tbuckley/cabot-search huggingface dataset:
Abstract 17498: Association Between 5-Year Change in Cardiovascular Risk and Atherosclerotic Cardiovascular Disease Incidence: A Multicohort Study
Authors: Jiayi Yi, Lili Wang
Journal: Circulation (2023)

Introduction: Early measurement of atherosclerotic cardiovascular disease (ASCVD) risk factors contains valuable information about an individual's risk history. Hypothesis: Individuals with different historical cardiovascular risk statuses have varied risks of future ASCVD incidence. Methods: We analyzed pooled data from 7 community-based prospective cohort studies with up to 20-year follow-ups ( panel A ). White or Black participants aged 40-75 years without prevalent ASCVD were included. Cardiovascular risk was assessed using the pooled cohort equation and was categorized into non-high (&lt;20%) or high risk (≥20%). Changes in CVD risk over a 5-year interval were considered. The main outcome is incident ASCVD. Results: Among 11026 participants (mean [SD] age,60.0 [8.1] years). 4272 (38.7%) were female and 3127 (28.4%) were Black. During a median follow-up of 9.9 years, 2560 (23.2%) ASCVD events occurred. Compared to individuals with consistently high risk, participants with non-high to high risk (HR 0.67; 95%CI 0.59-0.77), high to non-high risk (HR 0.57; 95%CI 0.41-0.80), and consistently non-high risk (HR 0.33; 95%CI 0.29-0.37) had a lower risk of incident ASCVD. Compared to individuals with consistently non-high risk, participants with high to non-high risk (HR 1.74; 95%CI 1.26-2.41), non-high to high risk (HR 2.04; 95%CI 1.84-2.27), and consistently high risk (HR 3.03; 95%CI 2.69-3.42) had an increased risk of incident ASCVD ( panel B ). Conclusions: Changes in the CVD risk status over time inform dissimilar ASCVD risk than a single risk assessment. Dynamic risk evaluation might enable more accurate cardiovascular risk stratification and decision on preventive interventions should take historical risk status into account.
Abstract 14252: Redefining the Blanking Period After Cryoballoon Ablation for Atrial Fibrillation: From Korean Cryoballoon Ablation Registry
Authors: jinsun park, Myung-Jin Cha, Chang Hee Kwon, Il-young Oh, Sung Ho Lee, Junbeom Park, Pil-sung Yang, Jaemin Shim, Hong Euy Lim, So Ryoung Lee, Ki-Hun Kim, JUN HYUNG KIM
Journal: Circulation (2023)

Background: Early recurrence (ER) of atrial arrhythmia in blanking period (&lt;3 months) after radiofrequency ablation for atrial fibrillation (AF) has been considered as benign episode. Recently, there were controversies of long-term outcome of ER in radiofrequency ablation. the evidences of long-term impact of ER in cryoballoon ablation was still lacking. Hypothesis: There would be a significant impact of ER in patients with cryoballoon ablation on late recurrence of atrial tachyarrhythmia. Thus, this study sought to evaluate long-term outcome according to presence and timing (&lt;1 month, 1-2 months, 2-3 months) of ER after cryoballoon ablation. Methods: Using the data from a multicenter registry of cryoballoon ablation for AF in Korea between May 01, 2018, and June 30, 2022, we identified 2,654 eligible patients. The primary outcome was late recurrence of atrial tachyarrhythmia including atrial fibrillation, atrial flutter, or atrial tachycardia longer than 30 seconds, excluding a blanking period of 3 months. A multivariable Cox proportional hazard model was performed to evaluate the impact of ER for late recurrence of AF. Results: Among 2,654 patients, 763 (28.7%) patients experienced ER of atrial arrhythmia after cryoballoon ablation. During mean follow-up periods (21.2 ± 10.3 months) after 3-month blanking period, 874 (32.9%) patients developed late recurrence of atrial arrhythmia. The 1-year freedom from late recurrence were 85.5% in patients without ER, 44.1% in those with ER &lt;1 month, 32.4% in those with ER of 2-3 month, and 39.0% in those of ER with 2-3 month, respectively ( p = 0.0001). In multivariable Cox proportional hazard model, ER was significantly associated with late recurrence (hazard ratio: 3.98; 95% confidence intervals: 3.47-4.57) ( p = 0.001). Conclusion: Anytime ER after cryoballoon ablation is a significant predictor of late recurrence of atrial arrhythmia.
Abstract 14149: Neighborhood Income and Heart Failure Outcomes: A Nationwide Retrospective Cohort Analysis
Authors: Prasanti Alekhya Kotta, vijay nambi, Arunima Misra, Savitri Fedson, Salim S Virani, Dmitry Abramov, Abdul Mannan Khan Minhas
Journal: Circulation (2023)

Introduction: The association between socioeconomic status (SES) and heart failure (HF) outcomes is not well understood. Methods: We conducted a retrospective analysis of adult HF hospitalizations from the United States National Inpatient Sample (NIS) between 2016 - 2020. Quartile classification of the median household income of the zip code of the patient’s residence provided by NIS was used. Multivariable logistic regression, adjusting for multiple variables (Table 1), was performed. Results: From lowest to highest income quartile, mean age and proportion of White race increased; proportion of females, Black, and Hispanic race decreased (Table 1). Higher income quartiles had a higher proportion of Medicare and private payors, lower income quartiles had higher proportion of Medicaid. Higher income quartiles received a greater proportion of care in urban teaching hospitals, lower income quartiles received more care in rural hospitals.The prevalence of obesity, pulmonary disease, diabetes, and substance use decreased; prevalence of atrial fibrillation, valvular disease, and ischemic heart disease increased in higher income quartiles. Compared with lowest income, highest income residents had higher rates of pressor use (odds ratio [OR] 1.32, 95% CI 1.2 - 1.5, P &lt; 0.001), mechanical circulatory support (OR 1.5, 95% CI 1.4 - 1.7, P &lt; 0.001), cardiogenic shock (OR 1.18, 95% CI 1.11 - 1.25, P &lt; 0.001), and cost ($16163 vs $12555). There was a decreasing, but statistically insignificant, difference in in-hospital mortality (OR 0.98, 95% CI 0.94 - 1.02, P = 0.35), and cardiac arrest (OR 0.95, 95% CI 0.9 - 1, P = 0.07); with no difference in disposition to care facility (OR 1.01, 95% CI 0.99 - 1.03, P = 0.216) in highest compared to lowest income quartiles. Conclusions: We found differences in demographic and clinical outcomes across income quartiles, which could be suggestive of different factors contributing to HF development, its trajectory, and management based on SES.
Abstract 13281: The Combined Effect of Omecamtiv Mecarbil and Low-Dose Dobutamine for Post-Arrest Myocardial Dysfunction in a Rat Model of Cardiac Arrest
Authors: HSIN YU LEE, Min-Shan Tsai, Wen-Jone Chen, CHIEN-HUA HUANG, Wen-Chu Chiang, Kuan-Ting Lu, Matthew Ma
Journal: Circulation (2023)

Introduction: Post-arrest myocardial dysfunction attributes unstable hemodynamic and mortality in successfully resuscitated cardiac arrest victims. Studies demonstrated that low-dose dobutamine (LDb) and Omecamtiv Mecarbil (OM) improved post-arrest myocardial dysfunction and neurological recovery, respectively. Hypothesis: Whether the combination of LDb and OM synergistically improves post-arrest myocardial dysfunction? Methods: Asphyxial cardiac arrest was induced in adult male wistar rats and left untreated for 9.5 minutes followed by cardiopulmonary resuscitation. Successfully resuscitated animal were randomized into control group (without medication), OM group(0.25 mg/kg/h), LDb group (5 micrograms/Kg/min), and OM+LDb group, in which drugs or normal saline were continuously intravenously infused for 4 hours. Hemodynamic were monitored for 4 h after return of spontaneous circulation. Survival status and neurological recovery were observed for 72 h. The difference of biomarkers, histological examinations and mitochondrial function of myocardium between groups were evaluated. Results: As compared with the control group, the OM, LDb, and OM+LDb groups all demonstrated improved left ventricular systolic function (dp/dt40), better cardiac output, lower Troponin-I, higher 72-h survival, and more favorable neurological recovery. The LDb group showed a higher dp/dt40 and cardiac output than the OM group, whereas OM+LDb group did not demonstrated significant benefit when compared to OM and LDb, respectively. The OM, LDb, and OM+LDb mitigated post-arrest myocardial damage and cardiac mitochondrial injury, and ameliorated myocardial and hippocampus apoptosis. However, the OM+LDb group showed no superiority to the OM group or LDb group. Conclusions: Both OM and LDb improved post-arrest myocardial dysfunction, cardiac mitochondrial injury, survival, neurological recovery following cardiac arrest. However, OM+LDb group did not exert synergistic effect in ameliorate post-arrest myocardial dysfunction.
Abstract 13383: Extracorporeal Membrane Oxygenation for COVID-19-associated Acute Respiratory Distress Syndrome: A Nationwide Analysis
Authors: Atsuyuki Watanabe, Aaqib H Malik, Tadao Aikawa, Alexandros Briasoulis, Toshiki Kuno
Journal: Circulation (2023)

Introduction: While extracorporeal membrane oxygenation (ECMO) has been used for patients with COVID-19-associated acute respiratory distress syndrome (ARDS), its benefit in the nationwide setting is unknown. Aim: To evaluate the association between the use of ECMO and outcomes of COVID-19-associated ARDS in the nationwide setting. Methods: Using the United States National Inpatient Sample in 2020, we identified adults hospitalized and mechanically ventilated for COVID-19 with ARDS and divided them into three groups according to the use of ECMO (i.e., no-ECMO, venovenous [VV]-ECMO, and venoarterial [VA]-ECMO). The primary outcome was in-hospital mortality, and the secondary outcomes were the length of hospital stay (LOS) and the total costs during hospitalization. We applied a multivariable logistic regression model for the primary outcome, adjusting for baseline characteristics and underlying comorbidities. Results: Of the total of 72,415 included patients, 68,795, 3,280, and 340 patients received no-, VV-, and VA-ECMO, respectively (Table) . The crude mortality was the highest in the no-ECMO group (59.8%; 41,110/68,795), followed by VA-ECMO (47.1%; 160/340), and VV-ECMO groups (44.8%; 1,470/3,280). LOS was the longest in VV-ECMO group, followed by VA-ECMO, and no-ECMO groups. Similarly, the total costs during hospitalization were the highest in VV-ECMO group, followed by VA-ECMO, and no-ECMO groups. After adjusting for the covariates, VV- or VA-ECMO was not associated with lower mortality compared to no-ECMO (adjusted odds ratio [95% confidence interval]: 0.98 [0.82-1.18] and 1.12 [0.62-2.04], respectively). Conclusions: In the nationwide setting, ECMO was not associated with improved mortality in patients with COVID-19-associated ARDS but was associated with longer LOS and higher costs. Future studies exploring the characteristics of suitable candidates for ECMO are warranted.
Abstract 17482: Association of Ankle-Brachial Index with Coronary Artery Calcium Scoring for Coronary Vascular Disease Risk Stratification
Authors: Andrew Gaballa, Adel Hajj Ali, Steven Feinleib, Paul Schoenhagen, Raul J Seballos, Tom Kai Ming K Wang, Natalia Fendrikova Mahlay, Milind Y Desai
Journal: Circulation (2023)

Introduction: The Ankle-Brachial Index (ABI) and coronary artery calcium scoring (CACS) are important tools for cardiovascular disease risk stratification. This study aimed to investigate the association between ABI index in combination with CACS for risk stratification of coronary vascular disease. Hypothesis: Given that both the ABI and the Coronary Artery Calcium Scoring are predictors of cardiovascular events, we hypothesize that an association between the Multiethnic Study on Subclinical Atherosclerosis Coronary Artery Calcium Scoring (MESA-CACS) and ABI exists. Methods: A total of 2655 patients (mean age 59±6 years, 72% male, and 87% white) who underwent CACS screening and ABI as part of a primary prevention screening program at the Cleveland Clinic between March 2016 and October 2021 were included in this study. ABI measurements were obtained by dividing the ankle systolic blood pressure by the brachial systolic blood pressure. The 10-year risk score based on MESA-CACS was calculated and categorized into 4 groups (&lt;1%, 1-4.99%, 5-9.99% and ≥10%). ABI was categorized into normal (1-1.4), non-compressible (≥ 1.4) and abnormal (&lt; 1). Results: Among the total of 2655 patients, 164 (6%) had a MESA-CAC score of &lt;1%, 1566 (59%) had a score of 1-4.99%, 501 (19%) had a score of 5-9.99%, and 424 (16%) had a score of ≥10%. The median ABI was 1.17 (range 0.79-1.77) on the left and 1.17 (0.50-1.78) on the right. Tabulating the patients based on their ABI index across the MESA-CACS categories showed no significant difference among the groups with a p-value of 0.830 (Fig 1), with the majority of the patients (&gt; 98% of patients) in all 4 groups having a normal ABI index of 1-1.4. Conclusion: The ABI did not demonstrate a significant association with the MESA-CACS, suggesting its potential use as a synergistic marker for coronary vascular disease risk stratification. Long-term cohort studies are needed to validate this result.
Abstract 13422: A Family With KCNH2 and SLC4A3 Mutation of Short QT Syndrome Inducing Frequent Sudden Death in Young Age
Authors: Noriko Fukue, Takeshi Ueyama, Masashi Kanemoto, Seiko Ohno, Hideaki Akase, Shinichi Okuda, Fumiaki Nakao, Yasuhiro Ikeda
Journal: Circulation (2023)

Case report: Short QT syndrome (SQTS) is an inherited disease characterized by abnormally short QTc intervals, which can lead to ventricular fibrillation(VF). However, the number of patients with SQTS are relatively low, and the optimal treatment for SQTS remains unclear. We experienced a family with SQTS inducing frequent sudden death of three sons. We identified KCNH2-H70Y in mother and three sons with QTc intervals 344, 300, 326, 322msec, respectively. Second son suffered cardiac arrest when he was 25-year-old. VF was recorded in the hospital, and the patient was successfully resuscitated. While recommended to implantable cardioverter defibrillator (ICD), oldest and third son suffered sudden death during nighttime sleep at their age 36 and 34. Functional analysis showed that cells expressing H70Y had significantly larger I Kr densities than WT. Also we identified SLC4A3 mutation in this family. Conclusions: Asymptomatic SQTS patients with family history may be recommended ICD implantation more strongly than class 2b. Registry studies of SQTS should be performed and solid guidelines should be established due to patients with poor prognosis of SQTS.
Abstract 14014: Inclusion of Chronic Kidney Disease Measures Improves Heart Failure Risk Prediction: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Neel Koyawala, Justin B Echouffo, Sui Zhang, VIJAY NAMBI, Morgan Grams, Kuni Matsushita, Roger S Blumenthal, Janani Rangaswami, Christie M Ballantyne, Josef Coresh, Chiadi E Ndumele
Journal: Circulation (2023)

Introduction: Although chronic kidney disease (CKD) is closely linked to hypertension and diabetes, and is an independent risk factor for heart failure (HF), most HF risk prediction algorithms do not include CKD measures as covariates. Hypothesis: We hypothesized that the addition of estimated glomerular function (eGFR), using creatinine (Cr) and cystatin C (CysC), and urine albumin to creatinine ratio (UACR) to the ARIC HF Risk Score will improve risk discrimination for HF. Methods: We performed a prospective analysis of participants at ARIC Visit 4 (1996-1998) to assess changes in risk prediction after incorporating CKD measures. eGFR was estimated by both Cr and by Cr-CysC using CKD-EPI 2021 race-free equations. Using eGFR and UACR, we categorized CKD into four risk progression levels per the Kidney Disease Improving Global Outcomes (KDIGO) heat map. We assessed changes in 10-year risk discrimination of the ARIC HF Risk Score with the addition of eGFR-Cr, eGFR-Cr-CysC, and with KDIGO CKD categories using eGFR-Cr+UACR and eGFR-Cr-CysC+UACR. Analyses were performed in the overall population and stratified by hypertension and diabetes. Results: Among 10,277 participants (mean age 63.2 years, 56% women, 21.4% Black, 15.5% diabetes, 40.8% hypertension), 845 people developed HF over 10 years. Risk discrimination progressively improved by adding eGFR-Cr, eGFR-Cr-CysC, and KDIGO categories with eGFR-Cr+UACR and eGFR-Cr-CysC+UACR to the ARIC HF Risk Score (C-statistic base model, 0.783 [95% CI, 0.768, 0.798] versus 0.796 [95% CI, 0.781, 0.810] with KIDIGO categories using eGFR-Cr-CysC+UACR). Greater improvements in risk discrimination were observed among those with diabetes and hypertension than in those without these conditions (Table). Conclusion: Incorporating eGFR and UACR in prediction algorithms improves HF risk discrimination and can help inform HF screening and prevention efforts, particularly among individuals with diabetes and hypertension.
Abstract 14074: Prodromal Symptom Cluster is Associated With Length of Hospital Stay After Cardiac Arrest Resuscitation
Authors: Izabela Martins Oliveira, Rita De Cassia Gengo E Silva Butcher
Journal: Circulation (2023)

Introduction: Little is known about the impact of cardiac arrest prodromal symptom clusters on survival after resuscitation. Hypothesis: Clusters of prodromal cardiac arrest symptoms are associated with the length of hospital stay until death or hospital discharge after resuscitation. Methods: This retrospective study included records of in-hospital and out-of-hospital cardiac arrest victims referred to a University Hospital in Brazil between 2010 and 2020. Data concerning the prodromal symptoms and length of hospital stay until death or hospital discharge were collected. Symptom clusters were examined by multiple correspondence analyses. Survival analysis and comparisons between those with and without symptoms were done by the Kaplan-Meier method and the Log-Rank test. Results: There were 120 eligible records (58.7 years old, 54.2% female, 86.7% White). Prodromal symptoms began during the 24 hours preceding the event in 67.2% of the victims; 64.1% had a return of spontaneous circulation. There were three symptom clusters. Symptoms of cluster 1 (dyspnea, cough, and edema), cluster 2 (mental confusion, restlessness, palpitations, reports of skin color changes, sweating, malaise, and stroke symptoms), and cluster 3 (fever, level of consciousness alterations, syncope, chest pain, abdominal pain, headache, and nausea), were found in 50.0%, 18.3%, and 54.1% of the records, respectively. Only individuals with symptoms of cluster 2 (Figure 1) had significantly lower lengths of hospital stay due to death than those without such symptoms (p = .04). Conclusions: Prodromal cardiac arrest symptoms occur in clusters that may indicate a worse prognosis after resuscitation.
Abstract 14029: Association Between Depressive Symptoms Severity and Physiological Age as Determined by Artificial Intelligence-ECG
Authors: Betsy J Medina-Inojosa, Jose R Medina-Inojosa, zhuo chen, Matthew M Clark, Nazanin Rajai, Amir Lerman, Zachi Attia, Paul Friedman, Francisco Lopez-Jimenez
Journal: Circulation (2023)

Background: Depression is prevalent in almost half of patients with cardiovascular disease (CVD) and is associated with CVD and mortality. We used an artificial intelligence algorithm using ECG that predicts physiological age (ECG-Age) that has been linked to increased total and CVD mortality and CVD risk factors. We hypothesized that depressive symptoms would be associated with physiologic aging, as measured by AI-ECG Methods: A previously validated algorithm was applied to determine ECG-Age to 105,732 consecutive ECGs of individuals age ≥18 who sought care at Mayo Clinic between June 2019 and January 2022 and filled the Patient Health Questionnaire-9 (PHQ-9) within a month of ECG. PHQ-9 ascertains severity and frequency of depressive symptoms with values from 0 - 27 and were categorized as (None≤4, Mild 5-9, Moderate 10-14, Moderately severe 15-19 and Severe ≥20). Delta-Age was defined as ECG-Age minus chronological age and accelerated aging was defined as a Delta-Age &gt;1SD above the mean. Logistic regression analyses associated PHQ-9 scores with positive Delta-Age while adjusting for CVD risk factors Results: Mean chronological age was 57±17 yr and mean ECG-Age 58±14 yr (R2 0.85, P &lt; 0.0001), Delta-Age 0.71±9.40 yr, 58% women, average PHQ-9 5±6, 61% had none, 20% mild, 10 % moderate, 5%moderately severe and 4% had severe depressive symptoms. Delta-Age was 2.10 years higher in those with depressive symptoms, reflecting accelerated aging. Compared to those with no depressive symptoms, those with severe symptoms were 1.5 times more likely to have Delta-Age &gt;1SD (OR 1.52 CI 95%1.73-1.33), independently of CV risk factors and the Charlson comorbidity index. Figure. There is significant attenuation of the association once accounting for age, sex and CVD risk factors Conclusions: Depressive symptoms are associated with physiologic aging, highlighting the role of depression in physiologic aging and the potential of preventive strategies in patients with depression and CVD
Abstract 14071: Plasma Protein Concentrations and Risk of Incident Cardiovascular Diseases in the UK Biobank
Authors: Ashley B Pournamdari, Art Schuermans, Jiwoo Lee, Rohan Bhukar, Aeron Small, Whitney Hornsby, Satoshi Koyama, Michael C Honigberg, Pradeep Natarajan
Journal: Circulation (2023)

Introduction: Profiling of plasma proteins has the potential to improve diagnosis, predict disease and reveal new biologic pathways for cardiovascular disease (CVD). Objectives: We tested the associations of circulating proteins with new-onset coronary artery disease (CAD), atrial fibrillation (AF), heart failure (HF), and aortic stenosis (AS) in the UK Biobank. Methods: The initial dataset consisted of 52,705 individuals and 1,463 proteins measured using the Olink platform. A total of 47,665 unrelated individuals without prevalent CVD and 1,459 proteins were retained after quality control. Cox proportional hazards models were used to evaluate associations of protein levels at baseline with incident CAD, AF, HF, and AS. Models were adjusted for age, age 2 , race, first ten principal components of genetic ancestry, sex, smoking, BMI, SBP, antihypertensive and lipid-lowering medication use, DMII, serum creatinine, LDL and HDL cholesterol, and Townsend deprivation index. The four outcomes were incorporated as time-varying covariates. Results: Among the 47,665 individuals, mean (SD) age was 56.8 (8.2) years, 25,674 (53.9%) were female, and 44,691 (93.8%) white. Over a median follow-up of 11.1 years, there were 2,941 (6.2%), 2,502 (5.2%), 1,470 (3.1%) and 420 (0.9%) incident cases of CAD, AF, HF, and AS, respectively. Multivariable-adjusted Cox regression revealed 270, 156, 385, and 21 significant associations (P &lt; 8.6 x 10-6) for CAD, AF, HF, and AS, respectively. Fifteen biomarkers overlapped across all outcomes. The strongest associations for CAD, AF, HF, and AS were with GDF-15 (HR = 1.33, 95% CI = 1.28 - 1.39), NT-proBNP (HR = 1.83, 95% CI = 1.75 - 1.91), HE4 (encoded by WFDC2; HR = 1.67, 95% CI = 1.57 - 1.77), and GDF-15 (HR = 1.51, 95% CI = 1.43 - 1.59), respectively. NT-proBNP, IGFBP-4 and HE4 were the strongest overlapping associations. Conclusions: High-throughput proteomics may offer new mechanistic insights and improve risk prediction for common CVDs.