bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4141106: AIR-TELTEC-HF Medical Expert System: a new rule-based tool of Intelligent Telemedicine for Chronic Heart Failure
Authors: Vianello Annamaria , Olivelli Martina , Donati Massimiliano , Fanucci Luca , Bechini Alessio , Petrucci Ilaria , MASI STEFANO 
Published: November 2024

Background:
Medical expert systems (MES) proceed on a “knowledge base” of clinical variables linked together by a set of rules written by medical experts. The
main
goal of our multidisciplinary team of medical experts and knowledge, information engineers was to create an “intelligent telemedicine” able to improve outcomes through early detection of clinical instability in patients with chronic heart failure (CHF) and multimorbidity.

Methods:
General Practitioners (GP) and Internal Medicine Specialists designed the "knowledge base" including 30 variables and 283 IF/THEN rules. Variables were: vital signs and symptoms, antropometric, age, sex, pharmacological, clinical and instrumental values of heart and renal failure, indices of cardiovascular comorbidities and other comorbidities determining cardiac and/or renal deterioration. A set of hierarchically organized rules identify: 1) the risk class at the time of enrollment, 2) the global risk, continuously updated from self-measurement data and clinical surveys, 3) the most appropriate monitoring plan (Fig.1).

Medical experts provided 8 plans (Fig.2a) for CHF patients, according to their global risk of worsening heart failure (WHF). The higher intensity of monitoring was assigned to all cases the MES was not able to handle.

Results:
AIR-TELTEC-HF MES underwent a first validation on 66 clinical cases, comparing its output vs the expected monitoring defined by medical experts. All cases with clinical instability and WHF (n° 18) were correctly assigned by the MES to the highest intensive monitoring plan. Overall, in 56 cases there was agreement between human expert and MES, leading to an F1-Score of 84% (Fig.2b).

Conclusions:
Our AIR-TELTEC-HF MES prototype for “intelligent telemedicine” reproduces the work of an expert medical team in telemonitoring settings. This prototype can be further improved involving other leading HF experts to enhance the clinical rules for many other cases of CHF and multimorbidity.

It is easy-of-use and explainable enough to assist GP in clinical practice, and to facilitate multidisciplinary clinical discussion on complex patient with CHF and multimorbidity. Using MES for student training would increase the future accuracy in following CHF patients.
Thanks to an appropriate monitoring of the initial phase of WHF, we would have a sensible decrease in hospitalizations. Moreover AIR-TELTEC-HF MES could be integrated with other MES, clinical records, and information systems to exchange data.
Abstract 4141821: Genotype and Family History as Risk Markers of Sudden Cardiac Death in Hypertrophic Cardiomyopathy
Authors: Sakhnini Ali , Montazeri Mahdi , Chow Cindy , Silver Josh , Saha Sudipta , Chan Raymond , Gollob Michael , Fan Steve , Rowin Ethan , maron Martin , Rakowski Harry , Adler Arnon 
Published: November 2024

Introduction:
The role of genotype in sudden cardiac death (SCD) risk stratification in hypertrophic cardiomyopathy (HCM) patients is unclear. Whether family history of SCD (FHxSCD) is independently associated with SCD after correction for genotype has never been investigated.

Methods:
This observational cohort study included HCM patients who had genetic testing at Toronto General Hospital or Tufts Medical Center. FHxSCD was defined as unexplained SCD before the age of 40 or due to HCM in a first-degree family member. SARC+ was defined as the identification of a (likely) pathogenic variant in a sarcomeric gene. The combined SCD outcome included SCD, resuscitated cardiac arrest (rCA), or appropriate ICD therapy.

Results:
The study included 3258 patients [2142 (65.7%) male, 896 (27.5%) SARC+]. Over a median follow-up of 5 years (IQR 1.9–9.6), 114 (3.5%) experienced a SCD outcome (10 SCD, 27 rCA, and 77 ICD therapies).

Both FHxSCD and SARC+ were independently associated with SCD, with hazard ratios of 1.97 [1.26-3.10, P = 0.003] and 1.73 [1.15-2.59, P = 0.008], respectively (Fig. 1). Among patients with FHxSCD but no other risk markers, the cumulative proportion of SCD was 7.8% and 9.8% at 5 and 10 years in SARC+ patients, but only 2.6% and 4.6% in SARC- patients (Fig. 2).
Adding genotype to the HCM SCD risk calculator resulted in a net reclassification index of 0.162 (0.046–0.285). Compared with the original model and using a 6%/5-year cutoff, the new model identified 8 more patients with events as high-risk but also an additional 4 patients without events.

Conclusion:
In our cohort, both FHxSCD and genotype were independently associated with SCD outcomes. In patients with FHxSCD as the sole risk marker, the risk of SCD is significant (>6%/5 years) in SARC+ patients but not in SARC- patients. Adding genotype to the HCM SCD risk calculator improves its ability to discriminate between patients at high and low risk.
Abstract 4142413: Left-Sided and Right-Sided Composite Advanced Hemodynamic Metrics for Prognostication in Heart Failure
Authors: Obaoye Joanna , Randazzo Michael , Kanelidis Anthony , Cochran Matthew , Acosta Mary , Sipiora Justin , Poonawalla Maria , Siddiqi Umar , Hoang Ryan , Belkin Mark , Grinstein Jonathan 
Published: November 2024

A complete invasive hemodynamic assessment, including both standard and advanced hemodynamic parameters improves risk stratification in patients with heart failure. Specifically, the novel advanced hemodynamic parameters, aortic pulsatility index (API) and cardiac power output (CPO), have shown robust prognostic potential in patients with cardiogenic shock and advanced heart failure. However, the incremental benefit of a simultaneous utilization of composite advanced hemodynamic parameters across the spectrum of left- and right- sided dysfunction currently remains unknown.
We performed a retrospective study of all patients with heart failure undergoing isolated right heart catheterization at our institution from 2013 to 2019. API, pulmonary artery pulsatility index (PAPI), as well as right and left ventricular CPO (RV-CPO, LV-CPO, respectively) were measured; RV CPO = (mPAP - RAP) * CO / 451. The primary outcome was freedom from left ventricular assist device (LVAD), orthotopic heart transplant (HT), and death at 24 months. Kaplan-Meier analyses were conducted based on previously determined cutpoints from receiver operator characteristic curve analysis.
A total of 709 patients were included (60 ± 14 years, 46% women, and 40% ischemic cardiomyopathy). There were 297 (42%) primary events in this cohort over 24 months: 46 LVAD, 38 HT, and 213 deaths. The left-sided parameters (API and LV-CPO) proved the primary drivers of the diversion in outcomes in all analyses (p <0.05). RV-CPO showed additional risk stratification when combined with either API or LV-CPO analyses, but only in patients with normal-range values (i.e. API ≥1.45 and LV CPO ≥0.64, p<0.05). No other composite markers showed prognostic significance (Figure).
Prognosis at 24 months for patients with heart failure was most sensitive to left-sided advanced hemodynamic parameters (i.e. API and LV-CPO), though RV-CPO, a right sided parameter, provided some additional prognostic benefit in those with a normal left-sided parameter.
Abstract 4143004: A Stepwise Approach to Identifying and Assessing the Content Validity of Patient-Reported Outcome (PRO) Measures for Use with Adults with Acute Heart Failure
Authors: OConnor Meaghan , Loughlin Anita , Waldman Laura , Rucker Sloan , Vaghela Shailja , Kwon Namhee , Sikirica Vanja 
Published: November 2024

Different patient-reported outcome (PRO) measures have been used and validated in studies of patients with heart failure (HF), including disease-specific measures like the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ). However, there is limited research available regarding the content validity (i.e., comprehensiveness, relevance, and comprehensibility) of those measures specifically as it relates to patients with acute HF (AHF).
This study used a stepwise approach to identify PRO measures used in AHF studies and evaluate their content validity through a landscape analysis, concept mapping, and cognitive debriefing (CD) interviews with US-based patients.
A landscape analysis was performed to identify PRO measures used in AHF studies. To assess concept coverage, items in each PRO measure were mapped to concepts (i.e., signs/symptoms and impacts on daily life) from the AHF conceptual model developed by Moshkovich et al. (2020). PRO measures with the most comprehensive and/or appropriate concept coverage were further evaluated through CD interviews with US adults who had been hospitalized for AHF within the last six months.
The landscape analysis resulted in the identification of 15 PRO measures for use in AHF; nine were deemed appropriate for concept mapping. Following mapping, four measures were selected for further research based on their comprehensive concept coverage (KCCQ, PROMIS®+HF-27), effectiveness at measuring health utility (EQ-5D-5L), and suitability for measuring shortness of breath (a dyspnea numeric rating scale [NRS]). The KCCQ, in particular, showed good concept coverage, addressing more than half (n=12) of the key concepts in the Moshkovich et al. (2020) model. Twenty adults with AHF, representing NYHA classes I (n=4), II (n=8), and III (n=8), a mean age of 64 years (range: 39-81), and an average of 110 days since hospitalization (range: 26-183), participated in CD interviews. Participants found each measure easy to understand and answer, with items relevant to their experience of AHF. Participants found the recall periods, ranging from 24-hours to 2-weeks, appropriate and easy to use.
This study’s stepwise approach allowed for the systematic identification and evaluation of the content validity of four PRO measures—the KCCQ, dyspnea NRS, EQ-5D-5L, and PROMIS®+HF-27—for use with adults with AHF. This research fills a gap in the current published literature regarding measures appropriate for use with adults with AHF.
Abstract 4143351: Early experience with percutaneous insertion of pulmonary blood flow restrictors to allow deferral of Norwood surgery
Authors: Prasanna Anagha , Fox Jeremy , Tannous Paul , Ohalloran Conor , Eltayeb Osama , Monge Michael , Nugent Alan , Allen Kiona , Berger Stuart , Winlaw David 
Published: November 2024

Deferral of the Stage 1 Norwood Palliation (S1P) for infants with hypoplastic left heart syndrome and other high-risk features is sometimes accomplished using a hybrid approach involving external pulmonary artery (PA) banding. Recently, percutaneous restriction of pulmonary blood flow has been accomplished with off-label modification of microvascular plugs (Medtronic) to delay surgical intervention.
This single-center, retrospective case series examines outcomes associated with PA flow restrictors in patients at both high and standard-risk for S1P. High-risk criteria included prematurity, birth weight less than 2.5 kg, moderate or greater atrioventricular valve regurgitation, highly restrictive atrial septum, and genetic comorbidities. Primary outcomes included death, need for extracorporeal membrane oxygenation (ECMO), PA re-intervention, and variation from expected pathway post bidirectional Glenn (BDG), which includes prolonged intubation (>24 hours), persistent hypoxia (saturation <75%), or prolonged hospital length of stay (>14 days).
From September 2023 to May 2024, bilateral PA flow restrictors were placed in 9 S1P-eligible neonates (Table 1). Two patients died with flow restrictors before S1P. One patient developed progressive heart failure and underwent a successful heart transplant after having PA flow restrictors in place for 200 days. The remaining 6 patients had a S1P operation with removal of flow restrictors and PA plasty at a median of 21 days post insertion and 25 days of life. Three patients required PA stents between S1P and BDG. Four patients have progressed to Glenn, all of whom had courses that significantly varied from the expected pathway, including 2 who required early PA stenting, 4 who had prolonged hospital stays, and 1 patient who died of multiorgan failure due to failed BDG circulation.
Flow restrictors can delay surgical S1P in high-risk patients, allowing for evaluation of additional comorbidities. They are a useful adjunct to the management of high-risk patients prior to S1P. However, their use appears to be associated with an important rate of PA complications, resulting in significant variation from the expected clinical course and may impact later quality of BDG circulation.
Abstract 4143488: POCUS Guided Diuresis in Acute Decompensated Heart Failure – Quality Improvement in the Cardiac Care Unit
Authors: Pargaonkar Sumant , Sunil Kumar Sriram , Chen Yi-Yun , Borkowski Pawel , Flatow Elie , Satish Vikyath , Brown Donclair , Kharawala Amrin , Maliha Maisha , ZOUMPOURLIS PANAGIOTIS , Adhikari Anurag , Garg Vibhor , GAshi Eleonora , Faillace Robert 
Published: November 2024

Background:
Patients with acute decompensated heart failure (ADHF) often require admission to the Cardiac Care Unit (CCU). Clinical examination alone may be inadequate for management, leading to suboptimal diuretic regimens and prolonged hospital stays. The use of Point-of-care ultrasound (POCUS) to evaluate the lungs for pulmonary edema and inferior vena cava (IVC) for size and collapsibility can enhance volume status evaluation.

Aim:
Reduce the average duration of IV diuresis by 20% among patients admitted to the CCU for ADHF in 1 year

Methods:
An algorithm for POCUS guided diuretic regimen escalation was implemented across three Plan-Do-Study-Act (PDSA) cycles. Patients who were intubated, on dialysis, or with isolated RV failure were excluded. PDSA-1 introduced the algorithm and provided training to a team of 5 residents. PDSA-2 included weekly reminders and recruitment of 14 residents to increase buy-in. PDSA-3 focused on incorporating POCUS assessments into nighttime care to facilitate early morning decision-making.

Results:
Process Measure: Quarterly compliance rates using the number of POCUS orders that were completed- Baseline (0%, n=23), PDSA-1 (0%, n=35), PDSA-2 (19%, n=15), PDSA-3 (31%, n=46).

Outcome Measure: The average duration of IV diuresis progressively decreased through the year: Baseline (5 days), PDSA-1 (5.3 days), PDSA-2 (4.4 days), PDSA-3 (3.5 days). There was an increase of 6% in PDSA-1 compared to baseline, but PDSA-2 and 3 showed a progressive reduction of 12% and 30% respectively.
Balancing Measure: The mean potassium supplementation showed variation throughout the year: Baseline (63.3 mg), PDSA-1 (141 mg), PDSA-2 (151.7 mg), PDSA-3 (75.7 mg), reflecting no significant negative impact from the intervention.
Equity Lens: The duration of IV diuresis, which at baseline ranged from 3 to 8 days across different races, standardized to approximately 5 days for all races by PDSA-3.

Conclusion:
We progressively reduced the duration of IV diuresis using POCUS-guided lung and IVC assessments with a structured diuretic regimen. This demonstrated improved patient care from early decongestion and symptomatic relief. Additionally, we demonstrate that POCUS plays a crucial role in promoting health equity by providing an objective assessment of volume status across diverse racial groups. This integration promises optimized heart failure management and potential cost reductions from reduced length of stay, highlighting the value of POCUS in clinical practice.
Abstract 4143638: Donation After Circulatory Death in Pediatric Heart Transplant Recipients: A Lost Opportunity for Donor Pool Expansion
Authors: Shikhare Anuja , Vaidya Gaurang , Aquino Liliam , Cocalis Mark , Aljohani Othman 
Published: November 2024

Background:
Donation after circulatory death (DCD) is underutilized in pediatric heart transplant (HTx).

Methods:
UNOS database was analyzed for HTx with reported DCD donors (1/2020-4/2024). Data is reported as median (interquartile range). Multiorgan and retransplant recipients were excluded from outcome analysis.

Results:
The youngest DCD heart donor was <1 year old and the median age was 15 years. During the study period, 86 (4%) pediatric donors were DCD. However, in terms of pediatric recipients, DCD accounted for only 12 (0.9%) of the total pediatric HTx. The remaining pediatric DCD donors (74) were assigned to adult recipients. In the same period, all DCD donors accounted for 10% of adult HTx.

The pediatric donor cohort was subdivided into 4 categories based on the recipient's age-group and whether the donor was DCD or not (table 1). Pediatric DCD hearts were allocated to lower priority listed recipients and those with blood group O (in both pediatric and adult recipients). Despite this, the total waitlist time was shorter among DCD recipients, suggesting the potential role of DCD to lower wait times. Distance travelled between donor to transplant center can be longer with DCD due to the use of a different organ care system. Table 1 summarizes the findings.
Few UNOS regions (4, 5, 10, 11) are using pediatric DCD hearts for pediatric recipients (figure A). For outcome analysis, adult recipients who received pediatric DCD hearts were compared to those who received pediatric non-DCD hearts. No difference was noted in the one-year survival (figure B).

Conclusion:
Pediatric DCD heart for pediatric recipients represents an unexplored strategy for donor pool expansion.
Abstract 4143977: Cardiovascular Toxicities in Chimeric Antigen Receptor Therapy in Relapsed and Refractory Multiple Myeloma and Lymphoma using FAERS database.
Authors: Ayoobkhan Fathima Shehnaz , Parvataneni Tarun , Balasubramanian Suryakumar , Ganiyani Mohammad Arfat , Reddy Matta Temujin 
Published: November 2024

Introduction:
Chimeric Antigen Receptor T-cell therapy (CAR-T) has revolutionized the treatment of relapsed refractory multiple myeloma (RRMM) and lymphoma over the past decade. Our objective is to examine the incidence, patterns, and outcomes of cardiac events in patients with RRMM and lymphoma who are receiving CAR-T therapy, utilizing the FDA Adverse Event Reporting System (FAERS) database.

Methods:
We employed the FDA Adverse Event Reporting System (FAERS) database and the Medical Dictionary for Regulatory Activities (MEDRA) to conduct a retrospective post-marketing pharmacovigilance inquiry. We analyzed the incidence of cardiac events associated with six CAR-T products, namely Idecabtagene vicleucel, Cilitacabtagene autoleucel, Axicabtagene ciloleucel, Tisagenlecleucel, Lisocabtagene maraleucel, and Brexucabtagene autoleucel, since their FDA approval (accessed 05/01/2024). We assessed the cardiotoxicities such as coronary artery disease (CAD), myocardial infarction (MI), arrhythmia, heart failure, and hypotension.

Results:
A total of 12,949 adverse events, including Axicabtagene ciloleucel (n=6222, 48%), Brexucabtagene autoleucel (n=1127, 8.7%), Tisagenlecleucel (n=3290, 25.4%), Lisocabtagene maraleucel (n=463, 3.5%), Idecabtagene vicleucel (n=722, 5.5%), and Cilitacabtagene autoleucel (n=1125, 8.6%). Of those, 675 cases (5.2% of the total) that were related to cardiac events, regardless of their severity. The cardiotoxicity incidence was highest in Brexucabtagene autoleucel (n=85,7.5%), followed by Idecabtagene vicleucel (n=50,6.9%), Tisagenlecleucel (n=208,6.3%), Axicabtagene ciloleucel (n=278,4.5%), Lisocabtagene maraleucel (n=17,3.6%), and Ciltacabtagene autoleucel (n=37,3.2%).

Cytokine release syndrome (CRS) is linked to nearly 440 cardiac events,accounting for 65% of all cardiac events.
The most prevalent cardiotoxic event was Atrial Fibrillation (122), followed by the development of heart failure (113), Ventricular arrhythmia (108), hypotension (87), and Brady arrhythmia (41).
The recipients of Brexucabtagene autoleucel had the highest mortality rate (n = 26,2.3%), followed by those receiving Tisagenlecleucel (n = 71,2.1%) and Lisocabtagene maraleucel (n = 10,2.1%).

Conclusion:
The cardiotoxic properties of CAR-T therapy can lead to fatal adverse events. Improving outcomes and preventing mortality in these populations can be achieved through timely monitoring.
Abstract 4144928: Association between Congenital Heart Disease and the Risk of Cancer and its subtypes.
Authors: Jaiswal Vikash , Hanif Muhammad , Jaiswal Akash , Sundas FNU , Gimelli Alessia , Grubb Kendra 
Published: November 2024

Background:
Relationship between congenital heart disease and the risk of cancer and its subtypes is not well understood.

Objective:
This study aim to investigate the association between CHD and risk of cancer and its subtypes among adult patients.

Method:
The TriNeTX research database was used to identify patients aged ≥18 years of age from January 2000 to January 2021. Patients were categorized into two groups, one with CHD and another without CHD group of patients. Patients were followed for 1 and 3 years respectively. Propensity score-matched analysis (PSM) (1:1) was performed on demographics and comorbidities such as hypertension and diabetes mellitus. The primary outcome was cancer risk, while secondary outcomes were breast cancer, thyroid cancer, skin cancer, gastrointestinal tract cancer (GI), lung cancer, and brain tumors.

Results::
After 1:1 propensity score matching, the study cohort comprised 33,581 CHD patients and 33,581 non CHD patients. CHD patients were having a significantly higher risk of cancer after 1 year of follow-up (RR, 2.10 (95% CI: 1.764-2.515, P<0.001). A similar trend of higher risk of cancer was observed after 3 years of follow-up (RR, 1.63 (95% CI 1.436-1.851, P<0.001) when compared with the non CHD group of patients.

The risk of lung cancer was significantly higher among CHD groups of patients after 1 year of follow-up (RR, 1.44 (95% CI: 1.024-2.049), P=0.035), and after 3 year of follow-up (RR, 1.28 (95% CI: 1.018-1.630, P=0.034). Skin cancer were found significantly higher in CHD patients after 1 year of follow-up (RR, 1.42 (95% CI: 1.171-1.741), P<0.001), however, this became non-significant after 3 years of follow-up (RR, 1.05 (95% CI: 0.926-1.203, P=0.416).
On the other hand, the risk of brain tumors was comparable in both groups after 1 year of follow-up (RR, 1.60 (95%CI: 0.727-3.530), P=238). However, after 3 years of follow-up, the risk of brain tumor became significantly higher in CHD patients (RR, 2.73 (95% CI: 1.369, 5.449), P=0.003) when compared with non CHD group of patients.
In contrast, the risk of breast cancer, GI tumor, and thyroid cancers were comparable both after 1 year follow-up, and after 3 years of follow-up among both groups of patients.

Conclusion:
These findings suggest that CHD patients are at higher risk of having Cancer, specifically lung cancer, dermatological cancer, and brain tumors.