tbuckley/cabot-search huggingface dataset:
Abstract 4145354: Sex Differences in Body Composition of Heart Failure Patients and its Relationship with Exercise Performance
Authors: Taeil Yang, Jooyeon Lee, Moojun Kim, Jaewon Oh, Chan Joo Lee, Seok-min Kang
Journal: Circulation (2024)

Introduction: Bioelectrical impedance analysis (BIA) is a non-invasive method to assess body composition and fluid status. The aim of this study was to investigate the differences in body composition and exercise performance by HF type and sex. Methods: This study is a retrospective analysis of patients with HF who had left ventricular ejection fraction (LVEF) &lt;50% in a single tertiary center from August 2020 to December 2022. A total of 302 patients underwent body composition assessment using BIA, and exercise capacity was measured with a 6-minute walk test (6MWT). The type of HF was divided into ischemic and non-ischemic HF (NIC-HF). Ischemic heart failure (IC-HF) was defined as the presence of a history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Results: The median age of the study participants was 64 [IQR: 54.3 - 72] years old, and 209 individuals (69%) were men. Among male patients, 78 (37%) had IC-HF and 131 (63%) had NIC-HF. Among female patients, 17 (18%) had IC-HF and 75 (82%) had NIC-HF. There was no statistical difference in skeletal muscle mass, total muscle mass, body fat mass, and visceral fat area between the NIC-HF and the IC-HF groups in men. However, the IC-HF group had higher body mass index (27.5kg/m 2 vs 24.2kg/m 2 , p=0.009), body fat mass (p=0.002), and visceral fat area (p=0.002) than the NIC-HF group regardless of age, although there was no difference in total muscle mass (p=0.129) and body weight (64.3kg vs 58.4kg, p=0.07) in women. The 6MWT did not show any differences by HF type in men. However, in women, the IC-HF group had a shorter 6MWT distance than the NIC-HF group (p=0.02). The increased visceral fat area showed an association with a shorter 6MWT distance in both women (p=0.004), regardless of age and type of HF. Conclusion: After adjustment for age, there were no statistical differences in body composition between the two HF groups in the males. Unlike men, women had lower exercise capacity in the IC-HF group than in the NIC-HF group, which may be partly explained by the relationship between the difference in visceral fat area and exercise capacity according to heart failure type in women.
Abstract 4145632: Impact of Anemia on the Prediction of Galectin-3 for Cause-specific Mortality in Patients With Suspected or Known Coronary Artery Disease: The ANOX Study
Authors: Hiromichi Wada, Masahiro Suzuki, Morihiro Matsuda, Yoichi Ajiro, Tsuyoshi Shinozaki, Satoru Sakagami, Kazuya Yonezawa, masatoshi shimizu, Junichi Funada, Takashi Takenaka, Yukiko Morita, Toshihiro Nakamura, Kazuteru Fujimoto, Hiromi Matsubara, Toru Kato, Takashi Unoki, Daisuke Takagi, Kyohma Wada, Miyaka Wada, Takumi Nakayama, Yuka Maeda, Nobutoyo Masunaga, Mitsuru Ishii, Kazuhiko Kotani, Mitsuru Abe, Masaharu Akao, Koji Hasegawa
Journal: Circulation (2024)

Background: High circulating levels of galectin-3 are associated with all-cause and cardiovascular (CV) mortality in patients with coronary artery disease (CAD). However, the impact of anemia on the prediction of galectin-3 with cause-specific mortality in patients with suspected or known CAD is unknown. Methods: Serum levels of galectin-3 were measured in 2,418 patients with suspected or known CAD undergoing elective coronary angiography. The outcomes were all-cause death, CV death, and non-CV death. Patients were divided into 2 groups according to the presence (n=882) or absence (n=1,536) of anemia, and followed up over a 6-year period. Results: During the follow-up, 329 anemic and 207 non-anemic patients died of any cause, 116 anemic and 50 non-anemic patients died of CV diseases, and 187 anemic and 139 non-anemic patients died of non-CV diseases. After adjustment for potential clinical confounders and established CV biomarkers, log-transformed (Ln-) galectin-3 levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.23; 95% confidence interval [CI], 1.10–1.37) and non-CV death (HR, 1.30; 95% CI, 1.13–1.50), but not with CV death (HR, 1.16; 95% CI, 0.95–1.41) in the entire cohort; significantly associated with all-cause death (HR, 1.20; 95% CI, 1.03–1.41) and non-CV death (HR, 1.49; 95% CI, 1.20–1.85), but not with CV death (HR, 0.95; 95% CI, 0.72–1.24), in anemic patients; and significantly associated with all-cause death (HR, 1.33; 95% CI, 1.13–1.57) and CV death (HR, 1.19; 95% CI, 1.00–1.42), but not with non-CV death (HR, 1.17; 95% CI, 0.95–1.43), in non-anemic patients. We also evaluated the incremental predictive performance of galectin-3 by calculating continuous net reclassification improvement, and integrated discrimination improvement metrics. The addition of Ln-galectin-3 levels to the model with potential clinical confounders and established CV biomarkers further improved the prediction of all-cause death and non-CV death, but not that of CV death, in the entire cohort and in anemic patients, and the prediction of all-cause death and CV death, but not that of non-CV death, in non-anemic patients. Conclusions: In patients with suspected or known CAD, distinct differences were observed between anemic and non-anemic patients, in the prediction for cause-specific mortality by galectin-3 levels, which independently predicted non-CV mortality in anemic patients and CV mortality in non-anemic patients.
Abstract 4145435: Diagnostic Accuracy of Non-Invasive Assessments for Detecting Cardiac Transplant Rejection: A Meta-Analysis
Authors: Donghee Han, Kunal Shah, In-Cheol Kim, Lily Stern, Evan Kransdorf, David Chang, Michele Hamilton, Andriana Nikolova, Michelle Kittleson, Jignesh Patel, Daniel Berman, Jon Kobashigawa
Journal: Circulation (2024)

Background: After heart transplantation, endomyocardial biopsy (EMBx) is the standard diagnostic modality for acute rejection (AR). However, EMBx is invasive with some limitations to conventional histological interpretation. Non-invasive assessments, such as cardiac magnetic resonance Imaging (MRI) and donor-derived cell-free DNA (dd-cfDNA) assays, have emerged as viable methods for diagnosing acute rejection. This study aims to assess the diagnostic performance of cardiac MRI and dd-cfDNA for evaluating acute cardiac transplant rejection. Method PubMed and Web of Science were searched for relevant publications reporting on the use of dd-cfDNA or cardiac MRI for the detection of acute cardiac transplant rejection defined as acute cellular rejection (ACR) and/or antibody-mediated rejection (AMR), with EMBx as the reference standard. Pooled sensitivity, specificity, and hierarchical modeling-based summary receiver-operating characteristic (sROC) curves were calculated. Results: Out of 725 screened papers, 23 studies were included (10 studies with cardiac MRI and 13 studies with dd-cfDNA). Five studies considered only ACR as a rejection criterion, while eighteen studies included both ACR and AMR. The sensitivity and specificity for detecting acute transplant rejection were 0.68 (95% CI: 0.58-0.77) and 0.82 (95% CI: 0.74-0.88) for dd-cfDNA, and 0.79 (95% CI: 0.66-0.88) and 0.72 (95% CI: 0.62-0.81) for cardiac MRI. The areas under the hierarchical modeling-based sROC curves were 0.82 (95% CI: 0.78-0.85) for dd-cfDNA and 0.82 (95% CI: 0.79-0.85) for cardiac MRI. While there was no significant difference in the sROC between dd-cfDNA and cardiac MRI (p = 0.959), cardiac MRI had significantly higher sensitivity (p &lt; 0.001) and dd-cfDNA had significantly higher specificity (p = 0.001) ( Figure ) Conclusion: dd-cfDNA and cardiac MRI demonstrated comparable high diagnostic accuracy for acute cardiac transplant rejection. Given the high sensitivity of cardiac MRI and the high specificity of dd-cfDNA, combining these two non-invasive modalities may provide an effective screening strategy to detect acute cardiac transplant rejection and reduce the need of EMBx.
Abstract 4145628: Association Between Lipoprotein A Levels and Vulnerable Atherosclerotic Plaques: Meta-Analysis
Authors: Arankesh Mahadevan, Samyuktha Prabu, Hemanth Dhananjaya, Himanshu Jog, Mansi Patel, Rashmi Gawde, Ninia Goyal, Rupak Desai
Journal: Circulation (2024)

Introduction: Lipoprotein A (LpA), an inherited, soluble protein formed in the liver, may be useful as a risk stratification tool for atherosclerosis. Asymptomatic atherosclerosis with a high tendency to rupture is known as vulnerable plaques, which can be defined with common morphologies such as thin-cap fibro-atheroma with a thin layer of depleted smooth muscles (TCFA) or a lipid-rich (LR) plaque. Hypothesis: A high LpA level is associated with an increased risk of vulnerable plaques, defined as TCFA or LR plaque. Methods: A systematic search of PubMed, SCOPUS, and Embase databases was conducted to find and include relevant observational studies that compared LpA levels with two primary outcomes of plaque vulnerability, TCFA or lipid-rich plaques. A total of 196 studies were identified, 67 underwent initial screening, and 15 were assessed for full-text eligibility. The random effects model was used to pool binary outcomes as odds ratios (OR) with 95% confidence intervals (CI), and the results were presented on forest plots. Sensitivity analysis was performed using the leave-one-out method, and heterogeneity was identified using I2 statistics. Publication bias was assessed using the Luis Furuya-Kanamori (LFK) index. Results: A total of 6 studies were included in our analysis, comprising three retrospective cohort studies and three prospective cohort studies involving 806 patients, out of which 503 were defined as low LpA and 303 as high LpA. Our analysis revealed that high LpA levels were associated with greater odds for both TCFA (OR 2.61 95% CI:1.30-5.24, p&lt;0.01) and LR plaques (OR 2.80 95% CI: 1.23-6.39, p=0.01). Leave-one sensitivity analysis confirmed the stability of our analysis. High heterogeneity values of I2=66% for TCFA and I2=76% for lipid-rich plaques (p&lt;0.01) were observed. However, the LFK index suggested major asymmetry for both outcomes (TCFA: 2.01 and LR plaque: 2.9), indicating the potential of publication bias to confound our results. Conclusions: Our analysis, the first of its kind, reveals an association between higher LpA levels and plaque vulnerability.
Abstract 4146266: Long-term temporal trend in Plaque eccentricity assessed through Intravascular ultrasound observations after heart transplantation.
Authors: Kai Nogami, Ilke Ozcan, Yoshihisa Kanaji, Lilach Lerman, Rajiv Gulati, Amir Lerman
Journal: Circulation (2024)

Background: Cardiac allograft vasculopathy (CAV) is one of the leading causes of graft failure and death after heart transplantation (HTx). Conventionally, CAV is characterized by concentric intimal thickening, however the long-term progression patterns of plaque morphology are not yet well understood. Research Question: This study aimed to assess the plaque morphology, including histology and eccentricity, in a temporal manner post-HTx using virtual histology intravascular ultrasonography (VH-IVUS). Methods: We included 50 patients who underwent serial VH-IVUS assessment at three assessment points (A1:0-1 year, A2:3-5 years, A3:7-10 years) after HTx. Differences in VH-IVUS findings between timepoints A1 to A2 (early period) and A2 to A3 (late period) were investigated. Plaque volume index was defined as (plaque volume/vessel volume) × 100%. Eccentricity index (EI) was defined as (maximum intimal thickness – minimum intimal thickness)/maximum intimal thickness and was evaluated in 39 patients with significant plaque (maximal intimal thickness &gt;0.50 mm at the A3) at each timepoint. The serial changes of EI and relationship between EI and other VH-IVUS findings were investigated. Results: Of 50 patients, mean age was 51±13 years, 36 (72%) were males. In both early and late periods, the plaque volume (PV) index showed a significant increase, however, the rate of progression was significantly slower in late period. (5.8% [0.9, 13.2] vs 2.4% [-0.2, 7.4], p=0.015). The EI showed a trend of decrease in the early period, compared to increases in the late period (-0.040 [-0.103, 0.004] vs 0.003 [-0.030, 0.052], p=0.036). Patients with EI change in late period higher than median value had significantly lower proportion of fibrous plaque (70.8% [67.2, 75.1] vs 62.7 [55.5, 66.9], p=0.002) and higher dense calcium (1.1% [0.9, 1.9], 4.5% [1.8, 6.9], p=0.022) at A3. Conclusion: In heart transplant patients, coronary artery plaque progression in the late period showed more eccentric progression with lower fibrous plaque composition, a pattern commonly observed in typical and conventional coronary atherosclerosis. These findings may provide a novel mechanism and therapeutic insight into the temporal patterns in CAV progression during long term follow up.
Abstract 4146232: Kidney Transplant Outcomes From Deceased Donors Who suffered Acute Kidney Injury: Systematic Review and Meta-Analysis
Authors: Ivo Queiroz, Arthur Tavares, Lucas Barbosa, Cynthia Mesquita, Giovanna Leandro, Christian Fukunaga, Tulio Pimentel, Arthur Monteiro, Maria Luiza Rodrigues Defante, Vanio do Livramento Junior Antunes
Journal: Circulation (2024)

Background: Kidney transplant is the most common transplanted organ in the world. However, the efficacy of transplants from deceased donors with acute kidney injury (AKI) before transplantation is a matter of debate. For this reason, we performed a meta-analysis to assess the outcomes of kidney transplants from deceased donors with AKI when compared to non-AKI deceased donors. Methods: We systematically searched MedLine, Embase, and Cochrane databases for studies comparing kidney transplants from deceased donors with AKI compared to those without AKI. The endpoints were Acute Rejection (AR), Delayed Graft Function (DGF), and Graft Failure (GF). We calculated event prevalence with risk ratios for binary outcomes, along with 95% confidence intervals (CI). Statistical analysis was performed using R version 4.3.2. A random-effects model was used for all outcomes, and heterogeneity was assessed with Cochrane's Q and I2 statistics. Results: We included 10 retrospective cohort studies, that comprised 68,619 patients, where 33,623 (49%) were females after we disposed of major overlapping populations. We found that the overall risk of AR, DGF, and GF to be respectively (RR 0.93; 95% CI: 0.88 to 0.98; p&lt;0.01; Figure 1), (RR 1.36; 95% CI: 0.98 to 1.90; p=0.07; Figure 2) and (RR 0.93; 95% CI: 0.84 to 1.03; p=0.16; Figure 3). The subgroup of stage 3 AKI showed an increase in the risk of DGF (RR 1.68; 95% CI: 1.28 to 2.19; p&lt;0.01; Figure 2) for these donors. Conclusion: In our Meta-analysis, we found that there’s no difference in the outcomes between AKI and non-AKI deceased donors. However, there is an increase in the risk of DGF in organs from deceased donors with stage 3 AKI. More studies are warranted to assess these results.
Abstract 4145437: Factors Associated with the Development of Incident Chronic Hypertension in the Postpartum Period: An Electronic Medical Record Analysis
Authors: Jennifer Lewey, Manyun Zhao, Megan Sheehan, Heather Burris, Jordana Cohen, Lisa Levine, Jinbo Chen
Journal: Circulation (2024)

Background: Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, are associated with increased risk of cardiovascular disease (CVD) later in life. This effect is strongly mediated by the subsequent development of chronic hypertension (HTN). Our objective is to identify clinical factors associated with incident HTN in a racially diverse cohort of postpartum patients using electronic health record (EHR) data. Methods: We identified patients with a delivery at Penn Medicine between 2012 and 2020 who did not have chronic HTN prior to delivery. The primary outcome was HTN between 6 and 24 months postpartum. HTN was identified based on ≥1 ICD code or ≥2 blood pressures (BP) ≥140/90. Univariable and multivariable logistic regression was used to model the association between patient factors assessed during pregnancy through the 6-week postpartum visit and incident HTN. Results: In the final cohort of 34,074 unique patients, mean age was 29.6 years, 42% identified as Black, and 38% had Medicaid insurance. A total of 1,078 patients (3.2%) developed incident HTN between 6 and 24 months postpartum. HTN was more common in patients with HDP compared to those without HDP (8.6% vs. 1.6%, p&lt; 0.001). Factors independently associated with HTN are listed in the Table. After adjusting for patient demographics and clinical factors, older maternal age, Black race (vs. White race), preterm birth, obesity, diabetes, HDP, and 6-week postpartum systolic BP (SBP) were associated with HTN. HDP (OR 3.8, 95% CI 3.2, 4.5) and pre-pregnancy BMI ≥35 kg/m2 (OR 2.2, 95% CI 1.8, 2.7) were associated with the highest odds of incident HTN. Every 1 mmHg increase in postpartum SBP was associated with a 6% higher odds of incident HTN, after adjusting for HDP and other clinical factors. Conclusions: Patient factors that are routinely collected in the EHR, including HDP and BMI, are strongly associated with increased risk of developing incident HTN between 6-24 months postpartum in a racially diverse cohort. SBP at 6-weeks postpartum is an independent and underappreciated risk factor for HTN. Future work will develop and validate prediction models of incident postpartum HTN in this population at risk for CVD.
Abstract 4145433: The Association of PREVENT-HF Risk Estimates with Subclinical (Stage B) HF and Clinical Implications for HF Risk: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Jelani Grant, Sui Zhang, Sadiya Khan, Bige Ozkan, VIJAY NAMBI, Ambarish Pandey, Roger Blumenthal, Christie Ballantyne, Elizabeth Selvin, Kuni Matsushita, Amil Shah, Joe Coresh, Chiadi Ndumele
Journal: Circulation (2024)

Background: PREVENT-HF is a risk prediction tool recently developed by the AHA to estimate heart failure (HF) risk. The association of PREVENT-HF with measures of subclinical HF (stage B HF), and the clinical implications of subclinical HF measures within PREVENT-HF categories are undefined. Methods: We performed a prospective analysis of 2,716 ARIC participants &lt;80 years of age without prevalent HF or atherosclerotic cardiovascular disease who attended Visit 5 (2011-2013). We grouped participants into PREVENT-HF 10-year risk categories (&lt;7.5%; ≥ 7.5 to &lt; 10%; ≥ 10 to &lt; 15%; ≥ 15 to &lt; 20%; and ≥ 20%). We identified stage B HF based on elevated cardiac biomarkers (N-terminal pro B-type natriuretic peptide ≥125 pg/mL or high sensitivity troponin T ≥22 ng/L for men and ≥14 ng/L for women) and/or abnormal cardiac function or structure on echocardiography (echo). We assessed the prevalence of subclinical HF within each PREVENT-HF category. We calculated HF incidence rates (IRs) within each PREVENT-HF category and assessed HF IRs for those with elevated cardiac biomarkers alone, abnormal echo alone, both abnormal or neither. Results: The mean age was 74 years, with 63% women and 22% Black adults and with 16%, 18%, 33%, 19% and 13% in PREVENT-HF 10-year risk categories of &lt;7.5%; ≥ 7.5 to &lt; 10%; ≥ 10 to &lt; 15%; ≥ 15 to &lt; 20%; and ≥ 20%, respectively. Higher PREVENT-HF estimated risk was associated with subclinical HF with the highest frequency of combination of both abnormal biomarkers + abnormal echo in 37% with PREVENT-HF ≥ 20%. Higher PREVENT-HF score was associated with a stepwise increase in HF IRs (Figure). Individuals with PREVENT-HF &lt;10% had relatively low IRs for HF even in the presence of abnormal biomarkers + echo. In participants with higher PREVENT-HF scores, the presence of abnormal biomarkers + echo identified a subgroup at very high HF risk (IRs of 37 and 51 per 1000 person-years in those with PREVENT-HF ≥15 to &lt; 20% and ≥20%, respectively), while the absence of abnormal biomarkers or echo identified a lower risk group. Conclusion: Stage B HF improves HF risk stratification in those with higher PREVENT-HF estimates but provides limited utility for absolute HF risk stratification in those with PREVENT-HF &lt;10%.
Abstract 4145445: Sex Differences in Time from Referral to Procedure, Functional Capacity, and Quality of Life Improvement After Transcatheter Aortic Valve Replacement
Authors: Meghali Singhal, Bryce Jones, Maha Gul, Samantha Yim, Colin Shafer, Peter Baay, Dominic Tedesco, Bina Ahmed, Michael Shenoda, Joe Aragon
Journal: Circulation (2024)

Background: Transcatheter aortic valve replacement (TAVR) has been shown to improve survival and quality of life (QOL). The Kansas City Cardiomyopathy Questionnaire (KCCQ) monitors four domains of valvular heart disease (physical limitation, symptom frequency, social limitation, and QOL) before and after TAVR, yielding an overall summary score (KCCQ-OS). Prior studies have acknowledged sex-based discrepancies in baseline health status prior to TAVR, such as older age and fewer cardiovascular comorbidities among females. However, time from initial referral to procedure date may contribute to sex-based differences in KCCQ-OS before and after TAVR. Methods: We compared differences between pre-procedure and post-procedure KCCQ-OS, assessed at 30-day and 1-year follow-up in 649 patients (353 males and 296 females) who underwent TAVR at Santa Barbara Cottage Hospital between 2015 and 2024. We also examined differences in baseline patient characteristics including age, co-morbidities, and time to procedure from initial referral date. Results: Females were older and had a higher prevalence of hypertension compared to males (80.1% vs 78.8%) but lower prevalence of all other traditional cardiovascular comorbidities. Females had significantly lower baseline KCCQ-OS compared to males (56.17 ± 26.01 vs 61.58 ± 26.09, p = 0.003) (Figure 1). Compared to baseline scores, all patients had significant increases in their scores at post-TAVR 30-day and 1-year follow-up (p &lt; 0.001) (Figure 1). At both 30-day and 1-year follow up, males had higher KCCQ-OS compared to females [(87.37 ± 16.55 vs 84.24 ± 16.91, p = 0.009), (87.87 ± 16.61 vs 85.42 ± 17.82, p = 0.04)] (Figure 1). Time to TAVR (days) from initial referral was significantly higher not only in patients under the age of 80 (p = 0.01) but also in females compared to males (p = 0.02) (Figure 1). Conclusion: Females consistently had lower KCCQ-OS at baseline and post-TAVR, indicating measurements of lower functional capacity and quality of life compared to males. Despite fewer comorbidities at baseline, the impact of delays from referral to procedure data among females may contribute to lower KCCQ-OS before and after TAVR.