tbuckley/cabot-search huggingface dataset:
Abstract 4141333: Predictors of venous thromboembolism in hospitalized patients with COVID-19
Authors: Giovanni Scimeca, Darsiya Krishnathasan, Sina Rashedi, Alyssa Sato, Zhou Lan, Nada Hamade, Antoine Bejjani, Candrika Khairani, Julia Davies, Nicole Porio, Ali Assi, Andre Armero, Anthony Tristani, Marcos Ortiz-Rios, Victor Nauffal, Zaid Almarzooq, Eric Wei, Valeria Zuluaga-Sanchez, Mehrdad Zarghami, Aditya Achanta, Sirus Jesudasen, Bruce Tiu, Geno Merli, John Fanikos, Orly Leiva, Aditya Sharma, Samantha Rizzo, Mariana Pfeferman, Ruth Morrison, Alec Vishnevsky, Judith Hsia, Mark Nehler, James Welker, Marc Bonaca, Brett Carroll, Samuel Goldhaber, Umberto Campia, Behnood Bikdeli, Gregory Piazza
Journal: Circulation (2024)

Background: COVID-19 is a multiorgan disease characterized by a prothrombotic state and increased risk of venous thromboembolism (VTE), especially in hospitalized patients. Although prior studies have attempted to identify predictors of VTE, restricted sample size and use of administrative claims data have limited such analyses. We conducted a multivariable analysis to identify predictors of VTE in hospitalized patients with COVID-19 in a multicenter patient-level registry. Methods: We utilized data from the CORONA-VTE Network, a US multicenter registry of 10,420 adult (≥18 years) patients with PCR-confirmed COVID-19 of whom 3,844 were hospitalized. The primary outcome was time-to-first-event for a composite of adjudicated pulmonary embolism and deep vein thrombosis (e.g. lower extremity, mesenteric, gonadal vein, etc.) during 90-day follow-up. The candidate variables were selected by a priori clinical consensus. The variables with ≥20% missing data were excluded, whereas those with missing data &lt;20% were estimated using multiple imputation. Selected variables included prophylactic anticoagulation during hospitalization, corticosteroid therapy, female sex, baseline prescriptions of anticoagulants and statins, use of hormone replacement therapy, history of peripheral artery disease, prior VTE, and known thrombophilia. Subsequently, we conducted cox proportional hazard regression adjusted for the selected variables for each imputed dataset and pooled the estimated HRs for reporting (p&lt;0.05 for significance). Results: The overall rate of VTE was 5.39%. The covariates associated with increased risk of VTE were history of VTE (HR: 1.71; 95% CI: 1.11-2.63), corticosteroid therapy (HR: 1.76; 95% CI: 1.32-2.33) and known thrombophilia (HR: 3.56; 95% CI: 1.54-8.21). The covariates associated with decreased risk of VTE were anticoagulation at baseline (HR: 0.42; 95% CI: 0.26-0.69), antecedent use of statins (HR: 0.67; 95% CI: 0.50-0.90), and prophylactic anticoagulation during hospitalization (HR: 0.52; 95% CI: 0.38-0.71). Conclusions: While prior VTE, corticosteroid therapy, and known thrombophilia were associated with increased risk of VTE, prescriptions of anticoagulation and statins were associated with a decreased risk.
Abstract 4140714: Prevalence and Outcomes of Percutaneous Coronary Intervention in Patients With and Without Bipolar Disorder: A National Inpatient Sample Analysis
Authors: Arshan Khan, Ramtej Atluri, Yazan Alkehef, omer alsheikh, Nancy Mesih, Sohail Hassan
Journal: Circulation (2024)

Background: Severe mental disorders (SMIs) such as bipolar disorder are associated with a reduced life expectancy of up to two decades, with cardiovascular disease as the leading cause of death. Post-acute coronary syndrome, SMI patients, including bipolar disorder, often face poor prognosis and lower percutaneous coronary intervention (PCI) rates. We aimed to assess PCI prevalence and outcomes in patients with bipolar disorder. Methods: We analyzed the National Inpatient Sample data from 2016-2019, identifying 4,483,509 hospitalized adults with myocardial infarction (MI). These hospitalizations were further stratified based on the presence or absence of bipolar disorder using ICD-10 codes. A multivariate regression model was used to adjust for confounders and analyze the variables. Results: Out of 142,420,378 hospitalizations, 4,483,509 (3.15%) were identified with MI. Among those with MI, 1,221,030 (27.24%) underwent PCI. PCI rates were higher among MI patients without bipolar disorder compared to those with bipolar disorder (27.4% vs. 20%; p&lt;0.001). Figure 1 depicts the Forest plot for multivariate analysis of complications. The length of stay (LOS) in patients with bipolar disorder was 0.24 days longer (p=0.02) on univariate analysis. However, on multivariate analysis, adjusted for patient demographics, comorbidities, and hospital characteristics, the difference in LOS was not statistically significant. Similarly, when adjusted for these variables, bipolar disorder patients who underwent PCI had no statistical difference in terms of mortality (adjusted odds ratio [AOR] 1.03; CI 0.79-1.34; p=0.81) and In-stent stenosis (ISR) (AOR 1.14; CI 0.95-1.37; p=0.13). Although bipolar disorder patients incurred slightly higher total hospitalization costs ($116,931 vs. $116,381 for those without bipolar disorder), this difference was not statistically significant (p = 0.812). Conclusion: Our study reveals a significant healthcare disparity: despite comparable outcomes in mortality, in-stent stenosis, and other complications, individuals with bipolar disorder are less likely to undergo PCI following MI. These findings underscore the need for targeted interventions to ensure equitable healthcare access for all patients.
Abstract 4140679: Defining the Prevalence and Incidence of Heart Failure Phenotypes Among Transgender Adults
Authors: Ian Everitt, Emily Sisson, Carl Streed, Monica Mukherjee
Journal: Circulation (2024)

Introduction: Transgender and gender diverse (TGD) adults have disproportionately greater burden of cardiovascular disease (CVD) risk. However, prevalent and incident heart failure (HF) and its risk factors have not been well-characterized in TGD populations. Objective: To determine the prevalence and incidence of HF risk factors and phenotype by gender identity. Methods: The study included commercial insurance claims data for 408,457 adults from 2006-2022. Gender identity was classified as cisgender male, cisgender female, transmasculine, transfeminine, or unclassified TGD identity. HF risk factors and phenotype (i.e., HFrEF, HFpEF, other HF) were abstracted using administrative billing codes. Multivariate logistic regression and Cox proportional hazard models examined associations between gender identity and prevalent and incident HF, respectively. Models were stratified by HF phenotype and adjusted for clinical comorbidities and presence of CVD. Results: Of 57,471 TGD patients, 9,652 (16.8%) were transfeminine, 17,898 (31.1%) were transmasculine, and 29,921 (52.1%) had unclassified TGD identity. The mean age was 35±16 years, followed for 5.5±4.7 years. The prevalence of HF risk factors differed by gender identity ( Table 1 ). Among TGD adults the overall prevalence of HFrEF, HFpEF, and other HF were 0.4% (n=204), 0.4% (n=222), and 1.8% (n=1,015), respectively. Prevalent HF differed by gender identity (p&lt;0.001). In adjusted models compared to cisgender males, transmasculine persons had lower odds of HFrEF (OR 0.38 [95% CI 0.21-0.71], p&lt;0.05), unclassified TGD persons had greater odds of HFpEF (OR 1.44 [95% CI 1.17-1.77], p&lt;0.05) and lower odds of other HF (OR 0.77 [95% CI 0.69-0.85], p&lt;0.05). Compared to cisgender males, transmasculine persons had less incident HFrEF, HFpEF, and other HF; transfeminine persons had less incident HFrEF; and unclassified TGD adults had greater incident HFpEF ( Table 2 ). Conclusions: Among a nationally representative administrative sample inclusive of TGD people, CVD risk factors, prevalent HF, and incident HF differ by gender identity. Gender identity and concomitant gender-affirming therapies represent underrecognized markers of HF risk and may act as HF risk modifiers in TGD adults.
Abstract 4140686: Comparison of Short-Term Outcomes after Lower Extremity Bypass versus Peripheral Vascular Intervention in Patients with Chronic Limb-Threatening Ischemia and Diabetes Mellitus
Authors: Abhinav Aggarwal, Gaelle Romain, Santiago Callegari, Jacob Cleman, Kim Smolderen, Carlos Mena-Hurtado
Journal: Circulation (2024)

Background: Comorbid diabetes mellitus (DM) is associated with worse outcomes in patients with chronic limb-threatening ischemia (CLTI). Both lower extremity bypass (LEB) and peripheral vascular interventions (PVI) have demonstrated improved outcomes in peripheral artery disease (PAD). However, comparative effectiveness data for LEB versus PVI in patients with CLTI and DM is limited. Objective: This study aimed to evaluate and compare 30-day and 90-day (1) all-cause mortality, and (2) major amputation rates among patients with CLTI and comorbid DM undergoing LEB versus PVI. Methods: Patients undergoing LEB and PVI were identified from the Vascular Quality Initiative registry, linked with Medicare claims outcomes data. Propensity scores were generated using 12 variables, and a 1:1 matching method was employed. The 30-day and 90-day mortality risks for LEB versus PVI were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models, incorporating interaction terms for DM. For amputation outcomes, cumulative incidence functions and Fine-Gray competing risks models were employed, with interaction terms for DM included. Results: Among 4,210 patients undergoing LEB or PVI (2,105 in each group), the mean age was 70.9 ± 10.9 years, with 69.3% being male and 76.4% white. DM was present in 62.3% (2,662 patients). In patients with DM, 30-day all-cause mortality rates were comparable between the LEB and PVI groups (2.1% vs. 2.6%; log-rank p-value=0.844). However, LEB was associated with significantly lower 90-day all-cause mortality rates compared to PVI (5.1% vs. 7.6%; log-rank p-value=0.013). Additionally, LEB was associated with a lower risk of 30-day major amputation rates compared to PVI (2.7% vs. 4.2%; p=0.049), though no significant difference was observed in 90-day major amputation rates (9.4% vs. 10.9%; p=0.196). Conclusion: Among patients with CLTI and comorbid DM, LEB was associated with a lower risk of 30-day major amputation rates and 90-day all-cause mortality compared to PVI. These findings provide contemporary insights into the management of CLTI in diabetic patients, supporting informed shared decision-making for those often considered high-risk for surgical intervention.
Abstract 4140903: Long-Term Clinical Outcomes in Definite versus Intermediate Ergovonine Provocation response in Multivessel Vasospastic Angina Patients
Authors: DongHyeon Joo, Youngkeun Ahn, Ju Han Kim, Doo Sun Sim, Young Joon Hong, Kyung-Hoon Cho, Joon Ho Ahn, Seung Hun Lee, Dae Young Hyun, Yongwhan Lim, Seok Oh, Yong-Kyu Lee, Seong Ho Park
Journal: Circulation (2024)

Background: Patients with multivessel coronary spasm showed relatively poor outcomes in vasospastic angina. Recent report also revealed that Ergovonine response definite group showed poor clinical outcomes compared to the Ergovonine response intermediate group. The purpose of this study is to evaluate the clinical impact of Ergovonine provocation definite or intermediate response in multivessel vasospastic angina patients. Methods: A total of 428 patients between May 2010 to November 2013, diagnosed as multivessel vasospastic angina who were registered in the Vasospastic Angina Korea (VA-KOREA) were enrolled. Patients were divided into Ergovonine provocation response definite group (n=111) and intermediate group (n=317). The primary endpoint was cumulative incidece of cardiac death, new onset arrhythmia, acute coronary syndrome, re-admission due to chest pain during 3 years follow-up. Results: In the baseline clinical chracteristics, Ergovonine response definite group had less proportion of male patients (32.4% vs. 49.8%, p=0.002). Other conventional cardiovascular risk factors were similar between two groups. In the angiographic characteristics, electrocardiogram changes during Ergovonine provocation was higher in the deinite group including ST change (18% vs 10.7%; p=0.046), ST elevation (16.2% vs 2.8%; p&lt;0.001), ST depression (7.2% vs 2.5%; p=0.009), induced arrhythmia (27.9% vs 15.5%; p=0.004). Combined atherosclerotic lesion was also higher in the definite group (29.7% vs 15.5%; p=0.001). Prescrpition rate of Calcium channel blocker was lower in the intermediate group compared to the definite group (93.7% vs. 83.6%; p=0.008). The incidence of primary end point was not statistically signficant in both groups (10.8% vs. 14.5%; p=0.327). Multivariative cox regression analysis revealed that Ergovonine provocation response had no significant clinical impact in multivessel vasospastic angina patients (adjusted harzard ratio [HR] 0.64; 95% confidence interval [CI] 0.32 – 1.28; p=0.207). Conclusion: The present study indicates that Ergovonine provocation response is not an independent prognostic factor in multivessel vasospastic angina patients. Thus, intensive medical treatment and risk control should be carried out in both patient groups.
Abstract 4140853: Gender Differences in Cardiovascular Mortality Among Patients with Immune Mediated Diseases: A 22-Year Analysis
Authors: Issam Motairek, Farah Abdulhai, Osamah Badwan, Tess Calcagno, Rochell Issa, Chadi Tabaja, Astefanos Al-Dalakta, Sammy Arab, Saeid Mirzai, Elaine Husni, heba wassif
Journal: Circulation (2024)

Introduction: Cardiovascular disease (CVD) poses a significant mortality risk for patients with immune mediated diseases (IMIDs) due to systemic inflammation. However, true population-based cardiovascular mortality data are lacking for this group, particularly with respect to gender disparities. This study examines gender disparities in CVD mortality over 22 years in this high-risk population. Methods: Using CDC Multiple Cause of Death files (1999-2020), we identified CVD deaths (ICD-10 I00-I99) with underlying IMIDs (ICD-10 M05.0-M13, M30-M35) in the United States. Age-adjusted mortality rates were computed annually. Linear regression and t-tests assessed trends and gender differences, with significance at p &lt; 0.01. Results: We analyzed 127,149 deaths. Age-adjusted mortality rates for females decreased from 4.2/100,000 in 1999 to 1.8/100,000 in 2020 (p &lt; 0.01). For males, rates declined from 2.9/100,000 to 1.4/100,000 (p &lt; 0.01). Gender differences were statistically significant (p &lt; 0.01), with females exhibiting consistently higher mortality rates. (Figure) Conclusions: Despite overall declines in CV mortality, females with IMIDs face higher CVD mortality, indicating a need for gender-specific interventions. Continuous efforts are vital to address these disparities and enhance cardiovascular health outcomes.
Abstract 4141249: Circulating Follistatin-like 3 and its Association with Postpartum Cardiac Dysfunction and Severe Maternal Morbidity
Authors: Marly Azzi, Sanela Potchileev, John Dreixler, Ariel Mueller, Sarosh Rana, Sajid Shahul
Journal: Circulation (2024)

Background: Hypertensive disorders of pregnancy (HDP) is a leading cause of pregnancy-related mortality in the United States and an important risk factor for postpartum cardiovascular disease (CVD). Previous animal data suggested that FSTL3 expression may be pathogenic in the development of cardiovascular dysfunction. The incidence of CVD during pregnancy has been increasing over time, which highlights the need to identify biomarkers that affect the development of the disease. We therefore hypothesized that peripartum FSTL3 levels would be associated with postpartum cardiovascular dysfunction and maternal morbidity. Methods: Pregnant patients age ≥ 18 years and singleton &lt; 41 weeks with preeclampsia or superimposed preeclampsia who delivered at the University of Chicago between May 2017 and November 2020 were included in this observational cohort study. The primary outcome was cardiovascular dysfunction defined as postpartum hypertension, cardiomyopathy (confirmed with echocardiography and cardiology consult), and pulmonary edema (confirmed with chest radiography). The secondary outcome was severe maternal morbidity. Categorical data were assessed with chi-square or Fisher’s Exact test. The association between FSTL3 levels and postpartum CV dysfunction was assessed using multivariable logistic regression. Results: Our study included 408 patients, of which 212 were diagnosed with HDP. The median age was 28 years old (IQR 23, 33), the median BMI was 33.4 (IQR 28.6, 39.3), and the majority were African American (67.1%). Elevated FSTL3 levels were associated with postpartum CV dysfunction (OR 1.02 [95% CI: 1.01, 1.04]; p &lt; 0.001). After multivariable adjustment for delivery gestational age, maternal age, BMI, nulliparous, HDP, smoking, and diabetes, the association between FSTL3 and CVD persisted (p = 0.02). Table 1 outlines the association between FSTL3 and maternal/neonatal outcomes. Conclusion: This study demonstrates that the biomarker FSLT3 predicts postpartum cardiovascular dysfunction and is associated with maternal morbidity. Our findings suggest that FSLT3 may facilitate the development of CVD and that therapeutic strategies targeting FSLT3 may affect the course of postpartum cardiovascular dysfunction.
Abstract 4141104: Safety and Therapeutic Potential of Allogeneic Adipose-Derived Stem Cell Spray Transplantation in Ischemic Cardiomyopathy: A Phase I Clinical Trial
Authors: Takuji Kawamura, Daisuke Yoshioka, Ai Kawamura, Yusuke Misumi, Takura Taguchi, Shunsuke Saito, Takashi Yamauchi, Shigeru Miyagawa
Journal: Circulation (2024)

Background: Ischemic cardiomyopathy, characterized by an imbalance in myocardial blood supply due to coronary artery atherosclerosis, presents a formidable health challenge. Although coronary artery bypass grafting (CABG) can enhance long-term survival, a subset of patients does not exhibit significant improvement in cardiac function post-surgery. This study investigated the safety and therapeutic potential of allogeneic adipose-derived stem cell (ADSC) spray transplantation combined with CABG in ischemic cardiomyopathy. Methods: This single-center, double-blind, randomized clinical trial included six eligible patients with ischemic cardiomyopathy who underwent CABG. The ADSCs, suspended in fibrin glue, were sprayed directly onto the heart during surgery. Primary endpoints encompassed adverse events, late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) volume changes, and feasibility. Secondary endpoints included alterations in left ventricular function, exercise tolerance, and heart failure symptoms. Results: All patients underwent surgery successfully without complications. ADSC spray transplantation, evidenced by a reduced LGE-MRI volume, exhibited potential therapeutic benefits by improving left ventricular function and exercise tolerance in the ADSC group compared to the placebo group (Figures 1 and 2). Adverse events were minimal and primarily associated with the CABG procedure. Conclusions: This study establishes the safety and feasibility of ADSC spray transplantation combined with CABG for the treatment of ischemic cardiomyopathy. The observed improvements in LGE-MRI volume and cardiac function suggest a potential therapeutic effect, warranting further investigation in larger phase II and III clinical trials. This novel approach holds promise as a clinically viable treatment strategy to enhance revascularization outcomes in patients with ischemic cardiomyopathy. Registration: https://clinicaltrials.gov/study/NCT04695522 https://jrct.niph.go.jp/en-latest-detail/jRCT2053190103
Abstract 4141041: Impact of atrial cardiomyopathy on early rhythm control therapy
Authors: Andreas Goette, Antje Albring, Ulrich Schotten, Stephan Willems, Katrin Borof, Lars Eckardt, Antonia Zapf, Harry Crijns, Alan Camm, Guenter Breithardt, Paulus Kirchhof
Journal: Circulation (2024)

Background: Whether the presence and extent of atrial cardiomyopathy (AtCM) has an impact on effectiveness of early rhythm control (ERC) in patients with atrial fibrillation (AF) is not known. Method: In this prespecified subanalysis of the EAST-AFNET 4 trial, the effects of ERC on outcome were compared between AF patients with different stages of AtCM. AtCM was determined by atrial size, PR interval in the surface ECG, and brain natriuretic peptide concentrations (NTproBNP). Associations between AtCM and the primary outcomes (cardiovascular death, stroke, hospitalization for heart failure and acute coronary syndromes; ACS) were compared over a mean follow-up of 5.1 years. Results: The EAST-AFNET 4 trial included a total of 2,789 patients. For this analysis, 1,395 patients on ERC and 1,394 on usual care (UC) were included. Left atrial (LA) size varied substantially in the overall study population (largest LA size up to 8.6 cm) without a significant difference between ERC and UC at baseline (mean ERC 4.4 ± 0.8 cm vs. UC 4.4 ± 0.9 cm; p=ns). PR intervals (ERC: 176 ± 32ms vs. UC 178 ± 37ms) and NTproBNP concentrations (mean ERC 772 ± 1,268 pg/mL vs. UC 825 ± 1,135 pg/mL; p=ns) were comparable between the two randomized groups. Larger left atrial diameters were related to occurrence of first primary outcome (HR per SD 1.26; 1.12-1.43; p&lt;0.001) and recurrence of AF (HR per SD 1.19; 1.09-1.29; p&lt;0.001). Similarly, higher NTproBNP concentrations were associated with the first primary outcome (HR per SD 1.81; 1.53-2.15; p&lt;0.001) and with AF recurrence (HR per SD 1.53; 1.37-1.7; p&lt;0.01). ERC reduced the first primary outcome during a 5.1 years follow-up (ERC HR 0.69;0.54-0.9; p=0.005), regardless of the degree of AtCM. Conclusion: In patients with recently diagnosed AF, recurrent AF and cardiovascular events are more common in the presence of atrial cardiomyopathy. Early rhythm control is effective regardless of the degree of AtCM in AF patients.