tbuckley/cabot-search huggingface dataset:
Abstract 18253: Hematocrit Level is Associated With Subclinical Vascular Inflammation in a Middle-Aged Brazilian Population
Authors: Shozab S Ali, Ebenezer Oni, Adil Karim, Wasim Maziak, Michael J Blaha, Seth S Martin, Theodore Feldman, Arthur A Agatston, Roger S Blumenthal, Jose A Carvalho, Raquel D Conceicao, Romeu S Meneghelo, Raul D Santos, Khurram Nasir
Journal: Circulation (2013)

BACKGROUND: Hematocrit (Hct) has been inconsistently reported to be a risk marker of cardiovascular morbidity and mortality. Previous studies have shown some association between Hct and cardiovascular risk, however, its association with subclinical disease is not clear. We aimed to investigate whether Hct is related to subclinical vascular inflammation in a middle-aged population. METHODS: We evaluated 6,437 healthy Brazilian subjects (43±10 years, 79% males) without clinical coronary heart disease between November 2008 and July 2010. A C-reactive protein (CRP) ≥ 3mg/dl was used as a marker for vascular inflammation and Hct was divided into quartiles. Anemia was defined as a hematocrit &lt;36% in women and &lt;39% in men. RESULTS: Mean±SD Hct was 43±4%. Overall, one third (31%) had elevated hs-CRP and 5% were anemic. The prevalence of elevated hs-CRP was significantly lower across Hct quartiles (1 st =35%, 2 nd =31%, 3 rd =29%, 4 th =29%, p=0.001). In addition, those with anemia were more likely to have a higher CRP level compared to those with normal Hct (36% vs. 31%, p=0.06). As shown in table below, even after controlling for confounding variables higher Hct levels were 29-35% less likely to have elevated hs-CRP levels. In fully adjusted model, presence of anemia was associated with 1.31 fold (95% CI 1.02-1.68) likelihood of elevated CRP. CONCLUSIONS: In our study, individuals with anemia and lower Hct were more likely to have higher burden of subclinical inflammation; however, causality cannot be proved due to cross-sectional nature of the study. Further prospective studies are needed to fully understand the interactions of maintaining an optimal Hct.
Abstract 18249: Spatially-Integrated Vectorcardiogram: An Enabling Technique for Arrhythmia Cardiac Gating in High-Field MRI
Authors: Thomas S Gregory, Zion T Tse
Journal: Circulation (2013)

Background: Accurate QRS complex detection is essential for Cardiac MR (CMR) gating and Heart Rate (HR) monitoring. Magnetohydrodynamic voltage (V MHD ) ellipses the real ECG QRS complex in high field MRI, and is severally irregular in patients with arrhythmia. This increases the difficulty of performing CMR imaging. Objectives: Detect QRS complexes in arrhythmic ECG signals, robust to effects of MHDs in high-field MRI. Methods: ECG data was acquired using an MRI-conditional 12-lead system from two patients diagnosed with Atrial Fibrillation (AF) both outside and in a 3T MRI [1]. A spatially-integrated Vectorcardiogram method (siVCG) was applied for cardiac gating. The siVCG involves synthesizing a VCG from the ECG (Fig A1-A4) using an inverse Dower transform [2-3]. The resulting VCG (Fig B1-B4) from outside the scanner was then used as a reference to estimate the heart’s principal (HPL) axis and to adapt the VCG pattern of the QRS complex. The VCG inside the MRI was projected onto the HPL axis (Fig C1-C2) to maximize the QRS complex amplitude [1]. The HPL axis was chosen also due to its close alignment with the MRI main field (B 0 ) for the minimized V MHD (V MHD is perpendicular to B 0 ). The HPL axis of the projected VCG was numerically integrated along the heart’s perpendicular (HPR) axis (Fig C3). This was performed to take advantage of the large changes of the VCG signal that happen in the HPL and HPR axes simultaneously during the short duration of the QRS complex . A threshold was then applied to the result for cardiac gating (D1-D2). Results: The siVCG maintained an improvement over the conventional VCG for cardiac gating, with each method having a percent error in these trials of 2.3% and 3.5% respectively (Fig C-D). Conclusions: The siVCG provides a notable improvement to cardiac gating in high-field MRI over conventional VCG. Ref: [1] Tse, MRM, 2013 [2] Fischer, MRM, 1999 [3] Dower, CC, 1980 Acknowledgements: NIH U41- RR019703 , NIH R03 EB013873 -01A1, SBIR-1 R43 HL110427 -01
Abstract 18239: Microrna-204 and -486 Regulate the Expression of Osteogenic Transcription Factors in Human Aortic Valve Cells: Evidence for Epigenetic Modulation of Valvular Cell Osteogenic Reprogramming
Authors: Rui Song, David A. Fullerton, Lihua Ao, Kesen Zhao, Xianzhong Meng
Journal: Circulation (2013)

Calcific aortic valve disease affects a large number of elderly people. Aortic valve interstitial cells (AVIC) play an important role in valvular calcification. However, pharmacological prevention of the progression of this disease is unavailable due to limited knowledge of underlying molecular mechanisms. Transforming growth factor-beta 1 (TGF-β1) and bone morphogenetic protein-2 (BMP-2) are capable of inducing AVIC reprogramming (expression of osteogenic transcription factors) and have been implicated in the pathogenesis of calcific aortic valve disease. We hypothesized that microRNAs modulate the responses of human AVIC to TGF-β1 and BMP-2 stimulation. Methods and results: Stimulation of AVIC isolated from normal human aortic valves with TGF-β1 or BMP-2 up-regulated the expression of osteogenic transcription factors Runx2 and Osx. Prolonged stimulation with TGF-β1 or BMP-2 induced calcium deposit formation. MicroRNA array and real-time qRT-PCR analysis revealed that TGF-β1 and BMP-2 each down-regulated microRNA-204 and up-regulated microRNA-486. MicroRNA-204 mimic suppressed the expression of Runx2 and Osx, and microRNA-204 inhibitor increased Runx2 and Osx levels in cells exposed to TGF-β1 or BMP-2. Conversely, microRNA-486 mimic increased Runx2 and Osx levels, and microRNA-486 inhibitor reduced Runx2 and Osx expression in cells exposed to TGF-β1 or BMP-2. More importantly, treatment of human AVIC with a combination of microRNA-204 inhibitor and microRNA-486 mimic up-regulated the expression of Runx2 and Osx, and induced calcium deposit formation in the absence of TGF-β1 or BMP-2. Conclusions: TGF-β1 and BMP-2 induce the expression of Runx2 and Osx in human AVIC that is associated with down-regulation of microRNA-204 and up-regulation of microRNA-486. MicroRNA-204 negatively, but microRNA-486 positively modulates Runx2 and Osx expression in human AVIC, and microRNA-204 inhibitor and microRNA-486 mimic synergistically promote human AVIC osteogenic reprogramming. These findings provide new insight into the mechanism by which TGF-β1 and BMP-2 promote aortic valve calcification and indicate that microRNAs are potential therapeutic targets for suppression of the progression of calcific aortic valve disease.
Abstract 18244: Implication of Obesity on Length of Stay and Cost in Atrial Fibrillation Patients- An Objective Evidence
Authors: Valay Parikh, Nilay Patel, Ghanshyambhai T Savani, Vipulkumar Bhalara, Nileshkumar J Patel, Ankit Chothani, Neeraj Shah, Erinmarie Sullivan, Kathan Mehta, Vikas Singh, Abhishek Deshmukh, Ankit Rathod, Apurva O Badheka, Marcin Kowalski, Raul D Mitrani, Juan Viles-Gonzalez
Journal: Circulation (2013)

Background: Obesity is considered to be an important co-morbidity in patients with atrial fibrillation (AF). However, its direct implication in terms of cost and length of stay is missing. METHODS: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2000 and 2010 using the ICD9-CM code of 427.31 for atrial fibrillation as a primary discharge diagnosis and 278.01 for obesity as a secondary diagnosis. Participants with &gt;18 years of age were only included. The NIS represents 20% of all hospitals in the US. All analyses were performed using the designated weighting specified to the NIS data base to represent national trends. We compared baseline characteristics, length of stay and total cost in obese and non-obese group. RESULTS: We studied 4092578 patients admitted with primary diagnosis of AF. Obese population was younger, had more diabetes and hypertension. Obese population had more private insurance including HMO and fewer medicares and Medicaid insurance. They were more likely to have invasive cardiac work-up including percutaneous cardiac interventions (PCI). Compare to non-obese population, obese patients had a longer length of stay (4.07 vs. 3.59, p&lt;0.0001) mainly driven by length of stay &gt;2 days (61.6% vs. 52%). Their adjusted total hospitalization cost was also higher as compared to non-obese population ($ 25632 vs. $ 21957, p&lt;0.0001). CONCLUSION: This is one of the largest studies to evaluate the implications of obesity on health care resource utilization in patients admitted with atrial fibrillation. Length of stay and cost were higher in obese population as compared to non-obese population. Considering the fact that both obesity and atrial fibrillation are in epidemic proportion right now, financial implication can be huge.
Abstract 18170: The Impact of Systematic Implementation of SPECT Appropriateness Criteria on Procedures Utilization and Cost: A Prospective and Randomized Clinical Trial With One Year Follow-Up
Authors: Jaime Rodriguez, Kaelin DeMuth, Marlow Hernandez, Howard Bush, Kenneth Fromkin, Hermann Stubbe, Nemer Dabage Forzolli, Diana Galindo, Robert Piloto, Jerry Ciocon, Jesus Loquias, Andrew Russell, Jose A. Gascon, Alisha Aggarwal, Paola Salguero, Michael Shen
Journal: Circulation (2013)

Background: The SPECT Appropriateness Criteria (AC) has been used for the last 8 years to improve SPECT and subsequent procedure utilizations. However, there is no prospective trial data on the change of procedure volumes after systematic implementation of AC in the cardiology and primary care clinic settings on daily basis using Electronic Medical Records (EMR). MPI Optimization &amp; Referrals (MORE) Trial is a single center, randomized and prospective study to investigate the long-term impacts of systematic implementation of AC on SPECT/subsequent invasive procedure volumes, clinical and financial outcomes. Methods: Consecutive 10,303 outpatients with 10 physicians were randomized into a control (CG) and interventional (IG) group. All patients were assessed using EMR and SPECT AC (2009). Recommendations to refer for SPECT in the IG were made only if patients were graded as Appropriate SPECT prior to their visits. No recommendations were made to CG. SPECT use through the 5-month study period was compared to the use 5 months prior to the trial as a baseline. All patients were followed for 1 year after initial AC assessment for subsequent catheterization, cardiac events (MI and death) and financial outcomes. Results: Compared to the baseline prior to the trial, SPECT volume had no change in CG, 64 to 68 (6%), but significantly increased in IG from 87 to 112 (29%, p &lt; 0.01). Among patients in the IG group, there is a significant decrease in catheterization from 174 to 110 (37%) compared to 176 to 135 in CG (23%, p&lt;0.002). No significant change in cardiac events (MI and death) between CG and IG in the 1-year follow-up. The cost is significantly decreased in the IG compared to the CG ($5,865±3,433 vs. $9,505±1,345) with the net average savings of $3,640 (38%, p&lt; 0.001) per patient after 1 year. Conclusion: This is the first randomized clinical trial to demonstrate that systematic implementation of SPECT AC using EMR in cardiology and primary care setting on daily basis not only increased SPECT service volume appropriately but also lead to less subsequent invasive procedure utilization and lower the entire care cost without any significant changes of adverse cardiac outcomes. Further studies with long term clinical and financial outcomes are warranted.
Abstract 11684: Involvement of Enhanced Inflammatory Changes in the Perivascular Adipose Tissue in the Pathogenesis of Coronary Hyperconstricting Responses After Drug-Eluting Stent Implantation in Pigs <i>in vivo (Best of Basic Science Abstract)</i>
Authors: Kazuma Ohyama, Yasuharu Matsumoto, Hirokazu Amamizu, Hironori Uzuka, Kensuke Nishimiya, Michinori Hirano, Jun Takahashi, Kenta Ito, Hiroaki Shimokawa
Journal: Circulation (2015)

Background: Recent studies implicated that perivascular adipose tissue (PVAT) plays an important role in cardiovascular disease as a source of various inflammatory mediators with resultant coronary vasomotion abnormalities. In this study, we examined whether inflammatory changes in the PVAT are associated with coronary hyperconstricting responses after drug-eluting stent (DES) implantation in pigs in vivo. Methods and Results: Everolimus-eluting stents (EES) were randomly implanted in pigs into either the left anterior descending or circumflex coronary artery while non-stented artery was used as a control. At 1 month after the implantation, coronary vasoconstricting responses to intracoronary serotonin (100 μg/kg) were examined by coronary angiography in vivo. Then, stented vessels were harvested for immunohistological study for inflammatory changes in the PVAT at the stent edges. Coronary vasoconstricting responses to serotonin were significantly enhanced at the edges of the EES site as compared with the control site (P&lt;0.05, n=12). Histological analysis showed that the extent of inflammatory changes in the PVAT as evaluated by CD68 (macrophage maker) and interleukin-1β (IL-1β) were significantly enhanced at the EES site compared with the control site (both P&lt;0.05) (Figure). Furthermore, there were significant positive correlations between the extent of inflammatory changes in the PVAT and that of coronary vasoconstricting responses (both P&lt;0.001) (Figure). Conclusions: These results suggest that inflammatory mediators in the PVAT (e.g. macrophages, IL-1β) are involved in the pathogenesis of DES-induced coronary hyperconstricting responses in pigs in vivo.
Abstract 18309: Outcomes of Single Versus Kissing Stenting Technique in Lateralized Complex Aortoiliac Bifurcation Lesion
Authors: Yongsung Suh, Young-Guk Ko, Won-Heum Shim, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang
Journal: Circulation (2013)

Backgrounds: Kissing stenting technique has been frequently performed even in the cases of unilateral aortoiliac diseases in order to protect contralateral common iliac artery (CIA) with intermediate plaque burden. However, kissing stenting is associated with loss of access from contralateral side for future revascularization. We compared the outcomes of single versus kissing stenting technique in lateralized complex aortoiliac occlusive disease. Methods: From Jan. 2006 to Dec. 2012, we retrospectively enrolled 86 consecutive patients (73 males, 67±9 years) treated with a single stenting technique and 33 patients (29 males, 68±8 years) treated with a kissing stenting technique for lateralized complex aortoiliac bifurcation lesions. A lateralized complex aortoiliac bifurcation lesion was defined as a significant unilateral CIA ostial stenosis (&gt;70%) combined with an intermediate (30~50%) stenosis of contralateral CIA. Results: Single stenting and kissing stenting was successfully performed in all patients without procedure-related major complications. However, in the single stenting group, bailout stenting in contralateral CIA was required in two (2.3%) cases due to unfavorable plaque shift. Median follow up duration of the single and the kissing stenting group was 24 (3~88) and 14 (3~82) months, respectively. The primary patency of the ipsilateral CIA in the single stenting group was 93.9% comparable with 94.9% in the kissing stent group (OR 0.823, 95% CI 0.157-4.298). Target lesion revascularization occurred in 5 (6%) cases of the single stenting group and in 2 (6.1%) cases of the kissing stenting group. Progression of the contralateral un-stented CIA requiring additional revascularization was observed in only 2 (2.4%) cases of the single stenting group during follow up. Conclusions: Single stenting technique in lateralized complex aortoiliac bifurcation lesion was relatively safe and showed comparable outcomes as the kissing stenting technique.
Abstract 18382: Stromal Cell Derived Factor-1Alpha Promotes C-kit+ Cardiac Stem/Progenitor Cell Quiescence Through Casein Kinase1Alpha and GSK3beta
Authors: Neviana Dimova, Marcin Wysoczynski, Gregg Rokosh
Journal: Circulation (2013)

A population of c-kit + cardiac stem/progenitor cells (CPSC) has been identified in the heart and shown to contribute to myocardial regeneration after infarction. Previously, we have shown the chemokine, stromal cell derived factor 1α (SDF1) is necessary for the myocardial response to infarction where chronic AMD3100 infusion exacerbated MI. Notably, AMD3100 increased CSPC proliferation. The effect of SDF1 on CSPC proliferation was further investigated in primary cultures of magnetically sorted c-kit + CSPCs. SDF1 facilitated CSPC quiescenc by blocking cell cycle progression at the G0 to G1 transition. SDF1 decreased casein kinase 1α (CK1α) consequently attenuating β-catenin phosphorylation, destabilization, and degradation. Increased levels of β-catenin with SDF1 were effective, increasing TCF/LEF reporter activity. SDF downregulation of CK1α was dependent on proteasomal degradation and decreased mRNA expression. CK1α siRNA knockdown verified SDF1-dependent CSPC quiescence requires CK1α downregulation and stablilization of β-catenin. Conversely, β-catenin knockdown increased CSPC proliferation. SDF1 also increased GSK3β Y216 phosphorylation responsible for increased activity. SDF1 mediated CK1α downregulation and increase in GSK3β activity affected cell cycle by downregulation of Bmi1, increased cyclin D1 phosphorylation, and decreased cyclin D1 levels. In conclusion, SDF1 exerts a quiescent effect on resident c-kit + CSPCs by decreasing CK1α levels, increasing GSK3β activity, stabilizing β-catenin, and affecting regulation of the cell cycle through Bmi1 and cyclin D1. SDF1 dependent quiescence is an important factor in stem and progenitor cell preservation under basal conditions, however, with stress or injury in which SDF1 is elevated, quiescence may limit expansion and contribution to myocardial regeneration.
Abstract 12101: Vectorcardiographic QRS and T Loop Roundness is Associated With Sudden Cardiac Death: The Atherosclerosis Risk in Communities and the Cardiovascular Health Study
Authors: Tuan V Mai, Muammar M Kabir, Golriz Sedeghat, Jason Thomas, Jonathan W Waks, Colleen M Sitlani, Mary L Biggs, Charles A Henrikson, Nona Sotoodehnia, Tor Biering-Sørensen, David S Siscovick, Wendy S Post, Elsayed Z Soliman, Scott Solomon, Alfred E Buxton, Mark E Josephson, Larisa G Tereshchenko
Journal: Circulation (2016)

Introduction: Vectorcardiography (VCG) analysis using QRS and T loop roundness has been shown to be associated with prior myocardial infarction, but their association with sudden cardiac death (SCD) remains unknown. Hypothesis: We hypothesized that QRS and T loop roundness are independently associated with sudden cardiac death (SCD). Methods: We prospectively analyzed reconstructed VCGs of 19,972 subjects at the baseline visit from the Cardiovascular Health Study (n=5374, age &gt;65) and the Atherosclerosis Risk in Communities study (n=14,598, age 45-64). QRS and T loop roundness was measured by the roundness index (RI) and principal component analysis (PCA) ratio. We evaluated the association between these parameters and the risk of SCD using 3 multivariate Cox Models. Model 1 adjusted for demographic characteristics (age, sex, race, study center/cohort), model 2 additionally adjusted for prevalent cardiovascular disease (coronary heart disease, heart failure, stroke, atrial fibrillation, use of beta blocker) and traditional cardiovascular risk factors (BMI, hypertension, diabetes, smoking, alcohol, cholesterol, HDL, triglycerides, physical activity index, creatinine), and model 3 further adjusted for ECG parameters associated with SCD (heart rate, QRS QTc, sex-specific Cornell product, BBB/IVCD). Results: Smaller QRS loop RI (SD) was independently associated with SCD in model 3 (HR 0.89 [95%CI 0.81-0.97]; p=0.01). Larger T loop RI (SD) was associated with SCD only in minimally adjusted model 1 (HR 1.14 [95%CI 1.06-1.23]; p=0.01). Larger T loop PCA ratio (SD) was associated with SCD in all three models (model 1, HR 1.32 [95%CI 1.23-1.43]; model 2, HR 1.16 [95%CI 1.07-1.25]; model 3, HR 1.11 [95%CI 1.03-1.20], all p &lt;0.01). Conclusions: Smaller QRS loop roundness and larger T loop roundness are associated with an increased risk of SCD. VCG analysis can help identify patients at increased risk of SCD.
Abstract 11635: Non-Alcoholic Fatty Liver Disease and Subclinical Atherosclerosis in Mexican Americans
Authors: Clarence D Gill, Kristina P Vatcheva, Jen-Jung Pan, Beverly Smulevitz, Michael B Fallon, David D McPherson, Joseph B McCormick, Susan P Fisher-Hoch, Susan T Laing
Journal: Circulation (2016)

Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of the metabolic syndrome, whose criteria are risk factors for atherosclerotic CVD. We aimed to evaluate the prevalence of NAFLD, its association with subclinical atherosclerosis, and factors that may account for this association in Mexican Americans. Methods: In a population based cross-sectional sample (n=164) drawn from the Cameron County Hispanic Cohort in Texas, carotid intima media thickness (cIMT), an indicator of subclinical atherosclerosis, was measured by ultrasound. Abnormal carotid study was defined as mean cIMT &gt;75 th percentile for age and gender and/or plaque presence. NAFLD was defined as steatosis by ultrasound in absence of other causes of liver disease. Multivariable weighted regression analyses were performed to evaluate associations between NAFLD and cIMT. Results: Mean age was 50.3±1.8 years with 60% females. Mean BMI was 30.1 ± 0.4 kg/m2 with 61% meeting criteria for the metabolic syndrome. There was a very high prevalence of NAFLD (49%) among Mexican Americans. Subjects with NAFLD had greater BMI, abdominal obesity, fasting glucose levels, dyslipidemia, and tended to have diabetes or metabolic syndrome. A third of subjects with NAFLD also had evidence of subclinical atherosclerosis (33%). After adjusting for covariates, there was an independent association between NAFLD and increased cIMT, but only in younger subjects &lt;55 years (p=0.02). Subjects who had both abnormal liver and carotid ultrasound studies tended to be obese, diabetic, and have the metabolic syndrome. Conclusion: There is a very high prevalence of NAFLD in this Mexican American cohort, with an independent association between NAFLD and subclinical atherosclerosis among younger subjects. Clustering of diabetes, obesity, and metabolic syndrome in this health disparity cohort, with increased risk of both liver disease and atherosclerosis, warrants attention and aggressive intervention.