tbuckley/cabot-search huggingface dataset:
Abstract 4143677: Derivation and internal validation of a nomogram for bleeding risk prediction in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention
Authors: Si-qi Lyu, Zhu Jun, YANMIN YANG
Journal: Circulation (2024)

Background: Standard scoring system for bleeding risk assessment has not been developed in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). This study aims to develop a practical nomogram for bleeding risk evaluation in patients with AF and ACS or undergoing PCI who received both oral anticoagulant (OAC) and antiplatelet therapy (APT). Methods: A total of 930 patients with AF and ACS/PCI receiving both OAC and APT were consecutively recruited and followed up for 1 year. The primary endpoint was defined according to the bleeding academic research consortium (BARC) criteria as major bleeding (BARC 3a, 3b, 3c, and 5). Potential prognostic variables of the primary endpoint were selected by the LASSO method and incorporated in a multivariable logistic regression model. A nomogram visualizing the logistic regression model was then generated. Discrimination was evaluated and compared by the receiver operating characteristic (ROC) curves and c-indexes. Calibration was assessed by the Hosmer-Lemeshow tests, Brier scores and calibration plots. Results: During 1-year follow-up, BARC type 3 or 5 bleeding occurred in 36 patients (3.9%). Four key predictors of the primary endpoint (previous bleeding history, hemoglobin, N-terminal pro-B type natriuretic peptide, and left atrial diameter) were selected by the LASSO method and integrated to construct a nomogram for bleeding risk prediction. This nomogram displayed good discrimination with a c-index of 0.740 (95% CI: 0.639-0.841). Bootstrap resampling was undertaken for internal validation and the bias-corrected c-index was 0.726. Compared to the HAS-BLED score, the nomogram displayed a significant improvement in bleeding risk prediction (c-statistics: 0.740 vs. 0.575, p&lt;0.001). According to the Hosmer-Lemeshow test and the Brier score, the calibration of this nomogram was good. Conclusion: In patients with AF and ACS or undergoing PCI who received both OAC and APT, a simple 4-variable nomogram provide a practical tool for 1-year BARC type 3 or 5 bleeding prediction.
Abstract 4143784: Long-Term Effectiveness of a Community Health Worker-Led Blood Pressure Intervention on Cardiovascular Disease and Mortality
Authors: Farah Allouch, Nanxiang Ouyang, Guozhe Sun, Lixia Qiao, Chang Wang, Songyue Liu, Chung-shiuan Chen, Katherine Mills, Hua He, Jing Chen, Danxi Geng, Ziyi Xie, Yao Yu, Zhi Li, Jiang He, Yingxian Sun
Journal: Circulation (2024)

Background: Hypertension is the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide. Community health worker (CHW)-led intervention has been effective in lowering blood pressure (BP) and CVD risk. However, the long-term effectiveness of CHW-led intervention is unknown. Aim: We assessed the long-term effectiveness of a CHW-led intensive BP intervention on CVD incidence and all-cause mortality. Methods: The China Rural Hypertension Control Project (CRHCP) involved 33,995 hypertensive individuals aged ≥40 years from 326 villages in rural China. A total of 163 villages were randomly assigned to a CHW-led intervention, while the other 163 villages were assigned to usual care. CHWs were trained village doctors who initiated and titrated antihypertensive medications using a simple stepped-care protocol according to ACC/AHA clinical guidelines. They also conducted health coaching and delivered free or discounted antihypertensive medications to participants. The primary effectiveness outcome was a composite of myocardial infarction, stroke, heart failure, or CVD death during the 48-month follow-up period. Secondary outcomes included CVD death and all-cause death. Safety outcomes were also assessed at 48 months. Results: During a median follow-up of 48 months, 1,744 CVD events (2.6% per year) were documented in the intervention group, compared to 2,191 CVD events (3.5% per year) in the usual care group. The CHW-led intervention resulted in a 27% reduction in CVD (hazard ratio [HR] 0.73; 95% CI 0.69 to 0.78). Furthermore, CVD deaths were reduced by 24% (HR 0.76; 95% CI 0.68 to 0.84), and all-cause deaths were reduced by 14% (HR 0.86; 95% CI 0.80 to 0.94) in the intervention group compared to the usual care group. Participants in the intervention group had a significantly lower rate of serious adverse events compared to usual care participants (risk ratio 0.94; 95% CI: 0.91 to 0.98). However, there was no statistically significant difference in injurious falls, symptomatic hypotension, or syncope between the two groups. Conclusion: This randomized cluster trial showed that a CHW-led intervention significantly reduced CVD risk and all-cause mortality over 48 months among rural residents in China. This feasible and effective BP intervention strategy should be scaled up in China and other low- and middle-income countries to reduce the burden of CVD worldwide.
Abstract 4143614: Clinical Features and Prognosis of FDG-avid Genetic Cardiomyopathies
Authors: Graham Bevan, Yovani Llamas Valle, Bryce Johnson, Richard Cheng, Babak Nazer
Journal: Circulation (2024)

Introduction: Cardiac 18 FDG-PET is frequently utilized to noninvasively diagnose inflammatory cardiomyopathies such as cardiac sarcoidosis (CS). Many patients are diagnosed with presumptive isolated CS based on cardiac 18 FDG-avidity and the Japanese Circulation Society (JCS) guidelines. However, individuals with genetic cardiomyopathies present similarly to CS, are often 18 FDG-avid, and may be misdiagnosed with isolated CS. Aims: Determine the prevalence of pathogenic or likely pathogenic variants (P/LP) in patients with 18 FDG-avid cardiomyopathy and evaluate how 18 FDG avidity may impact prognosis. Methods: This is a single center, retrospective analysis of patients who had undergone both cardiac 18 FDG-PET and commercial genetic testing with a comprehensive cardiomyopathy panel (Invitae). Patients with biopsy-proven extracardiac or CS were excluded. Group comparisons made using Chi-square. The composite endpoint of cardiac mortality, sustained VT, LVAD, heart transplant, and heart failure hospitalization was compared between groups using Cox Proportional Hazard’s Model. Results: Of 128 patients with both cardiac 18 FDG-PET and genetic testing, 112 patients (30% women; mean age 56) met our inclusion criteria. 18 FDG-avidity was present in 54 (48%), of which 9 (17%) had P/LP ([list genes here]). Of these 9, 5 (56%) met JCS diagnostic criteria for isolated CS, 4 were clinically diagnosed with CS, and 2 had been immunosuppressed prior to their genetic testing results. Baseline characteristics were similar between 18 FDG-avid and 18 FDG-negative patients with genetic cardiomyopathies (Figure 1). P/LP prevalence was significantly higher in the 18 FDG-negative group (13, 22%, p=0.01). LP/P variants were most commonly found in LMNA (n=10). Among patients with genetic cardiomyopathy, there was no significant difference in the composite endpoint between 18 FDG-avid and FDG-negative groups (Figure 1; HR 2.3 (95% CI: 0.7-7.2, p-value 0.17). Conclusions: Genetic cardiomyopathies are often mis-diagnosed as isolated CS based on 18 FDG-avidity, and genetic testing should be performed prior to diagnosing isolated CS. Larger, multi-center studies are needed to determine if 18 FDG-avidity predicts prognosis in genetic cardiomyopathies.
Abstract 4143731: Point of Care Ambulatory Blood Pressure Monitoring for Diagnosing Hypertension is Accepted by Youth, Parents, and Primary Providers
Authors: Carissa Baker-Smith, Varsha Zadokar, Bridgette Hindt, Jorge Gilces, Megan Keeth, Hal Byck, Erica Sood
Journal: Circulation (2024)

Introduction: Residence within a high deprivation community is associated with a greater odds of hypertension diagnosis in youth. Providers cite uncertainty about the etiology of an abnormal blood pressure (BP) measurement (white coat vs HTN) as a potential barrier to diagnosis. Placement of a 24-hour ambulatory BP monitoring (ABPM) device in the pediatric primary care (PPC) setting – “point of care” ABPM – represents a novel approach to diagnosing HTN in youth. Hypothesis: “Point of care” ABPM is (1) accepted by youth, parents, and PPC providers and (2) reduces PPC provider uncertainty regarding a diagnosis of HTN in youth. Aims: Qualitative assessment of factors associated with acceptance of “point of care” ABPM and acceptance of subsequent HTN diagnosis. Methods: “Point of care” ABPM was made available within a single, high deprivation PPC practice in Wilmington, DE. It was offered when manual BP measured &gt; 95th (age 10-12 years) or &gt; 130/80mmHg (13-17 years). Individual qualitative interviews of youth, their parents, and their providers were conducted by trained study team members. Qualitative data were coded and analyzed using an inductive thematic approach. Results: Twenty-five youth, 25 parents, and 8 PPC providers completed interviews. ABPM decision-making was influenced by perceptions of 1) importance of early HTN detection, 2) benefits/convenience of ABPM, 3) concerns regarding activity restrictions/discomfort, and 4) trust in the PPC provider (Table 1). Most parents and all providers reported high confidence in ABPM results, which they attributed to multiple BP readings in a comfortable environment, diagnosis consistent with family history, and trust in the PPC provider. Many youth/parents reported comfort with HTN management recommendations (e.g., lifestyle intervention, referral to subspecialist). Conclusions: “Point of care” ABPM is accepted by youth and their parents due to perceived high importance of early HTN detection. Youth, parent, and PPC provider confidence in the diagnosis of HTN was aided by the multiple BP readings captured by the ABPM device and measurements that were obtained in a comfortable environment. Trust in the PPC provider was also an important factor impacting both decision making and confidence in “point of care” ABPM results.
Abstract 4143792: Real-World Patterns of Statin Use, Titration, and Discontinuation Among a Racially Diverse Commercially-Insured Population
Authors: Pengyue Zhang, Alisha Alabre-Bonsu, Ping Zhang, ChienWei Chiang, Lang Li, Michael Milks
Journal: Circulation (2024)

Introduction: Statins remain the most evidence-supported and cost-effective medications to reduce atherogenic lipoprotein levels and atherosclerotic cardiovascular disease (ASCVD) risk. Among patients with ASCVD, high intensity statin treatment is indicated (e.g. atorvastatin 40-80 mg or rosuvastatin 20-40 mg daily). However, the effectiveness of statin therapy is limited by intolerance symptoms and other factors that lead to discontinuation or dose titration, some of which have been shown to vary in prevalence by race, gender, and certain comorbid conditions. Hypothesis: The propensity to discontinue or titrate new statin therapy varies by race, sex, and the starting statin agent-dose combination selected. Aim: Examine patterns of statin therapeutic persistence and titration among US commercial insurance or Medicare Advantage beneficiaries. Methods: New statin prescription episodes (n=1,859,442) were identified by a retrospective cohort design using the de-identified Optum Clinformatics® Data Mart Database (2007-2020). Included individuals were ≥45 years of age on the first day of enrollment and continuously enrolled for ≥3 years. The Indiana University IRB designated this study as exempt. RESULTS: Discontinuation or titration of an initial statin prescription occurred in &gt;70% of cases over 30 months. The incidence of dose increases or decreases varied by the statin agent and dose initially selected (Figure). Down-titration of rosuvastatin 40 mg/d and atorvastatin 80 mg/d varied based on racial group (Table). Conclusions: Statin dose adjustment and discontinuation are common following initial statin prescription. This observation from claims data implies that different choices of initial statin drug-dose combinations could result in variable likelihood of long-term treatment persistence. Cumulative LDL-C reduction over time, with likelihood of persistence as well as pharmacologic effect, should be considered with selection of an initial statin dose in ASCVD.
Abstract 4143662: Reverse J-shaped Associations of Serum Hypoxia-inducible Factor 1α Levels With All-cause Mortality in Patients With Suspected or Known Coronary Artery Disease: The ANOX Study
Authors: Moritake Iguchi, Masahiro Suzuki, Morihiro Matsuda, Yoichi Ajiro, Tsuyoshi Shinozaki, Satoru Sakagami, Kazuya Yonezawa, masatoshi shimizu, Junichi Funada, Takashi Takenaka, Yukiko Morita, Toshihiro Nakamura, Kazuteru Fujimoto, Hiromi Matsubara, Toru Kato, Takashi Unoki, Daisuke Takagi, Kyohma Wada, Miyaka Wada, Takumi Nakayama, Yuka Maeda, Nobutoyo Masunaga, Mitsuru Ishii, Kazuhiko Kotani, Mitsuru Abe, Masaharu Akao, Koji Hasegawa, Hiromichi Wada
Journal: Circulation (2024)

Background: Hypoxia-inducible factor-1 (HIF-1) is a heterodimeric transcription factor composed of a constitutively expressed β subunit (HIF-1β) and an oxygen-dependent α subunit (HIF-1α). HIF-1α has an important protective effect on the pathophysiology underlying coronary artery disease (CAD). However, the association between serum HIF-1α levels and mortality in patients with suspected or known CAD is unknown. Methods and Results: Serum levels of HIF-1α were measured in 2,418 patients with suspected or known CAD using a commercially available enzyme-linked immunosorbent assay kit (sensitivity, 30 pg/mL). The outcomes were all-cause death, cardiovascular (CV) death, and non-CV death. Patients were divided into 5 groups according to HIF-1α levels; below the sensitivity (Q0, &lt;30 pg/mL) and quartiles of measurable HIF-1α levels (Q1, 31-127; Q2, 128-303; Q3, 307-765; Q4, 774-4131 pg/mL). Patients were followed up over a 6-year period. During the follow-up, 536 (22.2%) deaths occurred, including 166 (6.9%) CV deaths, 326 (13.5%) non-CV deaths, and 44 (1.8%) undetermined deaths. At baseline, HIF-1α levels were significantly and inversely associated with the rate of current smoker (P&lt;0.001), and showed significant U-shaped associations with age (P=0.016) and high-sensitivity C-reactive protein levels (P&lt;0.001). Interestingly, HIF-1α levels exhibited U-shaped associations with incidence of all-cause, CV death, and non-CV death (Figure 1). Since the rates of incident outcomes were similar among Q1-Q3, we combined these 3 groups into the reference group for Cox proportional hazard analyses thereafter. After adjustment for potential clinical confounders and established CV biomarkers, the low HIF-1α level (Q0) was significantly associated with all-cause death (adjusted hazard ratio [aHR], 1.38; 95% confidence interval [CI], 1.02–1.91), but not with CV death (aHR, 1.12; 95% CI, 0.68–1.97) or non-CV death (aHR, 1.45; 95% CI, 0.98–2.23), while the high HIF-1α level (Q4) was not significantly associated with all-cause death (aHR, 1.12; 95% CI, 0.66–1.86), CV death (aHR, 0.76; 95% CI, 0.28–1.86), or non-CV death (aHR, 1.17; 95% CI, 0.58–2.25). Conclusions: We first demonstrated that serum HIF-1α levels exhibited a reverse J-shaped association with the risk of all-cause mortality in patients with suspected or known CAD.
Abstract 4143788: Physical Activity Reduces Incident DVT Risk: Greater Impact Among Individuals with Anxiety or Depression
Authors: Giovanni Civieri, Hui Chong Lau, Shady Abohashem, KRYSTEL ABI KARAM, Wesam Aldosoky, Maria Khalil, Antonia Seligowski, Michael Osborne, Rachel Rosovsky, Ahmed Tawakol
Journal: Circulation (2024)

Background: Physical activity (PA) reduces cardiovascular (CV) disease risk, and this has recently been shown to be due, in part, to reduction of stress-related neural activity (SNA). Further, the CV benefits of PA are higher in individuals likely to have higher baseline SNA (i.e., those with depression/anxiety). Moreover, anxiety and depression associate with increased risk of deep venous thrombosis (DVT) partly through increased SNA, yet it remains unknown how PA impacts this relationship. Hypotheses: 1) PA associates with lower risk of DVT, 2) this PA benefit is more pronounced in individuals with anxiety and depression. Aims: To evaluate the association between PA and DVT risk and the differential benefits among subjects with anxiety or depression. Methods: Subjects enrolled in the Mass General Brigham Biobank were studied; total PA was derived from a health survey that assessed different activities during the previous year. Higher vs lower PA was defined according to quintiles of PA in our population (low PA: 1° and 2° quintile; high PA: 4° and 5° quintile; subjects in the 3° quintile were excluded to avoid possible overlaps). Depression, anxiety, and DVT were defined using ICD codes. Subjects &lt;18 years old or with previous DVT were excluded. Risk of incident DVT was investigated with multivariable Cox-regression. Results: 49,081 subjects (mean age 53.8 ± 16.6 yrs, 39.8% male) were studied. The incidence of DVT progressively decreased across quintiles of PA (2.1% vs 1.9% vs 1.7% vs 1.3% vs 1.2%; p&lt;0.001). High PA was associated with lower risk of incident DVT after adjustment for the most common DVT risk factors (age, sex, cancer, oral contraceptives, and obesity; HR 0.764 [95% CI 0.648-0.901, p=0.001]) and additional confounders ( Fig. 1A ). The beneficial effect of PA on DVT risk was higher in those with anxiety and depression (interaction with anxiety p=0.002; interaction with depression p=0.052; Fig. 1B ). Conclusion: PA associates with lower risk of DVT, and this association is more pronounced among individuals with anxiety or depression. These results provide further support for a brain-clot connection and suggest that further mechanistic studies are needed.
Abstract 4143740: Efficacy of SGLT2 Inhibitors on Cardiovascular Outcomes Following Acute Myocardial Infarction without Heart Failure: A Propensity-Matched Registry Study
Authors: Rochell Issa, Tess Calcagno, Gauranga Mahalwar, Ryan Issa, David Kaelber, Andrei Brateanu, Venu Menon, Wai Hong Tang, Brian Griffin, Deborah Kwon, Tom Kai Ming Wang
Journal: Circulation (2024)

Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have a Class 2a indication for treating heart failure with preserved ejection fraction (HFpEF). Despite established benefits in heart failure management, their effects post-acute myocardial infarction (AMI) have not been fully explored. Aims: We aim to determine if an SGLT2 inhibitor (SGLT2i) may be associated with improved cardiovascular morbidity and mortality. Methods: Patients with AMI treated with or without SGLT2i were identified using the TriNetX global health network, which includes data from over 100 million patients. Propensity score matching utilizing demographic, medical, procedural, medication, and laboratory information created two cohorts of 18,546 patients. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. Survival analyses between 30 days and 5 years post-AMI were set to assess cohort outcomes, examining MACE and its individual component outcomes. Results: The analysis included 21,032 post-AMI patients between 2014 and 2023, with a mean age of 68.6 ± 11.4 years, 40.5% female. Of the SGLT2i group, 83.2% had T2DM compared to 84.8% of the non-SGLT2i group. The SGLT2i group had significantly lower 30-day mortality (2.6% versus 6.3%, P&lt;0.0001) and MACE (38.0% versus 44.2%, P=0.002). Over a 5-year period, the SGLT2i group exhibited significantly lower mortality (41.3% versus 56.1% HR 0.704, P&lt;0.0001) and a lower rate of MACE (58.6% versus 109.2%, HR 0.860, P&lt;0.0001). Other outcomes, including MI, stroke, and bleeding events, also favored the SGLT2i group at both 30 days and 5 years (P&lt;0.0001). Conclusions: This study showed that the use of SGLT2i post-AMI in patients with normal EF was associated with decreased mortality, MACE, AMI, and stroke. These results advocate for the further investigation of SGLT2i in the post-AMI care path, highlighting their potential to improve post-AMI outcomes.
Abstract 4143735: Cardiac MRI quantitative susceptibility oxygen mapping predicts prognostic risk among patients with pulmonary hypertension
Authors: Prianca Tawde, Rachel Axman, Jiahao Li, Pablo Villar Calle, Caitlin Chiu, Lily Jin, Annie Tsay, Mahniz Reza, Aditya Sahai, Pascal Spincemaille, Jonathan Weinsaft, Jiwon Kim
Journal: Circulation (2024)

Background: Newly developed cardiac magnetic resonance (CMR) derived cardiac quantitative susceptibility mapping (QSM) is a non-invasive technique to quantify venous oxygen saturation (SVO2). Objective: In this study, we test whether impaired non-invasive SVO2 (IΔO2) predicts prognosis independent of conventional imaging-based risk stratification. Methods: The population comprised of prospectively enrolled patients undergoing CMR for known or suspected pulmonary hypertension. Dedicated QSM imaging was performed to calculate non-invasive SVO2. In accordance with prior validation study of health volunteers, impaired SVO2 (IΔO2) was defined as greater than 23.7%. Echo was performed as a secondary measure of chamber remodeling and right ventricular (RV) afterload. Clinical data including heart failure hospitalization and all-cause mortality were acquired blinded to imaging indices. Results: In total, 227 patients underwent CMR (age 55.1 ± 15.2 years, 45.4% men); 41 patients (18.1%) had IΔO2. IΔO2 was associated with greater left ventricular (LV) and RV dysfunction on CMR (p&lt;0.05 for all) which was paralleled by more advanced heart failure symptoms (p&lt;0.001). IΔO2 was also closely linked to RV afterload; pulmonary pressure was significantly higher among patients with IΔO2 versus those without (29.6 ± 11.8 vs. 45.6± 22.8mmHg, p&lt;0.001). During a median follow up of 1.2 years, there were 36 composite outcomes (mortality and heart failure admission). IΔO2 was independently associated with heart failure hospitalization and death even after controlling for LV and RV function (HR: 2.52; CI 1.20-5.30; p=0.02). Figure 1 provides Kaplan Meier survival curve demonstrating increased mortality and heart failure hospitalization among patients with IΔO2 (p=0.004). Conclusion: CMR quantified IΔO2 improves prognostic stratification of pulmonary hypertension beyond conventional imaging indices.