bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4143128: Understanding the Circumflex Aortic Arch Anatomy is Critical in Transcatheter Aortic Valve Replacement and Critical Bicuspid Aortic Valve Stenosis.
Authors: Lan Merrina , Boudoulas Konstantinos , Henn Matthew , Marshall William 
Published: November 2024

Case description:
A 64-year-old male was referred for transcatheter aortic valve replacement (TAVR) due to critical bicuspid aortic valve stenosis (Figure 1A/B) with multiple episodes of unexplained syncope. A multidisciplinary discussion determined that he was at high surgical risk due to multiple comorbidities, including developmental delay, and prior renal transplantation with baseline serum creatinine of 1.8 mg/dL.

Transfemoral and trans-subclavian arterial approaches for valvular replacement were not anatomically feasible due to the circumflex aortic arch (Figure 2A/B). Left transcarotid approach was considered due to the location of the vessel as the first branch of the ascending aorta (Figure 2B, 3A) but was unsuitable due to significant left carotid artery calcification. Thus, the decision was to perform a transaortic approach under general anesthesia.
A right femoral artery sheath was inserted, and a wire was advanced to the aortic root (Figure 2B) for pigtail placement used to guide positioning during TAVR. A mini upper hemi-sternotomy was performed and J-ed into the right second intercostal space. The pericardium was suspended, and two concentric purse string sutures were placed in the aorta at the site of sheath placement. The valve was crossed and following valvuloplasty, the 29-mm Edwards SAPIEN 3 valve was delivered across the aortic valve annulus and deployed following balloon inflation with rapid ventricular pacing (Figure 3A). Postoperative echocardiography showed no prosthetic stenosis (Figure 3B) and no valvular or paravalvular regurgitation.

Discussion:
To our knowledge, this is the first report of a transaortic TAVR performed on a patient with a circumflex aortic arch. Circumflex aortic arch is a rare congenital anomaly and poses challenges to transcatheter aortic valve interventions from the extremities. This case illustrates the potential of transaortic TAVR as treatment for symptomatic aortic stenosis when there are no other options for access. Multidisciplinary collaboration and comprehensive imaging are critical in tailoring individualized cardiovascular intervention in patients with congenital anatomical variations.
Abstract 4143137: Lets talk about sex: update on sexual health and information need of persons with a cardiac illness.
Authors: Jaarsma Tiny , Klompstra Leonie , Persson Tommy , Klingvall Elin , Skoglund Anna , Saren Frida 
Published: November 2024

Background:
Sexual health is an important aspect of quality of life, regardless of cardiac disease. However, there is a significant gap between patients' information needs and the ability of the healthcare system to meet these. Most studies focus on clinical populations in specialized clinics, but data on sexual health and information needs among community based cardiac patients is scarce.

Method:
We conducted an online national survey in Sweden in 2024. The survey was developed based on literature and previous international surveys on sexual health in cardiac patients. Recruitment took place via patient organizations, clinical outpatient departments and via social media. All data was collected anonymously.

Results:
In total 135 persons (59% male, mean age 65, range 30-89) answered the survey, 47% had hypertension, 36% had a myocardial infarction, 30% atrial fibrillation, 24% heart failure.

In total 76% stated that their sexual health was impacted by their disease and affects their mood and well-being (n=102). Men more often than women thought their disease impacted their sexual health (65% vs. 35%, p=0.02) and more often that sexual health affected their mood and well-being (64% vs. 36%, p<0.01).
Only 5% received sexual health information, but 78% wanted it. Men more often expressed a desire for information compared to women (87% vs. 64%, p=0.02).
The most desired topics include medication side effects (60%, n=81), erectile dysfunction (50%. n=68), impact on relationships (47%, n=63) and anxiety before sex (35%, n=47). Men wanted information on erectile dysfunction (80% vs. 7%), and women wanted more often information on pain during sex (13% vs. 1%, p<0.01).
Patients prefer to receive information during annual check-ups (57%, n=77), and/or during diagnosis (51%, n=69), and/or during medication follow-ups (40%), n=54. Patients most favor conversations with healthcare professionals (79%) and/or getting information at various times from different sources (43%).

Conclusion:
This study highlights a significant gap between patients’ needs for sexual health information and the actual support provided by the healthcare system. Despite 76% of patients reporting that sexual health affects their mood and well-being, only 5% received relevant information or counseling. The study underscores the importance of structual policy changes addressing sexual health concerns in cardiac patients.
Abstract 4144216: Have Gender-Specific Outcomes After STEMI Improved? – A Meta-Analysis of the Past Decade
Authors: Hariyanto Jesslyn , Hardi Catherine Jillian , Setiawan Jessica Anastasia , Ng Sunanto 
Published: November 2024

Background:
Over the past decade, research has focused on gender disparities in cardiovascular outcomes. Historically, women have had higher mortality rates and worse outcomes after STEMI compared to men. This study aims to investigate if advancements in interventional cardiology and pre-hospital and in-hospital care have improved outcomes for women over 10 years.

Methods:
PubMed, Scopus and Cochrane were reviewed for cohort studies and registries from 2014-2024 comparing male and female STEMI patients, focusing on mortality, reinfarction, heart failure, stroke, and stent thrombosis. In-hospital and 1-year outcomes were assessed. Statistical analysis used Review Manager and I^2 for heterogeneity with a random-effects model.

Results:
We found 28 studies from 39 countries, with 39% female participants. T2DM was prevalent for 33.2% of males and 36.9% of females, with 32.2% of males and 21.3% of females being smokers. Both genders had an equal history (50%) of previous MI, PCI, and CABG. Primary PCI was performed in a majority (73%) of male patients compared to 62% of female patients; while thrombolysis was received by 73.1% of males and 61.5% of females.

For in-hospital outcomes, women have a higher all-cause mortality risk (RR = 1.77, 95% CI: 1.65-1.91), consistent in 2014-2018 (RR = 1.75, 95% CI: 1.49-2.05) and 2019-2024 (RR = 1.79, 95% CI: 1.63-1.96; P = 0.81) Women have higher risks of stroke (RR = 1.64, 95% CI: 1.34-2.02) and heart failure (RR = 1.50, 95% CI: 1.31-1.70) No significant differences were found in reinfarction (RR = 1.19, 95% CI: 0.82-1.74) or stent thrombosis (RR = 1.05, 95% CI: 0.53-2.07)
At 1 year, women have a significantly higher all-cause mortality risk (RR = 1.94, 95% CI: 1.48-2.53), observed in both 2014-2018 (RR = 1.77, 95% CI: 1.26-2.50) and 2019-2024 (RR = 1.98, 95% CI: 1.45-2.72; P = 0.64) Women also face higher cardiovascular mortality (RR = 2.45, 95% CI: 1.11-5.40) and stroke risk, (RR = 1.85, 95% CI: 1.43-2.39) with no significant difference in reinfarction risk (RR = 0.96, 95% CI: 0.53-1.73)

Conclusion:
Women with STEMI still face higher risks of in-hospital and 1-year all-cause mortality, stroke, and heart failure compared to men, indicating insufficient improvement in outcomes. There were no significant differences in reinfarction and stent thrombosis. It is important for future efforts to focus on understanding these disparities to improve outcomes for women.
Abstract 4145626: Comparative Bleeding Risks Following Acute Myocardial Infarction: Clopidogrel and Ticagrelor, with Consideration for Clopidogrel Resistance
Authors: Gupta Nikita , Anuforo Anderson , Vaishnav Pratyaksh , Ochani Rohan Kumar , Harisingani Dr. Avi , Devakumar Sahana , Chaudhuri Debanik 
Published: November 2024

Various studies have shown higher bleeding risks with ticagrelor in comparison to clopidogrel in acute myocardial infarction (AMI). The literature also reveals significant variability in Clopidogrel resistance and consequent efficacy in patients. Our study compares the post-AMI bleeding risks and outcomes of patients on Clopidogrel with confirmed inhibition of platelet aggregation via P2Y12 platelet reactivity assay, compared to Ticagrelor.
We queried the TriNeTX Global collaborative network for adults diagnosed with AMI between 01/01/08 to 12/31/23 and created two cohorts: one on Clopidogrel for at least one month post-AMI, after confirmed ADP-mediated P2Y12 inhibitor effect, and the second cohort was on Ticagrelor for at least one month post-AMI. We conducted propensity score matching(PSM) for around 35 variables, including race, age, sex, medications, and other comorbidities. Logistic regression was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) at one year. Upper Gastrointestinal (GI) bleeding and hemorrhagic stroke at one year were the primary outcomes. Secondary outcomes included 4-point major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of all-cause mortality, cardiac arrest, heart failure, and ischemic stroke.
The sample population had 1,460 post-AMI patients in the Clopidogrel cohort (Cohort 1) and 17,686 post-AMI patients on Ticagrelor (Cohort 2). After PSM both cohorts had 1,296 patients. The Clopidogrel cohort had significantly increased odds of upper GI bleeding (OR 1.656, 95% CI, 1.092-2.511) and hemorrhagic stroke (OR 2.119, 95% CI, 1.110 - 4.044) compared to Cohort 2 at one year. Among secondary outcomes, there was increased odds of heart failure (OR 1.565, 95%CI, 1.118-2.190), ischemic stroke (OR 1.745, 95%CI, 1.098 - 2.775), and 4-point MACCE (OR 1.549, 95%CI, 1.110 - 2.160) in the clopidogrel group compared to ticagrelor. There was no significance noticed in cardiac arrest and all cause-mortality.
In our study, post-AMI patients on Clopidogrel with confirmed in-vitro platelet aggregation effect had significantly higher odds of bleeding and MACCE than those on Ticagrelor. However, Ticagrelor use did not show any mortality benefit.
Abstract 4146665: Unveiling the Biological Subtypes of Left Ventricular Diastolic Dysfunction through Unsupervised Clustering of ECG Data
Authors: Shetty Samantha , Lampert Joshua , Jiang Joy , Nadkarni Girish , Vaid Akhil 
Published: November 2024

Left Ventricular Diastolic Dysfunction (LVDD) presents a challenge in terms of management given its multifaceted etiology and complex presentation. Conventional diagnostic categories may fail to fully reflect underlying pathophysiology variability. Using unsupervised clustering on electrocardiogram (ECG) data is a novel approach to capture subtle changes in the electrical signatures seen in ECGs and help uncover naturally occurring patient subtypes that may be invisible to traditional echocardiographic (echo) assessment.
We performed Natural Language Processing on long-form echo reports to extract annotations of LVDD. Echo reports were paired with an ECG performed within 7 days of the echo. Patients were excluded if their ECG diagnostic codes indicated conduction abnormalities, concurrent ischemia, and prior intervention. We applied a Convolutional Autoencoder to compress high-dimensional ECG data into a 128-dimensional, feature-rich space suitable for clustering. K-means clustering was then utilized to categorize patients into groups based on transformed ECG features. Silhouette analysis was employed to determine the optimal number of clusters and quantify differences between groups. Chi-square and ANOVA tests examined for differences in age, sex, and race across clusters.
We identified 22,183 patients paired with 96,921 ECGs with clinician confirmed LVDD. Silhouette score analysis on K-Means clustering identified 2 as the optimal number of clusters (Figure 1). Labels associated with each data point were visualized in 2D and 3D projections with the t-Stochastic Neighbor Embedding technique (Figure 2). Identified clusters differed significantly in terms of age, sex, and race, with p-values of <0.00001 for each demographic.
The identification of two distinct clusters underscores the potential of ECG-based phenotyping in revealing new biological subtypes of LVDD. Extending this technique to integrate other clinical variables and longitudinal data may enhance the clinical utility of identified subtypes. Future work will look at cluster-wise distribution of co-morbidities and longitudinal outcomes. Applying similar methodologies to other cardiac disorders may improve our approach to their diagnosis and management. Employing unsupervised clustering on ECG has proven to be effective in identifying novel subtypes of LVDD, showcasing the potential of ECG data to refine diagnostic and therapeutic strategies.
Abstract Sa601: Relationship between ETCO2 and Hemodynamics in Swine: An Exploratory Secondary Analysis
Authors: Yhdego Haben , Beka Sylvia , Pandit Sandeep , Appleby David , Lampe Joshua 
Published: November 2024

Background:
End-tidal carbon dioxide (ETCO2) has been proposed as a surrogate for cardiac output during cardiopulmonary resuscitation (CPR). Chest compressions alter the capnogram waveform, complicating the calculation of ETCO2 values. To explore the utility of ETCO2 as a surrogate marker, we have conducted a retrospective analysis of the relationship between local maxima in the capnogram and hemodynamic metrics in preclinical resuscitation studies.

Methods:
In eight domestic swine (~30 kg), the IVC blood flow, aortic pressure (AOP), right atrial pressure (RAP), and capnogram were measured during resuscitation. Coronary perfusion pressure (CPP) is the difference between the AOP and the RAP during relaxation. ETCO2 is calculated using three methods: averaging the maximum CO2 level reached during each chest compression, selecting the global CO2 maximum measured during each breath, and identifying the maximum CO2 level from the last compression for each breath. The data are modeled using multivariate linear regression as follows:

ETCO2= IVC + CPP + CC Depth + CC rate + Epoch # + Animal #

Results:
Table 1 shows R-squared values relating intra-compression CO2 maxima to hemodynamic measures and compression characteristics. The maximum CO2 value in a breath shows stronger correlations with these parameters than the other CO2 measurements. Table 2 presents regression coefficients for the model using this measure. CC Depth and CPP have coefficients of 3.67 and 2.05 respectively, indicating significant positive influences, while IVC has a coefficient of 0.84, indicating a weaker positive impact compared to CC Depth and CPP.

Table 1. Method for Calculating the ETCO2

Calculating ETCO2

R-Squared

Global CO2 Maximum per breath
0.67
Average of CO2 Maxima
0.64
CO2 Maximum of Last Compression
0.36
Table 2. Variable Coefficients

Outcomes

Regression Coefficients

CPP
2.05
IVC
0.84
CC Depth
3.67
CC Rate
-0.02
Epoch Number
-0.57

Conclusions:
The experimental results show that the global CO2 maximum per breath has the closest relationship to the hemodynamics in this experiment. The analysis suggests that increasing CC Depth, CPP, and IVC flow also increases the calculated ETCO2.
A Proteomics-Based Approach for Prediction of Different Cardiovascular Diseases and Dementia
Authors: Ho Frederick K. , Mark Patrick B. , Lees Jennifer S. , Pell Jill P. , Strawbridge Rona J. , Kimenai Dorien M. , Mills Nicholas L. , Woodward Mark , McMurray John J.V. , Sattar Naveed , Welsh Paul 
Published: November 2024

BACKGROUND:
Many studies have explored whether individual plasma protein biomarkers improve cardiovascular disease risk prediction. We sought to investigate the use of a plasma proteomics-based approach in predicting different cardiovascular outcomes.

METHODS:

Among 51 859 UK Biobank participants (mean age, 56.7 years; 45.5% male) without cardiovascular disease and with proteomics measurements, we examined the primary composite outcome of fatal and nonfatal coronary heart disease, stroke, or heart failure (major adverse cardiovascular events), as well as additional secondary cardiovascular outcomes. An exposome-wide association study was conducted using relative protein concentrations, adjusted for a range of classic, demographic, and lifestyle risk factors. A prediction model using only age, sex, and protein markers (protein model) was developed using a least absolute shrinkage and selection operator–regularized approach (derivation: 80% of cohort) and validated using split-sample testing (20% of cohort). Their performance was assessed by comparing calibration, net reclassification index, and
c
statistic with the PREVENT (Predicting Risk of CVD Events) risk score.

RESULTS:

Over a median 13.6 years of follow-up, 4857 participants experienced first major adverse cardiovascular events. After adjustment, the proteins most strongly associated with major adverse cardiovascular events included NT-proBNP (N-terminal pro B-type natriuretic peptide; hazard ratio [HR], 1.68 per SD increase), proADM (pro-adrenomedullin; HR, 1.60), GDF-15 (growth differentiation factor-15; HR, 1.47), WFDC2 (WAP four-disulfide core domain protein 2; HR, 1.46), and IGFBP4 (insulin-like growth factor-binding protein 4; HR, 1.41). In total, 222 separate proteins were predictors of all outcomes of interest in the protein model, and 86 were selected for the primary outcome specifically. In the validation cohort, compared with the PREVENT risk factor model, the protein model improved net reclassification (net reclassification index +0.09), and
c
statistic (+0.051) for major adverse cardiovascular events. The protein model also improved the prediction of other outcomes, including ASCVD (
c
statistic +0.035), myocardial infarction (+0.023), stroke (+0.024), aortic stenosis (+0.015), heart failure (+0.060), abdominal aortic aneurysm (+0.024), and dementia (+0.068).

CONCLUSIONS:
Measurement of targeted protein biomarkers produced superior prediction of aggregated and disaggregated cardiovascular events. This study represents proof of concept for the application of targeted proteomics in predicting a range of cardiovascular outcomes.
Unipolar Voltage Mapping to Predict Recovery of Left Ventricular Ejection Fraction in Patients With Recent-Onset Nonischemic Cardiomyopathy
Authors: Chaumont Corentin , Peyster Eliot G. , Siontis Konstantinos C. , Muser Daniele , Kapa Suraj , Markman Timothy M. , Pathak Rajeev K. , Oraii Alireza , Rodriguez-Queralto Oriol , Anselme Frederic , Margulies Kenneth B. , Marchlinski Francis E. , Frankel David S. 
Published: November 2024

BACKGROUND:
The ability to predict recovery of left ventricular ejection fraction (LVEF) in response to guideline-directed therapy among patients with nonischemic cardiomyopathy is desired. We sought to determine whether left ventricular endocardial unipolar voltage measured during invasive electroanatomic mapping could be used to predict LVEF recovery among those with recent-onset nonischemic cardiomyopathy.

METHODS:
We analyzed the left ventricular voltage maps of patients included in the eMAP trial (Electrogram-Guided Myocardial Advanced Phenotyping; NCT03293381), a prospective, nonrandomized, interventional trial conducted at 2 institutions between 2017 and 2020. Patients had recent-onset nonischemic cardiomyopathy defined by LVEF ≤45% and development of symptoms or signs of heart failure within the past 6 months. Detailed voltage maps of the left ventricular endocardium were generated using the Carto electroanatomic mapping system. Abnormal unipolar amplitude was defined as <8.27 mV. The primary end point was recovery of LVEF (Recovery) defined by a 1-year LVEF ≥50% or ≥45% with ≥10% increase from baseline.

RESULTS:

Of the 29 enrolled patients (median age, 49 years [25th percentile, 39; 75th percentile, 59], 8 females [27.6%]), LVEF recovered in 13 (44.8%) by 1-year follow-up. The percentage of total endocardial surface area with unipolar voltage abnormality (AUA) was significantly lower among Recovery patients than No Recovery patients (18.2% [25th percentile, 6.4; 75th percentile, 22.4] versus 80.0% [25th percentile, 29.5; 75th percentile, 90.9];
P
=0.004). Percent AUA was associated with lower likelihood of Recovery (odds ratio, 0.64 per 10% increase in AUA; 95% CI, 0.47–0.88;
P
=0.006). A 28% cutoff value for percent AUA was 92% sensitive and 75% specific with an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.63–0.99;
P
=0.001) for predicting recovery versus no recovery. The majority of patients (12 of 13; 92.3%) with a percent AUA >28% did not recover.

CONCLUSIONS:
Left ventricular unipolar voltage abnormality is a potent predictor of LVEF recovery among patients recently diagnosed with nonischemic cardiomyopathy. Detailed left ventricular unipolar voltage mapping could therefore be used as a valuable prognostic tool in guiding treatment decisions.
Left Ventricular Hypertrophy in Women With a History of Preeclampsia
Authors: Hauge Maria G. , Damm Peter , Kofoed Klaus F. , Møller Emma Louise Ries , Lopez Andrea G. , Ersbøll Anne S. , Johansen Marianne , Sigvardsen Per E. , Pham Michael H.C. , Goetze Jens P. , Fuchs Andreas , Kühl Jørgen T. , Nordestgaard Børge G. , Køber Lars V. , Gustafsson Finn , Linde Jesper J. 
Published: November 2024

BACKGROUND:
As a hypertensive disorder of pregnancy, preeclampsia is associated with increased cardiovascular morbidity and mortality later in life. Since early signs of myocardial affection could indicate a higher risk of future cardiovascular disease manifestations, we investigated whether women with prior preeclampsia have a higher prevalence of left ventricular hypertrophy compared with women from the general population and to what extent chronic hypertension affects any potential difference.

METHODS:

In a cohort study, women aged 40 to 55 years with prior preeclampsia were compared with age- and parity-matched women from the general population. They underwent a research cardiac computed tomography, and the primary outcome was left ventricular hypertrophy, defined as a left ventricular mass index >30 g/m
2.7
.

RESULTS:

In 679 women with prior preeclampsia and 672 controls (median age, 47 years), we found a higher prevalence of left ventricular hypertrophy (14.0% versus 6.4%) in the preeclampsia group with an odds ratio of 1.62, 95% CI (1.07–2.46),
P
=0.024, median of 15 years (range, 0–28) after pregnancy, after adjustment for cardiovascular risk factors, including chronic hypertension. Left ventricular hypertrophy was more frequent among women with preeclampsia with (26.2% versus 15.6%) and without (5.5% versus 2.4%) chronic hypertension, and a mediation analysis showed that chronic hypertension explained 22% of the association between preeclampsia and left ventricular hypertrophy.

CONCLUSIONS:
Women with prior preeclampsia had a 2-fold higher prevalence of left ventricular hypertrophy compared with women from the general population, and preeclampsia was independently associated with left ventricular hypertrophy, regardless of the presence of cardiovascular risk factors, including chronic hypertension.

REGISTRATION:

URL:
https://www.clinicalTrials.gov
; Unique identifier: NCT03949829.