bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4144952: A Meta-analysis of Folic Acid Supplementation Efficacy in Cardiovascular Diseases Prevention.
Authors: Calderon Martinez Ernesto , Arvelaez Pascucci Joanne , Castillo Jaqueline Livier , Alonso Ramirez Angie Carolina , Ghattas Patricia , Giron de Marza Maria Marcela , Sosaya Zuñiga Briggitte Solange , Martinez Lilan Jonathan David , Paredes Romero Enrique , Camacho Davila Karen Fabiola , Pinto Rafael , Arruarana Victor
Published: November 2024

Introduction:
Cardiovascular diseases are among the leading causes of morbidity and mortality worldwide. A key component is arteriopathy due to oxidative stress, involving homocysteine as a modifiable risk factor by supplementing folic acid.

Hypothesis:
This meta-analysis hypothesizes that folic acid supplementation reduces the risk of cardiovascular diseases by lowering homocysteine levels.

Methods:
Following PRISMA guidelines, a systematic search was conducted in PubMed, Cochrane, Scopus, Web of Science, CINAHL, and EMBASE databases up to March 18, 2024. Randomized controlled trials (RCTs) were included, comparing folic acid supplementation with placebo or alternative treatments in adult patients. The primary outcomes were impact on cardiovascular diseases, stroke, coronary heart disease, peripheral arterial disease, and mortality. Data were extracted and analyzed using random-effects models to calculate risk ratios (RR) and 95% confidence intervals (CI).

Results:
Our analysis included 16 studies with 39,034 participants meeting the inclusion criteria. The meta-analysis found a statistically significant reduction in stroke risk [RR: 0.87; 95%CI: 0.79, 0.96; P = 0.004] and mortality [RR: 0.92; 95%CI: 0.85, 0.99; P = 0.01]. It showed no statistically significant risk reduction in cardiovascular disease, coronary heart disease, or peripheral arterial disease. Additionally, when evaluating its effectiveness on HDL and LDL, folic acid supplementation showed no statistically significant difference in any of these values between the studies.

Conclusions:
Folic acid supplementation showed efficacy in reducing the risk of stroke and mortality. However, future research is necessary to investigate homocysteine's role in cardiovascular diseases and events. Systematic review registration number: PROSPERO registry— CRD42024525945.
Abstract 4144956: Identifying Inequities: The Underrepresentation of Racial and Ethnic Minorities in Guideline Informing Heart Failure Trials with Reduced Ejection Fraction and Its Implications
Authors: Ekpo Eson , Elmore Joshua
Published: November 2024

Background:
The prevalence of risk factors for heart failure and outcomes varies across racial and ethnic groups. Despite this variation, treatment guidelines for heart failure are standardized, potentially overlooking the unique needs and responses of minority populations. This study aims to critically assess the underrepresentation of racial and ethnic minority groups in major clinical trials that have significantly influenced the development of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF).

Methods:
We searched CINAHL, Embase, MEDLINE, and PubMed for randomized controlled trials (RCTs) that demonstrated reduced mortality or hospitalization through interventions in patients with HFrEF. We then analyzed the racial and ethnic data of the trial participants and compared minority enrollment to the 2020 United States Census demographic estimates.

Results:
We examined 30 trials conducted from 1987 to 2021. Thirty percent of the trials did not report racial/ethnic data. Among the remaining trials, 20 reported participation rates for non-Hispanic White (NHW) individuals, 14 reported Black participation, one reported Hispanic participation, and seven reported Asian participation rates. One trial reported participation rates for all four groups. When we analyzed the pooled participation among trials reporting race/ethnicity, most participants were non-Hispanic White (81.7%), followed by Asian (16.1%), Hispanic (6.0%), and Black (5.2%) (image). Trials primarily conducted in North America showed greater representation of racial/ethnic minorities. Compared participation rates with 2020 U.S. Census estimates showed that Black and Hispanic populations were underrepresented.

Conclusion:
The underrepresentation of racial and ethnic minorities in pivotal HFrEF clinical trials, which have significantly contributed to the development of guideline-directed therapy, is a matter of great concern. This lack of diversity may exacerbate health disparities by not adequately addressing the unique clinical characteristics and responses to therapy. It is not enough to acknowledge this problem; all stakeholders involved in clinical research must make sustained and collective efforts to ensure the equitable inclusion and reporting of racial and ethnic groups in trials. Improving the enrollment of ethnic minorities requires a shared and committed investment from investigators, research coordinators, oversight committees, and funding sources.
Abstract 4144964: Low-Dose IL-2 Lowers Arterial Inflammation and Trends Towards Lower MACE in patients with ACS: The results of the IVORY trial and IVORY FINALE study
Authors: Sriranjan Rothwell Rouchelle , Zhao Tian , Hoole Stephen , Bond Simon , Tarkin Jason , hubsch Annette , Helmy Joanna , Bumanlag-Amis Elaine , Jalaludeen Navazh , Templin Heike , Brubert Jacob , Krishnan Unni , O'Brien James , Rudd James , Cheriyan Joseph , Mallat Ziad
Published: November 2024

Major adverse cardiovascular (CV) events (MACE) occur in a substantioal percentage of individuals following acute coronary syndromes (ACS), primarily driven by residual vascular inflammation. Anti-inflammatory drugs have improved CV outcomes but their use is limited by significant side-effects. Low-dose interleukin 2 (IL2) increases regulatory T (Treg) cells, which are powerful endogenous regulators of the immune response, and could provide a new, targeted anti-inflammatory strategy in high-risk ACS patients. In IVORY, we hypothesised that treatment with low-dose IL2 would reduce arterial inflammation measured by
18
F-fluorodeoxyglucose (
18
F-FDG) positron emission tomography/computed tomography (PET/CT), compared to placebo. In IVORY FINALE we hypothesised that low dose IL2 could reduce MACE compared to placebo at follow up (up to 5 years.)

IVORY was a double-blind, placebo-controlled, Phase IIb trial randomising ACS patients with high-sensitivity CRP levels ≧ 2mg/L to receive either 1.5×10
6
IU IL2 or placebo (1:1). Dosing consisted of a daily induction (5 days) and a weekly maintenance phase (7 weeks).
18
F-FDG-PET/CT imaging of the ascending aorta and carotid arteries was performed before and after treatment. The primary outcome was the difference in the mean maximum target-to-background ratio (TBRmax) in the index vessel on follow-up imaging between the groups.

60 patients (IL2:placebo, n=31:29) completed the trial. Arterial inflammation in the index vessel was lower at the end of treatment in the IL2 group than in placebo (TBRmax = -0.171[-7.7%], 95% CI -0.308 to -0.034, p=0.015)[Fig1]. In more inflamed areas with a mean TBRmax ≧ 2 (active slices), the difference between the groups was greater (-0.185 [-8.3%], P=0.009, 95% CI -0.323 to -0.0478). Overall, the additive treatment effect of low-dose IL2 was greater at higher baseline inflammation [Fig 2]. Low-dose IL2 significantly increased circulating Tregs compared to placebo (p<0.001) [Fig 3]. There was no difference between the groups for changes in effector T cells. It was well-tolerated in ACS. At a median follow-up of 2.5 years, a trend towards lower MACE in the IL2 group (number of events [n]=0), compared to placebo (n= 7; 2 deaths, 2 non-fatal MIs, 3 unplanned revascularisations) was seen.

In summary, in high-risk ACS, immunomodulation with low-dose IL2 produces a safe and significant reduction in arterial inflammation, compared to placebo. Larger trials are needed to confirm its impact on CV outcomes.
Abstract 4144970: Prognosis of Percutaneous Coronary Intervention Versus Optimal Medical Therapy in the Treatment of Chronic Total Coronary Occlusion: A Systematic Review and Meta-Analysis
Authors: Suriyathumrongkul Napat , Wanichwecharungruang Nisha , leelaviwat Natnicha , Wattanachayakul Phuuwadith , Kulthamrongsri Narathorn , Srikulmontri Thitiphan , Vutthikraivit Wasawat
Published: November 2024

Introduction:
Chronic total coronary occlusion (CTO) management remains a challenge. Several studies have reported the benefits of percutaneous coronary intervention (PCI) in CTO. However, the outcomes of PCI vs optimal medical therapy (OMT) are still controversial. We conducted an extensive review and meta-analysis to compare the clinical outcomes between PCI and OMT in CTO.

Methods:
We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published cohort (prospective or retrospective) with propensity score matching analysis and randomized trials that reported all-cause death, cardiac death, and myocardial infarction (MI) with PCI and OMT in CTO patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odd ratios and 95% confidence intervals.

Results:
Sixteen studies, 6 randomized controlled trials (RCTs) and 11 observational studies with propensity score with matching (PSMs), were included in this meta-analysis involving 8,316 CTO patients (4,332 underwent PCI and 4,084 received OMT). In the overall analysis, all-cause death, cardiac death, and MI were significantly reduced in PCI compared to OMT group, respectively ([OR] 0.65, 95% CI 0.55-0.76, I
2
=0.0%, p<0.001, [OR] 0.60, 95% CI 0.49-0.74, I
2
=0.0%, p<0.001, and [OR] 0.72, 95% CI 0.52-0.99, I
2
=19.0%, p=0.041).

Conclusions:
Our study is the most updated meta-analysis to assess the impact of PCI compared to OMT in patients with CTO, analyzing the data being derived from PSMs and RCTs, that demonstrated significant impact of PCI on all-cause death, cardiac mortality, and MI.
Abstract 4144972: Predictors of cardiovascular disease risk and total mortality: Findings from the UK Biobank.
Authors: Agwara Ebiambu Ondoh , Armes Sarah , Lima Do Vale Marjorie , Delon Christine , Rajaram Ramya , De Paula Mayara , Gulobic Rajna , RAY SUMANTRA
Published: November 2024

Background:
Cardiovascular disease (CVD) continues to remain a major health challenge with several physiological and lifestyle markers associated with its incidence, burden and mortality.

Purpose:
We aimed to investigate diet and other lifestyle variables in combination with CVD risk markers (clinical and laboratory measurements) to estimate the risk of CVD events, all-cause Mortality, and survival rates over an 18-year period.

Methods:
Data from the UK biobank was utilised. Participants recruited between 2006 and 2010. Variables included predictor (sex, age, smoking history, and Townsend deprivation), Clinical (BMI, SBP, DBP, HBA1C, triglycerides, TC/HDL ratio, and total cholesterol (TC)) and behavioural (diet, physical activity). Deaths were coded using the ICD, 10th revision. COX proportional hazard models used to analyse each outcome for every predictor variable and models adjusted for confounders. Survival analysis was done with logistic regression models. Outcomes included all-cause mortality and incidence of fatal cardiovascular disease.

Results:
Over 502,621participants aged between 40-69 years with 54.4% males. 4.6% developed CVDs.

High (>8) and low (<7) sleep hours, High BMI, HBA1C, SBP, triglycerides and TC/HDL had a higher CVD incidence risk. Age, Sex, smoking, and Townsend deprivation were independent predictors of mortality with sex and smoking carrying the highest risk. Vegetarians and participants on combined special diets had a lower total mortality. Physical activity of 2-4 hrs and 4-6 hrs weekly had lower mortality compared to no physical activity. However, light or vigorous physical activity had no significant effect on total mortality. Similarly, individuals with no metabolic equivalent task (MET) had an increased mortality compared to those with 12-14 hrs, 14-16hrs, and 16-84hrs MET. High BMI, triglycerides, HBA1C and TC/HDL ratio were associated with significantly decreased survival rates while High HDL and high TC was associated with increased survival rates.

Conclusion:
Lifestyle factors including physical activity, sleep, and diets were identified as important predictors of all-cause mortality and CVD risk events. The findings further strengthen the evidence on the role of other known modifiable and non-modifiable factors in predicting CVD incidence risk and total mortality. The identified predictors would be useful in the development of risk scoring systems which incorporate lifestyle factors not factored into most CVD risk prediction models.
Abstract 4144973: AI-enabled Nationwide Opportunistic Screening of Non-Contrast Chest CT: Association between Cardiac Calcium Score and All-cause Mortality/Cardiovascular Events in Taiwan
Authors: Pan Heng-Yu , Lee Chih-Kuo , Lee Wen Jeng , HSIEH CHI-JENG , Wang Tzung dau
Published: November 2024

Background:
Cardiac calcium, which includes coronary and extra-coronary calcification, is often incidentally found in chest CT scans performed for various reasons. Despite its prognostic value, manual quantification of cardiac calcium in non-gated chest CT images is labor-intensive.

Goals:
This retrospective study aims to perform automatic quantification and scoring of cardiac calcium in non-contrast-enhanced chest CTs. The objective is to determine associations between automatic calcium scoring and outcomes such as all-cause mortality, non-fatal myocardial infarction (MI), and non-fatal stroke.

Methods:
We conducted a nationwide cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2016 to 2022. Patients under 20 years old, with a diagnosis of malignancy, or with outcome events before the CT acquisition were excluded. HeaortaNet 1.0, a validated AI model, was used for cardiac calcium scoring. Comorbidities were determined using ICD diagnostic codes for ≥2 consecutive outpatient visits within the year before the index date. Outcomes were censored at the first occurrence of mortality or relevant ICD codes for MI or stroke.

Results:
The retrospective cohort included 279,415 patients (56.37% male, mean age 60.31±16.54). All-cause mortality occurred in 12.82% of patients within a 3-year follow-up. The 3-year incidence rates of non-fatal MI and non-fatal stroke were 0.86% and 2.07%, respectively. Multivariate-adjusted Cox hazard ratios (95% confidence intervals) for any composite outcome were 1.51 (1.46-1.57), 2.09 (2.01-2.17), 2.63 (2.53-2.74), and 3.37 (3.24-3.50) for cardiac calcium scores of 1-100, 101-400, 401-1000, and >1000, compared to a score of 0. Adjusted Cox hazard ratios for all-cause mortality were 1.62 (1.56-1.69), 2.29 (2.19-2.39), 2.91 (2.78-3.04), and 3.80 (3.64-3.96) for scores of 1-100, 101-400, 401-1000, and >1000, compared to a score of 0.

Conclusion:
AI-enabled opportunistic screening of non-contrast chest CT for cardiac calcium scoring is associated with all-cause mortality and cardiovascular events. This is the first large-scale cohort study to use an AI model for comprehensive cardiac calcium screening.
Abstract 4144981: Impact of Patent Foramen Ovale on Transvenous Lead Extraction Characteristics and Outcomes
Authors: Park Aaron , Power John , Aldaas Omar , Ho Gordon , Maus Timothy , Birgersdotter-Green Ulrika , Pollema Travis
Published: November 2024

Background:
Transvenous lead extraction (TLE) may be indicated for cardiac implantable electronic device infection, malfunction, or upgrade. TLE can increase right heart pressures and mobilize debris, resulting in a right-to-left embolism and stroke via a patent foramen ovale (PFO).

Aims:
To identify the prevalence of PFO in patients undergoing TLE, characterize affected patients, and compare incidence of adverse events.

Hypothesis:
The presence of a PFO in patients undergoing TLE will result in a higher incidence of adverse events.

Methods:
Intraoperative transesophageal echocardiogram (TEE) is routinely performed during TLE at University of California, San Diego. Between 11/2021 and 12/2023, 200 patients had intraoperative TEE reports available, with Color flow Doppler being used to identify PFO. Lead-associated vegetation or thrombus was only reported on preoperative TEE. Patient characteristics and outcomes were collected and compared by PFO status.

Results:
Of 200 patients with TEE reported during TLE, mean age was 65.1 with a standard deviation of ± 15.1; 64% were male. PFO was detected in 26 (13%) patients but was not associated with different baseline characteristics. Overall, mean lead count was 2.3 ± 0.7, dwell time was 4.7 ± 3.7 years, and procedural success was 95.5% with no difference by PFO status. Most common extraction indications were malfunction (44.1%) and infection (29.6%). Preoperative TEE reported lead-associated thrombus in 0/14 (0%) patients with PFO versus 7/98 (7.1%) without PFO (p>0.99) and lead-associated vegetation in 2/6 (33.3%) patients with PFO versus 12/64 (18.8%) patients without PFO (p=0.59). In-hospital stroke was not different by PFO status (1/26 3.8% PFO vs 1/174 0.6% no PFO, p=0.24) and no patients experienced myocardial infarction. In-hospital mortality was significantly higher in patients with PFO (2/26 7.7% PFO vs 0/174 0% no PFO, p=0.016). Of these two deaths in the PFO cohort, one was due to stroke-related complications and the other to sepsis.

Conclusion:
PFO was detected in 13% of patients on intraoperative TEE during TLE. Stroke incidence was similar by PFO status, but mortality was higher in those with PFO. Further studies are needed to understand this association.
Abstract 4144991: Exploring Optimal Cardiac Electronic Implantable Devices Programming: Reducing Non-Actionable Alerts and Assessing Clinical Outcomes
Authors: Mostafa Mohamed , Bodziock George , Seiler Amber , Dillon John , Cotten Lindsey , Allred James , Bhave Prashant
Published: November 2024

Background:
Remote monitoring for cardiac electronic implantable devices (CIEDs) has become standard of care, resulting in an abundance of remote transmission data. While this data is valuable, the number of clinically irrelevant non-actionable alerts (NAA) can lead to alert fatigue and reduce device clinic efficiency.

Objective:
We aimed to propose clinically reasonable alert parameters to reduce the number of NAA and explore its impact on clinical outcomes.

Methods:
We included 412 participants with CIEDs indicated for atrial fibrillation (AF) or non-sustained ventricular tachycardia (NSVT) from a single academic medical center. Reprogramming changes set as no alerts for AF episodes < 5.5 hours, persistent AF episodes > 1 month when a prior alert has already been issued, AF episodes < 24 hours in patients with paroxysmal AF on anticoagulation or with left atrial appendage occlusion, NSVT in patients with defibrillators. The number of NAAs were tracked 90 days before and after reprogramming. Incident ischemic stroke and sudden cardiac death (SCD) was ascertained over a median follow-up of 20.9 months. Linear regression was used to compare differences in alarms between pre- and post-periods, and multivariable linear regression was applied to identify factors associated with alerts.

Results:
Among participants, indication for reprogramming included 69% (n=285) patients with AF and 30.7% (n=127) with NSVT. Compared to pre-programming, the number of NAAs was significantly lower post reprogramming implementation (median [IQR]: 3 [6] vs. 1 [2], P < 0.001) respectively. During follow up, the incidence of primary outcomes was 3.6% (
n
:15) for ischemic stroke and 0.7% (
n=
3) for SCD. (
Table
)

Conclusion:
Our findings demonstrate that implementing guidelines-derived alert parameters in patients with CIEDs significantly reduces the number of clinically irrelevant NAA. This reduction in NAA appears to be safe, with incidence of adverse clinical outcomes comparable to the general population of patients with CIED. This approach has the potential toreduce clinician alert fatigue and safely improve efficiency of device clinics.
Abstract 4144999: Cardiac Magnetic Resonance Imaging in Tetrology of Fallot Patients and Relationship to Obesity
Authors: Dusza Patrick , Tran Andrew , Hor Kan
Published: November 2024

Obesity is associated with increased cardiovascular risk and adverse cardiac changes such as left ventricular hypertrophy (LVH) and in TOF higher body mass index (BMI) contributed to increase risk. Previous multicenter study concluded that right ventricular (RV) dysfunction contributed to cardiovascular event. Current recommendations for pulmonary valve replacement (PVR) in TOF patients use indexed RV endiastolic volume (RVEDVi) to determine timing of PVR. In the presence of obesity, RVEDVi may underestimate the severity of RV volume load. We sought to determine both diastolic (RVEDV) and systolic (REVSV) volume in obese and non-obese patients and the impact of the volume on right ventricular ejection fraction (RVEF).

We conducted a retrospective study of adult TOF patients > 18 years age in obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) patients with a cardiac magnetic resonance imaging (CMR) prior to PVR for pulmonary regurgitation (PR). CMR database and electronic records were reviewed to compare anthropometric, demographic, and CMR variables between obese and non-obese patients.

Table 1 shows demographic and CMR results between non-obese (n = 57) and obese (n = 32) patients. Indexed ventricular volume were smaller in obese compared to non-obese patients (LVEDVi 78.7±12.1 vs 84.3±14.9 mL/m2, p=0.04; RVEDVi 157.4±21.5 vs 169.4±32.7 mL/m2, p=0.03), in contrast the non-indexed volume were significantly larger (LVEDV, 166.7±32.9 vs 148.8±30.5 mL, p=0.006; RVEDV 333.1±61.3 vs RVEDV 297.6±56.6 mL, p=0.004). There is an association with ventricular volume with lower RVEF. In both groups the mean RVEF was abnormal but not different (43.2±8.7 vs 43.8±8.4%, P=NS). Patients with lower RVEF trended towards a lower LVEF especially in the obese group (Figure 1A-F).

Our study showed that indexed ventricular volume was smaller in obese patients and may lead to false reassurance suggesting underestimation of the volume load from the PR. Our patients have lower RVEF which correlated with larger volume and evidence of ventricular-ventricular interaction with lower LVEF in patients with lower RVEF. When assessing timing of PVR in asymptomatic TOF patients, other parameters beyond indexed volume in those with elevated BMI should be considered including ejection fraction and different methods of indexing RV volume similar to LVM. Future larger and longitudinal studies are needed to determine if delayed repair in obese patients lead worse remodeling and outcomes.
Abstract 4145001: Renal Outcomes of Staged Versus Concomitant Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement: A meta-analysis
Authors: Chanda Veda , Bittar Vinicius , Carvalho Pedro , Garot Philippe
Published: November 2024

Background:
The impact of staged on renal outcomes percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) is uncertain.

Methods:
MEDLINE, Embase, and Cochrane were systematically searched for studies comparing staged versus concomitant PCI in patients with aortic stenosis and coronary artery disease undergoing TAVR and PCI. A random-effects model meta-analysis calculates the odds ratio (OR) with a 95% confidence interval (CI). Our outcome of interest was the incidence of contrast-induced acute coronary injury (CI-AKI) and its respective stages.

Results:
11 studies comprising 6,056 patients undergoing TAVR and PCI were included. Compared with concomitant PCI, staged PCI did not reduce the incidence of CI-AKI (OR 0.89; 95% CI 0.48-1.64; p=0.70; Figure 1). In a subgroup analysis, there was no difference between staged and concomitant PCI in the incidence of stage 1 CI-AKI (OR 1.99; 95% CI 0.38-10.47; p=0.70), stage 2 CI-AKI (OR 1.01; 95% CI 0.39-2.64; p=0.70), and stage 3 CI-AKI (OR 0.48; 95% CI 0.23-1.00; p=0.051).

Conclusion:
In patients undergoing TAVR, there was no difference between staged versus concomitant PCI in the incidence of contrast-induced nephropathy.
Abstract 4145002: Bowel Inflammation leads to Heart Transplantation
Authors: Mack Vincent , Mahoney Jenna , Vanderland Mark , Tanner Nathaniel , Ammari Zaid , Cushing Jessica
Published: November 2024

Introduction:
The ATTACH trial in 2003 demonstrated that Anti-tumor necrosis factor alpha therapy was associated with the evolution and progression of heart failure in patients with moderate to severe chronic heart failure. The United States FDA also reports that in rare cases, it is implicated in new onset heart failure in those under the age of 50. We present a case of new onset biventricular failure with cardiogenic shock in the setting of anti-TNF therapy, resulting in orthotopic heart transplantation.

Case:

A 22-year-old male with history of Crohn’s disease, on infliximab, presented to the ED with dyspnea. He was recently hospitalized for right middle cerebral artery CVA, during which he was diagnosed with new onset nonischemic cardiomyopathy with an LVEF 26% on cardiac MRI. Extensive workup was unrevealing for etiology of cardiomyopathy. He had a negative 3 generation family history to suggest familial or inherited cardiomyopathy. In the ED, he was hypotensive at 62/41 mmHg, tachycardic to 104 bpm. Laboratory data demonstrated a lactate 11.5 mmol/L, creatinine 1.96 mg/dL, AST 454, ALT 670, total bilirubin 1.3, and NT Pro-BNP 6607 pg/mL. A pulmonary artery catheter was placed, which revealed RAP 28 mmHg, PCWP 26 mmHg, PAPI 0.7, Fick CI 1.1 L/min/m
2
and CPO 0.41 W. A shock alert was called, and the patient was emergently cannulated for V-A ECMO with an IABP for LV venting. He was transferred to a transplant center, where he underwent OHT.

Discussion:
Anti-TNF therapy has been implicated in the worsening of chronic heart failure; however, the development of new-onset heart failure is rare, and the literature is limited. Kwon
et al
reported a case series from the FDA MedWatch list, which included 47 patients who experienced new or worsening heart failure after starting Infliximab or Etanercept for ulcerative colitis, rheumatoid arthritis, and psoriatic arthritis. Of these 47 patients, 38 (81%) developed new onset heart failure. The pathogenesis of heart failure in patients on TNF alpha therapy is thought to be related to a dose-dependent activation of the Death-promoting pathway mediated by TNF Receptor 1 and a relative decrease in activation of the Survivor Activating Factor Enhancement pathway mediated by TNF Receptor 2. We add this case to the growing body of literature regarding the risks of TNF-alpha inhibitors in patients with established heart failure and propose using TNF-alpha inhibitors as the etiology of this patient’s new onset cardiomyopathy.
Abstract 4145010: Efficacy of Autologous Stem Cell Therapy in Myocardial Infarction and Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis
Authors: Bag Soumyadeep , Patra Tumpa , Erva Snigdha , Regassa Henok , shanmugam Sruthi nandhaa , UMA DWARAKANATH NAMITHA , Jerry Merilyn , Kpadenou Vihoale , Kelangi Sarah Susan , puli srikanth , Panghal Ritvika , Gujarathi Rahul , Thakkar Badal , Hsieh Ya Ching , Patel Urvish , Dudenbostel Tanja
Published: November 2024

Introduction:
Coronary heart disease(CHD) and myocardial infarction(MI) cost American healthcare $99 billion annually. In the US, 20.5 million adults over 20 years of age suffer from CHD, and 9.3 million from MI. MI causes cardiac myocyte death and scarring, leading to ischemic cardiomyopathy (ICMY), heart failure(HF), and arrhythmia. Current treatments improve perfusion and prevent remodeling but cannot reverse scarring. Stem cell therapy(SCT) aims to replace scarred myocardium with viable tissue, preventing complications like ICMY and HF.

Aims:
Evaluating the efficacy of SCT, in treating MI and preventing ICMY and HF. Efficacy was measured after 6 months, 1 year, and the long term.

Methods:
We followed the PRISMA protocol and guidelines to identify all human clinical trials on PubMed since 2010 that used SCT in adults with MI. Observational, non-human studies and isolated case reports were excluded. Our population of interest: adults with MI and SCT were compared to the control group of standard therapy alone(ST). Cardio sphere-derived autologous stem cells, Autologous Bone Marrow Stem Cell Therapy, Bone marrow-derived mononuclear cells via anterograde intra-arterial coronary delivery, Intracoronary infusion of autologous CD34 (+) cell, and Mesenchymal Stem/Stromal Cells were utilized in these trials. The primary outcome measured was efficacy: defined as an increase in Left Ventricular Ejection Fraction(LVEF) by >10%.

Results:
More than 3000 articles were reviewed, and after applying rigorous inclusion and exclusion criteria, we narrowed down to 32 articles with 2613 patients for qualitative and quantitative analysis. We found an increase in LVEF of >10% with optimal treatment after 12 months of management in the SCT (P<0.05). No significant difference in adverse effects was observed comparing SCT to ST. Reduction in scar size and increase in viable myocardium with improved regional function of infarcted myocardium were observed with SCT.

Discussion:
CHD and MI are both widespread and impose a significant economic burden on our society. Therefore, it is vital to explore novel treatments for enhancing the survival rate and reducing the negative health outcomes linked to CHD. Our study shows that SCT can lower long-term complications such as ICMY and HF in patients with MI, without creating any substantial negative effects. Hence, additional research, such as extensive multi-center clinical trials, is necessary to examine the potential of SCT in treating MI.
Abstract 4145034: Drug-Coated Balloon Versus Drug-Eluting Stent in Small Vessel Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials
Authors: Suriyathumrongkul Napat , Wanichwecharungruang Nisha , leelaviwat Natnicha , Wattanachayakul Phuuwadith , Kulthamrongsri Narathorn , Srikulmontri Thitiphan , Vutthikraivit Wasawat
Published: November 2024

Background:
Revascularization of small vessel coronary artery disease (SvCAD) is still challenging despite the extensive use of drug-eluting stents (DESs), mainly because of an increase in target vessel failure. Drug-coated balloon (DCB) has emerged as an alternative strategy in SvCAD. However, the safety and efficacy of DCB in SvCAD is still controversial. We conducted a meta-analysis comparing the clinical outcomes of DCB and DES in SvCAD patients.

Methods:
We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2024. Included studies were published randomized control trials (RCTs) that compared major adverse cardiac events (MACE), target-lesion revascularization (TLR), and target-vessel revascularization (TVR) between DCB and DES in SvCAD patients. Data from each study were combined using the random-effects model.

Results:
Six RCTs were included in this meta-analysis involving 1,534 SvCAD patients (775 underwent revascularization with DCB and 759 with DES). There was no difference in MACE, TLR, and TVR between DCB and DES groups ([OR] 1.14, 95% CI 0.64-2.00, I 2 =58.2%, p=0.657, [OR] 1.34, 95% CI 0.56-3.23, I 2 =48.5%, p=0.516, and [OR] 1.09, 95% CI 0.59-2.01, I 2 =49.6%, p=0.795, respectively) (Figure 1). There was no publication bias observed in Funnel plot as well as no small-study effect observed in Egger’s test.

Conclusions:
As compared to DES, our study showed that DCB was associated with similar clinical outcomes and could be a potential alternative strategy in SvCAD patients.
Abstract 4145056: A Comparison of Outcomes in Heart Failure Patients with and without Iron Deficiency Anemia: A National Database Analysis
Authors: Bess Olva , Quevedo Ramirez Andres , Shaka Abdultawab , Oredipe Omotola , Bello Jeremiah , Shaka Hafeez
Published: November 2024

Introduction:
Iron deficiency anemia (IDA) affects millions of people with heart failure (HF) and is of a higher proportion in patients admitted for HF than those seen as an outpatient. The cause of IDA in patients with HF is postulated to be related to the chronic inflammatory process that occurs resulting in decreased erythropoiesis. This could also be a side effect of the extensive treatment. The fate of patients admitted for exacerbation of heart failure, especially those with IDA could be fatal. This study uses the NIS HCUP database to assess the outcome of patients admitted from 2016 to 2019 with heart failure and co-existing iron deficiency anemia.

Research question/ hypothesis:
Patients with HF and co-existing IDA have worse outcomes than those without.

Method:
We used the NIS HCUP 2016 to 2019 database for the analysis. The primary outcome was inpatient mortality. Secondary outcomes such as mean length of hospitalization (LOS), mean total hospital charges (THC) adjusted for inflation and proportion of complications were computed. Data was analyzed using regression models adjusted for significant, confounding, sociodemographic and comorbid conditions.

Discussion/ Results::
The total population of hospitalizations for HF from 2016 to 2019 was 1270784 with 6.9% having IDA. A higher proportion of hospitalizations with IDA were women. The mortality from the HF admission was 39350 patients. IDA was associated with lower adjusted odds of inpatient mortality (2.5 vs 3.2%, aOR: 0.75, 95% confidence interval (CI) of 0.68-0.84. However, patients with IDA had significantly longer mean LOS and higher THC compared to patients without IDA. Patients with IDA also had increased adjusted odds or requiring pressors, developing acute kidney failure and respiratory failure.

Conclusion::
Although IDA did not appear to impact mortality in patients with HF, it was associated with higher inpatient complications and higher healthcare cost utilization. Researchers postulate that limitation of different codes being used when data is recorded could have contributed to the unimpacted mortality. Further studies are needed to decipher other factors. Addressing comorbid IDA in the outpatient setting may significantly decrease the cost associated with hospitalization for HF by decreasing the length of hospitalization and the hospital charges associated with those hospitalizations.
Abstract 4145057: From Infection to Innovation: Leadless Pacemakers Implantation Following Infected Cardiovascular Implantable Electronic Device Extraction - An Updated Systematic Review
Authors: Nadeem Bilawal , Fatima Amel , Sedrakyan Surik , Ahmed Ali , Ali Baig Mirza Mehmood , Sherwani Mifrah Rahat Khan , Wylie John
Published: November 2024

Introduction:
Cardiovascular Implantable Electronic Device (CIED) infection is class I indication for complete transvenous lead removal (LR). The reimplantation strategies post-LR, especially in pacemaker-dependent patients or those necessitating cardiac resynchronization therapy (CRT) and/or implantable defibrillators, remain complex. Considering the limitations and risks associated with traditional approaches, the exploration of alternative devices such as leadless pacemakers (LP) have garnered attention due to their purported lower infection risk.

Methods:
We meticulously reviewed literature sources including PubMed, Scopus, and Embase utilizing a combination of search terms. The inclusion criterion was LP implantation post-LR of infected CIED, while the exclusion criterion was LR for noninfectious indications. Study endpoints encompassed patients’ outcomes during follow-up.

Results:
Our literature review yielded 818 articles, of which 21 met the inclusion criteria, encompassing a cohort of 612 patients who underwent LR followed by LP implantation (Table 1). A total of 250 (40.8%) patients underwent concurrent LP implantation during the LR procedure. The rest underwent staged procedures and the overall duration between LR of infected CIED and LP implantation was 4.32 ± 3.9 days. In our cohort, 172 (28.1%) patients had systemic CIED infections, whereas 130 (21.2%) had isolated pocket infections, with Staphylococcus aureus as the predominant causative organism in 96 (39.3%) cases. Procedural complications were scarce. Over a mean follow-up period of 13.2 ± 8.1 months, pacemaker syndrome was observed in 3 (0.67%) patients, while 1 (0.16%) patient had a re-infection related to LP.

Conclusion:
The remarkably low incidence of complications and re-infections following LP implantation underscores its potential utility as a viable implantation option after LR, particularly in pacing-dependent patients at higher risk of CIED infections.
Abstract 4145065: All Things in Moderation: Right Ventricular Moderator Band Induced Ventricular Fibrillation In A Young Male
Authors: Kamran Wali , Pusukur Bharani , Sutton Peter , Rao Yash , DeBoer Rebecca , Al-Mohamad Talal , Cossu Sergio , Patel Kunal
Published: November 2024

Idiopathic ventricular fibrillation (VF) arrest can be a challenging diagnosis, especially when the etiology is unclear. We present a case of a young male who was found to have VF originating from the right ventricular (RV) moderator band (MB).

A 19-year-old male with a history of idiopathic VF arrest with ICD placement presented with a complaint of sudden dizziness and lightheadedness. Upon device interrogation, he was found to have 17 seconds of fine-VF terminated by one out-of-hospital ICD shock. He reported non-adherence to daily nadolol. He was also noted to have a high burden of unifocal premature ventricular contractions (PVC) on telemetry. On EKG the morphology of PVCs was of a LBBB with a superior axis, suggesting origin from the MB. The patient then underwent an electrophysiological (EP) study, where it was felt that earliest site of activation was identified at the mid-inferior RV along a muscle band extending from mid inferior free wall, superiorly to the interventricular septum. He then had successful radiofrequency ablation at this site, with no post-ablation PVCs or ICD discharge, and was subsequently restarted on his home nadolol.

Idiopathic VF is defined as VF in the absence of clinical cause. Our patient’s PVCs and fine-VF were highly suspicious for RV MB origination. We proceeded with EP mapping and identified the earliest site of PVC activation at the MB. Pace mapping revealed 95% matching at this site. Following ablation, no further PVCs were induced even with isoproterenol. Though not fully understood, the MB is becoming increasingly noted as a source for Purkinje-mediated ventricular arrhythmias. Possible mechanisms of arrhythmogenesis include fibrosis, stretching of fibers, and ion channel variations. Arrythmias from the MB are potentially responsive to catheter ablation.

Early recognition of typical PVC morphology from the RV MB as the source of VF can provide an opportunity for timely intervention. Younger patients, especially, can be treated with catheter ablation to reduce their risk of sudden cardiac death.
Abstract 4145066: Risk for appropriate ICD intervention and complications in patients implanted after an out-hospital cardiac arrest compared to patients implanted for primary and other secondary prevention indication
Authors: Baldi Enrico , klersy catherine , Curcio Antonio , savastano simone , Nesti Martina , Palmisano Pietro , Arabia Gianmarco , Dell'Era Gabriele , Casula Matteo , Dusi Veronica , Guerini Giusteri Valentina , Crea Pasquale , Martini Nicolo , Guerra Federico , Barone Lucy , Russo Vincenzo , Cornara Stefano , Rordorf Roberto
Published: November 2024

Background:
it is unclear if patients implanted with an implantable cardioverter defibrillator (ICD) after an out-of-hospital cardiac arrest (OHCA) have a higher risk of appropriate device therapy than patients implanted for primary and other secondary prevention.

Aims:
to assess if appropriate device interventions (ATP/shocks) are higher in patients implanted after OHCA compared to patients implanted for primary and secondary prevention other than OHCA. To verify also if mortality, implantation-related complications (pneumothorax, hemothorax, hematoma, cardiac tamponade), device-related complications (lead displacement and fracture, infections) and inappropriate shocks/ATP are higher in OHCA patients.

Methods:
a retrospective multicenter international study. We included all the patients implanted with an ICD in 2015 and 2016 in the centers. Follow-up was concluded if death or at the last follow-up available until 12/2023. Patients were divided according to ICD indication (secondary prevention after OHCA, other secondary prevention, primary prevention).

Results:
1386 patients (79% males; median age 67, IQR 59-74) from 15 centers were included (median follow-up 83 months): 111 patients in OHCA group, 134 in other secondary prevention group and 1141 in primary prevention group. Considering the first appropriate intervention, a significant difference among the three groups was observed (Fig.1A) and, at post-hoc comparison, the OHCA group was at higher risk than primary prevention (HR 1.51, 95%CI 1.06-2.17, p=0.02), but was at similar risk than other secondary prevention (HR 0.79, 95%CI 0.51-1.23, p=0.3). This was confirmed also after correction for age, gender, history of atrial fibrillation, aetiology and multi-comorbidity (Fig.2A). Considering the number of appropriate interventions during follow-up, the risk of OHCA group was lower than other secondary prevention (IRR 0.28, 95%CI 0.11-0.68, p<0.01) and similar to primary prevention (IRR 0.97, 95%CI 0.47-1.96, p=0.93), also after correction for the other predictors (Fig.2B). The three groups showed no differences in survival (Fig.1B), implantation-related complication, device-related complications (Fig.1C) and inappropriate shocks/ATP.

Conclusion:
Our study highlights how OHCA patients represents a peculiar population with the same chance of survival and rate of complications compared to primary and other secondary prevention patients suggesting the need of more studies to improve their long-term treatment.
Abstract 4145096: Postural Orthostatic Tachycardia Syndrome and Inappropriate Sinus Tachycardia – Two Distinct Phenotypes in Post-COVID-19 Cardiovascular Dysautonomia: Prevalence, Overlap and Clinical Characteristics
Authors: Juszczyk Maria , Fedorowski Artur , Stahlberg Marcus , Lewinter Christian , Nawaz Sara
Published: November 2024

Introduction:
Postural orthostatic tachycardia syndrome (POTS) and Inappropriate sinus tachycardia (IST) are common manifestations of cardiovascular dysautonomia (CVAD) in patients with post-COVID-19 syndrome. Studies regarding differences between post-COVID-19 POTS and post-COVID-19 IST have been sparse and based on small patient series.

Aims:
To examine clinical differences between POTS and IST in patients with post-COVID-19 syndrome.

Methods:
A cross-sectional observational study based on a dataset of patients diagnosed with post-COVID-19 syndrome and POTS/IST, at Karolinska University Hospital, Stockholm in 2020-2023, was performed. Data was retrieved using patients’ medical records. ANOVA, chi-square tests and Fisher’s exact tests were used for analysis.

Results:
A total of 200 patients diagnosed with post-COVID POTS/IST (ICD-10 codes, I.498 + U.099) were included (female, 85%) and divided into a POTS-group (n=110) and IST-group (n=90). Sixty-one patients (31%) met the diagnostic criteria of both and were included in the IST-group. The mean ages were 38 years for the POTS-group and 42 years for the IST-group (p=0.027). Hypertension was more common within the IST-group (p<0.001). Of the entire study population, 73% developed their post-COVID-19 tachycardia after being infected by the SARS-CoV-2 virus in 2020. Non-cardiac symptoms were more common than cardiac symptoms and fatigue was the most frequently reported symptom amongst the entire study population, but both cognitive impairment (p=0.046) and nausea (p=0.020) were more commonly reported by the POTS-group. There was no significant difference regarding symptom burden according to Malmö POTS Score. Resting, average and maximum heart rate during 24-hour ECG monitoring were higher in the IST group compared to the POTS-group (89 vs. 78 bpm; 91 vs. 76 bpm; 157 vs.144; p<0.001). Ivabradine was the most frequently prescribed pharmacological agent within the study population, but Pyridostigmine was more commonly prescribed within the POTS-group (44% of the POTS-group vs. 31% of the IST-group, p=0.047).

Conclusions:
The diagnosis of POTS is more common than IST in patients suffering from post-COVID-19 syndrome, and there is a 31% overlap of patients diagnosed with both. There are some significant clinical differences between the groups, but both groups share the same symptom burden. The most commonly prescribed pharmacological treatment is Ivabradine, and Pyridostigmine is more frequently used for POTS.
Abstract 4145097: IL-6 based designer cytokine IC7 ameliorates cardiac function by shaping immune response in the infarcted mouse heart
Authors: Ding Zheheng , Rafii Puyan , Gorressen Simone , Ding Zhaoping , Scheller Juergen
Published: November 2024

Introduction:
In the setting of myocardial infarction (MI), the IL-6 cytokine family members, including IL-6 and CNTF, entail the potential to protect the myocardium against ischemia / reperfusion injury. Activation of gp130, the common β receptor for the IL-6 family cytokines, has been implicated to play a pivotal role in cardiac regeneration in neonatal mice and its downstream STAT3 signaling is known to protect the heart via a pre-conditioning manner. Thus, we engineered the chimeric cytokine IC7, a hybrid between IL-6 and CNTF, in which one gp130 binding site of IL-6 was substituted by a CNTF binding site that is capable of binding to LIFR. In the present study, we aim to examine the impact of the novel chimeric cytokine IC7 on cardiac function after MI.

Methods:
Mice underwent LAD ligation surgery and received IC7 i.p. either before or after and 24 hours after surgery. Cardiac function and structural benefits were evaluated by echocardiography and histological analysis (TTC and trichrome staining). Cardiac bulk RNA-Seq was employed to delve into the mechanistical basis by which IC7 regulated cellular process at transcriptional level.

Results:
IC7 injection prior to ischemic episode ameliorated ejection fraction (41.44% vs. 26.78%; p<0.01) and prevented pathological cardiac remodeling in the infarcted heart (end-diastolic volume 84.48 µl vs. 107.15 µl; p<0.05), starting from 1 week after surgery, while injection after ischemia reverted the benefits. This is in line with the histological findings from trichrome staining, confirming the results with decreased collagen volume fraction (7.89% vs. 14.01% ; p<0.05) and higher average wall thickness (0.81 mm vs. 0.57 mm ; p<0.05). Interestingly, TTC staining 24 hours after ischemia already revealed significant cardiomyocyte survival within the infarct zone after IC7 treatment (26.92% vs. 13.98% ; p<0.05). On a transcriptome level, RNA-Seq data unveils 24 up- and 14 downregulated genes in the IC7 treated heart, while IC7 in healthy hearts significantly upregulated 62 and downregulated 35 changed genes, primarily enriched with GO terms associated with immune response.

Conclusions:
Taken together, our results show, for the first time, how a synthetic cytokine (IC7) shapes the cardiac immune response to ischemic injury, leading to remarkably enhanced cardiomyocyte survival and alleviated cardiac remodeling. This finding points to a new promising category of therapeutics for ischemic heart disease.