tbuckley/cabot-search huggingface dataset:
Abstract 18223: The Afro-DPP Program: A Pilot Cluster-Randomized Virtual Cardiometabolic Health Program to Improve Hypertension and Glycemic Control Among African Immigrants
Authors: Oluwabunmi V Ogungbe, Ruth-Alma Turkson-Ocran, Thomas Hinneh, Loretta Owusu, Erin Spaulding, Jasmine Mensah, Serina Gbaba, Aminata Sinyan, Adeline Assani-Uva, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Background: Black persons and immigrants in the US are disparately impacted by poor cardiometabolic health (CMH). We hypothesized that combining lifestyle intervention with culturally specific curriculum and remote monitoring will improve CMH. Aim: To test the effectiveness of a culturally tailored intervention on blood pressure (BP) and hemoglobin (Hb) A1ccontrol among African Immigrants. Methods: Afro-DPP is a pilot cluster-randomized trial (NCT05144737) that compared effectiveness of a multicomponent CMH intervention in 60 adults with &amp;ge;2 CMH risk factors attending two churches (first intervention or delayed intervention arms). First intervention arm began the lifestyle intervention with a Lifestyle Coach; delayed intervention arm began 6 months later. The outcomes were 6-month change in BP, body weight, and HbA1c. Results: There were 30 adults in each arm, mean age was 50.6(±11.9) years. At 6 months, in the first intervention arm, systolic BP and diastolic (BP decreased by 11.32 mmHg and 9.73 mmHg, respectively; in the delayed intervention arm SBP and DBP decreased by 9.31 mmHg and 5.34 mmHg, respectively ( Figure ). In the first and delayed intervention arms, we observed a 2.6kg and 2.4kg weight reduction, respectively. HbA1c reduction was greater in the first compared to delayed intervention arm (-0.29, 95% CI, -0.58 to 0.01%). Likelihood of BP (&amp;lt;130/80mmHg) and HbA1c (&amp;lt;7%) control were 2.00 (95% CI 1.73 to 2.29) and 1.57 (95% CI 1.02 to 2.42) times higher in the first compared to delayed intervention arm. Conclusions: The improvement in BP and body weight supports effectiveness of a culturally specific multicomponent intervention in improving CMH among African immigrants.
Abstract 16816: The Impact of Age in Patients Undergoing Impella-Assisted High-Risk Percutaneous Coronary Intervention: It Gets Complicated
Authors: Tia Bimal, Janta Ukrani, Joanna Fishbein, Samy Selim, Puneet Gandotra, Lawrence Ong, Luis Gruberg
Journal: Circulation (2023)

Background: The Impella ventricular assist device is often used in patients (pts) with complex coronary artery disease undergoing high-risk percutaneous coronary interventions (PCI). Limited data exits on the risks and benefits of these devices in elderly pts. Aim: To compare major bleeding and major adverse cardiac and cerebrovascular events (MACCE) in pts undergoing Impella-assisted PCI, categorized by age groups. Methods: Data was collected for quality control on pts undergoing Impella-assisted PCI. Pts were divided by age into three groups: ≤69, 70-79 and ≥80 years. Bleeding was classified by Bleeding Academic Research Consortium (BARC). MACCE was the composite of major bleeding (BARC ≥3), death and post-PCI myocardial infarction and stroke. Results: From 2010 to 2018, 252 pts had Impella-assisted PCI (Table). Pts ≤69 were often male, presented with STEMI or NSTEMI (61%) and had lower left ventricular ejection fraction (LVEF) complicated by cardiogenic shock (CS). Bleeding complications, mortality and MACCE were similar among the groups. Covariate adjustment showed pts 70-79 were not at a higher risk of MACCE compared to ≤69 pts, whereas pts ≥80 had 2.7-fold odds of MACCE compared to pts ≤69 (Figure). Conclusion: In Impella-assisted PCI pts: 1) indications for Impella varies across different ages; 2) younger pts (≤69) were healthier but in the midst of an acute coronary syndrome with severely reduced LVEF and CS; 3) BARC ≥3, mortality and MACCE were similar among the three groups; 4) by multivariable analysis, older age, female sex, STEMI and pre-PCI CS were independent predictors of MACCE; and 5) the odds of MACCE increased by almost 3-fold in pts ≥80 when compared to younger pts.
Abstract 16546: Impact of Hyperuricemia on 5-year Clinical Outcomes in Patients With Percutaneous Transluminal Angioplasty
Authors: Seung-Woon Rha, Woo Jin Ahn, Seong Joon An, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Jinah Cha, Sujin Hyun, Soohyung Park, Dong Oh O Kang, Eun Jin J Park, Cheol Ung Choi
Journal: Circulation (2023)

Background: Although the correlation between hyperuricemia and cardiovascular disease (CVD) is well known, there have been limited data regarding the impact of hyperuricemia on long-term clinical outcomes in patients with peripheral arterial disease (PAD) after percutaneous transluminal angioplasty (PTA). Methods: A total of 943 patients who underwent PTA for PAD were enrolled. The patients were divided into the hyperuricemia group (N=168) and the normal group (N=550). Hyperuricemia was defined as a uric acid level ≥7.0 mg/dL in men, and ≥6.5 mg/dL in women. The primary endpoint was major adverse cerebral and cardiovascular event (MACCE), including death, myocardial infarction (MI), any coronary revascularization and stroke, up to 5 years. The secondary endpoint was major adverse limb event (MALE), including any repeated PTA, and target extremity surgery (TES). In addition, inverse probability weighting (IPTW) analysis, derived from the logistic regression model, was performed to adjust potential confounders. Results: After IPTW matching analysis, compared to the normal group, the hyperuricemia group was not associated with MACCE but associated with an increased incidence of MI (2.6% vs. 0.5%, p = 0.001), and coronary revascularization (6.7% vs. 3.9%, p = 0.018). Also, the hyperuricemia group was associated with higher incidence of MALE (45.3% vs. 28.9%, p &lt; 0.001), including a target extremity revascularization (TER; 25.1% vs. 15.9%, p &lt; 0.001), non-TER (11.5% vs. 5.6%, p &lt; 0.001), and TES (22.8% vs. 16.2%, p = 0.002). Conclusions: In the present study, hyperuricemia was associated with worse clinical outcomes during 5-year clinical follow-up. Further investigations should be made regarding the clinical benefit of controlling hyperuricemia on clinical outcomes.
Abstract 15363: Equivalent Total Medical Costs Between Remote Cardiac Rehabilitation and Facility-Based Cardiac Rehabilitation
Authors: Andrew Oehler, Ericka Holmstrand, Lulu Zhou, Arash Harzand, Harshvardhan Vathsangam, Kellee Kendall, George Gabriel, Srinivas Murali
Journal: Circulation (2023)

Purpose: Remote cardiac rehabilitation (RCR) represents a promising, non-inferior alternative to facility-based cardiac rehabilitation (FBCR). The comparable cost of RCR in US populations has not been previously studied. The purpose of this prospective, patient-selected study of traditional FBCR vs. a 3 rd party RCR platform was to assess whether RCR can be administered at comparable cost and clinical efficacy to FBCR. Methods: Adult insured patients were eligible for enrollment following an admission for a coronary event. Patients selected either FBCR or Movn RCR, a 12-week telehealth intervention using an app-based platform and internet-capable medical devices. Clinical demographics, intervention adherence, cost-effectiveness, and hospitalizations at 1-year post-enrollment were assessed from the Highmark claims database following propensity matching between groups. Results: A total of 260 patients were included, and 171 (65.8%) of those eligible received at least one cardiac rehab session, half of those choosing Movn RCR. Propensity matching produced a sample of 41 matched pairs between FBCR and RCR groups. Movn RCR led to quicker program initiation and higher completion rates (80% vs. 50%). Total medical costs were similar between Movn RCR and FBCR, though tended toward cost savings with Movn RCR ($10,574/patient). Cost of cardiac rehabilitation was lower in those enrolled in Movn RCR ($1377/patient, p=0.002). All-cause and cardiovascular-related hospitalizations or ED visits in the year following enrollment in both groups were similar. Conclusions: This pragmatic study of patients after a coronary event led to equivalent total medical costs and lower intervention costs for an RCR platform when compared to traditional FBCR while maintaining similar clinically important outcomes.
Abstract 17867: Inward Displacement: A Novel CMR Technique for Quantification of Myocardial Wall Motion in Patients With Myocardial Infarction
Authors: Erasmo De La Pena-Almaguer, Aldo Ponce, Jaime Guajardo
Journal: Circulation (2023)

Introduction: Inward displacement (InD) is a novel parameter which quantifies myocardial wall motion (WM) by measuring the distance travelled by endocardial tracked points towards their corresponding center of the left ventricle in systole, calculated from 3 LAX views obtained during CMR. Hypothesis: InD using CMR is capable of obtaining global quantifiable measurement of WM abnormalities in patients with myocardial infarction (MI) as defined by Late Gadolinium Enhancement (LGE). Methods: We compared patients with history of MI documented by LGE CMR.Studies were acquired in a 1.5 T Siemens Aera (Siemens, Erlangen Germany) scanner with an 18-channel body array coil; Multi-planar ECG-gated cine CMR was obtained using a balanced steady-state free precession readout and LGE images were acquired using an IR prepped sequence 10 min after Gadolinium contrast injection. Offline analysis using automated endocardial LV contour detection was conducted for each of the LAX series and manual corrections were performed as required. InD was measured in mm and expressed as a percentage. Values were compared between MI patients and normal subjects, and analyzed using a Medis Suite workstation (Medis Medical Imaging BV, Leiden, The Netherlands). Results: We analyzed 646 segments in 38 patients of which 9 had past history of myocardial infarction. Global InD for healthy subjects was 28% vs 19% SEM 0.97, as compared to patients with MI (p:&lt; 0.00001). Conclusions: InD is capable of quantification of abnormal motility in subjects with myocardial infarction, therefore producing an objective measure of LV segmental WM abnormalities, further studies are warranted.
Abstract 16612: Cardiomyocyte PGC-1α Prevents Cardiac Atrophy and Failure in Response to Endurance Exercise Training
Authors: Sumeet Khetarpal, Haobo LI, Claire Castro, Nicholas A Houstis, James Rhee, Hans-Georg Sprenger, Melanie Mittenbuhler, Alexandra Kuznetsov, Rebecca Freeman, Aarti Asnani, Phillip Dumesic, Jason D Roh, Anthony Rosenzweig, Bruce Spiegelman
Journal: Circulation (2023)

Introduction: Aerobic exercise promotes physiologic hypertrophy of the heart in healthy individuals. In skeletal muscle and heart, a key orchestrator of the adaptation to exercise is the transcriptional regulator PGC-1α. PGC-1α may mediate cardiac adaptation to physiological stress through myriad mechanisms. The role of cardiac PGC-1α to the systemic training response is poorly understood. Methods: We generated PGC-1α cardiomyocyte-specific knockout (KO) mice to study its role in endurance exercise. We also silenced Ppargc1a expression in a cell model of physiologic cardiomyocyte hypertrophy. Results: Sedentary KO mice demonstrated normal cardiac function and minimal differences in acute exercise tolerance. However, KO mice demonstrated a lack of ability to augment exercise capacity after 6 weeks of wheel running (work achieved 32.9 J in WT [39% increase] vs 23.1 J in KOs [no change vs baseline], p&lt;0.001, unpaired t-test). This was despite comparable voluntary wheel distance run during training (2.93-3.67 km/day for both over 5 weeks, p=0.58). Unexpectedly, after 6 weeks of training, KO mice developed a dilated cardiomyopathy and exercise-related dysfunction (contractile reserve [ΔFS stress-rest ] +6.0 in WT vs -6.4% in KO, p&lt;0.05, unpaired t-test). They also demonstrated features of cardiac cachexia as measured by 27% and 19% reductions in inguinal adipose and gastrocnemius mass, respectively (P&lt;0.05, unpaired t-test). RNA sequencing of the hearts from these mice demonstrated activation of pathological ( Nppa , Nppb , Myh7/Myh6 ), fibrotic and atrophic secreted factors ( Gdf15 , Fstl3 ). Silencing Ppargc1a in rat cardiomyocytes after IGF1 treatment failed to induce physiologic hypertrophy and activated fibrotic programs and conferred atrophy. Conclusions: Our studies posit cardiomyocyte PGC-1α as a key mediator of the adaptive response to exercise training and unveil its central role in protecting from exercise-related cardiac atrophy and fibrosis.
Abstract 15359: Impact of App-Based Monitoring and Remote Patient Management Services on Real-World Cardiac Device Clinic Workflow
Authors: Emmanuelle Nicolle, Roger Beadle, Susan Hughes, Sarah C Rosemas, Jason Sims, Mirko De Melis
Journal: Circulation (2023)

Introduction: Remote monitoring (RM) is recommended as standard of care for follow-up of patients implanted with cardiac devices. International medical societies have advised that reducing the frequency of or eliminating routine in-office visits is possible, if RM compliance is ensured. With the growing patient population, staff workload to manage RM is increasing. Solutions are needed to alleviate clinic burden. Hypothesis: A technology and service-enabled workflow including app-based monitoring, patient support, and monitoring and triaging services can positively impact clinic efficiency and satisfaction. Methods: A workflow survey for LINQ II insertable cardiac monitor (ICM) was undertaken, including questions about RM. Respondents were clinicians at 66 clinics in UK/Ireland, managing an average of 563 ICM patients per clinic. Results: With app-based monitoring, workflow was rated as somewhat or much more efficient for 72% of users, with reduction in phone calls and disconnected patients highlighted as improvements (Table). The patient support service, including RM education, ordering the appropriate monitor, initial set-up, troubleshooting, and answering patient phone calls, saved 30.6 mins per implanted patient. The monitoring and triaging service had a positive efficiency impact for 69% of users. A majority of respondents were moderately or extremely satisfied with the RM solutions offered: 88% for being provided different options (app/hardware), 75% for users of the support service and 71% for users of the monitoring/triaging service. App-based monitoring was considered moderately or extremely easy by 77% of users and 79% were moderately or extremely satisfied with it. Conclusions: This survey suggests that app-based RM, patient support and monitoring and triaging services provide satisfaction and workflow efficiency improvements. Enabling time savings for RM is key to optimize management of the growing population of implanted patients.
Abstract 15380: Diagnostic Performance of Ultrasonic Flow Ratio versus Quantitative Flow Ratio for Assessment of Coronary Artery Stenosis
Authors: Cheng Yang, Yong-Gang Sui, Jie Qian
Journal: Circulation (2023)

Introduction: Ultrasonic flow ratio (UFR) is a novel intravascular ultrasound (IVUS)-derived method for fast computation of fractional flow reserve (FFR) without pressure wires and adenosine. Aims: The aim of this study was to evaluate the diagnostic performance of UFR and compare it with angiography-based quantitative flow ratio (QFR), using FFR as the reference standard. Methods: Patients who underwent coronary angiography, IVUS and FFR were analyzed. UFR and QFR was computed offline in a central core-lab by independent analysts blinded to FFR. Results: A total of 111 paired comparisons between UFR, QFR and FFR from 56 patients were analyzed. UFR showed a numerically better correlation (r=0.83 vs. 0.79; p=0.27) and significant better agreement (standard deviation of the difference=0.07 vs. 0.08; p=0.02) with FFR than QFR. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio for UFR to predict FFR was 92% (95% CI: 85%-96%), 85% (95% CI: 71%-94%), 97% (95% CI: 89%-99%), 95% (95% CI: 83%-99%), 90% (95% CI: 82%-95%), 27.6 (95% CI: 7.0-108.4), and 0.16 (95% CI: 0.08-0.31), respectively. The area under curve for UFR to predict an FFR ≤ 0.80 was 0.94, is equivalent to QFR (difference=0.04; p=0.23), and higher than minimal lumen area (difference=0.09, p=0.006). Diagnostic accuracy was not significantly different in bifurcation lesions, nor in non-bifurcation lesions. Conclusions: The UFR showed good diagnostic concordance with FFR, equivalent to QFR. The good diagnostic performance of UFR provides a potentiality for the integration of physiological assessment and intravascular imaging in real-world clinical practice.
Abstract 18383: Body Composition Changes in Peak Oxygen Uptake Responders and Non-Responders During Cardiac Rehabilitation
Authors: Salaheddin M Sharif, Jenna L Taylor, Amanda Bonikowske, Thomas P Olson
Journal: Circulation (2023)

Introduction: Cardiac rehabilitation (CR) is known to improve peak oxygen uptake (VO 2 peak) and body composition (BC). However, not all CR patients improve VO 2 peak and it remains unclear if non-responders also exhibit limited improvement in BC. This study aimed to examine if non-responders to VO 2 peak also demonstrate limited improvement in BC and whether BC is related to VO 2 peak changes in CR patients. Methods: Retrospective analysis of patients who completed CR between 2015 and 2022 at Mayo Clinic. The study included 143 patients who completed both dual-energy X-ray absorptiometry and cardiopulmonary exercise testing before and after CR. Patients were grouped by VO 2 peak response to CR (36 non-responders=Δ≤0 vs 107 responders=Δ&gt;0 mL/kg/min). Within and between-group differences were assessed by paired and independent t-tests respectively. Regression models were used to evaluate whether baseline BC or ΔBC predict VO 2 peak changes. Results: As an entire cohort there were significant mean improvements in VO 2 peak and BC (Table 1, p&lt;0.05). VO 2 peak increased in 75% of patients (responders: Δ 2.9±2 vs non-responders: Δ -2.1 ±2, mL/kg/min, p&lt;0.05). There were no significant differences in baseline characteristics between groups including BC (Table 2, p&gt;0.05); however, non-responders had significantly shorter duration and exercise sessions compared to responders (Table 2, p&lt;0.001). Non-responders for VO 2 peak exhibited a significant improvement in body fat mass, body lean percentage, body fat percentage, and fat mass index (all p&lt;0.001), with no differences in ΔBC between groups (Table 3). Regression models revealed no significant BC predictors for VO 2 peak. Conclusion: Despite significant improvements in BC, 25% of patients did not improve VO 2 peak with CR. These data suggest VO 2 peak improvement is not related to baseline BC or change in BC. These findings suggest the need for additional strategies to maximize improvements in VO 2 peak for patients undergoing CR.
Abstract 15483: Mitoquinone Pretreatment Mitigates Dox-induced Systolic Dysfunction in Isolated Rat Hearts
Authors: Juliet Melnik, Kimberly Dawes, Meagan Lyons, Gabby Ghasb, Jonathan Amora, Lindon Young, Robert Barsotti, Qian CHEN
Journal: Circulation (2023)

Background: Doxorubicin (DOX) is a common and effective chemotherapeutic agent that can exert cardiotoxicity by inducing oxidative stress in mitochondria, compromising mitochondrial function, and inducing apoptosis. Currently, there is no treatment that targets this mechanism. We previously found that pretreatment with higher concentrations of mitoquinone (MQ), a mitochondrial antioxidant, exerts cardioprotection against DOX in myoblast H9C2 cells. Hypothesis: We hypothesize that MQ pretreatment would preserve cardiac function against DOX in isolated rat hearts. Methods: Cardiac parameters (heart rate (HR) and left ventricular end systolic pressure (LVESP)) were monitored before and after 60 min infusion of DOX, MQ, or DOX with MQ pretreatment (10-15 min) in a Langendorff preparation of male SD rat hearts. TUNEL assay was conducted on heart tissue slides to evaluate apoptosis. The ratio between the final and initial cardiac parameters was calculated and compared among experimental groups. Results: Higher dose DOX (25 μM, n=5) induced a higher reduction in the ratios of LVESP, to 39±5% than lower dose DOX infusion (20 μM, n=3; 74±3%). DOX had no effects on HR. A 60-minute perfusion of higher doses of MQ (1-5 μM, n=7) unexpectedly reduced the ratios of LVESP and HR to 73±12% and 66±5%, respectively. Higher dose MQ (1-2.5 μM, n=6) pretreatment showed similar improvement of LVESP ratio (68±9%) to lower dose MQ (0.25-0.5 μM, n=6; 71±11%). TUNEL assay showed that higher dose DOX caused a higher rate of apoptosis (number of TUNEL-positive nuclei) (326.3±6.4. n=3) than lower dose (214±29.5, n=3). Pretreatment with higher dose MQ prior to DOX 25 μM infusion resulted in a notable reduction of apoptosis (60.3±5, n=6) compared to DOX alone, while lower dose pretreatment reduced apoptosis to 70.5± 0.5 (n=4). Conclusion: This study suggests that infusion of DOX into the heart acutely attenuated cardiac systolic function accompanied with higher apoptotic cell damage. Although prolonged administration of higher doses of MQ suppressed cardiac function, MQ pretreatment for 10-15 minutes mitigated DOX-induced systolic dysfunction and reduced cardiomyocyte apoptosis. In summary, MQ pretreatment may mitigate DOX-induced cardiac damage.
Abstract 18358: Preclinical Evaluation of the Safety and Activity of JK07, A Novel Bifunctional Neuregulin Antibody Fusion Which Selectively Activates ErbB4, for the Treatment of Heart Failure
Authors: Samuel L Murphy, Wai Hong W Tang, Xiaolei Zhuang, John Li
Journal: Circulation (2023)

Background: Neuregulin (NRG) is a cardioregenerative growth factor that stimulates ErbB3 and ErbB4 signaling. NRG exhibited promising activity clinically in NYHA II/III heart failure (HF) patients, but concerns over cancer risk and GI tolerability limited development. Selective ErbB4 agonism might improve the tolerability and safety of NRG, but this hypothesis has not been evaluated previously due to lack of a selective ErbB4 agonist. JK07 is an ErbB3 antagonist antibody fused with the active domain of NRG-1, designed to selectively stimulate ErbB4. Methods: ErbB3 and ErbB4 activation by JK07 was evaluated in vitro in comparison to NRG-1. A left anterior descending (LAD) ligation model of HF in rats evaluated the ability of JK07 to improve left ventricular ejection fraction (LVEF) and alleviate symptoms of HF in comparison to control antibody-fused NRG-1. A rhesus macaque model of spontaneous heart failure was used to evaluate JK07’s ability to improve LVEF in animals with reduced LVEF (HFrEF) and to improve diastolic dysfunction in animals with preserved LVEF (HFpEF), in comparison to vehicle control and sacubitril/valsartan. Results: JK07 showed ErbB4 activation equivalent to NRG-1 in vitro, but significant attenuation of ErbB3 activation. In the LAD ligation model, JK07 induced dose-dependent increased LVEF, reverse remodeling, reduced collagen I deposition, reduced peripheral edema, increased exercise capacity and decreased infarct size. JK07 improvements were comparable to control NRG. In the rhesus model of HFrEF, both sacubitril/valsartan and JK07 treatment increased EF by at least 5% absolute in 7/10 animals, compared to 0/6 animals with placebo. In the rhesus model of HFpEF, diastolic dysfunction was improved by at least one grade in 6/10 animals receiving JK07, 1/10 animals receiving sacubitril/valsartan, and 0/6 animals receiving placebo. Conclusions: JK07 selectively activates ErbB4 in vitro. In a rodent LAD model of HF, selective ErbB4 activation was as effective as NRG-1 in improving LVEF and symptoms. In a spontaneous heart failure model in rhesus macaques, JK07 treatment was comparable to sacubitril/valsartan in the treatment of HFrEF and superior to sacubitril/valsartan in the treatment of HFpEF.