tbuckley/cabot-search huggingface dataset:
Abstract 15128: Impact of Paternal and Maternal Obesity on Offspring Systolic and Diastolic Function, and Liver Steatosis Early in Life
Authors: Jussara M Docarmo, John E Hall, Xuemei Dai, Nikaela Aitken, Kylie M Larson, Zhen Wang, Ana C Omoto, Alan J Mouton, Xuan Li, Alexandre A Da
Journal: Circulation (2023)

Introduction: Obesity in women and men of reproductive age may lead to adverse cardiovascular and metabolic developmental programing in their offspring. For example, we observed signs of cardiac diastolic dysfunction in offspring from obese rats as early as 3 weeks of age. However, the contribution from paternal and maternal obesity to increased susceptibility for developing cardiac dysfunction in their offspring early in life is unknown. Hypothesis: We hypothesized that paternal and maternal obesity both play important roles in causing impaired cardiac function and metabolic disorders such as fatty liver in their offspring early in life. Methods: Livers from male newborn Sprague-Dawley rats born from obese fathers (fHFD-offs), obese mothers (mHFD-offs), or from both parents being obese (fmHFD-offs) were weighed and analyzed for fat content by oil red-O and ECHOMRI. Additionally, within 1-3 days after weaning, male offspring were submitted to cardiac catheterization for assessment of cardiac function. Age-matched offspring from lean rats (ND-Offs) were used as controls. Results: fmHFD-Offs and mHFD-offs groups were heavier compared to fHFD-offs and ND-offs groups (61±4 and 64±2 vs 57±2 and 48±2 g, respectively) at 1-3 days after weaning. Newborn rats with at least one obese parent had more liver fat infiltration compared to ND-offs controls. Compared to ND-offs, only offspring from obese mothers (mHFD-offs) exhibited reduced dP/dt max (8998±466 vs. 10560±807, 11869±1171, and 11611±436 mmHg/s for mHFD-offs vs fHFD-offs, fmHFD-offs and ND-offs, respectively); fmHFD-offs and mHFD-offs showed additional signs of impaired diastolic function as indicated by increased Tau values (5.7±0.2 and 5.6±0.3 vs. 4.7±0.2 and 5.0±0.1 ms for fmHDF-offs and mHFD-offs vs ND-offs and fHFD-offs, respectively). Conclusions: These results indicate that while increased liver steatosis develops independent of which parent is obese, the presence of maternal obesity appears to be more critical for male offspring to develop cardiac dysfunction early in life. Additional studies in adult and aged offspring are needed to test if the impact of paternal and maternal obesity on offspring cardiometabolic function gets stronger with aging.
Abstract 18727: Outcomes of Utilization of Transesophageal Echocardiogram (TEE) vs Intracardiac Echocardiogram (ICE) for Atrial Fibrillation Ablations in the Real-AF Registry
Authors: Iva Minga, Kevin Lee, Allyson Varley, Christopher Thorne, Jose Osorio, Matthew Singleton, Benjamin DSouza, Joshua Silverstein, Mark Metzl
Journal: Circulation (2023)

Introduction: Transesophageal (TEE) and intracardiac (ICE) echocardiogram are widely used strategies to rule out LAA thrombus prior to atrial fibrillation (AF) ablation. We compare the utilization of TEE and ICE, outcomes and complications of each strategy. Methods: The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (PAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that is enrolling patients undergoing AF ablation at high-volume centers. We compared complications rates (Table 1) between TEE and ICE in patients with AF underdoing index ablation for AF in the REAL-AF registry. Patients who underwent both TEE and ICE were excluded from the analysis. Bleeding complication was defined as bleeding that occurs within the first 72 hours of the procedure requiring transfusion or resulting in &gt;20% drop in hemoglobin. Vascular access complications included AV fistula or pseudo-aneurysm needing intervention. Results: A total of 1628 patients were included in the analysis.The mean age was 64.78 (SD=11.43) years, 45.7% were women, mean BMI was 30.36 (SD=6.71) and mean CHAD2DS2VASc score was 2.49 (SD=1.51). TEE was used in 911 patients (58.5%) and ICE was used in 717 (46.1%) ] prior to ablation. There were 0% strokes reported in the TEE group vs 0.1% in the ICE group (p = 0.095). Among other complications reported there was no statistical difference between the two groups (Table 1). There was no significant difference between the two groups on recurrence of arrhythmias at 12 months (HR: = 0.983, CI: 0.79,1.3 , p &lt; 0.894) Conclusion: Both TEE and ICE are acceptable strategies for pre-ablation assessment of left atrium and LAA. There are no significant differences in stroke rates between the two groups. Other reported complications are also similar between the two groups. Choice of either TEE vs ICE depend on patient specific characteristics, hospital resources and operator preference.
Abstract 17359: UCP2 Induced Glycolysis Promotes Histone Acetylation to Regulate Cardiomyocyte Cell Cycle After Injury
Authors: Jennifer L Pennise, Vagner O Rigaud, Clare Zarka, Isabella Brosious, Sadia Mohsin, Mohsin Khan
Journal: Circulation (2023)

Developmental cardiac tissue is proliferative capable of robust regenerative response after myocardial injury, but this ability is lost by P7 when cardiomyocytes (CMs) exit the cell cycle and become terminally differentiated. Postnatal CMs exhibit a specialized metabolic state that supports rapid proliferation and is altered with loss of regeneration in the heart. Studies have shown that reliance on glycolysis for energy generation is preferred by proliferating CMs and activation of glycolysis promotes cardiac repair. Nevertheless, the role of glycolysis in regulating CM gene program linked to cell cycle and repair in the heart remains poorly studied. Here, we identify a novel role for mitochondrial uncoupling protein 2 (UCP2) in the heart regulating CM cell cycle dynamics. UCP2 was found to be primarily active during cardiac development, rapidly decreases after birth and is expressed at low levels in the adult heart. UCP2 overexpression in human IPS derived CMs increases cell cycle progression as assessed by immunostaining and flow cytometry-based DNA content analysis. In parallel, neonatal rat ventricular myocytes (NRVMs) overexpressing UCP2 showed increased glycolysis and glycolytic metabolites, reduced mitochondrial membrane potential and mitochondrial activity compared to controls. Next, we generated αMHC-UCPKO mice that showed reduction in total number of CMs and pHH3 levels, increased CM size and ploidy during postnatal development. Adult αMHC-UCPKO subjected to myocardial infarction injury showed significant cardiac dysfunction and fibrosis at 4 weeks compared to controls. Mechanistically, UCP2 induced glycolysis increases ATP-citrate lyase (ACLY) mediated acetyl-CoA generation in the CMs. Additionally, CMs isolated from P1 αMHC-UCPKO showed several histone modifications including decrease in histone acetylation marks. Similarly, NRVMs overexpressing UCP2 showed increased histone H3 acetylation and expression of histone acetyltransferases (HATs) and corresponding decrease in histone deacetylases (HDACs). In conclusion, UCP2 is a novel developmental metabolic regulator of CM cell cycle in the neonatal and adult heart. Moreover, UCP2 induced glycolysis increases cell cycle via altering CM histone acetylation.
Abstract 147: Is Effect Size of Targeted Temperature Management Different for Pediatric Post-Cardiac Arrest Syndrome According to the Severity?
Authors: Takeshi Namba, Shinichiro Ohshimo, Mitsuaki Nishikimi, Hiromi Miyoshi, Yuki Masuka, Nobuaki Shime
Journal: Circulation (2023)

Introduction: The beneficial effect of target temperature management (TTM) for pediatric post-cardiac arrest syndrome (PCAS) patients is controversial, and there are few studies on the differential effects of TTM according to the risk classification. Objective: The aim of this study was to evaluate the differential effects of TTM for pediatric PCAS patients according to a risk classification tool we previously developed, rCAST. Methods: We used data from the Japanese nationwide out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine. We classified eligible pediatric PCAS patients (aged ≤18 years) who achieved return of spontaneous circulation (ROSC) according to the quintile of score points on the rCAST. The effect of TTM for their neurological outcome was evaluated for each severity group. And then, focusing on the severity group that appeared to benefit from TTM, we also evaluated the effect of TTM by the propensity score analysis with several adjustment factors. Good neurological outcome was defined as a Cerebral Performance Categories score or Pediatric Cerebral Performance Categories score ≤2 at 30 days. Results: Among 1,526 OHCA pediatric patients in the registry, data of 307 PCAS patients who achieved ROSC were analyzed. The proportion of patients with a good neurological outcome was higher among those who underwent TTM compared to those who did not in the first to forth quintile (TTM vs non-TTM; 81% [21/26] vs 58% [21/36] [p=0.10] in the first, 11% [2/19] vs 7% [2/31] [p=0.63] in the second, 12% [2/17] vs 0% [0/55] [p=0.053] in the third, and 11% [1/9] vs 0% [0/21] [p=0.30] in the fourth). In the group of the fifth quantile (rCAST ≥ 18.5), no patients showed good neurological outcome regardless of TTM (0% [0/20] vs 0% [0/73]). The propensity score analysis showed that TTM was significantly associated with their good neurological outcome in the patients classified into the first to fourth quantile group (Odds ratio; 1.21 [1.04-1.40], p = 0.014). Conclusions: TTM was significantly associated with a good neurological outcome in the pediatric PCAS patients with rCAST ≤ 18.0. All patients with rCAST ≥ 18.5 showed poor neurological outcomes even if they underwent TTM.
Abstract 16126: Sex Differences in the Relationship Between Left Ventricular Global Longitudinal Strain and Abnormal Myocardial Flow Reserve in a Patient Population With Sleep Disordered Breathing
Authors: Magdalena Malczewska, Attila Feher, Robert L McNamara, Edward J Miller, Henry K Yaggi, Stephanie Thorn, Albert J Sinusas, Ehimen Aneni
Journal: Circulation (2023)

Introduction: Obstructive sleep apnea (OSA), a form of sleep disordered breathing (SDB), is associated with abnormal myocardial flow reserve (MFR), a precursor to heart failure with preserved ejection fraction (HFPEF). Sex differences have been reported in the prevalence of abnormal MFR and OSA. However, it is unknown if there are sex differences in the relationship between left ventricular (LV) global longitudinal strain (GLS) and abnormal MFR in a patient population with SDB. Methods: We compared LV GLS among patients in our institution who had sleep testing for obstructive sleep apnea (OSA), cardiac PET stress test and an echocardiogram between 2015 and 2019. We reprocessed the echocardiograms using a vendor neutral software to obtain the two-dimensional LV GLS. Results: Among the 148 participants, 59% were female. Compared with females, males had lower BMIs, a higher prevalence of prior myocardial infarction or revascularization, and a greater severity of nocturnal airway obstruction and hypoxia. Males also had a greater proportion with abnormal LV GLS (≥ -17). See Table. The prevalence of abnormal MFR (&lt; 2.0) was higher among participants with abnormal LV GLS ( P = 0.031). This association was persistent among males but was lost among females (see Figure ). In age and sex adjusted logistic regression persons with abnormal LV GLS had 2X the odds of abnormal MFR (OR 2.3; 95% CI: 1.02 - 5.03). Among males, this association was significant (OR 4.8; 95%CI:1.5 - 13.7). No association observed among females. Formal interaction analyses did not meet statistical significance ( P int = 0.106). Conclusions: In this patient population with SDB, there was a significant association between LV GLS and abnormal MFR. The sex differences in the relationship may be due to differences in the severity of OSA and prevalence of ischemic heart disease. Future studies should clarify these relationships and elucidate the drivers of the sex disparities observed in these findings.
Abstract 14873: Takotsubo Syndrome and Surgery: A Systematic Review
Authors: Pengyang Li, Travis Dobbin, Peng CAI, Ao Shi, Qi Liu
Journal: Circulation (2023)

Background: Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction. An increasing number of studies have shown surgery as a trigger for TTS. Methods: We performed a systematic review of all case reports and case series reporting an association between surgery and TTS by searching PubMed, EMBASE, and Cochrane Library databases in June 2022. A total of 172 cases (Surgery-TTS) were selected and compared with previously reported 1,750 TTS patients of any type (All-TTS). Results: In TTS patients triggered by surgery, the most common symptom was dyspnea (48.6%), followed by chest pain (31.8%) and dizziness (4.7%). The most common type of TTS was apical, accounting for 80.4% of cases, followed by the basal (8.2%), biventricular (5.1%), and midventricular (3.8%) types. Among these cases, 46.5% were associated with intraabdominal procedures, 25% with cardiothoracic surgery, followed by 12.3% with ENT/Ophthalmology and 8.7% with neurosurgery. Compared with the All-TTS cohort, the Surgery-TTS cohort was younger (55.9 vs 66.4, P &lt; 0.001) and had a lower incidence of chest pain (75.9% vs. 31.8%; P &lt; 0.001) and QT prolongation (18.0% vs. 47.7%, P &lt; 0.001) but a significantly increased in-hospital mortality (10.4% vs 4.1%, P = 0.001). Furthermore, basal-type TTS was significantly more common in the Surgery-TTS cohort than in the All-TTS cohort (8.2% vs. 2.2%, P &lt; 0.001). Conclusions: Surgical triggers are associated with increased mortality and atypical presentation in TTS patients when compared with patients who have TTS of all types. A high degree of clinical suspicion is required to concurrently diagnose TTS in surgical patients.
Abstract 18348: Causes and Predictors of 30-Day Readmissions Following Permanent Pacemaker Implantation in Patients With Cardiac Amyloidosis: From National Readmission Database (2016-2020)
Authors: Rohan Gajjar, Gianfranco Bittar Carlini, Ufuk Vardar, Sadichhya Karki, Taha Teaima, Bhavin A Patel, Manoj Kumar, Aviral Vij
Journal: Circulation (2023)

Introduction: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy where local deposition of amyloid fibrils causes heart failure, arrhythmias, and conduction system abnormalities. Involvement of the AV nodal and infra-hisian conduction system increases the need for a permanent pacemaker (PPM). Studies have noted worse outcomes in patients with implantable-cardioverter defibrillator placement in amyloidosis, but a comparison with PPM is lacking. We sought to analyze readmissions in CA patients following PPM placement utilizing National Readmission Database (NRD). Methods: NRD (2016 to 2020) was queried to identify adults with a diagnosis of CA who underwent PPM implantation using ICD-10 CM and PCS codes. The primary outcome was a 30-day readmission rate. Secondary outcomes were in-hospital mortality, length of stay (LOS), total hospital charge (THC), and predictors of readmission. Multivariate/univariate logistic and linear regression analyses were used to analyze the outcomes and adjust for possible confounders. Results: A total of 1,027 encounters of CA who underwent PPM were identified, of which 975 were discharged alive. Within 30 days from discharge, 141 (14.5%) were readmitted. Those readmitted had a longer LOS and higher burden of comorbidities while were similar in age, sex, hospital characteristics, and household income status. Readmissions lead to an additional mean THC of $55,079 and a mean LOS of 6.3 days. The top five causes of readmissions were heart failure (23%), sepsis (6.6%), hypertensive heart disease (4%), bradycardia (3.5%), and acute kidney injury (3.2%). Figure-1 shows the forest plot of a multivariate analysis of independent factors associated with readmissions. Conclusions: Our findings show that up to 15% of patients with CA who undergo PPM implantation get readmitted with heart failure being the most common etiology. Optimizing comorbidities with PPM implantation in CA may provide better outcomes and reduce admissions.
Abstract 13450: Clinical Outcomes With GLP-1 Receptor Agonists in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Yang Liu, Huilei Zhao, Menglu Liu, Weichun Lin, Peng Yu, Xiao Liu, Jingfeng Wang
Journal: Circulation (2023)

Background: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). However, there remains uncertainty about the efficiency of GLP-1 RAs in patients with heart failure (HF). Methods: Randomized controlled trials (RCTs) that reported the effect of GLP-1 RAs on prognosis in patients with HF were identified by searching databases. Results: There were nine RCTs involving 8,920 patients with HF included. GLP-1 RAs significantly reduced the risk of MACE compared with placebo (HR [hazard ratio]: 0.87, 95% CI [confidence interval] 0.77-0.98) in patients with HF and T2DM. The benefit was not observed in all-cause death (HR: 0.99, 95% CI 0.84-1.15), hospitalization for HF (HR: 1.04, 95% CI 0.89-1.22), cardiovascular death (HR: 0.95, 95% CI 0.79-1.16), myocardial infarction (HR: 0.88, 95% CI 0.71-1.08), stroke (HR: 1.03, 95% CI 0.75-1.43) and death or hospitalization for HF (HR: 1.07, 95% CI 0.78-1.46). GLP-1 RAs did not improve the change in LVEF (MD [mean difference]: -0.86, p=0.12, LVEDV (MD: 3.54, p=0.11), LVESV (MD: 2.78, p=0.07) or NT-proBNP (MD: -140.36, p=0.08). However, GLP-1 RAs significantly increased the change in the 6-MWT (MD: 19.74, p=0.002). In the subgroup analyses, human GLP-1 RAs, but not nonhuman GLP-1 RAs, reduced the risk of MACE (p interaction=0.11). Grading of Recommendations Assessment, Development and Evaluation (GRADE) showed moderate certainty for MACE, all-cause death and hospitalization for HF. Trail Sequential Analysis (TSA) revealed that there may be a high possibility of false positive results for MACE. Conclusion: Compared with placebo, GLP-1 RAs may reduce the risk of MACE in patients with HF and T2DM, with a more significant efficiency of human GLP-1 RAs.
Abstract 18822: Disparities in Access and Long-Term Survival in St Elevation Myocardial Infarction Patients the Brazilian Public and Private Health Services- Victim Registry
Authors: Ticiane Clair R Lima, Jussiely C Oliveira, Jeferson C Oliveira, Ikaro D Barreto, Paulo R Martins-Filho, Laís C Oliveira, Larissa A Arcelino, Fabio S silveira, Marcos A Almeida-Santos, Luís Flávio A Prado, Enilson V Moraes, EDUARDO FERREIRA, José T Mendonça, Thiago A Nascimento, Rafael V Barreto, Antonio S Sousa, José Augusto Barreto-Filho
Journal: Circulation (2023)

Introduction: This study aims to evaluate the impact of disparities in access to specialized services and reperfusion therapies on the long-term survival of patients with ST-elevation myocardial infarction (STEMI) treated under the Unified Health System (SUS) and those covered by Private Healthcare Insurance (PHI). Scarce data exist for regions characterized by significant socioeconomic disparities. Methods: The VICTIM registry was utilized to compare disparities among STEMI patients treated under SUS and PHI. The registry involved all Percutaneous Coronary Intervention (PCI) hospitals in Sergipe, the smallest state in Brazil, consisting of one facility for SUS patients and three facilities for private patients. We examined the patient's opportunity to reach a PCI hospital, reperfusion data from 2014 to 2018, and long-term survival through telephone interviews between 2020 and 2021. Long-term outcomes evaluated using the Gehan-Breslow test with Dunn correction, and significance level p&lt;0.05. Results: Out of the 1.082 patients evaluated, 893 (82.53%) received treatment under SUS, while 189 (17.47%) covered by PHI. SUS patients had to travel a distance six times greater from the site of pain to the PCI hospital (58.2 km vs. 8.7 km; p&lt;0.001); had lower rates of reperfusion (49.8% vs. 67.2%; p&lt;0.001) and primary PCI (47.2% vs. 66.5%; p&lt;0.001); and often had to pass through at least one institution before reaching the PCI hospital (76.1% vs. 41%; p&lt;0.001). The time from symptom onset to seeking help was similar for both groups, but the overall time from symptom onset to arrival at the PCI hospital was longer for public service patients (10.3h vs. 5.3h; p&lt;0.001). Fibrinolytic therapy was underused (2.5% vs. 1.1%; p=0.411). Long-term survival results displayed in Figure 1. Conclusions: SUS patients exhibited higher long-term mortality rates, longer travel distances, and reduced access to reperfusion therapies compared to PHI patients, indicating disparities in care.
Abstract 16425: Incidence of New-Onset Hypertensive Disorders of Pregnancy Before and During the Early COVID-19 Pandemic in the United States, 2018-2021
Authors: Ian K Everitt, Tejasvi Peesay, Xiaoning Huang, Natalie Cameron, William Grobman, Sadiya S Khan
Journal: Circulation (2023)

Introduction: The incidence of new-onset hypertensive disorders of pregnancy (HDP) has increased in recent years. During the COVID-19 pandemic, blood pressure control worsened in non-pregnant populations. Therefore, we sought to examine whether the incidence of HDP changed with the onset of the COVID-19 pandemic. Methods: A serial cross-sectional study of nulliparous individuals aged 15-44 years with singleton live births was conducted using the National Center for Health Statistics Natality Data Files from 2018-2021. HDP was determined by the professional attendant at birth. Maternal social determinants of health (SDoH), including education level, Medicaid insurance, and rurality of residence, were self-reported. Interrupted time series analyses compared the monthly national incidence of HDP before (1/2018-2/2020) and during (5/2020-12/2021) the COVID-19 pandemic, overall and stratified by maternal SDoH, adjusting for seasonal autocorrelation. Results: The sample included 5,246,061 pregnant individuals (22.2% Hispanic, 7.4% non-Hispanic Asian, 13.3% non-Hispanic Black, 53.8% non-Hispanic White). The incidence of HDP was 9.22% in 1/2018 and 12.15% in 12/2021. The incidence of HDP increased before (0.07±0.01%/month) and during the pandemic (0.06±0.01%/month), with no acceleration after pandemic onset (p=0.66, Figure ). There was no significant difference in monthly trends when stratified by maternal SDoH groups. Conclusions: Nearly 1 in 8 individuals in 2021 had a pregnancy complicated by new-onset HDP in the US. While the early COVID-19 pandemic was not associated with a significant acceleration, the incidence of HDP continues to steadily increase.