tbuckley/cabot-search huggingface dataset:
Abstract 15108: Systematic Review to Explore Differential Frequencies of Coronary Artery Disease in Survivors of Different Cancers
Authors: Ragani Velusamy, Cheng Hwee H Soh, Thomas Marwick
Journal: Circulation (2023)

Introduction: The leading non-neoplastic cause of morbidity and mortality in cancer survivors is cardiovascular disease, of which coronary artery disease (CAD) is emerging as a significant burden. Inherent in screening is an understanding of pre-test risk, and the association of CAD with particular cancers is not well-defined. Hypothesis: To develop a systematic review to explore differential frequencies of CAD in survivors of different cancers. Methods: We searched MEDLINE and EMBASE (2006-2021) for studies of CAD in survivors. For studies without a control population, we utilized a community prevalence for CAD from the 2021 US. National Centre of Health Statistics; 0.5% for 18-44 years, 4.7% for 45-64 years, 11% for 65-74 years and 19.5% for &gt;75 years. A random-effects model was used to compare CAD prevalence in survivors and controls. Results: Twenty studies (736,956 survivors) involved 17 types of cancer (bladder, breast, colorectal, hematologic, head and neck, kidney, liver, lung, melanoma, ovarian, pancreatic, prostate, renal, stomach, testicular, thyroid, uterus). Survivors overall were associated with an increased risk of CAD compared to controls (risk difference = 0.11, 95% CI: 0.07-0.15, p=0.0, I2=99.93%). Eight cancer types (breast, hematologic, head and neck, kidney, liver, pancreatic, stomach, and testicular) resulted in a significantly higher CAD compared to other cancer types (Figure). Conclusions: Cancer survivors are at an increased risk of CAD compared to general population, but certain cancer types associate with a significantly higher CAD risk.
Abstract 14917: The Influence of Coronary Artery Disease on Cerebrovascular Reactivity and Cognitive Function
Authors: Jenna L. Taylor, Andrew N Buskard, Kevin L Webb, Joshua D Donkor, Jessica I Johnston, Amanda R Bonikowske, Nikki H Stricker, Jill N Barnes, Bruce D Johnson
Journal: Circulation (2023)

Introduction: Patients with coronary artery disease (CAD) are at increased risk of cognitive decline. A proposed mechanism is cerebral hypoperfusion related to vascular dysfunction and impaired cerebral blood flow regulation Hypothesis: Patients with CAD will have lower cerebrovascular function than age- and sex-matched controls, assessed as reactivity to a vasodilatory carbon dioxide (CO 2 ) stimulus. Methods: Adults 40-70years old with CAD were recruited on enrollment to a cardiac rehabilitation program following a cardiac event or hospitalization. Age and sex-matched adults without known disease or cardiovascular risk factors were recruited as healthy controls. Cognitive function was assessed by the Fluid Composite of the NIH Cognition Toolbox. Following a familiarization visit, participants underwent a stepped CO 2 protocol (room air, 2% CO 2 , 4% CO 2 , 6% CO 2 ) while continuously measuring middle cerebral artery velocity (MCAv) using transcranial doppler ultrasound, mean arterial pressure (MAP), ventilation (VE), and end-tidal CO 2 . Cerebrovascular conductance (CVCi) was calculated as MCAv/MAP. Cerebrovascular reactivity was calculated as the linear regression slope of CVCi against the change in end-tidal CO 2 . The reactivity of MAP and VE (or chemosensitivity) were also calculated. Results: 19 patients with CAD and 10 healthy controls were recruited ( Table 1 ). Compared with controls, patients with CAD had a 2-fold lower cerebrovascular reactivity (p=0.003), higher MAP reactivity (p&lt;0.05), and a trend towards higher chemosensitivity (p&lt;0.1) ( Table 2 ). There were no group differences in resting CVCi or cognition ( Table 2 ). After adjustment for age and sex, lower cerebrovascular reactivity was associated with lower peak oxygen uptake, diabetes, and smoking history ( Table 3 ). Conclusions: Compared with healthy controls, we report that patients with CAD have significantly lower cerebrovascular function, with no differences in cognitive function.
Abstract 340: Automated External Defibrillator Utilization After Out-of-Hospital Cardiac Arrest at Recreational Facilities in the United States
Authors: Ahmed A Kolkailah, Paul S Chan, Qiang Li, Anezi Uzendu, Mirza Khan, Saket Girotra
Journal: Circulation (2023)

Background: Given the importance of public access defibrillation, some U.S. states have passed laws requiring an automatic external defibrillator (AED) to be available on-site at athletic facilities. However, rates of bystander AED application during out-of-hospital cardiac arrest (OHCA) in states with and without such laws remain unknown. Research Question: What are the rates of bystander AED application during OHCA at recreational facilities in U.S. states that mandate AEDs availability at such locations? Aim: To examine the rates of bystander AED application for OHCA at recreational facilities in states with and without laws mandating the presence of AEDs at athletic facilities. Methods: We included adults (≥18 years) in the Cardiac Arrest Registry to Enhance Survival (CARES) registry with a non-traumatic OHCA during 2013-2021 at a recreational facility in the U.S. The primary outcome was bystander AED application during OHCA. Secondary outcomes included survival to hospital admission and survival to hospital discharge. We examined the rates of bystander AED application and survival outcomes in states with laws that mandate AEDs at athletic facilities and in states without such laws. Results: Overall, there were 4,145 OHCAs cases at recreational facilities in 13 states that mandated AEDs at athletic facilities and 5,145 cases in 27 states that did not. In states with laws, the median rate of bystander AED application was 19.0%, with large between-state variation (IQR: 15.1%-22.0%). The median rate of survival to hospital admission was 44.5% (IQR 39.4%-56.9%) and survival to hospital discharge was 31.0% (IQR 25.2%-32.8%). In non-law states, the median rate of bystander AED application was 18.2% (IQR: 13.9%-25.0%). The median rate of survival to hospital admission was 45.0% (IQR 38.4%-52.1%) and survival to hospital discharge was 28.4% (IQR 25.9%-37.5%). Conclusions: Despite state laws that mandate on-site availability of an AED, rates of bystander AED application for OHCA at recreational facilities in such states remain low, with notable state-level variability. Our findings highlight that improving bystander AED application during OHCA will need to go beyond making AEDs available on-site.
Abstract 15591: Well-Being of Interventional Cardiologists: Sex Differences
Authors: Michaella Alexandrou, Bahadir Simsek, Athanasios Rempakos, Spyridon Kostantinis, Judit Karacsonyi, Bavana V Rangan, Olga Mastrodemos, Ajay J Kirtane, Anna E Bortnick, Hani Jneid, Lorenzo Azzalini, Anastasios Milkas, Khaldoon Alaswad, Mark Linzer, Mohaned Egred, Deniz Mutlu, Ahmed Al-ogaili, Sunil V Rao, Salman S Allana, Yader Sandoval, Emmanouil S Brilakis
Journal: Circulation (2023)

Background: Sex differences in the well-being of interventional cardiologists have received limited study. Methods: We conducted an international, anonymous, online survey exploring the sex variations in the well-being of interventional cardiologists. Results: Of 1,251 survey participants 121 (9.7%) were women. Women were more likely to be under 50 (82.6% vs 73.1%, p=0.031) and single (25.6% vs 7.9%, p&lt;0.001) and were more commonly practicing at academic institutions or hospitals with academic affiliation (69.2% vs 59.3%, p=0.046). There was no difference in overall burnout between women and men (68.7% vs 63.4%, p=0.353). On a scale of 0-10, men reported more often that too much paperwork (6.9±2.5 vs 6.2±2.7, p=0.013) and government regulations (4.8±3.1 vs 3.6±2.8, p&lt;0.001) are contributors to burnout. Women reported less often getting well along with colleagues (7.0±2.9 vs 7.5±2.1, p=0.047) and more often felt lonely during the last year (5.5±3.1 vs 4.3±3.2, p=0.001). Men reported that they more commonly choose exercise as a coping mechanism for burnout (4.8±3.2 vs 3.8±3.1, p=0.005), while women more often choose talking with family/friends (6.8±2.5 vs 5.8±2.8, p=0.003). Women prioritize additional paid time off (7.5±2.5 vs 6.9±2.7, p=0.041) as the most preferable wellness-related action and asked more often for respect/recognition from administration, opportunities for professional growth and mentorship opportunities. Conclusions: This survey indicates sex differences in contributors and coping mechanisms to burnout. Our data suggest that communication with administration and career development opportunities could be explored as remediable factors for burnout among all interventional cardiologists; and might be especially valuable in women.
Abstract 12895: Classification of Patients According to the Cardiometabolic-Based Chronic Disease Model in a Preventive Cardiology Center
Authors: Jose Joel Hernandez Sevillano, Masih Babagoli, Pranav Mellacheruvu, Yitong Chen, Shelley Liu, Janet Johnson, Valentin Fuster, Jeffrey mechanick
Journal: Circulation (2023)

Introduction: Cardiovascular disease results from complex interactions between metabolic drivers. The purpose of the novel cardiometabolic-based chronic disease model is to expose opportunities for early and sustainable prevention. Hypothesis: The cardiometabolic-based chronic disease (CMBCD) model allows allocation of patients with stage 1 (“risk”), stage 2 (“predisease”), stage 3 (“disease”), and stage 4 (“complications”) of each of the four metabolic drivers - adiposity, dysglycemia, dyslipidemia, and hypertension. Methods: Patients with a visit at the Center for Cardiovascular Health at Mount Sinai Heart, a multidisciplinary preventive cardiology center, were classified according to the CMBCD model relative to baseline characteristics. The context of this classification is the determination, based on statistical and mechanistic corroboration, of a dominant driver to be used to subsequently determine response and sustainability rates. Results: The most frequent dominant driver was adiposity-based chronic disease, in 642 (76.9%) patients, followed by dysglycemia-based chronic disease, in 104 (12.5%), hypertension-based chronic disease in 76 (7.5%), and lipid-based chronic disease in 13 (1.3%). A very large proportion of patients with adiposity-, dysglycemia-, and hypertension-based chronic disease (49%, 57%, and 25%, respectively) present with “complications” of “predisease” and “disease”. Conclusions: Abnormal adiposity and dysglycemia have proximal roles in the pathogenesis of cardiovascular disease in the cardiometabolic-based chronic disease model. This presents a window of opportunity for early lifestyle prevention strategies.
Abstract 341: Regional Variation in Cardiac Arrest Response and Outcomes in North Carolina - A Call to Action
Authors: Konstantin Krychtiuk, Lisa Kaltenbach, Eric S Yow, Lisa Monk, Steve Vandeventer, Carolina Malta Hansen, Edward Sharpe, Thomas Rea, Bryan F McNally, Darrell Nelson, Comilla Sasson, Sana M Al-Khatib, James Jollis, Daniel B Mark, Hussein Al-Khalidi, Monique A Starks, Christopher Granger
Journal: Circulation (2023)

Background: In the United States, despite advances in cardiac arrest systems of care, out of hospital cardiac arrest (OHCA) treatment and survival are highly variable. In North Carolina, intensive efforts to improve prehospital care are ongoing. We sought to investigate the variation in OHCA community response and outcomes in North Carolina (NC), and to assess underlying differences in system-, patient- and county-level characteristics in an effort to optimize regional cardiac arrest care. Methods: All adult (age &gt;18 years) OHCAs from 2016-2020 in 36 counties of North Carolina were included from the Cardiac Arrest Registry to Enhance Survival. We excluded cases that were EMS witnessed and that occurred in nursing homes. Response and outcome variation as well as county characteristics were described according to tertile of survival with good neurologic outcome (CPC 1/2). Results: Overall, 18,563 OHCAs occurred of which 22.4% had a shockable rhythm, 84.7% occurred at home and 50.7% were witnessed. Overall survival to hospital discharge with good neurologic outcome was 8.1%, with a state-wide variation among counties between 0% and 21.2% while Utstein survival was 26.1% overall, ranging between 0% and 47.8%. Bystander CPR rates were 41.8% (variation between 22.6% - 64.5%). First responder or bystander AED application was 42.9% of cases (variation between 8.6% - 66.6%) and 11.1% (variation between 2.7% and 19.7%) received defibrillation before EMS arrival. Counties within the highest tertile of survival were characterized by higher population density, lower unemployment rates and higher average household income. Such counties were further characterized by higher rates of bystander and first responder CPR and AED use prior to EMS arrival (Table 1). Conclusion: In NC, cardiac arrest response metrics and survival rates showed a dramatic regional variation, with particularly low survival in rural settings, calling for regional efforts to optimize cardiac arrest care.
Abstract 14918: Apical Cardiomyopathy in a Transplanted Heart
Authors: Michael Killian, Timothy Barry, Said Alsidawi
Journal: Circulation (2023)

Case description: A 67 year old female presented for annual review to the transplant clinic 4 years post orthotopic heart transplant for nonischemic dilated cardiomyopathy. She was asymptomatic. Her medical history included hypothyroidism, hypertension, osteoporosis, restless leg syndrome and calcineurin inhibitor related complications - CKD 3b, impaired glucose tolerance and a left partial glossectomy with neck dissection for stage 3 SCC of the left lateral tongue. Medications included aspirin, atorvastatin, prednisolone, tacrolimus, septrin and ropinirole. Family history was significant for heart failure in her father. She was a nonsmoker and did not consume alcohol. Physical examination was unremarkable. Diagnostic tests are shown below. Discussion: Apical hypertrophic cardiomyopathy (ApHCM) has rarely been described in post cardiac transplant populations. Characterized by increased left ventricular apical wall thickness, it results in a ‘spade-like’ appearance on imaging and is associated with marked T wave inversion on ECG. ApHCM is associated with progression to heart failure, apical aneurysm, ventricular arrhythmias and increased mortality rates. Patients may be asymptomatic at diagnosis. Regarding screening, criteria exist for the selection of donor hearts pre transplant with caution exercised if LVH &gt;13mm. Causes of non HCM hypertrophy in this population include calcineurin inhibitors, hypertension, obesity and graft versus host disease. Data for treatment for ApHCM is lacking however it follows the path of classical HCM, involving the use of beta and calcium channel blockers to reduce demand ischemia and management of sequelae.
Abstract 12487: Healthcare Access and Cardiovascular Risk Factor Management in Low-Income Working-Age Adults After the COVID-19 Pandemic
Authors: Lucas X Marinacci, ZhaoNian Zheng, Victoria Bartlett, Rishi K Wadhera
Journal: Circulation (2023)

Background: Low-income working age adults disproportionately experienced disruptions in care and deepening financial hardship at the onset of the COVID-19 pandemic. Little is known about how health care access and cardiovascular (CV) risk factor management changed as the pandemic went on, and if these patterns differed by state Medicaid expansion status. Methods: We identified adults aged 18-64 using the CDC’s Behavioral Risk Factor Surveillance System. Low-income adults were defined as those with incomes &lt;138% of the federal poverty level (FPL), and high-income adults &gt;400% FPL. We fit logistic regression models to compare changes in measures of health care access and CV risk factor management in 2021 to a pre-pandemic baseline (2019), adjusted for age and sex. We included an interaction term for income level and year, to evaluate whether there was a differential change between low- and high-income adults. We also evaluated changes among low-income adults in Medicaid expansion vs. non-expansion states. Results: As shown in the Table , health insurance coverage, access to personal health care provider, and ability to afford care all improved in 2021 compared to pre-pandemic baseline (2019), although gains were more pronounced for high-income vs low-income groups. In contrast, the proportion of adults with a check-up in the past 12 months, or who received recommended cardiovascular risk factor screening, worsened in both low- and high-income groups. Among the low-income group, those in Medicaid expansion states experienced greater increases in insurance coverage than those in non-expansion states (OR 1.53 [1.40,1.68] vs 1.27 [1.11,1.46], p = 0.0283). Conclusion: In this national study, low- and high-income working-age adults experienced decreases in outpatient check-ups and CV risk factor screening in 2021 compared with pre-pandemic baseline. Public health initiatives are needed to improve screening for CV risk factor as the US emerges from the pandemic.
Abstract 12829: Short- and Long-Term Outcomes of Takotsubo Syndrome and Acute Coronary Syndrome. A Meta-Analysis
Authors: Jia Ee Chia, Song Peng Ang, Vikash Jaiswal, Tong Hong Chia
Journal: Circulation (2023)

Introduction: Takotsubo syndrome (TTS) is a condition characterized by reversible left ventricular dysfunction with typical regional wall motion abnormalities. Although the presentation mimics acute coronary syndrome (ACS), its exact pathophysiology is not known. Despite the transient nature of cardiac dysfunction in TTS, the prognosis remained uncertain, with mortality rates reportedly comparable to that of ACS. The aim of this study was to compare the outcomes between patients with TS and ACS through a meta-analysis. Methods: We systematically searched various electronic databases including PubMed, Embase, and Cochrane Library to identify relevant studies. The outcomes were pooled using the Hartung-Knapp-Sidik-Jonkman random effects model, and the results were presented as odds ratio (OR) with their corresponding 95% confidence interval (CI). Results: 11 studies with 3,455,862 (95,165 TTS and 3,360,697 ACS) patients were included in the final analysis. The risk of in-hospital mortality (OR, 0.61(95%CI: 0.42-0.89), P=0.01), 30-day mortality (OR, 0.62(95%CI: 0.48-0.81), P&lt;0.001) were significantly lower in the TTS group compared to the ACS group. There was no difference in the risk of cardiogenic shock (OR, 0.87(95%CI: 0.54-1.42), P=0.58) between both groups. The risk of long-term all-cause mortality (OR, 1.10(95%CI: 0.61-1.97), P=0.75) was comparable between both groups, with significantly higher non-cardiovascular cause of mortality (OR, 2.40(95%CI: 1.83-3.15), P&lt;0.001) among the TTS group compared to the ACS group. Conclusions: This study suggests a favorable short-term prognosis for TTS patients compared to ACS patients, but a comparable risk of long-term mortality. It is noteworthy that TTS patients have a higher risk of non-cardiovascular mortality. Further studies are warranted to explore the factors contributing to the increased risk of non-cardiovascular mortality in TTS patients in order to improve outcomes in this population.
Abstract 14990: A Propensity Score Analysis of Five-Year Outcomes After Coronary Thrombus Aspiration in Acute Myocardial Infarction: Insights From the FAST-MI Real-Life Registry
Authors: Orianne Weizman, Marie Hauguel-Moreau, Guillaume Cayla, Gilles Lemesle, Jean Ferrieres, François Schiele, Tabassome Simon, Nicolas Danchin
Journal: Circulation (2023)

Introduction: Though previous trials and registries have shown no short-term benefit of thrombectomy in acute myocardial infarction (AMI), data on long-term outcomes are lacking. Hypothesis: Use of coronary thrombectomy in real-life conditions does not affect 5-year outcome. Methods: FAST-MI program consists of 3 nationwide French surveys (2005, 2010, 2015), including consecutive AMI patients over a 1-month period. This analysis focused on patients undergoing percutaneous coronary intervention (PCI, N=9,731). Five-year follow-up is &gt;96%. Results: Thrombectomy was used in 1,781 patients (18%; 2005: 7%, 2010: 27%, 2015: 18%), 87% of them had STEMI. They were younger (61±13 vs 65±14 yo), mostly men (81% vs 74%, p&lt;0.001), with less multivessel coronary artery disease (47% vs 55%, P&lt;0.001) and a culprit lesion mostly on the right coronary artery (40% vs 31%, P&lt;0.001). Crude in-hospital death was higher with thrombectomy (3.1% vs 2.0%, P=0.005) but 5-year death lower (13% vs 17%, P&lt;0.001; crude HR 0.74 [95%CI 0.66-0.82]). After adjustment on the propensity score (PS) for getting thrombectomy, OR for in-hospital death was 1.24[95%CI 0.82-1.87] and HR for 5-year death: 0.95 [95%CI 0.79-1.14], P=0.58. In hospital survivors, Cox multivariate adjustment including discharge medications yielded similar results (HR 0.96, 95%CI 0.76-1.21, P=0.73). After PS matching, the two cohorts (N=1,430 each) had even distributions for all baseline characteristics and medications. In-hospital death was similar (2.7% vs 2.6%, P=0.91) but stroke was numerically higher (0.8% vs 0.3%, P=0.13) with thrombectomy. Five-year survival was similar in the 2 cohorts: HR 0.93, 95%CI 0.75-1.14, P=0.46. (Figure) Conclusions: These real-world data show that the use of thrombectomy has increased until 2010 and declined thereafter, in keeping with international guidelines, and suggest that thrombectomy has no beneficial nor detrimental effect on long-term survival compared to PCI alone.
Abstract 15400: Association of Cardiovascular Health With Early Carotid Artery Changes in Young Adults From Disadvantaged Social Backgrounds: The Future of Families and Child Wellbeing Study (FFCWS)
Authors: Donald M Lloyd-Jones, Daniel Notterman, Noreen Goldman, Norrina B Allen, Amanda M Marma, Hongyan Ning, Russell Tracy, Lifang Hou, Yinan Zheng, Brian Joyce, Linda Van Horn, Claudia E Korcarz, Kristin Hansen, James H Stein
Journal: Circulation (2023)

Introduction: Associations of cardiovascular health (CVH), as measured by the AHA’s Life’s Essential 8 (LE8) score, with early markers of arterial injury have not been described in young adults. Methods: The FFCWS enrolled 4898 mother-baby dyads at delivery in 20 US cities in 1998-2000, oversampling mothers who were unmarried, including a disproportionate number of minority and low-income families. In 2021-23, offspring were invited to attend an in-person exam to measure CVH and perform carotid artery ultrasound. Individual CVH metric and overall LE8 scores (except sleep) were calculated for each participant (ppt). Carotid imaging was performed by 2 trained sonographers and images were analyzed by a core lab. We examined cross-sectional associations of LE8 scores with measures of carotid intima-media thickness (IMT), gray scale (a measure of early arterial injury), and distensibility, using linear regression. Results: Among 1211 offspring ppts, mean age was 22y, &gt;50% self-identified as female, and &gt;75% as Black or Hispanic. Black and Hispanic ppts had lower, and ppts from Other racial/ethnic groups had higher, overall LE8 scores compared with White ppts (all P≤0.01; Table 1A). In unadjusted analyses, Black ppts had thicker carotid IMT and lower Young’s elastic modulus measures. Prevalence of diagnostic plaque was low. In analyses adjusted for age, sex, and race/ethnicity (Table 1B), LE8 scores were significantly associated with lower carotid IMT, higher gray scale median, and lower Young’s elastic modulus. For example, for each 10 point higher (better) LE8 score, mean-maximal carotid IMT was lower by 0.008 mm. Conclusions: Among young adults largely from disadvantaged social backgrounds, the LE8 score was associated with early measures of carotid arterial injury. LE8 may be an important surrogate measure for monitoring long-term CVH and may help identify young adults with emerging subclinical disease and higher long-term cardiovascular risk.