tbuckley/cabot-search huggingface dataset:
Abstract 4142988: Effectiveness of Additive Cardiac Computed Tomography Angiography for Pre-procedural Planning of Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis
Authors: Vinicius Pereira, Julia Fernandes, Rafael Petri Santos Pinheiro, Naieli Andrade, Eric Katsuyama, Chidubem Ezenna, Mrinal Murali Krishna, Meghna Joseph, Wilton Gomes
Journal: Circulation (2024)

Introduction: The latest expert consensus on catheter-based Left Atrial Appendage Occlusion (LAAO) suggests considering either transesophageal echocardiography (TEE) alone or the addition of Cardiac Computed Tomography Angiography (CCTA) for pre-procedural planning. However, evidence comparing the effectiveness of adding CCTA to regular TEE planning on procedural success is limited. Methods: We aimed to perform a systematic review and meta-analysis to determine the impact of adding CCTA to regular TEE for pre-procedural planning in patients undergoing LAAO. We systematically searched Cochrane, Embase, and Medline for observational studies and randomized controlled trials (RCTs) comparing TEE alone to TEE with the addition of CCTA. The primary endpoint was procedural success. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model. Results: Four studies were included in our meta-analysis, three of which were RCTs and one observational study, comprising a total of 824 patients, of whom 496 (60.2%) underwent additional CCTA. In the pooled analysis, procedural success was higher in the group with added CCTA (RR 1.10; 95% CI 1.01 - 1.19; p=0.022; I2=52%). A subgroup analysis of RCTs alone confirmed these findings, with a slightly higher magnitude of effect in benefit of the addition of CCTA, and with lower heterogeneity (RR 1.15; 95% CI: 1.06 - 1.25; I2 = 0%). Conclusions: In this meta-analysis comparing TEE alone vs TEE with the addition of CCTA for preprocedural planning of LAAO, the addition of CCTA was associated with a higher procedural success rate, and this finding was confirmed in a subgroup analysis of randomized data.
Abstract 4142959: Carotid 3D Plaque Composition after Carnitine Supplementation in Patients with Metabolic Syndrome
Authors: Zejia Chen, Marie-France Hetu, Antoine Collet-Billon, Laurence Rouet, Robert Entrekin, Amer Johri
Journal: Circulation (2024)

Background: L-Carnitine (L-C) is a widely used nutritional supplement, but its effect on cardiovascular disease (CVD) is controversial. L-C has been shown to have benefits for CVD but is also believed to be associated with pro-atherogenic mechanisms. We have previously shown that L-C does not cause plaque progression (no effect) in metabolic syndrome patients supplemented with L-C but indicated an increase in stenosis. Carotid plaque ultrasound pixel distribution analysis (PDA) can identify plaque tissue types (soft vs calcified) indicating if a plaque is prone to rupture and to cause cardiovascular events. Beyond plaque volume (quantity), a change in plaque composition may have a role in causing cardiovascular events (increased lipid core). Research Questions/Hypothesis: Is there a change in 3D plaque composition from baseline to 6-month when taking an L-C supplement in metabolic syndrome patients? If L-C is associated with pro-atherogenic mechanisms, perhaps plaque composition may change (increased fat), increasing risk for events. Methods: Patients were selected from cardiology and stroke clinics who met the diagnostic criteria for metabolic syndrome. Participants (n=157) were randomized to 6-month L-C (2g/day, n=76) or placebo (n=81). Participants received a 3D carotid ultrasound at baseline and 6-months. Carotid plaques were analyzed using a novel 3D carotid arterial plaque composition analysis software (Carotid Model, Figure) that uses deep learning artery and plaque classifications with grayscale PDA (Philips Healthcare). 3D percent change in plaque volume, blood, fat, muscle, fibrous, and calcium due to L-C supplementation was assessed by pairwise t-test. Results: We found no difference in baseline characteristics between placebo and L-C arms. There was no change in percent total plaque volume (L-C=4.18% vs Placebo=17.0%; P=0.24). Each plaque composition component remained similar from baseline to 6-month within arms and between arms (Table). There was a slight increase in grayscale median value in the placebo arm. Conclusion(s): We did not observe a change in carotid 3D plaque volume or plaque composition following 6-month treatment with L-C. Our findings support the theory that L-C may not be directly involved in a pro-atherogenic mechanism. Although L-C supplementation did not influence plaque composition in this population, the software has great potential in determining changes in plaque vulnerability over time in response to drug therapy.
Abstract 4142030: A Polygenic Score to Identify Risk of Incident Stroke and Benefit from Primary Prevention Statin Therapy
Authors: Daniel McClintick, Frederick Kamanu, Giorgio Melloni, Marc Sabatine, Christian Ruff, Paul Ridker, Daniel Chasman, Nicholas Marston
Journal: Circulation (2024)

Background: Primary prevention statin use has been shown to significantly reduce the incidence of stroke, however, clinical risk scores for statin eligibility do not predict stroke specifically. A polygenic risk score (PRS) for stroke is a tool that may help identify individuals at greatest risk of stroke and most likely to benefit from statin therapy. Methods: We performed a prospective cohort study using genotyped individuals from a large primary prevention RCT (JUPITER), which tested rosuvastatin 20 mg daily vs placebo. We applied the validated GIGASTROKE PRS categorized by quintiles: low (Q1), moderate (Q2-Q4) or high risk (Q5). The primary outcome was occurrence of all-cause stroke. PRS risk was modeled per 1-SD and hazard ratios calculated for the moderate and high-risk groups relative to low risk. Formal testing of treatment interaction for rosuvastatin and PRS was performed. Results: Of 8,749 patients with genetic data (32% male, mean age 66), the median LDL-C was 110 mg/dL and hsCRP was 4.05 mg/L. During 4 years of follow up, 44 patients suffered a stroke. The PRS was strongly associated with risk of incident stroke ( Fig, A ). Compared to those at low genetic risk, the absolute risk of stroke was more than 2-fold greater in the moderate group (HR: 2.10, 0.78-5.67) and nearly 4-fold greater in the high-risk group (HR: 3.72, 1.27-10.88, p-trend =0.011). In this genetic cohort, rosuvastatin reduced the risk of stroke by 61% (HR: 0.39, 0.20-0.76, p=0.006). The relative risk reductions with rosuvastatin were 37% (HR 0.63, 0.11-3.77), 63% (HR 0.37, 0.16-0.88), and 68% (HR 0.32, 0.09-1.17) in low, moderate, and high-risk groups, respectively. The absolute risk reductions with rosuvastatin were 0.13% (-0.38-0.63), 0.46% (0.08-0.84), and 0.76% (-0.03-1.56) ( Fig, B) . Rosuvastatin in the high-risk subgroup reduced the incidence of stroke to the level of the low-risk subgroup receiving placebo (0.35%). Conclusion: A PRS can identify primary prevention patients with a 2 to 4-fold increased risk of stroke, which appears to be largely offset with statin therapy. As the use of PRSs increase in clinical practice, it may be a useful tool to help guide statin initiation for primary stroke prevention.
Abstract 4142935: Circulating endothelial cells and microthrombosis as markers of vascular dysfunction in Long COVID
Authors: Carolina Dias, Jose Manuel Condor, Emely Robleto, Patricia Guevara, Elizabeth Bast, Ana Palacio, Leonardo Tamariz, Lina Shehadeh
Journal: Circulation (2024)

Background. Post-COVID syndrome is related to a multisystem disorder that affects in part the cardiovascular system. This disease involves symptoms, and conditions that continue or develop after acute COVID-19. SARS-CoV-2 infection of immune and endothelial cells are associated with NETosis, microthrombosis and endothelial dysfunction that could persist several weeks after acute phase of infection. Damaged endothelial cells can expose the vessel pro-coagulant area leading to platelet and neutrophil clumps. Increased levels of circulating endothelial cells (CECs) have been described as biomarkers for cardiovascular diseases. Therefore, we hypothesize that CECs and microthrombosis are potential biomarkers of vascular dysfunction in Long COVID. Methods. A cross-sectional study was conducted at the Miami VA long COVID clinic. Long COVID cases and controls were recruited according to WHO definition for long COVID. A total of 23 patients and 7 controls were included in this study. Blood samples were collected in Heparin and Sodium Citrate tubes. Cell immunophenotyping and NETosis markers (MPO) were quantified on a Cytek Aurora spectral flow cytometer system. Microclots (CD62P + PAC-1 + ) and platelet response were assessed by flow cytometry and response to Adenosine di-phosphate (ADP), respectively. A ttest was used for statistical analysis. Differences were considered significant when p &lt; 0.05. Results. The age and gender were similar between cases and controls while their symptom score was significantly different. There was a significant increase in the number of CECs (CD31+CD309+CD45-CD133-) in Long COVID cases. MPO expression in neutrophils (CD11b + CD66b + CD15 + ) and classical monocytes (CD14 + CD16 - ) was significantly higher in Long COVID. Microclots were significantly elevated, and the platelet aggregation response was dysregulated in Long COVID. Conclusions. CECs and microthrombosis including NETosis are present in Long COVID and may serve as potential biomarkers or causative mechanisms for vascular dysfunction.
Abstract 4142966: Bullying Behavior in Children with Congenital Heart Disease: Key Findings From The National Survey of Children’s Health
Authors: Hitakshi Modi, Sagar Jani, Mario O'Connor, Hannock Patt, Alexandra Lamari-Fisher, Heather Van Diest, Carlos Mery, Charles Fraser, Andrew Well
Journal: Circulation (2024)

Background: Bullying can negatively impact children’s mental health and well-being. Research shows a higher prevalence of being bullied in those with chronic disease. Data on bullying behavior (being bullied as well as bullying others) in children with congenital heart disease (CHD) is limited. Research Question: Do children with CHD bully and get bullied more than those without? Methods: National Survey of Children’s Health (NSCH) 2022 data were utilized. Children aged 6-17 years were included. Three groups were created: bully, bullied by others, and not involved. Descriptive, univariate, and multivariable multinomial analyses were utilized. Results: A total of 32,984 children were included with 15,857(48%) female; 21,222(64%) Non-Hispanic White; and 803(2%) with CHD. Bullies were found to be 1,136(3%) and 3,566(11%) as being bullied. Children with CHD were more likely to bully(OR=1.53(95%CI:1.2-2.2), p&lt;0.001) and be bullied(OR=1.66(95%CI:1.2-1.8), p&lt;0.001) than those without. Autism, depression, anxiety, and developmental concerns were significantly associated with bullying and being bullied.(Table 1) In multivariable multinomial analysis, CHD was no longer significantly associated with bullying(aOR:0.92(95%CI:0.65-1.29),p=0.644) or being bullied(aOR:0.98(95%CI:0.80-1.24),p=0.983). Other factors including autism, depression, anxiety, and developmental concerns remained significantly associated with both bullying and being bullied.(Table 2) Conclusion: In a large national sample, CHD was not independently associated with bullying or being bullied. However, the presence of comorbidities common in CHD (e.g. developmental concerns) was significantly associated with bullying and being bullied. This suggests that CHD itself is not directly a significant factor, but its common comorbidities are. Additional work is needed to understand bullying and design interventions focused on comorbidities to effectively address and mitigate bullying in children with CHD.
Abstract 4142004: Predicting Cardiovascular Disease Events Using Uncalibrated Non-invasive Carotid Pressure Wave Components from Spectral Regression Learning
Authors: Arian Aghilinejad, Alessio Tamborini, Morteza Gharib
Journal: Circulation (2024)

Introduction: Pressure wave separation is a powerful tool for investigating wave phenomena in the cardiovascular system. However, its clinical application has been limited by the need for concurrent measurements of pressure and flow waveforms. Moreover, its predictive value for cardiovascular disease (CVD) remains unclear. Aim: This study aims to assess the performance of pressure wave components for CVD event prediction using single uncalibrated, non-invasive carotid pressure waveforms. Methods: The sample for this study is drawn from the Framingham Heart Study and includes tonometry recordings of carotid pressure waveforms for participants free of CVD at baseline (N=5110; mean age 47 years, 55% women). A recent machine Learning methodology for pressure-only wave separation, called spectral regression learning method ( Eur. Heart J. Open , 2024: oeae040) is applied to decompose the pressure waveform into forward and backward wave components. The pressure wave index, defined as the ratio of the peak backward wave to the sum of the peak forward and backward wave amplitudes, is computed in a testing population (N=1567) blinded to all stages of the regression learning development. Cox proportional hazards regression models and Kaplan-Meier analysis are used in this testing population to relate the pressure wave index to the first incident CVD event (166 cases) over a median follow-up of 9.6 years. Results: The method-derived pressure wave index from uncalibrated carotid pressure waveforms is associated with incident CVD, adjusted for age and sex (model 1; hazard ratio, 0.66 [95% CI, 0.57–0.76] per SD; p&lt;0.005), or adjusted for age, sex, brachial mean blood pressure, total cholesterol, high-density lipoprotein cholesterol, diabetes, and smoking (model 2; hazard ratio, 0.70 [95% CI, 0.59–0.83] per SD; p&lt;0.005). A lower pressure wave index is associated with an increased risk of CVD events (cumulative event trajectories from Kaplan-Meier analysis are shown in Fig. 1). Conclusion: Our results demonstrate that the proposed uncalibrated carotid pressure wave index, which can be acquired using affordable non-invasive devices like wearable electronics, is an indicator of vascular health and cardiovascular disease risk.
Abstract 4142836: Association of Lipoprotein(a) with Cardiovascular Outcomes Across the Spectrum of HbA1c Levels
Authors: Pamela Alebna, Mathew Ambrosio, Divine Akakpo, Gabrielle Bolden, Alexander Razavi, Nicholas Chew, William Hundley, Fadi Salloum, Laurence Sperling, Michael Shapiro, Harpreet Bhatia, Anurag Mehta
Journal: Circulation (2024)

Introduction: Both Lipoprotein(a) [Lp(a)] and Hemoglobin A1c (HbA1c) are established independent predictors of major adverse cardiovascular events (MACE). Evidence suggests there is an inverse association between Lp(a) concentration and risk of T2DM. While prior studies have evaluated the effect of Lp(a) on DM incidence, the association of Lp(a) with MACE across the spectrum of HbA1c and a potential interaction between the two markers has not been evaluated. This study assessed the association between Lp(a) and cardiovascular outcomes across HbA1c levels. Methods: This analysis included 356,054 participants from the UK Biobank. Non-elevated and elevated Lp(a) levels were categorized as &lt;125 nmol/L and &gt; 125 nmol/L, respectively. Participants with HbA1c levels below the 0 percentile (&lt;4.3%) and above the 99.9th percentile (&gt;9.0%) were excluded, totaling 2,342 individuals (less than 1% of the entire data). These values were excluded due to the poor performance of the spline model at the extremes. MACE was defined as a composite of myocardial infarction (MI), stroke, and cardiovascular death. The association of elevated Lp(a) with MACE was evaluated using a Cox proportional hazards regression model. A quadratic spline function of baseline HbA1c by Lp(a) was used to analyze the association of elevated vs. non-elevated measures of Lp(a) with MACE across a continuum of baseline HbA1c values. Secondary analyses were performed for the risk of MI, stroke, and heart failure. Results: There were 39,934 participants with Lp(a) &gt; 125 nmol/L (11.22%). The mean age was 56.5 years, 54.4% were women, and 94.2% were White. The mean HbA1c was 5.5% ± 0.6%. During a median follow-up of 14.3 years, there were 18,848 MACE (5.29%), including 10,826 MIs, 6,746 strokes, and 3,780 cardiovascular deaths. Elevated Lp(a) level (HR 1.20; 95% CI: 1.09 -1.32) and higher HbA1c (per 1% increase, HR 1.45; 95% CI: 1.38 -1.53) were independently associated with MACE. Across a continuum of HbA1c values, MACE was consistently higher and stable in participants with elevated Lp(a). (Figure). The interaction between Lp(a) and HbA1c in the quadratic spline model was not significant. A similar trend was observed for MI, stroke, and heart failure risk. Conclusion: Elevated Lp(a) and HbA1c are independently associated with MACE risk. HbA1c values do not modify the relationship of Lp(a) with MACE, suggesting that measurement of Lp(a) should be prioritized for individuals with and without DM
Abstract 4142124: Transcatheter mitral edge-to-edge repair in a patient with symptomatic SAM and LVOT obstruction following surgical robotic mitral valve repair
Authors: Andrew Chiou, Fady Ibrahim, Steven Romero, Matthew Price
Journal: Circulation (2024)

Background: Persistent systolic anterior motion (SAM) following robotic mitral valve repair can lead to symptomatic left ventricular outflow tract (LVOT) obstruction. Percutaneous mitral valve edge-to-edge repair using MitraClip to manage LVOT obstruction from SAM following mitral valve repair has been rarely reported. Case: A 64-year-old male with history of mitral regurgitation from posterior leaflet prolapse who underwent robotic mitral valve repair with posterior leaflet butterfly resection and 38 mm Cosgrove annuloplasty band presented with progressive dyspnea with exertion and fatigue three years later. Transesophogeal echocardiogram (TEE) revealed 3+ mitral regurgitation (MR) (mean mitral valve pressure gradient 4.2 mmHg, heart rate 88 bpm) and SAM of the mitral valve with LVOT obstruction (resting gradient of 78 mmHg). He underwent a left heart catheterization to accurately measure the LVOT gradient with Dobutamine infusion. Baseline LVOT gradient was 20 mmHg that increased to 40 mmHg, 60 mmHg, and 140 mmHg with Stage 1 (5 mcg/kg/min), Stage 2 (10 mcg/kg/min), and Stage 3 (20 mcg/kg/min) of Dobutamine infusion, respectively. Decision-Making: Given his symptomatic LVOT obstruction from SAM, he was initially referred to CT Surgery for consideration of mitral valve replacement, however, given his desire to avoid long-term anticoagulation and risk of redo surgery, he was evaluated for percutaneous management. He underwent TEE guided transcatheter mitral edge-to-edge repair using a single XTW MitraClip with capture of the A2 and P2 leaflets. Post-procedural transthoracic echocardiogram (TTE) revealed trace MR and no SAM or LVOT obstruction with a resting LVOT gradient of 8 mmHg. At outpatient follow up, his shortness of breath and fatigue had significantly improved. Conclusion: Mitral valve edge-to-edge repair using MitraClip can be a safe and effective management option for patients who develop persistent SAM resulting in symptomatic LVOT obstruction following mitral valve repair.
Abstract 4142036: Association of smoking status with incident heart failure among patients with chronic kidney disease: Insights from CRIC
Authors: Valentina Castro, Sushrut Waikar, Finnian Mc Causland
Journal: Circulation (2024)

Introduction: Smoking is a well-known risk factor for atherosclerotic cardiovascular disease and kidney failure among patients with chronic kidney disease (CKD). However, the association of former and current smoking status (vs. never) with incident heart failure (HF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) among patients with CKD warrants further exploration. Methods: Using data from participants of the Chronic Renal Insufficiency Cohort, without a history of HF, we used Cox regression models to estimate the association of smoking status (never, former, current) with incident HF. We also fit linear regression models to explore the association of smoking status with log-transformed NT-proBNP. Models were adjusted for demographics, comorbid disease, medications, systolic blood pressure, and socioeconomic variables (including income, education, marital status, illicit drug use, and alcohol use). Results: Of the 5,083 included participants, 2,423 (48%) were never smokers, 2,030 (40%) were former smokers, and 630 (12%) were current smokers. Over a median follow-up of 6.7 years, there were 664 HF events. In adjusted analyses, compared with never smokers, the risk for future HF events was non-significantly higher for former smokers (HR 1.10; 0.89, 1.35), but significantly higher for current smokers (HR 1.68; 95%CI 1.26, 2.24; Table 1). Similarly, compared with never smoking, former smoking was non-significantly associated with NT-proBNP (-3%; 95%CI -12, +6%), while current smoking was associated with higher NT-proBNP (+24%; 95%CI +9%, +42%). Conclusion: Current smoking status, but not former smoking, is associated with higher NT-proBNP and a higher risk of incident heart failure among patients with CKD. Enhanced public health efforts to promote smoking cessation among patients with CKD may be relevant to prevention of HF.