tbuckley/cabot-search huggingface dataset:
Abstract 4145775: Risk of Cardiac Adverse Events of Post-transplant Cyclophosphamide versus No Post-transplant Cyclophosphamide in Patients with Hematological Conditions Receiving Stem Cell Transplantation: A Systematic Review and Meta-Analysis.
Authors: Catalina Herran-Fonseca, Laura Jekov, Buena Aziri, Carlotta Persaud, Edin Begic, Fahad Alabbas
Journal: Circulation (2024)

Background: Cyclophosphamide is an alkylating agent of the nitrogen mustard class that has become standard of care for graft-versus-host disease prophylaxis after hematopoietic stem cell transplantation. Although its cardiac toxicity in conditioning regimens is well-documented, data on cardiac events after administration of post-transplant cyclophosphamide (PT-Cy) administration remains limited. Research Question: Is PT-Cy associated with a higher incidence of cardiac adverse events compared with no PT-Cy? Aims: We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing PT-Cy versus no PT-Cy in patients with hematological disorders who received hematopoietic stem cell transplantation. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing PT-Cy versus no PT-Cy in patients with hematological conditions who received hematopoietic stem cell transplantation. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1, under a random-effects model. Heterogeneity was assessed using I2 statistics. Results: We included four studies, all of which were retrospective, with 1,546 patients, of whom 826 (53%) received PT-Cy. Age ranged from 18 to 77 years, and 840 (54%) were male. A total of 1549 allogeneic transplants were performed, primarily for malignant hematological conditions. The conditioning regimens used were myeloablative (52%), reduced intensity (33%), non-myeloablative (8%), and sequential (7%). The most common cardiac events in patients receiving PT-Cy were heart failure (28%) and cardiomyopathy (27%), followed by arrhythmias (25%), pericarditis/pericardial effusion (14%) and acute coronary syndrome (5%). The incidence of adverse cardiac events was significantly higher in patients who received PT-Cy compared with those who did not receive PT-Cy (RR 2.05; 95% CI 1.36, 3.10; p&lt;0.001; I 2 =44%). Conclusion: These findings suggest that PT-Cy is associated with a higher incidence of adverse cardiac events, the most common of which is heart failure/cardiomyopathy.
Abstract 4145869: Predictive Value of Dipeptidyl Peptidase 3 Plasma Levels for Cardiogenic Shock and Mortality in Acute Coronary Syndromes
Authors: Shifa Younus, Sumiya Jatoi, Muhammad Hassan Cheema, Alamdar Hussain, Aeman Zafar, Noor Fatima, Aamir Ali, Tauseef Hussain, Hamza Saleem, Humais Choudhary
Journal: Circulation (2024)

Introduction: Dipeptidyl amino-peptidase 3 (DPP3) is an aminopeptidase released into the bloodstream following cell death. Studies have demonstrated that in patients experiencing cardiogenic shock (CS), there's an elevation in circulating DPP3 (cDPP3) plasma concentration, which is associated with a heightened risk of mortality. This research investigated the connection between serum DPP3 levels, CS occurrence, and mortality in individuals diagnosed with acute coronary syndromes (ACS). Methods and Materials: In this prospective, multicentric study, consecutive patients with acute coronary syndrome diagnosis were enrolled, and their plasma levels of DPP3 were evaluated at both baseline and 12-24 hours post-presentation. The ORBI risk score was used to classify patients with a higher risk of cardiogenic shock. Results: Elevated circulating levels of DPP3 were linked to in-hospital cardiogenic shock, even when considering established risk factors such as the ORBI risk score (with a hazard ratio of 2.17 per log-2 increase, 95% confidence interval 0.94–1.97, and a P-value &lt;0.005). Additionally, high DPP3 levels were identified as independent predictors of mortality at both 30 days (with a hazard ratio of 2.26, 95% confidence interval 1.14–3.44, and P &lt; 0.001) and one year (with a hazard ratio of 1.57, 95% confidence interval 1.25–2.11, and P &lt; 0.001) after adjusting for established risk factors. Conclusion: Our study concludes that circulating DPP3 is a novel marker for cardiogenic shock (CS) and increases mortality risk among ACS patients. Circulating DPP3 may serve as a predictive tool for CS advancement and informing decisions regarding treatment guidelines.
Abstract 4145932: Real World Data From A Nationwide Survey: Current Approaches Post Acute Coronary Syndromes By Cardiologists
Authors: Pierre SABOURET, Raul Santos, Ali Sharareh, thierry garban, Serge Cohen, Eric Parrens, Marc Villaceque, Dominique Guedjmeynier, Benoit Lequeux, Olivier Hoffman, Jean-Claude Dib, Philippe Durand, Marco Bernardi, Luigi Spadafora, Elad Asher, Deepak Bhatt, Giuseppe Biondi-Zoccai, Maciej Banach, Walid Amara, Francois Schiele, Nicolas Lellouche, Francois Dievart
Journal: Circulation (2024)

Background: A new ESC guidelines in 2023, the International Lipid Expert Panel (ILEP) 2021 recommendations, and a subsequent statement by EAS have been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists. Objective: To determine the current approach and therapeutic strategies concerning lipid lowering treatments post-acute coronary syndromes in France. Methods: This national survey was performed during October and November 2023 in France with an online questionnaire on the websites of 2 national French Societies of Cardiologists. Four mailings were sent to cardiologists to invite them to answer to the questionnaire. A total of 400 answers of cardiologists were collected during this 2-month period. Results: For ASCVD patients, cardiologists agreed with an LDL-C goal below 55 mg/dL (1.4 mmol/L) in 69%, below 70 mg/dL (1.8 mmol/L) in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL (1.8-2.5 mmol/L). An upfront lipid lowering combination strategy using fixed dose combination (FDC) of statins and ezetimibe was prescribed in less than 5% of patients, whereas high-intensity statins were prescribed in more than 90% of patients. No significant differences were observed in terms of sex of patients, geographical area, or strategies followed by male and female cardiologists ( p &gt; 0.05). A combination of statins and ezetimibe was prescribed only for a minority of patients, especially as an early upfront strategy. The use of PCSK9i remains marginal and the interval between the ACS and initiation of these medicines remains high. Conclusion: In this contemporary national survey, we report an excellent agreement of lipid goals in secondary prevention by cardiologists. Despite the declared consensus recommending a low LDL-C target in ACS patients, lipid lowering strategies are suboptimal, mainly consisting of high intensity statins. The lack of recommended use of ezetimibe and PCSK9i to lower LDL-C levels highlights the importance of better implementation of intensive and early upfront strategies to reduce recurrent ischemic events.
Abstract 4145992: Mortality Trends of Chronic Obstructive Pulmonary Disease and Acute Myocardial Infarction in the United States
Authors: Azeem Rathore, Safia Shaikh, Sameh Nassar, Prakash Upreti, Olayiwola Bolaji, Yasemin Bahar, M Chadi Alraies
Journal: Circulation (2024)

Introduction: Given the overlap in their risk factors, investigating the combined mortality trends of both chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI) represents a crucial yet understudied area. Methods: Using the CDC WONDER database, we queried mortality records from 1999 to 2019 among COPD-related deaths (ICD-10: J40, J41, J42, J43, J44) and AMI-related deaths (ICD-10: I21) in ≥ 45-years-old. Joinpoint regression analysis was utilized to assess trends in annual percentage change (APC) for underlying and contributing causes of death. Age-adjusted mortality rates (AAMR) were computed and compared cumulatively across subpopulation demographics. Results: Between 1999 and 2007, COPD and AMI mortality as underlying causes showed a notable decline (APC: -4.71, 95% CI: -6.09, -3.45), with a continued decrease from 2007 to 2020 (APC: -2.28, 95% CI: -2.61, -1.57). Conversely, as contributing causes, COPD and AMI demonstrated a downward trend from 1999 to 2009 (APC: -3.09, 95% CI: -4.22, -2.45), followed by a slower decline from 2009 to 2018 (APC: -1.52, 95% CI: -3.3, -0.93), and a slight increase from 2018 to 2020 (APC: 2.05, 95% CI: -1.18, 3.75). Gender-specific analysis revealed consistently higher AAMRs among males (458.8) than females (295.5), while Whites consistently had the highest AAMR (377.6) and Asians the lowest (145.9). Urbanization level played a role, with non-metropolitan areas consistently exhibiting higher AAMR (478.5) compared to metropolitan areas (353.1), with the Midwest showing the highest AAMR (396.1). Conclusion: The decline in COPD and AMI-related mortality reflects the success of public health initiatives targeting smoking cessation, improved air quality regulations, and advancements in cardiovascular care. The uptick in mortality rates from 2018 to 2020 underscores the necessity for ongoing vigilance and targeted interventions, especially in addressing disparities related to gender, race, and urbanization.
Abstract 4145783: Prevalence of Kidney Dysfunction and Hyperkalemia in a Specialized Heart Failure Clinic
Authors: Chen Hsiang Ma, Arthur Qi, Luke Gagnon, Ben Vandermeer, aminu bello, Gavin Oudit
Journal: Circulation (2024)

Introduction: Kidney dysfunction is highly comorbid in heart failure (HF) patients and contributes to suboptimal utilization of goal-directed medical therapy (GDMT). Worsening hyperkalemia is a common concern in GDMT implementation. We aimed to evaluate the prevalence of kidney dysfunction and rates of hyperkalemia in a specialized heart function clinic (HFC) cohort in Edmonton, Alberta, and characterize the impact of renal dysfunction on clinical outcomes. Methods: HF patients were enrolled in the HFC from Feb 2018 to Nov 2022. Outpatient serum creatinine measurements were used to estimate glomerular filtration rate (eGFR) using the 2021 CKD-EPI equation. Medication records (renin-angiotensin system inhibitors [RAASi], angiotensin receptor neprilysin inhibitors [ARNI], β-blockers, mineralocorticoid inhibitors [MRA], sodium-glucose cotransporter 2 inhibitors [SGLT2i]), laboratory results, and comorbidities using ICD-10 codes were obtained. Hyperkalemia events were defined as any serum potassium ≥5.5 mmol/L measured in a year. Adjusting for clinical covariates, we analyzed the association between GDMT use and hyperkalemia rates as well as between eGFR and all-cause mortality and hospitalization. Results: Our HFC cohort of 1401 patients (median age 68, 29% female) includes 54% with an eGFR ≥60, 37% with an eGFR from 30 to &lt;60, and 9% with an eGFR &lt;30. Prevalence of hyperkalemia increased with worsening renal function, from 9.1% in eGFR &gt;60, 18.1% in eGFR 30-60, to 34.2% in eGFR &lt;30 (p&lt;0.001). After adjusting for baseline clinical characteristics, ARNI, RAASi, MRA, and SGLT2i uses were not associated with increased rates of hyperkalemia. Using eGFR ≥60 as a reference, all-cause mortality increased in eGFR 30-60 (aHR 1.58, 95% CI 1.23-2.02) and eGFR &lt;30 (aHR 3.40, 95% CI 2.45-4.72). In addition, RAASi (aHR 0.57, 95% CI 0.43-0.74) and ARNI use (aHR 0.66, 95% CI 0.48-0.91) were associated with improved all-cause mortality. These results were similar across all-cause hospitalization. Conclusion: Although hyperkalemia is often viewed as a barrier to initiating and up-titrating GDMT, our results show no association between GDMT use and increased hyperkalemia rates. Given the high mortality and morbidity in patients with heart failure and renal dysfunction, further research on improving GDMT utilization and mitigating hyperkalemia in the context of worsening renal function is warranted.
Abstract 4145739: Predicted Peak Oxygen Consumption in Patients with Hypertrophic Cardiomyopathy is Highly Variable by Sex and Predictive Equation
Authors: Hannah Tandon, israt jahan, Yunwoo Burton, Bradley Petek, Ahmad Masri
Journal: Circulation (2024)

Introduction/Background: Cardiopulmonary exercise testing (CPET) can stratify risk of sudden cardiac death and determine eligibility for advanced therapies for patients with hypertrophic cardiomyopathy (HCM). Achieving &lt;80% of predicted peak oxygen consumption during physical exertion (pVO2) has negative prognostic value and has been used as an eligibility criterion in clinical trials. Research questions/Hypothesis: pVO2 predictive equations are derived from predominantly male historical cohorts, thus they may be unreliable for women. Goals/Aims: To determine the sex-based variability in pVO2 predictive equations in patients with HCM. Methods/Approach: This was an observational study of HCM patients undergoing symptom-limited CPET. Wasserman cycle and treadmill (±obesity correction), Jones cycle for men and women, Hansen/Jones, FRIEND, and FRIEND 2018 equations were used to generate predicted pVO2 values. Results/Data: A total of 131 HCM patients (median age 47 years, range 18-86) underwent CPET and were included in the analysis; 71 (53.8%) were women. The table summarizes the differences in percent (%) predicted pVO2 by sex for each equation. Equations without built-in sex corrections (Wasserman cycle and treadmill ± obesity correction, Hansen/Jones) resulted in lower percent predicted pVO2 values in women vs men, whereas those with sex corrections resulted in higher values for women vs men. Across equations, there was a high degree of variability in percent predicted pVO2 for women (range for medians 56 to 96%) compared to men (range for medians 68 to 74%). In equations that incorporate sex corrections, fewer women were found to have percent predicted values &lt;80%. Conclusions: There is a high degree of variability among equations of percent predicted pVO2, especially in women. Such variability likely introduces unwanted biases in evaluation, risk prediction, and recruitment in clinical trials. Further investigation is warranted to evaluate which predictive equations provide meaningful prognostic value in HCM patients without introducing sex-based biases.
Abstract 4145671: Characteristics and Association of Cannabis Use on Cardiovascular Outcomes in patients hospitalized with Atrial Fibrillation: An NRD Propensity Matched Analysis
Authors: Ajit Brar, Soumiya Ravi, Yashitha Chirumamilla, Ayushi Garg, Mohammed Omer, Nikky Maharjan, Shriya Maini, Ali Zreik
Journal: Circulation (2024)

Background: Cannabis use is rapidly rising with its legalization across multiple regions of the USA. Recent literature has identified that Atrial Fibrillation is the most common arrhythmia identified in cannabis users. Further research is needed to elucidate the impact of cannabis use in patients with Atrial Fibrillation. Aim: We aim to study the difference in characteristics and outcomes in patients with Atrial Fibrillation based on cannabis use through the National Readmission Database(2016-2020). Methods: NRD database was used to identify patients with Atrial Fibrillation using ICD-10 codes. Patients were stratified into two groups based on history of cannabis dependence. Information was collected on patient demographics, comorbidities, and outcomes. Propensity score matching was performed to compare outcomes among AFib patients based on cannabis use. Results: 12,394,481 patients with AFib were included in the analysis. Of these cannabis use was identified in 104,837 (0.84%) patients. The patients in the cannabis group were younger (60.2+- 0.03 yrs vs 75.16 +- 0.06 yrs), and had a higher prevalence of males (73.8% vs 52.9%) in comparison with the non cannabis group. Cannabis group had a higher rate of Obesity (20.98% vs 19.83), prior MI (12.04% vs 10.69), pulmonary disease (30.17% vs 26.61%) and liver disease (4.17% vs 2.33%) in comparison with the non-cannabis group. In the propensity matched analysis, cannabis group had a higher rate of myocardial infarction (5.59% vs 5.32%; p&lt;0.001) and Acute Stroke (1.66% vs 1.64%, p&lt;0.001). The cannabis group had a ra lower rate of in-hospital death (3.77% vs 4.74%, p&lt;0.001), acute kidney injury (25.24% vs 25.93; p&lt;0.001), heart failure (44.09% vs 46.34%; p&lt;0.001), sudden cardiac arrest (0.88% vs 0.75%;p&lt;0.001), mechanical circulatory device use(3.12% vs 3.5%;p&lt;0.001), major adverse cardiovascular events (11.6% vs 12.13%;p&lt;0.001) and net adverse events(59.55% vs 61.17%, p&lt;0.001) Discussion: Group with Afib and Cannabis use displayed a lower mean age and lower prevalence of females in comparison with the non-cannabis group. Furthermore, unmatched outcome analysis showed a higher rate of AKI, MI, sudden cardiac death and MACE among cannabis users in comparison with non-cannabis users. In comparison, propensity score matched outcomes displayed higher rates of acute stroke and myocardial infarction. Understanding the relationship between cannabis use and atrial fibrillation is crucial for improving outcomes.
Abstract 4145622: Fast Stress-Relaxing Hydrogels Modulate Transplanted Stem Cell Potency in the Ischemic Limb
Authors: Ngan Huang, Sree Aravindan, Caroline Hu, Gladys Chiang, Beu Oropeza, Michelle Huang, Sarah C Heilshorn
Journal: Circulation (2024)

Introduction: Endothelial cells (ECs) can improve blood perfusion in diseased blood vessels associated with peripheral artery disease, but direct injection of therapeutic cells significantly decreases their survival and functionality for angiogenesis. To address these limitations, we employed a class of mechanically tunable protein hydrogels to enhance the survival and angiogenic behavior of human induced pluripotent stem cell-derived ECs (iPSC-ECs). Hypothesis: We hypothesize that the optimal stress relaxing mechanical property of hydrogels will modulate iPSC-EC survival and function in a mouse model of hindlimb ischemia. Materials&amp;Methods: Engineered hydrogels, termed elastin-like protein (ELP)-polyethylene glycol (PEG), consists of two components of a hydrazine-modified elastin-like protein (ELP-HYD) and an aldehyde- or benzaldehyde-modified, polyethylene glycol (PEG-ALD or PEG-BZA), which interact with each other through hydrazone dynamic covalent chemistry bonds to form ELP-PEG hydrogels. By varying the use of PEG-ALD or PEG-BZA, we created hydrogels with the same stiffness but at either fast or slow stress relaxation rates. The hydrogels were assessed by dynamic oscillatory rheology. Afterwards, 10 6 human iPSC-ECs were encapsulated within gels and injected into a mouse limb ischemia model to assess transplant cell viability and the ability to restore vascular perfusion to the ischemic limb. Results and Discussion: Although both hydrogels had a Young’s Modulus of 500 Pa, the stress relaxation rate of the PEG-BZA was 2.5h (slow), whereas that of PEG-ALD was within minutes (fast). When the iPSC-ECs were injected into the ischemic limb within either fast or slow-relaxing hydrogels or in saline, bioluminescence imaging of the luciferase-tagged iPSC-ECs showed higher cell survival within the fast-relaxing hydrogel over the course of the first 7 days. Blood perfusion recovery by laser Doppler similarly showed higher mean perfusion ratio when cells were delivered in the fast-relaxing hydrogel. Conclusions: ELP/PEG-ALD promotes iPSC-EC cell survival and perfusion recovery in the ischemic limb.
Abstract 4145777: Left Atrial Appendage Closure Device Outcomes Among Patients With Diagnosed Coagulable Disorders
Authors: Chapman Wei, Ahmad Mustafa, Saran Teja Velaga, Alaukika Agarwal, Rina Shah, Philippe Akhrass, Marcin Kowalski, Mitchell Weinberg, Valay Parikh
Journal: Circulation (2024)

Background: The literature regarding outcomes among patients with coagulopathy who had left atrial appendage occlusion (LAAO) device procedure is limited. This study evaluated the inpatient outcomes among patients that underwent LAAO with and without diagnosed coagulable disorders. Methods: Patients that underwent LAAO were collected from the National Inpatient Sample database 2016-2019. Patients were stratified by the presence of diagnosed coagulable disorders. Demographic and comorbidity data were collected. Bleeding events and inpatient mortality were assessed. Chi-square and binary logistic regression analyses were utilized. Factors with p&lt;0.20 were used for the binary logistic regression models. Results: Among 12,280 patients, 538 (3.2%) had a diagnosed coagulable disorder. Patients with coagulable disorders were more male. They also had higher rates of cancer, chronic heart failure, anemia, chronic kidney disease, and chronic liver disease and lower rates of dyslipidemia and hypertension than patients without coagulable disorders. Regarding inpatient outcomes, see table 1. After performing logistic regression analysis, coagulable disorders were associated with increased rates of blood transfusion requirement, postoperative bleeding, hematuria, acute kidney injury, and mortality. Conclusion: Patients that underwent LAAO with coagulable disorders are associated with increased bleeding in 30 days/in the hospital except gastrointestinal bleeding. Similar risk of hemorrhagic stroke and ischemic stroke were present amongst both groups. Future long-term studies can be performed to corroborate these findings.
Abstract 4145753: Gender Differences in Accelerated Vascular Aging in Patients with Resistant Hypertension
Authors: Soumyadeep Bag, Christian Motley, AHMED ALI, Alina Sehar, Aesha Patel, Peter Abdelmessih, Li Peng, John Fanning, Tanja Dudenbostel
Journal: Circulation (2024)

Background: RHTN is defined as blood pressure above goal in spite of using ≥3 antihypertensive agents. Patients with RHTN have significantly higher rates of cardiovascular disease (CVD). CVD is the number one cause of death for both men and women. Although premenopausal women are relatively protected from CVD, the incidence increases disproportionately in women after menopause. Arterial stiffening is a risk factor for the development of CVD and for all cause mortality independent of the presence of all traditional CVD risk factors. The association between arterial stiffness and mortality has been shown to be almost twofold higher in women compared to men. In addition, heart failure with preserved ejection fraction (HFpEF) and coronary microvascular dysfunction are the more commonly diagnosed forms of CVD in women and are associated with elevated arterial stiffness in women. Our study tries to identify the role of accelerated vascular aging (AVA) in female patients with RHTN compared to patients with HTN as a potential mechanism for higher rates of CVD and associated morbidity and mortality. Methods: We conducted a cross-sectional analysis of a large cohort of 965 patients with HTN and RHTN referred to the RHTN Clinic at the University of Alabama at Birmingham. Results: Women with RHTN compared to men had a similar duration of hypertension (20.6± 12.1 vs. 20.5 ±12.4 years, p=0.99), later onset of HTN (49.5 ± 13.4 vs. 45.5± 14.4 years, p=0.019), similar number of antihypertensive medications, similar levels of serum aldosterone, and plasma renin activity. However, women over the age of 55 with HTN had higher arterial stiffness (AS) than men with HTN (pulse pressure: 90.0±25.6 vs 68.8 ±23.3 mmHg, p&lt;0.0001), and women with RHTN had higher AS than men with RHTN (pulse pressure: 90.0±25.6 vs 79.2±23.7 mmHg, p=0.0004). Furthermore, women with RHTN had higher AS than women with HTN. However, this was also true for men. Conclusion: The findings of our study suggest higher degree of accelerated vascular aging in women with RHTN despite later onset and similar duration of HTN compared to men. More evidence is needed to identify causes of accelerated aging in women older than 55 years of age.