tbuckley/cabot-search huggingface dataset:
Abstract 18878: Right Heart Valves Affected by Cancer-Related Non-Bacterial Thrombotic Endocarditis as Potential Cause of Pulmonary Embolism
Authors: sai swetha alladi, Kyle W Klarich, Reto Kurmann, David Hodge, Patrzalek Dariusz, Damon Houghton, Ewa Wysokinska, Waldemar E Wysokinski
Journal: Circulation (2023)

Background: Ca-NBTE primarily affects the mitral valve (MV) and aortic valve (AV), with rare involvement of the right heart valves. Premortem descriptions of this condition are limited to a few case reports. This study presents an initial clinical series focusing on patients with Ca-NBTE specifically affecting their right heart valves. We describe the underlying cancers, types of valve lesions, and associated embolic complications. Patients and Methods: A electronic search of medical records (March 31, 2002, to June 30, 2022) was followed by a manual review to identify adult patients with echocardiographically detected NBTE, active cancer, and no infectious endocarditis or lupus anticoagulant/antiphospholipid antibodies. Results: Out of 115 identified patients with Ca-NBTE (mean age 63.2±9.7 years, 66.1% female), there were 8 cases (7.0%) affecting right heart valves (mean age 64.5±12.1 years, 3 females) with underlying cancer: pancreatic (n=3), lung (n= 2), genitourinary (n=1), gastric (n=1) and neck sarcomatoid carcinoma (n=1). TV was affected in 8 patients and PV in one case; 4 patients had Ca-NBTE limited only to PV, 2 patients had MV and TV, 1 patient had mitral, aortic and TV, and 1 patient with pancreatic cancer had all four valves affected by NBTE. 5 patients had embolic complications to the brain with one patient in that group also experiencing emboli to the kidney and spleen. Out of 4 patients with NBTE limited to TV, two still had brain emboli, one had only pulmonary embolism, and one patient had no embolic complications. Conclusion: Around 7% of Ca-NBTE cases involve the right heart valves, with half of these cases limited to the TV. The cancer profile in these cases resembles that seen in left heart valve involvement.
Abstract 17569: Changes in Adherence to “Life’s Essential 8” and Subsequent Risk of Cardiovascular Disease
Authors: Zhangling Chen, Wenjuan Li, Shenghua Zhou, Aijun Xing, Shouling Wu
Journal: Circulation (2023)

Introduction: The American Heart Association recently released an updated algorithm for evaluating cardiovascular health (CVH)—Life’s Essential 8 (LE8). However, very few studies have evaluated associations between changes in LE8 score over time and risk of cardiovascular disease (CVD). Hypothesis: We hypothesized that improving adherence to LE8 score over time was associated with lower CVD risk. Methods: We examined associations between 6-year changes (from 2006 to 2012) in LE8 score (score range, 0-100) and risk of CVD, including heart disease and stroke (from 2012 to 2020). Participants were 53328 Chinese adults from the Kailuan Study who were free from CVD in 2012. Diet, lifestyle and health conditions were repeatedly assessed every 2 years. The LE8 score was calculated based on scores for 8 components: diet quality, physical activity, smoking status, sleep health, BMI, blood lipids, blood glucose, and blood pressure. We used Cox proportional-hazard models to estimate hazard ratios (HRs) with adjustment for age, sex, alcohol intake, education, income, and family history of CVD. Results: We documented 4264 incident CVD cases (2159 heart disease and 2311 stroke) (some individuals had both heart disease and stroke) during a median of 7.7 years of follow-up. Compared with participants whose LE8 scores remained stable, those with the largest increase of LE8 score had a 30% lower CVD risk, 30% lower heart disease risk, and 28% lower stroke risk (HR and 95%CI: 0.70 (0.63, 0.78) for CVD, 0.70 (0.61, 0.82) for heart disease, 0.72 (0.63, 0.83) for stroke); while participants with the largest decrease had a 47%, 57%, and 35% higher risk for CVD, heart disease, and stroke, respectively. Each 10 points increase of LE8 score was associated with 27%-29% lower risk for these diseases. Similar results were observed in secondary analyses of 4-year changes (2006 - 2010) and 8-year changes (2006 - 2014) in LE8 score with CVD risk. These associations persisted in subgroup analysis stratified by risk factors of CVD. Conclusions: Improving adherence to LE8 score over a 6-year period was associated with lower risk of CVD, heart disease, and stroke, whereas decreased adherence to LE8 score was associated with higher risk. These findings support greater adherence to LE8 for improving CVH.
Abstract 17042: Altered Myocardial Energy Substrate Utilization in Metabolic Syndrome May Impact Pathways Involved in Contractile Dysfunction in Ischemic Myocardium
Authors: Debolina Banerjee, Madigan Stanley, Frank W Sellke, Anny Usheva
Journal: Circulation (2023)

Introduction: Metabolic syndrome (MetS) is increasingly prevalent and an independent risk factor for ischemic heart disease (IHD). MetS favors lipids over glucose as the predominant myocardial energy substrate. Similarly, in IHD, energy utilization is dependent on ketone bodies. Evidence is emerging that such changes in cardiac energy metabolism may drive contractile dysfunction, but the underlying processes have not been clarified in the context of coincident MetS and ischemia. Aims: The purpose of this multiomics study was to define the global metabolic state of ischemic myocardium in the setting of MetS, with a focus on energy metabolism and pathways modulating myocardial function and contractility. We hypothesized MetS would further shift substrate utilization away from glycolysis to favor ketone bodies, contributing to pathways of contractile dysfunction in injured myocardium. Methods: We used our well-established porcine model of diet-induced MetS and chronic myocardial ischemia to study effects on left ventricular tissue. Tissue samples from MetS swine and controls were analyzed using targeted LC-MS/MS for polar metabolites, RNA-seq, proteomics, and computational nonnegative matrix factorization. Results: MetS swine had altered bioavailability of 302 polar metabolites together with changes in gene expression of enzymes involved in glycolysis, fatty acid metabolism, ketone body utilization, and abnormal activation of renin-angiotensin-aldosterone system (RAAS). MetS swine also had reduced expression of Apelin protein, a potent stimulator of cardiac contractility (Figure). Conclusions: Our data show MetS enzymatically downregulates glycolysis and upregulates ketone body utilization together with derangement in RAAS in injured myocardium. Decreased Apelin expression may contribute to lipid-induced cardiac dysfunction through maladaptive effects on contractility and remodeling, and thus may serve as a future therapeutic target.
Abstract 15871: Clinical Characteristics Associated With Response to Exercise and Serious Adverse Events During Home-Based Walking Exercise in People With Lower Extremity Peripheral Artery Disease
Authors: Neela D Thangada, Dongxue Zhang, Lu Tian, Lihui Zhao, Mary M McDermott
Journal: Circulation (2023)

Background: Home-based walking exercise improves walking performance in people with lower extremity peripheral artery disease (PAD). However, whether clinical and sociodemographic factors, such as age, sex, race, comorbidities, and income, are associated with response to exercise or rates of serious adverse events (SAEs) during a home-based walking exercise intervention for PAD is unclear. Methods: Data from participants randomized to two clinical trials of home-based walking exercise for PAD were pooled. Both clinical trials used behavioral methods to help participants adhere to walking exercise up to 5 days/week for up to 50 minutes/session for 6-months. Outcomes were change in six-minute walk (6MW) at 6-months and rates of SAEs at 12-months. SAEs were defined as death or hospitalization. Results: 325 unique participants [mean age 69.8 (9.1), 161 (49.5%) female, 182 (56.0%) Black] had available 6MW and SAE data. Home-based walking exercise improved 6MW distance, compared to control, at 6-month follow-up [mean: +46.4 meters (95% CI: +31.5 meters, 61.2 meters)]. The effect of home-based exercise on 6MW was similar across clinical and sociodemographic characteristics. 51 (27.3%) participants reported SAEs in the home-based exercise group and 32 (23.2%) reported SAEs in the control group (p=0.40). Among those randomized to home-based walking exercise, odds of SAE were significantly higher among Black compared to White participants, those with history of coronary artery disease (CAD) and heart failure (HF) compared to those without (Figure). Statistically significant interactions were identified between Black race (P&lt;0.001), coronary artery disease (P=0.006) and lower income zipcodes (P=0.047) and the effect of exercise on rates of SAEs. Conclusion: In people with PAD randomized to home-based exercise, those who were Black, had a history of CAD or HF were significantly more likely to experience SAEs, compared to people without these characteristics.
Abstract 18268: Angina and Functional Capacity Among Women Presenting With Angina and Non-Obstructive Coronary Disease
Authors: Yulith Roca Alvarez, Namrita Ashokprabhu, Cheryl Bartone, Lauren M Thompson, Mehmet Yildiz, Timothy D Henry, Odayme Quesada
Journal: Circulation (2023)

Introduction: Approximately 75% of women that undergo coronary angiography for angina do not have obstructive disease. However, a significant number have persistent angina, which can reduce their functional capacity and performance, impacting patients’ quality of life. There is a need for further studies that accurately compare angina and functional capacity among women angina with non-obstructive coronary disease (ANOCA). Objective: We examined the association between perceived anginal symptoms and functional capacity in patients with ANOCA Methods: A the Women’s Heart Center at the Christ Hospital, all women completed the Duke Activity Status Index (DASI) and Seattle Angina Questionnaire-7 (SAQ7) at the initial visit. DASI score range from 0 to 58.2 and assess functional capacity using self-assessment and VO2 peak formula with higher scores indicating better functional capacity. SAQ7 assesses angina symptoms, physical limitation, and quality of life; the score is from 0-100, where a lower score indicates a higher frequency of angina, increased physical limitation, and poor quality of life. DASI and SAQ7 scores were correlated. Sperman correlation and Mcnemar chi-square were used to compare DASI and SAQ7 score results. Results: Among 225 women with ANOCA, the mean DASI score was 16.73, and the mean SAQ7 score was 43.79. 63.1% reported a low score of SAQ7, and 79.6% reported a low DASI score. SAQ7 and DASI were moderately correlated (Spearman correlation of +0.42). Further analysis with McNemar chi- square showed that women with lower SAQ7 (score 0-49.4) tends to corresponds with low DASI (score 0-24.5) (Specificity 86.6%), compared to women with higher SAQ7 (score 49.5-100) and high DASI (score 24.6-58.2) (Sensitivity 32.5%) (p&lt;0.001). Discussion: Anginal symptoms are correlated with reduced functional capacity among women with ANOCA. Further prospective studies are needed to evaluate the correlation between angina improvement and functional capacity.
Abstract 19109: AI-Enabled Automated Cardiac Chambers Volumetry in ECG-Gated Coronary Calcium Scans vs. Non-Gated Lung Cancer Screening Scans
Authors: Morteza Naghavi, David Yankelevitz, Anthony Reeves, Matthew J Budoff, Chenyu Zhang, Kyle Atlas, Thomas Atlas, Claudia Henschke
Journal: Circulation (2023)

Introduction: We have developed an AI-enabled automated volume measurement of cardiac chambers (AutoChamber) that works on ECG-gated non-contrast coronary artery calcium scans and correlates well with contrast enhanced coronary CT angiography scans. Automated LA and LV volumes have shown to predict atrial fibrillation (Afib) and congestive heart failure. Hypothesis: In this study, we hypothesize that AutoChamber volumetry results in ECG-gated CAC scans correlated well with those of non-gated full-chest lung cancer screening scans in the same individuals. Methods: We have studied 169 cases of paired ECG-gated cardiac CT scans and non-gated lung scans. Mean±SD for age was 62±10 with 52% female. All caseswere asymptomatic and were scanned for preventive health assessment. AutoChamber was run on all cases by an independent operator who was not involvedin data analysis. P value was calculated using a two-tailed test of significance with α=0.05. Results: AutoChamber in cardiac scans vs lung scans reported volume (Mean±SD) for left atrium (LA) as 67.2 and 70.1, left ventricle (LV) 102.8 and 105.5 right atrium (RA) 81.9 and 85.7 right ventricle (RV) 140.7 and 134.2 left ventricle wall (LVW) 113.0 and 109.7 respectively (P &lt; 0.0001). Correlations between cardiac and lung scans for each cardiac chamber: LA (R2= 0.85), LV (R 2= 0.93), RA (R2= 0.91), RV (R2= 0.92), and left ventricular wall (LVW) R2= 0.95. (P &lt;0.0001 for all). Conclusions: AutoChamber volumetry results are similar in ECG-gated cardiac scans vs non-gated full-chest lung scans. This AI-enabled automated tool is promising as it can provide added value to patients undergoing coronary calcium and lung cancer screening scans flagging enlarged cardiac chambers at risk of future Afib and heart failure.
Abstract 14356: Higher Burdon of Premature Ventricular Complexes is Not Uncommon in Stable Well Treated Heart Failure Patients and Relate to Poorer Outcomes
Authors: Daria Kramarenko, Batool Shukr, Johnathan Stephan, BIN LIU, edward peterson, A.S. Amin, David E Lanfear, Yigal Pinto
Journal: Circulation (2023)

Introduction: While premature ventricular contractions (PVCs) are generally considered benign, recent evidence suggests that even the contractions preceding PVCs are inefficient so that even a moderate burden of PVCs may be associated with loss of contractile efficiency and increased risk of events. It is however unclear what proportion of stable heart failure (HF) patients have a moderate to high burden of PVCs, despite being well-treated. Aim: The aim of this study was to assess the proportion of HF patients that have more than 5% PVCs and whether this higher number is related to worse outcomes. Methods: We retrospectively analyzed electronic medical records from 676 adult patients with either an ejection fraction &lt; 40% or NTproBNP more than 600 pg/ml at the Amsterdam UMC (AMC) who received Holter monitoring between 2014 and 2022. In a second independent cohort from a heart failure registry at Henry Ford Hospital (HFH) in Detroit, Michigan, we retrospectively reviewed all participants with ejection fraction &lt; 40% that had a Holter monitor at any point (n=180). Results: The median baseline age of the Amsterdam UMC patients was 62 and 40% were female. The HFH cohort had a median age of 64 years and 50% were female. Results are summarized in the table. During the follow-up period, significantly more patients died in the group with more than 5% PVCs (p &lt; 0.05 in the Amsterdam UMC cohort). Conclusions: We show in two independent cohorts that around 8-10% of HF patients have a significant burden of PVCs (i.e. &gt;5% of all heartbeats), despite adequate use of beta-blocker therapy. This proportion of PVCs is associated with an increased risk of death over one year. This suggests that in HFrEF patients, PVCs burden more than 5% of heartbeats may not be as harmless as often thought.
Abstract 18866: Binge Alcohol Drinking and Myocardial Infarction Mortality in the United States
Authors: Khaled Shorbaji, Hiba Alkelani, Jennie Kwon, Ryan J Tedford, Brett Welch, Delgaizo John, Arman Kilic
Journal: Circulation (2023)

Introduction: Although moderate alcohol intake is related to decrease all cause and ischemic heart disease mortality, intake of large amounts at a time remains controversial. Some studies have shown that binge drinking (BD) could have a protective effect. Hypothesis: The aim of this study is to study life-style risk factors associated with cardiovascular mortality in the U.S. population. Methods: The CDC National Environmental Public Health Tracking Network was used to identify age-adjusted mortality rate due to myocardial infarction (MMI) per county among people ≥35 years between 2018 and 2019. County's age-adjusted prevalence of current smoking (CS), binge alcohol drinking (BD), no-leisure time physical activity (NLTPA) and obesity were also identified as potential community life-style risk factors for MMI. Multivariable regression model predicting MMI rate was used to identify relationship between county MMI rate and those 4 life-style risk factors. Results: A total of 3106 counties were included in this study. Median county age-adjusted MMI rate was 61.00 [46.30, 85.38] per 100.000. Median county age-adjusted prevalence of CS was 19.80% [17.40, 22.80], BD 17.70% [15.70, 19.90], Obesity 35.60% [32.70, 38.10], and NLTPA 26.50% [23.30, 30.68]. In a multivariable regression model, CS prevalence above 20% increased the MMI rate by 9.83 (6.82 to 12.84, p&lt;0.001) per 100.000, NLTPA prevalence above 29% increased the MMI rate by 21.57 (18.12 to 25.02, p&lt;0.001) per 100.000, and obesity prevalence above 36% increased the MMI rate by 8.30 (5.54 to 11.07, p&lt;0.001) per 100.000. On the other hand, BD prevalence above 18% was not associated with a significant increase in the MMI rate. [0.67 (-2.11 to 3.44, p=0.638) per 100.000]. Conclusions: Community life-style risk-factors associated with myocardial infarction mortality include current smoking, no-leisure physical activity, and obesity. Alcohol binge drinking did not reduce myocardial infarction mortality rate.
Abstract 14433: The Utility of Fibrinogen-Albumin-Ratio as a Prognostic Biomarker in Coronary Artery Disease Patients: A Comprehensive Meta-Analysis
Authors: Mohammad Tanashat, Mostafa Hossam El Din Moawad, Alaa Ramadan, Obieda Altobaishat, Abdallah Abbas, Mahmoud Shalaby, Marwa Elnagar, Mohamed Hendawy
Journal: Circulation (2023)

Background: Coronary artery diseases (CAD) are considered the leading cause of death and morbidity worldwide. The fibrinogen-to-albumin ratio (FAR), a novel inflammatory indicator, has been investigated to be associated with CAD. However, for CAD patients who received percutaneous coronary intervention (PCI), the predictive significance of the FAR is still unclear. Objective: This systematic review aimed to investigate the use of FAR as a prognostic biomarker for negative outcomes of CAD. Methods: Following the PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for eligible articles mentioning the utility of FAR in the prognosis of CAD patients. In conducting our meta-analysis, a random effect model was used. The results were examined using a pooled adjusted hazard ratio or mean difference with a 95% confidence level. The Q statistics and I2 value were used to evaluate heterogeneity. A p-value of equal or less than 0.5 indicated statistically significant results and heterogeneity. Results: We included 21 studies in our meta-analysis after the screening process. Four studies with a total of 2813 participants reported that the pooled estimates of FAR revealed that CAD patients had higher values compared to non-CAD patients (SMD = 1.23 [0.45, 2.02]; P = 0.002). Our meta-analysis showed that high FAR level was statistically significant associated with increased all-cause mortality, cardiac mortality, and MACE as observed by hazard ratio. Using mean difference, high FAR values were associated with lower LVEF, higher SYNTAX score and no reflow. Conclusion: FAR can be utilized as a prognostic biomarker in CAD patients to predict poor outcomes.
Abstract 15555: Decreased Severity of Underlying CAD in Patients With Acute MI and COVID: Are the Findings Unique to COVID Infection?
Authors: Zoltan G Turi, David B Landers, Steven Hollenberg, George Rockett, Taya Glotzer, Brent Klinkhammer, Jana Tancredi, Joseph E Parrillo
Journal: Circulation (2023)

Introduction: Approximately 20% of COVID hospitalizations during the first wave of the pandemic were associated with myocardial injury. The etiology of injury was mixed but preliminary findings from several databases have suggested diminished underlying CAD in patients with MI and COVID. Hypothesis: Patients with MI and COVID have less CAD than patients with MI alone or MI in the setting of other acute infections. Methods: We quantified CAD by rigorously calculating SYNTAX scores in 3 groups, all undergoing coronary angiography during acute MI: (1) a randomly selected control group with MI alone from 2010 to 2019, (2) patients with MI and COVID during the first COVID wave (2020), and (3) patients with pneumonia and MI from the pre-pandemic era. To improve specificity, the study was limited to patients with clinical features of STEMI and troponin-I &gt; 1.0; pneumonia with or without COVID occurred predominantly &lt; 48 hours before STEMI. Results: From 2010-2019, 9,758 patients presented with STEMI of whom 33 were randomly assigned to Group 1, 13 cases of COVID and STEMI were identified during the first COVID wave (Group 2), and 12 pre-pandemic patients were identified with acute pneumonia and STEMI (Group 3). Median peak troponin-I value for the 3 groups was 39 (range 1.3-440) with no significant difference between groups. Median SYNTAX scores (Figure) were highest (16.5, IQR 11.5-25.3) in Group 1, and were significantly lower in Group 2 (10, IQR 5.5-19.3, p&lt;0.03) and in Group 3 (10, IQR 4.4-13, p&lt;0.001). No difference was seen between Groups 2 and 3. Conclusions: Patients with COVID and STEMI had less underlying CAD than patients who had STEMI prior to the pandemic; this finding was not unique to COVID but was also seen in patients presenting with acute non-COVID pneumonia and MI. Our findings are consistent with COVID and non-COVID pneumonia triggering STEMI in the presence of less severe underlying CAD.