tbuckley/cabot-search huggingface dataset:
Abstract 4145866: Changes in Left Ventricular Systolic Function in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Anne Marie Jensen, Yimin Yang, Victoria Lamberson, Brian Claggett, Hicham Skali, Kuni Matsushita, Pamela Lutsey, Kenneth Butler, Dalane Kitzman, Tor Biering-Srensen, Amil Shah
Journal: Circulation (2024)

Introduction: Aging is associated with changes in left ventricular (LV) structure and function, and with increasing incidence of heart failure. However, little is known about longitudinal changes in LV systolic function in late life. Aim: To quantify changes in systolic function in late life. Methods: Among 2,779 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study who underwent protocol echocardiography at study Visits 5 (2011-2013) and 7 (2018-2019), systolic function was assessed by LV ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS). Abnormal function was defined using previously published ARIC-based cut-offs. Longitudinal change in systolic measures and abnormal prevalence were assessed using paired t-test and McNemar’s test respectively. Predictors of each abnormal systolic function measure at Visit 7 were assessed using logistic regression models adjusted for that measure at Visit 5 in addition to systolic blood pressure, heart rate and rhythm during echo at both visits. Results: Mean age was 74±4 years at Visit 5 and 81±4 years at Visit 7, 57% were female, and 24% reported Black race. At Visit 5, mean LVEF was 65±6%, GLS 18±2%, and GCS 28±4%. Over a mean of 6.5 years, LVEF decreased by 2±7%, GLS decreased by 0.5±2.9%, and GCS decreased by 0.6±4.2% ( p &lt; 0.001). The prevalence of abnormal LVEF increased from 14% to 23%, abnormal GLS prevalence increased from 18% to 23%, and abnormal GCS increased from 11% to 13% (Figure). At Visit 5, predictors of the development of abnormal LVEF and GLS included older age, male sex, prevalent coronary artery disease (CHD), diabetes, and chronic kidney disease, while only male sex and CHD associated with the development of abnormal GCS. On echocardiography, lower systolic measures, higher LV mass index, larger left atrial volume, and lower e’ at Visit 5 were each associated with higher odds of abnormal LVEF, GLS and GCS at Visit 7. Conclusions: LV systolic function decreases on average over 6 years in late life. Worse measures of both systolic and diastolic function associate with the development of subsequent systolic dysfunction.
Abstract 4145779: Proteomic Insights into High-Fat Diet's Impact on Chronic Myocardial Ischemia in a Swine Model
Authors: Dwight Harris, Christopher Stone, Mark Broadwin, Akshay Malhotra, Gabriela Melendez-Martinez, Sharif Sabe, Ruhul Abid, Frank Sellke
Journal: Circulation (2024)

Introduction: The effect of obesogenic diet on the outcomes of coronary artery disease are controversial with some clinical studies suggesting a paradoxical favorable effect of obesity. We seek to better understand the effects of high-fat diet on chronic myocardial ischemia using a swine model of chronic myocardial ischemia and Proteomic Analysis. Methods: Twenty 6-week-old Yorkshire swine received 5 weeks of normal diet (n=9, ND) or high-fat diet (n=11, HFD) prior to the placement of an ameroid constrictor on the left coronary circumflex artery to induce chronic myocardial ischemia. The swine continued ND or HFD for seven weeks after the procedure. At that time, the swine underwent terminal harvest with functional measurement and tissue collection for proteomic analysis. Results: There was a significant increase in ejection fraction, tau, myocardial perfusion, and PRSW in the HFD compared to ND (all p&lt;0.05). There was no change in cardiac output (p=0.73). Proteomic analysis identified a total of 2,782 proteins. The HFD ischemic myocardium had 430 significantly increased and 105 significantly decreased proteins. The HFD non-ischemic group had 251 significantly increased and 94 significantly decreased proteins. Pathway analysis of the ischemic myocardium showed increases in pathways related to fatty acid metabolism and amino acid metabolism and decreases in pathways related to cytoskeletal structure in the HFD compared to ND. Pathway analysis of the non-ischemic myocardium also showed increases in pathways related to fatty acid metabolism and decreases in pathways related to cytoskeletal structure in the HFD compared to ND. Conclusions: HFD results in paradoxical increases in cardiac perfusion and function in the setting of chronic myocardial ischemia. This was accompanied by an increase in fatty acid metabolism and amino acid metabolism in both the ischemic and non-ischemic myocardium in the HFD compared to ND. There were decreases in several pathways related to cytoskeletal organization in the HFD compared to ND. This suggests that a high-fat diet may initially increase cardiac function through altered metabolism, but deteriorations in cytoskeletal structure may help explain longer-term complications.
Abstract 4145763: Unexpected Devastation: Streptococcus mitis Endocarditis Leading to Multisystem Crisis in a Healthy Young Adult
Authors: Rita Offor, Muhammed Atere, Bisrat Nigussie, Stefanie Clinton Fotso Simo, Suzette Graham-Hill
Journal: Circulation (2024)

Case Description: A 27-year-old woman from outside the United States, with no prior medical history, presented to the emergency room (ER) with fever and unresponsiveness. Upon arrival, she was found to have a basilar tip occlusion with multifocal posterior fossa infarcts. Imaging also revealed a subarachnoid hemorrhage, suspected to be secondary to a ruptured distal basilar aneurysm. The patient experienced associated seizures and acute hypoxic respiratory failure due to aspiration and bulbar weakness, necessitating an upgrade to the neuro-intensive care unit (ICU). Blood cultures drawn in the ER were positive for Streptococcus mitis/oralis. A transthoracic echocardiogram (TTE) showed a thickened mitral valve with a thick shaggy vegetation on the atrial side of the anterior mitral leaflet, as well as vegetation on the posterior leaflet and severe mitral regurgitation (MR). The patient was diagnosed with S. mitis mitral valve endocarditis. Due to the severity of her neurological and cardiac conditions, she was pending cardiothoracic (CT) intervention after stabilization in the neuro ICU. Discussion: Streptococcus mitis endocarditis is relatively rare and typically affects individuals with pre-existing valvular abnormalities or immunosuppression. In this case, the patient had no known predisposing factors, making the diagnosis more intriguing. The pathogenesis of S. mitis endocarditis involves bacterial adherence to damaged or abnormal heart valves, leading to the formation of vegetations composed of fibrin, platelets, and bacteria. These vegetations can embolize to various organs, causing infarctions and other complications as seen in this patient. The management of S. mitis endocarditis involves prolonged antibiotic therapy and, in some cases, surgical intervention to address valvular damage. Conclusion: This case highlights the severe and multifaceted complications that can arise from Streptococcus mitis endocarditis, even in young and previously healthy individuals. The combination of multifocal posterior fossa infarcts, subarachnoid hemorrhage, severe mitral regurgitation, and acute hypoxic respiratory failure presents a significant clinical challenge. Further studies are needed to better understand the pathophysiology and optimal management strategies for S. mitis endocarditis, particularly in patients without traditional risk factors.
Abstract 4146664: Sleep duration and risk of incident heart failure in a cohort of primarily low-income Black and White adults
Authors: Kelsie Full, Meng Xu, Hui Shi, Debra Dixon, Leonie Dupuis, Deepak Gupta, Loren Lipworth
Journal: Circulation (2024)

Introduction: Short and long sleep durations have been associated with cardiovascular (CV) disease risk and mortality, but less is known about the relationship with heart failure (HF). Clinical guidelines recommend adults sleep at least 7 hours and less than 9 hours per night for optimal health. We prospectively investigated the association between sleep duration and incident HF in the Southern Community Cohort Study (SCCS), a large cohort of primarily low-income Black and White adults. Methods: The study included 26,669 Black and White SCCS participants without prevalent HF at enrollment (2002-2009) who were receiving Center for Medicare/Medicaid Services (CMS). Participants self-reported weekday and weekend sleep duration at enrollment; weighted average nightly sleep duration was calculated. Incident HF was ascertained using ICD-9/10 codes via CMS claims through December 31, 2016. Multivariable Cox models were conducted to test associations between sleep duration and incident HF. Results: Participants had a median age of 55 years, and were predominantly Black (69%), female (62%) and low-income (87% &lt; $25,000/year). Approximately 27% of participants reported a habitual sleep duration of 8-9 hours per night, while 18%, 21%, 17% and 17% reported sleep durations &lt;6, 6-7, 7-8 and &gt;9 hours, respectively. Over median 10 years of follow-up, 7,375 participants (27.6%) developed HF. Compared to those who slept 8-9 hours a night, participants with a sleep duration &lt;6 hours (HR 1.15; 95% CI 1.07-1.24) and between 6-7 (HR 1.07; 95% CI 1.00-1.15) were at greater risk for incident HF independent of demographics, socioeconomic indicators, employment, and health behaviors including smoking, alcohol consumption, physical activity, and diet ( Figure 1 ). The association for the shortest sleep duration (&lt;6 hours) persisted after adjustment for CV risk factors and depressive symptoms (HR 1.10; 95% CI 1.02-1.18). Sleep durations ≥9 hours were not significantly associated with HF risk. Conclusions: Shorter sleep duration was associated with higher risk of developing HF in a cohort of middle aged Black and White adults. Strategies to promote optimal sleep duration may improve primary prevention of HF among individuals at high-risk.
Abstract 4146635: Title: Socioeconomic and gender disparities in Stroke-related Mortality among Older Adults with Malignancy in the US from 1999 to 2020: CDC WONDER database analysis.
Authors: Muhammad Abdullah Naveed, Ahila Ali, Rabia Iqbal, Muhammad Omer Rehan, Bazil Azeem, MUHAMMAD KASHAN, Faizan Ahmed, yasar sattar, Bilal Munir
Journal: Circulation (2024)

Background: Stroke in malignancy is a significant cause of mortality among older adults. This study analyzes demographic trends and disparities in mortality rates due to stroke in malignancy among adults aged 65 and older from 1999 to 2020. Methods: A retrospective analysis was conducted using CDC WONDER death certificate data from 1999 to 2020. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons stratified by year, sex, race/ethnicity, and geographical regions. Trends were assessed using Average Annual Percentage Change (AAPC) and annual percent change (APC). Results: Between 1999 and 2020, Stroke in Malignancy resulted in 198,659 deaths among adults (≥65 years) in the United States. Fatalities occurred predominantly in medical facilities (36.5%), followed by nursing homes (29.3%), and at decedents’ homes (24.2%). The overall age-adjusted mortality rate (AAMR) for Stroke in Malignancy-related deaths decreased from 32.8 in 1999 to 16.5 in 2020, with an Average Annual Percentage Change (AAPC) of -3.35 (p-value &lt; 0.000001). Notably, there was a significant decline in AAMR from 1999 to 2018 (APC: -4.23, p-value &lt; 0.000001), followed by a notable increase from 2018 to 2020 (APC: 5.33, p-value = 0.025595). Both men and women showed decreased AAMRs, with men having higher rates (men: 28.1; women: 17.5). AAMRs varied among racial/ethnic groups, with Black/African Americans having the highest AAMR (31.0), followed by Whites (21.8), American/Alaska Natives (18.6), Asian/Pacific Islanders (12.9), and Hispanics (12.5). AAMRs decreased across all races, with the most significant decline observed in Asians (AAPC: -4.62, p-value &lt; 0.000001). Geographically, AAMRs varied among states, ranging from 11.0 in Arizona to 33.7 in Mississippi. Across regions, the Midwestern region had the highest mortality (AAMR: 23.4), with nonmetropolitan areas exhibiting slightly higher AAMRs (AAMR: 25.9). Both metropolitan and nonmetropolitan regions experienced decreased AAMRs over the study period (p-value &lt; 0.000001). Conclusion: The analysis reveals substantial demographic disparities in mortality rates attributed to Stroke in malignancy among older adults. While the overall decline in mortality rates indicates progress, the concerning upsurge in recent years necessitates proactive measures. Addressing these disparities through targeted interventions and equitable healthcare access is imperative to optimize outcomes for this at-risk population.
Abstract 4146651: Tissue-Engineered Vascular Grafts: Evaluation of Remodeled Neotissue and Its Effect on Flow Dynamics
Authors: Tatsuya Watanabe, Delaney Villarreal, Cole Anderson, Weiguang Yang, Marissa Guo, Satoshi Yuhara, Kirsten Nelson, Adrienne Morrison, John Kelly, Toshiharu Shinoka, christopher breuer
Journal: Circulation (2024)

Background: The Fontan surgery for treating hypoplastic left heart syndrome has significantly improved postoperative mortality. However, the materials commonly used for conduits, such as PTFE, can cause complications, such as graft calcification over long-term follow-up, which causes flow restriction and lower exercise tolerance as clinical complications. To address these issues, we have developed a tissue-engineered vascular graft (TEVG) composed of biodegradable polymers that are replaced by autologous tissue, called "neotissue," which exhibits histological similarity to native vessels(Figure1) and resistance to calcification. We are investigating the functional properties of this neotissue, focusing on distensibility, an essential function accommodating blood volume, and its impact on flow dynamics. Methods: We evaluated chronic sheep models (6-8 years post-implantation) with thoracic inferior vena cava (IVC) interposition grafts of TEVG (n=5) and PTFE (n=5), as well as age-matched surgically naive sheep (n=5). Using our established in vivo distensibility testing protocol(Figure1b), we measured distensibility in the target regions and compared the groups. Additionally, we utilized the 3D geometries obtained from 3D angiography to create patient-specific computational flow dynamics simulations using a software, SimVascular, allowing us to investigate the impact of distensibility and graft 3D morphology on flow dynamics. Results: Distensibility measurements showed no significant difference between TEVG (173.67±98.74[%100mmHg]) and native vessels (268.57±199.57), while PTFE grafts (10.35±12.67) exhibited significantly lower compliance compared to the other two groups(Figure1). The 3D fluid model simulations generated by SimVascular revealed that the native IVC revealed uniform dilation and smooth blood flows by fluid stress. TEVGs showed small velocity acceleration in the middle. In contrast, since the PTFE grafts were not distensible, they caused significant flow velocity acceleration and high wall shear stress at the graft region(Figure2,3). Conclusions: The TEVG neotissue demonstrated significantly higher distensibility than PTFE grafts and was not significantly different from native vessels. The simulation demonstrated that the differences in distensibility in response to fluid volume impact flow dynamics, which relate to the clinical complications of Fontan patients. TEVG has the potential to mitigate these complications.
Abstract 4145682: Impact of Cardiac Sarcoidosis on Short-term Outcomes in Heart Transplant Patients
Authors: Arush Rajotia, Ayushi Mohan, Jasninder Dhaliwal, Manraj Sekhon, Avronia Mourkus, Raheel Ahmed, Kamleshun Ramphul, Swaiman Singh
Journal: Circulation (2024)

Background: Heart transplantation (HTx) is a life-saving procedure for patients with end-stage heart disease. Sarcoid myocarditis (SM) is a rare condition characterized by granulomatous inflammation of the myocardium. The mainstay of therapy is immunosuppression but the incidence of cardiac sarcoidosis leading to advanced heart failure is increasing. HTx is a valid option in such cases however post-HTx outcomes in sarcoid population have been poorly investigated. Methods: A retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2021 was conducted. Outcomes compared between sarcoid and non-sarcoid HTx groups were mortality, length of stay (LOS), hospital charges, transplant rejection and graft failure. Mann-Whitney U test was utilized to compare differences between non-parametric variables, while multivariable logistic regression was applied to adjust for confounders. Results: During our study period a total of 17,635 patients underwent HTx out of which 235 (0.013%) had HTx due to sarcoid myocarditis. Multivariable analysis revealed a comparable mortality between sarcoid and non-sarcoid HTx (Adjusted Mortality: aOR 1.35; CI 0.40-4.56; p=0.61). Median length of stay in sarcoid myocarditis group was 29[IQR19-55] vs 28[IQR16-50] p=0.57. Total hospitalization charges were also comparable 956,893[IQR 649,498-1,451,199] vs 800,898[IQR 533,047-1,349,074], p=0.18. There was no significant increase in transplant rejection (aOR 1.43; CI 0.64-3.20; p=0.37) or graft failure (aOR 1.92; CI 0.55- 6.70; p=0.30) in the sarcoid myocarditis group (Table 1, Table 2). Conclusion: Sarcoid myocarditis patients undergoing HTx showed comparable mortality, LOS, total hospital charges, transplant rejection, or graft failure rates to patients undergoing HTx for other causes.While these findings suggest that SM, while rare, does not adversely affect transplant outcomes, we strongly advocate for more studies to adjust for limitations.
Abstract 4146639: Excessive Alcohol Consumption and Heart Attack Risk
Authors: Trisha Schuver, Thiveya Sathiyaseelan, Nnenna Ukoha, Eugene Annor, Emeka Obi, Arpana Karki, manik ahuja, Mercy Itopa, Philomena Osei, Chisom Nwaneki, Achala Ghimire, Hemanta Neupane, Oluseyi Aderinwale
Journal: Circulation (2024)

Background: Cardiovascular diseases are the leading cause of death globally today increasing from 14 million deaths in 2000 to 18 million deaths in 2019. Among these 85% of the deaths were from heart attacks. Excessive alcohol use is one of the preeminent preventable causes of death in the US. More than 38 million adults aged 18 and older reported binge drinking and do so on average four times a month. An increased risk of heart attack has been linked to binge drinking or heavy alcohol consumption. This study aims to study the effect of excessive alcohol consumption or binge drinking on heart attacks in the U.S. Methods: We used cross-sectional data from the 2022 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults aged 18 years and extracted data for non-metropolitan/rural counties. Logistic regression analyses were conducted to test the association between heavy and binge drinking with lifetime reports of experiencing a heart attack. We included the following covariates and controls no health insurance, poor sleep, depression, income, race/ethnicity, educational status, and age. Results: Overall, 5.64% (n=445132) of the participants had heart attacks among the total study population. Neither heavy alcohol use nor binge drinking were significantly associated with experiencing a heart attack. However, age (O. R=7.480 [7.098-7.883]), male gender (O. R=2.192 [2.134-2.253], low income (O. R=1.932 [1.887-1.988]), and depression (O. R=1.445 [1.400-1.491]) were associated with a heart attack. Conclusion: Despite the widespread concern regarding the link between excessive alcohol consumption and heart attacks, our study found no significant association between heavy alcohol use, binge drinking, and heart attack. However, other covariates like age, male gender, low income, and depression were associated with the prevalence of heart attack which underscores the influence of social determinants of health. Further research is needed to elucidate the nuanced relationship between alcohol consumption patterns and heart health.
Abstract 4145685: Battling Cardiogenic Shock: A Comparative Study of In-Hospital Outcomes for left ventricular assist devices (LVADs) vs. intra-aortic balloon pump (IABP)
Authors: GODFREY TABOWEI, Laura Gonzalez, Emmanuel Ukenenye, Gabriel Alugba, Oboseh Ogedegbe, Shahmeer Lodhi, Meron Tesfaye, Carlos Matute, Evbu Enakpene
Journal: Circulation (2024)

Introduction: Cardiogenic shock (CS), with a mortality rate of 30% to 50%, is a severe condition marked by the heart's inability to supply sufficient blood to meet the body's needs, which demands timely and effective intervention. Historically, the intra-aortic balloon pump (IABP) was the primary support device, but the use of left ventricular assist devices (LVADs) has increased. This study compared outcomes between CS patients treated with newer LVADs (CSLVAD) and older IABPs (CSIABP). Methods: This retrospective cohort study used the 2020 National Inpatient Sample (NIS) database to identify cardiogenic shock (CS) hospitalizations using ICD–10 codes. Our primary outcomes were in-hospital mortality, length of stay (LOS), total hospital charges (TOTCHG), and postprocedural complications among patients treated with LVADs and IABPs. Results: Out of 195,254 patients with cardiogenic shock, 2,609 received LVADs, and 21,169 received IABPs. The average age was 64.8 years for CSIABP patients and 54.8 years for CSLVAD patients. Males predominated in both groups (70.5% CSIABP, 75% CSLVAD). More Black patients received LVADs (33%) compared to IABPs (13%). Mortality was 23% in the CSIABP group versus 8% in the CSLVAD group. After adjusting for confounders, the CSLVAD group had statistically significant 62% lower odds of mortality (P=0.00, CL=0.25–0.57). The average LOS was longer in the CSLVAD group (39.4 days) compared to the CSIABP group (13.4 days), with a statistically adjusted increase of 20.1 days in the CSLVAD group (P=0.00, CL=17.6-22.6). The average TOTCHG was higher in the CSLVAD group ($1,265,731) compared to the CSIABP group ($399,160), with a statistically significant increase of $869,550 (P=0.00, CL=732,536-1,006,564). For cardiovascular outcomes, there was a 79% and 40% decrease in the odds of hypertension and CAD in the CSLVAD group(P=&lt;0.05). Interestingly, there were increased odds of CKD, anaemia, ventricular tachycardia, hypothyroidism, postprocedural complications, supraventricular tachycardia, and atrial fibrillation in the CSLVAD group(P=&lt;0.05). Conclusion: Patients treated with LVADs for cardiogenic shock had significantly lower mortality but higher LOS and TOTCHG compared to those treated with IABPs. Despite reduced odds of hypertension and CAD, the LVAD group had higher incidences of various complications (CKD, anaemia, ventricular tachycardia, hypothyroidism, postprocedural complications, supraventricular tachycardia, and atrial fibrillation).