tbuckley/cabot-search huggingface dataset:
Abstract 11606: Association Between Poor Quality Diet and Stroke Amongst Cardiovascular Diseases in US Adult Population
Authors: HONGBING SUN
Journal: Circulation (2023)

Background: Poor quality diet has been suggested to be related to cardiovascular diseases (CVD). However, relationships between poor quality diet and types of CVD and mortality from CVD are still understudied. The aim of the study was to examine the association of diet quality and CVD. Method: Diet quality was measured by the total Healthy Eating Index (HEI) 2015 scores and HEI-2015 scores of the 13 individual food components based on the 1 st day 24-hour dietary recalls of the US National Health and Nutrition Examination Survey cycles between 1999 and 2020. HEI-2015 scores were calculated for 66,952 adults, including 6390 reported having CVD: heart failure, coronary heart disease, angina/angina pectoris, heart attack and stroke, and 1985 deceased with CVD as the underlying cause of death by 2019. Odds ratios of reporting CVD and hazard ratio of death from CVD using HEI-2015 score, sex, age, smoking status, alcohol consumption, education, marital status, body mass index, physical activities and income to poverty ratio as covariates were calculated. Results: Diet quality measured by HEI-2015 score of US population was significantly lower in adults with CVD than in adults without CVD, particularly in those with stroke. For those aged 18 to 44 years old with reported stroke (total HEI-2015 score 44.1, 95%CI 41.6-46.6), their consumptions of added sugar and saturated fat were significantly higher than those without CVD (total HEI-2015 score 48, 95%CI 47.6-48.4). For those aged 18 to 44 years old surveyed and deceased by 2019 with CVD as the underlying cause of death (total HEI-2015 score 43.2, 95%CI, 40.7-45.8), their consumption of added sugar was significantly higher than those still alive (total HEI-2015 score 48 95%CI 47.6-48.4). Risk of having stroke, as indicated by the odds ratios (0.98, 95%CI 0.98-0.99) was significantly lower in those with higher total HEI-2015 scores. Associations between diet and CVD of other age groups (45-64, &gt;64 years old) are not as significant. Conclusions: There is an apparent association between poor quality diet and having CVD, particularly stroke. High consumptions of added sugar, refined grain, salt and saturated fat are the general contributors to the poor-quality diet in US adult population.
Abstract 12251: Impact on Effectiveness of Carvedilol and Bisoprolol for Patients With Heart Failure Aged 80 Years Old and Older
Authors: Kensaku Higashi
Journal: Circulation (2023)

Background: Heart failure remains a cause of significant mortality and morbidity. Multiple trials have shown the effects of both Carvedilol and Bisoprolol in treatment of heart failure. However, there are few reports that which is more effective for elderly patients. Objective: We investigate retrospectively the effectiveness of Carvedilol and Bisoprolol in reducing all-cause death and readmission due to worsening of disease condition in patients with heart failure aged 80 years old and older. Methods and Results: 604 consecutive patients over the age of 80 were enrolled who were admitted by acute heart failure in our hospital from July 2012 to December 2018. We evaluated the incident rate of clinical events by group treated with Carvedilol and Bisoprolol compared to group with no β-blocker treatment. The clinical events were defined as all-cause death and readmission by worsening of acute heart failure. In low LVEF group (LVEF&lt;50), Kaplan-Meyer methods analysis showed that there were no significant differences between three groups (Bisoprolol, Carvedilol and no beta-blocker). But, in high LVEF group (LVEF&gt;50), Bisoprolol and Carvedilol significantly increased the incident rate of clinical evets for the patients with HF compared with no β-blocker (Bisoprolol: χ2=3.840, Logrank; p=0.05, Carvedilol: χ2=5.443, Logrank; p=0.02).Cox proportional hazard analysis revealed that Bisoprolol and Carvedilol were significant risk factors associated with the adverse clinical events (Carvedilol: Hazard Ratio=1.538, 95% CI; 1.060-2.231: p=0.023, Bisoprolol: Hazard Ratio =1.427, 95% CI; 1.000-2.036: p=0.050). Conclusions: Carvedilol and Bisoprolol significantly increased the incident rate of clinical events in HFpEF with aged 80 years old and older. Beta-blocker therapy for these patients may be harmful. Recent advances in heart failure treatment have led to the need for further evaluation of the introduction and use of beta-blockers in heart failure treatment.
Abstract 12063: Ad Hoc Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry
Authors: Bahadir Simsek, Athanasios Rempakos, Spyridon Kostantinis, Judit Karacsonyi, Stephane Rinfret, Wissam Jaber, William Nicholson, sevket gorgulu, Khaldoon Alaswad, Jaikirshan Khatri, Paul Poommipanit, Nazif Aygul, Oleg Krestyaninov, Dmitrii Khelimskii, BARRY F URETSKY, OMER GOKTEKIN, Philip Dattilo, Srinivasa Potluri, Karim Al-Azizi, Deniz Mutlu, Olga C Mastrodemos, Bavana V Rangan, Salman S Allana, Yader Sandoval, M Nicholas Burke, Emmanouil S Brilakis
Journal: Circulation (2023)

Introduction: Although discouraged, ad hoc chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is occasionally performed. Methods: We examined the clinical, angiographic characteristics and procedural outcomes of patients who underwent ad hoc CTO PCI in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). Results: Of the 10,998 patients included in the registry, 899 (8.2%) underwent ad hoc CTO PCI. The incidence of ad hoc CTO PCI decreased from 18% in 2016 to 3% in 2022. Ad hoc CTO PCI patients had a lower prevalence of comorbidities and less complex angiographic characteristics demonstrated by lower J-CTO score (1.9 ± 1.2 vs 2.4 ± 1.3, p&lt;0.001). In these patients, PROGRESS-CTO major adverse cardiovascular events (MACE) (1.9 ± 1.4 vs 2.5 ± 1.7), mortality (1.2 ± 1.0 vs 1.6 ± 1.1), and perforation (1.5 ± 1.2 ± 2.2 vs 1.5) scores were lower (p&lt;0.001). Technical success was similar between the groups (86%). MACE were lower in the ad hoc CTO PCI group (0.8% vs 2.0%, p=0.009). Ad hoc CTO PCI was not associated with MACE after adjusting for potential confounders, odds ratio: 0.69 (95% confidence interval, 0.30-1.57). In patients with higher J-CTO scores, planned CTO PCI was associated with higher technical success (p&lt;0.001) (Figure). Conclusions: Approximately 8% of CTO PCI procedures are performed ad hoc, usually in less complex lesions and patients with lower complication risk. While ad hoc CTO PCI might be appropriate for carefully selected cases, a staged approach is recommended for most CTO PCI.
Abstract 12172: Trend of Yearly Prevalence and Seasonal Variation of Cardiovascular Diseases With Cancer in Japan
Authors: Nagisa Morikawa, Mika Enomoto, Ako Fukami, Yume Nohara, Shoichiro Nohara, Tatsuhiro Shibata, Koudai Shibao, Kazuo Ishii, Yoshihiro Fukumoto
Journal: Circulation (2023)

Introduction: The advance of anticancer therapy increases cardiovascular diseases (CVD) as comorbidity of cancer; however, data regarding cancer comorbidity in CVD patients remains scant. Further, there is a seasonal variation in CVD, but that in CVD with cancer are scarce. Therefore, we examined the trends of yearly prevalence and seasonal variation of CVD with cancer over 9 years using National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Methods: The NDB sampling dataset were randomly sampled 10% from the whole Diagnosis Procedure Combination (DPC) records extracted and anonymized by Ministry of Health, Labour and Welfare in January, April, July and October from 2011 to 2019. We analyzed each disease which required most medical resource in each patient; I110, I500-519 of ICD-10 code as heart failure (HF), I200-249 as acute coronary syndrome (ACS) and I260, 269 as pulmonary thromboembolism (PTE). We defined CVD prevalence as these CVD (HF, ACS and PTE) records divided by total DPC records, and that of CVD with cancer as CVD records, which included any cancer as comorbidity. Seasonal variation was tested by Chi-square test with a Bonferroni correction. Results: Each prevalence of HF, ACS and PTE was increasing (Panel A), decreasing (Panel B) and slightly increasing, respectively. Annual proportions of cancer comorbidity in HF, ACS and PTE were 5.8%, 3.3% and 15.2% and trends of HF and ACS with cancer comorbidity were slightly increasing (Panels D, E), while that of PTE with cancer was not changed. HF, ACS and PTE prevalence were significantly higher in January (winter) than in July (summer); however, the variation of CVD with cancer was diminished (Panels C, F). Conclusions: Cancer comorbidity proportion of HF and ACS have been gradually increased, while that of PTE has not changed for 9 years. Seasonal variation was diminished in CVD with cancer. CVD with cancer is expected to be increasing regardless of season.
Abstract 11968: Association of Invasive Measures of Congestion With Short- and Long-Term Kidney Function Outcomes Among Patients With Acute Decompensated Heart Failure
Authors: Amanda I Moises, Hocine Tighiouart, Tatsufumi Oka, Marcelle Tuttle, Run Banlengchit, Hannah Sarnak, Katie Ferguson, Jeffrey M Testani, Michael S Kiernan, Mark J Sarnak, Wendy McCallum
Journal: Circulation (2023)

Background: Reduced kidney function as evaluated by estimated glomerular filtration rate (eGFR) is a powerful risk factor for adverse outcomes among patients with acute decompensated heart failure (ADHF). Mechanisms for eGFR declines remain unclear. Studies evaluating congestion as a risk factor have been inconsistent. Hypothesis: Greater degree of congestion in patients with ADHF is associated with worse short- and long-term kidney function. Methods: We examined patients admitted for ADHF who required right heart catheterization from 2015-2021. Initial CVP and PCWP were used as measures of right- and left-sided congestion, respectively. Restricted cubic splines and linear mixed models for eGFR slopes were used to examine the relation between CVP and PCWP with baseline eGFR and in-hospital eGFR slope. End stage renal disease (ESRD) events were obtained from linkage to the US Renal Data System. Cox proportional hazards regression models were used to examine the relation of CVP and PCWP with mortality and ESRD. Results: Among 755 patients, the mean (SD) age and baseline eGFR were 62 (14) years and 58 (27) ml/min/1.73m 2 respectively. 440 (58%) required inotropes during hospitalization. Initial mean (SD) CVP and PCWP were 13.4 (6.6) and 23.4 (8.7) mmHg, respectively. Higher initial CVP and PCWP were significantly associated with lower baseline eGFR and in-hospital eGFR decline (Figure). Over median follow-up of 30 (IQR 10, 56) months, 62 (8.2%) reached ESRD and 264 (35%) died. In multivariable models, higher CVP and PCWP were each associated with increased risk for ESRD (HR [95%CI] per 1 SD higher CVP or PCWP were 1.49 [1.17, 1.91]; 1.30 [1.04, 1.64] respectively). Models were repeated with death as a competing event for ESRD and associations remained largely consistent (sHR 1.36 [1.03, 1.81] for CVP; sHR 1.25 [0.99, 1.57] for PCWP). Conclusion: Congestion is associated with lower baseline kidney function, greater acute declines in kidney function and increased risk of ESRD.
Abstract 12142: Treadmill Exercise Stress Echocardiography Exposes Impaired Left Ventricular Function in Patients Recovering From Hospitalization for COVID-19 versus Historical Controls
Authors: Robert E Goldstein, Edward A Hulten, Thomas B Arnold, Victoria M Thomas, Erika N Walker, Keiko Fox, Hyun Lee, Joya Libbus, Bethelhem Markos, Maureen Hood, Travis E Harrell, Mark C Haigney
Journal: Circulation (2023)

Usual clinical testing rarely reveals persisting cardiac abnormalities in patients after hospitalization for Covid-19. Such testing may overlook residual changes responsible for increased adverse cardiac events seen post-discharge. To further elucidate patients’ long-term status, we performed exercise stress echocardiography (ESE) in 15 patients age 30-63 without myocarditis 3 to 31 months after hospital discharge. We compared patient outcomes to published data in healthy controls (HC) exercising according to the same protocol. Patients’ treadmill exercise (Bruce protocol), averaging 8.2 min, was halted by dyspnea or fatigue. Baselines before stress averaged the same in recovering patients (RP) and HC except for heart rate (HR): 81±13 bpm for RP and 63±8 for HC (p&lt;0.0001). Peak stress values in RP were compared with HC: Stress revealed significantly lower LVEF and raised E/e’ soon after peak effort in RP compared with HC performing the same exercise. Thus, when stressed, patients with no known cardiac impairment before or during Covid-19 hospitalization showed modest but consistently diminished systolic contractile function and diastolic LV compliance during recovery compared to HC. Peak HR during stress was significantly elevated in RP vs. HC; peak SBP also trended higher. Average systolic pulmonary artery pressures among RP remained normal. Our measurements during ESE uniquely identified residual abnormality in cardiac contractile function not evident in the unstressed condition. This finding exposes a previously-unrecognized residual influence of Covid-19 that may relate to underlying autonomic dysfunction, microvascular disease, or diffuse interstitial changes after subclinical myocarditis and may have long-term implications for clinical management and later prognosis.
Abstract 11698: Torsades de Aortique Pustule: A Case of Aortic Abscess Leading to 2:1 AV Block and Torsades de Pointes
Authors: Benjamin Matthews, Martin Marak, Harish Doppalapudi
Journal: Circulation (2023)

Introduction: Endocarditis of the aortic valve has a propensity to create A-V conduction disturbances in up to 10% of cases. Torsades de pointes (TdP) is polymorphic ventricular tachycardia in the setting of prolonged QT interval and bradycardia that is typically preceded by a short-long-short sequence of ventricular activation. We present a case of infective endocarditis with aortic root abscess leading to acute 2:1 A-V conduction and culminating in TdP. Case Summary: A 30-year-old male with history of IV drug use and bioprosthetic aortic valve repair presented with pleuritic chest pain, nausea and vomiting. He was febrile and tachycardic with a systolic murmur at the right upper sternal border. Initial electrocardiogram showed sinus rhythm with no conduction abnormalities. A Transthoracic echocardiography showed a large aortic valve vegetation with an abscess cavity. E Blood cultures grew Streptococcus oralis. Two days later, he developed VT/VF arrest requiring external defibrillation. Preceding ECGs and telemetry showed sinus tachycardia with new left bundle branch block and prolonged QTc. B This progressed to 2:1 AV block C with abrupt transition to relative bradycardia and ventricular ectopy leading to short-long-short ventricular intervals and subsequent TdP. D A temporary pacemaker was placed, and he underwent an aortic root reconstruction with valve replacement. Discussion: While both the etiology of TdP and aortic root abscesses leading to conduction system disease are well described, this case exhibits the real time progression of aortic abscess involvement. The patient presented with a normal QRS morphology. During hospitalization, he developed new LBBB, and the appropriate sinus tachycardia then deteriorated into 2:1 AV conduction leading to relative bradycardia. This abrupt transition with QTc prolongation sets up the nidus for ventricular ectopy (due to early after depolarizations) with salvos of short-long-short sequences causing TdP.
Abstract 12139: Left Ventricular Myocardial Work in Patients With Chagas Disease From a Quaternary Hospital in Brazil
Authors: Alex dos Santos Felix, Daniel B Kasal, Rodolfo De Paula D Lustosa, Helena C Rey, Marcelo I Bittencourt, Felipe Neves de Albuquerque, Ana Luiza F Sales, PEDRO P SPINETI, RICARDO MOURILHE ROCHA
Journal: Circulation (2023)

Background: Left ventricular (LV) function assessment in patients (pts) with Chagas disease (ChD) is challenging. LV ejection fraction (LVEF) as a marker of myocardial contractility in these pts has issues, and alterations in myocardial deformation (MD) may occur in early stages of cardiac disease (CD) before the decline of LVEF. LV global longitudinal strain (GLS) is a good parameter to evaluate LV MD, but is dependent on afterload. LV myocardial work (MW) is a technique which integrates afterload to the calculation of GLS Purpose: To analyze LV function using MW in pts with ChD Methods: 39 pts with positive serology for ChD, (74,4% women, age 68,8 ± 9,7) followed in a quaternary Brazilian hospital, were divided in groups of stages of CD: G1 - normal Echocardiography (Echo) and ECG, G2 - alterations in ECG a/o Echo, normal LVEF, G3 - reduced LVEF. LV MW was measured integrating GLS with non-invasive blood pressure as an afterload index, for generation of pressure-strain loops by specific software(fig.1). Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were measured. Results: 11 pts (28,2%) were in G1, 14 (35,9%) in G2, and 14 (35,9%) in G3. In overall population median values of MW were within normal ranges: GWI = 1760mmHg% (&gt;968), GCW = 2046mmHg% (&gt;1550), GWW= 178mmHg% (&lt;331), GWE = 92 (&gt;83). Values of GWI, GCW and GWE were significantly lower and GWW was higher in G3, compared to G1 and G2, translating into less LV mechanical efficiency (ME) in these pts with more advanced CD (table 1). Despite LVEF and GLS similar between G1 and G2, values of GCW were 12% lower in G2 compared to G1, which could point to a tendency of early alterations in these pts, although not reaching statistical significance (p &gt; 0,05). Conclusion: In pts with advanced stages with Chagas CD (G3) there were significant alterations in parameters that evaluate ME, with reduced values of GWI, GCW and GWE, with higher GWW
Abstract 11635: Device and Formulation Optimization for MK2 Inhibition and Restenosis Prevention at Sites of Peripheral Angioplasty
Authors: William Tierney, Fang Yu, Jackey Ma, Joyce Cheung-flynn, Megan Keech, Jordan Brasuell, Devin Chang, Colleen Brophy, Craig Duvall
Journal: Circulation (2023)

Introduction: Peripheral angioplasty often fails due to intimal hyperplasia (IH), where contractile smooth muscle cells (SMCs) de-differentiate into proliferative, migratory, and pro-inflammatory synthetic SMCs, leading to restenosis. We have formerly shown that potentiation of an MK2 inhibitory peptide (MK2i) via delivery with poly(propyl acrylic acid) (PPAA) can block SMC phenotype switching and neointima formation in a transplant model. This work develops strategies for targeted in vivo MK2i+PPAA delivery to the site of angioplasty. Hypothesis: MK2i+PPAA can be effectively delivered into and retained within the arterial wall using either convective delivery or a coated angioplasty balloon. Methods: These studies have utilized isolated rat aortae as a model tissue. Aortae were balloon damaged and subjected to convective or coated balloon treatment. Delivery and retention of MK2i was determined with confocal microscopy and flow cytometry. MK2i activity was measured using IHC and western blots for pCREB, a downstream substrate of MK2. Results: Convective delivery studies have shown substantial MK2i delivery into the vascular wall, with pre-formed MK2i nanopolyplexes (NPs) having significantly more cell uptake than free MK2i or sequentially delivered PPAA and MK2i. Additionally, we have created a method for layered coating of MK2i+PPAA onto an angioplasty balloon that shows rapid release and successful arterial wall delivery. In efficacy studies, convective delivery of MK2i-NPs and balloon delivery of MK2i+PPAA with 50 mg/mL lactosucrose excipient significantly decreased levels of pCREB downstream of MK2 after balloon damage. Ongoing studies show that both delivery strategies block cellular proliferation in balloon damaged arteries after 7d in a flow loop bioreactor. Conclusions: Convective and coated balloon delivery show promise as strategies for on-target delivery of MK2i+PPAA to peripheral arteries after angioplasty to prevent restenosis.
Abstract 12043: Neutrophil Extracellular Traps in Heart Tissue Drive Cardiac Dysfunction and Adverse Outcomes in Dilated Cardiomyopathy
Authors: Shohei Ichimura, Tomofumi Misaka, Ryo Ogawara, Kazuto Nishiura, Tetsuya Tani, Yusuke Tomita, Yu Sato, Shunsuke Miura, Tetsuro Yokokawa, Takamasa Sato, Masayoshi Oikawa, Atsushi Kobayashi, Akiomi Yoshihisa, Yasuchika Takeishi
Journal: Circulation (2023)

Background: Neutrophil extracellular traps (NETs) have emerged as crucial contributors to cardiovascular diseases, but the significance of NETs in heart failure remains unclear. Aims: We aimed to clarify the relevance of NETs in myocardial tissue in heart failure. Methods and Results: We studied consecutive 62 patients with idiopathic dilated cardiomyopathy (DCM) who underwent endomyocardial biopsy. Using immunohistochemistry, NETs were identified in heart tissue by detecting the colocalization of citrullinated histone H3, neutrophil elastase, and DAPI. DCM patients had significantly higher numbers of NETs per tissue area and per neutrophil compared to control subjects without heart failure (n=11, Figure A ) (P &lt; 0.05 and P &lt; 0.05, respectively). When categorizing DCM patients based on the presence or absence of NETs, patients with NETs (n=32) had lower left ventricular ejection fraction and higher B-type natriuretic peptide levels than those without NETs (P &lt; 0.05 and P &lt; 0.05, respectively). Kaplan-Meier analysis revealed that NETs-positive DCM patients had lower event-free survival rates from the composite of cardiac events including cardiac deaths, decompensated heart failure, and left ventricular assist device implantation over a median 768-day follow-up ( Figure B ). In a multivariable Cox proportional hazard model, the presence of NETs independently associated with the risk of adverse cardiac events (hazard ratio, 5.96; P &lt; 0.05). Ex vivo analysis revealed that NETs-containing conditioned medium from wild-type neutrophils impaired mitochondrial oxygen consumption in mouse adult cardiomyocytes (P &lt; 0.05), while genetic ablation of peptidyl arginine deiminase 4, a molecule essential for NETs formation, abolished this effect. Conclusion: NETs in myocardial tissue contribute to cardiac dysfunction and adverse outcomes in DCM patients, potentially through mitochondrial dysfunction of cardiomyocytes.