tbuckley/cabot-search huggingface dataset:
Abstract 16738: Impact of Remnant Cholesterol Level on Long-Term Outcomes in Patients With Multivessel Disease Undergoing Coronary Artery Bypass Grafting
Authors: Liang Tang, Yuejiao Yang, Xin-qun Hu, Zhen-fei Fang, Xiao-bo Liao, Xin-min Zhou, Zhao-wei Zhu, Sheng-hua Zhou
Journal: Circulation (2023)

Introduction: The remnant cholesterol (RC) is being increasingly documented as an important risk factors of coronary artery disease. Thus far, the impact of RC level on the long-term outcomes of patients with multivessel coronary artery disease (MVD) undergoing coronary artery bypass graft (CABG) has not been investigated. Hypothesis: Elevated RC level is associated with increased risk of MACCEs in patients with MVD undergoing CABG. Methods: All patients who were diagnosed with multivessel coronary artery disease and undergoing CABG between 2011 and 2020 were considered for enrollment. RC was calculated as total cholesterol minus HDL-C minus LDL-C. Patients were categorized by RC thresholds and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs) was examined according to the RC level at one-year post-CABG. Results: A total of 2,072 patients (60.8 ± 8.3 years; 83.5% men) were included in this study. Patients was divided into four groups: RC &lt; 0.5 mmol /L, RC of 0.5-0.99 mmol/L, RC of 1.0-1.49, mmol/L, and RC ≥ 1.5 mmol/L. During a median follow-up of 4.2 years after the 1-year assessment, 25.0% of the patients had occurrences of MACCEs. The multivariable adjusted hazard ratios (95% CI) for MACCEs, cardiac death, nonfatal myocardial infarction, re-revascularization, cardiac rehospitalization (admission because of angina or heart failure) and nonfatal stroke, were respectively 2.49 (1.99-3.12), 2.20 (1.18-3.86), 3.18 (2.16-5.84), 3.02 (2.12-4.34), 1.93 (1.42-2.87), and 1.37 (0.83-2.27) in patients with RC ≥ 1.50 mmol/L, compared with patients with 1-year RC &lt; 0.5 mmol/L. The 1-year RC level was significantly associated with MACCEs, with the lowest risk of MACCEs reflected in the patients with RC &lt; 0.5 mmol/L. Conclusions : In patients with MVD undergoing CABG, the RC level at one-year after CABG were independently associated with long-term outcomes.
Abstract 15635: Sex Differences in the Effect of Nocturnal Hypoxia on Right Ventricular Myocardial Blood Flow
Authors: Sohum Kapadia, Magdalena Malczewska, Attila Feher, Robert deKemp, RAN KLEIN, Henry K Yaggi, Edward J Miller, Albert J Sinusas, Stephanie Thorn, Ehimen Aneni
Journal: Circulation (2023)

Introduction: Nocturnal hypoxia is common in patients with obstructive sleep apnea (OSA). However, it is unclear how nocturnal hypoxia affects the structure and function of the right ventricle (RV), and if there are sex differences in the impact of nocturnal hypoxia on RV dysfunction. We examined the sex-specific relationship between nocturnal hypoxia, as measured as T90% (time asleep with &lt;90% oxygen saturation), and RV myocardial blood flow (MBF) and myocardial flow reserve (MFR). Methods: RV MBF and MFR were examined for 78 patients who had a cardiac PET stress test and a sleep test between 2015 to 2019. MBF was analyzed using FlowQuant software (Ottawa, Canada). MFR was defined as the ratio of stress to rest MBF. We categorized reduced RV MFR as &lt; 2.3 (corresponding to the median value) and nocturnal hypoxia as T90 ≥ 8%. Results: The mean (± SD) age was 63 ± 10 years. Most patients (83%) were obese (BMI ≥ 30kg/m3). Fifty-one patients (63%) were female. Although not statistically significant, the median RV MFR was higher among females (2.4 vs. 2.2, p = 0.158). RV MFR was higher among those without nocturnal hypoxia compared to those with nocturnal hypoxia (2.4 vs. 2.0, p = 0.023). Among females, the median RV MFR was higher among those without significant nocturnal hypoxia (2.5 vs. 1.8, p = 0.004), while males showed no relationship (2.2 vs. 2.2, p = 0.696; see table for details). In age and BMI adjusted logistic regression analysis, patients with nocturnal hypoxia were 3X as likely to have reduced RV MFR (OR = 3.2, 95% CI: 1.1 - 9.3) and there was a significant statistical interaction by sex (p = 0.046). Conclusions: These findings suggest that nocturnal hypoxia is associated with a reduction in RV MFR, more prominently among females. Future studies should focus on elucidating the pathophysiologic implications of our findings and understanding the biologic processes that account for the sex differences observed.
Abstract 17097: Carotid Artery Atherosclerosis and Mid-Life Cognitive Function: Evidence From Bogalusa Heart Study
Authors: XUANYI JIN, Tasneem Z Naqvi, Yajun Guo, Soo Kang, Camilo Alonso, Katherine T Mills, Jiang He, Elaine M Urbina, Jing Chen, Lydia A Bazzano
Journal: Circulation (2023)

Background: Little is known about the relationship between carotid plaque formation and cognitive function in a middle-aged population. Hypothesis: We hypothesize that there will be an association between carotid atherosclerotic burden and cognitive function in middle-aged adults. Aim: The purpose of the present study is to examine the relationship between carotid artery (CA) plaque and cognitive function in middle-aged white and black men and women from the Bogalusa Heart Study (BHS) cohort. Methods: We included a total of 1,107 BHS participants with echocardiography and carotid ultrasound performed between 2013 and 2016. Cognitive function was quantified in a global cognitive score (GCS) comprised of the z standardized sum of 7 neuropsychiatric tests. CA plaque was defined by carotid intima media thickness ≥1.5mm in any segment of the CA including right and left common artery (RCC/LCC), bulbs (RCB/LCB) as well as right and left internal carotid artery (RIC/LIC). We compared demographic, clinical, and echocardiographic characteristics in participants with or without CA plaque and used linear regression analysis for the association between CA and GCS adjusted for age, sex, race and education. Results: Among all, 373 (33.7%) of participants had one or more CA plaque. The most common locations of CA plaque formation differed according to laterality, with 230 (61.7%), 189 (50.7%), 108 (29.0%), 92 (24.7%), 83 (22.3%), 10 (2.7%) participants having plaque in the RCB, LCB, LCA, RIC, LIC, and RCA, respectively. Participants with CA plaque were likely to be older (49.9 vs. 47.2 years), male (52 vs.38.9%), white (70.2 vs.63.4%,), have larger left ventricular (LV) end-diastolic volume (97.4 vs.94 ml) and LV mass index (83.4 vs.76.3 g/m 2 , all p -value&lt;0.01), but similar LV ejection fraction (60.1 vs.60.0%) as compared to those without CA plaque. Moreover, CA is associated with poorer cognitive function (GCS, standardized β coefficient=-0.07; p =0.02) adjusted for age, sex, and race. However, the association was attenuated after adjusting for education. Conclusion: CA plaque was highly prevalent and inversely associated with cognitive function. The association was attenuated by education emphasizing the importance of social determinants in cognitive health.
Abstract 18785: Prognostication of Neurological Outcomes in Cardiac Arrest Patients Based on Novel Serum Biomarkers
Authors: Hamza Maqsood, Fakhar Abbas, Laraib Jumani, Maryam Munir, Azouba Gulraiz, Samina Raza, Momna Wazir, Nabeeha Noor, Saad Mehmood, Hamza Saleem, FNU Neelam
Journal: Circulation (2023)

Introduction and Hypothesis: Patients with post-cardiac arrest syndrome (PCAS) rely on precise and timely diagnosis for good clinical outcomes. Our study sought to evaluate novel serum parameters' diagnostic and clinical efficacy in prognosticating neurological outcomes in post-cardiac arrest syndrome patients. Methods: 345 patients with cardiac arrest treated with target temperature management were enrolled in this retrospective, multicenter study. Blood samples were drawn and evaluated at a period of 0, 1, 2, and 3 days. Samples were analyzed for conventional biomarkers; S100 calcium-binding protein (S-100B) and neuron-specific enolase, and for novel biomarkers; ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and tau load. Patients were followed up for neurological outcomes over 6 months period Results: 328 patients completed the study in which the mean age was 68.4 years, and 23% were female. Normal values for NFL, UCH-L1, and tau proteins showed the highest sensitivity (91.8-96% of patients with poor neurological outcomes had abnormal values) and negative predictive value (90-94.5% with good neurological outcomes had normal values). Overall, all the novel biomarkers had independent statistically significant values for the diagnosis of clinical outcome (p&lt;0.005). The area under the curves of the novel serum biomarkers was highest at 72 h post-cardiac arrest (0.913 for NFL, 0.88 for tau, 0.961 for GFAP, and 0.947 for UCH-L1). Conclusions: Our study concluded that low levels of novel serum biomarkers are associated with good neurological outcomes. The reliability of these novel biomarkers highlights that they should be included in baseline laboratory investigation for better prognostication of neurological outcomes in patients with PCAS.
Abstract 236: Agency Factors Associated With First Response Systems That Improve Out-of-Hospital Cardiac Arrest Outcomes
Authors: Ryan Huebinger, Mary Spring, Bryan F McNally, Amanda Humphries, David Persse, Dominique Diggs, Eric Boerwinkle, Bentley Bobrow
Journal: Circulation (2023)

Background: Data are conflicting regarding the association between first responder (FR) cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) with improved outcomes after out-of-hospital cardiac arrest (OHCA). Additionally, little is known about why this association varies between EMS agencies, with FR interventions being associated with better survival for only some agencies. Hypothesis: Agency characteristic differ between agencies that do a do not successfully implement FR CPR/AED for OHCA. Methods: We studied the 2016-2021 national cardiac arrest registry to enhance survival (CARES) database. We defined the exposures as FR CPR and FR AED. The outcome was survival with favorable neurologic status. We used logistic regression models to evaluate the association between FR CPR/AED and OHCA outcome for each individual agency. Based on each agency’s association between FR AED/CPR and outcomes, we stratified agencies into positive association (95% confidence interval falling entirely above 1) and no association (95% confidence below or including 1). Agencies with poor model fit were excluded. We then compared characteristics between strata. Results: For the association between FR CPR and outcomes, 21 agencies caring for 42,856 patients had a positive association; 371 agencies caring for 449,824 OHCAs had no association. For FR AED, 47 agencies caring for 103,120 OHCAs had a positive association;262 agencies caring for 327,761 OHCAs had no association. For FR CPR and compared to the no association strata, agencies with a positive association had more annual OHCAs (+300), a lower rate of FR CPR (-11.3%), and a lower rate of FR AED (-10.8%). For FR AED and compared to the no association strata, agencies with a positive association FR AED and outcomes had more OHCAs per year (+150.5), a lower rate of FR CPR (-6.8%), a lower rate of FR AED (-13.3%), lower response times (-0.6 minutes), and more OHCAs from high-income neighborhoods (+3.7%). Conclusion: More agencies had a positive association between FR AED and survival with favorable neurologic outcome than between FR CPR and survival with favorable neurologic outcome. Agencies with better outcomes from FR interventions treated more OHCAs and had lower rates of FR intervention.
Abstract 17956: In Hospital Outcomes of Patients With Acute Coronary Syndrome With Underlying Immune Thrombocytopenia Purpura
Authors: Abdulkareem Lukan, Edwin Gwira-Tamattey, Muhammad Ahmad, Hama Ishfaq, Habib Alagbo, Rukayat Otulana, Muftawu-Deen Iddrisu, Tagbo C Nduka, Rocio Barriga Guzman
Journal: Circulation (2023)

Introduction: Acute coronary syndrome (ACS) represents a significant health burden worldwide. Immune thrombocytopenia (ITP), a condition characterized by low platelet due to immune-mediated destruction, has been associated with increased bleeding risk and altered hemostatic balance. This abstract aims to summarize a research study investigating the in-hospital outcomes of patients diagnosed with both ACS and underlying ITP, shedding light on the unique challenges posed by this comorbidity Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2020. The NIS was searched for hospitalization of adult patients with Acute Coronary Syndrome as a principal diagnosis with and without ITP as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality .The secondary results were sepsis, acute kidney injury (AKI), Cardiogenic shock (CS), Cardiac arrest (CA), Total hospital charge (THC), pulmonary embolism (PE), and length of stay (LOS). Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders. Results: About 1200515 patients were admitted for ACS, 0.19% (2225) had underlying ITP, Compared with those with ITP, there is statistically significant increase in LOS (8.85 vs 6.26, p&lt;0.004, IRR=1.16,), THC (161275.7 vs 116208.7, p&lt;0.003, IRR=31221.23,) and statistically significant decrease in cardiogenic shock (4.94% vs 5.94%,p&lt;0.039, OR=0.62, 95%CI 0.4-0.98). But there were no statistical significance in Death (13.93% vs 9.8%, p&lt;0.405, OR=1.13, 95%CI 0.84-1.51), sepsis (23.15% vs 18.0%, p&lt;0.728, OR=0.96, 95%CI 0.75-1.22), AKI (35.5% vs 46.52%, p&lt;0.395, OR=1.09, 95%CI 0.89-1.35), PE (2.7% vs 2.49%, p&lt;0.448, OR=0.78, 95%CI 0.41-1.47), and All_CA (13.03% vs 9.87%, p&lt;0.375, OR=1.29, 95%CI 0.73-2.3). Conclusions: These findings suggest that while ACS patients with underlying ITP may have certain differences in LOS, healthcare charges, and cardiogenic shock rates, they do not appear to be at significantly increased risk for mortality or other major complications. Additionally, the lower incidence of cardiogenic shock in the ITP group may indicate potential protective effects or differences in underlying pathophysiology, warranting further investigation
Abstract 18719: Trends in Representation of Authorship From Low and Low-Middle-Income Countries in Cardiology Journals Over the Last Two Decades: We Need More Representation
Authors: Alfonso Martinez de Majo, Christian Guilliod, victoria lam, Diana De Oliveira Gomes
Journal: Circulation (2023)

Background: Authors from developing countries encounter unique publishing barriers that limit their research output in international journals. The authorship representation from low and low-middle-income countries (LIC and LMIC) in cardiology journals remains unexplored. We examined publishing trends from authors affiliated with LICs &amp; LMICs in three distinguished cardiology journals from 2000 to 2022. Methods: We collected retrospective data using PubMed on the authorship affiliation of all articles published between 01/01/2000 and 12/31/2022 in the journals Circulation, European Heart Journal (EHJ), and Journal of the American College of Cardiology (JACC). Using the World Bank country classification list, we classified authors affiliations. Results: 61257 articles were published between 2000 and 2022 (24812 in Circulation, 16110 in EHJ, and 20335 in JACC), of which only 555 (0.91%) had one or more authors affiliated with institutions from an LMIC or LIC (180 in Circulation, 164 in EHJ, and 175 in JACC): 36 (0.06%) from LIC, and 519 (0.85%) from LMIC. The total number of authors from LIC was 63, more than 1/3 from Mozambique (N=22, 35%); meanwhile, 664 authors were from LMIC, the majority from India (N=287, 43%), followed by Lebanon (N=15.9%). The trend of authorship from LIC and LMIC is increasing in the last decade (Figure 1) Conclusion: Less than 1% of articles published over the last two decades in three distinguished cardiology journals have one or more authors affiliated with institutions from LIC and LMIC. Our results suggest remarkable obstacles for these authors to publish in top journals in the USA and Europe. The study indicates an upward trend in authorship during the last decade, implying a potential shift towards more inclusive publishing opportunities. Further endeavors should seek to understand structural barriers and that limit research output in developing countries to minimize healthcare gaps and promote more inclusive research.
Abstract 14891: Time to Therapeutic Range for Patients With Acute Pulmonary Embolism Undergoing Mechanical Thrombectomy
Authors: Robert S Zhang, Alvin M Ho, Lindsay Elbaum, Kelsey Grossman, Arushi Singh, Allison A Greco, Sylvie Hall, Tania Ahuja, Radu Postelnicu, VIKRAMJIT MUKHERJEE, Norma Keller, Carlos L Alviar, Sripal Bangalore
Journal: Circulation (2023)

Introduction: Anticoagulation therapy is the mainstay for the management of patients with acute pulmonary embolism (PE) and achieving a timely time to therapeutic range (TTR) is important. We sought to determine the TTR in patients with acute PE referred for mechanical thrombectomy (MT) and the proportion of patients with therapeutic activated clotting time (ACT) at the time of MT. Methods: This single center retrospective study included all patients who underwent percutaneous MT at a large academic public hospital from January 2020 through April 2023. Therapeutic anticoagulation was defined as an ACT &gt;200 seconds or if the patient received enoxaparin within 6 hours prior to MT. Results: A total of 63 patients (average age 58 years, 43% female) with intermediate or high-risk PE were included in the analysis. The median time from the diagnosis of PE or clot-in-transit (CIT) to MT was 15 (IQR 6.1-23.2) hours. Fifteen patients (23.8%) were initiated on enoxaparin at the diagnosis of acute PE or CIT. Among these patients, 5 (7.9%) were on enoxaparin only and 10 (15.9%) patients were initiated on enoxaparin and then transitioned to a heparin infusion prior to MT. One patient was initiated on argatroban, while the remaining 47 patients were initiated on a heparin infusion at time of diagnosis (77.6% received heparin bolus). In patients who received a heparin infusion, the median ACT in the cath lab was 134 (IQR 118-159) seconds. Only a total of 9/63 (14.3%) were therapeutic by ACT at the time of MT or received therapeutic enoxaparin within 6 hours of MT. Excluding patients who received enoxaparin initially, 34/48 (70.8%) patients reached a therapeutic anti-Xa or partial thromboplastin time (PTT) levels. The median time to reach a therapeutic anti-Xa or aPTT was 5.6 (IQR 3.3-8.2) hours (Figure). Conclusion: In patients with acute PE referred for MT, only a minority of patients had therapeutic ACT prior to mechanical thrombectomy.
Abstract 13185: Getting at the Heart of Allergies: A Case Series on Kounis Syndrome
Authors: Anamaria Dragan, Olga Toleva, Alexis Cutchins, Puja K Mehta
Journal: Circulation (2023)

Kounis Syndrome (KS) is a complex medical condition where acute coronary syndrome coincides with allergic reactions. KS presents a unique clinical challenge due to its varied presentation and simultaneous management of an allergic response and a cardiac event. This study aims to further our understanding of this underreported condition to improve outcomes in patients. We demonstrated the intricacies of KS by examining two case studies. In Case 1, a 51-year-old male suffered a myocardial infarction after a wasp sting. Workup revealed elevated tryptase levels and mastocytosis on bone marrow biopsy concerning for mast cell activation syndrome. In Case 2, a 48-year-old female was diagnosed with vasospastic angina exacerbated by exposure to various allergens and associated with elevated histamine levels. Both patients underwent coronary angiography which demonstrated no obstructive coronary artery disease. Functional coronary angiography with acetylcholine provocation confirmed a predisposition for coronary vasospasm. Both patients were treated with anti-anginals and antihistamines. A literature review was performed to describe the pathophysiology, diagnosis, and treatment of KS. The underlying pathophysiology includes mast cell degranulation, where the release of inflammatory mediators like histamine and tryptase provokes coronary vasospasm, plaque rupture, and thrombus formation. With prompt recognition and appropriate management, the prognosis of KS is favorable. A greater understanding of KS can support clinicians in delivering quality care for patients. Our cases demonstrate the importance of maintaining a high index of suspicion in patients exhibiting an acute allergic reaction with concurrent evidence of cardiac ischemia. While the current literature provides some management guidance, additional research is required to improve our mechanistic understanding, diagnostic criteria, and therapeutic strategies.
Abstract 17568: Myocardial Infarction Modifies the Effect of Food Insecurity on Diabetes-Related Mortality
Authors: Sri Banerjee, Tim Radak, Patrick Dunn, Rafael Gonzales-Lagos
Journal: Circulation (2023)

Introduction: Food Insecurity continues to be a public health problem that requires attention. A quarter of households have experienced food insecurity in their lifetime. Hypothesis: In this study, we will determine how myocardial infarction increases the effect of food insecurity among diabetes-related mortality. Methods: The National Health and Nutrition Examination Survey (NHANES) is a survey completed by non-institutionalized population of the U.S. All respondents from the NHANES survey, who were 20 years or older between the years 1999-2010 were included in the analysis with follow-up through 2019. Self-reported information was used for USDA Food Security Survey. Analysis was performed using complex samples Cox regression to determine the relationship of food insecurity on diabetes-related mortality and how myocardial infarction influences this. Results: Percent mortality among individuals with diabetes was 6.11% among males and 5.67% among females with mean follow-up of 13.7 years. For diabetes-related mortality, the crude hazard ratio (HR) for food insecurity was 1.42 (95% confidence interval [CI], 1.03-1.95 p = 0.03). The adjusted HR was elevated, 2.66 (CI 1.05-6.78, p = 0.04), among food insecure individuals who had myocardial infarction (MI) but close to 1.0 (1.33 CI 0.99-1.79, p = 0.06) among food insecure individuals who had no MI infarction, after adjusting for medical (tobacco use) and demographic risk factors (poverty-income-ratio, age, gender, ethnicity). Conclusions: We found that not only food insecurity leads to higher diabetes-related mortality, but also MI occurrence affects this relationship. Prevention programs for food insecurity are especially important with comorbidities to implement social change.