bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9555: Human Valve Atlas in Health and Disease
Authors: Liu Ziyi , Liu Yu , Yu Zhiyun , O'Donnell Anna , Guo Minzhe , Chen Ya-Wen , Glass Ian , Yutzey Katherine , Wu Joseph , Miao Yifei , Gu Mingxia
Published: June 2023

Background:
Semilunar and atrioventricular valves have distinct structures and are often affected differently in congenital valve diseases (CVD). Here we aim to define and compare the cellular composition and transcriptomic signatures of four different human fetal valves, which provide a reference map to engineer valves
in vitro
, and to study valve-specific impairment in CVD.

Methods:
Aortic, pulmonary, mitral, and tricuspid valves were barcoded respectively from a healthy human fetal heart at gestational day 105. Single-cell (sc)RNA-seq was performed. Spatial localization of new subpopulations was determined by immunostaining and in situ hybridization. Cell-cell interaction was revealed by cell-chat.

Results:
scRNA-seq analysis revealed major cell types including endothelial (VECs), interstitial (VICs), and immune cells. In addition to reported collagen & glycosaminoglycan (GAG) VIC in mice, VIC sub-clustering identified two human-specific APOE+ and CLDN11+ subpopulations. APOE+ VICs specifically located underneath VECs facing unidirectional flow, indicating cell-cell interaction of APOE+ VICs & VECs. VEC sub-clustering identified lymphatic VECs under turbulent flow, while CD55+ & PTGDS+ VECs under unidirectional flow. Cell-chat uncovered NOTCH3-JAG1 pairs in facilitating the co-development of spatially adjacent APOE+ VICs & PTGDS+ VECs. To further uncover valve-specific signatures, we compared gene expression profiles of four valves. In lymphatic VECs, genes regulating BMP pathway were enriched in semilunar valves. In GAG VICs, MAPK pathway was specifically enriched in pulmonary valve, indicating development of different valves may need activation of different pathways. Interestingly, when comparing valve with pulmonary atresia versus healthy pulmonary valve using scRNA-seq, both MAPK related genes and GAG VICs were significantly reduced, suggesting impaired MAPK may contribute to pulmonary-specific loss of GAG VICs leading to its abnormal development.

Conclusion:
Our high-resolution atlas of human fetal valves revealed subtypes of VIC & VEC with unique spatial locations. Comparison of four valves identified pulmonary valve-specific MAPK pathway that may explain loss of GAG VICs in patients with pulmonary atresia.
Abstract 9704: Role of Arterial Blood Gas Variables in the Prognostication of Patients With Acute Decompensated Heart Failure Admitted to Cardiac Intensive Care Unit
Authors: Quintana Miguel A , Lopez Ruiz Arnaldo , Benitez Marcos , Gimenez Jose , Martinez Jorge , Roa Johana , Enciso Angel
Published: June 2023

Introduction:
Several risk factors and scores have been studied to predict in-hospital mortality [IHM] and rehospitalization [RH] in patients with AHF.

Hypothesis:
The impact of the initial therapies implemented for AHF on the variables of the acid base gases (ABG) has not been evaluated for prognostication of IHM and RH.

Methods:
We prospectively evaluated 216 patients admitted in CICU with AHF from 2015 to 2021. Demographic, clinical and ABG variables were analyzed on admission and at 24 hours. Patients were grouped according to whether they presented improvement in respiratory failure, defined as improvement in SaO2, PaO2 and PaCO2 as well as de-escalation of respiratory support devices (NIV or high flow). The aim of the study was to identify whether the improvement in ABG variables, O2 requirement or respiratory support within 24 hours of admission is associated with lower IHM and RH at 60 days. Data was analyzed using bivariate and multivariate analyzes by logistic regression.

Results:
Mean age was 75 years (44% female), normal EF 62% and reduced 38%. Mean NT-pro-BNP was 9280 ng/dl. RH at 60 days was 25% and IHM was 8.7%. Mean PaO2 on admission was 75 mmHg and at 24 hours 82 mmHg, PaCO2 on admission was 38 mmHg and at 24 hours 40 mmHg, mean SaO2 on admission was 94% and at 24 hours 95%. In bivariate analysis, the highest elevation of the PaCO2 on admission as well as PaCO2 at 24 hours were identified as predictors of IHM (38.42 vs 40.26 mmHg, p = 0.025) and (40.17 vs 46.84 mmHg, p = 0.002) respectively. In multivariate analysis, AKI on CKD (p = 0.03), cardiogenic shock (p = <0.0001), acute myocardial infarction (p = <0.004), emergency PCI (p = <0.001), NIV failure (p = <0.001), NT-pro-BNP (p = <0.01), and elevated PaCO2 at 24 hours (p = 0.02) were identified as independent predictors for IHM. No association between the improvement in ABG variables and RH at 60 days was found.

Conclusions:
The lack of improvement in PaCO2 at 24 hours of admission to CICU for AHF identifies patients at higher risk for IHM. However, there was no association between the improvement ABG variables at 24 hours and the RH for AHF.
Abstract 9736: Steerable versus Non-Steerable Sheath Technology in Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis
Authors: Mhanna Mohammed , Beran Azizullah , Al-Abdouh Ahmad , Sajdeya Omar , Barbarawi mahmoud , Alsaiqali Mahmoud , Jabri Ahmad , Al-Aaraj Ahmad , Alharbi Abdulmajeed Abdullah , Chacko Paul
Published: June 2023

Introduction:
Catheter placement and stability are well-known challenges in atrial fibrillation (AF) ablation. As a result, steerable sheaths were developed to improve catheter stabilization and maintain proper catheter-tissue contact. The purpose of this systematic review and meta-analysis is to see if employing a steerable sheath influences procedure outcome.

Method:
We performed a comprehensive literature search for studies that evaluated the efficacy and safety of Steerable Sheaths (SS) compared to Non-Steerable Sheaths (NSS) in AF ablation. The primary outcome was the rate of atrial arrhythmia (AA) freedom by the time of the last follow-up. The secondary outcomes were the procedure-related complications and procedural characteristics. Risk ratio (RR) or the mean difference (MD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model.

Results:
A total of 10 studies, including 967 AF patients (mean age: 59.2±11.1 years, 516 patients managed with SS vs. 454 with NSS), were included. SS group showed a higher rate of freedom of AA compared to NSS (RR: 1.19; 95% CI 1.09, 1.29; P < 0.001). Both techniques had similar rate for procedural-related complication (RR: 1.09, 95% CI 0.50, 2.39; P = 0.83). The SS strategy had a shorter procedure time (MD -10.6 (min.), 95% CI -20.97, -0.20; P = 0.05) but comparable fluoroscopic and radiofrequency application times to the NSS group.

Conclusions:
The steerable sheaths for AF catheter ablation not only reduced the total procedure time but also significantly increased the rate of successful ablation while maintaining a similar safety profile when compared to the traditional non-steerable sheaths.
Abstract 9770: Pulmonary Artery Pulsatility Index After Pediatric Heart Transplant
Authors: Golbus Alexa E , Bryant Charles B , Savage Andrew J , Henderson Heather T , Rhodes John F
Published: June 2023

Background:
The Pulmonary Artery Pulsatility index (PAPi) is calculated by pulmonary artery pulse pressure divided by central venous pressure and is directly proportional to right ventricular contractility and stroke volume, and indirectly proportional to pulmonary artery afterload and filling pressures. We hypothesize that PAPi will correlate with known hemodynamic parameters and predict acute kidney injury (AKI) post heart transplant (HTx).

Methods:
Medical records and hemodynamic data were retrospectively reviewed for patients ≤18 years old undergoing HTx at a single center between 1/2007-9/2021. Subgroups by HTx indication were myopathy or congenital heart disease (CHD). PAPi was calculated at catheterizations up to 5 years post HTx, with normal ≥ 2.0.

Results:
Fifty-three children underwent HTx in myopathy (n=27) or CHD (n=26) subgroups. Mean age at HTx was 5.95 ± 6.13 years (range: 58 days-18 years) with no difference between myopathy and CHD subgroups. PAPi correlated with known cardiovascular measures including thermodilution cardiac index (TDCI) and right ventricular end-diastolic pressure (RVEDp), confirming PAPi as a predictor of cardiovascular hemodynamics (Table 1)
.
At 1 year, children with AKI (n=11/49) had a lower PAPi compared to those with no AKI (1.55 ± 0.43 vs. 2.50 ± 1.16; p=0.004). Comparing initial to 5-year PAPi, the myopathy subgroup (n=18) remained similar (2.10 ± 0.99 vs. 2.12 ± 1.55; p=0.48) and the CHD subgroup (n=12) declined significantly (2.12 ± 0.91 vs. 1.67 ± 0.55; p=0.04).

Conclusions:
The PAPi in children post HTx correlates with known hemodynamic parameters. PAPi serves as a marker predicting renal dysfunction 1 year post HTx. Between HTx and 5 years post HTx, PAPi did not improve for the myopathy subgroup and declined significantly for the CHD subgroup suggesting that incorporating PAPi into existing risk models may substantially improve earlier implementation for advanced therapies and thus improve clinical outcomes.
Abstract 9806: Financial Strain and Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis
Authors: Osibogun Olatokunbo , Ogunmoroti Oluseye , Turkson-Ocran Ruth-Alma N , Okunrintemi Victor , Kershaw Kiarri N , Allen Norrina B , Michos Erin D
Published: June 2023

Background:
Psychosocial stress is associated with an increased risk of cardiovascular disease (CVD). The relationship between financial strain, a toxic form of psychosocial stress, and ideal cardiovascular health (CVH) is not well established. This study examined whether financial strain was associated with poorer CVH in a multi-ethnic cohort free of CVD at baseline.

Methods:
This is a cross-sectional analysis of 6,468 men and women aged 45-84 years. Two measures of financial strain were assessed: ongoing financial strain and ongoing financial strain for >6 months. Responses to both measures were categorized as yes or no. CVH was measured from 7 metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and blood glucose). A CVH score was calculated from points assigned to the categories of each metric (poor = 0 points; intermediate = 1 point; ideal = 2 points) for a total of 14 points. Multinomial logistic regression was used to examine the association of financial strain with the CVH score (inadequate 0-8, average 9-10, and optimal 11-14 points) and number of ideal metrics, adjusting for sociodemographic factors.

Results:
The mean age (SD) was 62 (10) and 53% were women. Ongoing financial strain was reported by 25% of participants while 23% reported ongoing financial strain for > 6 months. Participants who reported ongoing financial strain had lower odds of having average (0.82 [0.71, 0.94]) and optimal (0.73 [0.62, 0.87]) CVH scores (
Table
). Likewise, ongoing financial strain for >6 months was associated with lower odds of having average (0.81 [0.70, 0.93]) and optimal (0.70 [0.58, 0.83]) CVH scores. Similar results were observed for the association of financial strain with the number of ideal metrics.

Conclusions:
Financial strain was associated with poorer CVH. More research is needed to understand this relationship so the burden of CVD can be decreased, particularly among people experiencing financial hardship.
Abstract 9856: Gender and Racial Disparities in Reported Cardiac Arrest Death in United States, 1999 to 2019
Authors: Matute Martinez Carlos F , Qudrat Ullah Muhammad , Usman Muhammad , Almani Muhammad Usman , Inestroza Karla , Sierra Juan G , Hamdan Ahmad , Sidhu Mandeep , Ernest Prince , Herrera-Ramos Alejandro J , Amador Pablo , Matute Martinez Felipe Jose J , Rojo Grajales Laura , Davis Mark
Published: June 2023

Introduction:
Cardiac arrest (CA) is the cessation of cardiac mechanical activity confirmed by the absence of signs of circulation. Data suggest that race and gender could impact the survival rate of CA (1,2). We aim to describe the temporal trend of the age-adjusted mortality rate of gender and race reported as any-mention cause of cardiac arrest death from 1990 to 2019.

Methods:
The United States statistics mortality data from the CDC WONDER database from 1999 to 2019 were used. The diagnosis of CA was stablished using the ICD-10 codes: I46.0, I46.1, I46.9 and I49.0. Mortality rate was calculated for all ages. Age-adjusted mortality rates per 100000 were calculated using 95% confidence intervals.

Results:
The study included 7435677 subjects with any-mention of CA death. Most deaths occurred in older individuals (90.7 % of the death reported in those 55 years or older). Cardiac Arrest deaths decreased from 138.1 in 1999 to 91.5 in 2019. Temporal trend depicted a gradual decline in the age-adjusted mortality rate per year (IRR 0.97 95 % CI 0.95 to 0.99). There was a progressive decrease mortality rate across both male (167.6 in 1999 to 110 in 2019 IRR 0.97 95% CI 0.96 to 0.98) and female (117.5 1999 to 76.5 in 2019 IRR 0.97 95% CI 0.96 to 0.98). The age-adjusted mortality rate was significantly higher in males compared to females (126.7 vs 91.3 IRR 1.39 95 % CI 1.27 to 1.52). There was a significant decrease in the mortality rate through 1999 to 2019 seen in all the races.

Conclusions:
There was an association in the CA mortality rate that persisted over the years favoring male over females. The Black race had the highest mortality rate among the races. American Native had the lowest mortality rate. The phenomenon underlying the race difference is not fully understood (3). Quality-improvement efforts have been associated with improvement of survival (4,5). The present data demonstrates a gradual decline of CA-related mortality associated with significant high gender and racial disparities.
Abstract 9885: Possible Risk Factors of In-Hospital Death Among Acute Ischemic Stroke Patients With Atrial Septal Defect; A Study From the 2019 National Inpatient Sample
Authors: Kumar Nomesh , Verma Renuka , Ramphul Kamleshun , Ramphul Yogeshwaree , Kumari Komal , Sombans Shaheen , Mejias Stephanie G , Arti Fnu , Lohana Petras
Published: June 2023

Introduction:
Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers.

Methods:
Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients.

Results:
Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p<0.01) and intravenous tissue plasminogen activator (IV tPA) (aOR 1.177, 95% CI 1.125-1.230, p<0.01). Unfortunately, 1.5% (295 cases) of patients with ASD died. A higher risk of mortality among ASD patients was seen if they had also undergone mechanical thrombectomy (aOR 2.839, 95% CI 2.033-3.936), while a lower risk of mortality was seen among those ages 25-60 (aOR 0.695, 95% CI 0.540-0.894, p<0.01) compared to those above 60, among those who underwent tPA (aOR 0.485, 95% CI 0.306-0.769, p<0.01), smokers (aOR 0.550, 95% CI 0.423-0.715), and those with hyperlipidemia (aOR 0.374, 95% CI 0.290-0.482, p<0.01). A lower overall mortality risk among ASD patients following AIS (1.5% vs 3.8%) was also seen (aOR 0.393, 95% CI 0.349-0.441, p<0.01).

Conclusions:
While several studies have shown that ASD predisposes to a higher risk of developing AIS, our study found that the risk of mortality among ASD patients following admission for AIS was lower than non-ASD patients. However, mechanical thrombectomy was associated with a higher risk of death among these patients. Further studies to understand the associated reasons, pathways, and methods to improve their outcomes should thus be encouraged.
Abstract 9901: In-Hospital and 30-day Post-Discharge Outcomes Associated With Postoperative Atrial Fibrillation: A Contemporary Analysis From the Society of Thoracic Surgeons Adult Cardiac Surgery Database
Authors: Park Tae Jin , Shah Darshini , Gillard Patrick , Ferguson William G , Subacius Haris , Gray Elizabeth , Romano Matthew A
Published: June 2023

Introduction:
Postoperative atrial fibrillation (POAF) is associated with worse in-hospital and post-discharge morbidity and mortality. However, current estimates vary widely among published studies due to limited study centers and differing patient populations. The objective of this study was to assess the risk-adjusted in-hospital and 30-day post-discharge clinical outcomes associated with POAF in the United States.

Methods:
A contemporary, retrospective study was conducted using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery database. The sample consisted of patients aged 40 to 90 who underwent open-chest coronary artery bypass and/or valvular surgery between 2011 to 2019. In-hospital and 30-day post-discharge clinical outcomes were compared between those who experienced POAF and those who did not (controls). Outcomes were risk-adjusted, where appropriate, for baseline demographics and prior medical and surgical history using a multivariable regression approach.

Results:
A total of 424,590 patients with a mean age of 69.3 (SD 9.2) years and 1,105,200 patients with a mean age of 64.8 (SD 10.2) years were identified in the POAF and control cohorts respectively, representing a POAF cumulative incidence of 27.8%. POAF patients experienced on average a postoperative length of stay that was 2.4 days longer (p < 0.001) and 32 additional hours (p < 0.001) in the intensive care unit compared to control patients. After risk adjustment, POAF was associated with 64% higher odds of in-hospital stroke (OR 1.64, 95% CI 1.59, 1.69), 158% higher odds of in-hospital renal failure (OR 2.58, 95% CI 2.52, 2.64), 29% higher odds of in-hospital mortality (OR 1.29, 95% CI 1.26, 1.32), 23% higher odds of 30-day readmission (OR 1.23 95% CI 1.21, 1.25), and 27% higher odds of 30-day mortality (OR 1.27, 95% CI 1.24, 1.30).

Conclusions:
POAF is associated with a significantly increased risk of both in-hospital and 30-days post-discharge morbidity and mortality. This study highlights the unmet need for more effective POAF prevention strategies.
Abstract 9903: Artificial Intelligence Driven Wearable 2-minute Seismocardiography Test for Detection of Aortic Valve Stenosis Severity
Authors: Johnson Ethan M , Robinson Joshua D , Rigsby Cynthia K , McCarthy Patrick M , Malaisrie S C , Allen Bradley D , Barker Alexander J , Markl Michael
Published: June 2023

Introduction:
Standard diagnosis of aortic valve stenosis (AS) requires clinical imaging by echocardiography or cardiac MRI. The purpose of this study was to test the performance of easy to use, artificial intelligent (AI) driven seismocardiogram (SCG) chest acceleration recordings for point of care screening and identification of AS.

Hypothesis:
SCG measurements can be used by a low dimensional convolutional neural network (CNN) to accurately predict presence or absence of aortic valve stenosis (AS) and severity of dysfunction.

Methods:
This IRB approved study included 45 controls (age 46±17y, 20 F, no known cardiovascular disease) and 30 aortic valve disease (AVD) patients (age 30±20y, 7 F, 21 bicuspid). A wearable SCG device (integrated ECG/accelerometer microelectronics) was placed for 2min chest acceleration recordings on the same day as standard of care echocardiography or cardiac MRI, which was used as ground truth data to classify valve function (normal: AS-, mild AS: AS+, moderate/severe AS: AS++). A deep learning CNN (2х2 kernel, softmax/cross entropy classification) was configured to predict/detect degree of AS from spectrally decomposed SCG measurements. Randomized 50% split of subjects was used for CNN training/testing. Performance detecting AS was evaluated for classification accuracy.

Results:
AI driven SCG detection of valve function abnormality had high sensitivity/specificity (90%, 67%) with a net area under curve (AUC) 0.86. Correct classification of the degree of AS was achieved in 76% of subjects. Normal (AS-) vs abnormal function (AS+ or AS++) was accurately identified by AI driven SCG for 86% of subjects.

Conclusions:
This feasibility study demonstrates that the combination of easily measured 2 minute SCG with a deep processing pipeline could successfully detect the presence and severity of AS, supporting clinical promise for potential use as a low cost, front line screening tool to identify patients with aortic valve dysfunction.
Abstract 9912: Cardiac Events Among Amyotrophic Lateral Sclerosis Patients in the United States; a Fresh Perspective From the 2019 National Inpatient Sample
Authors: Ramphul Kamleshun , Verma Renuka , Kumar Nomesh , Ramphul Yogeshwaree , Kumari Komal , Sombans Shaheen , Mejias Stephanie G , Lohana Petras , Arti Fnu
Published: June 2023

Introduction:
Respiratory distress and complications are the leading causes of death among Amyotrophic Lateral Sclerosis (ALS) patients. However, several studies have reported multiple cardiovascular complications linked with heart rate and rhythm. We, therefore, aim to investigate cardiovascular involvement among ALS patients further.

Methods:
Data from the 2019 National Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), and partners were analyzed to estimate the presence of multiple cardiovascular events in patients with a diagnosis of Amyotrophic Lateral Sclerosis in the United States via their respective ICD-10 codes. The risk of cardiopulmonary resuscitations and mortality rates were also estimated via multivariate regression models, accounting for different variables.

Results:
We identified 12,865 cases of ALS in the United States. Different cardiac arrhythmias were recorded, such as supraventricular tachycardia (2.1%), ventricular tachycardia (1.7%), ventricular fibrillation (0.2%), and paroxysmal atrial fibrillation (3.8%), and long QT syndrome (0.6%). Several cases of heart blocks were also observed as 0.4% had a first degree, 0.3% had a second degree, and 0.3% had third-degree atrioventricular blocks. 10.7% also had a diagnosis of heart failure, and 565 (4.4%) patients had an old myocardial infarct. Finally, we found 160 (1.2%) cases of cardiopulmonary resuscitation, which had a higher risk of occurring among diabetics (aOR 1.922, 95%CI 1.383-2.670, p<0.01) and patients with hypertension (aOR 1.516, 95% CI 1.007-2.134, p=0.017), while it was less common among Females (aOR 0.527,95% CI 0.368-0.755, p<0.01). The adjusted odds ratio of death in ALS patients with cardiopulmonary resuscitation was 14.910 (95% CI 9.760-22.78, p<0.01).

Conclusions:
Several cardiac arrhythmias can be observed among ALS patients. Cardiopulmonary resuscitation has a poorer outcome, and physicians treating ALS patients should be advised to watch for early changes, which may help reduce the need for CPR.
Abstract 9954: Single Operator Experience, Learning Curve, and Outcomes With Conduction System Pacing
Authors: Marion William , Schanz John , Patel Sonali , Co Michael , Pavri Behzad B
Published: June 2023

Introduction:
Conduction system pacing (CSP) is an increasingly used physiologic pacing modality by either His-bundle pacing (HBP) or left-bundle area pacing (LBAP). However, operators new to this technique may hesitate to implement CSP. We describe a single operator's experience (learning curve, clinical outcomes) with CSP from 07/2016-05/2022.

Methods:
Retrospective analysis of all 3830 Medtronic SelectSecure leads implanted by one operator at an academic institution. Patient characteristics, procedure times, ECG findings, pacing parameters, and clinical outcomes were analyzed.

Results:
A
total
of 140 CSP cases (Medtronic 3830 lead) were attempted over 70 months (78 HBP, 62 LBAP).
Implant frequency
(year → # of cases): 2016 → 3; 2017 → 5; 2018 → 24; 2019 → 25; 2020 → 36; 2021 → 35; 2022 → 12. The last HBP lead was implanted in March 2021; the 1st LBAP lead was implanted in December 2019. There were 23
unsuccessful attempts
to achieve CSP at initial implantation (18 in the 1st 34%, mainly HBP cases; 5 in the last 92 cases) and 5
revisions
(all HBP, see figure
). Procedure times
shortened after the 1st 25 procedures for both HBP (158 to 132 mins, P=0.028) and LBAP (174 to 133 mins, P=0.002). Mean
follow-up:
HBP=558.2 days and LBAP=109 days. Ten patients (4 HBP, 6 LBAP) were lost to follow up. LBAP leads showed significantly better capture
thresholds
compared to HBP at implant and follow-up, although QRS narrowing, LV activation times, and improvement in LV function were not significantly different (see table).

Conclusion:
LBAP is easier to learn and has fewer failure rates as compared to HBP. Procedure times improve with experience within 25 cases. Majority of failed attempts were in the first third of cases, and all but one were in the HBP group.
Operators new to CSP should forego HBP and employ LBAP.
LBAP provides similar reductions in QRS duration, LV activation times, and LVEF improvement as compared to HBP, but with lower failure/revision rates and superior long-term pacing thresholds.
Abstract 9985: Thirty Day Readmission Outcomes of Percutaneous Left Atrial Appendage Occlusion in Patients With Cancer
Authors: Zhang Yaqi , Yang Zhuoran , Soon-Shiong Raquel , Almani Muhammad Usman , Liu Bolun
Published: June 2023

Introduction:
Percutaneous left atrial appendage occlusion (LAAO) has been rapidly evolving since FDA’s approval in 2015, and has become more of a same-day-discharge procedure. Cancer patients who underwent LAAO are known to have more inpatient complications and longer hospital stay. Readmission data, however, were rarely studied in this patient population.

Hypothesis:
Readmission burden is relatively high in cancer patients who received LAAO.

Methods:
Data were derived from the National Readmission Database from 2016 to 2019. Patients with primary diagnosis of atrial fibrillation or flutter admitted for percutaneous LAAO (ICD-10 code 02L73DK) were grouped by cancer as a secondary diagnosis. We assessed inpatient mortality, length of stay, total charges and procedure complications from index hospitalization. We also compared readmission rate and most common readmission reasons. Stata SE 17.0 was used for data analysis.

Results:
There were 49882 index hospitalizations for LAAO, among which 1545 (3.1%) patients had a secondary diagnosis of cancer. From index hospitalizations, Patients with cancer had higher inpatient mortality (0.65% vs 0.14%, p=0.007), longer length of stay (1.54±0.08 vs 1.31±0.01, p<0.001) and higher total charges (120.25±3.44 vs 117.29±2.40, p<0.001). There was no statistical significance of 30-day readmission rate between patients with cancer and patients without cancer (10.0% vs 9.1%, p=0.34). The most common readmission reason in cancer patients was gastrointestinal bleeding.

Conclusions:
Readmission utilization is comparable between patients with cancer and patients without cancer who underwent LAAO.
Familial Associations of Prevalence and Cause-Specific Mortality for Thoracic Aortic Disease and Bicuspid Aortic Valve in a Large-Population Database
Authors: Glotzbach Jason P. , Hanson Heidi A. , Tonna Joseph E. , Horns Joshua J. , McCarty Allen Chelsea , Presson Angela P. , Griffin Claire L. , Zak Megan , Sharma Vikas , Tristani-Firouzi Martin , Selzman Craig H.
Published: June 2023

BACKGROUND:

Thoracic aortic disease and bicuspid aortic valve (BAV) likely have a heritable component, but large population-based studies are lacking. This study characterizes familial associations of thoracic aortic disease and BAV, as well as cardiovascular and aortic-specific mortality, among relatives of these individuals in a large-population database.

METHODS:

In this observational case-control study of the Utah Population Database, we identified probands with a diagnosis of BAV, thoracic aortic aneurysm, or thoracic aortic dissection. Age- and sex-matched controls (10:1 ratio) were identified for each proband. First-degree relatives, second-degree relatives, and first cousins of probands and controls were identified through linked genealogical information. Cox proportional hazard models were used to quantify the familial associations for each diagnosis. We used a competing-risk model to determine the risk of cardiovascular-specific and aortic-specific mortality for relatives of probands.

RESULTS:

The study population included 3 812 588 unique individuals. Familial hazard risk of a concordant diagnosis was elevated in the following populations compared with controls: first-degree relatives of patients with BAV (hazard ratio [HR], 6.88 [95% CI, 5.62–8.43]); first-degree relatives of patients with thoracic aortic aneurysm (HR, 5.09 [95% CI, 3.80–6.82]); and first-degree relatives of patients with thoracic aortic dissection (HR, 4.15 [95% CI, 3.25–5.31]). In addition, the risk of aortic dissection was higher in first-degree relatives of patients with BAV (HR, 3.63 [95% CI, 2.68–4.91]) and in first-degree relatives of patients with thoracic aneurysm (HR, 3.89 [95% CI, 2.93–5.18]) compared with controls. Dissection risk was highest in first-degree relatives of patients who carried a diagnosis of both BAV and aneurysm (HR, 6.13 [95% CI, 2.82–13.33]). First-degree relatives of patients with BAV, thoracic aneurysm, or aortic dissection had a higher risk of aortic-specific mortality (HR, 2.83 [95% CI, 2.44–3.29]) compared with controls.

CONCLUSIONS:

Our results indicate that BAV and thoracic aortic disease carry a significant familial association for concordant disease and aortic dissection. The pattern of familiality is consistent with a genetic cause of disease. Furthermore, we observed higher risk of aortic-specific mortality in relatives of individuals with these diagnoses. This study provides supportive evidence for screening in relatives of patients with BAV, thoracic aneurysm, or dissection.
Statin Use and Stroke Rate in Older Adults With Atrial Fibrillation: A Population‐Based Cohort Study
Authors: Shweikialrefaee Bisan , Ko Dennis T. , Fang Jiming , Pang Andrea , Austin Peter C. , Dorian Paul , Singh Sheldon M. , Jackevicius Cynthia A. , Tu Karen , Lee Douglas S. , Abdel‐Qadir Husam
Published: June 2023

Background

Atherosclerotic disease is an important contributor to adverse outcomes in patients with atrial fibrillation (AF). There is limited recognition of the association between statin use and stroke rates in AF. We aimed to quantify the association between statin use and stroke rate in AF.

Methods and Results

Using linked administrative databases in Ontario, Canada, we conducted a population‐based retrospective cohort study of patients, aged ≥66 years, diagnosed with AF between 2009 and 2019. We used cause‐specific hazard regression to determine the association of statin use with stroke rate. We developed a second model to further adjust for lipid levels in the subset of patients with available measurements in the year before AF diagnosis. Both models adjusted for age, sex, heart failure, hypertension, diabetes, stroke/transient ischemic attack, vascular disease, and P2Y12 inhibitors at baseline, plus anticoagulation as a time‐varying covariate. We studied 261 659 qualifying patients (median age, 78 years; 49% women). Statins were used in 142 834 (54.6%) patients, and 145 673 (55.7%) had lipid measurement(s) in the preceding year. Statin use was associated with lower stroke rates, with adjusted hazard ratios of 0.83 (95% CI, 0.77–0.88;
P
<0.001) in the full cohort and 0.87 (95% CI, 0.78–0.97;
P
=0.01) when adjusting for lipid data. Stroke rates increased in a near‐linear manner as low‐density lipoprotein values increased >1.5 mmol/L.

Conclusions

Statins were associated with lower stroke rates in patients with AF, whereas higher low‐density lipoprotein levels were associated with higher stroke rates, highlighting the importance of vascular risk factor treatment in AF.
Love, Knowledge, and Freedom in Pleasantville, Religious Scripture, and Wider Western Literature
Authors: Carr David
Published: June 2023

Love has long been extolled as a route to human moral and spiritual progress and fulfilment, not only in much past religious literature and narrative but in the more recent work of writers such as the philosopher and novelist Iris Murdoch. In such texts, however, the sentiment (or virtue) of love is clearly more than just blind or brute passion and presupposes distinctive human capacities for knowledge and free agency. That said, the relationship between knowledge and (right or virtuous) agency seems highly problematic or ambivalent on many traditional (perhaps most notably Christian) religious conceptions. This paper addresses such issues and complexities via some exploration of Genesis and the modern movie Pleasantville—with further aid from literary works of Shakespeare, Blake, Heinlein, and others—to the end of a more realistic view of human love and its moral and spiritual implications.
Image and Word
Authors: Houssni Joseph
Published: June 2023

The rapport between religion and film is not only historical but also ontological. The Abrahamic faiths specifically (Islam, Christianity, and Judaism) and the audio-visual medium of cinema share a complex affiliation with reference to two of their foundational elements: image and word. Building on the constitutive kernels of the Abrahamic religion of Islam (image and word), this paper will locate and define its formal manifestations in cinema; in other words, the way in which the conception of image and word at Islam marks film form. This endeavor will be sustained by calling upon some distinctive film cases of the so-called New Iranian Cinema. In particular, Offside (2006) and This Is Not a Film (2011) by Jafar Panahi, and Close-up (1990) by Abbas Kiarostami, as well as other films, will be utilized for analysis in order to delineate the qualities of the claimed religious film form in question. These films are selected as they foreground and thus play out the dialectic of image and word, their absence and their presence.
The Fundamental Word of Christ’s Eschatological Proclamation
Authors: Kelly Declan
Published: June 2023

Whether understood as an expression of the inner attitude or disposition of the Christian, as a description of the kingdom’s inhabitants, or as a Christianizing of virtue theory, the beatitudes have generally been read within the framework of Christian ethics. This is as true of the Protestant tradition as it is of others. This essay considers a notable exception to that general approach: the account of the beatitudes as found in Karl Barth’s Church Dogmatics IV/2. Read as a “word of grace,” the beatitudes are understood by Barth to be a deepening of the revelation that God is for us, and ultimately so, as the “total savior.” More specifically, this essay argues that Barth offers a christological-cosmological reading of the beatitudes orientated to the saving advent of God’s eschatological kingdom in a “wounded” cosmos subjected to foreign lords, and that he thereby taps into the “apocalyptic” character of these sayings.
The dose-effect regularity of artificial dermis combined with growth factor in repair wound of luxation of the bone tendon
Authors: Ren Fengli , Yang Xiaodi , Xin Zhiming , Wang Chengdong , Liu Zhao
Published: June 2023

To investigate the treatment efficacy of the artificial dermis combined with growth factor surgery in patients with luxation of bone tendon (LBT). A total of 40 patients with LBT in our prospective clinical research are randomly allocated to following four groups: Control, low dose,
medium dose, and high dose. The baseline characteristics, skin graft interval time, overage rate of regenerated tissue at bone and tendon, and visual estimation of patients were measured, which were then utilized to assess the treatment efficacy of the artificial dermis combined with growth
factor surgery in LBT patients. Our outcomes indicated that the artificial dermis combined with growth factor surgery showed significantly less skin graft interval time, higher overage rate of regenerated tissue at bone and tendon, less Vancouver scar scale score compared to those treated
by conventional imaging technology (all P < 0.05). It concludes that the artificial dermis combined with growth factor surgery can improve the treatment efficacy, and the medium dose growth factor is a promise dose to treat the patients with LBT.
Antiproliferative and apoptotic effects of strychnine in human hepatoma HepG2 cells and its mechanism
Authors: Liu Ruoxuan , Ouyang Jie , Gao Yinyi , Wang Bingyu , Li Liming , Geng Yi , Guo Jiewen
Published: June 2023

Hepatocellular carcinoma has the highest prevalence with poor prognosis in liver cancers. Effective treatment strategies are urgently needed to improve the survival of patients with hepatocellular carcinoma. Strychnine, the major active ingredient of the seed of Strychnos nux-vomica
L., has been reported to possess an anti-hepatocellular carcinoma function while the underlying mechanism is not fully understood. Here we aim to explore strychnine’s effect on the proliferation and apoptosis of human hepatoma HepG2 cells and clarify mechanism. The cytotoxic activity
of strychnine against HepG2 cells was measured. Flow cytometry was used to assess cell apoptosis. The miR-122 expression level was measured via real time quantitative PCR and cyclin G1 and anti-apoptotic proteins including survivin and livin were assessed using Western blot. Strychnine decreased
the viability of hepatocellular carcinoma cells and induced their apoptosis in vitro. The levels of livin and survivin were decreased in HepG2 cells after strychnine treatment. By restraining cyclin G1 expression in HepG2 cells, strychnine upregulated liver-specific miR-122 level for
the induction of apoptosis. Therefore, strychnine possessed the ability to inhibit cell proliferation and induce apoptosis. Strychnine may be applied for treating liver cancer.
Retrospective analysis of cefpodoxime proxetil dispersible tablets in the treatment of respiratory tract infection in children and study of the antibacterial effect of cefpodoxime proxetil nanoemulsion
Authors: Xue Jihong , Tian Jianhong
Published: June 2023

A study was conducted to determine the efficacy and safety of cefpodoxime proxetil (CFP) dispersible tablets in the treatment of respiratory tract infection in children and to analyze the antibacterial effect of cefpodoxime proxetil nanoemulsion (CFP-NE). A retrospective analysis was
conducted on 118 children with upper respiratory tract infection who received antibiotic treatment between March 2018 and March 2021. The control group was treated with cefradine and the CFP group was treated with CFP dispersible tablets. The serum indexes and bacteriological test results
of the two groups were collected before and after treatment, and the bacterial clearance rate, infection control, and occurrence of adverse reactions were observed and compared between the two groups. Cefpodoxime proxetil nanoemulsion (CFP-NE) was prepared and its surface characteristics were
observed. CFP-NE and CFP were used to treat infections by multiple strains of bacteria and the antibacterial effect and minimum inhibitory concentration (MIC) of CFP-NE were observed. The bacterial strain clearance rate of the CFP group was 96.2% and the total infection control rate was 94.92%.
The bacterial strain clearance rate of the control group was 88.9% and the total infection control rate was 81.36%. Serum index detection showed that antibiotic treatment could reduce serum indexes of amyloid A, C-reactive protein, procalcitonin, and other indexes and CFP had better efficacy.
There were only four cases of adverse reactions after treatment with CFP, a result similar to that of other antibiotics. The prepared CFP-NE system was stable, the particles were uniform, and the diameter of the inhibitory zone against pathogenic Escherichia coli and Salmonella
was larger than that of the CFP group. The MIC of CFP-NE was significantly lower than the MIC of the CFP group (P < 0.05). CFP dispersible tablets are safe and effective for the treatment of respiratory tract infection in children and the antibacterial effect of CFP-NE is greater
than that of CFP.
Weather Effects on the Spread of COVID-19: Characteristics and Critical Analysis of the First and Second Years of Scientific Research
Authors: Tan Ling , Schultz David M.
Published: June 2023

Numerous studies were published quickly in 2020 and 2021 to understand the effect of weather variables on the spread of COVID-19. We examined 289 peer-reviewed empirical publications, focusing on their characteristics and a critical analysis of their quality. Of the 289 publications, 280 (97%) reported an association between one or more weather variables and the transmission of COVID-19. Of those 289 publications, 109 publications (38%) did not consider any time lag between suspected infections and reporting of the COVID-19 cases, meaning that they examined the weather on the day when the COVID-19 case was reported, rather than the day when the infection occurred. The publications used data from as few as 7 days, with an average of 123 days. Most of these data were collected early in the pandemic when the temperatures were rising as the seasons transitioned from winter to summer in the Northern Hemisphere, making it difficult to determine the subtle effects of the weather on spread. Furthermore, the average time between submission and acceptance was 85 days, but the 10 most-cited publications—all in Science of the Total Environment—were accepted within 10 days of submission, with three accepted on the submission date. Twenty-four review articles were published in 2020 and 2021, with few providing critical reflection on strengths and weaknesses of the literature. Our analysis revealed errors in the publications that were not identified or rectified by corrigenda, comment–reply exchanges, or retractions. This article concludes with recommendations on publishing during future pandemics, as well as best practices for publishing research on weather and COVID-19 transmission.
St Paul VI and the Joy of the Gospel: From Humanae Vitae to Pope Francis
Authors: Johnston Eric
Published: June 2023

Paul VI is a forgotten, sometimes maligned pope, but his insight and influence are greater than often realized. This article explains his insight and influence by dividing his pontificate into three five-year periods: the first optimistic and prolific, the second pessimistic and uncommunicative, but the third newly hopeful. The first period ends with dissent over the natural-law teaching of Humanae Vitae. The third blooms forth with Evangelii Nuntiandi, where he discovers the necessity of proclaiming Jesus Christ. Popes John Paul II, Benedict, and Francis have each embraced this insight.
Five-year review (2014–2019) of paediatric accidental deaths in Cook County, Illinois (USA)
Authors: Serinelli Serenella , Gitto Lorenzo , Arunkumar Ponni
Published: June 2023

In the USA, intentional and accidental injuries are the most frequent causes of death in children. Many of these deaths could be avoided through preventive measures, and aetiological studies are needed to reduce fatalities. The leading causes of accidental death vary by age. We analysed all paediatric accidental deaths recorded by a busy urban Medical Examiner”s Office in Chicago, Illinois (USA). We searched the electronic database for accidental deaths in children aged under 10 between 1 August 2014 and 31 July 2019. 131 deaths were identified with a preponderance of males and African Americans. This is consistent with ratios of other deaths recorded for this age group (during the same period and area). The leading causes of death were asphyxia due to an unsafe sleeping environment (in subjects <1-year-old), and road traffic accidents/drowning (in subjects >1-year-old). Behaviours, risk factors and environments most likely to contribute to fatal injuries are discussed. Our study highlights the role of forensic pathologists and medico-legal death investigators who identify the causes and circumstances surrounding these deaths. The research results may help from an epidemiological perspective to implement age-specific preventive strategies.
Effects of COVID-19 anxiety and obsession on fear of childbirth in high-risk pregnancy during the pandemic in Turkey
Authors: Aksoy Sena D. , Ozdemir Suzi , Akbal Esra
Published: June 2023

Objective

The COVID-19 pandemic may have significant effects on fear of childbirth among women undergoing a high-risk pregnancy. This study sought to determine the relationship between the COVID-19 obsession and anxiety levels of women with high-risk pregnancies and their fear of childbirth.

Methods

A total of 326 hospitalized women with high-risk pregnancies were evaluated between March 2021 and March 2022. The COVID-19 Anxiety Scale (CAS), COVID-19 Obsession Scale (OCS), and Fear of Birth Scale (FOBS, composed of two subscales, FOBS1-anxiety and FOBS2-fear) were administered.

Results

Positive correlations were found between the FOBS1 and FOBS2 scores and CAS and OCS total scores ( p < .001). The participants with secondary school degrees, those who had not given birth before, those who had an unfavorable previous childbirth experience, and those who were planning to have vaginal delivery had significantly higher average FOBS1 and FOBS2 scores ( p < .05). Those living in an extended family were 3.22 times more likely to experience FOBS1 and 2.23 times more likely to experience FOBS2 than those living in a nuclear family. Women following COVID-19 information were 3.69 times more likely than others to experience these symptoms. In addition, those scheduled for vaginal delivery were 1.80 times more likely to experience FOBS2 than those scheduled for caesarean section.

Conclusion

Women with high-risk pregnancies may experience COVID-19 anxiety, which may worsen their fear of childbirth. Psychosocial interventions focused on addressing COVID-19 anxiety are warranted for women with high-risk pregnancies in Turkey and for those living in other areas of the world as well.
Understanding the Magnitude of Hypocrisy in Moral Contradictions: The Role of Surprise at Violating Strong Attitudes
Authors: Teeny Jacob D. , Lanzalotta Jaroth V. , Petty Richard E.
Published: June 2023

Although two people could both enact similar forms of hypocrisy, one person might be judged as more hypocritical than the other. The present research advances a novel, theoretical explanation for a paradigmatic instance of this: the increased hypocrisy ascribed to contradicting a morally (vs. nonmorally) based attitude. In contrast to prior explanations, the present research shows that people infer targets holding morally (vs. nonmorally) based attitudes are more difficult to change. Consequently, when people are hypocritical on these stances, it elicits greater surprise, which amplifies the perceived hypocrisy. Through both statistical mediation and experimental moderation, we provide evidence for this process and show how our explanation generalizes to understanding heightened hypocrisy in other contexts, too (i.e., violating nonmoral attitudes held with certainty vs. uncertainty). Altogether, we provide an integrative, theoretical lens for predicting when moral and nonmoral acts of hypocrisy will be perceived as particularly hypocritical.