed-effects regression.

Results:
Among 68 eligible adults, 41 participated in HCR, with a mean age of 60.1 years, 78.1% male, 24.3% Black, and 14.6% Asian/Mixed. HCR participation was significantly associated with being married (61% vs 33%, p=0.044) or employed (63% vs 26%, p=0.015). On average, 2.3 lipid panels were assessed per person over a median of 12 months (max 30 months) post-discharge. During this period, LDL-C levels decreased from 84.6 mg/dL (95% CI: 75.0-94.1) to 53.0 mg/dL (95% CI: 34.3-71.8) (p for trend = 0.003). Non-HDL-C decreased from 105.9 mg/dL (95% CI: 95.7-116.1) to 74.2 mg/dL (95% CI: 54.1-94.3) (p for trend = 0.005). Levels of HDL-C and triglycerides showed no significant changes (p for trend = 0.724 and 0.607). Among 34 participants with ≥2 lipid panels, the proportion of LDL-C <70 mg/dL increased from 41.2% at hospitalization to 64.7% at the most recent check, and LDL-C <55 mg/dL increased from 14.7% to 38.2%.

Conclusion:
Improvements in atherogenic lipid levels, in particular LDL-C and non-HDL-C, were observed in adults participating in HCR after a cardiovascular event. Our findings highlight the potential of HCR to support optimal lipid management in adults with cardiovascular disease.
Abstract 4142418: Immediate Leg Mobilization is Feasible after Catheter Ablation of AF Using Large Vascular Access Sheaths (Pulsed Field Ablation and Cryoballoon Ablation)
Authors: Sam Riya , Patel Romil , Singh Lavisha , Metzl Mark , Fisher Westby , Nazari Jose , Ro Alex , Demo Hany , Wasserlauf Jeremiah
Published: November 2024

Background:
Vascular recovery from catheter ablation (CA) generally requires a period of leg immobilization. Vascular closure devices reduce the length of bedrest and promote earlier discharge, however, a period of immobilization is still routinely observed. The objective of this study was to compare a strategy of immediate leg mobilization (IM) using percutaneous suture-mediated closure devices against figure-of-eight sutures and 4h bed rest (BR) after CA of atrial fibrillation (AF) using large vascular access sheaths for cryoballoon (CBA) and pulsed-field ablation (PFA).

Methods:
A total of 98 subjects were analyzed (49 IM and 49 BR). Vascular closure in IM consisted of a single percutaneous suture-mediated closure device (Perclose ProStyle) delivered to each of 3 venous access sites in a single groin. Following the procedure, both legs could be mobilized immediately with no head-of-bed restriction. Ambulation was instructed at 1h post-procedure, and discharge was scheduled at 3h. Hemostasis in BR was achieved using figure-of-eight sutures delivered to one or both groins utilized for access, and 4h bedrest. In both groups, one of the sheaths consisted of a 12F to 17F access for CBA or PFA. Protamine was administered prior to the removal of sheaths. Oral anticoagulation was resumed same day. The primary endpoint was the incidence of vascular complications. The secondary endpoint was time to discharge.

Results:
Baseline characteristics between groups were similar (Age 67.8 ± 13.1 years, BMI 30.2 ± 6.8, LVEF 55.7 ± 12.4, 48% female). 55% of IM and 100% of BR underwent CBA. The remainder underwent PFA. There was no difference in the rate of vascular complications between the two groups (1 IM vs 0 BR,
p = 0.315
). The time to discharge was significantly shorter in the IM group (3.9 ± 0.8 vs 5.4 ± 1.0 h,
p < 0.0001
).

Conclusions:
In this single-center study, immediate mobilization facilitated by suture-mediated vascular closure following catheter ablation using large access sheaths was associated with no difference in vascular complications compared to bedrest and resulted in earlier discharge. Larger studies evaluating cost, clinical endpoints, and patient-reported outcomes are needed.
Abstract 4142421: The Impacts of Blood Pressure Variability on Clinical Outcomes in Patients with Out-of-hospital Cardiac Arrest
Authors: Lin Shih-Neng , Chang Chen-Hsi , Huang Chin-Chou
Published: November 2024

Background:
Out-of-hospital cardiac arrest (OHCA) is associated with unfavourable survival rates and neurological outcomes. Blood pressure control is crucial in intensive care management, yet there are limited studies highlighting the influence of blood pressure variability (BPV). This study aims to investigate the impact of BPV within the first 48 hours on the outcomes in patients experiencing OHCA.

Methods:
A retrospective analysis was conducted on data from OHCA patients. Blood pressure measurements were collected and categorised into four intervals: 0-12 hours, 13-24 hours, 25-36 hours, and 37-48 hours after ROSC. BPV was assessed using the standard deviation (SD) and coefficient of variation (CoV) of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Mortality and cerebral performance category (CPC) were utilized in the study to assess the clinical outcomes at 30 days post-OHCA event.

Results:
A total of 185 patients who survived more than 48 hours after ROSC were enrolled. Survivors (n = 98) exhibited significant differences in BPV measures compared to non-survivors (n = 86). Higher BPV of SBP and MAP were associated with increased mortality for all four time intervals. Higher BPV of MAP in the initial 12 hours after ROSC were identified as predictors of 30-day mortality (hazard ratio [HR] 1.052, 95% confidence interval [CI] 1.029-1.075, P < 0.001 for SD of MAP). Furthermore, higher BPV of MAP in the initial 12 hours after ROSC were also identified as predictors of poor neurological outcomes (odds ratio [OR] 1.163, 95% CI 1.081-1.252, P < 0.001 for SD of MAP). Overall, BPV within the first 48 hours after ROSC were correlated with higher 30-day mortality, and BPV within the first 36 hours after ROSC were correlated with poor neurological outcomes.

Conclusion:
Increased BPV within the first 48 hours after ROSC is a significant predictor of mortality and poor neurological outcomes in OHCA patients. These findings underscore the importance of monitoring and managing BPV in the early post-arrest period to improve patient outcomes.
Abstract 4142422: Heart of the Mystery: Unveiling PFO's Role in Cryptogenic Stroke During Pregnancy
Authors: Bagha Zohaib , Ali Zohair , Wilson Sean , Grayver Evelina
Published: November 2024

Background:
Patent Foramen Ovale (PFO) is a common cardiac anomaly that persists into adulthood in approximately 25% of the population. Although often clinically silent, PFOs can lead to complications in pregnancy, such as paradoxical strokes. Here, we present a case of a pregnant patient with a cryptogenic stroke attributed to PFO, highlighting the complex decision-making involved in her management.

Case Description:
A 37-year-old woman, G2P1001 at 9 weeks gestation, presented to her ophthalmologist with 2 days of decreased vision in her left eye. She was diagnosed with branch retinal artery occlusion and underwent laser embolization. Subsequently, she was sent to the hospital for an expedited work-up. The patient was started on aspirin upon presentation. MRI of the brain and MR angiography of the head and neck were unremarkable, and lower extremity duplex studies were normal. Transthoracic echocardiography revealed a PFO with a mild interatrial septal aneurysm. Hypercoagulable work-up revealed low protein S free antigen and a positive anticardiolipin IgM, both difficult to interpret during pregnancy. Given the high-risk morphology of the PFO, there was concern for a paradoxical stroke. The RoPE Score was calculated to be 9, indicating an 88% chance that the stroke was due to the PFO. She was then initiated on enoxaparin daily and discharged with outpatient follow-up. The rest of the coagulable work-up was unrevealing. Repeat protein S levels were still low but considered normal for pregnancy. It was determined that the patient did not have genetic thrombophilia but was hypercoagulable due to pregnancy. After interdisciplinary discussions, the patient underwent PFO closure at 15 weeks gestation. Post-procedure, she was transitioned to aspirin and a three-month course of clopidogrel. Enoxaparin was resumed post-clopidogrel up until one month before delivery, when subcutaneous heparin was initiated. She successfully delivered at 39 weeks, after which enoxaparin was resumed and continued for 6 weeks postpartum. Repeat protein S testing 12 weeks postpartum was normal, and aspirin was discontinued.

Conclusion:
This case of a pregnant patient with stroke highlights the importance of prompt screening for PFO and tailored management to prevent recurrence. It underscores the importance of thorough evaluation and interdisciplinary collaboration in treatment planning and demonstrates the safety and effectiveness of PFO closure during pregnancy.
Abstract 4142450: In Hospital Outcomes of Mitral Valve Transcatheter Edge to Edge Repair (M-TEER) in Patients with Coronary Chronic Total Occlusion (C-CTO). Insight From The National Inpatient Database
Authors: Ahmed asmaa , Eisa Mahmoud , Mohamed Mohamed , Takla Andrew , Osama Muhammad , Arora Sahej , Feitell Scott
Published: November 2024

Introduction:
M-TEER is a minimally invasive procedure for selected patients with symptomatic mitral regurgitation. It remains unknown whether the concomitant C-CTO would affect the outcomes of M-TEER procedure.

Methodology:
We used the Nationwide Inpatient Sample Data between January 2016 and December 2020 to identify M-TEER hospitalizations with concomitant C-CTO. Baseline characteristics including demographic data and comorbidities were identified. Primary outcomes were in-hospital all-cause mortality and net all cardiac periprocedural complications defined as a composite of acute myocardial infarction, pacemaker placement, cardiac tamponade, pericardiocentesis, pericardiotomy, pericarditis, and hemopericardium.

Results:
48,835 cases of M-TEER were identified during the study period, of whom 700 patients (1.5%) had the diagnosis of C-CTO. The mean age of M-TEER patients was not significantly different between the two groups (76 vs. 75 years, p=0.11), however the CTO cohort had more males (66.72% vs. 53.41%, p=0.002), and more comorbisities as; previous myocardial infarction (32.14% vs.15.66%, p= 0.0003), peripheral artery disease (32.1% vs. 22.67%, p=0.03), complicated hypertension (80% vs. 68.6%, p= 0.001) and renal failure (52.8% vs. 37.3%, p= 0.0007). A higher percentage of M-TEER procedures in patients with CTO were performed in elective setting (62.8% vs. 46.5%, p=0.0008). M-TEER among patients with CTO was associated with a higher incidence of net all periprocedural cardiac complications (21.4% vs. 13.4%, p=0.04) with however similar in-hospital mortality between both groups (3.57% vs. 2.35%, p=0.46). The results remained consistent on adjusted analysis; M-TEER-CTO cohort had higher odds of net all cardiac periprocedural complications (aOR 1.83 ,95% CI (1.17-2.84), p=0.007) with no difference in in-hospital mortality (aOR 1.54, 95 %CI (0.52-4.56), p =0.43). M-TEER utilization in CTO patients was associated with higher costs ($270,385 vs. $237,190 p=0.05), however, no significant difference in mean length of stay (5.8 vs. 4.8 days, p 0.17)

Conclusions:
In patient undergoing M-TEER, concomitant C-CTO increases the risk of net all cardiac periprocedural complications with no significant increase in mortality
Abstract 4142470: Clinical management of select patients with surgically implanted Impella 5.5 left ventricular assist devices on a cardiovascular step-down unit
Authors: Ospina Meg , Griffin Jan , Van Bakel Adrian , Jackson Gregory , Rao Vishal N. , Atkins Jessica , Hajj Jennifer , Dodson Kaylen , Summer Mary Kathryn , Bull Lindsey , Inampudi Chakradhari , McMurray Jeffrey , Tedford Ryan , Witer Lucas , Bhandari Krishna , YOURSHAW JEFFREY , Houston Brian , Kilic Arman , Carnicelli Anthony
Published: November 2024

Introduction:
Surgically implanted Impella 5.5 percutaneous left ventricular assist device utilization is increasing. Most centers manage Impella 5.5 patients exclusively in the ICU; however, there are concerns regarding prolonged ICU bed utilization in clinically stable patients. This study evaluates our experience managing Impella 5.5 patients in a stepdown unit (SDU).

Methods:
In January 2023, select patients with Impella 5.5 at our institution were admitted to a SDU after ≥24 hours in the ICU post implant. Eligible patients had no significant bleeding, device issues, or ongoing hypoperfusion. Demographics, hemodynamics, outcomes, and adverse events (
Fig
) were collected retrospectively and adjudicated by multidisciplinary clinician review.

Results:
Between Jan 1, 2023 and Mar 31, 2024, a total of 64 patients with Impella 5.5 were managed at our institution. Of these, 42 (66%) were managed in SDU for a median (IQR) of 11 (7, 21) days (range 1-82), totaling 733 of 1055 (69%) Impella-days. SDU patients with Impella 5.5 had a median age of 60 (50, 63) years, were mostly male (55%), non-ischemic (79%), and presented with Stage C (52%) or D (43%) shock. Impella strategy in SDU patients was bridge to transplant in 60% (n=25), to decision in 31% (n=13), to durable LVAD in 8% (n=3), and for VT ablation support in 1% (n=1). Five (12%) patients required transfer back to the ICU for escalation of care.

Impella 5.5 patients on SDU experienced a total of 28 adverse events (0.027 events per Impella-day), with >1 adverse event in 16/42 (38%) patients (
Fig
). Twenty-eight (67%) SDU patients underwent heart transplant and 10 (24%) underwent LVAD implant during the hospitalization. One patient died during their hospital course, in whom care was withdrawn due to lack of a destination option.

Conclusions:
For select patients with Impella 5.5 who met institutional criteria, transfer to a SDU was feasible and safe. This strategy may increase ICU throughput and optimize resource allocation.
Abstract 4142487: ST-Elevated Myocardial Infarction in the Postpartum Period: Incidence and Predictors
Authors: Davis Elizabeth , El Haddad Danielle , Shan Yong , Gaalema Diann , Jneid Hani
Published: November 2024

Introduction:
The US maternal mortality rate is rising, with cardiovascular disease being the main cause of death. Acute myocardial infarction in particular (most commonly ST-elevation myocardial infarction (STEMI)) is associated with excess mortality. There have been no recent large, population-based studies estimating the current incidence of postpartum STEMI or identifying its risk factors.

Research Question:
Given the increasing risk of postpartum STEMI and the consequences of such a diagnosis we sought to identify recent incidence of postpartum STEMI and understand its predictors.

Goal:
The purpose of this study was to describe the incidence and risk factors of acute postpartum STEMI in the USA.

Methods:
This study was performed using MarketScan Commercial Claims and Encounters Data. Patient selection was from all deliveries resulting in a live birth between 2017 and 2020 with claims data available for 12 months prior and 6 months following delivery data. For all births, STEMI within 6 months was noted and the following risk factors were collected: age, hypertension (HTN), thrombophilia, anemia, diabetes mellitus (DM), and smoking. We then performed multivariate logistic regression models to estimate odds ratio (95% confidence interval) for STEMI adjusted for the aforementioned risk factors.

Results:
327,570 delivery cases were identified, of which 3330 (1%) had a STEMI in the time from hospital admission to 6 months postpartum. Most STEMIs occurred close to the time of delivery: 2823 (84.8%) cases within 24 hours of delivery and an additional 132 within 1 week, 80 within 2 weeks, and 52 within 4 weeks (cumulative totals of 89.4%, 91.8%, and 93.3% respectively). The following factors had a significant, independent, positive correlation with STEMI: age ≥40 (OR 1.6 [95% CI 1.4-1.9]), DM (OR 1.6 [95% CI 1.5-1.7]), HTN (OR 1.6 [95% CI 1.5-1.7]), and smoking (OR 1.5 [95% CI 1.3-1.8]). These are shown in Figure 1.

Conclusion:
Although rare, postpartum STEMI is associated with high morbidity and mortality and is occurring at an increasing rate. While maternal age is not modifiable, HTN, smoking and DM are, and more should be done to address these risk factors in those who are, or plan to become, pregnant.
Abstract 4142501: Bystander Abdominal Thrusts and Back Blows were Associated with Favorable Neurological Outcomes in Patients with Foreign Body Airway Obstruction
Authors: Igarashi Yutaka , Norii Tatsuya , Yokobori Shoji
Published: November 2024

Background:
Foreign body airway obstruction (FBAO) represents a major public health challenge in developed countries with aging populations. We previously reported that bystander FBAO interventions were associated with about a two-fold increase in favorable neurological outcomes; however, the impact of each different type of intervention on patient outcomes remains unknown.

Hypothesis:
We hypothesize that abdominal thrusts and back blows are associated with favorable neurological outcomes in patients with FBAO compared to no bystander intervention.

Methods:
The MOCHI (Multi-center Observational CHoking Investigation) registry is a prospective, multi-center study conducted in Japan, focusing on patients with FBAO in emergency departments. From April 2020 to March 2023, 25 hospitals, including eight university hospitals, participated. For this analysis, we included only adult patients who were over 18 years. Data were collected electronically, documenting demographics, FBAO specifics, bystander characteristics, intervention types, and 30-day outcomes. Primary outcomes were favorable neurological outcome defined as Cerebral Performance Category 1 or 2 and survival outcome at 30 days. Inverse probability of treatment weighting (IPTW) and logistic regression were used to adjust for potential confounders.

Results:
Among 407 patients, 24, 76, and 175 received abdominal thrusts, back blows, and no bystander interventions, respectively, while the rest received other interventions. Median age was 81, with equal male-to-female ratio. FBAO incidents mainly occurred at home (57%). Patients with abdominal thrusts or back blows had higher rates of favorable neurological outcome than those without bystander interventions (37% vs. 15%, p = 0.01 for abdominal thrusts; 32% vs. 15%, p = 0.004 for back blows). IPTW analysis showed that abdominal thrusts and back blows groups had higher rates of favorable neurological outcome compared to the no-bystander intervention group (38% vs. 15%, p = 0.038 for abdominal thrusts; 31% vs. 16%, p = 0.013 for back blows). Cox proportional models showed that the back blow was independently associated with survival (adjusted Hazard Ratio [HR] 0.52, 95% CI, 0.35–0.78); however, abdominal thrusts was not independently associated with survival (adjusted HR 0.73, 95% CI, 0.40–1.35).

Conclusion:
Bystander abdominal thrusts and back blows were associated with favorable neurological outcomes in FBAO compared with no bystander intervention.
Abstract 4142502: Stepwise Screening with AI-Enhanced Electrocardiogram and Point-of-Care Ultrasound Improves Cost Savings of Structural Heart Disease Detection Compared to AI-Enhanced Electrocardiogram Alone
Authors: Schlesinger Reid , Alexandrino Francisco , Bird Jared , Kane Garvan , Deshmukh Abhishek , Pellikka Patricia , Oh Jae , Noseworthy Peter , Lopez-Jimenez Francisco , Friedman Paul , Pislaru Sorin , Tsaban Gal
Published: November 2024

Background:
AI-ECG is a cost-effective tool for left ventricular dysfunction (LVD) screening. However, its cost-effectiveness for other forms of structural heart disease (SHD) is unknown. While AI-ECG is inexpensive, a drawback is low positive predictive value (PPV), which leads to high costs from unnecessary follow-up tests. Therefore, strategies to improve the yield of AI-ECG-based screening are needed.

Aim:
To evaluate the cost savings of a stepwise approach to SHD screening with AI-ECG followed by POCUS compared to AI-ECG alone.

Methods:
286 adult outpatients undergoing AI-ECG were selected at random. Participants received same-day POCUS and had a recent TTE (our gold standard for SHD). We evaluated four SHDs: aortic stenosis (AS), cardiac amyloidosis (CA), HCM, and LVD. The costs of AI-ECG ($75) and TTE ($1,305) were obtained from Healthcare Bluebook. The cost of POCUS ($100) was estimated independently. Cost savings were analyzed for simultaneous screening for all forms of SHD and screening for individual SHDs.

Results:
AI-ECG identified potential SHD in 125 patients, but only 39 were true positives by TTE (31% PPV). In AI-ECG positive patients, POCUS demonstrated findings of SHD in 52/125. Compared to TTE, this stepwise approach yielded 32 true positives and 20 false positives (62% PPV). The cost per patient diagnosed with SHD was $4,733 with AI-ECG alone but decreased to $3,182 with stepwise screening (33% cost savings). Screening for individual SHDs resulted in cost reduction from $18,724 to $6,315 (66% savings) for AS, $21,023 to $12,230 (42% savings) for CA, $9,883 to $6,175 (38% savings) for HCM, and $4,019 to $3,582 (11% savings) for LVD.

Conclusions:
Stepwise screening for SHD with AI-ECG followed by POCUS significantly reduces costs compared to AI-ECG alone. We also suggest a model for parallel screening for multiple SHDs, which is likely more cost-effective than screening for individual SHDs.
Abstract 4142520: Causal associations between age of menarche or sex hormones and the risk of cardiovascular mortality: A Mendelian randomization analysis
Authors: Hong Myunghee , Park Je-Wook , Kwon Oh-Seok , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-Sun , JOUNG BOYOUNG , Lee Moon-Hyoung , Pak Hui-Nam
Published: November 2024

Background:
Recently, observational studies have reported several sex-specific factors associated with risk of cardiovascular (CV) disease and mortality. In addition, endogenous sex hormone levels in both men and women are related to the risk of CV disease and mortality. We explored the causal relationships between several sex-specific factors or sex hormones and CV mortality.

Methods:
Among 219,320 women or 187,297 men registered in the UK biobank database, we investigated two-sample Mendelian randomization analyses for outcome data (CV mortality). Exposure data were extracted from published genome-wide association studies (GWAS) catalog database. We selected each SNP with sex-specific (age at menarche, age at menopause in women) factors and sex hormones (total testosterone, sex hormone-binding globulin adjusted for BMI, Estradiol, dehydroepiandrosterone sulfate (DHEAS), androsterone sulfate in both men and women), to use it as an instrumental variable. Mendelian randomization analysis was performed using the inverse variance weighted (IVW), MR-Egger regression, and weighted median methods.

Results:
Among the sex-specific factors, we found that genetically predicted age at menarche was causally associated (IVW, beta=−0.134, SE=0.062, P=0.031), but not the age at menopause (IVW, beta=-0.028; SE=0.019, P=0.131) with the risk of CV mortality in women. Among the several sex hormones, androsterone sulfate has a causal relationship with CV mortality (IVW, beta=0.272, SE=0.089, P=0.002), but not other sex hormones (IVW, P=0.498 for total testosterone; P=0.469 for sex hormone-binding globulin adjusted for BMI; P=0.441 for Estradiol (men); P=0.099 for DHEAS).

Conclusions:
These results provide evidence that the earlier age at menarche in women and higher androsterone sulfate levels are associated with increased CV mortality.

Key words:

sex specific factors, sex hormones, cardiovascular mortality, Mendelian randomization

,

genetic variants
Abstract 4142523: Factors Associated With Pericardial Effusion and Outcomes of Conservative Versus Surgical Treatment in Cases of Acute Type A Intramural Hematoma
Authors: Kowada Minoru , Hori Daijiro , Yamada Ryotaro , Kariya Hidetaka , Fujii Kento , Shirasugi Takehiro , Nakano Mitsunori , Shiraishi Manabu , Okamura Homare , Morita Hideki , Yamaguchi Atsushi , Kimura Naoyuki
Published: November 2024

Background:
Patients with aortic intramural hematoma (IMH) often present with cardiac tamponade. However, factors associated with the precipitating pericardial effusion remain to be elucidated.

Hypothesis:
Morphologic factors affect IMH-associated pericardial effusion.

Aims:
To identify factors associated with pericardial effusion and compare outcomes of conservative therapy vs urgent surgery in acute type A IMH.

Methods:
Included in the study were 195 patients hospitalized for IMH within 48 hours of onset. They were identified from among 803 consecutive patients with acute type A aortic syndrome treated at 2 aortic centers between 2009 and 2022, with 213 (27%) having IMH. Study 1: Per on-admission CT data, correlation between maximum pericardial effusion width and ascending aortic diameter or hematoma thickness was assessed. Factors associated with massive pericardial effusion (>12.6 mm, upper quartile) and cardiac tamponade (systolic blood pressure <80 mmHg with pericardial effusion, n=49) were assessed by multivariable analysis. Study 2: Outcomes were compared between patients who underwent conservative therapy (n=57) and those who underwent surgery (n=138). Conservative therapy was principally performed if certain conditions were met: ascending aortic diameter <50 mm, hematoma thickness <11 mm, absence of pericardial effusion.

Results:
Study 1: Pericardial effusion width was found to correlate with ascending aortic diameter (r=0.268, p<0.001) but not with hematoma thickness (r=-0.053, p=0.46). Association was found between dissection extending to the abdominal aorta and massive pericardial effusion (p=0.010, OR=0.41) and between ascending aortic diameter and tamponade (p=0.048, OR=1.053). Study 2: Median age (73 vs. 73.5 years, p=0.74), sex, and comorbidities were similar between the conservative therapy group and the surgery group. Five (9%) conservative therapy group patients underwent surgery for expansion of the aorta or hematoma within 30 days of onset, with no hospital death resulting. Thirty-day mortality (10.5% vs. 5.8%, p=0.25) and 5-year survival (81.1% vs. 84.2%, p=0.33) did not differ. However, the 5-year aortic event (surgery, redissection, aortic or sudden death) rate was increased in the conservative therapy group (27.3% vs. 12.6%, p=0.003).

Conclusions:
Extent of dissection and aortic diameter are associated with pericardial effusion and cardiac tamponade in type A IMH. Aortic events are of increased likelihood with conservative therapy.
Abstract 4142532: Vasovagal Syncope Due to Tonsillar Malignancy
Authors: Gurung Purnima , Tang Yicheng , Kim Cy , Paikal Michael
Published: November 2024

Introduction:
Vasovagal syncope occurs when an overwhelming parasympathetic tone is triggered by causes including emotion, pain, or baroreceptor stimulation. We present a rare case of vasovagal syncope mediated by locally invasive tonsillar squamous cell carcinoma (SCC).

Case:
A 66 year old man with untreated L tonsillar SCC presented with recurrent syncope, hypotension, sinus bradycardia and sinus arrest up to 6 seconds as observed on telemetry (figure 1, bottom). Symptoms were atropine responsive and reliably reproduced with head turning to the L or palpation. CT neck (figure 1A-B) showed extension of the tumor into the L carotid body and adjacent vagal sheath. Echocardiogram revealed no structural heart disease. Pacemaker implantation was deferred due to suspected reversible vasovagal mechanism. He received a course of steroids, targeted cancer therapy with weekly Cetuximab infusion and daily radiation to the neck mass. After treatment initiation, the patient remained hospitalized for 3 days with no recurrent syncope or bradycardia observed. He continued outpatient treatments with resolution of his neck mass (figure 1C-D) and had no syncopal episodes over the next year.

Discussion:
We highlight this case as an example of locally invasive tumor causing mechanical disruption of the carotid body and neural reflex stimulation via the vagal sheath. When associated with vasovagal syncope, this phenomenon has been previously named carotid body syndrome. Although vasovagal mechanism remains the most common cause of syncope, diagnosis and treatment can prove challenging, particularly due to variable demonstration of vasodepressor and cardioinhibitory reflexes amongst individual patients. Treatment of vasovagal syncope focuses on trigger avoidance and treatment for predisposing conditions. Pacemaker implantation remains controversial and may be offered to patients with predominantly cardioinhibitory reflex and high-risk recurrent syncope, with a possible role for implantable cardiac monitoring. In this case, the management strategy was guided by association of symptoms with head turning, and treatment of the culprit neoplastic process yielded resolution of vasovagal syncope with avoidance of device implantation.
Abstract 4142533: Ventricular rate of Patients With Atrial Fibrillation and Acute Coronary Syndrome or Percutaneous Coronary Intervention and the Risk of Adverse Outcomes
Authors: Wang Jingyang , Hao Jun , YANG YANMIN
Published: November 2024

Background:
Atrial fibrillation (AF) often coexists with acute coronary syndromes (ACS) or conditions requiring percutaneous coronary interventions (PCI), worsening the outcome. Although rate control is a cornerstone in AF management, the optimal rate-control target in patients with AF and ACS or undergoing PCI is not well-investigated.

Methods:
This study employed a post hoc analysis of a single-center prospective real-world cohort, including patients with AF and ACS or undergoing PCI who were receiving treatment with rate control drugs, from September 2016 to March 2020. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs) and all-cause death. We evaluated the impact of ventricular rate [(<60, 60–79, 80–99, and 100–110, > 110 beats per minute (bpm)] on subsequent adverse outcomes using multivariable Cox regression models.

Results:
The cohort consisted of 1004 patients with a median age of 68 years and predominantly male (72%). Patients with ventricular rates >110 bpm showed the highest incidence of MACCEs (40.3%), all-cause death (30.6%) and cardiovascular death (24.2%) compared to other groups. Multivariable analysis confirmed that ventricular rates >110 bpm were associated with greater risk of MACCEs (HR, 2.35; 95% CI, 1.38-4.00; P for trend = 0.0178) and all-cause death (HR, 2.64; 95% CI, 1.29-5.40; P for trend =0.0091). Additionally, clear evidence of a dose-response relationship existed between higher ventricular rates and the risks of MACCEs, all-cause death, and cardiovascular death.

Conclusion:
In patients with AF and ACS or receiving PCI who were managed with rate-control agents, ventricular rates >110 bpm were associated with higher risks of MACCEs and all-cause death.
Abstract 4142546: Single-Nucleus RNA Sequencing Reveals Region-Specific Cell Composition and Transcriptional Variations in Cardiac Sarcoidosis
Authors: Neyazi Meraj , Kim Yuri , Brown Kemar , Barish Syndi , Gorham Joshua , Layton Olivia , Viveiros Anissa , DeLaughter Daniel , Beyer Martin , Strohmenger Viktoria , Reichart Daniel , Bowles Dawn , Glass Carolyn , Oudit Gavin , Seidman Jonathan , Seidman Christine
Published: November 2024

Introduction:
Sarcoidosis is a granulomatous disease of unknown cause that can affect any organ. Cardiac involvement, indicated by arrhythmias, conduction abnormalities, heart failure, and sudden cardiac death, occurs in about 5% of cases and accounts for 50% of sarcoid-related deaths. Yet, autopsy studies have found cardiac granulomas in 15-90% of patients. The localized nature of granulomas in the heart makes diagnosis difficult. Treatment usually includes immunosuppression and standard cardiac care, but neither is curative or prevents adverse outcomes.

Research Questions:
We aimed to enhance the understanding of cardiac sarcoidosis pathobiology by performing single-nucleus RNA sequencing on different regions of diseased hearts, focusing on immune dysregulation and the regional impact of granulomas on the myocardium.

Methods:
We used 10X Chromium V3 chemistry to investigate granulomatous, seemingly unaffected, and scarred regions within the same patients. We conducted a comparative analysis of samples from sarcoidosis patients, normal donor hearts, and patients with DCM due to their similar clinical phenotype.

Results:
A total of 608,235 nuclei from 21 sarcoidosis patients (41 samples), 12 control subjects (31 samples) and 29 DCM patients (66 samples) were analyzed in this study. On average, sarcoid samples showed fewer cardiomyocytes and pericytes, with more fibroblasts, myeloid, and lymphoid cells, compared to controls. Those sarcoid tissues with a control-like cardiomyocyte proportion displayed a significant reduction in pericytes (14.3% vs. 3.3%, p = 9.1e-9), suggesting microvascular dysfunction even in regions without granuloma and scarring. All sarcoid samples showed a marked increase in a lipogenic and extracellular matrix remodeling fibroblast state (2.6% vs. 10.7%, p = 2.7e-8). Granulomatous regions contained CHI3L1 and DCSTAMP-expressing granuloma-associated macrophages, as well as pro-inflammatory Th17-like T-cells, which have been implicated in various autoimmune diseases, and IL1R1+ Treg cells resembling exhausted Tregs, which have previously been described in tumor microenvironments.

Conclusions:
This comprehensive single-nucleus profiling highlights considerable regional heterogeneity in cardiac sarcoidosis. Understanding immune dysregulation and the spatial impact of granulomas on the myocardium may lead to optimized therapies for this understudied and potentially lethal disease, which currently has ineffective treatment options.
Abstract 4142555: Late Gadolinium Enhancement in Childhood Hypertrophic Cardiomyopathy：A Long-term Prognosis Study
Authors: Chen Xingrui , Yang Shujuan , Ma Xuan , Tang Yun , Zhao Shihua
Published: November 2024

Background:
Myocardial fibrosis could be detected by cardiac MRI (CMR) with late gadolinium enhancement (LGE) which provides important prognostic information of risk stratification for adult hypertrophic cardiomyopathy (HCM). However, in childhood HCM, it remains uncertain the prevalence, pattern of LGE, and whether it is associated with adverse outcomes.

Aims:
This study aims to explore the characteristics of LGE in childhood HCM and to evaluate the prognostic value of LGE for adverse outcomes.

Methods:
In this retrospective study, a total of 231 consecutive childhood patients with primary HCM who were ≤18 years of age at diagnosis and underwent contrast-enhanced CMR from January 2011 to December 2019 were enrolled. The extent of LGE was quantified by measuring areas with the increased signal intensity of ≥6 standard deviations above the mean of normal myocardium. The primary outcome included a composite of sudden cardiac death (SCD) or equivalent events (resuscitated sudden cardiac arrest or aborted SCD), heart failure-related events (heart transplantation, death from heart failure, rehospitalization for heart failure).

Results:
Patients were 15±3 years of age at baseline and 65% were male. During a median follow-up of 61.7 months (IQR:39.2-84.5), 26(11.3%) patients with HCM reached the primary end points, 13 of whom experienced SCD events. LGE was present in 195(84.4%) childhood HCM patients with a median LGE extent 4.77%(IQR:2.01-9.18) and higher in the mid regions. After univariable analysis, multivariable Cox analysis adjusting clinical and cardiac functional factors, LGE extent was an independent predictor for the primary endpoints (HR, 1.11; P<0.01) and SCD event (HR, 1.09; P<0.01). Time-dependent receiver operating characteristic (ROC) analysis showed that LGE extent performed a superior efficacy of the five-year risk prediction of primary endpoints (AUC=0.80) and SCD event (AUC=0.82). Kaplan-Meier analysis showed a significantly increased risk of primary endpoints (log-rank P<0.01) and SCD event (log-rank P<0.01) in high LGE group (LGE extent>mean). LGE extent could improve the predictive model, such as HCM Risk-Kids model (C statistic 0.65 vs 0.79, P=0.011) and PRIMaCY SCD risk prediction model (C statistic 0.61 vs 0.80, P=0.014).

Conclusion:
LGE assessed by CMR is a common characteristic and an independent predictor of adverse outcomes among childhood HCM, providing incremental value to improve risk stratification in current clinical risk models.
Abstract 4142556: Incremental Value of Multiparametric Cardiac MRI for Non-invasive Identification of Significant Acute Cardiac Allograft Rejection: a Prospective and Biopsy-proven Study
Authors: Zhou Pengyu , Zhao Shihua
Published: November 2024

Background:
Multiparametric cardiac magnetic resonance (CMR) serves as the gold standard for evaluating cardiac structure and function in vivo, and allows assessing myocardial tissue characterization non-invasively, providing a potential alternative for identifying significant acute cardiac allograft rejection (SR).

Aims:
This study aimed to evaluate the association between CMR multiparameters and SR, and assess the incremental value of CMR multiparameters over conventional serum examinations for identifying SR using the likelihood ratio analysis.

Methods and results:
Heart transplantation (HTx) recipients with endomyocardial biopsy and healthy controls were prospectively recruited for CMR assessment. CMR feature tracking (CMR-FT) was performed to evaluate the left ventricular (LV) global strain in all three directions. The last serum examinations including N-terminal pro brain natriuretic peptide (NT-proBNP) before anti-rejection therapy were recorded. Participants were divided into 3 groups based on biopsy grade: control, SR (acute cellular rejection [ACR] grade≥2R and/or antibody-mediated rejection [AMR] grade≥pAMR1), and NSR (ACR grade<2R and AMR grade=pAMR0). Finally, thirty controls (43.3±13.6 years, 26 male) and 51 HTx recipients comprising 23 SRs (48.6±12.6 years, 24 male) and 28 NSRs (42.7±14.9 years, 16 male) were enrolled for analysis. Compared with NSRs, SRs showed elevated NT-proBNP (7797.0±7527.6pg/ml vs 3334.6±5935.3pg/ml, p<.001), worse LV global longitudinal strain (GLS) (-9.7±3.1% vs -13.1±2.9%, p<.001), and increased native T1 (1384±80.1ms vs 1321±69.9ms, p<.001) and T2 values (50.9±2.7ms vs 45.7±4.3ms, p<.001). In multivariable analysis, LVGLS (OR=0.76, 95%CI, 0.59 to 0.98, p=.03) and T2 value (OR=1.35, 95%CI, 1.10 to 1.65, p=.01) were independently associated with SR after NT-proBNP adjustment. Furthermore, the likelihood ratio test showed LVGLS (p=.002) and T2 value (p<.001) had incremental value over NT-proBNP for identifying SR.

Conclusion:
LV GLS and T2 value were independently associated with SR, providing incremental value for non-invasive identification of significant rejection in HTx recipients.
Abstract 4142598: Prognostic Value of Baseline and Change of Soluble Suppression of Tumorigenicity-2 in Light Chain Cardiac Amyloidosis
Authors: Xin Anran , Li Xinqing , Huang Yan , Zhuang Xiaofeng , Zhao Xuemei , Wang Jinxi , Zhou Ping , Zhang Jian , Zhang Yuhui
Published: November 2024

Background:
The predictive value of soluble suppression of tumorigenicity-2 (sST2) has been demonstrated in heart failure patients. However, studies on the association between baseline sST2 levels, dynamic changes in sST2, and prognosis in patients with light chain cardiac amyloidosis (AL-CA) are limited.

Aim:
The study sought to assess the predictive value of baseline circulating sST2 and added prognostic value of change in sST2 levels in patients with AL-CA.

Methods:
Patients diagnosed with AL-CA patients in Heart Failure Center, Fuwai Hospital between October 2015 to August 2023 were enrolled. The serum sST2 levels were measured at baseline and at 30 days. The change of sST2 (ΔsST2) was defined as the sST2 level at 30 days minus baseline sST2. The primary outcome was all-cause mortality. Kaplan–Meier analysis and Cox hazard models were performed to explore the predictive value of both sST2 at baseline and ΔsST2.

Results:
Overall, 132 patients were included. The median follow-up was 235 days. The mean age was 58.92 years (standard deviation [SD]: 10.74 years), and 62.1% of the participants were male. The median sST2 level was 30.42 ng/mL (IQR: 18.41–51.98 ng/mL), with the cutoff value set at 35 ng/mL. Higher sST2 levels at baseline (>35ng/ml) were associated with increased risk of all-cause mortality after adjusting for N-terminal pro–B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTNI), and difference between involved and uninvolved free light chain (dFLC) levels (adjusted hazard ratio [HR] 1.86, 95% confidence interval [CI]: 1.03-3.38; P<0.05). Among 40 patients with available ΔsST2, a total of 11 primary outcome events occurred. Patients who experienced these events exhibited higher levels of ΔsST2 (median: 193.55 ng/mL, IQR: 100.86-284.86 ng/mL) compared to those who did not (median: 8.04 ng/mL, IQR: -4.69-62.44 ng/mL). Moreover, higher ΔsST2 is also an independent indicator of worse prognosis, even after adjustment for baseline sST2, NT-proBNP, cTNI, and dFLC levels (adjusted HR 12.46, 95% CI: 1.26-123; P<0.05).

Conclusions:
Elevated baseline sST2 blood level (>35 ng/L) is a robust and independent indicator of prognosis in AL-CA patients. A dynamic increase in sST2 levels over the short term suggests a dismal prognosis.
Abstract 4142604: Artificial intelligence-based hyperspectral technique facilitates the diagnosis of heart failure with preserved ejection fraction
Authors: Yang Xiaomeng , Li Zeyan , Shi Xiaoyu , Yu Lilei
Published: November 2024

Background:
Heart failure with preserved ejection fraction (HFpEF) is an important type of heart failure. The diagnostic process for patients with HFpEF is complex. Hyperspectral cameras have the ability to acquire high-definition hyperspectral images and have a wide range of applications and advantages. Therefore, the development of a fast and non-invasive diagnostic model for HFpEF is innovative.

Hypothesis:
The aim of this study is to construct a rapid diagnostic model for HFpEF patients based on hyperspectral image and artificial intelligence.

Methods:
We enrolled 3500 hyperspectral images from HFpEF patients and control patients, and all data were randomly divided into training group (n=2625) and validation group (n=875). The characteristic spectral information and texture information were obtained using image segmentation software and image analysis software. We used various algorithms to identify the characteristic spectral bands that can be used to identify patients with HFpEF to screen out the best model, and compared the evaluation indexes of different algorithms. We compared the autonomic indexes and lipid metabolism indexes of HFpEF patients and non-HFpEF patients to explore the potential mechanism.

Results:
More than 30 artificial intelligence algorithms were used to filter the spectrum that best reflects the HFpEF patients, among which random forest algorithm was the best performing model. The accuracy was 0.829, precision was 1.000, recall was 1.000, F1 Score was 0.750, specificity was 0.792, sensitivity was 0.909, and Joden index was 0.701, the area under the curve of the was 0.884. There were significant differences in autonomic indexes between the two group, as well as lipid levels and body mass index, suggesting that differences in autonomic functional activity and lipid metabolism are potential mechanisms.

Conclusions:
An artificial intelligence HFpEF diagnostic model based on hyperspectral imaging was developed and validated. The model can quickly and efficiently help physicians to screen HFpEF patients, as well as help early self-identification of HFpEF patients to seek timely medical treatment, thus contributing to the early detection, early diagnosis, early treatment of HFpEF patients.
Abstract 4142619: Implications of Rate Limiting Medications in Patients with Atrial Fibrillation and Heart Failure with Preserved Ejection Fraction
Authors: Abbas Mohamed , Ariyaratnam Jonathan , Dziano Jenelle , Howie Jackson , Fitzgerald John , Jayakumar Mohanaraj , Evans Shaun , Elliott Adrian , Sanders Prashanthan
Published: November 2024

Introduction:
Concerns have been raised regarding the potential adverse effect of beta-blockers particularly in limiting chronotropic response in Heart failure with preserved ejection fraction (HFpEF) patients. While beta-blockers are commonly used in Atrial fibrillation (AF) management, their effect in patients with both AF and HFpEF remains uncertain.

Methods:
In patients undergoing AF ablation, invasive left atrial (LA) hemodynamic measurements were obtained at rest and following 500mL fluid challenge. Patients with HFpEF (baseline mean LA pressure >15 mmHg) and preclinical HFpEF (baseline mean LA pressure <15 mmHg, increasing to >15 mmHg post-fluid challenge) were included for analysis. Two subgroups were identified based on the use of rate-limiting medications (RLM) at the time of recruitment. The validated AF Severity Scale (AFSS) and Minnesota Living with Heart Failure questionnaire (MLHFQ) were utilised to assess AF and HFpEF symptoms respectively. Baseline Pro-BNP level and cardiopulmonary exercise test were also performed.

Results:
Of the 88 patients (mean age 65.1 ± 10.8 years, 64% males) included for analysis, 63.6% had clinical HFpEF and 36.4% had preclinical HFpEF. Patients on RLM (79.5%) and not on RLM (20.5%) had similar baseline characteristics including age (
p
=0.53) sex (
p
=0.24) type of AF (
p
=0.43) and pacemaker implantation (
p
=1.0). Treatment with beta-blockers did not significantly affect quality of life as measured by the AFSS (
p
=0.77) reported global wellbeing (
p
=0.51) or exercise capacity as assessed by maximum heart rate at peak exercise (
p
=0.75) and peak oxygen consumption (VO2ml/kg.min) (
p
=0.65). Additionally, there were no differences between groups in self-reported heart failure (HF) symptoms as measured by the MLHFQ (
p
=0.69) or in mean Pro-BNP levels (
p
=0.63). Results were consistent when groups matched for age and sex.

Conclusions:
While there is some apprehension regarding the use of RLM in patients with HFpEF, in this observational study, there was no difference in exercise capacity, quality of life, HF symptoms or biomarkers between those using RLM and those not.