tbuckley/cabot-search huggingface dataset:
Abstract 4145534: Impact of operation related myocardial infarction on the clinical outcome of patients undergoing coronary endarterectomy combined with coronary artery bypass grafting
Authors: Xieraili Tiemuerniyazi, Wei Zhao, Wei Feng
Journal: Circulation (2024)

Background: Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) is one of the last revascularization options for patients with diffuse coronary artery disease. However, concerns exist regarding the application of CE due to the increased perioperative risk, including operation related postoperative myocardial infarction (POMI). However, the impact of POMI on the later outcome is unknown. Research question: Does POMI influence the follow-up clinical outcome of patients undergoing CE+CABG? Aims: To evaluate the impact of POMI on the patient outcome after CE+CABG. Methods: Patients who underwent CE+CABG (excluding concomitant valvular or ventricular aneurysm surgery) between September 2008 and January 2024 were retrospectively enrolled. POMI was defined according to the Forth Universal Definition of Myocardial Infarction. Patients were divided into POMI and no POMI group. Propensity score matching (PSM) analysis with 1:4 ratio was performed to balance the potential baseline confounders. Kaplan-Meier analysis and log-rank test was performed to test the survival difference between the two groups. Cox regression analysis was used to calculate the hazard ratios (HR) and 95% confidence intervals (CI).The primary outcome was the follow-up overall survival, and the secondary outcome was the survival free of major adverse cardiovascular and cerebrovascular events (MACCE), composite of all-cause death, myocardial infarction, stroke and repeat revascularization. Results: A total of 859 patients met the inclusion criteria, including 52 in the POMI group and 807 in the no POMI group. The mean age was 61.1±9.0 years, and 78.5% of them were male. During a median follow-up of 13.1 [6.2, 37.7] months, 28 (3.3%) of the patients suffered from death, while 66 (7.7%) suffered from MACCE. The PSM resulted in pairing of 52 and 208 patients in the two groups. The survivals differed significantly between the two groups ( Figure 1A &amp; B ). Cox regression analysis revealed that POMI was observed to be associated with decreased overall (HR: 5.28, 95% CI:1.42-19.67, P=0.013) and MACCE-free (HR: 4.51, 95% CI: 1.69-12.01, P=0.003), which was in line with the unmatched analysis (Overall survival: P=0.001, MACCE-free survival: P=0.001). Conclusion: POMI after CE+CABG might impair the survival outcomes of patients.
Abstract 4146205: Housing Status Disparities in Inpatient Outcomes of Chronic Limb-Threatening Ischemia
Authors: Alexandra Millhuff, Mohammed Quazi, Aman Goyal, Abu Baker Sheikh
Journal: Circulation (2024)

Introduction: Chronic limb-threatening ischemia (CLTI) is associated with significant morbidity and mortality, and has a high risk of limb amputation. Previous studies have found gender and racial disparities with regards to mortality and disease severity, but the impact of other social factors such as housing status has yet to be investigated. Identifying potential disparities is key to developing targeted interventions to address inequities in social determinants of health. Research Question: What impact does housing status have on inpatient outcomes of limb-threatening ischemia? Methods: A retrospective analysis using the National Inpatient Sample database from 2016-2021 was carried out to identify patients admitted with CLTI who underwent revascularization, identified by ICD-10 codes. Patients were stratified by their housing status. A propensity-matched analysis was subsequently performed to compare demographics, comorbidities, mortality rates, types of intervention, and inpatient outcomes between patients with stable versus unstable housing. Results: 2,667,294 patients were identified who were admitted with a primary diagnosis of CLTI, and 463,435 (17%) underwent revascularization. Among these, 1,790 (0.4%) of patients were identified as unhoused. Patients who were unhoused were less likely to undergo open surgical intervention (aOR 0.40, CI 0.32-0.50, p=&lt;0.001) or endovascular revascularization (aOR 0.51, CI 0.43-0.61, p&lt;0.001). Unhoused patients had longer hospital stays (4 days longer, p&lt;0.001), and more expensive inflation-adjusted hospital costs ($8,501 higher, p&lt;0.001), compared to housed patients. Unhoused patients were more likely to leave against medical advice and be discharged to skilled nursing facilities rather than home. Unhoused patients also had higher rates of smoking and polysubstance use. Mortality rates were similar between housed and unhoused patients. Conclusion: Housing status has a significant role on interventions offered and inpatient outcomes of CLTI patients. Additional research is required to understand disparities in interventions for unhoused CTLI patients. Understanding heightened risk factors for the development of CLTI in unhoused populations is key to addressing disease morbidity in these groups.
Abstract 4146210: TCF7L2 Deficiency in Vascular Smooth Muscle Cells Mitigates Abdominal Aortic Aneurysm
Authors: Yongjie Deng, Yang Zhao, Haocheng Lu, Guizhen Zhao, Hongyu Liu, Y. Eugene Chen, Jifeng Zhang
Journal: Circulation (2024)

Introduction: Abdominal aortic aneurysm (AAA) is a major cardiovascular disease characterized by the dysregulation of vascular smooth muscle cell (VSMC) homeostasis. TCF7L2, a transcription factor involved in Wnt signaling, plays a key role in cell proliferation and differentiation. Genome-wide association studies (GWAS) have identified the gene as being positively associated with aortic aneurysms, but its specific impact and the underlying mechanisms on AAA remain unclear. Methods and Results: Two models were employed to induce AAA in VSMC-specific Tcf7l2 knockout (floxed Tcf7l2 / Myh11 -CreERT2) mice: elastase- and AngII/BAPN-induced AAA models. TCF7L2 deficiency in VSMCs significantly alleviated AAA formation, aorta dilation, elastin degradation, and VSMC apoptosis in both models. In primary human aortic smooth muscle cells, small interfering RNA-mediated Tcf7l2 knockdown attenuated glycolysis and lactate production, as revealed by RNA sequencing, targeted metabolomics, lactate assay, and Seahorse Glycolysis Stress Test. TCF7L2 deficiency in VSMCs also inhibited cell migration, TNFα/CHX- and FasL-induced apoptosis. Conversely, adenovirus-mediated overexpression of TCF7L2 promoted these processes. We further performed Cut&amp;Run sequencing and ChIP sequencing analysis, the data revealed that TCF7L2 binds to the promoter regions of Ldha/b and Tp53 genes, indicating that TCF7L2 promotes VSMC glycolysis and apoptosis through direct interaction with these key genes. Additionally, TCF7L2 upregulated the mRNA and protein expression of MMP14 in VSMCs, suggesting a mechanism by which TCF7L2 regulates extracellular matrix organization. Conclusions: Our data indicate that TCF7L2 plays a key role in AAA development by modulating VSMC glycolysis, apoptosis, migration, and extracellular matrix organization, highlighting TCF7L2 as a potential target for treating VSMC-related diseases.
Abstract 4146133: The prognostic impact of energetic hemodynamics on acute heart failure
Authors: Shih-Hsien Sung, Chih-Hsueh Tseng
Journal: Circulation (2024)

Background: Central aortic hemodynamics significantly affect left ventricular function and clinical outcomes in patients with heart failure (HF). We proposed that energetic hemodynamic parameters could offer a more detailed understanding and a stronger correlation with left ventricular function and outcomes, compared to traditional pressure-based parameters. Methods: A total of 166 patients (61 years, 26.5% women) hospitalized due to HF (24% with preserved systolic function) were enrolled. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured at admission. At discharge, we assessed the augmentation index (AI), backward pressure (Pb) and carotid-femoral pulse wave velocity (cf-PWV) using tonometry, as well as aortic doppler flow. Energetic hemodynamic parameters were calculated by integrating pressure multiplied by flow over time. Results: While subjects with a left ventricular ejection fraction (LVEF) &lt;50% exhibited significantly lower AI and Pb compared to those with LVEF of ≥50%, aortic and carotid energetic hemodynamic parameters were also significantly lower in patients with impaired LVEF. After adjusting for age, sex, estimated glomerular filtration rate, and NT-proBNP, the total and mean energy of the carotid artery were independently associated with mortality [hazard ratios and 95% confidence intervals: 1.009 (1.004-1.015) and 1.018 (1.006-1.026), respectively]. Subgroup analyses consistently demonstrated the prognostic value of energetic hemodynamics across different HF phenotypes. Conclusion: The study indicated that energetic hemodynamic parameters, especially the total and mean energy of the carotid artery, correlated with long-term survival, irrespective of LVEF. Notably, these energetic hemodynamics surpassed cf-PWV in their correlation with left ventricular systolic function.
Abstract 4146198: Myoepithelial cardiac tumor of the right atrium in the setting of metastatic recurrent small cell lung cancer status-post chemotherapy and radiation: A rare case report
Authors: Stefan Sarkovich, Rama Sai Kalyanam, Dveet Patel, Mitul Patel, Rami Akel
Journal: Circulation (2024)

Introduction: Lung cancer is divided broadly into two main types: Small cell lung cancer (SCLC) and non-small cell lung cancer-NSCLC. Approximately 70% of SCLC cases have metastasized to other parts of the body including lymph nodes, bone, liver, adrenal glands, and brain [1]. SCLS metastasis to cardiac tissue is rare. Primary cardiac tumors are as rare with a reported prevalence of 0.028% [2]. Here we present a 59-year-old female (59F) with recurrent SCLC metastasis with evidence of a newly diagnosed primary cardiac tumor. Case Presentation: 59F with a past medical history of SCLC status-post chemotherapy and radiation presented for evaluation of worsening left upper extremity pain, paresthesia, motor weakness, and neck pain. During the hospital admission, an echocardiogram demonstrated extensive thrombus from the Superior Vena Cava (SVC) into the right atrium (RA) and an irregular echogenic 37 mm x 26 mm mass partially attached to the posterior leaflet of the tricuspid valve. The RA mass was successfully removed by mechanical thrombectomy. Pathological results of the RA mass revealed significant malignant epithelioid and spindled neoplasm with myxoid stroma– concerning for myoepithelial disease. Discussion: Cardiac tumors, although uncommon, should be included in the list of possible diagnoses when observing any abnormal mass detected through cardiovascular or thoracic imaging techniques. Cardiac tumors are likely due to metastatic origins as metastatic cardiac tumors occur 20 times more frequently than primary cardiac tumors[3].When metastatic cardiac tumors are suspected, malignant melanoma and leukemia are the most frequent origins[4]. Rarely does SCLC metastasize to cardiac tissue. Primary cardiac tumors are typically benign (90%), with primary malignant tumors being very rare[5]. Patients may be asymptomatic, or present with nonspecific symptoms such as exertional dyspnea, fevers, arthralgias, or life-threatening cardiac tamponade[6]. For right atrial tumors, treatment strategies are usually dependent on symptomatology, in which removal via aspiration or surgical resection has demonstrated a favorable prognosis[7]. Conclusion: Given the rarity of primary cardiac tumors in the setting of metastatic SCLC, there exist no evidence-based guidelines for optimal management of right atrial tumors. In our patient, mechanical aspiration was performed without complications and prevented potential adverse cardiopulmonary events from occurring.
Abstract 4146138: Outcomes of Gastrointestinal Bleeding in Acute Myocardial Infarction (AMI): Systematic Review and Meta-analysis
Authors: Sawai Singh Rathore, Saif Syed, Bijay Jeswani, Sanjana Allam, Tirath Patel
Journal: Circulation (2024)

Background: Gastrointestinal (GI) bleeding is a significant complication that can occur during acute myocardial infarction (AMI), worsening the patient's condition and complicating treatment. However, the specific impact of GI bleeding on outcomes in AMI patients remains unclear. This meta-analysis aims to clarify the impact of GI bleeding on key clinical outcomes in these patients. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) and inverse variance standardized mean differences (SMDs) with 95% confidence intervals (CIs). Statistical significance was set at p &lt; 0.05. The primary endpoints were in-hospital mortality, major adverse cardiovascular events (MACE), stroke episodes, length of hospital stay, and long-term mortality. Results: Twenty-one articles, comprising approximately 1.7 million patients with AMI, were included in the meta-analysis. GI bleeding in AMI patients was associated with an increased risk of in-hospital mortality (OR = 4.61; 95% CI 2.95 to 7.20; p&lt;0.001), MACE (OR = 2.39; 95% CI 1.04 to 5.51; p&lt;0.001), stroke (OR = 2.71; 95% CI 1.07 to 6.89, p&lt;0.001) and long term mortality (OR = 5.27; 95% CI 3.95 to 7.04; p&lt;0.001) compared with AMI patient without complication of gastrointestinal bleeding. Furthermore, Patients with GI bleeding in AMI also experienced an increased length of hospital stay (SMD = 0.67; 95% CI 0.46 to 0.88; p&lt;0.001). Conclusion: These findings emphasize the significance of promptly recognizing and managing GI bleeding in the context of AMI to minimize its negative impact on patient outcomes.
Abstract 4146218: Sex differences in cardiovascular-kidney-metabolic health for degenerative valvular heart disease
Authors: Cheng Yang, ziang Li, Haiyan Xu, Jie Qian, Yong-Jian Wu
Journal: Circulation (2024)

Background: Despite the increasing prevalence of degenerative valvular heart disease (VHD), recommended preventive interventions are notably lacking. The cardiovascular-kidney-metabolic (CKM) health approach advocates for multidisciplinary early-stage disease prevention. We aimed to explore sex differences in CKM risk factors associated with VHD. Methods: Using data from UK Biobank, participants without a history of VHD or heart failure at baseline were included. We assessed the sex differences in hazard ratios (HRs) and population-attributable risk (PAR) for incident aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR) associated with five CKM risk factors: hypertension, diabetes, obesity, high lipoprotein(a), and chronic kidney disease (CKD). Results: Among 463,496 participants (54.4% women), AS, AR, and MR cases were observed at incidence of 1.05 and 0.52, 0.37 and 0.22, 1.04 and 0.70 events per 1000 person-years for men and women, respectively. Hypertension consistently accounted for the largest attributable risk factor for incident VHD in both sexes, with PARs of 29.96% and 26.61% for AS, 23.51% and 16.02% for AR, and 17.56% and 13.09% for MR in women and men, respectively. Compared to men, obesity, CKD, and hypertension were associated with higher risks of AS, AR, and MR in women (women-to-men ratios of HRs: 1.11[1.09–1.36], 1.62[1.01–2.63], and 1.27[1.09–1.49], respectively). Conclusions: This study offers comprehensive insights into the profiles of CKM risk factors for degenerative VHD among middle-aged individuals. Tailoring the prioritization of risk factors based on gender has the potential to improve the precision and effectiveness of VHD prevention strategies.
Abstract 4146119: Coronary fistula as a rare etiology of refractory angina in elderly
Authors: Sara Del Vecchio Ziotti, sarah grobe, Thiago Pereira, Caio Menezes Machado de Mendonça, Luciana Dourado, Marcelly Rosal, Renato Palacio de Azevedo, LUIZ CESAR, Luis Gowdak
Journal: Circulation (2024)

Introduction: Refractory angina (RA) is a challenging and debilitating condition in the presence of myocardial ischemia regardless of a combination of antianginal drugs and revascularization procedures. Among the phenotypes of RA, there is angina in the absence of obstructive coronary disease (ANOCA). Coronary artery fistulas (CAF) are rare connections between coronary arteries and heart chambers or vessels. 3% of CAF drain into the left ventricle (LV), which can lead to the coronary steal phenomenon and angina in the form of ANOCA. We report here under a case of symptomatic chronic coronary syndrome (CCS) and CAF. Case Report: An 85-year-old woman with CCS had angina progression, reaching functional class 3 and frequent need of nitrate use, despite the use of three antianginal drugs. Stress myocardial perfusion scintigraphy showed reversible hypoperfusion in the lateral, inferolateral and inferior LV walls. A coronary angiogram was performed, revealing the absence of obstructions. However, CAF for the LV was identified around the ischemic territory. It was decided to start our Alopurinol protocol for RA. A treadmill test was done before and after the treatment to assess time to angina occurrence and ST segment change. After 3 months, there were an improvement in the threshold and intensity of angina (class 2) and reduction in nitrate need. In a new scintigraphy, normalization of perfusion was observed, and a new treadmill test showed reduction of 4.1 minutes for angina occurrence with an increase of 1.7 mets and no difference in ST change. Discussion: CAF are rare, identified in up to 0.2% of angiograms. They can lead to heart failure (HF), myocardial ischemia and arrhythmias. Treatment is based on the clinic, the patient's age and the hemodynamic significance of the CAF. For adults, one of the indications for CAF occlusion is the presence of myocardial ischemia. However, the association between RA and CAF is rarely described in the literature. In the present report, we illustrate the case of an octogenarian with RA, ANOCA and FAC who, before considering interventional treatment, underwent medical optimization with excellent response and improvement in cardiac perfusion and exercise tolerance. Conclusion: In the scenario of RA and ANOCA, a combination of different antianginal drugs can promote symptoms control and improvement of myocardial perfusion and exercise performance, even in the face of uncommon causes such as the one here reported.
Abstract 4146071: Post Transcatheter Aortic Valve Replacement outcomes among patients with Cardiac Amyloidosis and Aortic Stenosis.
Authors: Vikash Jaiswal, Muhammad Hanif, Adriana Mares, FNU Sundas, Akash Jaiswal, Ramesh Daggubati, Kendra Grubb
Journal: Circulation (2024)

Background: Aortic stenosis (AS) and cardiac amyloidosis (CA) frequently coexist. There is a paucity of data on whether the presence of CA impacts post-procedural and clinical outcomes after transcatheter aortic valve replacement (TAVR) among AS patients. Objective: In this analysis, we sought to leverage data from the TriNeTX Global Collaborative Network to determine the impact of CA on mortality and cardiovascular/ischemic outcomes at 1-month and 1-year post-TAVR. Methods: The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years from January 2012 to April 2023. Patients with AS were categorized into two groups: one with CA and having TAVR, and a control group with non CA group having TAVR. Patients were followed for 1 month and 1 year respectively. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, race, hypertension, diabetes mellitus, and chronic kidney disease. Primary outcome was all-cause mortality (ACM), while secondary outcomes were acute myocardial infarction (AMI), ischemic stroke, ventricular arrhythmias, and major adverse cardiovascular event (composite of ACM, ischemic stroke and AMI). Results: After 1:1 PSM, the study cohort comprised of 351 patients in the CA group and 351 patients in the non-CA group. The mean age of patients in CA and non-CA groups was 79.6 and 79.5 years. PSM analysis showed that ACM was comparable between CA and non-CA group after 1-month (RR, 1.00 (95%CI: 0.42-2.39), P =0.98), and after 1-year follow up (RR, 0.92 (95%CI: 0.59-1.44), P =0.736). AMI was also found comparable between the two cohorts, both after 1-month (RR, 1.189 (95%CI: 0.503-2.811), P =0.693), and after 1-year (RR, 1.288 (95%CI: 0.598-2.773), P =0.516). Similar trends were found for ischemic stroke, ventricular arrhythmias and MACE both after 1-month and 1-year follow up. Conclusion: This study shows that TAVR can be safe to be considered among cardiac amyloidosis patients with aortic stenosis
Abstract 4146076: Lower atrial fibrillation recurrence with Polar X cryoballoon system in patients with persistent atrial fibrillation compared to Arctic Front Advance Pro system
Authors: Hyo Jin Lee, Juwon Kim, Ju Youn Kim, Seung-Jung Park, Kyoung-Min Park, YOUNG-KEUN ON
Journal: Circulation (2024)

Background: Cryoballoon ablation has been shown to be non-inferior to radiofrequency ablation in terms of efficacy and safety for atrial fibrillation (AF). However, the outcomes of newer cryoballoon ablation systems, such as PolarX, in patients with AF remain unclear. Research Questions: This study aimed to assess whether the PolarX cryoballoon ablation system offers superior AF-free survival and fewer complications compared to the established Arctic Front Advance Pro (AFA-Pro) system, particularly in patients with persistent AF. Methods: This retrospective cohort study included 217 consecutive patients diagnosed with AF who underwent cryoballoon ablation using either the AFA-Pro or PolarX systems at a single high-volume tertiary hospital between March 2023 and February 2024. Results: Patients were divided into two groups based on the cryoballoon ablation system used: the AFA-Pro group (n=100) and the PolarX group (n=117). Among those with persistent AF (n=68), there were 32 in the AFA-Pro group and 36 in the PolarX group. In the total patient cohort, the PolarX system did not significantly improve AF-free survival compared to the AFA-Pro system [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.32-1.25; p=0.18]. However, in the subgroup of patients with persistent AF, the PolarX system significantly improved AF-free survival compared to the AFA-Pro system (HR 0.26, 95% CI 0.08-0.80; p=0.01). The PolarX system was associated with a higher incidence of transient phrenic nerve palsy (PNP) compared to the AFA-Pro system [odds ratio (OR) 2.37, 95% CI 1.00-5.65; p=0.05], though it was not associated with permanent PNP. There were no significant differences in the rates of complications such as esophageal injury, cardiac tamponade, or vascular complications. Predictors of AF recurrence post-ablation included persistent AF (HR 2.80, 95% CI 1.41-5.56; p=0.01) and left atrium volume index (LAVI) (HR 1.03, 95% CI 1.00-1.06; p=0.04). Conclusion: The PolarX cryoballoon ablation system demonstrates comparable safety and efficacy to the AFA-Pro system in treating atrial fibrillation. The PolarX cryoballoon ablation system is associated with better AF-free survival compared to the AFA-Pro system in patients with persistent AF. LAVI may be a predictor of AF recurrence post-cryoballoon ablation.