tbuckley/cabot-search huggingface dataset:
Abstract 16623: Extra-Cellular Volume Fraction Analysis on Cardiac CT is Useful for Predicting the Prognosis of Hypertrophic Cardiomyopathy
Authors: Shuhei Aoki, Hiroyuki Takaoka, Kazunari Asada, Makiko Kinoshita, Satomi Yashima, Katsuya Suzuki, Kazuki Yoshida, Haruka Sasaki, Noriko Eguchi, Yoshio Kobayashi
Journal: Circulation (2023)

Introduction: Extra-Cellular volume fraction (ECV) analysis on MRI helps predict ventricular arrhythmia in hypertrophic cardiomyopathy (HCM). But the performance of cardiac MRI takes time, and there are also several contraindications. Cardiac CT is more versatile than cardiac MRI and is also helpful in screening coronary artery disease. We investigated the usefulness of ECV analysis on CT for the prognosis of HCM.Aim: To determine the utility of ECV analysis on CT to predict the prognosis in patients with HCM. Methods: Eighty-five HCM patients who underwent cardiac CT from December 2008 to March 2022 were analyzed. Left ventricular (LV) ECV (LV-ECV) on CT was measured, and we investigated the relationship between LV-ECV on CT and the major adverse cardiac events (MACEs) (cardiac death, fatal arrhythmia, and heart failure hospitalization) after CT. Results: All patients were followed for 69 ± 58 months after cardiac CT and 14 patients (16%) had MACEs. They had a significantly higher LV-ECV and lower ejection fraction (LVEF) than those without MACEs(42.4 ± 8.4% vs. 34.0 ± 7.0%, P=0.003, and (56.7 ± 11.8% vs. 66.7 ± 7.0%, P=0.011). The percentage of dilated phase HCM was significantly higher in the patients with MACEs than those without MACEs (21% vs 0%, p=0.003). LV-ECV was the only significant predictor of MACEs based on the multivariate analysis by Cox proportional hazard model (hazard ratio 1.13, 95% confidence interval 1.06-1.21). The optimal threshold of LV-ECV to predict MACEs was 37.59% based on the receiver operating characteristic analysis. The sensitivity and specificity of LV-ECV to predict MACEs were 79% and 75% at the best cut-off, and the area under the curve was 0.78 (Figure A). The patients with LV-ECV ≥ 37.59% (29 patients) had significantly higher MACEs than those with LV-ECV &lt; 37.59% during the follow-up periods (P &lt;0.001) (Figure B). Conclusion: ECV analysis on CT helped predict MACEs in HCM cases.
Abstract 12411: Fatty Acid Saturation Status in Murine High Fat Diets Modulates Platelet Reactivity
Authors: Maria Barrachina, Isabelle Becker, Daniela Freire, Karen Guo, Thomas Hirsch, Joseph E Italiano, mark puder, Kellie R Machlus
Journal: Circulation (2023)

Introduction: We have recently shown that membrane fatty acids are key modulators of megakaryocyte differentiation and platelet formation. In obesity, patients have an altered plasma lipid composition, which coincides with enhanced platelet responsiveness to activation. However, the mechanism underlying this platelet phenotype remains unknown. Hypothesis: We hypothesized that the obese plasma lipidome alters the composition of the megakaryocyte membrane, which ultimately leads to the generation of hyper-reactive platelets. Aim: To investigate the impact of high fat diets with different fatty acid compositions on megakaryocyte development and platelet reactivity. Results: Mice were fed chow or high fat diets enriched in either saturated fatty acids (50% SFAs) or polyunsaturated fatty acids (50% PUFAs, omega-6-enriched). Neither high fat diet resulted in changes in megakaryocyte numbers, but both caused a significant increase in the size of bone marrow megakaryocytes, suggesting diet-derived lipid uptake into megakaryocytes. When examining platelet reactivity, we found that mice fed the SFA-enriched high fat diet exhibited increased expression of the active form of integrin αIIbβ3 (JON/A) in resting platelets and that both JON/A and P-selectin expression were significantly decreased after platelets were stimulated with ADP and the thromboxane A 2 analogue U46619. In contrast, platelets from mice fed the PUFA omega-6-enriched high fat diet had no differences in platelet reactivity compared to mice fed normal chow. Conclusions: Our data reveal that dietary fatty acid saturation status affects platelet reactivity, consistent with previous human studies showing variability in platelet reactivity in obese individuals. Further explorations will elucidate if plasma and/or platelet lipid content may be an indicator of risk for thrombosis or cardiovascular disease.
Abstract 18105: Lean Six Sigma Approach to Improve Post Percutaneous Coronary Intervention Cardiac Rehab Referral Rates
Authors: Veronica Andre, Timothy A Shapiro, Shaung Ooi, Manju Bengaluru Jayanna
Journal: Circulation (2023)

Background: Cardiac rehabilitation referral rates remain low despite known benefits including decreased mortality and improved quality of life. Studies have identified factors tied to both positive and negative predictors of referral rates, however, overall, it appears to be due to site-specific variation demonstrating the need for hospital-level intervention. Aims: This quality improvement study aimed to improve cardiac rehabilitation referral rates after PCI at our institution utilizing the Lean Sigma Six (LSS) approach, which has been described as a means to improving the quality of healthcare delivery. Methods: An interdisciplinary team used the Define-Measure-Analyze-Improve-Control (DMAIC) framework to implement this study. A GEMBA walk i.e., personal observation of workflow was performed. We Define d and Measure d process of cardiac rehabilitation and the referral rates. We Analyzed to identify that the orders were being placed by multiple team members including residents, general and interventional cardiology fellows, attendings, and nurse practitioners. Process maps were created, and our Intervention was to involve interventional cardiology fellows as stakeholders best suited to place orders since they are involved in all PCIs at our institution. Education was provided specifically to them beginning in July 2022. Statistical Process Control charts were used to analyze data trends from 2019 - 2022 where a total of 3046 PCIs were performed. Control process involved reinforcing the effect of intervention in quarterly meetings. Results: Baseline referral rates ranged from 10-60%. A significant increase in cardiac rehabilitation referral rate achieving a target referral greater than 90% was observed and maintained through the subsequent quarters. Conclusion: LSS is a powerful methodology to examine causes of delay in care. Intervention using LSS principles and tools, may help improve system processes to achieve desired quality outcomes.
Abstract 17700: Double Trouble With Identification of Isolated Sub-Segmental Pulmonary Embolism Using ICD-10 Discharge Diagnosis Codes: The PE-EHR+ Study
Authors: Antoine Bejjani, Candrika D Khairani, Ying-Chih Lo, David Jimenez, Stefano Barco, Shiwani Mahajan, Cesar Caraballo, Eric A Secemsky, Erik Klok, Andetta Hunsaker, Ayaz Aghayev, Alfonso Muriel, Mohamad A Hussain, Abena Appah-Sampong, HAMID MOJIBIAN, Yuan Lu, Zhenqiu Lin, Sanjay Aneja, Rohan Khera, Samuel Goldhaber, Li Zhou, Manuel Monreal, Harlan M Krumholz, Gregory Piazza, Behnood Bikdeli
Journal: Circulation (2023)

Introduction: International Classification of Diseases 10 th revision (ICD-10) discharge diagnosis codes are widely used for research studies that use electronic databases. The accuracy of the codes for identifying patients with isolated sub-segmental pulmonary embolism (issPE) is unknown. Methods: We used data from the Mass General Brigham (MGB) health system (01/2016-12/2021) and included 1,734 patients randomly selected from 3 groups: Patients with ICD-10 Principal Discharge Diagnosis codes for PE, patients with secondary Discharge Diagnosis codes for PE, and patients with no ICD-10 codes for PE. Weighted estimates were obtained by considering the total number of hospitalizations in each category at MGB hospitals. Accuracy of the codes was assessed by two independent physicians who reviewed discharge summaries, daily notes, and radiology reports. Results: Of 1,734 records reviewed, 1,712 were included (age: 60.6±17.8 years, 52.3% female). Manual chart review found 865 patients with acute PE, including 104 (12.0%) with issPE. Of these 104 patients, 103 (98.3%) had ICD-10 codes for PE. However, only in 15 (14.6%) cases, PE codes were specified as being limited to subsegmental vessels (issPE). In turn, in another 43 cases, Principal-or-secondary ICD-10 codes for issPE were listed but the patients did not have acute issPE during index hospitalization per review of records. The sensitivity and specificity for issPE codes in Principal or secondary discharge position were 14.4% and 97.3% (Table, panel A). Positive predictive value in the weighted sample was only 26.2% (Table, panel B). Conclusions: ICD-10 codes are insensitive and have a poor positive predictive value for detection of isolated subsegmental PE and should not be used for case identification for research purposes or quality improvement initiatives.
Abstract 16841: Skeletal Muscle Fat Predicts Exercise Intolerance and Decreased Survival in Symptomatic Heart Failure With Preserved Ejection Fraction
Authors: Sabra C Lewsey, T. Jake J Samuel, Michael Schaer, Allison Hays, Joevin Sourdon, Gary Gerstenblith, Robert G Weiss
Journal: Circulation (2023)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is characterized by marked exercise intolerance (EI) and increased mortality. HFpEF is now thought to involve multi-organ dysfunction and skeletal muscle (SkM) changes including muscle loss and muscle fatty infiltration have been reported in HFpEF patients. However, it is not known if SkM changes are associated with cardiovascular (CV) mortality. Hypothesis: Skeletal muscle fat accumulation in symptomatic HFpEF patients is associated with worse EI and decreased survival. Methods: Patients with a clinical diagnosis of HFpEF and left ventricular ejection fraction &gt; 50% (n=64, age 65.2±11.2, BMI 38.6±8.2, mean±SD, 53% women) underwent 3T conventional magnetic resonance imaging (MRI) of the calf muscle to determine SkM mass and T2-weighted MRI for SkM fat fraction (FF) with subcutaneous fat excluded. Baseline EI was quantified by six-minute walk distance (6MW). HFpEF patients were followed prospectively for a minimum of 18 months for survival (median follow up 39.3 months). Simple linear regression was used to determine relationships with EI while Kaplan-Meier survival curves with log rank tests were created to explore CV mortality. Results: SkM FF was closely and inversely associated with 6MW (1A), but SkM mass (1B) was not, indicating that EI in HFpEF is more closely associated with SkM quality than quantity. SkM FF was not related to body mass index (BMI) (1C). When the HFpEF cohort was stratified based on median FF (median=18.79%), SkM FF predicted significantly worse survival from CV death (1D, p=0.0192). Conclusions: This is the first report to show that SkM fat content predicts cardiovascular mortality in HFpEF patients. Further, EI in HFpEF patients is closely associated with SkM fat accumulation but not sarcopenia. Thus, reducing SkM fat content may represent a new target for reducing EI and improving CV survival in HFpEF patients.
Abstract 14874: Trends and Disparities in Cardiovascular Death in Colorectal Cancer: A Population-Based Retrospective Study in the United States From 1999 to 2020
Authors: Zareh Ekmekjian, Min Choon Tan, Chrystina Kiwan, Min Xuan Tan, THEODORE R DACOSTA, jasjit walia, Joanne Mazzarelli, Addi Suleiman
Journal: Circulation (2023)

Background: Overlap between cardiovascular diseases and colorectal cancer(CRC) has become more prominent with enhanced life expectancy. The data on cardiovascular deaths (CVDs) among those patients is not well-established. Objective: This study sought to determine the longitudinal trends in mortality attributed to CVDs with comorbid CRC by race, sex, and region. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for CVDs with comorbid CRC among patients aged 18 and above. Diseases of the circulatory system were listed as the underlying cause of death, and colorectal cancer as contributing cause of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and determined the trends by using the Joinpoint Regression Program. Results: In the 22-year study period, 77,094 CVDs with comorbid CRC were identified between 1999 and 2020. The AAMR from CVDs with comorbid CRC decreased significantly from 29.73 per 1,000,000 individuals in 1999 to 9.65 per 1,000,000 individuals in 2020 (p&lt;0.05). The most common CVDs reported were ischemic heart disease (56%) and cerebrovascular disease (14%). Males had a higher AAMR compared to females (21.51 vs 12.53 per 1,000,000 individuals, p&lt;0.05). African Americans had the highest AAMR (18.12 per 1,000,000 individuals), while the AAMRs for White populations, American Indian, and Asian populations were 16.28, 9.09, and 9.06 respectively. Rural areas had a higher AAMR than urban areas (18.25 vs 15.76 per 1,000,000 individuals, p&lt;0.05). Conclusion: The CVDs in patients with CRC have decreased significantly over the past two decades, with disparities seen in African Americans and rural regions. This highlights the importance of early screening among high-risk populations, and the importance of improving healthcare access in underserved populations.
Abstract 16617: Effects of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors on Inflammatory and Haemostatic Parameters in Coronary Artery Disease Patients
Authors: Sabina Ugovšek, Andreja Rehberger Likozar, Miran SEBESTJEN
Journal: Circulation (2023)

Background and aims: Despite progress in treatment, elevated levels of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp(a)) represent a significant part of the residual risk. Both are associated with inflammation and the coagulation fibrinolytic system. The purpose of our research was to evaluate the effect of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) on lipid parameters and indicators of inflammation, coagulation and fibrinolysis. Methods: We included 100 patients after a myocardial infarction with insufficiently controlled LDL-C values despite the maximum dose of statin, and highly elevated Lp(a). Patients received alirocumab or evolocumab (150mg sc or 140g sc every two weeks; respectively) or placebo for 6 months. Results: In the group receiving PCSK9i, a significant decrease in total cholesterol (TC), LDL-C, triglycerides (TG) and Lp(a), and an increase in high density lipoprotein cholesterol (p&lt;0.001 for all) was found. Before treatment concentrations of TC, LDL-C and TG correlated with the concentration of thrombin activatable fibrinolysis inhibitor (r=0.41, p&lt;0.001; r=0.353, p&lt;0.001; r=0.311, p=0.003; respectively), and plasminogen activator inhibitor-1 (r=0.302, p=0.007; r=0.218, p=0.049; r=0.278; p=0.013; respectively). The concentration of TC and LDL-C correlated with overall fibrinolytic potential (r=-0.220, p=0.034; r=-0.207, p=0.047; respectively). The concentration of TG was related to the concentration of interleukin 6 (r=0.290, p=0.004) and interleukin 8 (r=0.332, p=0.001). No correlations between Lp(a) and inflammatory or haemostatic variables were found. No associations were found after treatment. Conclusion: Our results show that fibrinolytic parameters and inflammatory cytokines are related to the concentration of LDL-C and not Lp(a) before and with neither of them after treatment with PCSK9i.
Abstract 18349: The Impact of Concomitant Mitral Regurgitation on Aortic Valve Intervention Outcomes in Paradoxical Low-Flow Low-Gradient Severe Aortic Stenosis
Authors: Shani Dahan, Jacob Dal-Bianco, Ygal Plakht, Mayooran Namasivayam, Xin Zeng, Jonathan Passeri, Evin Yucel, Michael H Picard, Robert Levine, Judy Hung
Journal: Circulation (2023)

Background: Patients with paradoxical low flow low gradient severe aortic stenosis (LFLGAS) exhibit low transvalvular flow rates due to reduced stroke volumes, while maintaining preserved left ventricular ejection fraction (LVEF). The presence of mitral regurgitation (MR) adds complexity to this already challenging diagnosis, by further lowering flow rate. However, the impact of aortic valve intervention in this patient population remains uncertain. Methods: A total of 1178 patients were included from an institutional echo database with adjudicated aortic valve area (AVA &lt;1.0 cm2), transaortic gradients (mean gradient&lt; 40 mmHg) and low flow rate (Q ≤210 ml/sec), to confirm the diagnosis of LFLGAS and preserved LVEF (&gt;50%). Subgroups were formed based on the presence of severe MR and subsequent surgical and transcatheter aortic valve intervention (SAVR/TAVR). Patients who underwent mitral valve intervention were censored. All-cause mortality was assessed as the primary outcome. Results: Patients with severe MR had significantly lower flow rates compared to patients w/o severe MR (166.5 ± 26.3 vs 174.7 ± 25, p=0.006). During a median follow up of 1.3 years, 745 deaths (62.2%) were identified, with a cumulative incidence significantly lower in the intervention groups (Figure). After multivariate propensity adjustment for age, sex, aortic valve area and comorbidities, aortic valve intervention showed a significant reduction in mortality risk in both intervention groups, which was more pronounced in the severe MR group compared to patients w/o severe MR (AdjHR 0.334, p=0.015 vs 0.436, p&lt;0.001, p for interaction =0.24). Conclusions: In paradoxical low-flow low-gradient severe aortic stenosis, aortic valve intervention results in a survival benefit, especially among patients with concomitant severe MR. Our findings highlight the importance of recognizing severe MR as a flow-diverting lesion that can impact outcomes in LFLGAS.
Abstract 13285: Association Between Adverse Childhood Experiences and Sleep Duration in Children: Utilizing 2018 to 2021 National Survey of Children’s Health
Authors: Minkyoung Song, Nathan F Dieckmann, Andrew W McHill, Carol M Musil, Laura L Hayman
Journal: Circulation (2023)

Background: Adverse childhood experiences (ACEs) and short sleep duration are both negatively associated with cardiovascular health. However, there is limited knowledge on the association between ACEs and sleep duration in children. Objective: We investigated if sleep duration was associated with the number of reported ACEs. We also evaluated the trends in sleep duration among U.S. children over the 4-year period (2018-2021). Methods: We used data from the 2018-2021 National Survey of Children’s Health. Based on the American Heart Association (AHA) Life Essential 8 scoring algorithm, we calculated a score for sleep duration (range 0 [lowest] to 100 [highest]). Participants were categorized into three subgroups: (1) meeting age-appropriate optimal sleep duration; (2) ≥1-&lt;2 hour below or ≥ 1 hour above optimal sleep duration; and (3) ≥ 2 hours below optimal sleep duration. We employed multinomial logistic regression to assess the association of sleep duration with a cumulative count of ACEs. Secondarily, we examined trends in sleep duration from 2018 to 2021. We controlled for child’s sex, age, race/ethnicity, household poverty level, regular bedtime, physical activity, and caretaker’s level of education. Results: Among children aged 6 to 17 years in the 2018-2019 (n=42,141) and 2020-2021 (n=58,964) surveys, the mean sleep duration score was 76.5 (95% CI 75.8 to 77.2) and 77.2 (95% CI 76.6 to 77.9), respectively. The proportion of the children meeting age-appropriate optimal sleep scores increased from 64.5% in 2018-2019 to 65.9% in 2020-2021 (p&lt;0.001). Adjusting for covariates, for each additional ACE the likelihood of having suboptimal sleep duration increased (relative risk ratios: 1.08 [95% CI 1.04 to 1.11] for category (2); 1.26 [95% CI 1.21 to 1.31] for category (3) in 2020-2021. Results were nearly identical in 2018-2019. Conclusions: Our findings show that over one third of U.S. children, as assessed using the AHA’s Life Essential 8 scoring criteria, do not meet optimal sleep duration standards and that number of ACEs is associated with suboptimal sleep duration. Findings highlight the importance of screening for ACEs and for sleep insufficiency in childhood with the aim of promoting optimal life course sleep patterns and cardiovascular health.
Abstract 14427: Subclinical Age- and Sex-Differences in Ventricular Strain in the Community: A Framingham Heart Study Cardiac Magnetic Resonance Study
Authors: Rohit Pillai, Kevin Peters, Vibhav Jha, Christopher ODonnell, Warren J Manning, Connie W Tsao
Journal: Circulation (2023)

Introduction: Myocardial strain is a measure of deformation and a marker of cardiovascular disease (CVD). The subclinical age- and sex-associations of left and right ventricular (LV, RV) strain by feature tracking cardiovascular magnetic resonance (FT-CMR) are not well established in the community. Methods: Framingham Heart Study Offspring cohort participants (n=1077) without prevalent CVD, hypertension, diabetes, or use of treatment for these conditions underwent 1.5T CMR. Steady-state free precession cine images spanning the entirety of both ventricles were acquired in the short-axis, 2-chamber, and 4-chamber views. Global longitudinal (GLS), circumferential (GCS), and radial (GRS) strains were measured by FT-CMR (Circle cvi42 v.5.11.1). Comparisons among age groups (&lt;45 years, 45-54 years, 55-65 years, and &gt;65 years) were performed by one-way analysis of variance and between sexes by independent samples t -test. Results: Clinical characteristics, CMR measures, and LV and RV strain by age and sex for the cohort are presented in the Table . Across increasing age groups, we observed more favorable LV GLS, GCS, and GRS (p=0.010, p&lt;0.001, and p&lt;0.001, respectively). Similar trends were present for RV strain for GCS and GRS (both p&lt;0.001) but not GLS (p=0.22). Compared with men, women had greater magnitude (more favorable) LV and RV strain values for GLS, GCS, and GRS (all p≤0.013). Conclusions: In this large community based study of individuals without CVD, LV and RV strains by FT-CMR were greater (more favorable) with increasing age and in women. The associations and long-term implications of these differences in myocardial mechanics between groups require further investigation.