tbuckley/cabot-search huggingface dataset:
Abstract 12734: A Sex-Stratified Analysis of Social Determinants of Health and Adverse Cardiovascular Outcomes in Atrial Fibrillation
Authors: Yusheng Zhou, Jonathan Houle, Marco Proietti, Valeria Raparelli, Colleen M Norris, Michal Abrahamowicz, Gregory Lip, Giuseppe Boriani, Louise Pilote
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) is associated with a heightened risk of adverse cardiovascular outcomes. Current prediction models often overlook potential sex differences, as well as the combined influence of gendered social determinants of health (SDOH) with traditional cardiovascular risk factors. The objective of this study is to compare the associations between social determinants and adverse outcomes in models stratified by sex. Methods: Participants were sourced from the EURObservational Research Programme-Atrial Fibrillation (ESC-EHRA EORP-AF) General Long-Term Registry. Alongside CHA 2 DS 2 -VASc variables, SDOH factors, including education, living arrangements, gender inequality index (GII), and EQ-5D-5L questionnaire subscales, were evaluated. The primary outcome was a composite of major adverse cardiovascular events (MACE) and all-cause mortality. We evaluated the predictive performance of various models using C-statistics, including individual CHA2DS2-VASc components, SDOH only, and a combined model. Results: Among 11,096 patients (mean age: 69.2 years; 40.7% females) from 27 European countries, sex-stratified analyses indicated fewer SDOH associations with composite outcomes in females compared to males. For both females and males, higher self-reported health and regular exercise were associated with lower risk of composite outcomes. In the male model only, a higher education level, higher GII, reduced mobility, reduced self-care ability, alcohol use, and smoking were all associated with an increased risk of MACE and all-cause mortality (Figure 1). The combined model demonstrated modest superior predictive performance, while the improvement when combining CHA2DS2-VASc and SDOH components appears more pronounced in males compared to females. Conclusions: The study highlights the distinct impact of SDOH in AF, with males exhibiting a wider range of SDOH factors associated with outcomes.
Abstract 17840: Impact of Age and Sex on Mortality Trends of Infective Endocarditis in High-Income Countries
Authors: Makoto Hibino, Subodh Verma, Deepak Bhatt, bobby Yanagawa
Journal: Circulation (2023)

Introduction: Incidence of infective endocarditis may relate to a variety of background conditions which may vary depending on age groups and sex in a country. Its national trends in each age group and sex among high-income countries are still unclear. Hypothesis: We hypothesized that mortality from infective endocarditis is without sex differences and has improved in all age groups in both sexes among high-income countries. Methods: The WHO mortality database was analyzed to determine trends in mortality from infective endocarditis in the UK, Germany, France, Italy, Japan, Australia, the USA, and Canada from 2000 to 2021. Age-standardized and age-specific (≤49, 50-64, 65-79, ≥80 years) mortality rates per 100,000 persons in either sex were compared by using male-to-female ratio. Trends were analyzed using joinpoint regression. Results: Age-standardized mortality rates ranged from 0.40 (95%CI, 0.38, 0.42) in Japan to 1.29 (95%CI, 1.23, 1.35) in France in the most recent year and showed increasing trends in all studied countries except for Japan with decreasing trends and the USA with constant trends. During the studied periods, age-standardized mortality was male-dominant in all countries (p&lt;0.0001). In age-specific analysis, three age groups (≤49, 50-64, 65-79 years) showed male dominancy in all countries while age group ≥80 years showed no sex difference except for France. Different mortality trends were identified between the sexes. In the USA, female mortality rates showed increasing trends in the age group ≤49 years while there were decreasing trends in the other three age groups. Male mortality rates showed constant trends in age groups ≤49 and 50-64 years while there were decreasing trends in the age group 65-79 and ≥80 years. Conclusions: Mortality from infective endocarditis was male-dominant in age groups less than 80 years old in all studied high-income countries. The different mortality trends between sexes among age groups need to be contextualized.
Abstract 18326: The Association of s Shockable Rhythm and Automated External Defibrillator Use With Outcomes in Infants With Out of Hospital Cardiac Arrest: A Study From the Cardiac Arrest Registry to Enhance Survival
Authors: Maryam Y Naim, Heather M Griffis, Bryan F McNally, Rabab Al-Araji, Robert Berg, sarita chung, Vinay M Nadkarni, Joshua M Tobin, Victoria L Vetter, Joseph Rossano
Journal: Circulation (2023)

Introduction: Defibrillation with an automated external defibrillator (AED) is critical in the chain of survival following a cardiac arrest caused by pulseless ventricular tachycardia and ventricular fibrillation. However, in 2022 the International Liaison Committee on Resuscitation could not make a recommendation for or against the use of AEDs in infants. Hypothesis: We aimed to describe the association of a shockable rhythm with outcomes in infants with out of hospital cardiac arrest (OHCA) and test the hypothesis that a shockable rhythm and AED use with defibrillation would be associated with improved neurologically favorable survival at hospital discharge by analyzing data from a large cardiac arrest registry in the United States Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age &lt; 1 year of age and non-traumatic OHCA from January 1, 2013 through December 31, 2021. The primary outcome was neurologically favorable survival defined as a Cerebral Performance Category Scale of 1 or 2. Results: A total of 10,108 infants with OHCA were evaluated of which 308 (3%) had a shockable rhythm and 9,800 (97%) had a non-shockable rhythm. Compared to infants with non-shockable rhythms infants with shockable rhythms were more likely to be white (37.7% white, 25.6% black, 7.5% Hispanic), have a witnessed arrest (44.5% vs. 16%), a non-home/public arrest (16.9% vs. 6.7%), and bystander AED application with defibrillation (19.4% vs. 0.18%) (p&lt;0.05 for all). Neurologically favorable survival (19.2% shockable vs. 4.2% non-shockable was higher in arrests with a shockable rhythm compared to non-shockable arrests, p&lt;0.001). AEDs were applied by bystanders in 1479 (14.5%) arrests and were associated with neurologically favorable survival (11% AED with defibrillation vs. 3.5% AED without defibrillation, p=0.002) Conclusions: Although infants infrequently had an OHCA with a shockable rhythm survival outcomes were superior in arrests with a shockable rhythm and in arrests where there was bystander AED use with defibrillation. These results emphasize the importance of AED use in infants with shockable rhythms following an OHCA.
Abstract 15036: Identification of Fabry Disease Cardiac Phenotype in Hypertrophic Cardiomyopathy With Cardiac Magnetic Resonance Imaging Technology
Authors: jialin li
Journal: Circulation (2023)

Introduction: Cardiac magnetic resonance(CMR), especially T1 mapping, has an important role in the diagnosis of Fabry disease, but the differential value in myocardial diseases with hypertrophic phenotype needs further study. More importantly, there has been no systematic study of the difference between different CMR techniques indistinguishing Fabry cardiomyopathy from hypertrophic cardiomyopathy (HCM). Hypothesis: Myomapping technology can be a parameter in distinguishing Fabry cardiomyopathy from HCM. Methods: We continuously included patients with clinically diagnosed hypertrophic cardiomyopathy, completed systematic magnetic resonance imaging, and used genetic testing as the diagnostic criteria. We reported the prevalence rate in the population of HCM, and deeply conducted comparative studies on the differences in magnetic resonance characteristics between Fabry disease and HCM. We also analyzed the diagnostic value of magnetic resonance imaging in distinguishing Fabry cardiomyopathy from HCM. Results: We continuously included patients diagnosed with hypertrophic cardiomyopathy at West China Hospital from 2012 to 2022 and completed systematic magnetic resonance imaging examinations. We reported the prevalence of Fabry cardiomyopathy in the population using genetic testing as the diagnostic criteria, and deeply conducted comparative studies on the differences in CMR features between Fabry disease and HCM. We also analyzed the diagnostic value of CMR in distinguishing Fabry cardiomyopathy from HCM. Conclusions: We found a prevalence of 13 (2.6%) cases of Fabry disease in the hypertrophic cardiomyopathy cohort (494 cases). Our further analysis found that there were no significant differences in the degree of hypertrophy, overall cardiac function and size of Fabry patients compared with patients with HCM, as well as strain analysis. NativeT1 was significantly reduced in Fabry disease, and segmental analysis found that the basal and middle ventricular septum and anterior wall were the most obvious. ECV differed significantly between the two groups. There was no difference in T2 between the two groups. ROC analysis showed that T1 had the most discriminating value
Abstract 11591: Mechanism of Finerenone-Induced Vasorelaxation in Arteries From Human Visceral Adipose Tissue
Authors: Francesca SCHINZARI, Alessandro De Stefano, Giuseppina Vizioli, Manfredi Tesauro, Carmine Cardillo
Journal: Circulation (2023)

Introduction: Inadequate perfusion has emerged as a main determinant of adipose tissue (AT) dysfunction in obesity, sparking interest about possible ways to improve it. Among several mechanisms, mineralcorticoid receptor (MR) signaling has been shown to play a key role in the cross-talk between AT and the vasculature. Hypothesis: This study, therefore, tested the vasoactive properties of finerenone, a nonsteroidal MR antagonist, in arteries harvested from human AT. Methods: Small arteries (&lt;1 mm in diameter) were isolated from visceral AT and studied ex vivo in a wire myograph. After vessels had been contracted, changes in vascular tone were determined under different experimental conditions. Results: Finerenone elicited a concentration-dependent relaxation in arteries of obese individuals contracted with the thromboxane A2 analogue U46619 (n=9; P&lt;0001 vs. baseline); the steroidal MR antagonist potassium canrenoate, by contrast, did not induce any vasorelaxation (n=3; P&gt;0.05). The relaxing effect of finerenone on U46619-induced constriction was not different in arteries from lean (n=3) and obese subjects (P=0.155). Mechanistically, the vasorelaxing response to finerenone was not influenced by pre-incubation with the nitric oxide (NO) synthase inhibitor L-NAME (n=4; P=0.19 vs. saline), hence ruling out an involvement of NO. Interestingly, finerenone was also able to relax arteries contracted with endothelin-1 (n=7; P&lt;0.001) or with high-K + solution (n=4; P&lt;0001), as well as those contracted with the L-type Ca 2+ -channel agonist BayK8644 (n=5; P=0.007); similarly, the calcium-channel blocker nifedipine induced relaxation of arteries contracted with BayK8644 (n=3; P&lt;0.001). Conclusions: Finerenone induces NO-independent vasorelaxation in arterioles from human visceral AT, likely through antagonism of L-type Ca2 + -channels. This finding identifies a novel action of finerenone to improve AT perfusion, thereby potentially expanding the emerging observations about the cardiovascular benefits of this agent.
Abstract 14305: Experiences of Racism and Risk of Preeclampsia: Results From the Black Women’s Health Study
Authors: Michelle Ogunwole, Kimberly A Bertrand, Julie R Palmer, Wendy L Bennett, Yong Zeng, Jacky M Jennings, Theresa Boyer, Akua Amoah, Roland J Thorpe
Journal: Circulation (2023)

Introduction: In the United States (US) Black women have higher rates of preeclampsia than White women, which contributes to cardiovascular disease disparities. Differences in traditional cardiometabolic risk factors do not fully explain this disparity, and there is growing consensus that experiences of racism may be a root cause. Few studies have evaluated associations between racism and preeclampsia, and none have done so among a cohort of exclusively Black women. Research Question: Are daily and institutional racism associated with preeclampsia among Black women? Methods: We analyzed data from the Black Women’s Health Study, a follow-up study of approximately 59,000 US Black women beginning in 1995. We included 5,315 women who were nulliparous at baseline and had their first pregnancy between 1995 and 2009. Racism was measured as a total daily racism score (reported as daily exposure to interpersonal racism) and an institutional racism score (reported as ever treated unfairly due to race with respect to police, housing, or job). We used unadjusted and adjusted (age at first birth, total gravidity, baseline education attainment, health insurance, smoking, alcohol use, and Body Mass Index) logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for preeclampsia in quartiles of daily racism and domains of institutional racism. A sensitivity analysis examined associations for women with only one birth. Results: Among 5,315 participants, 9.2% had preeclampsia. [BK1] Compared to women in the lowest quartile of exposure to daily racism, those in the highest quartile had 53% increased odds of preeclampsia (adjusted OR 1.53; 95% CI 1.14, 2.05). Compared to women with no history of institutional racism, the ORs for preeclampsia in women who experienced institutional racism in two or three domains were 1.37 (95% CI 1.04, 1.80) and 1.27 (95% CI 0.085,1.86), respectively. Results were similar among women with only one birth: compared to the lowest quartile, women in the highest quartile of daily racism had an 89% higher risk (adjusted OR 1.89; 95% CI 1.31, 2.75). Conclusion: Racism is associated with an increased risk of preeclampsia in US Black women and may contribute to their disproportionately high prevalence of preeclampsia.
Abstract 12262: Tumor Plop Sound: A Unique Phonographic Finding of a Giant Atrial Myxoma Presenitng as an Acute Decompensated Heart Failure
Authors: Deepa Soodi, Somto Nwaedozie, Milind Shah
Journal: Circulation (2023)

Introduction: Atrial myxoma (AM) is the most common primary cardiac benign tumor, with the most common location being the left atrium (LA) near the fossa ovalis. As the tumor enlarges, hemodynamic changes similar to mitral valve stenosis can occur. Case: A 51-year-old female without cardiac history was admitted with an acute onset of shortness of breath, started a few minutes prior to arrival at the emergency department. Her blood pressure was 158/74 mmHg, and her heart rate (HR) was 99 bpm, with other vitals remaining stable. Physical examination revealed a tumor plop murmur in left lateral position (Fig.1). Lab work, including CBC, CMP, and high-sensitivity troponins, was unremarkable except for an elevated D-dimer and BNP. EKG indicated sinus rhythm (80 bpm) without ischemic changes. Chest x-ray revealed bilateral opacities, treated with antibiotics. CTA ruled out pulmonary embolism but detected a large hypodense mass in the LA extending to the mitral valve and partially into the left ventricle. Transthoracic echocardiogram measured the mass at 3.5 x 5.2 x 2.8 cm (Fig. 2). The mean diastolic transmitral gradient was 28 mmHg at a heart rate of 92 bpm. The patient was evaluated by cardiothoracic surgeon and underwent excision of the AM following a negative coronary angiogram. Left ventricular end-diastolic pressure was elevated (24 mmHg). Biopsy confirmed cardiac myxoma. The patient was discharged home in stable condition on postoperative day 5. The tumor plop murmur was absent postoperatively (Fig. 1). Discussion: AMs are predominantly found in the LA (75%) or the right atrium (25%). Thrombus, vegetation, or malignant tumors can be differential diagnoses. Presentation varies based on mass characteristics, with symptoms like flow obstruction, embolism, arrhythmias, valve dysfunction, heart failure, and syncope. Transthoracic/Transesophageal echocardiogram aids diagnosis, while cardiac MRI is the gold standard. Surgical excision is the primary treatment for AMs.
Abstract 16744: Antibody Responses to Myocardial Antigens Released in the Context of a Myocardial Infarction
Authors: Johanna Siegel
Journal: Circulation (2023)

Our study aims to investigate antigen-specific B cell responses after myocardial infarction. Recent research has indicated that B cells and myocardial antibodies may contribute to the development of ischemic heart failure and dampen post-myocardial infarction repair. However, the antigen specificity of these myocardial antibodies remains unknown. To produce high-affinity antibodies, B cells typically undergo multiple rounds of somatic hypermutation and selection processes within the germinal center (GC) reactions of secondary lymphoid organs. Therefore, we sought to characterize the germinal center B cell responses and to examine the repertoire of B cell receptors (BCR) in C57BL/6J mice subjected to experimental myocardial infarction. Flow cytometry analyses showed increased frequencies of GC B cells in infarcted mice at 5 and 14 days post-surgery. However, sham-operated mice also showed similar increase in GC frequencies on day 14 post-surgery. Single-cell RNA/BCR sequencing analyses enabled the identification of GC B cell and plasma cell (antibody secreting) populations expressing unique B cell receptors in infarcted mice that were not found in sham-operated mice. Over time, the number of GC B cells increased accompanied by a progressive clonal expansion, indicating the development of antigen-driven B cell responses. By examining immunoglobulin variable gene rearrangements within single B cells, we identified distinct B cell lineages expressing mutated antigen receptors suggestive of affinity maturation. Selected BCRs of interested were then cloned into immunoglobulin expression vectors and expressed in immortalized human embryonic kidney cells. When incubated with histological myocardial slices, one of these unique BCR expressed showed binding to myocardial antigens. These findings support the notion that myocardial infarction can trigger germinal center B cell responses, which then lead to the production of high-affinity heart-specific antibodies. Moreover, the ‘track-and-clone’ approach herein described could help unraveling the antigen specificity and functional significance of these myocardial antibodies.
Abstract 18823: Outcomes With Pulmonary Artery Catheter Use in Cardiogenic Shock Patients
Authors: Ravi Thakker, Ramya L Sunku, Ayman Elbadawi, Jose Iturrizaga, Khaled Chatila, Aiham Albaeni, Hani Jneid, Wissam Khalife
Journal: Circulation (2023)

Introduction: Patients presenting with cardiogenic shock (CS) have a high mortality. Pulmonary artery catheter (PAC) is a well-known invasive tool for guiding escalation and de-escalation of treatments for CS patients. Despite this, paucity of data still exists in outcomes of PAC use in this critically ill population. In this systematic review of the current literature, we report outcomes in in-hospital mortality, length of stay (LOS), and mechanical circulatory support (MCS) use among patients with and without PAC implementation. Methods: A comprehensive search of the MEDLINE, Cochrane, and EMBASE databases was performed from inception to June 2023. Keywords used were “pulmonary artery catheter”, “PA catheter”, and “cardiogenic shock.” Studies without a control group (no PAC arm) were excluded. The endpoints were in-hospital mortality, LOS, and MCS use. Statistical analyses was performed using chi-squared test and t-test. Results: A total of 9 studies were identified for in-hospital mortality, 3 studies for LOS, and 7 for MCS. Among the 166,199 patients with PAC 49,983 died (30%) versus 391,399 among the 1,055,665 patients with no PAC (37%) (P=&lt;0.001). The average LOS among the 2,808 patients with PAC was 3 days versus 10.4 days among the 19,224 patients with no PAC (P=0.09). MCS was used in 51,975 patients of the total 175,838 with PAC (29.6%) versus 323,738 patients of the total 1,179,528 with no PAC (27.4%) (P=0.09). Discussion: In this large systemic review we found statistically significant decrease in in-hospital mortality with PAC use. There was a numerical trend towards average LOS being lower among patients with PAC use although not statistically significant. MCS was utilized more in patients with PAC although not statistically significant. Further studies are needed to identify discrepancies in PAC guided treatment of CS patients.
Abstract 14698: Effect of Torsemide vs. Furosemide Among Patients With New Onset and Worsening Heart Failure: The Transform-HF Randomized Trial
Authors: SELIM R KRIM, Senthil Anand, Stephen J Greene, ANQI CHEN, Daniel Wojdyla, Juan Vilaro, Haught Herbert, John M Herre, Eric L Eisenstein, Kevin Anstrom, Bertram Pitt, Eric J Velazquez, Robert J Mentz
Journal: Circulation (2023)

Introduction: In the TRANSFORM HF trial, among patients discharged after hospitalization for heart failure (HF), torsemide compared with furosemide did not result in a significant difference in all-cause mortality over 12 months. Hypothesis: Differences in clinical profiles, outcomes, and treatment effects may exist between de-novo and worsening chronic HF (WHF) patients. Methods: Using data from TRANSFORM-HF trial, we compared clinical characteristics, outcomes, and treatment effect of torsemide versus furosemide of patients hospitalized with de novo versus WHF. Endpoints included all-cause mortality and hospitalization outcomes over 12 months, as well as change from baseline in KCCQ-CSS. Results: Among 2,858 patients, 838 (29.3%) patients had de novo HF and 2,020 (70.7%) patients had WHF. Irrespective of ejection fraction phenotype, de novo HF patients were younger, had a higher GFR and lower levels of natriuretic peptides. In contrast, a higher discharge diuretic dose along with a higher use of nitrate/hydralazine was noted among WHF patients. De novo HF was associated with lower all-cause mortality (de novo 13.7% vs. WHF 31.3%; adjusted hazard ratio: 0.53; 95%CI [0.43-0.66]; p&lt;0.001). Similarly, lower all-cause first re-hospitalization (de novo 30.3% vs. WHF 42.5%; adjusted hazard ratio: 0.72; 95%CI [0.64-0.81]; p&lt;0.001) and greater improvement in KCCQ-CSS at 12 months (de novo 29.9 vs. WHF 23.7; adjusted estimated difference in means: 6.3; 95%CI [3.7-8.8]; p&lt;0.001) were noted among de novo HF patients. No significant differences in mortality or hospitalizations were noted with torsemide versus furosemide in either de novo or WHF (Figure). Conclusions: Among patients discharged with acute HF, de novo HF was associated with better outcomes when compared to WHF. Regardless of de novo vs WHF status, there was no significant difference between torsemide and furosemide with respect to 12-month clinical or patient-reported outcomes.