tbuckley/cabot-search huggingface dataset:
Abstract 4139509: Effect Of A Comprehensive Personalized Behavioral Intervention On Cardiovascular Event-free Survival And All-Cause Event-free Survival In Veterans With Diabetic Neuropathy - The PATRIOT Randomized Clinical Trial
Authors: Sundar Natarajan, Andrew Nicholson, Nicholas Illenberger, Preethi Kumar, Yunika Khamcha Magar, Leah Haley, Kevin Stroupe, Tim Bigdeli, Sherene Sharath, Panagiotis Kougias
Journal: Circulation (2024)

Background: The PATRIOT trial (2015-2021) tested a personalized behavioral intervention (PBI) to prevent diabetic foot lesions by targeting general and foot-specific diabetes care. From the hospitalizations and deaths in the trial, we evaluated if time to cardiovascular events (CVE) or all-cause events (ACE) differed between PBI and current best practice (CBP). Methods: Adults with diabetic neuropathy were recruited from two urban Veterans Affairs hospitals and randomly assigned in parallel to PBI or CBP. The PBI included monthly phone calls targeting general diabetes care (medication adherence, physical activity, diet) and foot-specific care. CBP calls focused on non-cardiovascular and non-diabetes care. Participants were followed for 1.5 years post randomization. Hospitalizations and deaths were assessed from medical record review and participant/family report. After examining if CVEs and ACEs differed between arms by logistic regression, we tested if time to CVEs or ACEs differed by arm, using Kaplan-Meier curves and Cox models. Further, to account for repeat events while evaluating PBI, we used negative binomial regression. We report all model estimates with 95% confidence intervals (CI). Results: We randomized 406 participants (203 per arm). Mean (SD) age was 67.8 (8.4) years in PBI and 68.0 (8.8) years in CBP. Both arms were similar in race, education, social support, and cardiovascular risk factors (all P &gt; .05). There were 151 hospitalizations and 4 deaths. In total, 92 participants had at least one event and 31 had multiple events. The mean (variance) of ACEs was 0.37 (0.78). Most events (44) were CVEs (18 ischemic, 13 arrhythmic, 8 heart failure, and 5 vascular). The odds ratio for CVE in PBI vs. CBP was 0.29 (CI: 0.11, 0.67). There was longer time to CVE for PBI compared to CBP with the 1.5-year cumulative probability of CVE-free survival being 0.95 in PBI and 0.84 in CBP (log-rank P &lt; 0.01). Controlling for age and race, the hazard ratio for CVE comparing PBI to CBP was 0.30 (CI: 0.13, 0.67). Incorporating repeat CVEs, the rate ratio comparing PBI to CBP was 0.30 (CI: 0.13, 0.67). For ACE, PBI was superior to CBP, consistent with all the CVE analyses. Conclusions: The PBI led to greater CVE-free and ACE-free survival. Such comprehensive interventions that target a specific outcome also holds promise for preventing other serious outcomes, probably through raised health consciousness and more healthful behaviors. Registration: NCT02356757
Abstract 4140094: Prediction of Coronary Artery Calcium using Retinal Photographs via Deep Learning: Korean, Spanish and Indian populations
Authors: Yong Yu Tan, Ronaldo Correa Fabiano, Giuliano Generoso, Jun Hwan Cho, Beom-hee Choi, Yunnie Cho, Sahil Thakur, Tyler Hyungtaek Rim, Chan Joo Lee, David Masip, Ruben Barriada, Olga Servat, Cristina Hernandez, Ching-Yu Cheng, Florian Savoy, Nishanth K R, Divya Rao, Isabela Bensenor, Tien Yin Wong, Rafael Simo, Marcio Bittencourt
Journal: Circulation (2024)

Introduction: Cardiovascular diseases (CVD) are the leading cause of death in developed countries. Coronary artery calcium (CAC) is a clinically validated strong marker of CVD, and previous studies suggest that retinal blood vessels provide relevant information. This study aimed to validate the Reti-CVD model, developed for predicting CAC score through retinal photographs, using datasets from Spain, Korea and India. Hypothesis: We proposed the hypothesis that Reti-CVD model can accurately predict CAC scores from retinal photographs in the Spanish, Korean and Indian populations. Methods: The Reti-CVD model was applied to the Spanish Vall d'Hebron Institut de Recerca (VHIR) dataset (n=76), the Korean GreenCross Center dataset (n=3999), Korean Philip Screening Center dataset (n=5010) and the Indian population dataset (n=90). Key performance metrics were calculated to assess the model's effectiveness, including specificity, sensitivity, accuracy, and the area under the curve (AUC). Bootstrap replicates of 2000 were used to determine confidence intervals (CI) for the AUC, and the optimal thresholds were searched using Youden index method. Results: In the Spanish VHIR dataset, the Reti-CVD model showed strong predictive performance. The model achieved a specificity of 78.57%, sensitivity of 85.29%, and overall accuracy of 81.58%. The AUC was 0.8508, with a 95% CI of 0.7556-0.9307. In the Korean GreenCross dataset, the model achieved a specificity of 65.52%, sensitivity of 82.11%, and overall accuracy of 72.09%. The AUC was 0.8084, with a 95% CI of 0.7948-0.822. In the Korean Philip Screening Center dataset, the model achieved a specificity of 69.33%, sensitivity of 85.53%, and overall accuracy of 73.01%. The AUC was 0.845, with a 95% CI of 0.8329-0.8571. In the Indian population dataset, the model achieved a specificity of 55.77%, sensitivity of 75.00%. The AUC was 0.72. Discussion: The validation results indicate that the Reti-CVD model effectively predicts CAC scores using retinal photographs in the Spanish, Korean and Indian populations. These findings validate the model's robustness and generalizability and support the model's potential for non-invasive CVD risk screening within different ethnicities.
Abstract 4140019: Emergency or Non-referral Admission Was Associated with Poor Outcomes in Adults Hospitalized for the Treatment of Cardiovascular Comorbidities in Congenital Heart Diseases: Analysis of the Nationwide Claim-based Dataset from The Japanese Registry of all Cardiac and Vascular Diseases-Diagnosis Procedure Combination
Authors: Yoshihide Mitani, Michikazu Nakai, Isao Shiraishi
Journal: Circulation (2024)

Introduction: The number of adults with congenital heart diseases (CHD) is rapidly increasing, who are frequently associated with cardiovascular morbidities and may result in poor outcomes. However, limited information is available regarding the current demographic status and the prognostic factors of adults hospitalized for the treatment of such patients on a nationwide scale. Hypothesis: We hypothesize that the prevalence of such CHD patients may increase with age in adulthood and that indices of loss to follow-up, emergency or non-referral admission, are related to poor outcomes. Methods: Using a nationwide claim-based dataset from Japan, we analyzed adult patients (aged 15 and over) with CHD diagnosed according to the ICD10 codes, who were hospitalized for the treatment of cardiovascular comorbidities between April 2013 and March 2022. Treatment groups included the surgery group and the catheter intervention (PCI) group for CHD or coronary revascularization and an ‘others’ group (patients treated for heart failure, infectious endocarditis or brain abscess), excluding those in the other two groups. CHD diagnosis was made based on the ICD-10 codes, while treatment categorization was made using specific procedure codes. Results: The study comprised 27,754 patients (male 49%), with a median age of 59 years (36-74) displaying bimodal peaks at &lt;20 yo and 65-84 yo, and a body mass index of 21.6 (19.2-24.4). They were divided into 3 groups: surgery (n=8,800) (CHD surgery, n=8343; coronary bypass, n=457), PCI (n=3060) (CHD PCI, n=1998; coronary PCI, n=1062) and others (n=15,894) (heart failure, 96.9%). Underlying CHD by severity was categorized into simple (60.72%), intermediate (23.23%) and complex(9.44%) types. The overall patient cohort had emergency admissions (35.2%) and non-referral admissions (9.9%). Outcome measures included total hospital deaths (5.0%). In multivariate analysis, higher age, non-adult CHD center admission, CHD severity (intermediate or complex), emergency and non-referral admissions in the overall and the ‘others’ group correlated with hospital death (p&lt;.001). The former 3 indices were independently associated with the latter 2 indices (p&lt;.001). Conclusions: These findings demonstrated that higher age, underlying CHD severity, hospitals for admission, and indices of loss of follow-up were associated with poor outcomes. These findings underscore the importance of healthcare transition and CHD awareness in optimizing the outcomes.
Abstract 4139844: Clinical Relevance of FFR-guided PCI According to Left Ventricular Systolic Function in Patients with Acute Myocardial Infarction and Multivessel Disease
Authors: Yong-Kyu Lee, Seung Hun Lee, Hangyul Kim, Joon Ho Ahn, Kyung-Hoon Cho, Min Chul Kim, Doo Sun Sim, Joo Myung Lee, David Hong, Joo-Yong Hahn, Hyun Kuk Kim, Keun Ho Park, Eun Ho Choo, Chan Joon Kim, Gyun Ahn, Joon-Hyung Doh, Sang Yeub Lee, Sang Don Park, Hyun-Jong Lee, Min Gyu Kang, Chang-Wook Nam, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Seung-Hyuk Choi, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong, Hyeon-Cheol Gwon, Jin-sin Koh, Young Joon Hong
Journal: Circulation (2024)

Background: Fractional flow reserve (FFR) or angiography-guided complete revascularization was not evaluated in patients with acute myocardial infarction (MI) with reduced left ventricular ejection fraction (LVEF). Objectives: To evaluate impact of FFR-guided percutaneous coronary intervention (PCI) for AMI patients with multivessel disease according to left ventricular systolic function. Methods: We performed pre-specified analysis of FRAME-AMI trial which randomly allocated 562 patients into either FFR-guided PCI (FFR≤0.80) or angiography-guided PCI (diameter stenosis of &gt;50%) for non-infarct related artery (IRA). Patients were classified by LVEF into the preserved (LVEF ≥50%) and reduced (LVEF &lt;50%) groups. The primary end point was patient-oriented composite outcome (POCO), a composite of death, MI, and repeat revascularization. Results: Overall, 187 patients (33.3%) had reduced LVEF. At 4-year follow-up, AMI patients with reduced LVEF showed increased risk of MACE than those with preserved LVEF (18.9% vs. 10.8%; adjusted HR=2.65, 95% CI 1.53-4.58, P&lt;0.001). FFR-guided PCI for non-IRA significantly reduced POCO among preserved LVEF group (3.3% vs. 19.0%; adjusted HR=0.23, 95% CI 0.09-0.59, P=0.002). Conversely, there was no significant difference in POCO between FFR and angiography-guided PCI among reduced LVEF group (17.0% vs. 21.0%; HR=0.64, 95% CI 0.31-1.32, P=0.227). The prognostic impact of FFR-guided PCI tended to increase as LVEF increased (adjusted HR for POCO: 0.69 vs. 0.66 vs. 0.25 vs. 0.20, respectively, for the LVEF ≤40% vs. 40-50% vs. 50-60% vs. ≥60%, interaction P=0.028). Conclusion: In acute MI patients with multivessel disease, FFR-guided PCI for non-IRA showed differential clinical impact according to left ventricular systolic function. The beneficial effect of FFR-guided PCI might be maximized among patients with preserved LVEF rather than reduced LVEF.
Abstract 4139732: Timing of Anticoagulation in Pulmonary Embolism with Nontraumatic Intracranial Hemorrhage: A Multi-National Database Study
Authors: Kyle Chang, Bryce Hambach, Suhas Nareddy, Christiana Prucnal, Elvin Hernandez, Lisa Sovory
Journal: Circulation (2024)

Background: Pulmonary embolism (PE) occurs in 1% of patients with nontraumatic intracranial hemorrhage (ICH) despite thromboprophylaxis. Anticoagulation is the primary treatment of hemodynamically stable PE; however, risks of bleeding complications in ICH exist. We investigated the optimal timing of anticoagulation in patients with PE and ICH using a large retrospective database. Methods: We included patients with nontraumatic ICH and PE without acute cor pulmonale or prior long-term anticoagulation from the TriNetX Research Network. Patients were then categorized as early (0-3 days after ICH), intermediate (4-14 days), late (15-60 days), or no anticoagulation. Chi-square and independent t -tests were used for bivariable analyses. Cohorts were 1:1 propensity score-matched by 17 covariables including demographic information and comorbidities. Outcomes were all-cause mortality, neurological deficits due to ICH, and extracranial hemorrhage 90 days after ICH. Results: Of 13,042 included patients, mean age was 65±16 and 45% were female. Those receiving early anticoagulation after ICH had higher risk of mortality (RR=1.29, 95% CI: 1.20-1.38), neurological deficits, and extracranial hemorrhage compared to no anticoagulation. Intermediate anticoagulation had similar outcomes to no anticoagulation. Late anticoagulation had lower risk of mortality (RR=0.78, 95% CI: 0.66-0.92) and no significant difference in other outcomes. Conclusions: In patients with ICH and PE without acute cor pulmonale, early anticoagulation was associated with increased mortality, neurological deficits, and extracranial hemorrhage compared to no anticoagulation. Late anticoagulation was associated with decreased mortality and similar risks of neurological deficits and extracranial hemorrhage.
Abstract 4139858: Association Between the Amount of Feedback Received and the Adherence to Recommended Self-monitoring and Lifestyle Goals in a Weight Loss Clinical Trial
Authors: Susan Sereika, Zhadyra Bizhanova, Britney Beatrice, Jessica Cheng, Molly Conroy, Jacob Kariuki, Bambang Parmanto, Lora Burke
Journal: Circulation (2024)

Introduction: Self-monitoring (SM) lifestyle behaviors is the cornerstone of behavioral treatment for weight loss, but adherence declines. Mobile health (mHealth) tools can lessen the burden of SM and enable timely feedback (FB) to reinforce SM behaviors. Hypothesis: A greater number of FB messages received will be associated with better adherence to diet, physical activity (PA), and weight SM and study-prescribed diet and PA goals. Aims: To examine the association between adherence to diet, PA, and weight SM and calorie, fat and PA goals and the amount of FB received for participants assigned to the SM+FB arm in SMARTER, a 12-month mHealth weight loss clinical trial. Methods: We randomized 502 participants to either SM+FB or SM alone and asked them to self-monitor diet via the Fitbit app, PA via the Fitbit tracker and weight via a smart scale over 12 months. Participants recorded food intake and tracked PA daily and self-weighed at least weekly. Using SM data uploaded in real-time, the SM+FB group received 3 tailored FB messages daily on their study-designed smartphone app (daily for diet, every other day for PA, weekly for weight). We applied generalized linear mixed-effects modeling to examine the association between the number of FB messages opened and adherence to SM and to study-prescribed goals analyzed as a percentage or meeting the threshold and reported as the unstandardized regression coefficient (b) or odds ratio (OR) with 95% confidence interval (CI) and p-value. Results: The SM+FB group (n=251) was 84% white and 80% female with a mean age of 45.0±14.3 years and a mean BMI of 33.7±3.9 kg/m 2 . Over 12 months, the SM+FB group opened a mean 471.3±279.7 FB messages. While adherence to diet, PA, and weight SM and to diet (calorie and fat) and PA (weekly minutes) goals declined nonlinearly (p&lt;.05) over 12 months, the number of FB messages received was positively associated with SM and goal adherence: daily diet SM (OR=2.61, 95%CI=[2.46, 2.76]; p&lt;.001), daily PA SM (OR=3.04, [2.72, 3.40]; p&lt;.001), weekly weight SM (b=2.03, [1.90, 2.16]; p&lt;.001), daily calorie goals (b=2.21, [1.95, 2.47]; p&lt;.001), daily fat goals (square root transformed) (b=0.17, [0.14, 0.19]; p&lt;.001), and weekly PA goals (b=5.22, [3.49, 6.95]; p&lt;.001). Conclusion: Providing feedback to participants reduced the decline in adherence to SM and lifestyle change goals; however, additional strategies are needed to enhance long-term engagement with mHealth tools and improve weight loss outcomes.
Abstract 4139660: Human IL-8 BAC Transgenic Mice Reveal the Causative Role of IL-8 in Neointima Hyperplasia
Authors: Wei Zhang, Lihua Pan, xiaoliang wu, Kunzhe Dong, Xiaochun Long
Journal: Circulation (2024)

Interleukin-8 (IL-8, aka CXCL8) is a chemokine produced by multiple proinflammatory cells. A high level of serum IL-8 is correlated with increased risk of cardiovascular diseases; diseased vessels frequently express high levels of IL-8. Despite these correlations, it remains largely unknown whether IL-8 plays a causative role in vascular disease owing to the lack of mouse ortholog of IL-8 and thus knockout mouse models. To address the knowledge gap, we applied a bacterial artificial chromosome (BAC) transgenic (Tg) mouse model which carries the whole IL-8 gene locus as well as the surrounding regulatory elements to enable the pathophysiological expression of IL-8 in mice. As expected, the expression of IL-8 in the BAC Tg mice is substantially induced by vascular injury and ex vivo culture condition. To determine the role of IL-8 in vascular stenosis, we subjected BAC Tg mice to complete carotid artery ligation injury. We found that neointima formation is significantly increased in BAC Tg mice compared with WT controls; the neointima in Tg mice displays increased accumulation of MAC2 and PCNA positive cells. To further pinpoint the causative role of IL-8 in the phenotype seen in BAC Tg mice, we applied IL-8 antibody to neutralize IL-8 produced in the injured carotid arteries using Pluronic gel immediately after ligation surgery in the BAC Tg mice. We found IL-8 antibody significantly attenuated neointima formation compared with IgG control. Our studies, for the first demonstrated a causative role of IL-8 in neointima formation, suggesting that IL-8 is a potential therapeutic target for vascular stenosis. Our study also indicates BAC IL-8 Tg could serve as a useful tool for investigating the role of IL-8 in various vascular pathologies.
Abstract 4140003: Impact of Long-Term Blood Pressure Variability on Adverse Cardiovascular Outcomes in High- and Low-Risk Populations
Authors: Lynne Krohn, Dion Zappe, Rachel Hoffing, Aaron Holleman, Philip LoGerfo, Mollie Plekan, Sebastian Akle Serrano, Lucas Ward, Paul Nioi, Bryan Williams, Aimee Deaton, Ho-Chou Tu
Journal: Circulation (2024)

Background: Hypertension is a major preventable risk factor for cardiovascular (CV) disease. Emerging evidence suggests that in addition to blood pressure (BP) levels, controlling the consistency of BP is a key determinant of clinical outcomes. We aimed to assess the effects of consistency of BP control on adverse CV and renal outcomes using two metrics: long-term variability of systolic BP (LT-BPV) and the degree at which BP control is achieved, known as cumulative systolic BP load (CBPL). Methods: We collected clinic systolic BP (SBP) measurements from UK Biobank primary care records in those diagnosed with hypertension (N=39,816), chronic kidney disease (CKD, N=8,062), and neither of these (N=17,702), including a per-participant mean of 21 SBP values over 6 years. Instances of the primary outcome, 4-point major adverse cardiovascular events (MACE; stroke, acute myocardial infarction, heart failure hospitalization, and cardiovascular-related death), were collected from hospital records. Per-standard deviation (SD) and per-quartile hazard ratios (HR) were used to estimate LT-BPV, CBPL, and mean SBP separately using adjusted Cox regression. Sensitivity analyses were used to determine the independence of BP consistency effects from mean BP levels. Results: In those with hypertension, each per-SD increase in LT-BPV was associated with increased risk for MACE (HR=1.12, p=4.4E-11), specifically CV-related death, stroke, and HF hospitalization. LT-BPV effect estimates were strongest in those with controlled SBP and the strongest predictors for all events in those without high-risk comorbidities (coronary artery disease, CKD, peripheral vascular disease, and diabetes). CBPL was similarly associated with MACE (HR=1.13, p=8.1E-13), specifically stroke and acute myocardial infarction, but not with fatal events or HF. In those with CKD, both LT-BPV and CBPL were associated with progression to renal failure (HR=1.31-1.33, p&lt;6.8E-11), but only LT-BPV was associated with MACE and mortality. CBPL showed a J-shaped mortality distribution in all populations, whereas LT-BPV consistently showed a stepwise increase in fatalities across quartiles. Conclusions: LT-BPV was a robust predictor of adverse CV outcomes across all populations, especially in typically “lower-risk” populations where the need for preventative measures would not usually account for LT-BPV. Our study indicates the importance of controlling the consistency of BP to optimize protection against CV events.
Abstract 4139938: Lipidomic signature of acute ischemic and hemorrhagic stroke
Authors: Aleksandra Stamenkovic, Michael Chong, Michel Aliani, Grant Pierce, Guillaume Pare, Harold Aukema, Amir Ravandi
Journal: Circulation (2024)

Introduction: Stroke is the second leading cause of death worldwide and the leading cause of disability. Without a plasma biomarker care is often delayed. The brain is rich in lipids, which readily cross the blood-brain barrier, and therefore represent a target for biomarkers of stroke. The study aimed to determine the lipidomic changes in plasma in stroke patients through an untargeted and targeted analysis. Methods: A cohort of 482 patients from the INTERSTROKE study was included in the analysis. This included 241 stroke patients (120 ISCH, 121 HEM) and 241 age and sex-matched controls. A LC/MS/MS platform was used to perform a detailed lipidomic and oxylipidomic analysis of plasma. Biomarker analysis was performed using the Random Forest Classification algorithm (RFC). Results: Lipidomic analysis identified 141 lipid species and 32 oxylipins significantly altered in ISCH stroke compared to control and 167 lipid species and 34 oxylipins in HEM stroke. Between ISCH and HEM stroke there were in 87 significant lipids. There was a 141 % increase in phosphatidylserine (PS) 40:6 (p&lt; 0.0001) in patients with HEM stroke compared to ISCH, whereas prostaglandin E2 was found to be 94% higher (p&lt;0.0001) in ISCH stroke. RFC model identified lysophosphatidylcholine (LPC) 14:0 and 15-oxoETE as the most important features contributing to classification between control and stroke with a mean AUC score of 0.81 and 0.69 respectively. PS 40:6 and 14-HDoHE are the most important features contributing to separating ISCH and HEM stroke, with mean AUC scores of 0.84 and 0.67, respectively. PC 34:1 and PC-O 36:3 were found to be the biggest predictors of stroke outcomes at 30 days, measured by The Modified Rankin Score (mRS) score. In addition, four lipids: Ceramide 24:1, C14 Tetradecanoyl Carnitine, trihexosylceramide 16:0, and PS 40:6 were found to be the independent predictors of mortality in patients with stroke. Conclusion: We have demonstrated significant alterations in the human plasma lipidome during acute stroke, revealing distinct differences between HEM and ISCH subtypes. These lipid profiles not only differentiate between stroke subtypes but also predict clinical outcomes. Given the current lack of plasma biomarkers for stroke, our study underscores the potential of lipid molecules as valuable biomarkers for stroke diagnosis and prognosis.