tbuckley/cabot-search huggingface dataset:
Abstract 4147765: A Refractory Case of Prinzmetal’s Angina Treated with VATS Sympathectomy
Authors: Natasha Qureshi, Kirtivardhan Vashistha, Syed Ali, Ali Omar, Yumiko Kanei
Journal: Circulation (2024)

Case Description: A 74-year-old male with hypertension, hyperlipidemia, coronary artery disease status post PCI, paroxysmal atrial fibrillation, and coronary vasospasm presented with recurrent episodes of chest pain at rest described as substernal, pressure like, 10/10 lasting for a few minutes. The patient was hemodynamically stable upon presentation but had an event of pulseless ventricular tachycardia (VT) requiring shock x 2 (Image 1). The patient was stabilized, and an emergent left heart catheterization showed stable obstructive CAD with diffuse coronary vasospasm responsive to intracoronary nitrates (Image 2). The patient was transferred to the intensive care unit for further management. He had multiple prior presentations for chest pain, with one complicated by a transient hemodynamically unstable high grade AV block (Image 1). Prior work up was also consistent with coronary vasospasm despite being optimally managed on nitrates and calcium channel blockers. Despite medical management the patient had a refractory course with recurrent symptoms. Clinical Decision Making: As it was believed that symptoms were likely driven by high sympathetic tone, the patient was intubated and sedated for sympathetic drive suppression. After a multidisciplinary meeting with cardiothoracic surgery and electrophysiology, a decision was made to go for video assisted thoracoscopic surgery (VATS) which was performed successfully. The patient was extubated, had no recurrence of symptoms after, and was offered an implantable-cardioverter defibrillator at discharge for secondary prevention. Discussion: Coronary vasospasm can be life threatening due to transient and acute ischemia driven myocardial injury or arrhythmias. This case highlights the role of VATS sympathectomy in managing severe cases of vasospastic angina that are unresponsive to conventional treatments. Further studies are required to establish the efficacy and safety of this procedure in broader patient populations.
Abstract 4147415: Return-to-Play for Athletes with Desmosomal Arrhythmogenic Cardiomyopathy: A Single Center Experience
Authors: Katherine Martinez, Johan Bos, John Giudicessi, Michael Ackerman
Journal: Circulation (2024)

Background: Current guidelines discourage athletes with a positive genetic test for arrhythmogenic cardiomyopathy (ACM) from participating in sports. The evidence that exercise may act as a disease-accelerator is most compelling for PKP2-mediated ACM. As such, shared decision making (SDM) and return-to-play (RTP) for athletes with ACM may be possible for some genotypes. Objective: To examine the management, RTP, outcomes, and evolution of phenotype among athletes with genotype positive ACM. Methods: A retrospective review of the electronic medical records was performed on all self-identified athletes with genotype positive ACM. They were evaluated, risk stratified, and treated in Mayo Clinic’s (MC) Windland Smith Rice Genetic Heart Rhythm Clinic. Results: Among the 621 patients with genotype-positive ACM, there were 38 athletes [16 females (42%); mean age at either clinical diagnosis or positive genetic test 28 ± 19 years; mean follow-up 4 ± 4 years] participating in sports at all levels. The majority, 21 (55%), had PKP2-ACM and 7 (18%) had DSP-ACM. Prior to their first MC evaluation, 15 athletes (39%) were engaged in long distance running, swimming, cycling, or triathlons. Seven athletes (18%) had a non-lethal breakthrough cardiac event (BCE) after diagnosis, but prior to MC evaluation. During 150+ athlete-years of follow-up, there have been no ACM-associated deaths, but 5 athletes (13%) experienced a non-lethal BCE. Twenty-two athletes (58%) were phenotype negative at time of first MC evaluation including 10 endurance athletes (45%). Of these, 3 (14%) converted to phenotype positive (average age at conversion 25 ± 15 years), while 7/16 (44%) phenotype positive athletes exhibited further disease progression (average age at progression 32 ± 18 years). For these 10 athletes who either converted or progressed, treatment intensification included an ablation in 4, ICD in 2, and a heart transplant in 2. Seven resumed athletic activity in some capacity after conversion/progression and a non-lethal BCE occurred in 3. Conclusions: This is the first single center cohort of patients with ACM being empowered to remain an athlete. In contrast to athletes with other genetic heart diseases (GHDs), these athletes have exhibited more cardiac events, although nonfatal, and higher rates of disease conversion/progression than our other GHDs. Further studies are needed to determine how to effectively and safely enable appropriate sports participation in genetically-mediated ACM
Abstract 4147256: The Effect of Obesity on Outcomes of Mechanical Circulatory Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: Insight from the National Inpatient Sample Database
Authors: Oghenetejiri Gbegbaje, Chidubem Ezenna, Gabriel Alugba, Favour Nelson, Ovie Okorare, Uzoma Okey-Ndeche, Dipal Patel, Garly Saint Croix, Andrew Goldsweig
Journal: Circulation (2024)

Introduction: Studies suggest a complex relationship between body mass index (BMI) and percutaneous coronary intervention (PCI) outcomes. However, the effect of obesity on in-hospital outcomes of PCI with mechanical circulatory support (MCS) for acute myocardial infarction complicated by cardiogenic shock (AMICS) has not been established. Objective: To characterize outcomes of PCI with MCS for AMICS in patients with and without obesity. Methods: In the National Inpatient Sample (NIS) 2016-2020, we identified patients with AMICS treated with MCS with obesity (BMI 30.0-39.9) or normal BMI (20.0-24.9). The primary outcome was in-hospital mortality. Secondary outcomes included cardiac arrest, stroke, acute kidney injury, bleeding, acute respiratory failure, palliative consults, hospital length of stay (LOS), and total charges. Multivariate logistic regression models adjusted for baseline characteristics and estimated odds ratios (ORs) with 95% confidence intervals (CIs). Results: 5270 patients met study criteria (4870 obese). Obese and normal weight patients had a mean age of 69.8 vs. 63.5 years and male sex 78.1% vs. 71.3%. Obese patients had more hypertension, diabetes, dyslipidemia, and previous myocardial infarction (Table 1A). There was no difference in mortality [OR 0.84, CI (0.41-1.71), P=0.623] or the secondary outcomes (Table 1B). Normal weight was associated with longer LOS (13.0 vs. 8.5 days) and higher charges ($325,926.3 vs. $294,629.1). Conclusion: There were no significant differences in in-hospital mortality or secondary outcomes between obese and normal-weight AMICS patients treated with PCI and MCS. PCI with MCS may be performed safely in AMICS patients with and without obesity.
Abstract 4146919: Delta-like Ligand 4 Inhibitors Induce Pulmonary Arterial Hypertension in Clinical Trials
Authors: Casandra Besse, Cristian Puerta, Nolan Winicki, Moises Hernandez, Patricia Thistlethwaite
Journal: Circulation (2024)

Background: Delta-Like Ligand 4 (DLL-4) blockade with therapeutic monoclonal antibodies is an emerging cancer treatment targeting tumor angiogenesis. Inhibition of DLL-4 within the pulmonary vasculature allows for unopposed JAG-1-NOTCH3 signaling, leading to pulmonary vascular smooth muscle (vSMC) cell proliferation and the development of pulmonary arterial hypertension (PAH). Hypothesis: Clinical trials using DLL-4 inhibitors may show an increased incidence of PAH as a side effect of the drugs tested. Aims: Review the PAH incidence as an adverse outcome in DLL-4 inhibitor clinical trials. Methods: Clinicaltrials.gov was queried for studies on DLL-4 inhibition. Patient demographics, medication regimens, trial methodology, and outcomes were recorded. Adverse events were categorized according to National Cancer Institute Common Terminology Criteria for Adverse Events. PAH grades were defined as ranging from mild dyspnea (Grade 1) to life-threatening airway consequences or death (Grade 4-5). Degree of PAH was determined by the clinical trial investigators. Echocardiography and cardiac catheterization were most widely used as PAH diagnostic modalities. Results: Thirteen clinical trials (Phase: 1[n=3], 1a[n=1], 1b[n=6], 2[n=3]) from 2011-2023 investigating DLL-4 or DLL-4/VEGF inhibitors were included. The most common antibody used was Demcizumab(6), followed by Navicixizumab(2), Dilpacimab(2), ABL001(2), and Enoticumab(1). A total of 672 patients (median age 60, 52.5% female) underwent treatment. There were 74 new PAH cases reported (average incidence of 11.7%[± 5.8%]). Four of seventy-four PAH patients also manifested LHF. PAH grades 1-2 represented 81% (n=60) of cases, and 19% (n=14) were grades 3-5. PAH incidence was higher in combination DLL-4-VEGF inhibitor trials versus sole DLL-4 inhibitor trials (16.2% vs 7.9%). Phase 1 and 2 trials displayed similar PAH incidences (11.4% vs 13.0%). Resolution of PAH after drug cessation was reported in 46% of the studies. Conclusions: DLL-4 inhibition treatment for malignancies has demonstrated PAH as a side effect. These results are in accordance with our previous observation that unopposed JAG-1-NOTCH3 signaling, induces pulmonary vascular SMC proliferation and PAH. Discontinuation of DLL-4 inhibitors leads to resolution of disease. Further studies are needed to minimize PAH risk while optimizing oncological benefits of DLL-4 inhibitors before widespread utilization.
Abstract 4147420: Long-Term Exposure to Electronic Cigarettes Induces Ventricular Hypertrophy and Cardiac Conduction Abnormalities
Authors: Mahmoud Eid, Mohamed Ewees, Elsayed Mahgoup, Jay Zweier
Journal: Circulation (2024)

Introduction: Electronic cigarettes (e-cig) have been promoted as nicotine (NIC) delivery systems without the adverse effects of tobacco cigarettes; however, the increasing popularity of EC has prompted concerns about their potential cardiovascular (CV) toxicity. As e-cig are relatively new products, their long-term CV effects over the lifetime of the user remain unclear. We developed a mouse model of chronic e-cig exposure that mimics human NIC exposure levels to simulate long-term human use. Objective: To characterize the effects of long-term e-cig exposure on the structure, contractile function and electrophysiological function of the heart with exposures for &gt;50% of life-span. Methods: C57/BL6 male mice were exposed to either air (25 mice) or aerosol from e-cig liquid containing 24 mg/ml NIC (25 mice) for 3 hours/day, 5 days/week, over 64 weeks. Blood pressure (BP) was measured by tail-cuff. Echocardiography was performed to assess the structure and function of the left ventricle (LV) and right ventricle (RV). High-resolution 3D visualization of LV and RV was also performed by cardiac CINE-MRI. Cardiac rate and electrophysiology was measured by electrocardiography (ECG). Results: Compared to the air control group, e-cig exposure for 64 weeks led to major changes in heart structure and function (Table 1). Marked elevations in systolic BP (SBP), diastolic BP (DBP), and mean BP (MBP) of 49%, 66%, and 63%, respectively, were observed. Echocardiography revealed concentric LV hypertrophy (LVH) with increases in both LV and RV end-diastolic and end-systolic wall thicknesses. LV mass was 43% increased. Marked RV hypertrophy (RVH) was also observed. The presence of LVH and RVH was confirmed on cardiac MRI. ECG exhibited 6% slower heart rate with e-cig exposure along with 23% prolonged PR interval and 91% increase in P wave duration. QT interval was 20% prolonged indicative of delayed ventricular depolarization and repolarization. Conclusions: Long term e-cig exposure caused hypertension with LV and RV hypertrophy with alterations in atrial and ventricular conduction seen. Thus, long-term e-cig use may predispose to hypertrophic heart disease and cardiac conduction abnormalities.
Abstract 4146699: Blunted Hemodynamic Reactivity to Acute Mental Stress in the Lab is Associated with Autonomic Inflexibility at Home
Authors: Amit Shah, Hua She, lisa elon, Tatum Roberts, Lewam Stefanos, George Haddad, Jeffery Osei, Kara Suvada, Alexis Okoh, Shivang Desai, Matthew Gold, Vardhmaan Jain, Adithya Yadalam, Alexander Razavi, Charis Wiltshire, Paolo Raggi, Brad Pearce, Arshed Quyyumi, Reza Sameni, J Douglas Bremner, Gari Clifford, Viola Vaccarino
Journal: Circulation (2024)

Background: Growing evidence suggests that blunted blood pressure and heart rate responses to acute psychological stress independently associate with an increased risk of adverse outcomes in individuals with CHD, but assessment of mental stress reactivity in clinical settings is resource intensive. An alternative approach is to passively measure stress physiology at home with wearables, which is easier to translate into clinical practice. We tested the hypothesis that blunted mental-stress hemodynamic reactivity in the lab is associated with digital biomarkers of autonomic inflexibility at home. Methods: We conducted a mental stress test in 239 participants (age &lt; 60 years) with an MI within 8 months. Participants underwent a speech stressor task in front of an audience to induce mental stress, during which blood pressure and heart rate were measured repeatedly during a baseline 15-minute rest period and 5-minute stress challenge. Participants went home with a 7-day Holter monitor to measure autonomic function. We examined vagal autonomic inflexibility with deceleration capacity (DC), a digital biomarker calculated via phase rectified signal averaging of heart rate intervals. We also examined low frequency (LF) heart rate variability (HRV), an indirect measure of baroreceptor sensitivity. We measured mean values from 5-minute windows during sedentary periods only to avoid confounding due to physical activity. We used multivariable linear regression models to adjust for potential confounding due to age, beta-blockers, and sex. Results: The mean age was 52 years, 51% were black, and 36% were women. Lower DC most strongly associated with a blunted change in heart rate during acute mental stress challenge (adjusted p&lt;0.0001), followed by rate pressure product (p=0.01), systolic blood pressure (p=0.02), and diastolic blood pressure (p=0.035). The results were similar for LF HRV. We also found that the relationship was stronger in women than in men, especially for heart rate changes with stress and LF HRV (figure). Each 10 BPM reduction in heart rate reactivity associated with a 14% and 7% reduced DC in women and men, respectively. Corresponding reductions for LF HRV were 30% and 13% (p&lt;0.05 for all). Conclusions: In young and middle-aged individuals with recent MI, laboratory-induced hemodynamic changes with stress associate with digital biomarkers of autonomic inflexibility during sedentary periods, especially in women.
Abstract 4146931: The effectiveness of coronary sinus reducer in refractory angina: A meta-analysis of 18 studies
Authors: Ahmed Farid Gadelmawla, Ahmed Abdelaziz, Atef Hassan, Ahmed Wael Hageen, Shrouk Ramadan, Ahmed Mohamed, Ahmed Nasr, Raneem Afify, Sandi Banour, Basel Abdelazeem
Journal: Circulation (2024)

Introduction: Despite the continuous development of the medical therapeutic revolution, there are many conditions that pose a great challenge and are still spreading at increasing rates, such as refractory angina (RA), which is considered a burden on patients and on the health systems. However, with the emergence of effective treatment options such as a coronary sinus reducer (CSR) that works to narrow the coronary sinus in controlled manner aiming to restore efficient blood flow and reduce symptoms. Purpose: We aimed to study the effectiveness of CSR in patients with refractory angina (RA), and give a comprehensive appraisal from the published records. Methods: A comprehensive search was done on PubMed, Cochrane Library, Scopus, and WOS until Feb 2024. We included studies that assessed the effectiveness of CSR in patients with RA. Clinical improvement, implantation success, periprocedural complications, revascularization, 6MWT distance and change in SAQ score were our outcomes of interest. Results: 18 studies comprising 1149 patients were included in the analysis. The pooled implantation success was 98% (95% CI: 97% to 99%), clinical improvement &gt; 1 class was 63% (95% CI: 52% to 72%), and clinical improvement &gt; 2 class was 37% (95% CI: 32% to 41%). The incidence rate of periprocedural complications and PCI was reported as follows, respectively (OR: 0.05, 95% CI: 0.03 to 0.08, and 0.37, 95% CI: 0.18 to 0.61). Moreover, the incidence rate of all-cause mortality was low (OR: 0.06, 95% CI: 0.03 to 0.11). Regarding physical activity and quality of life, CSR improved 6MWT distance (MD = 323.82, 95% CI: 273.52 to 372.13), and all categories of SAQ score either angina frequency, angina stability, physical limitation, quality of life, or treatment satisfaction. Conclusion: Coronary Sinus Reducer is a promising treatment for the management of refractory angina, as it showed clinical improvement with higher implantation success. It also improved the physical activity and quality of life scores. Large-volume RCTs are warranted to test the efficacy of CSR in a long-term manner.
Abstract 4147150: <u>Geographic, Gender,&amp;Racial Trends in Mortality Due to Coronary Artery Disease in Hypertensive Adults Aged 25 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis</u>
Authors: Muhammad Abdullah Naveed, Ahila Ali, Sivaram Neppala, Muhammad Omer Rehan, MUHAMMAD KASHAN, Bazil Azeem, Rabia Iqbal, Huzaifa Ansari, Himaja Dutt Chigurupati, Timir Paul
Journal: Circulation (2024)

Background: Coronary artery disease (CAD) in patients with hypertension is a significant health concern among adults in the United States. This study investigates trends and demographic disparities in mortality rates due to CAD in hypertensive patients aged 25 and older from 1999 to 2020. Methods: The CDC WONDER database's mortality data from 1999 to 2020 was used for a retrospective analysis. Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) were used to evaluate trends and calculate age-adjusted mortality rates (AAMRs) per 100,000 people. The year, sex, race/ethnicity, and geographic regions were used to stratify the data. Results: Between 1999 and 2020, CAD in hypertension caused 1,512,89 medical facilities, accounting for 37.9% of all deaths. With an AAPC of 1.88 (95% CI: -0.81 to 4.36, p = 0.118), the overall AAMR grew from 7.7 in 1999 to 36.0 in 2020. There was a notable increase between 1999 and 2001 (APC: 30.07, p = 0.040) and a minor growth between 2001 and 2020 (APC: 0.85, p = 0.030). Adult men had higher AAMRs than women (men: 40.2; women: 25.2), with increases for both sexes [Men: AAPC: 4.75, p = 0.002; Women: AAPC: 2.70, p = 0.058]. AAMRs varied significantly by race, highest among Black individuals (39.9), followed by Whites (31.4), American Indians (30.4), Hispanics (27.7), and Asians (21.3). The AAMR increased for all races from 1999 to 2020, most notably in American Indians (AAPC: 4.91, p = 0.004). AAMRs varied by state, from 16.4 in Utah to 51.4 in West Virginia. The Midwest had the greatest regional death rate (33.6), followed by the West (31.1), Northeast (31.0), and South (30.9). Nonmetropolitan areas had higher AAMRs than metropolitan areas (34.7 vs. 31.0), with a greater increase in nonmetropolitan areas (AAPC: 6.22, p &lt; 0.000001). Conclusion: This analysis reveals significant demographic and geographic disparities in mortality rates due to CAD in hypertensive adults in the U.S. The AAMR has increased fivefold over the past two decades, particularly among certain racial groups and geographical regions. These findings underscore the urgent need for targeted interventions and equitable healthcare access to mitigate these disparities and improve outcomes.
Abstract 4147445: Framingham risk and major adverse cardiovascular events among patients with hypertension ineligible for SPRINT
Authors: Lucia Petito, Xiaoning Huang, Celeena Jefferson, Suma Vupputuri, Nicola Lancki, Faraz Ahmad, Dhruv Kazi, Chiadi Ndumele, Norrina Allen, Stephen Persell, Nilay Shah, Donald Lloyd-Jones, Sadiya Khan
Journal: Circulation (2024)

Background: Among older adults with hypertension and increased risk of cardiovascular disease (CVD), the SPRINT trial demonstrated benefit of intensive BP-lowering. However, several categories of individuals who are at increased CVD risk were not included in SPRINT, including persons with diabetes, advanced chronic kidney disease [CKD], or younger than age 50 years. Objectives: In an integrated health system, we aimed to compare the cumulative incidence of major adverse cardiovascular events (MACE) among patients with hypertension who (1) met all eligibility criteria for SPRINT and met all inclusion criteria for SPRINT but were excluded due to (2) diabetes, (3) advanced CKD, or (4) age &lt;50 years. Methods: In this retrospective analysis of electronic health records (EHR) from Kaiser Permanente Mid-Atlantic States between 2010-2018, we identified patients aged 18 years or older with a systolic BP 130-180mm Hg at increased risk of CVD as defined in SPRINT (Framingham predicted CVD risk&gt;15%, prior CVD, or CKD with eGFR 20 to &lt;60 mL/min/1.73m 2 ). We compared MACE with Kaplan-Meier analysis among those who were (1) eligible for SPRINT, (2) with diabetes, (3) with stage 4 or 5 CKD (eGFR &lt;20 mL/min/1.73m 2 not on dialysis), (4) or younger than 50 years. Results: In total, 104,757 individuals (47.3% female, 47.5% non-Hispanic Black) were identified with elevated BP and at increased CVD risk. Of these, 54.2% met all eligibility criteria for SPRINT, 32.2% had diabetes, 3.8% had advanced CKD, and 9.9% were aged 18-49y. At baseline, the 10-year Framingham CVD risk for each subgroup was: SPRINT-eligible: 24.2%; among those ineligible for SPRINT, those with diabetes: 32.2%; CKD: 25.0%; and adults aged 18-49 years: 18.8%. Over a median follow-up of 1.8 (IQR 0.9-3.8) years, the 3-year cumulative incidence of MACE ( FIGURE ) was SPRINT-eligible: 9.1% (95% CI 8.8-9.5%); among those ineligible for SPRINT, those with diabetes: 12.6% (12.1-13.0%); CKD: 18.8% (17.3-20.3%); and adults aged 18-49 years: 7.7% (7.0-8.4%). Conclusions: A large proportion of patients with hypertension in a diverse real-world sample were not eligible for SPRINT. However, CVD event rates were high in all groups, which suggests risk-based approaches to BP-lowering should be evaluated among those at increased CVD risk not included in SPRINT.