tbuckley/cabot-search huggingface dataset:
Abstract 4143227: Incidence of Hemorrhagic Stroke in Hypertrophic Cardiomyopathy
Authors: Thomas Schultz, Jennifer Choi, Julia Hasik, Abhinav Sharma
Journal: Circulation (2024)

Background: Individuals with hypertrophic cardiomyopathy (HCM) have an elevated risk of ischemic stroke, primarily driven by the increased risk of atrial fibrillation (AF) development in this patient population. This risk remains elevated regardless of CHADS2VASC score; thus, anticoagulation is recommended for all HCM patients with AF. Given the known association between anticoagulant medications and hemorrhagic events, there is likely an assumed risk of hemorrhagic stroke in these individuals. Currently, the incidence of hemorrhagic stroke in HCM and its relationship to AF and anticoagulation has not been well-established in the literature. The goal of this study was to establish the presence of and risk factors for hemorrhagic stroke in individuals with HCM. Methods: A retrospective review of all HCM patients ages 18 and older in our institution’s health system was performed from 2019-2023. ICD 10 codes were used to identify individuals with hemorrhagic stroke. Patient charts were reviewed for additional data including demographics, comorbid conditions, anticoagulant prescription, and other inciting factors prior to the hemorrhagic event. Results: The study cohort comprised 343 HCM patients, of which 47.1% were female and 72.7% were Caucasian. Concurrently, 30% (n=103) had a diagnosis of AF. The overall incidence of hemorrhagic stroke was 2.9% (5.8%, n=6 in those with AF vs 1.7%, n=4 in those without AF); furthermore, AF was associated with a non-statistically significant increased risk of hemorrhagic stroke (RR = 3.36, 95% CI 0.97-11.7). Anticoagulant use at the time of hemorrhagic event was observed in 4 individuals (67%) with AF and 1 individual (25%) without AF. Head trauma and falls were frequently observed as precipitating events prior to hospital admission for hemorrhagic stroke, occurring in 83% (n = 5) of patients with AF and 50% (n = 2) of those without AF. Conclusions: While ischemic stroke and anticoagulant use are commonly studied in those with HCM, the incidence of hemorrhagic stroke in this population is not negligible. Risk of hemorrhagic events in HCM appears largely influenced by anticoagulant use, particularly in those with concurrent AF, and by head trauma. Given the known benefits of anticoagulation on ischemic stroke risk in the HCM population, appropriate counseling and careful attention to individual patient factors may be warranted in the administration of anticoagulants.
Abstract 4140138: Coronary Artery Vasculopathy in a Cohort of 321 Heart Transplant Recipients: A Single Center Experience
Authors: Hussein Krayem, Richard Cooke, Nayef Abouzaki, Issa Kutkut
Journal: Circulation (2024)

Introduction: Despite advances in surgical techniques, organ preservation methods and immunosuppressant medications, the ten-year survival for orthotropic heart transplantation (OHT) remains around 50%. Coronary artery vasculopathy (CAV), among other factors, seems to have an important role in accelerated organ injury and failure. Aim: To determine the rate of survival and CAV development along with associated factors in a cohort of OHT recipients. Methods: Patients who underwent OHT at Virginia Commonwealth University (VCU) between October 2008 and September 2021 were retrospectively reviewed until June 2024. According to the VCU protocol, right heart biopsies were done weekly for the first month, every other week for the second month and at the first year mark post transplant. Left heart catheterizations were done one year after OHT and then at 2 year intervals. Survival, CAV development and need for percutaneous coronary interventions (PCI) as well as organ rejection rates in CAV patients were surveyed. Results: A total of 321 patients received OHT during that period with a median follow up time of 8.15 years from the date of transplant. Of these, 122 patients had 10-year follow up or more post OHT (53.27% survived) and 240 patients had 5-year follow up or more (66.25% survived). All patients had greater than 2.75 years of follow up. The overall mortality was 29.5%. CAV occurred in 55 patients out of 321 (17%) with median time of 2.82 years for CAV development. Mortality in the CAV group was 40% compared to 27% in the non-CAV group. Out of 55 patients with CAV, 19 required at least 1 PCI with 3 requiring interventions on chronic total occlusions. Evidence of rejection on right ventricle biopsy was observed in 51% of patients with CAV Conclusion: Our cohort had above average 10-year survival rate compared to the national data. Results revealed CAV is common post OHT and has implications on long term survival. Given CAV may develop in the absence of organ rejection, further studies are needed to identify factors associated with CAV and explore optimal treatment options that would potentially improve long-term survival post OHT.
Abstract 4136916: Indobufen: A Viable Alternative to Aspirin for Antiplatelet Therapy in patients with Aspirin Intolerance
Authors: Deivyd Cavalcante, Mrinal Murali Krishna, Meghna Joseph, Ana Clara Felix de Farias Santos, Nicole Ribeiro Asbeg, Annet Kirabo
Journal: Circulation (2024)

Introduction: Antiplatelet therapy with aspirin has been recommended for patients with stroke and myocardial infarction (MI). Clinicians face challenges when they come across aspirin hypersensitivity in their clinical practice. Therefore, potential alternative drugs can help avoid the omission of anti-thrombotic therapy. Indobufen is a cyclooxygenase-1 inhibitor studied as an alternative to aspirin. Hypothesis: Compared to aspirin, indobufen will be equally effective in preventing cardiovascular events in patients needing antiplatelet therapy but will cause fewer bleeding complications. Methods: We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing antiplatelet therapy with indobufen vs. aspirin. The efficacy outcomes of interest were composite vascular events, MI, and ischemic stroke. The safety outcomes of interest were major bleeding and any bleeding. Heterogeneity was assessed using I 2 statistics. Analysis followed the PRISMA guideline and was registered in the PROSPERO database (CRD42024540911). Results: The systematic review identified 4 studies, including 11,495 patients (indobufen n=5,728, 49.83%), with two studies in patients post-MI and two post-stroke patients. Composite vascular events at 90 days (RR 1.03; 95%CI 0.58-1.86; p=0.911; I 2 =46%) and 1 year (RR 1.10; 95%CI 0.96-1.27; p=0.184; I 2 =0%) did not show any difference between the groups. MI (RR 0.67; 95%CI 0.36-1.23; p=0.197; I 2 =0%) and ischemic stroke (RR 1.17; 95%CI 0.99-1.38; p=0.064; I 2 =0%) at 1 year did not show any significant difference between the groups. Major (RR 0.68; 95%CI 0.36-1.27; p=0.225; I 2 =74%) and any bleeding (RR 0.62; 95%CI 0.36-1.06; p=0.079; I 2 =91%) at 1 year were also comparable between the groups. Conclusion: Antiplatelet therapy with indobufen was comparable with aspirin in efficacy and safety. Indobufen can be considered an alternative to aspirin in patients with intolerance or hypersensitivity. However, more trials with a larger population are needed to confirm the clinical applicability.
Abstract 4141453: The Pandemic influenced the Self-care of African Immigrants with Diabetes and Hypertension
Authors: Onome Osokpo, Dolapo O Adeniji, Danny Bracy, Lisa Lewis, Barbara Riegel
Journal: Circulation (2024)

Background: Self-Care is essential for chronic illness management. Self-Care comprises three domains: Self-Care maintenance (daily behaviors to maintain health [e.g., medication adherence]), Self-Care monitoring (surveillance for changes), and (3) Self-Care management (prompt response to symptoms). The COVID-19 pandemic challenged self-care in some populations, but little is known about how it influenced the self-care of African immigrants living in the US with chronic illnesses such as hypertension and diabetes. Methods: Using a qualitative descriptive design, we enrolled a purposeful sample of 24 sub-Saharan African immigrant adults with self-reported symptomatic hypertension or diabetes. Participants who spoke English were enrolled between March 2020 and September 2021. Individual audio-taped interviews were transcribed and analyzed. Inductive and deductive thematic analysis was guided by the Theory of Self-Care of Chronic Illness. Results: Participants were mean=59 years (range 40-72). Most were Nigerian (n=16), male (n=16), married (n=17), living with family (n=21), highly educated (n=21), and reporting enough income to meet their needs (n=21). Five major themes were identified: (1) Being especially careful in following COVID-19 precautions (e.g., use of facemasks). (2) A focus on self-care maintenance (e.g., healthy diet, staying active while at home). Fear of COVID-19 increased medication adherence. Participants were diligent in taking medications as prescribed due to fear of COVID-19. (3) Close monitoring for symptoms. (4) Trouble reaching providers to discuss symptoms. (5) Access to resources. Participants reported loss of health insurance/jobs and lack of provider access, which impacted their ability to perform self-care. Conclusions: COVID-19 increased focused attention on self-care but also created barriers for sub-Saharan African Immigrants. Most impacted was self-care maintenance. Interventions to promote self-care in this population should leverage heightened vigilance to self-care and address challenges around access to resources.
Abstract 4143219: Pressure-Volume Analysis by Three-Dimensional Echocardiography: A Novel Method to Estimate Left Ventricular Efficiency
Authors: Lars-Egil Hammersboen, Espen Boe, Jurgen Duchenne, John Aalen, Hans Henrik Odland, Manuel Villegas-Martinez, Vetle Christoffer Frostelid, Faraz Khan, Ole Jakob Sletten, Marit Witsoe, Helge Skulstad, Filip Rega, Olivier Gheysens, Jens-Uwe Voigt, Otto Smiseth, Marie Stugaard, Espen Remme
Journal: Circulation (2024)

Background: Left ventricular (LV) efficiency is a key pathophysiological marker in heart failure (HF). LV pressure curve estimation and three-dimensional (3D) volumes via echocardiography allows for non-invasive pressure-volume (PV) analysis and calculation of an index of efficiency (Figure 1). Aim: Validate efficiency index by 3D echocardiography by comparing it to invasive measurements and efficiency derived from Positron Emission Tomography (PET) metabolism. Methods: Two experimental models were utilized - one with canines (n=21) and another with sheep (n=12). In canines, echocardiography provided 3D LV volumes and valve event timings. The pressure curve was estimated by adjusting the time axis of a reference pressure curve to the valve events and its amplitude to measured peak LV pressure, which in clinical practice would be approximated as systolic brachial cuff pressure. Invasive pressure was measured by micromanometer and volume by subendocardial piezoelectric crystals. Non-invasive and invasive efficiency indices, calculated as the ratio of stroke work to total mechanical energy (Figure 1), were compared during baseline, right ventricular pacing, aortic constriction and dobutamine infusion. Twelve sheep implanted with a pacemaker underwent 8 weeks of rapid dyssynchronous DDD pacing to induce dilated HF. LV efficiency index was calculated as in Figure 1, using measurements from a PV-catheter calibrated to end-diastolic volume by cardiac MRI, and compared to efficiency calculated as stroke work divided by total LV glucose metabolism via PET/CT. Recordings were performed during AAI and DDD pacing, at baseline (n=3) and following 8 weeks pacing-induced HF (n=12). Results: In canines, non-invasive and invasive efficiency indices showed excellent agreement (r=0.95, p&lt;0.0001; mean difference 0.4%, SD 3.4%) (Figure 2). In sheep, the efficiency index showed similar decline compared to efficiency by PET/CT after induction of HF and after switching from AAI to DDD pacing (p&lt;0.05 for all interventions). Overall correlation between the methods was moderate (r=0.67, p=0.0001) but excellent in animals with longitudinal data (r=0.89, p=0.0001) (Figure 3). Conclusions: Efficiency index by 3D echocardiography is accurate and reflects changes in efficiency measured by PET/CT. It may thus be of interest for clinical use.
Abstract 4139170: Relationship between hemodynamics and oxygen consumption in hypertrophic cardiomyopathy during maximal stress testing
Authors: Jonathan Parrish, Alasdair Blain, Nduka Okwose, Amy Fuller, Alaa Alyahya, Sophie Russell, Christopher Eggett, Peter Luke, Kristian Bailey, Guy MacGowan, Djordje Jakovljevic, Sarah Charman
Journal: Circulation (2024)

Background: Hypertrophic cardiomyopathy (HCM) is a global heart disease with great variability in disease severity, which can lead to significant impairment of exercise capacity. In healthy populations, oxygen consumption is related to cardiac output and arteriovenous oxygen difference. We sought to determine the relationship between hemodynamics (cardiac output and stroke volume) and oxygen consumption in HCM compared to healthy controls during maximal stress testing. Aims: To evaluate associations between the trajectories of hemodynamic function and oxygen consumption in HCM compared to healthy controls. Methods: Twenty individuals with HCM (51±15 years old, body mass index (BMI): 28±3 kg/m 2 , females, n=4) and 16 healthy controls (66±7 years old, 27±6 kg/m 2 , females, n=6) were included in the present study. Participants completed a maximal-graded stress test coupled with non-invasive hemodynamic bioreactance (cardiac output, stroke volume) and gas exchange (oxygen consumption, VO 2 ) measurements. Data were analyzed in quartiles (exercise only) and phases (rest, pre-pedalling, exercise and recovery) of the maximal-graded stress test. Results: In HCM, cardiac output declined in the fourth quartile of the exercise phase of the stress test (-0.39 L/min, p &lt;0.001) whilst VO 2 increased (3.86 ml/kg/min, p &lt;0.001). There was a significant difference in the gradient of cardiac output between HCM and controls in the final quartile of the test (-1.6 vs. 18.1 L/min, p&lt;0.001). In coherence, stroke volume declined in the fourth quartile of the test (-18.4 ml, p &lt;0.01) in response to increasing VO 2 in HCM. The rates of recovery were faster in HCM compared to the control group for VO 2 (-4.3 vs -2.6 mL/second, p&lt;0.001), cardiac output (-0.03 vs -0.02 L/second, p&lt;0.001), heart rate (-0.17 vs -0.10 beats/second, p&lt;0.001), and stroke volume (-0.18 vs -0.07 L/second, p&lt;0.001). Conclusions: In HCM, cardiac output declined during the later stages of maximal stress testing whereas in controls it continued to rise, indicating impaired maximal cardiac output responses to exercise. These findings have implications for exercise prescription and training regimens in HCM suggesting avoidance of maximal exercise levels.
Abstract 4144512: Impact of Nutritional Status on Transcatheter Edge-to-Edge Repair Outcomes in Mitral Regurgitation: Insights from a National Database Analysis
Authors: Olayiwola Bolaji, Mobeen Haider, Prakash Upreti, Yousef Alsmairat, Priya Hotwani, Kripa Rajak, Jawad Basit, Rohit Goru, Abubakr Ziaullah, M Chadi Alraies
Journal: Circulation (2024)

Introduction: Transcatheter edge-to-edge repair of the mitral valve with the MitraClip has offered a less invasive percutaneous alternative to surgical repair in select candidates with mitral regurgitation. Various factors impact the outcomes of MitraClip. We investigated the impact of nutritional status on the outcomes of MitraClip. Methods: Utilizing the nationwide inpatient sample data for years from January 1, 2016, and December 31, 2021, patients who underwent MitraClip were identified. They were categorized based on obesity and protein energy malnutrition (PEM). Statistical significance was assigned at p&lt;05. Results: Out of the 8115 patients undergoing MitraClip, 2215 had PEM, and 5900 had obesity—table 1. Patients in the PEM group were older, with a higher prevalence of comorbidities, including anemia, pneumonia, liver disease, and fluid and electrolyte disorders, compared to the obese group. Conversely, the obesity group had a higher prevalence of hypertension, diabetes, and hypertension with complications. Our analysis revealed that PEM subgroups had significantly higher in-hospital mortality, cardiogenic shock, mechanical circulatory support (MCS) requirement, post-procedural worsening heart failure, spontaneous cardiac arrest, and major adverse cardiovascular and cerebrovascular events (MACCE). After adjusting for potential confounders, PEM remained an independent predictor of increased odds of death, cardiac arrest, ECMO, MCS, and MACCE compared to obesity. The propensity score matching analysis confirmed that PEM was associated with significantly higher rates of in-hospital mortality, cardiac arrest, and MACCE compared to obesity. (Figure 1) Conclusion: Our results reveal that PEM is associated with significantly worse outcomes in patients undergoing MitraClip procedures compared to obesity. These findings are consistent across multivariate and propensity score matching analyses.
Abstract 4147639: Trends in Atherosclerosis-related mortality in the United States from 1999 to 2020; A Retrospective Analysis
Authors: Malik Saad Hayat, Muhammad Mukarram Shoaib, Rayyan Naseer, Muhammad Wajeeh Ul Hassan, Javeria Javeid, Muhammad Talha Shaukat, Aleenah Mohsin, Wania Rehman, Aqeeb Ur Rehman, Hadia Ahmad, Muhammad Ahmad Qureshi
Journal: Circulation (2024)

Background and Aims: Atherosclerotic diseases, including but not limited to myocardial infarction and stroke, are the leading cause of morbidity and mortality worldwide. Here we aim to identify and quantify temporal trends of atherosclerotic disease mortality among adults in the United States from 1999 to 2020, and pinpoint racial, local, regional, age and gender-wise variations in this trend. Methods: Data was sourced from the CDC WONDER database, with atherosclerosis identification based on ICD-10 Codes I70. We determined the crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals from 1999-2020. JointPoint regression was employed to examine the changes in AAMR across the years through annual percent change (APC) and the average annual percent change (AAPC). Results: The AAMR for atherosclerosis shows a uniformly declining trend from 1999 to 2020 with AAPC= -7.25; 95% CI -6.34 to -8.14. The analysis revealed significant disparities in mortality rates among different demographic groups. Mortality was significantly higher among female patients (AAPC=-7.09%; 95% CI -6.48 to -8.58), American Indian patients (AAPC=-7.88%; 95% CI -.6.58 to -9.11), and rural populations (AAPC=-7.62%; 95% CI -6.53 to -8.70). Most deaths occurred in the southern region of the US (AAPC: -7.62%; 95% CI -7.45 to -9.19). A notable exception to this was California which accounted for the highest mortality in the US. Conclusion: Our nationwide analysis showed an overall decreasing mortality trend due to atherosclerosis among adults in the US. However, the higher mortality rate among females, American Indians, and rural populations is concerning and requires further investigation that can explain and expand on the findings of our study and explain this variation in mortality rates.
Abstract 4140122: Bioengineered Self-Adhering Electrospun Nanoscaffolds to Deliver Mitochondrial Antioxidant, JP4-039
Authors: Mark Broadwin, Amy Oh, Frances Imarhia, Mason Ferbert, Zakhar Lyakhovych, Rayane Teixeira, Peter Wipf, Sankha Bhowmick, Frank Sellke, Ruhul Abid
Journal: Circulation (2024)

Introduction: Treatment of pathologic remodeling and subsequent decline in cardiac function post-myocardial infarction (MI) remains limited. Our lab has previously demonstrated that the targeted mitochondrial antioxidant, JP4-039 (JP4), can abrogate post-MI remodeling and decline in cardiac function, and that JP4 released from electrospun nanoscaffolds improved proliferation and migration of coronary vascular endothelial cells in vitro . The aims of this study were to develop a suture-free, bioadhesive electrospun nanoscaffold that will adhere post-MI cardiac tissue and reliably release JP4 in a localized manner. Hypothesis: Plasma treatment of JP4-loaded biocompatible electrospun nanoscaffold will adhere to cardiac tissue and deliver active moiety of JP4. Methods: A 2% poly(l-lactide-co-glycolide) (PGLA) was electrospun with and without 1% JP4. Nanoscaffolds then underwent plasma treatment for one minute followed by a force adhesion assay. SEM imaging and electron paramagnetic resonance ( EPR ) assays before and after plasma treatment of both control and JP4-loaded patches were performed to examine patch consistency and ensure the release of the unaltered, active structure of JP4. Results: JP4 loading and plasma treatment did not affect fiber dimeter of the scaffolds (p &gt; 0.5 for all; Fig. 1B). JP4-loaded patches demonstrated similar release pattern of the antioxidant’s nitroxide moiety by displaying a characteristic triple peak both before and after plasma treatment as determined by EPR (Fig. 1C). Plasma-treated patches demonstrated significant increase in force adhesion compared to non-treated patches in both the control and JP4-loaded scaffolds (p &lt; 0.0001) (Fig. 1A.). No significant difference in force adhesion was observed between the plasma treated control and JP4 loaded patch (p &gt; 0.05) as determined by ANOVA (Fig. 1A). There was no significant difference in force adhesion between one minute and two minutes of plasma treatment (p &gt; 0.05; Fig. 1A lower panel). Conclusion: The findings demonstrate that plasma-treated biocompatible JP4-loaded patches may reliably adhere to cardiac tissue and release the bioactive component of the mitochondrial antioxidant, JP4.