tbuckley/cabot-search huggingface dataset:
Abstract 4139458: Trends and Disparities in Arrhythmia-Related Deaths among Older Adults in the United States, 1999-2020
Authors: Muhammad Rafay Shahzad Cheema, Abdulqadir J. Nashwan
Journal: Circulation (2024)

Background: Cardiac arrhythmias significantly contribute to mortality in the United States (US), especially among older adults. This study examines two decades of mortality data to identify patterns and disparities in arrhythmia-related deaths across various demographics and regions. Hypothesis: The study hypothesizes that there are discernible patterns and disparities in cardiac arrhythmia-related mortality rates based on factors such as sex, race/ethnicity, and geographic region. It also seeks to determine whether these mortality rates have changed significantly over the past two decades. Aims: The objective is to identify patterns and disparities in cardiac arrhythmia-related mortality rates in the US older population over the past two decades Methods: Data were obtained from the CDC WONDER (1999-2020) focusing on arrhythmia-related deaths identified by ICD-10 codes I47, I48 and I49. The study examined demographic and regional patterns of mortality, employing statistical techniques for analysis. Joinpoint regression analysis was utilized alongside calculations of age-standardized mortality rates (ASMR) per 10,000 population and annual percentage change (APC). These metrics were stratified by year, sex, race/ethnicity, and geographic region to assess and compare variations in mortality trends over time Results: From 1999 to 2020, 3,516,612 arrhythmia-related deaths occurred in the US. ASMR per 10,000 increased from 38.0 in 1999 to 47.0 in 2020. Mortality rates decreased from 1999 to 2009 (APC: -0.9; 95% CI: -1.8, -0.4, p = 0.007), increased from 2009 to 2018 (APC: 1.5; 95% CI: 0.4, 2.3, p = 0.021), and significantly rose from 2018 to 2020 (APC: 7.4; 95% CI: 3.5, 9.4, p &lt; 0.001). Men accounted for 45.8% of deaths, with an ASMR of 45.2 compared to 33.0 for women. Non-Hispanic (NH) Whites had the highest ASMRs (40.5), followed by NH Blacks (31.1), NH American Indians (28.3), Hispanics (22.7), and NH Asians (19.7). The Midwest had the highest ASMRs (41.2), followed by the West (38.8), South (36.4), and Northeast (36.3). Nonmetropolitan areas had higher ASMRs (42.1) compared to metropolitan areas (37.2) Conclusions: After initially declining from 1999 to 2009, arrhythmia-related mortality have increased thereafter with evident disparities. Highest ASMRs were found in NH White and male populations, and in the Midwest and nonmetropolitan regions. These findings underscore the need for targeted interventions to reduce such mortality, particularly among vulnerable groups
Abstract 4139978: Multi-Modality Imaging Characteristics and Survivals By Aortic Stenosis Subtypes In Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Elio Haroun, Aro Daniela Arockiam, Tiffany Dong, Ankit Agrawal, Rishabh Khurana, Joseph El Dahdah, Mohammad Alamer, Joseph Kassab, Jaideep Singh Bhalla, Kashyap Bodi, Serge Harb, Zoran Popovic, L Rodriguez, Rishi Puri, Grant Reed, Amar Krishnaswamy, Brian Griffin, Samir Kapadia, Tom Kai Ming Wang
Journal: Circulation (2024)

Background: Discrepant transthoracic echocardiography (TTE) parameters are not infrequently observed in patients with significant aortic stenosis (AS), however, there is limited literature regarding their computed tomography (CT) characteristics and prognostic implications. Aims: We compared the multi-modality imaging characteristics and outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) by AS subtype. Methods: Patients with severe AS (defined as aortic valve area &lt;1.0 cm2 on TTE, n=906, age 79±9 years, 41.5% women) undergoing TAVR during 2019-2020 were classified by TTE as high-gradient (HG-AS, n=446, LVEF 61 ±8%), classical low-flow low-gradient (CLFLG-AS, n=121, LVEF 37 ±9%), paradoxical low-flow low-gradient (PLFLG-AS, n=261, LVEF 61 ±6%) and normal-flow low-gradient (NFLG-AS, n=78, LVEF 62 ±6%) AS. TTE and CT characteristics and all-cause mortality during follow-up were compared. Results: Aortic valve area by TTE (continuity equation) and CT (planimetry) were lowest for HG-AS patients (means 0.70cm 2 and 1.04cm 2 ), and highest for NFLG-AS patients (0.86cm 2 and 1.18cm 2 ), while aortic valve calcium score (AVCa) on CT was higher for HG-AS patients than other groups (2471HU versus 2009-2180 HU). Kaplan-Meier survival curves by AS subgroup are shown in the figure. Low-gradient AS subgroups (compared with HG-AS) remained independently associated with worse survival with hazards ratio 2.04 (95% confidence interval 1.50-2.77) even after adjusting for other clinical and AS imaging parameters. Conclusion: Characteristic TTE and CT features by AS subtypes are reported. TAVR patients with low-gradient AS (CLFLG-AS, PLFLG-AS and NFLG-AS) continue to have worse prognosis than HG-AS, highlighting the need for further research in these patients to improve their management and outcomes.
Abstract 4139347: Clinical Outcomes of Endovascular versus Surgical Revascularization in Frail and Non-Frail Older Adults
Authors: Darae Ko, Chan Mi Park, Peter Evans, Ashvin Pande, Naomi Hamburg, Dae Hyun Kim
Journal: Circulation (2024)

Background: Recent clinical trials (BEST-CLI and BASIL-2) have produced divergent results comparing endovascular vs surgical therapy in chronic limb-threatening ischemia (CLTI). The difference may be related to varying levels of frailty among the patient included. Objective: To compare the risk of major adverse limb events (MALE) or death in endovascular vs surgical therapy in real-world older adults with and without frailty Methods: We applied target trial emulation framework. This retrospective study using the 2016-2022 Medicare data included patients aged ≥65 years with CLTI who underwent surgical or endovascular therapy without revascularization in the prior year. Frailty was defined as a claims-based frailty index ≥0.25. The primary outcome was a composite of MALE or death. After propensity score (PS) matching, we estimated hazard ratios (HRs) using the Cox proportional hazards model for the total population and by frailty levels. Results: Before PS matching, the endovascular group (n=37513) was older (78 vs 76 years), more likely to be women (43% vs 39%), dually eligible for Medicaid (35% vs 28%), frail (56% vs 40%), and more likely to have diabetes (79% vs 67%), chronic kidney disease (81% vs 68%) and prior stroke (32% vs 27%) compared to the surgical group (n=8754). After PS matching (n=8116 per group), surgical therapy was associated with a lower rate of the primary outcome in the total population (55 vs 77 per 100 person-years, HR 0.73, 95% CI 0.70-0.77). The benefit of surgical therapy was consistent in frail patients (71 vs 95 per 100 person-years, HR 0.76, 95% CI 0.71-0.81) and non-frail patients (45 vs 67 per 100 person-years, HR 0.68, 95% CI 0.64-0.73) (Figure). Mortality rates per 100 person-years for surgical and endovascular groups were 42 and 47, respectively, in frail patients and 17 and 22 in non-frail patients. Conclusion: The effect estimates from our real-world data study were consistent with the effect estimate from BEST-CLI trial, with no treatment effect heterogeneity by frailty levels. The rate of primary outcome was very high in the frail group with nearly half dying within one year after surgical or endovascular therapy.
Abstract 4139434: Promotion of cardiac fibrosis and heart failure by LMCD1
Authors: Joice Thomas Gavali, Qing Qin, Nopprarat Tongmuang, ross summer, Jianxin Sun
Journal: Circulation (2024)

Introduction: Cardiac fibrosis is a typical pathophysiological process associated with ECM deposition, resulting in tissue scaring and organ dysfunction. No specific antifibrotic therapies exist for cardiac fibrosis, mainly because of a limited understanding of disease mechanisms. The activated fibroblasts secrete numerous fibrotic factors and ECM components, thus contributing to the development and progression of cardiac fibrosis. LMCD1 (LIM and cysteine-rich domain) is a member of the LIM family of proteins, which is highly expressed in the heart, and its expression is markedly reduced in heart failure (HF) patients. The role of LMCD1 in cardiac fibrosis remains poorly understood. This study aims to define the role of LMCD in cardiac fibrosis and the molecular mechanisms involved. Methods: The expression of LMCD1 in cardiac myocytes and fibroblasts from adult mouse hearts was determined by western blot analysis. TGF-β1 was used to induce cardiac fibrotic responses in vitro in human cardiac fibroblasts. A loss-of-functional approach was used to determine the functional significance of LMCD1 in cardiac fibrosis. Global LMCD1 KO mice were utilized to determine the functional significance of LIMCD1 in cardiac fibrosis and remodeling in vivo using a murine model of angiotensin II (AngII)-induced fibrosis. Echocardiography was performed to measure the cardiac function. Results: LMCD1 is highly expressed in human CFs, and its expression is markedly upregulated in a time and dose-dependent manner in response to the treatment of TGF-β1. Furthermore, we found that LMCD1 expression was markedly increased in the heart in mice after 4 weeks of Ang II infusion. In human CFs, LMCD1 knockdown significantly prevented TGF-β1-induced expression of fibrotic genes, and LMCD1 KO mice are protected from developing cardiac fibrosis induced by Ang II infusion. Protein and mRNA levels of fibrotic genes were significantly reduced in the heart of LMCD1 KO mice compared to their WT controls. Ang II infusion significantly increased LVAW and LVPW in WT mice, which were markedly attenuated in LMCD1 KO mice. Mechanistically, we found that TGF-β1-induced phosphorylation levels of SMAD2/3 were substantially decreased in LMCD1-deficient CFs. Conclusion: Our findings identified LMCD1 as a critical regulator in promoting cardiac fibrosis by targeting TGF-β1/SMAD signaling and suggested that targeted inhibiting LMCD1 may represent a novel therapeutic strategy to ameliorate cardiac fibrosis.
Abstract 4139631: Long Sleep Duration is Associated with an Increased Risk of Stroke
Authors: Ben Thiravetyan, Vitchapong Prasitsumrit, Tulaton Sodsri, Terasut Numwong, Sireethorn Wonghanchai, Nutchapon Xanthavanij, Watsachon Pangkanon, Narathorn Kulthamrongsri, Prin Vathesatogkit
Journal: Circulation (2024)

Background: Several studies have explored the association between sleep duration and cardiovascular outcomes, but the results have been contradictory. Additionally, there are limited studies conducted within the Asian population. Goal: This study aims to assess the relationship between sleep duration and cardiovascular outcomes in the Asian population. Methods: This cross-sectional study used data from a survey of employees at the Electricity Generating Authority of Thailand (EGAT). Baseline demographics, sleep history, and the presence of cardiovascular diseases were collected in 2012. Self-reported usual sleep and wake times were used to calculate sleep duration. Participants were categorized into 3 groups based on sleep duration: short (&lt; 6 hours), normal (6-8 hours), and long (&gt; 8 hours). Logistic regression analysis was used to assess the association between sleep duration and cardiovascular outcomes, with the normal sleep duration group as a reference. Adjustments were made for variables as shown in the table. Results: Among 1571 participants enrolled, 6%, 77%, and 17% were categorized into the short, normal, and long sleep duration groups, respectively. The mean (SD) age was 69 (4.6) years, and 73% were male, consistent across all groups. The median (IQR) sleep duration was 5 (4.5-5.0) hours, 7 (6.5-8.0) hours, and 9 (8.5-9.5) hours for the short, normal, and long sleep duration groups. Among these three groups, participants in the long sleep duration group had higher levels of HbA1C (p=0.049) and triglyceride (p=0.005), but a lower level of HDL cholesterol (p=0.003). Multiple logistic regression analysis demonstrated that long sleep duration was significantly associated with stroke, with an odd ratio (OR) of 3.25 (95% CI 1.27-8.36), and showed a non-significant trend towards a higher risk of coronary heart disease. We found no significant association between short sleep duration and cardiovascular outcomes. Conclusion: Long sleep duration is associated with an increased risk of cardiovascular diseases, especially stroke. Additional studies with larger sample sizes are needed to investigate the effects of short sleep duration.
Abstract 4139309: Rural-Urban Differences in Cardiovascular Mortality in the United States, 2010-2022
Authors: Lucas Marinacci, ZhaoNian Zheng, Rishi Wadhera
Journal: Circulation (2024)

Background: Between 2011-2017, US rural adults experienced higher cardiovascular (CV) death rates than their urban counterparts, and rural-urban disparities in CV mortality widened. Little is known about these trends have evolved in the wake of the pandemic. In this study, we provide an updated analysis of rural-urban differences in CV mortality. Methods: We used CDC WONDER to obtain national death data from 2010-2022. CV cause of death was identified by ICD-10 codes I00-99. Large metro, small/medium metro, and rural areas were defined using the National Center for Health Statistics Urban-Rural Classification. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population and compared 2022 vs. 2010 using rate differences and two-sample t-tests. We then fit a Poisson regression model to estimate annual percent change (APC), evaluating trends from 2010-2019 and 2019-2022 due to reversal in CV mortality observed after 2019. We included an interaction term to assess differential trends by rurality, and repeated the analysis for younger (age 25-64) and older (age&gt;64) adults. Results: Between 2010-2022, AAMRs were consistently highest in rural areas ( Figure 1, Table 1 ). AAMRs increased in rural areas (rate difference [RD] +3.4 [95% CI 0.4, 6.4]) but declined in urban areas (RD -23.8 [-25.3, -22.2]). This significant differential change was driven by a rise in AAMRs among younger, rural adults (RD +23.2 [21.2, 25.1). In contrast, older adults experienced a decline in AAMRs, though this reduction was greater in urban vs. rural areas ( Table 2 ). From 2010-2019, overall APCs in AAMR decreased for all areas. However, when stratified by age, younger rural adults saw a significant increase (+1.0% [95% CI 0.5, 1.5]), while those in large metro areas did not (-0.2% [-0.5, 0.1]). Older adults saw a significant decrease across all areas. Between 2019-2022, the overall APC in AAMR increased significantly in rural areas (+3.1% [0.4, 6]), but in not large metro areas (+1.2% [-0.4, 2.9]). CV mortality rose in most subgroups, but younger rural adults experienced the largest increase (+4.2% [1.3, 7.1]) ( Table 2 ). Conclusions: Between 2010-2022, CV mortality increased in rural areas and decreased in urban areas. Younger, rural adults experienced the most pronounced rise in CV death, while older, urban adults experienced the steepest decline. These findings highlight an urgent need to address widening rural-urban disparities, particularly among younger adults.
Abstract 4139985: The impact of severity of right atrial dyssynchrony on mortality in patients with submassive pulmonary embolism
Authors: Yoshiyuki Orihara, Shunsuke Eguchi, Ayumi Eguchi, Michael Pfeiffer, Brandon Peterson, Mohammed Ruzieh, John Boehmer, John Gorcsan, Ryan Wilson
Journal: Circulation (2024)

Background: Right atrial (RA) function contributes 15 - 30% to right ventricular stroke volume. However, limited studies have evaluated RA function in the setting of submassive pulmonary embolism (PE). We investigated whether the severity of right atrial dyssynchrony was associated with short-term mortality in patients with submassive PE. Methods: We performed a retrospective cohort study of 251 patient with submassive PE. Strain analysis was applied retroactively using TomTec software. 201 patients had images sufficient for RA strain analysis. RA dyssynchrony was defined as absolute max opposing wall delay (maxOWD) which was the time interval between peak lateral and septal wall strain in RA (Figure1) The primary outcome was 30-day all-cause mortality. The severity of dyssynchrony was defined according to max OWD and divided into four groups; no delay, first tertile (mild), second tertile (moderate), and third tertiles (severe). Results: The patient groups were defined as follows: no delay (0 ms; n = 40), first tertile/mild delay (&gt; 0 ms, ≤ 4.49 ms; n = 52), second tertile/moderate delay (&gt; 4.49 ms, ≤ 13.1 ms; n = 51), and third tertile/severe delay (&gt; 13.1 ms; n = 52). Of 201 patients, 23 patients (11 %) died within 30 days after diagnosis. Kaplan-Meier curves showed significant difference among the four groups (p &lt; 0.001). Additionally, there were significant differences between no delay and moderate delay groups (p = 0.0321) and between moderate and severe delay groups (p=0.010). (Figure2) Moreover, patients with severe RA dyssynchrony had 7.3 times higher risk of 30-day mortality compared to patients in other groups (p &lt; 0.001). Conclusions: The severity of RA dyssynchrony on presentation was associated with mortality in patients with submassive PE. Assessment of RA dyssynchrony on presentation could risk stratify patients with submassive PE.
Abstract 4139975: Field of View of Atrial Electrodes by Endocardial and Epicardial Computer Mapping
Authors: Miguel Rodrigo, Samuel Ruiperez-Campillo, Sanjiv Narayan
Journal: Circulation (2024)

Background: Mapping atrial fibrillation (AF) electrograms at each position on a multipolar catheter is complicated by the impact of far-field signals from colliding and chaotic wavelets. The actual field of view of unipolar and bipolar electrodes of different sizes and separations is undefined, yet may substantially impact recorded AF maps. Hypothesis: We tested the hypothesis that the field of view (antenna) of EGMs can be defined based on the size of electrode, their spacing, and tissue characteristics including conduction velocity using biophysical models of active myocardial tissue. Methods: We modeled conduction in atrial tissue of size 30 x 30 x 3 mm, to estimate the region around clinical Advisor TM HDGrid (Abbott), Octaray TM or Optrell TM (Biosense-Webster) multipolar catheters. We tested various 1 mm electrode configurations, separated by 2 mm, 5 mm and 10 mm. Using models discretized into 100,000 and 100 nodes, we varied conduction velocities and propagation directions to simulate myocardial propagation (fig. A). The EGM was constructed using the electric potential transfer equation between the tissue and the electrode, discretized for each tissue node to evaluate individual contributions of atrial regions to unipolar and bipolar EGMs. We defined the spatial near field as regions contributing &gt; 30% of signal amplitude. Results: Transverse recording antenna varied substantially with bipolar configuration. In Figure B, the unipolar electrode recorded near field activity within a 3D ellipsoid of radius 8 mm across-tissue and 2.7 mm transmurally with a 1.9 endo-to-epicardial amplitude ratio. Bipolar electrodes showed directional antennas for near field, aligned with the propagation direction (fig. C) with radii of 1.7, 5.7 and 8.3 mm for 2, 5, and 10 mm spacing, respectively (fig. C). Bipolar electrodes showed less transmural variability in near field antenna (range 2-2.7 mm), which was similar to unipolar (fig. D). Conclusions: Current generation multipolar catheters may record apparently “near field” signals in relatively large ellipsoids/spheres of radius 1.7 to ~8 mm. This may substantially impact signal fidelity when the same wave is not present throughout this volume, such as in AF or ventricular fibrillation, and may impact noise detection for atrial and ventricular tachycardia. Signal processing techniques are required to improve near field signal detection.
Abstract 4139313: Prognostic Implication Of Fibrosis-4 Index for Risk Of Mortality In Chronic Heart Failure Patients With And Without Type 2 Diabetes.
Authors: Abdullahi Mohamed, Daniel Christensen, Morten Schou, Gunnar Gislason
Journal: Circulation (2024)

Background and aim: The Fibrosis-4 (FIB-4) score is recommended as a first-line screening tool to rule-out advanced liver fibrosis. It is highly recommended to screen for liver fibrosis in patients with Type 2 diabetes mellitus (T2DM) and elevated liver enzymes using the fibrosis-4 (FIB-4) score.However, this recommendation does not extend to patients with chronic heart failure (CHF) who do not have T2DM. We aimed to investigate the predictors of high risk for advanced liver fibrosis according to the FIB-4 score and its association with all-cause and cardiovascular mortality, as well as major adverse liver outcomes (MALO), in patients with CHF, both with and without T2DM. Methods: This was a nationwide registry-based cohort study. We included patients registered in the Danish Heart Failure Registry who had laboratory data available to calculate FIB-4 scores from April 2003 to December 2019. Patients were classified as low-risk (Fib-4 &lt;1.3), indeterminate-risk (1.3 – 2.67), and high-risk of advanced liver fibrosis (≥2.67). The analysis was conducted using multiple logistic regression and Cox proportional hazards models. Results: A total of 6079 patients with CHF were included in the study. High-risk of advanced liver fibrosis was highly prevalent, affecting 30% of the studied population. Predictors of high-risk of advanced liver fibrosis, included older age, male sex, severe chronic kidney disease, previous myocardial infarction, ischemic heart disease, and atrial fibrillation/flutter. Patients in the high-risk group exhibited a significantly elevated risk of all-cause mortality (HR: 1.30, 95% CI: 1.17-1.45), cardiovascular mortality (HR: 1.80, 95% CI: 1.49-2.17), as well as MALO (HR: 4.42, 95% CI: 2.70-7.23) when compared to those in the low-risk group. This was regardless of the presence of T2DM. Additionally, patients in the indeterminate-risk group showed an increased risk of cardiovascular mortality (HR: 1.22, 95% CI: 1.02-1.46) and MALO (HR: 1.86, 95% CI: 1.13-3.06) when compared to the low-risk group. Conclusion: In this nationwide cohort study, we found a high prevalence of high-risk of advanced liver fibrosis according to the FIB-4 score. Several clinical predictors of high-risk of liver fibrosis was identified. High-risk patients exhibited significantly higher all-cause and cardiovascular mortality, as well as major adverse liver outcomes (MALO), compared to low-risk patients, independent of T2DM status.