tbuckley/cabot-search huggingface dataset:
Abstract 15585: Robotic versus Manual Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis
Authors: Muhammed K Elfaituri, Ala Khaled, Ahmed BenGhatnsh, Ahmed Elfaituri, Hazem Abdelkarem A Faraj, Ahmed Msherghi
Journal: Circulation (2023)

Introduction: Robotic percutaneous coronary intervention (PCI), a recent development in managing coronary artery disease, offers potential advantages such as enhanced precision, stability, and radiation protection over traditional manual PCI. Despite these promises, a comprehensive and current comparison of safety and effectiveness between these methods remains to be established. Hypothesis: This study aims to evaluate and compare the outcomes of robotic and manual PCI. Methods: A comprehensive search of electronic databases, including PubMed, EMBASE, and the Cochrane Library, was carried out up to May 2023, aiming to identify studies comparing robotic and manual PCI. The primary outcomes were major cardiovascular events and myocardial infarction rates, and secondary outcomes included contrast volume used (in mL), procedural time (in minutes), and fluoroscopy time (in minutes). Relative risk (RR) for categorical outcomes and mean difference for continuous outcomes were calculated using a random-effects model. All statistical analyses were performed using R software (version 4.0.3) with the metafor and meta packages. Results: Our search strategy identified eight studies, including 2339 patients (703 in the robotic group and 1636 in the manual group). The pooled RR of major cardiovascular events was 0.91 (95% CI: 0.48-1.70, P=0.76, I2=0%), and myocardial infarction rate was 0.88 (95% CI: 0.43-1.83, P=0.73, I2=0%), indicating no significant difference between robotic and manual PCI. Notably, robotic PCI was associated with a statistically significant mean reduction in the contrast volume of -14.28 mL (95% CI: -23.65 to -4.93, P&lt;0.01, I2=0%). However, the differences in procedural time and fluoroscopy time did not reach statistical significance, with 2.73 minutes (95% CI: -4.71 to 10.17, P=0.47, I2=62%) and -2.15 minutes (95% CI: -4.35 to 0.05, P=0.06, I2=51%) respectively. Conclusions: Compared to its manual counterpart, this study highlights that robotic PCI significantly decreases contrast volume use while maintaining similar outcomes in other procedural parameters. This underscores robotic PCI's potential in interventional cardiology, also indicating the need for more high-quality trials for long-term outcome confirmation.
Abstract 13904: Association Between Pre-Ablation and Post-Ablation Neutrophil-Lymphocyte Ratio and Atrial Fibrillation Recurrence: A Meta-Analysis
Authors: Sai Prasanna Lekkala, Sai Priyanka Mellacheruvu, Sahas Reddy Jitta, Himaja Dutt Chigurupati, Sivaram Neppala, Gurjot Singh, Puneeteshwar Khela, Manali Patel, Hrushikesh Reddy Pamreddy, Lavanya chowdary Kannekanti, Karanvir Singh Gill, Mohmed Junaid Hingora, Rupak Desai
Journal: Circulation (2023)

Introduction: Recurrence of atrial fibrillation (AF) has become prevalent in patients who have had catheter ablation. A high neutrophil-lymphocyte ratio (NLR) may predict the risk of AF recurrence. However, the research is inconclusive. This meta-analysis examined the importance of easy access and cost-effective pre and post-ablation NLR values as predictors of AF recurrence in post-ablation patients. Methods: We conducted a literature search in PubMed, SCOPUS, and Google Scholar to identify the relevant studies through May 2023. Random effects models were employed to estimate the pooled odds ratio (OR) of pre and post-NLR and AF recurrence. I2 statistics and leave-one-out sensitivity analysis were used to report inter-study heterogeneity. p&lt;0.05 was significant. Results: We retrieved 270 studies from the literature search, and seven studies were included in this meta-analysis, in which 1983 participants who had AF recurrence after undergoing ablation were analyzed. There are 5 retrospective and 2 prospective studies with a mean follow-up of 20.5 months. The pooled analysis showed the unadjusted odds ratio (OR) of AF recurrence for pre-ablation NLR as 1.33 (95% CI: 1.04-1.71, p&lt;0.01, I2 = 95.49%) and the adjusted OR as 1.45 (95% CI: 0.87-2.43, p&lt;0.01, I2 = 95.1%) (Fig. 1). For post-ablation NLR, the unadjusted OR was 1.21 (95% CI:1.09-1.36, p&lt;0.01, I2 = 85.9%), and the adjusted OR was 1.28 (95% CI: 0.93-1.76), demonstrating significant heterogeneity (I2 =95.32%) with a p-value of &lt;0.01 (Fig.1). Conclusion: NLR had a significant association with predicting the recurrence of AF. We recommend clinicians add a simple NLR blood test to their diagnostic modalities to detect AF recurrence.
Abstract 416: Conversion From Initial Non-Shockable Rhythm to Shockable Rhythm During Resuscitation With a Public Access Defibrillator Compared With Initial Shockable Rhythm; Incidence and Survival Outcomes
Authors: Amy Kernaghan, Adam Harvey, Hannah Currie, Raymond Bond, Dewar Finlay, David McEneaney, Jennifer Adgey
Journal: Circulation (2023)

Incidence of initial non-shockable rhythm during cardiac arrest is increasing and is associated with poorer outcomes. The aim of this analysis was to study non-shockable to shockable rhythm conversion treated using a public access defibrillator (PAD) and to study survival rates related to initial shockable rhythm. HeartSine PAD data were collected between October 2012 to May 2023. The dataset consisted of data downloaded from PADs, and data recorded in case report forms. Initial rhythm and conversion to shockable rhythm were determined. First shock success (FSS) was defined as the termination of the shockable rhythm for at least 5 seconds. Chi-squared test was applied to determine if there was difference in outcomes between those patients with: a shockable rhythm, non-shockable rhythm that converted to shockable, and non-shockable rhythm that did not convert to a shockable rhythm. Of the 6877 cases submitted initial shockable rhythm could be determined for 6736 cases. For the 30.5% (2053/6736) of cases with an initial shockable rhythm, patient outcome was reported for 1923, and 62.9% (1209/1923) survived to hospital admission. Incidence of initial non-shockable rhythm was 69.5% (4683/6736). Change to a shockable rhythm could be determined for 4664 cases and occurred in 5.0% (233/4664). A shock was delivered in 94.8% (221/233) of these cases. FSS could be determined for 165 cases. FSS was 85.5% (141/165). Patient outcome was reported for 87.6% (204/233) where 22.5% (46/204) resulted in survival to hospital admission. For the 95% (4431/4664) of non-shockable cases that did not convert to a shockable rhythm, patient outcome was reported for 82.2% (3644/4431), where 10.8% (395/3644) of patients survived to hospital admission.Thus, conversion from non-shockable to shockable rhythm had improved survival compared to patients who did not convert. Furthermore, when initial rhythm was shockable significantly higher survival to hospital admission was recorded.
Abstract 16697: Chronic Venous Insufficiency is Associated With Increased Risk of Limb Events in Patients Undergoing Lower Extremity Revascularization
Authors: gwangsil kim, Connie N Hess, Judith A Hsia, Marc P Bonaca
Journal: Circulation (2023)

Introduction: Chronic venous disease is associated with an increased risk of cardiovascular (CV) events, possibly due to systemic inflammation and increased oxidative stress. Hypothesis: To evaluate the impact of chronic venous insufficiency (CVI) on the risk of subsequent CV and limb events in patients undergoing lower extremity revascularization (LER). Methods: Real-world data from the University of Colorado health system, which serves a diverse population of rural and urban patients, were extracted from TriNetX (Cambridge, MA, USA) for patients undergoing LER from 2015 to 2022. The cohort was divided into those with vs without concomitant CVI and assessed for subsequent limb events (defined as major amputation or re-intervention) and CV events (defined as stroke, myocardial infarction or death). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated between propensity score (PS)-matched patients with and without CVI. Results: Among 5090 patients with LER, the 1370 (27%) with concurrent CVI were older (67±14 vs. 66±14, p &lt;0.01) and had more comorbidities such as hypertension (72 vs. 58%, p &lt;0.01), diabetes (40 vs. 30%, p &lt;0.01), chronic kidney disease (32 vs. 18%, p &lt;0.01), and obesity (28 vs. 15%, p &lt;0.01). During the 2-years following LER, occurrence of CV (37.2% vs. 31.9%) and limb events (27.0% vs. 18.0%) was higher among patients with CVI (upper panel). After PS matching, limb events remained significantly more frequent (HR 1.53, 95% CI 1.273-1.829) in the group with CVI (lower panel). Conclusion: Among patients undergoing LER, the presence of concurrent CVI identifies a population at significantly increased risk for subsequent limb events.
Abstract 14413: Contemporary Prevalence, Comorbidity Burden, and Treatment of Overweight and Obesity: Insights From the Multicenter Mass General Brigham Healthcare System
Authors: John W Ostrominski, Austen M Smith, Ozan Unlu, David J Zelle, Heather Baer, Michela Tucci, Anthony Fabricatore, Briain O Hartaigh, Joshua Toliver, Wojciech Michalak, Kelly Olsson, Christopher P Cannon, Caroline Apovian, Benjamin Scirica, Alexander J Blood
Journal: Circulation (2023)

Background: Real-world evidence is critical to identify treatment gaps and inform healthcare service design, but contemporary anti-obesity medication (AOM) use patterns are sparsely reported. Aims: To describe the prevalence of obesity/overweight, evidence-based obesity-related conditions (ORCs), and AOM use among eligible patients, with a focus on cardiovascular disease (CVD). Methods: In this cross-sectional analysis of the multicenter Mass General Brigham healthcare system spanning 2018-2022, we identified all adult patients eligible for AOM (BMI 27-29.9 kg/m 2 with ≥1 ORC or BMI ≥30 kg/m 2 ). The prevalence of ORCs was ascertained using administrative codes and available EHR data. Prescription of FDA-approved AOM by BMI category, number of ORCs, number of key CVD risk factors, and the presence of prior MACE were also evaluated. Results: Of 2,922,522 individuals who met inclusion criteria, 998,234 (34%) were eligible for AOM (mean age, 49 years; 53% female). Of these, 30%, 41%, 18%, and 11% had a BMI (kg/m 2 ) of 27-29.9, 30-34.9, 35-39.9, and ≥40, respectively. Prior metabolic/bariatric surgery was seen in 2.3%. Musculoskeletal disorders (54%), dyslipidemia/hyperlipidemia (35%), and hypertension (32%) were the most common ORCs, with ≥2 ORCs observed in 58%. Prescription of any FDA-approved AOM was observed in only 1.2% of all eligible patients. Liraglutide 3.0 mg (58% of all AOM) was the most prescribed AOM. AOM prescriptions increased modestly with higher BMI, ORC burden, and number of CVD risk factors ( Figure ). Among those with prior MACE (11%), 1.5% (1.0% if without T2DM) were prescribed FDA-approved AOM. Conclusions: Although more than 1 in 3 contemporary patients in a large healthcare system are eligible by guidelines and FDA labeling, AOM prescription remains exceedingly low, even among high-risk persons with severe obesity and established CVD. Novel care delivery pathways are needed to accelerate closure of these considerable implementation gaps.
Abstract 17836: ATP Citrate Lyase Coordinates Lipid Synthesis and Expression Cell Cycle Regulating Genes to Promote Vascular Remodeling in Pulmonary Arterial Hypertension
Authors: Charlotte Romanet, Yann Grobs, Sarah-Eve Lemay, Alice Bourgeois, Tsukasa Shimauchi, MABROUKA SALEM, Sandra Martineau, Sandra Breuils Bonnet, Melanie Sauvaget, Charlie Theberge, Francois Potus, Steeve Provencher, Olivier Boucherat, Sebastien Bonnet
Journal: Circulation (2023)

INTRODUCTION: Pulmonary arterial hypertension (PAH) is characterized by progressive obliteration of distal pulmonary arteries (PAs) due to enhanced proliferation, suppressed apoptosis and increased migration of PA smooth muscle cells (PASMCs). Like cancer cells, this abnormal phenotype of PASMCs is driven by epigenetic reprogramming and fueled by a metabolic shift towards glycolysis. ATP-Citrate Lyase (ACLY) is a nuclear-cytosolic enzyme that converts citrate to acetyl-CoA, which serves as substrate for histone acetyltransferases regulating gene expression and as a building block for lipid synthesis (required for proliferating cells to generate membrane). ACLY has recently emerged as a key player and therapeutic target in cancer. However, its role in PAH is unknown. METHODS/RESULTS: ACLY, p-ACLY (active form) expression and its nuclear localization were increased in distal PAs and PASMCs from PAH patients (WB and IF, p&lt;0.01). Similar results were observed in the Sugen/Hypoxia (Su/Hx) animal models. In vitro , ACLY inhibition (BMS, siRNA) decreases PAH-PASMCs proliferation (PLK1; Ki67; p&lt;0,01) and survival (Survivin; Annexin-V; p&lt;0.01). These effects were accompanied with a decreased glycolysis (PFKBP3, p-PDH) and increased OCR/ECAR (Seahorse). Moreover, ACLY inhibition decreases the PAH-PASMCs migratory potential. Using RNA-Seq, we demonstrated that inhibition of ACLY downregulates genes associated with cell division and lipid synthesis. Further experiments revealed that ACLY promotes nuclear acetyl-CoA production favoring acetylation of H3K27, H3K9, H4, and GCN5-mediated transcriptional activation of genes responsible for cell cycle progression. Accordingly, we demonstrated that GCN5 inhibition decreases proliferation and survival of PAH-PASMCs (Ki67, AnnexinV). In vivo , Acly loss-of-function targeted to SMCs conferred protection against Su/HX-induced PAH in mice (echo and RHC). Accordingly, pharmacological inhibition of ACLY using BMS-303141 or Bempedoic Acid improved hemodynamics (RVSP, mPAP, SV, TPR, p&lt;0.05) and vascular remodeling (EVG, p&lt;0.05) in Su/Hx rats with established PAH. CONCLUSION: We demonstrated that ACLY inhibition may represent a novel therapeutic avenue to improve vascular remodeling in PAH.
Abstract 13586: Sex-Specific Association Between Perivascular Inflammation and Plaque Vulnerability
Authors: Daisuke Kinoshita, Keishi Suzuki, Haruhito Yuki, Takayuki Niida, Daichi Fujimoto, Yoshiyasu Minami, Damini Dey, Hang Lee, Iris McNulty, Junya Ako, Maros Ferencik, Tsunekazu Kakuta, Ik-kyung Jang
Journal: Circulation (2023)

Introduction: Females were reported to have lower levels of perivascular inflammation assessed by pericoronary adipose tissue (PCAT) attenuation than males. However, the sex-specific difference in the association between perivascular inflammation and plaque vulnerability is unknown. Objective: The aim of this study was to investigate the sex-specific association between perivascular inflammation and plaque vulnerability. Methods: Patients who underwent coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) were enrolled. All images were analyzed at a core laboratory. The level of perivascular inflammation was assessed by PCAT attenuation on CTA and plaque vulnerability by OCT. Patients were divided into three groups according to the tertile range of PCAT attenuation (T1: ≤ -72.7 HU, T2: -72.8 - -66.9 HU, or T3: ≥ -67.0). Results: A total of 888 lesions in 363 patients were included; 176 lesions in 77 females (2.3 plaques per patient) and 712 lesions in 286 males (2.5 plaques per patient). Females were older (median [IQR] age: 71 [66-78] vs. 64 [56-72], P &lt;0.001) but had less severe coronary artery disease than males. Thin-cap fibroatheroma (TCFA) was more prevalent, and lipid index and macrophage grade were greater in T3 group than T1 group in females, but there was no difference among three groups in males (T3 vs. T2 vs. T1 in females: 45.5%* vs. 34.2% vs. 21.0; 1448 ± 1183* vs. 1140 ± 1000 vs. 942 ± 975; 14 ± 12* vs. 9 ± 14 vs. 7 ± 10; respectively; T3 vs. T2 vs. T1 in males: 32.0% vs. 27.1% vs. 25.0; 1273 ± 1140 vs. 1191 ± 1128 vs. 1060 ± 1138; 9 ± 12 vs. 8 ± 9 vs. 7 ± 10; respectively; * indicates P &lt;0.05 vs. T1) (Figure). Conclusions: A higher level of perivascular inflammation was associated with higher plaque vulnerability in females, but not in males.
Abstract 15814: Imaging Local and Systemic Reactive Oxygen Species After Ischemia-reperfusion Injury in Swine With Multimodal <sup>18</sup> F-ROStrace PET/CT and CMR
Authors: Sophia Swago, Elizabeth W Thompson, Abhijit Bhattaru, Brianna F Moon, Giovanni Ferrari, Estibaliz Castillero, Evan Gallagher, Meagan Mcmanus, Victor A Ferrari, Robert Gorman, Cory Tschabrunn, Robert H Mach, Joel S Karp, Walter R Witschey, Paco E Bravo
Journal: Circulation (2023)

Introduction Reperfusion injury after myocardial infarction (MI) can cause additional tissue damage and is associated with adverse outcomes, and inflammation of extra-cardiac tissue may occur post-MI. In this study, we used positron emission tomography (PET) radiotracer [18F]ROStrace to image reactive oxygen species (ROS) in myocardium and in extra-cardiac tissues in a swine model of subacute ischemia-reperfusion injury. Methods The mid left anterior descending coronary artery was occluded in three swine for 90 minutes, followed by reperfusion. Baseline and post-MI ROStrace data were acquired 3 days post-MI on the long axial field-of-view PennPET Explorer PET/CT system. A [82]Rb scan was acquired to calculate myocardial blood flow (MBF). Regions of interest (ROIs) were drawn in brain, lungs, bone marrow, spleen, skeletal muscle, myocardium (baseline) and infarcted and non-infarct myocardium (post-MI). ROStrace fractional uptake rate (FUR) was calculated in all ROIs. Cardiac FUR was corrected for MBF. Paired T-tests and Cohen's d effect size (ES) were used to evaluate the effect of MI on ROStrace activity in cardiac and extra-cardiac tissues. Cardiac MRI was done to quantify infarct size. Results In extra-cardiac tissues, MI had a nonsignificant medium effect on ROS in bone marrow (ES = 0.54, p = 0.45) and spleen (ES = 0.60, p=0.41), and a nonsignificant large effect in skeletal muscle (ES = 1.24, p = 0.17). No effect was seen in brain and lungs. In the heart, MI had a significant large effect on ROS in the region of the infarct, compared to baseline (ES = 3.84, p = 0.02) (Fig. 1). Infarct size on late gadolinium enhanced MRI ranged from 16.73 to 33.62% of the myocardium. Conclusion For the first time, systemic and local effects on ROS after MI were directly imaged using whole-body [18F]ROStrace PET. We found that ROS are increased in the infarcted myocardium in the subacute phase, and MI leads to moderate-to-large effects in ROS levels in hematopoietic tissues and skeletal muscle.
Abstract 17616: The Association Between Hypokinetic Left Ventricle And Pulmonary Embolism
Authors: Azka Naeem, Casey Sciandra, Armando Seitllari, Supraja Achuthanandan, Marlon E Rivera Boadla, Dmitriy Zadushlivy
Journal: Circulation (2023)

Case Description: A 49-year-old male patient working as a public transport driver presented with syncope lasting a few minutes, followed by non-exertional substernal discomfort. He was hemodynamically stable with a normal physical examination. Laboratory tests revealed an elevated D-dimer of 1146 mg/L and troponin peaking at 1.38 ng/mL. CT Pulmonary angiography was performed, revealing a saddle embolus with signs of right heart strain (Figure 1). A transthoracic echocardiogram revealed a left ventricular (LV) ejection fraction (EF) of 31-35%, and moderately decreased left ventricular systolic function. A venous duplex and hypercoagulability workup yielded negative results. Left-heart catheterization showed normal coronary arteries. A repeat transthoracic echocardiogram three days later showed improvement in LV systolic function with an EF of 41-45% and normal LV function. He was discharged on apixaban with appropriate follow-up. Discussion: Saddle embolism is one of the rare but life-threatening forms of pulmonary embolism. It causes RV dilatation and flattening of the interventricular septum towards the left side, decreasing cardiac output via the “Reverse Bernheim Effect". Rarely, it affects LV contractility and LV ejection fraction. Together, this can lead to severe hemodynamic instability and increase the risk of complications like pulmonary infarction, cardiac arrhythmias, and cardiogenic shock. Therefore, clinicians must be aware of this possibility, as early detection and timely treatment improve patient outcomes.
Abstract 13670: Prevalence and Long-Term Outcomes of Intravenous Iron Sucrose Therapy in Heart Failure With Reduced Ejection Fraction: A Single Institution Retrospective Cohort Study
Authors: Anderson C Anuforo, Shweta Paulraj, Prashanth Ashok Kumar, Ayorinde Soipe, Toluwalase Awoyemi, Michael Sandhu, Ashwini Ashwath, Eloho Olojakpoke, Ravi Singh, Alexander Somerville, Sherna Menezes, Joshua W Harrison, Andrew Weinberg
Journal: Circulation (2023)

Background: Iron deficiency (ID) is prevalent in heart failure with reduced ejection fraction (HFrEF) defined as left ventricular ejection fraction (LVEF) ≤ 40%. Most trials used in the 2022 AHA/ACC guidelines studied iron carboxymaltose; most had a short follow-up and evaluated heart failure readmissions. We explored the prevalence of iron use, long-term therapeutic benefits, and impact on all-cause readmission for patients with HFrEF. Methods: In this retrospective cohort study, we analyzed electronic medical record data from a university hospital from 2016 to 2021 with an ICD-10 code of systolic heart failure (LVEF &lt; 50%) and ID, or iron deficiency anemia (IDA) (n=619). Intravenous (IV) iron sucrose group was matched to a control group (n = 43) by propensity score matching for age and sex. Conditional logistic regression was utilized to estimate unadjusted odds ratios (uOR) with 95% confidence interval (CI), while Mann-Whitney test was utilized to compare median values of nonparametric estimates. Statistical analysis was done in SAS version 9.4. Results: 66.7% of the studied population were male and 61.1% were ≥ 65 years. The common comorbid conditions were ischemic cardiomyopathy (39.6%), chronic kidney disease (CKD) (26.2%), and gastrointestinal (GI) bleeding (12.3%). ID was present in 115 (18.6%); IDA in 95 (15.4%) and 43 (6.9%) received IV iron sucrose. IV iron administration was significantly associated with LVEF 41-49% (uOR = 2.65, 95% CI: 1.10 - 6.43), GI bleeding (uOR = 16.00, 95% CI: 2.12 - 120.65), chronic kidney disease (uOR = 3.67, 95% CI: 1.49 - 9.04), iron deficiency (uOR = 26.00, 95% CI: 3.53 - 191.60]) and iron deficiency anemia (uOR = 24.00, 95% CI: 3.23 - 177.41). LVEF ≤40% was non-significantly associated with all-cause mortality (uOR = 1.50, 95% CI: 0.61 - 3.67). The IV iron group had a higher median rate of 6-year readmissions (8 [IQR:8] vs.1 [2]; p&lt;0.001), and blood transfusions (11 [24] vs. 3.5 [2]; p=0.05). Conclusions: Patients with HFrEF were less likely to receive IV iron sucrose and more likely to die. Those with frequent blood transfusions, GI hemorrhage, and CKD were more likely to receive IV iron. The study indicates the impact of disease severity and comorbidities on management. Larger studies are needed to investigate this postulation.