tbuckley/cabot-search huggingface dataset:
Abstract 4142561: A 10-year longitudinal cohort study of lipid variability, cognitive decline, and dementia in 9846 community-dwelling older adults
Authors: Zhen Zhou, Chris Moran, Anne Murray, Sophia Zoungas, Mark Nelson, Stella Talic, Rory Wolfe, Joanne Ryan
Journal: Circulation (2024)

Background: Lipid metabolism in older adults is affected by various factors including biological ageing, functional decline, reduced physiological reserve, and nutrient intake. The dysregulation of lipid metabolism has been suggested to adversely impact brain health. This study aims to investigate the association between year-to-year lipid variability and subsequent risk of cognitive decline and dementia in older adults. Methods: ASPREE was a randomized trial of aspirin and extended into an observational study, ASPREE-XT with a maximum follow-up of 11 years. Included in this study were participants who had cholesterol values measured at baseline, and first three-year annual visits. Only those who initiated or discontinued lipid-lowering therapy during the measurement period were excluded as this study aims to explore change in lipid levels unrelated to changes in treatment. Year-to-year variability in total cholesterol (TC), Low-density-lipoprotein cholesterol (LDL-C), high-density-lipoprotein cholesterol (HDL-C), and triglycerides was quantified using variability independent of the mean (VIM). Associations with incident dementia and cognitive impairment-no dementia (CIND) were analysed using multivariable Cox proportional-hazards models. Linear mixed model was used for assessing the association with changes in different cognitive function domains including global, memory, processing speed, verbal fluency, and a composite over 11 years. Results: The analysis included 9,846 individuals. Baseline characteristics are shown in Table 1 . 509 incident dementia and 1,760 CIND events were recorded over a median follow-up of 5.8- and 5.4-years post-variability assessment. The HRs (95%CI) comparing the highest vs. lowest quartiles of TC and LDL-C variability, were 1.60 (1.23-2.08) and 1.48 (1.15-1.91) for dementia, and 1.23 (1.08-1.41) and 1.27 (1.11-1.46) for CIND. Restricted cubic splines revealed a monotonic increased risk of dementia with higher TC and LDL-c variability ( Fig 1 ). TC and LDL-C variability were also associated with a faster decline in global cognition, episodic memory, psychomotor speed, and the composite score (all p&lt;0.001). No strong evidence was found for an association between HDL-C and triglycerides variability with dementia and cognitive change. Conclusions: Tracking the variability of TC and LDL-C measured annually may serve as a novel biomarker for higher risk of incident dementia and cognitive decline in older adults.
Abstract 4142413: Left-Sided and Right-Sided Composite Advanced Hemodynamic Metrics for Prognostication in Heart Failure
Authors: Joanna Obaoye, Michael Randazzo, Anthony Kanelidis, Matthew Cochran, Mary Acosta, Justin Sipiora, Maria Poonawalla, Umar Siddiqi, Ryan Hoang, Mark Belkin, Jonathan Grinstein
Journal: Circulation (2024)

A complete invasive hemodynamic assessment, including both standard and advanced hemodynamic parameters improves risk stratification in patients with heart failure. Specifically, the novel advanced hemodynamic parameters, aortic pulsatility index (API) and cardiac power output (CPO), have shown robust prognostic potential in patients with cardiogenic shock and advanced heart failure. However, the incremental benefit of a simultaneous utilization of composite advanced hemodynamic parameters across the spectrum of left- and right- sided dysfunction currently remains unknown. We performed a retrospective study of all patients with heart failure undergoing isolated right heart catheterization at our institution from 2013 to 2019. API, pulmonary artery pulsatility index (PAPI), as well as right and left ventricular CPO (RV-CPO, LV-CPO, respectively) were measured; RV CPO = (mPAP - RAP) * CO / 451. The primary outcome was freedom from left ventricular assist device (LVAD), orthotopic heart transplant (HT), and death at 24 months. Kaplan-Meier analyses were conducted based on previously determined cutpoints from receiver operator characteristic curve analysis. A total of 709 patients were included (60 ± 14 years, 46% women, and 40% ischemic cardiomyopathy). There were 297 (42%) primary events in this cohort over 24 months: 46 LVAD, 38 HT, and 213 deaths. The left-sided parameters (API and LV-CPO) proved the primary drivers of the diversion in outcomes in all analyses (p &lt;0.05). RV-CPO showed additional risk stratification when combined with either API or LV-CPO analyses, but only in patients with normal-range values (i.e. API ≥1.45 and LV CPO ≥0.64, p&lt;0.05). No other composite markers showed prognostic significance (Figure). Prognosis at 24 months for patients with heart failure was most sensitive to left-sided advanced hemodynamic parameters (i.e. API and LV-CPO), though RV-CPO, a right sided parameter, provided some additional prognostic benefit in those with a normal left-sided parameter.
Abstract 4142577: The impact of advanced liver fibrosis on recurrence following catheter radiofrequency ablation in atrial fibrillation patients
Authors: Zhe Wang, Shuwen Zheng, Xiaojie Chen, Yingwei Chen, Yihong Sun
Journal: Circulation (2024)

Background: Non-alcoholic fatty liver disease (NAFLD) is not only a predictor of new onset of atrial fibrillation (AF), but also a predictor of AF recurrence following catheter ablation. Advanced liver fibrosis increase susceptibility to AF in NAFLD population. However, the effect of liver fibrosis levels on AF recurrence after catheter ablation remains unclear in the general population. This study was conducted to explore the effect of liver fibrosis on AF recurrence after radiofrequency catheter ablation (RFCA). Methods: The study was a prospective observational cohort study that enrolled consecutive inpatients who underwent their first RFCA of AF from June 2021 to August 2022 at the China Japan Friendship hospital and the First Affiliated Hospital of Zhengzhou University. Liver stiffness measurement (LSM) was performed by VCTE in all enrolled patients before ablation. The study endpoint was recurrence after ablation. The predictive values of SHR for adverse events were assessed. Results: The study finally included 279 patients with AF. Multivariate Cox regression analysis showed that a high level of LSM value was an independent predictor of AF recurrence following ablation, both as a continuous and a categorical variable. Kaplan-Meier curve analysis revealed that a significant disparity inthe recurrence of AF following ablation among the three groups with different levels of LSM value (P value&lt;0.001). Furthermore, restricted cubic spline showed an increasing risk of AF recurrence with increasing LSM values, based on an LSM value of 9.6 kPa as the reference point. Subgroup analyses revealed that a significant interaction between the presence or absence of NAFLD and the levels of LSM value on AF recurrence after ablation (P value for interaction=0.046). Kaplan-Meier curves showed that the rate of AF recurrence was significantly higher with LSM value≥6.9 kPa in NAFLD patients. Multivariate Cox regression analysis also demonstrated that NAFLD patients with LSM≥6.9 kPawere independent factors of higher risk of AF recurrence after RFCA. Conclusions: A high level of LSM value was a predictor for the risk of AF recurrence after the first RFCA, especially in patients with NAFLD. Therefore, LSM values may be a valuable marker for risk stratification of AF recurrence after RFCA.
Abstract 4142227: Accuracy Of Stroke Prediction Using The Predicting Risk Of CVD Events Equation Among Diverse Adults Of The Northern Manhattan Study
Authors: Robert Mesa, Hannah Gardener, Tatjana Rundek, Scott Brown, Eugene Yang, Mitchell Elkind, Jose Gutierrez, Lilah Besser, Carolina Gutierrez, Emir Veledar, Bonnie Levin, Christian Agudelo, Tali Elfassy
Journal: Circulation (2024)

Background: The Predicting Risk of CVD EVENTs (PREVENT) equations are a new set of sex-specific and race-free equations developed by the American Heart Association to calculate risk of cardiovascular disease, including stroke as an independent outcome. Objective: To describe the ten-year risk of stroke (ischemic and hemorrhagic) using the PREVENT equation and assess its validity in predicting stroke among racially and ethnically diverse adults. Methods: The Northern Manhattan Study is a community-based observational cohort of male and female participants who are of non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic background. Participants were aged 40 years or older and without a history of stroke at the baseline visit between 1993 and 2001. Information was collected on blood lipids, systolic blood pressure, body mass index, estimated glomerular filtration rate, smoking status, diabetes status, and anti-hypertensive or lipid lowering medication use. Using the base model PREVENT equation for stroke, we calculated the ten-year risk of stroke and categorized participants based on levels of risk. Participants were followed and stroke events occurring within ten years were adjudicated by an independent panel of clinicians. We calculated the stroke discordance rate by comparing the predicted to observed number of strokes overall, by sex, and by race/ethnicity. Results: Among 2,229 participants, mean age was 65 years, with 61% female, 17% NHW, 20% NHB, 60% Hispanic, and 2% Other. Overall, 25% had a &lt;2.5% risk of stroke; 34% had a 2.5 to &lt;5.0% risk of stroke, 25% had a 5.0 to &lt;7.5% risk of stroke, 11% had a 7.5 to &lt;10.0%, and 5% had a ≥10% risk of stroke. Men compared with women and NHB compared with NHW adults had a higher risk of stroke, p&lt;0.05. Over ten years, 106 strokes were predicted, and 136 strokes were observed (discordance rate: 22%). Stroke was more likely to be underpredicted among females (discordance rate: 24%) than males (discordance rate: 20%), p&lt;0.01 and among NHB (discordance rate: 42%) or Hispanic adults (discordance rate: 18%) compared with NHW adults (discordance rate: 0%), p &lt;0.01. Conclusion: In this sample of urban dwelling adults, the base model PREVENT equation for stroke was most accurate in predicting stroke among NHW adults but performed with less accuracy among NHB and Hispanic adults. Additional factors, such as the social deprivation index, may be important for estimating stroke risk in NHB and Hispanic populations.
Abstract 4142703: Characteristics and Transplant Outcomes of Patients with End Stage Hypertrophic Cardiomyopathy Stratified By Genotype
Authors: Melissa Austin, Anjali Agarwalla, Edan Zitelny, Anjali Owens, Nosheen Reza
Journal: Circulation (2024)

Introduction: Harboring a likely pathogenic/pathogenic (LP/P) sarcomeric genetic variant has been shown to be a predictor of developing hypertrophic cardiomyopathy (HCM) with systolic dysfunction. There are limited data describing the associations between genotype and clinical outcomes of patients with end stage HCM. Methods: All patients with HCM who underwent both genetic testing and heart transplantation (HT) between 2011 and 2023 at a quaternary care center were included. Baseline characteristics, peri-HT management and outcomes were compared between patients with or without LP/P variants for HCM using summary statistics and survival analysis. Results: Between 2011 and 2023, 38 patients with HCM were transplanted. Of these 38, 29 patients underwent genetic testing, and LP/P variants thought to be casual for HCM were identified in 20 (Gene+) (Table 1). Female patients composed 40% of the Gene+ cohort compared to 89% of the gene-negative (Gene-) cohort (p=0.04). The majority of LP/P variants were in MYH7 (7/20) and MYBPC3 (5/20). Pre-transplant cardiometabolic comorbidities were prevalent in both groups. Pre-transplant LVEFs were not significantly different (47% [IQR 34.0, 57.5] in Gene+; 55% [IQR 42.0, 60.0] in Gene-; p=0.23). Pre-transplant medication management and bridge to transplant strategies were similar between the two groups. NYHA Class at time of HT was higher in the Gene+ cohort (p=0.04), though a similar percentage of patients in both cohorts were upgraded to higher UNOS statuses while on the waitlist. Survival at 30, 90 and 180-days after HT (Figure) and incidence of rejection during the year following HT were similar in both cohorts (Table 2). Conclusion: Further investigation is needed to elucidate the impact of genotype on outcomes in end stage HCM.
Abstract 4142683: Piezo2 channels expressed in cardiac ganglionated plexus modulate atrial fibrillation susceptibility
Authors: Xunjun Li, Hong Jiang, Lilei Yu
Journal: Circulation (2024)

Background: Pressure overload of the atria has been postulated to play a significant role in the development of atrial fibrillation. Piezo is a mechanosensitive channel protein and studies have revealed that piezo overexpressed in cardiomyocytes and fibroblasts can promote atrial fibrillation. However, whether pizeo is involved in cardiac ganglionated plexus and its role in atrial fibrillation remains unclear. Hypothesis: The aim of this study is to investigate whether piezo is expressed in the cardiac ganglionated plexus and plays an important role in atrial fibrillation. Methods: Cardiac ganglionated plexus were collected from 6 specimen with high left atrial pressure (high-LAP) or normal left atrial pressure (normal-LAP). Beagles were randomly allocated into sham group, AF group and piezo2-/- group. Atrial electrophysiological parameters, wov, left atrial pressure, neural function, neural activity and tissue of ganglionated plexus were detected. Results: Compared to the normal-LAP specimen, high-LAP resulted in an elevation of piezo2 in ganglionated plexus. RAP-induced increase in left atrial pressure promotes atrial fibrillation by overexpression of piezo2 increasing the function, activity, inflammation and oxidative stress levels of ganglionated plexus. Piezo2 -/- ameliorated atrial fibrillation susceptibility and showed a mild neuranagenesis. Moreover, notch signaling pathway maybe a significant mechanism. Conclusions: Piezo2-mediated mechanical transduction promotes atrial fibrillation by increasing ganglionated plexus activity and facilitating nerve regeneration, possibly through notch signaling.
Abstract 4142597: Prognostic Value of Different Definitions of Iron Deficiency in Light Chain Cardiac Amyloidosis Patients
Authors: Xinqing Li, Anran Xin, Yan Huang, Xiaofeng Zhuang, Xuemei Zhao, Jinxi Wang, Ping Zhou, Yuhui Zhang, Jian Zhang
Journal: Circulation (2024)

Background: Previous research on the iron deficiency (ID) of patients with light chain cardiac amyloidosis (AL-CA) has been limited. Aims: The purpose of this study was to investigate how different definitions of ID affect its prevalence and association with prognosis in patients with AL-CA. Methods: Consecutive patients diagnosed with AL-CA at Heart failure Center, Fuwai hospital between September 2017 and July 2023 with available iron status were included. ID was defined as (1) serum ferritin concentration of &lt;100 ng/ml, or 100-299 ng/ml with transferrin saturation (TSAT) &lt;20% (according to international guidelines on heart failure), (2) TSAT&lt;20%, (3) serum iron &lt;13 μmol/L. The primary outcome measure was all-cause mortality. Kaplan–Meier cumulative endpoint curves were used to compare groups. Cox proportional hazards models were used to estimate the effects of variables on the primary outcome. Results: Overall, 133 patients were included, and the prevalence of ID was 41.4%, 42.1% and 69.9% respectively depending on the definition used. ID defined by TSAT and serum iron was associated with increased risk of all-cause mortality (hazard ratio [HR] 2.25, 95% confidence interval [CI]: 1.41-3.60, and HR 2.26, 95% CI: 1.26-4.06), but the same association was not seen with the guideline definition of ID (HR 1.51, 95% CI: 0.945-2.42). In the multivariable model adjusting for age, gender, hemoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I (cTnI) and difference between involved and uninvolved free light chain (dFLC) levels, the predictive value of TSAT&lt;20% remained (adjusted HR 2.15, 95% CI: 1.29-3.59). Conclusions: Different definitions of ID yield inconsistent results in terms of prevalence and prognosis. ID, as defined by TSAT&lt;20%, emerged as an independent predictor of all-cause mortality in patients with AL-CA.
Abstract 4142210: Stroke Risk in Patients with Cardioversion of Newly Diagnosed Persistent Atrial Fibrillation with and without Transesophageal Echocardiogram for Left Atrial and Left Atrial Appendage Thrombus Assessment
Authors: Kenan Dinchman, Marla Bashour, Benjamin Liu, Saima Karim
Journal: Circulation (2024)

The importance of transesophageal echocardiogram (TEE) to exclude left atrial (LA) and left atrial appendage (LAA) thrombus prior to cardioversion for atrial fibrillation (AF) has been debated in patients who are anticoagulated prior to cardioversion. Despite comprehensive anticoagulation protocols, discrepancies in pharmacologic responses due to patient-specific factors such as adherence to anticoagulation, renal function, and genetics suggest that imaging studies may still be critical for patient safety. Although anticoagulation prior to cardioversion is thought to be adequate to prevent thromboembolic disease after cardioversion, there are studies to suggest imaging is always associated with lower incidence of stroke (Palla, et al., 2023). This study evaluates the impact of TEE before cardioversion on stroke reduction in a contemporary cohort of patients with persistent AF, regardless of adequate anticoagulation time. Question: Do patients with newly diagnosed persistent AF who receive a TEE prior to cardioversion have lower incidence of transient ischemic attack /ischemic stroke compared to those who are anticoagulated for at least four weeks without interruption and cardioverted without thrombus exclusion? Method: This single-center, retrospective observational study involved 454 patients (&gt;18 years) with newly diagnosed persistent AF undergoing cardioversion. Patients were divided into two groups: those who underwent TEE before cardioversion (n=382) and those who did not receive TEE after a four-week period of uninterrupted anticoagulation. Primary outcomes measured were the incidence of stroke within one-year post-cardioversion. Secondary outcome was mortality. Results: The incidence of stroke was significantly lower in the TEE group, with a hazard ratio of 0.1358 (95% CI 0.06531-0.2824; p &lt; 0.0001). Mortality rates within a year did not differ significantly between the two groups. There was no significant difference in age, race, CHADS2VASc score, INR, GFR and platelet count between the two groups based on multivariate analysis. Discussion: TEE prior to cardioversion in patients with newly diagnosed persistent AF significantly reduces the risk of stroke compared to cardioversion after anticoagulation alone. In aligning with the results found in earlier trials such as ACUTE and AFFIRM, this study supports the paradigm that pre-cardioversion imaging to rule out LA/LAA thrombus could be beneficial even amongst patients who have been adequately anticoagulated.
Abstract 4142632: Identifying the Impact of Systolic Dysfunction on CKD Risk in HFpEF Patients
Authors: Thiago Nishimura, Lucas Damiani, Mariane Shinzato, Natasha Santos, Eduardo da Silva Farias, Victor Shiguematsu, Fernanda Batista, Lara Feres, Bruna Damiani, Tacianne Delamain, Gustavo Nishida, Farid Samaan, Fausto Feres, Kleber Franchini
Journal: Circulation (2024)

Introduction: Chronic kidney disease (CKD) is a critical comorbidity in heart failure with preserved ejection fraction (HFpEF), often linked to congestion due to elevated filling pressures. However, the role of subtle systolic dysfunction in CKD remains to be elucidated. This study aimed to investigate the predictive power of left ventricular systolic function for CKD in patients with HFpEF, using advanced machine learning (ML) techniques. Methods: We analyzed data from 497 patients referred to a specialized HFpEF clinic. Using machine learning models (Random Forest, XGBoost, Logistic Regression, Decision Tree), we assessed traditional risk factors (sex, age, hypertension, obesity, diabetes, and smoking) and renal function markers (eGFR and UACR) to estimate the risk of HFpEF based on the HFA-PEFF scoring system. Echocardiography-derived variables were used to predict CKD, defined as an eGFR &lt;60 ml/min/1.73 m 2 . SHapley Additive exPlanations (SHAP) provided insights into model predictions. Results: The study population consisted primarily of women (67%) with an average age of 62 ± 12 years, increased BMI (33 ± 7 kg/m 2 ), and prevalent hypertension (79%), dyslipidemia (71%), and type 2 diabetes (38%). The logistic regression model that incorporated traditional risk factors and renal markers achieved an AUROC of 0.80 ± 0.07, indicating significant impacts of lower eGFR and higher UACR on the risk of HFpEF (Panel A). The Random Forest model, which included variables derived from echocardiography, achieved the highest accuracy (AUROC 0.96 ± 0.02). Key systolic predictors of lower eGFR included reductions in tissue Doppler S wave and stroke volume index, as well as impaired left ventricular diastolic function (increases in E/e’ ratio) and elevated estimated pulmonary artery pressure (TRV - tricuspid regurgitation peak velocity) (Panel B). Conclusion: This study identifies subtle systolic dysfunction, along with impaired diastolic function and increased pulmonary arterial pressure, as significant predictors of CKD in HFpEF. Our findings highlight the potential of advanced ML techniques to better understand the disease mechanisms. Early detection of these impairments can improve risk stratification and guide targeted interventions in the management of HFpEF.