tbuckley/cabot-search huggingface dataset:
Abstract 4136498: Analysis of Cardiovascular Events in Cancer Survivors: A Comparative Study of Solid Tumors and Hematologic Malignancies at a Tertiary Cardiovascular Center
Authors: Eder Jonathan Amaro Palomo, Ximena Latapi Ruiz Esparza, Anna Elisa Adib Gracia, Javier Garate Togo, Jorge Daniel Sierra Lara Martinez, Sarai Hernandez Pastrana, Eder Gonzalez Macedo, Alberto Santiago Hernández, Raul Rodrigo Neri Bale, Claudia Galilea Cortes Flores, Braiana Diaz, Diego Araiza, Alexandra Arias-Mendoza, MARCO ANTONIO MARTINEZ RIOS
Journal: Circulation (2024)

Background: Cardiovascular disease (CVD) and cancer represent the leading contributors of death worldwide. Although advancements in antineoplastic therapies have notably enhanced prognoses, CVD now emerges as the primary cause of mortality in this population. Ojective: To assess the occurrence of CVD in cancer survivors and investigate disparities based on their previous cancer diagnosis, categorized into solid tumors or hematological malignancies. Methods: A cross-sectional study was conducted, including adult oncology survivors who had previously undergone oncological treatment and were referred to our center between 2010 and 2023 due to the presentation of major adverse cardiovascular events (MACE). They were categorized into two groups: those with hematological cancer and those with solid tumors. We used Chi2 test to assess differences between categorical variables and the Wilcoxon rank-sum test to evaluate differences in continuous parameters. Statistical analysis was performed using R 4.0 and StataMP 14.1. Results: A total of 214 oncological patients were included (median age: 69 [IQR: 55-80], women: 53%), comprising 164 (76.6%) with solid tumors and 50 (23.4%) with hematological cancer. Baseline characteristics were mostly similar between the groups (Table 1), with diabetes being more prevalent in patients with solid tumors (26% vs 12%, p=0.036). The prevalence of heart failure was predominantly NYHA I and II in solid tumors and NYHA III in hematological cancer (p=0.002) (Table 2). The incidence of coronary artery disease (CAD) was the most common MACE in solid tumors (39% vs 34%), but this was not statistically significant (p=0.04). In hematological cancer, the most frequent MACE was myocardial dysfunction, showing a significant difference (46% vs 24%, p=0.002). Similarly, valvular heart disease (VHD) appeared more frequently in this group (38% vs 20%, p=0.01). The remaining MACEs did not show significant differences, nor did the count of MACEs upon hospital arrival. Conclusion: Myocardial dysfunction and VHD exhibited a higher incidence in hematological cancer compared to solid tumors. Conversely, the incidence of CAD was higher in the solid tumor group; however, similar to the occurrence of other MACEs, there was no significant difference between the two groups. These findings could emphasize the importance of closely monitoring specific cancer types to enhance prevention strategies but still need further analysis to also determine the exact etiologies.
Abstract 4136277: The Lay Public Misconceives Characteristics of Acute Coronary Syndrome-Related Chest Pain
Authors: John Blakeman, Ann Eckhardt, MyoungJin Kim
Journal: Circulation (2024)

Introduction: The most common acute coronary syndrome (ACS) symptom is chest pain. Chest pain is an umbrella term more precisely described using words like pressure or tightness. Previous studies have not explored the lay public’s conceptions of ACS-related chest pain. Misconceptions about chest pain make it difficult for individuals to recognize this symptom if they were to experience it, delaying care seeking. Research Question: How does the lay public conceive of ACS-related chest pain? Methods: Participants from across the U.S. were recruited in May and June 2023. Participants completed an online survey including the Chest Pain Conception Questionnaire. Descriptive statistics were used to characterize conceptions of chest pain quality, timing, intensity, and distress. Conceptions of men and women were compared using the independent-samples t -test and Chi-square test. Results: Participants (n=597) were mostly women (n=355; 59.5%) with a mean age of 54.0 years (SD = 11.5). The sample was diverse: White (n=414, 69.2%), Black (n=101; 16.9%), Hispanic or Latina/o/e/x (n=96; 16.1%), and Asian (n=67; 11.2%). Participants often thought of pressure (78.9%), tightness (77.4%), squeezing (75.5%), gripping (72.9%), and heaviness (72.5%) as possible descriptors of ACS-related chest pain. They less often thought of discomfort (48.7%), fullness (16.8%), and indigestion (13.4%). Participants expected ACS-related chest pain to be “intense” and to bother them “a lot,” both with median scores of 4.0 on a 5-point Likert scale. Participants felt that ACS-related chest pain would “often” (median 4.0) occur with activity and “sometimes” (median 3.0) occur at rest. Women were more likely to rate specific descriptors of chest pain (i.e., pressure, tightness) and general descriptors of chest pain (i.e., discomfort, pain) as more likely ACS-related chest pain descriptors than men, (all ps ≤ .05). Women (n=58; 16.3%) were about twice as likely as men (n=22; 9.2%) to endorse indigestion as a possible descriptor of ACS-related chest pain, ( p = .013, OR = 0.52 [95% CI = 0.31-0.87]). Conclusions: As many as 1 in 5 participants did not endorse common descriptors such as pressure and tightness as potentially characterizing ACS-related chest pain. Most believed this symptom would be intense and bother them a lot. They also more often associated ACS-related chest pain with activity than with rest. Clinical and research interventions can target the misconceptions identified in this study.
Abstract 4136598: Osteochondrogenic transdifferentiation of vascular smooth muscle cells and microenvironmental dynamics in medial arterial calcification at single-cell resolution
Authors: Yasuhisa Nakao, Tomohisa Sakaue, Manabu Shirai, Katsuji Inoue, Shuntaro Ikeda, Osamu Yamaguchi
Journal: Circulation (2024)

Background: Medial arterial calcification (MAC) significantly contributes to cardiovascular mortality, yet effective treatments remain limited due to unclear molecular mechanisms. This study aimed to develop a mouse model of MAC using O-ring-induced transverse aortic constriction (OTAC) and to elucidate key genes, pathways, and cellular interactions involved in MAC formation through lineage tracing and single-cell RNA sequencing (scRNA-seq). Methods: An OTAC mouse model was established to replicate MAC. Adult C57BL/6J male mice underwent OTAC, and subsequent analyses were conducted at various time points. Histological and immunohistochemical assessments were performed to monitor changes in vascular smooth muscle cells (VSMCs). Lineage tracing was utilized to verify the origin of osteochondrogenic VSMCs. Furthermore, scRNA-seq was employed to capture dynamic changes in VSMCs and other cell types contributing to MAC development. Results: The OTAC model successfully induced osteochondrogenic transdifferentiation of VSMCs, leading to MAC. Immunohistochemical analysis demonstrated time-dependent decreases in α-SMA expression and increases in SOX9 and RUNX2 expression. Lineage tracing using Myh11CreERT2;ROSA26-EGFP mice confirmed that osteochondrogenic VSMCs originated from contractile VSMCs. scRNA-seq identified osteochondrogenic VSMCs and revealed dynamic changes in surrounding cells, including macrophages and fibroblasts, which were implicated in calcification-related and inflammatory processes. Conclusion: The OTAC method effectively mimicked human MAC pathology, offering comprehensive insights into the microenvironmental dynamics of MAC progression at the single-cell level. This model serves as a robust platform for future research on therapeutic interventions.
Abstract 4136597: Atherosclerotic plaque healing as a marker of plaque vulnerability: Insight from intracoronary polarization-sensitive optical frequency domain imaging
Authors: NAOKI FUJISAWA, Kenichiro Otsuka, Martin Villiger, Georgia Jones, Kazuya Sugioka, Hiroki Yamaura, Akihiro Okamoto, Tomohiro Yamaguchi, Shunsuke Kagawa, Takenobu Shimada, Atsushi Shibata, Asahiro Ito, Takanori Yamazaki, Brett Bouma, Daiju Fukuda
Journal: Circulation (2024)

Background: Collagen is the major extracellular matrix that imparts mechanical strength to fibrous caps covering fibroatheromas. Intracoronary polarimetry with polarization-sensitive (PS) optical frequency domain imaging (OFDI) measures polarization properties, such as birefringence and depolarization (Figure 1). Birefringence is elevated in collagen and collagen-synthesizing smooth muscle cells, while depolarization is increased by the presence of macrophages and lipid/necrotic cores. Purpose: This study aimed to investigate polarimetric signatures of coronary lesions with healed coronary plaques (HCP) in patients with ACS and chronic coronary syndrome (CCS). Furthermore, we aimed to investigate diagnostic value for birefringence and depolarization of ACS culprit lesions discriminating from CCS target lesions. Methods: We conducted a single center prospective registry of intracoronary PS-OFDI imaging in patients with coronary artery disease (n = 50). A total of 862 OFDI frames selected from culprit or target lesions were analyzed. Coronary plaque phenotypes were assessed using conventional OFDI imaging. HCP was defined as plaques with one or more layers of different optical density and a clear demarcation from underlying components on intensity images. Birefringence and depolarization of the newer intima was measured in cross-sectional images. Birefringence and depolarization of ACS- and CCS-lesions were compared using a generalized estimating equation model. Receiver operating characteristic (ROC) analysis was used to investigate the diagnostic performance of polarimetric signatures for identifying ACS-lesions. Results: Compared to CCS-lesions, ACS-lesions featured significantly higher lipid-burden index and maximum lipid arc (both p &lt; 0.05). Compared to the CCS-lesions, ACS-lesions exhibited significantly lower birefringence (p &lt; 0.05) and higher depolarization (p &lt; 0.05). In the ROC analysis for differentiating ACS-lesions from CCS-lesions, area under the curves (AUC) for birefringence and depolarization were 0.712 and 0.672, respectively. In the multivariable ROC analysis in diagnosing ACS lesions, combination of birefringence with depolarization improved the AUC to 0.755 (p ＝ 0.025). Conclusions: Intracoronary polarimetry provides quantitative assessment of plaque composition in patients. Further research is warranted to investigate whether birefringence can serve as a marker of healing failure following plaque rupture and erosion.
Abstract 4136600: Hypertensive disorders of pregnancy and the risk of Dementia, Alzheimer’s disease, and Vascular Dementia. A Systematic review and Meta-analysis of 25,03,538 women participants.
Authors: Vikash Jaiswal, Abhigan Shrestha, Muhammad Hanif, FNU Danisha, Vamsikalyan Borra, Song Peng Ang, Jia Ee Chia, Ira Gupta, Zarghoona Wajid, Madiha Ariff, Zouina Sarfraz, Yusra Nasir, Christine Dawn Daguipa
Journal: Circulation (2024)

Background: Hypertensive disorders of pregnancy (HDP) are associated with maternal adverse cardiovascular outcomes. However, their association with maternal Dementia and Alzheimer’s disease is not well established with limited and conflicting results to date. Objective: We sought to evaluate the association between HDP and risk of incidence of Dementia, and Alzheimer’s disease. Methods: We performed a systematic review and meta-analysis of available literature that enrolled women with HDP and women without HDP groups. PubMed, Embase and ClinicalTrials.gov were systematically searched from inspection till May 2024 without any language restrictions. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were pooled using a random-effect model. Results: A total of 8 studies with 2503538 patients (1,51,905 in women with HDP and 23,51,633 in the women without HDP group) were included. Pooled analysis shows that HDP women were having 37% higher risk of dementia (aHR, 1.37(95%CI: 1.27-1.46), P&lt;0.001, I2=0%) when compared with women without HDP. Further pooled analysis showed that women with HDP were having 28% higher risk of Alzheimer’s disease (aHR, 1.28(95%CI: 1.56), P&lt;0.001, I2=53.98%), and 2-fold higher risk of vascular dementia (aHR, 2.49(95%CI: 1.29-3.68), P&lt;0.001, I2=71.51%) when compared with women without HDP. Conclusion: Women with HDP were at higher risk of developing Dementia, and Alzheimer's disease in future.
Abstract 4136563: In-Hospital Outcomes of Percutaneous Versus Surgical Mitral Valve Repair in Patients With COPD
Authors: Chetan Yarlagadda, Esteban Rodriguez, Michael Ugarov, Bertrand Ebner, Rosario Colombo, Nikolaos Spilias
Journal: Circulation (2024)

Background: Percutaneous mitral valve repair has been increasingly utilized for the treatment of mitral valve disease in the recent years, although surgical mitral valve repair and/or replacement remains the preferred therapy, especially for primary mitral regurgitation. Chronic obstructive pulmonary disease (COPD) is a common comorbidity that can adversely affect outcomes of cardiac procedures. While COPD is an independent predictor of adverse outcomes after surgical mitral valve repair, its effects on percutaneous mitral valve repair is not well-defined. Methods: Using National Inpatient Sample data from 2011 to 2019, we conducted a retrospective study of adult patients with COPD who underwent surgical or percutaneous mitral valve repair, using ICD-9 and ICD-10 codes. We excluded patients with surgical mitral valve replacement. Patient baseline characteristics and in-hospital outcomes were compared and adjusted for covariates to investigate outcomes using a logistic regression model. Statistical significance was determined with a p-value of &lt;0.001. Results: A total of 18,050 patients with COPD were included. Of these, 10,308 (57.1%) underwent surgical mitral valve repair and 7,742 (42.9%) underwent percutaneous mitral valve repair. The percutaneous cohort had a higher prevalence of heart failure, previous myocardial infarction, pulmonary hypertension, chronic kidney disease, and diabetes, while the surgical cohort had a higher prevalence of obesity and atrial tachyarrhythmias. Percutaneous repair was associated with lower rates of mortality, intraoperative complications, postoperative shock, acute coronary syndrome, and transfusions. Upon logistic regression, percutaneous repair was associated with lower rates of mortality (OR 0.28; 99% CI [0.19-0.40]), acute kidney injury (OR 0.38; 99% CI [0.33-0.44]), pneumothorax (OR 0.14; 99% CI [0.09-0.22]), vascular complications (OR 0.40; 99% CI [0.26-0.62]), and infection (OR 0.54; 99% CI [0.39-0.73]; p&lt;0.001 for all groups). Conclusions: In patients with COPD, percutaneous mitral valve repair is associated with lower mortality and procedural complications compared to surgical repair. The presence of COPD should be taken into consideration when deciding treatment strategy for patients with mitral valve disease.
Abstract 4136677: High Visceral-to-Subcutaneous Fat Ratio is Correlated with Increased Cardiovascular Events in Patients with Low Waist Circumference Suspected of Coronary Artery Disease
Authors: Takuya Miyagi, Kyuhachi Otagiri, Keishiro Okawa, Yushi Oyama, Takahiro Sakai, Hiroshi Kitabayashi
Journal: Circulation (2024)

Introduction: Waist circumference (WC) has been recognized as an appropriate index of obesity and is closely associated with the amount of abdominal fat. Although abdominal fat distribution (AFD), which is represented by the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) area (V/S ratio), is possibly related to an increased risk of cardiovascular disease (CVD), few studies have explored the relationship between AFD and CVD outcomes. This study aimed to assess the influence of AFD based on the V/S ratio and physique categorized by WC on long-term clinical results in patients with suspected coronary artery disease (CAD). Methods: We evaluated 931 consecutive patients (mean age, 67 years; 42.4% women) with suspected CAD who underwent computed tomography (CT) angiography. The patients also underwent plain abdominal CT to assess and measure VAT and SAT areas; V/S ratio was calculated to assess AFD. The patients were divided into four groups based on the median V/S ratio (0.624) and reference values of WC for metabolic syndrome in Japan (85 cm for men, 90 cm for women). We assessed the relationship between the V/S ratio and long-term clinical outcomes in each WC group. The main outcome was major adverse cardiac events (MACEs, including cardiac death, any coronary revascularization, acute coronary syndrome, and emergency hospitalization due to cardiac cause). Results: Over a median follow-up of 1869 days, although the incidence of any cardiovascular event was not related to the V/S ratio among patients with high WC, a higher incidence of MACE and cardiac death was noted among patients with low WC in the high V/S ratio group than in the low V/S ratio group. Furthermore, Kaplan–Meier analysis revealed a significantly lower MACE-free survival rate among patients with low WC in the high V/S ratio group than in the low V/S ratio group, despite of no differences being noted among high WC patients in both the V/S ratio groups (Figure). Conclusion: Only in patients with low WC, a high V/S ratio was linked to increased risks of MACE. Thus, high V/S ratio may be an essential risk factor for CVD, specifically in patients with low WC. However, AFD did not influence CVD prognosis in patients with high WC.
Abstract 4136033: High-Dose Folic acid Supplementation in Acute Myocardial Infarction - A systematic review
Authors: Hashim Talib Hashim, Ahmed Qasim Mohammed Alhatemi, Shahzaib Ahmed, Mudassir Ahmad Khan, Uzair Iqbal, Muhammed Hassan Hafeez, Ahmed Dheyaa Al-Obaidi, Omar Saab
Journal: Circulation (2024)

Background: Folic acid, a B vitamin, is essential for DNA synthesis and repair, and its role in reducing homocysteine levels has been linked to cardiovascular health. Elevated homocysteine is a risk factor for cardiovascular diseases, including acute myocardial infarction (MI) and coronary artery disease (CAD). Despite evidence suggesting that folic acid supplementation may lower homocysteine levels, its clinical benefits in reducing cardiovascular events remain unclear. Methods: A comprehensive literature search was conducted in PubMed/Medline, Google Scholar, and Cochrane Library databases for studies published from 2000 to 2024 using MeSH terms related to “folic acid,” “B vitamin,” “acute myocardial infarction,” “cardiac arrest,” “heart attack,” and “coronary heart disease.” Only randomized controlled trials (RCTs) and observational studies in English involving adult patients with acute MI or CAD were included. Exclusion criteria were applied to poor-quality studies, irrelevant outcomes, overlapping populations, and non-English texts. Data on study characteristics and patient demographics were extracted, and study quality was assessed using the RoB2 tool. Outcomes were pooled using RevMan 5.3.4 software. Results: Fourteen studies on all-cause mortality showed a risk ratio (RR) of 0.99 [95% CI: 0.94-1.04], indicating no significant difference between folic acid and control groups. Eight studies on cardiovascular mortality yielded a RR of 0.90 [95% CI: 0.82-0.99], suggesting a significant reduction in cardiovascular deaths with folic acid supplementation. Analyses of sudden death, coronary artery bypass graft (CABG) events, revascularization procedures, stroke, and recurrent MI found no significant associations with folic acid supplementation. Conclusions: High-dose folic acid supplementation appears to reduce cardiovascular mortality in post-MI patients but shows no significant impact on other clinical outcomes. This meta-analysis’s limitations include potential publication bias, heterogeneity among included studies, and variability in folic acid dosages and treatment durations. Furthermore, the lack of comprehensive homocysteine level data constrained the analysis. Future large-scale RCTs are needed to fully ascertain the therapeutic potential of folic acid supplementation in secondary prevention of cardiovascular events.
Abstract 4136159: Determinants of Exercise Intolerance in Postural Orthostatic Tachycardia Syndrome: a Systematic Review
Authors: Gerardina Abbate, Austin Hogwood, Georgia Thomas, ROSHANAK MARKLEY, Anna Priday, Ross Arena, Antonio Abbate, Justin Canada
Journal: Circulation (2024)

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a syndrome of an exaggerated heart rate (HR) response with standing, disproportionately affecting young women associated with exercise intolerance due to dizziness, palpitations, and/or chest pain. Research question: How does the exaggerated increase in HR with standing translate into impaired exercise tolerance in subjects with POTS? Aims: To systematically analyze determinants of exercise intolerance in subjects with POTS. Methods: We searched the National Library of Science and identifed 11 cohorts with a diagnosis of POTS and an assessment of exercise capacity. We abstracted the information including type of exercise testing, hemodynamics and gas exchange parameters (peak oxygen consumption [VO 2 ]) with exercise, and effect of interventions (if present). Results: We identified 849 subjects with POTS, female:male ratio of 8.5:1, 25±8 years, and 365 age-and sex-matched controls. A cycle ergometer was used in 8 studies (574 subjects, 68%) and a treadmill in 3 (275 subjects, 32%). Peak VO 2 was measured in 10 studies (836 subjects, 98%), and exercise hemodynamics in 9 (593 subjects, 70%). All 11 (100%) studies described a higher HR at rest and during submaximal exercise in subjects with POTS, with a similar slope of HR/load, and shorter time to peak HR. Of the 9 studies with hemodynamics, 6 (67%) reported a reduction in stroke volume (SV) with standing and with exercise, but only 1 (11%) documented a reduction in cardiac output (CO). Two studies (22%) enrolling teenagers showed a variable increase in SV and CO in POTS. Peak VO 2 was reduced in 8 (80%) studies when compared with predicted values, but only in 4 (40%) when compared with controls matched for deconditioning. Intravenous fluid administration in two studies did not affect HR, SV, CO or peak VO 2 . Exercise training in one study (19 subjects) and propranolol 20 mg in another study (11 subjects) led to improving peak VO 2 . Conclusions: An exaggerated HR response with standing and with exercise is a hallmark of POTS, a mechanism by which subjects reach a higher HR at lower workloads. While the increase in HR is associated with a reduction in SV, CO is typically maintained and occasionally increased, therefore making it an unlikely mechanism responsible for the peculiar exertional symptoms of POTS. Strategies that result in a reduction in HR may, on the other hand, translate in improved exercise capacity in subjects with POTS.