tbuckley/cabot-search huggingface dataset:
Abstract 17178: Rates of Micro Embolic Signals at Different Stages of Carotid Artery Revascularization
Authors: Karlo A Wiley, Allison Anker, Cristina Sanina, Guliz Kozdag Gold
Journal: Circulation (2023)

Background: The American Heart Association currently estimates that over 160,000 people die every year due to new or recurrent strokes, many from carotid artery stenosis. This association has led to increased use of carotid revascularization procedures such as carotid endarterectomy (CEA) and carotid artery stenting (CAS). In this study we aim to describe the different rates of micro embolic signals (MES) at different stages of carotid artery revascularization. Methods: Before elective carotid revascularization 57 patients (mean age 72±8 years; 15 males, 21 females) underwent 3-T MRI. After localization of the carotid bifurcation using phase contrast imaging, Time-of-Flight, 3D T1 weighting, transverse T1 and T2 weightings and proton density sequences were acquired. The different plaque components: lipid core, intraplaque hemorrhage, calcification and the characterization of the fibrous cap were assessed. While 34 patients underwent CEA, 20 patients had CAS. CES was divided into 9 stages: 1- Pre-procedure, 2- Dissection, 3- IC clamp, 4- Shunt placement, 5- Shunt open, 6- Endarterectomy, 7- Clamped, 8- IC opened, 9- Post-procedure. Similarly, CAS was divided into 9 stages: 1- Pre-procedure, 2- Arch-carotid angiography, 3- Wire insertion, 4- Filter deployment, 5- Pre-dilation, 6- Stent deployment, 7- Post-dilation, 8- Final angiography, 9- Post-procedure. Patients were monitored continuously with transcranial doppler (TCD) to detect pre-procedural, intra-procedural and post-procedural MES rates. Results: MES was detected in 20 (87%) patients undergoing CAS compared to 18 (53%) patients undergoing CES during the IC Clamp/Wire Insertion stage (p=0.004). Greater mean micro embolic signals were also found in symptomatic patients undergoing CAS than in asymptomatic patients during arch-carotid angiography (10.8 vs 2.4, p= 0.022), post-dilation (3.1 vs 1.1, p=0.047), and post-procedure (4.8 vs 1.3, p=0.044). Conclusion: MES is increased during the wire insertion stage of CAS in addition to post-dilation and post-procedure stages. Also, the finding of increased MES during arch-carotid angiography suggests that less invasive alternatives to diagnostic angiography should be considered in symptomatic patients.
Abstract 14707: Telehealth Usage for Outpatient Cardiology Evaluations During the COVID-19 Pandemic
Authors: Matthew D Solomon, Madeline Somers, Jie Huang, Andrea Millman, Thomas K Leong, Elisha Garcia, Deborah Low, Veronica W Njuguna, edward mcnulty, Douglas Roblin, Alan S Go, Mary Reed
Journal: Circulation (2023)

Introduction: The use of telehealth for cardiac services rapidly expanded during the pandemic, but little is known about the factors driving use of telehealth versus traditional in-person outpatient evaluation. Research Question: What factors are associated with telehealth use for patients with symptoms of cardiovascular disease referred for outpatient cardiology evaluation during the COVID-19 pandemic? Methods: In a large, integrated healthcare system caring for &gt;4.5M patients, we identified those aged &gt;18 years without prior cardiology diagnoses or visits who were evaluated for symptoms of incident heart failure, coronary disease, or arrhythmias before (Jan 2018-Dec 2019) and during the pandemic (June 2020-May 2022) periods. We categorized patients based on initial cardiology visit type: telehealth (video or telephone) or in-person. We compared unadjusted demographic, socioeconomic (SES), and clinical characteristics between visit types, and examined multivariable associations using Cox regression. Results: Only 146 (2.2%) of 6376 pre-pandemic patients versus 4074 (69%; 1213 telephone, 2861 video) of 5898 pandemic patients had an initial cardiology telehealth visit. In the pandemic period, compared to those with in-person visits, patients with video visits were more likely to be younger (58 vs 64 yrs; p&lt;0.01), female (49% vs 45%; p&lt;0.01), and to be linked to a facility with parking fees (11% vs 7%; p&lt;0.01). Telephone visits had the highest proportion of patients with low SES, low internet usage, and a higher comorbidity burden. In adjusted models, these relationships were generally upheld ( Figure ), and the later year of the pandemic (2022) were strongly associated with increased in-person visits. Conclusions: Many patient and system level factors were associated with telehealth use during the COVID-19 pandemic. Future studies should examine the relationship between clinical outcomes and visit type, as telehealth has become part of routine care.
Abstract 16067: The Impact of a Prehospital Mobile Cloud ECG Transmission System on Myocardial Damage and Mid-Term Mortality in Patients With ST-Elevation Myocardial Infarction
Authors: Takaaki Toyofuku, Takashi Unoki, Taiji Inamori, Tomoko Nakayama, Toshiki FUKUDA, Junya Matsura, Satoko Hasegawa, Yutaka Konami, Hiroto Suzuyama, Masayuki Inoue, eiji horio, Kazuhisa Kodama, Eiji Taguchi, Tadashi Sawamura, Tomohiro Sakamoto, Koichi Nakao, Jyunjiro Koyama
Journal: Circulation (2023)

Background: Guidelines recommend that the door-to-balloon time (DTBT) should be reduced to ninety minutes or less in patients with STEMI. As such, it is critical that ambulance teams are adequately trained and equipped to identify STEMI utilizing ECG recorders and telemetry when necessary. Aims: This single-center study aims to evaluate the impact of the prehospital mobile cloud 12-lead ECG transmission system (SCUNA ® , MEHERGEN GROUP) on reducing DTBT, myocardial damage, and mortality in STEMI patients. Methods: In June 2018, SCUNA were integrated into the regional emergency medical service (EMS) departments in Uki and Kamimashiki cities in Kumamoto, Japan. We examined and compared door-to-catheterization laboratory time (DTCT), DTBT, peak CK, CK-MB levels, as well as 1-year mortality rates of STEMI cases in the four years before and after the introduction of the SCUNA. From June 2014 to May 2022, a total of 338 STEMI patients were transferred to our institute by ambulances from the two EMS departments. After excluding 29 patients with onset to reperfusion times exceeding 24 hours and 66 patients who were transferred without the use of SCUNA following its introduction, 243 consecutive STEMI patients who underwent emergency percutaneous coronary intervention (PCI) were included in the study. The patients were divided into two groups, 130 patients prior to SCUNA introduction (Pre-SCUNA), 113 patients after SCUNA introduction (Post-SCUNA). Results: There were no significant differences in age, gender, past medical history or Killip classification between the two groups. DTCT, DTBT, and onset to reperfusion time (OTRT) were significantly reduced in the Post-SCUNA group compared to the Pre-SCUNA group (Pre-SCUNA: 40 min vs. Post-SCUNA: 25 min; p &lt; 0.01, 71 min vs. 53 min; p &lt; 0.01, and 201 min vs. 166 min; p = 0.02, respectively). No significant differences were observed between peak CK and CK-MB levels in the two groups. Kaplan-Meier analysis revealed that SCUNA did not improve 30-day and 1-year outcomes compared with the Pre-SCUNA groups. Conclusion: While the prehospital mobile cloud ECG transmission system effectively reduced DTBT, it did not lead to a notable reduction in myocardial damage or mortality rates.
Abstract 18296: Insights From the LURIC Study: Decoding the Peripheral Immune Cell Composition in Atherosclerosis Through Single Cell RNA-Sequencing
Authors: Hauke Horstmann, Nathaly Anto-Michel, Sophie Hansen, Dirk Westermann, Winfried Maerz, Andreas Zirlik, Dennis Wolf
Journal: Circulation (2023)

Introduction: Atherosclerosis and its clinical sequelae, myocardial infarction and stroke, represent the main causes of death worldwide. Although preclinical evidence has suggested the existence of a sustained inflammatory and immune response driving disease and complications, the extend of cellular alterations in human atherosclerosis remains enigmatic. Hypothesis: Here, we employ single cell RNA-sequencing (scRNA-seq) on peripheral blood mononucleated cells (PBMCs) in a well-defined cardiovascular risk cohort from the Ludwigshafen Risk and Cardiovascular Health (LURIC) trial to define changes in the immune cell landscape in atherosclerotic patients Methods: Of 3317 patients enrolled in the LURIC trial, we selected individuals with stable coronary-artery disease (CAD) (n=31) and healthy patients (no CAD) (n=16) by propensity score matching, adjusted for CRP, NT-proBNP, Troponin T, LDL-C, and Cystatin-C, in a case-control design. scRNA-seq was performed by droplet sequencing on PBMCs stored in liquid nitrogen. Individual data sets were integrated and changes between healthy individuals and patients with CAD were evaluated on numeric and transcriptional levels. Results: We identified several regulated leukocyte populations that were differentially regulated between both conditions. Interestingly, small cell populations like Tregs (&gt;1.4-fold more), platelets (&gt;10-fold more), stem cells (&gt;3-fold more), and proliferating cells (&gt;2-fold-more) were significantly increased in PBMCs from patients suffering from CAD. On the contrary, naïve B cell and T cell populations were considerably overrepresented in healthy control patients (&gt;1.4-fold more). Pathway analyses of distinct clusters in patients with CAD revealed increased signalling for cellular exhaustion, response to stress, and leukocyte activation, which strikingly resembles the underlying pathology in atherosclerosis. Conclusions: Employing scRNAseq, we demonstrate that atherosclerosis is associated with a profound change in the circulating immune cell landscape even in the absence of measurable differences in inflammatory biomarkers. These findings propose the usage of scRNAseq for the discovery of outcome-relevant cellular biomarkers in the future.
Abstract 14993: Empagliflozin Exerts a Sympathoinhibitory Effect and Ameliorates Cardiorenal Injuries in a Rat Model of Hypertensive Heart Failure
Authors: Sho Matsumoto, Keisuke Shinohara, Shota Ikeda, Soichiro Kashihara, Ryosuke Nakashima, Daisuke Yoshida, Ono Yoshiyasu, Hiroka Nakashima, Hiroyuki Tsutsui, Shintaro Kinugawa
Journal: Circulation (2023)

Background: SGLT2 inhibitors may have protective effects on cardiac and renal injuries; however, their mechanisms remain unclear. Sympathetic activation has a crucial role in cardio/renal injuries. This study aimed to investigate whether empagliflozin can inhibit cardio/renal injuries through sympathoinhibition in a rat model of hypertensive heart failure. Methods: Male Dahl salt-sensitive rats were divided into low-salt (LS) and high-salt (HS) diet groups from 6 weeks of age. The rats in HS group were assigned to vehicle (HS-VEH) or empagliflozin (HS-EMPA) treatment group at 8 weeks. The effect of empagliflozin on central sympathetic regulation and cardio/renal injuries was assessed at 12 weeks (pre-heart failure phase), while its protective effect on heart failure was evaluated at 15 weeks in another cohort. Results: At 12 weeks , systolic blood pressure was similarly elevated in HS-VEH and HS-EMPA. Plasma norepinephrine levels were increased in HS-VEH compared to LS, and were suppressed in HS-EMPA, which was consistent with the neuronal activity of pre-sympathetic neurons in the brain. Increased left ventricular (LV) weight/body weight, plasma creatinine levels, renal fibrosis, and glomerular sclerosis in HS-VEH were attenuated in HS-EMPA. At 15 weeks , the high salt-induced blood pressure elevation was similar between HS-VEH and HS-EMPA. Although LV hypertrophy did not significantly differ, both decreased echocardiographic LV fractional shortening and increased lung weight observed in HS-VEH were attenuated in HS-EMPA. Elevated plasma creatinine and norepinephrine levels in HS-VEH were also attenuated in HS-EMPA. Conclusion: Empagliflozin inhibits sympathoexcitation and ameliorates cardio/renal injuries without lowering blood pressure in the hypertensive heart failure model. This sympathoinhibitory effect of empagliflozin observed in the pre-heart failure phase might contribute to the attenuation of heart failure progression.
Abstract 13175: Association of Heart Rate Variability and Electrolyte Changes During Hemodialysis in Patients With Chronic Kidney Disease
Authors: Sung I Im, BAE Su Hyun
Journal: Circulation (2023)

Introduction: Autonomic neuropathy commonly arises as a long-term complication in chronic kidney disease (CKD) and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram (ECG) recordings. Hypothesis: There is limited data about HRV using real-time ECG according to electrolyte levels during hemodialysis (HD) in patients with CKD. Methods: Total of 50 patients (62.1±10.7 years) with CKD underwent continuous real-time ECG monitor (237.4±15.3 mins) during HD for HRV using remote monitoring system and checked electrolyte levels before/after HD. And we compared HRV according to electrolyte levels. Results: During the monitor, we checked total 2374 times of ECG and electrolyte level simultaneously of all patients. Both time and frequency domain HRV were higher when the patients had lower K + level change before/after HD (&lt;0.5mEq/L) as compared with those with higher K + level change (&gt;0.5mEq/L) in Table. In addition, there were higher incidence of arrhythmic events including atrial/ventricular premature complexes, even though no difference of mean heart rate in patients with lower K+ level change group (P&lt;0.001). Conclusions: Poor controlled K+ level during hemodialysis was independently associated with higher HRV in patients with CKD. This is further substantiated by independent continuous associations between real-time measures of K+ level and higher HRV. These data strongly suggest that cardiac autonomic dysfunction can be caused by lower change before/after hemodialysis alone.
Abstract 12153: Prevalence and Prognostic Implications of Worsening Renal Function After Acute Myocardial Infarction
Authors: Pil-Sang Song, Jin-Ok Jeong
Journal: Circulation (2023)

Introduction: Limited data exist on the association between longitudinal changes in renal function and long-term clinical outcomes in patients who survive acute myocardial infarction (AMI) events. Hypothesis: We sought to investigate the relationship between worsening renal function (WRF) at one-year follow-up and clinical outcomes at three years after AMI. Methods: We analyzed data from 13,104 patients enrolled in the national AMI registry from November 2011 to December 2015. Patients with all-cause death, recurrent myocardial infarction (re-MI), and re-hospitalization for heart failure (rHHF) at one-year follow-up after AMI were excluded. A total of 6,235 patients were extracted and divided into WRF and non-WRF groups. WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline to one-year follow-up. The primary outcome was three-year major adverse cardiac events (MACE), a composite of all-cause death, re-MI, and rHHF. Results: On average, a -1.5 ml/min/1.73 m 2 /year rate of decline in eGFR was exhibited, and 575 (9.2%) patients exhibited WRF at one-year follow-up. After multiple adjustments, WRF at one-year follow-up was independently associated with increased risks of MACEs (adjusted hazard ratio: 1.498, 95% confidence interval: 1.113-2.016, P =0.01), all-cause death, and re-MI at three-year follow-up (Figure 1). Older age, female, diabetes, hypertension, non-ST segment elevation AMI, anterior AMI, anemia, left ventricular ejection fraction &lt;35%, and baseline eGFR &lt;30 ml/min/1.73 m 2 were identified as independent predictors of WRF after AMI. Conclusions: WRF at one-year follow-up after AMI intuitively seems like a risk marker indicating multiple comorbidities. Monitoring serum creatinine in patients at one-year follow-up after AMI may help to identify those who are at the highest risk and guide effective long-term therapeutics.
Abstract 14792: Predisposing Risk Factors Affecting Reversibility of Left Ventricular Diastolic Dysfunction in Patients With Moderate Diastolic Dysfunction and Preserved Ejection Fraction
Authors: Sung Woo Cho, Kyu-Yong Ko, Ji-Won Hwang, Sung Uk Kwon, Jae-Jin Kwak, June Namgung, Joon Hyung Doh, Sung Eun Kim, Girim Kim, Dong-Gil Kim
Journal: Circulation (2023)

Introduction: Few data exist on factors affecting the reversibility of diastolic dysfunction (DD) especially in patients with preserved left ventricular ejection fraction (LVEF). Hypothesis: In the present study, we investigated the predisposing risk factors affecting the reversibility of DD in patients with moderate DD and preserved LVEF. Methods: A total of 600 patients with moderate DD and preserved LVEF who underwent follow-up echocardiography were enrolled between 2011 and 2020. We compared their index and follow-up echocardiography findings and determined the predisposing factor affecting the reversibility of DD. Results: Comparing the index and follow-up echocardiography findings showed that 379 (63%) patients had improved to normal or mild DD (improved group) and 221 (37%) patients had maintained or worsened DD (unimproved group). Among the clinical risk factors, the incidence of paroxysmal atrial fibrillation (PAF) was significantly higher in the unimproved group than in the improved group (11 vs. 18, p=0.007). After adjustment for other clinical factors, PAF was determined to be an independent predisposing risk factor for the unimproved group (odds ratio, 2.76; 95% CI: 1.28-6.21, p=0.01). At follow-up echocardiography, the mean E/A ratio and E/e' were significantly improved in patients without PAF but remained in patients with PAF. Conclusions: We identified that PAF was an independent predisposing risk factor for the unimproved group in patients with moderate DD and preserved LVEF. Therefore, further management of PAF might be required in patients with moderate DD and preserved LVEF to prevent adverse cardiovascular events.
Abstract 18480: Type 2 Diabetic Patients Have Increased Coronary Plaque Burden and Plaque Progression During 10-Year Serial Coronary CT Angiography Follow-Up
Authors: Emilie L Gaillard, Nick S Nurmohamed, Michiel J Bom, Robin J de Groot, Shirin Ibrahim, James K Min, James Earls, R. Nils Planken, S. Matthijs Boekholdt, Andrew D Choi, Erik S Stroes, Paul Knaapen
Journal: Circulation (2023)

Background Individuals diagnosed with type 2 diabetes are at high risk for coronary artery disease, however, data on long-term progression of coronary artery plaque burden is lacking. This study investigated atherosclerotic plaque characteristics and long-term plaque progression in patients with and without type 2 diabetes mellitus (T2DM). Methods: Per-protocol, patients from a coronary CT angiography (CCTA) cohort were invited for repeat CCTA imaging, regardless of symptoms. A total of 299 patients underwent follow-up CCTA imaging with a median scan interval of 10.2 [IQR 8.7-11.2] years. Patients who underwent coronary artery bypass grafting and vessels revascularized by percutaneous coronary intervention were excluded. Scans were analyzed using atherosclerosis imaging-quantitative CCTA (AI-QCT; Cleerly Inc.). The associations between diabetic status, baseline and follow-up plaque burden and characteristics were evaluated using multivariable regression adjusted for clinical risk factors, statin use and scanner settings. Results: In total, 274 patients were included, 43 (15.7%) had T2DM at baseline. The mean age was 57±7 years, 42% were women. At baseline, patients with T2DM had a median percent atheroma volume (PAV) of 6.80 (2.80, 17.70) at baseline; patients without T2DM had a median PAV of 3.20 (0.80, 9.55). Adjusted for clinical risk factors, patients with T2DM had a higher rate of plaque progression (Figure 1). The difference in PAV caused by T2DM was similar to the effect of a 13-year age difference. At baseline patients with T2DM had a higher prevalence of high-risk plaque (OR 2.11; p=0.025). After 10 years of follow-up, patients with T2DM had a higher prevalence of both high-risk plaque (OR 3.49; p&lt;0.001) and low-density plaque (OR 3.74; p&lt;0.001). Conclusion Patients with T2DM had a more than twofold higher coronary plaque burden, increased plaque progression during 10-year follow-up and had an increased prevalence of high-risk and low-density plaque.
Abstract 16129: The Gender Difference in Risk Factors and Incidence Rate of Ischemic Stroke in Japanese Atrial Fibrillation Patients: The Fushimi AF Registry
Authors: KOSUKE DOI, Yumiko Nakanishi, Kimihito Minami, Kenjiro Ishigami, Syuhei Ikeda, Takashi Yoshizawa, Yasuhiro Hamatani, Yuya Ide, Akiko Fujino, Mitsuru Ishii, Moritake Iguchi, Nobutoyo Masunaga, Mitsuru Abe, Masaharu Akao
Journal: Circulation (2023)

Background: Gender-specific medicine is of concern in cardiovascular medicine. We previously reported that there was not gender difference in the incidence of ischemic stroke from the Fushimi AF Registry. However, the gender difference in risk factors of ischemic stroke in Japanese atrial fibrillation (AF) patients is little known. The aim of this study is to compare the risk factors and incidence rate of ischemic stroke in male and female using the latest data with longer follow-up. Method: In the Fushimi AF Registry, follow-up data were available for 4,496 patients. In the entire cohort, 2,677 were male and 1,819 were female. We compared clinical characteristics and risk factors and incidence rate of ischemic stroke between the two groups. Result: Male patients were younger (male vs. female; 71.5 years vs. 76.7 years, p&amp;lt;0.01), greater in body weight (65.0 kg vs. 51.2 kg, p&amp;lt;0.01), were more often sustained type (52.0% vs. 48.2%, p=0.04), more likely to have diabetes mellitus (26.2% vs. 19.9%, p&amp;lt;0.01), coronary artery disease (16.0% vs. 12.3%, p&amp;lt;0.01) and less likely to have prior heart failure (24.0% vs. 32.3%, p&amp;lt;0.01), chronic kidney disease (CKD) (33.7% vs. 39.3%, p&amp;lt;0.01) and had lower CHADS 2 score (1.96 vs. 2.15, p&amp;lt;0.01). In prescription data, male patients more often received oral anticoagulant (58.2% vs. 52.1%, p&amp;lt;0.01) and antiplatelet drug (APD) (29.0% vs. 23.8%, p&amp;lt;0.01). Hypertension, left atrium enlargement (LAE), previous stroke and major bleeding were comparable between the two groups. During the median follow-up of 1,824 days (longest 10 years), the incidence rate of ischemic stroke was not significantly different between two groups (0.86 vs. 0.89% per person-year, log rank p=0.32). On multivariate Cox regression analysis, age, previous stroke and LAE were significantly associated with an increased risk of ischemic stroke in both groups. CKD and prescription of APD were significantly associated with an increased risk of ischemic stroke in male, while body weight was in female. Conclusion: The incidence rate of ischemic stroke was not significantly different between male and female. The risk factors associated with ischemic stroke were different between male and female in Japanese AF patients.