tbuckley/cabot-search huggingface dataset:
Abstract 4140834: The Use of Angiotensin Receptor Blockers Decreased Three-Year and Five-Year Mortality in a VA Population with Ascending Thoracic Aortic Aneurysms
Authors: Vidur Kailash, Sally Tu, Siavash Zamirpour, William Pace, Marko Boskovski, Liang Ge, Elaine Tseng
Journal: Circulation (2024)

Background: The incidence of ascending thoracic aortic aneurysms (aTAA) is approximately 5-10/100000 individuals/year. Estimates of acute rupture or dissection range from 1.6-4/100000 individuals/year with a mortality rate for untreated dissection up to 50% within 48 hours. Current guidelines recommend surgical intervention for aTAAs ≥ 55mm in diameter. Risk factors that contribute to aTAA growth and mortality include diabetes, age, and smoking history however, not much investigation has been done to evaluate protective factors. Objective: To evaluate clinical factors that reduce three-year and five-year all-cause mortality in a veteran population who have dilated ascending aortas or ascending thoracic aortic aneurysms (aTAA) and who did not undergo repair within three or five years. Methods: We conducted a cohort study of 887 patients followed for aTAA (diameter ≥ 4.0cm) at a Veterans Affairs hospital. Patients who died of any cause before repair within 3 or 5 years of aTAA identification or had 3 or 5 years of follow-up without repair were further analyzed. 57 pertinent factors (including social, genetic, cardiac risk factors, aneurysm size, medications, etc.) were evaluated in univariate logistic regression models of three and five-year all-cause mortality. Variables with univariate p&lt;0.2 were combined in a multivariate logistic regression model. P&lt;0.05 was considered statistically significant. Results: In the 3-year model, 392 had ≥3 years follow-up without aTAA surgical repair. 35 out of 392 patients (8.9%) died within 3 years. The only statistically significant variable that reduced mortality was history of angiotensin receptor blocker (ARB) use (OR 0.24, p=0.042). In the 5-year model, 274 had ≥5 years follow-up without aTAA surgical repair. 68 out of 274 patients (24.8%) died within 5 years. Similarly, history of ARB use (OR 0.22, p=0.003) was the only pertinent variable. For both models, the results were independent of age, history of diabetes, valve disease, CHF, and stroke. Conclusion: Among modifiable risk factors, at both 3 and 5 years, history of ARB was associated with reduced mortality (13% mortality compared to 27% at 5 years) and should be further investigated.
Abstract 4141304: Clinical Impact of Ventricular and Supraventricular Arrhythmia Detection with a Novel Wearable Cardioverter Defibrillator
Authors: Anisha Phukan, Zain Syed, Laura Gustavson, Brian Li, Surovi Hazarika, Qarab Syed, Roy Chung, Navneet Sharma, Anish Pattisapu, Mohamed Kanj, Mina Chung, Christine Tanaka Esposito
Journal: Circulation (2024)

Background: The wearable cardioverter defibrillator (WCD) can prevent sudden cardiac death (SCD). It also provides continuous monitoring for detection of significant cardiac arrhythmias. Hypothesis: Detection of ventricular and atrial arrhythmia by the WCD can significantly impact clinical decisions and outcomes. Aims: Report occurrence of ventricular tachycardia/fibrillation (VT/VF) and atrial fibrillation/flutter (AF/AFL) detected by the WCD and clinical consequence of these diagnoses. Methods: Retrospective analysis of patients prescribed the ASSURE WCD at the Cleveland Clinic. Clinical data were collected via medical chart review. Rhythm classification, of all device-detected and patient-initiated episodes displayed with 4 independent ECG channels, was manually adjudicated by a Board-Certified Electrophysiologist. Results: Fifty-five patients were fitted with the WCD between January 2023 and April 2024. Overall median daily use was 22 hr/day (IQR 13-24) and median duration of use was 43 days (IQR 8-79). Mean age 60.1 ± 17.6 years; 49% females; 40% ischemic cardiomyopathy; 44% nonischemic cardiomyopathy; 16% other etiology; mean Ejection Fraction (EF) 31.5 ± 6.9% pre-WCD and 38.6 ± 9.3% post-WCD. Arrhythmia occurrence in this cohort is shown in Figure 1. Four patients (7%) had sustained VT/VF detected by the WCD, consequently all received a secondary prevention ICD. Notably, 2 patients were asymptomatic and only aware because of the device alerting of an imminent shock. Both patients showed significant recovery of EF &gt;35% during the WCD wear period, and had sustained VT/VF not been detected by the WCD, neither would have met indication for a prophylactic ICD. Additionally, 6 patients (11%) had AF/AFL recorded by the WCD. In 3 patients AF/AFL manifested in a paroxysmal pattern and the diagnosis was new. All were at high risk for stroke with median CHADS-VaSC=4 (IQR 4-6). Discussion: In addition to its primary utility for preventing SCD, the WCD can detect occult yet clinically significant arrhythmia. Detection of sustained ventricular arrhythmia in asymptomatic at-risk patients resulted in secondary prevention of SCD. Documentation of AF/AFL in high-risk patients could similarly lead to impactful risk reduction.
Abstract 4140643: Real World Evidence on Health Care Resources Utilization and Economic Burden of Arrhythmias in Patients with Diabetes and COPD.
Authors: Pierantonio Russo, Ramaa Nathan, Daniel Pfefer, Shilpa Kamdar, Brent Wright
Journal: Circulation (2024)

Introduction: We studied the healthcare resource utilization (HCRU) and medical costs of managing arrhythmias inT2D and COPD, and the impact of EKG screening on the rate of hospitalization and ER visits. Hypothesis: Arrhythmias in T2D and COPD generate high costs. Screening with EKG monitoring devices may be associated with a reduced rate of hospitalization and ER visits for arrhythmias. Methods: A retrospective claims analysis using the Merative MarketScan and the Symphony Integrated Dataverse databases. We identified patients &gt; 18 years with claims for T2D or COPD or both T2D and COPD (T2D+COPD) and assigned them into groups: Target: patients without prior history of arrythmias, followed by arrythmias claims. Control: patients with either of the conditions, but without arrhythmias claims. Target and control were matched 1:1 on demographic, year of first episode of arrhythmia, risk (ECI, DSI, Gold criteria). HCRU and medical cost drivers over 24 months were analyzed. HCRU of patients with arrythmia screened with EKG monitoring devices was compared to that of not screened patients. Results: Target group and control group included the same number of patients.213,226 T2D: 47,851 COPD; 31,571T2D/COPD. Atrial fibrillation was the most reported arrhythmia in the target cohort, followed by SVT. Hospitalizations/1000/year were: 584/205 (T2D target/control); 650/311(COPD target/control); 844/402 (T2D+COPD). The ER days/1000 /year and the 30 days readmissionfor the target patients were nearly twice as high than for the control. Total cost of care per patient / year was significantly higher for all target patients compared to control (T2D $34,171/ $18,687; COPD $ 37,719/$25,656; T2D COPD $46,484/ $30,802). The per patient / year cost of hospitalization was higher in the target patient's vs control (T2D $28,316/$19,439; COPD $25,098/$17,906; T2D COPD $28,694/$19,352). ER cost per patient/year was 35%-50% higher in the target cohort. Hospitalizations/1000 /month of patients screened with monitor devices was significantly lower than a 1:1 matched control cohort not using monitoring devices (T2D 64/215; COPD 69/198; 93/276). ER visits/1000/year were up to 50% lower in patients screened with monitoring devices. Conclusions: Arrhythmias significantly increase HCRU and total cost for T2D and COPD, particularly in patients requiring ER visits and hospitalization. Early detection with monitoring devices, could reduce the utilization of acute care and associated costs.
Abstract 4141415: Pseudo-Fontan Physiology From Venous Lead Obstruction: A Case Report of a Rare Complication of Permanent Pacemaker Leads
Authors: Nathan Kong, peter zimetbaum
Journal: Circulation (2024)

Lead related venous obstruction (LRVO) is an often underrecognized complication of pacemaker implantation. Symptoms of LRVO may include mild asymmetric upper extremity swelling to highly morbid superior vena cava (SVC) syndrome. We present an unusual case of a 54-year-old man with a history of retained pacemaker leads placed 26 years ago who presents with abdominal distention, lower extremity edema, and shortness of breath. He was found to have new onset ascites and significant pleural effusions. A liver biopsy showed hepatic fibrosis and pleural studies were consistent with chylothorax. After significant workup and diagnostic testing, it was believed that he had late complications often seen in Fontan physiology, notably hepatic fibrosis, lymphatic leakage, and protein losing enteropathy. A venogram and pressure measurements were performed which confirmed obstruction at the junction of the SVC and right atrium with elevated central filling pressures and significant flow through a markedly dilated azygous vein. A lymphangiogram suggested lymphatic leakage through the thoracic duct. An SVC stent was placed in an attempt to relieve the obstruction but the patient had progressive hemodynamic compromise leading to placement of mechanical circulatory support. Ultimately, the patient underwent surgical extraction of the retained pacemaker leads and reconstruction of the superior vena cava and right atrial junction, leading to near-resolution of his symptoms. This unusual presentation of SVC syndrome as a late complication of retained pacemaker leads highlights the potential severity of cardiac implanted electronic device lead-related complications.
Abstract 4141112: Identifying Gaps in Screening&amp;Treatment for Peripheral Artery Disease (Pad): A Survey on Provider Knowledge, Attitudes, and Practices
Authors: Keith Jones, Akshat Karambe, Kay Sadik, Brisa Hernandez
Journal: Circulation (2024)

Background: It is estimated that Peripheral Artery Disease (PAD) affects between 8.5 and 12 million Americans and its prevalence among adults over 40 years of age is increasing. PAD disproportionately affects Black Americans who, at any age, are twice as likely to experience PAD as their white counterparts but are less likely to be screened and benefit from early diagnosis and treatment. Research Questions/Hypothesis: Despite the high prevalence of PAD and the importance of early intervention, screening for PAD remains limited and/or underutilized particularly in primary care settings where most cases of PAD can be identified. This study sought to understand provider knowledge of PAD, associated risk factors, treatment, understanding of disparities in PAD and barriers and facilitators of PAD screening. It was hypothesized that limited resources, lack of awareness on the part of providers and patients, limitations of training in vascular medicine, and other issues are contributing to PAD morbidity and mortality, particularly among Black and Hispanic populations. Methods: Because no current PAD survey was found in the literature, a survey for providers to determine their knowledge, attitude, and beliefs about PAD and the importance and process of PAD screening for patients at risk was developed. The survey was administered to CommonSpirit Health providers in Sacramento, CA between December 2023- January 2024. Specialties engaged in the survey (N=145) included primary care, endocrine, nephrology, cardiology and podiatry providers. Results: Response rate was 21%. Of those responding, primary care was the specialty most represented(69%). A total of 65% of respondents identified medical treatment of risk factors as the primary way to treat PAD, 32% rated their knowledge of risk reduction therapies in PAD as below average, and 88% of respondents were either somewhat or not familiar with racial disparities in PAD. 24% of respondents identified the ‘lack of knowledge of PAD management guidelines’ as the most important barrier to their patients with PAD not receiving risk reduction therapies. Conclusions: Initial survey of providers identifies lack of knowledge as a key indicator of PAD screening practices, including knowledge on racial disparities in PAD. These identified gaps can inform targeted interventions to improve screening, early detection and treatment of PAD.
Abstract 4140981: In-Hospital Outcomes of Left Atrial Appendage Occlusion (LAAO) among patients with Atrial Fibrillation and Hematological Malignancy; Insight from The National Inpatient Database (2015-2020)
Authors: Muhammad Osama, Nauman Naeem, asmaa ahmed, Dmitry Chuprun, Jeremiah Depta, Mohan Rao
Journal: Circulation (2024)

Introduction/Background: Patients with hematological malignancies are at a higher risk of developing atrial fibrillation. Additionally, it can predispose to an increased risk of bleeding limiting anticoagulation for stroke prevention. LAAO has been successfully utilized among patients with atrial fibrillation and contraindication to anticoagulation. Research Question: What are the outcomes and in-hospital complications of left atrial appendage occlusion (LAAO) among patients with atrial fibrillation and hematological malignancy? Methods: The National Inpatient Sample (NIS) was analyzed from 2015-2020 to identify admissions for LAAO among patients with and without a hematological malignancy. Baseline characteristics were compared between the two groups and multivariate logistic regression was used to analyze hospitalization outcomes. Results: We identified 89,920 weighted admissions for LAAO procedures of which 1,665 patients (1.85%) had a hematological malignancy. In the adjusted analysis, the odds of MACCE (aOR 1.86, 95% CI 1.10-3.14, p 0.0205), cardiogenic shock (aOR 3.76, 95% CI 1.95-7.24, p &lt;0.001), cardiac tamponade (aOR 2.42, 95% CI 1.61-3.65, p &lt;0.001), pericardial drainage (aOR 2.54, 95% CI 1.50-4.29, p 0.005), ventricular arrhythmia (aOR 1.61, 95% CI 1.14-2.27, p 0.00061), and AKI (aOR 1.58, 95% CI 1.22-2.03, p 0.0004) was higher in the hematological malignancy cohort. Conclusion: The presence of a hematological malignancy was associated with higher rates of MACCE and other periprocedural complications among patients undergoing LAAO. These complications should be taken into account during clinical decision making and management of these patients.
Abstract 4141118: Identifying PDK4 as A Metabolic Regulator in Pulmonary Arterial Hypertension: Insights from Bulk, Single-cell Transcriptomics Analysis and Clinical Validation
Authors: Lingzhi Yang, Wei Huang
Journal: Circulation (2024)

Objective: Pulmonary Arterial Hypertension (PAH) is a fatal disease with high mortality rates and late diagnosis, currently lacking complete cure. Metabolic abnormalities play a crucial role in the pathophysiological process of pulmonary vascular remodeling. This study aimed to identify metabolic-related genes that may play important roles in PAH and analyze their expression and function and the clinical significance. Methods: Transcriptomic data were retrieved from the GEO database, including tissue transcriptome data (GSE113439, GSE53408, GSE198618) and single-cell transcriptome data (GSE210248, GSE203274); "limma" and "DEseq2" packages were used to identify differentially expressed genes (DEGs); By WGCNA and Boruta algorithm, we identified feature genes related to PAH; Transcription factor network analysis was analyzed using the "RTN" package; Single-cell and single-nucleus transcriptome data were analyzed using the Seurat pipeline; Concentration of key genes’ protein level in PAH were evaluated using ELISA. Results: The study found increased glycolysis, disrupted carnitine shuttle pathway, enhanced fatty acid degradation, decreased oxidative phosphorylation, and augmented polyamine synthesis in PAH. PIGN, SLC25A24, RPL5, PIK3CA, PIK3CB, DNM1L, SETD2, TPH1, ITPR2, PRKAA1, PTPN11, and PDK4 were identified as metabolic-related genes associated with PAH. PDK4 was significantly increased in pulmonary artery endothelial cells (PAECs) and right ventricular tissues of decompensated right heart failure, mainly expressed in cardiomyocytes. PDK4 was significantly elevated in the PAH group (control group: 4.15 ± 0.53 ng/ml; idiopathic pulmonary arterial hypertension group: 5.28 ± 0.77 ng/ml, p-value &lt;0.001), and showed linear correlations with mean pulmonary artery pressure (r=0.51, p=0.00033) and pulmonary vascular resistance (r=0.44, p=0.0019). Conclusion: This study provides important insights into the role of metabolic reprogramming and mitochondrial dysfunction in the pathogenesis of PAH, identifies 12 potential pathogenic regulatory factors related to metabolism, and suggests that PDK4 is strongly correlated with hemodynamic parameters of the disease, potentially participating in PAH and cardiac remodeling under right heart overload.
Abstract 4140645: Simultaneous Electro-Dynamic Stimulation Accelerates Maturation of Engineered Cardiac Tissue from Human Induced Pluripotent Stem Cells
Authors: Wusiman Maihemuti, Kozue Murata, Mosha Abulaiti, Hidetoshi Masumoto
Journal: Circulation (2024)

BACKGROUND: Electrical and dynamic stimulation are commonly used to enhance the maturation of engineered cardiac tissue (ECT) derived from induced pluripotent stem cells (iPSCs), reflecting the physiological environment of the heart. Electrical stimulation mimics natural bioelectrical signals, while dynamic stimulation replicates mechanical forces. However, the potential synergistic effects of combining electrical and dynamic stimulation simultaneously on ECT maturation have not been thoroughly investigated. HYPOTHESIS: We hypothesized that simultaneous electro-dynamic stimulation would enhance the maturation and function of the ECT more effectively than either stimulus alone . Methods: ECTs were created by co-culturing human iPSC-derived cardiovascular cells with Collagen I and Matrigel for 2 weeks. This was followed by a comparative analysis of four groups: no stimulation, dynamic stimulation, electrical stimulation (3 volts), and simultaneous electro-dynamic stimulation. For simultaneous stimulation, a specially designed sensor generated electrical pulses timed with dynamic mechanical stimulation. The physical training regimen lasted 2 weeks for all groups. The functionality of the ECTs was assessed using a video-based system to measure contractile capacity, and a flux analyzer to evaluate calcium indicators. Histological assessments examined structural maturation. RESULTS: During protocol optimization, the 30rpm dynamic culture significantly enhanced the cardiomyocyte (CM) component of the ECTs compared to the 60rpm group, highlighting the importance of dynamic stimulation frequency on tissue development. Simultaneous electro-dynamic stimulation significantly increased the CM component of ECT (control vs simultaneous stimulation: 16.1 ± 5.2 % vs 43.5 ± 12.1 %, P= 0.0009), elevated TNNT2 mRNA expression levels, and enhanced calcium transient capacity. Additionally, ECTs subjected to simultaneous stimulation exhibited a positive force-frequency relationship in contractility and an elevation in peak calcium flux, indicative of advanced tissue maturation. Moreover, simultaneous stimulation promoted vascular network formation within the ECTs, suggesting improved structural organization. CONCLUSION: Simultaneous electro-dynamic stimulation creates ECTs with superior functional and structural properties compared to electrical or dynamic stimulation alone. Simultaneous stimulation protocols are crucial for developing effective cardiac tissue engineering strategies.
Abstract 4141142: Environmental burden is associated with cardiometabolic risk factors in racially diverse breast cancer patients
Authors: Wonyoung Jung, Anran Huang, Saveri Bhattacharya, Oluwadamilola Fayanju, Hayley Knollman, Jennie Lattimer, Payal Shah, Amy Clark, Sophia Golec, Vivek Narayan, Jordan Isaacs, Daniel Koropeckyj-Cox, Rebecca Hubbard, Jinbo Chen, Richard Levy, Yehoda Martei, Kyunga Ko, Nicholas Wilcox, Amanda Smith, Clyde Yancy, Carmen Guerra, Tiffany Powell-Wiley, Bonnie Ky
Journal: Circulation (2024)

Background: The potential impact of neighborhood environment, a key structural social determinant of health, on disparities in cardiometabolic risk in cancer patients remains incompletely defined. We sought to determine the associations between environmental burden and cardiometabolic risk factors, and if these associations differed by race. Methods: Breast cancer patients initiating anthracycline and/or trastuzumab therapy at a multi-site health system were enrolled in a longitudinal prospective cohort study (NCT 05078190). At baseline, prior to cancer therapy initiation, neighborhood environment was defined by utilizing the Environmental Burden Module of the Environmental Justice Index from the CDC/ATSDR. The prevalence of cardiometabolic risk factors (hypertension, diabetes mellitus, dyslipidemia, obesity [BMI ≥30kg/m 2 ], physical activity (PA) as defined by the Godin Leisure Time Questionnaire) was also ascertained. Sufficient PA was defined by a moderate-to-vigorous PA score ≥24. Age-adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models. Results: Among 184 study participants (median [Q1-Q4] age 51 [43-60], 27.7% Black race), Black patients had greater (worse) environmental burden (0.83 [0.72-0.92]) compared to White patients (0.79 [0.46-0.87]). Patients with worse environmental burden were significantly less likely to meet sufficient PA levels (Q4 vs Q1 aOR 0.26, 95% CI 0.09-0.67), and more likely to have obesity (Q4 vs Q1 aOR 2.39, 95% CI 1.02-5.78). No significant associations were found with other cardiometabolic risk factors. In exploratory analysis stratified by race, associations between environmental burden and PA were more pronounced in Black patients, while associations between environmental burden and obesity were more pronounced in White patients (Table). Conclusions: Environmental burden was associated with PA and obesity in patients with breast cancer prior to the initiation of anthracycline and/or trastuzumab. Our findings motivate additional work in defining how environmental burden impacts cardiometabolic risk with cancer therapy longitudinally and disparities in cardiometabolic risk according to race.