bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145446: Scalable Phenotyping of Heart Failure Across Multicenter, Non-Interoperable Health Systems Using Retrieval-Augmented Generation and Large Language Models
Authors: Vasisht Shankar Sumukh , Thangaraj Phyllis , Adejumo Philip , Khera Rohan
Published: November 2024

Background:
While identifying patient characteristics is critical to all electronic health record (EHR)-based research, the ability to do multicenter studies is impeded by differences in data structures, such that tools don’t generalize across EHRs. Large language models (LLMs) can be optimized with Retrieval-Augmented Generation (RAG) to enable EHR-structure agnostic queries for cohort characterization with minimal a priori knowledge of EHR structure. We develop and validate a tabular RAG model to extract clinical characteristics across multiple domains among patients with heart failure (HF) in 2 distinct health system EHRs.

Methods:
Our approach employs a novel RAG architecture, combining information retrieval and a generative text model (Llama2-13b) to enhance data extraction from medical records. This identifies data relevant to the query for a clinical feature and then uses the generative model to interpretably synthesize the output. We evaluated this model on 1000 HF patients from the Yale New Haven Health System and 1000 deidentified records from Beth Israel Deaconess Medical Center (MIMIC-IV). Clinical knowledge-based queries extracted patient records, across categorical features (demographics, conditions, and medications) and continuous features (vital signs and labs) [A]. We tested the RAG's performance against manually extracted variables from the tables.

Results:
The RAG model performed robustly across key variables in both cohorts, with overall extraction accuracy of 81% for Yale cohort and 82.9% for MIMIC cohort. For categorical variables like myocardial infarction, peripheral arterial disease, and medications (beta blockers, ACE inhibitors), Cohen's kappa values indicated strong agreement with ground truth (Yale: 0.8, 0.76, 1.0, and 0.82; MIMIC: 0.66, 0.83, 0.94, and 0.95). Continuous variables like creatinine, heart rate and systolic blood pressure showed high correlations (Yale: 0.99, 0.90 and 0.92; MIMIC: 1.0, 0.87 and 0.51) [B]. No significant statistical difference was found between ground truth and extracted values for all categorical variables (Mcnemar’s p-value > 0.05).

Conclusion:
LLM-optimized RAGs can accurately extract clinical information across multiple EHRs with varying data architectures. This introduces the potential for phenotype extraction at scale, with applications in federated multicenter research, spanning clinical trials and electronic clinical quality assessment.
Abstract 4145449: Heart in Overdrive: Poly-supplementation leading to myopericarditis
Authors: Abdalla Mahmoud , Reddy Vipul , Anjum Mahnoor , Abela Oliver , Ahmad Aftab
Published: November 2024

Introduction:
Performance-enhancing supplements have been linked to several detrimental cardiovascular events including demand ischemia, tachyarrhythmias, and sudden cardiac death. However, cases of myopericarditis have seldom been reported. We present a case of a previously healthy young male with myopericarditis secondary to performance-enhancing supplements.

Case presentation:
Patient is a 33-year-old athletic male with no significant medical history who presented with severe retrosternal chest pain and exertional dyspnea. The patient was athletic and used multiple performance-enhancing supplements including SERMs, TRT, thermogenic fat burner, Cardarine, and a caffeinated pre-workout. Labs were notable for a peak hs-cTn of 391. An EKG showed sinus rhythm with new onset incomplete RBBB, nonspecific T wave inversions, and ST deviations. A TTE revealed an EF of 45-50% and diffuse hypokinesia. He was subsequently admitted as a case of NSTEMI. The patient underwent left heart catheterization which revealed no evidence of CAD. Myopericarditis was confirmed by CMR which demonstrated late enhancement and increased T1 and T2 mapping. Biventricular systolic dysfunction was also noted with a left and right ventricular EF of 43% and 34% respectively. The patient was diagnosed with HFmrEF and discharged on GDMT; metoprolol succinate and lisinopril.

Discussion:
Despite the widespread use and accessibility of performance-enhancing supplements, the body of literature regarding their cardiovascular effects remains insubstantial. Their suspected cardiotoxic effects are not solely attributed to their inherent adverse properties but also from frequent product contamination with other cardiotoxic agents, such as heavy metals, introduced through substandard manufacturing practices. Furthermore, these supplements are frequently used in combination, further potentiating their adverse effects. A significant consideration is the lack of FDA testing to verify label accuracy leaving consumers without vital information on ingredients, dosages, and possible interactions thus subjecting them to undisclosed hazards. A thorough examination of regulatory testing in the supplement industry could yield a positive impact on public health and facilitate the establishment of guidelines for safe and effective usage. We hope that as the body of evidence continues to grow, we can better evaluate the effects of individual supplements and their potential interactions when used concomitantly.
Abstract 4145451: Efficacy of Left Atrial Appendage Occlusion with Watchman Device in the Population with BMI>25
Authors: Mir junaid , Alraies M Chadi , Al-Ahmad Majd , Al-Ahmad Anas
Published: November 2024

Background:
Left atrial appendage closure (LAAC) with Watchman device is an alternative strategy to oral anticoagulation for decreasing ischemic stroke risk in selected patients with non –valvular atrial fibrillation (AF). There is a paucity of data about the efficacy of watchman device in overweight/obese population.

Methods:
We queried the National Inpatient Sample of the years 2016 to 2020. We identified patients who were admitted for Watchman procedures using ICD10-PCS codes. The risk of mortality and in-hospital complications in overweight/obese group was compared to the non–overweight/non obese group using multivariate logistic regression analysis.

Results:
During 2016-2020, there were a total of 90060 patients who were admitted for Watchman procedure, of which 15765(17.5%) patients were overweight or obese while 74295 (82.5%) were neither obese nor overweight. After adjusting for demographics, watchman procedure in overweight/obese population had higher odds of arrhythmia (aOR (adjusted odds ratio) 1.19; 95% CI 1.08–1.31 p <0.001), AKI (aOR 1.32; 95% CI 1.03–1.68p =0.026), respiratory failure (aOR 1.52; 95% CI 1.16–1.98 p =0.02), and non-invasive ventilation (aOR 1.9; 95% CI 1.33–2.7 p<0.001). There were no differences in mortality, GI bleed, Length of stay (LOS) and mean total cost of care between the two groups.

Conclusion:
Left atrial appendage occlusion with Watchman device in overweight /Obese population

has higher odds of arrhythmia, AKI, respiratory failure, and non –invasive ventilation

compared to non-overweight/non obese population. Further studies are needed to

elucidate the benefit of Watchman device in the overweight/obese population.
Abstract 4145452: A platelet biosignature in psoriasis associates with enhanced cardiovascular risk
Authors: Drenkova Kamelia , Kazatsker Filipp , Muller Matthew , Schlamp Florencia , Luttrell-Williams Elliot , Liberow Sarah , McGirl Siobhan , Kennedy Lauren , Garelik Jessica , Lo Sicco Kristen , Berger Jeffrey , Garshick Michael
Published: November 2024

Introduction:
Studies display an increased cardiovascular (CV) risk in psoriasis, but the underlying mechanisms and prevention strategies are not known. We investigated platelet aggregation and the platelet transcriptome as one potential mechanism to explain CV risk in psoriasis.

Methods:
Recruited psoriasis and controls (from the community) underwent platelet aggregation studies with light transmission aggregometry, and a subset underwent bulk platelet RNA sequencing with downstream analyses in R Studio.

Results:
Psoriasis subjects (n=75, age 47 ± 15 years, percent body surface area of psoriasis 6%) compared to controls (n=44, age 41 ± 15 years) were older (
p
=0.02), overweight, (BMI [kg/m
2
] 28 ± 6 vs. 26 ± 5,
p
<0.01), more often carried a diagnosis of dyslipidemia (35% vs. 16%
p
=0.03) and had higher high-sensitivity C-reactive protein values ([hsCRP in mg/L 3.1 ± 4.5 vs. 1.8 ± 2.5,
p
=0.02). Platelet aggregation was significantly higher in psoriasis vs. controls with collagen (86.6% vs. 72.0%,
p
=0.03) and ADP (88.2% vs. 75.7% vs.
p
=0.03). Platelet RNA sequencing revealed in psoriasis vs. control 384 genes upregulated and 414 genes downregulated (
p
<0.05). Hierarchical clustering of the differentially expressed platelet RNA genes allowed a natural separation into three groups including one predominantly encompassing controls (18/20), a middle group (psoriasis = 24, controls = 20), and a third group of predominantly psoriasis (psoriasis = 25/26). Pathway analysis showed dysregulated TNF, interferon, and VEGF signaling pathways. Using penalized lasso regression, a psoriasis platelet RNA signature comprised of 400 differentially expressed platelet genes correlated with arterial stiffness (
r
=0.3,
p
=0.02), coronary plaque (
r
=0.5,
p
=0.02), and coronary calcium (
r
=0.5,
p
=0.02) burden.

Conclusion:
Platelet aggregation is significantly increased in psoriasis with the platelet transcriptome associated with pro-inflammatory pathways and CV risk. Our results warrant further investigation of platelet involvement driving the heightened CV risk observed in psoriasis.
Abstract 4145509: Invasive Versus Conservative Management Strategy in NSTE-MI in ≥70-Year-Old Patients: A Meta-Analysis.
Authors: Banga Akshat , Talaei Fahimeh , Munjal Parth , Trivedi Yash Vardhan , Rathore Sawai Singh , Gurav Jaiprakash , Sah Biki , Mautong Hans , Bansal Vikas
Published: November 2024

Background:
Ambiguity surrounds invasive management of non-ST-segment elevation myocardial infarction (NSTE-MI) in older adults (≥70 years), and the number of elderly patients undergoing invasive treatment in clinical practice remains relatively low. Data comparing the efficacy of invasive versus conservative medical management for NSTEMI in this population is conflicting due to the under-representation or exclusion of the older population from randomized controlled trials (RCTs).

Methods:
We performed a meta-analysis of RCTs to evaluate the long-term outcomes of invasive versus conservative medical strategies in older patients with NSTEMI. Random effects meta-analysis was conducted to estimate the odds ratio (OR) with 95% CI for the individual endpoints of all-cause mortality, cardiovascular (CV) mortality, recurrent myocardial infarction (MI), unplanned revascularization, and readmission for cardiovascular causes.

Results:
A total of nine RCTs with 4,336 patients (Invasive: 2,368; Control: 1,968) with median follow-ups ranging from 6-63.6 months were included. Compared with a conservative strategy, an invasive strategy was associated with a significantly decreased risk of recurrent MI (OR 0.62, 95% CI 0.47-0.81; p<0.001) (Figure 1) and unplanned revascularization (OR 0.38, 95% CI 0.25-0.56; p<0.001). There was no difference in all-cause mortality (OR 0.81, 95% CI 0.39-1.35; p=0.42) (Figure 2), CV mortality (OR 0.72, 95% CI 0.43-1.23; p=0.23), or readmission for cardiovascular causes (OR 1.21, 95% CI 0.63-2.33; p=0.57) between invasive and conservative management strategies.

Conclusion:
In older patients ≥70 years old with NSTE-MI, an invasive strategy reduced the risk of recurrent MI and revascularization when compared with conservative management. However invasive strategy did not offer any benefit in mortality or cardiac-cause related readmission over conservative management.
Abstract 4145572:
LMNA
p.Q353R Mutation Causes Dilated Cardiomyopathy through Impaired Vitamin D Signaling
Authors: Ito Masamichi , Katoh Manami , Nomura Seitaro , Komuro Issei
Published: November 2024

Introduction:
Dilated cardiomyopathy (DCM) is one of the causative diseases of heart failure, caused by genetic mutations. Cases with mutations in the
LMNA
gene, which encodes lamin A/C protein and constitutes the nuclear lamina, are known to have a poor prognosis. We have previously shown that the DNA damage accumulation and the consequent activation of DDR in cardiomyocytes are the cause of cardiac function impairment. However, the method to reduce DNA damage in the heart has not been elucidated. Therefore, we decided to explore the compounds that could reduce it in the cardiomyocytes.

Methods and Results:
We generated iPS cells from DCM patients with a LMNA mutation (p.Q353R) and differentiated them into cardiomyocytes. The mutant cardiomyocytes showed severe deformation of nuclear morphology as well as reduced contractility. In addition, the number of positive foci for γH2AX, a DNA double-strand break marker, was increased in the nuclei of the mutant strain. These results indicate that in vitro disease modeling using iPS cell-derived cardiomyocytes was successfully achieved.

We administered a library of 175 compounds to the mutant cardiomyocytes to search for compounds that reduce the positive foci of γH2AX. We found that vitamin D2 (VD2) significantly reduced DNA damage in the mutant strains. RNA-seq analysis revealed that VD2 restored the expression of DNA repair enzymes that were downregulated in the mutant strains.

We then screened binding molecules of the mutant LMNA p.Q353R protein and wild-type LMNA protein using a protein array. The screening results showed that the binding to the vitamin D receptor (VDR) was significantly enhanced in the mutant protein compared to the wild-type protein. In the mutant cardiomyocytes, VDR was localized to the periphery of the nuclear membrane, and reporter assays showed decreased transcriptional activity of VDR.

Finally, we examined the effects of VD2 on DNA damage accumulation and cardiac function in vivo. VD2 analog reduced DNA damage accumulation and improved cardiac function in two mouse models: a pressure-loaded heart failure model and a Lmna nonsense mutant cardiomyopathy model.

Conclusion:
Using patient-derived iPS cells, we could recapitulate various pathological processes in diseased cardiomyocytes, as well as identify therapeutic candidates through compound screening. One of the existing drugs, VD2, was a hit in this screening, and clinical trials for drug repositioning are expected.
Abstract 4145577: Barriers to the Brain: Unveiling the Impact and Disparities of Sentinel Cerebral Protection in TAVR Patients
Authors: Tan Samuel , Zheng Lucy , Siu Wenchy , Trenschel Robert , Rivera Boadla Marlon , KHURANA SAKSHI , GULATI AMIT
Published: November 2024

Background:
The Sentinel Cerebral Protection System (SCPS) was initially demonstrated to lower stroke risk during transcatheter aortic valve replacement (TAVR). However, recent trials have failed to confirm these benefits and have excluded patients with specific risk factors that increase stroke risk.

Research Question:
What are the outcomes, utilization trends, and disparities in the use of the SCPS during TAVR procedures, and how do these outcomes vary by race, ethnicity, and income levels?

Objective:
To evaluate the impact of the SCPS on in-hospital mortality, complications, hospital costs, and length of stay in patients undergoing TAVR, and to identify trends and disparities in SCPS utilization across different racial, ethnic, and income groups.

Methods:
This retrospective study utilized the National Inpatient Sample to identify patients undergoing TAVR and SCPS from 2017 to 2020. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included complications, hospital costs, and length of stay. Weighted multivariable logistic regression and chi-square tests were used to analyze outcomes, controlling for comorbidities, age, gender, and, when appropriate, race/ethnicity.

Results:
The study included 67,670 TAVR patients, with 4,410 using SCPS. SCPS prevalence increased from 180 to 2,790 over the study period without significant differences in mortality, length of stay, or cost compared to those without SCPS. Patients using SCPS had lower odds of stroke (OR: 0.48; p < 0.040) and post-procedural hemorrhage (OR: 0.682; p < 0.039). Hispanic patients utilizing SCPS had higher hospital costs ($55,983; p < 0.010) without a difference in length of stay. SCPS was less likely to be used in Black (OR: 0.49; p < 0.001) and Hispanic (OR: 0.36; p = 0.013) patients. Compared to White patients in the lowest income quartile, SCPS was more likely to be used in the second (OR: 1.28; p < 0.017), third (OR: 1.67; p < 0.001), and fourth (OR: 1.74; p < 0.001) quartiles. No similar income-based trend was observed for other racial or ethnic groups.

Conclusion:
No significant difference in in-hospital mortality was observed among patients using SCPS during TAVR. However, SCPS use was associated with lower odds of complications without changes in length of stay or cost. Despite these associated benefits and the absence of significant contraindications, disparities in SCPS utilization were observed across racial, ethnic, and income groups.
Abstract 4145578: Clinical and Angiographic Outcomes of Paclitaxel-Coated versus Limus-Coated Balloons for Coronary In-Sent Restenosis: A Systematic Review and Meta-analysis
Authors: Rodriguez Esteban , Callizo Bedoya Maria Agustina , Hariyanto Jesslyn , Batool Gharira , Vargas Maria , Medina Jesse , Ebner Bertrand , Torres Heisecke Raul , Colombo Rosario
Published: November 2024

Background:
Drug-coated balloon (DCB) angioplasty with paclitaxel-eluting devices is an established treatment for coronary in-stent restenosis (ISR). Limus-coated balloons have emerged as an alternative. We aimed to perform a meta-analysis comparing clinical and angiographic outcomes between limus-coated balloons (LCB) and paclitaxel-coated balloons (PCB) in coronary ISR.

Methods:
Databases were searched for randomized and non-randomized studies comparing LCB with PCB in patients with coronary ISR. Angiographic outcomes included percent diameter stenosis and in-segment late lumen loss (mm) as assessed by quantitative coronary angiography (QCA). Clinical outcomes included a composite of cardiac death, target lesion myocardial infarction (MI), and target lesion revascularization (TLR). Statistical analysis was performed using Review Manager (Cochrane Collaboration).

Results:
A total of 1,224 patients from 7 studies were included, 5 of which were randomized controlled trials. PCBs were used to treat coronary ISR in 577 (47%) patients. The mean follow-up was 13.7±4.5 months. The mean age was 66±10 years, with 76.3% being male. Type 2 diabetes mellitus was present in 44.4% of the patients, and 31.5% had a prior MI. There were no significant differences between PCB and LCB in terms of percent diameter stenosis (mean difference: -4.58%, 95% CI: -10.79 to 1.62, P = 0.15) or in in-segment late lumen loss (mean difference: 0.02 mm, 95% CI: -0.07 to 0.11, P = 0.72) at follow-up QCA. At 12 months, there were no significant differences in the composite outcome of cardiac death, target lesion MI, and TLR (RR: 1.01, 95% CI: 0.77 to 1.32, P = 0.97) between groups. LCB showed similar TLR rates compared to PCBs (RR: 0.64, 95% CI: 0.30 to 1.34, P = 0.23) at 12 months (Figures 1A and 1B).

Conclusion:
For patients with coronary in-stent restenosis, both paclitaxel-coated and limus-coated balloons offer effective treatment options with comparable clinical and angiographic outcomes. This provides reassurance and flexibility in treatment choices. The trend favoring PCBs in percent diameter stenosis warrants further investigation in larger, well-powered studies to compare these DCB types in similar populations.
Abstract 4145588: Evaluating the Cardioprotective Effects of Sodium-Glucose Cotransporter-2 Inhibitors in Cancer Patients: A Systematic Review and Meta-Analysis of Recent Studies
Authors: Nugooru Sudeep , Sevella Prerana , Ginnaram Shravya , Rallabhandi Sai Sri Harsha , Janga Chaitra , Haddad Enad , Sudireddy Kavya , Qadir Shayan , Shah Shreeja , Watson Robert
Published: November 2024

Background:
Cancer therapies, including anthracyclines and tyrosine kinase inhibitors, can induce cardiotoxic effects, increasing the incidence of heart failure (HF). With improvements in cancer survival rates, the focus has shifted towards minimizing non-cancer-related morbidities and improving overall quality of life. SGLT2 inhibitors (SGLT2i) have demonstrated efficacy in reducing cardiovascular events, particularly HF, in patients with and without diabetes. Given their dual cardioprotective and anticancer properties, these drugs present a promising therapeutic option in the cardio-oncology field. Preclinical studies have shown that SGLT2i, especially canagliflozin, can impede tumor growth in various cancer models.

Methods:
We conducted a systematic review and meta-analysis following PRISMA guidelines. Four studies were identified from three databases up to May 2024: MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. The SGLT2i used in these studies included canagliflozin, dapagliflozin, and empagliflozin. The total sample size was 10,775 patients, with 1,649 in the SGLT2i group and 9,126 in the control group. Outcomes analyzed were hospitalizations for HF, total adverse events, and all-cause mortality using R/R Studio.

Results:
SGLT2i significantly reduced the risk of hospitalizations for HF compared to control (OR: 0.50; 95% CI: 0.38–0.66, p < 0.01), with significant heterogeneity observed (I
2
= 71%, p = 0.02). The incidence of total adverse events was lower in the SGLT2i group (OR: 0.99; 95% CI: 0.84–1.16, p < 0.01), with high heterogeneity noted (I
2
= 98%, p < 0.01). SGLT2i showed a trend towards reduced all-cause mortality but was not statistically significant (OR: 1.01; 95% CI: 0.87–1.18, p < 0.01), and high heterogeneity was present (I
2
= 98%, p < 0.01).

Conclusions:
SGLT2i use in cancer patients is associated with a significant reduction in hospitalizations for HF. While there is a trend towards reduced all-cause mortality and total adverse events, the results are not statistically significant. The high heterogeneity in the analyzed studies suggests variability in patient populations and study designs, indicating a need for further research to confirm these findings.
Abstract 4145755: Trends and Factors Associated with Lipid-Lowering Therapies and High-Intensity Statin Utilization in 381,046 Patients Hospitalized for Acute Myocardial Infarction: A Nationwide Survey using JROAD-DPC
Authors: Hayakawa Koji , nakao kazuhiro , Yoko Sumita , Kanaoka Koshiro , Takagi Kensuke , Otsuka Fumiyuki , Kataoka Yu , Asaumi Yasuhide , Miyamoto Yoshihiro , Yasuda Satoshi , Noguchi Teruo
Published: November 2024

Background:
Lipid-lowering therapy plays a crucial role in the secondary prevention of coronary artery disease (CAD), particularly following acute myocardial infarction (AMI). While International Guidelines recommend the early initiation of high-intensity statins post-AMI, there remains limited insight into the patterns of lipid-lowering drug utilization across healthcare systems.

Purpose:
This study aims to analyze the temporal trends and influencing factors associated with the utilization of lipid-lowering therapy, with a focus on high-intensity statins, among patients hospitalized with AMI.

Methods:
Using data spanning 2012 to 2020 from the Japanese Registry of All Cardiac and Vascular Diseases (JROAD-DPC), including all procedures and prescriptions during hospitalization, we examined 381,046 AMI cases discharged alive from 1,091 hospitals. We defined lipid-lowering therapies as the use of statins, ezetimibe, or PCSK9 inhibitors, and high-intensity statin use based on the following dosages due to insurance limits in Japan: Atorvastatin 20 mg, Rosuvastatin 10 mg, or Pitavastatin 4 mg per day. We investigated trends in lipid-lowering drug and high-intensity statin use and examined associated factors through subcategory analysis, developing a multivariate mixed logistic regression model with each institute considered a random intercept.

Results:
Within the cohort (with an average age of 69.2 years and comprising 26.5% females), the proportion of patients receiving any form of lipid-lowering therapies increased from 78.0% to 88.2% between 2012 and 2020. Among these individuals, the percentage of those prescribed any statins rose from 77.8% to 85.8% over the same period. However, the utilization of high-intensity statins remained relatively low, accounting for only 31.3% of cases in 2020 (Figure). In subgroup analyses, the usage of high-intensity statins was notably lower among females (26.8%) compared to males (32.9%) in 2020 (p<0.001). Upon adjusting for multivariate factors, including comorbidities and AMI severity, females exhibited a significantly lower likelihood of receiving high-intensity statin therapy, with an odds ratio of 0.92 (95% CI [0.89, 0.94], p<0.001).

Conclusion:
The early initiation of high-intensity statins post-AMI remains suboptimal. Disparities in utilization exist for females compared to males. Efforts to promote early adoptation of high-intensity statins are warranted to optimize secondary prevention strategies for AMI patients.
Abstract 4145772: Evaluation of the AHA PREVENT Models in a Diverse US Veteran Population Among Race and Ethnic Groups
Authors: Mathew Roy , Khan Sadiya , Coresh Josef , Ndumele Chiadi , Rangaswami Janani
Published: November 2024

Background:
The AHA recently developed the Predicting Risk of Cardiovascular Disease EVENTS (PREVENT) equations. PREVENT estimates risk for total cardiovascular disease (CVD: a composite of atherosclerotic cardiovascular disease [ASCVD] and heart failure [HF]), includes kidney function (eGFR) as a predictor, and did not include race as a predictor.

Aim:
We evaluated model performance of the PREVENT equations and the pooled cohort equations (PCEs) in a large multi-ethnic sample of US Veterans and compared accuracy of PREVENT and PCEs among self-identified race and ethnic groups.

Methods:
The Loma Linda VA IRB provided ethical approvals. Data were accessed through the Veterans Integrated Networking and Computing Infrastructure, with death data provided through the VA Information Resource Center. Individuals aged 30-79 with available risk factor data between 1/1/2007 and 12/31/2009 and without baseline CVD were eligible for inclusion. For PREVENT, we evaluated the base models predicting total CVD and ASCVD. For PCEs, we evaluated model performance predicting ASCVD. We assessed model discrimination with the C-statistic and calibration with observed vs. predicted curves. All analyses were stratified by self-reported race and ethnicity and utilized R statistical software.

Results:
Among 2,500,291 adults, mean age was 60.3 years and 1.2% were Asian/Native Hawaiian/Pacific Islander (AANHPI), 5.2% Hispanic, 15% non-Hispanic Black (NHB), and 70% non-Hispanic White (NHW). Over a median follow-up of 8.7 years, the incident CVD rate was 16.5%. The C-statistic (95% CI) for PREVENT for total CVD was 0.70 (0.69-0.71) in AANHPI, 0.70 (0.69-0.70) in Hispanic, 0.68 (0.68-0.69) in NHB, and 0.65 (0.64-0.65) in NHW individuals. Similar C-statistics were observed for PREVENT-ASCVD and PCEs. Calibration curves demonstrated accurate prediction with PREVENT for CVD and ASCVD across the range of predicted risk. In contrast, PCEs overpredicted ASCVD at high predicted risk for all race and ethnic groups (
Figure
).

Conclusion:
The AHA PREVENT equations more accurately and precisely estimates risk across race and ethnic groups. This demonstrates that removing race as a variable from outcomes prediction does not diminish predictive performance.
Abstract 4145775: Risk of Cardiac Adverse Events of Post-transplant Cyclophosphamide versus No Post-transplant Cyclophosphamide in Patients with Hematological Conditions Receiving Stem Cell Transplantation: A Systematic Review and Meta-Analysis.
Authors: Herran-Fonseca Catalina , Jekov Laura , Aziri Buena , Persaud Carlotta , Begic Edin , Alabbas Fahad
Published: November 2024

Background:
Cyclophosphamide is an alkylating agent of the nitrogen mustard class that has become standard of care for graft-versus-host disease prophylaxis after hematopoietic stem cell transplantation. Although its cardiac toxicity in conditioning regimens is well-documented, data on cardiac events after administration of post-transplant cyclophosphamide (PT-Cy) administration remains limited.

Research Question:
Is PT-Cy associated with a higher incidence of cardiac adverse events compared with no PT-Cy?

Aims:
We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing PT-Cy versus no PT-Cy in patients with hematological disorders who received hematopoietic stem cell transplantation.

Methods:
We searched PubMed, Embase, and Cochrane Library for studies comparing PT-Cy versus no PT-Cy in patients with hematological conditions who received hematopoietic stem cell transplantation. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1, under a random-effects model. Heterogeneity was assessed using I2 statistics.

Results:
We included four studies, all of which were retrospective, with 1,546 patients, of whom 826 (53%) received PT-Cy. Age ranged from 18 to 77 years, and 840 (54%) were male. A total of 1549 allogeneic transplants were performed, primarily for malignant hematological conditions. The conditioning regimens used were myeloablative (52%), reduced intensity (33%), non-myeloablative (8%), and sequential (7%). The most common cardiac events in patients receiving PT-Cy were heart failure (28%) and cardiomyopathy (27%), followed by arrhythmias (25%), pericarditis/pericardial effusion (14%) and acute coronary syndrome (5%). The incidence of adverse cardiac events was significantly higher in patients who received PT-Cy compared with those who did not receive PT-Cy (RR 2.05; 95% CI 1.36, 3.10; p<0.001; I
2
=44%).

Conclusion:
These findings suggest that PT-Cy is associated with a higher incidence of adverse cardiac events, the most common of which is heart failure/cardiomyopathy.
Abstract 4145901: The Impact of Fasting vs Non-fasting on Patient Safety and Comfort During Cardiac Transcatheter Procedures: A Systematic Review and Meta-Analysis
Authors: Lucena Larissa , Cavalcante Deivyd , Gomes Wilton , Freitas Marcos , Costa Borges Rafael , Arruda de Oliveira Antonio Lucas , Paiva Irina , Silva Carvalho Natália , Leite Victoria , SOUSA JULIO
Published: November 2024

Introduction:
Current guidelines recommend preprocedural fasting for at least 6 hours for solid food and 2 hours for clear liquids before cardiac transcatheter procedures. However, the supporting data are limited.

Research Question:
Does non-fasting impact (NF) patient safety and comfort compared to fasting (F) in transcatheter cardiac procedures?

Aims:
To compare the effects of fasting vs. non-fasting on patient outcomes in cardiac transcatheter procedures.

Methods:
We searched the Cochrane, Embase, and Medline databases for RCTs comparing fasting versus non-fasting states for cardiac transcatheter procedures. Risk ratios (RRs) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were pooled for binary and continuous outcomes, respectively, using a random-effects model. Endpoints were hunger, thirst, incidence of aspiration, nausea/vomiting, acute kidney injury (AKI), length of stay, and patient satisfaction.

Results:
Our meta-analysis included 8 studies with 2,930 patients. Hunger sensation was significantly lower in the NF group (SMD -0.91; 95% CI: -1.71 to -0.11; P = 0.026; I2 = 96%; Figure 1A), with no difference in thirst. The incidence of aspiration (RR 2.20; 95% CI 0.29–17.02; P = 0.449; I2 = 0%; Figure 1B), nausea/vomiting (RR 1.09; 95% CI 0.67-1.78; P = 0.723; I2 = 0%), and AKI (RR 1.90; 95% CI 0.84–4.31; P = 0.126; I2 = 0%) were not significantly different between groups. Similarly, length of stay (MD -0.01 days; 95% CI -0.39 to 0.36; P = 0.940; I2 = 3%; Figure 2A), and patient satisfaction (SMD -0.74; 95% CI: -1.54 to -0.07; P = 0.073; I2 = 98%; Figure 2B) were also similar in both groups.

Conclusions:
Our study suggests a non-fasting strategy is a safe option before transcatheter cardiac procedures.
Abstract 4146005: Cardiogenic Shock secondary to Acute Structural Valve Dysfunction of an Avalus Bioprosthesis in a Patient with Two Prior Valve Replacement Surgeries - Third Time’s the Charm
Authors: Matute-Martinez Carlos , Twayana Anu Radha , GUMPU SIVASHANKAR PRASHANTH , TABOWEI GODFREY , Tabatabaei Yeganeh Hanieh , Watts Abi , Boccalandro Fernando
Published: November 2024

Aortic valve replacement (AVR) with biological valve prostheses (BV) avoids long-term anticoagulation compared with mechanical vale prostheses. Their durability is limited due to structural valve dysfunction (SVD). Valve degeneration is gradual, leading to bioprosthetic valve failure (BVF). We present the first case reported of acute aortic Avalus bioprosthesis SVD with severe aortic regurgitation (AR) secondary to flail leaflet.

A very active 52-year-old male with CAD, atrial fibrillation/flutter, and bicuspid aortic valve (AV) with symptomatic severe aortic stenosis treated with a 25 mm Abbott St. Jude/EPIC
TM
Supra valve 16 years ago required a redo surgery for infective endocarditis with an aortic root abscess treated with a 25 mm Medtronic Avalus BV 5 years prior and aortic root reconstruction. He presented with a 3-day history of chest pain and severe dyspnea. On arrival, cardiogenic shock and respiratory failure ensued, requiring vasopressors and endotracheal intubation. CXR revealed pulmonary edema. Coronary angiogram revealed non-obstructive CAD. TEE revealed preserved LV function with severe acute AR. He underwent emergent AVR. Surgery revealed a sterile flail prosthetic valve leaflet with complete prolapse of the noncoronary cusp. A 27-mm Medtronic Evolute BV was placed. His course was complicated by transient complete heart block. He continued improving and was then discharged.

Acute AR should be suspected in patients with acute hemodynamic instability and history of AVR. TTE or TEE are crucial for the assessment of BV and diagnosis of AR. The only effective treatment for acute severe AR is emergent AVR. Newer generation BVs offer the possibly of not requiring long-term anticoagulation and enhanced durability. The PERIGON trial evaluating the Avalus bioprosthesis in AVR showed no cases of SVD with excellent durability and hemodynamic profile during the 5-year follow-up, being this the first case reported in the literature of acute catastrophic failure of this valve.

Our case highlights the importance of rapid diagnosis and intervention in acute aortic BVF. While newer BVs offer improved durability and hemodynamic properties, clinicians must remain vigilant for acute complications secondary to SVD. Studies with longer follow-up are needed to better characterize the safety and performance of the Avalus bioprosthesis. The lack of standardized definitions for SVD may have led to underreporting and underestimation of its incidence.
Abstract 4146007: Burden of Non-Rheumatic Valvular Heart Disease in High-income Asia Pacific from 1990-2019: A Benchmarking analysis
Authors: shaikh salomi , Shandilya Ashwinikumar , Patel Khushbu , Waqas Muhammad , Syed Saif , Lakkimsetti Mohit , Bhalodia Paritaben , Islam Hamza , PATEL JUHI , AMIN VISHRANT , DESAI HARDIK , sharma kamal
Published: November 2024

Introduction:
Non-Rheumatic Valvular Heart Disease (NRVHD) stands as the 5th leading cause of mortality and the 6th leading cause of disability in High-Income Asia Pacific (HIAP) nations. Despite its profound impact, there exists a dearth of comparable and consistent country-level measures for NRVHD.

Method:
Using global burden of disease methodology, incidence, mortality, and disability-adjusted life years (DALYs) due to NRVHD were estimated stratified by age, sex, year across HIAP countries from 1990-2019.

Results:
The total prevalence of NRVHD surged from 3 million (95%UI: 2.9-3.1) in 1990 to 5.8 million (5.5-6.2) in 2019, with deaths escalating from 6,023 (5307-6368) to 16,604 (11,447-19,355) over the same period. The age-standardized incidence rate (ASIR) witnessed a 6% annual percentage change (APC) from 1990 to 2019. Notably, Singapore exhibited the highest APC in ASIR at 53%, while Brunei Darussalam reported the highest mortality rate with a 45% increase, and DALYs rate with a 30% rise from 1990 to 2019. The highest incidence occurred in the 55-59 age group, accounting for 32,069 cases, while the highest number of deaths was observed in the 90-94 age group, totaling 4,450 cases, and DALYs peaked in the 85-89 age group, reaching 43,221 cases in 2019. Regarding gender disparities, females bore a higher burden compared to males, with APC in incidence rates of 52% versus 44%, deaths at 113% versus 214%, and DALYs at 47% versus 97% from 1990 to 2019.

Conclusion:
The study reveals a concerning rise in NRVHD burden across HIAP countries from 1990-2019, necessitating immediate attention and targeted interventions to curb its impact on public health. These findings provide vital insights for policymakers and healthcare stakeholders to formulate effective strategies in combating NRVHD.
Abstract 4146021: Post transcatheter aortic valve replacement outcomes among patients with heart failure with preserved ejection fraction versus heart failure with reduced ejection fraction.
Authors: Jaiswal Vikash , Hanif Muhammad , Jaiswal Akash , Mares Adriana , Sundas FNU , Daggubati Ramesh , Grubb Kendra
Published: November 2024

Background:
Heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF) is a common comorbidity in patients undergoing transcatheter aortic valve replacement (TAVR). However, post-TAVR outcomes among HFpEF and HFrEF patients have not been well studied.

Objective:
This study aims to investigate the clinical outcomes post-TAVR among patients with HFrEF vs. HFpEF.

Methods:
The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years from January 2005 to May 2023. Patients were categorized into two groups: HFpEF and a control group with HFrEF, with both groups of patients undergoing TAVR and followed for 1-month and 1-year. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, race, body mass index, hypertension, diabetes mellitus, chronic kidney disease, smoking status, hemoglobin level, low density lipid (LDL) level, and various drugs including ACEi, ARBi, beta-blockers, SGLT2i and statins. Primary outcome was all-cause mortality (ACM), while secondary outcomes were acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, major bleeding and major adverse cardiovascular event (MACE) (composite of ACM, AMI and ischemic stroke).

Results:
After 1:1 propensity score matching (
Figure 1
), the study cohort comprised of 11, 982 patients in HFpEF with TAVR and 11, 982 patients in the control group. The mean age of patients in HFpEF and HFrEF was 81.7 and 81.5 years, respectively. PSM analysis showed that post-TAVR outcomes among HFpEF patients were significantly associated with lower risk of ACM after 1-month (RR, 0.88 (95%CI: 0.707-0.953),
P
=0.009), and after 1-year (RR, 0.93 (95% CI: 0.87-0.99),
P
=0.041) compared with the HFrEF group. A similar trend was observed with a significant reduction in the risk of MACE after 1-month (RR, 0.86, (95% CI: 0.74-0.99),
P
=0.043), however, it was non-significant after 1-year (RR, 0.942 (95% CI: 0.881-1.007),
P
=0.077). However, the risk of AMI, ischemic stroke, hemorrhagic stroke, major bleeding both at 1-month and 1-year follow up were comparable between the HFpEF and HFrEF post-TAVR.

Conclusion:
In patients with HFpEF post-TAVR, there was a significant decrease in ACM at 1-month and 1-year, while there was a significant reduction in MACE only at 1-month. Further investigation is warranted to determine whether HFpEF has better clinical outcomes than patients with HFrEF.
Abstract 4146029: State-wide Burden of Ischemic Heart Disease attributable to dietary risk factors in the United States from 1990-2021: A benchmarking systematic analysis
Authors: Venugopal Darshine , AMIN VISHRANT , Shandilya Ashwinikumar , Jonnavithula Sashank , Irfan Adan , Syed Saif , Bhalodia Paritaben , PATEL JUHI , Lakkimsetti Mohit , DESAI HARDIK , sharma kamal
Published: November 2024

Introduction:
Ischemic heart disease (IHD) remains a significant cause of morbidity and mortality in the United States, with dietary risk factors playing a critical role. This study provides the first comprehensive estimate of the IHD burden attributable to various dietary risk factors over the last three decades, including the initial two years of the COVID-19 pandemic.

Methods:
Using the Global Burden of Disease Study 2021 tool, we estimated the deaths and disability due to IHD associated with twelve dietary risk factors across different age groups, genders, and years spanning from 1990 to 2021 in the US.

Results:
Over the period from 1990 to 2021, there was a 25% decrease in both the total percentage change (TPC) in deaths and years of life lost (YLLs), while years lived with disability (YLDs) saw a 35% increase (95% uncertainty intervals: 19%-86%). The highest mortality was associated with diets low in whole grains, resulting in 54,046 deaths, followed by diets low in Omega 3 fatty acids (36,886 deaths), and diets high in processed meat (27,280 deaths). Additional significant dietary factors included low fibre (26,681 deaths), low legumes (25,601 deaths), high sodium (21,484 deaths), high red meat (20,411 deaths), low fruits (18,551 deaths), low vegetables (13,000 deaths), low nuts and seeds (8,222 deaths), low omega 6 fatty acids (5,089 deaths), and high sugar-sweetened beverages (360 deaths). The age group with the highest number of deaths was 85-89 years old, accounting for 22,514 deaths. Males experienced a disproportionately higher disease burden compared to females over these three decades.

Conclusion:
Deaths due to IHD attributable to dietary risk factors accounted for 36.86% of all CVD-related deaths in the US in 2021. To reduce the burden of ischemic heart disease linked to dietary risks, targeted interventions such as eHealth education, mHealth apps for personalized diet tracking, and partnerships with influencers to promote evidence-based health messages are essential. These strategies can enhance public awareness and encourage healthier dietary choices, potentially improving public health outcomes significantly.
Abstract 4146031: Natriuretic Peptide Normative Levels and Deficiency Among South Asian Older Adults: The Longitudinal Ageing Study in India
Authors: Singh Sumitabh , Singhal Sunny , Segar Matthew , Keshvani Neil , Dey Sharmishtha , Dey Aparajit , Pandey Ambarish
Published: November 2024

Introduction:
Natriuretic peptides (NPs) are hormones produced by the heart in response to cardiac wall stress, stimulating natriuresis and vasodilation. NP levels vary by age, sex, and ethnicity, and their deficiency has been associated with adverse metabolic health among Caucasian and Black adults. South Asians have distinct cardio-metabolic profiles; however, the reference range of NPs and NP deficiency among older South Asian adults is not established.

Method:
Participants of the Longitudinal Aging Study in India who were part of the ancillary study on diagnostic assessment of dementia (LASI-DAD) and were free of CVD and CKD at baseline were included. NT-ProBNP was measured using a one-step immunoassay sandwich method (mini VIDAS platform, bioMèrieux, France). Median NT-ProBNP levels were compared across different age, sex, and BMI groups. Generalized Additive Models accounting was used to fit the quantiles of NT-proBNP according to age among males and females separately. The association of NP deficiency (<2.5th percentile for age and sex) with different cardiometabolic traits was assessed using linear models adjusted for age, sex, and BMI.

Result:
The study included 2,450 South Asian participants (45.4% male, age 67 y [IQR 63-72]). NT-ProBNP levels increased linearly across increasing age groups, with females (vs. males) having modestly higher NT-proBNP levels in the age groups of 60 – 69 y (119 vs 95 pg/mL)and 70 – 79 y (164 vs 151.5 pg/mL). NT-ProBNP levels decreased linearly across BMI categories among females (Figure). In contrast, among males, the NT-ProBNP levels had a U-shaped distribution across BMI categories, with the lowest level noted in overweight males (Figure). In adjusted analysis accounting for age, sex, and BMI, NP-deficiency was associated with hypertriglyceridemia (OR[95%CI]:1.78[ 1.18, 2.68]) and hyperlipidemia (OR[95%CI]: 2.01[1.22, 3.31]) but not hypertension (OR[95%CI]:0.73[ 0.50, 1.06])

Conclusion:
This study establishes the normative values of NT-proBNP across different age and sex groups for South Asian older adults. NP deficiency was associated with hyperlipidemia and hypertriglyceridemia and may contribute to adverse cardiometabolic health in South Asians.
Abstract 4146039: Temporal Trends in Hypertension and Malignant neoplasm-related mortality in the United States: Cross-sectional Analysis of a National Database from 1999 to 2020
Authors: Qazi Shurjeel , Ansari Huzaifa , Khan Adam , Ali Syeda Ayesha , Farhan Syed Husain , Murtaza Mustafa , Zuberi Zaid , Noman Ayesha , Ishtiaq Jawad , Naveed Muhammad Abdullah , Siddiqi Rabbia
Published: November 2024

Background:
While hypertension (HTN) is a major risk factor causing morbidity and mortality following anticancer treatment, the current trends regarding its impact remain unclear.This study utilizes CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to examine HTN and malignancy-related deaths in the US.

Methods:
CDC WONDER accessed mortality data for adults aged ≥25 from 1999 to 2020, citing HTN and malignant neoplasms as contributing causes of death. Results, presented as age-adjusted mortality rates (AAMRs) per 100,000, underwent Joinpoint regression for trend analysis and annual percentage change (APC)

Results:
From 1999 to 2020, 1,067,143 deaths occurred in patients with neoplasms and HTN (AAMR = 22.3, 95% CI: 22.3 - 22.4). Males had higher mortality (AAMR = 27.9) than females (AAMR = 18.4). AAMRs varied across racial groups: highest in non-Hispanic blacks (NHB) (35.9), followed by non-Hispanic Whites (NHW) (21.2), Hispanics (17.9), non-Hispanic American Indian/Alaska Native (NH-AIAN) (16.4), and lowest in non-Hispanic Asian/Pacific Islander (NH-API) (15.3). Region-wise analysis showed that mortality rates were highest in the Midwest region (23.2, 95% CI: 23.1 - 23.3) followed closely by the South region at (23.0, 95% CI: 22.9 - 23.0), and then the West region rates of (22.3, 95% CI: 22.2 -22.4) while the Northeast reported the lowest mortality rate (19.8, 95% CI: 19.7 - 19.9). Mortality rates in rural areas were consistently greater throughout the study period compared to urban areas (Rural: 26.0, 95% CI: 25.8 - 26.1; Urban = 22.2, 95% CI: 22.1 - 22.3). Overall AAMR increased sharply from 12.0 in 1999 to 18.1 in 2001, followed by a gradual increase till 2018 (24.4) and then 29.9 in 2020 (APC: 3.9 [95% CI=3.4,4.4]). AAMR rose in men (APC:4.3), and women (APC: 3.4) throughout the study (FigureA). Across races, NH-AIAN showed the largest increase (APC: 5.5), followed by NHW (APC: 4.4), Hispanic (APC: 4.8), NHB (APC: 2.1), and NH-API (APC: 2.0) (FigureB)

Conclusion:
Despite recent improvements, HTN-malignancy-related mortality is rising. AAMR increased among men, all racial groups, and those in rural areas. Associated risk factors and examining social determinants of health are crucial for better care