tbuckley/cabot-search huggingface dataset:
Abstract 11649: Serum Adiponectin Levels Correlate With Atrial PPARγ and TGFβ1 mRNA Expression in Patients Receiving Cardiac Surgery: Involvement of PPARγ on Atrial Fibrotic Remodeling
Authors: Takafumi Nakajima, Toshiaki Nakajima, AKIKO HARUYAMA, Taira Fukuda, Kentaro Minami, Masashi Sakuma, Syotaro Obi, Shichiro Abe, IKUKO SHIBASAKI, Hirotsugu Fukuda, Shigeru Toyoda
Journal: Circulation (2023)

Introduction: The peroxisome proliferator-activated receptor gamma (PPAR γ) plays important roles in regulating processes related to fibrogenesis. On the other hand, adiponectin, a marker for PPARγ activity, is a hormone involved in maintaining energy homeostasis, and exerts anti-profibrotic effects in various organs. However, the roles of PPARγ and adiponectin on atrial fibrotic remodeling are still unknown. Hypothesis: We investigated the association of serum adiponectin levels and atrial gene expression of adiponectin, PPARγ and fibrosis-related genes in cardiovascular surgery patients including heart valve disease. Methods: Atrial mRNA expression levels including adiponectin and PPARγ were analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR) in 59 cases (sinus rhythm (SR) 24 patients, atrial fibrillation (AF) 35 patients) in which left atrium (LA) tissues were removed from the appendage during surgery. The immunohistochemical studies were used to identify the protein expression. The serum levels of adiponectin were measured by ELISA. Results: The immunohistochemical staining showed the expression of adiponectin, PPARγ and PPARα. The significant correlations were observed among the mRNA expression levels of extracellular matrix (ECM) (COL1A1, COL3A1, fibronectin) and the fibrosis-related genes such as TGFβ1, TIMP1, MMP2, NOX2, CTGF and PDGFD attributed to the fibrosis of myocardium. The mRNA expression level of PPARγ, but not PPARα, positively correlated with that of the ECM and the fibrosis-related gene expression level. The mRNA expression level of adiponectin also positively correlated with that of ECM. Patients with AF had higher atrial expression level of adiponectin, PPARγ, COL1A1 and TGFβ than those with SR. Serum adiponectin levels significantly correlated with atrial mRNA expression level of PPARγ and TGFβ1. Patients with AF had serum higher levels of adiponectin than those with SR. Conclusions: Atrial PPARγ and adiponectin associate with atrial fibrotic remodeling in cardiovascular surgery patients. Serum adiponectin levels correlate with atrial PPARγ and TGFβ1 mRNA expression, and might have potential utility as a biomarker in atrial fibrotic remodeling.
Abstract 12103: Intraindividual Variability in Serial Lipoprotein(a) Concentration Among Placebo-Treated Patients in the OCEAN(a)-DOSE Trial
Authors: Prakriti Gaba, Michelle O'Donoghue, J. A Lopez, Robert S Rosenson, Gerald F Watts, Julia Kuder, KyungAh Im, Helina Kassahun, Huei Wang, You Wu, Jingying Wang, Erik Magnus Ohman, Marc S Sabatine
Journal: Circulation (2023)

Background: It has been suggested that lipoprotein(a) [Lp(a)] concentrations are stable over time and need to be measured only once in a lifetime. However, data assessing intraindividual variability in Lp(a) concentration are limited. Methods: OCEAN(a)-DOSE, a phase 2, randomized trial of the Lp(a)-lowering siRNA therapy olpasiran, enrolled 281 patients with atherosclerotic cardiovascular disease (ASCVD) and Lp(a) &gt;150 nmol/L. Analyses were conducted in patients randomized to placebo (n=53) with serial Lp(a) values every 4 to 12 weeks through 72 weeks (820 total serum samples). Intra-individual biological variation (CV i ) was calculated as standard deviation of Lp(a) values over time in an individual divided by the mean of those values. All Lp(a) values were measured using the Roche Tina-quant Gen.2 assay reporting in molarity (assay CV 0.7% at 105 nmol/L). Results: Median baseline Lp(a) in the placebo arm was 246 nmol/L (IQR 200-343); median number of Lp(a) measurements per subject was 16. Whereas the overall Lp(a) concentration remained similar across visits (standard deviation 2.6% of the mean), the intra-individual variation over time (CV i ) was 10% [SD 3.9%] of the mean. This variation remained similar across a range of mean Lp(a) values for each participant (Figure). The absolute observed differences in the placebo arm over time across all visits was 22 ± 21 nmol/L (mean ± SD), with a maximum absolute difference of up to 135 nmol/L from an individual patient’s mean. When evaluating outliers, 23% of patients experienced an upward or downward &gt; or equal to 25% change from their individual mean on at least 1 visit, and 51% experienced an upward or downward &gt; or equal to 50 nmol/L change on at least 1 visit. Conclusion: Among patients with ASCVD and elevated baseline Lp(a) concentration, there was notable intra-individual variability in Lp(a) concentration over 72 weeks of follow-up. These findings suggest that Lp(a) may need to be measured more than once in a lifetime.
Abstract 11950: Cardiometabolic Health Disparities in Sexual Minority Men
Authors: Humberto López Castillo, Christopher W Blackwell, Omar Martínez
Journal: Circulation (2023)

Aim: We summarize 3 meta-analyses conducted on hypertension, dyslipidemias, and obesity, comparing sexual minority men (SMM) and heterosexual men. Methods: We conducted a systematic search in 4 databases to identify studies comparing SMM and heterosexual men in measures for the three relevant outcomes. Prevalence rates, continuous, and inverse variance estimates were generated through random effect models and reported through proportions, mean differences (MDs), and odds ratios (ORs), respectively, with their corresponding 95% confidence intervals [in brackets]. Results: Hypertension. 20 studies showed men who have sex with men (MSM) were less likely (OR 0.34 [0.16, 0.70]) whereas bisexual men were more likely (OR 2.25 [1.54, 3.28]) to report hypertension. Bisexual men are more likely to use antihypertensive medication (OR 1.44 [CI 1.11, 1.85]) and all SMM had higher diastolic blood pressure (DBP; MD 1.46 [1.38, 1.55] mmHg). Dyslipidemias. 10 eligible studies showed lower prevalence of elevated cholesterol for SMM (45.21%; χ 2 [1]=54.78; P &lt;0.001) that does not hold with inverse variance analyses (OR 1.04 [0.91, 1.18]). While bisexual men—but not MSM—are more likely to take cholesterol-lowering medication (OR 1.47 [1.11, 1.93]) and present with lower cholesterol levels (MD –6.80 [–7.27, –6.34] mg/dL), MSM—but not bisexual men—present with lower triglyceride levels (MD –25.67 [–39.80, –11.55] mg/dL). Obesity. 43 studies identified lower prevalence of overweight, obesity, and elevated BMI among SMM, consistent with lower body mass index (BMI; MD –1.50 [–1.93, –1.08] kg/m 2 ) and decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Conclusions: SMM present more frequently with a history of hypertension, linked to elevated DBP—a marker of hypertension at earlier ages. Bisexual men are prescribed cholesterol-lowering medication and present with lower cholesterol levels; MSM present with lower triglyceride levels. Lower rates/likelihood of overweight, obesity, and elevated BMI may point to the obesity paradox—a sustained catabolic state presenting with lower BMI but poor cardiovascular outcomes—which, in connection to other stressors, warrants further research on cardiovascular disparities.
Abstract 11629: Prognostic Impact of Geriatric Nutritional Risk Index After Endovascular Treatment With Lower Extremity Artery Disease
Authors: Akinori Satake, Hirohiko Ando, toru niwa, MASAHIRO SHIMODA, Akihiro Suzuki, Yusuke Nakano, Tetsuya Amano
Journal: Circulation (2023)

Introduction: The number of patients with lower extremity artery disease (LEAD) continues to increase. Moreover, the volume of endovascular treatment (EVT) increases accordingly. On the other hand, malnutrition of LEAD patients is underestimated despite nutritional factors are potentially a correctable parameter. Geriatric nutritional risk index (GNRI), calculated from serum albumin and the components of the body mass index, is a simple nutritional screening method. However, it is not well known whether GNRI before EVT affects the prognosis of LEAD patients. Objective: We investigated whether GNRI before EVT affects the prognosis of LEAD patients Methods: This study was a single-center, retrospective analysis. Between January 2010 and December 2022, consecutive 130 patients underwent the first EVT for LEAD at our hospital. The patients were divided into two groups based on the median GNRI: GNRI ≥ 91 group (n = 68) and GNRI &lt; 91 group (n = 62). The primary endpoint was all-cause death, and the secondary endpoints were major amputation and target lesion revascularization (TLR) after EVT. Results: During the follow-up, 67 patients died after EVT. All-cause mortality was significantly higher in GNRI&lt;91 group (P &lt; 0.001). However, major amputation and target lesion revascularization rates were not significantly different between the two groups. Conclusions: The GNRI before EVT was independently associated with mortality in patients with LEAD
Abstract 11955: Hospital Readmission Outcomes After Myocardial Infarction Among Patients With Myeloproliferative Neoplasms
Authors: Orly Leiva, Hannah Beaman, Andrew Brunner, Joan How, Gabriela Hobbs
Journal: Circulation (2023)

Introduction: Myeloproliferative neoplasms (MPNs) are chronic leukemias associated with increased risk of arterial and venous thrombotic events. Prior studies suggest patients admitted for acute myocardial infarction (AMI) with MPN have similar in-hospital outcomes but lower rates of invasive management compared with patients without MPN. However, post-hospital outcomes in this patient population have not been well characterized. Methods: Adult MPN patients with a primary admission of AMI from January 2017 to December 2018 were identified using the National Readmission Database. Propensity score matching (PSM) was performed to match 1 MPN for 10 non-MPN controls. Primary outcomes were 30-day all-cause, arterial thrombosis (AT)-related, cardiovascular (CV)-related, and bleeding-related readmissions. Results: After PSM, patient characteristics were well-balanced between groups (Table 1). MPN patients had similar rates of in-hospital mortality but higher rates of bleeding during index hospitalization. MPN patients had increased risk of 30-day all-cause, CV, and AT readmissions but not bleeding (Figure). Conclusions: Among patients hospitalized with AMI, those with MPN are associated with increased risk of CV and AT but not bleeding-related readmissions despite higher rates of index hospitalization bleeding. Further investigation is needed in order to improve post-AMI outcomes in patients with MPN.
Abstract 11978: Invasive Hemodynamic Changes Associated With Sodium Glucose Transporter-2 Inhibitors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Abiodun Idowu, Olayinka Adebolu, Bruce Adrian Casipit, Bede Nriagu, Endurance O Evbayekha, Kevin Bryan U Lo, Janani Rangaswami
Journal: Circulation (2023)

Introduction: Sodium-Glucose cotransporter-2 inhibitors (SGLT2i) have been shown to lower incident heart failure (HF) and HF hospitalizations, but the mechanism of benefits in relation to invasive hemodynamics remain unclear. This meta-analysis explores the central hemodynamic effects of SGLT2i. Methods: Using PRISMA guidelines, we systematically reviewed PubMed, Embase, CINAHL, Cochrane library, Ovid MEDLINE, and Google scholar from inception to April 2023 for randomized trials evaluating the effect of SGLT2i on central hemodynamics. Included patients were on guideline directed medical therapy and SGLT2i was added in the experimental group compared to placebo for 3-6 months. Rest and peak-exercise central hemodynamics was measured via right heart catheterization pre- and post-intervention. Random-effect model meta-analysis at 95% confidence interval (CI) was done using RevMan 5.4. Results: Out of 267 articles identified, 3 studies with a total of 145 patients were included in the meta-analysis. The mean age was 62.8 + 4.0 years, 70.0% were male and mean BMI was 31.9 + 2.2. Compared to placebo, SGLT2i were associated with reduction in weighted mean difference of pulmonary capillary wedge pressure (PCWP) by 2.71 (95% CI: -4.33 to -1.08, I 2 =2%, p = 0.001) and 4.17 (95% CI: -7.20 to -1.13, I 2 =0%, p = 0.007) mmHg at rest and peak exercise respectively. Similarly, SGLT2i reduced mean pulmonary artery pressure (mPAP) by 1.16 (95% CI: -3.00 to 0.69, I 2 =0%, p = 0.22) and 2.73 (95% CI: -5.63 to 0.18, I 2 =20%, p = 0.07) mmHg at rest and peak exercise respectively, however this was not statistically significant. Conclusions: SGLT2i significantly reduced PCWP at rest and peak exercise. Rest and peak exercise mPAP were also reduced compared to baseline but not statistically significant. This hypothesis-generating study offers mechanistic insights into the association of favorable hemodynamic effects underpinning to the HF benefits of SGLT2i.
Abstract 17189: Association Between an Artificial Intelligence-Enabled ECG Algorithm for Detection of Atrial Fibrillation While in Sinus Rhythm, and Hospitalization for Recurrent Ischemic Stroke in the Community
Authors: Mohammad Ali Sheffeh, Jose R Medina-Inojosa, Robert D Brown, James P Klaas, Ahmed Koriesh, Betsy Medina-Inojosa, Kathryn Mangold, Andres Estrada Magana, Alejandro A Rabinstein, Peter A Noseworthy, Paul Friedman, Zachi Attia, Francisco Lopez-Jimenez
Journal: Circulation (2023)

Introduction: Artificial Intelligence-enabled electrocardiogram (AI-ECG) can estimate the probability of having atrial fibrillation (AFib) while in sinus rhythm. Recurrent stroke in subjects without known AFib may be due to undiagnosed AFib. We evaluated the association between AI-ECG AFib and recurrent ischemic stroke and with incident AFib Methods: Consecutive adults admitted to a Mayo Clinic or Mayo Clinic Health System hospital or to Olmsted Community Hospital for ischemic stroke between January,1,2000 and June,30,2022 were identified using the Rochester Epidemiology Project. Recurrent ischemic strokes were identified after reviewing medical records and imaging studies. We excluded those with known AFib or without ECGs within 3 years prior to the first ischemic stroke. The AI-ECG network was previously developed using 649,931 ECGs from &gt; 180,000 subjects. The primary endpoint was recurrent ischemic stroke; secondary endpoint was incident AFib. Cox model adjusted for age, sex, and CHA2DS2-VASc2 score variables. Results: We included 4,816 subjects, mean age 70±15 yr, 54% male, 92% white, median CHA2DS2-VASc2 score 4 [3-5], median follow-up 3 [1-7] yr. 280 subjects (6%) had a second stroke and 366 (8%) were diagnosed with incident AFib over follow-up. Those with a positive AI-ECG AFib had an increased risk for recurrent ischemic stroke(HR 1.54, 95% CI 1.21-1.96, P&lt;0.001 Figure A) This association remained significant after adjustment for CHA2DS2-VASc2 score(HR 1.37 95% CI 1.07-1.76, P=0.01). These associations were not affected by anticoagulation use over follow-up. AI-ECG AFib was also associated with incident AFib(HR 2.42 95% CI 1.96-2.98, P&lt;0.001 Figure B) Conclusions: AI-ECG AFib predicts recurrent ischemic stroke in the community, possibly reflecting undiagnosed AFib that can be detected by AI-ECG, as it also predicts incident AFib. These results underscore the potential utility of AI-ECG for risk stratification of patients with ischemic stroke.
Abstract 12039: Association Between Idiopathic Thrombocytopenic Purpura and Risk of Hemorrhagic Stroke: A Nationwide Inpatient Sample Study
Authors: Aamir Patel, Mehrnoosh Hashemzadeh, Rachna Guntu
Journal: Circulation (2023)

Background: Strokes are a major cause of morbidity and mortality worldwide. Low platelet counts are a known risk factor for hemorrhagic stroke, but the association between idiopathic thrombocytopenic purpura (ITP) and different types of strokes remains unclear. Objective: To investigate the impact of ITP on the prevalence of different types of strokes using the Nationwide Inpatient Sample (NIS) database. Methods: We analyzed data from 382,170,108 patients, including 535,602 patients with ITP, from the NIS database. We compared the prevalence of hemorrhagic and non-hemorrhagic strokes between patients with and without ITP. Results: From 2005 to 2014, hemorrhagic stroke occurred in 0.7% to 1.6% of ITP patients compared to 0.4% to 0.6% of patients without ITP. The odds ratio for hemorrhagic stroke in ITP patients was 1.75-2.19, with a statistically significant association in all ten years. Multivariate analysis adjusted for gender, age, race, and hypertension confirmed the positive association between ITP and hemorrhagic stroke across all ten years. Conclusion: Our study provides evidence of a positive association between ITP and hemorrhagic stroke, highlighting the need for increased vigilance in managing patients with ITP. The findings have important implications for clinical practice and suggest the need for further studies to elucidate the mechanisms underlying this association.
Abstract 14833: Association of RV Hemodynamics From 4D Flow CMR With RV Restrictive Physiology From Pediatric to Adult Repaired Tetralogy of Fallot
Authors: XIAODAN ZHAO, Ru-San Tan, Liwei Hu, Ping Chai, Jennifer A Bryant, Lynette Li San Teo, Marielle V Fortier, Tee Joo Yeo, Shuang Leng, Rongzhen Ouyang, John Allen, Marina Hughes, Pankaj Garg, Rob van der Geest, James Yip, Teng Hong Tan, Ju-Le Tan, Yumin Zhong, Liang Zhong
Journal: Circulation (2023)

Introduction: Right ventricular restrictive physiology (RVRP) is common after repair of Tetralogy of Fallot (rTOF), especially with residual pulmonary regurgitation. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) quantitates biventricular blood flow components and kinetic energy (KE) parameters, but their association with RVRP is unclear. We aimed to study 4D flow CMR parameters in adult and pediatric rTOF patients vs healthy controls and associations of 4D flow parameters with RVRP in rTOF. Methods: 103 rTOF patients (40 pediatric, 63 adult; age 24±17 years; 53M:50F) and 171 healthy controls (14 pediatric, 157 adult; age 40±15 years; 97M:74F) were prospectively recruited from centers in Singapore (2) and China (1) to undergo 4D flow CMR on multi-vendor scanners. LV and RV flow components—direct flow, retained inflow, delayed ejection flow and residual volume—and KE parameters (normalized to end-diastolic volume, KEi EDV )—global, peak systolic, average systolic, average diastolic, peak E-wave and peak A-wave—were analyzed. KE discordance was calculated as the ratio of RV and LV average systolic KEi EDV . Results: See Table. RVRP was identified in 70 patients (68%). rTOF with RVRP exhibited higher median RV stroke volume index, RV ejection fraction, RV direct flow, RV peak E-wave and E-wave/A-wave, and lower RV residual volume compared to rTOF without RVRP (all P&lt;0.05). Using binary multivariable logistic regression analysis—and after adjustment for age, pulmonary regurtitation, LV and RV ejection fraction, RV direct flow was found to be independently associated with RVRP in rTOF (P&lt;0.001). Conclusion: Patients with RVRP had higher RV direct flow, RVEF and RV peak E-wave energy, indicating the potential compensatory adaptations in patients with RVRP.
Abstract 13138: Outcomes of Surgical Repair for Sinus Venosus Atrial Septal Defect
Authors: Muhammad Moolla, Ryaan EL-Andari, Kevin John, Ashley Slingerland, Sandra Campbell, Anoop Mathew
Journal: Circulation (2023)

Introduction: Sinus venosus atrial septal defect (SVASD) is a rare congenital cardiac anomaly comprising 5-10% of all atrial septal defects. Although surgical closure is the standard treatment for SVASD, data on outcomes have been confined to small cohorts. Thus, we conducted a systematic review and meta-analysis of outcomes of SVASD repair. Methods: A comprehensive search of PROSPERO, MEDLINE, EMBASE, and Cochrane Library databases was conducted. The primary outcome was mortality. Secondary outcomes encompassed atrial fibrillation, sinus node dysfunction, pacemaker insertion, cerebrovascular accident (CVA), reoperation, residual septal defect, superior vena cava (SVC) obstruction, and reimplanted pulmonary vein obstruction. Pooled incidences of outcomes were calculated using a random effects model. Results: Forty studies involving 1,292 patients who underwent SVASD repair were included. The majority were male (59.4%), with 92.9% presenting with associated pulmonary anomalous venous connection. The weighted mean ages were 18.6 ± 12.5 years, and the overall weighted mean follow-up period was 8.6 ± 10.4 years. In-hospital mortality rate was 0.24%, with a 30-day mortality of 0.56% reported in 720 patients. Incidences of atrial fibrillation, sinus node dysfunction, pacemaker insertion, and CVA over the long-term follow-up were 2% (1-3%), 4% (2-6%), 2% (1-2%), respectively. Reoperation, residual septal defect, SVC obstruction, and reimplanted pulmonary vein obstruction occurred in 1% (0-2%), 2% (2-2%), 1% (1-1%), and 2% (2-2%) surgeries, respectively. Conclusions: This is the first comprehensive analysis of outcomes following surgical repair of SVASD. The findings affirm the safety and effectiveness of surgical intervention, establishing a reference point for evaluating emerging transcatheter therapies. Comparable safety and efficacy profiles to surgical repair are essential for widespread adoption of transcatheter treatments.
Abstract 11448: Secondary Quantitative Data Analysis of Active Commuting Infrastructure and Coronary Heart Disease in the United States
Authors: Nick Makosiej
Journal: Circulation (2023)

Background: It is established in modern scientific literature that physical inactivity is a significant risk factor for coronary heart disease. Implementing active commuting modalities like walking, cycling, and taking public transportation into daily living has been shown to increase physical activity. Prior research has shown the built environment influences the feasibility and likelihood of active commuting behavior. This begs the question of how the prevalence of coronary heart disease is impacted by available active commuting infrastructure. Purpose: Objective investigation of the relationship between active commuting infrastructure and age-adjusted prevalence of coronary heart disease, and associated cardiovascular risk factors in American cities. Methods: A quantitative secondary data analysis examining active commuting infrastructure via WalkScore, BikeScore, and TransitScore were correlated with and regressed against both risk factors for and age-adjusted prevalence of coronary heart disease. The sample included the top 150 most populated cities in the United States. Results: Better active commuting infrastructure has a strong inverse relationship with coronary heart disease prevalence and associated risk factors including hypertension, hyperlipidemia, and obesity. There are some limitations with conclusions that can be drawn from TransitScore and WalkScore due to lack of linearity in the data. Biking infrastructure has the most robust inverse correlation against coronary heart disease (R = -0.355, R 2 = 0.126, p = &lt;0.001, B co-efficient = 6.995, CI = [6.425, 7.485]). Conclusion: Investing in active commuting infrastructure, particularly promoting cycling, could be a population level method of primary prevention to decrease the morbidity and mortality due to coronary heart disease in American cities.