bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4116558: Navigator-driven Recommendations for Palliative Care Consults for Patients with Heart Failure and High Predicted Mortality
Authors: Anderson Matthew , Seals Austin , Taylor Amy , Simmons Taylor , Gilbert Olivia
Published: November 2024

Background:
Palliative care (PC) engagement can improve quality of life, reduce hospital costs, and enhance symptom control for individuals with heart failure (HF). For certain HF patients, PC can address symptoms and improve quality of life. However, referrals to PC often occur late, delaying benefits.

Hypothesis:
We hypothesize that a standardized recommendation for inpatient PC consultation will increase PC consultation rates and improve 30-day readmission without an impact on 30-day mortality rates.

Methods:
This interrupted time series study focused on high-risk HF patients at Atrium Health Wake Forest Baptist. The cohort included patients in the Golden Hearts Program, which is a local program to identify HF patients at elevated risk for 30-day readmissions and to accelerate resources to support their transitions. Baseline data were from patients 5 months before September 1, 2023, and the intervention group were from patients 5 months afterward. A standardized message recommending inpatient PC consultation was sent to attending physicians for patients with ESCAPE scores ≥4. Recommendations were also discussed at multidisciplinary rounds with senior residents. The primary outcomes were inpatient palliative care consultation and discharge to Hospice. Secondary outcomes were 30-day readmissions and 30-day mortality. Outcome measures were assessed post-discharge using Chi-square and T-test analyses.

Results:
The baseline group had 203 patients; the intervention group had 213. Post-intervention, PC consultation rates decreased from 12.3% to 8% (p=0.19), Discharge to hospice decreased from 2% to 0.9% (p=0.05), 30-day mortality decreased (8.4% vs 7%, p=0.74), and 30-day readmission dropped from 23.6% to 15% (p=0.04). The average length of stay remained 5.7 days in both groups. Limitations included provider buy-in and a limited time period.

Conclusion:
Though the intervention aimed at targeted PC consult recommendations for advanced HF patients led to reduced 30-day readmissions, there was a not a statistically significant impact on palliative care consultation or mortality.
Abstract 4116708: Variations in Patients’ Perceptions of Continuity of Care After Hospitalization Due to Cardiac Condition
Authors: Safstrom Emma , Stromberg Anna
Published: November 2024

Background:
Continuity of care is crucial to enabling a seamless chain of care after hospitalization due to cardiac conditions. Most measurements (e.g., continuity indexes) neglect the patient's perception of continuity. Inequality in medication and treatment is well known within cardiac care, but there is a lack of knowledge about whether there are inequalities in how patients perceive continuity of care after hospital discharge.

Aims:
Describe perceptions of continuity of care after hospitalization in patients with cardiac conditions and variations in age, gender, and diagnosis.

Methods:
This cross-sectional study included patients hospitalized at 4 hospitals in Sweden due to cardiac conditions. Data were collected using the Patient Continuity of Care Questionnaire, a 27-item questionnaire with 6-subscales. A sub-scale score <4 indicates an area of concern. Factorial ANOVA was used to analyze interactions or main effects of sex, age (<65 or ≥65), and diagnosis (angina, atrial fibrillation, heart failure, myocardial infarction) on perceived continuity of care. Independent t-tests or post-hoc analysis with LSD correction compared group differences.

Results:
A total of 1,000 patients were included, with a mean age of 72 (SD 10) years, 661 (66%) males. For the sub-scales, no significant 3- or 2-way effects were found. In the sub-scale: Information to patient (mean 4.1), significant differences were found in sex, age, and diagnosis. For the sub-scales Relations in hospital (mean 4.3) and Relations in community (mean 4.1), significant differences were found in sex and diagnosis. There were significant differences between the diagnosis groups in the sub-scale: Management of follow-up (mean 3.9). In the sub-scale: Management of communication (mean 3.7), significant differences were found in sex and age. For the sub-scale: Management of forms (mean 3.8), significant differences were found based on age. See Figure 1a-1c for details.

Conclusion:
Overall, patients hospitalized due to cardiac conditions reported a quite high level of continuity of care. However, statistically significant differences were found, and men, younger patients and those hospitalized due to myocardial infarction perceived higher levels of continuity or care. This indicates that patients who are more dependent on continuity of care, who might be more fragile and have a diagnosis with a complex clinical pathway, are experiencing lower levels of continuity of care
Abstract 4116714: Macrophage Colony Stimulating Factor as a Causal Metabolic Mediator of Cardiovascular Disease: An Observational and Mendelian Randomization Analysis
Authors: Narula Sukrit , Chong Michael , Pigeyre Marie , Perrot Nicolas , Yusuf Salim , Pare Guillaume
Published: November 2024

Background:
Macrophage biology plays a key role in the pathogenesis of atherosclerosis and circulating macrophage colony-stimulating factor (M-CSF) is a marker of macrophage activity. However, there is conflicting evidence regarding its role as a mediator of cardiovascular disease.

Methods:
We evaluated the association between plasma M-CSF concentration with myocardial infarction, stroke, heart failure and mortality in a large substudy involving 9992 participants drawn from 14 countries and followed for a median period of 9.8 years (Interquartile Range 8.9 years - 11.4 years) utilizing a nested case-cohort design in the Prospective Urban Rural Epidemiology (PURE) study. We then conducted a two-sample Mendelian randomization (MR) analysis to evaluate the upstream determinants (using genome wide association data from the PURE biobank and publicly available consortia) and downstream effects on clinical events..

Results:
The strongest causal upstream determinant of M-CSF concentration was body mass index (BMI), which showed a positive association with plasma M-CSF concentration (Beta: 0.17 SD increase; 95% CI: 0.08 - 0.27). In a survival analysis, M-CSF was independently associated with increased incident myocardial infarction (HR: 1.25 per 1 SD M-CSF increase; 95% CI: 1.13-1.38), stroke (HR: 1.17; 95% CI:1.04-1.32), and heart failure (HR: 1.34; 95% CI: 1.15-1.56) and other cardiovascular disease risk factors. Circulating M-CSF concentration also showed a strong association with long-term risk of overall mortality (HR: 1.44; 95% CI: 1.39-1.60). Mendelian randomization analyses confirmed that increased M-CSF was associated with increased risk of MI, heart failure, and ischemic stroke (specifically large artery atherosclerotic and cardioembolic stroke).

Conclusions:
M-CSF is a strong causal driver of cardiovascular disease morbidity whose concentration is causally influenced by body mass index. Our analysis suggests a role for macrophage activity in mediating the relationship between body mass index and cardiovascular disease outcomes.
Abstract 4117256: EFFECT OF CORONARY MICROEMBOLIZATION ON AUTOPHAGY-RELATED MICRORNA AND PROTEIN PATHWAYS STUDY
Authors: 薛 亚军
Published: November 2024

Background:
Coronary microembolization (CME) commonly occurs during PCI in acute coronary syndrome, leading to myocardial damage. The purpose of this study is to explore the effects of CME on autophagy-related microRNAs and protein pathways, and to identify possible mechanisms of myocardial injury caused by CME.

Methods:
This study randomly divided rats into 6 groups: sham and CME1h, 3h, 6h, 9h, 12h groups. A rat model of CME was established by injecting autologous microthrombi into the left ventricle. Echocardiography and HE staining were performed to evaluate myocardial infarct size in each group. The expression of microRNA-144-3p and microRNA-214-3p, LC3-II, p62/SQSTM1, phosphatase, and PTEN was detected.

Results:
Compared with the sham group, LVEF and LVFS decreased,LVESD increased (P<0.05) in the CME3h, 6h, 9h, and 12h groups,the myocardial infarct area significantly increased in the CME6h group (P<0.05). The expression of microRNA-144-3p and microRNA-214-3p in myocardial tissue increased after CME, reaching a peak at 1h (P<0.05); LC3II decreased at CME1h (P<0.05) and significantly increased in the CME6h group (P<0.05). p62/SQSTM1 increased at CME1h (P<0.05) and then gradually decreased, while PTEN increased after CME3h (all P<0.05), with a peak at 6h.

Conclusion:
Autophagy showed dynamic changes after CME, suggesting that enhanced autophagy aggravates myocardial damage after CME. Related microRNAs and PTEN are involved in the regulation of autophagy after CME.
Abstract 4117310: Alcohol-Related Cardiomyopathy - Exploration of Recent Mortality Trends in the United States
Authors: Aun Muhammad , Mughal Mohsin
Published: November 2024

Introduction:
Data is accumulating regarding the contemporary trends of mortality rates in patients with alcohol-related cardiomyopathy across the United States.

Hypothesis:

We hypothesized that with increased awareness about the adverse effects of alcohol on the cardiovascular system and the advancement of echocardiography in the early diagnosis of alcoholic cardiomyopathy, mortality rates may show a downward trend.

Methods:

This is a retrospective observational study that retrieved death certificates from the CDC WONDER (Center for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiological Research) database from 2001-2020. The mortality rate of alcohol-related cardiomyopathy using ICD code I42.6 (Alcoholic cardiomyopathy) was studied from 2001-2020. This study duration was further subdivided into five-year periods. We calculated the crude mortality rate and age-adjusted mortality rate per 100,000 for four U.S census regions (CR-1 Northeast, CR-2 Midwest, CR-3 South, CR-4 West).

Results:

The overall age-adjusted mortality rate remained at 0.1/100,000 deaths in four U.S census regions until 2015; however, in the last five years of the study period, AAMR(age-related mortality rate) increased from 0.1 to 0.2/100,000 deaths.

Conclusions:

The mortality trends associated with alcohol-related cardiomyopathy have not changed significantly over the past two decades. This can be explained by the larger number of people developing alcoholic cardiomyopathy due to the increase in global alcohol use in addition to the fact that more diagnosed patients are receiving earlier treatment with goal-directed medical therapy for cardiomyopathy. Limitations of this study include intrinsic weakness of the WONDER dataset (changes with ICD-9 to ICD-10 codes, and potentially miscoding) which needs further research.

Discussion:
This suggests that while mortality rates associated with alcohol-related cardiomyopathy remained relatively steady for most of the study period, there was a concerning uptick in the latter years. This could prompt further investigation into potential factors contributing to this increase, despite advancements in awareness and diagnostic techniques.
Abstract 4117345: Predicting Downstream Aneurysmal Degeneration Following Type A Dissection Repair With Computational Fluid Dynamics
Authors: Jensen Christopher , Ghorbannia Arash , Urick David , Moya-Mendez Mary , Vekstein Andrew , Draeger Erik , Williams Adam , Hughes G , RANDLES Amanda
Published: November 2024

Introduction:
Acute type A aortic dissection (ATAAD) is typically treated by replacement of the ascending aorta (+/- root) and proximal arch. However, 70-85% of patients have residual distal dissection post-repair, and 20-40% require late reoperation for aneurysmal degeneration of the distal aorta (ADDA). Since an individual patient’s risk of ADDA cannot be accurately predicted, current guidelines recommend lifelong aortic surveillance imaging for all patients.

Hypothesis:
Computational fluid dynamics (CFD) simulations of aortic hemodynamics post-repair can accurately identify patients at late risk of ADDA.

Methods:
We performed CFD simulations of 50 patients following hemi-arch replacement for ATAAD. Patient-specific 3D models were generated from the aortic root to iliac bifurcation (including arch branches) from postoperative 0.6mm contrast-enhanced CT angiograms taken <1 year after index repair (Figure). Exclusion criteria were known heritable thoracic aortic disease and absence of residual dissection. The primary outcome was ADDA, defined as late growth of the distal arch/descending thoracic aorta (DTA) to a diameter ≥5.5cm. Hemodynamic simulations were run for 6 cardiac cycles on a high-performance computing cluster using HARVEY, a CFD solver implementing the lattice Boltzmann method. The primary hemodynamic metric was time-averaged wall shear stress (TAWSS) ratio between the false and true lumens.

Results:
ADDA developed in 22 patients (44%) at a mean of 3.2 years postoperatively. There were no significant clinical differences between those with and without ADDA (Table). The development of late aneurysm growth was significantly associated with a higher TAWSS ratio in the proximal DTA (
p
<0.05, Figure).

Conclusion:
ADDA following hemi-arch repair for ATAAD is associated with significantly higher false lumen TAWSS as early as the first surveillance scan. CFD simulations may help clinicians risk-stratify patients years before they meet reoperation criteria.
Abstract 4117397: SGLT2i And Cardio-Renal Outcomes In Type 2 Diabetes Mellitus: A Systematic Review And Meta Analysis.
Authors: Zavaleta Corvera Carlos , Surco-Larico Carlos D , Rivas-Leiva Betty , BUSTAMANTE ORDOÑEZ MARINA ATENA , Marchand Bayona Eduardo , Caballero-Alvarado Jose
Published: November 2024

Background:
Diabetes Mellitus (DM) significantly impacts global health through cardiovascular and renal complications. SGLT2 inhibitors (SGLT2i) have emerged as beneficial for cardiovascular outcomes in Type 2 Diabetes Mellitus (T2DM). However, only few studies report outcomes related to renal function.

Aim:
This study aims to analyse the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM.

Methods:
A systematic review and meta-analysis, following PRISMA-2020 guidelines was conducted. We evaluated the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. We included randomized controlled trials(RCT) and post hoc analyses that compared SGLT2i with placebo, focusing on cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalizations, and renal outcomes such as the progression of albuminuria and the decline of eGFR. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI).

Results:
We identified 2753 studies, registered in PubMed(=788), Embase(n=538), WoS(n=369), Scopus(n=908), and Cochrane(n=150). We included 11 studies 6 RCT and 7 Post Hoc Analysis, sample size of 50.653 patients. Meta-analysis showed that SGLT2i improve cardiovascular outcomes such as reduced cardiovascular mortality (RR 0.84 [95% CI 0.73–0.97] p=0.02), heart failure hospitalizations (RR 0.65 [95%CI 0.54–0.77]p<0.00001), and their composites outcomes. Furthermore, renal outcomes with SGLT2i significantly improve Urinary Albumin-to-Creatinine Ratio (RR1.10 [95%CI 1.03–1.18]p=0.004), Improvement of the decline of the eGFR (RR1.08 [95%CI 1.04–1.11] p<0.00001) and progression of albuminuria (RR 0.69[95%CI 0.66–0.72]p<0.00001). Slower Doubling of serum creatinine (RR 0.71 [95% CI 0.61–0.82] p<0.00001), end-stage kidney disease (RR 0.66 [95% CI 0.53–0.83] p=0.0003). Reduced Acute Kidney Injury (RR 0.72 [95% CI 0.58–0.89] p=0.002) and renal impairment (RR 0.57 [95% CI 0.34–0.95] p=0.03). Regarding death from renal causes, we identified a 46% relative reduction in the risk in SGLT2i group, although was not statistically significant (RR 0.54 [95% CI: 0.23, 1.27] p=0.16). The observed heterogeneity across studies calls for careful application of these results to individual patients.

Conclusion:
SGLT2i confers notable advantages in managing cardiorenal complications in T2DM, demonstrating a reduction in cardiovascular mortality and heart failure hospitalizations and offering a nephroprotective effect.
Abstract 4117438: Machine Learning Predicts Successful Transcatheter Mitral Valve Edge to Edge Repair: A Systematic Review and Meta-Analysis
Authors: Sacoransky Ethan , Ke Danny Yu Jia , Abuzeid Wael
Published: November 2024

Introduction:
Transcatheter Mitral Valve Edge to Edge Repair (TEER) is an established percutaneous treatment for patients with severe symptomatic Mitral Regurgitation (MR). The current AHA/ACC guidelines recommend TEER for inoperable patients with severe primary MR or patients with symptomatic severe secondary MR despite medical therapy. Machine learning (ML) has emerged as a tool for TEER risk stratification due to the paucity of established risk scores. To address the lack of consensus on its efficacy, we conducted a systematic review and meta-analysis of studies that utilized ML to predict the success of TEER.

Methods:
Electronic databases, including Embase, MEDLINE, and the Cochrane Library, were searched from inception through April 2024. We included studies that used TEER and employed at least one ML model to predict the success of TEER. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to measure the accuracy of ML risk stratification algorithms.

Results:
102 publications were screened, with seven eventually included in this analysis. Two studies employed clustering techniques, two utilized extreme gradient boosting, and three used multiple ML algorithms to predict outcomes. Of the four studies that compared the accuracy of ML with traditional Cox regression, all four demonstrated higher accuracy with ML, and this difference was statistically significant in three of the four studies. The mean AUC of the aggregated ML data was 0.737 [95% CI: 0.717, 0.758], compared to 0.627 [95% CI: 0.600, 0.653] for the pooled traditional methods.

Conclusions:
To our knowledge, we conducted the first systematic review and meta-analysis of ML methods for prediction of TEER success. ML outperformed established risk scores, demonstrating promising potential. Future ML models, trained on larger patient datasets, may further improve predictive accuracy in this patient population.
Abstract 4117479: INTERPRETABLE PREDICTION OF HOSPITALIZATION COSTS FOR PATIENTS WITH ISCHEMIC HEART DISEASE USING NETWORK ANALYTICS AND MACHINE LEARNING
Authors: 薛 亚军
Published: November 2024

Background:
Ischemic heart disease (IHD) represents a significant global health challenge, imposing a considerable social and economic burden on individuals and healthcare systems worldwide. To optimize medical resource allocation and better serve populations, accurately predicting healthcare costs is paramount.

Methods:
This study proposes an interpretable feature extraction method based on network analytics to improve the prediction of IHD hospitalization costs. A diagnosis-procedure concurrence network is constructed, and a graph kernel-based approach is utilized to capture and encode information on diseases and treatments. The study introduces a hospitalization cost prediction model that utilizes a diagnosis-procedure concurrence network to extract features that strike a balance between predictability and interpretability.

Results:
Our model demonstrates superior performance, considering that the average cost for all patients in the HQMS dataset is approximately 20,000 CNY, whereas the average cost for our IHD patient dataset is 37,853 CNY. This indicates the effectiveness of our approach in predicting hospitalization costs for a specific patient population with complex treatment options such as IHD.

Conclusion:
This study aims to develop an interpretable and precise model for forecasting hospitalization costs of Ischemic Heart Disease (IHD) patients in China. It achieves this goal by integrating machine learning with network analytics and incorporating cost ratio features.
Abstract 4117594: Fetal Synthetic Glucocorticoid (sGC) Exposure Results in Later Life Cardiac Dysfunction and Ventricular Remodeling in Male Baboon Offspring
Authors: Yang Bowen , Adekunbi Daniel , Zhang Chen , Huber Hillary , Zhao Feiyang , Camones Raechel , Li Jinqi , Moody Alexander , Li Cun , Cox Laura , Wang Lu , Salmon Adam , Clarke Geoffrey , Nathanielsz Peter
Published: November 2024

The “theory of developmental origins of health and disease” posits that stress in critical developmental periods will program life-course health and may affect cardiovascular (CV) health. Mothers at risk for premature delivery receive synthetic glucocorticoids (sGC) to enhance fetal lung maturation and manage fetal respiratory distress, but sGC exposure is linked to long-term CV dysfunction in offspring. Four groups of male baboons were studied: sGC exposed
in utero
at middle age (sGC-MA, 13.8±0.2Y), older sGC exposed
in utero
(sGC-O, 17.1±0.4Y), middle age unexposed (CTR-MA, 13.5±0.6Y), and older, unexposed baboons (CTR-O, 17.4±0.4Y). Gated, breath-hold, cine cardiac magnetic resonance imaging was performed at 3 Tesla (Siemens TIM Trio) to assess left ventricular (LV) function and myocardial strain, analyzed using cvi42® software. Mitochondrial electron transport chain (ETC) complex activity was analyzed using LV tissue from sGC-O and CTR-O euthanized baboons. Protein quantification was used to measure mitochondrial function and RNA-seq assessed differential gene expression and gene ontology (GO) enrichment. Unpaired t-tests were used. Data are reported as mean ± SD. Stroke volume and ejection fraction were similar in the elderly groups (4 sGC-O, 8 CTR-O). However, higher end-systolic and end-diastolic sphericity indexes (SI) and shorter LV axis lengths indicated remodeling. Also, global longitudinal and radial strains were reduced (both p<0.04) in sGC-O vs. CTR-O. Reduced LV cardiac output (p=0.005) was found in 5 sGC-MA animals vs 4 sGC-O animals, but not in 5 CTR-MA vs 8 CTR-O. In sGC-MA vs sGC-O, but not CTR-MA vs CTR-O, significant increases in SI (p=0.001), radial strain (p=0.02), and longitudinal (p=0.03) strain were found, but LV axis length (p=0.03) was reduced. LV mitochondrial analysis in 4 sGC-O vs 4 CTR-O myocardial samples revealed 33.5% less ETC activity (p=0.002) and 19.8% less complex I expression (p=0.048) in sGC. LV RNA-seq identified 63 upregulated and 20 downregulated genes in the sGC-O samples. GO pathway enrichment included changes in heart contraction, wounding responses, and leukocyte regulation pathways. These findings indicate that fetal sGC exposure developmentally programs offspring with LV remodeling and long-term cardiac and gene expression changes in male baboons, the closest available experimental nonhuman primate species to man. Future studies on females will probe sexual dimorphism in developmental programming.
Abstract 4117646: The Ultimate Test in Hemocompatibility: HeartMate3 Restart After Prolonged Pump Shut Down
Authors: Goral Montana , hightower mary , Edwards Michele , varghese densey , Thomas Melanie , hardin elizabeth , Kim Han Wool , Malensek Paris , Beaini Hadi , Patel Ravi , O'Hara Patrick , Jawaid Anas , Hussain Fizza , Peltz Matthias , Farr Maryjane , Araj Faris
Published: November 2024

Introduction:
The HeartMate 3 (HM3) LVAD, was shown to have a higher survival free of hemocompatibility related adverse events (HRAE) compared to its predecessors (HM2, HVAD). Superior HM3 outcomes are attributed to wide blood flow pathways coupled with frictionless movement and intrinsic pulsatility, reducing shear stress and blood stasis. It is unknown if improved hemocompatibility can withstand pump restart after prolonged shutdown. We herein report a case of HM3 pump stoppage without subsequent HRAE.

Case Presentation:
A 41-year-old male underwent HVAD implant in 2019 for advanced non-ischemic cardiomyopathy. This was exchanged to HM3 for recurrent neurological events despite therapeutic anticoagulation. Ten months after exchange, he awakened one morning to find his LVAD had been off for an unknown period but had not heard any device alarms (85dB if on battery power, 165dB if on wall power). Since he felt well he changed to battery power resulting in immediate pump restart. Log file analysis showed pump stoppage 2 am – 10 am, without preceding low flow alarms or power elevations.

Management and Outcomes:
In the ER INR was 1.5 (2.8 one week prior) and systemic heparin was started. Evaluation included: 1) CT brain without acute infarcts 2) echocardiogram without intracardiac thrombus 3) CT Angiography with patency of the inflow cannula and outflow graft 4) stable serial LDH measurements. The controller was exchanged, and analysis noted normal function. 1-year later the patient is maintained on warfarin and aspirin 325mg without further HRAE. Given the patient’s neurologic history and pump stoppage event, we did not invoke ARIES trial guidance and thus continued aspirin.

Conclusion:
Pump stoppage occurs when there is complete battery depletion, disconnection of both power leads, or the percutaneous lead from system controller. Our case is unique in that the duration of pump shutdown was 8 hours and INR subtherapeutic, without HRAE in the background of neurologic events on HVAD support. It has been previously reported that complete outflow graft thrombosis can occur shortly after LVAD decommissioning. The HM3 User Manual recommends restarting the pump immediately if off for a few minutes and using clinical judgment for longer durations due to increased risk for thromboembolic events. Our case adds to the paucity of existing data on improved hemocompatibility of the HM3 during rare circumstances of the ultimate test in hemocompatibility: complete pump shut down.
Abstract 4117868: The Mediation Effect of Self-care Self-efficacy between Illness Perceptions and Self-care Behaviors among People with Heart Failure
Authors: HUANG Zehao , Chair Sek Ying
Published: November 2024

Introduction:
Heart failure (HF) self-care behaviors are related to patient outcomes. The Common-sense Model of Self-Regulation indicates that illness perceptions and self-care self-efficacy are crucial predictors of self-care behaviors. However, research evidence is limited on these relationships.

Aims:
To explore the associations among illness perceptions, self-care self-efficacy, and self-care behaviors in people with HF.

Methods:
A cross-sectional study design was adopted. People with HF were recruited from a tertiary hospital between February and April 2023 in China. All the participants were assessed for illness perceptions, self-care self-efficacy, and self-care behaviors. Data were analyzed using Pearson correlation and mediation analyses. The study was reported following the STROBE checklist.

Results:
A total of 164 people with HF were enrolled. Pearson analysis reported the negative correlations between the scores of illness perceptions and the scores of self-care maintenance (r=-0.344, p<0.001), symptom perception (r=-0.352, p<0.001), and self-care management (r=-0.519, p<0.001), as well as the positive associations between the scores of self-care self-efficacy and the scores of self-care maintenance (r=0.689, p<0.001), symptom perception (r=0.697, p<0.001), and self-care management (r=0.771, p<0.001). Moreover, a significant negative relationship between the scores of illness perceptions and the scores of self-care self-efficacy was observed (r=-0.527, p<0.001). Mediation analysis reported that the scores of self-care self-efficacy completely mediated the negative relationships between the scores of illness perceptions and the scores of self-care maintenance, symptom perception, and self-care management, and the mediation effect accounted for 71.4%, 72.5%, and 88.2% of the total effect, respectively.

Conclusions:
Among people with HF, self-care self-efficacy completely mediated the relationships between illness perceptions and self-care behaviors. Interventions targeting improving illness perceptions and self-care self-efficacy may enhance HF self-care behaviors.
Abstract 4117922: The Role of Combined Renin Angiotensin Aldosterone System Inhibitors (RAASi) Plus Beta Blocker Therapy For Cardiotoxicity Prevention In Patients Under Chemotherapy For Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
Authors: Khan Mohammad , Choi James , Akbari Amir , Hart Hannah , Goodfarb Justin , Romeo Francisco , Mahmood Kiran
Published: November 2024

Introduction:
Anti-neoplastic agents, including anthracyclines and trastuzumab, frequently employed in breast cancer treatment carry on considerable cardiotoxic effects impairing both cardiac chamber and cardiac fiber parameters leading to incident heart failure. In response to this challenging side effect, numerous randomized controlled trials (RCTs) have investigated the cardioprotective efficacy of RAASi and beta-blockers (BBs) in patients undergoing anthracycline and trastuzumab chemotherapy. We aim to perform an updated meta-analysis to elucidate the potential cardioprotective properties of these medications in patients undergoing chemotherapy for breast cancer.

Methods:
A comprehensive search of the literature was performed through April 2024 on PubMed, EMBASE and Clinicaltrials.gov. In total, data from 4 randomized studies were extracted and analyzed. The primary analysis was the effect of RAASi and BBs on LVEF as well as global longitudinal strain (GLS). Data were analyzed using a random-effects model to derive weighted mean differences (WMDs) and 95% confidence intervals for both LVEF and GLS. Data was analyzed using Review Manager 5.3 (RevMan 5.3) software.

Results:
In total, data from 248 patients (N = 124 on cardioprotection; N = 124 without cardioprotection) undergoing treatment with anti-neoplastic agents for breast cancer were included. At the end of treatment, patients undergoing cardioprotective therapy demonstrated improved LVEF preservation compared to the control group, (mean difference 2.14 [0.03, 4.25]; P=0.05; I2 = 79%). In addition, patients undergoing dual RAASi + BB therapy showed better GLS preservation compared to control group (mean difference –1.37 [-2.01, -0.72]; P < 0.0001; I2 = 0%).

Conclusion:
In breast cancer patients undergoing anti-neoplastic regimens comprising anthracycline and trastuzumab, the concomitant administration of RAASi and BBs demonstrated better LVEF as well as GLS preservation upon completion of treatment over those without cardioprotective therapy. These findings shed light on the potential benefit derived from the synergistic effects of RAASi and BBs therapy in safeguarding both cardiac chamber and fiber functions amidst aggressive anti-cancer regimens, although further investigations still need to be conducted.
Abstract 4118070: High Output Heart Failure After Leadless Pacemaker Placement In a Heart Transplant Recipient
Authors: Kim Han Wool , Malensek Paris , Morlend Robert , Beaini Hadi , Patel Ravi , O'Hara Patrick , Goral Montana , Hussain Fizza , Farr Maryjane , Araj Faris
Published: November 2024

Introduction:
The advent of leadless pacemaker (LP) technology has revolutionized cardiac rhythm management by minimizing risks associated with traditional transvenous pacemakers. LP use is expected to increase as dual-chamber LP systems emerge into clinical practice. The LP requires a large-bore venous sheath (27-Fr) through a femoral vein. One risk of large bore femoral cannulation is creation of an occult arteriovenous fistula (AVF), which can cause high output heart failure (HOHF) over time. In the LEADLESS II trial, the event rate for AVF was 0.2%. HOHF as a complication of LP implant has not been previously reported. We describe the first case of HOHF in a heart transplant (HT) recipient after LP.

Case Presentation:
An 82-year-old male with a history of HT 26 years earlier underwent leadless pacemaker for recurrent syncope, deemed associated with conduction system disease. He had no history of cardiac allograft rejection, angiographic coronary allograft vasculopathy or left ventricular dysfunction. Six months post-implant he presented with shortness of breath and bilateral lower extremity edema.

Management:
Evaluation included: 1) Chest X-ray which was suggestive of pulmonary edema 2) natriuretic peptide level of 5,500 pg/ml (6-fold increase from 6 months prior) 3) echocardiogram showing EF of 69%, and 4) bilateral lower extremity Doppler ultrasound where he was found to have a large AVF between the right superficial femoral artery and superficial femoral vein. Subsequent right heart catheterization was notable for a PCWP of 18 mmHg and a cardiac output/index of 11 L/min and 5.8 L/min/m2 respectively, hence confirming HOHF. Treatment with intravenous diuretic was initiated and percutaneous stent placement to correct the AVF was performed with symptomatic relief.

Conclusion:
This case highlights the rare but serious complication of unrecognized AVF following leadless pacemaker implant. Given that this event occurred in a HT recipient, a more exhaustive work-up was required to rule-out expected causes of congestion. To our knowledge there is only one other case report describing AVF post-LP implant for which no intervention was performed due to absence of symptoms at 6-month follow up and HOHF was not reported. Our case emphasizes that the differential diagnosis of new onset of signs and symptoms of heart failure that develop post LP implant in general and in HT recipients specifically, should include HOHF related to an unrecognized procedural AVF.
Abstract 4118178: Echocardiographic Measure of Right Ventricular-Pulmonary Arterial Coupling Predicts Survival in Lung Cancer
Authors: Rako Zvonimir , Cekay Michael , Yogeswaran Athiththan , Yildiz Selin , Arndt Philipp Friedrich , Kremer Nils , Schaefer Simon , Janetzko Patrick , Brito da Rocha Bruno , Mummert Chris , Franken Johanna , Soethe Henrik , Werner Hannah , Dumitrascu Rio , Grimminger Friedrich , Ghofrani Ardeschir , Savai Pullamsetti Soni , Seeger Werner , Naeije Robert , Savai Rajkumar , Eul Bastian , Tello Khodr
Published: November 2024

Background:
Echocardiographic indicators of pulmonary hypertension have been reported to predict decreased survival in lung cancer. We sought to test the hypothesis that this may be associated with impaired right ventricular (RV)-systolic pulmonary arterial pressure (sPAP) coupling, further enhancing the prognostic strength of echocardiography in lung cancer.

Methods:
This prospective observational study included 220 patients with non-small cell lung cancer (NSCLC) examined by Doppler, strain and 3D echocardiography before starting therapy. Prediction of overall survival was assessed by univariable analysis followed by multivariate Cox regression, receiver operating characteristic (ROC) curves and Kaplan-Meier analyses.

Results:
Echocardiographic examination was on average within normal limits, even though 30% of the patients had sPAP ≥35 mm Hg. In univariable analysis, overall survival was associated with measures of RV systolic function and probability of pulmonary hypertension. In multivariate Cox regression, only RV global longitudinal strain (GLS)/sPAP (HR: 5.766 [95% CI: 1.025–32.443]) and Eastern Cooperative Oncology Group performance status <2 (HR: 0.332 [95% CI: 0.171–0.644]) independently predicted survival. The optimal ROC curve-derived RV GLS/sPAP cut-off to predict survival was −0.54%/mm Hg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS/sPAP >−0.54%/mm Hg) had worse survival than those with maintained RV-arterial coupling (HR: 2.8 [95% CI: 1.5–5.3]); the latter subgroup had similar survival compared with patients in UICC stage 3 (HR: 0.57 [95% CI: 0.28–1.14]).

Conclusion:
RV GLS/sPAP as an echocardiographic measure of RV-arterial coupling adds to prognostication by the UICC status in NSCLC.
Abstract 4118183: Anxiety disorder, depression and coronary artery disease: associations and modification by genetic susceptibility
Authors: Nakada Shinya
Published: November 2024

Background:
Associations of anxiety disorder and depression with coronary artery disease (CAD) are heterogeneous between populations.

Research questions:
How does genetic susceptibility to CAD alter the associations between anxiety and depression and incident CAD?

Aims:
To investigate how genetic susceptibility to CAD alters the associations of anxiety and depression with incident CAD, comparing and combining anxiety and depression.

Methods:
This is a prospective cohort study using UK Biobank. Diagnoses of anxiety disorder and depression before the baseline assessment were ascertained through linked hospital admission data. Incident CAD was ascertained through hospital admission and death certificate data after baseline. CAD polygenic risk score (PRS) was obtained from CARDIoGRAMplus4 and categorised into low, intermediate, and high. Cox proportional hazard models were used to examine associations between anxiety and depression and CAD. The product term of PRS and these mental health conditions, and the relative excess risk due to interaction (RERI), were used to investigate the presence of multiplicative and additive interactions, respectively.

Results:
Our study included 288,152 participants of whom 54.4% were female, with a mean age of 56.4 years. Both anxiety disorder (HR: 2.24, 95% CI: 1.86–2.70) and depression (HR: 2.04, 95% CI: 1.80–2.32) were associated with CAD after adjusting for sociodemographic confounders. There was an addictive interaction between depression and PRS (RERI: 0.86; 95% CI: 0.06–1.65) such that the association between depression and CAD was strongest among those with a high PRS whilst there was no such evidence for anxiety disorder. Anxiety only (HR 1.69, 95% 1.17–2.45), depression only (HR 2.01, 95% CI 1.62–2.49) and concomitant anxiety and depression (HR 3.51, 95% CI 2.26–5.45) were associated with CAD even among people with a low PRS. Lifestyle mediators attenuated all these associations across PRS categories.

Conclusions:
CAD genetic susceptibility might partly contribute to the clustering of depression and CAD but does not provide a full explanation, nor does it explain the association between anxiety disorder and CAD. Therefore, other mechanisms should be explored.
Abstract 4118242: Impact of Pregnancy on Individuals with Hypertrophic Cardiomyopathy: Long-Term Clinical Outcomes - Population-Based Study
Authors: Abdelfattah Omar , Abdeldayem Jasmin , El Haddad Danielle , Sharma Garima , AHNERT AMY , Martinez Matthew , Sibai Baha , Khalife Wissam
Published: November 2024

Background:
The effect of pregnancy on individuals with Hypertrophic Cardiomyopathy (HCM) is not well investigated.

Objective:
To assess the impact of pregnancy on all-cause mortality and clinical outcomes among individuals with HCM

Methods:
Using the TriNetX research network, we identified individuals within reproductive age (
≥ 18-45 years)
with a diagnosis of HCM between 2012 and 2022 (n=10,936). Patients were stratified based on pregnancy history into two groups (a) those with a history of pregnancy/high-risk pregnancy supervision and (b) those without a history of pregnancy or subsequent antenatal/pregnancy supervision encounters throughout the study period. Propensity-score matching resulted in 3,399 patients in each cohort. The primary outcome was all-cause mortality. Secondary outcomes include a composite of arrhythmic events (SCD and SCD equivalents), major adverse cardiovascular events (MACE), and acute heart failure (HF) exacerbation during 10 years of follow-up.

Results:
Pregnancy in patients with HCM was associated with a comparable risk of all-cause mortality (adjusted OR:0.89; 95% CI: 0.7-1.14;
p
=0.37) at 10 years follow-up. MACE and acute HF exacerbation outcomes were lower in the pregnancy group; however, the arrhythmic events (SCD) did not differ between groups (adjusted OR: 0.93, 95%CI: 0.73-1.18;
p
=0.55).

Conclusion:
Pregnancy in individuals with HCM was not associated with a higher risk of adverse outcomes at long-term follow-up. Further efforts are warranted to better understand the short-term outcomes in this high-risk population
Abstract 4118332: Suvorexant is associated with the reduced risk of feart failure rehospitalization in elderly patients with heart failure and insomnia
Authors: Saito Tomoyuki , Nojiri Shuko , Naito Ryo , Kasai Takatoshi
Published: November 2024

Background:
Research that compares the safety of orexin receptor antagonists and other types of hypnotics prescribed to elderly patients with heart failure (HF) and insomnia remains lacking. This study aimed to compare an orexin receptor antagonist, Suvorexant, with benzodiazepines or Z-drugs for insomnia treatment and investigate the risk of HF-related rehospitalization in elderly patients with HF and insomnia.

Methods:
A national administrative claims database from April 2008 to December 2020 was utilized and analyzed. The study population, consisting of 1,159,937 patients aged ≥65 years, was randomly sampled from the database. Patients were then selected based on specific inclusion and exclusion criteria. Exposures were identified based on the classification of the first prescribed hypnotic. The follow-up period was continued considering the prescription interval and grace period. The end of follow-up was censored based on multiple criteria, including outcome occurrences (i.e., HF rehospitalization) and hypnotic classification changes. Kaplan–Meier survival analysis and Cox proportional hazards models were used. Hazard ratios were adjusted by propensity scores derived from patients’ background factors.

Results:
The analysis included 1,858 elderly who had their first HF-related hospitalization. They were categorized into Suvorexant, benzodiazepines and Z-drugs groups (N=490, 606 and 762, respectively). The average age for all participants was 82.7 ± 7.6 years, which is similar across three groups. Kaplan-Meier curves indicated a higher trend of HF-rehospitalization risk for benzodiazepines and Z-drugs groups than for Suvorexant. The adjusted hazard ratios were 2.77 (95% confidence intervals [CI]: 1.17-6.52) for benzodiazepines and 2.98 (95% CI: 1.33-6.68) for Z-drugs.

Conclusion:
Compared with benzodiazepines and Z-drugs, the use of suvorexant for insomnia treatment in elderly patients with HF indicates a potential for the reduced risk of rehospitalization due to HF exacerbation. The results of this study provide valuable information for the selection of hypnotics in elderly HF patients with concurrent insomnia.
Abstract 4118338: Predictors and 3-Year Outcomes of Compromised Left Circumflex Coronary Artery After Left Main Crossover Stenting
Authors: ULLAH HAMEED , Guo Ning , Yuan Zuyi , Hamed Karim , Ullah Najeeb , Asad Khan Muhammad , Ullah Habib
Published: November 2024

Background :
Predictors of decreased fractional flow reserve at left circumflex coronary artery after left main (LM) crossover stenting are still lacking. The objectives of the present study were to provide the predictors for low FFR at LCx and the possible treatment strategies for the compromised LCx-together with their long term outcomes.

Methods:
Total of 563 included patients out of 1974 patients admitted to our hospital from February 2015 to November 2020 with significant distal LM-bifurcation lesion. The enrolled patients underwent single-stent cross-over PCI under IVUS-guidance with further LCx-intervention as indicated by measured FFR.

Results:
The included patients showed angiographic significant LCx ostial affection after LM-stenting, but only 116 (20.6%) patients had FFR <0.8. The 3-year composite MACE rates were comparable between the high and low FFR groups (16.8% vs. 15.5%, respectively;
P
=0.744). In a multivariable analysis, a low FFR in the LCx was associated with post-stenting MLA of the LCx (OR: 0.032,
P
<0.001), post-stenting LCx-plaque burden (OR: 1.166,
P
<0.001), post-stenting LM-MLA (OR: 0.821,
P
=0.038) and and pre-stenting LCx-MLA (OR: 0.371,
P
=0.044). In patients with low FFR, management of compromised LCx with DEB had the lowest 3-year MACE rate (8.1%) as compared to either KBI (17.5%) or stenting group (20.5%),
P
=0.299.

Conclusion:
FFR-guided LCx intervention can avoid unnecessary LCx intervention. The post-stenting predictors of low FFR include post-stenting MLA and plaque burden of the LCx and MV stent length. The 3-year MACE rates were comparable between high FFR patients and patients who had low FFR and adequately managed.
Abstract 4118342: Acoustic Analysis For The Detection Of Leaflet Thrombosis After Transcatheter Aortic Valve Replacement
Authors: Lupu Lior , Shetrit Aviel , Kadosh Adi , Aviram Galit , Topilsky Yan , Banai Shmuel , Havakuk Ofer
Published: November 2024

Introduction:
Following trans-catheter aortic valve replacement (TAVR), patients may develop aortic valve leaflet thrombosis, a condition associated with an increased risk of embolic events. Currently, the diagnosis of post-TAVR leaflet thrombosis is based on echocardiography surveillance or cardiac tomography (CCT) scan, both require specialized team and equipment, and may also expose the patients to radiation and contrast.

Acoustic analysis is a non-invasive reproducible method, which incorporates the recording of cardiac sounds and analyzing them via machine learning algorithms.

Here, we investigated the diagnostic abilities of acoustic analysis in the detection of post-TAVR leaflet thrombosis.

Methods:
Using an electronic stethoscope, heart sounds were prospectively recorded at 2 time points: 24-hours and 6-months post-TAVR. CCT scan was performed 6-months following TAVR to detect leaflet thrombosis. Acoustic sounds were analyzed, using a Gaussian support vector machine (SVM) algorithm, to identify features associated with leaflet thrombosis.

Results:
Of 19 consecutive patients, 3 were found to have high-grade leaflet thrombosis based on CCT results. The SVM algorithm effectively classified heart sounds into "normal" and "thrombotic", with a sensitivity of 100% and specificity of 97.2%. Following anticoagulation therapy, all 3 patients showed no signs of leaflet thrombosis on follow-up CCT scans and were also classified as "normal" by the algorithm. Notably, at the time of leaflet thrombosis, Doppler echocardiographies showed normal pressure gradients across the affected valves.

Conclusions:
These initial results suggest that acoustic analysis, combined with machine learning algorithms, may identify post-TAVR leaflet thrombosis, providing a non-invasive, cost-effective, and radiation-free alternative to traditional diagnostic methods.