tbuckley/cabot-search huggingface dataset:
Abstract 4146069: <sup>18</sup> F-NaF and <sup>18</sup> F-FDG and calcification predict the development of abdominal aortic aneurysms and is attenuated by drug therapy
Authors: Takehiro Nakahara, Raita Miyazawa, Yu Iwabuchi, Kai Tonda, Nupoor Narula, Harry Strauss, Jagat Narula, Masahiro Jinzaki
Journal: Circulation (2024)

Background: Abdominal aortic aneurysms (AAA) expand over time and increase the risk of fatal ruptures. While large aortic diameter increases the risk of rupture, some AAA rupture at small diameters and some large aneurysms do not rupture. Therefore, identification of patients at increased risk of rapid AAA expansion and rupture is importance. To predict expansion, the isolated assessment of 18 F-fluorodeoxyglucose (FDG) and sodium fluoride (NaF) uptake or calcification volume in aneurysms has been investigated with variability in results. We systematically evaluated whether 18 F-FDG and 18 F-NaF uptake were predictive of AAA expansion. Methods: Seventy-four (74) male Sprague–Dawley rat AAA models were imaged using positron emission tomography-computed tomography (PET-CT) with 18 F-FDG and 18 F-NaF at 1, 2, 4, 6, and 8 weeks after CaCl 2 or saline stimulation. In the 1-week cohort (n=25), the correlation between 18 F-FDG or 18 F-NaF uptake and pathological markers was investigated. In the time-course cohort (n=49), animals received either atorvastatin, losartan, aldactone, or risedronate to assess the effect of these drugs, and the relationship between aortic size and sequential 18 F-FDG and 18 F-NaF uptake or calcification volume was examined. Results: In the 1-week cohort, the maximum standard unit value of 18 F-FDG and 18 F-NaF uptake correlated with CD68-(r=0.82, p=0.0010) and von Kossa staining-positive areas (r=0.89, p&lt;0.0001), respectively. In the time-course cohort, 18 F-FDG and 18 F-NaF uptake changed in a time-dependent manner and drugs attenuated this uptake. Specifically, 18 F-FDG showed high uptake at weeks 1 and 2, whereas a high 18 F-NaF uptake was noted throughout the study period. Although drugs suppressed 18 F-NaF and 18 F-FDG uptake, only atorvastatin significantly reduced aortic enlargement. Risedronate decreased the calcification volume; however, the aorta was significantly enlarged. The final aortic area correlated well with 18 F-FDG and 18 F-NaF uptake and calcification volume, especially at 1 and 2 weeks [ 18 F-NaF(1week): r=0.61, 18 F-FDG(2weeks): r=0.51, calcification volume(1week): r=0.59, p&lt;0.0001]. Multiple linear regression analysis showed that the combination of these factors predicted the final aortic size, with 18 F-NaF uptake at 1 week being the strongest predictor. Conclusion: The uptake of 18 F-NaF and 18 F-FDG and the calcification volume at appropriate times correlated with the development of AAAs, with 18 F-NaF uptake being the strongest predictor.
Abstract 4146184: Gender Disparities in Inpatient Outcomes of STEMI Patients with Obstructive Sleep Apnea
Authors: Alexandra Millhuff, Mohammed Quazi, Aman Goyal, Abu Baker Sheikh
Journal: Circulation (2024)

Introduction: Increasing evidence shows that obstructive sleep apnea (OSA) is a significant risk factor for cardiovascular disease. OSA may exacerbate recovery from ST-elevation myocardial infarction (STEMI), as chronic hypoxemia and hypercapnia has been shown to be associated with sympathetic hyperactivity, inflammatory response, endothelial dysfunction, and hypercoagulability. Acute outcomes of STEMI patients who have a diagnosis of OSA has not been well-studied. Research Question: Does OSA affect inpatient outcomes in patients with a primary diagnosis of STEMI? Methods: We conducted a retrospective analysis using the National Inpatient Sample database from 2016-2021 to examine the inpatient outcomes of STEMI patients in OSA patients compared to patients without OSA. Inclusion criteria encompassed patients diagnosed with acute STEMI and OSA based on ICD-10 codes. Results: A total of 1,203,915 STEMI patients were identified; among these, 1,128,880 (93.7%) did not have a diagnosis of OSA, while 75,035 (6.3%) had a known diagnosis of OSA. Patients with OSA had lower in-hospital mortality (aOR=0.86, CI 0.80-0.90, p&lt;0.001) compared to those without OSA but had higher rates of AKI (aOR 1.1), VTE (aOR 1.1), atrial fibrillation (aOR 1.4), atrial flutter (aOR 1.3), and non-invasive mechanical ventilation (aOR 3.1). Women with OSA, compared to men with OSA, were more likely to die in the hospital (aOR=1.17, CI 1.14-1.20, p&lt;0.001) and had higher rates of VTE (aOR 1.2), but were less likely to undergo PCI, CABG, or have an intra-aortic balloon pump or Impella placed. Despite their higher mortality rate, women with OSA were less likely than men with OSA to develop inpatient complications such as sudden cardiac arrest, AKI, ventricular fibrillation, or ventricular tachycardia. Conclusion: STEMI patients with a diagnosis of OSA had lower inpatient mortality rates compared to those without OSA, necessitating further investigation to understand this correlation. However, significant gender disparities were observed; women with OSA had higher mortality rates and underwent fewer interventions than men with OSA. Recognizing and addressing these trends is crucial for developing targeted interventions to mitigate these disparities.
Abstract 4145353: Sex Differences in Post-PCI Myocardial Injury and Long-Term All-Cause Mortality
Authors: Claire Graves, Nina Talmor, Sam Kozloff, Vincent Major, Binita Shah, Anvar Babaev, Louai Razzouk, Michael Attubato, Sunil Rao, Frederick Feit, James Slater, Nathaniel Smilowitz
Journal: Circulation (2024)

Background: Myocardial injury complicating percutaneous coronary intervention (PCI) is associated with mortality, but sex differences in outcomes are uncertain. We explored sex differences in the incidence and long-term outcomes of post-PCI myocardial injury (PPMI). Methods: Adults who underwent PCI at NYU between 2011-2020 were included in this retrospective analysis. Patients with ACS as the indication for PCI were excluded. PPMI was defined as a peak CKMB concentration &gt;99% of the upper reference limit. The incidence of PPMI by sex was compared by Chi-square tests. Independent predictors of elevated CKMB post-PCI were evaluated with linear regression models in subgroups by sex. Cox proportional hazard models were generated to evaluate relationships between PPMI and all-cause mortality by sex. Results: Of 10,807 adults undergoing PCI, 24.9% (2,694) were female. Females were older than males at the time of PCI (68.9 vs. 65.8, p&lt;0.001), more likely to have stage ≥3 CKD (30.3% vs. 23.9%, p&lt;0.001), and had shorter target lesion lengths (mean 24.6mm ± 18.3 vs 28.1mm ± 20.5, p&lt;0.001). PPMI was less common among females than males (14.1% vs. 17.7%, p&lt;0.001). Among females, older age, longer lesion length, multivessel PCI, severe vessel calcification, and thrombectomy device use were independently associated with higher post-PCI CKMB concentrations. Among males, older age, longer lesion length, vessel calcification, and atherectomy device use were associated with higher post-PCI CKMB concentrations. Over 4.3 year mean follow-up, 131 (4.9%) females and 341 (4.2%) males died. Males with PPMI had a greater risk of long-term death than males without PPMI (p&lt;0.001) (Figure 1), while in females PPMI was associated with a trend towards excess mortality that did not reach statistical significance (p=0.064). No significant sex interaction was observed in the association between PPMI and mortality (p=0.38). Conclusions: In this large, single-center experience, female patients had less extensive coronary artery disease and were less likely to develop PPMI than males. Myocardial injury was associated with higher long-term mortality overall and among males with no significant interactions between sex and mortality.
Abstract 4145614: Neuroimaging findings in adults with congenital heart disease: associations with demographic-clinical factors and neurocognition
Authors: Thalia Field, Vanessa Dizonno, Namali Ratnaweera, Farnaz Sahragard, Jason Andrade, Karen LeComte, Wayne Su, Preet Gandhi, Suneet Mangat, Jasmine Grewal
Journal: Circulation (2024)

Background: People with congenital heart disease (CHD) face developmental and acquired risks to their neurocognitive health. Mechanisms and clinical-neuroimaging correlates are not well-defined. We report baseline neuroimaging findings, their associations with demographic/clinical factors, and cognitive performance, from a longitudinal study of brain health in adult CHD (ACHD). Methods: Participants (n=99) aged &gt;18y with moderate-severe complexity CHD were recruited from the ACHD referral centre for Western Canada. They underwent clinical review and had bloodwork, Holter, echocardiography MRI brain, cognitive testing (MoCA, NIH Toolbox [NIHTB]). Forward stepwise linear and logistic regression models were used to identify demographic/clinical factors that predicted MRI findings. Relationships between demographic/clinical factors with MRI findings, and MRI findings with cognition, were then explored with multivariable linear and logistic regression as appropriate. Results: Median(IQR) age 35y (29-40); 42% female.(Figure 1) CHD complexity (21% severe) was independently associated with lower total brain volume (TBV). TBV independently predicted cognitive performance (B[95%CI] for MoCA change/100mm3: 2.73x10 -3 [3.0x10 -4 - 5.1 x 10 -3 ]; p=0.03; NIHTB 8.39x10 -3 [2.2x10 -3 - 1.46x10 -2 ]; p=0.009). History of dyslipidemia was independently associated with white matter hyperintensity (WMH) volume but not presence of WMH. Cerebral microbleeds (CMB, 60% of participants) and lacunes (16%) were independently associated with history and number of cardiopulmonary bypass surgeries. None of WMH, CMB or lacunes predicted cognitive performance. Conclusions: In this high-functioning cohort of mostly younger ACHD, neuroimaging abnormalities were common. TBV was independently associated with CHD severity. WMH were associated with dyslipidemia; CMB and lacunes with bypass. Only TBV predicted cognitive performance. Acknowledging our modest cohort size with heterogenous CHD types, our results suggest that the pathophysiology impacting brain health reflects a combination of early- and later-life factors. Longitudinal studies may identify optimal preventative interventions and their timing; dyslipidemia may be a modifiable target.
Abstract 4146087: Danish Pragmatic Randomized Trial to Evaluate the Effect of HeartLogic-Guided Management on Heart Failure Outcomes – The DANLOGIC-HF Preliminary Registry Findings
Authors: Lise Witten Davodian, Niklas Dyrby Johansen, Stefan Michael Sattler, Emil Wolsk, Niels Risum, Lars Kober, Finn Gustafsson, Danny Davodian, Scott Solomon, Christopher Chien, Marat Fudim, Adrian Hernandez, Brian Kwan, Craig Stolen, Tor Biering-Soerensen
Journal: Circulation (2024)

Background: Hospitalizations due to heart failure (HF) are costly and detrimental to patient health. The HeartLogic (HL) algorithm has been found to be predictive of impending HF decompensation. Purpose: To present characteristics of the Danish nationwide DANLOGIC-HF population and preliminary findings on the performance of the HL algorithm. Methods: All Danish patients with a HL compatible device implanted after 2017 were identified. Their retrospective HL index values were used to calculate active alert periods. HF status and other diagnoses were based on ICD10 diagnoses codes, and patients with a CRT-D were categorized as having known HF regardless of ICD10 diagnoses. The association between HL alerts and HF hospitalizations were assessed using a Cox proportional hazard model with alert status as a time-dependent covariate and clustered standard errors. Results: In this population of 1599 adult patients with a CRT-D or ICD, mean age was 59.6 years,75% were male, and 26.9% had ischemic heart disease. While 43% had known HF, only 24% of the population had a CRT-D. Aside from diabetes (7.4% vs 2.7%, p&lt;0.001) and chronic obstructive pulmonary lung disease (3.5% vs 0.5%, p&gt;0.001) being more frequent in patients with HF, the prevalence of cardiovascular comorbidities was similar between patients. Patients with HF had a lower left ventricular ejection fraction (LVEF) (29% vs 44%, p&lt;0.001) and higher NYHA class at implantation compared to patients without HF. Patients with HF also had a higher HF-related hospitalization rate (30 vs 7 per 100 patient-year, p&lt;0.001). At a mean follow-up time of 2.9 patient-years, HF at baseline and LVEF significantly modified the association between HL alert status and risk of HF hospitalization. The hazard ratio of being hospitalized with HF while in active HeartLogic alert was 7.9 [5.7, 11.1] for the entire population, 5.4 [3.8, 7.6] for patients with known HF and 14.7 [6.0, 36.4] for patients without known HF (p for interaction &lt;0.001). For patients with a LVEF&lt;40%, the hazard ratio for being hospitalized with HF if having an active HL alert was 7.1 [4.9, 10.6] compared with 33.7 [7.3, 157] for patients with a LVEF&gt;40% (p for interaction = 0.026). Conclusion: Being in active alert was associated with a high risk of being hospitalized with HF, especially among patients without known HF. These findings emphasize the potential utility of HL-guided management in improving HF outcomes, both amongst patients with and without known HF.
Abstract 4145549: All-Cause Mortality and Cardiovascular Outcomes with Glucagon-Like Peptide-1 Receptor Agonists in People with Type 2 Diabetes and Systolic Heart Failure
Authors: Aravinthan Vignarajah, Nishanthi Vigneswaramoorthy, Gautam Shah
Journal: Circulation (2024)

Background: There is an increasing prevalence of type 2 diabetes (T2D) and systolic heart failure. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are becoming popular in the management of T2D. Previous studies have demonstrated that GLP-1 RAs reduce major adverse cardiovascular events (MACE) in T2D patients compared to placebo. However, the impact of GLP-1 RAs on mortality and cardiovascular outcomes in patients with T2D and systolic heart failure remains uncertain. Aim This study examines the effects of GLP-1 RA on individuals with T2D and systolic heart failure, focusing on all-cause mortality, cardiovascular outcomes (including ischemic heart disease, acute myocardial infarction, heart failure exacerbations, stroke, peripheral vascular disease, chronic kidney disease), and all-cause hospitalization. Methods: The TriNetX research database was utilized to identify patients aged 18 years and older with T2D and systolic heart failure. Patients were classified into two groups: GLP-1 RA users and non-users. Propensity score matching (1:1) was conducted based on demographics, body mass index, comorbidities, glycated hemoglobin levels, and medications, resulting in a matched cohort of 23,873 patients. Outcomes analyzed included all-cause mortality, cardiovascular outcomes and all cause hospitalization. Survival analysis was performed using TriNetX software, estimating the probability of outcomes over 5 years from the index event and generating hazard ratios (HR), log-rank tests, and Kaplan-Meier survival curves. Results: The GLP-1 RA user group demonstrated a reduced hazard ratio (HR, 95% confidence interval) over 5 years compared with the control group for all-cause mortality (0.705, 0.675-0.736, P &lt;0.001), composite of cardiovascular outcomes (0.94, 0.922-0.958, P&lt;0.001), all cause hospitalization (0.809, 0.788-0.831, P &lt;0.001) (Figure), acute myocardial infarction (0.822, 0.790-0.857, P &lt;0.001), and heart failure exacerbation (0.962, 0.944-0.981, P &lt;0.001). All other individual cardiovascular outcomes also showed significant risk reductions in favor of the GLP-1 RA cohort. Conclusion: In patients with type 2 diabetes and systolic heart failure, GLP-1 RA therapy significantly reduces mortality and cardiovascular events over a 5-year period, independent of body weight.
Abstract 4145439: Cardiac Arrest Associated with Thyrotoxicosis: A Systematic Review
Authors: Ashraf Ahmed, Mohamed Badheeb, Shaun Abid, Fabricio Malaguez Webber, Samdish Sethi, Mayowa Adefuye, Deepak Vangipuram, Anda Gonciulea, Stuart Zarich, Gregory Buller
Journal: Circulation (2024)

Introduction: Thyrotoxicosis is a systemic condition caused by the effects of elevated levels of thyroid hormones. The cardiovascular manifestations of thyrotoxicosis range from sinus tachycardia and atrial fibrillation to heart failure. The incidence of malignant arrhythmias and cardiac arrest associated with thyrotoxicosis is not well known, and much of the current literature regarding this is limited to case reports. This study conducts a systematic review of the literature to identify patient demographics and outcomes where thyrotoxicosis manifests as cardiac arrest. Methodology: A systematic literature review was conducted by searching three different databases, Embase, PubMed, and Scopus from inception to January 5th, 2024, to identify and review case reports regarding patients with thyrotoxicosis who had a cardiac arrest. Results: We identified 98 patients with thyrotoxicosis manifested as cardiac arrest. The mean age was 40 ±15 years, and 62% were female. Most were previously healthy and had no history of a thyroid disorder (60%). Of the patients with preexisting hyperthyroidism, around 50% had Graves' disease. Notably, around 90% of these patients had no history of heart disease. The overall mortality was 23.5% (table 1). Conclusion: Thyrotoxicosis should be considered when an otherwise healthy patient presents with a cardiac arrest in the third or fourth decade of life. The outcome in these patients seems to be favorable, with more than three-quarters of patients in our study having survived the event.
Abstract 4146082: Evolving Burden of Congenital Heart Anomalies in the United States and its Trend in the last three Decade: A Benchmarking Analysis
Authors: Paritaben Bhalodia, Praveena Suppala, Lalitkumar Patel, Vishwesh Patel, Urvashi Rathod, Lovekumar Vala, Parth Kumar Nandania, Dhruvi Modi, Rutvij Patel, Siri Vummaneni, HARDIK DESAI
Journal: Circulation (2024)

Introduction: Congenital Heart Anomalies (CHA) are the leading cause of deaths among all congenital birth defects (CBD) in the United States. This study represents the first-ever effort to estimate the burden of CHA nationwide over the past three decades, including the first two years of the COVID-19 pandemic. Method: Using Global Burden of Disease 2021 tool, we estimated incidence, prevalence, deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to CHA by age, sex, year and location across the US from 1990-2021. The results were presented in absolute counts and age-standardized rates (per 100,000). Results: The total prevalence of cases rose from 441,000 (95% Uncertainty Interval: 391,325-492,037) in 1990 to 527,452 (475,661-579,228) in 2021. Over the same period, the total percentage change (TPC) in deaths decreased by 56%, while YLDs increased by 11% (3-17%). The largest increase in TPC in incidence rates was observed in Wisconsin at 19% (6-37%), followed by a YLD rate increase in Delaware of 4% (7-15%). By age, individuals under 20 years experienced the highest death count at 1,551 (1,295-1,942), those aged 20-54 years observed 695 deaths (623-827), and those over 55 years saw 378 deaths (332-519) in 2021. In terms of gender, females showed a higher increase in TPC for YLDs compared to males (11% vs 10%), although both genders observed decreases in incidence and deaths. Conclusion: Deaths due to CHA accounted for 31% of all CBD in the US in 2021. Study findings reveal a notable decrease in mortality but an increase in disability years, reflecting advances in treatment alongside ongoing challenges in managing long-term health outcomes. This underscores the need for a dual approach in public health: enhancing preventive strategies and improving management for those affected. Coordinated efforts among healthcare providers, policymakers, and community health programs are essential to address these needs effectively.
Abstract 4145947: New Perspective on Guideline-Based Management of Atrial Fibrillation According to Socioeconomic Disparity
Authors: Yeji Kim, Chang-Ok Seo, Joo Hee Jeong, Hyoung Seok Lee, Jaemin Shim, Young-Hoon Kim, Jong-Il Choi
Journal: Circulation (2024)

Background: As the global incidence of atrial fibrillation (AF) increases, the importance of implementing GDMT (Guideline-Directed Medical Therapy) for managing AF is being emphasized. Research Questions: Applying guidelines universally across all countries and situations is realistically challenging. Aims: Identifying the appropriate income level for GDMT and highlighting the need for new standards. Methods: Based on data from the Global Burden of Disease 2021 and provided by WHO and the World Bank, information from 186 countries was analyzed. GDP was based on 2021 United states dollar (USD), and the average cost of AF treatment was analyzed in correlation with GDP and OOPs (Out-of-pocket Expenses) across four income groups. The percentage of the average cost paid by an individual for AF out of total OOPs was calculated as (Estimated patient payment based on previous studies x prevalence) x 100 / OOPs. Results: Among the 186 countries, the average GDPs of 58 HICs (High-Income Countries), 52 UMICs (Upper Middle-Income Countries), 54 LMICs (Lower Middle-Income Countries), and 22 LICs (Low-Income Countries) were studied. The prevalence of AF in HICs, UMICs, and LMICs showed a trend of increasing with income level, with age-standardized rates per 100,000 being 645.6 ± 164.0, 613.9 ± 100.3, and 528.3 ± 105.7 respectively. However, the rate of AF-related deaths was 5.6 ± 1.7, 5.5 ± 2.0, and 4.6 ± 1.3 (age-standardized rates per 100,000) respectively, with the proportion of AF deaths relative to prevalence being highest in UMICs, and higher in LMICs compared to HICs. In terms of rhythm control strategy, the specific cost of catheter ablation (22,143.5, by 2021USD) was affordable primarily in HICs, and the majority of LMICs showed a GDP lower than the AAD-only specific cost (7,622.7 by 2020USD), indicating economic barriers to GDMT for AF. The proportion of AF cost in OOPs showed a tendency to increase as the income level decreased. Conclusion: In the AF management, catheter ablation is considered viable only for a very small part of UMICs and primarily for HICs. In LMICs and most UMICs, the importance of medication-based therapy is highlighted, suggesting the need to establish new guidelines according to socioeconomic status.