bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9958: Calcium-Phosphorus Product is Associated with Adverse Prognosis in Hospitalized Patients with Heart Failure and Chronic Kidney Disease
Authors: Abe Satoshi , Yoshihisa Akiomi , Takeishi Ryohei , Ohara Himika , Ichijo Yasuhiro , Watanabe Koichiro , Hotsuki Yu , Sato Yu , Kimishima Yusuke , Misaka Tomofumi , Sato Takamasa , Oikawa Masayoshi , KOBAYASHI ATSUSHI , Nakazato Kazuhiko , Takeishi Yasuchika
Published: April 2024

Introduction:
It has been reported that calcium-phosphorus (Ca-P) product > 55 mg
2
/dl
2
is an independent predictor for coronary calcifications, and Ca-P product > 80 or < 40 is a mortality risk in patients undergoing chronic hemodialysis. However, the association between Ca-P product and prognosis in patients with heart failure (HF) and chronic kidney disease (CKD) remains unclear. We aimed to evaluate the significance of the Ca-P product to predict prognosis of patients with HF and CKD.

Methods:
We conducted a prospective observational study of 793 patients with decompensated HF and CKD, who had been discharged from our hospital. According to the receiver operating characteristic curve analysis, the accurate cut-off value of Ca-P product in predicting post-discharge all-cause mortality and/or worsening HF was 28 mg
2
/dl
2
. These patients were divided into two groups: the high group (Ca-P product > 28, n=594) and the low group (Ca-P product < 28, n=199). We compared the patient baseline characteristics and their post-discharge prognosis between the two groups.

Results:
Age was significantly higher, and the prevalence of male, ischemic etiology and anemia was significantly higher in the low group than in the high group. In contrast, there was no difference in echocardiographic parameters between two groups. Ca-P product was correlated with cardio-ankle vascular index (a marker of arterial stiffness), but not with left ventricular ejection fraction. In the Kaplan-Meier analysis (mean follow-up 1089 days), all-cause mortality and/or worsening HF event rates were higher in the low group than in the high group (Figure, log-rank P=0.001). In the multivariable Cox proportional hazard analysis, the low group was found to be an independent predictor of all-cause mortality and/or worsening HF (hazard ratio 1.218, P=0.048).

Conclusions:
Lower Ca-P product is associated with arterial stiffness, and predicts adverse prognosis in patients with HF and CKD.
Abstract 9959: Narrowing the Survival Gap: Trends in Survival in Individuals with Down Syndrome with and without Congenital Heart Defects Born 1979 - 2018
Authors: Wright Lydia K , Stallings Erin B , Cragan Janet D , Pabst Laura J , Oster Matthew E
Published: April 2024

Introduction:
Congenital heart defects (CHD) affect nearly 50% of children born with Down syndrome (DS) and have been shown to affect both early (<1 year) and late mortality. In the non-DS population, survival with CHD has improved greatly over the last 40 years. We aim to evaluate if these changes have narrowed the survival gap between those with DS + CHD and those with DS alone over recent decades.

Methods:
Individuals with DS born in metropolitan Atlanta between 1979 and 2018 were identified through the Metropolitan Atlanta Congenital Defects Program, a population-based surveillance system maintained by the Centers for Disease Control and Prevention. Survival analysis was performed to evaluate predictors of mortality for those with DS + CHD and DS alone.

Results:
Cohort included 1,668 individuals with DS, 764 individuals of whom had a CHD. There were 150 deaths at a median age of 0.4 years (interquartile range (IQR) 0.1 - 4.5 years). In a multivariable model evaluating survival through 10 years, CHD, birthweight <2500g, birth before 2000, and maternal Black race were associated with mortality. Ten-year survival in DS + CHD improved steadily from the 1980s to 2010s (82% to 93%, p=0.01) but remained stable (96% to 95%, p=0.97) in those with DS alone; presence of CHD was not significantly associated with mortality for those born in the most recent decade (HR 1.65 [95% CI 0.60 - 4.51], Figure). In multivariable analysis conditioning on surviving to 1 year, presence of CHD (HR 3.04 [95% CI 1.79-5.18]) remained significantly associated with long-term mortality.

Conclusions:
Early survival among children with DS + CHD has significantly improved over the last 4 decades, such that the survival gap between those with DS + CHD and those with DS alone has disappeared in the most recent decade. It remains to be seen whether these improvements will translate into improved long-term survival; CHD continues to be a risk factor for late mortality for those born in earlier decades.
Abstract 9961: Combination Therapy with Selective Endothelin Type A Receptor Blockade and Angiotensin-converting Enzyme Blockade Improves Survival of Congestive Heart Failure Similarly to Both Monotherapies: Study in Ren-2 Transgenic Hypertensive Rats with Aorto-Caval Fistula
Authors: Kala Petr , Miklovic Matus , Honetschlagerova Zuzana , Skaroupkova Petra , Huskova Zuzana , Melenovsky Vojtech , Veselka Josef , Cervenka Ludek
Published: April 2024

Introduction:
New therapeutic strategies for congestive heart failure (CHF) are needed, and the current knowledge, including our previous studies, suggests that targeting the endothelin (ET) system could be a promising approach.

Hypothesis:
Chronic selective blockade of ET type A (ETA) receptors combined with angiotensin-converting enzyme inhibitor (ACEi) would attenuate the course of CHF induced by volume overload achieved by the creation of the aorto-caval fistula (ACF).

Methods:
ACF was created in Ren-2 transgenic rats (TGR), a model of angiotensin II-dependent hypertension, at the animal age of 8 weeks. Two weeks later the animals were randomly divided into four groups and the therapy began: chronic selective blockade of ETA receptors with atrasentan (ETA block.) (5 mg.kg-1.day-1 in drinking water, n = 31), angiotensin-converting enzyme inhibitor (ACEi) (trandolapril, 2 mg.L-1 in drinking water, n = 32), a combination of atrasentan plus trandolapril (ETA block. + ACEi) ( 5 mg.kg-1.day-1 + 2 mg.L-1 in drinking water, n = 31) or placebo (n = 30). Sham-operated TGR represented a control group (n = 8). The follow-up period was 20 weeks. GraphPad Prism 7 was used for statistical analysis with a log-rank (Mantel-Cox) test to analyze survival data.

Results:
All sham-operated rats survived till the end of the study. Contrary, all untreated CHF rats died by week 12. The treatment with the ETA block. or with ACEi similarly improved the survival rate, and the final rate was 45 % in ETA block. group (p < 0,01) and 62 % in ACEi group (p < 0,01), the combinational therapy (ETA block. + ACEi) improved survival rate over placebo (52 %, p < 0,01) but not compared with both monotherapies.

Conclusions:
Our present results suggest that in ACF TGR, the combination treatment with ETA block. and ACEi did not markedly attenuate CHF-dependent mortality over both monotherapies. Thus, more preclinical research needs to be done to deeper understand the endothelin system in CHF.
Abstract 9962: Associations of Prepregnancy Cardiovascular Health and Adverse Pregnancy Outcomes with Incident Coronary Artery Calcium During Midlife: A Mediation Analysis in the Coronary Artery Risk Development in Young Adults Study
Authors: Cameron Natalie A , Petito Lucia C , Colangelo Laura A , Gunderson Erica P , Catov Janet , Rana Jamal S , Terry James G , Lloyd-jones Don , Allen Norrina , Khan Sadiya
Published: April 2024

Introduction:
Adverse pregnancy outcomes (APOs) are emerging as critical risk markers for the development of cardiovascular disease (CVD). Risk of APOs are higher among women with worse prepregnancy cardiovascular health (CVH), but it remains unclear if APOs mediate the relationship between prepregnancy CVH and incident coronary artery calcium (CAC).

Methods:
We included individuals in the Coronary Artery Risk Development in Young Adults study with at least one singleton birth prior to 2001 and data on prepregnancy CVH (1985-1996) and CAC (2000-2011). Data on APOs were self-reported at each visit (gestational diabetes, hypertensive disorders of pregnancy, preterm birth and small for gestational age). We quantified prepregnancy CVH by summing across the American Heart Association’s Life’s Simple 7 (score 0-14). We used Cox proportional hazards models to obtain hazard ratios (HRs) for a one-point higher (better) prepregnancy CVH score for incident CAC (CAC > 0) adjusted for age, self-reported race, education (years) and parity. We used causal mediation analyses to estimate the proportion of the association between prepregnancy CVH and incident CAC mediated through any APO and each APO subtype.

Results:
Of the 906 included participants, 46.1% were Black, mean age ± SD was 28.1 ± 4.5 years at baseline and 43.0 ± 4.8 years at follow-up. Among individuals with low (0-7), intermediate (8-11) and high (12-14) prepregnancy CVH, APOs developed in 41.8%, 29.5% and 19.5% respectively, and CAC developed in 38.8%, 14.8% and 11.6% of women, respectively. Adjusted HR (95% CI) for one-point higher (better) prepregnancy CVH on incident CAC was 0.79 (0.72, 0.87). APOs did not significantly mediate the relationship between prepregnancy CVH and CAC (
TABLE
).

Conclusions:
Higher or more favorable prepregnancy CVH is associated with lower risk of subclinical CVD in midlife, regardless of APO status, and highlights the importance optimizing CVH early in the life course prior to pregnancy.
Abstract 9964: Influence of Worsening Heart Failure During Hospitalization on the Prognosis in Patients with Acute Decompensated Heart Failure
Authors: Yamamoto Erika , Kato Takao , Yaku Hidenori , Morimoto Takeshi , INUZUKA YASUTAKA , Tamaki Yodo , Ozasa Neiko , Sato Yukihito , Kuwahara Koichiro , Kimura Takeshi
Published: April 2024

Introduction:
Worsening heart failure (WHF) during hospitalization has been used as the one of endpoint in assessing treatments for acute decompensated heart failure (ADHF). However, there are few data on WHF and long-term prognosis, especially in Japanese population.

Hypothesis:
WHF during hospitalization can influence the long-term prognosis in patients with ADHF.

Methods and Results:
The Kyoto Congestive Heart Failure registry is a prospective multicenter cohort study enrolling 4056 consecutive patients hospitalized for ADHF in Japan. WHF was defined as additional intravenous inotropes, diuretics, respiratory management (noninvasive positive pressure ventilation or intubation), or extracorporeal ultrafiltration after 24 hours from admission. Among 4056 patients, 775 (19.4%) patients developed WHF during hospitalization. Inotropes use in emergency room was significantly higher (8.0% vs 2.7%, p<0.001), whereas diuretics use was significantly lower (45.6% vs 51.7%, p=0.002) in patients with WHF than those without WHF. In-hospital mortality was significantly higher in patients with WHF than in those without WHF (16.3% vs 4.0%, p<0.001). A composite of all-cause death and HF hospitalization at 1-year were compared in 3728 patients who were alive at discharge with available data. Patients with WHF (N=644, 18.3%) were younger (79 [70-85] vs 81 [7-85], p<0.001), more likely to be men (61.7 % vs 53.6%, p<0.001), and more likely to have diabetes (44.7% vs 35.2% p<0.001), chronic kidney disease (57.9% vs 41.3%, p<0.001), and ischemic etiology (41.6% vs 30.7%, p<0.001) than those without WHF (N=3084, 87.4%). After adjusting for confounders, the risk for primary outcome of WHF group remained significant (OR: 1.27, 95%CI: 1.02-1.58, p=0.03).

Conclusions:
The WHF during hospitalization was associated with worse 1-year clinical outcomes as well as in-hospital mortality in patients with ADHF.
Abstract 9966: Assessment of Wavefront Activation Duration Across the Right Ventricular Outflow Tract in Patients with Idiopathic Premature Ventricular Contractions Using Non Invasive Electrocardiographic Mapping: A Validation Study
Authors: Parreira Leonor , Carmo Pedro , Mesquita Dinis , Marinescu Catalin , Nunes Silvia , Chmelevsky Mikhail , Ferreira Antonio , Marinheiro Rita , Amador Pedro , Budanova Margarita , Goncalves Pedro , Marques Hugo , Adragao Pedro
Published: April 2024

Introduction:
Previous studies have reported that activation speed across the right ventricular outflow tract (RVOT) can distinguish premature ventricular contractions (PVCs) with a RVOT origin from PVCs with a left ventricular outflow tract (LVOT) origin.

Hypothesis:
Validate the non-invasive electrocardiographic mapping (ECGI) for assessment of RVOT endocardial activation duration (AD) during PVCs and assess the value of AD as a predictor of the origin of the PVCs.

Methods:
We studied 15 consecutive patients, 8 males, median age 56 (42-65) years that underwent ablation of frequent (> 10.000 per 24 h) idiopathic PVCs with inferior axis and had an ECGI performed before ablation. The ECGI was performed with the Amycard system, and all ablations were done with Stereotaxis and Carto system. Isochronal activation maps of the PVCs were obtained with the activation direction method (ADM) of the ECGI, and with the Carto isochronal activation map (10 ms isochrones). Total RVOT AD was measured as the time interval between the earliest and the latest activated region. Agreement between the two methods was performed using linear regression and Bland-Altman plot. The cutoff value of AD to predict PVC origin was calculated with ROC curve.

Results:
PVCs originated from the RVOT in 9 (60%) patients. The median (Q
1
-Q
3
) RVOT AD measured with ECGI was 50 (36-70) and with Carto 50 (37-72) ms. The agreement between both methods was good with an R
2
of 0.699, p<0.0001, Bland-Altman plot in figure, and example of the same patient measured with Carto and ECGI. The AD was significantly higher in PVCs from the RVOT vs LVOT, both with ECGI and Carto, respectively 67 (54-74) vs 36 (33-40) ms, p<0.0001 and 68 (57-77) vs 35 (30-41) ms, p<0.0001. The cutoff value of 43 ms for AD measured with ECGI predicted the origin of the PVCs with a sensitivity and specificity of 100%.

Conclusions:
We found good agreement between ECGI and Carto. The AD obtained with ECGI was accurate to predict the origin of the PVCs.
Abstract 9970: Prevalence of ECG Abnormalities and Association with Arrhythmic Risk and Myocardial Fibrosis in a Large Cohort of Patients with Mitral Valve Prolapse
Authors: Hu Gene , Lim Lisa , Dixit Shalini , Nguyen Thuy , Lee Yoo Jin , Delling Francesca N
Published: April 2024

Background:
Inverted or biphasic T-waves (IBTWs) in the inferior leads on a 12-lead electrocardiogram (ECG) have been previously described in small, retrospective samples of MVP with sudden cardiac arrest (SCA) or sudden cardiac death (SCD). However, prior studies are limited by selection of bileaflet involvement, referral bias or targeted autopsies. Moreover, the association of IBTWs with focal fibrosis remains poorly defined.

Objective:
To assess the rates of IBTWs and their association with arrhythmic risk and late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) in an unselected, longitudinal MVP cohort.

Methods:
We reviewed available 12-lead ECGs from a cohort of 570 MVP patients with clinical and ambulatory ECG or telemetry monitoring evaluated at the University of California San Francisco between 2012 and 2020. IBTWs were considered clinically relevant if present in at least 2 of 3 inferior ECG leads. Complex ventricular ectopy (ComVE) was defined as >5% burden of premature ventricular contractions, bigeminy, or non-sustained ventricular tachycardia. SCD cases were identified through the National Death Index. In a subset of 86 (15%) patients with available contrast CMR, we assessed the presence and location of LGE.

Results:
Among 570 MVP patients (52% male, mean age 64±17), 86 (15%) had IBTWs, 160 (28%) had ComVE, and 26 (5%) had severe arrhythmic events (2 sustained VT, 13 SCA, and 11 SCD). Of these 26, 15 (58%) were bileaflet. Rates of IBTWs were similar between MVPs with severe arrhythmic events (9/26, 35%), ComVE (28/160, 18%), and no ventricular arrhythmia (58/410, 14%) (
p=
0.33). Among MVPs with contrast CMR, there were higher rates of IBTWs in those with LGE (papillary muscles or basal inferolateral wall in all) versus without LGE (7/22 vs 6/64, respectively,
p
= 0.01).

Conclusions:
In a large, unselected MVP sample inclusive of all arrhythmic presentations and leaflet subtypes, the prevalence of IBTWs is overall low and similar in those with and without ventricular arrhythmia, including SCA/SCD. In those with IBTWs, LGE in the papillary muscles or basal inferolateral wall is common, suggesting focal myocardial traction/fibrosis as the underlying anatomical substrate for repolarization abnormalities in the MVP population.
Abstract 9971: Longitudinal Lipoprotein(a) Concentrations and Cardiovascular Risk: A Prospective Cohort Study
Authors: Trinder Mark , Paruchuri Kaavya , Haidermota Sara , Bernardo Rachel , Zekavat Seyedeh , Gilliland Thomas C , Januzzi James L , Natarajan Pradeep
Published: April 2024

Introduction:
When indicated, current guidelines recommend a single measurement of lipoprotein(a) for cardiovascular risk assessment. However, temporal variability in lipoprotein(a) concentration is not well understood, and it is unclear if repeat testing may help refine risk prediction of coronary artery disease (CAD).

Hypothesis:
We examined the longitudinal stability of lipoprotein(a) measurements and tested whether instability in lipoprotein(a) molar concentration was associated with incident CAD.

Methods:
We assessed the correlation between baseline and first follow-up measurements of lipoprotein(a) in the UK Biobank (molar concentration n=16,017) and Mass General Brigham cohorts (molar concentration n=271; mass n=1,748; cholesterol n=1,237). The association between change in lipoprotein(a) molar concentration and incident CAD was assessed among 15,432 UK Biobank participants using Cox proportional-hazards models.

Results:
Baseline and follow-up lipoprotein(a) molar concentration were significantly correlated in the UK Biobank over a median 4.42 years (IQR: 1.24 years) and Mass General Brigham cohorts over a median 0.94 years (IQR: 0.60 years) (Spearman correlations: 0.96 and 0.92, respectively; p-values <0.0001). Similar results were observed for lipoprotein(a) mass and cholesterol. Follow-up lipoprotein(a) molar concentration was significantly associated with risk of incident CAD (HR [95% CI] per 120 nmol/L: 1.31 [1.14-1.51], p-value=0.0002). However, delta lipoprotein(a) was not significantly associated with incident CAD independent of follow-up lipoprotein(a) (p-value=0.98).

Conclusions:
These findings suggest that, in the absence of therapies substantially altering lipoprotein(a) measures, longitudinal assessments of lipoprotein(a) are likely unnecessary for CAD risk assessment in the context of primary prevention.
Abstract 9973: Combined Inhibition of Transforming-Growth Factorβ1 and Platelet-Derived Growth Factor Receptor Improves Right Ventricular Fibrosis and Diastolic Function in Experimental Right Ventricular Pressure-Loading
Authors: Dauz John D , Yazaki Kana , Akazawa Yohei , Meister Theo A , Sun Mei , Golam Kabir , Connelly Kim A , Friedberg Mark K
Published: April 2024

Background:
Residual lesions in repaired tetralogy of Fallot and other congenital heart diseases induce chronic right ventricular (RV) pressure and/or volume loading. These activate cardiac fibroblasts (CFs) resulting in pathological myocardial remodelling, including fibrosis, contributing to eventual RV diastolic dysfunction, failure, and mortality. Transforming growth factor (TGF)β1 and platelet-derived growth factor (PDGF) are implicated in generating a hyper-fibrotic response to ventricular pressure-loading through synergistic activation and proliferation of CFs.

Hypothesis:
Dual TGFβ1 and PDGF inhibition will effectively reduce fibrosis in response to RV pressure-loading and thereby improve RV function.

Methods:
Sprague-Dawley rats underwent pulmonary artery banding (PAB) to induce RV pressure-loading or sham surgery (n=10-12/group). One-week post-PAB, rats were randomized to Tranilast (TRN), a dual TGFβ1/ PDGF inhibitor treatment, (300mg/kg/day, p.o.) or vehicle (n=10-12/group) for 5-weeks. Catheter hemodynamics were measured prior to tissue collection.

Results:
Preliminary hemodynamic measurements (n=8-10/group) showed similar mean RV/LV pressure ratio (PAB Vehicle 0.8±0.22 vs. PAB TRN 0.81±0.23), +dP/dT, and -dP/dT in PAB groups. PAB TRN rats demonstrated improved end-diastolic pressure (7.0±1.7mmHg vs. 8.59±3.0mmHg), tau (24.15±9ms vs. 31.26±16.5ms), and end-systolic elastance (0.084±0.038mmHg/μL vs. 0.1139±0.057mmHg/μL) compared to PAB vehicle. These were associated with reduced RV collagen deposition (6.5±2.3% vs. 10±5.1%, p<0.05), hypertrophy (Fulton ratio 0.46±0.11 vs. 0.61±0.14, p=0.001), and cardiomyocyte area (921.4±131.7μm
2
vs. 1141±168.7μm
2
, p=0.003), when compared to PAB vehicle-treated controls. Immunoblotting (n=5-6/group) demonstrated reduced RV PDGFRβ expression and SMAD2/3 activation (phosphorylation), despite similar TGFβ1 levels in TRN-treated PAB rats vs. controls.

Conclusion:
Attenuation of TGFβR1 signalling and reduced PDGFRβ expression were associated with reduced fibrosis and hypertrophy and improved RV diastolic function. Combined inhibition of TGFβ1 and PDGF may be a relevant therapeutic target to improve RV diastolic function in RV pressure-loading.
Abstract 9982: World Health Organization Cardiovascular Risk Score Correlates with Carotid Intima-Media Thickness, but Fails to Identify High Risk Black Patients Unlike the Framingham and Atherosclerotic Cardiovascular Risk Score Models
Authors: Weldehana Amha M , Tenaw Abel , Abegaz Natnael , Amenu Robel , Zewdie Tigest , Yaynishet Yodit , Gidena Eden , Legesse Abenezer , Shihur Tinsaye , melkie Addisu , Deyessa Negussie , cotsonis george , Mengistu Yewondwossen , Mehta Puja K
Published: April 2024

Introduction:
Correlation between various cardiovascular risk models and carotid intima-media thickness (CIMT) in the black population is not well described. To risk stratify patients in Ethiopia, three scores are used: Non-laboratory World Health Organization (nWHO) score, used for Sub-Saharan countries, ACC/AHA atherosclerotic cardiovascular risk score (ASCVD), and Framingham risk score (FRS). We compared these three scores and determined their relationship with a marker of subclinical atherosclerosis such as CIMT.

Methodology:
336 patients (ages 40-79) with no atherosclerotic cardiovascular disease were randomly selected in Ethiopia’s largest tertiary hospital and underwent CIMT measurement read by blinded readers. Participants were stratified into low, intermediate, and high-risk groups based on the three scores. Pearson correlations and Freedman’s comparisons were used.

Results:
The three risk scores and mean CIMT were moderately correlated (Figure 1). There were strong positive correlations between ASCVD and FRS (n=284, r=0.71, CI: 0.65-0.77, p<.0001), ASCVD and nWHO (n=279, r =0.73, CI: 0.67-0.78, p<.0001), as well as FRS and nWHO risk scores (n=331, r=0.76, CI: 0.71-0.78, p<.0001). However, there was significant disagreement in their risk categorization (Figure 2).

Conclusion:
Non-laboratory WHO risk score fails to identify high-risk patients stratified by ASCVD or FRS despite having similar correlations with CIMT. The use of nWHO score may underestimate risk in the Ethiopian population, compared to ASCVD and FRS scores. These findings have therapeutic implications for primary prevention.
Abstract 9985: Comprehensive Cardiac Magnetic Resonance Imaging Study for Characterising Remote Myocardial Zone Contractile Function, Perfusion and Fibrosis in Type 2 Diabetes Patients with Prior Myocardial Infarction
Authors: Thirunavukarasu Sharmaine , Chowdhary Amrit , Jex Nicholas , Procter Henry , Coles Lauren , Xue Hui , Kellman Peter , GREENWOOD John , Plein Sven , Levelt Eylem
Published: April 2024

Background:
Type 2 diabetes (T2D) is associated with accelerated increased risk of myocardial infarction (MI). However, ventricular dysfunction has been identified also in T2D patients without prior MI.

Objectives:
Using cardiac magnetic resonance (CMR), we assessed the effect of established MI on the non-infarcted myocardium’s contractile function, rest and stress myocardial blood flow (MBF) and extra cellular volume fraction (ECV) by comparing remote zone assessments in T2D patients with prior MI (priorMI-DM) to the global assessments in T2D patients with no MI (noMI-DM) and in controls. We also aimed to extrapolate the contributions of infarct size and glycemic control (HBA1c) to cardiac functional changes (global longitudinal strain [GLS] and left ventricular ejection fraction [LVEF]) in T2D.

Methods:
Age and sex matched 42 priorMI-DM, 47 noMI-DM, and 22 controls underwent CMR (3T).

Results:
Table-1 shows clinical and CMR data. Both T2D groups showed significant reductions in LVEF and GLS. PriorMI-DM remote zone stress MBF was decreased compared to stress MBF in noMI-DM and controls (remote zone priorMI-DM 1.6±0.6ml/g/min vs global noMI-DM 1.8±0.4ml/g/min vs global control 1.9±0.4ml/g/min, p=0.01). Remote ECV and global ECV were similar in priorMI-DM and were increased compared to noMI-DM and controls. Remote ECV correlated with infarct size (r=0.66, p=0.001). In priorMI-DM, infarct size correlated with GLS (r=0.4, p=0.005) and with LVEF (r=0.2, p=0.03) but not HBA1c. In noMI-DM, there was a significant correlation between HBA1c and GLS (r=0.3, p=0.03).

Conclusions:
T2D patients exhibit reductions in LVEF and GLS even in the absence of prior MI, suggesting that metabolic factors beyond high prevalence of MI contribute to the cardiac dysfunction in T2D. T2D patients with prior MI show significant increases in ECV in the remote zone, accompanied by reductions in stress MBF, while remote zone contractile function remains preserved.
Abstract 9989: Safety of Neurohormonal Antagonist Initiation Among Older Adults Following a Heart Failure Hospitalization
Authors: Onyebeke Chukwuma , Zullo Andrew , Gladders Barbara , Kwak Min Ji , Allen Larry A , Levitan Emily B , Safford Monika M , Gilstrap Lauren , Goyal Parag
Published: April 2024

Introduction:
Heart Failure (HF) hospitalizations may be an opportunity for clinicians to initiate neurohormonal antagonists (NHAs), but there is concern that initiation of multiple NHAs during the post-hospitalization period could worsen outcomes in older patients. We examined the safety of starting multiple NHAs in older adults following a hospitalization for HF with reduced ejection fraction (HFrEF).

Hypothesis:
Number of NHAs initiated following HFrEF hospitalization is associated with higher mortality and readmissions.

Methods:
The study population included beneficiaries aged >= 65 years with HFrEF from a random 40% national sample of Medicare Part A, B, and D discharged following a HF admission between 2008 and 2015. The exposure variable was the count of NHAs initiated within 90 days of discharge. NHAs included ACE inhibitors, Angiotensin II Receptor Blockers, Beta blockers, and Mineralocorticoid Receptor Antagonists. The primary outcomes were mortality and readmission at 90 days. We calculated the hazard ratios of number of NHAs initiated (0-3) for each outcome with 95% confidence intervals using probability weighting to account for group differences and generated cumulative incidence plots for both outcomes in each group.

Results:
We examined 211,885 patients, among whom 14% had 0 NHAs initiated, 33% had 1, 42% had 2, and 11% had 3. Mortality and readmission at 90 days were lowest among those with higher NHA initiation counts (Figures 1, 2).

Conclusion:
Greater NHA initiation following HFrEF hospitalization in older adults was associated with lower 90-day mortality and readmission rates. On average, the benefits of starting multiple NHAs may outweigh risks.
Abstract 9992: Homelessness and Heart Failure
Authors: Minhas Abdul , Salah Husam , Shahid Izza , Warraich Haider J , Fudim Marat , Nasir Khurram , Khan Safi U
Published: April 2024

Background:
Homelessness is an important social determinant of health. Since heart failure (HF) contributes to significant morbidity and mortality, we sought to investigate the association of homelessness with clinical outcomes in the patients hospitalized with HF.

Methods:
We analyzed the National Inpatient Sample (NIS) database between 2016 and 2018. Primary HF hospitalizations and homeless adults were identified through ICD codes. Multivariable adjusted logistic regression was used to assess the association of homelessness and clinical outcomes.

Results:
Of 3522459 weighted primary HF hospitalizations identified, only minority of patients were identified as homeless (n=28555; 0.81%). Homeless adults were younger (mean age: 56 vs. 72 years) and had lower prevalence of clinical comorbidities (diabetes, hypertension, obesity, dyslipidemia, renal failure, peripheral vascular disease, stroke) compared with non-homeless adults. However, homeless adults had higher prevalence of drug, tobacco, and alcohol abuse than non-homeless adults. Adjusted models showed lower odds of inpatient mortality and clinical complications among homeless adults.

Conclusion:
Homeless adults were younger and had higher prevalence of drug abuse, but lower burden of clinical comorbidities than non-homeless adults. While homeless adults had lower inpatient mortality and clinical complications, the interpretation of these results is limited by lower hospitalization rates among homeless. Majority of homeless adults may not seek medical attention due to poor social support. .
Abstract 9997: Sex Differences in Chamber Remodeling Associated with Non-Ischemic Cardiomyopathy and Functional Mitral Regurgitation: A Cardiac Magnetic Resonance Study
Authors: Wang Tom , Chan Nicholas , Kocyigit Duygu , Bullen Jennifer , Tang Wai Hong W , Griffin Brian P , Flamm Scott D , Kwon Deborah H
Published: April 2024

Background:
Sex differences in the chamber sizes of healthy individuals by echocardiography and magnetic resonance imaging (MRI) are well-established, however chamber remodeling discrepancies in cardiomyopathies and functional mitral regurgitation (FMR) are not well understood. This study compared MRI chamber quantification and remodeling parameters by sex in patients with non-ischemic cardiomyopathy (NICM) and varying degrees of FMR.

Methods:
We retrospectively studied 633 adult NICM patients undergoing MRI during 2002-2017. Quantitative chamber size, function and left ventricular remodeling parameters by MRI were compared by sex, adjusted for age, hypertension and diabetes, and assessed against FMR severity.

Results:
Mean age was 52.6 years and 256 (40.4%) patients were women. Significant adjusted women minus men mean differences (95%CI) include left ventricular end-diastolic volume indexed (LVEDVi) -8.5 (-15.1, -1.9)mL/m2 P=0.012, left ventricular mass indexed -11.7 (-15.6, -7.9)g/m2 P<0.001, sphericity ratio -0.08 (-0.13, -0.03) P=0.002, relative wall thickness (RWT) -4.5 (-7.2, -1.8)% P=0.001, right ventricular end-diastolic volume indexed (RVEDVi) -16.0 (-20.3, -11.8) mL/m2 P<0.001, right ventricular ejection fraction +5.2 (+3.2, +7.2)% P<0.001, and right atrial volume indexed (RAVi) -10.5 (-13.6, -7.4) mL/m2 P<0.001, while left ventricular ejection fraction, late gadolinium enhancement score and left atrial volume indexed were similar. With increasing FMR severity, LVEDVi and LAVi had a more prominent increase in women than men, while LVMi, sphericity ratio, RWT, RVEDVi and RAVi were consistently lower for women(Figure).

Conclusion:
Although women had significantly lower chamber size, RWT and sphericity ratio in NICM than men, their left-sided chamber sizes increased more steeply as FMR increased. These exploratory MRI findings highlight sex differences in chamber remodeling in NICM and responses to greater degree of FMR.
Ibn Taymiyya and his Circle on samāʿ: a means to Purify Sufism? (with an Arabic edition of al-Wāsiṭī’s (d. 711/1311) Bulgha)
Authors: Post Arjan , Van Eyken Sarah
Published: April 2024

By examining polemical treatises on Sufi samāʿ or ‘spiritual audition’, written by scholars with a Ḥanbalī or traditionalist orientation, we assess the strategies and rhetorical devices that they used to discuss the status of samāʿ within their tradition. Our exploration reveals a clear difference in approach between pre-Taymiyyan scholars, on the one hand, and ‘Taymiyyan’ scholars, including Ibn Taymiyya (d. 728/1328) himself, on the other. Unlike their predecessors, the latter systematically refer to the legacy of esteemed figures from the formative period of Sufism, such as al-Junayd (d. 289/910) and some of his contemporaries, invoking his spiritual authority to consolidate the relation between Ahl al-Ḥadīth traditionalism and what they considered to be Sufism in its ‘true’ form.
Pseudaphelenchus taedae n. sp. (Tylenchina: Aphelenchoididae) found in loblolly pine logs from the USA and peat from Lithuania
Authors: Gu Jianfeng , Zhao Lirong , Yan Fei , Fang Yiwu , Ma Xinxin , Wu Mutao , Bian Yong
Published: April 2024

Pseudaphelenchus taedae n. sp., isolated from loblolly pine logs (Pinus taeda L.) from the USA and peat from Lithuania, is described and figured. It is characterised by the male 355 (305-401) μm and female 427 (318-520) μm body lengths and by the presence of three equal incisures in the lateral field. The slender stylet has small but conspicuous basal knobs. Valve is located at posterior part of metacorpus. The excretory pore is located at the same level as valve plates or anterior. Spicules are paired, thorn-like, separate, condylus broadly rounded, rostrum conical or triangular with a bluntly pointed tip, calomus smoothly tapering together with lamina, thin and strongly arcuate in middle then tapering towards bluntly pointed distal tip, cucullus absent. A narrow bursa surrounds three quarters of tail but is inconspicuous in most cases. The conical male tail is bluntly rounded but mostly with a short pointed or blunt mucron. The female tail is conical in various shapes, smoothly tapering, slightly ventrally bent or curved, with broadly rounded or pointed terminus. Detailed phylogenetic analysis based on the 18S and D2-D3 region of 28S sequences confirmed the status of this nematode as a new species.
A Study on the High Quality Development Path of General Education in Applied Undergraduate Universities
Authors: Cuiping Zhang , Nana Wang
Published: April 2024

In the new era of leapfrog development and popularization of higher education, applied undergraduate universities play a vital role in the higher education system in China, becoming an indispensable force in building a powerful higher education country. Compared with the cultivation of academic talents, the cultivation of applied talents pays more attention to the traing of professional knowledge, abilities, and qualities, and pays more attention to the practicality and adaptability of talent cultivation. However, applied talents are not only technical specialists, but must also have goodcomprehensive quality, including citizenship, professional ethics, humanistic accomplishment, scientific literacy, etc., in order to better adapt to the needs of future development and change. Applied universities pay more attention to cultivating students’ practical application ability and entrepreneurial ability. General education in applied undergraduate universities has a significant impact on the process of talent cultivation. Based on the analysis of the current situation of general education in applied undergraduate universities, this article proposes ways to improve the quality of general education in applied undergraduate universities from updating the concept of general education, optimizing the setting of general education courses, reforming the teaching mode of general education, strengthening the construction of teacher teams, improving the evaluation system of general education, and expanding international exchanges and cooperation.
The application potential of mepiquat chloride in soybean: improvement of yield characteristics and drought resistance
Authors: Wang Xiyue , Zhao Wei , Wei Xinhe , Song Shuang , Dong Shoukun
Published: April 2024

Background

Drought can result in yield losses, the application of plant growth regulators is an effective measure to improve drought resistance and yield. The objective of the study was to explore the application potential of mepiquat chloride (MC) in regulating soybean yield and drought resistance.

Methods

In this study, a three-year field experiment was designed and combined with drought experiments to measure the yield of popularized varieties during 2021–2022 and drought-resistant and drought-sensitive varieties were selected, and planted in the field in 2023.

Results

MC increased the yield of HN84 and HN87 for two consecutive years from 2021 to 2022 and improved their physiological characteristics under field conditions. Under M200 treatment, the yield of HN84 increased by 6.93% and 9.46%, and HN87 increased by 11.11% and 15.72%. Different concentrations of MC have different effects on soybeans. The maximum increase of SOD, POD and proline in HN84 under M400 treatment reached 71.92%, 63.26% and 71.54%, respectively; the maximum increase of SOD, POD and proline in HN87 under M200 treatment reached 21.96%, 93.49% and 40.45%, respectively. In 2023, the foliar application of MC improved the physiological characteristics of HN44 and HN65 under drought-stress conditions. On the eighth day of drought treatment, compared to the drought treatment, the leaf and root dry weight of HN44 under M100 treatment increased by 17.91% and 32.76%, respectively; the dry weight of leaves and roots of HN65 increased by 20.74% and 29.29% under M200 treatment, respectively. MC also reduced malondialdehyde (MDA) content, decreased antioxidant enzyme activity and proline content. In addition, different concentrations of MC increased the chlorophyll fluorescence parameters (Fs, Fv/Fm, YII, and SPAD). In the field, the plant height of the two varieties decreased significantly, the yield increased, the number of two-grain and three-grain pods increased, and the stem length at the bottom and middle decreased with MC induction.

Conclusions

The application of 100–200 mg/L MC effectively improved drought resistance and increased yield. This study provided support for the rational application of MC in soybean production.
Predicting the need for urgent endoscopic intervention in lower gastrointestinal bleeding: a retrospective review
Authors: Ridha Barzany , Hey Nigel , Ritchie Lauren , Toews Ryan , Turcotte Zachary , Jamison Brad
Published: April 2024

Background

Lower gastrointestinal bleeding (LGIB) is a common reason for emergency department visits and subsequent hospitalizations. Recent data suggests that low-risk patients may be safely evaluated as an outpatient. Recommendations for healthcare systems to identify low-risk patients who can be safely discharged with timely outpatient follow-up have yet to be established. The primary objective of this study was to determine the role of patient predictors for the patients with LGIB to receive urgent endoscopic intervention.

Methods

A retrospective chart review was performed on 142 patients. Data was collected on patient demographics, clinical features, comorbidities, medications, hemodynamic parameters, laboratory values, and diagnostic imaging. Logistic regression analysis, independent samples t-testing, Mann Whitney U testing for non-parametric data, and univariate analysis of categorical variables by Chi square test was performed to determine relationships within the data.

Results

On logistic regression analysis, A hemoglobin drop of > 20 g/L was the only variable that predicted endoscopic intervention (p = 0.030). Tachycardia, hypotension, or presence of anticoagulation were not significantly associated with endoscopic intervention (p > 0.05).

Conclusions

A hemoglobin drop of > 20 g/L was the only patient parameter that predicted the need for urgent endoscopic intervention in the emergency department.
Identifying novel acute pancreatitis sub-phenotypes using total serum calcium trajectories
Authors: Li Chang-li , Lin Xing-chen , Jiang Meng
Published: April 2024

Background

Acute pancreatitis (AP) has heterogeneous clinical features, and identifying clinically relevant sub-phenotypes is useful. We aimed to identify novel sub-phenotypes in hospitalized AP patients using longitudinal total serum calcium (TSC) trajectories.

Methods

AP patients had at least two TSC measurements during the first 24 h of hospitalization in the US-based critical care database (Medical Information Mart for Intensive Care-III (MIMIC-III) and MIMIC-IV were included. Group-based trajectory modeling was used to identify calcium trajectory phenotypes, and patient characteristics and treatment outcomes were compared between the phenotypes.

Results

A total of 4518 admissions were included in the analysis. Four TSC trajectory groups were identified: “Very low TSC, slow resolvers” (n = 65; 1.4% of the cohort); “Moderately low TSC” (n = 559; 12.4%); “Stable normal-calcium” (n = 3875; 85.8%); and “Fluctuating high TSC” (n = 19; 0.4%). The “Very low TSC, slow resolvers” had the lowest initial, maximum, minimum, and mean TSC, and highest SOFA score, creatinine and glucose level. In contrast, the “Stable normal-calcium” had the fewest ICU admission, antibiotic use, intubation and renal replace treatment. In adjusted analysis, significantly higher in-hospital mortality was noted among “Very low TSC, slow resolvers” (odds ratio [OR], 7.2; 95% CI, 3.7 to 14.0), “moderately low TSC” (OR, 5.0; 95% CI, 3.8 to 6.7), and “Fluctuating high TSC” (OR, 5.6; 95% CI, 1.5 to 20.6) compared with the “Stable normal-calcium” group.

Conclusions

We identified four novel sub-phenotypes of patients with AP, with significant variability in clinical outcomes. Not only the absolute TSC levels but also their trajectories were significantly associated with in-hospital mortality.
Seasonality of influenza-like illness and short-term forecasting model in Chongqing from 2010 to 2022
Authors: Chen Huayong , Xiao Mimi
Published: April 2024

Background

Influenza-like illness (ILI) imposes a significant burden on patients, employers and society. However, there is no analysis and prediction at the hospital level in Chongqing. We aimed to characterize the seasonality of ILI, examine age heterogeneity in visits, and predict ILI peaks and assess whether they affect hospital operations.

Methods

The multiplicative decomposition model was employed to decompose the trend and seasonality of ILI, and the Seasonal Auto-Regressive Integrated Moving Average with exogenous factors (SARIMAX) model was used for the trend and short-term prediction of ILI. We used Grid Search and Akaike information criterion (AIC) to calibrate and verify the optimal hyperparameters, and verified the residuals of the multiplicative decomposition and SARIMAX model, which are both white noise.

Results

During the 12-year study period, ILI showed a continuous upward trend, peaking in winter (Dec. - Jan.) and a small spike in May-June in the 2–4-year-old high-risk group for severe disease. The mean length of stay (LOS) in ILI peaked around summer (about Aug.), and the LOS in the 0–1 and ≥ 65 years old severely high-risk group was more irregular than the others. We found some anomalies in the predictive analysis of the test set, which were basically consistent with the dynamic zero-COVID policy at the time.

Conclusion

The ILI patient visits showed a clear cyclical and seasonal pattern. ILI prevention and control activities can be conducted seasonally on an annual basis, and age heterogeneity should be considered in the health resource planning. Targeted immunization policies are essential to mitigate potential pandemic threats. The SARIMAX model has good short-term forecasting ability and accuracy. It can help explore the epidemiological characteristics of ILI and provide an early warning and decision-making basis for the allocation of medical resources related to ILI visits.
Alcohol consumption may be a risk factor for cerebrovascular stenosis in acute ischemic stroke and transient ischemic attack
Authors: Liu Yiti , Gu Shuo , Gou Maoyuan , Guo Xiaoyan
Published: April 2024

Background

Atherosclerosis are well established risk factors for ischemic stroke, however the association between alcohol consumption and atherosclerosis is controversial. This study aims to explore the potential correlation between alcohol consumption and cerebral stenosis in patients with acute ischemic stroke and transient ischemic attack (TIA).

Methods

Nine hundreds and eighty-eight patients with first acute ischemic stroke attack or TIA were recruited retrospectively. Alcohol consumption was classified into five consumption categories (non-drinkers, occasional drinkers, < 140 g per week [mild drinkers], 140–279 g per week [moderate drinkers], ≥ 280 g per week [heavy drinkers]). Computed tomography angiography (CTA) and digital subtraction angiography (DSA) were utilized to assess the carotid and cerebral artery in all patients. Five-step scale for degree of stenosis was applied: normal (0, 0 points), mild (< 50%, 1 point), moderate (50–69%, 2 points), severe (70–99%, 3 points), and occlusion (100%, 4 points).

Results

The carotid and cerebral artery stenosis scores were positively correlated with moderate alcohol consumption (B = 1.695, P < 0.001). Compared with nondrinkers, moderate alcohol consumption had significant increasing risk of moderate carotid and cerebral artery stenosis (OR = 4.28, 95% CI: 1.47–12.49, P = 0.008) and severe stenosis (OR = 4.24, 95% CI: 1.55–11.64, P = 0.005) and occlusion (OR = 3.87, 95% CI: 1.65–9.06, P = 0.002). Compared with nondrinkers, heavy alcohol consumption patients had significant higher risk of carotid and cerebral artery occlusion (OR = 2.71, 95% CI: 1.36–5.41, P = 0.005).

Conclusions

Higher alcohol consumption may associate with higher risk and more severity of carotid and cerebrovascular stenosis.