tbuckley/cabot-search huggingface dataset:
Abstract 4140795: Pregnancy Outcomes in Women with Cardiovascular Disease: A Retrospective Cohort Study from Kaiser Permanente Northern California
Authors: Ekta Partani, Carol Shi, Douglas Stram, Marisa McDonald, Cynthia Triplett, Jennifer Ting, Megan Stephenson, Nikhil Joshi, Seema Pursnani
Journal: Circulation (2024)

Background: Cardiovascular disease (CVD) remains a leading cause of maternal mortality in the United States, comprising 26.5% of pregnancy-related deaths. Objective: We aim to evaluate trends in CVD during pregnancy and maternal, obstetric, and fetal outcomes in pregnant women with CVD in the Kaiser Permanente Northern California (KPNC) integrated healthcare system. Methods: This is a retrospective cohort study of adult KPNC members with moderate or greater valvular heart disease, cardiomyopathy, congenital heart disease, or ischemic heart disease during pregnancy from 2010-2021. Bivariate analyses and multivariable logistic regression were used to evaluate associations between demographic and clinical risk factors and maternal outcomes in pregnant patients with CVD. Results: Of 320,902 pregnancies, 763 (0.24%) were identified with clinically significant CVD. The prevalence of CVD increased from 0.19% to 0.24% over the decade, predominantly due to an increase in prevalence of women with congenital heart disease. Mean gestational age at delivery was 36.7 weeks with 19.5% experiencing preterm delivery. Cesarean section, pre-eclampsia or eclampsia, and postpartum hemorrhage rates were 29.5%, 20.8%, and 13.1%, respectively. Fetal loss beyond the first trimester occurred in 7.1% pregnancies. Adverse maternal cardiac outcomes occurred in 12.6% of patients with clinically significant CVD, with the most common outcome being hospitalizations for congestive heart failure. Age, diabetes, parity, BMI, prior heart failure, prior CVD, lower LVEF, and systemic valvular regurgitation were significant predictors of adverse maternal events. Conclusions: The incidence of CVD during pregnancy increased between 2010-2021, largely driven by an increase in pregnancies among women with congenital heart disease. Rates of adverse maternal cardiac outcomes, pregnancy loss greater than 20 weeks, and maternal mortality in this cohort were similar to those previously reported in other large registries. High rates of pre-eclampsia or eclampsia and postpartum hemorrhage were noted in this cohort. Understanding risk factors for adverse outcomes in a contemporary, diverse setting can help refine cardio-obstetric risk assessment and preconception counseling.
Abstract 4141101: Loss of Chondroitin Sulfate N-acetylgalactosaminyltransferase-2 (ChGn-2) Impairs Thrombus Resolution in Mice Model
Authors: Aditya Adinata, Tetsuya Hara, Arinal Chairul Achyar, Ken-Ichi Hirata, Noriaki Emoto
Journal: Circulation (2024)

Background: Deep vein thrombosis (DVT) remains a significant health problem where current therapy management still possesses risks. Thrombus resolution during natural DVT progression involves various leukocyte influx and pro-inflammatory responses. Chondroitin sulfate glycosaminoglycans (CS-GAGs), linear polysaccharides found on blood vessel endothelium and leukocyte cell surfaces, have been reported to regulate leukocyte trafficking in several inflammatory diseases. Furthermore, GAG chain function depends on the alteration in GAG chain length or sulfation. One of the involved enzymes is Chondroitin Sulfate N-acetylgalactosaminyltransferase-2 (ChGn-2), an enzyme which is able to elongate GAG chain. In humans, the ChGn-2 gene is expressed widely, implying that ChGn-2 might play roles in various mechanisms throughout the body. Nonetheless, ChGn-2 role in the pathology of DVT remains unclear. Methods and results: We investigated ChGn-2 role in DVT by completely ligating the inferior vena cava in 10 – 12-week-old male C57BL/6J mice (n = 25) and mice with global deletion of ChGn-2 (n = 25). We found a higher thrombus burden (p&lt;0.0001) in day 4 and day 7 after surgery with a slower thrombus organization in the transgenic mice by Carstair staining in day 2 (p&lt;0.05) and day 4 (p&lt;0.01). Interestingly, loss of this gene also reduced MMP activity (p&lt;0.001) in day 7 along with pro-inflammatory cytokines and leukocyte markers. Moreover, immunohistochemistry staining also showed that leukocytes were mostly found at the edge of the thrombus in the transgenic mice. Further examination by in vivo imaging of femoral vein ligation revealed an impaired leukocyte influx in the transgenic mice. Transferring leukocytes from WT mice into transgenic mice rescued the phenotype, while the reverse experiment led to an impaired leukocyte influx. Finally, simultaneous imaging of WT and ChGn-2 KO leukocytes revealed that WT leukocytes could infiltrate inside the thrombus but not ChGn-2 KO leukocytes, confirming that ChGn-2 in leukocytes is important in our study.. Conclusion: Insufficient CS-GAGs length caused by the loss of ChGn-2 impaired thrombus resolution due to reduced leukocyte infiltration.
Abstract 4141274: Impact of Oxidative Stress on Aortic Vulnerable Plaques Detected by Non-obstructive General Angioscopy
Authors: Keisuke Kojima, Yudai Tanaka, Saki Mizobuchi, SHOHEI MIGITA, Katsunori Fukumoto, Yasunari Ebuchi, Riku Arai, Nobuhiro Murata, Daisuke Fukamachi, Yasuo Okumura
Journal: Circulation (2024)

Background: Atherosclerosis is the most common cause of cardiovascular death. Oxidative stress is related to the initiation and progression of atherosclerosis. However, how oxidative stress affects the progression of atherosclerosis in vivo has not yet been fully investigated. Non-obstructive general angioscopy (NOGA) can meticulously visualize directly aortic atherosclerosis in vivo. The purpose of this study was to evaluate the relationships between oxidative stress and NOGA-derived aortic plaques. Methods: We investigated 120 consecutive cases with coronary artery disease evaluated for the aorta by NOGA between July 2021 and February 2024. Atherosclerotic lesions of the aorta were screened using NOGA immediately after coronary arteriography. NOGA examination evaluated the counts of ruptured plaques, chandelier signs, intense yellow plaques, and red thrombi in the aorta. Regarding the number of each plaque, we assessed the proportion of aortic findings detected by NOGA at each vertebral level. Derivatives of reactive oxygen metabolites (d-ROMs) levels as indices of reactive oxygen species production were evaluated. Results: The mean age was 66 years, and the median d-ROM value was 289 U.CARR [interquartile range: 251-339]. The d-ROM value was significantly correlated with the proportion of ruptured plaques (r=0.28, p=0.015), but not correlated with the other plaque characteristics. In a multiple linear regression analysis for the proportion of ruptured plaques in the aorta, d-ROMs were one of the independent factors adjusted for age, sex, hypertension, dyslipidemia, and diabetes mellitus (β=0.14, p=0.004). Conclusion: The value of d-ROMs was related to the proportion of ruptured plaques in the aorta, but not to the proportion of the other plaque characteristics. Oxidative stress may help to elucidate the mechanism for the progression of aortic atherosclerosis.
Abstract 4140684: Global burden, regional inequality, and age discrepancy of developmental intellectual disorder attributable to congenital heart anomalies, 1990 - 2021, a systematic analysis for the Global Burden of Disease Study 2021
Authors: Xinjie Lin, Qiyu He, Kai Ma
Journal: Circulation (2024)

Introduction: The success of cardiac surgical techniques and progress of interventional therapies prolonged the life expectancy patients with congenital heart anomalies (CHA). Reduction of mortality and extension of lifespan exacerbated the burden of non-fatal comorbidities. Developmental intellectual disability (DID) is the most substantial non-fatal comorbidities of pediatric patients with CHA. However, no epidemiological study describe the global burden of DID attributable to CHA (DID-CHA). Research Question: What was the global burden, regional inequality, and age specific discrepancy of DID-CHA? Goal: The aim of this study is to address the gap of lacking epidemiological data of global burden, regional inequality, and age discrepancy of DID-CHA. Methods: This was a secondary analysis study by utilizing impairment data of GBD study 2021. Data was collected from the website of Institute for Health Metrics and Evaluation (IHME, query tool: https://ghdx.healthdata.org/gbd-2021 ). The prevalence, disability adjusted life years (DALYs), and their calculayted annual percentage changes (EAPC) across global, both sexes, seven regions, five SDI regions, and 204 countries and territories from 1990 to 2021 were investigated. Results: In 2021, the global number of DID-CHA cases was 1.05 million (95% UI: 0.83 to 1.24 million) with an age-standardized prevalence rates of 15.71 per 100,000 (95% UI: 12.36 to 18.58). From 1990 to 2021, the EAPC of prevalence was -0.15 (95% CI: -0.16 to -0.13). Regional inequality of disease burden of DID-CHA remained prevalent worldwide. Pediatric population, especially neonates and infants, had a more substatial disease burden of DID-CHA compared to adults aged over 20 years. Conclusions: This is the first study that thoroughly describe the global prevalence, regional inequality, and age discrepancy of the burden on DID-CHA, by utilizing the public data of GBD 2021. DID-CHD is believed to be a progressive issues for the whole-life management of CHD. Future efforts on resource allocation for neurodevelopmental disability in population with CHD should be comparable with the expenditure in reducing CHD mortality. Persistent regional socioeconomic disparities will definitely move to impact the discrepant burden of DID-CHA. Increasing socioeconomic resources aimed at improving DID-CHA outcomes should prioritize in neonate and infants with CHA, as they represent the most critically affected age groups.
Abstract 4140682: Clinical Case: Flipping the Script: Tackling CAD in Dextrocardia During Cardiac Catheterization
Authors: FNU Riya, Naveed Iqbal
Journal: Circulation (2024)

Introduction: Dextrocardia is a rare congenital condition where the heart's apex points to the right, with an incidence of about 0.01%. Patients usually have a normal life expectancy unless other structural heart diseases are present. The prevalence of atherosclerotic coronary artery disease (CAD) in these individuals is believed to be similar to that of the general population. Due to its rarity, data on coronary interventions in this subset are scarce, with available literature mostly limited to case reports. Patients with dextrocardia present a diagnostic challenge, particularly in the context of acute coronary syndrome. Case Presentation: A 49-year-old male with a medical history of dextrocardia, hypothyroidism, dyslipidemia and hypertension was referred to a cardiologist by his primary physician due to a 3-week history of unstable angina. His vital signs were normal, and the physical examination was unremarkable. Electrocardiogram (ECG) showed a prominent S wave in the left-sided leads and a prominent R wave in the right-sided chest leads, suggesting dextrocardia. Although he had a normal echocardiogram and stress test a year ago at a different hospital, due to his symptoms and intermediate-high risk probability of coronary artery disease (CAD), the decision was made to proceed with a cardiac catheterization using a trans-radial approach with a horizontal sweep technique. During the procedure, a 6-French tiger catheter (TIG) was guided into the left coronary sinus and advanced into the left ventricle under fluoroscopic guidance. The left main coronary artery was widely patent bifurcating into the left anterior descending and left circumflex. The left circumflex had 80% proximal stenosis with minimal luminal irregularities in the mid to distal portion. After guidewire crossing, balloon angioplasty was performed, and a drug-eluting stent was deployed. An intravascular ultrasound was also performed, which was negative for vessel dissection. There were no post-procedure complications, and the patient was discharged on beta blockers and dual antiplatelet agents. Conclusion: Performing cardiac catheterization in patients with dextrocardia presents unique technical challenges due to the mirror-image anatomy. This case report highlights the modifications in standard techniques, emphasizing the need for specialized skills and strategies to achieve successful outcomes in such cases.
Abstract 4140772: Social Deprivation is Associated with Readmission After Percutaneous Left Atrial Appendage Closure
Authors: Peter Brodeur, Enrico Ferro, Timothy Maher, Shu Yang, Jonathan Waks, Patricia Tung, Eduardo Saad, Andre d'Avila, peter zimetbaum, Daniel Kramer, Robert Yeh, Andrew Locke
Journal: Circulation (2024)

Introduction: Gender and racial disparities have been shown to impact outcomes with percutaneous left atrial appendage closure (LAAC) though no studies have directly evaluated the role of socioeconomic disadvantage. The Social Deprivation Index (SDI) is a metric designed to quantify socioeconomic variation in health outcomes. We aimed to evaluate if SDI increases the risk of readmission within one year after LAAC in patients with atrial fibrillation (AF). Methods: Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York (NY) and Florida (FL) from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2018 SDI data. International Classification of Diseases 10 codes for AF and LAAC were used. The risk of readmission was assessed using multivariable Cox proportional hazards regression with covariates age, sex, race, insurance, Charlson Comorbidity Index (0 vs ≥ 1 comorbidity), and SDI deciles. SDI is scored 1-100 with higher scores representing more disadvantage. Results: 7,786 patients underwent LAAC in NY and FL 2016-2019. The readmission rate at one, three, and twelve months was 10.1%, 21.5%, and 44%. The most common admitting diagnoses at readmission were dyspnea/chest pain (11.4%) and GI bleed (8.8%). Female sex, African American race, ≥ 1 Charlson comorbidity, and those with from areas with a higher SDI had a higher one-, three-, and twelve-month risk of readmission. Those with federal insurance had a higher three- and twelve-month risk of readmission. Conclusion: After adjustment, socioeconomic disadvantage was observed to place patients at higher risk of readmission within one year after LAAC. GI bleed remains a common complication post LAAC. Given the link between differential care and healthcare disparities, it is essential to raise awareness to ensure successful post-procedure management and equitable cardiovascular care.
Abstract 4141518: Disparities in Associations Between Migraine and Cardiovascular Events: A Cross Sectional Cohort Study in the Veterans Health Administration
Authors: Elizabeth Seng, Alexandra Schwartz, Richard Lipton, Ali Ezzti, Jason Sico
Journal: Circulation (2024)

The extent to which migraine is associated with cardiovascular events may differ across age, gender, racial and ethnic subgroups. The current study uses the migraine cohort from the Headache Centers of Excellence VHA Headache Cohort. Migraine cases include veterans who had an International Classification of Disease-9/10 code of migraine in the VHA electronic health record between 2008-2023. Controls had no headache ever coded in their VHA electronic health record, and were matched on age, gender, race, ethnicity, and point of care the year of cohort entry (defined as the first year in which headache was diagnosed for the migraine group). Baseline cardiovascular events were extracted from the VHA electronic health record using validated algorithms from 6 months prior to cohort entry to 12 months following cohort entry. Separate logistic regression models evaluated the relationship between migraine vs. matched control and each cardiovascular outcome separately in the following subgroups: gender (men and women), age (18-49 and 50+), race (White and Black), and ethnicity (Non-Hispanic and Hispanic). The cohort included 668,968 individuals with migraine and 1,337,937 non-headache controls. Overall, subgroup analyses found the strongest relationships between migraine (vs. matched control) and cardiovascular outcomes in younger adults (aged 18-49): ischemic stroke OR = 3.62, 95% CI = 3.33, 3.94; transient ischemic attack OR = 9.0, 95% CI = 7.65, 10.54; Notably, migraine was associated with higher odds of hemorrhagic stroke for younger adults (OR = 4.30, 95% CI =3.27, 5.66), but lower odds of hemorrhagic stroke in adults aged 50+ (OR = 0.28, 95% CI = 0.25, 0.31). An exception is acute myocardial infarction (MI), where the strongest relationship betwen migraine and acute MI was observed in adults aged 50+ (OR = 1.69, 95% CI = 1.57 1.83). Migraine (vs. matched control) was associated with slightly higher odds of heart failure among White patients (OR = 1.28, 95% CI = 1.23, 0.86), but slightly lower odds of heart failure among Black patients (OR = 0.92, 95% CI = 0.86, 0.9. ORs for cardiovascular events were relatively similar (e.g., within 1.0 OR) across gender, racial and ethnic groups. This study shows that age is a particularly important factor in understanding the relationship between migraine and cardiovascular events.
Abstract 4141389: Low Serum Albumin as a Predictor of All-Cause Mortality in HFpEF Patients
Authors: Jack Lopuszynski, Christopher Scott, Rimsha Ahmad, Maliha Zahid
Journal: Circulation (2024)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent form of heart failure (HF) in the US today. Our prior work revealed low albumin at first hospitalization for HF exacerbation with underlying HFpEF to be an independent predictor of all-cause mortality in a small cohort of patients. We now sought to confirm our earlier findings across a larger and more diverse patient population. Methods: Seven thousand, eight hundred and forty patients had a first admission to Mayo Clinic for HF exacerbation with an echo-confirmed left ventricular ejection fraction&gt;50% between 2010 and 2020. Patient baseline demographics, co-morbidities, admission laboratory values, echocardiographic parameters, discharge medications, and outcomes were obtained from chart abstraction. To validate our previous model, patients were grouped based on the number of risk factors as previously defined: age&gt;80 years, serum albumin level&lt;3.2 g/dl, medial E/e'≥20, N-terminal pro-brain natriuretic peptide (NT-proBNP) &gt;5,000 pg/mL, and the presence of hypertension (HTN). The association with 1 year mortality was studied using Cox regression. Kaplan Meier curves were generated based on the number of factors present per patient. Results: Eleven significant univariate predictors of all-cause mortality were identified from the data (Fig. 1A), with hazard ratios (HR) ranging from 1.22-2.04 (p&lt;0.001 for all). Notably, four previously identified prognosticators (age, albumin, medial E/e’, , HTN) were noted as significant independent predictors of all-cause mortality in HFpEF (HR 1.67, 2.14, 1.18, and 1.15, respectively, p&lt;0.004 for all ; Fig. 1B). Multivariate regression modeling identified low albumin on presentation as being a significant adverse prognosticator (HR=2.14; p-value&lt;0.001). Conclusion: Our analysis of 7840 HFpEF patients confirms our prior findings, suggesting that this model is a strong predictive tool for assessing the prognosis of HFpEF. Taken together, these five variables are easily available in the in-patient setting and can be incorporated into a model predictive of 1-year all-cause mortality.
Abstract 4141620: Large-Scale Proteomics Identifies Novel Circulating Markers of Pulmonary Hypertension: the Atherosclerosis Risk in Communities Study
Authors: Fernando Giugni, Mario Santos, Yimin Yang, Victoria Lamberson, Brian Claggett, Ron Hoogeveen, Christie Ballantyne, Bing Yu, Amil Shah
Journal: Circulation (2024)

Introduction: Biomarkers for early-stage pulmonary hypertension (PH) are unavailable in clinical practice. Aims: We aimed to discover novel plasma biomarkers associated with pulmonary pressure and PH. Methods: Among participants in the community-based Atherosclerosis Risk in Communities (ARIC) cohort study who underwent protocol echocardiography at the 5 th study visit (2011-2013), had assessable pulmonary artery systolic pressure (PASP), and were free of diagnosed heart failure (HF) or pulmonary disease, we measured 4,955 plasma proteins (SomaScan aptamer-affinity assay). Participants also performed spirometry at the same study visit. We assessed cross sectional associations of individual proteins with PASP using multivariable linear regression adjusted for demographic and clinical covariates. We further assessed the associations of candidate proteins with cardiac and pulmonary function to explore mechanisms of association with PASP. Additionally, we performed two-sample Mendelian Randomization (MR) analyses using cis -pQTLs to identify potential causal associations. Results: Among 2,015 participants included, mean age was 75±5 years, 64% were female, 17% reported Black race, and LVEF was 66±6%. Mean PASP was 28±6 mmHg. Twenty-five protein aptamers (21 unique proteins) were associated with PASP at Bonferroni significance (Figure A). Of these 21 candidate proteins, the 16 associated with higher PASP were also generally associated with greater LV mass, lower LVEF, and worse LV diastolic function (specially higher LA volume index and lower LA reservoir strain) and worse spirometric measures (Figure B). The 5 proteins associated with lower PASP were generally associated with better LV structure and function. Of these 21 proteins, two-sample MR identified one protein with potential causal effects on pulmonary arterial hypertension (PROC), one with effects on LV size (ENG), and 4 with effects on pulmonary function (ANGPT2, CLSTN2, ICAM5, SPON1). Conclusion: We identified novel protein markers of pulmonary pressure, with potential causal associations related to the pathological substrate for types 1, 2 and 3 PH.