bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147428: Breaking the Cycle: 'Snak-Chat' Intervention Transforms Heart Failure Management with MRA Optimization
Authors: Marvasti Tina , Murray Kevin R , Kozusko Stella , Brum Margaret , Verhoeff Natasha , Fan Steve , Ho Gloria , Ross Heather , Duero Posada Juan , Moayedi Yas
Published: November 2024

Introduction:
Heart failure (HF) remains an epidemic with high rates of hospitalization and mortality. Despite the proven efficacy of guideline directed medical therapy (GDMT), there is disparity between guidelines and real-world implementation. Of the pillars of GDMT, initiation and uptitration of mineralocorticoid antagonists (MRAs) pose challenges related to hyperkalemia. To address this, we developed an interdisciplinary intervention called "Snak-Chat" aimed at facilitating MRA optimization using a stepwise approach involving collaboration with a dietitian, and monitoring via our local remote patient monitoring application, Medly. This study aims to assess the rate of MRA optimization, incidences of hospitalization, and improvements in ejection fraction (EF).

Hypothesis:
The implementation of the Snak-Chat strategy will lead to a higher rate of MRA optimization, a reduction in hospitalization rates and improvements in ejection fraction (EF) among HF patients.

Methods:
This is a single center study of adult patients with HFrEF and history of hyperkalemia. Baseline potassium level, LVEF, and MRA dose were obtained. Patients were followed for one year, and MRA dose optimization, hyperkalemic incidents, HF-related hospitalization, and mortality were compared and matched to a standard-of-care (SoC) cohort followed on Medly. Time-to-event analyses were performed using Kaplan-Meier for mortality and Fine and Gray’s subdistribution methods for reaching MRA optimization and the incidents of hyperkalemia, and HF-related hospitalization. Between-group differences in mortality and cumulative incidence rates were evaluated using log-rank and Gray’s tests.

Results:
A total of 185 patients were included, with 51 in the intervention arm. Baseline potassium levels (5.1 vs. 4.2 mmol/L, p<0.0001) and hyperkalemic events (68.8% vs. 10.5%, p<0.0001) were significantly higher in the intervention group prior to enrollment. After a 12-month follow-up, there was a substantial increase in reaching MRA optimization (Figure 1A) with an associated improved LVEF (30.2% to 38.5%, p=0.0003) in the intervention group. There was a significantly lower rate of hospitalization in the intervention arm and no differences in the number of hyperkalemic or mortality events (Figure 1B-D).

Conclusion:
Our targeted interdisciplinary approach to MRA optimization led to near-complete optimization of MRA and improved EF, without an increase in hyperkalemic events and resulted in lower hospitalization.
Abstract 4147433: Left Ventricular Outflow Tract Gradient and Left Atrial Strain Predict Cardiac Outcomes in Young Hypertrophic Cardiomyopathy Patients
Authors: Gearhart Addison , Epstein Sonia , Gauvreau Kimberlee , Mangano Christina , Chen Ming-Hui
Published: November 2024

Background:
In adults with hypertrophic cardiomyopathy (HCM), left ventricular outflow tract (LVOT) obstruction and reduced left atrial strain (LAS) predict heart failure and cardiac event risk. However, data in children are limited.

Hypothesis:
LVOT gradient and LAS together determine cardiac outcome risk in children and young adults with HCM.

Methods:
All HCM patients with exercise stress echocardiography (ESE) from 2014-2022 at a single center were included. Patients were stratified by LVOT gradients: Group 1 (n=44, rest/exercise gradients < 30mmHg); Group 2 (n=41, rest < 30mmHg; exercise ≥ 30mmHg); Group 3 (n=29, rest/exercise ≥ 30mmHg). Composite cardiac outcome included cardiac syncope, non-sustained/sustained ventricular tachycardia, cardiac arrest, NYHA heart failure class ≥ II, heart transplantation, and HCM-related death. LA reservoir (LASr) and conduit (LAScd) strain were analyzed with TOMTEC AutoStrain LA. Cumulative incidence of composite outcome by LVOT group was estimated by Kaplan-Meier method. Multivariable Cox regression was used to evaluate the effect of adding LAS to a model containing only LVOT group. Model discrimination was assessed using the concordance (c) index.

Results:
114 patients (32%F, median age 17 years) formed the cohort. At median 2.1 years follow-up [IQR: 1.0, 3.4] composite cardiac outcome risk was higher in Group 3 vs. 2 (HR=4.97, p=0.013, Figure 1). Composite cardiac outcome risk was lower in Group 1 vs. 2, but not significant (HR=0.70, p=0.66). Adjusting for LVOT group, lower LASr and LAScd were associated with greater cardiac outcome risk (per 5% LAS decrease: LASr HR=1.56, p=0.008; LAScd HR=1.77, p=0.002, Table 1). C index increased with inclusion of LASr or LAScd in the model (Table 1).

Conclusion:
In one of the largest young HCM cohorts evaluated with ESE, cardiac outcome risk increased with resting LVOT obstruction and reduced LA strain. LA strain demonstrated additive value for prediction of cardiac outcomes in children.
Abstract 4147448: The Associations of Cardiovascular-Kidney-Metabolic (CKM) Syndrome Stages with Incident Cardiovascular Disease and Cardiovascular Mortality in Middle-Aged Adults: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ozkan Bige , Zhang Sui , Rangaswami Janani , Nambi Vijay , Echouffo Justin , Chow Timothy , Ishigami Junichi , Blumenthal Roger , Ballantyne Christie , Khan Sadiya , Coresh Josef , Ndumele Chiadi
Published: November 2024

Background:
In 2023, the American Heart Association defined Cardiovascular-Kidney-Metabolic (CKM) Syndrome, reflecting the connections among cardiovascular, kidney, and metabolic risk, and outlined a staging system for CKM Syndrome. The associations of CKM Stages with cardiovascular disease (CVD) subtypes have not yet been quantified.

Methods:
We categorized ARIC Visit 4 (1996-98) participants by CKM Stages: Stage 0, no CKM risk factors; Stage 1, excess/dysfunctional adiposity; Stage 2, metabolic risk factors (hypertriglyceridemia, hypertension, metabolic syndrome, or diabetes) and/or moderate- to high-risk chronic kidney disease (CKD); Stage 3, ≥20% predicted CVD risk per PREVENT calculator or very high-risk CKD; and Stage 4, clinical CVD. We used Cox regression to estimate relative risk associations of CKM stages with atherosclerotic CVD (ASCVD), heart failure (HF), total CVD (ASCVD + HF), and CVD mortality over 10 years and through 12/30/2021. We calculated population attributable fractions (PAFs) to estimate how much of CVD risk is attributable to CKM Syndrome for each CVD subtype. We further assessed time to CVD events and mortality across stages.

Results:
Among 8,937 participants (mean age 63 years, 55% female, 18% Black), 3.8% were at Stage 0, 12.8% at Stage 1, 57% at Stage 2, 5.7% at Stage 3, and 20.6% at Stage 4 of CKM Syndrome. There was a stepwise increase in CVD risk with higher CKM stages (Table), with CKM stage 3 vs 0 associated with HRs of 4.1 for ASCVD, 11.2 for HF and 4.8 for total CVD, and CKM stage 4 vs 0 with a HR of 5.9 for CVD mortality. At 10 years, the PAFs associated with CKM Syndrome were 55% for ASCVD, 80% for HF, 62% for total CVD, and 62% for CVD mortality. Patterns were similar but attenuated over the full follow-up. Over the full study period, CVD events occurred 6-7 years earlier in CKM stage 3 vs 0, and CVD mortality 7 years earlier in CKM stage 4 vs 0.

Conclusion:
Higher CKM syndrome stages are associated with greater risk of and earlier onset of CVD events, with CKM syndrome contributing the highest attributable risk for HF among CVD subtypes. These findings highlight the role of CKM staging for facilitating the prevention of CVD, especially HF, in the general population.
Abstract 4147453: Use of a Mobile Application and Improved Mental Health for Adults with Coronary Heart Disease: Results from the Mobile4Meds Randomized Clinical Trial
Authors: Park Linda , Elnaggar Abdelaziz , Hoffmann Thomas , von Oppenfeld Julia , Collins Eileen , Soni Krishan , Yong Celina , WINCHESTER DAVID , Minniefield Nicole , Whooley Mary
Published: November 2024

Background:
Adherence to cardiovascular medications is critical for avoid morbidity and mortality and may influence mental health. The use of text messaging (TM) or mobile applications (apps) for medication adherence may be supportive for mental health in patients with cardiovascular disease (CVD).

Objective:
This study sought to compare self-reported mental health (symptoms of depression, anxiety, and post-traumatic stress disorder) in participants of a 3-arm randomized clinical trial (RCT): 1) TM, 2) mobile app, 3) control groups. The primary goal of the parent study was to compare differences in antiplatelet medication based on group assignment.

Methods:
We analyzed data among Veteran and non-Veteran patients with CVD who were recruited from 4 Veterans Affairs (VA) and 2 non-VA Northern California medical centers from 2018 to 2022. Patients were followed at 3, 6, and 12 months. The variable of interest was change in self-reported mental health status after the mobile health intervention, which was measured from the 5-item mental health questions of the Short Form Survey (SF-20) questionnaire, Patient Health Questionnaire (PHQ-9), General Anxiety Disorder scale (GAD-7), and Posttraumatic Stress Disorder Checklist (PCL) through repeated measures. We used linear mixed models with predictor variables of group (with the control group as reference), time (baseline, 3, 6 months), and group-by-time interactions to detect group differences.

Results:
The mean age was 66.9 (SD 11), 49.5% female (N=99). Scores from the mental health questions of the SF-20 showed significant main effects of group-by-time interactions for the TM group at 3 and 6 months (B=11.89, standard error [SE]=4.84, p<.05; B=10.91, SE=5.03, p<.05, respectively), compared to the control group. The App group had significant group differences at 3 months (B=11.89, SE=5.29, p<.05); however, effects did not remain at 6 months. No significant group differences were detected from the other questionnaires measuring mental health.

Conclusions:
The findings of this RCT present the potential for mobile technology to improve mental health status in patients who were recently discharged after a cardiac event from one scale; however, not corroborated by other questionnaires. Further intervention development and measurement in fully powered RCTs can illuminate the impact of technology to improve mental health status, as these patient-reported outcomes remain a major public health priority for individuals with CVD.
Abstract 4147463: Impact of Timing on Outcomes in Rescue PCI for STEMI: Early vs. Late Intervention
Authors: Adib Gracia Anna Elisa , Santiago Hernández Alberto , Neri Bale Raul Rodrigo , Cuéllar Vargas Jorge , Gonzalez Macedo Eder , Diaz Braiana , Latapi Ruiz Esparza Ximena , Garcia Villarejo Mariana , Araiza Diego , Ontiveros Mercado Heriberto , Arias Alexandra
Published: November 2024

Introduction:
American guidelines recommend rescue PCI within 3 to 24 hours after failed fibrinolysis in patients with ongoing ischemia, hemodynamic instability, or other high-risk features. Given the large areas covered by relatively few centers, rescue PCI can be delayed.

Aims:
This abstract aims to compare complications in patients undergoing early rescue PCI (within 6 hours post-thrombolysis) versus late rescue PCI (more than 6 hours post-thrombolysis).

Methods:
A prospective registry was conducted, patients over 18 years with diagnosis of STEMI undergoing rescue PCI (reperfusion therapy when thrombolysis has failed) in a tertiary cardiology center in Mexico from august of 2023 to april of 2024 were included. We divided patients into two groups, the ones who received early rescue PCI (within 6 hours post-thrombolysis) versus late rescue PCI (more than 6 hours post-thrombolysis).

Results:
109 patients who received late Rescue PCI and 56 patients who received early Rescue PCI were included. Baseline characteristics in patients undergoing Rescue PCI before and after 6 hours are presented in table 1. Patients who underwent late rescue PCI showed worsening heart failure (KK: Killip Kimball IV) 14.2% vs 9.1% (p= 0.319.). The Major adverse cardiovascular events (MACE) reported with statistical significance are angina (p value 0.048) and especially renal failure (p= 0.016). The survival rate was significantly higher when the patient entered rescue PCI after 6 hours 95.4% vs 89.2% (p = 0.023).

Conclusion:
Although no specific time frame has been set for rescue PCI, patients who underwent to rescue PCI within six hours showed worsening outcomes such as angina and renal failure, possibly due to higher KK grades, the onset of cardiogenic shock, and lower survival rates. A major limitation of our study was the small sample size, which restricted comparisons of MACE with other outcomes. This limitation is expected to improve as our database expands. Despite these findings, it is essential to base the decision to perform a rescue PCI on the patient's initial condition upon arrival at a capable PCI center.
Abstract 4147474: Global and regional burden of alcohol-related atrial fibrillation from 1990 to 2021: An analysis of GBD study 2021
Authors: Shaukat Muhammad Talha , Rehman Wania , Hayat Malik Saad , Shahzaib Muhammad , Buhadur Ali Muhammad Khan , Bhatti Muhammad Imaz , Mohsin Aleenah , Rehman Aqeeb Ur
Published: November 2024

Background and Aims:
Atrial fibrillation constitutes a major global public health issue, with its epidemiological patterns having changed significantly over the past decades. In this study, we aimed to analyze trends of mortality due to alcoholic atrial fibrillation from 1990-2021, including identifying the patterns in age-standardized death rates (ASDR), years of life lost (YLL), and disability-adjusted life years (DALY) over time, and raising awareness about the global health burden of alcoholic atrial fibrillation.

Methods:
Data on alcohol-related atrial fibrillation was extracted from the Global Burden of Diseases 2021 study, including ASDR, YLL, and DALY from 1990 to 2021. The dataset was globally divided and categorized by continents and World Bank income levels. Joinpoint regression analysis was performed to determine average annual percentage changes (AAPC) from 1990 to 2021.

Results:
Globally, the Age standardized death rates (ASDR) for alcohol-related atrial fibrillation had a constant trend from 1990-2021. The ASDR was determined to be 0.15 (95% UI 0.1-0.2) both in 1990 and 2021 (AAPC=-0.014; 95% CI -0.014 to -0.036). Although the overall trend is constant, a considerable spike in mortality rates was observed from 2000-2010 (APC=0.38). Globally, the disability-adjusted life-years (DALYs) and the age standardized years of life lost (YLL) have remained fairly constant with AAPCs of -0.052 (95% CI -0.063 to -0.036) and -0.07 (95% CI -0.098 to -0.047), respectively. In continent wise analysis, North America and Asia had intermittent spikes in ASDRs while Europe and Africa showed a constant trend throughout the analysis. From 1990 to 2021, North America had an AAPC of 1.26 (95% CI 1.23-1.29), showing a deviation from global trend with an incline. Similarly, Asia had an increasing trend with AAPC of 0.58 (95% CI 0.55-0.6). Africa also had a minutely increasing trend from 1990 to 2021 with an AAPC of 0.36 (95% CI 0.33 to 0.38). According to World Bank income levels, high-income countries had the highest death rates, followed by upper-middle income, lower-middle income and low-income countries in descending order.

Conclusions:
Although trends in the burden of alcohol-related atrial fibrillation have varied globally, the net change in years of life lost (YLL) and age-standardized death rates (ASDR) from 1990 to 2021 have been minimal. The data highlights the need for further research, to develop specific strategies that are targeted at specific populations.
Abstract 4147508: Targeting Angiotensin II Type 2 Receptor Skeletal Muscle Stem Cells to Prevent Skeletal Muscle Atrophy and Fibrosis in Congestive Heart Failure
Authors: Yoshida Tadashi , Lott C. , Delafontaine Patrice
Published: November 2024

Introduction:
We have previously shown that angiotensin II (Ang II) type 2 receptor (AT2R) positively regulates skeletal muscle stem cell (MuSC) differentiation. Systemic angiotensin II (Ang II) increase or congestive heart failure (CHF) suppress AT2R expression, likely contributing to the development of skeletal muscle atrophy and fibrosis associated with these conditions.

Hypothesis:
We hypothesized that AT2R overexpression in MuSCs could prevent skeletal muscle atrophy and fibrosis associated with CHF.

Approach:
Two mouse models, systemic Ang II infusion and left anterior descending coronary artery (LAD) ligation were used in this study. MuSC differentiation, muscle atrophy and muscle fibrosis were assessed by analyzing gene expressions (e.g. myogenin and atrogin-1), myofiber cross sectional area, and the collagen deposition (Collagen I immunohistochemical staining and picrosirius red staining). Primary MuSCs were isolated from mouse hindlimb muscles. MuSC-specific AT2R-overexpressing transgenic mice were generated by crossing Pax7
CreER/+
mice (tamoxifen-inducible cre recombinase is expressed under Pax7 promoter) and CAG-stop
flox
-AT2R mice (AT2R is expressed under CMV early enhancer element, chicken β-actin gene promoter upon cre-mediated excision of floxed stop codon).

Results:
AT2R expression was robustly increased during MuSC differentiation both
in vitro
and
in vivo
. In both Ang II infusion and LAD ligation models, AT2R induction in MuSCs was significantly suppressed, associated with reduced muscle regeneration and increased atrophy and fibrosis. Consistently, AT2R knockdown significantly suppressed MuSC differentiation
in vitro
and skeletal muscle regeneration
in vivo
, leading to increased skeletal muscle fibrosis. Restoring AT2R levels via MuSC-specific AT2R overexpression
in vivo
increased muscle regenerative capacity (increased regenerative marker expressions), reduced muscle atrophy (reduced atrophy markers and increased myofiber cross sectional area) and fibrosis (decreased collagen) in CHF models.

Conclusions:
AT2R induction in MuSC is suppressed in CHF, possibly via increased Ang II. Decreased AT2R expression and its downstream signaling in MuSC lead to lowered muscle regenerative capacity and increased muscle atrophy and fibrosis. AT2R overexpression in MuSCs restores their regenerative potential, and prevent muscle atrophy and fibrosis in CHF condition.
Abstract 4147523: Bonnie and Clyde: Pulmonary artery aneurysm with concomitant ascending aortic aneurysm
Authors: Sandhu Hasnoor , Marrium Areeba , Shadrix Alyson , Kumar Amit , Hamoui Omar
Published: November 2024

Background:
Pulmonary artery aneurysms (PAAs) are rare with an incidence of 1 in 14,000. While rare, they are very critical conditions with a mortality rate of 50-100%. PAAs may be congenital or acquired via infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, inflammatory lung disease, neoplasm, or iatrogenic. The risk of PAA is due to respiratory compromise, compression of other structures, and dissection. We describe the rare presentation of a PAA with a concomitant ascending aortic aneurysm.

Case Description:
75-year-old woman with a PMH of hypertension, Group I pulmonary artery hypertension, HFpEF, non-obstructive CAD, aortic insufficiency s/p mechanical aortic valve replacement on warfarin since 02/2014, hyperlipidemia who was admitted due to altered mental status. Physical exam was remarkable for 4/6 diastolic murmur, 3/6 aortic murmur, prominent P2, and parasternal lift and no JVD or lower extremity edema. CXR incidentally showed enlarged pulmonary artery and CT chest showed PAA at 6.6 cm. Echocardiogram confirmed moderate to severe pulmonary hypertension and a markedly dilated PAA with pulmonary valvular insufficiency. In addition, she had an ascending aortic aneurysm with moderate aortic insufficiency. The two coinciding aneurysms could be distinct in etiology due to sequela of high pressure vessel wall degradation from pulmonary artery hypertension and systemic hypertension or related due to vasculitis or cystic medial necrosis/connective tissue disease. Due to multiple concomitant aneurysms, the patient is pending further workup.

Discussion:
Aneurysms are focal dilations with PAA larger than 29 mm and ascending aortic aneurysm larger than 44 mm. Common etiologies include vasculitis, connective tissue disease, and high vessel pressure. Due to the risk of fatal pulmonary hemorrhage, PAAs are critical. Diagnosis of PAA is via CTA and of aortic aneurysm is via TTE with annual monitoring. Surgical intervention is greater than 45-55 mm depending on risk factors for ascending aortic aneurysm and greater than 55 mm for PAA. Surgical interventions for PAAs include stent graft, aneurysmorrhaphy, lobectomy, aneurysmectomy, and pneumonectomy. Surgical resection comes with high risk in patients with severe pulmonary hypertension. Treating the underlying pulmonary artery hypertension is crucial to long term management along with determination and treatment of underlying cause.
Abstract 4147545: Adverse Events with Pulsed Field Ablation - A Review of the Food and Drug Administration’s Manufacturer and User Facility Device Experience Database
Authors: Cooper Julie , Zagrodzky William , Zagrodzky Jason , Omotoye Samuel , Sardana Mayank , Kaplan Andrew , Link Mark , Bunch Thomas , Daniels James
Published: November 2024

Introduction:
Pulsed field ablation (PFA) is an adaptation of direct current ablation first used for catheter ablation in the 1980s. Expectations of a reduced risk profile led to the current resurgence in investment and interest in the technology as a potential alternative energy source for ablations to treat atrial fibrillation (AF). However, reports of adverse events, including new risks, are increasing.

Research Question:
How many adverse effects are reported with the use of newly available PFA systems?

Aims:
Quantify and describe the adverse events from PFA reported to date in the Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database.

Methods:
We searched the U.S. FDA’s MAUDE database for all reports filed with the code “QZI”, which is the product code for PFA systems created with the first FDA approvals in February 2024. All reports from inception through April 2024 (a total of 3 months) were included in this review. Per manufacturer presentation in May 2024, approximately 1000 cases utilizing PFA had been captured in a post-market registry of the predominant commercially used technology, but the exact number of cases can not be determined from MAUDE data.

Results:
A total of 217 adverse events were reported over the first 3 months of US approval, with 91 of these considered patient injuries. These injuries included 10 cases of cardiac tamponade, 7 reports of postoperative arrhythmia, 6 instances of device-related tissue entrapment, 5 cases of hemolysis with impaired renal function, 5 cases of stroke or TIA, including both embolic and hemorrhagic, 3 cases of intraoperative heart block, 2 coronary spasms, and 2 cases of intraoperative ST elevation.
(Figure)
Of the 91 reported patient safety events, 46 required hospitalization, 13 cases required temporary pacing, 11 required pericardiocentesis, 4 required dialysis, 4 required cardiothoracic surgery, and 2 required cardioversion.

Conclusions:
A number of adverse events have been reported to the MAUDE database in the first 3 months of FDA approval of PFA. The cardiac electrophysiology community should remain vigilant to ensure that the benefit-risk profile remains acceptable for patient safety.
Abstract 4147547: Sex-Based Disparities in Paroxysmal Atrial Fibrillation Outcomes: An Analysis of the National Readmission Database
Authors: Klei Lauren , Arcidiacono Anne Marie , Hapshy Vera , Arcidiacono James , Imburgio Steven , Heaton Joseph , Hossain Mohammad , Patel Swapnil
Published: November 2024

Background:
Paroxysmal atrial fibrillation (PAF) is an intermittent irregular arrhythmia that terminates within seven days. Prior studies have shown that females with atrial fibrillation are at increased risk of mortality and readmissions compared to men. Given the dramatic rise in PAF diagnoses over the past several years, the impact of sex on clinical outcomes in this patient population requires further analysis. This study aims to investigate sex-based disparities in clinical outcomes over recent years for patients with PAF.

Methods:
In this large scale, retrospective cohort study, patients who were admitted with PAF were analyzed from 2016 to 2020 using the National Readmissions Database. The study population was divided into male and female groups. Diagnoses were classified according to the International Classification of Diseases Tenth (ICD-10) Revision codes. The primary outcome was 30-day readmissions. Secondary outcomes included inpatient mortality and length of stay.

Results:
During the study period, a total of 548,617 patients with PAF meeting inclusion criteria were admitted. Of this population, 55.3% were female (n = 303,412) and 44.7% (n =245,205) were male. The mean age was 73.7 ± 11.9 years for females and 65.7± 13.6 years for males. After adjusting for baseline characteristics, female sex was associated with a higher 30-day readmission rate (HR: 1.06, CI: 1.03-1.09, p < 0.001). Multivariate regression analysis for inpatient mortality and length of stay was higher for females than males (p < 0.01 for both).

Conclusion:
Female patients experienced worse overall outcomes compared to male patients with higher readmission rates, inpatient mortality, and longer length of stay. These data suggest that targeted intervention for females may be required to improve these outcomes.
Abstract 4147674: Real world analysis of adverse events with implantation of aveir leadless pacemaker in comparison to micra leadless pacemaker: a food and drug administration MAUDE database study
Authors: Thotamgari Sahith Reddy , Sheth Aakash , Smith Jake , PHILLIPS CALEB , Patel Harsh , Penagaluri Ashritha , Brar Vijaywant
Published: November 2024

Background:
Leadless pacemaker (LP) is a novel pacemaker offering an innovative approach to bradyarrhythmia treatment. Aveir LP and Micra LP are the two leadless pacing systems available in the United States. Aveir LP was approved by the Food and Drug Administration (FDA) in April 2022. Data regarding the adverse events (AE) following implantation of Aveir LP is scarce, largely limited to single centers, and no real-world comparative analyses were done previously.

Methods:
We queried the FDA Manufacturer and User Facility Device Experience (MAUDE) database between April 2022 and December 2023 to assess the safety and AE following implantation of Aveir LP. "AVIER" and "MICRA" were the key terms used to search the MAUDE database. The event types "death" and "injury" were included in our search to capture major clinical events related to the patient. Disproportionality analysis was performed using the reporting odds ratio (ROR) to compare the adverse events of Aveir LP with Micra LP. A signal to noise ratio was considered to be significant if the confidence interval (CI) did not cross the number "one".

Results:
Our search resulted in 207 event reports for Aveir LP and 1969 event reports for Micra LP. Major device related adverse events with Aveir LP were capturing problem (33.8%) followed by dislodgement (16.9%), and sensing problem (7.2%). Most encountered device related AE with Micra LP were capturing problem (37.8%), pacing problem (11.5%), and sensing problem (9.3%). Frequencies of all the analyzed AE are shown in Figure 1. The reporting of pericardial effusion (ROR 2.84, 95% CI 2.18-3.71), and dislodgment (ROR 1.85, 95% CI 1.26-2.73) were significantly higher with Aveir, whereas cardiac arrest (ROR 0.18, 95% CI 0.04-0.74) was disproportionately lower. Overall, patient related AE were significantly higher (ROR 1.53, 95% CI 1.20-1.95) and device related events were significantly lower (ROR 0.65, 95% CI 0.51-0.83) with Aveir LP compared to Micra LP (Figure 2).

Conclusion:
This is the first real-world comparative analysis of two leadless pacing systems available in the United States. Our analysis showed that, when compared to Micra LP, the newer Aveir LP had lower device related events but higher patient related events, largely driven by pericardial effusion. These events could be attributed to the operator learning curve and long-term data are needed to further verify these findings.
Abstract 4147686: Activities of Daily Living (ADLs) in Adults with Heart Failure Compared with Cancer: Analysis of Medicare Health Outcomes Survey Data
Authors: Pedamallu Havisha , Khan Sadiya , Haywood Carol , Baldridge Abigail , Grady Kathleen , Goyal Parag , Fonarow Gregg , Lagu Tara , Ahmad Faraz
Published: November 2024

Introduction:
Heart failure (HF) and cancer are highly morbid conditions and contribute to substantial impairments in physical, mental, and social health. Cancer-associated disability has been well described, but little is known about the degree to which HF limits functional status in older individuals. Therefore, we sought to examine self-report of functional status in older people living with HF compared to cancer.

Methods:
The sample included adults
>
65 years of age from the 2016-2020 Medicare Health Outcomes Survey (HOS), who self-reported a history of HF or cancer (lung, colorectal, breast, or prostate) and were undergoing active treatment. We analyzed differences in functional status with two measures: (1) Katz Index of Independence in Activities of Daily Living (KADLs), an assessment of skills required to manage basic physical needs and hygiene, and (2) Instrumental Activities of Daily Living score (IADLs), which is a composite score of the ability to complete a complex set of skills needed to live independently. KADL and IADL were examined in groups of severe impairment (KADL: 0-2, IADL: 0-3), moderate impairment (KADL: 3-5, IADL: 4-6), and full function (KADL: 6, IADL: 7). We compared the distribution of KADL and IADL groups with Chi-Squared.

Results:
The sample of individuals with HF included 51400 adults (52% female, 14% Black, 49.8%
>
75 years). 21.85% of individuals with HF had severe impairment in KADLs and 17.05% in IALDs. These numbers were significantly higher than the proportion of severe impairment in people with lung (KADL: 14.48%; IADL: 11.35%), colorectal (KADL: 15.74%; IADL: 10.39%), breast (KADL: 10.57%; IADL: 7.17%), or prostate (KADL: 10.23%; IADL: 8.32%) cancer (all p <0.001). Individuals with HF also had the lowest proportion of patients with full function in KADLs or IADLs.

Conclusion:
People living with HF have significantly greater disability compared with people who are undergoing active treatment for lung, colorectal, breast, or prostate cancer. Multidisciplinary care for HF patients that prioritizes physical and occupational therapy and self/home care may improve functional status and overall health-related quality of life.
Abstract 4147718: Effectiveness of Intensive Blood Pressure Control on Cardiovascular Disease in Diabetes: A Subgroup Analysis of the China Rural Hypertension Control Project
Authors: Sun Guozhe , Allouch Farah , Ye Ning , Wang Chang , Liu Songyue , Miao Wei , Qiao Lixia , Ouyang Nanxiang , Chen Chung-shiuan , Mills Katherine , He Hua , Chen Jing , Geng Danxi , Shi Chuning , Zhang Linlin , Zhang Pengyu , Yin Yangzhi , Xie Ziyi , Yu Yao , He Jiang , Sun Yingxian
Published: November 2024

Background:
Cardiovascular disease (CVD) is the leading cause of death among individuals with diabetes. However, evidence regarding optimal blood pressure (BP) targets in these patients remains uncertain.

Aim:
We assessed the effectiveness of a community health worker (CHW)-led intensive BP intervention on CVD and all-cause mortality in participants with and without diabetes.

Methods:
The China Rural Hypertension Control Project (CRHCP) involved 33,995 hypertensive individuals (6,300 with diabetes and 27,695 without diabetes) aged ≥40 years from 326 villages in rural China. A total of 163 villages were randomly assigned to a CHW-led intervention, while the other 163 villages were assigned to usual care. Diabetes status was defined as a self-reported history of diabetes or a fasting blood glucose level ≥126 mg/dL at the baseline visit. In the CRHCP, CHWs were trained village doctors who initiated and titrated antihypertensive medications using a stepped-care protocol to achieve a BP goal of <130/80 mmHg. The primary effectiveness outcome was a composite of myocardial infarction, stroke, heart failure, or CVD death during the 48-month follow-up period.

Results:
At the end of follow-up, the mean systolic BP in the intervention group was 127.5 mm Hg compared to 149.3 mm Hg in the usual care group among participants with diabetes. Among participants with diabetes, there were 462 CVD events (3.8% per year) in the intervention group, compared to 539 CVD events (4.8% per year) in the usual care group. The intensive BP intervention resulted in a 22% reduction in CVD (hazard ratio 0.78; 95% CI 0.69 to 0.87) in participants with diabetes. Additionally, all-cause deaths were reduced by 14% (hazard ratio 0.86; 95% CI 0.74 to 0.99) among participants with diabetes in the intervention group compared to the usual care group. There was no significant difference in safety outcomes examined at 48 months, including hypotension or syncope. Overall, results were similar for participants without diabetes, and there was no evidence of interaction between the intervention and diabetes status.

Conclusion:
This study showed that an intensive BP intervention targeting <130/80 mm Hg effectively reduced CVD and mortality in participants with and without diabetes. Intensive BP control in patients with diabetes should be scaled up to reduce the burden of cardiovascular disease among this population worldwide.
Abstract 4147732: Does Risk Stratification of Fetuses with d-Transposition of the Great Arteries Shorten Time to Transport and Cardiac Intervention?
Authors: Nam JoAnn , Michelfelder Erik , Jergel Andrew , Clarke Shanelle , Chanani Nikhil , Wolf Michael , Ro Sanghee
Published: November 2024

Background:
Newborns with d-transposition of the great arteries (d-TGA) often require an urgent balloon atrial septostomy (BAS) immediately after birth, which can be challenging to predict. As such, cardiac centers, especially those without in-house delivery, should plan for immediate transport and cardiac intervention. The objective of this study was to evaluate the impact of risk stratification on both transport times to the cardiac intensive care unit (CICU) and to BAS in the d-TGA population.

Methods:
A retrospective analysis was performed on all fetuses with d-TGA and an intact ventricular septum born between 1/1/2013 and 12/31/2023. Fetuses born before 2018 were not risk stratified or assigned a level of care (LOC) assignment. Fetuses born after 2018 were assigned either a moderate risk of hemodynamic instability (LOC 3) or high risk of hemodynamic instability (LOC 4), based on findings on fetal echocardiography (FE) associated with increased risk for urgent BAS. Primary outcomes were times from birth to CICU arrival and from birth to BAS. A BAS was considered urgent if completed within 2 hours of CICU arrival. A BAS was excluded if performed greater than 48 hours after birth. Statistical analyses compared time-based outcomes among pre-LOC and post-LOC fetuses (stratified as either LOC 3 or 4).

Results:
A total of 81 newborns with a prenatal diagnosis of d-TGA were analyzed. Fetuses assigned an LOC had a lower time between birth and CICU arrival compared to fetuses with d-TGA who were not risk stratified (p=0.012) (Table 1). There were no differences in times from birth to BAS or from CICU arrival to BAS for pre- or post-LOC groups.

Conclusion:
Implementation of risk stratification for d-TGA fetuses can help decrease time between birth and arrival to the CICU. Risk stratification and appropriate delivery planning should be considered, especially at centers without in-house delivery. Although risk stratification alone does not shorten time to cardiac intervention, further research is needed to determine if other prenatal characteristics may predict which patients will require an urgent BAS.
Abstract 4147740: Association of Tissue Sodium with Nocturnal Hypertension and Dipping in Salt Sensitivity of Blood Pressure
Authors: Demirci Mert , Ertuglu Lale , Pridmore Michael , Crescenzi Rachelle , Laffer Cheryl , Ikizler Alp , Kirabo Annet
Published: November 2024

Background:
Salt sensitivity of blood pressure (SSBP) is an independent risk factor for cardiovascular mortality but the mechanisms are not fully elucidated. Nocturnal dipping of blood pressure, i.e. a decrease in blood pressure during sleep, is considered a sign of a healthy circadian rhythm. The disrupted dipping pattern,known as the non-dipping phenotype, is seen in individuals with SSBP and is associated with nocturnal hypertension and vascular inflammation. Tissue sodium levels are also associated with vascular dysfunction, but their impact on nighttime blood pressure has not been studied. We hypothesized that increased tissue sodium levels are associated with non-dipping pattern in patients with SSBP.

Methods:
Thirty hypertensive subjects were examined with an inpatient salt loading (SL) and salt depletion (SD) protocol. SL was achieved through saline infusion and a high-salt diet (460mmol/24 hours), while SD was achieved via diuretic administration (furosemide 40mgx3) and a low-salt diet(10mmol/24hours). BP measurements were recorded via ambulatory BP device (Spacelabs 90207). Baseline muscle and skin Na
+
levels were assessed with the
23
Na MRI technique. Spearman's correlation was used to analyze the associations. Demographic data are presented with mean and standard error of the mean.

Results:
Participant demographics and clinical data were as follows: age 53 ± 1.34 years,53% female,baseline systolic 140.2 ± 2.62mmHg, diastolic blood pressure 87.30 ± 1.77 mmHg and salt sensitivity index 3.72 ± 1.4 mmHg. While there were no correlations between baseline muscle Na
+
levels and daytime BP measurements, we found direct correlations with nighttime systolic BP(r=0.56 p=0.0043), mean arterial pressure (r=0.56 p=0.0039) and pulse pressure (r=0.40 p=0.0481) values after SL. Muscle sodium levels inversely correlated with dipping of SBP in SL Day(r=-0.53 p=0.0072). 24-hour total potassium excretion significantly correlated with dipping of SBP on SL day (r=0.65 p=0.0004). We noted an opposite trend in dipping of BP after SD, but this association did not achieve statistical significance (r=0.24 p=0.24). There were no significant correlations between Skin Na
+
and other measurements.

Conclusion:
These preliminary findings showed that lower muscle Na
+
was associated with greater dipping of BP after SL. The trend to reversal of dipping after SD highlights the potential importance of muscle Na
+
as a dynamic tissue and suggests a relationship with nocturnal BP dynamics.
Abstract 4147750: Electronegative HDL and LDL Particles Synergistically Compromise Vascular Innate Immunity
Authors: Akyol Omer , Chiang Huan-Hsing , Hsu Wen-Li , Tsai Ming-Hsien , Woodside Darren , Chen Chu-Huang
Published: November 2024

Introduction:
It is now recognized that the quality of lipoprotein particles may impact atherogenesis more than their plasma concentration. HDL and LDL can be separated into five subfractions increasingly electronegative subfractions (H1 to H5 and L1 to L5), with H1 and L1 being beneficial and H5 and L5 being dysfunctional. This study examines the effects of H5 and L5 on the viability of endothelial cells (ECs) and monocytes, key components of vascular immunity.

Hypothesis:
We hypothesize that L5 induces cytotoxic responses in monocytes (THP-1 cells) and bovine aortic ECs (BAECs), with H5 exacerbating these effects, thereby promoting inflammatory and atherogenic processes in atherosclerosis.

Methods:
H5 and L5 were fractionated by anion-exchange chromatography. Cells were treated with 50 µg/mL of L1, L5, H1, and H5 for 24 hours. Cell viability was assessed using a fluorescence-based viability detection method after trypan blue exclusion staining. Image-based cytometric quantification was performed using the Nexcelom Cellometer. Lipidomics was used to characterize L5 and H5, and transcriptomic analysis was performed on BAECs treated with H1 and H5 to identify differentially expressed genes.

Results:
H5 slightly and L5 moderately reduced cell viability, while their combination significantly decreased both cell numbers and viability (Figures A and B). In contrast, H1 and L1 increased cell numbers compared to PBS control (Figure C). Lipidomic analysis revealed that H5 and L5 have higher triglyceride and lower phosphatidylcholine content than H1 and L1. Transcriptomic analysis indicated that H5 is associated with changes in cell cycle regulation and cellular senescence, affecting DNA damage response and chromosome organization.

Conclusion:
L5 and H5, particularly in a synergistic manner, significantly impact EC and monocyte viability, impairing vascular innate immunity and contributing to atherosclerosis pathogenesis. Conversely, H1 and L1 increase cell proliferation, indicating their non-cytotoxic role and potential nutrient provision. Lipidomic and transcriptomic analyses further support the distinct roles of these lipoprotein subclasses in impaired vascular innate immunity and their contribution to atherogenic processes.
Abstract 4147752: Agreement of Doppler Flow Velocity Reserve With PET Flow Reserve in Angina Without Obstructive Coronaries
Authors: Ismayl Mahmoud , Raphael Claire , Prasad Abhiram , Chareonthaitawee Panithaya , Bois John
Published: November 2024

Background:
Angina with no obstructive coronary arteries (ANOCA) is clinically challenging to diagnose and manage. The agreement between Doppler-derived coronary flow reserve (CFR
Doppl
) and PET-derived CFR (CFR
PET
) in patients with ANOCA remains unclear.

Aims:
To evaluate the correlation between Doppler- and PET-derived CFR in patients with ANOCA.

Methods:
We conducted a single-center, retrospective study of adult patients (age ≥18 years) with ANOCA who were referred for evaluation of possible microvascular ischemia with Doppler- and PET-derived CFR at the Mayo Clinic (Rochester, MN) between January 1, 2018, and May 1, 2024. Pearson correlation was used to quantify the association between Doppler- and PET-derived CFR. Agreement between Doppler- and PET-derived CFR was assessed by Bland-Altman analysis using a 2-way mixed effects model with measures of absolute agreement.

Results:
A total of 66 patients were initially identified, of which 40 were included in the final analysis (66.7% female, median age 58 years [Q1-Q3: 45-66 years]). Median time between PET- and Doppler-derived CFR was 8 days (Q1-Q3: 1-31 days). Median CFR
Doppl
was 2.75 (IQR: 2.23-3.28) and median CFR
PET
was 2.50 (IQR: 2.10-3.10). Doppler-derived CFR displayed a wider range than PET-derived CFR (0.8-5.2 vs 1.2-4.0). A strong correlation was found between Doppler- and PET-derived CFR (
r=
0.81; p<0.001). The corresponding Bland-Altman plot showed an overall bias of 0.27±0.56 (intraclass coefficient=0.85; p<0.001).

Conclusions:
While invasive coronary angiography with CFR
Doppl
is the gold-standard for the diagnostic evaluation of ANOCA, PET imaging with CFR
PET
offers an excellent first line non-invasive modality for diagnosis of coronary microvascular dysfunction.
Abstract 4147790: Comparison of Clinical Efficacy and Safety of Different Advanced Treatment Strategies for Acute Pulmonary Embolism: A Bayesian Network Meta-analysis
Authors: Oli Prakash , Dawadi Sagun , Shrestha Dhan , Shtembari Jurgen , Mattumpuram Jishanth , Katz Daniel
Published: November 2024

Background:
Anticoagulation therapy (ACT) remains the cornerstone of acute pulmonary embolism (PE) management and reduces the mortality risk to <1% in low-risk PE. However, AC is inadequate in intermediate and high-risk acute PE, thus requiring additional therapies. So, there has been a search for better advancement in therapeutic approaches, including catheter-directed thrombolysis (CDT) or thrombectomy, surgical embolectomy (SE), or mechanical thrombectomy (MT). We performed this network meta-analysis to analyze the outcome of different therapeutic approaches for acute intermediate and high-risk PE.

Method:
We conducted a Bayesian network meta-analysis to synthesize direct and indirect evidence from pertinent studies published until May 2024 using PubMed, Embase, and Scopus databases comparing different therapies for intermediate and high-risk PE patients. This study is registered with PROSPERO, and data analysis was performed using the “BUGSnet” package in R.

Result:
This analysis included 1,639,413 patients with intermediate or high-risk PE from 72 studies. The probability of CDT being ranked highest was for short-term mortality (catheter-directed intervention: 93), long-term mortality (Ultrasound-assisted Thrombolysis (USAT): 86.17), major bleeding (USAT: 85.58), and intracranial hemorrhage (USAT: 86.06) whereas surgical embolectomy for any and gastro-intestinal bleedings (93.76 and 78.7) respectively. The risk of short-term mortality and intracranial hemorrhage were lower among the patients treated with USAT [(OR: 0.38, CrI: 0.17 to 0.81) and (OR: 0.27, CrI: 0.10 to 0.69)] than those treated with AC only and MT in a random effects model.

Conclusion:
Based on the findings of this network meta-analysis, compared to other advanced PE management modalities, catheter-based interventions, especially ultrasound-assisted thrombolysis, could potentially reduce short and long-term mortality risk without increasing bleeding risk.