tbuckley/cabot-search huggingface dataset:
Abstract 15758: Platelet Aggregation is Elevated in Psoriasis and Associated With Cardiovascular Risk
Authors: Kamelia Drenkova, Maria Teresa Mata Vivas, Jessica Garelik, Kristen Lo Sicco, Andrea Neimann, Jeffrey Berger, Michael Garshick
Journal: Circulation (2023)

Introduction: Psoriasis is associated with increased CV risk the mechanisms and prevention of which are not fully known. We evaluated the platelet phenotype (implicated in atherothrombosis) and in vitro response to aspirin in patients with psoriasis and its association with vascular stiffness and coronary atherosclerosis. Methods: Patients with psoriasis (n = 64, age 47.9 ± 15 years, 65% male), percent body surface area (BSA) of psoriasis 3%, were compared to controls (n = 40, age 40.8 ± 16 years, 45% male). Percent platelet aggregation in response to agonists adenosine diphosphate (ADP), collagen (Col), and arachidonic acid (AA - with and without aspirin) was measured in freshly isolated platelet-rich plasma via light transmission aggregometry (LTA). Vascular stiffness (via pulse wave velocity [PWV]) and CT coronary angiography were each performed as readouts of CV risk. Results: Compared to controls, psoriasis patients were older, of Caucasian ethnicity (Figure 1A), and overweight, but otherwise similar. Platelet aggregation after treatment with Col (p=0.01), ADP (p &lt; 0.01), and AA (p = 0.05) were all higher in psoriasis vs. control (Figure 1B-D). Platelet aggregation after activation with high dose AA was similar between groups (Figure 1E) however co-incubation with high dose AA plus aspirin displayed incomplete platelet inhibition of psoriasis platelets vs. controls (Figure 1F). Platelet aggregation to low dose AA and high dose AA plus aspirin co-incubation were each higher in those with enhanced vascular stiffness (figure 1G/1H) and the presence of coronary plaque (Figure 1I/1J). Conclusion: Platelet aggregation is consistently elevated in psoriasis across a variety of agonists, incompletely inhibited by aspirin, and associated with biomarkers of CV risk such as vascular stiffness and the presence of coronary plaque. These findings highlight the need to evaluate various anti-platelet strategies to reduce atherothrombotic risk in patients with psoriasis.
Abstract 18044: Valvular Procedures in Pregnant Women With Congenital Heart Disease: The Magee Obstetric Maternal and Infant (MOMI) ACHD Substudy
Authors: Anita Saraf, Morgan Hindes, Kathryn Berlacher, Arvind Hoskoppal, Janet M Catov, Andreas P Kalogeropoulos, Paola Pastena
Journal: Circulation (2023)

Introduction: Pregnant women with adult congenital heart disease (ACHD) are at high risk of complications and may require interventions, including valvular surgery, after delivery. However, data on the long-term need for valvular surgery among pregnant women with ACHD are limited. Hypothesis: We hypothesized that increasing ACHD complexity and obstetric history are associated with the need for valvular surgery after delivery. Methods: Data from the University of Pittsburgh Medical Center clinical data warehouse were linked to all deliveries from 2004 to 2020 in pregnant women with ACHD (N=430) and without ACHD (N=876), who were included in the Magee Obstetric Maternal and Infant (MOMI) study. Women were matched at the delivery level for age, delivery year, and race. Valvular procedures were captured using Current Procedural Terminology codes until 8/31/2022. Results: Baseline characteristics and pregnancy outcomes are presented in Table 1 . Prior to index delivery, 8 women (6 with ACHD, 2 controls) had a valve replacement, Table 1. After a median of 5.1 (2.8, 8.8) years, 23 women with ACHD had a total of 25 valve procedures, corresponding to 1.0% per year (95%CI: 0.6 to 1.4). Most procedures were aortic valve (n=11, plus aortic root in 5) and pulmonary valve replacements (n=11), followed by tricuspid (n=5) and mitral (n=1) procedures; some women had &gt;1 valve replaced in the same procedure. There were no valvular interventions among controls. After adjusting for maternal age and race, the strongest predictor of need for valvular interventions was ACHD complexity. Compared to simple lesions; moderate ACHD had a HR of 6.58; 95%CI 1.85 - 23.4; P=0.004 and complex ACHD a HR of 9.35; 95%CI 1.37 - 64.0; P=0.023). The number of previous deliveries (or total pregnancies) was not associated with the need for valvular procedures. Conclusions: Women with moderate or complex ACHD have increased rates of valvular procedures after delivery, but multiple pregnancies do not modify this risk.
Abstract 13060: Nutritional Status is Associated With Cardiac Death in Patients With Chronic Limb-Threatening Ischemia Undergoing Endovascular Intervention
Authors: Nobuhiro Ito, Daisuke Kanda, Daichi Fukumoto, Kenta Ohmure, Hirokazu Shimono, Hiroyuki Tabata, Yoshiyuki Ikeda, Mitsuru Ohishi
Journal: Circulation (2023)

Introduction: Chronic limb-threatening ischemia (CLTI) represents the end-stage manifestation of peripheral artery disease. The Wound, Ischemia, and foot Infection (WIfI) clinical stage has been thought to have a prognostic value in patients with CLTI. Research Questions: The relationship between cardiac death in patients with CLTI undergoing endovascular intervention (EVT) and malnutrition is unknown. Methods: This retrospective study investigated 200 consecutive patients with CLTI and we individually assessed WIfI clinical stage and nutritional status assessed using Geriatric Nutritional Risk Index (GNRI). We then compared cardiac death after EVT between a WIfI stage 1, 2 group and a stage 3, 4 group, and investigated association between baseline characteristics. Results: In 200 consecutive patients, 123 patients (62%) showed WIfI stage 1 or 2, and the remaining 77 patients (38%) had WIfI stage 3 or 4. Age was significantly higher in the WIfI stage 3, 4 group [median 75, interquartile range (IQR) 68-82] compared with the WIfI stage 1, 2 group (median 70, IQR 63-79, p=0.004). GNRI was significantly lower in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (median 88, IQR 80-97 vs. median 103, IQR 94-111, p&lt;0.001). Median duration of follow-up was 966 days (IQR, 540-1268 days). Incidences of all-cause and cardiac deaths were higher in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (27% vs. 15%, p = 0.047 and 12% vs. 3%, p = 0.040, respectively). Kaplan-Meier analysis showed a significantly lower survival rate in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (p=0.002 by log-rank test). Cox proportional hazard univariate analysis revealed that WIfI stage 3, 4 group [Hazard ratio (HR); 4.22, 95% confidence interval (CI): 1.29-13.72, p = 0.012], GNRI (HR;0.93, 95%CI:0.87-0.97, p=0.002), Hemodialysis (HR;4,67, 95%CI:1.28-16.96, p=0.010), Statin (HR;4,52, 95%CI:1.00-20.43, p=0.022), LVEF (HR;0.96, 95%CI:0.92-0.99, p=0.045) were correlated to cardiac death. Multivariate analysis models adjusted for relevant factors showed GNRI (HR;0.93, 95% CI:0.86-0.99, p=0.019) was significantly associated with cardiac death. Conclusion: GNRI may be a crucial independent predictor for cardiac death in patients with CLTI undergoing EVT.
Abstract 15421: Cardiovascular Health of Middle-Aged US Adults by Income Level, 1999 to March 2020
Authors: Michael Liu, Rahul Aggarwal, ZhaoNian Zheng, Rishi K Wadhera
Journal: Circulation (2023)

Introduction: Cardiovascular mortality has increased among middle-aged US adults since 2011. Despite these alarming trends, it is unknown how the burden of cardiovascular risk factors has changed for this population by income level over the past two decades. Methods: We conducted a serial cross-sectional analysis of the NHANES to evaluate changes in the prevalence, treatment, and control of cardiovascular risk factors among low-income (&lt;200% federal poverty threshold) and higher-income middle-aged adults (ages 40-64) between 1999 and March 2020. Results: Among 20,761 middle-aged adults, the prevalence of hypertension, diabetes, and cigarette use was consistently higher among low-income adults between 1999 and March 2020. Low-income adults experienced a significant increase in hypertension (37.2% [95% CI: 33.5-40.9] to 44.7% [95% CI: 39.8-49.5]) over the study period, but no changes in diabetes or obesity. In contrast, higher-income adults did not experience a change in hypertension but had significant increases in diabetes (7.8% [5.0-10.6] to 14.9% [12.4-17.3]) and obesity (33.0% [26.7-39.4] to 44.0% [40.2-47.7]). Hyperlipidemia decreased in both groups. Cigarette use was high and stagnant among low-income adults (33.2% [28.4-38.0] to 33.9% [29.6-38.3]) but significantly decreased among their higher-income counterparts (18.6% [13.5-23.7] to 11.5% [8.7-14.3]). Income-based inequities in cardiovascular risk factors persisted in recent years even after adjustment for insurance coverage, health care access, and food insecurity. Treatment and control rates for hypertension were unchanged in both groups (&gt;80%), while diabetes treatment rates only improved among the higher-income group. Conclusions: The burden of several cardiovascular risk factors worsened among middle-aged adults (ages 40-64) over two decades with varying trends by income level. Income-based inequities in hypertension, diabetes, and smoking have not meaningfully narrowed.
Abstract 16606: Diagnostic Performance of AI-QCT <sub>ISCHEMIA</sub> for Abnormal FFR Across Calcified Plaque Subgroups
Authors: Alexander van Rosendael, Nick Nurmohamed, Ibrahim Danad, Paul Knaapen, James Earls
Journal: Circulation (2023)

Introduction: Coronary atherosclerosis and vascular morphology imaging by quantitative CT angiography (AI-QCT) provides detailed plaque and vessel measures of the coronary tree. These features combined in a tool (AI-QCT ISCHEMIA ) accurately estimate vessel level ischemia. We investigated the diagnostic performance of AI-QCT ISCHEMIA for abnormal invasive fractional flow reserve (FFR) across subgroups of calcified plaque. Methods: Symptomatic patients within the CREDENCE (N=305) and PACIFIC (N=208) studies underwent CCTA, myocardial perfusion imaging (MPI; single photon emission computed tomography [SPECT] and/or positron emission tomography [PET]), fractional flow reserve by CT (FFR-CT ) and invasive coronary angiography in conjunction with unbiased 3-vessel invasive FFR measurements as reference standard. The diagnostic performance of the non-invasive tests was compared on vessel-level across the tertiles of calcified plaque volume, on an intention-to-diagnose basis. Results: Within the CREDENCE study, AI-QCT ISCHEMIA had an area under the receiver operating characteristics curve (AUC ROC) of 0.887, 0.850, 0.816 across tertile 1-3 of calcified plaque, respectively, which was significantly higher than FFR-CT and MPI. Within the PACIFIC study, the AUC ROC was 0.811, 0.860, 0.817 across the calcified plaque tertiles 1-3, which was significantly better than SPECT, and comparable to FFR-CT ad PET. The specificity of AI-QCT ISCHEMIA was lower with increased calcified plaque, being approximately 70% for the most calcified vessels amongst both cohorts. Conclusion AI-QCT ISCHEMIA , a tool to assess coronary ischemia based on quantitative coronary plaque and vascular morphology retained good diagnostic performance for invasive FFR across calcified plaque subgroups.
Abstract 17555: Are Intermittent BP Control and Patient Complexity Barriers to Antihypertensive Treatment Intensification for Uncontrolled BP?
Authors: Brent M Egan, Ben Martin, Shaun Wagner, David Ramsey, Rob Davis, Klodiana Myftari, Susan E Sutherland, Michael Rakotz
Journal: Circulation (2023)

Background: Antihypertensive (AH) therapeutic intensification (TI) is the exception even when systolic blood pressure (SBP, mmHg) is ≥160. Adults with hypertension (HTN) often have multiple chronic conditions (CCs) and wide intra-individual BP variability. Patient complexity and intermittent control to &lt;140/&lt;90 may contribute to low rates of AH TI. Methods: The study included 119,260 adults 18-85 years with a HTN diagnosis and ≥3 encounters with BP values in the past 2 years (01/01/20-12/31/22). SBP on the last recent visit, number (n) and percent (%) of patients by SBP group on the last visit, number of Elixhauser chronic conditions (ECC), % of visit in the past 2 years with BP &lt;140/&lt;90, and % of last visits with AH TI (addition of a new BP med class) are provided in the Table. Results: The main results are shown in the Table. The rate of TI correlated with the % of visits with uncontrolled BP in the past 2 years when controlling for number of CC (partial r=0.046, p&lt;0.0001) and inversely with CC when controlling for SBP (partial r = -0.039, p&lt;0.0001). Adjusted odds ratios (OR) for percent of visits controlled and TI was 1.697 (95% CI [1.577, 1.826]) when controlling for age, SBP, and number of chronic conditions. OR was 0.933 (95% CI [0.925, 0.942]) for number of chronic conditions and TI, controlling for SBP and % visits controlled. Conclusion: Hypertension control varies, even among groups with last SBP &lt;120 or ≥160. In fact, BP in adults with last SBP ≥160, BP was &lt;140/&lt;90 on nearly one third of visits in the prior two years, which may contribute to the fact that TI occurred on only one in four visits in this group. However, patient complexity (ECC) was not a barrier to TI in this patient cohort.
Abstract 15677: Heart Transplant in Older Adults: Before and After the 2018 United Network for Organ Sharing Allocation Change
Authors: Stephanie Golob, Orly Leiva, Randal Goldberg, Bernard Kadosh, Jennifer Cruz, Haider Nazeer, alex reyentovich, John A Dodson
Journal: Circulation (2023)

Introduction: There is an increasing trend towards transplanting older adults, and the proportion of those over 70 who have been transplanted has increased in recent years. In 2018, the United Network for Organ Sharing (UNOS) implemented a 6-tier allocation policy to replace the prior 3-tier system. There have been significant shifts in cardiac transplantation practices and patient outcomes following the implementation of the new policy. Hypothesis: This study aims to evaluate the impact of the new allocation policy on older adults. Methods: Adult patients who received heart transplant between January 1, 2010 and December 31, 2021 were identified in the UNOS registry and stratified by whether they were transplanted pre-2018 or post-2018. Outcome of interest was mortality at 1 after heart transplant. Multivariable Cox proportional hazard modeling was used to estimate hazard ratios associated with outcomes of interest. Results: 661 patients over the age of 70 were transplanted pre-2018 and 413 patients over 70 were transplanted post-2018. Those who were transplanted after the 2018 UNOS allocation change were less likely to have had an ischemic cardiomyopathy, more likely to have had an IABP or be on ECMO prior to transplant, and more likely to have had cancer prior to transplant. There was no difference in rates of diabetes, prior CVA, and dialysis for those transplanted pre- vs post-2018. 1 Year mortality for those pre- and post-2018 were similar (10.4% pre-2018, 11.4% post-2018, HR 1.11, CI 0.77-1.61, p=0.6). Conclusions: There has not been a change in mortality in older adults with the 2018 UNOS allocation change. The increase in usage of IABP and ECMO prior to transplant post-2018 mirror changes in the overall population. Notably, post-2018, more older adults with prior malignancies are being transplanted.
Abstract 17511: Aortic Stiffness Among Mexican-American Adults With Diabetes and Prediabetes: Evidence of Accelerated Vascular Aging and Increased Cardiac Biomarkers
Authors: Benjamin Pickard, Craig Hanis, Christie M Ballantyne, VIJAY NAMBI, Eric Brown, Goo Jun, David Aguilar
Journal: Circulation (2023)

Introduction: Type 2 diabetes mellitus is associated with increased aortic stiffness, a finding that predicts adverse cardiovascular events. Whether individuals with dysglycemia below the diagnostic threshold for diabetes have increased aortic stiffness has been less studied, particularly in Hispanic adults, a population sharing a disproportionate burden of dysglycemia. Hypothesis: We hypothesized that individuals with prediabetes would: (1) have increased aortic stiffness compared to normal glycemia, and (2) increased aortic stiffness would be associated with biomarkers of myocardial injury. Aims: We aimed to: (1) identify the relationship between aortic stiffness and glycemic status in a Hispanic cohort, and (2) determine the relationship between cardiac biomarkers and aortic stiffness. Methods: We prospectively measured carotid-femoral pulse wave velocity (PWV) and glycemic measures in 728 Mexican American adults in Starr County, Texas. Cardiovascular biomarkers [high-sensitivity troponin T (hs-TnT), galectin-3, and NT-proBNP] were measured in a subset (n=404). Multivariable models (using natural log PWV) were used to adjust for confounders. Results: 45% of participants had diabetes, and 28% had prediabetes. PWV increased across glycemic categories; median PWV (25 th , 75 th ) in diabetes was 11.7 m/sec (9.9, 13.7), prediabetes 9.9 m/sec (8.6, 11.1), and normal glycemia 8.7 m/sec (7.9, 9.9) (adjusted p-value &lt;0.001 and 0.008, respectively). The figure demonstrates PWV stratified by age decade; PWV in prediabetes was similar to PWV in those without diabetes who were a decade younger. Median levels of hs-TnT, galectin-3, and NT-proBNP increased across quartiles of PWV (p trend &lt;0.001 for all). Conclusion: In a cohort of Hispanic adults, increased aortic stiffness develops before the onset of diabetes and seen in those with pre-diabetes. Importantly, increased aortic stiffness is associated with biomarkers of cardiac injury.
Abstract 331: Whether the Compliance of Target Temperature Management Protocol Affects Outcomes in Cardiac Arrest Survivors?
Authors: HSIN YU LEE, Min-Shan Tsai, Wen-Jone Chen, CHIEN-HUA HUANG, Matthew Ma, Wen-chu Chiang, Kuan-Ting (Chris) Lu
Journal: Circulation (2023)

Background: Targeted temperature management (TTM) improves neurological recovery in cardiac arrest survivors and protocols have been established during the implementation of high quality TTM with recommended about cooling rate, duration of maintenance, and rewarming speed. Research question Whether fitting TTM protocols results in better survival and neurological recovery remains un-investigated. Aim: To evaluate the benefit of TTM protocol compliance on the outcomes in cardiac arrest survivors. Methods: The retrospective cohort study enrolled 1141 non-traumatic adult cardiac arrest survivors and pre-arrest Cerebral Performance Category (CPC) score=1-2 during 2015-2020 at a tertiary medical center. Patients who underwent TTM (n=305) were further selected. Patients with spontaneous hypothermia (&lt;35°C) at ROSC (n=107) and those without TTM completion (n=21) were excluded. A total of 202 patients were finally enrolled in the study. As the protocol was divided into three categories: cooling rate, duration of maintenance, and rewarming speed, there were 110 patients in the protocol-fit group and 92 patients in the protocol non-fit group. The favorable neurological recovery was considered as CPC=1-2 at hospital discharge. Results: There were 42 patients (38.2%) in the protocol-fit group had favorable neurological recovery, while 32 patients (34.8%) in the protocol non-fit group. After adjusting age, initial shockable rhythm, witnessed collapse and CPR duration, the protocol non-fit group was associated to the poor neurological outcome (adjusted odds ratio [aOR] 2.44, 95% confidence interval [CI]= 2.23-5.35) but not the in-hospital mortality (aOR 2.31, 95% CI= 0.70-2.47). In the protocol non-fit group, the most common non-fitting reason was the prolong time-to-target temperature (n=33, 58.7%). Twenty-four patients who failed to fit the 2 categories. The number of non-fitting category was not significantly associated with in-hospital mortality and poor neurological recovery due to limited sample number. Conclusion: Among cardiac arrest survivors undergoing TTM, patients who did not fit the TTM protocols were associated with poor neurological recovery than those who completely fit the protocols.
Abstract 14623: SGLT2 Inhibitors versus Sulfonylureas as Add-On Therapy to Metformin in Type 2 Diabetes: A Systematic Review and Meta-Analysis
Authors: Muhammed Umer, Ali Salman, Shahrukh Nadeem, Abiha Iqbal, Fatema Tashrifwala, Neha Saleem Paryani, Eman Ali, Jai Kumar, Muhammad Talha Maniya, Dayab Asad, Saad A Ansari, Tariq J Siddiqi, Muhammad Shariq Usman
Journal: Circulation (2023)

Background: Traditionally, in patients with type 2 diabetes mellitus (T2DM) poorly controlled on metformin sulfonylureas were used as add-on therapy. Sodium glucose cotransporter 2 inhibitors (SGLT2i) have emerged as novel antidiabetic agents that have also shown improvement in cardiovascular outcomes. Aim: To conduct a meta-analysis comparing SGLT2i with sulfonylureas as add-on therapy to metformin in patients with poorly controlled type 2 diabetes mellitus (T2DM). Methods: We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library up till March 2023, to identify studies comparing SGLT2i versus sulfonylureas as add-on therapy to metformin in patients with poorly controlled T2DM (regardless of the presence of comorbid cardiovascular disease). Effect estimates were pooled using a random-effects model, and reported as risk ratios (RR) for dichotomous outcomes, and mean differences (MD) for continuous outcomes, along with 95% confidence intervals (CIs) for each. Results: Eleven studies met the inclusion criteria, all reporting mortality outcomes. Metformin-SGLT2i significantly reduced all-cause mortality (RR=0.76 [0.60, 0.95]; p=0.02; Figure ) and myocardial infarction (RR: 0.65 [0.47, 0.89]; p=0.008), in comparison to metformin-sulfonylureas. Metformin-SGLT2i was also associated with a significantly greater reduction in HbA1c (MD: -0.10% [-0.17 - -0.03]; p=0.004), fasting plasma glucose (MD: -0.55 [-0.69 - -0.41]; p&lt;0.001), systolic blood pressure (MD: -4.77 mmHg [-5.39, -4.16]; p&lt;0.001), and weight (MD: -4.57 kg [-4.74, -4.39]; p&lt;0.00), compared with metformin-sulfonylurea. Moreover, metformin-SGLT2i was associated with a significantly lower risk of hypoglycemic events (RR=0.13 [0.10-0.17]; p&lt;0.001). Conclusion: In patients with poorly controlled T2DM on metformin, addition of SGLT2i may yield superior outcomes compared with sulfonylureas.