tbuckley/cabot-search huggingface dataset:
Abstract 4138081: Neighborhood Level Social Determinants of Health and Loss of Blood Pressure Control
Authors: Jonathan Le, Andrew Nguyen, Tzu Yu Huang, Patrick Botting, Jesse Navarrette, Susan Cheng, Joseph Ebinger
Journal: Circulation (2024)

Introduction: Uncontrolled hypertension is a potent cardiovascular risk factor, with a higher prevalence in adults with disadvantaged social determinants of health (SDoH). While prior work has shown an association with uncontrolled blood pressure (BP) and adverse SDoH in general, less is known about specific SDoH domain drivers of this association, knowledge of which may inform interventions to improve health and reduce disparities. Methods: We examined health records in all adults with ≥2 outpatient visits/year in at least 2 consecutive years from 2017-2023. BP level was determined by the first 2 visits in the first year and last 2 readings in the second year; BP control was based on contemporary thresholds (&lt;130/80 mmHg). Loss of BP control (controlled in first year and uncontrolled in second year) was determined year over year. Neighborhood SDoH was assessed by linking patients’ zip codes to the Healthy Places Index (HPI), including 8 domains (economic, education, transportation, social, housing, health insurance, clean environment, and neighborhood). Multivariable regression analyses were used to examine associations of demographics, clinical, and SDoH characteristics. Results: A total of 145,318 patients were identified, of whom 94,276 (64.9%) lost BP control at some point during the study period. In analyses adjusting for demographic, clinical, and SDoH factors (Figure 1A), risk of losing BP control was associated with living in a neighborhood with a HPI score in the worst quartile (OR 1.12, 95% CI 1.08-1.15). Evaluation of SDoH domain identified the economic (1.15 [1.12-1.18], P = 0.012) and education (1.15 [1.12-1.18], P &lt; 0.001) as the only SDoH domains associated with loss of BP control, though positive association trends were also appreciated for transportation (1.09 [1.06-1.12], P = 0.079) and health insurance (1.1 [1.07-1.13], P = 0.097) domains (Figure 1B). Conclusions: In over 140,000 adults with controlled BP, almost two-thirds lost BP control in the subsequent year. This loss of BP control was associated with many neighborhood level SDoH factors, specifically economic and educational domains. These results inform potential targets to help reduce disparities and improve BP related health outcomes.
Abstract 4138074: Sex differences in safety and efficacy of dual antiplatelet therapy strategies for patients with acute coronary syndromes: A systematic review and meta-analysis
Authors: Tetsuya Saito, Yoshihisa Miyamoto, Tomohiro Fujisaki, Kaveh Hosseini, Sina Kazemian, Alexandros Briasoulis, Leandro Slipczuk, Abdul Rahman Akkawi, Hisato Takagi, Dhaval Kolte, Toshiki Kuno
Journal: Circulation (2024)

Background: Various durations and de-escalation strategies of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention for patients presenting with acute coronary syndromes (ACS) have been reported in randomized controlled trials (RCTs). However, it remains uncertain whether the effect of these DAPT strategies is influenced by sex. Methods: PubMed and EMBASE were searched in May 2024. We included RCTs which investigated DAPT strategies for ACS patients comparing any de-escalation strategies such as short-term DAPT (≤6 months) followed by P2Y 12 inhibitor or aspirin monotherapy, unguided de-escalation from potent P2Y 12 inhibitors to low-dose potent P2Y 12 inhibitors or clopidogrel at one month, and guided de-escalation with platelet function tests, compared with standard duration DAPT (6-12 months). We conducted a systematic review and meta-analysis. The efficacy and safety of each DAPT strategy was compared between sexes, and relative hazard ratios (RHR) were calculated. The primary outcome was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, and major bleeding (BARC 3 or 5). Results: Eleven RCTs that enrolled 27,033 patients with ACS were included. De-escalation of antiplatelet therapy had a lower risk of NACE than standard duration DAPT for both female (HR, 0.73; 95% CI, 0.55-0.96; I 2 =32%) and male (HR, 0.85; 95% CI, 0.74-0.97; I 2 =23%). There were no significant differences in NACE between female and male patients randomized to de-escalation vs. standard duration DAPT (RHR, 0.84; 95% CI, 0.65-1.09 ; I 2 =0%) (Figure). Similarly, no significant differences were observed between female and male patients with respect to major adverse cardiovascular events (RHR, 0.75; 95% CI, 0.52-1.08; I 2 =0%) or major bleeding (RHR, 1.37; 95% CI, 0.85-2.21 ; I 2 =0%). Conclusion: In patients with ACS, de-escalation of antiplatelet therapy is safe and effective irrespective of sex.
Abstract 4138056: Publicly-Insured Patients Have Lower Rates of Cardiac Rehabilitation Enrollment: A Statewide Experience in Michigan__PRESENT
Authors: Havisha Pedamallu, Julia Mantey, Devraj Sukul, Steven Keteyian, Francis Pagani, Robert Hawkins, Donald Likosky, Mike Thompson
Journal: Circulation (2024)

Introduction: Cardiac rehabilitation (CR) is a clinically effective and underused service for patients with recent cardiac events, and insurance coverage is an important, yet understudied, mediator. The objective of this study was to evaluate the relationship between insurance type and CR participation. Methods: Data from the Michigan Value Collaborative multi-payer claims based registry were used to identify Michigan residents admitted for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) between 01/01/2018-12/31/2022. Payer categories included commercial insurance, Medicare Advantage (MA), Medicare fee-for-service (FFS), and Medicaid. CR participation was defined as having at least one approved CR claim within 365 days of discharge. Unadjusted comparisons of CR enrollment across payers were done using chi-square tests. Multivariable logistic regression adjusted for patient demographics and comorbidities evaluated the association between payer category and CR participation. Results: The final sample included 74,505 episodes of PCI (82%) or CABG (18%) with mean (SD) patient age 67.7 (11.4) yrs, 68% male, and a payer breakdown of 23% commercial insurance, 22% MA, 41% Medicare FFS, and 14% Medicaid. Overall, 29,829 (40%) patients participated in a single session of CR, with a higher participation in CABG vs. PCI (60% vs. 36%, p&lt;0.001). There were significant differences in CR use across payers, with commercially insured individuals having highest rates (46%) followed by MA (43%), Medicare FFS (39%), and lowest for Medicaid (30%, p&lt;0.001). Compared with commercially insured patients, individuals with Medicaid (adjusted odds ratio, aOR=0.55 [0.52-0.58], p&lt;0.001) and Medicare FFS (aOR=0.87 [0.84-0.91], p&lt;0.001) were significantly less likely to participate in CR (Figure). The relationship persisted when stratified by the method of revascularization. Conclusion: Individuals with Medicaid and Medicare FFS coverage had lower rates of CR participation than those with MA or commercial insurance following PCI or CABG. Understanding disparities in CR usage by payer may help target quality improvement efforts and increase equitable use of secondary disease prevention strategies.&lt;object data-extension-version="1.0.1" data-supports-flavor-configuration="true" id="__symantecPKIClientMessenger" style="display: none;"&gt;&lt;/object&gt;&lt;span id="__symantecPKIClientDetector" style="display:none"&gt;__PRESENT&lt;/span&gt;
Abstract 4138101: CAR-T-associated Cardiovascular Events are Associated with Increased Resource Utilization
Authors: Justin Song, Jacqueline Vuong, Monica Mead, Jeffrey Gornbein, Michael Rothberg, Chelsea Pan, Jasmeet Dhaliwal, Jonathan Boiarsky, Daria Gaut, Herbert Eradat, Gary Schiller, SVEN DEVOS, John Timmerman, Ashley Stein-Merlob, Tomas Neilan, Sarah Larson, Patricia Young, Syed Mahmood, Eric Yang
Journal: Circulation (2024)

Background: Chimeric antigen receptor T-cell (CAR-T) therapy targeting CD-19 utilizes ex-vivo engineered T-cells to treat refractory malignancies. Widespread CAR-T adoption is limited by resource utilization and cost, and CAR-T has also been associated with adverse cardiovascular events. Limited data exist exploring the relationship between CAR-T-associated cardiovascular events and resource utilization events (RUE). Objective: To evaluate whether CAR-T-associated cardiovascular events are associated with RUE. Methods: Records of patients treated with an FDA-approved CAR-T product between 2018 and 2022 at a single institution were reviewed. Cardiovascular events post-CAR-T were defined as arrhythmia, acute coronary syndrome, stroke, cardiovascular death, new cardiomyopathy, heart failure, or pericarditis. RUE was a composite of intensive care unit (ICU) transfer, prolonged length of stay (LOS; &gt;75th cohort percentile), and unplanned 6-month readmission. Results: Of 117 patients, 30 (26%) experienced cardiovascular events over a median 16 (IQR 7-34) months follow-up. RUE occurred in 65 patients (56%): 28 (24%) ICU transfers, 23 (20%) prolonged LOS, and 48 (41%) readmissions. Those with RUE experienced subsequent higher mortality (62% vs. 21%, p≤0.001). Among patients who experienced cardiovascular events, 24 (80%) experienced RUEs. In a Cox model, cardiovascular events (HR 2.3, 95% CI 1.3-4.1) and high cancer burden (HR 2.1, 95% CI 1.3-3.5) were independently associated with increased RUE rate, after adjusting for age, Cytokine Release Syndrome grade ≥2, atrial fibrillation history, and CAR-T costimulatory domain. Conclusion: CAR-T recipients who experience cardiovascular events also experience increased resource utilization events. Further prospective studies are needed to assess whether post-CAR-T cardiovascular event management and/or pre-therapy assessment may reduce resource utilization burden.
Abstract 4138076: Clopidogrel plus aspirin vs. aspirin alone in patients with minor to moderate strokes within ≤ 72 hours onset. A meta-analysis of randomized controlled trials.
Authors: Abdelrahman Mahmoud, Mohamed Elfil, Kerollos Abdelsayed, Ahmed Mazen Amin, Mohamed Ramadan, Ali Ashraf Salah Ahmed, Ahmed S.A Osman, Sandi Banour, Basel Abdelazeem
Journal: Circulation (2024)

Background&amp;Objective: Recurrent stroke is a common event following a previous transient ischemic attack (TIA) or minor to moderate ischemic stroke. Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin monotherapy. We aim to study the effects on using DAPT vs. aspirin alone in patients with TIAs or mild to moderate ischemic strokes within 72 hours of symptoms. Methods: We conducted a meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by searching PubMed, EMBASE, Web of Science, SCOPUS, and Cochran. We used mean difference (MD) to pool continuous outcomes presented and the risk ratio (RR) for the dichotomous outcomes, with the corresponding 95% confidence interval (CI). Results: We included seven RCTs with a total of 20,992 patients. DAPT was more effective in reducing combined ischemic and hemorrhagic strokes recurrence (RR = 0.77, 95% CI (0.70, 0.84), P &lt; 0.00001) Fig-A , ischemic strokes (RR = 0.74, 95% CI (0.67, 0.82), P &lt; 0.00001) Fig-B , early neurologic deterioration (RR= 0.46, 95% CI (0.24, 0.88), P = 0.04) Fig-C , poor functional outcome (RR = 0.89, 95% CI (0.81, 0.98), P = 0.02) Fig-D , and composite of ischemic stroke, myocardial infarction, death from ischemic vascular causes, and major hemorrhage [RR = 0.80, 95% CI (0.73, 0.88), P &lt; 0.00001] Fig-E . However, DAPT led to more bleeding events occurrence (RR = 1.74, 95% CI (1.23, 2.48), P = 0.002) Fig-F . Conclusion: DAPT is a viable option for stroke recurrence prevention, leading to better functional outcomes, and less early neurologic deterioration; however, it increases the overall bleeding.
Abstract 4138060: Comparison of Alcohol Septal Ablation with Mavacamten in Obstructive Hypertrophic Cardiomyopathy
Authors: Ashraf Samhan, Danish Saleh, Ellis Kim, Mo Hu, Kayla Mueller, Abigail Garza, Abigail Baldridge, Jyothy Puthumana, James Flaherty, Lubna Choudhury
Journal: Circulation (2024)

Background: Mavacamten is the first commercially available myosin inhibitor shown to improve cardiac hemodynamics and functional status in patients with obstructive hypertrophic cardiomyopathy (HCM). Mavacamten may be considered in patients who have not responded to first-line medical therapies and are being considered for septal-reduction therapy (SRT). Research Question and Aims: The efficacy of Mavacamten relative to SRT remains unknown. This study compares Mavacamten and SRT with alcohol-septal ablation (ASA) in modifying cardiac hemodynamics and functional status in patients with obstructive HCM. Methods: Patients of the Bluhm Cardiovascular Institute (BCVI) of Northwestern University in Chicago, IL, managed for HCM from January 2008 to May 2024 were sampled. Patients who had undergone ASA (N = 41) or initiated treatment with Mavacamten (N = 40) were identified. Clinical and echocardiographic data were collected and reported for individuals at baseline, at 16 weeks, and after 24 weeks following ASA or the initiation of Mavacamten, respectively. Results: Baseline demographics were similar for both groups except for age and tobacco use history (Table 1). Patients who underwent ASA were older compared to counterparts treated with Mavacamten (75 v 61, p &lt; 0.001). Both ASA and Mavacamten were associated with a greater than 70% reduction in valsalva left-ventricular outflow tract (LVOT) gradient and mitral regurgitation. The maximal effect of ASA on LVOT gradient was observed at 16 weeks, whereas the maximal effect of Mavacamten was not appreciated until after 24 weeks. At baseline, the average left-ventricular ejection fraction (LVEF) was hyperdynamic in patients receiving Mavacamten relative to those treated with ASA. After 24 weeks, the average LVEF of patients treated with Mavacamten was reduced yet remained in the normal range. Patients who underwent ASA had a poorer NYHA functional class at baseline compared to those prescribed Mavacamten (~2.5 v 2.1, p &lt; 0.001); however, each therapy significantly improved functional capacity, and average NYHA scores were comparable after 24 weeks (1.5 v 1.3, not significant). Conclusion: In patients with obstructive HCM, ASA and Mavacamten yield significant and comparable improvements in hemodynamics, mitral regurgitation, and functional status with lower, but normal, ejection fraction among patients on Mavacamten at the end of 24 weeks.
Abstract 4138090: Time-in-range, Diabetes Eating Problems and Diabetes Distress among Individuals with Type 2 Diabetes
Authors: Soohyun Nam, Minjung Lee
Journal: Circulation (2024)

Background: Time-in-range (TIR), the percentage of time that glucose values are in the range of 70 to 180mg per dL as measured with continuous glucose monitoring (CGM), has become an important metric for assessing glycemic control for clinical care and as an endpoint in cardiometabolic research. For people with diabetes, a TIR &gt;70 % is recommended, which is about 17 hours of a 24-hour day. Diabetes eating and distress are modifiable factors associated with long-term glucose control, such as HbA1c. However, little is known about the relationship between diabetes eating, diabetes distress, and TIR. Research Hypothesis: A group with the recommended TIR (&gt;70%) will have fewer eating problems or diabetes distress than a group with TIR ≤70%. Methods: Participants with type 2 diabetes completed sociodemographic surveys, the Diabetes Eating Problem Survey (DEPS), and the Diabetes Distress Scale (DDS). The DDS has 4 subscales—Emotional Burden, Physician distress, Regimen Distress, and Interpersonal Distress. TIR was calculated by a 14-day blinded CGM. Results: Among 53 participants, 66% were female with a mean (M) age of 62.08±10.26 years. The majority were White (67.9%), followed by Black (17%). About 70% had a TIR over 70%. The mean DEPS score was 31.65 ±10.05, which indicates clinically significant disordered eating behaviors (cut off&gt;20). The mean overall DDS score was 2.0±1.0, indicating a moderate level of diabetes distress: regimen distress was the highest (M:2.3±1.1), followed by emotional burden (M:2.2±1.3). The DEPS score in the TIR&gt;70% group were significantly lower than in the TIR of ≤ 70% group (28.45 vs. 40.36; P=0.004). All DDS scores except physician-related distress were significantly higher in the TIR ≤ 70% group than in the TIR &gt;70% group (p&lt;0.05). Similarly, better TIR was significantly associated with fewer diabetes eating problems (r=-0.48, p&lt;0.05) and lower overall DDS score (r=-0.44, p&lt;0.05). Conclusions: In our cross-sectional study, diabetes eating problem was significantly associated with TIR—the group with recommended level of TIR showed fewer eating problems. Also, less diabetes distress was significantly associated with better TIR. These findings suggest that interventions targeting eating problems and diabetes distress may help to achieve the recommended TIR. Future research with a prospective study design and large sample size is needed to examine factors associated with TIR and its relationship in type 2 diabetes.
Abstract 4138107: Ventricular Tachycardia Mortality Trends in Oncology: Where Are We Now?
Authors: Yong Hao Yeo, Boon Jian San, Min Choon Tan, Qi Xuan Ang, Justin Lee, Nishaki Mehta
Journal: Circulation (2024)

Background: Advancements in chemotherapeutic modalities lead to improved cancer survival rates. While the cardiotoxicity related to the therapies is increasingly recognized, real-world data on ventricular tachycardia (VT) mortality among them is limited. Objective: This study sought to determine the longitudinal cardiovascular mortality trends related to ventricular tachycardia in the cancer population. Methods: We queried the CDC WONDER database among patients ≥ 25 years old from 1999 to 2020. Cardiovascular disease was listed as the main cause of death, while VT and cancer were listed as contributing causes of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals. We determined the trends over time by estimating the annual percent change (APC) using the Joinpoint regression program. Results: In the study period, there were 3,483 cardiovascular mortalities related to ventricular tachycardia in patients with comorbid cancer. The overall AAMR decreased significantly from 1.28 (95% CI, 1.11-1.44) in 1999 to 0.67 (95% CI, 0.57- 0.77) in 2020, with an average APC of -2.91 (95% CI, -3.95, -1.86). Overall, males had higher AAMR than females (1.25 [95% CI, 1.20 – 1.30] vs. (0.36 [95% CI, 0.34 – 0.39]). African Americans and White patients have comparable AAMR of 0.78 (95% CI, 0.69-0.86) and 0.77 (95% CI, 0.74-0.80), respectively, which were higher than Asians (0.34 [95% CI, 0.25-0.44]) and Hispanics (0.33 [95% CI, 0.27-0.40]). The AAMR was higher in the rural region than in the urban region (0.72 [95% CI, 0.69 – 0.75] vs. 0.76 [95% CI, 0.70 – 0.81]). The West region had the highest AAMR (0.79 [95% CI, 0.74 – 0.85]). Conclusion: Cardiovascular mortality related to VT in patients with comorbid cancer dropped significantly throughout the years. Further targeted approaches are needed to address the disparities in sex, race, and region.
Abstract 4138062: Pharmacological inhibition of HDAC6 improves post-infarction cardiac function by limiting mitochondrial fission in type 2 diabetic mice
Authors: Shelley Baumgardt, Ming Zhao, Zhengyuan Xia, Xuebin Fu, Anshuman Sinha, Swetha Krishnan, Vivek Mehta, My Linh Thi Nguyen, Vincent Dudley, Gregory Waypa, Amadou Camara, David Winlaw, Paul Schumacker, Edward Thorp, Zhi-Dong Ge
Journal: Circulation (2024)

Introduction: Histone deacetylase (HDAC) 6 functions to remove acetyl groups from lysine residues on histone and non-histone proteins. We showed that the augmented activity of HDAC6 in diabetic mice undergoing myocardial ischemia/reperfusion injury (MIRI) was associated with mitochondrial damage. However, it remains unclear how the inhibition of HDAC6 activity affects post-MIRI cardiac remodeling and function in type 2 diabetes. Hypothesis: HDAC6 inhibition suppresses adverse cardiac remodeling and improves mitochondrial dynamics and cardiac function after MIRI in type 2 diabetic mice. Methods: Type 2 diabetic db/db, db/+, and C57BL/6 mice underwent coronary artery occlusion for 20 min followed by reperfusion. Tubastatin A, a selective inhibitor of HDAC6, was injected intraperitoneally 60 min before coronary artery occlusion and once daily after surgery. Mouse hearts were evaluated with echocardiography 28 days after surgery. Myocardium was imaged using electron microscopy, and the expression of mitochondrial dynamin-related protein 1 (DRP1) and fission 1 was measured by Western blotting analysis. H9c2 cardiomyocytes were subjected to hypoxia for 3 hours followed by normoxia for 24 hours in the presence of 5.5- or 25.0-mM D-dextrose and tubastatin A or vehicle. Results: There were no significant differences in the activity of HDAC6, left ventricular diameters and fractional shortening, mitochondrial density volume and surface area, and the ratios of DRP1/GAPDH and fission 1/GAPDH between the db/+ and C57BL/6 groups. Compared to both db/+ and C57BL/6 groups, HDAC6 activity was lower, left ventricular diameters at both end diastole and end systole were longer, fractional shortening and mitochondrial surface area were smaller, and the expression of DRP1 and fission 1 was increased in the db/db group 28 days after MIRI. Interestingly, 10 mg/kg Tubastatin A significantly mitigated these effects of MIRI in db/db mice. Hypoxia/reoxygenation in the presence of 25.0-mM D-dextrose augmented HDAC6 activity and increased the expression of DRP1 and FIS1, which were blocked by Tubastatin A. Conclusions: Tubastatin A prevents post-MIRI cardiac remodeling and improves cardiac function by limiting mitochondrial fission in type 2 diabetic mice.
Unusual Antibacterial Property and Selectivity Enabled by Tuning Nanozyme Activities of <i>L</i>‐Arginine Derived Carbon Dots
Authors: Meizhe Yu, Peili Li, Jiaying Li, Xueli Chen, Zhimin Hu, Yiran Wang, Jing Zeng, Fengxuan Han, Xuedong Gong, Bin Li, Xiaodong Xing
Journal: Advanced Healthcare Materials (2024)

Abstract Functional integration of antimicrobial activity and cell proliferation promotion at low concentrations is important for the clinical application of carbon dots (CDs). In this study, the precursor, L ‐arginine, and dopant, copper salt, are used to prepare copper‐doped CDs (Cu‐CDs). Owing to their excellent synergistic enzyme‐like activities, Cu‐CDs can rapidly increase reactive oxygen species (ROS) to lethal levels, preferentially in bacteria, and exhibit potent antibacterial ability, which can mainly be attributed to the membrane disruption effect. Concurrently, the cell proliferation‐promoting activity of arginine‐derived CDs is inherited. The Cu‐CDs achieve perfect integration of dual functions at low concentrations, especially advantageous for applications. With as little as 100 µg mL −1 of Cu‐CDs, the infected wound heals obviously faster than 2 mg mL −1 of antibiotic, although the traditional antibiotic group shows slightly better antibacterial efficiency, suggesting its effect in simultaneously scavenging bacteria and promoting tissue repair effect in vivo. The super selective mechanism probably originates from the endocytosis of Cu‐CDs by mammalian cells, while superoxide dismutase down‐regulates ROS levels in cells to act as a mitotic signaling agent for promoting cell growth. This strategy provides an efficient, convenient, and safe solution to combat bacterial infections, and suggests a novel approach for modifying antimicrobial biomaterials.