tbuckley/cabot-search huggingface dataset:
Abstract 13802: Differences in the Incidences and Predictors of Major Adverse Cardiovascular Events Between in Patients With Acute and Chronic Coronary Syndromes
Authors: Shinnosuke Kikuchi, Kozo Okada, Katsuhiko Tsutsumi, Jin Kirigaya, Hidefumi Nakahashi, Yugo Minamimoto, Masaomi Gohbara, Yuichiro Kimura, Kensuke Matsushita, Masami Kosuge, Toshiaki Ebina, Teruyasu Sugano, Kiyoshi Hibi
Journal: Circulation (2023)

Backgrounds: Patients with acute coronary syndrome (ACS) have a higher risk of the recurrence of major adverse cardiovascular events (MACE) than those with chronic coronary syndrome (CCS). However, it remains undefined whether contributing factors to recurrent MACE are different between ACS and CCS, which information may be important for the individual patient’s management. Aims: This retrospective, single-center analysis aimed to examine and compare incidences and predictors of MACE after PCI in patients with ACS and CCS. Methods and Results: A total of 3115 patients (2201 ACS and 914 CCS) who received PCI were enrolled and followed for a median of 2.9 years for MACE, defined as a composite of cardiovascular death, myocardial infarction (MI), revascularization, ischemic stroke, and hospitalization for heart failure (HF). Incidences of MACE, especially cardiovascular death, myocardial infarction, and stroke were significantly higher in ACS than in CCS, whereas the rates of revascularization and HF hospitalization were comparable between the groups (Table 1A). Multivariable regression analyses identified different determinants for MACE between ACS and CCS, except for previous MI (Table 1B). Similarly, risk factors were different between ACS and CCS with respect to each MACE component (data not shown). Conclusions: Not only incidences of MACE but also their components and predictors were different between ACS and CCS. Further studies are warranted to investigate whether machine learning of electronic medical records may help enhance further risk stratification of MACE and could lead to improved clinical decision-making after PCI.
Abstract 12258: Ceramides Predict the Development of Type 2 Diabetes
Authors: Andreas Leiherer, Axel Muendlein, Thomas Plattner, Alexander Vonbank, Reijo Laaksonen, Arthur Mader, Lukas Sprenger, Maximilian Maechler, Barbara Larcher, Peter Fraunberger, Heinz Drexel, Christoph H Saely
Journal: Circulation (2023)

Introduction: Ceramides recently have attracted interest as a marker of cardiovascular event risk. Hypothesis: We hypothesize that they play a role in the development of type 2 diabetes (T2DM). Methods: We analyzed the ceramide ratio Cer d18:18/Cer d 18:24:0 (CerRatio) in 894 consecutive Caucasian patients who were referred to angiography for the evaluation of established or suspected stable coronary artery disease (CAD). T2DM was diagnosed according to ADA criteria. The incidence of T2DM was recorded over a follow-up time of up to 16 years (median: 13 [8-14] years). Results: At baseline, the CerRatio was significantly higher in T2DM (n=239) than in non-diabetic patients (4.6e-2 vs. 3.9e-2, p&lt;0.001). During follow-up, diabetes was newly diagnosed in 71 patients, i.e. in 11% of the initially non-diabetic subjects. The CerRatio strongly predicted the incidence of T2DM both univariately (standardized OR 1.47 [1.11-1.96]; p=0.008) and in a multivariately adjusted model (figure) comprising age, sex, BMI, the presence of significant CAD at angiography, and hemoglobin A1c (HbA1c; OR=1.45 [1.07-1.98]; p=0.018). Though the CerRatio was significantly correlated with BMI (r=0.138, p&lt;0.001) and HbA1c (r=0.137, p&lt;0.001), applying a mediation analysis revealed that BMI and HbA1c had only marginal indirect effects (5,7% and 3.6%, respectively) on the association of the CerRatio with T2DM incidence. Conclusions: We conclude that ceramides strongly and independently predict the development of diabetes.
Abstract 18238: ChatGPT Has the Potential to Increase Accessibility to Cardiology Research
Authors: Aorzala Atmar, Saman Andalib, Aidin Spina, John Dylewski, Tessa Haspil-Corgan
Journal: Circulation (2023)

Introduction: Generative language models like ChatGPT have experienced a novel rise in their implementation. This study explored ChatGPT’s potential in simplifying cardiology research abstracts published in specific journals within the family of Journals of American College of Medicine (JACC). If successful, this can expand the understanding of cardiology research among the public and those with low health literacy. Research Question: Can ChatGPT transform abstracts to be understandable by patient populations who cannot understand medical text without including extraneous or false information? Goals: We quantified the readability of abstracts published in JACC with clinically verified metrics. We assessed the readability of these same abstracts post-ChatGPT transformation. Methods: Review article abstracts published in the JACC from January to June 2023 were simplified using ChatGPT. The following prompt was used in ChatGPT to transform abstracts: “Please rewrite the following text to be readable at a 5th-grade level. Do not include information not contained in the original text, and do not exclude information contained within the original text.” Readability was quantified using Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) scores. A board-certified cardiologist assessed content validity and ensured accuracy. Results: All 24 abstracts had significantly lower FKGL and higher FKRE scores (P&lt;0.001) after transformation by ChatGPT, indicating improved readability. No extraneous information was found in 24/24 transformed abstracts. Conclusion: Medical literature exceeds the average reading and comprehension level of US adults, especially among those with low socioeconomic status. Our results indicate that ChatGPT effectively simplifies complex cardiology literature, maintaining information accuracy. This opens the door for further exploration of ChatGPT's role in improving accessibility to various cardiology topics.
Abstract 18157: Temporal Trends in Sex-Related Risk of Cardiac Events in Children With Congenital Long-QT Syndrome
Authors: Ido Goldenberg, Ilan Goldenberg, Wojciech Zareba, Valentina Kutyifa, Scott McNitt, Claudio D Schuger, Martin Steinberg, John Steinberg, Arwa Younis, Mehmet K Aktas
Journal: Circulation (2023)

Introduction: Unexplained male predominance during childhood until puberty is observed in long-QT syndrome (LQTS). As cardiac events in LQTS have been linked to the degree of physical activity, we hypothesized that the sex differential previously described may be attenuated by temporal trends in the level of activity in males and females with LQTS during childhood. Methods: The study population comprised 1,356 patients from the Rochester LQTS Registry with LQTS Types 1, 2, or 3 (genetically confirmed or retrospectively identified phenotype positive family members of a genotype positive subject) with follow-up from birth through 14 years. Based on their year of birth, patients were divided into 3 groups by vicennium: 1960-1979, 1980-1999, and 2000-2021. The primary endpoint was a CE defined as nonfatal cardiac arrest, unexplained sudden death, appropriate implantable cardioverter defibrillator shock, or syncope. The age-related incidence of a first CE in each vicennium, with birth used as the time of origin, was determined by the Kaplan-Meier method. The hazard ratio (HR) of experiencing a first CE by sex was calculated using multivariate Cox-regression analysis. Results: In the 1960-1979 cohort the incidence of first CE at age 14 was 28% versus (vs) 14% in boys vs girls, respectively (p&lt;0.001 for the overall difference during follow-up [Figure left panel]). This difference was attenuated in the 1980-1999 cohort as the incidence was 30% vs 25% in boys vs girls, respectively (p=0.150 for the overall difference during follow-up [Figure center panel]). In the 2000-2021 cohort, event rates were lower and the incidence of a CE was similar in both boys and girls (18%; Figure right panel). The HRs for boys vs girls were 2.31 (p&lt;0.001), 1.07 (p=0.684), and 0.95 (p=0.880) in the first, second, and third vicennium, respectively. Conclusions: The strength of sex as a risk factor for cardiac events appears attenuated in contemporary populations of children with LQTS.
Abstract 11320: Sonothrombolysis Leads to Early Improvement of Left Ventricular Function in Acute Coronary Syndromes
Authors: JULIANA E ROLIM, David LeBihan, Rodrigo B Bellio de Mattos Barretto, Carolina Stangenhaus, Maria C Abduch, Luciene F Azevedo, Carlos E Rochitte, Max R Reyes Barrenechea, Marcio Lima, Emmanuel Bedoya, Isabella S DiMonte, Paulo Soares, Alexandre Abizaid, FELIPE LIMA, Jose Nicolau, João C Sbano, Soufiane El Kadi, Otto Kamp, Thomas R Porter, Roberto Kalil Filho, Wilson Mathias
Journal: Circulation (2023)

Introduction: Acute coronary syndromes (ACS) are among the main causes of death worldwide. Despite important advances in revascularization strategies, there are a considerable number of patients who neither have access to these therapies, or, if so, may experience the no-reflow phenomenon. In STEMI, sonothrombolysis has been shown to restore patency of coronary vessels, especially in the microcirculation, leading to better left ventricular (LV) function recovery, hence emerging as a new adjuvant treatment to reperfusion. Hypothesis: Sonothrombolysis would improve the LV function in ACS. Aim: Compare ejection fraction (EF) and global longitudinal strain (GLS) in patients with ACS randomized to receive sonothrombolysis (therapy group-TG) or conventional treatment (control group-CG). Methods: Patients were randomized from two major clinical trials (NCT04732091 and NCT02410330 - HUBBLE databank). The therapy consists of high-energy intermittent ultrasound pulses associated with ultrasound-enhancing agent infusion (Definity® - Lantheus), initiated immediately after patient admission and continued after PCI or applied only after PCI for a total of 50 minutes. EF and GLS were measured off-line (TomTec Imaging System). Images were acquired immediately post Therapy/PCI or PCI only and 48/72 hours after the patient's inclusion. Comparisons were made using Student t-test, Chi-square test, and Fisher's exact test when indicated. Results: 120 patients were included (CG=60: 51 STEMI, 1 thrombolyzed STEMI, and 8 NSTEMI; TG=60: 53 STEMI, 1 thrombolyzed STEMI e 6 NSTEMI). Demographic characteristics were similar between groups, except for a tendency of higher number of diabetic patients in TG (43% vs. 25%, p=0.054). EF and GLS were similar between TG and CG immediately post-treatment (Therapy/PCI or PCI only) (47±12 vs. 45±11, p=0.393 and 13.2±4.1 vs. 12.5±3.3, p=0.325, respectively). However, after 48/72 hours, patients who received Therapy/PCI had similar values of EF despite higher GLS (49±10 vs. 46±11, p=0.126 and 13.5±3.8 vs. 11.8±3.1, p=0.010, respectively). Conclusions: Preliminary data shows that Sonothrombolysis associated with PCI could be an effective adjuvant treatment for ACS, contributing to the early improvement of LV function.
Abstract 15199: Pyridoxamine Limits Mitochondria-Dependent Ferroptosis in a Rat Model of Doxorubicin-Induced Cardiotoxicity
Authors: Sibren Haesen, Eline Verghote, Anouk Delaet, Esther Wolfs, Dorien Deluyker, Virginie Bito
Journal: Circulation (2023)

Background: The use of doxorubicin (DOX) chemotherapy is limited by cardiotoxicity characterized by mitochondrial iron accumulation and ferroptosis, both interesting targets for cardioprotection. We found that pyridoxamine (PM) protects against DOX cardiotoxicity in rats. In this study, we hypothesized that PM is cardioprotective by restoring iron regulation and limiting mitochondria-dependent ferroptosis. Methods: Female Sprague Dawley rats of six weeks old were divided into a DOX group (2 mg/kg/week, 8 weeks, IV, N=7) or control group (CTRL, saline, N=7). Others were treated with PM via drinking water (1 g/L) while receiving DOX or saline (DOX+PM, N=9 and CTRL+PM, N=8). Iron regulation, lipid peroxidation and mitochondrial damage in cardiac tissue were evaluated by qPCR, 4-hydroxynonenal (4-HNE) staining and transmission electron microscopy. Data were compared by 1-way ANOVA or Kruskal-Wallis test with posthoc tests. P values are presented with a mean difference (MD) and [95% CI] or mean rank difference (MRD). Results: DOX significantly increased ZIP14 (P=0.049 vs CTRL, 11.20 MRD) and mitoferrin-1 expression (P=0.0002 vs CTRL, 1.49 MD [0.71, 2.28]), indicating increased cytosolic and mitochondrial iron import. The DOX group showed features of ferroptosis including swollen mitochondria with disrupted cristae (Fig. 1), decreased mitochondrial density (P=0.085 vs CTRL, –0.12 MD [–0.24, 0.01]) and increased 4-HNE levels (P=0.029 vs CTRL, 6.90 MD [0.56, 13.24]). PM treatment significantly decreased ZIP14 (P=0.0055 vs DOX, –12.90 MRD) and mitoferrin-1 expression (P=0.0008 vs DOX, –1.17 MD, [–1.88, –0.46]), indicating restored iron regulation. PM also significantly increased mitochondrial density (P=0.0028 vs DOX, 0.22 MD [0.06, 0.37]) and limited mitochondrial damage (Fig. 1). Conclusion: In conclusion, we show that PM limits DOX-induced mitochondria-dependent ferroptosis, and could be a promising cardioprotective strategy for cancer patients.
Abstract 15832: Racial Differences in the Utilization and Outcomes of Transcatheter Aortic Valve Replacement
Authors: Akanimo Antia, Chinwendu Onuegbu, Carlos L Alviar
Journal: Circulation (2023)

Introduction: The use of transcatheter aortic valvular replacement (TAVR) improves outcomes in patients with aortic stenosis (AS). However, there is limited data describing racial disparities in TAVR use. Our aim was to evaluate outcomes according to racial groups and TAVR use in the national inpatient sample (NIS). Methods: We identified all patients undergoing TAVR between 2016 - 2020 from the NIS of the Health Care Utilization Project database. Patients were classified according to ethnic groups as white, black, Hispanic, and Asians. Outcomes included TAVR utilization by ethnic group, mortality, respiratory failure rates, cardiogenic shock, cardiac arrest, and hospital length of stay (H-LOS). Multivariate analysis was performed adjusting for age, sex, cardiovascular comorbidities, and socioeconomic status. Results: From 296,740 patients who underwent TAVR, 89.5% were white, 4.24% were black, 4.9% were Hispanic, and 1.39% were Asian. Blacks had higher rates of CHF, chronic kidney disease, peripheral vascular disease, obesity, and anemia but lower rates of myocardial infarction, CABG, pacemaker placement and PCI. Hispanic patients showed higher rates of AKI, while Asian patients had higher rates of DM. Blacks had lower adjusted mortality rates compared to whites (aOR: 0.56; CI 0.35 - 0.88 p=0.014). Respiratory failure rates (aOR: 0.82; CI 0.68 - 0.98, p=0.031) and H-LOS (5.2 days vs 3.7 days) were higher in black patients. Whites had a steeper increase in TAVR use compared to other groups during the study period. Patients with AS undergoing TAVR had significant lower adjusted mortality (aOR: 0.95; CI 0.92 - 0.98 p=0.005). Conclusion: White patients are most likely to receive TAVR compared to other ethnic groups. Such differences in TAVR utilization by ethnic group should be studied further to decrease healthcare disparities
Abstract 15843: Biatrial and Recurrent Cardiac Myxoma in a Rare Case of Carney Complex
Authors: Bibek Saha, Alex P Danielson, Victoria R Kalinoski-Dubose, Kyle W Klarich, Panithaya Chareonthaitawee
Journal: Circulation (2023)

Primary cardiac tumors (CTs) are exceptionally rare, and are predominantly benign masses. Myxomas make up more than 60% of these lesions and most frequently develop in the left atrium (LA), followed by the right atrium (RA). Carney complex (CNC) is a rare, typically autosomal dominant, multiple endocrine neoplasia characterized by cutaneous findings, myxomas, endocrine and/or nonendocrine neoplasms. We report a rare case of CNC involving biatrial and recurrent myxomas. A 36-year-old female presented to Cardiology Clinic at our center for management of CNC. Three years prior, she was evaluated at a local hospital for acute stroke where TTE showed a myxoma (2 x 2 x 2.5cm) attached to the left atrial septum, prompting resection. On followup TTE 2 years later, she had a mass in the LA, prolapsing through the mitral valve into the left ventricle. She underwent resection of the myxoma (2.9 x 3.9 cm) and left atrial appendage, which was complicated by recurrent stroke. She was found to have a PRKAR1A gene mutation (c.97 deletion) suggestive of CNC and was referred to our center. At Cardiology Clinic, she denied chest pain, dyspnea, presyncope, and syncope. Her father and children did not have the gene mutation. Exam revealed lentigines on her lower lip and pigmentation of an inner canthus. She was diagnosed with primary pigmented nodular adrenal disease by Endocrinology. On TEE, she was found to have a recurrent LA mass (1 x 1 x 0.8 cm) attached to the interatrial septum, but no right-to-left atrial shunt. This prompted surgery consultation. Numerous intracardiac myxomas were removed during surgery; one in the LA attached to the septum, 3-4 smaller ones, and one 2 cm myxoma located in the RA. The interatrial septum was also resected given recurrent myxoma in this region. She underwent cryoablation to prevent recurrence and did well post-surgery. CTs, which includes primary CTs and secondary metastatic disease, are uncommon where the former has an incidence of 0.001-0.3%. We presented a case of recurrent and biatrial cardiac myxomas in the setting of CNC, which is seldomly reported in the literature. Taken together, given the rarity of primary CTs, genetic predispositions or syndromes should be considered especially in the setting of recurrence and/or multiple masses.
Abstract 12996: Association Between Blood Cadmium Level and Congestive Heart Failure: Analysis of the NHANES 2017 - 2020
Authors: Phuuwadith Wattanachayakul, pongprueth rujirachun, Natchaya Polpichai, Chawin Lopimpisuth, Pakin Lalitnithi, Sasithorn Kunupakan, Ekamol Tantisattamo
Journal: Circulation (2023)

Introduction: Cadmium toxicity affects various organs, including the heart and kidneys. Whether the relationship between a broad range of cadmium levels, from normal to highly toxic and congestive heart failure (CHF), remains unclear. Hypothesis: Blood cadmium (Cd) level is associated with a higher prevalence of CHF. Methods: A nationwide cross-sectional study involving participants (≥ 18 years old) in the 2017 - 2020 NHANES was examined by using multiple logistic regression to determine the association between Cd levels and history of CHF informed by a doctor or other health professional. Results: Of 12,102 participants with blood cadmium (Cd) results were identified, of which mean age was 37±24 years, and 50.6% were female. The majority were White (33%), followed by Black (25%), Mexican American (13%), and Asian (10%). Among 8,074 participants with Cd results, 304 participants (3.8%) had a history of CHF. The participants were stratified into quartiles (Q) based on their Cd levels, with mean Cd levels of 0.08, 0.16, 0.29, and 0.93 μg/L for each quartile, respectively. Individuals in Q2, Q3, and Q4 were 2.48, 3.20, and 4.29 times more likely to experience CHF than those in Q1. (Q2: 95% CI 1.22, 5.06; Q3: 95% CI 1.61, 6.37; Q4: 95% CI 2.18, 8.45).After adjusting for age, gender, race, BMI, smoking status, high systolic blood pressure (&lt;130 vs. &gt;130 mmHg), diabetic status, and urine albumin creatinine ratio, participants in Q3 and Q4 remained at a higher risk of CHF compared to an individual in Q1, with a risk increase of 2.18 and 3.04, respectively. (Q3: 95% CI 1.02, 4.68; Q4: 95% CI 1.41, 6.52; Figure 1). While CHF was 2.11 times as likely to occur among participants in Q2 but not statically significant (Q2: 95% CI 0.97, 4.59; Figure 1). Conclusions: A graded association exists between blood cadmium levels, even within the non-toxic range, and an increased prevalence of CHF. Further longitudinal cohort studies are required to elucidate this relationship.
Abstract 15307: Sex-Specific Cognitive Effects of Intensive Systolic Blood Pressure Lowering in Patients With and Without Diabetes Mellitus
Authors: Qinglan Ding, Jessica Huber, Yuan Lu, Min Kyung Lee, Dustin Hammers, Haiqun Lin
Journal: Circulation (2023)

Background: The SPRINT trial demonstrated that intensive systolic blood pressure (SBP) lowering (&lt;120 mm Hg) reduced risk of mild cognitive impairment compared to standard SBP control (&lt;140 mm Hg). However, the ACCORD-BP trial did not show the same effect in patients with diabetes. Aims: This study aimed to 1) determine the impact of intensive SBP on cognitive impairment in patients with and without diabetes by analyzing individual patient data of ACCORD-BP and SPRINT, using three cognitive domains and the same follow-up durations, and 2) assess potential sex differences in the effect of intensive SBP lowering on cognitive function in patients with and without diabetes. Methods/Approach: We pooled individual patient data from the SPRINT and ACCORD-BP and standardized cognitive outcomes at baseline, 20-24 months, and 40-48 months post-randomization. Both studies randomized hypertensive patients to intensive SBP control or standard SBP control. Cognitive outcomes included general cognitive function, cognitive processing speed, and memory. Linear mixed models were employed, adjusting for covariates such as age, baseline BMI, SBP, eGFR and LDL. Analyses were repeated separately for patients with and without diabetes and for men and women. Results: The study cohort comprised of 10,800 patients (mean age 67.2 ±9.1 years; mean baseline SBP:139.6 ± 15.6 mmHg, with 14.7% having diabetes and 61.8% being women. Patients without diabetes in the intensive SBP control group had an accelerated decline in processing speed decline compared to the standard control group (P time*treatment interaction=0.02). Patients with diabetes exhibited similar rates of decline in all cognitive outcomes across treatment groups. Stratifying by sex, intensive SBP control was associated with improved memory in female patients (estimated sd=0.07 (0.03), p=0.06), and faster decline in processing speed in male patients. (p=0.03). Conclusions: The effects of intensive SBP control on general cognitive function were comparable between patients with and without diabetes and between men and women. While intensive SBP control was associated with accelerated decline in cognitive processing speed in patients without diabetes, it was linked to improved memory in female patients.