tbuckley/cabot-search huggingface dataset:
Abstract 17580: "Healthy Smile for a Healthy Heart": A National Study on the Correlation Between Periodontal Diseases and Coronary Artery Disease
Authors: Abbas Alshami, Ndausung Udongwo, Joseph Heaton, Timothy Donley, Brett Sealove
Journal: Circulation (2023)

Introduction: Chronic inflammatory periodontal disease (CIPD) is a common disease of the supporting tissues of the teeth that manifest as swelling, bleeding, pain, and clinical attachment loss (CAL) upon periodontal examination. CIPD has been associated with a chronic inflammatory state, also a known risk factor for coronary artery disease (CAD). Hypothesis: There is a possible correlation between CIPD and CAD. Methods: We utilized the 2013-2014 National Health and Nutrition Examination Survey database. We included participants aged 30 years and above who reported having gum disease and had undergone a periodontal examination. CAL measured in millimeters, was reported at six different locations around 28 teeth. To obtain national estimates, we conducted complex survey sample analyses, accounting for weights, clustering, and strata. Furthermore, we adjusted for well-known CAD risk factors in multivariate analyses. Results: Our study included 184,010,722 participants; 7.3% had CAD (n=13,461,796), and 17.1% reported CIPD (n=31,425,382). Baseline Characteristics are presented in Table 1. The unadjusted rate of CAD was higher in patients with CIPD than those without CIPD [10.3% (n=3,238,995) vs 6.7% (n=10,222,801), p=0.018]. Similarly, average CAL was higher in patients with CAD (2.04 vs 1.62 mm, p&lt;0.001). After adjusting for confounders listed in Table 1, CIPD was a significant predictor of CAD (OR 1.744, 95% CI 1.088-2.796, p=0.012). The average CAL of all the teeth also predicted CAD (OR 1.195, 95% CI 1.025-1.394, p=0.026). Conclusions: Our data suggest that patients with reported CIPD had a 1.7 times higher risk of developing CAD. Similarly, each 1 mm increase in CAL leads to a 20% increased CAD risk (OR 1.2). Further prospective studies are needed to confirm these findings and to explore whether treatment of CIPD mitigates the increased CAD risk. These findings underscore the significance of optimizing dental health in patients with CAD.
Abstract 14740: Identifying Predictors of Timing to Guideline-Directed Medical Therapy for Medical Beneficiaries With Heart Failure
Authors: Melody Chiang, Dennie Kim, Thomas Cascino, Hechuan Hou, Robert Hawkins, Kylee Funk, Keith D Aaronson, Lourdes Cabrera, Donald S Likosky, Jeffrey McCullough
Journal: Circulation (2023)

Introduction: Despite substantial evidence supporting the timely initiation and optimization of guideline-directed medical therapy (GDMT) for patients with heart failure, its utilization remains low. Hypothesis: Variation in GDMT prescribing will be explained by patient-, clinician-, and hospital-level determinants that can serve as targets for future interventions. Methods: This study included 793,319 fee-for-service Medicare beneficiaries admitted with heart failure (incident or acute-on-chronic) between 2009-17. The GDMT outcome was the receipt of 1 from each of 3 medication classes within 120 days of discharge: beta blockers, ACE inhibitors/ARBs, or MRAs. Candidate predictors included patient demographics, pre-admission medication, community distress (social determinants), and Charlson comorbidities. Models, estimated via logistic regression and marginal effects, considered unobserved changes in practice patterns over time and, in some specifications, provider differences (fixed effects). Other specifications controlled for observed hospital characteristics. Results: The cohort was 49% female (n=390,765), 16% Black (n=123,238), 6% Hispanic (n=50,138) with a median (IQR) of 78 years (69-86). The median number of comorbidities was 3 (IQR 2-4). The overall 120-day use of beta blockers was 55%, ACE inhibitors/ARBs 47%, MRAs 21%, and all three medications 11%. After adjustment, the largest predictors of GDMT were pre-admission medication use and comorbidities (eg, renal disease). Women achieved 0.9% lower GDMT (Figure). Community distress was associated with lower GDMT; yet, the magnitude of effect was small (-0.01%). Academic hospitals achieved 0.3% better GDMT despite having a more severe patient population. Conclusions: GDMT use was low (and lowest for MRAs). Targeted interventions to address these identified predictors may advance the prescribing and use of guideline-directed, evidence-based care for heart failure patients.
Abstract 14242: The Potential Impact of Inflammation on the Lipid Paradox in Patients With Acute Myocardial Infarction: A Multicenter Study
Authors: Guyu Zeng, Jinqing Yuan
Journal: Circulation (2023)

Introduction: Low-density lipoprotein cholesterol (LDL-C) is a well-recognized risk factor for cardiovascular diseases. However, several clinical studies demonstrated that LDL-C was inversely associated with mortality risk in patients with acute myocardial infarction (AMI), which is known as lipid paradox. Aims: To verify the association between LDL-C and mortality risk among AMI patients. Methods: A total of 5,358 patients with AMI from a nationwide cohort were included in our analysis. All individuals were stratified according to LDL-C quartiles (≤2.00 mmol/l, 2.00-2.54 mmol/l, 2.54-3.19 mmol/l, &gt;3.19 mmol/l) and hsCRP levels (hsCRP≤3 mg/l &amp; hsCRP&gt;3 mg/l). Primary outcome was cardiac mortality. Secondary endpoint was all-cause mortality. Results: During a median follow-up of 2.1 years, 297 deaths and 227 cardiac deaths occurred. Patients in the lowest LDL-C quartile experienced the highest incidence of cardiac and all-cause mortality. The association between mortality risk and LDL-C levels appeared to be U-shaped. Patients in the highest LDL-C quartile had increased incidences of cardiac and all-cause mortality in patients with hsCRP≤3 mg/l. However, higher incidences of both cardiac and all-cause mortality were observed in the lowest LDL-C quartile group among those with hsCRP&gt;3 mg/l. Multivariable COX regression analysis demonstrated that compared with the lowest quartile, the highest LDL-C quartile was significantly associated with a higher risk of cardiac mortality in patients with hsCRP≤3 mg/l (HR 3.04, 95%CI 1.33-6.96, p=0.008), but in patients with hsCRP&gt;3 mg/l, the other three LDL-C quartiles showed a trend for lower cardiac mortality risks, and the second LDL-C quartile met the statistical significance (HR 0.62, 95%CI 0.40-0.95, p=0.027). Conclusion: AMI patients with lower LDL-C levels had a higher risk of mortality. However, this association was only observed in those with high inflammation risk.
Abstract 12247: The Effect of Angiotensin Receptor-Neprilysin Inhibitor With Sodium-Glucose Cotransporter 2 Inhibitor versus Angiotensin Receptor-Neprilysin Inhibitor Without Sodium-Glucose Cotransporter 2 Inhibitor on Heart Failure Outcomes in Patients With Heart Failure With Reduced Ejection Fraction
Authors: SHARATH KOMMU
Journal: Circulation (2023)

Background: Angiotensin receptor-neprilysin inhibitor (ARNI) improves heart failure outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Similarly, sodium-glucose cotransporter 2 (SGLT2) inhibitors have also shown significant beneficial effects in this patient population. It is unclear if adding SGLT2 inhibitors to patients already using ARNI-containing regimen will have additional benefits in improving heart failure outcomes in patients with HFrEF. Methods: PubMed and MEDLINE search was performed using the search words – ARNI, SGLT2 inhibitor, and heart failure. Among the studies identified, we looked for randomized controlled, prospective, and retrospective studies on HFrEF that included patient groups using ARNI with SGLT2 inhibitors and ARNI without SGLT2 inhibitors and had heart failure outcomes. We identified three studies and performed a meta-analysis. Results: A total of 671 patients in the treatment group and 808 patients in the placebo group are included in our meta-analysis. The heart failure outcome analyzed is the composite of hospitalization for heart failure and cardiovascular death. Among the patients using ARNI without SGLT2 inhibitors, the outcome occurred in a total of 215 out of 808 patients (26.61%). In comparison, it occurred in 114 out of 671 patients (16.99%) among those who are on both ARNI and SGLT2 inhibitors. This study shows that there is a significant improvement in this heart failure outcome in patients with HFrEF taking an SGLT2 inhibitor and ARNI-containing regimen compared to those taking ARNI without an SGLT2 inhibitor with a relative risk (RR) of 0.67 and 95% confidence interval (CI) of 0.55 to 0.83 (p=0.0001). Conclusion: Though ARNI and SGLT2 inhibitors individually are known to improve heart failure outcomes, adding an SGLT2 inhibitor to ARNI significantly improves the heart failure outcome of the composite of hospitalization for heart failure and cardiovascular death in patients with HFrEF.
Abstract 18778: Patient-Derived Stem Cell Models of Pediatric Restrictive Cardiomyopathy Exhibit Increased Resting Tension and Cardiomyocyte Calcium Sensitivity
Authors: David Staudt, Ricardo Serrano, Sho Ozaki Tan, Dries Feyen, Mark Mercola
Journal: Circulation (2023)

Introduction: Pediatric Restrictive Cardiomyopathy (RCM) is a genetic cardiomyopathy resulting from profoundly increased stiffness of the wall of the cardiac ventricle with normal or low normal contractility. Treatment options are limited, with most patients necessitating heart transplant. Therapies that can improve diastolic function are needed for this severe disease. However, development of novel therapies has been limited by a paucity of models of this rare disease. Here, we develop two novel models of pediatric RCM and use novel high-throughput functional analysis to measure diastolic dysfunction and defects in calcium handling. Hypothesis: Patient-derived human induced pluripotent stem cell (hiPSC) models of pediatric RCM will exhibit increased resting tension indicative of diastolic dysfunction, as well as increased calcium sensitivity. Methods: Cardiomyocytes were differentiated from hiPSCs derived from two pediatric patients with RCM, as well as a paired isogenic CRISPR-corrected lines. Cells were replated onto polyacrylamide gels and stained with calcium sensitive dyes, and contractility, resting tension, and calcium sensitivity were measured using a novel high-throughput functional imaging platform. Results: RCM cells from both patients showed elevated contractility, resting tension, and calcium sensitivity compared to their isogenic controls. Conclusions: Patient-derived RCM cells show alterations in calcium sensitivity and resting tension that recapitulate and explain the diastolic dysfunction seen in patients. These lines, combined with the high-throughput measurement platform described here, will provide a powerful platform for exploring novel therapeutic strategies for this severe disease.
Abstract 15112: Characteristics and Clinical Outcomes of Patients With Sarcoidosis Admitted for ST-Elevation Myocardial Infarction
Authors: Hasan Ahmad, Kamleshun Ramphul, Raheel Ahmed, Ali Hasan, Muzammil Farhan, Azeem Hassan, Joseph Okafor, Caleb Carver, Taimurzeb Durrani, Ayesha Jadoon, Khadija Amanullah, Yumna Jamil, Maham Bilal, Sajeel Ahmed, Rahat A Memon, Hemamalini Sakthivel
Journal: Circulation (2023)

Background: Multisystem involvement is often seen in sarcoidosis. This study aims to explore the characteristics and clinical outcomes following hospitalization for ST-elevation myocardial infarction (STEMI) in patients with sarcoidosis when compared to patients without sarcoidosis. Methods: Patients with and without sarcoidosis admitted for STEMI were identified and compared from the 2016-2020 National Inpatient Sample (NIS) database whilst adjusting for confounders via logistic regression models. Results: A total of 851290 patients hospitalized with a primary diagnosis of STEMI between 1 st January 2016 to 31 st December 2020 were identified. Around 1215 (0.1%) had a diagnosis of sarcoidosis consisting of 58.4% males. When compared to patients without sarcoidosis, patients with sarcoidosis had a longer mean length of stay (LOS: 4.76 vs. 4.01 days, p&lt;0.01), a greater prevalence of diabetes (42.4% vs. 32.4%, p&lt;0.01), cirrhosis (1.6% vs. 0.5%, p&lt;0.01), depression (9.1% vs. 6.7%, p&lt;0.01), peripheral vascular disease (7.8% vs. 5.1%, p&lt;0.01), obesity (24.3% vs. 17.8%, p&lt;0.01), chronic kidney disease (25.9% vs. 13.1%, p&lt;0.01) and prior stroke (7.4% vs. 5.2%, p&lt;0.01). However, patients without sarcoidosis had a higher incidence of percutaneous coronary intervention (PCI) (79.8% vs. 75.3%, p&lt;0.01), smoking (52% vs. 35.4%, p&lt;0.01), drug abuse (2.8% vs. 1.2%, p&lt;0.01) and alcohol abuse (3.5% vs. 2.1%, p&lt;0.01) (Table 1A). Moreover, patients with sarcoidosis were less likely to have cardiogenic shock during their hospitalization (12.3% vs. 13.7%, aOR 0.768, 95% CI 0.636-0.927, p&lt;0.01). No statistically significant differences were seen for CABG or PCI use, events of Acute Kidney Injury, acute ischemic stroke and death (Table 1AB). Conclusion: Patients with sarcoidosis admitted for STEMI had a longer length of stay and fewer cardiogenic shock incidence when compared to patients without sarcoidosis. Complications and mortality was otherwise comparable.
Abstract 14878: Be Aware of False Negative Bubble Study in Diagnosis of Patent Foramen Ovale!
Authors: Emadeldeen Elgwairi, Stephen Dickson, Brian Friedman
Journal: Circulation (2023)

Introduction: Echocardiography plays an important role in diagnosis of Patent Foramen Ovale (PFO). However, there are some anatomic variations which may result in a false negative study. Case presentation: A 55-year-old male was hospitalized for acute right-hemiplegia. The EKG revealed normal sinus rhythm. Brain imaging revealed acute bilateral infarcts. The transthoracic echocardiogram (TTE) showed a normal ejection fraction without significant valve disease and a negative agitated saline Bubble study. A Trans-esophageal echocardiogram (TEE) revealed a negative Bubble study using intravenous access via the left arm. The TEE also revealed an atrial septal aneurysm and large eustachian valve (EV). The Bubble study was then repeated with agitated saline injected from lower extremity. This demonstrated a significant right to left shunt through a PFO. Discussion: EV is a remnant of the valve of the inferior vena cava that directs blood flow through the fossa ovalis during embryonic life. A large or prominent EV may be a risk factor for paradoxical embolism by preventing spontaneous foramen closure. Agitated saline originating from the superior vena cava (SVC) may result in a false-negative study due to the prominent EV preventing microbubbles from the SVC from crossing the interatrial septum. In this case, the patient’s age, clinical presentation and the finding of EV and atrial septal aneurysm raised the suspicion of PFO. Repeating the bubble study using a lower extremity peripheral access was positive. This step played a crucial role in the diagnosis of PFO in this patient and his subsequent management. Conclusion: Cardiologists should be aware that the presence of a prominent EV may result in a false negative bubble study result when the injection is performed via upper limb intravenous access.
Abstract 16549: Longitudinal Associations of Accelerometer-Based Sedentary Time and Physical Activity With Blood Pressure Progression From Childhood Through Young Adulthood: A 13-year Mediation and Isotemporal Substitution Study of 2513 Children
Authors: Andrew O Agbaje
Journal: Circulation (2023)

Introduction: Randomized controlled trials in the young population concluded that moderate-to-vigorous physical activity (MVPA) was ineffective in lowering blood pressure (BP). The associations of cumulative sedentary time (ST), light physical activity (LPA), and MVPA with BP from ages 11 - 24 years, the isotemporal substitution of ST with LPA or MVPA, and the mediation path through which movement behaviour exact their impact on BP was examined. Hypothesis: Increased ST would be associated with increased BP while cumulative LPA and MVPA would be associated with decreased BP. Methods: Altogether 2513 children (61% female) from the Avon Longitudinal Study of Parents and Children birth cohort, UK who had data on at least one time-point measure of accelerometer-based movement behaviour across the follow-up and complete BP measures at ages 11, 15, and 24 years clinic visits were studied. MVPA was categorized into ≥60mins/day or less according to WHO’s PA guidelines. Longitudinal associations and isotemporal substitutions were examined with generalized linear-mixed effect models whereas the mediation path was examined using structural equation models, adjusting for cardiometabolic and other lifestyle factors. Results: After full adjustment, a 1-minute cumulative ST from ages 11-24 years was positively associated with increased systolic BP (0.009 mmHg [95% CI 0.007 - 0.011]; p&lt;0.001), and diastolic BP. A 1-minute cumulative LPA was associated with decreased systolic BP (-0.007 mmHg [-0.009 - -0.004]; p&lt;0.001), but not diastolic BP. Persistent MVPA of ≥60mins/day was not associated with reduced systolic BP but paradoxically associated with increased diastolic BP (0.007 mmHg [0.002 - 0.013]; p=0.008). The longitudinal replacement of 10 minutes of ST with equal time in LPA during childhood, adolescence, and young adulthood cumulatively decreased systolic BP by -3 mmHg and diastolic BP by -2 mmHg during the 13-year follow-up period. Replacing 10 minutes of ST with 10 minutes of MVPA had no statistically significant effect. The positive association of ST with BP was fully mediated by lean mass (93% mediation). Conclusions: Future guidelines may emphasize the importance of early LPA intervention from childhood for the prevention and treatment of elevated BP.
Abstract 14690: ProduceRX Clinical Trial
Authors: Claudia Nau, Jason H Wu, Bing Han, Mina Habib, Zheng Gu, Xia Li, Ceping Chao, Pam Schwartz, Dariush Mozaffarian
Journal: Circulation (2023)

Background: Nutrition related cardiometabolic diseases are leading causes of morbidity, health disparities and health care spending. Produce prescriptions are highly promising to address these issues but impacts on health outcomes have not been tested in a randomized controlled trial. Hypothesis: A pre-randomized controlled trial that provides 6 months of free weekly produce deliveries to the intervention group reduces hemoglobin A1c (HbA1c), body mass index (BMI), and blood pressure (BP), among Medicaid patients with type 2 diabetes (T2DM) and persistently elevated HbA1c when compared to the control group. Methods: A total of 450 eligible Kaiser Permanente Southern California patients were enrolled 1:1:1 into control, high- and low-dose intervention groups. Eligibility criteria included: being enrolled through Medicaid (MediCal), age 18+ years, having T2DM with at least two HbA1c values &gt; 7.5% in the past 12 months. Produce amounts were scaled to household size and ranged from $90-270 and $90-180 for high and low-dose households, respectively. The primary endpoint was change in HbA1c at 6 months (measured up to 90 days post-intervention). Secondary outcomes were changes in BMI and BP. Primary analysis assessed both intervention groups compared to control; exploratory analyses considered dose-response. Analysis was conducted using random effects models. Results: Participants were predominantly Hispanic (85%), female (65%), and in average 59.4(SD=13.2) years old. At baseline, HbA1c was 9.40% (1.52); BMI 34.1kg/m2 (7.95); 74% had elevated BP or hypertension (stage 1 or 2), 58.3% were food insecure. Baseline characteristics were similar between control and intervention groups, 87% of participants had a 6-month HbA1c measure. In intention-to-treat analysis, compared to control, HbA1c at 6 months was significantly reduced in the intervention group: -0.37 [95%CI:-0.71;-0.04],p=0.028. Reduction in HbA1c was not significantly different between the high- and low-dose intervention. Results for BMI and BP are forthcoming. Conclusion: In the first randomized controlled trial of its kind, a produce prescription program significantly improved HbA1c among low-income patients on Medicaid with poor glycemic control at baseline.
Abstract 17973: Higher N-Terminal Pro-b-Type Natriuretic Peptide in Heart Failure With Rheumatoid Arthritis is Associated With Worse Short-Term Outcomes
Authors: Saeid Mirzai, Farah Abdulhai, Emily Littlejohn, Venu Menon, Wai Hong W Tang, heba wassif
Journal: Circulation (2023)

Background: The chronic inflammation of rheumatoid arthritis (RA) is known to cause a higher incidence of heart failure (HF); however, studies on the outcomes of patients with RA and HF are limited. Research Questions: We compared outcomes between matched patients with HF with versus without RA with a specific look at NT-proBNP as a prognostic marker. Methods: We conducted a retrospective study of adult patients with HF with RA (n=186) one-to-two propensity score matched to patients with HF without RA (n=135,233) from our tertiary care center from January 2001 to December 2022. RA and HF were defined by International Classification of Diseases (ICD) codes; HF was limited to ICD codes reported within the Heart, Vascular, and Thoracic Institute. Patients were matched using demographics (age, sex, and race) and comorbidities (hypertension, hyperlipidemia, diabetes, smoking, CAD, atrial fibrillation, CKD, COPD, cirrhosis, and cancer). Results: A total of 558 patients with HF were included, 186 with RA and 372 without RA. The sample’s mean age at HF diagnosis was 69±13 years, 69.2% were female, and 62.9% had HFpEF. Patients in the two groups did not differ by NT-proBNP or LVEF. During a maximum 1-year follow-up after HF diagnosis, the two groups did not differ in combined 1-year mortality/hospitalization. When each group was split by median NT-proBNP, patients in the higher NT-proBNP groups had less HFpEF and worse combined 1-year mortality/hospitalization (Figure 1; HR 2.44, 95%CI 1.39-4.27, p=0.002 in those with RA and HR 1.50, 95%CI 1.06-2.13, p=0.023 in those without RA). The outcomes did not differ when comparing patients with versus without RA with high NT-proBNP. Conclusions: Short-term outcomes did not differ amongst patients with HF with versus without RA once matched for demographics and comorbidities. Furthermore, NT-proBNP was a prognostic marker for worse short-term outcomes in patients with RA and HF.