tbuckley/cabot-search huggingface dataset:
Abstract 4140486: Cardioprotective Role of Metformin: A Systemic Review and Meta-Analysis on Reducing Reperfusion Injury and Improving Endothelial Function
Authors: Shahnawaz Notta, Hezborn Magacha, Mohannad Al Akeel, Nasir notta, Ashwin Jagadish, manar jbara, Vijay Ramu
Journal: Circulation (2024)

Introduction: Reperfusion injury, defined as the injury to tissue upon restoring blood flow after a period of ischemia, remains a concern in many clinical scenarios such as myocardial infarction and coronary artery bypass surgery. Among several mechanisms of action, metformin, a commonly used antidiabetic medication, has received attention recently for its potential protective effects against reperfusion injury. Hypothesis: Metformin ameliorates reperfusion injury due to a reduction in myocardial injury markers and improvement in endothelial function across diverse clinical settings. Methods: A systematic literature search of PubMed, Embase, and Cochrane Library databases up to January 2022 was performed. Metformin's effects on reperfusion injury were identified by searching myocardial injury and endothelial dysfunction. The study included eight articles on metformin and reperfusion injury. Animal studies, expert opinions, and reviews were excluded. Results: Treatment with metformin significantly lowered myocardial injury markers, with reduced troponin levels: pooled SMD -0.61, 95% CI -0.87 to -0.36, and infarct size by a pooled mean difference of -5.25%, 95% CI -8.96 to -1.53. Additionally, metformin had beneficial effects on the endpoints of endothelial function, including flow-mediated dilation (pooled SMD 0.68, 95% CI 0.38 to 0.97) and markers of oxidative stress and inflammation. Subgroup analysis showed a consistent effect of metformin across different patient populations and different clinical settings. The sensitivity analysis did not indicate the presence of a single study that affected the stability of the result. Conclusion: This meta-analysis supports the protective effect of metformin against reperfusion injury in various clinical settings. Metformin appears to reduce myocardial injury and promote improvement in endothelial function, which may translate into reducing the risk of adverse cardiovascular events among patient populations at high risk for them. Further research is warranted to investigate the mechanisms for its cardioprotective effect.
Abstract 4140296: Trajectory of Diastolic Dysfunction in Patients with Takotsubo Syndrome
Authors: Christopher Liu, Sara Ouaddi, Christopher Song, junyang lou, Adam Saltzman, Elena Salmoirago-Blotcher
Journal: Circulation (2024)

Introduction: Takotsubo Syndrome (TS) is associated with impairments in systolic function, but less information is available on diastolic function. Elucidating changes in diastolic function during the months following a TS episode is important to understand the long-term prognosis of this condition. Aim: To evaluate changes in diastolic function of patients with TS at follow-up (FU) vs. admission. Hypothesis: Echocardiographic measures of diastolic dysfunction will show improvements at follow-up compared to admission. Methods: Prospectively enrolled participants with a confirmed diagnosis of TS received a transthoracic echocardiogram at hospital admission (TTE1) and during FU (TTE2). TTE1 was performed for clinical reasons and data was abstracted from medical records. TTE2 was performed as part of an ongoing prospective study and analyzed by a cardiologist. To assess diastolic dysfunction, the following measures were considered: left atrial volume index (LAVI), e’ septal (e’s), e’ lateral (e’l), peak tricuspid velocity (TRV max), E/A, and mean E/e’. Left ventricular ejection fraction (LVEF) was also included. Differences were analyzed using paired samples t-test. P-values &lt;0.05 were considered significant. Sociodemographic information was collected through self-report surveys. Medical and psychiatric history were abstracted from medical records. Results: Patients (n=49; age=64.6 ± 9.3 years) were 98% female and 94% White. At FU (average = 2.2 months), systolic function had returned to normal (p &lt;.001). At admission, diastolic function measures were within normal range with the exception of e’s and e’l. At FU, patients showed improvements in e’l (p = &lt; .001) and TRV max (p= 0.039). There were no changes in LAVI, E/A, and mean E/e’. Conclusion: In this longitudinal sample of TS patients, minimal alterations of diastolic function were detected at admission, which improved at FU. The clinical significance of these findings need further study in larger, more diverse samples.
Abstract 4139970: Low-Dose Apixaban Safety and Efficacy in Patients with Atrial Fibrillation Who Have Gastrointestinal Bleed; A Nationwide Cohort Study
Authors: Carol Faris, Mark Ayoub
Journal: Circulation (2024)

Introduction: Anticoagulation (AC) is the mainstay of thromboprophylaxis for stroke prevention in atrial fibrillation (AF) and is recommended. Gastrointestinal bleeding (GIB) is a common complication with varied severity and often poses a challenge for cardiologists and gastroenterologists. The decision of whether to continue anticoagulation, when to resume and at what dose is often the challenge. Our study assesses the safety and efficacy of low-dose apixaban compared to a full-dose in patients with AF who had GIB over the course of 5 years. Methods: We queried the US Collaborative Network (which contains 63 healthcare organizations) of TriNetX deidentified research database. Patients with atrial fibrillation who have history of gastrointestinal bleed who received apixaban were identified and divided into two cohorts; patients on low dose of 2.5mg and those on full dose of 5mg. We excluded patients with serum creatinine ≥ 1.5 mg/dL and patients with body weight ≤ 132 lbs. Two well-matched cohorts were created using a 1:1 propensity-score matching (PSM) model using patients’ baseline characteristics and comorbidities. PSM components were age, gender, race, PPI use, anti-platelets, hypertension, coronary artery disease, heart failure, COPD, and CKD. We compared the risk of stroke, GIB, and mortality in 5 years. Results: A total of 19,427 patients with UGIB who have AFIB received oral apixaban were identified. Of those, 19% (n=3,701) were on low dose of 2.5mg and 81% (n=15,726) were on full dose of 5mg of apixaban. After PSM, each cohort included 3,701 patients. There was no statistically significant difference in the risk of stroke in 5 years between the patients on low dose compared to those on full dose (10.9% vs 11.9%, p=0.3). However, patients on low dose had a statistically significant lower risk of GIB compared to those on full dose (30.4% vs 35.3%, p&lt;0.0001). Mortality rates were not different between patients on low dose compared to full dose (21.8% vs 20.4%, p=0.13). Conclusion: The use of low-dose (2.5mg) apixaban in patients with GIB who have AF decreases the risk of GIB without significantly affecting the rate of stroke or mortality when compared to full-dose of 5mg. The use of a low-dose apixaban is safer and as efficacious as full-dose in patients with GIB who have AF.
Abstract 4140505: Sex-Based Disparities in the Care of Syncope Patients in the United States Using a National Database
Authors: Priyanka Devaguptapu, Chen Bai, John Petersen, Madeline Smoot, Emily Edwards, Sujay Kamisetty, Mamoun Mardini, Mohammed Ruzieh
Journal: Circulation (2024)

Introduction: Syncope is a common condition often leading to testing and hospital admissions. Research assessing sex-based differences in the workup as well as disposition following emergency department (ED) syncope visits is scarce. In this study, we sought to address this gap using a national database. Methods: From 2010 to 2019, we identified syncope patients using ICD-9 and ICD-10 codes. Using data from the IBM MarketScan Research Database, which captures de-identified individual-level health data from approximately 100 commercial payers and self-insured corporations in the United States, we assessed the incidence of testing using CPT codes in the 3 months following syncope diagnosis. Furthermore, we evaluated the percentage of syncope patients discharged from the ED. Sex-based comparisons were performed using the Chi-square test. Results: A total of 557,416 patients (54.0% women) were included in the cohort to assess for testing disparities (these are the patients who had at least 3 months of continuous enrollment following syncope diagnosis). Compared to men, women had significantly lower testing in most domains: long-term monitoring (6.8% vs. 7.4%), echocardiogram (13.3% vs. 17.2%), cardiac stress test (4.0% vs. 7.4%), chest X-ray (17.7% vs. 25.5%), imaging for pulmonary embolism (1.5% vs. 2.0%) and carotid Doppler ultrasound (5.4% vs. 7.3%); p&lt; 0.001 for all above comparisons, figure 1A. Tilt table testing was similar between both sexes (1.4% vs. 1.3%). A total of 1,325,023 patients (58.1% women) were included in the ED disposition cohort. Women presenting to the ED with syncope were more likely to be discharged compared to men (78.7% vs 72.1%; p&lt; 0.001), and this trend remained consistent throughout the study period, figure 1B. Conclusion: Women presenting with syncope are less likely to receive testing compared to men, and more likely to be discharged from the ED. There is a need to evaluate the reasons behind these disparities and assess their impact on patients’ outcomes.
Abstract 4140488: Late Gadolinium Enhancement CMR Tissue Characterization for Central Venous Catheter Associated Right Atrial Thrombus – Structural Risk Factors and Stratification of Embolic Outcomes among Systemic Cancer Patients
Authors: Rachel Axman, Kevin Schesing, Noel Tomy, Annie Tsay, Keefe Manning, Mahniz Reza, Jiwon Kim, Jennifer Liu, Jonathan Weinsaft, Angel Chan
Journal: Circulation (2024)

Background: Central venous catheters (CVC) are common in cancer pts but provide a nidus for right atrial thrombus (RA-Th). CMR can identify presence and risk factors for RA-Th. Objectives: To evaluate predisposing factors and embolic risk conferred by RA-Th. Methods: The population comprised adult (≥18yo) cancer pts with CVC who underwent CMR at two sites; RA-Th was defined by avascularity on LGE-CMR. Registry data included clinical and CVC indices and chart review for pulmonary embolism (PE) 1 month pre- or 6 months post-CMR. Results: 211 pts with CVC (52±17yo; 45% M) were studied, inclusive of RA-Th and controls matched for cancer etiology/stage (heme 28%| GI 27%| sarcoma 22%). CVC type varied (Mediport 81% |PICC 9%| pheresis 6%| HD 4%), as did time between RA-Th and catheter insertion (6.5[2.4-15.8] mo). Pts with and w/o RA-Th were of similar age, sex, CVC type/duration, and cardiac function on CMR (p=NS). CVC depth was greater in pts with RA-Th (2.8±1.6cm vs. 1.5±1.6cm, p&lt;0.001). Prevalence of RA-Th increased in proportion to CVC depth (&lt;1|1-3|&gt;3cm from SVC-RA: 31%|57%|75%; p&lt;0.001 without influencing RA-Th size (p=NS). Anticoagulation (LMWH 42%| NOAC 25%| warfarin 3.4%| combination 26%) was more common in pts with RA-Th (99% vs. 43%; p&lt;0.001). Despite this, RA-Th was strongly associated with embolic risk, as shown by &gt;5-fold higher incidence of PE vs. controls (16% vs 2.5%, p=0.002; OR=7.08 [CI 1.58–31.78], p=0.01; Table 1 ). In pts with RA-Th and PE (n=17), majority of PE (59%) occurred within 1mo of CMR, and the remaining occurred within 1-6mo after CMR ( Fig 1 ). Among pts with RA-Th, the likelihood of PE increased with high lesion mobility (27% vs 10%, p=0.02; OR=3.38 [CI 1.13–10.1], p=0.03). Conclusions: Increased catheter depth increases risk for RA-Th implicating mechanical factors as a key thrombogenic driver. Despite anticoagulation, patients with RA-Th are at markedly higher risk for embolic events, particularly within the first month of detection on CMR.
Abstract 4139718: Five-Year Real-World Clinical Outcomes After Intravascular Imaging Device-Guided Percutaneous Coronary Intervention with Paclitaxel-Coated Balloon versus Durable-Polymer Everolimus-Eluting Stent
Authors: Wataru Ariyasu, Takayuki Ishihara, masaharu masuda, Shin Okamoto, Kiyonori Nanto, Takuya Tsujimura, Yasuhiro Matsuda, Yosuke Hata, Hiroyuki Uematsu, SHO NAKAO, Masaya Kusuda, Satoshi Kudo, Subaru Fujii, Toshiaki Mano
Journal: Circulation (2024)

Background: Paclitaxel-coated balloon (PCB) has been used for the treatment of coronary artery disease in the small native coronary artery and its safety and efficacy have been reported in clinical trials. Research Questions: The real-word long-term outcomes after intravascular imaging device-guided percutaneous coronary intervention (PCI) with PCB have not fully elucidated. Aims: To elucidate the long-term outcome after PCB treatment. Methods: This was a single-center, retrospective and observational study. We enrolled 1226 lesions from 713 patients which were treated by intravascular imaging device-guided PCI with PCB (342 lesions from 211 patients) or durable-polymer everolimus-eluting stent (DP-EES, 784 lesions from 502 patients) which diameter was less than 3.0 mm in the native coronary arteries. Long-term clinical outcomes were compared between PCB and DP-EES. Primary outcome was major adverse cardiac event (MACE) defined as a composite of cardiac death (CD), myocardial infarction (MI), target vessel revascularization (TVR) and device thrombosis. Secondary outcomes were all-cause death, CD, MI, target lesion revascularization (TLR), TVR and device thrombosis. Cumulative incidences of clinical outcomes were estimated by the Kaplan-Meier method and compared by the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) of PCB relative to DP-EES for MACE were estimated through a multivariable Cox model and an inverse probability weighted (IPW). Results: Cumulative 5-year incidence of MACE was similar between PCB and DP-EES (18.5% vs. 20.7%, P=0.78, Figure). Cumulative 5-year incidences of all-cause death (23.2% vs. 16.8%, P=0.12), CD (8.0% vs. 7.0%, P=0.81), MI (2.2% vs. 2.5%, P=0.97), TLR (5.9% vs. 8.9%, P=0.35), TVR (12.6% vs. 14.4%, P=0.90) and device thrombosis (0% vs. 0.6%, P=0.20) were also similar between PCB and DP-EES. Even after adjustment for baseline characteristics, cumulative 5-year incidence of MACE was similar between PCB and DP-EES (multivariate and IPW adjusted HRs 0.72 [95% CI: 0.37-1.39], P=0.33 and 0.67 [95% CI: 0.21-2.07], P=0.48, respectively). Conclusion: PCB demonstrated comparable 5-year clinical outcomes with intravascular imaging device-guided PCI compared to DP-EES.
Abstract 4139890: High Visceral-to-Subcutaneous Fat Ratio is Correlated with Increased Coronary Artery Disease Severity Based on Computed Tomography-derived SYNTAX Score Regardless of Physique Stratified by Waist Circumference
Authors: Keishiro Okawa, Kyuhachi Otagiri, Takuya Miyagi, Yushi Oyama, Takahiro Sakai, Hiroshi Kitabayashi
Journal: Circulation (2024)

Background: Waist circumference (WC) has been recognized as a significant factor of metabolic syndrome and is closely associated with the amounts of abdominal visceral and subcutaneous fats. Although abdominal fat distribution (AFD) is indicated using the ratio of the visceral fat area (VFA) to the subcutaneous fat area (SFA), i.e., V/S ratio, which is possibly related to an increased risk of coronary artery disease (CAD), few studies have shown the impact of the AFD and physique on CAD. A computed tomography (CT)-derived SYNTAX score (CT-SX score) has been suggested as a feasible method of assessing CAD severity based on coronary CT angiography (CCTA). We aimed to evaluate the effect of AFD based on the V/S ratio and physique classified by WC on CAD complexity using the CT-SX score. Methods: CCTA was conducted on 931 consecutive patients suspected of CAD. Furthermore, a plain abdominal CT was also performed to measure VFA and SFA. To evaluate the AFD, V/S ratios were also determined. CAD severity was assessed using CCTA. Significant stenosis was defined as ≥50% diameter stenosis. The CT-SX score was calculated in patients with ≥1 significant stenosis. Finally, patients were classified into low and high WC groups based on their median value (84.79 cm). Results: Of the 931 patients enrolled, 308 (33.1%) had ≥1 significant stenosis. There was a positive correlation between the V/S ratio and CT-SX score regardless of the WC. Although VFA positively correlated with the CT-SX score in the low WC group, SFA negatively correlated with the CT-SX score in the high WC group. In a multivariate analysis adjusted for traditional coronary risks, same results were observed (Figure). Conclusions: The AFD indicated by the V/S ratio appears to be an effective index to determine CAD severity regardless of the physique based on WC. However, factors that increase the V/S ratio vary depending on the physique; therefore, interventional treatment tailored to each physique may help mitigate CAD progression.
Abstract 4140556: Comparison of the Risk of Cardiovascular Disease Between Degarelix Versus Gonadotropin-Releasing Hormone Agonists: a Systematic Review and Meta-Analysis
Authors: Nathalia Hoffmeister, Clara Rocha Dantas, Francinny Kelly, Artur de Oliveira Macena Lobo, Artur Menegaz de Almeida, Vitor Kendi Tsuchiya Sano, Francisco Cezar A de Moraes
Journal: Circulation (2024)

Background: Degarelix is a third-generation GnRH receptor antagonist approved for the treatment of prostate cancer. Recent data shows that the use of GnRH agonists is associated with higher cardiovascular morbidity and mortality and, suggesting the shorter time to testosterone suppression and lack of testosterone surge, GnRH antagonists might be more clinically beneficial. Purpose: We aimed to perform a meta-analysis comparing the cardiovascular disease risk between degarelix and gonadotropin-releasing hormone agonists in patients with all stages of prostate cancer. Methods: PubMed, Scopus and Web of Science databases were searched for randomized control trials (RCTs) and observational studies assessing the cardiovascular disease risk between degarelix and GnRH agonists in patients with prostate cancer. The outcomes of interest were (1) Cardiovascular Disease Risk, (2) Major Adverse Cardiovascular Events, (3) Stroke, (4) All-Cause Death, (5) Myocardial Infarction, (6) Heart Failure, (7) Arrhythmia, and (8) Hypertension. We computed binary endpoints risk ratio (RR) or hazard ratio (HR) with 95% confidence intervals (CI), which were analyzed using a random-effects model. Heterogeneity was examined with I2 statistics. P values of ≤ 0.05 were considered statistically significant. Statistical analyses were performed using RStudio, version 4.2.3. Results: 8 RCTs and 7 observational studies were included (123,969 patients; mean age 75 years; 12 months follow-up). Degarelix was associated with a significantly lower incidence of major adverse cardiovascular events (10.30% degarelix vs. 31.01% GnRH agonists; RR 0.59; 95% CI 0.41, 0.84; p = 0.003; I2=84%). Incidence of stroke (1.04% degarelix vs. 2.56% GnRH agonists; RR 0.89; 95% CI 0.56, 1.42; p = 0.62; I2=0%), all-cause mortality (3.15% degarelix vs. 5.24% GnRH agonists; RR 0.64; 95% CI 0.37, 1.13; p = 0.12; I2=41%), hypertension (4.05% degarelix vs. 5.78% GnRH agonists; RR 0.71; 95% CI 0.48, 1.04; p = 0.08; I2=0%), myocardial infarction (HR 1.04; 95% CI 0.59, 1.84; p=0.86; I2=66%), heart failure (HR 0.79; 95% CI 0.38, 1.62; p=0.52; I2=79%) and arrhythmia (4.58% degarelix vs. 10.67% GnRH agonists; RR 0.63; 95% CI 0.28, 1.41; p = 0.86; I2=37%), did not reach a statistically significant difference between groups. Conclusion: In patients with prostate cancer, degarelix is associated with a significantly lower incidence of major adverse cardiovascular events.
Abstract 4140208: Predicting 30-Day and 1-Year Mortality in Heart Failure with Preserved Ejection Fraction (HFpEF) using Electronic Health Record Data
Authors: Ikgyu Shin, Nilay Bhatt, Alaa Alashi, Keervani Kandala, Karthik Murugiah
Journal: Circulation (2024)

INTRODUCTION: Heart failure with preserved ejection fraction (HFpEF) represents 50% of heart failure patients. Predictive models in HFpEF, specifically those derived from electronic health record (EHR) data, are less established. HYPOTHESIS: EHR models can predict 30-day and 1-year mortality in HFpEF patients. Machine learning (ML) models compared with traditional may show superior performance. AIM: Develop and compare prediction models for 30-day and 1-year mortality in HFpEF using EHR data, using traditional and ML techniques. Methods: Using MIMIC-IV data (EHR data from the Beth Israel Deaconess Medical Center in Boston) from 2008-2019, we identified patients aged ≥ 18 years admitted with a primary diagnosis of HFpEF using ICD-9 and 10 codes. Demographics, vital signs, prior diagnoses, and lab data were extracted. After preprocessing, data was partitioned into 70% training and 30% test. Prediction models from seven model classes were developed using a variety of imputation and oversampling techniques using 5-fold cross validation - Support Vector Classifier (SVC), Logistic Regression, Lasso Regression, Elastic Net, Random Forest, HistGradient Boosting Classifier, and XGBoost. Model performance was compared using several metrics. SHapley Additive exPlanations (SHAP) analysis was used to assess individual feature influence on model output. Results: Among 3910 individual hospitalizations for HFpEF the 30-day mortality was 6.3% and 1-year mortality was 29.2%. Performance metrics of the best model in each class is shown in Table 1. By AUCs, Lasso and Elastic Net Regression models provided superior prediction for 30-day mortality (AUCs of 0.79, each), whereas Random Forest and HistGradient Boosting Classifier for 1-year mortality (AUCs of 0.78 each). Overall, considering all metrics, Elastic Net and Lasso regression models gave a good combination of sensitivity, specificity and AUC enhancing their clinical applicability. SHAP analyses showed age, NT-proBNP and sodium levels, WBC, and platelet counts as key drivers of these predictions. Conclusion: Models derived from EHR data, which is important for implementability, predict mortality after HFpEF hospitalization with good performance comparable to models derived from registry or trial data.