tbuckley/cabot-search huggingface dataset:
Abstract 4115231: Higher Global Registry of Acute Coronary Events Score is Associated with Lower Invasive Coronary Angiograpy Use
Authors: Sarah Slone, William Meeks, Kurt Barringhaus
Journal: Circulation (2024)

Background: Use of invasive coronary angiography (ICA) and the selection of other interventions in patients who present with NSTEMI should be guided by clinical risk stratification. National guidelines recommend ICA use in patients with intermediate and high risk scores. The Global Registry of Acute Coronary Events (GRACE) score is a commonly used risk score that is based on clinical characteristics available at the time of admission. Aim: Examine if patients with NSTEMI with higher risk stratification scores are more likely to have ICA. Methods: This cross-sectional study included all patients who presented with NSTEMI to an academic medical center that serves a rural population over a 12-month period. Data were derived from the American College of Cardiology Chest Pain – MI Registry data collected by trained abstractors at the facility and were verifed by the study team. Additional data needed to calculate the GRACE Score were abstracted by the study team. GRACE Scores were categorized into low (1-88), moderate (89-118), and high (119-263) risk. Multivariable logistic regression was used to test if higher GRACE scores are more associated with ICA use controlling for patient factors not included in the GRACE Score and further examined by GRACE score category. Results: The total sample size was 434 patients (Mean age 65±13.8, 36% female and 36% Black). Patients transferred from outlying facilities accounted for 40% of the sample. ICA was performed for 94% of the patients. Increasing GRACE score was associated with lower ICA use (aOR 0.98, 95% CI 0.97-0.99). Odds of ICA use between the low-risk group and the intermediate risk group (aOR 0.60, 95% CI 0.19-1.91) did not significantly differ. Patients in the high-risk category were less likely to undergo ICA compated to low-risk patients (aOR 0.22, 95% CI 0.07-0.62). Conclusions: Use of ICA decreased as GRACE score increased in this patient sample, suggesting that additional factors beyond GRACE score likely influence ICA use in patients who presented with NSTEMI during this time period. Influence of patient factors as well as provider and patient risk aversion on ICA selection must be explored to better understand incongruence with guideline recommendations.
Abstract 4117365: Effect Of Renal Denervation In Combination With Cardiac Ablation On The Recurrence Of Atrial Fibrillation: A Systematic Review and Meta-Analysis
Authors: Carlos Zavaleta Corvera, Caroline Dominguez-Herido, Zulema Mamani-Condori, Joaquin Chavez-Cano, MARINA ATENA BUSTAMANTE ORDOÑEZ, Alexis Ccoyllo Mayhuasca, Ruth Campos-Ramos, Jose Caballero-Alvarado
Journal: Circulation (2024)

Background: Atrial fibrillation(AF) is the most common cardiac arrhythmia, affecting millions globally. Despite various treatments, recurrence remains high, especially among those with drug-resistant hypertension. Aim: To evaluate the efficacy of combining Renal Denervation and Cardiac Ablation compared to Cardiac Ablation Alone in reducing AF recurrence. Methods: A systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines, A search for randomized controlled clinical trials was carried out in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ScienceDirect until March 2024. Specifically, about adult patients aged 18 years and above diagnosed with AF and drug-resistant hypertension undergoing renal denervation and or cardiac ablation. The primary outcome was the recurrence of AF. The secondary outcomes were effects on systolic blood pressure, diastolic blood pressure, cardiovascular structural changes, glomerular filtration rate (eGFR). In addition, periprocedural events and major complication events. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI). For continuous variables, the results were shown considering the mean difference (MD) and standard deviation with 95% CI. Results: From 409 studies identified, 8 studies and 695 patients were included. Meta-analysis showed a significant reduction in atrial fibrillation recurrence with the combination therapy (HR 0.66 [95% CI=0.55 – 0.79], p=0.00001). Blood pressure outcomes were superior in the combination group, with reductions in both systolic (MD = -9.66 mmHg [95% CI: -13.89, -5.42], p=0.00001) and diastolic pressures (MD = -7.09 mmHg [95% CI: -13.67, -0.50], p=0.003). Cardiovascular structural changes, such as left atrial size (RR 2.85 [95% CI: 2.13, 3.81], p=0.00001) and interventricular septal thickness (MD = -1.15 [95% CI: -1.85, -0.44], p=0.003), also favored the combination therapy. Kidney function, measured by eGFR was better preserved (MD = -10.34 [95% CI: -13.39, -7.28], p&lt;0.00001). Conclusion: The combination of RDN and CA is more effective than CA alone in reducing the recurrence of AF, with additional benefits in blood pressure control, cardiovascular structural improvements, and renal function preservation.
Abstract 4119680: First-in-Man Treatment of Heart Failure by Repeated Intravenous Infusions of a Cardiovascular Cell-Derived Extracellular Vesicle-Enriched Secretome
Authors: Philippe Menasche, Nisa Renault, Albert Hagege, Tania Puscas, VALERIE BELLAMY, Camille Humbert, Laetitia Le, Helene Blons, Clemence Granier, Nadine Benhamouda, Anne BACHER, Guillaume Churlaud, Brigitte Sabatier, Jerome Larghero
Journal: Circulation (2024)

Background: Most of the effects of intramyocardially transplanted stem cells can be duplicated by the sole administration of their secretome but this approach has not yet been tested in heart failure (HF). Methods: The SECRET-HF phase I trial (NCT05774509) was designed according to a Bayesian optimal interval scheme to assess the effects of repeated intravenous infusions of a cellular secretome in 12 patients with a non-ischemic dilated cardiomyopathy. The main inclusion criteria are severe symptoms (NYHA Class III despite an optimal guideline-directed medical therapy), a reduced left ventricular (LV) ejection fraction (EF ≤40%) and ineligibility for a heart transplant. The Investigational Medicinal Product was derived from human induced pluripotent stem cells reprogrammed from a healthy donor and differentiated in cardiovascular progenitor cells (CPC). Following CPC culture in a dedicated "vesiculation" medium, the conditioned media were collected, filtered, enriched for extracellular vesicles, concentrated by tangential flow filtration and scaled out into glass vials stored at -80°C. Quality controls were implemented throughout the whole process which was conducted according to current Good Manufacturing Practices. Results: Three patients, out of the 4 of the initial low-dose cohort, have now been treated. All had been previously fitted with an automatic internal cardioverter defibrillator (AICD). The secretome was delivered intravenously 3 times, 3 weeks apart, at a dose of 20 x10 9 particles/kg for each infusion. By November, 2024, the follow-up will be 16, 9, 6 and 2 months for each of them (mean: 8 months). So far, none of the treated patients has experienced a dose-limiting toxicity; in particular, there have been no post-treatments ventricular arrhythmia detected by the AICD, no allo-immunization and no inflammation based on the enumeration of lymphocyte subpopulations by flow cytometry. At 6 months, the first patient improved to NYHA Class II with a decrease in echographic LVEDV and LVESV (from 108 mL/m 2 to 87 mL/m 2 and from 80 mL/m 2 to 60 mL/m 2 , respectively) and a concomitant increase in LVEF from 25% to 32%. At 1 month post-treatment, the second patient also reports a symptomatic improvement (NYHA Class II) with an increase in EF from 21% to 28%. Conclusions: This initial experience supports the safety of repeated intravenous administrations of a cardiovascular cellular secretome as a potential noninvasive and user-friendly treatment of severe HF.
Abstract 4118387: Artificial Intelligence-Enhanced Echocardiogram Assessment Helps Distinguish Cardiomyopathy from Beat-to-Beat Variation in Atrial Fibrillation
Authors: Gloria Hong, David Ouyang, Amey Vrudhula, NEAL YUAN
Journal: Circulation (2024)

Background: Atrial fibrillation (AF) can be associated with reductions in left ventricular ejection fraction (LVEF) that improve upon conversion of AF to sinus rhythm. Such LVEF changes during AF may be due to LVEF measurement error from beat-to-beat variations related to AF itself. More precise artificial intelligence (AI)-enhanced LVEF assessment could help distinguish between such LVEF “pseudo-reduction” during AF and true cardiomyopathy, thus potentially preventing unnecessary downstream workup and treatment. Methods: Using a transthoracic echocardiogram database at a large academic medical center, we identified all patients whose LVEF fell below 50% while in AF who had subsequent LVEF recovery to over 50% within 90 days after converting from AF to sinus rhythm. For echocardiograms in AF, we compared the clinically assessed LVEF with AI-enhanced LVEF assessment by EchoNet-Dynamic, a validated deep learning algorithm. Results: In our cohort of 84 patients, the mean age was 74 years old, 36.9% were female, and 26.2% non-White. The mean LVEF recovery was 19.3% (95% CI 17.1-21.5%) after converting from AF to sinus rhythm with a mean duration of 27.4 days between the AF and sinus rhythm echocardiograms (Figure 1). For AF echocardiograms, the LVEF when reassessed by deep learning was 8.4% (6.3-10.5%) higher than the original clinical read, resulting in 30.3% of patients being reclassified as no longer having a reduced LVEF less than 50% while in AF. Among these patients with LVEF reductions during AF, 27.4% and 19.0% were given a new or worsened heart failure with reduced ejection fraction (HFrEF) diagnosis, 15.5% underwent ischemic testing, and 17.9% were started on new HFrEF medications. Discussion: LVEF reductions during AF can lead to new HFrEF diagnosis, workup, and treatment. However, such LVEF reductions may be temporary and partially explained by undermeasurement of LVEF during AF. AI-enhanced LVEF assessment may help reduce such measurement errors during AF and thereby prevent overdiagnosis of HFrEF. Further research is needed to understand the clinical significance of true but temporary LVEF reductions during AF.
Abstract 4118777: Outcomes Of Patients With Hypertrophic Cardiomyopathy In Academic Versus Non-Academic Centers: Analysis from the National Inpatient Sample Database 2012-2020
Authors: Ahmed El-Shaer, Alexander Hall, Sangeetha Tandalam Palanivelu, Noorhan Monther, Abubakar Tauseef, Ali Abdul Jabbar, Hasaan Ahmed, Ruth Ann Mathew Kalathil, Abdullah Shaik, Ali Mushtaq, Rutvij Patel, Paul Millner, Mohsin Mirza, Ryan Walters, amjad kabach
Journal: Circulation (2024)

Introduction: Hypertrophic Cardiomyopathy (HCM) is an uncommon heart condition associated with serious complications. Advances in medicine have improved its prognosis. Despite this, such potentially life-saving improvements concerning the implementation of best practices are not ubiquitous; guidelines recommend management at specialized centers. Unfortunately, not all hospitals have specialized HCM centers. However, given that a sizeable portion of these specialists are also in academic centers (ACs), we hypothesize that ACs may be better positioned than non-academic centers to provide the highest quality care for HCM patients. Purpose: Our study aimed to assess in-hospital outcomes and healthcare burdens among patient admissions with HCM diagnoses, comparing those treated at academic centers with those receiving care at non-academic centers. We examine all-cause in-hospital mortality, length of stay (LOS), hospital costs, and investigate ethnic differences in patients with HCM. Methods: The National Inpatient Sample database was utilized to obtain HCM patient hospitalizations from 2012 through 2020 in the United States. Patient hospitalizations for which adult patients had a primary diagnosis of HCM were identified. Outcomes included all-cause in-hospital death, LOS, and hospital costs. All-cause in-hospital mortality was evaluated using multivariable logistic regression analysis. Multivariable lognormal regression models were used to estimate LOS and inflation adjusted cost outcomes. Results: All-cause mortality unadjusted rates were 2.2% in non-teaching hospitals compared with 1.7% at teaching hospitals; however, this difference was not statistically significant ( p =.235). Both unadjusted and adjusted hospital LOS were 32% shorter for non-teaching hospitals ( p &lt;.001). Both unadjusted and adjusted hospital costs were 46% lower for non-teaching hospitals compared to teaching hospitals ( p &lt;.001; $37,829 vs $70,216). For both LOS and cost, the overall interaction between race and teaching status was statistically significant ( p &lt; .001.) Conclusion: Our study shows variations in hospital outcomes and costs between teaching and non-teaching hospitals. Non-teaching hospitals displayed shorter stays and lower costs. Additionally, the interaction of race and teaching status significantly impacted length of stay and costs. These results underscore the necessity of tailored interventions to address healthcare delivery and resource inequities, especially in teaching hospitals.
Abstract 4121042: Novel genetic risk loci of arterial stiffness in Asian ancestry individuals
Authors: Bangwei Chen, Shengyin Zeng, Zhiguang Zhao, lei ruan, Jiangguo Zhang, Shida Zhu, Cuntai Zhang, TAO LI
Journal: Circulation (2024)

Background: Arterial stiffness serves as an independent predictor of cardiovascular disease risk. Pulse-wave velocity (PWV) is a non-invasive measurement of arterial stiffness. However, the genetic risk variants associated with arterial stiffness in the Asian ancestry population remain largely unknown. This lack of knowledge hinders the development of targeted preventive and treatment strategies. Hypothesis: Arterial stiffness is associated with genotyped SNP loci that have genetic relationships with metabolic syndrome phenotypes. Methods: For PWV, we performed genome-wide association study and gene-based genetic association study in 912 individuals from the Tongji-BGI research cardiovascular health (TORCH) cohort. We then used linkage disequilibrium score regression to estimate pairwise genetic correlations between arterial stiffness, blood pressure, lipids, and diabetes. Results: Eleven risk loci associated with arterial stiffness were discovered at genome-wide significance ( P &lt; 5 × 10 −8 ), including three in intronic (rs978453410 mapping to PPP2R5E; rs146270927 mapping to ECI1; rs189517402 mapping to CNN2 ). UBE2U and ECI1 were identified as the PWV-associated genes by gene-based analysis. Genetic correlation analyses revealed inter-related of PWV with systolic blood pressure, mean arterial pressure, total cholesterol and diabetes. Conclusions: This research firstly identified eleven novel genetic variants associated with arterial stiffness in Asian ancestry individuals. Further research aimed at reducing arterial stiffness may benefit from the identification of SNPs and genes like ECI1, which is related to the oxidation of unsaturated fatty acids in the mitochondria.
Abstract 4120458: Predictors of School Non-Engagement in School Aged Children and Adolescents Born with Heart Disease
Authors: Sarah Hodgson, Jennifer Peterson
Journal: Circulation (2024)

Introduction: School engagement, or caring about doing well and doing required homework, is an important factor for academic success and may contribute to poorer academic outcomes in children born with heart disease (HD), compared to heart-healthy peers. Factors that influence lack of school engagement in children born with HD are not well known. Research Question: What factors predict school non-engagement in students with HD? Aims: To identify factors that predict school non-engagement in students with HD to assist in earlier detection and support for students at increased risk. Methods: We analyzed data from the 2022 National Survey of Children’s Health (NSCH), using procedures for complex weighted survey data. School-related outcomes in children ages 6 to 17 years born with and without HD were compared using Chi-square tests. Multivariate logistic regression was used to examine predictors of school non-engagement in students with HD. Results/Data: Of 54,065 NSCH responses, 34,284 were children ages 6 to 17 years, and 826 of these were born with HD. Children born with HD had lower school engagement (p&lt;0.001) and missed more days of school (p&lt;0.001) than peers not born with HD, but grades were not different between groups. Students born with HD were more likely than peers not born with HD to be bullied (p = 0.001), have a diagnosis of anxiety (3.71% vs 1.95%, p&lt;0.001) or depression (3.56% vs 2.09%, p =0.012), require a Special Education Plan (34.9% vs 16.1%, p&lt;0.001), or to receive mental health services (23% vs 14%, p &lt;0.001). Multivariate logistic regression identified factors that significantly predicted school non-engagement in students born with HD, including diagnosis of attention deficit/hyperactivity disorder (ADHD) (aOR 1.94, 95% CI [1.20, 4.58], p=0.013), behavior/conduct problems (aOR 2.77, 95% CI [1.46, 5.23], p=0.002), or learning disability (aOR 3.44, 95% CI [1.79, 6.59], p&lt;0.001). Sociodemographic variables, days of missed school, anxiety, depression, intellectual disability, autism spectrum disorder, and speech disorder were not significant predictors of school non-engagement. Special healthcare needs status neared significance in predicting lack of school engagement (p = 0.056) Conclusions: We identified ADHD, behavior/conduct problems, and learning disabilities as predictors of school non-engagement in students with HD. This information can be used to identify at-risk students born with HD who may benefit from proactive screening and support.
Abstract 4122957: C-C motif chemokine receptor-2 disruption Synergizes with Phosphodiesterase Type 5 Inhibition in Ameliorating Pulmonary Hypertension in Monocrotaline-treated Rats: Proof-of-Concept Study for a Combination therapy and Potential Mechanisms
Authors: NAOKI TSUBOYA, Yoshihide Mitani, Hirofumi Sawada, Mami Takeoka, Kazunobu Ohya, Hironori Oshita, Noriko Yodoya, Hiroyuki Ohashi, Junko Maruyama, Ryuji Okamoto, Tomoji Mashimo, Kaoru Dohi, Yuhei Nishimura, Kazuo Maruyama, Masahiro Hirayama
Journal: Circulation (2024)

Background: Whether and how any anti-inflammatory agents and their combination with conventional pulmonary vasodilators protect against pulmonary arterial hypertension (PAH) is unknown. Hypothesis: The disruption of C-C motif chemokine receptor (CCR) -2, a receptor for CCL-2, ameliorates PAH in any models with the reversal of the associated pro-inflammatory state and vascular cell phenotypes and synergizes with any conventional pulmonary vasodilators. Methods and Results: By using Ccr2 (-/-) rats generated by CRISPR/ Cas9 , we investigated PAH in Ccr2 (+/+) or Ccr2 (-/-) rats treated with monocrotaline (MCT), SU5416/hypoxia (SuHx), and chronic hypoxia (CH). Ccr2 (-/-) decreased the right ventricular systolic pressure, right ventricular hypertrophy, and mortality rate, and reversed increased expression of inflammatory cytokines/chemokines (IL-6, TNF-α, CCL2, IL-1β, TGF-β) in MCT-treated rats, but not in SuHx or CH models. Consistently, Ccr2 (-/-) decreased indices of pulmonary vascular diseases (PVDs) and perivascular macrophage infiltration, as well as reversed impaired BMPR2 signaling, increased endothelial apoptosis, impaired NO signaling (eNOS, peNOS/eNOS) and decreased phosphodiesterase (PDE)-5 expression in lungs in MCT-treated rats. Gene expression of the receptor for prostaglandin I 2 and endothelin was not altered in MCT-treated rats by Ccr2 (-/-). In cultured pulmonary arterial smooth muscle cells (PASMCs), Ccr2 (-/-) suppressed CCL2-induced hyperproliferation and dedifferentiation as well as reversed CCL2-induced decrease in PDE5 expression. Consistently, the whole-genome RNA sequencing analysis identified differentially expressed genes in CCL2-stimulated Ccr2 (-/-) PASMCs, which are related to cellular differentiation and contraction. Based on studies in rats and cultured PASMCs, we investigated whether a PDE5 inhibitor, tadalafil, synergizes with Ccr2 (-/-). Tadalafil administration ameliorated PH and PVDs in MCT-treated Ccr2 (-/-) rats but not in Ccr2 (+/+) rats, and further improved survival in Ccr2 (-/-) rats. Conclusions: PDE5 inhibition synergized with Ccr2 disruption in protecting against PAH in MCT-treated rats, which was mechanistically related to the restoration of proinflammatory states and associated vascular cell phenotypes. These findings confer a fundamental basis supporting that CCR2 may be a therapeutic target in intractable PAH patients with a certain CCR2-related inflammatory phenotype and refractory to conventional pulmonary vasodilators.
Abstract 4123478: The Impact of Social Determinants on Growth at 10 Years After the Norwood Procedure: Results from the Single Ventricle Reconstruction (SVR) Trial III
Authors: Cathleen Pruitt, Linda Lambert, Zhining Ou, Caren Goldberg, Angela Presson, Alaa Aljiffry, Jeffrey Anderson, Jon Detterich, Benjamin Frischhertz, Katherine Lupton, Andrew McCrary, Brian McCrindle, Amanda McCormick, Jane Newburger, Christian Pizarro, Chitra Ravishankar, Nancy Rudd, Amee Shah, Felicia Trachtenberg, Sinai Zyblewski, Luann Minich
Journal: Circulation (2024)

Background: The impact of social determinants of health (SDOH) on growth in patients with hypoplastic left heart syndrome (HLHS) is understudied. In a secondary analysis of the Pediatric Heart Network SVR III study, we explored the impact of SDOH on longitudinal somatic growth through age 10 years in transplant-free survivors with HLHS. Methods: Z-scores adjusted for age for weight (WAZ), height (HAZ), and BMI (BMIZ) were categorized at age 10 years. To assess relationships between z-scores at 10 years and SDOH variables, we modeled all annual measurements for each z-score outcome using a multivariable mixed effects regression that included an interaction between the SDOH predictor and age. We included Hollingshead Score (HH) as a SDOH marker. A higher HH indicates better family socioeconomic status. Results: Of 555 subjects enrolled in the SVR trial, 191 had 10-year growth data. The mean WAZ and HAZ were below normal, with values of -0.3±1.3 (p&lt;0.001) and -0.8±1.2 (p=0.002), respectively. BMIZ did not differ from normal, with a mean value of 0.0±1.3 (p=0.87). WAZ and HAZ were &lt;-2 in 9% and 13%, respectively; BMIZ was &lt;-2 in 4% and &gt;2 in 5%. At birth [coefficient (95% CI)], only higher HH was associated with higher HAZ [0.01 (0.01,0.03), p=0.02]. On multivariable analysis, lower WAZ at 10 years was associated with higher HH [-0.02 (-0.03,0.01)], private insurance [-0.5 (-0.85,-0.16)], and father with college education [-0.64 (-1.06,-0.22)] (p&lt;0.04 for all). Lower BMIZ was associated with higher HH [-0.01 (-0.03,0)] and private insurance [-0.47 (-0.89,-0.04)] (p&lt;0.05 for all). No SDOH factors were independently associated with HAZ at 10 years. Conclusion: Higher SDOH, indicated by private insurance, higher HH and higher father’s education, was associated with lower WAZ and BMIZ at age 10 years. This may be reflective of the general population as children with lower SDOH are at risk for high BMI. It is reassuring that few were under- and over-weight. Survivor bias of children with higher SDOH may also be influencing these results; however, these findings deserve further exploration.