bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145113: Association of Vasoactive-Inotropic Score and Poor Outcomes, Including Mortality, in Patients Who Underwent Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis
Authors: Damarlapally Nanush , Vempati Roopeessh , Vasudevan Srivatsa Surya , Banda Prathibha , Mathur Gaurav , Khan Afrasayab , Mourad Denise , Polamarasetty Harshavardhan , Desai Rupak
Published: November 2024

Background:
Vasoactive-inotropic score (VIS) has been previously utilized as one of the predictors in open heart procedures postoperatively, but its association with poor outcomes in patients who underwent coronary artery bypass graft (CABG) is still unclear. We aim to find the association in this population.

Methods:
PubMed, Google Scholar, and Scopus were systematically searched for studies showing an association of poor cardiovascular (CV) outcomes, including mortality with VIS from inception to May 2024 following CABG surgery. Pooled effect sizes were estimated using a fixed-effect model and 95% confidence intervals (CI). I
2
statistics was used to measure heterogeneity. Leave-one-out sensitivity analysis and meta-regression analysis were utilized to measure the robustness of our findings and detect influencing confounding variables, respectively. Quality assessment of the studies was done through the Joanna Briggs Institute (JBI) tool. P-value <0.05 was considered significant.

Results:
Six studies with a total sample size of 6504 patients following CABG surgery, with a mean age of 63.6 ± 3.15 years, containing predominantly males (71.8%) reported poor outcomes such as CV morbidity, cardiopulmonary resuscitation, mechanical ventilation, stroke, and mortality. Most studies had hypertension, diabetes, and chronic kidney disease as comorbidities. Our meta-analysis found a significant association between VIS > 5 and poor outcomes, including mortality in six studies with pooled unadjusted OR-1.08 [95% CI: 1.06-1.10, p < 0.0001] and in four studies with adjusted OR-1.07 [95% CI: 1.04-1.09, p < 0.0001] among those who underwent CABG (Figure 1a). Sensitivity analysis showed no variations among studies and confirmed the robustness of our findings (Figures 2a&2b). Additionally, meta-regression analysis indicated that mean age was associated with a minimal progression rate of mortality in patients succeeding CABG with a VIS > 5 (p = 0.04). (Figure 1b) High scores in the JBI tool revealed high quality among the studies selected.

Conclusion:
Our study suggests that there is a significant association of VIS > 5 with poor cardiovascular outcomes in patients following CABG surgery. This association can help in preventing deleterious cardiovascular outcomes.
Abstract 4145115: Chemogenetic hydrogen sulfide donor rescues aortic perivascular adipose tissue and endothelial cell senescence in aging
Authors: Shabanian Khatereh , Shabanian Taraneh , Gergely Karsai , Paneni Francesco , RUSCHITZKA FRANK , Saeedi Soheil
Published: November 2024

Introduction:
Hydrogen sulfide (H
2
S) is increasingly recognized as an important signaling small molecule that mitigates vascular aging and extends lifespan. Reduced H
2
S production in aged vasculature underscores the unmet need for effective strategies to controllably generate cell-specific H
2
S in vascular cells predisposed to cellular senescence in aging. Here, we develop a chemogenetic technology to offer a new class of H
2
S-donors to rescue perivascular adipose tissue (PVAT)-endothelial cell (EC) senescence in aging.

Methods:
To characterize our innovative (peri)vascular senotherapy, we employed a chemogenetic approach combined with biosensor-based real-time fluorescence imaging, and senescence and cell-cell interaction analyses.

Results:
We employed a recombinant AAV2/8-Adipo construct expressing a yeast D-amino acid oxidase (DAAO), which oxidizes D-Cysteine to yield 3-mercaptopyruvate (3MP), converting to H
2
S and pyruvate by mercaptopyruvate sulfurtransferase (MPST) in PVAT. We cloned DAAO as a fusion protein with the H
2
S biosensor hsGFP, enabling both generation (DAAO) and detection (hsGFP) of H
2
S in the cell mitochondria.

Old mice (>24 months) exhibiting senescence in their aortic PVAT and ECs (indicated by ROS-induced oxidative stress, mitochondrial dysfunction, increased SASP component IL6, and proliferative arrest marker p16
INK4a
), were infected with AAV2/8-Adipo-DAAO-hsGFP-mito constructs. Fluorescence imaging documented robust
in vivo
H
2
S production in the distinct subcellular organelle after treatment with D-Cysteine (10 mM). Interestingly, these mice showed restored mitochondrial function and adipocyte marker UCP1, alongside downregulated IL6 in aortic PVAT.

Our old PVAT-EC co-culture studies revealed that chemogenetic H2S, by reducing IL6 release towards ECs, rescues senescence and dysfunction in ECs (decreased SA-β-gal activity, DNA damage response (↓ γ-H2A.X), and proliferative arrest (↓ p16
INK4a
&p19
INK4d
)). The rescued ECs also exhibited restored angiogenic capacity, demonstrated by increased tube formation.

Conclusions:
Our recent advances in chemogenetic technology provide a remote-control (Turn ON/OFF) and cell-specific tool for intracellular H
2
S-mediated rescue of PVAT-EC senescence in aging. This innovative approach offers promising avenues for developing a new class of H
2
S-based senotherapies with significant potential for clinical applications.
Abstract 4145133: Impact of Neutrophil-to-Lymphocyte Ratio on clinical outcomes in patients with and without Diabetes undergoing Percutaneous Coronary Intervention
Authors: Di Muro Francesca , Sartori Samantha , Vogel Birgit , Bay Benjamin , OLIVA ANGELO , Smith Kenneth , Gitto Mauro , Krishnan Prakash , Sweeny Joseph , Moreno Pedro , Leone Pier Pasquale , Krishnamoorthy Parasuram , Kini Annapoorna , Dangas George , Sharma Samin , Mehran Roxana
Published: November 2024

Background:
The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with adverse cardiovascular outcomes. Its prognostic role in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) is unknown.

Aims:
To investigate the prognostic impact of NLR in patients with and without DM undergoing PCI.

Methods:
We retrospectively evaluated consecutive patients undergoing PCI at a large tertiary center between 2012 and 2022. Quartiles of NLR were derived in the overall population, and patients were stratified according to the presence of DM. Within each group, we estimated the risk of adverse events with a multivariable Cox regression model using the lowest NLR quartile as a reference. The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), or stroke. Secondary endpoints were MACE individual components, target vessel revascularization (TVR), bleeding and acute kidney injury (AKI).

Results:
A total of 7,287 patients were included (47.7% with DM). DM patients had more comorbidities and higher baseline hs-CRP levels. Overall, patients with elevated NLR exhibited multi-vessel disease with moderate to severe calcification, thus requiring more complex PCI. At 1 year, among DM patients, the 4
th
quartile had a higher crude risk of MACE compared to the 1
st
quartile, albeit attenuated after adjustment (p=0.059). This difference was mainly driven by MI rates occurring in 6.0% vs 3.8% respectively (adjHR 1.70, 95% CI 1.01-2.87; P=0.045). Non-DM patients in the highest NLR quartile had increased rates of MACE (adjHR 2.12, 95% CI 1.29-3.49; P=0.003) primarily due to all-cause mortality (adjHR 3.04, 95% CI 1.49-6.20; P=0.002) after adjustment. Regarding secondary endpoints, elevated NLR correlated with higher incidence of (i) bleeding and AKI in both groups and (ii) TVR only in non-DM patients
(Figure 1).

Conclusions:
Our results suggest that patients undergoing PCI with a higher NLR experience worse clinical outcomes regardless of DM status. This was due to more MI in DM group and higher all-cause mortality in non-DM group. Higher NLR was also associated with an increased risk of bleeding and AKI.
Abstract 4145153: Heartfelt Headaches: Exploring Cardiac Cephalgia as an Etiology of Headaches
Authors: Amin Sheena , Rashid Khaldoon , O'Gorman Brendan , Storms Daniel
Published: November 2024

Introduction:
Cardiac cephalgia is an under-recognized type of headache.

Description of Case:
A 68-year-old female with past medical history of chronic headaches presents with one week of non-radiating central chest pain, exertional dyspnea, palpitations, lightheadedness, and worsening headaches. The headaches were described as a “stabbing and throbbing” pain starting at the vertex and radiating anteriorly. Triggers included stress, and associated symptoms included photophobia and nausea. An electrocardiogram was notable for new T-wave inversions in the inferior leads. An echocardiogram demonstrated an ejection fraction of 44% with regional akinesis of the inferior and inferolateral walls. Patient proceeded for left heart catheterization, which depicted total occlusion of the middle segment of the right coronary artery; a stent was successfully placed and dual antiplatelet therapy was initiated. Following stent placement, she endorsed resolution of her chronic headaches and has not had recurrence.

Discussion:
This case presents a patient with chronic headaches, initially diagnosed as migraines and occipital neuralgia. She had previously been treated with triptans and botulinum toxin without effect. Resolution of her headaches following revascularization suggest that cardiac cephalgia may be the underlying etiology. Cardiac cephalgia is a secondary headache disorder that is related to cardiac ischemia. It has classically been described as a headache that is triggered by exertion or stress and alleviated by rest or nitrates. Pathophysiology is incompletely understood but current theories include referred pain, simultaneous constriction of cerebral and coronary vessels, reduced cardiac output resulting in increased cardiac pressures and therefore decreased venous return from the brain, and cardiac ischemia-induced neurotransmitter release leading to cerebral vasodilation. The diagnosis of this condition is supported by a temporal relationship between coronary ischemia and headache onset. Interestingly, this patient had a headache onset several months before exhibiting signs of coronary ischemia but had an acute worsening at the time of presentation. It is important to keep cardiac cephalgia on the differential for patients with headaches in order to prevent treatment with agents, such as triptans and ergot derivatives, that are contraindicated in coronary artery disease.
Abstract 4145166: Early Report of Heart Failure Readmissions and Guideline-Directed Medical Therapy Use in A Virtual Hospital at Home Model of Care
Authors: Patolia Harsh , Platek Nicholas , Tang Ryan , Hohman Jessica , Albert Nancy , Kapadia Samir , Estep Jerry , Delaney Conor , Rothman Richard , Martyn Trejeeve
Published: November 2024

Background:
Interest in hospital at home (HaH) has grown, driven by recognition of potential to ameliorate capacity constraints and lower total costs of care associated with traditional “brick-and-mortar” (BaM) hospitalizations. Heart failure (HF) patients often require decongestion with intravenous diuretics and titration of multiple guideline-directed medical therapies (GDMT). We aimed to demonstrate that a virtual HaH model represents a safe and feasible option for patients with acute heart failure (AHF).

Methods:
This was a retrospective cohort analysis of patients admitted to the Cleveland Clinic HaH after clinical and social screening and enrollment in HaH from 4/2023 to 1/2024 (Fig 1). Patients with AHF were identified through pre-specified ICD-10 codes. We performed chart abstraction to evaluate demographic characteristics, admissions, vitals, lab values, 30-day readmissions/death, use of individual HF medications, and tabulated GDMT scores among this cohort of HaH patients. Statistical analysis involved parametric and non-parametric paired analysis at admission and discharge.

Results:
81% of patients (78/96) with AHF that were offered HaH as an alternative to BaM hospitalization opted to enroll in HaH. Patient were of median age 81 years [IQR 16], median LVEF 51.0% [IQR 20], and median admission NTproBNP 3518 [IQR 4619]; 66% of patients were male. Among the cohort, 7 (8.9%) patients were readmitted 30 days from discharge, and there were no deaths in the cohort at 30 month follow-up. By paired analysis, there was a net increase in GDMT score. Systolic blood pressure, diastolic blood pressure, and weight significantly trended down after admission to the HaH (Fig 2).

Conclusions:
In an early cohort of patients, HaH was selected by most eligible patients over BaM hospital care. There were low rates of readmission and net improvement in GDMT use. HaH can be safe and effective for selected HF patients, though further prospective research is needed.
Abstract 4145171: The CCL22/CCR4 Axis Promotes Beige Adipocyte Formation
Authors: Hu Ruoci , Park Jooman , Xiong Shaolei , Xu Pingwen , Jiang Yuwei
Published: November 2024

Introduction:
Beige adipocytes hold therapeutic promise for obese and diabetic patients. Beige adipocytes can be generated from tissue-residing beige progenitors (APCs) in response to cold temperatures preferably around lymph nodes (LN), suggesting that there are unique LN-derived signals controlling beige adipocyte generation.

Methods:
CCR4 KO mice (spCas9 mice were injected with AAV8-CCR4-sgRNA into biolateral inguinal adipose tissue) were generated on a C57BL/6 background. Stromal vascular cells were isolated and differentiated into beige adipocytes for in vitro studies. Flow cytometer analysis were conducted for sorting and identifying immune cells.

Results:
Here, we show that local LN removal greatly impairs cold-induced beiging, and this impairment can be restored by injecting M2 macrophages or macrophage-derived chemokine C-C motif ligand 22 (CCL22) into iWAT. Mechanistically, cold exposure increases the level of CCL22, which binds to its receptor C-C chemokine motif receptor 4 (CCR4), and then promotes beiging. Furthermore, CCL22 levels are inversely correlated with body weight and fat mass, and elevated CCL22 levels prevent diet-induced obesity along with increased energy expenditure in mice and humans.

Conclusion:
The results suggest that beige adipogenesis around the inguinal LNs of white adipose tissues depends on the CCL22-CCR4 signaling. Our findings underline the potential of targeting the CCL22-CCR4 axis to counter obesity and its associated health complications.
Abstract 4145173: Neighborhood Socioeconomic Deprivation is Associated with Mortality and Readmission for Common Cardiovascular Conditions: a Nationwide Cohort Study of >2 Million Patients
Authors: Lusk Jay , Blass Beau , Mahoney Hannah , Hoffman Molly , Clark Amy , Bae Jonathan , Mentz Robert , Wang Tracy , Patel Manesh , Hammill Bradley
Published: November 2024

Introduction/Background:
Understanding the relationship between neighborhood socioeconomic environment and cardiovascular outcomes is important to implement effective quality strategies to ensure health equity.

Goals/Aims:
To determine the association of neighborhood socioeconomic deprivation with 30-day mortality and readmission for patients admitted with common cardiovascular conditions.

Methods/Approach:
We examined claims data from fee-for-service Medicare beneficiaries aged >=65 with 1 year of preceding fee-for-service eligibility between 2017-2019 admitted for heart failure, valvular heart disease, ischemic heart disease, or cardiac arrhythmias. The primary exposure was the Area Deprivation Index, and outcomes were 30-day all-cause mortality and unplanned readmission. We used logistic regression models and adjusted for demographics, medical comorbidity burden, access to healthcare resources, and characteristics of admitting hospitals.

Results/Data:
A total of 2,064,426 admissions were included. Patients from socioeconomically deprived neighborhoods generally had higher observed mortality and readmission (Table 1). After full adjustment, neighborhood socioeconomic status was associated with increased 30-day mortality and readmission for all cardiovascular conditions studied. Unadjusted and sequentially adjusted models for 30-day mortality are shown in Table 2. Figure 1 visualizes the adjusted association between neighborhood deprivation and 30-day mortality and readmission.

Conclusions:
Neighborhood socioeconomic deprivation was independently associated with increased 30-day mortality and readmission for several common cardiovascular conditions.
Abstract 4145195: Native Tricuspid Valve Hematoma and Pulmonary Artery Pseudoaneurysm Mimicking Cardiac Behcet's
Authors: Naseer Zaid , Motaweih Mohammad , Issa Najy , Kerley John , Aiken Matthew , Choudhry Mohammed , Schatz Aaron
Published: November 2024

We report a case of a giant organizing hematoma attached to a native tricuspid valve in a 32-year-old man. In the absence of predisposing valvular disease, trauma, endocarditis, or a hypercoagulable disorder, intracardiac hematoma formation on a native tricuspid valve is an extremely rare entity with no reported incidence.

A recently incarcerated 32-year-old man presented with subacute hemoptysis, dyspnea, and night sweats. He had a history of unexplained penile ulcers. His exam was notable for multiple tattoos and a systolic murmur. Chest CTA revealed a 4.6 cm x 2.5 cm right ventricular mass, multiple pulmonary nodules, and bilateral pulmonary emboli. Transesophageal echocardiogram identified a large irregularly bordered mass attached to the anterior tricuspid valve leaflet and right ventricular free wall. Cardiac MRI confirmed a lobulated mass within the right ventricle and an additional 2 cm lesion adjacent to the septum. Multiple sets of blood cultures were negative. Patient had a positive QuantiFERON TB gold and a negative AFB culture, suggesting TB latency. An extensive infectious, hematologic, and rheumatologic workup was otherwise negative. Despite anticoagulation and antibiotics, the mass remained unchanged. The mass was surgically resected, and the tricuspid valve was replaced with a bioprosthetic valve. Histopathology demonstrated an exuberant inflammatory response with organizing granulation tissue from a non-neoplastic process such as organizing hematoma. Postoperatively, the patient developed worsening hemoptysis, requiring intubation and bronchoscopic removal of large airway clots, and upper extremity deep venous thrombosis. Repeat CTA showed multiple pulmonary artery pseudoaneurysms, raising suspicion for vasculitis.

Our patient met the International Criteria for Behcet’s, with a score
>
4. Hughes Stovin Syndrome is a rare hypothesized cardiovascular variant of Behcet’s Disease that presents with pulmonary artery aneurysms, venous thrombosis, and intracardiac thrombi. Hematomas on a native cardiac valve in this context have never been reported and may result from similar local endothelial vasculitic processes. Steroids are the mainstay treatment, and anticoagulation is avoided in the presence of pulmonary artery pseudoaneurysms.

Vasculitis should be considered in cases of unusual cardiac masses. Although vascular lesions in Behcet’s syndrome are rare, their recognition is essential as they can be fatal if improperly treated.
Abstract 4145199: Prevalence and Prognostic Implications of Sleep Disordered Breathing in Hypertrophic Cardiomyopathy
Authors: Karim Shahid , Chahal Anwar , Venkataraman Shreyas , Deshmukh Abhishek , Siontis Konstantinos , mansukhani meghna , Konecny Thomas , Khanji Mohammed , Petersen Steffen , Geske Jeffrey , Somers Virend
Published: November 2024

Background:
Sleep disordered breathing (SDB) is frequently observed in patients with cardiovascular disease, and is associated with intermittent hypoxia, sympathetic activation, oxidative stress, and endothelial dysfunction, all of which may facilitate the development and progression of cardiovascular disease.

Objectives:
We sought to determine the prevalence, subtypes, and clinical implications of comorbid SDB in patients with hypertrophic cardiomyopathy (HCM).

Methods:
In this prospective observational study, patients with HCM without prior diagnosis of SDB were recruited to undergo inpatient polysomnography between May 1
st
2018 and October 31
st
2022. Electrocardiographic and echocardiographic parameters, cardiac biomarkers, and symptoms were comparatively assessed in patients with and without comorbid SDB. Patients were assessed for the development of major adverse cardiovascular events (MACE) during follow-up (median 29, range 3-57 months).

Results

Among 154 participants, 91 (59.1%) were diagnosed with SDB of whom 38 (41.8%) had mild, 22 (24.2%) moderate, 18 (19.8%) severe obstructive sleep apnea, and 13 (14.3%) had central sleep apnea. SDB was associated with greater left ventricular mass (median [IQR]) (128 [107, 161] vs. 109 [96, 134] g/m
2
,
p
=0.034) and E/e’ ratio (12.5 [10, 15] vs. 10.0 [8.3, 14.5],
p
=0.039). Patients with HCM over the age of 50 years, with body mass index ≥ 30kg/m
2
, who described their sleep as “poor” were at particularly high risk of having comorbid SDB, as were those who were diabetic, hypertensive, or described greater exertional limitation (NYHA Class ≥II 53% vs. 27%,
p
=0.005).

Importantly, subjects with SDB had elevated baseline Troponin T levels (14 ng/L vs 11 ng/L,
p
=0.030), and further substantial overnight troponin increases following untreated apneic sleep (2.1ng/L vs 0.2ng/L,
p
=0.009). Finally, patients with comorbid SDB experienced a significantly higher proportion of incident adverse cardiovascular events (MACE hazard ratio 5.3, 95% CI, 1.6, 17.2,
p
=0.006) than those without SDB.

Conclusions:
We report a particularly high burden of previously undiagnosed SDB in patients with HCM, particularly in older, heavier, male patients. Undiagnosed SDB in HCM is not benign and is associated with symptom progression, comorbidity, and a poorer prognosis, particularly in the case of central sleep apnea. These important new findings provide rationale for heightened vigilance and routine screening for SDB in patients with HCM.
Abstract 4145225: Sodium Glucose Cotransporter 2 Inhibitors After Acute Myocardial Infarction: An updated systematic review and meta-analysis.
Authors: Scardini Pedro Gabriel , Katsuyama Eric , Prata Alonzo , Falco Neto Wilson , Fukunaga Christian , Coan Ana Carolina , Fernandes Julia , Petri Santos Pinheiro Rafael , Andrade Naieli , Gioli-Pereira Luciana
Published: November 2024

Background:
Sodium-glucose co-transporter two inhibitors (SGLT2i) have recently been included in heart failure (HF) guidelines due to their benefits in reducing mortality and hospitalization rates. However, the benefits of SGLT2i in patients with post-acute myocardial infarction (MI) remain controversial. Therefore, we aim to perform an updated systematic review and meta-analysis comparing SGLT2i with placebo in patients after an acute MI.

Methods:
We performed a systematic review and meta-analysis to determine the impact of SLGT2i in patients with post-acute MI with or without diabetes type II (DM II). We systematically searched Pubmed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing SGLT2i and placebo in patients following an acute MI. The primary outcome assessed was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes:(2) cardiovascular (CV) mortality and (3) MI recurrence. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model.

Results:
Our meta-analysis included ten RCTs comprising 25908 patients, of whom 14098 (54.4%) received SGLT2i therapy and 15078 (58.2%) had type II diabetes. The mean age was 62 years, and the mean follow-up was 21.2 months. In the pooled analysis, HF hospitalization was significantly lower in the SGLT2is group (RR 0.76; 95%CI 0.68,0.84; p<0.001; Fig. 1). There was no statistically significant difference between the groups in terms of MI recurrence rates (RR 1.05; 95%CI 0.79,1.39; p=0.7; Fig. 2 A) and CV mortality (RR 0.91; 95%CI 0.75,1.11; p=0.34; Fig. 2 B).

Conclusion:
In this updated meta-analysis of patients with a history of acute myocardial infarction, the administration of SGLT2i was significantly associated with reduced hospitalization rates for heart failure. However, our results show no benefits in MI recurrence and CV mortality endpoints.
Abstract 4145226: Sex Differences in Associations Between Adverse Childhood Experiences, Psychological Distress and Health Status in Patients with Recent Myocardial Infarction
Authors: Bartelloni Alexis , Arabadjian Milla , Sareen Sinia , de Brito Stefany , Smilowitz Nathaniel , Reynolds Harmony , Spruill Tanya
Published: November 2024

Introduction:
Adverse childhood experiences (ACEs) are associated with psychological distress in adulthood and increased cardiovascular disease (CVD) risk. Less is known about these relationships in patients with established CVD.

Objective:
To examine associations between ACEs and psychological distress and disease-specific health status in adults with recent myocardial infarction (MI). We hypothesized that MI patients with higher ACE exposure will report greater distress and poorer health status with stronger associations in women than men.

Methods:
We analyzed baseline data from an ongoing longitudinal study of adults post-MI. Five ACEs were assessed: living with someone with chronic illness/disability, mental illness or substance abuse; parental separation/divorce; long-term financial problems. Outcomes were elevated perceived stress (PSS4 ≥6) and depressive symptoms (PHQ2 ≥3) and disease-specific health status (Seattle Angina Questionnaire [SAQ7 summary score]). We used chi-square tests, t-tests and linear regression to test univariate and multivariate associations, overall and by sex.

Results:
The 143 participants (36.4% women, mean age 61.5 years [SD=13.4]) completed questionnaires at median 40.5 days post-MI (IQR=22-64.5). At least one ACE was reported by 51% of participants (53.8% women vs. 46.2% men, p=0.73). Women had somewhat poorer health status than men (69.2±22.8 vs. 74.5±18.8; p=0.07) but similar rates of elevated stress (64.7% vs. 51.7%, p=0.16) and depressive symptoms (21.6% vs. 16.9%, p=0.51). Women with ≥1 ACE had poorer health status (62.6 vs. 77.1, p=0.01) and higher rates of elevated stress (78.6% vs. 47.8%, p=0.02) and depressive symptoms (32.1% vs. 8.7%, p=0.04) than those without ACEs; there were no associations in men. After adjusting for age, body mass index, time since MI and participation in cardiac rehabilitation, greater ACEs exposure (0-5) was associated with poorer health status in women (B=-7.2, SE=2.4, p=0.005) but not in men (B=1.9, SE=2.2, p=0.38); the association in women was reduced when further adjusting for PSS4 and PHQ2 scores (B=-3.7, SE=2.8, p=0.20), suggesting a possible mediating effect of distress.

Conclusions:
Higher ACE exposure is associated with greater psychological distress and worse disease-specific health status in women post-MI. These associations were not observed in men despite similar levels of ACE exposure. ACEs screening may help identify women who could benefit from psychosocial support after MI.
Abstract 4145231: Immuno-Hematologic Aging and Resilience: Novel Markers of Cardiovascular Risk
Authors: Yu Arion , Titus Anoop , Nasir Khurram , Zidar David , Al-Kindi Sadeer
Published: November 2024

Background:
Aging is a complex process that affects various organ systems, including the cardiovascular (CV) and immune systems. Chronologic age does not fully capture the heterogeneity in biological aging, and studies suggest that the immuno-hematologic (IH) systems play a critical role in the aging process and may contribute to CV disease. However, the relationship between IH aging and CV risk is not well characterized. Routine complete blood count with differential (CBC-diff) is a widely available test that assesses blood components. Its utility in capturing biological age and association with CV risk has not been explored.

Methods:
Using data from adult participants in NHANES 1999-2018, we trained an XGBoost model to predict chronologic age using 20 variables obtained from CBC-diff. The model was trained on 50% of the data (n=26,677), and the remaining 50% (n=26,677) was used to predict age (IH
AGE
). We calculated the difference between IH
AGE
and chronologic age (ΔAge), and categorized it into 3 groups: proportionate IH aging (ΔAge -10 to 10 years), accelerated IH aging (ΔAge >10 years), and resilient IH aging (ΔAge <-10 years). We then examined the association between IH groups and CV mortality using Cox regression models (model 1 adjusted for chronologic age and model 2 additionally adjusted for sex, race, body mass index, blood pressure, history of diabetes, kidney disease, heart failure, coronary disease, myocardial infarction, stroke, smoking and serum cholesterol).

Results:
A total of 10,621 (39.8%) had proportionate IH aging, 7,953 (29.8%) had resilient IH aging, and 8,103 (30.4%) had accelerated IH aging (figure). In model 1, accelerated IH aging was associated with near doubling of CVM risk (adjusted hazard ratio [aHR] 2.28, 95% CI [1.66-3.13], P<0.001), while IH resilience was associated with a near half the risk of CVM (aHR 0.54, 95% CI [0.47-0.62], P<0.001). In model 2, resilient aging was associated with 32% lower risk of CV mortality (aHR 0.68, 95% CI [0.58-0.80], P<0.001), while accelerated aging had a 75% higher risk of CV mortality (aHR 1.75, 95% CI [1.22-2.51], P<0.001), figure. The leading contributors to IH
AGE
were RDW, MCV and Absolute Lymphocyte Count.

Conclusions:
We introduce a new concept, IH
AGE
, which captures IH biologic aging from CBC-diff. IH aging is independently associated with CV mortality, providing a novel tool for risk stratification and personalized prevention strategies in cardiovascular disease.
Abstract 4145234:

Trends in 30-Day Readmission Rate, Mortality Outcome and Resources Utilization Among Patient who underwent Leadless Pacemaker Revision and Removal.
Authors: Fatuyi Michael , Udongwo Ndausung , Abe Temidayo , Akinti Oluwasegun , Stacy John , Amoah Joseph , IYEKU Akinwale , Kenarsary Aria , Goldberger Zachary , Modaff Daniel , Kalscheur Matthew , Vasireddi Sunil
Published: November 2024

Background:
Leadless pacemakers (LPM) utilization has grown significantly, yet data on LPM removal and/or revision (LPM-RR) remains limited. This study aims to evaluate trends in 30-day readmission rate (30-dRr), mortality, and resource utilization associated with LPM-RR

Method:
We analyzed data from the Nationwide Readmission Database from 2016 to 2021. Patients ≥ 18 years who underwent LPM-RR were identified using ICD-10 codes. The primary outcome was the trend on 30-dRr following LPM-RR. Secondary outcomes included mortality, resource utilization (Length of stay {LOS}&inflation-adjusted mean hospital cost),&most common readmission diagnosis. Predictive marginal effects over the years®ression analyses were conducted.

Results:
LPMs placement increased from 350 in 2016 to 16,225 in 2021 (p-trend < 0.001), while the rate of revisions and removals declined from 6.2% to 1.2% (p-trend < 0.001). The mean age at index admission was 70.9 years with 51.6% females, compared to 71.6 years and 60.8% males among readmitted patients. The 30-dRr increased slightly from 13.8% in 2016 to 16% in 2021 (p trend = 0.1). Index admission mortality trends were non-significant, decreasing from 7.4% in 2017 to 4.2% in 2021 (p-trend = 0.4). Readmission mortality trends also remained non-significant, from 8.3% in 2016 to 8.4% in 2021 (p-trend = 0.3). The index admission mean LOS was 12.1 days in 2016 to 10.2 days in 2021 (p trend = 0.09), while readmission mean LOS was 4.1 days to 3.8 days (p trend = 0.9). The inflation-adjusted mean hospital cost for index admissions decreased from $76,432.5 in 2016 to $61,501 in 2021 (p trend = 0.08), whereas readmission costs increased from $6,773 to $9,358 (p-trend = 0.7). The most common reason for readmission was hypertensive heart disease with heart failure.

Conclusion:
From 2016 to 2021, LPM implantation grew rapidly with a significant decline in revision and removal rates. During this period, 30-dRr&resource utilization have remained relatively stable, with a trend toward decreasing mortality within 30 days after LPM implantation, likely owing to technology/technique advancements, increased experience, as well as patient selection. Further research is needed to assess outcomes for the rapidly evolving use of LPM in an increasingly broader range of patient populations.
Abstract 4145244: Burden and Impact of Pulmonary Embolism in Young Adults Hospitalized With Sarcoidosis - Underreported Data from Nationwide Analysis (2016-2020)
Authors: Sura Harsh , Bhanushali Aditi , Suchday Pooja , Sampath Shrikanth , Chunduru Lohithasya chowdary , Byralinge Gowda Purvik , Kari Moulika , Karumanchi Abhimanyu , Desai Rupak
Published: November 2024

BACKGROUND:
Studies in the past have demonstrated an association between sarcoidosis and pulmonary embolism but little is known about its impact, especially in young adults. We aim to determine the burden and impact of pulmonary embolism (PE) in young adults hospitalized with sarcoidosis.

METHOD:
The study investigates the prevalence and consequences of PE in young adults aged 18-44 years hospitalized with sarcoidosis using data from the National Inpatient Sample (2016-2020) with relevant ICD-10 codes. This study aims to address the primary outcomes of the burden and trends of PE and its associated impact on in-hospital mortality. Additionally, it explores secondary outcomes such as healthcare resource utilization and discharge patterns.

RESULT:
Among 50,385 young adults (median age 37 years) hospitalized with sarcoidosis, 1120 had PE, showing a linear increase from 2% in 2016 to 2.9% (p<0.001) in 2020. Sarcoidosis-PE+ group, predominantly in young blacks, exhibited a higher prevalence of comorbidities such as obesity, smoking, drug use, peripheral vascular disease, hypothyroidism, and prior history of VTE. In contrast, the sarcoidosis-PE- group had a higher prevalence of diabetes (with/without chronic complication), hyperlipidemia, and chronic pulmonary disease. Multivariable regression analysis adjusted for all potential sociodemographic and comorbid variables showed higher odds of all-cause mortality (OR: 2.92, 95% CI: 1.18-7.24, p <0.02) in the sarcoidosis-PE+ group as compared to sarcoidosis-PE- group. The sarcoidosis-PE+ group also had higher hospital costs and length of stay.

CONCLUSION:
The higher odds of in-hospital mortality with an increased length of stay and hospital cost observed in the sarcoidosis-PE+ group highlight the often underreported complications of sarcoidosis, particularly in a younger demographic. The relevance of this study stems from its potential to uncover trends that could lead to improved diagnostic and therapeutic strategies.
Abstract 4145264: Balloon-expandable versus Self-expandable transcatheter aortic valve replacement for failed surgical prostheses: A systematic review and meta-analysis
Authors: K. Awad Ahmed , Khalefa Basma , Negmeldin Aly Yassin Mazen , Arnaout Moumen , Mostafa Naydeen , S. Naeem Mariana , Eljadid Ghaith , Gardezi Syed Karam
Published: November 2024

Background:
Transcatheter aortic valve-in-valve (VIV) replacement has emerged as a valid alternative to conventional re-operation for the treatment of failed bioprosthetic surgical aortic valves. Self-expandable valves (SEV) and balloon-expandable valves (BEV) are the two major devices used. The aim of this study is to compare outcomes between SEV and BEV when used for transcatheter aortic valve replacement (TAVR) procedures in failed surgical prostheses.

Methods:
A comprehensive search was conducted on PubMed, Scopus, Web of Science, Cochrane Library, and Embase databases to identify studies comparing aortic valve in valve (ViV) with SEV and BEV for failed surgical aortic prostheses from inception to May 22, 2024. To estimate the effect size, dichotomous outcomes were pooled as risk ratio (RR), and continuous outcomes were pooled as mean difference (MD) with their respective 95% confidence interval (CI).

Results:
We included nine studies with a total of 1258 patients in the SEV group and 1079 in the BEV group. Compared to patients in the BEV group, patients in the SEV group had significantly lower one-year mortality (RR = 0.69; 95% CI: [0.49-0.98], p = 0.04). SEV group also had less incidence of severe patient protheses mismatch (RR = 0.49; 95% CI: [0.32-0.75], p <0.01). On the other hand, patients with SEV had a significantly higher risk of moderate to severe aortic regurgitation (AR) (RR = 2.71; 95% CI: [1.69-4.36], p = <0.01) as well as permanent pacemaker implantation (PPI) (RR = 1.63; 95% CI: [1.18 - 2.26], p <0.01). There was no difference in the rate of coronary obstruction (RR = 0.87; 95% CI: [ 0.49-1.55], p = 0.64), stroke (RR = 0.82; 95% CI: [0.42-1.58], p = 0.55), and short-term mortality (RR = 0.76; 95% CI: [0.49-1.18], p = 0.23) between both groups. One-year change in mean aortic valve gradient was comparable between both groups (MD = -13.94; 95% CI:[-31.16-3.28], p = 0.11).

Conclusion:
The present systematic review and meta-analysis found that for patients with failed surgical protheses who underwent transcatheter aortic VIV, SEV was associated with significantly less rate of one-year mortality and severe patients Prosthesis mismatch, but higher rates of PPI implantation and AR of moderate or higher degree. These findings provide valuable information in guiding proper selection of devices for patients with degenerated aortic surgical bioprostheses.
Abstract 4145267: An Unusual Case of Listeria LVAD Infection Complicated by Intracranial Catastrophe
Authors: Zviman Julieann , Ramani Gautam , Jones Niya , Griffith Bartley , Dees Lynn , Nevin Amanda , Crowell Leigha , Soares Cullen , AMOROSO ANTHONY , Mouradjian Mallory , Rovelli Richard , Leventhal Sarah , Ananthram Manjula
Published: November 2024

Description of Case:
A 56-year-old male with ischemic cardiomyopathy, HeartMate 3 LVAD implantation presented with fatigue and diarrhea after eating expired cheese a week prior. Hypovolemia, AKI, an unremarkable LVAD interrogation and an INR of 3.4 were noted. Blood cultures and infectious work-up including imaging were obtained. Imaging was unremarkable. Over the first 2 hospital days, he was fluid resuscitated. Hemodynamics showed low biventricular filling pressures and adequate cardiac index. On hospital day 3, blood cultures revealed
Listeria monocytogenes
prompting initiation of IV ampicillin. AKI worsened, associated with altered mentation requiring endotracheal intubation and renal replacement therapy.

On hospital day 8, bronchoscopy was performed to address worsening respiratory secretions. An hour after procedural sedation, he never regained consciousness and anisocoria was noted. Emergent cranial imaging revealed multicompartment hemorrhage with midline shift. Neurosurgical intervention was not recommended due to the catastrophic nature of the bleeding. Supportive pharmacologic measures were futile; brain death was declared 48 hours later.

Discussion:
Listeria monocytogenes
is a gram-positive rod which causes gastrointestinal illness in immunocompetent adults. Cases of Listeria bacteremia in patients with indwelling cardiac hardware are rare but have been previously described in the literature. A case of
Listeria
bacteremia and leukocytoclastic vasculitis in an LVAD patient resulting in AKI has been reported. To our knowledge, this is the first published case of
Listeria
bacteremia in an LVAD patient complicated by acute intracranial hemorrhage.

While the exact mechanism of the brain bleed was not confirmed, it is postulated that the altered mental status and AKI were the products of septic embolization to the brain and kidneys, with ultimate hemorrhagic conversion noted in the setting of therapeutic anticoagulation. A transesophageal echocardiogram had been planned prior to the stroke but not performed due to medical futility.

Clinicians should be aware of the more unusual complications of
Listeria
infection in the setting of indwelling cardiac hardware.
Abstract 4145292: DERIVATION OF AN ARTIFICIAL INTELLIGENCE - BASED ELECTROCARDIOGRAPHIC MODEL FOR THE DETECTION OF ACUTE CORONARY OCCLUSIVE MYOCARDIAL INFARCTION
Authors: Diaz Braiana , Castro García Carlos Alan , Velez Talavera Karen Gissel , Roman-Rangel Edgar , Espinosa Pilar , March Santiago , Arias Alexandra , Araiza Diego
Published: November 2024

INTRODUCTION:
Current ACS guidelines suggest classifying patients according to the presence of persistent ST segment elevation, as a finding suggestive of acute thrombotic coronary occlusion. However, large series have documented that up to 15% of patients initially classified as NSTEMI will show evidence of total coronary occlusion on index angiography, increasing the length of stay, use of hospital resources, and short-term and long-term mortality. Therefore, prompt detection of Acute Coronary Occlusion Myocardial Infarction (ACOMI) is paramount.

AIMS:
We aimed to assess the performance of an AI-ECG based model capable of detecting ACOMI in the setting of patients with ACS.

Methods:
This is a prospective study based on the development of an AI-ECG based model capable of detecting ACOMI. A publicly available dataset (PTB-XL ECG) of 21,837 12-lead ECGs was used for training in recognizing ST-segment elevation. Regarding the detection of ACOMI, 12-lead ECGs from 361 patients who presented to the ED with an ACS (2017-2023) at our center were digitized with phone cameras of varying quality. ECGs were independently evaluated by two expert cardiologists blinded to clinical outcomes; each was asked to determine a) whether the patient had an STEMI, based on universal criteria or b) if STEMI criteria was not met, to identify any other ECG finding suggestive of ACOMI. ACOMI was defined as the presence of one of the following: TIMI V thrombus, TIMI thrombus grade 2 or higher + TIMI grade flow 1 or less, or the presence of a subocclusive (>90%) lesion. Patients were classified into four groups: STEMI + ACOMI, NSTEMI + ACOMI, STEMI + non-ACOMI and NSTEMI + non-ACOMI. Performance of the AI model was evaluated using a comparison of multiple areas under the receiver operating characteristic curve (AUC-ROC). Sensitivity, specificity, positive and negative (PPV, NPV) predictive values and F1-score were also calculated.

Results:
The AI model accomplished an AUC of 0.8667 in identifying ACOMI, outperforming ECG experts (AUC: 0.3333) and the use of universal STEMI criteria (AUC: 0.5095). It also accomplished a sensitivity of 1, specificity of 0.733, a PPV of 0.846, an NPV of 1 and an F1-score of 0.92.

Conclusion:
Our AI-ECG model demonstrated a higher diagnostic precision for the detection of ACOMI compared with experts and use of STEMI criteria. Further research and external validation is needed to understand the role of AI-based models in the setting of ACS.
:
Abstract 4145297: Cardiac Myxomas: Presentation, Radiological Aspects, and Surgical Outcomes - Successful Results in a Series of 54 Cases
Authors: KARBI Mohammed Amine , ZEBIRATE Linda , RAHDOUN Mohamed , BENTRIKI Sid Ahmed , djezzar mhamed , AMIR Makhlouf , OULDABDERRAHMANE Mohamed , Boukli Hacene Ahmed Zaki , Bouchenafa Sami , ATBI Mohamed
Published: November 2024

Introduction:
Cardiac myxoma is a rare and benign primary cardiac tumor, accounting for 50% of all primary cardiac tumors. The aim of this study is to analyze our experience of cardiac myxomas with a significant number of cases over the past seven years.

Materials and Methods:
This is a retrospective and descriptive study of 54 cases of cardiac myxomas, representing 93% of all cardiac tumors surgically treated in our cardiac surgery department, from June 2017 to May 2024. All clinical, morphological, perioperative data and the possibility of recurrence and tumor embolism of these patients were analyzed.

Results:
The mean age of the patients was 55 ± 5 years. Women represented 65% (n=35). The circumstances of discovery were dyspnea in 57% (n=31), asymptomatic in 20% (n=11), and embolism in 15% (n=8). Auscultation was normal in 75% (n=46). Complete arrhythmia by atrial fibrillation was observed in 18.5% (n=10). Transthoracic echocardiography revealed the location of the myxoma in the left atrium in 83.3% (n=45), the right atrium in 9.3% (n=5), an exceptional location at the ventricular side of the tricuspid valve in one case, and another rare location in the left ventricle. Myxomas were obstructive in 59% (n=32). Multiple myxomas were found in 4% (n=2). They had a broad implantation base in 85% (n=46). Cardiac CT and/or MRI was used in 28% (n=15). Surgical excision under extracorporeal circulation was performed in all patients, with 18.5% (n=10) considered emergencies and 15% (n=8) performed on a beating heart. Immediate postoperative outcomes were simple in 76% (n=41). There was one death with a mortality rate of 1.8%, and two recurrences were recorded with an actuarial recurrence rate of 0.037 (95% CI: [0.000; 0.087]). The long-term prognosis was excellent with an actuarial survival rate of 0.981 (95% CI: [0.945; 1.000]).

Conclusion:
Myxoma is the most common benign cardiac tumor, characterized by clinical polymorphism. Transthoracic echocardiography is the reference examination. Surgery involves a wide excision of the myxoma with its implantation area and should be performed as soon as the diagnosis is confirmed to avoid any embolic complications. The prognosis after surgery is excellent, but follow-up is recommended due to the risk of recurrence.
Abstract 4145368: Dexmedetomidine for prevention of postoperative delirium in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials
Authors: Barbosa Lucas , Tavares Arthur , Queiroz Ivo , Mesquita Cynthia
Published: November 2024

Background:
Postoperative delirium is a prevalent complication following cardiac surgery. In recents studies, dexmedetomidine has been proposed as a potential alternative to mitigate this condition. This meta-analysis aimed to evaluate the efficacy of dexmedetomidine for prevention of postoperative delirium after cardiac surgery.

Methods:
We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the efficacy of dexmedetomidine compared to placebo in patients undergoing cardiac surgeries. We pooled risk ratios (RR) for binary outcomes with 95% confidence intervals (CI) with a random-effects model. We used R version 4.3.2 for all statistical analyses.

Results:
Our meta-analysis included 12 RCTs comprising 3016 patients, of whom 1515 (50.2%) were randomized to dexmedetomidine. The mean age ranged from 43 to 74 years among studies. Compared with placebo, dexmedetomidine significantly reduced the incidence of postoperative delirium (RR 0.67; 95% CI: 0.48 to 0.95; p<0.05; Figure A). However, there were no significant differences in hypotension (RR 1.34; 95% CI: 0.75 to 2.42; p=0.33; Figure B), and death (RR 0.83; 95% CI: 0.45 to 1.53; p=0.54; Figure C) between groups.

Conclusion:
In patients undergoing cardiac surgery dexmedetomidine significantly reduced the incidence of postoperative delirium. Larger RCTs are warranted to validate these results.