tbuckley/cabot-search huggingface dataset:
Abstract 13714: Mortality Among Individuals With Prevalent Heart Failure and Low Socioeconomic Position
Authors: Alexa Perlick, Debra Dixon, Meng Xu, Loren Lipworth, Deepak K Gupta
Journal: Circulation (2023)

Introduction: Individuals of low socioeconomic position are at greatest risk for incident heart failure (HF). Few data exist, however, regarding factors associated with mortality among individuals with prevalent HF and low socioeconomic position. Methods: The Southern Community Cohort Study (SCCS) is a prospective observational study of 84,797 individuals of predominantly low socioeconomic position enrolled between 2002 to 2009 from 12 states in the southeastern US. Using Cox regression models, we examined demographic, social determinants, and clinical factors associated with 5-year all-cause mortality in a subset of 4,309 black or white adults with prevalent HF receiving Centers for Medicare and Medicaid Services at enrollment. Death was ascertained through linkage with the National Death Index and cohort follow-up. Results: Individuals with prevalent HF at SCCS enrollment were predominantly middle age (mean ~59 years), female (64%), black (70%), low income (75% &lt;$15k/year), and low education (46% &lt; high school). Over 5-year follow up, a total of 975 (23%) individuals died. Older individuals and men were at greater risk of death. Comorbidities such as history of myocardial infarction/coronary bypass, diabetes, hypertension, and smoking significantly associated with greater risk of death, as did lower physical activity and greater sedentary time. In contrast, social determinants such as race, income, education, and rural vs. urban residence did not significantly associate with mortality. Overall, body mass index (BMI) accounted for the greatest proportion of variance in the risk of death with a non-linear, predominantly inverse association ( Figure ). Conclusions: Among individuals of low socioeconomic position with prevalent heart failure residing in the southeastern US, clinical factors, particularly BMI, account for risk of mortality more so than social determinants.
Abstract 12028: Long-Term Repeat Intervention Incidence in Octogenarians After Robotic-Assisted Coronary Artery Bypass Grafting
Authors: Aleksander Dokollari, Serge Sicouri, Basel Ramlawi, Marco Gemelli, Stephanie Kjelstrom, Ali Fatehi Hassanabad, Scott Goldman, Georgia Montone, Gianluca Torregrossa, Roberto Rodriguez, Mary Ann Wertan, Francis Sutter
Journal: Circulation (2023)

Introduction: We aim to analyze long-term repeat intervention incidence in octogenarians undergoing robotic-assisted coronary artery bypass grafting (CABG). Hypothesis: We hypothesize that robotic-assisted CABG has a low incidence of repeat intervention compared to other clinical trials. Methods: All consecutive octogenarians (500 patients) undergoing robotic-assisted left internal thoracic artery (LITA) harvesting and CABG through a 4-cm left minithoracotomy with LITA to left anterior descending (LAD) artery anastomosis between 2005-2021 in a single center were included. Hybrid coronary revascularization (HCR) consists in robotic-assisted CABG followed by percutaneous coronary intervention (PCI) with DES in a non-LAD target within 7-days from the operation. Results: Preoperatively, mean age was 83 (±2.9) year-olds, and mean STS-PROM risk score was 3.6% (2.1- 6.6). Intraoperatively, 478 (95.6%) patients received 1 LITA, 14 (12.8%) received bilateral ITA, and 8 (1.6%) a saphenous venous graft. A total of 303 (60.6%) patients received multiple arterial revascularizations while 140 (28%) received HCR. A total of 376 (75.2%) patients were extubated in the operating room. Postoperatively, 2 (0.4%) patients experienced non-fatal stroke, 6 (1.2%) had reoperation for bleeding, and 12 (2.4%) had renal failure. There was no 30-day mortality while 1 (0.2%) patient had PCI with DES on LITA-LAD anastomosis due to graft failure. Mean-follow-up was 2.9-years while incidence of all-cause death was 103 (20.6%) patients, MACCE 136 (27.2%), stroke 8 (1.6%), myocardial infarction 16 (3.2%), and repeat intervention with stents 39 (7.8%) were low. There was no repeat surgical intervention while PCI with drug-eluting stents for new coronary disease was 15/39 (38.4%) patients. Conclusions: Robotic-assisted CABG in octogenarians evidenced a 7.8% incidence of repeat intervention with stents.
Abstract 12953: Targeting NEDD9 and SMAD3 in the Pathogenesis of Chronic Thromboembolic Pulmonary Hypertension
Authors: Shreya Sangam, Wei Qi, Andriy O Samokhin, Bradley A Maron
Journal: Circulation (2023)

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by unresolved pulmonary thrombi due, in part, to impaired fibrinolysis. We showed previously that oxidation of the Cas protein NEDD9 at cysteine-18 (Cys 18 ) inhibits complex formation between NEDD9 and the anti-fibrinolytic transcription factor SMAD3 in human pulmonary artery endothelial cells (HPAECs). However, the effect of NEDD9-Cys 18 oxidation on SMAD3 bioactivity in HPAECs is not known. Hypothesis: NEDD9-Cys 18 oxidation increases bioavailable SMAD3, which upregulates SERPINE1 that encodes plasminogen activator inhibitor (PAI)-1 to inhibit fibrinolysis pathways in HPAECs. Methods/Results: To assess the effect of SMAD3 on SERPINE1 transcription, HPAECs were transfected with cDNA-SMAD3 (1 μg/μl) for 72 hr to induce SMAD3 overexpression. Compared to vehicle (V) control, cDNA-SMAD3 increased PAI-1 and SERPINE1 expression by 35% (P=0.004) by immunoblot and 70% (P=0.003) by real-time PCR, respectively (N=3). To determine the effect of NEDD9 inhibition on SMAD3 activation, we analyzed the ratio of P-SMAD-Ser423/425:SMAD3 by immunoblot. Compared to scrambled RNA (scRNA), transfection with siRNA against NEDD9 (siNEDD9) for 48 hr increased the relative quantity of activated SMAD3 by 1.4-fold (P=0.006) and upregulated PAI-1 (P=0.004) expression by 1.7-fold in HPAECs (N=4). Next, we monitored the effect of oxidant stress on SMAD3 bioactivity. Compared to V-control, the expression of NEDD9, total SMAD3, and P-SMAD3 was increased by 66% (P=0.04), 81% (P=0.03), and 29% (P=0.04), respectively, in HPAECs treated with hydrogen peroxide (H 2 O 2 ) (500 μM) for 20 min. Next, the effect of NEDD9 silencing on H 2 O 2 accumulation in HPAECs was measured by Amplex Red assay. HPAECs were transfected with scRNA or siNEDD9 for 48 hr followed by measurement of H 2 O 2 production. Compared to scRNA, NEDD9 silencing significantly decreased H 2 O 2 concentration by 56% (N=4, P=0.02). Conclusion: These data demonstrate that oxidant stress increases SMAD3 activity and SMAD3-dependent upregulation of PAI-1 through a mechanism involving redox regulation of NEDD9. Identifying prothrombotic control of SMAD3 by NEDD9 may have important therapeutic implications for CTEPH.
Abstract 12638: The Independent and Joint Associations of Obesity and Hypertension on Incident Heart Failure: A Pooled Cohort Analysis
Authors: Arsalan Hamid, Abdul Mannan Khan Minhas, Daisuke Kamimura, Ambarish Pandey, Affan Rizwan, Maria Clarissa Tio, Candace M Howard, Alanna A Morris, VIJAY NAMBI, Robert J Mentz, Javed Butler, Michael E Hall
Journal: Circulation (2023)

Introduction: Obesity and hypertension (HTN) are major risk factors for incident heart failure (HF). Obesity is a major cause of HTN; thus, it is difficult to disentangle the impact of each risk factor on HF incidence. Further, it is not established what factors modify these relationships. Aims: To assess the associations of obesity and HTN as well as their potential synergistic effect on incident HF in large, diverse populations. Methods: We studied participants of 3 major epidemiologic cohorts: Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study. Participants were stratified into 4 groups: neither obesity nor HTN (reference), only obesity, only HTN, or both obesity and HTN. HTN was defined as ≥140 mmHg systolic or ≥90 mmHg diastolic blood pressure or use of antihypertensive medications. Obesity was defined as body mass index ≥30 Kg/m2. Cox proportional hazards models adjusted for age, sex, race, smoking, alcohol use, diabetes, coronary heart disease, and estimated glomerular filtration rate were used to assess the association of 4 groups with incident HF. Results: 18,351 participants (55.1% women and 31.4% black adults) followed over a mean 14 years were included in our analysis. Participants with only obesity (adjusted HR= 1.60; 95% CI 1.36 to 1.88) and only HTN (aHR 2.1; 95% CI 1.87, 2.37) demonstrated an increased risk of incident HF compared with participants with neither obesity nor HTN after adjustment for covariates. The greatest risk of incident HF was in participants with both obesity and HTN (aHR 2.97; 95% CI 2.63 to 3.36; Figure). HTN did not modify the effects of obesity or vice versa (p=0.193). Conclusions: Obesity and HTN are associated with incident HF and individuals with both have the highest risk of HF. This is an additive effect. These data emphasize the importance of blood pressure control and weight management in the prevention of HF.
Abstract 12414: Aggregated Data Masks Racial and Ethnic Disparities in Cardiometabolic Disease Prevalence
Authors: Alain Koyama, Kai Bullard, Yoshihisa Miyamoto, Ryan Saelee, Sandra Jackson, Meda Pavkov, Fang Xu, Stephen Onufrak
Journal: Circulation (2023)

Background: Although data disaggregation can unmask important differences in health disparities among subgroups, prevalence of cardiometabolic diseases among disaggregated racial and ethnical subgroups in the United States is inadequately characterized. Research Question: How does prevalence of diagnosed cardiometabolic diseases among US adults vary by racial and ethnic subgroups? Methods: A total of 3,970,904 US adults aged ≥18 years were identified from the Behavioral Risk Factor Surveillance System, 2013-2021. Prevalence of each cardiometabolic disease (diabetes, myocardial infarction, angina or coronary heart disease [CHD], stroke) was based on self-reported diagnosis by a healthcare professional, adjusting for age, sex, and survey year. Results: Adjusted prevalence of diabetes was 10.9% (95% confidence interval: 10.8-11.0%) in the total population, ranging from 9.1% (9.0-9.1%) among Non-Hispanic (NH) White adults, to approximately 16% among NH American Indian/Alaska Native, NH Black, and NH Pacific Islander adults. Diabetes prevalence was 11.5% (11.0-12.0%) for the aggregated NH Asian category, but ranged from 6.3% (4.7-8.4%) in the Vietnamese subgroup to 15.2% (13.8-16.8%) in the Filipino subgroup. Additional adjusted overall prevalences were myocardial infarction 4.3% (4.3-4.3%), angina or CHD 4.1% (4.1-4.2%), and stroke 3.2% (3.1-3.2%). Within the Hispanic subgroups, reported prevalence of angina or CHD ranged from 3.1% (2.3-4.0%) to 6.3% (6.0-6.6%) among Cuban and Puerto Rican subgroups, respectively. Conclusion: Prevalence of diagnosed cardiometabolic diseases varied considerably among racial and ethnic subgroups, highlighting the utility of data disaggregation in accurate characterization of health disparities within specific racial and ethnic populations. Such data can be used to better tailor disease prevention programs to disproportionately-affected subpopulations.
Abstract 12409: Ambient Fine Particulate Matter and Ozone Air Pollution Are Differentially Associated With Hospitalization for Unstable Angina and Acute Myocardial Infarction During Wildfire and Inversion Seasons
Authors: Benjamin D Horne, Francois Haddad, Elizabeth A Joy, Juyong B Kim, Jeffrey L Anderson, Mary Prunicki, Daniel Bride, Tami L Bair, Kari C Nadeau, Kirk U Knowlton
Journal: Circulation (2023)

Background: Short-term increases (days to weeks) in fine particulate matter (PM 2.5 ) air pollution are associated with hospitalization for acute coronary syndromes (ACS). A changing climate is shifting sources of PM 2.5 toward summer wildfires in the western US. This study evaluated if short-term increases in PM 2.5 and ozone were associated with ACS risks in wildfire (June-October) and winter inversion (Nov.-March) seasons. Methods: Case-crossover analyses examined N=21,414 subjects with emergency or inpatient hospitalization at 11 Intermountain hospitals for ACS, including the primary diagnosis of myocardial infarction (AMI, n=20,287) or unstable angina (USA, n=1,127). PM 2.5 data were collected in January 1, 1999 to March 31, 2022 (ozone: 2006-2022) from community monitors on Utah’s Wasatch Front. Odds ratios (OR) and 95% confidence intervals (CI) were computed by Poisson regression with adjustment for weather data. Results: Subjects averaged 66±14 years of age and 31.0% were female. Overall PM 2.5 increases were associated with concurrent day (lag 0 days) ACS hospitalizations (OR=1.024 per +10 μg/m 3 , CI: 1.004, 1.043, p=0.019), driven by AMI (OR=1.025 per +10 μg/m 3 , CI: 1.004, 1.045, p=0.017). USA admissions were delayed to the second week [lag moving average (mAvg) days 7-13] after PM 2.5 increases (OR=1.090 per +10 μg/m 3 , CI: 1.024, 1.159, p=0.007) and PM 2.5 associations with USA were strengthened by adjustment for ozone. Analyzed by wildfire and inversion seasons, PM 2.5 associations differed for AMI and USA (Figure). Short-term increases in ozone in wildfire season were associated with lower USA risk at lag 1, lag 2, 3-day mAvg 0-2, and 1-week mAvg 0-6 and lower AMI risk at mAvg 7-13, but not with inversion season risks. Conclusions: Short-term increases in PM 2.5 air pollution were associated with ACS hospitalizations for AMI and USA, with patterns of risk differing between wildfire and inversion seasons. Ozone increases were not associated with greater risk.
Abstract 11609: Developing a Novel Method for Measuring Relative Lung Perfusion at the Catheterization Laboratory
Authors: Yuval Barak-Corren, Christian Herz, Andras Lasso, Yoav Dori, Jie Tang, Christopher Long, Christopher Long, Ryan Callahan, Jonathan Rome, Matthew Gillespie, Matthew Jolley, Michael L Obyrne
Journal: Circulation (2023)

Background: Maldistribution of pulmonary blood flow (Qp) is common in patients with congenital heart disease and is associated with worse clinical outcomes. Currently, measurement of Qp-split can only be performed outside the catheterization laboratory, using either lung perfusion scans or cardiac magnetic resonance imaging. Aim: We sought to develop and evaluate a tool for measuring Qp-split using readily available fluoroscopy sequences. Methods: A retrospective cohort study of patients with conotruncal anomalies who underwent perfusion scan and subsequent cardiac catheterization. Inclusion criteria were non-selective angiogram of pulmonary vasculature, oblique angulation ≤20°, and an adequate view of both lung fields. A method was developed and implemented in 3D Slicer to calculate the amount of contrast that entered each lung field from the start of contrast-injection and until the onset of levophase. The predicted perfusion distribution was compared to the distribution measured by lung scan. Results: In total 32% (79/249) of screened studies met inclusion criteria. There was strong correlation between the predicted Qp-split and the measured Qp-split (R 2 =0.83, p&lt;0.001) with median absolute error (MAE) of 6%. Bias was not systematically worse at either extreme of flow distribution. Factors associated with better prediction were smaller BSA, younger age, right ventricle (vs. pulmonary artery) angiograms, and cranial angulations ≤20°. In cases with one or more of these conditions (n=40), the prediction achieved R 2 =0.87, MAE of 5.5%, and 78% of predictions were within 10% of true flow. Conclusions: Data from conventional angiograms can be used to provide accurate real-time measurement of relative perfusion of the left and right lungs. This has the potential to reduce unnecessary testing, associated costs, and radiation exposure.
Abstract 12623: Leadless Pacemaker Insertion is Safe in Pulmonary Hypertension Patients
Authors: Ahmad Harb, Amjad Harb, Abdelraouf Salah, Bilal Al Kalaji, Yuliana Petryshyn, Amulya Reddy Dwaram, Mariam Khabsa, Naim Battikh, Amer Muhyieddeen, Aman Dutta, Richard Orji, Jashan Gill
Journal: Circulation (2023)

Introduction: Compared to conventional single-chamber pacemakers, leadless pacemakers (LPM) had a higher risk of pericardial effusion and/or perforation, but decreased risk of other delayed device related complications. Pulmonary hypertension patients often have higher pressures in the adjacent right ventricle, possibly increasing the risk of perforation and pericardial complications. Methods: The National Readmission Database years 2017 to 2020 were queried for the patients who underwent LPM placement with the ICD10 code (02HK3NZ). Patient comorbidities were identified using the appropriate ICD10 codes. Multivariate logistic regression was used to compare outcomes in patients with and without pulmonary hypertension, adjusting for patient comorbidities shown in Table 1. Results: We identified 26,084 patients who underwent LPM placement, 4114 (15.77%) of whom had pulmonary hypertension. There was no statistically significant difference in the primary outcomes of 30-day readmission (aOR 1.01, p 0.37, 95% CI 0.936 - 1.193), or mortality (aOR 0.973, p 0.82, 95% CI 0.769 - 1.232). There was no difference in the composite outcome of pericardial complications (aOR 0.729, p 0.17, 95% CI 0.462 - 1.149) which included hemopericardium, tamponade, or the need for pericardiocentesis. However, patients with pulmonary hypertension had a higher risk of postprocedure bleed (aOR 1.182, p 0.036), hemothorax (aOR 2.493, p 0.003), and cardiogenic shock (aOR 2.447, p&lt;0.001). Rest of the outcomes shown in Table 2. Conclusions: Leadless pacemaker insertion appears to be safe in pulmonary hypertension patients, although patients seem to be at increased risk for bleeding complications.
Abstract 12361: Predictors and Utilization of Ultrasound Enhancing Agents for Echocardiography in the Outpatient Setting
Authors: Jordan B Strom, Yang Song, Wenting Jiang, Yingbo Lou, Daniel N Pfeffer, Omnya E Massad, Pierantonio Russo
Journal: Circulation (2023)

Background: The national utilization of ultrasound enhancing agents (UEAs) for transthoracic (TTE) or stress (SE) echocardiography in the outpatient setting and their association with downstream utilization of care remains uncertain. Methods: In a set of large, all-payer claims databases (ACTICS Open and Closed Claims) encompassing 90% of the US population, we evaluated rates, predictors of use, and association of UEAs with downstream utilization using linear mixed effects models amongst adult outpatients receiving TTE or SE, 2019-2022. Amongst those with recent hospitalization for AMI, we evaluated the association of UEA receipt and downstream healthcare utilization. Results: A total of 11,270,268 individuals receiving TTE and 744,175 adults receiving SE across 2,407 sites were included (mean age 63, 54.8% female), of which 6.8% receiving TTE and 21.0% receiving SE received UEAs. Patients receiving UEAs were more frequently older, male, and had a greater number of comorbidities. Sites performing UEAs were more frequently large, rural, nonprofits, and teaching facilities. Use varied widely by state ( Figure; 19.7% in Minnesota vs. 1.1% in Delaware) and was not explained by patient or site characteristics (median odds ratios = 4.35). Amongst those receiving TTE after AMI, UEA use was associated with a reduction in cardiac non-stress imaging (adjusted RR 0.77, 95% CI 0.64-0.92, p = 0.004), but no substantial differences in cost, days alive at home, readmission rates, cardiac catheterization, or stress imaging (p &gt; 0.05 for all). Conclusions: In this large, nationally representative cohort study, UEAs were used in 6.8% of TTEs and 21.0% of SEs performed in the outpatient setting but use varied widely across sites, unexplained by patient or site characteristics. Amongst outpatients, UEA receipt after AMI was associated with a reduction in cardiac stress imaging, but not other outcomes.
Abstract 12639: Comparison of Very High-Power Short-Duration, High-Power Short-Duration, and Low-Power Long-Duration Radiofrequency Ablation for Atrial Fibrillation: A Systematic Review and Network Meta-Analysis
Authors: Joey Junarta, Sebastian Rodriguez, Waqas Ullah, Muhammad Siddiqui, Joshua M Riley, Anjani Patel, Sean J Dikdan, James J Fradin, Jake Rosen, Daniel J Frisch
Journal: Circulation (2023)

Introduction: The optimal power and duration settings for radiofrequency (RF) atrial fibrillation (AF) ablation is unclear. We compared low-power long-duration (LPLD), high-power short-duration (HPSD), and very HPSD (vHPSD) settings for AF ablation. Hypothesis: Ablation utilizing HPSD and vHPSD are expected to have shorter procedural times than LPLD and may have improved arrhythmic outcomes. Aims: To compare LPLD, HPSD, and vHPSD ablation by network meta-analysis Methods: This network meta-analysis (NMA) was structured according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Observational and randomized studies were included. Eligible studies compared outcomes in AF patients who underwent first-time RF ablation with the following settings: vHPSD (70-90 Watts for 3-10 seconds), HPSD (45-60 W, 5-10 s), or LPLD (20-40 W, 20-60 s). Results: Thirty-six studies comprising 10375 patients were included (33% female). Frequentist NMA showed LPLD tended towards a lower odds of freedom from arrhythmia (FFA) vs. HPSD (OR 0.93, 95% CI 0.86-1.00). There was no difference in FFA between vHPSD vs. HPSD. Splitwise interval estimates showed a lower odds of FFA in LPLD vs. vHPSD on direct (OR 0.78, 95% CI 0.65-0.93) and network estimates (OR 0.85, 95% CI 0.73-0.98). Frequentist NMA showed less total procedural (TP) time with HPSD vs. LPLD (generic variance 1.06, 95% CI 0.83-1.29) and no difference between HPSD vs. vHPSD. Conclusion: This NMA shows improved procedural times in HPSD and vHPSD vs. LPLD. Although HPSD tended towards improved odds of FFA compared to LPLD, the result was not statistically significant. The odds of FFA in LPLD was lower vs. vHPSD on direct and network estimates on splitwise interval analysis. Randomized clinical trials are needed to validate HPSD and vHPSD settings.