tbuckley/cabot-search huggingface dataset:
Abstract 4146125: Demographic, Regional Trends and Place of Death of Cardiovascular Disease−Related Mortality in Colorectal Cancer in the United States (1999 to 2020)
Authors: Farah Yasmin, Muhammad Sohaib Asghar, Maryam Shaharyar, Rohan Kumar Ochani, M Chadi Alraies, Salim Surani
Journal: Circulation (2024)

Background: Patients with colorectal cancer (CRC) are 2-4 times more likely to develop cardiovascular disease (CVD), likely due to shared risk factors and the effects of chemo-radiotherapy. Despite existing evidence of increased CVD mortality in CRC, there remains a need for a comprehensive nationwide study. Methods: We utilized death certificates from the CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) database from 1999 to 2020 to evaluate the trends of CVD-related mortality in CRC patients using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and Annual Percentage Change (APCs) with 95% CI were stratified by year, sex, race/ethnicity, geographic region and place of death (POD). Results: Between 1999 and 2020, there were 1,304,077 deaths related to CRC in the United States. Of these, 414,367 (31.8%) deaths were related to CVD. The overall CRC + CVD related AAMR was 7.8 in 1999 and 4.6 in 2020 (Figure 1). The AAMRs of CRC + CVD deaths decreased at an APC of -3.69 (95%CI, -3.4 to -4.09) from 1999 to 2016; followed by an increase in AAMRs from 2016 to 2020 at an APC of 0.76 (95%CI, -1.29 to 5.4). Of the 387,618 CRC + CVD deaths with location available on POD, 153,114 (39.5%) occurred in medical facility, 128,728 (33.2%) in homes, 88,064 (22.7%) in nursing homes/long-term care and 17,712 (4.57%) in hospice facility. Males had higher overall AAMRs than females (7.1 vs. 4.6) which increased from 2016 to 2020 (APC 0.95); Black and African Americans had the highest AAMRs (7.8) which increased steadily by 5.1% from 2018 to 2020. Asian or Pacific Islander had the lowest AAMRs (3.9), however the rates increased by 4.4% in recent years between 2018 and 2020. Northeast region had the highest AAMR (6.7) while South had the lowest (5.0). The AAMRs was highest in rural (6.3) followed by urban (5.9), this gap widened in recent years as AAMR increased for rural (APC 1.7 from 2018 to 2020), while urban remained stable (APC -1.00 from 2016 to 2020). Conclusion: There has been a rising trend in CRC + CVD-related mortality in recent years despite an initial decrease for over a decade. Higher rates of hospital deaths and decreased usage of hospice facility was noted indicating lack of end-of-life-care. Significant demographic and geographic disparities exist amongst certain socioeconomic groups with increased mortality in recent years.
Abstract 4146019: Trends, Prevalence of Bradyarrhythmia and Pacemaker Implantation in Patients with Parkinson’s Disease.
Authors: Tochukwu Nzeako, Olayemi Adeniran, Shreya Singh, Saranjeet Kaur, Emmanuel Ukenenye, Neil Wimmer
Journal: Circulation (2024)

Background: Parkinson’s disease (PD) is one of the most common neurodegenerative disorders, affecting more than one million persons in the United States. Cardiovascular dysautonomia is a prominent dysfunction in PD, affecting the conduction system and causing bradyarrhythmia. However, no studies have assessed the prevalence and characteristics of bradyarrhythmia in patients with PD. Research Question: Is there an increased prevalence of bradyarrhythmia and pacemaker implantation in patients with PD? Aims: The study assessed the trends, prevalence, and risk factors of bradyarrhythmia and pacemaker implantation in PD patients. Methods: The National Inpatient Sample was utilized to identify patients' data with primary and secondary diagnoses of Parkinson’s disease (PD) in the United States from 2016 to 2020 using the International Classification of Disease, 10th Revision codes. Outcomes of interest included the trends and prevalence of bradyarrhythmia and pacemaker implantation in PD. We assessed potential predictors of bradyarrhythmia in patients with PD using a backward selection multivariable logistic regression. Results: A total of 333,242 patients with PD diagnosis were included (76.5 ± 15.2 years, 58.7% male, 80.1% white); of these, 5,092 (20.5%) had comorbid diagnoses of bradyarrhythmia, and 328,150 (79.5%) without bradyarrhythmia. The prevalence of bradyarrhythmia in patients with PD was 351.9 per 10,000 hospitalizations (3.5%). The trends of bradyarrhythmia showed a stable increase from 291.9 to 463.8 per 10,000 (AAPC 12.5%, CI: -0.2%, 26.8%). The overall prevalence of pacemaker implantation in patients with PD was 79.9 per 10,000 hospitalizations (0.8%). The overall trends of pacemaker implantation showed a stable decrease in patients with PD during 2016-2020, with an AAPC -0.9% (CI: -4.1% to 2.3%). Age≥ 65, male sex, comorbidities (atrial fibrillation, coronary artery disease, heart failure, hypertension, liver failure, obesity, peripheral vascular disease, renal failure) were associated with a higher likelihood of bradyarrhythmia in patients with PD. Conclusions: This study's findings revealed that the prevalence of bradyarrhythmia and subsequent pacemaker implantation in patients with PD remained relatively stable over the study period. The study provides the initial prevalence of bradyarrhythmia in patients with Parkinson’s disease. Further study is necessary to provide the characteristics and outcomes of bradyarrhythmia in PD.
Abstract 4146022: Serology supportive of recent coxsackievirus B infection is correlated with Multisystem Inflammatory Syndrome in Children (MIS-C)
Authors: Ramesh Kordi, Arthur Chang, Mark Hicar
Journal: Circulation (2024)

Background: Rarely, SARS-CoV-2 will lead to myocarditis associated with Multisystem Inflammatory Syndrome in Children (MIS-C). It remains unclear why MIS-C only targets specific children. Coxsackieviruses (CV) are prevalent infections during childhood and, like SARS-CoV-2, can lead to viral myocarditis. To explore an association with MIS-C we investigated the sero-epidemiology of CV in admitted pediatric patients. Method: A retrospective case control study was performed by chart review of children (age ≤ 21) admitted to a tertiary care hospital with CV serological testing from January 2017 to August 2023. Clinical, laboratory and imaging findings were used to classify patients as MIS-C and CV-unlikely or CV-possible for non-MIS-C patients. Results: Out of 182 admissions (179 patients, median age 6), CVB complement fixation (CF) assay on serotypes B1-B6 and CVA immunofluorescence assay IgG on serotypes A7, A9, A16, and A24 were positive in at least one serotype in 59.2% and 80.7% of cases respectively. We observed a significant drop in CVB CF seropositivity during the peak of social distancing in 2020. The CVB titers in CV-possible cases and MIS-C were similar. The likelihood of elevated CVB CF titers was significantly higher in MIS-C than CV-unlikely group (OR: 1.92, 95% CI: 1.02-3.63, p : 0.04). CVB CF titer trended toward higher values in African Americans compared to Whites (OR: 1.57, 95% CI: 0.98-2.50, p -value:0.057). As previously shown, the frequency of MIS-C was considerably higher in African Americans than Whites (18.1%, versus 9%, p : 0.1). Conclusion: Higher likelihood of elevated CVB CF titers in patients with MIS-C and in African Americans along with a notable higher frequency of MIS-C in African Americans warrant further investigation into the role of CVB infection in MIS-C development.
Abstract 4146495: Branched Chain Amino Acids Modulate Lung-Liver Axis in Pulmonary Arterial Hypertension
Authors: Madelyn Blake, Ryan Moon, Jeffrey Blake, Jenna Mendelson, Jeffrey Annis, Sasha Prisco, Steeve Provencher, Sandra Bonnet, Evan Brittain, Sebastien Bonnet, Kurt Prins
Journal: Circulation (2024)

Background: Valine, leucine, and isoleucine are the branched amino acids (BCAA). Elevated BCAAs predict worse outcomes in several cardiovascular diseases with metabolic origins, but the role of BCAAs in pulmonary arterial hypertension (PAH) remains unclear. Moreover, the effects of BCAAs on the emerging lung-liver axis are unexplored. Methods: The effects of small molecule (BT2) activation of BCAA catabolism and a low BCAA diet were evaluated in monocrotaline rats. Multi-omics analyses of the lung and liver were conducted in the BT2 arm. Confocal microscopy evaluated hepatocyte nuclear size in rodents and humans with PAH. Human livers were subjected to proteomic analysis. Human single nucleotide polymorphisms (SNPs) associated with elevated BCAAs and their relationship with PAH were investigated in the BioVU database. Results: Proteomics and metabolomics profiling demonstrated BT2 restructured lung fat metabolism, which increased exercise capacity, reduced PAH severity, and improved RV function. A low BCAA diet also mitigated PAH severity and improved RV function. Pathological hepatic shear stress phenotypes induced by RV dysfunction (nuclear hypertrophy, AKT signaling, electron transport chain (ETC) homeostasis, and ceramide accumulation) were blunted by BT2. Human PAH livers partially phenocopied the rodent hepatic shear stress phenotype (nuclear enlargement, AKT activation, and ETC protein downregulation). Finally, patients harboring SNP rs117643180 had increased risk of PAH. Conclusion: Rodent and human data link altered BCAA catabolism to the pathogenic lung-liver axis in PAH.
Abstract 4146024: Duration of Cardiopulmonary Resuscitation Enhances Prognostic Stratification in Cardiogenic Out-of-Hospital Cardiac Arrest
Authors: Miki Numaga, Takuro Abe, KOTARO MIYOSHI, Fumika Yoneyama, Kai Kitagawa, Junki Hashimoto, Madoka Ogata, Nozomiko Okuda, Yuki Kawahara, Akihiro Tani, Toshiyuki Ando, Hideori Komiyama, Shiro Ishihara, Kentaro Jujo
Journal: Circulation (2024)

Background: Despite advances in treatment strategies for out-of-hospital cardiac arrest (OHCA), prognosis remains poor. The MIRACLE2 score is an established prognostic predictor, but does not consider the duration of cardiopulmonary resuscitation (CPR), a critical determinant of outcomes. Stratifying risk at admission is crucial for guiding subsequent management decisions. Aims: To evaluate the prognostic value of CPR duration in patients with cardiogenic OHCA and assess its additive predictive utility beyond the MIRACLE2 score. Methods: We conducted a single-center, observational study (COEDO-CPA registry) of cardiogenic OHCA patients from 2018 to 2024. Receiver operating characteristic (ROC) analysis identified the optimal CPR duration cut-off for predicting 30-day mortality. We compared the predictive performance of MIRACLE2 score alone versus combined with CPR duration. Results: A total of 124 consecutive cardiogenic OHCA patients was ultimately analyzed, with an average age of 62.6 years; 87% were male, and the average MIRACLE2 score was 3.0. ROC analysis identified 35 minutes as the optimal CPR duration cut-off for 30-day mortality. Kaplan-Meier analysis revealed significantly higher mortality in patients with CPR duration &gt;35 minutes (Log-rank p&lt;0.001, Figure A). Multivariable Cox regression model showed CPR duration &gt;35 minutes independently predicted mortality after adjusting for MIRACLE2 score (HR: 3.41, 95% CI: 1.82-6.39). Additionally, compared to MIRACLE2 score alone, combining MIRACLE2 score with CPR duration &gt;35 minutes improved prediction of 30-day mortality (AUC: 0.81 vs. 0.78, p=0.005, Figure B). Conclusion: In cardiogenic OHCA patients, CPR duration &gt;35 minutes independently stratified mortality risk and enhanced the accuracy of existing prognostic models like MIRACLE2 score. Incorporating CPR duration could improve risk assessment and guide management decisions in this high-risk population.
Abstract 4145964: Association of Echocardiographic Traits with Deep Neural Network-Predicted Age from ECGs
Authors: Oseiwe Eromosele, Neha Gogineni, Matthew Tseng Sabatine, Luisa Brant, Antonio Ribeiro, Antonio Ribeiro, David Ouyang, Susan Cheng, Vasan Ramachandran, Emelia Benjamin, Honghuang Lin
Journal: Circulation (2024)

Background: Electrographic age (ECG-age), obtained by the estimation of age through deep neural networks, has been useful in predicting cardiovascular outcomes. Given the wide availability of echocardiograms and known associations of metrics with age, we sought to amplify the applicability of ECG-age, by exploring the association of echocardiographic traits with ECG-age. Research Questions/Hypothesis: We hypothesized that accelerated aging is associated with adverse cardiac remodelling measured by echocardiography. Conversely, decelerated aging is associated with improved levels of these echocardiographic traits. Goals/Aims: We aimed to ascertain the association of echocardiographic characteristics with ECG-age in the Framingham Heart Study (FHS). Methods/Approach: We obtained echocardiographic data and studied seven echocardiographic traits, including mean peak velocity E/A - ratio of early to late peak velocities, mean diastolic velocity time integral, left ventricular (LV) wall thickening, left atrial diameter, aortic root diameter LV fractional shortening, and LVmass. The predicted ECG-age was adjusted for chronological age, and the Δage was defined as the difference between the adjusted predicted ECG-age and chronological age. Participants were classified into accelerated, normal, or decelerated aging based on their Δage being within, higher, or lower than the mean absolute error. The association of each echocardiographic trait with Δage was tested using linear regression models, adjusting for age, sex, and cohort. In the secondary analysis, participants were classified into age groups using logistic regression models and adjusted for the same covariates as above. Results/Data: Our study included 9077 participants from the FHS (mean age 50±15 years, 53.6% women). The mean absolute Δage was 6.3 years. Accelerated aging was associated with increased LV wall thickness, left atrial diameter, aortic root diameter, and LV mass. Similarly, decelerated aging was associated with decreased LV wall thickness, left atrial diameter, aortic root diameter, and LV mass. Conclusion(s): Our study provides insight into the anatomical and functional factors underlying ECG-age. Both accelerated and decelerated aging assessed by ECG-age are associated with cardiac remodeling measured by echocardiography, and found changes in LV wall thickness, left atrial diameter, aortic root diameter, and LV mass that correlates with ECG-age.
Abstract 4146108: Impact of ECPELLA on Mid-Term Survival and Neurological Outcomes in Patients with Refractory Cardiac Arrest Who Received E-CPR
Authors: Toshifumi Ishida, Takashi Unoki, Taiji Inamori, Takaaki Toyohuku, Tomohide Sato, Yutaka Konami, Hiroto Suzuyama, Masayuki Inoue, Eiji Horio, Kazuhisa Kodama, Tadashi Sawamura, Tomohiro Sakamoto, Koichi Nakao, Ken Okumura, Jyunjiro Koyama
Journal: Circulation (2024)

Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used for cardiac arrest patients when conventional CPR is ineffective. While VA-ECMO sustains systemic perfusion, it also increases left ventricular (LV) afterload. The recent introduction of the transcatheter LV assist device, Impella, suggests benefits from its combination with VA-ECMO (ECPELLA), but the effectiveness of ECPELLA in E-CPR is still under investigation. Objective: This single-site cohort study aimed to evaluate the impact of ECPELLA versus VA-ECMO combined with intra-aortic balloon pump (IABP) in patients undergoing E-CPR. Method: We performed a retrospective review of 212 consecutive patients who underwent E-CPR at our institute from January 2012 to December 2023. After excluding 61 patients who received VA-ECMO alone, 151 patients were included in the study. These patients were divided into two groups: 67 in the ECPELLA group and 84 in the VA-ECMO with IABP group. We assessed the 90-day survival rate and favorable neurological outcomes, defined as a Cerebral Performance Categories (CPC) score of 1 or 2. Results: No significant differences were noted between the two groups regarding age, male ratio, coronary risk factors, initial shockable rhythm, acute coronary syndrome (ACS), out-of-hospital cardiac arrest (OHCA), and initial lactate levels. The ECPELLA group exhibited a significantly shorter time from cardiac arrest to VA-ECMO placement, known as low flow time (LFT) (35 min [IQR: 18-56] vs. 48 min [IQR: 24-73]; P=0.01), higher total MCS flow, and reduced catecholamine use during the first 72 hours, compared to the VA-ECMO with IABP group. Survival rates and favorable neurological outcomes at hospital discharge were significantly higher in the ECPELLA group (39% vs. 17%, P=0.002; 27% vs. 12%, P=0.02, respectively). The 90-day all-cause mortality was significantly lower in the ECPELLA group (P=0.003 by log-rank test). Multivariate Cox proportional hazard analysis, including age, shockable rhythm, ACS, OHCA, LFT, and ECPELLA, indicated that age (hazard ratio [HR] 1.02, 95% CI 1.01-1.04, P=0.004), LFT (HR 1.02, 95% CI 1.01-1.03, P&lt;0.001), and ECPELLA (HR 0.67, 95% CI 0.45-0.99, P=0.046) were significantly associated with 90-day all-cause mortality. Conclusion: ECPELLA was associated with improved 90-day mortality rates and neurological outcomes in patients who received E-CPR.
Abstract 4146080: Depolymerization of Myocyte Microtubules with Colchicine Normalizes Increased Left Ventricular Chamber Stiffness Induced by Brief Repetitive Pressure Overload
Authors: Luke Graser, Brian Weil, John Canty
Journal: Circulation (2024)

Objective: Swine subjected to brief (30-min) episodes of repetitive pressure overload (BRPO) exhibit increased left ventricular (LV) chamber stiffness in the absence of anatomic hypertrophy or increased interstitial fibrosis. We employed acute colchicine administration to determine the role of microtubule remodeling in this process. Methods: We used daily 30-minute infusions of phenylephrine (PE; 400µg/min, n=12) to induce BRPO. This raised LV systolic pressure from 102 ± 4 to 215 ± 14 mmHg and LVEDP from 12.5 ± 2.3 to 30.0 ± 1.8 mmHg. Serial LV chamber stiffness (ΔLVEDP / ΔLVEDV) was determined using echocardiography and LVEDP at rest and during PE-induced preload elevation (n=7). We assessed the contribution of microtubules to stiffness 1-hour after colchicine (1mg/kg iv). Results: Two-weeks of BRPO produced a significant increase in LV stiffness (Figure). Pathological analysis (n=5) demonstrated that this was associated with increased microtubule detyrosination (from 15.9 ± 1.7% to 21.9 ± 1.1% of myocyte area; p &lt;0.05) but no increase in interstitial fibrosis (5.03 ± 0.33% vs. 4.99 ± 0.34%, p=0.95). Serial studies of LV chamber stiffness showed an increase from 0.43 ± 0.08 mmHg/mL at baseline to 0.86 ± 0.08 mmHg/mL after 2-weeks of BRPO (p&lt;0.01). After colchicine, LV stiffness decreased to 0.54 ± 0.04 mmHg/mL (n=7, p&lt;0.01) and was not significantly different from baseline values before BRPO. Conclusions: Acute depolymerization of microtubules with colchicine reduces the increased LV chamber stiffness after BRPO to near baseline levels. These data indicate that myocyte microtubular remodeling is a major determinant of LV chamber stiffness arising from BRPO and contributes to diastolic LV properties in this model, which may pose relevance in some forms of hypertensive HFpEF.
Abstract 4145963: Mortality Trends of Pulmonary Hypertension and Congestive Heart Failure in the United States: A CDC WONDER Analysis
Authors: Azeem Rathore, Safia Shaikh, Sameh Nassar, Prakash Upreti, Jawad Basit, Olayiwola Bolaji, M Chadi Alraies
Journal: Circulation (2024)

Introduction: Pulmonary hypertension (PH) is a common comorbidity in congestive heart failure (CHF) patients. Despite studies showing the negative impact of PH on outcomes in CHF, temporal analyses of combined mortality trends are unknown. Methods: We queried the CDC WONDER database for PH (ICD-10: I27.0, I27.2, I27.8, I27.9) and CHF (ICD-10: 50.0, 50.1, 50.9) related deaths in ≥ 45-year-olds. Joinpoint regression analysis assessed annual percentage change (APC) trends for underlying and contributing causes of death. Age-adjusted mortality rates (AAMR) were computed and compared cumulatively across subpopulation demographics. Results: From 2012 to 2016, significant temporal changes were noted in PH and CHF as underlying causes (APC: 4.50% [95% CI: 2.50, 6.36]). Conversely, PH and CHF as contributing causes showed notable shifts from 1999 to 2012 (APC: -2.38% [95% CI: -2.72, -2.11]) and 2012 to 2020 (APC: 2.24% [95% CI: 1.65, 3.04]). Gender-specific analysis revealed higher AAMRs among males (313.7) than females (240.3) across this period. Race-specific analysis indicated higher AAMRs among Blacks than Whites and Asians (285.1, 273.8, and 122.6, respectively). Variation across major regions was statistically significant with the Midwest having the highest AAMR (296.3). Conclusion: PH and CHF are major contributors to mortality, with trends showing limited improvement across gender, race, and region. While PH and CHF were increasingly recognized as primary causes of death, their role as contributing factors in mortality is even more significant and has been rising more sharply. Targeted public health interventions are needed to address these disparities.
Abstract 4146091: Transvenous Extraction of Quadripolar Coronary Sinus Pacing Leads Is Feasible and Safe
Authors: Ethan Wagner, Robert Lewis, Sean Pokorney, Donald Hegland, Jonathan Piccini
Journal: Circulation (2024)

Introduction/Background: Quadripolar coronary sinus (CS) leads are commonly employed in cardiac resynchronization therapy. There are limited data on extraction of these leads. The presence of additional electrode terminals on quadripolar leads (compared to unipolar or bipolar leads) has raised concerns about CS fibrosis and extraction difficulty. Goals/Aims: The purpose of this study was to examine the safety and efficacy of quadripolar CS lead extraction and CS lead reimplantation, and to compare outcomes with extraction of non-quadripolar (unipolar or bipolar) CS leads. Methods/Approach: In this retrospective cohort study, patients who underwent extraction of CS leads between 2013 and 2024 at a large tertiary care center were included. Outcomes of interest included rates of complete CS lead removal, complete procedural success, major adverse events, and successful reimplantation in the CS. Group means were compared using the two-sample t-test assuming independent samples and unequal variances. Nominal categorical variables were analyzed with the Chi-square test or Fisher exact test where appropriate. A p value less than 0.05 was considered significant. Results/Data: A total of 182 patients were included (n = 102 quadripolar leads and n = 80 non-quadripolar leads). The mean patient age was 68.0 ± 11.6 years and 22% were female. The mean CS lead age was lower in the quadripolar group (3.0 ± 2.7 years vs. 8.2 ± 4.3 years, p &lt; 0.001), and the complete procedural success rate was higher (99% vs. 90%, p = 0.01). There was no significant difference in complete CS lead removal rates between groups (99% vs. 95%, p = 0.17). There were no major adverse events in the quadripolar group, and two major adverse events occurred in the non-quadripolar group. In the quadripolar group, manual traction alone was successful in 59%, laser sheaths were used in 39%, and rotational cutting tools were used in 9%. In the non-quadripolar group, manual traction alone was successful in 19%, laser sheaths were used in 79%, and rotational cutting tools were used in 26%. There was no significant difference in reimplantation success rates between groups (82% vs. 90%, p = 0.30). Conclusions: Quadripolar CS lead extraction had a high success rate and low rate of major adverse events. Reimplantation in the CS was possible with a good success rate but was limited by CS branch stenosis or occlusion.