tbuckley/cabot-search huggingface dataset:
Abstract 4142758: Circumferential Tethering Of Pacemaker Leads To Bone Is Associated With Costoclavicular Intervention During Lead Extraction
Authors: Ethan Wagner, Robert Lewis, Sean Pokorney, Donald Hegland, lynne koweek, Jonathan Piccini
Journal: Circulation (2024)

Introduction/Background: Binding sites in the costoclavicular space are commonly encountered during transvenous lead extraction. Severe adhesions may warrant use of more aggressive rotational cutting tools or surgical intervention. Research Questions/Hypothesis: It is not known whether pre-procedural CT can provide information about the likelihood that a patient will require costoclavicular intervention. Goals/Aims: The purpose of this study was to determine if there are pre-procedural CT findings associated with need for intervention in the costoclavicular space during lead extraction. Methods/Approach: In this retrospective, single-center, observational study, patients who underwent lead extraction between 2013 and 2024 and required use of stiffer rotational cutting tools (TightRail Sub-C) or surgical intervention in the costoclavicular space were included. Controls who did not require costoclavicular intervention and had at least one lead with dwell time &gt;10 years were matched to cases based on age and sex. Pre-procedural CT was evaluated for patterns of lead tethering to bone and adjacent calcification. Data were analyzed with descriptive statistics. Results/Data: Overall, 56 patients were included (n=20 Sub-C only, n=8 surgical intervention, and n=28 matched controls). The mean patient age of interventional cases was 65.0 ± 14.7 years, 18% were female, and the mean lead age was 12.3 ± 6.2 years. Four major patterns were identified on imaging: fat plane between lead and bone preserved by ≥1 mm (Sub-C intervention rate 5/24 patients, surgical intervention rate 0/24); fat plane not preserved (&lt;1 mm) and &lt;180° tethering of lead to bone (Sub-C 9/19, surgical 2/19); fat plane preserved with adjacent calcifications (Sub-C 2/4, surgical 1/4); and circumferential (&gt;180°) tethering of lead to bone (Sub-C 4/9, surgical 5/9). Conclusions: Tethering of at least one lead to bone &gt;180° was associated with a 100% rate of costoclavicular intervention and the highest rate of surgical intervention (56%). Absence of any degree of bone tethering or adjacent calcifications was associated with a 0% rate of surgical intervention. CT may be useful in pre-procedural planning for adhesions in the costoclavicular space.
Abstract 4142323: Access to Lipid-Lowering Therapies is Limited by Payer Coverage Restrictions and High Out-of-Pocket Costs on Medicare Prescription Drug Plans
Authors: Grant Young, Kannu Bansal, Ralph Riello, Kamil Faridi, Katherine Clark, Nihar Desai
Journal: Circulation (2024)

Introduction/Background: There is an urgent need to improve lipid control as one in four adults in the United States has elevated low-density lipoprotein cholesterol (LDL-C). Many non-statin lipid-lowering therapies such as ezetimibe, pro-protein convertase subtilisin-kexin type 9 inhibitors (PCSK9i), bempedoic acid, and icosapent ethyl are recommended for LDL-C and cardiovascular risk reduction, but usage remains suboptimal. Proposed barriers include payer restrictions and patient costs, but the extent of these issues for Medicare beneficiaries in the contemporary period is poorly defined. Research Questions/Hypotheses: To what extent do Medicare Prescription Drug Plans provide coverage or use payer management strategies to restrict access to lipid-lowering medications? What are the patient out-of-pocket expenses for these therapies? Methods/Approach: Plan coverage, payer restrictions, and annual out-of-pocket costs were extracted from Medicare Prescription Drug Plan files from July-September 2023. Medications studied included generic atorvastatin, rosuvastatin, and ezetimibe as well as brand-name PCSK9i, bempedoic acid, and icosapent ethyl. Results/Data: Among 4,754 plans, coverage of lipid-lowering therapies varied widely. Generic atorvastatin, rosuvastatin, and ezetimibe were universally covered, while branded therapies such as alirocumab and bempedoic acid were covered by only one-half and one-third of plans, respectively. Nearly all plans providing coverage placed non-generic medications in high cost-sharing tiers and required prior authorization for alirocumab (96% of plans), evolocumab (94% of plans), and bempedoic acid (93% of plans). Median annual out-of-pocket costs ranged from $71 to $147 for generic statins and ezetimibe, while patient expenses for all branded lipid-lowering therapies exceeded $1,000. Conclusions: Lack of coverage, widespread prior authorization requirements, and high out-of-pocket costs jeopardize access to non-generic lipid-lowering medications, and likely contribute to their low utilization in the mitigation of cardiovascular disease risk. Some cost toxicity for patients may be alleviated by the Inflation Reduction Act and additional Medicare negotiations on drug pricing, however addressing the barriers of limited coverage and payer restrictions will be paramount to improve use of these therapies.
Abstract 4142721: Hyperspectral imaging is effective in diagnosing patients with ischemia with non-obstructive coronary artery
Authors: Tianyou Xu, Lilei Yu
Journal: Circulation (2024)

Backround: Patients with Ischemia with non-obstructive coronary artery (INOCA) have symptoms of chronic myocardial ischemia without comorbid obstructive coronary artery disease. As a result, they often fail to receive timely diagnosis and treatment, increasing the risk of poor prognosis. Hyperspectral imaging (HSI), developed on the basis of multispectral remote sensing, can provide information on the spatial distribution of various tissue structures, analyze the chemical composition and physical characteristics of different diseases. Objective: In this study, we attempted to analyze the functional status of peripheral microvessels by HSI and thus identify patients with INOCA. Methods: This study was an observational cross-sectional study. The study included 500 patients with chest pain who underwent coronary angiography from December 2023 to May 2024 at Renmin Hospital of Wuhan University. We acquire HSI of the patient's face, palms and ears prior to coronary angiography. Patients were divided into a control group, an INOCA group, and a coronary artery blockage group according to guideline diagnostic criteria. Results: 1. The data model (Model 1) was built by deep learning the waveband and texture data of HSI, and it showed good sensitivity and specificity for recognizing INOCA patients;2. The image model (Model 2) is built after deep learning of HSI features, and it also has good sensitivity and specificity for the diagnosis of INOCA patients. The specificity of the image model is higher than the data model, but the sensitivity is slightly worse;3. We constructed the composite model (Model 3) by fusing the data model with the image model. Compared to the data model and image model, the composite model showed higher sensitivity and specificity in the identification of INOCA patients. Conclusion: The model constructed based on deep learning of peripheral microvascular HSI can diagnose INOCA patients with high sensitivity and specificity.
Abstract 4142331: Metabolomic Signature of Mitochondrial Dysfunction After Subacute Air Pollution Exposure: An Animal-to-Human Translational Study
Authors: Yan Lin, Gajalakshmi Ramanathan, Xinchen Lu, Rajat Gupta, Fen Yin, Oliver Fiehn, Junfeng Zhang, Yifang Zhu, Xinghua Qiu, Jesus Araujo
Journal: Circulation (2024)

Introduction: Exposure to air pollution is among the leading risk factors for cardiovascular diseases. This animal-to-human translational study aims to identify metabolomic signatures connecting subacute air pollution exposure with early mechanisms mediating chronic cardiovascular disease development. Methods: We studied ApoE -/- mice exposed to diesel exhaust (DE) or filtered air (FA) for 2 weeks and 26 healthy adults who traveled from Los Angeles (average PM 2.5 levels = 14.4 µg/m 3 ) to Beijing (average PM 2.5 levels = 67.6 µg/m 3 ) for 10 weeks. We previously reported increased systemic lipid peroxidation, inhibited paraoxonase 1 activity, without changes in HDL or total cholesterol levels in both animals and humans after air pollution exposure. In this study, we profiled plasma metabolomics using multiple analytical platforms and identified 547 metabolites in animals, and 1357 metabolites in humans with confirmed structure or putative chemical ID. We conducted enrichment analysis using ChemRICH algorithm and characterized molecular signature of common metabolic pathways affected by air pollution in both animals and humans. Results: Enrichment analysis of 154 overlap metabolites in animal and human plasma indicated that air pollution caused common metabolic alterations of (1) dicarboxylate acids, (2) acyl-carnitines, (3) tryptophan, (4) pyrimidine, and (5) lysine. Although the metabolomic signatures of tryptophan, pyrimidine, and lysine differ between animals and humans following air pollution exposure, we observed consistent increases in long-chain dicarboxylate acids and medium- to long-chain acyl-carnitines – likely due to mitochondrial dysfunction as evidenced by impaired mitochondrial respiration by a Seahorse assay on livers from the same animals. Conclusion: Subacute exposure to air pollution induced common metabolomic signatures of dicarboxylate acids and acyl-carnitines, suggestive of mitochondrial dysfunction.
Abstract 4142244: Complete Versus Culprit Only Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction Patients with Chronic Total Occlusion in Non-Infarct Related Artery: A Systematic Review and Meta-Analysis
Authors: Laibah Khan, Neha Paryani, Muhammad Khan, Neha Mohiuddin, Saba Fatima, Naija Ehsan, Tooba Shaukat Butt, Muhammad Usman
Journal: Circulation (2024)

Background: Multivessel coronary artery disease has a higher risk of adverse cardiovascular outcomes. Although patients presenting with STEMI usually undergo revascularization of the infarct-related artery only (i.e. cuplrit only percutaneous coronary intervention or CO-PCI), recent trials suggest improved outcomes with complete PCI of all arteries with chronic total occlusion (CTO). Aim: To meta-analyze data from randomized controlled trials comparing the impact of complete versus CO-PCI in STEMI patients with CTO in the non-infarct related artery (non-IRA). Methods: We conducted a comprehensive search of Medline, EMBASE, and Scopus up till May 2024, to identify studies comparing the clinical outcomes between CO-PCI versus complete PCI in patients with STEMI accompanied by CTO in the non-IRA. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) along with corresponding 95% confidence intervals (CIs), with a significant p value &lt; 0.05. Outcomes of interest include all-cause and cardiac mortality, myocardial infarction and stroke. Results: Our search strategy yielded 16 eligible studies (complete PCI, n= 7,982; CO-PCI, n= 7,753). Complete PCI significantly reduced all-cause mortality in comparison to CO-PCI (RR=0.64 [0.49, 0.84]; p=0.002). Complete PCI was also associated with a significant reduction in cardiac death (RR: 0.54 [0.41 - 0.72]; p&lt;0.0001), and myocardial infarction (RR=0.72 [0.60 - 0.86]; p=0.0003), compared with CO-PCI. However, there was no significant difference in stroke risk 1.10 [0.78-1.54; p=0.60]. The forest plots are illustrated in Figure 1. Conclusion: In STEMI patients with chronic total occlusion in the non-infarct related artery, complete PCI may yield superior outcomes compared with CO-PCI.
Abstract 4142430: Feasibility of Coronary Allograft Vasculopathy Assessment Using Cardiac Stress Magnetic Resonance Imaging with Fully Quantitative Myocardial Blood Flow
Authors: Meaghan O'Hara, Haonan Wang, Iva Minga, Sherry Huang, Maxine Tang, Shuo Wang, Gene Kim, Mark Belkin, Jeremy Slivnick, Roberto Lang, Amit Patel, Hena Patel
Journal: Circulation (2024)

Background: Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality following heart transplantation (OHT). Noninvasive methods to detect CAV and risk stratify OHT patients are needed. The value of fully quantitative stress cardiac magnetic resonance imaging has been recently validated and may be a promising technique for OHT surveillance. We aimed to evaluate the feasibility of quantitative stress CMR after OHT. Methods: We enrolled asymptomatic OHT recipients without coronary artery disease to undergo regadenoson stress CMR (1.5T GE HealthCare) with cine imaging, tissue mapping, and late gadolinium enhancement (LGE) imaging for routine CAV surveillance. Using the dual sequence technique, quantitative perfusion values were determined using Fermi deconvolution. Myocardial perfusion reserve (MPR) was calculated as the ratio of stress to rest myocardial blood flow (MBF). Results: Fifty-three subjects (mean age 47.06 ± 17.14 years) were included. OHT recipients (n=11, mean 6.77 ± 4.34 years post-transplant) were compared with healthy controls (n=43). No life-threatening adverse events, brief or prolonged atrioventricular block or other arrhythmias occurred with regadenoson. Coronary angiography was performed in 9 OHT patients before CMR, with an average of 1.99 ± 2.05 years between studies. No visual inducible ischemia was reported. Post OHT, rest MBF was significantly higher (1.69 ± 0.52 mL/g/min vs 1.01 ± 0.24 mL/g/min, p=0.004) and stress MBF was lower (2.33 ± 0.69 mL/g/min vs 2.95 ± 0.88 mL/g/min, p=0.02) compared to controls. MPR was significantly lower in OHT recipients compared to controls (1.46 ± 0.51 vs 3.11 ± 1.12, p&lt;0.001), and remained lower when corrected for rate pressure product (1.23± 0.32 vs 3.94 ± 1.5, p&lt;0.001) (Figure 1). Conclusions: Regadenoson stress perfusion CMR is safe and feasible in OHT recipients. We observed reduced coronary microvascular function (higher resting MBF, lower MPR) post OHT, despite normal perfusion on visual inspection. In addition to cardiac structure, function, and myocardial tissue characterization, quantitative assessment of MPR by CMR may have incremental value over qualitative assessment of ischemia and should be evaluated in future studies.
Abstract 4142342: Association of Obesity with Declines in Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction
Authors: Lixia Deng, Hocine Tighiouart, Tatsufumi Oka, Marcelle Tuttle, Brian Downey, Ethan Rowin, Mark Sarnak, Wendy McCallum
Journal: Circulation (2024)

Background: Obesity is considered one of the key drivers of the cardiovascular-kidney-metabolic syndrome. Obesity is highly prevalent among patients with heart failure with preserved ejection fraction (HFpEF) but there are few studies evaluating its relation with kidney function decline in this population. Hypothesis: We hypothesized that among patients with HFpEF, obesity measured by body mass index (BMI) and waist circumference (WC), is associated with increased risk of worse kidney outcomes. Methods: We performed a retrospective analysis using data from the TOPCAT (Spironolactone for Heart Failure with Preserved Ejection Fraction) trial, which was a multicenter, randomized trial assessing the effect of spironolactone vs placebo in patients with HFpEF. Our exposures of interest included BMI ≥30 kg/m 2 and WC ≥102cm in men and ≥88cm in women. The association between obesity with eGFR decline by &gt;40%, a validated surrogate endpoint for kidney failure, was examined using multivariable Cox proportional hazards models. Covariates included age, sex, comorbidities, baseline eGFR, and treatment group. Results: Among 3445 subjects over a mean follow up of 3.3 years, mean baseline eGFR was 67 ml/min/1.73m2; 1902 (55%) had BMI ≥30 kg/m2 and 2284 (72%) had high WC. After multivariable adjustment, subjects with high BMI had an increased risk (HR 1.39 CI 1.14-1.70) of &gt;40% eGFR decline. Similarly, those with high WC had a higher risk of &gt;40% eGFR decline (HR 1.54 CI 1.19-2.01) (Figure 1, Table 1). There was no significant interaction by randomization to spironolactone. After adjusting for covariates, no significant interaction by sex was found in the BMI group. In the WC group, while interaction was significant (p=0.02), this effect was not observed when assessing WC as a continuous variable. Conclusion: Obesity, whether assessed by BMI or WC, is associated with higher risk of eGFR decline in patients with HFpEF. Further investigation stratifying men and women is needed.
Abstract 4142757: Adiponectin receptor agonist alleviates heart failure with preserved ejection fraction by regulating NLRP3/Caspase-1/IL-1β and Pl3K/Akt signaling pathway
Authors: Siyi Cheng, Lilei Yu, Xiaoya Zhou
Journal: Circulation (2024)

Background: Treating and managing heart failure with preserved ejection fraction (HFpEF) remains challenging. With the gradual increase in the number of obese individuals, diabetics, and cases of hypertension, HFpEF prevalence accounts for half of the total number of patients with heart failure. HFpEF, for which no specific treatment exists, is the most challenging problem. Objective: To investigate the cardioprotective effects and mechanisms of an adiponectin receptor agonist, AdipoRon, as an anti-inflammatory agent in a two-hit HFpEF mice model. Methods: A mouse model of HFpEF was induced using a 60% high-fat diet plus 5.0g/L L-NAME drinking water for 12 weeks. AdipoRon (50 mg/kg) or a comparable volume of saline via gavage once daily was administered to the two-hit HFpEF mice model for four weeks. Cardiac function was evaluated by echocardiography, while molecular biology techniques were employed to determine the effect of AdipoRon. Results: The oral adiponectin receptor agonist, AdipoRon, inhibited HFpEF inflammation by downregulating NLRP3, caspase-1, IL-1β and IL-18, and suppressing the TLR4/NF-κB/TNF-α signaling pathway. This improved cardiac functional phenotypes, including cardiac diastolic dysfunction, pulmonary congestion, myocardial hypertrophy, reduced exercise tolerance, and glucose intolerance. AdipoRon improved heart rate variability (HRV) , decreased serum norepinephrine(NE), which inhibiting inflammation-induced cardiac sympathetic over-activation. AdipoRon dramatically reversed HFpEF-induced down-regulation of PI3K, Akt, and GSK3β phosphorylation, improved glucose metabolism and attenuated the cardiac damage associated with glucose accumulation. Our findings indicated AdipoRon’s ability to downregulate the expression of Bax/Bcl-2, inhibiting cardiomyocyte apoptosis, attenuating myocardial injury, and effectively improving cardiac function and ventricular remodeling. Conclusion: AdipoRon attenuated inflammatory response, improved cardiac function and phenotypes, and ameliorated impaired myocardial glucose metabolism and apoptosis in HFpEF mice. This was achieved by modulation of NLRP3/Caspase-1/IL-1β, Pl3K/Akt, and TLR4/NF-κB/TNF-α signaling pathways.
Abstract 4142745: Lipoprotein(a) distribution across autoimmune inflammatory diseases: a pooled analysis from 28 Phase III clinical trials
Authors: Michael Wilkinson, Aamir Khakwani, Silvia Zaoli, Manish Khatri, Belinda Schludi, Xingdi Hu, Sean McElligott
Journal: Circulation (2024)

Background: Lipoprotein(a) [Lp(a)] is largely determined by genetic factors and is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). Real-world evidence is limited due to low rates of Lp(a) testing, and little is known regarding the Lp(a) distributions in diseases beyond ASCVD, including autoimmune inflammatory diseases. Methods: This cross-sectional study identified adult patients with available Lp(a) levels at baseline (before randomization) from 28 Phase III randomized clinical trials across autoimmune inflammatory diseases: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PA), and ankylosing spondylitis (AS). Individuals from clinical trials for ASCVD were used as the reference group. Multivariable logistic regression analysis was performed to assess whether patients with certain autoimmune diseases were more likely to have Lp(a) ≥30mg/dL (≥75nmol/L) compared with ASCVD. Results: We identified 12,799 adults from RA (1287, 10%), psoriasis (5578, 44%), PA (1928, 15%), AS (1146, 9%), and ASCVD (2860, 22%) trials. Overall, the mean age (SD) was 50.4 (14.6) years, 41% female, 2.7% Black individuals, 15.2% Asian individuals, 37.7% history of ever smoking, and 77.8% with diabetes. Lp(a)&gt;=30mg/dL was most common among those with RA (57%), followed by PA (46%), ASCVD (43%), AS (42%) and psoriasis (39%). A consistent Lp(a) distribution across diseases was seen for Lp(a)≥50mg/dL (Figure). Adjusting for age, sex, race, BMI, diabetes, total cholesterol, lipid lowering therapies and C-reactive protein (CRP), patients with RA and PA were 72% and 39% more likely to have Lp(a)&gt;=30mg/dL compared with ASCVD (p&lt;0.05). CRP was also significantly associated with Lp(a)&gt;=30mg/dL: Odds Ratio (OR) = 1.07 (1.05 – 1.10), p&lt;0.0002). Conclusion: In this pooled analysis of Phase III trials, increased levels of Lp(a) were observed among patients with RA, psoriasis, PA and AS with patients with RA and PA more likely to have Lp(a)≥30mg/dL than patients with ASCVD. Future research with longitudinal Lp(a) levels is important to clarify the interplay between inflammation, Lp(a), and ASCVD risk, especially in autoimmune diseases associated with increased Lp(a) levels.
Abstract 4142612: External validation of CHIP score in patients undergoing in patients undergoing percutaneous coronary intervention in a large-scale Chinese cohort
Authors: Guyu Zeng, Jinqing Yuan
Journal: Circulation (2024)

Background: The CHIP score, developed from the BCIS (British Cardiovascular Intervention Society) database, predicts adverse in-hospital MACCE (major adverse cardiovascular and cerebrovascular events). However, its long-term prognostic value in Asian population remains unclear. This study aims to externally validate the CHIP score in a large Chinese cohort. Methods: We included 10,445 patients undergoing percutaneous coronary intervention (PCI), stratified into four groups based on the CHIP score (0, 1-2, 3-4, ≥5). The primary endpoint was 5-year MACCE, defined as a composite of all-cause mortality, myocardial infarction, and stroke. Secondary endpoints included the individual components of 5-year MACCE. Results: Higher CHIP scores were associated with significantly higher 5-year MACCE risk compared to a score of 0 (score 1-2: HR 1.31, 95% CI 1.15-1.49; score 3-4: HR 1.95, 95% CI 1.62-2.35; score ≥5: HR 3.81, 95% CI 2.93-4.96). This trend was consistent for 5-year all-cause mortality, myocardial infarction, and stroke. The discrimination ability of the CHIP score for 5-year MACCE risk was modest (C-statistics: 0.57, 95% CI: 0.55-0.59). For secondary endpoints, the discrimination for 5-year mortality risk was the highest (C-statistics: 0.61, 95% CI: 0.58-0.64). The Hosmer-Lemeshow goodness-of-fit test P values were all &lt;0.05 for all endpoints. Conclusions: The CHIP score demonstrates a modest ability to predict 5-year MACCE and its individual components in a large Chinese cohort undergoing PCI. While it shows a clear trend of increasing risk with higher scores, further refinement and validation are needed to improve its predictive accuracy in this population.