bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4144953: Prognostic Value Of sST2 Added To Mosaic Loss Of Y Chromosome As A Fibrosis-Related Disease-Specific Biological-Genomic Marker In Aortic Valve Stenosis
Authors: Mas-Peiro Silvia , Rasper Tina , Berkowitsch Alexander , Speer Thimoteus , Dimmeler Stefanie , Zeiher Andreas 
Published: November 2024

Background:
Risk stratification in severe aortic valve stenosis (AVS), even after contemporary TAVR therapy, is a significant unmet need. General risk scores (STSscore) or heart status biomarkers (NTproBNP) are useful, but prognostic value of potential disease-specific and mechanistically-based indexes is still low.

Myocardial replacement fibrosis, as assessed by cMRI, appears to be the most important prognostic factor after TAVR. Soluble ST2 (sST2), a general cardiac biomarker originally reported in inflammatory diseases, was shown to be an independent factor for myocardial fibrosis; and men have higher levels of sST2 in patients with AVS.
Experimentally, mosaic loss of Y chromosome in monocytes (mLOY) was associated with increased diffuse myocardial fibrosis, and we recently reported that mLOY is associated with a worse prognosis in severe AVS.

Aim:
We aimed at assessing the prognostic value of sST2 added to mLOY as a disease-specific biological-genomic marker focused on fibrosis in male patients with severe AVS.

Methods:
A cohort of 243 consecutive elderly male patients undergoing TAVR was studied. mLOY (i.e., Y/X ratio) was assessed with a digital PCR method in peripheral blood cells DNA, by targeting a 6 bp sequence difference between genes AMELX and AMELY using TaqMan. The previously established mLOY cut-off value of 17% was used. sST2 serum levels were measured, and its optimal cut-off point was calculated based on ROC-curve and Youden index.

2-year survival in the following groups was compared using KM-curves: LOY-low/sST2-low, LOY-low/sST2-high, LOY-high/sST2-low, LOY-high/sST2-high. A multivariate Cox regression analysis was used to assess mortality risk independent from most important comorbidity, echocardiographic and laboratory risk factors.

Results:
Optimal cut-off value for sST2 was 32.665 ng/ml. Separately, both mLOY (HR: 2.9 [1,7-4.9] and sST2 (4.2 [2.5-7.0]) predicted mortality (both, p<0.0001), but prognosis in LOY-high/sST2-high patients was significantly worse than in all other groups (p<0.001) and showed a substantial risk difference over time (see K-M curves). Multivariate analysis confirmed the risk prediction to be independent from other risk factors (HR 4.620, 95% IC 2.35-9.07, p<0.0001).

Conclusion:
In male patients with severe AVS undergoing TAVR, LOY-high/sST2-high, a combined biological-genomic marker for fibrosis, is a strong disease-specific and mechanistically-based mortality predictor, independent from general and cardiac risk markers.
Abstract 4144974: Pulsed ElectRic FiEld versus Cryoballoon to Treat Paroxysmal Atrial Fibrillation (PERFECT-PAF) Randomized Trial: a Periprocedural Clinical and Cost Analysis
Authors: Chierchia Gian Battista , Della Rocca Domenico , Vetta Giampaolo , Magnocavallo Michele , Glowniak Andrzej , Fernandez Barcelo Carla , Velagic Vedran , Hafermann Juliane , Silas Ubong , Pannone Luigi , marcon lorenzo , Almorad Alexandre , Tarkowski Adam , Audiat Charles , Rossi Pietro , Uffenorde Steffen , NAKASONE KAZUTAKA , Bala Gezim , Konopka Aleksander , Overeinder Ingrid , Doundoulakis Ioannis , Iacopino Saverio , Tsiachris Dimitrios , Sorgente Antonio , Marangoni Andrea , Stroker Erwin , Sieira Juan , Sarkozy Andrea , BIANCHI STEFANO , de Asmundis Carlo 
Published: November 2024

Background:
Pulsed ElectRic FiEld versus Cryoballoon to Treat Paroxysmal Atrial Fibrillation (PERFECT-PAF) is an investigator initiated, multicentre, randomized trial on pulmonary vein isolation (PVI) using either a pentaspline pulsed field ablation (PFA) or cryoballoon (CRYO) catheter.

Hypothesis:
It is of utmost importance to assess both the clinical and economic value of novel ablation technologies to ensure access to therapies that are effective and economically sustainable.

Aim:
To compare periprocedural safety and costs of PVI via PFA versus CRYO.

Methods:
Paroxysmal AF patients 18-75 years old were randomly assigned to PFA or CRYO at 6 European Centres. Data regarding clinical management during index hospitalisation, procedural details, and resources used were collected.

The primary safety endpoint included procedure- and technology-related adverse events within 7 days post-ablation (e.g., pericardial effusion, persistent (>30 days) or transient (periprocedural) phrenic nerve (PN) injury, vascular complications).

Results:
A total of 269 paroxysmal AF patients were randomly assigned to undergo PFA (n=134) or CRYO (n=135). Baseline characteristics were similar.

Room time (mean ± SD) was 77.1±13.9 min for PFA vs. 97.0±20.4 min for CRYO (+19.9 min, p<0.001). Procedural time was 52.5±11.8 min for PFA and 69.3±18.0 min for CRYO (+16.8 min, p<0.001).
Overall periprocedural adverse events were significantly more frequent with CRYO than PFA (+7.4%; p=0.0053). Major adverse events were documented in 1 (0.7%) and 4 (3.0%) patients for PFA and CRYO, respectively (p=0.3703). CRYO-related PN injury, either persistent (n=2; 1.5%) or transient (n=4; 3.0%), was the main determinant of this difference and hindered effective isolation of the right PVs in 3 (2.2%) CRYO cases. The adverse event rate at 7 days was also higher with CRYO than PFA (+5.2%; p=0.036).
The total costs per patient within 30 days were 13.7% lower in the PFA group.

Conclusion:
In paroxysmal AF patients, PFA overcame safety limitations of CRYO with optimal effectiveness, fewer adverse events, and shorter procedural times. Long-term follow-up data will be collected and analysed to further investigate the potential clinical and economic impact of PFA versus CRYO.
Abstract 4144977: The Association of Social Determinants of Health with Pediatric Pulmonary Hypertension Outcomes
Authors: Khurana Jai , Lipsitz Stuart , Moynihan Katie , Mullen Mary 
Published: November 2024

Background:
Social determinants of health (SDoH) impact access to healthcare and outcomes. Few studies examine SDoH in pediatric pulmonary hypertension (PH) patients.

Hypothesis:
Outcomes in pediatric PH patients will differ according to SDoH with increased mortality in those from 1) low Child Opportunity Index (COI) areas or 2) non-local to our specialized quaternary center, with 3) public insurance, 4) limited English proficiency (LEP) and 5) underrepresented races/ethnicities.

Methods:
In this single center, retrospective cohort study, pediatric PH patients (<18) with inpatient admission 2012-2021 were identified using ICD-10 codes. Demographics, clinical course and outcomes were compared according to SDoH. Logistic regression, with SDoH separately added, studied associations with mortality at current follow-up, controlling for clinical factors, number of admissions and follow-up length with Bonferroni correction.

Results:
Of 1735 pediatric PH patients, 232 (13.4%) died. Median time to last follow-up or death was 35 days (IQR 8, 241). Median age was 215 days (IQR 14, 1716) with etiological subgroups of pulmonary arterial hypertension (275, 15.9%), left heart disease (1169, 67.4%), lung disease (271, 15.6%), thromboembolic (16, 0.9%) and other (4, 0.2%). Patients had a median of 3 complex chronic conditions (IQR 2, 5), ECMO (10.3%), lung (1.5%) or heart transplant (2.8%), tracheostomy (12.1%) and utilized PDE5 inhibitors (29.9%), prostacyclins (1.7%), endothelin receptor antagonists (4.0%) and inhaled nitric oxide (11.9%).

Patients that died had lower COI (median 61.5 [IQR 30.8, 80.3]) vs. those who survived (median 69.0 [IQR 43, 88] p=0.002). Mortality was higher in those with public vs. private insurance (15.5% vs 11.7%, p=0.022). Mortality differed by race/ethnicity (p<0.001); 11.6% in non-Hispanic/Latino White patients, 9.5% ‘another’, 1.7% Asian, 19.6% Black, 9.5% Hispanic/Latino, 4.0% multiracial and 19.2% unknown. Survival for local vs. out of state and LEP patients were similar (p>0.6).
For a 10-point COI increase, adjusted mortality odds were 0.92 lower (95%CI 0.87, 0.98, p=0.009). Patients with Black (1.93 [95%CI 1.2, 3.2] p=0.011) and unknown race (1.99 [95%CI 1.4, 2.9] p<0.001) had higher adjusted odds of mortality vs. White. Payer was not independently associated with mortality.

Conclusions:
Black PH patients or those from lower COI areas had higher mortality. Deeper understanding of disparate outcomes is needed to advance health equity.
Abstract 4145081: ACUTE ISCHEMIC STROKE IN YOUNG CANNABIS USERS: A NATIONWIDE ANALYSIS
Authors: Joseph Varughese Vivek , Anil Peethambar Gowri , JAYARAJ RANJINI NIVED , Mummadisetty Anvitha 
Published: November 2024

Background:
The incidence of stroke in young adults is on the rise in the United States. Drug abuse has been proposed as a known modifiable risk factor for stroke in this age group. The association between cannabis use and stroke in young adults is an area that needs further exploration.

Research Hypothesis:
Cannabis is an independent modifiable risk factor for stroke in young adults with Cannabis Use Disorder(CUD).

Aim:
To investigate the association between Cannabis Use Disorder(CUD) and Stroke in young adults.

Methods:
Using the National Inpatient Sample 2019, admissions for stroke in the age group of 18-45 were identified. The cohort was subdivided into admissions with documented CUD. Demographic data of the cohort was analyzed, including the prevalence of comorbid conditions. Using multivariate binomial logistic regression, the association between cannabis use and the occurrence of stroke was studied, after accounting for age, smoking, cocaine abuse, and uncontrolled hypertension(HTN). A two-tailed p-value <0.05 was used to determine statistical significance.

Results:
Out of the 13,514 stroke admissions identified, 1,027 (7.06%) had documented CUD. Analyzing the population, 63.87% were male, 39.57% were White, 38.5% were Black, and 12.3% were Hispanic. The prevalence of other comorbid conditions in this group included uncontrolled HTN (45.67%), alcohol abuse (15.78%), major depression (13.08%), COPD (11.56%), congestive heart failure (8.95%), and cocaine abuse (5.98%). [Table 1]

The crude odds ratio (OR) for stroke among admissions with CUD was 2.998 (95% CI: 2.587-3.473, p=0.000). Significant association with stroke was also found between documented cocaine abuse (OR: 1.604, 95%CI: 1.195-2.152), smoking (OR: 2.214, 95%CI: 1.374-3.569), and uncontrolled HTN (OR: 2.114, 95%CI: 1.959-2.281,). Using binomial logistic regression analysis, after adjusting for age, smoking, cocaine abuse, and uncontrolled hypertension, the association between stroke and cannabis use disorder remained significant: OR of 2.956 (95%CI: 2.541-3.440). [Table 2]
Further analyzing 543,445 admissions of individuals aged 18-45 with documented CUD, we identified the following as significant risk factors for the occurrence of stroke: Black race (OR: 1.556, 95%CI: 1.16-2.08), uncontrolled hypertension (OR: 5.222, 95%CI: 3.92-6.94), congestive heart failure (OR: 2.763, 95%CI: 1.67-4.55), and a history of myocardial infarction (OR: 2.346, 95%CI: 1.15-4.76). [Table 3]
Abstract 4145209: Death on Admission- Characterizing 30-Day Mortality in Patients Admitted to the Coronary Care Unit for Heart Failure Following the COVID-19 Pandemic
Authors: Ghadiali Tejal , Doshi Pratik , Das Anushka , Jinno Stephanie , Fong Michael 
Published: November 2024

Background:
Acute decompensated heart failure accounts for an increasing proportion of hospitalizations in the United States and is linked to high readmission and 30-day mortality rates. Prior studies suggest up to 17% mortality rate within 30 days for patients admitted with heart failure.

Research Questions/Hypothesis:
We present an analysis characterizing patients who experienced mortality within 30 days of admission at a large safety net hospital following the COVID-19 pandemic.

Methods/Approach:
A retrospective review was conducted for all heart failure admissions of patients
>
18 years of age admitted to the coronary care unit (CCU) at Los Angeles General Medical Center from January to December 2021 after the peak of the COVID-19 pandemic. Demographics, insurance information, drug use, medication use, heart failure etiology, and CCU interventions were indexed. The primary outcome was all-cause mortality.

Results/Data:
172 patients were identified during the study period. 10% of patients died within 30 days of admission, of which 94% died during the same admission. Of patients who died during index admission, 88% had heart failure with reduced EF. None of these patients were on all four pillars of guideline-directed medical therapy (GDMT), with 33% on one or no GDMT medications.

There was not a statistically significant difference in mortality rate when comparing those with active stimulant use 5/60 (8%) to those without active illicit drug use 12/112 (11%) (RR 0.79, 95% CI, p= 0.64).
9/17 (53%) patients died of refractory cardiogenic shock, 5/17 (29%) were found in cardiopulmonary arrest of unknown etiology while undergoing treatment for acute decompensated heart failure. Two patients (12%) died of septic shock while 1/17 (5%) died of hemorrhagic shock related to chronic liver disease.

Conclusion(s)
The COVID-19 pandemic exacerbated significant healthcare inequalities, especially for urban underserved populations leading to late presentations of disease and worse outcomes, however, based on our data the overall inpatient mortality rate remained largely similar to pre-pandemic values.
Abstract 4145271: Systemic Lupus Erythematosus-Induced Libman-Sacks Endocarditis Complicated by Multiple Embolic Episodes and Atypical Secondary Valve Involvement
Authors: Roberts Jacob , Cho David 
Published: November 2024

A 42-year-old female with SLE, lupus cerebritis with related seizure disorder, and mesenteric venous thrombosis on warfarin initially presented for syncope. Acute stroke workup was negative, and syncope was attributed to possible brief seizure. Six months later, the patient was evaluated by cardiology for hypertension diagnosed during hospitalization. She reported no further syncope, but exam revealed a 3/6 holosystolic murmur. Subsequent TTE identified severe MR with primary MV degeneration and LVEF >60%. A TEE confirmed severe MR with myxomatous MV leaflets and moderate-sized nonmobile vegetations attached to the atrial side of A2 and P2 of the MV. Subsequent infectious workup including serial blood cultures were negative. The patient was diagnosed with non-bacterial Libman-Sacks endocarditis (LSE). Given a lack of symptoms and plan to resume immunosuppressive therapy and continue her anticoagulation (AC), surgical intervention was initially deferred with close follow-up.
The patient continued to endorse worsening headaches and brain MRI revealed new chronic small ischemic strokes. One morning, the patient noted sudden aphasia and presented to the ED. Stroke workup revealed an acute ischemic stroke with total left M2 occlusion of her MCA, and she underwent thrombectomy. Cerebral angiogram further revealed FMD. Given ongoing embolic phenomena, likely from LSE, she underwent MVR with mechanical valve and LA appendage ligation and continued mycophenolate and warfarin. Two months postoperatively, the patient remained asymptomatic with normal prosthetic valve function and neurologic status. However, evaluation for extracranial FMD with CTA revealed interval development of PV vegetations. These lesions and moderate PR were confirmed on TTE.

Discussion:
While response to immunosuppressive therapy and AC has been reported to improve early-phase LSE, this patient continued to experience thromboembolic events resulting from LSE vegetations while on mycophenolate and warfarin. Despite continuing these therapies after MVR, she later developed PV vegetations and PR. Pulmonary valve involvement is rare in LSE, and development of new disease while on recommended medical therapy represents unusual disease progression.
Abstract 4145413: Factors Associated with Long Term Adverse Limb Events after Endovascular Revascularization: The Boston Femoral Artery Endovascular Revascularization Outcomes (FAROUT) study
Authors: Mandieka Edwin , Ohiomoba Ramael , Sobieszczyk Piotr , Eisenhauer Andrew , Todoran Thomas , KINLAY SCOTT 
Published: November 2024

Background:
Patient, lesion, and procedural characteristics may impact the long-term risks of adverse limb outcomes differently after successful endovascular revascularization for lower extremity peripheral artery disease.

Objective:
To assess the relationships of patient, lesion, and procedural characteristics to the subsequent risk of major and minor adverse limb events over the decade after successful endovascular revascularization of the superficial femoral artery for chronic limb threatening ischemia (CLTI) or lifestyle limiting claudication.

Methods :
A retrospective cohort of patients who underwent endovascular revascularization between 2003-2011 were followed for a median of 9.3 (25-75%: 6.8, 11.1) years. Hazard ratios and 95% confidence intervals (HR, 95% CI) from Cox proportional hazards models assessed the risk of major adverse limb events (MALE) or minor revascularization, MALE alone, and minor revascularization alone.

Results:
There were 232 index limb revascularizations in 185 patients. Longer lesion length was associated with a higher risk of MALE or minor revascularization (HR=2.09, 95% CI=1.22, 3.60) and minor revascularization alone (HR=2.53, 95% CI=1.39, 4.61). Current smoking was linked with minor revascularization (HR=3.83, 95% CI=1.54, 9.56). CLTI was associated with MALE or minor revascularization (HR=1.89, 95% CI=1.09, 3.29), and MALE alone (HR=7.43, 95% CI=3.11, 17.79). Black race/ethnicity (HR=4.74, 95% CI=1.51, 14.9) and low density lipoprotein (LDL) >100 mg/dL (HR=2.76, 95% CI=1.20, 6.35) were linked to MALE alone.

Conclusion
Factors related to MALE differed from those related to minor revascularization. Lesion length and smoking were linked to minor revascularization, whereas CLTI, Black race/ethnicity and elevated LDL were linked to MALE.
Abstract 4145685: Battling Cardiogenic Shock: A Comparative Study of In-Hospital Outcomes for left ventricular assist devices (LVADs) vs. intra-aortic balloon pump (IABP)
Authors: TABOWEI GODFREY , Gonzalez Laura , Ukenenye Emmanuel , Alugba Gabriel , Ogedegbe Oboseh , Lodhi Shahmeer , Tesfaye Meron , Matute Carlos , Enakpene Evbu 
Published: November 2024

Introduction:
Cardiogenic shock (CS), with a mortality rate of 30% to 50%, is a severe condition marked by the heart's inability to supply sufficient blood to meet the body's needs, which demands timely and effective intervention. Historically, the intra-aortic balloon pump (IABP) was the primary support device, but the use of left ventricular assist devices (LVADs) has increased. This study compared outcomes between CS patients treated with newer LVADs (CSLVAD) and older IABPs (CSIABP).

Methods:
This retrospective cohort study used the 2020 National Inpatient Sample (NIS) database to identify cardiogenic shock (CS) hospitalizations using ICD–10 codes. Our primary outcomes were in-hospital mortality, length of stay (LOS), total hospital charges (TOTCHG), and postprocedural complications among patients treated with LVADs and IABPs.

Results:
Out of 195,254 patients with cardiogenic shock, 2,609 received LVADs, and 21,169 received IABPs. The average age was 64.8 years for CSIABP patients and 54.8 years for CSLVAD patients. Males predominated in both groups (70.5% CSIABP, 75% CSLVAD). More Black patients received LVADs (33%) compared to IABPs (13%).

Mortality was 23% in the CSIABP group versus 8% in the CSLVAD group. After adjusting for confounders, the CSLVAD group had statistically significant 62% lower odds of mortality (P=0.00, CL=0.25–0.57). The average LOS was longer in the CSLVAD group (39.4 days) compared to the CSIABP group (13.4 days), with a statistically adjusted increase of 20.1 days in the CSLVAD group (P=0.00, CL=17.6-22.6). The average TOTCHG was higher in the CSLVAD group ($1,265,731) compared to the CSIABP group ($399,160), with a statistically significant increase of $869,550 (P=0.00, CL=732,536-1,006,564).
For cardiovascular outcomes, there was a 79% and 40% decrease in the odds of hypertension and CAD in the CSLVAD group(P=<0.05). Interestingly, there were increased odds of CKD, anaemia, ventricular tachycardia, hypothyroidism, postprocedural complications, supraventricular tachycardia, and atrial fibrillation in the CSLVAD group(P=<0.05).

Conclusion:
Patients treated with LVADs for cardiogenic shock had significantly lower mortality but higher LOS and TOTCHG compared to those treated with IABPs. Despite reduced odds of hypertension and CAD, the LVAD group had higher incidences of various complications (CKD, anaemia, ventricular tachycardia, hypothyroidism, postprocedural complications, supraventricular tachycardia, and atrial fibrillation).
Abstract 4146562: Diagnosis of Left Ventricular Diastolic Dysfunction using Deep Learning on electrocardiograms
Authors: Shetty Samantha , Lampert Joshua , Jiang Joy , Nadkarni Girish , Vaid Akhil 
Published: November 2024

Left Ventricular Diastolic Dysfunction (LVDD) is implicated in conditions with abnormal LV filling and reduced LV distension and relaxation. Classified into grades I to IV, LVDD can be progressive particularly when its underlying cause is not appropriately treated. The prevalence of LVDD varies greatly (10-35%) in the elderly population, likely in the setting of varying inclusion criteria, LVDD grading and definitions. Specifically, LVDD Grade II/III is associated with a higher mortality risk and has been shown to predict major adverse cardiac events including myocardial infarction, heart failure, and all-cause mortality.
Echocardiography (echo) is used to quantify LVDD and its severity. Given its dynamic nature, identifying LVDD and its progression across other diagnostic modalities is vital. One such modality is the electrocardiogram (ECG). Although ECGs are widely accepted for the identification of abnormalities in cardiac conduction, pathology, and structure, some ECG findings may go undetected by human interpreters. Applying machine learning techniques to ECG for detection of LVDD may help address this need.
In this study, we used rule-based Natural Language Processing (NLP) on echo reports to extract cardiologist-confirmed annotations for the presence and grading of LVDD. The NLP pipeline labelled reports as having no LVDD, indeterminate LVDD, or LVDD of grades I, II, or III. These labels were paired to ECG data collected within 7 days of the echo. ECGs paired with an echo of LVDD Grade II were considered cases and were paired to controls matched based on age, sex and race. Patients were excluded if their ECG diagnostic codes indicated conduction abnormalities, concurrent ischemia, and prior intervention. We trained a ConvNeXt Large model capable of processing images of up to 512x512 pixels over 25 epochs against a patient aware 80% training and 20% testing split.
We collected 121,161 ECGs from 27,760 patients with an outcome prevalence of 31.4%. Our model detected patients with LVDD Grade II/III with AUROC of 0.87 (95% CI 0.86-0.87) and AUPRC of 0.82 (95% CI 0.81-0.83) (Figure 1). Saliency heatmaps showed regions around the QRS complex as more important for diagnosis of LVDD (Figure 2).
Our study demonstrates how machine learning can augment clinical practice. Specifically, it may prove to be a useful screening tool for patients at risk of worsening cardiac disease, resource limited areas, and primary care settings in which ECG is readily available.