tbuckley/cabot-search huggingface dataset:
Abstract 16975: Wheel-Running Exercise Abrogates Enhanced Sympathetic Neural-Immune Interface in Aortic Adventitia of Angiotensin II-Infused Hypertensive Mice
Authors: Jae Min Cho, Enbo Zhu, Mehrdad Roustaei, Khoa Vu, Jonah Nahoul, Mark W Chapleau, Tzung K Hsiai
Journal: Circulation (2023)

Background: Artery stiffness causes cardiovascular pathology. Although mechanisms underlying endothelial dysfunction and arterial stiffness are well characterized, it is unknown if neural-immune interaction in aortic adventitia (AA) influences arterial stiffness. We hypothesized that sympathetic innervation and CD68 + macrophages are increased in AA of Angiotensin II (Ang II)-infused mice leading to increased arterial fibrosis and stiffness, and that voluntary wheel-running exercise (VWR) mitigates these effects. Methods and Results: In eight-week-old C57BL/6 male mice, Ang II was infused at 1.5 μg/g/day for 4 weeks with and without VWR. Mean arterial blood pressure [MAP] measured by tail-cuff averaged 135±11 mmHg in Ang II-infused mice (n=5) and 90±10 mmHg in vehicle-infused mice (n=4). Staining for markers of nerve fibers/bundles with Neurofilament A (NF200), sympathetic nerves with tyrosine hydroxylase (TH), nerve endings in AA with synapsin, and CD68 + macrophages were all increased in AA removed from Ang II-infused mice compared with vehicle-infused mice. The increases in CD68 + macrophages and extracellular matrix (ECM) were associated with elevated pulse wave velocity (PWV), an index for arterial stiffness (Ang II: p &lt; 0.05 vs. vehicle). scRNA-seq analyses further corroborated that Ang II infusion promoted fibrosis and macrophage-associated genes in AA. VWR significantly attenuated the Ang II-induced increases in MAP, sympathetic innervation, CD68 + expression, ECM, and PWV (Ang II+VWR: all p&lt;0.05 vs. Ang II). To chemically “denervate” the sympathetic nervous system, we injected 6-hydroxydopamine (6-OHDA, 100 mg/kg on day 0 and 250 mg/kg on day 2, then weekly for 4 weeks) or vehicle in Ang II-infused mice. 6-OHDA decreased MAP, sympathetic innervation, macrophage expression, ECM accumulation, and PWV (Ang II+6-OHDA: p&lt;0.05 vs. Ang II+vehicle, n=3). Conclusion: Ang II-induced hypertensive mice develop increases in sympathetic innervation and macrophages in close proximity within AA that define an enhanced sympathetic neural-immune interface in association with vascular fibrosis, arterial stiffness, and hypertension. VWR significantly mitigates these pathophysiological responses.
Abstract 15849: Studying the Effects of Race, Community Health, and Vascular Inequities on Outcomes for Peripheral Artery Disease: Principal Components Analysis of Community Health Metrics Using the Agency for Healthcare Research and Quality Social Determinants of Health Database
Authors: Matthew C Bunte, Zhuxuan Fu, Kay Sadik, Philip Jones
Journal: Circulation (2023)

Introduction: Healthcare disparities associated with peripheral artery disease (PAD) are influenced by differences in healthcare quality and social determinants of health (SDOH). Hypothesis: We used principal components analysis (PCA) to summarize key themes of community-level SDOH variables. Methods: This retrospective analysis used data from a single health system quality improvement database of patients diagnosed with PAD between 2016-2019. Subjects were geocoded to census tracts and variables from the Agency for Healthcare Quality and Research SDOH database were obtained to examine small-area variability in social, economic, educational, physical infrastructure, and healthcare contexts. PCA was used to identify major themes in SDOH heterogeneity across communities. Relevant SDOH variables were normalized within a data matrix and those with a loading value &gt;0.2 were retained in a principal component (PC). PCs with an eigenvalue &gt; 1.0 were identified to parsimoniously exemplify key themes. Results: Among 7,187 subjects with PAD, the mean age was 72.2 11.1 years, 45.9% were female, 9.4% self-reported as non-Hispanic Black, and 86.6% as non-Hispanic White. PCA was applied to 29 SDOH variables relevant to vascular health. PCA retained 6 PCs to an SDOH matrix describing 73.8% of variance in census tract level data. The greatest variance in data was attributed to socioeconomic advantage (PC1) and urbanicity/migration context (PC2) with some overlap in Black neighborhood context (PC3), income inequality (PC4), multi-race cohesion (PC5), and underrepresented minority context (PC6). Conclusions: PCA transforms high-dimensional SDOH data into distinct typologies of community health while retaining complex features of the data. Future analysis will weight these results within a hierarchical model that accounts for patient-level characteristics and quality of care to inform a more complete social-ecological model of whole-person vascular care.
Abstract 16462: Phenotypic Features of Lipidic Plaque in Patients With Polyvascular Disease: Findings From the Reassure Near-Infrared Spectroscopy Imaging Multi-Center Registry
Authors: Aya Katasako, Yu Kataoka, Sayaka Funabashi, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Hiroyuki Miura, Satoshi Honda, Shuichi Yoneda, Kensuke Takagi, Fumiyuki Otsuka, Itaru Takamisawa, Nishihira Kensaku, Yasuhide Asaumi, Kenichi Tsujita, Teruo Noguchi
Journal: Circulation (2023)

Introduction: Polyvascular disease (PolyVD) is a high-risk atherosclerotic phenotype presenting worse cardiovascular outcomes. However, its atherosclerotic features remain to be fully elucidated yet. Near-infrared spectroscopy (NIRS) imaging quantifies lipidic plaque associated with clinical outcome. Hypothesis: Given a clustering of atherogenic risks in PolyVD, PolyVD may exhibit a distinct plaque phenotype, which accounts for their outcome. Methods: 224 culprit lesions in 203 CAD patients receiving PCI were evaluated by NIRS imaging. PolyVD was defined as those with additional ASCVD (stroke and/or LEAD). NIRS-derived lipidic plaque feature (maxLCBI 4mm ) and clinical outcome (all-cause death+non-fatal MI+stroke) were compared in PolyVD and non-PolyVD subjects. Results: 28.6% of study subjects exhibited PolyVD. They were older (77 v. 71 years, p=0.02) with a greater frequency of CKD (61 v. 45%, p=0.03). Under the use of statin (81 v. 71%, p=0.15) and ezetimibe (32 v. 21%, p=0.09), PolyVD patients had a lower LDL-C level (73 v. 84 mg/dL, p=0.01). Despite their LDL-C control, maxLCBI 4mm did not differ in two groups (median: 458 v. 576, p=0.19). Moreover, 64% of PolyVD patients still showed maxLCBI 4mm ≧400 (69% in non-PolyVD, p=0.44). On multivariate analysis, ACS independently predicted maxLCBI 4mm ≧400 (Figure) in PolyVD patients. Of note, PolyVD presenting ACS had a higher maxLCBI 4mm (790 v. 411, p=0.001) compared to those without ACS, whereas this relationship did not exist in non-PolyVD (622 v. 561, p=0.19, Figure). During the 3-year observational period, PolyVD was associated with an elevated risk of MACE (p=0.002). Conclusions: Despite lowering LDL-C levels, PolyVD harbored a large amount of lipidic materials, accompanied by worse cardiovascular outcomes. Given the relationship of ACS with maxLCBI 4mm in PolyVD, additional therapies which modulates ACS-related inflammatory activity may be warranted to alter their disease substrate and outcomes.
Abstract 19002: Impact of Pulmonary Hypertension on Covid-19 Pneumonia Hospitalizations: Analysis of The National Inpatient Sample 2020
Authors: Mouna Kodali, Ramtej Atluri
Journal: Circulation (2023)

Background: SARS-CoV-2 swept across the globe, overwhelming healthcare systems across the world regardless of borders and socioeconomic factors. COVID pneumonia (CP) can result in ARDS and increased pulmonary artery pressures. Pulmonary hypertension (PHT) is generally a chronic cardiopulmonary disease that is associated with progressive vascular remodeling. We aimed to assess the impact of underlying PHT on CP patients with a large sample size. Methods: We utilized the National Inpatient Sample from 2020 to identify 1,058,815 hospitalized adults with CP. These hospitalizations were further stratified based on the presence of PHT. A multivariate regression model was used to adjust for confounders and analyze the variables. Results: Of those who were admitted for CP, 24,284 (2.3%) had PHT. In-hospital mortality was higher in those with PHT (19.6% vs 10.9%; p&lt;0.001). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital outcomes when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, CP patients with PHT had longer length of stay (LOS) by 1.3 days (p&lt;0.001) and had additional hospital costs (HC) of $23,232 (p&lt;0.001). Conclusions: CP patients who had PHT had significantly worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, arrhythmias, sepsis, cardiogenic shock, and being intubated. These patients are unable to tolerate the ventilation-perfusion mismatch and the rise in pulmonary arterial pressures seen in ARDS.
Abstract 13489: Sex Differences in the Association of Multi-Ethnic Genome-Wide Systolic Blood Pressure Polygenic Risk Score With Hypertension
Authors: Naman S Shetty, Akhil Pampana, Nirav Patel, Li Peng, Krishin Yerabolu, Mokshad Gaonkar, Garima Arora, Pankaj Arora
Journal: Circulation (2023)

Introduction: Hypertension affects about half the US adult population with a higher prevalence in males. This study examines the contribution of the genetic architecture to the sex-associated differences in hypertension in a multi-ethnic US population. Methods: Multi-ancestry genome-wide association studies for systolic blood pressure (SBP) were conducted for each sex separately in the UK BioBank. Sex-specific SBP polygenic risk scores (SBP-PRS), comprising 1.1 million variants each, were generated from these GWASs. Sex-specific SBP-PRS was calculated in participants who underwent whole genome sequencing in the All of Us project. Based on the SBP-PRS, the cohort was stratified into low (&lt;2.5 th centile), low-intermediate (2.5 th -20 th centile), intermediate (20 th -80 th centile), high-intermediate (80 th -97.5 th centile), and high (&gt;97.5 th centile) genetic risk of SBP. Hypertension was defined as a BP ≥130/80 mmHg or anti-hypertensive use. Logistic regression models were used to assess the sex-stratified association of SBP-PRS with hypertension. Results: The All of Us cohort had 212,669 individuals [median age: 54 (38, 65) years] comprising 127,679 (60.0%) females and 97,600 (45.9%) non-White individuals (20.6% Black, 3.3% Asian, and 19.1% Hispanic). Hypertension was reported in 118,984 (55.9%) in the overall population and in 53,307 (62.7%) males and 65,677 (51.4%) females. Females [OR adj : 1.29 (1.27-1.30)] had higher odds of developing hypertension per SD increase in SBP PRS compared with males [OR adj : 1.22 (1.20-1.23)]. (P interaction :2.5x10 -6 ) On stratification by SBP-PRS, females in the high-risk group and the low-risk group had higher odds of developing hypertension [OR adj : 1.81 (1.68-1.95) vs. 1.61 (1.46-1.74)] and lower odds of hypertension [OR adj : 0.52 (0.48-0.56) vs. 0.65 (0.60-0.71)], respectively compared with males. Conclusion: The contributions of the genetic underpinnings to the development of hypertension vary by sex.
Abstract 14758: Using Interprofessional Continuing Education to Identify and Address Knowledge and Practice Gaps Regarding Lipoprotein(a) as a Cardiovascular Risk Factor
Authors: Katie Robinson, Jennifer Frederick, Robert A Esgro
Journal: Circulation (2023)

Introduction: High levels of Lp(a) are an independent and casual risk factor for ASCVD, though there is a lack of standardization of assays, guidelines, and targeted treatments. Hypothesis/Goals: To provide a dynamic, expert-led interprofessional continuing education (IPCE) activity for cardiologists, primary care (PC) clinicians, and pharmacists to educate on evolving standards in the assessment and management of Lp(a) as a CV risk factor. Methods: Vindico Medical Education provided a 2-day IPCE webinar on February 11 and 25, 2023. Baseline knowledge and behaviors, educational impact, and persisting perceived challenges were assessed via pre-, intra-, and post-test. Results: Complete datasets were available for 1,364 HCPs (13% cardiologists, 18% PC, 53% pharmacists, 16% other). Baseline knowledge was lowest in all cohorts regarding Lp(a) assessment vs management, and higher among cardiologists vs other professional cohorts. Low baseline knowledge translated to poor baseline competence on case-based questions, particularly regarding assessment and desirable Lp(a) levels. Additionally, only 42% of cardiologists were currently recommending Lp(a) screening for patients. Regarding management, while most were aware that PCSK9 inhibitors produced the greatest reduction in Lp(a) levels, knowledge scores regarding the use of lipid-apheresis and emerging pharmacotherapies was low (30% and 49%, respectively). Moreover, 64% on average were using statins to reduce Lp(a), despite proven benefit. Overall there was a 146% relative increase in knowledge, though the top requested topics for additional education were updates on how and in whom to offer Lp(a) screening and testing, communicating with the interprofessional care team and patient, and options for Lp(a) management, particularly as new options become available. Conclusions: Cardiology, pharmacy, and primary care clinicians who manage at elevated CV risk have inadequate knowledge regarding Lp(a) screening and management. While the IPCE provided addressed these knowledge and practice gaps, continued education is needed to facilitate practice change towards optimal patient care. As new options for screening and treatment become available, continued education is warranted.
Abstract 17285: Impact of Baseline Yellow Plaque Assessed by Coronary Angioscopy on 11-month Vascular Response After Stent Implantation
Authors: Takuya Tsujimura, Takayuki Ishihara, Isamu Mizote, Daisuke Nakamura, Naotaka Okamoto, Tatsuya Shiraki, Itaya Naoki, Mitsuyoshi Takahara, takaharu nakayoshi, Osamu Iida, Yosuke Hata, Masami Nishino, Takafumi Ueno, Daisaku D Nakatani, Shungo Hikoso, Shinsuke Nanto, Toshiaki Mano, Yasushi Sakata
Journal: Circulation (2023)

Background: In-stent yellow plaque (YP) evaluated by coronary angioscopy (CAS) 1 year after stent implantation is associated with the future adverse cardiac event. However, the impact of baseline YP on vascular response has not been fully investigated. Methods: This was a sub-analysis of the Collaboraiton-1 study (multicenter, retrospective, observational study). A total of 88 lesions from 80 patients with chronic coronary syndrome who underwent percutaneous coronary intervention with polymer-free biolimus A9-coated stent or durable-polymer everolimus-eluting stent implantation were analyzed. Optical coherence tomography (OCT) and CAS were serially performed immediately and 11 months after stent implantation. YP was defined as the stented segment with yellow or intensive yellow color assessed by CAS. Neoatherosclerosis was defined as a lipid or calcified neointima assessed by OCT. Neointimal coverage (NIC) over the stent was classified into 4 grades by CAS: grade 0, stent struts fully visible; grade 1, stent struts bulging into the lumen, although covered; grade 2, stent struts embedded in the neointima, but translucently visible; and grade 3, stent struts fully embedded and invisible. OCT and CAS findings at 11 months were compared between the lesions with baseline YP (YP group) and those without YP (Non-YP group). Results: Baseline YP was detected in 37 lesions (42%). OCT findings at 11 months showed that the incidence of neoatherosclerosis was significantly higher in YP than Non-YP groups (11% versus 0%, P=0.028) and mean neointimal thickness tended to be lower (104±43 μm versus 120±48 μm, P=0.098). CAS finding at 11 months demonstrated that dominant and minimum NIC grades were significantly lower (Figure) and maximum yellow color grade was significantly higher in YP than Non-YP groups. Conclusions: Baseline YP affected the incidence of neoatherosclerosis as well as poor neointimal coverage at 11 months after stent implantation.
Abstract 16254: Short and Long-Term Outcomes of Patients With Cardiac Amyloidosis Presenting in Cardiogenic Shock
Authors: Raunak M Nair, Ankit Agrawal, Sanchit Chawla, Shashank Shekhar, Andrew Higgins, Ran Lee, Wael A Jaber, Penelope Rampersad, Paul C Cremer, Venu Menon
Journal: Circulation (2023)

Background: The characteristics and outcomes of patients with cardiac amyloidosis who present in cardiogenic shock (CS) remains poorly defined. Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records and confirmed via physician chart review. Patients were further categorized into those with CS with cardiac amyloidosis (C-Amyloid) and CS without cardiac amyloidosis. 30-day and 1-year all-cause mortality was compared between the two groups with Kaplan-Meier (KM) estimates. Results: During the study period, a total of 2775 were patients were admitted to our CICU with CS of which, 29 patients (1%) had confirmed cardiac amyloidosis (C-amyloid). Amongst patients with CS and c-amyloid, 18 patients (62%) had TTR amyloid, 8 (28%) had AL amyloid and 3 were undefined. Compared to patients with other forms of CS, patients with C-amyloid were significantly older (median age of 70 vs 65, p=0.024), had lower prevalence of prior myocardial infarction (21% vs 42%, p=0.037) or coronary artery bypass grafting, and a higher prevalence of chronic kidney disease (69% vs 39%, p=0.002). There were no significant differences in the utilization of right heart catheterization, mechanical circulatory support or mechanical ventilation between the two groups. Comparison of survival probabilities revealed that CS patients with amyloid had similar 30-day (17% vs 21%, p=0.56) and 1-year all-cause mortality (38% vs 31%, p=0.6). Conclusion: Amyloid cardiomyopathy is a rare but unique etiology of CS in the CICU. Observed mortality rates are similar to patients with other forms of CS. Given breakthroughs in therapeutics for this condition, the proportion of patients with this clinical entity is expected to rise.
Abstract 12496: Prognostic Value of Glasgow Prognostic Score and Its Modified Scores on 5-Year Outcome in Patients With Percutaneous Coronary Intervention
Authors: Jiawen Li, Yulong Li, Kailun Yan, Yuejin Yang, Jinqing Yuan, Xueyan Zhao
Journal: Circulation (2023)

Background: Glasgow Prognostic Score (GPS) is an inflammatory score commonly used in clinical practice. In recent years, its modified scores have emerged, including modified GPS (mGPS) and hs-CRP-modified GPS (hs-mGPS). However, the long-term predictive values of these three scores (GPS, mGPS, and hs-mGPS) in coronary heart disease (CHD) remains unclear. Aim: To assess the predictive values of GPS, mGPS, and hs-mGPS on long-term survival in patients following percutaneous coronary intervention (PCI). Methods: Consecutive 10,724 patients with PCI were enrolled in the year of 2013. The primary endpoint was 5-year all-cause death. Results: Finally, 8909 patients with complete clinical data and no loss of follow-up were included. According to the original scores, the risk of all-cause death in patients with a high score of GPS, mGPS, and hs-mGPS was significantly higher than that in patients with a low score. All GPS, mGPS, and hs-mGPS had predictive values for all-cause death with relatively lower AUC of 0.534, 0.522, and 0.545, respectively. In further analysis, we improved hs-mGPS by using hs-CRP 2 mg/L and albumin 40 g/L, and established the CHD-hs-mGPS. The AUC of CHD-hs-mGPS was 0.554 which was significantly higher than mGPS (P = 0.017) and was numerically higher than GPS and hs-mGPS in the total population. Of these four scores (GPS, mGPS, hs-mGPS, and CHD-hs-mGPS), only the CHD-hs-mGPS had a predictive value for both ACS and non-ACS subgroups. Conclusion: For CHD patients, GPS, mGPS, and hs-mGPS had significant long-term predictive value for all-cause death. The score we modified, CHD-hs-mGPS, simultaneously had a predictive value in the total population, ACS and non-ACS subgroups. These inflammatory scores can help early identification of high-risk patients in the patients with established CHD following PCI.
Abstract 15135: Timing of Percutaneous Coronary Intervention and Risk of New-Onset Acute Ischemic Stroke in Non-ST Elevation Myocardial Infarction: An Insight of National Inpatient Sample 2016-2019
Authors: Bo Shi, Shaobin JIA, Xueping Ma, Guangzhi CONG
Journal: Circulation (2023)

Introduction: Current guidelines recommend an early invasive strategy within 24 hours only in high-risk non-ST elevation myocardial infarction (NSTEMI). New-onset acute ischemic stroke (NAIS) is a rare but fatal complication of percutaneous coronary intervention (PCI). However, the effect of the timing of the PCI and the risk of NAIS in NSTEMI is not well defined. Hypothesis: Late PCI is associated with NAIS risk in NSTEMI. Methods: NSTEMI patients who underwent PCI were queried from the National Inpatient Sample Database (2016-2019) and stratified into three groups: early (&lt;24 h), medium (24-72 h), and late PCI (&gt;72 h). Multivariable logistic regression models were used to determine the timing of PCI and NAIS, adjusted for demographics, comorbidities, and hospital characteristics. Results: Among 633,115 weighted hospitalizations in 2016-2019, late PCI patients had a higher incidence of NAIS (1.3%) compared to early (0.67%) and medium PCI (0.71%). Late PCI patients were older, more likely to be female, and had a higher prevalence of comorbidities (diabetes mellitus, congestive heart failure, chronic pulmonary and renal disease, and atrial fibrillation) than early and medium PCI. After adjustment, only late PCI was significantly associated with a 55% increased NAIS risk (adjusted OR: 1.55 [95% CI: 1.30-1.84]). There was heterogeneity in the magnitude of risk by age and gender. Younger people (&lt;65 years) ( p for interaction &lt;0.0001) and males (interaction -value p =0.0433) were more likely to encounter NAIS. The incidence of NAIS increased from 2016 to 2019 in both medium and late PCI. Conclusions: Late PCI over 72 hours was associated with a higher risk of NAIS than PCI performed within 24 hours, particularly among young and male people.