bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4146565: Evolving Burden of Cardiovascular Disease Attributable to High Body Mass Index in the United States and its Trend from 1990-2021: A Comparative and Consistent Analysis
Authors: sajeev KRISHNA , Kochhar Gunjan , John Jobby , Modi Dhruvi , Suppala Praveena , Patel Rutvij , Bhalodia Paritaben , Patel Vishwesh , Patel Lalitkumar , Katikala Venkata Ramana , DESAI HARDIK
Published: November 2024

Introduction:
Cardiovascular Disease (CVD) remains the primary cause of death and illness in the United States, incurring annual costs of $219 billion. Modifiable risk factors significantly contribute to the prevalence of CVD. This study is the first to estimate the burden of CVD attributable to high body mass index (HBMI) on CVD in the US over the past three decades, including the initial two years of the COVID-19 pandemic.

Method:
Using global burden of disease study 2021 standardized methodology, we estimated deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to CVD attributable to HBMI by age, sex, year and location across the US from 1990-2021.

Results:
From 1990-2021, the total percentage change (TPC) in deaths attributable to CVD linked to HBMI increased by 54% (95% Uncertainty Interval: 36% to 92%), and YLDs soared by 159% (128% to 207%). In 2021, the highest number of deaths was recorded from ischemic heart disease at 85,522, followed by hypertensive heart disease at 43,430, stroke at 13,886, atrial fibrillation and flutter at 5,278, lower extremity peripheral arterial disease at 3,098, and aortic aneurysm at 1,295. Oklahoma exhibited the highest age-standardized mortality rate (ASMR) due to CVD from HBMI at 49.46 (33.57-68.08) per 100,000 person-years, with the lowest in Massachusetts at 16 (8.16-25.32) in 2021. Louisiana reported the highest YLDs rate at 72.58 (31.04-120.32). The age group 70-74 years old saw the highest number of deaths at 17,997, with the most years of life lost in the 60-64 age group at 430,068 and the highest YLDs in the 70-74 age group at 49,054. Males showed a greater increase in burden compared to females, with TPC in deaths at 65% vs. 42%, DALYs at 59% vs. 43%, and YLDs at 193% vs. 130% from 1990-2021.

Conclusion:
Deaths due to CVD attributable to HBMI accounted for 16.83% of all CVD related deaths in US in 2021. To combat this trend, it is essential to launch comprehensive health campaigns that leverage the power of e-health and mobile health technologies. These platforms should be utilized to disseminate evidence-based healthcare strategies and preventive measures. Furthermore, engaging influencers and celebrities in these campaigns can amplify the reach and impact, encouraging broader public adoption of healthier lifestyles. Such innovative and inclusive public health initiatives are crucial for reversing the rising trend in CVD-related health burdens.
Abstract 4146621: Pulmonary Vascular Resistance Distribution in Pulmonary Hypertension Associated with Left Heart Disease
Authors: Cai Zongye , Omote Kazunori , Tada Atsushi , Fayyaz Ahmed , Reddy Yogesh , Koepp Katlyn , Rosenbaum Andrew , Behfar Atta , Frantz Robert , Redfield Margaret , Borlaug Barry
Published: November 2024

Background:
Pulmonary vascular resistance (PVR) is commonly considered to reflect opposition to lung blood flow caused by the arteries (PVRa), but downstream venous resistance (PVRv) may also contribute to pulmonary hypertension (PH) associated with left heart diseases (PH-LHD). In patients referred for right heart catheterization, we investigated PVR distribution and its pathophysiologic implications in PH-LHD and other forms of PH.

Methods:
Patients with PH-LHD (n=292), pulmonary veno-occlusive disease (PVOD, n=10), chronic thromboembolic PH (CTEPH, n=36) and controls without PH (Ctrl, n=28) were included. Pulmonary capillary pressure (Pc) was calculated using the pulmonary artery occlusion technique. PVR was partitioned into PVRa ((mPAP-Pc)/CO) and PVRv ((Pc-PAWP)/CO) with each expressed as % of PVR. PH-LHD was divided into isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH). Further, PH-LHD was categorized as heart failure with preserved (HFpEF, EF≥50%) or reduced (HFrEF, EF<50%) ejection fraction or left valvular heart disease (L-VHD). In subsets, functional tests (n=71-81) and histological pulmonary venous (PV) remodeling (autopsy, n=15) were performed to investigate correlations with PVR distribution.

Results:
PVR distribution showed an arterial predominance in Ctrl and CTEPH, and increasing venous contribution in PH-LHD (both IpcPH and CpcPH) and PVOD (Figure A-F). In PH-LHD, patients with HFpEF had proportionately greater venous contribution to PVR than HFrEF and L-VHD (Figure G-I), though not to the extent observed in PVOD. In subsets, PVRv was more strongly correlated with E/e’, extravascular lung water estimated by sonographic B-lines, arterial PO
2
, pulmonary dead space fraction (VD/VT), DLCO, and, among the autopsy series, PV intimal thickness as compared to PVRa (Figure J-O).

Conclusions:
Pulmonary venous contributions to PVR are amplified in patients with PH-LHD, which is correlated with greater lung congestion, ventilatory and gas exchange abnormalities, and histological venous remodeling. Further study is required to determine the molecular mechanism and novel therapeutics of pulmonary venous disease in PH-LHD.
Abstract 4146635: Title: Socioeconomic and gender disparities in Stroke-related Mortality among Older Adults with Malignancy in the US from 1999 to 2020: CDC WONDER database analysis.
Authors: Naveed Muhammad Abdullah , Ali Ahila , Iqbal Rabia , Omer Rehan Muhammad , Azeem Bazil , KASHAN MUHAMMAD , Ahmed Faizan , sattar yasar , Munir Bilal
Published: November 2024

Background:
Stroke in malignancy is a significant cause of mortality among older adults. This study analyzes demographic trends and disparities in mortality rates due to stroke in malignancy among adults aged 65 and older from 1999 to 2020.

Methods:
A retrospective analysis was conducted using CDC WONDER death certificate data from 1999 to 2020. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons stratified by year, sex, race/ethnicity, and geographical regions. Trends were assessed using Average Annual Percentage Change (AAPC) and annual percent change (APC).

Results:
Between 1999 and 2020, Stroke in Malignancy resulted in 198,659 deaths among adults (≥65 years) in the United States. Fatalities occurred predominantly in medical facilities (36.5%), followed by nursing homes (29.3%), and at decedents’ homes (24.2%). The overall age-adjusted mortality rate (AAMR) for Stroke in Malignancy-related deaths decreased from 32.8 in 1999 to 16.5 in 2020, with an Average Annual Percentage Change (AAPC) of -3.35 (p-value < 0.000001). Notably, there was a significant decline in AAMR from 1999 to 2018 (APC: -4.23, p-value < 0.000001), followed by a notable increase from 2018 to 2020 (APC: 5.33, p-value = 0.025595). Both men and women showed decreased AAMRs, with men having higher rates (men: 28.1; women: 17.5). AAMRs varied among racial/ethnic groups, with Black/African Americans having the highest AAMR (31.0), followed by Whites (21.8), American/Alaska Natives (18.6), Asian/Pacific Islanders (12.9), and Hispanics (12.5). AAMRs decreased across all races, with the most significant decline observed in Asians (AAPC: -4.62, p-value < 0.000001). Geographically, AAMRs varied among states, ranging from 11.0 in Arizona to 33.7 in Mississippi. Across regions, the Midwestern region had the highest mortality (AAMR: 23.4), with nonmetropolitan areas exhibiting slightly higher AAMRs (AAMR: 25.9). Both metropolitan and nonmetropolitan regions experienced decreased AAMRs over the study period (p-value < 0.000001).

Conclusion:
The analysis reveals substantial demographic disparities in mortality rates attributed to Stroke in malignancy among older adults. While the overall decline in mortality rates indicates progress, the concerning upsurge in recent years necessitates proactive measures. Addressing these disparities through targeted interventions and equitable healthcare access is imperative to optimize outcomes for this at-risk population.
Abstract 4146651: Tissue-Engineered Vascular Grafts: Evaluation of Remodeled Neotissue and Its Effect on Flow Dynamics
Authors: Watanabe Tatsuya , Villarreal Delaney , Anderson Cole , Yang Weiguang , Guo Marissa , Yuhara Satoshi , Nelson Kirsten , Morrison Adrienne , Kelly John , Shinoka Toshiharu , breuer christopher
Published: November 2024

Background:
The Fontan surgery for treating hypoplastic left heart syndrome has significantly improved postoperative mortality. However, the materials commonly used for conduits, such as PTFE, can cause complications, such as graft calcification over long-term follow-up, which causes flow restriction and lower exercise tolerance as clinical complications. To address these issues, we have developed a tissue-engineered vascular graft (TEVG) composed of biodegradable polymers that are replaced by autologous tissue, called "neotissue," which exhibits histological similarity to native vessels(Figure1) and resistance to calcification. We are investigating the functional properties of this neotissue, focusing on distensibility, an essential function accommodating blood volume, and its impact on flow dynamics.

Methods:
We evaluated chronic sheep models (6-8 years post-implantation) with thoracic inferior vena cava (IVC) interposition grafts of TEVG (n=5) and PTFE (n=5), as well as age-matched surgically naive sheep (n=5). Using our established in vivo distensibility testing protocol(Figure1b), we measured distensibility in the target regions and compared the groups. Additionally, we utilized the 3D geometries obtained from 3D angiography to create patient-specific computational flow dynamics simulations using a software, SimVascular, allowing us to investigate the impact of distensibility and graft 3D morphology on flow dynamics.

Results:
Distensibility measurements showed no significant difference between TEVG (173.67±98.74[%100mmHg]) and native vessels (268.57±199.57), while PTFE grafts (10.35±12.67) exhibited significantly lower compliance compared to the other two groups(Figure1). The 3D fluid model simulations generated by SimVascular revealed that the native IVC revealed uniform dilation and smooth blood flows by fluid stress. TEVGs showed small velocity acceleration in the middle. In contrast, since the PTFE grafts were not distensible, they caused significant flow velocity acceleration and high wall shear stress at the graft region(Figure2,3).

Conclusions:
The TEVG neotissue demonstrated significantly higher distensibility than PTFE grafts and was not significantly different from native vessels. The simulation demonstrated that the differences in distensibility in response to fluid volume impact flow dynamics, which relate to the clinical complications of Fontan patients. TEVG has the potential to mitigate these complications.
Abstract 4146654: Hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation: an updated systematic review and meta-analysis
Authors: Mazetto Roberto , Bulhoes Elisio , Antunes Vanio do Livramento Junior , Defante Maria Luiza Rodrigues , Garcez Luanna , Macedo Harthur Moreira , Romeiro Pedro , Barbosa Lucas , Queiroz Ivo , X. Mendes Beatriz , Bastos Eduarda , Silva Catarina , Coelho Anderson , Guerreiro Isabel , Couceiro Katia , Bueno Bruno , Guida Camila
Published: November 2024

Background:
Some studies suggest a potential benefit of hybrid ablation for patients with persistent and long-standing persistent atrial fibrillation (AF), but its efficacy and safety remain debated.

Objective:
We conducted a systematic review and meta-analysis to compare the efficacy and safety of hybrid ablation and catheter ablation in patients with persistent AF and long-standing persistent AF.

Methods:
We searched PubMed, Embase and Cochrane Central. Outcomes were the composite endpoints of freedom from atrial arrhythmias, major adverse events, total procedural time, and fluoroscopy time. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I
2
statistics.

Results:
We included 961 patients from 7 studies. Of those, 4 were RCTs and 3 were observational studies with propensity score matched cohorts. A total of 446 (46.41%) patients received hybrid ablation and 515 (53.59%) received only endocardial. Among the patients included in the study, 674 (70.14%) had persistent AF, and 287 (29.86%) had LSPAF. Moreover, the average atrial diameter was 4.43 cm, and the average duration since AF diagnosis was 3.06 years. Additionally, the average age of the patients was 61.7, and the number of male patients included was 911 (94.80%). The median follow-up ranged from 12 to 43.9 months. Compared to catheter ablation, hybrid ablation was associated with a higher odds of freedom from atrial arrhythmias off antiarrhythmic drugs (OR 3.25; 95% CI 2.08-5.06; p<0.001; I
2
= 85%; Figure 1A), and freedom from AF (OR 3.51; 95% CI 1.07 - 11.48; P=0.038; I
2
=84%; Figure 1B). There were no differences in major adverse events (p=0.98; Figure 1C), total procedure time (p=0.05; Figure 2A), or fluoroscopy time (p=0.85; Figure 2C) between hybrid ablation and catheter ablation.

Conclusion:
This meta-analysis shows hybrid ablation increases the likelihood of maintaining freedom from atrial arrhythmias in patients with persistent and long-standing persistent AF, compared to catheter ablation, without compromising safety.
Abstract 4146725: Young Adults with Migraine and Established Cardiovascular Disease Risk: Studying the Impact of Cannabis Use Disorder on Major Adverse Cardiac and Cerebrovascular Events in a Nationwide Study
Authors: Patel Bhavin , Lapsiwala Boney , Vanani Samir , Patel Shaurya , Suresh Aditya , Jariwala Prayag , Rajani Aayushi , Desai Rupak , Krishnamoorthy Geetha
Published: November 2024

Background:
With medical marijuana being used for migraine and high overlapping use of medicinal and recreational cannabis use with associated addiction potential, the impact on cardiovascular outcomes remains unexplored in the young population. Hence, we aim to analyze effect of cannabis use disorder (CUD) on major adverse cardiac and cerebrovascular events (MACCE) in patients with migraine.

Methods:
The National Inpatient sample from 2016-2020 was queried with pertinent ICD-10 codes to find inpatient encounters of young adults with migraine. A 1:1 propensity score-matched analysis was performed to obtain balanced CUD and without CUD cohorts matched on demographics and substance abuse. Multivariate logistic regression was used to analyze MACCE outcomes along with gender-based subgroup analyses.

Results:
We analyzed 490955 adults admitted with migraine with equal distribution of patients in both CUD and without CUD cohorts. Both the cohorts had significantly more females and patients with white ethnicity. Patients with CUD had significantly higher concomitant cocaine use disorder (6.8% vs 5.7%) but lower tobacco use disorder (50.6% vs 51.6%) compared to those without CUD. Surprisingly, non-CUD cohort had higher cardiometabolic comorbidities such as complicated hypertension (13.1% vs 9.8%), uncomplicated diabetes (9.8% vs 7.6%, hyperlipidemia (18.4% vs 16.2%), obesity (28.9% vs 19.9%). Multivariate regression analysis did not show any significant difference in overall MACCE outcomes. The subgroup analysis also did not show any difference in MACCE outcomes. Without CUD cohort had higher hospitalization cost compared to CUD cohort (32108$ vs 26721$).

Conclusion:
This nationwide covariate adjusted multivariate regression analysis shows no significant difference in all-cause mortality and other cardiovascular and cerebrovascular complications such as acute myocardial Infarction, atrial fibrillation, cardiac arrest, and stroke in young patients with migraine with and without CUD. Moreover, the subgroup analysis also shows comparable results in males and females.
Abstract 4146729: Residual Angina Following Anatomic Complete Revascularization for Chronic Coronary Disease in the ISCHEMIA Trial: Frequency, Characteristics, and Outcomes
Authors: Singh Ayesha , Brown David , Jones Philip , Fu Zhuxuan , Reynolds Harmony , Boden William , OBrien Sean , Mavromatis Kreton , Ali Ziad , Stone Gregg , Bangalore Sripal , Spertus John , Maron David , Hochman Judith
Published: November 2024

Background:
Although residual angina after revascularization for chronic coronary disease (CCD) is common, it is unclear if the cause is incomplete revascularization of epicardial coronary disease or other ischemic mechanisms such as microvascular dysfunction or vasospastic angina.

Methods:
Among invasively managed ISCHEMIA trial participants with angina at baseline and anatomic complete revascularization (ACR) determined by core lab analysis, the frequency of and characteristics associated with residual angina and its association with health status, medication use at 6 months, and 5-year all-cause and cardiovascular (CV) mortality were assessed. The Seattle Angina Questionnaire Angina Frequency (SAQ AF) was used in a binary fashion to define residual angina as a score <100 at 3 or 6 months, whereas angina-free status was as a SAQ AF = 100 at 3 and 6 months.

Results:
Of 2,588 participants randomized to the invasive arm, 1,442 had angina at baseline and no prior coronary artery bypass graft surgery, and 1,034 underwent revascularization within 90 days. Among 463 patients in whom ACR was achieved, 436 had SAQ AF scores available at 3 and 6 months. Of these, 184 (42%) had residual angina. Residual angina patients did not differ from those who were angina-free in age (63
+
10 vs. 62
+
10, P=0.37), female sex (33% vs. 27%, P=0.24), hypertension (76% vs. 72%, P=0.33), current smoking (12% vs. 14%, P=0.69), diabetes (41% vs. 41%, P=0.95), ejection fraction (62
+
8 vs. 62
+
8, P=0.98), degree of baseline ischemia, and extent of coronary disease. At baseline, their health status measures including SAQ AF (71 ± 17 vs. 72 ± 118, P= 0.76) were similar. However, at 6 months, patients with residual angina had reduced quality of life (SAQ QoL: 70
+
20 vs. 83
+
20, P<0.001), more physical limitation (SAQ Physical Limitation: 84
+
20 vs. 95
+
11, P<0.001), more dyspnea (Rose Dyspnea Score: 1
+
1.3 vs. 0.4
+
0.8, P<0.001), and were taking more anti-anginal medications (P=0.006). At 5-years, survival free of all-cause or CV death did not differ between groups.

Conclusion:
Residual angina following ACR for CCD is common and not predicted by any baseline demographic or clinical characteristics. It is associated with reduced QoL and health status despite greater anti-anginal medication use. The high rate of residual angina suggests that alternative mechanisms of ischemia often exist in combination with obstructive coronary disease and contribute to residual anginal symptoms.
Abstract 4146737: AmyNet: a Novel Deep Learning Imaging Approach to Identify Incidental Myocardial Uptake Indicative of Cardiac Amyloidosis on Whole Body 99Tc-Bone Scintigraphy Imaging
Authors: Bhattaru Abhijit , Rojulpote Chaitanya , Vidula Mahesh , Duda Jeffrey , Thompson Elizabeth , Swago Sophia , Gee James , Pieretti Janice , Drachman Brian , Dorbala Sharmila , Witschey Walter , Bravo Paco
Published: November 2024

Introduction:
Whole-body scintigraphy (WBS) is frequently performed for oncological indications but also has high sensitivity for incidental detection of transthyretin amyloid cardiomyopathy (ATTR-CM), which may be overlooked.

Goal:
Develop an algorithm that combines chest computed tomography (cCT) and WBS to identify incidental ATTR-CM in a large healthcare system.

Methods:
We included 3 cohorts: 1) 77 patients from Brigham and Women’s Hospital with high prevalence of patients positive for ATTR-CM (BWHC), 2) 982 continuous cohort of patients imaged with WBS at PennMedicine for oncological indications from 2010-2020 (PennC), and 3) 5 patients with proven ATTR-CM uptake on WBS when imaged for oncologic indications from 2021-2024 (PennC+). Using a U-Net model trained with Dice score, the AmyNet algorithm automatically segmented cCTs with regions of interest (ROIs) around the entire heart (ventricles, atria, blood pool). Maximal intensity projections of cCTs in the coronal plane were registered to WBS using rigid transformations from the ANTs library. Multiple template reconstructions of only BWHC projections augmented registration due to limited field of view of cCT by providing an initial alignment to the thorax. Transformations were applied to heart ROIs to identify the location on WBS. A modified contralateral ratio was calculated by taking the lateral 1/3 and inferior 2/3 region to avoid sternum and atria and reflecting it across the vertical axis. A cutoff ratio of 1.15 was established as positive for ATTR-CM.

Results:
Machine-generated and expert volumes were comparable (1071vs1087mL; p=0.74) with a Dice similarity index of 0.92±0.07. AmyNet had a 94% accuracy with 100% sensitivity and 90% specificity in detecting ATTR-CM in BWHC with positive patients having higher contralateral ratios (1.57±0.49 vs 1.01±0.18, p<0.0001). Screening of PennC identified one patient (0.1%) with myocardial uptake, which was confirmed ATTR-CM upon evaluation for HFpEF. All 5 PennC+ patients were detected positive for uptake by AmyNet.

Conclusion:
We created the first algorithm that leverages cCT data and WBS to detect incidental cardiac uptake suggestive of ATTR-CM in patients underdoing scans for other non-cardiac indications.
Abstract 4146750: Bundle Payment Reimbursements and Atrial Fibrillation Ablation Outcomes: Analysis of Real-World Data
Authors: Howie Cole , Byer Stefano , Cochran Ryan , xDominicx xPaarix
Published: November 2024

Background:
Bundled payments represent a shift in reimbursement models, promoting value-based care by providing providers a predetermined payment per episode of care rather than fee-for-service. This model incentivizes optimizing patient care while reducing spending on unnecessary tests, treatments, and days hospitalized. Atrial fibrillation (AF) ablation procedures transitioned to bundled payment reimbursements starting January 1, 2022.

Research Question:
What impact has value-based care made on patient care treatments and outcomes?

Methods:
This retrospective study utilized the TriNetX Global Research Network to review and compare patient outcomes for AF ablation patients (CPT code 93656) the year leading up to (Jan 1 – Dec 30, 2021) and year subsequent (Jan 1 – Dec 30, 2022) initiation of bundle payments. Propensity score matching was applied to balance cohorts based on demographic characteristics and comorbidities. One-year post-ablation complication rates were analyzed.

Results:
Propensity score matching of the pre-bundle (N = 14,690) and post-bundle cohorts (N = 16,734) resulted in 14,687 patients from 91 U.S. healthcare organizations. The post-bundle cohort suffered a lower prevalence of circulatory system diseases (ICD-10 code I00-I99) compared to the pre-bundle cohort (91.2% vs 92.4%, p<0.001). The post-bundle cohort was less likely to undergo ablations for subsequent tachyarrhythmias (1.9% vs 2.5%, p=0.006) and lower stroke rates one-year post-ablation (3.3% vs 3.8%, p=0.013).

Conclusion:
The transition to bundle payment reimbursements for AF ablation procedures was associated with a significant reduction in post-ablation stroke rates and a reduced likelihood of undergoing additional ablations for tachyarrhythmias. Future studies should focus on financial analyses of the AF ablation bundles to further optimize care under this reimbursement model.
Abstract 4146803: Long-term outcomes of Abnormal Global Longitudinal Left Ventricular Strain during Sepsis: A propensity-matched cohort study
Authors: Jonna Sadhana , Raavi Lekhya , huespe ivan , Isha Shahin , Jenkins Anna , Hanson Abby , Jena Anek , Saleem Faiz , Balavenkataraman Arvind , Tekin Aysun , Bansal Vikas , caples sean , Khan Syed , Jain Nitesh , Cartin-Ceba Rodrigo , Patel Bhavesh , Diaz Milian Ricardo , Venegas Carla , Shapiro Anna , Bhattacharyya Anirban , Chaudhary Sanjay , Kiley Sean , Quinones Quintin , Patel Neal , Guru Pramod , Moreno Franco Pablo , Sanghavi Devang
Published: November 2024

Introduction/Background:
Patients admitted with sepsis are at risk of developing septic cardiomyopathy (SCM), which may elevate their risk of short-term mortality. However, the effect of SCM on long-term outcomes after sepsis is poorly understood. This study explores whether patients with sepsis and SCM have worse long-term outcomes compared to those without SCM.

Research Questions/Hypothesis:
What are the long-term major adverse cardiovascular events, including death, stroke, and myocardial infarction (MACE) 36 months after ICU discharge for septic patients with abnormal global left ventricular strain (LV GLS)?

Methods:
We conducted a retrospective study of 396 sepsis patients from August 2018 to September 2022, approved by the Mayo Clinic IRB. Patient demographics, comorbidities, echo parameters, and outcomes were collected. Due to the expected non-linear relation between LV GLS and Hazard Ratio (HR) of MACE we employed Cox regression analysis with Restricted Cubic Splines. Secondly, we divided the population into 2 groups, patients with and without normal LV GLS (between -23 and -16). The effect of non-normal LV GLS on MACE was evaluated using Cox regression weight by inverse probability weighting (IPWT) analysis after propensity score assessment, adjusting for diabetes, hypertension, BMI, history of stroke or myocardial infarction, chronic kidney disease, age, and sex.

Results:
Demographic variables did not differ significantly based on normal versus abnormal LV GLS. In the restricted cox regression with cubic spline models, we observed that patients with normal values had HR lower than one compared with patients without normal values (Figure 1). Secondly, we found that the HR of MACE in patients with normal LV GLS was significantly lower in the crude analysis (HR 0.66 [CI 95% 0.5, 0.86]; p<0.01) and in the analysis adjusted by IPWT (HR 0.7 [CI 95% 0.53, 0.92]; p=0.01).

Conclusion:
Sepsis patients with abnormal global left ventricular strain (LV GLS) have a higher risk of major adverse cardiovascular events (MACE) within 36 months post-ICU discharge compared to those with normal strain. LV GLS values outside the range of -23 to -16 are associated with increased risk. Monitoring LV GLS in sepsis patients is important for identifying those at elevated risk for long-term cardiovascular complications.
Abstract 4146853: Factors Associated with Recovery of Right Ventricular Size After Transcatheter Device Closure of Isolated Atrial Septal Defects in Children
Authors: Gritti Michael , McCrindle Brian , Benson Lee
Published: November 2024

Introduction:
Children with significant left-to-right shunting across an isolated atrial septal defect (ASD) may have important right ventricular (RV) dilation. We sought to determine factors associated with RV recovery after percutaneous device closure.

Methods:
Children who underwent transcatheter device closure of an isolated ASD were included if they had no underlying genetic defect and echocardiography from prior to, immediately after and at follow-up. General linear regression modeling was used to determine factors associated with time-related RV dimensional recovery.

Results:
Inclusion criteria were met for 385 children (62% females; mean age 8.9
+
4.3 years) whose procedure occurred from 11/1985 to 11/2012. A single defect was present for 85%, with a mean size indexed to BSA of 14.9
+
6.6 mm/m
2
. A single device (Amplatzer for 80%) was used for 97% of the children, with a mild residual shunt present in 14% at the procedure. Mean BSA-indexed RV end-diastolic dimension (RVEDD) immediately post-closure was 2.20
+
0.66 cm/m
2
and decreased at a median follow-up of 1.8 years (range up to 13 years) to 1.71
+
0.48 cm/m
2
(p<0.001), corresponding to a mean BSA-adjusted Z score of +1.51 at follow-up (>+2 for 47% of children). Significant factors associated with a greater reduction in BSA-indexed RV size (
Figure
) included younger age at closure (p<0.001), larger indexed ASD size (p<0.001), greater RV size at closure (p<0.001) and longer follow-up time (p<0.001). Reduction was not associated with the presence of any residual shunt post-closure. QRS duration on ECG did not change significantly from pre-closure (mean 90
+
12 mmsec) to latest ECG (mean 89
+
12; p=035).

Conclusions:
Despite progressive reductions in RV size after ASD device closure, some children may continue to have RV enlargement. Earlier closure is associated with greater improvements.
Abstract 4146867: Catheter-Directed Interventions for High-Risk Acute Pulmonary Embolism in patients with Liver Cirrhosis
Authors: Kumar Manoj , Ali Shafaqat , Nso Nso , Jamshed Aneeza , Murthi Mukunthan , Kumar Nomesh , Kumar Sanjay , Kumari Rinkle , Alraies M Chadi , Gomez Valencia Javier , Ricciardi Mark , Arman Qamar
Published: November 2024

Background:
Catheter-Directed Interventions (CDIs) for Acute Pulmonary Embolism (PE) have been available for years. However, their use and effectiveness in patients with a concomitant diagnosis of liver cirrhosis is uncertain due to a paucity of data in this high-risk population. In this study, we aim to evaluate the safety, efficacy, and current trends in the use of CDIs for high-risk PE (HR-PE) in patients with liver cirrhosis.

Methods:
Nationwide Readmissions Database (2016-2021) was used to identify patients with liver cirrhosis presenting with HR-PE (shock, pressor or mechanical circulatory support requirement). Patients who received systematic thrombolysis were excluded. Mahalanobis Distance Matching within the Propensity Score Caliper was used to match patients who received CDIs vs those who did not recieve any catheter-directed intervention. Inverse Probability weighting (IPW) was utilized, and Pearson’s chi-squared test was applied to the PSM-2 matched cohorts to compare outcomes.

Results:
Among 427,802 hospitalizations of patients with HR-PE and concomitant diagnosis of liver cirrhosis, only 1,319 (0.3%) of the patients underwent CDI. After propensity matching (N: 668 in each group), patients receiving CDI had a significantly lower mortality (42.9% vs. 61.7%, aOR:0.44, p <0.001). However, bleeding complications including major bleeding (12.1% vs 5.4%, aOR:1.9, p<0.001), thoraco-respiratory bleeding (8.5% vs 3.3%, aOR:1.9, p <0.001) and intracerebral hemorrhage (5.1% vs 1.8%, aOR:2.3, p:0.001) was higher in patients receiving CDIs. Short-term (30-day) readmission rates were lower in cirrhotic patients receiving CDI (12.4% vs 18.8%, p: 0.024). From 2016-2021, mortality associated with HR-PE in cirrhotic patients has not changed significantly (mean: 61.2%, p >0.05). There has been increasing use of mechanical thrombectomy (MT) over thrombolysis in recent years (0.08% to 0.22%, p-trend <0.001).

Conclusion:
CDIs for HR-PE in patients with liver cirrhosis are rare and areassociated with significant reduction in mortality at the expense of higher bleeding risk. Despite a slight increase in the utilization of mechanical thrombectomy, mortality has not significantly decreased over the years.
Abstract 4146917: Role of left ventricular anisotropy in the outcome of myocardial infarction: Insights from a rodent model
Authors: Neelakantan Sunder , Mendiola Emilio , Mehdi Rana Raza , Xiang Qian , Zhang Xiaoxiao , Myers Kyle , Vanderslice Peter , Avazmohammadi Reza
Published: November 2024

Introduction:
Myocardial infarction (MI) leads to cardiac myocyte death and scarring, resulting in significant biomechanical remodeling of the left ventricle (LV). Maladaptive LV remodeling post-MI is known to contribute to the development of heart failure (HF). Understanding the role of LV free wall (LVFW) biomechanical remodeling in the transition of infarcted hearts to HF will improve prognostic capabilities and intervention strategies. Our objective in this study was to assess the association between LVFW anisotropic stiffening and organ-level functional adaptations.

Methods:
MI was induced in WKY rats via the ligation of the LAD artery, and transthoracic echocardiography was performed to measure ejection fraction (EF). Fresh LVFW myocardial samples were harvested and subjected to biaxial tensile loading hearts were harvested at five timepoints: sham, and weekly from 1wk to 4wk post-MI (n=6 for each timepoint). The samples were stretched to 30% along the circumferential and longitudinal directions, and stiffness (slope of stress-stretch curves at 30% stretch) in each direction was measured. The ratio between longitudinal and circumferential stiffnesses was defined as the LVFW anisotropy.

Results:
EF reduced post-MI (Fig. 1A), and pre- and post-MI changes in EF (denoted by ΔEF) showed a significant reduction at later timepoints (Fig. 1B). Although circumferential stiffness remained unchanged with time (Fig. 1C), longitudinal stiffness tended to increase post-MI, thus altering the overall anisotropy of LVFW tissues (Fig. 1C). The correlation between the anisotropy and EF indicated that an increased longitudinal bias post-MI was strongly correlated with reduced EF and LV decompensation (Fig. 1D).

Conclusions:
Our results suggest that the myocardium stiffness changes
anisotropically
with a bias in the longitudinal direction post-MI. The strong correlation between myocardial anisotropy and EF suggests that studying alterations in LVFW biomechanical markers and their relationships with deteriorations in LV function could provide insights into the mechanisms of transition to HF post-MI. The quantification of these markers through cardiac imaging offers to improve early prognostication of HF post-MI.
Abstract 4146919: Delta-like Ligand 4 Inhibitors Induce Pulmonary Arterial Hypertension in Clinical Trials
Authors: Besse Casandra , Puerta Cristian , Winicki Nolan , Hernandez Moises , Thistlethwaite Patricia
Published: November 2024

Background:
Delta-Like Ligand 4 (DLL-4) blockade with therapeutic monoclonal antibodies is an emerging cancer treatment targeting tumor angiogenesis. Inhibition of DLL-4 within the pulmonary vasculature allows for unopposed JAG-1-NOTCH3 signaling, leading to pulmonary vascular smooth muscle (vSMC) cell proliferation and the development of pulmonary arterial hypertension (PAH).

Hypothesis:
Clinical trials using DLL-4 inhibitors may show an increased incidence of PAH as a side effect of the drugs tested.

Aims:
Review the PAH incidence as an adverse outcome in DLL-4 inhibitor clinical trials.

Methods:
Clinicaltrials.gov was queried for studies on DLL-4 inhibition. Patient demographics, medication regimens, trial methodology, and outcomes were recorded. Adverse events were categorized according to National Cancer Institute Common Terminology Criteria for Adverse Events. PAH grades were defined as ranging from mild dyspnea (Grade 1) to life-threatening airway consequences or death (Grade 4-5). Degree of PAH was determined by the clinical trial investigators. Echocardiography and cardiac catheterization were most widely used as PAH diagnostic modalities.

Results:
Thirteen clinical trials (Phase: 1[n=3], 1a[n=1], 1b[n=6], 2[n=3]) from 2011-2023 investigating DLL-4 or DLL-4/VEGF inhibitors were included. The most common antibody used was Demcizumab(6), followed by Navicixizumab(2), Dilpacimab(2), ABL001(2), and Enoticumab(1). A total of 672 patients (median age 60, 52.5% female) underwent treatment. There were 74 new PAH cases reported (average incidence of 11.7%[± 5.8%]). Four of seventy-four PAH patients also manifested LHF. PAH grades 1-2 represented 81% (n=60) of cases, and 19% (n=14) were grades 3-5. PAH incidence was higher in combination DLL-4-VEGF inhibitor trials versus sole DLL-4 inhibitor trials (16.2% vs 7.9%). Phase 1 and 2 trials displayed similar PAH incidences (11.4% vs 13.0%). Resolution of PAH after drug cessation was reported in 46% of the studies.

Conclusions:
DLL-4 inhibition treatment for malignancies has demonstrated PAH as a side effect. These results are in accordance with our previous observation that unopposed JAG-1-NOTCH3 signaling, induces pulmonary vascular SMC proliferation and PAH. Discontinuation of DLL-4 inhibitors leads to resolution of disease. Further studies are needed to minimize PAH risk while optimizing oncological benefits of DLL-4 inhibitors before widespread utilization.
Abstract 4146931: The effectiveness of coronary sinus reducer in refractory angina: A meta-analysis of 18 studies
Authors: Gadelmawla Ahmed Farid , Abdelaziz Ahmed , Hassan Atef , Hageen Ahmed Wael , Ramadan Shrouk , Mohamed Ahmed , Nasr Ahmed , Afify Raneem , Banour Sandi , Abdelazeem Basel
Published: November 2024

Introduction:
Despite the continuous development of the medical therapeutic revolution, there are many conditions that pose a great challenge and are still spreading at increasing rates, such as refractory angina (RA), which is considered a burden on patients and on the health systems. However, with the emergence of effective treatment options such as a coronary sinus reducer (CSR) that works to narrow the coronary sinus in controlled manner aiming to restore efficient blood flow and reduce symptoms.

Purpose:
We aimed to study the effectiveness of CSR in patients with refractory angina (RA), and give a comprehensive appraisal from the published records.

Methods:
A comprehensive search was done on PubMed, Cochrane Library, Scopus, and WOS until Feb 2024. We included studies that assessed the effectiveness of CSR in patients with RA. Clinical improvement, implantation success, periprocedural complications, revascularization, 6MWT distance and change in SAQ score were our outcomes of interest.

Results:
18 studies comprising 1149 patients were included in the analysis. The pooled implantation success was 98% (95% CI: 97% to 99%), clinical improvement > 1 class was 63% (95% CI: 52% to 72%), and clinical improvement > 2 class was 37% (95% CI: 32% to 41%). The incidence rate of periprocedural complications and PCI was reported as follows, respectively (OR: 0.05, 95% CI: 0.03 to 0.08, and 0.37, 95% CI: 0.18 to 0.61). Moreover, the incidence rate of all-cause mortality was low (OR: 0.06, 95% CI: 0.03 to 0.11). Regarding physical activity and quality of life, CSR improved 6MWT distance (MD = 323.82, 95% CI: 273.52 to 372.13), and all categories of SAQ score either angina frequency, angina stability, physical limitation, quality of life, or treatment satisfaction.

Conclusion:
Coronary Sinus Reducer is a promising treatment for the management of refractory angina, as it showed clinical improvement with higher implantation success. It also improved the physical activity and quality of life scores. Large-volume RCTs are warranted to test the efficacy of CSR in a long-term manner.
Abstract 4146940: External Validation of EchoNet-LVH, a Deep Learning Model for Cardiac Amyloidosis, for Association with Cardiomyopathy
Authors: Marti Castellote Pablo-Miki , Duffy Grant , Zhou Wunan , Cheng Susan , Chen Jersey , Viney Nick , Tsimikas Sotirios , Solomon Scott , Ouyang David , Cunningham Jonathan
Published: November 2024

Background:
Early diagnosis of cardiac transthyretin amyloidosis (ATTR) facilitates disease-modifying therapies. EchoNet-LVH is a deep learning model trained on 16062 echocardiograms which quantifies the likelihood of cardiac amyloidosis. Patients with ATTR polyneuropathy are at risk for cardiac involvement, highlighting the systemic nature of ATTR.

Aim:
To evaluate whether the EchoNet-LVH prediction of cardiac amyloidosis identifies patients in an ATTR polyneuropathy cohort who have known amyloid cardiomyopathy.

Hypothesis:
The EchoNet-LVH cardiac amyloidosis score will be associated with amyloid cardiomyopathy, cardiovascular symptoms, and N-terminal pro-B-type natriuretic peptide (NT-proBNP).

Methods:
The NEURO-TTRansform trial enrolled patients with hereditary ATTR polyneuropathy, regardless of cardiac involvement. ATTR cardiomyopathy at baseline was defined by a clinical diagnosis of cardiac amyloidosis or IVSd≥13mm in the absence of hypertension. We applied Echonet-LVH to echocardiograms performed at baseline. The association of EchoNet-LVH score with amyloid cardiomyopathy, abnormal cardiovascular symptoms (NYHA functional class II or greater) and NT-proBNP (>125 pg/mL) was estimated by logistic regression, adjusted for age and sex.

Results:
EchoNet-LVH score could be calculated in 130 out of 204 patients (64%). Mean age was 55 years, 28% were female, and 52 were defined as having ATTR cardiomyopathy. The EchoNet-LVH categorized 62 patients (48%) as not predicted to have cardiac involvement, 28 (22%) as intermediate risk, and 40 (31%) as positive. Higher EchoNet-LVH category was associated with higher odds of amyloid cardiomyopathy (OR 4.5 [95% CI 2.6-7.67] per level, p<0.001). Among patients with predicted cardiac involvement 85% had cardiomyopathy, compared to 20% in the predicted negative and intermediate categories. Higher score was associated with greater likelihood NYHA functional class II or greater and elevated NT-proBNP.

Conclusion:
These data show the feasibility of utilizing the EchoNet-LVH model to identify patients with a higher likelihood of amyloid cardiomyopathy. Automated deep learning tools like this may aid in the early diagnosis of cardiac amyloidosis.
Abstract 4146986: Removal of the Entrapped distal embolic protection system behind the stent frame during the percutaneous intervention of critically stenosed Saphenous venous graft. A Case Report.
Authors: Abdul Basit Salman , Jamil Nadia , Saleem Muhammad Sabih , Shakir Muhammad Hassan , Kumar Sunny , SETHI NISHANT
Published: November 2024

Case Description and Procedural Technique:
86 year old female with a prior history of coronary artery bypass grafting presented with non-ST elevation MI underwent subtotal occlusion of vein graft supplying the large obtuse marginal artery.

The left coronary bypass catheter was used to cannulate the vein graft, supplying the obtuse marginal artery. Balanced middleweight universal wire (BMW) was used to cross the lesion. Given the critical nature of the lesion, it was pre-dilated using a 2 mm balloon. Bare wire and emboshield NAV6 (2.5-4.8mm) embolic protection was then used for distal protection. Due to hemodynamically intolerance, direct stenting was opted for, and a 3.5 x 16 mm synergy stent was deployed over the BMW wire with accidental entrapment of the bare wire and embossed filter protection system behind the stent frame.

We have then placed an un-inflated 2.5 mm balloon inside the stent frame over the BMW wire. A 1 mm sapphire balloon was advanced over the bare wire, and its distal tip was placed behind the proximal edge of the stent. It was then inflated at 8 atmospheres. Serial inflations behind the stent frame were done with slow advancement of the balloon, covering the entire length of the stent. The balloon was then upsized to 2 mm, and serial inflations were performed behind the stent frame. After creating enough lumen, the filter was pulled back and re-captured. The 2.5 mm balloon was then inflated inside the stent frame. The balloon was upsized to 3.5 mm for the good apposition of the stent frame. TIMI III flow was obtained without any complications.

Discussion:
Distal embolic protection with intravascular filters is often used during percutaneous intervention of saphenous venous grafts. Accidental entrapment of emboshield filter systems can occur behind the stent in emergent situations when buddy wire technique is used in the vein graft. Our technique describes removal of the entrapped filter in a safe manner keeping the stent frame in place without surgical intervention. A few similar cases have been reported in the literature with surgical removal of wire.
Abstract 4147012: Classic Physiology Revealed During Mitral Valve Transcatheter Edge-to-Edge Repair: A Case of Hypertrophic Obstructive Cardiomyopathy Resulting in Severe Mitral Regurgitation
Authors: Axline Michael , Axline David , Cudemus Gaston , Muller Laura , Verghese Dhiran , Sierra Juan , Dakkak Wael , Patel Sankalp , Cubeddu Robert
Published: November 2024

Case

This case demonstrates classic cardiac physiology revealed in an unorthodox manner. Our patient is a 76-year-old male with a past medical history of HOCM, CAD, mild mitral regurgitation who presents to the hospital in the setting of chest pain. Work up revealed a high sensitivity troponin trend concerning for NSTEMI. Patient underwent a left heart cath where he was found to have a proximal LAD lesion with 99% stenosis requiring stenting. Post-intervention patient developed recurrent chest pain and a stat echocardiogram raised concerns for impending cardiogenic shock. Patient thus underwent emergent left and right heart cath. Impella LVAD placed for hemodynamic support. TEE was later obtained revealing moderate to severe mitral regurgitation, representing a progression from prior. At this time both advanced heart failure and structural heart service were consulted. The progression of the patient’s mitral regurgitation was thought to be impacting clinical deterioration and mitral valve transcatheter edge-to-edge repair (TEER) was discussed to address MR in the setting of obstruction. A multidisciplinary meeting resulted in decision to proceed with mitral valve TEER. Baseline hemodynamic gradients confirmed the presence of HOCM with peak-to-peak pressure gradient of 110 mmHg. Intraoperative TEE confirmed the presence of SAM and severe MR. The patient was prepared for a Pascal ACE clip, though in setting of this procedure phenylephrine was required for blood pressure support, revealing improvement in both SAM and MR. The patient was hemodynamically challenged with phenylephrine resulting in temporary resolution of MR and LVOT obstruction. These findings demonstrated a competent mitral valve with regurgitation resulting from HOCM physiology. After a multidisciplinary discussion, decision made to abort and withhold MV TEER.

Discussion:
This case demonstrates classic HOCM physiology in the setting of an attempted TEER procedure. With the addition of phenylephrine and increased afterload SAM resolved, as did much of the patient’s valvular regurgitation. This confirmed a competent mitral valve impacted by HOCM physiology rather than primary mitral valvular pathology. This case demonstrates the impact of structural imaging and competent imagers in the setting of complex anatomy and physiology. In this case TEE findings from provocative hemodynamic testing prevented unnecessary procedures.