tbuckley/cabot-search huggingface dataset:
Abstract 13452: Clinical Usefulness of Oxygen Uptake Efficiency Slope for Evaluation Functional Capacity of Heart Failure With Preserved Ejection Fraction
Authors: ByengJu Son, Jang-Won Son, Jong-Seon Park, KANGUN CHOI, Jong-Ho Nam, Jong Il Park, Sun-o Kim, Yu-jung Jung, Jun-Chang Jeong, Ung Kim
Journal: Circulation (2023)

1. Backgrand: The diagnostic criteria for HFpEF have been established; however, the evaluation criteria for functional capacity, such as LVEF in HFrEF, have not been clearly delineated. Furthermore, exercise intolerance is a prominent manifestation in patients with HFpEF.Considering these factors, the objective of this study was to analyze the results of cardiopulmonary exercise testing (CPET) in the HFpEF patient cohort and utilize them for the assessment of functional capacity. 2. Methods: Exercise echocardiographic data were retrospectively analyzed in a cohort of 83 patients who underwent exercise echocardiography between September 2021 and October 2022. Among them, 64 patients also underwent cardiopulmonary exercise testing (CPET). The diagnostic criteria for HFpEF were determined based on the ASE/EACVI algorithm, as outlined below. 3. Result: Notably, only in the case of the oxygen uptake efficiency slope (OUES), the patient group with diastolic dysfunction displayed a statistically significant result that was significantly lower than that of the group with normal diastolic function. Based on these findings, when the ROC curve was generated using OUES as the negative predictive value, the AUC was 0.708, indicating a fair result. 4. Conclusions: The decrease in OUES was found to be statistically significant in HFpEF patients. As a result, it is anticipated that OUES can serve as a measure for evaluating functional capacity in HFpEF patients, in addition to serving as an objective indicator of improved cardiopulmonary exercise capacity when treating HFpEF patients.
Abstract 15869: Antiarrhythmic Effects of Mesenchymal Stromal Cells in a Post-Infarct Swine Model of Ventricular Tachycardia
Authors: Raul D Mitrani, Alex Velasquez, Andrew Sundin, Simona I Ionescu, LUIZA BAGNO, Jeffrey J Goldberger, Wayne Balkan, Joshua M Hare
Journal: Circulation (2023)

Introduction: Mesenchymal Stromal Cells (MSC) reduce scar burden in models of ischemic cardiomyopathy. It is unknown whether MSCs exert antiarrhythmic effects. Hypothesis: MSCs reduce inducibility of monomorphic VT (mmVT) or prolong VT cycle length by ≥20 msec in a post-infarct swine model of VT. Methods: Two groups of 8 Yorkshire Swine underwent a 180-minute occlusion of the LAD. Group 1 (n=8) pigs underwent initial MRI scan, electrophysiology study (EPS), and 3D electroanatomic mapping (EAM) with injection of open-label MSCs (200M cells) around the borderzone of the infarct, using a NOGA Myostar catheter (J&amp;J) guided by EAM. Group 1 pigs had repeat EAM, and final EPS 8 weeks later. Group 2 pigs (n=8) were randomized between placebo and MSC and underwent sequential MSC injections (100M cells/procedure), 7 weeks apart, followed by final EPS and MRI 7 weeks later. Scar% = total scar/myocardial mass (grams). Results: MmVT was induced in 5 of 8 (62.5%) at initial EPS (i-EPS) in Group 1 pigs and 3 of 8 (37.5%) at final EPS (f-EPS). In Group 2 all 4 MSC-treated swine had inducible mmVT during i-EPS but only 2 had mmVT at f-EPS. Overall, 9 of 12 MSC-treated pigs had mmVT initially and 5 of 12 pigs had mmVT at f-EPS (p=0.12). For MSC-treated pigs with persistently inducible mmVT (Groups 1 &amp; 2), the baseline VT CL increased in all pigs by ≥20msec and increased from 216 ± 17 msec initially to 274 ± 35 msec at f-EPS (p = 0.001). In Group 1, Scar% was unchanged (22.2±1.6% to 20.5±2.1%) after single MSC treatment (p=0.17). In Group 2 MSC-treated pigs, Scar% decreased from 25.8±2.0% to 17.9±0.6% after 2 MSC treatments (p=0.014). In pigs with mmVT at i-EPS, the scar% was 24.4±1.2%, compared with 19.3±2.0% in pigs without i-EPS inducible mmVT (p=0.025). In pigs with mmVT at f-EPS, scar% was 22.5±1.8% compared with 18.1±1.6% in pigs without mmVT at f-EPS (p=0.048). Placebo-treated pigs showed no change in scar% (22.5±2.6% to 22.4±2.9%, p=0.44) and no change in VT inducibility (3 of 4 pigs at i-EPS and f-EPS). Conclusions: This study demonstrates that MSC injection reduced myocardial scar and either suppressed induction of VT or prolonged VT cycle length, consistent with an antiarrhythmic effect. Lower scar burden was associated with non-inducibility of VT, either at baseline or final EPS.
Abstract 16867: Predictors of Long-Term Mortality in Chronic Limb Threatening Ischemia Derived From a Random Forest Machine-Learning Model
Authors: Santiago Callegari, Gaelle Romain, Jacob Cleman, Lindsey Scierka, Jeremy Provance, Carlos Mena-Hurtado, Kim G Smolderen
Journal: Circulation (2023)

Introduction: Optimizing limb survival in patients with chronic limb-threatening ischemia (CLTI) undergoing peripheral vascular intervention (PVI) is a major focus. Care plans that consider patients’ high-mortality risk are less common. Understanding which patients have the highest mortality risk would enable more personalized care plan designs to enable person-centered care. We aimed to leverage a random forest machine learning (RFML) model to predict long-term mortality in patients with CLTI undergoing PVI. Methods: A cohort of patients with CLTI undergoing PVI from 2017 to 2019 from the Medicare linked Vascular Quality Initiative registry was derived. Using 89 pre-procedural variables, we constructed a RFML model predicting 3-year mortality. Missing data were addressed by random forest imputation. The data were divided into a training sample (80%) and a test sample (20%) using random sampling without replacement comprising. Variables that most frequently caused branch splitting closest to the tree′s origin of were defined as the most predictive factors, with a total of 1,000 trees being built. Accuracy was assessed using the Continuous Ranked Probability Score (CRPS) and Harrell’s C-index. Results: A total of 10,114 patients were included (mean age 72 ± 11 years, 59% male, 74% white). The 3-year mortality rate was 39.1% (Median survival: IQR: ), Among the 15 most predictive variables, 14 variables are potentially modifiable, Remarkably, 5 functional or psychiatric variables were among the most predictive factors. CRPS and Harrerl′s C-index were 0.172 and 0.70, respectively. Conclusion: Our RFML model successfully predicted 3-year all-cause mortality in patients with CLTI undergoing PVI. Predictors of mortality in CLTI extend beyond medical history and encompass functional and behavioral variables. A shared decision-making individualized plan focusing on patient-centered care is needed to improve long-term mortality in patients with CLTI.
Abstract 18786: The Association Between Aortic Abdomen Calcification, Systemic Immune Inflammation Index, Estimated Pulse Wave Velocity, Atherogenic Index of Plasma and Triglyceride-Glucose Index Among Non-Diabetic Patients: A NHANES 2013-2014 Cross Sectional Study
Authors: Bisher Sawaf, Sarya Swed, Hidar Alibrahim, Haidara Bohsas, Mohamad Nour Nasif, Mostafa Hossam El Din Moawad, Nagham Jawish, Shayan Qadir, Hussam Al Hennawi, Mervat Naguib, Mahmoud Mahmoud, Naim Battikh, Abdul Rehman Zia Zaidi, Baraa alghalyini, Wael Hafez
Journal: Circulation (2023)

Background: Not enough studies showed the predictive value of systemic immune inflammation (SII) index, estimated pulse wave velocity (EPWV) index, atherogenic index of plasma (AIP) and triglyceride glucose (TyG) index for developing abdominal aortic calcification (AAC). This study assesses the relationship between the previous indexes and the risk of AAC. Methods: National Health and Nutrition Examination Survey (NHANES) data was utilized. The study included data from 2013 to 2014. We included non-diabetic participants aged 18 years or older. All studied indexes were divided into four quartiles, except AIP, into two categories. SPSS was used for the analysis. The sensitivity and specificity of the included indexes in predicting AAC were calculated by receiver operating characteristic (ROC) analysis. We performed univariate and multivariate logistic regression to analyze the associated factors with higher values of studied indexes. Results: The analysis included 1315 non-diabetic patients, of which 324 had AAC, and 74 had severe AAC. Except for SII index, all indexes showed a statistically significant association with the presence of AAC (P &lt; 0.05). AAC was more prevalent among patients in the third and fourth quartiles of all Triglyceride-Glucose Index models, p-value&lt;0.05. Participants in the second quartile of the AIP were more likely to be affected by AAC, p-value&lt;0.05. In addition, all unadjusted regression models showed that higher values of the inquired indexes were significantly associated with the risk of abdominal aortic calcification. The areas under the curve (AUC) for TyG index, AIP, and EPWV were 0.558 (95% CI 0.52-0.59), 0.551(95% CI 0.51- 0.58), 0.692 (95% CI 0.65- 0.72) (p-value ≤ 0.05), respectively. Conclusion: Among all involved indexes, the estimated pulse wave velocity index was the best indicator for abdominal aortic calcification.
Abstract 18781: Targeting GPR39 in Pericytes for Preventing No Reflow After Acute Myocardial Infarction
Authors: Carmen Methner, Dai-Trang E Le, Sanjiv Kaul
Journal: Circulation (2023)

Background: No reflow (NR) continues to contribute towards morbidity and mortality in acute myocardial infarction (AMI). Currently, there is no treatment specific to NR. We demonstrated that NR is caused by pericyte-inducted capillary constriction and identified the G-protein coupled receptor, GPR39, through which the vasoconstrictor 15-Hydroxyeicosatetraenoic acid (15-HETE) results in pericyte contraction during myocardial ischemia. GPR39 knockout mice demonstrate a marked reduction in NR after AMI associated with less pericyte-induced capillary constriction. Consequently, we developed a drug candidate, VC108, that inhibits GPR39 with high specificity (antagonist potency, fpki=7.9) and no effect on 87 other receptors involved in cardiovascular regulation. Methods: Forty-nine Wild-type Sprague Dawley rats (3-4 weeks old) of both sexes underwent 1 hour of coronary occlusion followed by 1 hr of reperfusion. Either vehicle (n=13) or VC108 (in-vivo half-life of 2 hr) at 3 different doses: 0.3 (n=11), 0.5 (n=13), and 1.0 mg/kg (n-12) was injected 5 min before reperfusion. Risk volume (as %of LV volume) was derived from 4-6 short axis slices using Evans Blue staining and NR volume was measured using Thioflavin S. Results: There was no significant difference in the risk volume in animals treated with vehicle and the 3 doses of VC108 (Figure 1). In contradistinction, compared to vehicle, VC108 showed marked reduction in NR at all doses (Figure 2) with a trend towards lower NR volume at the highest dose. Conclusion: Pharmacological inhibition of GPR39 results in marked reduced in NR after AMI. These findings open up a novel approach to treating AMI.
Abstract 15567: Associations Between Social Determinants of Health and Cardiovascular Health of Adult Cancer Survivors in the United States
Authors: Danish Iltaf Satti, Jeffrey Shi Kai Chan, Edward Christopher Dee, Yan Hiu Athena Lee, Abraham Ka Chung Wai, Sourbha S. Dani, Salim S. Virani, Michael D. Shapiro, Garima Sharma, Tong Liu, Gary Tse
Journal: Circulation (2023)

Background: Relationships between social determinants of health (SDOH) and cardiovascular health (CVH) of cancer survivors are underexplored. Aims: To investigate associations between SDOH and CVH of adult cancer survivors in the United States (US). Methods: Data from the US National Health Interview Survey (2013-2017) were used. Participants reporting a history of cancer were included, excluding those with only non-melanoma skin cancer, or with missing data for any domain of SDOH or CVH. SDOH was quantified with a six-domain, 38-item score consistent with the Centers for Disease Control and Prevention recommendations (higher score indicated worse deprivation). CVH was quantified based on the American Heart Association’s Life’s Essential 8. As detailed dietary data were unavailable, a seven-item CVH score was used (higher score indicated worse CVH). Survey-specific multivariable Poisson regression was used to test associations between SDOH quartiles and CVH. Results: Altogether, 8254 participants were analyzed, representing a weighted population of 10,887,989 persons. Worse SDOH was associated with worse CVH (highest vs. lowest quartile: risk ratio 1.30 [95% confidence interval 1.25, 1.35], p&lt;0.001), with a grossly linear relationship between SDOH and CVH scores ( Figure 1A) . Subgroup analysis found significantly stronger associations in younger participants (p interaction =0.026) and females (p interaction =0.001), but without statistically significant interactions with race (p interaction =0.051) ( Figure 1B) . Higher scores in all domains of SDOH were independently associated with worse CVH (all p&lt;0.001). Higher SDOH scores were also independently associated with the presence of all items of the CVH score (all p&lt;0.05 for highest SDOH quartile). Conclusions: An unfavorable SDOH profile was independently associated with worse CVH among adult cancer survivors, with notably stronger associations in females and younger individuals.
Abstract 14169: Deletion of P21 Activated Kinase-1 Modulates Energy Homeostasis and Affects Cardiac Function
Authors: Paola C Rosas, Marcos Munoz, Maximilian McCann, Koreena Rafael-Clyke, Jooman Park, Shamim Chowdhury, Yuwei Jiang
Journal: Circulation (2023)

Introduction: We investigated the consequences of P21-activated kinase-1 (PAK1) deletion on cardiac function, body weight, body composition, and energy balance using a mouse model of global PAK1 knock out. PAK1 is a protein kinase that plays a role in multiple aspects of cardiac health. We hypothesize that PAK1 plays a role in cardiometabolic health including cardiac function and adipose tissue homeostasis. Methods: We used PAK1 -/- in the FVB/N background. We included 10-12-week-old male and female mice. Age and sex-matched FVB/N mice were used as wild-type (WT) controls. Most results included both male and female mice together, as no differences were found between sexes. Ca 2+ kinetics was measured in neonatal cardiomyocytes. Results: Deletion of PAK1 was found to have a significant impact on cardiac function. Specifically, slower Ca 2+ release and reuptake kinetics accompanied with decreased phospholamban phosphorylation was observed in PAK1 -/- mice. These changes affected cardiac systolic (EF, s’) and lusitropy parameters (E/e’, IVRT). Moreover, our findings revealed body weight differences between PAK1 -/- and WT at 12 weeks, accompanied with increased % fat mass and decreased % lean mass in PAK1 -/- , indicating a shift towards adiposity. Further analysis revealed that PAK1 -/- mice had increased weights of white adipose tissue (WAT), and brown adipose tissue (BAT). Moreover, we found increased food intake, increased number of feeding bouts and decreased energy expenditure accompanied with decreased thermogenic markers in subcutaneous WAT and BAT in PAK1 -/- , further contributing to the obesogenic phenotype (see table for results). Conclusions: Deletion of PAK1 affected systolic and diastolic functions, and resulted in increased energy intake, decreased energy expenditure, and increased adiposity. Therefore, targeting PAK1 signaling pathways may represent a promising therapeutic strategy for improving cardiometabolic diseases.
Abstract 16523: Trends and Outcomes of Preeclampsia Hospitalizations According to the Nationwide Inpatient Sample 2016-2020; An Updated Retrospective Population-Based Study
Authors: Endurance O Evbayekha, Yara Jelwan, Carlos Gaibor, Rani Kuttab, Leonela Bastidas, Purav Desai, Favour Markson, thomas pohlman
Journal: Circulation (2023)

Introduction: Preeclampsia occurs in about 5-8% of pregnancies and is a leading cause of maternal morbidity and mortality. We aimed to study the inpatient population with preeclampsia. Hypothesis: The disparity gap remains apparent in maternal health, and minority populations would have poorer outcomes Methods: We conducted a retrospective analysis using the 2016 to 2020 Nationwide Inpatient Sample (NIS) database. Using ICD-10 codes, we identified all hospitalizations with a primary diagnosis of preeclampsia. We adjusted for confounders and used a multivariate logistic regression model to estimate the odds ratio (adjusted odds ratios (aOR)) of our outcomes of interest. Results: There were 126,255 primary preeclampsia hospitalizations (PRE) during the study period, of which 2.2% (2,736) had eclampsia (ECL). There was an increase in the number of PRE hospitalizations from 24459 (24.5 per 1000 deliveries) in 2016 to 28448 (28.4 per 1000 pregnancies) in 2020 (p &lt;0.0001). Contrary to PRE admissions, there was a considerable decrease in hospitalizations or diagnoses for ECL from 958 (1 per 1000 deliveries) in 2016 to 417 (0.4 per 1000 deliveries) in 2020 (p&lt;0.0001). The mean age was 29 years (SD=6.3), and the mean length of hospitalization was 4 days (SD=3.6). Compared to their Caucasian counterparts, the risk of eclampsia was higher in the minority populations, with aOR of 2.4 (CI 2.1-2.6, p&lt;0.0001) in the Black, 1.3 (CI 1.1-1.4, p&lt;0.0001) in the Hispanic, 1.01 (CI 0.8-1.3, p=0.7) in the Asian, and 1.7 (CI 1.1-2.4, p&lt;0.0001) in the Native-American populations. Furthermore, the PRE group had a higher likelihood of postpartum acute kidney injury, 9.6 (CI 7.8-11.6, p&lt;0.0001), and postpartum cardiomyopathy 3.3 (2.9-3.9, p&lt;0.0001). Conclusions: Our five-year inpatient analysis revealed that while preeclampsia hospitalizations increased, eclampsia decreased. It also highlighted a higher likelihood of eclampsia in Black, Hispanic, and Native-American women and a subsequent increased risk for postpartum cardiomyopathy and acute kidney injury. Tailoring individualized maternal cardiovascular care based on risk stratification is crucial in these populations.
Abstract 14934: Libman-Sacks Endocarditis and Sjogren’s Syndrome: Are They Associated?
Authors: Karla B Almaraz, Carlos A Roldan, Ishan Shah, Maedeh Kholghi, Arianna Pregenzler-Wenzler, Michelle Ratliff
Journal: Circulation (2023)

Introduction: Libman-Sacks endocarditis (LSE) in patients with systemic lupus erythematosus (lupus) is frequently complicated with stroke or TIA, acute or chronic progressive valve dysfunction, need for high-risk valve surgery, and increased morbidity and mortality. Sjogren’s syndrome characterized by dry eyes and mouth for &gt;3 months and positive anti-Ro/SSA or SSB antibodies is common in lupus patients, but its association with LSE is unknown Aim: To determine if Sjogren’s syndrome is associated and predictive of LSE. Methods: 76 lupus patients (71 women, 36 ± 12 years of age) and 26 age-and-sex frequency (3:1 ratio) matched controls (22 women, 34 ± 11 years of age) underwent TEE and assessment of demographics, atherogenic risk factors, and parameters of inflammation and thrombogenesis. Patients were also assessed for lupus duration, activity, injury, autoantibodies, and therapy. Libman-Sacks vegetations by TEE were defined as localized, protruding, and sessile echodensities &gt;3 mm in diameter with well-defined borders as part of valve leaflets, annulus, or subvalvular apparatus. All studies were coded, de-identified, and interpreted by observers blinded to participants’ clinical data. Univariate and multivariate regression analyses were used to identify predictors of LSE. Results: 39 (51%) lupus patients and 2 (8%) controls had vegetations (p&lt;0.001). Also, 39 (51%) patients had Sjogren’s syndrome and 28 (72%) of them had vegetations (p&lt;0.001). As shown in Table 1 , age, Sjogren’s syndrome, current smoking, β-2 glycoprotein antibodies, lupus duration, acute or recent stroke/TIA, past stroke, lupus activity and damage scores, and anti-thrombotic therapy were univariate predictors of LSE (all p≤ 0.05). However, Sjogrens’ syndrome, acute or recent stroke or TIA, and duration of lupus were the only multivariate predictors of LSE (all p≤0.02). Conclusions: Sjogren’s syndrome is an independent predictor of Libman-Sacks endocarditis.
Abstract 16493: An Evaluation of Heart Failure Management in the Non-White Population at a Safety Net Hospital Compared to a National Registry
Authors: Margarita Martinez, Shiva Barforoshi, Emily Jaalouk, Sophie Miller, Jack Aguilar, Robin Chand
Journal: Circulation (2023)

Introduction: The importance of guideline-directed medical therapy (GDMT) to improve outcomes in patients with heart failure has been proven in multiple studies. However, providers still fall short in prescribing these medications to heart failure patients. This is reflected in the CHAMP-HF registry, one of the largest registries utilized to observe and analyze the use of GDMT for heart failure. The CHAMP-HF registry population includes 3,518 patients from 150 U.S. primary care and cardiology practices. Of this population, approximately 25.1% are non-White. It remains unclear what GDMT treatment patterns are in a majority non-White population. Objective: This study aims to compare GDMT treatment patterns for heart failure at Harbor-UCLA Heart Failure (HUCLA HF) clinic, with a majority-minority population, to the CHAMP-HF registry published data. Methods: This prospective cohort study followed patients who visited the HUCLA HF clinic over four months. Providers used a checklist to prompt them to review each patient’s GDMT at the end of each visit. Patient demographic data and checklist data were entered into the HUCLA HF clinic registry. The registry was used to analyze the utilization of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). The percentage of patients using GDMT was compared to those in the CHAMP-HF registry. Results: Overall, the HUCLA HF clinic registry revealed a majority-minority patient population with about 91% of patients classified as non-White patients. The HUCLA HF clinic patients had a higher percentage on max ACE/ARB (21% vs 15.7%), max ARNI therapy (42% vs 13.8%), max beta-blocker therapy (47% vs 15.5%), and max MRA therapy (70% vs 14.5%) compared to the non-White population in the CHAMP-HF registry, respectfully. Conclusions: This study demonstrates greater utilization of GDMT at the HUCLA HF clinic compared to the patients in the CHAMP-HF registry. This difference was likely due to the checklist that reminded the provider to review the GDMT at each visit. Strategies that prompt clinicians to review GDMT must be implemented to maximize its use.