bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144794: Effects of Myectomy on Cardiac Magnetic Resonance Parameters in Obstructive Hypertrophic Cardiomyopathy
Authors: Lewontin Myra , Ondigi Olivia , Goodrich Robyn , De Carvalho Singulane Cristiane , Thomas Matthew , McClean Karen , Perry Allison , Bilchick Kenneth , Patel Amit , Kramer Christopher , Ayers Michael
Published: November 2024

Introduction:
Cardiac magnetic resonance (CMR) analyses in patients from the EXPLORER-HCM study showed that cardiac myosin inhibitors (CMIs) have favorable effects in obstructive hypertrophic cardiomyopathy (oHCM) characterized by decreased left ventricular (LV) maximal thickness, decreased left ventricular mass index (LVMI), decreased left atrial volume index (LAVI), and cessation of replacement fibrosis progression based on late gadolinium enhancement (LGE).

Question:
Do surgical and alcohol myectomy lead to less favorable LV remodeling and cessation of scar formation than CMIs using CMR findings from EXPLORER-HCM as the comparison reference?

Hypothesis:
We hypothesized that the extent of CMR changes observed with CMIs in oHCM would not be observed with myectomy.

Methods:
We identified patients who underwent surgical or alcohol myectomy at our center of excellence with pre- and postprocedural CMR. We analyzed changes in LAVI, LVMI, LV maximal thickness, LV ejection fraction (LVEF), percent scar volume (LGE%), and scar mass by LGE (LGE% x LV mass). We normalized these changes by LV mass for comparison with CMR findings with CMIs reported in EXPLORER-HCM.

Results:
Characteristics of five patients with CMR before and after surgical or alcohol myectomy are shown in Table 1. Median (IQR) time to postprocedural CMR was 6.6 (2.5-28.9) months. LV maximal thickness decreased by 2.0 ± 1.4 mm (p = 0.03) following myectomy (EXPLORER-HCM: 2.4 mm decrease), LVMI decreased by 13.2 ± 15.5 g/m
2
(p = 0.13)(EXPLORER-HCM: 15.8 g/m
2
decrease), LAVI decreased by 11.9 ± 13.3 g/m
2
(p = 0.12)(EXPLORER-HCM: 10.3 g/m
2
decrease), and LVEF decreased by 6.4 ± 9.2% (p = 0.20)(EXPLORER-HCM: 6.4% decrease). Myectomy patients had an increase in LGE% of 2.5 ± 3.3% (p = 0.16) and in LGE mass of 2.4 ± 6.9 g (p = 0.48). Corrected for LV mass change, there was decreased mean LV maximal thickness (-1.7 mm), trends toward decreased mean LVMI (-11.3 g/m
2
), LAVI (-10.2 g/m
2
), LVEF (-5.5%), and trends toward increased mean LGE% (2.1%) and LGE mass (2.0 g).

Conclusions:
Surgical or alcohol myectomy resulted in trends toward positive remodeling, with overall similar effects to those seen with CMIs. Limitations include small sample size and variable timing of CMRs. There was an increase in LGE during follow-up with myectomy, consistent with continued disease activity with myectomy compared to CMI. This plausible difference in scar formation merits further prospective investigation with a larger sample size.
Abstract 4144798: Hemodynamic Insights Using Pressure Volume Loops into Transcatheter Repair Effects on Left Ventricular Function in Patients with Primary Mitral Regurgitation
Authors: Nagueh Sherif , Pournazari Payam , Wessly Priscilla , Hatab Taha , Bhimaraj Arvind , Faza Nadeen , Little Stephen , Goel Sachin
Published: November 2024

Background:
Mitral transcatheter edge to edge repair (M-TEER) is an effective treatment for high surgical risk patients with primary mitral regurgitation (MR). Some patients have persistently elevated left atrial (LA) pressures despite successful reduction of MR. We sought to study the underlying reasons for elevated LA pressures after M-TEER.

Methods:
LV systolic and diastolic functions were evaluated using conductance catheters to obtain pressure volume loops in 22 patients with primary MR and control group of 17 heart transplant recipients with normal function and normal LV EDP response to exercise. LA pressures and LA operating chamber stiffness were obtained, and MR severity was assessed by echocardiography.

Results:
In comparison with the control group which had all indices of LV systolic and diastolic function in the normal range at rest and with exercise, primary MR patients had increased LV volumes and diastolic pressures, time constant of LV relaxation (t), and LV chamber stiffness constant (all P≤0.01). After M-TEER, LV and LA volumes and pressures, LA operating chamber stiffness, and MR regurgitant volume decreased (all P<0.05), without significant change in LV chamber stiffness constant. Post M-TEER. patients with LA V pressure ≥20 mmHg had significantly higher LA operating chamber stiffness [0.32 (0.13-0.7) vs 0.08 (0.05-0.21) mmHg/mL], time constant of LV relaxation (59±6 vs 48±12 ms), and LV chamber stiffness constant (0.07±0.02 vs 0.05±0.02) versus patients with V pressure <20 mmHg (for all 3 variables: P<0.05). However, there were no significant differences in heart rate, LV systolic function indices (including LV EF), LV volumes, LV energetics, LA volumes, mitral valve area, and residual MR regurgitant volume.

Conclusion:
After M-TEER, there is no significant change in invasive indices of LV contractility. LV chamber stiffness constant is abnormally increased before M-TEER without a significant change afterwards. Patients with LA V pressure ≥20 mmHg after M-TEER, have worse LV diastolic function and higher LA operating chamber stiffness in comparison with patient having LA V pressure <20 mmHg post M-TEER.
Abstract 4144815: Natriuretic peptide-guided therapy in acute decompensated heart failure: An updated systematic review and meta-analysis
Authors: Gioli-Pereira Luciana , Katsuyama Eric , Campos Grisa Padovese Camila , Ribeiro Papp Silvana , Hortêncio Melo Rafael , de Sant Anna Melo Edielle
Published: November 2024

Background:
Natriuretic peptides (NP) are frequently employed in diagnosing heart failure (HF); however, their effectiveness in guiding HF treatment lacks sufficient evidence. To address this gap, we conducted an updated meta-analysis assessing the efficacy of NP-guided therapy versus usual care in decompensated HF.

Methods:
PubMed, Embase and Cochrane database were searched for randomized controlled trials (RCTs) that compared NP-guided treatment to usual care for patients with acute decompensated heart failure. The reported outcomes were (1) all-cause mortality; (2) cardiovascular death; and a (3) composite of all-cause mortality and HF hospitalizations. Heterogeneity was examined with I
2
statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was done using R Studio 4.3.2.

Results:
We included 10 RCTs with 4122 patients, of whom 2072 (50.3%) underwent NP-guided treatment. Mean follow-up was 14.8 months. All-cause mortality (HR 1.03; 95% CI 0.81-1.32; p=0.79; figure 1A), cardiovascular death (HR 1.33; 95% CI 0.72-2.47; p=0.36; figure 1B), and the composite outcome of HF hospitalization or cardiovascular death (HR 0.92; 95% CI 0.77-1.11; p=0.4; figure 1C) were not significantly different between groups.

Conclusion:
These findings suggest that NP-guided therapy does not reduce mortality and heart failure readmissions in the management of patients with acute decompensated heart failure.
Abstract 4144819: Efficacy and Safety of Coronary Sinus Reducer for Refractory Angina: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Amin Ahmed Mazen , Khan Ubaid , Katamesh Basant , Khlidj Yehya , Elbenawi Hossam , Ewis Abdelrahman , Iltaf Arej
Published: November 2024

Background:
Refractory angina severely affects patients' quality of life around the world. Among the new treatment methods, the coronary sinus reducer (CSR) is one of the most thoroughly researched.

Purpose:
We aim to investigate the efficacy and safety of CSR for refractory angina.

Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until May 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3).

Results:
With the inclusion of three RCTs, our cohort comprised a total of 180 patients. Compared to the control group, after six months, CSR was significantly associated with decreased mean change of Canadian cardiovascular society (CCS) class (MD: -0.54 with 95% CI [-0.80, -0.27], P< 0.01), an increased number of patients in the CCS class I (RR: 2.29 with 95% CI [1.14, 4.61], P= 0.02), a decreased number of patients in the CCS class III (RR: 0.53 with 95% CI [0.32, 0.87], P= 0.01), and increased exercise time (MD: 50.46 with 95% CI [9.47, 91.45], P= 0.02). However, there was no significant difference between CSR and the control group in CCS class II, class IV, across all Seattle Angina Questionnaire (SAQ) domains, the incidence of any serious adverse events (RR: 3.44 with 95% CI [0.82, 14.42], P= 0.09), stroke (RR: 2.13 with 95% CI [0.20, 22.88], P= 0.53), and all-cause mortality (RR: 1.06 with 95% CI [0.07, 16.59], P= 0.97).

Conclusion:
CSR has been shown to reduce angina severity by lowering CCS class scores and increasing exercise time. Large-scale RCTs are needed to confirm its effectiveness in patients with refractory angina.
Abstract 4144832: Adult congenital heart disease (ACHD) as career? Examining encouraging and discouraging factors around the globe in the Global ACHD Survey.
Authors: Bravo Katia , Srour MHD Osama , Jenkins Petra , Luna Raquel , Tutarel Oktay , Kandavello Geetha , Guerrero Carlos , García Cruz Edgar , Ackerman Judith , elizari maria amalia , Valdez Ramos Miriam , Cupido Blanche , Zentner Dominica , Almasri Murad , Phillips Sabrina , McLeod Christopher , Burchill Luke , Bullock-Palmer Renee , Windram Jonathan
Published: November 2024

INTRODUCTION:
There is a significant shortage of specialized Adult Congenital Heart Disease (ACHD) cardiologists despite a rising prevalence of adults with this condition.

AIM:
Our study explores the specific motivations and deterrents that influence adult and pediatric cardiologists’ ACHD career decisions, which could serve as the basis for future solutions to overcome this shortage in each specific region.

METHODS:
An anonymous global survey was distributed to adult and pediatric cardiologists and trainees via email, social media, and medical society newsletters. The survey included demographics, ACHD exposure, career considerations, Likert scale ratings, and open-ended inquiries on ACHD career recommendations. Respondents included non-ACHD and ACHD cardiologists (defined as those caring for ACHD with or without formal training). The analysis covered regional variations across continents. Responses with less than 75% completion were excluded.

RESULTS:
A total of 811 valid responses were collected (53.5% female, 48.3% aged 31-40, and 43.3% White). ACHD cardiologists were 21%, mostly practicing in North America (44.1%) and Europe (32.9%). Almost all ACHD cardiologists (94.7%) recommended it as a career. Among the 641 non-ACHD cardiologists, 85.7% had been exposed to ACHD, however, only 35.1% considered pursuing it themselves. For ACHD cardiologists the top global motivators for pursuing an ACHD career were awareness of the field and its significance, mentor's influence, and sufficient clinical exposure during residency (Figure 1A). Factors that deterred non-ACHD cardiologists included a lack of compensation compared to other cardiology subspecialties, limited job opportunities, and the longer duration of training (Figure 1B). Absence of specialized training and educational programs emerged as a major deterrent in all continents except North America. The lack of mentorship or role models in ACHD was particularly pronounced in Africa and Central and South America. Limited exposure to ACHD during training was a significant issue in Europe and Africa.

CONCLUSION:
Most ACHD cardiologists recommend a career in ACHD. However, only a few non-ACHD cardiologists recommend it. Influential mentors, clinical exposure motivate; low compensation, lengthy training deter. Regional disparities require targeted interventions for better ACHD cardiologist recruitment.
Abstract 4144835: Caregiving Burden Does Not Moderate the Effect of the Cardiovascular Risk Reduction Program on Engagement in Healthy Behaviors for Rural Caregivers
Authors: Chung Misook , Lennie Terry , Rayens Mary Kay , Moser Debra
Published: November 2024

Introduction:
Given the substantial evidence that adults who provide informal care for their chronically ill families are at high risk of poor health, including the development of cardiovascular disease (CVD), engagement in and maintenance of healthy behaviors are critical. Furthermore, rural caregivers living in socioeconomically austere healthcare environments face additional challenges in engaging in self-care. We conducted a CVD risk reduction intervention program for rural caregivers to promote self-care in the context of caregiving burden.

Aims:
The aim was to determine whether caregiving burden moderated the intervention effect on engagement in healthy behaviors.

Method:
In this randomized controlled trial (RCT), rural caregivers with at least two or more CVD risk factors (N=311, 76% female, 96% white, mean age=54.8 years) were randomly assigned to either intervention or control groups. The 12-week education and counseling intervention designed to promote self-care was delivered by telehealth. Outcomes were assessed at 4 and 12-month follow-ups. Caregiving experience was assessed using the Zarit Burden Interview (ZBI) and the Osbert Caregiving Burden Scale (time spent and difficulty in caregiving subscales). Engagement in healthy behaviors was assessed using the modified version of the Medical Outcome Scale-Specific Adherence Scale. ANOVA and three-way repeated measures ANOVA were used.

Results:
Most caregivers reported a little or no burden (n=123, 39.5%) or mild-moderate caregiving burden (n=120, 38.5%), but one-fifth reported moderate to severe burden (n=68, 21.8%) as categorized by baseline ZBI scores. Caregivers with moderate to severe burden had more time spent on caregiving (p<.001) and higher levels of caregiving difficulty (P <.001) at baseline. The intervention group significantly improved engagement in self-care at 4 and 12 months compared to the control group (Time X RCT Group, P < 0.001), but the effect was not moderated by their caregiver burden groups (Time X RCT Group X Caregiving Burden groups, P = 0.843, Figure 1).

Conclusion:
The CVD risk reduction program designed for rural caregivers effectively improved engagement in heart-healthy behaviors regardless of their caregiving burden levels.
Abstract 4144878: Comparison of Glycemic Profile, Cardiovascular Risk Factors, and Insulin Resistance in Type 2 Diabetic Patients with Metabolic Syndrome: A Retrospective Analysis
Authors: Tripathi Pramod , Sul Lidiya , Lee Matthew , Nanjundappa aravinda , Kapadia Samir , Tiwari Dipitka , Kadam Nidhi
Published: November 2024

Background:
Metabolic syndrome (MtS) is a cluster of risk factors, including hypertension, hyperglycemia, abdominal obesity, and dyslipidemia, which increase the risk of cardiovascular disease and poor glycemic control in type 2 diabetes (T2D) patients. Understanding the differences in glycemic profiles, cardiovascular risk factors, and insulin resistance between T2D patients with and without MtS is crucial for developing targeted interventions and identifying key predictors of MtS.

Hypothesis:
T2D patients with MtS show poor glycemic control and higher cardiovascular (CV) risk factors than those without MtS.

Aims:
This study aimed to compare the glycemic profile, cardiovascular risk factors, and insulin resistance, and identify predictors of metabolic syndrome in patients with T2D.

Methods:
Anthropometric and biochemical data of 2923 T2D patients (aged 18 years or older) who participated in a one-year online diabetes management program in India from 2020 to 2022 were examined retrospectively. The diagnosis of Metabolic Syndrome (MtS) was based on the NCEP-ATP III criteria (Triglyceride (TG) ≥150mg/dL, Blood Pressure≥130/85mmHg, and Fasting glucose ≥100mg/dL).

Results:
The mean age of the study population was 50±10 years. Among the 2923 patients, 7% had MtS. Patients with Mts displayed significantly higher BMI (27.2 vs. 25.6kg/m2), HbA1c (8.7 vs. 7.4%), fasting glucose (162 vs. 128 mg/dL), and postprandial blood glucose (195 vs.151 mg/dL) compared to those with MtS (p<0.01) Additionally, individuals with T2D and MtS exhibited higher CV risk factors; HDL (39 vs. 41 mg/dL), LDL (119 vs. 99 mg/dL), TG (207 vs.121mg/dL), TG/HDL (5.3 vs.2.9), and blood pressure (140/90 vs.122/80 mmHg) (p<0.01). Moreover, patients with MtS also demonstrated higher insulin resistance calculated by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (3.9 vs.2.5), high sensitivity C-reactive protein (3.2 vs.1.7 mg/L), and urine microalbumin (11.2 vs.5.9 µg/ml), but lower vitamin D (19 vs. 23 ng/mL) (p< 0.01) than those without MtS. Notably,TG/HDL emerged as a significant predictor of metabolic syndrome (p<0.01).

Conclusion:
This study reveals significant differences in glycemic profiles, CV risk factors, and insulin resistance between T2D patients with and without metabolic syndrome, with the TG/HDL ratio identified as a key predictor of metabolic syndrome. This suggests the need for targeted strategies to reduce the risk factors associated with MtS in T2D patients.
Abstract 4144890: Efficacy and Safety of Pressure-controlled Intermittent Coronary Sinus Occlusion in ST-Elevation Myocardial Infarction (STEMI) Patients
Authors: Jeswani Bijay , Patel Tirath , Rathore Sawai Singh , Syed Saif , Allam Sanjana , Banga Akshat
Published: November 2024

Background:
Pressure-controlled intermittent coronary sinus occlusion (PiCSO) is an innovative therapeutic approach that enhances myocardial perfusion and minimizes reperfusion injury by intermittently occluding the coronary sinus, thereby increasing retrograde coronary perfusion. To date, no meta-analysis has comprehensively evaluated the efficacy and safety of PiCSO in this setting. This meta-analysis aimed to evaluate the addition of PiCSO to primary percutaneous coronary intervention (pPCI) in patients with STEMI, providing a comprehensive assessment of its potential benefits and risks in the clinical setting.

Methods:
A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using the inverse variance method, random-effect models were used to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. The primary endpoints were the mean infarct size (% LV mass), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV ejection fraction (LVEF), and microvascular obstruction extent (MVO) (%LV) at follow-up (2-5 days).

Results:
Six studies, encompassing 467 STEMI patients, were included in the analysis. PiCSO in addition to pPCI did not significantly alter infarct size (SMD = 0.16; 95% CI -0.31 to 0.63; p= 0.51), LVEF (SMD = 0.07; 95% CI - 0.14 to 0.28; p= 0.51), LVESV (SMD = -0.13; 95% CI -0.34 to 0.08, p= 0.21) and LVEDV (SMD = -0.11; 95% CI -0.32 to 0.10; p=0.31) compared with conventional treatment with pPCI alone. There was no significant difference in the extent of microvascular obstruction (MVO) between the two groups (SMD = -0.12; 95% CI -0.39 to 0.16; p = 0.37).

Conclusion:
Our meta-analysis suggests that PiCSO as an adjunct to pPCI does not significantly improve myocardial protection or ventricular function in STEMI patients. Future research should investigate whether specific patient subgroups might benefit from this intervention.
Abstract 4144899: Invasive vs conservative strategy in management of patients with Non-ST elevation myocardial infarction: A systematic review and meta-analysis of over a million patients.
Authors: Gadelmawla Ahmed Farid , Mohamed Ahmed , Abdelaziz Ahmed , Diab Rehab , Mansour Ahmed , Hassan Atef , Elnady Mohamed , Afify Raneem , Desouki Mariam , Ramadan Shrouk
Published: November 2024

Introduction:
Non-ST elevation myocardial infarction (NSTEMI) significantly contributes to the burden of cardiovascular diseases, affecting millions of patients. The management of NSTEMI has evolved and it involves invasive and conservative strategies, the optimal management remains unclear. We conducted this systematic review and meta-analysis to compare the two different strategies and their long-term outcomes.

Methods:
We systematically examined the clinical outcomes of conservative and invasive management of patients with NSTEMI using medical records from Web of Science, PUBMED, Scopus, and Cochrane. Our outcomes of interest were all-cause mortality, myocardial infarction (MI), and major bleeding. Odds Ratios (OR) and 95% CI were used in a fixed-effect model to analyze the data.

Results:
Our study included 24 studies with a total of 1,076,572 patients. the invasive strategy was significantly associated with a reduction in all-cause mortality (OR: 0.52, 95% CI: 0.51 to 0.53), and the incidence of myocardial infarction (OR: 0.84, 95% CI: 0.73 to 0.97). However, the invasive strategy showed a significant increase in major bleeding events (OR: 1.93, 95% CI: 1.87 to 1.98).

Conclusion:
The invasive strategy showed better clinical outcomes on the long-term follow-up related to all-cause mortality and myocardial infarction, with an increase in the incidence of major bleeding events.
Abstract 4144906: An Innovative telemonitoring-wearable device with third heart sound detection for early detection of worsening heart failure
Authors: Masuda Hirotada , Ekuni Shota , Misumi Yusuke , Akazawa Yasuhiro , Sakata Yasushi , Miyagawa Shigeru
Published: November 2024

Background:
Approximately 40% of chronic heart failure patients require rehospitalization for worsening heart failure (WHF) within one year after discharge. Implantable devices such as CardioMEMS have been developed to overcome this challenge but with the problem of invasiveness. We have developed a watch-type wearable device and software that could detect WHF early by detecting an outpatient's third heart sound (S3) and conducted a feasibility study at multiple centers in Osaka.

Objective:
To clarify the accuracy of our system in detecting S3 and WHF events.

Patients&Methods:
We lent the watch-type device and the smartphone to collect the outpatient's heart sound data. Patients wore the device with a built-in small microphone for six months, except while bathing or sleeping. The device was put on the patient's left side chest wall to record heart sounds at 8, 13, and 18 o'clock. These data were sent to the smartphone app and our server. Our unique algorithm, including an AI-based analyzing system, identified S3 in the heart sound data. If the WHF events occurred, the patients were admitted to the hospital. A cardiologist heard the same sound data of the server and annotated if the heart sound data included S3. S3 and WHF detection accuracy were measured.

Results:
Twenty-three patients enrolled, and three patients experienced a WHF event. Four hundred and eighty-three heart sound data were recorded. Four hundred and thirty-four of the sound data were used for building an AI-analysing system as training data, and 49 were used as test data. In the test data, 14 of 49 sound data had S3 due to a cardiologist diagnosis. Our AI system had a sensitivity of 93% and specificity of 80% for detecting S3 among them and predicted all WHF events before rehospitalization, referring to S3 present.

Conclusion:
Our system could detect S3 and WHF events with acceptable accuracy. This system would be a breakthrough technology for home monitoring in the cardiac field.
Abstract 4144910: AI-Enhanced Recognition of Occlusion in Acute Coronary Syndrome (AERO-ACS): A Retrospective Review
Authors: Choi James , Torelli Vincent , Diaz Sara , Vaish Esha , Katic Luka , Nagourney Alex , Khan Zara , Silverman Alex , Farhan Serdar
Published: November 2024

Introduction:
Traditional ST-elevation criteria do not exhibit high sensitivity for acute occlusion detection, with many total occlusions presenting as NSTEMI, often resulting in worse outcomes. AI-based EKG interpretation may improve the identification of occlusion myocardial infarction (OMI). This study evaluates a novel AI-EKG device's accuracy and clinical outcomes for detecting OMI in suspected ACS patients.

Methods:
Adult patients who underwent coronary angiogram (CAG) at Mount Sinai Morningside Hospital for unstable angina, NSTEMI, or STEMI between January 1 and December 31, 2022, were included. The AI model (PMCardio) analyzed all pre-CAG ECGs. Inclusion criteria: suspected ACS at the emergency department, no outside hospital transfers, and available peak troponin levels. OMI was defined as a culprit vessel with TIMI 0-2 flow or TIMI 3 flow and peak cTnI > 10.0 ng/mL. Primary outcome: AI EKG model's sensitivity and specificity for predicting OMI on CAG. Secondary outcomes: F1 score, predictive values, AI OMI prediction of inpatient mortality, reduced ejection fraction at 1 year, unplanned readmissions, and STEMI criteria performance.

Results:
Of 257 patients, 222 met the inclusion criteria: 72 STEMI (32%), 145 NSTEMI (65%), and 5 unstable angina (3%). Confirmed angiographic OMI: 60 (83%) STEMI and 51 (35%) NSTEMI patients. AI model sensitivity was 81.08%, specificity 87.39%, AUROC 0.8423, F1 score 0.8372, PPV 86.54%, NPV 82.20%. Odds ratio of 12.44 (1.56 - 98.98) for AI-detected OMI patients, unplanned readmissions (OR 1.15 [0.53 - 2.51]), and reduced ejection fraction at 1 year (OR 0.24 [0.26 -2 .16]). Traditional STEMI criteria sensitivity for OMI was 54.05%, and specificity 89.29%. The AI model was 100% sensitive for STEMI-OMI and correctly reclassified 8 out of 12 false positive STEMI patients as NOMI.

Conclusion:
The AI model nearly doubles the sensitivity of traditional STEMI criteria for OMI, enabling more accurate and earlier detection. Further studies are needed to determine if earlier OMI detection with AI improves clinical outcomes. The AI's high specificity in detecting STEMI-OMI may also reduce false positive catheterization lab activations while ensuring no true positive STEMI OMI cases are missed.
Abstract 4144928: Association between Congenital Heart Disease and the Risk of Cancer and its subtypes.
Authors: Jaiswal Vikash , Hanif Muhammad , Jaiswal Akash , Sundas FNU , Gimelli Alessia , Grubb Kendra
Published: November 2024

Background:
Relationship between congenital heart disease and the risk of cancer and its subtypes is not well understood.

Objective:
This study aim to investigate the association between CHD and risk of cancer and its subtypes among adult patients.

Method:
The TriNeTX research database was used to identify patients aged ≥18 years of age from January 2000 to January 2021. Patients were categorized into two groups, one with CHD and another without CHD group of patients. Patients were followed for 1 and 3 years respectively. Propensity score-matched analysis (PSM) (1:1) was performed on demographics and comorbidities such as hypertension and diabetes mellitus. The primary outcome was cancer risk, while secondary outcomes were breast cancer, thyroid cancer, skin cancer, gastrointestinal tract cancer (GI), lung cancer, and brain tumors.

Results::
After 1:1 propensity score matching, the study cohort comprised 33,581 CHD patients and 33,581 non CHD patients. CHD patients were having a significantly higher risk of cancer after 1 year of follow-up (RR, 2.10 (95% CI: 1.764-2.515, P<0.001). A similar trend of higher risk of cancer was observed after 3 years of follow-up (RR, 1.63 (95% CI 1.436-1.851, P<0.001) when compared with the non CHD group of patients.

The risk of lung cancer was significantly higher among CHD groups of patients after 1 year of follow-up (RR, 1.44 (95% CI: 1.024-2.049), P=0.035), and after 3 year of follow-up (RR, 1.28 (95% CI: 1.018-1.630, P=0.034). Skin cancer were found significantly higher in CHD patients after 1 year of follow-up (RR, 1.42 (95% CI: 1.171-1.741), P<0.001), however, this became non-significant after 3 years of follow-up (RR, 1.05 (95% CI: 0.926-1.203, P=0.416).

On the other hand, the risk of brain tumors was comparable in both groups after 1 year of follow-up (RR, 1.60 (95%CI: 0.727-3.530), P=238). However, after 3 years of follow-up, the risk of brain tumor became significantly higher in CHD patients (RR, 2.73 (95% CI: 1.369, 5.449), P=0.003) when compared with non CHD group of patients.

In contrast, the risk of breast cancer, GI tumor, and thyroid cancers were comparable both after 1 year follow-up, and after 3 years of follow-up among both groups of patients.

Conclusion:
These findings suggest that CHD patients are at higher risk of having Cancer, specifically lung cancer, dermatological cancer, and brain tumors.
Abstract 4144930: A novel approach for LV delay evaluation: non-invasive QLV measurement using UHF ECG
Authors: Poviser Lukas , Stros Petr , Vesela Jana , Curila Karol
Published: November 2024

Introduction:
Cardiac resynchronization therapy (CRT) improves quality of life, left ventricular (LV) systolic function and reduces heart failure hospitalizations and mortality. LV pacing at sites with prolonged electrical delay, such as invasively measured LV delay (QLV), is most effective in correcting electrical dyssynchrony in patients with LBBB-type intraventricular conduction abnormalities. UHF-ECG is a non-invasive tool optimized to calculate ventricular dyssynchrony between segments under the standard V1–V8 chest leads. However, the association between LV delay assessed by UHF-ECG and invasively assessed LV delay is still unknown. Our study aimed to compare invasive measurements of LV delay with LV delay using UHF ECG in patients with LBBB and undergoing CRT.

Methods:
We retrospectively analyzed electrophysiologic recordings, angiographic images, and UHF-ECG recordings from consecutive BVP-CRT procedures. The study included patients with symptomatic heart failure with LVEF ≤ 40 %, QRS duration ≥ 130 ms and spontaneous sinus rhythm with a non-RBBB morphology. The QLV interval was measured from the QRS complex onset to the steepest deflection of the local electrogram from the implanted CS lead. To quantify LV delay using UHF ECG, the time from the QRS onset to the activations in V6, V7, and V8 was measured. The left ventricular lateral wall was segmented into two regions: the basal segment (activating under V7-V8 leads) and the apical segment (activating under the V6 lead). Each LV lead electrode was assigned to a segment based on angiographic images.

Results:
Our study included 32 patients with an average LVEF of 30 ± 6 %, ischemic cardiomyopathy had 12 and Strauss criteria for LBBB met 28 patients. The average intrinsic QRSd was 171 ± 16 ms and spontanous e-dys was 82 ± 32 ms. There was no statistically significant difference between measured QLV and LV delay using UHF ECG (4.0 ± 8.4 ms; mean ± SD, p = 0.48) and linear regression analysis showed strong correlation between them (r = 0.95). Also, there was no difference in measurements between the apical and basal segments (3.3 ± 8.3 ms; mean ± SD, r = 0.95 for basal segment, r = 0.94 for apical segment, p = 0.14).

Conclusions:
Our study demonstrated that UHF-ECG measurements of LV activation delay are strongly correlated with invasively measured electrical LV delay in patients with LBBB undergoing CRT. This suggests that UHF-ECG can accurately identify sites of prolonged electrical delay.
Abstract 4144944: Critical Insights for a High-Risk Population: Low Life’s Essential 8 Scores among Post-Operative Coronary Artery Bypass and Percutaneous Coronary Intervention Patients; All of Us Research Program
Authors: Chang Austin , Won Daniel , Walker James , Congivaram Harrshavasan , Li Ruoqi , Prasanna Anagha , Davidson Laura , mehta chris , Lloyd-Jones Donald , Malaisrie S. Christopher
Published: November 2024

Background:
The American Heart Association’s (AHA) Life’s Essential 8 (LE8) concept serves as a quantitative framework for assessing cardiovascular health (CVH). Post-operative coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) patients are at high-risk for subsequent cardiovascular events (CVE). However, LE8 scores for post-procedural CABG or PCI patients remain unknown.

Methods:
Isolated post-operative CABG (n=208) or PCI (n=739) non-institutionalized patients from the National Institutes of Health’s (NIH) All of Us (AoU) Research Program (2017-2022) were included. LE8 scores (range 0-100, higher = better CVH; excluding diet metric) were calculated using methods recommended by the AHA. Physical activity and sleep metrics were derived from patients' Fitbit data, while all other metrics were sourced from electronic health records (EHR).

Results:
Overall LE8 scores for post-operative CABG (57.9 [95% CI: 56.6-59.2]) and PCI patients (55.3 [54.4-56.1]) were significantly lower than that of the general population (65.9 [65.1-66.7] (p<0.001). Significantly lower LE8 metrics were observed in post-op CABG and PCI patients compared to the general population for the following factors: nicotine exposure (-4.1 vs. -8.3, respectively), sleep health (-19.5 vs. -23.6), body mass index (-9.4 vs. -10.8), blood glucose (-36.5 vs. -35.0), and blood pressure (-13.5 vs. -16.5). Physical activity scores were low for post-op CABG patients (56.6 [52.3-60.8]), PCI patients (54.7 [52.3-57.1]), and the general population (51.6 [53.5-59.7])
(Figure 1A, 1B).

Conclusion:
Our study indicates that post-op CABG and PCI patients, who are at significantly increased risk for subsequent CVE, exhibit critically low overall CVH as measured by AHA’s LE8 metrics. These findings highlight the urgent need for targeted interventions, with nicotine exposure, physical activity, BMI, blood glucose, and blood pressure identified as key areas for improvement. Since LE8 metrics include behavioral and physiologic metrics associated with CVD risk, further research should focus on effective strategies to address these deficits in post-operative PCI and CABG patients.
Abstract 4144953: Prognostic Value Of sST2 Added To Mosaic Loss Of Y Chromosome As A Fibrosis-Related Disease-Specific Biological-Genomic Marker In Aortic Valve Stenosis
Authors: Mas-Peiro Silvia , Rasper Tina , Berkowitsch Alexander , Speer Thimoteus , Dimmeler Stefanie , Zeiher Andreas
Published: November 2024

Background:
Risk stratification in severe aortic valve stenosis (AVS), even after contemporary TAVR therapy, is a significant unmet need. General risk scores (STSscore) or heart status biomarkers (NTproBNP) are useful, but prognostic value of potential disease-specific and mechanistically-based indexes is still low.

Myocardial replacement fibrosis, as assessed by cMRI, appears to be the most important prognostic factor after TAVR. Soluble ST2 (sST2), a general cardiac biomarker originally reported in inflammatory diseases, was shown to be an independent factor for myocardial fibrosis; and men have higher levels of sST2 in patients with AVS.

Experimentally, mosaic loss of Y chromosome in monocytes (mLOY) was associated with increased diffuse myocardial fibrosis, and we recently reported that mLOY is associated with a worse prognosis in severe AVS.

Aim:
We aimed at assessing the prognostic value of sST2 added to mLOY as a disease-specific biological-genomic marker focused on fibrosis in male patients with severe AVS.

Methods:
A cohort of 243 consecutive elderly male patients undergoing TAVR was studied. mLOY (i.e., Y/X ratio) was assessed with a digital PCR method in peripheral blood cells DNA, by targeting a 6 bp sequence difference between genes AMELX and AMELY using TaqMan. The previously established mLOY cut-off value of 17% was used. sST2 serum levels were measured, and its optimal cut-off point was calculated based on ROC-curve and Youden index.

2-year survival in the following groups was compared using KM-curves: LOY-low/sST2-low, LOY-low/sST2-high, LOY-high/sST2-low, LOY-high/sST2-high. A multivariate Cox regression analysis was used to assess mortality risk independent from most important comorbidity, echocardiographic and laboratory risk factors.

Results:
Optimal cut-off value for sST2 was 32.665 ng/ml. Separately, both mLOY (HR: 2.9 [1,7-4.9] and sST2 (4.2 [2.5-7.0]) predicted mortality (both, p<0.0001), but prognosis in LOY-high/sST2-high patients was significantly worse than in all other groups (p<0.001) and showed a substantial risk difference over time (see K-M curves). Multivariate analysis confirmed the risk prediction to be independent from other risk factors (HR 4.620, 95% IC 2.35-9.07, p<0.0001).

Conclusion:
In male patients with severe AVS undergoing TAVR, LOY-high/sST2-high, a combined biological-genomic marker for fibrosis, is a strong disease-specific and mechanistically-based mortality predictor, independent from general and cardiac risk markers.
Abstract 4144974: Pulsed ElectRic FiEld versus Cryoballoon to Treat Paroxysmal Atrial Fibrillation (PERFECT-PAF) Randomized Trial: a Periprocedural Clinical and Cost Analysis
Authors: Chierchia Gian Battista , Della Rocca Domenico , Vetta Giampaolo , Magnocavallo Michele , Glowniak Andrzej , Fernandez Barcelo Carla , Velagic Vedran , Hafermann Juliane , Silas Ubong , Pannone Luigi , marcon lorenzo , Almorad Alexandre , Tarkowski Adam , Audiat Charles , Rossi Pietro , Uffenorde Steffen , NAKASONE KAZUTAKA , Bala Gezim , Konopka Aleksander , Overeinder Ingrid , Doundoulakis Ioannis , Iacopino Saverio , Tsiachris Dimitrios , Sorgente Antonio , Marangoni Andrea , Stroker Erwin , Sieira Juan , Sarkozy Andrea , BIANCHI STEFANO , de Asmundis Carlo
Published: November 2024

Background:
Pulsed ElectRic FiEld versus Cryoballoon to Treat Paroxysmal Atrial Fibrillation (PERFECT-PAF) is an investigator initiated, multicentre, randomized trial on pulmonary vein isolation (PVI) using either a pentaspline pulsed field ablation (PFA) or cryoballoon (CRYO) catheter.

Hypothesis:
It is of utmost importance to assess both the clinical and economic value of novel ablation technologies to ensure access to therapies that are effective and economically sustainable.

Aim:
To compare periprocedural safety and costs of PVI via PFA versus CRYO.

Methods:
Paroxysmal AF patients 18-75 years old were randomly assigned to PFA or CRYO at 6 European Centres. Data regarding clinical management during index hospitalisation, procedural details, and resources used were collected.

The primary safety endpoint included procedure- and technology-related adverse events within 7 days post-ablation (e.g., pericardial effusion, persistent (>30 days) or transient (periprocedural) phrenic nerve (PN) injury, vascular complications).

Results:
A total of 269 paroxysmal AF patients were randomly assigned to undergo PFA (n=134) or CRYO (n=135). Baseline characteristics were similar.

Room time (mean ± SD) was 77.1±13.9 min for PFA vs. 97.0±20.4 min for CRYO (+19.9 min, p<0.001). Procedural time was 52.5±11.8 min for PFA and 69.3±18.0 min for CRYO (+16.8 min, p<0.001).

Overall periprocedural adverse events were significantly more frequent with CRYO than PFA (+7.4%; p=0.0053). Major adverse events were documented in 1 (0.7%) and 4 (3.0%) patients for PFA and CRYO, respectively (p=0.3703). CRYO-related PN injury, either persistent (n=2; 1.5%) or transient (n=4; 3.0%), was the main determinant of this difference and hindered effective isolation of the right PVs in 3 (2.2%) CRYO cases. The adverse event rate at 7 days was also higher with CRYO than PFA (+5.2%; p=0.036).

The total costs per patient within 30 days were 13.7% lower in the PFA group.

Conclusion:
In paroxysmal AF patients, PFA overcame safety limitations of CRYO with optimal effectiveness, fewer adverse events, and shorter procedural times. Long-term follow-up data will be collected and analysed to further investigate the potential clinical and economic impact of PFA versus CRYO.
Abstract 4144977: The Association of Social Determinants of Health with Pediatric Pulmonary Hypertension Outcomes
Authors: Khurana Jai , Lipsitz Stuart , Moynihan Katie , Mullen Mary
Published: November 2024

Background:
Social determinants of health (SDoH) impact access to healthcare and outcomes. Few studies examine SDoH in pediatric pulmonary hypertension (PH) patients.

Hypothesis:
Outcomes in pediatric PH patients will differ according to SDoH with increased mortality in those from 1) low Child Opportunity Index (COI) areas or 2) non-local to our specialized quaternary center, with 3) public insurance, 4) limited English proficiency (LEP) and 5) underrepresented races/ethnicities.

Methods:
In this single center, retrospective cohort study, pediatric PH patients (<18) with inpatient admission 2012-2021 were identified using ICD-10 codes. Demographics, clinical course and outcomes were compared according to SDoH. Logistic regression, with SDoH separately added, studied associations with mortality at current follow-up, controlling for clinical factors, number of admissions and follow-up length with Bonferroni correction.

Results:
Of 1735 pediatric PH patients, 232 (13.4%) died. Median time to last follow-up or death was 35 days (IQR 8, 241). Median age was 215 days (IQR 14, 1716) with etiological subgroups of pulmonary arterial hypertension (275, 15.9%), left heart disease (1169, 67.4%), lung disease (271, 15.6%), thromboembolic (16, 0.9%) and other (4, 0.2%). Patients had a median of 3 complex chronic conditions (IQR 2, 5), ECMO (10.3%), lung (1.5%) or heart transplant (2.8%), tracheostomy (12.1%) and utilized PDE5 inhibitors (29.9%), prostacyclins (1.7%), endothelin receptor antagonists (4.0%) and inhaled nitric oxide (11.9%).

Patients that died had lower COI (median 61.5 [IQR 30.8, 80.3]) vs. those who survived (median 69.0 [IQR 43, 88] p=0.002). Mortality was higher in those with public vs. private insurance (15.5% vs 11.7%, p=0.022). Mortality differed by race/ethnicity (p<0.001); 11.6% in non-Hispanic/Latino White patients, 9.5% ‘another’, 1.7% Asian, 19.6% Black, 9.5% Hispanic/Latino, 4.0% multiracial and 19.2% unknown. Survival for local vs. out of state and LEP patients were similar (p>0.6).

For a 10-point COI increase, adjusted mortality odds were 0.92 lower (95%CI 0.87, 0.98, p=0.009). Patients with Black (1.93 [95%CI 1.2, 3.2] p=0.011) and unknown race (1.99 [95%CI 1.4, 2.9] p<0.001) had higher adjusted odds of mortality vs. White. Payer was not independently associated with mortality.

Conclusions:
Black PH patients or those from lower COI areas had higher mortality. Deeper understanding of disparate outcomes is needed to advance health equity.
Abstract 4144990: Relationships Between Degree of Obesity, Transthoracic Impedance, and Cardioversion Efficacy
Authors: Sanchez Alexandra , Murphy Barret , Aymond Joshua , Bernard Michael , Hiltbold Aimee , Khatib Sammy , POLIN GLENN , ROGERS PAUL , Castine Michael , Morin Daniel
Published: November 2024

Background:
In our recent multicenter randomized clinical trial comparing the efficacy of single versus dual direct current cardioversion (DCCV) in patients with significant obesity (body mass index [BMI] ≥35 kg/m
2
) undergoing DCCV for atrial fibrillation (AF), we found higher success rates using dual-DCCV. In addition to total energy applied, another important parameter is transthoracic impedance (TTI), as it impacts myocardial current density. Higher TTI is associated with DCCV failure. Previous studies found a positive correlation between BMI and TTI among normal-BMI patients (B=1.9 Ω/[kg/m
2
]). Whether there is a significant relationship between BMI and TTI in obese patients is unknown.

Objective:
In this post-hoc analysis of the dual-DCCV study, we investigated whether further increase in BMI above 35 kg/m
2
correlates with increasing TTI, and whether TTI impacts procedural success in obese patients.

Methods:
Of the 200 patients included in the primary study, impedance data were available for 112. The relationship between BMI and TTI was compared using linear regression, and t-tests were used to assess whether DCCV efficacy varied significantly with BMI or TTI.

Results:
Among these 112 patients (age 65±11 years, BMI 41±7 kg/m
2
, 36 [32%] female, 17 [15%] Black), increasing BMI was weakly associated with a small, though statistically significant, increase in TTI (R
2
=0.04, B=0.53, p=0.03). There was no difference between patients with successful cardioversion (n=101) vs. failure (n=11) in terms of BMI (41±6 vs. 44±14 kg/m
2
, p=0.16) or TTI (96±19 vs. 98±18 Ω, p=0.81). These relationships were also true when the analysis was limited to participants receiving single-DCCV (n=57; with success in 48 [84%]): 41±6 vs. 45±15 kg/m
2
, p=0.21; and 98±15 vs. 102±17 Ω, p=0.48.

Conclusion:
In patients with Class 2 or higher obesity undergoing DCCV, there is a weaker association between further increase in BMI and TTI than previously found among patients with BMI <35 kg/m
2
. Further, in this high BMI population, there is no difference in TTI or BMI based on success or failure of DCCV.
Abstract 4144992: Ambient Air Pollution Heightens Prevalence and Adverse Impacts of Clonal Hematopoiesis of Indeterminate Potential
Authors: Abohashem Shady , Aldosoky Wesam , Uddin Md Mesbah , Civieri Giovanni , LAU HUI CHONG , AbiKaram Krystel , Assefa Alula , Rajagopalan Sanjay , Osborne Michael , Natarajan Pradeep , Tawakol Ahmed
Published: November 2024

Background:
Clonal hematopoiesis of indeterminate potential (CHIP), characterized by the expansion of somatic leukemogenic variations in hematopoietic stem cells, has been linked to atherosclerotic cardiovascular disease. While particulate matter with aerodynamic diameter ≤2.5 micrometers (PM
2.5
) is known to elevate major adverse cardiovascular event (MACE) risk, potentially through enhanced leukopoietic activity, the specific connection between PM
2.5
and CHIP and their combined role in MACE risk, remains unclear.

Hypothesis:
We hypothesized that high levels of PM
2.5
exposure are associated with increased CHIP prevalence, which in turn mediates the relationship between PM
2.5
exposure and MACE risk.

Methods:
We analyzed data of 7015 participants from the Mass General Brigham Biobank, who had undergone genotyping and had their PM
2.5
exposure quantified (for the year prior to consent) based on residential addresses. CHIP detection utilized whole-exome sequencing of blood DNA. MACE diagnosis and risk factors were assessed using ICD codes and health surveys. Multivariable logistic regressions and mediation analysis were employed.

Results:
Of the participants (mean age of 64 (SD 0.2) years and 47.8% male), 972 exhibited CHIP. High PM
2.5
exposure was associated with an increased risk of CHIP (standardized odds ratio [OR] 1.140 [95% CI: 1.031, 1.262], p=0.011;
Fig 1A
) and a higher number of CHIP mutations (OR:1.403 [95% CI: 1.123, 1.753], p=0.003;
Fig 1B
) after adjusting for covariables related to CHIP*. Further, CHIP mediated the relationship between PM
2.5
exposure and MACE risk (p<0.05). Notably, MACE risk was greatest among individuals with CHIP who were exposed to higher PM
2.5
(OR:1.405 [95% CI: 1.104,1.786], p=0.006*;
Fig 2
).

Conclusion:
Our findings suggest that ambient air pollution exposure not only associates with the CHIP prevalence but also exacerbates the risk of adverse cardiovascular events through these genetic mutations. This study highlights the importance of addressing air quality as a modifiable risk factor in the prevention of cardiovascular diseases, particularly among individuals with or at risk for CHIP.