tbuckley/cabot-search huggingface dataset:
Abstract 16734: Patterns of Inflammatory Activation in Cardiovascular Disease: Insights From the Randomized Colchicine PCI Trial
Authors: Nina Talmor, Michael Pillinger, Ana Leonard, Fatmira Curovic, Binita Shah
Journal: Circulation (2023)

INTRODUCTION: Recent studies demonstrate that neutrophils accumulate in atherosclerotic lesions and that neutrophil counts correlate with disease severity. The randomized double-blind Colchicine-PCI study demonstrated that colchicine attenuated systemic inflammation (IL-6, CRP) after percutaneous coronary intervention compared with placebo. GOALS/AIMS: We characterized neutrophil activity in patients across a spectrum of cardiovascular phenotypes, including severity of coronary artery disease (CAD) and presentation of acute myocardial infarct (AMI). METHODS: The Colchicine-PCI biomarker sub-study enrolled 478 participants with pretreatment assessment of inflammatory biomarkers. White blood cell count and differential were performed using a hematology analyzer. Soluble markers of neutrophil activity, including neutrophil extracellular traps (NETs), and systemic inflammation were assessed using multiplex assays. Neutrophil surface markers of activity and neutrophil platelet aggregates were assessed using an Accuri C6 flow cytometer. RESULTS: We observed neutrophil concentration, adhesion, transmigration, and activation, as well as increased NETs complexes; but no difference in extent of neutrophil platelet aggregation or systemic inflammation in patients with versus without obstructive CAD. Conversely, in patients with versus without AMI, neutrophil markers of adhesion and transmigration did not differ, but systemic markers of inflammation and neutrophil activation were elevated. CONCLUSION: This single-site, prospective study is the largest neutrophil biorepository in patients with cardiovascular risk factors. Inflammatory activation, and particularly neutrophil profiles, differ in patients with obstructive CAD and in the setting of AMI.
Abstract 18257: Arrhythmias in Tumor Lysis Syndrome
Authors: Muhammad Osama, Amani Khalouf, Mohammad Ammad Ud Din, Anas Hashem, Nauman Naeem, Uzma Iqbal
Journal: Circulation (2023)

Background: Tumor lysis syndrome (TLS) is a common complication seen among hospitalized patients with acute promyelocytic leukemia (APL) undergoing induction therapy. Question: What is the incidence and type of arrhythmias in patients with TLS? Methods: This study utilized the National Inpatient Sample Database between 2015-2019 to identify patients hospitalized with APL and further subclassify them into those with and without TLS. ICD-10 codes were used to identify different types of arrhythmias in both groups. A multivariate logistic regression model was constructed to assess adjusted odds ratio for all-cause mortality and cardiac/renal complications. Results: A total of 9938 hospitalizations with APL were identified. Of those, 415 patients had TLS (4.2%). APL patients with TLS were older and more likely to be males. CVA, CHF, CAD, HTN and higher comorbidity scores were more frequent among patients with TLS (Table 1). On adjusted analysis, Patients with TLS had ~2.7-fold increase in all-cause mortality (aOR 2.74, 95% CI [2.12 - 3.55], p&lt; 0.01). In addition, TLS patients had higher rates of cardiac arrhythmias (33.7% vs 21.4%, p&lt;0.01). Atrial fibrillation was the most common arrhythmia (45%), followed by ventricular arrhythmias (11.3%), and lastly, torsade de pointes (8.2%). Finally, TLS patients were more likely to have AKI (aOR 4.13, 95% [3.31 - 5.16], and need hemodialysis (aOR 3.44, 95% CI [2.34 - 5.05], p&lt;0.01). Conclusion: Patients with TLS are at high risk for arrhythmias, all-cause mortality and cardiac morbidity. Preventive strategies like continuous telemetry monitoring may allow for early identification of arrhythmias and may help improve outcomes.
Abstract 16736: Comparison of Pulmonary Arterial Hypertension Risk Assessment Tools Using a Harmonized FDA Dataset
Authors: Charles Fauvel, Shili Lin, Priscilla Correa-Jaque, Allen D Everett, Adam Perer, Yongqi Liu, Manreet Kanwar, Rebecca Vanderpool, Jidapa Kraisangka, raymond Benza
Journal: Circulation (2023)

Introduction: One-year mortality risk for a pulmonary arterial hypertension (PAH) patient is the most substantial. Accordingly, the initial risk stratification should be the most accurate to ensure appropriate aggressiveness of the primary treatment choices. According to PAH guidelines, the European 3-strata system is recommended at baseline for risk assessment. However, the US REVEAL2.0 and REVEAL Lite risk scores also provide high performances. Yet, comparison of risk assessment performances at baseline in the same dataset of patients is still missing. Hypothesis: REVEAL 2.0 provide higher discrimination performances than the European 3-strata system at baseline. We aim to compare the discrimination power at baseline of the currently available tools. Methods: Treatment naïve PAH patients from 6 PAH trials were provided by the FDA and harmonized (AMBITION n=500, ARIES n=126, PATENT n=221, PHIRST n=77, GRIPHON n=231, and SERAPHIN n=270). Kaplan-Meier and log-rank tests were performed for each of the following tools: noninvasive FRENCH method (FR), European 3-strata system (E3), COMPERA2.0 4-strata (CO), REVEAL2.0 (RE), and REVEAL Lite (RL). Their C-indices were compared. A total of 100 bootstrap samples were obtained from the original data providing a robust method for comparing across the different tools. Results: Among the 1,425 patients, 78% were female, 54% NYHA 3-4 with a median age of 51(38, 64) yo, 6-min walking distance of 365(295, 418)m, mPAP of 49(38, 59) mmHg, PVR 9.3(6.2, 13.5) WU. At baseline, the C-index for FR, CO, E3, RL, and RE were 0.64, 0.67, 0.68, 0.69, 0.73, respectively. Out of the 100 bootstrap samples, 99% led to a better C-index for RE compared to E3, with a statistically significant paired t-test (p&lt;e -40 ) as well as RL compared to E3 (p&lt; e-8 ). Forrest plots of 95%CI for the C-index differences among the 100 bootstrap samples showed that RE was the best performer, followed by RL, while the E3 and FR models were comparable and worse than the others. Conclusions: REVEAL 2.0 and REVEAL Lite risk scores perform better than the European-3 strata, COMPERA-4 strata, and the noninvasive FRENCH models in predicting 1-year survival at baseline and should be considered as the initial stratification scheme in future guidelines.
Abstract 18320: Vessel-Specific Coronary Inflammation Quantified Using Perivascular Fat Attenuation Index Score on CCTA Detects the Vulnerable Coronary Artery and Predicts Acute Plaque Events
Authors: Kenneth Chan, Elizabeth Wahome, Alexios S Antonopoulos, Edward Nicol, Lucrezia Volpe, Henry West, Parijat Patel, Pete Tomlins, Stefan Neubauer, Keith M Channon, Charalambos Antoniades
Journal: Circulation (2023)

Background: Coronary artery inflammation can be detected non-invasively on routinely performed coronary computed tomography angiograms (CCTA) by measuring the 3D changes of perivascular adipose tissue attenuation. Fat attenuation index (FAI) Score is the corrected metric of coronary inflammation measured in any of the 3 coronary arteries, and predicts acute myocardial infarction (AMI). Although FAI score is able to detect the vulnerable patient, it is unclear whether it can be used to detect the vulnerable artery in advance of an acute event. Aim: To evaluate the ability of FAI Score to detect the vulnerable coronary artery in patients undergoing CCTA for investigation of chest pain. Methods: Consecutive patients (n = 3,393, mean age 61±15, 57% male) from two UK hospitals in the Oxford Risk Factors and Non Invasive Imaging (ORFAN) study underwent CCTA between 2010-2018 for suspected coronary artery disease (CAD), and were followed up prospectively for a median of 7.7 years. AMI events were recorded via nationwide screening and the culprit vessel was identified based on the target lesion in percutaneous coronary intervention (PCI). FAI score was generated with CaRi-Heart® device. Results: A total of 296 AMI events occurred during the follow up period and 176 patients underwent PCI (59 attributed to the right coronary artery (RCA), and 93 to left anterior descending artery (LAD)). Patients with high FAI score in the LAD had 2 times higher risk for AMI in the LAD (Fig. A), but not in the RCA (HR 1.73 95% CI 0.96-3.08, p=0.07). Similarly, patients with high FAI score in the RCA had 1.9 times higher risk for AMI in the RCA (Fig. B), and modestly elevated risk for an AMI from the LAD. (HR 1.62, 95% CI 1.02-2.59, p=0.04) Conclusion: Vessel-specific FAI score predicts AMI caused by a culprit lesion in the corresponding coronary artery. The ability of FAI score to identify the vulnerable artery before it gives a plaque rupture event may be useful in planning targeted therapeutic interventions.
Abstract 15372: The Lewis Lead
Authors: Mohamed Elhadi, Fadi W Adel, Ammar M Killu
Journal: Circulation (2023)

The Lewis lead is a modified ECG configuration that can enhance the amplitude of the atrial electrical activity and is useful when the atrial activity cannot be discerned in the standard ECG. The configuration involves applying the right arm electrode on the manubrium, left arm electrode to the 5th intercostal space on the right sternal border, left leg electrode over the right lower costal margin and right leg electrode in the standard position. The ECG is then interpreted in lead I and II. Herein we present a case where the Lewis lead aided in the diagnosis of complete heart block with underlying atrial fibrillation. Case Presentation: A 75 year old female with severe tricuspid regurgitation was admitted for tricuspid valve replacement. She had previous paroxysmal atrial fibrillation status post pulmonary vein isolation. The preoperative ECG revealed normal sinus rhythm. Postoperatively, ECG demonstrated a narrow complex ventricular rhythm at 70 beats per minute. No atrial activity could be clearly discerned (Image 1). The epicardial atrial wire placed intraoperatively was not functioning, therefore atrial electrogram could not be obtained. It was unclear from repeat ECGs if there was sinus arrest or atrial fibrillation in the atria. The Lewis lead was then utilized and revealed underlying atrial fibrillation (Image 1); together, this was consistent with atrial fibrillation and complete heart block with a junctional escape rhythm. The rhythm did not recover and there was progressive conduction system disease with widening of the QRS and episodes of severe bradycardia. She underwent pacemaker implantation. Discussion: By utilizing the Lewis lead we were able to establish the atrial rhythm and differentiate between atrial fibrillation and sinus arrest. The Lewis lead can also help narrow the differential for wide complex tachycardia by magnifying the p wave, thus making it easier to detect ventriculoatrial dissociation, a hallmark feature of ventricular tachycardia.
Abstract 15319: Impact of Atherosclerotic Cardiovascular Disease Risk Factors on Pregnancy Outcomes in Women With Heart Disease
Authors: Beatriz Aldara Fernandez Campos, Jasmine Grewal, Marla C Kiess, Birgit Pfaller-Eiwegger, Danielle Massarella, Samuel C Siu, Candice Silversides
Journal: Circulation (2023)

Introduction: The impact of atherosclerotic cardiovascular disease (ASCVD) risk factors on pregnancy outcomes in women with pre-existing heart disease (HD) has not been examined. Aim: To determine the risk of major adverse cardiovascular events (MACE), preeclampsia and fetal events in women with HD stratified according to the presence of ASCVD risk factors. Methods: We studied a consecutive cohort of pregnant women with heart disease. ASCVD risk factors included any of the following: obesity, hypertension, dyslipidemia, diabetes or smoking. Primary outcomes were MACE (heart failure, cardiac arrest, CV death, stroke and myocardial infarction), preeclampsia and adverse fetal events (pre-term birth, small for gestational age, intraventricular hemorrhage, neonatal death and respiratory distress syndrome). Univariate logistic regression was used to determine the odds of adverse outcomes. Results: In total, 1656 pregnancies (congenital heart disease n=1041, acquired heart disease n= 420, isolated arrhythmia n=195) were included. At least one ASCVD risk factor was present in 24% of pregnancies. Overall, MACE occurred in 7.1%, preeclampsia in 4.3% and adverse fetal events in 30.1% of the pregnancies. Compared to pregnancies in women without ASCVD risk factors, those with ASCVD risk factors were more likely to have pregnancies complicated by MACE (9.7% vs 6.3%, p= 0.025), preeclampsia (8.3% vs 3.4%, p &lt; 0.001), and fetal events (38.5% vs 27.5%, p &lt;0.001). There were differences in maternal and fetal outcomes with or without ASCVD risk factors when stratified by diagnosis (acquired heart disease, congenital heart disease, isolated arrhythmias) (Figure 1). Conclusions: The presence of ASCVD risk factors in women with heart disease is associated with worse maternal and fetal outcomes. Modification of ASCVD risk factors may improve pregnancy outcomes.
Abstract 16573: Orthostatic Blood Pressure Changes and Cognitive Function: Insights From the SPRINT MIND Trial
Authors: Ruixue Yang, Jun Cai
Journal: Circulation (2023)

Introduction: The association between orthostatic blood pressure (BP) changes and cognitive function has not been thoroughly investigated. Moreover, whether orthostatic hypotension or hypertension modifies the effects of intensive BP control on cognitive outcomes is unknown. Hypothesis: We hypothesized that orthostatic BP changes were associated with cognitive function and the effects of intensive BP control on cognitive outcomes might be different among individuals with/without orthostatic hypotension or hypertension. Methods: We performed a post hoc analysis of SPRINT MIND, a randomized controlled trial evaluating the effects of intensive vs. standard SBP control on cognitive outcomes in hypertensive patients. The relationships between baseline orthostatic BP changes (defined as baseline standing systolic BP [SBP]–baseline seated SBP) and probable dementia (PD) and mild cognitive impairment (MCI) were analyzed. The competing risk proportional hazards regression and cubic spline regression were used in analysis. Results: A total of 8547 participants (mean [SD] age, 67.9 [9.3] years; 5543 [64.9] men) were included in this analysis. In the crude model, the restricted cubic spline analysis showed L-shaped associations between orthostatic SBP change and new-onset PD and MCI (all P for nonlinearity&lt;0.05). However, these associations all disappeared after adjustment for covariates. Moreover, orthostatic diastolic BP change was not associated with the PD or MCI incidence. Intensive BP control did not alter the risk of PD or MCI in patients with/without orthostatic hypotension or hypertension. Conclusions: Orthostatic BP changes were not associated with the risk of PD or MCI; baseline orthostatic hypotension or hypertension did not influence the effects of intensive BP control on cognitive outcomes. These results are hypothesis-generating and merit further study.
Abstract 18312: Is the Presence of Multiple Valvular Heart Disease or Mitral Annular Calcification in Cancer Patients Exposed to Chest Radiotherapy or Chemotherapy That Underwent Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis Associated With MACE?
Authors: Sebastian Santos Patarroyo, Carolina Ricaurte, Diana Collantes, Andres Daryanani, Rafael Toro-Manotas, Mackram F Eleid, Sorin Pislaru, Hector I Michelena, Kevin Greason, Vuyisile T Nkomo, Hector R Villarraga
Journal: Circulation (2023)

Introduction: Multiple Valvular Heart Disease (VHD), defined as at least moderate stenotic or regurgitant lesions in ≥2 valves, mixed VHD as combination of lesions in the same valve and mitral annular calcification (MAC) are common conditions. Association between multiple-mixed VHD (MMVHD), MAC and MACE in patients exposed to Radiation Therapy (RT) and/or chemotherapy (CT) who underwent Transcatheter Aortic Valve Replacement (TAVR) has not been studied. Aim: Assess the presence of MMVHD and MAC in cancer patients with prior RT and/or CT and their correlation with MACE (cardiovascular death, myocardial infarction, revascularization, stroke and hospitalization for heart failure) after TAVR. Methods: 544 patients were included and divided into 3 groups: 187 with prior chest RT and CT (RT/CT), 155 CT only, and 202 without CT/RT as controls (Table 1). Data was obtained from the pre-procedure echocardiogram and quantified in a 1-6 scale (none, mild, mild/moderate, moderate, moderate/severe and severe). Fisher’s exact test or chi-square were used to compare categorical. Multiple VHD-MACE correlation was evaluated through multivariable Cox analysis using a proportional hazards model. Results: The prevalence of Multiple VHD was 37.4% in RT/CT, 23.2% in CT, and 13.9% in controls p&lt;0.001(Figure 1). The RT/CT group had a significantly higher prevalence of severe MAC. Multiple VHD predicted MACE at 18 months after TAVR in RT/CT (HR 3.42, CI 1.93-6.08, p&lt;0.001) and in CT (HR 2.55, CI 1.39-4.66, p=0.002) (Table 2). In RT/CT, severe MAC also predicted MACE (HR 3.68, CI 2.13-6.37, p&lt;0.001), while it was not a predictor in the other groups. Stenotic or regurgitant VHD was more prevalent in the RT/CT group (Figure 2). Conclusions: Multiple VHD was found higher in RT/CT and predicted MACE at 18 months post-TAVR, including CT only patients. Severe MAC was also a strong predictor of the outcome in RT/CT patients. Pre-TAVR evaluation of MMVHD lesions is crucial for optimal patient management.
Abstract 16755: Changes in Mid-Regional Pro-Adrenomedullin During Treatment With Sacubitril/Valsartan
Authors: Peder L Myhre, Yuxi Liu, Ian Kulac, Brian Claggett, Margaret Prescott, Michael Felker, Javed Butler, Ileana L Pina, Jean L Rouleau, Michael R Zile, John J McMurray, Jonathan Ward, Scott Solomon, James L Januzzi
Journal: Circulation (2023)

Background: Adrenomedullin is a vasodilatory peptide with a role in microcirculatory and endothelial homeostasis. Adrenomedullin is a substrate for neprilysin and may therefore play a role in beneficial effects of sacubitril/valsartan (Sac/Val) treatment. Methods: Mid-regional pro-peptide of adrenomedullin (MR-proADM) was measured in 156 patients with heart failure with reduced ejection fraction (HFrEF) treated with Sac/Val and 264 patients with HF with preserved EF (HFpEF) randomized to treatment with Sac/Val or valsartan. Echocardiography and Kansas City Cardiomyopathy Questionnaire results were collected at baseline and after 6 and 12 months in the HFrEF cohort. Results: Median (Q1-Q3) baseline MR-proADM concentrations were 0.80 (0.59-0.99) nMol/L in HFrEF and 0.88 (0.68-1.20) nMoL/L in HFpEF. After 12 weeks of treatment with Sac/Val, MR-proADM increased by median 49% in HFrEF and 60% in HFpEF, while there were no significant changes in valsartan-treated patients (median 2%). Greater increases in MR-proADM were associated with higher Sac/Val doses. Changes in MR-proADM correlated weakly with changes in N-terminal pro-B-type natriuretic peptide, cardiac troponin T and urinary cyclic guanosine monophosphate. Increases in MR-proADM were associated with decreases in blood pressure, but not significantly associated with changes in echocardiographic parameters or health status ( Figure ). Conclusions: MR-proADM concentrations rise substantially following treatment with Sac/Val, in contrast to no change from valsartan. Change in MR-proADM from neprilysin inhibition did not correlate with improvements in cardiac structure and function or health status. More data are needed regarding the role of adrenomedullin and its related peptides in the treatment of HF.
Abstract 15318: A Dene- and Drug-Eluting Peripheral Stent Using a Baculovirus-Eluting PVA Hydrogel Coating
Authors: Sabrina J Schaly, Satya Prakash
Journal: Circulation (2023)

Introduction: Over 20 % of people over 60 have peripheral artery disease (PAD), the narrowing of peripheral arteries due to atherosclerosis. More recent data suggests a surge in PAD in younger people (affecting up to 4 % of people). Atherosclerosis is complex, initially involving fat deposition and endothelial cell dysfunction, leading to inflammation, hyperproliferation of cells, plaque development, and calcification. This can lead to significant pain, discomfort, limb ischemia, stroke, and increases the risk of major cardiovascular events such as myocardial infarction and coronary artery disease. Often a bare-metal or drug-eluting stent will force the artery open. These stents are highly effective but come with complications such as restenosis, thrombosis, and enhanced endothelial dysfunction leading to patency as low as 60 % one-year post-implantation. Hypothesis: A gene- and drug-eluting hydrogel stent coating can promote endothelial recovery while the long-term drug elution prevents restenosis and inflammation, improving the clinical outcome of PAD (Figure 1). Methods &amp; results: The gene encoding nitric oxide had been cloned into a baculovirus, a highly efficient and safe gene delivery vector to arterial cells. Nitric oxide inhibits smooth muscle cell proliferation, promotes endothelial cell proliferation, promotes angiogenesis, and prevents reactive oxygen species production within the diseased artery. The 10-day gene elution has the potential to leave behind a healthy endothelial lining, and the 100-day Everolimus drug elution can prevent restenosis and inflammation. Moreover, the gene- and drug-eluting stent is stable during crimping and expansion, has a high tensile strength, is non-cytotoxic, and is anti-thrombotic by preventing platelet adhesion. Conclusion: Overall, the novel stent exhibits beneficial mechanical and cellular properties with the potential to mitigate current stenting complications using dual gene and drug therapy.
Abstract 18365: Elevated Biomarkers of Subclinical Myocardial Injury and Inflammation Among Community-Dwelling Adults With Covid-19
Authors: Oluwabunmi V Ogungbe, Melissa deCardi Hladek, Lori Sokoll, Phaedre Mohr, Cheryl R Dennison Himmelfarb, Patricia Davidson, Wendy S Post, Jason Farley, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Background: Subclinical cardiovascular impact of SARS-CoV-2 infection in mild-moderate cases is unclear. Hypothesis We hypothesized that positive anti-nucleocapsid/spike SARS-CoV-2 antibodies will be associated with elevated subclinical cardiac and inflammatory biomarkers. Methods: This study was nested within a randomized controlled trial among community-dwelling adults. We used logistic regression to estimate adjusted odds of positive anti-nucleocapsid/ spike protein antibodies and elevated cardiac and inflammatory biomarkers (high-sensitivity cardiac troponin [hs-TnI], N-terminal pro-B-type natriuretic peptide [NT-proBNP], Galectin-3 [Gal-3], and C-reactive protein, [CRP]). Results: Among 231 adults, mean (±SD) age was 50 (±17.6) years, 63% were female, 57% were Black persons. Overall, 11% had detectable hs-cTnI (&amp;ge;6 ng/L), 21% had elevated NT-proBNP (&amp;ge;125pg/dL), 42% had elevated Gal-3 (&amp;ge;18.5 ng/mL), 70% had elevated CRP (&amp;ge;0.9 mg/dL). CRP levels were significantly higher among persons with positive spike protein antibodies [positive: median, 1.9 (Interquartile range IQR, 4.1) vs. negative: median, 0.7 (IQR, 2.1); p=0.014]. Those with positive spike protein antibodies were 3.49 (95% CI, 1.33-9.15) times more likely to have elevated CRP than those who were negative. Cardiac/inflammatory biomarkers were slightly higher in persons with positive SARS-CoV-2 IgG antibody detecting nucleocapsid protein (virus-specific antibody) versus negative ( Figure ). Conclusions: In this sample, we observed elevated cardiac and inflammatory biomarkers indicative of myocardial injury. Further research on the durability of elevated cardiac biomarkers and their contributions to post-acute sequela of COVID-19 is needed.