tbuckley/cabot-search huggingface dataset:
Abstract 4148106: Hemophilia and Cardiovascular disease in the United States: Prevalence, Risk factors, and outcomes.
Authors: Tochukwu Nzeako, Olayemi Adeniran, Jen-Chin Wang
Journal: Circulation (2024)

Background: Hemophilia is a rare X-linked recessive inherited bleeding disorder. Owing to improved management, the life expectancy of patients with hemophilia has increased significantly and predisposes them to risk of cardiovascular diseases and thrombotic events. However, studies on cardiovascular risk factors and outcomes in patients with hemophilia are limited. Aims: Therefore, the present study aimed to examine the prevalence of cardiovascular disease, the risk factors, and the outcomes in patients with hemophilia. Methods: The study identified all adult males with a primary and secondary diagnosis of hemophilia in the National Inpatient Sample (NIS) database from 2018 – 2020. The overall study population was compared to the general population, non-hemophilia. The primary outcome was to estimate the prevalence of cardiovascular risk factors in patients with hemophilia compared to the general population. The secondary outcomes comprise the odds of adverse events, including myocardial infarction, ischemic stroke, transient ischemic attack (TIA), occlusive atherosclerotic disease, percutaneous coronary intervention, and coronary artery bypass graft (CABG)., We conducted a multivariate logistic regression to estimate the odds of the outcomes Results: Out of the total 7,377,811 adult male study population, 11,291 (0.2%) had hemophilia, and 7,377,811 (99.8%) with non-hemophilia. The hemophilia cohort was slightly older (63.2[16.8] vs. 61.5[17.4]) and was also more likely to have diabetes mellitus, hyperlipidemia, chronic lung disease, chronic kidney disease, chronic liver disease, BMI ≥ 25, anemia, metastatic cancer, and atrial fibrillation. In the adjusted models, patients with hemophilia had higher odds of myocardial infarction (OR 2.62, 95% CI: 2.47 – 2.77), ischemic stroke (OR 2.71, 95% CI: 2.53 – 2.89), TIA (OR 10.44, 95% CI: 9.40 – 11.60), occlusive atherosclerotic disease (OR 2.31, 95% CI: 2.08 – 2.56), PCI (OR 5.31, 95% CI: 4.86 – 5.80), and CABG (OR 7.62, 95% CI: 6.97 – 8.33). Conclusions: Our study found that patients with hemophilia had a higher prevalence of cardiovascular risk factors and adverse events compared to males without hemophilia in the United States. Further research is to identify potential ex-specific risk factors that predispose to worse cardiovascular outcomes among patients with hemophilia.
Abstract 4148051: Comparative Efficacy of Dual Antiplatelet Therapy Durations in Acute Coronary Syndrome Patients Undergoing PCI: A Network Meta-Analysis
Authors: Saliha Erdem, Muhammad Hamza, Hafiz Muhammad Waqar Younas, Abdul Rasheed Bahar, Jawad Basit, Mubashar Karamat
Journal: Circulation (2024)

Background: Dual antiplatelet therapy, involving aspirin and a P2Y12 inhibitor, is essential for preventing ischemic events in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Only limited number of studies challenge the optimal duration of DAPT in patients with ACS undergoing PCI. Methods: Pubmed and EMBASE databases were queried up to June 2024, and 7 eligible randomized clinical trials were included in our final analysis. We compared the efficacy and safety of different durations of DAPT in patients with ACS who underwent PCI. Outcomes studied included all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE), stent thrombosis, and clinically significant bleeding. We used a network meta-analysis module with inverse variance and random effects model in CRAN-R software to compute pooled risk ratios (RR) with 95% confidence intervals (CI) for statistical significance, using the 12-month DAPT strategy as a reference. Higgin’s I2 was used to test heterogeneity. Results: When compared to 12 months of DAPT therapy, there was no difference in all causes of mortality, CV death, MI, stroke, MACE, and stent thrombosis with a shorter duration of DAPT (1 month and 3 months). However, there was a lower risk of bleeding with 1 month and 3 months of DAPT therapy (Table 1). Conclusion: Shorter durations of DAPT (1 month and 3 months) are as effective as the traditional 12-month regimen in preventing all-cause mortality, CV death, MI, stroke, MACE, and stent thrombosis in patients with ACS undergoing PCI. Importantly, shorter DAPT durations are associated with a significantly lower risk of bleeding.
Abstract Sa507: Neurological prognostication by gray-white matter ratio on dual-energy brain computed tomography for extracorpeal cardiopulmonary resuscitation patients
Authors: Boyangzi Li, Oladi Bentho, Jason Bartos, Renee Fridman, Gregory Mello, Garima Dahiya, Rahul Singh, Rishabh Tandon, Alejandra Gutierrez, Demetris Yannopoulos, Andrea Elliott
Journal: Circulation (2024)

Introduction: Gray-white matter ratio (GWR) on non-contrast head computed tomography (HCT) is a helpful tool in neuro-prognostication in post-cardiac arrest patients. Its usage is unclear for those with angiography due to residual contrast. Hypothesis: GWR remains valid for neuro-prognostication in comatose patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) followed by coronary angiography (CAG) after out-hospital cardiac arrest (OHCA). Methods: We performed a retrospective study of comatose OHCA adults post ECPR and CAG at University of Minnesota from January to June 2022 with dual energy HCT within 12 hours. GWR was measured at basal ganglia, centrum semiovale, and high convexity levels. Gray matter areas of interest included caudate nucleus, putamen, thalamus, and medial cortex. The white matter areas of interest included the genu of the corpus callosum, posterior limb of the internal capsule, and medial white matter. Circular regions of interest (ROI, 10-15 mm 2 ) were placed bilaterally in corresponding areas to record the average attenuation in Hounsfield unit (HU). The basal ganglia, cerebrum, and overall GWRs were calculated as the ratio of average HU between the gray and white matter ROIs within the area. Primary outcome was inpatient death, further categorized by the primary cause being neurological or not. Logistic regression followed by receiver operating characteristic (ROC) curves was used to validate GWR in predicting death. All data analysis was performed by StataCorp Software (STATA 14). Result: 25 patients were included in the study. 18 (72%) were male with a median age of 60 (interquartile range (IQR): 45-67). The initial HCT was obtained at 2.08 hours (median, IQR: 1.37–2.43) post ECPR cannulation. 7 (28%) patients died from brain death or herniation and 15 (60%) died from non-neurological causes. None had intracranial bleeding. 1 patient had unilateral hypodensity on initial HCT, suggesting an acute embolic infarct. Patients who died had lower GWRs on initial HCT (Figure 1). ROC regression showed all GWRs demonstrated good prognostic performance on inpatient death with area under the curve (AUC) of 0.6970 (basal ganglia), 0.8485 (cerebrum), and 0.7576 (overall) (Figure 2). Conclusions: GWR in early HCT has prognostic value in predicting neurological outcomes despite residual contrast. It may be used as a risk stratification tool for comatose OHCA patients undergoing ECPR and angiography.
Abstract 4147924: An intensive longitudinal study of daily minority stressors and home blood pressure among sexual minority and heterosexual siblings
Authors: Zidu Xu, David Lopez Veneros, Billy Caceres
Journal: Circulation (2024)

Background: Sexual minority (e.g., gay/lesbian, bisexual) adults are at a higher risk of hypertension than heterosexual adults. Minority stressors, which are chronic psychosocial stressors related to one’s sexual minority identity, are hypothesized to influence these hypertension disparities among sexual minorities. However, these associations have not been formally tested. Aims: We sought to examine sexual identity differences in daily minority stressors (i.e., experienced and anticipated discrimination) and blood pressure (BP) between sexual minority and heterosexual siblings of the same sex. Hypothesis: We hypothesized that: 1) participants who reported greater daily minority stressors would have higher systolic BP (SBP), and 2) the associations of daily minority stressors with SBP would be stronger among sexual minority siblings. Methods: We conducted a 14-day daily diary study to examine the associations of personally experienced and anticipated (i.e., expectations of experiencing discrimination) discrimination with SBP among sexual minority adults and their heterosexual siblings with no history of hypertension or cardiovascular disease. Home SBP was assessed each morning and evening for 14 consecutive days following AHA guidelines. Daily minority stressors were assessed via structured diaries. We used multilevel linear models to estimate associations between daily minority stressors with same-day morning and evening SBPs. We then included interaction terms between each minority stressor and sexual identity. Results: The sample included 40 participants (20 sibling pairs) with a mean age of 26.7 (±5.35) years. Approximately 75% were assigned female sex at birth, 68% were White (68%), and 15% were Latinx. Sexual minority adults reported had higher same-day evening SBPs ( B= 2.16, p =0.03) than their heterosexual siblings. Participants who reported higher anticipated discrimination had higher same-day evening SBP ( B =0.68, p &lt;0.001) and next-morning SBP ( B =2.16, p =0.03). Daily experienced discrimination was not associated with SBP. Sexual identity did not moderate the associations between minority stressors with SBP. Conclusions: This is the first study to document that daily anticipated discrimination and having a sexual minority identity are linked with elevations in home SBP. Findings suggest there is a need for larger studies to investigate mechanisms linking anticipated discrimination with elevations in SBP and potential differences by sexual identity.
Abstract 4147884: Transitions Across Stages of Cardiovascular-Kidney-Metabolic Syndrome and Related Implications for Cardiovascular Disease Risk: the ARIC Study
Authors: Bige Ozkan, Sui Zhang, Vijay Nambi, Janani Rangaswami, Justin Echouffo, Roger Blumenthal, Christie Ballantyne, Sadiya Khan, Josef Coresh, Chiadi Ndumele
Journal: Circulation (2024)

Background: Higher stages of Cardiovascular-Kidney-Metabolic (CKM) Syndrome are associated with greater cardiovascular disease (CVD) risk. However, the rates of CKM stage progression over time and its impact on CVD outcomes are currently unknown. Methods: We evaluated 8,367 ARIC Visit 4 (1996-98) participants without CVD at Visit 1 (1987-89), with available data to define CKM stage at Visits 1 and 4. We categorized based on CKM Stages at Visits 1 and 4, defined as: Stage 0, no CKM risk factors; Stage 1, excess/dysfunctional adiposity; Stage 2, metabolic risk factors (hypertriglyceridemia, hypertension, metabolic syndrome, or diabetes) and/or moderate- to high-risk chronic kidney disease (CKD, per KDIGO classification); Stage 3, ≥20% predicted CVD risk per PREVENT calculator or very high-risk CKD; and Stage 4, clinical CVD. For those in CKM stages 0-3 at Visit 1, we quantified transitions in CKM stages by Visit 4, as well as incidence rates of atherosclerotic CVD (ASCVD), heart failure (HF), total CVD (ASCVD + HF), and CVD mortality over 10 years according to CKM stage progression. We evaluated rates of first CVD events for those in Stages 0 to 3 by Visit 4, and of first recurrent CVD events for those in Stage 4 by Visit 4. Results: The mean age was 55 years at Visit 1, with 52% female, and 21% Black adults. Most participants progressed to a higher CKM stage by Visit 4 (~9-year interval): 77% of those in Stage 0 at Visit 1, 73% of Stage 1, 42% of Stage 2, and 75% of Stage 3 (Figure). Within each CKM stage at Visit 1, progression to higher CKM stages by Visit 4 was associated with a higher incidence of CVD events (Table), with higher risk for those at a higher CKM stage at Visit 1. The transition from Stage 2 to 3 was associated with the highest rate (per 1000 person-years) of first CVD events (49.8, versus 20.0 for remaining in stage 2), while the transition from stage 3 to 4 was associated with the highest rate of recurrent CVD events (151.1). Similar patterns were seen for ASCVD, HF and CVD mortality. Conclusion: Most middle-aged adults transition to a higher stage of CKM Syndrome over a decade, which is linked to greater CVD risk. Preventing the progression of CKM Syndrome may help to mitigate CVD risk.
Abstract Sa601: Relationship between ETCO2 and Hemodynamics in Swine: An Exploratory Secondary Analysis
Authors: Haben Yhdego, Sylvia Beka, Sandeep Pandit, David Appleby, Joshua Lampe
Journal: Circulation (2024)

Background: End-tidal carbon dioxide (ETCO2) has been proposed as a surrogate for cardiac output during cardiopulmonary resuscitation (CPR). Chest compressions alter the capnogram waveform, complicating the calculation of ETCO2 values. To explore the utility of ETCO2 as a surrogate marker, we have conducted a retrospective analysis of the relationship between local maxima in the capnogram and hemodynamic metrics in preclinical resuscitation studies. Methods: In eight domestic swine (~30 kg), the IVC blood flow, aortic pressure (AOP), right atrial pressure (RAP), and capnogram were measured during resuscitation. Coronary perfusion pressure (CPP) is the difference between the AOP and the RAP during relaxation. ETCO2 is calculated using three methods: averaging the maximum CO2 level reached during each chest compression, selecting the global CO2 maximum measured during each breath, and identifying the maximum CO2 level from the last compression for each breath. The data are modeled using multivariate linear regression as follows: ETCO2= IVC + CPP + CC Depth + CC rate + Epoch # + Animal # Results: Table 1 shows R-squared values relating intra-compression CO2 maxima to hemodynamic measures and compression characteristics. The maximum CO2 value in a breath shows stronger correlations with these parameters than the other CO2 measurements. Table 2 presents regression coefficients for the model using this measure. CC Depth and CPP have coefficients of 3.67 and 2.05 respectively, indicating significant positive influences, while IVC has a coefficient of 0.84, indicating a weaker positive impact compared to CC Depth and CPP. Table 1. Method for Calculating the ETCO2 Calculating ETCO2 R-Squared Global CO2 Maximum per breath 0.67 Average of CO2 Maxima 0.64 CO2 Maximum of Last Compression 0.36 Table 2. Variable Coefficients Outcomes Regression Coefficients CPP 2.05 IVC 0.84 CC Depth 3.67 CC Rate -0.02 Epoch Number -0.57 Conclusions: The experimental results show that the global CO2 maximum per breath has the closest relationship to the hemodynamics in this experiment. The analysis suggests that increasing CC Depth, CPP, and IVC flow also increases the calculated ETCO2.
Abstract Sa702: Gender Differences in Sudden Cardiac Death During Endurance Racing: The Role of Behavioral Responses to Competition ?
Authors: Marion Chabrol, Richard Chocron, Thomas Laurenceau, Frankie BEGANTON, Wulfran Bougouin, Jean-Philippe Empana, Xavier Jouven
Journal: Circulation (2024)

Background: Men represent about 95% of Sudden Cardiac Death (SCD) that occur during sport activity. This over representation of men during exercise-related SCD which remains true even after adjustment for sport participation is not explained by biological and physiological factors. We hypothesized that male psychology and related behavioral responses might play a role in this over-representation. Methods: Data comes from the Paris Sudden Death Expertise Center. We collected the data from the last 10 years on the three most important running races in Paris: half marathon (HM), full marathon (FM) and 20 km. We analyzed the potential acceleration during the last km in men and women (only available for the HM (445,000 participations)), compared with the speed recorded during the previous 5km, each subject being its own control. We assessed the exact location of the SCD cases for each race. Using Artificial Intelligence (AI) and the electronic health record systematically collected for each subject in France (all drugs prescriptions, examinations and medical diagnoses), we assessed their theoretical risk for SCD. Results: Over the last 10 years and among the 1.2 million participants (mean age 38 ±11y, 71.6 % of males), there were 17 SCD (7 in 20km, 5 HM and 5 in FM). Of these, 88% (15/17) were men, with an average age of 42±13y. Incidence in men was 3-fold higher than women (16.9 vs 5.7 cases per million participations, p&lt;1/1000). CPR was initiated by a bystander for 15 subjects ( 88.2%). Initial shockable rhythm was present in 13 subjects (76.5%). All 17 subjects were transported to hospital, either with a return of spontaneous circulation (15 (88.2%)) or in a refractory state (2 (11.8%)). At hospital discharge, 14 (82.4%) were alive with a very good neurological outcome (CPC1). Among all participants, 87%accelerated during the last km, during which 65% (11/17) of SCDs occurred (Figure 1). Compared with the previous 5km, women's speed varied little compared with men's over the last km (Figure 2). Among those who accelerated the most (&gt;2 km/h) in the last km, the proportion of men was 1.96 times (CI 1.86-2.06) higher than that of women. On the basis of their medical history all but one of the subjects were considered as low risk for SCD by the IA algorithm. Conclusion: Although direct causality cannot be proven, men’s attitude and behavioral reactions to competition could partly explain their over-representation in sport-related SCD.
Abstract 4147929: Life Essentials 8 scores among Women by Race and Ethnicity in the National and Health Survey 2013-2020
Authors: India Washington, Mojisola Olusola-Bello, Chelsea Akubo, Tosin Tomiwa, Khadijat Adeleye, Janice Dugbartey, Faith Metlock, Ruth-Alma Turkson-Ocran, Yvonne Commodore-Mensah, Bunmi Ogungbe
Journal: Circulation (2024)

Introduction: Although the American Heart Association's Life's Essential 8 (LE8) score has been used to assess cardiovascular health in various populations, there has been a lack of focus on minoritized women and the unique intersectional identities that may influence risk factors for cardiovascular disease. Objectives: This study aims to assess differences in LE8 scores by race and ethnicity among women ages 18 and older. Methods: We analyzed cross-sectional data of women aged 18 years and older from the National Health and Nutrition Examination Survey (NHANES) 2013-2020. LE8 composite scores were computed from diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, blood glucose, lipids; scored between 0-100 points. The outcome, composite LE8 score, was categorized into quartiles very low (0-2.5), low (2.5-5), moderate (5-7.5) and high (7.5-10). Survey-weighted multinomial regression models were used to derive the relative risk ratio to assess the association between race and ethnicity categories and LE8 quartiles, adjusting for age, income, education, marital status, insurance, employment, and pregnancy history. Results: We included a sample of 9,848 women (corresponding to a weighed sample of 97,759,359 women), mean age 49(±17) years; 72% White, 13% Hispanic, 11% Black, and 3% Asian. Compared to Non-Hispanic White women, Hispanic women had higher relative risk ratios of being in very low (RRR = 2.53, 95% CI: 1.55, 4.12), low (RRR = 2.13, 95% CI: 1.30, 3.49), moderate (RRR = 2.03, 95% CI: 1.20, 3.43) LE8 scores quartiles. Similarly, Non-Hispanic Black women had higher relative risk ratios of being in the very low (RRR = 3.04, 95% CI: 1.81, 5.11), low (RRR = 2.25, 95% CI: 1.28, 3.95) LE8 score quartiles. Non-Hispanic Asian women had higher relative risk ratios of being in the low (RRR = 2.02, 95% CI: 1.23, 3.32) LE8 score quartiles, compared to Non-Hispanic White women (Figure). Conclusion: Black and Hispanic women are exposed to more cardiovascular health risk factors based on LE8 metrics. There is a need for increased LE8-focused interventions among Black and Hispanic women to bridge the significant cardiovascular health disparities.
Abstract 4148101: Prevalence and Characteristics of Hypertrophic Cardiomyopathy Phenotype in Patients with Cardiac Sarcoidosis
Authors: Abdul Zia, Mallika Lal, Babak Nazer, Benjamin Levin, Ahmad Masri
Journal: Circulation (2024)

Introduction: Hypertrophic cardiomyopathy (HCM) and cardiac sarcoidosis (CS) are distinct cardiomyopathies that can lead to heart failure and arrhythmias. Both diseases are under-diagnosed in the general population and often misdiagnosed due to overlapping phenotype. Research Question: This study aimed to investigate the co-occurrence of HCM and CS, define the expected prevalence, and outline their co-existent phenotypes. Goals: To define the prevalence and characteristics of coexistent HCM and CS. Methods: We calculated the expected population prevalence of CS and of HCM. We identified consecutive cases of patients with a CS diagnosis at OHSU and included those meeting CS criteria based on the Heart Rhythm Society (HRS) 2014 guidelines. These patients were then screened for HCM phenotype which was determined by the presence of left ventricular wall thickness greater than or equal to 15 mm that is otherwise unexplained, left ventricular outflow tract obstruction (LVOTO), pathogenic or likely pathogenic genetic variant and findings on cardiac magnetic resonance imaging (CMR). The diagnosis of CS and HCM were based on comprehensive detailed evaluation by expert multidisciplinary team with histological confirmation frequently employed. Results: Among the 46 patients meeting HRS criteria, 7 (15%) were identified with concomitant HCM phenotype. Based on published literature, the expected prevalence of HCM is 0.2%-0.4% and assuming independence between CS and HCM, we should have had 1 or no patients with HCM in our cohort. Notably, patients with the HCM-CS phenotype were predominantly male compared to the CS cohort (85.7% vs. 48.7%), had higher left ventricular (LV) ejection fraction (63.9%±3.8% vs 49.7±15.0%), and higher LV wall thickness (18.7±4.7 mm vs 10.7±2.3 mm). Among the HCM-CS patients, LV hypertrophy was asymmetric in 71.4%, and 71.4% had LV outflow tract obstruction. Characteristics of the two populations are shown in Table. Conclusions: Our data suggest a potential overlap between HCM and CS beyond the expected prevalence. Larger and more detailed pathologic studies will elucidate whether CS can have HCM phenotype versus the presence of common pathobiological processes linking the two entities.