tbuckley/cabot-search huggingface dataset:
Abstract 14382: Discovery of Magnetocardiography for Monitoring of Myocardial Injury Following Radiotherapy: A Case Report
Authors: Huan Zhang, Jiaxuan Yang, shuwen yang, Linqi Liu, Shu Zhou, Xueyao Yang, Zhao Ma, Ming Ding, Bin Cai, Chenchen Tu, Wen-Yang Liu, Xiantao Song, Hongjia Zhang
Journal: Circulation (2023)

Introduction: Radiotherapy, as one of the important management approaches for cancer, could induce the cardiomyocyte injury and increase the risk for cardiovascular diseases. However, early detection and identification of myocardial damage during radiotherapy is still challenging with routine methods. Magnetocardiography (MCG), a novel way to detect feeble magnetic fields formed by electrical activity of cardiomyocytes, is highly sensitive to the diagnosis of myocardial ischemia. Here, we present a case for whom the MCG changes observed during radiotherapy for thymoma. Case: The patient received radiotherapy for the tumor bed in the second month after transthoracoscope enlarged thymectomy and resection of the adherent tissues, with a total radiation dose of 50Gy/20F. The mean heart dose was 20.62Gy, and the volume of heart receiving greater than or equal to 30Gy is 31.77%. Comprehensive clinical biochemistry, ECG and echocardiography were taken before radiotherapy and presented without any abnormalities in cardiac structure and function. The magnetic field angle, character of positive and negative pole at T peak were also normal in magnetic field map before radiotherapy(Figure 1A). MCG and ECG were collected every week during radiotherapy. Nevertheless, during the whole 4 weeks, no significant abnormalities were found but the shape of positive and negative pole in magnetic field map became distorted gradually compared with the initial standard ellipse in MCG(Figure1B-D). Recurrent chest pain influenced the patient in the last two weeks either, which indicates the possibility of myocardial injury. Conclusions: Our case showed the possible minimal myocardial injury detected by MCG in the early stage of radiotherapy, while ECG is normal throughout the therapy. Therefore, our case may provide interesting insights into the potential of MCG for early detection of radiotherapy-induced myocardial damage, which deserves further validation study in the future.
Abstract 14915: Role of Diabetes and Diabetic Medication in Cardiovascular Events and Survival Among Older Men With Prostate Cancer on Androgen Deprivation Therapy: Longitudinal SEER Medicare Analysis
Authors: Priyanshu Nain, Biplab Datta, Stephanie Jiang, Vraj Patel, Lakshya Seth, Aditya Bhave, Sarah Malik, Darryl Nettles, Yan Gong, Michael Fradley, Darryl Leong, Neal L Weintraub, Avirup Guha
Journal: Circulation (2023)

Introduction: The effect of diabetes mellitus (DM) and DM therapy on cardiovascular events (CVE) in patients with prostate cancer (PC) undergoing androgen deprivation therapy (ADT) is unclear in the contemporary era. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified males ≥ 66-year-old with a new primary diagnosis of PC undergoing leuprolide therapy (ADT) between 2009-2017. These patients were followed for two years to identify a primary outcome of CVE that included heart failure (HF), atrial fibrillation (AF), acute myocardial infarction (AMI), peripheral artery disease (PAD), coronary artery disease (CAD), ischemic stroke (IS) and cardiovascular death. DM medications identified using part D data for this analysis were metformin, insulin, and other orals based on FDA approval dates until 2017. Adjusted Cox proportional hazards modeling was performed to estimate all-cause mortality in PC patients stratified by DM and among those with DM and on different therapies. Adjusted Fine-Gray modeling with appropriate competing risk (mortality or type of mortality) was utilized for other outcomes as presented. We adjusted for demographic factors, social determinants of health, cancer-specific factors, and other cardiovascular risk factors apart from the primary exposure of DM. Results: This study included 9,072 PC patients. Among these 2,822 (31.1%) had DM, and 5,105 (56.3%) had cardiovascular disease prior to PC diagnosis. New CVE was diagnosed in 619 (6.8%; HF = 144, AF = 107, AMI = 40, PAD = 132, CAD = 226, IS = 66) patients in a 2-year period after the PC diagnosis. DM was noted to be a risk factor for CVE [adjusted subdistribution hazards ratio (aSHR) = 1.22 (95% CI= 1.07-1.44)]. The effect of DM and DM medication on mortality is presented in Table 1. Conclusion: PC patients on ADT with DM have a higher risk of CVE and all-cause mortality. Metformin use is associated with reduced all-cause mortality.
Abstract 16063: African American's Are Prescribed Direct Oral Anticoagulants at Lower Rate Than White Patient's in an Inpatient Cohort With Diagnosis of Atrial Fibrillation
Authors: Lowell Safren, Krystal Hunter, Andrea M Russo
Journal: Circulation (2023)

Introduction: Previous studies have demonstrated racial disparities in the treatment of atrial fibrillation (AF). Potential explanations for disparities in care include cost and insurance coverage issues. This has not been examined in relation to anticoagulation (AC) therapy for thromboembolic prophylaxis of AF in a more contemporary practice using an inpatient cohort. Hypothesis: For hospitalized patients with AF, is there disparity in the rate of prescription of direct oral anticoagulant (DOAC) therapy at discharge for Black compared to White patients? Methods: A single-center retrospective query of all patients hospitalized at a University Hospital with a primary or secondary diagnosis of “AF” in 2022 and a prescription for AC at time of discharge was performed using EPIC. Baseline characteristics and AC prescription were compared between Black and White patients using the χ2 test for categorical variables and t test for continuous variables. Results: There were 275 patients that met the inclusion criteria. Demographics were 38.2% female, 66.5% White, and 14.9% Black (Table). DOAC was prescribed at discharge for 66.1% of White and in 55.0% of Black patients (p=0.01). The distribution of type of AC prescribed at discharge is shown (Figure). Conclusions: There is an ongoing racial disparity in the rate of DOAC prescription in hospitalized patients with AF, despite similar insurance status. Further investigation into underlying reasons for these differences and ways to eliminate disparities is warranted.
Abstract 13906: Electrocardiographic Correlates of Cardiac MRI Findings in Women With MINOCA
Authors: Mitchell Pleasure, Vita Jaspan, Olivia Liu, Emilie Lin, Raymond Kwong, Anais Hausvater, Tara Sedlak, Hayder Hashim, Caitlin Giesler, Kevin R Bainey, Aun-Yeong Chong, Bobak Heydari, Mobeen Ahmed, Nathaniel Smilowitz, Harmony Reynolds
Journal: Circulation (2023)

Introduction: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is identified in 6-15% of patients with MI and disproportionately affects women. Cardiac magnetic resonance (CMR) imaging is important to identify the cause of MINOCA but is restricted by its technical complexity and limited accessibility. The electrocardiogram (ECG), a simple, readily available tool, may predict features associated with abnormal CMR. Methods: Women with a diagnosis of MI and &lt;50% angiographic stenosis in all epicardial vessels were enrolled in the Women’s Heart Attack Research Program (HARP), a prospective, multicenter, observational study. Participants had CMR at a median of 6 days from MI (n=116). A CMR core laboratory interpreted images while blinded to clinical data and ECGs. Abnormal CMR findings included late gadolinium enhancement (LGE) or myocardial edema. The patient’s presenting ECG was analyzed. ECGs with ≥2 uninterpretable leads or with bundle branch block were excluded. ECGs were assessed for T-wave inversions (TWI), pathologic Q waves (QW), fractionated QRS (fQRS), and ST segment depression or elevation. The DETERMINE score is 2x the number of leads (#) with QW + # fQRS + # TWI, excluding leads V1 and aVR (maximum score 40). Results: (Figure, Table): Among 112 women with MINOCA, CMR abnormality was more likely in women with DETERMINE score ≥3 vs &lt;3 (86% vs 65%, p = 0.01). DETERMINE score ≥3 was associated with abnormal CMR on logistic regression (OR 3.4, p = 0.01). Patients with any TWI were more likely to have abnormal CMR than those with no TWI (84% vs 64%, p = 0.02), and were more likely to have LGE on CMR (61% vs 34%, p = 0.005). In those with a DETERMINE score of 0, CMR was abnormal in 62% vs 78% with DETERMINE score ≥1 (p=0.09), and LGE was present in 28% vs 54%, p = 0.01. Conclusion: ECG abnormalities were associated with abnormal CMR among women with MINOCA. The ECG may provide risk stratification for CMR, but the absence of QW, fQRS and TWI does not preclude CMR abnormality.
Abstract 17765: Stress Myocardial Blood Flow is Abnormal During Acute Takotsubo Syndrome
Authors: Retu Saxena, Joao Cavalcante, Dawn R Witt, Ross Garberich, Aaron Bae, Gretchen A Benson, Sarah Schwager, Peter Kellman, Hui Xue, Scott W Sharkey
Journal: Circulation (2023)

Introduction: Coronary microvascular dysfunction (CMD) is a proposed mechanism for takotsubo syndrome (TS). Therefore, we performed cardiac magnetic resonance imaging (CMR) with quantitative stress/rest perfusion and T2 mapping during acute TS and at 6-month post recovery. AIM: Quantitate stress/rest myocardial blood flow (MBF) in acute/recovery TS and compare basal with apical MBF. Methods: TS diagnosed by internationally accepted criteria. Each patient underwent acute and 6-month recovery CMR with automated in-line quantification of global/regional MBF, cine imaging, T2-mapping, and late gadolinium enhancement (LGE) imaging. Normal rest and stress MBF are 0.8-1.0 and &gt; 2.0 ml/min/g, normal myocardial perfusion reserve (MPR) is &gt; 2.4. Results: Acute and recovery studies were performed on 7 patients, all women, average age 63 + 8.5 years. CMR was performed within 72 hours of TS diagnosis. Initial versus (vs) follow-up EF: 40.3% vs 67.1%, left ventricular (LV) mass: 108.7 grams vs 86.3 grams. Acute studies demonstrated hypokinesis in the mid-apical segments with corresponding myocardial edema, LGE was absent in all patients. Myocardial edema and wall motion abnormality normalized at recovery. During acute TS, rest and stress MBF were 1.14 and 2.58 ml/min/g (base) vs 0.96 and 1.73 ml/min/g (apex). While at recovery, rest-stress MBF were 1.14 and 3.12 ml/min/g at base versus 1.09 and 2.76 ml/min/g at apex (Figure). MPR improved from acute to recovery: 2.14 vs 2.74 (global), 2.25 vs 2.84 (base), and 1.85 vs 2.64 (apex); p = 0.126; 0.035; 0.012 respectively (Figure). Conclusion points: Resting MBF is normal during acute TS in both basal and apical LV segments despite typical apical ballooning consistent with stunned myocardium. MPR is more abnormal in apical than base segments during acute TS, returning to normal at recovery. Myocardial edema might contribute to apical CMD during acute TS.
Abstract 15082: Novel Imaging/Hemodynamic Based Right Ventricular Phenotypes in Patients With Pulmonary Hypertension
Authors: Alexandra M Janowski, Scott H Visovatti, raymond Benza, Rebecca Vanderpool
Journal: Circulation (2023)

Introduction: Right ventricular function and ventricular dynamics associate with outcomes in pulmonary hypertension (PH). Measures of RV strain describe ventricular mechanics but are not included in RV function assessments. This study aimed to develop novel RV imaging-hemodynamic phenotypes using unsupervised machine learning. Methods: Participants with cardiac magnetic resonance (CMR) and right heart catheterization data were identified from The Ohio State University CMR PH registry (n=81). RV areas were segmented from CMR 4-chamber images and used to determine RV free wall (RVFW) and septal strain. K-medoids clustering was used on imaging features, RV hemodynamics, and RV function (Figure A). Correlation analysis was used to reduce collinearity. Significance was measured with Kruskal Wallis and chi-squared tests. A p-value &lt; 0.05 was considered significant. Results: Participants were assigned to three clusters and top contributors to cluster assignment were RVEF, RVFW strain, and Ea. RV phenotypes progress from mild/no RV dysfunction (Cluster 1) to severe RV dysfunction (Cluster 3) (Figure A). Cluster 1 had normal RV function with high RVEF and PA compliance, preserved LVEF, low RVSP, and low Eed. Compared to cluster 1, cluster 2 demonstrates more RV dysfunction with reduced RVEF, stroke volume, and PA compliance with an increase in RVSP but no change in Eed. In addition to more RV dysfunction (decreased RVEF and stroke volume), cluster 3 had increased RA pressure and Eed. In terms of RV strain, (Figure B), cluster 2 had less negative RVFW and septal strain compared to cluster 1. In cluster 3, RV septal strain is similar to cluster 2 but with decreased RVFW strain. Conclusions: Imaging and hemodynamic RV variables contribute to identification of novel RV-centric phenotypes and should be included in phenotyping efforts to better describe altered ventricular dynamics contributing to RV dysfunction in PH.
Abstract 16514: Head-to-Head Comparison of Quantitative Image Quality on Rubidium-82 Myocardial Perfusion Positron Emission Tomography Between a Digital Silicon Photomultiplierand Conventional Scanner
Authors: Hidenobu Hashimoto, Donghee Han, Hyun Mark, Keiichiro Kuronuma, Damini Dey, Piotr J Slomka, Daniel Berman
Journal: Circulation (2023)

Introduction: The purpose of this study was to compare rubidium-82 positron emission tomography ( 82 Rb PET) myocardial perfusion imaging (MPI) findings and quantitative image quality measures between the digital silicone photomultipliers (SiPM) scanner and a conventional scanner. Methods: We studied 24 consecutive patients (mean age 71.2±2.2 years) who underwent two clinically indicated rest/stress 82 Rb PET MPI examinations on two scanners, one using a SiPM-based PET scanner (Biograph Vision, Siemens Healthineers) and the other using a conventional photomultiplier tube (PMT)-based PET scanner (Discovery 710, GE Healthcare). Inclusion criteria were: 1) interval between the scans &lt;2 yr (median 1.1 yr, 95% CI: 0.9-1.4), 2) no interval revascularization, and 3) no interval symptom changes. Stress and imaging protocols were the same. 82 Rb doses were 925 MBq at rest and stress. Image quality was assessed using blood background coefficient-of-variation (COV), myocardium to blood signal to noise ratio (SNR) and contrast to noise ratio (CNR) calculated from the 82 Rb images. Results: Between two scanners, there were no significant differences in perfusion and functional measures, including summed stress score (SiPM: 1.6 ± 0.7 vs. PMT: 1.8 ± 0.8, p=0.21), summed rest score (SiPM: 2.7 ± 1.0 vs. PMT: 3.1 ± 1.2, p=0.34), LV function (LVEF, SiPM: 62.6 ± 2.8 vs. PMT: 61.4 ± 2.8, p=0.82) and volumes (LVEDV, SiPM: 62.6 ± 2.8 vs. PMT: 61.4 ± 2.8, p=0.51). Image quality measures significantly improved (Figure), with lower COV (SiPM: 15.3 ± 0.8 vs. PMT: 19.3 ± 1.1, p=0.006), higher SNR (SiPM; 26.4 ± 1.8 vs. PMT; 20.5 ± 1.5, p&lt;0.001) and CNR (SiPM; 14.2 ± 1.2 vs. PMT; 11.4 ± 1.1, p=0.02). Conclusions: 82 Rb PET MPI performed with SiPM-based a PET scanner showed significantly better image contrast and less noise compared to a PMT-based PET scanner. These findings suggest that the SiPM based PET scanner provides more previse evaluations for patients undergoing 82 Rb PET MPI.
Abstract 12864: Trim69 Alleviates Heart Aging and Mitochondrial Dysfunction by Restoring Mitophagy Through P53-Related Pathway
Authors: Jian Yang
Journal: Circulation (2023)

Introduction: Cardiac aging is defined as the heart structural and functional abnormality, manifesting as the aging-associated functional decline and the aging phenotypes. Trim69 is an E3 ubiquitin-protein ligase representing the potential to alleviate cardiac aging through poorly defined mechanisms. Hypothesis: Whether Trim69 signaling improves cardiac aging, and if so to further explore the underlying mechanism. Methods: The SD rats were subjected to subcutaneous injection of low-dose D-gal in the nape for 8 weeks to induce senility. The recombinant lentivirus was transmitted by myocardial multipoint injection to overexpress Trim69 in vivo. The assessment of cardiac function and aging-associated phenotypes were enforced through an ECG, β-gal staining, Masson staining, WGA staining, and western blot. Cardiac mitochondrial structure and mitophagy were observed through electron microscopy in vivo , which were detected by a mitophagy detection kit and JC-1 staining in vitro . H9C2 cardiomyocyte line derived from rats' embryonic stem cells was used to explore the protective effects and mechanism of Trim69 against D-gal-induced cardiac aging and mitochondrial dysfunction. Results: After 8 weeks of D-gal induction, the heart function of rats significantly declined, with marked manifestations of senility including positive for β-gal staining, increased oxidative stress, noticeable myocardial hypertrophy, and progression of myocardial fibrosis. Trim69 overexpression alleviated D-gal-induced cardiac dysfunction and mitochondrial damage, accompanied by mitophagy recovery. Mechanistically, Trim69 directly binds with P53 and promotes its ubiquitination and degradation, reversing the D-gal-induced mitophagy suppression via Parkin/Pink1 axis. Conclusions: Overexpression of Trim69 could promote ubiquitin degradation of P53, which further inhibits the accumulation of P53, therefore alleviate the cardiac aging and mitochondrial dysfunction.
Abstract 18553: Different Leg Symptoms and the Presence of Peripheral Artery Disease in the Community: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Study
Authors: Kentaro Ejiri, Simin Hua, Qibin Qi, Jessica S Williams-nguyen, Olga Garcia-Bedoya, Martha L Daviglus, Daniela Sotres-Alvarez, Shoshana Ballew, Matthew A Allison, Robert Kaplan, Christina Cordero, Barry E Hurwitz, Kunihiro Matsushita
Journal: Circulation (2023)

Introduction: Intermittent claudication is manifestation of lower extremity peripheral artery disease (PAD). However, most patients with PAD either have atypical leg symptoms or no symptoms. To what extent leg symptoms are associated with the presence of PAD in the community is unknown. Methods: We studied 8,402 HCHS/SOL participants aged 45 and older (mean age 56.2 years, 54% female) without a clinical diagnosis of PAD. We categorized leg symptoms with walking into: (a) typical calf pain (calf pain on exertion relieved within 10 min after stopping); (b) atypical calf pain (same as (a) except no quick relief after 10 min); (c) non-calf pain (exertional leg pain but not in calf); and (d) leg pain at rest (ever pain during standing or sitting) based on a questionnaire. PAD was defined as an ankle-brachial index (ABI) ≤0.9. We first quantified the associations of leg symptoms with the presence of PAD using multivariable logistic regression. Then, we assessed the validity of different leg symptoms to identify PAD. All analyses accounted for survey weighting. Results: The prevalence of PAD was 4.8% (95% CI 4.1-6.0%). The prevalence of leg symptoms are displayed in Figure 1A (e.g., 1.9% for typical calf pain). In multivariable logistic models, only typical calf pain was significantly associated with PAD, and its adjusted OR exceeded 5 (5.52 [95% CI 2.60-11.7], Figure 1A). In terms of validity, typical calf pain had 98.5% specificity, but the sensitivity was ~10% (Figure 1B) and the positive predictive value was 24.1%. The c-statistic of this leg symptom classification for detecting PAD was 0.58. Conclusions: In Hispanics/Latinos without clinical history of PAD, only typical calf pain on exertion was robustly associated with the presence of PAD. However, the limited positive predictive value and discrimination indicate the need to optimize the target population and/or further refine leg symptoms to utilize them to detect PAD in the community.
Abstract 14729: Association of Iliac Artery Non-Calcified Plaque Volume and Acute Limb Ischemia: Insights From the VOYAGER PAD Angiographic Core Lab
Authors: Marc P Bonaca, Warren Capell, Cameron Tong, Tolulope Popoola, April Kinninger, Venkat Sanjay Manubolu, Manesh R Patel, Connie N Hess, Mark R Nehler, Sebastian Debus, Sonia S Anand, Lloyd P Haskell, Eva Muehlhofer, Michael Szarek, Matthew J Budoff
Journal: Circulation (2023)

Introduction/Background: Acute limb ischemia (ALI) is a severe complication of peripheral artery disease. Lipid lowering and antithrombotic therapies reduce ALI but pathologic studies have described thrombus in distal arteries without plaque, suggesting that artery to artery embolism from proximal (aortic-iliac) athero-thrombosis may be a key driver. Research Questions/Hypothesis: We hypothesized that the burden and character of atherosclerosis in the iliac arteries of patients with PAD would be associated with long term risk of ALI. Methods: VOYAGER PAD enrolled 6,554 patients with PAD and collected 2,200 baseline angiograms in 1,664 patients including 400 CT angiograms enabling plaque characterization. A case-control of 9 who had ALI during follow up and 9 controls were matched on anatomic and patient characteristics, type of index revascularization and disease pattern. Images were read by a blinded, independent imaging core lab. Results/Data: Of the 9 ALI cases, 45% had iliac artery occlusion and 55% had distal artery occlusion. Plaque characteristics were different in cases relative to controls including significantly greater non-calcified plaque volume (OR 2.36, 95% CI 1.05 - 9.38, p=0.03) as well as similar trends for low attenuation plaque (OR 1.65, 95% CI 0.89 - 4.72, p=0.05), and plaque burden (OR 1.16, 95% CI 1.00 - 1.25, p=0.03, Figure). In patients who experienced ALI, there was a trend for greater non-calcified plaque in the limb that experienced the ALI relative to the contra-lateral limb (index 7.2 vs contra-lateral 5.4, p=0.08). Conclusions: In a case-control series, total non-calcified plaque volume and overall plaque burden in the iliac arteries were associated with future ALI over 3 years. Based on the observations in this case-control, we are now analyzing plaque and outcomes in the full cohort. These data are hypothesis generating and suggest that plaque characteristics may be associated with ALI and may serve a surrogate marker of risk.