tbuckley/cabot-search huggingface dataset:
Abstract 4147889: Nationwide Temporal Trends in Aortic Valve Replacement for Bicuspid and Tricuspid Aortic Valve Stenosis
Authors: Mohamed Barghout, Ahmed Elkaryoni, Hafiz Imran, Afshin Ehsan, Neel Sodha, J Dawn Abbott, Barry Sharaf, Paul Gordon, Marwan Saad
Journal: Circulation (2024)

Background: Recent data demonstrated a temporal increase in adoption of transcatheter aortic valve replacement (TAVR) for treating aortic stenosis (AS) across all age groups. Whether there is a differential trend in adoption of TAVR vs. surgical AVR (SAVR) according to valve type, i.e., bicuspid (BAV) vs tricuspid aortic valve (TAV), is unknown. Methods: The Vizient Clinical Database was queried to identify patients who underwent TAVR vs SAVR between October 2015 and November 2023. Patients who underwent AVR for aortic regurgitation or underwent concomitant surgery during SAVR were excluded. The final cohort was divided according to the valve type into BAV and TAV cohorts. National trends in TAVR vs SAVR were examined overall and across BAV and TAV cohorts stratified by different age groups (&lt;65, 65-80, &gt;80 years) using linear regression analysis. Logistic regression analyses were performed to examine if age and valve type are predictors of TAVR use. Results: Among 365,985 patients who underwent isolated AVR for AS, 248,697 (67.95%) underwent TAVR. BAV was present in 42,754 (11.7%) of the final cohort and was treated with SAVR in 85% of patients. Across all age groups, there was an uptrend in the overall use of TAVR and among both BAV and TAV cohorts. The relative rise in all TAVR use was highest in patients &lt;65 years (157%) and in TAVR for BAV was highest in patients 65-80 years (493.93%). In 2023, SAVR was the main AVR modality in all patients &lt;65 years (76.80%), while TAVR was the main modality in patients &gt;80 years (97.84%). In the BAV cohort, SAVR remained the main AVR modality in patients &lt; 65 years (92.65%) and 65-80 years (69.47%), while TAVR was the main modality in patients &gt;80 years (82.83%). In logistic regression analysis, patients 65-80 years and &gt;80 years were more likely to receive TAVR than younger patients &lt;65 years, and BAV patients were less likely to receive TAVR compared to TAV patients (p &lt; 0.05 for all). Conclusion: TAVR is increasingly adopted across all age group and is more commonly performed for tricuspid vs bicuspid AS. Per these contemporary national trends, SAVR remains the main AVR modality in all patients &lt;65 years, and in BAV patients &lt;80 years, while TAVR remains the main AVR modality in all patients &gt; 80 years.
Abstract 4146878: The NADPH Oxidase 4 Plays a Vital Role for the Endothelium under Hypoxia and in the Absence of Protective Laminar Blood Flow
Authors: Heike Brendel, Jennifer Mittag, Anja Hofmann, Helene Hempel, Sindy Giebe, Patrick Diaba-Nuhoho, Steffen Wolk, Christian Reeps, Henning Morawietz, Coy Brunssen
Journal: Circulation (2024)

Background: Increasing evidence support a vasoprotective role of the major endothelial NADPH oxidase isoform 4 (NOX4). NOX4 is notably induced by hypoxia. Research Question: What is the functional role of NOX4 under hypoxic conditions in the vessel wall? Aim: We aimed to elucidate NOX4’s significance in endothelial and vascular function under hypoxia. Methods: Primary cultures of human endothelial cells were exposed to hypoxia of 1% O 2 . Internal mammary arteries were obtained from patients undergoing coronary artery bypass grafting surgery. Surgical specimens of the artery wall proximal to occlusion were obtained from patients with peripheral arterial disease. Human NOX4 was downregulated by lentiviral sh NOX4 . Primary microvascular lung endothelial cells were isolated from wild-type and Nox4 -/- mice. Vascular function was assessed under hypoxia in murine mesenteric arteries and aortas in a Mulvany myograph. Laminar flow was applied by cone-and-plate viscometer or ibidi pump system. NO was measured by Griess reaction, H 2 O 2 by Amplex Red Assay and gene expression by real-time PCR and Western blot. Results: Hypoxia significantly elevated NOX4 expression and activity in endothelial cells. Inhibition of prolyl hydroxylase domain (PHD) enzymes, which stabilize hypoxia-inducible factors (HIFs), increased NOX4 expression even under normoxic conditions. In human hypoxia-prone vessels, NOX4 expression strongly correlated with genes relevant for vascular function, such as prostaglandin I2 synthase ( PTGIS ). Endothelial function assessments under hypoxia revealed elevated contraction and endothelial dysfunction in both wild-type and Nox4 -/- mice with Nox4 -/- mice exhibiting the most severe alterations in endothelium-dependent vasodilation. Laminar shear stress attenuated the hypoxic response in endothelial cells, reducing HIF1a and NOX4 expression while enhancing eNOS expression. NO synthase inhibition under combined hypoxia and laminar flow conditions upregulated NOX4 . Furthermore, NOX4 deletion affected PECAM1 expression and endothelial cell adhesion. Inhibition of NOX4 under combined hypoxia and laminar flow increased the number of endothelial cells not aligned in the direction of flow. Conclusions: Hypoxia-induced NOX4 ensures vasodilation in both conductive and resistant arteries. Laminar blood flow restores eNOS expression and mitigates the hypoxic response on NOX4. NOX4 deletion affects PECAM1 expression, reduces endothelial cell adhesion and alignment.
Abstract 4146703: Conservative versus invasive management of spontaneous coronary artery dissection: A meta-analysis of 7197 patients
Authors: Ahmed Abdelaziz, Ahmed Farid Gadelmawla, Ahmed Helmi, Ahmed Diaa, Rahma AbdElfattah Ibrahim, Ahmed Mohamed, Raneem Afify, Mariam Desouki, Ahmed Nasr, Sandi Banour, Basel Abdelazeem
Journal: Circulation (2024)

Background: Spontaneous coronary artery dissection (SCAD) is defined as a separation of the coronary arterial wall caused by intramural bleeding that is neither traumatic, iatrogenic, nor atherosclerotic. It is now recognized as a significant cause of acute coronary syndrome (ACS), particularly in young women. There is conflicting information regarding the acute therapy of SCAD. We aimed to summarize the available evidence and provide a comprehensive analysis of the management of SCAD. Methods: We systemically examined the clinical outcomes of conservative and invasive management of patients with SCAD using medical records from Web of Science, PUBMED, Scopus, and Cochrane. Our outcomes of interest were all-cause mortality, non-fetal myocardial infarction (MI), and target vessel revascularization (TLR). Risk ratios (RR) and 95% CI were used in a random-effects model to analyze the data. Results: A total of 27 studies were included in this meta-analysis, with a total sample size of 7,197. The conservative approach was associated with a reduction in all-cause mortality compared to the invasive method (RR = 0.29, 95% CI [0.20, 0.42], P &lt; 0.001), and non-fetal MI (RR = 0.74, 95% CI [0.55, 0.99], P = 0.04). Moreover, the conservative approach was associated with a reduced incidence of TLR over the invasive approach (RR = 0.53, 95% CI [0.37, 0.77], P = 0.009). Conclusion: Conservative management of patients with SCAD showed better clinical outcomes than invasive management. We detected lower rates of death, myocardial infarction, and target vessel revascularization among the conservatively managed group, which suggests that conservative therapy should be the first-line approach for patients with SCAD.
Abstract 4148020: Circulating Extracellular Vesicles-Mediated Cardiotoxicity: A Novel Mechanism Exacerbating Heart Failure in Chronic Kidney Disease
Authors: Xisheng Li, Nikhil Raisinghani, Alex Gallinat, shihong zhang, Anh Phan, seonghun yoon, Sabrina La Salvia, David Sachs, Navneet Dogra, Uta Erdbruegger, Susmita Sahoo
Journal: Circulation (2024)

Background: More than 50% of deaths in advanced chronic kidney disease (CKD) are attributed to cardiovascular disease (CVD). The degree of heart failure (HF) correlates with severity of CKD. Clinical observations suggest that kidney-derived factors contribute to the development of HF in CKD, independent of the known co-morbidities such as hypertension and hyperglycemia. However, to date, no kidney-specific risk factor that triggers early damage to the heart has been identified, primarily due to a paucity of studies in patients with reno-cardiac disease. Here, we investigate the role of circulating extracellular vesicles (EVs) from CKD patients in pathological communication from the kidney to the heart, causing cardiotoxicity, impair cardiac function and leading to HF. Methods and Results: We isolated the plasma EVs from patients with CKD (hCKD-EVs) and healthy control (hCtr-EVs) and assayed for their cardiotoxicity both in vitro (human AC16 and rat primary cardiomyocytes (CMs) in culture) and in vivo (intramyocardial injection to Nod-Scid mice). hCKD-EVs significantly induced apoptosis in cultured CMs and in injected mice hearts and impaired the contractility of CMs, compared with hCtr-EVs. We also established an adenine-induced CKD mouse model that developed HF with reduced cardiac function. In line with hCKD-plasma EVs, kidney-derived EVs from CKD mice (mCKD-kidney EVs) induced cardiotoxicity both in vitro and in vivo. Moreover, decreasing the circulating EVs in CKD mice using an inhibitor of EV-biogenesis, GW4869, significantly improved the cardiac function in CKD mice. Small RNA sequencing and qPCR analysis revealed several highly expressed miRNAs in both human and mouse CKD-EVs, which are associated with CM apoptosis. MiRNA mimics treated to AC16 CMs induced their apoptosis, confirming the cardiotoxic function of miRNAs. To demonstrate the renal origin of these CKD-EV-miRNAs, we quantified the levels of corresponding endogenous primary miRNAs. We detected that several CKD-EV-miRNAs are originating from the kidney tissues and specific kidney cells, such as PTCs and podocytes in CKD mice. Conclusion: Our studies establish that both human and mouse CKD EVs are cardiotoxic and impair cardiac function. CKD-EVs carry pro-apoptotic miRNAs and are key contributors to humoral cardiotoxicity in CKD patients. Thus, they have the potential to serve as biomarkers for early diagnosis of and novel therapeutics for chronic reno-cardiac disease.
Abstract 4147397: The Impact of Frailty on In-Hospital Outcomes of Percutaneous Coronary Intervention Performed for Stable Ischemic Heart Disease
Authors: Harriet Akunor, Nikita Singh
Journal: Circulation (2024)

Background: Ischemic heart disease (IHD) is a prevalent cardiovascular disease (CVD) associated with high morbidity and mortality. Over 600,000 percutaneous coronary interventions (PCI) are performed each year for IHD. Frailty and CVD are often interrelated, affecting disease and treatment outcomes. Frailty is a syndrome of physiological decline, characterized by marked vulnerability to adverse health outcomes. Frailty is prevalent in adults with IHD requiring PCI. However, the relationship between frailty and PCI outcomes is not well described. Methods: We analyzed the 2020 National Inpatient Sample (NIS) to identify index hospitalizations in which PCI was performed for patients &gt;18 years with stable ischemic heart disease (SIHD), defined as PCI discharges without acute coronary syndromes (ACS), such as STEMI, NSTEMI, or unstable angina. Patients were categorized as frail if they had a hospital frailty risk score (HFRS) of 5 or higher, and non-frail if their score was below 5. We assessed in-hospital mortality, intracranial hemorrhage, gastrointestinal (GI) hemorrhage, anemia requiring blood transfusion, acute kidney injury (AKI), and hospital length of stay (LOS) between both groups. Hospital-level discharge weights were applied during statistical analyses to derive national estimates. Results: A total of 116,620 patients underwent inpatient PCI for SIHD, of whom 33,875 were frail adults. Frail patients had higher odds of in-hospital mortality (adjusted odds ratio [AOR] = 8.72, 95% confidence interval [CI]: 7.44-10.23), intracranial hemorrhage (AOR = 4.65, 95% CI: 2.18-10.82), GI hemorrhage (AOR = 2.03, 95% CI: 1.63-2.53), anemia requiring blood transfusion (AOR = 1.65, 95% CI: 1.32-2.06), and AKI (AOR = 2.12, 95% CI: 1.93-2.32) during the index hospitalization, as well as a longer LOS (median 5 days, interquartile range [IQR] 3-10 days, vs. median 2 days, IQR 2-3 days). Conclusion: Frail adults undergoing inpatient PCI for SIHD are at increased risk for in-hospital mortality and periprocedural complications, with longer LOS. Frailty is common among patients undergoing PCI for SIHD; understanding these outcomes may improve shared decision-making for patients considering PCI.
Abstract 4147891: The neutrophil-to-lymphocyte ratio as a novel predictor of idiopathic left ventricular versus right outflow tract premature ventricular contractions.
Authors: Shaaf Ahmad, Pranati Panuganti, Edwin Lu, Mason Sanders, Anthony Mazzella, Faisal Syed
Journal: Circulation (2024)

Background: The pathogenesis of idiopathic premature ventricular contractions (PVCs) may differ between patients with left- vs right- outflow tract (LVOT; RVOT) PVCs. We hypothesized that PVCs of LVOT origin would be associated with a higher prevalence of inflammatory conditions, such as coronary artery disease (CAD) and aortic sclerosis (AS), and elevation in the inflammatory biomarker, neutrophil-to-lymphocyte ratio (NLR). Research Question: Is NLR associated with LVOT PVCs? Aim: To compare clinical factors and NLR between patients with left- versus right-outflow tract origin of PVCs. Methods: We studied 140 patients undergoing idiopathic outflow tract PVC ablations at our institution. Patients with acute inflammatory conditions were excluded. NLR was calculated by dividing the absolute neutrophil by lymphocyte counts. Associations between clinical variables, NLR, and PVC site of origin at ablation were examined using logistic regression analysis. Results: An LVOT site of origin was present in 48 (35%) patients, with significant differences in clinical variables to RVOT patients. Independent predictors of LVOT (vs RVOT) PVCs were chronic kidney disease (CKD, odds ratio [OR]: 5.3, 95% CI: 1.3 - 22.1), age&gt;50 (3.8, 1.6 - 8.6) and NLR (1.35, 0.9 - 1.9). An elevated NLR (≥3.92) was present in 14% of patients with LVOT PVCs vs 6.4% in those with RVOT PVCs (p&lt;0.006). Conclusions: We found a significant difference in risk factors between otherwise idiopathic LVOT vs RVOT PVCs. In contrast to those with RVOT PVCs, patients with PVCs of LVOT origin are older and have a higher prevalence of CKD. NLR is an independent predictor for LVOT PVCs. Our findings highlight the potential importance of inflammation as a selective mediator of LVOT PVCs.
Abstract 4147463: Impact of Timing on Outcomes in Rescue PCI for STEMI: Early vs. Late Intervention
Authors: Anna Elisa Adib Gracia, Alberto Santiago Hernández, Raul Rodrigo Neri Bale, Jorge Cuéllar Vargas, Eder Gonzalez Macedo, Braiana Diaz, Ximena Latapi Ruiz Esparza, Mariana Garcia Villarejo, Diego Araiza, Heriberto Ontiveros Mercado, Alexandra Arias
Journal: Circulation (2024)

Introduction: American guidelines recommend rescue PCI within 3 to 24 hours after failed fibrinolysis in patients with ongoing ischemia, hemodynamic instability, or other high-risk features. Given the large areas covered by relatively few centers, rescue PCI can be delayed. Aims: This abstract aims to compare complications in patients undergoing early rescue PCI (within 6 hours post-thrombolysis) versus late rescue PCI (more than 6 hours post-thrombolysis). Methods: A prospective registry was conducted, patients over 18 years with diagnosis of STEMI undergoing rescue PCI (reperfusion therapy when thrombolysis has failed) in a tertiary cardiology center in Mexico from august of 2023 to april of 2024 were included. We divided patients into two groups, the ones who received early rescue PCI (within 6 hours post-thrombolysis) versus late rescue PCI (more than 6 hours post-thrombolysis). Results: 109 patients who received late Rescue PCI and 56 patients who received early Rescue PCI were included. Baseline characteristics in patients undergoing Rescue PCI before and after 6 hours are presented in table 1. Patients who underwent late rescue PCI showed worsening heart failure (KK: Killip Kimball IV) 14.2% vs 9.1% (p= 0.319.). The Major adverse cardiovascular events (MACE) reported with statistical significance are angina (p value 0.048) and especially renal failure (p= 0.016). The survival rate was significantly higher when the patient entered rescue PCI after 6 hours 95.4% vs 89.2% (p = 0.023). Conclusion: Although no specific time frame has been set for rescue PCI, patients who underwent to rescue PCI within six hours showed worsening outcomes such as angina and renal failure, possibly due to higher KK grades, the onset of cardiogenic shock, and lower survival rates. A major limitation of our study was the small sample size, which restricted comparisons of MACE with other outcomes. This limitation is expected to improve as our database expands. Despite these findings, it is essential to base the decision to perform a rescue PCI on the patient's initial condition upon arrival at a capable PCI center.
Abstract 4146939: Impact of Diagnosis Timing (Early vs Late) on Atrial Fibrillation Progression in Patient with New Onset Atrial Fibrillation During COVID Illness
Authors: Michael Cutler, Tami Bair, Stacey Knight, Douglas Packer, Jeffrey Anderson, Kirk Knowlton, Heidi May
Journal: Circulation (2024)

Background: New onset AF during acute illness has a high rate of AF recurrence within 5-yr. However, little is known about AF progression in patients with new onset AF during COVID illness. It is also unknown whether the time of COVID diagnosis (early vs late) impacts AF progression. More specifically, did the potentially different immune and inflammatory responses during early vs late COVID produce structural and electrical cardiac remodeling that would increase the likelihood of AF progression. Objective: We sought to compare AF progression in patients with new onset AF during early vs late COVID and hypothesized that early COVID was associated with increased AF progression compared to late COVID. Methods: From Apr 2020 to Feb 2024, patients receiving a SARS-2-CoV test without a history of AF with new onset AF and at least 3-mo of follow up were included (N=11,767). Patients were subdivided based on pos vs neg SARS-2-CoV test and time of diagnosis. Early COVID diagnosis (n=3052) included Apr 2020-Aug 2021 and late COVID (n=8715) included Sep 2021-Feb 2024. AF progression endpoints at 3-, 6- and 12-mo included AF hospitalization, AF emergency department (ED) visit, cardioversion and AF ablation. Results: Patients with late COVID were more likely females with hypertension, coronary artery disease and hyperlipidemia compared to early COVID patients. At 3- and 6-mo follow-up there was no difference in AF progression between the early and late COVID groups for any endpoint. In contrast, at 12-mo follow up there was in increase in late diagnosis group AF ED visits (11% vs 7.6%, p &lt;0.0001) and a trend toward more AF hospitalizations (6.3% vs 4.1%, p =0.07). There was no difference in cardioversions or AF ablations between the groups at 12-mo. Finally, patients with an early COVID trended to be less likely to undergo AF ablation (3.9% vs 5.6%, p =0.14) and have an AF hospitalization (4.1% vs 6.3%, p =0.06) at 12-mo than new onset AF patients during the same time without COVID. There was no difference in AF progression between COVID pos and neg patients in the late COVID group. Conclusions: These findings demonstrate that there is no significant difference in AF progression in patients with new onset AF during COVID when stratified by timing of diagnosis. As such, our data do not support the hypothesis that early COVID resulted in more significant structural or electrical cardiac remodeling that would increase the likelihood of AF progression.
Abstract 4146960: Social Determinants of Health Associated With Worse Hypertension Stage in Low-Middle Income Country
Authors: David Jose Javier Rodriguez Szaszdi, Vikyath Satish
Journal: Circulation (2024)

Background: Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD) and is the leading cause of morbidity and mortality globally, with a rise in prevalence in low and middle-income countries (LMIC). While HTN awareness, treatment, and control have increased in high-income countries (HIC), this increase is less marked in LMIC. Objective: To describe the characteristics of social determinants of health associated with HTN in LMIC rural areas. Methods: Data was obtained from a cluster-randomized trial in Guatemala, implemented in rural areas nationwide. Trained interviewers used standardized questionnaires and measurements to collect data. HTN stage was defined according to AHA’s 2018 guidelines. The chi-squared test compared sociodemographic characteristics between HTN stages I and II. Results: Data from 1580 hypertensive participants with blood pressure readings over 130/80 mmHg with or without anti-hypertensive treatment was analyzed. The median age was 63 years, with 72% women. Spanish (Guatemala’s official language) was spoken by 65%, and the illiteracy rate was 58%. Mayan ethnicity represented 43%. The proportion of people aware of their HTN diagnosis was 69%, but only 60% of them were on anti-hypertensives. Median systolic and diastolic blood pressure (BP) was 142.5 and 76.5 mmHg, respectively. Median BMI was 27.6 kg/m 2 . A statistically significant difference (p&lt;0.05) was observed between HTN stages I and II in ethnicity (37% vs. 46% belonged to the Mayan Indigenous group), median age (61 vs. 64 years), Spanish language fluency (68% vs. 64%); literacy (46.3% vs. 39.6%); known HTN (74% vs. 66%); established anti-HTN treatment (69% vs. 54%); treatment adherence (76% vs 68%); and body mass index (28.1 vs 27.4 kg/m2). Conclusions: These results highlight significant disparities in the characteristics and management of hypertension among rural populations of LMIC. They emphasize the need for targeted interventions to improve hypertension control, specifically in rural areas, like enhancing access to healthcare, improving literacy and language proficiency, and addressing the specific needs of the Mayan indigenous population due to differing cultural habits and beliefs.