tbuckley/cabot-search huggingface dataset:
Abstract 18093: History of Stroke as a Predictor of High Left Atrial Fibrosis in Patients With Persistent Atrial Fibrillation
Authors: Abdel Hadi El Hajjar, Lilas Dagher, Mario Mekhael, Charbel Noujaim, Nour Chouman, Hadi Younes, Ala' Assaf, chao huang, Nassir Marrouche
Journal: Circulation (2023)

Introduction: The relationship between left atrial (LA) remodeling and ischemic stroke (IS) risk in patients with atrial fibrillation (AF) is well-established. The DECAAF II trial is the largest MRI-based, multicenter, randomized study conducted on persistent AF patients. Hypothesis: Our research investigates whether a history of stroke correlates with the extent of atrial fibrosis, as determined by late gadolinium enhancement magnetic resonance imaging (LGE-MRI), among the DECAAF II trial population. Methods: Patients with persistent AF who underwent LGE-MRI were enrolled and categorized into two cohorts: those with a history of stroke and those without. Covariates were adjusted using propensity score matching, and atrial fibrosis was compared between groups. Participants were then subdivided according to three baseline atrial fibrosis cut-off values: ≥ 15%, ≥ 20%, ≥ 25%. Univariate logistic regression and adjusted multivariate analyses were applied to evaluate the impact of clinical characteristics and risk factors on baseline fibrosis. Results: From the 843 patients involved in the DECAAF II trial, 70 (8.3%) had a stroke history. Those with stroke history had higher rates of hypertension, diabetes, and hyperlipidemia. Seventy patients without a stroke history were matched to stroke patients using propensity score analysis, revealing a significantly higher fibrosis in the stroke group (20.2% vs. 8.1%, p = 0.017). Increasing age significantly predicted all three baseline fibrosis categories (≥15%, ≥20%, ≥25%). Notably, stroke history was as a predictor of baseline fibrosis ≥25%, even after adjusting for other risk factors and clinical characteristics (OR = 1.98 [1.14-3.43], p = 0.01). Conclusions: There is a significant correlation between high left atrial fibrosis level and an increased risk of ischemic stroke in patients with persistent atrial fibrillation. This suggests that atrial fibrosis may provide insights into stroke risk classification.
Abstract 17653: Neighborhood Deprivation and Cardiovascular Health in US Adolescents, National Health and Nutrition Examination Survey 2007-2018
Authors: Carissa M Baker-Smith, Sam Neally, Bonita E Falkner, Robert E Akins, Tiffany M Powell-Wiley
Journal: Circulation (2023)

Introduction: AHA “Life’s Essential 8” scores cardiovascular health (CVH) as good, intermediate or poor based on diet, physical activity, sleep, tobacco exposure, cholesterol, blood pressure, blood glucose, and body mass index. CVH of the US population remains suboptimal, and the relationship between neighborhood deprivation and CVH in youth has not been fully explored. Hypothesis: We hypothesize that high neighborhood deprivation is associated with intermediate/poor CVH in adolescents. Methods: Using 2007-2018 National Health and Nutrition Examination Survey data, we examined the relationship between neighborhood deprivation index (NDI) and CVH status in adolescents. NDI was created from 2010 US Census data and reflects neighborhood level income, housing, education, and poverty status. Higher NDI indicates greater neighborhood deprivation. NDI values were divided into tertiles for analysis. We used proc survey logistic to assess the odds of poor/intermediate CVH status among youth living within high and intermediate compared to low deprivation communities. The model was adjusted for age, sex, ethnicity-race, household reference education and marital status, family poverty, rural vs urban residence and Citizenship status. All analyses were conducted using SAS 9.4, p&lt;0.05 . Results: We evaluated data from 3894 individuals, representative of 57,195,556 US adolescents 13 to 18 years of age. Most adolescents were non-Hispanic white (67%), male (51%), US Citizens (96%), mean age of 15 years, with an even distribution of youth living within low, intermediate and high deprivation neighborhoods (Table 1). We identified 31% greater odds of intermediate/poor CVH status among youth living within the most deprived communities (Table 2). Conclusions: Greater NDI associates with worse CVH in US adolescents. Public health initiatives should consider using NDI to tailor efforts in designing intervention strategies to preserve CVH status in US adolescents.
Abstract 14103: Neighborhood Environmental Burden and Cardiovascular Health in the United States
Authors: Michael Liu, Vishal R Patel, ZhaoNian Zheng, Rishi K Wadhera
Journal: Circulation (2023)

Introduction: Little is known about the association between cumulative environmental burden and cardiovascular health. Methods: This national study of 71,659 US census tracts linked the CDC environmental burden index and social vulnerability index (SVI) to 2020 PLACES. Mixed-effects linear regression models were used to determine associations between cumulative environmental burden (air pollution, hazardous/toxic sites, built environment, transportation infrastructure, water pollution) and cardiovascular risk factors (hypertension, diabetes, obesity) and diseases (coronary heart disease, stroke) after adjustment for age, sex, SVI, rurality, region, and health care access. Results: Neighborhoods with the highest environmental burden (quartile 4), compared to those with the lowest burden (quartile 1), had greater SVI scores (0.64 vs 0.42) and a higher proportion of racial/ethnic minorities (34% vs 12%). After adjustment, quartile 4 neighborhoods had significantly higher rates of cardiovascular risk factors than quartile 1 neighborhoods, including hypertension (32.8% vs 32.1%, adjusted difference: 0.84% [95% CI: 0.71-0.98]), diabetes (12.2% vs 10.7%, 0.62% [0.53-0.70]), and obesity (33.6% vs 30.9%, 0.77% [0.60-0.94]). Similarly, quartile 4 neighborhoods had higher rates of cardiovascular diseases (Figure) . Results were consistent after geospatial- and covariate-based matching of quartile 4 and 1 neighborhoods. Associations between increasing environmental burden quartiles and cardiovascular risk factors and diseases were significantly more pronounced in most versus least socially vulnerable neighborhoods. Conclusion: Across US neighborhoods, cumulative environmental burden was dose-dependently associated with higher rates of cardiovascular risk factors and diseases, particularly in socially vulnerable communities. Efforts addressing poor environmental conditions may improve cardiovascular health and reduce inequities.
Abstract 13038: Predictive Value of Cardiac Function Parameters and NT-proBNP in Patients With Pulmonary Arterial Hypertension (PAH) Treated With Sotatercept in the STELLAR Trial
Authors: Vallerie V McLaughlin, Marius M Hoeper, David B Badesch, Ardeschir H Ghofrani, Simon R Gibbs, Mardi Gomberg-Maitland, Ioana R Preston, Rogerio Souza, Aaron B Waxman, jianxin lin, Amy O Levonas, Janethe de Oliveira Pena, Marc Humbert
Journal: Circulation (2023)

Background: Sotatercept is an activin signaling inhibitor under investigation for PAH. Goal: Evaluate the prognostic utility of hemodynamic and cardiac function parameters in PAH patients receiving sotatercept vs placebo. Methods: Participants in STELLAR, a phase 3 trial (NCT04576988), were randomized 1:1 to sotatercept (0.3 up to 0.7 mg/kg once every 3 weeks) or placebo added to background therapies. Eligible participants had WHO functional class II-III, pulmonary vascular resistance ≥400 dyn·s·cm -5 , and 6-minute walk distance 150-550 m. This post-hoc analysis assessed clinical worsening events at last measurement by baseline echocardiography (ECHO), right heart catheterization (RHC), and NT-proBNP parameters. Clinical worsening events were assessed up to week 60. Uni-/multivariate-adjusted Cox models identified baseline parameters significantly (p&lt;0.05) associated with events. Parameters with p-values &lt;0.10 were carried forward to multivariate model. Receiver operating characteristic curves assessed discriminatory utility of cutoff values. Results: Of the significant univariate predictors, only study treatment and log2 NT-proBNP were significant independent predictors of clinical worsening in multivariate model (Table). Each unit increase in log2 NT-proBNP at baseline was associated with a 61% increase in risk (HR 1.61, 95% CI 1.39, 1.88; p&lt;0.001). The AUC for log2 NT-proBNP (0.76 [95% CI 0.67, 0.85]) showed good performance. The optimal NT-proBNP cutoff value was 322 pg/mL. Sotatercept treatment was associated with an 81% reduction in risk vs placebo (HR 0.19, 95% CI 0.10 to 0.38; p&lt;0.001), even after adjusting for NT-proBNP. Conclusions: This post-hoc analysis demonstrated that NT-proBNP is a strong predictor of clinical worsening events in PAH patients. Sotatercept treatment offered protection beyond that achieved with standard therapies alone, even after adjusting for the impact of NT-proBNP.
Abstract 13241: Long-Term Clinical Outcome After Transcoronary Cardiosphere-Derived Cell Infusion in Patients With Single Ventricle Congenital Heart Disease
Authors: Kenta Hirai, Hidemasa Oh
Journal: Circulation (2023)

Introduction: Although transcoronary infusion of cardiosphere-derived cells (CDCs) in patients with single ventricles provides short-term improvement in cardiac function, the long-term efficacy is still unknown. Hypothesis: We tested the hypothesis that CDC infusion is associated with improved long-term clinical outcome in patients with single ventricles and heart failure. Methods: Patients were enrolled in the TICAP phase 1 (Transcoronary Infusion of Cardiac Progenitor Cells in Patients With Single Ventricle Physiology) and PERSEUS phase 2 (Cardiac Progenitor Cell Infusion to Treat Univentricular Heart Disease) trials between January 5, 2011, and January 30, 2015. The inclusion criteria were that patients were aged &lt;6 years who were diagnosed with single ventricle lesions undergoing stage 2 (bidirectional Glenn) or stage 3 (total cavopulmonary connection) palliation. Medical records of patients with single ventricles were obtained and analyzed as a control group who were eligible but were treated by staged palliation alone. We evaluated the effectiveness of CDCs using an integrated cohort study in 93 patients with single ventricles, including 40 patients who received CDC infusion and 53 controls. Results: At the time of this study, 35 patients with CDC infusion and 43 controls were alive without cardiac transplantation, with mean follow-up of 10.0±1.2 years. The absolute changes in brain natriuretic peptide ( P = 0.015), atrioventricular regurgitation grade ( P = 0.018), and weight for age ( P &lt; 0.001) from baseline to last follow-up showed significant improvements in CDC-treated patients compared with controls. Survival rate did not differ between the 2 groups (log-rank P = 0.351), whereas overall patients treated by CDCs had lower incidents of late failure ( P = 0.043) and adverse events ( P = 0.036) compared with controls. Multivariate proportional hazard regression analyses showed that CDC infusion was associated with lower risks of late failure ( P = 0.003) and adverse events ( P = 0.013). Conclusions: Intracoronary delivery of CDCs in patients with single ventricles did not improve all-cause mortality rate but significantly reduced the incidence of late failure and adverse events at 8 years of follow-up.
Abstract 17855: Improvement of Mitral Valve Regurgitation Severity Following Catheter Ablation for Atrial Fibrillation
Authors: Kusha Rahgozar, Sam Apple, Sheetal vasundara MATHAI, Majd Al Deen Alhuarrat, Qussay Marashly, Mohamed Gabr, Olga Reynbakh, Ulrich P Jorde, Luigi Di Biase
Journal: Circulation (2023)

Background: The presence of concomitant mitral valve regurgitation (MR) in patients with atrial fibrillation (AF) is well known, yet the degree of MR improvement after catheter ablation is not well studied. We investigated the effect of catheter ablation on the degree of MR in patients with baseline ≥moderate MR and AF. Methods: We retrospectively reviewed charts of AF catheter ablation patients at Montefiore Medical Center (2018-2019). Patients with prior or subsequent mitral valve surgeries were excluded. Degree of MR, assessed through echocardiograms, was compared at baseline and follow-up. Early follow-up was defined as 6 months post-ablation. Patients were stratified by left atrial size and left ventricular ejection fraction (LVEF) to assess the influence of these parameters on MR severity after ablation. Results: A total of 202 patients were included in our analysis with an average age of 64 years. At baseline there were 149 patients (74%) with &lt;moderate MR and 44 patients with ≥moderate MR (22%). There was a statistically significant reduction in the number of patients with ≥moderate MR following ablation both at early and late follow-up (p&amp;lt;0.0001, Figure 1). Our results remained statistically significant after stratification by LVEF (&lt;40% vs ≥ 40%) and LA dimension (&lt;4.5cm vs ≥ 4.5cm) (p&amp;lt;0.001, Figure 2). Conclusions: Catheter ablation of AF improved the degree of MR severity in patients with baseline ≥moderate MR and AF. Our findings were preserved across stratification by left atrial size and LVEF subgroups. Further investigation is necessary to validate our findings.
Abstract 16530: Impact of Hyperuricemia on 5-year Clinical Outcomes in Patients With Critical Limb Ischemia Underwent Percutaneous Transluminal Angioplasty
Authors: Seong Joon An, Woo Jin Ahn, Byoung Geol Choi, Seung-Woon Rha, Se Yeon Choi, Jae Kyeong K Byun, Jinah Cha, Sujin Hyun, Soohyung Park, Dong Oh O Kang, Eun Jin J Park, Cheol Ung Choi
Journal: Circulation (2023)

Background: A growing evidence on the correlation between hyperuricemia and cardiovascular disease (CVD) has been previously reported. However, there have been limited data on the impact of hyperuricemia on long-term clinical outcomes in patients with critical limb ischemia (CLI) who underwent percutaneous transluminal angioplasty (PTA). Methods: A total, 425 peripheral artery disease (PAD) patients who underwent PTA for CLI were enrolled. The patients were divided into the hyperuricemia group (n=101) and the normal group (n=324). The primary endpoint was major adverse cerebral and cardiovascular event (MACCE), including death, myocardial infarction (MI), any coronary revascularization, and stroke, up to 5 years. The secondary endpoint was a major adverse limb event (MALE), including any repeated PTA, and target extremity surgery (TES). Inverse probability weighting (IPTW) analysis, derived from the logistic regression model, was performed to adjust for potential confounders. Results: After IPTW matching analysis, compared to the normal group, the hyperuricemia group was associated with a higher incidence of MACCE (20.7% vs. 13.6%, hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.15 - 2.38, p=0.006) including non-cardiac death (11.7% vs. 6.3%, HR: 1.95, 95% CI: 1.19 - 3.19, p=0.006) and MALE (47.7% vs. 36.0%, HR: 1.62, 95% CI: 1.23-2.13, p=0.001) including non-target extremity revascularization (TER) (15.0% vs. 6.8%, HR: 2.42, 95% CI: 1.52-3.84, P&lt;0.001). Conclusions: In the present study, hyperuricemia was associated with worse clinical outcomes in patients with CLI following PTA during 5-year clinical follow-up. Efficacy of controlling hyperuricemia in improving clinical outcomes should be evaluated in the further studies.
Abstract 15906: Cardiovascular Effects of CAR-T Cell Therapy: A Prospective Study
Authors: Benedicte Lefebvre, Yu Kang, Azin Vakilpour, Takeshi Onoue, Noelle Frey, Priya Brahmbhatt, Brian Huang, Kemi Oladuja, Daniel Koropeckyj-Cox, Courteney Wiredu, Amanda M Smith, Jesse Chittams, Joseph CARVER, Marielle Scherrer-Crosbie
Journal: Circulation (2023)

Background: Previous retrospective studies have shown that CAR-T cell therapy may be associated with major adverse cardiovascular events (MACE) especially in context of cytokine release syndrome (CRS) events. Objectives. The aim of this prospective observational study was to define the occurrence of MACE in adults undergoing treatment with CAR-T cell therapy and identify associated risk factors. Methods: Vital signs, blood samples and an echocardiogram were collected prior to, two days, one week, one month, and six months after CAR-T cell infusion, and chart consulted at 12 months. In the event of CRS, an echocardiogram was repeated within 72 hours. MACE were defined as cardiovascular death, symptomatic heart failure, acute coronary syndrome, ischemic stroke, and de novo cardiac arrhythmia. Results: A total of 44 patients were enrolled (58 ±11 years-old, 77 % male). The median follow-up was 487 days (258-622 days). There were 24 episodes of CRS in 23 patients (52%) (13 with grade 1, 10 with grade 2, and one with grade 3) with a median time to CRS of 4 days. Two patients had MACE (HFpEF and atrial fibrillation) within one year, six and seven days after CAR-T cell infusion respectively. There was no change in left ventricular ejection fraction (LVEF), however, a modest decrease in global longitudinal strain (GLS) was noted. Conclusions: There were few cardiac effects associated with contemporary CAR-T cell therapy. A small decline in LV mechanics was detected. As MACE occurred after CRS episodes, aggressive treatment and close follow-up during CRS events are essential.
Abstract 18559: Sex Differences In Acute Myocardial Infarction Related Cardiogenic Shock Across Different Levels Of Care
Authors: Sajal Datta, Apurva Sharma, Kylie Roslin, Rebecca Smoller, sana ahmad, Moein Mokhtari, Gerin R Stevens, Simon Maybaum, Miguel Alvarez Villela
Journal: Circulation (2023)

Background Previous registry data have suggested important sex-based differences in management and clinical outcomes for patients with acute myocardial infarction related cardiogenic shock (AMI-CS). Methods: We classified 11 hospitals in a metropolitan health network as different levels of care (LOC) for CS based on their highest mechanical circulatory support (MCS) capability; L1: Durable LVAD, L1A: ECMO, L2: Impella. We identified all patients ≥ 18 years of age treated for AMI-CS (ICD-10 diagnosis codes) from 2016 to 2022. Sex differences in management and hospital outcomes are reported. Descriptive statistics and logistic regression were performed using PRISM version 9. Results: In our cohort (n=1,956), women were a minority in L1 (30%) and L1A (31%) and L2 (41%) and were older with decreasing LOC, L1: 72y. (61-81), L1A: 74y. (64-82) and L2: 81y. (72-88), p&lt;0.01 for trend.Across LOC, left heart catheterization (LHC) and percutaneous coronary interventions (PCI) were used similarly in women and men, while coronary artery bypass grafting (CABG) in surgical centers (L1 and L1A) and MCS in PCI centers (except L1A) were used more frequently in men (Figure). After adjustment for LOC and other relevant covariates, female sex (aOR: 1.35, 95%CI: 1.09-1.67; p=0.007), age (aOR: 1.04, 95%CI: 1.03-1.05, p&lt;0.001) and admission cardiac arrest (aOR: 5.36, 95%CI: 3.63-8.54, p&lt;0.001) were associated with higher hospital mortality. Conclusion: In a metropolitan health system, despite similar rates of LHC and PCI across different LOC, women with AMI-CS received less CABG and MCS than men and had higher adjusted hospital mortality.
Abstract 16310: Adherence of Randomized Controlled Trials in Heart Failure to Consort Reporting Standards
Authors: Mohamed Bella Jalloh, Veronica A Bot, Cristiana Borjaille, Harriette G Van Spall
Journal: Circulation (2023)

Introduction: Randomized control trials (RCTs) have changed care in Heart Failure (HF), but the reliability of results is contingent on trial validity and transparent reporting. The Consolidated Standards of Reporting Trials (CONSORT) checklist was developed in 1996 and subsequently updated to guide the design and reporting of RCTs, but the adherence of HF RCTs to CONSORT remains poorly understood. This study sought to evaluate the adherence of HF RCTs to the CONSORT 2010 update and to examine temporal trends in trial reporting in HF trials. Methods: We searched MEDLINE, EMBASE and CINAHL for HF RCTs in high-impact journals between 2000 and 2020. The primary outcome measure was RCT CONSORT statement or CONSORT extension reporting presented as mean CONSORT score. Descriptive statistics were calculated for CONSORT scores. We used the Jonckheere-Terpstra test to examine temporal trends and employed multivariable linear regression to evaluate the association between prespecified trial characteristics and the mean CONSORT score. Results: There were 221 RCTs, and mean CONSORT score was 69.7% (SD 11.5). Adherence to CONSORT reporting standards improved from 61.5% (SD 11.1) in 2000-2003 to 76.5% (SD 8.8) in 2016-2020 ( P &lt;.001). Adherence was greater in two-group parallel individual-level RCTs (β =6.22 95% CI: 3.14, 9.30; P &lt;.001) than in other trial types. Drug (β= -3.91, 95% CI: -7.32, -0.50; P &lt;.001) and device/surgical (β= -2.82 (95% CI: -7.56, 1.93; P &lt;.001) interventions were associated with lower adherence to CONSORT reporting standards than other interventions, while publication after 2010 was associated with greater adherence (β=10.96, 95% CI: 8.37, 13.55; P &lt;.001). Funding source did not appear to have an association with adherence (β=1.51, 95% CI: -1.53, 4.55; P =.33). Conclusions: Among HF RCTs published in high-impact journals, adherence to CONSORT reporting standards has improved over time, but remains variable and suboptimal overall.
Abstract 16638: 4D Flow MRI Analysis of the Left Atrial Hemodynamics After Atrial Fibrillation Surgery
Authors: Motohiro Maeda, shunichiro sakamoto, ATSUSHI HIROMOTO, KENJI SUZUKI, Yosuke Ishii
Journal: Circulation (2023)

Introduction: Postoperative anticoagulation therapy after atrial fibrillation (AF) surgery remains a controversial topic because left atrial (LA) blood flow velocity and pattern remain unclear. This study utilizes four-dimensional (4D) flow magnetic resonance imaging (MRI) to analyze postoperative LA hemodynamics following various atrial fibrillation surgeries. Methods: This retrospective study included nine patients (mean age, 73 ± 8 years; range, 56-83 years) who underwent AF surgeries from August 2021 to June 2022. Maze surgery was performed in 3, pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC) in 3, and the LAAC alone in 3 patients. Postoperative 4D flow MRI scans of the left atrium were performed, and image analysis was conducted. Blood flow velocity in the left atrium was measured, with velocities below 10 cm/s considered flow stasis. The percentage of flow stasis within one systolic-diastolic cycle was evaluated as % stasis. Furthermore, the presence or absence of a physiological vortex flow was assessed from the flow images. Results: Sinus rhythm was postoperatively maintained in 6 patients, and 3 patients were analyzed in AF. The left atrial % stasis was significantly low in the sinus rhythm group (46.0 ± 22.7 in the sinus rhythm group vs. 100 in the AF group, p=0.027). The absence of vortex flow was observed during sinus rhythm in one patient after Maze surgery. Conversely, vortex flow was identified during AF in the patient after LAAC, being accompanied by moderate mitral regurgitation. Conclusions: Any type of AF surgery does not always provide physiological LA blood flow. Further, 4D flow MRI analysis contributes to our understanding of the discrepancy between ideals and reality which may or may not require anticoagulant therapy regardless of postoperative rhythm.