tbuckley/cabot-search huggingface dataset:
Abstract 15301: Sustained Presence of Left Ventricular Hypertrophy is Accompanied by Increased Cardiovascular Morbidity in Essential Hypertensives
Authors: D. Tsiachris, C. Tsioufis, V. Antonakis, K. Dimitriadis, D. Flessas, F. Lagiou, S. Galanakos, A. Milkas, D. Roussos, D. Tousoulis
Journal: Circulation (2015)

Hypothesis: To investigate the prognostic role of left ventricular hypertrophy (LVH) regression regarding incidence of cardiovascular diseasein essential hypertension. Methods: We prospectively followed up for a median period of 3.8 years 1226 essential hypertensives (mean age 57.8 years, baseline office BP=143.6/89.3mmHg). All subjects visited periodically the outpatient hypertensive unit of our institution and office BP at follow up was calculated based on the measurements of the last 3 visits. Echocardiographic evaluation and determination of the metabolic profile and creatinine levels was performed at entry and at follow up. LVH was defined as LV mass index ≥116g/m2 in men and LV mass index ≥96g/m2 in women. Endpoint of interest was the incidence of stroke, coronary artery disease and their composite. Results: At the end of follow up the incidence of the composite end-point was 4.0% (17 patients with stroke, 34 with CAD, 2 with both). According to the presence of LVH at baseline (20.2%) and at the end of follow-up (15.9%) patients were divided in two groups: with normal LV mass index at both examinations or with LVH at baseline and regression of hypertrophy (n=1031, 84.1%, group 1) and with LVH at baseline and at follow-up and with normal LV mass index at baseline and LVH at follow-up (n = 195, group 2). Hypertensives of group 2 compared to those of group 1 were older (by 6.3 years, p&lt;0.001), more frequently females (by 19%, p&lt;0.001) and had at baseline greater duration of hypertension (by 2.6 years, p&lt;0.001), increased number of antihypertensive drugs (by 0.6, p&lt;0.001) office pulse pressure levels (by 5mmHg, p&lt;0.001), increased body mass index (by 0.8kg/m2, p=0.024), glucose (by 7.4 mg/dl, p&lt;0.001) and decreased creatinine clearance (by 10.5 ml/min/, p&lt;0.001).Survival analysis revealed that hypertensives without LVH regression (group 2) compared to those of group 1 exhibited significantly higher rates of stroke (5.1% vs. 0.7%, log rank p&lt;0.001) and the composite end-point (7.7% vs. 3.3%, log rank p=0.020). Conclusions: Lack of regression of LVH is accompanied by increased incidence of stroke and combined cardiovascular disease in essential hypertensives.
Abstract 13891: Prognostic Value of Simple Risk Index at Discharge in Patients Admitted for Acute Decompensated Heart Failure With Reduced or Preserved Left Ventricular Ejection Fraction
Authors: Takahisa Yamada, Takashi Morita, Yoshio Furukawa, Shunsuke Tamaki, Yusuke Iwasaki, Masato Kawasaki, Atsushi Kikuchi, Takumi Kondo, Tatsuhisa Ozaki, Masahiro Seo, Yoshihiro Sato, Iyo Ikeda, Eiji Fukuhara, Makoto Abe, Jun Nakamura, Masatake Fukunami
Journal: Circulation (2016)

Backgrounds: Increased heart rate (HR) and low systolic blood pressure (SBP) are associated with adverse clinical outcomes in patients (pts) admitted for acute decompensated heart failure (ADHF). It has been reported that simple risk index (SRI) based on easily assessed clinical characteristics (age, HR, and SBP) is useful for the prediction of short-term mortality in pts with acute myocardial infarction. However, there is no information available on the prognostic significance of pre-discharge SRI in pts admitted for ADHF relating to reduce or preserved left ventricular ejection fraction (HFrEF or HFpEF). Methods and Results: We studied 303 consecutive ADHF pts discharged with survival (HFrEF(LVEF&lt;50%);n=163, HFpEF(LVEF≥50%);n=140), and obtained clinical characteristics, conventional hemodynamic parameters and laboratory data. SRI was calculated as (HRх[age/10] 2 )/SBP. During a follow up period of 4.2±3.3 yrs, 96 pts had all-cause death. In HFrEF group, at multivariate Cox analysis, SRI at the discharge (adjusted hazard ratio:1.055[95%CI 1.029 to 1.081], p&lt;0.0001) was significantly associated with total mortality, independently of prior heart failure hospitalization, and serum sodium and albumin levels after adjustment for anemia and renal function. The mortality risk significantly increased by SRI tertiles (lowest tertile [&lt;26.3]: 19%, middle tertile [26.3-36.3]: 38% and highest tertile [&gt;36.3]: 54%, p=0.0001). In HFpEF group, SRI at the discharge (adjusted hazard ratio:1.065[95%CI 1.022 to 1.109], p=0.0026) was also significantly associated with total mortality, independently of anemia and serum sodium level after adjustment for renal function. Pts with highest and middle SRI tertile had a increased risk of total mortality than those with lowest tertile (30% vs 28% vs 13%, p=0.002, respectively). Conclusion: SRI at the discharge would provide the long-term prognostic information in ADHF pts, regardless of HFrEF or HFpEF.
Abstract 19178: Cost Effectiveness of Therapeutic Drug Monitoring in Facilitating BP Control in Resistant Hypertension
Authors: Stephanie K Brinker, Ambarish Pandey, Colby Ayers, Fayez Raza, Angela Price, Debbie Arbique, Sandeep Das, Ethan A Halm, Norman Kaplan, Wanpen Vongpatanasin
Journal: Circulation (2013)

Nonadherence to antihypertensive medications is a major contributor to cardiovascular morbidity and mortality in the U.S. Recent studies have implicated Therapeutic Drug Monitoring (TDM) as a reliable method in monitoring adherence to antihypertensive medications in patients with resistant hypertension (RH) defined as BP 140/90 mmHg despite self-reported adherence to ≥ 3 antihypertensive drugs. However, the relationship between cost of testing and potential benefit of TDM in RH has not been assessed. We performed retrospective analysis of all new patients referred to the University of Texas Southwestern Medical Center Hypertension Clinic with RH between 2009-2012. Of 397 patients referred, 185 met criteria for RH. We found that 32 of 57 patients (57%) had undetectable serum levels of ≥ 1 drug screened, indicating medication nonadherence. Despite higher baseline BP (170/103 for non-adherent vs. 166/87 mmHg for adherent, p &lt; 0.01), the magnitude of BP reduction was significantly greater for non-adherent vs. adherent patients (reduction in SBP 43±7/23±4 mmHg vs. 15±5/5±2 mmHg, p &lt; 0.01) when the nonadherent patients were given feedback regarding their undetectable serum drug levels as part of their care. This greater reduction in BP was not explained by differences in treatment intensification (intensification score 0.02 for adherent vs -0.02 for non-adherent, p = 0.2). The median cost of TDM was $301 (224-544) in the non-adherent group vs. $277(140-375) in the adherent group (p = 0.2). Using bootstrap analysis with 1000 replication, we found the incremental cost per mmHg reduction in BP associated with TDM was $4.9, (3.8, 5.9), which is comparable to cost associated with many antihypertensive devices shown to be effective in reducing BP in resistant hypertension. In summary, our data suggested that therapeutic drug monitoring is cost effective in optimizing BP control in RH.
Abstract 14009: Serum NMR Metabolomics Identifies Similar Associations of Lipoproteins and Lipids With Risk of Myocardial Infarction and Ischemic Stroke but Not With Hemorrhagic Stroke
Authors: Michael V Holmes, Iona Y Millwood, Christiana Kartsonaki, Michael R Hill, Ruth Boxall, Robin G Walters, Mika Ala-Korpela, Sarah Parish, Robert J Clarke, Zhengming Chen
Journal: Circulation (2016)

Introduction: In observational studies, major circulating lipids (e.g. low density lipoprotein cholesterol) are associated with risk of myocardial infarction (MI) and ischemic stroke (IS), but their relationship with hemorrhagic stroke (HS) is not reliably established. An extensive panel of lipoprotein subclasses can be analysed by serum NMR metabolomics. Hypothesis: Circulating concentrations of lipoprotein particles and lipid constituents show similar patterns of association with risk of MI, IS and HS. Methods: The prospective China Kadoorie Biobank recruited 512,891 Chinese adults from 2004-08 with 7 years follow-up for incident events from registry and health insurance records. In a nested case-control study of 938 MI, 1276 IS and 1274 HS incident cases with 1355 controls, lipoprotein and lipid-related traits were quantified in baseline samples using serum NMR metabolomics. For each outcome, logistic regression yielded adjusted odds ratios (OR) associated with individual lipoprotein and lipid traits. Results: Concentrations of lipoprotein particles and their lipid components showed similar patterns of association with risk of MI and IS: risk increased with higher concentrations of very-low-, intermediate- and low-density lipoproteins (Figure). By contrast, for high density lipoproteins (HDL), increases in large particle concentration or lipid components were associated with reduced risk of both MI and IS, whereas medium HDL associated with reduced risk of MI but not IS. Small HDL showed null associations with MI and a trend towards increased risk of IS. No lipoprotein or lipid-related trait showed apparent associations with HS risk. Conclusions: Concentrations of lipoprotein particles and their lipid constituents show similar patterns of association with risk of MI/IS, whereas no associations were identified for HS. This suggests different etiologies and casts doubt on whether lipid-related traits play a major role in the etiology of HS.
Abstract 13901: Significance of Rotor Activation Observed Outside of the Pulmonary Vein for the Maintenance of Atrial Fibrillation: Three-dimensional Analysis Using a Non-contact Mapping System
Authors: Hiroshige Yamabe, Hisanori Kanazawa, Miwa Ito, Shozo Kaneko, Yusuke Kanemaru, Takuya Kiyama, Hisao Ogawa
Journal: Circulation (2016)

Background: It has been suggested pulmonary vein (PV) acts as the driving sources of atrial fibrillation (AF). However, it is unclear whether the rotor, which is located outside the PV, also maintains the AF. Objectives: To define the prevalence and significance of rotor observed outside the PV in the left atrium (LA), LA activation sequence was analyzed during AF after PV isolation. Methods: Endocardial mapping of LA was performed in 25 AF patients (9 paroxysmal and 16 persistent AF) using a non-contact mapping system (EnSite 3000) during AF perpetuated after PV isolation. Presence of rotor activation was defined when the circular activation around the functional block line once completed its whole reentrant activation. To define the role of rotor for the maintenance of AF, the number of pivoting activation involved in the rotor activation was compared with that not involved in the rotor activation. Further, the activation time involved in the rotor activation was compared with that not involved in the rotor activation. Results: Rotor was identified in 14 (56%) patients (3 paroxysmal and 11 persistent AF patients). Rotor was observed at the septum (8 patients), roof (4 patients), anterior (3 patients) and posterior (1 patient), respectively. The number of rotor activation was 1.5±1.8 times/sec. Total number of pivoting activation was 9.2±6.5 times/sec. The number of pivoting activation involved in the rotor activation was significantly fewer than that not involved in the rotor activation (2.7±3.0 vs. 6.5±5.4 times/sec, p=0.0034). The activation time in which the rotor was observed in the LA occupied 18.5±21.1 % of the total recording intervals. Thus, the percentage of activation time involved in the rotor activation was significantly lower than that not involved in the rotor activation (18.5±21.1% vs. 81.5±21.1%, p&lt;0.0001). Conclusions: Rotor activation was observed outside the PV in only half of AF patients. Further, most of pivoting activations were not involved in the rotor activation and the activation time involved in the rotor activation occupied a limited interval during AF. These suggest that AF after PV isolation was not maintained by the rotor, but was driven by the non-stationary random wave propagation associated with frequent pivoting activations.
Abstract 19186: Role of Exosomes and Their microRNA Constituents in Mediating the Therapeutic Benefits of Human Cardiosphere-Derived Cells in vitro and in Mice With Myocardial Infarction
Authors: Ahmed G Ibrahim, Ke Cheng, Eduardo Marbán
Journal: Circulation (2013)

Background: Exosomes are nano-sized bilayer vesicles that are secreted by most cell types. Exosomes are rich in microRNAs (mirs) which may function in a paracrine fashion. Cardiosphere-derived cells (CDCs) have been shown to regenerate heart after myocardial infarction (MI) in animal models and in the CADUCEUS clinical trial. However, most of the regenerated muscle is of innate origin, which suggests that CDCs function mainly through indirect pathways. Methods and Results: In vitro and in vivo, we compared three treatment groups: vehicle only (control), CDC-derived exosomes and normal human dermal fibroblast (NHDF)-derived exosomes. Neonatal rat cardiomyocytes (NRCMs) incubated with CDC exosomes were more frequently positive for Ki67 (n=4, p&lt;0.001), and less frequently tunel-positive, compared to NHDF exosomes or control (n=4, p&lt;0.01). CDC exosomes also stimulated tube formation in HUVEC cells compared to NHDF exosomes or control (p&lt;0.05). SCID mice injected with exosomes from CDCs during acute MI showed higher LVEF at two weeks (n=6, p&lt;0.05) and four weeks (n=6, p&lt;0.05) post MI, as well as increased viable mass. The therapeutic benefits of exosomes were equivalent to those of 105 injected human CDCs (p=ns). Inhibition of exosome secretion by ceramide synthesis inhibition abrogated the beneficial effects by CDCs in vivo and in vitro. Mir microarray analysis identified mirs146a as the most highly-up regulated mirs in CDC-exosomes compared to NHDF (262-fold, n=4). Mir-146a-treated NRCMs were more resistant to H2O2-induced stress compared to a mimic control. Array analysis of these NRCMs treated also showed suppression of IRAK1 and TRAF6 transcripts. SCID mice injected with 80 ng of mir-146a during acute MI showed higher LVEF at two weeks (n=6, p&lt;0.05) and four weeks (n=6, p&lt;0.05) post MI, as well as increased viable mass compared to mimic control. Conclusions: Mir-containing exosomes secreted by CDCs exhibit multiple beneficial effects on injured myocardium, suggesting that exosomes may mediate some of the therapeutic effects of CDCs. Most notably mir-146a provides cardioprotection in an acute model of MI.
Abstract 14955: Factors Associated With High Contrast Utilization During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry
Authors: Georgios E Christakopoulos, Georgios Christopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad, Robert W Yeh, Farouc A Jaffer, Michael R Wyman, William Lombardi, Aaron Grantham, David Kandzari, Nicholas Lembo, Jeffrey W Moses, Ajay Kirtane, Manish Parikh, Philip Green, Matthew Finn, Santiago Garcia, Anthony Doing, Mitul Patel, John Bahadorani, Muhammad Nauman J Tarar, Craig A Thompson, Subhash Banerjee, Emmanouil S Brilakis
Journal: Circulation (2015)

Background: High contrast utilization during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to peri-procedural complications, in particular contrast-induced nephropathy (CIN). Methods: We examined the association between several clinical and angiographic variables and contrast volume utilization during CTO PCI among 950 consecutive procedures performed at 10 experienced US centers between May 2012 and March 2015. Results: Mean age was 65±10 years, 87% of patients were men, and 34% had prior coronary artery bypass graft surgery (CABG). Technical and procedural success was 91% and 90%, respectively. The median contrast volume utilization was 260 (IQR:195, 360) mL. Approximately 33% of patients received &gt;310mL of contrast (high contrast utilization). On univariable analysis male gender (p=0.017), moderate or severe calcification (p=0.002) and tortuosity (p=0.004), proximal cap ambiguity (p=0.002), distal cap at a bifurcation (p=0.001), side branch at proximal cap (p=0.02), blunt/no stump (p=0.003), occlusion length (p&lt;0.0001), high J-CTO score (p=0.012), guide catheter size (&gt;7F) (p&lt;0.0001), retrograde approach (p=0.006), ad-hoc CTO PCI (p&lt;0.0001) and dual arterial access (p&lt;0.0001) were associated with higher contrast administration, whereas history of diabetes mellitus (p=0.008) and in-stent restenosis (p=0.049) were associated with less contrast use. On multivariable analysis proximal cap ambiguity (p=0.030), bigger guide catheter size (p=0.007), ad-hoc CTO PCI (p&lt;0.0001) and dual arterial access (p=0.002) were independently associated with higher contrast use during CTO PCI. On the other hand, in-stent restenosis (p=0.027) and presence of interventional collaterals (p&lt;0.0001) were associated with lower contrast use. Conclusions: Approximately 1 in 3 patients undergoing CTO PCI receive high contrast volume (&gt;310 mL). Several baseline clinical and angiographic characteristics can help predict the likelihood of high contrast volume administration. This knowledge could be used pre-procedurally and intra-procedurally to guide and intensify efforts to reduce contrast utilization and reduce the risk of contrast-induced complications during CTO PCI.
Abstract 218: Interaction Between Lung Disease and Anti-Psychotic Drugs in Pulseless Electrical Activity
Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uy-Evanado, Ronald Mariani, Harpriya Chugh, Karen Gunson, Jonathan Jui, Sumeet S Chugh
Journal: Circulation (2013)

Introduction: There has been a paradigm shift in manifestation of sudden cardiac arrest (SCA), with decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and an increase in the proportion of pulseless electrical activity (PEA). To elucidate mechanisms, we further evaluated the relationship between PEA and pulmonary disease, which has consistently been reported in epidemiologic and clinical evaluations of this condition. Methods: Cases with PEA and VF/VT (age ≥ 18 years) were enrolled from a large ongoing population-based study of out-of-hospital SCA in the Northwestern US (pop approx. 1 million). The presenting arrhythmia was determined from review of first responder resuscitation reports. Detailed clinical history was obtained from medical records prior to SCA. Pearson’s x 2 test and independent samples t -test were used for univariate comparisons. Logistic regression was used to evaluate significant factors associated with PEA vs. VF/VT. Results: Compared to VF/VT (n= 609), PEA cases (n= 346) were older, more likely to be female, were less likely to be witnessed, to arrest in public and have bystander CPR (p≤ 0.005). Survival to hospital discharge was lower in PEA than VF/VT (5% vs. 27%, p&lt; 0.0001). History of COPD or asthma was more common in PEA (38% vs. 24%, p&lt; 0.0001). Antipsychotic use was also more frequent in PEA group (13% vs. 4%, p&lt; 0.0001). In a logistic regression model adjusting for demographic and arrest circumstances, there was significant interaction between COPD/asthma and antipsychotics (p= 0.04). Compared to subjects with no history of COPD/asthma and no antipsychotic use, subjects with COPD/asthma only had an increased odds of PEA [OR 1.8 (95% CI 1.3-2.5), while odds for subjects with only use of antipsychotics was 4.8 (95% CI 2.2-10.6). Subjects with both COPD/asthma and antipsychotics were also more likely to present with PEA [OR 2.6 (95% CI 1.2-5.7)]. Conclusion: Susceptibility to PEA involves a significant interplay between pulmonary disease and use of antipsychotic drugs. These findings have potential implications for the ongoing mechanistic investigation of PEA, especially development of animal models.
Abstract 19213: Long-Term Prognostic Value of and Serial Changes in Plasma N-terminal Pro B-type Natriuretic Peptide in Patients Undergoing Transcatheter Aortic Valve Implantation
Authors: Henrique B Ribeiro, Luis Nombela-Franco, Marina Urena, Ricardo Allende, Florent Le Ven, Marie-Annick Clavel, Abdellaziz Dahou, Mélanie Côté, Jerôme Laflamme, Louis Laflamme, Hugo DeLarochelière, Robert DeLarochelière, Philippe Pibarot, Josep Rodes-Cabau
Journal: Circulation (2013)

Background: Little is known about the usefulness of evaluating cardiac neurohormones in patients undergoing transcatheter aortic valve implantation (TAVI). The objectives of this study were to evaluate the baseline values and serial changes of NT-proBNP following TAVI, its related factors and prognostic value. Methods and Results: A total of 333 consecutive patients undergoing TAVI were included. Baseline, procedural and follow-up (median: 20 [8 to 35] months) data were prospectively collected. Systematic NT-proBNP measurements were performed at baseline, hospital discharge, 1-month, 6- to12 months, and yearly thereafter. Baseline NT-proBNP values were elevated in 86% of the patients (median: 1692 [667-3910] pg/mL); lower left ventricular ejection fraction and stroke volume index, higher LV mass, and renal dysfunction were associated with greater baseline values (p&lt;0.01 for all). Higher NT-proBNP levels were independently associated with increased long-term overall and cardiovascular mortality (P&lt;0.001 for both), with a baseline cut-off level of ~2,000 pg/mL best determining poorer outcomes (P&lt;0.001). At 6- to 12-month follow-up, NT-proBNP levels had decreased (P&lt;0.001) by 23 (IQR: -62 to +32)% and remained stable up to 4-year follow-up. In 39% of the patients, however, NT-proBNP values increased to some degree. Pre-procedural chronic atrial fibrillation, lower mean transaortic gradient and moderate/severe mitral regurgitation were the predictors of the lack of NT-proBNP improvement after TAVI (P&lt;0.01 for all). Conclusions: Very high NT-proBNP levels were observed in most TAVI candidates, which in turn predicted a higher overall and cardiac mortality after a median follow-up of approximately 2 years. TAVI was associated with a significant decrease in NT-proBNP levels over time, but a lack of improvement was observed in more than one third of the patients, mainly due to the presence of chronic atrial fibrillation, a lower transvalvular gradient and moderate-to-severe mitral regurgitation. These results strongly suggest the usefulness of implementing NT-proBNP measurements for the clinical decision-making process and follow-up of TAVI patients.