tbuckley/cabot-search huggingface dataset:
Abstract 12766: Assessing the Economic and Clinical Impact of Surgical Aortic Valve Replacement on Patients With Symptomatic Aortic Valve Regurgitation
Authors: Sasha A Still, Michael Ryan, Candace Gunnarsson, Natalie Heidrich, James E Davies
Journal: Circulation (2023)

Hypothesis: The purpose of this study was to estimate the differences in mortality, healthcare utilization, and annualized cost among patients with symptomatic aortic regurgitation (sAR) who underwent surgical valve replacement (SAVR) compared with those that were managed non-operatively within 12 months of their diagnosis. Methods: Using the Optum® United Health Care Database, we identified 132,317 patients from 2016 to 2021 with a diagnosis of clinically symptomatic aortic regurgitation (sAR) who had a minimum of 6 months of continuous enrollment prior to sAR and at least 12 months of continuous enrollment following sAR and no record of aortic stenosis or transcatheter aortic valve replacement. sAR was defined as ≥ 2 visits for either heart failure, angina, dyspnea, or syncope in the presence of aortic regurgitation. Outcomes were all-cause mortality, healthcare utilization, and annualized cost. Inverse propensity score weighting (IPW) was employed to adjust for baseline differences and included patient demographics and comorbidities measured by the Elixhauser Comorbidity Index. Cox proportional hazards were used to model survival and general linear models were estimated for annualized healthcare utilization and total costs. Results: Among 132,317 patients identified with sAR, only 400 (0.3%) underwent SAVR within the first 12 months of their sAR diagnosis. They were younger on average 65 vs. 75 years (p&lt;0.0001), more often male (71 vs 48%, p&lt;0.0001), and had a slightly higher Comorbidity Index (5.1 vs. 4.8, p=0.0527). After IPW, sAR patients who had SAVR had lower mortality (HR 0.384; 95% CI 0.375-0.394; P&lt;.0001), estimated annualized inpatient visits (0.33 versus 0.43; P=0.0039) and emergency department visits (0.54 versus 0.70; P=0.0002), hospital days (2.70 versus 3.14; P&lt;.0001), and annualized cost ($33,744 versus $41,399; P&lt;.0001). Conclusion: In this retrospective study, SAVR performed within 12 months of the diagnosis of symptomatic aortic regurgitation is associated with improved mortality and lower annualized healthcare utilization and costs. The clinical and economic benefits related to timely surgical management of aortic regurgitation should be considered when managing patients with symptomatic aortic regurgitation.
Abstract 12747: Adaptive Coping, Resilience, and Cardiovascular Stress Reactivity in Women With Takotsubo Syndrome
Authors: Sara Ouaddi, Emily Gathright, Matthew Burg, Natalie Keirns, Christopher Breault, Janice Tripolone, Jinnette Abbott, Elena Salmoirago-Blotcher
Journal: Circulation (2023)

Introduction: Takotsubo Syndrome (TS) is often triggered by acute stressful events. While excessive stress reactivity is associated with worse cardiovascular (CV) outcomes, its role and that of possible stress response moderators in TS are poorly understood. Goals/Aims: To explore whether adaptive coping and resilience affect CV reactivity in TS patients. Hypothesis: Negative psychological functioning will be associated with greater CV reactivity. Methods: Prospectively enrolled women with TS (per Mayo criteria) completed coping (Brief-COPE) and resilience (Brief Resilience Scale) measures at enrollment (scores categorized as “high” or “low” using a median split) and a standardized stress reactivity protocol 2 weeks later. Systolic blood pressure (SBP) and diastolic BP (DBP) (mmHg) were measured every 5 min during Baseline (10 min), Mental Stress (10 min), and Recovery (20 min) using an automated BP cuff. SBP and DBP change from baseline to peak stress and 5 min into recovery were compared between low vs. high coping and resilience groups, respectively, using t-test statistics; p &lt; 0.05 was considered significant. Results: Patients (n=29; mean age 64.1 ± 8.8 years) with low (vs high) adaptive coping showed a smaller stress response (SBP: 15.9 ± 22.2 vs. 28.3 ± 19.2, p= 0.13; DBP: 8.1 ± 17.8 vs 21.8 ± 23.4, p= 0.11) and slower recovery (SBP -12.0 ± 7.0 vs -23.5 ± 19.3, p = 0.12; DBP -3.4 ± 17.6 vs -18.5 ± 22.1, p=0.07). Similar, non-significant responses were noted for the low (vs high) resilience group at peak stress (SBP: 18.8 ± 22.9 vs 27.9 ± 18.7, p= 0.28; DBP: 13.0 ± 20.9 vs. 16.9 ± 23.6, p=0.67) and recovery (SBP: -13.4 ± 17.4 vs -24.7 ± 19.3, p= 0.15; DBP: -5.3 ± 18.4 vs -18.3 ± 23.8, p= 0.16, Figure 1). Conclusion: Consistent with recent evidence in other populations, negative psychological functioning was associated with blunted CV reactivity in women with TS. Further investigation in fully powered studies is needed to confirm these novel, exploratory findings and their prognostic value.
Abstract 12926: Characteristics of Tafamidis-Treated Patients With Mixed Phenotype Transthyretin Amyloidosis: A Real-World Study in the Medicare Fee-for-Service Population
Authors: Haechung Chung, Sapna Prasad, Sameer Swarup, Darrin Benjumea, Aaron Crowley, Jose M Alvir, Franca S Angeli, Cindi Sounthonevat
Journal: Circulation (2023)

Introduction: Transthyretin amyloidosis (ATTR amyloidosis) is highly heterogeneous, characterized by predominantly cardiac, predominantly neurologic or mixed phenotypes. Diagnosis of mixed phenotype is often delayed, due in part to fragmented care. Research based on administrative claims data has improved knowledge of the disease, but investigation of the mixed phenotype has been limited by deficiencies in ICD diagnosis codes. Hypothesis: Proxy algorithms can be used to identify and characterize mixed phenotype ATTR amyloidosis in Medicare patients. Methods: This noninterventional, retrospective, observational cohort study was conducted using de-identified patient data from the US Medicare database (Jan 1, 2016-Dec 31, 2021). Based on literature review and clinician consultation, 3 distinct proxy algorithms were developed to select 3 cohorts of tafamidis-treated patients with possible mixed phenotype ATTR amyloidosis ( Figure ). Baseline patient characteristics were analyzed descriptively. Results: In 1,243 patients, mean (SD) age ranged from 76.0 (6.3)-79.5 (6.5) y, and 68-83% were men. Comorbidity burden was similar across cohorts (Charlson comorbidity indices: 1.6 [0.9]-1.7 [1.0]). The most common cardiovascular comorbidities were hypertensive diseases, arrhythmia, conduction disorders and LVH; the most common noncardiovascular comorbidities were cataracts, chronic and acute kidney disease, constipation and diabetes ( Table ). Conclusions: In this real-world study, proxy algorithms helped identify and characterize mixed phenotype ATTR amyloidosis in Medicare patients. Additional research is needed to further validate these algorithms.
Abstract 12727: Liver Elasticity in Elderly Heart Failure Patient
Authors: Hirohito Sugawara
Journal: Circulation (2023)

Introduction: Liver elastography is a novel ultrasound technique assessing elasticity of liver tissue. Clinical indication of liver elastography remains unrevealed. Moreover, reports about relationship between liver stiffness and heart failure subtypes haven’t well been published. Hypothesis: We have investigated the cardio-hepatic interaction using liver elastography in heart failure subtypes. Methods: We prospectively enrolled 58 consecutive patients with heart failure admission from April 2022 to March 2023. Liver elastography, transthoracic echocardiography and blood sampling were done at the time of discharge from heart failure treatment. Results: Patients were divided into two groups according to the left ventricular ejection fraction (LVEF) of echocardiography: heart failure with reduced ejection fraction (HFrEF) group (EF ≦40%, n = 11) and non-HFrEF group (EF &gt;40%, n = 31). The mean age of all patients was 83 ± 11 years. The mean age and the prevalence of hypertension and diabetes mellitus was higher in non-HFrEF group than in HFrEF group. The prevalence of taking sodium glucose co-transporter 2 (SGLT2) inhibitors was lower in non-HFrEF group than in HFrEF group. LV end-diastolic diameter, LV end-systolic diameter was larger in HFrEF group than in non-HFrEF group. Tricuspid regurgitation pressure gradient (TRPG) was higher in non-HFrEF group than in HFrEF group. Inferior vena cava diameter was not different between two groups. The mean values of almost liver function tests of all patients were within the normal range. eGFR was lower in non-HFrEF group than in HFrEF group. Liver elasticity was higher in non-HFrEF group than in HFrEF group (7.1 ± 2.7 vs. 5.1 ± 1.5 hPa; P=0.008) indicating liver stiffness. Pearson’s correlation coefficient showed that liver elasticity was positively correlated with the prevalence of diabetes mellitus, LVEF, TRPG, serum creatinine, aspartate aminotransferase, γ-glutamyl transpeptidase and was negatively correlated with LV end-diastolic diameter, LV end-systolic diameter. Conclusions: Liver stiffness was elevated in EF-preserved heart failure patients. Liver elasticity was correlated with parameters of congestion (TRPG) and useful for the assessment of congestion in patients with heart failure.
Abstract 14158: Ceria/Iron Oxide and Silver/Iron Oxide Nanohybrids: New Classes of Materials for Theranostics of Cardiovascular Diseases
Authors: Hang T Ta
Journal: Circulation (2023)

Introduction: The need for efficient and biocompatible treatment methods that can simultaneously deliver imaging and therapeutic agents for combined diagnosis and therapy have resulted in the development of theranostic nanoparticles in recent times. Nanotheranostics represent one of the last frontiers in precision medicine and provide real-time information about drug biodistribution, release, and targeted treatment in vivo. Hypothesis: Here we aim to develop biocompatible smart nanomaterials for efficient theranostics of cardiovascular diseases. Methods: We have developed various hybrid materials based on metal and metal oxide such as iron oxide, ceria, and silver for diagnosis and treatment of thrombosis, atherosclerosis and inflammatory diseases. Iron oxide offers magnetic resonance imaging (MRI) capability. Ceria provides antioxidant and anti-inflammatory effects. The incorporation of silver onto the particles not only provides photoacoustic imaging capability but also allows photothermal therapy. The developed nanohybrids were labelled with fluorescence molecules to enable optical imaging, and also tagged with targeting ligands for targeted delivery of the materials. Results: The ceria/iron oxide nanohybrids showed excellent theranostic property in a liver inflammation mouse model, and in an atherosclerosis model. MRI was successfully employed to monitor the delivery of the materials and detect the inflammation, and atherosclerosis. The particles could reverse liver inflammation and inhibit atherosclerosis progression while did not show any adverse effects systemically. The other nanohybrids, silver/iron oxide, exhibited multimodal imaging capability where both MRI and photoacoustic imaging could be used to image the materials and thus allowed the detection of thrombosis in mouse models. Triggered by 808nm light, the nanoparticles could induce excellent thrombolysis effect and completely restored blood flow in the clotted arteries. Interestingly, this material did not show any systemic adverse effect. Conclusions: Our data show that these new classes of materials are promising theranostic approaches for imaging and treating thrombosis and inflammation diseases such as atherosclerosis and liver inflammation.
Abstract 14009: Plasminogen Activator Inhibitor-1 (PAI-1) is an Essential Driver of Cardiovascular Aging in Mice
Authors: Anthony Kalousdian, Saul Soberanes, Mesut Eren, Emily Jorgensen, Elizabeth Lux, Lisa D Wilsbacher, Douglas E Vaughan
Journal: Circulation (2023)

Introduction: PAI-1 is the protein product of the gene Serpine1 . PAI-1 is a key contributor to cellular senescence in humans and mice, and elevated PAI-1 predicts the development of aging-related disorders including Type 2 diabetes and hypertension. GrimAge, a composite measure of epigenetic age, includes a DNA methylation estimator of plasma PAI-1 levels that independently predicts the development of cardiovascular (CV) morbidity including hypertension and time to heart failure. While many mechanistic contributions of PAI-1 to senescence and aging are well documented, its fundamental role in CV aging has not been fully investigated. Hypothesis: PAI-1 overexpression in mice promotes CV aging, while PAI-1 deficiency attenuates this phenotype in the presence of a stressor. Methods: To assess the effect of PAI-1 overexpression on CV aging, mice transgenic for a stable variant of human PAI-1 (n=14 transgenics, n=8 wild-type littermates) were characterized at 2 months and 7 months. To assess the effect of PAI-1 deficiency, mice heterozygous for a Serpine1 frame-shifting loss-of-function mutation (n=9) and wild-type littermates (n=10) were assessed; these mice underwent cardiovascular stress using N(ω)-nitro-L-arginine methyl ester (L-NAME) (1mg/L) for 8 weeks. Cardiovascular phenotyping included treadmill, pulse-wave velocity (PWV), echocardiography, and blood pressure (BP) measurement at the beginning and end of study. Histology was performed on aortas using Masson’s Trichome and analyzed for fibrosis quantification. Results: PAI-1 transgenic mice exhibited worse diastolic (E/e’) and vascular function (PWV, systolic and diastolic BP) compared to their wild-type counterparts. Histology showed more extensive peri-aortic fibrosis. In contrast, PAI-1 loss-of-function heterozygotes were broadly resistant to the vascular aging effects of L-NAME compared to wild-type mice. Molecular profiling of vascular tissues collected from animals is underway and includes bulk aorta RNAseq and measures of epigenetic age. Conclusion: PAI-1 is necessary and sufficient for the development of a CV aging phenotype in mice while PAI-1 deficiency attenuates stress-induced CV aging. Inhibition of PAI-1 will likely be tested for preventing CV aging in humans.
Abstract 12866: Increased Left Ventricular Mass Has Greater Association With Fat Free Mass Than Fat Mass in Black and White Females
Authors: Jordan Sill, Jessica G Woo, Elaine M Urbina
Journal: Circulation (2023)

Introduction: Increased left ventricular mass (LVM) is a risk factor for adult CV disease and is associated with increased body mass including obesity. The effects of different measures of body composition on LVM in young adulthood are not well described. Goals/Aims: Utilizing an existing longitudinal data set of black and white female young adults, we aimed to determine the contribution of various types of body composition measures to increased LVM. Methods: Data from the National Growth and Health Study, a study of racial differences in the development of obesity, including dual energy X-ray absorptiometry (DEXA), MRI, and echocardiogram (collected at ages 24-27) were analyzed. Logistic regression was conducted and receiver-operator characteristic (ROC) curves compared to assess the contribution of fat mass by DEXA (FM), fat-free mass by DEXA (FFM), subcutaneous adipose tissue mass by MRI (SAT), and visceral adipose tissue mass by MRI (VAT) towards the development of LVH (defined as LVMI ≥ 38.6 g/m 2.7 ). Multiple linear regression analyses were performed to assess for contributions to LVMI. Results: 550 women were included in the analysis (52.6% Black, mean age 24.9 ± 0.7 years at baseline). Using logistic regression, FM, FFM, SAT, and VAT were significantly associated with LVH (p &lt; 0.0001 for all), adjusting for SBP, DBP, and race. The ROC for FFM is greater than FM, SAT, and VAT (0.849 vs. 0.832, 0.813, and 0.788 respectively). In linear regression, FFM and DBP were significant contributors to LVMI. Black race was a significant predictor of LVH in the visceral fat model. There were no other significant racial differences. Conclusions: FFM had the greatest association with LVM, confirming previously published data. While the contribution of FFM towards the development of LVH was greater than that of FM and BP, FM and BP are modifiable risk factors and thus targets for clinical intervention.
Abstract 13991: Sleep Patterns and Quality of Life in Pulmonary Arterial Hypertension
Authors: Andrew M Hughes, Jeffrey Annis, Anna R Hemnes, Alisha Lindsey, Kelly Burke, Evan Brittain
Journal: Circulation (2023)

Introduction: Data on sleep duration and quality of life (QOL) in PAH are limited to self-reported surveys. Commercial wearables represent a cost-effective, low-burden approach to objectively assess real-world sleep patterns. We aimed to describe sleep patterns and associations with quality of life (QOL) in a cohort of PAH patients. Methods: We enrolled patients with expert adjudicated PAH from the NHLBI-funded Pulmonary Vascular Disease Phenomics (PVDOMICS) and compared them with individuals from the All of Us Research Program matched on age, sex, body mass index, and monitoring dates. Sleep variables were measured using Fitbit devices, which patients wore continuously for 12 weeks at baseline and again after 1 year. In PAH patients, QOL (Minnesota Living with Heart Failure (MLHF) survey) was assessed at baseline and 1 year; higher MLHF scores indicate greater impairment. Results: We enrolled 36 patients with PAH (48.9 ± 13.2 years, 81% female). Total minutes in bed and total minutes per sleep stage at baseline and 1 year follow-up are shown in Table 1. Compared with matched controls, patients with PAH have similar minutes in bed and asleep but markedly reduced minutes of deep (p&lt;0.001) and REM sleep (p &lt;0.001). In the PAH cohort, changes in sleep parameters from baseline to year 1 correlated inversely with changes in MLHF emotional score from baseline to year 1 including: time in bed (r = - 0.61, p = 0.017), total minutes asleep (r = -0.59, p = 0.020), total minutes light sleep (r = -0.53, p = 0.041), and total minutes deep sleep (r = - 0.52, p = 0.047). Minutes of deep and REM sleep over 1 year were inversely correlated with medication escalation over that year (rs = -0.49 and -0.47, p&lt;0.02 for both). No sleep measures correlated with baseline 6-minute walk distance. Conclusions: Patients with PAH have poor sleep quality compared to healthy controls. Poor sleep quality may contribute to or result from some of the common symptoms of PAH such as fatigue, mood disorders, and decreased QOL.
Abstract 13703: Left Ventricular Assist Device Therapy in “Cold and Dry” Patients
Authors: Amrita Balgobind, Dimitrios Varrias, Snehal R Patel, ISRAEL SAFIRIYU, Michail Spanos, Miguel Alvarez Villela
Journal: Circulation (2023)

Introduction: Patients who suffer from end-stage HF and have low PCWP are referred to as “cold and dry” patients and are an understudied minority, where the benefit derived from LVAD therapy is unclear. We therefore conducted a retrospective analysis to evaluate functional outcomes and quality of life after LVAD in patients with low versus high PCWP on pre-LVAD hemodynamics. Methods: Adults receiving LVADs between 2006 and 2017 were identified from the INTERMACS database. Outcomes include assessment of functional status with 6-minute walk test (6MWT) distance and quality of life measures, with KCCQ and EuroQol questionnaire scores pre- and post-LVAD, stratified by pre-LVAD PCWP. Median follow up was 364±41 days. Results: Study sample comprised 10310 patients who received LVAD from 2006 to 2017. Mean age was 57 ± 13, 8113 (79%) were male, and the mean PCWP prior to LVAD implantation was 25 ± 9.19 mmHg. The patients were separated into a high (PCWP &gt;15 mmHg) and a low (PCWP&lt;15 mmHg) group based on pre-LVAD hemodynamics. For patients with PCWP &lt;15 mmHg, mean age was 58.1±12.4, 1191 (74%) were males, LVEDD was 6.7±1 cm, and mean PCWP was 11±3.2 mmHg (Table 1). When compared to patients with high PWCP, those with a PCWP &lt;15 mmHg showed less improvement in quality of life questionnaire scores, including EuroQol (+0.11 vs +0.17, p=0.001) and KCCQ (+26 vs +31, p=0.03), and functional capacity with 6MWT distance (+194 feet vs +340 feet, p=0.02) after LVAD (Figure 1). Conclusions: In patients with end-stage HF and low PCWP, LVADs are associated with less improvement in functional capacity and quality of life when compared to patients with high PCWP.
Abstract 12928: Deep Learning-Derived Characterization of Lung Tissue Predicts Future Diagnosis of Heart Failure
Authors: Cody R Hou, Joel Ramo, Shinwan Kany, Samuel Friedman, Patrick T Ellinor, James Pirruccello
Journal: Circulation (2023)

Background: Cardiovascular and respiratory diseases are intrinsically coupled. Scalable methods for quantifying cardiac and pulmonary structures may improve our understanding of cardiopulmonary disease. Aims: We sought to quantify textural parameters of the lung fields in cardiovascular magnetic resonance imaging (cMRI) from the UK Biobank. We then sought to determine their genetic basis and their relationship with heart failure. Methods: We fine-tuned a convolutional neural network to segment left and right lung on cMRIs performed during expiratory breath hold. A random sample of 300 coronal slices from unique individuals was manually annotated for fine-tuning. The model was applied to 912,320 coronal cMRI images. Segmentation masks were stacked, and lung volume and texture metrics were quantified from the resulting 3D masks using the pyradiomics Python package. Results: After quality control, we computed lung traits in 45,179 participants. Mean lung volume was 2.19 ± 0.49 L in women and 2.87 ± 0.68 L in men. After adjustment for age and sex, lung volume was associated with forced vital capacity (FVC) (β = +0.30 L per SD, p &lt; 1.1 х 10 -308 ). After adjustment for age and sex, body size traits (e.g. standing height and heel bone mineral density) were associated with increased lung volume, whereas adiposity traits (e.g. body mass index and visceral adipose tissue) were associated with decreased lung volume. Greater heterogeneous and coarse lung textures were associated with an increased risk of heart failure (1-SD hazard ratios: 1.21 (95% CI [1.12, 1.31]) and 1.32 (95% CI [1.18, 1.47]), respectively). This association was still significant among non-smokers and after adjustment for left ventricular ejection fraction. Conclusions: Deep-learning derived measures of lung texture are linked to future heart failure. Our findings suggest that heart failure may manifest as changes in lung tissue that are detectable on MRI before changes in cardiac function.