tbuckley/cabot-search huggingface dataset:
Abstract 16508: Use of Ultrasound Enhancing Agents in Echocardiography for Stroke Across Yale New Haven Health System
Authors: Gini Priyadharshini Jeyashanmugaraja, Md Mashiul Alam, Robert L McNamara, Evgeny Shkolnik
Journal: Circulation (2023)

Background: Transthoracic echocardiography (TTE) is routinely performed for evaluation of stroke. We examined patterns of ultrasound enhancing agent (UEA) use for stroke across Yale New Haven Health System (YNHHS) Hypothesis: Prevalence of left ventricular (LV) thrombus depends on LV function, wall motion and UEA use. Methods: 15209 TTE studies with indication of cerebrovascular accident or transient ischemic attack were performed from January 2019 to December 2022 across YNHHS. UEA was used in 7578 studies (49.8%). We compared the prevalence of LV thrombus and frequency of UEA use stratified by location (community hospitals, university hospitals, and outpatient sites) and by LV function. Chi square was used to compare rates of LV thrombus as well as frequency of UEA use stratified by LV function and location. Results: UEA use varied from 2.6% in community outpatient sites, 23.3 % in community hospitals to 77% in a university hospital. LV thrombus was detected in 56 of 7578 UEA studies (0.74%). Increasing prevalence of LV thrombus was associated with decreasing LV function (p&lt;0.0001). LV thrombus was detected only in 1/3716 UEA studies (0.027%) with normal LV function and normal wall motion. Increased frequency of contrast use in university hospital compared with community hospitals did not lead to overall higher rate of thrombus detection.When stratified by LV function, only subgroup with normal function had marginally higher rate of LV thrombus, but prevalence of LV thrombus in this subgroup was very low. Conclusion: Significant variability of UEA in TTE exists for evaluation of stroke across YNHHS with low prevalence of thrombus in hyperdynamic to normal LV function without wall motion abnormalities. Increased use of UEA was not associated with increased rate of LV thrombus detection, except group with normal function. Value of increased detection in this group with low prevalence of thrombus should be balanced against cost and risk of adverse reactions.
Abstract 12619: Positional Obstructive Sleep Apnea and Risk of Atrial Fibrillation
Authors: Jeongok G Logan, Ha Do Byon, Younghoon Kwon
Journal: Circulation (2023)

Introduction: Obstructive sleep apnea (OSA), a common sleep disorder, has been associated with the risk of atrial fibrillation (AF). OSA is a heterogenous condition but is heavily position-dependent. Positional OSA (POSA) is a common form of OSA in which OSA is predominantly manifested in a supine position. The implication of POSA in cardiovascular risks is unclear. This study aimed to examine whether the risk of AF is different between individuals with POSA and those with non-positional OSA (nPOSA). Methods: We identified individuals with OSA (AHI ≥ 5/h) from the Sleep Heart Health Study (SHHS) cohort. POSA was defined if overall AHI ≥ 5/h, supine AHI ≥ 5/h, and supine AHI greater than twice the non-supine AHI based on the SHHS visit 1 sleep study. Incident AF was deemed present if detected on a 12-lead ECG during the SHHS visit 2 or confirmed by the parent cohorts at any time between the baseline PSG and the final follow-up date for AF assessment. Multiple logistic regression analysis was conducted with covariates including age, race, gender, body mass index, smoking status, systolic blood pressure, use of hyperlipidemia medication, use of diabetes medication (oral or insulin), use of hypertension medication, cholesterol, triglyceride, and high-density-lipoprotein, and other sleep characteristics (total sleep duration, sleep efficiency, and sleep onset latency). Results: The study included a total of 1712 participants (females, 45%; mean age, 65 years old) with OSA. Compared with individuals with nPOSA, those with POSA were more likely to be white (p=.002), older (p&lt;.043), have lower AHI (p&lt;.001), lower BMI (p&lt;.001), lower systolic blood pressure (p&lt;.001), and lower triglyceride (p=.029), longer sleep duration (p=.002), and less likely to take hypertension medication (p&lt;.001). After accounting for these differences, the odds of incident AF were about 30% lower in the individuals with POSA compared with those with nPOSA (OR=0.7, p=.037). Conclusions: Individuals with OSA exhibit a lower risk of AF when they have POSA. While it is possible that residual confounding could account for this finding, we conclude that POSA might represent a unique phenotype with distinct cardiovascular implications.
Abstract 15697: Exposure to Serum From Exclusive Heated Tobacco Product Smokers Induces mTOR Activation and Fibrotic Features in Human Cardiac Fibroblasts
Authors: Vittorio Picchio, Francesca Pagano, Roberto Carnevale, Alessandra D'Amico, Claudia Cozzolino, Erica Floris, Antonella Bordin, Leonardo Schirone, Wael Saade, Fabio Miraldi, Elena De Falco, Mariangela Peruzzi, Sebastiano Sciarretta, Giuseppe Biondi-Zoccai, Giacomo Frati, Isotta Chimenti
Journal: Circulation (2023)

Introduction: Smokers are at higher risk of fibrosis-related atrial fibrillation. The use of heated tobacco products (HTPs) is rising worldwide with unclear effects on health. The SUR-VAPES chronic trial showed that exclusive HTP smokers have increased serum markers of oxidative/endothelial stress versus non-smokers (NS), comparable to cigarette smokers. Hypothesis: We hypothesized that the serological profile of HTP smokers can activate atrial fibroblasts towards a pro-fibrotic phenotype. Methods: CFs were isolated from discarded atrial tissue from elective cardiac surgery procedures, and exposed to serum lots (20 healthy young subjects each) from HTP smokers (mean exclusive use=1.5 years) or clinically matched NSs from the SUR-VAPES Chronic trial. ANOVA testing was applied. Results: CFs treated with HTP serum increased expression of fibrotic genes, including PDGFA (1.18-fold, p&lt;0.01) and THY1 (1.22-fold, p&lt;0.01), and increased aSMA protein levels (1.87-fold, p&lt;0.01), compared to NS serum. Connexin 43 was downregulated at both mRNA (1.17-fold, p&lt;0.05) and protein levels (1.56-fold, p&lt;0.01) in CFs after exposure to HTP serum versus NS. COL1A1 expression increased (1.46-fold, p&lt;0.01), with higher soluble collagen release (1.56-fold, p&lt;0.05). CFs pre-treated with HTP serum released lower levels of cardioprotective proteins (e.g. Adiponectin, Chi3L1, VEGF) by protein arrays/ELISA (p&lt;0.05 vs NS). Paracrine support of CF-conditioned media to endothelial tube formation (63.3±4.7 vs 37.3±5.7 mesh #/well, p&lt;0.05) and to cardiomyocyte viability under starvation (0.60±0.04 vs 0.47±0.01 normOD vs t0, p&lt;0.001) were reduced when pre-treated with HTP versus NS serum. Array screening of 37 phospho-proteins in CFs exposed to HTP serum for 1h found several beneficial pathways blunted, with many inhibiting mTOR, including decreased P-PRAS40 (-2.43-fold) and P-p53 (-2.32-fold, p&lt;0.05). Western blot analysis on CFs after 48h of HTP serum treatment confirmed increased P-mTOR (1.40-fold), and its targets P-S6K (1.39-fold) and P-4EBP1 (1.83-fold, all p&lt;0.05). Conclusions: The serological profile of chronic exclusive HTP smokers induces CF activation and fibrotic features pointing to a potential risk for atrial fibrosis.
Abstract 13435: The Efficacy and Safety of Botulinum Toxin Type A to Prevent Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials
Authors: Basel Abdelazeem, Soumya Kambalapalli, Othman Saleh, Majd M. AlBarakat, Ibrahim Gowaily, Abdelrahman Mahmoud, Shafaqat Ali, Mohamed T Abuelazm
Journal: Circulation (2023)

Background: Postoperative atrial fibrillation (POAF) is prevalent in about 30 to 60 percent of patients undergoing cardiac surgery leading to worse outcomes. However, effective POAF therapies are lacking. Botulinum toxin type A (BTX) epicardial injection can prevent POAF by impairing cholinergic signaling. Methods: We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through November 23 rd , 2022. RevMan version 5.4 software was used to pool dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD) presented with the corresponding confidence interval (CI). Results: Three RCTs with a total of 509 patients (308 in the BTX group and 205 in the placebo group) were included in our analysis. Two RCTs included patients undergoing open-chest cardiac surgery, including coronary artery bypass graft (CABG) and/ or valve surgery, while one RCT included patients undergoing CABG only. There was no difference between BTX and placebo regarding POAF incidence (RR: 0.81 with 95% CI [0.65, 1.00], P= 0.05), postoperative hospital length of stay in days (MD: -0.03 with 95% CI [-0.54, 0.49], P= 0.91), all-cause mortality, (RR: 1.64 with 95% CI [0.22, 12.17], P= 0.63), any adverse event (RR: 1.03 with 95% CI [0.94, 1.12], P= 0.51), and any serious adverse event (RR: 0.89 with 95% CI [0.68, 1.15], P= 0.36). Conclusion: There was no difference between epicardial fat injection of BTX versus placebo for preventing POAF; however, BTX showed a similar safety profile compared to placebo and our analysis can be underpowered to detect a significant effect. Hence, further large-scale RCTs are warranted to investigate BTX for POAF, especially in high-risk cohorts.
Abstract 16428: Impact of Low-Dose Rivaroxaban Plus Aspirin on Myocardial Infarction in Patients With Peripheral Artery Disease With and Without Concomitant Coronary Artery Disease: Insights From VOYAGER PAD
Authors: Mario Enrico Canonico, Justin Morrison, Sonia S Anand, Manesh R Patel, Sebastian Debus, Mark Nehler, Connie N Hess, Judith A Hsia, Warren Capell, Eva Muehlhofer, Lloyd P Haskell, Scott D Berkowitz, Rupert Bauersachs, Marc P Bonaca
Journal: Circulation (2023)

Background: Patients with peripheral artery disease (PAD) are at heightened risk of major adverse cardiovascular events (MACE). In VOYAGER PAD, rivaroxaban 2.5 mg BID reduced ischemic risk in PAD patients after lower extremity revascularization (LER). Whether the benefits for MACE and in particular for Myocardial Infarction (MI) differ in those with and without clinically known coronary artery disease (CAD) has not been described. Hypothesis and Methods: VOYAGER PAD randomized patients with symptomatic PAD undergoing LER to rivaroxaban 2.5 mg BID plus aspirin versus aspirin alone. MACE was defined as composite of MI, ischemic stroke, or cardiovascular death. Subtypes of MI were adjudicated according to the Universal Definition. Comorbid CAD was a prespecified subgroup. Results: Of 6,564 symptomatic PAD randomized, 2,083 (32%) had documented CAD at baseline. The benefit of rivaroxaban plus aspirin was greater for MACE in those with vs without CAD (HR 0.79, 95% CI 0.62 - 1.00 vs HR 1.12, 95% CI 0.92 - 1.36; p-interaction 0.03). Similarly, MI reduction with rivaroxaban plus aspirin was greater for those with vs without CAD (HR 0.78, 95% CI 0.56 - 1.10 vs HR 0.96, 95% CI 0.69 - 1.34; p-interaction 0.39). Considering MI subtypes, the effect of rivaroxaban plus aspirin on type 1 MI was consistent in patients with CAD (HR 0.91, 95% CI 0.58 - 1.42) and without CAD (HR 0.74, 95% CI 0.74 - 1.11, p-interaction 0.50). However, a trend towards benefit of rivaroxaban plus aspirin was seen for Type 2 MI in those with CAD (HR 0.71, 95% CI 0.41 - 1.24) but not in patients without CAD (HR 1.66, 95% CI 0.89 - 3.09, p-interaction 0.0475, figure). Type 4 MI was infrequent regardless of CAD. Conclusions: Rivaroxaban plus aspirin had consistent effects in MACE for PAD and CAD patients undergoing LER. Our analysis of MI subtype suggests that events adjudicated as MI due to supply demand mismatch (Type 2) may have a thrombotic component and are lowered with rivaroxaban and aspirin in PAD and CAD patients undergoing LER.
Abstract 16990: Empagliflozin Therapy is Associated With Improved Left Ventricular Diastolic Function in Patients With Transthyretin Amyloid Cardiomyopathy
Authors: Gregor Zemljic, Sabina Frljak, Gregor Poglajen, Neza Zorz, Andraz Cerar, Renata Okrajsek, Bojan Vrtovec
Journal: Circulation (2023)

Introduction: Although SGLT-2 inhibitors demonstrated beneficial clinical effects in patients with heart failure with preserved ejection fraction, their role in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) remains undefined. Hypothesis: We investigated the effects of empagliflozin on myocardial function in patients with ATTR-CM. Methods: In a prospective single-center non-randomized cohort study we enrolled 15 consecutive patients with ATT-CM receiving tafamidis 61 mg qd and standard heart failure therapy for at least six months prior to enrolment. At the time of inclusion, all patients started receiving empagliflozin 10 mg qd. Biochemical and echocardiographic parameters were evaluated at baseline and again at 6-months. Results: At the time of inclusion, the average age of patients was 74.8±5.7 years, 14 (93%) were male, and 14 (93%) had NYHA class II symptoms; 10 (67%) patients were receiving ARNI/ACEI/ARB, 5 (33%) were treated with beta blockers, and 3 (20%) were receiving mineralocorticoid receptor antagonists. At 6-months follow-up we found no change in NT-proBNP levels (1694±1237 ng/L at baseline vs. 1549±1203 ng/L at follow up; P=0.78), hs-Troponin I levels (33±19 ng/L vs. 39±26 ng/L; P=0.50), or eGFR (65.9±14.4 mL/min vs. 64.9±14.8 mL/min; P=0.87). Furthermore, we observed no changes in LVEDV (84±19 mL vs. 88±17 mL; P=0.61), LVEF (57±8% vs. 57±7%; P=0.94), LV mass (265±74 g vs. 279±88 g; P=0.67), or RVIDd (39±8 mm vs. 36±7 mm; P=0.39). However, at 6 months we found a significant decrease in E/e’ (19.2±5.1 vs. 14.9±5.4; P=0.05). When stratifying patients according to the baseline E/e’ value we found a significant improvement of right ventricular FAC (44.1±6.2% vs. 31.9±8.9%; P=0.04) and TR pressure gradient (26.0±5.7 mmHg vs. 39.7±5.2 mmHg; P=0.04) in patients with E/e’ below median compared to patients with E/e’ above median value. Conclusion: In patients with ATTR-CM, empagliflozin therapy appears to reduce left ventricular filling pressures and may be associated with improved right ventricular systolic function in a subset of this patient population.
Abstract 14830: Digital Central Monitoring Units Reduce Telemetry Alert Burden and Improve Clinician Alert Response Metrics
Authors: Veniamin Melnychuk, Vishrut Shah, Richard Blumingold, Pallavi Aneja, Jason Kelly, John Beard
Journal: Circulation (2023)

Introduction: Cardiac electrocardiographic telemetry is guided by AHA Practice Standards and is associated with improved patient outcomes. Cardiac telemetry digital central monitoring units (dCMU) optimize telemetry performance by facilitating alert dispatches and providing processes for quality improvement. Hypothesis: Implementation of dCMU would result in a reduced number of alerts transmitted to bedside staff and improved alert management. Methods: From May 2022 to March 2023, alerts were collected and analyzed at 6 hospitals transitioned from standard telemetry practice to dCMU. Standard practice includes monitor technicians reviewing alerts and waveforms, ranking alerts and manually contacting clinicians. The dCMU platform organizes and ranks clinical alerts after which a CMU tech dispatches alerts to a mobile app. The bedside clinician receives the alert, patient data, and real time waveform for contextual analysis. The alert is marked “handled” when the provider accepts the message. If the message is not accepted, the alert enters an escalation pathway. The dCMU platform also contains performance analyzing software which guides process improvement. Results: Alert counts and characteristics were collected and analyzed during an 11-month period. Comparing a 30-day baseline period to the last 30-day post-implementation period, dispatched alerts to clinician devices decreased 35.5% - from 5,032 to 3,246 alerts per day and the rate of notifications handled by providers increased 88% - from 42% to 78.8% of all dispatched alerts (Figure 1). The total time that patients were in alert state decreased 32.4% - from 31,930 to 21,576 minutes per day. Conclusions: The introduction of dCMU structured and streamlined the telemetry dispatch process leading to reduced alert burden and improved bedside clinician alert handling. Further studies are necessary to determine the effects of dCMU dispatch control on patient outcomes compared to standard telemetry practice.
Abstract 15177: Unloading Reveals a Latent Cardiomyocyte Regeneration Potential in the Human Heart
Authors: Wouter Derks, Julian Rode, Sofia Collin, Fabian Rost, Paula Heinke, Anjana Hariharan, Lauren Pickel, Irina Simonova, Eniko Lázár, Evan Graham, Ramadan Jashari, Michaela Andrä, Anders Jeppsson, Mehran Salehpour, Kanar Alkass, Henrik Druid, Christos Kyriakopoulos, Iosif Taleb, Thirupura S S Shankar, Craig Selzman, Hesham A Sadek, Stefan Jovinge, Lutz Brusch, Jonas Frisen, Stavros G Drakos, Olaf Bergmann
Journal: Circulation (2023)

Introduction: Cardiomyocytes in the adult human heart show a minimal regenerative capacity. Whether this regenerative capacity of human cardiomyocytes is employed in heart failure (HF) has been controversial. Advanced HF patients can be supported with a left ventricular assist device (LVAD) and a subset of these patients show significant functional and structural cardiac improvement (termed responders). It remains unknown how mechanical unloading affects cardiomyocyte renewal, and if there is a difference between responders and non-responders. Hypothesis: Mechanical unloading differentially induces cardiomyocyte renewal in responders and nonresponders. Methods: We determined cardiomyocyte renewal by measuring the 14C concentration of cardiomyocyte genomic DNA. We included 52 patients with advanced HF, 28 of whom received LVAD support. Nuclear ploidy and the number of nuclei per cardiomyocyte were measured using both flow cytometry and image cytometry to distinguish the extent of non-productive cell cycle activity from proliferation. To integrate the measured 14C concentrations with the data on cardiomyocyte DNA synthesis mathematical modeling was performed and used to investigate renewal in HF, with and without mechanical unloading. Results: Cell cycle activity increased in failing hearts rather than renewal, which was reduced &gt;18-fold in non-ischemic and &gt;50-fold in ischemic failing hearts compared to healthy hearts. Conversely, LVAD responders showed a &gt;6-fold increase in cardiomyocyte renewal relative to a healthy heart. Conclusions: LVAD-mediated functional cardiac improvement was accompanied by cardiomyocyte renewal, indicating a latent potential for regeneration in the adult heart.
Abstract 13184: Relationships Between Food Insecurity and Dietary Quality in Persons With Cardiovascular Disease in NHANES (National Health and Nutrition Examination Survey), 2009-2020
Authors: Monica M Godden, Janice F Bell, Tequila Porter, Julie T Bidwell
Journal: Circulation (2023)

Background: Most guidelines recommend a nutrient-rich, heart-healthy diet for management of cardiovascular disease (CVD). Following dietary guidelines may be challenging for individuals experiencing food insecurity, but there is limited knowledge on how food insecurity relates to diet quality in persons with CVD. Hypothesis: We hypothesized that for persons with CVD (hypertension, heart disease, angina, MI, heart failure, or stroke), higher levels of food insecurity would be associated with lower levels of dietary quality. Methods: This was a cross-sectional analysis of 5 cycles of data (2009-2020) from the nationally representative National Health and Nutrition Examination Survey (NHANES). Participants aged &gt; 19 with self-reported CVD were included. Food insecurity was measured using the 10-item Food Security Scale. Dietary intake was measured using 24-hour dietary recall from which individual nutrients were derived. Key nutrients examined as indicators of diet quality included sodium, potassium, polyunsaturated and monounsaturated fats, fiber, and total sugars. Relationships between food insecurity and diet quality were quantified using multivariable linear regression models, incorporating NHANES sample weights and controlling for common sociodemographic confounders. Results: The sample consisted of 17,102 persons (weighted study N = 311,708,767). Half were female (55.48%); most were non-Hispanic White (68.74%) and in middle (45-64 years, 44.82%) or late adulthood (≥65 years, 32.29%). Nearly a quarter (23.9%) were food insecure. With the exception of sodium intake (sodium, mg, β=-156, p=0.02), higher levels of food insecurity were significantly associated with poorer diet quality (potassium, mg: β=-157, p&lt;0.004; polyunsaturated fats, gm: β=-1.81, p&lt;0.003; monounsaturated fats, gm: β= -2.19, p=0.003, fiber, mg: β= -1.08, p=0.003, total sugars, gm: β=13.15; p&lt;0.010). Conclusions: In persons with CVD, higher levels of food insecurity were significantly associated with lower diet quality in key nutrients essential for a heart-healthy diet. This study underscores the importance of considering social determinants of health to support patient and family success in following heart-healthy guidelines.
Abstract 13191: Effectiveness of a Telemedicine Intervention in Reducing Heart Failure Hospitalizations in Brazil: A Randomized Clinical Trial
Authors: EDMAR G RIBEIRO, Luisa C Brant, Regina T Bernal, Lilian C Rezende, Graziela Chequer, Barbara V Temponi, Daniel B Vilela, Julia B Buback, Tulio B Franco, Antonio L Ribeiro, Deborah Malta
Journal: Circulation (2023)

Introduction: Telemedicine interventions (TMI) for heart failure (HF) can reduce hospitalizations and deaths. It is unknown if lower literacy and access to technology in low- and middle-income countries could hamper these positive results. We evaluated if a TMI could reduce HF-related rehospitalizations in HF patients discharged from public hospitals in Brazil compared to usual care. Methods: In a randomized clinical trial (UTN: U1111-1263-9802), patients &gt;30 years, hospitalized due to HF in 6 public hospitals (09/2021 to 06/2022) were randomized before discharge to usual care (n=57) or to a multi-component TMI (n=70). The TMI included a weekly structured telephone support from a nurse to evaluate the daily monitoring of weight, blood pressure and heart rate collected by the patient, assess decompensation signs and treatment adherence barriers, and promote self-care education - including flexible diuretics dosing. The nurse was linked to a cardiologist for teleconsultations, according to pre-defined clinical decision trees. An educational program was also available, including unidirectional messages and two-way messaging in working hours. The primary outcome was HF-related rehospitalizations after 180 days, analyzed by intention-to-treat. Results: Of 127 patients, mean age was 64±11 years, 48% were female, 71% were black/“pardo”, 33% had &lt;4 years of education, and 68% had reduced ejection fraction. At 180 days, HF-related hospitalizations occurred in 18 (26%) patients from the TMI vs. 26 (46%) from the usual care group (RR=0.56, 95%CI 0.34-0.91, p&lt;0.01). Kaplan-Meier curves for the primary outcome are shown in Figure 1 . All-cause death or rehospitalizations (secondary outcome) occurred in 30% of patients in the TMI vs 47% in the usual care group (RR=0.63, CI95% 0.40-0.99, p=0.04). Conclusions: In HF patients discharged from hospitals in Brazil, a TMI reduced HF-related rehospitalizations compared to usual care.