tbuckley/cabot-search huggingface dataset:
Abstract 4141361: Aging, Lifestyle, and Diet Quality in a Black Heart Failure Population
Authors: Erica Davis, Sandra Dunbar, Melinda Higgins, Erin Ferranti, Brittany Butts
Journal: Circulation (2024)

Introduction: Black adults with heart failure (HF) have issues with dietary preferences that warrant further study to achieve optimal self- and culturally-congruent care. Greater knowledge of dietary patterns and behaviors is essential to understanding barriers with improving diet quality. Aging in Black populations with HF may also affect diet, inflammation, and lifestyle choices. Metabolites like trimethylamine N-oxide (TMAO) are linked to inflammation which contributes to deterioration in HF, especially with renal involvement. More research is needed to ascertain the impact of diet quality, lifestyle factors, and inflammatory biomarkers in this population. Research Question: What factors are associated with diet quality,TMAO, and lifestyles in Black adults with HF? Methods: Thirty-one participants were recruited from a cardiac center (mean age 57 years, 65% women). Measures included age, diet quality (Healthy Eating Index [HEI]); lifestyle factors (Lifestyle Score [LIS] from smoking, alcohol, activity, body mass index [BMI]); comorbidities (Charlson Comorbidity Index [CCI]]; creatinine measures, and TMAO. Analyses included descriptive, correlational, and inferential statistics. Results: HEI score (range:47-87; mean 64 + 10) out of a possible ideal score of 100, was positively correlated with age (r=.368, p=.054). TMAO level (mean 6.3 + 0.7) was negatively correlated with LIS (r= -.470, p=.008). The mean LIS was 2 + 0.9 and the mean for CCI was 3 + 2. There was a positive correlation with age and comorbidities (r= .423, p=.018). A multiple regression model with creatinine levels and LIS as predictors of TMAO accounted for 16.6% of the variance (F(2,27)=3.89, p=.033). LIS was the key predictor related to TMAO levels. T-tests were performed for each component of the LIS variable and notably TMAO concentrations of those who consumed alcohol were lower than those who did not (mean difference 0.41 ± 0.18, p=.026, d=0.66). Conclusion: Black persons with HF have a high number of comorbidities with increasing age. The greater the age in this sample, the higher the HEI diet quality score. However, HEI scores were in the range for needing improvement. The LIS in relation to TMAO has a counterintuitive result but suggests that BMI, smoking, exercise ability, and alcohol use may influence metabolite levels that are linked to the diet. Findings suggest that diet quality is a strong intervention target for older Black adults with HF, especially for those with high comorbidities.
Abstract 4140687: Characterization of the Near-Field Bipolar Voltage Substrate Using a Novel Automated Peak Frequency Algorithm in Patients Undergoing Catheter Ablation of Postinfarction Ventricular Tachycardia
Authors: Manojna Nimmagadda, Monica Korzon, Arwa Younis, Justin Lee, Koji Higuchi, Jakub Sroubek, Roy Chung, Mohamed Kanj, Shady Nakhla, Walid Saliba, Mandeep Bhargava, Oussama Wazni, Hiroshi Nakagawa, Ayman Hussein, Pasquale Santangeli
Journal: Circulation (2024)

Background: Ventricular tachycardia (VT) substrate characterization in patients with ischemic cardiomyopathy (ICM) utilizing conventional peak-to-peak bipolar voltage mapping is limited by preferential automatic annotation of large amplitude far-field electrograms (EGMs). Objective: To investigate the role of a novel peak frequency (PF) software that prioritizes annotation of the near-field high-frequency component of bipolar EGMs as compared to standard bipolar voltage mapping (Std-Bip) for postinfarction substrate characterization. Methods: We studied 23 patients (age 67.2±9.4 years, 95.7% male, LVEF 37.4±14.6%) undergoing catheter ablation of postinfarction VT (34.8% anterior infarction, 73.9% inferior infarction). High-density endocardial substrate maps were created in sinus rhythm (43.5%) or right ventricular pacing (56.5%) using a 16-electrode mapping catheter (HD grid, Abbott, IL). The peak-to-peak bipolar voltage of collected EGMs was analyzed in Std-Bip configuration and after applying the PF software. Results: A total of 105,815 Std-Bip and PF EGMs were analyzed. Overall, 30.6% Std-Bip EGMs had a voltage 0.5-1.5 mV and 39% a voltage &lt;0.5 mV. After applying the PF software, 26.3% PF EGMs had a voltage 0.5-1.5 mV and 48.4% a voltage &lt;0.5 mV (p&lt;0.01 for comparison, Figure ). The PF software reclassified an average of 8.9% (range 3.1% to 21.9%) Std-Bip EGMs to a voltage &lt;0.5 mV and an average 3.5% (range -7.9% to 13.5%) Std-Bip EGMs to a voltage 0.5-1.5 mV. This resulted in an average increase in LV surface area subtending low voltage (&lt;1.5 mV) EGMs of 3.9±0.03%. Conclusions: Postinfarction substrate mapping with a PF annotation algorithm significantly improves identification of low voltage bipolar EGMs compared to Std-Bip mapping.
Abstract 4140735: Associations Between Smoking Status and Sleep Health among South Korean Adolescents
Authors: Nagyeong Cho, Sung-il Cho
Journal: Circulation (2024)

Background: Cigarette smoking has been linked to sleep problems in both adults and adolescents. Some recent studies suggest dual users of conventional cigarettes (CC) and e-cigarettes (EC) may be more likely to experience sleep problems compared to CC-only users. Given the shorter sleep duration observed among South Korean adolescents compared to their global peers, this study investigates the relationship between smoking status and sleep health in Korean adolescents aged 13-18. Methods: We analyzed data from the 16th to 19th Korea Youth Risk Behavior Survey, a cross-sectional annual survey of health risk behaviors among Korean middle and high school students conducted from 2020 to 2023. The sample included 195,636 participants who reported sleep duration and satisfaction. Participants were categorized into five groups based on tobacco use: non-users, former users, current CC-only users, current EC or heated-tobacco product (HTP)-only users, and current dual users (CC+EC or CC+HTP). Sleep health was assessed using self-reported questionnaires on sleep duration during weekdays and overall sleep satisfaction: ‘&lt;7 hours&amp;Insufficient’, ‘≥7h&amp;Insufficient’, ‘&lt;7h&amp;Sufficient’, and ‘≥7h&amp;Sufficient’. Adolescents categorized as experiencing ‘Short (&lt;7 hours)&amp;Insufficient’ sleep were considered to have the poorest sleep health. We conducted a multinomial logistic regression analysis to explore the association between sleep health and smoking status. Covariates adjusted for the analysis included gender, grade, year, economic status, residential status, academic achievement, self-rated health, perceived stress, and smartphone use. Results: Of 195,636 adolescents, 41.2% of girls and 27.6% of boys experienced ‘Short&amp;Insufficient’ sleep. Current dual users of CC and EC or HTP had the highest prevalence (52.7%) of experiencing ‘Short&amp;Insufficient’ sleep compared to other smoking groups. Compared to non-users, the odds ratio (OR) for ‘Short&amp;Insufficient’ sleep was significantly highest in the current dual users (OR 2.37, 95% CI 2.10-2.67). Current CC-only users, current EC or HTPs-only users, and former users had ORs of 2.08 (95% CI 1.85-2.34), 1.74 (95% CI 1.34-2.25), and 1.77 (95% CI 1.50-2.10), respectively. Conclusions: Our findings suggest that current smoking and dual use of tobacco products are associated with poor sleep health among Korean adolescents. Implementing smoking cessation programs may contribute to better sleep quality in this population.
Abstract 4141296: Dietary Sodium Intake and The Gut Microbiome: A Pilot Study in COSMOS
Authors: Haidong Zhu, Yanbin Dong, Jun Li, Rikuta Hamaya, Kyu Ha Lee, JoAnn Manson, Howard Sesso
Journal: Circulation (2024)

Background: Recent animal studies connect high sodium intake to the gut-immune axis and highlight the gut microbiome as a potential therapeutic target to counteract salt-sensitive conditions and hypertension. However, the relationship between sodium intake on the gut-immune axis in humans is largely unknown. We previously showed that dietary sodium reduction increased circulating levels of gut-produced short-chain fatty acids (SCFAs), in persons with untreated hypertension. Therefore, we examined whether dietary sodium intake is associated with gut microbial taxonomic features. Methods: The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a recently completed randomized, double-blind, placebo-controlled, 2x2 factorial trial of a multivitamin and cocoa extract supplement (containing 500 mg/d flavanols, including 80 mg/day (-)-epicatechin) in 21,442 older adults. Dietary intake was assessed by a validated Food Frequency Questionnaires at baseline and year 2. We previously conducted a deep shotgun metagenomic sequencing in a pilot study of 30 COSMOS participants using fecal samples collected at baseline and year 2 to explore whether the interventions affected gut microbial composition and function. We leveraged available taxonomic profiling data and analyzed the association between energy-adjusted sodium intake and microbial features at baseline. Results: We did not observe significant associations between sodium intake and alpha diversity parameters including Shannon Diversity Index and Inverse Simpson Index ( P &gt;0.05). The PERMANOVA analysis showed that sodium intake was significantly associated with the overall taxonomic beta diversity (Bray-Curtis dissimilarity) (R 2 = 0.067, p=0.031), suggesting 6.7% of the variation in beta diversity was explained by sodium intake. The Spearman’s rank-order correlation test showed several nominally significant associations (P&lt;0.05) between sodium intake and taxonomic features (4 Family, 6 Genus, 15 Species, 16 Strains, 18 Pathways). At genus level, Bacteroides was associated with sodium intake (r=0.566, p=0.0037). A superpathway of geranylgeranyldiphosphatevbiosynthesis I (r=-0.527, p=0.0076) was associated with sodium intake, which play key roles in signaling pathways, cytoskeletal regulation, intracellular transport, and cell proliferation. Summary: This pilot study suggests that dietary sodium intake may be related to beta diversity and some microbial taxa or pathways. Large studies are warranted.
Abstract 4141182: Extreme Heat and Atrial Fibrillation in Patients with Implanted Devices
Authors: barrak alahmad, Michael Noone, Claire Strohmeyer, Taofik Oyekunle, Petros Koutrakis, Theofanie Mela
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) is becoming more prevalent both in the US and globally, with its incidence rising at an alarming rate. While this rise can be partly explained by enhanced surveillance, an aging population, or increase in traditional risk factors, it is also prudent to start examining the role of emerging environmental risk factors like extreme heat driven by climate change. Methods: Data from the Medtronic Product Surveillance Registry for all patients in the US who underwent a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) device implant from 2016 to 2023. For each patient, we extracted the first arrhythmic episode of AF detected on the device. These episodes were matched with hourly ambient temperature recordings from the nearest station in their respective town/city. In a case-crossover design, we created multiple control hours within the same individual that matched the episode hour by time of day, day of the week, month, and year. Conditional logistic models were then pooled across all climate zones in the US to obtain the dose-response relationship between outdoor heat and AF episodes, allowing for non-linearity. In an additional analysis, we limited episodes to those lasting 30 minutes or longer. Results: A total of 2,313 individuals with atrial arrhythmic events were analyzed. We found fewer AF episodes in the early morning hours (12am-7am) compared to normal working hours (8am-5pm) (p&lt;0.001). We found fewer AF episodes occurring on Saturday and Sunday compared to weekdays (p&lt;0.001). Pooled across all regions in the US, compared to locally optimal temperatures (those associated with least odds; between 5°C to 8°C), the odds ratios of AF events when outdoor temperatures were 39°C, 40°C, and 41°C were 2.66 (95% CI: 1.57 – 4.54), 2.87 (95% CI: 1.57 – 5.22), and 3.09 (95% CI: 1.58 – 6.01), respectively. Lagging temperature exposure did not improve the models. Restricting to episodes longer than 30 minutes showed similar results. Conclusion: We observed a dose-response relationship between rising outdoor temperatures and increased AF events with doubling to tripling of odds when temperatures reach extreme hot levels. This study highlights the urgent need to consider emerging environmental factors, such as climate change-induced heat, in managing and preventing AF.
Abstract 4141627: Not The Corona You Wish For After a Successful Atrial Fibrillation Ablation!
Authors: Hussein Krayem, Rafae Shaikh, MACK HENDRIX, Jose Huizar, Alex Tan, Kenneth Ellenbogen, KAROLY KASZALA
Journal: Circulation (2024)

Background: Corona mortis artery or ring of death, is a common variant (25-30%) vascular anastomosis between the obturator artery and inferior epigastric or external iliac artery. However, injury to this vessel during EP procedures has not been described. We present a case of an inguinal hematoma secondary to arteriovenous fistula(AVF) and pseudoaneurysm of the corona mortis artery due to puncture injury during atrial fibrillation(AF) ablation. Case: A 71-year-old male underwent pulmonary vein isolation for persistent AF. The right femoral vein was accessed using ultrasound guidance and 3 sheaths were placed after which intravenous heparin was administered. At the end of the case, protamine was given for heparin and a figure of 8 suture was placed after sheath removal. Six hours post procedure, a soft 2.5 cm right groin hematoma was noted, that was treated conservatively with manual pressure and pressure dressing overnight. The patient was discharged home next day but returned one week later with continued groin pain and swelling. Examination revealed a moderate groin hematoma, ecchymosis and a loud right femoral bruit. Duplex ultrasound demonstrated a fistula between the right external iliac artery and vein with potential pseudoaneurysm at the fistula site. CT angiogram of the abdomen and pelvis showed a pseudoaneurysm of a distal branch of the external iliac artery arising from the inferior epigastric artery and an AVF (Fig 1a). Selective arteriogram was performed via left groin access, which confirmed the above findings as a result of injury to the corona mortis (Fig 1b). Coil embolectomy of the right inferior epigastric artery and the obturator branch up to the respective origins was performed with resolution of the fistula (Fig 1c). The patient was discharged home and oral anticoagulation therapy was restarted 24 hours later. He recovered well with no further sequelae. Discussion: The corona mortis artery is a common vascular variant which may be a source of bleeding complications during groin injury or during vascular groin access. Familiarity with this variant allows its consideration in the differential diagnosis of post procedural groin hematoma which ensures rapid diagnosis and appropriate management.
Abstract 4140798: Genome-Wide Association Studies (GWAS) of Angiotensinogen Levels in the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Karita Lidani, Shubham Tomar, Hossein Mousavi, Robert Buscaglia, Alexander Landry, Kirolos Michael, Leonie Dupuis, Erin Michos, Erin Morgan, Xiuqing Guo, Jerome Rotter, Sotirios Tsimikas, Patrick Trainor, Andrew DeFilippis
Journal: Circulation (2024)

Background: The renin angiotensin aldosterone system (RAAS) is crucial for circulatory homeostasis and multiple cardiovascular diseases. Despite research on key RAAS components, resulting in multiple therapeutics, the role of angiotensinogen, the sole substrate, remains less understood. We sought to elucidate the relationship between circulating angiotensinogen levels and single nucleotide polymorphisms (SNPs) in a multi-ethnic cohort study. Methods: Genome-wide association analyses of plasma angiotensinogen levels were conducted in 4,899 MESA participants (self-identified as White, n=1,868; Hispanic, n=1,115; Black, n=1,283; and Chinese, n=633). Plasma angiotensinogen levels were measured at the baseline using an enzyme-linked immunoassay. Linear models were adjusted for age, sex, comorbidities, and sex hormones, along with top principal components to account for population structure. Furthermore, we conducted conditional analysis identifying SNPs meeting genome-wide significance for population-specific associations conditioned on the lead SNP in each race/ethnicity. Results: We identified 115 SNPs associated with angiotensinogen levels (p&lt; 5×10 −8 ), including the lead SNP rs4762 (Thr174Met) in exon 2 (β=-0.159, p=1.51E -100 ) and SNP rs5050 (A-20C) in the promoter region (β=-0.109, p=2.26E -69 ) within the AGT gene. Strong Linkage Disequilibrium [LD (r 2 &gt;0.8)] was observed between rs4762 and rs35837081 for White, Black, and Hispanic ethnicities. Conversely, this level of LD was noted between rs4762 and rs3789657 specifically within Chinese. The LD between rs4762 and rs5050 was higher for White (r 2 =0.65), followed by Chinese (r 2 =0.56), Hispanic (r 2 =0.55), and Black (r 2 =0.29). Conditioned on rs4762 in the White population, we identified four secondary signals associated with angiotensinogen including rs2493151 (β=0.053, p=4.08E -9 ), implicated in transcription factor binding. Measured angiotensinogen levels were 9.7%, 12.8%, and 17.3% lower in Black, Hispanic, and Chinese, respectively, compared to White participants. Conclusions: These findings extend angiotensinogen research, highlighting the SNPs rs4762 and rs5050 as the key variants associated with angiotensinogen levels, both previously linked to hypertension.
Abstract 4140789: Clinical Impact of Utilization of Circulatory Assist Pump Cathter as Bridge to Cardiovascular Surgery for Preoperative Cardiogenic Shock -J-PVAD registry study-
Authors: Keitaro Domae, Takehito Mishima, Yuki Okoshi, Shuhei Suzuki, Ryo Onishi, Yuka Okubo, Takeshi Okamoto, Masanori Tsuchida
Journal: Circulation (2024)

Background: Cardiogenic shock in the perioperative period of cardiovascular (CV) surgery is a major challenge that worsens the prognosis and jeopardizes of treatment opportunities. Recently, the preoperative use of circulatory assist pump catheter (Impella) has been reported as a bridge to CV surgery in patients presenting with cardiogenic shock. However, the clinical impact has not been fully investigated. Aims: In this study, we aimed to investigate the safety and efficacy of utilization of Impella for preoperative cardiogenic shock as a bridge to CV surgery using the national database of Japanese Registry for Percutaneous Ventricular Assist Devices (J-PVAD). Methods: We selected and analyzed 102 patients with cardiogenic shock who utilized Impella before CV surgery from J-PVAD registry database from 2020 to 2021. The average age was 70.2 years, the etiologies were ischemic in 94 cases (92.2%), valvular disease in 8 cases (7.8%). The median time from onset to Impella support was 2.5 hours, the lactate level before insertion was 5.8±4.9 mmol/l, and LVEF was 37.7±14.6%. The devices used were Impella alone in 72 case (CP/2.5 in 66, 5.0 in 6) and combination of ECMO in 30 cases. Results: The detail of CV surgery was CABG alone in 43 cases, VSP repair in 27 cases, MV surgery in 25 cases and repair of LV rupture in 7cases. The mean duration of Impella support was 6.7 days, with 79 patients (77.5%) weaning off Impella, 21 patients (20.5%) dying during support, and 2 patients (2.0%) converting to durable LVAD. Bleeding events were observed in 26 patients (25.4%). Hemolysis in 10 patients and lower extremity ischemia in 5 patients, all of whom were CP cases. Post-weaning mortality was observed in 25 cases, and in-hospital mortality in 46 cases (45.1%). Freedom from all cause death at 30-day was 68.8% with no significant difference between ECPELLA and Impella alone (Log rank p=0.38). Conclusions: The clinical outcomes of bridge to CV surgery using Impella for preoperative cardiogenic shock from J-PVAD registry demonstrated acceptable postoperative weaning rate, however several cases of post-weaning mortality were observed, suggesting that appropriate protocol of weaning the device and prevention of complication is mandatory to improve outcomes.
Abstract 4140906: Cardiovascular Prognosis in Patients with Diabetes Mellitus Mediated by the Functional Post-revascularization Level
Authors: Zhihao Zheng
Journal: Circulation (2024)

Background and Aims: Functional complete revascularization (FCR) subsequent to percutaneous coronary intervention (PCI), as assessed by the residual functional SYNTAX score (rFSS), has been correlated with enhanced prognostic outcomes. This study sought to comprehensively apprehend the adverse cardiovascular prognosis within diabetic cohorts, determining what extent the association of diabetes with clinical outcomes is explained by functional revascularization. Methods: A total of 1,555 patients with available post-PCI quantitative flow ratio (QFR) were included, whose data were collected from PANDA III trial (Figure 1). FCR was defined as rFSS = 0, while anatomic complete revascularization (ACR) was defined as residual SYNTAX score (rSS) = 0. Firstly, we determined the ACR and FCR among DM and non-DM cohorts. Second, multiple cox regression was used to screen for potential mediating variables. Finally, we used structural equation modeling to analysis whether FCR explained the relationship between DM and the risk of 2-year rates of major adverse cardiac events (MACE). Results: Patients with DM had a significant lower percentage of FCR (71.9% vs 80.2%, P&lt;0.001), however ACR was not (38.68 vs 42.21, P=0.265, Figure 2). Multiple cox regression revealed that DM was associated with MACE (P=0.007), but not after adding FCR to the model (P=0.05), suggesting a mediation effect. Structural equation modeling analysis revealed a significant indirect effect of DM on MACE through FCR (P=0.006, Mediated (%) =27.3,Figure 3), suggesting a partial mediation effect. Conclusion: The degree of functional revascularization emerges as a central mechanism pivotal in elucidating the association between DM and the risk of MACE.