tbuckley/cabot-search huggingface dataset:
Abstract 4145337: Evaluating Complications And Healthcare Utilization Of Intravascular Ultrasound Guided Percutaneous Coronary Interventions: A Retrospective Observational Study
Authors: Aditya Thakkar, Soumya Gupta, Koushik Sanku, SAI KARTHIK KOMMINENI, Lalith Namburu, Dilpat Kumar, manar jbara, jeetendra patel
Journal: Circulation (2024)

Background: While using intravenous ultrasound(IVUS) during Percutaneous interventions(PCI) enhances lesion assessment, stent placement, and procedural precision, it may also potentially increase procedural costs and complications. Research Question: This study aims to evaluate the outcomes, complications, and healthcare utilization associated with IVUS-guided PCI. Method: We conducted our study utilizing data from the nationwide inpatient sample database from January 2016 to December 2020. The study cohort comprised 444,571 hospitalized patients who underwent PCI during their hospitalization. We compared the outcomes of interventions with the use of IVUS and those without. The primary outcome was inpatient mortality. Secondary outcomes were the length of stay, cost of hospitalization, in-hospital and procedural complications as well as the need for life-saving interventions. Results: Among 444,571 patients who underwent PCI, 37,482(8.4%) had IVUS used during their procedure. Among the study population, 67.3% were male, 75.4% were white, 9.5% were black and the remaining 15.1% comprised of other races. The average age of the population was 65.37 years. All outcomes in this study were adjusted for age, race, sex, and comorbidities using the Charlson comorbidity index. Cases that utilized IVUS experienced a significant reduction in in-patient mortality. However, they did have an increased risk of acute renal failure and ventricular arrhythmias. There was also an increase in procedure-related complications like access site-related hematoma, access site-related infection, deep venous thrombosis, coronary artery dissection, and coronary artery aneurysm. They also had an increased need for interventions like dialysis, extra-corporeal membrane oxygenation, pressors, and blood transfusions. Additionally, this group also had a significantly higher length of stay (mean 5.2 days vs. 4.9 days, p&lt;0.001), and cost of hospitalization ($134,914 vs. $117,411, p&lt;0.001). Conclusion: Although IVUS-guided PCI is linked to an uptick in certain complications and overall healthcare costs, it concurrently shows a decrease in in-hospital mortality. This contrast paints a complex picture; the modest increase in risk is counterbalanced by a critical mortality benefit. Ultimately, the benefits of potentially improved survival rates may justify the use of IVUS in PCI, particularly in settings where precision and detailed assessment can significantly impact patient outcomes.
Abstract 4145747: Impact of SLGT2-I on Clinical Outcomes in Heart Transplant Recipients with Type 2 Diabetes Mellitus
Authors: Thomaz Costa, Lucas Tramujas, Alleh Nogueira, Nicole Felix, Neiberg Lima
Journal: Circulation (2024)

Background: Type 2 diabetes mellitus (T2DM) is common among heart transplant recipients and is associated with increased morbidity and mortality. Whether there is a need for a specific approach to managing T2DM post-heart transplantation remains unclear, and there is a paucity of data regarding the use of sodium-glucose cotransporter type-2 inhibitors (SLGT2-I) in this patient population. Hypothesis: SGLT2-I use impacts mortality and hospitalization in T2DM patients and hospitalization while providing effective glycemic control. Aim: To evaluate the impact of SGLT2-I use on mortality, hospitalization, and the achievement of glycated hemoglobin ≤ 7.0% among heart transplant recipients with T2DM. Methods: We conducted a retrospective cohort study using de-identified, aggregated data from 120 centers via the TriNetX research network. We identified patients ≥ 18 years of age with T2DM who had undergone heart transplantation from April 1, 2013, to January 1, 2024, using Current Procedural Terminology codes. Patients were stratified based on baseline SGLT2-I use and underwent propensity-score matching. Patients with end-stage kidney disease were excluded. The outcomes were collected within a 2-year time window and included: all-cause mortality, all-cause hospitalizations, and achievement of HbA1c ≤ 7.0%. Results: Propensity-score matching resulted in 1,015 patients in each cohort, with a mean age of 57. The mean follow-up was 463 ± 257 and 561 ± 245 days in the SGLT2-I and control cohorts, respectively. SGLT2-I use in heart transplant recipients with T2DM was associated with a significantly lower risk of 2-year all-cause mortality (HR 0.58: 95% CI 0.43-0.78; p&lt;0.001) and higher odds of meeting HbA1c ≤ 7.0% (aOR 0.69; 95% CI 0.48-0.99; p=0.04). However, the rates of all-cause hospitalizations did not differ between groups (HR 1.27; 95% CI 0.82-1.97; p=0.29). Conclusions: In this propensity score-matched cohort study comprising 2,030 patients with T2DM and a history of heart transplant, the use of SGLT2-Is was associated with better glycemic control and a significantly lower risk of all-cause mortality over a two-year follow-up period, with no significant difference in all-cause hospitalization.
Abstract 4146029: State-wide Burden of Ischemic Heart Disease attributable to dietary risk factors in the United States from 1990-2021: A benchmarking systematic analysis
Authors: Darshine Venugopal, VISHRANT AMIN, Ashwinikumar Shandilya, Sashank Jonnavithula, Adan Irfan, Saif Syed, Paritaben Bhalodia, JUHI PATEL, Mohit Lakkimsetti, HARDIK DESAI, kamal sharma
Journal: Circulation (2024)

Introduction: Ischemic heart disease (IHD) remains a significant cause of morbidity and mortality in the United States, with dietary risk factors playing a critical role. This study provides the first comprehensive estimate of the IHD burden attributable to various dietary risk factors over the last three decades, including the initial two years of the COVID-19 pandemic. Methods: Using the Global Burden of Disease Study 2021 tool, we estimated the deaths and disability due to IHD associated with twelve dietary risk factors across different age groups, genders, and years spanning from 1990 to 2021 in the US. Results: Over the period from 1990 to 2021, there was a 25% decrease in both the total percentage change (TPC) in deaths and years of life lost (YLLs), while years lived with disability (YLDs) saw a 35% increase (95% uncertainty intervals: 19%-86%). The highest mortality was associated with diets low in whole grains, resulting in 54,046 deaths, followed by diets low in Omega 3 fatty acids (36,886 deaths), and diets high in processed meat (27,280 deaths). Additional significant dietary factors included low fibre (26,681 deaths), low legumes (25,601 deaths), high sodium (21,484 deaths), high red meat (20,411 deaths), low fruits (18,551 deaths), low vegetables (13,000 deaths), low nuts and seeds (8,222 deaths), low omega 6 fatty acids (5,089 deaths), and high sugar-sweetened beverages (360 deaths). The age group with the highest number of deaths was 85-89 years old, accounting for 22,514 deaths. Males experienced a disproportionately higher disease burden compared to females over these three decades. Conclusion: Deaths due to IHD attributable to dietary risk factors accounted for 36.86% of all CVD-related deaths in the US in 2021. To reduce the burden of ischemic heart disease linked to dietary risks, targeted interventions such as eHealth education, mHealth apps for personalized diet tracking, and partnerships with influencers to promote evidence-based health messages are essential. These strategies can enhance public awareness and encourage healthier dietary choices, potentially improving public health outcomes significantly.
Abstract 4145406: The Outcome of Acute Pulmonary Embolism in the Population with Preexisting Atrial Fibrillation
Authors: junaid Mir, Majd Al-Ahmad, Nitish Singh Nandu, Anam Basharat, Jawad Basit, M Chadi Alraies
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is the most common arrhythmia. Patients with AF are at high risk of pulmonary embolism (PE). Similarly, patients with PE are at high risk of AF. There is scarcity of data regarding the outcomes of acute pulmonary embolism in the patients with preexisting AF. Methods: This is an analysis of the National Inpatient Sample of the years 2016 to 2020. We identified patients who were admitted with PE using ICD-10-CM codes. We divided the population into two groups by secondary diagnosis of AF. The risk of mortality and in-hospital complications in the PE/AF group was compared to the PE/non-AF group using multivariate logistic regression analysis. Results: During 2016-2020, there were a total of 934225 patients who were admitted with PE, of which 102705(11%) patients had AF. After adjusting for demographics, hospitalized PE patients with AF had higher odds of mortality (aOR (adjusted odds ratio) 1.40; 95% CI 1.30–1.52 p &lt; 0.001), GI bleed (aOR 1.30; 95% CI 1.18–1.43p &lt; 0.001), cardiogenic shock (aOR 1.83; 95% CI 1.64 – 2.04 p&lt; 0.001), cardiac tamponade (aOR 2.93; 95% CI 1.88–4.57 p&lt;0.001) ,cerebral infarction (aOR 1.42; 95% CI 1.21–1.67 p&lt; 0.001),AKI (aOR 1.23; 95% CI 1.18–1.29 p&lt; 0.001), respiratory failure (aOR 1.22; 95% CI 1.18–1.27 p&lt; 0.001), longer LOS (aMD (adjusted mean difference) 0.84 days; 95% CI 0.76– 0.92 days p&lt; 0.001) and higher total cost of care (aMD 9987$; 95% CI 8799 – 11173$ p&lt; 0.001) compared to PE patients without AF. (Figure 1) Conclusion: Hospitalized PE patients with preexisting AF have higher odds of mortality, GI bleed, cardiogenic shock, cardiac tamponade, cerebral infarction, AKI, respiratory failure, longer LOS, and higher total cost of care compared to PE patients without AF. Physicians should be aware of this prognostic effect of AF and include AF in risk stratification of patients with PE.
Abstract 4145719: Predictors of New-Onset Left Ventricular Systolic Dysfunction in Patients Undergoing Orthotopic Liver Transplantation
Authors: Martine Webb, Elizabeth Hutchins, Andrew Melehy, Justin Song, Samuel Daneshvar, Megan Kamath, Alex Bui, Vatche Agopian, Ashley Stein-Merlob
Journal: Circulation (2024)

Background: Postoperative left ventricular systolic dysfunction (LVSD) in patients undergoing orthotopic liver transplant (OLT) is a known phenomenon, however, risk factors are not fully delineated. Methods: We performed a single-center retrospective analysis of all patients undergoing OLT from 2015 to 2022 and identified cases in which post-OLT left ventricular ejection fraction (LVEF) was less than or equal to 45% within one year. Controls were identified using 1:1 propensity matching on the variables of age, sex, pre-OLT Model for End-Stage Liver Disease (MELD) score, cirrhosis etiology, and pre-transplant LVEF. Baseline demographic, laboratory and echocardiographic parameters were collected. Univariate logistic regression with odds ratios (OR) and 95% confidence intervals (CI) were calculated for each predictor variable. Results: Of all patients who underwent OLT (n=956), 66 (6.9%) developed LVSD, with 41 cases (62.1%) occurring within the first 30 days post-OLT. Mean length of stay was not significantly different (79 ± 52 versus 63 ± 53 days, p = 0.086), though patients with LVSD had increased ICU length of stay (56 ± 43 versus 33 ± 27 days, p= 0.002). Preoperative diagnosis of obstructive coronary artery disease (CAD) (OR 8.6, CI 2.3 – 56.5) and chronic obstructive pulmonary disease (COPD) (OR 7.7, CI 1.3 - 146), as well as pre-operative mineralocorticoid receptor antagonist use (OR 2.5, CI 1.3 – 5.2) were independent predictors of LVSD. Of the echocardiographic parameters measured, none were significantly associated with the development of LVSD, though increased left ventricular (LV) size showed a trend towards being predictive (OR 2.71 CI 0.940 – 8.89 p = 0.077). See Figure 1 for Forest Plots of all variables analyzed. Conclusions: After OLT, LVSD occurs in a significant minority of patients most commonly within 30 days post-transplant and is associated with increased ICU length of stay. Baseline obstructive CAD and COPD were associated with the development of LVSD after OLT. Although no basic echocardiographic parameters were predictive of post-OLT LVSD, LV size showed a trend towards significance and signals a potential avenue for future research into more advanced echocardiographic predictors.
Abstract 4146430: Microglia Mediated Neuroinflammation: Understanding Mechanisms of Augmented Sympathetic Nerve Activity in Chronic Kidney Disease
Authors: Swati Sharma, Janos Paloczi, Patrick McTernan, Rajesh Mohandas
Journal: Circulation (2024)

Background: Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD). Excess sympathetic nerve activity (SNA) is thought to be a major mechanism for elevated cardiovascular risk in these patients. However, the mechanisms that drive excess SNA in patients with CKD are not well understood. A growing body of evidence suggests that CKD is associated with inflammation and immune dysfunction. However, the role of neuroinflammation in CKD has not been studied. Hypothesis: We hypothesize that microglial activation and neuroinflammation underlies excess sympathetic activity in chronic kidney disease (CKD). Aim: Understand the extent to which microglia mediate neuroinflammation and contribute to excess SNA in CKD. Methods: C57/BL6 mice (18-22 gm, 8 weeks old) were randomized to 0.2% adenine in casein (CKD) or continued on casein-only diet (Control) for 2, 4 or 6 weeks. SNA was assessed by heart rate variability, as determined by spectral analysis of the electrocardiogram (Low Frequency / High-Frequency HF/LF ratio) and catecholamine levels (ELISA). Neuroinflammation will be evaluated by profiling the cytokines/chemokines in serum and CSF using Luminex cytokine array. Microglia phenotyping was performed by flow cytometry. Renal function was quantified by serum creatinine and cystatin C levels. Results: The adenine model resulted in significant CKD by 2 weeks. SNA was increased by week 4 as evidenced by an increased LF/HF ratio [0.46 ± 0.1 in CKD vs. 0.21 ± 0.05 Controls] P = 0.02. There were no differences in SNA at 2 weeks. However, changes in microglia were evident as early as 2 weeks, with CKD mice showing significantly increased numbers of activated microglia (CD11b+ CD45low/int P2RY12+ CD86+) (P = 0.007). The areas of the brain that control sympathetic output showed excess microglia. Conclusion(s): Our data suggests that CKD is associated with neuroinflammation in sympathetic areas of the brain. Microglia activation precedes increases in SNA. Experiments to examine the effect of microglia depletion on SNA are ongoing. Together, these experiments will provide comprehensive insight into how microglial function and neuroinflammation synergize to increase SNA in CKD.
Abstract 4146529: Impact of Connective Tissue Features on Vascular Outcomes in Fibromuscular Dysplasia
Authors: Srekar Ravi, George Bcharah, Christine Firth, Austin Saugstad, Mayowa Osundiji, Yuxiang Wang, Chadi Ayoub, Fadi Shamoun
Journal: Circulation (2024)

Introduction/Background: Fibromuscular Dysplasia (FMD) is a non-atherosclerotic vascular disease that primarily affects medium-sized arteries and is characterized by abnormal cell development in the artery walls. Recent studies have suggested that various connective tissue features may be prevalent in patients with FMD, however the clinical significance of these findings on the disease course are uncertain. Research Questions/Hypothesis: We hypothesized that the presence of connective tissue features in patients with FMD might indicate a more severe disease course, potentially associated with increased severity of vascular complications. Goals/Aims: To evaluate the association between connective tissue features and the severity of vascular complications in FMD patients on outcomes including dissections and stroke. Methods/Approach: This cross-sectional study involved 2,454 patients diagnosed with FMD at a tertiary referral center. Patients were classified into two groups based on the presence (n=324) or absence (n=2130) of connective tissue features (pectus deformity of any kind, scoliosis, pneumothorax, inguinal hernia, uterine rupture, bowel perforation, Achilles tendon rupture). We evaluated the incidence of dissections and ischemic or hemorrhagic strokes using odds ratios and chi-squared tests. Results/Data: The cohort consisted of 2,454 participants with an average age of 64.8 years, of whom 89.1% were female and 92.4% identified as White. When comparing groups with and without connective tissue features, there were no significant differences in the prevalence of aneurysms at any site. Among the subgroup of FMD patients with connective tissue features (n=234), prevalent conditions included pectus (12.35%), scoliosis (47.22%), pneumothorax (16.67%), inguinal hernia (13.58%), uterine rupture (16.36%), bowel perforation (6.48%), and Achilles tendon rupture (1.85%). Vascular outcome analysis showed significant differences: the odds of experiencing a stroke were higher in patients with these features (odds ratio: 1.60; P-value: &lt;0.01), whereas the odds of experiencing dissections were lower (odds ratio: 0.77; P-value: 0.03). Conclusion: The presence of connective tissue features in patients with FMD is associated with 60% higher odds of experiencing a stroke, equivalent to a 1.6-fold increase, compared to those without these features. This association may represent a novel finding in the literature, warranting further investigation.
Abstract 4145942: A hepatic steatosis-mediated metabolite reprograms macrophage lipid metabolism and aggravates atherosclerosis
Authors: Ting Long, Ruijia Feng, Weiqi Feng, Guiyan Peng, Wenchao Yang, Zilun Li, Kan Huang, Guangqi Chang
Journal: Circulation (2024)

Background: Atherosclerotic cardiovascular disease (ASCVD) stands as the foremost cause of mortality and disability among adults worldwide. Despite non-alcoholic fatty liver disease (NAFLD) has been well-characterized as an independent risk factor of atherosclerosis (AS), the precise underlying mechanisms remain poorly elucidated. We recently identified N-methyl-2-pyridone-5-carboxamide (2PY), the main end product of nicotinamide in human, as a pro-steatotic metabolite markedly elevated in hepatic steatosis conditions. The pathological increase in plasma 2PY levels has been intricately linked to an escalated susceptibility to cardiovascular issues. Research Questions: We hypothesized that 2PY might be a potential mediator bridging the association between NAFLD and the progression of AS. Goals: To elucidate the role and mechanistic insights of 2PY in the crosslink between hepatic steatosis and AS. Methods: Mass spectrometry was conducted to determine the plasma levels of 2PY in Apolipoprotein E-deficient (ApoE-/-) mice. Five-week-old male ApoE-/- mice fed a standard laboratory diet (SLD) or a western diet (WD) were intraperitoneally injected with 2PY or its vehicle for 10 weeks. Parameters of systemic metabolism, hepatic steatosis and AS were evaluated. Human THP-1 macrophages were used to investigate the effect of 2PY on oleic acid-induced foam cell formation. Lipidomic and transcriptomic analysis were performed to identify the alterations of lipids and genes in THP-1 macrophages upon 2PY treatment. Results: The expression of hepatic aldehyde oxidase 1, a key metabolic enzyme involved in 2PY metabolism, showed upregulation in the steatotic liver, resulting in the excess 2PY in WD-induced ApoE-/- mice. The plasma concentration of 2PY directly correlated with plaque area and lipid deposition in mice aortas. Furthermore, our study demonstrated that administration of 2PY aggravated lipid metabolic dysbiosis, hepatic steatosis and AS progression in mice fed either a SLD or a WD. In vitro, supplementation of 2PY dose-dependently increased intracellular lipid content in THP-1 macrophages. Mechanistically, 2PY upregulated ELOVL Fatty Acid Elongase 6 (ELOVL6) expression and induced lipid metabolic reprogram in macrophages, thereby facilitating foam cell formation. Conclusion: Our study indicates 2PY as a pro-atherogenic metabolite that mediates the association between NAFLD and elevated ASCVD risk, thus providing mechanistic insight into the pathogenesis of AS.
Abstract 4146493: 84 Immune checkpoint profiling in major aortic diseases leads to identification of potential roles of CD155-CD206 pathway in suppressing inflammation and immune responses
Authors: Ying Shao, Fatma Saaoud, Keman Xu, Yifan Lu, Xiaohua Jiang, Wang Hong, Xiaofeng Yang
Journal: Circulation (2024)

Immune checkpoints are a group of immune regulatory plasma membrane proteins expressed on antigen-presenting cells and T cells, which are crucial for maintaining self-immune tolerance and modulating the effectiveness of T cell immune responses. The importance of selected immune checkpoints in cardiovascular diseases have been widely recognized. However, we identified a significant knowledge gap in the comprehensive understanding of immune checkpoint signaling across multiple levels in cardiovascular diseases. To bridge this gap, we developed a framework that encompasses disease stages and cell types regulated by immune checkpoint axes within the contexts of three major aortic diseases such as abdominal aortic aneurysm, atherosclerosis, and diabetic aortic pathology. Initially, at the transcriptional level, we analyzed the expressions of 58 pairs of immune checkpoint genes in mouse aorta across three models of abdominal aortic aneurysm, four models of hyperlipidemia and atherosclerosis, and three models of diabetes, each representing various stages of the respective diseases. At the single-cell level, we investigated the gene enrichment within separate clusters of aortic cells under diseased conditions. From the results, we found that among the immunosuppressive or double functional immune checkpoints, CD155 expression patterns were different from that of CD274 in more than 50% samples, suggesting that CD155 may play immunosuppressive/anti-inflammatory roles in aortic diseases that are different from CD274. Therefore, we performed flow cytometry to investigate potential regulation of the TIGIT/CD155 axis at the cellular levels in four organs of ApoE-/- mice compared to wild type. The results identified that TIGIT/CD155 axis is upregulated in aortic CD45+ leukocytes but not in CD45- non-leukocyte cellular compartments. CD155 enrichments were identified in CD45+CD11b+CD11c+ cells in blood and kidney, as well as in CD45+CD11b-CD11c+ cells in the lung. Furthermore, among the three functional markers used to identify the subclusters of heterogeneous aortic antigen-presenting cells—CD206, CX3CR1, and CD103—positive correlations were observed between CD155 expressions and the anti-inflammatory marker CD206, while correlations with CX3CR1 and CD103 were absent. These results have demonstrated that CD155-CD206 pathway may play surrogative roles to CD274 in suppressing inflammation and immune responses in atherosclerosis and aortic diseases.