tbuckley/cabot-search huggingface dataset:
Abstract 4140290: Long Term Remote Patient Monitoring Reduces Blood Pressure in Patients with Stage II Hypertension
Authors: Ajan Subramanian, Yong Huang, Nitish Nagesh, Li Wang, Zhiyu Liu, Weiyi Hou, Iman Azimi, Randall Stafford, Amir Rahmani
Journal: Circulation (2024)

Background: We evaluated the efficacy of a digital health program integrating self-measured blood pressure (BP) monitoring and lifestyle coaching in managing hypertension (HTN). Conducted from 2019 to 2022 across 39 healthcare facilities in 10 US states, using Bluetooth-enabled devices, mobile apps, and a care coordination platform, longitudinal BP data was collected. Methods: Linear mixed models with patient-specific random intercepts assessed within-subject BP changes. Causal modeling evaluated BP improvement by adherence level, measured by the regularity and frequency of BP measurements in the first 6 months, adjusting for covariates including age, gender, BMI, and medication compliance. To assess the patient adherence to the impact on BP outcomes in the long term we also analyzed those with data at baseline and endpoints from 6 to 24 months. Results: We analyzed 5520 patients with baseline HTN II (SBP/DBP: 152.6 ± 12.7 / 87.6 ± 10.5 mmHg, mean± SD), 51.3% female, 43.3% in 65-80yr and 34.9% in 46-65yr. BP change at 6 months was -12.5 ± 16.9 / -6.9 ± 10.0 (N = 4171, p&lt;0.001); at 12 months, -13.1 ± 17.3 / -7.5 ± 10.0 (N = 2625, p&lt;0.001); and at 24 months, -14.1 ± 17.8 / -8.0 ± 10.4 (N = 1424, p&lt;0.001). Regression analysis accounting for covariates showed steep initial reductions (-0.4 mmHg/week, p&lt;0.001 for 0-6 months) with continued reductions of diminished magnitude with further follow-up (-0.07 mmHg/week, p&lt;0.001 for 7-24 months). Causal modeling demonstrated that higher program adherence was linked to significantly greater reductions in SBP. Those with the highest adherence had greater reductions in SBP vs. those with the lowest adherence at both 6 months (-16.3 vs. -6.1, p&lt;0.001) and 24 months (-17.1 vs. -11.4, p&lt;0.001). Patients in the lowest adherence group (N = 1145, 3.7 ± 2.3 BP measurements/week with 3.0 weeks of gap between measurement weeks) also showed significant reductions in BP with 24.0% and 41.4% controlled (&lt;140/90 mmHg) at 6 and 24 months respectively. Conclusions: The digital BP monitoring program significantly improved self-measured BP control in HTN stage II patients. Causal modeling showed that longer-term remote monitoring was linked to greater reductions in BP. Greater adherence to self-measurement led to greater reductions in BP, while the minimal adherence group also showed significant improvement, underscoring the program's effectiveness in long-term cardiovascular health management in a population with diverse engagement levels.
Abstract 4140237: Cardiac Magnetic Resonance Anatomic-derived Indices Better Predict Arrhythmia than Functional Parameters in Patients with Ebstein’s Anomaly
Authors: Thomas Urbina, Andres Ochoa, Daniela Torres Gomez, Eduardo Villa Pallares, Oscar Perez-Fernandez, Julian Francisco Forero, Laura Acosta Izquierdo, Hector Medina, Mark Fogel, Carlos Guerrero
Journal: Circulation (2024)

Introduction: Ebstein’s anomaly (EA) patients are at risk of arrhythmias. However, data regarding cardiac magnetic resonance (CMR) for predicting arrhythmic events using anatomic and functional parameters are scarce. Goal/Aims: To assess whether CMR-derived anatomical and functional data can predict arrhythmias in EA. Methods: Retrospective single-center cohort assessing EA patients referred for CMR between June 2016 and December 2023. Anatomic, volumetric and functional ventricular parameters were obtained from the CMR, and arrhythmias were found in the medical records. Arrhythmia occurrence was assessed from the CMR date (time-0), excluding pre-existing arrhythmias. Normality was assessed with Shapiro-Wilk for continuous variables, followed by a t-test or Wilcoxon. For categorical variables, we calculated chi-square or Fisher exact test. Receiver Operating Characteristic curves evaluated CMR predictors for arrhythmia occurrence. The 95% confidence interval lower bound must be &gt; 0.5 to be statistically significant. Results: Forty-two patients were included (mean age 24.1 years±15.3); 21 (50.0%) were males. Other parameters are presented in Table1. There were 11 (26.2%) patients with arrhythmias after CMR: 72.7%patients developed supraventricular tachycardia, 18,2% atrial flutter, and 9.1% patients for each of the following: sustained ventricular tachycardia, atrial fibrillation and high-grade AV block. True tricuspid annulus (AUC=80.4, CI: 65.0-95.7) was a good predictor. In contrast, GOSE index (AUC=77.9, CI:63.3-92.5), apical displacement (AUC=76.4, CI:59.2-93.6), Ebstein’s angle (AUC=70.5, CI: 52.5-88.6), right atrial size (AUC=70.9, CI:54.6- 87.2) and right ventricular ejection fraction (AUC=74.2, CI:56.4-92.0) had fair predictive capacity (Figure1). Conclusion: CMR metrics predict arrhythmias in EA patients, with anatomic variables outperforming volumetric, but not functional ones. Larger studies are needed to confirm these findings.
Abstract 4139659: Ostial versus Crossover Stenting for Ostial Left Anterior Descending Artery Lesions: A Systematic Review and Meta-Analysis
Authors: Parth Desai, John Suffredini, Stephanie Koh, Anupama Bk, Umair Khalid, Waleed Kayani, Xiaoming Jia
Journal: Circulation (2024)

Introduction: Significant coronary atherosclerotic lesions that involve the ostium of the left anterior descending (LAD) artery (Medina 0,1,0) pose unique challenges. The two main techniques used for percutaneous coronary intervention (PCI) of ostial LAD lesions are ostial stenting (OS) and crossover stenting (CS), in which a stent is deployed across the lesion extending from the left main (LM) artery into the LAD. Several observational studies have compared the efficacy of the two techniques, but the results have been mixed with respect to clinical outcomes. Research Question: Is there a difference in efficacy between CS and OS in ostial LAD lesions based on pooled data from existing studies? Methods: A systematic review was performed for studies comparing CS and OS techniques with respect to long-term outcomes (≥1 year). We used the Mantel-Haenszel random effects model to compute relative risk (RR) with 95% confidence intervals (CI) comparing rates of major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) between groups using the CS and OS techniques. In the secondary analysis, we included only studies with a high proportion (&gt;50%) of intravascular ultrasound (IVUS) use in the CS group, given guideline recommendations of intravascular imaging in LM stenting. Results: We included 1448 patients across eight studies. In the primary meta-analysis, there was no significant association between the stenting technique and MACE (RR 0.72, 95% CI 0.38-1.39), all-cause mortality (RR 0.88, 95% CI 0.34-2.33), MI (RR 0.73, 95% CI 0.36-1.48), and TLR (RR 0.62, 95% CI 0.38-1.01). CS was favored with respect to ST (RR 0.34, 95% CI 0.13-0.93, p=0.04). There was significant heterogeneity between studies. In the secondary analysis, CS was favored with respect to MACE (RR 0.56, 95% CI 0.34-0.94, p=0.03) when including only studies that employed a high percentage of IVUS use in LM stenting. No significant differences were found with respect to all-cause mortality, MI, TLR, or ST. Conclusion: Based on our study, CS and OS appeared similar with respect to MACE, death, MI, and TLR, though there was significant heterogeneity across studies. CS did appear to be associated with lower ST. Moreover, CS was more favorable with a lower risk for MACE when IVUS was used more frequently, suggesting the importance of intravascular imaging in ostial LAD PCI.
Abstract 4139661: Usefulness of High-sensitive Troponin I and N-terminal pro-B-type Natriuretic Peptide in Coronavirus Disease 2019 Risk Stratification on and after Omicron Variant Waves: COVID-MI Registry Cohort-2 Analysis
Authors: Toshiaki Toyota, Tomohiro Ichiyanagi, Madoka Sano, Takeshi Morimoto, Yuta Azumi, Hayashi Hideyuki, Ryosuke Murai, Junichi Ooka, Yasuhiro Sasaki, Tomohiko Taniguchi, Kitae Kim, Atsushi Kobori, Natsuhiko Ehara, Makoto Kinoshita, Yutaka Furukawa
Journal: Circulation (2024)

Introduction: Troponin-defined myocardial injury or N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation frequently coincides with coronavirus disease 2019 (COVID-19). Our prior study (COVID-MI Registry Cohort-1) confirmed that high-sensitive troponin I (HsTnI) and NT-proBNP effectively stratified mortality risk. However, variants of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) change rapidly, and it remains unclear whether these biomarkers are consistently effective in predicting prognosis of COVID-19 patients irrespective of epidemic periods. Research Questions: Can HsTnI or NT-proBNP stratify mortality risk in recent COVID-19 cohorts? Aims: To assess the potential of HsTnI and NT-proBNP levels for risk stratification in the recent COVID-19 waves. Methods: In the COVID-MI Registry Cohort-2, we enrolled 1115 consecutive COVID-19 patients admitted between October 2021 and October 2022, during the Omicron variant endemic. We collected data of HsTnI or NT-proBNP levels from hospital charts or using the samples in our hospital's serum/plasma bank if the data were not available. The primary outcome measure was all-cause mortality. Results: On admission, more than one-third of patients were classified as having severe COVID-19. HsTnI and NT-proBNP levels were available for 427 and 414 patients, respectively. The median HsTnI and NT-proBNP levels were 16 (interquartile range [IQR]: 5-57) ng/L and 524 (IQR: 140-2056) pg/mL, respectively. We stratified the patients into three groups by HsTnI level: &lt;5.0 ng/L (95 patients), 5.0 ng/L to 99%ile URL (151 patients), and ≥99%ile URL (181 patients). For NT-proBNP, patients were grouped as follows: &lt;125 pg/mL (95 patients), 125-900 pg/mL (161 patients), and ≥900 pg/mL (158 patients). The median follow-up duration was 25 days. Regarding cumulative 30-day incidence of mortality, higher HsTnI as well as higher NT-proBNP levels were associated with a higher risk. (HsTnI: &lt; 5.0 ng/L group, 1.1%; 5.0 ng/L to 99%ile URL group, 3.0%; and ≥ 99%ile URL group, 21.7%; P &lt;0.001. NT-proBNP: &lt; 125 pg/mL group, 0%; 125-900 pg/mL group, 4.7%; and ≥ 900 pg/mL group, 17.1%; P &lt;0.001). Conclusions: HsTnI and NT-proBNP levels on admission can stratify mortality risk in recent COVID-19 cohorts, which is consistent with previous studies on different SARS-CoV-2 variants.
Abstract 4140407: The Importance Of The Atrium For Cardiac Performance In Athletes: A Sample Of Athletes Monitored At The Heart Institute, University Of Sao Paulo Medical School (InCor-HCFMUSP).
Authors: Leonardo Galvao de Oliveira Oldra, Gabriele Sevilhano Milanesi, Guilherme Wesley Peixoto da Fonseca, Francis Souza, Maria-Janieire Alves, Roberto Kalil Filho
Journal: Circulation (2024)

Background: Long-term high physical performance athletes are more susceptible to major cardiac adaptations. However, the onset and variations in these adaptations within specific populations, such as Brazilians, remain unclear. Research Questions: Which significant cardiac adaptations do high-performance athletes (HPA) exhibit compared to non-competitive regular practitioners (NCRP), and if these adaptations are still physiological. Aims: To evaluate the anatomical adaptations of cardiac chambers resulting from physical exercise in Brazilian HPA. Methods: This retrospective study analyzed exams conducted from October 2014 to May 2024. We enrolled 28 HPA and 185 NCRP who regularly exercised recreationally. Echocardiograms were performed using a two-dimensional echocardiogram with color Doppler, including atrial measurement by the Teichholz method. Maximum oxygen consumption (VO2max) was assessed by cardiopulmonary exercise testing (CPET). Results: There was no difference between groups for age (49±15 vs. 53±14 years; p=0.094), body weight (69.3±10.0 vs. 70.0±11.7 kg; p=0.094) and resting heart rate (63±8 vs. 60±13 bpm/min; p=0.684). VO2max (57.6±13.9 vs. 47.3±9.4 ml/kg/min; p&lt;0.001), interventricular septum (9.2±1.2 vs. 9.0±1.2 mm; p=0.094), left atrium (37.6±2.9 vs. 35.1±3.6 mm; p&lt;0.001) and left ventricular end-systolic diameter (34.2±5.1 vs. 31.2±3.3 ml; p&lt;0.001) were higher in HPA, while mass index (91.7±13.9 vs. 83.3±17.6; p=0.051) and left ventricular wall (9.1±1.2 vs. 8.6±1.1 mm; p=0.056) showed a tendency to be higher in HPA compared to NCRP. Left ventricular ejection fraction (LVEF) was lower in HPA in comparison to NCRP (63±6 vs. 66±4; p=0.004). There were correlations between VO2max and diastolic volume (r=-0.17; p=0.031), systolic volume (r=-0.30; p&lt;0.001) and LVEF (r=0.73; p=0.016). In a stepwise backward regression using the median value of 48.7 ml/kg/min for VO2max, right ventricle (OR, 1.208; 95% CI, 1.051-1.389; p=0.07), body mass index (OR, 0.625; 95% CI, 0.466-0.837; p=0.002), and systolic volume (OR, 0.723; 95% CI, 0.542-0.965; p=0.028) were independently associated. Conclusion: HPA shows echocardiogram-assessed heart changes within clinical range. Increased atrial size and end-diastolic volume, despite proper systole, may affect cardiac filling and function by impairing cardiac output and performance, suggesting early atrial function screening to prevent future diseases in high-performance athletes.
Abstract 4140013: Sleep Disparities Across Demographics and Cardiometabolic Disorders in the NIH All of Us Fitbit Database
Authors: Adeep Kulkarni, Dhairya Upadhyay, Morgan Grams, Souptik Barua
Journal: Circulation (2024)

Background: Prior research has noted disparities in sleep duration among demographic groups and those with cardiometabolic disorders. However, these are mostly based on self-reported data. The NIH All of Us Fitbit database offers a new method for objective and reliable sleep assessment. Goals: The study aimed to objectively assess sleep duration using the All of Us Fitbit database across various demographic variables and cardiometabolic disorders. Methods: All of Us participants with at least one year of Fitbit data were identified. Fitbit’s "minutes asleep" parameter was extracted daily over the first year of Fitbit use and averaged. The average total minutes asleep (TMA) was compared across self-reported age, sex and race groups. For those individuals who also shared their electronic health record (EHR) data, TMA was compared between those with and without hypertension, diabetes, and sleep apnea. T-test and ANOVA were used for comparisons. Results: The first year of Fitbit data for 13,039 participants (51 [16]* years, 69% female, 82% White) was analyzed, with sleep information available for 330 [104] days (90% complete data). TMA decreased with age, with the 18-44, 45-64, and 65+ groups averaging 366 [64], 348 [72], and 339 [85] minutes respectively (p&lt;0.0001). Men and women had a small difference in TMA (342 [74] vs 351 [77] mins respectively, p&lt;0.0001). Individuals who self-reported as Black or African-American had significantly lower TMA (304 [68] mins) compared to other groups (White: 353 [76] mins, Asian: 334 [67] mins, Other: 344 [69] mins; p&lt;0.0001). Among 8587 individuals who also shared their EHR data, lower TMA was observed in those with, compared to those without, prevalent hypertension (332 [83] vs 353 [76] mins), diabetes (320 [82] vs 349 [78] mins), and sleep apnea (328 [77] vs 350 [79] mins) respectively (all p&lt;0.0001). *mean [SD] Conclusion: Fitbit data analysis identified variations in sleep duration across age, race, and presence of cardiometabolic disorders. Objective sleep assessment using wearables could provide more reliable insights into sleep disparities and their associations with cardiometabolic outcomes.
Abstract 4139810: Acute Bilateral Breast Swelling as a Rare Manifestation of Heart Failure Exacerbation: A Case Report
Authors: Moiud Mohyeldin, Anandu Anto, Muhammad Hossain
Journal: Circulation (2024)

Background: Bilateral breast swelling is a rare and often overlooked presentation of congestive heart failure (CHF) exacerbation. It can mimic other conditions like cellulitis or malignancy, posing a diagnostic challenge. Recognizing this unusual manifestation is crucial for timely diagnosis and appropriate management. Case Presentation: A 77-year-old female presented with acute onset bilateral breast enlargement, tenderness, and erythema, along with symptoms of CHF exacerbation including dyspnea, orthopnea, and lower extremity edema. Physical examination revealed markedly enlarged, tender breasts. Imaging studies including mammography (Figure 1: Right and left craniocaudal views; Figure 2: Right and left mediolateral oblique views) and breast ultrasound showed diffuse skin and subcutaneous edema without evidence of infection or malignancy. Echocardiography confirmed reduced ejection fraction and diastolic dysfunction. Skin biopsy findings were consistent with CHF-related changes. The patient's symptoms improved with diuresis and optimization of guideline-directed medical therapy for heart failure. Conclusion: This case highlights breast edema as a rare manifestation of CHF exacerbation that clinicians should be aware of. It can mimic inflammatory breast disorders or malignancy, leading to delayed diagnosis. A high index of suspicion in patients with cardiovascular disease and close collaboration between specialties are key for accurate diagnosis. Treatment involves managing the underlying CHF with diuretics, medical therapy, and supportive measures. Prompt recognition can help alleviate symptoms, prevent complications, and improve patient outcomes.
Abstract 4139875: Trends in Comorbid Diabetes Mellitus and Heart Failure-Related Mortality Among Older Adults: Demographic and Regional Analysis from CDC WONDER - 1999 to 2019
Authors: Arooba Ejaz, Adeel Ahmad, Madiha Salman, Naima Khan, Hafsah Alim Ur Rahman, Sandesh Raja, Eman Ali, Ishaque Hameed, Wajeeh Rehman, Asim Shaikh
Journal: Circulation (2024)

Background and Purpose: Older adults in the United States face worsening trends in the incidence and prevalence of comorbid diabetes mellitus (DM) and heart failure (HF). This study aimed to examine the trends in DM and HF-related mortality among adults ≥65 years in the United States. Methods: The Multiple Cause-of-Death data using CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) were analyzed for DM and HF-related deaths from 1999 to 2019 in adults ≥65 years. Age-adjusted mortality rates (AAMRs) per 100,000 population were determined and stratified by year, sex, race/ethnicity, and geographic region. Joinpoint regression was used to analyze trends in AAMRs using annual percent change (APC). Results: A total of 842,785 deaths occurred among older adults in the United States related to comorbid HF and DM. The overall AAMR for deaths due to comorbid DM and HF in older adults was 97.4. The AAMRs remained stable between 1999 and 2005. From 2005 to 2009, AAMRs steadily declined at an APC of -3.41 (95% CI: -4.75 to -0.52). Following a period of stability from 2009 to 2014, AAMRs increased at an APC of 2.80 (95% CI: 1.97 to 4.68) till 2019. Men (116.2) had consistently higher AAMRs than older women (84.8) throughout the study period. Upon stratification by race and ethnicity, AAMRs were observed to be highest in non-Hispanic (NH) American Indian or Alaska Native (144.1), followed by NH Black or African American (124.4), Hispanic or Latino (100.5), NH White (95.3), and NH Asian or Pacific Islander (62.0) populations. Non-metropolitan areas had higher AAMRs for comorbid HF and DM than metropolitan areas, with overall AAMRs of 126.9 and 90.9, respectively. States that fell into the top 90 th percentile included Kentucky, Mississippi, Oklahoma, Oregon, Vermont, and West Virginia, which had twice the AAMRs than states that fell into the bottom 10 th percentile, including Arizona, Florida, Hawaii, Massachusetts, Nevada, and New York. Conclusion: Our analysis revealed a concerning rise in mortality related to comorbid DM and HF in U.S. adults ≥ 65 years old since 2014. Men, NH American Indian and Alaska Native populations, and residents of non-metropolitan areas displayed the highest AAMRs. Future efforts focusing on improved risk assessment and the adoption of therapeutic therapies are needed for the effective management of patients with comorbid DM and HF to help alleviate the mortality burden.
Abstract 4140073: Impact of Myosin S2 and cMyBP-C Interaction on Cardiac Contractility in Hypertrophic Cardiomyopathy
Authors: Megan Maguire, Lisa Green, Rohit Singh, Brandon Ason, Michelle Nieman, Sheryl Koch, Henry Gong, John Lorenz, Jack Rubinstein, Jonathan Kirk, Aaron Burton, Sakthivel Sadayappan
Journal: Circulation (2024)

Background: Cardiac muscle contraction and relaxation are regulated by the interaction between myosin neck region (S2) and cardiac myosin binding protein-C (cMyBP-C). Clinically, several mutations in the myosin S2 region, affecting its interaction with cMyBP-C, have been linked to hypertrophic cardiomyopathy (HCM). However, the molecular mechanism by which mutations in myosin S2 affect function is unknown. The interaction of the myosin S2 region with cMyBP-C and whether facilitating this interaction using a small peptide of myosin S2 can efficiently improve cardiac contractility remains unclear. Objectives: To determine the interactive region of myosin S2 with cMyBP-C on contractility in vitro, and define the impact of an E932del mutation in α-myosin (Myh6E932del) in vivo , which is located in the myosin S2 region affecting its interaction with cMyBP-C. Methods and Results: To target the cMyBP-C-myosin interaction, we used the proximal region of S2 (126aa) and nine overlapping and shortened variations of the S2 region in solid-phase binding and skinned papillary muscle assays. Based on these experiments, we determined that Amg 27119, a 22-amino acid myopeptide, was highly efficacious in improving contractile function in cardiac muscle. Next, we generated a CRISPR-Cas9 mediated knock-in mouse model expressing the Myh6E932del mutation. Echocardiography and real-time PCR data from heterozygous mice at 9 months of age revealed cardiac hypertrophy with preserved cardiac function and increased expression of cardiac hypertrophic genes compared to wild-type controls, respectively. In vivo catheterization analyses indicated impaired relaxation, with reductions in dP/dt min and tau in mutant mice versus controls. pCa-force measurements showed significantly increased force production in mutant skinned myocytes (29.289 nM/mm^2, p=0.0039) compared to controls (20.311 nM/mm^2), without affecting myofilament calcium sensitivity and the Hill coefficient. Conclusion: The myopeptide was determined to target and relieve the cMyBP-C inhibition of myosin, thereby improving contractility in vitro . Disrupting the interaction between myosin S2 and cMyBP-C with HCM mutations results in diastolic dysfunction and hypercontraction.