tbuckley/cabot-search huggingface dataset:
Abstract 4140399: The Importance of Measuring Body Composition in Determining Cardiorespiratory Fitness Across the Adult Age Range
Authors: Priya Gajjar, Sandhiya Ravichandran, Shivani Sahni, Gregory Lewis, Douglas Kiel, Ravi Shah, Matthew Nayor
Journal: Circulation (2024)

Background: Maintaining cardiorespiratory fitness (CRF) is essential for healthy aging and is linked to lower risk of age-related cardiovascular diseases and frailty. However, the relations of body composition metrics and CRF levels across the adult age range are poorly understood. Hypothesis: Healthy body composition, characterized by higher lean mass and lower visceral and total adiposity, is associated with greater oxygen (O 2 ) uptake during exercise across age and sex. Aims: To investigate relations of components of body composition with O 2 uptake measures during exercise and to evaluate how age and sex affect the associations. Methods: Framingham Heart Study participants (n=2742) underwent dual-energy X-ray absorptiometry (DXA) for body composition assessment and maximal cardiopulmonary exercise testing on a cycle ergometer at the same exam cycle. Sex-stratified linear models between DXA and O 2 uptake measures were adjusted for age, height, HDL/total cholesterol, smoking, systolic blood pressure, hypertension treatment, diabetes, and physical activity index. Results: The study sample had a mean age of 54±9 years, was 54% women, 9% non-white, and had a peak O 2 uptake [VO 2 ] 95±20% of predicted. Higher lean mass was associated with higher peak VO 2 in ml/min in both men and women (β for standard deviation (SD) difference in log-transformed peak VO 2 for a 1-SD higher value of lean mass was 0.49 in men and 0.57 in women, P&lt;0.0001 for both). Conversely, measures of total and visceral fat mass were associated with higher peak VO 2 in women (β= 0.14-0.15, P&lt;0.0001) but not in men (P&gt;0.05). The variance explained (adjusted R 2 ) in peak VO 2 was higher for lean mass than other DXA measures: lean mass, age, and height explained 45-47% of the variance in peak VO 2 in men and women, while age, height, and other DXA measures explained ≤37%. Furthermore, individuals with higher observed lean mass than predicted based on age, sex, and BMI had higher observed peak VO 2 , consistent with the finding that higher lean mass is associated with higher peak VO 2 across age and sex (Figure). Conclusion: Maintaining lean mass across the adult age range is linked with higher peak VO 2 , which may have important implications for promoting healthy aging.
Abstract 4140518: LVAD Recipients and Caregivers Expectations for Communication
Authors: Aroosa Malik, Matthew Mignery, Supriya Shore
Journal: Circulation (2024)

Introduction: Effective communication strategies regarding illness trajectory with left ventricular assist device (LVAD) recipients and their caregivers are lacking. This study evaluated LVAD recipients and caregivers’ preferences for effective communication surrounding end of life care and risk of complications. Methods: We conducted a qualitative study using semi-structured interviews with 9 LVAD recipients and 9 caregivers between 4/1/2024 – 5/6/2024. Interviews were transcribed and coded, with themes identified using rapid qualitative analysis. Results: Included patients had a median age (range) of 65 (24-81) years, 6 (67%) were men, 5 (56%) were White and 5 (56%) received their LVAD as destination therapy (DT). Participating caregivers included 8 (89%) women supporting 5 (56%) DT LVAD recipients. When asked about ways to improve communication regarding illness trajectory with a LVAD, majority of patients and caregivers desired to have communication prior to LVAD placement and favored learning about survival, risk of complications, quality of life with an LVAD. They favored precise estimates of associated risks and survival rather than general outcomes. Additionally, majority of patients and caregivers preferred healthcare providers initiate end of life discussions, with caregivers present in a clinic visit. We identified three themes explaining patients and caregivers’ preference for improved communication for LVAD (i) direct and honest communication (ii) caregiver or care partner as an advocate and (iii) type of information desired. Exemplary quotes highlighting these themes are provided in the Table below. Conclusion: Our qualitative study highlights patients and caregivers’ preference for communication surrounding LVAD prognosis, risk, and end of life discussions. This highlights areas of improvement regarding LVAD communication.
Abstract 4140363: Developing and testing a new theoretical model of pain among patients with heart failure
Authors: Asa Smith, Miyeon Jung, Susan Pressler
Journal: Circulation (2024)

Introduction: An estimated 23-85% of adults with chronic heart failure (HF) experience comorbid chronic pain, yet no comprehensive theoretical models have been developed or tested that completely capture the salient variables which affect pain. The aim of this study was to construct a preliminary theoretical model of pain in HF and evaluate the associations between identified variables in the model with pain presence. Methods: In this cross-sectional study, baseline data were obtained from the Cognitive Intervention to Improve Memory in Heart Failure Patients study (MEMOIR-HF) (n = 235). The Biopsychosocial Model of Chronic Pain was adapted for an HF-specific population. The dependent variable was pain presence (yes/no), which was measured using the Health Utilities Index Mark-3 (HUI-3). Independent variables were identified for the model using previous literature and univariate analyses comparing patients with vs. without pain in MEMOIR-HF. Logistic regression was used to test for differences between patients with pain present and not present. Results: Demographics were 45.5% men, 54.5% women, 86.4% White, 13.6% Black, mean age 66.39 (SD 12.04) years. Of 235 patients, 159 (67.66%) reported pain on the HUI-3 items. The variables that were included following univariate analysis and literature review were age, self-reported race and gender, comorbid conditions, sleep disturbances, HF severity, B-type natriuretic peptide, brain-derived neurotrophic factor, body mass index, and depression. Patients with pain were more likely to have worse HF severity (NYHA Class II or III compared with Class I) (Class II: OR 5.09 [1.71 – 15.08], p = .003, Class III: 5.05 [1.73 – 14.71], p = .003), more severe depression (OR 1.14 [1.06 – 1.23], p = .001), and worsened daytime sleepiness (OR 0.90 [0.83 – 0.98], p = .017), see Table 1. Conclusions: We believe this study is one of the first to construct and test a preliminary comprehensive model of pain in HF. Complete characterization of pain in HF is needed before treatments can be improved. Future research is needed to explore variables that were not available in the MEMOIR-HF dataset. More robust pain measures are needed to adequately test all variables.
Abstract 4140574: Echoes of Danger: A Case of Recurrent Atrial Myxoma with Cerebral Embolization
Authors: Obada Kholoki, Akshita Sahi, Julian Kaufmann
Journal: Circulation (2024)

Introduction: Atrial myxomas are cardiac tumors that can cause arterio-occlusive diseases due to embolization of myxomatous fragments. Treatment is through prompt surgical resection, with recurrence rates relatively rare. Herein, we present a case of recurrent left atrial myxoma with hemorrhagic, cerebral embolization. Case Report: A 34-year-old male presented with acute onset numbness and tingling of the left arm. He was vitally stable with unremarkable physical examination or bloodwork. CT Head showed multifocal brain metastases in the bilateral parietal and left frontal lobes. Brain MRI demonstrated multiple hemorrhagic masses throughout the cerebral hemispheres with vasogenic edema. The patient’s past medical history was pertinent for bilateral occlusion of the femoral and popliteal arteries, with workup revealing a left atrial myxoma that was surgically resected in 2005. The patient presented again in 2021 with right facial paresthesia and arm weakness. Brain MRI showed bilateral cortical and subcortical MCA ischemic strokes. TEE confirmed the recurrence of a left atrial myxoma, requiring a repeat sternotomy and resection. Since then, the patient was frequently hospitalized with seizures and strokes. Surveillance brain MRIs consistently demonstrated hemorrhagic masses of varying sizes and vasogenic edema, localized to the watershed territories of the cerebral arteries. The patient underwent left frontal craniotomy and resection of a left frontal lobe lesion in 2023, with pathology specimens representing organizing cerebral hemorrhage of unclear etiology. Repeat echocardiograms did not show recurrence of a myxoma. The overwhelming clinical opinion states that these are myxomatous metastasis from before the patient’s last cardiac surgery. Given the tumor burden and progressive nature of the disease, the patient was deemed inappropriate for neurosurgery or chemotherapy. Discussion: Recurrence after surgical resection of atrial myxomas is rare, with 0.5 cases reported per 1000-person years, and is mainly attributed to inadequate surgical resection. Limited research exists regarding malignant atrial myxomas. The prevailing hypothesis points to the neoplastic transformation of myxomatous emboli into malignant lesions. Our patient is a unique case of a recurrent atrial myxoma with symptomatic cerebral metastasis. This case highlights the importance of adequate resection of cardiac myxomas to prevent the malignant transformation of an otherwise benign tumor.
Abstract 4139802: The Safety and Efficacy of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Uzair Jafar, Muhammad Sami Khan, Tallal Mushtaq Hashmi, Maryam Ijaz, Hanzala Jehangir, Sanjna Devi Jagani, Irja Munawar, Ayesha Khalid, Maham Maqsood, Muhammad Faiq Akram, Usman Saeed, Adeel Ahmad
Journal: Circulation (2024)

Background: SGLT2 inhibitors improve cardiovascular outcomes in patients with heart failure and chronic kidney disease. However, the evidence on their efficacy in patients who have had acute myocardial infarction is still lacking. This systematic review and meta-analysis aimed to assess the safety and efficacy of SGLT2 inhibitors on cardiovascular outcomes in patients with a recent acute myocardial infarction. Methods: We searched various electronic databases including MEDLINE (via PubMed), Embase, the Cochrane Library, and Clincaltrials.gov to retrieve randomized controlled trials comparing SGLT2 inhibitors to placebo in patients with acute myocardial infarction. We performed statistical analysis on RevMan 5.4 using the random effect model. We reported dichotomous outcomes as relative risk (RR) along with 95% confidence intervals (CI) and continuous outcomes as mean difference (MD) along with 95% CI. Results: Our meta-analysis included 6 RCTs involving 11,256 patients. SGLT2i significantly decreased the rate of hospitalization for heart failure (RR 0.73, 95% CI: 0.61-0.88, I2=0%) with no significant change in mortality (RR 1.05, 95% CI: 0.78-1.40, I2=25%). There was no significant change between the two groups when assessing the rate of all-cause hospitalization (RR 1.00, 95% CI: 0.84-1.17, I2=%), cardiovascular death (RR 1.03, 95% CI: 0.83-1.28, I2=%), hepatic injury (RR 1.99, 95% CI: 0.54-7.40, I2=%), ketoacidosis (RR 2.00, 95% CI: 0.18-22.01, I2=%), hypoglycemia (RR 0.80, 95% CI: 0.21-2.97, I2=%), or lower limb amputation (RR 1.80, 95% CI: 0.60-5.36, I2=%). The mean change in NT-pro BNP (MD -0.28 95% CI: -0.61-0.05, I2=0%] and LVEF at follow-up (MD 0.62, 95% CI -0.73-1.97, I2=0%] were also comparable between the two groups. Conclusion: SGLT2i reduces the rate of hospitalization for heart failure with no change in mortality or other cardiovascular outcomes. Further high-quality and large-scale RCTs are required to confirm or refute our findings and provide more reliable results.
Abstract 4140201: Disparities in Defibrillator Implantations during COVID-19: Insights from the NCDR registry
Authors: Saima Karim, Rachel Lampert, kevin kennedy, John Spertus, Beixin He
Journal: Circulation (2024)

Introduction: While implantable cardiac defibrillators (ICD) decrease sudden cardiac death, disparities in ICD use remain. The COVID-19 pandemic created strains on the US healthcare system that may have exacerbated these disparities. Methods: Using the US NCDR registry of primary and secondary prevention ICD implants, we compared sex, racial and ethnic disparities for 239,014 patients, aged 19-90 years, grouped into three time intervals from 2016 to 2022: Pre-COVID, COVID and Post-COVID. Centers without consistent reporting were excluded, as were patients with incomplete sex, race or ethnicity data. ICD implantation rates were compared using a Poisson regression model with interaction tests for sex, race and ethnicity by time window to see if disparities changed within this period. Implant rates by indication were also assessed. Results: Overall ICD implants decreased over the study period (Figure 1) with an average monthly rate of 3271 in the first three months of 2016 declining to 2334 in the last three months of 2022 (p=0.017). Disparities in ICD implantation for women, racial and ethnic minorities were observed pre-COVID and persisted (Table 1). Average ICD implant rates during these time periods varied by race with predominance in White patients. While gaps in ICD implant persisted, the disparities did not worsen during COVID-19 by sex, race or ethnicity (p-value for interactions were 0.79; 0.47; and 0.095, respectively). There was a more significant decrease in primary prevention ICD compared to secondary prevention ICD (p&lt;0.0001), but similarly, there was no significant interaction based on sex, race and ethnicity. Conclusion: Since COVID-19, a period of extreme healthcare rationing, overall ICD use decreased. Historical gaps in ICD implantation for women, racial and ethnic minorities persisted but did not increase. While it is encouraging that disparities did not worsen during a time of limited resources, there is an ongoing need for greater equity in ICD implantation.
Abstract 4140471: Deleting Tissue B-Cell Dynamics Prevents Angiotensin II-Induced Hypertension in Mice
Authors: Jasmeen Kaur Monga, Annie Zhou, Tao Wang, Abdul Momen, M. Ahsan Siraj, Mansoor Husain
Journal: Circulation (2024)

Background: Hypomorphic c-myb mice (with reduced B cells) manifest low baseline blood pressure [BP], increased 24-h urinary sodium and water excretion, and protection from DOCA salt-induced hypertension [HTN]. Here we study B cell dynamics and their role in angiotensin [Ang]-II-induced HTN using tissue flow cytometry [FC] and diphtheria toxin [DT]-induced B cell depletion in CD19-Cre/R26-iDTR mice. Methods&amp;Results: To investigate B cell dynamics in HTN, wild-type [WT] C57BL/6J male mice aged 10-12 wk were implanted with either (a) 500 ng/kg/min x 28-d (low-dose) or (b) 1000 ng/kg/min x 28-d (high-dose) Ang-II, or (c) saline for FC of all B cell subsets in aorta, spleen, and bone marrow. CD19 + B cells in aorta increased 9.3-fold with low-dose (1.5±0.9E 2 vs. 1.4E 4 cells/aorta; N=1-4/group; p&lt;0.01) and 8-fold with high-dose of Ang-II (1.5±0.9E 2 vs. 1.2±0.4E 4 ; N=2-4/group; p&lt;0.01). In spleen, CD138 + plasma cells increased 3.4-fold with low-dose- (2.1±0.3E 5 vs. 7.2E 5 cells/spleen; N=1-4/group; p&lt;0.001) but not with high-dose Ang-II (2.1±0.3E 5 vs. 1.3±0.1E 5 ; N=2-4/group; p=0.14). In bone marrow, plasma cells decreased 4-fold with low-dose (2.3±0.3E 6 vs. 0.59±0.6E 6 cells/bone marrow; N=2-4/group; p&lt;0.05) but increased 2.2-fold with high-dose-Ang-II (2.3±0.3E 6 vs. 5.2±0.9E 6 cells/bone marrow; N=2-4/group; p&lt;0.01). Then, 10-12-wk old male CD19-Cre/R26-iDTR mice and R26-iDTR controls were implanted with osmotic minipumps to deliver Ang-II (500 ng/kg/min) over 28-d. Intraperitoneal DT (25 ng/g) was injected weekly x 4 to both groups. Flow cytometry [FC] of blood and spleen at d-28 confirmed successful depletion of all B cell subsets in CD19-Cre/R26-iDTR but not R26-iDTR controls. BP measurements at d-28 showed attenuated HTN in B cell-depleted mice compared to non-depleted controls (94±15 vs. 134±12 mmHg; N=5/group; p&lt;0.05). Metabolic studies revealed only non -B cell depleted mice to have increased 24-h Na + and urine excretion in response to Ang-II (N=4/group). Conclusion: CD19 + B cells infiltrate aorta during Ang-II-induced HTN. Ang-II levels regulate peripheral plasma cell homeostasis possibly through migration from/to or expansion within bone marrow and spleen. B cell depletion in the CD19-Cre/R26-iDTR model demonstrates the importance of B cell subtypes in the pathogenesis of Ang-II-induced HTN, suggesting a potential therapeutic strategy for HTN.
Abstract 4140472: Promotores De Salud: An Essential Workforce in Enhancing Hypertension Health Knowledge in Puerto Rico
Authors: Janak Patel, Mide Arowolo, Carmen Cosme Pitre, Kathleen Scanlin, Alizenet Vargas, Ashley Wagner, Eduardo Sanchez
Journal: Circulation (2024)

Introduction: Hypertension (HTN) is a major risk factor for cardiovascular disease, and its prevention and management are influenced by health knowledge. This paper reviews the findings of a community-based HTN health knowledge program in Puerto Rico, facilitated by Community Health Workers (CHWs), also known as Promotores de Salud, who maintain a close relationship with their communities. Hypothesis: CHWs will positively impact a community’s HTN health knowledge and self-reported confidence in making lifestyle/behavior modifications with the use of Empowered to Serve (ETS) Health modules. Methods: American Heart Association (AHA) partnered with One Stop Career Center, a community-based organization in Puerto Rico. The program utilized AHA ETS modules focused on HTN prevention and management. CHWs instructed and implemented these modules across 10 community-based settings from 09/20/23 to 12/26/23. Participants were given a multiple-choice survey before and after each module. Descriptive Analysis and Two Proportion Z Test was performed on the surveys. CHWs also conducted a community discussion, distributed blood pressure devices, and referred participants to a self-measured blood pressure program. Results: The total count for pre-surveys was 214 and post-surveys was 224. Majority of participants identified as female (67.9% female) and Hispanic (95.2%), with 46.4% completed high school or less. Comparing pre- and post-surveys, confidence scores improved in monitoring blood pressure at home (41.0%, n/N=34/83 to 68.5%, n/N=61/89; p value=&lt;0.001) , lifestyle changes to manage blood pressure (35.4%, n/N=29/82 to 73.0%, n/N=65/89; p value=&lt;0.001), reading a nutrition label (40.2%, n/N=51/127 to 69.9%, n/N=95/136; p value=&lt; 0.001), using spice alternatives when cooking (60.6%, n/N=77/127 to 80.7%, n/N=109/135; p value=&lt;0.001), and reducing processed foods (36.5%, n/N=46/126 to 68.4%, n/N=93/136; p value=&lt;0.001). Graph 1 contains the results of 4 knowledge-based questions. Conclusions: The data suggest that the CHWs, with the use of ETS modules, might play an important role in enhancing HTN health knowledge and improving confidence to support lifestyle/behavior modifications within Puerto Rican communities.
Abstract 4140381: Does Induction Therapy with Anti-thymocyte Globulin Decrease First-year Intimal Thickening in Patients Experiencing Ischemia-Reperfusion Injury Immediately after Heart Transplantation?
Authors: Yosef Manla, Jignesh Patel, Michelle Kittleson, Avani Kanungo, Andriana Nikolova, Evan Kransdorf, David Chang, Lawrence Czer, Lily Stern, Jon Kobashigawa
Journal: Circulation (2024)

Introduction: Post-heart Transplant (HTx) ischemia-reperfusion injury (IRI) is associated with an increased risk of rejection and cardiac allograft vasculopathy (CAV). It has been suggested that induction therapy with anti-thymocyte globulin (ATG) may protect against immediate (in the first 30 days) IRI post-HTx. Additionally, ATG has been associated with reduced first-year coronary plaque progression as assessed by intravascular ultrasound (IVUS) among HTx recipients. Whether ATG can decrease first-year intimal thickening in patients experiencing IRI has not been investigated. Therefore, we aim to examine the clinical outcomes of patients who received ATG induction therapy and experienced immediate IRI post-HTx. Methods: Between 2010 and 2020, we assessed 241 patients undergoing HTx and were noted to have immediate post-HTx IRI on their endomyocardial biopsy. Patients were divided into those who received ATG (n=105) induction therapy vs. non-receivers (n=136). In our program, ATG is given to sensitized patients or those with baseline serum creatinine &gt;2.0 mg/dL to delay the initiation of tacrolimus, which may introduce bias to this study. Endpoints included 1-year freedom from any treated rejection (ATR), acute cellular rejection (ACR, grade 2R or 3R), and antibody-mediated rejection (AMR, pAMR grade ≥1, 3-year survival, and 3-year freedom from non-fatal major adverse cardiac events (NF-MACE, including myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, and stroke). IVUS was performed at 4-8 weeks (baseline) and at 1 year post-HTx. Studied IVUS parameters included first-year average change in maximum initial thickness (MIT) and change in MIT ≥0.5mm. Results: Among patients with immediate post-HTx IRI, patients who received ATG induction therapy (57% were sensitized pre-HTx) remained at high immunological risk at 1 year with significantly lower freedom from ATR and AMR but had similar 3-year survival as compared to those who did not receive ATG (Table 1). No between-group differences were observed in the average 1-year change in MIT or the percentage of patients with ≥0.5mm change in MIT. Conclusion: Induction therapy with ATG did not appear to decrease first-year intimal thickening in patients experiencing IRI immediately post-HTx. Future studies are warranted to mitigate immunological complications and reduce coronary plaque progression in high-risk HTx patients.