tbuckley/cabot-search huggingface dataset:
Abstract 15542: Social Determinants of Health Screening of Patients With Congestive Heart Failure Within Multiple Urban Ambulatory Clinics
Authors: Aaisha Shah, Kyle Kapcin, Anushree Puttur, Xiarepati Tieliwaerdi, Abdallah Naser, Yadhu Dhital, Richard Amoateng, Mrudula Gadani
Journal: Circulation (2023)

Introduction: There is a growing body of literature dedicated to understanding the implications of social determinants of health (SDOH) on cardiovascular disease. This study evaluated a pilot of standardized SDOH screening questionnaires in two large urban ambulatory clinics within a quaternary integrated health network in the Northeastern United States. Goals/Aims: This study aims to investigate common social determinants of health which may influence patients with congestive heart failure (CHF). Methods: A retrospective review of the incidence of SDOH in adult patients from two Internal Medicine outpatient residency clinics between 2020 and 2023 was performed. SDOH assessment was performed at every visit. Multivariate logistic regression analysis was performed to assess the association of SDOH in patients with and without CHF. Results: A total of 14,516 patients were evaluated during this study period (mean age 66 years, 62% female). When matched for age and sex, 808 patients with CHF were compared to those without CHF. In matched data, those with CHF were significantly less likely to endorse food insecurity (64.2% vs 94.6%, p&lt;0.05), lack of safety (1.4% vs 2.8%, p&lt;0.05), lack of social connection (34.4% vs 86.8%, p&lt;0.05), and stress (29.1% vs 84.3%, p&lt;0.05). Patients with CHF were more likely (91% vs 26%, p&lt;0.05) to report a positive PHQ-9 depression screen [Table 1]. Patients with CHF were also noted to have a higher incidence of comorbid illnesses. Conclusions: Utilization of evidence-based SDOH screening questions in the workflow can help identify key barriers to cardiovascular diseases such as CHF. Multidisciplinary care in patients with CHF may contribute to improved SDOH reporting. Future studies should use qualitative and quantitative data in combination to further evaluate and address barriers to care in patients with CHF.
Abstract 13765: ECG Signal Quality Assessments of Real-Time Single-Lead Wearable SmartPatch and 12-Lead ECG
Authors: Sung I Im, BAE Su Hyun, sung phil Cho
Journal: Circulation (2023)

Introduction: There is an increasing clinical interest using wearable single-lead ECG sensors for continuous cardiac monitoring. Hypothesis: However, there is limited to qualify the reliability of those. The purpose of this study is to assess ECG signal quality assessments of real-time wearable SmartPatch (HiCardi Plus) compared to 12-lead ECG. Methods: To analyze the similarity between the standard 12-Lead ECG and HiCardi Plus signals, 31 subjects were simultaneously acquired with SmartPatch (HiCardi Plus) and 12-Lead ECG. The 12-lead ECG equipment used in this experiment is IntelliVue Patient Monitor MX700 (Philips) Results: It was found that even if the distance between electrodes was short, the ECG signal measured from the electrode pair located diagonal (direction of the electrical axis of the heart) and vertical direction with chest had a very high correlation with the standard 12-lead ECG signal and was sufficient for diagnosis Conclusions: Our device (HiCardi Plus) has substantial equivalence with standard 12-Lead ECG, in terms of QRS-complex detection and arrhythmia classification in the intended use condition.
Abstract 17826: Plasma Biomarkers of Endothelial Dysfunction and Myocardial Fibrosis in Relation to Measures of Coronary Microvascular Disease in Ischemia With No Obstructive Coronary Arteries
Authors: Shajan Shekarestan, Christina Ekenback, Fadi Jokhaji, Samantha Lorstad, Hakan Wallen, Mattias Törnerud, Petter Ljungman, Bassem Samad, Rickard Linder, Jonas Persson
Journal: Circulation (2023)

Background: Increased hyperemic microcirculatory resistance and/or low coronary flow reserve (CFR) diagnostic criteria for coronary microvascular disease in ischemia with no obstructive coronary arteries (INOCA). For optimal therapy pathophysiological mechanisms need to be determined. Aim: To investigate plasma levels of markers of i) endothelial dysfunction (syndecan-1, E-selectin, thrombomodulin and hyaluronan) and ii) myocardial fibrosis (procollagen type I carboxy-terminal propeptide [PICP], suppression of tumorigenicity 2 [ST2], and tissue inhibitor of metalloproteinases-1[TIMP-1]) in relation to the index of microcirculatory resistance (IMR) and CFR in INOCA. Methods: Measurements of corrected IMR and CFR were determined in the LAD using thermodilution technique during coronary angiography (CA) in chronic coronary syndrome (CCS) patients. Plasma biomarkers were quantified using an ELISA and the association between each biomarker and i) IMR and ii) CFR was analyzed using linear regression. Results: We selected 162 random patients with INOCA from a cohort of 503 all-comer CCS patients with no congestive heart failure that underwent CA with measurements of CFR and IMR in the LAD. The mean age was 65 ±10 years and 101 (62.3%) were male. Median IMR and CFR were 19.1 (interquartile range [IQR] 11.9-30.7) and 3.5 (IQR 2.3-5.1) respectively. IMR was associated with syndecan-1 (Figure 1A) but not with PICP (Figure 1C) or the other biomarkers. CFR was inversely associated with syndecan-1 (Figure 1B), PICP (Figure 1D), and E-selectin (p=0.049). Conclusion: IMR is associated with increasing plasma levels of syndecan-1 but not with myocardial fibrosis, indicating endothelial dysfunction, with glycocalyx shedding, to be involved in high hyperemic microcirculatory resistance in INOCA. Low CFR is also associated with PICP indicating involvement of myocardial fibrosis in coronary microvascular disease in INOCA.
Abstract 17707: The Association of Atrial Fibrillation With Tricuspid Regurgitation Progression is Age-Dependent
Authors: Ranel Yosef Loutati, Sagit Ben-Zekry, Paul Fefer, Efrat Mazor, Robert Klempfner, Israel Barbash, Victor Guetta, Amit Segev, Rafael Kuperstein, Elad Maor
Journal: Circulation (2023)

Background: The prevalence of significant Tricuspid Regurgitation (TR) in individuals with Atrial Fibrillation (AF) is notably high. This analysis aimed to investigate the association of AF with TR progression after more than 10 years, and to ascertain influencing factors of this association. Methods: Electrocardiographic reports linked to clinical data (N=52,389; 2007-2012) were reviewed. Only patients with apparently normal left heart and with ECG and echocardiographic reports at baseline and at after a minimum of 5 years were included. The primary outcome was the occurrence of new significant TR in a follow-up echocardiogram. Results: The final study included 5,691 patients with a median age of 62 (IQR: 53-70), 845 (14%) of whom had baseline AF. During a median follow-up period of 12 years, 279 (5%) patients developed significant TR. Patients with AF were 6 times more likely to develop significant TR in a univariate model (95% CI 5.3-6.8,p &lt;.001). A multivariate model demonstrated that AF, older age, female sex and pulmonary pressures were all associated with increased risk of TR progression (p&lt;.001 for all). The association of AF with future TR was age-dependent such that among patients older than 60, AF was associated with 3.6-fold increased risk compared with 4.5-fold increased risk among younger adults (p for interaction=0.01). During follow up, 1,197 (21%) patients died. Kaplan-Meier analysis revealed increased mortality risk with significant TR and/or AF (log-rank p&lt;.001 for both). Multiarvariate Cox analysis demonstrated that compared to significant TR patients without AF, the combination of TR and AF was associated with a significant 42% higher risk of death during follow up (p=0.04). Conclusions: The association of AF with TR progression after more than 10 years of follow up is more prominent among younger patients. This emphasize the importance of TR screening in AF patients and implementing interventions to mitigate TR progression and improve outcomes.
Abstract 16970: Acetyl-CoA Metabolism: A Catalyst for Improved Vascular Recovery in Limb Ischemia via Transdifferentiation Mechanisms
Authors: Shuang Li, Alexander J Lu, Kaylee N Carter, Eric S Nagueh, John P Cooke, Li Lai
Journal: Circulation (2023)

Background: Angiogenic transdifferentiation, the process by which resident fibroblasts transform into endothelial cells, contributes to restoring perfusion and preserving ischemic tissue. The metabolic shift is essential for transdifferentiation in vitro. Acetyl-CoA, a metabolite involved in histone acetylation, is a key substrate, and ATP Citrate Lyase (ACL) is the enzyme responsible for converting citrate to acetyl-CoA. We hypothesized that acetyl-CoA metabolism may regulate vascular recovery in limb ischemia through angiogenic transdifferentiation. Methods: We employed in vivo Matrigel plug assays, a murine hindlimb ischemia model, fibroblast lineage tracing mice, and ACL fibroblast-specific knockout mice to investigate the function of acetyl-CoA in vascular recovery and transdifferentiation. Isotope tracing assays were conducted to identify the primary carbon sources of acetyl-CoA during transdifferentiation, and pharmacological interventions targeting the corresponding transporters were used to confirm the findings. Results: In our hindlimb ischemia model, we observed a significant increase in ACL expression, particularly in fibroblasts, in the ischemic tissue on day 3 after surgery, coinciding with the peak of vascular flow recovery. Subcutaneous administration of Matrigel in mice revealed that ACL knockdown in fibroblasts reduced plug vascularity and the number of induced endothelial cells. Furthermore, both pharmacological inhibition of global ACL expression and genetic suppression of ACL in fibroblasts significantly impaired limb vascular recovery following ischemia. Importantly, inhibition of ACL in lineage-tracing mice resulted in a significant reduction in the population of induced endothelial cells, indicating that ACL ablation in fibroblasts blocked angiogenic transdifferentiation. In addition, we demonstrated that glucose and glutamine were the primary carbon sources for accumulated acetyl-CoA, and inhibition of glucose transporter (Glut1) or glutamine transporter (Slc1a5) significantly impaired transdifferentiation. Conclusions: Acetyl-CoA accumulation through ACL-mediated metabolism improves vascular recovery in limb ischemia by promoting angiogenic transdifferentiation.
Abstract 15045: Anti CTLA-4 and PD-1 Monoclonal Antibodies Increases Systemic SDF-1 and Galectin-3 Levels and Reduces Myocardial Strain Through NLRP3 and MyD-88 Pathways
Authors: Nicola Maurea, Claudia De Lorenzo, Margherita Passariello, Annabella Di Mauro, Irma Bisceglia, Martina Iovine, Alessia Merola, Francesca Bruzzese, Antonio Luciano, Giuseppe Palma, Domenico Gabrielli, Carlo Maurea, Maria Laura Canale, Vincenzo Quagliariello
Journal: Circulation (2023)

Background: Immune checkpoint inhibitors (ICIs) have significantly changed the oncology clinic in recent years, improving survival expectations in cancer patients. ICI therapy have a broad spectrum of side effects from endocrinopathies to cardiovascular diseases. In this study, pro-inflammatory and pro-fibrotic effects of short-term ICIs therapy in preclinical models were analyzed. Methods: Firstly, human cardiomyocytes co-cultured with hPBMC were exposed to ICIs (with CTLA-4 or PD-1 blocking agents, at 200 nM) for 72h. After treatment, production of DAMPs and 12 cytokines were analyzed in the supernatant through enzymatic assays. C57/Bl6 mice were treated with CTLA-4 or PD-1 blocking agents (15 mg/kg) for 10 days. Before (T0), after three days (T3) and after treatments (T10), ejection fraction, fractional shortening, radial and longitudinal strain were calculated by using bidimensional echocardiography (Vevo 2100,Fujfilm). Fibrosis, necrosis, hypertrophy and vascular NF-kB expression were analyzed through Immunohistochemistry. Myocardial expression of DAMPs, MyD88, NLRP3 and twelve cytokines have been analyzed. Systemic levels of SDF-1, IL-1β and IL-6 were analyzed before, during and after ICIs therapy. Results: Radial and longitudinal strain were decreased after 10 days of ICIs therapy. Histological analysis of NF-kB expression shows that short-term anti-CTLA-4 or anti-PD-1 treatment increased vascular and myocardial inflammation. No myocardial hypertrophy was seen with the exception of the pembrolizumab group. Myocardial fibrosis and expression of galectin-3, pro-collagen 1-α and MMP-9 were increased after treatment with all ICIs. Both anti-CTLA-4 or anti-PD-1 treatments increased the expression of DAMPs, NLRP3 and MyD88 and induced both in vitro and in vivo the secretion of IL-1β, TNF-α and IL-6. Systemic levels of SDF-1, IL-1β and IL-6 were increased during and after treatment with ICIs. Conclusions: Short therapy with PD-1 and CTLA-4 blocking agents increases vascular expression of NF-kB, systemic SDF-1, IL-1β, IL-6 levels and myocardial NLRP3, MyD88 and DAMPs expression in preclinical models. A pro-inflammatory cytokine storm was induced in myocardial tissues after ICIs therapy.
Abstract 14047: Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Patients With Left Ventricular Systolic Failure: A Systematic Review and Meta-Analysis
Authors: Soban Ahmad, Amman Yousaf, Joshua Peltz, Muhammad Junaid Ahsan, Kirellos Said Abbas, Muhammad Zoraiz Ahsan, Christopher Watson, Zain Ul Abideen Asad, Michael H Kim
Journal: Circulation (2023)

Introduction: There is limited data comparing the effectiveness of Left Bundle Branch Area Pacing (LBBAP) and traditional Biventricular Pacing (BiVP) in patients with left ventricular systolic failure. The aim of this study was to assess the electromechanical and clinical outcomes of both cardiac resynchronization (CRT) techniques. Hypothesis: LBBAP offers comparable or superior clinical outcomes compared to BiVP in patients with systolic left ventricular failure Methods: We conducted a systematic review of PubMed (MEDLINE), Embase, Google Scholar, Scopus, and Cochrane Central Register of Control Trials (CENTRAL) for studies comparing LBBAP with BiVP from inception till May 22, 2023. To evaluate categorical and continuous outcomes, risk ratios (RRs) and standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were calculated using RevMan version 5.4 software. Results: We selected 12 studies involving 3,004 patients (LBBP=1,242; BiVP=1,762) for our meta-analysis. The pooled results demonstrated significant improvements with LBBAP in left ventricular ejection fraction (LVEF) (SMD=0.40, 95%CI[0.25, 0.54], P&lt;0.00001), NYHA functional class (SMD=-0.44, 95%CI[-0.65, -0.23], P&lt;0.0001), reduction in QRS duration (SMD=-0.90, 95%CI[-1.14, -0.66], P&lt;0.00001), fewer heart failure hospitalizations (RR=0.72, 95%CI [0.62, 0.85], P&lt;0.0001), and improved survival (RR=0.73, 95%CI [0.58, 0.92], P=0.007). Additionally, LBBAP was associated with a lower pacing threshold at implantation (SMD=-1.03, 95%CI[-1.32, -0.74], P&lt;0.00001) as compared to BiVP. Conclusions: LBBAP was associated with significant improvements in both electromechanical and clinical outcomes, including LVEF, reduction in QRS duration, NYHA class, heart failure hospitalizations, and all-cause mortality in patients with systolic left ventricular failure.
Abstract 18565: Statin Utilization and Outcomes Among Patients With Coronary Artery Disease Undergoing Percutaneous or Surgical Revascularization
Authors: Saarang S Mulukutla, Jianhui Zhu, Floyd W Thoma, Oscar C MARROQUIN, Amber Makani, Ibrahim Sultan, Michael D Shapiro, Anum Saeed
Journal: Circulation (2023)

Background: Patients undergoing coronary revascularization are at high risk for adverse health outcomes. Accordingly, current guidelines suggest high-intensity use of statin intervention therapy to help mitigate atherosclerotic risk. We analyzed outcomes of patients following coronary revascularization stratified by the level of statin intervention in a large, real-world integrated healthcare system. Methods: Patients were stratified by type of coronary revascularization (percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG)). Statin use was divided as: (1) no statin, (2) less than guideline-directed statin intensity (&lt;GDSI), and GDSI. HRs and incidence rate per 1000-person years were assessed for secondary ASCVD outcomes (MI, ischemic stroke/TIA and all-cause death) in the population. Results: Over a mean follow up of about 5 years, a total of 33,513 patients underwent PCI and 12,436 underwent CABG. Over 35% of patients in both groups received either &lt;GDSI or no statin therapy. Patients who underwent PCI and were given no statin treatment had higher incidence of MI (69 vs 23 per 1000PY), stroke (21 vs 10) and death (69 vs 30) than those on GDSI. Patients who underwent CABG and were given no statin treatment had higher incidence of MI (31 vs 15 per 1000PY), stroke (30 vs 13) and death (79 vs 20) than those on GDSI. Amongst both groups, adjusted analysis showed that patients receiving GDSI had significantly lower risk for all major adverse cardiovascular outcomes (Table). In particular, GDSI in patients undergoing PCI was associated with the most significant reduction in MI, with an HR of 0.42. Conclusions: Underuse of GDSI was highly prevalent in patients undergoing coronary vascularization, both for PCI and CABG, and this was associated with suboptimal outcomes. Further practical interventions should be studied to assure that patients are treated aggressively with guideline directed therapies to lower risk for adverse outcomes.
Abstract 17327: Heterogenous Shared Decision-Making Approaches to Sports Eligibility Decisions for Athletes With Cardiovascular Disease
Authors: Sarah Montembeau, Jonathan H Kim, Christine Baugh, Neal W Dickert
Journal: Circulation (2023)

Background: Historically, almost all pathologic cardiovascular (CV) diagnoses led to complete restriction from competitive sports. In 2015, the American College of Cardiology (ACC) and American Heart Association began to embrace a more nuanced, patient-centered approach to sports eligibility using shared decision-making (SDM). While SDM is a conceptually defensible approach to sports eligibility, operationalization is complex, and we know very little about how physicians understand and deploy it. Methods: To assess sports cardiologists’ understandings of SDM and approaches to eligibility decisions, in-depth interactive interviews were conducted with (N=20) self-identified sports cardiologists. Participants were sampled at random from the ACC Sports and Exercise Cardiology Section. Interviews were conducted using video conference or telephone, and transcripts were analyzed for qualitative description of key domains. Results: Analysis revealed heterogeneity regarding core elements of SDM. All 20 clinicians endorsed SDM, but conceptions of what SDM means varied. Some emphasized communication between physicians rather than with patients, and there was variation in describing the clinician’s role primarily as a provider of information or a more active driver of the decision. Furthermore, even though lifestyle considerations are a key component of SDM for sports eligibility, few clinicians (n=6) specifically referenced elicitation of a patient’s preferences as part of the SDM process. Clinicians also stated highly variable thresholds for prohibitive annual risk of sudden cardiac death during sports participation ranging from &lt;1% to &gt;10%, and they expressed heterogenous views of how athletes interpret risk. Some believed athletes can interpret risk in similar ways as other people; others felt they are largely blind to risk. Conclusions: These data collectively demonstrate heterogenous views of and approaches to SDM for sports eligibility decisions that likely result in very different encounters and decision outcomes. There is a need to develop a more robust understanding of how SDM is operationalized in this context and determine an evidence-based approach to SDM for sports and exercise eligibility in the context of CV disease.
Abstract 17110: Racial Differences in the Performance of the Transthyretin Amyloid Cardiomyopathy Risk Score
Authors: Michel Chedid El Helou, Mohak Gupta, Muzna Hussain, Mazen A Hanna, Wael A Jaber, Wai Hong W Tang, Patrick H Collier, Trejeeve M Martyn
Journal: Circulation (2023)

Introduction: Early diagnosis of transthyretin cardiac amyloidosis is crucial, particularly with the availability of disease-modifying therapies. Tc-99m pyrophosphate scintigraphy (PYP scan) is widely used for diagnosis. A previously validated score derived from a nearly all Caucasian cohort has shown promise in predicting PYP scan positivity in patients with HFpEF; but further assessment in a racially diverse cohort is needed. Aims: To evaluate the performance of the ATTR-CM score in predicting PYP scan positivity overall, and across racial groups. Methods: We included all patients referred for PYP with SPECT/CT at the Cleveland Clinic between 1/2012 and 1/2020 who had undergone echocardiography within one year of PYP scan. The ATTR-CM score was calculated, consisting of the following variables: Age (if 60-69, +2; if 70-79, +3; if ≥80, +4), Sex (if Male, +2), Hypertension diagnosis (if present, -1), Ejection Fraction (if &lt;60%, +1), Posterior Wall Thickness (if ≥12 mm, +1) and Relative Wall Thickness (if &gt;0.57, +2). A score ≥6 was considered high-risk. Results: The cohort consisted of 540 patients (64% white; 33% black). The overall prevalence of ATTR-CM was 28.5%, with no significant difference between racial groups (27.5% vs 29.9%; p = 0.52). A higher proportion of black patients had an EF &lt; 40% (23.3% vs 35.4%, p = 0.01). The score showed good discrimination with an AUC of 0.816, with similar performance between racial groups (0.824 vs. 0.824; p &lt; 0.001; Figure 2). For a score ≥6, sensitivity was 77.3% (82.7% white; 67.3% black), specificity was 70.2% (64.3% white; 80.6% black), PPV was 50.9%, and NPV was 88.6%. Similar findings were observed when considering only patients with EF ≥ 40%. Conclusions: The overall performance of the ATTR-CM risk score by AUC was consistently good across races. However, it was less sensitive for detecting disease in black patients. Efforts to scale ATTR-CM diagnosis tools should be mindful of racial differences in risk prediction models.