tbuckley/cabot-search huggingface dataset:
Abstract 4147574: Prevalence of albuminuria in US adults: 2017-2020
Authors: Ramzi Kibbi, Xiaoning Huang, Laura Seegmiller, Matthew OBrien, Sadiya Khan, Nilay Shah
Journal: Circulation (2024)

Introduction: Chronic kidney disease (CKD) is a major source of morbidity and mortality yet is underdiagnosed. Screening for CKD can include measurement of urinary albumin-to-creatinine ratio (UACR). However, the yield of elevated UACR to diagnose CKD in the US population with cardiometabolic comorbidities is not known. Objective: We sought to investigate the prevalence of elevated UACR among high-risk populations to explore the public health benefits of UACR screening within those populations. Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2017 to March 2020. We included adults aged 20 years and older with available data on UACR. Elevated UACR was defined as ≥30 mg/g and was evaluated overall and among adults with a diagnosis of hypertension or diabetes, defined as self-reported diagnosis or use of medication. Elevated UACR was also evaluated across various weight statuses, including obesity (BMI ≥ 30). All analyses accounted for the NHANES complex sampling design. Chi-square analysis evaluated for differences in proportion with elevated UACR among participants with and without cardiometabolic risk factors. Results: Among 8,644 participants representing 240,823,181 US adults, mean (standard deviation) age was 48 (18) years. Participants were 16% Hispanic, 11% non-Hispanic Black, and 63% non-Hispanic White. There was a high prevalence of obesity (41%), hypertension (32%), and diabetes (11%). In the overall sample, approximately 10% had elevated UACR. The prevalence of elevated UACR was higher in those with obesity (12%), hypertension (18%), and diabetes (31%). Chi-square analysis showed that the proportion of participants with elevated UACR was higher among adults with cardiometabolic risk factors (p&lt;0.001). Conclusions: A substantial proportion of US adults have elevated UACR, especially among those with cardiometabolic comorbidities, such as hypertension and diabetes. Future research should evaluate the cost-effectiveness of screening for CKD with UACR.
Abstract 4146892: Takotsubo cardiomyopathy with Cirrhosis - Mortality and Outcomes among hospitalised patients in the United States
Authors: Priya Hotwani, Sujana Sanka, Tanvi Borse, Andy Alvarez, Anwer Habib, M Chadi Alraies
Journal: Circulation (2024)

Background: Takotsubo cardiomyopathy (TCM) is a unique and reversible heart condition typically triggered by intense emotional or physical stress. Meanwhile, Cirrhosis, a chronic liver disease, is associated with increasing inflammation and oxidative stress, which can potentially worsen cardiovascular problems. In this study, we aimed to study the impact of cirrhosis on outcomes in TCM. Methods: A retrospective analysis was performed using the NIS database 2016 -2020 and the International Classification of Diseases, Tenth Revision codes to identify patients &gt; 18 years old with the principal diagnosis of Takotsubo cardiomyopathy. The effect of cirrhosis was studied on in-hospital mortality and secondary outcomes such as cardiogenic shock, ventricular arrhythmia (VA), acute respiratory and acute kidney injury (AKI), as well as resource utilisation. Categorical variables were compared using the chi-square test, and continuous variables were compared using the t-test—multivariable regression analyses adjusted for demographics, hospital-level characteristics, and relevant comorbidities. Results: We identified a total of 190,025 patients with TCM. Of these, 3,335 (1.76%) patients had liver cirrhosis, with notably higher prevalence of diabetes (33.6%), CKD (20.7%), anemia (10.2%), and major depressive disorder (25.6%) in the cirrhosis group. A higher incidence of in-hospital mortality (12.9% vs. 6.3%, p&lt;0.001), cardiogenic shock (11.7% vs. 6.5%, p&lt;0.001), AKI (41.4% vs. 22.8%, p&lt;0.001), and ARF (40% vs. 31.6%) was noted in the cirrhosis group. After adjusting for confounding factors, the liver cirrhosis group had higher odds of in-hospital mortality (aOR 1.39, 95% CI 1.1-1.75, p=0.006), AKI (aOR 1.53, 95% CI 1.28-1.82, p&lt;0.001), longer length of stay (11.2 days vs. 6.8 days, p&lt;0.001), and higher total hospitalization charges ($198,786 vs. $99,712, p&lt;0.001). The relationship between cirrhosis and cardiovascular outcomes such as cardiogenic shock (aOR 1.23, 95% CI 0.95-1.58, p=0.116) and VA (aOR 1.01, 95% CI 0.75-1.36, p=0.942) was not statistically significant. Discussion: Our study noted that TCM patients with cirrhosis had higher in-hospital mortality and resource utilization. There was no statistically significant relationship between cirrhosis and cardiovascular outcomes suggestive of the adverse consequences to be related to cirrhosis itself rather than TCM.
Abstract 4147691: Sex-specific Thresholds for Energy Loss Index to Predict Survival in Paradoxical Low Flow Low Gradient Severe Aortic Stenosis
Authors: Shani Dahan, Rasmus Bach, Mayooran Namasivayam, Nathanael Tran, Robert Levine, Judy Hung, Jacob Dal-Bianco
Journal: Circulation (2024)

Background: The prognosis of patients with paradoxical low flow, low gradient, severe aortic stenosis (LFLGAS) is variable, necessitating improved risk stratification. Although this entity is more common in women, the impact of sex on outcomes remains unclear. Energy loss index (ELI), which accounts for aortic root size in estimating the severity of aortic valve stenosis, may enhance risk prediction in LFLGAS. This study aims to investigate sex-based ELI prognostic value in patients with paradoxical LFLGAS. Methods: This study analyzed clinical, echocardiographic, and outcome data collected in 294 patients with paradoxical LFLGAS, with AVA&lt;1 cm 2 , mean transaortic gradient&lt;40mmHg, preserved left ventricular ejection fraction (LVEF&gt;50%) and low flow state, defined as transvalvular flow rate (Q)&lt;210 ml/sec. ELI was calculated using the formula ELI= [AVA x Aa / (Aa - AVA)] / BSA, where Aa is the cross-sectional area of the aorta at the level of the ascending aorta and BSA is the body surface area. Spline curve graphs and maximally selected rank statistics (maxstat package in R) were used to determine optimal sex-specific thresholds. Results: Optimal ELI thresholds were identified for men (0.43 cm 2 /m 2 , n=102) and women (0.39 cm 2 /m 2 , n=192). After adjusting for clinically relevant risk factors (age, LVEF, diabetes mellitus, hypertension), a lower ELI was independently associated with an increased composite outcome of mortality and need for aortic valve replacement for both women [HR 2.88 (95% CI 1.85-4.54), p&lt;0.001] and men [HR 2.63 (95% CI 1.61-4.35), p&lt;0.001], whereas the more commonly used threshold for ELI (0.6 cm 2 /m 2 ) was not predictive. Conclusion: In the challenging landscape of paradoxical low flow, low gradient, severe aortic stenosis, our results suggest that using sex-specific energy loss index thresholds is a promising strategy for risk stratification, and better than the more commonly used threshold.
Abstract 4146740: Procedure-related Ischemic Stroke in Atrial Fibrillation Ablation in a Contemporary Cohort at a Tertiary Care Center
Authors: Abdel Hadi El Hajjar, Chadi Tabaja, Arwa Younis, Ahmad Gharaibeh, Medhat Farwati, Astefanos Al-Dalakta, Issam Motairek, Walid Saliba, Patricia Bouscher, Bryan Baranowski, Mohamed Kanj, Shady Nakhla, Thomas Callahan, Hiroshi Nakagawa, David Martin, Mandeep Bhargava, Mina Chung, Jakub Sroubek, Justin Lee, Tyler Taigen, Oussama Wazni, Ayman Hussein
Journal: Circulation (2024)

Background: Ischemic stroke incidence after catheter ablation is historically reported at 0.2-0.3%. With advancements in catheter design, mapping, ablation techniques, and reduced ablation times, it is pertinent to reevaluate stroke incidence. We aim to determine the rates of procedural stroke in a contemporary patient series and characterize the clinical profiles associated with procedure-related Ischemic stroke. Methods: All patients undergoing AF ablation from 2013 to 2021 at our center were enrolled in a prospective registry for outcomes and procedural complications and an automated platform for patient reported outcomes (AF symptom severity score, QoL, AF burden). Peri-procedural anticoagulation was continued peri-procedurally with therapeutic INRs or holding one dose of apixaban or dabigatran the morning of the procedure. Patients who experienced an ablation-related ischemic stroke or transient ischemic attack (TIA) were identified and compared to the general population of patients undergoing ablation. Results: Of 7020 patients undergoing ablation, only 8 had an ischemic cerebrovascular event (0.11%, 5 strokes, 3 TIAs). The average age was similar in stroke patients (66 years) and the general cohort (65 years). The average CHA 2 DS 2 Vasc score was higher in the stroke group (2.6) compared to the general cohort (2.3), with larger left atrial diameter (4.5 cm vs. 4.2 cm) and a more frequent history of TIA (11% vs. 3.2%). AF burden was higher in stroke patients at baseline with higher AF frequency scores (8.8 vs 6.8) and higher AF duration scores (10 vs. 7.0 in controls). Other characteristics of patients with ischemic cerebrovascular events are summarized in table. All but one patient recovered without residual neurological deficits. Conclusion: In this contemporary cohort of patients undergoing ablation, procedural related ischemic stroke incidence was 0.11% and associated with higher CHA 2 DS 2 Vasc score, larger atria, and baseline AF burden. This suggests that stroke rate is lower in modern practice versus historical cohorts.
Abstract 4146940: External Validation of EchoNet-LVH, a Deep Learning Model for Cardiac Amyloidosis, for Association with Cardiomyopathy
Authors: Pablo-Miki Marti Castellote, Grant Duffy, Wunan Zhou, Susan Cheng, Jersey Chen, Nick Viney, Sotirios Tsimikas, Scott Solomon, David Ouyang, Jonathan Cunningham
Journal: Circulation (2024)

Background: Early diagnosis of cardiac transthyretin amyloidosis (ATTR) facilitates disease-modifying therapies. EchoNet-LVH is a deep learning model trained on 16062 echocardiograms which quantifies the likelihood of cardiac amyloidosis. Patients with ATTR polyneuropathy are at risk for cardiac involvement, highlighting the systemic nature of ATTR. Aim: To evaluate whether the EchoNet-LVH prediction of cardiac amyloidosis identifies patients in an ATTR polyneuropathy cohort who have known amyloid cardiomyopathy. Hypothesis: The EchoNet-LVH cardiac amyloidosis score will be associated with amyloid cardiomyopathy, cardiovascular symptoms, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Methods: The NEURO-TTRansform trial enrolled patients with hereditary ATTR polyneuropathy, regardless of cardiac involvement. ATTR cardiomyopathy at baseline was defined by a clinical diagnosis of cardiac amyloidosis or IVSd≥13mm in the absence of hypertension. We applied Echonet-LVH to echocardiograms performed at baseline. The association of EchoNet-LVH score with amyloid cardiomyopathy, abnormal cardiovascular symptoms (NYHA functional class II or greater) and NT-proBNP (&gt;125 pg/mL) was estimated by logistic regression, adjusted for age and sex. Results: EchoNet-LVH score could be calculated in 130 out of 204 patients (64%). Mean age was 55 years, 28% were female, and 52 were defined as having ATTR cardiomyopathy. The EchoNet-LVH categorized 62 patients (48%) as not predicted to have cardiac involvement, 28 (22%) as intermediate risk, and 40 (31%) as positive. Higher EchoNet-LVH category was associated with higher odds of amyloid cardiomyopathy (OR 4.5 [95% CI 2.6-7.67] per level, p&lt;0.001). Among patients with predicted cardiac involvement 85% had cardiomyopathy, compared to 20% in the predicted negative and intermediate categories. Higher score was associated with greater likelihood NYHA functional class II or greater and elevated NT-proBNP. Conclusion: These data show the feasibility of utilizing the EchoNet-LVH model to identify patients with a higher likelihood of amyloid cardiomyopathy. Automated deep learning tools like this may aid in the early diagnosis of cardiac amyloidosis.
Abstract 4146871: Comparative Analysis of Transcatheter Mitral Valve Replacement versus Redo-Surgical Mitral Valve Replacement: A Systematic Review and Meta Analysis
Authors: Muhammad Talha Shaukat, Wania Rehman, Aqeeb Ur Rehman, Aleenah Mohsin, Saad Ur Rahman, Hafiz Imran, Muhammad Ahmad Qureshi, Jinnette Abbott, Afshin Ehsan, Frank Sellke
Journal: Circulation (2024)

Background: Transcatheter mitral valve replacement (TMVR) has emerged as a promising alternative to conventional redo-surgical intervention in patients presenting with mitral valve prosthesis failure. We conducted a meta-analysis to delineate efficacy and safety of transcatheter mitral valve replacement (TMVR), encompassing both valve-in-valve (ViV) and valve-in-ring (ViR) procedures, compared to redo-surgical mitral valve replacement (SMVR). Aim: The primary aim of our meta-analysis was to investigate the early clinical outcomes following either ViV/ViR TMVR or SMVR. Methods: PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov were systematically searched according to predefined inclusion and exclusion criteria. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Results: Fourteen retrospective cohort studies (patients=18,519) were evaluated in this analysis. Compared with redo-SMVR for mitral valve prosthesis failure, TMVR exhibited lower in-hospital mortality (OR=0.69; 95% CI 0.56–0.86; p&lt;0.01). Moreover, stroke (OR=0.46; 95% CI 0.31–0.68; p=0.05), renal dysfunction (OR=0.49; 95% CI 0.38–0.63; p&lt;0.01), need for pacemaker implantation (OR=0.28; 95% CI 0.23–0.34; p&lt;0.01), major cardiac complications (OR=0.43; 95% CI 0.32–0.59; p&lt;0.01), length of ICU stay (OR=-2.11; 95% CI -2.82 - -1.39; p&lt; 0.01), and need for exploration for bleeding (OR=0.23; 95% CI 0.17–0.30; p&lt;0.01) also revealed significant improvements in the TMVR cohort. To minimize heterogeneity, we performed subgroup analysis for in-hospital mortality, which remained significant (OR=0.42; 95% CI 0.34–0.51; P&lt; 0.01) on propensity matching. Conversely, paravalvular leak (OR=22.12; 95% CI 2.81-174.16; p=0.003) generated results favoring SMVR. There was negligible and nonsignificant difference in mean mitral valve gradient (MD: -0.01; 95% CI: −0.57 to 0.5; P =0.97), 30-day mortality (OR: 0.86; 95% CI: 0.48–1.53; P = 0.60), and 1-year mortality (OR: 1.05; 95% CI: 0.68–1.61; P = 0.83) between the two groups. Conclusion: In patients experiencing mitral valve prosthesis failure, TMVR offers an efficacious, safe, and less invasive alternative to SMVR. However, the risk of paravalvular leak requires careful monitoring.
Abstract 4147214: Association of Intensity of E-cigarette Use with Heart Rate in Daily Life in Young Adults using a Text-Messaging Partnered with Mobile Health Monitoring Platform
Authors: Elmira Javanmardi, Rabindra Kadel, Kathryn Barger, Erika Minetti, Rachel Hoover, Jacqueline Gallagher, Niusha Manoochehri Arash, Robert Weisbrod, Rachel Keith, Naomi Hamburg
Journal: Circulation (2024)

Background: Electronic Cigarettes (e-cig) are popular among young adults raising questions about the cardiovascular health impacts. In research settings, acute e-cig use leads to transient heart rate (HR) elevation. We evaluated how e-cig use intensity relates to HR during daily living using a text-messaging program partnered with continuous HR monitoring. Methods: We enrolled healthy young people (age 18-24) sole e-cig users and non-user controls in a text-messaging based program that assessed self-reported e-cig use intensity (vape sessions and puff count) over 5 two-hour time windows spanning awake period over 2 days. HR was collected using Fitbit and aligned to the text-messaging windows. We compared information collected about use intensity (vape sessions and puff number) to HR measures in two models: linear regression associations at a per person level over the total wake time and a repeated measures analysis based on individual time windows accounting for clustering by participant using compound symmetry. Results: In the 78 participants, mean age 21±2 years was similar in e-cig users (N=59, 47% women, 39% Asian, 7% Black, 9% Hispanic) and non-users (N=19, 61% women, 28% Asian, 22% Black, 6% Hispanic). At baseline e-cig users reported high intensity of use: 26±6 days/month, 16±20 vape sessions/day, 6±5 puffs/session. Over the 2-day monitoring period, total vape sessions reported was 23±26 and total puff 77±68 measured per participant and 2.4±4 vape sessions and 8.1±13.3 puffs per 2 hour window. In the per participant analysis, both higher number of vape sessions and puff counts were associated with higher average HR (β=0.08±0.03, P=0.01 and β=0.03±0.01, P=0.003) but not maximum or minimum HR. In the repeated-measures per window analysis, vape sessions and puff counts were associated with higher average HR (β=0.89±0.14, P&lt;0.0001 and β=0.29±0.05, P&lt;0.0001) as well as maximum HR (β=1.1±0.18, P&lt;0.0001 and β=0.33±0.05, P&lt;0.0001) and minimum HR (β=0.70±0.13, P&lt;0.0001 and β=0.20±0.04, P&lt;0.0001), providing temporal evidence linking variability in vaping intensity measures and HR measures. Conclusion: Our findings using an innovative mobile health platform suggest that the intensity of e-cig use is associated with higher HR during daily living in young people. Further investigation is needed to link short term hemodynamic impact of e-cig use to long-term health impacts.
Abstract 4147686: Activities of Daily Living (ADLs) in Adults with Heart Failure Compared with Cancer: Analysis of Medicare Health Outcomes Survey Data
Authors: Havisha Pedamallu, Sadiya Khan, Carol Haywood, Abigail Baldridge, Kathleen Grady, Parag Goyal, Gregg Fonarow, Tara Lagu, Faraz Ahmad
Journal: Circulation (2024)

Introduction: Heart failure (HF) and cancer are highly morbid conditions and contribute to substantial impairments in physical, mental, and social health. Cancer-associated disability has been well described, but little is known about the degree to which HF limits functional status in older individuals. Therefore, we sought to examine self-report of functional status in older people living with HF compared to cancer. Methods: The sample included adults &gt; 65 years of age from the 2016-2020 Medicare Health Outcomes Survey (HOS), who self-reported a history of HF or cancer (lung, colorectal, breast, or prostate) and were undergoing active treatment. We analyzed differences in functional status with two measures: (1) Katz Index of Independence in Activities of Daily Living (KADLs), an assessment of skills required to manage basic physical needs and hygiene, and (2) Instrumental Activities of Daily Living score (IADLs), which is a composite score of the ability to complete a complex set of skills needed to live independently. KADL and IADL were examined in groups of severe impairment (KADL: 0-2, IADL: 0-3), moderate impairment (KADL: 3-5, IADL: 4-6), and full function (KADL: 6, IADL: 7). We compared the distribution of KADL and IADL groups with Chi-Squared. Results: The sample of individuals with HF included 51400 adults (52% female, 14% Black, 49.8% &gt; 75 years). 21.85% of individuals with HF had severe impairment in KADLs and 17.05% in IALDs. These numbers were significantly higher than the proportion of severe impairment in people with lung (KADL: 14.48%; IADL: 11.35%), colorectal (KADL: 15.74%; IADL: 10.39%), breast (KADL: 10.57%; IADL: 7.17%), or prostate (KADL: 10.23%; IADL: 8.32%) cancer (all p &lt;0.001). Individuals with HF also had the lowest proportion of patients with full function in KADLs or IADLs. Conclusion: People living with HF have significantly greater disability compared with people who are undergoing active treatment for lung, colorectal, breast, or prostate cancer. Multidisciplinary care for HF patients that prioritizes physical and occupational therapy and self/home care may improve functional status and overall health-related quality of life.
Abstract 4147796: Cardiovascular Manifestations of Amphetamine Misuse: A Pooled Analysis
Authors: Zouina Sarfraz, Lakshit Jain, Anum Shahzad, Syed Rafay Ali Sabzwari
Journal: Circulation (2024)

Background: In the United States, the misuse of stimulants such as the amphetamines Adderall and Ritalin is rising. Recent data indicates that annually, about 5.1 million Americans aged 12 and older misuse these prescription medications. The literature on the cardiovascular effects of such misuse, including acute myocardial infarction (MI), cardiac arrhythmias, and catecholamine toxicity, remains limited. This first-ever pooled analysis aims to document and report the cardiovascular manifestations associated with amphetamine misuse. Methods: This study was reported in adherence to PRISMA Statement 2020 guidelines. An exhaustive literature search was conducted without language or date restrictions up to June 8th, 2024, using PubMed/Medline, Scopus, Cochrane, and Web of Science, in addition to manual hand searching following an umbrella framework. This strategy yielded 621 potential studies, with 42 undergoing full-text review. Seventeen studies met the inclusion criteria, pooling a total of 433,392 patients. SPSS V26 (IBM) was used to compute pooled counts. Results: The median age was 30 years (IQR: 11.5). Males constituted 293,798 (67.75%) and females 140,594 (32.25%). Intravenous administration was reported in 2,586 (0.60%) of cases, and oral administration in 6 (0.0014%). The mean dosage of amphetamine was 186.25 mg. The median duration of exposure was 9 years (IQR: 7.75). Hypertension was present in 218,435 (50.7%), smoking in 169,720 (39.4%), and diabetes mellitus in 112,767 (26.2%). Recreational use was reported in 431,825 (99.77%) of cases. Chronic or long-term use was seen in 2,020 (0.47%) and daily use in 32 (0.0074%). Atherosclerotic cardiovascular disease was reported in 135,703 (31.51%), ischemic heart disease in 110,823 (25.72%), and MI in 68,443 (15.89%). Clinical diagnosis methods confirmed 430,763 (99.39%) of cases. Medication management was used in 32 (0.0074%) of cases. Continued medical therapy was needed in 30 (0.007%) of cases. Mortality was reported in 499 (0.115%) of cases. Conclusion: This pooled analysis highlights the significant cardiovascular risks associated with amphetamine misuse, particularly hypertension, smoking, and diabetes. There is an urgent need for coordinated psychiatric-cardiological interventions, focusing on early detection, comprehensive addiction therapy, and managing cardiovascular health to improve patient outcomes.