tbuckley/cabot-search huggingface dataset:
Abstract 17286: Ninety-Day Adjudicated Cardiovascular Events in Patients With Covid-19: Association With Vaccination Status and Changes Over Time in the Corona-VTE Network Study
Authors: Behnood Bikdeli, Antoine Bejjani, Candrika D Khairani, Darsiya Krishnathasan, Julia Davies, Nicole D Porio, Anthony Tristani, Andre Armero, Ali Assi, Victor Nauffal, Umberto Cambia, Zaid Almarzooq, Eric Wei, Aditya Achanta, Sirus Jesudasen, Bruce Tiu, Geno J Merli, Orly Leiva, John Fanikos, Aditya Sharma, Alec Vishnevsky, Judith A Hsia, Mark Nehler, James Welker, Marc P Bonaca, Brett Carroll, ZHou Lan, Samuel Goldhaber, Gregory Piazza
Journal: Circulation (2023)

Background: Coronavirus disease 2019 (COVID-19) is associated with excess risk of cardiovascular events. Despite the progress in our understanding of cardiovascular complications, uncertainty persists with respect to contemporary event rates, and the association between use of vaccines and outcomes, and changes in incidence rates over time. Methods: Adult patients with polymerase chain reaction-confirmed COVID-19 who received care at Mass General-Brigham health system, Beth Israel Deaconess Medical Center, Anne Arundel Medical Center, University of Virginia Medical Center, University of Colorado Health System, and Thomas Jefferson University Health System were included. The Brigham and Women’s Hospital served as the central coordinating center. Clinical events were adjudicated by independent physicians. The primary outcome was 90-day major cardiovascular events, defined as venous or arterial thrombosis, myocarditis or heart failure with inpatient treatment, new atrial fibrillation/flutter, or cardiovascular death. Findings were pre-specified to be assessed separately for patients who were hospitalized with COVID-19 vs outpatients. Results: The study included 9,932 patients (03/2020-06/2022, age: 54.8 ± 19.9 years; 55.7% female). Among hospitalized patients, the 90-day cumulative incidence of primary outcome was 15.4 % (95% CI: (14.2-16.7%). Respective 90-day event rates for outpatients were 2.0% (95% CI: 1.3-15.7%) (Figure, Panel A). Cumulative incidence of 90-day outcomes based on vaccination status (restricted to cohort from 12/14/2020 onward) is summarized in Panel B. The change in cardiovascular events over time is represented in Figure, Panel C. Conclusions: Adjudicated cardiovascular events are common in hospitalized patients with COVID-19, while the event rates are seven-fold lower among outpatients. Association between vaccination status and outcomes and trends over time require further investigation.
Abstract 17843: Direct Oral Anticoagulants versus Low Molecular Weight Heparin for Venous Thromboembolism in Cancer Patients: An Updated Systematic Review and Meta-Analysis
Authors: Usman Akbar, Ahmad Kabir Mughal, Ahmad Ali Khan, Ahmed Muaaz Umer, Saad U Malik, Talha Shamshad, AHMED ALI, Nouman Shafique, Ali Danish, Rana Usman Anwar, Muhammad Wajid Rasool, Sobaan Taj, Shaheryar Qazi, - Muhibullah, Jawad Basit, Sourbha Dani
Journal: Circulation (2023)

Introduction: Patients with cancer have an increased risk of venous thromboembolism (VTE). We aim to evaluate the risk of recurrent VTE and major bleeding in patients with cancer when started on DOACs versus low molecular weight heparin (LMWH). Methods: We conducted a systematic literature search according to PRISMA guidelines to identify studies using the terms: “venous thromboembolism,” “low molecular weight heparin,” and “direct oral anticoagulants.” After the screening, We extracted the data until May 2023 in a data extraction sheet. Our inclusion criteria were: adult patients, and cancer patients, who were on DOACs or LMWH for VTE or atrial fibrillation. We used a variance-weighted random-effects model to analyze data on DOACs vs. LMWH, estimating event rates and odds ratios while assessing heterogeneity. Data were analyzed using the ‘meta’ package in R. Results: Our analysis included 16 studies (n= 12216 patients). Cancer patients on DOACs significantly reduced the risk of recurrent VTEs compared to LMWHs OR 0.69 (95% CI: 0.56- 0.86, I 2:23% ). However, for major bleeding and clinically relevant non-major bleeding, although the statistical significance was not reached, a consistent trend favoring DOACs was observed (OR = 0.92, 95% CI: 0.65-1.30) and OR=1.19 (0.90-1.59) respectively. (Figure1) Conclusions: Among cancer patients, DOACs are associated with a significantly lower risk of recurrent VTEs than LMWHs. Although the statistical significance was not reached for major bleeding and clinically relevant non-major bleeding, there was a trend favoring DOACs over VKA. Increased recruitment of cancer patients in clinical trials is needed to provide us with updated data to refine treatment strategies.
Abstract 14318: Right Ventriculo- Arterial Coupling Assessment by High-Fidelity Hemodynamic Measurements in Patients Undergoing Left Ventricular Assist Device Implantation
Authors: Alina Nicoara, Crosby Culp, Mary W Cooter, Kendall Hunter, Richard Krasuski, Marat Fudim, Jacob Schroder, Carmelo Milano, Anne D Cherry, Mihai V Podgoreanu
Journal: Circulation (2023)

Background: The changes in RV function after LVAD placement are not fully understood. RV- PA coupling, defined as the ratio of RV end-systolic to arterial elastances (E ES /E A ), offers unique insight into the cardiopulmonary unit and opportunity to address these knowledge gaps. We present early results from our study investigating RV adaptive changes after LVAD implantation by intraoperative placement of RV conductance catheters. Methods: Conductance catheter, echocardiographic, and hemodynamic data were gathered starting on the day of surgery. We used a 7Fr high-fidelity RV conductance catheter delivered through a 9Fr central venous sheath. P-V loop parameters were obtained before skin incision and after chest closure. Single- beat methods were used for E ES /E A determination. Early RVF was defined according to INTERMACS criteria. Intraoperative pre- and post-implantation echocardiographic and hemodynamic parameters were compared. Results: We present data on the first 14 patients who underwent successful placement of the RV conductance catheter. Moderate or severe RVF occurred in 3 patients (21.4%). Data are presented in the table. While overall E Es (1.2 vs 1.3, p=0.785), E A (1.1 vs 1.3, p=0.154), and RV-PA coupling (E ES /E A ratio 1.1 vs 1.0, p=0.129 ) remained unchanged, several patients underwent dramatic changes, either increase or decrease, in E ES and E A (Figure). Measures of energetic expense, such as stroke work ( SW, correlate of myocardial energy transferred) and pressure-volume area (PVA, correlate of myocardial oxygen consumption) significantly decreased after LVAD implantation. Conclusions: We have shown that RV function assessment using conductance catheters and 3D echocardiography is feasible and able to identify individual responses in RV-PA coupling after LVAD implantation. Continued accrual of data will help identify different phenotypes of RV adaptation and establish a cut-off level of RV-PA uncoupling at which RVF occurs.
Abstract 16479: The Effects of Pulmonary Artery Catheter Usage and Treatment Intensity on Mortality in Patients With Cardiogenic Shock by Etiology
Authors: Wissam Khalife, Aiham Albaeni, Jacob Abraham, Van-Khue Ton, Maya Guglin, Rachna Kataria, Yijing Zhang, BORUI LI, Kevin John, Gavin W Hickey, Jaime Hernandez-Montfort, Shashank Sinha, Paavni Sangal, Neil Harwani, Manreet Kanwar, Arvind Bhimaraj, Daniel Burkhoff, Navin K Kapur
Journal: Circulation (2023)

Background: The routine usage of pulmonary artery catheter (PAC) in the management of cardiogenic shock (CS) by etiology remains controversial. Objectives: We sought to study the prognostic effects of PAC usage and the escalation of care in a large CS cohort. Methods: Multicenter, retrospective, observational study from the Cardiogenic Shock Working Group registry (CSWG) registry. The baseline characteristics, hospital course, and outcome of patients (pts) with acute decompensated heart failure-CS (ADHF) and acute myocardial infarction-CS (AMI) who had PAC during hospitalization were obtained. Different types of interventions were analyzed and compared between survival and non-survival by etiology. Results: The registry had 3524 pts (58% ADHF, 28% AMI). The overall mortality rate was significantly higher in the AMI group (41 vs 29%, p &lt;0.0001). There was no difference in PAC usage (68 vs 62%). In ADHF, the mortality was significantly lower when PAC was used (22 vs 35%, P&lt;0.0001). However, in AMI, there was no significant mortality difference with PAC usage (40 vs 46%, P=0.052).Pts who had PAC (n=2260, 71% male, 2/3 ADHF) were then analyzed. ADHF had longer duration of PAC (6.3 vs 4.7 days). ADHF pts had more comorbidities (CKD, DM, AF) and better admission and max SCAI stage. However, AMI pts were older (60±14 vs 66±12 year p&lt;0001), more HTN and higher transfer rate. During hospitalization, the effect of treatment intensity with mechanical circulatory support (MCS) and drugs usage on mortality is summarized in fig.1 (a,b). Conclusions: In a large CS registry, we identified that ADHF is more common with much better prognosis than AMI despite similar PAC and drugs usage, and less MCS usage. This can be explained by the difference in baseline characteristic and the shock severity. PAC usage did correlate with better survival only in ADHF group. Multiple MCS and multiple drugs usage were associated with higher mortality in both groups. IABP, when used alone, had better survival.
Abstract 14457: Safety and Effectiveness of P2Y12 Inhibitors in Critically Ill Patients With COVID-19: A Meta-Analysis of Randomized Controlled Trials
Authors: Sahib Singh, Udaya Tantry, Kevin Bliden, Paul Gurbel
Journal: Circulation (2023)

Introduction: Critically ill patients with COVID-19 have a high risk of developing thromboembolic events. Randomized controlled trials (RCTs) have shown conflicting results regarding the use of P2Y12 inhibitors in such patients. We conducted a meta-analysis of the available trials. Methods: Studies comparing P2Y12 inhibitors vs control in critically ill patients with COVID-19 were searched from online databases. The primary endpoints of interest were myocardial infarction (MI), systemic arterial thromboembolism, deep venous thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, mortality, and major bleeding at the longest available follow up. Random-effects model was used to calculate risk ratios (RR) with 95% confidence intervals (CI). Results: Three RCTs, with a total of 2,223 patients - 1,084 in the P2Y12 inhibitor group and 1,139 in the control group were included. The mean age was 57 years and 63% of patients were men. The follow up duration varied from 28 to 90 days. The two groups had similar risk of DVT (RR 0.91, 95% CI 0.65-1.28, p = 0.60), ischemic stroke (RR 2.25, 95% CI 0.91-5.55, p = 0.08), MI (RR 1.37, 95% CI 0.54-3.47, p = 0.50), PE (RR 0.95, 95% CI 0.47-1.95, p = 0.90), systemic arterial thromboembolism (RR 1.20, 95% CI 0.24-6.09, p = 0.82), mortality (RR 0.89, 95% CI 0.77-1.03, p = 0.12) (Figure 1) and major bleeding (RR 1.34, 95% CI 0.47-3.78, p = 0.59) (Figure 2). Conclusions: No significant difference was found in venous or arterial thromboembolism, mortality, or major bleeding events in critically ill COVID-19 patients treated with P2Y12 inhibitors as compared to control.
Abstract 13280: Plasma Extracellular microRNAs Associated With Cardiovascular Disease Risk Factors in Middle-Aged and Older Populations
Authors: Hannah Karlin, Meera Sooda, Martin Larson, Jian Rong, Tianxiao Huan, Michelle M Mens, Frank v Rooij, M. A Ikram, Paul Courchesne, Jane E Freedman, Roby Joehanes, Gregory P Mueller, Maryam Kavousi, Mohsen Ghanbari, Daniel Levy
Journal: Circulation (2023)

Background: Extracellular microRNAs (miRNAs) are a class of non-coding RNAs that resist degradation and remain stable in the extracellular milieu where they contribute to various physiological and pathological processes by facilitating intercellular signaling. Previous studies have reported associations between miRNAs and cardiovascular diseases (CVD); however, the plasma miRNA signatures of CVD and its risk factors have not been fully elucidated at the population level. Methods: Plasma miRNA levels were measured in 4,440 Framingham Heart Study (FHS) participants from the Third Generation and Omni II cohorts using qRT-PCR. Linear regression analyses were conducted to test the cross-sectional associations of each miRNA with CVD risk factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides, HDL and total cholesterol, blood glucose, BMI, and cigarette smoking. Prospective analyses of the associations of miRNAs with new-onset obesity, hypertension, type 2 diabetes, CVD, and all-cause mortality were conducted using proportional hazards regression. A false discovery rate threshold of 0.05 was applied for each risk factor and outcome individually. Replication was carried out in 2,000 Rotterdam Study (RS) participants with data on plasma miRNA levels measured using RNA-seq. Pathway enrichment analyses were conducted and gene targets were predicted for miRNAs associated with five or more risk factors in FHS. Results and Conclusions: In FHS, six miRNAs (miR-193b-3p, miR-122-5p, miR-365a-3p, miR-194-5p, miR-192-5p, miR-193a-5p) were associated with five or more CVD risk factors. This miRNA signature was enriched for biological processes and cellular pathways associated with CVD; many of the genes annotated to these pathways are predicted targets of the identified miRNAs. In RS, miR-193b-3p, miR-194-5p, and miR-193a-5p were associated with two or more risk factors. Prospective analysis revealed eight miRNAs associated with all-cause mortality only in FHS, including miR-193b-3p, miR-122-5p, miR-192-5p, and miR-193a-5p. These findings suggest plasma miRNA levels are associated with CVD risk factors and could provide opportunities to investigate their possible contributions to CVD pathogenesis.
Abstract 16587: Sodium Glucose Cotransporter-2 Inhibitors Post Acute Coronary Syndrome Induced New Heart Failure
Authors: Alaa Rahhal, Tahseen Hamamyh, Ammar Chapra, Mostafa Najim, mohammad hemadneh, Hazem Faraj, Ahmed Yasin, Haneen Toba, Wafa Mohammed, Mohammad Khair Hamad, Wael Kanjo, Nawras Al-Tikrety, Ahmed Mahfouz, Sumaya Alyafei, Mohammed Al-Hijji, Abdulrahman Arabi, Ashfaq Patel
Journal: Circulation (2023)

Introduction: Patients with acute coronary syndrome (ACS) have an unmet need for further risk reduction in major adverse cardiovascular events (MACE) and heart failure (HF) development despite guideline-directed medical therapy. As sodium glucose cotransporter-2 inhibitors (SGLT2i) are cardioprotective, in this study, we assessed the effectiveness of SGLT2i post-ACS with new onset HF. Hypothesis: SGLT2i use improves the effectiveness outcomes post-ACS induced new HF. Methods: We conducted a retrospective observational cohort study that included all diabetic patients admitted to the main tertiary cardiology center in Qatar between 1/06/2017 and 1/06/2021 with ACS complicated by new HF defined as new clinical HF requiring diuretics during the index admission, or ejection fraction (EF) &lt;40%. We divided the study population in two groups; (1) SGLT2i users; (2) non-SGLT2i users. Primary outcomes were evaluated at 30 and 360 days, including a composite of ACS, HF hospitalization, and all-cause mortality. A propensity score-matched model (1:1) was used to adjust for baseline characteristics between the study groups. Cox proportional hazard regression analysis was used to evaluate the outcomes. P-value &lt;0.05 indicated statistical significance. Results: We included 465 ACS patients who met the eligibility criteria (93% male, mean age 55±10 years, and 72% Asian). Using 1:1 propensity score matching, 78 patients were included per arm with an absolute standardized difference &lt;0.1 for all baseline characteristics. The use of SGLT2i post ischemia-induced new HF resulted in lower composite outcomes at 30 and 360 days [ 30-day: 2.6% vs. 11.5%, HR= 0.20 (0.04-0.94), P =0.041; 360-Day: 14.1% vs. 23.1, HR= 0.46 (0.22-0.99), P= 0.046]. Conclusions: Our findings suggest cardioprotective effects of SGLT2i post-ACS induced new HF, which widens the SGLT2i spectrum of indications and may encourage cardiologists to prescribe SGLT2i for this population.
Abstract 15537: The Role of Liver Epsins in Nonalcoholic Steatohepatitis
Authors: Bo Zhu, Hao Wu, Beibei Wang, Yao Wei Lu, Hong Chen
Journal: Circulation (2023)

Introduction: Nonalcoholic steatohepatitis (NASH) is a chronic liver disease that is associated with high risks of cardiovascular diseases. Epsin is an evolutionarily conserved protein family that is involved in clathrin-mediated endocytosis. We found that both Epsin1/2 expressions in the liver are significantly up-regulated by the Western Diet (WD) induced NASH mice model, as well as in the liver biopsy of NASH patients. Hypothesis: We hypothesize that the expressions of Epsin1 and Epsin2 in the liver are required for NASH progression. Methods: We conditionally deleted Epsin1/2 using Albumin-Cre (Liver-DKO). We then induced a mouse model of NASH by feeding both WT and Liver-DKO mice a WD for 52 weeks. We used single cell multiome, combined with molecular approaches to study the mechanisms. We tested a strategy to deliver Epsin1/2 siRNAs encapsulated nanoparticles (NPs) targeting the liver via intravenous injection to treat diet induced NASH in mice. Results: We found WD-fed Liver-DKO mice have significant reductions in hepatic fibrosis formation and less lipid accumulation, and this was associated with better glucose and insulin tolerance, as well as lower serum aspartate transaminase (AST) and alanine aminotransferase (ALT) compared with WD-fed WT mice. Through analysis of the single cell multiome from the WT and Liver-DKO livers, we found more Kupffer cell in WT NASH mice compared with DKO. Interestingly, monocyte-derived inflammantory Kupffer cell (KCs) are enriched in WD-fed WT mice, however, embryonic-derived KCs are the enriched in liver DKO, and associate with dramatically reduced total KCs population. We also found that HNF4a was dramatically reduced in WD-fed WT mice, but its expression was preserved in WD-fed Liver-DKO mice, suggesting the loss of hepatocyte identity was inhibited by Epsins deletion. Therapeutically, we found significant resolution of hepatic fibrosis after knockdown of Epsin1/2 siRNA NP treatment. Conclusions: Liver specific deletion of Epsin1/2 significantly inhibits NASH progression by suppression of inflammation that protects hepatocytes from severe chronic injury. Our preclinical data suggests specially targeting Epsin1 and Epsin2 in the liver could be a promising therapeutic strategy for NASH treatment.
Abstract 234: Longitudinal Trends in Prehospital Advanced Airway Management in the United States
Authors: Henry E Wang, Mengda Yu, Remle Crowe, Michelle Nassal, Christopher Gage, Madison Hyer, Jonathan Powell, Alexander Ulintz, Lai Wei, Travis Sharkey-Toppen, Ashish R Panchal
Journal: Circulation (2023)

Background: While endotracheal intubation (ETI) is the most common prehospital advanced airway management technique in the United States (US), observations from clinical trials and the COVID-19 pandemic have motivated the broader use of supraglottic airways (SGA). The current national patterns of prehospital airway practices are unknown. We sought to describe longitudinal trends in Emergency Medical Services (EMS) advanced airway management in the US. Methods: We analyzed 2011-2021 data from ESO, a data set of US prehospital electronic health records. We identified all 911 events with attempted advanced airway management, determining the annual percentage receiving ETI and/or SGA attempts. We determined temporal trends using mixed effects regression. We stratified the analyses by condition (cardiac arrest, trauma, medical non-arrest) and age (adult vs. children [&amp;lt;18y]). Results: During the study period 355,532 patients underwent prehospital advanced airway management (annual incidence 9.0-10.0 per 1,000 911 events). Annual patients with SGA attempts increased almost three-fold (20.8% to 53.2%; p-trend&amp;lt;0.001), while annual patients with ETI attempts decreased (90.0% to 60.7%, p-trend&amp;lt;0.001). (Figure) Trends for cardiac arrest (SGA increased from 25.1% to 60.6%; ETI decreased from 87.3% to 54.7%) and trauma (SGA increased from 17.2% to 40.7%; ETI decreased from 90.5% to 71.8%) were similar. Advanced airway management in medical non-arrest patients remained stable (SGA 15.7% to 20.0%, p-trend=0.26; ETI 93.3% to 87.5%, p-trend=0.85). In children SGA attempts increased five-fold (11.2% to 50.9%, p-trend&amp;lt;0.001) while ETI attempts decreased (89.7% to 60.6%, p-trend&amp;lt;0.001). Conclusion: US prehospital advanced airway management practices have shifted, with marked increases in SGA and decreases in ETI attempts. These observations have critical implications for EMS care, training and system planning.
Abstract 13061: Association of Right Ventricular - Pulmonary Arterial Coupling and Progression of Tricuspid Regurgitation in Patients With Non-Valvular Atrial Fibrillation
Authors: Dae-Young Kim, Sung Kee Ryu, Ji-Hun Jang, Sung-Hee Shin
Journal: Circulation (2023)

Introduction: Tricuspid regurgitation (TR) severity in patients with atrial fibrillation (AF) is associated with poor prognosis. Recently, right ventricular-pulmonary arterial (RV-PA) coupling has been shown to be related to clinical outcomes in TR patients. However, data on the relationship of RV-PA coupling to the progression of significant TR is limited. Hypothesis: This study aimed to investigate whether RV-PA coupling affects the progression of significant TR in patients with non-valvular AF. Methods: A total of 300 consecutive AF patients with insignificant TR were included among 371 patients with AF who underwent follow-up echocardiography. Insignificant TR was defined as TR less than a mild degree. We excluded other significant valvular diseases, regional wall motion abnormality, LVEF &lt;50%, the cardiac implantable electronic device, cardiac surgery, and poor echo image for RV analysis. RV-PA coupling was assessed by the ratio of RV global longitudinal strain (GLS) using speckle tracking echocardiography to pulmonary artery systolic pressure (PASP). Results: During a mean 4.7±2.5 years of follow-up, 31 (10.3%) patients (mean age 67.5±11.7 years, 37.0% female) have progressed to significant TR as more than moderate degree. The patients who progressed to significant TR were older, more likely to be female, and had a higher prevalence of ischemic stroke, higher PASP, larger RV size, lower right atrial (RA) strain, lower RVGLS, and lower RVGLS/PASP than patients without TR progression. RV-PA coupling reflected by RVGLS/PASP was independently related to the progression of TR after adjusting for age, gender, and history of stroke (p&lt;0.001). It remained significant for predicting TR progression even after further adjustment for PASP, RA strain, or RV strain (Figure). Conclusions: RV-PA coupling was associated with the progression of TR in patients with non-valvular AF, which might suggest that it can be a helpful parameter in monitoring this population.