tbuckley/cabot-search huggingface dataset:
Abstract 14300: Biomarkers of Myocardial Injury, but Not Systemic Inflammation, Predict the Risk of Incident Ventricular Arrhythmia
Authors: Egil Riveland, Nur Sourur, Patrycja Naesgaard, Harald Kjekshus, Alf Inge Larsen, Helge Rosjo, Torbjorn Omland, Peder L Myhre
Journal: Circulation (2023)

Background: Cardiac troponins and biomarkers of inflammation are elevated in heart failure (HF) and predict cardiovascular risk. Whether these biomarkers associate with risk of ventricular arrhythmias (VA) is unclear. Purpose: To assess whether cardiac Troponin T (cTnT), growth differentiation factor 15 (GDF-15), interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations are associated with incident VA. Methods: In a prospective, observational study of patients treated with implantable cardioverter defibrillator (ICD), cTnT, GDF-15, IL-6, and CRP were measured at baseline and after 1.4±0.5y, and associated with ICD-detected incident VA, HF hospitalizations and mortality. Results: We included 489 patients, aged 66±12y and 83% were men. Median (quartile 1-3) concentrations of cTnT were 15 (9-25) ng/L at inclusion, and higher concentrations were associated with higher age, male sex, diabetes mellitus, coronary artery disease (CAD), and HF. During 3.1±0.7y follow-up, 137 (28%) patients had ≥1 VA. cTnT concentrations were associated with an increased VA risk (HR 1.63 [95% CI 1.31-2.01] per log-unit, p&lt;0.001), also after adjustment for age, sex, BMI, CAD, HF, renal function, and LVEF (p&lt;0.001). GDF-15, IL-6, and CRP concentrations were not associated with incident VA, but all (including cTnT) were associated with HF hospitalization and mortality. Changes in cTnT, GDF-15, IL-6, and CRP from baseline to 1.4y were not associated with subsequent VA. Conclusions: Higher concentrations of cTnT, GDF-15, IL-6, and CRP associate with HF hospitalization and death, but only cTnT predicts incident VA. These findings suggest that myocardial injury rather than inflammation may play a pathophysiological role in VA and sudden cardiac death.
Abstract 17642: Takotsubo Cardiomyopathy After Guillian Barre Syndrome
Authors: Saher Taj Shiza, Kenneth Ong, Zahoor Ahmed
Journal: Circulation (2023)

Introduction: Guillian Barre Syndrome (GBS) has the potential to cause acute and long-term cardiac effects. Takotsubo Cardiomyopathy(TCM) is a life-threatening manifestation of dysautonomia in patients with GBS, although infrequently reported in the literature. We present a case of TCM in the setting of GBS. Case Presentation: A 54-year-old woman with no past history presented with progressive ascending bilateral lower limb weakness, numbness and paraesthesia following a recent chest infection. On exam, she had reduced motor power and absent deep tendon reflexes. MRI brain was normal. CSF analysis revealed albuminocytologic dissociation(1a). Nerve Conduction Studies(NCS) showed severe sensorimotor polyneuropathy with demyelinating features suggestive of GBS. She was treated with plasmapheresis. The next day, she developed respiratory failure and was hemodynamically unstable with persistent tachycardia and labile blood pressure. ECG showed sinus tachycardia with ST-segment depression(1b). Chest CT was normal. Echocardiogram showed moderate anterolateral hypokinesia with an ejection fraction(EF) of 30%. Coronary angiography showed no significant arterial stenosis, suggesting TCM with a diagnostic TCM score of 59 (1c,1d). She received steroids, furosemide and norepinephrine. Repeat ECG and echocardiogram on day 11 were normal with improved EF (52%).This was followed by a Cardiac MRI which was normal (1e). Discussion: The precise etiology of TCM in GBS is unknown and is believed to be related to a complex interplay of autonomic dysfunction, catecholamine release and inflammation. Although rare, TCM is a fatal complication of GBS, warranting urgent evaluation and management. Sudden onset hemodynamic instability and new onset ECG changes may raise the suspicion of TCM in GBS and must be ruled out. Early diagnosis and treatment can improve the patient’s prognosis.
Abstract 17857: Demographic Disparities and Survival Outcomes in Primary Cardiac Tumors
Authors: Nithya Ramesh, Shanjeev Kumar Rajeshkumar Chitra, Harsha Sai Sreemantula, AISHA SULTANA SHAIK, Jawad Basit, Rajesh Thirumaran, Vignesh Sundaram
Journal: Circulation (2023)

Introduction: Secondary cardiac tumors are not uncommon as they are seen in almost 14% of patients with multiple distant metastases, the most common primaries being lung, breast, and hematological malignancies. Whereas, primary cardiac tumors are rare, and only about 10-25% of these are primary malignant cardiac tumors (PMCT). With this study, we aim to analyze the demographic disparities and the determinants of survival in this infrequent group of cardiac neoplasms. Methods: We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database, 17 registries, Nov 2022 sub (2000-2020) for PMCT. A total of 713 samples were obtained after excluding patients with unknown age, race, and survival. Cox proportional hazard regression was used for multivariate survival analysis. Results: The mean age at diagnosis of PMCT was 55.13 ± 20.47 years, with the standard deviation reflecting a wide range and dispersion. Males accounted for 51.75% of the patients. Racial demographics showed a predominance of White (61%), followed by Hispanic (18.65%), Asian/pacific islander (10.09%), and Black (9.67%) populations. The most predominant types were sarcomas (62.27%) and lymphomas (27.48 %), with the rest 10.23% including tumors like mesothelioma and adenocarcinoma among others. Kaplan-Meier method was used to estimate overall survival (OS) at 1, 3 and 5 years to be 50.8%, 26.6% and 18% respectively. Cox regression demonstrated statistically significant differences in survival only with age and histopathology. Older patients [HR 1.008 (1.004-1.012)] had worse OS. Compared to sarcomas, lymphomas [HR 0.45 (0.36-0.55)] had better OS, while the group comprising the other 10.23% of PMCTs [HR 1.52 (1.17-1.96)] had worse OS. No statistically significant differences in survival were noted between males and females, and also between different racial groups. Conclusions: Despite being rare malignancies, PMCTs continue to have a poor prognosis. Though sex and ethnicity do not influence survival, older patients with sarcomas and other rare PMCTs have poorer outcomes. Further investigations aimed at improving survival in these at-risk groups are warranted. This information will also aid providers in advanced care planning.
Abstract 16246: Hypothermic and Hyperkalemic Perfusion Prolonged the Ischemic Time in Porcine Model of Donor After Circulatory Death
Authors: Keita Inoguchi, Takuji Kawamura, Daisuke Yoshioka, Masashi Kawamura, Ai Kawamura, Kizuku Yamashita, Yusuke Misumi, Masaki Taira, Kazuo Shimamura, Shigeru Miyagawa
Journal: Circulation (2023)

Introduction: There is a worldwide shortage of donors in heart transplantation(HTx), and one way to expand donor sources is HTx from donors after circulatory death (DCD). Several nations have successfully incorporated DCD HTx into clinical practices. However, the limitation of ischemic time from cardiac arrest is one of the significant barriers to the expansion of DCD. Hypothesis: Hypothermic and hyperkalemic (HT-HK) perfusion can prolong the time from cardiac arrest to heart procurement. Methods: A model of brain death was created by balloon occlusion of the intracranial cavity of pigs, and the ventilator was stopped to create a controlled DCD model. To mimic HTx, we adopted a model in which the ascending aorta was cross clamped (AXC) under open chest in pigs, systemic circulation was maintained using ECMO, and then the AXC was released to resume heartbeat and evaluate cardiac function. 1. To examine the limitation of the warm ischemic time (WIT), we performed systemic perfusion including the heart after a certain period from cardiac arrest, and evaluate whether the heartbeat resumed or not. 2. Following cardiac arrest, we performed HT-HK perfusion, accompanied by chest opening, AXC for cardioplegia infusion, and simultaneous systemic warming and potassium correction. Then, we evaluate whether the heartbeat resumed and cardiac function. 3. the preserved heart by HT-HK perfusion was transplanted orthotopically into the other pig and evaluated its cardiac function. Results: 1. ECMO reperfusion within 30 minutes after WIT led to heartbeat resumption, while reperfusion after 60 minutes did not. 2. Among the six pigs subjected to HT-HK perfusion, one had cardiac arrest during brain death preparation, and another went into ventricular fibrillation after the release of AXC. However, four pigs resumed heartbeat and normal contraction with an average time of 94.0±9.2 minutes from the cardiac arrest. Cardiac function after HTx from DCD with HT-HK perfusion was favorable, with a left ventricular ejection fraction of 63% after weaning from cardiopulmonary bypass. Conclusions: DCD with hypothermic and hyperkalemic perfusion prolonged the time from cardiac arrest to procurement, and exhibited favorable post-transplant cardiac function, suggesting its usefulness.
Abstract 16312: Sex-Based Differences in Response to Interleukin-1 Blockade With Anakinra in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Giuliana Corna, Michele Golino, Azita Talasaz, Francesco Moroni, Marco Del Buono, Juan Ignacio Damonte, juan guido chiabrando, Cory R TRANKLE, Georgia Thomas, ROSHANAK MARKLEY, Justin M Canada, Jeremy Turlington, Benjamin W Van Tassell, Antonio Abbate
Journal: Circulation (2023)

Introduction: Interleukin-1 blockade with anakinra reduces C-reactive protein (CRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). Sex-based differences in STEMI patients have been reported, but no data are available regarding response to anakinra in this setting. Methods: We analyzed sex-based differences in the systemic inflammation (CRP levels) and composite end-point of new-onset HF or death in patients with STEMI from three different Virginia Commonwealth University Anakinra Response Trial (VCU-ART) randomized clinical trials. Data are reported as median and interquartile range [IQR] or number and percentage (%). Kaplan-Meier curves for event-free survival were constructed for the time-dependent composite endpoint and compared using the log-rank analysis. Results: We analyzed 139 patients from three VCU-ART trials, 29 (21%) were women while 110 (79%) were men. Baseline CRP was higher in women compared to men (8.9 [5.2-13.5] vs 4.2 [2.1-7.7] mg/L, P&lt;0.001). Twenty-two (75%) women and 62 (56%) men were treated with anakinra. Area under the curve (AUC)-CRP at 14 days was numerically lower in patients receiving anakinra versus placebo both in men (86 [37-130] vs 223 [119-374] mg day/L) and in women (73 [46-313] vs 242 [102-988] mg day/L) (P&lt;0.001 at ANOVA for multiple groups, P for interaction 0.22) Figure A . The incidence of the composite endpoint was also numerically lower in the anakinra group compared to placebo, both in men (4 [6.4%] vs 14 [29.1%]) and in women (3 [13.6%] vs 2 [28.5%]) (P=0.019 at ANOVA, P for interaction 0.44) Figure B . There were no statistically significant differences between women and men in AUC-CRP and HF events when comparing separately the anakinra and placebo groups (all P&gt;0.05). Conclusions: Women were underrepresented in the VCU-ART trials, they appeared to have higher CRP levels at time of presentation, yet to benefit similar to men by treatment with anakinra in STEMI.
Abstract 16232: Life’s Essential 8 Cardiovascular Health Score and Cardiorespiratory Fitness in the Community
Authors: Sandhiya Ravichandran, Priya Gajjar, Maura E Walker, Ravi Shah, Vanessa Xanthakis, Gregory Lewis, Matthew G Nayor
Journal: Circulation (2023)

Background: Cardiorespiratory fitness (CRF) is a key indicator of cardiovascular health (CVH) and is inversely associated with cardiovascular disease (CVD) and mortality, but its relations with lifestyle behaviors and factors linked with CVH are incompletely elucidated. Hypothesis: Greater CVH, as assessed by a score comprising lifestyle and standard risk factors, is associated with greater CRF. Aim: To evaluate the cross-sectional relations of AHA’s Life’s Essential 8 (LE8) metrics with CRF in the community. Methods: Maximal cardiopulmonary exercise tests (CPET) were performed in the Framingham Heart Study (FHS). An LE8 score was constructed for each participant by averaging scores across all LE8 components (ranging 0-100). We related CRF and other CPET measures with total LE8 score, individual LE8 components as three-level variables (optimal/suboptimal/poor), and changes in LE8 score over an ≈8 year interval. Results: In 1838 FHS participants (age 54±9 years, 54% women, BMI 28±5 kg/m 2 ), mean LE8 score was 76±12. In age- and sex-adjusted models, a higher LE8 score was associated with higher peak VO 2 , better ventilatory efficiency, lower resting heart rate, and favorable blood pressure response to exercise (p&lt;0.0001 for all). A clinically meaningful 5-point higher LE8 score was associated with a 6.0% greater peak VO 2 (≈1.4 ml/kg/min at the sample mean). There was no evidence of effect modification by age, sex, or CVD status. The eight LE8 score components were statistically significantly associated with peak VO 2 in models adjusted for age and sex, but blood lipids, diet, and sleep health were no longer statistically significant after adjustment for all other LE8 components ( Figure ). Over an ≈8-year interval, a 5-unit increase in LE8 score was associated with a 3.7% higher peak VO 2 (p&lt;0.0001). Conclusion: Higher LE8 score is associated with greater CRF in the community, highlighting the importance of CVH as assessed by LE8 metrics in maintaining and promoting CRF.
Abstract 13257: Impact of Epicardial Adipose Tissue and Its Distribution on Cardiac Function in Patients With Diastolic Dysfunction
Authors: Alexander Schulz, Soeren J Backhaus, Torben Lange, Ruben Evertz, Shelby Kutty, Johannes Kowallick, Gerd P Hasenfuss, Andreas Schuster
Journal: Circulation (2023)

Background: Epicardial adipose tissue (EAT) was identified as an important risk factor for diastolic dysfunction and affects cardiac structural remodeling. However, within this patient group the impact of increased EAT and its regional distribution on cardiac function is yet unclear. Methods: 68 patients with exertional dyspnea (NYHA≥II), preserved ejection fraction (EF≥50%) and diastolic dysfunction (E/e’≥10) underwent rest and stress right heart catheterization (RHC), transthoracic echocardiography and cardiac magnetic resonance (CMR). EAT volumes were depicted from CMR short-axis stacks. First, the impact of increased total EAT was analyzed. Second, we investigated the association of ventricular and atrial EAT with impaired strain at rest and during exercise stress of the adjacent chambers in multivariable regression analysis. Results: Patients with high EAT had higher HFA-PEFF and H2FPEFF-Scores as well as nt-proBNP levels (p&lt;0.048). Furthermore, they were diagnosed with manifest heart failure with preserved ejection fraction (HFpEF) more frequently (low EAT: 37% vs. high EAT: 64%; p=0.029) and had signs of adverse remodelling indicated by higher T1-times (p&lt;0.001).While both groups had no differences in biventricular volumetry and left ventricular mass (p&gt;0.074), functional analysis in high EAT patients revealed impaired atrial strain at rest and during exercise stress, while ventricular strain was impaired during exercise stress only.The assessment of regional EAT revealed an independent association of higher ventricular and atrial EAT with functional impairment of the adjacent chambers. Conclusion: Patients with diastolic dysfunction and increased EAT show more pronounced signs of diastolic functional failure and structural remodeling. Despite similar morphological characteristics, patients with high EAT show significant cardiac functional impairment, in particular of the atria. Our results indicate that regionally increased EAT directly induces atrial functional failure, which represents a distinct pathophysiological feature in HFpEF.
Abstract 15190: Association of Initiating SGLT2i and GLP1Ra Therapeutics on Insulin Utilization and MACE Outcomes Among Patients With Diabetes in an Integrated Healthcare System
Authors: Viet T Le, Heidi T May, Tami L Bair, Stacey Knight, Benjamin D Horne, Kirk U Knowlton, Jeffrey L Anderson
Journal: Circulation (2023)

Background: Nearly 10% of US adults diagnosed with diabetes (DM) begin using insulin within 1 year (yr) of the diagnosis. A third of all patients (pts) with DM experience an atherosclerotic cardiovascular (CV) event. SGLT2is and GLP1Ras, have been shown to reduce major adverse CV events (MACE). Meta-analyses show a reduction in insulin utilization when these medications are initiated individually or concurrently. This study evaluated the real-world impact on MACE and insulin usage among pts with DM initiating SGLT2is and GLP1Ras. Methods: Intermountain pts (n=6,476) ≥18 years of age with ≥3 encounters and on insulin at time of initiation of SGLT2i, GLP1-RA, or combined therapy from January 1, 2012 to November 30, 2021 were studied. Pts were stratified by whether they stopped-insulin (st-in) within 90 days of having started SGLT2i, GLP1Ra, or both or continued-insulin (co-in). MACE was defined as death, MI, CVA, or HF hospitalization and was assessed at 1- and 3-yrs. Results: Of 6,476 pts, 93.3% (n=6,039) st-in and 6.7% (n=437) co-in. St-in pts had less comorbidities, but were older (58.2 vs. 55.0 years), male (55% vs. 48.5%), weighed less (105.5 vs. 110.7 kg), and included fewer pts with DM I (18.5% vs 38.4%). Renal function and hemoglobin A1C were similar. Compared to co-in, pts with st-in were prescribed SGLT2i (30.0% vs 20.4%) or combination (SGLT2i/GLP1Ra) (16.2% vs 11.2%) more often. St-in vs co-in had a higher frequency of MACE, which persisted after adjustment by risk factors, comorbidities, and medications (Table). Conclusion: In pts with DM on insulin, adding SGLT2i, GLP1Ra, or both led to a change in insulin utilization, with &gt;90% of pts stopping insulin entirely. However, we observed an increase in 1-yr and 3-yr MACE for st-in vs co-in pts. This suggests a need for caution when initiating these medications in those already on insulin with regards to insulin management, including a decision to discontinue insulin. More data are needed to further understand our observations.
Abstract 14558: Causes and Predictors of Short-Term Readmissions Following Percutaneous Left Atrial Appendage Closure Procedure in Patients With and Without Rheumatic Mitral Valve Disease
Authors: Naim Battikh, Ufuk Vardar, Ahmad Harb, Aviral Vij
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by erratic heart beats. AF increases the risk of thromboembolic events particularly stroke. Percutaneous left atrial appendage closure (LAAC) is an alternative option to prevent embolic stroke in patients with AF who have contraindication to anticoagulants. Up to our knowledge, this is the first National Readmission Database (NRD) study to elucidate the difference in readmission rates between rheumatic vs non-rheumatic AF patients who underwent LAAC. Methods: We utilized the Nationwide Readmissions Database (NRD) between the years 2016-2020. The study involved hospitalizations with rheumatic mitral valve disease (R-MVD) and non-rheumatic mitral valve disease (NR-MVD) who underwent LAAC using ICD-10 diagnostic codes. We deemed this as the index admission. We excluded patients less than 18 years old and October-December hospitalizations from 90-day readmission analysis, due to lack of adjoining period to assess readmission. Results: Among 9,150 patients with mitral valve disease who underwent LAAC in their index hospitalizations, 9,122 were discharged alive. 4,200 patients (45.8%) were readmitted in 90-days. R-MVD 90-day readmission rate compared to NR-MVD (52.3% vs 40.7% respectively, p&lt;0.001). The most common cause of readmission in both groups was atrial fibrillation, 96% of total readmissions in R-MVD and 97% of total readmissions in NR-MVD group. This was followed by “accidental puncture and laceration of a digestive system organ or structure” in 0.3% of R-MVD group vs “mitral valve insufficiency” in 0.7% of NR-MVD readmission causes. Figure 1 shows the Forest plot of multivariate analysis of independent factors associated with readmissions. Conclusion: Among AF patients who underwent LAAC with or without history of mitral valve rheumatic heart disease, those with history of R-MVD had significantly higher 90-day readmission rate.
Abstract 15003: Risk Factors Associated With the Initiation and Progression of Mitral Annular Calcification: A Two-Step Process
Authors: Kyung An Kim, Soyoung Lee, Yuran Ahn, DONGHYEON LEE, Hae-Ok O Jung
Journal: Circulation (2023)

Background: Mitral annular calcification (MAC) is hypothesized to be a representation of atherosclerosis and is associated with adverse outcomes. However, the pathophysiology and risk factors associated with MAC are not completely understood. Methods: From the KOrea Initiatives on Coronary Artery calcification registry, 738 asymptomatic individuals who underwent health screening with echocardiography and serial cardiac computed tomography (CT) scans were included for analysis. MAC was identified on CT and measured using Agatston units (AU). Risk factors associated with the initiation of MAC were identified with multivariable logistic regression, and risk factors associated with the progression of MAC were determined using multivariable linear regression on the annualized progression of the MAC AU. Results: The initial prevalence of MAC was 7.0%, and the median rate of progression was 3.4 AU/year (IQR 0.2-14.7 AU/year) during a median interscan duration of 36.4 months. In addition, 4.3% of the participants developed new MAC between the first and last examinations. The factors associated with the initiation of MAC were age (p&lt;0.001), body mass index (p=0.046), history of smoking (p=0.048), HbA1c (p=0.011), and left atrial volume index (p=0.034). Meanwhile, the factors associated with MAC progression were initial MAC Agatston score (p&lt;0.001), male sex (p=0.005), and calcium-phosphorus product (p=0.002). Conclusion: Traditional cardiovascular risk factors and increased hemodynamic stress seem to be more important in the initiation of MAC, while initial MAC severity and calcium-phosphate metabolism seem to be a major determinant in the later phase of MAC progression.