bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4138277: Protamine Administration and Bleeding Risk Following Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis
Authors: Kara Arwi Omar , S. Beshr Mohammed , Alzubi Alhasan Saleh , Alansari Arowa hassan abdulrahman , Arhaym Esraa , Mukhtar Aburawi Dania , EL AWAMI MOSTAFA , Shahin Hatim , Abdelwahed Abdelrahman Farag , Abdulsalam Anas Atiyah , ALMEZGHWI HEYAM , Elhadi Muhammed 
Published: November 2024

Background:
Bleeding risk is a major concern for patients receiving transcatheter aortic valve implantation (TAVI) due to heparin use. In recent studies, Heparin antagonists, such as protamine, have shown potential in mitigating this complication. We aim to evaluate its potential role in reducing the risk of bleeding in patients post-TAVI.

Methods
On March 18, 2024, related articles were searched in the following databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, Wiley Library, VHL, Google Scholar, and clinicaltrials.gov. The inclusion criteria consisted of studies that reported the use of protamine in patients who underwent TAVI, with the aim of reducing bleeding risk compared to administering a placebo or no treatment. Our primary outcomes included major bleeding, life-threatening bleeding, the need for blood transfusion, the 30-day mortality rate, and any events of stroke or transient ischemic attack (TIA). The effect size was calculated using the odds ratio with a 95% confidence interval. Meta-analysis was conducted based on random-effect model using Revman.
Results

Out of the 14,705 articles we obtained, only 5 papers were included. One was a randomized controlled trial; the remaining 4 were observational cohorts with control groups. These studies comprised a total of 3,502 patients. Protamine significantly reduced major bleeding (OR 0.44, 95% CI 0.29-0.69, p = 0.0003, I
2
= 37%), especially with full-dose administration (1 mg/100 U UFH) compared to partial-dose administration (0.5 mg/100 U UFH) (OR 0.38, 95% CI 0.25-0.58, p < 0.00001, I
2
= 0%). Similarly, protamine significantly reduced life-threatening bleeding (OR 0.37, 95% CI 0.20-0.67, p = 0.001, I
2
= 4%), particularly with full-dose usage compared to partial-dose (OR 0.37, 95% CI 0.18-0.73, p = 0.004, I
2
= 0%). However, no significant difference was observed in the need for blood transfusion (OR 0.75, 95% CI 0.46-1.24, p = 0.27, I
2
= 33%), stroke/TIA risk (OR 0.82, 95% CI 0.41-1.61, p = 0.56, I
2
= 49%), or 30-day mortality (OR 0.93, 95% CI 0.62-1.39, p = 0.73, I
2
= 0%).

Conclusions
The use of protamine appears to significantly reduce major and life-threatening bleeding. The need for blood transfusion, risk of stroke or TIA, and 30-day mortality did not show significant differences. These findings suggest that protamine may be an effective intervention for reducing bleeding complications post-TAVI. However, large randomized controlled trials are needed to validate these findings.
Abstract 4138487: A Novel Technique in Managing Equipment Entrapment: A Complicated Case of Aortic Valvuloplasty Balloon Rupture and Detachment
Authors: ABDELSALAM MAHMOUD , Ezaldin Shady , Abu-Halimah Shadi , Han Richard 
Published: November 2024

Introduction:
A 79-year-old male patient with a history of surgical AVR presented with severe bioprosthetic aortic stenosis requiring valve-in-valve TAVR. The plan was to place an Evolut CoreValve after intentionally fracturing the basal ring of his surgical valve. Through an 18F sheath, a 25mm x 4.5cm True balloon was advanced to the surgical valve over a Lunderquist wire. However, the balloon ruptured immediately after fracturing the valve ring.

Decision making:
Efforts were made to remove the ruptured True balloon while maintaining the position of the wire, but attempts to withdraw it through the 18F sheath were unsuccessful due to resistance at the distal tip of the sheath. Subsequently, the proximal portion of the balloon catheter was partially detached and removed.

An exchange was made to a 22F Gore DrySeal sheath, but again, efforts to withdraw the ruptured balloon were unsuccessful (Figure 1). Various snares were employed, but all attempts to manipulate the balloon into the sheath were ineffective. The ruptured balloon remained in the abdominal aorta and eventually detached from the hypotube.
The 22F sheath was then exchanged for a 20F Inari Protrieve sheath. Two Supracore wires were then inserted through the sheath, with one designated for snare delivery and the other for maintaining vessel access. A Tulip snare was guided over one Supracore wire to the descending thoracic aorta, where the snare was opened and the Lunderquist wire was captured at the junction between the stiff and soft parts of the wire (Figure 2). The snared wire and ruptured balloon were retracted into the exposed Nitinol cone of the Inari sheath, successfully engulfing the balloon and compressing it (Figure 3). The sheath, wire, balloon, and snare were then removed as a unit while the wire access was maintained.
A new 22F Gore DrySeal sheath was inserted. Inspection confirmed the complete removal of all components of the ruptured True balloon and the catheter. The procedure concluded with the successful deployment of a 29mm Evolut pro CoreValve. The patient made an uneventful recovery and was discharged home the following day.

Conclusion:
The Inari Protrieve sheath proved valuable in this case of complicated intravascular equipment entrapment. The soft, funnel-shaped nitinol cone aided in capturing and compressing the bulky ruptured balloon, obviating the need for a surgical cutdown.
Abstract 4138547: The A Body Shape Index and Type 2 Diabetes are Mutually Independent Predictors of Cardiovascular Events in Patients With Established Coronary Artery Disease
Authors: Plattner Thomas , Larcher Barbara , Mader Arthur , Vonbank Alexander , Leiherer Andreas , Muendlein Axel , Drexel Heinz , Saely Christoph H 
Published: November 2024

The A Body Shape index (ABSI) is a validated measure of visceral adiposity that is calculated based on waist circumference, height and BMI. Its power to predict cardiovascular events in patients with coronary artery disease (CAD) is unclear and is addressed in the present study.
We prospectively recorded cardiovascular events in a cohort of 938 patients with CAD over a mean follow-up time of 8.1±4.2 years.
At baseline, the ABSI was higher in patients with type 2 diabetes (T2DM; n=308) than in those who did not have diabetes (8.4±0.6 vs. 8.3±0.5; p=0.032). Prospectively, the ABSI significantly predicted the incidence of cardiovascular events (n=389) after adjustment for age, gender, smoking, hypertension, LDL cholesterol, HDL cholesterol, and T2DM (standardized adjusted HRs 1.12 [1.03-1.22]; p=0.009, respectively). T2DM in turn also significantly predicted cardiovascular events in this model with a HR of 1.23 [1.02-1.49]; p=0.034 after adjustment for ABSI.
We conclude that ABSI and T2DM are mutually independent risk factors for cardiovascular events in patients with established CAD.
Abstract 4139327: Life-Saving Synchrony: Treating Leadless Pacemaker-Induced Cardiogenic Shock with Cardiac Resynchronization Therapy
Authors: Mbisike Chinwe , Udongwo Ndausung , Lyonga Ngonge Anthony , Adeniyi Adeyinka , Esomonye Theodora , ALKUBEYSI MO , Zhuo David 
Published: November 2024

Leadless pacemakers (LPMs) represent a significant advancement in cardiac pacing technology, offering several advantages over traditional transvenous systems. However, they are not without complications such as leadless pacemaker-induced cardiomyopathy (LPM-CMP). We present a case of cardiogenic shock from LPM-CMP requiring cardiac resynchronization therapy (CRT) as a rescue strategy.
A 77-year-old female with a history of heart failure with reduced ejection fraction, coronary artery disease status post recent percutaneous coronary intervention to the proximal-to-mid left anterior descending artery, complete heart block status post LPM implantation, and chronic kidney disease stage 3b, presented to the emergency department after a syncopal event. Initial vital signs were blood pressure 96/64 mmHg and heart rate 62 bpm, while LPM interrogation showed 100% right ventricular pacing burden. Physical exam revealed congestion with jugular venous distension and 2+ pitting bilateral lower extremity edema. Initial labs (BNP 4792 pg/mL, hs-troponin 202 ng/L, lactate 5.5 mmol/L, AST/ALT 68/30 U/L, and creatinine 3.3 mg/dL (baseline 1.5 mg/dL)) were consistent with SCAI Stage B cardiogenic shock. She was transferred to the cardiovascular intensive care unit for inotropic and vasopressor support. By hospital day 10, she was on 10 mcg/kg/min of dobutamine, 3 mcg/min of epinephrine, and 14 mcg/min of norepinephrine. Despite this and extensive diuresis, she continued to deteriorate. After ruling out acute coronary syndrome, LPM-CMP was suspected as the etiology, and CRT-D was implanted on day 14. Echocardiography-assessed stroke volume correspondingly improved from 25 mL on pressors to 30 mL after CRT-D and off pressors. She was subsequently optimized on heart failure guideline-directed medical therapy, and discharged home on day 19.
LPM-CMP is a rare but potentially serious complication of LPM implantation. Early recognition and appropriate management are essential for optimizing patient outcomes. In this case, CRT-D implantation proved to be a successful intervention, resulting in significant clinical improvement and symptom resolution. This underscores the importance of individualized patient management and the role of advanced device therapies in the treatment of LPM-induced complications. Further research is needed to better understand the risk factors, pathophysiology, and optimal management strategies for LPM-CMP, especially as a rescue strategy in cardiogenic shock.
Abstract 4139823: Decline In Treatment, Testing and Control of Lipids Amongst Diabetic Patients, a Population-Level Analysis
Authors: King Daniel , Harris Daniel , Akbari Ashley , Gravenor Michael , Halcox Julian 
Published: November 2024

Background:
In patients with diabetes mellitus (DM), lipid-lowering therapy (LLT) with statins +/- adjuvant LLT are recognised treatment approaches. It is unknown what proportion of patients with DM are prescribed LLT, have documented low-density lipoprotein cholesterol (LDL-C) levels, or achieve guideline LDL-C targets.

Aims:
To document population trends in (i) the incidence and prevalence of DM, (ii) prescribing of LLT, and (iii) testing and achievement of LDL-C targets in patients with or without atherosclerotic cardiovascular disease (ASCVD).

Methods:
We conducted a retrospective, population-level, observational study using linked anonymised health record data amongst 269,735 diabetic patients in Wales (UK). Associations between patient characteristics and (i) statin prescription and (ii) achievement of LDL-C target of (<1.8 mmol/L) were evaluated.

Results:
The prevalence of DM increased from 6,519 to 8,128 per 100k, and incidence increased from 543 to 633 per 100k per year (2010-21). The proportion of patients prescribed any LLT decreased from 89.5% to 82.9% in those with ASCVD and from 53.2% to 37.8% without. An increasing and greater proportion of patients with ASCVD were prescribed high-intensity statin therapy (14.1% to 36.1%) over the study period, compared to those without (2.3% to 5.1%; Figure 1).

The proportion of patients with documented LDL-C decreased (from 68.1% to 52.3% in those with ASCVD and 64.7% to 48.3% without) over the study period. A greater proportion of those with ASCVD achieved an LDL-C <1.8 mmol/L (43.1% to 45.4%) than those without (22.2% to 22.0%). In a multivariate logistic regression, presence of ASCVD and history of hypertension were associated with prescription of statin therapy (ORs = 4.01, 1.75, respectively; both p < 0.01). Male sex and presence of ASCVD were associated with achievement of LDL-C target (ORs = 1.25, 8.15; both p < 0.01).
Conclusions: The incidence and prevalence of DM is increasing over time, but the overall quality of lipid management is decreasing, as evidenced by documented testing, treatment and control of LDL-C. In order to realise the full evidence-based benefit from LLT, improvement in the implementation of guideline-recommended care is required.
Abstract 4140175: Association of Non-Cardiac Comorbidities With Long-Term Re-Hospitalization for Heart Failure: Contemporary Analysis of 88,528 Consecutive Cases
Authors: Ambrosio Giuseppe , Tagliabue Elena , Pellicori Pierpaolo , Lund Lars , Pontiroli Antonio 
Published: November 2024

Background:
Heart failure (HF) may coexist with non-cardiac comorbidities. Yet, while relevant, the impact of non-cardiac comorbidities on long-term HF re-hospitalizations (Re-Hosp) is is not well established. Previous studies do not reflect modern HF management, often report just all-cause Re-Hosp, or are based on selected populations from randomizd trials.

We investigated the association of non-cardiac comorbidities with long-term Re-Hosp for HFafter discharge for HF in a large, contemporary setting.

Methods:
Administrative hospital discharge data for HF (primary diagnosis) (Jan 1st 2015-Dec 31st 2019) of all >10 Million residents of Lombardy (Italy); follow up through June 30th 2021. Comorbidities assessed from discharge information and/or administrative codes for chronic diseases. Re-Hosp risk for HF (primary diagnosis) after HF discharge as a function of non-cardiac comorbidities was assessed by Cox proportional-hazard models (age- and sex-adjusted). Kaplan Meier curves for HFRe-Hosp were stratified for number of non-cardiac comorbidities.

Results:
88,528 consecutive patients received a HF primary discharge; over 42.8±18.3 months of follow-up, 79,533 HF Re-Hosp occurred (32.44/100 patient/year). Risk of HF Re-Hosp increased with increasing number of non-cardiac comorbidities. Adjusted by age, females with >4 comorbidities had a 3.08 (CI 2.73-3.47) greater risk of Re-Hosp compared with females without comorbidities; males with >4 comorbidities had a 2.62 (CI 2.39-2.87) greater risk compared with males without comorbidities. By multivariable analysis, number of comorbidities, age, and male sex, remained significantly associated with Re-Hosp risk (Figs 1, 2).

Risk of all-cause death also increased with increasing number of non-cardiac comorbidities, from 1.42 for HF patients with 1-2 comorbidities to 2.20 for HF patients with >4 comorbidities.
Also the number of days spent in hospital because of HF after index HF discharge significantly increased with increasing number of non-cardiac comorbidities, from 19.9±19.3 days in patients without non-cardiac comorbidities to 45.4±33.0 days for patients with >4 non-cardiac comorbidities (p<0.0001).

Conclusion:
In a large, contemporary real-world series of patients hospitalized with HF, HF re-hospitalizations, all-cause mortality, and life-time spent in hospital due to worsening HF increased with number of non-cardiac comorbidities. Non-cardiac comorbidities substantially impact the clinical trajectory of HF patients.
Abstract 4140337: Resting Heart Rate and Chronotropic Incompetence are Linked
Authors: Li Anita , Samuels Summer , Meyer Markus 
Published: November 2024

Background:
Cardiac output reserve and exercise capacity are strong predictors of life expectancy. Chronotropic incompetence (CI) is the inability to reach an age appropriate maximum heart rate with exercise. CI reduces cardiac output reserve and exercise capacity, both of which increase all-cause mortality risk. Sinus node dysfunction may manifest as CI and abnormally low resting heart rate (RHR). The relationship between low RHR and CI has yet to be described.

Purpose:
We hypothesize that resting sinus bradycardia (low RHR) could be a predictor of chronotropic incompetence and reduced exercise capacity.

Methods:
The derivation cohort consists of 201 patients with normal Bruce protocol treadmill stress echocardiogram. Patients with ejection fractions <50%, baseline or stress induced wall motion abnormalities, and valvular diseases were excluded. The confirmation cohort, which was obtained from the National Institute of Health, consisted of 3315 patients with normal Bruce protocol treadmill stress test results in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) Trial. RHR and peak exercise heart rates (PHR) were tabulated. All patients were categorized based on whether their PHR reached 85% of age-predicted maximum heart rates (APMHR) by the Astrand formula (220 - age in years) and the Tanaka formula (208 - 0.7 x age in years).

Results:
The mean(SD) age in the derivation cohort was 60(±11) years old and 45% were female. 46/201 (23%) did not reach their APMHR. The mean(SD) RHR in CI patients was 65.6(±12) beats per minute (BPM), while it was 69.2 (±12) BPM without CI (p =0.04).

In the confirmation cohort, the mean age was 60(±6.9) years old and 48% were female. 427/3315 (13%) did not reach their APMHR. The mean RHR in CI patients was 68.9(±12) BPM versus 74.0 (±13) BPM in the patients that reached APMHR (p <0.001). The Tanaka formula revealed similar results (p <0.001).
Patients with RHR below or equal to 60 BPM were almost twice as likely to have CI (20%) when compared to patients with RHR over 60 BPM (11%), with a statistical significance of p < 0.001. Patients with CI had a greater cumulative hazard ratio for death and hospitalizations due to myocardial infarction or unstable angina (Image 1).

Conclusion:
These results demonstrate that CI is linked to lower RHR. Below 60 BPM RHR may therefore be an indicator of sinus node dysfunction and CI, both of which predict a reduced exercise capacity and increase all-cause mortality risk.
Abstract 4140565: Chimpanzee Induced Pluripotent Stem Cells (iPSCs)-derived Cardiomyocytes as Surrogates for Human iPSCs in Cardiomyocyte Research and Cross-Species Chimeric Embryo Development
Authors: Roodgar Morteza , Parham Maryam , Suchi Fabian , Bajpai Vivek , Nakauchi Hiromitsu , Wu Joseph , Snyder Michael 
Published: November 2024

Induced pluripotent stem cells (iPSCs) provide valuable insights into early tissue and organ development, with potential applications in cross-species comparative studies. Nonhuman primate (NHP) iPSCs, particularly those derived from chimpanzees (Pan troglodytes), which share the closest evolutionary relationship with humans, offer a unique opportunity to study cardiomyocyte comparative developmental physiology. Given the limitations of using human cells, chimpanzee iPSCs can serve as an effective surrogate in earliest stages of embryonic development.
In this study, we derived and maintained chimpanzee iPSCs under novel optimized conditions. We investigated the compatibility of human and chimpanzee iPSCs and their derived cardiomyocytes by co-culturing and differentiating these cells into cardiomyocytes. Our results demonstrate that mixed colonies of human and chimpanzee iPSCs can form homologous intermix colonies and differentiate into synchronized beating cardiomyocyte layers. This high level of compatibility suggests similar differentiation pathways in both species.
Utilizing chimpanzee iPSCs as surrogates for human iPSCs, we assessed their potential in forming primate cross-species chimeric preimplantation embryos. When injected into early rhesus macaque blastocysts, chimpanzee iPSCs were able to survive and proliferate near the inner cell mass. Our study not only introduces a new resource of NHP iPSCs with detailed transcriptome and proteomics characterizations but also highlights the high compatibility of chimpanzee and human iPSC-derived cardiomyocytes, evidenced by the formation of synchronized beating layers during co-culture experiments. These findings hold significant implications for advancing our understanding of cardiomyocyte development and potential therapeutic applications.
Abstract 4141104: Safety and Therapeutic Potential of Allogeneic Adipose-Derived Stem Cell Spray Transplantation in Ischemic Cardiomyopathy: A Phase I Clinical Trial
Authors: Kawamura Takuji , Yoshioka Daisuke , Kawamura Ai , Misumi Yusuke , Taguchi Takura , Saito Shunsuke , Yamauchi Takashi , Miyagawa Shigeru 
Published: November 2024

Background:
Ischemic cardiomyopathy, characterized by an imbalance in myocardial blood supply due to coronary artery atherosclerosis, presents a formidable health challenge. Although coronary artery bypass grafting (CABG) can enhance long-term survival, a subset of patients does not exhibit significant improvement in cardiac function post-surgery. This study investigated the safety and therapeutic potential of allogeneic adipose-derived stem cell (ADSC) spray transplantation combined with CABG in ischemic cardiomyopathy.

Methods:
This single-center, double-blind, randomized clinical trial included six eligible patients with ischemic cardiomyopathy who underwent CABG. The ADSCs, suspended in fibrin glue, were sprayed directly onto the heart during surgery. Primary endpoints encompassed adverse events, late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) volume changes, and feasibility. Secondary endpoints included alterations in left ventricular function, exercise tolerance, and heart failure symptoms.

Results:
All patients underwent surgery successfully without complications. ADSC spray transplantation, evidenced by a reduced LGE-MRI volume, exhibited potential therapeutic benefits by improving left ventricular function and exercise tolerance in the ADSC group compared to the placebo group (Figures 1 and 2). Adverse events were minimal and primarily associated with the CABG procedure.

Conclusions:
This study establishes the safety and feasibility of ADSC spray transplantation combined with CABG for the treatment of ischemic cardiomyopathy. The observed improvements in LGE-MRI volume and cardiac function suggest a potential therapeutic effect, warranting further investigation in larger phase II and III clinical trials. This novel approach holds promise as a clinically viable treatment strategy to enhance revascularization outcomes in patients with ischemic cardiomyopathy.

Registration:
https://clinicaltrials.gov/study/NCT04695522
https://jrct.niph.go.jp/en-latest-detail/jRCT2053190103