tbuckley/cabot-search huggingface dataset:
Abstract 4122284: HEART Score Classification of Major Adverse Cardiovascular Events in Patients with Diabetes Mellitus
Authors: Mohammad Alhamaydeh, Stephanie Helman, Ahmed AlQaqaa, Huabin Luo, Salah Al-Zaiti
Journal: Circulation (2024)

Introduction: Risk stratifying diabetes mellitus (DM) patients with chest pain in the emergency department (ED) can pose significant challenges because of atypical symptoms, non-specific ECG changes, and elevated baseline troponin levels. This study aims to evaluate HEART Score performance in DM versus non-DM patients. Methods: A prospective observational cohort study included chest pain patients transported by Emergency Medical Services to University of Pittsburgh Medical Center-affiliated hospitals. Data collection involved extracting data from electronic health records, including both DM and non-DM patients with chest pain. The HEART Score was retrospectively calculated by impartial assessors.The primary endpoint was major adverse cardiac events (MACE) within 30 days. This analysis included the classification performance of bivariate comparisons between the HEART Score and ACS outcomes using the area under the receiver-operator characteristic curve (AUC). Results: 4,058 patients were included. 52.7% were male, 42% were white, there was a mean age of 59.24 years (16.13 SD), 28.63% had DM, and 22.1% had MACE. MACE prevalence was 19.7% in non-DM patients and 28% in patients with DM. The AUC demonstrated more robust discriminatory ability of the HEART Score in non-DM (AUC = 0.81) (95% CI 0.79-0.83) versus DM patients (AUC = 0.74) (95% CI 0.71-0.78) (p 0.001). The performance of HEART Score components, including history, age, and risk factors, exhibited better significant predictive capability for MACE in non-DM patients compared to DM patients. Conversely, the HEART-ECG and troponin components were not different between the DM and non-DM groups. The HEART Score demonstrates better performance in White individuals and females when contrasted with males and Black individuals. Nevertheless, these disparities do not reach statistical significance. Conclusion: The HEART Score performs differently in DM versus non-DM patients, with stronger discrimination observed in non-DM individuals. The troponin and ECG components exhibit poorer performance in diabetes mellitus (DM) patients within the context of the HEART Score. This underscores the complexity of risk assessment in DM patients with chest pain and suggests the necessity for further exploration and refinement of risk stratification strategies in this population.
Abstract 4119250: Partial versus Full ECMO Support in Combined Cardiogenic and Septic Shock – ELSO Registry Analysis
Authors: Hannah Granger, Aniket Rali, Lyana Labrada, Mohammad Alarfaj, Lena Tran, jinxiang hu, Jordan Baker, Taylor Rali, Matthew Bacchetta, Marc Anders, Joseph Tonna, Joann Lindenfeld, Zubair Shah
Journal: Circulation (2024)

Background: There remains paucity of data on patient outcomes with combined cardiogenic and septic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. While guidelines exist on target VA-ECMO flow in cardiogenic shock patients, optimal (partial versus full) flow in combined shock remains largely unknown. Methods: We queried the Extracorporeal Life Support Organization registry to identify patients in combined cardiogenic and septic shock supported with VA-ECMO between 2017 and 2022. Patients were categorized into either partial or full ECMO support based on ECMO flow at 24 hours indexed to body surface area. Partial support was defined as &lt; 2.2 liters/m2 while full support was ≥2.2 liters/m2. Patients with other forms of mechanical circulatory support, VA-ECMO as bridge to advanced therapies or discharged on VA-ECMO were excluded from the analysis. Primary outcome of interest was survival to discharge. Baseline characteristics including center volumes and Charlson co-morbidity index were compared between survivors and non survivors. Predictors of mortality were identified using multivariable logistical regression model. Results: A total of 452 patients with combined shock supported with VA-ECMO were identified. Overall mortality was 63%. Patients that survived to discharge were younger (46.3 vs 53 years, p &lt; 0.001) and had lower BMI (29.3 vs 31.1, p = 0.041), Charlson co-morbidity index (1.4 vs 2.0, p = 0.01) and rates of pre-ECMO cardiac arrest (28.7% vs 39.4%, p = 0.023). Survivors were also more likely to be at high [&gt; 25 ECMO runs per year] volume centers compared to low [≤ 10 ECMO runs per year] volume centers (62.3% vs 20.4%, p = 0.04). Patients receiving full ECMO support had a higher likelihood of survival to discharge than partial support (42.6% vs 33.8%, p = 0.063), although it did not reach statistical significance. [Table 1] Indexed VA-ECMO flow at 24 hours was also associated with improved outcomes when assessed as continuous variable. [ Figure 1] Advanced age [aOR 1.02, 95% CI 1.01-1.04, p &lt; 0.001], pre-ECMO cardiac arrest [aOR 1.71, 95% CI 1.11-2.65, p = 0.016] and baseline Charlson co-morbidity index [aOR 1.13, 95% CI 1.01-1.28, p = 0.043] were all associated with increased mortality after adjustment for baseline differences. Conclusion: Mortality among patients requiring VA-ECMO for combined cardiogenic and septic shock is high. Full circulatory support may be associated with improved survival in this cohort.
Abstract 4122080: Outcomes of Left Atrial Appendage Occlusion With and Without Concurrent Catheter Ablation for Patients at High Bleeding Risk: A Systematic Review and Meta-analysis
Authors: Abhigyan Majumdar, Tanesh Ayyalu, Fred Charles, Ewen Shengyao Huang, Hayley Turch, Felipe Martignoni, Akil Sherif
Journal: Circulation (2024)

Introduction: The prevalence of non-valvular atrial fibrillation (NVAF) and stroke-related morbidity is rising. First-line therapy remains rate or rhythm control with anticoagulation, with catheter ablation (CA) also considered in suitable candidates. Left atrial appendage closure (LAAC) is increasingly used due to mounting evidence of non-inferiority compared to anticoagulation. Despite improved pre-procedural planning and patient selection reducing complications, adverse outcomes such as pericardial effusion and device-related thrombus occur in about 5% of patients. This study evaluates the outcomes of LAAC with CA versus standalone LAAC in NVAF patients with contraindications to anticoagulation. Methods: We searched PubMed, EMBASE, and Cochrane databases for all cohort studies comparing LAAC with CA to LAAC alone in patients with NVAF. Case series, reviews, and non-English language studies were excluded. The assessed outcomes included device compression rate at implant, device-related thrombosis, pericardial effusion, need for pericardiocentesis, and peri-device leak at 6 weeks. Statistical analysis was performed using Review Manager 5.1.7. Heterogeneity was assessed with I 2 statistics. Results: We included 6 studies with 51,545 patients, of whom 1,221 (2.3%) underwent both procedures. LAAC with CA and standalone LAAC cohorts had similar baseline demographics including age (68, 69 years), percentage of women (48%, 46%), CHA2DS2-VASc score (3.6, 3.7), and HAS-BLED score (3.1, 3.2). LAAC with CA was associated with a reduced incidence of device-related thrombosis (OR=0.18; 95% CI= 0.04-0.89; p=0.04) without an increase in pericardial effusion rates (OR=0.85; 95% CI= 0.48-1.51; p=0.59). There were no significant differences in device compression rates at implant (MD=0.34; 95% CI= -0.77-1.45; p=0.55), the need for pericardiocentesis (OR=1.01; 95% CI= 0.30-3.48; p=0.98), or rates of peri-device leak at 6 weeks (OR=0.61; 95% CI= 0.21-1.78; p=0.37). Conclusion: Concomitant LAAC with CA may reduce rates of device-related thrombosis compared to standalone LAAC without increasing the risk of pericardial effusion or peri-device leak at 6 weeks. These findings support the consideration of combining these procedures in the management of high-risk NVAF patients unable to tolerate anticoagulation.
Abstract 4122092: Carotid plaque progression predicts persistent endothelial dysfunction in an infarct-related coronary artery in STEMI survivors
Authors: Takeo Horikoshi, Takamitsu Nakamura, Toru Yoshizaki, Tsuyoshi Kobayashi, Akira Sato
Journal: Circulation (2024)

Background and Aim: Persistent coronary endothelial vasomotor dysfunction predicts future coronary events; however, performing multiple invasive endothelial function tests is difficult in actual clinical practice. This study examined whether carotid plaque changes can predict persistent coronary endothelial dysfunction using serial assessments of the coronary vasomotor response to acetylcholine (ACh) in the infarct-related artery (IRA) among patients with ST-elevation acute myocardial infarction (STEMI). Methods: This study included 169 consecutive patients with a first acute STEMI due to the left anterior descending coronary artery (LAD) occlusion who underwent successful reperfusion therapy with percutaneous coronary intervention. The vasomotor response to ACh in the LAD was measured within two weeks of acute myocardial infarction (AMI) (first test) and repeated at six months (second test) after AMI under optimal anti-atherosclerotic therapy. Ultrasonography of the bilateral common carotid artery (CCA) and internal carotid artery (ICA) was performed during the acute phase, and the thickest intima media thickness (IMT) of either artery was measured as the maximum IMT. After six months, the IMT at the site of maximal IMT was measured to determine whether there was an increase or decrease in IMT. Results: Finally, 87 STEMI patients analyzed in this study. At 6 months, 25 patients (28.7%) showed carotid plaque progression. In a multivariable adjusted analysis, carotid plaque progression was identified as an independent predictor of persistent coronary endothelial dysfunction, both in terms of coronary diameter response [OR 3.22, 95% confidence interval1.13 - 9.15, P = 0.03] and coronary flow response [OR 2.65, 95% confidence interval 1.01 - 7.00, P = 0.04]. Conclusions: Carotid plaque progression could independently predict persistent endothelial vasomotor dysfunction in the IRA of STEMI survivors.
Abstract 4120805: Comparison of Thermodilution and Doppler Flow Velocity Derived Indexes of Coronary Physiology using Intracoronary Adenosine in Patients with Angina and Unobstructed Coronary Arteries (ANOCA)
Authors: Louisa Lauinger, Astrid Hubert, Andreas Seitz, Raffi Bekeredjian, Johanna McChord, Peter Ong
Journal: Circulation (2024)

Introduction: Patients with angina but unobstructed coronaries (ANOCA) represent a diagnostic and therapeutic challenge. Current Guidelines recommend invasive testing using acetylcholine and adenosine for evaluation of coronary vasomotor disorders. However, there is a broad variability among the different measurement techniques. Purpose: To assess the differences of bolus thermodilution versus Doppler flow velocity derived indexes of coronary physiology using intracoronary adenosine in patients with ANOCA. Methods: A total of 162 patients (61.1% women, mean age 63±28 years) with ANOCA (no epicardial stenosis &gt;50%, FFR &gt;0.80) were enrolled between 2018 and 2023. All patients underwent wire-based assessment of coronary flow reserve (CFR) and microvascular resistance (MR) using adenosine in the left anterior descending artery. The bolus thermodilution technique was applied in 46 patients (CFR/IMR, CFRThermo) and the Doppler technique in another 116 patients (CFR/HMR, CFRDoppler). All measurements were performed according to a standardised protocol. The commonly applied cut-offs for CFR (&lt;2.5), HMR (&gt;2.5) and IMR (&gt;25) were used. Results: The study population was characterized by the following risk factors: arterial hypertension (63%), hypercholesterolemia (62%), positive family history for cardiovascular disease (36%), diabetes (16%) and smoking (10%). The frequency of an abnormal CFR &lt;2.5 was 36%. There was a significant difference between the frequency of an abnormal CFR among patients with CFRThermo (8/46, 17.4%) and patients with CFRDoppler (50/116, 43.1%, p=0.002). Moreover, the median CFR was higher in the CFRThermo group compared to the CFRDoppler group (3.5 [IQR2.8] vs. 2.6 [IQR 0.9], p&lt;0.0005) with a much larger interquartile range in the former (Figure 1). Assessment of MR revealed an abnormal result in 20% of cases which was more often observed with the thermodilution (IMR &gt;25 in 39.1%, median 22.5 [IQR 17.0]) compared to the Doppler technique (HMR &gt;2.5 in 12.1%, median 1.7 [IQR 0.7], p&lt;0.0005). Multivariable analysis revealed arterial hypertension (OR 4.04, CI 1.88 – 8.77, p&lt;0.0005) and female sex (2.12, 1.04 - 4.34, p=0.04) as independent predictors for an abnormal CFR. Conclusion: Comparison of thermodilution and Doppler derived indexes of coronary physiology in patients with ANOCA reveals marked differences among the different measurement techniques. The results are important for the endotype classification and subsequent patient management.
Abstract 4120105: Meta-Analysis of Outcomes in Patients Developing Acute Kidney Injury Following Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection
Authors: Aman Goyal, Samia Sulaiman, Hritvik Jain, Amir Sohail, Abhigan Shrestha, Irfan Ullah, Darshan Puttaswamy, Haleema Qayyum Abbasi, Fatima Raza, Agastya Belur
Journal: Circulation (2024)

Background and Aims: Thoracic endovascular aortic repair (TEVAR) is warranted in patients with Stanford Type-B aortic dissection who are at an increased risk of aneurysm rupture and enlargement. While studies indicate that development of post-operative acute kidney injury (AKI) (with incidence rate varying from 1.5% to 34%) may potentially worsen outcomes and increased mortality, the specific role of AKI in the postoperative period for patients undergoing TEVAR for Stanford Type-B aortic dissection remains understudied and unclear. Our meta-analysis aims to contribute valuable insights into this aspect. Methods: A comprehensive literature search spanning major bibliographic databases was conducted to retrieve studies comparing outcomes in Stanford Type-B aortic dissection patients undergoing TEVAR who developed AKI postoperatively versus those who did not. Our outcomes of interest included the risk of in-hospital mortality, stroke, and requirement for dialysis. Relative risks (RRs) were pooled from all studies using DerSimonian and Laird random-effects models in the ‘meta’ package of R software (Version: 2023.12.1+402). Statistical significance was set at p &lt;0.05. Results: Three studies were included with 1091 patients (234 in the AKI group and 857 in the non-AKI group). The development of AKI was associated with a significantly higher risk of in-hospital mortality [RR: 5.31; 95% CI: 3.10, 9.08; p&lt;0.0001; I 2 =0%], a higher risk of stroke [RR: 2.33; 95% CI: 1.30, 4.17; p=0.0046; I 2 =0%], and an increased risk of requiring dialysis [RR: 18.43; 95% CI: 3.35, 101.46; p=0.0008; I 2 =0%] (Figure 1). No heterogeneity was observed between the studies (Figure 1 and 2). Conclusion: The development of AKI after TEVAR in patients with Stanford Type-B aortic dissection is associated with an increased risk of in-hospital mortality, stroke, and dialysis requirement. Hence, further research into early recognition of the risk factors associated with the development of AKI after TEVAR is warranted, along with determining its effects in longer follow-up durations.
Abstract 4122620: Triglyceride Levels Associate With Cardiovascular Risk Across the Full Range but Not Among Individuals With Mild-to-Moderate Hypertriglyceridemia
Authors: Ask Nordestgaard, Aruna Pradhan, Brendan Everett, Jean MacFadyen, Deepak Bhatt, Frank Visseren, Peter Libby, Raul Santos, Steven Nissen, Borge Nordestgaard, Paul Ridker
Journal: Circulation (2024)

Background: Guidelines focus on individuals with triglyceride levels of 200 to 499 mg/dL (2.3 and 5.6 mmol/L), a group for whom triglyceride-lowering therapy does not convincingly decrease risk. Hypotheses and goals: We re-assessed the hypotheses that triglyceride levels across the full biological range and within this constrained range strongly associate with cardiovascular risk. Methods: We calculated multivariable adjusted hazard ratios for major cardiovascular events and death according to baseline triglyceride levels among 119,573 individuals with triglycerides across the full biological range from the Copenhagen General Population Study, among 27,757 individuals with baseline triglycerides between 200 and 499 mg/dL (2.3 and 5.6 mmol/L) from the Copenhagen General Population Study and the Women’s Health Study, and among 31,372 individuals with mild-to-moderate hypertriglyceridemia participating in the PROMINENT, REDUCE-IT, and STRENGTH randomized trials. Results: Increasing triglyceride levels across the full range were associated with increasing risk of major cardiovascular events (N=12,241) (Figure 1). In individuals with mild-to-moderate hypertriglyceridemia from the two cohorts, combined hazard ratios (95% confidence interval) for major cardiovascular events (N=3,928) from lowest to highest triglyceride quartile were 1.0 (referent), 0.95 (0.87-1.04), 1.04 (0.95-1.13), and 1.13 (1.04-1.23). In the contemporary trials of patients selected for mild-to-moderate hypertriglyceridemia, the corresponding hazard ratios for major cardiovascular events (N=4,265) from lowest to highest triglyceride quartile were 1.0 (referent), 1.01 (0.93-1.10), 1.05 (0.96-1.14), and 1.10 (1.01-1.19). In neither prospective cohorts nor trials were triglyceride levels strongly associated with risk of cardiovascular or all-cause death within the constrained range. Conclusions: Contrary to expectations, individuals with mild-to-moderate hypertriglyceridemia may not express the same magnitude of cardiovascular risk as that observed across the full range of plasma triglycerides. Future trials of triglyceride-lowering therapy may want to consider enrollment across a wider range of triglyceride levels if there is no prior history of pancreatitis.
Abstract 4120623: Sphingosine Kinase 1 Is Integral For Elastin Deficiency-induced Arterial Hypermuscularization
Authors: Junichi Saito, Jui Dave, Inamul Kabir, xEunate xGallardo-Vara, Timothy Hla, Daniel Greif
Journal: Circulation (2024)

Introduction: Defective elastic lamellae and smooth muscle cell (SMC) accumulation are characteristics of diverse obstructive arterial diseases (e.g., atherosclerosis, pulmonary hypertension, and supravalvular aortic stenosis [SVAS]) as well as physiological closure of the ductus arteriosus (DA). Mechanistic links between defective elastin and SMC proliferation are not well elucidated. Methods: Immunostaining for proliferation marker Ki67 was performed on wild-type (WT) and Eln (-/-) mouse aortas at embryonic day (E) 13.5 and E15.5 because elastin (ELN) is expressed in the mouse aorta from E14. Bulk RNA-seq was conducted on mouse aortic SMCs isolated from WT or Eln (-/-) embryos at E15.5. As sphingosine kinase 1 (SPHK1) was found as a highly promising candidate, its expression was evaluated in human SVAS patient aortas and in mouse Eln (-/-) aortas and WT DA. S1P receptor 1 (S1PR1) activity was assessed in aortic SMCs from S1pr1 (knock-in/knock-in) , H2B-GFP mice. Genetic deletion of Sphk1 in SMCs was performed on the elastin mutant background. Pharmacological SPHK1 inhibition was evaluated on both elastin mutants and WT embryos. Regulatory mechanisms of SPHK1 were assessed by mRNA stability assay and TRANSFAC database analysis. Results: SMC hyperproliferation was first observed in Eln (-/-) aorta at E15.5, prior to morphological differences. Bulk RNA-seq revealed that Sphk1 is the most upregulated transcript in Eln (-/-) aortic SMCs at E15.5. Reduced ELN increases SPHK1 levels in SMCs of human patient aortas and mouse aorta and DA. S1PR1 expression and activity are increased by elastin insufficiency. SMC Sphk1 deletion attenuates SMC proliferation and muscularization in the elastin-defective aorta, leading to extended viability of Eln (-/-) mice. Similarly, pharmacological SPHK1 inhibition ameliorates elastin aortopathy but leads to patent DA in WT mice. mRNA stability assay indicated Sphk1 is upregulated by enhanced transcription. TRANSFAC and bulk RNA-seq data suggested that transcription factor early growth response 1 (Egr1) induces Sphk1 transcription. Indeed, EGR1 was upregulated in elastin mutant aortas and DA. Conclusions: Elastin deficiency upregulates SPHK1 transcription, leading to SMC proliferation and hypermuscularization in elastin aortopathy as well as during physiological DA closure. Inhibiting SPHK1 is a promising therapeutic strategy for elastin aortopathy and for select congenital heart diseases in which patent DA maintains circulation.
Abstract 4120898: Assessment of Subclinical Atherosclerosis in Psoriasis Patients Using Echocardiographic Coronary Flow Parameters: A Systematic Review and Meta-Analysis
Authors: Hritvik Jain, Ramez Odat, Aman Goyal, Jyoti Jain, Mushood Ahmed, Nandan Patel, Siddhant Passey, Shrey Gole
Journal: Circulation (2024)

Background: Chronic inflammatory diseases are associated with a higher risk for atherosclerosis and adverse cardiovascular events. Psoriasis is a systemic inflammatory condition that significantly increases coronary artery disease risk. Subclinical atherosclerosis can be estimated by echocardiographic parameters like coronary flow velocity reserve (CFVR), diastolic peak flow velocity (DPFV), and hyperemic DPFV. Limited literature investigates these parameters in psoriasis, with inconsistent results. Methods: We systematically searched the major bibliographic databases including PubMed, Embase, Cochrane Library, and Google Scholar from inception to 7th May 2024 to retrieve relevant studies. The outcomes were pooled using the inverse variance random-effects model, and the results were presented as standardized mean difference (SMD) with the corresponding 95% confidence interval (CI). Results: 4 studies with 557 participants (281: psoriasis and 276: controls) were included. The mean age of the psoriasis group was 44.7 ± 7.7 years and of the control group was 45.2 ± 5.9 years. Psoriasis patients had a significantly lower CFVR [SMD: -0.71; 95% CI: -0.97, -0.45; p&lt;0.00001] and hyperemic DPFV [SMD: -0.71; 95% CI: -1.30, -0.12; p=0.02] compared to healthy controls. However, the difference between baseline DPFV was insignificant between the two groups [SMD: 0.20; 95% CI: -0.92, 1.32; p=0.73]. Conclusion: This study demonstrates that psoriasis is associated with coronary microvascular disease as measured by significantly lower CFVR and hyperemic DPFV. These results suggest that impaired myocardial perfusion in psoriasis patients may be an early manifestation of cardiac involvement. Hence, early risk stratification in psoriasis patients is crucial. Further large, randomized trials are essential to corroborate the results of this meta-analysis.