tbuckley/cabot-search huggingface dataset:
Abstract 15777: Vascular Density and Fibrosis in Heart Failure Recovery
Authors: Rajul K Ranka, Keith A Youker, Arvind Bhimaraj, John P Cooke
Journal: Circulation (2023)

Introduction: Chronic unloading with a left ventricular assist device (LVAD) leads to LV remodeling including increased endothelial density, reduction of fibrosis, and improved cardiac function. Specific mechanisms of such recovery have not been fully explored in humans. Hypothesis: We hypothesize that recovery from non-ischemic heart failure is accompanied by increased vascular density and reduction in fibrosis. Methods: We developed and characterized a murine model of non-ischemic heart failure (HF) and recovery (HFR) using Angiotensin II infusion pumps and L-NAME/NaCl in water for 5 weeks followed by removal of these insults to induce a recovery. Ejection fraction, LV mass, fibrosis, and vessel density were assessed at various time points. We quantified vessel density using fluorescent microsphere bead perfusion and measured fibrosis using Masson’s Trichrome staining. Statistical analysis was performed using One way ANOVA, n=5 mice/group with 2 replicate experiments. ( p &lt;0.05 was considered significant.)Results: LV mass and interstitial fibrosis increased significantly while ejection fraction and vascular density showed significant decreases in HF vs control mice while recovering hearts showed normalized ejection fraction and LV mass with a significant reduction in fibrosis. There was a very significant increase in vascular density when compared to HF mice (Fig. 1). Together, these preliminary data support our hypothesis that recovery from heart failure involves a vascular recovery. Conclusions: Morphological recovery of cardiac function is accompanied by an increase in vascular density along with a reduction in fibrosis in a non-ischemic mouse model of heart failure recovery. This increase in vascular density may be a required component of the recovery process from heart failure and further studies are necessary to understand the specifics of such mechanisms.
Abstract 14586: Early Life Trauma Exposure and Subclinical Cardiovascular Disease Risk in Black Men and Women
Authors: Telisa Spikes, Puja Mehta, Jordan Pelkmans, Roland J Thorpe, Priscilla E Pemu, Herman A Taylor, Sandra B Dunbar, Arshed A Quyyumi
Journal: Circulation (2023)

Introduction: Childhood trauma is associated with a greater risk of developing hypertension in adulthood. Black individuals develop hypertension at younger ages, have more aggressive hypertension, and are more likely to experience childhood trauma compared to White individuals. Yet, the impact of childhood trauma on vascular stiffness in Black individuals remains less clarified; thus, we examined the association between childhood trauma and arterial stiffness in Black individuals. Hypothesis: Childhood trauma exposure will be associated with vascular dysfunction and this association may differ by sex. Methods: Childhood trauma exposure and vascular function were assessed in a cohort of healthy Black participants without known CVD [n=404] from a large metropolitan city. Childhood trauma was assessed using the Early Trauma Inventory short form [ETISR-SF] consisting of four-physical, sexual, emotional, and general-domains, with higher scores indicative of higher traumatic life events assessed before age 18 years. Outcomes of central augmentation index [CAIx] and carotid femoral pulse wave velocity [CfPWV] were measured as indices of wave reflections and arterial stiffness using applanation tonometry [Sphygmocor Inc.], and central pulse pressure [CPP] was calculated as the difference between the aortic systolic and diastolic blood pressures. Relationships between ETISR-SF and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models. Results: Mean age of the cohort was 53(SD=10.3), 61% women. Cumulative childhood trauma was associated with CAIx β =0.33%, 95%CI: 0.04,0.62 and CPP β =0.24mmHg, 95%CI:0.04,0.45, but not CfPWV β =-0.02m/s, 95%CI:-0.07,0.02 after adjusting for demographic, BMI, BP, lipids, glucose, clinical history, health behaviors, and depression. Significant traumaxSex interactions were identified for CAIx P=0.01 and CPP P=0.02 . Among women, childhood trauma was associated with higher CAIx β =0.32%, 95%CI: 0.04, 0.60 and CPP β =0.19 mmHG, 95%CI: -0.02, 0.41, but not in men. Conclusion: Exposure to childhood trauma is associated with measures of arterial stiffness in Black women, noting the detrimental effects of childhood trauma on future CVD risk in Black women.
Abstract 15250: Increased CD81 is Associated With Enhanced Apoptosis in Acute Kidney Injuries Induced by Candesartan/Low Salt Diet
Authors: Haonan Duan, Ping Wang, Zhiyun Ren, Weiwan Wang, YuTao Jia, Mingzhuo Zhang, Xiaoyan Wang
Journal: Circulation (2023)

Introduction: Our previous studies have demonstrated that the upregulation of renal CD81 (cluster of differentiation 81), contributes to the sustained hypertension observed in LPS-preeclampsia rats with kidney injuries. Candesartan (Can) lowers blood pressure by selectively blocking type 1 angiotensin II receptors and results in acute kidney injury (AKI) when used together with dietary sodium restriction. Various cell deaths including apoptosis and necrosis are involved in the pathogenesis of AKI. Hypothesis: Renal CD81 may increased in candesartan/low salt diet(LS+Can) model via activation of apoptosis. Methods: Male SD rats aged 8-10 weeks were fed with LS (0.01% NaCl) or normal salt diets (NS, 0.8% NaCl) (6-10rats/group) respectively for 7 days.All rats were intraperitoneally injected with candesartan (1mg/kg/d) simultaneously.Systolic blood pressure(SBP) was monitored with tail-cuff method.The rats were sacrificed by over-anesthesia after the samples of blood and urine (metabolic cage) were collected.The kidneys were immediately removed for immunoblotting, and TUNEL(TdT-mediated dUTP Nick-End Labeling) measurements.P&lt;0.05 was considered significant for 2 group comparison with t-test. Results: Compared with rats on NS+Can, the serum creatinine (20.3±0.3 vs 50.8±4.2 mmol/L) and BUN(4.05±0.2 vs 18.6±2.5 mmol/L) were more than doubled in LS+Can rats ;Creatinine clearance was decreased (100±4.1 vs 40.8±3.7ml/min); systolic blood pressures was lowered slightly (101.7±1.7 vs 88.9±2.7mmHg, n=7-8). Renal CD81 protein abundance by immunoblotting was increased (258.8±52.4,% of control, n=6/group,p&lt;0.05, same as below).At the same time, there were increases in apoptosis-associated proteins including bax(312.6±71.5),caspase-3(124.6±6) ,cleaved caspase3(133.8±9.6) in Can+LS group.The rate of tunel-positive cells was elevated in the Can+LS group. (100.0±8.5 vs 482.72±59.4,p&lt;0.05,n=10/group).However, necrosis-related inflammatory factors, including Interleukin-6,tumor necrosis factor-α, were not affected in the rat kidneys from LS+Can treated rats. Conclusions: Our findings suggest that Increased CD81 may be associated with enhanced apoptosis in rat kidneys with acute kidney injuries.
Abstract 15087: First Clinical Trial in China to Evaluate the Efficacy and Safety of Moyoassist® Extra-VAD System
Authors: wang yue, Ningning Yuan, Po-Lin Hsu
Journal: Circulation (2023)

Cardiogenic shock(CS)is associated with significant morbidity and mortality. For patients unresponsive to medicinal treatment, an alternative is a mechanical circulatory support (MCS) system. In China, common treatments using short-term MCS include IABP and VA-ECMO, both methods found their limitations. Therefore, a better strategy must be proposed to improve prognosis in CS patients, such as extracorporeal VAD (Extra VAD). Here, we reported 40 patients' data collected from a prospective, multicenter, single group clinical trial conducted from July 2021 to Feb 2023, which aims to evaluate the efficacy and safety of MoyoAssist® Extra-VAD system. MoyoAssist® is developed based on fully magnetically levitated pump technology to temporarily support the left, right, or biventricular circulation of patients with acute heart failure and cardiogenic shock of all causes. Patients were recruited for various indications, with PCCS (50%) and BTT (32.5%) being the top two causes. A combination of median sternotomy (22.5%), peripheral venous cannulation (52.5%) and mini-incision (25%) were employed to implant the device. Especially, jugular vein cannulation was a pioneering approach proposed to enable patients’ early ambulation and recovery. MoyoAssist® Extra-VAD has demonstrated stable and sufficient circulation support without severe device associated adverse events. The mean support duration was 7d16hrs, and overall survival rate at 30-day follow up was 62.5%. Hemodynamics indicated improvement with increased MAP and reduced CVP in all sub-groups. Lactate has shown a significant decrease in the PCCS-survival group (3.95 vs. 1.05, p&lt;0.05), indicating improved reperfusion of organ tissues. While AST has shown a significant drop in the BTT-survival group (67.10 vs. 56.17, p&lt;0.05), indicating improved liver function. During the support, 3 patients with peripheral cannulation and 2 patients with mini-incision were able to ambulate early. The types of complication seen were similar to those reported with CentriMag, but the rates of bleeding (15%) and hemolysis (0%) were much lower. In conclusion, MoyoAssist® Extra-VAD has demonstrated its safety and efficacy for short-to-mid-term support of patients with acute heart failure and cardiogenic shock.
Abstract 15859: Cardiopulmonary Exercise Function in Methamphetamine-Associated Heart Failure
Authors: Sophia Y Xiao, Emily R Cedarbaum, Danny Li, YUANER WU, Teresa Wang, Matthew S Durstenfeld, Priscilla Hsue
Journal: Circulation (2023)

Introduction: The role of methamphetamine (meth) cessation in the functional recovery of methamphetamine-associated HF (meth-HF) is unknown. Objective To evaluate the role of active meth use on cardiopulmonary function in participants with meth-HF. Methods: We recruited participants from a longitudinal cohort study of meth-HF and used cardiopulmonary exercise testing (CPET) with maximal effort upright cycle ergometer to assess exercise cardiorespiratory function. Descriptive analysis was used to study associations between cardiopulmonary function and 1) active use and 2) ejection fraction (EF) recovery. Results: Of those assessed for eligibility (n = 55), 11 were deceased and 30 could not be contacted/declined participation. Ten studies were completed of the 14 scheduled, with three no-shows and one termination due to pre-test PVCs. Of those who completed studies, 90% were male, median age was 52 years [40, 54] and duration of HF was 33 months [16, 58]. Five were active users, and five had a recovered EF. All were on quad-guideline-directed medical therapy (GDMT) for a median duration of 15 months [9.1, 29]. Baseline EF was 28% [21, 42], and EF closest to CPET date was 50% [42, 59]. Peak VO 2 (% predicted) in prior vs. active use was 73 [66, 75] and 60 [48, 66]; in persistently low vs. recovered EF, it was 75 [66, 75] and 63 [60, 66] ( Figure 1A ). Adjusted heart rate reserve (aHRR, %) in prior vs. active use was 42 [37, 43] and 46 [44, 58]; in persistently low vs. recovered EF, it was 58 [44, 62] and 37 [35, 43] ( Figure 1B ). In prior vs. active use, VO 2 pulse (VO 2 /HR, mL/beat) was 16 [15, 17] and 13 [12, 15]. One participant died of sudden cardiac death between CPET and time of analysis. Conclusions: To our knowledge, this is the first study looking at cardiorespiratory fitness in the setting of meth use and HF. Our preliminary findings suggest that peak VO 2 and aHRR remain low, which suggests the presence of persistent cardiac effects of meth use despite cessation of use and/or recovery of EF.
Abstract 13183: The Burden of Uncontrolled Hypertension (HTN) in Chronic Kidney Disease (CKD). Impact of the Revised KDIGO Guidelines
Authors: Richard McGregor, Y Fred F Yang, James McCabe, Bill Cacheris
Journal: Circulation (2023)

Introduction: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease for patients not receiving dialysis highlights the increasing awareness of controlling HTN in CKD patients. Goals/Aims: To identify the number of persons in the US with HTN and advanced CKD. Research Question: Determine the current number of persons with advanced CKD and HTN based on various blood pressure thresholds and to project the increase in the number of patients over the next 10 years. Methods: The analysis is based on multiple years of the US National Health and Nutrition Examination Survey (NHANES). Results: We examined and projected the prevalence, awareness and treated number of HTN patients as well as the number of patients with uncontrolled HTN. Uncontrolled HTN was defined as taking at least 2 or more anti-hypertensive medications and the analysis focused on advanced CKD patients not requiring dialysis (stage 3b/4). Lowering the systolic/diastolic blood pressure threshold (mm Hg) from &gt;140/90 to &gt;130/80 or &gt; 120/70 shows significant current numbers of patients with uncontrolled HTN and advanced kidney disease of 1.5 MM, 2.0 MM, and 2.7 MM, respectively. The number of patients is expected to increase 20% in the next 10 years highlighting the need for effective management of HTN in CKD.
Abstract 12993: Higher Risk of Heart Failure in Patients With Sickle Cell Disease
Authors: Terrence Henry, Yong Eun, Raji Ayinla
Journal: Circulation (2023)

Background: Sickle cell disease (SCD) is a known risk factor for the development of cardiovascular disease. Congestive heart failure (CHF) is a major cardiovascular complication in patients with SCD. A high-output cardiac state and increased systemic vascular resistance in SCD patients lead to ventricular hypertrophy and diastolic dysfunction. The subject of this study is to examine the risk of developing CHF in SCD when compared to patients without SCD using the All of Us Database. Methods: We conducted a propensity score matching (PSM) analysis to evaluate the effect of sickle cell disease (SCD) on the risk of developing congestive heart failure (CHF) in a cohort of 287,012 American individuals enrolled in the All of Us database. Covariates for matching included age, gender, race, ethnicity, income level, education level, marital status, cigarette exposure, alcohol exposure, drug exposure, and comorbidities. The resulting control group (n=761) was matched to the SCD patient group (n=761) based on propensity scores. A logistic regression analysis was then conducted to determine the association between SCD and CHF, adjusting for significant factors. Results: The logistic regression analysis revealed a significant association between SCD and CHF. In the unadjusted model, SCD patients had an odds ratio (OR) of 1.42 (95% CI: 1.09-1.84, p=0.009) for developing CHF compared to the control group. After adjusting for age group, income, marital status, drug exposure, and modified Charlson comorbidity index, the adjusted OR was 1.60 (95% CI: 1.20-2.15, p=0.002). Conclusion: Patients with SCD had an increased risk of developing CHF, compared to propensity score-matched controls.
Abstract 12600: COVID-19 Hospitalizations With and Without Pulmonary Hypertension: An Analysis of the 2020 Nationwide Inpatient Database
Authors: Endurance O Evbayekha, Yara Jelwan, Carlos Gaibor, Leonela Bastidas, Rani Kuttab, Purav Desai, Favour Markson, Bobby Shah
Journal: Circulation (2023)

Introduction: Among individuals with active SARS-CoV-2 (COVID-19) infection, emerging evidence suggests that pulmonary hypertension (pHTN) of any etiology may be associated with poor outcomes. We studied the in-hospital population with pHTN and COVID-19 infection. Hypothesis: Studying the impact of COVID-19 on pHTN patients is essential and may inform optimizing patient management and improving outcomes. Methods: We derived our sample using the 2020 National Inpatient Sample Database (NIS) discharge data. Our population was patients with a primary admission diagnosis of COVID-19 identified using the ICD 10 code U071. We divided this sample into two groups based on a secondary diagnosis of pHTN or no pHTN. We used multivariate logistic regression analysis to account for confounders and estimate the probability of our outcomes. Results: There were 1,058,815 primary hospitalizations for COVID-19, and 2.37% (25,070) had pHTN, with a female predominance of 56.8% and a mean age of 71.3 years ±14.7. By ethnicity, 58.7% were Caucasians, 22.1% were Blacks, and 12.9% were Hispanics. Following multivariate analysis, we found that pHTN was associated with significantly higher odds of pulmonary embolism (PE), adjusted odds ratio (aOR) 2.2 (1.9-2.5, p&lt;0.0001), cardiogenic shock 3.2 (2.4-4-2, p&lt;0.0001), acute respiratory failure 1.7 (1.6-1.8, p&lt;0.0001), Invasive mechanical ventilation, 1.6 (1.5-1.7, p&lt;0.0001), and in-hospital mortality 1.7 (1.6-1.9, p&lt;0.0001). Conclusion: Our study showed that pulmonary hypertension was associated with significantly higher odds of acute respiratory failure, invasive mechanical ventilation, pulmonary embolism, cardiac shock, and in-hospital mortality in patients admitted for COVID-19. Particular emphasis on preventive measures cannot be overemphasized in this group.
Abstract 15178: Cardiac Power and the Association With Heart Failure and Cardiovascular Death in the General Population
Authors: Sofie Bøgh-Sørensen, Maria Dons, Ali Shabib, Flemming Javier Olsen, Ditte Vesterlev, Filip Soeskov Davidovski, Caroline Espersen, Mats Lassen, Kristoffer G Skaarup, Niklas Johansen, Peter Schnohr, Gorm Boje Jensen, Rasmus Mogelvang, Tor Biering-Sørensen
Journal: Circulation (2023)

Introduction: Cardiac power (CP) integrates echocardiographic and clinical parameters of hemodynamics, but the prognostic value of CP in the general population remains to be established. Hypothesis: This study investigates the association between CP and incident heart failure (HF) and cardiovascular (CV) mortality in the general population Methods: A total of 4,022 participants without known HF from a general population cohort study was included in the study. CP was calculated by cardiac output x mean blood pressure x 0.222. CP was expressed in W/100 g of LV myocardium. The composite outcome was incident HF or CV death. Cox regression models were used to determine the association of cardiac power with the risk of the composite outcome. Cumulative incidence curves were constructed to visualize the risk of outcome throughout the follow-up period, while accounting for non-cardiovascular death as a competing event. The association was additionally explored in a restricted cubic spline model. Results: During a median follow-up of 3.5 years (IQR 2.6;4.4 years), 134 (3.3%) participants reached the composite outcome. The risk of the composite outcome was significantly increased in those with CP &lt;0.84 W/100 g throughout the follow-up period, while accounting for non-cardiovascular death as a competing event. We found significant interaction between LVEF and CP (p interaction &lt;0.001). When stratifying the population according to LVEF, CP had no prognostic value in LVEF &gt;50% (p=0.74) but in individuals with LVEF &lt; 50%, CP remained an independent prognostic marker after multivariable adjustment (HR 1.20 per 0.1 W/100 g decrease in cardiac power (95% CI: 1.04-1.37, p=0.01) (Figure 1). Conclusion: CP was associated with incident HF and CV death in the general population, however, LVEF significantly modified the relationship between CP and the composite outcome. CP was only independently associated with incident HF and cardiovascular death in participants with LVEF&lt;50%.
Abstract 12805: Risk Factors of Mortality in Patients on Temporary Mechanical Circulatory Support Undergoing Heart Transplant
Authors: Rahat A Memon, Jasninder S Dhaliwal, Abhimanyu Ravalani, Kamleshun Ramphul, Nomesh Kumar, Shaheen Sombans, Yogeshwaree Ramphul, Petras Lohana
Journal: Circulation (2023)

Introduction: Recent studies have shown a rise in temporary mechanical circulatory support (MCS) use among patients requiring heart transplants(HT) in the United States. However, there is a lack of data on the potential risk factors for death among HT patients who also used MCS. We, therefore, explored the National Inpatient Sample(NIS) database to investigate further. Methods: All procedures for HT in adults via the 2016-2020 NIS were retained for our study. The use of MCS was also identified via procedural codes based on previous studies. We estimated factors that could influence mortality among MCS patients via multivariable regression analysis. Results: Our selection criteria yielded 14545 cases of HT between 2016-2020, and an estimated 31.6%(4590) patients used MCS. A higher mortality rate in MCS patients was reported as 10.1% (465 cases out of 4590) did not survive (vs. 3.1% in non-MCS patients, aOR 3.473, 95% CI 2.966-4.066, p&lt;0.01). In the MCS cohort, patients who died were older (mean age 56.13 vs. 53.65 years), with a higher mean Charlson Comorbidity Index (CCI) score ( mean score of 6.03 vs. 4.30, p&lt;0.01). Factors that contributed to an increased odds of death included Weekend admissions (aOR 1.413, 95% CI 1.086-1.839, p=0.10), Hispanics (vs. Whites, aOR 1.926, 95% CI 1.398-2.652, p&lt;0.01), history of peripheral vascular disease (PVD) (aOR 4.426, 95% CI 2.712-7.221, p&lt;0.01), obesity (aOR 1.668, 95% CI 1.238-2.248, p&lt;0.01), age ≥60years (aOR 1.982, 95% CI 1.593-2.466, p&lt;0.01), and patients covered by private insurance forms (vs. Medicare, aOR 1.341, 95% CI 1.067-1.685, p=0.012). Meanwhile, those with lipid disorders (aOR 0.313, 95% CI 0.234-0.418, p&lt;0.01) and a history of stroke (aOR 0.484, 95% CI 0.246-0.954, p=0.036) showed lower mortality risks. Conclusions: Patients who used MCS and are now undergoing HT are at a higher risk of death. Weekend admissions, Hispanics, PVD, obesity, age ≥60 years, and private insurance were linked with higher risks in the MCS cohort, while a history of stroke and lipid disorders had lower risks. Thus, physicians must address these risk factors in their choice of care and provide the appropriate steps to reduce mortality.