tbuckley/cabot-search huggingface dataset:
Abstract 13354: Higher Severe Maternal Morbidity Rates at Delivery Hospitalization Among Racial and Ethnic Groups Related to Chronic Hypertension and Hypertensive Disorders of Pregnancy
Authors: Michael Najem, Mara Greenberg, Baiyang Sun, Stacey Alexeeff, Janet Alexander, James M Roberts, Mai N Nguyen-Huynh, Erica P Gunderson
Journal: Circulation (2023)

Severe maternal morbidity (SMM) affects 0.5-3% of pregnancies in the United States, with risk varying for racial and ethnic groups. Studies have rarely evaluated how chronic hypertension (cHTN) and hypertensive disorders of pregnancy (HDP) affect differences in SMM risk. This study sought to evaluate cHTN and HDP as contributors to racial disparities in SMM rates. Retrospective cohort study of 263,518 patients aged 18-46 years who received prenatal care ≤14 weeks' gestation and delivered a stillborn or live singleton birth ≥20 weeks’ gestation at a Kaiser Permanente Northern California hospital (2009-2019). We evaluated the relation of cHTN and HDP [preeclampsia (PE), gestational hypertension (GH) and superimposed preeclampsia (s_PE)] to SMM at delivery hospitalization, defined as the presence of at least 1 of 21 conditions meeting CDC criteria. Modified Poisson regression models estimated the adjusted relative risk (aRR) of SMM associated with cHTN and HDP among self-reported racial and ethnic groups [Asian, Black, Hispanic, Native Hawaiian Pacific Islander (NHPI), White] adjusted for covariables. There were 13,626 women (5.2%) with cHTN, in whom 4297 (31.5%) developed s_PE. For patients with no cHTN, 11,744 (4.7%) developed PE and 11,514 (4.6%) developed GH. The overall SMM rate (number of cases/10,000 births) was 219.7. SMM rates were higher for patients with cHTN vs no cHTN (417.6 vs. 208.9, p&lt;.0001), and for PE (934.3) and s_PE (898.3) vs no cHTN + no HDP (165.9), p&lt;0.001. SMM rates differed for racial and ethnic groups. Compared to White patients with No cHTN or HDP, aRRs of SMM associated with PE and s_PE increased in order for White, Asian, Hispanic, Black, and NHPI groups (Table 1). Preeclampsia was 6 times more prevalent among those with cHTN than no cHTN. Preeclampsia was strongly associated with higher SMM rates in both women with cHTN and without cHTN, especially among NHPI and Black groups. Preeclampsia may contribute substantially to racial disparities in SMM.
Abstract 16380: Does Non-Alcoholic Fatty Liver Disease Increase the Risk of Ventricular Arrhythmias in Patients With Heart Failure?
Authors: Manasa Dondapati, Chad Gier, ibrahim almasry, Abhijeet Singh, Roger Fan, Eric J Rashba
Journal: Circulation (2023)

Background: Non-alcoholic fatty liver disease (NAFLD), including non-alcoholic fatty liver and non-alcoholic fatty steatohepatitis, is associated with increased incidence of heart failure (HF). Previous studies have shown an association of NAFLD with increased incidence of ventricular arrhythmias (VAs). however, it is unknown if the increased rate of VA is related to increased HF or if from an independent NAFLD-related mechanism. Therefore, this study aimed to investigate the effect of NAFLD on VA in patients with HF. Methods: A retrospective cohort study of electronic heath records using the TriNetX Research Network was performed. Patients at least 18 years old with diagnosis of cardiomyopathy (CM) or HF were identified by ICD-10-CM codes from January 1, 2014 to December, 31, 2019. Patients were separated based on the diagnosis of NAFLD. Patients who had HF and NAFLD were propensity-score matched (PSM) using age, sex, race, hypertension, hyperlipidemia, ischemic heart disease, cerebrovascular disease, atherosclerosis, diabetes mellitus, acute or chronic kidney disease, acute or chronic respiratory failure, anemia, atrial fibrillation/atrial flutter, body mass index, corrected QT interval, presence of implantable cardioverter-defibrillator, and medications with patients with HF alone. The primary outcomes were 3-year all-cause mortality, hospital admission, and incident VAs. Results: After PSM, 50,969 pairs were analyzed. NAFLD diagnosis was associated with significantly higher odds of VA (odds ratio [OR] 2.75, 95% confidence interval [CI] 2.54-2.98, p &lt;0.0001) and hospital admission (OR 1.05, CI 1.03-1.08, p &lt;0.0001) at 3-years. No significant difference was observed in mortality (OR 0.98, 95% CI 0.95-1.01, p =0.10). Conclusion: Patients with HF diagnosed with NAFLD had significantly higher odds of VA and hospital admission but not mortality at 3-years. Future studies are needed to evaluate mechanisms of VA in NAFLD patients.
Abstract 14281: Association of Sleep Apnea Prevalence and Severity With H <sub>2</sub> FPEF Score and Echocardiographic Markers of Heart Failure With Preserved Ejection Fraction
Authors: John E Connolly, Michael V Genuardi, Jorge I Mora, Stuart B Prenner
Journal: Circulation (2023)

Background: While heart failure with preserved ejection fraction (HFpEF) is highly associated with the presence of sleep apnea, few studies have examined the association between diagnostic scoring systems used to predict HFpEF risk, such as the H 2 FPEF score, and OSA prevalence and severity. Methods: We performed a retrospective chart review on all patients (N = 434) who underwent both an echocardiogram and a sleep study at the University of Pennsylvania between July 1, 2020, and June 30, 2022. Associations between echocardiographic parameters and OSA severity, as well as between H 2 FPEF score and OSA severity, were examined using linear tests of trend. The association between H 2 FPEF score categorization and odds of prevalent OSA was examined with logistic regression. Results: OSA severity was associated with echocardiographic markers of diastolic dysfunction including greater LV mass index (p = 0.04), left atrial volume index (p = 0.03), and LV relative thickness (p = 0.008). Patients with intermediate H 2 FPEF risk scores had 4.3 times greater odds of prevalent OSA compared with those patients with low risk H 2 FPEF scores (95% CI 2.2, 8.7, p &lt; 0.001). Patients with high H2FPEF risk scores had over 17-fold higher odds of prevalent OSA compared to those with low-risk scores (17.7, 95% CI 4.3, 120.7, p &lt; 0.001) (Figure 1). Increasing risk of HFpEF according to H 2 FPEF categorization was strongly correlated with OSA severity as measured by apnea-hypopnea index (p &lt; 0.001) and oxygen desaturation index (p = 0.002). Conclusions: In an ambulatory population referred for both sleep study and echocardiogram, markers of diastolic dysfunction were associated with OSA severity. OSA prevalence and severity were strongly associated with increased H 2 FPEF scores. Clinicians should have a low threshold for referring OSA patients with dyspnea for cardiac workup, as well as a low threshold for referring HFpEF patients for sleep study.
Abstract 16213: No Cardiac Benefit After Single Dose of Intramyocardial or Intravenous Mesenchymal Stem Cell-Derived Extracellular Vesicles Post-Myocardial Infarction Supports Need for Bioengineered Extracellular Vesicles With Non-Invasive Cardiac Uptake
Authors: Cynthia M Xu, Mark Broadwin, Patrick Faherty, Rayane Brinck Teixeira, Frank W Sellke, Ruhul Abid
Journal: Circulation (2023)

Introduction: In pre-clinical models, mesenchymal stem cell-derived extracellular vesicles (MSC-EV) have benefits in ischemic CVD. We previously showed that only intramyocardial (IM) injection of MSC-EV, an invasive method of administration, and not intravenous (IV) injection, resulted in reliable cardiac uptake after acute MI. No prior studies have compared the functional outcome of IM versus IV injection after acute MI. Hypothesis: IM injection of MSC-EV will result in improved cardiac outcomes whereas IV injection will not. Aim: To demonstrate the long-term outcomes of IM versus IV MSC-EV after acute MI. Methods: MSC-EV were isolated and characterized. FVB mice underwent left anterior descending coronary artery ligation and subsequent injection of the following: 1) IM saline control (IM-C; n = 8), 2) IM 2*10 9 MSC-EV particles (IM-EV; n = 9), 3) IV saline control (IV-C; n = 8), and 4) IV 2*10 9 MSC-EV particles (IV-EV; n = 8). The mice underwent pre-operative, and post-operative weekly echocardiograms. On post-operative day 28, the mice were euthanized, and the hearts were harvested. Results: Preliminary data showed no significant differences in left ventricular ejection fraction (p = 0.6151) or fractional shortening (p = 0.1135) in the IM-EV and IV-EV groups compared to the controls IM-C and IV-C, respectively, at post-operative day 28 (Figure 1A). There were also no significant differences in infarct size (p = 0.05620) (Figure 1B) or anterior border zone fibrosis (p = 0.6333) (Figure 1C) on Masson-Trichrome staining. Conclusions: Preliminary findings demonstrate that a one-time IM or IV dose of MSC-EV given immediately after acute MI results in no observable effects. Additional MSC-EV doses after MI may produce beneficial effects. Results from our ongoing studies on the creation of stem cells bioengineered to produce MSC-EV with surface cardiac targeting peptides and immune-evasion properties will be presented in August 2023.
Abstract 16138: Hepatic Steatosis, Cardiorespiratory Fitness, and Metabolic Mediators in the Community
Authors: Victor V Florea, Jingxian Tang, Priya Gajjar, Ravi V Shah, Megan Davenport, Michael Mi, Madeleine Haff, Xiaoyu Zhang, Shi Huang, Ching-Ti Liu, Gregory Lewis, Michelle T Long, Matthew Nayor
Journal: Circulation (2023)

Background: Cardiorespiratory fitness (CRF) is a powerful predictor of cardiovascular (CV) outcomes and multi-organ reserve capacity. Hypothesis: We hypothesize that hepatic steatosis, an emerging CV risk factor, is associated with lower CRF and that certain metabolites mediate this association. Objective: To determine if hepatic steatosis contributes to impaired CRF in community-dwelling individuals. Methods: Framingham Heart Study participants (n=2722) underwent vibration-controlled transient elastography for assessment of controlled attenuation parameter (CAP; a measure of hepatic steatosis) and maximal cardiopulmonary exercise testing (CPET). In individuals with available metabolomic data (n=1346), we evaluated whether blood metabolites mediate the association of CAP and peak CRF (peak oxygen uptake [VO 2 ]). Results: The study sample (mean age 54±9 years, 53% women) had a peak VO 2 of 95±20% of the predicted value, and 722 participants (26.5%) had hepatic steatosis (defined as CAP≥290 dB/m). In multivariable regression models adjusted for age, sex, alcohol use, smoking, systolic blood pressure, hypertensive medication use, diabetes, and prevalent CV disease, both CAP (continuous) and hepatic steatosis were associated with lower peak VO 2 (in ml/kg/min) and VO 2 at the anaerobic threshold, and unfavorable heart rate and blood pressure responses to exercise (at Bonferroni-adjusted P&lt;0.008 for all; Figure 1). Eighteen out of 201 measured circulating metabolites were associated with both peak VO 2 and CAP in separate multivariable models also adjusted for BMI (at FDR 5%). Of these metabolites, 16 significantly mediated the association between CAP and peak VO 2 , with dimethylguanidino valeric acid and lysophosphatidylcholine 20:1 demonstrating the highest proportion mediated. Conclusions: Hepatic steatosis is associated with impaired CRF in the community and this association is partially mediated by known and novel circulating metabolites.
Abstract 13743: Validity and Reliability of a Palliative Care Needs Assessment Tool in Japanese Patients With Heart Failure
Authors: Daishiro Tatsuta, Takuma Sato, Toshiyuki Nagai, Jiro Koya, Kotaro Nishino, Seiichiro Naito, Yoshifumi Mizuguchi, Taro Temma, Kiwamu Kamiya, Hisashi Narita, Kenkichi Tsuruga, Toshihisa Anzai
Journal: Circulation (2023)

Backgrounds: Although patients with heart failure (HF) frequently experience considerable symptom burden and require significant care similar to those with cancer, most HF patients do not receive timely intervention due to the absence of standardized method for identifying those in need of palliative care. Several tools have been employed to assess palliative care needs and identify eligible patients. However, their validity and reliability have yet to be fully examined worldwide. We sought to assess the validity and reliability of The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) in Japanese HF population. Methods: We enrolled consecutive HF patients admitted in our university hospital between February and May 2023 and their caregivers were also included. The NAT: PD-HF were translated into Japanese by our professional multidisciplinary team in accordance with cultural and medical background. We assessed the internal consistency of the NAT: PD-HF with Cronbach`s alpha, and the inter-rater and test-retest reliability with Cohen`s kappa. After using this tool, patients, caregivers, and health care providers were asked whether the tool adequately identify their burden and care needs. Results: During the study period, 75 patients, 67 caregivers, and 17 health care providers agreed to participate. Cronbach's alpha was 0.80 and the minimum Kappa coefficient was 0.73 for inter-rater reliability and 0.83 for test-retest reliability. Seventy-one patients (94%) and 64 caregivers (95%) found this tool useful to identify their burden and care needs. Seventy patients (93%) and 63 caregivers (94%) felt that the tool will improve the quality of care. Sixteen health care providers (94%) also believed this tool was helpful to understand the burden and care needs of both patients and caregivers. However, 7 of them (41%) considered they may not have enough time to use the tool in their daily clinical practice. Conclusions: The NAT: PD-HF was suggested to be a reliable and potentially valid tool even among Japanese HF patients. This tool was very well accepted by patients, caregivers, and health care providers to identify burden and care needs. Further follow-up studies are needed to examine the prognostic impact of using this tool.
Abstract 16128: The Winslow Pathway and Internal Mammary Artery Harvesting in Patients With Aortoiliac Occlusive Disease
Authors: Muhammad Hassan Shakir, Salman Abdul Basit, Muhammad Sabih Saleem, nasir hameed, Muhammad S Pir
Journal: Circulation (2023)

Introduction We present a case where the left Internal Mammary Artery (IMA) was not a straightforward choice as the grafted vessel in a patient undergoing Coronary Artery Bypass Grafting (CABG). Case Presentation Patient was a 66 years old female with Hypertension, Hyperlipidemia, hypothyroidism, and tobacco use disorder. Evaluation for a motor vehicle accident secondary to a syncopal episode, and intermittent chest tightness over the past few months, showed ST depressions on ambulatory electrocardiographic monitoring, reversible ischemia in the anterior and apical walls on Exercise Stress Test and severe multivessel coronary artery disease involving the distal main left coronary artery and its branches on Coronary Angiography. CABG was advised. Preoperative peripheral angiogram showed bilateral common iliac artery occlusion, precluding IABP placement. Selective angiography of the left IMA showed the left IMA to be the major vessel supplying collateral circulation to the left iliac system. Patient subsequently underwent CABG with bilateral Saphenous Vein Harvest. Discussion IMA harvesting in patients with Aortoiliac Occlusive Disease (AOD) with prominent collaterals through the subclavian-IMA-inferior epigastric-external iliac pathway, AKA the Winslow Pathway (WP), can result in limb threatening ischemia, and elective IMA angiography and/or doppler flow evaluation before CABG can help identify this important collateral pathway. Alternative approaches in patients with AOD include simultaneous coronary and peripheral revascularization, completely avoiding IMA harvesting or in some cases, angioplasty, although there is no consensus thus far.
Abstract 13194: Association Between Left Atrial Function and Frailty: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Daokun Sun, Romil Parikh, Wendy Wang, ANNE EATON, Pamela L Lutsey, B Gwen Windham, Riccardo M Inciardi, Scott Solomon, Amil M Shah, Lin Y Chen
Journal: Circulation (2023)

Background: Frailty is highly common in people with cardiovascular disease. Worse left atrial (LA) function is an independent risk factor for cardiovascular disease. However, whether worse LA function is independently associated with frailty is unclear. Aim: To evaluate the association of LA function with incident frailty in community-dwelling older adults. Methods: We included 3,292 older adults from the Atherosclerosis Risk in Communities (ARIC) study who were non-frail at baseline (visit 5, 2011-2013) and had LA function (reservoir strain, conduit strain, and contractile strain) measured from two-dimensional speckle-tracking echocardiography. The validated Fried frailty phenotype, which includes measurements of weight loss, slowness, exhaustion, weakness, and low physical activity, was used to define frailty (≥3 of the 5 components). Incident frailty was assessed between 2016 and 2019 during 2 follow-up visits; all the included participants attended at least 1 of the 2 visits. LA function was assessed continuously (per 1-SD decrement) and categorically in quintiles. Multivariable logistic regression was used for analysis. Results: The median (IQR) age was 74 (71-77) years (58% female) and 214 (7%) participants developed frailty during a median (IQR) follow-up of 6.3 (5.6-6.8) years. After adjusting for potential confounders, each 1-SD decrement in LA reservoir strain and LA contractile strain was associated with 35% (95% CI: 11-65%) and 22% (95% CI: 2-45%), respectively, greater odds of developing frailty ( Table 1 ). Compared to the highest quintile, participants in the lowest quintile of LA reservoir strain had 2.3-fold greater odds of developing frailty. Conclusions: Worse LA function is associated with higher incidence of frailty. Future studies are needed to investigate the mechanism underlying this association.
Abstract 16298: Higher Genetic Risk for Neuroticism Heightens Cardiovascular Risk Related to Chronic Sleep Deprivation
Authors: Shady Abohashem, Simran S Grewal, Wesam Aldosoky, Iqra Qamar, Giovanni Civieri, Abdulaziz Alhamam, Omar Alani, Erin R Hanlon, Charbel Gharios, Antonia V Seligowski, Karmel Choi, Jordan W Smoller, Michael Osborne, Ahmed A Tawakol
Journal: Circulation (2023)

Introduction: Chronic sleep deprivation associates with an increased risk of Major Adverse Cardiovascular Events (MACE), in part via heightened stress-related neural mechanisms. Similarly, increased polygenic risk score for neuroticism (nPRS), a measure linked to stress-sensitivity, associates with greater activity in stress-related neural pathways. Hypothesis: We hypothesized that higher nPRS increases the MACE risk associated with chronic sleep deprivation. Methods: A total of 9,619 participants (median age 65 years, 46% male) from the Mass General Brigham Biobank were studied. nPRS was assessed. Sleep deprivation was defined as either a short sleep duration (&lt;7 hours/night) or a diagnosis of a sleep disorder (e.g., insomnia, sleep apnea). Sleep duration and disorders, MACE incidence, and cardiovascular risk factors were assessed using health questionnaires and International Classification of Disease codes. Logistic regression models were employed to evaluate the association between sleep deprivation and MACE and the presence of an interaction. Results: During a median (Interquartile range) of 4.9 (4.1-5.9) years of follow-up, 807 (8.3%) individuals experienced MACE. Among individuals with higher nPRS (≥median), sleep deprivation associated with a two-fold increase in MACE risk (odds ratio [OR] [95% confidence interval (CI)]: 2.283 [1.929, 2.703], p&lt;0.001*) compared to individuals with lower nPRS (&lt;median) (OR [95%CI]: 1.632 [1.390, 1.917], p&lt;0.001*; Table 1 ) with a significant interaction observed (p=0.010*). A similar trend was observed in a sensitivity analysis that excluded sleep apnea (p-interaction 0.074). Conclusions: Our findings suggest that a high nPRS doubles the MACE risk associated with sleep deprivation. Further research is warranted to elucidate the underlying mechanisms driving this relationship.
Abstract 15311: Predict Factors Affected With In-Hospital Clinical Outcomes Between Endovascular Therapy and Fogarty Thrombectomy for Patients With Acute Limb Ischemia: A Large Number Analysis Based on JROAD-DPC Database
Authors: Takaaki Ozawa, Kenji Yanishi, Tomotsugu Seki, Jun Yoshimura, Daiki Goto, Hirofumi Kawamata, Hideo Tsubata, Naohiko Nakanishi, Takeshi Nakamura, Kan Zen, Satoaki Matoba
Journal: Circulation (2023)

Background: The etiology of acute limb ischemia (ALI) has been often reported to be embolism caused by atrial fibrillation (Af) and/or atrial flutter (AFL), and thrombosis caused by atherosclerosis. Although endovascular therapy (EVT) or fogarty thrombectomy (Fogarty) is recommended as a primary treatment for patients with ALI, which treatment should be chosen is still controversial. Aim: To evaluate differences of clinical outcomes between primary treatments for patients with ALI, and identify prognostic predictors. Methods: This was a retrospective study based on the database in the JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination). Figure.1 showed the flow chart of this study. Comparison with EVT-alone and Fogarty-alone group was analyzed using propensity score matching with 16 clinically relevant covariates. Clinical outcomes were death, major adverse cardiovascular events (MACE; myocardial infarction, coronary intervention, heart failure, stroke, cerebral hemorrhage), bleeding complications with bleeding academic research consortium (BARC) type 3-5, and any amputation. Results: Figure2-4 showed the results of this study. Figure.3 demonstrated that bleeding complications and any amputation in Fogarty-alone group were significantly less than EVT-alone group. Figure.4 revealed that Fogarty tended to decrease an amputation-free survival rate in ALI patients who had no history of peripheral artery disease (PAD) and not administered an antiplatelet before onset. Conclusions: Fogarty should be selected as the primary treatment as much as possible for ALI patients, especially those without PAD.