tbuckley/cabot-search huggingface dataset:
Abstract 4141178: Papillary fibroelastomas: clinical presentation, anatomical characteristics, and bleeding rates in those undergoing surgical and conservative management
Authors: Hassan Saleh, Ibrahim Khaleel, Morgan Korn, Saleem Alameh, Mitchell Sarkisov, Anthony Dils, David McNamara
Journal: Circulation (2024)

Papillary fibroelastomas (PFEs) are benign cardiac tumors, most commonly arising on left sided heart valves but have been reported on non-valvular structures. Histologically, PFEs are comprised of throngs of an avascular mucopolysaccharide core with an overlying layer of endothelial cells. While PFEs carry no inherent malignant potential, the risk of embolization poses a unique challenge to clinicians. Case series exist describing the anatomical characteristics of PFEs, though as echocardiography has become more ubiquitous and imaging quality has dramatically improved, little contemporary data exists on the patient characteristics, management techniques employed, and outcomes. Our objective was to describe a quaternary center’s experience with PFEs. A single quaternary center, retrospective case review of patients with a diagnosis of cardiac tumor between Janurary 1 2008 and Janurary 30 2024, using ICD codes D15.1 and I42.4, resulted in 410 patients. Using chart review, 80 of the 410 patients had a suspected diagnosis of PFE based on TEE or TTE characteristics. We then performed a retrospective analysis of the 80 patients. Of the 80 patients, 47 underwent surgical resection, 5 roboticly, with no evidence of PFE on subsequent TTE. The median age at time of diagnosis was 67.7 +/- 13.8 years. 35 patients had a diagnosis of stroke any time prior to PFE identification. The most common indication for the diagnostic echocardiogram was arterial emboli. Valvular PFEs were commonly found on the upstream aspect of valves (55.9%) and most commonly located on the aortic valve (63.8%). Of the 27 patients with a diagnosis of stroke and PFE size data, 20 had a PFE &gt;/= 5 mm. In the non-surgical group 7 were on P2Y12 inhibitor or therapeutic anticoagulation for the indication of PFE. Within 3 years there was 1 mortality in the surgical group and 6 in the non-surgical group. In the non-surgical group 15.2% were hospitalized for bleeding at 3 years verse 6.25% in the surgical group. While PFEs have been previously characterized in case series, there remains a scarcity of literature on their clinical presentation and management techniques. This single center case series demonstrates an association between PFEs and arterial embolic events with low three-year mortality. There may be a relation to PFE size and stroke as stroke was more common in those with a PFE &gt;/= 5mm. Additional studies evaluating PFE characteristics and treatment strategies are necessary to guide PFE management.
Abstract 4141539: Impact of Left Ventricular End-Diastolic Diameter on the Prognosis in Patients with Atrial Fibrillation and Acute Coronary Syndrome or Undergoing PCI
Authors: Wei Xu, Yan-min Yang
Journal: Circulation (2024)

Introduction: Atrial fibrillation (AF) is a common cardiac arrhythmia, the risk of cardiovascular adverse outcome rises when it coexists with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). Studies have shown that an increased left ventricular end-diastolic diameter (LVEDD) is associated with worse outcomes in various cardiovascular conditions, including heart failure, and coronary artery disease (CAD). In patients with AF, an enlarged LVEDD may indicate underlying left ventricular dysfunction and structural heart disease, which could potentially predispose to myocardial fibrosis if patients are combined with ACS. Therefore, it is essential to research the impact of LVEDD on the prognosis of patients combined with AF and ACS or PCI. Hypothesis: We hypothesized that LVEDD could be a risk factor for adverse outcomes in AF patients with ACS/PCI. Aims: This study aimed to explore the impact of LVEDD on the major adverse cardiovascular events (MACEs) in patients with AF and ACS or undergoing PCI. Methods: This study consecutively included a total of 2,182 patients with atrial fibrillation combined with ACS or undergoing PCI from 2017 to 2019. The primary endpoint was MACEs, which represented a composite event of all-cause death, stroke, systemic embolism, and massive hemorrhage. Results: The 2,182 patients were divided into two groups: LVEDD＞60mm group (n=370) and LVEDD ≤60 mm group (n=1812). During a median follow-up of 36 months, patients in LVEDD＞60 mm group had a higher incidence of MACEs ( 39.7% vs. 26.0%), Compared with the LVEDD ≤60 mm group. The Kaplan-Meier curves (Figure 1) compared by the log-rank test showed that patients with LVEDD＞60 mm were associated with a higher risk of MACEs (P＜0.001). In Table 1, LVEDD as a continuous variable and LVEDD＞60 mm was independently associated with increased risk of MACEs after adjusting age, sex, BMI, AF type, CAD type, PCI, coronary artery bypass graft, prior myocardial infarction, prior heart failure, prior hypertension, prior diabetes mellitus, troponin I, antiplatelet drugs, anticoagulant drugs, statins in Model 3. The restrictive cubic spline in Figure 2 showed that LVEDD greater than 60 mm increased the risk of MACEs. An LVEDD less than 60 mm seemed to be safe for such patients. Conclusions: LVEDD can be a predictor for MACEs in patients with AF combined with ACS or undergoing PCI. Furthermore, left ventricular dilation indicates a worse prognosis for these patients.
Abstract 4141570: In-hospital cumulative exposure of inflammation reflect the prognosis of patients with myocardial infarction with nonobstructive coronary artery disease
Authors: Sizhuang Huang, Mengyue Yu, Yanwen Fang, Hanyang Liang
Journal: Circulation (2024)

Background: Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is a special syndrome with clear evidence of myocardial ischemia, but no clear stenosis of coronary artery imaging sign. Inflammation is closely related to the prognosis of such diseases. This study focuses on the correlation between cumulative exposure of inflammation during the hospital stay period and the prognosis of MINOCA patients. Methods: This study was a single-center, prospective cohort study. Patients who underwent coronary angiography and diagnosed with MINOCA in Fuwai Hospital from January 2015 to December 2019 and met the inclusion criteria were enrolled. We mainly explored the correlation between the in-hospital cumulative exposure of inflammation (calculated as the area under the highly sensitive CRP(mg/L)-time(days) curve) and long-time outcomes of MINOCA.Patients had their blood hsCRP levels tested at least twice during their hospital stay. Kaplan-Meier analyses and Cox regression analyses were performed to evaluated survival rate of patients and hazard ratio during a 77.2-month follow-up. ROC analyses were also adapted in this study to detect the best cut-off value for Results: A total of 890 MINOCA patients were enrolled, including 148 (16.6%) with major adverse cardiovascular events (MACEs). Patients in higher quartile group of cumulative exposure to inflammation had an apparently higher rate of MACE during the follow-up time. After adjusted for multiple clinically relevant variables, higher cumulative exposure of inflammation was still associated with an increased risk of MACE (HR=1.79; 95% CI: 1.08-2.92 P&lt;0.001). Moreover, AUC of hsCRP(mg/L)-time(days) had an AUC of 0.72 for MACE prediction with the best cut-off value of 6.36mg*L -1 *d, higher than that of peak hsCRP (AUC 0.64). Conclusions: Inflammation is closely related to the development of disease and adverse events in patients with MINOCA. Cumulative exposure of inflammation during the hospital stay period have better predictive value than single peak-hsCRP index. Routine assessment of hsCRP and AUC of hsCRP-time data may help this specific population benefit from the prognostic information or even guiding the timely initiation of anti-inflammatory treatment.
Abstract 4140796: Association Between the Severity of Coronary Artery Stenosis with the Minimum Responsive Dose of Intracoronary Acetylcholine Provocation Test
Authors: Seung-Woon Rha, Woo Jin Ahn, sujin hyun, Jinah Cha, Se Yeon Choi, Byoung Geol Choi, Markz Sinurat, Soohyung Park, Cheol Ung Choi, Chang Gyu Park, Dong Oh
Journal: Circulation (2024)

BACKGROUND: Coronary artery spasm (CAS) is a cause of variant angina and is typically diagnosed by intracoronary acetylcholine (ACH) provocation test. Investigations regarding association between the severity of coronary artery stenosis and the minimum responsive dose of ACH required for provocation is limited. METHODS: In this study, 3,915 patients who underwent the acetylcholine (ACH) provocation test and showed CAS between October 2004 and December 2022 were enrolled. Significant CAS was defined as temporary narrowing of ≥70% during the ACH test. Patients were divided into three groups, based on the minimum responsive dose of ACH: A1 group (20ug, n=227), A2 group (50ug, n=1,366) and A3 group (100ug, n=2,322). RESULTS: In patients who were documented with positive intracoronary ACH provocation test, 5.8% responded at the lowest dose (20ug), 34.9% responded at the medium doses (50ug) and 59.3% responded only at the highest dose of ACH (100ug). The baseline characteristics of the patients among the 3 groups were similar, demonstrating no significant difference in the prevalence of hypertension, diabetes mellitus, and dyslipidemia. However, patients who responded at lower dose showed higher proportion of smokers (A1 37.9% vs. A2 35.7% vs. A3 31.0%, p=0.004). A1 group demonstrated the highest proportion of severe stenosis (63.0%), followed by A2 group (60.1%) and A3 group (47.4%) (Figure 1). CONCLUSION: In patients with chest pain with positive intracoronary ACH provocation test, severe stenotic lesions were found to be more frequent and more susceptible in patients who responded at lower doses of ACH.
Abstract 4141636: Ventricular Arrhythmia Risk in Repaired Tetralogy of Fallot: Implications of Prior Pulmonic Valve Interventions
Authors: Mark Sonderman, Bryce Johnson, Graham Bevan, Rosemary McDonagh, Andrew Pistner, Eric Krieger, Nazem Akoum, Neal Chatterjee, Melissa Robinson, Babak Nazer
Journal: Circulation (2024)

Background: Ventricular tachycardia (VT) is common in adult patients with repaired Tetralogy of Fallot (rTOF). The majority of VT originates from 1 of 5 arrhythmogenic slowly conducting anatomic isthmuses (SCAI) that exist between non-conducting anatomic and surgical borders. Catheter and surgical ablation of spontaneous VT, as well as of inducible VT at time of risk stratification electrophysiologic study (EPS), frequently target SCAI. The effects of prior pulmonary valve (PV) interventions on the prevalence of SCAI is unknown. Aims: We sought to quantitate differences in the prevalence of SCAI and VT inducibility based on prior PV interventions. This may help identify patients more or less likely to benefit from risk stratification EPS. Methods: We compared patients with rTOF who underwent EPS with electroanatomic mapping for either clinical history of spontaneous VT (n=22) or risk stratification (n=60). Patients were divided in 4 groups based on presence of: RV-PA conduit, prior surgical PV replacement, prior transcatheter PV replacement, or no PV intervention after initial repair. We described the presence of SCAI, VT inducibility prior to ablation, and rates of ablation success among patients in these groups. Results: SCAI were more frequently identified in patients undergoing VT ablation than risk stratification (91% vs 53%, p=0.004). Among risk stratification patients, SCAI were present in 37% of patients with prior PV interventions versus 66% of patients without (p=0.04). Prior RV-PA conduit and surgical PV replacement frequently had dense, inexcitable scar in isthmuses 2-4, but SCAI were still present in 36% of these patients even without a history of VT. There was no significant difference in incidence of pre-ablation VT inducibility (7% vs 15%, p=0.60) or SCAI ablation success (87% vs 96%, p=0.47) between patients with prior PV interventions and those without. Conclusion: Compared with patients with no prior PV interventions, those with prior interventions were less likely to have SCAI due to pre-existing scar in isthmuses 2-4, but SCAI still remained frequent and was ablated successfully at a similar rate. The presence of prior PV interventions should not influence the decision to pursue risk stratification EPS.
Abstract 4140656: Educational Attainment Level and Risk of Mortality and Cardiopulmonary Outcomes in High-Risk Cardiovascular Disease Patients: The INVESTED Trial
Authors: Mats Lassen, Nicholas Howell, Brian Claggett, Tor Biering-Srensen, Orly Vardeny, Scott Solomon, Jacob Udell, Jacob Joseph, Sheila Hegde
Journal: Circulation (2024)

Background: Social determinants, such as educational attainment level (EAL), are indicators of socioeconomic status and have been shown to be inversely related with adverse health outcomes. However, the association between EAL and risk of cardio-pulmonary events in heart failure (HF) and myocardial infarction (MI) survivors has not been extensively investigated. Methods: In the INVESTED trial, 5260 patients from the US and Canada with recent HF or MI hospitalization were randomized 1:1 to high-dose trivalent or standard-dose quadrivalent influenza vaccine from Sep 2016 to Jan 2019. We examined the association between EAL and risk of adverse clinical outcomes for each participant across all enrolling seasons using Cox models adjusted for treatment assignment and clinically relevant confounders and stratified by trial entry year. Participants were categorized by EAL (high school or less [HS], post-high school or trade [post-HS/T], and college or more [Col+]). Results: Of the 4,912 participants (mean age: 65.5 years, 28% females, 80% White, 39% with MI and 61% with HF hospitalization as qualifying event) with EAL information, 43% were in the HS group, 28% were in the post-HS/T group, and 29% were in the Col+ group. At baseline, those with higher EAL were more likely to be White or Asian, be married/with long-term partner, have higher left ventricular ejection fraction, have lower NYHA class, and less likely to have cardiovascular comorbidities and risk factors than those with lower EAL. During follow-up (median: 9 months [6-16]), 1,706 (35%) participants experienced the composite of all-cause death or cardiopulmonary hospitalization. Compared to HS, higher EAL was associated with a stepwise decrease in the risk of the composite outcome (post-HS/T: HR: 0.88 95%CI: [0.79-0.99]; Col+: HR: 0.71 95%CI: [0.63-0.81], overall p-value &lt;0.001). A similar protective effect of higher EAL was observed for additional adverse clinical outcomes ( Figure ). Conclusion: High EAL is independently associated with a decreased risk of adverse clinical outcomes in patients with high-risk cardiovascular disease, highlighting the need to consider EAL in risk assessment and target additional resources towards those with low EAL to improve prognosis.
Abstract 4140887: Impact of Advanced Lung Cancer Inflammation Index on All-Cause Mortality Among Patients With Heart Failure: A Meta-analysis with Reconstructed Time-to-Event Data
Authors: Ahmed Mazen Amin, Ramy Ghaly, Hossam Elbenawi, Ubaid Khan, Abdelrahman Ewis, Khaled S M Elshaer, Mohamed Abuelazm, Basel Abdelazeem, Brijesh Patel
Journal: Circulation (2024)

Background: Heart failure (HF) is associated with systemic inflammation and hypercatabolic syndrome, impacting body metabolism. The advanced lung cancer inflammation index (ALI) is a novel inflammatory and nutritional biomarker. Purpose: We aimed to investigate the prognostic role of ALI in patients with HF. Methods: We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through March 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1. This meta-analysis was registered at PROSPERO (CRD42024535227). Results: We included four studies with 2,247 patients. In the pair-wise meta-analysis, ALI ≤ 25 was significantly associated with an increased incidence of all-cause mortality compared with ALI &gt; 25 (risk ratio [RR] 1.73, 95% confidence interval [CI] 1.36-2.21, P&lt; 0.01). On the adjusted prognostic meta-analysis, higher ALI (&gt;25) was significantly associated with a reduction in the incidence of all-cause mortality (hazards ratio [HR] 0.45, 95% CI 0.35-0.58, P&lt; 0.01). The reconstructed Kaplan Meier showed that ALI &gt; 25 was significantly associated with a 56% reduction in the incidence of all-cause mortality compared with ALI ≤ 25 (HR 0.44, 95% CI 0.38-0.50, P&lt; 0.000001). Conclusion: Among patients with HF, a low ALI was associated with a higher incidence of all-cause mortality rate than those with a high ALI. These findings suggest that ALI can be used for prognostic stratification and aid clinical decision-making in HF management.
Abstract 4140677: Racial disparities in acute type B aortic dissection presentation, management, and outcomes: insights from the International Registry of Acute Aortic Dissection (IRAD)
Authors: Priya Patel, Cole Evans, Kevin Harris, Bradley Taylor, Qing-Guo Li, Eric Isselbacher, Ibrahim Sultan, Anil Bhan, Dan Gilon, Joseph Coselli, Owen Glotzer, Chih Wen pai, William Brinkman, Derek Brinster, Kim Eagle, Marc Schermerhorn
Journal: Circulation (2024)

Background: Racial disparities are known to exist in cardiovascular disease such as acute coronary syndrome and heart failure. However, data are limited in examining possible racial disparities related to aortic dissection due to the rare nature of this disease. Hypothesis: We hypothesize that, among patients presenting with acute type B aortic dissection, racial differences exist in disease severity at time of presentation as well as initial management, in-hospital and long-term outcomes. Methods: Our analysis included white (n = 2517, 80%) and black (n = 629, 20%) patients with acute Type B aortic dissection in the International Registry of Acute Aortic Dissection collected from 62 sites between 1996 and 2024. Other races were excluded given small sample size and limited follow up data. Results: When compared with white patients, black patients were younger (mean age 58 ± 12 years vs 65 ± 14 years, P &lt; .0001), and more likely to have a history of hypertension (94% vs 83%, P &lt; .0001), diabetes (19% vs 11%, P &lt; .0001), chronic kidney disease (18% vs 9.5%, P &lt; .0001), and cocaine use (14% vs 1.6%, P &lt; .0001). Black patients were also more likely to present with abdominal pain (51% vs 43%, P = .003), lower extremity pain (16% vs 11%, P = .018), hypertension (72% vs 61%, P &lt; .0001), renal malperfusion (24% vs 12%, P &lt; .0001), abdominal vessel involvement (58% vs 47%, P &lt; .0001) and pericardial effusion (12% vs 6%, P = .001). Black patients were more likely to undergo endovascular management (40% vs 28%, P &lt; .0001) and less likely to be medically managed alone (49% vs 61%, P &lt; .0001). Prior to any intervention, black patients were more likely to experience stroke (3.3% vs 1.1%, P = .001) and extension of dissection (10% vs 7.2%, P = .028). In-hospital mortality was similar (black 6.5% vs white 8.4%, P = .139). Overall survival was also similar at 4 years post-discharge (black 86% vs white 83%, P = .172). Among patients with endovascular management, black patients had better 4-year survival (93% vs 81%, P = .028). Conclusions: Our analysis shows differences in baseline characteristics, presentation, management, and in-hospital adverse events for black patients presenting with acute type B dissection compared to white patients; however, without any significant difference in in-hospital or 4 year mortality. Future studies may aim to evaluate modifiable risk factors and optimal treatment strategies to reduce the incidence of aortic dissection in black patients.
Abstract 4141553: CD38 Deficiency Increases NAD Levels And Improves Pulmonary Hypertension
Authors: Samisubbu Naidu, Katie Thompson, Haiyang Tang, Eduardo Chini, Ankit Desai
Journal: Circulation (2024)

Background&amp;Hypothesis: Nicotinamide adenine dinucleotide (NAD) is a critical coenzyme, essential for a variety of cellular processes. Pulmonary arterial hypertension (PAH) is associated with impaired metabolism and reduced NAD levels that contribute to its hyperproliferative state. CD38 is an ecto-enzyme that degrades NAD and produces several byproducts including cyclic ADPR. We hypothesized that CD38 mediates pathological reductions in NAD levels contributing to PAH vascular remodeling. Methods: To test this hypothesis, we evaluated expression levels of CD38 across PAH tissues, tested its functional role in human pulmonary artery endothelial cells (PAEC) and smooth muscle cells (PASMCs), and examined the response of a global CD38 knockout mouse ( CD38 -/- ) in an established chronic hypoxic (10% FiO2, 4 weeks) model of pulmonary hypertension. Results: CD38 expression was elevated in human PAECs derived from PAH cases and in rodent whole lung homogenates. Media from PAEC exposed to a CD38 inhibitor (78c) led to reduced PASMC proliferation. CD38 -/- mice exposed to chronic hypoxia exhibited attenuated PH compared to cage controls. Specifically, histological assessment of murine lungs revealed reduced PA medial thickness compared to control. CD38 -/- mice exhibited reduced right ventricular systolic pressure and a corresponding decrease in Fulton Index after hypoxic exposure. Consistent with these results, targeted metabolite measurements revealed that CD38 -/- mice exhibited elevated NAD levels in the lungs. Discussion: These results suggest that CD38 is a novel PAH target, and its deficiency restores NAD levels in the lungs and reduces pulmonary hypertension in mice.