tbuckley/cabot-search huggingface dataset:
Abstract 4141198: Serum Homoarginine is a Strong Predictor of Cardiovascular Mortality in Patients with Chest Pain and Non-Obstructive Coronary Artery Disease
Authors: Silje Kjellevold Storesund, Adrian McCann, Per Magne Ueland, Mai Tone Lonnebakken, Ottar Nygard, Eva Pedersen
Journal: Circulation (2024)

Introduction: As substrates for nitric oxide, arginine (Arg) and its metabolites are involved in the regulation of vascular function. Ischemia caused by vascular dysfunction is common in patients with non-obstructive coronary artery disease (NOCAD) and may indicate a subgroup at increased risk of cardiovascular disease (CVD) mortality. Research question: We evaluated serum arginine (Arg), homoarginine (hArg), symmetric dimethylarginine (SDMA), and asymmetric dimethyl arginine (ADMA) as long-term predictors of CVD mortality in patients with chronic coronary syndrom. Particularly, we were interested in potential effect modifications according to diagnoses of NOCAD versus obstructive coronary artery disease (OCAD) at baseline invasive coronary angiography (ICA). Methods: 4164 patients underwent elective ICA from 2000-2004. Serum metabolite concentrations were measured by liquid chromatography-tandem mass spectrometry using isotope labelled internal standards. Metabolite associations with CVD mortality risk were explored by Cox regression adjusting for age, sex, body mass index, HbA1c, hypertension, smoking status, serum LDL cholesterol, previous myocardial infarction, and estimated glomerular filtration rate. HRs (95% CI) are reported per SD increment of (log transformed) metabolites. Potential effect modifiers were evaluated by adding interaction terms to the model. Results: Median age was 62 years at inclusion. 72 % were men, 25 % had NOCAD, while 75 % had OCAD. During median 14 years of follow-up, 14 % of patients died from CVD. In multivariable analyses, serum concentrations of Arg, hArg and SDMA predicted CVD mortality with HRs (95% CI) of 0.90 (0.83-0.98), 0.81 (0.74-0.88) and 1.30 (1.12-1.50), respectively. Serum hArg was a significantly stronger inverse predictor in patients with NOCAD than in OCAD with HR (95% CI) of 0.54 (0.40-0.73) versus 0.84 (0.77-0.92), respectively (Pint = 0.037). No significant effect modifications were observed for the other arginine form (Pint ≥ 0.09). Conclusion: In patients with stable chest pain, Arg, hArg and SDMA significantly predicted long term CVD mortality. Interestingly, hArg was a stronger inverse predictor among NOCAD compared to OCAD patients. Further studies investigating hArg as a potential marker of a high-risk phenotype in NOCAD are merited.
Abstract 4141387: Clinical Study on The Blood Pressure Changes in Patients with VEGFR-TKI-induced Hypertension During Anti-tumor Treatment
Authors: Jiaxin Li, Jing Yu
Journal: Circulation (2024)

Background and Objective: To investigate the differences in Ambulatory Blood Pressure Monitoring (ABPM) parameters in patients affected by VEGFR-TKI and tumors, and to summarize the relationship between VEGFR-TKI, tumors, and blood pressure. Methods: 43 patients who received VEGFR-TKI anti-tumor treatment and developed induced hypertension were selected for ABPM. Additionally, 94 cases of tumor-associated hypertension and 96 cases of primary hypertension were randomly selected for comparison. The ambulatory blood pressure-related parameters between the VEGFR-TKI-related hypertension group and the tumor-associated hypertension group, as well as between the tumor-associated hypertension group and the primary hypertension group, were analyzed. Results: Compared with the tumor-associated hypertension group, the VEGFR-TKI-related hypertension group showed higher 24-hour average diastolic blood pressure [(85.37±13.21) vs. (80.41±10.71) mmHg, t =2.332, P =0.021], daytime average diastolic blood pressure [(85.98±13.19) vs. (80.69±10.98) mmHg, t =2.452, P =0.015]. Multivariate linear regression analysis revealed that after adjusting for tumor type and BMI, the use of VEGFR-TKI remained independently associated with nighttime average diastolic blood pressure ( B =5.921, P =0.021). Compared with the primary hypertension group, the tumor-associated hypertension group exhibited significantly reduced nighttime systolic blood pressure decline rate [(1.10±9.01) vs. (6.33±6.87), t =-4.508, P &lt;0.001] and nighttime diastolic blood pressure decline rate [(2.13±10.09) vs. (6.38±7.42), t =-3.317, P &lt;0.001]. Multivariate linear regression analysis showed that after adjusting for age, BMI, and hypertension history, the tumor remained independently associated with nighttime systolic blood pressure decline rate ( B =-5.336, P &lt;0.001). Conclusion: In comparison with the tumor-associated hypertension group, VEGFR-TKI anti-tumor treatment induced predominantly increased diastolic blood pressure during nighttime periods, and the use of VEGFR-TKI was identified as an independent risk factor for elevated nighttime average diastolic blood pressure. In contrast to the primary hypertension group, tumors primarily influenced the blood pressure decline rate in dynamic blood pressure parameters, and the tumor was identified as an independent risk factor for reduced nighttime systolic blood pressure decline rate.
Abstract 4141165: Long-Term Contemporary Outcomes of the Ross Procedure
Authors: ismail bouhout, Vincent Chauvette, Maximiliaan Lukas Notenboom, Nancy Poirier, Philippe Demers, Ismail El-Hamamsy
Journal: Circulation (2024)

Background: Current evidence supports the use of the Ross procedure (pulmonary autograft) in adults with aortic valve disease. Aims: To examine the ten-year clinical and echocardiographic outcomes following the Ross procedure using a tailored approach. Methods: This prospective cohort included 455 consecutive adults (333 male [73.1%]) with a median age of 50.0 years (IQR, 40.0-57.0) undergoing a Ross procedure at a single center. Patients with aortic aneurysms (37.4%), previous cardiac surgery (15.2%) and active endocarditis (5.7%) were included. The predominant lesion was aortic stenosis (AS) in 379 patients (83.3%) and aortic insufficiency (AI) in 76 patients (16.7%). The study period ranged from February 1, 2011, to December 31, 2019. Primary endpoints were cumulative incidence of any, autograft, or homograft reintervention, and time-related valve function (AI grades 0-4). The secondary endpoint was ten-year survival among Ross patients compared with that in the age- and sex-matched Canadian population. Median clinical follow-up was 6.0 years (maximum 13 years). Follow-up was 90% complete for clinical and 87% complete for echo follow-up. Results: Operative mortality was 0.4% (n=2). Both patients were operated among the first 100 cases. At 10 years, cumulative incidence of any aortic and/or pulmonary reintervention was 5.0% (95% CI, 2.3-9.4%); autograft reintervention 1.5% (0.5-3.4%); and homograft reintervention 3.4% (1.9-5.7%). In patients with preoperative AS, cumulative incidence of autograft reintervention was 1.8% at 10 years (0.6-4.1%), versus 0% in patients with preoperative AI (p=0.6) ( Figure 1 ). At 10 years, cumulative incidence of AI grade &gt;2 was 2.0% (0.9-4.2%), and did not differ between patients with preoperative AS or AI (p=0.9) ( Figure 1 ). Ten-year survival was 96.5% (95% CI, 94.7-98.7%), translating to a relative survival of 100% (99.4-100%) compared to the matched general population. Conclusion: This study demonstrates that using a tailored surgical approach and contemporary perioperative management strategies, the Ross procedure is associated with excellent long-term valve function and freedom from reintervention in an all-comer adult patient population. Moreover, it translates into restored late survival, mimicking the general population. These results further support the notion that, in reference centers, the Ross procedure should be considered in adults needing valve replacement.
Abstract 4141011: Less Coronary Artery Disease Motivating Intervention Among Out-of-Hospital Cardiac Arrest With Increased Refractoriness
Authors: Lis Frykler Abazi, Felix Bohm, Nils Witt, Martin Jonsson, Gabriel Riva, Ludvig Elfwen, Jacob Hollenberg
Journal: Circulation (2024)

Background: Significant coronary artery disease has been suggested as the main cause of the refractory state among patients with out-of-hospital cardiac arrest (OHCA) and initial ventricular fibrillation (VF). Research Question/Hypothesis: The aim of this study was to describe the coronary angiography findings in relation to degree of treatment refractoriness, measured as the number of shocks, among patients with shockable OHCA in Sweden. We hypothesized that increasing number of shocks was associated with an increased prevalence of coronary artery disease (CAD) and more frequent percutaneous coronary intervention (PCI). Methods: All patients with primary VF OHCA in Sweden between January 1, 2010, and December 31, 2019, who underwent coronary angiography, were included using three national registries. Patients were divided according to the number of delivered defibrillations and subgrouped according to presence of STEMI on ECG. Coronary angiography findings of acute occlusions, PCI performed, chronic total occlusions as well as multivessel disease were described in relation to level of refractoriness. Results: In total, 3369 patients were included. Among them 67%/N=2270 required 1-3 defibrillations, 23%/N=758 4-6, 7%/N=222 7-9 and 4%/N=119 ≥10 defibrillations. There was no significant difference regarding acute coronary occlusions between the groups. The proportion of patients receiving PCI decreased with increased number of shocks (67%/N=1525 for 1-3 shocks, 58%/N=435for 4-6 shocks, 54%/N119 for 7-9 shocks and 55%/N=65 for ≥10 shocks). This was true for both subgroups with or without STEMI. Survival and neurological function decreased in accordance with increased need of defibrillations (74% to 35%; p=&lt;0,001), a clear difference that was unaffected when adding coronary angiography findings as well as PCI in an adjusted multivariable model. Conclusions: In this comprehensive study including all VF OHCA undergoing coronary angiography in Sweden, patients with an increased number of defibrillations have less coronary artery disease motivating PCI in relation to those receiving fewer defibrillations.
Abstract 4141113: Sex, Race and Age Group Disparities in Pericardial Diseases Related Mortality Rates; Data from CDC Wonder 1999-2022
Authors: Khawaja Abdul Rehman, Rohab Sohail, Muhammad Ahsen Niazi, Ramsha Mumtaz, Faraz Arshad, Javeria Javeid, Ansab Godil, Salman Sani, Sameen Aftab, Bisma Akram, Sabin Zafar, Maham Zaman, Qazi Muhammad Zarlish
Journal: Circulation (2024)

Background: Pericardial Diseases (PD) have become a significant cause of morbidity and mortality over the last two decades. They contribute secondarily to deaths associated with other primary illnesses and can present clinically as pericarditis, pericardial effusion, and hemopericardium. Despite treatment advances, U.S. mortality trends for PD are unexplored. Aim: This study aims to assess the trends in PD-related deaths in the United States from 1999 to 2022. Methods: PD-related deaths in adults aged 25 years and above were identified through CDC WONDER database from 1999 to 2022 from multiple causes of death. Crude mortality rates and age-adjusted mortality rates (AAMR) per 100,000 population were determined. Joinpoint regression was used to examine changes in trends and annual percentage change (APC) overall, and then stratified by sex, ethnicity, and age groups. Results: A total of 105,536 deaths occurred from PD between 1999 to 2022. Overall, AAMR related to PD decreased from 1999 (2.4) to 2012 (1.7) (APC -2.73 [95% CI, -3.09 to -2.36]), then gradually increased until 2019 (2.0) (APC 2.92 [95% CI, 1.57 to 4.29]), followed by a sharp increase until 2022 (APC 7.65 [95% CI, 4.42 to 10.99]). After an initial decline, APC in AAMR increased in women (4.36) starting in 2012, while in men, it decreased significantly until 2011 (-2.26), followed by a slight increase until 2016 (1.05), and then a marked increase from 2016 to 2022 (4.19). After an initial decline, AAMR increased among non-Hispanic (NH) Blacks (APC 5.42) and NH Whites (APC 4.95) starting in 2014, among Hispanics (APC 4.10) from 2012 to 2022, and among NH Asian or Pacific Islanders (APC 2.4) from 2007 to 2022. Mortality rates have been steadily increasing across all age groups over the last decade, with the highest increase seen recently in the 85+ age group (2017-2022 APC 9.09 [95% CI, 6.50 to 11.76]). Conclusion: PD-related mortality has increased over the last decade. Mortality among males, NH Blacks, and the 85+ age group has been growing at a faster rate than any of the other groups. These results highlight the need for further investigation into the factors contributing to the observed disparities and trends in PD mortality rates.
Abstract 4141585: Lipoprotein(a) and risk of cardiovascular disease events: an analysis in a large US national database
Authors: Diane MacDougall, Mary McGowan, Xingdi Hu, Wess Boatwright, Theresa Stern, Bonnie Hartsuff, Katherine Wilemon
Journal: Circulation (2024)

Introduction/Background: Despite increasing awareness of lipoprotein(a) [Lp(a)] as an independent, genetically determined, causal risk driver of atherosclerotic cardiovascular disease (ASCVD), Lp(a) screening occurs infrequently, and nationwide, comprehensive data characterizing the risk of elevated Lp(a) are lacking. Aims: To evaluate the association of Lp(a) level with cardiovascular disease (CVD) events in individuals with and without pre-existing ASCVD using real-world data from the Family Heart Database TM . Methods: Observational, retrospective cohort study using longitudinal data in over 324 million individuals from 2012-2021. Selection criteria included individuals ≥18 years with ≥1 Lp(a) test measured in nmol/L during May 1, 2013 to December 31, 2020, and ≥1 medical claim pre- and post-index date (date of earliest Lp[a] test). Lp(a) levels were categorized by percentile (&lt;20th, 20 th to 80 th , and &gt;80 th ). Elevated Lp(a) was defined as &gt;80 th percentile (&gt;140 nmol/L). Multivariable Cox Proportional Hazards model analyses compared a group with Lp(a) &lt;20 th percentile [&lt;10 nmol/L] and no ASCVD to five other groups that differed by pre-index ASCVD status (Yes/No) and category of Lp(a) level. Results: A total of 392,835 individuals were included: mean (SD) age 59 (13.6) years, 55% female, and 43.0% with pre-index ASCVD. Elevated Lp(a) was most prevalent in women and Black individuals. Mean/median follow-up duration was 3.0/2.5 years. In individuals without pre-index ASCVD, those with Lp(a) &gt;140 nmol/L had an adjusted 12% increased risk of CVD events (p&lt;0.0001) versus those with Lp(a) &lt;10 nmol/L. Compared to individuals with no pre-index ASCVD and Lp(a) &lt;10 nmol/L, individuals with pre-index ASCVD and Lp(a) &gt;140 nmol/L had the highest CVD event risk: adjusted HR = 3.25, 95% CI 3.11, 3.41, P&lt;0.0001. Conclusions: In one of largest analyses of US individuals with Lp(a) levels to date, elevated Lp(a) consistently predict the increased risk of future CVD events in individuals with and without pre-index ASCVD. These findings highlight the substantial unmet need for Lp(a) screening to support risk stratification and subsequent care.
Abstract 4141027: Platelet Activation in Patients with Peripheral Artery Disease From 43 Sites: Assessment of Samples Transported by Overnight Mail
Authors: William Stubblefield, Alexander Sullivan, Taneem Amin, Olivier Boutaud, Katherine Cahill, David Flaherty, Brittany Matlock, Jeffrey Berger, Joshua Beckman
Journal: Circulation (2024)

Background: Platelet activation plays a key role in peripheral artery disease (PAD), but the relevant platelet activation mechanism in chronic limb threatening ischemia remains unclear. Moreover, multi-center study of platelet activation remains difficult due to methodologic limitations. We report the feasibility of a novel method to measure platelet activation using samples sent via overnight mail. The primary objective was to report baseline markers of platelet activation from samples sent by overnight mail compared to an age-matched population recruited locally without known atherosclerosis. Methods: Peripheral venous blood was drawn from 190 participants with severe peripheral artery disease at 43 sites in the BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients with Chronic Limb Ischemia) Trial and shipped by Federal Express cold pack from study site locations within the continental United States to Vanderbilt University Medical Center. Fifty-six volunteers with and without diabetes were recruited locally as time and age-matched control subjects. Samples were collected using a platelet activation inhibitor. Thromboxane B2, dilysyl-malondialdehyde (MDA), p-selectin, WEDE 15, and SPAN 12 as markers of platelet activation were measured using liquid chromatography with tandem mass spectrometry and flow cytometry. Results: Compared with control subjects, patients from the BEST-CLI trial were more likely to be male (72.6% vs 51.8%, p&lt;0.01), have prior atherosclerotic cardiovascular disease (22.1% vs 0%, p&lt;0.01), and be prescribed aspirin (69.4% vs 35.7%, p&lt;0.01) or clopidogrel (20.0% vs 0%, p&lt;0.01). Thromboxane B2 (0.5 vs 2.9 ng/mL, p&lt;0.01) and dilysyl-MDA (4.7 vs 9.7 ng/mg, p&lt;0.01) were significantly higher in BEST-CLI patients than control subjects while p-selectin (592.0 vs 420.5 MFI, p&lt;0.01) was lower. Levels of thromboxane B2 (figure 1A) and dilysyl-MDA (figure 1B) varied significantly and as expected across the range of antithrombotic prescription (p&lt;0.01). Conclusions: Measurement of platelet activation after sample shipment on cold pack is feasible and yields reliable results that match expected clinical values.
Abstract 4141141: Obesity is Associated with Impaired Angiogenesis in Patients with Heart Failure with Preserved Ejection Fraction
Authors: Sabina Frljak, Gregor Poglajen, Gregor Zemljic, Andraz Cerar, Matjaz Sever, Bojan Vrtovec
Journal: Circulation (2024)

Background: Obesity was associated with cardiac vessel remodelling, microvascular rarefaction, and poor angiogenetic response in patients with metabolic syndrome. Aim: Since myocardial microvascular damage may represent a key parameter in the pathogenesis of heart failure with preserved ejection fraction (HFpEF) we sought to investigate a potential correlation between obesity and parameters of angiogenesis in HFpEF patients. Methods: We enrolled 30 consecutive HFpEF patients with NYHA class III, left ventricular ejection fraction (LVEF) &gt;50%, E/e' &gt;15, and NT-proBNP &gt;300 pg/ml. In all patients, endothelial progenitor cells (EPCs) were mobilized by granulocyte-colony stimulating factor (G-CSF; 10 mcg/kg, 5 days) and collected via apheresis. Before EPC mobilisation we performed echocardiography and measured plasma levels of biomarkers of angiogenesis. At the time of enrolment, obesity was defined as BMI &gt;27 kg/m 2 . Results: Obesity was present in 17 patients (57%; Group A) and absent in 13 patients (43%; Group B). The groups did not differ in age (62±8 years in Group A vs. 61±7 years in Group B, P=0.65), gender (male: 76% vs. 77%, P=0.97), serum creatinine (1.06±0.24 mg/dL vs. 1.05±0.42 mg/dL, P=0.52), LVEF (58±8% vs. 59±5%, P=0.56), or E/e’ (21.4±4.0 vs. 19.5±2.1, P=0.20). In Group B we found higher levels of NT-proBNP (2105±1015 pg/mL vs. 915±320 pg/mL in Group A, P=0.04). After G-CSF stimulation, we found significantly lower numbers of EPCs in Group A (62±48 x10 6 cells/L) than in Group B (98±54 x10 6 cells/L, P=0.01). Similarly, apheresis yielded lower numbers of EPCs in Group A (82±72 x10 6 cells vs. 187±90 x10 6 cells in Group B, P=0.01). When compared to Group B, patients in Group A had lower levels of pro-angiogenic biomarkers (agiopoietin-1: 6.8±2.3 ng/mL vs. 12.1±4.9 ng/mL, P=0.01; vascular endothelial growth factor: 22.5±18.2 pg/mL vs. 53.2±19.1 pg/mL, P=0.01), and higher levels of anti-angiogenic biomarkers (endostatin: 61.3±17.4 ng/mL vs. 31.7±12.2 ng/mL, P=0.01; thrombospondin-2: 17.1±3.9 ng/mL vs. 9.0±4.5 ng/mL, P=0.02). Conclusion: In patients with HFpEF, obesity appears to be associated with reduced mobilisation of endothelial progenitor cells and impaired angiogenesis.
Abstract 4141427: Refining the risk of all-cause death at mid-term in pulmonary embolism using four-cardiac chambers myocardial strain analysis
Authors: Laurie Soulat-Dufour, Isaure Evain, Sylvie LANG, Manon GERARD, Stephane EDERHY, Marion Chauvet-Droit, Elodie Capderou, Camille Arnaud, Pierre Antoine Le Bos, Pauline Fagnen, Lucas Benoudiba Campanini, Franck Boccara, Ariel Cohen
Journal: Circulation (2024)

Introduction: In acute pulmonary embolism (PE), right ventricular (RV) remodeling and hemodynamic involvement using echocardiography data are associated with in-hospital prognosis. The impact on mid-term outcome of right atrial (RA), RV, left ventricle (LV), and left atrial (LA) involvement using myocardial deformation analysis is poorly evaluated. Hypothesis: We hypothesized that acute PE had a global impact on 4-heart cavities geometry and functions. Aims: We sought to evaluate the prognostic value at mid-term of myocardial strain of the 4-cardiac cavities in patients with acute PE. Methods: We retrospectively analyzed 488 patients hospitalized for acute PE. LV, LA, RA and RV strains were measured using speckle tracking transthoracic echocardiography (TTE) at admission. Primary outcome was mid-term all-cause mortality. Results: During a median follow-up of 3.6 (2.7-4.7) years, all-cause death occurred in 93 patients. At baseline, patients with the highest severity of PE, based on ESC risk score determination, had significantly lower LA (reservoir, conduit, contractile), RA (reservoir, conduit), LV (global, GLS) and RV (free wall) longitudinal strains (Figure 1). The optimal strain thresholds associated with mortality are displayed in Table 1: -19.1% for LV and RV, +36.4% for LA reservoir strain, +16.6% for LA conduit strain, +27.5% for RA reservoir strain, +16.0% for RA conduit strain. Kaplan Meier curves for cumulative hazards for all-cause death using strain parameters showed significant difference of survival according to LV GLS, RV free wall strain, LA and RA reservoir strains, LA and RA conduit strains (Figure 2). Conclusion: Beyond RV cavity remodeling and dysfunction, PE induces acute alteration of the 4-cardiac chambers strains. Strain analysis appears as an interesting tool in addition to conventional echocardiographic parameters to assess heart cavities dysfunction and predict mid-term outcome.