tbuckley/cabot-search huggingface dataset:
Abstract 4117772: Age-Related Differences in Aortic Valve Calcium Progression and the Risk for Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis
Authors: Natalie Marrero, Kunal Jha, Jelani Grant, Alexander Razavi, Matthew Budoff, Sanjiv Shah, Roger Blumenthal, Wendy Post, Leslee Shaw, George Thanassoulis, Jerome Rotter, Michael Blaha, Seamus Whelton
Journal: Circulation (2024)

Background: Aortic valve calcium (AVC) is strongly associated with an increased risk for severe aortic stenosis (AS). The prevalence of AVC increases with age affecting 40-50% of individuals ≥80 years. The impact of age on the progression of AVC and its association with incident AS remains unknown. Methods: Our study included 6,810 participants (52.9% women) free of cardiovascular disease between ages 45 and 84 from the Multi-Ethnic Study of Atherosclerosis. AVC was measured using non-contrast cardiac CT at Visit 1. Progression was calculated as the change in AVC divided by years between CT scans with up to 10 years between scans. Long term incident AS was adjudicated using medical chart review and echocardiogram data from Visit 6 with a median follow up of 16 years. Multivariable adjusted 1) linear regression was used to examine AVC progression and 2) multivariable adjusted Cox proportional hazards ratios (HR) were used to examine the association of AVC with incident AS. Results: The prevalence of AVC &gt;0 was 4.9% among participants &lt;65 and 23.2% for those ≥65 years old. Among participants with AVC &gt;0, the median AVC was 34.1 (IQR 13-1,113) for participants &lt;65 versus 69.0 (IQR 23-2,453) for participants ≥65. Participants &lt;65 years and ≥65 years had no significant difference in median annualized AVC progression within the baseline AVC categories of 1-99 (10 versus 12 AU/year, p=0.303) and AVC &gt;100 (50 versus 47 AU/year, p=0.846) ( Figure 1 ). Overall, linear regression models showed older age was associated with greater AVC progression (p=0.001), but after additional adjustment for baseline AVC, the association became non-significant (p=0.134). AVC &gt;0 was associated with significantly increased risk of incident AS for both younger (HR 13.37; 95% CI 5.67-31.52) and older participants (HR 10.59, 95% CI 6.77-16.56). Conclusion: We observed a similar progression of AVC for younger versus older persons after adjusting for baseline AVC burden. Additionally, AVC &gt;0 independently conferred at least a ten-fold higher risk for severe AS among both younger and older participants. These findings demonstrate that the AVC progression is primarily associated with baseline AVC burden and that AVC is a strong marker of risk for severe AS for both younger and older persons.
Abstract 4122840: Patient activation improves with a multi-component personalized mHealth intervention in older adults at risk of cardiovascular disease
Authors: Dion Candelaria, Marysol Cacciata, Reimund Serafica, Andrew Thomas Reyes, Jung-Ah Lee, Janett Hildebrand, Axel Sta. Maria, Anna Stromberg, Lorraine Evangelista
Journal: Circulation (2024)

Background: Patient activation, a person’s level of confidence, comprehension, and autonomy toward their health, is an essential goal of cardiovascular disease therapy. Previous research has shown a link between high levels of patient activation and better patient outcomes and experiences. However, whether individualized interventions such as a text-based mobile health (mHealth), improve patient activation is unclear. Research on patient activation in people at risk for cardiovascular disease and influential factors is minimal. Aims: This study aimed to 1) determine the effect of a multi-component mHealth intervention on patient activation and 2) examine its predictors among older adults at risk for cardiovascular disease. Methods: In this pilot randomized controlled trial, community-dwelling older adults with poor eating behaviors and reduced physical activity (n=54) were randomly assigned to the GetFIT (control) or GetFIT+ (intervention) groups, with three- and six-month follow-up periods. The GetFIT group received healthy lifestyle counseling from a licensed health coach, a free commercial mHealth app with push alerts on physical activity, and an activity tracker for physical activity monitoring. The GetFIT + group received the same components but had personalized text messages instead of push alerts. The 13-item Patient Activation Measure assessed patient activation; higher scores indicate better activation. Linear mixed-effects models were used to investigate between-group changes in outcomes across time. Results: The mean age was 65.4 ± 6.0 years; 61% were females and 61% were married. Baseline characteristics were comparable between groups. Significant improvements were observed in the GetFIT+ group at three months (mean 3.53, 95% CI 0.11, 6.96; p=0.043) and six months (mean 4.37, 95% CI 0.91, 7.83; p=0.014), whereas improvements in the GetFIT group were non-significant. Adjusting for age, gender, education, employment, marital status, social support, smartphone confidence, and self-perceived health did not alter the results. Nevertheless, only social support was associated with higher patient activation overall (B=5.14, 95% CI 1.00, 9.27; p=0.015). Conclusions: People at risk for cardiovascular disease can improve their self-management abilities, knowledge, and confidence through personalized text messaging. Possessing social support is critical for maximizing the benefits of mHealth interventions.
Abstract 4117256: EFFECT OF CORONARY MICROEMBOLIZATION ON AUTOPHAGY-RELATED MICRORNA AND PROTEIN PATHWAYS STUDY
Authors: 亚军 薛
Journal: Circulation (2024)

Background: Coronary microembolization (CME) commonly occurs during PCI in acute coronary syndrome, leading to myocardial damage. The purpose of this study is to explore the effects of CME on autophagy-related microRNAs and protein pathways, and to identify possible mechanisms of myocardial injury caused by CME. Methods: This study randomly divided rats into 6 groups: sham and CME1h, 3h, 6h, 9h, 12h groups. A rat model of CME was established by injecting autologous microthrombi into the left ventricle. Echocardiography and HE staining were performed to evaluate myocardial infarct size in each group. The expression of microRNA-144-3p and microRNA-214-3p, LC3-II, p62/SQSTM1, phosphatase, and PTEN was detected. Results: Compared with the sham group, LVEF and LVFS decreased,LVESD increased (P&lt;0.05) in the CME3h, 6h, 9h, and 12h groups,the myocardial infarct area significantly increased in the CME6h group (P&lt;0.05). The expression of microRNA-144-3p and microRNA-214-3p in myocardial tissue increased after CME, reaching a peak at 1h (P&lt;0.05); LC3II decreased at CME1h (P&lt;0.05) and significantly increased in the CME6h group (P&lt;0.05). p62/SQSTM1 increased at CME1h (P&lt;0.05) and then gradually decreased, while PTEN increased after CME3h (all P&lt;0.05), with a peak at 6h. Conclusion: Autophagy showed dynamic changes after CME, suggesting that enhanced autophagy aggravates myocardial damage after CME. Related microRNAs and PTEN are involved in the regulation of autophagy after CME.
Abstract 4113961: Contemporary Guideline Directed Medical Therapy in Heart Failure in Clinical Practice - Results from the EMPACE Study
Authors: Stephen Greene, Atif Adam, Niklas Schmedt, Christian Carlsen, Milou Brand, Jack Brewster, Leila Karimi, Juergen H. Prochaska, Phuong Tran, Sarah Seager, Ayman Alhamdow
Journal: Circulation (2024)

Background: Guideline directed medical therapy (GDMT) for heart failure (HF) evolves, incorporating newer therapies such as SGLT2i within recommendations for HFmrEF and HFpEF. Understanding the contemporary profile of real-world HF patients, in combination with real-world utilization of GDMT, is important for informing GDMT implementation and quality improvement strategies. The EMPACE study aims to improve our comprehension of HF GDMT utilization in real-world settings during post-2020 . Objectives: To describe baseline demographic and clinical characteristics, including baseline treatments, of patients with HF hospitalization (HHF). Methods: This non-interventional, retrospective cohort study used patient data standardized to the OMOP Common Data Model from the Optum Market Clarity, an integrated EHR and Claims database in the U.S. The study period spanned from Jun-2020 to Oct-2023. Adult patients with a primary diagnosis of HF during hospitalization were stratified by HF phenotypes (HFrEF, HFmrEF, HFpEF) based on left ventricular ejection fraction (EF). Results: A total of 30,762 patients with HHF were included (74% HFrEF, 4% HFmrEF, and 22% HFpEF). The mean age was 70.1 years, 60% were male, mean BMI was 30.6 kg/m 2 , and mean eGFR was 58.7 mL/min/1.73m 2 . Of them, 72% had a history of HF and 43% has been previously hospitalized for HF in the past 1 year. The prevalence of baseline comorbidities was as follows: hypertension (90%), coronary artery disease (54%), chronic kidney disease (38%), atrial fibrillation (40%), peripheral artery disease (9%), stroke history (9%), and end-stage renal disease (1%). Medication prior to HF hospitalization are described in the figure 1. Overall, prior comorbidities and HF medication use in the last 365 days prior to HHF were similar between all HHF patients and the HFrEF, HFmrEF, and HFpEF phenotypes, except for the lower use of MRA and ARNI in HFmrEF, and HFpEF patients. Conclusion: This study showed a high comorbidity burden and a low utilization of many GDMT prior to hospitalization, especially for novel GDMT (ARNI and SGLT2i) and in HFmrEF and HFpEF. Despite many medications having a varying strength of guideline recommendation depending on EF, absolute differences in rates of GDMT utilization were relatively small across the EF phenotypes. Across the spectrum of EF, further efforts are needed to improve use of GDMT and reduce the missed opportunities for GDMT implementation that are occurring prior to HHF.
Abstract 4116285: Safety and Efficacy of Early Direct Oral Anticoagulants Versus Low Molecular Weight Heparin in Patients with Ischemic Stroke and Immobility: A Multi-National Database Study
Authors: Kyle Chang, Suhas Nareddy, Bryce Hambach, Christiana Prucnal, Elvin Hernandez, Lisa Sovory
Journal: Circulation (2024)

Background: Low molecular weight heparin (LMWH) is the preferred anticoagulant for venous thromboembolism (VTE) prophylaxis in patients with ischemic stroke and reduced mobility. However, some patients may have indications for early direct oral anticoagulants (DOACs) and are continued on this therapy rather than transitioning to LMWH. Whether outcomes differ between these groups is unknown. We compared the safety and efficacy of early DOACs versus LMWH from a large retrospective database. Methods: Patients within the TriNetX Research Network receiving either DOACs or LMWH within 72 hours of ischemic stroke and a Modified Rankin Scale of 4-5 were included. A 1:1 propensity score matching analysis was performed using 27 covariables including demographic information, comorbidities, and medications. Chi-square and independent t -tests were used in bivariable analyses. Outcomes were all-cause mortality, VTE, intracranial and extracranial hemorrhage at 30 and 90 days. Results: Of 5,492 propensity-matched patients, mean age was 73±13, and 43% were male. Mortality in the DOAC group was significantly lower than in the LMWH group at 30 days (RR=0.59, 95% CI: 0.51-0.69) and 90 days (RR=0.63, 95% CI: 0.56-0.71). Risk of VTE was not significantly different at 30 days (RR=0.80, 95% CI: 0.43-1.50) or 90 days (RR=0.74, 95% CI: 0.45-1.22). Risk of intracranial hemorrhage was not significantly different at 30 days (RR=0.81, 95% CI: 0.36-1.80) or 90 days (RR=0.62, 95% CI: 0.34-1.15). Conclusions: In patients with acute ischemic stroke and reduced mobility, early use of DOACs was associated with lower mortality compared to early use of LMWH.
Abstract 4113475: Association of Age at Diabetes Diagnosis and All-cause and Cardiovascular Mortality among 600,000 US Adults
Authors: Blake Thomson, Fiona Bragg, Shoa CLARKE, William Herrington, Themistocles Assimes, Jonathan Emberson, Pascal Geldsetzer
Journal: Circulation (2024)

Introduction: Diabetes is a leading cause of morbidity and mortality in the United States, causing an estimated 440,000 deaths among US adults in 2019. Establishing the relevance of diabetes diagnosis at various ages to mortality in the contemporary US population, both overall and among major demographic subgroups, may inform public health policy and strategy. Methods: We aimed to quantify the association between age at diabetes diagnosis and all-cause and cardiovascular mortality among US adults using publicly-available data from the National Health Interview Survey 1997-2018, linked to the National Death Index through 2019. We used Cox regression adjusted for age, sex, race and ethnicity, educational attainment, smoking status, body-mass index, physical activity, and insurance coverage to estimate all-cause and cardiovascular mortality rate ratios overall, by sex, and by race and ethnicity. Results: Among 601,467 included adults (56% female, 16% Hispanic and 14% non-Hispanic Black) there were 75,122 deaths during 6.6 million person-years of follow-up. Overall, the all-cause mortality rate ratio associated with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years were 3.87 (95% CI 3.47-4.32), 2.87 (2.68-3.07), 2.26 (2.16-2.36), 1.72 (1.65-1.79), 1.47 (1.41-1.53), and 1.26 (1.19-1.33), respectively. The corresponding cardiovascular mortality rate ratios were 5.02 (4.09-6.16), 3.37 (2.99-3.78), 2.88 (2.65-3.13), 1.94 (1.81-2.09), 1.53 (1.43-1.65), and 1.27 (1.15-1.40), respectively. Although these associations were similar by sex and by race and ethnicity, the age-specific prevalence of diabetes was greatest among non-White participants. Among individuals with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years, an estimated 74%, 65%, 56%, 42%, 32%, or 20% of deaths from any cause were attributable to diabetes. Conclusion: Age at diabetes diagnosis was associated with all-cause and cardiovascular mortality in a dose-dependent and approximately log-linear manner. Although associations were similar across diverse demographic groups, age-specific diabetes prevalence was greatest among non-White individuals, leading to greater mortality burden. If these associations were interpreted as largely causal, diabetes accounted for more than half of all deaths among those diagnosed before age 50 years. Preventing, delaying, and appropriately managing diabetes could prevent substantial excess mortality among US adults.
Abstract 4114597: Spontaneous coronary artery dissection: Case series and review of associated cardiovascular risks
Authors: Eyad Ahmed, Rajwant Kaur, Atul Prakash
Journal: Circulation (2024)

Background: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of ACS, myocardial infarction, and sudden death particularly among young women and individuals with few conventional atherosclerotic risk factors. We reveiwed possible risk factors that could predispose to SCAD. Methods: We reviewed 13 consecutive patients presenting with SCAD across three different institutions over a period of 5 yrs and determined risk fatcors associated with this disase entity. Results: 13 patients presented with SCAD represented % 0.5 of the total number of patients who underwent cardiac cathaterizations for chest pain requiring admissions. 11/13 (84%) were female. 5/13 (38%) were Caucasian or Hispanic, and 3/13 (23%) were African-American. Mean age age was 49.3 + years. 8/13 (61%) had associated hyperlipidemia with LDL levels &gt; than 110 mg/dL, 9/13 (64%) had an A1c &lt; 5.6% and only 1/13 (0.07%) had A1c of 6.4%. HTN was present in 6/13 (46%) of patients, and family history of SCD or heart disease were only seen in 2/13 (15%). None of the patients had features suggestive of associated fibromuscular dysplasia or connecive tissue disease. D-dimer was elevated in 5/13 (38%) with average value of 1578 ng/dL. Inflammatory markers were reviewed, only 3 patient has had ESR and CRP ordered, and only 1/3 had a mildly elevated CRP 3.9 mg/dL. Only 1/13 (0.07%) required intervention which was due to further drop in her ejection fraction requiring PCI, with improvement in her symptoms. All patients were treated with dual anti-platelet therapy for 1 year, 1 was discontinued due to persitent chest pain and decision was made to treat with only aspirin. Traditionally, risks for SCAD were thought to be due to non-atheresclerotic factors, however our case series shows that more then 60% of patients had elevated LDL's and 46% with hypertension, implying that traditional atheresclerotic risk factors should not be ignored and may play a crucial role. Autoimmune diseases were not found in any of our patients. Conclusion and implications: In this series patients who had SCAD had conventional risk factors of CAD including HLD and hypertension. The variability of co morbidities makes the identification of specific risk factors very difficult and none of the patients had Fibromuscular dysplasia or any signs of inflammation. Elevated D Dimer was also seen in a majority of patients, and all but one was managed medically with a favorable outcome
Abstract 4114970: Comparing efficacy and safety between pulsed field ablation, cryoballoon ablation and high-power short duration radiofrequency ablation in atrial fibrillation: A systematic review and Network meta-analysis.
Authors: Natee Deepan, Adivitch Sripusanapan, Narut Prasitlumkum, Noppachai Siranart, Ronpichai Chokesuwattanaskul, Leenhapong Navaravong, Jakrin Kewcharoen, Patavee Pajareya, Nithi Tokavanich
Journal: Circulation (2024)

Background: Pulsed field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) are emerging techniques for treating atrial fibrillation (AF), offering promising results compared to cryoballoon ablation (CBA). This network meta-analysis aims to evaluates the efficacy and safety of PFA, HPSD, and CBA. Method: PubMed, Embase, Cochrane Central Register of Controlled Trials, and EBSCO Information Services were systematically searched for relevant studies until April 2024. The primary outcome is freedom from atrial arrhythmia. A random-effects model was used for data synthesis, and P-scores were employed for outcome ranking. Point estimation (odd ratios) was calculated for comparisons. Results: Fifteen studies were included in our network meta-analysis, involving 5,093 atrial fibrillation patients: 812 (16%), 2,659 (52%), and 1,622 (32%) patients underwent PFA, CBA, and HPSD, respectively. PFA demonstrated the highest efficacy (P-scores 99.3%). Point estimation between PFA and HPSD, and PFA and CBA, were 1.394 (95% CI: 1.047-1.858) and 1.479 (95% CI: 1.134–1.929), respectively. PFA had higher complications compared to HPSD (OR=4.44, 95% CI: 1.405-14.031) and CBA (OR=2.581, 95% CI: 0.992–6.720). HPSD had the shortest fluoroscopic time (P-scores 100%), while CBA had the longest (P-scores 0%). PFA had the shortest procedural time compared to CBA and HPSD with P-scores of 100% 50% and 0%, respectively. Conclusion: PFA showed higher efficacy but higher complication risk than HPSD and CBA. HPSD and CBA demonstrated similar efficacy and safety.
Abstract 4123391: CardioMEMS and Mavacamten: A Synergistic Approach in Managing Hypertrophic Obstructive Cardiomyopathy with HFpEF Phenotype
Authors: Momina Iftikhar, Ningxin Wan
Journal: Circulation (2024)

Introduction: Mavacamten is a cardiac myosin inhibitor that has been approved for obstructive hypertrophic cardiomyopathy (oHCM). The CardioMEMS PA (pulmonary artery) sensor allows remote pulmonary artery diastolic (PAD) pressure monitoring to adjust diuresis in heart failure with preserved ejection fraction (HFpEF). We present the case of a patient with oHCM and HFpEF where data extrapolated from CardioMEMS provided valuable insight to the hemodynamic impact of cardiac myosin inhibitors. Case: A 66-year-old female with hypertension, obesity and oHCM presented with worsening dyspnea and was evaluated for septal myectomy. However, surgery was deferred because of decompensated HFpEF, as evidenced by significant leg edema on exam, and severely elevated left and right-side filling pressure, with restrictive physiology on right heart catheterization. A CardioMEMS PA sensor was implanted to guide decongestion, however, escalation of diuresis was limited due to severe left ventricular outflow tract (LVOT) obstruction. PAD remained elevated at 20-30 mmHg. Due to the refractory LVOT obstruction and despite the use of maximally tolerated beta blockers, Mavacamten was initiated and escalated according to protocol. LVOT obstruction resolved on follow up echocardiogram. Without any adjustment in her diuretic regimen, her PAD decreased to 15-20 mmHg. On follow-up visit, the patient reported improvement in dyspnea and reduction in lower extremity edema. Discussion: Managing oHCM is challenging, particularly when complicated by HFpEF. Mavacamten has shown promise in reducing LVOT gradients and improving symptoms in oHCM. However, managing fluid status in these patients can be difficult due to the risk of exacerbating LVOT obstruction while optimizing filling pressures. Our case provides direct evidence that treating LVOT obstruction with a cardiac myosin inhibitor leads to improvement in decompensated heart failure, as evidenced by the reduction in PAD. Conclusion: Addressing LVOT obstruction is key to decongesting and managing heart failure in oHCM patients. In our case, the use of CardioMEMS PA sensor system allowed a novel perspective of assessing hemodynamic impact of cardiac myosin inhibitors.
Abstract 4113047: Discovering novel biomarkers and predicting cardiovascular disease using AI/ML techniques for precision medicine
Authors: Zeeshan Ahmed
Journal: Circulation (2024)

Personalized interventions are deemed vital given the intricate characteristics, advancement, inherent genetic composition, and diversity of cardiovascular diseases (CVDs). The appropriate utilization of artificial intelligence (AI) and machine learning (ML) methodologies can yield novel understandings of CVDs, enabling improved personalized treatments through predictive analysis and deep phenotyping. In this study, we proposed and employed a novel approach combining traditional statistics and a nexus of cutting-edge AI/ML techniques to identify significant biomarkers for our predictive engine by analyzing the complete transcriptome of CVD patients (Figure 1). After robust gene expression data pre-processing, we utilized three statistical tests to assess the differences in transcriptomic expression and clinical characteristics between healthy individuals and CVD patients. Next, a classifier assigned rankings to transcriptomic features based on their relation to the case-control variable. The top ten percent of commonly observed significant biomarkers were evaluated using four unique ML classifiers. After optimizing hyperparameters, the ensembled models, which were implemented using a soft voting classifier, accurately differentiated between patients and healthy individuals. We have uncovered 18 transcriptomic biomarkers that are highly significant in the CVD population that were used to predict disease with up to 96% accuracy (Figure 2). Additionally, we cross-validated our results with clinical records collected from patients in our cohort (Figure 3). The identified biomarkers served as potential indicators for early detection of CVDs. With its successful implementation, our newly developed predictive engine provides a valuable framework for identifying patients with CVDs based on their biomarker profiles.