tbuckley/cabot-search huggingface dataset:
Abstract 12114: Advancing Heart Failure Knowledge and Therapies Through a Multicenter Registry and Innovative Platform for Extended Outpatient Hemodynamic Monitoring: The Hemodynamic Frontiers in Heart Failure (HF <sup>2</sup> )
Authors: Timothy Jordan, Kartik Munshi, Margaret Mcdermott, Evan D Muse, Jacob Abraham, maya guglin, Hirak Shah, Arvind Bhimaraj, Monique R Robinson, Rola Khedraki, Patrick McCann, Elizabeth Volz, Guha Ashrith, Orvar Jonsson, Kunjan A Bhatt, Andrew J Sauer, Mosi K Bennett, Terrie A Benjamin, Marat Fudim, J Thomas Heywood
Journal: Circulation (2023)

Background: Hemodynamic Frontiers in Heart Failure (HF 2 ) is a multicenter research consortium of institutions with active remote pulmonary artery pressure monitoring programs that aims to promote research in this field. The consortium recently created a registry of patients with pulmonary artery hemodynamic (HD) monitors (HDM) to facilitate the research mission. Goals/Aims: HF 2 registry aims to collect demographic, clinical, laboratory, echocardiographic and HD data from HDM patients to create a test bed to advance scientific knowledge about ambulatory HD monitoring and quickly evaluate new therapies. Methods: HF 2 includes patients aged &gt;18 who would have been implanted with a HDM as per FDA indications of NYHA Class III HF diagnosis with a prior hospitalization or patients with NYHA Class II or BNP elevation without hospitalization. HF 2 registry data warehouse rests through University of Kansas Medical Center (KUMC) and was approved by their institutional review board (IRB) board followed by local IRBs at participating institutions with required Data use agreements. Institutions report data into the electronic registry database using REDCap, housed at KUMC. Results: This initial data set includes 254 patients implanted from 2019 until May 2023. See Table 1 for initial demographic, comorbidity, laboratory, echocardiographic, and medication data. See Table 2 for HD measurements at time of implant. Conclusion: A real-world registry/test bed of patients with HDM can evaluate long-term outcomes in such patients, provide data in unique patient groups, and provide an opportunity to evaluate HD effects of new HF therapies in rapid turnaround cross over trials.
Abstract 11695: Long-Term Clinical Outcomes of Minimally Invasive Aortic Valve Surgery in Patients With Aortic Valve Disease
Authors: Aleksander Dokollari, Gianluca Torregrossa, Francesco Cabrucci, Marco Gemelli, Roberto Rodriguez, Edvin Prifti, Michel Pompeu Sa, Beatrice Bacchi, Scott Goldman, Ali Fatehi Hassanabad, Serge Sicouri, Ramlawi Basel, Massimo Bonacchi
Journal: Circulation (2023)

Introduction: We aim to analyze multicenter long-term clinical outcomes of minimally invasive aortic valve replacement (MI-AVR) in patients with aortic valve disease. Hypothesis: We hypothesize that MI-AVR provides good long-term clinical outcomes in patients undergoing aortic valve surgery. Methods: All consecutive 1,972 patients undergoing MI-AVR with either ministernotomy (n= 986) or right anterior minithoracotomy (RAM, n=986) between 1999 and 2019, were included. Primary outcomes were all-cause mortality and cardiac death. Results: Preoperatively, mean age was 72.1 (±13.7) year-old, and mean STS-PROM risk score was 0.38%. Intraoperatively, mean operative time (min) was 213.97 (± 56.9), while 313 (15.9%) patients were converted to full sternotomy. Postoperatively, 69 (3.5%) patients had prolonged mechanical ventilation (&lt; 24 hours), 59 (3%) patients had re-exploration for bleeding, 10 (0.5%) patients had paravalvular leak (moderate/severe), 22 (1.1%) patients had non-fatal stroke, and 28 (1.4%) patients had non-fatal myocardial infarction. Mean intensive care unit stay was 14.45 (± 10.15) hours, and mean hospital length of stay (LOS) was 7 (± 3.5) days. Thirty-day all-cause mortality occurred in 39 (2%) patients while 30-day cardiac-death occurred in 23 (1.2%) patients. Thirty-day predictors for all-cause mortality included age &lt;75-years, post-operative LOS, peri-operative stroke, and RAM. Mean follow-up time was 10-years. At 20-year follow-up, all-cause death and CV-death incidence were 1156 (60%) and 170 (8.8%) patients, respectively. Valve-related deaths occurred in 33 (1.7%) patients. Long-term predictors for all-cause mortality included age &lt;75-years, chronic kidney failure, mechanical ventilation &lt;12 hours, RAM, and hospital LOS &lt;10 days. Conclusions: MI-AVR is a safe, valid, and reproducible surgical procedure for patients with aortic valve disease. In addition, it provides good long-term outcomes.
Abstract 11684: Comparison of Two Implantable Loop Monitors Implanted in the Same Patient and at the Same Site
Authors: Atul Prakash, eisha gupta, Tarick Hadaya, kartikeya srivastava
Journal: Circulation (2023)

Introduction: Implantable loop recorders (ILR) are utilized for diagnosis of AF and evaluation of syncope. The diagnosis of AF is based mainly on RR variability. Under sensing and Oversensing with these ILRs is being reported in a separate retrospective analysis. In this study we compared the real time &amp; recorded Electrogram characteristics obtained with two ILRs in the same patient at the same site Hypothesis: The amplitude of the R wave &amp; clarity of P wave would enable the correct diagnosis of a recorded event &amp; minimize under sensing and oversensing. This would thereby increase the specificity and sensitivity of the diagnosis of AF &amp; asystole. Methods: The two ILRs were the Medtronic REVEAL LINQ I and the BioMonitor III device. The Biomonitor is 77.5mm x8.6 mm x4.4 vs the LINQ I is 44.8x7.2x4 mm. When the Medtronic ILRs reached EOS they were replaced with a BioMonitor III at the same site using the existing pocket. We compared the amplitude of the R wave, presence of a clear P wave at the time of implant, undersensing and oversensing of recorded events. Results: 30 consecutive patients were included in the study. 17 Male and 13 Female Mean age was 70.3 + 8 yrs. Mean BMI was 28.4 + 5.05. Indication for implantation was AF management in 23 and syncope in 7. The mean R wave was 0.35 + 0.2 mv with the Reveal as compared to 0.98 + 0.4 with the BioMonitor III, ( p=0.001 ).P wave in sinus rhythm was present in 19/30 with the Reveal vs 28/30 of the BioMonitor III implants (P=0.004).Undersensing of events was seen in 5/ 30 patients with the Reveal vs 5/30 with the BioMonitor III (p&gt;0.1), Oversensing was seen in 4/30 with the reveals vs 0/30 with the BioMonitor III P&gt;0.1(p=0.12). The amplitude of the R wave and the presence of a clear P wave had a negative correlation with the BMI R =(-0.2) ). A clear P wave when present confirmed an AF episode as labelled by the device /mechanism of tachycardia and type of block in both loop monitor’s Conclusions: 1.R wave was significantly greater with the BioMonitor III (greater surface area) than a Reveal LINQ. 2. A clear P wave was more often present in sinus rhythm with a BioMonitor III 3. BMI had a negative correlation with both the amplitude of R wave and the presence of a clear P wave with both ILRs. 4. A clear P wave in the recordings significantly impacts the confirmation of an AF episode
Abstract 11962: Breaking Down the Relationship Between Atrial Fibrillation Class and Risk of Embolic Stroke: Beyond CHADSVASC Score
Authors: Nmair Alziadin, saleh alhalaseh, Ahmed Maraey, Zaid Alwarawrah, Apoorva T Raju, Sabrina A Mann, Omar Al Wahadneh
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is recognized as a risk factor for stroke. To evaluate the risk of stroke in AF patients, the CHADSVASC score is commonly utilized. However, the correlation between AF classification and the risk of embolic stroke beyond the CHADSVASC score remains unclear. Methods: We analyzed data from 488,790 admissions with embolic stroke, out of which 133,429 had atrial fibrillation, between 2016-2020 to examine the association between AF class and risk of embolic stroke. The CHADSVASC score was computed for each patient, with risk factors being assigned point values ranging from 0 to 2 based on their association with embolic stroke. Patients were categorized into one of four AF classes, namely paroxysmal, persistent, long-standing persistent, or permanent. Results: Patients with persistent, long-standing persistent, and permanent AF had a higher risk of embolic stroke compared to those with paroxysmal AF, even after adjusting for CHADSVASC score (OR: 3.15, 95% CI: 3.08-3.22, P=0.000, 3.48, 95% CI: 3.26-3.71, P=0.000, 3.56, 95% CI: 2.84-4.47, P=0.000, OR: 3.21, 95% CI: 3.12-3.30, P=0.000). Conclusion: Based on our study findings, it can be concluded that nonparoxysmal atrial fibrillation is associated with a higher risk of embolic stroke compared to paroxysmal atrial fibrillation , regardless of the CHADSVASC score. Therefore, patients diagnosed with persistent, long-standing persistent, and chronic AF should receive enhanced monitoring and more proactive management strategies to effectively mitigate the risk of embolic stroke.
Abstract 11953: Aortic Stenosis Severity, Symptom Status, and Long-Term Outcomes
Authors: Matthew D Solomon, Thomas K Leong, Elisha Garcia, David Lange, Jacob Mishell, edward J mcnulty, Femi Philip, Andrew Rassi, Anthony N Demaria, Rick A Nishimura, Alan S Go, Andrew P Ambrosy
Journal: Circulation (2023)

Introduction: The relationship between aortic stenosis (AS) severity, AS-related symptoms, and clinical outcomes is poorly understood. Research Question: Does a history of AS-related symptoms at the time of diagnosis affect clinical outcomes including death and AS-related hospitalization? Methods: Using a combination of natural language processing algorithms and administrative codes, we ascertained physician-assessed AS, AS severity, and AS-related symptoms (chest pain, acute coronary syndrome, syncope, presyncope, orthopnea, dyspnea, PND, and worsening heart failure) in the year prior or up to 60 days after an initial AS diagnosis among 602,821 adults with echocardiograms in a large, integrated health system from 2010-2019. We examined multivariable associations between AS severity and recent AS-related symptoms for the outcomes of death and AS-related hospitalizations using Cox models. Results: Among 40,333 patients identified with incident AS, the majority had recent AS-related symptoms (mild: 80%, mild-moderate: 77%, moderate: 77%, moderate-severe: 85%, and severe AS: 87%). Patients with recent symptoms were older (mean [SD] age 78 [10] vs 75 [11] years; p&lt;0.01), more likely female (51% vs 47%; p&lt;0.01), and had a higher comorbidity burden. In unadjusted analyses, symptom status was a strong discriminator of risk over a median (IQR) of 2.2 (0.8-4.3) years of follow-up ( Figure ). After multivariable adjustment, AS-related symptoms remained strongly associated with death and AS-related hospitalization across the spectrum of AS severity, with moderate symptomatic patients having risk similar to severe asymptomatic patients. Conclusions: The majority of patients diagnosed with AS have recent and/or active AS-related symptoms, which is associated with a significantly increased risk of adverse outcomes. Incorporating symptom status across the individual grades of AS may improve risk stratification beyond AS severity alone.
Abstract 11754: Trends in Cardiovascular Mortality Before and During the COVID-19 Pandemic
Authors: Jacob Clarke, Frances Greathouse, Ahmed Elkaryoni, Parth V Desai, Mark Mujer, Amir Darki
Journal: Circulation (2023)

Introduction: The COVID-19 pandemic has placed increased strain on the US healthcare system, limiting the prevention and treatment of cardiovascular diseases. Previous studies have noted an increase in excess mortality among patients with chronic medical conditions during the pandemic. However, these trends have not been fully explored in patients with acute pulmonary embolism (APE) and cardiovascular disease. Methods: Death-certificate data from the CDC Wonder database were used to calculate death rates of APE, heart failure (HF), and myocardial infarction (MI) from 1999 to 2022. Training data from 1999 - 2019 were used to create a prediction model that was used to calculate excess mortality during the COVID-19 pandemic stratified by disease, year, sex, and race. Results: Between 1999 and 2022, the most common studied cause of death was HF followed by MI and APE. All studied causes of death occurred at higher rates during 2020 compared to 2019. For all included diseases, there was a positive correlation between monthly excess mortality and total US covid deaths. APE had the highest percent excess mortality (86.5%) followed by MI (31.6%), and HF (16.2%) (Figure 1). When stratified by sex and race, males and black individuals experienced greater cumulative excess mortality across all included diseases (Figure 2). Conclusions: COVID-19 has had a heterogenous effect on different cardiovascular diseases both directly through infection and indirectly through increased strain on the healthcare system. Understanding the impact of COVID-19 on CVD burden can help guide public policy in future health care-system stressors.
Abstract 11891: Pulmonary Delivery of Novel BEPI/NO-Microparticle for Treatment of Pulmonary Arterial Hypertension
Authors: Se Yong Y Jung, Yoogyeong Oh, Sanghoon Kim, Jinkee Hong
Journal: Circulation (2023)

Introduction: Pulmonary arterial hypertension (PAH) is an incurable disease characterized by elevated blood pressure in the pulmonary artery causing right heart failure and even sudden cardiac death. Nitric oxide (NO) is a strong potent regulator of PAH. However, the therapeutic effects of exogenous NO depend on its concentration and its half-life is very short. Hypothesis: we prepared NO-releasing inhalers with controlled porous structures to modulate the deposition in lung. Methods and Results: NO-releasing inhalers with micro-sized pores showed improved nebulization efficiency. Furthermore, the cGMP expression and macrophage polarization were evaluated. The fluorescence intensity of Nile red was analyzed using photoluminescence spectroscopy to confirm the amounts of NO-MPs on the slide glass. As with confocal images, 0.8k BPEI/NO-MPs could arrive the lower region than 25k BPEI/NO-MPs. NO produced by endothelial nitric oxide synthase (eNOS) induce vasodilation by increasing cGMP in vascular smooth muscle cells. Hence, the delivery of NO mimicking the physical production of the endothelium in range of 0.05-0.4 nmol cm -2 min -1 is required to restore vascular homeostasis. Therefore, BPEI0.8k/NO-MPs release 0.277 nmol cm -2 min -1 of NO that mimics the environment in healthy endothelium, while BPEI25k/NO-MPs showed a higher concentration as 0.548 nmol cm -2 min -1 . BPEI0.8k/NO-MPs increased the synthesis of cGMP in cells, whereas BPEI25k/NO-MPs presented adverse effects due to an initial burst release. When cell populations were quantified, BPEI0.8k/NO-MPs increased the number of M2-like cells while decreasing the number of M1-like cells. Furthermore, using fluorescence activated cell sorting analysis, proteins and gene levels of cells, anti-inflammatory factors increased in BPEI0.8k/NO-MPs treatment groups Conclusions: novel BPEI/NO-releasing inhalers could deliver NO to deep lungs and has the potential for treatment of PAH
Abstract 12080: Comprehensive Proteomics Profiling of Human Myocardium Reveals Signaling Pathways Dysregulated in Severe Forms of Hypertrophic Cardiomyopathy
Authors: Heidi Hartman, Mark Sherrid, Kohei Hasegawa, Elizabeth Adlestein, Daniel Swistel, Albree Tower-Rader, Michael A Fifer, Veli K Topkara, mathew S Maurer, Muredach P Reilly, Yuichi Shimada
Journal: Circulation (2023)

Introduction: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, affecting 1 in 200-500 people. There is significant heterogeneity in disease severity. The signaling pathways that link gene mutations to severe HCM disease remain unknown. Analysis of the myocardial proteome is a novel approach to understanding severe forms of HCM. Hypothesis: Comprehensive proteomics profiling of myocardium identifies signaling pathways that are differentially regulated in severe forms of HCM. Methods: Proteomics profiling of 7289 proteins from myocardium was performed on patients with HCM. Univariable analysis with the Wilcoxon rank sum test or Spearman’s rank correlation test was used to determine the association between protein concentration and 5 clinical indicators of severe HCM: 1) left ventricular ejection fraction (LVEF), 2) atrial fibrillation (AF), 3) ventricular arrhythmias, 4) maximum septal thickness, and 5) late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR). Pathway analysis of proteins with significantly different concentrations (i.e., nominal p&lt;0.05) in association with each clinical indicator was executed. Results: There were 106 patients with HCM included in the study. Pathway analysis of proteins associated with each indicator of severe HCM revealed dysregulation of inflammatory pathways and Ras-MAPK-related pathways ( Figure ). Metabolic pathways and adhesion pathways were dysregulated in association with LVEF and AF. Dysregulation of angiogenesis pathways (e.g., HIF-1, VEGF) was associated with LGE (FDR&lt;0.05). Conclusions: Comprehensive proteomics profiling of human HCM myocardium was used to identify dysregulated signaling pathways associated with clinical features of severe HCM. Findings from this study support the role of both known (e.g., inflammation, metabolism, adhesion, and angiogenesis) and novel (e.g., Ras-MAPK) pathways in the development of severe forms of HCM.
Abstract 12132: The Intercellular Adhesion Molecule-1 Missense Variant rs5491, High-Sensitivity C-reactive Protein, and Heart Failure With Preserved Ejection Fraction Risk
Authors: Pedro Giro, Kent D Taylor, Sanjiv J Shah, Ravi B Patel
Journal: Circulation (2023)

Introduction: Intercellular adhesion molecule-1 (ICAM-1) is a cell surface protein involved in leukocyte transmigration, thereby promoting inflammation. A missense genetic variant in ICAM1 , rs5491, is common among Black individuals but rare in other race/ethnic groups, and has been associated with increased risk of heart failure with preserved ejection fraction (HFpEF). The pathways by which rs5491 may lead to HFpEF, however, are not known. Hypothesis: We hypothesized that rs5491 is associated with systemic inflammation as measured by high-sensitivity C-reactive protein (hsCRP) and that the association between rs5491 and HFpEF is mediated by higher hsCRP. Methods: Among Black individuals within the Multi-Ethnic Study of Atherosclerosis, we evaluated the association of rs5491 with hsCRP at Exam 1 and performed a formal mediation analysis of hsCRP on the association between rs5491 and incident HFpEF. Results: Among 1558 Black participants (mean age 62±10 y, 47% female), individuals with at least one copy of rs5491 (N=580) had higher hsCRP in unadjusted analysis (2.78 mg/L [IQR: 1.11-6.25] vs 2.25 mg/L [IQR: 0.99-4.82], P=0.009). After covariate adjustment, each additional rs5491 allele was significantly associated with higher hsCRP (β: 0.15, SE: 0.07, P=0.02; Figure ). Each additional rs5491 allele remained significantly associated with incident HFpEF after adjustment for hsCRP in addition to clinical covariates and principal components of ancestry 1-10 (HR 1.86, 95% CI: 1.15-3.01, P=0.01). On mediation analysis, hsCRP did not significantly mediate the association between rs5491 and HFpEF (percent mediated: 0%, 95% CI: 0-31%, P= 0.08). Conclusions: In Black individuals, the ICAM1 missense variant rs5491 is associated with incident HFpEF and systemic inflammation, as measured by hsCRP. The relationship between rs5491 and HFpEF is not mediated by hsCRP, suggesting that other inflammatory pathways may drive HFpEF risk among individuals with this variant.
Abstract 11936: Cardiorenal Prognostic Significance of IGFBP-7 Concentrations in Chronic Heart Failure: Findings From EMPEROR-Pooled
Authors: Reza Mohebi, James L Januzzi
Journal: Circulation (2023)

Introduction: Insulin-like growth factor binding protein-7 (IGFBP-7) is a biomarker of tissue senescence with a role in heart failure (HF) pathophysiology. We examined the association of IGFBP-7 with risk of HF hospitalization or cardiovascular (CV) death and progression of renal disease in the EMPEROR-Reduced and EMPEROR-Preserved Trials. Methods: IGFBP-7 was measured in serum samples in the placebo and empaglifozin arms at baseline (N= 561, 564), 12 weeks (N=558, 557) and 52 weeks (N=355, 358). IGFBP-7 was measured using Roche Cobas Elecsys assay within the Biomarker Research Agreement of Boehringer Ingelheim, the sponsor of the EMPEROR trials and Roche Diagnostics International Ltd. Association between IGFBP-7 and risk of HF hospitalization or CV death, estimated glomerular filtration rate (eGFR) slope, and renal composite outcome of sustained eGFR reduction ≥40% or end-stage renal disease were evaluated using multivariable modeling. Results: Study participants with IGFBP-7 levels in the third tertile had a higher risk clinical profile compared to those with lower values. Empagliflozin was not meaningfully associated with change in IGFBP7 at 12 or 52 weeks. In Cox proportional hazards models adjusted for clinical variables, N-terminal pro-B type natriuretic peptide and high-sensitivity cardiac troponin T, baseline IGFBP-7 values above the second tertile predicted a higher risk of HF hospitalization or CV death (HR: 2.00 95% CI 1.28-3.10, p=0.002), higher rate of eGFR decline (β estimate: -2.45, 95% CI: -3.40 - -1.50, p for trend =0.005) and higher risk of renal composite endpoint (HR: 4.66, 95% CI: 1.61-13.53, p=0.005). Empagliflozin reduced risk for CV death/HF hospitalization irrespective of baseline IGFBP-7 (p-trend across IGFBP-7 tertiles=0.26). Concentrations of IGFBP-7 were moderately correlated with other prognostic HF biomarkers of tissue remodeling including fatty acid binding protein-3, growth differentiation factor-15, and angiopoietin-2. Conclusions: IGBP-7 was correlated with worse clinical presentation and associated with adverse cardiovascular outcomes even in models adjusted for conventional biomarkers. Empagliflozin did not significantly affect IGFBP-7 levels over time.