tbuckley/cabot-search huggingface dataset:
Abstract 4144894: Patient Frailty Rather than Procedural Approach Associated with Loss of Life and Limb
Authors: Sabina Sorondo, Katherine Arnow, Aditi Kashikar, Arash Fereydooni, Amber Trickey, Shipra Arya, Elizabeth George
Journal: Circulation (2024)

Objectives: Evidence behind frail patients preferentially undergoing endovascular interventions for peripheral arterial disease remains sparse; thus, we evaluated the association of frailty and revascularization-approach with long-term mortality and major adverse limb events (MALE). Methods: VQI-Medicare linked VISION databases were queried for patients who had their first infrainguinal open or endovascular (endo) procedure between 2011-2015 [N=27,200]. Frailty was measured using the VQI-Risk Analysis Index (RAI) and dichotomized into “frail” (RAI≥37) and “non-frail” (RAI&lt;37). The primary endpoints were 4-year mortality and MALE (major amputation and/or reintervention). Associations of frailty and approach were estimated using Kaplan-Meier analysis and multivariable Cox hazards regression using an interaction term and stratified by indication. Results: Frail patients experienced significantly worse mortality and amputation-free survival, but both frail and non-frail patients experienced worse survival following an endo first approach (Figure 1, both log-rank p &lt; 0.001). In adjusted Cox regression, frail patients with CLTI were at significantly increased risk of amputation (HR = 1.36; 95% CI: 1.18-1.56; p &lt;.0001), MALE (HR:1.09, 95% CI:1-1.19; P=.049) and mortality (HR = 2.70; 95% CI: 2.51-2.89; p &lt;.0001); endo approach for CLTI demonstrated a similar pattern of adverse outcomes (Table 1). However, interaction terms were not significant - the effects of frailty and approach did not influence each other. In claudicants, frailty was associated with increased mortality (HR = 3.05; 95% CI: 2.40-3.86; p &lt;.0001) but not MALE, and endo approach was associated with increased MALE but not amputation; again, interaction terms were not significant. Conclusion: Endovascular approach did not mitigate the adverse effects of frailty on life and limb-related outcomes, thereby underscoring the need for frailty screening and accordingly tailoring treatment and managing expectations given their high mortality risk.
Abstract 4144790: Impact of Prolonged PR Interval on Recurrence of Atrial Fibrillation after Catheter Ablation: A Systematic Review and Meta-analysis with Reconstructed Time-to-Event Data.
Authors: Ahmed Mazen Amin, AlMothana Manasrah, Karnav Modi, Abdo-rahman Khassawneh
Journal: Circulation (2024)

Background: A prolonged PR interval has been demonstrated as a predictor of increased risk for incident atrial fibrillation (AF), coronary artery disease, heart failure, and pacemaker implantation. Purpose: We aim to investigate the impact of prolonged PR interval &gt; 200 ms on AF recurrence after catheter ablation. Methods: We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through May 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1. Results: With the inclusion of four studies, our cohort comprised a total of 2,790 patients. Regarding pair-wise meta-analysis, PR interval &gt; 200 ms was significantly associated with an increased incidence of AF recurrence compared to PR interval ≤ 200 ms (RR: 1.50 with 95% CI [1.33, 1.70], P&lt; 0.01). Regarding adjusted prognostic meta-analysis, PR interval &gt; 200 ms was significantly associated with a 92% increase in the risk of AF recurrence compared to PR interval ≤ 200 ms (HR: 1.92 with 95% CI [1.61, 2.30], P&lt; 0.01). Our reconstructed Kaplan Meier showed that a PR interval &gt; 200 ms was significantly associated with a 65% increase in the risk of AF recurrence compared to a PR interval ≤ 200 ms (HR: 1.65 with 95% CI [1.42, 1.92], P&lt; 0.00001) over 120 months follow-up. Conclusion: Our meta-analysis concluded that a prolonged PR interval greater than 200 ms is a significant predictor of AF recurrence after catheter ablation, reflecting atrial remodeling, and since the PR interval can be easily measured by a surface 12-lead ECG, patients with a prolonged PR interval may require additional treatment strategies.
Abstract 4145167: Long-term Outcomes of Cardiogenic Shock and Cardiac Arrest Complicating ST-Elevation Myocardial Infarction According to Timing of Occurrence
Authors: GABRIEL KANHOUCHE, Jose Carlos Nicolau, Remo Furtado, Luiz Sergio Carvalho, Brunna Pileggi, Mauricio Felippi de Sa Marchi, Pedro Abi-Kair, Talia Falcao Dalcoquio, Neuza Lopes, Roberto Giraldez, Luciano Baracioli, Felipe GALEGO, Roberto Kalil, Ludhmila Abrahao Hajjar, Fabio de Brito Junior, Alexandre Abizaid, Henrique Ribeiro
Journal: Circulation (2024)

Background: Cardiogenic shock (CS) and cardiac arrest (CA) are serious complications in ST-elevation myocardial infarction (STEMI) patients, with lack of long-term data according to their timing of occurrence. Objective: This study sought to determine the incidence and the relationship between timing of occurrence and prognostic impact of CS and CA following STEMI in the long-term follow-up. Methods: We conducted a retrospective analysis of consecutive STEMI patients treated from 2004 to 2017. Patients were divided into four groups based on the occurrence of neither CA nor CS, CA only, CS only, and both CA and CS (CA-CS-, CA+, CS+ and CA+CS+, respectively). Adjusted Cox regression analysis was used to assess the independent association between the CS and CA categories and mortality. The timing of their occurrence was evaluated according to initial cardiac catheterization as pre-, during- or post-procedure. Results: A total of 1,603 STEMI patients were followed for a median of 3.6 years. CA and CS occurred in the 12.2% and 15.9% of patients, and both impacted long-term mortality [adjusted HR 2.59 (95%CI 1.53-4.41), p&lt;0.001, and HR 3.16 (95%CI 2.21-4.53, p&lt;0.001], respectively as shown in Figure 1. CA+CS+ occurred in 7.3%, with the strongest association with higher long-term mortality [adjusted HR 5.36 (95%CI 3.80-7.55), p&lt;0.001]. Using flexible parametric models with B-splines and landmark analysis, the increased mortality was restricted to the first ~10 months after STEMI. In addition, among CS patients, overall mortality rates were higher at all CS timings, pre-, during and post-procedure (all with p&lt;0.001). In contrast, CA during initial cardiac catheterization was not associated with overall mortality (p&lt;0.183), while both CA pre- and post-procedure (all with p&lt;0.001) were associated with higher mortality. Conclusion: CS and CA complicating patients presenting with STEMI were associated with higher long-term mortality rate, especially in the first 10 months. While CS at any time frame appeared to impact clinical outcomes, only CA pre- and post- cardiac catheterization were associated with higher mortality rates.
Abstract 4144906: An Innovative telemonitoring-wearable device with third heart sound detection for early detection of worsening heart failure
Authors: Hirotada Masuda, Shota Ekuni, Yusuke Misumi, Yasuhiro Akazawa, Yasushi Sakata, Shigeru Miyagawa
Journal: Circulation (2024)

Background: Approximately 40% of chronic heart failure patients require rehospitalization for worsening heart failure (WHF) within one year after discharge. Implantable devices such as CardioMEMS have been developed to overcome this challenge but with the problem of invasiveness. We have developed a watch-type wearable device and software that could detect WHF early by detecting an outpatient's third heart sound (S3) and conducted a feasibility study at multiple centers in Osaka. Objective: To clarify the accuracy of our system in detecting S3 and WHF events. Patients&amp;Methods: We lent the watch-type device and the smartphone to collect the outpatient's heart sound data. Patients wore the device with a built-in small microphone for six months, except while bathing or sleeping. The device was put on the patient's left side chest wall to record heart sounds at 8, 13, and 18 o'clock. These data were sent to the smartphone app and our server. Our unique algorithm, including an AI-based analyzing system, identified S3 in the heart sound data. If the WHF events occurred, the patients were admitted to the hospital. A cardiologist heard the same sound data of the server and annotated if the heart sound data included S3. S3 and WHF detection accuracy were measured. Results: Twenty-three patients enrolled, and three patients experienced a WHF event. Four hundred and eighty-three heart sound data were recorded. Four hundred and thirty-four of the sound data were used for building an AI-analysing system as training data, and 49 were used as test data. In the test data, 14 of 49 sound data had S3 due to a cardiologist diagnosis. Our AI system had a sensitivity of 93% and specificity of 80% for detecting S3 among them and predicted all WHF events before rehospitalization, referring to S3 present. Conclusion: Our system could detect S3 and WHF events with acceptable accuracy. This system would be a breakthrough technology for home monitoring in the cardiac field.
Abstract 4145115: Chemogenetic hydrogen sulfide donor rescues aortic perivascular adipose tissue and endothelial cell senescence in aging
Authors: Khatereh Shabanian, Taraneh Shabanian, Karsai Gergely, Francesco Paneni, FRANK RUSCHITZKA, Soheil Saeedi
Journal: Circulation (2024)

Introduction: Hydrogen sulfide (H 2 S) is increasingly recognized as an important signaling small molecule that mitigates vascular aging and extends lifespan. Reduced H 2 S production in aged vasculature underscores the unmet need for effective strategies to controllably generate cell-specific H 2 S in vascular cells predisposed to cellular senescence in aging. Here, we develop a chemogenetic technology to offer a new class of H 2 S-donors to rescue perivascular adipose tissue (PVAT)-endothelial cell (EC) senescence in aging. Methods: To characterize our innovative (peri)vascular senotherapy, we employed a chemogenetic approach combined with biosensor-based real-time fluorescence imaging, and senescence and cell-cell interaction analyses. Results: We employed a recombinant AAV2/8-Adipo construct expressing a yeast D-amino acid oxidase (DAAO), which oxidizes D-Cysteine to yield 3-mercaptopyruvate (3MP), converting to H 2 S and pyruvate by mercaptopyruvate sulfurtransferase (MPST) in PVAT. We cloned DAAO as a fusion protein with the H 2 S biosensor hsGFP, enabling both generation (DAAO) and detection (hsGFP) of H 2 S in the cell mitochondria. Old mice (&gt;24 months) exhibiting senescence in their aortic PVAT and ECs (indicated by ROS-induced oxidative stress, mitochondrial dysfunction, increased SASP component IL6, and proliferative arrest marker p16 INK4a ), were infected with AAV2/8-Adipo-DAAO-hsGFP-mito constructs. Fluorescence imaging documented robust in vivo H 2 S production in the distinct subcellular organelle after treatment with D-Cysteine (10 mM). Interestingly, these mice showed restored mitochondrial function and adipocyte marker UCP1, alongside downregulated IL6 in aortic PVAT. Our old PVAT-EC co-culture studies revealed that chemogenetic H2S, by reducing IL6 release towards ECs, rescues senescence and dysfunction in ECs (decreased SA-β-gal activity, DNA damage response (↓ γ-H2A.X), and proliferative arrest (↓ p16 INK4a &amp;p19 INK4d )). The rescued ECs also exhibited restored angiogenic capacity, demonstrated by increased tube formation. Conclusions: Our recent advances in chemogenetic technology provide a remote-control (Turn ON/OFF) and cell-specific tool for intracellular H 2 S-mediated rescue of PVAT-EC senescence in aging. This innovative approach offers promising avenues for developing a new class of H 2 S-based senotherapies with significant potential for clinical applications.
Abstract 4145104: Can Stress Echocardiography during Cardiopulmonary Exercise Testing Help Predict Clinical Outcomes in Right-Sided Congenital Heart Disease?
Authors: Samantha Dizon, Yamini Krishnamurthy, Jonathan Kochav, Matthew Lewis, Marlon Rosenbaum, noa zemer wassercug
Journal: Circulation (2024)

Background: The optimal timing for intervention for pulmonary and right ventricular outflow tract stenosis in adult congenital heart disease (ACHD) remains uncertain. While stress echocardiography is an established modality to improve risk stratification in stenotic left-sided lesions, its utility in right-sided valve disease in the ACHD population has not been studied. We assessed if stress echocardiographic assessment of right ventricular (RV) function during cardiopulmonary exercise testing (CPET) can facilitate risk stratification in the ACHD population. Objectives: The purpose of this study was to determine the relationship between RV augmentation on stress echocardiogram during CPET and morbidity in ACHD patients with sub-pulmonary right ventricles and right-sided stenotic lesions. Methods: A retrospective cohort study of ACHD patients with sub-pulmonary right ventricles who underwent CPET with stress echocardiogram was performed. The primary outcome was defined as having at least one of the following: 1) cardiac related hospitalization, 2) new documented arrhythmia, or 3) new or worsening heart failure. RV augmentation on stress echo was verified by concordance with a second observer. Results: The study included 87 patients, 41 (47%) with repaired tetralogy of Fallot, 9 (10.3%) with RV-PA conduits, and 9 (10.3%) with pulmonary stenosis. On baseline transthoracic echocardiogram, median peak pulmonary valve gradient was 38.7 mmHg (Q1 17.9 , Q3 49.0) and 30% of patients had RV dysfunction. On stress imaging, 13 (14.9%) did not demonstrate RV augmentation. Those without RV augmentation had a lower percent predicted peak Vo2 (61.4% vs 75.4%, p=0.007). Eleven (12.6%) met the primary outcome. Lack of RV augmentation was strongly associated with the primary outcome (OR 4.25, CI 1.04 –17.46, p = 0.04). This association remained true in patients with baseline peak PV gradients less than 50mmHg (OR 8.7, CI 1.68 – 46.79, p = 0.009) and was more pronounced in patients with tetralogy of Fallot (OR 33.99, CI 3.29 – 829, p = 0.007). Conclusions: Lack of RV augmentation on stress echo during CPET is associated with increased morbidity in ACHD patients with right-sided stenotic lesions. These results suggest that stress echocardiography at the time of CPET should be considered in this population.
Abstract 4145037: Effects of Empagliflozin on cardio-renal interaction in heart failure: Results from the CINNAMON-study and in-vivo experiments
Authors: Frederick Sinha, Susanne Klatt, Alexander Rietmann, Anna Schoepperl, Sebastian Born, Lars Maier, Frank Schweda, Stefan Wagner
Journal: Circulation (2024)

Background and Purpose: Heart failure is associated with renal dysfunction suggesting a pathophysiological link between heart and kidney. Empagliflozin, a SGLT2 inhibitor, showed beneficial effects on both cardiovascular and renal endpoints. However, mechanistically, it is unclear if empagliflozin-dependent kidney protection is mediated via inhibition of tubular SGLT2 or more indirectly via improved cardiac function. We hypothesized that Empagliflozin treatment improves left ventricular ejection fraction (LVEF) and thereby renal function in patients and mice independent of renal SGLT2 inhibition. Methods: We evaluated LVEF and GFR in our patients with HF with reduced (n=32) and preserved ejection fraction (n=59) after 30 and 180 days (prospective, single-arm CINNAMON-study, DRKS00031101). Furthermore, we conducted transverse aortic constriction (TAC) in C57BL/6J (wildtype, WT) and SGLT2 deficient mice (SGLT2-KO). Animals received either Empagliflozin (10 mg/kg bw) or vehicle. Cardiac function was evaluated by echocardiography and kidney function by FITC-Sinistrin measurement (GFR). Results: Empagliflozin treatment improved LVEF in patients with reduced LVEF whereas in patients with preserved LVEF (Fig. A, B) there was no change in LVEF (Fig. C). Interestingly, only in patients with LVEF &lt; 40% there was a parallel improvement in GFR (Fig. D, E), whereas in patients with LVEF &gt; 40% we only observed the well-known transient drop of GFR (Fig. F). In mice after 10 weeks, echocardiography confirmed TAC induced pressure-overload, leading to reduced LVEF, which was attenuated by EMPA (Fig. G). Interestingly, at 10 weeks, TAC also reduced GFR, which was prevented by EMPA (Fig. H). To test if direct inhibition of SGLT2 is mechanistically involved, TAC surgery was repeated in SGLT2-deficient mice (SGLT2-KO). In fact, exposure to TAC resulted in comparable reduction of LVEF in SGLT2-KO and EMPA prevented this deterioration similar to WT mice (Fig. G vs. I). Surprisingly, EMPA also prevented GFR deterioration 10 weeks after TAC in SGLT2-KO mice with comparable magnitude as in WT mice (Fig. J), suggesting that the reno-protective effect of Empagliflozin was independent from SGLT2 inhibition. Conclusion and Outlook: This is the first study investigating the role of SGLT2 in Empagliflozin-dependent kidney protection in patients and of mice with heart failure. Importantly, Empagliflozin treatment prevented deterioration of LVEF and GFR independent of the presence of SGLT2.
Abstract 4145223: Impact of High Lipoprotein(a) Levels on 5-year Clinical Outcomes following Percutaneous Coronary Intervention with Drug-eluting stent in Korean population
Authors: Seung-Woon Rha, Byoung Geol Choi, Woo Jin Ahn, sujin hyun, Jinah Cha, Se Yeon Choi, Markz Sinurat, Soohyung Park, Cheol Ung Choi, Chang Gyu Park, Dong Joo Oh
Journal: Circulation (2024)

Background: This study evaluated the association between elevated levels of Lipoprotein(a) [Lp(a)] and the long-term risk of recurrent ischemic events in patients who underwent percutaneous coronary intervention (PCI), and tracked changes in Lp(a) over time. Methods: The study population was enrolled from the Korea University Guro hospital (KUGH)-PCI registry from January 2004 to January 2018. A total of 5,790 patients (pts) who underwent PCI with drug-eluting stents(DESs), and have been completed clinical follow-up for 5 years. All subjects were divided into two groups according to Lp(a) level; Lp(a)≥50 mg/dL (n=319pts), Lp(a)&lt;50 mg/d (n=1701pts). Results: The Lp(a)≥50 group was 15.8% (319/2020) of the total. Although there were more males (59.5% vs. 68.7%, P=0.001) in the Lp(a)&lt;50 group, baseline, angiographic and procedural characteristics were well balanced between the two groups. In a 5-year clinical follow-up, compared to the Lp(a)&lt;50 group, the Lp(a) ≥50 group had significantly more cardiovascular events, including myocardial infarction (7.5% vs. 3.5% P=0.001), repeated-PCI (20.3% vs. 13.6% P=0.002), and stent thrombosis (4.0% vs. 1.8% P=0.015). The use of statins or ezetimibe did not significantly reduce Lp(a) levels between the time of PCI and up to 1 year in the Lp(a) ≥50 group. Conclusion: This observational study demonstrated that elevated baseline Lp(a) levels in patients who underwent PCI were significantly associated with recurrent ischemic events. The prescription of statins or ezetimibe at discharge did not significantly reduce Lp(a) levels up to one-year follow-up.
Abstract 4145216: Association of Neutrophil-Lymphocyte Ratio With Cardiovascular Mortality and All-cause Mortality in Patients Receiving Chronic Hemodialysis: A Systematic Review and Meta-analysis
Authors: Roopeessh Vempati, Nanush Damarlapally, Srivatsa Surya Vasudevan, Prathibha Banda, Denise Mourad, Harshavardhan Polamarasetty, Gaurav Mathur, Afrasayab Khan, Rupak Desai
Journal: Circulation (2024)

Background: The neutrophil-lymphocyte ratio (NLR) has been proposed as a potential prognostic marker for mortality outcomes in various conditions, yet its association with chronic hemodialysis (HD) remains underexplored. We aim to study its utility by conducting a meta-analysis of this specific population. Methods: We conducted a comprehensive systematic search from PubMed, Google Scholar, and Scopus to identify studies showing the association between NLR and mortality outcomes in patients with chronic HD. Random-effects model with 95% confidence intervals (CI) were employed to pool adjusted hazard ratios (aHRs) and odds ratios (OR), I 2 statistics for evaluating heterogeneity for all-cause mortality (ACM) and cardiovascular mortality (CVM) outcomes. Leave-one-out sensitivity analysis and meta-regression analyses assessed changes in overall effects and identified confounders, respectively. The Joanna Briggs Institute (JBI) tool was used to assess the quality of the studies. Results: Out of 180 articles analyzed, nineteen studies comprising 9,047 patients with a mean age of 59.5 ± 5.86 years and a mean follow-up duration of 46.7 months were included in our meta-analysis. The majority of the sample had a smoking history, hypertension, diabetes, and cerebrovascular diseases. Our meta-analysis revealed a significant association between higher NLR (&gt;2.5) and increased risks of both ACM (aHR: 1.24, 95% CI: 1.13-1.36, P &lt; 0.0001) (Figure 1a) and CVM (aHR: 1.23, 95% CI: 1.02-1.49, P = 0.03). (Figure 1b) Studies reporting outcomes in OR also reported similar findings for ACM (OR: 4.58, 95% CI: 1.73 - 12.1, p = 0.002) (Figure 1c) and CVM (OR: 1.11, 95% CI: 1.01 - 1.23, p = 0.03). Sensitivity analysis revealed no variations. The pooled AUC was 0.711 (95% CI: 0.63 - 0.80, p &lt; 0.0001). JBI tool revealed higher scores indicating higher quality studies. Meta-regression analysis did not identify significant associations between NLR and confounding variables such as age. (Figure 1d) Conclusion: This meta-analysis strongly concludes that NLR (&gt;2.5) is significantly associated with ACM and CVM in patients with chronic HD and can be useful in planning for the prevention of mortality-related strategies.