tbuckley/cabot-search huggingface dataset:
Abstract 18858: At Heart <i>,</i> a Progressive Web App for Women With Heart Disease: A Pilot Randomized Controlled Trial
Authors: Monica Parry, Hance Clarke, Ann Kristin Bjørnnes, Paula Harvey, Colleen M Norris, Louise Pilote, Jennifer Price, Vincenza Spiteri DeBonis, Donna Hart, Nicole Nickerson, Arland O'Hara
Journal: Circulation (2023)

Introduction/Background: At heart ’s novel core feature set includes a Heart Check, Wellness Check, and a Library, with an interactive Chatbot to manage its content and conversations. at heart is the first of its kind; there are no previous trials of an intervention rigorously developed and tested. Goals/Aims: The overall goal of this study was to develop and evaluate a digital health intervention for women with heart disease. Specific aims of the pilot randomized controlled trial (RCT) were to examine: 1) the feasibility of randomization, recruitment, and retention, 2) acceptability and barriers to implementation (including the symptom triage algorithms), and 3) engagement with the intervention. Methods/Approach: This was a two-group parallel single blind pilot RCT. Women greater than 18 years of age with heart disease were recruited, all women spoke and read English. Following completion of baseline measures, participants were randomized to either an intervention or a usual care group. Participants randomized to the intervention group used at heart for 3 months. Recruitment, retention, and adverse events were tracked and engagement was assessed using Google Analytics . Acceptability was assessed with a six-item modified Acceptability e-Scale (AES), yielding a total acceptability score of 6-30. Results/Data: A total of 98 women were assessed for eligibility, 18 were excluded. Eighty women were randomized, 40 allocated to usual care and 40 to receive the intervention. Attrition was low. Mean age was 57 years (SD 13), 32% (n=27) were employed full time, and 48% (n=41) had a post-secondary diploma/certificate. There were 226 heart checks; 1-15 per participant, most symptoms were triaged as low risk (n=176, 78%). There were 198 wellness checks, 1-12 per participant. The mean number of articles accessed in the library was 8 per participant. The mean acceptability score was 23.46 (SD 4.87), there were no barriers to implementation, and no adverse events were reported. Conclusion(s): The at heart intervention is feasible; women were engaged and reported high acceptability scores. A larger, powered RCT is necessary.
Abstract 15275: Cardiac Magnetic Resonance Ventricular Function and Hemodynamic Multivariable Model Predictors of Exercise Performance in Tetralogy of Fallot Using Machine Learning and Multivariable Modelling: A Substudy of the <i>Single Center Cardiac Magnetic Resonance Outcomes Registry-Tetralogy of Fallot</i>
Authors: Mark A Fogel, Keerthi Reddy, Abdullah Mahmood, Xuemi Zhang, Steve Ampah, Jen Faerber, Elizabeth Goldmuntz, Matthew Harris, David Biko, Sara Partington, Stephen Paridon, Michael Mcbride, Victor Ferrari, Kevin K Whitehead, Laura M Mercer-Rosa
Journal: Circulation (2023)

Background: There are no robust predictors of exercise performance in repaired tetralogy of Fallot (rTOF) using both ventricular function and hemodynamics. Aim: To utilize machine learning and multivariable modeling to determine cardiac magnetic resonance (CMR) and other metrics predictive of exercise performance. Methods: We retrospectively reviewed data of all rTOF pts undergoing CMR from 2005-2020. Those who had cardiopulmonary exercising testing (CPET) within 6 months of CMR were analyzed using the machine learning technique LASSO to choose candidate variables for subsequent testing with multivariable modeling. CMR parameters included right (RV) and left ventricular (LV) function and hemodynamics. Significance P&lt;0.05. Results: 266 of 761 pts with rTOF met the inclusion criteria (age at CMR 16.1 + 9.7 years old, age at repair 0.36 years old, 56% male). Higher RV mass, RV global function index and lower pulmonary regurgitant fraction (PR) were independently associated with higher % predicted (%P) maximum oxygen consumption (VO 2 max). In addition, females and non-syndromic pts were also associated with higher %P VO 2 max (table). Those with a higher LV end-diastolic volume (EDV), females and pts without pulmonary atresia performed better at %P work. Those with a higher RV mass/volume demonstrated a worse ventilatory equivalent of carbon dioxide (VE/VCO 2 ). See table. Conclusion: RV ventricular functional parameters, PR (hemodynamics), gender and syndromic status are all independently associated with %P VO 2 max. Those with larger LV volumes were able to perform more work and those with a higher RV mass/volume had a worse VE/VCO 2 . Our findings shed some light into the etiology of poor rTOF exercise performance.
Abstract 15976: Age and Sex Differences in the Association of Habitual Physical Activity With Cardiovascular Structure and Function in Community-Dwelling Adults
Authors: Sean P Meagher, Zhiyong J Dong, Nicole L Spartano, Gary F Mitchell, Emelia J Benjamin, Susan Cheng, Ramachandran S Vasan, Connie W Tsao
Journal: Circulation (2023)

Introduction: The association of habitual physical activity (PA) with subclinical cardiovascular remodeling and their modifications by age and sex are not well understood in community-dwelling adults. Methods: We studied 5685 (mean age 49±15 y, 53% F) participants of the Framingham Heart Study 2 nd generation Exam 8 (2005-2008) and 3 rd generation Exam 1 (2002-2005) without cardiovascular disease (CVD) and with PA, echocardiography [left ventricular mass, volume (LVM, LVEDV)], and applanation tonometry (aortic stiffness, carotid-femoral pulse wave velocity [CFPWV]. PA was assessed using a validated activity questionnaire. We assessed the relationship of PA to echocardiographic and vascular stiffness measures using linear regression adjusting for CVD risk factors and evaluated age and sex interactions on these relations. Results: Higher PA was overall associated with greater LVM (p&lt;0.0001) and LVEDV (p&lt;0.0001), which appeared driven by those aged &lt;48 years of age (p&lt;0.0001) and men (p≤0.0002 for both LVM and LVEDV) [ TABLE ]. In women, PA was associated with higher LVM (p=0.02) but not LVEDV (p=0.09). There was a borderline inverse association of PA with PWV (p=0.05). In contrast to the association of PA with LV structure, the associations of PA with PWV were significant among age ≥48 years (p=0.005) and women (p=0.008). Conclusions: In a large sample of adults in the community, we observed divergent associations of habitual PA with ventricular and vascular remodeling between age and sex groups. The mechanisms of these differential associations and impact on outcomes deserve further study.
Abstract 15998: Impact of Atrial Fibrillation Detected by Cardiac Implantable Electronic Devices on Embolic Stroke Events in Cancer Patients
Authors: Miyo Nakano, Yusuke Kondo, Masahiro Nakano, Takatsugu Kajiyama, Ryo Ito, Toshinori Chiba, Masafumi Sugawara, Yutaka Yoshino, SATOKO RYUZAKI, Yuya Komai, Yukiko Takanashi, Yoshio Kobayashi
Journal: Circulation (2023)

Background: Cancer patients have a higher risk of atrial fibrillation (AF) than general population, however, the link between cancer and AF is not fully understood. The association between AF detected by implanted cardiac implantable electronic devices (CIEDs) and the incidence of embolic stroke events has been reported. However, little is known about the incidence of AF and embolic stroke events in Japanese cancer patients with CIEDs. Moreover, the cut-off value of new-onset AF duration detected by CIEDs for embolic stroke is still unknown, and a problem to be solved in the future. The aim of this study is to identify the incidence of embolic stroke in Japanese cancer patients with a CIED and to examine the risk factors of embolic stroke. Methods: We retrospectively analyzed the database of our CIEDs clinic. Every 6 months, AF events were checked by CIEDs. Patients who had a history of AF or had received anticoagulant therapies before a CIED implantation and who are prescribed anticoagulants after a CIED implantation were excluded. We examined the characteristics and incidence of embolic stroke events and investigated the relationship between new-onset AF detected by CIEDs and the incidence of embolic stroke. Results: We enrolled 138 consecutive cancer patients with CIEDs who had no prior AF and took no anticoagulant in this study (follow-up period, 76±48 months; age, 73±16 years). During the follow-up period, 13 patients (9.4%) had embolic stroke events. Receiver-operating characteristic curve analysis confirmed that 20 seconds was the best cut-off value of AF duration detected by CIEDs for embolic stroke events (AUC = 0.75). Multivariate analysis demonstrated that independent predictors for embolic stroke were left atrial diameter ≥ 40mm (P=0.018) and new-onset AF ≥ 20 seconds (P = 0.0082). Conclusions: AF episodes lasting for ≥ 20 seconds and enlarged left atrium were the risk factors of embolic stroke events. We consider examining AF burden carefully in this population.
Abstract 16059: Real-World Exploration of Low Density Lipoprotein Cholesterol Management in Patients With Atherosclerotic Cardiovascular Disease
Authors: Nishant P Shah, Hillary Mulder, Betsy Lydon, Karen Chiswell, Zachary Lampron, Lauren Cohen, Adrian F Hernandez, Manesh R Patel, Susan Taubes, Wenliang Song, Suresh R Mulukutla, Anum Saeed, Daniel P Morin, Steven M Bradley, Xingdi Hu, Neha J Pagidipati
Journal: Circulation (2023)

Introduction: Although guidelines recommend low-density lipoprotein cholesterol (LDL-C) to bel &lt;70mg/dL in patients with atherosclerotic cardiovascular disease (ASCVD), implementation of these recommendations remains low. Research Question: To understand LDL-C management nationally and identify gaps or disparities in guideline directed care. Methods: A retrospective cohort study utilizing electronic medical record data from five health systems participating in the CardioHealth Alliance and PCORnet® was performed on patients with a LDL-C measurement in 2021 and prior ASCVD. Multivariable regression modeling was used to determine the relationship of clinical factors with guideline directed LDL-C targets. Results: Among 216,074 ASCVD participants, only 86,188 (40%) had LDL-C &lt;70 mg/dL. Compared with participants with uncontrolled LDL-C (≥70mg/dL), those with LDL-C &lt;70 mg/dL tended to be male (64.9% vs 49.1%), White (87.3% vs 83.9%), had coronary artery disease (83.5% vs 73.0%), heart failure (29.1% vs 21.3%), diabetes (48.2% vs 34.1%), and atrial fibrillation (26.1% vs 19.3%). Among those with LDL-C ≥70 mg/dL not on lipid lowering therapy (LLT) at baseline (n=53,957 [41%]), only 20% were initiated on any LLT within 6 months of the elevated LDL-C value. Several factors were associated with not achieving LDL-C &lt;70 mg/dL (Figure) including female sex (RR 1.13 [95% CI 1.12-1.14] p &lt;0.001), Black race (1.15 [1.14-1.16] p &lt;0.001), and Hispanic ethnicity (1.04 [1.01-1.06] p=0.007). Additionally, prior Lp(a) testing was associated with reaching LDL-C target (0.87 [0.82-0.92], p&lt;0.001). Conclusions: Within five large U.S. health systems, only 40% of ASCVD patients achieved target LDL-C of &lt;70 mg/dL. Patients who were female, Black, and/or Hispanic were particularly unlikely to achieve target, highlighting significant disparities. Multidisciplinary and inclusive approaches from health system to community may be needed to improve LDL-C care nationally.
Abstract 17715: Heart Rate Reduction Alone Produces Reverse Remodeling in Heart Failure Patients Refractory to Beta-Blockers: The PROBE-IT Trial
Authors: Natasha Altman, Leslie K Meyer, Rami Kahwash, Anis Karimpour-Fard, Jessica Wagner, Ed Gill, David P Kao, Wayne Minobe, William T Abraham, Sitaramesh Emani, Eric Jonas, Sam Ellis, peter buttrick, Michael R Bristow
Journal: Circulation (2023)

In a 2-center trial ( P ulse R eduction o n Be ta-Blocker and I vabradine T herapy (PROBE-IT)) we tested the hypothesis that failure to adequately reduce heart rate (HR) contributes to non-response to beta-blockers. Twenty-two dilated cardiomyopathy patients (DCM) with a sinus rhythm (SR) heart rate (HR) ≥70 bpm without reverse remodeling after target doses of beta-blockers were randomized 2:1 to 5±2.5 mg b.i.d of ivabradine (IVB) or matching placebo, and treated for 24 weeks with continuation of beta-blockers. Echocardiograms for LVEF measurements and endomyocardial biopsies for measurement of global gene expression by RNA-Sequencing were performed at baseline and end of study. The protocol design aimed for approximately equal numbers of patients with a HR reduction (HRι) and a control group with no change in HR (HRν), with the predefined statistical analysis plan comparing subjects above and below the median HR change. Characteristics and changes from baseline in the 17 patients who completed the trial were (*P &lt;0.05, † P &lt;0.01 vs. HRν):HRν patients had a longer duration of HF,, 112 months vs. 35 months in HRι (P = 0.005). In HRι vs. HRν, gene expression findings included 18 mRNAs at a P &lt;0.0005 and 39 at a P of &lt;0.001 with higher abundance, and 34 (P &lt;0.0005) and 94 (P &lt;0.001) lower abundance. The classification of these genes was distinct from molecular changes described for reverse remodeling from beta-blockers alone, with only a 2.1% overlap. Gene expression changes that could have contributed to reverse remodeling in HRι included: increases in NRG1 (neuregulin 1), PP1R3C (protein phosphatase 1), and multiple mitochondrial electron transport genes; and lower expression of genes encoding cardiotrophin-1 cytokines (CTF1 and CLCF1). Conclusions: In NDC patients meeting the PROBE-IT entry criteria, HR lowering produces a substantial increase in LVEF accompanied by gene expression changes that differ from those associated with beta-blocker therapy.
Abstract 16998: A Novel Preclinical Model of Calcified Coronary Chronic Total Occlusion
Authors: Aleksandra B Gruslova, Drew Nolen, Luis A Diaz Sanmartin, Mohammed I Aslam, Deborah Vela, Louis M Buja, Andrew Valen, Maurice Valen, James J Elliott, Marc D Feldman
Journal: Circulation (2023)

Introduction: These is significant research into the development of new medications and devices to treat chronic total occlusions (CTO). However, there is a lack of large animal models which reproduce the anatomy of clinical CTOs. Aim: Create an experimental model that mimics the anatomic features of human CTOs. Methods: CTOs were created in coronary arteries of live Yorkshire pigs (weight 80-120 lbs). The bioactive dental plug material (OsteoGen® Plug, Impladent Ltd) was implanted into the middle segment of one of coronary arteries (LAD, LCX or RCA). Angiography (C- Arm, Siemens) was performed before, immediately after plug implantation and before autopsy to confirm the presence of a CTO lesion. Animals were sacrificed at 9 hours to 3 months (n=12) and all coronary arteries underwent histopathological examination. Results: Histopathologic assessment confirmed that the bioactive plug composed of calcium apatite crystals and bovine collagen matrix mimics the pathological appearances of human CTOs. Serial histological sections showed complete resorption of the collagen matrix with replacement by fibrotic tissue 2 months after plug implantation, while the calcium content remains in the CTO. Conclusions: We have developed a reproducible model of calcified CTOs in pigs. Our model can provide a platform for evaluation of new drugs and devices for the treatment of calcified CTOs as well as to serve as a live model for training interventional cardiologists learning to cross CTOs.
Abstract 18729: cBIN1 Gene Therapy Improves Recovery of Peri-Infarction Muscle in a Canine Model of Chronic Ischemic Heart Failure
Authors: Muhammad S Khan, Yuki Ishidoya, Douglas Smego, Jing Li, Emmanuel Offei, Sofia Ruizcastillo, Annie Hirahara, Omar Gharbia, Benjamin Seamons, Joseph Palatinus, Lauren Krueger, Guillaume Hoareau, Tingting Hong, Ravi Ranjan, Craig Selzman, Derek J Dosdall, Robin M Shaw
Journal: Circulation (2023)

BACKGROUND: Heart failure (HF) due to ischemic dilated cardiomyopathy (IDCM) is a major cause of morbidity and mortality. In failing hearts, loss of T-tubule microdomains is central to impaired calcium transients and loss of cardiac function. Cardiac bridging integrator 1 (cBIN1), a membrane scaffolding protein that organizes T-tubule microdomains, is transcriptionally reduced in failing hearts. Hypothesis: cBIN1 gene therapy will improve cardiac function in ischemic cardiomyopathy. AIM: Evaluate the effectiveness of catheter-based delivery of cBIN1 gene therapy in preserving bipolar voltage (an assay of muscle health) and LVEF in a canine model of IDCM. Methods: Nine healthy adult mongrel dogs (30±3 kg) underwent LAD ligation, developing IDCM and HFrEF (LVEF &lt; 40% and NT-proBNP &gt;900 pmol/L) over 3-4 months. Animals received a single treatment at 20 sites by intramyocardial injection of either AAV9-GFP (control, n=3) or AAV9-cBIN1 (n=6) using a MyoStar catheter-mediated subendocardial injection. Low voltage LV regions were quantified as percent of total endocardial area with bipolar voltage &lt;1.5 mV on the day of the treatment (pre-therapy) and the terminal study (5-10 weeks post-therapy). Results: In control-treated dogs, low voltage areas did not change significantly (19.5±3.4 vs. 28.7±9.8%, p=0.143, Figure A ), whereas in the cBIN1-treated cohort, the low voltage areas surrounding infarction zones decreased significantly (18.9±10.9 vs. 13.4±9.1%, p=0.038, Figure B ). Control therapy was associated with an additional 9.2% loss LV myocardium, whereas cBIN1 therapy caused a 6.5% recovery of myocardium (p=0.024, Figure C ). Post-therapy week 5, LVEF decreased in control animals (36±2 vs. 29±3%, p&lt;0.001) yet improved in the cBIN1-treated animals (37±2 vs. 41±3%, P=0.003). CONCLUSION: Intramyocardial injection of cBIN1 gene therapy can halt and reverse expansion of peri-infarction low voltage areas and improve LVEF in a preclinical IDCM model of chronic HF.
Abstract 13692: Incidence, Recurrence, and Ethnicity Specific Risk Factors for Premature Coronary Artery Disease in South Asians and Europeans
Authors: Mehima Kang, Navraj Malhi, Kate Huang, Diana Vikulova, Simon Pimstone, Liam R Brunham
Journal: Circulation (2023)

Introduction: Premature coronary artery disease (CAD) incidence is increasing globally. South Asians (SA) have a disproportionately high burden of atherosclerotic cardiovascular disease (ASCVD). However, the effect of SA ethnicity on the risk of recurrent events in patients with premature CAD has not been prospectively evaluated. Methods: Patients in the SAVEBC and UK biobank (UKB) registries were enrolled and stratified by ethnicity and presence of premature CAD. The co-primary outcomes were to compare proportion of premature CAD and the incidence of recurrent ASVCD events. Secondary exploratory outcomes included describing demographic, physical, biochemical variables between cohorts. Results: 11,136 patients were included, 1,129 (143 SA; 21%) were from SAVEBC and 10,007 (400 SA; 4.0%) from UKB. There was a higher proportion of premature CAD in SA compared to Caucasians in UKB (5.2% vs. 2.0%, p &lt; 0.001). Similarly, SA were overrepresented in SAVEBC (21% of cohort vs. 7.9% of British Columbia population). SA compared to Caucasians with premature CAD had increased prevalence of diabetes (SAVEBC: 20.1% vs 13.8%, p=0.08; UKB: 37.5% vs 18.0%, p&lt;0.001), and lower mean HDL cholesterol (SAVEBC: 1.4±0.4 vs 1.5±0.4, p=0.21; UKB: 1.1±0.3 vs 1.2±0.3, p&lt;0.001). SA had more diffuse disease reflected by more coronary segments affected (4.9±3.0 vs. 4.1±2.6, p=0.05), and a trend towards more affected coronary vessels compared to Caucasians (1.31±1.4 vs. 0.61±0.91, p=0.14). SA had greater incidence of recurrent ASCVD vs. Caucasians (4.19 vs. 3.08 events per 100 P-Y; incidence rate ratio p-value &lt; 0.001). SA had higher risk of recurrent ASCVD events (HR 1.35, 95% CI 1.13,1.61, p&lt;0.001). SA ethnicity remained a predictor of recurrent events on adjusted COX regression (HR 1.24, 95% CI 1.03,1.48, p=0.02). Conclusion: Using two prospective registries, SA had a higher proportion of premature CAD and recurrent cardiovascular events with shorter time to recurrent events. Some risk may be explained by adverse cardiometabolic profiles, however significant risk mechanisms are yet to be elucidated. Understanding the unique mechanisms of cardiovascular risk in SA is critical to appropriately identify high-risk individuals and initiate contemporary preventative therapies.
Abstract 12632: Clinical Outcomes Across Groups of Ejection Fraction and Grades of Diastolic Dysfunction
Authors: Jacqueline Levene, Aditya Bhonsale, Krishna Kancharla, Floyd W Thoma, Suresh R Mulukutla, Andrew Voigt, Alaa Shalaby, Nathan A Estes, Sandeep Jain, Samir Saba
Journal: Circulation (2023)

Introduction: Previous studies have examined the association of diastolic dysfunction (DD) with cardiovascular (CV) outcomes. Understanding how clinical outcomes for those with a normal ejection fraction (EF) and DD compared to those with reduced EF is important in mitigating CV risk and optimizing management. Methods: 153,305 patients with echocardiograms performed at our institution between 2009 and 2022 were included in this analysis and divided into 2 cohorts: A) Normal EF patients (n=136,455) who were further stratified by grade of DD; and B) low EF (EF&lt;50%, n=16,850) patients who were further stratified by EF into four groups. Patients were followed for CV hospitalization or death. Results: Over a median follow up of 3.42 years, 23,946 (16%) patients died. There were 31,113 (20%), 13,305 (9%), and 1,269 (1%) hospitalizations for any CV diagnosis, heart failure (HF), or cardiac arrest (CA), respectively. After adjustment for age, CAD, HF, DM, hypertension, AF and CKD, the risk of all-cause mortality and of CV or HF hospitalizations increased steadily with increasing grade of DD in patients with normal EF (Table). The same was observed in cohort B with worsening EF, to greater extent than in patients with preserved EF (Table). The risk of hospitalization for CA in patients with grade III DD, however, was comparable to that of patients with an EF &lt;25% (HR=0.97, 95% CI 0.58-1.62, p=0.90) and worse than patients in better EF quartiles (p&lt;0.001). Patients with grade II DD had a CA hospitalization risk comparable to those with EF between 36-40% (HR=1.11, 95% CI 0.79-1.57, p=0.54). Conclusions: Although systolic dysfunction is associated with worse overall death and HF hospitalizations than DD, the risk of CA in patients with grade II and III DD is comparable to that of patients with moderate and severe systolic dysfunction, respectively. Future studies are needed to examine the mechanisms of CA in DD, and optimal treatment strategies for these patients.