tbuckley/cabot-search huggingface dataset:
Abstract 11400: Coronary Artery and Carotid Artery Plaques in Patients With Heterozygous Familial Hypercholesterolemia
Authors: Hayato Tada, Soichiro Usui, Kenji Sakata, Masa-aki Kawashiri, Masayuki Takamura
Journal: Circulation (2023)

Background: Little is known regarding the formation coronary and carotid plaques and their impact on cardiovascular disease in patients with familial hypercholesterolemia (FH). Objectives: We aimed to determine 1) when coronary and carotid plaques develop, 2) if the development of coronary and carotid plaques are correlated and 3) if these plaques are associated with major adverse cardiac events (MACEs). Methods: This was a retrospective review of 622 patients with heterozygous FH at Kanazawa University Hospital, assessed coronary and carotid plaque scores using coronary computed tomography and carotid ultrasound within 1 year. Spearman correlation coefficients were assessed among variables. Risk factors for MACEs were determined using the Cox proportional hazard model. Results: These scores were significantly correlated (Spearman’s r=0.82; p &lt;0.001 in males and Spearman’s r=0.87; p &lt;0.001 in females). We observed 132 MACEs during the median follow-up period of 13.2 years. Coronary and carotid plaque scores were significantly associated with the occurrence of MACE (hazard ratio: 3.33; 95% confidence interval: 1.88-4.78; p &lt;0.001, hazard ratio: 2.24; 95% confidence interval: 1.28-3.20; p &lt;0.001, respectively). The regression equations between age and the coronary and carotid artery plaque scores, respectively, were Y=0.358X-9.44 and Y=0.146X-3.68 in males, and Y=0.330X-11.76 and Y=0.121X-3.60 in females ( p &lt;0.001 for all). Conclusion: Coronary and carotid plaque scores were significantly correlated, and both were independently associated with MACEs. Based on the regression equations, the average age of onset of coronary and carotid artery plaque developments, respectively, were 26 and 25 years old in males and 35 and 30 years in females.
Abstract 12112: Establishing a Minimally Clinically Important Difference Threshold for Health-Related Quality of Life in Atrial Fibrillation: The SAGE-AF Study
Authors: Isabelle C Pierre-Louis, Benita A Bamgbade, David D McManus, Sara Lopez-Pintado
Journal: Circulation (2023)

Introduction: Health related quality of life (HRQoL) is increasingly recognized as an important patient reported outcome but few research has focused on HRQoL meaningful changes overtime. Using data from Systematic Assessment of Geriatric Elements in Atrial Fibrillation, we identified clinically meaningful change over 1-year in older patients with AF and examined sociodemographic and geriatric factors associated with change. Methods and Results: Between 2016-18, 1,244 patients aged 65+ with atrial fibrillation (AF) were recruited from medical centers in Massachusetts and Georgia. At baseline and 1-year follow-up, patients completed validated HRQoL measure. We used a distribution-based approach to calculate a clinically meaningful threshold (9 points) and to define three groups: improve (N=154, 14%), stable, (N=617, 56%), and decline (N=326, 30%). Logistic regression was used to examine factors associated with clinically meaningful improvement and decline in HRQoL. CHA2DS2-VASC score was associated with an increased odds of HRQoL decline (adjusted odds ratio [AOR]= 1.16, 95% CI: 1.03, 1.32). Frailty (AOR= 1.89, 95% CI: 1.20, 2.92) and depression, (AOR=1.62, 95% CI: 1.17, 2.25) were associated with an increased odds of HRQoL improvement, while cognitive impairment (AOR= 0.72, 95% CI: 0.52, 0.99) was associated with a decreased odds of improvement in HRQoL. Conclusions: A change in HRQoL of 9-points was identified as clinically meaningful over 1-year in our cohort. The majority of patients remained stable in HRQoL over a year of follow-up. Understanding meaningful change in HRQoL can assist providers with knowing how to best treat their patients and develop strategies to improved or stabilize HRQoL.
Abstract 12095: Efficacy, Safety, and Cardio-Protective Effect of GLP-1 Receptor Agonists Among Patients With Diabetes Mellitus: A Meta-Analysis and Meta-Regression
Authors: Vikash Jaiswal, Marina Saleeb, Vibhor Agrawal, Song Peng Ang, Maitri Shah, Nirmit Patel, Monodeep Biswas, Akash Jaiswal
Journal: Circulation (2023)

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists have shown promising results in reducing the incidence of major adverse cardiovascular events (MACE) in patients with Diabetes Mellitus (DM). However, the reports of previous trials show inconsistent reports for other endpoints like myocardial infarction, stroke, and cancer. Objective: We sought to evaluate the efficacy and safety of GLP-1 receptor agonists among DM patients by including recently published trials evaluating cardiovascular outcomes. Methods: We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10th March 2022. Primary clinical outcomes were the incidence of MACE. The secondary efficacy outcomes were cardiovascular mortality (CVM), all-cause mortality (ACM), myocardial infarction (MI), stroke, and heart failure hospitalization (HFH). Results: A total of 8 randomized controlled trials with xx (518,105 GLP-1 RA vs. 6,817,729 placebo) patients were included in the analysis. The mean age of the patients with GLP-1 RA and the placebo group was 70.0 and 69.2 years. The mean follow-up duration was xx years. Pooled analysis shows that GLP-1 receptor agonists were associated with significant 14% reduction in MACE [HR 0.86, 95% CI (0.80-0.93), p&lt;0.01], 17% reduction in stroke [HR 0.83, 95% CI (0.76-0.92), p&lt;0.01], 10% reduction in MI [HR 0.90, 95% CI (0.83-0.99), p=0.02], 13% reduction in CVM [HR 0.87, 95% CI (0.81-0.94), p&lt;0.01), 12% reduction in ACM [HR 0.88, 95% CI (0.83-0.93), p&lt;0.01] and 9% reduction in HFH [HR 0.91, 95% CI (0.84-0.99), p=0.04] compared to that of placebo. Among safety outcomes, the risk of thyroid cancer was significantly higher in GLP-1 RA [OR 2.33, 95% CI (1.08-5.03), p=0.03) compared to placebo. Conclusions: GLP-1 receptor agonists significantly reduced MACE, MI, ACM, CVM, HFH, and stroke. However, the risk of thyroid cancer significantly increased in GLP-1 RA patients.
Abstract 11889: Ischemic Evaluation in Patients Presenting With Advanced Atrioventricular Block - Experience From a Large County Health System
Authors: Jasmeet K Kalsi, mahboob alam, Jing Liu, June K Pickett, John Suffredini, Waleed T Kayani, Xiaoming Jia
Journal: Circulation (2023)

Introduction: Coronary artery disease (CAD) is a risk factor for advanced (2 nd degree Mobitz II and 3 rd degree) atrioventricular (AV) block. Research Question: While AV block in the setting of acute myocardial infarction (AMI) is often reversible, data is limited on utility of ischemic evaluation in advanced AV block without AMI. Aim: We assessed whether ischemic evaluation and revascularization was associated with reversibility of advanced AV block not in the setting of AMI. Methods: We queried the electronic medical records of a large county health system that serves the Houston metropolitan area for patients with diagnosis of advanced AV block between 1/1/2018 and 1/1/2022. Demographic, medical history, ischemic evaluation (by coronary catheterization or stress test) data and pacemaker interrogation reports were abstracted from the medical records. Patients with AV block from AMI were excluded. Results: Over a period of 4 years, there were 116 patients who presented with advanced AV block, of which 73 (62.9%) underwent ischemic evaluation either by coronary angiography or non-invasive imaging. Patients who underwent ischemic evaluation were associated with lower pacing burden on device interrogation compared to those with no ischemic evaluation (Table 1). In multivariable regression, ischemic evaluation was associated with lower odds of pacing burden &gt;40% on device interrogation (OR -1.53, 95% CI -3.02, -0.03) but not AV block resolution (OR 0.41, 95% CI -1.76, 2.58). Of those who underwent ischemic evaluation, 26.0% had obstructive CAD, of which 78.9% underwent revascularization. AV block resolved in 13.3% who underwent revascularization. Conclusion: Among patients presenting with advanced AV block not in the setting of AMI, ischemic evaluation was associated with decreased pacing burden but not AV block resolution. In patients found to have obstructive CAD, a minority had resolution of AV block after revascularization.
Abstract 12088: Left Ventricular Non-Compaction, Coronary Artery Fistula, and Infective Endocarditis: A Rare Combination
Authors: Kyung An Kim, Yuran Ahn, Soyoung Lee, Hae-Ok Jung
Journal: Circulation (2023)

Description of Case: A 48-year-old man underwent echocardiography for multifocal subacute infarctions found on brain MRI. No intracardiac shunts were found, but prominent LV trabeculae raised suspicion of LV non-compaction (LVNC). LV ejection fraction was 53%, and LV volume was within upper-normal range. Cardiac MRI confirmed these findings, although non-compacted:compacted myocardium ratio was 1.9. (Panel A-B) A right coronary artery to LV fistula was also diagnosed. (Panel C-D) The patient was followed-up uneventfully, but 10 months later was admitted after a generalized seizure episode. Brain MRI detected multiple new hemorrhagic infarcts, and echocardiography revealed a 10.8mmх10.1mm mobile mass and high-speed diastolic flow near the basolateral LV wall. (Panel E-F) Gemella morbillorum was identified on two blood cultures. The patient underwent surgery for fistula closure and vegetation resection. Vegetation pathology and culture however was negative for bacterial growth. Paroxysmal atrial fibrillation was also detected, before discharge with full recovery. Discussion: LVNC and coronary artery fistula (CAF) are both caused by arrest in embryonic myocardial compaction. Despite a hypothetical common origin, reports of co-occurrence are extremely rare. This is the first to report the association of a mild form of LVNC and a single large CAF. This is also the first to report infective endocarditis due to CAF by G. morbillorum . G. morbillorum infective endocarditis is rare, subacute in course, and causes significant destruction. The extensive, prolonged embolism found here has not been reported in other cases of CAF-associated infective endocarditis and may be due to G. morbillorum .
Abstract 12070: An Implementation Study to Improve Statin Optimization in Primary Prevention Patients at a Resident Run Clinic in Rural US
Authors: Sameer Acharya, Jillian Senner, Kanwal Ejaz, Yashashwi Pokharel
Journal: Circulation (2023)

Introduction: Despite the benefit of statin in primary prevention of atherosclerotic cardiovascular disease (ASCVD), guideline-concordant statin use (statin optimization) remains low. Methods: We previously showed that among 325 consecutive 40-75 years old patients at baseline 35.4% did not have lipids ordered and 49.2% had lipid results unavailable over 3 years in electronic medical record (EMR). Using mixed-methods design, we previously identified provider and patient-related barriers; lack of automated ASCVD risk score reporting in EMR, insufficient clinic time and follow up visits. We identified and used several implementation strategies: 1) designed and disseminated a simplified process map and a guideline directed algorithm, 2) developed an automated ASCVD risk score reporting in EMR, 3) conducted telemedicine follow up, and 4) provided several refresher trainings/reminders. Now, we report two-year results among 354 consecutive patients with hypertension following the program adoption. Results: Mean age was 59.2 (61.9% male) and 50.6% were White patients and mean BMI was 30.2 (7.1). Compared with baseline, percentage of lipid labs ordering (64.6% vs 95.5%), lipid lab orders completion (78.6% vs 95.3%), ASCVD risk score assessment (3% vs 91%) and primary prevention statin optimization (34.6% vs 90.1%), all increased at 2 years (Table). Conclusions: Contextually appropriate implementation strategies can be helpful to address provider- and system-level barriers in cholesterol management and using statin for primary prevention.
Abstract 11638: Physician Attitudes Toward Beta Blocker and Antiplatelet Therapy in Spontaneous Coronary Artery Dissection Patients
Authors: Olivia Liu, Vita Jaspan, Anais Hausvater, Jacqueline Saw, Harmony Reynolds
Journal: Circulation (2023)

Background: Spontaneous Coronary Artery Dissection (SCAD) primarily affects younger women and is a cause of acute coronary syndrome for which medical management guidelines and clinical trial data are lacking. Our study assessed physician attitudes toward beta blocker (BB) and antiplatelet therapy (APT) in SCAD. Methods: We conducted an online survey among 165 physicians who treat SCAD. Data were collected about their demographics, BB and APT prescribing practices in hypothetical SCAD patients each with one key difference from the base case, and willingness to randomize patients to BB or no BB and to dual APT [DAPT] (12 months of aspirin and P2Y12 inhibitor, then only aspirin) or single APT [SAPT] (3 months of aspirin, then no APT). Results were analyzed with descriptive statistics and chi-squared test. Results (Table): Of the respondents, 163 (99%) were cardiologists, and 64 (39%) were women. When considering BB at discharge, 88% of physicians would prescribe BB in the base case of an otherwise healthy 49-year-old woman with SCAD, with higher likelihood of prescribing BB in a patient with hypertension or ejection fraction (EF) &lt; 50%. Most physicians (95%) were willing to randomize the base case to BB or no BB. Respondents expressed uncertainty about the benefit of BB use, particularly in patients with normal blood pressure or with EF &gt; 50%. When considering APT at discharge, 38% of physicians would prescribe DAPT, 46% would prescribe SAPT, and 16% would prescribe no APT in the base case. Most physicians (92%) were willing to randomize the base case to the DAPT or SAPT strategies. Physicians expressed concern about inadequate and excessive APT, indicating a range of opinions. Conclusion: Most physicians would prescribe BB and APT at discharge after SCAD, with the type of APT varying widely. Nearly all were willing to randomize patients to BB or no BB and to DAPT or SAPT. Our results suggest clinical equipoise exists for BB and APT use in SCAD and point to the need for clinical trial data.
Abstract 12100: Association Between Rheumatoid Arthritis and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis
Authors: Vikash Jaiswal, Nishat Shama, Poulami Roy, Song Peng Ang, Amira Mohamed Taha, Akanksha Sharma, Anupam Halder, Vibhor Agrawal, Kriti Kalra, Harpriya Khela
Journal: Circulation (2023)

Background: Rheumatoid arthritis (RA) is an autoimmune disorder with a varying range of organs involved and leading to adverse outcomes. However, very little is known, with conflicting results about the association between RA and atrial fibrillation (AF) and the incidence of acute coronary syndrome (ACS). Objective: We aim to evaluate the incidence of atrial fibrillation (AF), ACS, and other clinical outcomes among RA patients. Methods: We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until 10th April 2023. Primary clinical outcomes were AF. Secondary endpoints were acute coronary syndrome (ACS), stroke, and all-cause of mortality. Results: A total of 4,667,199 patients were included in the analysis, with 77460 (xy%) patients in the RA group and 4589739 patients in the NRA group. The most common Comorbidity includes hypertension among RA and NRA groups (27% vs. 6%), respectively. Pooled analysis of primary outcomes shows that RA groups of patients had significantly higher odds AF (OR, 1.17(95%CI: 1.11-1.23), P&lt;0.00001, I2=34%) compared with NRA groups. Secondary Outcomes shows that the RA group of patients had significantly higher odds of ACS (OR, 1.37(95%CI: 1.23-1.53), P&lt;0.00001) compared with the NRA groups. However, the likelihood of stroke (OR, 1.02(95%CI: 0.95-1.08), P=0.65), and all cause mortality (OR, 1.25(95%CI: 0.84-1.87), P=0.27, I2=91%) was comparable between both the groups of patients. Conclusion: Our study shows that RA groups of patients are at increased risk of having atrial fibrillation and acute coronary syndrome. However, mortality risk was comparable between both groups.
Abstract 11959: The Relationship of Matrix Gla Protein With Coronary and Extracoronary Calcification in the Multi-Ethnic Study of Atherosclerosis
Authors: Ashley A Berlot, Xueyan Fu, Kyla Shea, Russell Tracy, Matthew J Budoff, Ryung Kim, Mahim Naveed, Sarah Booth, Jorge R Kizer, Anna E Bortnick
Journal: Circulation (2023)

Introduction: Vascular calcification regulators are understudied. Matrix Gla protein (MGP) is a calcification inhibitor, and its inactive dephosphorylated-uncarboxylated (dp-ucMGP) form has been linked to calcification. The longitudinal relationship of dp-ucMGP with coronary and extracoronary artery calcification in large populations is unknown. Hypothesis: Higher levels of dp-ucMGP may be associated with greater coronary artery, ascending thoracic aortic, and descending thoracic aortic calcification (CAC, ATAC, DTAC). Aim: To determine the association of dp-ucMGP with CAC, ATAC, and DTAC. Methods: Calcification was measured on serial thoracic computed tomography (CT) scans in the Multi-Ethnic Study of Atherosclerosis (MESA, n=6814). Dp-ucMGP was measured at baseline in a random subset of available serum samples (n=2663), 2539 included in the fully adjusted models) in participants with a baseline (2000-02) and follow-up CTs at Exam 5 (2010-12) ( InaKtif MGP ELISA, Perkin Elmer, Waltham, MA). Linear mixed effect models were used to determine the association of baseline dp-uc MGP levels with long-term CAC, ATAC, and DTAC incidence and progression. Results: Participants were on average 61 + 9 years, 51.3% women, and 37.7% white. For each one standard deviation (178 pmol/L) increase in dp-ucMGP, CAC increased by 3.44 ([95% CI = 1.68, 5.21], p&lt;0.001) Agatston units/year (AU/year), ATAC increased by 0.63 ([95% CI = 0.27, 0.98], p=0.001) AU/year, and DTAC increased by 8.61 ([95% CI = 4.55, 12.67], p&lt;0.001) AU/year, in fully adjusted models. Conclusion: We found an association of the inactive form of matrix Gla protein, dp-ucMGP, with long-term incidence/progression of CAC, ATAC, and DTAC. Future studies should investigate MGP as a calcification regulator and possible therapeutic target.
Abstract 11897: Admission Rates for Pediatric Supraventricular Tachycardia From the Emergency Department Are Affected by Primary Insurance Payor: An Analysis of the NEDS Database
Authors: Mathew Hakimi, Antara Mondal, Steve Ampah, Michael L Obyrne, Christopher Janson
Journal: Circulation (2023)

Introduction: Supraventricular tachycardia (SVT) is the most common arrhythmia in children and often requires emergency department (ED) care. Recent data highlight disparities in access to care for pediatric patients with SVT, though the association of socioeconomic factors with ED outcomes remains unclear. Hypothesis: Outcomes of ED encounters for pediatric SVT will differ by insurance payor. Methods: We performed a retrospective cohort study utilizing encounter-level data from the 2006-2018 US Nationwide Emergency Department Sample (NEDS). All encounters for patients age 0-18 years with a primary diagnosis of SVT were evaluated, excluding those with diagnoses of congenital heart disease or cardiomyopathy. The primary exposure was insurance payor: private vs. public. The primary outcome was hospital admission/transfer. Secondary outcomes included inpatient length of stay (LOS), procedures (cardioversion, catheter ablation), and mortality. Logistic regression models evaluated the association of payor with outcomes, including the following covariates: age, hospital teaching status, hospital region, patient residence, and patient income. Results: A total of 38,896 ED encounters were analyzed: median age 11.5 years (IQR 6-15); 48% male; 53% private payor, 38% public payor. Encounters with public payor had a higher rate of admit/transfer than private (24% vs. 18%, p&lt;0.0001). There were no differences in LOS (2.5 days public vs. 1.8 days private, p= 0.6) or procedures by payor; there were no mortalities. In multivariate analysis, public payor was an independent predictor of admission/transfer (OR 1.6, 95% CI 1.2-2.2). Patient age was also associated with admission/transfer, with all age groups less likely to undergo admission/transfer compared to age &lt; 1 year: age 1-4, OR 0.3, 95% CI 0.2-0.6; age 5-8, OR 0.1, 95% CI 0.1-0.2; age 9-12, OR 0.1, 95% CI 0.1-0.2; age 13-18, OR 0.1, 95% CI 0.1-0.2. Conclusions: This analysis demonstrates that public payor is associated with higher rates of hospital admission/transfer for pediatric SVT, independent of age. Though we cannot evaluate why publicly insured patients are admitted more often, it may be due to more severe illness caused by delays in care for SVT. If so, this should be a target for intervention.
Abstract 12083: Symptoms of Depression and All-Cause and Cardiovascular Disease Mortality Among US Adults, NHANES 2005-2018
Authors: Zefeng Zhang, Sandra Jackson, Cathleen Gillespie, Robert K Merritt, Quanhe Yang
Journal: Circulation (2023)

Introduction: Depression is a common mental health disorder among the US population. Depressive symptoms are associated with increased cardiovascular disease (CVD) incidence and mortality rates. Few recent studies have examined the association between depressive symptoms and mortality among US adults. Hypothesis: Depressive symptoms increase all-cause and CVD mortality among US adults. Methods: The present study used the National Health and Nutrition Examination Survey (NHANES) 2005-2018 data with the NHANES 2019 Linked Mortality Files among adults aged ≥20 years. Depressive symptoms were defined by the Patient Health Questionnaire-9 (PHQ-9) scores and categorized into 3 groups: (1) none or minimal (0-4); (2) mild (5-9); and (3) moderate to severe (10-27). Cox proportional hazard models were used to evaluate the association between depressive symptoms and all-cause, CVD, and ischemic heart disease mortality, adjusting for sociodemographic factors, lifestyle factors, and clinical characteristics. Results: Prevalences of none or minimal, mild, and moderate to severe depression were 77.9%, 14.9%, and 7.2%, respectively. For all-cause mortality, hazard ratios were 1.35 (95% confidence interval, 1.06, 1.72) for mild depressive symptoms vs none, and 1.61 (1.24, 2.10) for moderate to severe depressive symptoms vs none. The corresponding hazard ratios were 1.49 (1.11, 2.00) and 1.79 (1.22, 2.62) for CVD mortality, and 0.96 (0.58, 1.60) and 2.21 (1.24, 3.91) for ischemic heart disease mortality. The associations were largely consistent across subgroups. Approximately 11.0%-16.1% of the associations between depression and mortality could be explained by lifestyle factors. Conclusions: Overall, there was a graded and positive association between depressive symptoms and mortality among US adults. Public health and healthcare efforts to improve awareness and treatment of depression and its related risk factors can support a comprehensive strategy to reduce the overall burden of depression nationwide.