tbuckley/cabot-search huggingface dataset:
Abstract 4137958: Transthoracic Echocardiography-based Differentiation of Hypertrophic Cardiomyopathy and Cardiac Amyloidosis
Authors: Ololade Akingbade, Tommy Chiou, Srisha Kotlo, Juan Cotella, Anthony Kanelidis, Andrew Beaser, Roberto Lang, Jeremy Slivnick
Journal: Circulation (2024)

Introduction: Hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA) have similar features on transthoracic echocardiography (TTE) which may make the two difficult to distinguish. However, it is recognized that CA presents at an older age compared to HCM. Our aim was to determine optimal TTE parameters for differentiating HCM from CA and the incremental value of age at the time of diagnosis for differentiation of these two disorders. Methods: Patients with CA (N=121) and HCM (N=227)—diagnosed in accordance with guidelines—who underwent TTE were retrospectively identified. TTE parameters—including left ventricular global longitudinal strain (LVGLS), apical sparing ratio (ASR), AMYLoidosis Index (AMYLI), relative wall thickness (RWT) and ejection fraction to strain ratio (EFSR)—were calculated using artificial intelligence software (US2.AI) and validated by a level III echocardiography reader. Univariate and multivariable logistic regressions were used to compare TTE parameters between CA and HCM patients. Receiver operating characteristic curve (ROC) analysis was conducted to determine performance of echo parameters in distinguishing CA and HCM. Findings: CA patients were older compared to HCM ( Figure 1A ). With respect to TTE parameters, CA was associated with lower magnitude of LVGLS and higher value of ASR, AMYLI, and EFSR. LVGLS (AUC 0.865, 95% CI 0.81-0.91) outperformed AMYLI, RWT, and EFSR for differentiation of HCM from CA ( Figure 1B ). For all five TTE parameters, age provided incremental predictive value for LVGLS (p&lt;0.001), ASR (p&lt;0.001), AMYLI (p=0.007), RWT (p&lt;0.001), and EFSR (p&lt;0.001), Figure 2A-C ). LVGLS &lt;-15.8% was 85% sensitive and 79% specific for CA. Conclusion: LVGLS is an optimal echo parameter for differentiating CA from HCM, outperforming all other traditional CA diagnostic markers. Age provides incremental diagnostic value in the differentiation of these two groups with TTE.
Abstract 4137306: Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Vulnerable Atherosclerotic Coronary Plaques: A Pilot Meta-Analysis of Randomized Controlled Trials
Authors: Hritvik Jain, Ramez Odat, Aman Goyal, Sawai Singh Rathore, Mayank Jha, Jyoti Jain, Ashish Yadav, Siddhant Passey, Maryam Saleem, Hassan Suleiman
Journal: Circulation (2024)

Background: Vulnerable coronary plaques are identified as thin-capped fibroatheromas with substantial plaque and a lipid-enriched necrotic core. These plaques are often non-flow-limiting on assessment; however, they have been associated with future adverse clinical outcomes, such as unstable angina, myocardial infarction, and sudden cardiac death. Current guidelines do not recommend revascularization of such coronary plaques; however, percutaneous coronary intervention (PCI) can theoretically slow atherosclerotic progression and potentially reduce future adverse events. Methods: Major electronic databases were searched for randomized controlled trials (RCTs) that compared PCI to optimal medical therapy (OMT) for vulnerable coronary plaques. The outcomes were pooled using a random-effects model, and the results were expressed as risk ratios (RR) with corresponding 95% confidence intervals (CI). Results: 3 RCTs with 1811 patients (909: PCI and 902: OMT) were included. PCI demonstrated a statistically insignificant trend towards a decreased risk of all-cause mortality [RR: 0.40; 95% CI: 0.13, 1.27; p=0.12], cardiovascular mortality [RR: 0.17; 95% CI: 0.02, 1.38; p=0.10], myocardial infarction [RR: 0.78; 95% CI: 0.35, 1.72; p=0.53], target vessel-related myocardial infarction [RR: 0.68; 95% CI: 0.04, 11.27; p=0.79], ischemia-driven target vessel revascularization [RR: 0.22; 95% CI: 0.04, 1.22; p=0.08], and major adverse cardiovascular events [RR: 0.41; 95% CI: 0.14, 1.18; p=0.10] compared to OMT. Conclusion: This study concluded that PCI was comparable to OMT in patients with vulnerable atherosclerotic coronary plaques. Further large-scale RCTs with longer follow-up durations are required to confirm these findings.
Abstract 4137296: Single-cell Atlas of Human Epicardial Adipose Tissue Reveals Aging IL4R <sup>+</sup> Naive B cell Contributing To Atrial Fibrillation
Authors: Shengkang Huang, Ziang Yang, Chenglong Fang, Wei Zhao, Wei Feng
Journal: Circulation (2024)

Background: Numerous recent evidence suggested a role of epicardial adipose tissue (EAT), the visceral fat depot of the heart, in the development of Atrial Fibrillation (AF). However, the cellular and molecular mechanisms underlying the association remain elusive. Methods: We performed single-nucleus RNA sequencing on eleven EAT samples collected from 2 groups of subjects: patients with nonvalvular AF undergoing coronary bypass surgery for severe CAD (n=7), and a control group of patients without concomitant AF (n=4). Comparative analyses were performed between the groups, including cellular compositional analysis, cell type–resolved transcriptomic changes, and functional analysis. Results: Unsupervised clustering of 92734 nuclei identified 11 clusters, encompassing all known cell types in the adipose tissue. Pseudobulk differential expression analysis between the AF and control groups revealed pronounced differences in a select subset of genes located on the X and Y chromosomes, including XIST and TSIX. Subsequent pathway analysis identified that the most significantly impacted pathways were those associated with immune cell functions. Meanwhile, differences in cellular composition and transcriptomic profiles, particularly concerning B cells, were observed between normal and AF conditions, highlighting distinct immune cell dynamics. Comparison of pathways across different B cell states revealed the enrichment of distinct pathways within each state, including those involved in cellular senescence, antigen processing and presentation, and programmed cell death signatures. Notably, aging IL4R + naive B cell and inflammatory ITGB1 + memory B cell were identified as important regulators potentially involved in functional changes of EAT and AF pathogenesis. Conclusions: We built a complete single-nucleus transcriptomic atlas of human EAT in normal and AF conditions. Our study lays the foundation for developing novel therapeutic strategies for treating AF by targeting and modifying B cell functions within EAT.
Abstract 4138035: Inclisiran in Routine Clinical Practice: Results from a Nationwide Study of &gt;5,000 Patients
Authors: Jay Lusk, Fan Li, Brian Mac Grory
Journal: Circulation (2024)

Introduction: Inclisiran is a small interfering RNA drug which inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9). Inclisiran was recently approved for the treatment of hypercholesterolemia and durably lowers LDL levels by around 50% with injections once every six months based on the results of large, randomized controlled trials. However, no nationwide studies have evaluated the use or effectiveness of Inclisiran in routine clinical practice. Goals/Aims: To characterize the use and effectiveness of Inclisiran in routine clinical practice in a large nationwide cohort. Methods/Approach: We used the Truveta healthcare database, a large nationwide database of electronic health records, to study patients who were administered Inclisiran up to September 2023. Patient demographic characteristics and lipid levels before and after treatment were summarized. Means and 95% confidence intervals were estimated using t-tests. Results/Data: A total of 5,256 patients (median age 71, first quartile 65, third quartile 76) were prescribed Inclisiran, of whom 2,919 (55.5%) were Female. In terms of race, most of the patients identified as White (81.0%), and a smaller proportion as African American (7.3%), Asian (2.1%), or American Indian/Alaska Native (0.5%); 7.3% of patients identified as more than one race or did not provide race data. Mean LDL and HDL levels (mg/dL) before Inclisiran were 125 (95% CI 123-127) and 51 (95% CI 51-52) respectively and after Inclisiran were 88 (95% CI 85-90) and 50 (95% CI 49-51) respectively. The mean difference in LDL after treatment was -39 (95% CI -42 to -37) mg/Dl for a mean percent change of -22% (95% CI -25% to -19%). Effects of Inclisiran on LDL levels are shown in Figure 1. At the conference, we will compare effects of Inclisiran to those of Alirocumab and Evolocumab (two older monoclonal antibodies against PCSK9) using a propensity score overlap weighting design. Conclusions: In a large cohort of patients administered Inclisiran in routine clinical practice, Inclisiran use was associated with substantial decreases in LDL levels, but those decreases were nonetheless smaller than the effects seen in randomized controlled trials of the drug.
Abstract 4138024: Identifying the Medications with the Greatest Reduction in Mortality in Coronary Artery Dissection
Authors: Usman Kazi, Abraheim AL-Nasseri, Huy Ho, Suman Pasupuleti
Journal: Circulation (2024)

Introduction: Coronary artery dissection (CD) is a potentially fatal complication, usually arising either spontaneously or iatrogenically. Therefore, identifying treatment methods that reduce mortality is of great importance. The American College of Cardiology recommendations stipulate that patients who have experienced CD may benefit from beta-blocker therapy, as beta-blockers have been shown to reduce the incidence of recurrent CD. Currently, there is little published data in support of beta-blockers providing mortality reduction for CD. Given the significant risk of mortality from CD, we aimed to test the veracity of these recommendations using a retrospective multicenter study as well as having a main objective of exploring means to lower mortality in CD. Methods: We conducted a retrospective, multicenter cohort that identified 2,104 patients diagnosed with CD. We extracted the data from across 16 West Florida hospitals in between the years of 2017-2022. Our patients were identified and stratified based on common lab values and cardioprotective medications they were taking. Chi-square and binary logistic regression was used to calculate odds ratios for mortality. The odds ratio estimate for mortality was our primary outcome with attention given to factors that were associated with an increased or decreased likelihood of mortality in patients with CD. Results: Patients on beta-blockers, angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) were the only variables that were statistically significant. Out of 2,104 patients, 1,562 patients were on beta-blockers (74.2%), and 921 were on an ACEi/ARB (43.8%). Our data revealed that the odds ratio for mortality in patients with CD while on beta blockers was 0.375 (p-value 0.0009, confidence interval 0.210-0.669), and while on ACEi/ARBs was 0.447 (p-value 0.0077, confidence interval 0.247-0.808). These results indicate a significant reduction in mortality in patients who are taking beta-blockers and/or ACEi/ARB medications after being diagnosed with CD. Conclusion: Our data can be viewed as supportive of the current recommendation for the primary use of beta-blockers in patients with spontaneous CD, as well as suggesting angiotensin receptor blockers and angiotensin-converting enzyme inhibitors as possible additional therapies
Abstract 4137933: High ABSI is associated with elevated risk of cardiovascular events
Authors: Masato Kajikawa, Tatsuya Maruhashi, shinji kishimoto, Takayuki Yamaji, Takahiro Harada, Yukiko Nakano, Farina Mohamad Yusoff, Yukihito Higashi
Journal: Circulation (2024)

Background: A Body Shape Index (ABSI) has been reported to have associations with cardiovascular risk factors. However, there is no information on the association between ABSI and incidence of cardiovascular events. Methods: We investigated the associations between ABSI and first major cardiovascular events (death from cardiovascular disease, nonfatal acute coronary syndrome, and nonfatal stroke) in 1857 subjects from the database of Flow-Mediated Dilation Japan registry and from Hiroshima University Vascular Function registry. Results: The areas under the curves of ABSI to predict the first major cardiovascular events were 0.672 (95% confidence interval [CI], 0.568-0.761) in men and 0.749 (95% CI, 0.624-0.842) in women. The subjects were divided into two groups based on the cutoff value of ABSI for predicting first major cardiovascular events: a low ABSI group (&lt;0.0822 in men and &lt;0.0814 in women) and a high ABSI group (≥0.0822 in men and ≥0.0814 in women). During a median follow-up period of 41.6 months, 56 subjects died (23 from cardiovascular causes), 16 had nonfatal acute coronary syndrome, and 14 had nonfatal stroke. The Kaplan-Meier curves for first major cardiovascular events were significantly different between the two groups (men, P&lt;0.001; women, P&lt;0.001). Multivariate analysis revealed that high ABSI remained an independent predictor of first major cardiovascular events (men: hazard ratio, 2.33; 95% CI, 1.07 to 5.06; P=0.033; women: hazard ratio, 8.33; 95% CI, 1.06 to 65.49; P=0.044). Conclusions: High ABSI is independently associated with incidence of cardiovascular events. ABSI calculation should be performed for evaluation of risk of cardiovascular events.
Abstract 4137945: A Tuscany regional screening program for juvenile sudden cardiac death in high schools: the JUST project
Authors: Alberto Giannoni, Francesca Bonanni, Francesco Gentile, Francesca Moschetti, Angela Durante, Francesca Pennucci, Pier Romano Mariani, Marco Di Paolo, Claudio Passino, Sabina Nuti, Michele Emdin
Journal: Circulation (2024)

Background: Juvenile sudden cardiac death (SCD) has high impact on the family and society of the victim. While SCD screening programmes are effective in athletes, most (70-80%) young non-athletes individuals are not routinely screened. Research question: We hypothesized that a low-cost screening program may early identify subjects at risk of juvenile SCD, even in non-athletes. Goals: To evaluate the prevalence of SCD-related abnormal findings and, ultimately, to test the effectiveness of a screening programme in high schools. Methods: Between April 2023 and June 2024, high school individuals were enrolled in a screening programme in Tuscany (Pisa, Lucca and Livorno), based on a questionnaire investigating family history of juvenile SCD or diseases predisposing to SCD and symptoms (syncope, palpitations, chest pain), and digitally recorded electrocardiograms (ECGs). In case of abnormal findings, second-line investigations locally (echocardiography, Holter ECG monitoring and/or exercise testing) or third-line investigations at Fondazione Monasterio, Pisa, Italy (cardiac MRI, genetics or electrophysiological testing) were planned. Only preliminary results of the first-line screening are hereby reported. Results: We have currently enrolled 872 individuals (age 17.1±1.8 years, 481 [55%] males, 288 [33%] smokers, 102 [11.7%] recreational drugs users, and 645 [74%] non-competitive athletes). At questionnaires, 56 individuals (6.4%) had a family history of SCD, 32 (3.7%) a first-degree relative with cardiomyopathy, and 13 (1.5%) with channelopathy. As for symptoms, 21 participants (2.4%) reported chest pain or 26 (3%) syncope during exertion, while 90 (10.3%) paroxysmal palpitations. At ECG, we found 2 cases (0.2%) with a type-2 Brugada pattern, 1 female case (0.1%) with prolonged QTc interval (QTc 480 ms), 20 cases (2.3%) with V1-V3 T wave inversion (age &gt; 16 years), 18 cases (2%) of left ventricular hypertrophy (non-athletes), and 4 cases (0.5%) with atypical ventricular ectopy. After the first-line screening, 61 (7%) and 10 (1.2%) individuals were referred to second and third-line investigations, which are currently ongoing. Conclusions: We hereby propose a screening model in high schools that includes specific health questionnaires and digitally recorded ECGs. From preliminary analyses, this approach seems sensitive enough to be tested as a model to favour the early diagnosis of diseased conditions associated with juvenile SCD in the general population.
Abstract 4137949: Trends in Hypertensive Related Heart Disease Mortality Among Older Adults in the United States, 1999 - 2020
Authors: Muhammad Sameer Arshad, Zoaib Habib Tharwani, Muhammad Saad, Muhammad Umer Sohail, FNU Deepak, Muhammad Ovais Sohail, Pankaj Kumar, Izza Shahid, Muhammad Memon
Journal: Circulation (2024)

Background: Hypertensive heart disease (HHD) is a major global health concern that impairs quality of life and causes significant morbidity and mortality, especially among older adults. We aimed to examine the temporal trends in HHD-related mortality in the United States (U.S.) between 1999 to 2020. Methods: The CDC WONDER multiple-cause of death database was utilized to identify HHD-related mortality among adults aged ≥ 55 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, gender, race, and geographic region. Results: A total of 1,186,183 HHD-related deaths were recorded among individuals ≥ 55 years old. Overall, AAMR increased from 36.7 in 1999 to 133.9 in 2020. AAMRs showed a steady increase between 1999 and 2017 (APC: 3.72 [95% CI: 2.72 to 4.49]), followed by a surge from 2017 to 2020 (APC: 14.28 [95% CI: 8.21 to 22.93]). Gender-based analysis showed a constantly higher AAMR among older men compared to older women. Variations in AAMR based on race revealed that Non-Hispanic (NH) Black or African American population had the highest AAMRs. Geographic disparities among states showed that the District of Columbia had the highest AAMR while Nebraska had the lowest. The southern U.S. also had a consistently higher AAMR followed by the West, Northeast, and Midwest. Moreover, metropolitan areas had a higher AAMR than nonmetropolitan areas. Conclusion: Our findings reveal an increase in HHD-related deaths and demonstrate that NH Blacks consistently bear a higher burden of disease mortality. These insights underscore the importance of integrating demographic and geographic variables into public health planning and interventions.
Abstract 4137965: D-dimer as a 5-year predictor of death in females admitted with chestpain of suspected coronary origin surpasses that of males.
Authors: Dennis Nilsen, Trygve Brugger-Andersen, Reidun Aarsetoey, Thor Ueland, Annika Michelsen, Pal Aukrust, Volker Poenitz, Harry Staines, Heidi Grundt
Journal: Circulation (2024)

Background: D-dimer (DD) and fibrin monomer (FM) are endstage markers of activated coagulation and reflect prothrombotic states, and α2-antiplasmin (SERPINF2 -SF2) is the main inhibitor of fibrinolysis at the level of plasmin. Women may experience a higher rate of morbidity and mortality compared to men following a myocardial infarction (MI). We present the prognostic potential of DD, FM and SF2 in females as compared to males during 5 years follow-up in a population admitted with chest pain of suspected coronary origin. Methods: A total of 871 consecutive patients with a median age of 72.6 years (females 77.3, males 69.1) were admitted in the study. Of these, 386 were diagnosed with an acute MI based on Troponin-T (TnT) levels &gt;50 ng/L. Stepwise Cox regression models, applying normalized continuous log e /SD values, were fitted for the biomarkers with total mortality within 5 years as the dependent variable. Results: Death was recorded in 246 patients; 34.4% females vs. 27.2% males (Chi-squared test p-value = 0.02). Blood samples were available for analysis of DD, FM and SF2 in 820, 810 and 846 patients, respectively. Females had a signficantly higher mean of DD (p&lt;0.0001) and FM (p=0.0020) than males and SF2 did not differ (p=0.0825). In the univariate analysis, a highly significant association between DD and total death was observed in both sexes (p&lt;0.001). However, after adjusting for confounders in the multivariable analysis, the associations remained significant in females but not in males, with an HR of 1.62 (95%CI 1.36 – 1.93), p&lt;0.0001 vs. 1.16 (95%CI 0.98 - 1.39, p=0.094, respectively, (p for interaction &lt;0.001). Similar findings were noted in the multivariable analysis of FM with HR 1.46 (95%CI 1.19 – 1.80), p=0.0003 in females vs. 1.12 (95%CI 0.93 -1.35), p=0.22 in males (p for interaction 0.056). In the univariate analysis, SF2 was not associated with all-cause mortality; p=0.56 in females vs. p=0.83 in males, and remained essentially unchanged after adjustment; p=0.84 vs. HR 0.92 (95%CI 0.78 – 1.09). p=0.35 in males, yielding a p=0.36 for interaction. Conclusion: Activated endstage coagulation was associated with total death at 5 years FU in females admitted with chest pain of suspected coronary origin, whereas plasmin inhibition was not. A significant p-value for interaction between the two sexes indicates that the prognostic value of DD surpasses that of men.
Abstract 4137870: Nasal Etripamil Spray efficacy for Acute Paroxysmal Supraventricular Tachycardia: A Systematic Review, Meta-Analysis and Trial Sequential Analysis.
Authors: Ivo Queiroz, Lucas Barbosa, Maria Luiza Rodrigues Defante, Beatriz X. Mendes, Vanio do Livramento Junior Antunes, Pedro Romeiro, Roberto Mazetto, Catarina Silva, Elisio Bulhoes, Camila Guida
Journal: Circulation (2024)

Background: Acute paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia. Etripamil, a novel calcium channel blocker via nasal spray, has shown promise for PSVT management. This meta-analysis and trial sequential analysis (TSA) evaluates the efficacy and safety of nasal Etripamil for treating PSVT. Methods: We systematically searched Pubmed, Embase, and Cochrane databases for studies assessing the efficacy and safety of Etripamil for PSVT. The main outcome was conversion to sinus rhythm(CSR) within 15 minutes. Secondary outcomes included adverse events(AE). Meta-analysis was performed using random-effects models, and TSA was employed to assess the robustness of the evidence and required information size. Results: Three randomized controlled trials (RCTs) and two extensive trials involving 1,652 participants were analyzed. Nasal Etripamil significantly increased the CSR within 15 minutes compared to placebo (RR 1.87 95% CI; 1.39-2.52, p &lt;0.001; Figure A). Outcome TSA suggested a low risk of type 1 error; therefore, this result may be conclusive (Figure B). For the AEs both a pairwise and single-arm meta-analysis of studies was performed with 1 AEs being statistically significant in the single-arm plot, Nasal Discomfort (22.11 95% CI; 16.02-29.70 events per 100 observations, p &lt;0.01 Figure C). In the pairwise, the overall was statistically significant and it favored placebo (RR 3.93, 95% CI; 2.46-6.27, p &lt;0.001 Figure D). Conclusion: Nasal Etripamil is effective and safe for the treatment of acute PSVT, offering a non-invasive alternative to traditional therapies. Larger-scale RCTs are warranted to confirm these findings and explore long-term outcomes.