bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4121359: Heart Disease and Heart Failure: Trends and Disparities in Mortality Rates in the United States from 2000 to 2020
Authors: Akem Dimala Christian , Reggio Christopher , Donato Anthony , Khalife Wissam
Published: November 2024

Background:
The remarkable decline in the overall prevalence and mortality rates of cardiovascular diseases (CVD) in the United States (US) over the past few decades has not been consistent across all age groups, sexes, races, and types of cardiovascular diseases. Heart disease (HD) and heart failure (HF) still pose a significant burden to the healthcare system.

Objectives:
This study sought to describe the age, sex and racial disparities in the trends in mortality rates for these two outcomes in the US over the past two decades.

Methods:
This was an ecological study with trend analysis of the mortality from heart disease and heart failure in the US between 2000 and 2020. Data on CVD was obtained from the National Centers for Disease Control and Prevention (CDC) surveillance databases and analyzed. Binomial regression models were used to evaluate trends in outcomes. Statistical significance was considered for p-values < 0.05.

Results:
There was a significant decrease in the age-standardized mortality for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases (p<0.001)). Mortality rates were significantly higher in males (p<0.001, R2 = 0.92), non-Hispanic blacks (p<0.001) and non-Hispanic whites (p<0.001) compared to Hispanics, (R2 = 0.94) and in adults aged 65+ (p<0.001) and 75+ (p<0.001) (R2 = 0.98). There was no significant decrease in the age-standardized mortality for HF (from 26.9 per 100,000 cases to 25.7 per 100,000 cases (p=0.706)) due to a reversal in the trend after 2011. Though the rates were significantly lower in males overall (p=0.001, R2 = 0.27), these rates became higher in males and in non-Hispanic Blacks compared to non-Hispanic Whites beyond 2016. Mortality rates due to HF were highest in the 65+ and 75+ age groups.

Conclusions:
This study on national trends in heart disease and heart failure across age groups, sexes and races over the past two decades confirmed a significant reduction in heart disease mortality rates over this period, but with persistent disparities between males and females, non-Hispanic Blacks and other races and the older age groups. This study also highlights important reversals of heart failure mortality rates trends in more recent years in males and females, and non-Hispanic Blacks and Whites, the reasons for which are amenable to further research.
Abstract 4122120: Prospective Implementation of a Cardiovascular Implantable Electronic Device Algorithm-Based Management Pathway in Routine Heart Failure Care
Authors: Kratka Allison , Rohrbach Greg , PUCKETT CARRIE MARGARET , Rotering Thomas , Raitt Merritt , Whooley Mary , Dhruva Sanket
Published: November 2024

Introduction:
More than 1 million patients in the US are hospitalized annually with heart failure (HF), many of whom have cardiovascular implantable electronic devices (CIEDs). CIEDs monitor physiologic variables that could identify subacute HF decompensation and impending HF hospitalization (HFH). One such algorithm is Medtronic’s TriageHF
TM
, which integrates nine diagnostic inputs from remote monitoring data to stratify patients into categories of low-, medium-, or high-risk of HFH in the next 30 days.

Goals/Aims:
To implement and evaluate a program in which two Veterans Health Administration (VHA) cardiology clinics receive high-risk TriageHF
TM
scores for patients with CIEDs, followed by contacting and assessing patients and then taking appropriate clinical action.

Methods:
From 1/18/24 to 4/19/24, TriageHF
TM
risk scores were calculated from both HF-specific remote transmissions that were scheduled every 30 days and unscheduled remote transmissions. Clinicians then contacted patients with high-risk scores regarding possible symptoms and provided an empiric 3-day diuretic intervention (initiation or dose augmentation), adjusted guideline-directed medical therapy (GDMT), or performed another clinical action as appropriate.

Results:
Among 358 patients with 1140 transmissions, 72 (6%) patients had a high-risk transmission. Mean patient age was 72.8 years, 346 (97%) were male, and 221 (62%) had a pre-existing diagnosis of heart failure. Of the 72 patients with high-risk transmissions, 67 (93%) were successfully contacted; 34 (51%) had no HF symptoms, 24 (36%) had mild to moderate symptoms, 2 (3%) had severe symptoms, 4 (6%) had non-HF symptoms, and 3 (4%) could not report symptoms. Of the 67, 57 (85%) reported adherence to medications and 17 (25%) were identified as likely having a non-HF related high-risk score. Forty-six (69%) had a clinical action taken in response to the high-risk score, including 28 (42%) with a diuretic intervention, 12 (18%) with GDMT augmented, and 25 (37%) with other actions, such as being referred to HF clinic.

Conclusions:
In this implementation study, clinicians contacted and assessed nearly all patients at high-risk for HF decompensation based on CIED remote monitoring data. Approximately 70% of patients had an actionable high-risk score, with approximately half prescribed empiric diuretics or augmented GDMT. A randomized clinical trial is needed to determine whether this algorithm and subsequent intervention improves clinical outcomes.
Abstract 4122122: Comparison of Transradial Versus Transfemoral Access for Chronic Total Occlusion Percutaneous Coronary Intervention: A Meta-Analysis
Authors: Jain Hritvik , Odat Ramez , Goyal Aman , Jha Mayank , Jain Jyoti , Fatima Eeshal , Jenil Franco Ancy , Idrees Muhammad , Passey Siddhant , Saleem Maryam
Published: November 2024

Background:
Chronic total occlusion (CTO) contributes to increased mortality because it is often revascularized by percutaneous coronary intervention (PCI). Traditionally, transfemoral (TF) access has been preferred in CTO-PCI owing to its high procedural complexity and ease of introduction of a large guide catheter. Transradial (TR) access is gaining popularity in PCI, but its efficacy in CTO-PCI has not been well investigated.

Methods:
We searched major databases to retrieve studies comparing TR and TF access in patients with CTO who underwent PCI. The DerSimonian and Laird random-effects model was used to pool the odds ratios (OR) and mean differences (MD) with 95% confidence intervals. Statistical significance was considered at p<0.05.

Results:
We included 18 studies with 30,286 CTO PCI cases (TR: 10921 and TF: 19365). For procedural outcomes, TR access was associated with a significantly lower total contrast volume requirement [MD: -19.57; 95% CI: -34.34, -4.81; p=0.009], with comparable procedural success [OR: 1.16; 95% CI: 0.97, 1.40] and total procedural time [MD: -5.30; 95% CI: -21.09, 10.48]. For clinical outcomes, TR was associated with significantly lower risks of in-hospital mortality [OR: 0.46; 95% CI: 0.25, 0.85; p=0.01], major adverse cardiovascular events [OR: 0.73; 95% CI: 0.59, 0.92; p=0.007], vascular complications [OR: 0.35; 95% CI: 0.25, 0.51; p<0.00001], and major bleeding [OR: 0.33; 95% CI: 0.20, 0.56; p<0.0001] compared with TF access.

Conclusion:
CTO PCI using TR access demonstrated favourable outcomes regarding lower contrast volume requirement, lower risks of in-hospital mortality, major adverse cardiovascular events, vascular complications, and major bleeding compared with TF access. The selection of appropriate arterial access varies on a case-to-case basis and according to operator preferences.
Abstract 4122290: Association between SGLT2 inhibitors and risk of Dementia and Parkinson’s Disease: A Meta-analysis of 12 Randomized Controlled Trials.
Authors: Jaiswal Vikash , Mashkoor Yusra , Jaiswal Akash , Raj Nishchita , Rajak Kripa , Fonarow Gregg
Published: November 2024

Background:
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated to reduce the risk of hospitalizations from heart failure and cardiovascular mortality. However, SGLT2i therapy’s potential effects on the risks of dementia and Parkinson’s disease are not well established, with conflicting results based on observational studies.

Objective:
We sought to evaluate the association between SGLT2i and the risk of dementia and Parkinson’s disease in patients with type 2 diabetes mellitus (T2DM), heart failure, or chronic kidney disease.

Methods:
We performed a systematic literature search on PubMed, Scopus, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until March 2024 without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model.

Results:
A total of 12 RCTs with 74, 442 patients (40784 in the SGLT2i group and 33658 in the control group) were included in the analysis. The mean age of patients in SGLT2i and control was 65.3 and 65.2 years respectively. The mean follow-up duration was 2.9 years. Pooled analysis showed that there is no significant association between SGLT2i and the risk of dementia (OR, 1.37 (95%CI: 0.70-2.69),
P=
0.36, I2=0%), dementia Alzheimer’s type (OR, 2.62 (95%CI: 0.47-14.49),
P=
0.27, I2=0), vascular dementia (OR, O.52 (95%CI: 0.09-2.98),
P=
0.46, I2=0%), and Parkinson’s disease (OR, 0.75 (95%CI: 0.25-2.25),
P=
0.61, I2=0%) was comparable between SGLT2i and control groups.

Conclusion:
Our study suggest that there is no significant association between SGLT2i and the risk of dementia, its subtypes, and Parkinson’s disease. Further large-power randomized trials are needed to strengthen the understanding of neuropsychiatric beneficial effects of SGLT2i.
Abstract 4122507: Fetal Socioeconomic and Environmental Exposures Influence Fetal Brain Growth and Risk of Neonatal Brain Injury in Congenital Heart Disease
Authors: DeRose Lesje , Martin Megan , Luna Silva Karla , Nunez Gallegos Flora , Steurer Martina , George Elizabeth , Xu Duan , McQuillen Patrick , Peyvandi Shabnam
Published: November 2024

Introduction:
Fetuses with CHD have smaller total brain volume (TBV) and are at risk for acquired brain white matter injury (WMI), both of which are linked to neurodevelopmental impairments. Social determinants of health (SDOH) and other fetal environmental factors have been linked to fetal brain health in other populations. Our aim was to test our hypothesis that these exposures influence fetal brain growth and postnatal WMI risk in severe CHD.

Methods:
Our prospective longitudinal cohort study enrolled fetuses with severe CHD to undergo fetal brain MRI and postnatal pre-operative brain MRI. Participants completed home environment surveys on individual SDOH and exposures. Community SDOH metrics were determined using Child Opportunity Index (COI) based on home address. An ‘at risk’ fetus composite was created if there was exposure to: personal/household smoking, welfare/food stamps, or poverty. TBV was calculated at both time points. Presence/degree of WMI was determined on postnatal MRI. Repeated measures analysis and logistic regression were performed to determine association between individual and community SDOH metrics with rate of TBV growth and risk of WMI.

Results:
55 participants enrolled (54 fetal scans: mean GA 33.9 wks, 95%CI: 33.7,34.1; 47 neonatal scans: mean GA 39.3 wks 95%CI: 38.9,39.6). Fetal sex, smoking exposure, and several individual SDOH were associated with TBV growth. Adjusting for fetal sex and GA at scan, rate of TBV growth was slower with smoking exposure (coeff: -5.2, 95%CI: -10.3, -0.2, p= 0.04) and trended towards significance for those with welfare/food stamps or poverty. ‘At risk’ fetuses had slower rate of TBV growth than those without risk (coeff: -2.5, 95%CI: -5.0, -0.07, p= 0.04) (Figure 1). There were lower odds of pre-operative WMI with high COI compared to low after adjusting for GA at scan (OR= 0.16, 95%CI: 0.03, 0.9, p= 0.04).

Conclusion:
Smoking exposure and individual-level SDOH influence brain growth, while community COI is associated with risk of postnatal pre-op WMI in CHD. Our findings identify targets for intervention to optimize brain growth and outcomes in the CHD population, including smoking cessation programs, and nutritional and needs assessment during pregnancy.
Abstract 4122677: Reduced Costs and Readmissions With Outpatient Versus Inpatient Diuresis in Heart Failure Patients at UNC Hospital
Authors: Tharwani Sonum , Leamy Alexandra , Baker Emily , Eubanks Grayson , Sanders Mason , Neal Carrie , Waters Sarah , Weickert Thelsa
Published: November 2024

Background:
Heart failure (HF) remains a leading cause of hospital admissions, with high morbidity, mortality, and projected healthcare costs of $70 billion by 2030. Effective management of the patient’s volume status is crucial in managing symptom burden, preventing rehospitalization, and thus reducing healthcare expenses. In 2017, UNC Hospital opened an ambulatory diuresis clinic to address this issue.
Aim:
This retrospective cohort study evaluates the cost and rehospitalization rates of HF patients treated in the ambulatory diuresis clinic versus those receiving inpatient diuresis at the hospital.

Methods:
We retrospectively analyzed 2,950 unique HF patients from August 2017 to September 2023, treated with IV diuresis at UNC Hospital or its outpatient clinic. Patients were classified into a clinic cohort, who visited the diuresis clinic at least once, and a non-clinic cohort, who never visited and were defined by a primary HF diagnosis with an ED/observation visit or inpatient stay ≤ two days. The primary outcome measured was average readmissions per cohort; the secondary outcome included total charges from billing records. Rehospitalization and mortality rates were tracked via EHR. Statistical analyses, including descriptive and inferential statistics, were conducted to compare costs and outcomes between the two groups.

Results:
This study compared 996 patients in the clinic group with 1,954 in the non-clinic group, noting similar baseline characteristics of average ages of 66.80 and 67.24 years, BMIs of 33.95 and 33.73 kg/m^2, and one-year all-cause mortality rates of 21.18% and 22.77%, respectively. Average admissions per cohort were higher for the clinic group one year prior to the index visit—0.159 vs. 0.127—but decreased post-index visit: by six months, admissions were 0.094 for the clinic and 0.161 for the non-clinic; at one year, they were 0.133 and 0.210, respectively. Financially, the clinic group incurred $7,895 less in charges during the index visit and had lower total costs one-year post-index, at $17,785 compared to $23,982 for the non-clinic group.

Conclusions:
The study demonstrates that outpatient diuresis at UNC Hospital is more cost-effective than inpatient diuresis for HF patients and reduces rehospitalization rates at six months and one-year post-index visit. These results suggest that outpatient diuresis is cost-effective, may enhance patient outcomes, and could alleviate the strain on healthcare resources.
Abstract 4122957: C-C motif chemokine receptor-2 disruption Synergizes with Phosphodiesterase Type 5 Inhibition in Ameliorating Pulmonary Hypertension in Monocrotaline-treated Rats: Proof-of-Concept Study for a Combination therapy and Potential Mechanisms
Authors: TSUBOYA NAOKI , Mitani Yoshihide , Sawada Hirofumi , Takeoka Mami , Ohya Kazunobu , Oshita Hironori , Yodoya Noriko , Ohashi Hiroyuki , Maruyama Junko , Okamoto Ryuji , Mashimo Tomoji , Dohi Kaoru , Nishimura Yuhei , Maruyama Kazuo , Hirayama Masahiro
Published: November 2024

Background:
Whether and how any anti-inflammatory agents and their combination with conventional pulmonary vasodilators protect against pulmonary arterial hypertension (PAH) is unknown.

Hypothesis:
The disruption of C-C motif chemokine receptor (CCR) -2, a receptor for CCL-2, ameliorates PAH in any models with the reversal of the associated pro-inflammatory state and vascular cell phenotypes and synergizes with any conventional pulmonary vasodilators.

Methods and Results:
By using
Ccr2
(-/-) rats generated by CRISPR/
Cas9
, we investigated PAH in
Ccr2
(+/+) or
Ccr2
(-/-) rats treated with monocrotaline (MCT), SU5416/hypoxia (SuHx), and chronic hypoxia (CH).
Ccr2
(-/-) decreased the right ventricular systolic pressure, right ventricular hypertrophy, and mortality rate, and reversed increased expression of inflammatory cytokines/chemokines (IL-6, TNF-α, CCL2, IL-1β, TGF-β) in MCT-treated rats, but not in SuHx or CH models. Consistently,
Ccr2
(-/-) decreased indices of pulmonary vascular diseases (PVDs) and perivascular macrophage infiltration, as well as reversed impaired BMPR2 signaling, increased endothelial apoptosis, impaired NO signaling (eNOS, peNOS/eNOS) and decreased phosphodiesterase (PDE)-5 expression in lungs in MCT-treated rats. Gene expression of the receptor for prostaglandin I
2
and endothelin was not altered in MCT-treated rats by
Ccr2
(-/-). In cultured pulmonary arterial smooth muscle cells (PASMCs),
Ccr2
(-/-) suppressed CCL2-induced hyperproliferation and dedifferentiation as well as reversed CCL2-induced decrease in PDE5 expression. Consistently, the whole-genome RNA sequencing analysis identified differentially expressed genes in CCL2-stimulated
Ccr2
(-/-) PASMCs, which are related to cellular differentiation and contraction. Based on studies in rats and cultured PASMCs, we investigated whether a PDE5 inhibitor, tadalafil, synergizes with
Ccr2
(-/-). Tadalafil administration ameliorated PH and PVDs in MCT-treated
Ccr2
(-/-) rats but not in
Ccr2
(+/+) rats, and further improved survival in
Ccr2
(-/-) rats.

Conclusions:
PDE5 inhibition synergized with
Ccr2
disruption in protecting against PAH in MCT-treated rats, which was mechanistically related to the restoration of proinflammatory states and associated vascular cell phenotypes. These findings confer a fundamental basis supporting that CCR2 may be a therapeutic target in intractable PAH patients with a certain CCR2-related inflammatory phenotype and refractory to conventional pulmonary vasodilators.
Abstract 4123308: Trends in Gestational Diabetes Mellitus By US State, 2019 -2023
Authors: Nayak Tanvi , Shah Nilay , venkatesh kartik , Huang Xiaoning , GROBMAN William , Khan Sadiya , Cameron Natalie
Published: November 2024

Introduction/ Background:
Gestational diabetes mellitus (GDM) is one of the most frequent adverse pregnancy outcomes and increases the risk of lifetime cardiometabolic disease. Given known geographic disparities in maternal morbidity and mortality in the US, we examined state-level prevalence and trends in GDM from 2019-2023.

Methods:
We conducted a serial, cross-sectional analysis of maternal health data recorded on birth certificates from all livebirths in the US using the National Center for Health Statistics Natality Files. We included pregnant individuals aged 15-44 years who gave birth from 2019-2023, had a singleton, live birth, and did not have pre-pregnancy diabetes. We calculated the age-standardized prevalence and average-annual percent change (AAPC) in GDM from 2019-2023, overall, by U.S. census region (Northeast, Midwest, South, and West), and in each US state and the District of Columbia (DC).

Results:
Of the 17,432,486 individuals with live births between 2019 and 2023, overall prevalence of GDM per 100 live births (95% confidence interval) was 6.9 (6.9, 6.9) in 2019 and 8.0 (8.0, 8.1) in 2023 (AAPC 3.2 [-1.7, 8.5]). There was significant geographic variation in overall prevalence of GDM by US region and state (
Figure 1
). In 2023, prevalence was higher in the Midwest (8.8 [8.7, 8.9]) and Western states (8.6, [8.5,8.6]) compared with the Southern (7.3, [7.3, 7.4]) and Northeastern states (8.1, [8.0,8.2]), ranging from 5.5 (4.9,6.0) in DC to 13.0 (12.2,13.8) in Alaska. Prevalence was higher in 2023 compared with 2019 in all US regions and states and DC, except Alaska, Connecticut, Idaho, Maine, New Jersey, and Wyoming. Prevalence increased most rapidly in the Western US states (AAPC 4.2%/year [0.1, 8.4]) with the greatest change observed in Montana from 5.1 (4.7, 5.6) in 2019 to 8.0 (7.5, 8.5) in 2023 (AAPC 10.3%/year [5.6, 15.3]).

Conclusions:
GDM prevalence increased significantly from 2019-2023 with substantial heterogeneity by US region and state. More localized state-level analysis with context-specific polices that address factors associated with geographic differences in GDM are needed to promote maternal cardiometabolic health equity in the US.
Abstract 4123806: Early Findings on the Impact of Renin-Angiotensin-Aldosterone System Inhibitors on Bicuspid Aortic Valve Disease Progression: A Single Center Cohort Study
Authors: Brem Ofir , Samuels Elchanan , Bental Tamir , Richter Ilan , Kornowski Ran , Hirsch Rafael , Witberg Guy , Schamroth Pravda Nili
Published: November 2024

Introduction:
Patients with a bicuspid aortic valve (BAV) often have an associated aortopathy, increasing their risk of aortic dissection. Currently, there is no proven therapy to stabilize the growth of BAV aortopathy. This study aimed to assess the effect of cardioprotective medications, specifically renin-angiotensin-aldosterone system inhibitors (RAASi), on the progression of aortic dilation in adult BAV patients.

Methods:
A retrospective cohort study was conducted including adult patients with BAV followed at our center between 1996-2020. All patients had echocardiography imaging with at least 5 years of follow-up. The cohort was divided based on the chronic use of RAASi, as determined by pharmacy check-out data. The primary endpoint was defined as either the progression of ascending aortic diameter ≥ 4.5 cm or surgery for ascending aortic replacement.

Results:
The study included 262 patients with a mean age of 54.3±19.5 years, of whom 75.2% (n=197) were male, and 34.7% (n=44) had a diagnosis of hypertension. At baseline, the average size of the ascending aorta was 4.2±4.1 mm and 3.5±4.0 mm at the level of the aortic sinuses. The average follow-up time was 5.8±0.8 years. During follow-up, 23 patients underwent ascending aortic replacement with concurrent aortic valve replacement, 66 patients experienced progression of ascending aortic diameter ≥ 4.5 cm, and 2 patients died. Patients using RAASi (n=40) had a lower incidence of the primary endpoint compared to those without RAASi chronic therapy (12.8% vs. 24.8%, p=0.147). Multivariate analysis indicated that patients without RAASi chronic therapy had a significantly increased risk of the primary endpoint (HR=2.87, 95% CI [1.03-8.01], p=0.43).

Conclusions:
Our early findings suggest that RAASi may have a preventative role in the progression of BAV aortopathy.
Abstract 4123864: Fractional flow reserve-guided complete revascularization versus culprit-only revascularization in patients with myocardial infarction and multivessel disease: A GRADE assessed meta-analysis of randomized controlled trials
Authors: Rahman Asad , Ahmed Mushood , Javaid Hira , Ahsan Areeba , Singh Priyansha , Jain Hritvik , Ahmad Adeel , Khan Sohail , Ramphul Kamleshun , Shahid Farhan , alam mahboob , Ahmed Raheel
Published: November 2024

Background:
Fractional flow reserve (FFR) guided complete revascularization (CR) is an approach that can be used to improve clinical outcomes in patients with acute myocardial infarction (MI) and multivessel disease (MVD). The objective of the present meta-analysis was to investigate whether FFR-guided CR leads to better cardiovascular outcomes as compared to culprit-only revascularization (COR) in acute MI and MVD by pooling recently published data.

Methods:
A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library from inception until April 2024 to retrieve eligible randomized controlled trials (RCTs). Clinical outcomes were assessed using the random-effects model by pooling risk ratios (RRs) along with 95% confidence intervals (CIs). We assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Results:
Four RCTs were pooled with 3,175 patients. FFR-guided CR significantly reduced the risk of repeat revascularization as compared to COR (RR = 0.52; 95% CI: 0.33-0.81, p = 0.004) [absolute risk difference 83 fewer per 1,000 patients (95% confidence interval: 116 to 33 fewer) moderate certainty]. Though there was a reduction in the risk of MACE with FFR-guided CR (RR = 0.68, 95% CI: 0.44-1.04,
p
= 0.08; moderate certainty), it didn't attain statistical significance. Clinical outcomes such as all-cause death (RR = 1.10, 95% CI: 0.84-1.45, p = 0.48; moderate certainty), cardiac death (RR = 0.79, 95% CI: 0.53-1.17, p = 0.24; high certainty), risk of MI (RR = 0.94, 95% CI: 0.54-1.66, p = 0.84; moderate certainty) and major bleeding (RR = 0.95, 95% CI: 0.54-1.67, p = 0.87; moderate certainty) were comparable between the two groups.

Conclusion:
FFR-guided CR in patients with MI and MVD can lead to a decreased risk of repeat revascularizations while not affecting all-cause and cardiac deaths.
Abstract 4123899: Stroke Risk in Patients with an Isolated Interventricular Membranous Septal Aneurysm
Authors: Elias Joseph , Konje Swiri , Argulian Edgar
Published: November 2024

Aim:
This study investigates the prevalence of isolated interventricular membranous septal (IVMS) aneurysms detected via echocardiography and assesses the associated stroke risk without other classical risk factors.

Methods:
We searched the echocardiography database at Mount Sinai Morningside from January 2017 to September 2023. Identified echocardiograms were reviewed to confirm IVMS aneurysms and exclude sinus of Valsalva aneurysms. Patients with concurrent structural heart anomalies were excluded. Medical records were examined for baseline characteristics, risk factors, and cortical brain infarcts.

Results:
From 51,732 subjects, 18 were identified with IVMS aneurysms, yielding a prevalence of 0.04%. Four patients with significant structural heart disease were excluded, resulting in a final sample size of 14. Of these, 9 (64%) were female with a mean age of 59.6, and 5 (36%) were male with a mean age of 55.4. The mean BMI was 27.9 kg/m
2
, with 4 classified as obese. All patients were nonsmokers; 2 had a family history of stroke. One patient had diabetes, 8 had hyperlipidemia, and 9 had hypertension. Only one patient had paroxysmal atrial fibrillation, with a CHA2DS2-VASc score of 0. Echocardiography revealed structurally normal hearts with a mean left ventricular ejection fraction of 61% and a mean left atrial volume index of 24.8 mL/m
2
. The mean neck diameter of the aneurysm was 8.7 mm, and the mean diameter was 11.9 mm. Two patients had inter-atrial septal aneurysms, and one had a patent foramen ovale.

Out of the 14 patients, 5 had a history of ischemic stroke (4) or transient ischemic attacks (1), all of whom were 64 years or younger with a mean RoPE Score of 6 and a mean CHA2DS2-VASc score of 1.6 at the time of their first neurologic event. All patients were treated with aspirin and statin therapy. Two patients had recurrent strokes, one of whom had four recurrent strokes, all cortical infarcts. These patients were switched to clopidogrel after 3 months of dual antiplatelet therapy. No anticoagulation was used.

Conclusion:
This retrospective study highlights a notable association between isolated IVMS aneurysms and an increased risk of ischemic stroke (36%) and recurrent ischemic stroke (14%). Despite their rarity, these anomalies should be considered in unexplained strokes. Optimal management strategies remain ambiguous, but anticoagulation may be favored based on presumed stroke mechanisms. Large-scale multicenter studies are needed for validation.
Abstract 4123926: Suprasomatic Serial Growth of Right Heart Structures in Fetuses with Hypoplastic Left Heart Syndrome Demonstrated by Fetal Echocardiography
Authors: Ro Sanghee , Milligan Ian , Schlosser Brian , Gleason Michelle , Michelfelder Erik
Published: November 2024

Background:
In hypoplastic left heart syndrome (HLHS), the single right ventricle (RV) accounts for the entire cardiac stroke volume. This physiology may produce elevated transpulmonary flow velocities and dilation of the right heart structures. Little data exists regarding normal right heart dimensions and transpulmonary velocities in relation to somatic growth in these fetuses. We sought to assess serial changes in the size of right heart structures and pulmonary valve (PV) velocities in fetuses with HLHS and compare findings to fetuses with normal cardiac anatomy.

Methods:
A retrospective cohort study of fetuses with HLHS or normal cardiac anatomy confirmed by fetal echocardiogram between 1/1/13 – 12/31/22 was performed, excluding multiple gestation pregnancies. Fetal echocardiograms were assessed by an independent reviewer who obtained RV, PV and tricuspid valve annulus dimensions, and PV flow velocities. Nomograms were created for both HLHS and normal cohorts. The association between gestational age and PV velocity, PV annulus, RV diameter and tricuspid valve annulus was assessed and compared between groups using linear mixed models.

Results:
There were 290 total fetal echocardiograms for 177 patients with HLHS compared against 408 normal fetuses. [MG1] PV velocities were higher for patients with HLHS compared to normal cardiac anatomy throughout gestation (p < 0.001). In addition, the PV velocity increased more rapidly with gestational age for the HLHS (+0.02 m/s/week) group compared to those with normal cardiac anatomy (+0.01 m/s/week) (p=0.019) (Figure 1). Similarly, the RV dimension grew more rapidly with gestational age for those with HLHS (+3.2% cm/week) compared to those with normal cardiac anatomy (+2.5% cm/week) (p<0.001) (Figure 2). Lastly, the tricuspid valve annulus grew more rapidly with gestational age for patients with HLHS (+2.6% cm/week) compared to those with normal cardiac anatomy (+2.3% cm/week) (p=0.010) (Figure 3). While the PV annulus size increased with gestational age, there was not a significant difference in growth between the two groups (p=0.119).

Conclusions:
In fetuses with HLHS, the PV velocity, RV size and tricuspid valve size increase at a rate greater than normal somatic growth. These nomograms help identify expected RV size, tricuspid valve size and PV velocities for fetuses with HLHS and any who may deviate from the norm.
Abstract 4124005: Sex, ethnic and social determinants of health differences in high-potency P2Y12 inhibitors prescription among patients with acute coronary syndrome: An analysis of the American Heart Association Get With The Guidelines®–Coronary Artery Disease Registry
Authors: Mansoor Hend , Poudel Remy , Hong Haoyun , Li Shen , Thomas Kathie , Sigal Stephen , Tamis-Holland Jacqueline , Goyal Abhinav , Elgendy Islam
Published: November 2024

Background:
Sex and racial differences in the outcomes of patients with acute coronary syndrome (ACS) persist and could be related to the differences in management including high-potency P2Y12 inhibitors.

Aim:
This study aims to examine the contribution of social determinants of health on the association between sex and racial differences in the prescription of high-potency P2Y12 inhibitor upon discharge.

Methods:
Patients with ACS undergoing percutaneous coronary intervention (PCI) from the American Heart Association Get With The Guidelines®–Coronary Artery Disease Registry between October 2019 to December 2022 were included. Multivariable hierarchical models were used to assess whether there are differences in high-potency P2Y12 inhibitors (i.e., ticagrelor or prasugrel) prescription at discharge adjusting for race/ethnicity, insurance, age, social vulnerability index (SVI), zip code designation, and medical history. Analyses were performed in women and men separately.

Results:
Among 135,153 patients with ACS who underwent PCI, 59.8% were discharged on a high-potency P2Y12 inhibitor. Compared with men, women were less likely prescribed high-potency P2Y12 inhibitor (66.9% vs 72%), and this pattern did not change during the study period (P=0.50) (Figure). There was a significant interaction between sex and race for high-potency P2Y12 inhibitor prescription (P< 0.05). Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities. However, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription compared with non-Hispanic Whites among men after adjusting for all covariates.

Conclusions:
In this large contemporary observational analysis of patients with AMI undergoing PCI, women were less likely prescribed a high-potency P2Y12 inhibitor upon discharge. Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities; however, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription. Further efforts should be directed to minimize these sex and racial disparities.
Abstract 4124070: Dual-action Nanomatrix Coated Stent for Improving Endothelialization while Suppressing Restenosis and Inflammation
Authors: Jun Ho-wook , Cross Robbie , Zhang Xixi , Chen Jun , Ahn Yujin , Brott Brigitta , Anderson Peter , Sherwood Jennifer , Yoon Young-sup , Virmani Renu
Published: November 2024

Introduction:
The most common cause of cardiovascular disease (CVD) is atherosclerosis. The progression of atherosclerosis is characterized by endothelial cell dysfunction, proliferation of smooth muscle cell proliferation, and plaques which lead to progressive arterial stenosis. Bare metal stents (BMS) were developed to hinder stenosis, but re-stenosis has been observed following deployment. Drug-eluting stents (DES) have been developed to mitigate this, by releasing anti-proliferative drugs to suppress smooth muscle cell proliferation. However, these drugs also suppress endothelial growth. To address this, we are developing and evaluating a dual action nanomatrix coated stent comprised of a nitric oxide (NO) releasing peptide amphiphile (PA) and everolimus-encapsulated liposomes to improve endothelial proliferation and suppressing smooth muscle cell proliferation and inflammation.

Materials and Methods:
The nanomatrix coating contains a PA generated via solid phase peptide synthesis consisting of a nitric oxide donor and a cell adhesive ligand. The everolimus-encapsulated liposomes were prepared with DPPC, DOTAP, DSPE-PEG, and cholesterol via thin film rehydration, followed by encapsulation with everolimus. TEM was performed on liposomes to assess their stability. The release kinetics were evaluated via UV-vis of samples containing released everolimus. To evaluate the dual effect of the nanomatrix coating on metabolism, NO and everolimus were used to treat endothelial and smooth muscle cells, and an MTT assay was done.

Results and Discussion:
TEM showed that liposomes maintained stability over time. It was found that 60% of everolimus was released by day 30. The MTT assay showed that NO with everolimus increased endothelial cell metabolic activity and maintained or lowered smooth muscle cell activity compared to everolimus alone.

Conclusions:
Everolimus-encapsulated liposomes have potential as an effective delivery method of everolimus. NO and everolimus have a synergistic effect of improving endothelial function and suppressing smooth muscle cells.
Abstract 4124281: Dexmedetomidine for junctional ectopic tachycardia in patients undergoing tetralogy of Fallot repair: a meta-analysis of randomized controlled trials
Authors: Barbosa Lucas , Queiroz Ivo , Defante Maria , Romeiro Pedro , Antunes Vanio , Bulhoes Elisio , X. Mendes Beatriz , Silva Catarina , Guida Camila , Barbosa Edna , Iwashita Lages Thais
Published: November 2024

Background:
Junctional ectopic tachycardia (JET) occurs in 2 to 22% of patients after cardiac surgery for congenital heart diseases, including tetralogy of Fallot (TOF) repair. Dexmedetomidine emerged as a potential drug to prevent JET in these patients. This systematic review and meta-analysis aimed to evaluate the efficacy of dexmedetomidine in JET in patients undergoing TOF repair.

Methods:
We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the use of dexmedetomidine in patients undergoing TOF repair. We pooled risk ratios (RR) for binary outcomes, and mean differences (MD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of incidence of JET. We used R version 4.3.2 and TSA version 0.5.9.10 for statistical analyses.

Results:
Our meta-analysis included 5 RCTs comprising 546 patients, of whom 268 (49%) were randomized to dexmedetomidine. Compared with control, dexmedetomidine significantly reduced the incidence of JET (RR 0.46; 95% CI: 0.30 to 0.71; p<0.05; Figure A). However, there were no significant differences in mortality (RR 0.45; 95% CI: 0.12 to 1.71; p=0.24; Figure B) between groups. In addition, dexmedetomidine also reduced the length of intensive care unit (ICU) stay (MD -7.75 hours; 95% CI: -15.08 to -0.41; p<0.05; Figure C). There were no significant differences in ionotropic score (MD -0.97 ug.min/Kg; 95 % CI: -1.98 to 0.18; p=0.10; Figure D), and ventilation time (MD -2.29 hours; 95% CI: -8.39 to 2.41; p=0.27; Figure E). For the primary endpoint, TSA suggested a low risk of type 1 error; therefore, this result may be conclusive.

Conclusion:
In patients undergoing TOF repair surgery, dexmedetomidine significantly reduced the incidence of JET and the length of ICU stay.
Abstract 4124293: Exercise Capacity in Patients with Fontan Physiology
Authors: Ruiz Kalani , Soine Laurie , Buber Yonatan , Pistner Andrew
Published: November 2024

Introduction/Background:
In the absence of a sub-pulmonary ventricle in the Fontan circulation, augmentation of pulmonary blood flow and filling of the systemic ventricle during exercise are limited. Cardiopulmonary exercise testing (CPET) is a reliable method for evaluation of aerobic capacity, gas exchange, and other physiologic parameters used for risk stratification in this population. Despite the ubiquitous use of CPET, reference ranges for patients with Fontan physiology are limited. The purpose of this study is to describe exercise characteristics and their relationship with different characteristics of Fontan physiology, imaging, and hemodynamics.

Methods/Approach:
In this retrospective cohort study, CPET results were reviewed for adult Fontan patients at the University of Washington between May 2021 and February 2024. Demographics, comorbidities, medications, type of Fontan conduit, imaging characteristics, hemodynamics, and exercise characteristics were included. Results were compared to a large previously published cohort of Fontan patients. Univariate linear regression was used to identify associations between demographics, cardiac anatomy, and exercise parameters. A p-value of less than 0.05 was considered statistically significant.

Results/Data:
Baseline demographics were notable for an older patient population (31±7 years) with lower indexed peak VO
2
(20.5±5.6 mL/kg/min) and greater V
E
/VCO
2
slope (37±7) compared to the historic cohort. Indexed peak VO2 was associated with age, BMI, type of Fontan conduit, FEV1, FVC, resting oxygen saturation, peak systolic blood pressure, and peak heart rate. Indexed peak VO
2
was notably not significantly associated with sex, systemic ventricular morphology, ventricular systolic function, Fontan pressure, or the presence of conventional heart failure medical therapy.

Conclusions:
In the growing population of older patients with Fontan physiology, development of age-specific population normative data may increase the clinical utility of CPET. Further investigation of the relationship between imaging characteristics, hemodynamics, and exercise parameters is needed in the Fontan population.
Abstract 4124506: Short Physical Performance Battery as a Marker of Severity and Predictor of Clinical Outcomes in Transthyretin Amyloid Cardiomyopathy (ATTR-CM)
Authors: Dershowitz Lyle , Teruya Sergio , Bampatsias Dimitrios , Wardhere Abdirahman , Mirabal Alfonsina , Santana Del Rosario Denisse , Maurer Mathew
Published: November 2024

Background:
ATTR-CM has an age dependent prevalence and is a disorder that almost exclusively affects older adults. Objective evaluations of function are critical to assessing and managing ATTR-CM in older adults. The short physical performance battery (SPPB) is a valid measure of functional capacity that predicts morbidity and mortality in older adults but its utility in ATTR-CM remains unknown.

Aims/hypothesis:
To establish SPPB as a useful marker of disease severity and predictor of outcomes in ATTR-CM. We hypothesized that SPPB scores would correlate with validated markers of ATTR-CM severity and improve clinical prediction.

Methods:
This is a retrospective analysis of patients referred to the Columbia University Cardiac Amyloid Program. Patients were stratified into low (SPPB 0-6), moderate (7-9), and high (10-12) cohorts based on initial SPPB score and baseline characteristics were compared between groups. Cox proportional hazard models and Kaplan Meier (KM) curves were generated to assess associations with mortality as well as a composite of death and cardiovascular (CV) hospitalization in follow-up.

Results:
A total of 263 patients, age 78 years (IQR 73, 84), 86% male, 22% with ATTRv (variant) and 78% with ATTRwt (wild type) were studied. SPPB showed no limitation in 59%, mild limitation in 33%, and severe limitation in 8%. Lower SPPB was associated (p <0.05) with older age, prior stroke/TIA, shorter 6-minute walk test, elevated NT-proBNP and HS-troponin, worse quality of life metrics on Kansas City Cardiomyopathy Questionnaire, more advanced NYHA and Mayo stages, and higher Columbia scores. On multivariate regression (adjusted for age, sex, genotype, NYHA), SPPB was independently associated with the composite of mortality and CV hospitalization, with each point increase corresponding to 13% lower incidence of the outcome (HR 0.87, p=0.01). Chair stands score, one of three SPPB subdomains, was independently associated with the composite and mortality. KM curves showed significant association with SPPB and both the composite and mortality (Fig. 1).

Conclusions:
SPPB score is a marker of ATTR-CM severity, associated with validated biomarkers and staging systems, and independently predicts clinical outcomes.
Abstract 4124606: Disparities in statin use following identification of Coronary Artery Calcium
Authors: Ellberg Charlotte , Bal Kavenpreet , Duran Edward , Criqui Michael , Shapiro Michael , Bhatia Harpreet
Published: November 2024

Introduction:
Coronary artery calcium (CAC) scoring is a useful tool for risk stratification in asymptomatic individuals, and guidelines recommend statin use in individuals with CAC. A growing body of research has aimed to identify and mitigate health disparities and their relation to CVD risk. Likewise, studies have highlighted social determinants of health (SDOH) that contribute to health disparities in CVD. We sought to extend this work by evaluating whether disparities exist with regards to statin use after identification of CAC within the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
The sample consisted of all MESA participants with baseline CAC >0, not already on statin therapy, and without prior CVD events (n=2665). The association between race/ethnicity, age, sex, primary language, and an aggregate SDOH score with statin prescription at short (exam 2, median 1.6 year) and long (exam 5, median 9.4 year) term follow-up was evaluated in logistic regression models with adjustment for traditional CVD risk factors. The SDOH score was created from 14 components which covered the 5 general domains described in the Healthy People 2030 initiative (Figure 1).

Results:
Rates of statin prescription after CAC identification by race/ethnicity, language, and SDOH score tertile are shown in Figure 2. At short-term follow up, those with a higher SDOH score (worse burden) (OR 0.39, 95% CI 0.16-0.91), Hispanic / Latino participants (OR 0.59, 95% CI 0.40-0.85) and Spanish speaking participants (OR 0.51, 95% CI 0.30-0.83) were less likely to report statin use following CAC identification. At long-term follow up, Black participants (OR 0.71, 95% CI 0.52-0.96), Chinese participants (OR 0.58, 95% CI 0.39-0.86) and Chinese speaking participants (OR 0.50, 95% CI 0.33-0.76) were also less likely to report statin use following CAC identification, and a trend was noted for SDOH score (OR 0.53, 95% CI 0.26-1.09).

Conclusion:
This study identifies disparities in statin use after identification of CAC by race/ethnicity, language and social determinants of health. Future studies should investigate underlying reasons for these disparities and potential interventions to reduce disparities in cardiovascular care.
Abstract 4124655: Multi-trait analysis identifies 307 genomic loci for thoracic aortic diameter and disease
Authors: Zamirpour Siavash , Depaolo John , Brundage James , Damrauer Scott , Pirruccello James
Published: November 2024

Introduction:
Thoracic aortic aneurysm and dissection (TAAD) is a morbid cardiovascular disease with 21 known common-variant genomic risk loci. Aneurysm represents an extreme of diameter, so we sought to jointly analyze TAAD and aortic diameter to enhance discovery power.

Methods:
Genome-wide association studies (GWAS) were performed for UK Biobank MRI-derived aortic diameter measured at the aortic root (N=62,919), ascending aorta (N=61,156), and descending aorta (N=62,412). Separately, TAAD GWAS summary statistics from UKB (1,076 cases, 416,263 controls), FinnGen (3,880 cases, 381,977 controls), and the Million Veteran Program (8,626 cases, 453,043 controls) were meta-analyzed. Genetic correlation was assessed with
ldsc
. Multi-trait analysis was then performed for the aortic measurements and TAAD with
MTAG
. A 1.1-million-variant polygenic risk score (PRS) was produced and tested in the
All of Us
biobank.

Results:
The genetic correlation between ascending aortic diameter and TAAD was 0.83 (P=6.6E-129). The TAAD meta-analysis had an effective sample size of 53,516, augmented to 147,377 after multi-trait analysis. We identified 59 risk loci for TAAD (189 in the multi-trait analysis). These loci included one on the X-chromosome near
MIR222HG
, previously reported to be regulated by angiopoietin-2; others were near TGF-β-superfamily members (
FBN1
,
FBN2
,
GDF6
,
GDF7
,
LTBP4
,
TGFB2
,
SMAD3
); genes involved in vasoconstriction (
ADRA1D
,
ADRB1
,
ANGPT1
,
EDN1
,
EDN2
,
EDNRA
,
PDE3A
); and cell cycle regulators (
CCND2
,
CCNE1
,
CDC27
,
CDK6
,
CDKN1A
,
CDKN1B
,
CENPW
,
DSCC1
,
MAD2L1
,
TP53
). 307 distinct loci were significantly associated with at least one of the four traits; all but 7 TAAD loci were genome-wide significant for one of the three aortic measurements, and all loci had at least sub-significant signal in those traits. Gene-set analyses highlighted contributions from fibroblasts, pericytes, and vascular smooth muscle cells. In
All of Us
, a one standard deviation (SD) greater PRS was associated with a hazard ratio (HR) of 1.88 for TAAD (P=1.2E-78) and 1.62 for thoracic aortic dissection (P=5.7E-05). Individuals in the top 5% for the PRS had HR 3.77 for TAAD (P=2.7E-48) and HR 2.87 for thoracic aortic dissection (P=3.3E-03).

Discussion:
The multi-trait analysis yielded an eight-fold expansion of loci for TAAD risk. The findings underscore that sporadic TAAD is a complex, common disease—intricately linked with the processes associated with normal variation in aortic diameter.