tbuckley/cabot-search huggingface dataset:
Abstract 18244: A Multi-Ancestry GWAS of Calcific Aortic Stenosis Among 2.7 Million Individuals
Authors: Aeron M Small, Line Dufresne, Eric Farber-Eger, Erik Abner, Kristin Corey, Kári Stefánsson, Lincoln Nadauld, Henning Bundgaard, Jiwoo Lee, Johannes Schumacher, Teresa Trenkwalder, Stefan Soderberg, Andrea Ganna, Daniel J Rader, Marta Riise Moksnes, Meng Lin, Fabien Laporte, Susanna Larsson, Gustav Smith, Ron Do, Kaoru Ito, Hilma Holm, Yan Sun, Kelly Kim, PETER WILSON, Christopher J Odonnell, Gina Peloso, Jamie C Engert, George Thanassoulis, Pradeep Natarajan
Journal: Circulation (2023)

Introduction: Calcific aortic stenosis (CAS) is a common, progressive fibrocalcific pathology of the aortic valve without medical therapy. The genetics of CAS remain only partially understood. Methods: We performed a genome wide association study (GWAS) of CAS among 2,799,598 individuals from the International Aortic Valve Genetics Consortium (IAVGC), comprising 28 cohorts. CAS was identified using a common ICD/CPT based phenotype. GWAS were meta-analyzed using inverse variance weighting with adjustment by linkage-disequilibrium score regression (LDSR) intercept. Unique genome-wide significant (GWS) loci and causal genes were annotated by nearest gene and eQTL colocalization. Genetic correlations were performed against atherosclerotic, adiposity, and lipid traits using LDSR with publicly available GWAS (CARDIoGRAMplusC4D for coronary artery disease [CAD], Million Veteran Program for peripheral artery disease [PAD], MEGASTROKE for ischemic stroke [IS], GIANT for body mass index [BMI], and GLGC for lipids). Results: There were 85,329 individuals with CAS (79,397 White, 3,126 Black, 1,403 Hispanic, and 1,403 East Asian) among 2,799,598 individuals. Meta-analysis of GWAS resulted in 224 unique GWS genomic regions, of which 205 were novel. The majority of the GWS genomic regions (134) did not overlap with prior risk loci for CAD, PAD, IS, BMI, or lipids. Genetic correlation demonstrated modest but significant correlations between CAS and CAD ( r =0.26, p=3.3x10 -18 ), PAD ( r =0.41, p=1.4x10 -30 ), IS ( r =0.18,p=2.8x10 -7 ), BMI ( r =0.22,p=8.6x10 -30 ), and lipids (LDL-C r =0.17,p=3.6x10 -10 ;triglycerides r =0.10,p=1.9x10 -5 ; HDL-C r =-0.07,p=8.0x10 -4 ). Conclusions: This largest to-date multi-ancestry GWAS of CAS identified 205 novel genomic regions. We demonstrate that CAS is genetically distinct from cardiometabolic traits, with only modest genetic correlations and with a majority of CAS risk loci having no overlap with cardiometabolic GWAS risk loci.
Abstract 18173: Spinal Cord Protective Strategy Before Extensive Surgical Procedure for Patients With Acute Type A Aortic Dissection
Authors: Fei Xu
Journal: Circulation (2023)

Introduction: Spinal cord injury (SCI) is a devastating complication following total arch replacement (TAR) with frozen elephant trunk (FET) procedure in acute type A aortic dissection (ATAAD). This study aims to evaluate the efficacy of spinal cord protective strategy (SCPS) implemented before this extensive procedure. Methods: Between January 2013 and December 2021, a total of 1105 ATAAD patients underwent TAR with FET procedure. SCPS included preoperative assessment of segment number of the false lumen closest to the spinal cord between T9-L3 level. If segment number exceeded 5, indicating high risk of postoperative SCI, prophylactic cerebrospinal fluid drainage would be conducted. SCPS was performed since June 2017 at our institution (703 patients). The remaining 402 patients were served as the control group. The two groups were compared to assess the efficacy of SCPS in preventing SCI. Results: The average age was significantly higher in the SCPS group (48.9±11.1 vs 46.6±10.0, P&lt;0.001). The patients in SCPS group presented with higher percentage of coma (P&lt;0.001). The mean duration of cardiopulmonary bypass was significantly longer in SCPS group (P&lt;0.001), while the mean duration of hypothetical cardiac arrest was significantly lower (P&lt;0.001). Propensity score matching was conducted, resulting in a matched sample of 186 patients from each group to adjust for differences in patient characteristics. The incidence of postoperative SCI was significantly lower in SCPS group (1.7% vs 7.2%, P&lt;0.001). Propensity score matching demonstrated higher estimated incremental protective efficacy of SCPS (1.1% vs 9.7%, P&lt;0.001). Multivariate logistic regression analysis revealed that preoperative SCPS was an independent protective factor for postoperative SCI (OR=0.226, 95% CI: 0.114-0.448, P&lt;0.001). Conclusions: The implementation of preoperative SCPS is an effective strategy for reducing the incidence of SCI follow extensive surgical procedure in ATAAD.
Abstract 14390: Interatrial Block in the Presence of Lipomatous Hypertrophy of the Interatrial Septum
Authors: Abdulaziz Malik, Kevin John, Mohamad Wahoud, Basel Humos, Guy Rozen, Jennifer Chee, Munther Homoud, Christopher Madias
Journal: Circulation (2023)

Introduction: Interatrial block (IAB) from disruption of conduction through Bachmann’s bundle results in atrial electromechanical dysfunction. Delay in conduction and alteration in the pattern of atrial activation causes P-wave lengthening (≥120 ms) and characteristic biphasic P-waves in the inferior ECG leads. IAB has been associated with atrial arrhythmia and risk of stroke. Generally, the anatomic substrate for IAB is a fibrotic atrial myopathy; however, intertrial masses have also been associated with IAB. Lipomatous hypertrophy of the interatrial septum (LHIS) constitutes an anatomical barrier that could similarly lead to IAB. Hypothesis: The presence of LHIS is associated with an increased prevalence of IAB. Methods: A query of the echocardiography database at our institution from 2017 to present revealed 312 subjects with LHIS. Data collection included demographic characteristics, ECG and echocardiographic parameters. Prevalence of IAB and associated clinical variables were assessed. Results: The mean age was 72 years (56% male). In the total group IAB was present in 131 patients (42%). Comparison between the group with IAB versus without IAB was notable for a higher prevalence of stroke in those with IAB (24 subjects versus 16; p value = 0.013). The prevalence of atrial fibrillation was not statistically different between the two groups, but atrial flutter was noted to be more prevalent in those with IAB (16 subjects vs 9; p value = 0.018). Hypertension and male sex were also associated with IAB. Conclusions: Subjects with LHIS have a high prevalence of IAB, likely consequent to localized disruption in conduction through Bachmann’s bundle. We demonstrate a higher prevalence of atrial flutter and stroke in those with LHIS and IAB. These results highlight the importance of LHIS as a potential cause of IAB that can contribute to atrial structural remodeling and electromechanical dysfunction associated with atrial arrhythmia and stroke.
Abstract 17782: Reverse Remodeling as a Survival Predictor in Chagas Cardiomyopathy
Authors: Maria Tereza S Sampaio de Sousa Lira, Silas Furquim, Daniel Catto De Marchi, Pamela Camara S Maciel, Rafael Dantas, Fabio Fernandes, Silvia Moreira Ayub Ferreira Ferreira, Eduardo G Lima, Edimar A Bocchi
Journal: Circulation (2023)

Introduction: Chagas cardiomyopathy (CC) has a worse prognosis than other etiologies. Reverse remodeling (RR) is consistently associated with better mortality and morbidity outcomes in heart failure with reduced ejection fraction (HFrEF) of non-chagasic etiology. Still, the impact on CC has been poorly studied. Hypothesis: RR improves survival in patients with CC. Methods: From January 2006 to September 2021, the medical records of 1049 patients with positive serology for Trypansosoma cruzi infection associated with left ventricular ejection fraction (LVEF) &lt;40% were reviewed. RR was defined as a 10% absolute increase in LVEF or absolute LVEF &gt; 40% on the second echocardiogram. Participants were divided into 2 groups: negative RR (NRR) and positive RR (PRR). Results: 221 patients had PRR and 828 NRR. At baseline, the median age in the PRR group was 59 years versus 56 years in the NRR (p &lt;0.001), with 48.2% males in the RRP group versus 58.9% in the RRN (p 0.005). Regarding treatment, only the use of furosemide showed a difference (63.3% in the PRR and 75.4% in the NRR; p &lt;0.001). Regarding baseline ECOTT: the median of LVEF was 30.5% in PRR and 29% in NRR (p &lt;0.001), median LV Diastolic Diameter (DD) (PRR 60 mm; NRR 64mm; p &lt;0.001); median LV Systolic Diameter (SD) (PRR 50 mm; NRR 55 mm); the presence of moderate to severe mitral insufficiency (PRR 37.8%; NRR 50.6%; p &lt;0.001). In the second ECOTT, the PRR group had a median LVEF of 41%, LVDD of 58 mm, and LVSD of 44 mm. In both the univariate analysis and the adjustment made by the multivariate analysis by COX regression, the PRR was an independent predictor associated with all-cause death (HR 0.625, 95% CI 0.421-0.928; p 0.020). Median survival time (and 95% CI) was 8,8 (8,4-9,2) years in the NRR group and 11,4 (10,8-13,8) in the PRR group. Survival was significantly better for PRR than NRR (p &lt;0.001, pairwise Log-Rank comparison). Conclusions: This study suggests a positive association between PRR and increased survival in patients with CHD and HFrEF. Previously published studies didn’t demonstrate this association, possibly due to the small number of patients included.
Abstract 16665: Traditional Risk Factors and Acute Coronary Syndrome Free Survival
Authors: Edina Cenko, Jinsung Yoon, Natalia Fabin, zorana Vasiljevic, Guiomar Mendieta Badimon, Marija Zdravkovic, Marija vavlukis, Sasko Kedev, Davor Milicic, Lina Badimon, Olivia Manfrini, Raffaele Bugiardini
Journal: Circulation (2023)

Introduction: Recent studies claim that the discriminatory power of traditional risk factors (RF) in predicting acute events and mortality from coronary heart disease (CHD) is low. This claim implies a potential misinterpretation, which may negatively affect healthcare organizations Aim: To investigate the association between the four traditional RF, hypertension, current smoking, hypercholesterolemia and diabetes, and the lifetime occurrence of first acute coronary syndrome (ACS) and consequent mortality Methods: We analysed data of 70953 Caucasian patients presenting with first ACS, but without prior CHD enrolled in the ISACS Archives. RF were used to stratify patients into mutually exclusive categories using a balancing strategy by inverse probability weighting. Trends were evaluated by the Pearson's correlation coefficient (r). Primary endpoints were patient’ age at hospital presentation for ACS and rates of all-cause mortality within 30 days after hospital admission Results: For fatal ACS (n=6097), exposure to at least one RF ranged from 77.6% in women to 74.5% in men. The presence of all four RF significantly (P trend&lt;0.001) decreased the age at time of ACS event by nearly half a decade compared with the absence of any RF in both women (from 67.1 to 61.9 years) and men (from 62.8 to 58.9 years). Similar trends were observed for fatal ACS among women (from 73.3 to 67.6 years) and men (from 69.3 to 63.2 years). Current smoking (ORs 4.17 in women; 3.00 in men) and hypercholesterolemia (ORs 1.34 in women; 1.44 in men) were the predominant RFs for premature ACS presentation, with diabetes being the largest for death from premature ACS (ORs 1.50 in women; 1.65 in men). In contrast, there was an inverse association between the presence of RFs and the risk of 30-day mortality. The risk ratios (RR) among individuals with at least one RF vs those with no RFs were 0.72 (95%CI 0.65-0.79) in women and 0.64 (95%CI 0.59-0.70) in men. This association was consistent among patient subgroups Conclusions: In contrast with recent thinking, the presence of traditional RFs is associated with very high lifetime risk of developing ACS and markedly shorter survival. Public health policies should still place significant emphasis on traditional RFs and the lifestyle behaviors causing them
Abstract 18632: Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention
Authors: Elliott Miller, Aliza Gordon, Ying Liu, Tariq Ahmad, Saket Girotra, Carlos D Davila, Geoffrey Crawford, John Whitney, Nihar R Desai
Journal: Circulation (2023)

Background: The use of mechanical circulatory support (MCS) devices for high-risk percutaneous coronary intervention (PCI) has increased over the last decade. However, data on outcomes between MCS device type have been mixed and long-term outcomes are limited. Our aim was to examine the association between intravascular microaxial left ventricular assist device (LVAD) or intra-aortic balloon pump (IABP) use in patients without cardiogenic shock undergoing PCI. Methods: This retrospective study analyzed administrative claims data from a large, insured population across the United States. Patients who underwent PCI without cardiogenic shock from 4/1/2016 to 7/31/2022 were included. Using inverse probability treatment weighting (IPTW), we assessed for the association between device type and all-cause mortality during the index admission, 30-days, and up to 1-year. Secondary outcomes included stroke, bleeding, incident dialysis, repeat revascularization, and total healthcare costs. Results: We identified 2,879 patients undergoing PCI without cardiogenic shock, the mean (SD) age was 68.2 (12.5) years, 27% (n=764) were women, and 61% (n=1,757) had a primary diagnosis of acute myocardial infarction (AMI). After IPTW, intravascular LVAD use was not associated with a statistically significant difference in in-hospital (Odds ratio [OR] 1.30; 95% Confidence interval [CI]: 0.88-1.91, P =0.19) or 30-day (OR 1.19; 95% CI:0.84-1.69, P =0.33) mortality compared to IABP use. At 1-year, intravascular LVAD use was associated with a significant increase in mortality (Hazard ratio 1.23; 95% CI:1.04-1.46, P =0.01). Compared to those receiving an IABP, index admission mean total costs ($81,970 vs. $65,298; P &lt;0.001) and mean monthly costs ($11,030 vs. $14,133; P &lt;0.001) up to 1-year were significantly higher in those receiving an intravascular LVAD. There was no significant association between device type and stroke, bleeding, incident dialysis, and repeat revascularization at any timepoint (all, P &gt;0.05). Conclusions: In patients without cardiogenic shock undergoing PCI, intravascular LVAD use was associated with higher costs but not associated with lower mortality. Randomized data is needed to improve device selection for these patients.
Abstract 15333: The Addressing Hypertension Care in Africa (ADHINCRA) Study: A Multi-Level Nurse-Led, Mobile-Health Enhanced Intervention to Improve Hypertension Control in Ghana
Authors: Yvonne Commodore-Mensah, Ruth-Alma N Turkson-Ocran, Kathryn Foti, Cheryl R Dennison Himmelfarb, Kathryn Carson, Lambert T Appiah, Gideon Nyamekye, Linda Mobula-Shufelt, Lisa A Cooper, FRED S SARFO
Journal: Circulation (2023)

Background: Ghana, is experiencing silent epidemics of hypertension (HTN) and cardiovascular disease (CVD). There is a dire need to implement multilevel strategies to improve HTN control in Ghana. The Addressing Hypertension Care in Africa (ADHINCRA) Study sought to test the feasibility of a multilevel, nurse-led, mobile-health enhanced intervention to improve HTN control in Ghana. Methods: Using a cluster-randomized controlled pilot trial design, we enrolled 4 hospitals in Kumasi, Ghana and recruited 240 patients with uncontrolled HTN, defined as systolic blood pressure (BP) ≥140 mm Hg. Two hospitals were randomized to the intervention and 2 to the enhanced usual care (UC) arm. Patients in the intervention arm received nurse-led task-shifting, a mobile health application and home BP monitoring. The intervention was administered for six months, after which it was withdrawn and patients were followed for 6 more months. The enhanced UC arm received usual care, plus short text messages on health. The primary outcome was change in BP control status at 6 and 12 months. We used general linear models to examine the probability of BP control, accounting for clustering within hospitals. Results: The mean age was 53 ± 9.7 years, 51% were women. After 6 months, BP control improved in the intervention arm (57.0%, 95% CI 56.8% to 57.1%) versus 18.1%, 95% CI 16.9% to 19.3%, for the UC arm), with a between-group difference of 38.9% (95% CI 37.7% to 40.1%; p&lt;0.001). After 12 months, BP control improved in the intervention arm (80.5%, 95% CI 65.5% to 95.4%) versus 24.2%, 95% CI 10% to 38.5%, for the UC arm), with a between-group difference of 56.2% (95% CI 35.6% to 76.8%; p&lt;0.001). ( Figure) Conclusion: A multi-level intervention nurse-led, mobile-health enhanced intervention was associated with greater BP control than enhanced UC among patients with HTN in Ghana. A larger scale study is warranted to support future scale-up of the ADHINCRA Study.
Abstract 16466: Sex-Specific Risks of Air Pollution on Coronary Artery Disease and Adverse Events: Insights From the PROMISE Trial
Authors: Isabel L Langenbach, Thomas Mayrhofer, Marcel Langenbach, Michael T Lu, Julia Karady, Neha J Pagidipati, Svati H Shah, Maros Ferencik, Alison Motsinger-Reif, Pamela S Douglas, Borek Foldyna
Journal: Circulation (2023)

Introduction: Sex-specific differences in coronary artery disease (CAD) have significant implications, yet the potential sex-specific impact of air pollution on CAD and adverse outcomes remains unexplored. Hypothesis: The association between air pollution and CT-derived CAD phenotype or cardiovascular (CV) events varies by sex. Methods: We assessed annual average exposure to particulate matter (PM 2.5 &amp; PM 10 ) and ozone by home zip codes in the CT arm of the PROMISE trial. Pollutant exposure was related to CAD measures on CT (any plaque, obstructive CAD (stenosis ≥50%), high-risk plaque (HRP)) and composite endpoint (death, myocardial infarction, unstable angina), adjusting for age, obesity, ASCVD risk, and Socioeconomic Determinants of Health, using sex-stratified regression analyses. Results: We analyzed 2,252 (52%) women and 2,091 (48%) men (62±8 vs. 59±8 years, p&lt;0.001) with intermediate ASCVD risk (12% vs. 17%, p&lt;0.001). Women were less frequently exposed to PM 2.5 ≥9.5 μm/m 3 (45.1% vs. 48.8%, p=0.011) but more frequently to ozone &gt;45 ppb (40.5% vs. 36.8%, p=0.011) compared to men. Exposure to PM 2.5 ≥9.5 μm/m 3 related to 42% higher odds of obstructive CAD (aOR 1.42, 95%CI: 1.02-1.97, p=0.040) in women but not in men. High PM 10 and ozone exposures did not relate to stenosis or HRP in either sex (p&gt;0.14) (Figure 1a) . Exposure to ozone &gt;45 ppb was related to a higher hazard of events in men (aHR 2.20, 95%CI: 1.36-3.55, p=0.001) but not in women (aHR 1.05, 95%CI: 0.58-1.90, p=0.88). Exposure to high PM 2.5 and PM 10 levels was not associated with events in sex-stratified analysis (Figure 1b) . Conclusions: Sex significantly influences pollutant impact on CAD. High PM 2.5 exposure increases obstructive CAD risk exclusively in women, while high ozone exposure raises CV event risk in men. Findings stress the need for sex-specific strategies in combating pollution's cardiovascular effects.
Abstract 16473: Validation of the Artificial Intelligence-Based 5-Lead 3D Vectorcardiography in Comparison to the 12-Lead ECG in a Mixed Population
Authors: Caroline Schmidt-Lucke, Betty Lischke, Eugenia Weber, Daniel Günther, Anne Schomoeller, André Schmidt-Lucke
Journal: Circulation (2023)

Introduction: Artificial Intelligence-based 5-lead 3D-vectorcardiography (5L3DVCG-AI) offers additional information over 12-lead electrocardiography (ECG) in the detection of significant coronary stenoses. 5L3DVCG-AI is under investigation as a new screening tool for coronary vascular disease (CVD). Hypothesis: We tested the hypothesis of variables from the reconstructed “12-lead ECG” (5L12L-ECG, modified Dower transformation) corresponding with the standard 12-lead ECG (ECG). Methods: In this monocentric exploratory retrospective study, raw data of 331 patients with 5L3DVCG-AI and ECG were included. Cardiac pathology (CP) was categorised as exclusion of any CP (control), mild CP or overt CP by 2 independent cardiologists. The following variables were compared: RR-interval, P, PQ, QRS, QT, QTcB, QTcF, QRS-morphology, and ST-morphology. Cardiovascular risk factors (CVRF) were quantified with the modified PROCAM score. Results: From 331 patients (m:w 60:40%, 50.0 ± 19.8 years) of mixed ethnicity and moderate CVRF (2.1 ± 1.2), 70% were controls, 21% had mild CP and 9% overt CP. All variables from reconstructed 5L12L-ECG correlated to the corresponding individual variables from ECG (r= 0.49 to 0.7, p&lt;0.001). With identical RR-intervals in both methods, all defined variables were significantly, but irrelevantly or mildly (Cohen’s d) different in 5L12L-ECG compared to ECG (P 106 ± 12 vs. 109 ±20 ( d =0.3), PQ 152 ± 24 vs. 159 ± 26 ( d =0.3), QRS 105 ± 16 vs. 97 ± 14 ( d =0.7), QT 380 ± 33 vs. 396 ± 27 ( d =0.46), QTcB 432 ± 31 vs. 426 ± 25 ( d =0.57), QTcF 414 ± 26 vs. 416 ± 19 ( d =0.53). 5L3DVCG-AI was able to distinguish between controls and patients with CVD (Sensitivity 78%, Specificity 66%, p=0.01). Comparing heart axis, there was a small, but significant difference with a significant correlation between methods (r=0.30, p&lt;0.01). Conclusions: The easy to use 5-lead ECG may thus be used in clinical practice to reconstruct valid 12-lead ECG curves without major training or expertise. Additionally, 5L3DVCG-AI can identify persons at risk for CVD. Shorter values for the defined variable will have to be considered when interpreting 5L12L-ECG and separate “normal” value ranges will be given and validated in the ongoing prospective large-scale performance clinical trials.
Abstract 14853: Effects of Yearlong High Intensity Aerobic Exercise on Reducing Left Atrial Epicardial Adipose Tissue
Authors: Ali A Noorbaksh, Aditi Shankar, James P MacNamara, Christopher M Hearon, Benjamin D Levine, Satyam Sarma
Journal: Circulation (2023)

Background: Left atrial epicardial adipose tissue (LA EAT) is often elevated in patients with heart failure and has been linked to abnormal atrial function and increased risk for atrial fibrillation. Whether LA EAT is potentially modifiable is unknown. We tested the hypothesis that one year of high intensity interval training (HIIT) would reduce LA EAT area and in turn be associated with improved atrial function in an obese cohort at risk for developing heart failure with preserved ejection fraction (HFpEF). Methods: Middle-aged obese adults (n = 80, age 40-55 yrs) enriched for increased HFpEF risk (N-terminal pro-B-type natriuretic peptide &amp;gt;40 pg/mL or high-sensitivity cardiac troponin T &amp;gt;0.6 pg/mL; visceral fat &amp;gt;2kg) were randomized to one year of HIIT or attention control. Outcome variables included LA EAT area and LA strain. LA EAT area was quantified through tracings of anterior, posterior, and lateral EAT depots in long axis views on cardiac MRI. LA strain was measured with MRI feature tracking as reservoir strain during left ventricular (LV) systole, conduit strain during early LV diastole, and contractile strain during late LV diastole. Results: Fifty-three participants completed the study. There was no difference in LA EAT area after one year in either the HIIT group (n = 26) or controls (n = 27); difference in mean = -0.17 cm 2 , 95% CI = -0.93 to 0.59, p = 0.66. However, amongst all participants, reduction in LA EAT was associated with improvement in LA reservoir strain (r = -0.50, 95% CI = -0.68 to -0.26, p &amp;lt; 0.001) and LA conduit strain (r = 0.51, 95% CI = 0.27 to 0.68, p &amp;lt; 0.001) but not LA contractile strain (r = 0.15, 95% CI = -0.13 to 0.40, p = 0.298). Conclusions: One year of HIIT did not reduce LA EAT in at-risk obese patients. However, regardless of assignment, decreased LA EAT was associated with improved LA reservoir and conduit strain, suggesting efforts to reduce LA EAT may improve LA function in at-risk obese patients.