tbuckley/cabot-search huggingface dataset:
Abstract 14790: Association of Neighborhood Socioeconomic Disadvantage in Early Pregnancy and 30-Year Predicted Probability of Cardiovascular Disease 2-7 Years Postpartum
Authors: kartik K venkatesh, Sadiya S Khan, Janet M Catov, jiqang wu, Rebecca McNeil, Victoria L Pemberton, Philip Greenland, Judith Chung, Lisa Levine, Lynn Yee, Hyagriv Simhan, David Haas, George Saade, C Noel N Bairey Merz, William Grobman
Journal: Circulation (2023)

Introduction: To determine whether neighborhood socioeconomic disadvantage as measured by the Area Deprivation Index (ADI) in early pregnancy is associated with higher 30-year predicted risk of cardiovascular disease (CVD) by the Framingham Risk Score. Methods: A secondary analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be (nuMoM2b) Heart Health Study (HHS) longitudinal cohort. Participant home addresses in the first trimester were geocoded at the census-tract level. The exposure was neighborhood socioeconomic disadvantage using the 2015 ADI by tertile (least deprived [T1], reference; most deprived [T3]). The primary outcome was the predicted 30-year risk of hard CVD using the Framingham Risk Score (composite of fatal and non-fatal coronary heart disease and stroke). The secondary outcome was predicted 30-year risk of total CVD (composite of “hard” CVD plus coronary insufficiency and angina pectoris, stroke, transient ischemic attack, intermittent claudication and heart failure). Outcomes were assessed categorically as high-risk defined as a predicted probability of CVD &gt; 10%, and secondarily as a continuous measure of absolute risk (%). Modified Poisson and linear regression models adjusted for age, insurance, education, and income. Results: Among 4,310 nulliparous individuals, the median age was 27 years (IQR: 23-31), and the median ADI was 43 (IQR: 22-74). At 2-7 years postpartum (median: 4 years), the median 30-year risk of hard CVD was 2.3% (IQR: 1.5-3.5), and total CVD was 5.5% (IQR: 3.7-7.9). Individuals living in neighborhoods in the highest tertile of socioeconomic disadvantage were more likely to have a high 30-year predicted risk of hard CVD (≥10%) compared with those in the lowest tertile (aRR: 2.25; 95% CI: 1.23, 4.11), with similar results for high 30-year predicted risk of total CVD (aRR: 1.36; 95% CI: 1.09, 1.69). Living in the highest ADI tertile was associated with a higher absolute risk of 30-year hard (adj. ß: 0.41; 95% CI: 0.19, 0.63) and total CVD (adj. ß: 0.76; 95% CI: 0.38, 1.14) when analyzed as a continuous outcome. Conclusions: Neighborhood socioeconomic disadvantage in early pregnancy is associated with higher predicted risk of 30-year CVD 2-7 years after delivery.
Abstract 14657: p66Shc Mediates SUMO2-Induced Endothelial Dysfunction and ROS Production
Authors: JITENDRA KUMAR, Shravan kumar Uppulapu, Sujata Kumari, Kanika Sharma, Ravi P Yadav, Vikas Kumar, Santosh Kumar
Journal: Circulation (2023)

Endothelial dysfunction is one of the earliest changes promoting vascular pathologies. Studies suggest that promoting sumoylation increases endothelial dysfunction and development of atherosclerotic plaque. We showed that overexpression of SUMO2 (one of the sumo isoforms) leads to impaired vasorelaxation. However, the molecular signaling is not well understood.P66Shc is an adaptor protein known to regulate vascular function. Studies in mice suggest that p66Shc impairs endothelial function via promoting oxidative stress. Mice with p66Shc knockout are protected against endothelial dysfunction due to hyperlipidemia, diabetes, and aging. Therefore, we asked if p66Shc mediates endothelial effects of SUMO2. We show that p66Shc is modified by SUMO2 and knockdown of p66Shc in endothelial cells inhibits SUMO2-induced reactive oxygen species production as well as inflammation. To identify the specific residue of p66Shc getting sumoylated, we generated recombinant p66Shc and SUMO2ylated it with a commercially available kit. Using mass spectroscopy, we identified that lysine-81 in CH2 domain of p66Shc is specifically modified by SUMO2. We also show that SUMO2-modificaiton of p66ShcK81 promotes oxidative activation (serine-36 phosphorylation) and mitochondrial translocation of p66Shc which are essential for ROS production. P66Shc non-sumoylatable at lysine 81 (p66ShcK81R) is resistant to SUMO2-induced serine-36 phosphorylation and mitochondrial translocation. To examine physiological significance of p66ShcK81-SUMO2, we generated a mouse model having knock in of p66ShcK81R. Using aortic rings from p66ShcK81R knock in and wild type mice, we show that overexpression of SUMO2 significantly impairs endothelium dependent relaxation in wild type mice aortic rings while aortic rings from p66ShcK81R knock are protected against it. Together, we demonstrate that SUMO2-p66Shc is a novel molecular signaling regulating vascular endothelial function.
Abstract 16745: Continuous Stellate Ganglion Block for Ventricular Arrhythmias: Case Series, Systematic Review and Comparison With Epidural Anesthesia
Authors: arianna morena, Antonio Toscano, Filippo Angelini, Carol Gravinese, Simone Frea, Andrea Saglietto, Eleonora Balzani, martina cedrone, Matteo Giunta, Andrea Costamagna, Matteo Anselmino, Mauro Rinaldi, Luca Brazzi, Gaetano Maria De Ferrari, Veronica Dusi
Journal: Circulation (2023)

Background: Percutaneous single bolus injection left stellate ganglion block (PLSGB) and thoracic epidural anesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). Data on continuous PLSGB (C-PLSGB) are scant. Objectives: to report our single center experience with C-PLSGB and perform a systematic review on C-PLSGB and TEA to preliminary compare these 2 techniques. Methods: consecutive patients receiving C-PLSGB were enrolled. The systematic literature review was performed following the latest PRISMA criteria. Results: our single-center case series (8 pts, 88% male, 60 ±16 years, all with structural heart disease) supports that C-PLSGB is feasible and safe, even on fully anticoagulated patients and leads to a complete VAs suppression in half and to an overall clinical benefit in all patients. Overall, considering previously published data, 34 patients received C-PLSGB, and 18 TEA for refractory VAs. Most (61%) in the TEA group were on general anesthesia, as opposed to 24% in the C-PLSGB group (p=0.01); 52% of patients were on full anticoagulation at C-PLSGB, none at TEA (p&lt;0.01). C-PLSGB and TEA efficacy was not significantly different (31/34 versus 13/18 had a complete or at least partial response, p=0.1). No major complications occurred, yet the discontinuation rate was significantly higher in the TEA compared to C-PLSGB (22% versus 3%, p=0.037). Conclusions: C-PLSGB seems feasible, safe and effective for the acute management of refractory VAs. C-PLSGB efficacy seems to be not significantly different to that of TEA and may be accomplished with less concerns of anticoagulation, and lower discontinuation rate.
Abstract 14804: Automated Semantic Segmentation and Stenosis Detection of Coronary Arteries on Invasive Coronary Angiograms Using Hypergraph Matching and Information Fusion
Authors: Chen Zhao, Michele Esposito, Jingfeng Jiang, Zhihui Xu, Weihua Zhou
Journal: Circulation (2023)

Background: Invasive coronary angiography (ICA) remains the gold standard for diagnosing CAD. Our objective was to develop a machine learning method for coronary semantic segmentation and stenosis detection in ICA. Method: We first extract coronary artery branches using ICAs and convert the vascular tree into ICA graphs. Then, we construct the hyper association graph from two individual ICA graphs. The vertex in the hyper association graph encodes the correspondence between two artery branches, and each hyperedge represents the correspondence between multiple artery branches. Hypergraph matching is used to find feature correspondence by considering higher-order structural information, and the artery semantic labeling task is converted into a vertex classification. Ultimately, by learning the semantic mapping of artery branches between ICAs, the unlabeled arteries are categorized by labeled arteries so that semantic segmentation is achieved. After performing the semantic labeling, a deterministic network performs stenosis detection. More specifically, a convolution long-short-term network is employed to extract imaging features, and an LSTM is employed to extract the radius features along the artery. The late fusion technology is employed to fuse the feature representation, and a softmax classifier is employed to detect the stenosis. Results: 310 ICAs from 179 subjects were collected and utilized for data analysis. Our graph-matching model achieved an average accuracy of 0.86 for coronary artery semantic labeling. The deterministic network achieved an accuracy of 0.80 for coronary artery stenosis detection. Conclusion: We have developed and validated a hypergraph-based graph-matching algorithm for coronary semantic labeling and a fusion network for artery stenosis detection. This has important implications for integrating AI software in ICA, potentially resulting in automated report generation or as an assistant for clinical decision-making.
Abstract 17068: Proportionate Suicide Mortality in Cardiovascular Disease in the United States From 1999 to 2019
Authors: Kenyon Agrons, VIJAY NAMBI, Abdul Mannan Khan M Minhas
Journal: Circulation (2023)

Introduction: Few studies have investigated disease associated suicide other than mental health. We aimed to assess suicide mortality in cardiovascular disease. Methods: We used CDC WONDER to access National Vital Statistics System data from 1999 to 2019. Suicide and CVD related deaths in patients ≥ 25 years of age were identified from multiple causes of death. Proportionate suicide mortality (PSM) was calculated as number of suicide deaths listed with CVD, divided by number of all cardiovascular-related deaths irrespective of suicide, and reported as PSM per 100,000 cardiovascular deaths. Joinpoint regression was used to examine changes in trend using annual percentage change (APC) overall and by sex, race/ethnicity, disease subtype, and age. Results: PSM by disease category from most to least were mental health,, nervous system, musculoskeletal, gastrointestinal, cardiovascular, respiratory, and lastly malignant neoplasm. The CVD PSM increased from 62.8 in 1999 to 90.5 in 2019 (average APC 2.1* [95% CI, 0.2 to 3.9]). Notably, APC decreased from 2013-2019 (APC -2.1 (95% CI -3.6 to -0.5). In racial/ethnic groups, PSM was highest in non-Hispanic White (NHWs) (103.8) then Hispanic/Latino (H/L) (63.6), and lastly NH Black (NHB) (29.2) individuals. PSM was highest in 25-39 years age group (858) followed by 40-54 years (382.8), 55-69 years (146.2), 70-84 years (55.9), and lastly 85+ (17). APC in PSM initially increased in men (3.1 until 2013), women (4.1 until 2014), NHW (3.9 until 2013), H/L (3.5 until 2014), 40-54 (2.9 until 2013), 55-69 (6.0 until 2013) then either stabilized or decreased. While APC in NHBs (1.0) and 25-39 years (1.4) consistently increased till 2019. Conclusion: Among non-mutually exclusive disease categories, CVD ranked 3rd to last. PSM in CVD peaked in the early 2010s, with variable increases across various sex, racial/ethnic, and age groups. Further research is needed to understand the causes of these disparities to develop preventative strategies.
Abstract 13550: Prognostic Value of the Global Left Ventricular Contractility Index in Patients With Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction
Authors: Vinay B Panday, Jessele Lai, Nicholas L Gao, Beth S Lim, Aloysius Leow, Ching-hui Sia, Ru San Tan, Liang Zhong, William Kong, Kian Keong Poh
Journal: Circulation (2023)

Introduction: Global left ventricular (LV) contractility index, dσ*/dt max , defined as the maximal rate of change of pressure-normalized LV wall stress, is given by the formula 3(dV/dt) max /2V m where dV/dt max is the product of left ventricular outflow tract (LVOT) velocity and area; and V m , left ventricular mass index (LVMI). In published reports, prediction of clinical outcomes in aortic stenosis were observed. It is unknown if dσ*/dt max would predict clinical outcomes in patients with severe mitral regurgitation (MR). Aim: We studied the association of dσ*/dt max with clinical outcomes in severe MR with preserved LV ejection fraction (EF). Methods: Consecutive patients with severe MR and LVEF ≥50% diagnosed on index echocardiogram at a single centre were retrospectively analyzed. Patients with other valvular lesions of moderate severity or more, or valvular interventions, were excluded. Clinical outcomes were ascertained by review of medical records. The primary outcome was a composite of heart failure hospitalizations and all-cause mortality. Results: 176 patients were included in the analysis. Table 1 depicts the characteristics of the study population. Patients with composite outcomes were older, more likely to be female, had higher LVMI, lower regurgitation volume and dσ*/dt max (2.2 +/- 0.7 vs 2.7 +/- 0.9, p = 0.02). On multivariable Cox regression (Table 2), only age and dσ*/dt max (adjusted HR 0.42, 95% CI: 0.220 - 0.806, p = 0.01) remained independently associated with occurrence of the primary outcome. Conclusions: In patients with isolated severe mitral regurgitation and preserved LVEF, low dσ*/dt max was an independent predictor of adverse clinical outcomes.
Abstract 15584: Artificial Intelligence-Guided Screening for Atrial Fibrillation Detection Among Patients With Different Socioeconomic Status
Authors: Victoria Kalinoski-DuBose, Xiaoxi Yao, Peter A Noseworthy, Yihong Deng, Zachi Attia, Francisco Lopez-Jimenez, Bernard J Gersh, Jonathan Graff-Radford
Journal: Circulation (2023)

Introduction: Recently, an artificial intelligence (AI) algorithm was validated for identifying ECG signatures of atrial fibrillation (AF) risk during normal sinus rhythm. Traditionally, socioeconomically disadvantaged populations are less likely to receive novel or guideline-recommended treatments, and have high chronic disease burden, including cardiovascular diseases. There have also been concerns about new technologies creating a digital divide, worsening existing health disparities. Hypothesis: An AI algorithm will detect AF risk unequally across patients with different levels of social determinants of health (SDOH). Methods: The initial prospective, non-randomized, interventional study leveraged EHR and digital technologies to prospectively enroll 1004 patients with a broad range of AI-ECG risks of AF, who received continuous cardiac rhythm monitoring for up to 30 days. The Area Deprivation Index (ADI) was used as a composite measure of SDOH which is comprised of indicators spanning four domains: income, education, employment, and house quality. 904 intervention patients linked to the ADI data were matched to 904 real-world control patients derived from eligible but unenrolled patients. Those with ADI under 33% were defined as having better SODH; and patients with ADI above 33% were defined as having worse SODH. Results: Median age was 74 years and 38% were women. After matching, the intervention and control arms were balanced in all baseline characteristics, including HF, HTN, diabetes, stroke, CAD and ADI. A hazard ratio of 3.11 (P&lt;0.001) was computed when comparing intervention to control for primary AF diagnosis outcome. In patients with worse SDOH, the intervention increased AF detection from 2.6% to 8.8% (HR 3.63 [2.09, 6.32]); in the better SDOH, the intervention increased AF detection from 3.9% to 9.3% (2.41 [1.23, 4.74]). Conclusions: An AI-guided AF screening program increased the detection of AF in both patients with better or worse SDOH. The current study validates the use of AI in historically disadvantaged populations displaying the possibility for broad implementation with decreased possibility of perpetuating disparities.
Abstract 16539: Endometriosis Does Not Have a Causal Role in Determining Cardiovascular Disease and Cardiac Structure and Function: Evidence From Mendelian Randomization
Authors: Maddalena Ardissino, Jun Yu Chen, Ophelia Millar, Gillian Xu, Joanna Girling, Fu Siong Ng
Journal: Circulation (2023)

Introduction: Previous observational studies have suggested an association between endometriosis and higher risk of cardiovascular disease. However, in the observational setting residual confounding could drive the association. Hypothesis: In this study, we hypothesize that endometriosis might be causally related to cardiac disease, structure and function, and investigate this using Mendelian randomization (MR), a method that is not liable to influence by observational confounding. Methods: Genome-wide significant (p&lt;5x10-8) uncorrelated (r2&lt;0.001) variants associated with endometriosis in a recent genome-wide association study of 60,674 cases and 701,926 controls were extracted as instrumental variants. Gene-outcome association data was extracted from GWAS of atrial fibrillation, coronary artery disease, heart failure, ischaemic stroke, and 15 different indexed cardiac magnetic resonance markers of structure and function. Inverse-variance weighted MR was used for primary analysis. A further exploratory analysis was performed for the outcome of atrial fibrillation, extracting data from a different GWAS study, to further explore to a borderline result on primary analysis. Results: A higher genetically-predicted risk of endometriosis was not associated with risk of atrial fibrillation (OR 1.06, 95%CI 1.00 to 1.12, p=0.059), coronary artery disease (OR 1.00, 95%CI 0.93 to 1.07, p=0.933), heart failure (OR 1.00, 95%CI 0.94 to 1.05, p=0.920), or ischaemic stroke (OR 0.97, 95%CI 0.91 to 1.03, p=0.342). Replication analysis using a different data source for atrial fibrillation corroborated a lack of association (OR 1.02, 95%CI 0.96 to 1.09, p=0.488). There were no associations with any of measures of cardiac structure and function, as displayed in Figure 1. Conclusions: The results do not support a causal role of endometriosis in determining the risk of cardiovascular diseases, and in promoting an adverse cardiac structure and function.
Abstract 16971: Unraveling the Burden of Cerebrovascular Disease: Exploring the Role of Peripheral Vascular Disease and Kidney Transplant in End-Stage Renal Disease Hospitalization Rates (Insights From the National Inpatient Sample, 2005 to 2019)
Authors: Tyler J Canova, PATRICK BAXTER, Naoru Koizumi, Obi Ekwenna, Rochell Issa
Journal: Circulation (2023)

Background: Patients with end-stage renal disease (ESRD) face a higher risk of cerebrovascular disease, but the impact of peripheral vascular disease (PVD) and a kidney transplant (KiTx) on hospitalization rates for cerebrovascular conditions remains uncertain. This study aimed to investigate the rates of hospitalization for cerebrovascular disease in patients with ESRD, PVD, KiTx, or a combination. Methods: Using the National Inpatient Sample (NIS), 2,713,194 ESRD hospitalizations (2005-2019) were analyzed. We focused on two cerebrovascular conditions of interest: 1) cerebral infarction due to thrombosis, embolism, and occlusion (CITO) and 2) artery occlusion resulting in cerebral ischemia (AOSI). Comparative analysis utilized t-tests and odds ratios. Results: Among ESRD hospitalizations, 66,927 (2.47%) had KiTx, 63,411 (2.34%) had PVD, and 1,406 (0.05%) had both. Key findings included: 1) ESRD patients with PVD had higher odds of hospitalization for CITO (OR 1.33, CI 1.1-1.8, p=0.009) or AOSI (OR 2.63, CI 2.5-2.8, p&lt;0.001) compared to those without PVD (Fig. 1AB); 2) ESRD patients hospitalized with CITO had higher odds of having KiTx and PVD compared to those without KiTx or PVD (OR 3.17, CI 1.0-9.3, p=0.035, Fig. 1AB); 3) ESRD patients with PVD had higher rates of being hospitalized with AOSI (7.29%) than those without AOSI (2.29%, p&lt;0.001); 4) ESRD patients hospitalized with CITO had higher odds of having KiTx and PVD compared to those without KiTx or PVD (OR 3.17, CI 1.0-9.3, p=0.035, Fig. 1AB) and 5) ESRD patients hospitalized with AOSI demonstrated a higher rate of having KiTx and PVD (0.09%) compared to those without AOSI (0.05%, p=0.002). Conclusion: This nationwide analysis reveals that the presence of PVD and KiTx is associated with increased rates of hospitalization for cerebrovascular conditions. These findings underscore the importance of proactive management to mitigate the risk of cerebrovascular disease in this vulnerable patient population.
Abstract 14510: Precision Phenotyping of Social Determinants of Health and Risk of Coronary Disease, Heart Failure, and Stroke: The Jackson Heart Study
Authors: Rani Zierath, Victoria Lamberson, Yimin Yang, Brian Claggett, Michael E Hall, Tanya M Spruill, James S Floyd, Michelle C Odden, Mario Sims, Amil M Shah
Journal: Circulation (2023)

Introduction: While social determinants of health (SDOH) are associated with cardiovascular disease (CVD) risk, limited data exist regarding their interrelated impact on distinct CVD events. Methods: Among 4,164 Black adults in the Jackson Heart Study (JHS) free of prevalent coronary disease (CHD), heart failure (HF), and stroke at baseline (2000-2004), we used consensus clustering - an unsupervised class discovery and validation approach - to identify subgroups of participants based on 9 SDOH measures reflecting the Healthy People 2030 framework: income, education, discrimination, food insecurity, healthy food stores within 1 mile, healthcare access, neighborhood violence, neighborhood disadvantage, and air pollution (PM2.5). We used multivariable Cox proportional hazards models to relate cluster membership to risk of incident CHD, HF, and stroke adjusting for age, sex, hypertension, diabetes, obesity, and chronic kidney disease. Results: Mean age was 55 ± 13 years and 63% were women. We identified 4 participant clusters with differential exposure to SDOH: Cluster 1 (n=1359) had the most favorable SDOH profile with highest income and lowest neighborhood disadvantage and violence; Cluster 2 (n=915) had highest PM 2.5 and lowest frequency of food stores; Cluster 3 (n=998) had lowest education level and highest neighborhood disadvantage and violence; and Cluster 4 (n=820) had lowest income and healthcare access and highest prevalence of food insecurity. Over a median of 11 [IQR 10 - 11] years, 255 participants developed HF, 159 CHD, and 167 stroke. Compared to Cluster 1, Clusters 3 and 4 were associated with higher risk of incident HF while Clusters 2 and 3 were associated with higher risk of stroke ( Figure ). Cluster membership was not associated with risk of CHD. Conclusions: Multiparametric SDOH assessment identifies unique clusters of individuals differentially burdened by individual-level social determinants and at heightened risk for distinct CVD events.