tbuckley/cabot-search huggingface dataset:
Abstract 4140711: Efficacy and Safety of Sodium-Glucose Co-transporter-2 Inhibitors in Acute Heart Failure: A Meta-Analysis of Randomized Controlled Trials
Authors: Prerana Sevella, Sai Sri Harsha Rallabhandi, Sudeep Nugooru, Shravya Ginnaram, Chaitra Janga, Karanam Amrutha, Robert Watson
Journal: Circulation (2024)

Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated benefits in chronic heart failure. Their efficacy in acute decompensated heart failure (ADHF) is not well established, warranting further investigation. This meta-analysis evaluates the impact of SGLT2i (empagliflozin, dapagliflozin, and sotagliflozin) on patients with ADHF. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Relevant studies were sourced from MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials up to May 2024. Six studies met the inclusion criteria: Cox et al. (2024), Abdelrahman et al. (2023), Voors et al. (2022), Ibrahim et al. (2020), Dammam et al. (2020), and Bhatt et al. (2020). Three studies used dapagliflozin, two used empagliflozin, and one used sotagliflozin. Outcomes included all-cause mortality, heart failure [HF] events, HF readmissions, and major adverse events. Data analysis was performed using Microsoft Excel and R/R Studio [Version 4.4.0]. A risk ratio (RR) with 95% confidence intervals (CI) was calculated using both fixed and random effects models to assess heterogeneity. Results: A total of 5-6 studies were included for each outcome, with total sample sizes ranging from 2146 to 2246 participants. For all-cause mortality, the fixed effect model indicated a significant reduction by 25% (RR = 0.750, 95% CI [0.570, 0.987]), whereas the random effects model did not (RR = 0.750, 95% CI [0.524, 1.072]), with low heterogeneity. SGLT2i significantly reduced heart failure events or exacerbations in both models with a 34% reduction (RR = 0.660, 95% CI [0.577, 0.755] for fixed effect and RR = 0.660, 95% CI [0.514, 0.848] for random effects), with very low heterogeneity. Heart failure readmissions showed a significant reduction in the fixed effect model (RR = 0.757, 95% CI [0.625, 0.917]) but not in the random effects model (RR = 0.765, 95% CI [0.484, 1.208]), with moderate heterogeneity. Major adverse events showed no significant reduction in either model. Conclusion: SGLT2i significantly reduces heart failure events and potential readmissions in ADHF patients. The impact on all-cause mortality and major adverse events is less clear. These findings support the use of SGLT2i in heart failure management, although further research is needed to confirm benefits and identify optimal patient subgroups. Low to moderate heterogeneity supports the robustness of the results across diverse populations.
Abstract 4141357: Diagnostic and prognostic value of quantitative stress perfusion CMR in the non-invasive assessment of cardiac allograft vasculopathy
Authors: Giandomenico Bisaccia, Isabella Leo, Roberto Licordari, Giulia La Vecchia, Maria Perotto, Maria Cristina Procopio, Nikolaos Miaris, Daniele Torella, Fabrizio Ricci, SABINA GALLINA, Peter Kellman, Joyce Wong, Chiara Bucciarelli-Ducci
Journal: Circulation (2024)

Background: Cardiac allograft vasculopathy (CAV) is a rapidly progressive form of coronary atherosclerosis limiting long-term survival after heart transplantation. Objectives: We evaluated the diagnostic and prognostic yield of quantitative stress cardiovascular magnetic resonance (CMR) perfusion for CAV detection in heart transplant recipients. Methods: Patients who received orthotopic heart transplants and underwent stress CMR for CAV assessment were included in the study and followed up for almost 2 years (median 1.8; IQR 0.9,2.7). The diagnostic accuracy of qualitative and quantitative stress CMR was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), using invasive or CT coronary angiography as the reference for CAV detection. The area under the curve (AUC) was compared for qualitative and quantitative stress CMR. Adjusted hazard ratios for major adverse cardiac events (MACE), including death and unplanned cardiac hospitalizations were derived in all patients. The global myocardial perfusion reserve index (MPRi) was obtained by normalization to the rate-pressure product. Results: In a cohort of 60 patients, n=18 (30%) had significant CAV (grade 2 or 3), and n=11 (18.3%) experienced MACE. At the Youden index threshold of 2.1, the myocardial perfusion reserve index (MPRi) demonstrated a sensitivity of 85.7%, a specificity of 70.3%, a PPV of 52.2%, and an NPV of 92.9%. The MPRi was significantly more accurate than visual assessment (p &lt; 0.001) in identifying underlying CAV (Figure 1) and it was an independent predictor of MACE (HR:0.26;95%CI:0.07,0.93; log-rank p=0.022; Figure 2), while the visual presence of inducible myocardial perfusion defect did not (HR:2.23;95%CI:0.57,8.66; p=0.2). Conclusions: In patients with previous heart transplantation, quantitative stress CMR perfusion has incremental diagnostic and prognostic value over qualitative stress CMR for the non-invasive detection of CAV.
Abstract 4141502: Gender Variations in Atrial Fibrillation Incidence Among the American Indian Population in Northern Arizona
Authors: Juan Vargas, Kunal Deora, ritu yadav, Hammad Ashraf, Taylor Forbeck, Jaron Lowis, Neha Jha, John Ashurst, Rangadham Nagarakanti
Journal: Circulation (2024)

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with gender disparities in age, comorbidities and anticoagulation (AC) therapy. These differences in American Indians (AI) with AF remain underexplored. We aim to evaluate gender differences in demographics, comorbidities, AC status and direct-oral anticoagulant (DOAC) use among AI patients with AF in rural Northern Arizona. Methods: We performed a retrospective analysis of AI patients aged &gt;18 years with AF between January 2022 and October 2023 from a health system with two hospitals in northern arizona. We collected demographic variables, comorbidities, AC status, and calculated CHADS-VASc and HAS-BLED scores. Statistical analysis was conducted using chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables, with statistical significance defined as a p-value ≤ 0.05. Results: We identified 490 AI patients with AF, 185 (37.8%) were female, and 305 (62.2%) were male. The mean age was 68.8±16.2 years, with females being older on average compared to males (73±14.5 years vs. 66±16.7 years; p &lt; 0.0001) (Table 1). Hypertension was the most common comorbidity, in 70% (343) of patients. Significant gender differences were observed in Coronary artery disease (CAD) (32.1% males vs. 20.5% females, p = 0.005), diabetes mellitus (71.1% males vs. 60.5% females, p = 0.01), alcohol use (22.6% males vs. 4.9% females, p &lt; 0.0001), and tobacco abuse (11.5% males vs. 2.2% females, p = 0.0002). AC use were higher in females (61.1% vs. 49.8% in males, p = 0.02). DOAC use was more prevalent among females (56.8% vs. 43.9% in males, p = 0.006). The mean CHADS-VASc score was higher in females (4.7±1.6 vs. 3.2±1.8 in males, p &lt; 0.0001), whereas HAS-BLED scores did not differ significantly between genders (2.5±1.1 in females vs. 2.6±1.3 in males, p = 0.53) Conclusions: Our study found significant gender differences in this population of AI patients with AF. Females were older, had higher CHAD-VASC scores, and more likely to be anticoagulated with DOACs compared to males. These findings highlight the need for gender-specific strategies to optimize AC in this population. Further research is warranted to explore the underlying reasons for these differences and develop targeted interventions.
Abstract 4141098: Prognostic value of Achilles tendon assessment by ultrasonography to predict complexity of coronary artery disease in patients with acute coronary syndrome
Authors: SHIMPEI FUJIOKA, Daisuke Shishikura, Masahito Michikura, Hideaki Morita, Mariko Harada-Shiba, Masaaki Hoshiga
Journal: Circulation (2024)

Background: One of the major causes of atherosclerotic cardiovascular diseases is high low-density lipoprotein cholesterol (LDL-C) levels and prolonged exposure to high LDL-C can lead to the formation of atheromatous lesion. Achilles tendon thickening (ATT) is also known to be due to exposure to high LDL-C from the childhood in familial hypercholesterolemia (FH) and is one of the criteria for the diagnosis of FH in Japan. We have reported that ATT can be measured more accurately by ultrasonography（US-ATT）than X-ray（Xp-ATT）. The US-ATT in FH patients correlate with the severity of coronary artery disease; however, it is unknown whether the US-ATT correlates with the severity of coronary artery disease in non-FH patients. In this study, we investigated whether the evaluation of US-ATT could serve as a predictive indicator for the severity of coronary artery disease in non-FH patients. Methods: We investigated 95 consecutive patients who presented with acute coronary syndrome (ACS) at Osaka Medical and Pharmaceutical University Hospital from April 2023 to May 2024. ATT was measured by ultrasonography and radiography. The complexity of coronary artery disease was evaluated using the Syntax score and the number of coronary artery lesions with &gt;50% diameter stenosis. FH diagnosis was based on clinical findings. Excluding FH patients, the relationship between the complexity of coronary artery disease and the mean of the right and left US-ATT as the mean US-ATT was evaluated. Results: The mean age of the patients was 67.7 years, and 81.9% were male. There were 10 patients with FH and 85 patients with non-FH. The mean US-ATT was 5.1 ± 0.6 mm. The mean US-ATT was associated with coronary multiple vessel disease in non-FH patients (p = 0.029). The association between the mean US-ATT and Syntax score was observed in non-FH patients (p = 0.031). The correlation between ATT and Syntax score was found to be stronger for US-ATT than Xp-ATT (p &lt; 0.001 and p = 0.009). Multivariate analysis adjusting for age, gender, smoking, and HbA1c revealed that the mean US-ATT was an independent predictor of severe coronary artery disease (OR: 5.4, 95% CI: 1.45-20.2, p = 0.001). Conclusions: Even in non-FH patients, US-ATT was significantly associated with the complexity of CAD and showed a significant correlation. Given its greater accuracy, simplicity, and lack of radiation exposure, US-ATT could serve as an alternative method to predict severe CAD.
Abstract 4140708: Association between Age at Menopause and Age at Onset of Myocardial Infarction: An Analysis of NHANES Data from 2017-2020
Authors: Narathorn Kulthamrongsri, Napat Suriyathumrongkul, Nisha Wanichwecharungruang, Prachawanee Nuchpramool, Kritpong Kulthamrongsri, Smuch Siramongkholkarn, Chutawat KOOKANOK, Thanaboon Yinadsawaphan, Phuuwadith Wattanachayakul, Sakditad Saowapa, Pojsakorn Danpanichkul, Sorawit Ongsupankul, Adivitch Sripusanapan, Nicha Wareesawetsuwan, Koravich Lorlowhakarn, Natee Deepan, Nopavit Mohpichai, Phatsawut Siritongtaworn, Ekamol Tantisattamo
Journal: Circulation (2024)

Introduction: Menopause is known to be associated with myocardial infarction (MI). However, the association between menopause age and MI onset in a nationally representative population remains unknown. Objective: To examine the correlation between age of menopause and age of MI onset in the general population and the association between early menopause (onset of menopause ≤ 40 years old) and early onset of MI (onset of MI ≤ 40 years old). Methods: A cross-sectional study was conducted using a population from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The questionnaire collected self-reported data on the participants' menopause age and their age of first MI. The relationship between these two parameters was analyzed by multivariate linear and logistic regression analyses. Multivariate analysis was adjusted for race, age, body mass index (BMI), smoking status, diabetes mellitus (DM), hypertension, and dyslipidemia status. Results: Among 2,200 postmenopausal females, 90 (4.1%) have had MI. The study involved 85 postmenopausal females who reported both menopause age and MI onset, with a mean ± SD age of 55 ± 13 years. This study found a significant association between menopause age and MI onset. After adjusting for confounders, it was found that every 1-year increase in the age of menopause will delay the onset of MI by 0.28 years, with a 95% CI of 0.013 to 0.552 (Table 1A, Graph 1A, Graph 1B). Additionally, early menopause carries an almost significantly increased risk of 2.11 times (95% CI: 1.00, 4.45) for early-onset MI. After adjusting for confounders, the magnitude of the association was lower and not statistically significant, but the direction remains (OR (95% CI): 2.08 (0.87, 4.95)). However, after stratification with comorbidities, DM status was identified as an effect modifier, with early MI significantly observed in patients with DM in both univariate and multivariate analyses, with OR (95% CI) of 3.03 (1.10, 8.37) and 4.88 (1.26, 18.96), respectively (Table 2A). Conclusion: This study demonstrated a positive association between menopause age and MI onset in a generally representative population. This suggests that prolonged estrogen exposure due to late menopause may delay the onset of MI. Additionally, early menopause was associated with early MI onset in the DM population. Further longitudinal studies are required to examine the potential mechanisms involved in menopause onset and MI onset.
Abstract 4141021: Association of Cardiovascular Health by Life’s Essential 8 with Subsequent Coronary Artery Calcification: A Prospective Cohort Study
Authors: hyoeun an, Jooeun Jeon, Hyeok-Hee Lee, Jee-Seon Shim, Hyeon Chang Kim, Hokyou Lee
Journal: Circulation (2024)

Introduction: “Life’s Essential 8” (LE8) is an updated construct for measuring cardiovascular health (CVH). We hypothesized that a higher CVH score by LE8 is associated with a lower risk of subsequent coronary artery calcification (CAC&gt;0) among middle-aged Koreans. Methods: The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) study is a community-based prospective cohort study conducted in Seoul, Korea, including 1,269 healthy participants with a baseline visit in 2013-2018 and a follow-up visit in 2022-2023. The baseline CVH score was calculated as the average of 8 metrics: diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure, each scaled from 0 to 100 points, according to the AHA’s LE8 definition. The CVH scores of 80 to 100 were classified as “high”, 50 to &lt;80 as “moderate”, and 0 to &lt;50 as “low” CVH group. The main outcome was CAC&gt;0 at the follow-up visit. The association of baseline CVH score with the outcome was evaluated based on odds ratios (OR) and 95% confidence intervals (CI) using multivariable logistic regression models. Results: At baseline, the median age of the participants was 55 years, and 65.5% were female. After a median follow-up of 7 years, 519 (40.9%) participants had CAC&gt;0. The proportion of CAC&gt;0 at follow-up was 65.3% in the low CVH group, 40.6% in the moderate CVH group, and 31.0% in the high CVH group (Figure A). Using the low CVH group as the reference, the multivariable-adjusted OR (95% CI) for follow-up CAC&gt;0 was 0.37 (0.25-0.55) in the moderate CVH group and 0.24 (0.15-0.38) in the high CVH group. Higher baseline CVH scores were log-linearly associated with lower odds of follow-up CAC&gt;0 (Figure B). Each 10-point higher baseline CVH score was associated with a 27% lower odds of CAC&gt;0 at follow-up (OR, 0.73; 95% CI, 0.66-0.82). The association was consistent across pre-specified subgroups and sensitivity analyses. Conclusions: Higher CVH by LE8 score was associated with a lower risk of developing CAC&gt;0 among healthy middle-aged Koreans, suggesting the importance of promoting ideal CVH for the prevention of cardiovascular disease.
Abstract 4141332: Gut Microbiota Dysbiosis Contributes to the Development of Diabetic Cardiomyopathy
Authors: Chaoyue Zhang, Yunke Shi, Ao Shi, Hongyan Cai
Journal: Circulation (2024)

Background: Diabetic cardiomyopathy (DCM) is one of the most serious complications of diabetes mellitus (DM). However, studies exploring the roles of gut microbiome in DM and cardiovascular disease remain limited. Hypothesis: Gut microbiota dysbiosis is associated with the development of DCM. Methods: We collected fecal and serum samples from 18 DCM patients and 13 matched control subjects for metagenomic and metabolomic analysis. Fecal microbiota transplantation (FMT) with samples from both groups was performed on the pseudo-germ-free (PGF) rats. Then, we analyzed rat gut microbiota by 16S rDNA sequencing, and examined cardiac parameters and blood glucose indicators of PGF rats. Serum and myocardium metabolomic analysis was performed on DCM rats and compared with human samples. Results: Linear Discriminant Analysis Effect Size ( p ＜0.05, LDA≥2.0) of the metagenomics data identified 11 gut microbiota, which can be used as the DCM patient’s biomarkers. After FMT, compared to control-PGF rats, DCM-PGF rats showed significant differences in the composition of gut microbiota (α-diversity, simpson p =0.015, shannon p =0.011; β-diversity p= 0.005). Moreover, DCM-PGF rats had higher fasting blood glucose levels ( p =0.036), intraperitoneal glucose tolerance test showed higher blood glucose levels at 15 and 30 minutes ( p =0.000, 0.030), left ventricular (LV) end systolic diameter was larger ( p =0.009), diastolic and systolic LV anterior wall thickness, and systolic LV posterior wall thickness were thicker ( p =0.011, 0.035, 0.036), fibrosis area was larger ( p =0.022). When comparing metabolic profiles of serum of DCM patients, serum of DCM rats and the myocardium of DCM model with the corresponding controls, we identified 2 shared differential metabolites: Hydroxybutyric acid and 15,16-DiHODE . Spearman correlation analysis of these two metabolites with differential gut microbiota species in DCM patients vs. control subjects showed that Hydroxybutyric acid and 15,16-DiHODE are strongly correlated with 7 species ( p ＜0.05, r＞|0.5|) and with 23 species ( p ＜0.05, r＞|0.5|) respectively. Conclusions: Our study found that DCM patients have their characteristic altered gut microbiota and serum metabolites, which may be responsible for the development of DCM. Gut microbiota is expected to be a potential target for therapeutic intervention in DCM.
Abstract 4141063: Differences on Periprocedural Blood Flow Dynamics between Self- and Balloon-expandable Valves in Patients with Small Aortic Annulus Undergoing Transcatheter Aortic Replacement
Authors: Takeshi Hamaya, Toshiyuki Nagai, Kiwamu Kamiya, Satonori Tsuneta, Hirokazu Komoriyama, Yuki Takahashi, Akinori Takahashi, Yuki Mori, Seiichiro Naito, Sakae Takenaka, Suguru Ishizaka, Takuma Sato, Takao Konishi, Toshihisa Anzai
Journal: Circulation (2024)

Backgrounds: A recent trial has shown that the supra-annular self-expanding valve (SEV) is superior for valve function and noninferior for clinical outcomes at one year compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). However, differences on blood flow hemodynamics between the valves remain unclear. We aimed to investigate these differences between the SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). Methods: We prospectively examined 95 consecutive patients with severe AS and a SAA who underwent TAVR between May 2018 and April 2024 (31 SEV and 64 BEV). SAA was defined as ≤430 mm 2 based on the trial. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the SEV and BEV using 4D flow CMR. Results: The absolute reductions in the vortical flow, helical flow and flow eccentricity were significantly higher in the SEV group than in the BEV group after TAVR (SEV: -0.35 ± 0.88 vs. BEV: 0.15 ± 1.01, P = 0.02, SEV: -0.87 ± 0.81 vs. BEV: -0.38 ± 0.88, P = 0.003, and SEV: -0.61 ± 0.92 vs. BEV: -0.21 ± 0.83, P = 0.037, respectively) (Figure 1A-C). The absolute reduction of average WSS was significantly higher in the SEV group than that in the BEV group after TAVR (SEV: -1.9 [-3.7 – -0.90] Pa vs. BEV: -0.94 [-2.6 – 0.35] Pa, P = 0.049) (Figure 1D). The systolic EL significantly decreased after TAVR in both groups, whereas its absolute reduction was comparable between the groups (SEV: -4.9 [-7.6 – 0.21] mW vs. BEV: -4.4 [-9.5 – 1.5] mW, P = 0.61). Conclusions: The vortical flow, helical flow, flow eccentricity, and average WSS in the AAo after TAVR were significantly decreased in the SEV compared to those in the BEV in patients with SAA undergoing TAVR. Our findings suggest the favorable profile on blood flow dynamics in the supra-annular SEV, possibly supporting its superiority of valve function.
Abstract 4141191: Early-life Exercise Extends Healthspan and Attenuates Cardiovascular Aging in Aged Mice
Authors: Mengya Feng, Min Li, Jing Lou, Guiling Wu, Yanzhen Tan, Xuyun Liu, Jiankang Liu, Xing Zhang, Feng Gao
Journal: Circulation (2024)

Introduction: Regular physical exercise is widely recognized for its beneficial effects on overall health. Despite emerging evidence that early-life experiences profoundly impact adult and aged health, the long-term effects of early-life exercise remain uncertain. Hypothesis: We hypothesized that early-life exercise extends healthspan and attenuates cardiovascular aging in aged mice. Methods: Male and female C57BL/6J mice were subjected to a 3-month swimming exercise regimen starting from 1 month of age (1.5 hour per day, 5 days per week), while no exercise intervention was conducted at other times. The sedentary group was raised under similar conditions. The healthspan of aged male and female mice was assessed, including overall metabolic function, cardiovascular function, frailty index and other relevant measurements. Transcriptional profiling of young and old mice was performed to gain insights into the mechanisms underlying the effects of early-life exercise on aging. Results: Early-life exercise improved metabolic health in aged mice. Assessment of body composition showed increased lean mass in the exercise group. When subjected to food deprivation stress in metabolic chambers, aged mice with early-life exercise exhibited increased energy expenditure, carbohydrate oxidation, and fat oxidation levels in both males and females. Evaluation of frailty index at 24 months of age, involving 31 frailty phenotypes, indicated lower frailty index score in the early-life exercise group, suggesting an attenuation of age-related phenotypes. While no significant differences were observed in blood pressure and cardiac systolic function, early-life exercise was associated with improved cardiac diastolic function at 19 months of age. Furthermore, early-life exercise resulted in decreased heart-carotid pulse wave velocity and improved endothelial-dependent vascular relaxation in aged mice, indicating better vascular function in elderly mice with early-life exercise. Conclusions: The findings demonstrate that early-life exercise contributes to an increased healthspan, as evidenced by enhanced metabolic health and reduced frailty. Both male and female aged mice exposed to early-life exercise exhibit improved cardiovascular function.