bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 13027: Reduced Left Atrial Strain is More Common in Embolic Stroke of Undetermined Source Compared to Non-Cardioembolic Stroke and Can Predict Atrial Fibrillation on Outpatient Cardiac Monitoring
Authors: Bashir Zubair , Chen Edward W , Wang Shuyuan , Goldstein Eric D , Rana Maheen , Shu Liqi , Kala Narendra , Dai Xing , Mandel Daniel , Yaghi Shadi , Has Phinnara , Simmons James , Song Christopher , Haines Philip 
Published: June 2023

Embolic stroke of undetermined source (ESUS) accounts for 20% of all ischemic strokes with at least 30% having biomarkers of atrial cardiopathy. Traditional parameters of left atrial (LA) structure and function (particularly Left Atrial Volume Index) are similar in ESUS and non-cardioembolic (NCE) stroke subtypes. LA strain measured by speckle tracking echocardiography (STE) is an emerging non-invasive technique to assess LA structure, function, and biomechanics. Our study evaluates whether LA strain differs between patients with ESUS and NCE and whether LA strain magnitude predicts diagnosis of atrial fibrillation (AF) in ESUS.
Hospitalized patients with ESUS and NCE stroke subtypes who underwent in-hospital echocardiography were included. STE was performed, and three phases of LA strain (reservoir, conduit, and contractile) were measured. Binary logistic regression analyses were performed to determine the association between different phases of LA strain and stroke subtypes (ESUS vs NCE) as well as AF detection in ESUS patients.
A total of 685 patients met the inclusion criteria. Mean age was 65 years; 55% were men; 49% of strokes were NCE; and 51% were ESUS. In patients with ESUS, 57% (189/330) underwent cardiac monitoring. AF was detected in 17.4% (33/189). In fully adjusted binary logistic regression analysis, patients with ESUS had lower LA reservoir strain (adjusted OR 0.99, 95% CI 0.98-0.99, p = 0.039) and LA contractile strain (adjusted OR 0.98, 95% CI 0.97-1.00, p = 0.089). Furthermore, lower LA reservoir strain was associated with AF detection in ESUS patients (OR 0.96, 95% CI 0.93-0.99, p = 0.028).
In conclusion, all phases of LA strain were reduced in ESUS compared to NCE. This suggests the presence of atrial cardiopathy in ESUS stroke patients. Furthermore, atrial strain was significantly reduced in ESUS patients found to have AF. These findings may carry mechanistic significance in stroke development and AF detection in ESUS patients.
Abstract 13233: Covid Related Thrombus or Vasculitis?
Authors: Rashmi Prama , Urja Prakrity 
Published: June 2023

COVID is associated with cardiovascular manifestations. It worsens the pre-existing cardiovascular diseases, and newly diagnosed cardiovascular diseases are being reported with it. In our abstract we present a case with unusual cardiac manifestation with COVID.
63-years-old, covid positive male with hypertension, hyperlipidemia and coronary artery disease with prior RCA stent was admitted for inferior STEMI.The angiogram showed instent stenosis, with distal vessels narrowing. Stent was placed in RCA. Despite this, he had persistent chest pain and ST elevation, so he was taken back to Cath lab. It confirmed patent stent. For distal vessel narrowing with ongoing pain intra-aortic balloon pump was placed. Aggrastat and heparin was continued. At the time of discharge, he had ongoing dyspnea and chest pain, which was thought to be associated with COVID. He was readmitted in six days for pericardial effusion with constriction and echocardiographic finding of tamponade. He had elevated inflammatory markers and liver enzyme. With recent COVID infection, elevated inflammatory markers, echo findings and known distal coronary artery narrowing there was a concern of vasculitis and pericarditis. He was started on steroid and colchicine with significant improvement.
COVID can cause direct myocardial injury or indirect injury due to altered myocardial demand-supply. The pericardial involvement is associated with heightened inflammation and increased vascularity. Interestingly, our patient who initially presented as ACS had resolution of symptoms with steroids. Could ACS symptoms not resolving with antiplatelets and stenting be a part of inflammatory picture of COVID? In post-COVID autopsy and surgical tissue diffuse lymphocytic endotheliitis and apoptotic bodies are seen in the vascular beds. Vasculitis lesion in skin and Kawasaki’s disease is reported in adolescents and children. However, adult-onset vasculitis is still to be studied.
Abstract 13240: The Relationship Between History of Valve Surgery and Heart Failure Event in Japanese Atrial Fibrillation Patients: The Fushimi Af Registry
Authors: DOI KOSUKE , Ishigami Kenjiro , Ikeda Syuhei , Yoshizawa Takashi , Hamatani Yasuhiro , Ide Yuya , Fujino Akiko , Ishii Mitsuru , Iguchi Moritake , Ogawa Hisashi , Masunaga Nobutoyo , Wada Hiromichi , Hasegawa Koji , Abe Mitsuru , Akao Masaharu 
Published: June 2023

Background:
We previously reported that valvular heart disease (VHD) was associated with an increased risk of hospitalization for heart failure (HF) in Japanese atrial fibrillation (AF) patients. However, the association of history of surgery for VHD with HF hospitalization remains unknown.

Method: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, which is a typical urban district of Japan. We started to enroll patients from March 2011, and follow-up data were available for 4,489 patients by the end of July 2021. In the entire cohort, 747 patients had VHD. We divided them to surgery group (n=182) and non-surgery group (n=565). We compared clinical characteristics and incidence rates of HF hospitalization between two groups.
Result: Patients who received valve surgery were younger (72.0 years vs. 78.0 years, p&lt;0.001), had lower systolic blood pressure (118 mmHg vs. 123 mmHg, p=0.02) and pulse rate (75.5 bpm vs. 79.1 bpm, p=0.003), more often paroxysmal type (46.7% vs. 31.0%, p&lt;0.001), less likely to have hypertension (51.1% vs. 66.2%, p&lt;0.001) and had lower CHADS2 score (2.09 vs. 2.55, p&lt;0.001) than non-surgery group. Body weight, sex, prior HF, chronic kidney disease and prescription data were comparable between two groups.
During the median follow-up of 1,679 days, the incidence rate of HF hospitalization was lower in surgery group than non-surgery group (2.58% vs. 4.43% per person-year, respectively, log rank p=0.001). On multivariate Cox regression analysis, history of surgery was not significantly associated with a lower risk of HF hospitalization (adjusted hazard ratio 0.76; 95% confidence interval 0.52-1.12, p=0.16).

Conclusion:
The incidence rate of HF hospitalization was lower in patients with valve surgery than non-surgery group. However, history of valve surgery was not independently associated with a lower risk of HF hospitalization in Japanese AF patients.
Abstract 13391: Exploring Prognostic Implications of Socioeconomic Status in Patients With Peripheral Arterial Disease
Authors: Leveille Nayla , Chen Mia , Nauche Benedicte , Drudi Laura M 
Published: June 2023

Introduction:
This systematic review sought to describe the prognostic implications of SES on clinical outcomes in patients undergoing vascular interventions for claudication and critical limb threatening ischemia (CLTI).

Hypothesis:

Methods:
Studies were systematically searched across 5 databases from inception to June 2021. Studies focused on patients with claudication or CLTI undergoing open, endovascular, or hybrid procedures. Studies were included if SES was documented and associated with a clinical outcome. Two independent reviewers selected studies for inclusion, extracted data, and assessed risk of bias using ROBINS-I and Newcastle-Ottawa scales. Extracted data included study and clinical characteristics, demographics, interventions, outcome measured, and association of SES with the clinical outcomes.

Results:
Thirty four studies met our inclusion criteria and addressed the impact of SES in patients undergoing interventions for PAD, with 8 articles including only claudication patients, 2 including only CLTI patients, and 24 including a combination of both groups. The way SES was defined varied across studies, with some describing it in relation to insurance status (n=14), household income (n=13), income in area of living (n=8), income in the hospital’s area (n=1) and employment status (n=1). Low SES was associated with higher rates of amputation as a primary intervention, higher rates of above the knee amputation compared to below the knee amputation, higher 30 day postoperative death, longer lengths of stay, higher surgical sites infections, amputations following primary interventions, in-hospital complications, long term major adverse limb events and long term amputation rates. Given the amount of heterogeneity that was present in the designs, populations, and comparators among the included studies, we were unable to statistically pool data across trials.

Conclusions:
Our qualitative findings suggest that low SES is associated with significant adverse outcomes in patients with PAD including higher rates of primary amputation, post-operative mortality, length of stay, among others. Reasons for these disparities should be explored to identify solutions for decreasing and eliminating these health inequities.
Abstract 14249: COVID-19 and Complete Heart Block in a Vaccinated Adult
Authors: Lawrence Luke , Brahier Mark , Srichai-Parsia Monvadi B , Thomaides Athanasios 
Published: June 2023

Introduction:
Complete heart block (CHB) in association with Covid-19 is uncommon and has been described primarily in the pre-vaccine time period. In the setting of acute Covid-19 infection, decision to treat CHB with permanent pacemaker (PPM) is often uncertain as the CHB may resolve or persist. We present a case of reversible CHB and Covid-19 infection in a vaccinated healthy 28-year-old.

Case:
A healthy 28-year-old female presented after syncope. She had been vaccinated three times against Covid-19 with Pfizer-BioNTech mRNA vaccine with her third dose four months prior. She had known Covid-19 exposure and developed sore throat three days prior to presenting with syncope. She had no other symptoms.

Physical exam was remarkable only for bradycardia. Labs showed positive Covid-19 PCR test and elevated troponin of 0.396 ng/mL. Complete blood counts, metabolic panel, ESR and CRP were normal. Lyme IgM and IgG were negative by Western blot. ECG showed CHB with a rate of 35 beats per minute (Figure 1A). Echocardiogram showed no abnormalities.
The patient remained in CHB for 24 hours, at which point PPM was implanted after shared-decision making. Post-PPM ECG showed AV-paced rhythm (Figure 1B). At follow up, PPM interrogation showed that she transitioned to sinus rhythm with right bundle branch block (RBBB) followed by a return to normal sinus rhythm without RBBB 5 days after implantation (Figure 1C). Cardiac MRI two months after PPM implantation showed no abnormalities.

Discussion:
This was a case of Covid-19 associated myocardial injury with CHB in a fully-vaccinated, healthy adult treated with PPM. Despite vaccination, this patient experienced myocardial and conduction system involvement during acute Covid-19 infection. Myocardial injury along with this ECG progression suggested that there was transient inflammation of the myocardial septum resulting in CHB. It may be reasonable to delay PPM implantation in cases of CHB and Covid-19 infection as the CHB may be transient.
Abstract 14413: Possible Antibody Mediated Cardiac Rejection After Combined Heart-Kidney Transplant in a Sensitized Patient Associated to COVID-19 Pneumonia
Authors: Castillo Josefina , Ortiz Ana Mireya , Jalil Jorge , Greig Douglas , Córdova Samuel , Fernández Rodrigo , Castro Pablo 
Published: June 2023

Background:
Antibody mediated rejection (AMR) starts with the appearance of donor-specific antibodies (DSA), followed by graft injury that may be subclinical and can progress to cardiac allograft vasculopathy (CAV) and chronic graft dysfunction.

Case report
A 48-year-old man with a past medical history of right nephrectomy due to congenital renal atrophy and dilated cardiomyopathy required heart transplantation at age 31, presented an episode of AMR grade 2 ten years post-transplant developing CAV with graft loss and end-stage renal disease. He was listed for a combined heart-kidney transplant. His panel reactive antibody (PRA) level was 40%, requiring desensitization therapy (plasmapheresis, intravenous gamma globulin and rituximab). At age 44, he received a heart-kidney transplant. Methylprednisolone and rabbit antithymocyte globulin were used for induction and desensitization therapy with plasmapheresis and intravenous gamma globulin at months 0-3-6-12 was continued. Maintenance immunosuppression therapy continued with tacrolimus, mycophenolic acid and prednisone. During follow-up persistent circulating DSA anti-class II HLA were detected and PRA reached 80%.

He was admitted with a multifocal COVID-19 pneumonia. He had received 4 doses of the messenger RNA vaccine BNT162b2. Dexamethasone was started and mycophenolic acid was discontinued for 14 days. He did not need mechanical ventilation.
Echocardiogram revealed marked concentric LVH, LVEF = 60%, grade II diastolic dysfunction and reduced global longitudinal strain (-7,6%). Pro-BNP was 962 pg/ml, and Troponin T 100 pg/ml. Endomyocardial biopsy showed no signs of cellular rejection nor capillary injury. Immunopathologic findings were negative. Coronary angiogram showed no significant lesions. AMR was suspected, the patient was treated with methylprednisolone, plasmapheresis and intravenous gamma globulin. Clinical response was satisfactory, and he was discharged in functional class I (NYHA).

Conclusions
Although both histological and immunopathologic studies were negative, clinical suspicion for AMR in a highly sensitized patient prevailed in the context of a recent infectious intercurrence. Other diagnosis cannot be completely ruled out in this clinical scenario.
Abstract 14568: Recognition of Cardiovascular Disease Related Risk Factors, Eligibility and Completion of Recommended Health Checks Among Australian Adults
Authors: Nijam Lucy C 
Published: June 2023

Introduction:
Cardiovascular disease (CVD) is a leading cause of death in women globally. Risk factors include hypertension (HTN), hyperlipidaemia, high body mass index (BMI), diabetes, poor mental health and health literacy. Early identification and management of risk factors is imperative, given that CVD in women is often under-recognised.

Methods:
Using selected social media platforms a survey was conducted among adult Australians (>18yrs) in 2019, evaluating knowledge of risk factors for CVD, eligibility and completion of Australian Guideline recommended health checks.

Results:
Amongst 229 respondents 77% (177/229) were women. 62% of women (111/177) and 71% of men (37/52) were under the age of 44 years.

Women reported a mean of 5/12 risk factors and men reported a mean of 7/12 risk factors for CVD. Women were more likely to report family history compared to men (29.3%, 52/177; vs 9.61%, 5/52; p=0.001), hyperlipidaemia (29.3%, 52/177; vs 11.5%, 6/52; p=0.004), high BMI (37.85%, 67/177 vs 23%, 12/52 p=0.002), HTN (18%, 32/177; vs 5.76%, 3/52; p=0.015) and an unhealthy diet (35%, 62/177; vs 27%, 14/52; p=0.1382). Women were less likely to report inactivity (33% 59/177, vs 36.5%, 19.52; p=0.334). Smoking was the most frequently reported risk factor by both sexes (40.3%, 74/177 and 41.8%, 21/52; p=0.427).
Fewer women were aware of eligibility for a blood pressure check (9.6%, 17/177; vs 11.5%, 6/52; p=0.341), cholesterol (13%, 9/66; vs 33%, 5/15; p=0.034) and weight check (0%, 0/177; vs 2%, 1/52; p=0.033).
Awareness of eligibility for a diabetes check was similar between the sexes (12%, 8/66 in women vs 11%, 1/15 in men; p=0.272). More women had completed a blood pressure (71%, 126/177; vs 65%, 32/52; p=0.093) and weight check (34%, 61/177; vs 32%, 17/52; p=0.406) than men however less women had completed a cholesterol (52%, 34/66; vs 60%, 9/15; p=0.276) and diabetes check (21%, 14/66; vs 33%, 5/15; p=0.159).

Conclusion:
This pilot study found that knowledge of CVD risk factors and eligibility for health checks was low & risk factor profiles differed significantly between the sexes. Future studies evaluating a larger cohort are needed to further assess the significance of sex-based differences in awareness to risk factors, eligibility and completion of health checks.
Abstract 14693: Venous Thromboembolism in the Modern Era of Multiple Myeloma : An Analysis of Real-World Data From a Nationwide Claims Database in Japan
Authors: SHIINA TETSUYA , Dohi Tomotaka , Ohtsu Hiroshi , Yonemoto Naohiro , Sase Kazuhiro , Minamino Tohru 
Published: June 2023

Introduction:
Treatment for Multiple Myeloma (MM) with new therapeutic agents has dramatically improved outcomes and increased the number of survivors. Although venous thromboembolism (VTE) is common in MM, the pathophysiological interplay between VTE and MM, including risk factors related to the patient, disease, and modern treatments, is complex and incompletely understood.
Objectives:
To evaluate real-world data on the risk factors of VTE and outcomes of patients with MM using a nationwide claims database.

Methods:
This study involved the retrospective observational analysis of the Japan Medical Data Center (JMDC, Tokyo, Japan) database, an anonymized patient-level claims database younger than 75 years old. We identified cases with diagnosis and treatment of MM with codes provided by JMDC. Patients with a tentative diagnosis code of MM [C90] were included. Cases with a history of VTE or a pre-diagnostic history of fewer than six months were excluded. Propensity score (PS) was calculated using logistic regression based on age, gender, and cardiovascular risk factors.

Results:
We identified 2,023 eligible cases (mean age 53.6 ± 11.8 years) between January 2015 and December 2020. After 1:1 PS matching, the number of patients, mean age (years), follow-up (months) were as follows: MM group (n=280, 58.7 ± 8.1, 18.6 ± 14.8), Control group (n=280, 58.5 ± 8.1, 24.4 ± 18.4). Kaplan-Meier analysis indicated that the rate of VTE within 60 months was significantly higher among MM than in Control (25.7% vs 2.5%, Log-rank p<.001). Within the MM group, multivariable Cox proportional hazard model showed that lenalidomide had a risk of VTE (Hazard Ratio 1.16 [95% Confidence Interval: 1.19-7.69]) among modern therapies (stem cell transplantation 37.1%, elotuzumab 6.4%, daratumumab 16.8%, bortezomib 88.9%, carfilzomib 21.8%, ixazomib 11.8%, thalidomide 3.9%, lenalidomide 78.9%, and pomalidomide 15.4%).

Conclusions:
Patients who underwent modern MM therapies, including immunomodulatory agents, had significantly higher VTE risk than PS-matched Control. Therefore, further studies using real-world data to improve prevention, early detection, and treatment of MM-related VTE are warranted.
Abstract 15528: Indeterminate Cardiomyopathy in a Patient With Birt Hogg Dubé Syndrome and a Clinical Diagnosis of Scleroderma and Prior Atrial Tachy Arrhythmias: A Diagnostic and Therapeutic Dilemma
Authors: Maher Aoife , McAdam Brendan F 
Published: June 2023

Birt Hogg Dubé (BHD) syndrome, tachycardia induced cardiomyopathy and scleroderma are three well defined diagnoses. A link between them has not been reported. We present a diagnostic and treatment challenge, of a patient with BHD, clinical scleroderma and prior tachycardia induced cardiomyopathy with persistent left ventricular dysfunction despite restoration of sinus rhythm. Mr. X medical history includes recurrent bilateral pneumothoraces and bullectomy, with a cystic lung disease. He was diagnosed with BHD syndrome in 2018. He was diagnosed clinically with scleroderma with myositis based on symptoms and clinical signs with paucity of inflammation on muscle biopsy and negative biomarkers. There has been a limited response to immunosuppressants. In 2020 he presented with symptomatic paroxysmal atrial fibrillation. CMRI showed biventricular dilatation with increased volumes with LVEF of 40%, ​RVEF of 25% in sinus bradycardia. LGE showed subendocardial signal in ​​the basal and mid segment of the lateral and posterolateral walls with small foci of myocardial ​​​signal at the basal and mid inferior RV-LV hinge points.
A bespoke CRT-D (secondary to cavity size) was inserted following documented broad complex tachycardia, given the history of reduced ejection fraction despite medical therapy. Right and left heart catheterisations were normal. Endomyocardial biopsy showed no pathological features and no fibrosis or evidence of infiltrative disease. Genotype results are pending. BHD is a genetic disorder, affecting folliculin protein, associated with cystic lesions of the lung, kidney, and skin with an increased risk of renal cell carcinoma (1). There is no known link of BHD syndrome with cardiomyopathy. Studies have demonstrated folliculin has a role in cardiomyocyte generation (2). Given the cardiac biopsy result, not in keeping with scleroderma or tachycardia induced cardiomyopathy, he may have an independent cardiomyopathy, or a first case of cardiomyopathy secondary to BHD.
Our challenge continues to be optimising available therapies ensuring the best quality of life, whilst balancing the potential need for cardiac transplant with lifelong immunosuppressant therapy in a condition which has a seven-fold increased risk of renal cancer.
Abstract 171: Correlation Between The Neurological Pupil Index And Blood Brain Barrier Permeability In Out Of Hospital Cardiac Arrest Patients Treated With Target Temperature Management
Authors: You Yeonho , Kang Changshin , Ahn Hong Joon J , Park Jung Soo , Jeong Won-joon , Min Jinhong , In Yong N 
Published: June 2023

BBB disruption following OHCA causes poor neurological prognosis and the changes in the prognostic value of biomarkers. However, several tools to evaluate BBB disruption are either invasive or cannot provide a continuous monitoring. Blood retina barrier (BRB) is similar with BBB anatomically and functionally, and BRB disruption influences the pupillary light reflex (PLR). Therefore, we studied on the correlation between BBB permeability and NPi in OHCA patients treated with TTM.This study was prospectively conducted between October 2020 and March 2022 (**** IRB 2019-07-033-09). NPi and Albumin quotientt (Qa) to determine BBB permeability were presented every 2 h until 24 h, and then 48 h and 72 h after ROSC. 25 patients were required after sample size calculation, and partial correlation analysis between NPi and Qa was performed with prognostic control. Changes in NPi and Qa over time were analysed using the generalised estimating equation. Basal characteristics were in table 1 and figure 1. Since this study aimed to elucidate the correlation between NPi and Qa, data on NPi and Qa during seizures were included in this study. Additionally, the drug used in this study was found to have no effect on NPi in previous studies. NPi was lower, and Qa was higher in the group with poor neurological prognosis (Table 2,3, and Fig. 2). There was a moderate negative correlation between NPi and Qa (Fig. 3).This study demonstrated that NPi had a moderate negative correlation with BBB permeability in OHCA patients treated with TTM. Therefore, further studies on prognostic strategies using biomarkers and NPi considering the increase in BBB permeability are needed.
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