tbuckley/cabot-search huggingface dataset:
Abstract 12224: Long Term Mortality in Patients With Low-Risk Myocardial Perfusion Imaging
Authors: Mahati Dasari, Pramukh Arun Kumar, Pradnya Brijmohan Bhattad, Ajay K Mishra, Arushi Sharma, Ashwini Bhat, Michael Leblanc, Eddison Ramsaran, neeta shah
Journal: Circulation (2023)

Introduction: Stress testing is utilized for diagnosis and risk stratification for coronary artery disease, with low-risk myocardial perfusion imaging (MPI) indicating less than 1% cardiac mortality per year. We aimed to determine the long-term cardiac mortality in these patients. Methods: We performed a retrospective observational study of 1,300 patients with low-risk MPI in 2015, including pharmacological and exercise studies in a tertiary care center in Central Massachusetts, USA. Each patient was followed from the time of the MPI study for a total duration of 7 years. All-cause mortality and cardiac death were identified. We calculated the pharmacologic and exercise MPI percentage in patients with cardiac death. A cardiac mortality graph was plotted to observe trends over seven years. Results: Out of the 1,300 patients, 3.2% [n=42; mean age 74.6+/-20 years, 78% male (n=32)] of patients had a cardiac death in the follow-up period of 7 years. The pharmacological MPI group had 5% (n=41) cardiac deaths as compared to 0.2% (n=1) in the exercise MPI with the low Duke Treadmill Score group (p-value 0.04) [Figure 1a]. The cardiac death trend over the seven years revealed the highest mortality in year 6 (19%, n= 8) and the lowest in year 4 (7.1%, n=3) [Figure 1b]. Conclusions: The incidence of long-term cardiac deaths is less than 0.5% each year in patients with low-risk MPI, in both groups. Cardiac mortality was higher in patients who underwent pharmacological stress tests indicating appropriate assessment of underlying cardiac pathology. Exercise MPI depends on multiple variables to be optimal, while all patients undergoing pharmacological MPI are maximally stressed. Extensive, multi-center, controlled studies are necessary to evaluate the differences in risk stratification of low-risk MPI between exercise and pharmacological stress tests.
Abstract 12181: Association of Left Atrial Function With Vascular Brain Injury: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)
Authors: Wendy Wang, Riccardo M Inciardi, Jorge L Reyes, Thomas Mosley, Michelle C Johansen, Rebecca F Gottesman, Alvaro Alonso, Pamela L Lutsey, Clifford R Jack, Scott Solomon, Amil M Shah, Bruce A Wasserman, Lin Y Chen
Journal: Circulation (2023)

Background: Lower (worse) left atrial (LA) function is associated with higher dementia risk. It is unclear whether lower LA function is associated with vascular brain injury on brain MRI, an established correlate for higher dementia risk. Using data from the Atherosclerosis Risk in Communities (ARIC) study, we assessed the cross-sectional association between LA function measures and brain MRI markers of vascular brain injury (cerebral microbleeds, brain infarcts). Hypothesis: Participants with lower LA function will be more likely to have presence of &gt; 1 cerebral microbleed or brain infarct. Methods: ARIC participants who had both an echocardiogram and brain MRI at visit 5 (2011-13) were included. We excluded those with prevalent dementia, stroke, or atrial fibrillation. LA function measures were obtained from 2D-echocardiograms and assessed in quartiles (highest quartile was the reference). Brain MRI measures were assessed as the presence or absence of &gt; 1 cerebral microbleed or brain infarct. Logistic regression was used. Results: Of the 1502 participants (mean [SD] age 76 [5], 60% female, 27% Black) in this analysis, 345 (23%) and 351 (23%) had &gt; 1 cerebral microbleed or brain infarct present. Compared to the highest quartile, lower LA reservoir and conduit strain quartiles were associated with higher odds of cerebral microbleeds. LA contractile strain was not associated with cerebral microbleeds. Compared to the highest quartile, the lowest LA conduit strain quartile, but not reservoir strain, was associated with higher odds of brain infarcts. LA contractile strain was inversely associated with brain infarcts. Conclusion: In this community-based cohort, lower LA function was cross-sectionally associated with cerebral microbleeds and brain infarcts. The inverse relationship with LA contractile strain may be due to contractile function compensating for a decrease in early diastolic filling. Prospective studies are needed to confirm these findings.
Abstract 12234: Concurrent Amyloid Light-Chain Cardiac Amyloidosis and Abdominal Leiomyosarcoma - Diagnostic and Therapeutic Challenges
Authors: Joshua H Arnold, Ofer Merimsky, Sivan Shamai, Ido Wolf, Shmuel Banai, Yan Topilsky, Irit Avivi, Yael Cohen, Tamir Shragai, Michal Laufer Perl
Journal: Circulation (2023)

Background: AL amyloidosis is a rare disorder characterized by organ infiltration of unstable misfolded light chain proteins. Diagnosis requires a high degree of suspicion, and cardiac involvement has poor outcomes. Anthracycline-based regimens are preferred for treating abdominal leiomyosarcoma (LMS) but pose a challenge in the presence of cardiac AL amyloidosis. Case: A 66-year-old male presented with bilateral leg edema and underwent evaluation for new heart failure. Echocardiography revealed preserved left ventricle ejection fraction (LVEF) with mild hypertrophy, increased interventricular septum thickness, and diastolic dysfunction. Due to concern for cardiac amyloidosis, the patient underwent nuclear scintigraphy scan, which was negative. Ongoing clinical suspicion prompted endomyocardial biopsy, which was positive for Congo Red staining, and serum studies revealed monoclonal lambda spike with increased free light chains. PET-CT was done to assess the lung nodule, revealing abdominal LMS. While Anthracycline is the drug of choice for LMS, its potential cardio-toxic effect in the presence of heart failure need be addressed. Treatment decisions involved a multidisciplinary team, resulting in bortezomib for AL amyloidosis, gemcitabine/paclitaxel for LMS, and symptomatic heart failure management. Decision-making: Anthracycline therapy was avoided due to potential cardiotoxicity. Daratumumab was added to expedite light chain reduction and minimize cardiotoxic effects. Individualized treatment considered the patient's clinical presentation and comorbidities. Conclusion: Diagnosing cardiac amyloidosis requires a high index of suspicion. Concurrent AL amyloidosis and LMS is extremely rare and presents a therapeutic dilemma, necessitating personalized management. Further research is needed to assess the potential cardio-toxic effect of anthracycline in the presence of cardiac AL amyloidosis.
Abstract 12472: Impact of Left Ventricular Unloading on Outcome of Heart Transplant Bridging With Extracorporeal Membrane Oxygenation Support
Authors: Vasiliki Gregory, Kenji Okumura, Elliot Levine, Ameesh Isath, Shazli Khan, Masashi Kai, David Spielvogel, Suguru Ohira
Journal: Circulation (2023)

Introduction: The new heart allocation policy prioritizes veno-arterial extracorporeal membrane oxygenation (ECMO) supported candidates at the highest status. Evidence suggests that left ventricular (LV) unloading during ECMO is beneficial by reducing the LV end-diastolic pressure and increasing support. The impact of LV unloading on outcomes following bridging to heart transplant (HT) with ECMO is uncertain. Methods: Under the new policy (Oct 18, 2018 to Jun 30, 2022), 596 patients on ECMO at the time of HT were identified in United Network for Organ Sharing database and divided into two groups: ECMO alone (N=387) vs. ECMO with LV unloading (N=209). Sub-analysis was performed in LV unloading group: Impella (N=73) vs. intra-aortic balloon pump (IABP) (N=136). Results: The median duration on the waitlist was 5 days for both groups. The ECMO alone group had younger recipients (ECMO alone, 48 vs. LV unloading, 53 years, P=0.018) and younger donors (ECMO alone, 29 vs. LV unloading, 32 years, P=0.041). Other characteristics were similar. In LV unloading group, recipient characteristics were comparable between Impella and IABP patients. Kaplan-Meier survival analysis showed comparable 1-year survival rates between the groups (ECMO alone, 88.1±1.8% vs. LV unloading, 89.8±2.3%, P=0.96, Figure 1A). Multivariable Cox hazard model revealed no association between LV unloading and post-HT mortality (hazard ratio, 0.95, 95% confidence interval, 0.59, 1.54, P=0.80). In the different LV unloading methods, 1-year survival was similar: Impella, 90.6±3.7% vs. IABP, 88.9±2.9%, P=0.65, (Figure 1B). There was a trend toward a higher stroke rate with Impella (12%) compared to IABP (5.2%) (P=0.061). Conclusions: LV unloading did not impact survival in patients bridging to HT with ECMO under the new allocation policy, regardless of the specific mode of LV unloading. Individualized approaches are crucial for patients on ECMO undergoing HT, as LV unloading might not always be necessary.
Abstract 12289: A Postpartum Diastolic Murmur
Authors: Joyce Han, Sameer Sheth, Eric M Isselbacher, Nandita Scott
Journal: Circulation (2023)

A 44-year-old G3P1011 underwent uncomplicated Caesarian section for obstetric indications with delivery of a healthy girl. Several hours postpartum, she developed hypoxemia requiring transient supplemental oxygen. Cardiology was consulted for further evaluation. Upon initial assessment, she appeared comfortable with an oxygen saturation of 93% on room air. She reports an otherwise uneventful pregnancy. Her past medical history is significant for chronic hypertension on propranolol. She was afebrile with a HR of 91, BP 147/66 (left arm) and 155/68 (right arm). Her JVP was 10-11 cm H20. There was a III/IV low-pitched decrescendo early-mid diastolic murmur, loudest at the left lower sternal border, radiating to the apex, and a systolic ejection murmur. EKG (panel A) showed normal sinus rhythm, with no ischemic abnormalities. Due to the discovery of a new murmur, there was concern for valvular pathology as a cause for her suspected heart failure, particularly aortic regurgitation (AR). An urgent TTE (panel C-E) was requested and showed a dissection flap in the ascending aorta, effacement of the sinotubular junction, and severe AR. CT angiogram confirmed the diagnosis of type A aortic dissection (AD; panel B). Twelve hours after the delivery of her baby, she underwent emergent aortic valve repair and aortic arch replacement. She recovered well and was discharged home post-op day 6. Though no human data exists, animal data suggests increased AD risk in breastfeeding animals with Marfan Syndrome. Due to her near catastrophic presentation, she elected to not breastfeed. Her genetic testing results are pending. AD in pregnancy is rare. There is an increased risk of AD in pregnant compared to non-pregnant women. AD often occurs in the third trimester or postpartum, and most women are unaware of a preexisting arteriopathy. In this case, the detection of a diastolic murmur resulted in rapid diagnosis and treatment, essential in the management of this life-threatening condition.
Abstract 12444: Pulse Pressure and Cardiovascular and Renal Outcomes by Age in the Chronic Renal Insufficiency Cohort
Authors: Clara Fischman, Raymond R Townsend, Debbie L Cohen, Mahboob Rahman, Matthew R Weir, Stephen P Juraschek, Andrew South, Lawrence J Appel, Paul Drawz, Jordana Cohen
Journal: Circulation (2023)

Pulse pressure (PP) is associated with cardiovascular events and the progression of chronic kidney disease (CKD) to end stage kidney disease (ESKD). While PP is known to widen with age, it is less clear what other clinical factors affect PP and whether the risks associated with wide PP are the same across all ages. We used Cox proportional hazards models to investigate the association of PP with development of 1) atherosclerotic cardiovascular disease (ASCVD) events (congestive heart failure hospitalization, myocardial infarction, stroke and peripheral artery disease) or death and 2) 50% reduction in estimated glomerular filtration rate (eGFR) or ESKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. In sensitivity analyses, we evaluated the association of time-updated PP with these outcomes, accounting for potential time-updated confounders using inverse probability of treatment weighting. We evaluated for effect modification by age (divided into tertiles), apparent treatment-resistant hypertension (HTN), baseline diabetes mellitus (DM) status, baseline CKD stage and baseline cardiovascular disease (CVD). Among 5,621 participants with CKD followed for ~5.4 years, mean PP was 57±19 mmHg, 1,396 (25%) had an ASCVD event, 1,186 (21%) died and 1,783 (32%) participants experienced the composite renal outcome. Every 10 mm Hg wider PP was associated with 6% higher risk of an ASCVD event or death (time-updated adjusted hazard ratio [HR]=1.06, 95% CI 1.04, 1.08) and 17% higher risk of the composite renal outcome (time-updated adjusted HR=1.17, 95% CI 1.16, 1.18). Wider PP was associated with a higher risk of ASCVD events or death among participants in the lowest age tertile (21-61 years; Figure 1A ), but a higher risk of the composite renal outcome in the oldest age tertile (71-79 years; Figure 1B ), suggesting PP may be associated with different pathophysiology across ages.
Abstract 12155: Trends in the Clinical Outcomes and Resource Utilization of Catheter-Based Thrombolytic Therapy vs. Systemic Thrombolytic Therapy in Patients With Acute Pulmonary Embolism
Authors: Arham Pasha, Muddasir Ashraf
Journal: Circulation (2023)

Introduction: Contemporary trends in clinical outcomes and resource utilization in patients with acute pulmonary embolism (PE) undergoing thrombolytic therapy are not well-known. Research Question: We wanted to analyze the trends in outcomes of catheter-based thrombolytic therapy (CDT) vs. systemic thrombolytic therapy (ST) in patients with PE. Aim: We aimed to compare the trends in in-hospital mortality, length of stay (LOS), and hospital costs in patients with PE who underwent CDT vs. ST. Methods: Using the National Inpatient Sample, all adult patients hospitalized with PE from 2012 to 2018 were identified using the International Classification of Disease diagnostic codes. Multivariate linear and logistic regression were used to obtain trends and effect sizes. Results: We identified 1.27 million patients with PE, of which 45,950 underwent thrombolytic therapy (CDT=30.1% and ST=69.9%). The mean age of patients receiving CDT vs. ST wasn't different (59.7 vs. 59.3, P=0.14). The proportion of CDT among all patients with PE increased from 0.4% in 2012 to 1.9% in 2018. Baseline characteristics of patients who underwent CDT vs. ST are shown in panel A. Risk-adjusted mortality was significantly lower in patients receiving CDT vs. ST (AOR=0.38, P=&lt;.01). Risk-adjusted LOS was 0.19 days non-significantly higher in patients with CDT vs. ST (P-value=0.12). The hospital cost was significantly higher in patients who underwent CDT vs. ST (β=2917 USD, P&lt;.01). Temporal trends of these outcomes are shown in panels B-D. Conclusions: It is encouraging to see an increasing trend in the utilization of CDT. In-hospital mortality decreased in patients with CDT and ST, but CDT continues to be superior. The LOS was not significantly different among these groups but significantly decreased in both groups over time. Finally, hospital cost was higher in patients with CDT vs ST, but these cost differences between CDT and ST narrowed due to decreasing cost of CDT and increasing cost of ST over time.
Abstract 11795: CXCL5 Inhibition Recovers Neovascularization in Diabetes Mellitus
Authors: Ting-Ting Chang, Ching Chen, Liang-Yu Lin, Jaw-Wen Chen
Journal: Circulation (2023)

Introduction: Diabetes mellitus (DM) is a chronic inflammatory disease accompanied by dysfunction of vascular endothelial cells. Vascular complications are the main causes of death in patients with DM. CXCL5 is an inflammatory chemokine that upregulated in patients with type 2 DM. However, its role in diabetic vasculopathy was not clarified. This study aimed to explore the impacts and mechanistic insights of CXCL5 in neovasculogenesis in DM. Methods: Endothelial progenitor cells (EPCs) and human aortic endothelial cells (HAECs) were used in vitro. Streptozotocin-induced diabetic mice and dbdb mice were used as type 1 and type 2 DM models. CXCL5 knockout mice were also used to generate the diabetic animal model. The hindlimb ischemia surgery, matrigel plug assay, and aortic ring assay were conducted. Flow cytometry were used to evaluate the circulating number of EPCs. Results: CXCL5 concentrations were increased in plasma and EPCs culture medium from type 2 DM patients. CXCL5 inhibition by neutralizing antibody upregulated VEGF/SDF-1 expression and improved migration and tube formation abilities in EPCs from type 2 DM patients and high glucose-treated EPCs from non-diabetic subjects as well as HAECs. Intraperitoneal injection of CXCL5 neutralizing antibody increased circulating EPC number, enhanced capillary density, and recovered the blood flow after hindlimb ischemia surgery in both type 1 and type 2 diabetic animals. Protein levels of VEGF and SDF-1 in ischemic muscle were upregulated in the CXCL5 inhibition group. Additionally, diabetic mice injected with CXCL5 neutralizing antibody showed higher hemoglobin contents and neovascular branches in the matrigel plug assay and aortic ring assay, respectively. Importantly, CXCL5 knockout diabetic mice showed improved ischemia-induced angiogenesis and higher expression of angiogenic proteins in ischemic muscle compared with wild-type diabetic mice. Conclusion: CXCL5 inhibition can improve neovasculogenesis via protecting vascular endothelial function and upregulating angiogenic protein expressions in both type 1 and type 2 DM. Further clinical studies are needed to verify that CXCL5 may be a potential therapeutic target for DM vascular complications.
Abstract 11637: Using Dielectric Sensing in Making Discharge Decision for Patients With Heart Failure
Authors: Richard D McLane, Angela D Stultz, Daniel F Pauly
Journal: Circulation (2023)

Introduction: Decompensated heart failure is a leading cause of hospitalization in the United States and is driven by high readmission rates. Despite numerous advancements in diagnosing and treating advanced heart failure, there remains a lack of validated measures to predict patient volume status and readmission rates. Remote dielectric sensing (ReDS) is a non-invasive, radiation-free measure of lung fluid content. Hypothesis: We aim to assess the utility of ReDS in guiding clinical management and as a quantitative metric to predict 30-day readmission rates. We predict normalization of lung fluid value before discharge will have a lower 30-day readmission rate than patients with no normal value before discharge. Methods: Lung fluid values were collected using ReDS vests for 1,224 patients with advanced heart failure. Our retrospective analysis compared patients with normalization of lung fluid values during admission to patients without normalization of these measures to determine a difference in readmission rates between groups. Secondary analyses were performed to assess the effects of other clinical markers, including ejection fraction and age, on lung fluid values and 30-day readmission rates for individual patients. Results: The primary comparison between patients with normal lung fluid values at discharge and patients without normalization of lung fluid values revealed a trend towards lower readmission for those with normalization of lung fluid values (16.6% vs. 29.2%, p=0.07). No differences were observed in patients who had non-normal repeat lung fluid values before discharge and those who did not receive a repeat measure (29.2% vs. 29.8%, p=0.88). Readmitted patients had a higher initial lung fluid value (45±6.6 versus 44 ± 5.9, p=0.02). No differences in lung fluid values at discharge or changes during hospitalization were observed. Conclusions: Remote dielectric sensing may predict lower readmission rates in patients whose values normalize during admission compared to patients with non-normalized values. Future prospective studies are necessary to determine the full utility of ReDS in the clinical setting.
Abstract 12307: Machine Learning Model Predicting Bleeding Risk in Patients With Coronary Artery Disease
Authors: Masanobu Ishii, Taishi Nakamura, Yoshinori Yamanouchi, Yasuhiro Otsuka, sou ikebe, Kenichi Tsujita
Journal: Circulation (2023)

Background: Bleeding complication during antiplatelet therapy for coronary artery disease (CAD) is an adverse issue due to high risk of subsequent death and cardiovascular events. Although many bleeding risk scores have been proposed, simple and personalized risk assessment in routine clinical practice is challenging because of the heterogeneous and multifactorial pathophysiological condition. We aimed to develop a machine learning-based risk prediction for bleeding events in CAD patients treated with antiplatelet therapy. Methods: This study was a retrospective, observational cohort study using the Japanese nationwide electronic medical record database. Data from 49,324 CAD patients who underwent revascularization and received antiplatelet therapy between July 2008 through July 2022 were randomly assigned to the model derivation and validation sets. Data balancing technique: synthetic minority over-sampling technique was used to process the imbalanced data. Risk prediction model was developed using random forest (RF) after feature selection by the Boruta algorithm. Outcome was defined as bleeding events requiring hospitalization. Results: Of all, 1,684 (3.4%) bleeding events were observed during study period. The area under the curves of receiver operator characteristics of RF (95% confidence intervals) for bleeding were 0.977 (0.976-0.978) in derivation and 0.975 (0.972-0.977) in validation set. The performance metrics of the model were well acceptable (accuracy, 0.939; precision, 0.990; recall, 0.887; F1-score 0.936, respectively) in validation set. The sigmoid calibrated RF models resulted in well approximating observed bleeding events in the calibration plot and the Brier score of 0.042. Conclusions: This machine learning model could predict bleeding risk for CAD patients treated with antiplatelet therapy in real-world setting.