bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Listening to Holy Quran Recital on Pain and Length of Stay Post‐CABG: A Randomized Control Trial
Authors: Eid Aburuz Mohannad , Al-Dweik Ghadeer , Ahmed Fatma Refaat
Published: November 2023

Background. Nearly, 75% of patients post‐CABG complain of moderate to severe pain during their hospital stay. Nonpharmacological interventions have been investigated; however, the effect of Holy Quran recital post‐CABG is still not well studied, especially in developing Islamic countries. Objective. To investigate the effect of listening to the Holy Quran recital on pain and length of stay post‐CABG. Methods. This was a randomized control trial on 132 patients recruited from four hospitals in Amman, Jordan. The intervention group listened to the Holy Quran recited for 10 minutes twice daily while the control group received the usual care. Data were analyzed using paired and independent samples t‐tests. Results. Paired t‐test testing showed that there was a significant reduction in the pain level, (M [SD], 6.82 [2.27] vs. 4.65 [2.18], t = 23.65, p < 0.001) for the intervention group. In addition, the intervention group had shorter LoS in the ICU and in the hospital compared to the control group, (M [SD], 5.0 [4.02] vs. 6.58 [4.18], t = −2.1, p < 0.05), (M [SD], 10.15 [9.21] vs. 15.01 [13.14], t = −2.6, p < 0.05), respectively. Conclusions. Listening to the Quran was significantly effective in improving pain intensity among post‐CABG patients and shortening their hospital/ICU stay. This trial is registered with NCT05419554.
Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis
Authors: Wang Chenyang , Liu Sheng , Kamronbek Raimov , Ni Siyao , Cheng Yunjiu , Yan Huiyuan , Zhang Ming
Published: November 2023

Introduction. Chronic total occlusion (CTO) of coronary arteries constitutes a substantial clinical challenge and has historically been managed through medical management and coronary artery bypass grafting (CABG). However, with the advancement in interventional technology, the success rate of percutaneous treatment has been significantly improved, and percutaneous coronary intervention (PCI) has emerged as a primary mode of treatment for CTOs, demonstrating remarkable clinical efficacy. The objective of this systematic review and meta-analysis is to evaluate and contrast the outcomes of PCI and CABG in patients with CTO. Methods and Results. A systematic search was conducted in the databases of PubMed, Embase, and Web of Science. The primary endpoints evaluated in this meta-analysis were the occurrence of major adverse cardiac events (MACE) and all-cause mortality. Secondary endpoints included myocardial infarction (MI), cardiac death, and the need for repeat revascularization. Nine studies, encompassing a total of 8,674 patients, were found to meet the criteria for inclusion and had a mean follow-up duration of 4.3 years. The results of the meta-analysis revealed that compared to CABG, PCI was associated with a lower incidence of all-cause mortality (RR: 0.78, 95% CI: 0.66–0.92;P = 0.003) and cardiac death (RR: 0.55; 95% CI: 0.31–0.96;P < 0.05), but an increased risk of myocardial infarction (MI) (RR: 1.96; 95%CI: 1.07–3.62;P < 0.05) and repeat revascularization (RR: 7.13; 95% CI: 5.69–8.94;P < 0.00001). There was no statistically significant difference in MACE (RR: 1.11; 95% CI: 0.69–1.81;P = 0.66) between the PCI and CABG groups. Conclusion. In the present meta-analysis comparing PCI and CABG in patients with chronic total occlusion of the coronary arteries, the results indicated that PCI was superior to CABG in reducing all-cause mortality and cardiac death but inferior in decreasing myocardial infarction and repeat revascularization. There was no statistically significant difference in MACE between the two groups.
Monitoring Glucocorticoid Receptor in Plasma-derived Extracellular Vesicles as a Marker of Resistance to Androgen Receptor Signaling Inhibition in Prostate Cancer
Authors: Gentile Emanuela , Hahn Andrew W. , Song Jian H. , Hoang Anh , Shepherd Peter D. A. , Ramachandran Sumankalai , Navone Nora M. , Efstathiou Eleni , Titus Mark , Corn Paul G. , Lin Sue-Hwa , Logothetis Christopher J. , Panaretakis Theocharis
Published: November 2023

Disease progression following androgen ablation was shown to be associated with upregulation of the glucocorticoid receptor (GR). Longitudinal monitoring of GR expression in circulating extracellular vesicles (EV) may reflect changes in the tumor cell and facilitates detection of acquired resistance. We utilized LNCaP, LREX cells and a patient-derived xenograft, MDA PDX 322-2-6a, for in vitro and in vivo experiments. Plasma-derived EVs were isolated from patients with localized high-risk prostate cancer undergoing androgen ablation. The mRNA levels of GR in EVs and their responsive genes were detected by transcriptome analysis, qRT-PCR and the protein levels by Western blot analysis. We detected changes in GR expression at mRNA and protein levels in EVs derived from LNCaP and LREX cells in in vitro studies. In in vivo experiments, LNCaP and the PDX MDA 322-2-6a–bearing mice were treated with enzalutamide. GR levels in plasma-derived EVs were increased only in those tumors that did not respond to enzalutamide. Treatment of mice bearing enzalutamide-resistant tumors with a GR inhibitor in combination with enzalutamide led to a transient pause in tumor growth in a subset of tumors and decreased GR levels intracellular and in plasma-derived EVs. In a subgroup of patients with high-risk localized prostate cancer treated with androgen signaling inhibition, GR was found upregulated in matching tissue and plasma EVs. These analyses showed that GR levels in plasma-derived EVs may be used for monitoring the transition of GR expression allowing for early detection of resistance to androgen ablation treatment.

Significance:

Longitudinal monitoring of GR expression in plasma-derived EVs from patients with prostate cancer treated with androgen signaling inhibitors facilitates early detection of acquisition of resistance to androgen receptor signaling inhibition in individual patients.
Clinician’s Ability to Identify Non-Melanoma Skin Cancer on 3D-Total Body Photography Sectors that Were Initially Identified during In-Person Skin Examination with Dermoscopy
Authors: Hobelsberger Sarah , Steininger Julian , Laske Jörg , Berndt Katja , Meier Friedegund , Beissert Stefan , Gellrich Frank Friedrich
Published: November 2023

Introduction: Non-melanoma skin cancer (NMSC) is a cause of significant morbidity and mortality in high-risk individuals. Total body photography (TBP) is currently used to monitor melanocytic lesions in patients with high risk for melanoma. The authors examined if three-dimensional (3D)-TBP could be useful for diagnosis of NMSC. Methods: Patients (n = 129; 52 female, 77 male) with lesions suspicious for NMSC who had not yet had a biopsy underwent clinical examination followed by examination of each lesion with 3D-TBP Vectra®WB360 (Canfield Scientific, Parsippany, NJ, USA) and dermoscopy. Results: The 129 patients had a total of 182 lesions. Histological examination was performed for 158 lesions; the diagnoses included basal cell carcinoma (BCC; n = 107), squamous cell carcinoma (SCC; n = 27), in-situ SCC (n = 15). Lesions were located in the head/neck region (n = 138), trunk (n = 21), and limbs (n = 23). Of the 182 lesions examined, 12 were not visible on 3D-TBP; reasons for not being visible included location under hair and on septal of nose. Two lesions appeared only as erythema in 3D-TBP but were clearly identifiable on conventional photographs. Sensitivity of 3D-TBP was lower than that of dermoscopy for BCC (73% vs. 79%, p = 0.327), higher for SCC (81% vs. 74%, p = 0.727), and lower for in-situ SCC (0% vs. 33%, p = 125). Specificity of 3D-TBP was lower than that of dermoscopy for BCC (77% vs. 82%, 0.581), lower for SCC (75% vs. 84%, p = 0.063), and higher for in-situ SCC (97% vs. 94%, p = 0.344). Diagnostic accuracy of 3D-TBP was lower than that of dermoscopy for BCC (75% vs. 80%), lower for SCC (76% vs. 82%), and lower for in-situ SCC (88% vs. 89%). Lesion location was not associated with diagnostic confidence in dermoscopy (p = 0.152) or 3D-TBP (p = 0.353). If only lesions with high confidence were included in the calculation, diagnostic accuracy increased for BCC (n = 27; sensitivity 85%, specificity 85%, diagnostic accuracy 85%), SCC (n = 10; sensitivity 90%, specificity 80%, diagnostic accuracy 83%), and for in-situ SCC (n = 2; sensitivity 0%, specificity 100%, diagnostic accuracy 95%). Conclusion: Diagnostic accuracy appears to be slightly lower for 3D-TBP in comparison to dermoscopy. However, there is no statistically significant difference in the sensitivity and specificity of 3D-TBP and dermoscopy for NMSC. Diagnostic accuracy increases, if only lesions with high confidence are included in the calculation. Further studies are necessary to determine if 3D-TBP can improve management of NMSC.
TVs universitárias, digitalização e campo público: dez anos depois
Authors: Prevedello Carine Felkl
Published: November 2023

A transição das TVs universitárias vinculadas ao campo público de emissoras no Brasil para a Digitalização, seja em termos de estrutura técnica de produção, seja de sistema de transmissão, é atravessada por singularidades, em um contexto cada vez mais marcado pela complexidade relacionada às redes sociais e plataformas digitais. Este relatório traz atualização de pesquisa realizada há dez anos sobre os canais de TV vinculados às Instituições de Ensino Superior (IES) públicas, em cidades do interior do país. Além do aumento quantitativo dos núcleos de produção audiovisual e da adaptação às plataformas digitais, a pesquisa registra canais em desmantelamento e diversificação.
Abstract 12502: Association Between Catheter Ablation and Dementia Among Patients With Atrial Fibrillation: A Meta-Analysis
Authors: Jaiswal Vikash , Ang Song Peng , Deb Novonil , Nasir Yusra , Roy Poulami , Rajak Kripa , Sharma Vagisha , Iturburu Alisson
Published: November 2023

Background:
Atrial fibrillation (AF) has been found to be associated with an increased risk of dementia. However, catheter ablation (CA) for AF might reduce the risk of dementia is unclear, with conflicting results till date.

Objective:
We aimed to evaluate the association between CA among AF patients and the incidence of Dementia.

Methods:
We performed a systematic literature search using the PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until 10th May 2023. Hazard ratios (HR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant.

Results:
A total of 6 studies with 146709 patients (47040 in the AFCA group and 99669 in the non-CA group) were included in the study. The mean age of patients among CA and non-CA groups was comparable (58.7 vs. 58.18). The most common comorbidity among CA and non-CA groups was hypertension (30.30% vs.67.70%), respectively. Pooled analysis of primary outcome showed that CA significantly reduced the incidence of dementia (HR, 0.63(95%CI: 0.52-0.77), P<0.001). Similarly, pooled analysis of secondary outcomes showed that the CA group of patients were having significantly reduced incidence of alzheimer's disease (HR, 0.78(95%CI: 0.66-0.92), P<0.001) compared with the non-CA group. However, a non-statistically significant lower incidence of vascular dementia was observed in the AFCA group (HR, 0.63(95%CI: 0.38-1.06), P=0.08) compared with the non-CA group.

Conclusion:
Catheter ablation reduced the risk of dementia and alzheimer’s disease compared with the non-ablation group of patients.
Abstract 12516: Explaining the Increase Mortality From Cardiovascular Disease in Indonesia: Unraveling the Trends in the Influence of Metabolic and Behavioral Risk Factors (2000-2019)
Authors: Harmadha Wigaviola Socha Purnamaasri , Muharram Farizal Rizky , Gaspar Renato S , Sulistya Hanif Ardiansyah , Azimuth Zahras , Firmansyah Fikri Febrian , Multazam Chaq El Chaq Zamzam , Harits Muhammad , Putra Rendra Mahardika
Published: November 2023

Background:
CVD burden has shifted from developed to developing countries; it decreased from 48% in 1990 to 43% in 2010, while in developing countries, it increased from 18% to 25%. According to several studies, current behavioural and metabolic risk factors enhance the risk of cardiovascular disease risk.

Aims:
We investigated whether changes in the risk factors—hyperglycemia, obesity, dyslipidemia, hypertension, and smoking—caused the rise in CVD mortality and incidence from 2000 to 2019 in Indonesia.

Methods:
Data from 34 province-year observations for CVD outcomes and changes in risk factors between 2000 and 2019 in Indonesia were obtained from IHME. A statistical model calculated risk factor fatalities using population-attributable fractions and baseline year death data. Multivariate regression on Summary Exposure Values of risk factors with mortality and incidence rates and lag year analysis was performed using R, measuring heteroscedasticity-consistent standard errors. Covariates, including the Socio-demographic Index, Primary healthcare, and GDP per capita, were added.

Results:
The age-standardized mortality rate per 100,000 for CVD from 2000 to 2019 in Indonesia increased from 356 to 412 among men and decreased from 357 to 354 among women. There was an increase in exposure to risk factors; obesity by 9%, smoking by 1%, dyslipidemia by 1.3%, hyperglycemia by 2%, and hypertension by 1.2%. An additional 14,517 men and 17,917 women died from CVD, attributable to obesity. Multivariate regression with province-fixed and year-fixed analysis shows a strong correlation between hyperglycemia in women (6;95% CI 0 to 12) with an increasing death rate in IHD. Notably, the association between hyperglycemia and IHD mortality was regardless of socioeconomic class and healthcare coverage. The association between a 10-year lag of high LDL and incidence of IHD was five times stronger compared to other risk factors, particularly in men (5;95%CI 2 to 8, incidence per 1-point increase).

Conclusion:
Female hyperglycemia increases CVD mortality risk. However, the prior-year analysis showed that high LDL levels increase incidence in men and women. These findings imply policymakers should prevent high LDL risk factors and hyperglycemia 10 years earlier.
Abstract 12522: Non-Ischemic Papillary Muscle Rupture Due to MRSA Myocarditis
Authors: Maryniak Andrii , Huang Jiannan , Oleszak Filip , Maziarz David , Stys Tom P , Stys Adam
Published: November 2023

Case Presentation:
A 46-year-old male with diabetes, ESRD, and recurrent MRSA bacteremia, presented with septic shock and suffered cardiac arrest. Following resuscitation EKG showed inferolateral ischemia. TTE revealed acute mitral valve regurgitation resulting from posteromedial papillary muscle rupture (PMR). An intra-aortic balloon pump was implanted for cardiogenic shock. Coronary angiography revealed right dominant circulation and thrombotic occlusion of a small caliber distal left circumflex artery (LCX). Emergent mitral valve replacement surgery was performed. Pathologic analysis of the excised muscle and leaflet showed marked acute inflammation, bacterial invasion, and myocyte necrosis, confirming non-ischemic rupture due to MRSA myocarditis.

Discussion:
PMR predominantly occurs after MI, complicating 0.03% of STEMI cases in the reperfusion era. Non-ischemic causes are rare. Coexistence of myocarditis, infective endocarditis (IE), and MI poses a challenge in determining etiology. Establishing causation guides whether to expedite emergent valve surgery or focus on cardiomyocyte salvage by revascularization. The posteromedial papillary muscle is most commonly involved in PMR due to single blood supply from the PDA (most commonly a branch of the RCA, and less commonly the LCX). Coronary angiography, postoperative histopathology, and culture results determined the etiology of PMR was fulminant MRSA bacteremia culminating in myocarditis. Bacterial colonization and resultant inflammation induced physical and mechanical strain leading to complete rupture. The occluded LCX was incidental, and may have been the result of septic embolization, which occurs in up to 65% of left-sided IE. Albeit rare, non-ischemic etiologies must be considered when the anatomic presentation of acute PMR on TTE is incongruent with angiography. Definitive treatment relies on surgical intervention and mechanical circulatory support is often necessary.
Abstract 12529: Exercise Patterns and Body Mass Index in a Large Cohort of Patients With Anomalous Aortic Origins of Coronary Arteries
Authors: Przybycien Thomas S , Gray Kimberly B , Sadiq Sameer , Mihail Sandra , Doan Tam T , Sachdeva Shagun , Reaves-O'Neal Dana , Binsalamah Ziyad , Molossi Silvana M
Published: November 2023

Introduction:
Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in the young. Exercise patterns in relation to BMI and surgery status are lacking.

Hypothesis:
Exercise patterns are variable in AAOCA and relate to BMI and surgery.

Aim:
To identify differences in exercise patterns and BMI in patients with AAOCA and their relation to surgery status.

Methods:
Single-center retrospective study of 573 patients with AAOCA (median age = 11.9 years, IQR 6-15), 63% males. Exercise patterns were classified as recreational or organized/competitive. BMI percentiles were stratified as normal (5
th
to ≤ 85
th
%ile), overweight (85
th
to ≤ 95
th
%) and obese (≥ 95
th
%ile). Exercise patterns and BMI were compared across demographic parameters, presence of ischemia, and surgery status. Mann-Whitney U test was for non-parametric and χ
2
test for categorical variables.

Results:
Two-thirds of patients exercise recreationally, 1/3 are overweight (BMI > 85
th
%ile) and 20% are obese (BMI >95
th
%ile) (Table 1). Those who had surgery were more likely to exercise competitively (24% vs 15%, p=0.026). Myocardial ischemia was more likely in those who were exercise restricted (34% vs 14%, p=<0.001). There was no difference in BMI percentile in those with ischemia or who exercised competitively (Table 2).

Conclusion:
Most patients with AAOCA exercise recreationally and 1 in 5 is obese. Surgery positively relates to competitive exercise. BMI or exercise patterns are unrelated to ischemia but associated with exercise restriction. Future studies are needed to determine optimal exercise recommendations to promote active lifestyle while minimizing the risk of sudden death.
Abstract 12532: Maximal Exercise Capacity is Inversely Related to Incident Peripheral Artery Disease: Data From the Henry Ford Exercise Testing (FIT) Project
Authors: Ehrman Jonathan K , Keteyian Steven J , Aronow Herbert D , Ahsan Syed , Blaha Michael J , Al-Mallah Mouaz H , Brawner Clinton A
Published: November 2023

Introduction:
Maximal exercise capacity (EC) is a strong, independent predictor of incident coronary and cerebrovascular disease. However, less is known about the relationship between EC and incident peripheral artery disease (PAD). Using data from the Henry Ford Exercise Testing (FIT) Project, we evaluated the relationship between EC and incident PAD.

Hypothesis:
EC, measured in metabolic equivalents of task (METs), is inversely related to incident PAD.

Methods:
We assessed 41,268 patients (age= 55±12 yrs, 49% female, and 64% white) who completed a clinically indicated exercise stress test between January 1991 and June 2009 at a Henry Ford Health facility. Patients with established PAD at the time of testing were excluded. METs were estimated from peak treadmill speed and grade and standardized to the equivalent of a 50-year-old male to account for differences in absolute risk for a given MET level by age and sex. METs were categorized as <6, 6-9, 10-11, and
>
12. ICD9 codes 440.XX and 443.9 were used to identify first incidence of PAD from the test date through June 2010. Multivariable Cox regression was used to relate METs to incident PAD. Patients were censored at the date of death or last clinic visit.

Results:
During a median follow-up of 7.1 years (IQR 4.2-11.1 yrs) there were 2,596 (6%) incident diagnoses of PAD. In the adjusted analysis, each 1 MET increase in maximal EC was associated with a 7% lower risk of PAD (aHR=0.93 [0.91, 0.94]). There was a graded, inverse risk of incident PAD by MET category (see Table). A significant interaction was noted for race (overall p=.04; white [HR=0.93 (0.92, 0.95)] vs black [HR=0.91 (0.88, 0.93)], p=.02; white vs other [HR=0.97 (0.87, 1.07)], p=0.47), but not for sex (p=.79).

Conclusion:
In a diverse cohort that completed a clinically indicated exercise stress test, higher EC measured in METs, is independently and inversely associated with a lower risk of incident PAD.
Abstract 12539: Relationship Between the Kansas City Cardiomyopathy Questionnaire Score and New York Heart Association Class in Patients With Hypertrophic Cardiomyopathy: Insights From EXPLORER-HCM
Authors: Sherrod Charles F , Wang Andrew , Gosch Kensey L , Elliott Perry M , Lakdawala Neal K , Reaney Matthew , Zhong Yue , Lam Jenny , Wyrwich Kathleen W , Spertus John A , Sauer Andrew J
Published: November 2023

Background:
Treating hypertrophic cardiomyopathy (HCM) aims to improve health status. Given the importance of accurately assessing health status and the limitations of the New York Heart Association (NYHA) Class, the Kansas City Cardiomyopathy Questionnaire (KCCQ) has gained interest. Thus, frameworks for interpreting the KCCQ in the context of the NYHA are needed.

Methods:
EXPLORER-HCM (NCT03470545) randomized patients with NYHA class II-III HCM to mavacamten or placebo and collected the NYHA and KCCQ. We pooled subjects for analyses who had KCCQ scores and NYHA class at baseline and 30-weeks. KCCQ scores, stratified by class at baseline, 30 weeks, and by change in class were reported as means±standard deviations. We generated two unadjusted models predicting the probability of NYHA class attribution for a given KCCQ-Overall Summary Score (OSS) at 30 weeks and for change in NYHA class by changes in KCCQ-OSS.

Results:
Of 196 participants, mean age was 57.9±12.2 years, 120 (61.2%) were male, and the baseline mean LVOT gradient was 51.5±30 mm Hg. Mean KCCQ scores by NYHA classes at baseline and 30 weeks are included in Table 1. Figure 1 maps the probability of NYHA Class by KCCQ. KCCQ-OSS Scores <40 mapped to Class III, scores from 40-85 mapped to Class II, and >85 mapped to Class I. Reductions of >25 points on the KCCQ-OSS aligned with worsening class and increases by >8 points on the KCCQ-OSS reflected improvement in class.

Conclusion:
NYHA Class is concordant with KCCQ, but there is variability in health status within class and changes in class. These analyses may help clinicians interpret both cross-sectional and changes in KCCQ scores for patients with obstructive HCM.
Abstract 12542: Effectiveness of Icosapent Ethyl on First and Total Cardiovascular Events in the Metabolic Syndrome: REDUCE-IT MetSyn
Authors: Miller Michael , Bhatt Deepak , Brinton Eliot A , Jacobson Terry A , Steg Philippe G , Pineda Armando L , Ketchum Steven , Doyle Ralph , Tardif Jean-Claude , Ballantyne Christie M
Published: November 2023

Introduction:
The Metabolic Syndrome (MetSyn) is associated with persistently high risk of cardiovascular (CV) events despite statin treatment.

Methods:
REDUCE-IT was a multinational, double-blind trial that randomized 8179 high CV risk statin-treated patients with controlled low density lipoprotein cholesterol, and elevated triglycerides, to icosapent ethyl (IPE) 4 grams/day or placebo. In the overall trial, IPE reduced the risk of the primary composite endpoint (CV death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization or hospitalization for unstable angina) and the key secondary composite endpoint (CV death, nonfatal myocardial infarction or nonfatal stroke). Here we examine the prespecified patient subgroup with a history of MetSyn, but without diabetes at baseline.

Results:
Compared with placebo, IPE use in patients with MetSyn at baseline (n=2866) was associated with a 29% relative risk reduction for the primary composite endpoint (hazard ratio [HR], 0.71 [95% CI, 0.59-0.84]; P <0.0001, absolute risk reduction [ARR]=5.9%; number needed to treat [NNT]=17) and 41% reduction in total (first plus subsequent) events (rate ratio [RR], 0.59 [95% CI, 0.48-0.72]; P <0.0001) (Figure 1). The risk for the key secondary composite endpoint was reduced by 20% (P=0.05) with a 27% reduction in fatal/nonfatal MI (P=0.03), 47% reduction in urgent/emergent revascularization (P <0.0001) and 58% reduction in hospitalization for unstable angina (P <0.0001). Non-statistically significant reductions were observed in fatal/nonfatal stroke (27%), cardiac arrest (44%) and sudden cardiac death (34%).

Conclusions:
In statin-treated patients, the addition of IPE significantly reduced the risk of first and total CV events in REDUCE-IT patients with a history of MetSyn. The large relative and absolute risk reductions observed support IPE as a therapeutic consideration for high CV risk patients with MetSyn.
Abstract 12544: Point-of-Care Ultrasound Estimation of Right Atrial Pressure Predicts Early Readmission in Patients With Acute Decompensated Heart Failure
Authors: Knapp Michael , Aluko Oluwatosin , Chapagain Himal , Faizee Faizan , Kainat Aleesha , Chaudhary Rahul , Simon Marc A , Pacella John
Published: November 2023

Introduction:
We previously developed and validated a highly accurate non-invasive, point-of-care ultrasound (POCUS) technique that uses right internal jugular vein (RIJV) compliance to predict elevated right atrial pressure (RAP). We sought to determine whether this POCUS technique would predict 30-day readmission in acute decompensated heart failure (ADHF) patients.

Hypothesis:
POCUS-based estimation of RAP at the time of discharge can predict 30-day readmission in patients with ADHF.

Methods:
In this prospective cohort study, consecutive patients admitted with ADHF were screened for eligibility. POCUS images of the RIJV at end-expiration and at maximal expansion during Valsalva were collected daily during the patient’s stay. To assess compliance, the change in cross-sectional area (CSA) of the RIJV induced by Valsalva was calculated using ImageJ and referred to as the distensibility index (DI). From ROC analysis, a DI≥66% was considered negative for elevated RAP while a DI<66% was considered positive (PPV 87%). 30 days post-discharge, readmission data were collected from patients’ EMR and a follow-up phone call. Sensitivity/specificity and predictive value analyses were conducted based on readmission data for those discharged with positive and negative tests.

Results:
A total of 237 admitted patients were eligible for this analysis. Patients discharged with a POCUS-estimated elevated RAP had a 30 day readmission rate 3.5 times greater than those discharged with normal POCUS-estimated RAP (26.7% vs 7.6%). POCUS-based normal RAP at discharge had a 92.4% negative predictive value (NPV) for avoiding 30-day readmission (P<.001). A subset of patients in this cohort (n=81) were admitted to a local community hospital. In this setting, POCUS estimation of RAP at discharge had a 95.7% NPV (P<.001) for avoiding 30-day readmission, and patients discharged with a POCUS-based elevated RAP had a 30-day readmission rate 9.6 times greater than those discharged with a normal POCUS test (41.2% vs 4.3%) .

Conclusions:
POCUS estimation of RAP strongly predicts avoidance of 30-day readmission for ADHF. Using this technique to guide discharge planning, potentially to reduce readmission for ADHF, deserves further investigation in a prospective randomized trial.
Abstract 12545: Inpatient Physical Therapy Use Among US Veterans Hospitalized for Heart Failure
Authors: Polsinelli Vincenzo B , Nyonyotsi Bissilola , Bekelman David B , Hess Paul L , Carey Evan P , Flint Kelsey
Published: November 2023

Background:
Physical debilitation is a common adverse effect of heart failure (HF) hospitalization and is associated with adverse outcomes.

Hypothesis:
Inpatient physical therapy (PT) mitigates the adverse effects of HF hospitalization, and improves outcomes in patients hospitalized with HF.

Methods:
Patients with an index hospitalization for HF at a VA facility between January 1, 2013 to December 31, 2017 were identified. Change in PT use over time was evaluated using the Cochran-Armitage trend test. After propensity matching, the impacts of inpatient PT exposure on 90-day all-cause mortality, and a composite of all-cause mortality and readmission were assessed.

Results:
Of 44,299 patients admitted with HF, 11,685 (26.3%) received inpatient PT. Compared with those who did not receive PT, those who did were older (70.7 vs 75.8; P<0.001), more frequently White (70.0% vs 74.0%; P<0.001), and had a longer length of stay (3.9 vs 7.4; P<0.001). The proportion of patients who utilized PT increased from 24.9% to 55.4% during the study period (P<0.001). After propensity matching, inpatient PT use was associated with worse all-cause mortality (HR: 1.24 [1.14 - 1.36]; P<0.0001) (
Figure
), and a composite outcome of death or all-cause hospitalization (HR: 1.07 [1.02 - 1.12]; P=0.0038) at 90 days.

Conclusions:
Inpatient PT use significantly increased from 2013 to 2017. After propensity matching, utilization of PT services was associated with adverse outcomes.
Abstract 12554: Machine Learning-Based Detection of Intraoperative Ischemia Utilizing the VitalDB Database
Authors: Hussain Iqram , Pandian Balaji , Zeepvat Julianna , Armoundas Antonis A , Boyer Richard
Published: November 2023

Introduction:
Myocardial ischemia, characterized by insufficient blood supply to the heart, is a critical condition often associated with adverse cardiac events, including myocardial infarction. Detecting intraoperative ischemia holds substantial clinical significance. This study aims to develop a machine-learning (ML) model to detect intraoperative hypotension as a marker of ischemia using electrocardiogram (ECG) features.

Hypothesis:
We hypothesize that machine-learning algorithms can detect changes in ECG episodes during ischemic or subischemic events associated with prolonged hypotension.

Methods:
The study utilized the VitalDB database, a comprehensive repository of intraoperative data of 6,388 patients, including ECG recordings and other vital signs. The ML model was a binary classifier of a hypotensive event (MBP <65 mm Hg) or a non-hypotensive event (MBP >75 mm Hg) by analyzing ECG-II and ECG-V5 waveforms. We extracted relevant ECG features such as ST-deviation (ST-elevation or ST-depression), as clinical indicators of myocardial ischemia. The adaptive boosting (AdaBoost), Gradient boosting (GB), and Extreme gradient boosting (XGB) methods, ML boosting techniques, were employed to develop a hypotension predictive model for detecting ischemic episodes. The primary outcomes were the accuracy and the area under the receiver operating characteristic (AUROC) curve. Additionally, we utilized the Shapley Additive Explanations (SHAP) to determine the contribution of the ECG features to the ML model.

Results:
The GB machine learning model exhibited the best results (Accuracy: 89%, AUROC: 0.92) in predicting hypotensive events. Furthermore, the model achieved high sensitivity and specificity in identifying ischemic episodes. SHAP analysis revealed that ST-deviation is the most significant contributing ECG feature in predicting intraoperative hypotension.

Conclusions:
These results demonstrate the potential utility of ML-based identification of ECG features in accurately identifying ischemic episodes. Implementation of an improved diagnostic methodology for intraoperative ischemia detection can have a significant impact on patient care, enhancing patient safety and improving surgical outcomes.
Abstract 12559: Functional Autoantibodies Against Angiotensin II Receptor Type 1 and Endothelin-1 Receptor Type A Predict Adverse Remodeling and Cardiovascular Events After Acute Myocardial Infarction
Authors: Civieri Giovanni , Masiero Giulia , Perazzolo Marra Martina , Vadori Marta , Iop Laura , Cozzi Emanuele , Iliceto Sabino , Tona Francesco
Published: November 2023

Introduction:
Myocardial infarction is a leading cause of death worldwide. Although advances have been made in acute treatment, an incomplete understanding of left ventricular (LV) remodeling (LVR) processes has limited the effectiveness of therapies to reduce late-stage mortality.

Hypothesis:
We hypothesized that autoantibodies (AAs) activating angiotensin II receptor type 1 (AT1R-AAs) and endothelin-1 receptor type A (ETAR-AAs) are associated with LVR after ST-elevation myocardial infarction (STEMI) and with recurrent major adverse cardiac events (MACE).

Methods:
We studied 131 STEMI patients (age 61±11 years, 112 males) treated with primary percutaneous coronary intervention between February 2021 and January 2022 at Padua University Medical Center. Within 48 hours of admission standard 2D echocardiography was performed and blood samples were obtained for AAs level measurement. Echocardiography was performed at 6 months repeatedly in all patients. The endpoint was LVR, defined as an increase of 20% or more of LV end-diastolic volume index.

Results:
Overall, 41 (32%) patients experienced LVR. The titer for the autoantibodies was significantly higher in patients with LVR (p=0.009 for AT1R-AAs; p=0.01 for ETAR-AAs). The prevalence of AT1R-AAs and ETAR-AAs seropositivity was higher in patients with LVR (39% vs. 11%, p<0.001 and 37% vs. 12%, p=0.001, respectively). At multivariable analysis, AT1R-AAs seropositivity was the strongest predictor of LVR (OR=4.25, p=0.002). Similarly, AT1R-AAs seropositivity was a strong predictor of recurrent MACE, both before (OR, 4.09; p
=
0.006) and after (OR 19.6; p=0.002) adjusting for the confounding factors.

Conclusions:
Our results support the hypothesis that AT1R-AAs and ETAR-AAs concentration are a risk factor for LVR in STEMI patients. AT1R-AAs is also a predictor of recurrent MACE. These initial observations may set the stage for a better pathophysiological understanding of the mechanisms contributing to LVR.
Abstract 12560: Single Cell RNA Sequencing Signature of Cardiac Allograft Vasculopathy
Authors: Tada Yuko , Armstrong Suthahar Sujit Silas , Suryawanshi Vasantika , Wu Amy , Wang Erpei , Cusi Vincenzo , Ley Klaus F , Kim Paul
Published: November 2023

Background:
Cardiac allograft vasculopathy (CAV) is one of the major causes of death after heart transplantation (HTx). However, immunological mechanisms of CAV remain incompletely understood. This study aimed to determine distinct immune profiles of CAV compared to HTx patients with normal graft function (CONTROL).

Methods:
Peripheral blood mononuclear cells (PBMC) obtained from the International Society for Heart and Lung Transplant grade 2 or 3 CAV (n=6), and CONTROL (n=12) patients were analyzed using single cell RNA sequencing (498 genes) on the BD Rhapsody platform combined with 56 protein markers (CITE-seq) and VDJ-seq. Cells were clustered into major cell types using 18 protein markers. Targeted clustering was then performed to determine subclusters using proteomic and transcriptomic data.

Results:
Proportions of memory B cell (0.5±0.4% vs 1.4±0.8%, p=0.01) and CD16+CD56+ TEMRA CD8 T cell (0.5±0.3% vs 1.0±1.7%, p=0.007) were decreased and proportion of C1q+ nonclassical monocyte (1.0±0.5% vs 0.4±0.3%, p=0.01) was increased in CAV patients compared to CONTROL. In Th1 effector memory CD4 T cell cluster, CAV had a significantly higher proportion of clonally expanded cells (24.1±10.0% vs 11.3±9.2%, p=0.01) characterized by higher expression of NKG7, GZMH, CCL5, and CST7 compared to non-expanded cells in this cluster. Signature genes with the highest positive coefficients determined by LASSO regression to predict CAV (72.2% accuracy) included IFITM3, LAIR2, CD52, IFITM2, NKG7, NAMPT, CD74, F13A1, IL3RA, and RNASE2. IFITM3 and LAIR2 were the best positive predictors for CAV and overexpressed predominantly in CD4 T and CD8 T cells (Figure).

Conclusion:
CAV demonstrates distinct immune cellular and transcriptomic phenotypes compared to CONTROL. IFITM3 and LAIR2 overexpression in PBMCs may predict severe CAV in HTx patients.
Abstract 12570: Catheter Ablation Rates for Typical Atrial Flutter in Military Tactical Athletes
Authors: Tunzi Matthew , Bush Kelvin
Published: November 2023

Introduction:
Cavotricuspid isthmus (CTI)-dependent atrial flutter is known to adversely impact exercise physiology and occupational readiness in active-duty military personnel. Despite guideline recommendations supporting catheter ablation for CTI-dependent flutter, there is a paucity of literature reporting the utilization and outcomes of catheter ablation in military personnel and other tactical athletes.

Aims:
This study aims to characterize United States military personnel diagnosed with CTI-dependent flutter and investigate the rates of catheter ablation and personnel returning to tactical athletic occupations.

Methods:
Military personnel diagnosed with CTI-dependent flutter from 2016 to 2022 were analyzed. Baseline clinical characteristics and typical flutter management was reviewed. CTI-flutter diagnoses were confirmed by electrocardiogram and electrophysiology study with entrainment or activation mapping.

Results:
During the study dates 40 military members (mean age, 40.7±10.7 years; 98% male; mean BMI 28.3±4.2 kg/m
2
; mean LVEF 58.3%±7.7) were diagnosed with typical flutter. 34/40 (85%) of service members diagnosed with typical flutter were retained on military status after diagnosis. Of those retained, 13/34 (38.2%) were able to complete deployments. Electrophysiology study and successful CTI ablation was performed in 27/40 (67.5%) of personnel with zero complications. 26/27 (96.3%) servicemembers who underwent CTI ablation maintained their tactical occupation whereas only 8/13 (61.2%) service members who did not receive CTI ablation were retained (p=0.009). 10/27 (37.0%) who received CTI ablation were able to subsequently deploy whereas only 3/13 (23%) who did not receive CTI ablation were able to deploy (p=0.484).

Conclusions:
Most military tactical athletes with CTI-dependent flutter receive safe and effective CTI ablations. CTI ablation increases tactical occupation retention rates when compared to treatment without CTI ablation. This data supports the use of CTI ablation as first-line treatment for military personnel and highlights the role of increasing ablation rates in other similar athletic populations.
Abstract 12582: Predicting a Relationship Between Cancer and Cardiovascular Comorbidities by a Machine Learning Model
Authors: Fakhra Sadaf , Gonuguntla Karthik , Thyagaturu Harshith , sattar yasar , Armstrong Ashley , Bandaru Aishwarya , Hoang Ngan Thi , Patel Brijesh
Published: November 2023

Introduction:
Cardiovascular disease and cancer have previously been linked to share similar pathophysiological pathways, although these two entities are rarely studied in congruence.

Method:
We analyzed the 2019 National Readmission Database (NRD) and used unsupervised learning and K-means clustering for data analysis. We employed the Shapley Additive Explanation (SHAP) model to explain which features contribute the most to clustering. The final cohort was divided into four clusters guided by the Elbow method. Continuous variables were analyzed with Kruskal-Wallis test and reported as medians and interquartile ranges (IQR) after checking for normality test. We also performed sensitivity analysis on patients with cancer without applying a Boruta algorithm.

Results:
The final cohort includes 297,597 patients, and we randomly sampled 100,000 patients within divided into 4 clusters. The most prevalent types of cancer in clusters 1 were brain cancer (15%), prostate cancer (9.4%), non-Hodgkin’s lymphoma (8.7%), lung cancer (8.6%), and other specified and unspecified types of non-Hodgkin’s lymphoma (7.8%). Most prevalent cancers in cluster 2 were lung cancer (13.1%), prostate cancer (11.6%), breast cancer (8.5%), colon cancer (7.9%), and kidney cancer (5.5%). In cluster 3, lung cancer (15.6%), prostate cancer (9.3%), multiple myeloma (8.9%), lymphoid leukemia (7.6%), and other specified and unspecified types of non-Hodgkin’s lymphoma were more prevalent. Furthermore, in cluster 4, myeloid leukemia (27.7%), non-Hodgkin’s lymphoma (20.1%), multiple myeloma (14.8%), lymphoid leukemia (12.4%), and other specified and unspecified types of non-Hodgkin’s lymphoma (10.4%) were the most prevalent cancers. Patients grouped in Cluster 3 had higher percentages of cardiovascular risk factors and comorbidities such as hypertension, diabetes, hyperlipidemia, kidney diseases, and pulmonary hypertension. Cardiovascular outcomes were naturally more frequent in cluster 3.

Conclusion:
Although cardiovascular disease and cancer have previously been linked to share pathophysiology, our study emphasizes that commonality between two seemingly different diseases may all be secondary to shared underlying cardiovascular risk factors.
Abstract 12587: Cardiac Tamponade and Pericardial Effusion in a Patient With Stage 3 Malignant Melanoma Treated With Pembrolizumab
Authors: Ubokudom Daniel A , Okorare Ovie , Jumbo Unwam
Published: November 2023

Introduction:
The introduction of immunotherapy has revolutionized the treatment of cancer, with improved clinical outcomes. One of such agents include Pembrolizumab a humanized antibody which acts as an immune check point inhibitor by binding to Programmed cell death Protein 1 receptors. One principal setback is its autoimmune-dysfunctional side effect.

Case Presentation:
A 74-year-old male with BRAF-negative malignant melanoma status post resection, with recurrent neoplasm involving lymph nodes of the base of the left neck presented to the emergency department with palpitations, diarrhea and difficulty in breathing. Symptoms began three weeks after his fourth course of adjuvant therapy. On presentation he was hemodynamically unstable with positive Kussmaul sign on examination. His heart sounds were muffled, with clear lung bases bilaterally. Results of EKG and echo are has shown below.

Decision-Making:
Patient was commenced on Intravenous fluid normal saline, oxygen therapy, was evaluated by cardiology and had emergency pericardiocentesis with about 250mls of fluid drained from the pericardial cavity and improvement of symptoms. Pericardial fluid analysis showed acute inflammation without malignant cells. Patient was placed on steroids and a consensus was reached to discontinue Pembrolizumab and pursue other lines of treatment as determined by the hospital tumor board.

Discussion:
The exact incidence of pericardial disease in cancer patients treated with Immune check inhibitors including Pembrolizumab is unknown. When effusion occurs, urgent intervention should be performed to prevent life threatening cardiac events. Treatment with steroids has shown improved outcomes and should be encouraged.

Conclusion:
Pericardial effusion is a fatal complication of Pembrolizumab. Though incidence remains rare, a high index of suspicion should be maintained in Patients receiving this immune check point inhibitor. The Decision to continue therapy after a cardiovascular event such as Pericardial Effusion should be individualized.
Abstract 12594: Comparison of Effects of Face-to-Face and Online Community-Based Healthy Lifestyle Behavior Change Programs on Life Simple 7 Score in the Elderly
Authors: Huang Tsueyyuan , Tsai Ming-Fen , Moser Debra K
Published: November 2023

Introduction:
The Life Simple 7 (LS7) score, developed by the American Heart Association, is a powerful predictor of an individual's cardiovascular health. It consists of seven key cardiovascular health metrics, including cholesterol levels, blood pressure, blood sugar, body mass index, diet, smoking status, and physical activity levels. In-person behavior change programs that target LS7 may not be accessible to older people.

Aims:
Our aim was to compare the impact of face-to-face and online community-based programs on the LS7 score among elderly individuals.

Methods:
Elderly participants were recruited from local community centers and randomly assigned to either a face-to-face or online program group. The face-to-face group attended weekly sessions at the community center, while the online group received program content through a web-based platform. Changes in the LS7 score were measured at baseline and six weeks after the intervention. An analysis of covariance (ANCOVA) was used to compare outcomes.

Results:
A total of 114 elderly individuals, with an average age of 71.75 ± 10.39 and 70.8% males, participated in the study (face-to-face group, n=48; online group, N=66. The findings indicate significant improvements in blood pressure (p=0.048), cholesterol (p=0.021), exercise (p=0.000), and diet scores (p=0.001). However, no significant differences were observed between the two groups (F=0.16, p>.05).

Conclusion:
The findings suggest that both modes of intervention are effective in improving cardiovascular health, highlighting the potential of online programs during times such as the COVID-19 pandemic or in rural areas.
Abstract 12595: Vascular and Cardiac Ultrasound as the Primary Imaging Tool to Safely Deliver Pacing Leads While Implanting Single Chamber Cardiac Implantable Electronic Devices. RADICAI USE Investigators
Authors: Moustafa Ahmed T , Triemstra Samuel , Mokhtar Ahmed T , Saravu Saketh , Mtwesi Viwe , Gula Lorne J , Leong-Sit Peter , Manlucu Jaimie , Skanes Allan C , Yee Raymond , TANG Anthony , Khan Habib R
Published: November 2023

Introduction:
Conventional Cardiac implantable electronic devices (CIEDs) implantation requires fluoroscopy. Risks involved with implantation include pneumothorax, lead dislodgement, and perforation of the right ventricular wall. In addition, there are long-term risks of malignancy associated with prolonged and repeated use of radiation over the decades of operators’ employment and mechanical injuries related to heavy personal protection equipment. To reduce these risks, we aimed to study the utilization and safety of ultrasound (US) for the entire procedure to implant single-chamber devices.

Methods:
The RADICAI USE study (Reduction or Elimination of Radiation Use in Single Chamber Cardiac Devices using ultrasound) is a prospective, single-arm and multi-operator case series enrolled patients awaiting a single-chamber CIED. A fluoroscopic cut-off time of 20 seconds was used to define the success (Group A) or failure (Group B) of using the US for the entire implant duration. Patients were followed up at 1 week, 1 month and 1-year post-implant.

Results:
The study enrolled 63 patients, with 50 pacemakers and 13 ICDs, a mean age of 79.5 ± 13.8 years (95% CI = 76.1 - 82.9), and a mean weight of 74.1 ± 14.6 (95% CI = 70.5 - 77.7). Overall, 53 (84.1%) CIEDs were successfully implanted with a radiation time of less than 20 seconds (Group A). Fluoroscopic over 20 seconds was required due to poor echocardiographic windows, challenging access, or anatomy. No iatrogenic new or worsening of tricuspid regurgitation was noted. The mean procedure time including US setup time was 65.2 ± 20.2 (95% CI = 60.2 -70.2) minutes. Fluoroscopic time was significantly reduced in Group A compared to Group B (5.8 ± 4.5s vs 109.5 ± 92.9s, p = 0.004). Follow-up showed no device-related complications, with only two patients requiring lead revisions due to poor sensitivity, one unrelated to US use and another probably related.

Conclusions:
US-guided implantation of single-chamber CIEDs is feasible and safe, reducing the need for fluoroscopic guided implantation and subsequent risks of higher radiation exposure. Further studies are required to evaluate the cost-effectiveness and to explore fluoroscopic-free single-chamber CIED implantations using the US.