tbuckley/cabot-search huggingface dataset:
Abstract 4146282: Safety and efficacy of the bioactive titanium-nitric-oxide coated stent in contrast to everolimus-eluting stents (EES) among patients diagnosed with ACS: An updated meta-analysis.
Authors: Ahmed Abdelaziz, Mariam Desouki, Shrouk Ramadan, Ahmed Elaraby, Ahmed Mohamed, Raneem Afify, Ahmed Nasr, Ahmed Hamdy G. Ali, Roua Arian, Sandi Banour, Basel Abdelazeem
Journal: Circulation (2024)

Introduction: Drug-eluting stents (DES) have effectively decreased the incidence of restenosis; however, recent investigations raised the potential for late stent thrombosis (LST). Bioactive stent (BAS) coated with titanium-nitride-oxide has demonstrated favourable outcomes with conflicting results in individuals with acute coronary syndromes. We aimed to outline the comparison of BAS and EES among patients diagnosed with acute coronary syndrome (ACS). Methods: We systematically searched PubMed, Web of Science, Scopus, and Cochrane Central, and EMBASE from inception until February 2024. We included randomised controlled trials (RCTs) and observational studies comparing bioactive titanium-nitric-oxide coated stent stents versus EES stents. The primary outcome was MACE, while secondary outcomes were MI, Cardiac death, All-Cause Death, definite stent thrombosis, and Minimal lumen diameter. All data were pooled as either Mean difference in the random effect model with the corresponding SD or pooled as RR and 95% CI for dichotomous data. Results: Seven RCTs involving 3101 patients were included in the analysis. BAS coated was associated with a reduction in definite stent thrombosis (OR= 0.35, 95% CI [ 0.16 to 0.77], P=0.009), MI (OR= 0.47, 95% CI [ 0.34 to 0.64], P=&lt;0.001), and minimal lumen diameter (MD= -0.22, 95% CI [ -0.35 to -0.10], P=0.0004). However, there was no significant difference in terms of MACE, all-cause mortality, or cardiac mortality between the two studied approaches. Conclusion: BAS showed a reduction in definite stent thrombosis, MI, and minimal lumen diameter, with no significant difference in other reported outcomes. This opens the door for large-volume RCTs to validate the current findings.
Abstract 4146295: Sex disparity in the in-hospital outcomes of patients with chronic kidney disease admitted for ST elevation myocardial infarction: Insights from a large national database
Authors: Frederick Rivera, Jade Monica Marie Ruyeras, Wailea Faye Salva, Jeremiahdominic Balbin, Samantha Tang, John Paul Aparece, Polyn Luz Pine, Gabriel Tangco, Nathan Ross Bantayan, John Andrew Amigo, Marie Francesca Ansay, Maria Angela Matabang, Edgar Lerma, Kenneth Ong, Fareed Moses Collado, Amir Kazory
Journal: Circulation (2024)

Background: Previous studies have highlighted the impact of sex differences on the outcomes of patients admitted for ST-elevation myocardial infarction (STEMI). However, there is limited evidence as to whether there is a difference in the outcomes between females and male STEMI patients who have a concomitant diagnosis of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Research Question: Does sex affect the outcomes for STEMI patients with concomitant CKD and ESRD? Methods: This is a retrospective population-based cohort study that uses the National Inpatient Sample database. CKD patients in the United States hospitalized for STEMI were identified using the International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and 10) codes. Inclusion criteria were adult patients who were hospitalized from 2012 to 2020. A subset of patients with ESRD were also identified. Multivariate regression analysis was performed, with the model adjusted for age and comorbidities. The primary outcome of interest was in-hospital mortality. Secondary outcomes evaluated included ischemic stroke, major bleeding complications, pressor requirement, permanent pacemaker implantation, percutaneous coronary intervention, coronary artery bypass grafting, surgery, pericardiocentesis, mechanical circulatory support, and mechanical ventilation. Results: A total of 1,283,255 STEMI patients without CKD, 158,715 STEMI patients with CKD, and 22,690 STEMI patients with ESRD were identified and analyzed. Among patients with STEMI and CKD, females demonstrated higher in-hospital mortality compared to male counterparts (16.7% vs 12.7%, aOR=1.13, 95% CI: 1.05-1.21, p&lt;0.01). Females were also more likely to develop ischemic stroke (4.0% vs 3.0%, aOR=1.16, 95% CI: 1.01-1.34, p=0.04). While there was no sex difference in the in-hospital mortality and most secondary outcomes among STEMI patients with ESRD, female patients in this group were less likely to receive coronary artery bypass grafting (5.0% vs 8.7%, aOR=0.54, 95% CI: 0.42-0.70, p&lt;0.001) and mechanical circulatory support (12.8% vs 17.8%, aOR=0.69, 95% CI: 0.58-0.83, p&lt;0.001). Conclusion: Increased in-hospital mortality rates were shown for females admitted for STEMI with CKD. However, for STEMI patients with ESRD, there was no significant difference between males and females with respect to mortality rates. Further research needs to be conducted to better explain this said difference in outcomes.
Abstract 4146081: Hospital Outcomes in Hispanic Children with Long QT Syndrome: A Large National Database Study
Authors: Carlos Lodeiro, Keila Lopez, Sara Stephens, Christina Miyake, Vimal Konduri, Taylor Howard, Tam Dan Pham, Wilson Lam, Michael Bruno, Jeffrey Kim, Santiago Valdes
Journal: Circulation (2024)

Background: Long QT Syndrome (LQTS) is an inherited arrhythmia syndrome that predisposes patients to sudden death. Prior studies on racial disparities in LQTS have shown similar number of cardiac events, but longer QTc in Black patients compared to non-Hispanic Whites (NHW). There is limited data on cardiac events in Hispanic children with LQTS. We hypothesized that Hispanic children with LQTS have worse outcomes compared to NHW children. Methods: This retrospective cohort study of the Pediatric Health Information System (PHIS) database included children ages 0 - 17 years hospitalized from 2013-2024 with an International Classification of Disease 9 th or 10 th edition code for LQTS listed in the first five admission diagnoses. Patients with congenital heart disease and chromosomal abnormalities were excluded. The primary predictor variable was race/ethnicity, with covariables including age, sex, and insurance type. Our primary outcome variable was a documented lethal arrhythmia, and secondary outcomes included pacemaker and/or implantable cardioverter defibrillator (ICD) placement. Chi-square was used to assess patient characteristics. Univariable mixed-effect log-binomial regression was used to assess risk of outcomes by characteristics using hospital as a random effect with multivariable models generated via backward elimination. Results: We identified 6,476 children (24% Hispanic, 76% NHW). Compared to NHW children, Hispanic children were more often male and presented earlier (median age 11y vs 13y, 25-75 IQR 6-15; p&lt;0.0001) (Table 1). Hispanics had a higher use of public insurance and a longer length of stay (LOS) than NHW (Table 1). Both groups had similar numbers of cardiac arrest and mortality (Table 1). On multivariable analyses, there was no increased risk of lethal arrhythmias (p= 0.76) or pacemaker/ICD placement (p=0.56) for Hispanics compared to NHW. Conclusion: This is the first national descriptive study assessing outcomes in Hispanic children with LQTS. Hispanics with LQTS were hospitalized at an earlier age, had a longer LOS, and higher rates of public insurance. Further studies are warranted to determine knowledge of family history of LQTS, medication adherence, and long-term ability for follow up.
Abstract 4146077: Escalating burden of Ischemic Heart Disease and its trend attributable to Air Pollution in Southeast Asia, East Asia, and Oceania from 1990-2021: A Benchmarking analysis for the global burden of disease study 2021.
Authors: Aishwar Dixit, Shruthi Katam, Adan Irfan, salomi shaikh, nimrat dhillon, Saif Syed, Mohit Lakkimsetti, Ashwinikumar Shandilya, Parth Adrejiya, Paritaben Bhalodia, HARDIK DESAI, kamal sharma, VISHRANT AMIN
Journal: Circulation (2024)

Introduction: Ischemic Heart Disease (IHD) is the primary cause of morbidity and mortality across Southeast Asia, East Asia, and Oceania. Although there has been a lack of comprehensive studies on the burden of IHD attributable to air pollution, this study is the first to estimate its impact over the last three decades, including the initial two years of the COVID-19 pandemic. Method: Using global burden of disease tool, we estimated deaths, disability adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs) due to IHD attributable to Air pollution by age, sex, year across the SEA, EA, and Oceania from 1990-2021. Results: From 1990 to 2021, the annual percentage change (APC) in total deaths due to ambient particulate matter pollution increased by 112% (95% UI: 79-151%), with DALYs rising by 77% (51-108%) and YLDs by 106% (91-120%). The age-standardized mortality rate (ASMR) increased by 124%, and DALYs rate by 102%. Timor-Leste observed the highest APC in ASMR at 329%, followed by China at 147%, while the highest DALYs rate was also in Timor-Leste at 321%, followed by the Solomon Islands at 141%. The highest number of deaths was recorded in the 80–84-year-old age group with 148,592, and DALYs were highest in the 70-74 age group at 2.2 million due to IHD attributable to AP in 2021. Males experienced a higher burden compared to females over the last three decades, with a total percentage change in deaths at 168% vs. 130%, YLDs at 128% vs. 153%, and YLLs at 112% vs. 73%. Conclusion: Urgent action is crucial to combat the escalating burden IHD due to AP in Southeast Asia, East Asia, and Oceania. Public stakeholders and policy makers must implement robust strategies to slash particulate matter pollution and protect public health.
Abstract 4146047: Improving Heart Failure Caregiver Competency Improves Caregiver Burden, Sleep and Mental Health
Authors: Melinda Higgins, Brittany Butts, Rebecca Gary, Sandra Dunbar
Journal: Circulation (2024)

Introduction: The COOL-HF (caregiver (CG) opportunities for optimizing lifestyles) randomized clinical trial tested a psychoeducational intervention (with and without exercise) to address heart failure (HF) CG risk for poor health outcomes due to the burden of caregiving. These analyses examine factors that affected response to the intervention. Hypothesis: HF CGs who received the intervention will have improved CG self-efficacy which will mediate improved outcomes (evidenced by lower depressive symptoms and CG burden and better mental health and sleep quality). Methods: CGs of persons with HF were randomized to 3 groups: usual care, psychoeducational only (PEd) or PEd plus exercise (PEdEx). The psychoeducational intervention included 4-weeks of in-person classes on nutrition, HF education, CG skills, communication, coping, self-care, and health improvement. In addition to sociodemographics, family caregiver version of Self-Care of Heart Failure Index (SCHFI) competency (self-efficacy) scale, Center for Epidemiological Studies-Depression (CES-D) score, Oberst Caregiving Burden Scale (time and difficulty scores), Pittsburgh Sleep Quality Index (PSQI) and Mental Health Continuum (MHC) were measured at baseline and 6m. The indirect mediation effect of the within-participant improvements in CG self-efficacy on outcomes were estimated with structural equation modeling using the lavaan R package to implement the MEMORE (Mediation and Moderation for Repeated Measures) algorithm. Results: The 127 CGs in the study were aged 55 +/- 11, 92% female, 58% Black, 55% spouses and 70% had a college or higher education. The HF patients’ severity ranged from NYHA class I (25%), II (25%), III (38%), to IV (12%). Significant mediation effects were found in both PEd and PEdEx groups for which SCHFI competence scores increased on average 1.99 +/- 3.15 points (moderate-to-large effect size (es) d=0.63) from baseline to 6m (p&lt;.001), which mediated improvements in depression (indirect effect 95% confidence interval [-3.24, -0.22], small-to-moderate es=-0.18), Oberst time [-3.75, -0.27, es=-0.18], Oberst difficulty [-4.12, -0.64, es=-0.24], PSQI [-1.55, -0.14, es=-0.20] and MHC [0.37, 2.68, es=0.15]. Conclusions: The COOL-HF psychoeducational intervention improved CG competency which mediated improvements in mental health, burden and sleep quality. These data suggest that effort to increase self-efficacy should be a key aspect of HF CG programs to promote improved psychosocial outcomes.
Abstract 4146041: Spatiotemporal Stability of Dominant Frequency Sites in Atrial Fibrillation Using Digital Twin Technology and Clinical Outcomes of Catheter Ablation
Authors: Taehyun Hwang, Oh-Seok Kwon, BYOUNGHYUN LIM, Moon-Hyun Kim, Daehoon Kim, Je-Wook Park, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, BOYOUNG JOUNG, Moon-Hyoung Lee, Hui-Nam Pak
Journal: Circulation (2024)

Background: Although the dominant frequency (DF) may localize the reentrant drivers of atrial fibrillation (AF), its meandering nature makes it difficult to localize as an extra-pulmonary vein (extra-PV) target. Hypothesis: We explored and quantified the spatiotemporal stability of DF by sophisticated digital-twin maps and the association with the rhythm outcome of clinical AF catheter ablation (AFCA). Methods: We retrospectively examined the DF sites in the digital twin integrated by high-density electroanatomical maps (EAM) of 170 patients previously included in the CUVIA-AF2 trial (male 70.6%, 59.2±11.3 years old, 100% persistent AF). We monitored 34 seconds of virtual AF and analyzed DF sites in 10 different left atrial (LA) regions at 3 consecutive periods (6 seconds each after 16 seconds of induction and blanking periods). The spatiotemporal stability index (STSI) was calculated to quantify mean DF's spatial and temporal variability. During protocol-based rhythm follow-up, we assessed the atrial arrhythmia recurrence rate by dividing patients into two groups based on STSI 0.75. Results: During the simulation, 108 out of 170 (63.5%) patients recorded the mean DF in all consecutive periods. There were 26 (24.1%) patients in the stable DF group (STSI ≥0.75, Stable group) and 82 (75.9%) patients in the unstable DF group (STSI &lt;0.75, Unstable group). Although the proportion of patients with hypertension (73.1 vs. 47.6%, p=0.041) was higher and left ventricular end-diastole diameter (51.3±3.9 vs. 49.0±4.4 mm, p=0.020) was larger in the stable DF group than in the unstable DF group, other parameters, including LA size, LA voltage, or AF ablation targets, did not differ between two groups. During the median 19 [15-22] months follow-up, the atrial arrhythmia recurrence rate of the Stable group is higher than that of the Unstable group (log-rank p=0.031, HR = 2.06, CI [1.06-4.01]) Conclusions: We found that the temporally stable DF in EAM-integrated virtual AF, the potential extra-PV AF drivers, is a surrogate marker of the adverse rhythm outcome of AFCA. A prospective clinical trial targeting the spatiotemporally stable DF will be warranted.
Abstract 4146109: Genetic Mouse Models of Obesity may provide mechanistic insights into atrial myopathy and atrial fibrillation: Insights from <i>Mc4r</i> -KO Mice
Authors: Arvind Sridhar, Jaime DeSantiago, Mahmud Arif, Asia Owais, Miles Barney, Hanna Chen, Abhinaya Baskaran, Liang Hong, Mark McCauley, Dawood Darbar
Journal: Circulation (2024)

Background: Although a causal relationship between diet-induced obesity (DIO) and atrial fibrillation (AF) has been established, the underlying pathophysiological mechanisms in genetic obesity remain unclear. A high-fat diet (HFD) is used to generate DIO mice, but investigating genetic models of obesity may provide mechanistic insights into atrial myopathy, a precursor state of AF and stroke that is of increasing clinical and research interest. Objective: We used a genetic (melanocortin-4 receptor knockout, Mc4r -KO) mouse model of obesity to test the hypothesis that obesity-mediated atrial myopathy creates an electrophysiologic (EP) substrate for AF. Method: MC4R mutations are the most common monogenic form of obesity in humans. Transesophageal rapid (TE) pacing, invasive electrophysiology studies, immunohistochemistry, western blotting of plasma membrane proteins, mitoSOX staining, and whole-cell patch clamping were performed to evaluate AF burden and analyze the molecular and whole-animal EP phenotype. Results: Mc4r -KO mice were significantly heavier than wild-type lean controls ( Figure A ). AF burden was 257 ± 175 seconds in Mc4r -KO mice vs. 14.4 ± 29 seconds in control mice (P=XX; Figure B-C ). Patch-clamping and optical mapping studies showed that Mc4r -KO mice displayed a shortened atrial action potential (APD) (data&amp;P=) and reduced conduction velocity ( Figure D-F ). Mc4r -KO mice also displayed significantly reduced peak cardiac sodium current (I Na ) and delayed rectifier potassium current (I Kr ), but the L-type Ca 2+ current (I Ca,L ) was unchanged, indicating that the atrial APD changes are mostly due to I Na modulation ( Figure G-H ). Mc4r -KO atrial myocytes showed increased MitoSOX staining, indicating elevated ROS production ( Figure J ). Notably, fibrosis was not increased in Mc4r -KO mice, suggesting AF susceptibility is primarily due to electrical remodeling ( Figure K ). Conclusion: Our study indicates that mice with genetic susceptibility to obesity are more prone to develop AF primarily through electrical remodeling, with minimal structural changes, differing from DIO mice. This risk is in part mediated by modulation of the cardiac Na + channel and increased oxidative stress. These findings may have important implications for the management of obesity-mediated AF in humans.
Abstract 4146486: Prevalence, Incidence, and Progression of Cardiovascular-Kidney-Metabolic Syndrome in a Diverse Nationwide Cohort
Authors: Savannah Xinyi Tan, Fan Li, Brian Mac Grory, Jay Lusk
Journal: Circulation (2024)

Introduction: Recent studies using cross-sectional survey data have suggested high prevalence of cardiovascular-metabolic-kidney syndrome in the United States. However, these studies are limited by their cross-sectional design and cannot estimate progression or incidence reliably. In this study, we use the longitudinal nature of the AllofUs cohort to estimate the incidence and observe the progression and impact of CKM syndrome stages within a diverse cohort. Research Aims: To understand the distribution and impact of various stages of CKM syndrome within a diverse population cohort over an extended period and identify risk factors for CKM progression. Methods/Approach: Utilizing data from the AllofUs Research platform, we conducted a longitudinal analysis of patients within the cohort. Prevalence was calculated annually, while incidence was estimated by identifying new diagnoses of CKM syndrome. The incidence rate was calculated as the number of new diagnoses over the number of people at risk of developing that stage, using a one-year look-back window. We defined CKM stages according to recent AHA criteria, and additionally created three additional stages, which we termed Stage 5 (CVD and CKD stage 3-5), Stage 6 (&gt;=2 CVD and CKD stage 3-5), and Stage 7 CKM (&gt;=2 CVD, CKD stage 3-5, and &gt;= one metabolic risk factor). Results: Our analysis revealed that the prevalence of CKM syndrome increased over the study period. For instance, the prevalence of Stage 1 CKM syndrome increased from 64.7% in 2018 to 80.18% in 2021, while Stage 2 CKM syndrome rose from 84.5% in 2018 to 92.91% in 2021. The incidence of various CKM stages in 2021 are shown in Table 1. The prevalence of all CKM stages are shown in Figure 1. At the conference, we will present models of risk factors for progression of CKM over time. Conclusions: More than 9 in 10 participants in a large nationwide cohort had Stage 2 CKM and the annual incidence of CKM ranged from 12% for Stage 1 CKM to ~3% for stage 4 CKM.
Abstract 4146473: Regional Differences in the Impact of Rurality on Ischemic Stroke Hospitalization Among Fee-for-Service Medicare Beneficiaries
Authors: Abdullah Rabah, Djhenne Dalmacy, Fayz Quadri, Nitin Kanneganti, Yordanos Tiruneh, Jarett Berry
Journal: Circulation (2024)

Background: Stroke presents a significant burden to the health care system of the United States. Previous research has shown a higher rate of stroke mortality in rural compared to urban areas. Rural communities are highly heterogeneous, and less is known about the variation in stroke across rural communities. Therefore, we sought to examine the association between rurality and hospitalization for acute ischemic stroke across rural vs urban zip codes among US census geographic regions. Methods: We included fee-for-service Medicare beneficiaries with prevalent hypertension and/or diabetes followed from 2017 to 2021. Participants were categorized at the residential zip code level into metropolitan, micropolitan, small towns, and rural areas using Rural Urban Commuting Area Codes. Census geographic regions were categorized at the state level into Northeast, South, Midwest, and West. First hospitalization for ischemic stroke or TIA were identified using algorithms from Medicare claims. The association between rurality and stroke hospitalization was estimated in age, race, and sex adjusted models. Additional models were stratified according to census region. Results: We included 25,915,862 participants (age 73; 45% male; 97.6% hypertension; 41.6% diabetes; 75.5% metropolitan). Hypertension prevalence was similar across RUCA codes (98%) but diabetes prevalence was slightly lower (42% vs. 39%, metropolitan vs. rural zip codes). After a mean follow-up of 3.8 years, we observed 832,567 first stroke hospitalizations. The south had a higher event rate compared to all other regions (8.79 vs. 8.17 per 1,000 person-years). In multivariable-adjusted models, compared to metropolitan zip codes, stroke risk was similar across micropolitan and small town areas but lower among rural areas. A different pattern of results was observed across geographic regions, with a higher risk for stroke across categories of rural areas in the south but not in other geographic regions (see Table). Conclusion: The impact of rurality on stroke risk varies by geographic region, with a higher risk for stroke among rural zip codes in the south but not in other geographic regions. Further research is needed to characterize the causes of the variability in stroke risk across rural communities.