tbuckley/cabot-search huggingface dataset:
Abstract 4144137: Discontinuation vs Continuation of Renin-Angiotensin System Inhibition Before Non-Cardiac Surgery: A Systematic Review and Meta-Analysis
Authors: Ivo Queiroz, Maria Luiza Rodrigues Defante, Lucas Barbosa, Vanio do Livramento Junior Antunes, Beatriz X. Mendes, Roberto Mazetto, Elisio Bulhoes, Catarina Silva, Pedro Romeiro, Camila Guida
Journal: Circulation (2024)

Background: The optimal management of angiotensin-converting enzyme (ACE) inhibitors during elective surgeries remains uncertain. While some studies suggest that continuing ACE inhibitors increase the risk of perioperative hypotension, others argue that discontinuation may heighten the risk of significant clinical events. This meta-analysis aims to clarify the clinical outcomes associated with continuation compared to discontinuation of ACE inhibitors in surgical settings. Methods: We conducted a systematic search of MEDLINE, Cochrane, and Embase for clinical trials comparing the effects of continuing versus discontinuing ACE inhibitors during surgery. Outcomes evaluated included death, stroke, myocardial injury (MI), intraoperative hypotension, postoperative hypotension, and acute kidney injury (AKI). Data were synthesized using odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed with I2 statistics, and a random-effects model was applied. Statistical analyses were performed using R software version 4.3.2. Results: From 865 identified studies, 15 studies involving 11,519 patients met the inclusion criteria. Not all studies had outcomes available for comparison between them. The average age was 65.75 years, with 86.45% having hypertension and 13.13% with heart failure. Continuing ACE inhibitors was associated with a higher risk of intraoperative hypotension (OR 1.33; 95% CI 1.16-1.53). No significant differences were found between groups for mortality (OR 1.06; 95% CI 0.68-1.65), stroke (OR 0.99; 95% CI 0.47-2.09), MI (OR 0.98; 95% CI 0.72-1.31), postoperative hypotension (OR 1.27; 95% CI 0.74-2.17), and AKI (OR 0.88; 95% CI 0.66-1.16). Conclusion: Discontinuation of ACE inhibitors before non-cardiac surgery may lower the risk of intraoperative hypotension without significantly affecting mortality, stroke, MI, postoperative hypotension, or AKI. Further research with greater power and better design is needed to confirm these findings.
Abstract 4144161: The impact of atrial fibrillation on no-reflow phenomenon in acute coronary syndrome patients following percutaneous coronary intervention: A meta-analysis of the current literature
Authors: Tufan Cinar, Almina Erdem, Hoang Nhat Pham, Faysal Saylik, Vedat cicek, Levent Pay, Aleksan Khachatryan, joel alejandro, Berke Cenktug Korucu, Mert Hayiroglu
Journal: Circulation (2024)

Background: Percutaneous coronary intervention (PCI) is a cornerstone in the management of acute coronary syndrome (ACS) patients. Despite technological advancements, the occurrence of no-reflow phenomenon remains a significant concern among ACS patients. Atrial fibrillation (AF) is a common arrhythmia associated with cardiovascular events. We conducted a meta-analysis to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. Methods: Relative risk (RR) with a 95% confidence interval (95%CI) served as the summary measure in our meta-analysis using the random-effects model to estimate the summary effect. The primary outcome is to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. We assigned I2 &gt; 50% as an indicator of statistical heterogeneity. P value &lt;0.05 was considered significant. Data analysis was conducted using SPSS v.25. A comprehensive literature search was performed identifying relevant studies published up to January 2024 from October 2001 from PubMed, Google Scholar, Scopus databases. Studies reporting the baseline AF and no-reflow in ACS patients post-PCI were included. Case reports, duplicate studies, reviews and metaanalysis were excluded. Data screening and analysis were conducted independently by two reviewers. Results: The meta-analysis included 10 studies comprising a total of 11079 ACS patients who underwent PCI. No reflow developed in 2442 of these patients. In total, 653 patients had baseline AF and 10426 patients had not AF. No-reflow developed in 243 of the patients with baseline AF. Also, no-reflow developed in 2199 of the patients with non-AF. Our findings revealed a statistically significant association between AF and increased incidence of no-reflow in ACS patients following PCI (RR: 1.5 Cl %95) (p &lt; 0.05). There was moderate statistical heterogeneity across the studies that evaluated no-reflow outcomes (I2= 61%) Conclusion: In this meta-analysis, we provide evidence suggesting that the presence of AF may have a deleterious effect on the development of no-reflow phenomenon in ACS patients following PCI. AF may have deleterious effects on the coronary microvasculature. Further research is warranted to elucidate the underlying mechanisms and to determine the clinical implications of these observations.
Abstract 4144043: Automated Left Ventricular Volumetry using Artificial Intelligence in Coronary Calcium Scans (AI-CAC) Predicts Heart Failure Comparably to Cardiac MRI and Outperforms NT-proBNP: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Morteza Naghavi, Anthony Reeves, Kyle Atlas, Chenyu Zhang, Thomas Atlas, Matthew Budoff, Sion Roy, Claudia Henschke, David Yankelevitz, Nathan Wong, Daniel Levy
Journal: Circulation (2024)

Introduction: Artificial intelligence-powered coronary artery calcium scan (AI-CAC) provides more actionable information than currently reported. We have previously shown in the Multi-Ethnic Study of Atherosclerosis (MESA) that AI-enabled left atrial (LA) volumetry in CAC scans (AI-CAC) enabled prediction of atrial fibrillation (AF) as early as one year. Furthermore, we have shown adding AI-CAC LA volumetry to CHA 2 DS 2 -VASc risk score improved stroke prediction in MESA. We have recently reported that AI-CAC left ventricular (LV) volumetry and mass significantly predicted incident heart failure (HF) and outperformed NT-proBNP. In this study, we compared LV volume measured by AI-CAC versus cardiac magnetic resonance (CMR) imaging and NT-proBNP for predicting HF. Additionally, we compared AI-CAC vs. NT-proBNP for detection of left ventricular hypertrophy (LVH) defined by the 95th percentile of CMR LV mass. Methods: We used 15-year outcomes data for incident HF from 3078 asymptomatic MESA participants (52.3% women, age 62.2±10.3 years) who underwent both CAC scans and CMR at the baseline examination. We applied the AutoChamber TM (HeartLung.AI, Houston, TX) component of AI-CAC to 3078 CAC scans.Data on CMR semi-automated LV volume, NT-proBNP, and Agatston CAC score were obtained from MESA. Discrimination was assessed using the time-dependent area under the curve (AUC) for incident HF. Results: Over 15 years of follow up, 133 cases of HF were diagnosed. The AUC for AI-CAC (0.789) and CMR (0.793) were not significantly different (p=0.67) but were significantly higher than NT-proBNP (0.719) and Agatston score (0.664) (p&lt;.0001) for prediction of incident HF. AI-CAC and CMR significantly improved the continuous Net Reclassification Index of NT-proBNP (0.37) and Agatston score (0.45) for HF prediction (p&lt;0.001 for all). The AUC for AI-CAC vs. NT-proBNP for LVH was 0.871 vs. 0.600 for males and 0.854 vs. 0.600 for females. Conclusion: In this multi-ethnic asymptomatic population, AI-CAC automated LV volumetry and CMR semi-automated LV volumetry similarly predicted incident HF over 15 years and outperformed NT-proBNP. AI-CAC significantly outperformed NT-proBNP for detection of LVH. Both AI-CAC and CMR significantly improved on NT-proBNP and Agatston CAC score for predicting incident HF.
Abstract 4144186: Can Noninvasive Evaluation of Right Atrial Pressure by Internal Jugular Vein Imaging Complement Inferior Vena Cava Imaging?
Authors: Lakshmi Murugesan, Yan Naung Htay, Sakthi Kasi, angelena manova, Shakthi Prabhakaran, Varun Victor, Prabhakaran Gopalakrishnan
Journal: Circulation (2024)

Background: Right atrial pressure (RAP) is estimated noninvasively by sonographic evaluation of inferior vena cava (IVC) size and collapsibility. We evaluated a new internal jugular vein (IJV) based approach for RAP estimation. Methods: Sixty-nine patients underwent right heart catheterization and sonographic evaluation of IVC and right IJV. Both IVC long axis (LA) – IVC(LA) and short axis (SA) - IVC(SA) images were analyzed for RAP. SA images of right IJV were obtained at the clavicular level at 0°and clavicular and mandibular levels at 45°&amp;90° (60° if the patient is unable to sit upright) (Figure 1). Cine images were recorded during free breathing, sniff, and valsalva maneuvers at each location, in each posture. IJV was classified as distended (D), pulsatile (P), or collapsed (C). Models were developed to grade noninvasive RAP (niRAP) based on IJV classification in these images – IJV(c) and combined IJV&amp;IVC imaging – IJV+IVC (Figure 2). A simple model IJV(s) using only 45° posture was also analyzed. The invasive RAP (iRAP) was categorized as 3 (&lt;5 mm Hg), 8 (5-10 mm Hg), and 15 (&gt;10 mm Hg) and compared with the niRAP from IJV(c) , IJV(s) , IVC(LA) , IVC(SA) and IJV+IVC . Results: IVC(LA) was nondiagnostic in 3 patients and IVC(SA) in 8 patients. In comparison, both IJV(c) and IJV(s) were diagnostic in all patients. The correct niRAP category was identified in more patients by IJV (c-54%, s-54%) than by IVC imaging (LA-39%, SA-46%). IVC(SA) performed better than the traditional IVC(LA) . While both IJV(c) and IJV(s) had an overall similar performance, IJV(c) was better when iRAP&gt;10 and the IJV(s) was better when iRAP ≤10. Combined IJV+IVC identified RAP category correctly in most patients (64% overall, 84% if iRAP &gt;10) (Table 1). Discussion: While IJV was diagnostic in all patients, IVC imaging was nondiagnostic in some. IJV correctly identified the RAP category more often than IVC and combined IJV and IVC had the best performance. IJV imaging was easier to perform and more comfortable for patients. A simpler 45° only evaluation of IJV had a performance similar to comprehensive IJV imaging. While IVC(SA) was nondiagnostic in more patients, its classification was more accurate than IVC(LA) . Conclusion: Sonographic imaging of IJV is potentially better than IVC imaging in noninvasive evaluation of RAP. Combined IJV and IVC imaging is better than IJV or IVC alone. When IVC only imaging is done, short axis or biplane imaging is preferable to long axis alone.
Abstract 4144131: High Prevalence of CAC on PET/CT in Patients Undergoing Genetic Testing for Familial Hypercholesterolemia Regardless of Genetic Result
Authors: Stacey Knight, Viet Le, Megan Rimmasch, Bailey Kamp, Leslie Iverson, Kirk Knowlton, Jeffrey Anderson
Journal: Circulation (2024)

Introduction: Recently it was published that 40-50% of genetic positive familial hypercholesterolemia (FH) patients will have zero coronary artery calcium (CAC). However, it is unclear if this rate is similar to patients who met indications for FH genetic testing but had a negative genetic result. We tested the hypothesis that the presence of CAC will be similar for these 2 patient groups. Methods: All patients undergoing genetic testing for FH from July 2016 to Jan 2024 (n=332) that also had a cardiac positron emission tomography-computed tomography (PET/CT) stress test (n=101) were studied. The presence of CAC was determined for these patients using the low-dose attenuated correction CT images. We further examined CAC severity for those with an Agatston CAC score (n=53) or with a report of CAC severity based on the low-dose attenuated correction CT (n=18). Fisher exact tests and Wilcoxon rank sum tests were used for the comparisons. Results: Of patients undergoing FH testing (n=332), average age was 49±19 years, 51% were male, and 89% white. For those who had a PET/CT (n=101), the average age at time of FH testing was 57±13y, 59% were male, and 87% white. Patients who underwent PET/CT were less likely to have a positive genetic test (14%) compared to those without a PET/CT (27%) (p=0.006). The CAC, other PET/CT results and conclusions by the reading cardiologist, and maximum low-density lipoprotein cholesterol (LDL-C) are shown in the table. A large percentage of both positive (93%) and negative (84%) FH genetic tested patients had CAC present. The presence and severity of the CAC was not significantly different between these 2 groups. Other PET/CT results were also similar for the FH positive and negative genetic test groups. However, those with genetically confirmed FH had significantly higher maximum LDL-C than those with a negative result (p=0.006) and a higher LDL-C closest to the time of PET/CT (p=0.02). Conclusion: While this is a small study of selected FH tested patients with PET/CT, we found nearly all of the genetically confirmed FH patients that had a PET/CT, had CAC. Those with genetically confirmed FH had almost double the LDL-C values compared to patients that tested negative for FH on genetic testing. However, this did not result in significantly higher rates or more severe CAC scores or higher risk assessment on PET/CT.
Abstract 4144108: Incorporating AI-enabled Left Atrial Volume Measurement from Coronary Artery Calcium Scans (AI-CAC) to CHA <sub>2</sub> DS <sub>2</sub> s-VASc Risk Score Improves Stroke Prediction in the Asymptomatic Population: The Multi-Ethnic Study of Atherosclerosis
Authors: Morteza Naghavi, Anthony Reeves, Kyle Atlas, Chenyu Zhang, Thomas Atlas, Claudia Henschke, David Yankelevitz, Matthew Budoff, WENJUN FAN, Ruilin Yu, Andrea Branch, Ning Ma, Sion Roy, Khurram Nasir, Sabee Molloi, Zahi Fayad, Michael McConnell, Ioannis Kakadiaris, Javier Zulueta, David Maron, Prediman Shah, Kim Williams, george Abela, Daniel Levy, Nathan Wong
Journal: Circulation (2024)

Background: The CHA 2 DS 2 -VASc risk score is a clinical tool for stroke prediction. It is mainly used in patients with atrial fibrillation (AF) but is also applied to the non-AF population. We previously reported that artificial intelligence (AI)-enabled left atrial (LA) volumetry from coronary artery calcium (CAC) scans (AI-CAC) predicts AF as early as one year and outperformed CHARGE-AF and NT-proBNP. In this report, we compare AI-CAC LA volumetry to the CHA 2 DS 2 -VASc risk score and evaluate the incremental value of incorporating AI-CAC LA volume to CHA 2 DS 2 -VASc for incident stroke prediction in the non-AF population. Methods: We applied the AutoChamber TM LA volumetry component of AI-CAC to CAC scans of 5830 people without AF (52.2% women, age 61.7±10.2 years) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) baseline (2000-2002). We used the 15-year outcomes data for incident stroke (ischemic and hemorrhagic) and assessed discrimination using the time-dependent area under the curve (AUC) between AI-CAC LA volume vs. CHA 2 DS 2 -VASc risk score. Notably, the CHA 2 DS 2 -VASc score in this non-AF population ranges from 0 to 5, whereas in the AF population it typically ranges from 0 to 9 points. Results: 252 cases of stroke accrued over 15 years. The median and mean ± SD of CHA 2 DS 2 -VASc score at baseline were 1.0 and 1.58 ± 1.15, respectively. The cumulative incidence of stroke for the 95 th percentile of AI-CAC LA volume (n=291) vs. CHA 2 DS 2 -VASc 4 or 5 points (n=364) was 13.0% and 13.7%, respectively. AI-CAC LA volume significantly improved the AUC of CHA 2 DS 2 -VASc for stroke prediction at 2-year follow-up (0.76 for CHA 2 DS 2 -VASc vs. 0.81 for CHA 2 DS 2 -VASc plus LA volume, p=0.03), 5-year follow-up (0.73 vs. 0.77, p=0.01), 10-year follow-up (0.70 vs. 0.75, p&lt;0.0001) and 15- year follow-up (0.70 vs. 0.74, p&lt;0.0001). Conclusion: In this multi-ethnic longitudinal cohort of people without AF, addition of LA volume significantly improved performance of the CHA 2 DS 2 -VASc risk score for stroke prediction from 2 to 15 years follow-up. Further studies are needed to evaluate the clinical utility of adding LA volume to CHA 2 DS 2 -VASc risk score in people with and without AF.
Abstract 4144165: Transcatheter mitral valve repair demonstrates lower early mortality rates and lower rates of adverse events compared to surgical mitral valve repair among patients with mitral regurgitation: an updated systematic review and meta-analysis
Authors: Ahmed Elfaituri, Alhasan Saleh Alzubi, Hazem Abdelkarem Faraj, Ala Khaled, Muhammed Elfaituri
Journal: Circulation (2024)

Introduction: Transcatheter mitral valve repair (TMVR) has recently emerged as a therapy option for patients with severe mitral regurgitation (MR) deemed unsuitable for traditional cardiac surgery. In contrast to surgical mitral valve replacement (SMVr), its effectiveness is uncertain. Therefore, there is a need to assess safety, mortality, and morbidity. Hypothesis: To compare the mortality and morbidity of TMVR intervention versus SMVr in patients with MR. Methods: Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature were searched in May 2022. We only included studies that reported the outcomes of patients undergoing TMVR intervention compared to SMVr for MR, either secondary or primary. The primary outcome was early mortality and major adverse cardiac events (MACE). The secondary outcomes were reoperation rate, long-term survival, and complications. Statistical analysis was performed using R 4.0.3 Results: Eleven studies comprising 10,627 patients (5307 TMVR and 5320 SMVr) were included in the analysis. In early mortality, the results showed TMVR has a significantly lower mortality rate than SMVr (RR: 0.84; 95% CI, 0.43-1.63; P &lt; 0.01; I2 = 47.8%). MACE was significantly lower in TMVR than SMVr (RR: 0.52; 95% CI, 0.22-1.22; P &lt; 0.01; I2 = 45.1%). Acute kidney injury (AKI) was significantly lower in TMVR compared to SMVr (RR: 0.76; 95% CI, 0. 34-1.67; P &lt; 0.01; I2 = 75.1%). Although not significant, TMVR associatedwith higher rates of reoperation (RR: 2.46; 95% CI, 1.31-4.61; P = 0.53; I2 = 0%). TMVR was associated with non-significant lower rates of bleeding complications and the needs for transfusion (RR: 0.23; 95% CI, 0.20-0.28; P = 0.56; I2 = 0%). However, in long survival outcome, TMVR showed significant higher non-survival rate to SMVr (HR: 1.37; 95% CI, 0.85-2.23; P &lt; 0.01; I2 = 26.1%). Conclusions: TMVR showed significantly lower early mortality, MACE, andAKI than SMVr. Long survival outcomes showed a negative trend for TMVR compared to SMVr in a few included studies. Therefore, TMVR can be a safe and effective approach for mitral valve regurgitation with lower early mortality and morbidity when compared to surgical management. However, there is a need for longitudinal studies on long-term outcomes.
Abstract 4144244: Delineating SCAD and Non-SCAD in Acute Myocardial Infarction: Prevalence, Demographic Predictors, and Clinical Outcomes
Authors: Samuel Tan, Atsuyuki Watanabe, Robert Trenschel, Wenchy Siu, Paulus Adinugraha
Journal: Circulation (2024)

Background: Spontaneous Coronary Artery Dissection (SCAD) is an rare but increasingly recognized cause of acute myocardial infarction (AMI) traditionally thought to predominantly affect young healthy women without typical cardiac risk factors. Recent studies suggest that SCAD may be underdiagnosed, particularly among underrepresented ethnic minority groups, and that its prevalence and clinical characteristics may vary across different populations. Furthermore, gender specific differences have not yet been well explored. Contemporary population-based studies on SCAD are lacking while comparing risk factors and trends to SCAD are not well explored. Research question: This study aims to elucidate the trends, incidence, and risk factors associated with SCAD compared to non-SCAD acute myocardial infarction (AMI) patients. We hypothesize that there are demographic and clinical differences between SCAD and non-SCAD AMI patients Objectives: To describe the incidence and trends of SCAD among AMI patients. To identify and compare risk factors for SCAD versus non-SCAD AMI. To analyze in-hospital outcomes associated with SCAD. Methods: We utilized data from the Nationwide Inpatient Sample (NIS) database from January 1, 2016, to December 31, 2019, identifying patients with AMI who underwent angiography. Patients were stratified into SCAD and non-SCAD AMI groups. Multivariable logistic regression was performed to identify risk factors associated with SCAD, and in-hospital outcomes were compared between the two groups. Results: Out of 1,912,780 AMI patients, 0.93% were identified with SCAD. Female SCAD patients had a median age of 57 years compared to 72 years for non-SCAD females. For males, the median age was 62 years for SCAD and 67 years for non-SCAD. Older age was associated with a lower risk of SCAD, while female sex and fibromuscular dysplasia (FMD) increased the risk. SCAD patients experienced higher in-hospital mortality (5.1% vs 3.5%), more post-procedural bleeding (8.0% vs 6.6%), and greater use of mechanical circulatory support (MCS) (13.9% vs 6.2%). Conclusion: SCAD patients show distinct age and gender-specific risk factors compared to non-SCAD AMI patients. SCAD is associated with higher in-hospital complications, including mortality and post-procedural bleeding. Understanding these differences is crucial for improving the diagnosis and management of SCAD in diverse patient populations.
Abstract 4144170: Association of loneliness and social isolation with incident atrial fibrillation: a population-based cohort study using the UK Biobank
Authors: Zhiwei Zeng, Yingyi Zhang, Peng Wang, Runze Chen, xi li, Zhe Zheng
Journal: Circulation (2024)

Background: The role of socio-psychological factors, such as loneliness and social isolation has gained increasing attention, especially in a post-COVID world. However, their related evidence on atrial fibrillation (AF) is scarce. Aims: We sought to assess whether loneliness and social isolation are associated with the risk of incident AF, and which behavioral factors serve as the mediators in such association. Methods: Using data from the UK Biobank, we included the participants free of AF at baseline, and categorized them into three-level loneliness and social isolation scales by self-reported questionnaires, respectively. After adjusting for potential confounders, the hazard ratios (HRs) with 95% confidence interval (CI) of incident AF were estimated by Cox proportional hazard models. The mediating effects of behavioral factors (including current smoking, excess alcohol use, insufficient physical activity, unhealthy diet, sleep deprivation, and obesity) were assessed using a 2-stage regression method for survival data. Results: Among 459,282 participants (mean age of 56.4 years, 55.0% female), 25,406 incident AF cases were documented during a median follow-up period of 12.1 years. In the fully adjusted models, compared with participants with the lowest loneliness scale (zero), participants with the highest loneliness scale of 2 had a significantly higher risk of incident AF (HR 1.21 [95% CI 1.15-1.27]. However, those with social isolation scale of ≥2 had only mild additional risk, with marginal significance (HR 1.06 [95% CI 1.02-1.10]. The association between loneliness and risk of AF was significantly modified by sex (P for interaction=0.029), with female participants suffering from the more detrimental effect of loneliness. Obesity, current smoking, and sleep deprivation were the top three mediators, with a mediated proportion of 20.3%, 8.4%, and 7.6%, respectively. Conclusions: Loneliness was independently associated with a higher risk of incident AF, which was mediated by unhealthy behaviors.