bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4146923: Self-reported Race, Genomic Ancestry and Hypertension in Hispanic/Latino adults: The Hispanic Community Health Study/Study of Latinos (HCSH/SOL)
Authors: Montanez Valverde Raul , Kim Vivian , Duran Luciano Priscilla , Yuan Yawen , Sofer Tamar , kaplan robert , Browning Sharon , Gallo Linda , Talavera Gregory , Perreira Krista , Daviglus Martha , Rosas Sylvia , Llabre Maria , Elfassy Tali , Li Xihao , Isasi Carmen , Rodriguez Carlos
Published: November 2024

Introduction:
Among non-Hispanics, hypertension (HTN) disparities by self-reported race exist. Hispanics/Latinos (H/L) are an admixed population of African (AA), European (EA) and Amerindian (AI) continental genetic ancestry (GA). Few studies have explored self-reported race and HTN among H/L. We assessed, among H/L, the associations of self-reported race with GA, and self-reported race and GA with HTN.

Methods:
Data was obtained from the HCHS/SOL, a population-based cohort of United States (US) H/L. We included mutually unrelated subjects ≥18 years old with genotyping data. Proportions and quintiles of GA were computed with the ADMIXTURE software. HTN was defined as systolic blood pressure (SBP) >130mmHg, diastolic BP (DBP) >80mmHg or on antihypertensive medication. Self-reported race categories were based on the Federal Directive 15. Sampling weights were utilized.

Results:
We report 9,592 subjects, 49.6% female, mean age 42.9 ±0.28 years. Over half of all H/L self-reported race as Unknown, Declined or Some Other Race (UNK), which did not vary per background group except for H/L of Cuban descent. Among those who self-reported race as Black, White and Native American (NA), the majority were of Dominican, Cuban and Mexican descent, respectively. H/L who self-reported race as Black and White had the greatest proportion of AA and EA ancestry, respectively. H/L who self-reported race as NA or UNK had a predominant mix of EA and AI ancestry. The highest HTN prevalence was seen in H/L who self-reported Black race, as well the ones in the highest EA and AA quintile. H/L in the highest AI quintile had the lowest HTN prevalence along with lower mean SBP and DBP, compared to those in the lower AI quintiles.

Conclusions:
The majority of H/L did not identify their race suggesting that the concept of race does not resonate since the social context of race in Latin America may not be equivalent to the US. H/L self-reporting race as Black and White, had predominantly AA and EA ancestry, respectively. H/L self-reporting race as Black or in the highest AA quantile had the highest HTN prevalence, similar to what has been reported in non-Hispanic Blacks, whereas H/L in the highest AI quantile had a more favorable HTN profile.
Abstract 4146941: Sex Differences in Utilization and Outcomes of Peripheral Left Ventricular Assist Devices in ST Elevation Myocardial Infarction Associated Cardiogenic Shock in the United States
Authors: Kumar Manoj , Nso Nso , Gomez Valencia Javier , Ricciardi Mark , Arman Qamar , Kumar Nomesh
Published: November 2024

Background:
Peripheral Left Ventricular Assist Devices (pLVAD) are used to achieve rapid ventricular unloading and improve systemic perfusion in myocardial infarction (MI) associated cardiogenic shock (CS). We aim to compare sex-based differences in utilization and outcomes of pLAVD use in ST elevation MI (STEMI) associated CS.

Methods:
Nationwide Readmissions Database (2016-2021) was used to identify STEMI-CS patients who underwent pLVAD placement. Mahalanobis Distance Matching within the Propensity Score Caliper was used to match males and females. Inverse Probability Weighting (IPW) was utilized, and Pearson’s chi-squared test was applied to the PSM-2 matched cohorts to compare outcomes.

Results:
Among 27,664 hospitalizations of STEMI-CS patients undergoing pLVAD support, only one-fourths (N: 7,358; 27.2%) of the patients were females.

After propensity matching (N: 4,301 in each group), females had significantly higher mortality (52.1% vs. 46.8%, aOR:1.42 [95% CI: 1.29-1.55], p <0.001), pericardial complications (including hemopericardium, cardiac tamponade, pericarditis or any need for pericardiocentesis) (3% vs. 1.8%, aOR:1.50 [95%CI: 1.15-1.96], p <0.001) and blood transfusion requirement (17% vs. 14.4%, aOR:1.32 [95% CI:1.17-1.48 ], p <0.001).

From 2016-2021, mortality of STEMI-CS has remained unchanged (males: 37%; females: 40%) (p-trend > 0.05). However, a decline in pLVAD utilization was observed in both males (48% to 41.6%, p-trend <0.001) and females (39% to 32.8%, p-trend <0.001).

No significant difference was observed in 30-day, 90-day and 180-day readmission rates between the two groups (p>0.05).

Conclusion:
Females had higher mortality and complication in STEMI-CS requiring pLVAD utilization. Mortality of STEMI-CS has not changed significantly across the years; however, utilization of pLVAD has been decreasing.
Abstract 4146952: Clinical Characteristics, Survival Rates, and Prevalence of Cardiovascular Readmissions in Patients with Primary Malignant Cardiac Tumors
Authors: Anand Reddy Maligireddy , Frick William , Dickey Sierra , sinha shrishti , Okeke Barbara , Chitturu Niteesh , Golemi Lolita , Bandaru Revanth Reddy , Khan Sumrah , Rojulpote Chaitanya , Lin Chien-Jung , Mikhalkova Deana
Published: November 2024

Background:
Primary malignant cardiac tumors (PMCT) pose a unique clinical challenge due to their rarity, limited treatment options, and aggressive disease course. The aim of this study is to understand clinical characteristics and survival rates based on initial presentation of patients admitted with PMCTs.

Methods:
From 2016 to 2020, we employed the National Readmission Database to identify individuals ≥18 years of age who were initially admitted with a diagnosis of PMCT. Kaplan-Meier survival analysis was reported as hazard ratios to estimate survival rates. All statistical analyses were performed using Stata 18.0 software.

Results:
We identified 1,646 patients with PMCTs (mean age 54.9 years, 52.2% female).The all-cause in-hospital mortality rate was 10.9% (n=180). Amongst surviving patients at index admission, overall 30-day readmission rate was 25.7%, while the 90-day readmission rate was 32.7% post the index admission. Heart failure, atrial fibrillation, and ventricular tachycardia/ventricular fibrillation were the leading causes of index hospitalization, 30-day and 90-day readmission (
Table 1)
. When assessing survival rate based on the index admission, a significant difference was noted amongst patients based on their acute coronary syndrome (ACS) status; HR: 2.7 [1.01- 7.45], p=0.048. A trend for significance was observed based on atrial fibrillation (AF) status; HR: 1.5 [0.92- 2.6], p=0.096. There was no difference in survival rates amongst patients based on their HF status; HR: 1.07 [0.63- 1.81], p=0.811. A sub-analysis of patients with heart failure with preserved (HFpEF) and reduced ejection fraction (HFpEF) revealed similar results; HR: 0.5 [0.16- 1.59], p=0.239.

Conclusion:
Patients with PMCTs have comparable survival rates despite variations in clinical presentations on index hospitalization. Elevated 30-day (25.7%) and 90-day (32.7%) readmission rates underscore the need for patient centered, pre-discharge management.
Abstract 4146972: Left Atrial Reservoir Strain as an Independent Predictor of Ischemic Stroke Following Coronary Artery Bypass Grafting
Authors: Maqsood Hamza , Younus Shifa , Maryam Iqra , khaliq muhammad , Ali Aamir , Cheema Muhammad Hassan , Cheema Muhammad Hussnain , Choudhary Humais , Hussain Tauseef
Published: November 2024

Introduction:
Acute ischemic stroke (AIS) represents a significant long-term complication following cardiac surgery, often linked with unfavorable outcomes. Left atrial (LA) mechanics, notably LA strain, have been identified as predictors for both stroke and atrial fibrillation in various populations. However, conflicting evidence exists regarding the clinical relevance of postoperative atrial fibrillation (POAF), and its contribution to the relationship between LA mechanics and ischemic stroke remains uncertain.

Objective:
Our study examined the significance of left atrial strain parameters as autonomous predictors of acute ischemic stroke (AIS) among patients undergoing coronary artery bypass grafting (CABG). Additionally, we investigated the association between AIS and postoperative atrial fibrillation (POAF) in CABG patients.

Methods and Materials:
For a retrospective cohort analysis, we enrolled patients undergoing isolated coronary artery bypass grafting between 2021 and 2023. Transthoracic echocardiography was conducted preoperatively. The main outcome assessed was ischemic stroke. We explored the relationship between left atrial (LA) reservoir strain and ischemic stroke using uni- and multivariable Cox proportional hazards regression models, with adjustments for postoperative atrial fibrillation.

Results:
We analyzed a cohort comprising 410 patients, among whom 78 (19%) developed postoperative atrial fibrillation (POAF). Over a median follow-up period of 1.4 years, 19 patients (4.6%) experienced ischemic stroke. In univariable analysis, a significant association was observed between left atrial (LA) reservoir strain and ischemic stroke (hazard ratio [HR] 1.34, 95% confidence interval [CI] 0.97–1.23, p < 0.005) per 1% absolute decrease. Even after adjusting for factors including LA volume index (LAVi) and prior stroke, LA reservoir strain remained a significant predictor of ischemic stroke (HR 1.07, 95% CI 1.01–1.21, p < 0.005 per 1% absolute decrease; HR 3.6, 95% CI 1.23–11.04, p < 0.005 for < vs. >median). The inclusion of POAF as a covariate did not affect the significance of LA reservoir strain in the model.

Conclusion:
Our study concluded that among patients who underwent CABG, LA reservoir strain independently predicted ischemic stroke over the long term.
Abstract 4146987: Forecasting US state-level health expenditures for cardiovascular diseases through 2050
Authors: Wahab Feras , Lindstrom Megan , Roth Gregory , Dieleman Joseph
Published: November 2024

Introduction:
The cost of cardiovascular care in the United States has increased rapidly but detailed future cost forecasts are unavailable. To address this gap, we estimated conservative future health expenditures for specific cardiovascular diseases and types of care through the year 2050 for each US state and nationally.

Methods:
We used data from the Institute for Health Metrics and Evaluation’s Disease Expenditure Project for the years 2000-2019, which captures >85% of all US healthcare spending at the age, sex, cause of death, risk factor, type of care, and state-specific level. Input data included insurance claims, drug prescriptions, emergency department visits, inpatient stays, ambulatory care visits, and nursing facility stays. Using population forecasts from the Global Burden of Disease study and holding utilization and cost rates constant, we estimated, in 2019 dollars, cardiovascular expenditures for 2020-2050 per age, sex, type of care, cause, and state to forecast conservative lower bounds for costs.

Results:
Total cardiovascular spending in the US was forecasted to rise from $324 billion in 2019 to $460 billion in 2050. Across all types of care, inpatient care expenditure was the highest and remained so at 42.6% of total spending by 2050. Spending was forecasted to rise the most for nursing facility care and home healthcare, from 11.8% to 13.9% and 7.1% to 8.2% of the total respectively. By 2050, spending was highest for ischemic heart disease at $110 billion, up from $79 billion in 2019, followed by heart failure at $102 billion, up from $64 billion in 2019. As a proportion of overall spending, heart failure was forecasted to increase from 19.7% in 2019 to 22.1% in 2050. Over the same period, spending on treating obesity was forecasted to rise from $13 to $15 billion, but as a proportion of overall cardiovascular spending, this represented a fall of 0.8% due to increases for other conditions.

Conclusion:
Cardiovascular expenditures in the US were projected to increase by at least 41.9% by 2050, using conservative projection methods. The largest increases across types of care were for those associated with an aging population. Updates to forecasts will be needed as data on the impact of the COVID pandemic and new obesity pharmacotherapies become available and modelling methods improve. Large increases in the absolute cost of cardiovascular care in the US over the next 3 decades will require changes in health policy and system reform.
Abstract 4147013: Impact of Obstructive Sleep Apnea on Mortality Patterns in COPD: A Comparative Analysis Across Age, Sex, and Racial Groups
Authors: Zahergivar Aryan , Mynedi Swetha , Homayounieh Fatemeh , Mehari Alem
Published: November 2024

Introduction/Background:
Chronic Obstructive Pulmonary Disease (COPD) is a major health issue characterized by long-term breathing problems and poor airflow, leading to significant morbidity and mortality. Obstructive Sleep Apnea (OSA) is a prevalent condition that can exacerbate complications in patients with COPD. The coexistence of COPD and OSA, known as "overlap syndrome," has been linked to worse patient outcomes, including higher cardiovascular morbidity and all-cause mortality.

Research Question:
How does the presence of OSA affect mortality patterns in COPD across different age, sex, and racial groups?

Goals/Aims:
To analyze mortality patterns in COPD with and without the presence of OSA.

Methods/Approach:
This retrospective study used CDC’s public mortality data from 1999 to 2020 to identify patients aged 35 and older with COPD (ICD-10 codes J40-J44) and those with OSA (ICD-10 code G-47.3). Mortality patterns were assessed across different age ranges, genders, and races. Statistical analyses included an independent two-sample t-test (Welch’s t-test) to compare average ages of death and Chi-Square Tests to assess differences in mortality patterns due to specific causes. Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were calculated, with statistical significance set at p < 0.05.

Results/Data:
The study identified 5,952,368 deaths in patients with COPD, including 68,935 deaths in patients with both COPD and OSA. Leading causes of death were chronic lower respiratory diseases and diseases of the heart. The highest mortality in COPD-only cohort occurred in the 80-84 age group, while in COPD+OSA group was in the 70-74 age group. The weighted average age of death was 76.56 years for the COPD-only group and 69.34 years for the COPD + OSA group (p < 0.001). Chi-square analysis revealed significant differences in mortality patterns across age groups, with higher heart disease mortality risk in the older (i.e.,55+) COPD+OSA population. Men showed higher crude death rates in both groups. COPD + OSA mortality odds were higher in American Indian or Alaska Native and African American populations compared to Whites.

Conclusion(s):
OSA significantly impacts cardiac-related mortality in patients with COPD, evidenced by a lower average age of death and increased cardiovascular mortality risk in higher age groups. Early diagnosis and effective management of OSA in COPD patients are crucial for reducing premature mortality and improving outcomes.
Abstract 4147136: Functional Consequences and Phenotypic Manifestations of
KCNJ2
Variants in Andersen-Tawil Syndrome
Authors: Hartle Cassandra , Dinsmore Ian , Mirshahi Tooraj , Luo Jonathan , Mangano Robert , Moore Bryn
Published: November 2024

Introduction:
Andersen-Tawil Syndrome (ATS) is a rare genetic disorder characterized by periodic paralysis, skeletal abnormalities, and elongated QTc. ATS is caused by mutations in
KCNJ2
, which encodes the inwardly rectifying Kir2.1 channel that constitutes IK
1
in the heart. Out of 2.3 million subjects in our EHR, only 3 had an ATS diagnosis, confirmed by clinical genetic testing. Due to the low prevalence and variable expressivity, diagnosing ATS is challenging.

Hypothesis:
ATS is often misdiagnosed and protein truncating variants (PTV) in
KCNJ2
are not sufficient to cause disease.

Methods:
For 173,589 patients with exome sequencing in the EHR we identified all
KCNJ2
variants with allele frequency <0.01 and performed gene burden testing using REGENIE. We performed chart reviews and functional testing on all subjects with PTVs and any missense variant with at least one carrier with LQTS or ATS. Variants were tested by whole cell patch clamp, western blot, and immunofluorescence for function, expression and localization, respectively. Dominant negative effect was assessed by co-expressing the wild-type channels.

Results:
Gene burden analysis revealed cardiac arrhythmias as the only phenotype significantly associated with alpha-missense predicted pathogenic
KCNJ2
variants. We found 11 carriers of 4 PTVs (R40Ter, E118Ter, E241fs, L368fs). We also found 5 carriers of 4 missense variants V4E, T75M, R218W, and R312H, which had at least one diagnosis of LQTS or ATS. In whole-cell patch clamp, PTVs did not produce functional channels or affect the function of co-expressed wild-type channels. None of the PTV carriers had ATS. Patients with LQTS diagnoses and PTV variants often had secondary underrated conditions, which can result in elongated QT intervals. V4E showed no functional deficits or dominant effects, and the carrier lacked ATS phenotype with a LQTS diagnosis due to an acute electrolyte imbalance.

Variants T75M, R218W, and R312H produced small currents and exhibited dominant negative effects when co-expressed with WT channels. T75M reduced current size and altered channel rectification, and R218W and R312H reduced PIP

2

interactions. Four carriers of these missense variants, including a mother-son pair with the T75M variant, manifested various ATS-related phenotypes.

Conclusions:
Kir2.1 protein truncation alone does not result in pathogenicity. We propose missense variants in
KCNJ2
exerting a dominant-negative effect could result in an ATS phenotype.
Abstract 4147143: The value of high coronary artery calcium score (CACS) in prediction of stroke incidence.
Authors: Wasef Natale , Maryniak Andrii , Oleszak Filip , Pham Melissa , Hajek Catherine , Bartaria Shubhi , GU SHAOPENG , Guo Xiuqing , Rotter Jerome , Larson Eric , Stys Adam , Petrasko Marian , Rajpurohit Naveen , Stys Tom
Published: November 2024

Introduction:
In multiple recent studies, a higher coronary artery calcium score (CACS) has been associated with a higher risk of MACE and all-cause mortality. The relationship between coronary artery calcium (CAC) and the incidence of stroke is poorly defined.

Method:
Patients were obtained from the Sanford heart screening program from April 25, 2011 through June 23, 2023. The sample was limited to only those who underwent a CACS. A high CACS was deemed as anything greater than or equal to 300, whereas anything lower was identified as non-high CACS. The odds ratio was calculated via multiple logistic regression to analyze the data.

Results:
A total of 33249 patients with CACS were analyzed in this study. The average age of the patients is 56.19 (SD =9.97) and 46% of them are male. Among all the patients in the study, 3529 had a high CACS, of which 399 of them had stroke (11.3%). Our study shows that there is a positive effect between a high CACS and the incidence of stroke. The odds of having stroke are predicted to be 1.95 times larger in patients with high CACS (P-value < 0.001). In comparison to the patients who smoke frequently, the odds of developing a stroke shrink by a factor of about 0.53 and 0.48 for patients who do not smoke (P-value < 0.001) and patients who smoke occasionally (P-value=0.003), respectively. Furthermore, a five-year increase in age results in a 32% increase in odds of developing a stroke for patients with CACS less than 300 (P-value < 0.001), and a 17% increase in odds of developing a stroke for patients with high CACS (P-value = 0.006). However, for each additional year after CACS testing, the odds of stroke decreased by 18%, for patients with CACS less than 300 (P-value < 0.001), and 27%, for patients with high CACS (P-value < 0.001), likely due to interventions done.

Conclusion:
Our study showed that a high coronary artery calcium score predicts an increased incidence of stroke in our patient population.
Abstract 4147146: Mortality Trends Of Peripheral Arterial Disease
Authors: abdulelah Hussein , Abdulelah Zaid , Abdulelah Mohammad , Abdulelah Ahmed , Alayyat Ahmad , damlakhy Ahmad , Rahman Mansoor , Al-Dqour Mohammad , Al Balbissi Kais
Published: November 2024

Introduction:
Peripheral arterial disease (PAD) carries a high prevalence of around 200 million individuals worldwide, and is known to significantly contribute to mortality, morbidity and healthcare expenditures in the elderly. Co-morbidities such as hyperlipidemia, diabetes, hypertension, and smoking are all risk factors associated with development of PAD. The rising prevalence of such co-morbidities has affected the mortality trends of PAD despite the significant advances in both medical and interventional therapeutic options over the past 30 years.

Research Question:
Has there been any changes in PAD associated mortality trends in the last 30 years?

Methods:
Mortality trends of PAD across the USA were evaluated through calculating Annual percentage change (APC) and average APC (AAPC) of mortality via JoinPoint Analysis software. The data was obtained from the Global Burden of Diseases 2019 database.

Results:
From 1990 to 2019, there have been 268,129 PAD associated deaths in the US. Mortality trends over different age groups revealed an overall statistically significant decrement in those older than 75 (AAPC –0.3953, 95% CI –0.4590 to –0.3336; p<0.001). While a statistically significant increment was observed in those between the age of 15-49 (AAPC 1.1774; 95% CI 1.0923 to 1.2710; p <0.001) and those who were 55-75 years old (AAPC 0.2986; 95% CI 0.1968 to 0.4379; p=0.002).

Furthermore, stratification by gender yielded a statistically significant increment in males with an AAPC of 1.2657 (95% CI 1.1641 to 1.3511, P<0.001) while a non-significant increment was noted in females (AAPC 0.9563; 95% CI 0.9078 to 1.0010; P<0.001). The highest decrement in mortality for females was observed between 2004 to 2008, during which an AAPC of -2.3519 (95% CI -2.9828 to -1.8419; p=0.02) was observed. On the other hand, male gender noted its highest decrement in mortality between 2002-2009 (AAPC-1.3020; 95% CI -2.2156 to -0.7734; p=0.03) (Figure 1).

Conclusion:
Our findings identify variable trends in PAD mortality among age groups. Additionally, male gender appeared to influence mortality trends. Our findings suggest a need for further investigations to define age and gender based therapeutic regimens for PAD.
Abstract 4147227: TET2-mediated Clonal Hematopoiesis Exacerbates Foam Cell Generation
Authors: Adkar Shaunak , Mitchell Shaneice , lotfi Mozhgan , Kojima Yoko , Sorondo Sabina , Luo Lingfeng , Fu Changhao , Bell Caitlin , Jaiswal Siddhartha , Klarin Derek , Leeper Nick
Published: November 2024

Introduction:
Clonal Hematopoiesis of Indeterminate Potential (CHIP) is associated with atherosclerotic cardiovascular disease (ASCVD) and is often caused by somatic mutations in the epigenetic modifier TET2. Reduced TET2 causes ASCVD through increased inflammatory signaling in tissue macrophages. Recently, macrophage lipid loading has been shown to potentiate inflammatory activation, particularly in the context of TET2 deficiency. Therefore, we sought to test the hypothesis that TET2 deficiency exerts a proinflammatory phenotype by directly increasing macrophage lipid uptake.

Methods:
Using CRISPR/Cas9 genome editing, we modeled TET2-CHIP through monoallelic disruption of the
TET2
open reading frame in THP-1 monocytes (TET2
+/-
). We targeted the AAVS1 safe harbor locus to generate mock-edited control lines (AAVS1
+/-
). After differentiation to macrophages, we assayed uptake of phrodo-labeled low density lipoprotein (phrodo-LDL) using live cell imaging and fluorescently conjugated oxidized LDL (DiI-oxLDL) using flow cytometry. RNA-sequencing libraries were constructed from TET2
+/-
and AAVS1
+/-
lines treated with or without oxLDL. Differentially expressed genes (DEGs) were identified with DESeq2. Pathway analysis was conducted using clusterProfiler. We used publicly available CHIP-seq data to assay TET2 binding at ENCODE candidate cis-regulatory elements (cCREs).

Results:
We observed a two-fold increase of phrodo-LDL uptake in TET2
+/-
cell lines compared to controls over a 24 hour period (p < 0.05). TET2
+/-
lines treated with DiI-oxLDL exhibited significant increases in both mean fluorescence intensity (9774 vs. 7954, p < 0.001) and proportion of DiI
+
foam cells (81.7% vs. 74.7%, p < 0.05). Compared to controls, TET2
+/-
lines had four-fold increased expression of inflammatory cytokine CCL5 with and without oxLDL stimulation (p<0.001). The most significantly upregulated genes in TET2
+/-
lines treated with oxLDL were VDLR (3.7-fold, p < 0.001) and LDLR (9-fold, p<0.001). Pathway analysis revealed significant enrichment of KEGG term ‘IL-17 signaling’ in ox-LDL treated TET2
+/-
lines (p<0.001). CHIP-seq revealed TET2 occupancy at an LDLR cCRE.

Conclusion:
We demonstrate that TET2 deficiency stimulates foam cell formation through increased LDL and oxLDL uptake, possibly due to aberrant activation of LDLR and VLDLR. These data suggest that therapeutic approaches targeting lipid metabolism may have an outsized benefit for patients with TET2 CHIP.
Abstract 4147317: Impact of the Addition of Cardiac MRI Features and Sex Interactions with a Validated Clinical Risk Score to Improve Discrimination of Risk
Authors: Rizkallah Diane , Ammoury Carl , Bodi Kashyap , Korkerdsup Theerawat , Obuchowski Nancy , Wang Tom Kai Ming , Poppe Katrina , Doughty Robert , Calcagno Tess , Chen David , Nguyen Christopher , Tang Wai Hong , Kwon Deborah
Published: November 2024

Introduction:
The “Meta-analysis Global Group in Chronic Heart Failure” (MAGGIC) score is a validated clinical score, but does not include quantitative insights provided by cardiac magnetic resonance (CMR). We sought to determine if CMR parameters result in further discrimination of risk prediction.

Methods:
We evaluated 1414 ischemic and non-ischemic cardiomyopathy (ICM vs NICM) patients, who were referred for CMR between 2001-2017. The primary endpoint was the composite event of death, transplant, or LVAD. The data was split equally into development and validation cohorts using stratified randomization with presence/absence of an event and ICM/NICM as the two strata. A Cox proportional hazards regression model was first developed in the training patient cohort using only the MAGGIC score alone (baseline model). CMR measures with associated interactions with sex were then added to the baseline model in addition to ICM vs NICM categorization. The final fitted model was tested on a validation cohort of 704 patients. Uno concordance index was estimated with Wald test to assess significance.

Results:
There were 782 ICM patients and 674 NICM patients, with the following characteristics: 31.8% female, mean age 58±14 years, LVEDVi 131±45.0 mL/m
2
, LVEF 30±11%, LAEF 38±17%, RVEF 43±13%, LGE 8±11% and mitral regurgitant fraction 15±15%. The final model with CMR parameters is described in table 1. The MAGGIC score was a significant predictor of outcomes with a c-index of 0.635±0.0190, which increased to 0.656±0.0154 after adding CMR features and cardiomyopathy classification in the validation cohort (
p<0.001 for c-index difference
). Interaction of male sex and LVEDVi and RVEF yielded a maximum likelihood estimation (MLE) of -0.0077 (p=0.003) and 0.016 (p=0.023) respectively, suggesting attenuated impact of increasing LVEDVi and declining RVEF on risk in men compared to women.

Conclusion:
Integration of CMR parameters with novel sex interactions with the MAGGIC score significantly improves discrimination of risk. Further studies are needed to validate this CMR-enhanced risk score and to determine its association with adverse outcomes and differential therapeutic benefit in external patient cohorts.
Abstract 4147352: Donation After Circulatory Death Is Associated with Increased Morbidity and Mortality in Heart Transplant Patients Supported by Mechanical Circulatory Support Devices
Authors: Song Melinda , Fiedler Amy , Smith Jason , Klein Liviu , Aras Mandar
Published: November 2024

Background:
In recent years, both mechanical circulatory support devices (MCSD) and grafts from donation after circulatory death (DCD) are increasingly utilized for patients undergoing heart transplant. Multiple studies have demonstrated no difference in outcomes for DCD recipients compared to donation after brain death (DBD). To date, no study has examined whether outcomes remain similar among patients supported with MCSD pre-transplant.

Methods:
Using the United Network for Organ Sharing database, adult patients who underwent single-organ heart transplant from 12/1/2019 to 12/31/2023 were identified. MCSD included extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), Impella, and durable ventricular assist devices (VAD).

Results:
Among 12131 patients as defined above, 1059 (8.7%) received DCD and 11072 (91.3%) received DBD grafts. Of these, 557 (52.6%) DCD recipients and 7315 (66.1%) DBD recipients were supported with at least one MCSD pre-transplant. Recipients on ECMO or IABP were more likely to receive DBD grafts, whereas those with durable VADs were more likely to receive DCD grafts (Figure 1). There was no significant difference in DCD vs. DBD selection for patients supported by Impella (4.06% vs. 4.85%, p=0.087).

In the MCSD population, DCD recipients had a 30% increased risk of mortality compared to DBD recipients (95% confidence interval: 1% to 69%; Figure 2). Compared to DBD recipients, DCD recipients had higher rates of new dialysis post-transplant (17.4% vs. 14.0%, p=0.031) and higher rates of re-transplant (1.3% vs. 0.4%, p=0.016). Mean graft left ventricular ejection fraction at 1 year did not differ significantly between DCD vs. DBD recipients (59% vs. 60%, p=0.308).

Conclusions:
For patients supported by MCSD pre-transplant, receiving a DCD graft is associated with higher morbidity and mortality. Clinicians should proceed with caution in selecting DCD donors for this population.
Abstract 4147361: SCAI stage transition after axillary mechanical circulatory support in heart failure cardiogenic shock
Authors: Desai Aarti , Alak Cetin , Sharma Shriya , Luce Caitlyn , Ruiz-Morales Jose , Patel Parag , Goswami Rohan
Published: November 2024

Background:
The Society for Cardiovascular Angiography and Interventions (SCAI) staging system is a crucial tool for categorizing cardiogenic shock (CS) and guiding interventions. SCAI staging is traditionally static and may not capture dynamic changes. We evaluated the impact of axillary mechanical circulatory support and SCAI stage transition in patients with CS supported until heart transplantation.

Methods:
A retrospective study was conducted on patients with Impella support as bridge to transplant. Hemodynamic and vasoactive support parameters were collected and SCAI stage recorded at baseline and after 72 hours.

Results:
36 patients were included in the analysis. The median age was 61 (52 – 68) with an EF of 19% (15-26%) (Figure 1). Before Impella placement, the distribution of patients across SCAI stages was as follows: 19 patients in SCAI B, 8 patients in SCAI C, and 9 patients in SCAI D. After 72 hours of Impella support, 7 patients initially classified as SCAI C transitioned to SCAI B with one deteriorating to SCAI D (Figure 2). Patients in SCAI D showed notable improvement, with 8 out of 9 patients transitioning to SCAI B.

For patients initially SCAI B, RA changed from 10 to 11 mmHg, and PCWP decreased from 23 to 17 mmHg. The Fick CI increased from 2.53 to 3.02 L/min/m
2
(p=0.04), and the vasoactive inotropic score (VIS) decreased from 7.5-5.0 (p=0.05).

In patients initially classified as SCAI C, RA pressure decreased from 13 to 8 mmHg, and PCWP reduced from 32 to 30 mmHg. The Fick CI improved from 1.79 to 2.61 L/min/m
2
(p<0.001), while the VIS decreased from 9.2 to 6.3 (p=0.004).

For those initially in SCAI D, RA pressure reduced from 8 to 5 mmHg, and PCWP decreased from 27 to 18 mmHg. The Fick CI increased from 1.55 to 2.67 L/min/m
2
(p=0.002), and the VIS was notably reduced from 4.75 to 3.8 (p=0.36).

All 36 patients survived to heart transplantation without major pre-transplant complications.

Conclusion:
SCAI stage C-E mortality ranges from 25 – 50% or worse. Implementing Impella 5.5 support reduced SCAI severity and may be associated with improved survival in HFCS. We demonstrated lower VIS after Impella 5.5 and a 100% event free survival to heart transplantation despite a 25% baseline SCAI D cohort. Larger data should be evaluated to assess this trend.
Abstract 4147376: Leveraging Telemedicine to Assess Care Quality Among Rural-Residing Patients with Heart Failure: The Rural-HF Registry
Authors: Miller James , Keshvani Neil , Ghosh Pritam , Gallagher Chris , Sanchez Katherine , Butler Javed , Pandey Ambarish
Published: November 2024

Introduction:
Heart failure (HF) poses a major public health challenge in the United States, and patients in rural areas experience worse HF outcomes. Telemedicine has effectively provided access to specialty cardiovascular care to hospitalized patients in rural hospitals. A better understanding of care quality among patients hospitalized with HF in rural hospitals is needed to improve outcomes in this vulnerable population.

Methods:
We developed a virtual registry of patients hospitalized with acute HF in rural hospitals in collaboration with the American Heart Association (Grant: 23DSG1154425) and Access Telecare, a nationwide telehealth provider. Patients hospitalized to 13 rural hospitals across Texas, Indiana, South Carolina, and New Mexico are prospectively enrolled. Patients with acute HF are identified with an ICD 10 code for HF in the primary or first secondary position. Demographics, in-hospital care, post-discharge follow-up, and discharge utilization of GDMT (renin-angiotensin-aldosterone inhibitors (RAASi), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i) for HFrEF; RAASi, MRA, SGLT2i for HFpEF) were abstracted from the electronic medical record.

Results:
As of June 6, 2024, 254 patients (mean age 72 y, 40.2% female, 7.5% Black) were included (Table). 42.1% had HFrEF. 37% underwent LVEF assessment during the hospital stay. 74.4% of all patients received any GDMT at any dose, 4.7% received all classes of GDMT at any dose, and only 1.2% were prescribed GDMT at optimal doses. Among patients with HFrEF, evidence-based (vs non-evidence-based) BB was 58.9% and 15%, respectively. Furthermore, 74.7% of patients with HFrEF received ≤ 2 GDMT classes. At discharge, 0.4% of patients were referred for cardiac rehabilitation and 41.3% had a follow-up visit scheduled. Among patients with a history of atrial fibrillation/flutter, the rate of anticoagulation was 57.3%.

Conclusion:
There are considerable implementation gaps in GDMT and post-discharge care for patients with HF hospitalized in rural areas. Effective and scalable telemedicine interventions are needed to improve the uptake of GDMT among hospitalized HF patients in rural areas.
Abstract 4147395: Peanut Induced Myositis: The Adversity from Overconsumption of Omega 6 Fatty Acids
Authors: Samad Ayesha , Rothberg Michael , Machchhar Riddhi , Manchio Lee , Marin Andrea , Ali Syed , Shah Yash
Published: November 2024

Background:
Peanuts, a heart-healthy staple due to their high polyphenolic antioxidant content, contain a substantial amnount of omega 6 fatty acids. An excess of the Omega-6 polyunsaturated fatty acids (PUFAs), up regulates the body’s inflammatory pathways.The n-6 PUFA-derived lipid mediators trigger inflammation, platelet aggregation, and vasoconstriction. Omega 3 fatty acids in foods such as salmon or avocado, inhibit inflammation and platelet aggregation while enhancing vasodilation. Over consumption of omega 6 fatty acids by more than the 5-10% daily recommendation can lead to inflammatory conditions like myositis, as seen in this case presentation.

Case Presentation:
A 70-year-old Caucasian male presented to his primary care clinic for worsening bilateral lower extremity myalgias for the past few months. His medical history includes hypertension, non-insulin- dependent type 2 diabetes, and hyperlipidemia. He denied any trauma, strenuous exercise, myocardial infarction, or mechanical falls. His home medications were aspirin, low-dose Crestor, Pioglitazone, Janumet, and Farxiga. Radiographic imaging of the lower extremities was unremarkable. He had elevated creatinine kinase (CK) levels from 2018-2022, ranging from 300-500’s. A trial withholding the statin (Crestor), was initiated to check for improvement, but serum creatinine levels remained high. His muscle biopsy was unrevealing as well. During an office visit in 2022, the patient incidentally stated he had been eating a one-pound bag of shelled peanuts daily for the lat 4 years to improve his health. He was advised to eliminate peanuts for a month and have a follow up CK level testing.

Results:
The creatinine kinase levels between 2018-2022 revealed a baseline elevation until May 2022 when the patient returned for an office visit after abstaining from peanuts for a month. His CK levels not only normalized in May 2022, but also coincided with resolution of his myalgias. These results reveal the association between over consumption of omega 6 fatty acids as a trigger for myositis.

Conclusion:
The patient was educated on the detrimental health effects from over consumption of omega 6 fatty acids and the importance of moderation in the diet. This case illustrates the link between omega-6 fatty acid as a precursor to inflammatory disease. The patient's peanut consumption being the culprit of his myositis also highlights the importance of good history taking and exploring diet as a conduit to disease management.
Abstract 4147420: Long-Term Exposure to Electronic Cigarettes Induces Ventricular Hypertrophy and Cardiac Conduction Abnormalities
Authors: Eid Mahmoud , Ewees Mohamed , Mahgoup Elsayed , Zweier Jay
Published: November 2024

Introduction:
Electronic cigarettes (e-cig) have been promoted as nicotine (NIC) delivery systems without the adverse effects of tobacco cigarettes; however, the increasing popularity of EC has prompted concerns about their potential cardiovascular (CV) toxicity. As e-cig are relatively new products, their long-term CV effects over the lifetime of the user remain unclear. We developed a mouse model of chronic e-cig exposure that mimics human NIC exposure levels to simulate long-term human use.

Objective:
To characterize the effects of long-term e-cig exposure on the structure, contractile function and electrophysiological function of the heart with exposures for >50% of life-span.

Methods:
C57/BL6 male mice were exposed to either air (25 mice) or aerosol from e-cig liquid containing 24 mg/ml NIC (25 mice) for 3 hours/day, 5 days/week, over 64 weeks. Blood pressure (BP) was measured by tail-cuff. Echocardiography was performed to assess the structure and function of the left ventricle (LV) and right ventricle (RV). High-resolution 3D visualization of LV and RV was also performed by cardiac CINE-MRI. Cardiac rate and electrophysiology was measured by electrocardiography (ECG).

Results:
Compared to the air control group, e-cig exposure for 64 weeks led to major changes in heart structure and function (Table 1). Marked elevations in systolic BP (SBP), diastolic BP (DBP), and mean BP (MBP) of 49%, 66%, and 63%, respectively, were observed. Echocardiography revealed concentric LV hypertrophy (LVH) with increases in both LV and RV end-diastolic and end-systolic wall thicknesses. LV mass was 43% increased. Marked RV hypertrophy (RVH) was also observed. The presence of LVH and RVH was confirmed on cardiac MRI. ECG exhibited 6% slower heart rate with e-cig exposure along with 23% prolonged PR interval and 91% increase in P wave duration. QT interval was 20% prolonged indicative of delayed ventricular depolarization and repolarization.

Conclusions:
Long term e-cig exposure caused hypertension with LV and RV hypertrophy with alterations in atrial and ventricular conduction seen. Thus, long-term e-cig use may predispose to hypertrophic heart disease and cardiac conduction abnormalities.
Abstract 4147422: Risk of Stroke in Patients with Left Ventricular Thrombosis who undergo Coronary Angiography: A system-wide Retrospective Analysis
Authors: Ahmed Ashraf , Abid Shaun , Aggarwal Abhinav , Sethi Samdish , Ryzhkov Ilia , Rahman Nur , Rehman Asad Ur , Badheeb Mohamed , Opoku Isaac , Kaddoura Rasha , Singh Rajvir , NAYAK SUNDEEP , Lancaster Gilead
Published: November 2024

Background:
Left ventricular thrombus (LVT) has been associated with an increased risk of cardioembolic stroke. However, it has not been established if coronary angiography (CAG) or percutaneous intervention (PCI) would enhance that risk. This study aims to determine the risk of cardioembolic stroke among patients with LVT who underwent CAG or PCI.

Methods:
This retrospective study includes patients diagnosed with LVT between June 1
st
, 2017, and May 31
st
, 2023 across the Yale New Haven Health System. The data was retrieved using ICD-10 and CPT codes, followed by manual review of the patients’ charts. The patients were divided into two groups, those who had a stroke versus those who did not. The data retrieved includes patient demographics, pre-existing medical conditions, LV function as assessed by echocardiogram, along with the findings on CAG and PCI. The statistical analyses were performed using t-test, ANOVA, and Fisher's exact test.

Results:
A total of 1,104 charts were manually reviewed, of which 311 patients met the inclusion criterion of a confirmed LVT. Among these, 54 patients (17.4%) experienced an ischemic stroke. The mean age of these patients was 65.3 ± 14.8 years, with 219 patients (70.4%) being male, of whom 39 had a stroke. Among all the studied parameters (Table 1), only CAG was found to be associated with a significantly increased risk of stroke in these patients (RR: 1.47, 95% CI: 1.04-2.09, P = 0.014). There was no significantly increased risk of stroke among those patients who underwent PCI.

Conclusion:
Coronary angiography appears to carry a significantly increased risk of cardioembolic stroke among patients with LVT in a 6-month follow-up period, that is independent of subsequent percutaneous coronary intervention. Clinicians should carefully weigh the benefits and risks of CAG in patients with LVT and consider alternative diagnostic and therapeutic strategies when appropriate. Further studies are recommended to identify specific patient populations that might benefit from more targeted stroke prevention strategies post angiography.
Abstract 4147426: Intravascular Lithotripsy vs Rotational Atherectomy in Calcified Left Main Coronary Artery Disease: A Systematic Review and Meta-analysis
Authors: Lingamsetty Shanmukh sai pavan , Thyagaturu Harshith , Santer Matthew , Abugrin Mohamed , Awad Maan , Padala Vikram , Saifuddin Mohammed
Published: November 2024

Background:
Calcified left main disease is a high-risk and procedurally complex subset of coronary artery disease. So, adequate lesion preparation before stenting is crucial in achieving a favorable outcome. We performed a meta-analysis to compare the safety of intravascular lithotripsy (IVL) and rotational atherectomy (RA) in preparation of calcified left main coronary artery disease.

Hypothesis:
We hypothesize that there are no significant differences in angiographic and in-hospital outcomes between RA and IVL while treating calcified left main coronary disease.

Methods:
We systematically searched PubMed, Embase, and Cochrane databases until May 2024 for studies comparing IVL and RA in calcified left main coronary disease. A random-effects model was used to pool risk ratios (RR) with corresponding 95% confidence intervals (CI). Statistical analyses were performed using software R and heterogeneity was assessed using I
2
statistics.

Results:
We included 3 studies comprising 276 patients undergoing PCI for calcified left main disease, of whom 109 (39.5%) underwent lesion preparation with IVL. The mean age was 72.9 years and 73.1% were males. In the pooled analysis, there were no significant differences between the IVL and RA treated groups in terms of in-hospital mortality (RR 0.30; 95% CI 0.08 to 1.13, p=0.07, I
2
=0%; Figure 1A) and in-hospital myocardial infarction (RR 0.85; 95% CI 0.17 to 4.11, p=0.83, I
2
=0%; Figure 1B). There was also no significant difference in angiographic outcomes such as coronary perforation (RR 0.56; 95% CI 0.15 to 2.04; p=0.37, I
2
=0%; Figure 2A) and slow-flow/no-reflow (RR 1.43; 95% CI 0.22 to 9.51; p=0.70, I
2
=0%; Figure 2B).

Conclusion:
This meta-analysis showed that both IVL and RA were comparable in terms of in-hospital and angiographic outcomes while treating calcified left main coronary disease.
Abstract 4147427: Pulmonary Artery Distensibility in Pulmonary Artery Hypertension: Comparison of Cardiac Magnetic Resonance with Echocardiography
Authors: Giacalone Marco , Mombeini Hoda , Mercurio Valentina , Jani Vivek , Osgueritchian Ryan , Shah Ami , Zimmerman Stefan , Ambale Venkatesh Bharath , Mathai Stephen , Hassoun Paul , Mukherjee Monica
Published: November 2024

Background:
Right heart adaptation to emerging pulmonary arterial hypertension (PAH) largely determines outcomes. While numerous studies focus on ventricular remodeling, few explore the contribution of pulmonary artery (PA) stiffness indices across PAH subtypes.

Research Questions and Aims:
We assessed PA distensibility (PAD) in systemic sclerosis (SSc) patients with and without PAH compared with idiopathic pulmonary arterial hypertension (IPAH) using cardiac magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE). We also assessed the intermodality agreement in PAD assessment.

Methods:
We included SSc and IPAH patients who underwent right heart catheterization (RHC), CMR, and TTE. PAD was calculated using CMR transaxial PA images and TTE parasternal short-axis PA view with measurement of systolic and diastolic diameters. The areas corresponding to these diameters were derived using the formula for the area of a circle (πr
2
). PAD was computed as PA pulsatility over pulse pressure, with PA pulsatility being the percentage change in PA cross-sectional area between systole and diastole.

Results:
Of 45 SSc patients (34 with PAH, 11 without) and 16 IPAH patients, 46 had adequate image quality. Mean PA pressure by RHC was notably higher in IPAH cases than in those with SSc-PAH. PAD and PA pulsatility were lowest in the SSc-PAH group, followed by IPAH, and highest in the SSc without PAH group (p<0.001). In PAH, PA pulsatility differed between SSc-PAH and IPAH.
Figure 1
demonstrates a strong positive correlation (R=0.965) and substantial intermodality consistency (CCC=0.942). Agreement was stronger at lower values, with increased dispersion at higher values. Over 60 months, intermodality metrics of PAD and PA pulsatility predicted mortality. Kaplan-Meier analysis revealed that PA pulsatility greater than 10.5% significantly predicts better survival than less than 10.5%.

Conclusion:
We found diminished PAD in SSc-PAH than IPAH, despite lower PA pressures, predictive of mortality. We also demonstrate intermodality agreement supporting that TTE may be an alternative to CMR for assessing PAD.