tbuckley/cabot-search huggingface dataset:
Abstract 15315: Cardiac MRI Tissue Characterization for Intra-Cardiac Thrombi Therapeutic Response in Systemic Cancer Patients
Authors: Raina Jain, Michael Park, Nicole Liberman, Hannah Agoglia, Jiwon Kim, Richard Steingart, Jennifer Liu, Jonathan W Weinsaft, Angel T Chan
Journal: Circulation (2023)

Introduction: Cardiac MRI (CMR) is often used to identify thrombi (C THR ) based on absence of contrast enhancement but its utility as a predictor of therapeutic response of anticoagulation (AC) is unknown. Methods: Adult (≥18yo) pts with systemic cancer were matched 1:1 for cancer etiology/stage and presence/absence of C THR on CMR. Cine-CMR assessed cardiac structure/function and localization of C THR . Contrast-enhanced CMR (0.2 mmol/kg gadolinium) was performed for identification of C THR and quantitative tissue properties. C THR resolution was evaluated on serial TTE at a time point of 3 months post CMR; clinical f/u and anticoagulation therapy were determined by chart review. Results: 189 pts (54±16 yo; 50% M) were studied, 106 with C THR and 83 without. Cancer etiology varied (heme 30%
Abstract 18533: Exploring the Rising Incidence of Myocarditis and Other Cardiovascular Adverse Events of Nivolumab and Ipilimumab: Analysis of FDA Adverse Event Reporting System Database
Authors: Resha Khanal, Sharad Oli, Kripa Rajak, Anupam Halder, Raied Hufdhi, BINITA BHANDARI, Shital Oli, M Chadi C Alraies
Journal: Circulation (2023)

Introduction: Nivolumab and Ipilimumab are human monoclonal antibodies that target cell surface PD1 and anti-CTLA-4 receptors respectively. Nivolumab and ipilimumab combination is used for metastatic small cell lung carcinoma, advanced renal cell carcinoma and metastatic melanoma. The pre-approval CHECKMATE trials have underestimated the occurrence of cardiovascular adverse events (AEs). In contradiction, post-marketing studies have demonstrated a higher incidence of cardiac AEs, particularly myocarditis.Therefore, it is important to establish a post-marketing safety profile of these medications. Methods: We investigated the cardiovascular AEs of nivolumab and ipilimumab using U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). Healthcare professionals (HCPs) reported 79.73% and 80.92% of AEs until March 2023 for nivolumab and ipilimumab respectively. We conducted further subgroup analysis of cardiovascular AEs in male, females as well as in three age groups: 18-64, 65-85 and &gt;85 years. Results: Amongst the cardiovascular AEs reported by HCPs, myocarditis was reported in 905 (1.55 %) in nivolumab vs 445 (1.72%) in ipilimumab group. There were higher reports of other cardiovascular AEs including heart failure (1.15% vs 0.74%), pericarditis/pericardial effusion (1.19% vs 0.6% ), myocardial infarction (0.18% vs 0.71%), cardiomyopathy (0.36% vs 0.29%), cardiac arrest (0.41% vs 0.53%) and cardiac death (0.01% vs 0.02%) in nivolumab vs ipilimumab. On sub-group analysis, we observed higher incidence of myocarditis in females (1.54% vs 1.6%) males (1.73% vs. 1.84%) and in patient with age 18-65 years (1.17% vs 1.15%) in both nivolumab vs ipilimumab group as compared to previous studies. Conclusions: The reported events of myocarditis were significantly higher in FAERS reporting as compared to the CHECKMATE trials (&lt;1%) in both nivolumab and ipilimumab groups. Clinicians need to be vigilant in detecting immune-mediated myocarditis, as it often manifests with nonspecific symptoms, with early onset and rapid progression. Given the growing utilization of these medications, it is imperative to conduct additional randomized controlled trials to gain a better understanding of their cardiovascular safety profile.
Abstract 13066: Ten-Year Atherosclerotic Cardiovascular Risk Trajectory Among Women Veterans Diagnosed With Breast, Colorectal, Lung and Thyroid Cancer
Authors: Erum Z Whyne, Erika M Shults, Sung-Hee Choi, Jonathan E Dowell, Suzanne Conzen, Haekyung Jeon-Slaughter
Journal: Circulation (2023)

Introduction: Despite recognized sex-difference in cardio-oncology, women are understudied due to lack of large and diverse data. The study examined atherosclerotic cardiovascular disease (ASCVD) risk in women veterans with breast, colorectal, lung, and thyroid cancer using Veterans Affairs (VA) national Electronic Health Records (EHR) data. Hypothesis: Elevated ASCVD risk in women with breast, colorectal, lung and thyroid cancer after cancer diagnosis due to accumulated cardiotoxicity induced from cancer therapy. Methods: We retrospectively followed 78,556 women veterans aged 30-79 from 2007 to 2017. We used AHA/ACC ASCVD risk score and VA women CVD risk score to measure ASCVD risk over the study period. Both scores included age, systolic blood pressure (treated/untreated), total cholesterol and HDL-C, smoking status, diabetes, and major depression. The study selected the top four most common cancers among women veterans. Discontinuity regression models were used to estimate trajectories of ASCVD risk at both pre and post cancer periods. Results: Both pre- and post-cancer ASCVD risk in women with breast, colorectal, and lung cancer was significantly elevated compared to the no cancer group, while women with thyroid cancer had lower ASCVD risk during the pre-cancer diagnosis. All women veterans with cancer except colorectal cancer showed premature aging in ASCVD risk after cancer diagnosis (Figure 1). Conclusions: Women cancer survivors are at increased risk of ASCVD not only post-cancer, but also long before their cancer diagnosis. ASCVD risk monitoring and management in women may serve as shared risk reduction and cancer prevention along with heightened cancer screening.
Abstract 16362: Does Extra-Pulmonary Triggers or Autonomic Neural Activity Affect the Rhythm Control by Anti-Arrhythmic Drugs in Patients With Post-Ablation Atrial Fibrillation Recurrence?
Authors: Hanjin Park, Daehoon Kim, Je-Wook Park, Hee Tae Yu, Tae-Hoon Kim, Jae-sun Uhm, BOYOUNG JOUNG, Moon Hyoung LEE, Chun Hwang, Hui-Nam Pak
Journal: Circulation (2023)

Introduction: Although the EAST-AFNET trial demonstrated the usefulness of atrial fibrillation (AF) rhythm control, including antiarrhythmic drugs (AADs), little is known about their effect on recurred AF after catheter ablation (CA). Hypothesis: We explored the effect of AADs depending on the presence of extra-pulmonary vein triggers (ExPVT) or post-ablation heart rate variability (HRV) in patients who recurred after AFCA. Methods: In this retrospective analysis of a single-center cohort, we analyzed 2,036 patients who underwent de-novo AFCA, and 486 of them had recurrent AF and subsequently underwent rhythm control with AADs. We investigated the effects of the extra-pulmonary vein (PV) triggers and post-procedural 3 rd month HRV (rMSSD; cut-off determined by Youden index) on the AAD responsiveness. Results: The post-AFCA recurrence was significantly higher in patients with ExPVT (Log-rank p&lt;0.001, HR 1.45 [1.16-1.83], p=0.001) or higher 3 rd month post procedure HRV-rMSSD (Log-rank p&lt;0.001, HR 1.36 [1.11-1.65], p=0.003) than their counterparts. Patients with ExPVT at de novo procedure had significantly higher 3 rd month rMSSD (15.0 [11.0-23.0] vs. 17.0 [11.0-28.0], p=0.022) and patients with high 3 rd month rMSSD showed a higher rate of ExPVT identified at the 2 nd repeat procedure (n=160, 41.0% vs. 22.2%, p=0.019). Among those patients how recurred AF after AFCA, post-AAD recurrence did not differ depending on ExPVT (Log-rank p=0.455, HR 1.12 [0.78-1.69], p=0.436) or rMSSD (Log-rank p=0.457, HR 1.16 [0.87-1.55], p=0.300). Post-AAD recurrence did not differ between class IC and III AADs (p for interaction = 0.311). Conclusion: ExPVT and post-procedural high rMSSD are independent risk factors for post-AFCA recurrences but not for AAD response in recurred AF patients. Whether AADs may suppress ExPVT and modulate cardiac autonomic activity after post-AFCA recurrences need further investigation.
Abstract 18916: Myocardial Proteomic Signatures in Human Heart Failure With Preserved Ejection Fraction
Authors: Vivek Jani, Edwin J Yoo, David A Kass, Virginia S Hahn
Journal: Circulation (2023)

Introduction: Heart Failure with Preserved Ejection Fraction (HFpEF) constitutes more than half of all heart failure but has few effective therapies. Recent myocardial transcriptomics and metabolomics have revealed major differences between HFpEF and controls and HF with a reduced ejection fraction (HFrEF); however, how this translates at the protein level is unknown. Methods: Endomyocardial biopsies from patients with HFpEF, nonfailing donor controls and analyzed by data-dependent (n=10 HFpEF, n=9 non-failing controls) and data-independent (n=44 HFpEF, n=5 non-failing controls) mass-spectrometry-based proteomics. Results: The results were integrated with reported RNAseq and clinical characteristics. Proteomics data were analyzed with machine learning and gene ontology (GO) pathway analysis. Both HFpEF and HFrEF proteomes exhibited remarkable similarities, showing upregulation of cytoskeletal pathways and down regulation of oxidative phosphorylation pathways. Notably, structural ribosomal proteins and proteins associated with EIF 2 signaling were downregulated in HFpEF but not HFrEF. Integration with prior transcriptome data found a striking discrepancy between gene (up) and protein (down) expression for oxidative phosphorylation pathways in HFpEF, versus concordant reduction in HFrEF. Agnostic clustering of the HFpEF proteome identified two sub-groups, one with marked downregulation of oxidative phosphorylation and translational initiation pathways versus the other. This sub-group also had the highest proportion of HFpEF patients above the median BMI (40 kg/m 2 in our cohort). Conclusions: To our surprise, no hemodynamic and echocardiographic differences were observed between these groups. Despite marked differences in clinical presentation and pathophysiology, both HFpEF and HFrEF had very similar changes in protein abundance related to cytoskeletal and oxidative phosphorylation related pathways. Integration of proteomics, transcriptomics, and pathway analysis identifies a major deficit in protein translation in HFpEF that is not predictable based on clinical indices. These data reveal a unique proteomic HFpEF signature and identify potential proteins and pathways for therapeutic intervention.
Abstract 17106: Comparing Pre- and Post- Pandemic Personal Health Monitoring Using Wearable Devices in United States Adults With or at Risk for Cardiovascular Disease: A Nationally Representative Study
Authors: Lovedeep S Dhingra, Arya Aminorroaya, Evangelos K Oikonomou, Veer Sangha, Harlan M Krumholz, Rohan Khera
Journal: Circulation (2023)

Introduction: The COVID-19 pandemic represented a major global health crisis that potentially refocused public attention on personal health monitoring. We evaluated changes in personal health monitoring using wearable devices, before and after the pandemic. Methods: To evaluate the changes in self-reported use of wearables pre- and post-pandemic, we used the nationally representative Health Information National Trends Survey (HINTS) study for Jan 2019 through Feb 2020 (pre-pandemic) and 2022 (post-pandemic). We assessed use in individuals with cardiovascular disease (CVD), and CV risk factors (hypertension, diabetes, smoking, obesity), accounting for the complex survey design. We also examined the interaction of sociodemographic features with the pandemic, for wearable use, using survey logistic regression. Results: Of the 15,555 individuals in HINTS, 10,262 (60 ± 16 years, 57% women) had CVD or risk factors. There was a 28% increase in wearable use in the overall population and 27% in adults with CVD or risk factors. An estimated 48.7 (43.9-53.4) million adults with CVD or risk factors (31% [29-34] of all adults with CVD or risk factors) reported using wearable devices post-pandemic, compared with 38.1 (34.7-41.5) million (25% [23-27]) pre-pandemic. In adults with CVD or risk factors, wearable use increased among all sociodemographic subgroups. (Fig) The pandemic was independently associated with increased use of wearables (OR 1.42 [1.24-1.63]). However, there was no significant interaction between the pandemic and sociodemographic subgroups (all P &gt; 0.05). Conclusion: The use of wearable devices increased across sociodemographic subgroups in adults with or at risk for CVD. However, the uptake was not disproportionately greater in subgroups with known worse health outcomes. Despite the increased awareness for health monitoring during the pandemic, inequities in use of wearable health technology continue to threaten disparities in patient outcomes.
Abstract 17060: Preliminary Assessment of Artificial Intelligence Guided Echocardiographic Screening of Cardiac Amyloidosis
Authors: Lily K Stern, Irene R Marker, Grant Duffy, SANDY JOUNG, Alan C Kwan, Joseph E Ebinger, Florian Rader, Susan Cheng, Jignesh K Patel, David Ouyang
Journal: Circulation (2023)

Background: Cardiac amyloidosis (CA) diagnosis is often overlooked. Novel CA treatments underscore the importance of early identification, as untreated CA has a poor prognosis. EchoNet-Screening is an echocardiogram-based artificial intelligence model to identify CA; previously refined by echocardiograms from patients with known CA. The goal of our study is to prospectively evaluate the accuracy of EchoNet-Screening across a large health system. Methods: All echocardiographic studies from our cardiac quaternary care center between 2019-2021 were batch-processed by EchoNet-Screening to produce a CA risk-prediction score (CA-RPS) for each patient based on the highest quality study, which is determined by the model. 336 patients with the highest CA-RPS underwent evaluation by detailed chart review by our CA clinical cardiology team. High risk patients without an alternative diagnosis are subsequently referred for CA specialty evaluation. (ClinicalTrial.gov/NCT05139797) Results: EchoNet-Screening was performed on echocardiographic images from 58,236 patients. Preliminary retrospective assessment of 336 patients with the highest CA-RPS revealed CA in 142 patients; almost half were not known from our advanced heart failure (AHF) registry and newly identified from chart review. 62 patients are pending prospective enrollment for CA subspecialty evaluation to further characterize the performance of EchoNet-Screening. Conclusions: Preliminary results from our trial demonstrate a high accuracy of EchoNet-Screening for detection of patients with known CA, emphasized by high rates of identification of CA patients even on initial chart review. Further work is ongoing to evaluate the performance of EchoNet-Screening to bring high-risk patients to new diagnoses and eventual care.
Abstract 13407: Long-Term Outcomes of Chronic Thromboembolic Pulmonary Hypertension Treated With Pulmonary Endarterectomy and Balloon Pulmonary Angioplasty: Results From the Japanese Prospective CTEPH Registry (CTEPH AC Registry)
Authors: Kohei Masaki, Kazuya Hosokawa, Kouta Funakoshi, Yu TANIGUCHI, Shiro Adachi, takumi inami, Jun Yamashita, Hitoshi Ogino, Ichizo Tsujino, Masaru Hatano, Nobuhiro Yaoita, Nobutaka Ikeda, Hiroto Shimokawahara, Nobuhiro Tanabe, Kayoko Kubota, Ayako Shigeta, Yoshito Ogihara, Koshin Horimoto, Yoshihiro Dohi, Takashi Kawakami, Yuichi Tamura, Koichiro Tatsumi, Kohtaro Abe
Journal: Circulation (2023)

Introduction: In Japan, balloon pulmonary angioplasty (BPA) is more commonly adopted in patients with chronic thromboembolic pulmonary hypertension (CTEPH) compared to European countries or US due to their expertise. However, there are no reports from regions where BPA is extensively practiced. Aims: This study aims to explore the treatment outcomes in Japan. Methods: The study involved a nationwide, prospective, observational registry that included all patients diagnosed with CTEPH from August 2018 to February 2023 in Japan. Patients were categorized as naïve or prevalent cases based on their previous reperfusion therapy (pulmonary endarterectomy and/or BPA) at the time of enrollment. Each case was further classified as operable or BPA group. The primary outcome measure was morbidity and mortality (MM) events since enrollment, which comprised all-cause death, CTEPH-related hospitalization, rescue reperfusion therapy, initiation of parenteral pulmonary vasodilators, and worsening of CTEPH characterized by a decrease in 6-minute walk distance greater than 15% and deterioration of the WHO functional class. Results: A total of 1194 patients, including naïve cases (operable: n = 54, BPA: n = 293) and prevalent cases (operable: n=125, BPA: n = 532), were identified. Among the naïve cases, there were no significant differences in age or disease severity between the operable and BPA groups. Among the prevalent cases, the BPA group was older (63 ± 13 vs. 58 ± 14 years old, p &lt; 0.0001) and had higher pulmonary vascular resistance (364 ± 279 vs. 293 ± 206 dyne*sec/cm5, p = 0.001) compared to the operable group. The results of primary outcome measures were comparable between both the groups (Figure). Conclusions: BPA as well as pulmonary endarterectomy is considered as safety and effective therapeutic option in CTEPH patients.
Abstract 18567: Acute Inhibition of Phosphodiesterase 1 (PDE1) Decreases Tension Generation in Pediatric Heart Failure
Authors: Nadia Chaudhry-Waterman, Eric Jonas, Matthew Stone, Carmen Sucharov, Brian L Stauffer, Shelley D Miyamoto, Stephanie J Nakano
Journal: Circulation (2023)

Introduction: Children with heart failure (HF) due to dilated cardiomyopathy (DCM) or single ventricle congenital heart disease (SV) ultimately require heart transplantation due to the lack of effective medical therapies. Inhibition of PDE1 (PDE1i) is currently being investigated in adult HF, however it is unclear if PDE1i use should be extrapolated to pediatric HF. Objective: To evaluate the acute effect of PDE1i on loaded myocardial contractility in pediatric DCM and SV trabeculae. Methods: Hearts were obtained from DCM (N=25) and SV (N=27) children who underwent transplant between 2010-2020. Right ventricular trabeculae are freshly isolated and mounted in a multi-chamber muscle bath. Ex vivo contractile response of isolated trabeculae was measured in response to 10uM PDE1i, the non-selective β-agonist isoproterenol (Iso), and untreated. To assess contractile response with increased cyclic adenosine monophosphate (cAMP) from β-adrenergic stimulation, a subset of baths received Iso and PDE1i. Percent change in max tension was determined by the difference between max tension and baseline tension, divided by baseline tension. Results: In pediatric DCM and SV trabeculae, acute PDE1i resulted in lower max tension generation when compared to untreated trabeculae (DCM p=0.003 and SV p=0.01). In DCM trabeculae, % change in tension was also lower with PDE1i when compared to Iso (p=0.0053) however there was only a trend toward significance in SV (p=0.06). There was no difference between % change in tension between Iso and PDE1i+Iso in either DCM or SV. Conclusions: Although PDE1 has high expression and activity in human cardiomyocytes, acute PDE1i treatment of explanted trabeculae results in decreased max tension generation. Even in the setting of elevated cAMP, PDE1i does not alter max tension generation. Thus, while there may be beneficial effects of PDE1i in pediatric HF, the consequences are unlikely related to a direct increase in cardiomyocyte contractility.
Abstract 13243: Different Efficacy of Angiotensin Receptor Blockers for Nocturnal Blood Pressure Reduction in Patients With Mild to Moderate Hypertension: A Systematic Review and Meta-Analysis
Authors: Jing Liu, Wei Chen, Shihuan Shao, Yuanyuan Chen, Hongyi Wang, yang xi, Luyan Wang
Journal: Circulation (2023)

Introduction: High nocturnal blood pressure (BP) is correlated with an increased risk of cardiovascular events and is an important predictor of cardiovascular death in hypertensive patients. Thus, nocturnal BP control is of great importance for cardiovascular risk reduction. Hypothesis: As the most commonly prescribed BP-lowering agents, angiotensin II receptor blockers (ARBs) maybe have different efficacy for nocturnal BP reduction in patients with mild-to-moderate hypertension (MMH). Methods: We conducted a systematic search in PubMed, EMBASE, Cochrane Library and Web of Science from inception to August 8th, 2022, and collected the ambulatory BP study data of different ARBs (allisartan, candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan) in patients with MMH following PICOs principle. Data was extracted and the risk of bias of the included studies was evaluated accordingly, and R software (version 4.0.0) was used for statistical analysis. Results: Seventy-eight studies with 13,108 patients were included. The results of meta-analysis showed that allisartan, olmesartan, telmisartan were associated with greater reduction in nocturnal systolic BP, while valsartan, olmesartan and telmisartan demonstrated greater efficacy in reducing nocturnal diastolic BP. In the aspect of the nocturnal-diurnal BP drop ratio, only allisartan was greater than 1 (figure). Additionally, allisartan showed more advantages in the last 4-6 hours ambulatory BP drop, the proportion of patients with dipping BP pattern, and the 24 hours ambulatory BP drop as compared to other ARBs. Conclusions: For patients with MMH, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs, while allisartan can reduce nocturnal BP more than daytime BP and improve the dipping pattern, contribute to restore normal BP rhythm.
Abstract 14466: Study Protocol: Heart Camp Connect - Promoting Adherence to Exercise in Adults With Heart Failure With Preserved Ejection Fraction
Authors: Windy W Alonso, Sara Bills, Scott Lundgren, Joseph Norman, Steven J Keteyian, Alfred Fisher, Kevin Kupzyk, Cheng Zheng, Fernando A. Wilson, Erin Salahshurian, Bunny J Pozehl
Journal: Circulation (2023)

Background: Heart failure with preserved ejection fraction (HFpEF) remains a challenge in cardiovascular care. A chief complaint in adults with HFpEF is fatigue, and regular exercise training is the only treatment shown to routinely improve this symptom. Adherence to exercise recommendations is difficult. We significantly improved 12-month adherence to exercise in adults with persistent HF using an in-person coaching intervention. Secondary analysis of our HFpEF subgroup showed promising long-term exercise adherence. These findings support our recently funded trial to test an intervention delivered in-person vs. virtually to achieve long-term exercise adherence in adults with HFpEF. Aims: We will: 1) Evaluate effects of in-person vs. virtual coaching and enhanced usual care on 12- and 18-month exercise adherence, 2) Determine the optimal minutes of moderate-intensity exercise that yields clinically meaningful change in patient-reported outcomes, 3) Evaluate interventional mechanisms and interim clinical events as mediators of adherence behaviors, and (4) Examine the cost of intervention delivery. Approach: This multi-site, 3-group randomized controlled trial will recruit 300 adults with stable HFpEF to compare an in-person coaching intervention to a virtual coaching, and both to enhanced usual care (UC). After a run-in period, all participants receive a medical fitness center membership (in-person or virtual) for 18 months and are randomized following a 2-2-1 strategy to in-person coaching and exercise (n=120), virtual coaching and exercise (n=120) or UC virtual exercise only (n=60). The primary outcome is adherence to ≥120 minutes of exercise/week measured using a heart rate monitor at 12 months, with a sustainability endpoint at 18 months. Secondary outcomes include health status, physical function and activity, HFpEF symptoms, and inflammatory biomarkers. Data are collected at baseline, 6, 12, and 18 months. Conclusions: Our findings will guide selection of the most efficacious and cost-effective delivery approaches to promote exercise adherence. Identifying active interventional mechanisms and the dose of exercise needed to elicit a response will help to achieve a clinically meaningful change in patient-reported outcomes in HFpEF.