tbuckley/cabot-search huggingface dataset:
Abstract 4140859: Reverse Takotsubo Syndrome in Women at Different Stages after In Vitro Fertilization
Authors: Alexander Lee, Siddharth Singh, Janet Wei
Journal: Circulation (2024)

Case Descriptions: Takotsubo Syndrome (TTS) typically occurs in postmenopausal women who experience acute transient left ventricular (LV) systolic dysfunction that is most commonly apical, but may occur with other patterns such as a basal and midventricular “reverse” type. TTS pathophysiology has been attributed to catecholamine cardiotoxicity, microvascular dysfunction, and estrogen deficiency, although the mechanisms for reverse TTS (rTTS) remain to be elucidated. Here, we share rTTS cases of premenopausal women who underwent recent in vitro fertilization (IVF), suggesting a link between altered hormone milieu and basal LV dysfunction in the setting of TTS. Patient 1: A 35-year-old G0P0 woman presented immediately after IVF egg retrieval for hypotension and hemoperitoneum. TTE revealed EF 18% with basal-mid LV akinesis and preserved LV apical contraction. After 5 days of diuresis and vasopressor weaning, TTE showed improved EF 38%. TTE 15 days later demonstrated recovery of wall motion, EF 50%. Patient 2: A 36-year-old G3P1011 woman at 16 weeks gestation from IVF pregnancy was admitted with acute respiratory failure. TTE showed EF &lt;20% with basal-mid LV hypokinesis and apical sparing. Her worsening respiratory failure required intubation and ultimately ECMO. TTE 6 days later showed EF 63% without wall motion abnormalities. Discussion: Previous studies suggest that rTTS has higher prevalence in pregnant and younger women compared to apical TTS. Hypotheses of contributing mechanisms are two-fold: 1) estrogen is protective against catecholamine surges, and 2) estrogen receptors have increased concentration towards the LV apex. IVF and pregnancy are both associated with high estrogen levels. As such, our cases provide additional support for estrogen’s cardioprotective role, which may disproportionately assist the LV apex, favoring the rTTS variant. Both cases had emotional and/or physical stressors, no EKG ST elevation, and no coronary artery lesions or preexisting heart disease. Estrogen and catecholamine levels were not drawn, thus limiting our understanding. Although these cases suggest a hormonal influence on rTTS variant, the pathophysiology of TTS variants remains elusive and is likely multifactorial.
Abstract 4141338: Independent positive associations of coronary calcium density and volume with incident cardiovascular events in the 75-and-older population: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Hairong Liu, Yejin Mok, Amil Shah, Lin Chen, Matthew Budoff, Michael Blaha, Kuni Matsushita
Journal: Circulation (2024)

Background: Coronary artery calcium (CAC) is usually quantified by Agatston score, integrating both its density and area. Importantly, several studies have reported different prognostic implications between calcium density and volume, with the former inversely associated with cardiovascular disease (CVD) events suggesting predominantly “stable/healed” plaque and the latter better representation of total plaque burden. However, those studies predominantly involved middle-aged populations, with limited data on very older adults, and used estimated CAC density. Aim: To examine the independent association of directly measured CAC density and volume with incident CVD events among the 75-and-older population. Methods: We included 1,456 participants aged &gt;75 from ARIC visit 7 (2018-2019) with CAC data (mean age 80.4 [SD 4.2] years, 58.2% female, 18.2% Black). We assessed CAC maximum peak density (the highest density across all calcified plaque[s] in each participant) and volume. We ran multivariable Cox models with composite CVD (myocardial infarction, stroke, and heart failure) as the outcome. Mean peak CAC density(the average of the highest HU in every plaque in each participant) were used to check the pattern consistency. Results: During a median follow-up of 2.9 years, there were 122 CVD events. After adjusting for traditional CVD risk factors, both CAC density and volume were positively associated with CVD (e.g., hazard ratio for the highest (Q4) vs. the lowest (Q1) quartile 3.73 [95%CI 2.02-6.90] and 4.33 [2.44-7.66], respectively) (Model 1 in Table ). When we further adjusted for each other, the associations were attenuated but remained significant (Model 2 in Table ). The patterns were largely similar when we explored mean peak density. Conclusions: Unlike results in previous studies with middle-aged adults and estimated CAC density, both directly measured CAC density and volume were positively and independently associated with increased CVD risk in the 75-and-older population.
Abstract 4141528: Cardiovascular and Cerebrovascular Events in Patients with Inflammatory Bowel Disease Initiating Tofacitinib, Vedolizumab, Ozanimod, or Ustekinumab: A Propensity Score-matched Cohort Study in the United States
Authors: Sheng-Yin Chen, Yi-Jin Hsieh, Chuan LU, Ting-Wei Ernie Liao, Cheng-Chung Wei
Journal: Circulation (2024)

Background: Patients with IBD exhibit elevated risk of cardiovascular and cerebrovascular events. While anti-inflammatory medications such as 5-amiosalicylic acids (5-ASA) and TNF-α antagonists are associated with reduced ischemic heart disease (IHD) risk, recent concerns about newer drugs like tofacitinib have been raised by the FDA. This study evaluates the cardiovascular and cerebrovascular risks associated with newer agents including tofacitinib, vedolizumab, ozanimod, and ustekinumab. Goals: To assess and compare the risks of IHD, acute myocardial infarction (AMI), and cerebrovascular accidents/transient ischemic attacks (CVA/TIA) among patients treated with newer IBD agents versus those treated with traditional TNF-α antagonists. Methods: This retrospective cohort study utilized the TriNetX network comprising over 60 health care organizations in the US. Eligible patients were those aged over 15, diagnosed with IBD following the FDA approval dates for each studied newer agents (tofacitinib, vedolizumab, ozanimod, and ustekinumab). We excluded patients with prior diagnoses of IHD, AMI, CVA/TIA, cardiomyopathies, heart failure, atrial fibrillation, or cerebral insults. A 1:1 propensity score-matching (PSM) method was employed to adjust for baseline characteristics. We matched IBD patients using all newer agents individually to IBD patients using TNF-α antagonists (Etanercept, Adalimumab, or Infliximab). Cox proportional hazard regressions were applied to compute the hazard ratios (HR) and 95% confidence intervals (CI) for IHD, AMI, and CVA/TIA events. Patients were followed-up until June 4, 2024 or the development of events, whichever came first. Results: Patients treated with tofacitinib, vedolizumab, and ozanimod showed no significant increased risk of IHD, AMI, or CVA/TIA compared to TNF-α antagonist users. Notably, ustekinumab users demonstrated a decreased risk for these events. Detailed data were shown in Table 1 . Conclusion: Newer medications such as tofacitinib, ozanimod, and vedolizumab do not increase cardiovascular or cerebrovascular risks in IBD patients. Ustekinumab may offer protective benefits against such risks, indicating its potential utility in managing elevated cardiovascular risks among these patients.
Abstract 4141265: Single Center Utilization of Prenatal Palliative Care in Patients with Critical Congenital Heart Disease: Missed Opportunities?
Authors: Hannah Tredway, Katie Moynihan, Hadley Bloomhardt, Jennifer Snaman, Nicholas Purol, David Hoganson, Christina Ronai
Journal: Circulation (2024)

Background: Congenital heart disease (CHD) is a common congenital anomaly with lesions requiring intervention before initial hospital discharge defined as critical CHD (CCHD). Advances in prenatal detection, surgical, and post-operative care have improved early survival of patients with CCHD, yet long-term survival is limited. Fetal echocardiography has improved diagnosis and characterization of CCHD, and prenatal palliative care (PC) consult can improve shared decision making, communication, and parental stress of patients with life-limiting conditions. We hypothesized that the utilization of prenatal PC consults for patients with CCHD would be low (&lt;10%). Methods: Descriptive patient series of prenatal CCHD diagnosess at Boston Children’s Hospital from January 2020-December 2023. CHD type, prenatal characteristics, mode of delivery, cardiac interventions, intubations, mechanical circulatory support, timing of PC consult, and survival or mechanism of death were collected and analyzed. Early PC consult was defined as prenatal or occurring more than 30 days prior to death. Mode of death and age at death were compared between early, late, and PC. Results: 603 patients had a prenatal diagnosis of CCHD. 23% (n=141) had single ventricle heart disease. 10% (n=62) had a PC consult, only 4.8% (n=3) were performed prenatally. Median age at PC consult was 143 days [31 wks gestation, 4 yrs]. 8% (n=49) died, with a median age at death of 57 days [IQR 13, 171]. The majority of patients (65%, n=31) died following discontinuation of life-sustaining treatment, 29% (n=14) died following treatment limitation (TL), and 17% (n=8) underwent unsuccessful resuscitation. Of the deceased patients, 63% (n=31) had a PC consult . Early PC consult occurred in 33% (n=15) of deceased patients. Early PC consult was significantly associated with an older age at death (255 +/- 180 days), in comparison to late or no PC consult (69 +/- 77 days, 88 +/- 196 days). Patients with early PC consults were less likely to die following active resuscitation or TL (20%, n=3) than those with late or no PC consult (57%, n=8, 33%, n=6 respectively, p &lt; 0.05). Discussion/Conclusion: Patients with CCHD experience significant morbidity and mortality. Despite the known support that PC provides in decision making, establishing goals of care, and providing an extra layer of longitudinal support for families, early integration of PC upon prenatal diagnosis of CCHD is infrequently utilized at our institution.
Abstract 4141170: Impact of Serum 5-Hydroxytryptophan Levels on 15-Year Major Adverse Cardiovascular Events in ST-Elevation Myocardial Infarction Patients
Authors: Chin-Yuan Chia, Chao-Yung Wang
Journal: Circulation (2024)

Background: 5-Hydroxytryptophan (5-HTP) is a natural amino acid and precursor to serotonin, which is essential for various physiological functions. In cardiovascular research, serotonin has been implicated in modulating vascular tone, platelet aggregation, and myocardial function. Another derivative of 5-HTP, 5-methoxytryptophan (5-MTP), has been associated with reduced inflammation and cardiovascular calcification. However, the specific cardiovascular effects of 5-HTP remain less understood. This study investigates the relationship between baseline 5-HTP levels and the incidence of major adverse cardiovascular events (MACE) in patients who have experienced ST-elevation myocardial infarction (STEMI). Objective: Our goal was to determine if higher 5-HTP levels at the time of initial blood draw correlate with a lower incidence of MACE during long-term follow-up. Methods: This prospective cohort study included 453 STEMI patients (mean age 69.8 years, 53 women) followed for up to 15 years. Baseline serum 5-HTP levels were measured, with 2.42nM used as the threshold to categorize patients into high and low 5-HTP groups. The primary outcome was the incidence of MACE, including death, acute myocardial infarction, recurrent angina, congestive heart failure, coronary artery bypass grafting, stroke, planned percutaneous coronary intervention (PCI), unplanned PCI, and atrial fibrillation. Results: During the 15-year follow-up, 232 patients (51.2%) experienced MACE. Using the Cox proportional hazards model, we found that patients with higher baseline 5-HTP level (≥2.42nM) had a significantly lower risk of experiencing MACE (hazard ratio: 0.747, 95% CI: 0.561-0.996). Further analysis using a multivariable Cox proportional hazards model, adjusting for hypertension (HTN), use of Clopidogrel, use of Ticagrelor, Killip class during the initial STEMI event, age, and gender, confirmed that high 5-HTP levels were independently associated with a lower risk of MACE (hazard ratio: 0.712, 95% CI: 0.510-0.995). Conclusion: Higher 5-HTP levels are independently associated with a reduced risk of MACE in patients after STEMI. These findings suggest that 5-HTP could potentially be used as a biomarker for cardiovascular risk stratification. Additionally, supplementation with 5-HTP might be explored as a therapeutic strategy to reduce the risk of subsequent MACE in this high-risk population. Further research is warranted to confirm these findings and to understand the underlying mechanisms.
Abstract 4141353: Predictors of Coronary Artery Calcium Distribution in Older Adults Aged ≥ 75: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Abhishek Gami, Siyu Zou, Zeina Dardari, Ramzi Dudum, Yejin Mok, Matthew Budoff, Pamela Lutsey, Candace Howard, David Couper, Kuni Matsushita, Michael Blaha
Journal: Circulation (2024)

Background: Coronary artery calcium (CAC) is commonly measured using the Agatston score. Prior work has shown that inclusion of measures of CAC distribution, such as the number of coronary vessels with involved CAC and the relative distribution of CAC burden across different vessels, may improve cardiovascular risk prediction. However, the long-term predictors of CAC distribution at older age have not yet been explored. Aims: We aimed to characterize the patterns of distribution of CAC in adults ≥ 75 years and identify risk factors associated with a more diffuse CAC distribution. Methods: Time-weighted average exposure to traditional cardiovascular risk factors (e.g., blood pressure, LDL-C, HDL-C, BMI) was calculated over a 30-year period, using ARIC data from Visit 1 (1987-1989) to Visit 7 (2018-2019). ARIC conducted cardiac CT at Visit 7, and the CAC “diffusivity index” was calculated as 1 - (CAC in most affected vessel/total CAC). Participants with a diffusivity index &gt;75 th percentile were classified as having a diffuse CAC phenotype. Multivariable logistic regression was used to quantify the associations between time-averaged risk factors and diffuse CAC phenotype. Ordinal logistic regression was used to identify predictors of the number of coronary vessels with any CAC (0-4 [including left main]). Results: Of 2,143 participants (62% female, mean age 49 at Visit 1 and 80 at Visit 7), the mean diffusivity index was 0.28 (SD 0.23). In adjusted models, SBP ≥140 mmHg and HDL &lt;35 mg/dL were associated with diffuse plaque phenotype. Other predictors included ever smoking (OR 1.52, 1.22-1.91), male sex (OR 2.12, 1.67-2.70), and limited education (OR 1.49, 1.03-2.14) ( Table 1 ). SBP ≥140 mmHg (ordinal OR 2.06, 1.44-2.96), LDL ≥160 mg/dL (OR 2.28, 1.35-3.90), HDL &lt;35 mg/dL (OR 2.78, 1.96-3.95), BMI ≥30 kg/m 2 (OR 1.54, 1.02-2.32), ever smoking (1.47, 1.24-1.73), and limited education (OR 1.35, 1.00-1.80) were associated with increasing number of vessels with CAC. Conclusion: Traditional risk factors such as hypertension or low HDL-C are strong graded risk factors of a more diffuse CAC phenotype in older adults age &gt;75. Men, individuals with a smoking history, and those with limited education also had more diffuse CAC.
Abstract 4141287: Sodium Glucose Cotransporter-2 Inhibitors (SGLT2i) and Improves Function in ANOCA Patients
Authors: Paxson Tipler, Danielle Tapp, Christian Schmidt, Namrita Ashokprabhu, Sukhleen Kaur, Denaja Haygood, Michelle Hamstra, A. Phillip Owens, Timothy Henry, Odayme Quesada
Journal: Circulation (2024)

Introduction: Angina with non-obstructive coronary arteries (ANOCA) affects four million individuals in the U.S. and is associated with an economic burden that exceeds obstructive coronary artery disease (CAD). Sodium Glucose Cotransporter-2 Inhibitors (SGLT2i) are a novel class of glucose control medications initially indicated for use in type 2 diabetes that also reduce the risk major adverse cardiovascular events (MACE) in cardiovascular diseases. SGLT2i have recently been found to reduce the risk of MACE in patients with heart failure with preserved ejection fraction (HFpEF), which shares a common pathophysiological mechanism (coronary microvascular dysfunction) to ANOCA. Here, we examined the effects of SGLT2i on symptoms in ANOCA patients. Methods: Utilizing the Women’s Heart Center (WHC) Registry, we conducted a retrospective chart review of ANOCA patients who previously underwent coronary functional testing (CFT), were prescribed SGL2i, and were assessed for follow-up within 6 months. All brands of SGLT2i (dapagliflozin and empagliflozin) were included and symptoms were assessed utilizing validated questionnaires (NYHA HF and CCS angina class) pre- and post-treatment. Results: Among 34 ANOCA patients who underwent CFT and were clinically treated with SGLT2i’s, 29 (88%) were female (mean age=60.2; SD=11.4) and median treatment duration was 276 days (IQR:151,531). At the time of CFT, 50% had diabetes, 68% had hypertension, 97% had dyslipidemia, and 26% had a history of obstructive CAD. Among ANOCA patients, there were significantly fewer patients reporting angina at CCS class of 3 or 4 (moderate or severe limitation) post SGLT2i treatment (McNemar’s Exact, p=0.039, Figure 1). Among ANOCA patients with contaminant HFpEF (N=15, 53%), there were significantly fewer patients reporting a functional impairment at NYHA class of III and IV (marked or severe limitation) post SGLT2i treatment (McNemar’s Exact, p=0.016). Conclusions: SGLT2i show potential for reducing angina in ANOCA patients and improving function in patients with both ANOCA and HFpEF. Together, these data suggest benefit of SGLT2i in ANOCA patients and future studies should examine the effect these drugs have on underlying mechanisms (CMD).
Abstract 4140803: Vasomotion in human arteries and its ion channelbased on regulations: 10 years study
Authors: kim Young Chul
Journal: Circulation (2024)

Vasomotion is the oscillation of vascular tone which gives rise to flow motion of blood into an organ. As is well known, spontaneous contractile organs such as heart, GI, and genitourinary tract produce rhythmic contraction. It imposes or removes pressure on their vessels alternatively for exchange of many substances. It was first described over 150 years ago, however the physiological mechanism and pathophysiological implications are not well understood. This study aimed to elucidate underlying mechanisms and physiological function of vasomotion in human arteries. Conventional contractile force measurement, immunohistochemistry, and Western blotting were employed to study human left gastric artery (HLGA) and uterine arteries (HUA). RESULTS: Circular muscle of HLGA and/or HUA produced sustained tonic contraction by high K + (50mM) which was blocked by 2µM nifedipine. Stepwise stretch and high K produced nerve-independent spontaneous contraction (vasomotion) (around 45 % of tested tissues). Vasomotion was also produced by application of Bayk 8644, 5-HT, prostagrandins, oxytocin. It was blocked by nifedipine (2µM) and blockers of intracellular Ca 2+ stores. Inhibitors of Ca 2+ -activated Cl - channels (DIDS and/or niflumic acid) and ATP-sensitive K + (K ATP ) channels inhibited vasomotion reversibly. Metabolic inhibition by sodium cyanide (NaCN) and several neuropeptides also regulated vasomotion in K ATP channel-sensitive and -insensitive manner. In Next step, we identified TMEM16A Ca 2+ -activated Cl - channels and subunits of K ATP channels (Kir 6.1/6.2 and sulfonylurea receptor 2B (SUR2B)), and c- Kit positivity by Western blot. Fianally, we also foud regulation of vasomotion by other second messengers in HLGA and muscle specific events too. We conclude that vasomotion is sensitive to TMEM16A Ca 2+ -activated Cl - channels and metabolic changes in human gastric and uterine arteries. Vasomotion might play an important role in the regulation of microcirculation dynamics even in pacemaker-related autonomic contractile organs in humans.
Abstract 4141292: Neo-Sinus Washout Time Following Transcatheter Aortic Valve Replacement and Hemodynamic Outcomes
Authors: Shivabalan Kathavarayan Ramu, Toshiaki Isogai, Saksham Beotra, Vishwum Kapadia, Nikita Thakore, Ankit Agrawal, Shashank Shekhar, Maryam Muhammad Ali Majeed-Saidan, Rohan Prasad, Agam Bansal, Abdelrahman Abushouk, Odette Iskandar, Larisa Tereshchenko, Grant Reed, Rishi Puri, James Yun, Serge Harb, Rhonda Miyasaka, Zoran Popovic, Amar Krishnaswamy, Samir Kapadia
Journal: Circulation (2024)

Background: Leaflet thrombosis and associated transcatheter heart valve (THV) dysfunction are major concerns in managing transcatheter aortic valve replacement (TAVR) recipients. Prolonged neo-sinus contrast washout time (NWT) may increase the risk of hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, leading to early valve degeneration. This study aims to assess the association between NWT measured in-vivo and hemodynamic outcomes in patients undergoing TAVR. Methods: In this retrospective cohort study, NWT was obtained from aortograms using computer vision algorithm in 2256 patients (mean [SD] age 79 [9] years; 40% female) who underwent TAVR at our center between 2016 and 2020. NWT was stratified into terciles (T1: &lt;1.33 s, T2: 1.33-2.08 s, T3: &gt;2.08 s) and adjusted for heart rate (HR). Hemodynamic assessments focused on transvalvular aortic mean and peak gradients post-TAVR, with evaluations at 30-day and 1-year follow-ups. The association between NWT and HALT presence was also studied. Unpaired t test was used to compare the gradients between terciles at different time points. Mann-Whitney test was used to compare NWT between HALT and no HALT. Results: At the 30-day follow-up, the transvalvular aortic mean gradient was higher in T3 compared to T1 (12.61 [5.07] mm Hg vs. 11.98 [4.75] mm Hg, p=0.03). At the 1-year follow-up, patients with 29 mm valves in T3 had higher mean gradients than those in T1 (11.13 [4.35] mm Hg vs. 9.65 [3.85] mm Hg, p=0.04). Patients with 30-day HALT exhibited significantly greater NWT (z=-2.06, p=0.04). Conclusion: Prolonged NWT measured in-vivo is associated with elevated transvalvular aortic mean gradients at both 30-day and 1-year follow-ups post-TAVR. Moreover, patients with HALT had higher NWT. NWT can help identify patients at risk of valve deterioration and HALT at an early stage, guiding post-procedural pharmacotherapy.