tbuckley/cabot-search huggingface dataset:
Abstract 4144690: Impact of Apolipoprotein A-1 Infusion on Coronary Atherosclerosis Post-Acute Coronary Syndrome: A Network Meta-Analysis of randomized controlled trials.
Authors: Shree Rath, Mohamed Saad, Warda Rasool, Hossam Hassan, Fatima Saeed, Arwa Alabide, Diaa Hakim
Journal: Circulation (2024)

Background: High-density lipoproteins (HDLs) have various potentially beneficial circulatory effects. Apolipoprotein A-1, one of the HDL mimetics, has been shown in several studies to slow the progression of atherosclerosis after an acute coronary syndrome (ACS) event. Aim: To evaluate the comparative efficacy of Apo A1 on Total Atheroma Volume (TAV), Percent Atheroma Volume (PAV), and changes in these parameters. Methods: We systematically searched articles in PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase published up to June 2024. Eligible randomized controlled trials (RCTs) enrolled adults who received Apo A1 infusion, compared to placebo, within 2 weeks of an ACS event (defined as unstable angina, non-ST or ST-segment elevation myocardial infarction) or with at least one narrowing of ≥20% on coronary angiography at baseline. Apo A1 infusion preparations evaluated include ETC-216, CER-001, CSL-111, and MDCO-216. Network meta-analysis was performed. Results: A total of 5 RCTs were included in our analysis. Outcomes evaluated include PAV, TAV (measured by intravascular ultrasonography catheter), and changes in these values from baseline to follow-up. For changes in PAV, only ETC-216 45 mg was statistically significant (MD: -12.74, [-20.70; -4.78]). All other regimens were statistically insignificant: ETC-216 15 mg, ETC-216 15 and 45 mg combined, CER-001 3 mg, CER-001 6 mg, CER-001 12 mg, MDCO-216 20 mg, and CSL-111 40 or 80 mg. In addition, changes in TAV showed no significant treatment effects. PAV was lowest at follow-up in the CER-001 3 mg (MD: -1.68, [-4.73; 1.38]) and MDCO-216 20 mg (MD: 1.00, [-3.64; 5.64]) groups; all other ETC-216 and CER-001 regimens were insignificant. For TAV, only MDCO-216 20 mg (MD: -10.00, [-39.58; 19.58]) and CER-001 3 mg (MD: -2.47, [-19.84; 14.90]) showed insignificant treatment effects, while all ETC-216 regimens had no beneficial effect. Conclusion: Our analysis concludes that ETC-216, 45 mg showed a significant reduction in PAV. Other regimens were insignificant in their effect on atheroma reduction. This analysis highlights the need for further clinical trials to explore this regimen for enhancing responses in ACS patients.
Abstract 4144697: Cardiac outcomes with different types of Heart Failure in Polycythemia vera: Analysis from National Inpatient Sample
Authors: Karnav Modi, Himil Mahadevia, Ronak Modi, Shriya Bavishi, Deepthi Vodnala, Taiyeb Khumri, TALAL ASIF
Journal: Circulation (2024)

Background: Previous studies have shown poor outcomes in Polycythemia vera (PV) patients (pts) with comorbid heart failure (HF). Given lack of data, we studied the role of systolic heart failure (SHF), and diastolic heart failure (DHF), with and without acute exacerbation in PV pts from a national database. Methods: Using National Inpatient Sample 2019-21, we identified all pts with PV. They were further reclassified into 4 different study populations depending on type of HF. This included MM pts with and without acute SHF, chronic SHF, acute DHF, and chronic DHF. In each study population, we excluded those with any other type of comorbid HF. Outcomes were compared using Pearson’s chi-square test and multivariate regression analysis. Results: 65780 had PV. Among them 5.2% (n=3425) had only acute SHF, 4.2% (n=2750) had chronic SHF, 6.6% (n=4315) had acute DHF, and 5.9% (n=3895) had chronic DHF. Those with acute SHF had significantly higher odds of mortality (adjusted odds ratio (aOR) 1.7, p=0.002), cardiogenic shock (CS) (aOR 6.6, p&lt;0.001), acute myocardial infarction (MI) (aOR 4.2, p&lt;0.001), and similar odds of cardiac arrest (CA) (aOR 1.6, p=0.116). Those with chronic SHF had similar odds of mortality (aOR 0.8, p=0.237), CS (aOR 1.3, p=0.472), acute MI (aOR 0.7, p=0.07) and CA (aOR 0.7, p=0.455). Similarly, those with acute DHF had similar odds of mortality (aOR 0.9, p=0.5), CS (aOR 1.1, p=0.745), acute MI (aOR 1.3, p=0.069) and CA (aOR 0.9, p=0.878). Those with chronic DHF also had similar odds of mortality (aOR 0.9, p=0.444), and CA (aOR 1.4, p=0.301), and lower odds of CS (aOR 0.3, p=0.039), and acute MI (aOR 0.6, p=0.001). Please refer Table 1 for rates of complication (Pearson’s chi-square). Conclusion: Among different types of HF in PV pts, acute SHF is associated with higher odds of mortality and even significantly higher odds of cardiac complication like CS (560%), acute MI (320%). All other types of HF including chronic SHF, acute DHF and chronic DHF showed similar odds of mortality and similar or even lower (for chronic DHF) odds of cardiac complications. This data helps guide timing for cardiology consultation and need for care escalation depending on HF type in PV.
Abstract 4144700: Short Term Effect of His bundle pacing on Myocardial Fatty Acid Metabolism, Perfusion and Function.
Authors: Takeshi Fujita, Masato Kawasaki, Takahisa Yamada, Mitsutoshi Asai, Takashi Morita, Atsushi Kikuchi, Takumi Kondo, Tsutomu Kawai, Masahiro Seo, Jun Nakamura, Takuya Oshita, Yuki Kokubu, Yuto Fukuda, yuzo furuta, Motoshi Yoshida, Fumiya Oyama, Kenji Noda, Ryota Yagi, Masatake Fukunami
Journal: Circulation (2024)

Background: Long term right ventricular apex pacing has been reported to affect myocardial metabolism and perfusion to lead to impaired left ventricular function. However, there is little information available on the effect on fatty acid metabolism, myocardial perfusion and function in RV septal or His bundle pacing. Methods and Results: We studied 94 patients (mean age 77±11 years, male 40%, AV block 71%) admitted for pacemaker implantation in our prospective cohort study, excluding patients with coronary artery disease who had past histories of coronary arterial revascularization and severe stenosis in coronary CT or coronary angiography. Forty-five patients had right ventricular apex pacing (RVA; n=10) or right ventricular septal pacing (RVS; n=35), 17 had selective or non-selective His bundle pacing (HIS) and, as a control, 32 had right atrial pacing (RA). The patients underwent 123I-β-methyl-P-iodophenyl-pentadecanoic acid (BMIPP) SPECT imaging and Tc-99m- methoxyisobutylisonitrile (MIBI) SPECT imaging between 3 months and 1 year after implantation. The uptakes of both tracers were displayed on a polar map, which was divided into 17 segments. Regional tracer activity at each segment was quantified as %uptake. Left ventricular ejection fraction (LVEF) was also obtained in MIBI imaging. There were no significant differences in baseline characteristics such as age, gender, or underlying heart disease between the four groups. LVEF in MIBI rest imaging in RVA group was significantly lower than RA group (58.3±2.1% vs 64.9±1.2%, p=0.013), while there was no significant difference in LVEF among RVS, HIS and RA groups, with non-significantly (p=0.25) lower LVEF in RVS (62.5±1.1%) than HIS (65.3±1.6%) groups. The average of BMIPP %uptake in 17 segments significantly correlated with LVEF (r=-0.259, p=0.01). BMIPP and MIBI (stress and rest) %uptake were significantly lower in RVA group and RVS group than RA group in the septal or anterolateral area. Especially, BMIPP %uptake in RVA group was significantly lower at the broad area. On the other hand, BMIPP and MIBI (stress and rest) %uptake in HIS group were almost similar to those in RA group. Conclusion: His bundle pacing, but not RV septal pacing, maintains myocardial metabolism, perfusion and function.
Abstract 4144727: <i>In vitro</i> modelling and functional improvement of TNNT2-R141W mutant pediatric dilated cardiomyopathy <i>.</i>
Authors: TOSHIAKI NAGASHIMA, Kenji Miki, Shigeru Miyagawa
Journal: Circulation (2024)

Introduction: Dilated cardiomyopathy (DCM) is a common cardiomyopathy characterized by ventricular dilatation and systolic dysfunction. The TNNT2-R141W mutation is known to cause DCM in both humans and mice and is associated with Ca 2+ desensitization and reduced contractility. However, there are no reports of utilizing patient-derived induced pluripotent stem cells (iPSCs) carrying the TNNT2-R141W mutation, looking at functional improvement after gene replacement. Here, we describe the characteristics of TNNT2-R141W mutant iPSC-derived cardiomyocytes (iPSC-CMs) in vitro . Methods: Two human iPSC lines were derived from pediatric DCM patient samples, with the TNNT2-R141W mutation (R141W-iPSC), and a R141W-iPSC derived TNNT2 overexpression line (TNNT2-OE iPSC) for comparison. The Ca 2+ handling and sarcomere structures of the differentiated hiPSC-CMs were then assessed. Results: In TNNT2-OE iPSC-CMs, the expression level of TNNT2 was significantly higher than R141W-iPSC-CMs. Evaluation of Ca 2+ handling revealed that R141W-iPSC-CMs exhibited a significant decrease in maximum fluorescence intensity (amplitude) and a prolongation of time to maximum fluorescence intensity (time to peak), which are characteristic of failing heart tissue (Figure 1a, b, and c). Ca 2+ reuptake efficacy during relaxation, measured by Ca 2+ decay tau, or the time taken for an 80% signal reduction, was also significantly prolonged in R141W-iPSC-CMs (Figure 1d). In addition, R141W-iPSC-CMs displayed abnormality in sarcomere alignment (Figure 2). These properties were corrected in TNNT2-OE iPSC-CMs, indicating that R141W-iPSC-CMs reflect DCM phenotypes in vitro . Conclusions: R141W-iPSC-CMs exhibited Ca 2+ desensitization and abnormal sarcomere structure, further suggesting that gene therapy with normal TNNT2 may be a future therapeutic approach for DCM with TNNT2 mutations.
Abstract 4144401: Hypertension and Incident Cardiovascular Events following Thoracic Radiotherapy
Authors: Megan McCrohan, Prem Patel, Tyren Busby, Adia Holtman, Anna Siefker, Elizabeth Wade, Ning Jin, Robert Merritt, Dayssy Diaz, Sanam Ghazi, Mussammat Ferdousi, Patrick Ruz, Sohil Reddy, Eric Miller, Daniel Addison
Journal: Circulation (2024)

Introduction: Radiation therapy (RT) is associated with high efficacy in treating thoracic malignancies. However, it has been linked to potentially limiting cardiotoxicity, including anecdotal reports of profound hypertension (HTN). Yet, the long-term incidence and implications of HTN development after RT is unknown. Aims: We aimed to define the relation between RT and HTN development in patients with lung and esophageal cancers, as well as the association of RT with major adverse cardiac event (MACE) and overall survival. Methods: From a large cohort of consecutive esophageal and lung cancer patients treated with thoracic RT from 2007-2019, we assessed the incidence and outcomes of incident (new) or worsened HTN [systolic blood pressure (SBP) ≥130mmHg] after RT initiation. Secondary outcomes were MACE (heart failure, myocardial infarction, stroke, arrhythmia and sudden death) and overall survival by RT dose. Differences in outcomes by HTN status were also evaluated via landmark analysis, excluding those with undiagnosed HTN. Observed new HTN rates were compared to Framingham predicted rates, and absolute excess risks were estimated. Multivariate regression was used to define the relation between clinical and RT measures (including cardiac and aorta substructure dose) and outcomes. Results: Overall, 439 RT-treated patients (238 esophageal; 201 lung; 66.7% male; mean age 63.2 years; 57.9% baseline HTN) were identified. Most (67.4%) had advanced T3-4 disease. Over a median follow-up of 23 months, 262 (59.7%) developed new or worsened HTN; median SBP increase of 8 mmHg. In landmark analysis, the cumulative incidence of new or worsened HTN by 1 year was 48.0% and 68.5%, respectively. Using the JNC 8 cutoff of ≥140/90 mmHg, the new HTN rate was 19.1% at 1 year, translating to a 1.7-fold higher rate than the Framingham predicted rate (RR 1.72, P &lt;0.0001). In multivariate models, RT dose consistently associated with new or worsened HTN development ( P &lt;0.05). Similarly, beyond age, only RT-dose (aorta max dose, mean dose, V60; whole heart, left atrium, left ventricle, right atrium V60; right ventricle max dose, mean dose, V50, V60) consistently associated with MACE ( P &lt;0.05 for all). In multivariate analysis, new HTN remained associated with improved overall survival (HR: 0.75, P &lt;0.001), even after accounting for surgical resection and disease-related factors. Conclusion: In patients with lung and esophageal cancers, RT increases HTN risk even within 1-year of treatment.
Abstract 4144762: Fear of Recurrence in Acute Myocardial Infarction Survivors
Authors: Sarah Zvonar, Andrew Thomas Reyes, Stephen Benning, Jennifer Kawi, Reimund Serafica
Journal: Circulation (2024)

Background: Each year, millions of people worldwide experience cardiovascular events, including acute myocardial infarctions (AMIs). Surviving an AMI can result in psychological sequelae, including negative illness perceptions, fear of recurrence, and perceived stress, that may interfere with survivors’ recovery, individually influencing their physical, emotional, and cognitive outcomes. Though influential, little is known about the individual relationships between these variables in persons who have experienced an AMI. Purpose: This study examined the relationships between illness perceptions, fear of recurrence, and perceived stress in AMI survivors. Also examined were predictors of fear of recurrence and perceived stress, changes in fear of recurrence over time, and effects of anxiety or depression. Methods: We used a repeated measures descriptive design to evaluate relationships with the brief illness perception questionnaire, the fear of progression questionnaire, perceived stress scale, and the depression, anxiety, and stress scale (N =171). Additionally, we examined the relationship between participant demographics and modifiable risk factors such as diet, exercise, and smoking. Our hypotheses were tested via multiple linear regression and mediation modeling. Results: Fear of recurrence was a significant mediator of the relationship between illness perceptions and perceived stress in AMI survivors [ F (2,168) =43.31, R &lt;span style="font-size:10.8333px"&gt;2&lt;/span&gt; =0.34, p &lt;0.001]. Fear of recurrence did not decrease over time (M=68.45, SD=21.72), and was still a significant mediator of illness perceptions and perceived stress, after controlling for depression and anxiety [B = 0.09, SE = 0.05, t (166) = 2.03, p = 0.044]. The regression models identified age and race as significant predictors of fear of recurrence. Alcoholic beverage intake was a significant predictor of both fear of recurrence and perceived stress. Conclusions: Providers should be aware that fear of recurrence is a separate symptom from anxiety and/or depression and should be evaluated separately. Fear of recurrence and the relationships with illness perceptions and perceived stress suggest that psychological sequelae may interfere with adaptive coping and health behaviors and should be further explored. Keywords: Fear of Recurrence, Acute myocardial infarction, illness perception, perceived stress
Abstract 4144773: Trends In Cerebrovascular Disease-related Mortality Among Older Adults In The United States From 1999 To 2020: An Analysis Of Gender, Race/Ethnicity, And Geographical Disparities.
Authors: Muhammad Saad, Maria Saleem, Umar Maqbool, Fareeha Khan, Maleeha Saleem, Eman Alamgir, Salvia Qazi, Haram -, Aleena Ali, Arfa Assad, Aasma Javed, Qais Bin Abdul Ghaffar, Ammad Adeel, Faheemullah Khan, Adarsh Raja
Journal: Circulation (2024)

Background: Cerebrovascular disease is a leading cause of morbidity and mortality in the US, mainly affecting older adults. Aging significantly influences its manifestations and pathophysiology, impacting late-life quality. However, mortality trends in cerebrovascular disease among older adults of different gender, race, and geographic areas have not been thoroughly examined. Understanding these correlations and current death patterns is crucial for improving medical treatment and strategies. Research Aim: To investigate the impact of gender, race, and geographic disparities on cerebrovascular disease-related mortality rates among older adults in the United States, utilizing CDC-WONDER data from 1999 to 2020. Methodology: Cerebrovascular disease-related data from the CDC-WONDER database (1999-2020) using ICD-10 codes I60-I69 were analyzed. Annual Percent Change (APC), and Age-adjusted mortality rates (AAMR) per 100,000 persons were calculated and stratified by gender, race, place of death, state, census regions, and urban/rural classification. Joinpoint regression was utilized to assess trend changes and APC. Results: Between 1999 and 2020, 3,813,729 elderly individuals died from cerebrovascular disease. Overall, AAMR decreased from 1264.3 to 812.5, yet a rise was noted from 2018 to 2020, particularly in males (APC 6.069* vs. 4.668* in females). Non-Hispanic (NH) Blacks showed the highest APC (8.026*) from 2018 to 2020, while NH American Indians or Alaska Natives declined from 2013 to 2020 (-0.926). Non-metropolitan areas consistently had higher AAMRs, sharply increasing since 2018 (APC 4.818* vs. 5.135*). The Midwest had the highest APC (7.253*) from 2018 to 2020, while the South had the lowest APC (4.598*). Tennessee had the highest overall AAMR (1076.3) from 1999 to 2020, and New York had the lowest AAMR (609.7). (Figure 1) Conclusion: Despite declining overall mortality, persistent disparities exist in cerebrovascular disease-related mortality, with NH black males and rural residents facing the highest rates. Urgent public health action is needed, given the alarming rise in mortality from 2018 to 2020.
Abstract 4144767: Long-term effect of beta-blockers after acute myocardial infarction in patients with preserved ejection fraction: A systematic review and meta-analysis
Authors: Mariana R.C. Clemente, Lucca Lopes, Vinicius Bittar, Denilsa Navalha, Lara Almeidinha, Braiana Diaz, Maria Carolina Bortoletto Mussolini, Victor Gomez, Ana Gabriela Ponte Farias, Amanda Fernandes
Journal: Circulation (2024)

Background: The efficacy of beta-blockers (BB) in patients with heart failure and reduced ejection fraction (EF) is well established. In fact, current guidelines widely recommend BB use after myocardial infarction (MI). However, the effects of long-term BB therapy in patients with acute myocardial infarction (AMI) and preserved EF remains uncertain. Hypothesis: The use of BB after AMI improves long-term outcomes in patients with preserved EF. Aims: To compare the long-term effects of BB with non-BB post AMI in patients with preserved EF. Methods: PubMed, Embase, and Cochrane Library were systematically searched from inception to May 2024 to identify studies comparing BB with no BB use after AMI in patients with preserved EF (&gt;50%), with a minimum follow-up of 1 year. We pooled hazard ratios (HR) with 95% confidence intervals (CI) to preserve time-to-event data in the pooled analysis. Statistical analyses were performed using R software version 4.3.1. Results: We included two randomized controlled trials and eight cohorts comprising 25,357 patients, of whom 47% received BB and 52% were men. Mean age of patients ranged from 58 to 66.2 years. Follow-up ranged from 1 to 5.2 years. There were no significant differences between groups in all-cause mortality (HR 0.86; 95% CI 0.68-1.08; p=0.20; Figure 1A), myocardial infarction (HR 1.02; 95% CI 0.84-1.24; p=0.86; Figure 1B), or hospitalization for heart failure (HR 1.06; 95% CI 0.78-1.43; p=0.71; Figure 1C). However, when performed a leave-one-out sensitivity analysis in all-cause mortality we saw significant results favoring the use of BB after omitting each study. Conclusion: In this meta-analysis, there were no significant differences in all-cause mortality, myocardial infarction, or hospitalization for heart failure when comparing long-term use of BB with no BB use after AMI in patients with preserved EF. Further trials are needed to clarify the role of BB in this setting.
Abstract 4144743: From Tummy Trouble to Heart Hassle: A Case of Traveler's Diarrhea Triggering Myopericarditis
Authors: Nicole Guynn, Alarica Dietzen, IshwaR Chuckaree, Quentin Loyd, Mariana Garcia, Modele Ogunniyi
Journal: Circulation (2024)

Case description: &gt;A 38-year-old male with a history of paroxysmal atrial fibrillation status post-RFA ablation, presented to the emergency department (ED) with a 3-week history of non-bloody diarrhea, abdominal cramping, nausea, fever, and headache after a trip to Guatemala. In the ED, his vital signs were temperature (99.3 °F), and heart rate (116 bpm). Notable physical exam findings were diffuse erythematous macular rash and conjunctival injection. Initial labs demonstrated elevated white count (15,100 K/mcL) and lactate (3.2 mmol/L). He was treated with ceftriaxone and metronidazole, with clinical improvement. Stool cultures were positive for salmonella and cyclospora cayetanensis. On hospital day 3, he developed severe substernal chest pain, minimal ST elevation in the anterolateral leads on ECG and elevated HS- troponin levels of 7000 ng/ml, peak of 12000 ng/ml. Transthoracic echocardiogram showed normal LV systolic function, with no evidence of pericardial effusion and regional wall motion abnormalities. Subsequent cardiac MRI demonstrated evidence of myopericarditis(anterior and lateral pericardial enhancement, along with focal epicardial late gadolinium enhancement in the mid inferolateral wall of the left ventricle with associated myocardial edema, and a small pericardial effusion). He was discharged home on Trimethoprim-Sulfamethoxazole and started on colchicine, with no recurrent chest pain. Discussion: Myopericarditis is a complication of acute pericarditis due to pericardial inflammation extension to the myocardium. It is usually caused by a virus and rarely due to bacteria as demonstrated by this case, presenting as elevated troponin levels and ST-segment elevation on ECG. To our knowledge, there are no known reports of cyclospora cayetanensis causing myopericarditis. The adherence of the salmonella bacteria to the cardiac endothelium can result in myocyte necrosis and release of self-antigens leading to the development of antibodies and autoimmune myocarditis. Long-term management of bacterial myopericarditis is dependent on the severity of the clinical presentation and includes antibiotics, anti-inflammatory medications, and colchicine. Most patients recover within one month, but persistent cardiac dysfunction and progression to end-stage dilated cardiomyopathy can occur, thus follow-up echocardiography is recommended.