tbuckley/cabot-search huggingface dataset:
Abstract 18311: Low and Borderline Ankle Brachial Index Are Associated With Intracranial Aneurysms - A Retrospective Cohort Study
Authors: Dan Laukka, Essi Kangas, Jussi Hirvonen, Tiia Rissanen, Melissa Rahi, Juri Kivelev, Jaakko Rinne, Harri Hakovirta
Journal: Circulation (2023)

Background: A low ankle-brachial index (ABI) is associated with a higher risk of cardiovascular diseases, stroke, and systemic inflammation. Intracranial aneurysms (IAs) share similar risk factors with other cardiovascular diseases. However, there is a lack of studies that investigate the association between low ABI and IAs. Aims: To study whether low, borderline, or high ABI is associated with an increased risk of IAs compared to a normal ABI. Methods: We conducted a retrospective review of all patients (n=2751) who had ABI measurements at our tertiary hospital between 2011 and 2013. Patients with available cerebrovascular imaging or a diagnosis of a ruptured IA were included in the study (n=776) to examine the association between ABI and saccular IAs. The patients were classified into four groups as follows: low ABI (≤0.9, n=464), borderline ABI (0.91-0.99, n=47), high ABI (&gt;1.4, n=56), and normal ABI (1.00-1.40, n=209). Results: The prevalence of IAs was 20.3% (18.1% unruptured IAs) in the low ABI group, 14.9% (12.8% unruptured IAs) in the borderline ABI group, 7.0% (5.3% unruptured IAs) in the high ABI group, and 2.4% (1.9% unruptured IAs) in the normal ABI group (p &lt;0.001). In the multinomial regression, which included clinically relevant variables, low ABI (odds ratio [OR], 11.3; 95% confidence interval [CI], 4.1-31.5; p &lt; 0.001) and borderline ABI (OR, 7.1; 95% CI, 1.9-26.6; p &lt;0.001) were the only variables significantly associated with unruptured IAs. Conclusions: Patients with low ABI and borderline ABI had a higher prevalence of IAs compared to patients with a normal ABI. The prevalence of IAs was almost 9-fold higher in the low ABI group and nearly 7-fold higher in the borderline ABI group when compared to the normal ABI group.
Abstract 15392: Performance of a Novel Unshielded Magnetocardiography Device in a First-in-Human Study
Authors: Frances Lu, Justin Cortez, Jason Ku, Geoffrey Z Iwata, Ethan J Pratt, Kit Yee Au-Yeung, Clifton Watt
Journal: Circulation (2023)

Background: Magnetocardiography (MCG) is a non-contact measurement of magnetic fields generated by the heart’s electrical currents, represented by Magnetic Field Maps (MFMs). It is effective in detecting coronary ischemia and NSTEMI. Despite the advantages of MCG, adoption has been limited due to poor usability and high costs. We designed and built a novel bedside MCG device that measures cardiac magnetic fields without the limitations of magnetic shielding or cryogenics, and tested the performance of this prototype at a hospital in a first-in-human study. Objective: We aimed to characterize the safety and technical feasibility of the device, prominence of cardiac features in the average waveforms, and evaluate background interference rejection. Methods: We enrolled 26 participants (73% Age &amp;gt;=55, 54% Male, 85% White) at intermediate to high risk for CAD scheduled for cardiac testing (ECG, stress test, CTA, or cardiac catheterization) as part of standard clinical care at an urban hospital. On the day of testing, all participants received a 15-minute MCG scan and a reference 12-lead ECG simultaneously. Participants were contacted 7 days later for a safety assessment. Study staff were trained for 1 hour on device operation. Results: Of the 26 MCG scans, 23 (88%) showed cardiac features such as QRS complex and T-waves. The average signal-to-noise ratio (SNR) of the QRS complex was 11 (SD = 6), and the average T-wave SNR was 3.6 (SD = 2). The device effectively rejected background interference &amp;gt;1000x larger than cardiac signals. No adverse device effects were reported. Conclusions: The device successfully captured cardiac signals in a magnetically noisy hospital environment. The SNR level indicates the device has the potential to generate MFMs with future capability of classifying disease states. The device’s non-contact operation, quick set-up, and bedside ease of use enables wider adoption of MCG in the clinic.
Abstract 18145: Meta-Analysis Comparing Immediate and Staged Complete Revascularization for Multivessel Disease in Acute Coronary Syndrome Patients
Authors: Syed H Mufarrih, Nada Qureshi, Mohammad Saud Khan, Sajjad Haider, Jeffrey Foley, Muhammad Akbar, Mohammed Kazimuddin, Omar N Hyder, Jinnette D Abbott
Journal: Circulation (2023)

Background: Acute coronary syndrome (ACS) patients undergoing PCI often have severe non-culprit vessel involvement known as multivessel disease (MVD), which is linked to worse outcomes. While guidelines recommend complete revascularization, the optimal timing is unclear. Comparing immediate vs. staged approaches is crucial to identify the optimal approach to revascularization. Research question: Do outcomes differ between immediate complete revascularization (ICRV) and staged complete revascularization (SCRV) in patients with ACS and MVD? Methods: PubMed, Cochrane library and Web of Science were searched for studies comparing immediate vs. staged complete revascularization for ACS and MVD. Randomized controlled trials (RCTs) and prospective studies reporting all-cause mortality, major adverse cardiac events (MACE), myocardial infarction (MI), and revascularization were included. Thirty-day and extended-term outcomes were evaluated, and risk ratios (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results: The meta-analysis comprised 6 RCTs and 5 prospective studies, involving 3,631 patients (ICRV: 1,728; SCRV: 1,903) presenting with ACS (ST-elevation MI (STEMI)=9, NSTEMI=1; Mixed=2). The mean age was 62.4 ± 9.4 years, with 79.5% male. The ICRV group exhibited significantly higher 30-day mortality (RR: 2.19 [1.31-4.06], p=0.004), while the SCRV group had higher revascularization rates at 30 days and extended term (RR: 0.27 [0.10-0.69], p=0.007 and RR: 0.68 [0.48-0.96], p=0.03, respectively). No significant difference was found in 30-day and extended-term MACE and MI between the ICRV and SCRV groups. Conclusion: Although there was no significant difference in overall MACE between the two complete revascularization strategies for patients with ACS and MVD, the SCRV group showed lower 30-day all-cause mortality, while the ICRV group demonstrated a lower incidence of revascularization rates.
Abstract 17960: Lipoprotein(a) Testing Frequency and Predictors in a Multiethnic Health System
Authors: Sumeet S Brar, Qiwen Huang, Xiaowei Yan, Ramzi Dudum, Powell Jose, Ashish Sarraju, Latha Palaniappan, Fatima Rodriguez
Journal: Circulation (2023)

Introduction: Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Contemporary practice guidelines recommend incorporating Lp(a) testing into routine clinical practice. We examined the prevalence of Lp(a) testing and characteristics that predicted which individuals underwent testing. Methods: This was a retrospective cohort study. Eligible individuals were patients of a large Northern Californian health system with 2 or more primary care visits between the years 2010 to 2021. Incident density matching was used to select controls matched with a case if a visit date was within ±6 months of the index date of initial Lp(a) test. Prevalence of Lp(a) testing was determined by year. Conditional logistic regression was used to assess the relationship between Lp(a) testing and sociodemographic, clinical, and healthcare utilization variables. Results: Of the 1,484,410 individuals in the cohort, 12,506 (0.84%) had their Lp(a) level checked. The median Lp(a) level was 35 mg/dL and 5,598 (37.78%) of those who underwent testing had a Lp(a) level &gt; 50mg/dL. Among those with Lp(a) testing, there was a higher proportion of Asian individuals and a lower proportion of non-Hispanic Black and Hispanic individuals. In adjusted-analyses, those with a history of ASCVD had over twice the odds of undergoing testing (OR = 2.11 (95% CI = 1.98, 2.26)). South Asian individuals were three times more likely to have undergone Lp(a) testing as compared to non-Hispanic White individuals (OR = 3.25, (95% CI = 3.06, 3.46)), while those identified as non-Hispanic Black and Hispanic were significantly less likely to have undergone Lp(a) testing (OR = 0.7, (95% CI = 0.62,0.8) and 0.62 (95% CI = 0.57, 0.67), respectively). Conclusions: This study examined the real-world clinical testing patterns of Lp(a) over a decade within a large, diverse health system. Expanding access to Lp(a) testing may help reduce disparities within ASCVD risk assessment and treatment.
Abstract 15325: SAH-Responsive Genes Mediate Worsening Metabolic Crosstalk Between Homocysteine-Methionine, Glucose-Related &amp;Lt Lipid Metabolic Systems
Authors: Ramon Cueto, Wen Shen, Lu Liu, Xianwei Wang, Nathaniel Snyder, Xiaofeng Yang, Hong Wang
Journal: Circulation (2023)

Introduction: Hyperhomocysteinemia (HHcy) is an independent risk factor for cardiovascular disease, and other chronic disease. We recently proposed that the homocysteine-methionine (H-M) cycle is a metabolic sensor system responsible for pathological signaling in chronic disease. We identified metabolic worsening crosstalk between HHcy, hyperglycemia and hyperlipidemia in concomitant mouse disease models and in human coronary artery disease. Research Question: What is the molecular mechanism mediating worsening metabolic crosstalk in concomitant metabolic disorders? Methods: mRNA levels of 324 metabolic genes in three metabolic systems were examined, including 119 for H-M, 95 for glucose-related and 110 genes for lipid in 21 human and 20 mouse organs. Organs were classified based on specific metabolic gene expression. Hcy-metabolites were measured in 6 mouse organs (heart, liver, brain, lung, spleen, and kidney) by LS-ESI-MS/MS. Hcy-metabolites responsive genes were identified by linear regression analyses between metabolites and gene expression levels and used to establish Hcy-metabolites responsive metabolic networks. Results: We identified 7 Hcy-, 64 SAH- and 18 SAM:SAH-responsive genes and 3 pathological SAH-responsive cross-talking metabolites (serine, taurine and glycine 3 phosphate). SAH-responsive genes associated with activated upper glycolysis and suppressed lower glycolysis leading to glycolysis-related redox imbalance. A negative correlation between SAH and serine synthesis enzyme PHGDH suggests that increased SAH may suppress serine synthesis which leads to the impairment of transsulfuration, and taurine reduction. SAH-related taurine reduction can further negatively impact cholesterol (CH) degradation. SAH-related upper glycolysis activation leads to the increase of G3P synthesis, which is a substrate for triglyceride (TG) synthesis. In addition, SAH levels may activate fatty acid uptake and β-oxidation leading to elevated acetyl-CoA, CH and TG synthesis. Conclusion: H-M cycle is a metabolic sensor system. Production change of serine, taurine and G3P via SAH-responsive metabolic genes can be the key cross-talking metabolites responsible for worsening metabolic crosstalk in metabolic syndrome.
Abstract 18327: Influence of Microtubule Detyrosination on Left Atrial Myopathy in a Rat Model of Heart Failure With Preserved Ejection Fraction
Authors: Julia N Smolyak, Deborah M Eaton, Khaled Hached, Siem VAN DER LAAN, Benjamin L Prosser, Kenneth B Margulies, Benjamin W Lee
Journal: Circulation (2023)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is characterized in part by increased left ventricular (LV) stiffness and left atrial (LA) remodeling. LA myopathy in HFpEF is associated with poor clinical outcomes. In the LV, the magnitude of post-translational detyrosination of α-tubulin, regulated by vasohibins (VASH1/2), contributes to LV stiffness. However, the role of tubulin detyrosination in the LA is currently unknown. To this end, we assessed the extent of LA myopathy in the ZSF rat model of HFpEF, and assessed the effect of acute VASH inhibition on LA remodeling. Methods: ZSF obese rats with diastolic dysfunction were compared alongside ZSF lean hypertensive-only rats and Wistar Kyoto rats (WKY). Rats were aged to 30 weeks, then received a tail vein injection of VASH inhibitor or vehicle, followed by echocardiography. Following a second injection, hearts were excised, and LA and LV were separated for downstream protein analysis. Results : ZSF obese rats develop hallmark features of HFpEF including preserved systolic function, left ventricular hypertrophy, and slowed relaxation compared to lean and WKY. ZSF obese animals demonstrated significant LA myopathy, including increased LA area, reduced LA emptying fraction, and reduced LA strain. Acute VASH inhibition led to trends towards normalization of LA kinetics. There were no significant differences in levels of detyrosinated tubulin between vehicle and VASH inhibition groups in the LA, though there was a significant reduction of detyrosinated tubulin in the LV by Western Blot (detyrosinated tubulin / GAPDH relative quantity Vehicle: 1.5±0.2 vs. VASH inhibitor 0.5±0.1; p&lt;0.05). Conclusions: Acute VASH inhibition improves LA kinetics in ZSF obese rats secondary to reductions in detyrosinated tubulin in the LV. Future studies employing sustained reductions of detyrosinated tubulin may lead to better understanding of LA-LV interactions in the pathogenesis of LA myopathy in HFpEF.
Abstract 18317: Implications of Noise on Deep Learning Models for 12-Lead ECG Construction
Authors: Utkars Jain, Michael Leasure, Adam Butchy, Veronica A Covalesky, Gary S Mintz
Journal: Circulation (2023)

Introduction: ECG construction with deep learning can help standardize ECGs and remove noise and artifacts, transforming potentially unusable ECGs into clinically useful ones. However, noise levels, often unpredictable in clinical settings, may impact model performance. Hypothesis: This study explores the relationship between ECG noise levels and deep learning model performance in constructing noise-free ECGs. We hypothesize that beyond a certain noise threshold, the model's output ceases to be clinically usable. Aims: Our study aims to determine noise effects on the performance of deep learning models in constructing 12-Lead ECGs, providing insights into the model's robustness and the optimal conditions for its application. Methods: Using 250 digital 12-Lead ECGs from the PTB database, we injected Gaussian noise (mean 0.0, standard deviations between 0.0 and 1.0) into these ECGs, all processed and scaled to unitless values (-1 to +1) and resampled at 100Hz. A model was asked to construct a noise-free ECG from a full 12-lead ECG with noise injection, which was compared to the original noise-free ECG. Results: The findings reveal two distinct linear phases in the relationship between noise and model performance (measured by mean absolute error, MAE). Between standard deviations of 0.0 and 0.03, the MAE increased marginally, while a sharp increase occurred between 0.03 and 1.0. Importantly, critical features of the original ECG were retained for noise levels up to 0.08, implying a noise threshold for clinical usability. Conclusions: Deep learning models, though not entirely resistant to noise, demonstrate efficacy in constructing ECGs up to certain noise levels (standard deviation 0.03). Beyond this, performance declines markedly. These findings outline the limits and potential of deep learning models like ECGio in clinical practice. Future research should focus on resilience to higher noise levels or noise-reduction preprocessing strategies.
Abstract 15374: An Energy-Harvesting Leadless Pacemaker: Proof of Principle
Authors: Abby Gilstrap, Kevin Tang, Jedi Biswas-Diener, Mohammad H Malakooti, Babak Nazer
Journal: Circulation (2023)

Introduction: Leadless pacemakers (LPM) offer several benefits over transvenous pacemakers, including lower risks of infection and vascular complications. However, their limited battery life and long-term retrieval challenges restrict their use in younger patients. Aims: We aim to extend the battery life of LPM by harvesting energy from right ventricular (RV) pressure fluctuations through a housing made of biocompatible piezoelectric materials, which can transduce pressure into voltage and thus recharge the battery. Methods: Cylindrical prototypes (n = 3) of LPM housing were fabricated using polyvinylidene fluoride (PVDF) with a thickness of 100 μm and a polyetherimide insulator wrapped around an aluminum rod, representing the LPM (1A). Our prototypes were sealed with epoxy (1B) and their dimensions (radius 9.5 mm, length 26 mm) were comparable to that of the Micra LPM (Medtronic). Prototypes were placed in a pulsatile cardiac pressure simulator (1C) and subjected to RV systolic/diastolic pressures at 1 Hz. A pressure transducer and an oscilloscope simultaneously recorded the simulator’s pressure and prototype’s transduced voltage respectively (1D). Impedance matching was performed, and an optimal resistance of 39 MΩ (1E) was identified for energy harvesting. Results: At oscillating “RV” pressures of 40 and 0 mmHg, our prototype generated 4 V (1D), corresponding to 52.5 nW of harvested power on an impedance-matched circuit. Under an assumed pacing output of 1.0 V at 0.24 ms and a pacing impedance of 500 Ω, each pacing stimulus requires 480 nW. Thus, our prototype can harvest 10.9% of the energy required to power an LPM. Conclusion: A first-generation PVDF-based energy-harvesting LPM housing can harvest approximately 10% of the power needed for pacing from RV systolic/diastolic pressures, marginally prolonging battery life. Future work will focus on increasing energy harvesting through material selection, device structure, and circuit design.
Abstract 16560: Home Blood Pressure Monitoring Among Hypertensive Patients and Their Caregivers in a North Indian Population
Authors: Anusha Singhania, Ankur Singla, Harsimran Kalsi, Diksha Mahendru, Samneet Singh, Ishaan Goyal, Hiyanoor Ghosh, Aditya Uppal, Nishma Dhand, Namita Bansal, Akash Batta, Aaina Dhanda, Ankush Mittal, SARIT SHARMA, Meenakshi Sharma, Roopa Shivashankar, kavita singh, Gurpreet S Wander, Bishav Mohan
Journal: Circulation (2023)

Introduction: Hypertension (HTN) management guidelines recommend home blood pressure monitoring (HBPM) as an important tool for BP control. Limited data exists on HBPM epidemiology among people with HTN and their caregivers in the Indian context. Aim: Assess the prevalence, training and technique of HBPM among people with HTN and their caregivers. Methods: People with HTN diagnosed &gt;3 months ago, and their caregivers, were screened from outpatient departments of 3 hospitals (1 tertiary care, 2 community level) in North India and their HBPM use was evaluated. HBPM practices were assessed by observing participants measuring BP using a pre-validated, structured 16-point observational checklist. HBPM knowledge was assessed using a 19-point self-administered questionnaire based on 2017 AHA guidelines. Responses were graded and classified based on quartiles. Results: A total of 2750 participants were screened, of which 2588 (48.8% female) were included. The proportion of respondents using HBPM was 20.5% (424/2070) in urban, and 8.5% (44/518) in rural areas. Only 24.7% (n=116) of the 468 participants (232 caregivers) measuring BP at home recalled ever receiving training from any healthcare workers. The majority (75.2%, 352/468) of participants reported learning BPM themselves through observation, videos, and reading. Age, gender, residence, education and occupation had no impact on the length of time participants had used HBPM. In HPBM practice assessment, 15.9% of people with HTN (37/232) vs 5.9% caregivers (14/236) scored excellent (score &gt;75%). In HPBM knowledge assessment, 0.4% of people with HTN (1/232) vs 0 caregivers scored excellent. HPBM practices were better than knowledge, with mean scores of 62.3 ± 13.1% and 40.1 ± 16.2% respectively. Higher education level was associated with improved patient knowledge (p=0.041), but not practices (p=0.225).The most common reason for non-use of HBPM was lack of knowledge of BPM (36.1%, 171/474) in rural areas, and most people in urban areas feeling it was not necessary (41.1%, 677/1646). Conclusion: There is need for more robust training on HBPM to enable affording people from all backgrounds to better manage their BP, especially in rural areas. Education level is not a barrier to learning good BPM technique.
Abstract 16799: Galectin-1 Alleviates Aortic Valve Calcification via Modulating Integrin-Mediated Cytoskeletal Reorganization and Focal Adhesion
Authors: Ying-wen Lin, Dongtu Hu, Xiangjie Lin, Juncong Li, Shuwen Su, Dingli Xu, Qingchun Zeng
Journal: Circulation (2023)

Background Galectin-1, a beta-glycoside binding protein, has been reported to involve a variety of cell functions including proliferation, cell migration and focal adhesion. The role of cell-matrix interaction in calcific aortic valve disease (CAVD) is not fully investigated and whether galectin-1 is involved in this process remains unclear. We hypothesized that galectin-1 mitigates the fibrocalcific response and mechanosensitivity of valve interstitial cells (AVICs) by modulating integrin-mediated cytoskeletal reorganization and focal adhesion. Methods and Results We enrolled patients with CAVD and age- and sex-matched controls to detect serum galectin-1 and found that circulating galectin-1 was lower in CAVD. The expression of galectin-1 decreased in fibrocalcific valves and AVICs cultured in osteogenic medium (OM), as shown by western blot, qPCR, immunohistochemistry (IHC) and immunofluorescence. Silencing galectin-1 by short-interfering RNA exacerbated the fibrocalcific change of AVICs in vitro while recombinant galectin-1 (rGal-1) prevented these effects. AVICs cultured in OM also presented enhanced integrin signaling, cytoskeletal reorganization and focal adhesion. Anti-integrin blocking experiments and co-immunoprecipitation assays demonstrated that the galectin-1 directly interacted with integrin αvβ1 to regulate AVICs adhesion to a fibronectin matrix. Western blot, qPCR and Immunofluorescence assays confirmed that actin cytoskeletal reorganization was induced by αvβ1 activation through Rac1-WRC-Arp2/3 signaling axis. Western blot, alkaline phosphatase (ALP) as well as Alizarin red staining demonstrated that silencing galectin-1 enhanced AVICs sensitivity to piezo1 activation, which is dependent on αvβ1 binding and actin polymerization. In vivo, aortic valve disease was constructed by direct wire injury (DWI), and we showed that overexpression of galectin-1 by adeno-associated virus significantly decelerated the progression of aortic valve lesion induced by DWI in mice. Conclusion Galectin-1 interacts with integrin αvβ1 to modulate cytoskeletal reorganization and AVICs adhesion to fibronectin, thus mitigating the fibrocalcific response of AVICs and aortic valve calcification.