tbuckley/cabot-search huggingface dataset:
Abstract 4145926: The Importance of Dietary Salt in the Process of Atherosclerosis The Results of the International Survey
Authors: Stanislaw Surma, Joanna Lewek, Tomasz Sobierajski, Maciej Banach
Journal: Circulation (2024)

Introduction: Excessive dietary salt intake is a recognized ASCVD risk factor, and causes approximately 1.89 million deaths annually. There is also an ongoing discussion whether dietary salt might be associated with the direct ASCVD risk. Thus, we aimed to check the knowledge, perception, diagnosis, and management of indirect and direct salt-related ASCVD risk among healthcare professionals. Methods: The survey, consisting of 17 questions, was developed by the Polish Lipid Association (PoLA). It was launched in March 2024 and promoted through multiple online channels. Many questions allowed for multiple responses. The questionnaire is ongoing and available at the PoLA webpage. Results: By the end of May 313 respondents (48.6% females) from 40 countries participated in the survey, 70% of whom were physicians. They mostly came from cities with over 500 thousand inhabitants (53.4%). The largest percentage of responses were from Poland (28.7%), Lithuania (19.4%), and Romania (14.8%). More than 1/3 of the respondents correctly indicated the permissible amount of salt in the diet recommended by WHO; even larger percentage (86.3%) correctly indicated that limiting salt intake in the diet applies to both healthy and sick people. Excess salt in the diet was indicated as a recognized risk factor in the case of hypertension 82.4%, atrial fibrillation 28.8%, obesity 36.4%, type 2 diabetes 20.4%, lipid disorders 18.5%, heart failure 59.1%, stroke 56.9%, and atherosclerosis 42.2%. It is worth emphasizing that a significant percentage did not have or had incorrect knowledge about excessive salt consumption and the risk of the above diseases – from 6.4 to even 53%. In the context of data indicating a large number of deaths related to excessive salt intake, only 57.5% of respondents clearly correctly answered the question on the excess salt association with a higher risk of mortality. The respondents' knowledge about the mechanisms linking excessive dietary salt intake with the progression of atherosclerosis varied greatly, with the majority (38%) indicating that it was only a result of increased BP. Conclusion: A significant percentage of respondents have incomplete knowledge about the role of excessive dietary salt intake on ASCVD risk. It is worth emphasizing that excessive salt intake in the diet directly damages the vascular endothelium and thus contributes to ASCVD development. This extremely important mechanism was indicated by only 24% of respondents.
Abstract 4146679: Effects of Daily Muscle Stretching in Peripheral Artery Disease Patients
Authors: Santh Prakash Lanka, Yaman Alsabbagh, Sam Nussbaum, Matthew Martenson, Joshua Maraj, Xiuwen Liu, Cesar Rodriguez, Carl Ade, DAVID PROCTOR, Sam Farres, albert hakaim, Judy Delp
Journal: Circulation (2024)

Introduction: Peripheral artery disease (PAD), an atherosclerotic disease of the peripheral arteries, also results in microvascular dysfunction. PAD patients are recommended to undergo supervised walking and medical management; however, compliance with supervised walking programs is limited due to inconvenience and pain, necessitating alternative non-pharmacological interventions. We have shown that daily muscle stretching improved microvascular function in aged rats. This prompted us to study the effect of daily muscle stretching on microvascular function of the calf muscles in PAD patients. Methods: A randomized, single-blinded study was conducted on 24 PAD patients. Patients were assigned to either stretching or placebo stretching using a dorsiflexion splint (Image 1) for 30 min/day, 5 days/wk for 4 wks. Calf muscle oxygen saturation (smO 2 ) was recorded using near-infrared spectroscopy during the six-minute walking test (6MWT) before (Visit 1) and after (Visit 2) stretching or placebo stretching. The percentage decrease in smO 2 (from baseline) at minute 1 (Δ1) and minute 2 (Δ2) of the 6MWT was determined. Two-way ANOVA was used to compare Δ1 and Δ2 between the stretching and placebo stretching groups. Results: The mean age of the patients was 74.1±11.4 yrs with 52% (13/23) males. There was no significant difference in the changes in smO 2 during the 6MWT at either minute 1 (Δ1: 44.1±7.3% vs 27.1±7.0%, p=0.12) or minute 2 (Δ2: 78.7±8.2% vs 58.1±7.9%, p=0.08) between the stretching group and placebo stretching group at Visit 1. In contrast, at Visit 2, there was a significantly greater change in smO 2 at minute 2 (D2: 83.1±8.2% vs 51.3±7.9%, p=0.008) in the stretching group compared to the placebo stretching group with a trend towards a statistically greater change in smO 2 at minute 1 (Δ1: 39.0±7.3% vs 20.4±7.0%, p=0.06) (Image 2). Conclusion: Daily stretching of the calf muscles for 4 weeks is associated with increased oxygen extraction by the calf muscles during walking.
Abstract 4146666: The Risk of Bundle Branch Block Following Transcatheter Aortic Valve Implantation Across Different Valve Types: A Systematic Review with Meta-Analysis
Authors: Zaid Abdulelah, Ahmed Abdulelah, Mohammad Al-Dqour, Muna Rommaneh, Qais Salah, Jude Al Daradkah, Abdulrahman Alhajahjeh, Kais Al Balbissi
Journal: Circulation (2024)

Introduction: Transcatheter aortic valve implantation (TAVI) is widely regarded as the treatment modality of choice for the effective and safe treatment of native aortic stenosis among patients with high surgical risk. However, bundle branch block (BBB) following TAVI is well-documented and widely regarded to be the leading complication associated with TAVI, along with other conduction abnormalities such as atrioventricular node block (AVB). Research Question: is the risk of BBB higher with a particular type of TAVI valve compared to the rest? Aim: To evaluate the risk of developing BBB following TAVI across the different valve types in a systematic and meta-analytic approach. Methods: The following databases were searched; PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov. We used the following keywords in the search; ((Transcatheter aortic valve implantation OR Transcatheter aortic valve replacement OR TAVI) AND (Bundle branch block OR Right bundle branch block OR Left bundle branch block OR BBB)). The studies were included if they reported the prevalence of BBB in patients undergoing TAVI with a specified type of valve such as balloon-expandable valve (BEV), self-expandable valve (SEV), and mechanical-expandable valve (MEV). Results: A total of 827 articles were initially identified and eventually only 176 studies were thoroughly reviewed. Finally, 105 articles (55 BEV, 44 SEV and 6 MEV) were included in this systematic review and meta-analysis with a total number of included patients being 65,491. The prevalence of patients who underwent BEV and developed a bundle branch block were 30% (95%CI 0.29-0.31). Moreover, the prevalence of bundle branch block in patients who had a SEV implant were 16% (95% CI 0.16-0.16), whereas patients who underwent a MEV implant had an exceptionally high prevalence of bundle branch block of 54% (95%CI 0.52-0.56). The overall prevalence of BBB in patients undergoing a TAVI was 31% (95% CI 0.17-0.50) using random effects model. Utilization of this model also demonstrated significant heterogeneity (P-value&lt;0.001, I2=100%) Conclusion: The prevalence of bundle branch block following TAVI is alarmingly high at an overall rate of 31%. More importantly, MEV implants demonstrated a worrisome 54% overall prevalence of bundle branch block, and thus hindering their potential utilization, especially among patients with pre-existing bundle branch block.
Abstract 4145983: Non-Invasive Optical Brain Pulse Monitoring In High-Risk Cardiac Surgery
Authors: Elliot Teo, Sigrid Petautschnig, Barry Dixon
Journal: Circulation (2024)

Background: Early detection and intervention of stroke have been shown to significantly reduce the burden of stroke-related disability and healthcare costs. The challenge, however, is that early detection is limited by currently available monitoring technologies. Non-invasive optical brain pulse monitoring (OBPM) offers bilateral, continuous measurement of brain pulse waveforms, from which cerebral oxygen saturation (StO 2 %), intracranial pressure (ICP), and brain compliance can be derived. The use of OBPM in high-risk cardiac surgery may enable real-time identification of cerebral events and allow for early intervention. Aims: To observe and characterise the OBPM signal changes in cardiac surgery patients during the perioperative period. Methods: Eight patients aged between 59 and 85 underwent coronary artery bypass graft procedures with OBPM measurements taken pre-, intra-, and post-operatively for up to 12 hours. Three patients had simultaneous procedures: one mitral valve repair and one left atrial appendage ligation. Results: Cardiopulmonary bypass time ranged from 68 to 151 minutes, with 53 to 120 minutes of cross-clamp time. Seven patients underwent continuous flow bypass, and one underwent pulsatile flow bypass. No OBPM device-related adverse events were reported during the study. The OBPM showed distinct waveforms pre-, intra-, and post-operatively, with unique signals during pulsatile and continuous bypass. One patient experienced two intraoperative cardiac arrests, with the OBPM demonstrating signatures of significant cerebral hypoxia during both episodes. Three patients showed reduced brain compliance intraoperatively, which normalized before sternal closure. Six episodes across two patients of transient reduction in cerebral oxygen saturation (&lt;10%) were identified. Conclusion: OBPM successfully identified distinct waveform patterns and provided indications of cerebral hypoxia during cardiac arrest, and changes in brain compliance in patients undergoing high-risk cardiac surgery with no device-related adverse events. Continuous, non-invasive optical brain pulse monitoring is a safe and effective tool in the perioperative management of high-risk cardiac surgery patients. The benefits of early detection and informed clinical decision-making will significantly impact both clinical and economic value for healthcare stakeholders.
Abstract 4145901: The Impact of Fasting vs Non-fasting on Patient Safety and Comfort During Cardiac Transcatheter Procedures: A Systematic Review and Meta-Analysis
Authors: Larissa Lucena, Deivyd Cavalcante, Wilton Gomes, Marcos Freitas, Rafael Costa Borges, Antonio Lucas Arruda de Oliveira, Irina Paiva, Natália Silva Carvalho, Victoria Leite, JULIO SOUSA
Journal: Circulation (2024)

Introduction: Current guidelines recommend preprocedural fasting for at least 6 hours for solid food and 2 hours for clear liquids before cardiac transcatheter procedures. However, the supporting data are limited. Research Question: Does non-fasting impact (NF) patient safety and comfort compared to fasting (F) in transcatheter cardiac procedures? Aims: To compare the effects of fasting vs. non-fasting on patient outcomes in cardiac transcatheter procedures. Methods: We searched the Cochrane, Embase, and Medline databases for RCTs comparing fasting versus non-fasting states for cardiac transcatheter procedures. Risk ratios (RRs) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were pooled for binary and continuous outcomes, respectively, using a random-effects model. Endpoints were hunger, thirst, incidence of aspiration, nausea/vomiting, acute kidney injury (AKI), length of stay, and patient satisfaction. Results: Our meta-analysis included 8 studies with 2,930 patients. Hunger sensation was significantly lower in the NF group (SMD -0.91; 95% CI: -1.71 to -0.11; P = 0.026; I2 = 96%; Figure 1A), with no difference in thirst. The incidence of aspiration (RR 2.20; 95% CI 0.29–17.02; P = 0.449; I2 = 0%; Figure 1B), nausea/vomiting (RR 1.09; 95% CI 0.67-1.78; P = 0.723; I2 = 0%), and AKI (RR 1.90; 95% CI 0.84–4.31; P = 0.126; I2 = 0%) were not significantly different between groups. Similarly, length of stay (MD -0.01 days; 95% CI -0.39 to 0.36; P = 0.940; I2 = 3%; Figure 2A), and patient satisfaction (SMD -0.74; 95% CI: -1.54 to -0.07; P = 0.073; I2 = 98%; Figure 2B) were also similar in both groups. Conclusions: Our study suggests a non-fasting strategy is a safe option before transcatheter cardiac procedures.
Abstract 4145712: Cancer Type and Baseline Cardiometabolic Risk Factors Predict Major Adverse Cardiac Events in Patients Receiving Immune Checkpoint Inhibitor Therapy
Authors: Elizabeth Hutchins, Jeffrey Feng, Eric Yang, Melissa Lechner, ALEXANDRA DRAKAKI, Enat Arega, Eric Yang, Alex Bui, David Madnick, Ashley Stein-Merlob
Journal: Circulation (2024)

Introduction: Immune checkpoint inhibitors (ICI) are increasingly used to treat a wide variety of malignancies. The long-term cardiovascular risk profile of ICI therapy remains incompletely understood. Methods: All patients at a single academic center receiving any ICI therapy between 2015 and 2023 were identified. Using ICD codes, we adjudicated major adverse cardiac events (MACE) after initiation of ICI therapy, defined as a composite endpoint of coronary artery disease (CAD), acute coronary syndrome (ACS), cardiomyopathy and heart failure (HF), arrhythmia, ischemic stroke, cardiac arrest, pericarditis, and myocarditis. Cancer type and baseline cardiometabolic risk factors were identified. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for all variables measured. Results: Of patients receiving ICI therapy (n=5991), 1196 developed MACE, including ACS (n=152), stable CAD (n = 300), HF (n=217), arrhythmia (n=380), ischemic stroke (n=92), cardiac arrest (n=30) and myo- or pericarditis (n=25). Prior to a MACE event, patients received an average of 11.6 ± 12.7 ICI doses over 332.4 ± 448.0 days. Compared to the non-MACE group, those who developed MACE were older (OR 1.18, CI 1.09-1.27) and of male sex (OR 1.17, CI 1.00-1.23). They were more likely to have higher body mass index (BMI) (OR 1.13, CI 1.06-1.21), pre-existing hypertension (OR 1.3, CI 1.21-1.39), be on statin therapy (OR 1.19, CI 1.11-1.28) and have higher B-nauretic peptide (BNP) levels (OR 1.25, CI 1.06-1.47). Regarding cancer type, MACE was more likely to develop in those with melanoma (OR 1.11, CI 1.02-1.20), lung (OR 1.22, CI 1.11-1.34), colon (OR 1.08, CI 1.01-1.15), genitourinary (OR 1.19, CI 1.10-1.29), and prostate cancers (OR 1.08, CI 1.01-1.15). MACE was less likely to develop in breast cancer (OR 0.88, CI 0.80-0.96). All-cause mortality was higher in the MACE group (59.4% vs. 51.9%, p &lt; 0.001). Conclusion: Risk factors for developing MACE with ICI therapy include older age, male sex, cancer type, prior MACE, hypertension, statin use, and higher BMI and BNP. MACE is associated with higher all-cause mortality. These findings can assist in identifying and attenuating cardiovascular risk in patients undergoing ICI therapy.
Abstract 4146654: Hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation: an updated systematic review and meta-analysis
Authors: Roberto Mazetto, Elisio Bulhoes, Vanio do Livramento Junior Antunes, Maria Luiza Rodrigues Defante, Luanna Garcez, Harthur Moreira Macedo, Pedro Romeiro, Lucas Barbosa, Ivo Queiroz, Beatriz X. Mendes, Eduarda Bastos, Catarina Silva, Anderson Coelho, Isabel Guerreiro, Katia Couceiro, Bruno Bueno, Camila Guida
Journal: Circulation (2024)

Background: Some studies suggest a potential benefit of hybrid ablation for patients with persistent and long-standing persistent atrial fibrillation (AF), but its efficacy and safety remain debated. Objective: We conducted a systematic review and meta-analysis to compare the efficacy and safety of hybrid ablation and catheter ablation in patients with persistent AF and long-standing persistent AF. Methods: We searched PubMed, Embase and Cochrane Central. Outcomes were the composite endpoints of freedom from atrial arrhythmias, major adverse events, total procedural time, and fluoroscopy time. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I 2 statistics. Results: We included 961 patients from 7 studies. Of those, 4 were RCTs and 3 were observational studies with propensity score matched cohorts. A total of 446 (46.41%) patients received hybrid ablation and 515 (53.59%) received only endocardial. Among the patients included in the study, 674 (70.14%) had persistent AF, and 287 (29.86%) had LSPAF. Moreover, the average atrial diameter was 4.43 cm, and the average duration since AF diagnosis was 3.06 years. Additionally, the average age of the patients was 61.7, and the number of male patients included was 911 (94.80%). The median follow-up ranged from 12 to 43.9 months. Compared to catheter ablation, hybrid ablation was associated with a higher odds of freedom from atrial arrhythmias off antiarrhythmic drugs (OR 3.25; 95% CI 2.08-5.06; p&lt;0.001; I 2 = 85%; Figure 1A), and freedom from AF (OR 3.51; 95% CI 1.07 - 11.48; P=0.038; I 2 =84%; Figure 1B). There were no differences in major adverse events (p=0.98; Figure 1C), total procedure time (p=0.05; Figure 2A), or fluoroscopy time (p=0.85; Figure 2C) between hybrid ablation and catheter ablation. Conclusion: This meta-analysis shows hybrid ablation increases the likelihood of maintaining freedom from atrial arrhythmias in patients with persistent and long-standing persistent AF, compared to catheter ablation, without compromising safety.
Abstract 4146676: Trends In Temperature Control After Cardiac Arrest In Cardiac Intensive Care Units: An Analysis From The Critical Care Cardiology Trials Network (CCCTN) Registry
Authors: Robert Ariss, Jianping Guo, David Morrow, David Berg
Journal: Circulation (2024)

Introduction: Temperature control (TC) is recommended for comatose patients after cardiac arrest (CA). In the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial, targeted normothermia (≤37.5°C) resulted in similar mortality and functional outcomes as targeted hypothermia (33°C). Aim: To examine temporal trends in TC use and targets in CICUs before and after the TTM2 trial. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multinational registry of advanced CICUs coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions were captured during annual 2-month collection periods across participating CICUs (2018-2023). Comatose CA patients were classified as being admitted before (2018-2021) or after (2021-2023) publication of TTM2. TC utilization rates, and temperature targets were compared between the pre- and post-TTM2 eras, including in subgroups of shockable (VT/VF) and non-shockable (PEA/asystole) rhythms. Results: Of 1,355 comatose CA admissions (median age 64y, 30% women, 69% OHCA, 52% shockable/40% non-shockable/8% unknown, 70% in shock, 28% acute MI), 773 were pre-TTM2 and 582 were post-TTM2. Rates of TC use were similar pre- and post-TTM2 (74% vs. 75%; p=0.45), including in the subgroups of shockable (84% vs 82%; p=0.45) and non-shockable rhythms (64% vs. 67%; p=0.53). As compared to pre-TTM2 admissions, post-TTM2 admissions had significantly higher median target temperatures (38% [pre] vs 67% [post] with target temperature ≥36°C; p &lt; 0.001; Figure 1A). This trend was consistent in the subgroups of shockable and non-shockable rhythms (Figure 1B). Conclusion: In a large CICU cohort of comatose CA patients, overall TC utilization remained stable, but temperature targets were higher after publication of the TTM2 trial. These data provide reassurance that temperature control remains a focus of post-arrest care despite a shift in clinical practice patterns favoring normothermia.
Abstract 4146638: Comparative Assessment of hsCRP and Apolipoprotein B as ASCVD Risk Biomarkers
Authors: Saheed Oladele Amusat
Journal: Circulation (2024)

Introduction/Background: According to the American Heart Association, the accumulation of plaque in the walls of arteries is identified as the primary cause of atherosclerotic cardiovascular disease (ASCVD). Apolipoprotein B (apo B) has been identified as a more precise cardiovascular risk marker than LDL-C, while high-sensitivity C-reactive protein (hsCRP) has shown potential as a cardiovascular disease indicator. Research Questions/Hypothesis: Goals/Aims: To investigate the diagnostic performance and routine screening cut-off of hsCRP for early ASCVD risk in adult patients, comparing it with Apo B. Methods/Approach: A sample of 494 individuals from the NHANES 2015-2016 laboratory dataset, with a mean age greater than 17 years, was used for this study. ASCVD risk was measured by non-HDL-C, categorized into low and high risk based on the Mayo Clinic reference range. Predictors included apo B, and hs-CRP. Binomial logistic regression and ROC curve analyses were conducted using the generalised linear models and pROC packages in RStudio IDE. Hypotheses were validated at p≤0.05, and diagnostic performance metrics such as ROC AUC, sensitivity, and specificity were measured on a scale of 0-1. Results: The findings revealed that for every 1g/L increase in apo B concentration, the odds of high ASCVD risk were approximately 3.8 ×1011 times higher. Additionally, the model indicated that the odds of high ASCVD risk were 1.03 times higher for every 1mg/L increase in hsCRP concentration. However, this indicates that hsCRP level was not associated with odds of ASCVD risk. The ROC AUC for apo B and hsCRP were approximately 0.9739 and 0.6165, respectively, with cut-off values (sensitivity, specificity) of approximately 0.9g/L (0.927, 0.897) and 2.4 mg/L (0.596, 0.601), respectively. Thus, levels above these thresholds for both apo B and hsCRP are associated with high ASCVD risk. Conclusion(s): The study demonstrates that apo B exhibits high discriminatory and diagnostic accuracy, making it a suitable ASCVD risk biomarker compared to hsCRP. While hsCRP shows moderate diagnostic accuracy, it is not sufficient as a standalone ASCVD risk diagnostic marker. Therefore, apo B could serve as a replacement for LDL-C, while hsCRP could possibly serve as an add-on test in ASCVD risk assessment.