tbuckley/cabot-search huggingface dataset:
Abstract 15794: Incidence &amp; Complications of Myocarditis in US Active-Duty Service Members Hospitalized With COVID-19 Infection
Authors: Patton McClelland, Kevin O'Gorman, Raphael John Sabado, Nicholas Thorneloe, Matthew Soderstrom, John Henry Dean, rosco gore, Emilio Fentanes
Journal: Circulation (2023)

Introduction: Cardiovascular complications of coronavirus disease 2019 (COVID-19) infection, including myocarditis, have been widely reported. Research question/hypothesis: What was the incidence and clinical implications of viral myocarditis resulting from COVID-19 infection in hospitalized United States active-duty service members (US ADSM)? Goal/aims: Report the incidence of complications in US ADSM who suffered COVID-19 associated myocarditis. Methods: This retrospective observational cohort study from the Joint Trauma Service COVID-19 Registry included 399,284 US ADSM who contracted COVID-19 infection. Our team independently reviewed records of hospitalized US ADSM who were determined to have COVID-19 associated myocarditis. Results: Among the 399,284 US ADSM who contracted COVID-19, 1,629 (0.4%) required hospitalization and 18 (1.1%) met criteria for myocarditis. The most common presenting symptoms were chest pain (72%) and dyspnea (67%). Half of the patients required ICU level care of which 44% required inotropes or vasopressors, and one patient required mechanical circulatory support. Eight (44%) patients had clinical findings consistent with acute heart failure and two (11%) patients suffered intermittent advanced heart block that did not require permanent pacing. No patients died in the hospital. In the patients who had a left ventricular ejection fraction of less than 50% during their illness, 75% had full recovery of their left ventricular systolic function during follow up imaging. Conclusions: While myocarditis was an uncommon complication in US ADSM hospitalized for COVID-19, its clinical course was not benign.
Abstract 13047: The Modulatory Effects of Perivascular Adipose Tissue on the Renal Arterial Vasorelaxation and Its Relationship With Kidney Function in Metabolic Syndrome
Authors: Satomi Kagota, Kana Maruyama-Fumoto, Kazumasa Shinozuka
Journal: Circulation (2023)

Metabolic syndrome (MetS) is a cluster condition that increases the risk of cardiovascular diseases and type 2 diabetes. Perivascular adipose tissue (PVAT) regulates the arterial tone. We have demonstrated that the renal arterial PVAT enhances the vasorelaxation response in MetS model strains, SHRSP.Z- Lepr fa /IzmDmcr rats (SPZF) and SHR/NDmcr-cp rats (CP). Furthermore, we have found that overactivation of angiotensin II type 1 receptor (AT1R) signaling and a decrease in apelin levels in PVAT leads to a decline in compensatory PVAT effects. MetS is associated with chronic kidney disease, and the dysfunction of the PVAT favoring the vasorelaxation response could be a reason for kidney disease development. Therefore, we investigated the relationship between PVAT function and kidney function using MetS model rats.Renal arteries were isolated from the male and female SPZF and CP at 23 weeks of age. Vasorelaxation and mRNA transcript levels in PVAT were examined using organ bath methods and quantitative real-time polymerase chain reaction, respectively. Systolic blood pressure (sBP) was measured using a tail-cuff method. Insulin, glucose, and creatinine in the serum and protein in the urine were measured using commercial kits and eGFR, and the HOMA-IR were calculated.sBP was higher in SPZF than CP, but lower in females than males. HOMA-IR and urine protein levels were the lowest, while eGFR and enhancing effects of PVAT on acetylcholine-induced relaxations were the highest in female CP among the groups. eGFR was negatively correlated with sBP, HOMA-IR, and urinary protein levels. The enhancements of relaxations by PVAT were negatively correlated with sBP, HOMA-IR, and AT1R activity in PVAT.This study suggests that the insulin resistance and high blood pressure are associated with PVAT dysfunction, resulting from AT1 activation in PVAT, while it does not support the hypothesis that the disappearance of the effects of PVAT directly leads to kidney dysfunction.
Abstract 14460: Impact of Carotid Artery Plaque Detection on Cardiovascular Disease Risk and the Importance of Age in the Multi-Ethnic Study of Atherosclerosis
Authors: Matthew C Tattersall, Spencer Hansen, Robyn McClelland, Claudia E Korcarz, Kristin Hansen, Wendy S Post, Michael D Shapiro, James H Stein
Journal: Circulation (2023)

Background Carotid artery plaque (CAP) predicts future atherosclerotic cardiovascular disease (ASCVD) events; however, its prevalence increases with age and differs by sex and race/ethnicity, so how its presence influences ASCVD risk in clinical settings is uncertain. Hypothesis: We hypothesized that the impact of CAP detection on relative ASCVD risk declines with age. Methods: CAP was detected and quantified by ultrasound in adults free of clinical ASCVD at Exam 1 of the Multi-Ethnic Study of Atherosclerosis who were followed longitudinally for coronary death, myocardial infarction, angina, stroke, and ASCVD death. Cox proportional hazards models investigated associations of CAP and incident ASCVD events in subsets defined by age categories. These models were adjusted for confounders and an age*CAP interaction. Results: The 5198 participants were a mean (standard deviation) 61.8 (10.1) years old (53% female, 27% Black, 22% Hispanic, 12% Chinese) and experienced 880 ASCVD events over 14.3 (5.7) years. Prevalence of CAP and the age at which 50% of participants had detectable CAP differed by age, sex, and race/ethnicity, ranging from 13% in Chinese women &lt;50 years old to 97% in Non-Hispanic White men 80-84 years old (Figure). CAP presence independently predicted ASCVD events (hazard ratio, 1.35, [95% confidence interval 1.17-1.57], p&lt;0.001), however the strength of this association declined with increasing age (p interaction =0.029, Figure). CAP detection in younger individuals conferred higher relative ASCVD risk than in older participants who had higher absolute risk, regardless of CAP. Conclusions: Prevalence of CAP varies by sex and race/ethnicity. CAP becomes very common with increasing age and its relative association with future ASCVD events declines. These data can assist in guiding ASCVD risk assessment in younger adults and provide perspective for incidentally detected CAP on clinical imaging studies in older adults who have higher absolute ASCVD risk.
Abstract 19104: Hemodynamic Analysis of Pulmonary Artery for Congenital Right-Side Heart Disease in Adulthood by 4d-Flow MRI
Authors: Akio Inage, Naokazu Mizuno, Kanako Kishiki
Journal: Circulation (2023)

Introduction: Using 4D-flow MRI, we evaluated hemodynamics in the pulmonary artery of congenital right-side heart disease in adulthood. Hypothesis: We hypothesize that 4D flow MRI may be used to assess pulmonary artery flow hemodynamics in adults with congenital right heart disease. Methods: In 20 adults, we measured energy loss (EL) and helicity of the main pulmonary artery (MPA) by cardiovascular MRI. The maximum value (peak EL) in one heartbeat and the total value were obtained for EL. Helicity was defined as a vector quantity, with clockwise rotation being positive and counterclockwise rotation being negative, and the total value was calculated. Results: The mean age was 27.9 years. The cases included 15 cases of postoperative tetralogy of Fallot without pulmonary arterial hypertension (TOF) and 5 cases of congenital heart diseases with pulmonary arterial hypertension (CHD-PAH). Peak EL, time to peak EL, and total helicity were higher in the CHD-PAH group than TOF group. Peak EL values were significantly higher during systole but were observed during diastole in 8 patients (40%). The combined mean value of helicity was positive, with clockwise predominance in 12 cases (60%). A strong correlation was found between peak EL and clockwise helicity (r=0.68) and counterclockwise helicity (r=-0.73). In addition, a correlation was observed between diastolic EL/BSA and diastolic clockwise helicity (r=0.51) and diastolic counterclockwise helicity (r=-0.52). A correlation was also observed with the pulmonary regurgitant fraction (r=0.49). Conclusions: In this study, helicity in the MPA was dominant clockwise in congenital right-side heart disease in adulthood. It was suggested that EL was involved in helicity throughout the entire cardiac cycle and that peak EL had a particularly large effect.
Abstract 15085: Analysis of the Composite of Death and Stroke at Follow-Up Among Risk Profiles in Trials Comparing Transcatheter and Surgical Aortic Valve Implantation. A Systematic Review and Meta-Analysis
Authors: Fabio Barili, Amedeo Anselmi, Jay Brophy, William E Boden, Raffaele S De Caterina, Victor Dayan, Jorge R Roda, Miguel Sousa-Uva, RUI M ALMEIDA, Jacques Tomasi, Jean-Philippe Verhoye, Francesco Musumeci, John M Mandrola, Sanjay Kaul, Alessandro Parolari
Journal: Circulation (2023)

Introduction: To compare the effectiveness of transcatheter vs surgical aortic valve implantation on mid-term composite of death for any cause or stroke within high, intermediate and low-risk profiles. Methods: We performed a systematic review of the literature between 2007 and 2023 including randomized controlled trials comparing a composite of all-cause mortality or stroke of transcatheter vs surgical aortic valve replacement. Hazard ratios (HRs) and restricted mean survival time (RMST) differences within high, intermediate and low-risk profiles were estimated by reconstructing time-to-event data from Kaplan-Meier curves. Results: Seven trials were included (8418 participants). The incidence of composite endpoint increases concordantly with higher risk profiles for both treatments. A time variant effect unites all the risk profiles with transcathteter superior to surgery early and a trend toward HR reversal after 24 months, also supported by an cumulative additional time-to-event of 0.57 months at 3 years driven by high risk (95%CI 0.19 - 0.9) that is reabsorbed at 60 months, The benefit of transcatheter approach increased over time till 5 years in high risk, while intermediate and low risk showed a similar quadratic association (a parameter -0.0004, 95%CI -0.0008 - 0, p-value 0.05; b parameter 0.029, 95%CI 0.012 - 0.046, p-value 0.001), with a smaller increase of the transcatheter that is reabsorbed after a nadir at 36 months. Conclusions: There is a different trend of benefit of transcatheter approach within risks. TAVI maintains a benefit over surgery at 5-years in high risk, while its advantage is smaller and runs out at 5 years in the low-mid risk groups.
Abstract 15828: Variations in the Use of Catheter Ablation for Atrial Flutter Among US Adults Using Nationwide Inpatient Sample (NIS) Database
Authors: Patrick Benjamin, Olamide Oyenubi, Andreea-Constanta Stan, Joseph A Salami, Jiannan Huang
Journal: Circulation (2023)

Introduction: Atrial flutter is one of humans' most common cardiac arrhythmias. Catheter ablation is the definitive treatment for typical atrial flutter because of a very high success (&gt;95%) and low complication rate. Therefore, we explored variations in the use of catheter ablation for atrial flutter among US adults. Methods: We used the 2017-2019 National Inpatient Sample (NIS) for this analysis. Multivariable logistic regression analysis was used to assess factors associated with catheter ablation among patients with atrial flutter in the US. Results: Of the 1406220 adults hospitalized with a diagnosis of atrial flutter, 66825 (4.75%) underwent ablation for atrial flutter. Blacks were less likely to undergo ablation for atrial flutter compared to Whites (AOR=0.91; 95% CI: 0.85-0.99, P = 0.01). Similarly, patients with Medicare (AOR=0.88; 95% CI: 0.83-0.92, P=0.00), and Medicaid insurance (AOR=0.80; 95% CI: 0.74-0.87, P=0.00) were less likely to have catheter ablation for aflutter compared to those with private insurance. Other significant predictors of the likelihood of getting an ablation included younger age 0.98 (95% CI: 0.97-0.98, P=0.00), and lower co-morbidity burden ( class II with AOR of 0.65; 95% CI: 0.62-0.69 and Class III with AOR of 0.43; 95% CI: 0.41-0.46 compared to class I). No gender disparity was observed in this analysis, females had an AOR of 0.96 (95% CI: 0.92-1.00) Conclusions: Findings highlight significant racial and insurance-related disparities in access to catheter ablation for atrial flutter. Addressing social and structural issues underlying these disparities is critical for achieving equitable outcomes for patients with atrial flutter.
Abstract 165: Immediate Internalization of Transplanted Mitochondria in Circulatory Immune Cells After Cardiac Arrest Resuscitation in Rats
Authors: Tomoaki Aoki, Lance B Becker, Yusuke Endo, Eriko Nakamura, Kei Hayashida
Journal: Circulation (2023)

Background: Mitochondrial transplantation (MTx) is an innovative technology that has the potential effect for attenuating ischemia reperfusion injury. We previously demonstrated that MTx significantly improves survival and neurological outcomes after cardiac arrest (CA) and resuscitation in rats. However, the underlying mechanism by which MTx enhances CA outcomes remains unclear. Aim: To investigate the hypothesis that injected donor mitochondria are rapidly internalized by circulatory immune cells, particularly monocytes/macrophages, which play crucial roles in post-CA inflammatory signaling. Methods and Results: Adult male Sprague-Dawley rats underwent sham operation or 10 minutes of asphyxial CA followed by resuscitation with CPR. Either a respiration buffer as a vehicle or donor mitochondria labeled with MitoTracker Deep Red (MTDR) was intravenously injected to animals of both groups. In the CA groups, the injection was performed upon achieving spontaneous circulation. Serial blood samples were collected at 30, 75, and 150 seconds after injection. Flow cytometry analysis revealed that a marked increase of MTDR-positive ratios, peaking at 30 seconds, in CD45 + leukocytes, CD3 + T lymphocytes, and CD11b/c + monocytes/macrophages in the MTx-treated CA group compared to the other groups (Figure A). Notably, in sham-operated rats with donor mitochondrial injection, only minimal donor mitochondria were found in the circulating immune cells at those time points. Brain and spleen 1 h post-CA with MTx showed enhanced signals of MTDR measured using an in vivo imaging system, indicating successful transfer of injected mitochondria to organs (Figure B). Conclusion: Our findings demonstrate rapid internalization of injected mitochondria by circulatory immune cells after MTx in post-CA rats, suggesting a pivotal role for circulating immune cells in the mechanism underlying the beneficial effects of MTx in CA resuscitation.
Abstract 17404: Heart Failure Hospitalization Readmissions and Mortality on Cardiology versus Non-Cardiology Services in a U.S. Hospital System
Authors: Racquel Hammonds, Austin Seals, Dalane W Kitzman, Olivia Gilbert
Journal: Circulation (2023)

Introduction: With the number of patients diagnosed with heart failure (HF) in the U.S. exceeding the number of cardiologists specialized to care for them, there is increasing reliance on non-cardiologists for treatment of acute decompensated heart failure (ADHF). Based on prior studies, there is concern that outcomes may be inferior under this circumstance. Hypothesis: Patients admitted with ADHF have lower 30-day readmissions when admitted to cardiology versus non-cardiology services. Methods: This was an observational, retrospective cohort study of 6885 patients with a primary diagnosis of ADHF based on ICD diagnosis-codes from 2015 to 2020. Data were retrieved from an EPIC-based registry with patients admitted to any of five network hospitals in a single health system. The registries were constructed through Clarity. Logistic regression adjusted for age, race, and gender was employed to distinguish differences in 30-day readmissions in those admitted with ADHF to cardiology vs. non-cardiology services. Results: Of the 6885 patients, 14% were admitted to cardiology, and 86% under non-cardiology services. The total cohort’s mean age was 69 (±15). The majority were White (71%) and male (54%). There was a statistically significant difference in mean age between cardiology services (68 [±14]) and non-cardiology services (69 [±15]) (p= 0.013). Black patients represented 15% of patients on cardiology services and 28% on non-cardiology services (p &lt;0.0001). There were more male patients on the cardiology services (64%) than the non-cardiology services (52%) (p &lt;0.0001). Unadjusted 30-day readmissions were lower for those admitted to cardiology vs. non-cardiology services (odds ratio 0.82 [95%CI: 0.67, 0.99, p=0.041]). Adjusted 30-day readmissions for those admitted to cardiology vs non-cardiology services were also lower (odds ratio 0.79 [95%CI: 0.65, 0.97, p=0.022). Conclusion: In this institutional electronic health record-based study, 30-day HF readmissions were found to be significantly lower in those admitted to cardiology vs. non-cardiology services. A future study to explore the variables contributing to these outcomes and to validate this data in a larger population is required.
Abstract 16605: Differential Impact of Nighttime Home Blood Pressure on Between Patients With and Without Subclinical Heart Failure
Authors: Takahiro Komori, Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2023)

Introduction: Nighttime blood pressure (BP) has stronger association with cardiovascular events than office BP, 24-hr BP, and awake BP. However, it was not clear whether the impact of nighttime BP is different for patients with or without heart failure (HF). Hypothesis: Nighttime home BP has stronger association with cardiovascular events in patients with HF. Methods: We analyzed the data from the Japan Morning Surge-Home Blood Pressure study with NT-proBNP and nighttime home BP measurement. We enrolled 2494 patients who had at least one cardiovascular risk factor. Morning, evening, and nighttime home BP were measured and cardiovascular events were followed up. Results: During 7.1 years follow-up, 168 events occurred. When NT-proBNP of 125pg/ml was used as cutoff, the patients with NT-proBNP&gt;125pg/ml was higher daytime home SBP and nighttime home SBP than the patients with NT-proBNP≤125pg/ml (137±16 vs 132±13 mmHg, p&lt;0.01, 126±18 vs 120±14 mmHg, p&lt;0.01, respectively). In Cox regression analysis adjusting for significant covariates, daytime and nighttime home SBP were significant predictor for the outcome in the patients with NT-proBNP&gt;125pg/ml (HR 1.02, 95%CI:1.01-1.03, p&lt;0.01, HR 1.02, 95%CI:1.00-1.03, p=0.045, respectively). On the other hands, only nighttime home SBP was remained as a predictor for the outcome in the patients with NT-proBNP≤125pg/ml (HR 1.02, 95%CI:1.00-1.03, p=0.01). Conclusions: Nighttime home BP was associated with prognosis in patients with and without subclinical HF. Daytime home BP was associated with prognosis in patients with subclinical HF but not in the without subclinical HF.
Abstract 15521: Wnt Signaling Inhibition Prevents Postnatal Inflammation and Disease Progression in Congenital Myxomatous Valve Disease
Authors: Na Xu, Christina M Alfieri, Yang Yu, Katherine E Yutzey
Journal: Circulation (2023)

Introduction: Myxomatous valve disease (MVD) is the most common cause of mitral regurgitation, leading to cardiac dysfunction and heart failure. MVD in a mouse model of Marfan syndrome (MFS) includes valve leaflet thickening and increased immune cell infiltration. However, the underlying mechanisms by which immune cells are recruited in MFS valves remain undefined. Hypothesis: Inhibition of Wnt signaling prevents MVD progression in MFS valves. Methods: Mice with the Fibrillin 1 variant Fbn1 C1039G/+ recapitulate histopathological features of MFS and Wnt signaling activity was detected in TCF/Lef-lacZ reporter mice. Single-cell RNA sequencing was performed from mitral valves of WT and Fbn1 C1039G/+ mice at 1 month-of-age. Inhibition of Wnt signaling was achieved by conditional induction of Wnt inhibitor Dkk1 in valve interstitial cells of Fbn1 C1039G/+ ; Periostin-Cre; tetO-Dkk1; R26-rtTA mice. Dietary doxycycline was administered for 1 month beginning with MVD initiation (1-month-old) or MVD progression (2-month-old). Histological evaluation and immunofluorescence for immune cells were performed. Results: Wnt signaling pathway gene expression is activated early in mitral valve disease progression, prior to immune cell infiltration in Fbn1 C1039G/+ mice. Single cell transcriptomics revealed similar mitral valve cell heterogeneity between WT and Fbn1 C1039G/+ mice at 1 month-of-age. Wnt ligands and responsive genes were predominantly increased in valve interstitial cells and valve endothelial cells of Fbn1 C1039G/+ mice. Inhibition of Wnt signaling by Dkk1 induction at 1 month-of-age prevented the initiation of MVD as indicated by reduced valve leaflet thickness with decreased CD45+ leukocytes and CCR2+ immune cells in Fbn1 C1039G/+ mice. However, later Wnt inhibition starting at 2 months when inflammation and myxomatous changes are occurring did not prevent the progression of MVD. Conclusions: Wnt signaling is involved in the initiation of mitral valve abnormalities and inflammation, but is not responsible for valve disease progression once it has been initiated. Thus, Wnt signaling inhibition prevents initiation of congenital MVD, which provides a promising therapeutic target for the early treatment of congenital MVD.
Abstract 13574: A 5-Year Nationwide Analysis: Management &amp; In-Hospital Outcomes of Acute ST-Elevation Myocardial Infarction in the ≥90-Year-Old
Authors: Spandan Desai, Nicholas Roma, Kashyap Shah, Jamshid Shirani
Journal: Circulation (2023)

Introduction: The number of individuals living at or beyond age 90 is increasing and many have ischemic heart disease (IHD). There is limited data for management and in-hospital outcomes of acute ST-segment elevation myocardial infarction (STEMI) in this age group. Methods: National Inpatient Sample 2016-2020 was used to query 1,003,305 hospitalizations for adults with STEMI that were divided into two groups: adults ≥90 years and adults between ages 18 and &lt;90. Results: 33,515 (3.3%) cases with acute STEMI were observed in ≥90-year-old population group (67% females, 84% Caucasians, p&lt;0.001). There was a decline in annual admissions for acute STEMI in the ≥90-year-old group as listed in Table 1. This group had lower rates of diagnostic and reperfusion therapies (coronary angiography (CA) 41% -vs- 86%, P&lt;0.001, PCI 34.5% -vs- 73.2%, p&lt;0.001, CABG 0.3% -vs- 5.50%, p=0.090, Fibrinolysis 0.2% -vs- 0.8%, p=0.061). Smoking history was observed less often in the ≥90-year-old group (21.5% -vs- 49.6%, p&lt;0.001). Hospital mortality in this group was significantly higher (27.6% -vs- 9.1%, p&lt;0.001) and there were higher rates of complications including AKI (32.6% -vs- 18.9%, p&lt;0.001), CHF (53.6% -vs- 38.5%, p&lt;0.001), ventricular arrhythmias (11.1% -vs- 19.2%, p=0.003), and cardiogenic shock (15.1% -vs- 14.1%, p=0.753). In the ≥90-year-old group that died as compared to ≥90-year-old group that survived, there were lower rates of CA (25% -vs- 44%) and PCI (18% -vs- 36%), all p&lt;0.001. In this same comparison group, there were higher rates of development of AKI- 43.2% -vs- 28.5%, need for ICU- 25.7% -vs- 4.3%, need for vasopressors- 6.7% -vs- 1.6%, and need for mechanical ventilation- 23.0% -vs- 3.2%, all p&lt;0.001. Conclusions: In the ≥90-year-old population admitted with acute STEMI, there were lower rates of reperfusion therapy while In-hospital mortality and complications rates remain high.