tbuckley/cabot-search huggingface dataset:
Abstract 11704: Conduction Abnormalities Among Chronic Chagas’ Disease Patients With Heart Involvement and Events of Cardiogenic Shock
Authors: Sudhamai Akkaramani, Kamleshun Ramphul, Raheel Ahmed, Rahat A Memon, Shruti Aggarwal, Jasninder S Dhaliwal, Hasan Ahmad, Muzammil Farhan, Ali Hasan, Azeem Hassan, Pramod Kumar Ponna, Shaheen Sombans, Hemamalini Sakthivel
Journal: Circulation (2023)

Introduction: Chronic Chagas Cardiomyopathy can disrupt various conduction pathways, triggering arrhythmias and cardiogenic shock (CS). The American Heart Association recently advocated for better global awareness in endemic regions. We aim to provide a perspective on cardiac arrhythmias seen in Chronic Chagas disease with heart involvement in the United States. Methods: Cases of “Chagas' disease (chronic) with heart involvement” were used via the 2016-2020 National Inpatient Sample. The presence of several cardiac arrhythmias was analyzed. Results: Between 1st January 2016 to 31st December 2020, around 1920 patients were hospitalized with Chronic Chagas’ disease with heart involvement in the United States. The cases were predominantly Males (61.2%) who were also younger compared to Females (mean age of Males: 55.83 years vs. mean age of Females 58.86 years, p&lt;0.01). The mean age of all patients was estimated at 57.0 years. The patients were primarily covered by Medicaid (40.4%), followed by Medicare (26.0%), and Private insurance (21.9%). Moreover, 90.9% of hospitalizations took place in Urban-teaching centers. Several arrhythmias such as atrial fibrillation (37.2%, 715 cases), supraventricular tachycardia (4.7%, 90 cases), ventricular tachycardia (29.2%, 560 cases), ventricular fibrillation (4.2%, 80 cases), and atrial flutter (6.8%, 130 cases), as well as conduction defects such as first-degree Atrioventricular block (1.6%, 30 cases), complete atrioventricular block (3.9%, 75 cases), and sick sinus syndrome (2.9%, 55 cases), were observed. The mean Charlson Comorbidity Index (CCI) score among these patients was 2.66. Around 185 patients (9.6%) developed CS during their hospitalization. While no statistical significance was seen in the mean ages of patients with and without CS (58.57 vs. 56.84 years, p=0.062), those with CS had a higher mean CCI score (3.73 vs. 2.55, p&lt;0.01; 14.6% of patients with CCI≥4 vs. 8.0% with CCI &lt;4, p&lt;0.01), with a longer hospitalization (22.97 days vs. 6.49 days, p&lt;0.01). Conclusions: Patients with Chagas disease with heart involvement can experience various conduction abnormalities. CS was more common in patients with a higher CCI score, resulting in a longer stay.
Abstract 12446: Trajectories of Frailty and Cardiovascular Outcomes Among Medicare Beneficiaries, 2003-2015
Authors: Yusi Gong, Yang Song, Jiaman Xu, Huaying Dong, Daniel B Kramer, Ariela R Orkaby, John A Dodson, Jordan B Strom
Journal: Circulation (2023)

Background: Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent role of frailty progression on health outcomes remains uncertain. Methods: In Medicare Fee-for-Service beneficiaries ≥ 65 years with continuous enrollment from 2003-2015, we calculated frailty progression or regression, using a continuous, validated Fried phenotype-based frailty index in years 1-5. We used linear mixed effects models and Cox proportional hazards models, adjusting for baseline frailty, to evaluate the influence of frailty trajectory on the risk of adverse health outcomes (death, HF, MI, ischemic stroke, MACE, and days at home [DAH] within the calendar year). Results: Among 26,414,887 individuals (mean age 75.4 ± 7.0 years, 57% female, 13% non-white race), 20.4% had frailty progression and 13.6% had frailty regression. Compared to frailty regressors, progressors had a greater risk of mortality (HR 1.59, 95% CI 1.58-1.59) and all cardiovascular outcomes. With increasing quartile of frailty progression and adjusting for baseline frailty, there was a graded risk in mortality (quartile 4 vs. 1, HR 2.21, 95% CI 2.21-2.23, p &lt; 0.001) and all adverse cardiovascular outcomes (Figure). Compared to those in the lowest frailty progression quartile, those in the highest quartile had significantly fewer DAH (270.4 ± 112.3 vs. 308.6 ± 93.0, RR 0.88, 95% CI 0.87-0.88, p &lt; 0.001). Conclusions: In this large, nationwide sample of older Medicare beneficiaries, the degree of frailty progression, independent of baseline frailty, was associated with increased risk of all-cause mortality, HF, MI, ischemic stroke, and MACE, and fewer DAH. Frailty progression therefore identifies patients at high risk for adverse outcomes and increased health services utilization.
Abstract 12105: Cardioprotective Effect of Antiviral Therapy Among Hepatitis C Infected Patients: A Meta-Analysis
Authors: Vikash Jaiswal, Akash Jaiswal, Muhammad Hanif, Song Peng Ang, abhigan babu Shrestha, Mayank Jha, Anupam Halder, Yusra Nasir, Jia Ee E Chia, Kripa Rajak, Nirmit Patel, Alisson Iturburu
Journal: Circulation (2023)

Background: Hepatitis C (HCV) infections have been shown to be associated with a higher risk of atherosclerotic cardiovascular disease (CVD). However, the use of antiviral therapy (AVT) and the risk of CVD has not been well established with limited literature. Objective: We sought to evaluate the association between AVT use post-HCV infection and cardiovascular outcomes. Methods: We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10th March 2023. Primary clinical outcomes were the incidence of any CVD. Secondary endpoints were all-cause of mortality, stroke, myocardial infarction, peripheral artery disease, and heart failure. Results: A total of 394,452 patients were included in the analysis (111,076 in the AVT group and 283376 patients in the NAVT group). The mean age of patients among AVT and NAVT groups was comparable (58.7 vs. 58.18). The pooled analysis of primary outcomes showed that AVT was associated with a significantly reduced risk of any CVD (HR, 0.55(95%CI: 0.41-0.75), P&lt;0.001) compared with the NAVT group of patients. Secondary outcomes including ACM (HR, 0.38(95%CI: 0.32-0.46), P&lt;0.001), MI (HR, 0.62(95%CI: 0.41-0.94), P=0.02), and PAD (HR, 0.62(95%CI: 0.41-0.93), P=0.02) were significantly lower among AVT groups compared with NAVT groups of patients with HCV infection. However, the risk of stroke was comparable between both groups of patients (HR, 0.79(95%CI: 0.58-1.07), P=0.13). Conclusion: Our analysis shows HCV-infected patients post-AVT have a significantly lower risk of any CVD, MI, ACM, and PAD compared with NAVT groups of patients.
Abstract 11944: Atherosclerotic Cardiovascular Disease Among Insured Adults by Gender Identity
Authors: Carl G Streed, Gretchen Swabe, Emily Sisson, Sari Reisner, Guneet Jasuja, Tonia Poteat, Monica Mukherjee, Howard Cabral, Vin Tangpricha, Michael Paasche-Orlow, Emelia J Benjamin, Jared W Magnani
Journal: Circulation (2023)

Background: Atherosclerotic cardiovascular disease (ASCVD) risk is significantly affected by sex; however, the increasing impact of gender identify is unclear. Hypothesis: We hypothesized that transgender and gender diverse (TGD) adults had higher prevalence of ASCVD risk factors and higher incidence of ASCVD outcomes compared to cisgender persons. Methods: We used a large claims-based dataset (Optum’s de-identified Clinformatics® Data Mart Database) to conduct a cohort study of ASCVD risk and morbidity. We used a validated algorithm to identify TGD persons. Covariates included age, sex, race and ethnicity; ASCVD risk factors (e.g., hypertension); socioeconomic factors (e.g., education). We examined incidence and hazard ratios (HRs) of ischemic stroke (IS), myocardial infarction (MI), and coronary revascularization by gender identity in multivariable models. Results: We identified 85,282 TGD adults from 2010-2022 and frequency matched them to 414,590 cisgender referents (1:5 ratio). Incidence of MI, IS, and revascularization ( Table 1 ) for TGD persons assigned male at birth over 50 years of age were 18.90, 32.16, and 9.88 per 1000 persons-years, respectively. For TGD persons assigned female at birth over 50 years of age, incidence of MI, IS, and revascularization was 8.37, 15.21, and 4.61 per 1000 persons-years, respectively. Accounting for demographic characteristics, ASCVD risk factors, and socioeconomic status, the HRs for TGD persons assigned male at birth compared to cisgender women for MI, IS, and revascularization were 2.02, 0.93, and 4.30, respectively. HRs for TGD persons assigned female at birth compared to cisgender men for MI, IS, and revascularization were 0.89, 0.70, 1.64, respectively. Conclusion: We identified significant differences in ASCVD risk and morbidity by gender identity. Further research is needed to identify intervenable targets to improve the cardiovascular health of TGD populations.
Abstract 12123: Descending Aortic Diastolic Flow Reversal in Aortic Regurgitation: Optimizing Definitions and Assessment on Cardiac Magnetic Resonance
Authors: Mujtaba Saeed, Maan Malahfji, Duc T Nguyen, Ahmed Ibrahim I Ahmed, Valentina Crudo, Mouaz Al-Mallah, William A Zoghbi, Edward A Graviss, Dipan J Shah
Journal: Circulation (2023)

Introduction: Holodiastolic flow reversal (HDR) in the descending aorta (DA) may indicate hemodynamically significant aortic regurgitation (AR). However, the optimal definition and quantification of flow reversal on cardiac magnetic resonance (CMR) is unknown. Methods: We studied 346 chronic AR patients with regurgitant volume (RegVol) ≥30 mL or regurgitant fraction (RegF) ≥30%. The presence of HDR and quantitation of reverse volume in the DA (DA-RVol) was performed by a blinded observer. The threshold for DA-RVol that identified ≥ moderate-severe AR (RegVol ≥45 mL and RegF ≥40%) was established by derivation (50% random sample), validation (50% remaining sample), and ROC curve analysis. Multivariable logistic regression models adjusting for age, gender, NYHA Class, and indexed left ventricular end-diastolic volume were performed to compare HDR and DA-RVol. Results: The median age was 61 (IQR 50-70) years, 79.2% men, and 30.3% with bicuspid aortic valve. The median RegF was 37% (IQR 32-44) and DA-RVol was 12 mL (IQR 5-27). HDR was observed in 150 (43.2%), with 63% sensitivity and 77% specificity for detecting ≥ moderate-severe AR. The threshold of DA-RVol which identified ≥ moderate-severe AR was 17 mL (AUC 0.82, sensitivity 68%, and specificity 87%). The ROC curve analysis revealed a higher AUC for DA-RVol ≥17 mL relative to HDR (0.78 vs 0.70, P &lt;0.001) for predicting ≥ moderate-severe AR. On multivariable analysis models, DA-RVol ≥17 mL was superior to HDR (AUC 0.83 vs 0.80, P =0.008). Conclusion: Quantitation of flow reversal in the descending aorta is a more reliable method to identify hemodynamically significant AR compared to simple presence of holodiastolic flow reversal.
Abstract 12288: Sex Differences in Cardiac Adaptation to Obesity During Adolescence: A Role of Cardiopulmonary Exercise Testing
Authors: Takeshi Tsuda
Journal: Circulation (2023)

Introduction: Heart size is known to increase in obese individuals as a physiological adaptation. Cardiac hypertrophy is also regarded as a risk factor for future adult cardiovascular disease. Sex differences of cardiac adaptation to obesity during adolescence are poorly understood. Hypothesis: Physiological cardiac responses to obesity are different between male and female adolescents. Methods: Anthropometric measurements, left ventricular mass index (LVMI; g/m 2.7 ), and cardiopulmonary exercise testing parameters were analyzed. Peak oxygen consumption (VO2), ventilatory anaerobic threshold (VAT), and submaximal sloop parameters including ΔVO2/Δheart rate (HR) and ΔHR/Δwork rate (WR) were obtained. Data are shown as mean ± standard deviation. * denotes weight-indexed value. Results: Table 1 showed enrolled obese adolescents (19 males and 40 females). ΔVO2/ΔHR and ΔHR/ΔWR are surrogates of stroke volume and HR-dependency, respectively. Males showed significantly higher pVO2, pVO2*, VAT*, ΔVO2/ΔHR, and ΔVO2*/ΔHR but lower ΔHR/ΔWR and ΔHR/ΔWR* than females, suggesting males had higher peak exercise performance, higher stroke volume, and lower HR-dependency than females. Significant correlation was noted between LVMI and VAT* only in males (p = 0.045) and between LVMI and body mass index (BMI) only in females (p = 0.006), suggesting cardiac hypertrophy may not effectively contribute to exercise performance in females (Figure 1). Cardiac hypertrophy assessed by LVMI presented different physiological significance between obese males and females. Conclusions: Cardiac adaptation to obesity occurs differently between males and females during adolescence.
Abstract 12093: Bi-Ventricular Cardiac Adaptations to 20 Weeks of High-Intensity Resistance Training in Healthy Untrained Men: A 3D Echocardiography Longitudinal Study
Authors: Nicolas Pamart, Joffrey Drigny, Helene Azambourg, Marion Remily, Maxime Macquart, Alexandre Lefevre, Kamal Lahjaily, Jean-Jacques Parienti, Amelia Rocamora, Henri Guermont, Antoine Desvergee, Pierre Ollitrault, Francois Tournoux, Eric Saloux, Hervé Normand, Emmanuel Reboursiere, Antoine Gauthier, Amir Hodzic
Journal: Circulation (2023)

Introduction: The historical description of cardiac remodelling between strength and endurance athletes, made by Morganroth in the 1970s, has been challenged with the advancements in our understanding of the protective effect of Valsalva manoeuvres and the emergence of sophisticated imaging techniques for cardiac function assessment. Objective: We aimed to analyze the kinetics of muscular and cardiac responses to 20 weeks of high-intensity resistance training in healthy untrained volunteers. Methods: A total of 27 young and healthy men with an average age of 22.8±3.2 years participated in a 20-week strength training program. The training program intensity was guided by 1-Repetition Maximum (RM) testing. Before and after 12 and 20 weeks of training, participants were assessed using body composition analysis, electrocardiogram, 3D transthoracic echocardiography, cardiopulmonary exercise testing ( V O 2peak ), and muscle isokinetic dynamometry. Anova was utilized to analyse time effect. Results: Among the initial cohort, 22 subjects completed the study protocol. Arterial blood pressure significantly decreased at both time points. Isokinetic evaluation confirmed increases in maximal strength for quadriceps (Δ 0-20wk =+46.8Nm, P&lt;0.001), hamstrings (Δ 0-20wk =+25.3Nm, P=0.025), triceps (Δ 0-20wk =+11.6Nm, P=0.005), and biceps (Δ 0-20wk =+9.2Nm, P=0.023). Regarding cardiac analysis, after 20 weeks of training 3D left ventricular (LV) mass increased (120.1±15.4 to 133.7±16.3 g, P=0.018), with an augmentation in both septal wall (6.1±1.1 to 7.2±1.4 mm, P=0.027) and posterior wall thickness (5.5±1.3 to 7.1±1.3 mm, P&lt;0.001). 3D LV end-diastolic volume increased by 7.28% without reaching a significant difference. Right ventricular (RV) wall thickness also increased (3.33±0.73 to 3.89±0.8 mm, P=0.04), with a slight non-significant augmentation of 3D RV end-diastolic volume by 7.89%. No significant changes were found in LV and RV systolic or diastolic function. Conclusions: This study demonstrated that our 20-week high-intensity strength training program resulted in a rapid and significant increase in muscular strength. The cardiac response to strength training showed a moderate biventricular response like that of endurance athlete
Abstract 12035: Impact of Viruses on Donor Derived Cell Free DNA After Heart Transplantation
Authors: Amit Alam, Johanna van Zyl, Srikant Patlolla, Hira Shakoor, Dana Farsakh, Brenda Astorga, Ahmad Abdelrehim, Abbey Hanks, Shane Moore, Shelley Hall
Journal: Circulation (2023)

Introduction: Little is known about the relationship between active viral infections and donor-derived cell free DNA (dd-cfDNA) levels in patients following heart transplantation. Methods: Paired respiratory viral panel, cytomegalovirus (CMV) or other for-cause viral studies and dd-cfDNA (AlloSure) results were prospectively collected on single-organ heart transplant recipients enrolled between August 2022 and March 2023. The levels of dd-cfDNA were compared between patients with positive and negative viral results at enrollment. Results: Of 44 patients enrolled, 18 tested positive with viral infections. Baseline characteristics were comparable between groups (median age 61 years, 73% male). The median time post-transplant was 289 days in patients with viral infections and 126 days in those without infections (p=0.046). None of the patients had concerns for concomitant rejection or graft dysfunction at time of their viral infection. Viral infection cases included 10 CMV, 1 Hepatitis-B and CMV, 3 Epstein-Barr virus (EBV), 2 Influenza, 1 Respiratory Syncytial virus (RSV), and 1 Coronavirus-19. Allomap gene-expression profile scores were similar between groups (p=0.15); whereas dd-cfDNA levels were significantly higher in patients with viral infections compared to controls (p=0.002). Table 1, Figure 1 Conclusion: Active viral infections can raise the level of dd-cfDNA levels in patients following heart transplantation. Further studies are needed to validate these preliminary findings.
Abstract 11954: Predictors of Adverse Outcome in STEMI Patients Post-PCI With Cardiogenic Shock Requiring Intra-Aortic Balloon Pump Support
Authors: Sabrina A Mann, saleh alhalaseh, Nmair Alziadin, Apoorva T Raju, Omar Al Wahadneh
Journal: Circulation (2023)

Introduction: Cardiogenic shock is a serious complication of ST-segment elevation myocardial infarction (STEMI), however clinical and demographic factors may further impact outcomes. This study investigated how age, gender, income, comorbidities, and arrhythmias affect mortality of STEMI patients receiving intra-aortic balloon pumps (IABP) for management of cardiogenic shock. Methods: This retrospective study used the National Inpatient Sample (NIS) database from 2016 to 2020. We identified STEMI admissions as the principal diagnosis and cardiogenic shock as the secondary diagnosis. Patients who received IABP support were included using the ICD-10 Procedure Coding System (PCS) code 5A02210. Logistic linear regression was used to analyze the data while adjusting for confounding variables such as age, sex, and comorbidities. Results: Of the 24,915 admissions with STEMI requiring IABP post PCI, the average age was 65, 29.5% were female, 28.8% died and 51.7% patients had congestive heart failure. The highest mortality rate was associated with liver disease, followed by left bundle branch block, age over 65, ventricular fibrillation, renal failure, female gender, peripheral vascular disease (PVD), and ventricular tachycardia (table 1). Income in the bottom 25 th percentile also had increased mortality. Conclusion: This study identified several predictors of adverse outcomes in post-PCI STEMI patients with cardiogenic shock requiring IABP support, including ventricular fibrillation, ventricular tachycardia, left bundle branch block, peripheral vascular disease, renal failure, liver disease, age 65 or older, female, and low income. These findings may aid in the management of STEMI patients with cardiogenic shock by allowing healthcare providers to identify patients at high risk for adverse outcomes and tailor their treatment accordingly.
Abstract 11707: Differences in Erythrocyte Morphology in Thrombus From Infarct-Related Artery: Cardioembolic Thrombosis vs. Atherothrombosis, Pathological Analyses From MITO Study
Authors: Tomomi Koizumi, Noriyuki Kato, Inadome Yukinori, Fumimasa Tabata, Tomosato Yamazaki, Masao Ono
Journal: Circulation (2023)

Introduction: Diagnosis of cardioembolic thrombosis is important because anticoagulant therapy is recommended for its secondary prevention. However, it is difficult to make a clear distinction in the pathogenesis between cardioembolic thrombosis and atherothrombosis. It has been reported that CD163 positive macrophage which related hemoglobin-haptoglobin complex was more involved in cardioembolic thrombus than atherothrombosis. Hypothesis: Erythrocyte morphology and its hemolysis in thrombus are associated with difference in thrombus formation between cardioembolic thrombosis and atherothrombosis. Methods: The Macrophage in Thrombus (MITO) study is an observational study examining pathological and biological differences of arterial thrombus between sinus rhythm (SR) and atrial fibrillation (AF). Patients with acute thromboembolic stroke (ATS) or ST elevation myocardial infarction (STEMI) whose solid thrombus could be retrieved from the infarct-related artery were enrolled. Patients were divided into 2 groups as follows; Group C; ATS with AF (presumed cardioembolic thrombosis) and Group A; STEMI with SR: (presumed atherothrombosis), and compared erythrocyte morphology score; 1: erythrocyte morphology is maintained; 2: The erythrocyte morphology is not maintained, but part of its fragment are seen; and 3: The erythrocyte morphology is not maintained at all in the thrombus seen by х40. Circulating blood counts (CBC), haptoglobin and soluble CD163 were measured all the patients. Results: The score of Group C (n=20) was significantly higher than that of Group A (n=28) (p&lt;0.01)Figure. Laboratory findings are shown in the Table. Conclusions: Erythrocyte morphology disruption was thought to be more involved in cardioembolic thrombus formation. Erythrocyte morphology and CBC with soluble CD163 level are likely to help distinguish cardioembolic thrombus from atherothrombus.
Abstract 12097: Genetics of Cardiac Troponin
Authors: Pranav Sharma, Scott M Damrauer, Michael Levin
Journal: Circulation (2023)

Introduction: In the absence of coronary artery disease, observational studies suggest that myocardial injury may occurs because of drugs/toxins, infection, inflammatory disease, and malignancy, alongside commonly associated conditions such as heart failure, kidney disease, and hypertension, among others. The causes and optimal treatment for myocardial injury without ischemic heart disease remains an unmet need in cardiovascular medicine. We aimed to leverage genome-wide association studies (GWAS) to identify previously unreported risk loci for circulating troponin levels in the absence of ischemia, and Mendelian randomization (MR) to highlight causes of myocardial injury and identify potential targets for intervention. Methods: We performed a GWAS meta-analysis of circulating cardiac troponin I (cTnI) and T (cTnT) among up to 46,267 healthy ambulatory individuals using METAL. Using publicly-available GWAS of ~40 common cardiovascular risk factors such as lipids, blood pressure, and kidney function available from the IEU Open GWAS Project, we used Mendelian randomization (MR) to identify their potential causal association with circulating troponin. We primarily employed inverse-variance weighted MR; weighted median and weighted mode methods were applied as sensitivity analyses. Results: Our meta-analysis revealed three risk loci each for cTnI and cTnT, including a previously unreported signal on chromosome 3 (rs1706435) for cTnT. After accounting for multiple testing by controlling the false discovery rate (q &lt; 0.05), MR identified 8 and 10 cardiovascular risk factors associated with elevated cTnI and cTnT, respectively. These factors included blood pressure, creatinine, classes of obesity, and waist circumference. Conclusions: This analysis identified a new risk locus for circulating troponin in the absence of ischemia. Our MR results provide human genetic evidence to support obesity and hypertension as important contributors to elevated circulating troponin, highlighting their potential role in myocardial injury.