tbuckley/cabot-search huggingface dataset:
Abstract 15474: Factors Associated With Shock at Presentation for Patients With Kawasaki Disease versus Multisystem Inflammatory Syndrome in Children Associated With COVID-19
Authors: Supriya S Jain, Robert Lowndes, michelle grcic, Ayisha Bashir, Luis M Garrido, Nagib Dahdah, Nilanjana Misra, Joseph J Pagano, Victoria Maksymiuk, Pei-Ni Jone, Deepa Prasad, Tyler Harris, Jacqueline R Szmuszkovicz, Benjamin Barnes, Tapas K Mondal, Manaswitha Khare, Dongngan Truong, Pedrom Farid, Cedric Manlhiot, Brian W McCrindle
Journal: Circulation (2023)

Background: Comparisons between Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) have been critiqued, with suggestions that KD Shock Syndrome (KDSS) patients may be a more valid comparison. We compared contemporaneous KD and MIS-C patients, both with and without shock at presentation. Methods: The International KD Registry enrolled 2144 patients with either KD (site diagnosis confirmed by AHA criteria) or MIS-C (site diagnosis confirmed by CDC criteria) from 40 sites in 7 countries from 01/2020 to 01/2023. Data collected included demographics, clinical features and presentation, management, laboratory values, and outcomes, and diagnosis/shock groups were compared. Results: Shock at presentation was noted for 19 of 672 (2.8%) KD patients and 653 of 1472 (38%; p&lt;0.001) MIS-C patients. For both groups, shock patients were significantly more likely to be admitted to ICU, receive inotropes, and have cardiac arrest or arrhythmia. Groups did not differ by sex, but MIS-C patients and shock patients were older. While MIS-C shock patients were less likely to be White, KD shock and MIS-C shock patients more likely to be Black. For inflammatory markers, while shock patients in both groups had higher CRP and ferritin compared to non-shock patients, ESR was similar in both groups to non-shock patients, and higher WBC was only noted for MIS-C shock versus MIS-C non-shock patients. KD shock patients had similar values to MIS-C shock patients, with the exception of lower ferritin. Shock patients had higher NTproBNP (both diagnoses) and Troponin I (MIS-C only). Shock patients had lower LV ejection fraction, more so for MIS-C patients ( Figure A ). KD shock patients had higher max coronary artery Z scores versus MIS-C patients ( Figure B ). Conclusions: KD shock patients are more similar to MIS-C patients, particularly those with shock. Shock was associated with worse coronary artery involvement for KD patients, and worse LV dysfunction for both MIS-C and KD.
Abstract 15489: Clinical Characteristics and Outcome of Patients With Acute Myocardial Infarction and Pre-Existing Left Heart Valvular Disease
Authors: Tamilla Muzafarova, Zuzana Motovska, Ota HLINOMAZ, Milan Hromadka, Petr Kala, Teodora Vichova, Jan Mrozek, Jiri Kettner, Martin Hutyra, Robert Petr, Pavol Tomasov, Oana Ionita, Jiri Jarkovsky
Journal: Circulation (2023)

Introduction. With the aging population and rising prevalence of cardiovascular risk (CV) factors, the global number of patients with acute myocardial infarction (AMI) and left valvular heart disease (VHD) is expected to increase substantially. Aims: To analyze the impact of pre-existing significant mitral regurgitation (MR) and aortic stenosis (AS) on clinical characteristics and outcome of AMI. Methods: The analysis is based on national all-comers’ registry of AMI enriched by information from the National Registry of Reimbursed Health Services. Results: Among 47,436 AMI-patients admitted during 2017-2021 selected VHD was documented in 1,445 (3.0%) patients; 510 (35.3%) with MR, 869 (60.1%) with AS. Patients with VHD (compared to without) had worse CVrisk profile - older (mean(SD)) age 73.9(10.6) vs. 65.6(12.5)ys, more previous PCI 23.5% (vs. 14.9%), CABG 23.4% (vs. 5.3%), higher comorbidity (diabetes 27.6% vs. 20%, CKD 11.9% vs. 5%); p&lt;0.001 for all comparisons. NSTEMI was the most frequent manifestation in 58.9% of VHD patients (vs. 41.3% without, p&lt;0.001). Patients with VHD had a wider extent of coronary artery disease with multivessel- 61.5% (vs. 53.6%) and left main disease 10.9% (vs. 5.5%), a higher proportion of TIMI 3 before PCI in 48.8% (vs. 38.0%), and with more frequent ≤80% IRA-stenosis in 20.0% (vs. 13.1%); p&lt;0.001 for all comparisons. The presence of VHD fundamentally affects the short- and long-term prognosis (Fig). The AS patients had the highest prevalence of diabetes (30.1%), the highest risk of Killip ≥3 (OR 1.78; 95%CI 1.48-2.15) and need of mechanical ventilation (OR 1.29; 95%CI 1.04-1.59), and the highest risk of death. Conclusion: Preexisitng significant VHD modifies the risk profile, presentation, and prognosis of AMI patients. AS patients have the worst prognosis, which may point to the need for earlier planning of valvular intervention, especially in those with current coronary disease.
Abstract 16302: Beyond the Veins: A Critical Right Atrial Termination Site in High Burden Paroxysmal Atrial Fibrillation Identified Using Spatiotemporal Dispersion After Failure of High Quality Pulmonary Vein Isolation
Authors: Ngoda Manongi, Seth Goldbarg
Journal: Circulation (2023)

Case Presentation: A 55 year-old female with two-year history of persistent atrial fibrillation (AF) presented for elective catheter ablation. Her smart watch recorded frequent prolonged episodes of AF, and event monitoring confirmed 71% AF burden. Metoprolol improved her symptoms only slightly. At the beginning of the procedure, patient’s rhythm was on sinus (NSR). During the completion of pulmonary vein isolation (PVI), the patient developed typical flutter, which degenerated into AF during ablation. Biatrial dispersion mapping in the right atrium (RA) revealed a single highly dispersed area in the posterior RA. Ablation at this site immediately terminated AF to NSR. The patient was non-inducible and remains free of AF. Discussion: Maintenance of NSR in AF is associated with improved clinical outcomes and quality of life. Catheter ablation has the highest efficacy for minimizing AF burden. PVI has a success rate of 67-89% in treating patients with paroxysmal AF and PVI alone is typically employed. A dispersion area is characterized by local clusters of electrograms which may or may not be fractionated, and display interelectrode time and space dispersion such that activation is spread over the entire AF cycle length. Identification and ablation of dispersion regions in persistent AF has demonstrated a high acute termination rate and improved outcomes in early follow-up, but is difficult to reproduce (Seitz et al. 2017). Here, we present a case of a patient with high burden paroxysmal AF who underwent PVI but remained in AF. Using visual dispersion mapping, we were able to identify a critical RA dispersion area, which rendered patient non-inducible (Figure 1).
Abstract 13565: Long-Term Prognostic Value of the Combination of Systemic Immune-Inflammation Index and AHEAD Score and in Patients Admitted for Acute Decompensated Heart Failure
Authors: Takahisa Yamada, Tetsuya Watanabe, Takashi Morita, Masato Kawasaki, Atsushi Kikuchi, Takumi Kondo, Tsutomu Kawai, Yuji Nishimoto, Masahiro Seo, Jun Nakamura, Takeshi Fujita, Masanao Taniichi, Yongchol Chang, Masatake Fukunami
Journal: Circulation (2023)

Backgrounds: Systemic inflammation plays a critical role in the outcomes of heart failure patients. A newly defined index, which is named as systemic immune-inflammation index (SII), had been reported to have prognostic value in patients with cardiovascular disease. On the other hand, comorbidities are strongly associated with poor clinical outcome in heart failure patients (pts). AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score was known to be related to clinical outcomes in acute decompensated heart failure (ADHF) patients. We sought to investigate the prognostic value of the combination of SII and AHEAD in patients admitted for ADHF. Methods and Results: We studied 263 patients admitted for ADHF and discharged with survival. At the discharge, we obtained SII, which is computed as neutrophils x platelets / lymphocytes, and AHEAD score (range 0-5, atrial fibrillation, hemoglobin &lt;13 mg/dL for men and 12 mg/dL for women, age &gt;70 years, creatinine &gt;130 μmol/L, and diabetes mellitus). During a follow-up period of 5.0±4.2 yrs, 67 patients had cardiovascular death (CVD). At multivariate Cox analysis, SII and AHEAD score were significantly independently associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure and left ventricular dimension index. The patients with both greater SII (≥571 determined by ROC analysis: AUC 0.632[0.553-0.712]) and AHEAD score (≥3: AUC 0.635[0.562-0.707]) had a significantly increased risk of CVD than those with either and none of them (51% vs 28% vs 16%, p&lt;0.0001, respectively). Conclusion: The combination of SII and AHEAD score would be useful for stratifying patients at risk for cardiovascular-renal poor outcome in ADHF patients.
Abstract 16827: Safety and Efficacy of Cangrelor in Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis
Authors: Mostafa R Mostafa, Mohamed Eid, Andrew Takla, Mostafa Najim, Sarah Mohamed, Kirolos Barssoum, Karim M Al-azizi, Andrew M Goldsweig, Hani Jneid
Journal: Circulation (2023)

Introduction and Hypothesis: Cangrelor is a potent intravenous non-thienopyridine P2Y12 inhibitor. We conducted a network meta-analysis to study the efficacy and safety of cangrelor compared to oral P2Y12 inhibition or placebo in acute coronary syndromes. Methods: This meta-analysis followed the Cochrane collaboration guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. Outcomes of interest included all-cause mortality, myocardial infarction, stent thrombosis, major bleeding, minor bleeding, and the need for blood transfusion. Results: In a network meta-analysis of 6 studies comprising 26,444 patients, Both cangrelor and clopidogrel showed no statistically significant difference compared to placebo in all-cause mortality (P= 0.46, I 2 = 22%) [Figure 1], myocardial infarction (P= 0.50, I 2 = 24%) [Figure 2], stent thrombosis (P= 0.84, I 2 = 0%) [Figure 3], major bleeding (P= 0.73, I 2 = 11%) [Figure 4], or the need for blood transfusion (P= 0.43, I 2 = 17%) [Figure 6]. Additionally, clopidogrel did not show a significant difference in the occurrence of minor bleeding compared to placebo. However, cangrelor was linked to an increased risk of minor bleeding (P=0.04, I2=54%) [Figure 5]. Conclusion: Cangrelor has comparable outcomes to clopidogrel in patients with acute coronary syndromes and can be used as a reliable alternative in this population.
Abstract 14883: Low Dose Intravenous AAV9 Mediated Transduction of cBIN1 Lasts at Least Six Months in Minipig Hearts
Authors: Claire Wang, Jing Li, Pia Balmaceda, Robin M Shaw
Journal: Circulation (2023)

Introduction: Heart failure (HF) is a highly morbid disease with few treatment options that are designed to benefit heart muscle. In individual cardiomyocytes, HF is associated with disrupted t-tubule microdomains, limiting organization of the calcium handling machinery and cardiac function. Microdomain disruption is caused by reduced transcription of cardiac bridging integrator 1 (cBIN1), which can be restored by gene therapy to rescue HF. In a minipig model of non-ischemic HF, we found low dose intravenous delivery of cBIN1 gene therapy is efficacious for at least 6 months. However, it is not known how long the exogenous cBIN1 transgene persists in minipig hearts. Hypothesis: AAV9-cBIN1 transduction in minipig hearts can last for months Methods: 8-10 months old Yucatan minipigs with tachycardia-induced HF received a dose of PBS or AAV9-CMV-cBIN1-V5 (6x10 11 vg/kg, i.v. ). Weekly blood work was obtained to evaluate liver and renal function. Animals were terminated 6 months after injection and tissue samples were obtained from heart and other organs for histopathology and gene expression analysis. rtPCR was used to quantify exogenous mouse cBIN1-V5 gene using a probe detecting V5 and endogenous cBIN1 using a probe specific for porcine cBIN1 gene. Results: Throughout the 6-month period, no organ dysfunction was noted by blood test, or with histopathology at 6 months. At 6 months, ΔΔCt results of V5/HPRT1 indicate that AAV9 effectively transduces cBIN1-V5 (24.1 ± 5.4 fold above PBS) in hearts without detectible transduction elsewhere (Figure 1). ΔCt results of V5/cBIN1 (porcine) indicate that exogenous cBIN1-V5 expresses at 20.9 ± 1.8 % of endogenous cBIN1 gene in minipig hearts which is the level of cBIN1 overexpression needed to restore cardiac function. Conclusions: A single low dose intravenous therapy of AAV9-cBIN1 can reach efficacious levels for at least 6 months in minipig hearts without transduction in other organs.
Abstract 18548: Racial Disparities in the In-Hospital Outcomes of Patients Undergoing Percutaneous Peripheral Endovascular Procedures
Authors: Richard Orji, Nso Nso, Favour Markson, Ayodeji Ilelaboye, Ahmad Harb, Abdelraouf Salah, Somto Nwaedozie
Journal: Circulation (2023)

Introduction: Endovascular revascularization is becoming the mainstay management of peripheral vascular disease (PVD). Our study seeks to find out the impact of racial disparity on the outcome of this procedure. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest all-payer inpatient healthcare database in the United States. The NIS was searched for hospitalization of adult patients with PVD who had endovascular revascularization, using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Following Propensity score matching, we assessed for a primary outcome of inpatient mortality. The secondary results were acute kidney injury (AKI), amputation, cardiac arrest, cardiogenic shock, total hospital charge (THC), and length of stay (LOS). Results: About 395,510 patients with PVD had endovascular revascularization; 322,015 patients who had the procedure were either White (n=254,840, 79.1%) or Black (n=67,175, 20.9%). White patients had a mean age of 69.2±0.1 years compared to 64.9±0.1 years in Black patients (males: 61.1% versus 53.4%; females: 38.9% versus 46.6%). Compared to White patients, Blacks had significantly lower in-hospital mortality (2.2% versus 2.6%; p=0.005) and cardiogenic shock (0.9% vs 1.2%; p=0.004); however, they had significantly higher AKI (21.6% vs 19.0% p-value 0.015), amputations (7.6% vs 4.4% p-value &lt;0.001), and LOS (10.1 vs 7.5; p-value &lt;0.001) compared to Whites. Conclusions: This study showed that compared to Whites, Black patients were more predisposed to amputations, AKI, and higher LOS despite having a lower mortality rate after endovascular revascularization.
Abstract 18313: Sex Disparities in Optimal Medical Therapy for Ischemic Heart Disease
Authors: Hassan A Alhassan, Harnoor Mann, Leonard Chiu, Malamo Countouris, Amber E Johnson
Journal: Circulation (2023)

Background: Despite secondary prevention guidelines recommending optimal medical therapy (OMT) forischemic heart disease (IHD), which includes antiplatelets, statins, renal-angiotensin aldosterone inhibitors (RAASi), and β-blockers, significant sex disparities in OMT utilization have been observed. However, theimpact of national efforts on narrowing this gap in contemporary cohorts remains uncertain. Methods: Using data from the National Health and Nutrition Examination Survey cycles 2011-2020, we examined the distribution and trends of OMT medication classes and combinations used in the preceding 30 days (verified through containers in most cases) among adult men and women with self-reported IHD (myocardial infarction or coronary artery disease). Results: Among 1905 adults included (40.6% women, mean age 65.4years), women had significantlylower proportions of OMT use across all medication classes- antiplatelets (68% vs. 77.7%), statins (57.2% vs. 73.9%), RAASi (45.6% vs. 59.0%), and β-blockers (51.2% vs. 61.1%); as well as combinations such as aspirin+statins (47.4% vs. 64.1%) and all four medications (17.5% vs. 32.5%). After adjusting forsociodemographic and clinical factors, the odds of using antiplatelets (OR 0.71 95%CI 0.52-0.94), statins (OR 0.62, 0.40-0.96), and RAASi (OR 0.56, 0.38-0.84) were significantly lower among women than men,whereas β-blocker use was comparable. Moreover, between 2011 to 2020, fewer women consistentlyreported using statins, RAASi, β-blockers, antiplatelets+statins, and all four medications in each survey cycle. Conclusion: This nationally representative study reveals persistent sex disparities in OMT utilization forIHD, with women receiving suboptimal treatment compared to men. These findings emphasize the urgentneed for novel targeted interventions to address and mitigate the sex disparities in OMT utilization foreffective IHD prevention.
Abstract 14622: The Effects of SGLT2 Inhibitor Therapy in Patients With Non-Compaction Cardiomyopathy
Authors: Andraz Cerar, Martina Jaklic, Sabina Frljak, Renata Okrajsek, Neza Zorz, Gregor Poglajen, Gregor Zemljic, Miran SEBESTJEN, Bojan Vrtovec
Journal: Circulation (2023)

Introduction: Current therapeutic options in patients with noncompaction cardiomyopathy (NCC) are very limited. Recent evidence suggests that sodium glucose co-transporter 2 inhibitors (SGLT2i) may be effective across the spectrum of heart failure. Hypothesis: We sought to analyze the effects of SGLT2i on cardiac function in patients with NCC. Methods: We have prospectively enrolled 30 (23 male, 7 female) patients with NCC, confirmed by cardiac MRI from 2020 to 2022. Clinical, biochemical and echocardiography data were obtained at SGLT2i introduction and 6-month follow-up. On inclusion the patients were on stable HF therapy; dapagliflozin 10mg was prescribed to 23 patients, empagliflozin 10 mg to 7 patients. On follow-up echo myocardial recovery was defined as an increase of left ventricle ejection fraction (LVEF) ≥5%. Results: During follow-up, we found significant improvements in LVEF (29.8±7.5% vs. 43.5±9,5%; P&lt;0.001), LVOT VTI (14.3±7.5cm vs. 17.6±9.7cm; P=0.005), E/e' (15.7±6.4 vs. 10,0±4.1, P&lt;0.001) and TAPSE (2.0±0.4 vs. 2.3±0.4, P=0.012). NT-proBNP levels also decreased significantly (2843±3302 pg/mL vs. 582±803 pg/mL; P=0.002). A total of 18 (60%) of patients showed signs of myocardial recovery (Group A), whereas 12 (40%) showed no significant LVEF improvement (Group B); 5 patients had an event during follow-up (1 sudden cardiac death, 4 had heart Tx or LVAD implantation performed). The two groups did not differ significantly in age (50±15 vs. 46±15 years, P=0.54), sex (67% vs. 83 % male, P=0.28), baseline creatinine (83.3±27 μmol/Lvs. 89.3±21 μmol/L, P=0.53) or bilirubine (21±15 μmol/L vs. 17±12 μmol/L, P=0.56). When compared to Group B at inclusion, Group A had smaller EDD (6.4±0.8 cm vs. 7.1±0.9 cm in Group B, P=0.025), lower NTproBNP levels (1720±1662 pg/mL vs. 4527±4397 pg/mL, P=0.02), lower γGT levels (0.7±0.5 μkat/L vs. 1.4±1.1 μkat/L, P=0.017) and lower incidence of atrial fibrillation (11% vs. 57% in Group B, P=0.032). Conclusions: In patients with NCC, the introduction of SGLT2i appears to be related to significant myocardial recovery. The improvement may be more pronounced in NCC patients with smaller LV diameter, less neurohormonal activation, better hepatic function and lower incidence of atrial fibrillation.
Abstract 15519: Frailty is Associated With Incident Heart Failure in US Veterans Across Multiple Frailty Indices: The Million Veteran Program
Authors: Saadia Qazi, Benjamin Seligman, Sarah R Preis, Manas Rane, Peter W Wilson, Luc Djousse, David Gagnon, Michael Gaziano, Jane Driver, Kelly Cho, Ariela Orkaby
Journal: Circulation (2023)

Introduction: Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk via overlapping mechanisms such as inflammation, insulin resistance, and cellular senescence. However, the association of frailty with incident heart failure (HF) has not been well characterized. We calculated three distinct frailty scores and examined their association with HF in the Million Veteran Program (MVP). Methods: Participants comprised U.S. Veterans aged 50 years or older at baseline (2011-2018) enrolled in the prospective MVP study who were free of HF. We calculated frailty using three validated approaches: primarily the 36-item MVP-frailty index (FI) based on questionnaire data, 31-item Veterans Administration-FI (VA-FI) EHR-based index, and the 3-item Study of Osteoporotic Fractures (SOF) physical frailty score. Incident HF was ascertained via ICD-9 and ICD-10 codes. Multivariable-adjusted Cox proportional hazards models were constructed to assess the association between frailty status via each index and incident HF. Results: Among 190,688 Veterans (aged 69 ±9 years, 94% male), using the MVP-FI frailty screening tool, 29% were robust, 42% were pre-frail, and 29% were frail. Frailty prevalence increased by age, from 27% among 50-59-year-olds to 42% among those 90 years or older. Over a mean follow-up of 6±2 years, 15,816 (8.3%) Veterans developed incident HF. Pre-frail and frail compared to robust Veterans had nearly a 1.5-fold and 3-fold hazard of HF, respectively. The VA-FI and SOF indices yielded concordant findings (Table). Conclusion Among US Veterans aged 50 years or older, frailty was associated with incident HF. A graded increase in the hazard of HF occurred with increasing level of frailty, irrespective of frailty tool used. The present analysis lays the groundwork for future studies needed to further define the role of frailty in the pathogenesis of HF and inform clinical interventions for prevention of frailty and downstream HF.
Abstract 18695: C5ORF51/RIMOC1 - A Novel Regulator of Cardiogenesis
Authors: Xueyang Zhang, Alay Gandhi, Gayatri Ratakonda, Charles H Williams, Lingfei Sun, FENG LI, Christopher W Ward, Charles C Hong, Mark T Gladwin, Vijay K Yechoor, Ruya Liu
Journal: Circulation (2023)

Introduction: Adult human cardiomyocytes (CMs) have poor capacity for proliferation and functional recovery after heart attack, thus leading to the high morbidity and mortality of cardiovascular diseases. Thus, there is great need to understand the underlying mechanisms of adult CM turnover and maturation. While screening for modulators of TEAD1, the downstream transcriptional effector of Hippo pathway, my lab identified a novel factor—C5ORF51/RIMOC1—as a potential cardiomyogenic modulator. C5ORF51 (hereinafter referred to as C5x) is a previously uncharacterized protein of nearly unknown function, which appears to play critical roles in the regulation of CM homeostasis and heart size. Hypothesis: C5x is a novel cardiomyogenic regulator which determines CM turnover, maturation, and function. Methods and Results: (1) Ex vivo C5x deletion in mouse neonatal CMs leads to significantly increased percentages of cells in S-G2-M phases, suggesting that C5x mediates CM cell cycle arrest in a cell-autonomous manner; (2) In vivo CM-specific C5x-knockout mouse model shows significantly enhanced CM proliferation in adult mice as well as increased CM endowment and mononuclear diploid populations, indicating that C5x has an essential role in cell replication and division in vivo; (3) With age, C5x-CM-knockout mice develop systolic dysfunction, massive cardiomegaly, late-onset dilated cardiomyopathy, and premature mortality, demonstrating a critical role of C5x in maintaining normal cardiac function; (4) RNA sequencing analysis further reveals that C5x loss-of-function activates fetal gene expression while its gain-of-function suppresses fetal gene expression, suggesting C5x as a gatekeeper of the fetal gene program. Conclusions: C5x is required for CM cell cycle arrest, and its loss results in fetal gene activation leading to a primitive cell state and immature CM expansion.