tbuckley/cabot-search huggingface dataset:
Abstract 16307: Does the Method of Calculating the 30-day Readmission Rate After Hospitalization for Heart Failure Matter? Data From the VancOuver CoastAL Acute Heart Failure Registry
Authors: Samaneh Salimian, Sean Virani, Thomas Roston, Ren Jie Robert J Yao, Ricky Turgeon, Justin A Ezekowitz, Nathaniel Hawkins
Journal: Circulation (2023)

Introduction: The 30-day readmission rate after a heart failure (HF) hospitalization is widely used for assessing healthcare quality and system performance. However, there are different methodological approaches which may influence estimated rates, and no single accepted approach. The combined impact of these methods is unknown. Goals: We calculated 30-day HF readmission rates (RRs) of hospitalized patients using different published approaches to sampling and measurement. Methods: We included 1,849 patients discharged following unplanned hospitalization with a primary diagnosis of HF between 2016 to 2018 from the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry. We combined five distinct methodological factors (Table 1) to create 64 unique definitions and associated HF RRs. The readmission rates were averaged over 3-years. Multiple linear regression was used to determine the impact of different factors on estimated readmission rates. Results: The calculated 30-day RR for HF varied more than twofold depending solely on the methodological approach (6.4% to 15.0%, 8.6% absolute difference, 134% relative difference). The rates were highest when including all consecutive index admissions (11.1% to 15.0%), and lowest including only one index admission per patient per year (6.4% to 11.4%). The regression model ranked variables affecting RR as: index selection method, reference period, ICD-10 codes, 30-day survival, and index day (Table 2, p&lt;0.001 in all). Conclusions: Our findings have important implications for policy and reporting. Transparent and consistent methods are needed to calculate 30-day RRs to ensure reproducible and comparable reporting.
Abstract 11799: Sex Disparities in Characteristics and Outcomes in Patients Admitted With Takayasu Arteritis
Authors: Shruti Aggarwal, Rahat A Memon, Jasninder S Dhaliwal, Kamleshun Ramphul, Shaheen Sombans, Abhimanyu Ravalani, Hemamalini Sakthivel
Journal: Circulation (2023)

Introduction: Takayasu Arteritis (TA) is a rare form of chronic and progressive granulomatous vasculitis, mainly affecting the aorta and its branches. It is known to be more prevalent in young females of childbearing age. Our study compares potential disparities between Males and Females with TA. Methods: Our study focused on patients diagnosed with TA admitted between 2016-2020 via the National Inpatient Sample. We compared the prevalence of different comorbidities between Males and Females . Logistic models allowed us to evaluate any differences between outcomes between the two groups. Results: We found 7210 patients with TA in the United States, comprising 1575 (21.8%) males and 5635(78.2%) females. Females were older (mean age 45.67 years) than Males( mean age 43.29 years, p&lt;0.01), but with a lower mean Charlson Comorbidity Index (CCI) score (2.45 in females and 2.75 in males, p&lt;0.01). Considerable differences in patient characteristics were also observed, as described in Table 1. Overall Males were also more likely than females to report events of aortic aneurysms (aOR 1.959, 95% CI 1.607-2.389, p&lt;0.01), aortic dissections (aOR 3.147, 95% CI 2.337-4.238, p&lt;0.01), acute kidney injury (AKI) (aOR 1.589, 95% CI 1.344-1.879, p&lt;0.01), acute limb ischemia (aOR 1.896, 95% CI 1.138-3.160, p=0.014), and death (aOR 1.381, 95% CI 1.012-1.883, p=0.042). However, no differences were noted in events of major adverse cardiac events (MACE) (aOR 1.028, 95% CI 0.838-1.257, p=0.807). Conclusions: Males had less prevalence of TA than Females but still reported a higher likelihood of complications of aortitis, i.e., Aortic aneurysms as well as dissection. The greater incidence of AKI in males may be linked to direct insult to the vessels or secondary to their comorbidities. Even though no differences in MACE were seen between the two sexes, male patients had higher mortality.
Abstract 17828: Sex Differences in Mortality Trends of Rheumatic Heart Disease in High-Income Countries
Authors: Makoto Hibino, Junichi Shimamura, Raj Verma, Nitish Dhingra, bobby Yanagawa, Deepak Bhatt, Subodh Verma
Journal: Circulation (2023)

Introduction: Rheumatic heart disease has traditionally been considered to be more prevalent among females; however, current trends in mortality in each sex are unclear in high-income countries. Hypothesis: We hypothesized that mortality from rheumatic heart disease is higher among females but has improved in both sexes in high-income countries. Methods: We analyzed the WHO mortality database to determine trends in mortality from rheumatic heart disease in the UK, Germany, France, Italy, Japan, Australia, the USA, and Canada from 2000 to 2020. Sex-specific age-standardized mortality rates per 100,000 persons were calculated and compared by using female-to-male ratio. Annual percentage change was analyzed using joinpoint regression. Results: In the most recent year, female sex-specific age-standardized mortality rates were significantly higher in the UK (0.60 vs 0.44), Italy (1.24 vs 0.98), the USA (0.63 vs 0.47) and Canada (0.79 vs 0.57). Over the observation period, there was a trend to deceasing sex-specific age-standardized mortality rates in both sexes in the UK, France, Japan, and USA (p&lt;0.01, respectively) and only in female sex in Italy and Australia (p&lt;0.01, respectively), while the mortality rates in both sexes were constant in Canada and demonstrated increasing trends in Germany. Average female-to-male mortality rates ranged from 1.07 (95% CI, 1.02, 1.11) in France to 1.59 (95% CI, 1.51, 1.67) in the UK and were decreasing toward 1 with statistical significance in all countries (average annual change ranged from -1.6% to -0.6%) except for France. Conclusions: Mortality from rheumatic heart disease in females exhibited a decreasing trend in the 6 studied high-income countries while increasing in Germany and constant in Canada. Female-dominated mortality was becoming less pronounced in the studied high-income countries, with the exception of France, which already had the lowest average female-dominant mortality rates.
Abstract 13731: Right-Sided Precordial U Waves as a Screening Tool for Aortic Stenosis
Authors: Matthew Pulaski, Aditi Newadkar, Iman Richie, Ivan Ho, Jubin Joseph, Ray Matthews, Anil Mehra, Junaid Zaman
Journal: Circulation (2023)

Introduction: AS affects 3% of individuals ≥ age 65 and portends an increased risk of morbidity and mortality. Cardiac auscultation to categorize AS severity depends on provider skill. Recent studies have identified an association between AS and right precordial U waves (RPUW) using machine learning. Therefore, the ECG may serve as an adjunctive screening tool for AS. Hypothesis: Are RPUW correlated with AS severity? Methods: A retrospective cohort analysis was performed of 50 patients ages 65-89 with a diagnosis of HTN, echocardiogram on file, and RPUW (V1-V3) in consecutive leads with U wave amplitude ≥ 0.5 mm in at least one lead. Patients with prior aortic valve replacement, ventricularly paced rhythms, AF or AFL, LBBB, potassium (K) &lt; 3, and HR &lt; 50 were excluded. A control cohort of 50 age- and gender- matched patients with RPUW &lt; 0.5 mm was included. Echocardiograms were unblinded only once patients were selected by ECG criteria. Results: In total, 976 charts and 294 charts were reviewed to identify 50 eligible patients for the experimental and control arms respectively. Median time between ECG and lab collection (to ensure a K ≥ 3) was 0 days for both arms. Median time between ECG and echocardiogram was 1 day and 1.5 days respectively for experimental and control arms. U waves were significantly correlated with AS severity using a chi-square test (X2 = 16.77, df = 3, p &lt; .001). A multinomial logistic regression analysis showed no significant association between gender (p = .69) or systolic blood pressure (SBP) as a categorical variable (SBP &lt; 125, 126-145, &gt; 145) (p = .35) and AS severity, but increasing age group (ages 65-73, 74-81, or 82-89) was associated with greater odds of moderate or severe AS (p = .002), OR 3.43 (95% CI: 1.59, 7.40). Conclusions: RPUW ≥ 0.5 mm demonstrate a significant correlation with AS severity. A prospective study which collects first-time echocardiograms for patients with RPUW serves as a next step in determining the utility of ECGs for screening of AS.
Abstract 17627: The Relationship Between Physical Activity, Extracellular Vesicles, and Diabetes Risk in African American Women at Risk for Cardiovascular Disease: Data From a Pilot Study of the Step It Up Physical Activity Intervention
Authors: Anca Dobrian, Noel Miller, Matthew Bavuso, Nithya Vijayakumar, Sam Neally, Billy Collins, Kameswari Potharaju, Joniqua Ceasar, Kaveri Curlin, Marcus Andrews, Briana Turner, Cristhian Gutierrez-Huerta, James Troendle, Valerie Mitchell, Maureen Sampson, Alan Remaley, Yvonne Baumer, Tiffany M Powell-Wiley
Journal: Circulation (2023)

Background: Diabetes and cardiovascular disease (CVD) disproportionally affect African American (AA) women. Prior studies suggest extracellular vesicles (EV) are involved in atherogenesis, but little is known about relationships between PA and EVs in AA women. Thus, we examined associations between diabetes risk markers, EV, and PA in a community-based cohort of AA women at risk for CVD from resource-limited Washington, D.C. neighborhoods. Methods: Participants were enrolled in pilot testing of Step It Up, a place-tailored mobile app designed to increase PA. Baseline daily step counts for PA were measured by Fitbit® (Charge 2) and fasting baseline blood samples were cryopreserved. NMR (Nuclear magnetic resonance) spectroscopy was used to measure Lipoprotein Insulin Resistance Index (LP-IR), a diabetes risk marker. EV were isolated from heparinized plasma using size exclusion chromatography with size and numbers determined by nanoparticle tracking analysis. Associations between LP-IR, EVs, and daily step count were analyzed using multivariable regressions adjusted for BMI and ASCVD 10-year risk score. Results: The study cohort was a convenience sample of AA women with overweight/obesity (N=24, Age: 57±12, BMI: 35±6, ASCVD: 9±5). Smaller EV size associated with higher LP-IR (β=-0.45, p=0.04) with EV concentration trending to a positive association with LP-IR (β=0.38, p=0.08). Higher daily step count associated with larger EV particle size (β=0.48, p=0.02) but not with EV concentration. Additionally, higher daily step count associated with lower LP-IR (β=-0.42, p=0.04). Conclusions: Our data show that reduced EV size and increased EV concentration associate with higher LP-IR, a diabetes index among a community-based cohort of AA women. Additionally, our findings suggest that PA might help mitigate these associations. More research is needed to understand the potential impact of PA on EV, diabetes risk and subsequent CVD. Future PA interventions in at-risk patients may reduce existing diabetes and CVD-related health disparities and EVs may emerge as a mechanistic link.
Abstract 321: Manual vs Automated Ventilation During Automated Head-Up Cardiopulmonary Resuscitation in a Porcine Model
Authors: Pouria Pourzand, Mike Lick, Stephen Richardson, Johanna C Moore, Susana Arango, Mithun Suresh, Bayert Salverda, Anja Metzger, Keith G Lurie
Journal: Circulation (2023)

Background: The efficacy of mechanical ventilation during CPR with the combination of active compression-decompression, an impedance threshold device, and head-up positioning, collectively termed automated head-up (AHUP)-CPR, is unknown. Hypothesis: Hemodynamic and ventilatory parameters will be similar with manual bag ventilation (MBV) versus automated bag ventilation (ABV) during AHUP-CPR in a porcine model of cardiac arrest. Aim: Assess the proof-of-concept that ABV is safe and effective during AHUP-CPR. Methods: Nine male and female swine (~40 kg) were anesthetized and ventilated. VF was induced and left untreated for 8 min. AHUP-CPR was performed at 105 compressions/min for 7 min using MBV, followed by 6 min using an automated mechanical bag compressor to deliver 10ml/kg of tidal volume (TV) over 1 sec at 10 breaths/min. Pigs were randomized during ABV to a synchronized (Sync) breath delivered at the start of decompression or an asynchronous (Async) breath. Cerebral perfusion pressure, coronary perfusion pressure, end-tidal CO2, intracranial pressure, esophageal intrathoracic pressure, peak airway pressure (PAP), inspiratory and expiratory TVs as well as arterial blood gases were continuously measured. Values (mean ± SD) were compared by paired and unpaired student’s t-tests with a Bonferroni correction. Results: Parameters during the last minute of MBV and ABV are summarized in the table. No significant differences were observed in hemodynamic and ventilatory parameters, except for PAP and pO2 values which were significantly lower with MBV. No significant differences were also observed between the Sync and Async ABV modes. Conclusion: Manual and mechanical ventilation resulted in overall similar physiological effects. The clinical relevance of the observed significant differences in PAP and pO2 is unclear. Additional studies are warranted to further assess the safety and effectiveness of mechanical ventilation during AHUP-CPR.
Abstract 15643: Social Determinants of Health, Epigenetic Aging, and Subclinical Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Havisha Pedamallu, Hongyan Ning, Kyeezu Kim, Brian Joyce, Kiarri N Kershaw, Donald M Lloyd-Jones
Journal: Circulation (2023)

Introduction: Associations of social determinants of health (SDOH) with subclinical cardiovascular disease (CVD), such as left ventricular mass index (LVMI) and coronary artery calcification (CAC), are poorly described. Mechanisms of such associations may involve epigenetic changes like DNA methylation. We sought to examine associations between selected SDOH measures and subclinical CVD, and potential mediation by GrimAge acceleration (GrimAA), a measure of epigenetic aging. Methods: We included 2932 Black and White adults from the CARDIA year 20 (Y20) exam (mean age 45y, 48% Black, 57% female). Associations between SDOH measures at Y20 (or cumulative up to Y20) and Y25 ln(CAC score +1) or LVMI (in g/m 2.7 ) were examined using linear regression. Statistical mediation analysis was used to estimate the proportion of associations attributable to GrimAA among 880 participants in whom it was measured. Results: All selected SDOH measures at Y20 - residential racial segregation (G* Score); census tract poverty; food insecurity; difficulty paying for basics, medications, or healthcare; and maximum years of participant or parental education - were associated with LVMI at Y25 (Table). For example, each 1% higher census tract poverty was associated with an average 0.95 g/m 2.7 higher LVMI. Several SDOH measures were also associated with CAC score at Y25. Similar associations were observed between cumulative SDOH exposures from Y0-Y20 and Y25 subclinical CVD. GrimAA mediated &gt;30% of the statistical association between participant education and LVMI or CAC (Table), and &gt;20% of the associations of residential segregation and census tract poverty with LVMI. Conclusions: SDOH metrics were significantly and longitudinally associated with subclinical CVD in midlife. DNA methylation, as represented by GrimAge acceleration, appears to statistically mediate these associations, suggesting possible molecular mechanisms by which SDOH may accelerate CVD risk.
Abstract 14752: FGF-23, Cardiovascular Events, and the Benefit of Canagliflozin in the CANVAS Trial
Authors: Aranya Punithan, Ehsan Ghamarian, Daniela Grothe, macy Maclean, Kim Connelly, Bruce C Neal, Alanna Weisman, David Cherney, Filio Billia, Jacob A Udell
Journal: Circulation (2023)

Background: The incremental prognostic value of FGF-23 with cardiovascular (CV) risk, composite kidney outcomes (KO) and treatment response was assessed in the CANVAS trial, which studied the efficacy of the sodium glucose co-transporter 2 inhibitor canagliflozin (cana) versus placebo in patients with type 2 diabetes (T2D) and high CV risk. Methods: 3188 patients with available baseline FGF-23 samples were studied. The association between FGF-23 and the composite of time to CV death or hospitalization for heart failure (HHF) (primary endpoint), HHF, CV death, major adverse CV events (MACE) and KO were assessed using multivariable Cox proportional hazard regression models adjusted for clinical risk factors. Events rates by randomized treatment assignment were calculated for FGF-23 after assignment to a ‘low risk’ (Quartiles 1-3) or ‘high risk’ (Q4) group. Results: The median level of FGF-23 was 64.1 RU/mL (IQR 48.3-94.1). A doubling of FGF-23 was significantly associated with the primary endpoint (HR, 1.32; 95% CI, 1.19-1.46; P &lt;0.001) as well as HHF (HR, 1.53; 95% CI, 1.31-1.79, P &lt;0.001), CV death (HR, 1.18; 95% CI, 1.03-1.35, P =0.014), and KO (HR, 1.11; 95% CI, 1.02-1.21, P =0.014) but not MACE (HR, 1.05; 0.95-1.15, P =0.3) in the fully adjusted model (Table 1). Cana yielded consistent risk reduction for the primary endpoint, HHF and KO regardless of whether patients were categorized in the high or low risk group (all P heterogeneity&gt;0.30) (Table 2). Conclusion: High levels of FGF-23 are associated with an increased risk of CV death and HHF, HHF, CV death, and KO in patients with T2D and high CV risk. Treatment with cana provides consistent benefit across higher and lower levels of FGF-23.
Abstract 17696: Perm1 Stabilizes Nrf2 via Keap1 Oxidation to Protect the Heart Against Reperfusion Injury
Authors: Chun Yang Huang, Shinichi Oka, Junichi Sadoshima
Journal: Circulation (2023)

Introduction: Reperfusion after ischemia (IR) produces reactive oxygen species (ROS) that promote myocardial injury. Nrf2 is a transcription factor that promotes transcription of antioxidant enzymes. Keap1 is a negative regulator of Nrf2. When oxidated by ROS, Keap1 releases Nrf2, leading to Nrf2 activation. Perm1 (PPARGC-1 and ESRR-induced regulator, muscle specific 1) is a scaffold or adaptor protein that maintains cellular metabolism. However, whether and how Perm1 protects the heart against IR injury via Nrf2 remains unknown. Methods: We used systemic Perm1 knockout (KO) mice and adeno-associated virus (AAV)-induced cardiac-specific Perm1 overexpression to investigate the pathological role of Perm1 in IR injury. Results: IR-induced myocardial infarction was greater in Perm1KO mice than in control mice. Consistently, infarction was smaller in mice with Perm1 overexpression (Infarction size/area at risk (AAR): AAV-GFP as a control 0.41 and AAV-Perm1 0.28*; p&lt;0.05). Myocardial oxidative stress, evaluated via increases in dityrosine, 4HNE and GSSG/GSH, after IR was greater in Perm1KO but less in Perm1 overexpression mice. Expression of IR-induced Nrf2 target genes, such as catalase, superoxide dismutase 2, heme oxygenase 1, NADH quinone dehydrogenase 1 and thioredoxin 1, was inhibited in Perm1KO but promoted in overexpression mice. The detrimental effects observed in Perm1KO mice were normalized by ML334, an inhibitor of Keap1-Nrf2 interaction (Infarction size/AAR: Wild 0.42; Perm1KO 0.58; Wild with ML334 0.37 and Perm1KO with ML334 0.42*; p&lt;0.05 vs. Perm1KO), suggesting that Perm1 protects the heart via Nrf2. In primary cultured rat cardiomyocytes, Perm1 was bound to Keap1 and promoted its oxidation, thereby stabilizing and activating Nrf2. Perm1-induced Nrf2 activation was verified with reporter gene assays using a consensus binding sequence of Nrf2, termed antioxidant response element. In an in vitro system using recombinant proteins, Perm1 directly bound to Keap1. Conclusions: These results suggest that Perm1 is a novel regulator of cellular redox homeostasis through Nrf2 activation via Keap1 oxidation that protects the heart against IR injury.
Abstract 14892: Sex Difference in the Prognostic Power of Growth Differentiation Factor 15 for Cardiovascular Event: The Japan Morning Surge-Home Blood Pressure Study
Authors: Satoshi Hoshide, Kazuomi Kario
Journal: Circulation (2023)

Introduction: Growth differentiation factor 15 (GDF-15), a cytokine secreted in response to cellular stress and inflammation, has been associated with cardiovascular event. Although previous studies have reported that there was a close association between sex hormones and GDF-15, data are sparse about sex difference in the prognostic power of GDF-15 for cardiovascular event. Hypothesis: We hypothesized that there is the differential prognostic power of GDF-15 for cardiovascular outcome according to gender. Methods: This prospective practitioner-based cohort study was conducted between 2005 and 2012 and included participants in the Japan Morning Surge-Home Blood Pressure Study with a history of at least one cardiovascular event who had GDF-15 measurements at baseline. Results: The study included 4066 participants (mean age 64.8 years; men, n=1897; women, n=2169). During an average 6.2 years follow-up, 249 cardiovascular events (coronary artery disease, stroke and heart failure) occurred. GDF-15 levels were significantly higher in the male vs. the female group (median [interquartile], 1014 [741.3-1432] ng/L vs. 909.9 [671.6-1257] ng/L; P&lt;0.001). In women, multivariate Cox analysis revealed that after adjusting other potential predictors, log-transformed GDF-15 was independently associated with cardiovascular events (Hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.31-3.35; P=0.002), whereas this association was not found in men. In women, higher GDF-15 (≥1200 ng/L) was independently associated with cardiovascular event (HR, 2.23; 95%CI, 1.41-3.53; P=0.001), whereas this association was not found in men. The interaction between higher GDF-15 and cardiovascular event according to sex tended to be significant (P=0.087). Conclusions: There is a sex difference in the prognostic power of GDF-15 for cardiovascular event.