tbuckley/cabot-search huggingface dataset:
Abstract 12858: Myocardial Infarction Promotes Breast Cancer Growth Through the Nerve Growth Factor/Tropomyosin Receptor Kinase A Pathway
Authors: Tetsuya Tani, Masayoshi Oikawa, Tomofumi Misaka, Takafumi Ishida, Yasuchika Takeishi
Journal: Circulation (2023)

Background: Epidemiological studies have suggested that patients with heart failure due to myocardial infarction (MI) have a higher cancer incidence. Nerve growth factor (NGF) plays a pivotal role in sympathetic nerve remodeling after MI, but several studies have suggested that NGF also plays a significant role in cancer progression. However, the impact of NGF on cancer progression in the setting of MI remains to be elucidated. Methods and Results: MI was induced by permanent ligation of the left anterior descending artery in female BALB/c mice. 4T1 cells, mammary tumor cells, were injected into the right mammary fat pad 2 weeks after surgery. Levels of NGF expression in the myocardium 3 days after surgery (1.40±0.17 AU vs. 1.00±0.09 AU, P=0.049) and serum NGF at 2 weeks after surgery (279±34 pg/ml vs. 173±16 pg/ml, P=0.044) were higher in the MI group than in the sham group. In addition, the tumor volume was significantly larger in the MI group than in the sham group 3 weeks after 4T1 cell injection (465.3±32.6 mm 3 vs. 292.1±28.3 mm 3 , P&lt;0.001). The percentage of Ki67-positive cells in tumor tissue was higher in the MI group than in the sham group (37.1±5.7% vs. 16.5±3.6%, P=0.010). Moreover, phosphorylation activities of membranous tropomyosin receptor kinase A (TRKA, 1.54±0.04 AU vs. 1.00±0.09 AU, P&lt;0.001) and AKT (1.56±0.18 AU vs. 1.00±0.08 AU, P=0.046) were higher in the MI group than in the sham group. Inhibition of TRKA by a TRKA inhibitor, GW441756 (20 mg/kg/week, I.P.), suppressed tumor volume in MI mice compared to DMSO-treated MI mice (281.6±34.8 mm 3 vs. 443.9±50.8 mm 3 , P&lt;0.001). The percentage of Ki67-positive cells (31.9.1±2.8% vs. 42.2±2.0%, P=0.010), phosphorylation levels of TRKA (0.99±0.07 AU vs. 1.68±0.09 AU, P&lt;0.001) and AKT (0.90±0.01 AU vs. 1.19±0.05 AU, P=0.001) in tumor tissues were decreased in GW441756-treated MI mice than in DMSO-treated MI mice. Conclusion: The NGF/TRKA pathway is involved in accelerated tumor cell growth under MI-induced heart failure.
Abstract 18597: Is Sleep Disordered Breathing Optimized in Patients With Bradycardic Rhythm Disorders Prior to Pacemaker Implantation? - A Retrospective Observational Study and a Quality Improvement Project
Authors: Kripa Rajak, Anupam Halder, Seema Sharma Gautam, Aslan Amirian, Gabriela Calderon Barahona, Hanna Bobrysheva, Yijin Wert, Anas Atrash, Navitha Ramesh
Journal: Circulation (2023)

Introduction: Obstructive sleep apnea (OSA) is associated with cardiovascular (CV) morbidity and mortality ranging from asymptomatic bradycardia to sudden death. Studies have shown that sleep-related bradyarrhythmias, decrease with continuous positive airway pressure (CPAP) and are unlikely to develop symptomatic bradycardia in the long-term. AHA/ACC/HRS recommends to evaluate and treat suspected or documented conduction disorder during sleep including patients who have received or are being considered for permanent pacemaker (PPM). Objective We aim to examine the number of sleep studies and CPAP performed and address the barriers of under-diagnosis and treatment with post intervention quality improvement initiative. Methods: We performed retrospective analysis of patients &gt;18 years admitted for elective PPM placement from 01/10/2021-01/01/2023. Categorical variables were reported as number and percent and numerical variable was reported as mean. Multiple logistic regression was used to identify predictors for compliance and sleep study prescription. All statistical analyses were performed with SAS software, version 9.4. Results Of 423 patients, mean age was 78.1 years, 56.50% were males, 96.9% were Caucasians and mean BMI was 30.1 kg/m 2 . Only 34.75 % (N= 147/423) received sleep study. 93.2% (N=137/147) were diagnosed with OSA and 82.9% (N=122/137) were treated with CPAP. Only 63.1% were compliant with CPAP. Males were more complaint with CPAP [OR 3.13 (95% CI 1.36-7.18, p=0.0072)]. Mean BMI at OSA diagnosis was 33.7 kg/m 2 and 30.1 kg/m 2 at PPM implantation. Weight loss was noted but most patients remained obese. Males, age ≥80 and obesity were significant predictors to get sleep study. After study outcomes, we adopted a standardized algorithm for risk assessment, incorporated EHR reminder and educated doctors. The intervention is currently ongoing. Conclusion Data on underutilization of sleep study helped us to work with administration to produce a protocol for screening high risk patients. Treating sleep apnea not only alleviates apnea-related symptoms but also improves CV outcome by avoiding unnecessary pacemaker implantation and minimizing unnecessary health care cost. If effective, this strategy can be a model for other hospitals.
Abstract 15698: Association of Social Factors on Sex-Specific Management of Atrial Fibrillation
Authors: Tarryn Tertulien, Gretchen Swabe, Jared W Magnani
Journal: Circulation (2023)

Introduction: Prior studies have reported disparities by sex in managing atrial fibrillation (AF), with many studies having limited analysis of the effects of social risk factors. We examined the effect of social risk factors on sex differences in the management of AF in a large, socially diverse cohort of insured patients. Hypothesis: We hypothesized that women with AF would receive less AF care, including the receipt of AF-related medications, pulmonary vein isolation ablation, and cardiology follow-up, compared to men. Methods: We identified individuals with AF from 2013-2019 captured by Optum’s de-identified Clinformatics® Data Mart Database. Sex was categorized as men and women. Covariates included demographics (age, sex, race, and ethnicity), Elixhauser variables, and social factors such as estimated annual household income and race or ethnicity. We used stepwise multivariable-adjusted Cox proportional hazards models to assess the effect of race, ethnicity, and household annual income on sex-specific differences in the receipt of AF-related medications, pulmonary vein isolation ablation, and cardiology follow-up. Results: We identified 190,760 individuals (age 74.0±11.4 years; 49.9% women) with incident AF. Women with AF were less likely to receive pulmonary vein isolation ablation and cardiology follow-up over a six-year follow-up than men. Prescriptions of antiarrhythmic were identical among both sexes. When stratified by race and ethnicity, women of Black (HR 0.75, 95% CI 0.61,0.92) and White race (HR 0.83, 95% CI 0.78, 0.88) were less likely to receive pulmonary vein isolation ablation than men. Women of Asian (HR 0.90, 95% CI 0.83,0.97) and White race (HR 0.93, 95% CI 0.92,0.94) were less likely to have cardiology follow-up after initial diagnosis of AF than men. Higher household income did not attenuate sex-specific differences in AF care. Across all income categories, women were less likely to have pulmonary vein isolation and cardiology follow-up. Conclusions: We identified sex differences in AF management that were not attenuated when considering race, ethnicity, and annual household income. Our findings suggest continued evidence of sex, racial, ethnic, and socioeconomic inequities in contemporary AF management.
Abstract 15313: Prognostic Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Chronic Total Occlusion
Authors: Sangyeub Lee, Sang Min Kim, Jang-whan Bae
Journal: Circulation (2023)

Background: Limited data exist regarding use of intravascular image during chronic total occlusion (CTO) intervention. Objectives: Current study investigated the prognostic impact of intravascular imaging-guided PCI in CTO lesions. Methods: Study population was derived from the RENOVATE-COMPLEX-PCI (n=1639) which demonstrated superiority of intravascular imaging-guided PCI than angiography-guided PCI in patients with complex coronary artery lesions. Current prespecified study selected patients who underwent CTO intervention and clinical outcomes were compared between intravascular imaging-guided PCI and angiography-guided PCI groups. Results: Among 1639 patients, 319 patients with CTO underwent intravascular imaging-guided PCI (n=220) or angiography-guided PCI (n=99). At a median follow-up of 2.1 years (interquartile range 1.1-3.0 years), the risk of TVF was significantly lower in intravascular imaging-guided PCI group than in the angiography-guided PCI group (5.0% vs. 13.5%; HR 0.303; 95% CI 0.130-0.710, P=0.006). When patients in imaging-guided PCI group were divided according to stent optimization, both patients with (1.3% vs. 13.5%; HR 0.14; 95% CI 0.02-0.56; P=0.003) and without (6.8% vs. 13.5%; HR 0.41; 95% CI 0.17-0.99; P=0.049) stent optimization had significantly lower risk of TVF than the angiography-guided PCI group. Conclusions: In patients with CTO, intravascular imaging-guided PCI was associated with reduced risk of TVF. Graded risk of TVF according to stent optimization by intravascular imaging supports the importance of intravascular imaging-guided PCI and achievement of stent optimization in CTO intervention.
Abstract 18806: How Well Does Left Atrial Remodeling Predict Adverse Outcomes in Patients With Chronic Severe Aortic Regurgitation?
Authors: Joseph El Dahdah, Emmanuel Akintoye, Lorenzo Braghieri, Osamah Badwan, Hardik Patel, M. Marwan Dabbagh, Joseph Kassab, Michel Chedid El Helou, Christine L Jellis, Milind Y Desai, L L Rodriguez, Richard A Grimm, Eric E Roselli, Brian P Griffin, Zoran B Popovic
Journal: Circulation (2023)

Introduction: Aortic regurgitation (AR) leads to left ventricular (LV) remodeling by increasing LV load. We recently showed that LV dimensions, widely adopted marker of severe AR, are not reliable predictors of adverse CV outcomes in older patients and female sex. Here we sought to study the effects of chronic severe AR on left atrial (LA) size and function as a prognostic adjunct to LV dimensions. Methods: Adult patients with ≥3+ AR on routine surveillance with serial echocardiograms between 1/2010 and 12/2016 were included in this study. We assessed longitudinal trends of LA volume indexed to body surface area (LAVI) and LA reservoir strain (LAr) stratified by age and sex. Clinical endpoints included the occurrence of heart failure hospitalization, urgent aortic valve surgery, or all-cause mortality and were used to assess the prognostic value of our studied parameters. Results: A total of 525 patients with 1,687 serial echocardiograms conducted over a median (IQR) follow-up duration of 2.0 (1.0-3.6) years were included. As shown in figure 1, we observed a substantial increase in LAVI (1.0 [95% CI: 0.76-1.2] mL/m2 per year of follow-up) and a decrease in LAr (-1.3% [95% CI: -1.6 to -0.92%]) over the study period. There was no significant interaction related to sex or age (p ≥0.17). 210 adverse events were recorded and were significantly predicted by both LA parameters. Optimal discriminatory threshold for LAVI was determined to be 37 mL/m2 and LAr at 35% and were both found to be consistent across categories of sex and age. Conclusions: This study indicates that LA remodeling, unlike LV remodeling, shows a similar rate of progression across different categories of sex and age among patients with chronic severe AR. Furthermore, LA parameters provide an added prognostic value over LV parameters and may therefore be better suited to inform the timing of AR intervention.
Abstract 18970: Sex Differences and In-Hospital Outcomes of Acute Coronary Syndrome Among Patients With Mediastinal Radiation Exposure: Insights From the National Inpatient Sample (2009-2020)
Authors: asmaa Ahmed, Mohammed Faisaluddin, Muhammad Osama, Harsh P Patel, Samarthkumar Thakkar, Richard Alweis, Sourbha Dani, Uzma Iqbal
Journal: Circulation (2023)

Background There is a paucity of data about the sex disparities and temporal trends in outcomes of Acute Coronary Syndrome (ACS) patients with prior mediastinal radiation. Methods: The National Inpatient Sample database years 2009 to 2020 was queried for ACS hospitalizations of patients with prior mediastinal radiation. The primary outcome was MACCE (major cardiovascular events) and secondary outcomes included other hospital cardiovascular outcomes including hospital resource utilization. Results: A total 23385 hospitalizations for ACS with prior mediastinal radiation exposure were identified. Females accounted for 15904 (68.01%) of the cases. Median age was 70 vs 72 and the majority of the cases were whites 82.79% vs 78.22% for females and males respectively. Cases were mostly non-ST elevation MI in both genders 75.98% vs 79.71% while ST-elevation MI represented 24.02% vs 20.29% of them. Female patients with ACS had a higher burden of hypertension, diabetes mellitus, hyperlipidemia and obesity, however, males had a higher burden of Peripheral vascular disease, chronic heart failure and smoking. After propensity matching, primary outcome related to MACCE was higher in males (aOR1.803, 95%CI (1.65-1.96)) along with cardiogenic shock (aOR: 1.77, 95%CI (1.55-2.02)) and Mechanical Circulatory Support (MCS) use (aOR: 1.48, 95%CI (1.29 -1.71)). Similar findings were noted after the subgroup analysis in STEMI and NSTEMI where males had the worst In-hospital outcomes compared to females. Overall, we observed an increasing trend in ACS hospitalizations among females from 2.85% in 2009 to 7.91% in 2020 however, mortality decreased over the years from 8.69% in 2009 to 3.51% in 2020. Conclusions: This nationwide observational analysis showed significant disparities and burden of cardiovascular comorbidities among male and female ACS patients with prior mediastinal radiation history, with higher hospitalization rates among females but higher mortality among males.
Abstract 12880: Riluzole Significantly Lowers Heart Failure Incidence
Authors: Przemyslaw Radwanski, KIBUM KIM, Sodam Kim, Margaret Katana, Mark A Munger
Journal: Circulation (2023)

Objective: Reduction of intracellular sodium accumulation through inhibition of late Na + current has been recognized as a target for cardiac calcium handling which underlies myocardial contractility and relaxation in heart failure (HF). This approach may augment neurohormonal balance to evade HF progression. Riluzole , a brain-type Na + channel blocker with enhancement of Ca 2+ -activated K + channel function, used for management of amyotrophic lateral sclerosis (ALS). The study aim was to investigate whether riluzole lowers HF incidence. Methods: Rates of incident HF were compared using a commercial insurance and Medicare supplement claims databases. Patients who filled a prescription for riluzole (treatment) between 06/2009 and 12/2019 were compared to those with no-riluzole (control). We excluded HF patients during the 180-day baseline period. Study endpoint was the first diagnosis of HF from the index riluzole prescription or ALS diagnosis. HF onset was compared using Kaplan-Meier cumulative incidence estimates and multivariable Cox proportional hazard regression model. Results: The study cohort consisted of 4,324 riluzole and 6,415 ALS control patients. The 24-month cumulative incidence of HF onset for riluzole vs. control patients was 4.71% vs. 8.73%, calculating hazard ratio (HR) [95% CI, p -value] of 0.399 [0.297 - 0.537, p&lt;0.001]. Adjusting for patient demographics and comorbid conditions, the 24-month HR: 0.495 [0.367 - 0.668, p&lt;0.01]. The lower rate of HF onset was independent of age (&lt;65 and ≥65 age groups, HR: 0.378 [0.234 - 0.611, p&lt;0.01] and 0.611 [0.413 - 0.881, p&lt;0.01]) respectively. Conclusions: Riluzole is associated with a lower rate of HF onset, suggesting a potential prevention strategy for early management.
Abstract 135: Identifying Optimal Mean Arterial Pressure in Cardiac Arrest Patients: Are Precision Medicine Approaches Feasible?
Authors: Rachel Beekman, Noah Kim, Eva Kitlen, Charles R Wira, Akhil Khosla, Kevin N Sheth, Nils H Petersen, Emily J Gilmore
Journal: Circulation (2023)

Introduction: Loss of cerebral autoregulation after cardiac arrest (CA) is associated with worse outcomes. A population-based mean arterial pressure (MAP) threshold, such as a post-resuscitation goal of ≥ 65 mmHg, may be insufficient to account for patient-specific factors, like autoregulatory failure. We investigated the feasibility of determining optimal MAP (MAP OPT ) using regional cerebral tissue oxygen monitoring with near-infrared spectroscopy (NIRS). Hypothesis: Autoregulatory failure and MAP OPT can be identified in individual patients after CA. Methods: We prospectively enrolled adult comatose CA survivors undergoing invasive MAP and regional cerebral oxygen monitoring with NIRS in an ICU between April 2022 and May 2023. Tissue oxygenation autoregulatory index (TOx) was derived using a moving Pearson correlation coefficient of 30 consecutive, 10-second averaged values of MAP and tissue oxygen index signals. TOx ≥ 0.3 defined impaired autoregulation. MAP values were divided into bins of 5 mmHg for which each corresponding TOx was averaged. Parabolic curve fitting determined the MAP value with the lowest associated TOx value (MAP OPT ). Results: Of 35 patients enrolled, 74.3% experienced out-of-hospital cardiac arrest with a mean (SD) age of 55.0 (13.9) years. Six (17.1%) patients survived to hospital discharge and 4 (11.4%) progressed to brain death. Monitoring was initiated at a median [IQR] of 14.9 [10.9 - 20.6] hours from CA for a duration of 47.5 [27.1 - 75.1] hours. The time spent with impaired autoregulation was 22.6 [18.4 - 31.6] % of the recording duration, corresponding to 10.1 [6.9 - 15.9] hours. MAP OPT could be identified in 33 (94.3%) patients and 47.7 [32.1 - 59.6] % of the recording duration. The average MAP OPT was &lt;75 mmHg in 2 (6.1%), 75 - 85 mmHg in 14 (42.4%), and &gt;85 mmHg in 17 (51.5%) patients. MAP OPT did not differ between survivors and non-survivors (mean (SD) 87.2 (9.6) vs. 88.2 (12.1) mmHg respectively, p=0.86). Conclusion: MAP OPT could be identified in all but two patients and calculated for half of the recording duration. Average MAP OPT was ≥ 75 mmHg in 94% of our cohort. Future studies are needed to evaluate whether targeting personalized physiologic thresholds influences outcomes.
Abstract 12874: Risk of Ischemic Heart Disease in Young Women With Dysmenorrhea: A Cross-Sectional Study on Electronic Health Records
Authors: Eugenia Alleva, Leslee J Shaw, Erwin P Bottinger, Susan Kahlil, Jovita Rodrigues, Ipek Ensari
Journal: Circulation (2023)

Introduction: Ischemic heart disease (IHD) incidence is increasing among young individuals, particularly women. Suboptimal primary prevention due to risk underestimation is thought to contribute to this trend. Non-traditional risk factors, such as stress and female-specific factors, are often overlooked but offer an opportunity to improve risk stratification. Dysmenorrhea is the most prevalent menstrual complaint, and associated with increased stress and autonomic dysfunction. To date, contribution of dysmenorrhea to cardiovascular disease risk has not been investigated. Hypothesis: Dysmenorrhea is associated with increased risk of IHD before 50 years of age. Methods: We extracted a cohort of 30,554 women with dysmenorrhea and 25,350 controls from Mount Sinai data warehouse as shown in Fig 1. For statistical analysis we performed full propensity score matching on demographic and clinical covariates, followed by weighted logistic regression with IHD before age 50 as a binary outcome. We then investigated IHD subtypes (angina, acute myocardial infarction (AMI), AMI complications, chronic IHD) in separate regression models, and evaluated the inclusion of menstrual abnormalities (MA) and endometriosis as additional covariates in the models (vs other covariates only). Results: Dysmenorrhea was associated with a significant increase in the OR for overall IHD, angina and chronic IHD (Table 1), independently from MA or endometriosis. Conclusions: Dysmenorrhea might be an important risk factor for early IHD. The risk appears to be largest for angina and chronic IHD. Further research can investigate dysmenorrhea as a predictor of future IHD risk.
Abstract 16304: Contemporary Practice Patterns and Opportunities to Improve Type 2 Diabetes (T2D) Therapy in Patients at Elevated Cardiovascular and/or Kidney Risk
Authors: Alexander J Blood, Lee-Shing Chang, Caitlin Colling, Gretchen Stern, Dan Gabovitch, David Zelle, Emily Zacherle, Josh Noone, Carey Robar, Lina Matta, Samuel Aronson, Thomas Gaziano, Jorge Plutzky, Christopher P Cannon, Deborah Wexler, Benjamin Scirica
Journal: Circulation (2023)

Background: Evidence-based SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1 RA) reduce cardiovascular (CV) events and improve kidney outcomes in patients with type 2 diabetes (T2D) who are at elevated cardiac or renal risk; however, prescription rates are low despite guidelines recommending their use. We aimed to evaluate the eligibility for, and utilization of, SGLT2i and GLP-1 RA in real-world practice in a large, integrated, multicenter health system. Aim: To determine the prevalence of CV and kidney comorbidities in patients with T2D and current medication use patterns within a large, urban healthcare system. Methods: In this cross-sectional analysis of the Mass General Brigham healthcare system from 2020-2023, we identified all patients with T2D meeting current guideline eligibility criteria for SGLT2i and/or GLP-1 RA. Indications for therapy included ASCVD, heart failure, kidney disease, or high risk for developing ASCVD - determined by EHR data. High risk for developing ASCVD and ASCVD were mutually exclusive, however other indications were reported as identified comorbidities by patient. Demographics, medications, laboratory values, and comorbidities were assessed. Results: There were 148,046 people with T2D and an HbA1c within 3 years: mean age 68 years, HbA1c 7.3%, 53% male, 28% non-white, 12% non-English language preferred. 122,202 (83%) patients had &gt; 1 CV or kidney comorbidity: 60,168 (41%) high risk for developing ASCVD, 51,014 (34%) ASCVD, 17,875 (12%) HF, 63,996 (43%) kidney disease, and 60,947 (41%) with ≥ 2 comorbidities. Of the 122,202 patients with an indication, 20,475 (17%) were prescribed an SGLT2i, 27,188 (22%) a GLP-1 RA, and 7,255 (6%) both ( Figure 1 .) Conclusion: Ongoing limited use of agents with proven CV and kidney benefit exists among commonly encountered patients with T2D despite guideline recommendations; novel strategies are needed to overcome the barriers that keep patients from improved outcomes.