bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4139852: Plozasiran and Triglyceride Levels in Hypertriglyceridemia: Long-Term Efficacy and Safety Data From Subjects in an Open-Label Extension Trial
Authors: Ballantyne Christie , Watts Gerald , Rosenson Robert , Vasas Szilárd , Pall Denes , Clifton Peter , Nicholls Stephen , Azizad Masoud , Fu Ran , Muhsin Maan , Melquist Stacey , Hellawell Jennifer , Gaudet Daniel 
Published: November 2024

Despite current modestly effective triglyceride (TG) lowering therapies, the availability of more effective agents for persistently lowering elevated TGs and risk of acute pancreatitis remains a continuing need. More recently identified triglyceride-rich lipoproteins (TRLs), specifically remnant cholesterol (RC)-rich particles, are important drivers of ASCVD risk independent of LDL-C, driving development of more effective TG-directed therapies. Apolipoprotein C3 (APOC3) raises TGs by inhibiting lipoprotein lipase (LPL) dependent and -independent pathways. Plozasiran, a RNAi agent targeting APOC3 mRNA in hepatocytes, demonstrated large reductions in circulating APOC3, TGs, TRL-RC with a good safety profile in placebo-controlled trials.
Here we report extension data to characterize long term safety and efficacy of plozasiran in subjects with elevated TGs.

Plozasiran was studied in subjects with mixed hyperlipidemia (entry TGs 150-499 mg/dl) and severe hypertriglyceridemia (entry TGs
>
500-4000 mg/dl) in separate Phase 2 trials (MUIR and SHASTA-2). Subjects completing double-blind, placebo-controlled treatment could enter this open-label extension. Endpoints included changes in fasting TG levels, other lipid and lipoprotein parameters and safety assessments for up to 24 months. Data cut-off was 5/16/24 for this analysis, (up to 15 months of follow up) in the ongoing study.

251 and 165 subjects from MUIR and SHASTA-2 entered the extension in which all received plozasiran 25 mg SQ dosed quarterly. 10, 25 or 50 mg of plozasiran under blinded conditions produced mean reductions in TGs of -52 to -64% (MUIR) and -69 to -74% (SHASTA-2), 12 weeks (trough) after the second dose. Corresponding trough reductions in the extension ranged from -44 to -73% (MUIR) and -62 to -86% (SHASTA-2) through 15 months follow-up. Common reported AEs were consistent with the index studies and patient populations and mean HbA1c did not increase, providing further evidence that long-term safety remains favorable with repeated dosing and longer observation periods.
Extended open-label treatment with plozasiran in subjects with moderate to severely elevated TGs continue to show reductions of TG levels and safety consistent with the blinded index studies, demonstrating incidence rate and severity of TEAEs remain favorable with repeated dosing and longer observation. Results of additional lipid and lipoprotein parameters are also consistent with the blinded index data and will also be reported.
Abstract 4139853: Altering Cardiovascular Mortality in HFpEF with SGLT2i or ARNI — A Head-to-Head Analysis
Authors: Hariyanto Jesslyn , Veera Chirag , Lenzi Pinto Manoela , Chatterjee Anoushka , Eltawansy Sherif 
Published: November 2024

Background:
Therapeutic options for HFpEF are continuously evolving. The latest AHA guidelines recommend ARNI with a class 2B and SGLT2i with a class 2A for HFpEF. Trials indicate that both SGLT2i and ARNI can improve clinical outcomes, but the practical implications of these costly novel agents must be considered. In this study, we assessed the effects of ARNI and SGLT2 inhibitors on cardiovascular mortality in HFpEF patients.

Methods:
PubMed, Scopus, and Cochrane search identified RCTs comparing ARNI with Valsartan, ACEi, or placebo, and SGLT2i with placebo. The outcome was cardiovascular mortality, comparing ARNI and SGLT2i subgroups. Heterogeneity was assessed with I^2 statistics with a random-effects model.

Results:
We included 8 RCTs with 15212 patients. Four studies were included with 27.6% being females with an age range of 70.9 - 72.9 years. Follow-up ranged from 8 weeks to 41 months, and mean LVEF was 57.3 ± 8%. Pooled RR for cardiovascular mortality (0.71 [95% CI: 0.47-1.09], P = 0.11) indicated no significant reduction in risk, with moderate heterogeneity (I^2 = 48%, P = 0.12)

In four studies in the SGLT2i subgroup, the age range was 60 to 71.9 years, with an LVEF range of 45 - 61%, and 48.7% of the participants were female. One study found women were more likely to have EF >60% than EF ≤45%. Background medication of ARNI or RAAS inhibitors was continued. Follow-up time ranged from 26.2 months to 4.2 years. Pooled RR for cardiovascular mortality (0.94 [95% CI: 0.83-1.06], P = 0.30) showed no significant reduction in risk, with low heterogeneity (I^2 = 34%, P = 0.21)
Combining both ARNI and SGLT2i groups, the total number of patients was 15,212 for the treatment group and 12,426 for the control group. The overall pooled RR (0.91 [95% CI: 0.81-1.03], P = 0.13) suggested no significant difference in cardiovascular mortality, with low heterogeneity across all studies (I^2= 34%, P = 0.16) The test for subgroup differences between ARNI and SGLT2i was not significant (P = 0.22) with low heterogeneity (I^2 = 33.4%)

Conclusion:
In HFpEF, subgroup analysis showed no significant differences in cardiovascular mortality reduction between ARNI and SGLT2i. Further research should investigate additional clinical and functional endpoints, considering the cost-effectiveness of these treatments.
Abstract 4140291: Unraveling the potential receptors involved in mediating globular CTRP9's protective effects in the cardiovascular system
Authors: Wyatt Kayleigh , Tan Huilan , Wu Yalin , Shila Taslima Akter , Mahmoud Amr , liu yanwen , Ma Xinliang-Xin , Zhao Jianli , Wang Yajing 
Published: November 2024

Improved reperfusion strategies have significantly reduced mortality rates after acute myocardial infarction. However, chronic heart failure cases are rising. Cardiokines and adipokines, as paralog family members, share similarities in multiple aspects and play critical roles in protecting against heart failure by blocking its progression. It has been debated and remains elusive whether the CTRP family has its own receptors or shares them with other family members during disease conditions. Our previous research has indicated that globular CTRP9 (gCTRP9) plays a vital role in protecting the cardiovascular system by promoting cell proliferation and energy production in ischemic-injured hearts. However, the signal transduction mechanisms are not yet fully understood.
To address this gap in knowledge, we aimed to identify the potential cell membrane receptor for CTRP9 by analyzing the interaction between CTRP9 and three candidate receptors, namely Cadherin-13, adiponectin receptor 2, and adiponectin receptor 1. We utilized Surface Plasmon Resonance to examine the binding specificity, kinetics, and affinity of CTRP9 at a concentration of 50 µg/ml with varying levels of Cadherin-13 and Adiponectin Receptor 1, ranging from 0.1 to 100 µg/ml.
Our results showed that gCTRP9 exhibited saturation on the carboxyl chip, indicating its ability to bind to specific mobile receptors on the surface. Notably, we observed a significant binding affinity between CTRP9 and Adiponectin Receptor 1 in a dose-dependent, suggesting a stronger interaction between Adiponectin Receptor 1 and CTRP9. In contrast, Cadherin-13 also exhibited some binding affinity with CTRP9, although the response was comparatively lower. Importantly, no binding signals were detected between CTRP9 and Adiponectin Receptor 2.
In conclusion, our study provides evidence that Adiponectin Receptor 1 is a potential cell membrane receptor for gCTRP9, playing a crucial role in transmitting signals that protect injured or diabetic cardiomyocytes. Further research is needed to fully understand the downstream signaling pathways and mechanisms by which gCTRP9 and Adiponectin Receptor 1 interact to exert their protective effects on the cardiovascular system.
Abstract 4140472: Promotores De Salud: An Essential Workforce in Enhancing Hypertension Health Knowledge in Puerto Rico
Authors: Patel Janak , Arowolo Mide , Cosme Pitre Carmen , Scanlin Kathleen , Vargas Alizenet , Wagner Ashley , Sanchez Eduardo 
Published: November 2024

Introduction:
Hypertension (HTN) is a major risk factor for cardiovascular disease, and its prevention and management are influenced by health knowledge. This paper reviews the findings of a community-based HTN health knowledge program in Puerto Rico, facilitated by Community Health Workers (CHWs), also known as Promotores de Salud, who maintain a close relationship with their communities.

Hypothesis:
CHWs will positively impact a community’s HTN health knowledge and self-reported confidence in making lifestyle/behavior modifications with the use of Empowered to Serve (ETS) Health modules.

Methods:
American Heart Association (AHA) partnered with One Stop Career Center, a community-based organization in Puerto Rico. The program utilized AHA ETS modules focused on HTN prevention and management. CHWs instructed and implemented these modules across 10 community-based settings from 09/20/23 to 12/26/23. Participants were given a multiple-choice survey before and after each module. Descriptive Analysis and Two Proportion Z Test was performed on the surveys.

CHWs also conducted a community discussion, distributed blood pressure devices, and referred participants to a self-measured blood pressure program.

Results:
The total count for pre-surveys was 214 and post-surveys was 224. Majority of participants identified as female (67.9% female) and Hispanic (95.2%), with 46.4% completed high school or less.

Comparing pre- and post-surveys, confidence scores improved in monitoring blood pressure at home (41.0%, n/N=34/83 to 68.5%, n/N=61/89; p value=<0.001) , lifestyle changes to manage blood pressure (35.4%, n/N=29/82 to 73.0%, n/N=65/89; p value=<0.001), reading a nutrition label (40.2%, n/N=51/127 to 69.9%, n/N=95/136; p value=< 0.001), using spice alternatives when cooking (60.6%, n/N=77/127 to 80.7%, n/N=109/135; p value=<0.001), and reducing processed foods (36.5%, n/N=46/126 to 68.4%, n/N=93/136; p value=<0.001).
Graph 1 contains the results of 4 knowledge-based questions.

Conclusions:
The data suggest that the CHWs, with the use of ETS modules, might play an important role in enhancing HTN health knowledge and improving confidence to support lifestyle/behavior modifications within Puerto Rican communities.
Abstract 4140759: Clinical Outcomes Of SGLT2 Inhibitors In Patients Hospitalized With Acute Heart Failure: A Meta-analysis Of Randomized Control Trials
Authors: Gupta Soumya , Thakkar Aditya , Koh Won-joon , Choi James , Hart Hannah , Mahmood Kiran 
Published: November 2024

Introduction:
Acute heart failure (AHF) presents challenges due to its poor prognosis and limited therapeutic options compared to chronic heart failure (CHF). The potential benefits of SGLT2 inhibitors in AHF patients are being explored, yet systematic evaluation is lacking. Our meta-analysis aims to bridge this gap by comparing the efficacy and safety of SGLT2 inhibitors versus placebo in AHF patients.

Research question:
Clinical Outcomes Of SGLT2 Inhibitors In Patients Hospitalized With Acute Heart Failure

Methods:
We searched Medline, Embase, and Cochrane databases for randomized controlled trials involving adult patients hospitalized with AHF, who received SGLT2 inhibitors. Our primary outcomes were all-cause mortality, heart failure events, and readmissions. The secondary outcomes were change in KCCQ-TSS (Kansas City Cardiomyopathy Questionnaire), weight, length of stay and NT-proBNP levels. Safety outcomes included hypotension, hypoglycemia, UTI, DKA, and acute renal failure. We used Review Manager 5.4 for statistical analysis, employing standardized mean difference (SMD) and risk ratio (RR) with 95% confidence intervals (CI).

Results:
Seven RCTs were included, involving a total of 2321 patients, with 49.5% receiving SGLT2 inhibitors. Patients receiving SGLT2 inhibitors showed a significant reduction in the risk of readmissions by 32% (RR = 0.68, p < 0.00001). They also showed a non-significant but reduced risk of all-cause mortality by 24% (RR = 0.76, p = 0.04), and heart failure events by 27% (RR = 0.63, p = 0.09).

With respect to the secondary outcomes, there was a significant reduction in KCCQ-TSS (SMD= -0.17; 95% CI: -0.26 to -0.08; p=0.004) and weight (SMD= -0.34; 95% CI: -0.55 to -0.13; p=0.002) in the intervention group as compared to the placebo group. This group was also associated with a non-significant but reduced length of stay (SMD= -0.01; 95% CI: -0.20 to -0.18; p=0.90) and NT-proBNP levels (SMD= -0.06; 95% CI: -0.29 to -0.17; p=0.61).
On analysis of the safety outcomes, there was a non significant difference in the risk of acute renal failure, UTI, and DKA.

Conclusion:
In patients with AHF, initiation of SGLT2 inhibitors showed a statistically significant reduction in heart failure rehospitalizations, improved weight-based diuretic efficiency, and KCCQ-TSS. These findings suggest that starting SGLT2 inhibitors in patients hospitalized for AHF is well tolerated and leads to clinical benefits.
Abstract 4141518: Disparities in Associations Between Migraine and Cardiovascular Events: A Cross Sectional Cohort Study in the Veterans Health Administration
Authors: Seng Elizabeth , Schwartz Alexandra , Lipton Richard , Ezzti Ali , Sico Jason 
Published: November 2024

The extent to which migraine is associated with cardiovascular events may differ across age, gender, racial and ethnic subgroups.
The current study uses the migraine cohort from the Headache Centers of Excellence VHA Headache Cohort. Migraine cases include veterans who had an International Classification of Disease-9/10 code of migraine in the VHA electronic health record between 2008-2023. Controls had no headache ever coded in their VHA electronic health record, and were matched on age, gender, race, ethnicity, and point of care the year of cohort entry (defined as the first year in which headache was diagnosed for the migraine group). Baseline cardiovascular events were extracted from the VHA electronic health record using validated algorithms from 6 months prior to cohort entry to 12 months following cohort entry. Separate logistic regression models evaluated the relationship between migraine vs. matched control and each cardiovascular outcome separately in the following subgroups: gender (men and women), age (18-49 and 50+), race (White and Black), and ethnicity (Non-Hispanic and Hispanic).
The cohort included 668,968 individuals with migraine and 1,337,937 non-headache controls. Overall, subgroup analyses found the strongest relationships between migraine (vs. matched control) and cardiovascular outcomes in younger adults (aged 18-49): ischemic stroke OR = 3.62, 95% CI = 3.33, 3.94; transient ischemic attack OR = 9.0, 95% CI = 7.65, 10.54; Notably, migraine was associated with higher odds of hemorrhagic stroke for younger adults (OR = 4.30, 95% CI =3.27, 5.66), but lower odds of hemorrhagic stroke in adults aged 50+ (OR = 0.28, 95% CI = 0.25, 0.31). An exception is acute myocardial infarction (MI), where the strongest relationship betwen migraine and acute MI was observed in adults aged 50+ (OR = 1.69, 95% CI = 1.57 1.83). Migraine (vs. matched control) was associated with slightly higher odds of heart failure among White patients (OR = 1.28, 95% CI = 1.23, 0.86), but slightly lower odds of heart failure among Black patients (OR = 0.92, 95% CI = 0.86, 0.9. ORs for cardiovascular events were relatively similar (e.g., within 1.0 OR) across gender, racial and ethnic groups.
This study shows that age is a particularly important factor in understanding the relationship between migraine and cardiovascular events.
Abstract 4142999: How many and which leads in ECG do you need to estimate a patient’s ejection fraction? A Deep Learning Approach.
Authors: Ku Tienhsiung , Chang Hao-Chun , Chiu Chih-Wei , Shih Dann-Pyng , Li Tzong-shiun , Tsai Ming-Tse 
Published: November 2024

Patients with heart failure (HF) can range from being asymptomatic to experiencing various combinations of symptoms. Left ventricular ejection fraction (EF), measured via echocardiography, is the primary tool to differentiate between different HF types and guide therapies. However, the availability of echocardiography varies geographically. In contrast, electrocardiograms (ECGs) are more common and easily accessible. In this study, we use a deep learning approach to correlate ECG readings with their corresponding EF. Low EF is defined as ≤ 35%.
Patients with the International Classification of Diseases codes for HF were screened retrospectively at Changhua Christian Hospital, Taiwan, from 2016 to 2022 with IRB approval. Only data comprising sex, age, a 10-second ECG record with a sampling rate of 500 Hz, and an echocardiography report obtained within 7 days after ECG acquisition were included. There were 3,508 samples (low EF: normal EF = 1,430:2,078) from 1,240 patients in the dataset. We reserved 10% of the samples as the final testing set (n=351) and split the remaining 90% randomly into the training and validation sets (n=2,525 and n=632) in a ratio of 8:2. A convolutional neural network was trained to classify input ECG lead(s) as either low or normal EF. For simplicity, the model with the lowest validation loss was selected and further evaluated on the final testing set.
There were 721 males and 519 females with a mean age of 70.47 (±14.59). We experimented with various combinations of limb and chest leads as input ECG data and used the validation set to assess their performance, as shown in Table 1. The model trained with leads V2, I, and II had the lowest validation loss and achieved 71.3% sensitivity, 88.6% specificity, and an AUC of 87.6% on the testing set.
With more information from multiple leads, a patient’s EF could be better predicted; however, the incremental benefits tapered off quickly. In our investigation, the best model was found by combining information from three leads: I, II, and V2. Our study discovered a pathway to ECG-based artificial intelligence applications and provided innovative insights into medical device design, which could benefit patients in under-resourced areas.
Abstract 4143001: Rapid Diuresis Protocol in Decompensated Heart Failure: Improving Guideline-Directed Medical Therapy Titration and Timely Outpatient Follow-up
Authors: Munoz Sherilyn , Habhab Mazin , Hollowell Matthew , Weber Paul , Crane Ryan , Bury Anastasia , Korn Morgan , Mitchell Nicole , gonzalez matthew 
Published: November 2024

Current guidelines for treating acute decompensated heart failure (ADHF) recommend inpatient intravenous diuresis until congestion relief, as well as the initiation and advancement of guideline-directed medical therapy (GDMT). Our institution has developed a rapid diuresis team (RDT) to expedite decongestion in hospitalized ADHF patients with the goal of safely reducing length of stay. This study examines the RDT’s potential impact on GDMT titration as well as outpatient follow up timing.
Does the RDT protocol improve GDMT titration and time to outpatient follow-up after discharge in patients with ADHF?
This retrospective single-center study includes patients undergoing inpatient treatment for ADHF from March 2022 to November 2023 at a tertiary referral center. Demographic, clinical, and laboratory data were obtained. Standard parametric and non-parametric analyses were conducted, along with Kaplan-Meier curve analysis, with statistical significance set at p<0.05. The RDT protocol involves early aggressive diuresis with daily monitoring of weight, fluid intake, and urine output. Aggressive diuresis goals (3-4 L/day urine output) were set and included regular assessments by a multidisciplinary team. Discharge criteria focus on resting symptom resolution, adequate oral diuretic response, and an established follow-up within 3-5 days where GDMT can be adjusted as needed.
Out of 255 patients, 128 underwent RDT and 127 received standard care. Patients in the RDT protocol had a shorter average time from hospital discharge to cardiology appointment (4 days vs. 5 days; p = 0.044). Additionally, those in the RDT protocol tended to have higher rates of follow-up within 30 days post-discharge (90% vs. 77%; p = 0.052) (Figure 1). GDMT titration prior to discharge was more common in the RDT group (93 vs. 74 patients; p = 0.025). At the follow-up visit, GDMT titration was also more frequent in the RDT group (55 vs. 43 patients; p = 0.207).
Compared to standard care, the RDT protocol results in a shorter time to outpatient follow-up and improved inpatient and outpatient GDMT titration for the treatment of heart failure. The implementation of the RDT protocol appears to enhance the management and outcomes of patients with ADHF.
Abstract 4143074: Left Atrial Stiffness in Patients with Cryptogenic Ischemic Stroke
Authors: Hernandez del Rio Jorge Eduardo , Miranda - Aquino Tomas , Gonzalez-Padilla Christian , Lomeli Sanchez Oscar , Ochoa Castillo Daniel , Alonso Diaz Daniela Alejandra , Gloria Valencia Natalia 
Published: November 2024

Introduction:
Atrial fibrillation (AF) is a risk factor for the development of ischemic stroke. Left atrial (LA) function has been described as a predictor of AF, however, atrial stiffness has been little studied.

Objectives:
To determine if there is a difference in left atrial stiffness between patients with ischemic stroke who presented AF and those who did not, the association of stiffness with AF and the stiffness cut-off points.

Methods:
An analytical, cross-sectional, single-center study was conducted. Patients older than 18 years with a diagnosis of cryptogenic ischemic stroke who were in sinus rhythm, had no history of atrial fibrillation and underwent an echocardiogram and a 24-hour rhythm Holter during hospitalization were included in the study.

The echocardiograms were performed using a Siemens ACUSON SC 2000 machine with a 2.5 MHz sectorial 4v1c transducer. The reservoir LA strain (LASr) was determined using the VVI technique. The left atrial stiffness was obtained through the ratio E/e’ between the LASr.
Variables were analyzed using chi-square or Student's t-test. ROC curves were used to determine the cutoff points for predicting AF. The association of variables with the development of AF was analyzed using logistic regression.

Results:
A total of 96 patients were obtained, of which 35 had documented AF, 16 women and 19 men. Two groups were formed, Group 1: patients with ischemic stroke and AF (35), Group 2: with ischemic stroke without AF (61), which were used as control (Table 1). Among patients with AF, we found they were older and had a higher prevalence of diabetes mellitus, higher E/e' value, LA indexed volume, and greater LA stiffness as well as lower LASr values. LA stiffness (>0.29) and LASr (<36%) were the best predictors of AF in the ROC curves (Image 1) . The association with the development of AF found that LA stiffness was significant in both univariate and multivariate analyses (Table 2).

Conclusion:
The stiffness of the left atrium is an easy-to-determine echocardiographic parameter that allows us to predict the presence of atrial fibrillation in patients with an ischemic cerebrovascular event who should have a greater intentional search for atrial fibrillation.