tbuckley/cabot-search huggingface dataset:
Abstract 17527: Plasma Proteomic Representations of Central Hemodynamics Over Time in Heart Failure
Authors: Anna Egerstedt, Tomasz Czuba, Jacob Lundgren, Carl Lejonberg, Oscar O Braun, Goran Radegran, Olof Gidlof, Robert E Gerszten, Gustav Smith
Journal: Circulation (2023)

Introduction: Perturbation of central hemodynamic parameters are defining features in heart failure (HF) and strong prognostic factors, including increased filling pressures, reduced cardiac output (CI), extended blood circulation times and increased peripheral oxygen extraction (ΔAVO2). Invasive catheterization is used for precise assessment of central hemodynamics. Hypothesis: We postulated that plasma proteins may serve as non-invasive representations of central hemodynamics in HF patients. Methods: Affinity-based plasma proteomic profiling of 1305 proteins was applied to a cohort of patients with advanced HF undergoing invasive cardiac catheterization before and 6 months after heart transplantation. A total of 30 central hemodynamic parameters were measured and calculated. Protein profiles associated with central hemodynamics over time were identified from repeated-measures models. Results: We identified 1304 associations for 201 unique proteins meeting our Bonferroni-adjusted significance threshold (p&lt;1x10-6) for at least one hemodynamic parameter. Most of the 201 proteins were associated with more than one parameter. Most proteins (70%) associated with parameters in more than one of five domains (filling pressures, left ventricular (LV) function, right ventricular (RV) function, systemic arterial function, pulmonary arterial function). No proteins were associated with 6 of the 30 hemodynamic parameters, which changed little after transplantation and related to arterial function or RV function. The largest number of protein associations were observed for RAP, cardiac power index, left ventricular stroke work index, and ΔAVO2 followed by systolic blood pressure, CI, and PAWP (&gt;80). These include expected associations of natriuretic peptides, ST2 with LV function, filling pressures and of angiotensinogen with vascular function parameters. We further describe the discriminatory ability of identified proteins for clinically relevant differences in key hemodynamic parameters. Conclusions: We have identified circulating biomarkers to non-invasively monitor central hemodynamics in HF over time. Our findings may also inform understanding of pathways involved in HF pathophysiology and circulatory regulation.
Abstract 15670: Intramural Coronary Artery is Predictive of Short and Long-Term Coronary Complications Following Arterial Switch Operation
Authors: Zachery Thompson, Ryan Bishop, Anna Thompson, Sara Stephens, Alyssa Kalustian, Jeffrey S HEINLE, Iki Adachi, Ziyad Binsalamah, Tam Doan
Journal: Circulation (2023)

Background: Intramural coronary arteries (IMCA) are associated with worse outcomes following arterial switch operations (ASO), though data on the effect of IMCA on longer term coronary complications following ASO remains sparse. Hypothesis: IMCA increases the risk of coronary complications both short and long-term following ASO. Methods: A retrospective cohort study included 393 patients with available data following ASO at a tertiary center (1995-2020). IMCA and Yacoub types were recorded from operative reports. Coronary outcomes included mortality (n=7), coronary reintervention (n=6), abnormal perfusion on stress imaging (n=4) or left ventricular (LV) dysfunction (n=7). Demographic and surgical data was collected. Wilcoxon rank-sum test assessed differences in continuous variables. We performed univariable Cox proportional hazard (PH) regression to examine time-to-event during 4 periods: the entire study period, 1-year, 5-year, and 10-year post-op. Multivariable Cox PH using Schoenfeld residuals with backward elimination was performed for the entire cohort and 1-year post-op. Results: A total of 28/393 (7%) patients had IMCA. During a median follow-up of 10 years (4 - 17), 6% (n=24) had coronary complications. On univariable analyses, IMCA and Yacoub-B were associated with overall coronary complications. At 1-year, IMCA and Yacoub-C were predictive while higher operative weight and male sex were protective of outcomes. At 5- and 10-year post-op, IMCA remained predictive. On multivariate analysis, IMCA was an independent risk factor of coronary complications, hazard ratio of 11.09 (2.98-41.30), p&lt;0.0001 at 1 year postop and 4.37 (1.73-11.04), p=0.002 for the entire study period. Conclusions: Coronary related complications occurred in 6% of patients following ASO. Increased risk of immediate and long-term coronary complications after ASO in patients with IMCA supports a more intense follow-up and stress testing.
Abstract 16105: Sex-Based Differences in Potential Risk Factors for Sudden Death in Patients With Mitral Valve Prolapse
Authors: Nathan C Shaul, Andrew P Cesmat, Abdul M Chaudry, Suhani Gupta, Thelsa T Weickert, Ross J Simpson, Faisal F Syed
Journal: Circulation (2023)

Background: The majority of individuals experiencing sudden arrhythmic death attributable to mitral valve prolapse (MVP) are women. However, factors leading to this increased risk in women are unknown. Aims: To describe sex differences in factors associated with MVP. Methods: We studied 637 patients aged 18-90 with MVP diagnosed by echocardiography at our center between 2016 and 2019. Clinical, echocardiographic and ECG parameters were compared between men and women using Fisher’s exact and Wilcoxon rank-sum tests, including features associated with arrhythmic MVP (bileaflet prolapse, mitral annular disjunction [MAD], ECG T-wave inversion (TWI), and complex or frequent ventricular ectopy (cfVE) including nonsustained ventricular tachycardia [NSVT]). All statistical tests are univariate, reported as OR [95% CI], and p-values are two-sided. Results: Among patients with MVP, 335 (52.6%) were women, 103 (16.2%) were African American and median (IQR) age was 67 (55-76.5) years. Women were more likely than men to have MAD (60/335 [17.9%] vs 35/302 [11.6%] respectively, 1.66 [1.06-2.61], p=0.026) and less likely to have moderate or severe mitral regurgitation (85/335 [25.4%] vs 99/302 [32.8%] respectively, 0.70 [0.49-0.98], p=0.044). There was no difference between women and men in presence of other features associated with arrhythmic MVP. Men were more likely than women to have cardiometabolic risk factors for sudden death including hypertension, diabetes, dyslipidemia, coronary artery disease, and heart failure. Conclusions: In patients with mitral valve prolapse, potential risk factors for sudden death vary by sex. Women are more likely than men to have mitral annular disjunction, while men are more likely to have cardiometabolic risk factors. Further studies are needed to determine whether mitral annular disjunction-associated ventricular arrhythmias can explain the increased incidence of sudden arrhythmic death in women with mitral valve prolapse.
Abstract 18991: Effect of Sex Steroids on Lipid Profile in Female to Male Transgender Patients: A Systematic Review and Meta-Analysis
Authors: Saad Ur U Rahman, Mohammad Hamza, Aakanksha Sharma, Nomesh Kumar, Bansari Patel, Neel N Patel, Masooma Naseem, Hamza Naveed, Yasar Sattar, Chadi Alraies
Journal: Circulation (2023)

Background The medical transition of transgender individuals involves the administration of exogenous sex steroids to induce desired changes in secondary sexual characteristics. In the case of female-to-male (FtM) transgender individuals, the use of testosterone therapy is common. The impact of testosterone on lipid metabolism and dyslipidemia in this specific population is not well understood. Our study combines all the previous studies to study the impact of sex steroids in FtM transgender population. Aim To assess the effects of sex steroids on lipid profile in FtM transgender patients. Methods: PubMed, Cochrane, and Embase were searched from inception till May 2023 for all randomized control trials (RCTs) and observational studies. Primary outcomes were changes in basal metabolic profile (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride levels (TG), HDL, and LDL. All the baseline values before and after utilization of sex steroids were studied. A meta-cont module was used along with Inverse-variance method to calculate the pooled standard mean difference (SMD) for continuous outcomes with a probability value of p &lt; 0.05 considered to be statistically significant. Results: A total of 21 studies with 1208 FtM transgender patients were included. Sex steroids resulted in statistically significant elevation in LDL-C (SMD 0.2850 [0.1169; 0.4531] p &lt; 0.0009), TG (SMD 0.4312 [0.2522; 0.6101] p &lt; 0.0001), TC (SMD 0.1754 [0.0536; 0.2972] p &lt; 0.0048), and BMI (SMD: 0.2429 [0.0983; 0.3875] p &lt; 0.0010) while HDL levels were significantly reduced from the baseline. However, no significant relationship between SBP and DBP was studied (Figure 1). Conclusion: In conclusion, sex steroids increase lipid levels in transgender patients, potentially contributing to dyslipidemia and cardiovascular risk.
Abstract 13349: The Effect of Chronic Standard Cigarette Smoke Exposure Compared to Chronic Electronic Cigarette Exposure With or Without Nicotine on Blood Pressure
Authors: Wangde Dai, Jianru Shi, Juan Carreno, Michael T Kleinman, David Herman, Rebecca Johnson, Samantha Renusch, Irene A Hasen, Amanda Ting, Robert A Kloner
Journal: Circulation (2023)

Background: While the acute exposure to electronic cigarette (e-C) vapor has been associated with an increase in blood pressure, the chronic effect of e-C vapor on blood pressure compared to standard cigarette smoke has not been extensively studied. We determined the effect of chronic e-C exposure versus standard cigarette smoke on blood pressure and other cardiac functional measures. Methods: Sprague Dawley rats (both sexes) were randomly exposed to air (n=34), e-C with nicotine (e-Cn; n=30), e-C without nicotine (e-C; n= 28) or standard cigarette smoke (SCS; n=27) for 12 weeks. After 12 weeks of exposure hemodynamics were determined by Millar catheter, echocardiography, and thermodilution catheter, a few days after their last exposure. Results: As shown in the Table, SCS was associated with higher systolic, diastolic and mean blood pressures and peak LV systolic pressure compared to air or e-Cn or e-C groups. Neither fractional shortening or cardiac output differed among the groups. dp/dt min, a measure of diastolic LV function, was lowest in the e-C group. Tau, a measure of LV relaxation was worse in this group as well. Conclusions: Standard cigarette smoke exposure was associated with an increase in blood pressure when blood pressure was tested at 12 weeks. Neither electronic cigarette smoke with or without nicotine caused an increase in blood pressure compared to air. However, e-C was associated with worse diastolic function. Standard cigarettes may be associated with a greater sympathetic surge causing elevated blood pressure compared to electronic cigarettes.
Abstract 14691: Safety and Efficacy of Catheter Ablation for Atrial Fibrillation in Patients With a History of Cancer: A Systematic Review and Meta-Analysis
Authors: Thomaz A Costa, Nicole Felix, Mariana R Clemente, Larissa Teixeira, Marcelo Antonio Pinheiro Braga, Livia Silva, Roberta Florido
Journal: Circulation (2023)

Background: Patients with an active or past medical history of cancer have an increased risk of atrial fibrillation (AF) and drug-refractory AF. However, evidence for the safety and efficacy of catheter ablation in this population remains limited. Hypothesis: Catheter ablation is a safe and effective strategy for rhythm control in cancer survivors with AF. Aims: To perform a systematic analysis of published studies comparing the safety and efficacy of AF catheter ablation in persons with and without prior or active cancer. Methods: We systematically searched PubMed, Cochrane Library, and Embase from inception to April 2023 for studies comparing the safety and efficacy of AF catheter ablation in persons with and without cancer. Outcomes of interest were bleeding events, recurrence of AF after 12 months, and the need for repeat ablation. Statistical analyses were performed using Review Manager 5.4.1. Results: We included five retrospective cohort studies comprising 998 patients, of whom 413 (41.4%) had a history of cancer diagnosis, including 58 (14%) with active cancer at the time of catheter ablation. Patients with a diagnosis of cancer had at significantly higher risk of clinically relevant bleeding (OR 2.07; 95% CI 1.03-4.15; p=0.04; Figure 1A) compared to those without cancer. Recurrence of AF after 12 months (OR 1.26; 95% CI 0.81-1.96; p=0.31; Figure 1B) and the need for repeat ablation did not differ significantly between groups (OR 0.71; 95% CI 0.37-1.37; p=0.31), respectively. Conclusions: The findings from our meta-analysis suggest that patients with a history of cancer have an increased risk of bleeding after AF catheter ablation compared to patients without cancer, with no significant differences in the efficacy of the catheter ablation between patients with or without cancer.
Abstract 17775: Utilization Patterns and Outcomes Associated With Open vs. Endovascular Abdominal Aortic Aneurysm Repair: Findings From the National Inpatient Sample
Authors: Bede N Nriagu, Abiodun Idowu, Endurance O Evbayekha, Olanrewaju Adabale, Olayiwola Bolaji, Faizal Ouedraogo
Journal: Circulation (2023)

Introduction: Abdominal aortic aneurysm (AAA) is associated with significant morbidity and mortality. Treatment options include open and endovascular AAA repair. We explored the utilization patterns and outcomes of open and endovascular AAA repair among hospitalized patients in the US. Hypothesis: We hypothesized that there would be no difference in the utilization patterns of open and endovascular AAA repair by race and gender. Methods: Using the ICD-10 diagnosis and procedure codes, we queried the National Inpatient Sample 2016 to 2019 for hospitalizations among patients ≥18 years old who had an open or endovascular AAA repair. Multivariable logistic regression was used to estimate the odds of death and discharge dispositions comparing open to endovascular AAA repair. Regression models were adjusted for age, sex, median income zip, history of aneurysm of carotid, iliac, and lower extremity artery, co-morbidities including diabetes, hypertension, smoking, obesity, chronic kidney disease, congestive heart failure, myocardial infarction, COPD, and atherosclerosis. Results: Our study included 132,775 and 36,010 weighted hospitalizations for endovascular and open AAA repair, respectively. The open AAA repair cohort were younger compared to those of endovascular AAA repair (mean age ± S.D: 65.0 ± 10.4 Vs.73.3 ± 9.0). A higher proportion of female underwent open AAA repair than endovascular AAA repair (33.5% vs. 20.9%). Across all racial/ethnic groups, endovascular repair for AAA was more common than open AAA repair among males, except for black males. A higher proportion of black males underwent open AAA repair than endovascular repair (5.7% vs. 3.9%). Patients who had open AAA repair had higher odds of death compared to those who had endovascular repair (Adjusted odds ratio [aOR], 5.99 [95% CI, 5.22-6.87]; p&lt;.0001 ). Conversely, a higher odd of discharge to home/short term facility was noted among patients who had endovascular compared to open AAA repair (aOR, 5.83 [95% CI, 5.38 - 6.32]; p&lt;.0001) . Conclusions: Disparities exist in the utilization of open versus endovascular AAA repair among hospitalized patients. Results could be used to support future research to examine factors driving these disparities.
Abstract 13666: Pooled Prevalence of Anemia and Its Concerning Disparities in Type 2 Myocardial Infarction Hospitalized Patients - A Global Systematic Review and Meta-Analysis
Authors: Ananth V Guddeti, Pavan Vihar R Podduturi, Manoj R Allala, Hem Shah, Viraj Shah, Abhiram Rao Damera, Kamya U Thakkar, Sidhartha G Senapati, Shaylika Chauhan, Rupak Desai
Journal: Circulation (2023)

Background: Anemia in Type 2 Myocardial Infarction (T2MI) related hospitalizations has been linked to higher one year mortality along with other causes of hemodynamic stress. We conducted the first ever meta analysis to evaluate the overall global prevalence of Anemia among patients with T2MI with differences by subgroups. Methods: PUBMED, SCOPUS and Google Scholar Databases were systematically reviewed to find studies through January 2023 ascertaining prevalence of Anemia in T2MI. Binary Random Effects models were used to estimate the pooled prevalence and subgroup analysis of anemia in T2MI. Heterogeneity was assessed using I 2 statistics. Leave-One-Out sensitivity analysis was also performed. Results: A total of 16 cohorts with 28,629 patients, hospitalized with T2MI (Mean Age 74; SD13) revealed a 23.3% [95% CI 17.8% - 28.8%, I 2 -98.61%, P&lt;0.001] pooled prevalence of Anemia and a Mean Hb level of 121; SD - 25 in g/L. The prevalence of Anemia was higher among T2MI cohorts with younger Mean Age [Mean &lt;70 vs &gt;70 Years; 24.6% (95% CI 14.1% - 34.1%) vs 21.4% (95% CI 15.6 - 27.2%)]; smaller sample size [ n&lt;500 vs n&gt;500; 26.6% (95% CI 18.4% - 34.8%) vs 18.6% (95%CI 10.4% - 26.8%)]; prospective studies [Prospective vs Retrospective; 26.1% (95%CI 17.4% - 34.7%) vs 18.7% (95%CI 12.7% - 24.7%)] and single center studies [Single Center vs Multi Center; 24.9% (95%CI 17.5% - 32.2%) vs 21.4% (95%CI 12.7% - 30.1%)]. The prevalence of Anemia in T2MI related hospitalizations was also higher in studies from Asia [36.2% (95%CI 24.6% - 47.7%)], Europe [21.9% (95% CI 14.1% - 29.7%)] and Multinational [21.1% (95%CI 11.9%-30.2%)] as compared to North America [16.4% (95%CI 8% - 24.8%)]. Conclusions: The pooled prevalence of Anemia in this worldwide meta analysis of T2MI hospitalized patients was 23.3% with wide variance among subgroups. Further studies should focus on scrutinizing the outcomes and devastating complications of Anemic patients with T2MI among various populations universally.
Abstract 17095: Change in Oral Anticoagulant Use for Atrial Fibrillation From 2013 to 2018 Among US Veterans and the Impact of Frailty
Authors: Awsse Al-Ani, Joel Reisman, Wen Hu, Ariela R Orkaby, David D McManus, Darae Ko
Journal: Circulation (2023)

Introduction: Direct oral anticoagulants (DOACs) are superior to warfarin in both efficacy and safety regardless of frailty status. Data on prescribing patterns of different oral anticoagulants (OACs) in frail older adults are limited. Methods: We utilized the Veterans Health Administration clinical data, to identify those aged 65 and older with a diagnosis of non-valvular atrial fibrillation (AF) who initiated anticoagulation in 2013 and 2018. Frailty was assessed using the 31-item VA Frailty Index (VA-FI). Patients were stratified into 3 categories. VA-FI: frail (frailty index &gt;0.2), pre-frail (frailty index 0.11-0.2), and non-frail (frailty index 0-0.1). Baseline data on prior stroke, CHA 2 DS 2 -VASc score, and bleeding were extracted. Descriptive statistics and logistic regression were used to examine association of frailty with choice of OAC. Results: Among 39,647 Veterans included from 2013 and 2018, mean age was between 71 to 76. 99% were male and 88% white race. From 2013 to 2018, DOACs use increased from 21% to 88%, while warfarin use decreased accordingly. Among the OACs, dabigatran was dominant (65%) in 2013 but apixaban was dominant (66%) in 2018. Increasing frailty was associated with reduced use of DOACs (p&lt;0.001 in 2013 and 2018). Regardless of the choice of drug, the prior bleeding and prior stroke/transient ischemic attack were mostly seen in the frail population ranging between 54-60% and 20-21% respectively. CHA 2 DS 2 -VASc score averaged 3 for non-frail, and 4 for prefrail and frail patients regardless of the year. (Figure) Conclusion: Prior bleeding and stroke episodes were more common among the frail population. There was significant reduction in use of DOACs in both years with increasing frailty. Studying the impact of anticoagulant choice on clinical outcomes among frail older adults with non-valvular AF are needed.
Abstract 13664: Relationship Between Vascular Inflammation Assessed by 18FDG-PET/CT and Coronary Calcification in Patients With Lung Cancer
Authors: Misayo Hayashi, Jun Matsumoto, Takatomo Watanabe, Hiroyuki Okura
Journal: Circulation (2023)

Background: As the prognosis of lung cancer (LK) has improved over the years, atherosclerotic cardiovascular disease may affect the prognosis of LK. Previous studies have shown that vascular inflammation assessed by 18FDG-PET/CT and coronary artery calcification (CAC) assessed by chest CT can predict cardiovascular events. Objective: This study aimed to evaluate the relationship between vascular inflammation on 18FDG-PET/CT and CAC in patients with LK. Methods: Ninety-nine patients with LK who underwent both chest CT and 18FDG-PET/CT were included in this study. Vascular inflammation was assessed by 18FDG-PET/CT. Target-to-background ratio (TBR) was measured in 8 major arteries and was used as a marker of vascular inflammation. Agatston score was measured using chest CT images and was used as a marker of CAC. Results: The mean age was 70 years old (61 male). The median TBR was 1.39 (IQR: 1.33-1.43). Using a median value of TBR, patients were divided into 2 groups, high TBR group (≧1.39, n=50) and the low TBR group (&lt;1.39, n=49). High TBR group had more male gender (72% vs. 51%, p=0.03), was significantly older (71 (67-74)vs. 62(57-70)years, p&lt;0.001), and had diabetes (p=0.03). In contrast, the history of hypertension (p=0.993), dyslipidemia (p=0.622) and smoking(p=0.113) were similar between the groups. Agatston score was significantly higher in the high TBR group than in the low TBR group (168±338 vs. 56±97, p=0.005). Conclusion: Patients with lung cancer patients with high vascular inflammation had significantly higher Agatston score, suggesting an association between vascular inflammation and advanced coronary atherosclerosis. The impact of vascular inflammation and/or coronary calcification on the prognosis of LK needs further investigation.