tbuckley/cabot-search huggingface dataset:
Abstract 4141938: Effect of Menopausal Status on Cardiovascular Responses to Exercise
Authors: Gizem Cifci, Eric Bruhn, Marissa Kauss, Sarah Armour, Timothy Curry, Katie Talbott, Thomas Bissen, Sophie Miller, Joshua Smith
Journal: Circulation (2024)

Introduction: An elevated blood pressure (mean arterial pressure, MAP) response to exercise is an independent predictor of hypertension (HTN) development. HTN is highly prevalent in postmenopausal females. Postmenopausal, compared to premenopausal, females have a higher MAP at rest and during exercise primarily due to higher systemic vascular resistance (SVR). Studies using small muscle mass exercise have suggested that postmenopausal females have augmented increases in MAP from rest to exercise. However, it is unclear if postmenopausal females have augmented MAP responses from rest to exercise during whole-body exercise. Hypothesis: We hypothesized that postmenopausal females would have greater increases in MAP and smaller decreases in SVR from rest to peak exercise than premenopausal females. Methods: Normotensive premenopausal (n=16; age: 30±7 yrs; BMI: 23±4 kg/m 2 ) and postmenopausal (n=14; age: 57±7 yrs; BMI: 27±4 kg/m 2 ) female participants performed an incremental cycling test until task failure. Blood pressure was measured by manual sphygmomanometry, cardiac output (Q) via open-circuit acetylene wash-in technique, and SVR was calculated. Data are reported at rest and peak oxygen uptake (VO 2 ). Data are also reported as % change from rest to VO 2 peak. Results: Postmenopausal females had higher MAP and SVR at rest and at VO 2 peak than premenopausal females (all, p&lt;0.05). Postmenopausal, compared to premenopausal, females had lower Q at VO 2 peak commensurate with the lower achieved VO 2 peak (p&lt;0.01). Resting MAP was positively related to MAP at VO 2 peak in postmenopausal females (r=0.85, p&lt;0.01), but not premenopausal females (p=0.22). % change in MAP from rest to VO 2 peak was not different between groups (Post: 18±8 vs. Pre: 18±9%) (p=0.94). However, postmenopausal females had smaller % decreases in SVR from rest to VO 2 peak (Post: -44±7 vs. Pre: -54±8%) and smaller % increases in Q compared to premenopausal females (Post: 113±31 vs. Pre: 162±50%) (both, p&lt;0.01). Conclusion: Our findings indicate that postmenopausal and premenopausal females have similar increases in MAP from rest to VO 2 peak; however, the mechanisms contributing to the MAP response differed by menopausal status. Postmenopausal females relied on smaller decreases in SVR, whereas premenopausal females had greater increases in Q. These findings provide important insight into the mechanisms contributing to the clinically relevant higher MAP response during exercise in postmenopausal females.
Abstract 4141917: Incidence of Autoimmune Disease in Hospitalized Patients with Congenital Heart Disease
Authors: Natalie Caryl, Marci Macaraeg, Cameron Bose, Omar Meziab, Claudia Guerrero, Jennifer Andrews, brent barber, Michael Seckeler
Journal: Circulation (2024)

Introduction: Individuals with congenital heart disease (CHD) have increased risk of immune suppression and elevated inflammatory markers in response to abnormal cardiac physiology. This pathologic milieu may put them at risk for developing autoimmune disease (AID). Hypothesis: We hypothesized a higher incidence of AID in patients with CHD. Methods: We conducted a retrospective review of the Vizient® Clinical Data Base (a national, administrative database) from 10/2019–12/2023 for admissions aged 1-25 years with ICD-10 codes for AID, with and without ICD-10 codes for CHD. ICD-10 codes for 22q11 deletion were also included in the query due to its potential confounding immunologic effects. Data included: demographics, length of stay (LOS), complication and in-hospital mortality rates, and costs. Comparisons were made between the groups with CHD and AID and those without AID (NO-AID). Results: There were 4,680,247 admissions without 22q11 deletion. Of these admissions, there was a lower incidence of AID in the CHD group compared to those without CHD [1,771 (0.7%) vs 59319 (1.3%), p &lt;0.001]. There was no difference in 22q11 deletion in CHD admissions with AID and those without (2.1 vs 2.2%, p =0.643); only the population without 22q11 deletion was analyzed further. Of 61,090 admissions with CHD, there were 1,771 with AID and 59,319 with NO-AID. Details are in Table 1. CHD patients with AID were older (18 vs 6 years), more likely female (54.9% vs 47.6%), more commonly White individuals (63% vs 58.9%) and had longer LOS ( p &lt;0.001 for all). There were no differences in complication and mortality rates or costs. Conclusions: This national database review suggests a lower incidence of AID in patients with CHD compared to those without CHD. However, patients with CHD and AID were older and had a longer LOS. These findings highlight a possible time-dependent component in AID development, as well the potential negative effects on hospital outcomes in the setting of multiple, complex comorbid conditions.
Abstract 4141959: Neighborhood Disadvantage is Associated with Uncontrolled Blood Pressure and Therapeutic Inertia among Older Adults with Hypertension
Authors: Michael Saban, M. Samie Tootooni, Talar Markossian, Amy Wozniak, Grant Hiura, Beatrice Probst, Katherine Habicht, Holly Kramer
Journal: Circulation (2024)

Blood pressure (BP) control among older adults may differ by neighborhood due to differences in access to healthy foods, safe places to exercise, and stress. Neighborhood disadvantage may also influence clinician behaviors for hypertension management. This retrospective observational study utilized electronic health data from 52,750 primary care visits among 8,434 adults age ≥ 65 years with hypertension between January 1, 2017, and March 10, 2020 to examine the association of Area Deprivation Index (ADI) with odds of uncontrolled BP during a clinic visit and with therapeutic inertia (TI). Higher ADI values indicate higher deprivation. TI was defined as the absence of a prescription for or escalation of a new BP lowering medication during clinic visits with systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. Binary generalized linear mixed models were used to determine the association of ADI quartiles with uncontrolled BP and with TI during a clinic visit while adjusting for demographics, comorbidities, insurance status, and the intra-patient correlation. Among the 8,434 patients, the mean age at the first visit was 74.3 years (standard deviation 7.8), 57.7% were female, and race/ethnicity was self-reported as non-Hispanic (NH) White in 69.1%, NH Black in 15.9%, NH Other in 5.0%, and Hispanic in 8.2%. The median ADI was 41 (interquartile range: 26-53). The percentage of clinic visits with uncontrolled BP ranged from 39.1% in the first to 44.1% in the fourth ADI quartile. Figure 1 shows the unadjusted and adjusted odds of uncontrolled BP and TI by ADI quartiles. Adjusted odds of uncontrolled BP during a clinic visit was 1.17 (95% confidence interval (CI) 1.06, 1.28) in the fourth vs. first ADI quartile. Among the 21,928 clinic visits with uncontrolled BP, TI occurred in 79.5%, 82.2%, 83.0%, and 81.6% of visits in ADI quartiles one, two, three, and four, respectively. Adjusted odds of TI during a clinic visit was 1.16 (95% CI 1.01, 1.33) in the fourth vs. first ADI quartile. Our findings of higher odds of uncontrolled BP and TI during clinic visits with patients residing in neighborhoods with higher vs. lower ADI suggest that neighborhood disadvantage is associated with both uncontrolled BP and TI in older adults.
Abstract 4141834: Impact of a quality health care program in Mexico: Preliminary results of “Calidad con Corazon”. The AHA GWTG-CAD pilot project in Mexico
Authors: Leslie Marisol Lugo Gavidia, Jorge Saucedo, Jose Leiva-Pons, Manuel De Los Rios, Pedro Gutierrez- Fajardo, Alexandra Arias-Mendoza, Arturo Guerra Lopez, Jorge Cossio-Aranda
Journal: Circulation (2024)

Introduction: The healthcare system in Mexico is complex and fragmented which becomes an impediment to implementing national-wide quality improvement initiatives in the cardiovascular area. The American Heart Association Get With The Guidelines® (GWTG) Quality program has become an important tool to improve healthcare standards for patients in US. Aims: To develop for the first time, the “Calidad Con Corazon Program” to apply the AHA GWTG framework in Mexico to improve adherence to guideline-directed medical therapies(GDMT) for the treatment of patients with CAD. Methods/Approach: Calidad con Corazon program included 10 PCI-capable hospitals from five states in Mexico, representing both public and private health systems. Data included patients with ACS/STEMI/NSTEMI diagnosis. All hospitals were provided quality improvement consultations to identify barriers and develop action plans. This analysis includes data from the first 18 months of the project (Sep 2022 to May 2024). Results: We included 2087 patients; Overall, the mean age was 62.1±13.7 and included 73.8% males, with a history of hypertension (57.3%), dyslipidemia (13.6%), diabetes Mellitus (42%), and myocardial infarction (12.3%). Clinical presentation was predominantly STEMI in 66% (n=1378). A progressive improvement overtime was observed on the proportion of patients receiving an ECG in &lt;10 min after arrival to the PCI-hospital, from 53.3% of cases pre-program to 86.2% at 12-18 months after the program (p&lt;0.001). The result was a decrease from a mean of 22.8 minutes to 8.2 minutes respectively (p&lt;0.001). STEMI/NSTEMI patients showed an increase in the proportion of GDMT at discharge for statins(95.2% to 96.9%), betablockers(81.5% to 86%), aspirin(95.4% to 97.1%) and ARB/ACEi(79.5% to 88%). Procedure improvements included a decrease in missing ECG documentation(11.7% to 4.1%), an increase in LVEF measurement (82.7% to 92%), and lipid profile measurement(42.9% to 83.3%). Conclusion: Hospitals participating in the first national quality improvement program in Mexico adopting the AHA’s GWTG framework for patients with ACS demonstrated improvement in hospital procedure protocols over a 18 months period, reflected as an improvement in the performance metrics.
Abstract 4141946: Characterization of Cardiac, Autonomic, and Exercise Physiology in Patients with Long COVID
Authors: Emmett Suckow, Kate Pierce, kyla wulff, Chelsea Arent, Shelanna Kreye, Michael Rosenberg, Katie Sabin, Hugh Parker, Lindsay Forbes, Barry McDonnell, Eric Stöhr, William Cornwell
Journal: Circulation (2024)

INTRODUCTION: Mechanisms contributing to the post-acute sequelae of SARS-CoV-2 (PASC, aka Long COVID) and associated functional limitations are unclear. RESEARCH QUESTION: Determine cardiovascular, autonomic and exercise physiology among patients with Long COVID. METHODS: Twenty-one Long COVID patients (16 females, 41±12yrs) underwent cardiovascular assessment during head-up tilt at supine, 30 o and 60 o , a 10-minute upright standing orthostatic challenge and cardiopulmonary exercise testing (CPET). Baroreceptor sensitivity was determined with Valsalva maneuver. Heart rate (HR) and blood pressure (BP) were monitored continuously. Plasma norepinephrine (NE) was monitored during tilt. RESULTS: During tilt, HR increased with transition from supine to 30 o and 60 o (72±12 v. 80±14 v. 90±15bpm, P&lt;0.001). Plasma NE increased (2519±896 v. 3407±1085 v. 4025 ±1153pg/mL, P&lt;0.001) and MAP was maintained (92±10 v. 94±10 v. 97±10mmHg, P=0.103). HR increased during Phase IIA of the Valsalva in response to a reduction in systolic blood pressure with group-averaged baroreceptor sensitivity of 8.2±6.0ms/mmHg ( Figure 1 ). During the 10-minute stand, HR increased and BP was maintained ( Figure 2 ). CPET data are presented in Table 1 demonstrating reduced peak oxygen uptake of 19.5±6.7ml/kg/min (74±18% predicted). CONCLUSIONS: Patients with Long COVID demonstrate preserved autonomic function, with appropriate increase in catecholamines and preservation of blood pressure in response to orthostatic challenge. HR and BP increased appropriately during exercise for the level of work achieved, but overall functional capacity was reduced. Further research is needed to identify novel treatment strategies to improve outcomes.
Abstract 4141940: Outcomes in Middle Eastern Atrial Fibrillation Patients with Prior Ischemic Stroke/Systemic Embolism: Findings from the JoFib Study
Authors: Jowan Al-Nusair, Mohammed Al-Nusair, Nasr Alrabadi
Journal: Circulation (2024)

Objective: Examine the sociodemographic and clinical profiles of Middle Eastern patients with atrial fibrillation (AF) who have a history of prior ischemic stroke or systemic embolism (SSE) and compare the risk of adverse events between AF patients from the Middle East with and without a history of SSE. Methods: The study population was drawn from the JoFib study, a multicenter, nationwide, prospective registry of AF patients from the Middle East. Patients with a history of prior hemorrhagic stroke were excluded from this analysis. The remaining patients were divided into two groups based on their history of prior SSE to compare baseline sociodemographic and clinical characteristics and the one-year risk of all-cause death, cardiovascular death, non-cardiovascular death, SSE, and major bleeding between AF patients with and without prior SSE. Multivariable Cox proportional hazards models and Fine-Gray sub-distribution hazards models were used to adjust for confounding factors. Additionally, multivariable logistic regression models were applied to compare the secondary outcome of clinically relevant non-major bleeding (CRNMB) between the two groups. Results: The study included 2,003 AF patients, divided into two groups: 318 patients (15.9%) with a history of prior SSE and 1,685 patients (84.1%) without. Patients with prior SSE were older than those without (45.3% vs. 30.4%, p&lt;0.001). Compared to the no prior SSE group, those with prior SSE were less symptomatic (61.3% vs. 72.8%, p&lt;0.001), had higher rates of diabetes (49.1% vs. 42.4%, p=0.03) and dyslipidemia (51.9% vs. 43.6%, p=0.007), and were less often obese (34.0% vs. 42.2%, p=0.009). Rhythm-control strategies were used less frequently in the prior SSE group (16.0% vs. 22.0%, p=0.02), while antithrombotic medications were more commonly used, including anticoagulants (89.0% vs. 80.7%, p&lt;0.001) and antiplatelets (48.4% vs. 37.6%, p&lt;0.001). The prior SSE group had a higher risk of all-cause death (aHR 1.64, 95% CI 1.21-2.22), cardiovascular death (adjusted subhazard ratio [aSHR] 1.50, 95% CI 1.04-2.16), non-cardiovascular death (1.76, 95% CI 1.00-3.08), and SSE (3.05, 95% CI 1.83-5.07). However, a history of prior SSE did not significantly affect the rates of major bleeding (0.67, 95% CI 0.27-1.65) or clinically relevant non-major bleeding (CRNMB) (AOR 0.79, 95% CI 0.47-1.33). Conclusion: AF patients with a history of prior SSE face a higher risk of adverse events compared to those without prior SSE.
Abstract 4141854: Paclitaxel Coated versus Uncoated Balloon for Coronary In-stent Restenosis: A Systematic Review and Meta-Analysis with Trial Sequential Analysis
Authors: Vinicius Oliveira, Pedro Lucas Alves Alencar, Izadora Oliveira, Andre de Sousa, Ricardo Figueiredo Paro Piai, Joao Victor Alves Alencar, Felipe Schmaltz Zalaf, Humberto Graner Moreira
Journal: Circulation (2024)

Background: Drug-coated balloons present a potentially advantageous therapeutic approach for managing coronary in-stent restenosis. However, the comparative benefits of paclitaxel-coated balloons (PCBs) over uncoated balloons (UCBs) in coronary interventions remain unclear. Therefore, we conducted a systematic review and meta-analysis with trial sequential analysis (TSA) to evaluate the clinical outcomes of patients treated with PCBs compared to those treated with UCBs for coronary in-stent restenosis. Methods: We searched PubMed, Embase and Cochrane databases for randomized clinical trials (RCTs) comparing the use of PCBs and UCBs in the treatment of coronary in-stent restenosis. A random-effects model was employed to pool odds ratios (ORs) and their 95% confidence intervals (CIs). Statistical analyses were performed using Review Manager version 5.4.1. and TSA version 0.9.5.10 beta. Results: We included 7 RCTs with a total of 1,344 patients, of whom 834 underwent percutaneous coronary intervention (PCI) with PCBs. In our pooled analysis, patients treated with PCBs had lower odds of target lesion revascularization (OR 0.21; 95% CI 0.11 – 0.40; P&lt;0.01; Figure 1A), target vessel revascularization (OR 0.43; 95% CI 0.32 – 0.59; P&lt;0.01), major adverse cardiac events (MACE) (OR 0.15; 95% CI 0.09 – 0.27; P&lt;0.01; Figure 1B), and myocardial infarction (OR 0.56; 95% CI 0.33 – 0.94; P=0.03). However, there were no significant differences between groups in the odds of all-cause mortality (OR 0.56; 95% CI 0.18–1.77; P=0.33), cardiac death (OR 0.81; 95% CI 0.12 – 5.27; P= 0.82) and stent thrombosis (OR 0.20; 95% CI 0.03 – 1.36; P=0.10). TSA indicates that the observed effect on the primary outcome of TLR can be deemed conclusive, with a low risk of type 1 error. Conclusions: These findings suggest that PCBs are superior to UCBs regarding the occurrence of target lesion revascularization, target vessel revascularization, MACE, and myocardial infarction. Nonetheless, there were no significant differences in the odds of all-cause mortality, cardiac death, and stent thrombosis.
Abstract 4141873: Estrogen Activates Endothelial Neutral Sphingomyelinase in a Sex-Dependent Manner
Authors: Rachel Limpert, Gopika SenthilKumar, Brian Lindemer, Julie Freed
Journal: Circulation (2024)

Microvascular endothelial dysfunction is a strong predictor of future adverse cardiac events. We have previously shown that exposure to chronic estrogen induces microvascular endothelial dysfunction in isolated microvessels from otherwise healthy adults, with more extensive dysfunction exhibited in vessels from males. Further, we have demonstrated sex-specific, estrogen-induced increases in endothelial ceramide, a sphingolipid that when accumulated promotes microvascular endothelial dysfunction. The source of ceramide in response to estrogen remains unknown. Here we hypothesized that exogenous estrogen activates the ceramide-forming enzyme neutral sphingomyelinase (NSmase) in a sex-dependent manner. Sex-specific human umbilical vein endothelial cells (HUVECs) were cultured to passage 3 and treated with 17β-estradiol (E2, 100nM) or vehicle for 0, 1, and 2 minutes prior to collection and lysis of cells. NSmase activity was measured by the Neutral Sphingomyelinase Activity Assay Kit (Echelon Biosciences) according to manufacturer instructions. NSmase activity was greater in female compared to male HUVECs after 1 minute of treatment with E2 (normalized %change from control±SE; Untreated Control vs. 1 min E2; female:0.00±9.4% vs. 42.33±9.4%, n=6 vs. n=3, respectively, p =0.0174; male:-0.17±4.45 vs. 27.33±6.36, n=6 vs. n=3, respectively, p =0.1507; one-way ANOVA). Interestingly, NSmase activity was also significantly increased following 2 minutes of E2 treatment, an effect not observed in cells from females (normalized %change from control±SE; Untreated Control vs. 2 min E2; female:0.00±9.4% vs. 19.0±4.7%, respectively, n=6, p =0.26; male:-0.17±4.4 vs. 38.3±6.9, respectively, n=6, p =0.004). These data suggest that estrogen activates NSmase in a sex-dependent manner with an earlier, transient activation observed in females and a more sustained response in males. Collectively, this may further explain the sexually dimorphic response to estrogen and provide a potential therapeutic avenue to prevent microvascular damage in individuals chronically exposed to estrogen.
Abstract 4141927: Risk of myocardial infarction in paroxysmal vs. non-paroxysmal atrial fibrillation: an individual patient-level data analysis of 71,466 patients from COMBINE AF
Authors: Georgios Ntaios, Andreas Goette, Michael Palazzolo, Elliott Antman, Christian Ruff, Eugene Braunwald, Mark Link, Kenneth Mahaffey, John Eikelboom, Christopher Granger, Manesh Patel, Lars Wallentin, Robert Giugliano
Journal: Circulation (2024)

Background: Prior data suggest the MI risk may be higher with paroxysmal AF (PAF) vs. non-paroxysmal AF (non-PAF). Proposed mechanisms include tachycardia-induced oxidative stress (via LOX-1) with microvascular flow abnormalities, ischemia downstream of a fixed coronary obstruction, and plaque rupture. Methods: We compared MI rates in pts with PAF vs. non-PAF in COMBINE AF, a patient-level metanalysis of 4 RCTS of DOACs vs warfarin (ARISTOTLE, ENGAGE AF-TIMI 48, RE-LY,ROCKET AF). Secondary endpoints were ischemic stroke and CV death. Cox proportional-hazards models stratified by trial and adjusted for elements of the CHADS-VASc score were constructed. Sensitivity analyses were performed across subgroups, omitting pts on lower-dose DOAC regimens, and accounting for competing risk of death. Results: Of 71,466 pts, 16,609 (23%) had PAF at enrollment. Pts with PAF vs non-PAF were similar age (median 72 vs 72. P=0.15), but more likely women (43 vs 36%), with prior CAD (35 vs 31%), and on aspirin (41 vs 32%); but less likely Asian race (12 vs 15%) or with CHADS-VASc score &gt; 4 (59 vs 60%), p &lt; 0.002 for each. During &gt;160,000 pt-yrs of follow-up, 1033 MIs occurred: 277 (1.67%) in pts with PAF vs 766 (1.40%) in pts with non-PAF, corresponding to rates of 0.81% and 0.70% per pt-year. The HR adj for MI with PAF vs non--paroxysmal AF was 1.17 [1.02-1.35], p=0.028 (Fig). Ischemic stroke occurred in 364 (2.19%) vs 1425 (2.60%) pts with PAF vs non--paroxysmal AF (HR adj 0.81 [0.72-0.91], p&lt;0.001). CV death occurred in 625 (3.77%) pts with PAF vs 3027 (5.52%) with non-paroxysmal AF (HR adj 0.75 [0.68-0.81], p&lt;0.001). No significant effect modification of pt characteristics on MI risk by AF pattern were present, although a trend was seen for higher MI risk with PAF vs non-PAF in pts with prior CAD (HR 1.34 [1.12-1.59]) vs no prior CAD (HR 0.96 [0.76-1.22]), P INT 0.06. Results were consistent across trials, by anticoagulant, excluding lower dose DOACs, and accounting for competing mortality risk. Conclusions: This individual patient-level metanalysis of 71,466 pts from COMBINE AF shows that the adjusted risk of MI is higher in pts with PAF than non--paroxysmal AF, while the adjusted risks of ischemic stroke and CV death were lower in pts with PAF.