tbuckley/cabot-search huggingface dataset:
Abstract 4124839: Does Anticoagulation Status Before LAA Thrombus Detection Influence Stroke Risk?
Authors: Eisuke Kagawa, Takayuki Hidaka, Eiji Kunita, AYA YAMANE, Shogo Matsui, Munehiro Kanegawa, Masaya Kato
Journal: Circulation (2024)

Introduction: Thrombus in the left atrial appendage (LAA) is known to be one of the risk factors for ischemic stroke, and after the detection of LAA thrombus, anticoagulation therapy is usually administered. However, the role of anticoagulation therapy before the detection of LAA thrombus in the prognosis is still unclear. Hypothesis: We assessed the hypothesis that the anticoagulation status at the time of LAA thrombus detection with transesophageal echocardiography (TEE) affects the future incidence of ischemic stroke. Methods: Patients who underwent TEE and were found to have LAA thrombus were included. Patients were divided into two groups based on their anticoagulation status before TEE. To exclude strokes that might occur due to the detected LAA thrombus itself, landmark analysis was performed by excluding patients who had a stroke or died within 30 days after detection of the LAA thrombus. The difference in the 7-year cumulative incidence of ischemic stroke was assessed using the Gray-test. Fine-Gray proportional hazard regression was utilized to assess the impact of anticoagulation status on ischemic stroke. Results: Among 183 patients detected with LAA thrombus, 15 suffered ischemic stroke or death within 30 days of detection, and 168 patients were included in this study. Of these, 58 patients were treated with anticoagulation therapy before the index detection of LAA thrombus (PreAC group). Patients in the PreAC group were older (median 76 years [interquartile range 51-88 years] vs. 74 years [38-89 years], P = 0.032) than those in the non-PreAC group. The rates of CHA2DS2-VASc score ≥ 2 (93% vs. 89%, P = 0.582), male sex (64% vs. 70%, P = 0.488), and history of atrial fibrillation (98% vs. 95%, P = 0.667) were similar between the two groups. The cumulative ischemic stroke rate was higher in the PreAC group than in the non-PreAC group (P = 0.048, Figure). Even after adjusting for CHA2DS2-VASc score, anticoagulation therapy before detection of LAA thrombus was significantly associated with the cumulative incidence of ischemic stroke (P = 0.049). Conclusions: Anticoagulation status before the detection of LAA thrombus is a determinant of a higher incidence of ischemic stroke. The background mechanisms suggesting a tendency toward thrombus generation even when treated with anticoagulation are proposed.
Abstract 4124307: Outcome of Obesity in Atrial Fibrillation - Insights from The National Inpatient Sample Database
Authors: Allan Santos Argueta, Junaid Ali, Marlon Rivera Boadla, Hector Santos Argueta, Parthiv Amin
Journal: Circulation (2024)

Background: Obesity is considered a significant risk factor for numerous cardiovascular conditions due to its effects on cardiac structure and function. The prevalence of atrial fibrillation (AF) is elevated among patients with obesity due to the dysregulation of several mechanisms. Weight loss has been shown to reverse cardiac remodeling, leading to a lower recurrence of AF despite the better prognosis in obese patients described as the obesity paradox. Methods: We utilized the National Inpatient Sample 2016-2019 to extract patients ≥18 years of age admitted with AF as the primary diagnosis based on ICD 10 codes. We performed univariate and multivariate regression analysis for known coronary risk factors. We divided patients based on their body mass index (BMI), and our primary outcomes were determining the odds of electrical cardioversion (ECV) and cardiac ablation (CA) due to AF. Results: The analysis included 1,625,809 weighted patients. Patients include underweight (6.66%), normal BMI (4.03), overweight (6.51%), obesity class I (20.65%), obesity class II (21.45%), and obesity class III (40.7). After multivariate regression analysis, patients with obesity class I, II, or III had higher odds of ECV, irrespectively of coronary risk factors (OR 1.3, 95% CI 1.25-1.37, OR 1.3, 95% CI 1.32-1.43, OR 1.3, 95% CI1.29-1.38, respectively, with statistically significant P values). However, underweight or normal BMI patients had fewer odds of ECV (OR 0.5 95%CI 0.49-0.61 and OR 0.6 95%CI 0.58-0.74, respectively, with P values &lt;0.001). Meanwhile, there was no statistical significance between a BMI and the odds of CA. Conclusion: Our study highlights the significant impact of BMI on managing atrial fibrillation, particularly regarding electrical cardioversion (ECV). Patients in higher BMI categories (obesity class I, II, and III) demonstrated increased odds of undergoing ECV, suggesting that obesity may influence treatment approaches and outcomes in AF management. Interestingly, BMI did not affect the likelihood of cardiac ablation (CA), indicating a more complex relationship between body weight and AF treatment modalities that warrants further investigation. These findings underscore the importance of personalized treatment strategies to optimize outcomes, with a focus on weight management.
Abstract 4124313: An unusual case of pericardial mass
Authors: Jingyi Gong, Esra Gumuser, Anna O'Kelly, Maria Chen, Albree Tower-rader, Doreen Yeh, Jeanne Vaughn, Ibiayi Dagogo-jack, Tomas Neilan
Journal: Circulation (2024)

A 30-year-old male electrician presented with two days of fever and positional left shoulder pain and was found to have elevated inflammatory markers and a large pericardial effusion with echocardiographic evidence of tamponade for which he underwent pericardiocentesis. He was discharged on a course of anti-inflammatory therapy with presumed diagnosis of idiopathic pericarditis based on negative cytology. He returned 6 months later with several weeks of upper respiratory infection symptoms as well as new abdominal discomfort and emesis. On presentation, his vital signs were notable for tachycardia to 113 and cardiac exam was notable for tachycardia, regular rhythm, no rubs or murmurs, nondisplaced precordial impulse, normal jugular venous pressure with Kussmaul sign, and pulsus paradoxus of 6. An electrocardiogram showed sinus tachycardia with diffuse ST segment changes (Figure A). His cardiac biomarkers were unremarkable (troponin 21). His labs revealed normocytic anemia with hemoglobin of 11 and erythrocyte sediment rate above assay. Echocardiogram demonstrated a circumferential complex pericardial effusion with echocardiographic evidence of early tamponade (Figure B, C). A pericardiocentesis was attempted with inability to advance wire within pericardial space. A malignancy workup was initiated. CT demonstrated multi-station thoracic and lower cervical lymphadenopathy, moderate left pleural effusion, and an intrapericardial mass with associated pericardial effusion (Figure D). Cardiac magnetic resonance imaging demonstrated a circumferential intrapericardial non-mobile mass measuring up to 22 mm in thickness posteriorly and the mass was isointense to myocardium indicating low-fat content (Figure E). A supraclavicular lymph node biopsy was obtained with immunohistochemical staining positive for WT1 and calretinin, consistent with metastatic epithelioid mesothelioma of pericardial versus pleural etiology (Figure F). A PET-CT subsequently showed a FDG-avid circumferential anterior pericardial mass and multiple pleural-based lesions concerning for metastatic mesothelioma. He was initiated on pemetrexed/carboplatin systemic chemotherapy. With systemic therapy, his disease has been stable for 6 months. Pericardial mesothelioma is a rare malignancy. This case underscores the diagnostic challenges associated with pericardial mesothelioma and the importance of cancer workup as part of the pericardial effusion workup.
Abstract 4124518: Recent Trends in Cardiovascular Risk Factors in Latin America and the Caribbean: The Rising Threat of a Cardiometabolic Epidemics
Authors: Beatriz Polachini, Rafael Lino, Victoria Bramucci, Ana Luiza Ciminelli, Antonio Luiz Ribeiro, Luisa Brant
Journal: Circulation (2024)

Introduction: The sociodemographic context of population growth and ageing, social disparities and the high level of urbanisation in Latin America and the Caribbean (LAC) provide a unique entry point to reflect on the impact of cardiovascular diseases (CVD) on populations. Our objective was to evaluate recent trends in cardiovascular risk factors (CVRF) in LAC to inform the development of potential solutions to address CVD in LAC. Methods: Using data from the “NCD Risk Factor Collaboration (NCD-Risc)” available for public consultation, we evaluated trends in the main CVRFs in LAC from 1990 to 2016-2020, namely: systolic blood pressure (SBP) in mmHg, total cholesterol (TC) in mmol/ml, body mass index (BMI) in average kg/m2 and prevalence of diabetes. NCD Risc compiles and harmonises data from studies representative of populations from various countries around the world. Data on the estimated prevalence of smoking in the region come from the “Global Burden of Diseases” study. Data are presented standardised by age to allow comparison of different periods, given that the age distribution of the population varied. Results: The CVRFs that showed favourable trends in LAC in recent decades were: smoking, mean SBP and TC. The prevalence of smoking fell from 69% to 17% for men and 67.6% to 7.6% for women, reducing the CVD risk attributable to tobacco by 34%. Mean SBP fell from 130 mmHg to 129 mmHg for men and 127 mmHg to 122 mmHg for women. The mean CT reduced from 4.7 mmol/L to 4.6 mmol/L for men and 4.8 mmol/L to 4.7 mmol/L for women. Obesity and diabetes showed unfavourable trends. The average BMI increased from 23.0 kg/m2 to 26.8 kg/m2 for men and from 23.0 kg/m2 to 27.5 kg/m2 for women, with the prevalence of obesity increasing from 3% to 11% in men and from 6% to 15% in women. The prevalence of diabetes followed this pattern and increased from 5.4% to 8.8% for men and from 5.8% to 9.6% for women. Conclusion: CVRF trends are heterogeneous and demonstrate success for policies aimed at CVRF, such as high blood pressure and smoking. However, the trends reveal that the problem in the coming decades will be the rise in obesity and its consequences, which may reverse favourable trends in CVD mortality risk in LAC. Population and individual strategies, considering the social determinants of health, need to be planned, such as taxation of ultra-processed foods and campaigns to encourage physical activity.
Abstract 4124342: Invasive CPET-based hemodynamic correlates of abnormal peak VO <sub>2</sub> and V <sub>E</sub> /VCO <sub>2</sub> in HFpEF and pre-capillary Pulmonary Hypertension
Authors: Ahmed ElShaer, Anas Abed, Wanxin Tu, Justin Jan, Margaret Cochrane, Mariana Garcia-Arango, Aria Kenarsary, Arthur Gallegos, arif Abdul wahab, Babak Tehrani, James Runo, Farhan Raza
Journal: Circulation (2024)

Introduction: Pulmonary hypertension (PH) is a heterogeneous disease characterized by impaired gas exchange (CO 2 , O 2 ) in the pulmonary circulation, leading to dyspnea and exercise intolerance. We hypothesize that specific hemodynamic metrics correlate with poor gas exchange in PH phenotypes, which can be leveraged to define therapeutically relevant hemodynamic targets. Aim: This study aims to define hemodynamic correlates of poor gas exchange (peak VO 2 , V E /VCO 2 slope) in heart failure with preserved ejection fraction (HFpEF) and pre-capillary PH. Methods: We retrospectively analyzed 170 participants with invasive cardiopulmonary exercise testing: HFpEF (n=91), pre-capillary PH (n=54), and non-cardiac dyspnea (NCD, n=25). Linear regression models, adjusted for patient groups with interaction, were used to assess the association of peak VO 2 and V E /VCO 2 slope with predictors (pulmonary vascular resistance [PVR], distensibility, and pulmonary arterial compliance [PAC]). Results: In the order of NCD vs. HFpEF vs. pre-capillary PH, rest PAC (5.5±1.6 vs 3.8±1.7 vs 2.6±1.3 mL/mmHg), rest PVR (1.4±0.6 vs 3.2±2.0 vs 5.7±3.0 Woods unit), and distensibility (1.5±0.5 vs 0.8±0.4 vs 0.5±0.2 % per mmHg). In comparison to a non-significant correlation with rest PVR and distensibility, peak VO 2 (%predicted) showed significant correlation with rest PAC (p&lt;0.01) with significantly positive slope of +6 in HFpEF and +10 in pre-capillary PH. Similarly, significant slopes were noted with rest PAC and V E /VCO 2 relationship (p&lt;0.01) in HFpEF (-3) and pre-capillary PH (-4). Conclusion: Pulmonary arterial compliance (PAC) is the best correlate of poor gas exchange. Improving rest PAC by 1.0 mL/mmHg can lead to improvement in peak VO 2 predicted (+10% in pre-capillary PH, +6% in HFpEF), and V E /VCO 2 slope (-4 in pre-capillary PH, and -3 in HFpEF). In comparison to pre-capillary PH, more limited improvement in HFpEF is likely due to multi-organ dysfunction leading to exercise intolerance.
Abstract 4124335: Ticagrelor monotherapy the way forward after Percutaneous Coronary Interventions : An updated meta-analysis
Authors: Zeeshan Mansuri, Hadiah Ashraf, Thahsin Taikadan, Gokul Rajith, Ayesha Ayesha, Urooj Fatima, Gabriel Erzinger
Journal: Circulation (2024)

Background: With the advent of newer generation drug eluting stents, the chorus for shortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary interventions (PCI) is getting louder and louder. Ticagrelor monotherapy after a short course of DAPT has been studied in a few randomized controlled trials with promising results. We conducted a systematic review and meta-analysis comparing the ticagrelor monotherapy with DAPT after short duration DAPT in patients undergoing PCIs. Methods: PubMed, Embase and Cochrane databases were searched for RCTs comparing ticagrelor monotherapy to DAPT after PCI and reported the outcomes of Major Adverse Cardiac Events including death, myocardial infarction or stroke (MACE); Major Adverse Cardiac and Cerebrovascular Events including death, myocardial infarction, stroke, stent thrombosis or target vessel revascularization (MACCE); Major bleeding; Death from any cause; CV death; Stent thrombosis and Target vessel revascularization (TVR). Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Statistical analysis was performed using Review Manager Web (Cochrane Collaboration). Heterogeneity was examined with I 2 test. Results: Out of 3208 database results, 5 RCTs with 32,393 patients were included; 16,188 (50%) received Ticagrelor monotherapy. Studies had mean follow-up ranging from 12 months to 24 months. Baseline characteristics are as per Table 1. Safety endpoints of major bleeding (HR 0.50; 95% CI 0.38-0.66; p &lt; 0.0001; I 2 = 23 %; Figure 1A), was significantly less with ticagrelor monotherapy. Efficacy endpoints of MACE, MACCE, Death from any cause, CV Death, target vessel revascularization (TVR) and stent thrombosis were not significantly different between ticagrelor and DAPT (Figure 1 and 2). Conclusion: Ticagrelor monotherapy reduces major bleeding as compared to continued DAPT for 12 months after PCI. Major ischemic outcomes were similar in both groups. Ticagrelor monotherapy may be the way forward after short duration of DAPT in patients undergoing PCI.
Abstract 4119635: The Effect of Exercise Training on Apolipoproteins: A Trial Sequence Meta-Analysis.
Authors: Neil Smart, Tom van der Touw
Journal: Circulation (2024)

Background: The role of lipoprotein sub-units in the development of CVD not as well understood as for the standard lipid profile. We conducted a systematic review and meta-analysis of the effect of Exercise training (ExTr) effect on common lipid sub-units. Methods: We conducted a systematic search for randomized, controlled trials of ExTr versus sedentary controls that reported lipid sub-units Apo AI, Apo AII, Apo B, HDL-2, HDL-3 and Lp(a) up until January 31, 2024. Results: We included 24 included studies with 27 intervention groups, with a total of 1,429 participants, 775 ExTr and 654 control. We found significant favourable anti-atherogenic changes in Apo A1; MD 5.96 mg/dL 95% CI (3.63, 8.30); Apo B; MD -0.11 mg/dL (-0.19, -0.04); HDL-2; MD 1.28 mg/dL 95% CI (0.28, 2.28). Our TSA analysis showed that futility was achieved for Apo A1, but not for Apo B and HDL-2. The minimal clinically important differences (MCID) for Apo A1, Apo B and HDL-2 were 0.76 mg/dL, 0.02 mg/dL and 0.26 mg/DL respectively, meaning ExTr is capable of adequately achieving clinical significance for these 3 outcomes. Analyses of Apo A2, Lp(a)and HDL-3 were not significant and these TSA analyses failed to show futility. Conclusion: ExTr produces significant improvements in ApoA1, Apo B and HDL-2, with the MCID achieved and evidence of futility reached for all three of these outcomes. The effect of ExTr on Apo A2, Lp(a)and HDL-3 is unclear as futility has not been reached. ExTr changes observed in Apo AI are similar in size to those from statin trials that were associated with an 11% reduction in CV events.
Abstract 4121378: Non-invasive, Automated Approach to Estimate Septal Curvature as a Surrogate of Mean Pulmonary Arterial Pressure for Pediatric Pulmonary Hypertension Patients
Authors: Takashi Fujiwara, Vivian Lu, Dunbar Ivy, Brian Fonseca, LaDonna Malone, Benjamin Frank, Helio Neves da Silva, Daniel Sassoon, Dale Burkett, Lorna Browne, Alex Barker
Journal: Circulation (2024)

Background: Pediatric pulmonary hypertension (PH) is diagnosed and monitored using echocardiography and right heart catheterization. Recently, non-invasive measurements using cardiac MRI have also been investigated for patient monitoring. A promising measurement is MRI-based septal curvature, which has excellent correlation with mean pulmonary arterial pressure (mPAP). However, this approach requires significant manual interaction and is subject to observer-dependent measurement variability. Hypothesis: Automated septal curvature computation can predict mPAP and is less observer-dependent than the manual approach. Aims: To develop an automated approach to measure septal curvature and compare its performance with a manual approach in pediatric PH patients. Methods: Pediatric PH patients (mPAP≥25mmHg) who had both a clinical cardiac MR exam and right heart catheterization were retrospectively enrolled. From the mid-slice of short-axis stack images for the ventricles, time-resolved contours for both ventricles were automatically generated with cvi42, and imported to a custom MATLAB tool to automatically compute normalized septal curvature (Fig.1). The minimum normalized curvature (a 7-point average around the minimum value in a cardiac cycle) was computed to investigate its association with mPAP and a composite outcome (death or referral for heart/lung transplant). The new and manual approaches were conducted by two observers to test interobserver agreement. Pearson correlation, univariable logistic regression, receiver-operating characteristic curve, area under the curve (AUC), and intraclass correlation coefficients (ICC) were conducted. P&lt;0.05 was considered statistically significant. Results: Twenty-seven patients (14.3±5.4 years; mPAP, 44 [35.5–57] mmHg) were enrolled. Minimum normalized curvature was correlated with mPAP (r=0.78, p&lt;0.001; Fig.2A). Logistic regression found significant association between outcomes and minimum curvature (AUC, 0.88; 95% CI, 0.74–1.00; p&lt;0.001; Fig.3AC). The proposed approach found excellent interobserver agreement (ICC, 0.98; 95% CI, 0.96-0.99) and was similar or superior to the manual one in all performance metrics (manual: correlation with mPAP: r=0.67, p&lt;0.001; AUC: 0.84, 95% CI, 0.69–0.99, p=0.004; ICC: 0.89, 95% CI, 0.81-0.94; Figs.2B,3BD). Conclusion: The proposed automated approach to compute septal curvature is less observer dependent than the manual approach and could be a robust tool to follow up pediatric PH patients.
Abstract 4120957: Endovascular Thrombectomy Versus Medical Management for Acute Ischemic Stroke with Large Infarct: An Updated Meta-Analysis of Randomized Controlled Trials
Authors: Hritvik Jain, Ramez Odat, Aman Goyal, Jyoti Jain, Ancy Jenil Franco, Nandan Patel, Janhvi Shah, Jagriti Jha, Siddhant Passey, Shrey Gole
Journal: Circulation (2024)

Background: Endovascular therapy (EVT) has revolutionized the treatment of acute ischemic stroke due to large vessel occlusions. Despite the increasing evidence for EVT, its efficacy remains understudied in patients with acute ischemic stroke with large infarcts. Patients with large-volume ischemic strokes are excluded from major randomized controlled trials (RCTs) despite contributing up to 25% of all acute ischemic strokes. Aim: This study aimed to compare clinical outcomes with endovascular thrombectomy versus medical management in patients with acute ischemic stroke with large infarct. Methods: We conducted a systematic literature review on PubMed, Embase, Scopus and Cochrane Library from inception to 15th May 2024 for RCTs. The inverse-variance random-effects model was used to pool odds ratio (OR) and risk ratio (RR) with 95% confidence intervals. The statistical significance was set at p&lt;0.05. Results: 6 RCTs with 1887 patients (945: EVT and 942: medical management) were included. The mean age in both EVT and medical management groups was 70 ± 11.4 years. EVT was associated with a better modified Rankin Score (mRS) at 90 days [OR: 1.68; 95% CI: 1.38, 2.04; p&lt;0.00001], mRS at 90 days (0-2) [OR: 2.47; 95% CI: 1.87, 3.27; p&lt;0.00001], mRS at 90 days (0-3) [OR: 1.96; 95% CI: 1.56, 2.46; p&lt;0.00001], and early neurological improvement [RR: 2.35; 95% CI: 1.79, 3.10; p&lt;0.00001] compared to medical management. EVT was also associated with a higher risk of symptomatic intracranial hemorrhage [RR: 1.71; 95% CI: 1.09, 2.66; p=0.02]. The 90-day mortality [RR: 0.86; 95% CI: 0.72, 1.02; p=0.08] was comparable between the two groups. Conclusion: Patients with acute ischemic stroke with large infarct had superior functional outcomes with EVT as compared to medical management alone. However, EVT was associated with higher risks of symptomatic intracranial hemorrhage, with comparable 90-day mortality risk. Further large RCTs are warranted to evaluate the outcomes with EVT in acute ischemic stroke with large infarct.