tbuckley/cabot-search huggingface dataset:
Abstract 16877: Role Of Short Term Atrial Fibrillation in Different Stroke Entities
Authors: Michael Buerke, Priyanka Boettger
Journal: Circulation (2023)

Introduction: Stroke including ESUS is one of the most common causes of disability and death in the world. Atrial fibrillation (AF) of more than 30 sec is considered as reason for cardioembolic stroke. Hypothesis: Nevertheless, shorter periods of AF might also be a possible risk factor. Methods: We determined periods of AF of 0-14 sec, AF 15-30sec and AF&gt; 30 sec in patients with different stroke entities. We analysed all ischemic strokes and transient ischemic attacks at the Stroke Unit in Siegen over 6 months. All stroke patients were prospectively ECG monitored over a minimum of 24h and characterized for the different AF periods. Results: A number of 714 patients over 6 months were hospitalized suffering a stroke. Among them 163 (30.8%) had a cryptogenic Stroke, including 98 (19%) ESUS patients. Furthermore, 185 (26%) TIA, 209 (39%) cardioembolic, 110 (21%) atherosclerotic, 40 (8%) lacunar and 7 (1%) other specific strokes were registered. Manifest atrial fibrillation (&gt;30s) showed a prevalence within our stroke population of 23%. Whereas 15% had an AF episode of 15-29 s and 16% presented AF episode of 0-14 s. Among cardioembolic infarcts, 45% had manifest atrial fibrillation (&gt;30 s), 20% had an atrial fibrillation episode of 15-29 s, and 22% showed an atrial fibrillation episode of 0-14 s. Taken together, more than 90% of cardioembolic infarcts show an episode of atrial fibrillation of any duration. An AF episode of 15-29 s or 0-14 s is also found in almost 35% of ESUS patients;similar to cryptogenic infarcts. In 22% of TIA patients manifest atrial fibrillation has been detected. 7% of TIA patients showed one or more episodes of AF of 15-29 s and 10% an episode of 0-14 s. Among the atherosclerotic infarcts, the proportion of AF &gt;30 s is significantly lower at 12%, however the percentage of AF for 15-29 s was 14. Conclusions: In our study, AF showed the largest ratio with 48% among cardioembolic infarcts. Since a manifest AF is an exclusion criterion for ESUS, none suffered from manifest AF. However, it is striking that 15% had an AF episode of 15-29 s and 18% had an AF episode of 0-15 s. Possibly, the definition of AF has to be adjusted or at least advanced rhythm monitoring should be provided. This should be investigated in future prospective studies.
Abstract 19076: The Association of Soluble Fms-Like Tyrosine Kinase-1 (sflt-1) With Risk of Heart Failure and Atrial Fibrillation: Insights From the Dallas Heart Study
Authors: Lajjaben Patel, Vinayak Subramanian, Aditya Nagori, Ambarish Pandey, Rina Mauricio
Journal: Circulation (2023)

Introduction: sFlt-1 has emerged as a biomarker of cardiovascular disease (CVD). However, its role in the development of incident non-atherosclerotic CVD (atrial fibrillation and heart failure) among a multi-ethnic community-dwelling cohort is not known. Methods: Participants from the Dallas Heart Study with available sFlt-1 measures at baseline were included. The primary outcome of interest was a composite of incident Heart Failure (HF), Atrial Fibrillation (AF), and death, and secondary outcome was a composite of recurrent HF, AF or death. The clinical events were adjudicated by a blinded end-point committee. Adjusted Cox proportional hazard models and Anderson Gill models were used to determine the association of sFlt with composite outcomes adjusting for traditional CV risk factors (diabetes, hypertension, hyperlipidemia, smoking, and BMI). Results: The study included 2907 participants (mean age 43.8 yrs, female 57%, median sFLt level 0.46 ng/mL). Participants with higher s-flt levels were older and had a higher proportion of traditional CV risk factors (Q1 vs Q4: 43 yrs vs 46 yrs, HTN 29.9% vs. 38.3%; DM 8.7% vs. 14.3%). Over a median follow-up of 14 years, the primary composite outcome occurred in 323 participants. In unadjusted analysis, sFlt was associated with a higher incidence of the primary composite outcome (HR [Q1 vs. Q4] 95%CI = 2 [1.4-2.7]; p&lt;0.001). This association was completely attenuated after adjustment for traditional CV risk factors (HR 1.3[0.9-1.9, p=0.1]). s-Flt was associated with a higher risk of secondary composite outcome in unadjusted analysis (HR [Q1 vs. Q4] 95%CI = 3.1 [1.3-7.3]; p&lt;0.01) but not after adjusting for traditional CV risk factors (HR [Q1 vs. Q4] 95%CI = 2 [0.8-4.7]; p=0.1) Conclusion: Higher levels of sFlt-1 were associated with the development of adverse non-atherosclerotic CVD events among participants of the Dallas Heart Study. However, this did not persist after adjustment for traditional CV risk factors.
Abstract 19044: Upfront Right Ventricular Assist Device at the Time of Lvad Implantation Reduces Mortality, Stroke, and Major Bleeding Risk
Authors: MARIA GAMERO HUAMAN, Mark Liotta, Praneet Kaki, Yevgeniy Brailovsky, Indranee Rajapreyar
Journal: Circulation (2023)

Introduction: Right ventricular failure (RVF) is a major cause for increased morbidity and mortality after continuous-flow left ventricular assist device (cf-LVAD) implantation. Patients who are high-risk for developing RVF would benefit from early support via right ventricular assist devices (RVADs) to improve hemodynamics and reduce RVF associated complications. However, current RVF prediction models have limited predictive value. To reduce RVF complications, select institutions have implemented upfront RVAD use in those deemed high-risk with mixed results. In this study, we examined our institutional cohort of high-risk RVF patients who received either emergent or upfront RVADs during LVAD implantation and associated one-year outcomes. Hypothesis: Does providing temporary RVAD support upfront to high-risk patients during LVAD implantation impact associated complications and outcomes. Goals/Aims: To assess one-year clinical outcomes for high-risk patients receiving RVADs during LVAD implantation. Methods: We retrospectively reviewed patients who underwent placement of both LVAD and upfront RVAD at our institution between January 2015 and August 2022. Patients were stratified by the type of RVAD placed (percutaneous vs central) and timing of support (upfront vs emergent). Outcomes were assessed up to one-year post-LVAD implantation. Results/Data: Of the 50 patients reviewed, 36 (72%) underwent upfront RVAD implantations and 14 (28%) underwent emergent RVAD implantations. The upfront cohort consisted of 16 of the total 19 INTERMACS 1 patients, 15 of total 21 INTERMACS 2 patients, 4 of total 9 INTERMACS 3 patients, and 1 of 1 INTERMACS 4 patients. Compared to emergent RVADs, patients who received upfront RVAD had significantly decreased one-year mortality (17.1% vs 50.0%, p=0.031), decreased cerebrovascular accidents (2.8% vs 28.6%, p=0.018), and decreased major bleeding (0% vs 40%, p=0.005). There was no significant difference in the length of stay, arrhythmias, gastrointestinal bleed, hemodialysis requirement, driveline infections or vasoplegia. Conclusion: Patients receiving upfront RVAD at the time of cf-LVAD implantation have improved survival and decreased incidence of cerebrovascular accidents.
Abstract 13141: Max Opposing Wall Delay in Right Atrial Strain Can Be a Prognostic Factor at 30-day Mortality in Submassive Pulmonary Embolism
Authors: Yoshiyuki Orihara, Shunsuke Eguchi, Ayumi Eguchi, Michael Pfeiffer, Brandon Peterson, Mohammed Ruzieh, Zhaohui Gao, John Boehmer, John Gorcsan, Ryan Wilson
Journal: Circulation (2023)

Background: Submassive pulmonary embolism (sPE) is common and associated with significant mortality. Right ventricular dyssynchrony caused by sPE were reported previously. However, limited studies have evaluated dyssynchrony of right atrium (RA) strain in the setting of sPE. The purpose of this study was to identify the potential role of RA dyssynchrony in patients with sPE. Methods: 201 patients with sPE were assessed in this retrospective cohort study. All echocardiograms were completed within 48 hours of diagnosis. RA strain was analyzed retroactively using TOMTEC®. RA dyssynchrony was defined as absolute max opposing wall delay which was time interval between peak lateral and septal wall strain in RA after R-R interval correction (maxOWD) (Figure 1). The primary outcome was 30-day all-cause mortality. Results: 201 patients included in the study. Mortality rate of 11.4% was seen at 30 days. Median maxOWD in survivors was significantly low compared to that in non-survivors (4.35 vs 16.20, p &lt; 0.001). Univariable and Multivariable analysis showed maxOWD was an independent factor to predict short-term mortality. Receiver operating characteristics (ROC) analysis revealed area under the curve was 0.795 and best cutoff value was 10.43. Using the cutoff value, Kaplan-Meier curves depicted survival rate in patients with maxOWD &gt; 10.43 was significantly lower than those with maxOWD ≤ 10.43. (Hazard Ratio 7.84, p &lt; 0.001) (Figure 2) Conclusions: Max opposing wall delay after R-R interval correction in RA strain has significant prognostic value in assessing risk of mortality in patients with submassive PE.
Abstract 18929: Sex Differences in Outcomes and Morphologic Features in Patients With Non-Ischemic Cardiomyopathy With Implantable Cardioverter-Defibrillators Implanted for Primary Prevention
Authors: Danah Al-Deiri, Alan Kiang, Donna Salam, Tom Kai Ming Wang, David Chen, Pasquale Santangeli, Wilson Tang, Christopher Nguyen, Reza Nezafat, Jakub Sroubek, Deborah H Kwon
Journal: Circulation (2023)

Background Prior studies have demonstrated significantly lower rate of mortality and appropriate primary prevention implantable cardioverter defibrillator (ICD) therapy in female non-ischemic cardiomyopathy (NICM) compared to men. However, the sex specific mechanisms of protective risk in women are unclear. Therefore, we sought to compare morphologic and tissue characteristic features of NICM patients who underwent cardiac magnetic resonance (CMR) prior to ICD implantation and risk of ventricular arrhythmia and mortality based on sex. Methods: NICM patients who underwent prior CMR within 1 year of ICD implantation between 2002 and 2018 were evaluated. Cox and Fine-Gray models were used to compare event-free survival as appropriate. Clinical characteristics; left atrial volume; ventricular volume, function and remodeling; and late gadolinium enhancement derived from CMR were evaluated with simple t test and chi square analysis to determine their predictive value. Results: We identified a total of 311 patients (118 (37.9% female), median age 65) who met our inclusion criteria. Despite similar scar percentage and LVEF between both genders (p = 0.26, p= 0.62, respectively), females demonstrated significantly lower risk of all-cause mortality/LVAD/transplant in comparison to males (HR 0.48, CT 0.27-0.87; P = 0.016). There was a trend towards lower risk of appropriate ICD therapy in females, (HR 0.54, CI 0.28-1.01; P = 0.055). Comparison of morphologic and functional measures based on sex are listed in Table. Conclusions: Female NICM patients who underwent primary prevention ICD implantation experienced significantly lower mortality/LVAD/transplant rates compared to men, despite similar LVEF and scar burden. Sex differences in ventricular/atrial volumes and function, as well as relative wall thickness, may provide insights into underlying mechanisms of protective effects.
Abstract 19059: Risk Factors for the First Cardiopulmonary Hospitalization Differ From Those of Recurrent Cardiopulmonary Hospitalizations in Patients With Cardiovascular Disease Vaccinated Against Influenza — <i>A Secondary Analysis of the INVESTED Trial</i>
Authors: Bahar Behrouzi, Brian Claggett, Thomas Havighurst, Lu Mao, Jacob Joseph, Peter Austin, Douglas Lee, Orly Vardeny, Scott Solomon, Jacob A Udell
Journal: Circulation (2023)

Background: Influenza vaccines are recommended for patients with CVD due to their protective effects and favorable safety profile. Patients with recent MI/HF hospitalization are at high risk of multiple events, but it is not known which flu vaccine type can mitigate recurrent events. Research Questions: What are predictors of recurrent cardiopulmonary hospitalization and death in patients with CVD and does the high-dose trivalent flu vaccine reduce the rate of recurrent events compared with standard-dose quadrivalent vaccine? Methods: In this pragmatic, active comparator trial, patients with recent MI/HF hospitalization across 157 sites were randomized to either vaccine type and revaccinated each enrolled season (2016-2019). Recurrent event analysis with a Markov multistate model, negative binomial, and Lin-Wei-Yang-Ying regression models was applied, adjusting for clinical and sociodemographic factors, flu infection and vaccine history, with vaccine type as the main exposure. Cardiopulmonary hospitalization and all-cause death comprised the multistate model’s main states and the composite primary outcome for remaining analyses. Results: Among 5260 patients (mean age 65.5 years; 28% women; 63% with recent HF), 12% were readmitted ≥1 for cardiopulmonary causes, accounting for half of total cardiopulmonary hospitalization. In the multistate model, a history of comorbidities (e.g., low LVEF and COPD) was associated with recurrent hospitalization (Figure), whereas age and frailty primarily determined a higher rate of death, particularly after a first hospitalization. There were no significant differences between the vaccines on the rate of recurrent events and death in the multistate and negative binomial regression models. Conclusions: As hospitalizations accrue, the association of certain predictors changes in this population. Alternative strategies beyond vaccine type are needed to mitigate the total burden of cardiopulmonary disease.
Abstract 18679: Sex Ed Can Never Be Bad With a VAD
Authors: Catherine Shelton, Johanna van Zyl, Sandra Carey, Ann Marie Warren, Whitney Whiteley, Aasim Afzal, Lesia Parker, Aayla Jamil, Joost Felius, Shelley Hall, Amit Alam
Journal: Circulation (2023)

Introduction: Little is known about the impact on sexual activity and sexual quality of life in patients with durable left ventricular assist devices (LVADs). Objective: To describe the impact of LVADs on sexual quality of life, depression, and anxiety in patients and their partners. Methods: This is a single-center, prospective, observational analysis from December 2021 to May 2023. Consecutive patients ≥4 months post-LVAD implantation and their partners completed the Sexual Activities in Left Ventricular Assist Device Patients Or PaRtners (SALVADOR) questionnaire to assess sexual quality of life, the Patient Health Questionniare 8 Item (PHQ-8) to assess symptoms of depression and the Generalized Anxiety Disorder 7 Item (GAD-7) to assess symptoms of anxiety. Results: 61 patients and 58 partners completed the questionnaires. 87% patients and 14% partners were male. The median age of patients was 58 years with 87% living with their partner and 13% being single. 10% of patients and 19% of partners had a current diagnosis of a psychological condition, most frequently depression and/or anxiety. Overall, 50% of participants indicated that the VAD influenced their sexual activity. Disturbances from the driveline was the most common problem indicated. 24% of participants had scored in the mild to moderate depression range on the PHQ-8 and 29% scored in the mild to severe anxiety range on the GAD-7. The median total GAD-7 were comparable between patients and partners; whereas patients had a higher total PHQ-8 score. A preference to receive information regarding sexuality while on VAD support was indicated by 55% of participants and did not differ between patients and partners. Written resources was the most common preferred source of information. Conclusion: LVADs severely affect the sexual quality of life for patients and their partners. The presence of a driveline is a major cause for concern. Patients prefer receiving information on how to improve their sexual quality of life.
Abstract 18626: Cardiac Malformations in a Pheochromocytoma and Paraganglioma Syndrome: Reconsidering the Origins of Structural Cardiovascular Disease
Authors: Matthew A Nazari, Jared S Rosenblum, Herui Wang, Arlene Sirajuddin, Andrew Bradley, Yasemin Cole, Abhishek Jha, Andrew E Arai, Karel Pacak, Zhuang Zhengping
Journal: Circulation (2023)

Introduction: Structural cardiovascular (CV) disease and heart failure in patients with pheochromocytoma/paraganglioma is thought to develop from catecholamines and hypertension. A syndrome of polycythemia, catecholamine-releasing paragangliomas, and resultant hypertension caused by pathogenic mosaic variants in hypoxia-inducible factor 2-alpha (HIF2A or EPAS1 ) was described. Hypothesis: We hypothesized this syndrome may have both developmental and secondary causes of structural CV disease. Methods: We evaluated CV structure and function in syndromic patients (n=10), hypertensive pheochromocytoma patients without a known syndrome (n=29), and polycythemic patients (n=29) using cardiac magnetic resonance imaging (MRI) and contrast-enhanced computed tomography (CT) and compared their findings to normal volunteers. We also evaluated the mouse model via vascular casting and subsequent micro-CT or ex vivo 14 tesla MRI at embryonic, post-natal, and adult stages. We tested affected tissue from the mouse model for the genetic variant. Results: Compared to normal volunteers, hypertensive pheochromocytoma, and polycythemic patients, syndromic patients had enlarged left and right atrial appendages relative to respective atria (LAA/LA ratio 0.18 ± 0.04 p&lt;0.001; RAA/RA: 0.20 ±0.10 p=0.005) [ Table ]. We observed similar abnormalities in the mouse model and confirmed the genetic variant in the affected cardiac tissue ( Figure ). Conclusions: This study identifies a signature for distinguishing primary from secondary causes of CV disease in patients with pheochromocytoma and paraganglioma using an atrial appendage to atrial volume ratio.
Abstract 18844: LncRNA MIR17HG and Peripheral Arterial Disease
Authors: sonia batan, Vijay C Ganta
Journal: Circulation (2023)

Introduction: VEGF-A, a potent angiogenic growth factor has been extensively investigated as a therapeutic for Peripheral artery Disease (PAD). Recently, we have shown that increased levels of the anti-angiogenic VEGF-A isoform (VEGF165b) decreases perfusion recovery by inhibiting a truncated miR-17-20a cluster in ischemic endothelial cells and macrophages. Since miR-17-20a cluster is produced from the lncRNA-MIR17HG, we wanted to determine the role of VEGF165b-MIR17HG axis in regulating ischemic angiogenesis and perfusion recovery in PAD Methods: Hypoxia serum starvation in Human Umbilical vein endothelial cells (HUVECs) and Human microvascular endothelial cells (HMEC-1) was used as an in vitro PAD model. Results: Since LncRNAs have multiple transcript variants, we first determined if a specific MIR17HG transcript is present in human chronic limb threatening ischemia (CLTI) vs. normal. Bioinformatics analysis of a recently published bulk RNA-Seq data showed that among 17 annotated transcripts, transcript-1 (MIR17HG-Tr1) is specifically expressed in normal and CLTI muscle biopsies. Analysis of FPKMs showed a numerical increase in MIR17HG-Tr1 in CLTI vs. normal biopsies. qPCR analysis using primers specific for MIR17HG-Tr1 showed significantly higher expression of MIR17HG-Tr1 in HSS-HUVECs and HSS-HMEC-1 vs. their respective controls. VEGF165b inhibition in HSS-HUVECs and HSS-HMECs significantly decreased MIR17HG-Tr1 expression compared to IgG controls. To determine whether MIR17HG functions independent of its miRNA cluster, we silenced MIR17HG-Tr1 and examined miR17-92 cluster expression. Silencing MIR17HG-Tr1 didn’t significantly affect the expression of miR-17-92 cluster members either under normoxic or HSS conditions. In vitro tube formation assay showed that silencing MIR17HG-Tr1 significantly increased the angiogenic capacity of HSS-HUVECs vs. control. Conclusion: This data indicates VEGF165b inhibits MIR17HG-Tr1 to induce ischemic angiogenesis independently of its miR17-92 cluster. Ongoing studies are aimed at understanding the mechanism by which 1) VEGF165b regulates MIR17HG-Tr1 and 2) MIR17HG-Tr1 regulates revascularization in PAD.
Abstract 16872: Sex Differences in Acute Decompensated Heart Failure: A Pooled Analysis
Authors: Prerna Gupta, David P Kao
Journal: Circulation (2023)

Introduction: Sex differences in heart failure physiology, presentation, and symptoms have been well established across the heart failure spectrum. Sex differences in presentations of acute decompensated heart failure (ADHF) have not yet been well explored. We pooled data from 5 clinical trials to assess sex-based differences in presentation of ADHF. Methods: Patient clinical variables, hemodynamic parameters, patient-reported outcomes, and clinical outcomes were compared among trial data from ATHENA, CARRESS, DOSE, ESCAPE and ROSE. Baseline characteristics, physiologic variables, and medications were compared between men and women in aggregate as well as by study. Echo and invasive hemodynamics were assessed in ESCAPE only. Correlations were assessed in a stepwise manner assess relationships between clinical parameters. We also compared weight change and net fluid balance between sexes. Results: Among 1,649 patients pooled across trials, 466 (28%) were women. Men had significantly lower LVEF, pulse pressure, systemic vascular resistance, and body mass index. Women had lower natriuretic peptide, intracardiac filling pressures and six-minute walk distance. Women had higher pulse pressure and systemic vascular resistance (Table). Women had much higher rates of LV hypertrophy (71% vs 43%, p = 0.007) using sex-specific criteria whereas men had much higher rates of anemia using sex-specific criteria. At discharge women had a lower net fluid balance and less weight loss both in absolute terms and adjusted for body weight. Conclusion: The results above demonstrate significant sex-based differences in presentation for ADHF. Despite generally similar signs and symptoms of congestion, women presented with less fluid accumulation, lower filling pressures and preserved peripheral hemodynamics. These differences suggest warning signs for ADHF and treatment goals during hospitalization may be different in women than men.