tbuckley/cabot-search huggingface dataset:
Abstract 17281: Outcome of Stress-Induced Cardiomyopathy in Patients With Covid-19 Infection: A US Cohort Propensity-Matched Study
Authors: Pratik Wagle, AHMED SUBAHI, Roaa Mohamed, Osama Hamid, Mohamed Abdelrahman
Journal: Circulation (2023)

Introduction: COVID-19 has affected millions of people worldwide and is associated with cardiovascular complications like myocarditis, MI, pericarditis &amp; stress-induced cardiomyopathy (Takotsubo cardiomyopathy). Hypothesis and aim: The aim of our study was to examine the outcomes of stress-induced cardiomyopathy in patients with COVID-19. Methods: Using TriNetX, which aggregates &gt;100 million patients' charts, we identified adults (&gt;18) between Jan. 2020 &amp; Apr. 2023. We identified 2 groups: stress induced cardiomyopathy in the setting of COVID-19, &amp; stress-induced cardiomyopathy without COVID-19. We performed 1:1 propensity score matching for demographics and co-morbidities like DM, HTN, HLD, IHD, CKD, obesity, PVD, COPD, liver cirrhosis, smoking &amp; alcohol abuse. We conducted Kaplan-Meier survival analysis to assess all-cause mortality. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated to express the risk of each outcome. Results: We identified 1990 cases of stress-induced cardiomyopathy with COVID-19, and 27,702 patients with stress-induced cardiomyopathy without COVID-19. The majority were female gender and white race across the groups. Table 1 summarizes the demographics and characteristics of cohorts. After matching, stress-induced cardiomyopathy with COVID-19 were more likely to develop LV thrombus (aOR 1.41 [1.02-1.61]), cerebral infarction (aOR 1.25 [1.05-1.47]), acute respiratory failure (aOR 1.72 [1.53-1.94]), cardiogenic shock (aOR 1.37 [1.09-1.72]), and VTE (aOR 1.86 [1.61-2.14]). No difference was found in VT (aOR 0.89 [0.72-1.10]), or cardiac arrest (aOR [1.13 (0.88-1.45]), figure 1. All cause-mortality was worse in COVID-19 associated stress-induced cardiomyopathy (HR 1.17 [1.007-1.35]). Conclusions: Stress induced cardiomyopathy in the setting of COVID-19 was associated with a higher risk of adverse events and increased mortality compared to stress induced cardiomyopathy without COVID-19.
Abstract 15999: Proportional Pulse Pressure and Shock Index as Predictors of Cardiac Index in Patients With Intermediate-Risk Pulmonary Embolism
Authors: Carlos L Alviar, Radu Postelnicu, Mireia Padilla-Lopez, Robert Zhang, Usman Alam, Lindsay Elbaum, Constantine Tarabanis, Kelsey Grossman, Arushi Singh, Allison Greco, Kerry Hena, Vikramjit Mukherjee, Sylvie Hall, Rafael Harari, Norma Keller, Sripal Bangalore
Journal: Circulation (2023)

Background: Risk stratification in intermediate-risk pulmonary embolism (PE) plays an important role in appropriate selection of therapies, however this is often challenging given variable phenotype. Proportional pulse pressure (PPP) and shock index (SI) have demonstrated to accurately predict cardiac index (CI) in patients with cardiogenic shock. Nonetheless, their applicability to patients with acute PE remains uncertain. Our objective is to investigate whether PPP and SI correlate with invasive assessment of CI in intermediate-risk PE. Methods: We retrospectively analyzed patients included in the Pulmonary Embolism Response Team (PERT) registry at NYCH+H/Bellevue who underwent invasive hemodynamic assessment. PPP was calculated as systolic blood pressure - diastolic blood pressure/systolic blood pressure. SI was calculated as heart rate/systolic blood pressure. Linear regression and correlation coefficients were used to examine the relationship between PPP, SI and CI as well as other clinical variables. Results: A total of 45 intermediate-risk PE patients were included (mean age was 57 ± 13 years and 43% were female). The SI moderately correlated with the composite pulmonary embolism shock score (CPES) (r = 0.5, p=0.0002), sPESI (r = 0.37, p=0.007), cardiac index (-0.42, p=0.004) and poorly correlated with lactate levels (r=0.23, p=0.18). PPP correlated poorly with CPES (r = 0.01, p=0.96), sPESI (r = -0.04, p=0.73), CI (r = 0.1 p=0.51) and lactate (-0.18, p=0.2). There was poor correlation between SI and PPP (r = -0.17, p=0.23). For every 0.1 increase in the shock index, the cardiac index was lower by 0.17L/minute/m 2 (p=0.017). Conclusions: In patients with intermediate-risk PE, a higher SI was associated with a lower CI, while PPP was not associated with CI. SI may provide additional valuable information to risk-stratify patients with acute PE and can potentially assist clinicians in triaging monitoring level therapeutic decisions.
Abstract 15760: A Critical Contribution of Cardiac Myofibroblasts and a Predictive Role of UCP2 SNPs in the RV Decompensation in Pulmonary Hypertension
Authors: Yongneng Zhang, Maria A Lorenzana Carrillo, Saymon Tejay, Alois S Haromy, Yongsheng Liu, Yuan Yuan Zhao, Gopinath Sutendra, Evangelos D Michelakis
Journal: Circulation (2023)

Introduction/hypothesis: The mechanism driving the transition from compensated (cRVH) to decompensated right ventricular hypertrophy (dRVH) in pulmonary hypertension (PHT) is unknown. We hypothesized that a transition from cardiac fibroblasts (cFB) to cardiac myofibroblasts (cMFB) underlies this mechanism. Decreased mitochondrial calcium (mCa ++ ) promotes cMFB differentiation (from cFB). Methylation of mCa ++ uptake 1 (MICU1) and lack of UCP2 (uncoupling protein 2, a component of the mCa ++ uniporter complex) decrease mCa ++ , and therefore, activity of Krebs enzymes that produce diffusible metabolites, regulating epigenetic mechanisms that drive change in cell identity. Methods/Results: In the monocrotaline-rat PHT model, we separated cRVH from dRVH based on strict hemodynamics (canulating the main pulmonary artery through the jugular vein) and Echo: dRVH had decreased cardiac output, increased right atrium pressure, decreased TAPSE and increased RV end diastolic diameter compared to cRVH. In isolated hearts, RV systolic pressure was lower in dRVH but in isolated cardiomyocytes (CM), contractility (sarcomere shortening) was not, pointing to a non-cardiomyocyte difference. The number of cMFB was not different between cRVH and Control, but dramatically increased in dRVH. Mitochondrial respiration was lower in dRVH cMFB than cRVH cFB. mCa ++ was progressively decreased from Control to cRVH to dRVH c(M)FB, while it was not different in CM. The MICU1 methyltransferase (PRMT1) levels and methylation of immunoprecipitated MICU1 were increased but the expression of UCP2 was decreased from Control to cRVH to dRVH c(M)FB (but not CM). In human RV tissues (from autopsy or biopsy, n=15), dRVH had increased number of cMFB compared to Control and cRVH. Cytoplasmic PRMT1 was increased and UCP2 was decreased from Control to cRVH to dRVH c(M)FB. In a cohort of 25 patients with PHT that had Echo and right heart Cath within 48 hours, carriers of the loss-of-function UCP2 SNP (rs659366) had decreased TAPSE compared to non-carriers that had similar mean PA pressure. Conclusion: A change of cell identity (cFB to cMFB) in the RV may be the basis of cRVH to dRVH transition, rather than contractile failure of CM. UCP2 SNP may predict early dRVH, if confirmed in larger cohorts.
Abstract 18753: Dynamic Phenotypic Transition of Smooth Muscle Cells During Human Ascending Thoracic Aortic Disease Progression: From Compensation in Aortic Aneurysm to Decompensation in Aortic Dissection
Authors: Yanming Li, Chen Zhang, Hernan Vasquez, Yang Li, Abhijit Chakraborty, Kimberly Rebello, Samantha Xu, Lin Zhang, Hisashi Sawada, Zhen Zhou, Rui Chen, yumei li, Yvan Saeys, steven eisenberg, Hong S Lu, Lisa A Cassis, Joseph S Coselli, Alan Daugherty, Dianna M Milewicz, Ying H Shen, Scott A Lemaire
Journal: Circulation (2023)

Introduction: Although ascending thoracic aortic aneurysm (ATAA) and ascending thoracic aortic dissection (ATAD) share common pathologic features of aortic degeneration, the specific elements that lead to rapid disease progression in ATAD remain poorly understood. We examined the molecular and cellular dynamics in smooth muscle cells (SMCs) of aortic tissues from ATAA and ATAD patients and further examined mechanisms in a mouse model. Methods: Single-cell RNA sequencing (scRNA-seq) analyses were performed in ascending aortic tissues from individuals without aortic disease (n=8), patients with ATAA without dissection (n=9), and patients with acute ATAD (n=9). Further, scRNA-seq and scATAC-seq were performed in ascending aortic tissues from mice infused with angiotensin II (AngII) or control mice; scRNA-seq analyses were performed on SMC-specific Tgfbr2 -/- mice. Results: Six SMC subtypes were identified in human aortic tissues. Cluster proportion and trajectory analyses indicated a profound SMC transition from contractile in control to extracellular matrix (ECM)-contractile phenotype in ATAA, however, was reduced in ATAD tissues. Instead, ATAD showed significant SMC transition to inflammatory phenotype. Consistently, many genes in ECM organization and muscle contraction, collectively termed compensatory response, were upregulated in ATAA but downregulated in ATAD tissues compared with controls, whereas inflammatory response and cell death pathway genes were significantly upregulated in ATAD compared with control and ATAA tissues. Cell-cell interaction, regulatory network, and motif analysis suggested that TGF-beta-MEF2C signaling contributed to the induction of the ECM-contractile SMC phenotype. MEF2C + SMCs exhibited the capacity of transition towards ECM-producing SMCs in both mouse and human aorta. SMC-specific Tgfbr2 -/- mice showed compromised SMC transition to ECM-producing phenotype. Conclusions: Our study reveals SMC phenotypic transitions to ECM-producing SMCs in ATAA and to inflammatory and pro-death SMCs in ATAD, which represent a compensatory response in ATAA and a decompensatory status in ATAD. TGF-beta-MEF2C, a novel regulatory axis, promoted the compensatory response in SMCs of the ascending aorta.
Abstract 17966: Behavioral Characteristics of High-Risk Postpartum Individuals Predict Response to a Digital Health Intervention to Improve Physical Activity
Authors: HIlary Bediako, Tang Li, Dazheng Zhang, Mary Putt, Lisa Levine, Jinbo Chen, Jennifer Lewey
Journal: Circulation (2023)

Background: Hypertensive disorders of pregnancy (HDP) are common among women and increase risk for cardiovascular disease later in life. Postpartum interventions can motivate healthy lifestyle changes but are not universally effective. Patient demographics insufficiently predict intervention response. Our goal is to use cluster analysis to determine how behavioral phenotypes are associated with response to a digital health intervention targeting postpartum women with HDP. Methods: We analyzed 122 participants in the STEP-UP Mom study, a randomized clinical trial comparing wearable step tracker and team-based gamification (intervention) to wearable step tracker alone (control) over 12 weeks. Behavioral characteristics were collected at baseline using validated surveys, to which we applied the k-means method to identify two distinct patient clusters. Linear mixed-effects models were used to estimate mean step count difference between arms from baseline across 12-week follow-up in each cluster. Results: Among the 122 participants, the median age was 33 years and 54% identified as Black. Participant characteristics in each cluster are shown in the Table. Participants in Cluster 1 had higher baseline steps, lower exercise self-efficacy and greater psychosocial distress. There was no significant difference in change in step count in the intervention arm compared to the control arm (-289 steps, 95% CI -1294, 717; p=0.57). Participants in cluster 2 had lower baseline steps, higher exercise self-efficacy, and less psychosocial distress. In cluster 2, participants in the intervention arm walked 1,309 more steps per day on average compared to the control arm (95% CI 475, 2144; p= 0.003). Conclusion: Participants had varied response to a digital health intervention based on behavioral phenotype. This finding may help identify individuals who may benefit from a higher touch or tailored intervention in future studies to increase step count in the postpartum period.
Abstract 17085: An Unusual Case of Severe Hypertrophic Cardiomyopathy in a 23-Year-Old Systemic Lupus Erythematosus Patient on Hydroxychloroquine
Authors: Bernard Brown, Budzikowski Adam, sabu john
Journal: Circulation (2023)

A 23-year-old female with Systemic lupus erythematosus (SLE), lupus nephritis, antiphospholipid syndrome, venous thromboembolism, stroke, Libman-Sacks endocarditis, and hypertension presented with right upper and lower extremity weakness, right facial droop, and aphasia. Her home medications included hydroxychloroquine, mycophenolate, apixaban, and losartan. ECG showed normal sinus rhythm, left atrial enlargement, ST and T wave abnormalities in V5 and V6. Computed tomography angiography of the brain showed left middle cerebral artery occlusion. Transthoracic echocardiogram (TTE) showed left ventricular ejection fraction of 65%, severe left ventricular hypertrophy, moderate pericardial effusion, and moderately thickened mitral valve (MV) leaflets. Transesophageal echocardiogram showed large vegetations on atrial aspect of both MV leaflets concerning for Libman-Sacks endocarditis. We attempt to investigate the cause of this hypertrophic cardiomyopathy (HCM) in a young patient with SLE. Few reported cases of HCM in patients with SLE were medication induced. Tacrolimus has been observed to induced HCM in a Japanese patient with dermatomyositis. Hydroxychloroquine has been associated with myocardial thickening. Its use can lead to enlarged myocardiocytes with intracytoplasmic vacuoles consisting of concentric lamellar myelin figures in single membrane bound vesicles, curvilinear bodies, glycogen accumulation and fused mitochondria. Hydroxychloroquine use led to reversible inhibition of lysosomal enzyme activity. Cessation of medication use in both cases led to reduction in left ventricle thickness. These patients, like our own, has no family history of aortic valve stenosis, mitral valve prolapse, or HCM. However, this patient’s use of hydroxychloroquine to treat her SLE can be assumed to be a contributing factor to her HCM. This could suggest possible screening with ECG and TTE in patients taking hydroxychloroquine.
Abstract 15764: Early versus Late Initiation of Non-Vitamin K Antagonist Anticoagulation After Ischemic Stroke in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Alla Adelkhanova, Prakash Oli, Dhan B Shrestha, Mtanis Khoury, Jurgen Shtembari, Rafae Shaikh, George Bodziock, Nimesh Patel, Gautham Kalahasty, S. Patrick Whalen, Ghanshyam Shantha
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is a common cause of acute ischemic stroke (AIS). Non-vitamin K antagonist oral anticoagulants (NOACs) are recommended for stroke prevention. However, presumed higher risk of hemorrhagic transformation in early (≤ 5 days) start of NOACs delays timing of anticoagulation initiation after AIS. This meta-analysis was conducted to evaluate granularity of data on the timing of initiation of NOACs after AIS in patients with AF. Methods: This meta-analysis followed the PRISMA guidelines and is registered in PROSPERO (CRD42023391198). PubMed, PubMed Central, Embase, and Scopus databases were searched for relevant articles from inception through May 2023. Title and abstract were screened by two independent authors, followed by full text review in Covidence platform. Pertinent data was extracted in Microsoft Excel. Data were analyzed using RevMan v5.4 with odds ratio as effect measure. Results: A total of 6326 studies were identified from database search. Five studies with 7442 patients were included. There was no significant difference between the groups in terms of recurrent stroke (OR 0.86, CI 0.62-1.20;), intracranial hemorrhage (OR 0.71, CI 0.26-1.93), major bleeding (OR 1.22, CI 0.66-2.26) or mortality (OR 0.75, CI 0.44-1.27). However, pooled results from two studies showed a statistically significant lower occurrence of hemorrhagic transformation in early NOAC group as compared to late NOAC group (OR 0.43, CI 0.32-0.60). Conclusions: Based on this meta-analysis, early NOAC initiation after AIS in patients with AF is a safe strategy in terms of efficacy (recurrent stroke) and safety (major bleeding, intracranial hemorrhage, mortality, and hemorrhagic transformation).
Abstract 15815: Non-Contrast Computed Tomography Attenuation Measurement for Early Detection of Aortic Valve Microcalcifications
Authors: Hamza Akhtar, Jolien Geers, Gregg S Pressman, marc dweck
Journal: Circulation (2023)

Introduction: Calcific aortic stenosis (AS) is often diagnosed at its late stage. 18F- sodium fluoride (18F-NaF) PET can identify areas of active calcification before appearance of macrocalcifications. Hypothesis: We hypothesized that CT attenuation measurement could detect areas of microcalcification as determined by 18F-Na F PET. Methods: 18F-NaF PET/CT data were evaluated in 102 patients (age 71 ± 8 years, 21% female) with calcific AS at baseline and 2-year follow-up. Multiple 3 mm regions of interest were identified based on 18Na-F PET uptake and presence of macrocalcification (Hounsfield units, HU&gt;130): PET-/CT-, PET+/CT- and PET+/CT+. Assessment of CT attenuation was also performed in 20 control patients with no AS at baseline and after 1 year. Results: At baseline, PET+/CT- regions had greater HU than PET-/CT- regions (median 50 [IQR 42-55] vs. 39 [IQR 32-46]; p &lt; 0.001). Further, PET+/CT- regions showed greater 24-month change vs PET-/CT- (median 16 [IQR) 7-28] vs. 0.83 [IQR -2.56-6.91]; p &lt; 0.001) (Figure 1). A cut off value of 48.76 HU yielded sensitivity/specificity of 57%/85% for detection of microcalcifications, AUC = 0.760. Applying this threshold to the control group the calculated 24-month increase in HU was greater in patients above the threshold vs those below (median 9.89 [IQR -2.92-29.82] vs. 0.57[IQR -7.16-4.31]; p &lt; 0.001) (Figure 2). Conclusions: Aortic valve non-contrast CT X-ray attenuation value above 48.76 HU was able to identify regions of 18F-NaF uptake in patients with AS. Therefore, measuring X-ray attenuation on non-contrast CT has the potential to identify regions of developing microcalcification within the aortic valve.
Abstract 18758: Pain and Quality of Life in Older Adults With Advanced Heart Failure
Authors: Jun Yeong Byun, Andres Azuero, Marie A Bakitas, Rachel Wells
Journal: Circulation (2023)

Background: Over 80% of people with advanced heart failure (HF) experience pain; however, little is known about the relationship between pain and quality of life (QoL). Research Objectives: Examine the relationships between: 1) Total Pain Theory constructs and 2) pain and QoL across time. Methods: A secondary analysis of usual care participants in the ENABLE CHF-PC, a palliative care RCT (ClinicalTrials.gov: NCT02505425). Primary outcome was pain (PROMIS Pain Intensity &amp; Interference). Total Pain constructs include physical and mental health (PROMIS Global Health 10), social support (Multidimensional Scale of Perceived Social Support), and spirituality (Negative Religious Coping). Mixed models assessed the relationships between pain and Total Pain constructs. Cross-lagged path analysis examined the temporal relationship between pain and QoL (baseline, 24-weeks, 48-weeks). Results: Of 205 usual care participants, mean age was 64.15 (SD 9.14), 108 (52.7%) men, and 111 (54.1%) African American. At baseline, participants’ QoL was poor (35.98, SD 10.7) with greater pain interference (54.5, SD 10.70) but not pain intensity (45.09, SD 10.47) compared to the general population. Among Total Pain constructs, only physical health was significant. As physical health decreased, pain intensity (b = -0.80, SE = 0.09, CI = -0.99, -0.62, p &lt; .001) and pain interference (b = -0.69, SE = 0.10, CI = -0.89, -0.49, p &lt; .001) increased. An unadjusted path analysis suggested variable magnitude temporal relations: a significant, large relationship between pain intensity and QoL at baseline (standardized cov. = 0.53), but medium-sized across baseline to 24-weeks (B = 0.28), and across 24- to 48-weeks (B = 0.32). Relationship between pain interference and QoL was also significant at baseline (standardized cov. = 0.54) and across baseline to 24-weeks (B = 0.41). Conclusions: Variability in magnitude of relationships between pain intensity and interference and QoL demonstrates the complex nature of pain in advanced HF.
Abstract 14794: Relationship Between Cerebral Infarction Incidence and Humidity in a Super-Aging Society
Authors: Kihei Yoneyama, Shunichi Doi, Toshiya Yoshida, Yasuhito Kawagoe, Yuki Ishibashi, Masaki Izumo, Yasuhiro Tanabe, Tomoo Harada, Yoshihiro J Akashi
Journal: Circulation (2023)

Introduction: Cerebral infarction is one of the major causes of physical disability among the elderly worldwide. Weather temperature and humidity are rarely reported as predictors of cerebral infarction in our super-aging society. Hypothesis: Temperature and humidity are associate with cerebral infarction admission in super aging society. Methods: The Japanese registry of all cardiac and vascular diseases database includes patients with cardio-cerebrovascular disease who required admission and constitutes a nationwide dataset in Japan. This study included 606,807 consecutive patients with cerebrovascular disease requiring admission were admitted between 2015 and 2019. We investigated the relationship between cerebral infarction admission and temperature, or humidity. Results: Data were collected from 422,759 admitted patients with cerebral infarction. In the population with cerebrovascular disease admission, the median age was 75.0 (66.0-83.0) years and 55.8% of subjects were male. The mean temperature and humidity 1 day before cerebral infarction hospitalization were 17.2 °C and 69%, respectively. Multilevel mixed-effects linear regression models showed non-linear relationship of temperature and humidity with cerebral infarction admissions after adjusting for air pollution, hospital, and patient demographics. A negative linear association was found between mean temperature and humidity with cerebral infarction admission at mean temperature &lt;7°C and mean humidity &lt;40% (coefficient, -2.098 [-2.220 to -1.976] per °C, coefficient, 0.165 [0.151 to 0.179] per %, respectively).However, a positive linear association was found at mean temperature ≥7°C, at mean humidity ≥40% (coefficient, 0.190 [0.161 to 0.219]per °C, coefficient, 0.136 [0.103 to 0.168] per %, respectively). Conclusions: Extremely lower or higher temperature and humidity are both associated with an increased incidence of cerebral infarction admission in Japan.