tbuckley/cabot-search huggingface dataset:
Abstract 4145880: Incidence and Outcomes of Acute Myocardial Infarction (AMI) in Hematological Malignancy Patients: Systematic review and Meta-analysis
Authors: Sawai Singh Rathore, Ameer Farrukh, Sem Josue Nsanh Yao, Ibrahim Al Shyyab, Vanessa Vidaurre Corrales, Zario Wint, Hritvik Jain, Aman Goyal, Ashish Kumar
Journal: Circulation (2024)

Background: Patients with hematological malignancies may face increased cardiovascular risks, including acute myocardial infarction (AMI). This systematic review and meta-analysis aims to evaluate the incidence and outcomes of AMI in patients with hematological malignancies compared with the general population. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs). The inverse variance method with DerSimonian–Laird (DL) of Tau2 was used to calculate standardized mean differences (SMDs) with CIs. Statistical significance was set at p &lt; 0.05. The primary endpoint was the incidence of AMI, while secondary outcomes included in-hospital mortality, length of hospital stay, likelihood of undergoing invasive procedures, total hospital costs, bleeding events, and stroke outcomes. Results: Twenty-six articles, including approximately 6.33 million patients with hematological malignancies, were included in the meta-analysis. Hematological malignancies were not associated with an increased incidence of AMI compared with the general population (OR = 0.91; 95% CI 0.80 to 1.03; p&lt;0.001). AMI in hematological malignancies was associated with an increased risk of in-hospital mortality (OR = 1.71; 95% CI 1.57 to 1.86; p&lt;0.001), bleeding event (OR = 1.30; 95% CI 1.12 to 1.60; p&lt;0.001), and stroke (OR = 1.24; 95% CI 1.09 to 1.42) compared with AMI in the general population. Patients admitted due to AMI in hematologic malignancies also experienced an increased length of stay (SMD = 0.25; 95% CI 0.20 to 0.28; p&lt;0.001) compared with AMI in the general population. There was no significant difference between the two groups in terms of the likelihood of undergoing invasive procedures (OR = 0.62; 95% CI 0.56 to 0.69) or total hospital expenditure (SMD = 0.09; 95% CI -0.01 to 0.19). Conclusion: While hematological malignancies do not appear to increase the incidence of acute myocardial infarction (AMI), patients who experience AMI episodes are at higher odds of in-hospital complications.
Abstract 4136977: Childhood Food Security and Cardiometabolic Health in Young Adulthood
Authors: Emily Lam, Abigail Gauen, Namratha Kandula, Daniel Notterman, Noreen Goldman, Donald Lloyd-Jones, Norrina Allen, Nilay Shah
Journal: Circulation (2024)

Background: Food insecurity is associated with adverse cardiometabolic health in adults. To understand the early, long-term impact of food insecurity, we examined the associations of food insecurity in childhood with young adult cardiovascular-kidney-metabolic (CKM) syndrome stage and suboptimal cardiovascular health (CVH), and the modifying effects of participation during childhood in the Supplemental Nutrition Assistance Program (SNAP). Methods: In the Future of Families and Child Wellbeing Study of individuals enrolled at birth (1998-2000) and followed through age 22 years (2020-24) across 20 US cities, the associations of household food insecurity during childhood (age 3-5 years; score ≥1 on the US Household Food Security Survey) with CKM stage (0 [reference], 1, 2, or 3/4) and Life’s Essential 8 CVH score (high 80-100 [reference], intermediate 50-79, low 0-49) at age 22 years were evaluated with adjusted multinomial logistic regression. The interactions of food insecurity and SNAP participation, and food insecurity and race, were evaluated. Results: Among 1,071 participants, 53% were female; 53% non-Hispanic Black, 25% non-Hispanic White, 18% Hispanic; 39% lived in households with food insecurity, and 44% participated in SNAP. Food insecurity was associated with higher odds of being in CKM Stage 1 (aOR 1.41 [95% CI: 1.02-1.93]) and Stage 3/4 (aOR 1.78 [95% CI 1.11-2.83]) compared with Stage 0 at year 22 (Table). Food insecurity was also associated with having intermediate vs. high CVH in young adulthood (aOR 1.46 [95% CI 1.04-2.06]). SNAP participation modified the association of food insecurity and CVH; ffood insecurity was more strongly associated with intermediate vs. high CVH among those who did not participate in SNAP (aOR 2.37 [95% CI 1.39-4.04]) compared to those who were SNAP participants (aOR 0.79 [95% CI 0.46-1.35]) in childhood. There was no significant interaction of food insecurity and race for either outcome. Conclusions: Childhood food insecurity is associated with worse cardiometabolic health in young adulthood, especially among children whose families did not participate in SNAP. Policies to promote food security in children may promote cardiometabolic health across the life course.
Abstract 4144520: Glucagon-like Peptide-1 Receptor Agonists for the Primary Prevention of Major Adverse Cardiac Events in Drug-naïve Type 2 Diabetes: A Propensity-score Analysis
Authors: Kuan Yu Chi, Pei Lun Lee, Anita Osabutey, Pawel Borkowski, Junmin Song, Zafer Akman, Laura Romero Acero, Maisha Maliha, Vikyath Satish, Yu Chang, Michele Nanna, MD, FACC, Michael Nanna
Journal: Circulation (2024)

Background: The effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RA) as a first-line agent for the primary prevention of major adverse cardiac events (MACE) in obese patients with diabetes mellitus (DM) is unknown. Research Question: Does initial treatment with GLP-1 RA in obese drug-naïve patients with type 2 DM prevent future MACE? Aims: To examine the association between GLP-1 RA treatment and the primary prevention of MACE in drug-naïve type 2 DM patients with obesity. Methods: A retrospective propensity score-matched (PSM) analysis was conducted using the TriNetX Global database. We implemented a new-user design, including adult overweight/obese patients with drug-naive type 2 DM between January 1 st , 2019 and May 1 st , 2023. Patients with prior heart failure (HF), myocardial infarction (MI), coronary revascularization, stroke, or cardiac arrest were excluded. We compared those starting GLP-1 RA versus starting non GLP-1 RA. Medication starting window spans from the first diagnosis to 3 months afterwards. Patients with insulin were excluded if they had any emergency or inpatient encounters during this window. The primary outcome was incident MACE, defined as any death, decompensated HF, MI, cardiac arrest, or ventricular tachycardia/fibrillation, within 5 years of initial drug dispense. Secondary outcomes were individual MACE. Gastrointestinal bleeding was set as a falsification endpoint. Results: Of 1,245,340 patients with A1c &lt;10% and 293,072 patients with A1c ≥10%, 7,483 and 1,563 patients started on GLP-1 RA as a single agent and part of a combined approach, respectively. After PSM, baseline covariates were balanced between the two treatment groups and no significant differences were observed in the falsification endpoint by treatment arm (Figure) . Compared with non-GLP-1 RA, with the exception of sodium-glucose cotransporter-2 (SGLT2i), starting a GLP-1 RA first was associated with a significant reduction in MACCE, primarily driven by reductions in decompensated HF (Figure) . Conclusions: Initiation of a GLP-1 RA as the first agent for obese patients with drug-naïve type 2 DM was associated with a significant reduction in MACE compared to all other diabetes medications, with the exception of SGLT2i.
Abstract 4144560: Phase 2 Open-label, Single-arm, Multi-center Clinical Trial to Evaluate the Efficacy and Safety of Camostat Mesylate in Patients with Protein-losing Enteropathy after Fontan Operation-Preliminary Outcome
Authors: Woo Young Park, Gi Beom Kim, Sang Lee, Jae Suk Baek, Soo jin Kim, Jowon Jung, Myung Chul Hyun, Young Tae Lim, Hyoung-Doo Lee, Hoon Ko, Joowon Lee
Journal: Circulation (2024)

Introduction: Protein-losing enteropathy (PLE) is a multifaceted condition that profoundly affects the systemic health and quality of life of Fontan patients. Despite medical progress, the treatment of PLE remains a significant challenge. This study investigates the efficacy and safety of Camostat Mesylate for managing PLE patients who have undergone the Fontan operation. Hypothesis: We hypothesize that Camostat Mesylate will enhance the gut environment, resulting in increase of serum albumin levels and decrease of stool alpha-1 antitrypsin levels in PLE patients following Fontan operation. Methods: This phase 2, multicenter, open-label, single-arm trial included patients over 4 years old diagnosed with PLE following Fontan operation. Camostat Mesylate was added to conventional treatments, with follow-up assessments at 1, 3, and 6 months, and a final evaluation one month after discontinuation. Efficacy was measured by changes in serum albumin, stool alpha-1 antitrypsin levels, and PLE symptoms such as diarrhea, edema, weight changes, and ascites. Results: Nineteen patients were enrolled in the study, of whom fifteen patients completed follow-up as per protocol. The median age was 15 years (interquartile range, 12.0-21.3). The median time between the Fontan operation and PLE diagnosis was 2.4 years. Serum albumin levels increased from 2.5 to 2.6 g/dL (p=0.504), and stool alpha-1 antitrypsin levels decreased significantly from 280.0 to 172.1 mg/dL (p=0.033). Notably, patients with diarrhea at baseline showed substantial improvement in both parameters, with increased serum albumin levels from 1.8 to 2.2 g/dL and decreased stool alpha-1 antitrypsin levels from 220.3 to 80.2 mg/dL. No serious adverse events were reported during study period. Conclusions: Camostat Mesylate demonstrated safety and efficacy, reducing stool alpha-1 antitrypsin in PLE patients after Fontan operation, especially those with diarrhea at baseline. Therefore, Camostat Mesylate could be considered as an additional treatment option for patients with PLE following Fontan operation. Key words: Camostat mesylate; protein-losing enteropathy; Fontan operation Source of Funding: This research was funded by SNUH Lee Kun-hee Child Cancer&amp;Rare Disease Project, Republic of Korea.
Abstract 4119535: Aspirin Use and Cardiovascular Disease Incidence in Adults with High Lipoprotein(a): A Multi-Cohort Study
Authors: Lisandro Colantonio, Zhixin Wang, Lama Ghazi, Chibuike Alanaeme, Ashley Christenson, Medha Dubal, Waqas Malick, Emily Levitan, Robert Rosenson, Vera Bittner
Journal: Circulation (2024)

Introduction: There is an active debate about who may benefit from taking aspirin to reduce their incidence of cardiovascular disease (CVD). Some prior cohort studies with small sample size suggest that aspirin use may be associated with a lower incidence of CVD or coronary heart disease (CHD) in adults with Lp(a) ≥50 mg/dL but not in those with Lp(a) &lt;50 mg/dL, a hypothesis that needs confirmation. Research question: Does the association of aspirin use with incident CVD or CHD vary by Lp(a) among US adults? Methods: We analyzed publicly available data from adults without CVD at baseline in the ARIC (n=13,085, mean age 54 years), CHS (n=3,956, mean age 72 years), and MESA (n=6,324, mean age 62 years) studies. Lp(a) ≥50 mg/dL was defined as high. Participants were followed for incident CVD (myocardial infarction, stroke, or CVD death) and CHD (myocardial infarction or CHD death; median follow-up: ARIC 26 years, CHS 12 years, MESA 14 years). Hazard ratios associated with aspirin use were calculated after propensity score matching (primary analysis) and in all participants using multivariable adjustment (secondary analysis). Mixed-effects models were used to obtain pooled hazard ratios. Results: Aspirin use was 25.1% in ARIC, 29.6% in CHS, and 19.9% in MESA. In MESA, adults taking aspirin were older, had higher blood pressure, and were more likely to have diabetes and a low estimated glomerular filtration rate and to be taking antihypertensive medication and a statin versus those not taking aspirin. These differences were attenuated or not present in ARIC and CHS. The CVD incidence rate per 1,000 person-years (95%CI) was higher in adults with versus without high Lp(a): 16.3 (15.3-17.4) and 12.5 (12.1-13.0), respectively, in ARIC, 35.8 (31.5-40.1) and 32.3 (30.6-34.0) in CHS, and 10.8 (9.1-12.4) and 8.2 (7.5-8.9) in MESA. Aspirin use was not associated with CVD or CHD incidence in adults with or without high Lp(a) in the primary analysis ( Figure ). No association between aspirin use and CVD or CHD incidence was present in the secondary analysis using multivariable adjustment (data not shown). Conclusion: The association of aspirin use with CVD and CHD incidence did not differ by Lp(a) in this multi-cohort study.
Abstract 4143242: Right Ventricular Remodeling During the First Decade After Tetralogy of Fallot Repair: An Echocardiographic Study
Authors: Jose Galan, Andrea Jones, Ryusuke Numata, Antara Mondal, Angeli Thomas, Yan Wang, Michael DiLorenzo, Alexis Zavez, Elizabeth Goldmuntz, Laura Mercer-Rosa
Journal: Circulation (2024)

Background: After TOF repair (TOFr), pulmonary regurgitation resulting in right ventricular (RV) dilatation and dysfunction is common. We have previously demonstrated that RV function (RVF) improves in the first two years after TOFr, however RV changes in the first decade after TOFr are less known. We investigated RVF and RV size (termed remodeling) using echocardiography during the first decade after TOFr. Methods: Retrospective cohort study of patients who underwent TOFr and were followed at our institution from 3/2012 to 12/2023. Those with at least two echocardiograms separated by one year were included. Two patients that received a pulmonary valve replacement were excluded. After confirming intra- and inter-reader reproducibility, RV remodeling was assessed offline by global longitudinal strain (GLS), free wall strain (FWS), fractional area change (FAC), end systolic area (ESA/BSA) and end diastolic area (EDA/BSA). RVF changes over time were assessed with multivariable linear mixed effects models adjusting for perioperative covariates. Two years after TOFr (Y2) was used as reference given RVF peaks at this point following surgery. Results: Out of 758 echocardiograms from 116 patients, 688 were suitable for analysis. Median age at TOFr was 3.5 months (IQR:1.92, 4.89). Compared to Y2, we identified the largest decline in RVF at Year 3, with no worsening from year to year until Y10. There were no associations of perioperative covariates with RVF except for ventriculotomy (FAC) and residual pulmonary stenosis (FWS). There was no progression in RV remodeling over the first decade after TOFr. (Graph, table). Conclusion: After the initial 2-year improvement following TOFr, RVF worsens but remains stable throughout the first decade with stable RV size accounting for BSA. Our findings augment the knowledge of RV remodeling during childhood and could help guide outpatient follow up, counseling, frequency of echocardiograms, and timing of the first cardiac MR.
Abstract 4143258: Sex Differences in Health Status Outcomes: Analysis of the ISCHEMIA Randomized Clinical Trial
Authors: Anna Grodzinsky, Yoon Joo Cho, Philip Jones, Leslee Shaw, C Noel Bairey Merz, William Boden, Gregg Stone, Daniel Mark, John Spertus, David Maron, Judith Hochman, Harmony Reynolds
Journal: Circulation (2024)

Background: Despite a lesser extent and severity of coronary artery disease (CAD), women had a higher burden of angina than men in the ISCHEMIA trial, suggesting that other factors may explain symptom severity in women. We aim to describe demographic and clinical characteristics, as well as differences in care patterns, associated with health status differences in women, as compared with men, in the conservative and invasive treatment groups of the ISCHEMIA trial. Methods: The ISCHEMIA trial randomized participants with moderate or severe ischemia to a routine invasive strategy of cardiac catheterization with complete revascularization plus guideline-directed medical therapy (GDMT), or an initial conservative strategy of GDMT alone with catheterization reserved for GDMT failure. Health status was a key secondary outcome. Using linear regression models we compared raw and adjusted Seattle Angina Questionnaire (SAQ) scores in women and men at baseline and at 1 year, stratified by randomized treatment strategy. Within the invasive strategy, sex differences were adjusted for completeness of revascularization among those with ≥1 coronary stenosis ≥70%. Results: Of 4,617 ISCHEMIA participants with valid SAQ data, women had lower (worse) baseline SAQ summary scores (SS) throughout follow up (Figure) after adjustment for demographics and clinical characteristics, including severity of CAD (difference 5.4 points, 95% CI 4.0-6.7). Women had lower SAQ SS after adjustment for post-randomization treatment (i.e., medical therapy, achievement of risk factor goals and, in the invasive strategy, complete revascularization), 2.4 points lower (95% CI 0.7-4.1) in the conservative group (Figure), and 1.9 points lower than in men (95% CI 0.1-3.7) in the invasive group. Findings were similar for all SAQ subscales. Conclusions: Women with chronic coronary disease in ISCHEMIA had worse health status than men at baseline and 1 year later, which was not explained by demographic or clinical characteristics, intensity of medical therapy, or completeness of revascularization.
Abstract 4148095: The Impact of Body-Mass Index on Ventricular Tachycardia Outcomes Post-Catheter Ablation
Authors: Aastha Poddar, Pragyat Futela, Tiffany Woelber, Narut Prasitlumkum, Hina Amin, Abhishek Deshmukh, Kiyan Heybati, Gurukripa Kowlgi
Journal: Circulation (2024)

Background: In recent years, catheter ablation has emerged as a sustainable, first-line therapy for the management of ventricular tachycardia (VT). Given the rise of the “obesity paradox” theory in atrial ablation outcomes, we sought to study the effect of BMI on patients undergoing structural VT ablation. Purpose: To assess the outcomes of VT ablation, specifically VT recurrence, in patients with elevated vs. normal BMI. Methods: Clinical characteristics and demographic data were collected for VT patients who underwent ablation at Mayo Clinic Rochester from 2012-2022. Patient BMI was classified as non-obese (&lt;30 kg/m2), obese (30-40 kg/m2), and morbidly obese (≥40 kg/m2). The endpoint was a composite of initial monomorphic VT recurrence and repeat ablation after adjusting for age, sex, and comorbidities. Results: A total of 399 patients underwent 508 ablations. 51.4% of ablations had a BMI &lt;30, 39.2% were between 30-40, and 9.4% were ≥40. There was a greater prevalence of hypertension and type 2 diabetes mellitus in morbidly obese patients (p &lt;0.01). Morbidly obese individuals also had a significantly increased rate of general anesthesia during ablation and long VT cycle lengths. The Kaplan-Meier curve demonstrates no statistically significant differences in time to VT recurrence among the three BMI groups (p = 0.324). Neither morbid-obesity (aHR= 1.20; CI = 0.94-1.56, p = 0.14) nor nonmorbid-obesity (aHR = 0.92; CI = 0.76-1.10, p = 0.4), compared to non-obesity was a significant independent predictor of VT recurrence or repeat ablation on multivariate regression after adjusting for age, sex and comorbidities. Conclusion: There was no significant association between BMI groups and VT recurrence or repeat ablation, and no difference in complications. We did not find the obesity paradox to be relevant for VT ablation in our patient population. Further study would be needed with larger samples to corroborate these findings.
Abstract 4144521: Racial disparities in heart transplantation: long term graft survival and non-mortality outcomes
Authors: Steven Hamilton, Brian Wayda, Yingjie Weng, Shiqi Zhang, Kiran Khush
Journal: Circulation (2024)

Background: There is conflicting evidence on whether racial disparities still exist in heart transplant (HT) outcomes, with prior studies focusing primarily on differences in short-term mortality. We examined disparities in HT survival over a longer follow-up duration alongside a broader range of post-HT outcomes. Methods: Using the United Network for Organ Sharing (UNOS) database, we evaluated adult HT recipients between 2017 and 2022 and classified each according to race as either Black, non-Hispanic White and Other. The primary outcome was graft survival and secondary outcomes included rejection, renal dysfunction, and post-transplant diabetes. Chi-squared tests were used to compare baseline clinical factors and selected outcomes by racial group. Kaplan-Meier and Cox proportional hazards analyses were performed to compare risks of the primary outcome by race. Results: Among 15,873 recipients (63% non-Hispanic White, 23% Black, 14% Other), Black recipients were more often female, less often college educated, and more often had public (vs. private) insurance. Blacks had higher use of durable ventricular assist devices (VAD) and intra-aortic balloon pump (IABP) at the time of HT. Graft survival at one year did not differ by race (91.8% for Blacks vs. 91.1% for non-Blacks), but at three years was significantly lower for Blacks (83.4%) than non-Blacks (85.7%). Blacks had higher risk of graft failure after adjustment for baseline socioeconomic status (SES) and clinical variables (HR 1.28, CI 1.17 - 1.41). Blacks also had significantly higher prevalences of acute rejection (12.4% vs. 10.2%), diabetes (10.8% vs. 7.1%), and progression of renal dysfunction at 3-years post HT (40.9% vs. 37.1%; p &lt; 0.05 for all). Conclusions: Racial disparities in graft survival after HT remain in the contemporary era but are only evident after longer-term follow-up. These survival disparities could be mediated by concurrent disparities in shorter term outcomes such as development of acute rejection, chronic kidney disease, and new onset diabetes.