bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4138449: High Output Heart Failure from an Aortocaval Fistula
Authors: Wubker Diaz Laura , Spence-Miller Shanice , Sancassani Rhea , Bornak Arash , Colombo Rosario
Published: November 2024

Introduction:
High output heart failure (HOHF) due to a post-traumatic aortocaval fistula is a rare entity. This case seeks to explore the presentation as well as complexities of management of these patients.

Case Presentation:
A 50-year-old male with a prior right abdominal stab wound requiring exploratory laparotomy 20 years ago presented with worsening dyspnea on exertion and palpitations. Physical examination was remarkable for jugular venous distention, lower extremity edema, and a pulsatile mass in the right abdomen with an audible bruit. A 12-lead ECG showed rapid atrial flutter. A transthoracic echocardiogram (TTE) showed a reduced left ventricular ejection fraction (LVEF) of 30-35%, severely dilated atria and inferior vena cava (IVC) with high velocity flow.

Abdominal computed tomography venogram showed dilation of the IVC up to 8cm and an aortocaval fistula at the level of the right renal vessels, resulting in an atrophic right kidney. Cardiac catheterization was notable for a cardiac output (CO) of 12L/min, cardiac index (CI) of 7L/min/m2 and reduced systemic vascular resistance (SVR). He was managed with beta blockers and diuretics, followed by TEE-guided cardioversion for atrial flutter to restore sinus rhythm. Vascular surgery performed a successful, first of its kind endovascular repair of the abdominal aorta with stenting of the right common iliac artery and placement of a 20mm Amplatzer Septal Occluder device in the right renal artery. He tolerated the procedure well, and post-operative TTE showed a recovered LVEF of 55-60% and CO of 6L/min.

Discussion:
HOHF is defined by a CO more than 8L/min or CI more than 4L/min/m2 along with clinical symptoms. Decreased SVR leads to sympathetic activation and stimulation of the renin-angiotensin-aldosterone system, leading to fluid retention, cardiac remodeling, and exacerbation of symptoms. Challenges present in the management of HOHF and the use of vasodilatory agents should be avoided, as they can exacerbate the problem. In our case, limitations were also faced in the use of many traditional HF therapies due to renal dysfunction as a result of the fistula. Therefore, repair was the only viable long-term solution.

Conclusion:
This case displays an uncommon etiology of HOHF, emphasizing the need for meticulous evaluation to ensure proper management. Early detection of aortocaval fistulas is crucial to prevent worsening cardiac dysfunction, with symptoms resolving rapidly post-repair.
Abstract 4138455: Employing Bioinformatic Tools to Identify High-Risk Variants of Unknown Significance in Aortopathy Genes Associated with Aortic Dissection
Authors: Depaolo John , Guo Dongchuan , Murdock David , Cecchi Alana , LeMaire Scott , Shen Ying , Estrera Anthony , Coselli Joseph , Smith Joshua D. , Bamshad Michael , Damrauer Scott , Milewicz Dianna
Published: November 2024

Introduction:
Pathogenic (P) or likely pathogenic (LP) aortopathy gene variants cause hereditary thoracic aortic aneurysm and dissection, but P/LP variants only explain approximately 20% of cases of thoracic aortic disease. Variants of unknown significance (VUS) are frequently identified among individuals undergoing genetic testing for thoracic aortic disease, however managing patients with VUSs remains clinically challenging.

Hypothesis:
Bioinformatic tools can be used to determine thresholds above which VUSs may be considered “high-risk.”

Methods:
Primary analyses were performed in the Penn Medicine Biobank (PMBB) which is composed of 43,731 participants who volunteered to have clinical information linked to biospecimen data including DNA which has undergone whole exome sequencing. PMBB participants were screened for VUSs in one of 11 aortopathy genes. VUS REVEL, AlphaMissense and minor allele frequency (MAF) high-risk thresholds were derived using cutpointR, a statistical package to optimize continuous variable thresholds based on binary outcomes. These thresholds were applied to VUS carriers in the PMBB and two independent validation cohorts. Logistic regression analysis was performed to test the association of high-risk VUSs with prevalent thoracic aortic disease.

Results:
There were 11,925 individuals in PMBB who carried at least one missense VUS. Carrying a VUS was associated with a modest increased risk of thoracic aortic aneurysm (TAA: OR=1.14, 95% confidence interval [CI] 1.01 to 1.29,
P
=0.034) but no increased risk of thoracic aortic dissection (OR=1.04, 95%CI 0.55 to 2.00,
P
=0.896). As VUS REVEL or AlphaMissense increased, or MAF decreased, the association between VUSs and thoracic aortic disease became statistically significant. Using cutpointR, we derived REVEL (>0.649), AlphaMissense (>0.2543), and MAF (<8.16x10
-6
) thresholds that together identified 435 high-risk VUSs robustly associated with prevalent dissection (OR=7.85, 95%CI 4.73 to 13.03,
P
<0.001), though the association with TAA was attenuated (OR=2.35, 95%CI 1.62 to 3.42,
P
<0.001). Similar results were observed in the UK Biobank (UKB) and Early Onset Sporadic Thoracic Aortic Dissection (ESTAD) cohorts.

Conclusions:
VUSs that met high-risk bioinformatic thresholds were strongly associated with prevalent aortic dissection in the PMBB, UKB and ESTAD. Future investigation is warranted to determine if these thresholds can instruct clinical care of individuals carrying aortopathy gene VUSs.
Abstract 4138484: Exploring medical students’ clinical preparedness to provide cardiovascular care for sexual and gender minorities
Authors: Koehler Andreas , Beyer Rebecca , Nieder Timo , Briken Peer , Smith Sidney , Simpson Ross
Published: November 2024

Sexual and gender minorities (SGM) have unique risk factors for cardiovascular disease (CVD). A higher likelihood of tobacco use, inadequate exercise, diabetes, dyslipidemia, hypertension, and obesity have been found, driven by increased psychosocial stressors across the lifespan. Specific treatments, especially gender-affirming hormone therapy, can also increase the CVD risk. Even though SGM-related issues have been introduced into medical education, students’ expertise regarding cardiovascular care for SGM populations has not been studied. The present study examines the clinical preparedness, attitudes, and basic knowledge of medical students regarding cardiovascular care for SGM populations.

Medical students from Germany were recruited to take part in an online survey. Additionally, medical students from the UK and the USA will be recruited in the future. We used a variety of channels for recruitment (e.g., mailing lists of student councils, social medical groups). The LGBT-DOCSS was used to assess SGM-related clinical competency. Based on prior work of our research group, we developed items to assess the knowledge of SGM-related cardiovascular care and educational needs. We calculated descriptive statistics to describe the outcomes of interest.

Currently, 217 medical students (20% final-year) from 5 German medical schools participated in the study. Regarding general SGM-related clinical competency, participants scored below average on clinical preparedness (3.4/7.0), above average on basic knowledge about SGM-specific healthcare (5.1/7.0), and low on explicit bias and prejudice towards SGM individuals (6.4/7.0). 84 % of the participants reported not feeling appropriately prepared to deliver cardiovascular care for SGM populations. Most participants (72 %) only knew about one or two SGM-specific CVD risk factors. There was a high interest in learning about cardiovascular care for SGM populations (96%) and a preference to implement the issue in medical school curricula (93%). Additional data from Germany, the USA, and the UK will be presented at the time of the conference presentation.

The present study provides insights into the clinical preparedness of medical students regarding cardiovascular care for SGM populations. Despite showing a high interest in learning about SGM-specific cardiovascular care, most medical students feel underprepared on the issue. Implementing SGM-specific cardiovascular health into medical school curricula could close this gap.
Abstract 4138486: Unplanned Readmissions Due to Post-Acute Myocardial Infarction Complications: Insights from the Nationwide Readmission Database
Authors: Eltawansy Sherif , Udongwo Ndausung , Fatuyi Michael , Ghali Jalal , Heaton Joseph , Almendral Jesus
Published: November 2024

Introduction:
Acute myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. Despite advances in treatment, readmissions within 30 days remain a significant concern, impacting both patient outcomes and healthcare costs. This study aims to analyze trends in 30-day readmission rates (30-dr) for patients discharged after an acute MI.

Methods:
We analyzed the 2016-2020 Nationwide Readmission Database for patients aged ≥ 18 years with initial admission of acute MI and were readmitted within 30 days. Variables were identified using ICD-10 codes. The primary outcome was trends in 30-dr; secondary outcomes included trends in complications, mortality rate, length of stay (LOS), and healthcare costs. Multivariate and descriptive bivariate analyses were conducted, with p-values <0.05 considered statistically significant.

Results:
There was a notable decrease in the acute MI index admissions total number from 507,608 in 2016 to 471,292, p trend < 0.01. The index admission mean age throughout the study years was 66.9 ± 13.5 years, with 62.7% male patient. Index admission inpatient mortality dropped reaching OR 0.92 (CI 0.88-0.96) by 2020 with a drop of 0.08 OR from 2016 with (p trend < 0.01) using logistic regression. The index admission LOS remained consistent with allover average 4.64 days (p trend = 0.25). The mean healthcare costs saw a significant increase from $22,456 in 2016 to $27,249 in 2020 (p trend < 0.01). The 30-dr trend decreased from 9.41% in 2016 to 7.8% in 2020 (p trend < 0.01). The top five readmission reasons in order included heart failure (14.94%of total readmission), myocardial reinfarction (13.59%), sepsis (4.49%), Acute kidney injury(2.4%), and chest pain(2.1%). The risk of readmission went up 1% for each year increase of age and 12% for female gender (using OR,logistic regression), despite initial admission was more male dominant.

Conclusion:
Our study demonstrates a declining initial admission, its mortality rate,and 30-dr. There was readmission healthcare costs increase. We noticed four top complications-driven readmission falling under cardiovascular diseases category with the top one as heart failure and myocardial reinfarction. This study tries to highlight relevant data to target interventions to reduce readmissions and complications, ultimately improving patient outcomes and reducing the healthcare economic burden.
Abstract 4138507: Uncovering Risk Factors for Myocarditis and Cardiac Arrhythmia in Youth Post-SARS-CoV-2 Infection: Insights from the N3C Database and Advanced Machine Learning
Authors: Goggins Ann , Jurkovitz Claudine , Zhang Ran , Hossain Md Jobayer , McCahan Suzanne , Chen Chuming , Bunnell Timothy , Gumpili Sai Prashanthi , Prospero Carol , Cowart Julie , Akins Robert , Wu Cathy , Srivastava Shubhika
Published: November 2024

Background:
SARS-CoV2 infection has been associated with cardiovascular consequences, including myocarditis and cardiac arrhythmias. Myocarditis secondary to SARS-CoV2 infection and cardiac arrhythmias may often go unrecognized and can present with late and nonspecific symptoms. Predicting those at risk allows for prompt treatment and prevention of their potentially life-threatening consequences.

Methods:
The National COVID Cohort Collaborative (N3C) database was used to identify patients aged 0-30 years with COVID-19 index date between 1/1/2020 and 3/31/2022, whose sites provided data for at least six months beyond the index date. Outcomes included myocarditis and new arrythmias within 6 months of the index visit. Patients with known cardiac comorbidities were excluded. Predictors included gender, race, COVID severity as an ordinal scale, vaccination status, clinical comorbidities, and Area Deprivation Index (ADI). The data were stratified by age groups (0-4, 5-17, 18-30). Random forest models were used for data analysis and SHapley Additive exPlanations (SHAP) method was applied to optimize results. These analyses were conducted using the NCATS N3C Data Enclave.

Results:
Of the 1,487,741 patients in our study population, 4,105 (0.28%) had the measured outcomes; 404 had myocarditis only, 3,634 had arrhythmia only and 67 had both. Severity of COVID (SHAP 0.2344 for 0-4 years, 0.2114 for 5-17, 0.1370 for 18-30) was identified as the most important risk factor for de-novo myocarditis and arrhythmias overall. Increase in ADI (indicating lower socioeconomic status) was the second most important risk factor for the 0-4 and 5-17 age groups (SHAP: 0.0370, 0.0223). Among the 18-30 age group, race (SHAP 0.0321) and gender (SHAP 0.0289) were the second and third most important risk factors, with White and Black patients more likely to develop an event and Hispanic patients less likely. Women were less likely to develop a cardiac outcome than men.

Conclusion:
The severity of COVID was identified as the most important risk factor for the occurrence of myocarditis or cardiac arrhythmia within 6 months of infection. ADI, race, and gender were also identified as important, though less influential, risk factors.
Abstract 4138558: The effect of pulsatile vs. non-pulsatile perfusion on hospital stay, ICU stay, and intubation time in patients undergoing cardiopulmonary bypass: A meta-analysis randomized controlled trials.
Authors: Mahmoud Abdelrahman , Ramadan Mohamed , Amin Ahmed Mazen , Salamah Hazem Mohamed , Ahmed Ali Ashraf Salah , Saeed abdallah , Ali Mohamed Ahmed , Elshenawy Salem , Ayman Dina , Alshaker Hassan , Katamesh Basant , Hassan Abdul Rhman , M. AlBarakat Majd , Alsaed Mohamad , Abdelazeem Basel
Published: November 2024

Background:
Pulsatile perfusion is a developing technique that attempts to mimic the natural pulsatile flow of blood during cardiopulmonary bypass (CBP).

Purpose:
Our meta-analysis was done to evaluate the effects of pulsatile perfusion in CPB compared to non-pulsatile on hospital stay, ICU stay, and intubation time.

Methods:
Randomized control trials that evaluated the implementation of pulsatile perfusion during CPB were identified by a literature search of the following databases (PubMed, Web of Science, Scopus, Central, and Embase) up to February 2024.

Results:
Our search yielded 33 trials with 3174 patients, the analysis showed that pulsatile perfusion led to a significant decrease in hospital stay [MD = -1.38, 95% CI (-2.51, -0.25), P = 0.016], ICU stay [MD = -0.47, 95% CI (-0.82, -0.13), P = 0.007], intubation time [MD = -3.73, 95% CI (-5.42, -2.04), P < 0.001]. However, no significant difference between the two regimens was detected in the adult subgroup when we performed sungroup analysis based on the age for hospital stay and ICU stay outcomes [MD = -0.31, 95% CI (-0.95, 0.33), P = 0.334] and [MD = -3.73, 95% CI (-5.42, -2.04), P < 0.001] respectively.

Conclusion:
Pulsatile perfusion showed positive effects on hospital stay, ICU stay, and intubation time. However, there was no difference between the two methods on hospital and ICU stay in the adult’s subgroup. Also, the outcomes showed significant heterogeneity, which requires more robust RCTs to be conducted to increase the quality and the certainty of evidence.
Abstract 4138593: Sex-, Age-and Racial- specific disparities, echocardiographic myocardial mechanics and biomarkers, and 1-year survival among patients with heart failure.
Authors: Matshela Mamotabo
Published: November 2024

Background:
Heart failure with reduced ejection fraction (HFrEF) is a global health burden affecting millions worldwide, particularly among resource constrained communities. Information is limited regarding addative prognostic relations of sex -, age- and racial- differences, myocardial mechanics and biomarkers, in HFrEF.

Aim:
Assess prognostic implications of sex-, age- and racial- related disparity in HFrEF; and additive prognostic implications of these parameters to other markers including echocardiography (myocardial mechanics).

Methodology:
The HFrEF patients’ data were prospectively evaluated during the initial assessment and those hospitalized, and subseguently followed for at least 12months. Patients' KCCQ and EQ-5D-5L Questionnaires were assessed during the initial evaluation and follow-up. Sex, age and racial/ethnic disparities, in-hospital management, follow-ups, health status and 1year mortality were assessed. These parameters were further assessed in addition to biomakers and echocardiographic parameters including LV and RV systolic and distolic strain. Multivariable Cox regression models were fitted to investigate additive prognostic differences.

Results:
The study population consisted mainly of blacks and major factors were hypertension, diabetes, mitral valve disease, and older age (p<0.0001). Of the initial
2642 screened, only 1883 completed the 1year follow-up visit (mean LVEF 38%).
Women were likely to have hypertension, atrial fibrillation and diabetes (p<.001). Rheumatic or valvular heart diseases were more commonly identified among younger, black ethnicity, and males patients. No demonstrated sex differences in functional class and biomarkers including NT-proBNP levels. Men demonstrated significant risk for one-year mortality than women, as was black ethnicity and older age. Impaired strain parameters (RV>LV systolic) were independent risk factors for poor survival, more so when added to sex, racial ethnicity, age and biomarkers i.e. the NT-proBNP levels.

Conclusion:
The prevalence of HFrEF was higher than anticipated. Men, black ethnicity and older age were associated with a high one-year mortality. Impaired strain (RV>LV systolic) parameters were independent risk factors for poor survival, with additive prognostic implications to sex, racial ethnicity, age and traditional biomarkers. These parameters should be assessed routunely to risk stratify HFrEF patients earlier during their disease course.
Abstract 4138602: Effect of Left Ventricular Ejection Fraction On Computed Tomography-Derived Fractional Flow Reserve Diagnostic Accuracy For Significant Coronary Artery Disease
Authors: Narvaez-Guerra Offdan , Offord Evan , Denu Mawulorm , Mahagaokar Kedar , Gerson David , Aurigemma Gerard , Fitzgibbons Timothy
Published: November 2024

Background:
Coronary Computed Tomography Angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR) accurately assess the severity of coronary artery disease. However, the diagnostic accuracy of CT-FFR in patients with low left ventricular ejection fraction (LVEF) is unknown.

Goal:
Describe the per-vessel diagnostic performance of CT-FFR to detect significant coronary disease in patients with normal and reduced LVEF by echocardiogram.

Methods:
This was a retrospective study of 441 patients who underwent CCTA and CT-FFR at the UMass Memorial Health System between 2020 and 2023. Those with echocardiogram and invasive coronary angiography were analyzed and divided in two groups based on two-dimensional LVEF: those with LVEF < 55%, and with LVEF ≥ 55%. We excluded those with prior coronary stents, incomplete CCTA, CT-FFR data due to artifacts, or poor-quality echocardiographic images. CT-FFR ≤ 0.8 was considered abnormal. Significant coronary disease by invasive angiography (reference standard) was defined as lumen stenosis ≥ 70% (left main ≥ 50%), or abnormal physiologic characteristics by FFR, resting full-cycle ratio, or instantaneous wave-free ratio.

Results:
222 coronary vessels (102 patients) were analyzed. Of 102 vessels (44%) with significant coronary artery disease, 55 (53.9%) were treated with percutaneous coronary intervention, and 25 (24.5%) with coronary artery bypass grafting. Overall, CT-FFR sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 86.7% (95%CI 78.3-92.7), 75.0% (95%CI 66.4-82.3), 73.2% (95%CI 66.6-78.9), 87.7% (95%CI 81.0-92.3), and 80.1% (95%CI 74.3-85.2), respectively. 37 vessels corresponded to patients with LVEF < 55%, and 185 to those with LVEF ≥ 55%. Diagnostic accuracy in both groups is seen in table 1.

Conclusions:
Low-normal and reduced LVEF adversely affects the diagnostic performance of CT-FFR, by reducing sensitivity, and slightly increasing specificity.
Abstract 4138662: Mineralocorticoid receptor antagonist in patients with acute myocardial infarction: An updated systematic review and meta-analysis of randomized trials
Authors: d'Entremont Marc-Andre , Cheema Zain , Chauhan Ashwin , Kedev Sasko , Cornel Jan , Stankovic Goran , Moreno Raul , Storey Robert , Bossard Matthias , Montalescot Gilles , ZANNAD Faiez , Beygui Farzin , Pitt Bertram , Jolly Sanjit
Published: November 2024

Background:
While mineralocorticoid antagonists (MRA) reduce mortality in patients developing heart failure post myocardial infarction (MI), it is unclear whether they are beneficial in an unselected post-MI population.

Aims:
Using a systematic review and meta-analysis, we aim to determine the effect of MRA treatment versus no MRA treatment on all-cause mortality in unselected post-MI patients from randomized data, simultaneously with the presentation of the largest randomized controlled trial on the topic, the CLEAR SYNERGY trial.

Methods/Approach:
We completed a systematic review of all randomized controlled trials comparing MRA treatment to no MRA treatment in post-MI patients. We will perform our primary analysis using fixed effects with the Peto odds ratio method and use random effects as a sensitivity analysis. The primary outcome will be all-cause mortality, and secondary outcomes will include cardiovascular mortality, new or worsening heart failure, recurrent myocardial infarction and stroke.

Results/Data:
Our systematic review of Pubmed, Embase, and CENTRAL from inception until April 30, 2024, yielded 456 records. A total of 11,199 participants from 11 randomized clinical trials will be included in addition to the late-breaking CLEAR SYNERGY trial. The CLEAR SYNERGY trial is a 2 x 2 factorial randomized controlled trial of low-dose colchicine 0.5mg daily versus placebo and spironolactone 25mg daily versus placebo in 7,062 post-MI patients who were within 72h of the index percutaneous coronary intervention. The results of the spironolactone factorial will be presented in the fall of 2024 with an expected median follow-up of 3.5 years. As the investigators of the CLEAR SYNERGY trial, we will combine our data with the other 11 trials for a total of 12 trials and 18,261 participants.

Conclusions:
CLEAR SYNERGY is the largest randomized controlled trial with the longest follow-up of spironolactone in the post-MI population. Our meta-analysis will provide updated effect estimates of post-MI MRA treatment, leveraging the late-breaking CLEAR SYNERGY data to reflect the totality of the evidence.
Abstract 4138663: Peak nocturnal home blood pressure as an early and strong novel risk factor for stroke: the practitioner-based nationwide J-HOP Nocturnal BP study
Authors: Kario Kazuomi , Okawara Yukie , Kanegae Hiroshi , Tomitani Naoko , Hoshide Satoshi
Published: November 2024

Background:
Clinical implications of high peak nighttime home blood pressure (BP) are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in individuals with ≥1 cardiovascular risk factor.

Methods:
In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days at baseline using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare). Peak nighttime home SBP was defined as average of the highest three values over the 14-night measurement period. Occurrence of cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) was determined over a mean 7.1 years’ follow-up.

Results:
This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male). After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), stroke risk was significantly higher in individuals with peak nighttime home SBP in the highest (Q5, ≥149.0 mmHg) versus lowest quintile (Q1, <119.3 mmHg) (hazard ratio [HR] 4.24, 95% confidence interval [CI] 1.07–16.77; p=0.039 overall and 8.92, 1.49–53.43; p=0.017 in the subgroup with ≥6 nighttime home SBP measurements). This increased stroke risk remained significant after controlling for day-by-day average real variability of nighttime BP. The average peak nighttime home SBP cut-off value for predicting an increased risk of incident stroke was 136 mmHg.

Conclusions:
We propose exaggerated peak nighttime home SBP determined from ≥6 measurements as a novel risk factor for stroke, independent of conventional office and home BP values.
Abstract 4138672: Blood Pressure and Cardiovascular Outcomes in Adults with Diabetes and Chronic Kidney Disease
Authors: Lee Hyeok-Hee , Jhee Jong Hyun , Kim Eun Jin , Kim Hyeon Chang , Shimbo Daichi , Lee Hokyou
Published: November 2024

Background:
Most international guidelines recommend intensive blood pressure (BP) targets (e.g., <130/80 mm Hg) for patients with chronic kidney disease (CKD). However, the data supporting these recommendations are limited, particularly for those with concomitant diabetes.

Hypothesis:
Systolic BP (SBP) <130 mm Hg and diastolic BP (DBP) <80 mm Hg are associated with a reduced risk of cardiovascular disease (CVD) in adults with diabetes and CKD.

Aims:
To determine the association of BP with incident CVD risk among adults with diabetes and CKD.

Methods:
From a Korean nationwide health screening database, we identified 373,966 adults aged 20-79 with both diabetes and CKD who: (1) underwent baseline health examinations in 2009-2013; (2) had ≥3 BP measurements; and (3) did not have CVD at baseline. The associations of baseline average SBP and DBP with CVD risk were assessed using multivariable-adjusted cause-specific Cox models. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or death from CVD.

Results:
The median (Q1-Q3) age of the participants was 62 (53-70) years; 40.8% were female. Over a median follow-up of 10.2 years, a total of 40,781 incident CVD events occurred. Compared with SBP 130 to <140 mm Hg as the referent group, the multivariable-adjusted HRs (95% CIs) for CVD event in the SBP ≥150 mm Hg, 140 to <150 mm Hg, 120 to <130 mm Hg, and <120 mm Hg groups were 1.34 (1.29-1.39), 1.11 (1.08-1.14), 0.89 (0.87-0.91), and 0.77 (0.74-0.80), respectively. Compared with DBP 80 to <90 mm Hg as the referent group, the HRs (95% CIs) in the DBP ≥100 mm Hg, 90 to <100 mm Hg, 70 to <80 mm Hg, and <70 mm Hg groups were 1.70 (1.56-1.85), 1.19 (1.15-1.24), 0.88 (0.86-0.90), and 0.83 (0.80-0.87), respectively (Figure A). SBP <130 mm Hg and DBP <80 mm Hg were each associated with a reduced CVD risk in a log-linear manner (Figure B, Figure C). The findings were consistent when examining kidney instead of cardiovascular outcomes.

Conclusion:
Among patients with diabetes and CKD, SBP below 130 mm Hg and DBP below 80 mm Hg were associated with a reduced risk of CVD.
Abstract 4138719: Effect of Recombinant Human Brain Natriuretic Peptide on Cardiac Surgery Associated Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Zhang Heng , Han Jiawei , Zeng Juntong , Su Xiaoting , Zhou Hongyan , Liu Sheng , Zheng Zhe
Published: November 2024

Backgrounds:
Cardiac surgery associated acute kidney injury (CSA-AKI) is a prevalent and detrimental complication following cardiac surgery, with significant effects on both in-hospital and long-term morbidity and mortality. The effect on renal prognosis of recombinant human brain natriuretic peptide (rhBNP) for patients undergoing cardiac surgery remains unclear.

Purpose:
This study aims to evaluate the association between postoperative rhBNP and the risk of CSA-AKI following coronary artery bypass grafting (CABG).

Methods:
This retrospective cohort study included 16096 consecutive patients undergoing CABG between 2017 and 2022. The primary outcome was in-hospital postoperative AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcome was the amplitude of postoperative NT-proBNP reduction, defined as a difference value between the highest and last results during hospitalization. Multivariate Cox proportional hazards regression models and linear regression models were constructed to assess the association between perioperative statin and pre-defined outcomes.

Results:
A total of 9392 (58.3%) patients received postoperative rhBNP therapy, with a total of 1474 (9.2%) patients developing CSA-AKI. For the primary outcome, postoperative rhBNP was associated with a significantly increased risk of CSA-AKI (83.0% vs. 55.9%; adjusted Odds Ratio [OR], 3.615 [95% CI, 3.136-4.166]; p < 0.001). Noticeably, we found that postoperative rhBNP was also related to increased amplitude of postoperative NT-proBNP reduction, with an average of 3193.98 versus 1040.21 pg/mL (p for linear < 0.001). For the subgroup analysis, the association between postoperative rhBNP and reduced CSA-AKI risk was greater among patients with HFpEF (p for interaction = 0.087).

Conclusions:
Postoperative rhBNP therapy was associated with a significantly higher risk of CSA-AKI following CABG. Meanwhile, rhBNP contributed to NT-proBNP reduction postoperatively, with a more pronounced effect in patients with HFpEF.
Abstract 4138739: Insulin Resistance as a Marker of Multivessel Coronary Artery Diseases in Patients With Cardiovascular-Kidney-Metabolic Risk: Inshight From Invasive Coronary Angiography
Authors: FUJISAWA NAOKI , Otsuka Kenichiro , Yamaura Hiroki , Okamoto Akihiro , Yamaguchi Tomohiro , Kagawa Shunsuke , Shimada Takenobu , Shibata Atsushi , Ito Asahiro , Yamazaki Takanori , Fukuda Daiju
Published: November 2024

Background:
Cardiovascular-Kidney-Metabolic (CKM) syndrome is the concept of a combined diseases, including diabetes and chronic kidney disease (CKD), to stratify patients at cardiovascular risks. However, whether CKM components and insulin resistance differ in risk for coronary artery disease (CAD) severity is unknown.

Purpose:
This study aimed to investigate the association of distinct CKM risks and insulin resistance with CAD severity.

Methods:
In this study, we included 849 patients (74% male, 69±10 years of age) who underwent coronary angiography to assess chronic CAD. We assessed CKM risks using following components: (1) BMI ≥23 kg/m
2
, (2) diabetes, (3) hypertension and dyslipidemia, and (4) CKD. According to the number of CKM risk components, patients were categorized into four groups (Group A as having 0 or 1, Group B as 2, Group C as 3, and Group 4 as 4 risks). Insulin resistance was assessed by HOMA-IR and triglyceride-glucose index (TyG index) calculated as Ln (fasting plasma glucose × triglyceride/2). Coronary artery stenosis was categorized into single-vessel or multi-vessel CAD (MVD) per AHA classification. Gensini score was calculated to assess CAD extent. Logistic regression analysis was performed to determine independent predictors of MVD among CKM risk components.

Results:
MVD was diagnosed in 26.3% (n = 223) patients (mean Gensini score was 58±40 points). Among the four groups, there were significant differences in age, body mass index, hemoglobin A1c levels, TyG index, HOMA-IR, and Gensini score. Compared with Group A as reference, Group C (odds ratio [OR], 1.58; 95% confidence interval [CI] 1.03–2.42) or Group D (OR, 1.75; 95%CI, 1.06–2.89) but not Group B (OR, 1.09; 95%CI, 0.70–1.71) had higher risk for MVD (Figure). In a logistic regression model adjusting for age, male, smoker, and CRP ≥2 mg/dL, independent predictor of MVD was diabetes (OR, 2.15; 95%CI,1.55–2.99; p < 0.001; model 1 in Table). In addition, when adjusting for age, male, smoker, and CRP ≥2 mg/dL, HOMA-IR>2.5 was an independent predictor of MVD (model 2 in Table). Similarly, TyG index, an alternative marker of insulin resistance, remained as an independent predictor of MVD (model 3 in Table).

Conclusions:
In chronic CAD patients who underwent coronary angiography, subgroups stratified by the CKM risk components exhibit distinctly different insulin resistance, CAD severity and risk for MVD. Insulin resistance and diabetes were independent risks for MVD in this population.
Abstract 4138754: Analysis of Polarization Changes in Ascending Aortic Endothelial Cells Induced by Aortic Valve Regurgitation
Authors: Tamagawa Yuki , Kawamura Takuji , Harada Akima , Miyake Keisuke , Kawamura Ai , Kido Takashi , Yamashita Kizuku , Shimamura Kazuo , Saito Shunsuke , Miyagawa Shigeru
Published: November 2024

Background:
Fragility of the ascending aortic wall has been reported in patients with aortic regurgitation (AR), thought to be affected by turbulence in the ascending aorta. However, the mechanism behind this effect is unclear. We hypothesized that turbulence in the ascending aorta of AR patients causes changes in the polarization of endothelial cells. This study aimed to clarify that the polarization of endothelial cells in the ascending aortic wall is altered in AR patients.

Methods:
Twenty patients who underwent ascending aortic replacement at our institution from October 2022 to July 2023 were included: ten with thoracic aortic aneurysms (TAA) and ten with TAA and AR. The polarization of endothelial cells in the greater curvature of the ascending aortic wall collected during surgery was evaluated by measuring the ratio of the long axis to the short axis, the angle between the long axis and the blood flow axis, and the alignment of the Golgi apparatus and nucleus parallel to the blood flow.

Results:
There were no significant differences in patient background between the AR and non-AR groups. Additionally, there was no significant difference in the diameter of the ascending aorta between the two groups (AR vs. non-AR, 47.7±3.8 mm vs. 44.5±2.2 mm, p=0.479). The long axis to short axis ratio (aspect ratio) of endothelial cells in the ascending aorta was significantly smaller in the AR group than in the non-AR group. The angle (θ) between the long axis of the endothelial cells and the blood flow axis was significantly smaller in the AR group than in the non-AR group. The ratio of Golgi apparatus and nucleus alignment parallel to the blood flow was significantly lower in the AR group than in the non-AR group. Degeneration of the aortic tunica media was also observed in the AR group compared to the non-AR group.

Conclusion:
The results of this study suggest that the presence of AR alters the polarization of endothelial cells in the ascending aortic wall.
Abstract 4138794: Risk Factors of Cumulative Limb Amputation in Patients with Thromboangiitis Obliterans (Buerger's Disease): Insights from Nationwide Inpatient Sample
Authors: Zheng Shuo , Yang Yi , Wu Fangqin , Ling Danyang , Chen Ziwei , Hu Zhizhi , Ai Lisha , Su Guanhua , Wang Qi , Li Wenzhu
Published: November 2024

Background:
Thromboangiitis obliterans (TAO) is a rare, nonatherosclerotic, inflammatory disease that typically onsets in male patients at young age with heavy smoking. TAO commonly affects small and medium-sized arteries in extremities, and up to 1/3 of patients with TAO will experience limb amputation. However, the role of social determinants of health (SDoH) are not well studied in TAO patients with limb amputation in a real-world dataset.

Methods:
A cross-sectional study was performed in Nationwide Inpatient Sample (NIS) of United States, from calendar year 2016-2021. The diagnosis of diseases was identified by ICD-10-CM codes. Univariable logistic regression analysis was performed to identify characteristics associated with cumulative limb amputation (CLA). Stepwise multivariate logistic regression model was further employed to analyze association between significant characteristics and CLA.

Results:
In this study, 33.3% (N=432) patients with TAO (N=1297) had CLA. Variables showed significant association with CLA identified by univariable analysis were further included in stepwise multivariate logistic regression model. In the multivariate model, middle-age patients had higher risk of CLA than young patients (OR=1.41, 95% CI=1.00-1.99, p=0.050). Female showed lower CLA risk than male patients (OR=0.53, 95% CI=0.41-0.69, p<0.001). Black patients showed higher CLA risk than White (OR=1.82, 95% CI=1.24-2.68, p=0.002). Compared to Medicare insurance, self-pay (OR=0.51, 95% CI=0.30-0.87, p=0.014) and Private insurance (OR=0.69, 95% CI=0.49-0.97, p=0.035) patients had lower CLA risk. Higher socioeconomic status associated with lower CLA risk, and patients in the 3
rd
percentile had significantly lower CLA risk than those in the 1
st
percentile (OR=0.68, 95% CI=0.49-0.95, p=0.028). Patients with tobacco smoking showed higher CLA risk (OR=2.11, 95% CI=2.49-3.00, p<0.001).

Conclusions:
The CLA rate was up to 33.3% among the TAO patients in NIS 2016-2021. SDoH like age, sex, race, insurance type and socioeconomic status showed significant association with CLA risk in TAO patients. Further studies are warranted to explore mechanism, health equity and multidisciplinary care to decrease CLA for patients with TAO.
Abstract 4142517: Reduced Global Longitudinal Strain Assessed by Echocardiogram is Associated with Higher Collateral Burden and Volume Overload in Fontan Patients
Authors: Moreno Andres , Beattie Meaghan , Buddhe Sujatha , Chen Sharon , Syed Ali , Maskatia Shiraz
Published: November 2024

Background:
In patients with Fontan palliation, ejection fraction (EF) and global longitudinal strain (GLS) are associated with exercise capacity and survival. We investigated the associations between EF and GLS on echo and 4-dimensional phase contrast (4DF) cardiac MRI (CMR) parameters, including percent collateral flow (%CF).

Methods:
Single-center, retrospective review of patients post-Fontan who underwent CMR in 2023 and echocardiogram within 1 year. GLS was measured on echo in the apical 4-chamber view. %CF and regurgitant fractions were measured using 4DF. Indexed ventricular end-diastolic (iEDV) and end-systolic (iESV) volumes and EF were also measured. Descriptive data are presented as median (Q1 – Q3). Spearman correlation was used to compare continuous variables. Linear regression analysis was performed to quantify the relationship between GLS and predictor variables.

Results:
Thirty-two patients met inclusion and exclusion criteria. Of the 32 patients in the study cohort, 40.6% were females and 75% had a systemic right ventricle. Median age at CMR was 16.6 (12.1 – 20.0) years, median duration between echo and CMR was 49.5 (2 – 95) days. There was moderate to high correlation between GLS and iEDV, GLS and iESV, and GLS and EF. There was no significant association between %CF and GLS, and %CF and EF (table). Moderate or severe valve regurgitation was present in 12 (38%) patients. When excluding these patients, GLS had a moderate correlation with %CF, EF, iEDV, and iESV (table). Multivariable linear regression analysis was performed to test if a combination of CMR parameters could best predict GLS. EF and %CF, remained associated with GLS. The overall regression was statistically significant (R2 = 0.5, F(2, 17) = 8.75, p = .002).

Conclusion:
In this pilot cohort of Fontan patients, worse (less negative) GLS% was associated with larger iEDV and iESV. There was also an association between GLS and higher %CF when excluding patients with more than mild valve regurgitation. This relationship may be mediated by volume load of collateral flow on the heart. These data may provide evidence of an early impact of %CF burden and resultant volume overload on ventricular contractility.
Abstract 4142676: Advancing towards the development of an AI application for angina diagnosis through medical interviews
Authors: Fujita Kosuke , Shoda Yudai , KANNO Honoka , Handa Hisashi , Nakazawa Gaku
Published: November 2024

Background:
Interview techniques for angina pectoris in patients with chest pain have demonstrated a low positive probability of 35.7% (PROMISE study) when using the Diamond-Forrester approach, which evaluates pre-test probability (PTP) based on classic chest symptoms, age, and gender. Therefore, it is beneficial to use artificial intelligence (AI) to create a more precise medical interview system by combining patient clinical data. Our objective is to create such a system.

Methods:
A medical interview is taken from patients presenting with chest pain as a chief complaint. Then, coronary artery examinations (CAG, contrast-enhanced CT, stress tests) will be conducted to definitively diagnose angina. The results of these definitive diagnoses will be combined with the patients' baseline data to develop an AI algorithm. The input attributes used for the interview are listed in Table 1. A multilayer perceptron (MLP) was applied to predict patients diagnosed with angina pectoris, and these models were validated using 10-fold cross-validation.

Results:
There were a total of 315 patients, of whom 135 were diagnosed with angina pectoris. Additionally, patient information including atherosclerosis risk factors such as diabetes (102 cases), dyslipidemia (216 cases), hypertension (225 cases), and smoking status (never: 141 cases, past: 124 cases, current: 23 cases) were added as attributes and analyzed. Using only medical interviews and setting the threshold at 80% (where the AI determined the probability of angina to be 80% or higher), the prediction accuracy was 62.6%, with a sensitivity of 30.8% and a specificity of 87.7%. The precision was 66.6%. Additionally, when the four atherosclerosis risk factors were included, the prediction accuracy increased to 69.9%. Notably, the precision reached 79.9%. (Figure1)

Conclusion:
Our AI system based on interview data demonstrated high accuracy for diagnosis of angina while it was improved by adding the attribute of the four atherosclerosis risk factors. Further investigation is needed to complete a highly accurate AI-based application by increasing the number of samples.
Abstract 4142693: Deletion of Prekallikrein enhances atherosclerotic plaque stability and prevents plaque rupture by modulating macrophages and smooth muscle cells
Authors: Yu Fu , Jiang Hong , Yu Lilei
Published: November 2024

Background:
Atherosclerosis plaque rupture is the pathological basis and chief culprit of most acute cardiovascular events and death. Emerging evidence suggests that prekallikrein plays an important role in the pathogenesis of atherosclerosis including control of coagulation, complement, and inflammation processes, and regulation of cholesterol levels. However, little is known about the modulation mechanisms of prekallikrein in atherosclerotic plaque stability.

Method:
We divided 120 ACS patients into those with and without plaque rupture (PR and non-PR, respectively) based on optical coherence tomography image analysis, and quantified the patients' serum prekallikrein levels. Next, we engineered KLKB1 deficient mice (Klkb1
-/-
Apoe
-/-
) and a murine atherosclerosis model with vulnerable plaques was induced with high-cholesterol diet and perivascular carotid collar placement surgeries in Apoe
-/-
mice. Pathological staining was used to detect necrotic plaque cores, ratios of neutral lipids and cholesterol crystal, as well as collagen fiber contents in these mice to characterize plaque stability. Finally, we further investigated the role and mechanism of prekallikrein in smooth muscle cells and macrophages phenotype switching, proliferation and migration by in vitro experiments.

Result:
The serum prekallikrein levels of PR patients is significantly higher than that of non-PR patients, and significantly correlated with the thickness of the fibrous cap of the plaque and the length and arc of the lipids. which may be an effective predictor of PR. On a high-fat diet, Klkb1
-/-
Apoe
-/-
mice exhibit reduced necrotic plaque cores, as well as neutral lipid and cholesterol crystal ratios, with increased collagen fiber content. Additionally, macrophage apoptosis and phenotypic changes of smooth muscle cells are inhibited in the plaques of Klkb1
-/-
Apoe
-/-
mice. In vitro, Klkb1 deficiency inhibits ox-LDL-induced macrophage autophagy and the smooth muscle cells phenotype switching, proliferation and migration.

Conclusion:
In the present work, we uncover a crucial role for prekallikrein in atherosclerosis as an important regulator of macrophage apoptosis and macrophages phenotype switching and subsequently atherosclerotic plaque destabilization. Cumulatively, these results suggest that targeting prekallikrein may represent a new treatment strategy for the prevention and treatment of acute cardiovascular deaths caused by PR.
Abstract 4142807: DIFFERENTIAL CARDIAC PROTECTIVE RESIDENT MACROPHAGES IN FEMALE MICE WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION
Authors: Ocaranza Maria Paz , sepulveda Ruth , Moya Jackeline , Rojas Joaquin , Araos Patricio , Amador Cristian , Hermoso Marcela , Gabrielli Luigi , Jalil Jorge
Published: November 2024

Background:
Women with heart failure with preserved ejection fraction (HFpEF) exhibit better clinical outcomes than men. In the recent murine model of HFpEF elicited by a high-fat diet (HFD) coupled with
N
[w]-nitro-l-arginine methyl ester (L-NAME), female mice showed less cardiac remodeling than males, independently from sex hormones. Also, male cardiac macrophages (Mo) from mice are more susceptible to inflammatory stimuli. It is unknown whether cardiac pro-inflammatory Mo derived from monocytes (CCR2
+
MHCII
+
) and resident repair Mo (CCR2
-
MHCII
+
and CCR2
-
MHCII
-
) differ between males and females.

Purpose:
To characterize in mice of both genders with HFpEF the cardiac pro-inflammatory and the protective resident repair Mo.
Methods:
12-week-old male and female C57BL/6N mice received HFD (60% kcal from fat) and L-NAME (0.65 g/L in drinking water) or control diet during 15 weeks and then sacrified. Cardiac function and cardiac pro-inflammatory and repair Mo were determined.

Results:
(mean±SEM, n=11-13 mice/group). Compared with males, female mice with HFpEF gained less BW (30% vs 47%, p<0.001) and walked a greater distance on the treadmill (550±52 vs 365±28 mts, p<0.01). Blood pressure was similar and significantly increased in both genders (p< 0.001). Glucose intolerance was observed only in males with HFpEF. The left ventricle septum and posterior wall were thicker in HFpEF males vs controls and HFpEF females (p≤0.001, F=67.1). Left atrium size was increased only in males with HFpEF by 24% (p<0.0001). In the female myocardium, the CCR2
-
MHCII
-
Mo were significantly increased both in controls and in HFpEF mice vs male (p<0.001, F=11.4). Only in males with HFpEF, the CR2
+
MHCII
+
Mo increased by 59% (p<0.001, F=12.9) and the CCR2
-
MHCII
+
Mo decreased by 29% (p<0.05, F=3.7).

Conclusions:
The protective resident Mo (CCR2
-
MHCII
-
) are significantly increased in the heart of females versus males. In females, the HFpEF did not modify the levels of protective residents Mo which was associated to less CRM and better exercise performance in females versus males. Only in males with HFpEF, the cardiac monocyte-derived macrophages (CCR2
+
MHCII
+
) increased and resident macrophages (CCR2
-
MHCII
+
) that are partially replaced by monocytes decreased. The activation of resident cardiac Mo may be an important mechanism for prevention and treatment of cardiac remodeling in HFpEF. FONDECYT 1221585 (MPO), 1231604 (JJ), 1231909 (CAA), 11241074 (PA) and FONDAP 15130011(MPO, LG).