tbuckley/cabot-search huggingface dataset:
Abstract 4146242: Superiority of Ultrahigh-Resolution Photon-Counting Computed Tomography in Follow-up In-Stent Restenosis
Authors: Duc Chinh Nguyen, Cuong Tran, Tuan Ngo Minh, Bich Bui, Quoc Anh Nguyen Duong, Tuyen Dang Hoang, Khiem Ngo, Loc Vu, Dung Ho, Thach Nguyen
Journal: Circulation (2024)

Background: In 2021, the Food and Drug Administration approved the first Photon Counting Computed Tomography (PCCT) system, marking an extraordinary milestone in medical imaging. This advanced technology offers significant advantages in cardiac imaging, particularly in detecting severe calcification lesions and in-stent restenosis (ISR). Subsequently, in October 2023, our hospital became the first to implement a PCCT system. Leveraging the benefits of PCCT, we conducted a study to investigate ISR in patients who had undergone stenting over the course of a year. Methods: From October 2023 to January 2024, all high-risk stented patients, including those with multiple stents, bifurcation lesions, chronic total occlusions, and severe calcification lesions, were included in the study. The PCCT system (tube voltage 120 kV, collimation 120 x 0.2 mm, 50-70 ml Iohexol 300 mg/ml) was utilized to detect ISR. Intra-stent lesions with more than 50% narrowing were classified as ISR. Additionally, the quality of the PCCT images was assessed by two radiology experts using a five-point scale, where 1 indicated excellent quality (absence of artifacts) and 5 indicated non-diagnostic quality (severe artifacts). Results: Eighty patients (77.5% male) met the inclusion criteria, with a mean age of 64.7 ± 10.9 years. Among these patients, 56 had stents in the Left Anterior Descending (LAD) artery, while 27 and 34 had stents in the Left Circumflex Artery (LCx) and Right Coronary Artery (RCA), respectively. In total, 25 patients (31.2%) were identified with ISR. Specifically, ISR was most prevalent in the LCx at 25.9% (7/27), followed by the LAD at 21.4% (12/56), and the RCA at 17.7% (6/34). Nine patients underwent repeat percutaneous coronary intervention (PCI). The overall image quality was rated as excellent, with a median score of 1.5 [IQR, 1-2]. Additionally, 40 patients (50%) had a calcium score over 400. Conclusion: These findings represent the first results obtained using PCCT at our hospital. The results indicated a relatively high rate of ISR, particularly among high-risk patients. Given the excellent image quality, PCCT is a promising technique for the follow-up of patients post-PCI.
Abstract 4146248: Statewide Burden of Lower Extremity Peripheral Arterial Disease in the United States from 1990-2021: A Benchmarking Systematic Analysis for the Global Burden of Disease Study 2021
Authors: Anaswara gopi, Tapan Giri, Madiha Haseeb, Saif Syed, Ratan Pal Yadav, Mohit Lakkimsetti, Ashwinikumar Shandilya, Paritaben Bhalodia, Hamza Islam, kamal sharma, VISHRANT AMIN, HARDIK DESAI
Journal: Circulation (2024)

Introduction: Lower Extremity Peripheral Arterial Disease (PAD) ranks as the leading cause of incidence among all cardiovascular diseases (CVD) in the United States. Due to a significant lack of data on the overall burden of PAD, this pioneering study investigates the trends of PAD over the past three decades in the US, including the initial two years of the COVID-19 pandemic. Method: We estimated prevalence, incidence, deaths, and disability-adjusted life years (DALYs) due to PAD by age, sex, year and location across the US from 1990-2021 using the global burden of disease 2021 methodology. Results were presented in absolute counts and age-standardized rate (per 100,000 person-years) Results: From 1990 to 2021, the overall prevalence of PAD in the US rose from 8.6 million (95% uncertainty interval: 7.4-10 million) to 14.9 million (13.4-16.6 million). The total percentage change (TPC) in deaths increased by 93% (82%-102%), and DALYs by 87% (79%-96%). Pennsylvania recorded the highest increase in age-standardized incidence rate (ASIR) at 3%, followed by Delaware at 2%. Kansas saw the highest death rate (ASMR) increase at 20%, with Kentucky close behind at 19%. The 65-69 age group had the highest incidence count at 265,188, while the 85-89 age group saw the most deaths at 1,827, and the 70-74 age group recorded the most DALYs at 36,772 in 2021. Males experienced a higher increase in TPC across incidence, deaths, and DALYs compared to females, with figures at 85% vs 56%, 104% vs 85%, and 99% vs 76%, respectively. Conclusion: While deaths due to Peripheral Arterial Disease (PAD) constituted only 1.22% of all cardiovascular-related fatalities in the US in 2021, the growing burden of the disease highlights a critical area for public health focus. Although mortality rates remain relatively low, the high incidence compared to other cardiovascular diseases suggests the need for targeted prevention and early intervention strategies. Strengthening awareness, improving diagnostics, and enhancing treatment accessibility can help mitigate the rising impact of PAD and improve cardiovascular health outcomes nationwide.
Abstract 4146209: Comparative Efficacy and Safety of Colchicine and Anti-Interleukin-1 Agents in Recurrent Pericarditis: A Pairwise and Network Meta-analysis of Randomized Controlled Trials
Authors: Muhammad Ehsan, Alveena Syed, Biah Mustafa, Muhammad Hammad Khan, Allan Klein
Journal: Circulation (2024)

Background: The management of recurrent pericarditis has evolved to include colchicine and novel anti-interleukin-1 agents, given the limited efficacy of traditional NSAIDs and corticosteroids. We conducted a pairwise and network meta-analysis to evaluate the efficacy and safety of colchicine and anti-IL-1 agents in recurrent pericarditis. Methods: We conducted a comprehensive search on various databases and registries, such as MEDLINE (via PubMed), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL), to retrieve relevant RCTs. We used STATA version 17 to perform meta-analyses under a random-effects model and applied the empirical Bayes (Paule and Mandel) variance estimator to dichotomous data. We performed a network meta-analysis with a placebo/standard therapy group as the comparator in MetaXL 5.3 using the Generalized Pairwise Modeling based on the Bucher method. Results: A total of 6 RCTs were included in the meta-analysis. The risk of pericarditis recurrence was significantly decreased by colchicine (RR 0.46, 95% CI 0.37-0.58) and anti-IL-1 agents (RR 0.13, 95% CI 0.03-0.54) compared to placebo or standard therapy. Colchicine significantly decreased the risk of treatment failure (RR 0.42, 95% CI 0.31-0.57) but did not have a significant impact on the risk of adverse events (RR 1.06, 95% CI 0.31-3.62). No significant risk of adverse events (RR 2.16, 95% CI 0.66-7.01) or serious adverse events (RR 1.01, 95% CI 0.23-4.41) was observed with anti-interleukin-1 agents. Colchicine was also associated with a decreased risk of pericarditis-related rehospitalization (RR 0.26, 95% CI 0.10-0.70). The network meta-analysis showed that anti-IL-1 agents (RR 0.13, 95% CI 0.05 to 0.30) were associated with a greater reduction in pericarditis recurrence than colchicine (RR 0.46, 95% CI 0.37 to 0.59). All anti-interleukin-1 agents significantly decreased the risk of pericarditis recurrence, with comparable efficacies among the different agents. Conclusion: Colchicine and anti-IL-1 agents significantly reduced the risk of pericarditis recurrence with the anti-IL-1 agents demonstrating greater efficacy. Further, high-powered, large-scale RCTs that directly compare various treatment options are needed to confirm or refute our findings.
Abstract 4146203: Ultrasound-Targeted Microbubble Cavitation For The Treatment Of Myocardial Microvascular Obstruction: A Porcine Study
Authors: Muhammad Wahab Amjad, Soheb Anwar Mohammed, Xucai Chen, Flordeliza Villanueva, John Pacella
Journal: Circulation (2024)

Introduction: In 2019, 17.9 million people died from cardiovascular disease, 85% of which were due to acute myocardial infarction (AMI). Post-AMI congestive heart failure is increasing due to microvascular obstruction (MVO). MVO is the blockage of the microcirculation by atherothrombotic debris and tends to occur after coronary stenting for AMI. Current therapeutic strategies for MVO are not consistently effective. Aim: Our goal is to develop ultrasound (US)-targeted microbubble cavitation (UTMC) as a potential treatment for MVO. Methods: Initially, we demonstrated the efficacy of UTMC in a rat hindlimb model of MVO. Given these promising findings, in the current work, we expanded our investigation to a clinically relevant porcine model of myocardial MVO. On day 1, MVO was created in the left anterior descending (LAD) microcirculation and confirmed by myocardial contrast echocardiography (MCE). The MVO in the LAD bed was then treated with UTMC therapy during concurrent infusion of Definity ® contrast agent. The therapeutic ultrasound (1.3 MHz center frequency, 1.3 MPa peak negative pressure, 1 ms pulse duration) was delivered with Philips EpiQ (with S5-1 probe). Cardiac MRI was obtained at 36 hours to measure infarct size and area of MVO. At 48 hours post UTMC therapy, MCE was repeated, and the animals were euthanized. Hearts were stained with Evans Blue/ TTC dyes and sectioned for analysis of infarct size. A total of 11 pigs, 5 Control (MVO, no treatment) and 6 UTMC (MVO, UTMC treatment) were done. Results: LAD angiographic flow was improved at 48 hours post UTMC treatment in comparison to control. MCE imaging revealed that the UTMC treatment significantly improved LV systolic performance, and LAD blood volume (Figure 1), as compared to control. MRI clips showed that UTMC ameliorated MVO and left ventricular (LV) segmental wall motion and ejection fraction (EF) also improved after UTMC treatment versus control. Infarct size was reduced as shown by both Evans Blue/TTC staining and MRI. Conclusions: Taken together, we demonstrated that UTMC significantly reduced infarct size, enhanced LAD microvascular perfusion and improved LV systolic performance, and should enable clinical translation of this promising therapy.
Abstract 4145694: Dilated Cardiomyopathy Mortality: A Nationwide Cross-Sectional Analysis
Authors: Enkhtsogt Sainbayar, Hoang Nhat Pham, Ramzi Ibrahim, Abdulla Alabagi, April Olson, Le Duc Thien Ha, Phillip Tran
Journal: Circulation (2024)

Introduction: Dilated cardiomyopathy (DCM) is associated with a significant mortality risk, with untreated cases showing a five-year survival rate of just 50%. However, there is a scarcity of data on how DCM-related mortality rates have changed over time. Goals: How have temporal trends and demographic disparities in DCM mortality evolved in the United States over time? Methods: Mortality/demographic data (i.e. sex, race, ethnicity, and area of residence) in adults in the US spanning from 1999-2020 were sourced from the CDC-WONDER database, using ICD-10 code I42.0. Age-adjusted mortality rates (AAMR) per 1,000,000 population were standardized to the 2000 US population. Temporal trends in mortality were assessed using log-linear regression, with results expressed as the average annual percentage change (AAPC). Results: A total of 168,702 DCM deaths were recorded between 1999-2020. DCM-related AAMR declined from 34.00 [95% CI, 33.31-34.69] in 1999 to 17.17 [16.74-17.59] in 2020, with AAPC -3.47%, p&lt;0.001. Higher mortality was observed in males (AAMR 33.94 [33.74-34.15]) than females (AAMR 14.68 [14.56-14.80]), in non-Hispanic populations (AAMR 24.06 [23.94-24.18]) compared to their Hispanic counterparts (AAMR 16.68 [16.35-17.01]), and in rural regions (AAMR 23.31 [23.03-23.59]) compared to urban regions (AAMR 23.31 [23.19-23.44]). Black populations (AAMR 41.89 [41.42-42.36]) and residents of the Midwestern US region (AAMR 26.14 [25.89-26.39]) experienced the highest mortality rates. Conclusions: DCM-related mortality halved between 1999 and 2020. However, the burden of mortality disproportionately affected males and Black populations. Further research is essential to uncover the underlying factors contributing to these disparities.
Abstract 4146386: The Effect of Pioglitazone on Rate of Atrial Fibrillation in Patients with Diabetes Mellitus and Stable Coronary Artery Disease
Authors: Andrew Abraham, Hussein Noureldine, Qusai Alqudah, Sanaullah Mojadeddi, ann tong
Journal: Circulation (2024)

Introduction: Atrial fibrillation (AF) and coronary artery disease (CAD) has a strong association. Diabetes Mellitus (DM) is also a known risk factor for the development of AF and the severity of DM is almost directly correlated with worsening AF burden. Thiazolidinediones (TZDs) are a treatment option in DM that have been found to decrease risk of developing AF in certain populations. Hypothesis: We hypothesized that the use of pioglitazone in patients with DM and stable CAD decreases the odds of developing AF and development of rapid ventricular response (RVR) in patients with AF. Methods: We identified adult patients presenting to any Hospital Corporation of America (HCA) facility within the North Florida division with a diagnosis of Type II DM and stable CAD between 01/01/2021 and 12/31/2022 (N=38,151). A cohort of patients with documented pioglitazone usage (N=1,055) compared AF rates against those with no documented pioglitazone usage using a Chi-Square Test of Proportions. We also examined a cohort of patients with documented pioglitazone usage (N=197) who had diagnosed AF with RVR against those no documented pioglitazone usage using a Chi-Square Test of Proportions. In addition, multiple covariates that contribute to the development of AF and AF with RVR were evaluated using Logistic Regression with Firth’s Penalized Likelihood. Results: We find evidence that pioglitazone usage is associated with 0.846 lower odds of developing AF (95% CI 0.719-0.991, p&lt;0.038). However, within patients with established AF, pioglitazone use is not associated with decreased odds of developing RVR. Odds of AF and AF with RVR increase if the patient is diagnosed with chronic kidney disease, obstructive sleep apnea, cirrhosis, and alcohol use disorders, regardless of pioglitazone usage. Conclusion: Based on the results of this study, use of pioglitazone was associated with decreased odds of developing atrial fibrillation. However, when we control for various factors, we do not see a difference in rates of developing RVR in patients with AF taking pioglitazone versus those not taking pioglitazone. Further research is needed to establish if there is a synergistic role to other anti-diabetic medications that lower risk of AF.
Abstract 4146394: Plasma proteomics reveals the potential causal impact of ECM proteins on abdominal aortic aneurysm
Authors: Samuel Khodursky, Shuai Yuan, Joshua Spin, Philip Tsao, Michael Levin, Scott Damrauer
Journal: Circulation (2024)

Background: Abdominal aortic aneurysm (AAA) is a common and life-threatening vascular disease. Genetic studies have identified numerous associated loci, many potentially encoding plasma proteins. However, the causal effects of plasma proteins on AAA have not been thoroughly studied. We used genetic causal inference approaches to identify plasma proteins that have a potential causal impact on AAA. Methods: Causal inference was performed using two-sample Mendelian randomization (MR). For AAA, we utilized recently published summary statistics from a multi-population genome-wide association (GWAS) meta-analysis including 39,221 individuals with, and 1,086,107 individuals without, AAA from 14 cohorts. We used protein quantitative trait loci (pQTLs) identified in two large-scale plasma-proteomics studies (deCODE and UKB-PPP) to generate genetic instruments. We tested 2409 plasma proteins for possible causal effects on AAA using two-sample MR with inverse variance weighting and common sensitivity analyses to evaluate the MR assumptions. Bayesian colocalization and gene ontology (GO) enrichment analyses provided additional insights. Results: MR identified 77 plasma proteins whose levels were associated with AAA at FDR&lt;0.05. Of these proteins, 21/77 (27%) were supported by colocalization analysis (posterior probability H4&gt;0.7), indicating that the plasma levels and AAA likely shared causal variants. Among those supported by both MR and colocalization were previously experimentally validated proteins such as PCSK9 (OR 1.3; 95%CI 1.2-1.4; P&lt;1e-10), along with proteins such as LTBP4 (OR 3.4; 95%CI 2.6-4.6; P&lt;1e-10) and COL6A3 (OR 0.6; 95%CI 0.5-0.7; P&lt;1e-6). GO analysis revealed an enrichment of proteins found in extracellular matrix (ECM, OR 7.8; P&lt;1e-4). Gene expression data suggested that some of these ECM proteins have maximal mRNA levels in aortic tissue. Reverse MR for these ECM proteins found no association between genetic liability for AAA and changes in circulating levels of the proteins – suggesting that changes in their plasma levels were not caused by the aneurysm itself. Conclusions: Our results highlight proteins and pathways with potential causal effects on AAA, providing a foundation for future functional experiments. These findings suggest a possible causal pathway whereby genetic variation affecting ECM proteins expressed in the aortic wall cause their levels to change in blood plasma while simultaneously facilitating the formation of AAA.
Abstract 4146155: Comparative outcomes of IABP vs. Impella 5.0 and 5.5 support as a bridge to heart transplantation – a matched cohort study
Authors: Mohammad Al-Ani, Jeremy Balch, Chen Bai, Dan Neal, Maisara Bledsoe, Alex Parker, Mustafa Ahmed, Juan Aranda, Benjamin Shickel, Juan Vilaro, Mamoun Mardini
Journal: Circulation (2024)

Importance: Despite the increasing use of intra-aortic balloon pumps (IABP) and Impella bridge to heart transplant (HTx), there is a paucity of comparative data on their use as bridges to heart transplantation. Objective: To compare the efficacy of IABP vs Impella (5.5 and 5.0) devices as a bridge to HTx in a cohort transplanted under the current UNOS heart allocation system. Design, Setting, and Participants: A retrospective longitudinal study of the United Network for Organ Sharing (UNOS) registry included adult patients listed for HTx between Oct 2018 and April 2022 as status 2, who were supported by IABP or Impella (5.5 and 5.0) and had a complete set of demographics, hemodynamics, medical comorbidities, inotrope requirements, and biochemical variables. The primary endpoint was a successful bridging to HTx as status 2. IABP and Impella groups were propensity-matched at a 3:1 ratio for demographics, UNOS region, baseline hemodynamics, and liver and kidney function. Results: Of 32,806 HTx during the study period, 991 patients met the inclusion criteria (Impella n=88, IABP n=903). Post-matching, there were no differences between the IABP and Impella groups in any baseline characteristic. The primary outcome occurred in 89.5% of the pre-matched population (IABP 90.1% vs Impella 83%, P = 0.055). In the matched cohort, the primary outcome occurred in 85.2% (IABP 86%, Impella 83%, P = 0.603); there was no difference in the listing by exception, multiorgan transplantation, waitlist time, waitlist mortality, or delisting. Post-transplant graft survival, infection, and renal failure were not different. Impella was associated with a lower rehospitalization rate (OR 0.54, 95% CI 0.33–0.9, P = 0.02), coronary allograft vasculopathy (OR 0.23, 95% CI 0.05–1, P = 0.05), and rejection requiring hospitalization (OR 0.13, 95% CI 0.02–1, P = 0.05). Conclusions: IABP and Impella (5.5 and 5.0) devices are equally effective as bridge-to-transplant platforms with a high transplantation rate as status 2. Additionally, Impella was associated with lower post-HTx events.
Abstract 4146158: Sodium-glucose cotransporter 2 inhibitors use and outcomes in transthyretin amyloid cardiomyopathy
Authors: Vikash Jaiswal, Muhammad Hanif, Akash Jaiswal, FNU Sundas, Jishanth Mattumpuram, Gregg Fonarow
Journal: Circulation (2024)

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated to reduce the risk of hospitalizations from heart failure (HF) and cardiovascular mortality. However, SGLT2i therapy’s potential effects on transthyretin amyloid cardiomyopathy (ATTR-CM) have not been well studied. Objective: This study aims to investigate the association of SGLT2-inhibitors with outcomes in patients with transthyretin amyloid cardiomyopathy. Methods: The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years of age from January 2000 to April 2023. Patients were categorized into two groups, one with transthyretin amyloid cardiomyopathy on SGLT2i and a control group with transthyretin amyloid cardiomyopathy without SGLT2i. Patients were followed for 1 month and 1 year respectively. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, race, BMI, hypertension, diabetes mellitus, chronic kidney disease, smoking status, hemoglobin level, low density lipid (LDL) level, left ventricular ejection fraction, pro-BNP levels and various drugs including ACEi, ARBi, beta-blockers, diuretics and statins. Primary outcome was all-cause mortality (ACM), while secondary outcomes were heart failure (HF), ischemic stroke, atrial fibrillation (AF) and ventricular tachycardia (VT). Results: After 1:1 propensity score matching, the study cohort comprised 2,153 patients in SGLT2i and 2,153 patients in the control group. The mean age of patients in SGLT2i and control group was 74.2 and 74.4 years. PSM analysis showed that SGLT2-inhibitors in ATTR-CM patients were significantly associated with lower risk of ACM after 1 month (RR, 0.26 (95%CI: 0.18-0.40), P&lt;0.001), and after 1 year (RR, 0.49 (95% CI: 0.41-0.57), P&lt;0.001) compared with a control group. A similar trend was observed with a significant reduction in the risk of ischemic stroke after 1 month (RR 0.321, 95% CI: 0.157-0.660), P&lt;0.001), and after 1 year (RR, 0.572, 95% CI: 0.418-0.782), P=0.001). However, the risk of HF, AF, and VT both at 1 month and 1 year follow-up was comparable between the SGLT2i group and control group among ATTR-CM patients. Conclusions: These findings suggest that SGLT2i use among transthyretin amyloid cardiomyopathy patients is associated with reduced risk of mortality and ischemic stroke, but not atrial fibrillation and heart failure.