tbuckley/cabot-search huggingface dataset:
Abstract 4144007: Regional differences of treatment disparities in Black and White patients with peripheral artery disease across the United States
Authors: Birgit Vogel, Katerina Dangas, Francesca Di Muro, Samantha Sartori, ANGELO OLIVA, George Dangas, Prakash Krishnan, Harrison Yoon, Katherine Etter, Daniel Erim, Yuriy Pylypchuk, Rachel Keever, Roxana Mehran
Journal: Circulation (2024)

Background: Racial disparities exist regarding treatment and outcomes of peripheral artery disease (PAD) in the United States (US). Black versus White Americans are more likely to have delayed PAD diagnosis and are at higher risk of lower limb amputation. Aim: To investigate regional differences in PAD treatment disparities between Black and White Americans. Methods: Data on 2,376,300 Black and White Medicare Fee-For-Service beneficiaries with a first diagnosis of PAD between 2018 and 2022 were studied. Patient counts for diagnosis, revascularization, and amputation were summarized for each state and used to create forest plots of revascularization and amputation rates. County-level rates of revascularization and amputation rates by race were also correlated against publicly available county-level Social Vulnerability Index (SVI). Results: Black versus White patients were slightly younger (75.8±7.9 years vs 76.9±7.8 years; p&lt;0.001) and more likely female (54.7% vs 47.8%; p&lt;0.001) with higher prevalence of comorbidities. Black patients were more likely to undergo procedures for PAD compared with White patients with marked variation between states (Figure 1). Black patients were also more likely to have revascularizations or amputations compared with White patients (8.4% vs 7.0%; p&lt;0.001 and 3.0% vs 0.9%; p&lt;0.001, respectively). Correlations between county-level SVI and revascularization rates were stronger among white patients (rho = 0.08, p-value = 0.005) compared to Black patients (rho = 0.04, p-value = 0.40). Similarly, correlations between county-level SVI and amputation rates were stronger among White patients (rho = 0.27, p-value &lt;0.01) compared to Black patients (rho = 0.12, p-value = 0.17). Conclusion: Treatment disparities between Black and White patients with PAD differed markedly in the US by state with largest racial differences in amputation rates occurring among Southern states. Community-level risk, as identified by the SVI, may play a role in certain treatment patterns and warrant further investigation. Full data on this will be presented.
Abstract 4144008: MindMoves: Effect of Lifestyle Physical Activity and Cognitive Training Interventions on Blood Biomarkers in Older Women with Cardiovascular Disease
Authors: Shannon Halloway, Jeffrey Borgia, Shamatree Shakya, Michael Schoeny, Annabelle Volgman, Joellen Wilbur, Lisa Barnes, Sachin Vispute, Kaitlin Wilhelm, Claire Auger, Susan Pressler, Zoe Arvanitakis
Journal: Circulation (2024)

Background: Physical activity and cognitive training can improve cognitive health, including related neurotrophic biomarkers, with potential interactive effects. In older women with cardiovascular disease (CVD) who are at increased risk for poor cognitive health, we evaluated the efficacy of MindMoves , a 24-week multidomain physical activity and cognitive training intervention, on change in serum biomarkers, including brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), and growth differentiation factor 15 (GDF-15). Methods: This randomized controlled trial (NCT04556305) with a 2x2 factorial design tested independent and combined efficacies of Mind (tablet-based cognitive training) and Move (lifestyle physical activity) on change in serum biomarkers (BDNF, VEGF, IGF-1, GDF-15). Women ( n = 253) aged 65 years and older with CVD were randomized to Mind , Move , MindMoves , or usual care. Women completed fasting venipunctures at baseline, 24, 48, and 72 weeks. We conducted multilevel linear growth models adjusting for age, education, and racial and ethnic background. To examine intervention effects on linear change in serum biomarkers over 72 weeks, we included main and interaction effects of Mind and Move . Results: Participants were, on average, 72.4 years old at baseline ( range = 65–90), primarily of non-Hispanic White (54%) and Black (38%) racial backgrounds, and 60% graduated college. A total of 86% ( n = 218) of participants completed the 72-week data collection. Attrition was not a significant function of intervention condition or sociodemographics (all p ’s &gt; .05). There were no significant main effects of Mind or Move on linear change for any of the four serum biomarkers. However, there was a significant interaction effect ( Mind * Move ) on linear change over all four timepoints for GDF-15, whereby those in the control and combined conditions improved (decreased) relative to those in the Mind or Move conditions ( t = -2.20, p = .028). Conclusions: In this cohort of older women with CVD, there were significant Mind*Move interactive effects on GDF-15, a biomarker that may be associated with risk of Alzheimer’s disease or other conditions related to neuroinflammation. However, there were no significant intervention effects for the other biomarkers. Future analyses should examine other biomarkers related to Alzheimer’s disease and inflammation that may provide more mechanistic insight.
Abstract 4143963: Cardioprotective Role of Sodium-glucose cotransporter 2 Inhibitors in Cancer Patients Undergoing Anthracycline Therapy: A Systematic Review and Meta-Analysis
Authors: Abhigan Shrestha, Ashok Adhikari, Nischal Mainali, Sajina Shrestha, Harshwardhan Khandait, Aayush Shrestha, Sulochana Khadka, Vikash Jaiswal
Journal: Circulation (2024)

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are known to have cardioprotective effects in diabetes mellitus and heart failure patients. Anthracyclines, chemotherapeutic agents used in the treatment of various malignancies, carry a high risk of cardiotoxicity and heart failure. The use of SGLT2i to prevent cardiotoxicity and adverse cardiovascular outcomes in cancer patients undergoing anthracycline therapy is not well established. Hypothesis: This meta-analysis aims to evaluate the relationship between the use of SGLT2i for the reduction of adverse cardiovascular outcomes in patients undergoing anthracycline therapy. Methods: We systematically searched for relevant articles published until March 2024 on PubMed, Cochrane, and Embase. The hazard ratio (HR) was pooled using the random-effects model and a p-value of &lt;0.05 was considered statistically significant. Results: Four studies involving 5590 patients (SGLT2i group: 1617 and non-SGLT2i group: 3973) were included in our analysis. The composite outcome, which included heart failure hospitalization, acute myocardial infarction, ischemic stroke, and death was significantly reduced in individuals receiving SGLT2i therapy compared to those who did not receive it (HR: 0.44, 95% CI: 0.27-0.61, I2=0.00%, p&lt;0.005). Moreover, the risk of hospitalization due to heart failure (HR: 0.58, 95% CI: 0.31-0.85, I2=0.00%, p&lt;0.005), and all-cause mortality (HR: 0.51, 95% CI: 0.30-0.72, I2=67.29%, p&lt;0.005) were significantly lower among patients treated with SGLT2i. However, the risk of new heart failure diagnosis (HR: 0.65, 95% CI: 0.27-1.04, I2=0.00%, p=0.86) was comparable. Conclusion: The findings suggest that SGLT2i among cancer patients with anthracycline therapy is associated with a lower risk of composite outcomes, heart failure hospitalization, and overall mortality.
Abstract 4143835: Cardiac Magnetic Resonance Imaging in Pediatric Heart Transplant Recipients: Correlation With Cardiopulmonary Exercise Testing
Authors: Sarah Tucker, Garett Griffith, Lajja Desai, Alan Wang, Katheryn Gambetta, Kendra Ward, Nazia Husain
Journal: Circulation (2024)

Background: Cardiac magnetic resonance (CMR) is increasingly used for rejection surveillance in pediatric heart transplant recipients (PHTR). It is unclear if CMR-derived tissue characterization and myocardial perfusion correlate with functional status, i.e. VO 2peak as derived by cardiopulmonary exercise testing (CPET). Lower VO 2peak has been associated with poor cardiometabolic health and development of coronary artery vasculopathy in PHTR. Aim: Our aim was to evaluate the correlation between CMR derived variables and CPET outcomes. Methods: PHTR who underwent CMR within 1 year of CPET were retrospectively reviewed. Those with submaximal effort on CPET (RER&lt;1.1) or clinical events (rejection, new or worsening CAV, or cardiac hospitalizations) between CMR and CPET were excluded. CMR variables were biventricular volumes, ejection fraction, myocardial T2, T1/extracellular volume fraction (ECV) which are biomarkers for edema and fibrosis respectively, and myocardial perfusion reserve index (MPRI). CPET variables were VO 2peak , O 2 pulse, age-predicted maximum heart rate (APMHR), HR reserve and exercise duration. Relationships between variables were studied using Pearson’s correlations and regression. Results: Fifty PHTR met inclusion criteria (age 16.5 ± 2.9 yrs, female=25). Time from transplant and time between CPET and CMR were 5.9 ± 0.5 yrs and 0.5 ± 0.3 yrs, respectively. CPET mean baseline HR was 89 ± 11 bpm and peak HR was 167 ± 21 bpm; 8 patients were on beta blockers. Mean LVEF was 60 ± 4.5%. Higher T2 correlated with reduced VO 2peak ( R = -0.346, p =0.029) and higher global MPRI correlated to increased exercise duration ( R =0.323, p =0.048). Associations were also noted between CMR variables and HR-dependent CPET variables including O 2 pulse, HR reserve and %APMHR (table 1). However, given known abnormal HR response to exercise related to denervation and variable timing of reinnervation in PHTR, the significance of these associations is unclear. Conclusion: In PHTR with normal LV function, CMR cardiac structure and tissue characteristics have correlations with exercise capacity and duration. Larger studies are needed to understand the role of multiparametric CMR in the functional surveillance of PHTR.
Abstract 4143995: Association of left ventricular summit arrhythmias with pathogenic gene variants
Authors: Nitin Kondamudi, Graham Bevan, Babak Nazer, Andrew Stergachis, Fuki Hisama, Neal Chatterjee
Journal: Circulation (2024)

Background: Genetic cardiomyopathies (CM) are increasingly diagnosed among patients with ventricular arrhythmias (VA). There is increasing recognition of the regional nature of potential arrhythmic substrate in genetic CM, including involvement of the basal left ventricular (LV) septum and LV summit. Whether anatomically constrained ventricular arrhythmias predict genetic CM is not known. Research question: Are LV summit arrhythmias associated with pathogenic/likely pathogenic (P/LP) gene variants? Aims: To examine whether LV summit VA is associated with P/LP gene variants in patients referred for ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation. Methods: The cohort included patients with arrhythmia and cardiomyopathy panel genetic testing (Invitae) between 2018 and 2024 who also underwent VT/PVC ablation at the University of Washington. VA location (summit vs. non-summit) was defined using electroanatomic voltage and activation mapping. The prevalence of P/LP gene variants in those with and without LV summit VA were compared using Fisher’s exact testing. Logistic regression was used to examine the association of LV summit VA with P/LP gene variants with multivariable adjustment for anti-rhythm drugs and standard risk factors including age, sex, and LV ejection fraction (LVEF). Results: The study included 57 patients (mean age 55±16 years, 82% male, LVEF 44±13%, n=22/35 PVC/VT ablation). LV summit VA was identified in 10 patients and P/LP gene variants were found in 22 patients. The prevalence of P/LP genetic variants was significantly higher in LV summit vs. non-summit patients (70% vs. 32%, p=0.04). Those with LV summit arrhythmias had a 7-fold higher odds of P/LP genetic variants compared to non-LV summit arrhythmias (adj OR [95% CI]: 6.6 [1.1-39.6]. P/LP variants in LV summit VA individuals were either TTN (n=3 [2 truncating variant, 1 splice site]) or LMNA (n=4 [3 missense, 1 deletion]). Conclusion: LV summit VA are associated with P/LP genetic variants with known tropism for basal septal pathology. This preliminary work supports efforts to expand the paradigm that anatomically-specific VA may represent the electrical manifestation of genetic CM.
Abstract 4144019: Early total cell-free DNA, but not donor fraction, predicts late events in heart transplantation
Authors: Steven Zangwill, Shriprasad Deshpande, Marc Richmond, Liyun Zhang, Pippa Simpson, Mahua Dasgupta, Aoy Tomita-Mitchell, Michael Mitchell
Journal: Circulation (2024)

Introduction: Donor fraction (DF) cell-free DNA (cfDNA) is an emerging tool for non-invasive rejection surveillance in heart transplantation (HTx). Little is known about the significance of DF and/or total cfDNA (TcfDNA) in the first month post HTx. We explored the relationship between early cfDNA results and later clinical events in adult and pediatric HTx recipients. Aims: 1. Explore the relationship between early cfDNA levels and late events after HTx 2. Describe the decline in DF during the first month post HTx Methods: Retrospective data from the multicenter prospective blinded DTRT study (DNA-based transplant rejection test) was used. DF and TcfDNA results from samples drawn post HTx day 1 (&lt;24h), day 4 (+/- 12h), day 7 (+/- 12h), day 14 (+/- 24h) and day 28 (+/- 7 days) were compared in subjects with or without events &gt;35d to 1 year post HTx. Captured events include cardiac arrest, mechanical circulatory support or death. Exclusions included absent TcfDNA, multiorgan Tx, any PTLD, or other cancer in previous 2 yrs. Cell-free DNA values were compared across event groups and time windows using GEE (generalized estimating equation) with Max Likelihood Estimation. Results: 190 subjects had 566 samples drawn &lt; 35 days post HTx. Median age was 17.8 yrs with a range of 26 days - 73.4 yrs; 51.8% were pediatric. 16 subjects (8.4%) had events bridging or following day 35 post HTx; 23 with events prior to day 35 were included as non-event subjects. TcfDNA was significantly higher in event subjects on days 4, 7 and 28 post HTx. [Fig 1]. There was no difference in DF between event and non-event subjects. Median (IQR) DF at 14 days was 0.26% (0.20, 0.39) and 0.19% (0.13, 0.29) at 28 days. Conclusions: Elevated TcfDNA, even in the setting of normal DF, may be a useful early marker to identify patients at risk for later events in the first year post HTx. The majority of patients reach low DF levels by 28 days post HTx suggesting an opportunity to incorporate cfDNA earlier into rejection surveillance protocols.
Abstract 4143964: Combined electrocardiography artificial intelligence and echocardiography model to characterize precapillary versus postcapillary pulmonary hypertension in end stage chronic kidney disease.
Authors: Isabel Scalia, JUAN FARINA, Milagros Pereyra, Nima Baba, Ahmed K. Mahmoud, Mohammed Tiseer Abbas, Moaz Kamel, Kamal Awad, Kristen Sell-Dottin, Said Alsidawi, Timothy Barry, Robert Scott, Chadi Ayoub, Girish Mour, Reza Arsanjani
Journal: Circulation (2024)

Introduction: Pulmonary hypertension (PHTN) is common in patients with chronic kidney disease (CKD), however categorization as precapillary or postcapillary is challenging due to the need for invasive right heart catheterization (RHC). Studies have validated transthoracic echocardiography (TTE) to characterize PHTN and ECG-artificial intelligence (AI) to predict diastolic dysfunction risk. The utility of these noninvasive tools in patients with CKD is unknown. Methods: Retrospective analysis of patients with end stage CKD who underwent RHC between 2011 and 2021. Patients with PHTN (pulmonary artery pressure &gt;20mmHg on RHC) were categorized as having precapillary (pulmonary capillary wedge pressure, PCWP, ≤15mmHg and pulmonary vascular resistance, PVR, &gt;2WU) or postcapillary PHTN (PCWP &gt;15mmHg and PVR ≤2WU for isolated postcapillary or PVR &gt;2WU for combined). TTE and ECG within 3 months of RHC were obtained. TTE measurements were used to calculate ePLAR (echocardiographic pulmonary to left atrial ratio); tricuspid regurgitant peak velocity (TRV max ) divided by mitral E/e’. ECGs were analyzed with an AI risk tool for diastolic dysfunction (score 0-3, increasing with increasing risk). Receiver operating curves (ROC) evaluated the performance of these tests. Results: 60 patients were included; 16 (27%) with precapillary and 44 (73%) with postcapillary PHTN. ROC analysis found good accuracy for both ECG-AI diastolic dysfunction risk score to predict precapillary PHTN with AUC 0.724 (sensitivity=60% and specificity=88% for an ECG score value ≤1) and ePLAR with AUC 0.715 (sensitivity=75% and specificity=70% for ePLAR &gt;0.17m/sec). Highest accuracy for detection of precapillary PHTN was reached by combination of ePLAR and ECG-AI tool, with AUC 0.756 (sensitivity=73%, accuracy of 86% for a value ≤1.17). Conclusions: ECG-AI generated diastolic risk score of 0-1 (low risk) and high ePLAR showed good accuracy in characterizing precapillary PHTN in patients with end stage CKD. The combination of these noninvasive tools further increased the diagnostic accuracy, reflecting its potential utility in classification of patients with CKD and PHTN, a crucial determinant of the ideal therapeutic plan in kidney transplant candidates.
Abstract 4143910: Comparative Outcomes of Cardiogenic Shock in Acute Myocardial Infarction Versus Acute Heart Failure: A Meta-Analysis
Authors: Ragavendar Saravanabavanandan, Darshine Venugopal, Shubhashis Saha, Viraj Panchal, Sharini Venugopal, Mohammed Al-Tawil, Raja Pullatt
Journal: Circulation (2024)

Introduction: Clinical trends show a rise in non-ischemic causes of cardiogenic shock (CS), especially acute heart failure CS (AHFCS). Compared to acute myocardial infarction cardiogenic shock (AMICS), AHFCS typically occurs in the context of chronic heart failure with compensatory mechanisms that seem to better withstand hemodynamic disturbances. Given the clinical heterogeneity, we aim to compare the in-hospital outcomes of AMICS and AHFCS to enhance clinical decision-making. Methods: We conducted a comprehensive literature search until April 2024 and included 8 studies from PubMed, Scopus, Embase, etc. We used Mantel-Haenszel random effects and inverse variance models to estimate the pooled risk ratio (RR) and mean differences at a 95% confidence interval. Results: Patients with AMICS were older by an average of 6.3 years compared to those with AHFCS [p&lt;0.00001]. The AMICS cohort showed an 80% greater risk of using temporary mechanical circulatory support (tMCS) [RR: 1.80; p&lt;0.00001] and an 88% greater risk of using &gt; 1 tMCS [RR: 1.88; p&lt;0.00001] than patients with AHFCS. When categorized by tMCS type, Impella use was notably higher in the AMICS group [RR: 1.65; p&lt;0.0001]. AMICS patients showed a 79% lower risk of undergoing LVAD implantation [RR: 0.21; p=0.03] and 88% lower risk of heart transplantation (HT) [RR: 0.12; p&lt;0.0001] compared to AHFCS cohort. Our meta-analysis revealed no significant differences between the two groups in hospital mortality [RR: 1.13; p = 0.50], length of stay (LOS), vasopressor use, or occurrence of bleeding. Conclusion: This pioneering meta-analysis reveals distinct differences in treatment approaches between AMICS and AHFCS. AMICS patients more frequently utilized tMCS but were less likely to receive LVAD or HT. Despite these variations, in-hospital mortality, LOS, vasopressor use, and bleeding remain comparable between the two groups. This emphasizes the critical need for tailored treatment strategies based on CS etiology.
Abstract 4143933: Body size relations of ascending aorta dimensions: An analysis of 49,193 adults in the UK Biobank reveals an optimal normalization method
Authors: Hamed Tavolinejad, Cameron Beeche, Marie-Joe Dib, Oday Salman, Joe David Azzo, Walter Witschey, Hannah Maynard, Julio Chirinos
Journal: Circulation (2024)

Background: Organ size and body size relations are often non-linear (allometric). However, allometric relations for thoracic aorta are poorly understood and current practice is based on linear (ratiometric) indexation of aortic dimensions, which can provide misleading information in individual patients. Assessing allometric relationships can have important implications for the detection of aneurysms, particularly at the extremes of body size. Methods: A U-Net convolutional neural network (CNN) segmentation architecture was trained, validated, and used to segment the ascending aorta (AA) and derive its maximum cross-sectional dimensions using MRI scans obtained from 49,193 UK Biobank participants. Sex-adjusted allometric (log-log) models were used to derive allometric exponents describing the relationship of AA size (diameter and cross-sectional area) to body size (height and BSA) in a healthy reference subgroup (n=3,972). Prognostic associations with all-cause mortality and aneurysm complications were then assessed in the entire population over a median follow-up of 66 months. Results: Relationships between AA diameter or area and BSA were highly non-linear ( Table 1 ) and exhibited significant differences between males and females (P for interaction=0.013), precluding the use of a single exponent for both sexes. In contrast, a quasi-linear relationship was found for aortic area and body height (exponent=0.98), making simple ratiometric indexation allometrically adequate. Moreover, no differences in this allometric relation were found between men and women (P for interaction=0.32), indicating its suitability regardless of sex. In contrast, ratiometric diameter/height, diameter/BSA, or area/BSA indexation provided markedly and systematically biased prevalence estimates for aortic dilation, misclassifying many individuals at the extremes of body size ( Figure ). Finally, the use of the linear area/height ratio was consistently predictive of death and aneurysm complications in the overall population and provided the highest C-index for aneurysm complications regardless of body size ( Table 2 ). Conclusions: In contrast to all other indexation methods, the linear AA area/height ratio is a practical, allometrically correct, and most informative aortic size index, and can be utilized equally in men and women. This should guide strategies for aneurysm detection and decision making in clinical practice and future studies.