tbuckley/cabot-search huggingface dataset:
Abstract 16621: Factors Influencing the Difficulty of Guidewire Passage in Duplex-Guided Endovascular Treatment for Femoropopliteal Chronic Total Occlusions
Authors: Otowa Kanichi, Shintaro Matsuura, Naoki Dotani, Yusuke Miya, KEISUKE USUDA, Akio Chikata, Michiro Maruyama, Kazuo Usuda
Journal: Circulation (2023)

Introduction: Previous studies have shown the effectiveness of duplex-guided endovascular treatment (EVT) for femoropopliteal chronic total occlusions (FP-CTO). However, the factors that contribute to the difficulty of guidewire passage during duplex-guided EVT have not been clearly understood. Therefore, this study aimed to examine the factors associated with prolonged guidewire passage in the CTO segment using this method. Methods: In this single-center, retrospective analysis, data from patients who underwent duplex-guided EVT for FP-CTO from April 2018 to March 2023 were collected. The guidewire passage index (GPI), defined as the time required for guidewires to pass the CTO segment divided by the length of the CTO segment, was used. The study aimed to explore the correlation between the GPI and the personal backgrounds and lesion characteristics of the patients. Results: A total of 40 lesions in 35 patients (28 males, mean age: 75.8 ± 6.5 years) with consecutive de novo lesions were treated using duplex-guided EVT. The patients had a mean height of 162.0 ± 7.8 cm, weight of 58.9 ± 10.9 kg, body mass index (BMI) of 22.4 ± 3.4 kg/m 2 , and pre-EVT ankle brachial index (ABI) of 0.50 ± 0.19. The mean lesion length was 218.2 ± 67.8 mm, and the CTO length was 159.4 ± 85.0 mm. All procedures were successful, with an average time of 44 ± 48.2 min required for guidewires to pass the CTO segment and a GPI of 2.9 ± 2.7 min/cm. There was a negative correlation (–0.46) between the time required for guidewires to pass the CTO segment and age, while positive correlations were found between the time required for guidewires to pass the CTO segment and weight, BMI, lesion length, and CTO length (0.32, 0.44, 0.48, and 0.58, respectively). However, no associations were found between GPI and factors such as gender, hypertension, diabetes, dyslipidemia, renal insufficiency, smoking status, CTO length of 150 mm or more, Rutherford classification, Fontaine classification, or puncture site. Additionally, no correlations were found between GPI and age, height, weight, BMI, preoperative ABI values, lesion length, or CTO length. Conclusions: The patient background does not appear to have an impact on the difficulty of guidewire passage in duplex-guided EVT for FP-CTO.
Abstract 18242: Mitral Valve Repair vs. Mitral Valve Replacement in Rheumatic Heart Disease Patients: A Systematic Review and Meta-Analysis
Authors: Omer Ul Hassan, Farah Yasmin, Abdul Moeed, Saad Ur U Rahman, Shizra Jawed
Journal: Circulation (2023)

Background Mitral valve repair (MVP) is recommended over mitral valve replacement (MVR) for mitral valve disease. However, its benefits in rheumatic heart disease (RHD) patients are unclear. We conducted this meta-analysis to compare perioperative and long-term clinical and safety outcomes of MVP vs. MVR. Methods: MEDLINE, Google Scholar, and Scopus were searched from inception till June 2023 comparing clinical outcomes with MVP vs. MVR in RHD patients. Primary outcomes were early mortality and long-term survival. Secondary outcomes were freedom from reoperation, freedom from valve related adverse events, postoperative infective endocarditis (IE), thromboembolic events (TEE), and hemorrhagic events. The outcome measures were summary random effects risk ratio (RR) and hazard ratios (HR) with 95% confidence intervals. Results: A total of 19 studies with 10,724 RHD patients (3,495 MVP vs. 7,229 MVR; mean age: 38.3 years for MVP vs. 43.5 years for MVR) were included. MVP was associated with significantly lower early mortality (RR 0.62 [0.45, 0.85]; p=0.003), and long-term mortality (HR 0.53 [0.37, 0.76]; p=0.0006). Upon meta-regression analysis, only increasing age was associated with early mortality (Coeff: 0.0194, p=0.037). However, MVP was associated with significantly lower freedom from reoperation at both 5- (RR 0.88 [0.83, 0.93]; p&lt;0.0001) and 10-year (RR 0.90 [0.83, 0.98]; p=0.01) follow-ups. Freedom from valve related adverse events was higher in the MVP group at 10-year follow-up (RR 1.15 [1.06, 1.24]; p=0.0006) with no significant difference at 5-year follow-up (RR 1.03 [0.94, 1.14]; p=0.50). No significant difference was seen for IE (RR 1.03, p=0.91) and hemorrhagic events (RR 0.70, p=0.05). TEE were significantly lower in the MVP group (RR 0.59 [0.44, 0.78]; p=0.0003). Conclusion: In RHD, MVP reduced early- and long-term mortality and achieved greater freedom from valve related adverse events. However, there was a higher risk of reoperation in MVP.
Abstract 18081: Using Evidence-Based Strategies, Including Coverage of Home-Based Cardiac Rehabilitation, to Increase Participation in Cardiac Rehabilitation - A Community Health Plan’s Experience
Authors: Zainab Magdon-Ismail, Sheree Murphy, Vickie Gauthier, Tiana Wyrick, Cori Rowe, Rachael Austin, Pennie Cuevas, Bruce Coplin
Journal: Circulation (2023)

Introduction: Barriers to referral, enrollment and participation in cardiac rehabilitation (CR) contribute to low rates of completion despite known benefits. Barriers are system, provider and patient related. We sought to examine the impact a non-integrated community health plan can have on addressing these barriers, given the absence of formal studies evaluating its impact. Hypothesis: Implementing evidence-based strategies would increase CR participation. Methods: Between October 2019-October 2022, The Capital District Physicians’ Health Plan (CDPHP) developed and implemented an enhanced cardiac rehabilitation initiative (ECRI) to increase CR rates using evidence-based strategies. CDPHP: 1) eliminated patient cost-share, 2) covered home-based cardiac rehabilitation (HBCR), 3) implemented physician valued-based incentives, 4) presented metrics to providers, 5) educated providers and patients, and 6) dedicated staff to facilitating enrollment. CR rates were evaluated between Q2 2021 and Q2 2022. Results: Time from ECRI program conception to implementation was 18 months. Enrollment in HBCR went from 4% (19/485) (Q2, 2021) to 7.8% (33/422) (Q2, 2022). Enrollment in center-based cardiac rehab (CBCR) went from 11% (53/485) to 11.4% (48/422) respectively. Total enrollment in CR increased from 14.8% (72/485) to 19.2% (81/422). Conclusions: The ECRI created a call-to-action among providers to address modifiable barriers such as patient identification for CR and referral and enrollment processes. The introduction of HBCR increased CR rates and were additive to CBCR rates, suggesting the introduction of HBCR can increase CR rates and not displace CBCR. Increasing CR engagement and amplifying the results found in this demonstration, requires coordinated effort from all stakeholders-cardiology providers, hospitals, CR providers and health plans.
Abstract 15304: Nature Exposure and Cardiovascular Outcomes in a Large Metropolitan Area: The Role of Access to Nature
Authors: Omar M Makram, Nwabunie Nwana, Alan P Pan, Charlie Nicolas, Rakesh Gullapelli, Zulqarnain Javed, Jay E Maddock, Bita Kash, Khurram Nasir
Journal: Circulation (2023)

Background: Previous studies have found conflicting results regarding the association between greenspaces and cardiovascular health. We aimed to investigate the relationship between cardiovascular risk factors (CVRF) and diseases (CVD), and NatureScore, as well as access to nature using the Walk Score. Methods: Cross-sectional study including one million adult patients in Houston Methodist Outpatient Registry (2016-2022) living in the greater Houston metroplex. NatureScore is a composite score of natural environment exposure and quality of greenspace calculated for each patient. NatureScore was categorized as follows: nature-deficient/light (0-39), nature-adequate (40-59), nature-rich (60-79), and nature-utopia (80-100). Walk Score was divided into 4 categories: car-dependent (all errands) (0-19), car-dependent (most errands) (20-39), somewhat walkable (40-59), and very walkable/ walker’s paradise (60-100). Results: A total of 1.07 million patients (mean age 52, female 59%, Hispanic 16%, NHB 14%) were included with median NatureScore of 69 and 99% living in urban areas. The prevalence of CVRF and CVD (CAD, PAD, and stroke) was significantly higher in patients living in neighborhoods with high NatureScore without taking access to nature into account (Figure). On adjusting for access to nature (Walk Score), patients living in the highest NatureScore areas had 9% lower odds of any CVRF and 4% of any CVD, than those living in the lowest NatureScore areas. On stratification by Walk Score, those living in high NatureScore high walkability areas had lower odds of CVRF than those in high NatureScore low walkability areas (Figure). Conclusion: Our findings suggest that greenspace can positively impact cardiovascular health, yet its accessibility plays a crucial role in determining its actual effect. Our results can guide stakeholders in allocating resources for population health improvement and urban design that consider both exposure and access to nature.
Abstract 15427: Lipoprotein(a) Proteomic Signatures and Links to Metabolic Pathways
Authors: Nelsa Matienzo, Anastasiya Matveyenko, Rajesh Soni, Gissette Reyes-Soffer, Masanori Aikawa, Sasha A Singh
Journal: Circulation (2023)

Introduction: High levels of Lp(a) are positively associated with the development of ASCVD. The pathways regulating levels and links to disease are not clear. Lipoprotein(a) has two main proteins: apolipoprotein(a) [apo(a)] and apolipoporoteinB100 (apoB100).The aim of this study was to describe additional proteins on Lp(a) and links to pathways that may drive disease mechanisms. Methods: We analyzed plasma from 10 healthy volunteers, mean age 47 ±13 years, 50% female (5 Blacks, 3 Hispanics, 2 Whites). Lp(a) was isolated via immunoprecipitation (IP). Two distinct proteome analyses were compared: in-gel versus in-solution digestion of immunoprecipitated Lp(a), in two independent laboratories. Proteins that were identified with at least 3 unique peptides, and present in every IP sample were considered. Biological networks were generated based on protein abundance using the STRING database. Results: There were 55 proteins identified in every IP sample via in-gel preparation and 92 proteins met the same criteria via in-solution preparation. We found 26 proteins overlapping between the two methods (Table 1A). Apo(a) and apoB100 met the strict criteria we set forth, showing that we successfully immunoprecipitated Lp(a) from plasma. The top gene ontology biological processes and networks associated with the Lp(a) proteome are presented on Table 1B and Figure 1, respectively. Conclusions: Lp(a) proteome analysis via two platforms provides pathways that can increase our understanding of Lp(a) links to disease mechanisms. Further studies of these protein-protein interactions and their pathways can lead to enhanced understanding of Lp(a) links to ASCVD and other diseases.
Abstract 18072: Multiple Sclerosis and Covid-19-Related Myocarditis: A Brain and Heart Affectation
Authors: ALI VAELI ZADEH, Andres Redondo, Ricardo Criado Carrero, Britony Dixon, Claudia Marcano, Vincent Hsu, Elias Collado, Joshua Larned
Journal: Circulation (2023)

Introduction: Myocarditis (MC) and multiple sclerosis (MS) are inflammatory affectations of the myocardium and the central nervous system, respectively. It has been suggested that MS and MC share similar immunological dysfunctions. MS and MC also have associations with viral infection, and SARS-CoV-2 specifically has been associated with MC, indicating that a viral infection may induce or enhance a dysfunctional immune response favored by individuals' genetic susceptibility. Hypothesis: We hypothesized that patients with preexisting MS may be more susceptible to COVID-19-related MC. Methods: A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD codes, a cohort of patients admitted for COVID-19 as the primary diagnosis (index event) was identified. The cohort then was divided into two groups based on the presence of MS upon admission. The records of both groups were compared by demographics and a panel of 16 comorbidities. Pearson's chi-square and t-test were used to compare the group's characteristics when appropriate. A Kaplan-Meier analysis was then used to compare the probability of the outcome (MC) 90 days following the index event. A p-value of &lt;0.05 was considered significant. Results: We found a total of 2,782,278 patients admitted for COVID-19, with 24,515 (0.88%) having a history of MS. Patients with MS were younger (mean age 58 vs. 60, p&lt;0.0001), predominantly female (73%), and had more comorbidities (Elixhauser Comorbidity Index 8.8 vs. 6.3, p&lt;0.0001). A history of hypertension, heart failure, obesity, cerebrovascular accident, drug abuse, smoking, asthma, cancer, diabetes, MC, and MI were significantly more prevalent in the MS group. No differences in rheumatoid arthritis, CKD, and HIV were identified. COVID-19 patients with pre-existing MS were significantly at higher risk of MC, 90 days after admission (Log-Rank p=0.04). Conclusions: Despite its striking analogies to MS, the precise mechanism by which SARS-CoV-2 induces MC is unknown. Our findings highlight the likelihood that SARS-CoV-2 can induce myocardial inflammation in patients with a dysfunctional immune response. Moreover, MS patients were more exposed to established cardiovascular disease risk factors.
Abstract 16368: Opioid Withdrawal-Induced Takotsubo Cardiomyopathy in Hypertrophic Cardiomyopathy
Authors: Brendan P O'Gorman, Girish Pathangey, Rohitha A Moudgal, Kajal P Shah, Terrence D WELCH
Journal: Circulation (2023)

Introduction: This case highlights opioid withdrawal-induced Takotsubo cardiomyopathy (TCM) in a patient with pre-existing hypertrophic cardiomyopathy (HCM) and discusses the concurrent management. Clinical Presentation: An 85-year-old female with HCM, depression, and chronic back pain presented with generalized weakness five days after opioid discontinuation. She exhibited elevated troponin levels and ST elevation in anteroseptal leads, concerning for STEMI. Coronary angiogram revealed nonobstructive coronary artery disease. Transthoracic echocardiogram revealed newly reduced EF 45%, hyperdynamic basal left ventricle, and akinetic mid-distal left ventricle, consistent with TCM. Notably, marked basal anteroseptum thickness and systolic anterior mitral valve motion with left ventricular outflow tract obstruction (LVOTO) and a peak gradient of 92 mmHg. Presentation was complicated by hypotension, pulmonary edema and cardiorenal syndrome. β-blocker use initially deferred, opting for phenylephrine and diuresis until stabilization permitted β-blocker introduction. Discussion: We present a unique case of TCM precipitated by opioid withdrawal in a patient with existing HCM. Standard critical care management for TCM involves hemodynamic support until cardiac function recovers, though the use of vasopressors and inotropes remains controversial. Importantly, this case demonstrates severe provoked LVOTO, mimicking acute myocardial ischemia. Recognizing such scenarios is vital, as inappropriate use of vasodilators or inotropes can be fatal. Class I-IIa recommendations endorse β-blockers and vasoconstrictors for severe provoked LVOTO with hypotension and pulmonary edema. Phenylephrine, a selective α-agonist, maintains LVOT turgidity through preload enhancement, while β-blockers facilitate ventricular filling and reduce LVOT pressure gradient. Further research is warranted as current evidence level remains class C.
Abstract 18449: Myocarditis in Patients With Cancer Undergoing Combination Checkpoint Inhibitor Therapy
Authors: Alistair C Lindsay, Alexander N Walker, Sebastian Schneeweiss
Journal: Circulation (2023)

Introduction: Immune checkpoint inhibitors (ICI) have improved the clinical outcomes of several cancers but have also been associated with a greater risk of cardiovascular adverse effects. Hypothesis: The use of combination ICI therapy is associated with an increased risk of myocarditis, compared to use of a single ICI. Methods: A cohort study was conducted using medical and pharmacy claims data (2011 to 2022) in the Optum Clinformatics database. Cox regression models quantified the comparative risk of myocarditis between cancer patients receiving combination therapy (nivolumab and ipilimumab) and those taking a single ICI. Results: Among 53,018 patients to whom ICI were dispensed there were 148 cases of myocarditis (0.3%): 33 (0.7%) in patients on combination therapy and 115 (0.2%) in patients on monotherapy. The crude risk of myocarditis per 1,000 patients was 7.40 in the combination therapy group and 2.37 in the monotherapy group (risk ratio= 3.12; 95% CI: 2.12 to 4.60) over an average follow-up period of 226 days (IQR 93-495 days). After propensity score-matching the hazard ratio comparing myocarditis in the combination therapy versus monotherapy groups was 3.67 (1.76 to 7.67; p&lt;0.01). 76% of all myocarditis events in both groups occurred within six months of commencing treatment (figure). Conclusions: Simultaneous combination therapy with nivolumab and ipilimumab was associated with an increased risk of myocarditis compared to the use of single agents. Myocarditis was infrequent and occurred most often within six months of treatment start.
Abstract 18413: Therapeutic Genome Editing of Endothelial FABP4 by Endothelium-Targeted Nanoparticle Delivery of the CRISPR/Cas9 System Inhibits Pulmonary Arterial Hypertension in Mice and Rats
Authors: Jingbo Dai, Yi Peng, Youyang Zhao
Journal: Circulation (2023)

Introduction: Pulmonary arterial hypertension (PAH) is a devastating disease characterized by progressive vasoconstriction and obliterative vascular remodeling. The molecular mechanisms of obliterative pulmonary vascular remodeling remain elusive. Hypothesis: Therapeutic genome editing of endothelial Fabp4 will knockout FABP4 expression selectively in endothelial cells and inhibit PAH in mice and rats. Methods: Employing the newly developed endothelial cell (EC)-targeted nanoparticle delivery technology, plasmid DNA expressing CRISPR/Cas9 controlled by Cdh5 promoter and Fabp4 -specific guide RNAs driven by U6 promoter was administered i.v. to adult SD rats and Egln1 Tie2Cre mice which exhibit severe PAH and obliterative pulmonary vascular remodeling. One week after nanoparticle administration, the rats were injected with a single dose of monocrotaline (MCT) to induce PAH. At 4 weeks post-MCT, right ventricular systolic pressure (RVSP), ratio of right ventricular versus left ventricular plus septum (RV/LV+S) and pulmonary vascular remodeling were determined. Pharmacological FABP4 inhibitor was also employed to treat MCT rats as a comparison. Similarly, the pulmonary hypertensive phenotype in genome-edited Egln1 Tie2Cre mice was also characterized. Results: Nanoparticle delivery of the all-in-one CRISPR rCdh5 plasmid DNA knockout Fabp4 selectively in endothelial cells in adult rats and Egln1 Tie2Cre mice leading to reduced RVSP, RV hypertrophy and pulmonary vascular remodeling in MCT rats and also in Egln1 Tie2Cre mice. Obliterative pulmonary vascular remodeling seen in Egln1 Tie2Cre mice was inhibited and the mortality rate in endothelial Fabp4-deficient Egln1 Tie2Cre mice was reduced. Treatment of FABP4 inhibitor also inhibits PAH in MCT rats. We also observed a marked increase of FABP4 expression in endothelial cells of lung samples of IPAH patients. Overexpression of FABP4 in primary cultures of human lung microvascular endothelial cells resulted in a 70% increase of cell proliferation. Conclusions: These findings demonstrate endothelial FABP4 is a promising target for PAH therapy. EC-targeted nanoparticle delivery of the genome editing system may represent an effective and safer gene therapy approach for PAH treatment.
Abstract 18300: Do Current Cardiovascular Risk Models Predict the Development of Cardiotoxicity in Lymphoma Patients Treated With Anthracycline?
Authors: Carolina Ricaurte, Sebastian Santos Patarroyo, Andres Daryanani, Diana Collantes, Rafael Toro-Manotas, Lara Nhola Barros, James Cerhan, Joerg Herrmann, Carrie Thompson, Hector R Villarraga
Journal: Circulation (2023)

Introduction: Assessing baseline cardiovascular (CV) risk factors is crucial for identifying cancer patients at higher risk of cardiotoxicity (CT). While both CT specific scores, including Heart Failure Association-International Cardio Oncology Society (HFA-ICOS) and our institutional score, as well as general CV scores like Atherosclerotic cardiovascular disease (ASCVD), have been used to assess CT risk; in lymphoma patients undergoing anthracycline therapy, their utility remains unknown. Aim: Evaluate the performance of each risk score to predict CT in a cohort of newly diagnosed lymphoma patients undergoing anthracycline treatment, followed for a median of 5.4 years. Methods: 326 Hodgkin and non-Hodgkin lymphoma patients treated and followed from 2013 to 2021 were prospectively assessed. Baseline measurements of the three risk scores were obtained. ASCVD score was not assessed in patients &gt;80 or &lt;40 years old or without baseline cholesterol. CT was defined during or after one year of chemotherapy as severe, moderate, or mild according to 2022 ESC guidelines. Logistic regression and AUC were used to assess the association of each score and compare the models. Results: Among 326 patients, 78 developed CT (8 severe, 21 moderate, 49 mild). A high-risk score from HFA-ICOS was significantly associated with severe and moderate CT(OR: 6.1, p=0.001), sensitivity 37%, and specificity 88%. A very high-risk classification of the institutional score was associated with severe and moderate CT (OR: 8.4, p=0.006), sensitivity 44%, and specificity 81%. No association was found between the ASCVD score stratification and CT. When mild CT was included in the analysis, the AUC values were lower (see Table 1). Conclusions: Cardio-oncology risk scores were associated with severe and moderate CT, outperforming ASCVD, but their predictive capacity was weak. Incorporating other serum or imaging biomarkers into the models may improve the predictive accuracy of CT risk assessment.