bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4125106: Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis; A Meta-Analysis.
Authors: sabanci rand , Saeed Moiz , Martinez Salazar Adolfo , Kim Andrew , Siddiqi Zan , Salam Mohammad Saad , Rayamajhi Karuna , George Abela
Published: November 2024

Background:
Internationally, drug-coated balloons have emerged as a new treatment approach in In-Stent Restenosis (ISR) offering localized drug delivery to inhibit neointimal growth without the need for additional stent layers. However, their use has not been assessed or approved in the United States. Paclitaxel-coated balloons (PCBs) are gaining traction as alternatives for in-stent restenosis patients. Yet, their safety and effectiveness compared to uncoated balloons remain uncertain. This meta-analysis seeks to systematically assess PCBs' safety and efficacy for ISR treatment by comparing them to uncoated balloons.

Research Question:
Are paclitaxel-coated balloons (PCBs) superior to uncoated balloons (UCBs) in terms of safety and efficacy for the treatment of coronary in-stent restenosis (ISR)?

Aims:
Systematically assess the safety and efficacy of paclitaxel-coated balloons (PCBs) compared to uncoated balloons (UCBs) for the treatment of coronary in-stent restenosis (ISR).

Methods:
A comprehensive literature review was conducted utilizing multiple databases up to May 2024, focusing on randomized controlled trials comparing PCB vs UCB in patients with coronary in-stent restenosis. Six randomized controlled trials with a total of 1,347 patients who completed 1-year follow-up were included. Dichotomous data were calculated as odds ratios (ORs) and 95% confidence intervals (95% CI). P<0.05 was considered to indicate a statistically significant difference. The primary outcomes included Target Lesion Revascularization (TLR), Myocardial Infarction (MI), Stent Thrombosis (ST) and Total Mortality (TM).

Results:
Compared with patients who underwent UCB angioplasty, those in the PCB group exhibited a clear superiority in TLR [odds ratio (OR), 0.21; 95% CI [ 0.11,0.41]; P<0.00001], and MI [odds ratio (OR), 0.55; 95% CI [0.33,0.91]; P<0.02]. ST was numerically lower in the PCB arm without statistical significance (OR, 0.21; 95% CI [0.03,1.48]; P=0.11). TM was also numerically lower with PCB without reaching statistical significance (OR, 0.60; 95% CI [0.32,1.11]; P=0.10).

Conclusion:
This meta analysis supports that PCBs are associated with superior outcomes when compared with UCBs in the management of ISR. Paclitaxel-coated balloons are an effective treatment option for patients with coronary in-stent restenosis as demonstrated by superior outcomes in target lesion revascularization and recurrent myocardial infarction.
Abstract 4125300: Prognostic Value of NT-proBNP and the H
2
FPEF Score on Empagliflozin-associated Left Ventricular Remodeling: Insights from the EMPA-HEART and EMPA-HEART 2 CardioLink Trial
Authors: Hibino Makoto , Verma Subodh , Quan Adrian , Puar Pankaj , Akhavein Farhad , Wang Chao-Hung , Yan Andrew , Connelly Kim , Mazer David , Teoh Hwee
Published: November 2024

Background:
NT-proBNP is a prognostic and diagnostic marker for heart failure while the H
2
FPEF score is used to aid in diagnosing heart failure with preserved ejection fraction.

Aims:
These post hoc analyses of the randomized controlled EMPA-HEART CardioLink-6 and EMPA-HEART 2 CardioLink-7 trials examined how baseline NT-proBNP and the H
2
FPEF score influenced empagliflozin-associated left ventricular (LV) remodeling in people with either type 2 diabetes and coronary artery disease or without diabetes but with cardiovascular risk factors.

Methods:
A total of 242 participants were assigned to either empagliflozin 10 mg QD (n=118) or placebo (n=124) for 6 months. NT-proBNP was measured and cardiac MRI performed at baseline and end-of-study. Two independent analyses were performed. One divided the participants into those with baseline NT-proBNP < and ≧125 pg/mL and the other into those with H
2
FPEF score ≦2 and ≧3. The relationships between empagliflozin-associated LV mass and functional changes with baseline NT-proBNP and H
2
FPEF scores were assessed with linear models that adjusted for baseline differences (ANCOVA).

Results:
Mean age of the pooled cohort was 60.6 years; 14.0% were females, 37.2% had type 2 diabetes. Mean (SD) LV ejection fraction (LVEF) was 58.0 (10.2) %; median (IQR) NT-proBNP 77.5 (33, 164) pg/mL; mean (SD) H
2
FPEF score 2.9 (1.4). Empagliflozin (vs placebo) did not significantly alter LV mass index (mean [SD] -1.35 g/m
2
[0.75]; P=0.07) and LV end-systolic volume index (LVESVi; mean [SD] -1.37 mL/m
2
[0.74]; P=0.07) but did improve LVEF (mean [SD] 2.08% [0.82]; P=0.01). The effect of empagliflozin based on the subgroups of baseline NT-proBNP and H
2
FPEF scores are shown in Figures 1 and 2, respectively.

Conclusions:
These post hoc analyses suggest that lower baseline NT-proBNP levels and H
2
FPEF scores may be associated with more favourable reverse LV remodelling by empagliflozin and should be validated in larger studies.
Abstract 4125334: Disparities In Clinical And Demographic Outcomes Of Non-Acute Myocardial Infarction-Associated Cardiogenic Shock In African American Vs. Non-African American Patients: An Analysis From The National Inpatient Sample Database
Authors: Javed Nismat , Jadhav Preeti , Chilimuri Sridhar , Bella Jonathan
Published: November 2024

Background:
Limited knowledge exists regarding non-acute myocardial infarction-associated cardiogenic shock (nACS-CS) and its associated outcomes within the African American population.

Aim:
This investigation aimed to examine the clinical outcomes of nACS-CS in the African American population compared to the non-African-American population in the United States.

Methods:
The National Inpatient Sample (NIS) database was employed to identify hospitalizations with nACS-CS from 2018 to 2020. Patients were categorized as either African Americans or non-African Americans. Statistical analyses, including Chi-square and t-tests, were conducted using STATA version 18.

Results:
Out of 8,607 nACS-CS hospitalizations, 1,325 (15.4%) involved African Americans between 2018 and 2020 (Figure 1a). African American patients with nACS-CS tended to be younger (60.9±16.6 vs. 65.8±16.7 years; p < 0.05). Moreover, the length of stay for this cohort was notably longer (16.2±0.75 vs. 14.8±0.32 days; p < 0.05). The demographic age group affected by cardiogenic shock exhibited a decreasing trend as time progressed up to 2020 (p-trend<0.05; Figure 1b). The mean hospital charges were also higher for the African American cohort (p<0.05). In-hospital mortality also showed a progressive increase among African Americans over time (p<0.05).

Conclusion:
Among African American patients with nACS-CS, there is an escalating burden on healthcare, evidenced by a progressively younger demographic being affected over time, coupled with worsening rates of in-hospital mortality. Furthermore, there is a higher mean cost of hospitalization and a prolonged length of stay compared to their non-African American counterparts.
Abstract 4125500: Obesity-Related Left Atrial Functional Change Becomes Apparent in Infancy
Authors: Harada Kenji , Harada Yukiko , Hatakeyama-Sasaki Miho , Nakamoto Yuichi , Toyono Manatomo
Published: November 2024

Background:
Impaired left atrial (LA) function is observed in obese patients, however, there is little information on when LA dysfunction begins to appear. To clarify this issue, we assessed LA volume and function in obese infants.

Methods:
Two-dimensional speckle-tracking echocardiography was performed in 96 infants aged 4 months. Subjects were divided into 3 groups according to body mass index (BMI): normal (n=53), <17 kg/m
2
; overweight (n=28), 17 to 19.9 kg/m
2
; obese (n=15), ≧20 kg/m
2
. LA maximal volume, LA minimal volume, and LA pre-atrial contraction volume and LA longitudinal strain (reservoir, conduit, and booster) were measured. LA total emptying fraction, passive emptying fraction, and active emptying fraction were calculated.

Results:
Systolic blood pressure was significantly higher in the obese group than in the normal group (Table). LA maximal volume, minimal volume, and pre-atrial contraction volume increased significantly with increasing BMI (r = 0.53, 0.54, and 0.63, respectively, p <0.01). Compared with the normal group, reservoir LA strain was significantly lower in the overweight and obese groups. Conduit LA strain and passive emptying fraction were significantly lower in the overweight and obese groups than those in the normal group (Table). Reservoir LA strain, conduit LA strain, and passive emptying fraction decreased significantly with increasing BMI (r = -0.28, -0.27, and -0.33, respectively, p <0.01). There was no significant difference in booster LA strain among the 3 groups. Compared with the normal group, LA active emptying fraction was significantly higher in the obese group (Table).

Conclusions:
Higher BMI is associated with impaired reservoir and conduit LA function and higher booster LA pump function, which may be compensatory. Thus, obesity-related changes in LA functional begin to appear in infancy. Our data support prevention of obesity in early childhood because higher BMI is responsible for significant changes in LA function in early life.
Abstract 4125667: National Estimates of Patient Eligibility for Renal Denervation Therapy Post-FDA Approval
Authors: Watson Nathan , Earle William , Kandzari David , Kirtane Ajay , Mahfoud Felix , Cluett Jennifer , Krawisz Anna , Juraschek Stephen , Secemsky Eric
Published: November 2024

Background:
Renal denervation (RDN) has been shown in randomized trials to improve blood pressure compared with a sham procedure. Currently, there are two FDA-approved RDN devices in the United States (US). While nearly half of the US population has hypertension (HTN), the number of patients who may benefit from RDN therapy remains uncertain. In this study, we used a nationally representative dataset to approximate the proportion of patients with HTN who may be eligible for consideration of RDN based on selective criteria.

Methods:
All adult patients with HTN who participated in the National Health and Nutrition Examination Survey (NHANES) between the years 2009-2020 were identified. We characterized the proportion of these participants that met eligibility criteria based on 1) the FDA indication, 2) the SCAI 2023 RDN position statement, and 3) enrollment criteria from the RDN on-medication randomized trials. National estimates were obtained utilizing survey weighting from the NHANES multistage probability survey design.

Results:
In total, we identified 16,677 patients with HTN in the US, representing a weighted total of 113,786,149 patients (
Table
). Using the FDA indication, 31.6% (95% CI, 30.7%-32.6%) of patients meet eligibility criteria for RDN, corresponding to 35,988,870 US adults. By the SCAI 2023 position statement selection criteria, 21.5% (95% CI, 20.7%-22.3%) of patients are eligible for consideration of RDN. Based on enrollment criteria from the RDN on-medication randomized trials, 2.05% (95% CI, 1.81%-2.33%) of US adults meet eligibility for consideration of RDN (
Figure
).

Conclusions:
Our findings indicate that nearly one third of US adults with HTN are eligible for consideration of RDN based on the FDA indication; however, a smaller proportion of patients would be eligible based upon society recommendations and randomized trial inclusion criteria. Future studies are needed to further inform which patients will best benefit from this intervention.
Abstract 4125679: Physical activity among gender minority adults: A systematic review
Authors: Lopez Veneros David , Sharma Yashika , Bockting Walter , Jackman Kasey , Caceres Billy
Published: November 2024

Introduction:
Gender minority (GM; e.g., transgender, non-binary) adults have a higher prevalence of cardiovascular disease (CVD) than their cisgender (i.e., non-transgender) counterparts. Physical activity (PA) is associated with a lower risk of CVD and all-cause mortality. Compared to cisgender adults, GM adults face unique challenges (e.g., discrimination, lack of safe spaces) to meeting aerobic and muscle-strengthening PA recommendations, which may negatively impact their overall health and well-being. There is also limited evidence on factors associated with lower PA among GM adults.

Goal:
To understand differences in the prevalence of PA between GM and cisgender adults and to identify factors associated with PA among GM adults.

Methods:
Following the PRISMA guidelines, we performed a comprehensive search using five databases (PubMed, Embase, Web of Since, CINAHL, and Scopus). We included peer-reviewed, English-language, quantitative empirical studies focused on PA among GM adults published between 2004 and 2024. We excluded qualitative studies, reviews, editorials, conference abstracts, and grey literature. We performed quality appraisal using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

Results:
A total of 5,163 articles were retrieved and 24 met inclusion criteria. The included studies had a low to moderate risk of bias. Methodological weaknesses of the included studies were an overreliance on self-reported PA with no objective assessment using accelerometry, use of non-validated PA measures, and limited assessment of muscle-strengthening PA. Most studies (n = 15) reported lower aerobic and muscle-strengthening PA among GM adults compared to their cisgender counterparts. Two studies found that GM adults with higher perceived psychological stress reported lower PA. One study found that GM adults who were on gender-affirming hormone therapy reported higher PA than GM adults who were not.

Conclusions:
Findings highlight that GM adults report lower aerobic and muscle-strengthening PA than cisgender adults. There is a need for more comprehensive research to understand these disparities and their impact on GM adults’ cardiovascular health. This systematic review can inform future research and the development of tailored interventions to increase PA among GM adults.
Abstract 4125887: Aladyn Individual: Dynamic Individual Comorbidity Modeling for Genomic Discovery and Clinical Prediction
Authors: Urbut Sarah , Ding Yi , Taraszka Kodi , Yeung Ming Wai , Patel Aniruddh , Hornsby Whitney , Duan Rui , Gusev Alexander , Parmigiani Giovanni , Natarajan Pradeep
Published: November 2024

Intro:
Considering comorbidity patterns for both discovery and prediction of individual disease trajectories is essential for personalized medicine. Existing methods often lack genetic integration and interpretability. We develop an approach suited for dynamic environments that combines genetics with individual and population level-trajectories for enhanced discovery and prediction.

Method:
Our method employs a dynamic Bayesian hierarchical latent allocation framework to learn and predict disease trajectories. Leveraging longitudinal electronic health care data from 485,698 UK Biobank participants and 287,012 All of Us Research Program participants, we aim to learn individual and population level disease trajectories for 352 distinct conditions. Genetic risks inform the model in two fundamental ways: First, we introduce a genetic warping parameter that recognizes the tendency of an individual to experience events earlier or later within these profiles while retaining the relative order of progression (1a). Second, we introduce a gaussian process to combine individual and population level trends in comorbidity profile prevalence over time (1b), whose mean is augmented by genetic predilection. Finally, we allow for profile weights to update with each new diagnoses, merging prediction and classification.

Results:
Our results indicate stark disparities in disease progression; individuals at high genetic risk for myocardial infarction experience events nearly a decade earlier than those at low risk (median age of onset 53.7 [53.1-53.9] vs 62.6 years [61.4-63.1]) (1b). Our model dynamically updates and predicts correct diagnoses 79.5% more frequently than existing topic-modeling approaches (1c,d). The dynamic approach adjusts disease profiles by at least 11.7% annually for 50% of individuals, with 65% experiencing over a 10% change in comorbidity profiles. Simulation results confirm the model's superior accuracy [51.4-41%], precision [50.9 vs 39.9%], and recall [48.4 vs 39.2%] compared to fixed-weight approaches.

Summary:
We offer a novel approach for integrating genetic risk with dynamic modeling of complex disease profiles for joint biologic discovery and personalized clinical prediction over the lifetime.
Abstract 4126358: Fetal cardiac physiology but not cerebrovascular resistance predicts neurodevelopmental outcomes in congenital heart disease
Authors: Bradford Victoria , Lipsitz Stuart , Herrera Pujols Kaysi , Hart Nicholas , Waring Kyla , Sadhwani Anjali , Tworetzky Wayne , Newburger Jane , Friedman Kevin , Rollins Caitlin
Published: November 2024

Introduction:
Fetal “brain sparing” autoregulatory mechanisms respond to reduced cardiac output or substrate delivery by decreasing cerebrovascular resistance to maintain cerebral blood flow. In patients with congenital heart disease (CHD), data are conflicting on the association between fetal cerebral Doppler measures and postnatal neurodevelopment, possibly due to the heterogeneity of fetal cardiac physiology.

Aim:
To evaluate whether fetal cerebrovascular resistance estimated by middle cerebral artery pulsatility index (MCA PI) and cerebroplacental ratio (CPR; MCA PI divided by umbilical artery PI) predict neurodevelopment in patients with CHD.

Methods:
This retrospective analysis of a prospectively-enrolled cohort included cases with isolated CHD and healthy controls with a family history of CHD. Cases were classified by fetal cardiac physiology: single vs. biventricular circulation, outflow obstruction (none, systemic, pulmonary), and cerebral substrate delivery (normal, mixed, abnormal). Subjects underwent fetal echocardiography with cerebral and umbilical doppler measures (normalized for gestational age) as well as neurodevelopmental evaluation at two years of age with the Bayley Scales of Infant and Toddler Development III and IV.

Results:
Fetal echocardiograms and neurodevelopmental testing were obtained in 82 cases and 48 controls. There was no difference in MCA PI or CPR between cases and controls; however cases with mixed vs. normal substrate delivery had lower z-scores for MCA PI (-1.08
+
1.16 vs. -0.43
+
1.38, p=0.05) and CPR (-0.74
+
0.62 vs. -0.37
+
0.59, p=0.02). Cases had lower Bayley scores across all composite domains: cognitive (97.8
+
11.8 vs. 103.4
+
14.7, p=0.03), language (97.6
+
15.6 vs. 105.6
+
21.3, p=0.03), and motor (94.0
+
10.7 vs. 100.4
+
10.9, p=0.003). MCA PI and CPR were not associated with Bayley scores in cases or in sub-group analysis by fetal cardiac physiology. In multivariable analyses of Bayley scores adjusting for medical and demographic data, lower motor composite score was predicted by mixed vs. normal substrate delivery (partial R2=12.4%, p<0.001) and single ventricle physiology (partial R2=6.5%, p=0.008).

Conclusions:
In patients with CHD, fetal single ventricle physiology with mixed substrate delivery was associated with worse motor development. The lack of association of fetal cerebral dopplers with neurodevelopment may suggest that decreased cerebrovascular resistance is not necessarily an effective compensatory mechanism in CHD.
Abstract 4126650: Prognostic Value of Femoral-Ankle Pulse Wave Velocity for Cardiovascular Outcomes in Older Adults: The Atherosclerosis Risk in Communities (ARIC) study
Authors: Shibata Tatsuhiro , Mok Yejin , Ballew Shoshana , Tanaka Hirofumi , Matsushita Kunihiro
Published: November 2024

Background:
Carotid-femoral pulse wave velocity (cfPWV) is a representative measure of central arterial stiffness and an independent predictor of cardiovascular disease (CVD). Femoral-ankle PWV (faPWV) represents peripheral arterial stiffness, but its association with CVD has not been specifically studied.

Aim:
To compare faPWV and cfPWV regarding their associations with CVD outcomes.

Methods:
We analyzed 3,402 ARIC participants without prior heart failure (HF), coronary heart disease (CHD), or stroke at visit 5 (2011-13) (mean age 74.8 [SD 4.9] years, 36.1% male, and 78.0% White). faPWV and cfPWV were measured by Omron VP-1000 Plus. The outcomes of interest were composite and individual outcomes of CVD (HF, CHD, and stroke). We ran unadjusted and multivariable Cox proportional hazards models.

Results:
During a median follow-up of 9.0 years, there were 607 CVD events. Overall, faPWV showed an inverse association with CVD (Table). P-for-trend reached statistical significance in Models 1 and 2 and was borderline significant in Model 3 (p=0.077). In contrast, as anticipated, cfPWV was positively associated with CVD in all Models, although the association was somewhat attenuated in Model 3 (p-for-trend=0.045 and hazard ratio [HR] for top vs. bottom quartile 1.22 [95%CI 0.95-1.56]). Given their opposite patterns, we explored the ratio of cfPWV and faPWV (“cf/fa ratio”) and found that its association with CVD appeared stronger (p-for-trend=0.004 and HR for top vs. bottom quartile 1.37 [1.08-1.74]) than cfPWV. When each CVD subtype was examined separately, HF showed most consistent associations with our stiffness measures, and only the cf/fa ratio remained significant for HF up to Model 3 (p-for-trend=0.010 and HR for top vs. bottom quartile 1.40 [1.03-1.90]).

Conclusions:
faPWV was inversely associated with CVD, and cf/fa ratio appeared more strongly associated with CVD compared to cfPWV. Our findings indicate distinct prognostic implications of central vs. peripheral arterial stiffness and suggest cf/fa ratio as a new stiffness measure predicting CVD.
Abstract 4127071: Pulmonary Artery Catheter Utilization in Cardiogenic Shock: Clinical Characteristics and Outcomes
Authors: Krauspe Ethan , Kyriakopoulos Christos , Scott Monte , Sheffield Eric , Taleb Iosif , Selko Sean , Sideris Konstantinos , Maneta Eleni , Ou Zhining , Hamouche Rana , Geer Laura , Stehlik Josef , Goodwin Matthew , Tonna Joseph , Hanff Thomas , Drakos Stavros
Published: November 2024

Background:
The pulmonary artery catheter (PAC) is used for hemodynamic monitoring, but its impact on patient outcomes, especially in cardiogenic shock (CS), is controversial. Several studies have shown no significant benefits and noted complications, leading to a decline in PAC use. However, PAC use appears to have increased recently in guiding management decisions in CS. Our study aims to assess the clinical characteristics and outcomes of CS patients receiving PACs versus not.

Methods:
We included patients with CS admitted to a tertiary academic medical center between May 2015 and December 2023. Variables were compared using Kruskal-Wallis, chi-squared, and Fisher's exact tests. Hemodynamic parameters were collected from either right heart catheterization or from a PAC. Endpoints included native heart survival to discharge, durable left ventricular assist device (LVAD) implantation, heart transplant (HTx), and 30-day and 1-year survival from discharge.

Results:
The study group consisted of 742 patients with CS. Of these, 385 (52%) received a PAC and 357 (48%) did not. The baseline characteristics of the two groups are shown in Table 1A . PAC patients had more severe shock, worse hemodynamics, and higher rates of temporary mechanical circulatory support (MCS) use. Hemodynamic measurements at shock onset differed, with PAC patients having higher right atrial pressures and lower cardiac index by Fick. Clinical outcomes and MCS related complications are shown in Table 1B. There was no significant difference in native heart survival at discharge, but HTx and durable LVAD implantation was higher in the PAC group. PAC placement was associated with longer hospital stays and more MCS related complications, including bleeding and hemolysis. The 30-day survival rate was similar between groups, and 1-year survival was marginally higher in the PAC group.

Conclusion:
PAC patients exhibited more severe clinical characteristics, longer hospital stays, higher rates of temporary MCS use and complications, durable LVAD implantation, and HTx. Short-term survival rates were similar, but 1-year survival was slightly better for PAC patients. Further studies are needed to provide clearer insights into PAC use in CS.
Abstract 4128187: Does Health-related Quality of Life Differ by Race over time in Older Patients with Heart Failure from Before to After Heart Transplantation or Long-term Mechanical Circulatory Support?
Authors: Dixon-Evans Jerian , Andrei Adin-cristian , Wu Tingqing , Clay Shondra , Mazurek Kathryn , Grady Kathleen
Published: November 2024

Background:
Minority patients are disproportionately affected by heart failure. Therefore, we aimed to determine the impact of race on health-related quality of life in three groups of older patients (60-80 years) with heart failure who underwent advanced surgical therapies (within race and by surgery group): (1) heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS]), (2) HT without pre-transplant MCS (HT Non-MCS), or (3) long-term MCS, if ineligible for HT.

Methods:
Secondary analyses were conducted using data from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support study. From 10/1/15 to 12/31/18, 396 patients with heart failure were recruited at 13 U.S. medical centers, of which 305 patients underwent HT (n=161 [68 HT MCS and 93 HT Non-MCS]) or long-term MCS (n=144) and had data through 1 year follow-up. Analysis included non-inferiority testing (Long-term MCS vs HT MCS; Long-term MCS vs HT Non-MCS). To demonstrate non-inferiority, the surgical strategies by race needed to show a difference of at least 5 percentage points, with a 95% lower confidence boundary and a two-tailed p-value<0.05 in health-related quality of life, using the Kansas City Cardiomyopathy-12 Questionnaire Overall Summary Score at baseline and 3-, 6-, and 12 months.

Results:
The entire cohort was on average 66.2±4.7 years, 78% male, and 84% White. All three surgical groups experienced improved health-related quality of life from before to 1 year follow-up; with the largest gain through 3-months. Using non-inferiority testing, the long-term MCS minority group did not demonstrate non-inferiority when compared to both the HT MCS minority group and HT Non-MCS minority group confidence limits above the non-inferiority margin of -5 (Figure). Also, the White long-term MCS group did not demonstrate non-inferiority when compared to the White HT MCS and White HT Non-MCS groups.

Conclusion:
Differences in health-related quality of life among groups based on race were not statistically significant. Per non-inferiority testing, HT is superior to long-term MCS for health-related quality of life, regardless of race.
Abstract 4128201: Reducing Blood Product Waste in a Pediatric Cardiac Catheterization Laboratory – A Quality Improvement Initiative
Authors: Morrison Jacqueline , Zedalis Jacqueline , Parrish Benjamin , Goenaga Diaz Eduardo , David Friedman , Hawkins Jaleah , Shah Farzana , Basu Sharna , Ryan Edith , Tang Jie , Smith Christopher , Callahan Ryan , GILLESPIE MATTHEW , Rome Jonathan , Hehir David , O'byrne Michael
Published: November 2024

Background/Aim:
Transfusion can be a life-saving intervention, however routine pre-procedural blood products frequently go unused. Recent national blood product shortages highlight the importance of blood product stewardship. In our pediatric cardiac catheterization laboratory (PCCL), packed red blood cells (pRBCs) were ordered prior to all cases. These units are rarely transfused and sometimes cannot be reallocated, resulting in waste. As a quality improvement project, we set a primary aim to reduce the percentage of monthly pRBC waste from a baseline mean of 7.4% to <5% over 12 months.

Methods:
Baseline data on all cardiac catheterization cases, excluding electrophysiology, lymphatic, and hybrid cases, were collected from 1/1/2022 to 2/28/2023. Interventions (Table 1) were implemented and outcomes measured from 3/1/2023 to 3/31/2024. Primary outcome measures were monthly percentage of blood wasted, and percent of unused pRBC orders. Emergency blood product activation was measured as a balancing metric. Statistical process control charts were used to display and analyze data.

Results:
During the intervention period 1,318 cases were performed of which 32% met low-risk criteria for pRBC order de-implementation. The percent of blood that was subsequently wasted was reduced from 7.4% to 5.5% (Figure 1A), primarily driven by the reduction in the anecdotal practice of pRBC unit splitting in patients <1 year old (Figure 1B). The percent of unused pRBC orders was reduced from 97% to 79% with sustained improvement following two cycles of routine blood order de-implementation for low-risk cases. No emergency blood activation occurred (0%, 97.5% CI: 0-0.28%).

Conclusion:
De-implementation of default pRBC orders for low-risk catheterization procedures and reduction in unit splitting reduced the percent of blood wasted in our PCCL, saving time and cost without compromising patient safety. A data-driven approach to blood stewardship may be broadly applicable across procedural areas.
Abstract 4128377: Association between Mean Platelet Volume (MPV) and coronary artery disease: An analysis of NHANEs 2017-2020
Authors: Wattanachayakul Phuuwadith , Sripusanapan Adivitch , Isaacs Evan , Idowu Abiodun , Srikulmontri Thitiphan , Kulthamrongsri Narathorn , Wannaphut Chalothorn , Malin John , Danpanichkul Pojsakorn , Polpichai Natchaya , Pereira Lucas , Lalitnithi Pakin , Saowapa Sakditad , Wanichwecharungruang Nisha , Casipit Carlo Gabriel , Suriyathumrongkul Napat , Vutthikraivit Wasawat , Amanullah Aman
Published: November 2024

Background:
Recent data showed that mean platelet volume (MPV) is linked to mortality after myocardial infarction and restenosis following coronary angioplasty. However, its association with coronary artery disease (CAD) remains unclear. Therefore, we aim to investigate the association between MPV and CAD using a nationwide database.

Methods:
We analyzed retrospective cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, including participants aged 18 years and older. The data on MPV were classified into three groups: below the 10th percentile (P10), between the 10th and 90th percentiles (P10 to P90), and above the 90th percentile (P90). Univariable and multivariable logistic regression models were utilized to identify the association between MPV and CAD.

Results:
A total of 12,156 patients with MPV results were identified. Their mean age was 37 ± 24 years, with females constituting 51.0% of the population. The racial distribution was primarily White at 33.8%, Black at 25.7%, Mexican American at 13.2%, Asian at 10.7%, and other races at 16.6%. The participants were categorized into three MPV groups: below P10 (11.2%), P10 to P90 (77.3%), and above P90 (11.5%), with median MPV values of 6.8, 8, and 9.7 fL, respectively. In a univariable analysis using participants with MPV in the P10 to P90 as a reference, those with MPV above the 90th percentile had a significantly higher risk of CAD, with an OR of 1.39 (P90-MPV: 95% CI 1.05, 1.83; P=0.021). No significant association was found between participants with MPV below the 10th percentile and risk of CAD (P10-MPV: OR 0.91, 95% CI 0.59, 1.41; P=0.684). After adjusting for age, gender, smoking status, blood pressure (SBP >130 vs <130 mmHg), type 2 diabetes, urine albumin creatinine levels, serum creatinine, heart failure, and stroke history, the association between those with MPV above P90 and increased CAD risk remained significant (P90-MPV aOR 1.65; 95% CI 1.16, 2.34; P=0.005). Gender and race did not modify this effect.

Conclusion:
Our findings indicate that high MPV (above the 90th percentile) is positively associated with the risk of CAD in the general population. Further longitudinal cohort studies are necessary to explore this relationship and its clinical implications thoroughly.
Abstract 4128962: Medicaid Work Requirements and Changes in Insurance Coverage, Employment, Access to Care, and Health Status Overall and Among People with Cardiovascular Disease
Authors: Engel-Rebitzer Eden , Marinacci Lucas , Zheng ZhaoNian , Wadhera Rishi
Published: November 2024

Introduction:
Medicaid work requirements have been at the forefront of health policy debate. Proponents argue that these policies increase employment, reduce poverty, and improve health. Critics have raised concerns that work requirements lead to loss of coverage and impede access to care.

Hypothesis:
We hypothesized that Medicaid work requirement implementation would be associated with decreased insurance coverage and healthcare access without impacting employment.

Methods:
We used the Behavioral Risk Factor Surveillance System (a nationally representative survey administered by the CDC) to estimate the impact of Medicaid work requirements on insurance coverage, employment, access to care, and self-reported health. We used a difference-in-differences (DID) approach to compare changes in outcomes in Arkansas (where work requirements were implemented) versus control states. Outcomes were self-reported and included: 1) insurance coverage, 2) employment, 3) presence of a personal healthcare provider, 4) inability to see a doctor due to cost, and 5) self-reported health. The analysis was conducted among all respondents and among respondents with cardiovascular disease, who were hypothesized to be particularly vulnerable to negative sequelae of insurance loss.

Results:
The implementation of Medicaid work requirements in Arkansas was associated with decreased insurance coverage compared with control states (adjusted DID estimate -4.3%, CI -8.4%, -0.1%), but no increase in employment rates (-2.2% CI -7.0%, 2.6%). There was a trend toward decreased likelihood of having a personal healthcare provider (-4.7% CI -9.9%, 0.5%). There was no change in inability to see a doctor due to cost or self-reported good health. When this analysis was repeated among participants with cardiovascular disease, work requirement implementation was not associated with changes in any of the outcome variables.

Conclusions:
The implementation of Medicaid work requirements in Arkansas was associated with decreased insurance coverage and no change in employment. Our findings are particularly relevant given national policy debate about work requirement expansion and the recent implementation of Medicaid work requirements in Georgia. Despite the null findings among respondents with cardiovascular disease (likely the result of a small sample size), this study has important implications for cardiovascular health given the close association between insurance coverage and cardiovascular outcomes.
Abstract 4129440: Ventricular Stunning Following Direct Current Cardioversion: A Case Report
Authors: Truitte Ryan , Fellows Emily , Fanous Hanna , Shah Kevin
Published: November 2024

Background:
Ventricular stunning refers to a transient mechanical dysfunction of the myocardium, typically manifesting in response to ischemic insults, reperfusion injury, inflammatory states, or neurohormonal overload. Here, we present an unusual case of ventricular stunning precipitated by direct current electrical cardioversion (DEC).

Case Report:
A 73-year-old man with a history of heart failure with reduced ejection fraction, paroxysmal atrial fibrillation (AF), coronary artery disease, and chronic kidney disease was admitted to a Veterans Affairs hospital for heart failure exacerbation. His hospitalization was complicated by recurrent episodes of symptomatic AF with ventricular rates in the 120-150’s. This was initially managed with intravenous amiodarone and eventually DEC. He continued to experience symptomatic episodes of AF. Later in the hospitalization a repeat DEC with a single 200 joule shock was performed with restoration of sinus rhythm. Several hours afterwards he was found to be unresponsive and hypotensive. Cool extremities and rising serum lactate raised suspicion for cardiogenic shock resulting in transfer to the intensive care unit where vasopressor and inotropic support were initiated. Echocardiogram revealed a precipitous decrease in left ventricular ejection fraction from 25% to 5%. Serum troponin concentrations were unchanged from prior and ECGs demonstrated rate-controlled AF.

Clinical Decision Making:
This case highlights an episode of unexpected decrease in cardiac output following an otherwise routine repeat DEC for recurrent AF requiring escalation to mechanical circulatory support. His decompensation worsened, necessitating transfer to the local university center for placement of catheter-based miniaturized ventricular assist device (Impella 5’5). Over the subsequent days, with supportive care, his left ventricular ejection fraction recovered to baseline, and mechanical and inotropic support were withdrawn.

Conclusion:
Ventricular stunning, leading to cardiogenic shock, is a rare and incompletely understood complication of DEC. It warrants consideration when monitoring patients after cardioversion. Implementing vigilant observation protocols post-DEC to detect ventricular stunning and predisposing risk factors could significantly enhance clinical management strategies.
Abstract 4129520: The mechanism of cardiac hypertrophy induced by testosterone in postmenopausal women through the activation of the mTORC2/Atg9a
Authors: Wang Wenting , Yu Jing
Published: November 2024

Objectives:
The estrogen level of postmenopausal women decreased sharply, while the androgen level did not decrease significantly, which was characterized by the inversion of estrogen / androgen ratio. Therefore, it could be observed that relative excess androgen in the circulation of postmenopausal women, which may be one of the reasons for the increase of cardiovascular disease in postmenopausal women. In this study, the model of postmenopausal hypertension was established by bilateral ovariectomy in spontaneously hypertensive rats (SHR), and the specific mechanism of testosterone-induced myocardial hypertrophy in ovariectomized SHR was explored.

Methods:
24 SHR were randomly divided into four groups: WKY group (n=6), sham operation group (Sham group, n=6), bilateral ovariectomized group (OVX group, n=6) and testosterone propionate intervention group (OVX+T group, 6mg/kg/Weekly, im for 4 weeks, n=6). Western Blot was used to detect the protein expression of β-MHC, ANP, Androgen receptor, Akt, p-Akt, mTORC2 and its subunits Rictor. Moreover, the expression of autophagy-related proteins LC3 was observed.

Results:
1. The study revealed that the expression of β-MHC and ANP was significantly increased in both the OVX and OVX+T groups when compared to the WKY and Sham groups. Remarkably, testosterone induced a more significant cardiac hypertrophy response than observed in the OVX group alone. Additionally, the expression of androgen receptors was markedly upregulated in both the OVX and OVX+T groups. These findings strongly suggest that testosterone primarily induces myocardial hypertrophy in SHR after ovariectomy through androgen receptors.

2. Although no significant difference in mTORC2 expression was noted between the WKY, Sham, and OVX groups, testosterone exhibited a notable capacity to activate mTORC2 expression and the p-Rictor subunit in the OVX+T group.

3. The expression of LC3II/LC3I and mitochondrial fission protein DRP1 were increased in the OVX+T group when compared to the WKY, Sham, and OVX groups. While the expression of MFN2 in the four groups shows no significant difference. Meanwhile, the expression of Atg9a was increased in OVX+T group. The results indicate that testosterone might activate mitophagy via inducing the expression of Atg9a.

Conclusions:
In bilateral ovariectomized SHR, testosterone has the potential to activate mitophagy by activating the mTORC2/Atg9a pathway, which, in turn, leads to cardiac hypertrophy.
Abstract 4129709: Aspirin-Nanoparticle for Dual Therapies: Targeted Anti-Inflammatory and Prolonged Anti-Platelet Effects for Atherosclerosis
Authors: Chung Seyong , Yu Seung Eun , Kim Jueun
Published: November 2024

Background:
The current unmet needs for aspirin usage in atherosclerosis lie in its short half-life and narrow indication for anti-platelet effects. Daily aspirin intake is mandatory, and the anti-inflammatory effects of aspirin for atherosclerosis have not successfully translated to clinical practice. Nanoparticles remain in circulation for 2-3 days, with a large portion being cleared by splenic monocytes, which are known to inherently target inflamed sites.

Hypothesis:
By altering the pharmacokinetics of aspirin through loading into nanoparticles, aspirin-nanoparticles can exert prolonged anti-platelet effects and target atherosclerosis sites via monocyte carriers for anti-inflammatory effects, resulting in dual therapies.

Methods:
Splenic monocytes were loaded with aspirin-liposomes and co-cultured with endothelial cells or platelets to examine the interactions between them using high-resolution time-series microscopy. Prolonged anti-platelet effects and targeted anti-inflammatory effects of aspirin were validated in intact mice and hindlimb ischemia models, respectively. Furthermore, the dual therapies of aspirin-liposomes were validated in an atherosclerotic mouse model created by partial carotid ligation and a western diet in apoE gene knock-out mice.

Results:
When splenic monocytes were loaded with aspirin-liposomes, they emitted extracellular vesicles (EVs) loaded with aspirin towards endothelial cells or platelets. As inflamed cells upregulate caveolin expression, they uptake an increased amount of transferred EVs compared to non-inflamed cells. Additionally, aspirin-liposomes showed prolonged circulation time and increased splenic accumulation compared to aspirin itself, resulting in prolonged anti-platelet effects (>7 days) and targeted anti-inflammatory effects at inflamed sites. Compared to the daily oral aspirin group in the atherosclerosis model, the weekly intravenous aspirin-liposome group showed superior therapeutic effects, including attenuated systemic and local inflammation and patent lumen in atherosclerotic sites.

Conclusion:
Aspirin-nanoparticles can exert prolonged anti-platelet effects combined with targeted anti-inflammatory effects, resulting in superior therapeutic effects on atherosclerosis.
Abstract 4129839: Successful Left Atrial Appendage Occlusion (LAAO) with WATCHMAN FLX via Transhepatic Approach
Authors: Charbonne Gael , Card Alex , Fischer Karley , Mitiek Omar , Valencia Damian , Schwartz Brian
Published: November 2024

Left atrial appendage occlusion (LAAO) with the WATCHMAN FLX (Boston Scientific) has been proven to reduce stroke risk in patients with paroxysmal atrial fibrillation (PAF). Certain circumstances may preclude LAAO1. In this case, transhepatic vein access was used to successfully deploy a WATCHMAN FLX in a 72 year old male with PAF not on anticoagulation due to recent subdural hemorrhage and recurrent bilateral lower extremity deep venous thrombosis (DVT) post IVC filter placement. Recent attempt at LAAO was unsuccessful due to total occlusion of bilateral femoral veins (Figure 1 A-B) and inability to cross the IVC.

Access to the inferior branch of the right hepatic vein was achieved by micropuncture technique at the right mid-axillary line at the level of the 12th rib, which was confirmed by venogram (Figure 2A). The 4F microsheath was upsized to 16F. Intraoperative TEE was used for device sizing and delivery (Figure 3A). The transseptal sheath and dilator were positioned in the right atrium at the level of the fossa ovalis (Figure 3B) before successfully crossing into the left atrium (Figure 2B). After confirming placement (Figure 3C), a pigtail catheter was positioned within the LAA (Figure 3D) and an angiogram was performed (Figure 2C). A 24 mm WATCHMAN FLX was partially unsheathed and positioned (Figure 3E). Repeat LAA angiogram was performed through the WATCHMAN delivery sheath (Figure 2D). A Tug test was performed. The device was released (Figure 3F). Repeat venogram was performed to confirm location (Figure 2E) of the access site, and coil embolization closure of the venotomy access site was performed (Figure 2F). The patient was discharged the following day on dual antiplatelet (aspirin, clopidogrel) without complication. Venous access via right hepatic vein is a viable option for LAAO using the WATCHMAN FLX device.
Abstract 4132062: Early changes in albuminuria and their interaction with eplerenone treatment in patients hospitalized for acute heart failure: findings from the EARLIER trial
Authors: TEZUKA AYAKO , Kobayashi Masatake , Yamashina Akira , Satomi Kazuhiro , Ito Shin , Asakura Masanori , Kitakaze Masafumi
Published: November 2024

Background:
Patients hospitalized for acute heart failure (AHF) have high degrees of congestion, which may be associated with albuminuria. Mineralocorticoid receptor antagonists (MRAs) have natriuretic effects, possibly diminishing the degree of albuminuria. However, early changes in albuminuria, their prognostic value and interaction with MRA therapy remain unclear in AHF.

Methods:
The EARLIER trial included patients with AHF who were randomized to receive eplerenone or placebo over 6 months. Urine albumin-to-creatinine ratio (UACR) at admission and week 1 were measured, and Cox proportional hazards models were used for analyses.

Results:
Among 296 patients (mean age, 67±13years; 72% male), median B-type natriuretic peptide was 386 (190-660) pg/ml, and mean left ventricular ejection fraction was 30±8%. Patients with an UACR of ≥30 mg/g at admission had more severe congestion and poorer exercise capacity compared to those without (all-P<0.01). From admission to week 1, UACR levels significantly decreased (P<0.01), without significant differences between treatment groups (P>0.10). UACR levels at both admission (adjusted-HR [95% CI]=1.23 [1.03-1.47]) and week 1 (adjusted-HR [95% CI]=1.23 [1.01-1.50]) were associated with the risk of cardiovascular death and hospitalization. Additionally, eplerenone vs. placebo reduced the risk of a composite of all-cause mortality, HF re-hospitalization, investigator-reported worsening HF, and/or out-of-hospital diuretic intensification (HR [95% CI]= 0.53 [0.29-0.97]), irrespective of the severity of albuminuria (P-for-interaction>0.10).

Conclusion:
In patients with AHF, the degree of albuminuria at both admission and week 1 was associated with post-discharge prognosis. Although eplerenone did not reduce albuminuria levels, the benefit from eplerenone was consistent regardless of the albuminuria severity.