bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145711: Disparities related to amyloidosis and heart failure: A retrospective analysis of US mortality data
Authors: Pham Hoang Nhat , Ramzi Ibrahim , Alabagi Abdulla , Habib Adam , Aiti Danny , Barker Kenneth , Marco Tom , Mahmood Numaan , Thien Ha Le Duc , Tran Viet Nghi , Tran Phillip , Singh Amitoj
Published: November 2024

Background:
Cardiac amyloidosis, often unrecognized, presents a significant mortality risk when complicated by heart failure (HF). Disparities in amyloid-related outcomes have been previously identified.

Question:
What are the mortality trends and disparities associated with amyloidosis and HF in the United States (US) from 1999 to 2020?

Methods:
Mortality due to amyloid and HF as contributors of death were queried from death certificates within the CDC database during 1999 to 2020. Age-adjusted mortality rates (AAMR) per 100,000 population and 95% confidence intervals were compared by race and ethnicity. Log-linear regression models were utilized to assess temporal variation (annual percentage change [APC]) in mortality.

Results:
Between 1999 and 2020, there were 9,526 deaths related to HF and amyloidosis, with AAMR rising from 0.09 in 1999 to 0.27 in 2020. While HF-AAMR in general population declined slightly from 1999 to 2020 (average APC -0.4%, p=0.003), HF-related mortality in amyloidosis increased gradually from 1999 to 2013 (APC +1.4%, p=0.048), then accelerated from 2013 to 2020 (APC +13.3%, p<0.001). AAMR was higher in urban (AAMR 0.14) than rural regions (AAMR 0.11), among males (AAMR 0.20) than females (AAMR 0.07). Mortality increased steadily in males from 1999 to 2013 (APC +0.8%, p=0.003) with an accelerating inflection in 2013 to 2020 (APC +13.8%, p<0.001). Mortality in females remained stagnant from 1999 to 2013 (APC -1.0%, p=0.300) followed by an increase from 2013 to 2020 (APC +10.8%, p<0.001). Mortality was highest in Black populations (AAMR 0.33), followed by White (AAMR 0.10), Asian/Pacific (AAMR 0.06), and American Indian populations (AAMR 0.04). Mortality among Black populations remained consistent from 1999 to 2012 (APC +1.1%, p=0.184) followed by an increase from 2012 to 2020 (APC +14.0%, p<0.001). Among White populations, mortality remained stagnant from 1999 to 2013 (APC +0.7%, p=0.302) followed by an increase in mortality starting in 2013 to 2020 (APC +13.5%, p<0.001).

Conclusion:
Amyloid and HF related mortality increased in the recent 22-year period, primarily starting in 2013. This is likely a result of increased awareness and availability of novel diagnostic testing like Tc-PYP.
Abstract 4145712: Cancer Type and Baseline Cardiometabolic Risk Factors Predict Major Adverse Cardiac Events in Patients Receiving Immune Checkpoint Inhibitor Therapy
Authors: Hutchins Elizabeth , Feng Jeffrey , Yang Eric , Lechner Melissa , DRAKAKI ALEXANDRA , Arega Enat , Yang Eric , Bui Alex , Madnick David , Stein-Merlob Ashley
Published: November 2024

Introduction:
Immune checkpoint inhibitors (ICI) are increasingly used to treat a wide variety of malignancies. The long-term cardiovascular risk profile of ICI therapy remains incompletely understood.

Methods:
All patients at a single academic center receiving any ICI therapy between 2015 and 2023 were identified. Using ICD codes, we adjudicated major adverse cardiac events (MACE) after initiation of ICI therapy, defined as a composite endpoint of coronary artery disease (CAD), acute coronary syndrome (ACS), cardiomyopathy and heart failure (HF), arrhythmia, ischemic stroke, cardiac arrest, pericarditis, and myocarditis. Cancer type and baseline cardiometabolic risk factors were identified. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for all variables measured.

Results:
Of patients receiving ICI therapy (n=5991), 1196 developed MACE, including ACS (n=152), stable CAD (n = 300), HF (n=217), arrhythmia (n=380), ischemic stroke (n=92), cardiac arrest (n=30) and myo- or pericarditis (n=25). Prior to a MACE event, patients received an average of 11.6 ± 12.7 ICI doses over 332.4 ± 448.0 days. Compared to the non-MACE group, those who developed MACE were older (OR 1.18, CI 1.09-1.27) and of male sex (OR 1.17, CI 1.00-1.23). They were more likely to have higher body mass index (BMI) (OR 1.13, CI 1.06-1.21), pre-existing hypertension (OR 1.3, CI 1.21-1.39), be on statin therapy (OR 1.19, CI 1.11-1.28) and have higher B-nauretic peptide (BNP) levels (OR 1.25, CI 1.06-1.47). Regarding cancer type, MACE was more likely to develop in those with melanoma (OR 1.11, CI 1.02-1.20), lung (OR 1.22, CI 1.11-1.34), colon (OR 1.08, CI 1.01-1.15), genitourinary (OR 1.19, CI 1.10-1.29), and prostate cancers (OR 1.08, CI 1.01-1.15). MACE was less likely to develop in breast cancer (OR 0.88, CI 0.80-0.96). All-cause mortality was higher in the MACE group (59.4% vs. 51.9%, p < 0.001).

Conclusion:
Risk factors for developing MACE with ICI therapy include older age, male sex, cancer type, prior MACE, hypertension, statin use, and higher BMI and BNP. MACE is associated with higher all-cause mortality. These findings can assist in identifying and attenuating cardiovascular risk in patients undergoing ICI therapy.
Abstract 4145719: Predictors of New-Onset Left Ventricular Systolic Dysfunction in Patients Undergoing Orthotopic Liver Transplantation
Authors: Webb Martine , Hutchins Elizabeth , Melehy Andrew , Song Justin , Daneshvar Samuel , Kamath Megan , Bui Alex , Agopian Vatche , Stein-Merlob Ashley
Published: November 2024

Background:
Postoperative left ventricular systolic dysfunction (LVSD) in patients undergoing orthotopic liver transplant (OLT) is a known phenomenon, however, risk factors are not fully delineated.

Methods:
We performed a single-center retrospective analysis of all patients undergoing OLT from 2015 to 2022 and identified cases in which post-OLT left ventricular ejection fraction (LVEF) was less than or equal to 45% within one year. Controls were identified using 1:1 propensity matching on the variables of age, sex, pre-OLT Model for End-Stage Liver Disease (MELD) score, cirrhosis etiology, and pre-transplant LVEF. Baseline demographic, laboratory and echocardiographic parameters were collected. Univariate logistic regression with odds ratios (OR) and 95% confidence intervals (CI) were calculated for each predictor variable.

Results:
Of all patients who underwent OLT (n=956), 66 (6.9%) developed LVSD, with 41 cases (62.1%) occurring within the first 30 days post-OLT. Mean length of stay was not significantly different (79 ± 52 versus 63 ± 53 days, p = 0.086), though patients with LVSD had increased ICU length of stay (56 ± 43 versus 33 ± 27 days, p= 0.002). Preoperative diagnosis of obstructive coronary artery disease (CAD) (OR 8.6, CI 2.3 – 56.5) and chronic obstructive pulmonary disease (COPD) (OR 7.7, CI 1.3 - 146), as well as pre-operative mineralocorticoid receptor antagonist use (OR 2.5, CI 1.3 – 5.2) were independent predictors of LVSD. Of the echocardiographic parameters measured, none were significantly associated with the development of LVSD, though increased left ventricular (LV) size showed a trend towards being predictive (OR 2.71 CI 0.940 – 8.89 p = 0.077). See Figure 1 for Forest Plots of all variables analyzed.

Conclusions:
After OLT, LVSD occurs in a significant minority of patients most commonly within 30 days post-transplant and is associated with increased ICU length of stay. Baseline obstructive CAD and COPD were associated with the development of LVSD after OLT. Although no basic echocardiographic parameters were predictive of post-OLT LVSD, LV size showed a trend towards significance and signals a potential avenue for future research into more advanced echocardiographic predictors.
Abstract 4145739: Predicted Peak Oxygen Consumption in Patients with Hypertrophic Cardiomyopathy is Highly Variable by Sex and Predictive Equation
Authors: Tandon Hannah , jahan israt , Burton Yunwoo , Petek Bradley , Masri Ahmad
Published: November 2024

Introduction/Background:
Cardiopulmonary exercise testing (CPET) can stratify risk of sudden cardiac death and determine eligibility for advanced therapies for patients with hypertrophic cardiomyopathy (HCM). Achieving <80% of predicted peak oxygen consumption during physical exertion (pVO2) has negative prognostic value and has been used as an eligibility criterion in clinical trials.

Research questions/Hypothesis:
pVO2 predictive equations are derived from predominantly male historical cohorts, thus they may be unreliable for women.

Goals/Aims:
To determine the sex-based variability in pVO2 predictive equations in patients with HCM.

Methods/Approach:
This was an observational study of HCM patients undergoing symptom-limited CPET. Wasserman cycle and treadmill (±obesity correction), Jones cycle for men and women, Hansen/Jones, FRIEND, and FRIEND 2018 equations were used to generate predicted pVO2 values.

Results/Data:
A total of 131 HCM patients (median age 47 years, range 18-86) underwent CPET and were included in the analysis; 71 (53.8%) were women. The table summarizes the differences in percent (%) predicted pVO2 by sex for each equation. Equations without built-in sex corrections (Wasserman cycle and treadmill ± obesity correction, Hansen/Jones) resulted in lower percent predicted pVO2 values in women vs men, whereas those with sex corrections resulted in higher values for women vs men. Across equations, there was a high degree of variability in percent predicted pVO2 for women (range for medians 56 to 96%) compared to men (range for medians 68 to 74%). In equations that incorporate sex corrections, fewer women were found to have percent predicted values <80%.

Conclusions:
There is a high degree of variability among equations of percent predicted pVO2, especially in women. Such variability likely introduces unwanted biases in evaluation, risk prediction, and recruitment in clinical trials. Further investigation is warranted to evaluate which predictive equations provide meaningful prognostic value in HCM patients without introducing sex-based biases.
Abstract 4145745: Inter-hospital Transfer for Cardiogenic Shock patients: Contemporary Strategies and Outcomes
Authors: Kochar Ajar , Liang Lichen , Almarzooq Zaid , Song Yang , Kazi Dhruv , Secemsky Eric , Yeh Robert
Published: November 2024

Background:
Cardiogenic shock (CS) is often managed with strategies that require inter-hospital transfers. The contemporary practice patterns and outcomes of transferred CS are unknown.

Methods:
Patients with CS were identified using ICD-10 codes in Medicare claims from 2016-2021. We used a logistic regression model to assess the association of hospital transfer with mortality. We conducted a sensitivity analysis examining the association of early transfer (≤ 24 hours) versus later transfer (>24 hours) and mortality.

Results:
We identified 260,092 patients with CS; of which 9.7% required inter-hospital transfer. Mean time to transfer was 3.5 days (Figure). Transferring hospitals were smaller (229 versus 396 beds), less likely teaching hospitals (43% versus 70%), and more likely rural (7% versus 0.4%). Compared with patients with CS that were not transferred, transferred patients were were older (77 versus 75 years) and had comparable co-morbidity burdens (heart failure 71% versus 73%, diabetes 55% versus 55%). Transferred patients were more likely to receive PCI (21% versus 17%), CABG (18% versus 9%), and MCS, including intra-aortic balloon pumps (21% versus 11%) and percutaneous left ventricular assist devices (11% versus 5%). Transferred patients had longer hospital length of stay (17.8 versus 9.8 days) and ICU length of stay (9.7 days versus 5.6 days). Observed mortality for transferred versus not transferred patients with CS was 37.4% and 40.4% respectively. In addition, transferred patients were associated with a lower mortality (adjusted OR 0.78; 95% CI: 0.76 – 0.81). Early transfer was associated with a slightly lower mortality compared with later transfer (36% vs 38%; p < 0.01).

Conclusions:
Nearly 10% of older patients with CS are transferred to another hospital. Transferred patients were more likely to be treated with revascularization and MCS. Transfer of patients with CS was associated with a lower mortality, especially if the transfer is early within the first 24 hours.
Abstract 4145747: Impact of SLGT2-I on Clinical Outcomes in Heart Transplant Recipients with Type 2 Diabetes Mellitus
Authors: Costa Thomaz , Tramujas Lucas , Nogueira Alleh , Felix Nicole , Lima Neiberg
Published: November 2024

Background:
Type 2 diabetes mellitus (T2DM) is common among heart transplant recipients and is associated with increased morbidity and mortality. Whether there is a need for a specific approach to managing T2DM post-heart transplantation remains unclear, and there is a paucity of data regarding the use of sodium-glucose cotransporter type-2 inhibitors (SLGT2-I) in this patient population.

Hypothesis:
SGLT2-I use impacts mortality and hospitalization in T2DM patients and hospitalization while providing effective glycemic control.

Aim:
To evaluate the impact of SGLT2-I use on mortality, hospitalization, and the achievement of glycated hemoglobin ≤ 7.0% among heart transplant recipients with T2DM.

Methods:
We conducted a retrospective cohort study using de-identified, aggregated data from 120 centers via the TriNetX research network. We identified patients ≥ 18 years of age with T2DM who had undergone heart transplantation from April 1, 2013, to January 1, 2024, using Current Procedural Terminology codes. Patients were stratified based on baseline SGLT2-I use and underwent propensity-score matching. Patients with end-stage kidney disease were excluded. The outcomes were collected within a 2-year time window and included: all-cause mortality, all-cause hospitalizations, and achievement of HbA1c ≤ 7.0%.

Results:
Propensity-score matching resulted in 1,015 patients in each cohort, with a mean age of 57. The mean follow-up was 463 ± 257 and 561 ± 245 days in the SGLT2-I and control cohorts, respectively. SGLT2-I use in heart transplant recipients with T2DM was associated with a significantly lower risk of 2-year all-cause mortality (HR 0.58: 95% CI 0.43-0.78; p<0.001) and higher odds of meeting HbA1c ≤ 7.0% (aOR 0.69; 95% CI 0.48-0.99; p=0.04). However, the rates of all-cause hospitalizations did not differ between groups (HR 1.27; 95% CI 0.82-1.97; p=0.29).

Conclusions:
In this propensity score-matched cohort study comprising 2,030 patients with T2DM and a history of heart transplant, the use of SGLT2-Is was associated with better glycemic control and a significantly lower risk of all-cause mortality over a two-year follow-up period, with no significant difference in all-cause hospitalization.
Abstract 4145753: Gender Differences in Accelerated Vascular Aging in Patients with Resistant Hypertension
Authors: Bag Soumyadeep , Motley Christian , ALI AHMED , Sehar Alina , Patel Aesha , Abdelmessih Peter , Peng Li , Fanning John , Dudenbostel Tanja
Published: November 2024

Background:
RHTN is defined as blood pressure above goal in spite of using ≥3 antihypertensive agents. Patients with RHTN have significantly higher rates of cardiovascular disease (CVD). CVD is the number one cause of death for both men and women. Although premenopausal women are relatively protected from CVD, the incidence increases disproportionately in women after menopause. Arterial stiffening is a risk factor for the development of CVD and for all cause mortality independent of the presence of all traditional CVD risk factors. The association between arterial stiffness and mortality has been shown to be almost twofold higher in women compared to men. In addition, heart failure with preserved ejection fraction (HFpEF) and coronary microvascular dysfunction are the more commonly diagnosed forms of CVD in women and are associated with elevated arterial stiffness in women.

Our study tries to identify the role of accelerated vascular aging (AVA) in female patients with RHTN compared to patients with HTN as a potential mechanism for higher rates of CVD and associated morbidity and mortality.

Methods:
We conducted a cross-sectional analysis of a large cohort of 965 patients with HTN and RHTN referred to the RHTN Clinic at the University of Alabama at Birmingham.

Results:
Women with RHTN compared to men had a similar duration of hypertension (20.6± 12.1 vs. 20.5 ±12.4 years, p=0.99), later onset of HTN (49.5 ± 13.4 vs. 45.5± 14.4 years, p=0.019), similar number of antihypertensive medications, similar levels of serum aldosterone, and plasma renin activity. However, women over the age of 55 with HTN had higher arterial stiffness (AS) than men with HTN (pulse pressure: 90.0±25.6 vs 68.8 ±23.3 mmHg, p<0.0001), and women with RHTN had higher AS than men with RHTN (pulse pressure: 90.0±25.6 vs 79.2±23.7 mmHg, p=0.0004). Furthermore, women with RHTN had higher AS than women with HTN. However, this was also true for men.

Conclusion:
The findings of our study suggest higher degree of accelerated vascular aging in women with RHTN despite later onset and similar duration of HTN compared to men. More evidence is needed to identify causes of accelerated aging in women older than 55 years of age.
Abstract 4145767: Genetic impairment in myosin-5b related transport processes mediates cardiac dysfunction and sudden cardiac death
Authors: Ricke-Hoch Melanie , Heimerl Maren , Erschow Sergej , Mueller-Olling Mirco , Manstein Dietmar , Decher Niels , Kauferstein Silke , Jenewein Tina , Pich Andreas , Hilfiker-Kleiner Denise
Published: November 2024

Background:
Class-5 myosin motor proteins including the members MYO5a, b and c are responsible for intracellular sorting and trafficking of different cargoes, e.g. receptors, metabolites, mRNAs, proteins.

Aim:
The aim is to examine the expression and role of class-5 myosins in the heart with specific focus on MYO5b.

Methods:
By performing next-generation sequencing, a cohort of SCDY/SIDS patients was screened for variants in MYO5b. Expression analysis were performed using RNA-Seq, qRT-PCR, immunohistochemistry and Western blot. Protein binding partners were identified by proteomics following immunoprecipitation. Mice with a cardiac-specific knockout (KO) of MYO5b (aMHC-Cre
tg/-
;MYO5b
flox/flox
) and isolated cardiomyocytes were analysed regarding heart function, morphology and molecular alterations compared with controls.

Results:
MYO5a and MYO5b encoding the myosin-5a and -5b heavy chains show an expression pattern dependent on the developmental status. A reduction in myosin-5b protein expression was detectable in a cohort of human end-stage failing hearts. Human genetic analysis of a sudden cardiac death in the young/sudden infant death (SCDY/SIDS) cohort (n=95) revealed rare and likely pathogenic missense variants in MYO5b in 3%. Young MYO5b-KO mice showed no difference in heart function compared with WT mice, however, displayed impaired electric conductance, metabolism and reduced sarcomeric integrity. Aging KO mice developed heart failure (HF) ending fatal in all mice. RNA-Seq of left ventricular tissue prior to HF revealed deregulated gene expression of sarcomeric and metabolic genes, ion channel subunits and genes involved in Ca
2+
-homeostasis. Proteomic analysis of myosin-5b binding partners revealed them to be mostly ribosomal and mitochondrial in nature. The mitochondrial membrane potential in cardiomyocytes with reduced MYO5b was downregulated. RNA-Seq of MYO5b-bound ribonucleoprotein particles (RNPs) revealed mRNAs coding for sarcomere structure and function, ion channel subunits and metabolic proteins.

Conclusion:
Myosin-5b is involved in the transport of mRNA/ribosome complexes important for sarcomere function, metabolism, Ca
2+
homeostasis and ion channels. Genetic variants or pathophysiological conditions impairing cardiac MYO5b-related transport are associated with an increased risk for cardiomyocyte dysfunction, HF and sudden death.
Abstract 4145771: Association Between Sleep Quality Parameters and Risk of Stroke: A Meta-Analysis of Mendelian Randomization Studies
Authors: Mahadevan Arankesh , Prabu Samyuktha , Patel Mansi , Dhananjaya Hemanth , Jog Himanshu , Goyal Ninia , Gawde Rashmi , Desai Rupak
Published: November 2024

Background:
Sleep quality has emerged as a potential contributor to ischemic stroke risk, and genetic associations have been increasingly investigated for this association. Our analysis aims to elucidate the current understanding of the genetic basis linking sleep quality parameters to ischemic stroke through four distinct exposure groups: short sleep duration, long sleep duration, total sleep duration, and the presence of insomnia.

Method:
The PubMed database was searched to find Mendelian randomization studies reporting the association between ischemic stroke and associated sleep durations and parameters using title abstract keywords and medical subject headings. The initial search yielded 76 results, of which 62 underwent title abstract screening, and nine studies were identified for full-text screening. Eight studies were included in the final analysis. The random effects model was used to pool binary outcomes as odds ratios (OR) with 95% confidence intervals (CI), and the results were presented on forest plots. P value < 0.05 was considered for statistical significance.

Results:
Our pooled analysis revealed a statistically significant association between insomnia and higher odds of ischemic stroke (1.11 [95% CI 1.01-1.22, p=0.03]). However, this finding was limited by high heterogeneity (I2 = 77%, p<0.01). Short sleep vs. normal sleep duration, long sleep vs. normal sleep duration, and total sleep duration did not show statistically significant associations with ischemic stroke (OR: 1.06 [1.00-1.12], 1.01 [0.94-1.08], and 0.99 [0.98-1.00], respectively).

Conclusion:
Our pooled analysis of Mendelian randomization studies finds a positive association between insomnia and the odds of ischemic stroke. However, the associations between sleep duration and ischemic stroke cannot be ruled out. Suggesting potential genetic underpinnings between sleep quality parameters and cerebrovascular events.
Abstract 4145869: Predictive Value of Dipeptidyl Peptidase 3 Plasma Levels for Cardiogenic Shock and Mortality in Acute Coronary Syndromes
Authors: Younus Shifa , Jatoi Sumiya , Cheema Muhammad Hassan , Hussain Alamdar , Zafar Aeman , Fatima Noor , Ali Aamir , Hussain Tauseef , Saleem Hamza , Choudhary Humais
Published: November 2024

Introduction:
Dipeptidyl amino-peptidase 3 (DPP3) is an aminopeptidase released into the bloodstream following cell death. Studies have demonstrated that in patients experiencing cardiogenic shock (CS), there's an elevation in circulating DPP3 (cDPP3) plasma concentration, which is associated with a heightened risk of mortality. This research investigated the connection between serum DPP3 levels, CS occurrence, and mortality in individuals diagnosed with acute coronary syndromes (ACS).

Methods and Materials:
In this prospective, multicentric study, consecutive patients with acute coronary syndrome diagnosis were enrolled, and their plasma levels of DPP3 were evaluated at both baseline and 12-24 hours post-presentation. The ORBI risk score was used to classify patients with a higher risk of cardiogenic shock.

Results:
Elevated circulating levels of DPP3 were linked to in-hospital cardiogenic shock, even when considering established risk factors such as the ORBI risk score (with a hazard ratio of 2.17 per log-2 increase, 95% confidence interval 0.94–1.97, and a P-value <0.005). Additionally, high DPP3 levels were identified as independent predictors of mortality at both 30 days (with a hazard ratio of 2.26, 95% confidence interval 1.14–3.44, and P < 0.001) and one year (with a hazard ratio of 1.57, 95% confidence interval 1.25–2.11, and P < 0.001) after adjusting for established risk factors.

Conclusion:
Our study concludes that circulating DPP3 is a novel marker for cardiogenic shock (CS) and increases mortality risk among ACS patients. Circulating DPP3 may serve as a predictive tool for CS advancement and informing decisions regarding treatment guidelines.
Abstract 4145926: The Importance of Dietary Salt in the Process of Atherosclerosis The Results of the International Survey
Authors: Surma Stanislaw , Lewek Joanna , Sobierajski Tomasz , Banach Maciej
Published: November 2024

Introduction:
Excessive dietary salt intake is a recognized ASCVD risk factor, and causes approximately 1.89 million deaths annually. There is also an ongoing discussion whether dietary salt might be associated with the direct ASCVD risk. Thus, we aimed to check the knowledge, perception, diagnosis, and management of indirect and direct salt-related ASCVD risk among healthcare professionals.

Methods:
The survey, consisting of 17 questions, was developed by the Polish Lipid Association (PoLA). It was launched in March 2024 and promoted through multiple online channels. Many questions allowed for multiple responses. The questionnaire is ongoing and available at the PoLA webpage.

Results:
By the end of May 313 respondents (48.6% females) from 40 countries participated in the survey, 70% of whom were physicians. They mostly came from cities with over 500 thousand inhabitants (53.4%). The largest percentage of responses were from Poland (28.7%), Lithuania (19.4%), and Romania (14.8%). More than 1/3 of the respondents correctly indicated the permissible amount of salt in the diet recommended by WHO; even larger percentage (86.3%) correctly indicated that limiting salt intake in the diet applies to both healthy and sick people. Excess salt in the diet was indicated as a recognized risk factor in the case of hypertension 82.4%, atrial fibrillation 28.8%, obesity 36.4%, type 2 diabetes 20.4%, lipid disorders 18.5%, heart failure 59.1%, stroke 56.9%, and atherosclerosis 42.2%. It is worth emphasizing that a significant percentage did not have or had incorrect knowledge about excessive salt consumption and the risk of the above diseases – from 6.4 to even 53%. In the context of data indicating a large number of deaths related to excessive salt intake, only 57.5% of respondents clearly correctly answered the question on the excess salt association with a higher risk of mortality. The respondents' knowledge about the mechanisms linking excessive dietary salt intake with the progression of atherosclerosis varied greatly, with the majority (38%) indicating that it was only a result of increased BP.

Conclusion:
A significant percentage of respondents have incomplete knowledge about the role of excessive dietary salt intake on ASCVD risk. It is worth emphasizing that excessive salt intake in the diet directly damages the vascular endothelium and thus contributes to ASCVD development. This extremely important mechanism was indicated by only 24% of respondents.
Abstract 4145933: Short-Term Outcomes After Temporary Mechanical Circulatory Support Escalation From Intra-Aortic Balloon Pump to Impella in Patients With Cardiogenic Shock: Insights From the J-PVAD Registry
Authors: Yokoi Masashi , Ito Tsuyoshi , Kawada Yu , Mizoguchi Tatsuya , Kikuchi Shohei , Kitada Shuichi , Goto Toshihiko , Seo Yoshihiro
Published: November 2024

Introduction:
Cardiogenic shock (CS) remains a clinical challenge with a high mortality rate. An escalation strategy from intra-aortic balloon pump (IABP) to Impella has been proposed for patients with CS refractory to IABP therapy, but clinical data on this approach are lacking. This study aimed to elucidate the short-term clinical outcomes after IABP-Impella escalation in patients with CS.

Methods and Results:
From the Japanese nationwide registry of Impella (J-PVAD) database between 2020 and 2022, a total of 2,578 patients with CS who received Impella support were classified into the IABP-Impella group (n=189) or the Primary Impella group (n=2,389). We applied a 1:3 propensity score matching, selecting 180 patients in the IABP-Impella group and 540 patients in the Primary Impella group. Before matching, the IABP-Impella group presented significantly longer shock-to-Impella time, worse laboratory data indicating multiorgan damage, and more frequent inotrope use compared to the Primary Impella group. After matching, the baseline characteristics were well-balanced between the two groups. The clinical outcomes within 30 days after the initiation of Impella were compared between the matched groups. The IABP-Impella group showed a significantly higher rate of additional mechanical circulatory support (MCS) use than the Primary Impella group (33.9% vs. 25.6%, p=0.034). Although the incidence of mortality was similar between the two groups (30.6% vs. 30.9%, p>0.99), the incidence of major complications (a composite of bleeding, hemolysis, infection, stroke, myocardial infarction, limb ischemia, and vascular injury) tended to be higher in the IABP-Impella group (43.0% vs. 36.3%, p=0.053). Notably, the incidence of infection was significantly higher in the IABP-Impella group than in the Primary Impella group (10.0% vs. 4.8%, p=0.018). Kaplan-Meier estimates revealed that infection occurred more frequently in the IABP-Impella group during the 30-day follow-up period (log-rank p=0.016).

Conclusions:
Patients undergoing the IABP-Impella escalation strategy showed poorer baseline clinical conditions in baseline and were associated with a higher likelihood of further MCS upgrade and an increased risk of infection.
Abstract 4145990: Time Trend Analysis of Clinical Outcomes for Drug-Coated Balloon versus Drug-Eluting Stent among Patients with Coronary In-Stent Restenosis: A Meta-Analysis of Randomized Controlled Trials
Authors: Soltani Moghadam Arman , Kazemian Sina , Shojaei Shayan , soltani moghadam saman , Hosseini Dolama Reza , Ebrahimi Rasoul , Ojaghi Shirmard Fatemeh , Pourfaraji Seyed Morteza Ali , Najafi Mohammad Sadeq , Hobaby Sara , Soleimani Hamidreza , Tehrani Behnam , Elgendy Islam , Allana Salman , Raphael Claire , Basavarajaiah Sandeep , Hosseini Kaveh
Published: November 2024

Background:
Coronary in-stent restenosis (ISR) secondary to neointimal hyperplasia or neoatherosclerosis remains a significant challenge following percutaneous coronary interventions (PCI), with no consensus on the optimal revascularization strategy. We compared the outcome of PCI for ISR using drug-coated balloons (DCB) and drug-eluting stents (DES) and investigated the time trends in their clinical outcomes.

Methods:
PubMed, Embase, Scopus, and the Cochrane Library databases were searched through May 2024. We included randomized controlled trials (RCTs) comparing DCB versus DES among patients with coronary ISR. The primary outcome was target lesion revascularization (TLR). Secondary outcomes included all-cause mortality, myocardial infarction (MI), stent thrombosis, and late lumen loss (LLL). Random-effects models were employed to analyze outcomes within 1-year and beyond 1-year intervals. Meta-regression analysis was used to investigate the effect of age, sex, history of diabetes, hypertension, dyslipidemia, smoking, and ejection fraction on all outcomes by applying mixed-effect models.

Results:
We included 10 RCTs (1034 patients in the DCB group and 943 patients in the DES group). We found similar incidence of 1-year TLR (odds ratio [OR] 1.36; 95% confidence interval [CI] 0.86, 2.14;
P
0.194; I
2
43.3%) and >1-year TLR (OR 0.94; 95% CI 0.57, 1.56;
P
0.817; I
2
0%) with the use of DCB versus DES. The risks of all-cause mortality, MI, and stent thrombosis were comparable between DCB and DES in 1-year and beyond 1-year follow-ups. At 6-9 months angiographic follow-up, DCB was associated with non-significantly lower LLL compared to DES (standardized mean difference [SMD] -0.12 millimeters; 95% CI -0.29, 0.05;
P
0.170; I
2
71.7%). Meta-regression indicated that higher prevalence of diabetes was associated with an increased risk of 1-year revascularization after DCB compared to DES (Estimate 0.07;
P
0.003; I
2
0%). Additionally, male sex was associated with an increased LLL in DCB versus DES (Estimate 0.034;
P
0.001; I
2
41.8%). No association was found between other baseline characteristics and measured clinical outcomes.

Conclusion:
DCB demonstrated comparable PCI outcomes compared to DES in patients with coronary ISR.
Abstract 4146037: Navigating the Diagnostic Challenges and Therapeutic Landscape of Giant Cell Myocarditis: A Compelling Case Study of Survival and Recovery
Authors: Bitton Neria , Caplan Alex , Nelson Favour , Olenginski Gregory , Gonter Aric , de Ridder Gustaaf , Carry Brendan , henry Lucie
Published: November 2024

Introduction:
Giant cell myocarditis (GCM), a rare and often fatal heart disease, presents diagnostic challenges due to its varied symptoms mimicking other cardiac conditions. Treatment can involve medical management and heart transplant. Early diagnosis and targeted therapy can improve survival without transplant.

Case presentation:
A 66-year-old female with type II diabetes, obesity, and coronary artery disease (CAD), presented with dyspnea, orthopnea, epigastric pain, and hypotension. Laboratory findings showed troponin at 2301 ng/L and lactic acidosis, with nonspecific ST changes on EKG prompting treatment for acute coronary syndrome (ACS). She was started on dobutamine and admitted to the cardiac ICU for cardiogenic shock. An echocardiogram revealed left ventricular ejection fraction (LVEF) of 25% with diffuse hypokinesis. She underwent coronary angiography which showed no significant obstructive CAD. She remained in cardiogenic shock despite inotropic support, prompting placement of an Impella and endomyocardial biopsy. Pathology revealed diffuse interstitial giant cells and multifocal cardiomyocyte necrosis, consistent with GCM. She was treated with pulse-dose steroids, tacrolimus, and placed on the heart transplant list. After 14 days with Impella 5.5 support, her LVEF improved to 45%. She has since been managed with mycophenolate, prednisone, and guideline-directed medical therapy for heart failure.

Discussion:
Without treatment, GCM has a median survival of 3 months. Early diagnosis is often challenging as symptoms can mimic acute coronary syndrome. Refractory cardiogenic shock with myocardial injury in the presence of benign coronary angiography should prompt an endomyocardial biopsy to investigate uncommon etiologies such as GCM. While treatment primarily involves immunosuppressive therapy and heart transplantation, not all patients are eligible candidates for transplant. In this case, mechanical support stabilized the patient's hemodynamics, allowing immunosuppression to reverse myocardial inflammation, potentially improving survival, and reducing the need for a transplant. We highlight the diagnostic challenges of GCM and the critical role of medical and mechanical therapy in improving outcomes.
Abstract 4146038: Inpatient Tricuspid Valve transcather and surgical procedural outcomes: A Propensity Matched analysis
Authors: Alayyat Ahmad , Alhuneafat Laith , Rasheed Waqas , Kapcin Kyle , Manalo Kathryn , Maaita Abdel latif mohd abdellatif , jabri Ahmad
Published: November 2024

Background:
Tricuspid regurgitation (TR) is a common valvular heart disease, and associated with increased cardiovascular mortality. Adverse events from surgical treatment of severe TR are limiting this approach.

Aim:
To analyze the outcomes of using surgical and transcatheter TV interventions across the United States.

Methods:
We used The National Inpatient Sample (NIS) data base and included data between January 1, 2011 and December 31, 2020. We selected patients who underwent Transcatheter tricuspid valve intervention (TTVI), surgical TR repair (STVr), and surgical TR replacement (STVR). TTVI patients were propensity-matched 1:1 to STVr and STVR using nearest neighbor matching. Analyses were conducted using STATA version 17.

Results:
Between 2011 and 2020, a total of 98,202 TV interventions were identified. Of these, 1,830 (1.9%) underwent TTVI, 76,747 (78.2%) underwent STVr and 19,625 (19.9%) underwent STVR. Patients receiving TTVI were older, more likely to be white and to be treated at a teaching hospital. STVR accounted for the highest proportion of TV procedure-related deaths overall, followed by surgical TV replacement, and lastly, TTVI. In our PSM analysis, STVr and STVR were associated with increased inpatient mortality (7% vs 2.3%, 11.6% vs 2.4%, respectively), when compared to TTVI (p<0.001). Among patients who underwent tricuspid intervention, the odds of experiencing circulatory shock were higher in STVr (24.0% vs 11.8%) and STVR (11.6% vs 2.3%) when compared to TTVI (P<0.001). Moreover, STVr (7.0% vs 2.4%) and STVR (11.6% vs 2.3%) were also associated with higher likelihood of post-procedure respiratory failure (p<0.001). Patients with STVr and STVR experienced longer hospital stays, higher inpatient costs, increased likelihood of non-routine discharge, utilization of mechanical circulatory support (MCS), cerebrovascular accidents, blood transfusions, mechanical ventilation, myocardial infarctions, and pericardial complications

Conclusions:
Our study does present findings favoring TTVI over surgical interventions. TTVI demonstrates advantages in terms of hemodynamic stability, inpatient mortality, length of stay, and likelihood of MCS use. Nevertheless, additional research is necessary to characterize the long-term durability of TTVI.
Abstract 4146071: Post Transcatheter Aortic Valve Replacement outcomes among patients with Cardiac Amyloidosis and Aortic Stenosis.
Authors: Jaiswal Vikash , Hanif Muhammad , Mares Adriana , Sundas FNU , Jaiswal Akash , Daggubati Ramesh , Grubb Kendra
Published: November 2024

Background:
Aortic stenosis (AS) and cardiac amyloidosis (CA) frequently coexist. There is a paucity of data on whether the presence of CA impacts post-procedural and clinical outcomes after transcatheter aortic valve replacement (TAVR) among AS patients.

Objective:
In this analysis, we sought to leverage data from the TriNeTX Global Collaborative Network to determine the impact of CA on mortality and cardiovascular/ischemic outcomes at 1-month and 1-year post-TAVR.

Methods:
The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years from January 2012 to April 2023. Patients with AS were categorized into two groups: one with CA and having TAVR, and a control group with non CA group having TAVR. Patients were followed for 1 month and 1 year respectively. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, race, hypertension, diabetes mellitus, and chronic kidney disease. Primary outcome was all-cause mortality (ACM), while secondary outcomes were acute myocardial infarction (AMI), ischemic stroke, ventricular arrhythmias, and major adverse cardiovascular event (composite of ACM, ischemic stroke and AMI).

Results:
After 1:1 PSM, the study cohort comprised of 351 patients in the CA group and 351 patients in the non-CA group. The mean age of patients in CA and non-CA groups was 79.6 and 79.5 years. PSM analysis showed that ACM was comparable between CA and non-CA group after 1-month (RR, 1.00 (95%CI: 0.42-2.39),
P
=0.98), and after 1-year follow up (RR, 0.92 (95%CI: 0.59-1.44),
P
=0.736). AMI was also found comparable between the two cohorts, both after 1-month (RR, 1.189 (95%CI: 0.503-2.811),
P
=0.693), and after 1-year (RR, 1.288 (95%CI: 0.598-2.773),
P
=0.516). Similar trends were found for ischemic stroke, ventricular arrhythmias and MACE both after 1-month and 1-year follow up.

Conclusion:
This study shows that TAVR can be safe to be considered among cardiac amyloidosis patients with aortic stenosis
Abstract 4146104: The Supplementary Anti-Obesity Medication Integration into a Longitudinal Weight Loss (SAIL) Program: Early Experience in a Remote Comprehensive Weight Management Solution In Patients with CardioMetabolic Risk
Authors: Ostrominski John , Tucci Michela , Zelle David , Baer Heather , Unlu Ozan , McCarthy Ashley , Gabovitch Dan , Apovian Caroline , Scirica Benjamin , Blood Alexander
Published: November 2024

Background:
There is substantial imbalance between the prevalence and treatment of overweight/obesity. Team-based remote care programs have shown promise in closing healthcare delivery gaps for several cardiometabolic disorders, but whether this strategy can enhance the uptake of guideline-directed therapy for weight management remains uncertain.

Methods:
In this quality improvement program, we developed and deployed a remote, patient navigator and pharmacist-led, pharmacotherapy-oriented weight management intervention (Supplementary Anti-Obesity Integration into a Longitudinal Weight Loss [SAIL] program). SAIL was conducted within the Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0 (PROPS 2.0) program, an ongoing 12-month digital health program pairing an online weight management program (RestoreHealth; HealthFleet, Inc.) with personalized support from health coaches. After 6 months, PROPS 2.0 participants who did not experience weight reduction were offered possible enrollment in SAIL. Pharmacists, enabled by a collaborative drug therapy management program, prescribed, titrated, and monitored anti-obesity medications (AOM) with physician (cardiologist) supervision.

Results:
Overall, 2,540 invitations for participation in SAIL were sent to the 5,061 patients enrolled in PROPS 2.0, of whom 200 responded. Of the respondents, 98 (49%) were eligible for SAIL, and 75 patients were enrolled. Based randomly by enrollment period, 45 patients participated without a remote physician visit, while 30 had a video telemedicine visit. Among the 75 program participants, 70 (93%) received a prescription for AOM (29/30 with a visit vs. 41/45 without; P=0.64). After a median follow-up of 143 days (IQR 79-193), 61/70 were taking prescribed AOM (26/29 with a visit vs. 35/41 without; P=0.73) (
Figure
).

Conclusion:
This study extends prior experiences leveraging remote, team-based care, emphasizing the potential of this approach to enhance weight management. Given the dramatic cardiometabolic detriments of prolonged exposure to overweight and obesity, innovative approaches are necessary to meet demand. Remote and team-based care are proven methods to improve care and outcomes and may provide a novel model for delivering care for overweight and obesity. Further studies are needed to ascertain the effectiveness of this strategy on weight-related health outcomes.
Abstract 4146112: Colchicine for secondary prevention in patients with Acute Coronary Syndrome (ACS). A systematic review and meta-analysis.
Authors: Shaikh Safia , Hamza Mohammad , Umer Ahmed Muaaz , KC Manish , Neppala Sivaram , Singh Sahib , Basit Jawad , Pandya Krutarth , sattar yasar , Alraies M Chadi
Published: November 2024

Background:
Despite optimal therapy, coronary artery disease (CAD) remains a significant public health concern in the United States. The literature increasingly acknowledges the role of inflammation in the development of atherosclerosis. Colchicine, a potent anti-inflammatory drug commonly used to treat gout and pericarditis, is being evaluated in this study for its safety and efficacy in preventing CAD following an acute coronary syndrome (ACS).

Methods:
We searched PubMed and Embase to find studies up to April 2024 that compared colchicine to placebo in patients with ACS. The primary outcomes were major adverse cardiovascular events (MACE), stroke, recurrent ACS, and recurrent hospitalizations. Secondary endpoints consisted of cardiovascular death and the incidence of congestive heart failure (CHF). We also examined the gastrointestinal effects of colchicine in all subjects. To combine the data, we used the random-effects model.

Results:
We included ten studies with a pooled sample size of 7,260 patients. The mean age was 60.1 (±11.8) years, with 19.3% females and an average follow-up duration of 8.5 (±6) months. Patients who received colchicine treatment demonstrated a reduced risk of MACE (OR: 0.72, 95% CI: 0.59-0.88, p- 0.001), stroke (OR: 0.41, 95% CI: 0.20-0.84, p- 0.01), recurrent ACS (OR: 0.73, 95% CI: 0.57-0.93, p- 0.01), and hospitalization (OR: 0.52, 95% CI: 0.34-0.81, p- 0.003). However, there was no significant difference in cardiovascular death (OR: 1.01, 95% CI: 0.60-1.72, p- 0.95) and the incidence of CHF (OR: 1.04, 95% CI: 0.64-1.69, p-0.89) between patients treated with colchicine and those without. Notably, patients treated with colchicine experienced more gastrointestinal effects than those without colchicine treatment (OR: 1.16, 95% CI: 1.02-1.32, p-0.02).

Conclusion:
Adding colchicine to standard medical therapy in ACS patients significantly reduced the incidence of major adverse cardiovascular events, stroke, recurrent ACS events, and hospitalizations. Further prospective trials are required to validate these findings and determine if early intervention with colchicine treatment improves clinical outcomes in ACS patients.
Abstract 4146149: Influence of Hypertension on Cardiovascular Injury of Short-term Particulate Air Pollution Exposure in Mice
Authors: Jin Lexiao , Junard Matthew , Bonvillain Gabriel , Barnett Sarah , Miller Alexis , Shirk Gregg , Gumpert Anna , Singhal Richa , Conklin Daniel
Published: November 2024

Background:
The WHO estimates that air pollution causes 7 million premature deaths or about 1 in 8 global deaths. Epidemiological studies indicate that 60-70% of the premature mortality attributed to air pollution are cardiovascular deaths especially in those with pre-existing conditions such as hypertension and heart failure. The underlying pathophysiological mechanisms by which exposures to air pollution worsen cardiovascular disease are unclear.

Hypothesis:
We hypothesized that the cardiovascular toxicity of particulate air pollution (PM
2.5
) exposure would be enhanced in the setting of hypertension.

Methods:
To test this, we combined air pollution exposure with a hypertension model (angiotensin II, 2.5 mg/kg bwt/day: ANGII osmotic pump) where normotensive and hypertensive male wildtype (WT, C57BL/6J) mice were exposed to filtered air or concentrated ambient PM
2.5
(CAP) for 3 weeks. To understand how combined hypertension and CAP exposure may alter cardiac remodeling, fibrosis and gene transcription (bulk RNAseq) were quantified.

Results:
Mice with ANGII-infusion developed hypertension (non-invasive tail cuff) that was significantly elevated by CAP exposure. Hypertensive mice also developed cardiac hypertrophy (heart weight/tibia length ratio, mg/mm) independent of exposure [hypertensive: WT+Air, 9.6±0.4; WT+CAP, 10.3±0.4; normotensive groups: WT+Air, 8.3±0.3; WT+CAP, 7.4±0.1). CAP exposure had no effect on differential gene transcription in normotensive mice, yet CAP exposure significantly induced 996 differentially expressed genes (DEG) in hypertensive mice (332 up, 664 down). Gene Ontogeny (GO) analysis found dysregulated gene clusters (>40 genes) primarily for cardiac and striated muscle development and differentiation. Increased genes included caspase 12 (
Casp12
) and catechol-
O
-methyltransferase (
Comt)
genes that likely reflect enhanced apoptosis and sympathetic input. Downregulated genes included 2 collagen genes (
Col5a3
and
Col6a3
) and death inducer-obliterator 1 (
Dido1
) -- reflecting dysregulated cardiac remodeling.

Conclusions:
Hypertension enhanced the susceptibility of short-term air pollution exposure to worsen cardiovascular effects especially cardiac remodeling. This study reveals potential genetic mechanisms by which air pollution hastens cardiac dysregulation and promotes heart failure – a serious, globally relevant cardiovascular health risk of particulate air pollution.