tbuckley/cabot-search huggingface dataset:
Abstract 12733: The Effect of Mavacamten Treatment on Hemolysis Biomarkers in Patients With Obstructive Hypertrophic Cardiomyopathy in the EXPLORER-HCM Study
Authors: Zhaoqing Wang, Warren Anderson, Amy J Sehnert, Aiqing He, Gregory Kurio, iacopo olivotto, Peter Schafer
Journal: Circulation (2023)

Introduction: In patients with obstructive hypertrophic cardiomyopathy (HCM), blood flow changes from left ventricular outflow tract (LVOT) obstruction can lead to hemolysis and release of red blood cell proteins into circulation. Increased cell-free plasma hemoglobin (Hb) and reduced haptoglobin (Hp) are biomarkers of intravascular hemolysis. Mavacamten, a cardiac myosin inhibitor, reduced LVOT obstruction in the phase 3 EXPLORER-HCM study; however, its effect on hemolysis biomarkers is unknown. Aim: To assess the effect of 30 weeks of mavacamten treatment versus placebo on levels of intravascular hemolysis biomarkers in patients with obstructive HCM. Methods: Hemolysis biomarkers were measured as part of exploratory proteomic analyses from randomized EXPLORER-HCM (NCT03470545) patients at baseline and Week 30 (mavacamten, n = 115; placebo, n = 120) using a proteomic platform (SomaScan v4.1). Results: At Week 30, mavacamten treatment showed decreases in cell-free plasma Hb (Log 2 fold change = -1.57, FDR = 1.7х10 -4 ) and increases in cell-free plasma Hp (Log 2 fold change = 1.83, FDR = 1.2х10 -4 ) vs placebo (Figure). Hb and Hp levels were negatively correlated at baseline and at Week 30. In general, patients can be grouped into high- or low- hemolysis biomarker profile (high Hb with low Hp or low Hb with high Hp, respectively) at baseline and Week 30. Patients who received mavacamten and changed from high- to low hemolysis biomarker profile at Week 30 trended towards greater LVOT reductions under resting and Valsalva conditions. No changes were detected for either group in whole blood Hb or hematocrit. Conclusions: Reduced cell-free plasma Hb and increased cell-free plasma Hp levels, suggest a reduction in intravascular hemolysis by mavacamten in obstructive HCM. These results are consistent with improved hemodynamic effects (less outflow obstruction) and indicate that mavacamten may reduce shear forces on red blood cells in the heart.
Abstract 11988: Understanding Ethnic Differences in the Risk of Cardiovascular Events and Mortality Among Immigrants in Canada
Authors: Sneha Annie Sebastian, Inderbir Padda, Yashendra Sethi, Ubaid Khan, Gurpreet Johal
Journal: Circulation (2023)

Introduction: Immigrants make up the largest share of the population in Canada, and one in four Canadians has come to the country as an immigrant. The high level of immigration has resulted in significant ethnic diversity in Canada, and each presents with a cardiovascular disease (CVD) risk profile unique to their ethnicity and country of birth. Methods: We performed a literature search of 6 electronic databases, including the grey literature sources of conferences, reports, theses, and dissertations from January 2000 until May 25, 2023. We included pertinent English language literature that summarized the evidence on ethnic differences in CVD risk and mortality among immigrants of the following ethnic groups in Canada: South Asian (East Indian, Pakistani, Sri Lankan), Chinese, Black, Latin American, Southeast Asian (Vietnamese, Cambodian, Malaysian), West Asian (Iran, Afghan), Arab, Korean, Japanese, and Filipinos. Results: Of the 9968 studies identified, 47 studies formed the basis of the review. Four overarching themes of CVD risk were found, comprising individual characteristics, ethnic differences, gender-related risks, and duration of residence in Canada. Among the different ethnic groups, South Asians had the greater risk of cardiovascular events, in which males had a striking difference in mortality of (42%) compared to females (29%), whereas East Asians had the least risk. No significant difference in the incidence of CVD was reported with the duration of residence between varied ethnic groups. However, East Asians showed a notable exception, with an increase in the incidence of CVD after 10 years of stay in Canada by 40% and 60% among males and females, respectively. Conclusions: Ethnic inequalities in CVD attributes to a combination of modifiable and non-modifiable risk factors, and this disparity in CVD incidence can be tackled by targeting interventions according to ethnic differences in risk profiles.
Abstract 12380: Importance of Quantifying Lung Fluid Status in Patients With Heart Failure Using Chest Computed Tomography
Authors: Hiroyasu Uzui, Tatsuhiro Kataoka, Tomokazu Ishida, Tomohiro Shimizu, Ryouhei Nomura, Toshihiko Tsuji, Tomoharu Fujita, Hirotsugu Fujita, Moe Mukai, Daisetsu Aoyama, Yusuke Sato, machiko Miyoshi, Junya Yamaguchi, Naoto Tama, Hiroyuki Ikeda, Toshihide Itoh, Kentaro Ishida, Hiroshi Tada
Journal: Circulation (2023)

Background: Heart failure (HF) is a complex condition that requires accurate assessment for optimal management. B-type natriuretic peptide (BNP) has been widely used for diagnosis and monitoring, but its correlation with symptoms and prognosis can be inconsistent. This study investigates the utility of chest computed tomography (CT)-based evaluation of lung congestion as an additional tool in HF. Methods: CT imaging (SOMATOM Force, Siemens Healthineers) was performed in 129 HF patients on admission. Concurrently, BNP levels were measured. For image analysis, mean lung density (MLD), an index of lung congestion obtained from imaging, was analyzed by image analysis software (Syngo. CT Pulmo 3D, Siemens Healthineers). MLD was converted to fluid content (FC) in percentage units according to the equation: FC [%] = (MLD + 1000) / 10. The correlation between CT findings, BNP levels, clinical data, and prognosis was analyzed. Results: The FC of HF patients were significantly higher than those of non-HF patients (30.2 ± 6.2% vs. 18.2 ± 4.1%, p &lt; 0.01), and showed a weak correlation with BNP levels at admission (r = 0.205, p = 0.020). The subjects were divided into four groups based on FC values (median 30.2%) and BNP levels (median 617 pg/mL): S1 (&lt;30.2, &lt;617), 2 (≥30.2, &lt;617), S3 (&lt;30.2, ≥617), and S4 (≥30.2, ≥617). During the observation period of 7 to 38 months (mean 19.5 months), 38 out of 129 patients died. FC values were significantly higher in patients who were readmitted (32.2 ± 6.2% vs. 29.4 ± 6.1%, p = 0.024). Cardiovascular death and survival were compared between groups (Figure). Group S1 showed significantly better survival compared to the other groups. Higher mortality rates were observed in groups with the higher FC values, even in those with lower BNP levels. Conclusion: The present data suggest that the evaluation of the lung congestion level (FC value) using CT imaging on admission in HF patients is an additional indicator for accurate prognostic evaluation, in addition to BNP.
Abstract 12907: Aging Drives Cerebrovascular Network Remodeling and Functional Changes in the Mouse Brain
Authors: Qingguang Zhang, Hannah C Bennett, Yuan-ting Wu, Uree Chon, Hyun-Jae Pi, Patrick J Drew, Yongsoo Kim
Journal: Circulation (2023)

Introduction: Cerebrovascular dysfunction has been implicated in age-related cognitive decline and dementia, but the underlying vascular mechanisms are not well understood. An improved understanding of the nature of normal cerebrovascular aging is needed to help to establish the role that vascular dysfunction might play in cognitive decline and dementia. Methods: Here, we asked how normal aging differentially impacts the vascular structure and function in different brain areas in mice. We investigated structural changes in aged cerebrovascular networks and pericytes utilizing serial two-photon tomography (STPT). To further investigate potential remodeling of different vascular compartments and pericyte subtypes, we utilized tissue clearing, 3D immunolabeling, and light sheet fluorescence microscopy (LSFM) imaging. We also assessed how healthy aging impacts brain hemodynamics in response to voluntary locomotion and whisker stimulation in awake, head-fixed mice using wide field optical signal imaging and two-photon imaging. We tested mice of both sexes at 2-month, 18-month (early aging), and 24-month (late aging) of age. Results: Whole-brain vascular tracing using STPT showed an overall ~10% decrease in vascular length and branching density, and LSFM imaging with 3D immunolabeling further revealed increased arteriole tortuosity in aged brains. We also uncovered a selective vascular and pericyte loss in deep cortical layers, basal forebrain regions, and the hippocampal network. This may contribute to their regional vulnerabilities in neurodegenerative disorders. Moreover, our in vivo imaging in awake, head-fixed mice identified delayed neurovascular coupling response and inefficient oxygen delivery in aged brains. Conclusions: Our study reveals aging-related brain-wide changes in vascular and mural cell types that can explain vulnerability and resilience of different brain areas in normal aging. Moreover, we identified an age-related decrease in brain oxygenation and delayed neurovascular coupling responses which can be linked with cognitive impairment in aged brains. These aging-related changes will serve as a common factor to understand many neurodegenerative disorders and cognition decline in the elderly population.
Abstract 13790: Efficacy of Stellate Ganglion Block for Refractory Ventricular Arrhythmias: An Updated Systematic Review
Authors: Yong Hao Yeo, Min Choon Tan, Jia Wei Tham, Justin Lee, Pattara Rattanawong
Journal: Circulation (2023)

Background: Stellate ganglion block (SGB) has emerged as an alternative approach to refractory ventricular arrhythmias (VAs). However, data on the outcome of SGB for refractory VAs are limited. Objective: This study aimed to assess the in-hospital efficacy of SGB in refractory VAs. Method: A systematic search was performed in MEDLINE and EMBASE according to the PRISMA guidelines from July 2017 to October 2022. Studies reporting the characteristics of in-hospital VAs before and after the SGB were included. Studies that had missing outcomes were excluded. Results: Of 515 publications reviewed, 162 patients (60.6 ± 13.6 years of age, 81.5% male) were included across 27 studies. Amongst, 103 patients (63.6%) had ischemic cardiomyopathy, and the mean ejection fraction was 29.8 ± 12.7%. Prior to the SGB procedure, 100 patients (61.7%) required two or more anti-arrhythmic medications control. Following SGB, there was a significant 92% reduction of VAs episodes from 13.9 ± 18.5 to 0.9 ± 2.1 (p&lt;0.01) during the hospitalization (31±35 days). Of the reported patients, 46.5% remained free of VAs, and 53.5% had recurrences before discharge. Among 61 patients who required additional neuromodulation after SGB in the same hospitalization, 32 patients (52.5%) received repeated SGB, 15 patients (24.6%) underwent surgical sympathectomy, and 14 patients (23%) underwent catheter ablation. Of the reported patients, 75.4% of patients survived throughout the hospital course. Conclusion: SGB significantly reduced VAs episodes in patients with refractory VAs during hospitalization. More than three-quarters of the patients survived following the SGB for refractory VAs. This highlights the potential effective role of SGB in managing refractory VAs. Figure Change in Ventricular Arrhythmias Burden after Stellate Ganglion Block
Abstract 12836: Safety and Efficacy of Left Atrial Appendage Occlusion in Patients With Chronic Kidney Disease: A Meta-Analysis
Authors: Song Peng Ang, Jia Ee Chia, Vikash Jaiswal, Tong Hong Chia, Jose Iglesias
Journal: Circulation (2023)

Introduction: Left atrial appendage occlusion (LAAO) has been recognized as an alternative to preventing thromboembolic stroke in selected patients with non-valvular atrial fibrillation (AF). However, limited evidence exists regarding the safety of LAAO in patients with chronic kidney disease (CKD). This meta-analysis aims to evaluate the safety and efficacy of LAAO in CKD patients. Methods: We conducted a comprehensive search across various electronic databases, including PubMed, Embase, and the Cochrane Library, to identify relevant studies comparing the outcomes of CKD and non-CKD patients undergoing LAAO. The outcomes of interest included procedural success, in-hospital mortality, major bleeding, stroke, transient ischemic attack (TIA), and pericardial effusion/tamponade. The outcomes were pooled using the Hartung-Knapp-Sidik-Jonkman random-effects model, and the results were expressed as odds ratios (OR) with their corresponding 95% confidence intervals (CI). Results: Seven studies involving 38,184 patients (5,742 CKD, 32,442 non-CKD) were included in the final analysis. The rate of procedural success (98.4% vs. 97.2%, OR 1.64, 95% CI: 0.78-3.45, p=0.19) was similar between both groups. Regarding procedural complications, there were no significant differences in terms of the risk of in-hospital mortality (OR 1.87, 95% CI: 0.60-5.82, p=0.28), stroke (OR 2.19, 95% CI: 0.76-6.29, p=0.15), TIA (OR 1.64, 95% CI: 0.78-3.45, p=0.19), major bleeding (OR 1.85, 95% CI: 0.78-4.42, p=0.16), or pericardial effusion/tamponade (OR 1.23, 95% CI: 0.76-2.00, p=0.39) between the two patient groups. Conclusions: Our study demonstrates comparable safety and efficacy of LAAO in patients with CKD compared to those without CKD. Further large prospective studies are warranted to confirm these findings.
Abstract 12839: Anti-Thrombotic Therapy, Bleeding, and Mortality in Patients With Acute Myocardial Infarction and a History of Cancer: A Report From JAMIR, the Multi-Center, Nationwide Prospective Registry
Authors: Ayumi Adachi, Kazuma Oyama, Jun Takahashi, Satoshi Honda, Nishihira Kensaku, Sunao Kojima, Misa Takegami, Yasuhide Asaumi, Jun Yamashita, Mike Saji, Kiyoshi Hibi, Yasuhiko Sakata, Morimasa Takayama, Tetsuya Sumiyoshi, Hisao Ogawa, Kazuo Kimura, Satoshi Yasuda
Journal: Circulation (2023)

Background: The relationship between a history of cancer and clinical outcomes including bleeding in acute myocardial infarction (AMI) patients remains unclear in a contemporary cohort. Aims: This study aimed to analyze clinical outcomes of patients following AMI according to the history of cancer. Methods: Consecutive patients with spontaneous onset of AMI were enrolled between December 2015 and May 2017 at 50 institutions in the Japan AMI Registry (JAMIR), a multi-center, nationwide prospective registry. The outcomes of interest were all-cause death, major bleeding defined as BARC type 3 or 5, and composite ischemic events defined as cardiovascular (CV) death, MI, and ischemic stroke. Results: A total of 3,411 AMI patients were enrolled, and followed for a median of 358 days. Among those, 292 patients (8.6%) had a history of cancer. They were older, had more comorbidities, and were more likely to use clopidogrel but not prasugrel than those without. They had a similar risk of composite ischemic events, and major bleeding compared with those without, whereas were at higher risk for all-cause mortality (adjHR 1.64 [95% CI 1.16-2.32], P=0.005; Figure 1 ). While no between-group difference in CV death was observed, non-CV death and death due to cancer were higher in the cancer group than in the no-cancer group (adjHR 2.05 [95% CI 1.24-3.39], P=0.005; adjHR 18.16 [95% CI 6.74-48.97], P&lt;0.001, respectively; Figure 2 ). When further stratified by age, the difference in all-cause mortality became pronounced in the group aged&lt;75 years but not in the group aged&gt;75 years (adjHR 3.32 [1.88-5.85] and 1.26 [0.81-1.96], respectively; P for interaction=0.008; Figures 1 and 3 ). Conclusion: The nationwide multi-center registry, JAMIR demonstrated that a history of cancer was associated with increased mortality in AMI patients aged&lt;75 years. These results might suggest the need for a multidisciplinary approach to improving the prognosis of younger AMI patients with a history of cancer.
Abstract 12359: Does E/e’ Independently Predict Atrial Fibrillation Recurrence Post Catheter Ablation?
Authors: Ari Zimmer, Dimitrios Varrias, Kristie Coleman, Stefanos Zafeiropoulos, Christopher Gasparis, Jonas Leavitt, Elliot Wolf, Laurence Epstein, Rajat Goyal, Stavros Mountantonakis
Journal: Circulation (2023)

Introduction: Left atrial size has been traditionally used as a surrogate of atrial fibrillation (AF) chronicity and prognosticator for success post catheter ablation (CA). The importance of other echocardiographic parameters in predicting maintenance of sinus rhythm post CA has not been well studied. Research Question: Which echocardiographic parameter best predicts 1 year AF-free survival post CA? Goal: Elucidate which parameter best independently predicts AF recurrence and identify which patients may benefit from earlier intervention. Methods: We conducted a retrospective cohort study of patients with symptomatic AF. We included patients who were undergoing first-time ablation and had follow-up visits for at least 24 months post CA. Baseline echocardiographic and laboratory data were extracted from common electronic medical records across a large healthcare system. Clinical outcomes were determined after manual review of each 6, 12, and 24-month visit. Echocardiographic measures were used in a stepwise estimation logistic regression model using STATA /IC 16.1. Results: Out of a cohort of 1,435 patients (age 67.1 ± 10.4 years, 565 female) who received CA for AF between 2014 and 2022, 402 had AF recurrence at their 12-month follow-up visit (28%). Larger left atrial volumes (p = 0.01), higher mitral valve E/e’ ratios (p = 0.008), and higher degree of aortic regurgitation (p = 0.02) were univariately associated with AF recurrence in 1 year. Stepwise estimation regression model showed that after adjusting for age, sex, BMI, mitral valve E/e’, and left atrial volume, the only independently associated predictor was mitral valve E/e’. The R 2 of our model was 0.31 and its predictive accuracy for recurrence was 85%. Conclusion: Among all echocardiographic measures, the diastolic dysfunction parameter of E/e’ was the only independent predictor of 1-year AF recurrence.
Abstract 12026: Life Essential 8 is Positively Associated With a Higher Executive Cognitive Function in US Children - ABCD Study
Authors: Augusto Cesar Ferreira De Moraes, Marcus V. Nascimento-Ferreira, Ethan H Hunt, John Virostko, Susan S Tapert, Harold W Kohl
Journal: Circulation (2023)

Background: While the association between cardiovascular health components has been linked to a higher risk of cognitive decline in adults, the relationship between cardiovascular health indicators and executive/cognitive function in US children remains poorly understood. Research Question: Are measures of cardiovascular health associated with executive, cognitive function and in US children? Aims: The purpose of this study was to determine cross-sectional associations of Life Essential 8 components with executive and cognitive function. Methods: This was a baseline analysis from a multicenter, prospective cohort study, known as the Adolescent Brain Cognitive Development (ABCD) study. Data were analyzed from the baseline ABCD data release 1.0. Participants were children aged 9 to 10 years old recruited in 21 US cities. Participants with incomplete questionnaire data for dietary intake, physical activity, nicotine exposure, or sleep health; health evaluation for body mass index, blood lipids, glycated hemoglobin, or blood pressure; or covariate data were excluded. Each cardiovascular health indicator ranges from 0 to 100 points, enabling the calculation of a composite cardiovascular health score as the unweighted average of all components, which also ranges from 0 to 100 points. The National Institutes of Health Toolbox neurocognitive battery assesses general cognitive ability, executive function, and learning/memory using raw scores and age-corrected measures. Results: A total of 978 individuals were analyzed. The mean (SD) age was 9.9 (0.2) years, 44.9% were girls, and 53.4% were White. Individuals with more favorable cardiovascular health behaviors showed better executive cognitive function (β = 0.170; CI 95%, 0.076 to 0.265; p = 0.001), and overall cardiovascular health was associated with higher executive cognitive function (β = 0.209; CI 95%, 0.067 to 0.351; p = 0.002). Conclusions: Cardiovascular health behaviors and overall cardiovascular health were directly linked to cognitive and executive function in 9-10-year-old US children, supporting public health recommendations to promote these behaviors for their potential benefits to cognitive function and brain development.
Abstract 12738: Comparing Costs of Non-Invasive Cardiac Diagnostic Tests and Deferred Testing for Incident Chest Pain - A Population-Based Study
Authors: Idan Roifman, Anna Chu, Peter Austin, Pamela S Douglas, Harindra C Wijeysundera
Journal: Circulation (2023)

Introduction: Cardiac non-invasive diagnostic tests (NIT) for patients with suspected coronary artery disease cost &gt; $3 billion annually in the US, and may be overused. Consequently, comparing costs of different NIT strategies, including deferred testing, is of urgent importance to healthcare planning. Methods: We compared population-based downstream costs between patients undergoing evaluation for chest pain in Ontario, CA with one of four NIT tests (exercise stress testing (GXT), stress echocardiography, cardiac computed tomography angiography (CCTA) and myocardial perfusion imaging (MPI)) as well as no-testing. To compare costs among the tested and non-tested groups, we used a log-gamma generalized linear model to account for the skewed distribution of health care costs, adjusting for relevant clinical covariates. Results: Of 2,340,699 included patients, 481,170 (21%) received one of four NITs: GXT: 254,492 (53%), MPI: 154,137 (32%), stress echo: 69,160 (14%), and CCTA: 3,381 (&lt;1%). After adjustment for patient characteristics including cardiac risk factors, frailty and location (Table 1), receipt of any NIT was associated with a 12% reduction in downstream 1-year mean costs compared to those without an NIT (cost ratio 0.88, 95%CI 0.87, 0.89). Comparing the different testing strategies with no testing, both GXT (cost ratio 0.80, 95%CI 0.79-0.81) and stress echocardiography (cost ratio 0.82, 95%CI 0.81-0.83) had lower downstream costs, while both MPI (cost ratio 1.26, 95% CI 1.25, 1.27) and CCTA (cost ratio 1.29, 95% CI 1.23, 1.35) had higher downstream costs. Conclusions: In a large (&gt;2 million) population-based cohort with incident chest pain, receipt of any type of non-invasive testing was associated with a 12% reduction in downstream costs compared to no testing. GXT and stress echocardiography had the least downstream costs, whereas CCTA and MPI had the highest costs. These findings may help inform testing decisions in chest pain patients.