tbuckley/cabot-search huggingface dataset:
Abstract 4146031: Natriuretic Peptide Normative Levels and Deficiency Among South Asian Older Adults: The Longitudinal Ageing Study in India
Authors: Sumitabh Singh, Sunny Singhal, Matthew Segar, Neil Keshvani, Sharmishtha Dey, Aparajit Dey, Ambarish Pandey
Journal: Circulation (2024)

Introduction: Natriuretic peptides (NPs) are hormones produced by the heart in response to cardiac wall stress, stimulating natriuresis and vasodilation. NP levels vary by age, sex, and ethnicity, and their deficiency has been associated with adverse metabolic health among Caucasian and Black adults. South Asians have distinct cardio-metabolic profiles; however, the reference range of NPs and NP deficiency among older South Asian adults is not established. Method: Participants of the Longitudinal Aging Study in India who were part of the ancillary study on diagnostic assessment of dementia (LASI-DAD) and were free of CVD and CKD at baseline were included. NT-ProBNP was measured using a one-step immunoassay sandwich method (mini VIDAS platform, bioMèrieux, France). Median NT-ProBNP levels were compared across different age, sex, and BMI groups. Generalized Additive Models accounting was used to fit the quantiles of NT-proBNP according to age among males and females separately. The association of NP deficiency (&lt;2.5th percentile for age and sex) with different cardiometabolic traits was assessed using linear models adjusted for age, sex, and BMI. Result: The study included 2,450 South Asian participants (45.4% male, age 67 y [IQR 63-72]). NT-ProBNP levels increased linearly across increasing age groups, with females (vs. males) having modestly higher NT-proBNP levels in the age groups of 60 – 69 y (119 vs 95 pg/mL)and 70 – 79 y (164 vs 151.5 pg/mL). NT-ProBNP levels decreased linearly across BMI categories among females (Figure). In contrast, among males, the NT-ProBNP levels had a U-shaped distribution across BMI categories, with the lowest level noted in overweight males (Figure). In adjusted analysis accounting for age, sex, and BMI, NP-deficiency was associated with hypertriglyceridemia (OR[95%CI]:1.78[ 1.18, 2.68]) and hyperlipidemia (OR[95%CI]: 2.01[1.22, 3.31]) but not hypertension (OR[95%CI]:0.73[ 0.50, 1.06]) Conclusion: This study establishes the normative values of NT-proBNP across different age and sex groups for South Asian older adults. NP deficiency was associated with hyperlipidemia and hypertriglyceridemia and may contribute to adverse cardiometabolic health in South Asians.
Abstract 4145973: Pemafibrate Provides Multiple Antiatherothrombotic Effects for Patients with Dyslipidemia Receiving Statin
Authors: Tatsuaki Murakami
Journal: Circulation (2024)

Background: Statin is thought to be highly effective against complex atherothrombogenic processes, but further therapies for the residual risk after statin have not been established. Hypothesis: We assessed hypothesis that treatment with pemafibrate, a selective peroxisome proliferator-activated receptor α (PPARα) modulator, inhibits atherothrombotic progression in patients with coronary artery disease and dyslipidemia receiving statin, one of the best possible antiatherosclerotic treatment. Methods: Thirty dyslipidemic patients with stable coronary artery disease were randomized to group-P where they received pemafibrate (0.2mg/day), or to group-C where they continued antidyslipidemic therapy without a fibrate for 3 months. We quantified flow-mediated endothelium-dependent dilation of right brachial artery after 5 minutes forearm occlusion (BFMD), and we also quantified intima-media thickness of brachial artery (BIMT) using high-resolution ultrasonography. Changes in BFMD, BIMT, and other serum variables were compared between the two study groups. Results: Group-P (n=20) manifested good compliance to the treatment with pemafibrate and improvements in clinical variables represented by triglycerides and D-dimer after medication of pemafibrate, while there were no improvements in group-C. BFMD (%) improved after medication in group-P (from 4.1±1.6 to 5.4±2.5, p&lt;0.01) and BIMT (mm) decreased in group-L (from 0.33±0.10 to 0.30±0.11, p=0.03), while both remained unchanged in group-C (BFMD; from 4.0±2.1 to 3.9±1.8, p=0.58, BIMT; from 0.33±0.14 to 0.34±0.18, p=0.44). Changes of BFMD or BIMT in group-P did not correlate to those of triglycerides (FMD: r=0.18, p=0.62, BIMT: r=0.11, p=0.80). Conclusion: This study suggests that pemafibrate safely improves arterial function and inhibits progression of wall thickness independent of reversal for dyslipidemic status, and has novel potential benefit for residual risk management of atherothrombosis in dyslipidemics receiving statin.
Abstract 4145962: Evaluating a Single-Lead, Mobile Electrocardiogram for Screening of Atrial Fibrillation in Patients with Obstructive Sleep Apnea
Authors: Ajay Mittal, Victor Savu, Mansi Patel, Kevin Kapadia, Mark Segal
Journal: Circulation (2024)

Introduction: Obstructive sleep apnea (OSA) affects nearly a billion adults worldwide, and is associated with an increased risk of coronary artery disease, heart attack, heart failure, and arrhythmias - notably atrial fibrillation (AF). Low cost, point of care mobile electrocardiograms (MobileECGs) record and detect heart rhythm abnormalities in 30 seconds. This study aims to assess the effectiveness of the KardiaMobile (AliveCor) MobileECG device as an AF screen in the OSA patient population. Methods: The MobileECG Sleep Study enrolled 500 adult University of Florida Health patients in an observational study between March 2021 and March 2024. After providing consent and completing a brief survey regarding pre-existing health conditions and overall sleep health, a trained research assistant performed the AF screening with the KardiaMobile ECG device. ECG readings were marked for previously undetected abnormalities (potential AF, tachycardia, bradycardia, etc.) and statistically analyzed to determine stroke risk using the CHA2DS2-VASc scoring system. CHA2DS2-VASc criteria includes congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female). Results: A total of 500 participants were enrolled over a 3 year period at University of Florida Health Sleep Center. Of which 276 (55.2%) were female and 224 (44.8%) were male, with a mean age of 56.34 (SD 15.74) and a mean weight of 222.50 (SD 63.25). Of those tested, 68 (13.6%) had irregular, previously undetected AF readings. Patients with irregular AF readings using the KardiaMobile ECG device had CHA2DS2-VASc scores of t(68) = 2.15, p = .042, d = 0.26 indicating an intermediate risk for stroke. Oral anticoagulation is recommended for a score of ≥ 2 if the patient has no contraindication. After prior 12-lead ECG data for patients is obtained the determinations will be compared to the KardiaMobile ECG readings using Cohen’s Kappa. Conclusion: MobileECGs offer a rapid, point of care screening tool for AF in an outpatient sleep clinic setting. Early detection of AF in the OSA patient population can result in improved outcomes and reduced instances of stroke events through anticoagulation therapy guided by CHA2DS2-VASc scores. Further research is necessary to understand the long term impact of surveillance AF screening in high risk patient populations on mortality and cost of healthcare.
Abstract 4145961: Assessing Short- and Long-Term Prognoses In Minor Stroke Patients With Nonvalvular Atrial Fibrillation
Authors: Hamza Maqsood, Shifa Younus, Muhammad Khan, Muhammad Awais, Alamdar Hussain, muhammad khaliq, Hamza Saleem, Shahzad Zafar
Journal: Circulation (2024)

Introduction: Approximately 20% of ischemic strokes are linked to a cardioembolic source, with 80% of cardioembolic strokes being attributed to atrial fibrillation. This study aimed to investigate the impact of non-valvular atrial fibrillation (NVAF) on mortality and recurrent stroke following a minor stroke event, considering AF as the most prevalent sustained cardiac rhythm disorder associated with stroke. Methods and Materials: Consecutive patients experiencing minor acute ischemic stroke (NIHSS&lt;5) underwent a thorough assessment, including transesophageal echocardiography and prolonged electrocardiography monitoring, before enrollment. Two subgroups were formed based on the diagnosis of NVAF. Clinical outcomes, encompassing all-cause mortality, cardiovascular death, recurrent ischemic stroke, and recurrent hemorrhagic stroke, were recorded. The association between NVAF and clinical outcomes was determined using Cox proportional hazards models. Results: Our study comprised a total of 6,190 patients, among whom 440 (7.1%) had NVAF, with a mean age of 63.4 years. In multivariate analyses, NVAF was associated with 12-month cardiovascular mortality (hazards ratio [HR] = 5.32, 95% CI 1.58 - 13.53). There was no discrepancy in the in-hospital ischemic stroke recurrence rate between the two groups (hazards ratio [HR] = 0.58, 95% CI 0.21 - 1.26). However, patients with NVAF exhibited a lower rate of recurrent ischemic stroke at medium- (3 months and 6 months) and long-term (12 months) follow-up (hazards ratio [HR] = 0.28, 95% CI, 0.19 - 0.74 at 3 months; 0.51, 95% CI 0.31–0.93 at 6 months; 0.62, 95% CI 0.29 - 0.90 at 12 months, respectively) compared to those without NVAF. Conclusion: In our study, patients with minor stroke and NVAF faced an elevated risk of cardiovascular death but experienced a reduced rate of recurrent ischemic stroke compared to those without NVAF over the following year post-stroke. This underscores the need for tailored guidelines for this patient cohort.
Abstract 4146038: Inpatient Tricuspid Valve transcather and surgical procedural outcomes: A Propensity Matched analysis
Authors: Ahmad Alayyat, Laith Alhuneafat, Waqas Rasheed, Kyle Kapcin, Kathryn Manalo, Abdel latif mohd abdellatif Maaita, Ahmad jabri
Journal: Circulation (2024)

Background: Tricuspid regurgitation (TR) is a common valvular heart disease, and associated with increased cardiovascular mortality. Adverse events from surgical treatment of severe TR are limiting this approach. Aim: To analyze the outcomes of using surgical and transcatheter TV interventions across the United States. Methods: We used The National Inpatient Sample (NIS) data base and included data between January 1, 2011 and December 31, 2020. We selected patients who underwent Transcatheter tricuspid valve intervention (TTVI), surgical TR repair (STVr), and surgical TR replacement (STVR). TTVI patients were propensity-matched 1:1 to STVr and STVR using nearest neighbor matching. Analyses were conducted using STATA version 17. Results: Between 2011 and 2020, a total of 98,202 TV interventions were identified. Of these, 1,830 (1.9%) underwent TTVI, 76,747 (78.2%) underwent STVr and 19,625 (19.9%) underwent STVR. Patients receiving TTVI were older, more likely to be white and to be treated at a teaching hospital. STVR accounted for the highest proportion of TV procedure-related deaths overall, followed by surgical TV replacement, and lastly, TTVI. In our PSM analysis, STVr and STVR were associated with increased inpatient mortality (7% vs 2.3%, 11.6% vs 2.4%, respectively), when compared to TTVI (p&lt;0.001). Among patients who underwent tricuspid intervention, the odds of experiencing circulatory shock were higher in STVr (24.0% vs 11.8%) and STVR (11.6% vs 2.3%) when compared to TTVI (P&lt;0.001). Moreover, STVr (7.0% vs 2.4%) and STVR (11.6% vs 2.3%) were also associated with higher likelihood of post-procedure respiratory failure (p&lt;0.001). Patients with STVr and STVR experienced longer hospital stays, higher inpatient costs, increased likelihood of non-routine discharge, utilization of mechanical circulatory support (MCS), cerebrovascular accidents, blood transfusions, mechanical ventilation, myocardial infarctions, and pericardial complications Conclusions: Our study does present findings favoring TTVI over surgical interventions. TTVI demonstrates advantages in terms of hemodynamic stability, inpatient mortality, length of stay, and likelihood of MCS use. Nevertheless, additional research is necessary to characterize the long-term durability of TTVI.
Abstract 4146456: Biased Activation of RXFP1 signaling via ML290 Attenuates Experimental Pulmonary Hypertension
Authors: Shreya Sangam, Georgios Triantafyllou, Uyen Pham, Luca Troncone, Lai-Ming Yung, Anand Chundi, Srikrishna Darbha, Gregory Gipson, Shreyas Rajesh, Riley Brackin, Ana Zeghibe, Elizabeth Shin, Irina Agoulnik, Juan Marugan, Alexander Agoulnik, Sudarshan Rajagopal, Paul Yu
Journal: Circulation (2024)

Background: Dysregulated smooth muscle cell (SMC) hypertrophy and proliferation contribute to vascular remodeling in pulmonary arterial hypertension (PAH). Relaxin-2 (RLN2), a peptide hormone known to exert potent vasodilator, anti-fibrotic, anti-apoptotic, and anti-inflammatory effects in diverse myogenic lineages, signals via G-protein coupled receptor (GPCR) Relaxin Family Peptide Receptor 1 (RXFP1). Therapeutic use of RLN2 has been limited by its short half-life and need for parenteral administration. ML290, an orally bioavailable small molecule allosteric agonist of human RXFP1, exhibits properties of biased GPCR signaling compared to RLN2. Hypothesis: Biased modulation of relaxin-RXFP1 signaling via ML290 attenuates experimental PH. Methods and Results: RXFP1 expression was upregulated in the smooth muscle layer of lung sections from patients with PAH compared to controls. In human pulmonary artery SMCs (HPASMCs), RLN2 (100 ng/mL) and ML290 (10 mM) inhibited TGFβ-SMAD2/3 signaling, and inhibited myofibrogenic differentiation of HPASMCs, blocking TGFβ-mediated expression of αSMA, Calponin, Caldesmon, fibronectin and type 1 Collagen. Both RLN2 and ML290 inhibited serum-induced and PDGF-BB-induced migration of HPASMCs. TRUPATH BRET assays performed in HEK cells revealed ML290 to be less potent in activating Gαi3, GαoB, and GαS than RLN2, and that ML290 elicted partial cAMP and cGMP responses. In contrast to RLN2, ML290 did not recruit β-arrestin 1 and had diminished activation of β-arrestin 2. Continuous infusion of RLN2 did not improve experimental PH in several rodent models. In contrast, ML290 (10 mg/kg daily oral gavage) attenuated right ventricular systolic pressure, RV hypertrophy and muscularization in humanized RXFP1 knock-in ( hRXFP1 KI/KI ) mice exposed to Sugen-hypoxia (SuHx). but not in WT or Rxfp1 -/- mice, demonstrating specificity for human RXFP1. Conclusions: ML290 exhibits biased GPCR-mediated signaling of RXFP1 in comparison to the native ligand RLN2. ML290 potently inhibits TGFb-mediated plasticity of vascular SMCs, and demonstrates efficacy in experimental PH in RXFP1 KI mice. The efficacy of ML290 in contrast to RLN2 in experimental PH may be related to its biased signaling, pharmacokinetics, or pharmacodynamics.
Abstract 4146396: Age-Associated CD8+ T Cells Accumulate in the Aging Brain
Authors: MD AKKAS ALI, Donald Vardaman, Chase Bolding, Harrison Tidwell, Daniel Tyrrell
Journal: Circulation (2024)

Introduction/Background: By 2050, the U.S. will see a demographic shift where individuals over 65 outnumber those under 65. This change underscores a rising prevalence of neurodegenerative diseases, particularly Alzheimer’s disease and various vascular dementias. Over the past 20 years, dementia cases have increased by 20% and are expected to triple in the next 30 years due to aging. The cerebral vasculature becomes increasingly stiff and blood-brain barrier molecules degenerate during aging, leading to accumulation of T cells in the aged brain. The role of T cells on neuroinflammation and dementia during aging is a key unanswered question. Research questions/Hypothesis: How does vascular impairment impact immune cells and inflammation in the brain? How does aging impact immune cells and inflammation in the brain? Goals/Aims: To quantify and characterize T cells within the brain during aging and in a model of vascular contributions to cognitive impairment and dementia (VCID). To determine interactions between brain-resident immune cells (glia) and T cells in aging and a model of VCID. Methods/Approach: We isolated T cells and microglia from 3-month old and 21-month old brains in a model of vascular contributions to cognitive impairment and dementia (VCID). We performed single-cell RNA sequencing to identify and characterize peripheral and resident immune cells in the brain in the setting of typical aging and a model of VCID. Results: We identified a substantial increase in Gzmk + expressing effector memory CD8+ T cells in the brains of 21-month-old mice compared to 3-month-old mice. These cells were distinguished by their unique transcriptome, cytokine secretion profiles, and accumulation patterns. We also found a significant shift of microglia from an anti-inflammatory expression pattern toward a pro-inflammatory profile in the VCID group compared to control. Conclusions: We found a significant accumulation of age-associated T cells which may promote dementias. This study highlights the importance of using aged animal models to understand the cellular dynamics of chronic inflammatory diseases and dementias, potentially guiding the development of targeted therapeutic strategies.
Abstract 4146065: Sex Differences in Clinical Profile and Outcomes of Infective Endocarditis: A Meta-Analysis
Authors: Yousef A. Hamad, Heba Salim, Huda Alwadiya, Woroud Siriya, Baraa Mansour, Haya Alhadad, Walid Marouf, Mohammed Ayyad, Ragavendar Saravanabavanandan, Mohammed Al-Tawil, Assad Haneya
Journal: Circulation (2024)

Background: Infective endocarditis (IE) presents significant morbidity and mortality, with potential sex differences in clinical profile and outcomes. This meta-analysis aims to compare the clinical profile and outcomes of IE between males and females. Hypothesis: The clinical profile and outcomes of IE differ between males and females. Methods: We conducted a meta-analysis comparing the clinical profile and outcomes of IE in males versus females. Twelve studies were retrieved from PubMed, EMBASE, SCOPUS, and Cochrane databases up to January 1, 2024, with 9 studies reporting on patients admitted for IE and 3 studies reporting on patients who underwent surgery for IE. Results: Our meta-analysis revealed notable sex differences in the incidence and complications of IE. Males exhibited a higher incidence of aortic valve IE (RR 1.57; 95% CI [1.31, 1.88]), surgical indications for IE (RR 1.38; [1.12, 1.70]), Streptococci infection (RR 1.36; [1.04, 1.77]), intracardiac abscess (RR 1.22; [1.05, 1.42]), and Enterococci IE (RR 1.44; [1.28, 1.61]). In contrast, females had a higher incidence of mitral valve IE (RR 0.79; [0.67, 0.94]) and a higher in-hospital mortality rate (RR 0.84; [0.74, 0.96]). There were no major sex differences in the occurrence of valve vegetation, tricuspid valve IE, embolization, or Staphylococcus IE. Male patients had a longer in-hospital stay, although this was only marginally significant (RR 3.15; [-0.16, 6.45]; p = 0.06). Among patients who received surgery for IE, male patients had significantly lower mortality rates (RR: 0.67; [0.59, 0.76]; p&lt;0.01). Conclusions: Compared to females, males exhibit higher rates of aortic valve IE, IE-related surgical indications, intracardiac abscesses, streptococci IE, and enterococci IE. In contrast, females have higher rates of mitral valve IE and in-hospital mortality. Conversely, the incidence of stroke, embolization, and in-hospital stay duration is comparable between both sexes.
Abstract 4146462: Ablation versus Anti-arrhythmic Drug Therapy for Ventricular Tachycardia in Patients with Ischemic Heart Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Ubaid Khan, Ahmed Mazen Amin, Ahmed A. Ibrahim, Muhammad Imran, Mohamed Rakab, Arej Iltaf, Majd M. AlBarakat, chet ranabhat, Justin Brilliant, Kashif Chaudhry
Journal: Circulation (2024)

Background: Recurrent ventricular tachycardia (VT) is common in patients with ischemic heart disease (IHD), even with anti-arrhythmic drugs on board. While ICDs can abort VT episodes, ICD shocks can be painful. Ablation therapy can reduce the number of ICD shocks and interventions, but the optimal ablation technique is still uncertain. Purpose: We aim to review the clinical efficacy and safety of catheter ablation vs anti-arrhythmic drugs in patients with IHD. Methods: We conducted comprehensive searches across PubMed, CENTRAL, WOS, Scopus, and EMBASE until Feb 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024551760. Results: We included seven RCTs with a total of 836 patients. Patients who underwent ablation had a lower risk of VT storm compared to those who received anti-arrhythmic drugs [RR: 0.65 with 95% CI (0.49, 0.87), P &lt; 0.01), Compared to anti-arrhythmic drugs, the catheter ablation group also required less Appropriate ICD therapy [RR: 0.72 with 95% CI (0.57, 0.90), P &lt; 0.01), and fewer ICD shocks [ RR: 0.64 with 95% CI (0.45, 0.93), P = 0.02). However, there was no significant difference in VT recurrence [RR: 0.91 with 95% CI (0.74, 1.14), P = 0.42), all-cause mortality [RR: 0.87 with 95% CI (0.65, 1.16), P = 0.34), or any adverse events [RR: 0.96 with 95% CI (0.50, 1.84), P = 0.91) between the two groups. Conclusion: Our meta-analysis showed that catheter ablation was associated with a reduction in VT storm, ICD therapy, and ICD shocks. However, when compared to anti-arrhythmic drugs, catheter ablation for VT in IHD patients did not appear to afford any significant survival advantage.
Abstract 4145703: Sickle Cell Disease is Associated with Increased Readmission Rates in Patients Admitted with Acute Coronary Syndromes
Authors: Arif Mahmud, Orly Leiva, Ethan Loftspring, Miriam Osei, Sripal Bangalore, Sunil Rao
Journal: Circulation (2024)

Introduction: Acute coronary syndrome (ACS) is a leading cause of cardiovascular (CV) death. Sickle cell disease (SCD) is the most common inherited blood disorder in the United States and is associated with coronary microvascular dysfunction and impaired myocardial perfusion reserve. However, data on post-ACS outcomes in patients with SCD are scarce. Methods: Patients admitted with ACS from 2014-2020 with and without SCD were identified using the National Readmissions Database. In-hospital outcomes were death, major bleeding, stroke or arterial thromboembolism, and venous thromboembolism (VTE). Ninety-day readmission outcomes were CV-related, heart failure (HF) related, bleeding-related, and all-cause. Multivariable logistic or Cox proportional hazards were utilized with age, sex, chronic kidney disease, prior MI, prior stroke, prior VTE, pulmonary hypertension, STEMI, cardiogenic shock, revascularization, anemia, mechanical circulatory support use, hospital size and teaching status in addition to social factors as co-variables. Results: A total of 2,190,358 patients with ACS were included, of whom 1,471 (0.067%) had SCD. After multivariable adjustment, there was no difference in in-hospital mortality (OR 0.92; 95% CI 0.68-1.26) or major bleeding (OR 1.03; 95% CI 0.82-1.28) between patients with and without SCD. There was no significant difference in 90-day CV-related (HR 1.11; 95% CI 0.94-1.3) or bleeding-related (HR 0.86; 95% CI 0.49-1.52) readmissions between patients with and without SCD. However, SCD was associated with a higher rate of HF-related (HR 1.25; 95% CI, 1.04-1.52) and all-cause 90-day readmissions (HR 1.17; 95% CI, 1.04-1.32). Conclusion: Among patients admitted with ACS, SCD was not associated with increased risk of in-hospital outcomes though there was an association of increased HF-related and all-cause 90-day readmissions with SCD. Further investigation is needed to better characterize and improve outcomes of patients with SCD and ACS.