tbuckley/cabot-search huggingface dataset:
Abstract 15558: Blood Pressure Responses During Exercise Were Associated With Average Home Blood Pressure and Home Blood Pressure Variability: The Electronic Framingham Heart Study
Authors: Xuzhi Wang, Yuankai Zhang, Chathurangi H Pathiravasan, Nicole L Spartano, Emelia J Benjamin, David D McManus, Gregory Lewis, Martin Larson, Vasan S Ramachandran, Joanne Murabito, Chunyu Liu, Matthew G Nayor
Journal: Circulation (2023)

Introduction: Abnormal blood pressure (BP) responses during exercise are associated with incident hypertension and cardiovascular disease, but how exercise BP responses relate to average home BP and home BP variability (BPV) over one-year follow-up is unknown. Objective: We investigated whether exercise BP was associated with average home BP and home BPV, after accounting for resting BP, in the electronic Framingham Heart Study (eFHS). We hypothesized that higher exercise BP predicts higher average home BP and home BPV over one-year follow-up. Methods: At a FHS research exam (2016-2019), participants underwent maximum incremental ramp cycle ergometry cardiopulmonary exercise testing (CPET) with BP measured every two minutes. Participants enrolled in the eFHS were provided with a digital BP cuff to measure home BP weekly for up to one year. Linear regression models were used to examine associations of exercise BP with average home systolic BP (SBP) and week-to-week average real variability (ARV) of home SBP over one-year follow-up, adjusting for covariates. ARV, which considers both the dispersion and order of BP readings, was quantified as the average of the absolute differences between consecutive BP readings. We used p&lt;0.05 for significance. Results: The study sample included 806 participants (mean age 53 years, 58% women, 46% hypertension, median number of home BP returns 22, average home SBP 122 mmHg). Adjusting for resting SBP and other covariates, higher exercise SBP (as measured by peak SBP, SBP at 75 Watts, and SBP/workload slope) was associated with higher average home SBP ( Figure 1A ). Higher SBP/workload slope was associated with elevated ARV of home SBP in men ( Figure 1B ). Conclusion: Higher exercise SBP responses are associated with higher average digital home-based SBP and home-based SBP variability over one-year follow-up after accounting for resting SBP.
Abstract 15291: Early Outcomes With Left Cardiac Sympathetic Denervation for Medically Refractory Idiopathic Ventricular Fibrillation
Authors: Raquel Neves, Ramin Garmany, Sahej Bains, Johan M Bos, Samuel Asirvatham, John Giudicessi, Michael J Ackerman
Journal: Circulation (2023)

Introduction: Treatment options for patients with recurrent ventricular arrhythmias (VAs) refractory to pharmacotherapy and/or ablation are minimal. Although left cardiac sympathetic denervation (LCSD) is well established in long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT), LCSD’s role in idiopathic ventricular fibrillation (IVF) is less clear. Here, we report our single-center experience regarding the early outcomes of LCSD in patients with IVF. Hypothesis: To determine the efficacy of LCSD on reducing VAs in IVF patients refractory to conventional therapy. Methods: A retrospective analysis of the electronic health record of patients with IVF between January 2000 to April 2023 was performed. Cardiac event rates [defined as arrhythmic syncope/seizure, appropriate implantable cardioverter defibrillator (ICD) therapy, sudden cardiac arrest (SCA), or sudden cardiac death (SCD)] before and after LCSD for each patient were calculated and a Wilcoxon signed rank test was performed. Results: In total, 94 patients (41% female) were classified as IVF. Overall, 15/94 patients (16%) had LCSD due to refractory VAs (60% male; mean age at LCSD 36 ± 20 years) despite beta-blocker treatment (100%) or combined drug therapy (67%). In total, 14 patients (15%) had an electrophysiology study performed before LCSD of which 10 (67%) had VAs ablation. All patients had a structurally normal heart and genetic testing performed in 14/15 patients (93%) confirmed absence of genetic cardiomyopathies and channelopathies. SCA was the sentinel event in 10 of 15 patients (67%); 14 patients (93%) had an ICD in place. The average follow-up time after LCSD was 3 ± 4 years. The VA event rate before LCSD was 4 ± 3 events per year and was reduced to 1 ± 3 per year (p&lt;0.04) after LCSD. Patients had a median of 3.2 less events per year after LCSD (p=0.02) with 7 patients (47%) having no post-LCSD recurrences thus far while 3 (20%) patients were deemed LCSD non-responders with no reduction of event rate. Conclusions: LCSD represents a substrate-independent, anti-fibrillatory treatment option for patients with life-threatening, genetic arrhythmias. While not curative, the early outcomes of LCSD for patients with medically refractory IVF are promising.
Abstract 14516: Combined Platelet Morphology and Clinicoradiological Features to Predict Type II Endoleaks Following Endovascular Abdominal Aortic Aneurysm Surgery
Authors: Muhammad Yogi Pratama, Benjamin King, Katherine Teter, Christina Bi, Natalie Presedo, Keerthi Harish, Thomas Maldonado, Bhama Rhamkhelawon
Journal: Circulation (2023)

Introduction: Persistent endoleak and associated endotension following endovascular abdominal aortic aneurysm repair (EVAR) can compromise successful repair and lead to continued sac expansion and eventual life-threatening rupture event. Hypothesis: A risk-stratification algorithm of the inherent anatomical and systemic cellular characteristics of patients might predict the incidence of type II endoleaks on abdominal aortic aneurysm (AAA) patients undergoing EVAR or fenestrated endovascular aortic aneurysm repair (FEVAR) procedures. Methods: Single-center retrospective study includes 146 AAA patients undergoing primary elective EVAR and FEVAR procedures between September 2013 and July 2021. A review of institutional medical records was conducted for the analysis. Patients who or who did not developed a type II endoleaks were included in this study. Results: Mean platelet volume (MPV) was significantly increased in patients with type II endoleaks and was associated with lower endoleak-free survival. Receiver operating characteristic (ROC) curve analysis showed that MPV demonstrated satisfactory predictive performance in distinguishing patients who developed type II endoleaks, yielding an area under the curve (AUC) value of 0.64. A risk-stratification panel consisting of postoperative MPV, history of type II diabetes, and number of preoperative patent lumbar arteries achieved an AUC value of 0.72 and predicted endoleak-free survival rate with HR of 4.88. We built an easy-to-use nomogram for predicting the risk of postoperative type II endoleak and revealed that MPV had the highest scoring weight of any variable in our model. Conclusions: We refined the anatomical and systemic traits in the blood that identified MPV as a significant predictor for type II endoleaks, which might facilitate post-surgical monitoring using complete blood count (CBC) as a supplement to imaging practice.
Abstract 16279: Does the Number of Antianginals Influence Clinical Outcomes and Quality of Life in Stable Ischemic Heart Disease? Insights From the BARI2D Trial
Authors: Yasser Jamil, Dae Yong Park, Luis More Verde, Matthew W Sherwood, Behnam N Tehrani, Wayne B Batchelor, Kelly Epps-Anderson, Jennifer Frampton, Abdulla Damluji, Michael Nanna
Journal: Circulation (2023)

Introduction: Medical therapy is essential for managing stable ischemic heart disease (SIHD), including anti-anginals. remains unclear whether combining anti-anginal agents provides benefits beyond monotherapy in terms of QoL and cardiovascular outcomes. Hypothesis: The use of a single anti-anginal (β-Blockers, calcium channel blockers, or nitrates) is non-inferior to ≥2 anti-anginals Methods: We utilized data from the BARI-2D trial, which compared cardiovascular and QoL outcomes in patients with SIHD and diabetes mellitus (DM) randomized to revascularization with intensive medical therapy or intensive medical therapy alone. We categorized patients into three groups: ≥2 vs 1 vs 0 anti-anginals. We compared patient characteristics, QoL metrics, and cardiovascular endpoints at baseline and at 5 years, creating a multivariable model to adjust for key clinical confounders. Results: Among 2,368 patients, 348 patients (14.7%) were on 0 anti-anginals, 1,020 patients (43.1%) were on 1 anti-anginal, and 1,000 patients (42.2%) were on ≥2 anti-anginals at baseline. The most common anti-anginal class was β-Blockers. At baseline, patients on 0 anti-anginals had better QoL metrics than patients on ≥2 anti-anginals. However, at a 1-year follow-up, patients taking only 1 anti-anginal showed greater QoL improvement than those taking 0 anti-anginal; this superiority in QoL metrics was not seen in patients taking ≥2 anti-anginal agent, even after adjusting for multiple covariates such as age, heart failure, diabetes control and myocardial jeopardy index. (Figure 1) Lastly, at 5-year follow-up, after adjustment, there were no differences in all-cause mortality, major adverse cardiovascular events, or myocardial infarction between patients taking different numbers of anti-anginals. Conclusion: Treating adults with SIHD and DM with a single anti-anginal was at least as effective in improving QoL compared to two or more anti-anginal agents at one year of follow-up.
Abstract 17651: Long-Term Outcomes of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Individual Patient Data
Authors: Michel Pompeu Sa, Xander Jacquemyn, Jef Van den Eynde, Danny Chu, Derek Serna-Gallegos, Tjark Ebels, Marie-Annick Clavel, Philippe Pibarot, Ibrahim Sultan
Journal: Circulation (2023)

Introduction - It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement (SAVR). Hypothesis - PPM is associated with poor outcomes after SAVR. Methods - Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by March 2023. Results - Sixty-five studies met our eligibility criteria and included 122,989 patients (any PPM: 68,332 patients, 55.6%). At 25 years of follow-up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (HR 1.16; 95%CI 1.13-1.18, p&lt;0.001). At 20 years of follow-up, the survival rates were 19.5%, 12.1 and 8.8% in patients with no, moderate and severe, respectively (moderate vs no PPM: HR 1.09; 95%CI 1.06-1.11; p&lt;0.001; severe vs no PPM: HR 1.29; 95%CI 1.24-1.35; p&lt;0.001). RMST was 0.8 years shorter in patients with moderate PPM, and 2.1 years shorter in patients with severe PPM in comparison with patients without PPM (10.2 years and 8.9 years vs. 11.0 years respectively, p&lt;0.001). PPM was associated with higher risk of cardiac death, HF-related hospitalizations and aortic valves reinterventions over time (p&lt;0.001). Statistically significant associations between PPM and worse survival were observed regardless of type of valves (bioprosthetic vs mechanical valves), contemporary PPM definitions unadjusted and adjusted to body mass index and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta-regression analysis revealed that populations with more women tend to have higher HRs for all-cause death associated with PPM. Conclusions - The results of the present study suggest that any degree of PPM is associated with poorer long-term outcomes following SAVR and provide support for implementation of preventive strategies to avoid PPM after SAVR.
Abstract 13924: Combined Gene Therapy Approach Targets Parasympathetic Signaling and Oxidative Stress to Reverse Pre-Existing Persistent Atrial Fibrillation in a Canine Model
Authors: Aleksei Mikhailov, Anna Pfenniger, Shin Yoo, David Johnson, Wenwei Zhang, William Marszalec, Asish K Ghosh, Rebecca A Ober, Rod S Passman, Bradley P Knight, Rishi Arora
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is a multifactorial disease, with oxidative stress (NADPH oxidase 2, NOX2) and autonomic remodeling (hyperinnervation and parasympathetic signaling) playing an important role. Disrupting both mechanisms simultaneously with gene-based therapy may allow for reversal of established remodeling in AF. Hypothesis: Gene therapy aimed at attenuation of parasympathetic signaling (Gαi/o inhibitory peptides, GiGo_ct) and prevention of nerve sprouting (nerve growth factor short hairpin RNA, NGF shRNA) combined with reduction of oxidative stress (NOX2 shRNA) can reverse AF in a large animal chronic AF model. Methods: Chronic AF model was created by rapid atrial pacing (RAP) at 600bpm in 5 dogs, followed by gene therapy treatment (Panel A). A combination of NOX2 shRNA and GiGo_ct plasmids with (n=2) or without (n=3) NGF shRNA was injected in both atria followed by electroporation to facilitate gene delivery. Control RAP dogs did not receive gene (n=5) or underwent scrambled gene injection (n=6). AF burden was assessed over time and residual AF was recorded at terminal EP study. NOX2 and NGF knockdown and GiGo_ct expression were evaluated by PCR. Results: After 3.3±1.3 weeks of RAP, all 11 animals reached &gt;80% AF burden. Combined (NOX2+GiGo±NGF) gene therapy significantly reduced AF burden by 66% (p&lt;0.05) compared to scramble controls and by 38% (p&lt;0.05) compared to pre-treatment AF burden (Panel B). Residual AF after the treatment was slower and more organized than in controls (panel C). PCR analysis showed NOX2 and NGF downregulation and evidence of GiGo_ct expression. Conclusions: Gene-based attenuation of autonomic remodeling through inhibition of parasympathetic signaling and nerve sprouting, and reduction of oxidative stress by NOX2 downregulation may be effective at reversing AF. Development of optimized gene therapy to target multiple AF mechanisms simultaneously may lead to more effective treatments for persistent AF.
Abstract 17264: PFO Cover Index by 3D-TEE Predicts Residual Shunting After Transcatheter Closure
Authors: Tanuka Datta, Nicholas J Ruggiero, Andrew C Peters, Ashley Pender, Rebecca Marcantuono, Alec Vishnevsky, Praveen Mehrotra
Journal: Circulation (2023)

Introduction: Proper defect sizing and device size selection are imperative for ensuring successful clinical outcomes after transcatheter patent foramen ovale (PFO) closure. However, with current sizing techniques, residual shunting remains as high as 25% and is associated with an increased risk of recurrent neurologic events. Since 2017, we adopted a PFO sizing strategy based on right atrial (RA) tunnel “width” oversizing utilizing three-dimensional transesophageal echocardiography (3D-TEE). Hypothesis: We hypothesized that the PFO tunnel width at the RA opening and a cover index based on this dimension would predict residual shunting at long term follow-up. Methods: Sixty-four patients underwent transcatheter PFO closure (60 patients utilizing a 3D-TEE based oversizing strategy) at our institution between 2015 and 2022. PFO tunnel length, tunnel width at RA opening, and tunnel width at left atrial opening were determined by 3D-TEE either before or at the time of closure. We determined an absolute PFO “cover index” for each patient as follows: RA disc diameter - RA tunnel width. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive ability of 3D-TEE derived PFO dimensions and the PFO cover index to predict residual shunting at follow-up. Results: Fifty-one of sixty-four patients had a long-term follow-up bubble study (mean follow-up time 8.0±3.7 months). Of the 47 patients closed utilizing a 3D-TEE based sizing strategy and with a follow-up bubble study, only 5 patients (10.6%) had residual shunting at follow-up. Of the three 3D-TEE based PFO dimensions, only the RA tunnel width was predictive of residual shunting at follow-up (AUC 0.84, p=0.004). A cutoff of 15.5 mm or greater for RA tunnel width had the best combination of sensitivity (86%) and specificity (73%). The PFO cover index was also strongly predictive of residual shunting at follow-up (AUC 0.87, p=0.002). A cutoff of 9.5 mm or less had the best combination of sensitivity (86%) and specificity (82%). Conclusions: A larger PFO tunnel width at the right atrial opening and a lower cover index based on this dimension predict residual shunting at follow-up. Our findings have important implications for improving sizing strategies for transcatheter PFO closure.
Abstract 13361: The Effect of Electronic Cigarette Exposure on Flow Mediated Vasodilation and LV Remodeling in a Chronic Myocardial Infarction Model
Authors: Wangde Dai, Jianru Shi, Juan Carreno, Michael T Kleinman, David Herman, Rebecca Johnson, Samantha Renusch, Irene Hasen, Amanda Ting, Robert A Kloner
Journal: Circulation (2023)

Introduction: There is little information about the effect of electronic cigarette (e-C) exposure on the cardiovascular system in the setting of myocardial infarction (MI) and whether e-C’s could alter vascular or cardiac function during the healing phase of MI. We determine the effect of e-C on endothelial function, cardiac remodeling and function during the healing phase of MI. Methods: Sprague Dawley rats (both sexes) were anesthetized and subjected to a proximal left coronary artery occlusion to induce a large anterior wall MI. At one week, rats were randomized to receive either 12 weeks of exposure to purified air (n=37) or e-cig vapor plus 15 mg/ml of nicotine (e-Cn=32). At 12 weeks endothelial function was tested by assessing femoral artery diameter and blood flow following a 5- minute femoral artery occlusion and reperfusion (ultrasound and flow probe). Cardiac function was assessed by echocardiography; remodeling was also assessed by quantitative histologic analysis. Results: Baseline blood flow in the femoral artery did not differ between groups, but peak reperfusion blood flow was blunted in the e-Cn group (1.59 ± 0.15 ml/min) vs. the air group (2.11 ± 0.18 ml/min; p=0.034). Femoral artery diameter after reperfusion was narrower in the e-Cn group (0.54 ± 0.02mm) compared to the air group (0.60 ± 0.02mm; p=0.023). Postmortem left ventricular (LV) volumes were similar in the e-Cn (0.69 ± 0.04 ml) and air groups (0.73 ± 0.04 ml; p=NS); and myocardial infarct expansion index did not differ between groups (1.4 ± 0.1 in e-Cn group versus 1.3 ± 0.1 in air group; p=NS). Gross pathology LV wall thickness was greater in the e-Cn group (1.38 ± 0.12 mm) versus the air group (1.04 ± 0.10 mm) despite no increase in blood pressure at 12 weeks in the e-CN group. LV fractional shortening by echo did not differ between groups at 12 weeks (e-Cn at 29 ± 2% and air at 27 ± 1%; p=NS). Conclusion: Exposure to e-Cn during the healing phase of MI was associated with altered endothelial function with reduced femoral artery blood flow and diameter at reperfusion, but not with worsened LV dilation or worsened cardiac function. E-Cn did increase gross pathologic LV wall thickness. E-Cn exposure during the healing phase of MI has deleterious effects on the CV system but does not dilate the LV.
Abstract 18209: The Association Between Lp(a) and Low-Density Plaque Volume is Not Modified by CRP
Authors: Rebecca Fisher, Nick Nurmohamed, Waqas A Malick, Melissa Aquino, James K Min, James P Earls, Sascha N Goonewardena, Edward A Fisher, Robert S Rosenson
Journal: Circulation (2023)

BACKGROUND: Inconsistent data have suggested an interaction between Lp(a) and hs-CRP levels, putting patients with concomitant elevation at the greatest risk for atherosclerotic cardiovascular events. To date, the association between Lp(a), systemic inflammation as measured by hs-CRP, and coronary plaque phenotype has not been unraveled. METHODS: Among consecutive asymptomatic patients evaluated for primary prevention of coronary artery disease, we explored the associations between Lp(a), hs-CRP and coronary atherosclerosis using atherosclerosis imaging-quantitative coronary CT angiography (AI-QCT; Cleerly Labs, Cleerly Inc., Denver,CO). The associations between Lp(a), hs-CRP and the AI-QCT outcomes defined as percent atheroma volume (PAV) as well as percent low-density non-calcified plaque volume (LD-NCPV) were assessed using multivariable linear regression adjusted for clinical risk factors. RESULTS: The mean age of the 373 included patients was 56.2 ± 8.9 years, 71.6% were male, and 54.2% was on statin therapy. Mean±SD LDL-C was 106 ± 41 mg/dl, median (IQR) Lp(a) was 31 (11, 89) nmol/L, while median hs-CRP levels were 0.8 (0.4, 1.8) mg/L. In the multivariable-adjusted analysis, Lp(a) levels were significantly associated with an increase in PAV (0.367 increase in PAV per 100 nmol/l increase in Lp(a), p=0.026) and percent LD-NCPV (0.018 increase in PAV per 100 nmol/l increase in Lp(a), p=0.031). However, there was no effect of adding hs-CRP to the models (p=0.446), and we observed no direct relationship between hs-CRP and PAV (p=0.446) or percent LD-NCPV (0.871). Table 1. CONCLUSIONS: Lp(a) is associated with low-density non-calcified plaque and total coronary plaque burden. The current study found no impact of hs-CRP on these associations, nor were hs-CRP levels associated with plaque burden.
Abstract 13516: Outcomes Among Heart Failure Patients Hospitalized for Infective Endocarditis: A United States National Cohort Study
Authors: Bruce Adrian Casipit, Abiodun Idowu, Hussein Al Sudani, Carlo Casipit, Kevin Bryan Lo, Ola Khraisha, Aman M Amanullah
Journal: Circulation (2023)

Introduction: We aim to investigate the impact of heart failure (HF) among hospitalized patients with infective endocarditis (IE) in terms of in-hospital outcomes including the risk for mortality, development of cardiogenic shock (CS) and certain arrythmias, as well as hospital length of stay (LOS). Methods: We queried the 2018-2020 United States National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified hospitalized adult patients greater than 18 years of age with HF and IE using appropriate ICD-10 CM codes. Those with HF were subsequently stratified into systolic and diastolic HF. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest. Results: A total of 150,059 hospitalized patients with IE were identified in the years 2018-2020, of which 33.58% (50,390/150,059) had HF. The overall in-hospital mortality rate among hospitalized patients with IE is 12.13% (18,185/150,059). Among those with HF, the in-hospital mortality rate was significantly higher at 15.11% (7,614/50,390, p&lt;0.001). Using a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, HF among hospitalized patients with IE increased the risk for adverse in-hospital outcomes. (Table 1) Conclusions: Our study showed that concomitant HF among hospitalized patients with IE increased the risk for in-hospital mortality, longer LOS, development of CS and certain arrythmias including atrial fibrillation, ventricular tachycardia, and ventricular fibrillation. This highlights the significant impact of HF as a potential predictor of worse outcomes among hospitalized IE patients.