tbuckley/cabot-search huggingface dataset:
Abstract 13769: Prognostic Impact of Sodium-Glucose Co-Transporter-2 Inhibitors Therapy on All-Cause Mortality Among Patients With Diabetes Mellitus and Cancer
Authors: Moran Gvili Perelman, Ido Wolf, Rafael Y Brzezinski, Michal Laufer Perl
Journal: Circulation (2023)

Introduction: Diabetes mellitus (DM) and cancer are prevalent diseases associated with the process of aging and exhibit a high likelihood of co-occurrence. Extensive evidence supports the notion that DM serves as a risk factor for various forms of cancer, and it is strongly associated with an unfavorable prognosis. The correlation is believed to be influenced by multiple pathways, including hyperinsulinemia, hyperglycemia, and inflammation. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective antidiabetic therapies associated with reduced all-cause mortality and cardiovascular outcomes. Hypothesis: The aim of our study was to assess the correlation between SGLT2i therapy and all-cause mortality, among patients diagnosed with DM and cancer Methods: We conducted a retrospective, single-center, observational study including all patients diagnosed with DM and cancer between January 2016 to January 2023. Patients were divided into two groups: patients treated with SGLT2i prior to cancer diagnosis (SGLT2i) and patients SGLT2i naive (non-SGLT2i). The primary endpoint was all-cause mortality. Results: Overall, 7085 patients were included in our cohort; 985 patients in the SGLT2i group and 6100 patients in the non-SGLT2i group. At a median follow-up of 42 months [IQR 23, 60] we observed a significantly lower all-cause mortality among the SGLT2i group (23% vs. 38%, p&lt;0.001). Using a multivariable Cox regression analysis, SGLT2i therapy emerged as an independent significant predictor for reduced all-cause mortality (Hazard Ratio (HR) 0.637 [95% confidence interval (CI) 0.555-0.731], p&lt;0.001). Conclusions: SGLT2i therapy was found to be effective, associated with a significantly reduced all-cause mortality in patients diagnosed with DM and cancer. Randomized clinical trials are needed to establish the role of SGLT2i specifically in cancer patients and better understand its mechanism.
Abstract 11359: Association Between PROMIS Scores and Heart Failure Severity in Children
Authors: Lindsay May, Chiu-Yu Chen, David N Rosenthal, Linda M Lambert, Kimberly Molina, Desiree Machado, Dalia Lopez-Colon, Renata Shih, Taylor Gibbons, Brian A Madden, Angela Presson, Zhining Ou, Amy Cizik, Josef Stehlik, Heather Keenan
Journal: Circulation (2023)

Introduction: Patient reported outcome (PRO) measures correlate with heart failure (HF) severity among adults and are widely used as adjunct tools in the assessment of adult HF. However, limited data exist in pediatric HF. PROs may be valuable in monitoring heart failure (HF) status in children. Hypothesis: Patient Reported Outcome Measurement Information System (PROMIS) fatigue score correlates with HF severity in children. Methods: In this prospective cohort study, English and Spanish speaking patients were recruited from 4 pediatric HF centers 09/2019 - 02/2023. Children 8.0 to 18.0 years old with systolic and/or diastolic HF were enrolled while receiving inpatient HF treatment. Pediatric self-report PROMIS measures were administered during inpatient treatment and at additional outpatient follow-up time point(s) within 6 months post-discharge. Measures included mobility, fatigue, anxiety, depressive symptoms, and peer relationships. NYU HF Index scores were calculated at each time point. Pearson’s correlation with a 95% confidence interval (CI) compared PROMIS Fatigue T-score and NYU HF Index score at the inpatient time point, and a linear mixed effects model determined their association over time. Results: We enrolled 41 patients with median age of 13.5 ±4.2 years. Patient diagnoses included cardiomyopathy (48.8%), congenital heart disease (41.5%) and other (9.7%). Twenty patients (48.8%) were discharged from hospital alive and without a VAD or heart transplant, of which 18 completed both inpatient and outpatient follow-up assessment. Median PROMIS Fatigue T-scores and NYU HF Index scores improved from inpatient to outpatient assessment. NYU Index scores improved from 12.0 (IQR 11.2, 15.0) to 7.5 (IQR 5.8,10.2); p&lt;0.05. PROMIS fatigue scores improved from 58.5 (IQR 54.6, 64.9) to 50.2 (IQR 33.5, 59.2); p&lt;0.05. The correlation between PROMIS Fatigue T-score and NYU HF Index score at the inpatient time point was 0.5 (95% CI 0.2, 0.7), and their correlation over time was 0.5 (95% CI 0.3, 0.6). Conclusions: PROMIS Fatigue T-score moderately correlates with HF severity in children. Larger scale application of PROMIS could aid in longitudinal symptom management of pediatric HF patients and should be further tested in routine clinical care.
Abstract 12719: The Association of High Vitamin B12 With Mortality Risks and Related Metabolisms Among Hypertensive Population
Authors: Tianyu Cao, Lishun Liu, Xiao Huang
Journal: Circulation (2023)

Background: The association of high serum vitamin B12 (B12) with mortality risks is not well studied, and its independence from related metabolites needs to be disentangled. This study aims to explore the association of high serum B12 levels with all-cause mortality and its interaction with serum folate and plasma total homocysteine (tHcy) among Chinese adults with hypertension. Methods: This large observational study obtained data from the China Stroke Primary Prevention Trial (CSPPT), a multi-center RCT. The study sample consisted of 9,695 hypertensive adults who were not exposed to B vitamin supplements at baseline and during follow-up. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. Patients were stratified by B12 tertiles, and previously published cutoffs: B12 &lt; 299.52 pg/ml included patients with circulating B12 deficiency and sub-optimal deficiency; B12 &lt; 349.69 pg/ml with concomitant elevated tHcy determines B12 metabolic deficiency; B12 ≥ 349.69 ng/ml refers to those who are free from both circulating and metabolic B12 deficiency. Results: During the median follow-up time of 4.5 years, 284 deaths occurred. Compared to individuals with lower B12 levels, those with elevated B12 showed increased risk of all-cause mortality (hazard ratio (HR), 1.41 95%CI 1.07-1.85) and cardiovascular mortality (HR, 3.01; 95% CI 1.30-7.01). The association between elevated B12 and all-cause mortality risk appears robust in all tested subgroups. After excluding those with potential B12 metabolic deficiency, elevated B12 remains significantly and independently associated with all-cause mortality (HR, 1.36 95%CI 1.05, 1.76) and cardiovascular mortality (HR, 2.44 95%CI 1.15, 5.18). The Bayesian kernel machine regression results showed that higher B12 is associated with increased all-cause mortality risk independent of baseline folate and tHcy. Conclusion: Among Chinese adults with hypertension, elevated B12 levels is associated with increased risk of all-cause mortality, independent of baseline folate, tHcy, and other traditional risk factors. These findings, if further confirmed, have important implications for nutritional counseling and clinical recommendations on B vitamin therapy.
Abstract 13800: Comparison of Predictive Value of Risk Scores for Mortality in Asian Patients With Heart Failure With Preserved Ejection Fraction
Authors: Katsuomi Iwakura, Masato Okada, Nobuaki Tanaka, Yasushi Koyama, ATSUNORI OKAMURA, Watanabe Heitaro, Masahiro Seo, Takaharu Hayashi, Masamichi Yano, Akito Nakagawa, Shunsuke Tamaki, Takahisa Yamada, Yasumura Yoshio, Yohei Sotomi, Shungo Hikoso, Daisaku D Nakatani, Yasushi Sakata
Journal: Circulation (2023)

Background: Several risk scores have been developed to predict mortality and morbidity in heart failure (HF), including heart failure with preserved ejection fraction (HFpEF). However, these scores have primarily been derived from data obtained from Western patients. Research Questions: It remains unclear whether these risk factors are applicable to Asian patients, whose pathophysiology of HFpEF may exhibit ethnic differences compared to Western populations. Aims: To compare the predictive value of widely used risk scores for mortality in Japanese patients with HFpEF. Methods: We assessed the predictive value of three commonly utilized risk scores: MAGGIC, BCN-BioHF, and 3C-HF risk scores, which are applicable to patients with HFpEF. A total of 1,095 patients registered in the PURSUIT-HFpEF, a multicenter registry comprising individuals hospitalized with decompensated HFpEF, were enrolled (mean age 81±9 years, 54.8% female). The MAGGIC risk score and the predicted 1-year mortality rate by the web-based BCN-BioHF and 3C-HF risk calculators were obtained for all patients. Patients were followed for a median duration of 428 days (interquartile range: 208-794 days) to observe all-cause mortality. The predictive value of the risk scores was compared using the area under the curve (AUC) of time-dependent ROC curves for 1-year mortality. Results: Complete risk scores and predicted 1-year mortality rates were available for 1,082 (98.8%) patients. The AUC for 1-year mortality prediction was 0.73 (95% CI 0.68, 0.78) for the MAGGIC score, 0.65 (0.59, 0.71) for BCN-BioHF, and 0.71 (0.64, 0.76) for 3C-HF. The MAGGIC score exhibited a significantly higher AUC than BCN-BioHF (p=0.003), while no significant differences were observed between the MAGGIC score and 3C-HF, or between BCN-BioHF and 3C-HF. Conclusion: This study demonstrates that the MAGGIC, BCN-BioHF, and 3C-HF risk scores provide good predictive value for 1-year mortality in Japanese patients with HFpEF. The superior performance of the MAGGIC score suggests that considering the ethnic differences in HFpEF pathophysiology is crucial for accurate risk prediction in Asian populations.
Abstract 12012: Adverse Social Determinants of Health Are Associated With Increased Risk of Uncontrolled Hypertension Among Cancer Patients in Rural Georgia: A Prospective Cohort Study
Authors: Priyanshu Nain, Nickolas Stabellini, Sandeep Yerraguntla, Gaurav Gopu, Aditya Bhave, Lakshya Seth, Vraj Patel, Stephanie Jiang, Sarah Malik, Neal L Weintraub, Alberto J Montero, Alusine Fofanah, Jennifer Cullen, Neeraj Agarwal, Xiaoling Wang, Bonnie Ky, Lauren A Baldassarre, Ryan A Harris, Avirup Guha
Journal: Circulation (2023)

Introduction: The role of social determinants of health (SDOH) in the short-term control of hypertension (HTN) in cancer patients is unknown. Understanding the role of SDOH is important for equitable care of cancer patients, especially in the rural US. Hypothesis: High SDOH scores are associated with uncontrolled HTN in hypertensive cancer patients. Methods: We performed a prospective observational study at a tertiary care cancer center cardio-oncology clinic. Patients with cancer and HTN were asked to complete the Protocol for Responding to &amp; Assessing Patients' Assets, Risks &amp; Experiences (PRAPARE) questionnaire on their first visit. Blood pressure (BP) readings were taken at 2 follow-up visits. Uncontrolled HTN was defined as SBP≥130 mmHg and/or DBP≥80 mmHg with corroborated home blood pressure readings. Patients who did not perform home readings but had elevated BP at 2 nd visit were considered uncontrolled. The goals were the same regardless of cancer treatment. The SDOH score was calculated using PRAPARE SDH Risk Tally Score. We performed Cox proportional hazards regression adjusting for age, gender, and metastasis to identify the role of SDOH on short-term HTN control. The adversity cutoff for the SDOH score was informed by spline regressions. Results: In the cohort of 175 patients, median age was 66 (IQR 58-75) years, 55% were females, 42.2% were Non-Hispanic Black patients and 20.5% had breast cancer. Mean SDOH score was 6±3. The median duration of follow-up was 91 days (55-139). Uncontrolled HTN was noted in 59.4% of patients at their 2nd visit. For each 1-point increase in the SDOH score, uncontrolled hypertension increased by 9% (HR=1.09, 95% CI=1.03-1.15, p=0.002). Conclusions: Rural cardio-oncology patients with HTN have a high burden of SDOH. These study findings help identify contributors of SDOH that limit optimal HTN control in this population, allowing for better risk stratification and preventive intervention in clinical practice.
Abstract 13677: Incidence and Survival to Hospital Discharge After Maternal Cardiac Arrest: A Systematic Review and Meta-Analysis
Authors: Sanjana Nagraj, ISRAEL SAFIRIYU, Damianos Kokkinidis, Amrin Kharawala, Jiyoung Seo, Dimitrios Varrias, Sumant Pargaonkar, Shruthi Sridhar, Sahar Hassanain, Ahmad Naser, Andreas Tzoumas, Rosy Thachil
Journal: Circulation (2023)

Introduction: Maternal cardiac arrest (MCA) is considered a rare but devastating complication of pregnancy. However, the overall incidence, etiologies, and maternal and neonatal survival outcomes remain unknown. Research Question: What is the incidence of MCA? What are the underlying etiologies and survival to hospital discharge rate in women with MCA? Methods: Electronic databases PubMed, Embase, and Cochrane were searched from inception up to May 2023 for studies reporting the incidence, etiology, or outcomes of MCA (in-hospital or out-of-hospital cardiac arrest). Primary outcomes of interest were pooled incidence of MCA per 100,000 maternities and maternal survival to hospital discharge rate. Secondary outcomes of interest included frequency of underlying etiologies, perimortem cesarean section (PMCS) rate, and neonatal survival rate. A random-effects model meta-analysis was performed. Heterogeneity was assessed using I-squared test. Results: Eight studies surveying 63,859,400 maternities were included. Median (interquartile range) gestational age at the time of MCA was 32.03 (26.33-37.72) months. Pooled incidence of MCA was 5.83 (95% CI: 3.07-8.59) per 100,000 maternities (Figure 1A) . Rate of survival to hospital discharge after MCA was 42% (95% CI: 30-54) (Figure 1B) . Of the studies that reported etiologies, most common were maternal obstetric hemorrhage (30%; 95% CI: 16-43), cardiac etiology (20%; 95% CI: 11-28), amniotic fluid embolism (13%; 95% CI: 12-14) and venous thromboembolism (13%; 95% CI: 6-19). Incidence of PMCS was 36% (95% CI: 11-62) and neonatal survival rate in women with MCA was 45% (95% CI: 18-73). Conclusions: Less than half of the women with maternal cardiac arrest survived to hospital discharge and only 36% underwent perimortem cesarean section. The most common etiologies of MCA were maternal obstetric hemorrhage, cardiac etiology, amniotic fluid embolism and venous thromboembolism.
Abstract 11621: Impact of Data Reporting on Outcome Analyses of Intra-Aortic Balloon Pump versus Impella Devices in Bridging Adult Heart Transplant Patients
Authors: Jeremy Balch, Chen Bai, Benjamin Shickel, Mamoun Mardini, Mohammad A Al-Ani
Journal: Circulation (2023)

Introduction: There is a paucity of evidence to guide temporary mechanic circulatory support (tMCS) as bridge to heart transplant (HTx). Question: Can matching techniques reveal device-related effects on peri-HTx outcomes between IABP (Intra-Aortic Balloon Pump) and Impella? Methods: Using the UNOS registry, this retrospective study selected adult patients listed as status 2 on IABP or Impella (V5.0 or V5.5) from 10/2018 to 1/2023. We assessed demographic, medical, hemodynamic, and biochemical data. Primary outcome was failure of status 2 listing strategy (composite of waitlist mortality, escalation of tMCS, and deactivation or delisting due to medical instability). Propensity scores were calculated using logistic regression and matching with a k-nearest neighbors classifier. Results: 3505 IABP and 648 impella patients were identified based on missingness: (1) No missing data (n = 991, 23%), (2) missing hemodynamic data (n = 1606, 39%), (3) missing both hemodynamic and biochemical data(n = 1664, 40%), and (4) the completedataset (n = 4153). Prior to matching,, failure on status 2 occurred in 12.1% of all patients, 11% of IABP patients, and 17.7% of impella patients in group 4 (p &lt; 0.01). After matching, only in group 4 did impella patients have a significantly higher rate of failure on status 2 (12.6 vs 18%, p &lt; 0.01). Average treatment effect for impella on failure of status 2 was nonsignificant for group 1(ATE 0.06, 95%CI -0.016-0.166) and significant for group 2(ATE 0.06; 95% 0.001-0.125), group 3 (ATE 0.05, 95%CI 0.012-0.094), and group 4 (ATE 0.067, 95%CI 0.037-0.102) cohorts, favoring IABP. There was an increase in request for status 2 by exception in group 4 for impella patients (9.8% vs 8.6%, p=0.04). Conclusion: IABP versus Impella had minimal to no impact on failure on status 2 for matched cohorts. Differences appeared when either biochemical or hemodynamic data were omitted. Complete data availability is crucial for developing trustworthy and actionable models.
Abstract 12014: Macrophage-Specific DNaseII Deficiency Plays a Critical Role in Vascular Inflammation and Atherosclerosis in Apolipoprotein E-Deficient Mice
Authors: Kumiko Suto, Tomoya Hara, Sachiko Nishimoto, Shuri Kaneyama, Masataka Sata, Daiju Fukuda
Journal: Circulation (2023)

Background: Atherosclerosis is a chronic inflammatory disease of the walls of blood vessels. Macrophage activated by endogenous ligands plays an important role in chronic inflammation of blood vessels. Deoxyribonuclease (DNase) II in macrophages digests the endogenous DNA derived from apoptotic cells. Recent studies show that Toll-like receptor 9 (TLR9), one of the major receptors of endogenous DNA, activates macrophages, suggesting that DNA degradation by DNase II may contribute to the pathogenesis of inflammatory disease. We investigated whether DNase II in macrophages contributes to the development of vascular inflammation and atherogenesis using apolipoprotein E-deficient (ApoE-/-) mice. Methods: Macrophage specific DNase II deleted ApoE-/- (DNase2flox LysMCre ApoE-/-) mice and its control (DNase2flox ApoE-/-) mice were generated. For in vivo TLR9 inhibition, DNase2flox LysMCre ApoE-/- mice received TLR9 antagonist (iODN2088) or genetically lacked TLR9 (DNase2flox LysMCre ApoE-/- TLR9-/-) mice were also evaluated. All mice were fed a western-type diet and received subcutaneous angiotensin II infusion (1000 ng/kg per minute) for 8 weeks. Atherosclerotic lesions were investigated by en face Sudan IV staining and quantitative reverse transcription polymerase chain reaction. In vitro experiments using peritoneal macrophages were performed to confirm the proinflammatory roles of mitochondrial DNA (mtDNA) in the absence of DNase II. Results: Expression of DNase II and TLR9 increased in the atherosclerotic plaques. Macrophage-specific DNase II deletion significantly atherogenesis in the aortic arch in ApoE-/- mice (P&lt;0.05) and increased RNA expression of inflammatory molecules in the aorta. In vitro experiments demonstrated that mtDNA or TLR9 agonist significantly increased the expression of inflammatory molecules in DNase II deficient peritoneal macrophages. Activation of NF-κB signaling was involved in DNase II deficient vascular inflammation and macrophage activation. Conclusions: Macrophage-specific DNase II deletion accelerated vascular inflammation and atherogenesis, which are attenuated by genetic deletion or pharmacological blockade of TLR9. DNase II may be a potential therapeutic target for atherosclerosis.
Abstract 12199: Mid-Term Survival of Low-Risk Patients Treated With Transcatheter versus Surgical Aortic Valve Replacement: Meta-Analysis of Reconstructed Time-to-Event Data
Authors: Michel Pompeu Sa, Xander Jacquemyn, Jef Van den Eynde, Derek Serna-Gallegos, Danny Chu, Marie-Annick Clavel, Philippe Pibarot, Ibrahim Sultan
Journal: Circulation (2023)

Background: We performed a meta-analysis of reconstructed time-to-event data from randomized controlled trials (RCTs) and propensity-score matched (PSM) studies comparing transcatheter versus surgical aortic valve replacement (TAVR versus SAVR) to evaluate mid-term outcomes in patients considered low risk for SAVR. Methods and Results: Study-level meta-analysis of Kaplan-Meier-derived time-to-event of RCTs and PSM studies published by December 31, 2022. Eight studies (3 RCTs; 5 PSM studies) met our eligibility criteria and included 5,444 patients (2,639 patients underwent TAVR and 2,805 patients underwent SAVR). TAVR showed a higher risk of all-cause mortality at 8 years of follow-up [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.03-1.43, P=0.018]. Up to 2 years of follow-up, TAVR was not inferior to SAVR (HR 1.08, 95%CI 0.89-1.31, P=0.448); however, we observed a statistically significant difference after 2 years with higher mortality with TAVR (HR 1.51; 95% CI 1.14-2.00; P=0.004). This difference was driven by PSM studies; our sensitivity analysis showed a statistically significant difference between TAVR and SAVR when we included only PSM studies (HR 1.41, 95%CI 1.16-1.72, P=0.001), but no statistically significant difference when we included only RCTs (HR 0.89, 95%CI 0.69-1.16, P=0.398). At 8 years of follow-up after the primary intervention, the treatment difference in restricted mean survival time (RMST) is statistically significant, resulting in a benefit of 187.2 days (95% CI, 85.1-289.2, P&lt;0.001) in the SAVR arm. Conclusion: In comparison with TAVR, SAVR appeared to be associated with improved survival beyond 2 years in low-risk patients. However, the survival benefit of SAVR was only observed in PSM studies and not in RCTs. The addition of data from ongoing RCTs as well as longer follow-up in previous RCTs will help to confirm if there is a difference in mid- and long-term survival between TAVR vs. SAVR in low-risk population.
Abstract 13791: Non-Alcoholic Fatty Liver Disease Risk SNP Variants Affect Lipid Metabolism
Authors: Hiroaki Ikezaki, Masayuki Murata, Nobuyuki Shimono, Ernst J Schaefer
Journal: Circulation (2023)

Introduction: The impact of non-alcoholic fatty liver disease (NAFLD) risk SNP variants on changes in lipid metabolism in the general population has yet to be determined. We aimed to assess this association using a large prospective cohort study. Methods: A total of 1488 Japanese men and women (median age 62 years and median body mass index 24.7 kg/m2) free of cardiovascular disease were studied. Among NAFLD risk SNPs, variants of patatin-like phospholipase domain containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2), glucokinase regulator (GCKR), and neurocan (NCAN) were assessed. Plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C), LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL3-C, triglycerides (TG), lipoprotein(a), and adiponectin were measured at both baseline and after a five-year follow-up. Univariate and multivariate analyses, Kruskal-Wallis, Wilcoxon’s rank sum, and paired t-tests were performed to examine the associations between NAFLD risk SNPs and lipoproteins. Results: All of the measured lipoproteins increased significantly over 5 years. The TM6SF2 variant did not affect lipoproteins at baseline. However, after 5 years, the nonCC group had significantly lower HDL-C and HDL3-C and significantly higher LDL-C, sdLDL-C, and LDL-TG than the CC group. For the GCKR variant, TG, LDL-C, sdLDL-C, and LDL-TG were significantly higher in the CT/TT group at baseline, and LDL-C, sdLDL-C, and LDL-TG were still significantly higher in the same group at 5 years versus the CC group. The PNPLA3 and NCAN variants did not affect lipoproteins in this study. Conclusions: NAFLD risk SNP variants associated with gene products regulating both glucose and lipid metabolism can affect atherogenic lipoprotein levels.