bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4118668: Understanding Medication Adherence to Oral Anticoagulants in Atrial Fibrillation Management: Patient and Provider Perspectives in a Mixed Methods Study
Authors: Gill Monique , Jones Kyle , Ghosal Ritu , Gilmore Aisha , Johnson Angela , Wilson Eleni , Imboden Mary , Ateya Mohammad , Dai Feng , Manzey Laura , Townsend Kevin , Wendt Staci
Published: November 2024

Background:
Atrial fibrillation (AF) increases risk of stroke. National guidelines recommend oral anticoagulant (OAC) use to reduce this risk. Medication adherence is pivotal for effective AF management, necessitating an understanding of adherence barriers.

Aims:
This mixed-methods study aimed to identify patient and provider factors influencing OAC adherence.

Methods:
Patients with nonvalvular AF and OAC prescriptions were sampled from a large community health system serving seven states. A stratified random sample of 2,000 patients was surveyed by mail, achieving a 13.3% response rate (266 patients). Twenty-eight semi-structured interviews were conducted with a purposive sample of patient survey respondents. Eligible providers were surveyed by email, resulting in a 3% response rate (78 providers). Survey data were analyzed descriptively and using multivariable regression models. Interview data were analyzed thematically.

Results:
Of 213 patients with an adherence score available, 31.5% reported non-adherence. Nonadherent patients were more likely to report poor healthcare experiences, including discrimination in a healthcare setting and poorer mental/emotional health. Receiving information from providers was significantly associated with adherence, especially among younger patients and those with fewer chronic conditions. High self-efficacy score was associated with adherence, particularly among older and rural patients. Interview analyses showed provider communication about AF medications, perceptions of AF as a serious illness, and a sense that medication was helping manage AF were all important for medication adherence. In contrast, most providers (87%) perceived high non-adherence among AF patients, citing forgetfulness, cost, and side effects as the main reasons. Providers’ responses indicate a need for improving communication and support for addressing adherence barriers.

Conclusion:
Most patients reported adherence to their medications, with adherence being associated with positive healthcare experiences and better mental/emotional health. Providers perceived relatively low adherence among their patients but aligned with patients on the need for improved communication and shared decision making. Tools that encourage discussion with patients and open communication between providers and patients are pivotal for optimizing patient care and enhancing medication adherence and treatment outcomes.
Abstract 4118766: Lower Winter and Higher Summer Temperatures Increase the Risk of Hospitalization With Aortic Aneurysm or Aortic Dissection
Authors: Yin Kanhua , Wei Yaguang , Schwartz Joel
Published: November 2024

Background:
Seasonal variation in aortic dissection incidence are well-documented. This study utilized a high-resolution surface temperature model and state-specific administrative medical data to investigate the relationship between long-term exposure to winter and summer temperature averages and hospitalization rates for aortic aneurysm or dissection.

Methods:
Using data from the 2000-2016 State Inpatient Databases (SID), 265,795 hospitalizations with a principal diagnosis of aortic aneurysm or dissection for residents of 19 U.S. states were identified via ICD-9 and 10 codes. Daily surface temperature data, extracted from Oak Ridge National Laboratory’s Daymet weather model on a 1-km grid, were aggregated to zip codes to match SID's spatial resolution. Linear regressions, adjusted for demographics, comorbidities (including hypertension, hyperlipidemia, atherosclerosis, smoking, and genetic disorders), air pollution, and neighborhood socioeconomic status, estimated absolute changes in annual hospitalization rates associated with variations in winter and summer temperature averages. Nonlinear exposure-effect relationships were assessed using penalized cubic splines with at most nine degrees of freedom.

Results:
Each Celsius degree decrease in winter and increase in summer was associated with 19.0 (95% CI: 17.5, 20.8, p<0.001) and 10.4 (95% CI: 8.0, 12.7, p<0.001) additional hospitalizations per one million person-years, respectively. These statistically significant associations were consistent across subgroups, including thoracic vs. abdominal and aneurysm vs. dissection. Further analysis revealed that cooler-than-average winter temperatures consistently correlated with increased hospitalization rates for overall aortic aneurysms or dissections and their subtypes.

Conclusion:
Colder winter and hotter summer temperatures significantly increase the risk of hospitalization for aortic aneurysm or dissection. This emphasizes the importance of understanding how environmental factors contribute to aortic disease.
Abstract 4118777: Outcomes Of Patients With Hypertrophic Cardiomyopathy In Academic Versus Non-Academic Centers: Analysis from the National Inpatient Sample Database 2012-2020
Authors: El-Shaer Ahmed , Hall Alexander , Tandalam Palanivelu Sangeetha , Monther Noorhan , Tauseef Abubakar , Abdul Jabbar Ali , Ahmed Hasaan , Mathew Kalathil Ruth Ann , Shaik Abdullah , Mushtaq Ali , Patel Rutvij , Millner Paul , Mirza Mohsin , Walters Ryan , kabach amjad
Published: November 2024

Introduction:
Hypertrophic Cardiomyopathy (HCM) is an uncommon heart condition associated with serious complications. Advances in medicine have improved its prognosis. Despite this, such potentially life-saving improvements concerning the implementation of best practices are not ubiquitous; guidelines recommend management at specialized centers. Unfortunately, not all hospitals have specialized HCM centers. However, given that a sizeable portion of these specialists are also in academic centers (ACs), we hypothesize that ACs may be better positioned than non-academic centers to provide the highest quality care for HCM patients.

Purpose:
Our study aimed to assess in-hospital outcomes and healthcare burdens among patient admissions with HCM diagnoses, comparing those treated at academic centers with those receiving care at non-academic centers. We examine all-cause in-hospital mortality, length of stay (LOS), hospital costs, and investigate ethnic differences in patients with HCM.

Methods:
The National Inpatient Sample database was utilized to obtain HCM patient hospitalizations from 2012 through 2020 in the United States. Patient hospitalizations for which adult patients had a primary diagnosis of HCM were identified. Outcomes included all-cause in-hospital death, LOS, and hospital costs. All-cause in-hospital mortality was evaluated using multivariable logistic regression analysis. Multivariable lognormal regression models were used to estimate LOS and inflation adjusted cost outcomes.

Results:
All-cause mortality unadjusted rates were 2.2% in non-teaching hospitals compared with 1.7% at teaching hospitals; however, this difference was not statistically significant (
p
=.235). Both unadjusted and adjusted hospital LOS were 32% shorter for non-teaching hospitals (
p
<.001). Both unadjusted and adjusted hospital costs were 46% lower for non-teaching hospitals compared to teaching hospitals (
p
<.001; $37,829 vs $70,216). For both LOS and cost, the overall interaction between race and teaching status was statistically significant (
p
< .001.)

Conclusion:
Our study shows variations in hospital outcomes and costs between teaching and non-teaching hospitals. Non-teaching hospitals displayed shorter stays and lower costs. Additionally, the interaction of race and teaching status significantly impacted length of stay and costs. These results underscore the necessity of tailored interventions to address healthcare delivery and resource inequities, especially in teaching hospitals.
Abstract 4119052: Redefining the phenotypic continuum of cardiovascular disease using machine learning
Authors: Curran Lara , Inglese Paolo , Rjoob Khaled , McGurk Kathryn , Lu Chang , Zheng Sean , Tahasildar Shamin , Kalaie Soodeh , Bai Wenjia , Halliday Brian , Tayal Upasana , de Marvao Antonio , Ware James , Prasad Sanjay , O'Regan Declan
Published: November 2024

Background:
Current approaches that define cardiovascular disease rely on assignment of traditional diagnostic labels which may not reflect the natural continuum of phenotypic expression, influenced by genetic and environmental modifiers, or adequately identify groups with shared molecular mechanisms. Machine learning can leverage advances in genetic and imaging characterisation to reclassify phenotypic diversity along a continuum, from health to disease.

Research Aims:
Our study aims to build a tree-like classification of cardiovascular phenotypes in the community where branches represent subjects with shared features, ordered by their severity. Using dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) as exemplar conditions with opposing phenotypes, we aim to demonstrate the interaction between genetic and environmental modifiers of disease expression.

Methods:
We analysed cardiovascular magnetic resonance (CMR) imaging, electrocardiogram (ECG), biomarkers and clinical data from participants in the UK Biobank. Using unsupervised learning of multiparametric data, we built a tree of phenotypic expression. We projected the risk of DCM and HCM cases, and associated rare and common variant risk, onto the tree structure.

Results:
Ten main branches were discovered, using data from 41,525 participants (51.7 % female, median age 65 yrs [IQR: 58, 70]). The extremities of branches 1 and 6 were enriched for DCM cases (p <0.05) and participants with reduced ejection fraction and high left ventricular volumes (p <0.05). Compared with subjects at the tree centre, distal participants in branch 1 had increased blood pressure (BP) and body mass index (BMI), whilst those in branch 6 were more likely to have high HbA1c levels and carry a pathogenic DCM variant (p <0.05). The extremity of branch 5 was enriched for HCM cases, rare sarcomeric variants (p = 0.004) and high polygenic risk (p <0.001). Whilst the ends of branches 3 and 9 had high polygenic risk for HCM, they were less likely to have elevated BP and BMI, and had reduced likelihood of HCM expression, compared with branch 5. A phenomapping model was trained to accurately project unseen subjects onto the tree (R
2
0.98).

Conclusions:
We present a tree-like continuum of cardiovascular phenotypes, providing a novel framework for mechanistic discovery and exploration of genotype-phenotype associations. Phenomapping of unseen subjects enables personalised estimation of genetic and cardiovascular risk.
Abstract 4119167: Electromagnetic Interference from Electric Vehicles: Implications for Subcutaneous Implantable Cardioverter-Defibrillators
Authors: Salam Kamil , Salih Anmar , Goswami Tarun , Wase Abdul
Published: November 2024

Background:
Electromagnetic interference (EMI) refers to signals discernible by a device’s circuitry, potentially resulting in erroneous sensing, pacing, mode switching and defibrillation. EMI poses potential risks to the functionality of cardiac implantable electronic devices, with Subcutaneous- Implantable Cardioverter-Defibrillators (S-ICDs) potentially more susceptible due to their design.

Research Question:
Does EMI from Electric Vehicles (EV) interfere with the functionality of S-ICDs?

Goals:
Developing and utilizing a loop antenna device that mimics S-ICDs to assess the susceptibility of S-ICDs to EMI from EVs in different charging conditions.

Methods:
A loop antenna device mimicking the S-ICD lead design was developed, and then validated by the Food and Drug Administration, to detect electromagnetic signals. The device was positioned at different locations in a Tesla Model 3 to measure electromagnetic signals.

Results:
Statistical analysis revealed a significant difference (p-value < 0.0001) in detected voltage (400-504 mV) around the cup holder compared to all other measured locations. These signals fell within the R-Wave Spectrum of 30-300 Hz.

Conclusion:
We identified EV-emitted EMI capable of disrupting S-ICD functionality. Further in-vivo studies are essential to determine the level of interference between S-ICDs and EMI from EVs.
Abstract 4119195: Proteomic Analysis of Primary Angioplasty in Acute Myocardial Infarction: Implications for Left Ventricular Remodelling and Recovery of Function
Authors: Kim Jin Un , Little Callum , Acquah Vanessa , Ponticos Markella , Kotecha Tushar , Rakhit Roby
Published: November 2024

Introduction:
Acute myocardial infarction (AMI) is a leading global cause of mortality. Following primary percutaneous coronary intervention (PCI), 25% require hospitalisation for symptomatic heart failure. Further understanding of the molecular pathogenesis and the temporal relationship of the protein profile associated with ischaemic insult and subsequent cardiac remodelling is required to improve risk stratification following AMI.

Methods:
20 patients with AMI presenting to Royal Free Hospital in London were recruited for proteomic analysis (O link Proximity Extension Immunoassay) at presentation and at 24 and 72 hours following primary PCI. All underwent initial CMR on admission and at 6 month follow up to assess for myocardial oedema, left ventricular volumes and function and assessment of scar.

Results:
Proteomic biomarkers that increased on discharge following AMI were: IGFBP2 (8% increase, p=0.001), MMP-10 (5% increase, p=0.001), TIMP4 (14.4% increase, p<0.001), CSF-1 (3.4% increase, p<0.001), CHI3L1 (15% increase, p<0.001), ST2 (19% increase, p=0.001), TGF-alpha (17% increase, p=0.001), IL6 (38% increase, p<0.001), and NT-proBNP (93% increase, p<0.001). The only biomarker that significantly decreased was IGFBP-1 (24% decrease, p=0.003). Notably, increased post-PCI biomarkers correlated with reduced infarct size at follow-up, including CCL23 (R=-0.6, p=0.016), IL6 (R=-0.051, p=0.04), NT-proBNP (R=-0.72, p=0.002). High biomarkers at initial presentation associated with reduced left ventricular end diastolic volume (LVEDV) were CSF-1 (R=-0.64, p=0.03) and CCL23 (R=-0.76, p=0.006).

Discussion:
Following AMI, we observed increase in proteins implicated in inflammation, angiogenesis and tissue repair. IGFBP1 as a stress hormone significantly decreased after PCI. Markers that showed linear association with reduced cardiac preload measured by LVEDV were linked with angiogenesis promotion and resolution of inflammation.
Abstract 4119300: Prevalence and Outcomes of Atrial Fibrillation during Pregnancy and Puerperium
Authors: zeng zhenyu , Wu Shengyong , Xu Xudong , liu suxuan
Published: November 2024

Background:
Atrial fibrillation (AF) during pregnancy and puerperium is devastating for the mother and her family, yet data regarding incidence and outcomes are very limited.

Objective:
We aimed to investigate the incidence and outcomes of AF during pregnancy and puerperium in a large database. The value of the CHA
2
DS
2
-VASc score in predicting adverse outcomes during pregnancy was also assessed.

Study Design:
The National Inpatient Sample (NIS) database was queried to identify pregnancy-related hospitalizations from 2008 to 2017. Temporal trends in the incidence and outcomes of AF were extracted. The CHA
2
DS
2
-VASc score was calculated for all patients, and the score was classified into three groups: low-risk group (1 point), moderate-risk group (2-3 points), and high-risk group (≥4 points).

Results:
Among 40,996,860 pregnancy-related hospitalizations, 15,162 (0.037%) were diagnosed with AF. The incidence increased from 2.18 per 10,000 hospitalizations in 2008 to 4.87 per 10,000 in 2017 (

P
trend

< .0001). The proportion of patients with AF increased with advanced maternal age (

P
trend

< .0001). Subgroup analysis showed that the incidence of AF was higher in black women, lowest-income households, and elderly parturients (

P
trend

< .0001). The following factors were significantly associated with AF during pregnancy: age ≥45 years, lipid metabolism disorders, hypertension, obstructive sleep apnea, hyperthyroidism, and valvular disease (
P
< .0001). The in-hospital mortality rate of pregnant women with AF was significantly higher than those without AF (OR = 2.26, 95%CI = 1.75-2.93,
P
< .0001). The mortality rate of AF during pregnancy was positively associated with an increasing CHA
2
DS
2
-VASc score (

P
trend

< .0001), which was 0.35% (95% CI: 0.24%-0.47%) in the low-risk group, 1.30% (95% CI: 0.98%-1.62%) in the moderate-risk group, and 2.18% (95% CI: 0.86%-3.51%) in the high-risk group. The incidence of stroke, acute myocardial infarction, acute heart failure, and cardiac shock during pregnancy was also significantly correlated with the increasing CHA
2
DS
2
-VASc score in AF patients (

P
trend

< .0001), with the highest prevalence in the high-risk group.

Conclusion:
The incidence of AF during pregnancy and puerperium increased consistently, associated with high maternal mortality. The CHA
2
DS
2
-VASc score can be an essential risk stratification tool to predict severe cardio-cerebral vascular events and even death in AF patients during pregnancy and puerperium.
Abstract 4119470: ST-Elevation Myocardial Infarction as a Complication of Granulomatosis with Polyangiitis
Authors: Goodrich Robyn , Moroni Francesco , Ravindra Krishna , Abbate Antonio
Published: November 2024

Description of Case:
A 19-year-old female with history of granulomatosis with polyangiitis (GPA) presented to the emergency department after a syncopal episode at a concert. She reported a prodrome of feeling hot and dizzy prior to the event, followed by epigastric discomfort, nausea, and vomiting after regaining consciousness. She had been diagnosed with GPA one year prior to presentation based on serology and biopsy results. Because her disease was felt to be well-controlled on azathioprine, she had been tapered off of prednisone one month prior to presentation.

Initial vitals included blood pressure of 90/60 mmHg, and heart rate of 94 bpm. A 12-lead EKG revealed ST segment elevation in leads I, II and aVF with T wave inversions in the lateral leads (
Figure 1
). Initial bloodwork was notable for troponin I of 0.11ng/mL (upper limit of normal 0.034 ng/mL).

A diagnosis of inferior ST-elevation myocardial infarction was made. She was treated with oral aspirin and prasugrel load as well as intravenous heparin and taken urgently to the catheterization laboratory. Diagnostic coronary angiography was significant for single vessel coronary artery disease (CAD) of the right coronary artery (RCA), with acute complete occlusion of the mid-RCA (
Figure 2A-B
). She was treated successfully with primary percutaneous coronary intervention and implant of two overlapping drug eluting stents in the mid-RCA (
Figure 2C
).

Discussion:
GPA is a systemic necrotizing vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) that predominantly affects small to medium sized vessels in the respiratory tract and kidneys. Cardiovascular manifestations in GPA are uncommon, but include pericarditis, myocarditis, and coronary arteritis. GPA can affect the coronary arteries either primarily through inflammatory changes in the arterial wall or via systemic inflammation leading to accelerated atherosclerosis. No standardized criteria exist to establish the diagnosis of coronary arteritis and to differentiate it from accelerated atherosclerosis. Long-term treatment of vasculitis patients with coronary involvement is also poorly supported by evidence. Optimization of cardiovascular risk factors is advocated as per standard of care, and vasculitis control may slow disease progression. This case not only raises awareness of cardiac complications in GPA, but highlights the current lack of evidence surrounding secondary prevention in young patients with vasculitis and cardiac complications.
Abstract 4119611: Catheter ablation approach and outcome in HIV+ patients with atrial fibrillation: a systematic review and meta-analysis
Authors: Mazetto Roberto , Bulhoes Elisio , Queiroz Ivo , Antunes Vanio , Defante Maria Luiza Rodrigues , Romeiro Pedro , Barbosa Lucas , X. Mendes Beatriz , Silva Catarina , Bastos Eduarda , Guida Camila
Published: November 2024

Background:
Catheter ablation has emerged as an effective treatment option for atrial fibrillation (AF) in the general population. However, limited data exist on the outcomes of catheter ablation in patients infected with the Human Immunodeficiency Virus (HIV+) with concomitant AF.

Objectives:
This systematic review and single arm meta-analysis aims to comprehensively evaluate the literature on catheter ablation approach and outcome in HIV+ patients with AF.

Methods:
A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted following PRISMA guidelines.Studies meeting the intervention of catheter ablation for AF in HIV+ patients, using radiofrequency, cryoballoon, or pulsed field ablation techniques, were included and data were collected and synthesized using proportion meta-analysis techniques. Statistical analysis was carried out using R software.

Results:
Three studies met the inclusion criteria, involving 89 HIV+ patients, with an average age of 51.5 years, of whom 83.1% were men, undergoing catheter ablation. Two studies performed received isolation of the pulmonary vein (PV) + posterior wall and superior vena cava. And one study evaluated only the isolation of the pulmonary veins. Of these patients, 43.8% had paroxysmal AF and 56.1% had persistent AF. In two studies reporting freedom from atrial arrhythmias, all patients (62) experienced recurrence of atrial arrhythmias within 5 years of follow-up. Freedom from repeat ablation was 6.26% (Figure 1A). The rate of Pulmonary Vein Trigger was 31.28% (Figure 1B), while the rate of Non-Pulmonary Vein Trigger (non-PV) was 76.64% (Figure 1C).

Conclusion:
In this systematic review and meta-analysis assessing outcomes of ablation in HIV patients with AF, we observed a similar prevalence of paroxysmal and persistent AF. Furthermore, contrary to the non-HIV+ patients, a high incidence of non-pulmonary vein triggers of AF was noted in this population.
Abstract 4119613: Evaluation of Gender, Racial and Ethnic Differences in Time to PCI in the Pre and Post Covid-19 Era
Authors: Jnani Jack , Kamel Maikel , Weintraub Spencer , George Riya , Impastato Brandon , Sood Aditya , Tsai Andrew , Hsieh Ji-Cheng , Cheng Austin , Alboucai Jack , Bulsara Kishen , Srivastava Shreya , Alvarez Villela Miguel , Griffin Matthew , Pierce Matthew
Published: November 2024

Introduction:
Percutaneous Coronary Intervention (PCI) is recommended for reperfusion of patients presenting with ST-segment myocardial infarction (STEMI) within 90 minutes. In this study, we sought to identify differences in PCI timing based on gender, race and ethnicity in the pre- and post-COVID era.

Methods:
We collected retrospective data on 760 patients admitted with STEMI at our quaternary academic medical center from 2018-2022. We defined our binary outcome as time to PCI less than 90 minutes, and adjusted for transfers from outside hospitals. We utilized univariate logistic regression analysis to analyze the association of demographic, clinical, and cardiac catheterization details on our outcome. We then utilized multivariate logistic regression analysis to determine the association of our covariates of interests with time to PCI. The logistic regression model was adjusted for collinearity which were deemed not significant.

Results:
Among our study population, COVID did not significantly impact whether or not a patient had a diagnostic cardiac catheterization on univariate analysis (OR 2.68, 95% CI 0.61-18.40, p=0.23). However, the post-COVID era was significantly associated with a delayed time to PCI on multivariate analysis [OR 1.62, 95% CI 1.04-2.55, p=0.035) [Figure 1]. In addition, females were 1.8x more likely to have a delayed PCI than males on multivariate regression [OR 1.80, 95% CI 1.10-2.95, p= 0.019) [Figure 1]. Interestingly, on multivariate analysis, females were more likely to have delayed reperfusion in the pre-COVID era (OR 2.92, 1.29-6.77,p= 0.01) but not the post-COVID era (OR 1.54, 0.78-3.06,p=0.2134). Patients in the post-COVID era had increased risk of having their culprit coronary not revascularized on multivariate analysis (OR 2.85, 1.2-8.03, p= 0.03).

Conclusions:
At our center, COVID did not significantly impact cardiac catheterization rates. However, COVID was significantly associated with delayed reperfusion timing and not revascularizing culprit vessels. Females were much more likely to have a delayed PCI than males in the pre-COVID era which was not seen following COVID-19.
Abstract 4119619: Congruency of Stated Aortic Stenosis Severity and Reported Doppler Exam Values in a Large Health Care System Based on ACC/ASE Guidelines
Authors: Kokoy Sarwar , Woods Tim
Published: November 2024

Background:
Peak aortic valve Doppler velocity, mean aortic valve gradient, and Doppler estimated aortic valve area are key measures recommended for assessing aortic stenosis severity. Discordance often occurs among these measures, posing diagnostic challenges. Failure to accurately diagnose severe aortic stenosis is critical. This study focuses on the discordance between reported aortic valve area (AVA) and stenosis severity, comparing guidelines from the ASE and ACC seen in
Table 1.

Goals:
Assess the incidence of discordance between reported AVA and severity of aortic stenosis and compare how the differing guideline recommendations of the ASE versus ACC for defining severe AS by AVA would affect reporting severity in a large clinical practice.

Methods:
A query of all transthoracic echocardiograms obtained in patients 18 years of age and above was performed in a large multi-hospital healthcare system between Jan 1 and Jun 30 of 2023. This group was then filtered to include only exams in which the reported aortic valve area was 1 cm2 or less, excluding all cases with prosthetic aortic valves. This group was then further filtered to contain only those patients in whom the physician did NOT report severe aortic stenosis.

Results:
Between Jan and June 2023, 16,675 subjects ages 18-95 (avg 74) underwent transthoracic echocardiograms in our healthcare system, with 190 (1.1%) reported as having an AVA ≤ 1 cm2. Of those exams, 63 (33% of those with AVA ≤ 1) were not reported as having severe aortic stenosis. Of those 63 exams, 35 (56%) had a reported SVI < 35 ml/m2 compatible with a low flow state. However, only 1 of those 35 cases mentioned flow-status in labeling the stenosis severity in the report. Based on the ASE Doppler AVA definition of severe AS (< 1.0 cm2 (≤ 0.94 )) vs ACC (≤ 1 cm2 (≤1.04), the AV Doppler and SVI data contained in the reports should have led to the grading of the aortic valve as being ”Severe” or “Moderate” aortic stenosis as described in
Table 2.

Conclusion:
Discordance in labeling severe aortic stenosis relates to differing AVA criteria. Cases are often termed "moderate to severe" under ACC criteria. The majority (56%) of cases failing to describe severe AS despite meeting AVA criteria were in low flow states, suggesting this phenomenon is not well understood in clinical practice. Various factors contribute to these findings, warranting further investigation.
Abstract 4119680: First-in-Man Treatment of Heart Failure by Repeated Intravenous Infusions of a Cardiovascular Cell-Derived Extracellular Vesicle-Enriched Secretome
Authors: Menasche Philippe , Renault Nisa , Hagege Albert , Puscas Tania , BELLAMY VALERIE , Humbert Camille , Le Laetitia , Blons Helene , Granier Clemence , Benhamouda Nadine , BACHER Anne , Churlaud Guillaume , Sabatier Brigitte , Larghero Jerome
Published: November 2024

Background:
Most of the effects of intramyocardially transplanted stem cells can be duplicated by the sole administration of their secretome but this approach has not yet been tested in heart failure (HF).

Methods:
The SECRET-HF phase I trial (NCT05774509) was designed according to a Bayesian optimal interval scheme to assess the effects of repeated intravenous infusions of a cellular secretome in 12 patients with a non-ischemic dilated cardiomyopathy. The main inclusion criteria are severe symptoms (NYHA Class III despite an optimal guideline-directed medical therapy), a reduced left ventricular (LV) ejection fraction (EF ≤40%) and ineligibility for a heart transplant. The Investigational Medicinal Product was derived from human induced pluripotent stem cells reprogrammed from a healthy donor and differentiated in cardiovascular progenitor cells (CPC). Following CPC culture in a dedicated "vesiculation" medium, the conditioned media were collected, filtered, enriched for extracellular vesicles, concentrated by tangential flow filtration and scaled out into glass vials stored at -80°C. Quality controls were implemented throughout the whole process which was conducted according to current Good Manufacturing Practices.

Results:
Three patients, out of the 4 of the initial low-dose cohort, have now been treated. All had been previously fitted with an automatic internal cardioverter defibrillator (AICD). The secretome was delivered intravenously 3 times, 3 weeks apart, at a dose of 20 x10
9
particles/kg for each infusion. By November, 2024, the follow-up will be 16, 9, 6 and 2 months for each of them (mean: 8 months). So far, none of the treated patients has experienced a dose-limiting toxicity; in particular, there have been no post-treatments ventricular arrhythmia detected by the AICD, no allo-immunization and no inflammation based on the enumeration of lymphocyte subpopulations by flow cytometry. At 6 months, the first patient improved to NYHA Class II with a decrease in echographic LVEDV and LVESV (from 108 mL/m
2
to 87 mL/m
2
and from 80 mL/m
2
to 60 mL/m
2
, respectively) and a concomitant increase in LVEF from 25% to 32%. At 1 month post-treatment, the second patient also reports a symptomatic improvement (NYHA Class II) with an increase in EF from 21% to 28%.

Conclusions:
This initial experience supports the safety of repeated intravenous administrations of a cardiovascular cellular secretome as a potential noninvasive and user-friendly treatment of severe HF.
Abstract 4119891: Risk Factors of Anemia in Pulmonary Arterial Hypertension Patients with Endothelin Receptor Antagonists Administration and Related Treatment
Authors: Xin Li , Zhao Zhihui , Luo Qin , zhao qing , Jin Qi , Zhang Yi , Huang Zhihua , Duan Anqi , zhang sicheng , Gao Luyang , Wang Yijia , Li Sicong , Liu Zhihong
Published: November 2024

Background:
Endothelin receptor antagonists (ERAs) demonstrated significant efficiency in delaying clinical deterioration and improving survival of patients with pulmonary arterial hypertension (PAH). However, the frequent occurrence of anemia after ERAs administration has gained clinical attention currently, whereas the etiology of anemia is unclear. The risk factors of ERAs associated anemia remained undefined. Therefore, we aim to investigate risk factors of developing anemia after ERAs treatment and whether iron supplement could correct anemia.

Method:
A retrospective cohort study was performed among patients with PAH who received ERAs between January, 2017 and December, 2019 in Fuwai hospital. The primary outcome was development of anemia after ERAs therapy and secondary outcome was correction of anemia after iron supplement.

Results:
A total of 120 patients with PAH were included in the study and 28 patients developed anemia during follow up
.
Distinctively, all the patients who developed anemia were female. After ERAs administration, iron metabolism (Ferritin 95.29±144.79 μg/L versus 69.9±118.25 μg/L,
P
<0.001) and hemoglobin (154.21±23.80 g/L versus 136.12±28.61 g/L,
P
<0.001) reduced significantly in the total cohort with patients who developed anemia more significant. Baseline iron metabolism (Ferritin: HR 0.98, 95%CI 0.96-0.99,
P
=0.02) was independently associated with development of anemia after ERAs administration. Compared with patients with iron replete, patients with iron deficiency had over 9-fold risk of developing anemia after receiving ERAs (HR = 9.59, 95%CI 3.62-25.41,
P
< 0.01). Iron supplement could effectively correct anemia.

Conclusion:
It is advised that patients receiving ERAs monitor iron metabolism and hemoglobin regularly, especially females and those with low hemoglobin level and compromised iron homeostasis before ERAs administration, which facilitates prevention and early detection of anemia. ERAs-related anemia is mostly mild, oral iron supplement could effectively reverse anemia and aberrant iron metabolism.
Abstract 4120105: Meta-Analysis of Outcomes in Patients Developing Acute Kidney Injury Following Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection
Authors: Goyal Aman , Sulaiman Samia , Jain Hritvik , Sohail Amir , Shrestha Abhigan , Ullah Irfan , Puttaswamy Darshan , Abbasi Haleema Qayyum , Raza Fatima , Belur Agastya
Published: November 2024

Background and Aims:
Thoracic endovascular aortic repair (TEVAR) is warranted in patients with Stanford Type-B aortic dissection who are at an increased risk of aneurysm rupture and enlargement. While studies indicate that development of post-operative acute kidney injury (AKI) (with incidence rate varying from 1.5% to 34%) may potentially worsen outcomes and increased mortality, the specific role of AKI in the postoperative period for patients undergoing TEVAR for Stanford Type-B aortic dissection remains understudied and unclear. Our meta-analysis aims to contribute valuable insights into this aspect.

Methods:
A comprehensive literature search spanning major bibliographic databases was conducted to retrieve studies comparing outcomes in Stanford Type-B aortic dissection patients undergoing TEVAR who developed AKI postoperatively versus those who did not. Our outcomes of interest included the risk of in-hospital mortality, stroke, and requirement for dialysis. Relative risks (RRs) were pooled from all studies using DerSimonian and Laird random-effects models in the ‘meta’ package of R software (Version: 2023.12.1+402). Statistical significance was set at p <0.05.

Results:
Three studies were included with 1091 patients (234 in the AKI group and 857 in the non-AKI group). The development of AKI was associated with a significantly higher risk of in-hospital mortality [RR: 5.31; 95% CI: 3.10, 9.08; p<0.0001;

I
2

=0%], a higher risk of stroke [RR: 2.33; 95% CI: 1.30, 4.17; p=0.0046;

I
2

=0%], and an increased risk of requiring dialysis [RR: 18.43; 95% CI: 3.35, 101.46; p=0.0008;

I
2

=0%] (Figure 1). No heterogeneity was observed between the studies (Figure 1 and 2).

Conclusion:
The development of AKI after TEVAR in patients with Stanford Type-B aortic dissection is associated with an increased risk of in-hospital mortality, stroke, and dialysis requirement. Hence, further research into early recognition of the risk factors associated with the development of AKI after TEVAR is warranted, along with determining its effects in longer follow-up durations.
Abstract 4120131: Absence of standard modifiable risk factors (SMuRF-less) among 5002 Middle Eastern patients with atherosclerotic cardiovascular disease: (Interim analysis from the Jo-SMuRF Study)
Authors: Aldalal'ah Mo'men , Hamza Ibrahem , Alqudah Mohammad , Khasawneh Hasan , Alomari Sawsan , Alomari Ahmad , H. Assaf Sarah , Zaqqa Ayah , Khatatbeh Moawiah , Hammoudeh Ayman
Published: November 2024

Introduction:
A growing number of patients develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of standard modifiable risk factors i.e. hypertension (HTN), type 2 diabetes (T2D), dyslipidemia (DSL), and cigarette smoking (SMuRF-less). There is scarcity of studies on prevalence and clinical profiles of SMuRF-less patients in the Middle Ease (ME).

Aim:
To study the prevalence and clinical features of ME patients with ASCVD who are SMuRF-less vs. those with ≥ 1 SMuRFs, presence of other risk factors and utilization of secondary preventive medications in the 2 groups, and one year survival.

Methods:
Clinical details of adult patients with ASCVD who participated in 5 previous registries were analyzed according to the absence or presence of ≥ 1 SMuRFs.

Results:
Of the 5002 patients included in the analysis, 676 (13.5%) were SMuRF-less and 4326 (86.5%) had ≥ 1 SMuRFs. Prevalence of the 4 SMuRFs in the whole cohort was 53.5% HTN, 47.8% T2D, 40.2% smoking, and 37.5% DSL, and the SMuRF group was 61.9%, 55.2%, 46.5%, and 43.4%, respectively. Compared with the SMuRFs group, patients in the SMuRFless group were younger (mean age 52±11.4 years vs. 56.3±11.5 years, respectively, p<0.001) and more likely to be women than men (38.6% vs. 27.9%, p<0.0001). Furthermore, SMuRF-less patients had lower mean body mass index, and less prevalence of metabolic syndrome, heart failure, and family history of ASCVD. Utilization of secondary cardiovascular prevention medications was significantly less in the SMuRF -less group than those with SMuRFs; dual antiplatelet therapy (36.4% vs. 69.5%), statins (66.3% vs. 87.4%), B blockers (57.5% vs. 70.5%), and renin-angiotensin inhibitors (35.2% vs. 55.3%, respectively, all p<0.001. Of the subgroup with one year follow up after percutaneous coronary intervention (N=2641), mortality rate was not different in the 2 groups; 1.4% vs. 1.8%, p=0.98.

Conclusions:
In this first study of SMuRFs in ASCVD patients in the Middle East, SMuRF-less patients account for nearly 14% of the studied cohort. These patients were younger, had less comorbid disease, received less guidelines-recommended prevention medication, and had same one year event rate compared with patients who have SMuRFs.
Abstract 4120229: Shift in body mass index category and associated cardiometabolic risk factors: a post hoc analysis from the SURMOUNT-4 trial
Authors: Sattar Naveed , Srinath Reshmi , Lee Clare , Wang Hui , Plat Arian
Published: November 2024

Background:
In SURMOUNT-4, participants with obesity demonstrated a mean weight reduction of 21% during the 36-week lead-in with the maximum tolerated dose (MTD) of tirzepatide (TZP). During the 52-week double-blind period, participants who switched to placebo (PBO) experienced a 14% weight regain, while those who continued TZP achieved an additional 6% weight reduction. This post hoc analysis assessed whether participants who shifted to a lower BMI category had improved cardiometabolic factors.

Methods:
Shift in BMI category (<25 kg/m
2
, 25 to <30 kg/m
2
, 30 to <35 kg/m
2
, 35 to <40 kg/m
2
, and ≥40 kg/m
2
) from baseline (week 0) during the lead-in period (week 36) and at the primary endpoint (week 88) and from week 36 to week 88 was assessed in participants from SURMOUNT-4 randomized to TZP MTD (N=332) or PBO (N=329). BMI shifts were grouped into “improved” (shift to ≥1 lower category) or “not improved” (stable/attenuated [no change/shift to a higher category]). Changes from baseline in waist circumference, fasting insulin, fasting glucose, HbA1c, vitals and lipid profile were assessed.

Results:
From weeks 0 to 36, 296 (89%) participants improved in BMI category with TZP, and none had attenuated (Table). From weeks 36 to 88, 130 (39%) participants improved in BMI category with TZP, while the majority (99%) randomized to PBO did not. Overall, from weeks 0 to 88, 304 (92%) vs 189 (57%) participants improved in BMI category with TZP vs PBO, respectively, where the improvements observed in the PBO group originated from the 36-week lead-in period. In general, participants who improved in BMI category at week 88 were noted to have greater improvements in cardiometabolic parameters with TZP vs PBO, including decreases from baseline in waist circumference, fasting insulin, fasting glucose, HbA1c, blood pressure, triglycerides, and cholesterol (total, non-HDL-c, LDL-c, and VLDL-c).

Conclusions:
In this post hoc analysis of SURMOUNT-4, the majority of TZP-treated participants shifted to lower “improved” BMI categories. Shift to an improved BMI category was accompanied by improved cardiometabolic risk factors, suggesting that TZP treatment may lower further cardiovascular outcomes. Relevant outcomes trials are ongoing.
Abstract 4120246: PFO Device Complications: Literature Review and Possible Implications for Echocardiographic Follow-up
Authors: Foreman Kaitlyn , Lyman Elizabeth , Conroy Sara , Salavitabar Arash , Cua Clifford
Published: November 2024

Introduction:
Transthoracic (TTE) guidelines after PFO device closure are vague.

Goal:
To perform a literature search to characterize the type, frequency, and timing of complications that occur after PFO device placement to determine the utility of routine TTE in post-device patients.

Methods:
A search was performed in Medline (PubMed) with English language and publication date (2000-2023) filters applied. Studies were included if they reported on PFO device closures. If a study included both PFO and ASD device closures with no distinction between the groups, it was included. Studies were excluded if it only reported on ASD device closures, were meta-analysis/review papers, or did not report any outcomes for the PFO device procedure.

Results:
Total of 305 articles met criteria. Incidence of complications was 6.9% (3358/48348). Maximum range of follow-up was 0 – 17 years. Types and timing of complications presented in Tables 1 and 2. Majority of complications occurred
<
6 months (57.8%, 1941/3358) with only 0.8% (27/3358) occurring > 5 years post-device. All patients with complications > 5 years device placement presented with clinical symptoms related to their complications.

Conclusion:
Incidence of complications after PFO device placement appeared to significantly decrease 5 years post-procedure. Late complications were all preceded by clinical symptoms. Routine use of TTE < 5 years post-device may be reasonable, but > 5 years, TTE may only be needed if clinical symptoms occur.
Abstract 4120332: RISING TRENDS IN ISCHEMIC HEART DISEASE RELATED MORTALITY AMONG OLDER ADULTS WITH SLEEP APNEA IN THE UNITED STATES FROM 1999 TO 2021
Authors: Tariq Muhammad Ali , Amin Hamza , Asrar Aeman
Published: November 2024

Introduction:
Sleep apnea (SA) is often underrecognized and undertreated despite its high prevalence in the adult population and its association with adverse cardiovascular outcomes. There are limited estimates of national trends on cardiovascular mortality in older patients with sleep apnea. We aimed to assess the sex and race-related trends of ischemic heart disease (IHD) mortality in the older adults with SA using a large population-based database.

Methods:
We utilized the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) database which provides information from death certificates of all US residents according to the International Classification of Diseases, Tenth Revision (ICD-10). The demographic and mortality data were obtained for the United States population >65 years from 1999 to 2021. Ischemic heart disease (ICD-10 codes I20-I25) was listed as the underlying cause of death, and SA (G47.3) as a contributing cause of death. Age adjusted mortality rates (AAMRs) per 1,000,000 population were calculated by standardizing deaths to the year 2000 US population. We used Jointpoint Regression Program to analyze temporal trends in mortality from 2000 to 2021. Average annual percentage change (AAPC) with 95% CI were calculated to examine trends in AAMR over time.

Results:
Overall, AAMR of IHD mortality for patients with SA increased from 7.9 per 1,000,000 (95% CI, 6.9-8.8) in 1999 to 53.4 per 1,000,000 (95% CI, 51.4-55.4) in 2021 with an AAPC of 9.1% per year (95% CI, 8.8-9.5). Men had consistently higher AAMR than women throughout the study period (overall AAMR men: 45.51 (95% CI, 44.8-46.2); women: 12.5 (95% CI, 12.2-12.8). Both the groups had a similar increasing trend in AAMR, with men having a steeper increase. [AAPC men: 9.3% (95% CI, 8.5-10.8) versus AAPC women: 8.6%, 95% CI, 8.1-9.7]. Non Hispanic (NH) White population had the greatest AAMR throughout the study period, followed by NH Black and Hispanic or Latino. The NH White population had the largest increase in AAMR from 1999 to 2021 (AAPC 9.4%, 95% CI:8.9-10.1).

Conclusion:
In the United States, there has been a general increase in IHD mortality related to sleep apnea over the last two decades. This rising trend as noted in our analysis is concerning and underscores the need for more robust cardiovascular surveillance in these patients.
Abstract 4120434: A Rare Case Of Localized Ventricular Tachycardia Due To Mitral Annular Disjunction And a Subvalvular Aneurysm
Authors: O'Toole Timothy , Binder Michael , Hama Amin Ali
Published: November 2024

Introduction:
Mitral annular disjunction (MAD) is an abnormality of the mitral valve where a portion of the mitral annulus and valve leaflets insert into the left atrium away from the fibrous annulus. Since its identification in 1981 its diagnosis has increased due to the advancements in cardiac imaging. It’s association with ventricular arrythmia (VA) and sudden cardiac death (SCD) underscores the importance of its identification. We present a case of ventricular tachycardia (VT) that is attributed to MAD with associated sub-mitral valve left ventricular aneurysm (SMA) formation.

Case:
A 51-year-old African American male with history of posterior papillary muscle premature ventricular contractions (PVC), PVC induced cardiomyopathy, and family history of sudden cardiac death in his mother who presented to the emergency department due to palpitations. Electrocardiogram (ECG) showed sustained monomorphic VT at a rate of 160 bpm. This converted to normal sinus rhythm with intravenous amiodarone and metoprolol. Further work up included cardiac magnetic resonance which identified a 4 x 1.8 x 1.4 cm SMA on the basal inferior and inferolateral walls. There was near transmural late gadolinium enhancement (LGE) of the aneurysm and an associated 7 mm of MAD with posterior mitral valve prolapse (MVP). He underwent left heart catheterization which was normal. ECG showed a superior right axis with associated right bundle branch block which correlated to a basal inferolateral exit and to the location of the SMA. Ultimately the patient underwent implantation of secondary prevention implantable cardioverter-defibrillator and initiation of sotalol.

Discussion:
The prevalence of MAD is approximately 30% in those with MVP and 8% in the general population. Those patients with MAD and MVP appear to be at higher risk for VA and SCD. The most likely mechanism for this association is the fibrotic changes that occur in the basal inferolateral left ventricle because of mechanical stretch on the papillary muscles by the prolapsing leaflets. The scar and aneurysm that develop can serve as substrate for reentrant VA. Treatment for this involves surgical repair of the mitral valve annulus and correction of the MAD distance which has been shown to improve arrythmia.

Conclusion:
This case illustrates an important but poorly understood arrhythmogenic entity that will increase in incidence as cardiac imaging advances. Its implications in VA and SCD warrant further research.