tbuckley/cabot-search huggingface dataset:
Abstract 4141320: Heart Failure Quality of Care and Outcomes among Asian Ethnic Groups in the United States
Authors: Xiaoning Huang, Clyde Yancy, Gregg Fonarow, Sadiya Khan, Nilay Shah
Journal: Circulation (2024)

Background: Asian populations in the United States experience heterogenous burden of cardiovascular disease (CVD). Heart failure (HF) hospitalization quality of care or outcomes have not been reported in these populations. Methods: Participants were adults age ≥18 years in the AHA Get with the Guidelines Heart Failure registry (2015-2023) who had a primary admission diagnosis of HF, and identified as Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese, or non-Hispanic White (NHW). Odds of optimal medical therapy (receiving up to three medication classes for which they were eligible based on ejection fraction [EF] and absence of contraindication [1: ACE inhibitor, ARB, or ARNI; 2: beta blocker; 3: mineralocorticoid receptor antagonist]), length of stay &gt;4 days, and in-hospital mortality were evaluated in each Asian subgroup vs. NHW, with sex-stratified multivariable logistic regression models, adjusted for age; EF; diabetes, hypertension, and smoking history; and insurance status. Results: Among Asian (n=3,112) and NHW (n=315,994) registry patients with HF and reduced EF&lt;40%, adjusted odds of optimal medical therapy vs. NHW were lower in Japanese (adjusted odds ratio [aOR] 0.69, 95% confidence interval [CI] 0.50, 0.94) and Vietnamese (aOR 0.68, 95% CI 0.48, 0.98) male patients, and higher in Asian Indian patients (male aOR 2.06, 95% CI 1.68, 2.53; female aOR 1.84, 95% CI 1.28, 2.64) (Table). Among Asian (n=7,261) and NHW (n=790,237) registry patients with HF and any EF, likelihood of length of stay &gt;4 days vs. NHW was lower in Vietnamese male (aOR 0.65, 95% CI 0.45, 0.93), and Asian Indian (aOR 0.63, 95% CI 0.42, 0.94), Chinese (aOR 0.58, 95% CI 0.38, 0.88), and Filipina (aOR 0.66, 95% CI 0.48, 0.91) female patients. In-hospital mortality occurred in 2-4% of Asian patients and 3% of NHW patients, with no statistically significant differences in in-hospital mortality rates in Asian compared with NHW patients. Conclusions: HF quality of care may vary among Asian subgroups in the US. Quality improvement programs must identify and address the factors that result in variations in HF care among US Asian patients.
Abstract 4140896: Variations in BNP Levels (35-100 pg/mL) and Their Implications for Predicting Future Heart Failure in Pre-clinical Stages A/B: Novel Risk Stratification Methods from the CHART-2 Study
Authors: Hiroyuki Takahama, Kotaro Nochioka, Satoshi Miyata, Hideka Hayashi, Takumi Inoue, Kai Susukita, Kazuma Oyama, Takashi Shiroto, jun takahashi, Hiroaki Shimokawa, Satoshi Yasuda
Journal: Circulation (2024)

Background: Recent revisions in the guidelines for pre-clinical heart failure (HF), particularly concerning B-type natriuretic peptide (BNP) levels between 35-100 pg/mL, indicate a more detailed approach. Research question: 1) BNP is influenced by several factors, including age, leading to potential variation in BNP's predictive value for future HF events. 2) Risk stratification for HF in the pre-HF state (BNP levels: 35-100 pg/mL) has not been established. Hypothesis: We hypothesized that variations in BNP values predicting HF events exist in association with specific clinical variables. Methods: We prospectively evaluated consecutive HF patients in Stage A/B (stage A/B: 731/4,537) from the multicenter observational CHART-2 (Chronic Heart Failure Registry and Analysis in the Tohoku District-2) Study. Previous studies identified the following parameters for BNP levels: age, body mass index (BMI), and estimated glomerular filtration rate (eGFR). We assessed their 10-year HF-related events. Results: The enrolled patients had the following characteristics: mean age 67.6±12.0 years, 71.1% male, BMI 24.2±12.0 kg/m 2 , and eGFR 67.4±19.2 ml/min/1.73m 2 . As shown in Figures 1A-C , variations in AUC and cut-off values exist in each category (A: age quartiles, B: BMI per WHO criteria, and C: eGFR). The minimum cut-off value was 38.25 pg/mL in the youngest quartile. We performed risk stratification for those with BNP values of 35-100 pg/mL (n=1412) using classification and regression tree (CART) methods, identifying these cut-off values as shown in Figure 2 . The hazard ratios (HR) for HF events were significantly higher in type 2 (age &lt;74.5 years, eGFR &lt;45.5 ml/min/1.73m 2 ) (HR: 3.97, 95% CI: 2.43-6.50) and 4 (age &gt;74.5 years, BNP &gt;50.9 pg/mL) (HR: 3.94, 95% CI: 2.88-5.38) compared to type 1 (both, P&lt;0.001). Conclusion: Although variations in BNP cut-off values predicting HF events exist, the guideline-recommended value (&gt;35 pg/mL) encompasses all at-risk patients in Stage A/B.
Abstract 4141555: Impact of multiple cardiovascular events on mortality and bleeding risks in Asian acute coronary syndrome patients: a nationwide population-based cohort study
Authors: Chih-Wei Chen, Yi-cheng Lin, Chia-Li Chang, Chun-Yao Huang, Yu-Hsuan Shao, Chien-Yi Hsu
Journal: Circulation (2024)

Introduction: Patients with acute coronary syndrome (ACS) face significant risks of recurrent cardiovascular (CV) events and bleeding complications. These bleeding risks are particularly pronounced in Asian populations, who may have a higher predisposition to bleeding complications due to genetic and physiological factors. This study aims to compare the long-term outcomes and characteristics of ACS patients who experienced only a single ACS event with those who had multiple CV events. Methods: Utilizing Taiwan's National Health Insurance Research Database, this retrospective cohort study categorized patients into single-event and multiple-event groups based on the occurrence of major adverse cardiovascular events within two years after index ACS. In this cohort study, 28,535 patients were considered. After 1:2 matching by age, sex, and interval between the first and second CV events, the final cohorts included 8,720 patients in the multiple-event group and 17,368 in the single-event group. Results: The multiple-event group had higher rates of comorbidities, including hypertension, prior coronary artery disease, heart failure, stroke, atrial fibrillation, peripheral vascular disease, and chronic kidney disease. Over a 5-year period, the multiple-event group exhibited higher all-cause mortality (34.1% vs. 24.6%, p &lt; 0.0001) and CV mortality (11.4% vs. 6.2%, p &lt; 0.0001) compared to the single-event group. Non-CV deaths (22.7% vs. 18.3%, p &lt; 0.0001) and major bleeding events (7.8% vs. 1.6%, p &lt; 0.0001) were also more frequent in the multiple-event group, as were minor bleeding events (34.4% vs. 7.2%, p &lt; 0.0001). Additionally, we found that compared to the single-event group, which showed a significant decrease in major bleeding events after one month from the index ACS, the multiple-event group continued to have a higher rate of major bleeding events within three months following the index ACS. A previous major bleeding event in the multiple-event group was linked to earlier subsequent CV events, with each day preceding of the major bleeding advancing the CV event onset by 1.0044 days. Conclusion: ACS patients with multiple CV events have higher rates of all-cause mortality, CV mortality, and major bleeding compared to the single-event group. However, major bleeding events may be associated with subsequent CV events, highlighting the importance of implementing a tailored antiplatelet strategy in Asian populations.
Abstract 4140649: A Simple One-Item Nursing Falls Assessment Predicts Outcomes For Patients With Stage D Heart Failure Undergoing Surgical Advanced Therapies
Authors: Vincent Salvador, Jaime Abraham Perez, Paige Hudec, Eiran Gorodeski, Thomas Oneill
Journal: Circulation (2024)

Introduction: Frailty portends worse outcomes for patients with advanced heart failure (HF) undergoing surgical advanced therapies. Falls are characteristic of frailty, but it is unknown to what degree a history of falls predicts post-operative risk. We hypothesized that a one-item falls survey routinely conducted by nurses in ambulatory settings is associated with worse outcomes in this population. Methods: We conducted a retrospective cohort study of all patients undergoing heart transplantation or left ventricular assist device (LVAD) implantation at our institution between January 2020 and December 2023. Our primary exposure of interest was falls as assessed by a nursing questionnaire (“Have you had one or more falls within the last year?”) within 12 months or less prior to surgery. We investigated a variety of relevant clinical outcomes including hospital- and ICU-length of stay, duration of mechanical ventilator use, renal replacement therapy, and survival. Results: The cohort consisted of 73 primarily middle-aged (median age 55 y) white (53%) men (75%), of whom 10 (14%) had a history of falls. Compared to those without falls, those with a history of falls had a higher prevalence of albuminemia (28% vs. 60%, P=0.043) and lower peak VO2 (11.3 ml/kg/min vs. 6.9 ml/kg/min, P=0.015). History of falls was associated with increased time on mechanical support (mean difference: +1.5 days, P=0.002), prolonged ICU stay (mean difference: +13 days, P=0.03), and prolonged hospital stay (mean difference: +17 days, P=0.03). Patients with a history of falls also had a higher rate of needing renal replacement therapy in the 90-days following surgery (adjusted HR 4.7, 95% CI 1.1-20, P=0.035). There were no differences in survival between the two groups. Conclusions: Among patients with advanced HF undergoing heart transplantation or LVAD, a simple one-item nursing falls assessment is associated with markers of malnutrition and poor cardiovascular performance, and predicts clinically-relevant worse outcomes.
Abstract 4141693: EPA/DHA Supplementation Modulates Monocyte Subpopulations in a 15-Lipoxygenase-dependent Fashion
Authors: Haihan Zeng, Pilar Alcaide, Sheldon Rowan, Stefania Lamon-Fava
Journal: Circulation (2024)

Background: Atherosclerosis is a chronic inflammatory disease driven by the defective resolution of inflammation. Alterations in monocyte/macrophage subtypes in the atherosclerotic plaque, particularly a shift towards inflammatory subtypes, contribute to chronic inflammation and the progression of atherosclerosis. Previous studies have documented a protective effect of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation on atherosclerosis, but the specific impact of specialized pro-resolving lipid mediators (SPMs) derived from EPA and DHA on modulating monocyte populations remains unclear. Hypothesis: We tested the hypothesis that EPA/DHA supplementation would alter the monocyte landscape toward a pro-resolving phenotype in LDL receptor knockout ( Ldlr -/- ) atheroprone mice, and that this effect would be blunted by the deletion of the 15-lipoxygenase gene ( 15Lox ), which is responsible for the synthesis of most SPMs. Methods: Ldlr -/- /15Lox +/+ single knockout (SKO, n=48) and Ldlr -/- /15Lox -/- double knockout (DKO, n=48) male and female mice were randomized to four diet groups (n=12/group): 1) low-fat diet (LFD, 4% fat and 0.02% cholesterol); 2) LFD + 1% EPA/DHA (w/w); 3) high-fat diet (HFD, 20% fat and 0.2% cholesterol); and 4) HFD + 1% EPA/DHA (w/w). The diet interventions lasted for 16 weeks. At the end of the study, mice were euthanized, fresh splenocytes were harvested, and flow cytometry was performed using the markers CD11b, Ly6G, and Ly6C to profile pro-inflammatory and pro-resolution monocytes. Results: EPA/DHA supplementation did not affect the spleen monocyte landscape in either SKO or DKO mice fed the LFD. However, in SKO mice fed the HFD, the proportion of pro-inflammatory monocytes (CD11b + Ly6C hi ) was significantly lower in the EPA/DHA supplementation group (19±6% versus 12±7%, mean±SD, p=0.03 ), with a trend toward higher resolving monocytes (CD11b + Ly6C low , 80±6% versus 87±7%; p=0.12 ). Strikingly, EPA/DHA supplementation did not significantly change pro-inflammatory monocytes (14±5% versus 13±6%, p=0.84) or resolving monocytes (85±5% versus 86±6%, p=0.95 ) in DKO mice fed the HFD. Conclusions: Our results suggest that EPA/DHA supplementation exerts immune modulatory effects that are dependent on the expression of 15Lox . Ongoing work is focused on assessing the impact of these effects on atherosclerosis plaque burden.
Abstract 4141294: Cerebral Oxygen Saturation for Early Prognostication Following Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Yi Li, Cong Geng, Nan Chen, Hui Chen, Jian Huang, Shiqi Lu, Ke Zhang
Journal: Circulation (2024)

Introduction: Veno-arterial extra-corporeal membrane oxygenation therapy (VA-ECMO) following refractory cardiogenic shock (r-CS) or cardiac arrest (r-CA) is associated with morbidity and mortality. Early prediction of neurologic outcomes is crucial , but data remains limited in the clinical setting.We investigated the prognostic value of regional oxygen saturation (rSO 2 ), using near infrared spectroscopy (NIRS) for the quantitative measurement of cerebral oxygenation. Methods: This was an observational cohort study of patients underwent VA-ECMO with routine cerebral rSO 2 monitoring at the early phase following ECMO insertion in the intensive care unit from January 2020 and January 2024.Using NIRS sensors,continuous rSO 2 monitoring was assessed during the first 72 hours. Trends of rSO 2 over time were correlated to 28-day mortality, and the prognostic performance of the rSO 2 , alone and in combination with the SAVE score, was evaluated. Results: A total 87 consecutive patients were studied (59 r-CS/28 r-CA).The SAVE score was -8.67 ± 4.56. The 28-day survival rate was 40.2% (35/87 patients). Non-survivors (n=52) had significantly lower rSO 2 than survivors at all time-points (all p &lt;0.001). Abnormal rSO 2 (&lt;50%, at any time from 24 to 72 hours) was 100% specific for 28-day mortality, with 0% false positives. Adding SAVE score to the rSO 2 provided the best prognostic performance (specificity 100% [95% confidence interval 90-100%], sensitivity 77% [62-89%], area under the ROC curve 0.91). Conclusions: Quantitative rSO 2 alone had excellent ability to predict a poor outcome from day 1 after VA-ECMO insertion, with no false positives. Combining rSO 2 and SAVE score increased sensitivity of outcome prediction, while maintaining 100% specificity.
Abstract 4141200: Association of Increased AST/ALT Ratio with Future Cardiovascular Events in Diabetic Patients without Prior Cardiovascular Disease
Authors: Yoshiyasu Ono, Shota Ikeda, Keisuke Shinohara, Sho Matsumoto, Daisuke Yoshida, Ryosuke Nakashima, Hiroka Nakashima, Ryohei Miyamoto, Kohtaro Abe
Journal: Circulation (2024)

Introduction: Increased aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) has recently been reported to be associated with all-cause and cardiovascular disease (CVD) mortality; however, its association with CVD events remains unclear. Research Question: Can the AST/ALT ratio predict CVD events in diabetic patients without a history of CVD? Aim: To investigate if the AST/ALT ratio is associated with future CVD in diabetic patients without known CVD but at high risk for it. Methods: Data form the EMPATHY study, which compared intensive and standard statin therapy in patients with type 2 diabetes mellitus (T2DM), diabetic retinopathy, and hyperlipidemia without known CVD, were used. Patients were divided into two groups based on a baseline AST/ALT ratio cut-off of 1.0, in accordance with previous reports, and the association with CVD events was analyzed. Results: A total of 4871 patients were divided into high (&gt;1.0, n=2414) and low (≤1.0, n=2457) AST/ALT ratio groups. During a median follow-up of 36.7 months, 261 CVD events occurred. The cumulative incidence of CVD was significantly higher in the high AST/ALT group compared to the low AST/ALT group (P=0.008, log-rank test) ( Fig. A ). Multivariate Cox regression analysis showed that a high AST/ALT ratio was significantly associated with increased risk of CVD compared to a low AST/ALT ratio (HR, 1.36 [95% CI, 1.04–1.79], P=0.002). This significant association was also observed when analyzing the AST/ALT ratio as a continuous variable, consistent with the restricted cubic spline curve analysis ( Fig. B ). The association of a high AST/ALT with CVD events was similar in subgroups stratified by sex, age, body mass index, and hemoglobin A1c ( Fig. C ). Conclusion: Increased AST/ALT ratio was significantly associated with the risk of CVD in patients with T2DM, diabetic retinopathy, and hyperlipidemia without a history of CVD, suggesting its usefulness as a predictor of CVD events in these patients.
Abstract 4140995: Ultrasonic Vaping Devices Heat at Lower Temperatures than Coiled E-Cigarettes, but can Cause Comparable Levels of Cardiac Fibrosis
Authors: Natasha Goyal, Ping Wang, Zhong-Min Wang, Maansa Kavuri, Ronak Derakhshandeh, Kazukiyo Kumagai, Matthew Springer
Journal: Circulation (2024)

Background: Coil-less ultrasonic vaping devices like Surge use an ultrasonic chip that vibrates at several million Hz, aerosolizing the e-liquid. They are advertised as emitting significantly lower levels of toxins than coiled e-cigs by heating to lower temperatures that produce fewer chemical breakdown products. We tested the hypothesis that ultrasonic e-cigs cause less adverse cardiac effects than coiled e-cigs. Methods: We exposed 3 groups of conscious Sprague Dawley rats (n=8/group) to aerosol from JUUL (Virginia Tobacco 5% nicotine), Surge (Rich Tobacco 18 mg/ml nicotine), or air. Pulsatile exposure consisted of 10 consecutive cycles, each consisting of 2s exposure to aerosol followed by 28s of clean air, over 5 min, for 9 weeks using a Gram Research universal vaping machine. Hearts were then isolated, sectioned, and stained for left and right ventricular fibrosis with Sirius Red. Temperature profiles for the Surge ultrasonic vaping device were obtained at the California Department of Public Health (CDPH) via a single point thermocouple probe. Results: Temperature profiles of Surge during one session of aerosol production (with airflow) showed temperatures not exceeding 132 degrees Celsius. (We previously reported that the USONICIG Zip ultrasonic vaping device with air flow heated to ~77 degrees Celsius; reported temperatures of coiled e-cigs are up to 300 degrees Celsius.) Fibrosis was significantly increased in the JUUL group compared to air (p=0.04). Mean fibrosis in the Surge group was comparable to that in the JUUL group (p=0.84) and was higher than air fibrosis but did not reach significance (p=0.15), potentially due to high variability of Surge values. Conclusion: Temperature profiles of ultrasonic vaping devices are substantially lower than those of coiled vaping devices, with Surge being warmer than USONICIG Zip under airflow conditions. Despite lower temperatures, ultrasonic vaping devices cause a comparable level of cardiac fibrosis to conventional coiled vaping devices. Therefore, Surge does not avoid the increase in cardiac fibrosis that we have reported for coiled e-cigs and for smoke from tobacco or marijuana.
Abstract 4141028: Predicting survival after percutaneous ventricular assist device for patients with cardiogenic shock: J-PVAD risk score
Authors: Toru Kondo, Tomo Yoshizumi, Ryota Morimoto, Takahiro Imaizumi, shingo kazama, Hiroaki Hiraiwa, TAKAHIRO OKUMURA, Toyoaki Murohara, Mutsuga Masato
Journal: Circulation (2024)

Background: Cardiogenic shock (CS) is a lethal condition and mechanical circulatory support is indicated if refractory to drug treatment. A recent report showed using Impella with standard care led to a lower risk of death in patients with acute myocardial infarction and CS. This finding may increase the clinical use of Impella, but prognostic models for patients after Impella are lacking. Aims: To identify factors that predict in-hospital mortality in CS requiring Impella and to develop a new prognostic model. Methods: We used the dataset of the Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD), which included all the cases treated with Impella in Japan. Two-thirds of the patients treated with Impella due to CS were randomly assigned to a derivation cohort, and the other third was reserved as a validation cohort. Using the derivation cohort, a backward stepwise logistic regression model was built to identify the factor associated with in-hospital mortality. Results: Of the total 1,715 patients in the derivation cohort, 989 patients were discharged alive and 726 patients (42.3%) died during hospitalization. From 28 variables available in the J-PVAD registry, 12 variables were independently associated with in-hospital mortality and applied for a component of the risk model; age, sex, body mass index, etiology of fulminant myocarditis, cardiac arrest in hospital, extracorporeal membrane oxygenation use, mean arterial pressure, lactate level, lactate dehydrogenase level, total bilirubin level, creatinine level, and albumin level (Table 1). The J-PVAD risk score was created by assigning scores to these components based on the coefficients (Table 1). An Example of predicted in-hospital mortality according to the J-PVAD risk score is shown in Table 2. The area under the receiver operating characteristics curve (AUC) of the J-PVAD risk score was 0.76 (95% confidence interval [CI] 0.73–0.78). The comparison of predicted and observed in-hospital mortality according to the 7th quantiles by the J-PVAD risk score showed good calibration (Figure A). In the validation cohort (n=726), the J-PVAD risk score showed good discrimination ability (AUC 0.77 [95%CI 0.74–0.81]) and calibration (Figure B). Conclusions: The J-PVAD risk score can be calculated using variables easily obtained in routine clinical practice. It helps the accurate stratification of the risk for mortality and facilitates clinical decision-making.