tbuckley/cabot-search huggingface dataset:
Abstract 4138815: Prognostic Implications of Glycemic Variability Assessed by Continuous Glucose Monitoring-derived Coefficient of Variation among Patients Hospitalized for Acute Heart Failure
Authors: Haruyasu Ito, Hiroshi Yukawa, Eiichiro Nakagawa, Kazuya Nagao, Chinatsu YAMADA, tomohisa tada, Yohei Kobayashi, Takenori Kanazawa, Naoaki Onishi, Kenji Aida, Kiyotaka Shimamura, Toshinori Makita, FUJIO HAYASHI
Journal: Circulation (2024)

Background: Recent findings indicate that high glycemic variability (GV) could increase the risk of adverse outcomes in patients with cardiovascular disease. With the advances in technology, the utility of continuous glucose monitoring (CGM) has grown during recent years, which can provide valuable information that is not captured by HbA1c. We used the glucose coefficient of variation (CV, calculated as the ratio of standard deviation divided by the mean glucose level) of the obtained CGM data to analyze GV. Aims: We aimed to analyze CGM-derived CV as an indicator of GV and to evaluate prognostic implications of CGM-derived CV in patients hospitalized for acute heart failure (HF). Methods: Patients hospitalized for HF who had not been diagnosed diabetes were performed 75g-oral glucose tolerance test (OGTT). CV was evaluated using CGM system for at least 72 consecutive hours after being able to have meals stably during hospitalization. The primary outcome was a composite of cardiovascular death or re-hospitalization for HF. Patients were divided into two groups based on the median value of CV. Results: We prospectively analyzed 130 patients (mean age: 76±10 years, male 56%) admitted for acute HF. Following the 75g-OGTT, only 21% of the entire cohort exhibited normal glucose tolerance. During the median follow up period of 905 days, Kaplan–Meier curve analysis revealed that the cumulative incidence of the primary outcome event was significantly higher in patients with CV above median than in those with CV less than median (51.7% versus 24.4%, Log-rank P=0.01)(Figure). Multivariate Cox proportional analysis demonstrated that the risk of CV per 1% increment for the primary outcome was significant adjusted for history of diabetes, CGM-derived mean glucose level, and HbA1c level (hazard ratio: 1.06, 95% confidence interval 1.03–1.09). Conclusions: CGM-derived CV was associated with long term prognosis of patients hospitalized for HF with or without diabetes.
Abstract 4138686: Impact of Ejection Fraction on Incidence of Atrial Fibrillation Following Admission for Heart Failure
Authors: Thomas Fretz, Sarah Fortna, Onyedika Ilonze, Tanyanan Tanawuttiwat, Mithilesh Das
Journal: Circulation (2024)

Introduction: Though the prevalence of atrial fibrillation (AF) is similar amongst heart failure (HF) with reduced, mildly reduced, and preserved ejection fractions, population-level data suggests a modestly increased prevalence in patients with HFpEF compared to those HFrEF. The development of atrial fibrillation is associated with increased risk of stroke, hospitalization, and cardiovascular death in all types of heart failure, though some data suggests morbidity and mortality is worse amongst those with HFpEF. Whether ejection fraction plays a role in development of AF following a HF hospitalization is unclear. Hypothesis: We hypothesized incidence of AF following heart failure hospitalization is increased in patients with preserved ejection fractions. Aim: The goal of this study is to assess the impact of ejection fraction on development of new atrial fibrillation following heart failure exacerbation. Methods: Patients admitted to an academic tertiary care hospital with a primary diagnosis of HF without a previous diagnosis of AF were identified and followed for up to one year for this retrospective study. Demographic, comorbidity, medications, and echocardiography of these patients were obtained from the medical record and analyzed. Consistent with the American Heart Association heart failure guidelines, we defined HFrEF as an EF less than 40%, HFmrEF as an EF between 40-50%, and HFpEF as an EF greater than 50%. This data was analyzed on SPSS using cox-regression and Kaplan-Meier survival analysis. Results: Of the 3,953 patients included in our study, 22.2% had HFrEF, 13.5% had HFmrEF, and 64.3% had HFpEF. At the end of one year 23.5% of those with HFrEF, 20.1% of those with HFmrEF, and 15.9% of those with HFpEF, developed atrial fibrillation. The difference in AF incidence was noted to be statistically significantly lower in HFpEF compared to HFrEF (p&lt;0.001) and HFmrEF (p=0.019). The difference between HFmrEF and HFrEF did not reach statistical significance (p=0.144). Conclusion: In patients without atrial fibrillation, a reduced ejection fraction is associated with an increased incidence of atrial fibrillation one year following a hospitalization for heart failure compared to a preserved ejection fraction.
Abstract 4138799: SGK1 inhibition shortens action potential duration in LQT3 mice and LQT2 rabbits via inhibition of late sodium current
Authors: Miriam Barbieri, Simona Casini, Julien Louradour, Tanja M. de Waal, Philip Sager, Saumya Das, Arthur Wilde, Katja Odening, Carol Ann Remme
Journal: Circulation (2024)

Background: Serum and glucocorticoid regulated kinase 1 (SGK1) activation during pathological conditions has been shown to increase late sodium current, prolong action potential duration (APD), and induce ventricular arrhythmias, thus recapitulating a long QT syndrome (LQTS) phenotype. Hence, pharmacological SGK1 inhibition may be a novel therapeutic approach in inherited LQTS. Aim: We aimed to investigate potential effects of SGK1 inhibition in animal models of different LQTS subtypes, and the potential involvement of late I Na inhibition. Methods: Cardiomyocytes (CMs) isolated from wild-type (WT) and LQT3 mice ( Scn5a -1798insD) as well as from WT, LQT1 ( KCNQ1 -Y315S) and LQT2 ( KCNH2 -G628S) rabbits, were incubated for 3-5 hours with SGK1-inhibitor (SGK1-inh, 300 nM-3 μM) or DMSO (vehicle). Patch-clamp experiments were performed to assess AP properties, short-term variability (STV) of APD and late I Na . Result: SGK1-inh incubation significantly shortened the prolonged APD 90 in LQT3 CMs by 23% and in LQT2 CMs by 25% (restoring them towards the WT level), without affecting other AP properties. In contrast, in WT and LQT1 CMs, no effect of SGK1-inh on APD 90 was observed. Furthermore, short-term-variability (STV) of APD, a measure of pro-arrhythmia, was pathologically increased in LQT3 (5.6±0.2 ms vs WT 2.7±0.3 ms, p&lt;0.05) and LQT2 (14.7±2.8 ms vs WT 5.9 ±1.1 ms, p &lt; 0.0001), but not in LQT1. SGK1-Inh markedly reduced STV in LQT3 (to 2.9±0.1 ms) and LQT2 CMs (to 7.2± 1.2 ms), but had no effect in WT and LQT1 CMs. While enhanced late I Na was previously demonstrated in LQT3 CMs, we now also observed increased late I Na in LQT2 CMs as compared to WT (-0.14 ± 0.02 pA/pF vs WT -0.08 ± 0.02 pA/pF, p &lt; 0.005), but not in LQT1 CMs. SGK1-Inh significantly reduced late I Na in LQT3 (by 32%) and LQT2 CMs (by 43%), but not in LQT1 CMs, confirming that SGK1-inh directly targets late I Na . Conclusion: SGK1-inhibition exerts a beneficial APD-shortening and anti-arrhythmic effect in LQT3 and LQT2 by reducing the enhanced late I Na associated with these LQTS genetic subtypes. These findings furthermore underscore the contribution of increased late I Na to the LQT2 phenotype.
Abstract 4138754: Analysis of Polarization Changes in Ascending Aortic Endothelial Cells Induced by Aortic Valve Regurgitation
Authors: Yuki Tamagawa, Takuji Kawamura, Akima Harada, Keisuke Miyake, Ai Kawamura, Takashi Kido, Kizuku Yamashita, Kazuo Shimamura, Shunsuke Saito, Shigeru Miyagawa
Journal: Circulation (2024)

Background: Fragility of the ascending aortic wall has been reported in patients with aortic regurgitation (AR), thought to be affected by turbulence in the ascending aorta. However, the mechanism behind this effect is unclear. We hypothesized that turbulence in the ascending aorta of AR patients causes changes in the polarization of endothelial cells. This study aimed to clarify that the polarization of endothelial cells in the ascending aortic wall is altered in AR patients. Methods: Twenty patients who underwent ascending aortic replacement at our institution from October 2022 to July 2023 were included: ten with thoracic aortic aneurysms (TAA) and ten with TAA and AR. The polarization of endothelial cells in the greater curvature of the ascending aortic wall collected during surgery was evaluated by measuring the ratio of the long axis to the short axis, the angle between the long axis and the blood flow axis, and the alignment of the Golgi apparatus and nucleus parallel to the blood flow. Results: There were no significant differences in patient background between the AR and non-AR groups. Additionally, there was no significant difference in the diameter of the ascending aorta between the two groups (AR vs. non-AR, 47.7±3.8 mm vs. 44.5±2.2 mm, p=0.479). The long axis to short axis ratio (aspect ratio) of endothelial cells in the ascending aorta was significantly smaller in the AR group than in the non-AR group. The angle (θ) between the long axis of the endothelial cells and the blood flow axis was significantly smaller in the AR group than in the non-AR group. The ratio of Golgi apparatus and nucleus alignment parallel to the blood flow was significantly lower in the AR group than in the non-AR group. Degeneration of the aortic tunica media was also observed in the AR group compared to the non-AR group. Conclusion: The results of this study suggest that the presence of AR alters the polarization of endothelial cells in the ascending aortic wall.
Abstract 4138635: The Association of Perioperative Statins and Cardiac Surgery Associated Acute Kidney Injury in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Jiawei Han, Heng Zhang, Juntong Zeng, Xiaoting Su, Hongyan Zhou, Sheng Liu, Zhe Zheng
Journal: Circulation (2024)

Backgrounds: Cardiac surgery associated acute kidney injury (CSA-AKI) is a prevalent and detrimental complication following cardiac surgery, with significant effects on both in-hospital and long-term morbidity and mortality. The renal protective effect of statins for patients undergoing cardiac surgery remains unclear. Purpose: This study aims to evaluate the association between perioperative statin therapy and the risk of CSA-AKI following coronary artery bypass grafting (CABG). Methods: This retrospective cohort study included consecutive patients undergoing CABG between 2013 and 2022, with one year follow-up after hospital discharge. Any usage of statin initiated from admission to 72 hours after surgery was defined as perioperative statin therapy. The primary outcome was in-hospital postoperative AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcomes were composite measures including all-cause mortality and dialysis at 30 days and one year. Multivariate Cox proportional hazards regression models were constructed to assess the association between perioperative statin and pre-defined outcomes. Results: Among the included 36288 patients, 22272 (61.3%) patients received perioperative statin therapy, with a total of 19683 (54.2%) patients developing CSA-AKI. For the primary outcome, perioperative statin was associated with a significantly decreased risk of CSA-AKI (52.8% vs. 56.5%; adjusted Odds Ratio [OR], 0.865 [95% CI, 0.829-0.904]; p &lt; 0.001). Additionally, the occurrence of a composite measure including all-cause mortality and dialysis was statistically lower in patients who underwent perioperative statin therapy at 30 days (0.7% vs. 1.6%; OR, 0.485 [95% CI, 0.394-0.597]; p &lt; 0.001), as well as at one year (adjusted Hazard Ratio [HR], 0.632 [95% CI, 0.543-0.737], p &lt; 0.001). For the subgroup analysis, the association between perioperative statin and reduced CSA-AKI risk was greater among patients with chronic heart failure and undergoing on-pump CABG. Conclusions: Perioperative statin therapy was associated with significantly lower risks of CSA-AKI following CABG, and a composite measure including all-cause mortality and dialysis at both 30 days and one year. The preventive effect of perioperative statin was more pronounced in patients with chronic heart failure and undergoing on-pump CABG.
Abstract 4138730: Analysis of Coronary Artery Disease and COPD Mortality in Older Adults in the United States, 1999-2020: CDC Data on Geographic, Gender, and Racial Trends in Mortality
Authors: Muhammad Abdullah Naveed, Mohammad Alboushi Aldabagh, Ahila Ali, Faizan Ahmed, Muhammad Omer Rehan, Bazil Azeem, Rabia Iqbal, Mustafa Sajjad Cheema, Ramesh Daggubati, yasar sattar
Journal: Circulation (2024)

Background: The coexistence of coronary artery disease (CAD) and Chronic Obstructive Pulmonary Disease (COPD) represents a major health challenge for older adults in the United States. This study designed to examine the variations in mortality rates associated with CAD and COPD among individuals aged 65 and above from 1999 to 2020. Methods: Using the CDC WONDER database, a retrospective analysis was conducted on death certificate data from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and trends were evaluated using Average Annual Percentage Change (AAPC) and Annual Percentage Change (APC). The data were stratified by year, sex, race/ethnicity, and geographical region. Results: Between 1999 and 2020, coronary artery disease (CAD) and Chronic Obstructive Pulmonary Disease (COPD) were responsible for 881,875 deaths among adults aged 65 and older in the United States. The majority of these deaths occurred in medical facilities (40.3%) and in the decedents' homes (28.3%). The overall Age-Adjusted Mortality Rate (AAMR) decreased from 119.4 in 1999 to 86.9 in 2020, with an Annual Percent Change (APC) of -1.65 (p &lt; 0.000001). Notably, AAMRs moderately decreased from 1999 to 2018 (APC: -2.13, p = 0.025195), followed by a significant increase from 2018 to 2020 (APC: 2.95, p = 0.296341). Men had notably higher AAMRs than women (men: 139.8; women: 67.4), with both sexes experiencing almost equal declines over the study period. In terms of race, Whites had the highest AAMRs (106.5), followed by Native Americans (87.3), Blacks (60.7), Hispanics (51.0), and Asians (30.4). While all racial groups experienced decrease in AAMR , the decline was more signficance in Asians [AAPC: -3.26, (CI: -4.30 to -2.27) (p-value &lt; 0.000001)]. Geographically, AAMRs varied widely among states, with the highest mortality rates observed in the Midwestern region. Nonmetropolitan areas generally had higher AAMRs than metropolitan areas, and both showed decreases from 1999 to 2020, with greater declines in metropolitan areas. Figure 1 Conclusion: This research emphasizes the temporal trends and demographic discrepancies in mortality rates linked to CAD and COPD among older adults aged 65 and above in the United States. Despite an overall decrease in mortality rates, the recent rise necessitates additional investigation and focused interventions to address inequalities and improve outcomes in affected demographic groups.
Abstract 4138724: Artificial-Intelligence Based Tracking of Atrial Fibrillation Waves that Exit Pulmonary Veins Predicts Response to Ablation
Authors: Suhaas Anbazhakan, Ricardo Carlos Abad Juan, Samuel Ruiperez-Campillo, Miguel Rodrigo, Sanjiv Narayan
Journal: Circulation (2024)

Background: Pulmonary vein isolation (PVI) has been shown to reduce morbidity and mortality in patients with atrial fibrillation (AF). However, a major challenge is identify which patients will or will not respond. Hypothesis: We hypothesized that patients in whom AF activity predominantly exits the pulmonary veins (PV), identified using a novel artificial-intelligence (AI) wave tracking approach, will respond to ablation compared to patients in whom activity predominantly enters the PVs. Methods: We examined 26,640 electrograms in N=37 patients at AF ablation (age 66.3 ± 8.6 years, 13.5% females, 59.5% non-paroxysmal AF). Patients had AF recordings with multipolar catheters. We analyzed AF in 3X3 electrode grids, representing 1-3 cm 2 areas that approximate minimum tissue wavelength, near and remote from PVs. For each grid, we determined if AF waves exited PVs (i.e. active PVs) or entered PVs using AI-algorithms to assign electrode activations and grid vectors. We compared the numbers of waves that exited versus entered PVs relative to ablation success, defined using ambulatory ECGs over 1 year. Results: Spatial grids in Fig A show AF waves exiting the left superior PV in a 60 year old man with persistent AF whose PVI was successful. Fig B shows AF waves entering the PVs in a 70 year old woman whose subsequent PVI was unsuccessful. Examining 720 grids per patient (48 four second grids over 1 minute), AF waves varied considerably. Fig. C shows that more AF waves exited the PVs in patients with PVI success than in patients with PVI failure (p=0.03). Conversely, more AF waves headed towards the PVs in patients with PVI failure than with PVI success (p=0.04). Conclusions: In this study, AI-based wave identification enabled the identification of AF patients in whom PVI was more or less successful. The approach to determine active versus passive PVs could be extended to other metrics, including non-invasive tools.
Abstract 4138647: Opportunistic Screening for Cardiovascular Risk Using Chest X-Rays and Deep Learning: Associations with Coronary Artery Disease in the Project Baseline Health Study and Mass General Brigham Biobank
Authors: Jay Chandra, Vineet Raghu, Julia Karady, Audra Sturniolo, Nory Klop-Packel, David Maron, Fatima Rodriguez, Kenneth Mahaffey, Svati Shah, Michael Lu
Journal: Circulation (2024)

Introduction/Background: We previously demonstrated that an open-source deep learning model (CXR-CVD Risk) can predict 10-year major adverse cardiovascular events (myocardial infarction&amp;stroke), based on a chest radiograph image (CXR). As deep learning models are black boxes, establishing the biological processes the model captures to predict risk may help build understanding and trust in the model. Research Questions/Hypothesis: To test associations between deep-learning derived CXR-CVD Risk and markers of cardiovascular disease including coronary artery calcium (CAC) and stenosis ≥50% on CT, systolic blood pressure (SBP), ankle brachial index (ABI), and prevalent myocardial infarction and stroke. Methods/Approach: We conducted external validation of CXR-CVD-Risk in two cohorts: 1) 2,097 volunteers in the Project Baseline Health Study (PBHS) and 2) 1,644 Mass General Brigham Biobank (MGBB) patients. The CXR-CVD-Risk model estimated 10-year cardiovascular event risk (probability between 0 and 1) from a CXR image. We calculated linear associations with SBP, ABI, and the logarithm of coronary artery calcium and odds ratios for prevalent hypertension, myocardial infarction, stroke, and, in the MGBB, coronary artery stenosis ≥50%. Analyses were adjusted for age, BMI, sex, smoking status, and enrolling site. Results/Data: CXR-CVD-Risk was associated with CAC in both populations (PBHS: 1.11-fold increase, 95% CI: [1.07-1.16]; MGBB: 1.03-fold increase [1.01-1.05] in CAC per 1% increase in CXR-CV-Risk). CXR-CVD-Risk was also associated with SBP (0.59 mmHg increase [0.24-0.93] in SBP per 1% increase in CXR-CV-Risk), history of hypertension, history of myocardial infarction, and stroke. There was an inverse association with ABI (0.010 decrease [0.005-0.014] in ABI) in the PBHS. In the MGBB, CXR-CVD-Risk was associated with coronary artery stenosis ≥50% (OR = 1.004 [1.002-1.007]). All estimates are after covariate adjustment. Conclusion: This deep learning CXR risk score was associated with coronary artery disease (calcium score and stenosis ≥50%), CVD risk factors, and prevalent CVD. Opportunistic screening using CXRs in the electronic record can identify patients at high risk of CVD who may benefit from prevention.
Abstract 4138552: Prevalence, Complications, and Outcomes of Cardiogenic Shock in Breast Cancer Patients; A Population Based Study
Authors: Ahmad Taimoor Bajwa, Rabia Iqbal, Amina Jafar, Hnin Nadi Linn, Sujana Sanka, Sindhu Gollamudi, Mrunanjali Gaddam, Abbas Mallick
Journal: Circulation (2024)

Background: Cardiovascular disease and cancer are the leading causes of mortality in developed countries. Recent evidence suggests that these conditions share common underlying factors, such as inflammation and oxidative stress. However, there is a lack of data on the association between cardiogenic shock and cancer. Purpose: Our study aimed to investigate the prevalence and outcomes of cardiogenic shock in patients with a history of breast cancer. Methods: We conducted a retrospective analysis of data from the National Inpatient Sample Database (2018-2020) to identify patients with a primary diagnosis of breast cancer. We employed the International Classification of Diseases (ICD-10) diagnostic criteria. Our analysis focused on the impact of cardiogenic shock on mortality, morbidity, and resource utilization. We used chi-square tests for categorical variables and t-tests for continuous variables. Results: Our analysis identified 516,125 breast cancer patients admitted between 2018 and 2020, with 11.3% experiencing cardiogenic shock. The mean age of these patients was 64 years, with 1.2% males and 98.8% females. The mortality rate among patients with cardiogenic shock was 11.8%, which was significantly higher than the 4.1% mortality rate in those without cardiogenic shock (OR 1.9, CI 1.5-2.4, p-value &lt;0.05). Patients with cardiogenic shock were more likely to experience arrhythmias (OR 1.2, CI 1.13-1.4, p-value &lt;0.05) cardiac arrest (OR 2.1, CI 1.3-2.9, p-value &lt;0.05), acute kidney injury (OR 2.2, CI 2.1-2.3, p-value &lt;0.05), and systemic inflammatory response syndrome (SIRS) (OR 2.8, CI 2.5-3, p-value &lt; 0.05). These complications were associated with increased hospitalization costs, with patients with cardiogenic shock incurring $77,185 in costs compared to $64,300 for those without cardiogenic shock (p-value 0.00). Conclusion: Our study highlights the significant prevalence of cardiogenic shock in patients with breast cancer (11.3%) and its association with increased mortality rates. These findings highlights the importance of immediate management of cardiogenic shock to prevent adverse outcomes and emphasize the need for close monitoring and early intervention to minimize the risk of related complications. Multidisciplinary cooperation between cardiologists, intensivists, and oncologists is crucial during these critical situations.