tbuckley/cabot-search huggingface dataset:
Abstract 13729: Subclavian Artery, Thoracic Aorta, and Coronary Artery Calcification, Age, Race/Ethnicity and Sex Distributions: The Multi-Ethnic Study of Atherosclerosis
Authors: Daniel A Duprez, David R Jacobs, Michael Daniels, Leah Andrews, Lyndia Brumbach, Julie Denenberg, Kelly Watanabe, Germaine Cornelissen Guillaume, Michael Criqui, Moyses Szklo, Matthew A Allison
Journal: Circulation (2023)

Introduction: Upper extremity atherosclerosis is typically localized in the subclavian arteries, although it is less prevalent and less often symptomatic than in the lower extremities. Subclavian artery calcification (SAC) is a metabolic consequence of subclavian artery atherosclerosis. Hypothesis: SAC is different in gender and in different ethnicties. Aim: We studied SAC, in comparison with coronary artery calcification (CAC) and descending thoracic aorta calcification (TAC) in the MESA study population. Methods: We quantified SAC, TAC, and CAC in MESA participants who had a chest CT in 2016-18 (N = 2756, mean age 68.3±9.2 years, 48% male, 27% Black, 13% Chinese, 22% Hispanic, 38% White). We characterized the distributions of SAC and TAC, relative to CAC, and examined their associations with age, race/ethnicity, and sex. Race and sex differences were studied separately using logistic regression, adjusted for age, for each vascular bed. Results: Prevalence of any SAC was 62%, TAC 60%, and CAC 69%. Among those with any calcification, N, median and 90th percentiles were SAC: 1704, 76, 534; TAC: 1655, 152, 2011; CAC 1896, 135, 1118. Pairwise correlations [ln(Agatston score + 1)] were SAC - TAC: 0.61, SAC - CAC: 0.48, TAC - CAC: 0.48. Correlations with age were 0.46 for SAC, 0.58 for TAC and 0.40 for CAC. SAC and TAC prevalences were similar for males and females, but CAC was more common in males (Table, p&lt;0.05 for each race/ethnic group). Differences in prevalence varied by race, with small race differences for SAC, Chinese highest for TAC, and CAC highest for White (Table, groups with the same superscript within row do not differ significantly). Conclusion: In older adults, SAC and TAC occur almost as commonly as CAC. Calcification is moderately correlated between beds. The racial distribution is different for CAC than for SAC or TAC.
Abstract 11310: T Helper 1 Lymphocytes Promote Diastolic Dysfunction and Fibrosis in a Non-Hypertensive Angiotensin II Mouse Model of Heart Failure
Authors: Michelle M Kim, Eleonora Mezzaroma, Nadia Martinez Naya, Adolfo G Mauro, Pilar Alcaide, Antonio Abbate, Stefano A Toldo
Journal: Circulation (2023)

Introduction: Angiotensin (Ang) II induces cardiac fibrosis and diastolic dysfunction, also in absence of hypertension (HTN). We found that a non-HTN AngII infusion fails to induce dysfunction and fibrosis in T cell receptor α deficient mice ( Tcrα -/- , bereft of T cells). Hypothesis: Since T helper 1 (Th1) lymphocytes promote adverse remodeling in models of heart failure (HF), we hypothesized that Th1 cells are sufficient to induce diastolic dysfunction and fibrosis in a non-HTN AngII model. Methods: Naïve CD4+ cells were isolated from wild type (WT) mice lymph nodes (LNs) and spleens (MACS columns) and differentiated into Th1 cells over 7 days using plates coated with anti-CD3 antibody (5 μg/ml) plus IL-12 (10 ng/ml) and anti-IL-4 (1 μg/ml) and from day 4, IL-2 (20 ng/ml). Adoptive transfer (AT) of 10 7 Th1 cells/500 μl PBS, naïve CD4+ cells, or PBS alone was performed into Tcrα -/- mice (3-11 months old, N=8-16/group) implanted with AngII (0.2 μg/kg/day) osmotic pumps for 4 wks. AT was repeated two weeks later. LV dimensions, ejection fraction (EF), and diastolic function (isovolumetric relaxation time - IRT) were measured with Doppler echocardiography. LV end-diastolic pressure (EDP) and peak systolic pressure (PSP) were measured with a Millar catheter. Heart slides were stained with picrosirius red to measure interstitial fibrosis. Results: All groups had similar LV dimensions, EF, and PSP (not shown). AT of naïve CD4+ cells or PBS did not increase the IRT vs baseline (7.3±0.9 vs 7.6±0.6 and 9.9±0.7 vs 8.8±0.7 ms). AT of Th1 cells significantly increased the IRT (15.6±0.9 vs 9.0±0.7 ms, all p&lt;0.0001). EDP was significantly higher in Th1 mice (11.5±0.8 mmHg) vs naïve CD4+ mice (4.6±0.8 mmHg) or PBS (5.2±0.6 mmHg) (all p&lt;0.0001). Interstitial fibrosis in Th1 mice (1.4±0.2%) was significantly higher than in naïve CD4+ mice (0.7±0.1%) or PBS (0.8±0.1%) (all p&lt;0.001). Conclusions: Th1 cells are sufficient to induce diastolic dysfunction and fibrosis in a non-HTN AngII HF mouse model.
Abstract 13720: Global Burden, Trends, and Attributable Risk Factors for Ischemic Heart Disease, 1990~2019: A Systemic Analysis of the Global Burden of Disease Study 2019
Authors: Yichao Xiao, Shali Jiang, Shuting Ji, Nini Li, Wenrui Ni, Qiming Liu, Shenghua Zhou
Journal: Circulation (2023)

Background: As the primary culprit for nearly half of global cardiovascular deaths, ischemic heart disease (IHD) exerts a significant medical and economic toll, particularly on low- and middle-income countries. The rise in IHD incidence and mortality from 1990 to 2019 necessitates revising analyses and developing effective IHD strategies. Research Questions: To categorize IHD incidence, mortality, and Disability-Adjusted Life Years by country, sex, age, and Sociodemographic Index (SDI) from 1990-2019. To identify key risk factors and establish a model predicting IHD incidence till 2044.Aims: To assess global IHD incidence, dissect disease burden distribution, identify central risk factors, and forecast incidence trends. Methods: Leveraging the Global Burden of Disease (GBD) database for global population and IHD data from 1990 to 2019, we explored regional, gender, age attributes, and IHD temporal progression. We utilized a joinpoint model and an age-period-cohort model to decipher IHD incidence trends, scrutinized primary IHD risk factors, and predicted global IHD incidence till 2044. Results: Global age-standardized IHD incidence decreased from 316 (95% UI 282-352) in 1990 to 262 (95% UI 233-293) in 2019, primarily due to high SDI and high-middle SDI regions. Men had higher IHD incidence across all ages, notably between 35-74. Diet remained the leading risk factor from 1990 to 2019. Projections suggest a steady global IHD incidence similar to 2019 levels by 2044. Conclusions: Future trends indicate the IHD burden will concentrate in middle or lower SDI regions, with stable global IHD incidence over the next two decades. Joint initiatives to mitigate IHD's burden are vital, demanding specific policies and interventions. The GBD database is instrumental for health priority strategies. Collective efforts can lead us towards sustainable development and improved global health.
Abstract 12377: Differing Response to Left Bundle Branch Area Pacing versus Biventricular Pacing for Cardiac Resynchronization According to Septal Scar Burden Among Nonischemic Cardiomyopathy Patients
Authors: Zhongli Chen, Xuan Ma, Keping Chen
Journal: Circulation (2023)

Introduction: Whether left bundle branch area pacing (LBBAP) have similar benefit compared with biventricular pacing (BVP) for cardiac resynchronization therapy (CRT) in nonischemic cardiomyopathy (NICM) with different septal scar burden is still unknown. Hypothesis: We hypothesize that a higher septal scar burden might attenuate the relative benefits of LBBAP versus BVP. Aims: This study aims to assess the effect of the septal scar on the response to LBBAP and BVP for CRT. Methods: We retrospectively included nonischemic cardiomyopathy (NICM) patients with wide QRS complex and CRT indications who underwent pre-procedure cardiac magnetic resonance (CMR) examination and received either BVP or LBBAP. Late gadolinium enhancement (LGE) was analyzed for scar quantification. CRT response was defined as an absolute increase of≥ 5% in left ventricular ejection fraction (LVEF) at 6 months follow-up. Results: A total of 147 patients were included. Fifty-one patients (34.7%) had LBBAP, and 96 (65.3%) had BVP. As septal LGE extent increased, LVEF improvement at 6-month follow-up gradually decreased in the BVP group whereas dropped sharply in the LBBAP group. The nonlinear inverse relationship between the relative benefit of LBBAP versus BVP for response and septal LGE extent, as well as cut-off points (4.4%, 13.3%) of septal LGE extent, were determined using a restricted cubic spline model. Among patients with low septal scar extent (&lt;4.4%), LBBAP was associated with higher response odds than BVP [Odds Ratio (OR) 3.87,95% confidence interval (CI): 0.99-15.17,p=0.052]. In the medium septal scar extent (4.4%-13.3%) group, response odds did not differ between LBBAP and BVP (OR 2.00,95%CI: 0.41-9.74, p=0.391). Among patients with high septal scar extent (&gt;13.3%), BVP was associated with higher response odds (OR 0.12, 95%CI: 0.03-0.54, p=0.006). Conclusions: Response to LBBAP and BVP among NICM patients might be impacted by septal scar burden.
Abstract 12741: Malignant Left Ventricular Hypertrophy and Risk of Cognitive Impairment or Probable Dementia: A Post Hoc Analysis of the SPRINT Trial
Authors: Muhammad Ahmad, Timothy M Hughes, Richard Kazibwe, Lin Y Chen, Elsayed Z Soliman
Journal: Circulation (2023)

Background: Left ventricular hypertrophy (LVH) accompanied by biomarker of myocardial injury as measured by high sensitivity cardiac troponin (hs-cTnT) and neurohormonal activation, as measured by N-terminal pro-B-type natriuretic peptide (NT-proBNP), indicates a malignant form of LVH. While malignant LVH has been linked to poor CVD outcomes, its association with cognitive outcomes is unclear. Aim: To examine the association of malignant LVH with cognitive outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT). Hypothesis: Malignant LVH is associated with incident cognitive outcomes. Methods: We performed a post hoc analysis of 8,027 SPRINT participants with at least one cognitive assessment. Participants were classified into six groups based on the presence or absence of LVH assessed by 12-lead electrocardiogram (ECG), and elevations in levels of hs-cTnT ≥14 ng/L or NT-proBNP ≥125 pg/mL at baseline visit. The adjudicated outcome of incident probable dementia or mild cognitive impairment (MCI) or a composite outcome of probable dementia or mild cognitive impairment. Cox proportional hazard models were used to examine the association of baseline LVH/biomarker groups with incident cognitive outcomes. Results: During a median follow-up of 5 years, 597, 306, and 818 participants developed MCI, dementia, and composite outcome respectively. Compared with participants without LVH or elevated biomarkers, participants with LVH or elevated biomarkers, either in isolation or combined, had a higher risk of MCI and composite outcome. Highest risk for composite outcome was observed in those with concomitant LVH and elevated levels of both biomarkers. There was no significant association between LVH/biomarkers with incident probable dementia except for those with concomitant LVH and elevated levels of both biomarkers ( Table ). Conclusions: Among SPRINT participants, malignant LVH is associated with mild cognitive impairment and probable dementia.
Abstract 12625: Characterising Mechanisms of Ischemia in Patients With Myocardial Bridges
Authors: Aish Sinha, Haseeb Rahman, Ozan Demir, Ronak Rajani, Ankur Gulati, Matthew Li Kam Wa, Holly Morgan, Saad Ezad, Howard Ellis, Dexter Hogan, Ajay M Shah, Andrew Webb, Michael Marber, Divaka Perera
Journal: Circulation (2023)

Background: Myocardial bridges (MB) have been associated with ischemic syndromes. Abnormal cardiac coronary coupling is implicated but has not been systematically evaluated. We sought to determine the substrates for ischemia in patients with angina, nonobstructive coronary arteries (ANOCA) and a MB in the left anterior descending artery. Methods: Patients with ANOCA underwent acquisition of intracoronary pressure and flow during rest, supine bicycle exercise and adenosine infusion. Coronary wave intensity analysis was performed, and perfusion efficiency defined as accelerating wave energy/total wave energy (%). Endothelial dysfunction was defined as a reduction in epicardial vessel diameter by &gt;20% with intracoronary acetylcholine. Patients with ANOCA and a MB were compared to those with microvascular angina (CMD: coronary flow reserve, CFR, &lt;2.5) or ANOCA with normal CFR (controls). Results: 87 patients were enrolled (25 MB [age 56±9 years], 34 CMD [57±11 years], 28 control [57±8 years]). FFR in these 3 groups was 0.86±0.05, 0.92±0.04 and 0.94±0.05; CFR was 2.6±0.5, 2.0±0.3 and 3.3±0.6. Perfusion efficiency improved during exercise in controls (61±11% to 65±15%, p=0.044), but decreased in patients with CMD (63±11% to 44±10%, p&lt;0.001) and MB (59±9% to 50±9%, p=0.001). In CMD, the reduction in perfusion efficiency was driven by diminished microcirculation derived accelerating energy in early diastole, whereas in MB this was driven by diminished accelerating energy arising from the upstream epicardial vessel in early systole ( Figure ). 55% of patients with MB, versus 33% of patients with CMD and 29% controls, had endothelial dysfunction. Conclusions: MBs result in impaired coronary perfusion efficiency during exercise, which is due to diminished accelerating wave energy. Additionally, there is a high prevalence of endothelial dysfunction; both mechanisms may cause ischemia and, therefore, represent distinct treatment targets.
Abstract 11617: Characterisation of Blood Biomarkers in Cardiac ATTR Amyloidosis
Authors: Adam Ioannou, Rishi Patel, Yousuf Razvi, Aldostefano Porcari, Muhammad Rauf, Ana Martinez-Naharro, Lucia Venneri, Helen Lachmann, Ashutosh Wechalekar, Carol Whelan, Philip Hawkins, Julian D Gillmore, Marianna Fontana
Journal: Circulation (2023)

Introduction: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognised cause of heart failure. However, the role of cardiac and non-cardiac biomarkers in patients with ATTR-CA remains poorly understood. We sought to characterise a range of routinely measured blood biomarkers in ATTR-CA, and assess which biomarkers are independently associated with prognosis. Methods: Consecutive patients diagnosed with ATTR-CA between 2005 and 2023 were included. Results: We identified 2566 patients (wild-type ATTR = 1834, p.(V142I) = 425, non-p.(V142I) = 307). Anaemia (39%), uraemia (52%), hyperbilirubinemia (18%), raised alkaline phosphatase (ALP) (16%), raised c-reactive protein (CRP) (27%) and a troponin-T &gt;56ng/L (52%) were common findings in the overall population, while hyponatraemia (6%) and hypoalbuminemia (2%) were less common. These abnormalities were most common in p.(V142I) patients, and became more prevalent as the severity of cardiac disease increased, as measured by New York Heart Association (NYHA) functional class (p&lt;0.001 for all) and National Amyloidosis (NAC) disease stage (p&lt;0.001 for all). Multivariable Cox regression analysis adjusting for age, NAC stage, and hereditary vs wild-type ATTR-CA demonstrated that anaemia (HR=1.19, 95%CI[1.04-1.37], P=0.013), uraemia (HR=1.23, 95%CI[1.04-1.45], P=0.011), hyperbilirubinemia (HR=1.32, 95%CI[1.13-1.57], P=0.001), raised ALP (HR=1.20, 95%CI[1.01-1.42], P=0.035), hyponatraemia (HR=1.65, 95%CI[1.28-2.11], P&lt;0.001) and troponin-T &gt;56ng/L (HR=1.72, 95%CI[1.46-2.03], P&lt;0.001) were all independently associated with an increased risk of mortality. Conclusions: Blood biomarker abnormalities are common in ATTR-CA and are more prevalent in patients with advanced cardiac disease. ATTR-CA is a complex and multifaceted disease process with both cardiac and non-cardiac biomarkers being independently associated with prognosis.
Abstract 12297: A Rare Case of May-Thurner Syndrome Due to External Compression of the Right and Left Common Iliac Veins
Authors: Logan S Schwarzman, Jack Aguilar, Mohammed Siddiqui, Nichelle Megowan
Journal: Circulation (2023)

Description of Case: A 54yr male with HTN and CKD stage IIIa presented with asymmetric right greater than left lower extremity (LE) edema. Vital signs were normal. His exam showed asymmetric right greater than left LE edema to the mid-thighs. ECG revealed sinus rhythm. Medical therapy with increasing titration of diuretics was unsuccessful in resolving his asymmetric LE edema. A TTE showed EF of 55-60% with normal bi-ventricular size and function and no significant valve abnormalities. Bilateral duplex US showed no DVT. CT abdomen pelvis showed no hydronephrosis or compressive masses. Right heart catheterization revealed normal bi-ventricular filling pressures. Bilateral peripheral venogram showed bilateral common iliac vein stenosis (Figure 1A). IVUS showed external compression of the right common iliac vein (RCIV) between the right external and internal iliac arteries with external compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) against the lumbar spine (Figure 1A). A diagram of the compression observed in this case is included (Figure 1B). The RCIV had an 18mmHg gradient with no significant gradient on the LCIV. The RCIV was stented using an 18x60mm self-expanding stent and balloon dilation. Final IVUS and venogram showed no residual stenosis, edge dissection or perforation (Figure 1D). The patient was discharged on dual-antiplatelet therapy for three months and aspirin thereafter with continued diuretics. He had significant reduction in asymmetric LE edema with marked improvement in ambulation capacity and no further LE asymmetry at the 30-day follow-up visit. Discussion: Here we present a rare case of May-Thurner Syndrome via compression of the LCIV by the RCIA and RCIV by the right internal and external iliac arteries with successful management. We also illustrate the importance of a broad differential diagnosis in patients with persistent asymmetric LE edema refractory to diuretic management
Abstract 12721: Myocardial DNA Damage Predicts Heart Failure Outcome in Various Underlying Diseases
Authors: Zhehao Dai, Toshiyuki Ko, Seitaro Nomura, Kanna Fujita, Shunsuke Inoue, Kenji Onoue, Eisuke Amiya, Masaru Hatano, Norifumi Takeda, Hiroyuki Morita, Yoshihiko Saito, Issei Komuro
Journal: Circulation (2023)

Background: Responses to treatment for heart failure vary widely, and a reliable predictor has been long awaited. Aims: To investigate the relationship between DNA damage in myocardial tissue and treatment response and prognosis of heart failure. Methods: In this multicenter cohort study including patients with heart failure with reduced ejection fraction (HFrEF) of various underlying etiologies, we performed immunostaining of DNA damage markers, poly(ADP-ribose) (PAR) and γ-H2A.X on endomyocardial biopsy specimens. We calculated the percentage of nuclei positive for each DNA damage marker as %PAR and %γ-H2A.X. The primary outcome was left ventricular reverse remodeling (LVRR) at 1 year, and the secondary outcome was a composite of cardiac death, heart transplantation, and ventricular assist device implant. Inverse probability weighted method was used to restore the balance of baseline variables. Results: Of the 175 included patients with a mean age at 56 years and a median follow-up of 1213 days, 72% were male, and 55% achieved LVRR. A lower DNA damage marker positivity was associated with a higher probability of achieving LVRR [OR per 10 increase in %PAR 0.07 (95%CI 0.03–0.17); OR per 10 increase in % γ-H2A.X 0.40 (95%CI 0.29–0.55)]. There was a negative correlation between the average degree of DNA damage and the probability of LVRR, across different underlying diseases. Patients with higher %PAR or %γ-H2A.X had more long-term clinical events [HR per 10 increase in %PAR 1.63 (95%CI 1.31-2.01); HR per 10 increase in %γ-H2A.X, 1.48 (1.27-1.72)]. Of the 41 patients who consented on whole exome sequencing, those with non-sarcomere gene mutations (LMNA, etc; 10 patients) had a higher degree of DNA damage than those with sarcomere gene mutations (TTN, etc; 4 patients). Conclusions: DNA damage determines the consequences of heart failure. Assessment of DNA damage is useful to predict treatment efficacy and prognosis of patients with HFrEF of various underlying etiologies.
Abstract 12729: Leadless Pacemaker Insertion is Safe in Nonagenarians
Authors: Ahmad Harb, Amjad Harb, Abdelraouf Salah, Bilal Al Kalaji, Mariam Khabsa, Amulya Reddy Dwaram, Naim Battikh, Amer Muhyieddeen, Richard Orji, Jashan Gill
Journal: Circulation (2023)

Introduction: Increased age is associated with increased frailty and often worse postoperative outcomes. We aim to assess the safety of leadless pacemaker (LPM) insertion in the very elderly population. Methods: We queried the National Readmission Database years 2017-2020 for patients who underwent LPM insertion with the ICD10 code 02HK3NZ. Patients with age 90 or more were included in the nonagenarians group. Patient comorbidities were queried through the appropriate ICD 10 codes. We compared outcomes using multivariate logistic and linear regression, adjusting for patient comorbidities. Results: At baseline, nonagenarians had a higher prevalence of hypertension, history of stroke, A fib./A. flutter, dementia and hypothyroidism. The control group had more of diabetes, coronary disease, chronic kidney disease, chronic pulmonary disease, oxygen use, coagulopathy, anemia, obesity, substance abuse and chronic liver disease (Table 1). Compared to controls, nonagenarians were found to have shorter length of stay (-2.486 days, p &lt;0.001), lower rate of mortality (aOR 0.696, p 0.0187), lower rates of postprocedural cardiac arrest (aOR 0.301, p 0.0267), mechanical ventilation (aOR 0.378, p &lt;0.001), and vasopressor use (aOR 0.583, p 0.001). Nonagenarians were only found to have increased risk of pericardial complications (tamponade, pericardiocentesis, hemopericardium) (aOR 1.596, p 0.0151). There was no significant difference in 30-day readmissions (aOR 0.97, p 0.696), postoperative bleed (aOR 0.84, p 0.072), or stroke (aOR 0.586, p 0.112). Conclusions: Our study demonstrates LPM insertion is safe in the very elderly population. However this is likely a demonstration of survivorship bias as patients in the nonagenarians group had overall less comorbidities. Even though our analysis adjusted for comorbidities, there are always unknown confounders which cannot be accounted for. Age itself does not seem to be a risk factor for worse outcomes in this population.