tbuckley/cabot-search huggingface dataset:
Abstract 4140993: Time-Restricted Feeding Alleviates Cardiac Aging through Gut Microbiota
Authors: Shi Tai, Liyao Fu, Rukai Yang, Shenghua Zhou
Journal: Circulation (2024)

Background: Time-restricted feeding (TRF) is an effective strategy for anti-aging management yet its prophylactic/therapeutic applicability against cardiac aging is unknown. Methods: To assess the effects of TRF on cardiac aging, male mice were randomized into the normal diet+ad libitum feeding (N-ALF), normal diet+TRF (N-TRF), high-fat diet+ALF (H-ALF), high-fat diet+TRF (H-TRF). Metagenomic sequencing was used to investigate the diversity, composition, and evolution of the gut microbiota. The metabolomics was employed to investigate the impact of TRF on the metabolic profile of feces. Using fecal microbiota transplantation, TRF has been validated to delay cardiac aging by optimizing gut microbial composition and function. Results: Compared to the H-ALF group, the H-TRF group showed that the expression of senescence markers p53 and p21 was reduced. In addition, the myocardial interstitial collagen deposition and the expression of collagen I and III were reduced by TRF. Moreover, TRF reduced left ventricular posterior wall dimensions at end-diastole, interventricular septal thickness at end-diastole, and myocardial diastolic function index E/e' in mice. These suggested that TRF delays high-fat diet-induced cardiac aging. Compared with the H-ALF group, the TRF group exhibited an increase in the alpha diversity of gut microbiota. At the phylum level, the abundance of the Bacteroides was increased by TRF. At the genus level, the abundance of Bacteroides, Parabacteroides, and Akkermansia was increased by TRF. There were 11 characteristic strains in the H-TRF group, six of these strains are closely related to the production of short-chain fatty acids (SCFAs). Function prediction of the differential genes showed an increase in the SCFAs pathway in the H-TRF. LC-MS profiling of feces showed that TRF can reduce the levels of l-tyrosine, l-tryptophan, phenylalanine, valine, indoxyl-sulfate, cholesterol-sulfate, and tetradecanedioic acid in the intestines from high-fat diet mice. TRF increased the levels of 16-oxo-heptadecanoic acid, propionic acid, butyric acid, 2-methylpropionic acid, acetoacetate, succinate, and acetoacetyl-CoA. Using the mice with HFD, those that received gut microbiota from H-TRF showed decreased levels of cardiac senescence markers. It was suggested that gut microbiota plays a crucial role in TRF improving cardiac aging. Conclusions: TRF improves high-fat diet-induced cardiac aging by optimizing the composition and function of gut microbiota.
Abstract 4141695: Empagliflozin reduces both infarct size and no-reflow in a rat experimental myocardial ischemia/reperfusion model
Authors: Wangde Dai, Juan Carreno, Niema Pahlevan, Rashid Alavi, Jesus Chavez, Robert Kloner
Journal: Circulation (2024)

Background: Whether acute administration of empagliflozin (EMPA) , a sodium glucose cotransporter-2 could reduce myocardial infarct size is controversial. Its effect on no-reflow is unknown. We determined whether intravenous administration of EMPA at 10 min before coronary occlusion combined with 1 min prior to reperfusion, could limit myocardial infarct (MI) size and the no-reflow phenomenon compared to chronic therapy in a standardized rat model. Methods: Male SD rats were randomized into 3 groups (n = 13 in each group): (1) Control group: rats were fed diet without EMPA; (2) Acute treatment group: EMPA was given intravenously through the jugular vein at 10 minutes prior to coronary artery occlusion (10 mg/kg) and repeated at one minute prior to reperfusion; (3) Chronic treatment group: EMPA was administrated to the rats by food (20 mg/kg) for 7 days before myocardial ischemia. The coronary artery occlusion was maintained for 30 minutes followed by 3 hours of reperfusion. Results: The ischemic risk area (blue dye technique) was comparable among the 3 groups. MI size (Triphenyl tetrazolium staining) as percent of risk zone was significantly reduced in both acute EMPA treated group (46.9 ± 2.0%) and chronic EMPA group (48.8 ± 5.8%) compared to the control group (70.0 ± 2.6%; p = 0.005, figure A). No-reflow size (thioflavin S technique) as percent of risk zone was significantly smaller in the acute EMPA treated group (36.3 ± 3.3%) and chronic EMPA group (33.9 ± 4.3%) compared to the control group (53.4 ± 3.3%; p = 0.012, figure B). Conclusions: Both acute and chronic EMPA treatment significantly reduced infarct size. We showed for the first time that EMPA reduced no-reflow in an acute rat myocardial ischemia/reperfusion model.
Abstract 4141628: Prescription of Lipid-Lowering Treatments in the year following a first Atherosclerotic Cardiovascular Event: updated results from the French Nationwide Claims Database.
Authors: Bertrand Cariou, Thomas Goronflot, stephanie Duret, Mathilde Pouriel, Alexandre Bastien, Julie Prax, Christophe Leux, Nadege COSTA, Sophie BELIARD, Jean Ferrieres, Matthieu Wargny
Journal: Circulation (2024)

Introduction: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality worldwide. Lipid-lowering therapies (LLTs) are a key element to reduce the risk of recurrence of ASCVD events. However, despite concordant guidelines, LLTs are often underused in real-life setting. Research questions: The aim of this study is to describe the use of LLTs and its impact on morbi-mortality in the year following a first ASCVD event. Methods: This retrospective study used the national health data system (SNDS), collecting health insurance claims and hospital discharge data from 99% of the French population. Incident cases in 2021 were identified, corresponding to all adults with a first ASCVD event, based on ICD-10 hospital coding. ASCVD includes coronary artery disease [myocardial infarction, unstable angina or coronary revascularization], cerebrovascular events [ischemic stroke, carotid revascularization] and peripheral artery disease (PAD) requiring artery revascularization. In patients discharged alive from the index event, longitudinal analyses were performed at 1-year from discharge to describe LLT use, occurrence of major ASCVD events and all-cause mortality. Results: In 2021, 195,211 newly diagnosed ASCVD cases were identified among 43,1M adults (mean age: 70.3 (±13.7) yo; 62% of male). The first ASCVD event was myocardial infarction (N=51,614) or ischemic stroke (N=52,865) in 53.5% of incident cases. The remaining 46.5% corresponded mostly to coronary revascularization procedures (N=83,910), followed by PAD (N=26,925). In-hospital mortality was 5.5% (N=10,673). In patients analyzed at 1 year (N=180,875), 16.9% did not receive any LLT. This value rose to 26.7% among patients who had no received LLT prior to the ASCVD event. After a myocardial infarction, patients were more likely to receive LLT (91.9%) compared to after an ischemic stroke (72.9%) or revascularization for PAD (68.0%). Finally, 1-year all-cause mortality was higher in non-LLT compared to LLT patients (20.9% vs 4.0%). Additional data on the recurrence of ASCVD events as a function of LLT use are currently being analyzed and will be presented at the congress. Conclusion: Contrary to recommendations, the underuse of LLTs after a first ASCVD event remains very high, particularly after a stroke. This is associated with a significantly higher mortality at 1 year, justifying the need to reinforce implementation of the guidelines in real life for a better management of residual lipid risk.
Abstract 4141224: Prognostic Value of Serum Glycated Albumin in Acute Coronary Syndrome Patients Without Standard Modifiable Cardiovascular Risk Factors
Authors: Xiaoming Zhang, Yu Du, Yujie Zhou
Journal: Circulation (2024)

Background: Glycated albumin (GA) has been demonstrated to be associated with adverse outcomes in patients with acute coronary syndrome (ACS). However, as a specific subgroup of ACS, a significant proportion of patients with ACS without standard modifiable cardiovascular risk factors (SMuRFs) are currently being identified. The prognostic value of serum GA for adverse events in such patients remains unexplored. Aims: This study aims to evaluate the prognostic value of GA in predicting adverse outcomes in patients with ACS without SMuRFs. Methods: This study involved 1,140 consecutive patients who were diagnosed with ACS without SMuRFs at the Beijing Anzhen Hospital between May 2018 and December 2020 and underwent coronary angiography. Each patient was followed up for a period of 35–66 months after discharge. The primary endpoint of this study was major adverse cardiovascular and cerebrovascular events (MACCEs) that included all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, and ischemia-driven revascularization. Results: The average age of the study participants was 59.55 ± 10.98 years, and men accounted for 61.8%. The average GA level was 14.37 ± 2.42. The median follow-up duration was 48.3 months, during which 220 cases (19.3%) experienced MACCEs. In the fully adjusted model, with GA as a continuous variable, the hazard ratio (HR) for MACCEs in the high GA group was 1.069 (95% confidence interval (CI): 1.008, 1.133), the HR for ischemia-driven revascularization was 1.095 (95% CI: 1.021, 1.175), and the HR for all-cause mortality was 1.155 (95% CI: 1.021, 1.306), all with P values less than 0.05. Similarly, when GA was considered as a categorical variable, in the fully adjusted model, GA was associated with MACCEs, ischemia-driven revascularization, and all-cause mortality, with P values all less than 0.05. The restricted cubic spline curve showed that the relationship between GA and MACCEs was linear (p for non-linear = 0.079; p for overall association = 0.026). Furthermore, GA levels were correlated with poor prognosis in the subgroups of patients. Conclusion: Serum GA might be an independent predictor of all-cause death, ischemia-driven revascularization, and MACCEs in patients with ACS without SMuRFs.
Abstract 4141549: The Diagnostic Utility of the Longitudinal Myocardial Blood Flow Gradient is Dependent on the Magnitude of the Hyperemic Stimulus in Swine with an Epicardial Coronary Stenosis
Authors: Alex Fees, Beth Palka, John Canty, Brian Weil
Journal: Circulation (2024)

Introduction: The hyperemic longitudinal myocardial blood flow (MBF) gradient (i.e., hyperemic MBF from the base to the apex of the left ventricle) has been proposed as an emerging non-invasive index to identify hemodynamically significant epicardial coronary artery disease (CAD). However, whether the utility of this parameter is influenced by the magnitude of the hyperemic stimulus has not been studied. Accordingly, we measured the longitudinal MBF gradient at rest and during submaximal and maximal adenosine (ADO)-induced hyperemia in swine with a fixed epicardial coronary stenosis. Methods: Swine (n=11) were chronically instrumented with a fixed LAD stenosis (89±3%). Regional MBF was assessed with fluorescent microspheres at rest and during submaximal (150 or 300 µg/kg/min) and maximal (900 µg/kg/min) ADO vasodilation, with concomitant phenylephrine (8±3 µg/kg/min) during maximal ADO to avoid hypotension. Coronary flow reserve (CFR) was calculated as the quotient of MBF during ADO divided by MBF at rest and the longitudinal MBF gradient was calculated as the difference in absolute MBF between the base and apex of full-thickness myocardium in LAD (ischemic) and PDA (non-ischemic) perfusion territories. Results: ADO elicited a dose-dependent increase in MBF that was blunted in the LAD perfusion territory vs. the PDA perfusion territory, such that a dose of at least 300 µg/kg/min was necessary to identify a significant regional difference in CFR ( Figure A ). The longitudinal MBF gradient was negligible in the normally perfused region of the left ventricle at rest and across all ADO doses. In contrast, an abnormal decrease in the longitudinal MBF gradient was evident In the LAD perfusion territory, but only when ADO was given at a dose of at least 300 µg/kg/min ( Figure B ). Conclusion: These results demonstrate that a proximal LAD stenosis leads to an abnormal decrease in the base-to-apex perfusion gradient during ADO hyperemia in swine. However, the reduction in the longitudinal MBF gradient is not evident at relatively low doses of ADO, suggesting that the diagnostic utility of this parameter is dependent on the magnitude of the hyperemic stimulus.
Abstract 4140966: Outpatient Cardiology Performance Metric Achievement by Clinicians in the Veteran Affairs Health Care System
Authors: Christine Chow, Taufiq Salahuddin, Claire Chen, Elise Gunzburger, PAUL HESS, Jacob Doll
Journal: Circulation (2024)

Introduction: Veterans Affairs (VA) facilities evaluate cardiology clinicians using three performance measures for outpatient care: anticoagulation for atrial fibrillation or atrial flutter (AF) with elevated stroke risk, statin therapy for coronary artery disease (CAD), and renin-angiotensin-aldosterone system (RAAS) inhibition for heart failure (HF). We sought to assess these metrics and their differences by clinician characteristics using VA health record data. Methods: We assessed AF, CAD, and HF performance measures for cardiology clinicians with at least 50 annual outpatient encounters from 2017-2023 in VA. A clinician-patient relationship was defined as ≥2 encounters within 1 year or ≥3 encounters within 3 years. Performance measure achievement was calculated separately for each clinician as well as an overall average. If more than one encounter occurred per year for a clinician-patient dyad, one was chosen at random for evaluation. Clinician performance distributions were represented as histograms, and differences in unadjusted performance by clinician training status and gender were assessed using Welch two sample t-tests. Results: Of 456,071 unique cardiology encounters, 179,476 included AF with elevated stroke risk, 313,603 included CAD, and 225,476 included HF with EF ≤40%. There were 1,046 cardiology providers including 53% physicians and 52% women. Overall mean performance measure achievement was 87.7%. Mean performance scores for AF, CAD, and HF were 86.3%, 94.2%, and 78.9% respectively, and distributions are shown in the Figure . There was a modest difference in unadjusted overall performance between physicians and non-physician providers (88.0 vs. 87.2%, p = 0.005) and no difference between female and male clinicians (87.5% vs. 87.8%, p = 0.4) Conclusion: There was high achievement of three established VA outpatient cardiology performance measures with minimal differences by clinician training or gender. This may represent a ceiling effect. However, significant variation remained at the clinician level, indicating potential opportunities for quality improvement even for these well-established treatments.
Abstract 4141698: Outcomes of catheter ablation in cardiac sarcoidosis patients with ventricular tachycardia
Authors: haider al taii, Ritika Saxena, Diann Gaalema, Chockalingam Narayanan, Ramez Morcos, Muhie Dean Sabayon, Hani Jneid
Journal: Circulation (2024)

Background: Ventricular tachycardia (VT) in patients with cardiac sarcoidosis (CS) can lead to sudden cardiac death. The role of ventricular tachycardia ablation (VTA) in CS has been investigated in a few small, single-center, and some larger observational studies, but the evidence remains scarce. Hypothesis: We hypothesize that patients with CS have worse cardiovascular outcomes. Aims: This study aimed to investigate the clinical outcomes of VTA in patients with CS admitted with a diagnosis of VT. Methods: A retrospective analysis was conducted using TrinetX database: US collaborative network from 2010-2024. Patients undergoing ablation for VT with and without CS were identified. Two groups were created for propensity score analysis matching on history of hypertension, diabetes, obesity, peripheral vascular diseases, heart failure, ischemic heart diseases, atrial fibrillation, and chronic kidney disease. The primary outcome was incidence of death, cardiogenic shock, heart failure, acute myocardial infarction, hemorrhagic stroke, ischemic stroke, and ventricular tachycardia within one year from the date of the index procedure. Results: Results: Out of 15,958 patients who underwent catheter ablation for VT, 776 patients had CS. The mean age of patients with VT and CS who underwent ablation was 58.6 (SD:11.3), compared to 61.1 (SD:15) in patients with VT without CS. In the propensity-matched analysis, there was no significant difference in one-year mortality (hazard ratio (HR) 0.65; 95% CI [0.45, 0.94], χ2 = 3.05, p = 0.08), heart failure (HR 1.18; 95% CI [1.04, 1.33], χ2 = 1.5, p = 0.2), cardiogenic shock (HR 1.33; 95% CI [0.95, 1.89], χ2 = 0.005, p = 0.94), acute myocardial infarction (HR 0.81; 95% CI [0.5, 1.11], p = 0.67), hemorrhagic stroke (HR 0.89; 95% CI [0.18, 4.41], p = 0.42), ischemic stroke (HR 1.18; 95% CI [0.80, 1.7], p = 0.79) or ventricular tachycardia (HR 1.17; 95% CI [1.04, 1.31], p = 0.19) Conclusion: This analysis shows there is no significant difference in major complications in patients with cardiac sarcoidosis undergoing catheter ablation for ventricular tachycardia compared to patients without cardiac sarcoidosis.
Abstract 4141371: Comparing predictors of atrial fibrillation recurrence following <i>de novo</i> versus repeat catheter ablation
Authors: Mark Brahier, Hannah Schwennesen, Andrew Vista, Daniel Friedman, Jonathan Piccini
Journal: Circulation (2024)

Background: Approximately 1 of 5 catheter ablations for atrial fibrillation (AF) are repeat procedures. Despite this, little is known about risk factors for recurrence in patients undergoing repeat ablation compared with those undergoing de novo ablation. Objective: To compare predictors of AF recurrence following de novo and repeat catheter ablation. Methods: To compare AF recurrence between those with and without prior ablation, we conducted a retrospective cohort study of patients undergoing catheter ablation for treatment of symptomatic and drug-refractory AF. In this analysis, early recurrence was defined as 30 seconds of AF, atrial flutter, or atrial tachycardia within a 3-month blanking period, while late recurrence was defined as recurrent arrhythmia at &gt;3 months. Multivariable Cox proportional hazard regression analysis was used to identify independent factors associated with recurrence. Results: Among 659 patients, 487 (mean age 63.3 +/- 10.1 years, 33% female, CHA2DS2-VASc 2.8 +/- 1.8, 62% paroxysmal) underwent de novo ablation and 172 (mean age 65.1 +/- 10.0 years, 34% female, CHA2DS2-VASc 3.1 +/- 1.9, 60% paroxysmal) underwent repeat ablation with average follow up of 24.4+/-18.4 months. Multivariable modeling revealed that left atrial volume index (LAVi) [HR 1.015, p&lt;0.0001], body mass index (BMI) [HR 1.025, p=0.043], and early recurrence [HR 2.496, p&lt;0.0001] were predictive of late recurrence in the de novo ablation cohort, compared to LAVi [HR 1.014, p=0.006] and early recurrence [HR 2.053, p=0.001] in the repeat ablation cohort. Age, sex, AF type (paroxysmal vs non-paroxysmal), obstructive sleep apnea, heart failure, CHA2DS2-VASc scores, and energy source (cryoballoon vs radiofrequency) were not predictive of recurrence in either cohort (p&gt;0.05). There was a trend towards higher probability of recurrence following repeat ablation (log-rank p=0.052). Conclusion: Predictors of late AF recurrence following de novo and repeat catheter ablation are similar at &gt;2 years follow-up. The left atrial volume index and early recurrence are the strongest predictors of late recurrence.
Abstract 4141135: Right atrial functional reserve and liver stiffness after complete repair of tetralogy of Fallot
Authors: Wing Ki Bosco Chik, Kwok-lap Chan, Pak-cheong Chow, Kwong Man Yu, Yumi Yuk-ting Chan, Yiu-Fai Cheung
Journal: Circulation (2024)

BACKGROUND: Right atrial (RA) dysfunction related to right ventricular (RV) function has been reported in patients with repaired TOF. Increased liver stiffness in these patients has also been reported. Whether RA function worsens under exercise stress, and its relationship with worsened liver stiffness is unknown. HYPOTHESIS: In patients after TOF repair, RA functional reserve during exercise stress is reduced and correlated with raised liver stiffness and RV dysfunction. METHODS: 19 patients (8 male) aged 17.92 ± 3.81 at 16.06 ± 3.98 years after repair and 25 controls (16 male, aged 19.99 ± 1.67 years) were studied. RA mechanics was assessed by speckle-tracking echocardiography (STE) at rest and during bicycle exercise, with quantification of positive, negative, and total strain, and strain rates at ventricular systole (aSRs), early diastole (aSRed), and atrial contraction (aSRac). RAFR is calculated as (Change in RA total strain x [1-1/ baseline RA total strain]). Biventricular (RV, LV) function were quantified using Doppler interrogation and STE. Hepatic shear wave velocity (c) and tissue elasticity (E) were measured using shear wave elastography. RESULTS: At rest, patients had lower RA positive, negative and total strain, aSRs and aSRed than control subjects (all p&lt;0.001). RAFR were lower in patients than controls (p&lt;0.05). Hepatic shear wave velocity and tissue elasticity were higher in patients than controls (both p&lt;0.003). Compared with controls, patients had lower RA strains, aSRs, aSRed and aSRac during exercise (all p&lt;0.001). No significant difference in hepatic stiffness indices were found between patients and control subjects at exercise (both p&gt;0.05). RAFR correlated negatively with baseline hepatic shear wave velocity and tissue elasticity (both p&lt;0.001). RAFR tended to correlate with pulmonary regurgitation severity (p=0.06), and correlated with RV function, such as exercise RV strain rate at late diastole (SRa), exercise transtricuspid early (E) and late (A) inflow velocities during exercise, and resting RV systolic strain (all p&lt;0.05). Multivariate analyses revealed that RV and LV systolic strain, and RV strain rate at early diastole (SRe) are predictors of right atrial total strain at exercise and RAFR, whilst RV SRa is also a predictor of exercise RA total strain (all P&lt;0.05). CONCLUSIONS: In young adults after TOF repair, right atrial function reserve is impaired, and is associated with increased liver stiffness and RV dysfunction.