tbuckley/cabot-search huggingface dataset:
Abstract 17162: High Lp(a) is Associated With Activation of the Arachidonic Acid Pathway
Authors: Waqas Malick, Phyu Mar, Sascha N Goonewardena, Robert S Rosenson
Journal: Circulation (2023)

Introduction: High lipoprotein(a) [Lp(a)] is associated with increased platelet aggregation, inflammation and cardiovascular events. Eicosanoids such as eicosapentaenoic acid (EPA) and arachidonic acid (AA) have anti- and pro-inflammatory effects, respectively. In this cross-sectional study, we explored the associations between eicosanoids, Lp(a), and oxidized phospholipids on apolipoprotein B (oxPL:apoB). Hypothesis: Increased platelet aggregation and inflammation associated with high Lp(a) levels may be due to relative EPA and AA levels. Methods: Consecutive outpatients with known Lp(a) levels seen in an outpatient cardiology practice between April 2021 to April 2023 underwent repeat testing for Lp(a) and measurement of OxPL:apoB, EPA and AA levels. OxPL:apoB was measured using chemiluminescent immunoassay. Fatty acid measurements were done via column chromatography/mass spectrometry. Lp(a), OxPL-apoB, EPA, and AA were log e -transformed to satisfy the assumption of normality. Results: We enrolled 238 patients with a mean age of 56.5 ± 13.5 years (46% being female, 69% white, 10% black, 14% Asian). Statin therapy was used in 66%, and mean LDL-C was 87.3 ± 47.5 mg/dL. Median (IQR) Lp(a), OxPL:apoB, AA, and AA:EPA ratio was 167.7 (57.3-233.5) nmol/L, 2.3 (1.2-3.9) nmol/L, 287.3 (234.8-350.2) ug/mL, and 10.3 (6.1-14.9), respectively. Lp(a) correlated with OxPL:apoB (r=0.48, p&lt;0.0001). In multivariate analysis adjusting for age, race, sex, hypertension, LDL-C, statin use and PCSK9 inhibitor use, log-Lp(a) was associated with AA (p=0.002) and log-AA:EPA (p=0.02), but not associated with log-EPA (p=0.19). LogOxPL:apoB was associated with log AA (p=0.03). Conclusion: Higher Lp(a) levels are associated with elevated AA levels, suggesting a pathway by which Lp(a) may contribute to increased platelet aggregation and inflammation in patients with high Lp(a).
Abstract 13640: Baseline Kidney Function and the Effects of Dapagliflozin on Health Status in Heart Failure: A Pooled Patient-Level Analysis From DFEINE-HF and PRESERVED-HF
Authors: Andrew P Ambrosy, Andrew J Sauer, Shachi Patel, Sheryl Windsor, Barry A Borlaug, Mansoor Husain, Silvio E Inzucchi, Dalane W Kitzman, Darren K McGuire, Sanjiv J Shah, Kavita Sharma, Guillermo Umpierrez, Mikhail N Kosiborod
Journal: Circulation (2023)

Background: Sodium-glucose co-transport-2 (SGLT2) inhibitors have been shown to reduce clinical events and improve health status (symptoms, function, and quality of life) in patients with HF across the range of EF. Baseline kidney dysfunction is common in HF, complicates HF management, and is strongly linked to worse health status. Aim: The study objective was to assess whether the treatment effects of dapagliflozin on health status vary based on baseline eGFR. Methods: Patient-level data were pooled from the DEFINE-HF (N = 263 participants with EF &lt; 40%) and PRESERVED-HF trials (N = 324 participants with EF &gt; 45%). Both were double-blind, randomized trials of dapagliflozin vs. placebo, enrolling participants with NYHA class II or higher and elevated natriuretic peptides. The primary endpoint for this analysis was Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CCS) at 12 weeks. Interaction of dapagliflozin effects on KCCQ-CCS by baseline eGFR (mL/min/1.73m 2 ) was assessed as categorical (i.e., eGFR &lt;60 vs. &gt; 60) and continuous variables. Results: Across both trials there were 583 (99.3%) participants with available baseline eGFR. The median (25 th , 75 th ) eGFR was 59 (46,77). Dapagliflozin improved KCCQ-CSS at 12 weeks (placebo-adjusted difference, +5.0 points, 95% Confidence Interval [CI] 2.6-7.5; p-value &lt;0.001), and this was consistent in participants with an eGFR &gt; 60 (+6.0 points, 95% CI 2.4-9.7; p=0.001) and &lt;60 (+4.1 points, 95% CI 0.5-7.7; p=0.025) (p-interaction = 0.46). The benefits of dapagliflozin on KCCQ-CSS were robust across eGFR when modeled continuously (p-interaction = 0.46) ( Figure ). There was no heterogeneity of treatment effects when analyzing other KCCQ domains based on eGFR categorically or continuously (all p-interaction = NS). Conclusion: Treatment with dapagliflozin for 12 weeks led to significant and consistent improvements in health-related quality of life in patients with HF across a wide range of eGFRs.
Abstract 16694: Impact of Frailty in Non-Valvular Atrial Fibrillation Elderly Patients on Anticoagulation Therapy
Authors: Kunihiko Matsui, Kengo F Kusano, Masaharu Akao, Hikari Tsuji, Shinya Hiramitsu, Yutaka Hatori, Hironori Odakura, Hisao Ogawa
Journal: Circulation (2023)

Background: As the number of elderly people increases, we see more chances to consider anticoagulant therapy for elderly people with frailty. Research Question: Does frailty affect the outcome of anticoagulation therapy? Goals: To show the impact of frailty to the effectiveness and safety of anticoagulant therapy with rivaroxaban in elderly Japanese non-valvular atrial fibrillation (NVAF) patients. Methods: The GENERAL (GENeral practitioners and Embolism pRevention in NVAF patients treated with RivAroxaban: real-Life evidence) study was an observational study of elderly NVAF patients with rivaroxaban at general practice settings in Japan. We employed multiple imputation for missing baseline characteristics, and propensity score (PS) matching to estimate the treatment effect of frailty accounting for the patients’ imbalance. In each imputed and PS matched data set, the treatment effects of frailty were assessed with Cox proportional hazard models for each outcome. Results: A total of 5,717 (mean 79.3 years old, male 64.8%) were observed for a mean of 2.0 years and up to 3 years. Of these, 485 (8.5%) were classified frailty. Variable missing rates ranged from 0% to 35%. After the imputation and matching, the patients' backgrounds were well matched and balanced between two groups. Frailty was not associated with the primary endpoint: stroke/systemic embolism (Hazard Ratio [HR] 1.128, 95% Confidence Interval [CI]: 0.500 - 2.547, p=0.767). Also, frailty was not associated with all-secondary endpoints (Figure 1). In the sensitivity analyses with the complete cases, the cases with any missing variables were deleted, frailty was significantly related with outcome events except for the bleeding events (Figure 2). Conclusion: In our study results, frailty did not affect the effectiveness or safety of anticoagulant therapy with rivaroxaban for this population. However, we should consider the necessity and benefit for this population to start anticoagulant therapy.
Abstract 18935: A Prospective Evaluation of a Community-Based Outreach Initiative for Black Women With Severe, Uncontrolled Hypertension
Authors: Bradi B Granger, Awanya Caesar, Amnazo Muhirwa, Dana Guggenheim, Daniel Hatch, Julie Thompson, Holly Biola
Journal: Circulation (2023)

Introduction: Despite American Heart Association evidence-based guidelines for care, inequities in prevalence and management of HTN disproportionately impact minority populations. Though studies have evaluated strategies to improve management of HTN and self-measurement of blood pressure (SMBP), existing strategies have not included a patient-partner who is a peer in literacy level, socio-economic status, and the lived experience of hypertension. Hypothesis: This pilot study was designed to evaluate a community-based intervention using patient-selected partners to improve blood pressure at 12 months. Secondary aims were to improve engagement in care, BP cuff distribution and use, and patient-centered goal setting for Life’s Essential Eight. Methods: We used a prospective, pre-post cohort design to evaluate the peer-partnership intervention. The team-based intervention included:1)Distribution of blood pressure cuffs and provision of skill-based training for BP self-monitoring to women at a federally qualified health center (FQHC).2) Implementation of coaching and feedback with patients on SMART goal setting for Life’s Essential Eight, to improve goal concordance and goal achievement. Results: Participants included Black women (n=335), average age 56 (SD 9.6). Preliminary results on key process measures indicate early signs of adoption: patient engagement in calls completed (n=426), cuffs distributed (n=186), SMART goals set (187, 56%), and partnerships established with family or community sites (n=91, 27%). Blood pressure was significantly reduced overall from baseline to 12 months (pre-systolic mean 172.05 (SD 13.3) mmHg versus post-systolic mean 140.3 (SD 20.9) mmHg; p&lt;.0001) Focus groups evaluating patient perceptions of the added value of peer-partnership are ongoing. Conclusions: Community-based partnerships may improve SMBP skills, goal setting, and communication among patients in minority and low socioeconomic groups.
Abstract 13515: Continuous Optimization of Atrioventricular Pacing Timing of Cardiac Resynchronization Therapy in Heart Failure Patients With Pacemaker Dependency
Authors: Toshihiro Nakamura, kohei ishibashi, Nobuhiko Ueda, Satoshi Oka, Yuichiro Miyazaki, Akinori Wakamiya, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Takeshi Aiba, Kengo Kusano
Journal: Circulation (2023)

Background: BLOCK HF study demonstrated that biventricular pacing was superior to conventional right ventricular pacing in heart failure (HF) patients with atrioventricular (AV) block. An adaptive cardiac resynchronization therapy algorithm (aCRT) provides continuous pacing timings of AV delays based on periodic automatic evaluation of electrical conduction even in the patients with AV block, and is effective in patients with CRT devices. However, it is uncertain whether this algorithm has better benefits even in patients with pacemaker dependency. Methods: Between Jan/2016-Dec/2022, a total of 359 patients were implanted CRT devices. Pacemaker-dependent CRT patients with aCRT algorithm function were selected from them. Sixty-five patients with pacemaker dependency (31 patients using the aCRT algorithm [adaptive group] and 34 patients not using the aCRT algorithm [non-adaptive group]) were included in the analysis. Pacemaker dependency was defined as absence of spontaneous ventricular activity during sensing test at VVI 30 bpm or long atrioventricular delay (&gt;300ms). The primary endpoint was a composite clinical outcome of all cause death and/or HF hospitalization. Results: There were no significant differences in baseline characteristics between two groups. During a median follow-up of 1,067 days (interquartile range 553-1,776 days), the aCRT reduced the risk of the composite clinical outcome in patients with pacemaker dependency (log-rank P=0.0187, Figure). In addition, use of the aCRT algorithm was an independent predictor of the composite clinical outcomes in the multivariate analysis (hazard ratio 0.32, 95% confidence interval: 0.12-0.88, P=0.028). Conclusions: The aCRT algorithm was useful and significantly reduced the risk of the clinical outcome, even in patients with pacemaker dependency.
Abstract 14379: Get With The Guidelines <sup>®</sup> Registry Data Tools and Analysis Platform
Authors: Chandler D Beon, Pratheek Mallya, Lanjing Wang, Vihaan Manchanda, Holly Picotte, Jennifer L Hall, Juan Zhao, Xue Feng
Journal: Circulation (2023)

Introduction: The American Heart Association (AHA) Get With The Guidelines ® (GWTG) registry has emerged as a vital resource in hospital-based quality improvement and advancing the standards and practices for inpatient cardiovascular/stroke care. The GWTG registry data, with over 13 million records collected from over 2600 hospitals, has resulted in over 600 peer-reviewed publications. Goal: The goals of this project were to test new technology tools, including an interactive web-based interface connected to a database in a cloud-based workspace on the AHA Precision Medicine Platform (PMP) , to simplify GWTG data queries and analysis for researchers. Methods: A new GWTG database was built using the PostgreSQL relational database system. Integration between the database and the user interface was built using the Django web framework. Data processing and quality control was done through a series of steps including schema verification, documentation generation, and de-identification. The user interface was tested within an AHA PMP workspace that provides security, privacy, statistical analysis tools and computational power. Results: The interactive user interface and GWTG database will be accessible to researchers with approved manuscript proposals conducting their own analysis on the AHA PMP. As shown in the figure, the user-friendly interface allows researchers to efficiently filter large volumes of data using structured querying language or built-in filtering functions. Researchers can create the cohort needed and perform the approved analysis, leveraging the statistical tools within the secure and private workspace on the AHA PMP. Conclusion: The AHA is committed to the FAIR (Findable, Accessible, Interoperable, Reusable) guiding principles of data. We have launched this new technology to provide streamlined access to GWTG data, powerful analysis tools, and computational power for all researchers.
Abstract 16053: Mitral Valveception: The Promising Technique of Mitral Valve-in-Valve Replacement for Bioprosthetic Valve Dysfunction
Authors: Samir P Mehta, Shahmir Naveed, Jenna Campbell, Muhammad A Shakir, Wasif Qureshi
Journal: Circulation (2023)

Introduction: Degeneration of bioprosthetic mitral valves often presents as regurgitation or stenosis. The gold standard is surgical repair; however, many patients are considered too high risk for repair and therefore transcatheter mitral valve replacement (TMVR) can be considered in appropriately selected patients. We present a Mitral Valve in Valve (ViV) replacement as a rescue option for severe bioprosthetic mitral stenosis. Case: A 45-year-old male with a history of IV drug use, ischemic cardiomyopathy with placement of ICD and severe mitral regurgitation s/p bioprosthetic MVR (27mm Edwards) 7 years ago presented with dyspnea. He was found to have decompensated heart failure with evidence of cardiogenic shock. He required inotropes and admission to the Cardiac ICU. Echocardiogram demonstrated biventricular dysfunction with an EF of 15%, and a well-seated malfunctioning bioprosthetic valve with fixed posterior leaflets and severe degenerative stenosis (3D planimetry valve area 0.85cm2). His cardiogenic shock was felt to be in the setting of severe mitral stenosis on the background of underlying cardiomyopathy. He was deemed a poor surgical candidate by multidisciplinary team with an STS mortality and morbidity risk of 39% and 85%. He hence underwent a mitral ViV with successful placement of a 29mm Edwards SAPIEN 3 transcatheter valve with impella protection. Patient improved and was discharged off inotropes. Discussion: Surgical mitral valve replacement remains the standard of care currently for degenerated bioprosthetic mitral valves. Patients at heightened risk may require ViV procedure instead. In ViV, the ring of the bioprosthetic valve can serve as an anchoring point for the new valve. This avoids a major limitation with TMVR in the native mitral annulus. Severity of acute illness proved to be the determining factor heightening the need for ViV replacement as a rescue option in our patient. Conclusion: Management of failing surgical mitral bioprosthesis remains a challenge. ViV-TMVR is an evolving approach that can be used as an alternative in patients who are not surgical candidates. Low rates of periprocedural morbidity and mortality reported in literature strengthen the argument for TMVR, although more data is needed to guide management.
Abstract 13289: Medicaid Patients in Cardiac Rehabilitation: Underrepresented, High Risk, High Need
Authors: Sherrie Khadanga, Patrick Savage, Blair Yant, Bradley Anair, Phillip Ades, Diann Gaalema
Journal: Circulation (2023)

Purpose: Patients with lower-socioeconomic status (SES) have higher rates of cardiovascular (CV) events and therefore, have the most to gain from cardiac rehabilitation (CR). Unfortunately, those with lower-SES are much less likely to engage in CR which has made characterization of this population quite difficult. Our CR program specifically increased recruitment of lower-SES patients, allowing for careful comparison of medical, psychosocial, and behavioral risk factors between lower and higher-SES patients eligible for secondary prevention. Methods: Demographic and clinical characteristics were prospectively gathered on consecutive individuals entering Phase 2 CR from 1/2014-12/2022. Patients were classified as lower-SES if they had Medicaid insurance. Statistical methods included chi-square and non-paired t-tests. A p value of &lt;0.01 was used to determine significance. Results: The entire cohort consisted of 3131 individuals. Compared to higher-SES patients, lower-SES individuals (n=405, 13%) were a decade younger, almost 6 times more likely to be current smokers, nearly 3 times more likely to have elevated depressive symptoms, and had significantly higher body mass index, waist circumference, and hemoglobin A1c, with more abnormal lipid profiles (all p&lt;0.001). Despite being a decade younger, lower-SES patients had lower measures of peak VO 2 and self-reported lower levels of physical function (both p&lt;0.001). Conclusion: Lower-SES patients have a remarkably prominent high-risk CV profile resulting in a substantially higher risk for a recurrent coronary event than higher-SES patients. Accordingly, strong efforts must be placed to engage this high-risk population in CR. It is imperative for CR programs to ensure that they are appropriately equipped to intervene on risk factors such as low fitness, depression, and smoking.
Abstract 16795: Blood Pressure Lowering Therapeutical Strategies Have Different Impact on Brain Functional Connectivity
Authors: Lorenzo Carnevale, angelo maffei, alessandro landolfi, Daniela Carnevale, Giuseppe Lembo
Journal: Circulation (2023)

Hypertension is a major risk factor for cognitive impairment and dementia. Using functional MRI, researchers have been able to study the brain’s functional connectivity in hypertensive patients. This has revealed that even before showing signs of vascular dementia, hypertensive patients have altered brain connections compared to normotensive patients. Our aim is now to characterize whether different classes of antihypertensive drugs, which vary in their mechanism of action and ability to cross the blood-brain barrier, have different effects on the brain’s functional organization. In this study, 42 hypertensive patients with controlled blood pressure underwent resting-state functional MRI. The data was analyzed using CONN to build functional connectivity network matrices and analyze the amplitude of spontaneous brain activity fluctuations (fALFF). These results were then evaluated using general linear models to identify connections that were modulated by specific classes of antihypertensive drugs. We applied regression models taking into account age, sex, BMI, alcohol, smoke and BP levels as covariates. Our results show that treatment with diuretics was associated with a large connectivity network among several brain networks (A). Treatment with ACE inhibitors (B), ARBs (C), and beta-blockers (D) was also associated with significant modulation of specific connections (all highlighted connections p&lt;0.05, statistics in figure). Overall, diuretics had the greatest impact on brain function, possibly due to their effect on blood volume and cerebral circulation, with the effect further confirmed by fALFF analyses, showing a widespread reduction of the BOLD-signal intensity of spontaneous cerebral activity (all highlighted clusters p&lt;0.05, statistics in figure E). These findings may help inform the choice of antihypertensive treatment for individual patients, taking into account the potential cognitive and functional impact of different drugs.
Abstract 18113: O <sub>2</sub> Pulse is Not Stroke Volume: Changes in Oxygen Pulse Do Not Reliably Track Changes in Stroke Volume During Exercise in Health or Heart Failure
Authors: Carlos Tovar, Denis J Wakeham, Tiffany L Brazile, Mitchel Samels, Diana De Oliveira Gomes, Matthew M Howrey, Christopher M Hearon, James P MacNamara, Benjamin D Levine, Satyam Sarma
Journal: Circulation (2023)

Background: Oxygen Pulse (O2P) is often used to index peak stroke volume (SV) during cardiopulmonary exercise testing (CPET) when measures of cardiac output are not possible. O2P is calculated as Oxygen uptake (V˙O 2 ) / heart rate (HR) and based upon rearrangement of the Fick equation (V˙O 2 = [HR x SV] x arterial-venous O 2 difference [Δa-vO2]; Δa-vO2 is not included in the O2P calculation). As little data exist to validate the use of O2P, we assessed whether O2P tracks changes in SV during exercise in health and disease. Methods: We studied 401 individuals: 232 healthy adults (healthy; 51% males; age: 61 ± 11 [28-88] years); 119 adults at high-risk for future development of heart failure (high-risk; 47% males; age: 51 ± 6 [40-64] years); and 50 adults with heart failure with preserved ejection fraction (HFpEF; 36% males; age: 71 ± 7 [56-86] years). Participants were studied at rest, during light (~30% V˙O 2 max), moderate (Mod; ~60% V˙O 2 max) and maximal exercise (Max). V˙O 2 (indirect calorimetry) and cardiac output (Q˙c; acetylene rebreathing) were measured, enabling calculation of SV (Q˙c/HR) and O2P. Data were compared via two-way (measure*stage) ANOVA. Results: We observed a significant measure*stage interaction for all three groups (all, P&lt; 0.001; Figure), suggesting different responses to exercise between measures. Specifically, SV and O2P increased from rest to light exercise in all groups (all, P &lt;0.001; Figure). Thereafter, O2P continued to increase from light-Mod (all, P&lt;0.001) and Mod-Max (all, P &lt;0.001; other than for Mod-Max in HFpEF, P =0.124). However, actual SV did not increase from light-Mod exercise (all groups, P&gt;0.917) or from Mod-Max exercise in high-risk (Δ0±13 ml, P =0.999) and HFpEF (Δ-3±14 ml, P =0.564), but fell slightly in healthy individuals from Mod-Max (Δ-5±13 ml, P &lt;0.001). Conclusions: Changes in O2P do not reflect changes in SV between exercise stages during CPET in health or disease and should therefore be used with caution.