tbuckley/cabot-search huggingface dataset:
Abstract 15070: Predicting Steam-Pop Incidence Using Ex-Vivo Bipolar Ablation Model of Porcine Ventricular Myocardium
Authors: Takafumi Okuyama, Hisaki Makimoto, Masashi Kamioka, Tomonori Watanabe, Hiroaki Watanabe, Ayako Yokota, Takahiro Komori, Tomoyuki Kabutoya, Yasushi Imai, Kazuomi Kario
Journal: Circulation (2023)

Introduction: Bipolar ablation has been reported to be able to create deep myocardial ablation lesion as compared to unipolar ablation, however, the incidence of steam-pop can lead to undesirable periprocedural complication. Hypothesis: Steam-pop occurrence during bipolar ablation can be predicted by the settings of bipolar ablation and the myocardial tissue characteristics such as tissue thickness and initial impedance prior to RF. Methods: Using porcine cardiac tissues ex-vivo ablation experiments were conducted. We adopted the commercially available radiofrequency (RF) ablation catheters. Each ablation catheter was placed on both sides of the myocardial slice at an angle of 45 degrees under targeted contact force of 10g. We recorded the occurrence of steam-pop under the multiple settings of tissue thickness, RF power and ablation duration. We created a generalized linear model (GLM) to predict steam-pop based on the bipolar ablation settings and the myocardial tissue characteristics. Results: In total 194 bipolar applications were analyzed. Steam-pops were observed in 11 out of 194 applications (5.7%). In the applications with steam-pop, the RF energy was higher (median 40W [q1-q3: 30-50] vs 30W [20-40], P=0.017), the initial impedance was lower (88 [86.75 - 91.5] vs 93 Ohm [89.75 - 95.75], P=0.0042) and the tissue thickness was thinner (9.4 [8.43 - 9.89] vs 12.9 mm [10.06 - 15.47], P&lt;0.0001) as compared to the applications without steam-pop. Using tissue thickness, RF energy and initial impedance, the constructed GLM achieved sensitivity of 100%, specificity of 93% and the area under the receiver-operator-characteristics curve of 0.969. Conclusion: Our data showed that the steam-pop occurrence during bipolar ablation may be predicted based on the initial RF settings and the tissue characteristics in the ex-vivo porcine myocardial model. Further studies are necessary to validate the feasibility of predicting steam-pops using the RF and tissue characteristics in the beating heart and human heart, which may enable us to titrate the RF settings and lead to safer bipolar ablation.
Abstract 14614: Effect of SGLT2 Inhibitors on Renal Outcomes Across Various Patient Populations
Authors: Tariq J Siddiqi, Muhammad Shariq Usman, Hasan F Siddiqui, Javed Butler
Journal: Circulation (2023)

Background: The effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on renal outcomes in patients with varying combinations of heart failure (HF), chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) remains unclear. Methods: Online databases were queried up to May 2023 for primary and secondary analysis of trials of SGLT2i in patients with HF, CKD, or T2DM. Outcomes of interest were composite renal endpoint (defined as an eGFR &lt;15 mL/min/1.73 m2, doubling of serum creatinine, some percent change in eGFR, and/or need for kidney replacement therapy) and change in estimated glomerular filtration rate (eGFR) slope. Hazard ratios (HR) and mean difference with their 95% confidence intervals were pooled using the generic inverse variance method and a random-effects model. Results: 10 trials (n=70,117 patients) were included. Compared with placebo, SGLT2i reduced the risk of composite renal endpoint by 35% in HF (HR: 0.65; 95% CI: 0.50-0.84), 38% in CKD (HR: 0.62; 95% CI: 0.54-0.71), and 37% in DM (HR:0.63; 95% CI: 0.54, 0.73). A similar pattern of benefit was observed in different combinations of these diseases ( Figure 1 ), as well as patients without baseline HF (HR:0.57; 95% CI: 0.51, 0.63), CKD (HR:0.64; 95% CI: 0.42, 0.98) and T2DM (HR:0.62; 95% CI: 0.45, 0.86). Findings were similar for change in eGFR slope. Conclusions: SGLT2i improve renal outcomes in cohorts of HF, CKD and T2DM and these effects appear consistent across patients with different combinations of these conditions.
Abstract 15303: The SGLT2 Inhibitor Canagliflozin Attenuates Fibrosis and Mitochondrial Dysfunction Induced by Hyperglycemia in Isolated Primary Human Cardiac Fibroblasts
Authors: Fahimeh Varzideh, Stanislovas Jankauskas, Urna Kansakar, Angela Lombardi, Gaetano Santulli
Journal: Circulation (2023)

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been recently approved as antidiabetic drugs showing beneficial effects on major adverse cardiac events. The exact mechanisms underlying the favorable cardiac actions are mostly unknown. Methods: Human cardiac fibroblasts (HCFs) were cultured in 5mM glucose (normal glucose; NG), 30mM glucose (high glucose; HG) or 30mM with 1μM SGLT2is empagliflozin (EMPA), dapagliflozin (DAPA), canagliflozin (CANA), and ertugliflozin (ERTU)-containing medium for 24h. RNA-sequencing, Western blots, proliferation rate, Ca 2+ imaging, mitochondrial reactive oxygen species (ROS) were performed on HCFs. Results: HG induced a greater mitochondrial ROS production compared to NG, which was attenuated by SGLT2is. Specifically, we observed less ROS in the CANA group in comparison to EMPA, DAPA, and ERTU. In addition, sodium-hydrogen exchanger-1 (NHE-1) was upregulated in HG and such upregulation was markedly mitigated by SGLT2is, particularly by the CANA. Therefore, we continued other experiments using CANA. RNA-sequencing data revealed a clear segregation between HG and HG plus CANA. Strikingly, we observed upregulation of some genes (including NEAT1 , RNY1 related to cardiac fibrosis) in the HG group, which were downregulated in HG plus CANA. CANA significantly reduced proliferation rate compared to NG and HG. Compared to NG, HG significantly increased expression of Collagen I, Smad-2, mitochondrial fission (DRP-1) protein, and Beclin 1 (autophagy marker) which were instead reduced with CANA. Moreover, CANA upregulated mitochondrial fusion (MFN-1) protein. We assessed the difference in Ca 2+ flux in HCFs: HG decreased the capacity of the endoplasmic reticulum (ER) to accumulate Ca 2+ and delayed storage-operated Ca 2+ entry (SOCE); treatment with CANA partially prevented loss of ER Ca 2+ storage capacity and significantly improved SOCE timing. Conclusion: Our data indicate that CANA attenuates fibrosis, autophagy and mitochondrial dysfunction in HCFs in HG conditions and that this effect might be mediated through NHE-1 inhibition.
Abstract 13410: Severe Brain White Matter Hyperintensity is Associated With Local Brain Atrophy of Parahippocampal Gyrus and Predicts Prognosis in Heart Failure Patients Without Dementia
Authors: Tomomi Meguro, Yuko Meguro, Nobusada Funabashi
Journal: Circulation (2023)

Introduction: Aged heart failure (HF) patients without dementia may have a risk of cognitive impairment (CI) that attenuates the effect of treatment for HF. White Matter Hyperintensity (WMH) is a potential risk of CI through a disconnection of subcortical brain network. On the other hand, patients with CI have severe brain atrophy in parahippocampal gyrus (PHG). However, it is not clear whether WMH is associated with atrophy in PHG and predicts prognosis of HF patients. Hypothesis: In HF patients without dementia, WMH is associated with brain atrophy of PHG, a potential risk of CI, and predicts prognosis. Methods: Sixty-five HF patients (age 76±11 years, NYHA class II, EF47±17 %) were enrolled. We excluded patients with dementia using mini-mental state examination. We took 3D-T1 weighted images and Fluid Attenuated Inversion Recovery (FLAIR) images of whole brain using 1.5T magnetic resonance imaging. Image analysis was performed to evaluate the severity of atrophy of PHG and volume of WMH using 2mm voxel-based morphometry by the statistical parametric mapping software. The Z-score value was calculated to evaluate the severity of atrophy in PHG. A Kaplan-Meier Curve adjusted with age, sex, presence of atrial fibrillation, and blood pressure was constructed using inverse probability weighting method. Results: We determined the cut-off point of the volume of WMH for estimating cardiac death using a receiver operating characteristic curve. Patients were divided into High-WMH group (n=37, volume of WMH 30±13 mL) and Low-WMH group (n=28, volume of WMH 8±5 mL) according to the cut-off value (15mL). As shown in representative cases (Figure1), the Z-score value in PHG (pink circle) was higher in High-WMH group (1.45±0.78, white arrow) compared to Low-WMH group (0.94±0.57, P=0.006). Adjusted Kaplan-Meier curves showed poor prognosis of High-WMH group (Figure 2). Conclusions: In HF patients without dementia, severe WMH is a potential risk of CI and predicts poor prognosis.
Abstract 17225: Association Between Moderate and Vigorous Physical Activity on Long-Term Heart Failure Risk: The Cooper Center Longitudinal Study
Authors: Julianna West, Djhenne Dalmacy, David Leonard, Laura Defina, Jarett D Berry
Journal: Circulation (2023)

Introduction: Regular physical activity (PA) is associated with a lower risk of heart failure (HF). However, the relative contributions of moderate and vigorous intensity exercise on HF risk is still unclear. We characterized the association between moderate (MPA) and vigorous physical activity (VPA) on the long-term risk for HF. Methods: We included participants free from baseline coronary disease in the Cooper Center Longitudinal Study (CCLS) who were Medicare eligible at age 65 years. PA was measured from a self-report instrument that included duration (minutes/week) and intensity of exercise (METs), with moderate intensity as 3-6 METs and vigorous intensity as 6 METs. Incident HF was defined as a HF hospitalization event (primary diagnosis) from Medicare claims files. MPA and VPA were considered separately as continuous variables. The association between baseline PA and incident HF was evaluated by Cox proportional hazards models adjusted for standard HF risk factors. Results: Of 32,322 individuals (mean age 50.9, 74.2% men), the mean number of hours/week of MPA and VPA was 1.2 and 1.4, respectively. 56.42% reported zero MPA and 42.6% reported zero VPA. Higher levels of VPA, but not MPA, were associated with a lower burden of HF risk factors. After 275,373 person-years of follow-up, we observed 954 incident HF hospitalizations. MPA was not significantly associated with HF risk in either model. VPA was inversely associated with HF risk in age-adjusted models. After multivariable adjustment, VPA was not associated with HF risk (see table). Conclusions: Midlife VPA, but not MPA, was associated with a lower risk for HF. However, after additional adjustment for traditional HF risk factors, the association between higher VPA and HF risk was no longer significant. These findings suggest that the inverse association between midlife VPA and long-term HF risk may be mediated by a more favorable risk factor profile.
Abstract 17131: Association of Objectively Measured Sleep With 6-minute Walk Distance in Older Adults
Authors: Swaty Chapagai, Katharine Harrington, Shaina Alexandria, Thanh-Huyen T Vu, Sadiya S Khan, Mercedes R Carnethon, Kristen Knutson
Journal: Circulation (2023)

Background: Decline in physical function in older adults is associated with higher risk of cardiovascular diseases. While disturbances in sleep may contribute to declines in physical function with aging, prior research is limited by the use of subjective sleep measures. Hypothesis: Older adults with sleep disturbance will have impaired functional capacity measured via 6-minute walk test. Aim: This study aimed to examine the association between objectively measured sleep parameters and 6-minute walk distance (6MWD), a marker of functional capacity, in a diverse sample of older adults aged ≥55 years. Methods: This analysis included 96 participants who were enrolled in the Disparities in Sleep and Cognitive Outcomes (DISCO) study, a prospective cohort study of older adults with objective measurement of sleep and functional capacity. Sleep duration (minutes), efficiency (%), and fragmentation (%) were measured using 7 days-wrist actigraphy. Sleep stages including non-REM stage 3 (N3) duration (minutes) and REM duration (minutes) were measured using an overnight home sleep monitor. Total distance (meters) completed in 6-minutes was the primary outcome. Covariates included age, sex, race, ethnicity, body mass index, smoking status, and pain/ inflammation. Linear regression models were used for analysis. Results: Mean age of participants was 69.1 ± 5.4 years (range 56-82 years), 69.8% were women, 72% were White and 97% were Non-Hispanic/Latino. The average 6MWD was 495.6 ± 87 meters. Sleep duration, N3 duration, and REM duration were not statistically associated with total distance walked. In the fully adjusted models, higher sleep efficiency was associated with higher total 6MWD (p&lt;0.001), and greater sleep fragmentation was associated with lower total 6MWD (p=0.016) (see Table 1). Conclusions: Less favorable sleep quality, as indicated by lower sleep efficiency and more fragmented sleep, was associated with poorer functional capacity in older adults.
Abstract 15292: The Association Between High Serum Uric Acid Level and New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting
Authors: Yilin Pan, Linqi Liu, Kun Hua, Xiubin Yang
Journal: Circulation (2023)

Introduction: Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, increasing stroke risk, morbidity, and mortality. At present, the specific pathogenesis of POAF remains to be fully elucidated. Though the potential impact of uric acid on atrial fibrillation has been suggested, the relationship between serum uric acid (SUA) levels and POAF in patients undergoing coronary artery bypass graft surgery (CABG) remains unclear. Hypothesis: This study investigates the potential association between SUA levels and the incidence of POAF in patients who have undergone CABG. Methods: We conducted a retrospective, observational cohort study (NCT05888168) that included 16,682 patients who underwent CABG at Beijing Anzhen Hospital from January 2018 to December 2021. Patients with a previous history of atrial fibrillation or requiring concomitant cardiac surgery were excluded. A cox regression model was used to determine predictors of POAF, with confounding variables adjusted via multivariable adjustment, inverse probability of treatment weighting, and propensity score matching. Results: The analysis encompassed 12,293 patients. SUA level values were 328 [273.6, 389.9] μmol/L and high SUA level (≥370μmol/L) were found in 3919 (31.88%) patients. The incidence of POAF was significantly higher in patients with high SUA level compared to those without (32.69% versus 29.53%, P&lt;0.001). High SUA level was associated with an increased hazard ratio (HR) of POAF (HR [95%CI]: 1.21 [1.13-1.30]). These results were confirmed through inverse probability of treatment weighting and propensity score matching analyses. Conclusions: High SUA level is predictive of POAF in CABG patients, even after adjusting for age, sex, cardiovascular risk factors, medical therapy, echocardiographic parameters, and laboratory markers.
Abstract 18252: Comparison of an Artificial Intelligence Heart Failure Detection Model and Clinical Prediction Models in Patients With Heart Failure With Preserved Ejection Fraction (HFPEF)
Authors: Ashley P Akerman, Nora Al-Roub, Constance Angell-James, Rasheed Thompson, Lorenzo Bosque, Will Hawkes, Hania Piotrowska, Paul Leeson, gary woodward, Ross Upton, Jordan B Strom
Journal: Circulation (2023)

Background: An artificial intelligence (AI) model to diagnose heart failure (HF) with preserved ejection fraction (HFpEF) based on deep learning of echocardiographic (TTE) images could improve under-recognition of disease. However, the diagnostic accuracy in high-risk patients, compared to existing clinical prediction models, remains uncertain. Methods: In this retrospective case-control study, we identified patients who received routine TTE at Beth Israel Deaconess Medical Center, Harvard Medical School. Cases were defined by presence of ICD-10 codes for HF (I50.X), LVEF≥50%, and grade II or III diastolic dysfunction. Controls were defined by absence of HF within 1 year of the index TTE. The discriminatory performance of an AI HFpEF model (EchoGo Heart Failure, Ultromics Ltd.) was compared to the clinical H2FPEF score. Results: Both cases (n=213, 75±12 years, 53% female, 29.4±7.1 kg/m2) and controls (n=226, 75±13 years, 54% female, 27.0±5.6 kg/m2) were high-risk for HFpEF, with high rates of hypertension, atrial fibrillation, diabetes, coronary artery, kidney, and pulmonary disease. The H2FPEF score demonstrated high sensitivity (mean [95% CI]; 97.3% [94.3, 100%]) and modest specificity (38.1% [25.9, 55.9%]). The AI HFpEF model had similar sensitivity (88.8% [84.0, 93.4%]) and slightly improved specificity (55.6% [47.7, 64.0%]). In the 265 patients (60.4%) with non-diagnostic H2FPEF scores, the AI HFpEF model successfully classified 144 patients as probable HFpEF ( Figure ). The H2FPEF score identified 31 (54.5%) whereas the AI HFpEF model identified 45 (78.9%) HFpEF patients who were hospitalized within 1 year of the TTE. Conclusions: An AI model to detect HFpEF improves upon identification of HFpEF amongst high-risk individuals, thus potentially improving the capacity to identify patients who might benefit from treatment.
Abstract 18814: Glycoprotein VI is Critical for the Detection and Progression of Abdominal Aortic Aneurysms
Authors: Tyler W Benson, Mindy M Pike, Anthony Spuzzillo, Sarah Hicks, Michael Pham, Rohan Bhandari, Seth Brunner, Caris Wadding-Lee, Kelsey Conrad, Hannah Russell, Taylor Coughlin, Anu Aggarwal, Sean Lyden, Kevin Mani, Martin Gustaf Bjorck, Anders Wanhainen, Doran S Mix, Loren Lipworth, Cassianne Robinson Cohen, Sharon Shim, Todd I Edwards, Michael Tranter, Elizabeth Gardiner, Nigel Mackman, Scott J Cameron, A. Phillip Owens
Journal: Circulation (2023)

Objective: Abdominal aortic aneurysms (AAA) frequently feature the formation of a nonocclusive intraluminal thrombus (ILT) along the site of aortic dilation. Platelets are known to maintain hemostasis and propagate thrombosis through several redundant activation mechanisms, yet the role of platelet activation in the pathogenesis of AAA associated ILT is still poorly understand. Thus, we sought to investigate how platelet activation via the glycoprotein VI (GPVI) platelet receptor impacts the pathogenesis of AAA. Methods and Results: RNA sequencing of age-matched control human aortic tissue, AAA aortic tissue, and AAA ILT demonstrates that platelet transcripts comprised 25% of significantly enriched genes AAA thrombus compared to AAA tissue and control aortic wall, with GPVI increased by 9.1 Log2-FC (P = 3.21E -08 ). Examination of soluble GPVI (sGPVI), a specific marker of platelet activity, in 2 independent AAA patient cohorts is predictive of AAA case status, associates strongly with aneurysm growth rate, and better predicts the presence of a fast-growing AAA when compared to D-dimer. To determine if GPVI blockade ameliorates AAA progression, mice were subjected to either the angiotensin II (AngII) infusion or the topical elastase models of aneurysm formation. Following model initiation, aortic diameter was monitored by weekly ultrasounds. After two weeks, mice which developed an aneurysm (defined as an aortic diameter of &gt;1.2mm) were randomized into control (IgG-50μg) or treatment (JAQ1-50μg, monoclonal GPVI antibody) groups. Treatment with JAQ1 blunted GPVI mediated platelet activation, attenuated aneurysm progression, and increased survival in both murine AAA models versus control. Conclusions: The highly specific platelet activation biomarker soluble glycoprotein VI strongly predicts both AAA case status and growth rate with potential use in identifying high risk patients. Specific blockade of GPVI-mediated platelet activation attenuates progression of established aneurysms in two independent murine models. Thus, our work demonstrates that specific targeting of GPVI to blunt platelet activation in AAA could be a potential therapeutic for a pathology with no current pharmacological treatments.
Abstract 13323: Impact of an Institutional Process Change Adopting End-Systolic Coronary CTA Acquisition on Patient Throughput and Image Quality
Authors: Nisha Hosadurg, Kara Harrison, Patricia Rodriguez, Amit Patel, Patrick Norton, Todd C Villines
Journal: Circulation (2023)

Introduction: Prospective ECG-triggered end-systolic coronary computed tomographic angiography (CCTA) acquisition is less prone to motion artifacts with arrhythmias and high heart rates, and with increasing utilization, has the potential to improve scan and CT laboratory efficiency by reducing the need for IV/oral beta-blockers (BB) prior to the scan. Methods: We implemented an institutional process change in CCTA performance effective January 2023, transitioning from prospective ECG-triggered mid-diastolic acquisitions supervised by a physician at the scanner to an algorithmic approach with prospective end-systolic acquisition (200-400 ms after R peak) without BB administration, all on 3 rd -generation 192 slice dual-source scanners. We reviewed 100 consecutive CCTAs done pre- and post-process change in Jan 2022 and Jan 2023. Two experienced CCTA readers assessed segmental image quality by consensus using an 18-segment SCCT model on a 5-point Likert scale (1=non-interpretable; 2=poor; 3=satisfactory; 4=good; 5=excellent). Results: Post-process change, median overall patient appointment [94 (78 - 127) min vs. 69 (53 - 86) min; P &lt; 0.001] and scan times [12 (10 - 16) min vs. 7 (6 - 9) min; P &lt;.001] were significantly lower, and patient throughput doubled [2 (2 - 3)/day vs. 4 (3 - 6)/day; P =.024]. Median segmental image quality score decreased from excellent to good [5 (4 - 5) vs. 4 (4 - 5); P &lt;.001], with a decrease in signal-noise ratio [23.5 (18 - 28.8) vs. 11.8 (8.7 - 14.7); P &lt;.001], and no significant difference in poor or non-interpretable segments in the end-systolic cohort. More scans were repeated with end-systolic scans (10% vs. 18%), with no significant change in radiation dose (Table 1). Conclusion: Utilizing prospective ECG-triggered end-systolic acquisition avoided the use of BB, significantly reduced scan times, doubled patient throughput, at similar radiation doses, and maintained diagnostic performance with only a mild compromise in image quality.