tbuckley/cabot-search huggingface dataset:
Abstract 4141497: Left ventricular diastolic function by echocardiography is related to extracellular volume and is an independent predictor of mortality in patients with aortic regurgitation
Authors: Hossam Lababidi, Maan Malahfji, Edward Graviss, Dipan Shah, Sherif Nagueh
Journal: Circulation (2024)

Background: Cardiac catheterization along with cardiac biopsy studies have shown the presence of abnormally increased left ventricular (LV) chamber stiffness in patients with severe aortic regurgitation (AR) and its significant correlation with interstitial fibrosis. LV diastolic dysfunction (DD) is associated with increased mortality in several patient populations. However, there is a paucity of data on the association of DD with mortality in patients with AR. Hypotheses: 1 - LV DD is related to extracellular volume (ECV), imaging marker of interstitial fibrosis, by cardiac magnetic resonance imaging (CMR) 2 - LV DD by echocardiography is associated with mortality in patients with AR Methods: We studied patients with moderate or greater AR who underwent echocardiographic and CMR imaging within 12 months. We excluded patients with concomitant valve disease, prior valve intervention, cardiomyopathy deemed unrelated to AR, congenital heart disease and terminal conditions. The primary outcome was all-cause death. CMR was used to obtain LV volumes, EF and mass, AR severity, scar extent by delayed hyperenhancement, and ECV. DD was assessed by comprehensive echocardiography. Results: The study included 323 patients. Mean age was 61.9 ± 16.0 years and 22% were female. Median follow-up was 3.8 years, during which 65 patients died and 172 had aortic valve replacement. Median LV EF was 56 (47-65) %, AR volume on CMR was 40 (30-61) mL, and AR fraction was 40 (33-47) %. ECV progressively increased with higher grades of LV DD (Figure 1). Table 1 shows the univariate associations with mortality in the study. On multivariable analysis based on the Lasso variable selection process, Euroscore, Charlson comorbidity index, DD grade, and RAP were associated with total mortality. Conclusion: ECV by CMR progressively increases with higher grades of DD by echocardiography, and DD is independently associated with mortality in patients with AR.
Abstract Sa1107: Resuscitation of Lungs after Cardiac Arrest with Ex-Vivo Lung Perfusion: A Bench Study to Minimize Ventilator-Induced Lung Injury through Flow Modulation
Authors: Michiel Stiers, Joris Guldentops, Tom Schepens, Jan Vercauteren, Cornelia Genbrugge, Olivier Hoogmartens, Benoit Marinus, Arne Neyrinck, Marc Sabbe
Journal: Circulation (2024)

Introduction: Lung donation after uncontrolled circulatory death (uDCD) following a witnessed cardiac arrest is feasible after resuscitation and assessment with ex vivo lung perfusion (EVLP). This bench study explores the efficacy of expiratory flow modulation in minimizing damage caused by mechanical power during volume-controlled ventilation within the EVLP procedure. Methods: Donor lungs were simulated using the ASL 5000 lung simulator (IngMar Medical) and ventilated in volume-controlled mode using the ViX-ventilator (KU Leuven), set at 7 breaths per minute with a positive end-expiratory pressure of 5 cmH 2 O. (Figure 1) Baseline measurements were obtained to deliver tidal volumes (VT) of 300, 400, and 500 mL. These measurements were then compared to an intervention where expiratory flow was modulated using an in-house designed device, the flow modulator. Mechanical power (J/min) was calculated using the pressure-volume curve. Differences in power between the baseline and various levels of flow modulation were assessed using a one-sided t-test. Results: No clinically relevant differences were observed in VT delivery between baseline settings and during expiratory flow modulation. (Table 1) However, significant differences in mechanical power were noted between baseline and flow modulation across the three VT settings (p&lt;0.001). The reduction in power varied from 10.9% to 58.5%, depending on the selected VT and the degree of flow modulation applied. Notably, the extent of power reduction increased with the level of flow modulation. Conclusion: Flow modulation in the expiratory circuit during volume-controlled ventilation in a bench set-up does not affect VT delivery and can significantly reduce mechanical power by up to 58.5%. This reduction in mechanical power could potentially reduce iatrogenic damage during EVLP. Consequently, this might extend preservation times and improve the resuscitation outcomes of uncontrolled DCD lungs. Emergency medicine has the opportunity to leverage this vital pool of donor lungs, moving towards a future with minimal transplant waitlists.
Abstract 4139199: Quantifying the Burden of High Polygenic Risk for Cardiometabolic Disease in a US-based Healthcare System Biobank
Authors: Anika Misra, Buu Truong, Catherine Spinks, Sara Haidermota, Emma Perez, Shaan Khurshid, Tiffany Bellomo, Krishna Aragam, Akl Fahed, Anna Lewis, Whitney Hornsby, Patrick Ellinor, Matthew Lebo, Elizabeth Karlson, Pradeep Natarajan, Aniruddh Patel
Journal: Circulation (2024)

Background: Healthcare systems are increasingly collecting genotype data on patients. Polygenic risk scores (PRS), which quantify inherited risk of a given disease, have the potential to leverage this data to identify high risk individuals. While PRS for single traits have often been evaluated, the same data can be used to calculate PRSs across traits and evaluate the overall burden of high cardiometabolic polygenic risk using a single test. Methods: We examined the association of cardiometabolic PRS from the Polygenic Score Catalog among 236,393 All of Us (AoU) participants for 6 target traits of interest, using all available PRS for coronary artery disease (CAD; 57 PRS), atrial fibrillation (AF; 30 PRS), heart failure (HF; 9 PRS), type 2 diabetes mellitus (T2DM; 133 PRS), venous thromboembolism (VTE; 9 PRS), and thoracic aortic aneurysm (TAA; 2 PRS). PRSMix is a tool that incorporates information across several PRS for a given trait to improve prediction accuracy for a target population. We generated a PRSMix for each trait and externally benchmarked its performance against individual PRS in the Mass General Brigham Biobank (MGBB). Phenotypes were ascertained using hospital diagnosis and procedural codes. Logistic regression was performed, adjusting for age, sex, and the first 10 principal components of inferred genetic similarity. Results: Of the 53,306 genotyped MGBB participants, 55.6% are female, mean enrollment age is 53 ± 17 years. Each trait-specific PRSMix demonstrated generally stronger associations with the target trait compared to any individual contributing score. This included trait-specific PRSMix associations (OR/SD, [95%CI]) of 2.07 [1.99-2.15] for CAD, 1.88 [1.82-1.95] for AF, 1.47 [1.43-1.51] for HF, 2.07 [2.00-2.14] for T2DM, 1.43 [1.39-1.47] for VTE, and 1.40 [1.34-1.46] for TAA. Findings were consistent across inferred genetically similar ancestry groups, with stronger PRSMix associations for CAD detected in the EUR group (2.14 [2.05-2.22]) compared to the AFR group (1.43 [1.21-1.70]). Approximately 37% of people in MGBB have 3-fold greater risk of at least one cardiometabolic disease, with 22% at risk for CAD, 14% for T2DM, 13% for Afib, 3% for VTE, 2% for HF and &lt;1% for TAA. Conclusion: We developed PRSMix scores for cardiometabolic traits in AoU and validated them in MGBB. We identified 37% of biobank participants with at least 3-fold greater disease risk associated with high polygenic scores for at least one cardiometabolic outcome.
Abstract 4140130: Association of Depression and Anxiety with Coronary Plaque: The Miami Heart Study (MiHeart)
Authors: Tanvi Bafna, Omar Dzaye, Zeina Dardari, Miguel Cainzos, Ron Blankstein, Theodore Feldman, Matthew Budoff, Jonathan Fialkow, Khurram Nasir, Michael Blaha
Journal: Circulation (2024)

Introduction: The prevalence of psychological disorders have been increasing, especially since the COVID-19 pandemic. Multiple mechanisms such as medication nonadherence, negative coping behaviors, and systemic inflammation may mediate the potential effects of depression and anxiety on atherosclerosis. Question: Is there an association of depression or anxiety with the presence of plaque assessed by coronary computed tomography angiography (CCTA) among adults free of clinical coronary artery disease (CAD)? Aim: We aim to examine the association of psychological factors with CCTA-based plaque, as they may be key targets for prevention and CCTA could be considered for enhanced risk characterization. Methods: This cross-sectional study analyzed baseline data from the community-based Miami Heart Study (MiHeart). Depression was assessed by the Patient Health Questionnaire 8-item scale with a score ≥10 indicating binary depression. Anxiety was assessed by the Generalized Anxiety Disorder 7-item questionnaire with a score ≥10 demonstrating binary anxiety. The outcome was the binary presence of any plaque on CCTA. Multivariable logistic regression models were adjusted for potential confounders and clinically relevant risk factors. Sensitivity analyses further examined the severity of depressive symptoms, severity of anxiety symptoms, individuals with either depression or anxiety, and individuals with both depression and anxiety as predictors of coronary plaque. Results: Of the 2,356 individuals (mean age 53.4±6.8 years), 50.4% were men and 47.1% were of Hispanic ethnicity. Depression and anxiety were reported in 143 (6.1%) and 224 (9.5%) of individuals, respectively. CCTA-identified plaque was present in 49.0% of participants with depression and 54.0% of those with anxiety, and plaque presence did not significantly differ when compared to those without depression or without anxiety, respectively. There were no significant associations between depression and plaque (adjusted odds ratio [aOR]: 1.03; 95%CI [0.70, 1.52]; p=0.891) or between anxiety and plaque (aOR: 1.27; 95%CI [0.93, 1.73]; p=0.138) in all regression models. On sensitivity analysis, there were also no statistically significant associations found. Conclusion: Our study found no association of depression, anxiety, their combination, or their severity with coronary plaque on CCTA in asymptomatic adults. To our knowledge, this is the first large study on this topic utilizing CCTA data in a U.S. population.
Abstract 4143264: A Case of Spike-on-T Phenomenon and Polymorphic Ventricular Tachycardia
Authors: Brittany Tran, Harun Thimmiah, Lawrence Rosenthal
Journal: Circulation (2024)

Background: R-on-T phenomenon occurs when an electrical stimulus is delivered at a critical point during ventricular repolarization. This can initiate ventricular arrhythmias like polymorphic ventricular tachycardia (PMVT). We describe a case of ventricular pacemaker spikes delivered on the T wave causing PMVT. Case: A 53-year-old female with CAD s/p stent, postpartum cardiomyopathy s/p Bi-V CRT-D (Boston Scientific G124), and paroxysmal atrial fibrillation presented for elective endoscopy and colonoscopy to evaluate her dysphagia and abdominal pain. Her CRT-D was reprogrammed from DDD pacing with lower rate limit (LRL) 50 bpm to an asynchronous Bi-V DOO mode at 50 bpm (‘electrocautery mode’) for the procedure (tachy therapy disabled). Her LV-RV offset was 40 msec. Prior to receiving sedation or medications, she was found unresponsive. Telemetry showed Spike-on-T phenomenon which initiated PMVT. She was externally defibrillated with 200J and received magnesium and an IV amiodarone bolus. She returned to sinus rhythm, but one minute later had another Spike-on-T event initiating PMVT. She was successfully defibrillated with 360J. Post-shock EKG showed an asynchronous Bi-V paced rhythm at 50 bpm. Decision Making: The patient was admitted to the CCU for post-resuscitation care. Her electrolytes and cardiac enzymes were unremarkable. Her CRT-D was reprogrammed to DDD 80-140 bpm. Transthoracic echocardiogram showed normal biventricular systolic function. Cardiac catheterization did not show obstructive CAD. After reprogramming of her device, she had no further events. After initial treatment with IV amiodarone load, she was discharged home on oral magnesium gluconate. Discussion: The only intervention prior to her procedure was device reprogramming (DDD 50 bpm to DOO 50 bpm). Telemetry showed pacer spikes initiating PMVT. Given the LV-RV offset of 40 msec, she would have received these two tightly coupled pacemaker spikes in an asynchronous mode, in this unfortunate instance during her T wave. While her bowel preparation may have led to electrolytes abnormalities, post-resuscitation electrolytes were normal. Fortunately, she received prompt therapy and was reprogrammed with increased LRL. Conclusion: We described a case of Spike-on-T PMVT prior to colonoscopy without obvious provocation other than asynchronous pacemaker spikes. Reprogramming devices in DOO mode with increased LRL may prevent PVCs and asynchronous pacemaker spikes from triggering PMVT.
Abstract 4112931: The Nature of Collagen Cross-links Differs in Reversibly and Irreversibly Infarcted Myocardium
Authors: Eman Akam-Baxter, David Bergemann, Sterling Ridley, Samantha To, Brittany Andrea, Brianna Moon, Hua Ma, Peter Caravan, Juan Manuel Gonzalez-Rosa, David Sosnovik
Journal: Circulation (2024)

Background: Persistent scarring after myocardial infarction (MI) is a major driver of heart failure in mammals. However, unlike mammals, zebrafish exhibit a remarkable ability to resorb scar, which consists predominantly of collagen in both species. Aims: We aimed here to develop a toolbox of techniques to characterize the nature of collagen in infarcted mammalian and zebrafish hearts. Specifically, we aimed to characterize the early and late cross-links that form in collagen and determine whether differences in these cross-links exist in zebrafish and mammals. Methods: To characterize the initial oxidation and cross-linking of collagen we developed a novel fluorescent probe (TMR-O) that binds to lysine aldehydes on collagen and inform on the degree of collagen cross-linking. Additionally, we used high performance liquid chromatography (HPLC) to quantify degradation-resistant mature collagen cross-links, such as pyridinoline (Pyd), and its precursor, hydroxylysine. Results: TMR-O imaging revealed similar overall CCL levels in both zebrafish and mouse infarcts. However, the irreversible cross-link pyridinoline (Pyd) was abundant in mouse infarcts but completely absent in zebrafish (p&lt;0.0001). High Pyd levels in mice were accompanied by a dynamic increase in lysine hydoxylation (&gt;200%), which was not observed in zebrafish (&lt;10%). Conclusions: While collagen in mammalian and zebrafish infarcts may appear histologically similar, marked biochemical differences exist. Mature degradation-resistant collagen cross-links, such as Pyd form, in murine but not zebrafish infarcts and likely explains why zebrafish can resorb myocardial scar. Targeting Pyd formation in mammals could pave the way for novel therapeutic strategies to promote scar resolution and improve cardiac function after MI.
Abstract 4141475: Prognostic Impact of Acute Kidney Injury Following Repair of Stanford Type A Aortic Dissection: A Systematic Review and Meta-Analysis
Authors: Aman Goyal, Surabhi Maheshwari, Haleema Qayyum Abbasi, Yusra Mashkoor, Hritvik Jain, Muhammad Daoud Tariq, Urooj Shamim, Mah I Kan Changez
Journal: Circulation (2024)

Background: Acute Kidney Injury (AKI) is a multifactorial complication following repair of Stanford Type A aortic dissection (TAAD) with an alarmingly high incidence, varying from 20 to 77%. Postoperative AKI following life-threatening disease tends to be much more complex. However, the exact role of postprocedural AKI in the prognosis of patients undergoing TAAD repair has not been elucidated. Aims: This meta-analysis aimed to evaluate the prognostic significance of postprocedural AKI in patients undergoing TAAD repair. Methods: A literature search was conducted using PubMed, EMBASE, and SCOPUS databases. The primary endpoint was 30-day mortality with several secondary endpoints. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using Review Manager software. Statistical significance was set at p &lt;0.05. Random-effects meta-analyses were performed for all outcomes. Results: Our analysis included 21 studies comprising 10396 patients. Patients with AKI exhibited a significantly higher risk of 30-day mortality (RR=3.98; 95% CI: 3.04-5.22; p&lt;0.00001; I 2 =57%), stroke (RR= 2.05; 95% CI: 1.68-2.50; p&lt;0.00001; I 2 =32%), dialysis requirement (RR= 32.9; 95% CI: 10.39-104.24; p&lt;0.00001; I 2 =90%) (Figure 1), cardiovascular complications (RR= 2.85; 95% CI: 1.65-4.92; p&lt;0.0002; I 2 =85%), sepsis (RR= 4.92; 95% CI: 2.62-9.24; p&lt;0.00001; I 2 =64%), and re-exploration for bleeding (RR=2.46; 95%CI: 1.79-3.39; p&lt;0.00001; I 2 =58%) compared to those without AKI (Figure 2). Conclusion: Patients with AKI demonstrated a significantly increased risk of mortality, stroke, need for dialysis, sepsis, postoperative cardiovascular complications, and re-exploration for bleeding. Further prospective studies are required to better understand the prevention strategies and long-term effects on prognosis of AKI post-repair for TAAD.
Abstract 4136963: Long-term Effects of Continuous Positive Airway Pressure on Cardiovascular Outcomes after Acute Myocardial Infarction in Obstructive Sleep Apnea Patients
Authors: Jaskiran Khosa, Ahmad Adam, Amina Madhwala, Jane Lin, jiaxiao shi, Dennis Hwang, Jie Ren
Journal: Circulation (2024)

Background: There is increasing evidence of a strong association between obstructive sleep apnea (OSA) and ischemic heart disease. Previous studies have demonstrated OSA to be a significant predictor of incident CAD, while recent studies have confirmed individuals with OSA to have 3.9 times greater incidence of major adverse cardiac and cerebrovascular events (MACCE) at one year following acute myocardial infarction (AMI) than individuals without OSA. Whether treatment with continuous positive airway pressure (CPAP) after AMI in OSA patients reduces MACCE is not known. This study investigated the long-term cardiovascular outcomes associated with CPAP therapy after AMI in OSA patients, and is the first study to evaluate the effect of CPAP on secondary prevention after AMI. Methods: This retrospective study was conducted from 2015 to 2019 and included adults with AMI. Patients with at least moderate OSA (n=180) were followed for at least 1 year and categorized as either AMI and compliant to CPAP (54 patients) or AMI and non-compliant to CPAP (126 patients). We estimated the incidence of MACCE (early rehospitalization, re-catheterization, CABG, recurrent MI, CHF, arrhythmia, stroke, and death) in each group during follow-up from the index event. Continuous and categorical variables were analyzed for significance with Wilcoxon’s test and Fisher’s exact test respectively. Multivariate analyses were performed to adjust for confounders. Results: Most participants were male, the average age was 66 years old, and no significant demographic difference was identified between the two groups. Compared with non-compliant patients, CPAP-compliant patients exhibited significantly lower overall MACCE incidence (22.2% vs 40.5%, p=0.03) and repeat catheterization rate (1.9% vs 11.1%, p=0.04) after AMI. Conclusion: Long-term, compliant CPAP therapy, as compared with non-compliant CPAP therapy, significantly reduces recurrent cardiovascular events and provides effective secondary prevention after AMI in patients with at least moderate OSA.
Abstract 4142768: Association Between Right Ventricular-Pulmonary Arterial Coupling and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction
Authors: Alborz Sherafati, Alex Kloster, Sareeta Manandhar, Anas Fares, Vaishnavi Aradhyula, Prabhatchandra Dube, Ahmed Elzanaty, Omar Sajdeya, XBellaX XKhatib-ShahidiX, catalin dragomirescu, Pamela Brewster, David Kennedy, Rajesh Gupta, Samer Khouri
Journal: Circulation (2024)

Introduction: Right ventricle (RV)-pulmonary artery (PA) coupling reflects functional adaptation of RV to afterload. Impaired RV-PA coupling is associated with worse outcomes in patients with pulmonary hypertension. However, the association between RV-PA coupling and outcomes in patients with heart failure with preserved ejection fraction (HFpEF) is not well established. Objective: To assess the association between RV-PA coupling and outcomes in patients with HFpEF and determine an optimal cutpoint of the TAPSE/RVSP ratio for prediction of adverse events. Methods: Participants with a diagnosis of HFpEF were enrolled at the University of Toledo Medical Center from March 2012 and were followed until August 2023. The ratio of tricuspid annular plain systolic excursion (TAPSE) to right ventricular systolic pressure (RVSP) on echocardiogram was used as a measure of RV-PA coupling. The primary endpoint was death or heart failure hospitalization. ROC analysis was performed to determine an optimal cutpoint point for TAPSE/RVSP. Cox proportional hazards regression model was used to assess the association between TAPSE/RVSP and outcomes. Results: 83 participants (age 68.69 ± 10.72, 67.5% female) with HFpEF and available echocardiogram data were enrolled in the study. The median TAPSE/RVSP was 0.41. Death or heart failure hospitalization occurred in 51 (56.6%) individuals. Using ROC curve analysis, we identified the optimal cutpoint of TAPSE/RVSP of 0.31 which had a sensitivity of 57% and specificity of 88% for predicting mortality (AUC 0.756, 0.622-0.889). TAPSE/RVSP less than 0.31 was associated with higher risk of death or heart failure (HF) hospitalization (HR=2.61, CI=1.28-5.33, p= 0.008), death (HR=3.40, CI=1.34-8.64, p= 0.01), and HF hospitalization (HR=2.45, CI=1.06-5.68, p= 0.03). Conclusion: Worse RV-PA coupling was associated with worse outcomes in individuals with HFpEF. The TAPSE/RVSP cutpoint of &lt;0.31 had a good specificity for prediction of adverse events including death or HF hospitalization.
Abstract 4140134: Impact of Cancer on Outcomes in Patients with Acute Myocardial Infarction; a Systematic Review and Meta-analysis.
Authors: Abhigan Shrestha, Tanzina Afroze, Vikash Jaiswal, Aman Goyal, Anirudra Devkota, Sajina Shrestha, Kripa Rajak
Journal: Circulation (2024)

Background: Cardiovascular diseases are the second leading cause of death among cancer patients, after cancer-related mortality. It has not been well established if a patient's malignancy status increases their risk of cardiovascular events following a myocardial infarction (MI). Hypothesis: This study aims to assess the impact of cancer on cardiovascular outcomes following an acute myocardial infarction. Methods: We systematically searched electronic databases such as Pubmed, Embase and Cochrane Library from inception until March 2024 using the appropriate Mesh terms, “ cancer,” “myocardial infarction,” and “cardiovascular mortality”, “in-hospital mortality”. Pooled relative risk and their corresponding confidence interval were calculated using the random effect model. A p-value of &lt;0.05 was considered statistically significant. Results: A meta-analysis was conducted with seven articles, with 32856 cancer patients and 520421 noncancer patients with MI. Pooled analysis showed that patients with cancer had to have a significantly higher risk of recurrent MI in (RR 1.49, 95% CI:1.03-1.96), major bleeding (RR 1.96, 95% CI: 1.28-2.64), cerebral infarction (RR 1.29, 95% CI: 1.21-1.38), the in-hospital mortality rate (RR 1.62, 95% CI: 1.04-2.20), cardiovascular mortality (RR 1.57, 95% CI: 1.00-2.13), and hospitalization due to heart failure (RR 1.51, 95% CI 1.46, 1.56) when compared with noncancer patients. Conclusion: This study shows that cancer is strongly associated with an increased risk of recurrent MI, major bleeding, cerebral infarction, hospital mortality, cardiovascular mortality, and hospitalisation due to heart failure in patients with acute MI. Proper monitoring of cardiac function and lab markers can be effective in reducing morbidity and mortality.