tbuckley/cabot-search huggingface dataset:
Abstract 4142639: Assessing low-density lipoprotein cholesterol (LDL-C) equations in childhood for long-term risk of cardiovascular disease events: Superior performance of the Sampson equation
Authors: Yaxing Meng, Feitong Wu, Markus Juonala, David Jacobs, Lydia Bazzano, Stephen Daniels, Terence Dwyer, Mika Kahonen, Alan Sinaiko, Julia Steinberger, Elaine Urbina, Alison Venn, Jorma Viikari, Kara Whitaker, Jessica Woo, Olli Raitakari, Costan Magnussen
Journal: Circulation (2024)

Background: Low-density lipoprotein cholesterol (LDL-C) is the primary lipid factor for diagnosing and managing lipid disorders in children. Although multiple equations are available for estimating LDL-C, the best one for assessing long-term cardiovascular (CV) risk is unclear. Hypothesis: Childhood LDL-C levels estimated from different equations differently associates with adult CV events. Aim: To compare the prospective association of childhood LDL-C levels estimated by the Friedewald, Martin/Hopkins, Sampson, and DeLong equations with adult CV events. Methods: Data were from seven prospective cohorts in the US, Finland, and Australia within the International Childhood Cardiovascular Cohort Consortium. LDL-C levels were estimated using four equations: Friedewald, Martin/Hopkins, Sampson, and DeLong. Discordance was defined as differing LDL-C categorizations (acceptable &lt;110 mg/dL versus elevated ≥110 mg/dL) between equations. CV events were adjudicated from medical records. Associations between discordance and incident CV events were estimated using proportional-hazards regression, adjusted for sex, childhood age, systolic blood pressure, and body mass index. Results: Over a mean follow-up of 35 years, 171 fatal CV events occurred among 22262 participants (49.4% male; 24.2% Black; mean age 11.9 years in childhood) and 376 fatal/nonfatal CV events among 11627 participants. Although LDL-C levels estimated by different equations were similarly associated with CV events, predictive utility varied with discordant classifications (discordance ranging from 1.2-4.7%). Children with acceptable LDL-C by the Friedewald equation but elevated by the Martin/Hopkins, Sampson, or DeLong equations had an increased risk for CV events compared to those with concordant LDL-C (Figure). Similarly, discordance between acceptable Martin/Hopkins LDL-C but elevated LDL-C by the Sampson or DeLong equations indicated an increased risk. Conversely, discordance between elevated DeLong LDL-C but acceptable Sampson LDL-C indicated a decreased risk. Conclusions: The Sampson equation provides the most accurate assessment of long-term CV risk—outperforming the underestimation by Friedewald and Martin/Hopkins and the overestimation by DeLong— suggesting its potential for estimating elevated childhood LDL-C and improving early risk stratification.
Abstract 4142677: Impact of baseline tricuspid regurgitation on outcomes after transcatheter edge – to - edge repair in patients with mitral regurgitation
Authors: Bernard Cosyns, Andreea Motoc, Erwan Donal, Benjamin Marut, Xavier Galloo, STIJN LOCHY, Philippe Unger, adel aminian, Edgard Alexander Prihadi, Steven Droogmans
Journal: Circulation (2024)

A moderate or severe tricuspid regurgitation (TR) is frequently associated with mitral regurgitation (MR) and may impact prognosis after mitral valve intervention. It is yet unclear whether both valves should be treated simultaneously, especially using a percutaneous approach. Therefore, we sought to determine the impact of TR on outcomes in patients with moderate-to-severe or severe MR treated by edge-to-edge repair (TEER). Methods: Consecutive patients undergoing transcatheter mitral valve edge - to edge repair for moderate or severe MR from 2 tertiary centers were retrospectively included in a registry. The primary endpoint was one-year primary composite of death and heart failure hospitalization (HFH) and with the separate endpoints as secondary endpoints. 268 patients (76.4 ± 9.0 years old, 61.9% males) were included in the study, divided into 2 groups by baseline TR severity: none/trace/mild TR (≤Mild TR) (n=144) and moderate/severe TR (≥Mod TR) (n= 124). Primary MR was present in 124 (46.3%) patients, 117 (43.7%) patients had a secondary MR and 27 (10.0%) patients had a mixed MR etiology. In the total population, 45 patients reached the primary endpoint: 26 patients died and 24 patients had a HFH during the follow - up period of 1 year. An associated ≥Mod TR was an independent predictor of the primary endpoint in the global study population (OR 3.737, CI 1.020 – 13.694, p = 0.047). Other independent predictors of the primary endpoint in the global population by multivariable logistic regression analysis were left ventricle ejection fraction (OR 0.951, CI 0.916 – 0.987, p =0.009) and glomerular filtration rate (OR 0.960, CI 0.933 – 0. 987, p =0.009). In the primary MR subgroup, 14 (11.2%) patients reached the primary endpoint. In this subgroup, a ≥Mod TR was present in 56 (45.2%) of the patients and it was significantly associated with a worse outcome by univariable logistic regression analysis (OR 5.296, CI 1.398 - 20.065, p=0.014). In the secondary MR group, 21 (17.9%) patients reached the primary endpoint. In this subgroup, an associated ≥Mod TR was present in 47 (40.2 %) of the patients. A ≥Mod TR was not significantly associated with the occurrence of the primary endpoint in the secondary MR subgroup analysis. In conclusion ≥Mod TR conveys a worse 1-year outcome after TEER for MR. TEER for primary MR is associated with a worse outcome when ≥Mod TR is present, suggesting that, in this subgroup, a concomitant TEER for the TR could improve prognosis.
Abstract 4142422: Heart of the Mystery: Unveiling PFO's Role in Cryptogenic Stroke During Pregnancy
Authors: Zohaib Bagha, Zohair Ali, Sean Wilson, Evelina Grayver
Journal: Circulation (2024)

Background: Patent Foramen Ovale (PFO) is a common cardiac anomaly that persists into adulthood in approximately 25% of the population. Although often clinically silent, PFOs can lead to complications in pregnancy, such as paradoxical strokes. Here, we present a case of a pregnant patient with a cryptogenic stroke attributed to PFO, highlighting the complex decision-making involved in her management. Case Description: A 37-year-old woman, G2P1001 at 9 weeks gestation, presented to her ophthalmologist with 2 days of decreased vision in her left eye. She was diagnosed with branch retinal artery occlusion and underwent laser embolization. Subsequently, she was sent to the hospital for an expedited work-up. The patient was started on aspirin upon presentation. MRI of the brain and MR angiography of the head and neck were unremarkable, and lower extremity duplex studies were normal. Transthoracic echocardiography revealed a PFO with a mild interatrial septal aneurysm. Hypercoagulable work-up revealed low protein S free antigen and a positive anticardiolipin IgM, both difficult to interpret during pregnancy. Given the high-risk morphology of the PFO, there was concern for a paradoxical stroke. The RoPE Score was calculated to be 9, indicating an 88% chance that the stroke was due to the PFO. She was then initiated on enoxaparin daily and discharged with outpatient follow-up. The rest of the coagulable work-up was unrevealing. Repeat protein S levels were still low but considered normal for pregnancy. It was determined that the patient did not have genetic thrombophilia but was hypercoagulable due to pregnancy. After interdisciplinary discussions, the patient underwent PFO closure at 15 weeks gestation. Post-procedure, she was transitioned to aspirin and a three-month course of clopidogrel. Enoxaparin was resumed post-clopidogrel up until one month before delivery, when subcutaneous heparin was initiated. She successfully delivered at 39 weeks, after which enoxaparin was resumed and continued for 6 weeks postpartum. Repeat protein S testing 12 weeks postpartum was normal, and aspirin was discontinued. Conclusion: This case of a pregnant patient with stroke highlights the importance of prompt screening for PFO and tailored management to prevent recurrence. It underscores the importance of thorough evaluation and interdisciplinary collaboration in treatment planning and demonstrates the safety and effectiveness of PFO closure during pregnancy.
Abstract 4142690: Yoga with Low-Exercise Movement is Beneficial for Improving Sleep Quality and Altering a Sedentary Lifestyle in Patients with Heart Failure
Authors: Misook Chung, Debra Moser
Journal: Circulation (2024)

Introduction: Given the well-documented benefits of yoga on the cardiovascular system and improvement of exercise tolerance and quality of life, the American Heart Association recently recommended yoga as a safe and well-tolerated adjunctive therapy for patients with heart failure (HF). However, most studies have focused on testing yoga with moderate levels of physical movement, leaving a gap in our understanding of the potential benefits of yoga with low levels of physical movement. The specific aims of this pilot study were to explore the potential benefits of yoga with low levels of physical exercise movement, combined with longer deep breathing and meditation, on the psychological and physical health outcomes of patients with HF. Methods: Yoga was delivered using tele-health to patients with HF at home. Outpatients with HF (N=17) were randomly assigned to either the intervention (n=11) or the control (n=6) groups using a 2:1 ratio. The intervention group participated in twice-weekly live-streamed yoga sessions over a 12-week period led by nurse yoga instructors. Outcome measures included depressive symptoms (Patient Health Questionnaire-9), anxiety (Hospital Anxiety Index), sleep quality (Pittsburgh Sleep Quality Index), perceived control (Control Attitude Scale-Revised), sit-stand test, and length of activity measured with an ActiGraph watch worn for 7 days. Paired t-tests were conducted to examine the differences in outcomes over time. Results: For the intervention group, there was a significant improvement in global sleep quality (8.8 vs. 6.0, p= 0.4 respectively), with a significant increase in sleep duration (3.0 vs 0.6, P &lt;.001). The sit-stand score also improved significantly (9.4 vs. 11.4, p =.048). Sedentary time, as measured by ActiGraph watch, decreased significantly by 10.06 hours over 7 days (5463 vs 4859 minutes, p= 0.17), and moderate activity time increased by 2.5 hours per week, though this was not statistically significant (P=0.126). Depressive symptoms (p= 0.073) and anxiety (p=0.065) decreased, and perceived control (p =.095) improved, but those were not statistically significant. The control group showed no changes in any measures. Conclusion: Yoga with a low level of physical movement demonstrated benefits for enhancing sleep quality and altering sedentary lifestyles in patients with HF, with several other potential advantages. Large randomized controlled trials are needed to confirm these findings.
Abstract 4142296: Radiomic Texture Analysis of Peri-Coronary Adipose Tissue Significantly Improves Risk Prediction of Major Cardiac Events in the CORE320 Study
Authors: Devina Chatterjee, Sangmita Singh, Joao AC Lima, Bharath Ambale-Venkatesh, armin zadeh
Journal: Circulation (2024)

Introduction: Peri-coronary adipose tissue (PCAT) assessment using coronary computed tomography angiography (CCTA) is an evolving method for risk stratification in non-invasive evaluation of coronary artery disease. Radiomic texture analysis of PCAT has greater predictive value than traditional risk stratification metrics, detecting structural changes linked to heart disease Aim: To assess the effectiveness of radiomic texture features from peri-coronary adipose tissue in predicting cardiac events compared to traditional methods Methods: The CORE320 study enrolled 381 patients referred for invasive coronary angiography (ICA) due to known or suspected coronary artery disease (CAD). Participants underwent CCTA and were monitored for 5 years for major adverse cardiac events (MACE), defined as revascularization, all-cause death, and myocardial infarction. The analysis focused on the proximal 10-50 mm of the right coronary artery (RCA), where 284 RCA vessels were manually contoured using 3D Slicer. Using PyRadiomics Python, we extracted 113 radiomic features from the peri-coronary adipose tissue (PCAT), including previously published PCAT values. Feature importance for predicting a 5-year incidence of major adverse cardiac events (MACE) was determined using the XGBoost algorithm. These features were assessed in a multivariable model using Cox proportional hazards regression on a held-out test set Results: In the complete analysis, MACE occurred in 99 of the 381 patients (28%) during the follow-up period. Traditional measures of PCAT attenuation (HR 0.96, 95% CI 0.75-1.22, p=0.59) did not provide significant predictive value for MACE events. Among the 113 radiomic features extracted from the peri-coronary adipose tissue, the XGBoost classifier identified texture features associated with 5-year MACE after adjusting for clinical risk factors. The top-5 included homogeneity, entropy, energy, correlation, and cluster shade. In multivariate analysis, entropy and homogeneity remained independently associated with MACE after adjustment for clinical risk factors. The addition of these two radiomic features to a model with clinical risk factors significantly improved discrimination for 5-year MACE (C-statistic improved from 0.69 to 0.74, p=0.003) Conclusions: Radiomic texture analysis of PCAT on CCTA can significantly enhance risk stratification for major adverse cardiac events in patients with suspected coronary artery disease, surpassing traditional clinical risk factors
Abstract 4142315: Genetically enhanced CHA <sub>2</sub> DS <sub>2</sub> VASc score predicts post-ablation ischemic stroke in patients with atrial fibrillation
Authors: Je-Wook Park, Myunghee Hong, Moon-Hyun Kim, Daehoon Kim, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Hui-Nam Pak
Journal: Circulation (2024)

Introduction: Although atrial fibrillation (AF) catheter ablation (AFCA) may reduce the risk of ischemic stroke (IS), those patients still have some risk. It is unclear whether post-AFCA IS has a genetic background as generally diagnosed IS. We explored the post-AFCA IS-associated single nucleotide polymorphisms (SNPs), and their polygenic risk score (PRS) has an incremental benefit to predict post-AFCA IS in addition to CHA 2 DS 2 VASc scores in the two independent cohorts. Methods: We developed PRS for post-AFCA IS from the UK Biobank (N=2,063) and validated from the independent Yonsei AF ablation cohort (N=2,897) after excluding the procedure-related IS (&lt;14 days of the procedure). For sensitivity analysis of oral anticoagulant (OAC), the patients with ≥80% OAC prescriptions during follow-up were considered as OAC treatment patients. We evaluated the incidence and timing of IS after AFCA, comparing the predictive values of CHA 2 DS 2 VASc score and CHA 2 DS 2 VASc+PRS scores. Results: 46 (2.2%) and 48 (1.7%) experienced IS after AFCA in discovery data with a median of 1873 days of follow-up and replication data with a median of 1500 days of follow-up, respectively. Five genome-wide significant loci for post-AFCA IS were identified and replicated in the two independent cohorts’ data. The PRS was higher in patients who experienced post-AFCA IS (1.9±2.2 vs. 0.3±0.7, p&lt;0.001; hazard ratio 1.80 per 1 SD, [95% CI, 1.63-1.99]). CHA 2 DS 2 VASc+PRS score showed higher C statistic than CHA 2 DS 2 VASc alone (0.754 vs. 0.599, p&lt;0.001). The superiority of CHA 2 DS 2 VASc+PRS score over CHA 2 DS 2 VASc was consistent in the patients with OAC&lt;80% (C statistic 0.805 vs. 0.648, p&lt;0.001) and those with OAC ≥80% (C statistic 0.720 vs. 0.646, p=0.012). In tertile analysis for CHA 2 DS 2 VASc+PRS score, predicted high-risk groups showed early onset overall IS within mean 288 days (p&lt;0.001) after AFCA as compared to intermediate (mean 1231 days) and low (mean 2208 days) risk groups. Conclusions: The CHA 2 DS 2 VASc+PRS score improved the IS prediction after AFCA as compared to CHA 2 DS 2 VASc alone. The predicted high-risk group suffered from IS in a relatively earler perior (within a year) after AFCA.
Abstract 4142605: Differences in Acute Myocardial Infarction and Heart Failure Cardiogenic Shock: Utilization of Temporary Mechanical Circulatory Support and Outcomes
Authors: Laith Alhuneafat, Fares Ghanem, Ahmad Jabri, Abdallah Naser, Muhammad Ibraiz Bilal, Mohannad Al Akeel, Mir Basir, Tamas Alexy, Andrea Elliott
Journal: Circulation (2024)

Introduction: Cardiogenic shock (CS) is marked by substantial morbidity and mortality. The two major CS etiologies include heart failure (HF) and acute myocardial infarction (AMI). The utilization trends of mechanical circulatory support (MCS) and their clinical outcomes are not well described. Methods: This study compares the rates of MCS utilization, factors associated with utilization, and clinical outcomes in patients who present with HF-CS and AMI-CS, using 2016-2020 National Inpatient Sample data. Results: The study included 329,280 patients, comprising 204,660 cases of AMI-CS and 124,620 of HF-CS. MCS utilization increased over the study period with variable degree among devices, and CS-phenotype. AMI-CS had higher intraaortic balloon pump (32.4% vs. 8.9%), extracorporeal membrane oxygenation (2.8% vs. 2.4%), and percutaneous ventricular assist device use (14.5% vs. 8.1%) compared to HF-CS (p&lt;0.01). Factors linked to lower MCS use were female sex, age over 60 years, Black race, atrial fibrillation, chronic obstructive lung disease, diabetes mellitus, cirrhosis, previous stroke, or myocardial infarction. After adjusting for various factors, patients with HF-CS vs. AMI-CS had significantly fewer adverse outcomes, including inpatient death, stroke, tracheostomy, mechanical ventilation, and blood transfusion. However, HF-CS had higher odds of acute renal failure requiring dialysis. AMI-CS was associated with shorter hospital stays (8.8 vs. 15.0 days, p&lt;0.001), lower charges ($251,580 vs. $294,792, p&lt;0.001), and were less likely to discharge home. Conclusion: Despite the evolving trends in MCS utilization over time, CS patients still face high morbidity and mortality rates. The underlying shock etiology has a substantial impact on outcomes, with AMI cases demonstrating worse complications. This highlights the need for a personalized approach to CS management, considering not only etiology but also individual characteristics and comorbidities.
Abstract 4142609: Lifestyle associated-factors influencing serum LDL-C and HDL-C levels and RNA-seq analysis in monozygotic twins of Osaka University Twin Research Registry
Authors: Sae Nishihara, Masahiro Koseki, Katsunao Tanaka, Takashi Omatsu, Hiroshi Sawabe, Ayami Saga, Takeshi Okada, Tomoaki Higo, Makoto Nishida, Tomohiro Ueno, Yasushi Sakata, Mikio Watanabe, Osaka Twin Research Group
Journal: Circulation (2024)

Introduction: Lifestyle habits are considered to be significant determinants of serum lipoprotein concentration. There have been many studies on the factors affecting serum LDL cholesterol(LDL-C) or HDL cholesterol(HDL-C) levels, however, most studies have been conducted in unrelated individuals who had different genetic backgrounds, making it difficult to determine which factors affecting lipid profile might be genetic or environmental. Research Questions: Monozygotic(MZ) twins share almost the same genes, so we hypothesize that twin research may allow us to determine factors associated with lipid profile. Aim: The aim is to examine factors that affect LDL-C and HDL-C levels using data of monozygotic twins database including nutrition survey data, anthropometric and biochemical parameters and to identify genes whose expression levels changed in pairs with large within-pair difference of LDL-C or HDL-C. Methods: The database of 263 pairs of MZ twins in the Osaka University Twin Research Center was analyzed. 1. As for the dietary, smoking, exercise, and drinking habits, we confirmed their influences on LDL-C or HDL-C by Wilcoxon’s signed-rank test in the MZ pairs with the different lifestyle habits. 2. We performed a linear regression analysis of 263 pairs to identfy anthropometric and biochemical parameters(BMI, serum TG, TP and HbA1c etc) associated with the difference in LDL-C(ΔLDL-C) and HDL-C(ΔHDL-C). 3. RNA-seq data derived from peripheral blood mononuclear cells of 59 pairs were examined in the group of large ΔLDL-C or ΔHDL-C. Result: 1. LDL-C increased with increased cholesterol intake(n=65 pairs, p&lt;0.05). HDL-C decreased with smoking(n=15 pairs, p&lt;0.05) and increased with exercise (n=23 pairs, p&lt;0.005). 2. Linear regression analysis of 263 pairs showed that ΔLDL-C was significantly associated with age, ΔTG and ΔBMI, and ΔHDL-C was significantly associated with ΔBMI, ΔTG, ΔTP, and ΔLDL-C. 3. In the 20 pairs of larger ΔLDL-C or ΔHDL-C among the total 59 pairs, RNA-seq revealed that the expression of downstream genes of TLR4 and IFNG was suppressed due to increased HDL-C levels in the large difference of ΔHDL-C. Conclusion: Cholesterol intake, aging, and BMI are factors that affect serum LDL-C levels, and smoking, exercise, and BMI are factors that affects serum HDL-C levels in MZ twins. In addition, the subject who had lower HDL-C in twins showed more inflammatory gene expressions in peripheral blood mononuclear cells.
Abstract 4142248: Pulmonary Artery Pressure Monitor is Associated with Improved Outcomes in the Octogenarian-plus Age Group
Authors: Ashley Mitchell, Talha Siddique, Gregory Panza, Abhishek Jaiswal, Andrew Scatola
Journal: Circulation (2024)

Background: Pulmonary artery pressure monitoring with an implantable device (PAPM) improves heart failure hospitalizations (HFH) in patients with symptomatic heart failure. This device has been previously validated in clinical trials among participants with a mean age of 69 years and a maximum age of 78 but not in the octogenarian-plus age group (≥80). Methods: We retrospectively evaluated 277 heart failure (HF) patients who had a PAPM device placed between 1/1/19 and 10/31/22, with at least 1 yr follow up and compared outcomes between patients aged &lt;80yr (n=218) vs aged ≥80yr (n=59). Continuous data were compared with independent samples t-test and categorical data were compared using chi-square or Fisher’s exact test. Multivariable logistic regression was used to further examine post-PAPM outcomes while adjusting for covariates. Results: Patients in the &lt;80yr group were aged 65.6 ± 10.6yr and 51% were male&amp;in the ≥80yr group were aged 84.5 ± 3.8yr and 67% were male. Patient characteristics are outlined in table 1. Post-PAPM outcomes between groups are presented in Table 2. HF readmission within 30 days was significantly less in the ≥80yr group compared to the &lt;80yr group (P=.001). HFH at 1yr was not significantly different between groups. Need for inotrope within 1yr was significantly lower in the ≥80yr group compared to the &lt;80yr group (P=.006). Mortality within 30d of PAPM implant was not significantly different between the two groups. Results did not change after adjusting for relevant covariates. Conclusion: To our knowledge, this study is the first of its kind to show that octogenarian-plus individuals had less 30d HFH and less need for inotropes within 1yr post-PAPM implant compared to those &lt;80yr. There was no difference in mortality between groups. These results indicate that the use a PAPM device in the octogenarian-plus demographic is safe and effective and warrants a prospective clinical trial.