tbuckley/cabot-search huggingface dataset:
Abstract 18023: What is the Relationship Between Summer Ambient Temperatures &amp; Heart Failure Hospitalizations Among Low-Income Older Adults in the US?
Authors: Nathaniel Kuhrt, Daniel Bisno, Poonam Gandhi, Ashwaghosha Parthasarathi, David Robinson, Soko Setoguchi
Journal: Circulation (2023)

Background: A trend of warmer nights and higher daily minimum temperatures (T min ) during summer is a leading indicator of climate change. The impact of increased T min on hospitalizations in low-income older adults with heart failure (HF) remains unknown. Hypothesis: Higher T min increases the risk of HF hospitalization among older adults and low-income patients will be more impacted. Methods: We conducted a time-stratified case-crossover study among older adults (age ≥ 66 years) hospitalized for HF during summer months (May-Sept) between 2008-2019 using 20% Medicare data. We employed bidirectional sampling to select controls. Data on daily T min from the Parameter-elevation Relationships on Independent Slopes Model were linked using patient zip code. The non-linear effect of T min was estimated using conditional logistic regression with a restricted cubic spline in all patients and by Medicaid eligibility. Results: Among 460,072 patients hospitalized for HF (mean age 78 years, 62% female, 86% white), the risk of HF hospitalization increased nearly linearly with higher T min (OR: 74 °F = 1.09 [1.09 - 1.10], 84 °F = 1.18 [1.16 - 1.20]) relative to the median summer T min (64 °F) (Figure 1). Patients with Medicaid dual eligibility experienced greater risk of HF hospitalization than their counterparts (Figure 2). Conclusions: Among older US adults, summer days with higher T min were associated with increased risk of HF hospitalization. Low-income patients were at greater risk, possibly secondary to behavioral differences. This effect may be mediated through physiological stress from warmer nights; increased ambient temperatures are associated with inflammation and myocyte damage.
Abstract 17953: Predictors of Mortality Among Hospitalized Patients With Chronic Constrictive Pericarditis
Authors: Aniekeme S Etuk, Inimfon Jackson, Olalekan Olanipekun, ADENIYI A AJENIFUJA, Olusola Olubowale, Mina Jacob
Journal: Circulation (2023)

Introduction: Studies have been conducted on patients with constrictive pericarditis but there is no literature on the factors associated with mortality among hospitalized patients in this population. We examined the predictors of mortality among patients hospitalized with chronic constrictive pericarditis with or without arrhythmias. Hypothesis: Patient and hospital associated factors can predict mortality among hospitalized patients with chronic constrictive pericarditis. Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS), 2016-2020. Multivariate logistic regression modelling was used to examine the factors associated with mortality among hospitalized patients with chronic constrictive pericarditis with or without arrhythmias. Results: Among those with arrhythmias, African Americans (AOR: 1.83; CI: 1.36-2.48) and Hispanics (AOR: 2.08; CI: 1.43-3.01) had higher odds of mortality compared to non-Hispanic whites. Those admitted electively were 62% (AOR: 0.38; CI: 0.27-0.53) less likely to die than the non-elective cases. Length of stay of more than 5 days, (AOR: 1.78; CI: 1.41-2.24) was associated with higher odds of mortality relative to 5 days or less. Other predictors of mortality were charlson comorbidity index and median household income national quartiles. Furthermore, among those without arrhythmias, older age (AOR: 1.88; CI: 1.37-2.59), and longer length of hospital stay (AOR: 2.87; CI: 2.27-3.63) were associated with higher odds of mortality. Conclusions: Our findings highlight the predictors of mortality among patients hospitalized with chronic constrictive pericarditis. Additional studies are needed to further explore patient and hospital related factors associated with mortality, especially among those with comorbid arrhythmias. This will enable physicians to identify high risk patients who may benefit from closer monitoring.
Abstract 15744: Worse Impact of Diabetes on All-Cause Mortality in Women Following CABG
Authors: Amelie Paquin, Pierre Voisine, Jeanne Roberge, Paul Poirier, Marie Eve E Piche
Journal: Circulation (2023)

Introduction: Women referred for coronary artery bypass grafting (CABG) have worse metabolic disorders. The latter are associated with adverse cardiovascular (CV) events and bear a worse prognosis in women. Yet, our understanding of the sex-specific impact of metabolic disorders on mortality after CABG is limited. Aim: To evaluate the interaction of sex with metabolic abnormalities on mortality after CABG, with the hypothesis that they would lead to higher mortality in women. Methods: In a prospective cohort (2006-19), we selected patients who underwent elective isolated CABG, excluding early (&lt;48h) mortality, atrial fibrillation/flutter, pacemaker/defibrillator or heritable dyslipidemia. Sex-specific predictors of all-cause mortality after CABG and their interaction with sex were assessed with Cox proportional hazard models (stepwise selection for each model). Diabetes was defined as per Canadian Diabetes Association Guidelines. Results: We included 6,177 individuals (17% women) in this analysis. All-cause mortality incidence was 438 (9%) and 119 (11%) in men and women respectively (p=0.01) over a median of 5.7 yrs. Compared to men, women were older (67 ± 9 vs 65 ± 9 yrs), more likely to have hypertension (85% vs 78%), diabetes (40% vs 34%), abdominal obesity (82% vs 51%), chronic kidney disease (27% vs 15%), LVEF ≥40% (94% vs 92%) and had higher LDL-cholesterol (72 [17-238] vs 67 [10-221] md/dL) (all p&lt;0.05). Prior myocardial infarction was similar in both sexes (11%, p=0.48). Predictors of mortality are in Figure 1. An interaction between sex and diabetes was found (p=0.03), suggesting worse impact of diabetes in women after CABG. Conclusion: Women undergoing CABG have worse CV risk factors and metabolic risk profile, including diabetes which significantly increased mortality risk vs men. Studies are needed to evaluate which sex- or gender-related factors, like poorer diabetes management or reduced participation in cardiac rehabilitation, may be involved.
Abstract 13062: Association Between Blood Pressure Levels and Cognitive Decline in Community-Dwelling Older Adults: A Prospective Analysis of the China Health and Retirement Longitudinal Study
Authors: Man Wang, Haibin Li
Journal: Circulation (2023)

Background: The association between blood pressure (BP) and the risk of cognitive impairment in older adults is limited. It is unclear at which thresholds BP increases the risk of cognitive decline. We aimed to investigate the association between BP and hypertension treatment status with cognitive decline in older adults. Methods: This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Participants were categorized into five groups according to their visit measures of BP: 1) BP &lt;120/80 mm Hg; 2) systolic BP (SBP) 120-129 mm Hg and diastolic BP (DBP) &lt;80 mmHg; 3) BP ≥130/80 and &lt;140/90 mmHg; 4) BP ≥ 140/90 mmHg; 5) and participants with anti-hypertensive medication treatment regardless of their BP levels. The global cognitive Z score was calculated as the average score of episodic memory and mental intactness. Linear mixed models were used to assess the longitudinal association between the BP group, SBP, pulse pressure (PP), and cognitive decline. Results: A total of 11,671 participants from CHARLS were included (47.3% men and mean age 58.6 ± 9.0 years). After adjusting for potential confounders, participants with BP ≥ 140/90 mm Hg but no anti-hypertensive medication were independently associated with accelerated cognitive decline ( β = -0.020, 95% CI -0.028 to -0.012; P &lt;0.001). This trend was not significant for participants on anti-hypertensive treatment regardless of their BP levels. Elevated SBP and PP were found to be independently associated with accelerated cognitive decline ( P &lt; 0.001 for both). However, participants on anti-hypertensive treatment for pre-existing hypertension, but with controlled SBP &lt; 140 mm Hg and PP &lt; 70 mm Hg did not have a significantly increased risk of cognitive decline. Conclusions: Uncontrolled hypertension was associated with subsequent cognitive decline. Effectively controlling BP with anti-hypertensive treatment can preserve cognitive health in older adults.
Abstract 14786: Disparities in Composite Cardiovascular Risk Factor Control in US Adults With Diabetes in the NIH Precision Medicine Initiative All of Us Research Program
Authors: Frances D Golden, Yufan Gong, Nathan D Wong
Journal: Circulation (2023)

Background/Objective: There are limited contemporary data in real-world populations on composite cardiovascular risk factor (RF) control in adults with diabetes mellitus (DM). We studied the proportions of patients with DM at target for individual and multiple cardiovascular RFs including HbA1c, LDL-C, BMI, blood pressure, and smoking status. Methods: We included adults ≥18 years of age with DM from the NIH Precision Medicine Initiative All of Us Research Program 2018-2022. RFs and target values were defined as 1) HbA1c (&lt;7% w/ atherosclerotic cardiovascular disease (ASCVD) or &lt;8% w/o ASCVD), 2) LDL-C (&lt;55mg/dL w/ ASCVD or &lt;70mg/dL w/o ASCVD), 3) blood pressure (&lt;130/80 mmHg), 4) BMI (&lt;25 kg/m 2 ), and 5) smoking status (never or former smoker). We investigated the proportion (%) of patients at target for individual RFs, ≥3 RFs, ≥4 RFs, and mean number at target by sex, race/ethnicity, and ASCVD status. Results: Individual and composite cardiovascular RF control was found to be low among the 83,093 participants with DM. Control of &gt; 3 RFs and ≥ 4 RFs was only 25% and 5% overall, respectively, with fewer than 1% at target for all 5 RFs; female sex, Asian race/ethnicity, and those with prior ASCVD were more likely to have multiple RFs at target. Non-Hispanic black participants had the lowest proportion of RFs at target. In a multiple logistic regression, higher income, higher education level, employment, female sex, and Non-Hispanic White &amp; Asian race/ethnicity positively predicted control of ≥ 4 RFs with p-value &lt; 0.001. Conclusions: Individual and composite RF control remains suboptimal in many patients with DM, with disparities across certain demographic subsets. Further efforts are required to address social determinants that may be responsible for continuing gaps in adequate RF control and to educate clinicians and patients on the importance of controlling key RFs that impact ASCVD and other outcomes in those with DM.
Abstract 15937: The Impact of Social Vulnerability on Aortic Arch Surgery
Authors: Adam M Carroll, Alejandro Suarez-Pierre, Ananya Shah, Jessica Y Rove, Catherine Velopulos, Muhammad Aftab, T B Reece
Journal: Circulation (2023)

Introduction: Socioeconomic status is a known factor influencing morbidity and mortality. The CDC’s social vulnerability index (SVI) quantifies neighborhood-level vulnerability. Although high SVI has been associated with adverse outcomes in trauma, CABG, and AAA repair, its impact on aortic arch surgery remains unknown. Hypothesis: In total aortic arch (TAR) and hemiarch (HAR) replacement, higher SVI will correlate with increased comorbidities, surgical acuity, and post-operative morbidity and mortality. Methods: This single-center retrospective study examined patients undergoing HAR and TAR performed for aortic aneurysm and/or dissection between 2010 and 2022. SVI was calculated by patient residential ZIP code. The cohort was stratified into three groups: SVI&lt;0.33, SVI 0.33-0.66, and SVI≥0.66. The primary endpoint was postoperative mortality, with control for confounding bias through multivariable logistic regression. Results: For 753 patients, higher SVI correlated with more baseline comorbidities and minority status. SVI was associated with dissection pathology (p=0.04) and urgent/emergent procedure (p=0.02). Higher SVI was associated with TAR (p=0.01), reflected by lower nadir bladder temperatures (p=0.01), longer cardiopulmonary bypass (p=0.02) and circulatory arrest times(p=0.01), and more coagulation product usage. High SVI patients had longer length of stay, higher rates of infection (p=0.01) and a trend towards increased stroke risk. SVI did not correlate with in-hospital or late mortality, confirmed by multivariable regression. Conclusion: Socially vulnerable patients, often from minority backgrounds, tend to have more comorbidities and present urgently or emergently with dissection pathology, requiring more extensive arch repair. Post-procedure, they have a higher risk of infection and a trend towards more stoke risk, but not higher rates of other adverse outcomes or increased mortality during or after hospital stay.
Abstract 171: Hyperoxia Potentiates Pro-Inflammatory Immune Cell Activation in vitro
Authors: Tyler Rolland, Daniel Cucinotta, Sumbule Zahra, Brian R Weil
Journal: Circulation (2023)

Objective: Supplemental oxygen (O 2 ) is commonly administered to critically ill patients to prevent hypoxemia, but there is growing evidence that hyperoxemia may be an equally deleterious physiological insult. Given the key role of immune activation in critical illness, we investigated whether oxygen tension influences the leukocyte response to pro-inflammatory stimuli in vitro . Methods: Naïve peripheral blood mononuclear cells (PBMCs) from healthy swine (n=12) were cultured at 10% O 2 (hyperoxia, n = 4), 5% O 2 (physoxia, n = 4), or 3% O 2 (hypoxia, n = 4) for 24 hours with and without lipopolysaccharide (LPS), mitochondrial DNA (mtDNA), or plasma collected from swine 1 hour following resuscitation from sudden cardiac arrest (post-SCA). Leukocyte activation was assessed via TNFα release (ELISA) and inflammatory surface marker expression (flow cytometry), and compared to basal media, transfection control, or pre-SCA plasma, respectively. Results: Hyperoxia significantly increased PBMC TNFα release in response to LPS, mtDNA, and post-SCA plasma compared to each respective control ( Figure). In contrast, stimulated TNFα release was blunted (SCA plasma) or comparable (LPS and mtDNA) to that observed at physoxia. Consistent with these results, hyperoxia increased PBMC expression of inflammatory surface markers (CD163, CD172, CD14, and CD16) across all conditions, while less pronounced changes were evident after hypoxia. Conclusions: Hyperoxia potentiates TNFα release and shifts PBMCs towards an activated phenotype in the presence of several pro-inflammatory stimuli, including LPS, mtDNA, and plasma collected following resuscitation from SCA. These findings indicate that leukocyte activation is oxygen tension-dependent and suggest that hyperoxemia should be avoided in critically ill patients to minimize the risk of an excessive inflammatory response.
Abstract 14880: Optimizing Percutaneous Mitral Valvuloplasty for Rheumatic Mitral Stenosis: Clinical Significance of Mitral Valve Area Changes
Authors: Kyu-Yong Ko, Iksung Cho, Geu-Ru Hong, Dae-Young Kim, seonhwa lee, KANGUN CHOI, Hee Jeong Lee, Incheol Kim, Jang-Won Son, Jong-Won Ha, Chi Young Y Shim, Seo-Yeon Gwak, Kyu Kim, William D Kim, Jiwon Seo, Kyungeun Ha, Hojeong Kim
Journal: Circulation (2023)

Introduction: Percutaneous mitral valvuloplasty (PMV) is an established treatment for severe rheumatic mitral stenosis (RMS). However, there is limited data on the clinical significance of mitral valve area change (ΔMVA) during PMV on prognosis. Hypothesis: The prognosis improves with greater post-procedure ΔMVA. Methods: Data from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, which included 3,140 patients with at least moderate RMS were analyzed. Out of those, patients with severe RMS (MVA &lt; 1.5 cm 2 ) who underwent their first PMV were included for analysis. Changes in echocardiographic parameters before and after PMV were calculated, and composite outcomes including all-cause death, heart failure admission, stroke, and mitral valve re-intervention were evaluated. Results: A total of 295 patients were included, and during the median follow-up of 91.1 months, composite outcomes occurred in 76 patients (16.5% in optimal and ΔMVA &gt; 0.5 cm2 group vs. 27.7% in optimal but ΔMVA ≤ 0.5 cm2 group vs. 35.7% in suboptimal group, respectively). Patients who achieved optimal results with ΔMVA &gt; 0.5 cm 2 had a better prognosis compared to other groups. (log-rank p=0.002). The group with optimal result but ΔMVA ≤ 0.5 cm2 had a higher risk for composite outcomes compared to the group with ΔMVA &gt; 0.5 cm2 (Hazard’s Ratio: 2.29, 95% confidence interval: 1.11-4.72, p=0.024). Conclusions: Achieving a significant increase in ΔMVA of at least 0.5 cm 2 can improve prognosis, and this could be recommended as an additional objective during PMV, in addition to the traditional optimal targets.
Abstract 17716: Comprehensive Cardiac Rehabilitation Following Myocardial Infarction Improves Clinical Outcomes Regardless of Exercise Capacity in a Long-Term Follow-Up
Authors: Takashi Hiruma, Atsuko Nakayama, Junko Sakamoto, Kentaro Hori, Mamoru Nanasato, Toru Hosoda, Mitsuaki Isobe
Journal: Circulation (2023)

Background: Reduced exercise capacity is recognized as a prognostic indicator of adverse outcomes in patients with myocardial infarction (MI). However, there is limited research evaluating the effectiveness of comprehensive cardiac rehabilitation (CR) in this population. Here, we show for the first time that participation in CR can improve the prognosis of MI patients with reduced exercise capacity in a long-term study. Methods: This cohort study included 610 consecutive patients with MI who underwent percutaneous coronary intervention (PCI) between 2008 and 2015. Patients who received supervised CR were divided into two groups according to the duration of CR: the non-CR group (only hospitalization) and the CR group (continued to outpatient-CR). Within the CR group, patients were further divided into a reduced exercise capacity group (% predicted peak VO2 &lt;80%) and a preserved exercise capacity group (≥80%). Comprehensive CR consisted of a 150-day supervised exercise program at the anaerobic threshold (AT) performed in the hospital under the supervision of a multidisciplinary team. Major adverse cardiovascular events (MACE) were compared among groups. Results: Mean follow-up was 6.1 ± 4.0 years. The MI patients were divided into three groups: the non-CR group (n = 180), the CR group with reduced exercise capacity (n = 241, peak VO2: 17.2 ± 3.9 ml/min/kg) and with preserved exercise capacity (n = 147, peak VO2: 23.1 ± 4.6 ml/min/kg). There was no significant difference in the improvement of the lower limb exercise capacity index, AT, peak VO2 and risk of MACE between the CR groups with reduced and preserved exercise capacity. However, the risk of MACE was lower in the CR groups compared with the non-CR group (log-rank p = 0.014). Multivariable Cox regression analysis showed that chronic kidney disease (aHR 1.89, 95% CI 1.19-3.01, p &lt; 0.01), non-Killip class 1 (aHR 1.90, 95% CI 1.01-3.57, p = 0.047) and CR participation (aHR 0.57, 95% CI 0.36-0.90, p = 0.015) were independent predictors of MACE. Conclusions: Comprehensive CR after PCI in patients with MI effectively reduces the occurrence of MACE, regardless of their exercise capacity. We should also actively encourage patients with low exercise capacity to participate in comprehensive CR.
Abstract 15568: Myocardial Strain Assessment for Comprehensive Risk Prediction in Patients Following Acute Myocardial Infarction
Authors: Torben Lange, Roman Gertz, Alexander Schulz, Soeren J Backhaus, Ruben Evertz, Johannes T Kowallick, Gerd Hasenfuss, Steffen Desch, Steffen Desch, Holger Thiele, Thomas Stiermaier, Ingo Eitel, Andreas Schuster
Journal: Circulation (2023)

Background: Cardiovascular magnetic resonance-feature tracking (CMR-FT) derived strain analyses provide incremental prognosticbenefit in patients following acute myocardial infarction (AMI). This study aimed to evaluate and re-validate previously reportedprognostic implications of comprehensive strain analyses in a large independent cohort of patients with ST-elevation myocardialinfarction (STEMI). Methods: Overall, 566 STEMI patients of the CONDITIONING-LIPSIA trial including pre-/postconditioning treatment and/orconventional percutaneous coronary intervention underwent CMR imaging in median 3 days after primary percutaneous coronaryintervention. CMR-based left atrial (LA) reservoir (Es), conduit (Ee) and boosterpump (Ea) strain as well as left ventricular (LV)global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain analyses were carried out. Previously identified cut-offvalues were revalidated for risk stratification. Major adverse cardiac events (MACE) comprising death, reinfarction and newcongestive heart failure were assessed within 12 months after the index event. Results: Both atrial and ventricular strain values were significantly reduced in patients with MACE (p&lt;0.01 for all). PredeterminedLA and LV strain cut-offs enabled accurate risk assessment. All LA and LV strain values were associated with MACE on univariableregression modeling (p&lt;0.001 for all) with LA Es emerging as independent predictor of MACE on multivariable regression modeling(HR 0.92, p=0.033). Furthermore, LA Es provided an incremental prognostic value above LVEF (c-index increase from 0.7 to 0.74,p=0.03). Conclusion: External validation of CMR-FT-derived LA and LV strain evaluations confirmed the prognostic value of cardiacdeformation assessment in STEMI patients. Within the current study especially LA strain parameters enabled further riskstratification and prognostic assessment over and above clinically established risk parameters.
Abstract 16592: Cancer as a New Risk Factor for Major Adverse Cardiovascular Events in Secondary Prevention
Authors: Renzo Melchiori, Sara Diaz Saravia, Lucas Szlaien, Pablo Rubio, Sergio Baratta, Alejandro Hita, Romina Mouriño, Manglio M Rizzo
Journal: Circulation (2023)

Introduction: The inflammatory mechanisms of cancer can be associated to the formation and progression of atherosclerosis. There is scarce evidence about the evolution of oncologic patients in secondary prevention after an Acute Coronary Syndrome (ACS). Methods: An observational retrospective study was done with 937 patients who underwent a PCI for Acute Coronary Syndrome (ACS) from 2008 to 2022. Patients with a prior history or Major Cardiovascular Events (MACE) were excluded, leaving a total of 787 patients. They were then divided into two subgroups according to the presence or absence of cancer: G1 non-oncologic, and G2 oncologic. The primary endpoint was a composite of MACE in secondary prevention within 3 years of STEMI. Results: G1 group consisted of 698 patients, and G2 of 89 patients. A total of 180 (22.9%) MACE were identified in the follow-up period in both groups combined, with a median follow-up time of 45 months [IQR= 14-72]. The cumulative incidence of MACE for G1 was 22.2% (155/698) and 28.4% (25/88) for G2. The median follow-up time for G1 was 48 months (IQR=15-84), and for G2 was 36 months (IQR=11-48). G2 presented a density index of MACE significantly superior compared to G1 (0.78 MACE/100 patients/month CI 95% [0.51-1.12] vs 0.48 MACE/100 patients/month CI 95% [0.37-0.50], p 0.01). Kaplan-Meier analysis showed a significantly higher probability of MACE in G2 compared to G1 (P = 0.0086). Multivariable Cox Hazard analysis showed that a history of cancer was an independent and significant predictor of MACE (HR 1.66, 95% CI [1.1-2.6], P = 0.025) adjusted for other risk factors (hypertension, diabetes, smoking history, sedentarism, obesity, age, sex, and family history). Conclusions: In our population, patients with cancer (G2) had a higher incidence of MACE during follow-up. History of cancer behaved as a significant and independent risk factor for MACE adjusted for other classical risk factors. Further studies are warranted to investigate this phenomenon.