tbuckley/cabot-search huggingface dataset:
Abstract 4139879: Impact of Catheter Contact Angle on the Relationship between Contact Force and Local Impedance Change with the Novel Diamond-embedded Temperature-controlled Ablation Catheter in a Porcine Experimental Model
Authors: Sho Ogiso, Hidehira Fukaya, Emiyu Ogawa, Hitoshi Mori, Yuya Masuda, Yuto Yazaki, Yusuke Murayama, Saito Daiki, Yuki Arakawa, Shuhei Kobayashi, Hironori Nakamura, Naruya Ishizue, Jun Kishihara, Shinichi Niwano, Jun Oikawa, Junya Ako
Journal: Circulation (2024)

Background: The DiamondTemp TM (DT) catheter enables precise temperature-controlled ablation. However, the DT catheter lacks contact force measurement capabilities. This study investigated the impact of catheter contact angle on the relationship between contact force and local impedance change in a porcine experimental model. Hypothesis: We hypothesized that a correlation between contact force and local impedance would differ in different contact angles of the DT catheter. Aims: To evaluate the impact of different contact angles (30°, 45°, 90°) of the DT catheter on the relationship between the contact force and local impedance change. Methods: We used freshly sacrificed porcine hearts and set them in the circulated water pool. The contact force (5, 10, and 30 grams) and catheter contact angles (30°, 45°, and 90°) were changed in each set (n = 13 each). Local impedance was measured, and the correlation with contact force was assessed using Spearman's rank correlation coefficient. Results: Strong correlations were found between local impedance rise and contact force at catheter contact angles of 90° (Spearman’s rank correlation coefficient: 0.70, p &lt;0.001) and 45° (0.60, p &lt;0.001). However, there was no correlation between catheter contact force and local impedance rise at 30° (0.31, p = 0.057). Conclusion: Local impedance rise of the DT catheter was correlated with contact force at the catheter contact angle of 90° and 45°; however, it became insignificant at 30°, suggesting that local impedance could not be utilized to speculate contact force in the shallower catheter contact angles.
Abstract 4140229: Hypertension Enhances the Impact of Lipoprotein (a) on Coronary Artery Calcification in Coronary Heart Disease Patients Undergoing Percutaneous Coronary Intervention
Authors: Yulong Li, Kailun Yan, Kexin Zhang, Yue-Jin Yang, Jinqing Yuan, Xueyan Zhao
Journal: Circulation (2024)

Introduction: Both lipoprotein (a) [Lp(a)] and hypertension have been identified as the independent risk factors for atherosclerotic cardiovascular diseases. Coronary artery calcification (CAC) is a highly specific marker of atherosclerosis. However, though the association of Lp(a) and CAC is controversial, the combined effect of hypertension and Lp(a) on CAC remains unclear. Objective: This study aimed to investigate the combined effect of hypertension and Lp(a) on CAC in coronary heart disease patients undergoing percutaneous coronary intervention (PCI). Methods: 10,724 consecutive patients undergoing PCI in 2013 were enrolled. High Lp(a) level was defined as Lp(a)≥30mg/dl. Patients were divided into low-degree CAC group and high-degree CAC group according to the coronary angiography results. (Figure 1) Results: A total of 9,781 patients (mean age, 58.24 ± 10.30; male, 76.8%) who had both Lp(a) and CAC results were finally enrolled for analysis. Multivariate logistic regression analysis (Figure 2) showed that compared with patients without hypertension and high Lp(a), those with only high Lp(a) but without hypertension was not associated with high-degree CAC, which was same as in those with only hypertension but without high Lp(a) (all P &gt;0.05). However, patients with both hypertension and high Lp(a) had significantly higher risk of high-degree CAC (OR=1.180, 95% CI=1.007-1.382, P =0.041). Moreover, age, diabetes and prior coronary artery bypass grafting were relevant risk factors of high-degree CAC (all P &lt;0.05). Conclusions: In this large-scale real-world study, we reported for the first time that patients with both hypertension and high Lp(a) had significantly higher risk of high-degree CAC. In the future, whether targeting on both hypertension and Lp(a) could delay the progression of atherosclerosis and CAC deserves further investigation.
Abstract 4140454: The Outcome of Restrictive Cardiac Allograft Physiology in Severe Coronary Allograft Vasculopathy
Authors: Masaki Tsuji, Jignesh Patel, Michelle Kittleson, David Chang, Evan Kransdorf, Andriana Nikolova, Lily Stern, Nayana Bhatnagar, Jon Kobashigawa
Journal: Circulation (2024)

Background: Microvascular dysfunction after heart transplantation leads to restrictive cardiac allograft physiology (RCP), which is classified to severe coronary allograft vasculopathy (CAV); however, the prognosis of RCP remains unclear. This study aimed to elucidate the prognosis of RCP in comparison with that of severe angiographic CAV. Methods: We assessed patients with RCP defined as mean right atrial pressure &gt;12 mmHg, pulmonary capillary wedge pressure &gt;25 mmHg, and cardiac index &lt;2.0 L/min/m 2 who underwent heart transplantation between 2004 and 2023. The primary outcome was death or re-transplantation. Results: Of the 116 patients with severe CAV, 42 had RCP (RCP-CAV group) and 74 had severe angiographic CAV without RCP (Angio-CAV group). A significantly shorter time from heart transplantation to diagnosis and lower subsequent percutaneous catheter intervention after diagnosis were seen in the RCP-CAV group than in the Angio-CAV group (both p&lt;0.001). The incidence of death or re-transplantation within 5 years after was significantly higher in the RCP-CAV group than in the Angio-CAV group (69.0% vs 50.0%, p=0.047). Freedom from death or re-transplantation at 5 years was significantly worse in the RCP-CAV group compared to the Angio-CAV group (18.4% vs 35.4%, p=0.001). In the Cox proportional hazard model, RCP was independently associated with an increased risk of death or re-transplantation (Hazard ratio 2.08, 95% Confidence intervals 1.26-3.44, p=0.004). Conclusions: The prognosis of patients with RCP was significantly worse than that of patients with severe angiographic CAV. The early detection of microvascular dysfunction and re-transplantation listing may improve the prognosis of patients with RCP.
Abstract 4139922: Differential Impact of Functional Autoantibodies Against Angiotensin II Receptor Type 1 and Endothelin-1 Receptor Type A on Microvascular Obstruction and Adverse Cardiovascular Events According to Infarct Size
Authors: Giovanni Civieri, Marika Martini, Donatella Tansella, Giacomo Bernava, Giulia Masiero, Nicola Meynardi, Martina Perazzolo Marra, Marta Vadori, Laura Iop, Emanuele Cozzi, Sabino Iliceto, Francesco Tona
Journal: Circulation (2024)

Introduction: autoantibodies (AAs) activating angiotensin II receptor type 1 (AT1R-AAs) and endothelin-1 receptor type A (ETAR-AAs) are associated with microvascular obstruction (MVO) and major adverse cardiovascular events (MACE) after ST-elevation myocardial infarction (STEMI). Hypothesis: we hypothesized that the effect of AT1R-AAs and ETAR-AAs on MVO and MACE is stronger in patients with smaller infarct extension. Indeed, while larger infarcts are expected to face more MVO and worse prognosis, AT1R-AAs and ETAR-AAs could explain the quote of STEMI patients with smaller infarct sizes and poor outcomes. Methods: we studied STEMI patients treated with primary PCI between February 2021 and April 2024 at Padua University Hospital ( Fig A) . Blood samples for AAs level measurements were obtained within 12 h of admission. Patients were defined as seronegative, single, or double seropositive according to the AT1R-AA and ETAR-AA seropositivity (&gt;10 U/mL). Cardiac magnetic resonance (CMR) was performed within 30 days after STEMI. Telephonic interviews and medical record revisions were performed to investigate MACE (death, myocardial reinfarction, and hospitalization for HF). Smaller or larger infarct was defined using the median infarct size in the MVO analysis and the median peak troponin level in the MACE analysis. Results: 56 patients (median age 58 yrs, 82% males) underwent CMR. The degree of seropositivity was associated with the prevalence of MVO in patients with a smaller infarct size (p=0.047), but not in those with a larger infarct size (p=0.129) ( Fig B) . A total of 174 patients (median age 61 yrs, 84% males) were investigated for incident MACE. Compared to seronegativity, double seropositivity was associated with a significantly higher risk of MACE in patients with a smaller (p=0.035), but not a larger (p=0.265), infarct extension ( Fig C). The results were confirmed after adjusting for age and infarct-related artery. Conclusions: the degree of autoantibody seropositivity was strongly correlated with MVO and MACE in patients with smaller infarct sizes, suggesting that AT1R-AAs and ETAR-AAs could play a relevant role in patients who, despite relatively small infarcts, face the adverse complications of STEMI.
Abstract 4140044: Female Patients with Occlusive Myocardial Infarction without ST Elevation Experience Longer Delays in Receiving Emergent Reperfusion
Authors: Timea Kisova, Robert Herman, Anthony Demolder, Jakub Bahyl, Hana Hybasek Dzurikova, Stephen Smith, Harvey Meyers, Mark Hellerman, Rinaldo Lauwers, David Pletnickx, Dan Schelfaut, Fadi El Ters, Alain Tanios, Fabrizio Ricci, Davide Rossi, Jozef Bartunek, Emanuele Barbato
Journal: Circulation (2024)

Background: Sex disparities in symptom presentation are well-documented in female patients with Acute Coronary Syndrome (ACS). Moreover, nearly half of the patients with acutely occlusive myocardial infarction (OMI) do not meet the STEMI criteria at admission, leading to delays in receiving emergent reperfusion. This delay may be more pronounced in female OMI patients without ST-elevation (NSTEMI-OMI), potentially due to differences in symptom presentation and recognition. Purpose: To investigate disparities in delays from admission ECG to percutaneous coronary intervention (PCI) between male and female patients with acute OMI stratified according to the presence of STEMI criteria. Methods: Electrocardiograms (ECGs), laboratory and coronary angiography (CAG) data were sourced from a total of 623 consecutive OMI patients from five international cohorts from 2012 to 2023. The final diagnosis of OMI was adjudicated by two expert physicians based on all available data. Patients were stratified into STEMI-OMI and NSTEMI-OMI based on their initial admission ECG and time-to-PCI: &lt;2hrs vs. &gt;2hrs, respectively. Each cohort was further subdivided based on sex (male vs. female). Results: A total of 314 STEMI-OMI patients (24% female) and 309 NSTEMI-OMI (30% female) were included in the analysis. Median ECG-to-balloon (E2B) time between STEMI-OMI and NSTEMI-OMI patients was 48 minutes and 17.1 hours, respectively (p&lt;0.001). Female STEMI-OMI patients had an E2B of 47.0 minutes (95% CI: 30-78), compared to 50.6 minutes (95% CI: 30-72) for male patients, respectively, and did not differ significantly (p=0.85) (Fig 1A). In NSTEMI-OMI, female patients had a significantly longer median E2B time of 20.1 hours (95% CI: 10.2-48.2) as compared to 15.7 hours (95% CI: 5.6-28.0) (p=0.002) in male patients (Fig 1B). Conclusion: The present international multi-centric validation of consecutive patients with acute coronary occlusion reveals a significant sex disparity in NSTEMI-OMI patients, with female patients experiencing a 4.4-hour delay to reperfusion compared to males. These findings highlight the need for unbiased diagnostic strategies to address sex differences in ACS presentation.
Abstract 4140002: Health Literacy Exacerbates Neighborhood Social Vulnerability in Older Black and Hispanic Adults with Heart Failure: Results from the SCAN-MP Study
Authors: Shabatun Islam, Sergio Teruya, Denise Fine, Natalia Sabogal, Sergylensky Fils, Ikram Ullah, Anya Sanchorawala, Edward Miller, Cesia Gallegos, Cinthia de Freitas, Damian Kurian, Natalia Ionescu, Ivrose Janvier, Farbod Raiszadeh, Jared Magnani, Mathew Maurer, Frederick Ruberg
Journal: Circulation (2024)

Introduction: Neighborhood residence and health literacy are associated with cardiovascular outcomes, however their interactions in minoritized populations are unknown. We evaluated the association between neighborhood social vulnerability, heart failure hospitalization (HFH), and all cause mortality in a cohort of older Black and Hispanic individuals with prior diagnosis of HF in the northeastern US. Hypothesis: Individuals living in the most socially vulnerable neighborhoods have the highest HFH and 12-month mortality, and having limited health literacy will exacerbate these effects. Methods: We recruited individuals &gt;60 years self-identified as Black race or Hispanic ethnicity with heart failure as part of the Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Population ( SCAN-MP) study. We assessed their social vulnerability index (SVI) at the census-tract level; health literacy (HL) with the Newest Vital Sign; and symptom burden with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Cox proportional hazards ratio models evaluated the association between participants’ SVI and HFH (with death as competing risk) and 12-month mortality. We assessed interaction of HL with SVI. Outcomes were stratified for those with limited health literacy. Results: Of 619 participants (mean age 73y, 51% women, 85% Black race), 50% lived in neighborhoods of extreme vulnerability (&gt;89 th percentile national ranking of SVI). Individuals in the highest quartile (versus lowest) of SVI had increased HF symptoms (KCCQ Overall Score 64.8 vs. 70.6) and lower adequate health literacy (10% vs. 19%). After adjusting for age, sex, ethnicity, and gait speed, the highest quartile of SVI (vs. lowest) experienced higher HFH with death as competing risk (HR 1.71 [1.06, 2.76], p=0.03) and higher 12-month mortality (HR [95% CI] 5.17 [1.13, 23.69], p=0.03). Formal test of interaction for health literacy was significant for HFH (p=0.04), but not mortality (p=0.99). In stratified analysis of those with limited health literacy, living in the most vulnerable neighborhood was especially associated with higher HFH (HR 2.69 [1.48, 4.88], p=0.001). Conclusion: Older Black or Hispanic individuals with HF residing in neighborhoods with higher SVI had increased HFH and 12-month mortality. HL modified the association with HFH. These results suggest that addressing health literacy may impact the risk of HFH among those in the most vulnerable neighborhoods.
Abstract 4140452: Impact of Beta-Blocker Dosage on All-Cause Mortality Post-Myocardial Infarction in Patients with Ejection Fraction ≥50%
Authors: Ghaith Zaatari, Raul Mitrani, Jeffrey Goldberger
Journal: Circulation (2024)

Background: The recent REDUCE-AMI trial showed no benefit to beta-blockers (BB) for patients post-myocardial infarction (MI) with preserved ejection fraction (EF≥50%). Target doses were metoprolol 100 mg and bisoprolol 5 mg daily (50% of the target doses used in the initial randomized clinical trials [RCTs] of BB post-MI). Research question: Do lower BB doses improve survival in post-MI patients with EF≥50%? Aims: To compare the effect of BB dose on all-cause mortality post-MI in patients with EF≥50%. Methods: This is a sub-study from the OBTAIN prospective multi-center registry. Of 7057 patients enrolled with acute MI, 3402 with EF≥50% were discharged alive (age:62.5±13.4 years, 67% male, 28% diabetics, length of stay 6.1±6.0 days). Discharge BB dose was indexed to the target daily BB dose used in RCTs, reported as %. Dosage groups were &gt;0-12.5%, &gt;12.5-25%, &gt;25-50%, and &gt;50% of the target dose. Follow-up vital status was obtained by chart review, Social Security Death Index, or direct contact up to 3 years post-MI. Kaplan-Meier (KM) method was used to calculate three-year survival. Cox proportional hazard regression model was used to identify significant predictors and conduct univariate and multivariate analysis. Results: The KM 3 year survival estimates were 89.0% and 84.3% for patients on and off BB, respectively (unadjusted hazard ratio (HR)=0.66, p=0.012; adjusted HR=0.52, p=0.18). The KM 3 year survival estimates(figure) were 89.8%, 91.0%, 87.9%, and 83.1% for patients on &gt;0-12.5%, &gt;12.5-25%, &gt;25- 50%, and &gt;50% of the BB target dose (unadjusted HR of 0.58, p=0.007; 0.58, p=0.003; 0.70; p=0.066; and 0.98, p=0.93), respectively, compared to no BB. After multivariate analysis, BB target dose showed similar trend, but not statistically significant (adjusted HR=0.65, p=0.46; 0.42, p=0.13; 0.53, p=0.31; 1.01, p=0.92). Conclusion: In OBTAIN, patients treated with low dose BB (≤25% of the target dose) had improved survival post-MI. As this dose was not studied in REDUCE-AMI, these findings are complementary and confirm only that high dose BB therapy provides no benefit post-MI in patients with preserved EF. RCTs to assess the benefit of low dose BB therapy post-MI with preserved EF are needed.
Abstract 4140467: The Effect of PCSK9 Inhibition With Alirocumab in Patients With Probable Familial Hypercholesterolemia or Type III Hyperlipoproteinemia: Results from the ODYSSEY OUTCOMES Trial
Authors: Gregory Geba, Kusha Mohammadi, AMY DAMASK, Charles Paulding, Luca Lotta, George Hindy, Robert Pordy, Garen Manvelian, Michael Shapiro, Vera Bittner, Deepak Bhatt, Michael Szarek, Gregory Schwartz, Philippe Steg, Sergio Fazio
Journal: Circulation (2024)

Background: Patients with acute coronary syndrome (ACS) and elevated LDL-C levels despite statin therapy may have genetic dyslipidemias, such as heterozygous familial hypercholesterolemia (HeFH) or type III hyperlipoproteinemia (T3HLP), which convey heightened cardiovascular (CV) risk due to lifelong exposure. In this post hoc analysis of the ODYSSEY OUTCOMES trial, we identified patients likely affected by HeFH or T3HLP and evaluated the lipid-lowering and CV efficacy of alirocumab. Methods: Clinical HeFH was based upon ACS at age &lt;55 (males) or &lt;60 (females) with back-calculated untreated LDL-C ≥250 mg/dL, or ACS at any age with back-calculated LDL-C ≥330 mg/dL. T3HLP was based upon non-HDL-C:apolipoprotein (apo)B ratio &gt;2.6, which was validated using the UK Biobank database. Additionally, a pharmacogenomics (PGx) subgroup (n=11,880) was studied for variants in genes causing HeFH and for apoE genotypes (T3HLP). Results: Clinical HeFH was identified in 6.7% of the full trial cohort and 5.9% of the PGx subgroup. In the PGx subgroup, 295 patients (2.5%) had genetically confirmed HeFH, 45.8% of whom also qualified as clinical HeFH. Baseline LDL-C was higher in patients with vs without clinical or genetic HeFH ( Table ). Percent LDL-C-lowering was lower but absolute LDL-C lowering and hazard ratio for major adverse CV events (MACE) with alirocumab were similar in patients with versus without clinical or genetic HeFH. Only 0.09% of subjects in the UK Biobank carried the T3HLP biomarker ratio, with 89% of these carrying the apoE2/2 homozygote genotype. Only 30 of 18,924 patients (0.16%) in the trial were classified as T3HLP. Of these, 13 were in the PGx subgroup of whom 7 (53.8%) were apoE2/2 homozygotes. Lipid responses to alirocumab in patients with T3HLP were comparable with those in the overall population (&gt;50% LDL-C lowering and numerically lower MACE rate). Conclusions: In this post hoc analysis of ODYSSEY OUTCOMES, individuals with HeFH were common and those with T3HLP were rare. Carriers of either genetic condition benefited from alirocumab in terms of lipid response and clinical outcomes.
Abstract 4140382: Does pain predict physical function, cognitive function, activities of daily living, or health-related quality life among adults with heart failure?
Authors: Asa Smith, Miyeon Jung, Susan Pressler
Journal: Circulation (2024)

Introduction: Although an estimated 54% of patients with heart failure (HF) and chronic pain report high symptom-associated distress, it is unclear whether pain predicts reduced physical function, cognitive function, independent activities of daily living (IADL) or health-related quality of life (HRQL) over time. The aims were to evaluate baseline pain presence as a predictor of physical function, cognitive function, IADL, and HRQL at baseline, 10 weeks, 4 months, and 8 months after baseline. Methods: In a retrospective longitudinal secondary analysis, data were analyzed from 237 participants with HF enrolled in the Cognitive Intervention to Improve Memory in Heart Failure Patients study. Pain presence was measured with the Health Utilities Index Mark-3 Questionnaire (HUI-3), physical function was measured by the Timed Up and Go (TUG), cognitive function was measured with the Montreal Cognitive Assessment (MoCA), IADL was measured by the Everyday Problems Test (EPT), and HRQL was measured by the Minnesota Living with Heart Failure Questionnaire (LHFQ). Descriptive statistics, independent t-tests, and linear mixed models were used to achieve the aims while controlling for gender. Results: The demographics were mean age 66.31 ± 12.02 years, gender 46% men, 54% women, race 13.5% Black, 85.7% White, 0.8% Other, NYHA class I: 9.7% II: 37.6% III: 52.7%, average LVEF: 48.9%. A total of 160 (67.51%) reported pain. In independent t-tests, patients with pain experienced significantly longer (i.e., worse) TUG scores at all timepoints except 10 weeks, and significantly higher (i.e., worse) LHFQ scores at all timepoints (see Table 1). However, in linear mixed models, pain at baseline did not predict TUG scores (F = 1.239, p = .298), MoCA scores (F = 0.148, p = .931), EPT scores, (F = 0.522, p = .668), or LHFQ scores (F = 0.364, p = .779) over time – see Table 1. Conclusions: Patients with HF and pain experienced significantly worse LHFQ and TUG scores at multiple timepoints. However, pain did not significantly predict cognitive function, physical function, IADL, or HRQL over time. Future prospective studies are needed to examine other outcomes associated with pain in this population and utilize more robust pain instruments.