tbuckley/cabot-search huggingface dataset:
Abstract 4126158: Persistence to once weekly GLP-1 RAs is associated with lower risk of MI, stroke, and 2-point MACE among patients with T2D and ASCVD in the real world.
Authors: Tyler Dunn, Yong Zhu, Noelle Gronroos, Lin Xie, Josh Noone, Andrew Sargent, Cory Gamble, Liana Billings
Journal: Circulation (2024)

Introduction: Studies have shown the reduction of CV events in patients with T2D treated with GLP-1 RAs. However, little is known about how persistent use of GLP-1 RA therapy affects CV outcomes in patients with T2D and ASCVD. The objective of this study was to estimate the association between persistent use of once weekly (OW) GLP-1 RAs and 2-point MACE and its components (MI, stroke) in patients with T2D and ASCVD in a real-world setting. Methods: Adult patients with T2D and ASCVD with ≥1 pharmacy claim for OW GLP-1 RAs during Jan 2018-Nov 2022 were identified in the Optum Research Database. The date of the first OW GLP-1 RA claim was defined as the index date. Patients were followed until a CV event occurred or censored. Discontinuation was defined as a ≥60-day gap in supply of OW GLP-1 RAs. All patients were required to be persistent for ≥3 months of follow-up to allow titration of the therapy. CV events of interest include 2-point MACE, MI and stroke. Kaplan-Meier analyses were used to examine risk of CV events by persistent status within 6, 12, or 18 months of follow-up. Cox proportional hazards models with time-varying exposures were used to assess associations between persistent status and MACE, with persistent status of patients updated for each day of follow-up, adjusting for demographic and baseline clinical characteristics. Results: Among a total of 29516 patients, the median follow up duration was 412 days, median persistence was 254 days, and 63.9% of patients (n=18849) were persistent throughout their variable follow up period. Kaplan-Meier analyses indicated risk of 2-point MACE, MI, and stroke was significantly lower in patients who were persistent within 6, 12 or 18 months of follow-up compared to patients who discontinued within 6, 12 or 18 months of follow-up (all p&lt;0.05); longer persistence led to a qualitatively greater risk reduction. Adjusted hazard ratio (95% confidence interval) from Cox regression with time-varying persistence status during the full variable follow up in all patients for risk of 2-point MACE, MI, and stroke associated with persistent use of OW GLP-1 RAs was 0.70 (0.63-0.77), 0.71 (0.62-0.81), and 0.67 (0.57-0.78), respectively. Conclusions: Patients with T2D and ASCVD who were persistent with OW GLP-1 RAs had a lower risk of 2-point MACE, MI, and stroke than those who discontinued the therapy in real-world clinical practice. Longer persistence of OW GLP-1 RAs appeared to provide greater CV benefits.
Abstract 4125093: Association of Systemic Inflammatory Index and Systemic Inflammatory Response Index with Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome Who Had Primary Percutaneous Coronary Intervention
Authors: Jafar Alshraideh, Nemeh Al-Hawamdeh, Heba Alkanash
Journal: Circulation (2024)

Introduction: Inflammation plays an important role in the pathogenesis of coronary artery disease and Acute Coronary Syndrome (ACS). Inflammatory indicators such as neutrophil count and monocyte count potentially may predict patients’ outcomes and prognosis in ACS. White blood cells count is an affordable and accessible way to assess the systemic immune response. Considering their multidirectional effect on atherosclerosis, new inflammatory biomarkers integrating various leukocyte subgroups have been proposed to calculate the systemic inflammatory response index (SIRI) and systemic inflammatory index (SII). Aim: The aim of this study was to assess the association between the systemic inflammatory response index (SIRI) and Systemic inflammatory index (SII) at admission with major adverse cardiovascular events (MACE) 30-days after Primary Percutaneous Coronary Intervention (PPCI) among patients with Acute Coronary Syndrome (ACS) at one referral hospital in Jordan. Method: A Prospective design was used to assess and follow 150 adults presented with ACS and received PPCI at one referral hospital in Jordan. Data was collected from patients and their medical records during hospital stay using a structured data collection form. The MACE was assessed 30-days after PPCI through phone calls with patients and confirmed from medical records. Results: The study included 150 patients with ACS, 82.7% (n= 124) of them were males. The mean age of patients was 57.68 (SD= 11.19) years. Types of ACS include stable angina 5.3% (n=8), unstable angina 24% (n=36), NSTEMI 28.7% (n=43), and STEMI 24% (n=36). All patients had interventional PCI with balloon and stent insertion. The mean of SIRI was 24.45 (SD=25.49) and the mean of SII was 663.30 (SD= 403.75). Rate of MACE as composite outcome 30-days after PPCI as 24.7% (n=37). The most MACE was unplanned repeat revascularization (n=14, 38% of MACE). Significant association between SIRI and SII, and MACE was found SIRI:(Χ 2 (2)&gt; = 12.63, p = 0.001), SII:(Χ 2 (2)&gt; = 4.23, p = 0.03) . Conclusion: The SIRI and SII are inflammatory biomarkers that should be studied as potentially predictors of MACE among patients presented with ACS.
Abstract 4125025: Association between Marital Status and Major Adverse Cardiovascular Events: Role of Stress-Related Neural-Immune Mechanisms
Authors: HUI CHONG LAU, Shady Abohashem, Krystel AbiKaram, Giovanni Civieri, Alula Assefa, Erin Hanlon, Iqra Qamar, Maria Khalil, Wesam Aldosoky, Antonia Seligowski, Michael Osborne, Ahmed Tawakol
Journal: Circulation (2024)

Background: Chronic stress is associated with cardiovascular disease (CVD) in part through neural mechanisms that potentiate inflammation. Disrupted social connections are associated with higher chronic stress. As such, we hypothesized that: 1) previously married (divorced, separated) individuals have higher major adverse cardiovascular event (MACE) risk compared to married individuals and 2) that greater activation of stress-related neural-immune mechanisms contributes to this relationship. Methods: Participants (N=75,638) enrolled in the Mass General Brigham Biobank were studied. Marital status and MACE were identified using survey data and ICD-10 codes, respectively. A subset (N=1,121) underwent clinical 18 F-FDG-PET imaging, enabling assessment of stress-related neural activity as the ratio of the amygdala to prefrontal cortex activity (AmygAc). Clinical high-sensitivity C-reactive protein (hs-CRP) levels were assessed in another subset of the cohort (N=10,358). Linear and Cox regression and mediation analyses were used. Results: Among participants (median age 62 years; 53% female), 2,978 subjects developed MACE after Biobank enrollment. Previously married (vs. currently married) individuals had greater MACE risk (HR 1.33 [95% CI: 1.20,1.57], p=&lt;0.001, Figure 1A ) , higher AmygAc (B=0.23 [95% CI: 0.06-0.40], p=0.009) and higher hs-CRP (B=0.19 [95% CI: 0.13-0.25], p=&lt;0.001). MACE risk remained significant after adjustment for key confounders ( Table 1 ), and both the AmygAc and CRP were higher among divorced or separated individuals ( Figure 1B and 1C ). Moreover, increased AmygAc and hs-CRP associated with increased MACE risk (HR=1.24 [1.14-1.36], p=&lt;0.001 and 1.13 [1.09-1.16], p=&lt;0.001, respectively), and both AmygAc and hs-CRP mediated the relationship between marital status and MACE (p&lt;0.05). Conclusions: Our findings suggest that divorced and separated individuals are at an increased risk for MACE. This relationship appears to be driven in part by stress-related neural-immune mechanisms.
Abstract 4125940: Hypertensive Disorders During Pregnancy: Patient Perspectives on Care, Barriers, and a Path Forward
Authors: Kismet Rasmusson, Justin Poll, Heidi May, Angela Anderson, Kirstin Hesterberg, Kaley Graham, Sheralee Petersen, audrey jiricko, Amy Campbell, Donna Dizon-Townson
Journal: Circulation (2024)

Background: The future risk of cardiovascular disease (CVD) after a diagnosis of hypertensive disorders of pregnancy (HDP) is well established. Blood pressure (BP) assessment and management after delivery is one essential part of downstream risk mitigation of future CVD. This requires intentional follow-up by clinicians and understanding by patients. We sought the perspectives of patients regarding solutions to barriers for health care interventions and self-care support after a HDP diagnosis. Methods: Phone interviews were conducted three to six months following a delivery from a random sample of women diagnosed with HDP, determined by ICD-10 codes. Interview questions were designed by a multidisciplinary team that included those who specialize in women’s CVD health and pregnancy. Interviews were conducted by a senior qualitative researcher. Questions aimed to discover health care and self-care steps taken following HDP diagnosis, reasons why these were not started or used consistently, education recalled, and areas for improvement. Results: A total of 20 women were interviewed from ages 21-42 (20-29, n=10; 30-39, n=8; and 40-42, n= 2) among 9 different hospitals (1 quaternary, 3 tertiary care hospitals, and 5 small-medium-rural community hospitals). Of the respondents, 50% were diagnosed during their third trimester, 25% in their second trimester, 20% in their first trimester, and 5% within a week after delivery. A total of 8 (40%) of the women were induced early given HDP concerns. Table 1 describes health care and self-care steps taken for HDP during and after pregnancy. If health care and/or self-care for HDP did not start or did not continue beyond the fourth trimester (&gt;12-weeks post-delivery), reasons included BP stabilized or returned to normal, the clinician ‘wasn’t concerned’, and/or they didn’t have a history of a hypertension diagnosis. Table 2 lists suggested areas from those interviewed for improving support to women with HDP. Conclusion: This study suggests a high prevalence of unclear education with low patient recall and incomplete follow-up after delivery among women with HDP, with health care support and self-care diminishing after the fourth trimester. Understanding the perspectives of women with HDP and its associated risk factors can help in developing effective clinician and patient education and clinical pathways to reduce barriers for long-term care and CVD risk mitigation.
Abstract 4125419: Very-Low-Density Lipoprotein Induces Neuronal Growth with Increased Tyrosine Hydroxylase Expression through Cardiomyocyte-Secreted Exosomes in Metabolic Syndrome
Authors: Alexander Lan, Hsiang-Chun Lee
Journal: Circulation (2024)

Introduction: Metabolic syndrome (MS) is an important predisposing factor for atrial fibrillation, and is highly related to the autonomic nervous system. Triglyceride-rich very-low-density lipoprotein (VLDL) has specific VLDL receptors (VLDLR), which are abundantly expressed in cardiomyocytes. Hypothesis: VLDL affects neuronal growth through cardiomyocyte-secreted exosomes in metabolic syndrome. Goals/Aims: To determine whether exosomes from VLDL-incubated cardiomyocytes can alter neuronal proliferation. Methods/ Approach: HL-1 cardiomyocytes were incubated with VLDL isolated from human subjects with MS, and exosomes were extracted at the end of the incubation period. VLDLR knockdown HL-1 cells were used to determine the role of VLDLR in exosome secretion. The molecular contents of exosomes were determined by mass spectrometry, which identified neurotropic proteins only detected in the exosomes of MS VLDL-incubated cardiomyocytes. We selected transmembrane protein 14B (TMEM14B) to investigate its effect on neuronal proliferation in P19 cells. Results: Regardless of the knockdown or overexpression of VLDLR in HL-1 cardiomyocytes, exosomes isolated from after VLDL incubation were shown to cause 2.062-fold and 2.084-fold expression of tyrosine hydroxylase (TH) in P19 cells, relative to P19 cells induced by non-VLDL-treated HL-1 cardiomyocyte-secreted exosomes. A similar trend could be seen with HL-1 cardiomyocytes without VLDLR editing, as VLDL-incubated HL-1 cardiomyocytes produced exosomes that could cause 1.926-fold increase in P19 TH expression, relative to treatment by exosomes from HL-1 cardiomyocytes without VLDL-incubation. The P19 cells incubated with TMEM14B demonstrated increased neurite length, with an average of 2.342-fold neurite length when compared with that of control cells. Conclusions: VLDL in MS induced HL-1 cardiomyocytes to secrete exosomes containing neurotrophic molecules and increased dendritic growth of neuronal cells. This effect was VLDLR-independent and was partially caused by TMEM14B in the exosomes.
Abstract 4125996: Outcomes Of Transvenous Lead Extraction As a Function Of Lead Dwell Time: Does Risk Plateau With Very Old Leads?
Authors: Wissam Mekary, Mikhael El-Chami, Neal Bhatia, Michael Lloyd, Stacy Westerman, Anand Shah, Miguel Leal, David Delurgio, Anshul Patel, Christine Tompkins, Faisal Merchant
Journal: Circulation (2024)

Introduction: Longer lead dwell time is associated with worse outcomes during transvenous lead extraction (TLE). It has been suggested that risk may plateau beyond a certain dwell time but data on this are lacking. Methods: We identified all TLE procedures at Emory Healthcare from 2007-2023. Clinical characteristics and procedural details were collected from medical records. Procedural outcomes were reported using the 2017 HRS/ACC/AHA consensus statement on TLE. Procedural success was defined as complete removal of all targeted lead hardware without any major complications. Clinical success was defined as retention of a small portion (&lt;4 cm) of targeted lead which does not negatively impact the outcome of the procedure. Results: We identified 1,717 TLE procedures. Mean patient age at extraction was 64.6 ± 15.1 yrs, 61.4% were male, 53% had ICD leads and 21% had CRT systems. Extraction indications included lead malfunction (46%), infection (38%) and venous occlusion with need for system upgrade (11%). The dwell time of the oldest lead targeted for extraction was &lt; 1 yr (n=326, 19%), 1-5 yrs (n=633, 36.9%), 5-10 yrs (n=467, 27.2%), 10-15 yrs (n=178, 10.4%), 15-20 yrs (n=71, 4.1%) and &gt;20 yrs (n=42, 2.4%). Procedural and clinical success rates decreased with longer lead dwell time (Figure 1A). Success rates were excellent (&gt;95%) among leads &lt;5 yrs old whereas success rates dropped to the 70-75% range for leads &gt;20 years old. Most clinical failures among very old leads were due to inability to remove all lead material in the setting of infection. Across the entire cohort, the major complication rate was 1.3% and procedural death rate was 0.5%. Complications increased with increased lead dwell time (Figure 1B). Peri-procedural death occurred in 2.8% of cases with dwell times of 15-20 yrs. There were no major complications or deaths among dwell times of &gt;20 yrs, however, the vast majority of these were pacemakers, not ICDs. Conclusion: TLE success rates decrease and complication rates increase with increased lead dwell time, without any clear evidence of a plateau effect. These data have implications for making decisions about abandoning vs. extracting redundant leads.
Abstract 4126672: Clinical Predictors and Outcomes of Catheter-Directed Therapies in Patients with Intermediate-Risk Central Pulmonary Embolism
Authors: Omar Cantu Martinez, Jose Manuel Martinez Manzano, Mikaela Nikkola Jara-Tantoco, Alexander Prendergast, Simone Jarrett, Mara Briseno, Maria Planchart, Sahana Tito, John Malin, Karecia Byfield, Andrew Geller, Evan Isaacs, Maria Carolina Musri, Ammaar Wattoo, Zurab Azmaiparashvili, Kevin Bryan Lo
Journal: Circulation (2024)

Background: The management of intermediate-risk pulmonary embolism (PE) is unclear. The use of catheter-directed therapies (CDTs) in these patients has increased. However, their selection is not standardized, and outcomes of CDT compared to anticoagulation alone (ACA) are limited. Research Question: What are the clinical predictors of using CDT and their outcomes compared to ACA? Methods: Single center, 11-year, retrospective study of patients with intermediate-risk central PE. We stratified data by CDT use vs. ACA. We used the simplified pulmonary embolism severity index (sPESI) and right ventricular (RV) dysfunction as surrogates of PE severity and the VTE-BLEED score for baseline bleeding risk. We looked for predictors of CDT use and bleeding complications on multivariate logistic regression analyses. Results: Of 490 patients identified, 110 (22%) underwent CDT (Figure 1, Table 1). Higher BMI (OR 1.04, 95% CI 1.01-1.06; p=0.002), prior venous thromboembolism (VTE) episodes (OR=1.92, 95% CI 1.05-3.50; p=0.032), saddle PE (OR=3.42, 95% CI 2.00-5.85; p&lt;0.0001), RV dysfunction (OR=6.93, 95% CI 3.53-13.57; p&lt;0.0001), and creatinine elevation (OR=1.36, 95% CI 1.13-1.64; p=0.001) were independently associated with CTD use (Table 2). After adjusting for PE severity and bleeding risk, CDT was independently associated with bleeding complications (OR=3.77, 95% CI 1.74-8.15; p=0.001) (Table 3). The overall in-hospital mortality was low (3%, n=13). Conclusions: Higher BMI, prior VTE, saddle PE, RV dysfunction, and creatinine elevation were independently associated with CDT use. The CDT group had more major bleeding without mortality difference compared to ACA. Further studies are needed to standardize the use of CDT in intermediate-risk PE.
Abstract 4126581: COVID-19 Impacted Septal Reduction Therapies in Hypertrophic Cardiomyopathy
Authors: Spandan Desai, Nicholas Roma, Megan Pattoli, Matthew Durkin, Kashyap Shah, Eluwana Amaratunga, Lindsey Magid, Vikas Yellapu, Jamshid Shirani
Journal: Circulation (2024)

Background: Coronavirus Disease-19 (COVID-19) pandemic had a significant impact on emergent and elective treatment strategies in patients with cardiovascular disease. We aimed to examine the impact of COVID-19 on septal reduction therapy (SRT) in hypertrophic cardiomyopathy (HCM). Methods: National Inpatient Sample 2019-2021 was queried to identify patients with HCM and SRT using appropriate ICD codes. Temporal trends for SRT were obtained before and after COVID-19 outset. Results: There was a significant decline in the number of SRT from 2019 to 2020 (1505 vs. 1180, p&lt;0.001) with partial recovery in 2021 (1250 vs. 1180, p&lt;0.001). Geographic differences existed with differential decrease in number of SM in midwestern and Western Unites States. In addition, the proportion of patients who underwent surgical myectomy (SM) decreased in 2020 (44.6 vs. 48.7%, p=0.008) in favor of alcohol septal ablation (ASA). Patients undergoing SRT in 2020 had higher prevalence of heart failure (39.5 vs. 29%, p=0.002). In-hospital complication rates for cardiogenic shock, bleeding requiring transfusion, acute kidney injury and admission to the critical care unit were higher in 2020 compared to 2019. Hospital length of stay (LOS) was not significantly different however there was an overall increase in LOS in septal myectomy group from 2019 to 2021 (9.1 vs. 10 days, p=0.028). The overall proportion of comorbidities and other in-hospital complications remain unchanged during this study period. Conclusions: Our data indicates that COVID-19 resulted in a significant decrease in total number of SRTs and a shift from surgical to percutaneous septal reduction therapy. Partial recovery of procedure numbers were noted in the year following the pandemic outset.
Abstract 4125493: Is There an Obesity Paradox for Cardiovascular Outcomes in Patients Undergoing Transcatheter Edge-to-Edge Repair? A Pilot Meta-Analysis
Authors: Aman Goyal, Surabhi Maheshwari, Hritvik Jain, Rozi Khan, Haleema Qayyum Abbasi, Samia Sulaiman, Darshan Puttaswamy, GAURANGA MAHALWAR
Journal: Circulation (2024)

Background: The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an 'obesity paradox' exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI. Methodology: We conducted a systematic literature search using major databases to identify studies investigating the association between baseline BMI status and post-procedural outcomes in patients undergoing TEER. Patients were categorized into four BMI groups: underweight (BMI &lt; 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25-29.9 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ). The endpoints included were the risk of in-hospital mortality, myocardial infarction, and stroke. Data were pooled using Review Manager with a random-effects model. Risk ratios (RRs) with their 95% confidence intervals (CIs) were used as the effect measure. Statistical significance was set at p&lt;0.05. Results: Our study included a total of six observational studies, encompassing 7,627 obese and 74,820 non-obese patients. The outcome of in-hospital mortality revealed no significant difference between the two groups (RR: 0.85; 95% CI: 0.57, 1.27; p=0.43). Subgroup analysis showed a trend towards higher in-hospital mortality risk for underweight patients compared to overweight (RR: 1.48; 95% CI: 1.11, 1.95; p=0.007) and obese patients (RR: 1.40; 95% CI: 1.02, 1.92; p=0.04). The comparison between underweight and normal-weight patients did not reach statistical significance (RR: 1.18; 95% CI: 0.91, 1.55; p=0.22). Additionally, the risk of myocardial infarction (RR: 1.10; 95% CI: 0.77, 1.58; p=0.59) and stroke (RR: 0.43; 95% CI: 0.13, 1.42; p=0.17) did not differ significantly between obese and non-obese patients. Conclusions: Our study found no significant difference in in-hospital mortality between obese and non-obese patients. However, underweight patients had a higher mortality risk compared to both overweight and obese patients. While myocardial infarction rates were similar across all groups, there was a non-significant trend suggesting a potentially lower risk of stroke in obese patients. These findings warrant further prospective studies to provide robust evidence.