tbuckley/cabot-search huggingface dataset:
Abstract 4123956: Upgrade to Implantable Cardioverter-Defibrillator in Patients Diagnosed with Cardiac Sarcoidosis after Permanent Pacemaker Implantation for High-Grade Atrioventricular Block
Authors: Brett Austin, Andrew Rosenbaum, Omar Abou-Ezzeddine, John Giudicessi, John Bois, Melanie Bratcher, Suraj Kapa, Abhishek Deshmukh, Konstantinos Siontis
Journal: Circulation (2024)

Introduction: Unexplained high-grade AV block (AVB) in patients age &lt;65 years is among the salient features of cardiac sarcoidosis (CS). Guidelines recommend that CS patients with high-grade AVB should receive an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) rather than a permanent pacemaker (PPM). However, in clinical practice, CS may be recognized after PPM implantation for high-grade AVB. Aims: To evaluate the characteristics and outcomes of patients diagnosed with CS after PPM implantation for high-grade AVB and assess the decision-making and rationale for upgrade to ICD/CRT-D. Methods: Retrospective review of the Mayo Clinic Sarcoid Registry (n=848) was performed to identify all patients for which a PPM was implanted for high-grade AVB prior to the diagnosis of CS. Baseline clinical and imaging characteristics were collected during index evaluation at our institution. Decision-making for ICD upgrade, lead management strategy, immunosuppression initiation, and outcomes were assessed. Results: Overall, 29 of 848 (3.4%) of CS patients (62% probable/definite CS; 77% male; median (IQR) age 56 (48-61) years; and median (IQR) LVEF 58% (50-62) received a PPM for high-grade AVB prior to a CS diagnosis. Median (IQR) interval between PPM implant and index evaluation was 10 (3-23) months. Eight of 29 patients underwent upgrade to ICD (n=4) or CRT-D (n=4). Among them, the pacing lead was extracted in 4. All patients were upgraded for primary prevention of sudden cardiac death (SCD), with 3 of them also having LVEF&lt;50% requiring upgrade to CRT-D. Twenty-two (79%) patients in the total cohort were treated with immunosuppression. During median (IQR) follow-up 37 months (11-74), 1 patient in the upgrade group had sustained VT appropriately treated with anti-tachycardia pacing. No events were documented among patients in the non-upgrade group. At last follow-up, 6 (75%) patients in the upgrade group and 12 (57%) in the non-upgrade group were pacemaker dependent. Median LVEF change was 0% in patients who underwent upgrade to CRT-D and –0.2% in those who underwent upgrade to ICD or no upgrade. Conclusions: In this cohort of patients diagnosed with CS several months after a PPM had been implanted for high-grade AVB, incident VT/VF was infrequent with contemporary CS management. In the absence of other SCD risk factors, CS patients who received a PPM for high-grade AVB prior to their CS diagnosis may not require ICD upgrade.
Abstract 4113854: Outcomes Of Atrial Fibrillation Ablation In Elderly: A Retrospective Cohort Study
Authors: Aditya Thakkar, Soumya Gupta, Koushik Sanku, SAI KARTHIK KOMMINENI, Lalith Namburu, Dilpat Kumar, vijay ramu
Journal: Circulation (2024)

Introduction: Atrial fibrillation (Afib) is a common cardiac arrhythmia that increases in prevalence with age. Ablation has been widely used for managing Afib, but its outcomes in octogenarians have been less thoroughly investigated. Research Question: This study aims to assess the in-hospital outcomes of Afib ablation in patients aged above 80 compared to those below 80 years old. Methods: Data was obtained from the Nationwide Inpatient Sample database from January 2016 to December 2020. The study included all adult patients with a primary discharge diagnosis of Afib who underwent catheter ablation during their hospitalization. These patients were then categorized into two groups based on age: below 80 and above 80 years. In-hospital outcomes for these groups were then looked at. The primary outcome was inpatient mortality. Secondary outcomes were the length of stay, cost of hospitalization, cardiac arrest, cardiac tamponade, arrhythmias, acute respiratory failure, acute renal failure, procedural complications as well as the need for dialysis, transfusions, pressors, ventilators, and tracheostomy. Results: Out of about 35 million admissions screened, 403,247 patients had Afib as their primary discharge diagnosis, of these, 17,927 patients underwent catheter ablations during their hospitalization. Amongst them, 3,051(17%) were above the age of 80 years. The in-hospital mortality was slightly higher in the elderly compared to the younger cohort (1.1% vs 0.5%, aOR: 1.87; 95% CI: 1.20-2.92, p=0.006). They had a longer hospital stay (5.14 days vs. 3.72 days, p&lt;0.001) and lower hospitalization costs (USD 138,091 vs. USD 162,788, p&lt;0.001). Complications such as acute respiratory failure and acute renal failure were more frequent in the older age group, while no significant differences were observed in cardiac arrest, cardiac tamponade, ventricular arrhythmias, and most device-related complications. The need for new dialysis, mechanical ventilation, and pressor use was significantly less in the above-80 group. Conclusion: Afib ablation in older adults, results in slightly higher in-hospital mortality and longer hospital stays compared to younger patients. Despite these differences, the overall complication rates are comparable, suggesting that age alone should not deter the selection of patients for Afib ablation. Further studies are needed to validate these findings and optimize management strategies for the elderly population.
Abstract 4113371: Impact of Protein-Energy Malnutrition on Atrial Fibrillation Outcomes: Insights from National Inpatient Sample (NIS) Study
Authors: Prakash Upreti, Binita Neupane, Sunita Karki, Astha Prasai, Roshan Karki, Mohan Rao, Wilbert Aronow, Kamala Tamirisa
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia. Protein-energy malnutrition (PEM) has been implicated in various cardiovascular conditions, but the studies on its impact on AF outcomes are limited. This study aims to investigate the relationship between PEM and AF outcomes, since malnutrition could be a modifiable risk factor. Methods: Utilizing data from NIS (2017–2020), patients of age more than 18 years with a primary diagnosis of AF and a secondary diagnosis of PEM were identified. Data analysis was performed using STATA, employing the Student's t-test and Fischer's exact test to compare continuous variables and proportions, respectively. Adjusted odds ratios were calculated through multivariate regression analysis. The primary outcome was mortality, with secondary outcomes being mean length of stay (LOS), total hospitalization cost, major adverse cardiovascular events (MACE) and various in-hospital complications. Trends in mortality, LOS, and total cost of hospitalization were also assessed. Results: A total of 17,652,695 patients with AF were identified, of whom 1,452,695 (8.22%) had PEM. Patients with PEM had increased mortality (10.8% vs 4.52%, p&lt;0.001), increased mean LOS (10.14 days vs 5.52 days, p&lt;0.001) and a higher hospitalization cost ($121,721 vs 69,348, p&lt;0.001). In AF patients with PEM compared to those without PEM, there were significantly increased rates of ACS (adjusted odds ratio, or aOR=1.21, 2.48 vs 1.85, p&lt;0.001), pulmonary edema (aOR=1.37, 0.61 vs 0.44, p&lt;0.001), CVA (aOR=1.45, 1.7 vs 1.04, p&lt;0.001) acute respiratory failure (aOR=1.78, 20.27 vs 11.75, p&lt;0.001), need of mechanical ventilation (aOR= 2.46, 9.36 vs 3.96, p&lt;0.001), ARDS (aOR= 2.8, 0.55 vs 0.21, p&lt;0.001), AKI (aOR=1.57, 35.45 vs 24.12, p&lt;0.001), and septic shock (aOR= 3.32, 10.3 vs 3.24, p&lt;0.001). There is an increased trend of mortality (10.77 in 2017 vs 11.87 in 2020, p&lt;0.001), LOS (10.49 in 2017 vs 10.8 in 2020, p=0.04) and total hospitalization cost ($121,233 in 2017 vs $140,869 in 2020, p&lt;0.001) in patients with AF and PEM. Conclusion: Our study highlights the association between PEM and adverse AF outcomes, revealing PEM as a significant predictor of increased mortality, morbidity, length of stay, and hospitalization costs. These results emphasize the necessity for targeted nutritional interventions in AF management. Further research and clinical strategies addressing nutritional deficits in AF populations are essential for improving outcomes.
Abstract 4113890: Impact of blood pressure management on cardiovascular events among patients with familial hypercholesterolemia
Authors: Hayato Tada, Yasuaki Takeji, Atsushi Nohara, Masa-aki Kawashiri, Masayuki Takamura
Journal: Circulation (2024)

Background: Hypertension status has been associated with worse outcomes among patients with familial hypercholesterolemia (FH). We aimed to determine clinical impact of management of blood pressure in development of major adverse cardiovascular events (MACE). Methods: Patients with clinically diagnosed heterozygous FH (HeFH) (N=1,273, male/female=614/659) with blood pressure data were assessed. We divided the patients into 4 groups (group 1: patients without hypertension from baseline to their follow-up, group 2: patients without hypertension at baseline, but developed hypertension at follow-up, group 3: patients with hypertension at baseline, but well-controlled at follow-up, group 4: patients with hypertension from baseline and uncontrolled at their follow-up). Cox proportional hazards models were used to assess factors associated with MACE, including cardiovascular death and any coronary events. Results: The median follow-up period was 10.9 years. During the follow-up period, 142 MACEs were observed. We found that the management of blood pressure was significantly associated with the occurrence of MACE (hazard ratio (HR): 2.50; 95% confidence interval (CI): 1.30–3.70; p&lt;0.001, HR: 4.18; 95% CI: 2.08–6.28; p&lt;0.001, HR: 10.96; 95% CI: 6.10–17.58; p&lt;0.001, in group 2, group 3, and group 4, respectively when group 1 was considered as reference). Conclusions: Blood pressure management appears to be very important among patients with HeFH.
Abstract 4113263: Serum Metabolomics Adds Predictive Value to Clinical and Polygenic Risk Scores for Atrial Fibrillation: A UK Biobank study of &gt;240,000 Patients
Authors: Subhanik Purkayastha, Joseph Park, Sebastian Beyer, Bruce Lerman, James Lo, Jim Cheung
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) poses substantial morbidity and mortality burdens globally. It is critical to identify individuals at high-risk for AF to implement both lifestyle modifications and close monitoring for initiation of oral anticoagulants. Currently, risk prediction in AF relies on clinical scores such as CHARGE-AF. Small molecule metabolites are thought to play a role in AF pathogenesis, but the additional predictive value of metabolomics over clinical and genetic risk factors is unknown. Using the UK Biobank (UKBB), we sought to perform this evaluation. Methods: We included all UKBB participants with complete 1 H-NMR metabolite measurements. We excluded participants with prior history of AF or with incomplete AF Polygenic Risk Score (AF-PRS) or CHARGE-AF components. The final cohort included 240,628 patients. In-patient records, primary care notes, and death registries were queried to identify patients who had developed incident AF within 5 years of enrollment. The cohort was divided into a 80/20:Train/Test split. We compared the performance of an Elastic-Net regularized Cox Proportional Hazards (EN-CPH) model trained on CHARGE-AF, AF-PRS, and the full 170 metabolite panel to a CPH model trained only on CHARGE-AF and AF-PRS. Results: Within 5 years, 4,174 (1.7%) patients developed AF. Compared to the control population, the incident AF cases were more likely to be older (62 vs. 56, p&lt;0.001), male (65% vs 45%, p&lt;0.001), and have higher CHARGE-AF and AF-PRS scores (p&lt;0.001). After training the EN-CPH model on CHARGE-AF, AF-PRS, and 170 metabolites, the final model included 8 metabolites on top of CHARGE-AF (HR: 1.28) and AF-PRS (HR: 1.11). After adjusting for CHARGE-AF and AF-PRS, creatinine level was associated with increased risk of AF (HR: 1.01) while linoleic acid level (HR: 0.985) was associated with decreased risk. Furthermore, total cholesterol, esterified cholesterol, free cholesterol, cholesteryl esters in IDL, omega-6 fatty acids, and cholesterol in large LDL were associated with HR 0.993-0.999. The EN-CPH model out-performed the CPH model without metabolomics on the test set (AUC 0.786 vs 0.753, p &lt; 0.001). Conclusions: The addition of metabolomics to clinical and genomic risk scores improves prediction of 5-year incident AF within a general population. This study highlights the significance of the metabolome as an independent prognosticator of AF risk. Further study of the mechanisms by which selected metabolites alter AF risk is needed.
Abstract 4113411: Long Term Outcomes of Hypertension and Antihypertensive Drugs in Young Healthy Adults: A Nationwide Population-based Prospective Cohort Study in Korea
Authors: In Tae Moon, Yung Ki Park
Journal: Circulation (2024)

Background: Long term follow-up data on elevated blood pressure (BP) or antihypertensive drugs in young adults are scarce. The effect of hypertension (HTN) and antihypertensive medications on the cardiovascular disease incidence in young healthy adults (20~45 years) was analyzed using a large-scale population medical use database in Korea. Methods: In total, 4,590,597 young Korean adults without comorbidities who underwent regular health examination were included in this study. They were stratified into four groups according to their BP (optimal BP, normal BP, high normal BP, and HTN). The primary outcome was a composite of the incidence of myocardial infarction and ischemic and hemorrhagic stroke, obtained by tracking the medical use data of the first-ever ICD-10 codes. Subgroup analysis was conducted by categorizing the HTN group into two subgroups according to the prescription ratios of the antihypertensive drugs during the follow-up period. Results: The average age was 33.8 years and median follow-up duration was 15.9 years. HTN elevated the incidence risk of major cardiovascular disease by 2.16 times compared to that of the optimal BP group. Dyslipidemia and HTN were the most dominant risk factors for myocardial infarction and stroke, respectively. In the subgroup analysis, antihypertensive medications decreased the incidence of cardiovascular disease by 70% in all diseases. Conclusions: Cardiovascular risk factors, including HTN, contribute to major cardiovascular disease incidence in young adults. The antihypertensive medications decreased the major cardiovascular disease incidence estimates.
Abstract 4115222: Distinct Demographic, Cognitive, and Psychosocial Factors Associated with Different Types of Self-Care in Patients with Type 1 Diabetes and in Patients with Type 2 Diabetes
Authors: Seongkum Heo, Tammy Barbe, JinShil Kim
Journal: Circulation (2024)

Background: Poor self-care in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) leads to increased diabetes complications and health costs. While the goal of self-management for patients with T1DM and T2DM is to maintain normal blood glucose levels, the major methods for achieving this differ (exogenous insulin delivery vs. a combination of self-care techniques, respectively). This implies that factors associated with self-care in the two groups may differ. Hypothesis: Distinct demographic, cognitive, and psychosocial factors are associated with overall self-care, diet, exercise, blood glucose testing, foot care, and smoking in patients with T1DM and T2DM, in separate models. Methods: In this cross-sectional, correlational study, data were collected from 148 patients with T1DM (n = 64, mean age: 51.3 years) or T2DM (n = 84, mean age: 62.5) using REDCap during 2023. The participants were recruited from various organizations, institutions, and ResearchMatch in the United States. Several multiple regression analyses were done to test the hypothesis. Results: Patients with T1DM had better self-care, including overall diabetes self-care, exercise, and blood glucose testing than the T2DM group. Older age (p = .003), lower body mass index (BMI) (p = .040), and stronger knowledge (p = .028) in the T1DM group (F[10,53]= 2.290, p = .026, R 2 = .302), while lower BMI (p = .045) and higher levels of self-efficacy (p &lt; .001) in the T2DM group were associated with better overall diabetes self-care (F[10,73] = 3.219, p = .002, R 2 = .306). Older age, lower BMI, stronger knowledge, stronger resilience, and lower self-esteem were associated with better self-care in diet, blood glucose testing, and/or foot care in the T1DM group, while lower BMI, stronger knowledge, higher levels of self-efficacy, and less severe depressive symptoms were associated with better self-care in diet, exercise, and/or blood glucose testing in the T2DM group. None were associated with smoking in both groups. Diabetes distress, self-compassion, and social support were not associated with any types of self-care. Conclusions: Factors associated with self-care differed based on types of self-care and types of diabetes, thus, supporting the hypothesis. When healthcare providers provide interventions to improve diabetes self-care in individual patients with diabetes, they need to consider types of diabetes, types of self-care, and distinct factors associated with each type of self-care.
Abstract 4113300: Targeting Liver Epsins Ameliorates Dyslipidemia in Atherosclerosis
Authors: Bo Zhu, Krishan Gupta, Kui Cui, Marrina Malovichko, sanjay srivastava, Kaifu Chen, Jinjun Shi, Hong Chen
Journal: Circulation (2024)

Rationale: Low density cholesterol receptor (LDLR) in the liver is critical for the clearance of low-density lipoprotein cholesterol (LDL-C) in the blood. In atherogenic conditions, proprotein convertase subtilisin/kexin 9 (PCSK9) binds to LDLR on the surface of hepatocytes, preventing its recycling and enhancing its degradation in lysosomes, resulting in reduced LDL-C clearance. Our recent studies demonstrate that epsins, a family of ubiquitin-binding endocytic adaptors, are critical regulators of atherogenicity. Given the fundamental contribution of circulating LDL-C to atherosclerosis, we hypothesize that liver epsins promote atherosclerosis by controlling PCSK9-triggered LDLR endocytosis and degradation. Objective: We will determine the role of liver epsins in promoting PCSK9-mediated LDLR degradation and hindering LDL-C clearance to propel atherosclerosis. Methods and Results: We generated double knockout mice using albumin Cre in which both genes of epsin, namely, epsin 1 and epsin 2, are specifically deleted in the liver (Liver-DKO) on an ApoE -/- background. We discovered that western diet (WD)-induced atherogenesis was greatly inhibited, along with diminished blood cholesterol and triglyceride levels. Mechanistically, using scRNA-seq analysis on hepatocyte-derived data revealed elevated pathway involved in LDL particle clearance under WD treatment in ApoE -/- /Liver-DKO, which was coupled with diminished plasma LDL-C levels. Further analysis using the MEBOCOST algorithm revealed enhanced communication score between LDLR and cholesterol, suggesting elevated LDL-C clearance in the ApoE -/- Liver-DKO mice. In addition, we showed that loss of epsins in the liver upregulates of LDLR protein level. We further showed that epsins bind LDLR via the ubiquitin-interacting motif (UIM), and PCSK9-triggered LDLR degradation was abolished by depletion of epsins, preventing atheroma progression. Finally, our therapeutic strategy, which involved targeting liver epsins with nanoparticle-encapsulated siRNAs, was highly efficacious at inhibiting dyslipidemia and impeding atherosclerosis. Conclusions: Liver epsins promote atherogenesis by mediating PCSK9-triggered degradation of LDLR, thus raising the circulating LDL-C levels. Targeting epsins in the liver may serve as a novel therapeutic strategy to treat atherosclerosis by suppression of PCSK9-mediated LDLR degradation.
Abstract 4114220: Majority of Patients with New Ventricular Dysfunction After Acute COVID-19 Infection Did Not Have Cardiac Recovery
Authors: Crystal Yan, Beatriz Rivera Rodriguez, Sharon Andrade-Bucknor
Journal: Circulation (2024)

Background: It is still not well understood whether cardiac injury observed during acute COVID-19 infection extends after recovery from the initial viral infection. The purpose of this study was to determine the incidence of left and right ventricular dysfunction in patients hospitalized with acute COVID-19 and evaluate for cardiac recovery. Methods: A multicenter, retrospective cohort study was conducted. Adult patients were identified by hospitalizations using ICD-10 code U07.1 from March 2020 to October 2021. Patients were included if they had: 1) acute COVID-19 infection confirmed by RT-PCR and 2) a transthoracic echocardiogram (TTE) performed during their hospitalization. Clinical and echocardiographic data were collected and analyzed. Longitudinal TTE parameters were obtained from follow-up studies performed after discharge. Results: A total of 750 patients (mean age 64.3 ± 15.3 years, 60.0% male) were included. The average time to follow-up TTE was 8.7± 7.4 months. 133 patients (17.7%) had new LV dysfunction seen on TTE ( Figure 1 ). LV recovery (defined as normalization of LVEF or improvement of LVEF by &gt; 10% from baseline) was observed in 28 of 74 (37.8%) survivors. 9 of 26 patients (34.6%) who had a follow-up TTE &lt;6 months post-discharge recovered their LV function, while 19 of 48 patients (39.6%) who had a follow-up TTE ≥6 months had LV recovery. 94 of 725 patients (13.0%) with reported RV parameters had new RV dysfunction seen on TTE. RV recovery (defined as normalization of RV function) was observed in 11 of 38 (28.9%) survivors. 6 of 18 patients (33.3%) who had a follow-up TTE &lt;6 months post-discharge recovered their RV function, while 5 of 20 patients (25%) who had a follow-up TTE ≥6 months had RV recovery. Conclusions: Most surviving patients who developed new LV or RV dysfunction did not recover their ventricular function at follow-up, but recovery extended beyond 6 months follow-up.