tbuckley/cabot-search huggingface dataset:
Abstract 13683: Deciphering the Effects of Quercetin on Blood Pressure: A Systematic Review and Meta-Analysis
Authors: Muhammed K Elfaituri, Alhasan Saleh Alzubi, Taha Khaled, Hazem Abdelkarem A Faraj, Ahmed BenGhatnsh, Ahmed Msherghi
Journal: Circulation (2023)

Introduction: Hypertension, a key driver of global cardiovascular diseases, has prompted interest in nutritional solutions like dietary supplements for managing blood pressure. The flavonoid quercetin, found in fruits and vegetables, has garnered attention for potential antihypertensive effects, although research on quercetin supplementation's impact on blood pressure has yielded varied outcomes. Hypothesis: This study aims to assess Quercetin supplementation's effects on blood pressure to comprehend its potential role in hypertension management. Methods: A systematic search was conducted across PubMed, Cochrane Library, Embase, and Scopus databases until December 2022 to include studies on the effects of Quercetin supplementation on blood pressure. The Mean Difference in Blood Pressure was used as the pooled effect size to compare the impact of Quercetin on patients, calculated with a random-effects model in R (version 4.0.3) using the metafor and meta packages. The I2 statistic was employed to evaluate heterogeneity. Results: The meta-analysis included ten studies with 743 participants, with 372 and 371 in the Quercetin and placebo/control groups, respectively. Quercetin supplementation in patients diagnosed with hypertension led to a statistically significant reduction in systolic blood pressure (MD: -3.19 mmHg; 95% CI: -4.41 to -1.99, P&lt;0.01, I2=73%). However, the reduction in diastolic blood pressure was not statistically significant (MD: -2.65 mmHg; 95% CI: -6.79 to 1.51, P=0.21, I2=98%). In individuals with normal blood pressure, quercetin supplementation resulted in a significant reduction in systolic blood pressure (MD: -2.97 mmHg; 95% CI: -4.72 to -1.22, P&lt;0.01, I2=74%), while its effect on diastolic blood pressure was not significant (MD: -2.99 mmHg; 95% CI: -10.18 to 4.21, P=0.42, I2=99%). Conclusions: The results indicate that quercetin supplementation notably lowers systolic blood pressure in hypertensive and normotensive individuals, but its impact on diastolic blood pressure is insignificant. These findings hint at Quercetin's potential as an auxiliary treatment for systolic hypertension, with a need for more high-quality, randomized controlled trials to determine its optimal dosage and duration.
Abstract 13239: Atrial Fibrillation Ablation With High-Power Short-Duration Setting Reduces Change in Periprocedural Thrombotic Marker and Suppresses the Onset of Silent Stroke
Authors: Masashi Kamioka, Takafumi Okuyama, Tomonori Watanabe, Hiroaki Watanabe, Hisaki Makimoto, Ayako Yokota, Takahiro Komori, Tomoyuki Kabutoya, Yasushi Imai, Kazuomi Kario
Journal: Circulation (2023)

Background: Atrial fibrillation (AF) ablation with high-power short duration (HP-SD) setting has been widely recognized to decrease the procedure time and to improve the ablation outcome. Hypothesis: We hypothesized that AF ablation with HP-SD setting can minimize the change in periprocedural thrombotic markers and the risk of silent stroke (SS). Aims: The aim of the present study is to investigate the impact of HP-SD setting ablation for AF on thrombotic markers and SS. Methods: We enrolled 101 AF patients: HP-SD group (n =67) using 50W; and Conventional ablation group (n = 34) using 30 to 40W. D-dimer, thrombin antithrombin complex (TAT) and total plasminogen activator inhibitor-1 (tPAI-1) were analyzed pre, post and 1 day after procedure. Magnetic resonance imaging was performed 1 day after procedure. Results: Left atrial (LA) dwelling time was significantly shorter in HP-SD group (P&lt;0.05). In Conventional ablation group, the D-dimer and tPAI-1 levels continued to increase until 1 day after, while the TAT peaked after the ablation. On the other hand, the range of the variation of these thrombotic markers in HP-SD group was smaller ( Figure 1 ). SS occurred more frequently in Conventional ablation group than in HP-SD group (26% vs 4%, P&lt;0.05). In logistic regression analysis, HP-SD setting and TAT difference (post - pre-procedure) remained independent predictor for SS (Odds ratio: 0.141 and 5.838, P&lt;0.05, respectively). Conclusion: HP-SD setting was associated with the shorter LA dwelling time and the smaller thrombotic markers change than conventional ablation, which could contribute to the lower prevalence of SS.
Abstract 17237: Trends in Sex and Regional Disparities Among Authorships in American Heart Association Scientific Sessions (2019-2023): A Bibliometric Analysis
Authors: Ayodya Perera, Avilash Mondal, BONEY LAPSIWALA, Vaidehi Mendpara, Amritha Nair, Athri Kodali, Rohini Bhuvaneshwari Gurumoorthy, Venkata Balaji Chenna, Pratik Bharat Rajpopat, Valeriia Iermolenko, Brinda Desai, Subramanian Gnanaguruparan, Rupak Desai
Journal: Circulation (2023)

Background: Women continue to be underrepresented in clinical medicine, including cardiology, despite improvements in participation. We aim to examine gender and regional disparities in authorship of abstracts published in AHA scientific sessions. Method: AHA journal was screened for abstracts with keywords: "Meta-analysis", "Systematic Review" or "Pooled analysis from 2019-2023. 499 out of 567 studies were included from circulation journal of AHA, and data on gender of first and corresponding (last) author was extracted with a validated smartdata application from 7.5 billion people's names (namsor.app). Abstract category and regions of affiliation data were extracted. Chi-square was used to describe trends. Results: Of 499 abstracts (2019:21.4%, 2020:23.2%, 2021:20.2%, 2022:31.9%, 2023:3.2%) females as first author were 24% and as last author was 18.8%. Categories of abstracts were general cardiology (GC)(32.7%), interventional cardiology (IC)(24.8%), electrophysiology (EP)(12.4%), and cardio-oncology (CO)(2.6%). North America (NA) had the highest number of abstracts (67.5%). Meta-analyses were higher than systematic reviews (88.6% vs. 10.6%), pooled analyses were higher than comparison plots (51.1% vs 41.3%, p =0.001). Male corresponding and first author (62.2%) were higher than inter-sex corresponding and first authors. Yet, corresponding male authors with female first was higher than female corresponding with male first (16.4% vs 11.5%) and corresponding female authors with female first was lower than male first (11.5% vs. 9.9%, p=0.015). Disparity is noted in abstract categories across regions. IC was more in Asia (23.5% vs. 21.6) compared to GC, while GC was more common in Europe (48.5% vs. 24.2%) and NA (32.7% vs 23.2%). Conclusion: Gender disparity was noted across abstract categories and regions. Women need to be represented more in clinical and academic research. Further studies are needed to identify barriers to equal representation.
Abstract 15895: Bariatric Surgery and Subclinical Myocardial Injury
Authors: Ebenezer K Aryee, Amelia S Wallace, Sui Zhang, Erin D Michos, Justin B Echouffo, Gary Gerstenblith, Roger S Blumenthal, Xin Chu, G Wood, Peter Benotti, Ron C Hoogeveen, Christie M Ballantyne, Josef Coresh, Elizabeth Selvin, Chiadi E Ndumele
Journal: Circulation (2023)

Background: Obesity is linked with subclinical myocardial injury, even in those with metabolically healthy obesity (MHO). There is limited data on the impact of weight loss via bariatric surgery on myocardial injury, particularly at different levels of metabolic health. Methods: We prospectively evaluated 294 Geisinger Obesity Institute Registry participants undergoing bariatric surgery and 294 controls matched on age, sex, body mass index (BMI;± 5kg/m 2 ) and diabetes status. High-sensitivity cardiac troponin I (hs-cTnI) was measured pre-operatively and at 6-18 months post-operatively in bariatric surgery patients, and at similar intervals in controls. Using linear regression, we examined the association of bariatric surgery with change in log transformed hs-cTnI (ln-hs-cTnI), stratified by metabolic health status: MHO (metabolic syndrome absent), metabolically unhealthy obesity (MUO; metabolic syndrome present), and MUO with diabetes. We used logistic regression to characterize the association of weight change (modeled as a restricted cubic spline) with the OR of transitioning from detectable to undetectable hs-cTnI (limit of detection 1.2ng/L). Results: The mean age was 45 years with 83% female, 97% White, and mean BMI of 47 kg/m 2 . Baseline characteristics of bariatric surgery patients and controls were similar. Bariatric surgery was associated with significant reduction in ln-hs-cTnI compared with controls in each stratum of metabolic health (P for interaction = 0.63; Panel A). Bariatric surgery was associated with an OR of 9.02 (95% CI 3.52-23.10) for transitioning from detectable to undetectable hs-cTnI, with a dose response association between weight loss and higher odds of developing undetectable hs-cTnI (Panel B). Conclusion: Bariatric surgery induced weight loss mitigates subclinical myocardial injury in graded fashion and across metabolic health strata, which may reflect one mechanism for the cardioprotective benefits of weight loss.
Abstract 18043: Massive Right Coronary Artery Aneurysm With a Massive Thrombus Presenting as ST Elevation Myocardial Infarction
Authors: Muhammad Asim Shabbir, Moiz Ehtesham, Tushar Sharma, Jennifer Nickol, Shahbaz Malik
Journal: Circulation (2023)

Introduction: Coronary artery aneurysm (CAA) is a vessel dilation exceeding 1.5 times adjacent normal segments. We present a case of massive right coronary artery (RCA) aneurysm complicated by ST elevation (STE) myocardial infarction. Case Summary: An 87-year-old female with no significant medical history presented with chest pain. Vitals signs and physical exam were normal. A 12 lead EKG demonstrated STE in inferior leads. Coronary angiography revealed a large aneurysm of the RCA throughout its course (max diameter 20 mm) with TIMI I flow. In the mid RCA, there was a long filling defect with irregular borders consistent with a congealed, organized layered thrombus causing 90% stenosis. Percutaneous coronary intervention (PCI) was not pursued due severe aneurysmal dilation and risk for embolization. The proximal to mid left anterior descending artery (LAD) and abdominal aorta were also aneurysmal. The patient was deemed not to be a surgical candidate after a heart team discussion (STS risk of morbidity or mortality = 12.6%). Left ventricular ejection fraction was 60%. Chest pain resolved and patient was discharged on indefinite anticoagulation and antiplatelet therapy. Discussion: Giant CAAs are rare, with an incidence of 0.02%. Causes include atherosclerosis, Takayasu arteritis, Kawasaki disease, or congenital defects. Although mostly incidental, CAA can be complicated by thrombosis, embolization, fistulation, rupture, arrhythmia, or sudden death. Our patient had an acute RCA thrombus due to stasis and turbulent blood flow in the aneurysm. Localized CAA are treated with surgery or percutaneous coiling or stenting. However, PCI was not feasible in our patient due to risk of embolization and difficultly with stent apposition in the setting of a diffuse, giant-sized aneurysm. Conclusion: CAAs are rare but may cause grave complications. A heart team discussion is essential to guide appropriate medical, percutaneous, or surgical treatment based on vessel anatomy.
Abstract 16706: Women With Coronary Vascular Dysfunction Have Heightened Emotional Responses to Mental Stress With Attenuated Recovery
Authors: Nishant Vatsa, Esha Dave, Vishrut S Thaker, Yetunde A Fatade, Janet Wei, Chrisandra Shufelt, Margo B Minissian, C Noel N Bairey Merz, Puja K Mehta
Journal: Circulation (2023)

Introduction: Coronary vascular dysfunction (CVaD) is associated with major adverse outcomes, recurrent chest pain, and can be triggered by mental stress. Hypothesis: We hypothesized that women with CVaD have heightened emotional response and attenuated recovery compared to reference control (RC) women. Methods: Women diagnosed with CVaD (cases, n=57, age: 57±1 years) by abnormal adenosine or acetylcholine response during invasive coronary function testing were enrolled in Cardiac Autonomic Nervous System Study and compared to age-matched, asymptomatic RCs women (n=25, age: 56±3 years), free of cardiac or risk factor history. All underwent two 4-minute standardized mental stress tests - anger recall and mental arithmetic - followed by 15 minutes of recovery. Emotional arousal (tension, anxious, depressed) and chest pain were assessed via self-reported Likert scale at baseline, after stress, and after recovery. The difference between post-stress or post-recovery and baseline scores was used to evaluate stress provocation and recovery. Increased differences indicate more provocation or recovery attenuation. We utilized multivariate models adjusted for anti-anginal medications, statins, and aspirin or traditional cardiovascular risk factors and chest pain to assess associations between CVaD and chest pain or emotional arousal, respectively. Results: The two groups did not differ in hemodynamic response to mental stress (p&gt;0.05). In multivariate models, CVaD status was associated with more stress-provoked chest pain (β 1.24 [0.1, 2.4], p=0.03) and more attenuated chest pain recovery (β 1.5 [0.6, 2.3], p=0.001) than RC. Similarly, after adjustment, cases were associated with more stress-provoked anxiety (β 1.2 [0.2, 2.2], p=0.02) and tension (β 1.2 [0.001, 2.4], p=0.05) while having more attenuated recovery of anxiety (β 1.1 [0.1, 2.0], p=0.02) and tension (β 1.1 [0.2, 2.0], p=0.02) compared to RC. There were no differences in feelings of depression between the two groups. Conclusions: Response to mental stress is heightened with attenuated recovery in women with CVaD. An improved understanding of mechanisms in stress response and CVaD is needed for potential therapeutic targets that may improve angina and quality of life.
Abstract 18325: Comparative and Incremental Diagnostic and Prognostic Yield of Exercise ECG, CMR and SPECT in Patients With Suspected Ischaemic Heart Disease: A CE-MARC Sub-Study
Authors: Giandomenico Bisaccia, Peter P Swoboda, Chiara Bucciarelli-Ducci, Sven Plein, John GREENWOOD
Journal: Circulation (2023)

Background: Guidelines recommend exercise ECG and stress imaging as first line diagnostic tests for the management of patients with suspected ischemic heart disease (IHD). We compared 1) the accuracy in detection of angiographically defined IHD and 2) the prognostic significance of exercise ECG, single photon emission computed tomography (SPECT) and cardiovascular magnetic resonance (CMR), as well as the sequential use of exercise ECG and an imaging test, in the CE-MARC study. Methods and Results: Of 752 patients in CE-MARC, 580 had exercise ECG and angiography, and 503 also had SPECT and CMR. The sensitivity, specificity, positive and negative predictive values (95%CI) of exercise ECG were 68.3 (61.9,74.0), 72.5 (67.6,76.9), 61.0 (54.8,66.8), 78.4 (73.7,82.5). Exercise ECG was significantly less sensitive than CMR and less specific than CMR and SPECT. Furthermore a positive exercise ECG result was not predictive of MACE at follow-up (HR 1.14 [95% CI 0.75 to 1.72], p = 0.53). Sequential SPECT following an inconclusive exercise ECG compared to SPECT alone resulted in improved sensitivity (86.3% vs. 65.5%) and negative predictive value (79.0% vs. 87.9%) but at a cost of reduced specificity and positive predictive values (83.7% vs. 64.1%; 72.1% vs. 60.7%), and was not prognostically significant (HR 2.31 [95% CI, 0.88 to 6.08], p = 0.091). CMR alone had greater diagnostic and prognostic yield than exercise ECG, SPECT or a combination of the two. Sequential CMR in patients with inconclusive exercise ECG did not outperform CMR alone, but allowed effective prognostication (p = 0.011), contrary to SPECT (p = 0.081). Conclusions: In patients recruited to CE-MARC, exercise ECG was less sensitive than CMR and less specific than both CMR and SPECT. Positive exercise ECG results had no clear prognostic value. CMR alone was more sensitive and offered greater prognostic yield than exercise ECG, SPECT, or a combination of both. Diagnostic and prognostic yield of CMR was not improved by combination with exercise ECG. Importantly, sequential use of CMR, but not SPECT, improved prognostication following an inconclusive exercise ECG.
Abstract 376: Comparison of Pre and Post Conditioning With Poloxamer 188 in Rat Model of Severe Hemorrhagic Shock
Authors: Takuro Oyama, Matthew Barajas, Matthias L Riess
Journal: Circulation (2023)

Background: Hemorrhagic shock remains a leading cause of morbidity and mortality after trauma. Poloxamer (P) 188, an FDA-approved copolymer-based cell membrane stabilizer, is a nonionic triblock copolymer believed to prevent cellular injury after ischemia and reperfusion. While post conditioning may be used in a broad range of scenarios, pre-conditioning may add improved efficacy in scenarios where hemorrhage can be expected, the peri-operative period. We have previously demonstrated prolonged survival with P188 post-conditioning however without complete rescue, here we hypothesize pre-conditioning would further improve survival. Methods: 35 male Sprague Dawley rats (564+/-73 g) were anesthetized, ventilated and instrumented. All rats underwent rapid controlled blood loss of 40% estimated blood volume over 30 min, followed by prolonged permissive hypotension for 60 min before re-transfusion of the lost blood to euvolemia and up to 6 hrs of monitoring under general anesthesia. Rats were then randomized to 3 groups: 10 rats received a 0.8 cc iv bolus of 250mg/kg P188 15min before hemorrhage (pre), 12 rats received the same dose of P188 after hemorrhage (post), and 13 control rats only received 0.8 cc vehicle. Primary endpoint was survival time from the start of hemorrhage. Data are median and IQ range; statistics: Kruskal-Wallis and Chi-Square tests, *p&lt;0.05. Results: P188 administration immediately after hemorrhage significantly improved median survival time compared to both the pre and control groups [post *245 (49, 314) min vs. control group; 53 (32-60), vs pre; 59 (24-70) min, p = 0.0174, 0.00045, respectively]. However, there was no significant differences in survival time between pre and control grouyps and there were no differences in survival rate at 6 hours (pre; 0% vs post; 8% vs control; 7%). Conclusion: A bolus of P188 given immediately after a severe hemorrhagic insult prolonged survival time significantly. However, administration of P188 15 min before hemorrhage did not produce a significant prolongation of survival time.P188 is a highly promising compound whose dose, application timing and application duration in severe hemorrhagic shock require more research.
Abstract 19028: Revascularization in Ischemic Cardiomyopathy With Left Ventricular Systolic Dysfunction- Percutaneous Intervention (PCI) vs Medical Therapy
Authors: Ruth ann Mathew Kalathil, Akshay Machanahalli Balakrishna, Suma Pusapati, Ahmed Aboeata
Journal: Circulation (2023)

Background: The benefits of percutaneous revascularization in patients with reduced Left Ventricular (LV) systolic function secondary to stable coronary artery disease (CAD) is still ambiguous. We aim to compare the survival benefits of PCI in patients with Ischemic cardiomyopathy with reduced LV Ejection Fraction (LVEF &lt;35%) compared to Medical Therapy (MT) alone. Methods: A systematic search was conducted in PubMed, Google Scholar, and Cochrane databases from inception to 5 th June 2023. Among 108 results from the systematic search, a total of 4 studies (2080 patients) were included. Our outcome of interest was all-cause mortality in patients undergoing PCI vs. medical therapy. We used random-effects models to aggregate data and to calculate pooled incidence and relative risk (RR) with 95% confidence intervals (CIs). Results: Of 1082 patients undergoing revascularization with PCI and 998 patients in the medical therapy arm, the outcome of all-cause mortality occurred in 168 patients (15.5%) in the PCI group and in 200 patients (20.0%) in the medical therapy group (Hazard ratio, 0.88; 95% confidence interval [CI], 0.71 to 1.09; P=0.25). However, a non-statistical trend toward lower mortality was noted in the PCI arm. Low heterogenicity was noted between the studies. Conclusions: In patients with ischemic cardiomyopathy with reduced LV systolic function (EF &lt;35%), revascularization with PCI is associated with similar all-cause mortality compared to medical therapy.
Abstract 16373: Pyridoxamine (Vitamin B6) Mitigation of Protein Glycation and Deleterious Platelet-Material Interactions in Bioprosthetic Heart Valve Leaflets
Authors: Nikia T Toomey, Stanley J Stachelek, Chandrasekaran Nagaswami, Ivan S Alferiev, Robert J Levy
Journal: Circulation (2023)

Introduction: Though bioprosthetic heart valves (BHV) most often do not require anticoagulation, it has been reported that 12% of BHVs have significant leaflet thrombosis. We identified Vitamin B6 (pyridoxamine, abbr. PYR) as a pretreatment agent to reduce advanced glycation end-product (AGE) accumulation within bovine pericardial (BP) BHVs. AGEs contribute to valvular degeneration through collagen crosslinking and immune signaling. PYR is also known to inhibit platelet aggregation. Hypothesis: PYR pretreatment and supplementation mitigate BHV thrombosis. Methods: Glutaraldehyde fixed collagen coated (GFC) PVC tubing was used as a leaflet surface model and methylglyoxal (MGO) pretreatment to simulate glycation. PYR pretreated collagen surfaces and perfusate PYR supplementation were compared to untreated controls. These studies were repeated with glycated GFC. Fresh citrated human whole blood from healthy donors was perfused over the surfaces for 4 hours at 37 °C and arterial shear using the Chandler loop apparatus. Post perfusion platelet activation (CD62P expression via flow cytometry) and nitric oxide synthase (NOS) activity were measured. Platelets adhered to the tubing sections were visualized and quantitated via scanning electron microscopy. Results: PYR pretreatment of GFC surfaces reduced platelet activation after perfusion compared to the control (Fig1a). Surface glycation with MGO resulted in increased platelet activation, but PYR pretreatment of the glycated surface mitigated the effect of glycation on platelet activation (Fig1b). NOS activity was impaired by surface glycation and PYR treatment appears to rescue function in glycated environments (Fig1c). Platelet adhesion to GFC was increased by glycation (Fig1d-f). Conclusions: Glycated surfaces, even in euglycemia, are prothrombotic when compared to non-glycated surfaces. Vitamin B6 reduces platelet activation and adhesion in both glycated and non-glycated environments.