tbuckley/cabot-search huggingface dataset:
Abstract 12823: As Anticoagulation Use Increases, Embolic Events Downtrend in Atrial Fibrillation Hospitalizations
Authors: Moises A Vasquez, Crystal L Yan, Ivan A Mijares, Juan Quintero Martinez, Jose Luna Alvarez Amezquita, mohammed mustafa, Mina Iskander, Litsa Lambrakos, Alex Velasquez, Jeffrey J Goldberger, Raul D Mitrani
Journal: Circulation (2023)

Background: Direct oral anticoagulants and Left atrial appendage closure (LAAC) were approved for use in 2010 and 2015, respectively. Data on temporal changes in stroke prevention strategies and rates of embolic complications in atrial fibrillation (AF) in the 2010s decade are limited. Aims: Describe trends in long-term anticoagulation (AC), LAAC use, and in-hospital AF associated ischemic stroke (IS), transient ischemic attacks (TIA), and systemic embolic events (SEE) between 2010 and 2019. Methods: The national inpatient database was used to identify patients with AF from 2010 to 2019. Data were divided into 2 eras: 2010-2014 and 2015-2019. Results: A total of 40,787,136 inpatients with AF were identified: prevalence increased from 18,594,372 in 2010 to 2014 (46%; mean [SD] age 75.5 [12.0] years; 50.3% male) to 22,192,764 in 2015 to 2019 (54%; mean [SD] age 75.1 [11.8] years; 52.5% male). There was a marked increase in long-term AC use (27.2% to 40.2%; P=0.001) and rates of percutaneous LAAC procedures (0.01% to 0.6%; P &lt;0.001) from 2015 to 2019. IS rates among patients with AF increased from 2010 to 2014 (3.5% to 3.8%; P=0.04), with no significant temporal change from 2015 to 2019 (P=0.84). TIA rates declined from 2010 to 2014 (1.2% to 1.0%; P=0.017) and continued a downtrend from 2015 to 2019 (0.9% to 0.7%; P=0.002). There was no temporal change in SEE or the composite outcome of all embolic events from 2010 to 2014, followed by a decline from 2015 to 2019 in SEE (0.5% to 0.4%; P 0.012) and all embolic events (5.1% to 4.8%; P 0.026) ( Figure 1 ). Mean rates of major bleeding events increased from 5.7% in 2010-2014 to 9.1% in 2015-2019 (P &lt;0.001). Conclusion: In an inpatient AF population, the composite outcome of all embolic events and specifically SEE downtrend from 2015 to 2019, likely due to increased AC use. Further data assessing the risk-benefit ratio of available therapies for stroke prevention in inpatients with AF - AC and LAAC - are needed to optimize personalized strategies.
Abstract 12346: Atherosclerotic Cardiovascular Disease Risk Associated With Social Determinants of Health at Individual and Area Levels
Authors: Mengying Xia, Jaejin An, Monika M Safford, Lisandro Colantonio, Paul Muntner, Kristi Reynolds, Andrew E Moran, Yiyi Zhang
Journal: Circulation (2023)

Introduction: Adverse social determinants of health (SDOH) are associated with an increased risk for atherosclerotic cardiovascular disease (ASCVD). However, it is unclear if the ASCVD risks associated with area-level SDOH are similar to those with individual-level measures. Further, SDOH are not included in the Pooled Cohort Equations (PCEs) when estimating 10-year ASCVD risk. Studies have shown that PCEs systematically underestimate risk for socially deprived individuals. Aims To examine the association of individual- and area-level SDOH including education, income, and employment with incident ASCVD. Also, we assessed if adding SDOH to the PCEs improves risk prediction accuracy. Methods: We pooled data from four cohorts: Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis, Framingham Heart Study Offspring Cohort, and Reasons for Geographic and Racial Differences in Stroke Study. We excluded participants with a history of ASCVD. Individual-level SDOH were based on participants’ self-report and area-level SDOH were derived by linking participants’ addresses to US Census tract data. We used Cox proportional hazards models to assess the associations between SDOH and ASCVD. We also assessed the changes in discrimination (Harrell’s C-index) and calibration (Integrated Brier Score) after adding SDOH to risk prediction models. Results: We analyzed data from 27,603 participants (mean age 61.4 years, 59% women, and 49% White). During a median follow-up of 13 years, 2,839 incident ASCVD events occurred. Both individual- and area-level SDOH were associated with ASCVD ( Figure, Panel A ). Adding both individual- and area-level SDOH to risk prediction modestly improved model discrimination and calibration in Black men and women ( Figure, Panels B &amp; C ), and also improved calibration in non-Black women. Conclusions: The findings suggest that SDOH may be considered in the development of future ASCVD risk assessment tools, particularly among Black individuals.
Abstract 12179: Neutrophil-Specific Deletion of Beta2 Integrins Alleviates Myocardial Ischemia-Reperfusion Injury in Male Mice
Authors: Wei Liu, Chunxia Cronin, Lai Wen, Klaus Ley, Bruce T Liang, Zhichao Fan
Journal: Circulation (2023)

Neutrophil recruitment and their mediated inflammatory responses are critical for cardiovascular diseases, including myocardial ischemia-reperfusion (I/R) injury, which accounts for 9% mortality and 10% morbidity rates in ischemic heart disease patients. Blocking leukocyte recruitment in mouse knockouts (KO) of beta2 integrin (CD18) or blocking beta2 integrin with antibodies in multiple animals significantly reduced infarct size after myocardial I/R injury. However, the neutrophil-specific contribution of beta2 integrin to I/R injury is unknown. This study used the newly established CD18 flox/flox (hITGB2 KI) mouse strain to address this knowledge gap. We crossed them to MRP8-cre (S100A8) and confirmed the neutrophil-specific KO of beta2 integrins. Interestingly, all leukocyte subtypes were elevated in the blood of MRP8-cre CD18 flox/flox mice, indicating potential chronic inflammation. After 35 minutes of myocardial ischemia and 24 hours of reperfusion, we found MRP8-cre CD18 flox/flox mice have significantly reduced infarct size compared to cre- controls. However, if we distinguish the sex in analysis, we only saw a significant alleviation in male but not female MRP8-cre CD18 flox/flox mice. The quantification of leukocyte recruitment in hearts after I/R injury showed that male but not female MRP8-cre CD18 flox/flox mice have less recruitment of neutrophils and Ly6C high inflammatory monocytes. These results suggested sex bias of neutrophil-specific contributions of beta2 integrins in myocardial ischemia-reperfusion injury and provided new insights into beta2 integrin targeting therapies.
Abstract 12298: Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Rheumatic Mitral Valve Disease
Authors: Siddharth Agarwal, Bilal Munir, Vagisha Sharma, Harsh P Patel, Satyam Krishan, joshua E payne, Christopher V Desimone, Abhishek Deshmukh, Stavros Stavrakis, Warren M Jackman, Sunny S Po, Zain Ul Abideen U Asad
Journal: Circulation (2023)

Introduction: There is a lack of data on procedural safety and outcomes in patients with rheumatic mitral valve disease (RMVD) undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that the presence of RMVD may affect the outcomes of patients undergoing AF ablation and tested this hypothesis using data from a large, nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients with RMVD were then identified by using ICD-10 CM codes. A multivariable logistic regression model was used to adjust for confounders. Results: Our cohort included 50,728 weighted AF ablation procedures, of which 3,500 (6.9%) patients had RMVD. Patients with RMVD were older at the time of catheter ablation, with a significantly higher percentage of females, less likely to have paroxysmal AF, and had a higher burden of comorbidities including congestive heart failure, renal failure, and hypertension. On multivariable analysis, the presence of RMVD was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.28; 95% confidence interval [CI]: 1.12-1.47; p&lt;0.01) with no difference in the odds of in-hospital mortality or other periprocedural outcomes. Also, RMVD was associated with longer length of stay (adjusted mean difference: +1.06; 95% CI: +0.67 - +1.45; p&lt;0.01) days and lower odds of routine home discharge (aOR:0.77; 95% CI: 0.69-0.87; p&lt;0.01). There was no difference in the odds of 30-day or 180-day all-cause, AF-related, or atrial flutter-related readmissions in patients with RMVD vs. no RMVD (Figure 1). Conclusion: In conclusion, patients with RMVD undergoing AF ablation have higher odds of periprocedural cardiovascular complications with similar odds of 30-day and 180-day all-cause and AF-related readmissions
Abstract 12177: Quantitative Flow Ratio is a Great Predictor of Microvascular Obstruction in ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention
Authors: Yanguo Xin, Jiayu Li, Hongwei Li
Journal: Circulation (2023)

Backgrounds: Compare the predictive effects of ST-segment resolution (STR) and quantitative flow ratio (QFR) in the detection of MVO in STEMI patients after PCI. Research Questions: To investigate the efficacy of STR/QFR in the evaluation of MVO detected by CMR in STEMI after PCI. Methods: A prospective cohort study enrolled 208 consecutive patients with STEMI. The degree of STR post procedure and predischarge after reperfusion was calculated. QFR were measured according to the angiography, CMR was performed within median time 5 days after revascularization to determine MVO. Clinical factors were enrolled to predict the incidence of MVO. Results: The MVO/LV mass is 1.42±2.28 in 126 patients with MVO according to CMR, and the area under ROC curves (AUC) identified QFR is the best predictor (AUC: 0.784, P &lt;0.001). Factors including QFR, STR, TIMI flow, CK-MB, cTnI, WBC, and HsCRP showed good predictive effects for the incidence of MVO ( P &lt;0.05). Except for peak cTnI, QFR (%) was the best predictor (AUC: 0.784, P &lt;0.001) ( Figure 1 ). A nomogram for predicting MVO was done (c-index: 0.894) ( Figure 2 ). A significant correlation was observed between STR and various parameters ( P &lt;0.05), except for the correlation between predischarge STR and MVO/LV mass at 6 months. Predischarge STR has the best correlation with infarct size after the 6-month follow-up ( r =-0.509, P &lt;0.001) ( Figure 3 ). Regression analysis indicated that postoperative STR (β=-0.248, P =0.007) was a significant predictor of MVO/LV mass ( Figure 3 ). Figure 4 further analyzed heart function from in-hospital CMR between different postoperative STR levels, and from 6 months CMR between predischarge STR subgroups. Higher STR predicted less cardiac injury and more ideal index of cardiac remodeling. Conclusions: In STEMI patients after PPCI, QFR demonstrated better predictive effect of the incidence of MVO than STR. Predischarge STR is closely related to infarct size and ejection fraction after 6-month follow-up.
Abstract 12147: Flow-Induced Cellular Reprogramming in Mouse Atherosclerosis Model
Authors: Christian Park, Nicolas Villa-Roel, KIYOUNG JEONG, Kyung In Baek, Yerin Kim, Aitor Andueza, Hector Zepeda, Amy Chou, Sandeep Kumar, Dong-Won Kang, Hanjoong Jo
Journal: Circulation (2023)

Introduction: Atherosclerosis, a leading cause of death worldwide, is a chronic inflammatory disease that occurs preferentially in the arterial regions exposed to disturbed flow (d-flow), while those exposed to stable flow (s-flow) are protected. Recently, we reported d- F low I nduced R eprogramming of E ndothelial cells (ECs) ( FIRE ), including endothelial inflammation, endothelial-to-mesenchymal transition (EndMT) and endothelial-to-immune-cell transition (EndIT). Hypothesis: D-flow plus hypercholesterolemia (HighChol) exacerbates reprogramming of arterial cells leading to atherosclerosis development compared to d-flow alone and HighChol alone. Methods: To test this hypothesis, we induced atherosclerosis in C57BL/6 mice by an AAV-PCSK9 injection and high-fat diet to induce HighChol and/or partial carotid ligation (PCL) surgery to expose left carotid artery (LCA) to d-flow compared to the right CA (RCA) exposed to s-flow. Single cells prepared from collagenase digestion of the LCAs and RCAs at 2 and 4 weeks post-PCL were analyzed by scRNA-seq and integrated with our prior scRNA-seq data obtained at 2 days and 2 weeks post-PCL under normal blood cholesterol levels. Results: Overall, our data showed that d-flow was the most predominant regulator of arterial cell characteristics while HighChol alone had relatively minor effects. In the RCA, homeostatic EC, smooth muscle cell (SMC), and macrophage (MΦ) clusters were dominant regardless of cholesterol levels. Additionally, for these cell types, we found clusters that increased in response to d-flow in the LCA, which further increased with HighChol and time. Surprisingly, diffusion map trajectory analysis revealed a clear convergence of transcriptomic profiles of EndIT ECs, SMC-derived foam cell SMCs, and foamy MΦs. Conclusions: These results suggest FIRE initiated by d-flow is exacerbated by HighChol. We also found that SMCs and MΦs transition toward proatherogenic phenotypes under d-flow, which is further exacerbated by HighChol. Furthermore, differential gene expression analysis showed that proatherogenic ECs, SMCs, and MΦs show common transcriptomic profiles, suggesting common set of genes and pathways that could be targeted as effective atherosclerotic therapeutics.
Abstract 12143: Hearing is Believing: A Case of a Ruptured Sinus of Valsalva Aneurysm
Authors: Sean P Murphy, Giselle A Suero-Abreu, Adam N Paine, Duke E Cameron, Christopher P Learn, Jordan P Bloom, Doreen Defaria Yeh
Journal: Circulation (2023)

A 36-year-old previously active and healthy male was referred to our Adult Congenital Heart Disease clinic with worsening exertional dyspnea and intermittent palpitations over the past 6 months. He had recently been diagnosed with a membranous ventricular septal defect (VSD) and membranous septal aneurysm at another hospital, although images were not available for review.On physical exam, a continuous cardiac murmur was noted which prompted reconsideration of the diagnosis, with highest suspicion of ruptured sinus of Valsalva aneurysm (SVA). An urgent cardiac CT was obtained, which showed a large, mobile right SVA protruding into and partially obstructing the right ventricular outflow tract (RVOT), with pulmonic regurgitation and dynamic closure of a supracristal VSD (Figure 1A). A margin of the SVA was ill-defined and suspicious for rupture, although no definite communication was seen. An expedited TTE showed findings consistent with SVA rupture (Figure 1B), and he was admitted for surgery soon thereafter. Intra-operatively (Figure 1C), SVA rupture into the RVOT was confirmed by direct inspection; the SVA tissue was resected, the defect closed with a fresh autologous pericardial patch, and the VSD was closed with pledgeted sutures. Post-operatively, there was no leakage around the patch margin and only trace aortic regurgitation.A ruptured SVA causes continuous shunting from the aorta into an adjacent cardiac chamber and if left unrecognized, can lead to right heart failure, arrhythmia, and potentially sudden death, emphasizing the need for early identification. Echocardiography may show an aneurysmal sinus of Valsalva with a continuous (with accentuation in diastole) high-velocity, turbulent flow-jet into an adjacent cardiac chamber, and holodiastolic aortic flow reversal; a VSD is often present. Cross-sectional imaging is also important for diagnosis and surgical planning. A comprehensive physical exam is crucial to mitigate the risk of misdiagnosis.
Abstract 12292: Lipid-Lowering Therapy and LDL-C Control for Primary Prevention in Persons With Diabetes Across 90 Health Systems in the United States
Authors: Emily Decicco, Eric D Peterson, Anand Gupta, Kristin Gillard, Evelyn Sarnes, Ann Marie M Navar
Journal: Circulation (2023)

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in persons with type 2 diabetes, and national guidelines recommend statin therapy for primary prevention of ASCVD in persons with type 2 diabetes (T2DM). Aim: To evaluate the degree of utilization of appropriate intensity statin therapy for primary prevention in patients with T2DM in community practice. Methods: We evaluated lipid-lowering therapy (LLT) and LDL-cholesterol (LDL-C) levels in patients aged 40–75 years with T2DM but without atherosclerotic cardiovascular disease (ASCVD), across 90 health systems in the United States participating in an EHR-derived dataset, Cerner Real World Data at baseline and one year follow-up. Multivariable logistic regression was used to evaluate factors associated with guideline-recommended (moderate- to high-intensity) statin therapy use. Results: We identified 241,232 patients with T2DM (58.1% on appropriate statin, 7.0% on low-intensity statin, and 34.9% on no statin. Predictors of appropriate statin therapy included retinopathy (adjusted odds ratio [aOR], 1.26; 95% CI, 1.15–1.38), hypertension [aOR 1.52 (1.43-1.61)], and stage 3 chronic kidney disease [CKD; aOR 1.14(1.07–1.21]. Women (aOR, 0.85, 95% CI, 0.82-0.87), and those with rheumatoid arthritis [aOR, 0.79 (0.71–0.87)], psoriasis [aOR, 0.85 (0.75–0.96)], and hepatitis C [aOR, 0.4 (0.39–0.46)] had reduced odds of appropriate statin treatment. Utilization of ezetimibe was rare (2.0%). LDL-C control was suboptimal (36.9% and 27.9% had LDL-cholesterol ≥100 mg/dL and &lt;70 mg/dL, respectively). Therapy uptitration was infrequent; at one-year only 65.3% of patients were on appropriate statin intensity (Figure). Conclusions: Increased efforts are needed to improve primary prevention of ASCVD in adults with T2DM, particularly among women and those with risk-enhancing inflammatory conditions.
Abstract 12393: Pexidartinib Ameliorates Monocrotaline-Induced Pulmonary Arterial Hypertension in Rats
Authors: Kazuto Nishiura, Tetsuro Yokokawa, Tomofumi Misaka, Shunsuke Miura, Yusuke Tomita, Akihiko Sato, Masayoshi Oikawa, Koichi Sugimoto, Kazuhiko Nakazato, Yasuchika Takeishi
Journal: Circulation (2023)

Background: Pulmonary arterial hypertension (PAH) is a life-threatening disease caused by pulmonary artery remodeling, inflammation, and altered immune responses. Lungs from PAH patients show that accumulation of perivascular macrophages is a key factor for the development of pulmonary artery remodeling, which leads to right ventricular failure. However, pharmacological inhibition of this pathway for treating PAH has not been thoroughly examined. Pexidartinib inhibits macrophage proliferation and polarization, thus can be a candidate for treating PAH. Objective: To investigate the effect of pexidartinib in PAH. Methods: Male Sprague-Dawley rats were divided into 4 groups: control, pexidartinib treated, monocrotaline (MCT)-exposed, pexidartinib treated and MCT-exposed rats. Right ventricular hemodynamic changes, right ventricular hypertrophy, and pulmonary artery morphological features were examined. Pulmonary artery perivascular macrophage infiltration was determined by immunofluorescence of CD68 and arginase-1 (M2 macrophage marker). Results: Immunofluorescence of lungs from MCT-exposed PAH rats showed perivascular CD68- and arginase-1-positive macrophage infiltration (P &lt; 0.05, each) and muscularization of pulmonary arteries (P &lt; 0.05) compared to controls. Treatment of pexidartinib inhibited perivascular CD68- and arginase-1-positive macrophage infiltration (P &lt; 0.05, each) and attenuated right ventricular systolic pressure and the right ventricle to the left ventricle plus septum ratio (RV/LV+IVS) in MCT-exposed PAH rats (Figure 1). Conclusion: Pexidartinib treatment prevented MCT-induced PAH and right ventricular hypertrophy by inhibiting perivascular macrophage infiltration and M2 macrophage polarization in rat pulmonary arteries. Therefore, pexidartinib may be a promising drug for the treatment of PAH.
Abstract 12391: Correlation of Admission Heart Rate With MACE Among ST-segment Elevation Myocardial Infarction Patients (killip1) Undergoing Primary Percutaneous Coronary Intervention
Authors: Jian Yang, Ping Zeng
Journal: Circulation (2023)

Introduction: Different admission heart rate (AHR) levels are frequently observed in ST-segment elevation myocardial infarction (STEMI) patients. However, it is not clear whether AHR is related to the occurrence of major adverse cardiovascular effects (MACE) after pPCI. Hypothesis: We aim to explore the possible correlation between AHR and MACE after STEMI patients receive the primary percutaneous coronary intervention (pPCI). Methods: The Chinese STEMI pPCI Registry was registered with ClinicalTrials.gov (NCT04996901). We analyzed 5586 patients with STEMI who underwent pPCI in a multi-center study in China, and patients were grouped according to the AHR greater or less than 70 bpm. Patients’ in-hospital MACE referred to new-onset heart failure and death. The association between AHR and in-hospital MACE was assessed in Logistic regression analysis. Results: 4004 patients were enrolled ultimately, including 1105 patients with AHR&lt; 70 bpm and 2899 patients with AHR≥ 70 bpm. After multivariate adjustment for age, gender, DBP, HR, smoking, hypertension, et al., the OR of MACE in patients with AHR ≥ 70 bpm was 1.573-1.581 times that of the other group in calibration Model I to IV. Subgroup analysis showed that it was also observed in the young (&lt;60 years old) or the old (≥60 years old), male or female, Left anterior descending (LAD), and Right circumflex artery (RCA) patients (all P &lt;0.05). We still found that AHR was a risk factor for in-hospital MACE after excluding those patients with a history of MACE, RCA occlusion and AHR less than 50 bpm or greater than 90 bpm in sensitivity analysis. ROC curve of AHR in predicting the occurrence of MACE after pPCI was 0.699. The cubic spline also confirmed that the risk of MACE decreased significantly with the reduction of AHR. Conclusions: In STEMI patients undergoing pPCI, elevated AHR (≥70 bpm) identifies those at increased risk of in-hospital MACE. AHR less than 70 bpm may be a protective factor to avoid the occurrence of MACE.