tbuckley/cabot-search huggingface dataset:
Abstract 4138564: Fitbit-Measured Physical Activity Is Inversely Associated With Incident Atrial Fibrillation Among All Of Us Participants
Authors: Souptik Barua, Dhairya Upadhyay, Aditya Surapaneni, Morgan Grams, Sean Heffron
Journal: Circulation (2024)

Background: Studies show that moderate to vigorous physical activity (MVPA) reduces atrial fibrillation (AF) risk. However, these studies used subjective questionnaires or short-term (&lt;1 week) accelerometry assessments. Objective: This study investigated the link between MVPA levels and AF incidence using long-term (1-year) accelerometry data from the NIH All of Us Fitbit database. Methods: The study included All of Us participants who agreed to share electronic health record (EHR) and Fitbit data between January 1, 2016 to July 1, 2022. Among participants without an existing diagnosis of AF, the average weekly minutes of MVPA over the first year of Fitbit use was computed. Incident AF events were identified using validated ICD-10 codes in a five-year follow-up period. The risk of incident AF was evaluated using Cox proportional hazards regression models, for both MVPA as a continuous and a categorical variable (&lt;30, 30-150,151-300, and &gt;300 minutes MVPA per week; aligned with WHO guidelines). Covariates included age, sex, race/ethnicity, BMI, smoking status, and diagnoses of hypertension and diabetes. In a subset of participants with whole genome data, we evaluated if the association between MVPA and AF incidence varied by a participant’s AF genetic risk score (GRS) Results: 6086 participants (mean age 50 years, 71% female, 83% White) had EHR and at least 1 year of Fitbit data. Over the 1-year MVPA assessment period, participants had 41±12 weeks of complete data and a median 202 [241] minutes of MVPA per week. 55 participants (0.9%) experienced incident AF in the five-year follow-up period. In adjusted analysis, every additional hour of MVPA was associated with an 11% reduced risk of AF (HR = 0.89 [0.81,0.98], p = 0.02). There was a step-wise reduction in risk of AF by MVPA category with &lt;30 min/week as the reference: 30-150 (HR = 0.62 [0.24,1.6], p = 0.31), 151-300 (HR = 0.40 [0.15,1.07], p = 0.07), and &gt;300 (HR = 0.35 [0.13,0.95], p = 0.04) ( Figure 1 ). These associations also held after adjusting for GRS. Conclusion: Higher amounts of objectively measured MVPA were inversely associated with risk of incident AF, independent of clinical and genetic risk factors.
Abstract 4138373: Machine learning identifies clinically distinct phenotypes in patients with aortic regurgitation.
Authors: Brototo Deb, Christopher Scott, Hector Michelena, Sorin Pislaru, Vuyisile Nkomo, Garvan Kane, Juan Crestanello, Patricia Pellikka, Vidhu Anand
Journal: Circulation (2024)

Background: Aortic regurgitation (AR) is a prevalent valve disease with a long latent period to symptoms. Recent data has suggested the role of novel markers of myocardial overload in assessing onset of decompensation. Method: We sought to evaluate the role of unsupervised cluster analyses in identifying different clinical clusters, including clinical status, and a large number of echocardiographic variables including left ventricular (LV) volumes, and their association with mortality. Patients with ≥moderate-severe chronic AR identified using echocardiography at Mayo Clinic, Rochester were retrospectively analyzed. Primary outcome was all-cause mortality censored at aortic valve surgery/last follow-up. Uniform Manifold Approximation and Projection (UMAP) with K -means algorithm was used to cluster patients using clinical and, echocardiographic variables at the time of presentation. Missing data were imputed with the Multiple Imputation by Chained Equations (MICE) method. A supervised approach trained on the training set was used to find cluster membership in a hold-out validation set. Log-rank tests were used to assess differences in mortality rates between the clusters, both in the training and validation sets. Results: Three distinct clusters were identified among 1100 patients (log-rank P for survival &lt;0.001). Cluster 1 (n=337), which included younger males with severe AR but fewer symptoms, showed the best survival, 75.6% (69.5, 82.3). Cluster 2 (n=235), older and more females with elevated filling pressures, showed intermediate survival of 64.2 % (56.8, 72.5). Cluster 3 (n=253), characterized by severe symptomatic AR, demonstrated the lowest survival of 45.3 % (34.4, 59.8) at 5 years. Similar clusters were formed in the internal validation cohort. Conclusion: Distinct clusters with variable echocardiographic features and mortality differences exist within patients with chronic ≥moderate-severe AR. Recognizing these clusters can refine individual risk stratification and clinical decision-making after verification in future prospective studies.
Abstract 4138617: Temporal and Regional Trends in Cardiovascular Mortality Associated with Parkinson's Disease from 1999 to 2020: A Retrospective Study in the United States
Authors: Zain Nadeem, Obaid Ur Rehman, Muhammad Bilal Sardar, Eeman Ahmad, Aimen Nadeem, Rohan Kumar Ochani
Journal: Circulation (2024)

Introduction: Parkinson’s disease (PD) is a common neurodegenerative disorder, and existing evidence links it to cardiovascular (CVD) mortality. Research Question: Is the CVD-related mortality higher in PD patients compared to that in the general population? Goals: We aim to identify CVD-related mortality trends in patients with PD in the US stratified by age, sex, race, and region, and compare them to CVD-related mortality trends in the general population. Methods: Death certificates from the CDC-WONDER database were examined for adults aged ≥65 years. Crude rates (CR) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and change in AAMR was estimated via annual percent change (APC) and the average annual percent change (AAPC) using Joinpoint regression. Results: From 1999 to 2020, a total of 138,151 CVD-related deaths occurred in individuals with PD. The AAMRs decreased moderately till 2002 (APC: -3.25), then sharply till 2014 (APC: -5.43), but increased thereafter till 2020 (APC: 1.77). Males had higher AAMR than females, and the AAPC for CVD-related deaths in PD differed significantly from those in the general population. NH Whites displayed the highest AAMR (16.14) while NH Blacks or African Americans displayed the lowest (9.65). Hispanics or Latinos showed an AAMR of 11.22, followed by NH Asians or Pacific Islanders (10.24) and NH American Indians or Alaska Natives (9.70). AAMRs also varied substantially by region (West: 16.64; Midwest: 16.40; Northeast: 15.59; South: 13.12). States with the highest AAMRs were Nebraska, California, and Oklahoma. Rural regions exhibited a higher AAMR (16.34) than Urban regions (14.88). The AAPC for CVD-related deaths in PD differed significantly from those in the West and in urban regions. Most deaths occurred at nursing homes or long-term care (43.85%). The adults aged ≥85 years exhibited an alarmingly high CR (53.04), and the AAPC differed significantly from the general population due to CVD. Conclusions: We observed overall decreasing trends in CVD-related deaths in adults with PD from 1999 to 2014, which increased thereafter till 2020. Highest mortality was exhibited by males and NH Whites, residents of the West and the Midwest, and adults ≥85 years.
Abstract 4138547: The A Body Shape Index and Type 2 Diabetes are Mutually Independent Predictors of Cardiovascular Events in Patients With Established Coronary Artery Disease
Authors: Thomas Plattner, Barbara Larcher, Arthur Mader, Alexander Vonbank, Andreas Leiherer, Axel Muendlein, Heinz Drexel, Christoph H Saely
Journal: Circulation (2024)

The A Body Shape index (ABSI) is a validated measure of visceral adiposity that is calculated based on waist circumference, height and BMI. Its power to predict cardiovascular events in patients with coronary artery disease (CAD) is unclear and is addressed in the present study. We prospectively recorded cardiovascular events in a cohort of 938 patients with CAD over a mean follow-up time of 8.1±4.2 years. At baseline, the ABSI was higher in patients with type 2 diabetes (T2DM; n=308) than in those who did not have diabetes (8.4±0.6 vs. 8.3±0.5; p=0.032). Prospectively, the ABSI significantly predicted the incidence of cardiovascular events (n=389) after adjustment for age, gender, smoking, hypertension, LDL cholesterol, HDL cholesterol, and T2DM (standardized adjusted HRs 1.12 [1.03-1.22]; p=0.009, respectively). T2DM in turn also significantly predicted cardiovascular events in this model with a HR of 1.23 [1.02-1.49]; p=0.034 after adjustment for ABSI. We conclude that ABSI and T2DM are mutually independent risk factors for cardiovascular events in patients with established CAD.
Abstract 4138639: Exploring advanced therapeutic approaches for atherosclerosis: Targeting efferocytosis and EndoMT with a focus on the CD47
Authors: Bandana Singh, Kui Cui, Beibei Wang, Qianman Peng, Bo Zhu, SHAHRAM EISA-BEYGI, Hao Wu, Donghai Wang, Scot Wong, Douglas Cowan, Hong Chen
Journal: Circulation (2024)

Background: The anti-phagocytic molecule CD47 is upregulated in the atherosclerotic plaques of patients with cerebrovascular disease; however, the molecular mechanisms responsible for the development and progression of atherosclerotic lesions have not been fully established. In this study, we postulate how endothelial-specific CD47 promotes endothelial-to-mesenchymal transition (EndoMT) in potentiating atherosclerosis and assess the efficacy of the development of novel therapeutic interventions for cardiovascular disease. Methods: Using single-cell RNA sequencing (scRNA-seq), combined with molecular, cellular, and biochemical analyses, we investigated the role of endothelial CD47 in stimulating EndoMT using knock-out in ApoE-/- atherosclerotic mouse models. Results: ScRNA-seq revealed that CD47 promotes EndoMT, and the loss of endothelial CD47 inhibits EndoMT marker expression as well as transforming growth factor-beta signaling in vitro and atherosclerotic mice, which is associated with smaller lesions in Apoe-/- mouse model. In endothelial cells, CD47 hinders efferocytosis of senescent ECs and represses macrophage’s efferocytotic capacity to propel arterial inflammation and atherogenesis. Mechanistically, the interaction between CD47 and efferocytic receptor MerTK exacerbates inflammation by inhibiting the process of efferocytosis in endothelial cells and macrophages under atherogenic conditions. In response to atherogenic stimuli, endothelial CD47 upregulates the endocytic adaptor protein epsin, causing fibroblast growth factor receptor-1 (FGFR1) signal attenuation that upregulates TGF-β signaling and promoting EndoMT and potentiating atherosclerosis. Conclusion: We conclude that endothelial CD47 potentiates EndoMT during atherogenesis by increasing TGF-β signaling through FGFR1 internalization and degradation and targeted manipulating CD47 expression with precision nanomedicine offering a novel approach for mitigating cardiovascular disease.
Abstract 4138514: From Treatment to Trigger: A Case of Atomoxetine-Induced Brugada Pattern
Authors: MAHMOUD ABDELSALAM, Omar Elsayed, Shady Ezaldin, Maram Ahmed, Elie Gharib
Journal: Circulation (2024)

Introduction: Brugada syndrome is an inherited cardiac disorder characterized by specific ECG patterns, notably the coved-type ST-segment elevation in the right precordial leads (V1-V3), leading to an increased risk of sudden cardiac death. This condition often stems from mutations in the SCN5A gene, which impair cardiac sodium channel function. The manifestation of Brugada Pattern, showing typical ECG findings without clinical criteria like sudden cardiac arrest or syncope, is significant. We highlight a case where atomoxetine, a selective norepinephrine reuptake inhibitor used for ADHD, unveiled a type 1 Brugada pattern. Case Presentation: A 26-year-old male with a history of ADHD on atomoxetine only presented to the emergency department with sudden substernal chest pain radiating to his left arm. His initial ECG showed right bundle branch block and type 1 Brugada pattern (Figure.1). Despite normal troponin levels and a negative coronary CT angiography, the patient's ECG abnormalities raised concerns. With no personal or familial history of arrhythmia or SCD and no other medications, atomoxetine was suspected as the trigger. Upon discontinuation, the patient's ECG type 1 Brugada pattern resolved (Figure. 2), and he remained asymptomatic with a normal Holter monitor at a 1-month follow-up. Discussion: Brugada syndrome is marked by dynamic ECG abnormalities, which can surface due to triggers like fever, certain medications, and electrolyte imbalances. Atomoxetine, an ADHD treatment and selective norepinephrine reuptake inhibitor, affects the human cardiac sodium channel (hNav1.5), encoded by the SCN5A gene. This interaction can disrupt heart action potentials, leading to conditions like long QT syndrome and Brugada pattern, by slowing cardiomyocyte depolarization and conduction. Its effect on hNav1.5 resembles that of antidepressants like Fluoxetine, increasing the risk of Brugada pattern. In our case, a patient's type 1 Brugada pattern, with no underlying heart disease or family history, pointed to atomoxetine as the cause. Discontinuing the drug resolved the ECG abnormalities. Conclusion: This case emphasizes the importance of assessing cardiovascular risk before prescribing atomoxetine, especially in individuals at risk for cardiac sodium channel dysfunctions. Immediate intervention and monitoring are critical to prevent severe arrhythmias.
Abstract 4138491: Association of histologic findings with long-term outcomes in symptomatic obstructive hypertrophic cardiomyopathy patients undergoing surgical myectomy
Authors: Shada Jadam, Andrew Gaballa, Alaa Alashi, Bo Xu, Maran Thamilarasan, E Rodriguez, Carmela Tan, Susan Ospina, Nicholas Smedira, Zoran Popovic, Milind Desai
Journal: Circulation (2024)

Background: In hypertrophic cardiomyopathy (HCM), histologic findings like myocyte hypertrophy&amp;disarray, interstitial fibrosis (IF)&amp;small intramural coronary arteriole dysplasia (SICAD) account for the left ventricular hypertrophy, diastolic dysfunction, arrhythmogenicity&amp;microvascular ischemia. Objectives: To evaluate the association between histology&amp;outcomes in obstructive HCM (oHCM) patients undergoing surgical myectomy (SM). Methods: This was an observational study of 1722 symptomatic oHCM patients (mean age 56±14 years, 948 [55%] men) who underwent SM at a tertiary care center between 2005-18. Baseline clinical data was collected. The SM specimen was analyzed for presence&amp;severity of a) myocyte hypertrophy b) myocyte disarray c) IF&amp;d) SICAD. Histologic findings were graded as 0-3 (none, mild, moderate,&amp;severe)&amp;a score from 0-12 was calculated. Primary endpoint was a composite of death, appropriate defibrillator discharge or cardiac transplantation during follow-up. Results: 896 (52%) were in New York Heart Association (NYHA) class III/IV, 457 (21%) had exertional syncope, 727 (42%) had ≥1 sudden death risk factor&amp;409 (24%) had atrial fibrillation (AF). Moderate&amp;severe histologic findings were distributed as follows: myocyte hypertrophy (1341 [78%]), disarray (237 [14%]), IF (448 [26%])&amp;SICAD (258 [15%]). The mean total histologic score was 5.1±1.4. At 5.1±5.2 years, there were 352 (20%) primary events (317 [18%] deaths). On spline analysis (Figure 1A), a total histology score of ≥ 6 was associated with primary events. On Kaplan-Meier analysis (Figure 1B), patients with a histology score ≥ 6 had greater events vs. those with a score &lt;6 (147/598 [25%] vs. 205/1124 [18%], log-rank p-value 0.002). On multivariable Cox analysis, age (for 10-year increase, Hazard ratio or HR 1.49 [95% confidence interval or CI 1.35-1.65], p&lt;0.001), NYHA Class III/IV (HR 1.58 [95% CI -1.25-2.01], p&lt;0.001), AF (HR 1.65 [95% CI 1.30-2.10], p&lt;0.001)&amp;histology score ≥6 (HR 1.24 [95% CI 1.03-1.54], p=0.03) were independently associated with higher primary events. Conclusions: In symptomatic oHCM patients undergoing SM, a higher histologic score was independently associated with long-term outcomes.
Abstract 4138486: Unplanned Readmissions Due to Post-Acute Myocardial Infarction Complications: Insights from the Nationwide Readmission Database
Authors: Sherif Eltawansy, Ndausung Udongwo, Michael Fatuyi, Jalal Ghali, Joseph Heaton, Jesus Almendral
Journal: Circulation (2024)

Introduction: Acute myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. Despite advances in treatment, readmissions within 30 days remain a significant concern, impacting both patient outcomes and healthcare costs. This study aims to analyze trends in 30-day readmission rates (30-dr) for patients discharged after an acute MI. Methods: We analyzed the 2016-2020 Nationwide Readmission Database for patients aged ≥ 18 years with initial admission of acute MI and were readmitted within 30 days. Variables were identified using ICD-10 codes. The primary outcome was trends in 30-dr; secondary outcomes included trends in complications, mortality rate, length of stay (LOS), and healthcare costs. Multivariate and descriptive bivariate analyses were conducted, with p-values &lt;0.05 considered statistically significant. Results: There was a notable decrease in the acute MI index admissions total number from 507,608 in 2016 to 471,292, p trend &lt; 0.01. The index admission mean age throughout the study years was 66.9 ± 13.5 years, with 62.7% male patient. Index admission inpatient mortality dropped reaching OR 0.92 (CI 0.88-0.96) by 2020 with a drop of 0.08 OR from 2016 with (p trend &lt; 0.01) using logistic regression. The index admission LOS remained consistent with allover average 4.64 days (p trend = 0.25). The mean healthcare costs saw a significant increase from $22,456 in 2016 to $27,249 in 2020 (p trend &lt; 0.01). The 30-dr trend decreased from 9.41% in 2016 to 7.8% in 2020 (p trend &lt; 0.01). The top five readmission reasons in order included heart failure (14.94%of total readmission), myocardial reinfarction (13.59%), sepsis (4.49%), Acute kidney injury(2.4%), and chest pain(2.1%). The risk of readmission went up 1% for each year increase of age and 12% for female gender (using OR,logistic regression), despite initial admission was more male dominant. Conclusion: Our study demonstrates a declining initial admission, its mortality rate,and 30-dr. There was readmission healthcare costs increase. We noticed four top complications-driven readmission falling under cardiovascular diseases category with the top one as heart failure and myocardial reinfarction. This study tries to highlight relevant data to target interventions to reduce readmissions and complications, ultimately improving patient outcomes and reducing the healthcare economic burden.
Abstract 4138488: Association Between Guideline-directed Medical Therapy and Reintervention Risk at 2 Years Following Peripheral Vascular Interventions
Authors: Santiago Callegari, Jacob Cleman, Mufti Rahman, Isabella Capuano, Kim Smolderen, Carlos Mena-Hurtado, Gaelle Romain
Journal: Circulation (2024)

Introduction: Patients with peripheral artery disease (PAD) undergoing peripheral vascular interventions (PVI) face frequent reinterventions. The association between the use of guideline-directed medical therapy (GDMT) and reintervention risk is unclear, we therefore aimed to study the association between GDMT and 2-year reintervention risk using the largest national vascular registry. Methods: PVI procedures in patients with claudication or chronic limb-threatening ischemia between 2017-2018 were abstracted from the Vascular Quality Initiative (VQI) registry. GDMT was defined as statin, antiplatelet, and ACE/ARB if hypertensive prescribed at discharge. Reintervention was obtained from Medicare claims data. Propensity score of no GDMT vs. GDMT was calculated using 22 preprocedural variables followed by 1:1 matching of patients. The 2-year cumulative incidence of reintervention and subhazard ratios (sHR) for 2-year reintervention risk in no GDMT vs. GDMT were assessed using Aalen-Johansen method and Fine-Gray model, respectively, to account for the competing risk of death. Results: A total of 13,244 patients (6,622 by GDMT group) were included after 1:1 matching (mean age 72.0 ± 9.9, female 38.9%, white 79.4% Black or African American 15.3%) . At 2 years, the cumulative incidence of reintervention was 43.0% (95% CI 41.0%-44.9%) for patients with no GDMT vs. 41.2% (95%CI 39.4-43.0) for the GDMT group (P=0.293). Not receiving GDMT was not associated with 2-year risk of reintervention (sHR: 1.03 95%CI 0.97-1.10; P=0.293). Conclusion: Around 40% of patients undergoing a PVI will have a reintervention at 2 years. The receipt of GDMT at discharge was not associated with a lower reintervention risk at 2 years, as currently assessed. Further granular measures of GDMT should integrate adherence information, as well as information on other lifestyle and cardiovascular risk management to obtain a more complete assessment of a potential association with reintervention risk.
Abstract 4138424: Ring of Power: Unraveling a Rare Diagnosis in a Young Male with Palpitations
Authors: Ali Jafry, Joshua Silverstein, Amit Thosani, Victor Farah, Georgios Lygouris, Indu Poornima
Journal: Circulation (2024)

Case Description: A 36-year-old male presented for an outpatient treadmill ECG stress test for further evaluation of palpitations exacerbated by exercise. He had no ischemic ECG changes, but developed a sustained episode of polymorphic VT at 13 minutes (Figure 1a). The test was stopped and the VT self-terminated after 43 seconds. The patient was admitted for further workup. Lab workup was unremarkable; baseline ECG demonstrated no ST-T wave changes and displayed normal QT and QRS duration. TTE showed mild biventricular dysfunction. Coronary CT angiogram showed type 3 subtype of Vieussens’ arterial ring (VAR), with an absent left main and super-dominant RCA supplying both LAD and LCx. FFR-CT showed non-hemodynamically significant stenosis in the mid-distal LAD (Figure 1b). Left heart catheterization confirmed presence of VAR and mild diffuse disease in a small-caliber mid-distal LAD (Figures 1c&amp;d). No malignant course or dynamic coronary compression was present. Cardiac MRI revealed normal biventricular function and the absence of late gadolinium enhancement. An exercise stress test, now with myocardial perfusion, was performed and was entirely normal without evidence of myocardial ischemia. Genetic testing for catecholaminergic polymorphic VT was negative. After a multidisciplinary discussion, it was decided not to pursue CABG in the absence of demonstrable ischemia at peak exercise. He underwent an ICD placement for secondary prevention and was discharged on beta blockers. Discussion: Three distinct subtypes of VAR have been described, with type 3 being the rarest. The coronary anomaly was first described by Raymond de Vieussens in 1706, and represents an embryologic remnant of the conotruncal circle. It may be diagnosed incidentally in asymptomatic patients or present with angina especially if underlying CAD, aneurysms or fistulae are present. We report the first case of exercise-induced polymorphic VT in a type 3 VAR patient, theorizing that intermittent myocardial ischemia at peak exercise may induce VT in these patients. Surgical revascularization may be considered if myocardial ischemia is demonstrated on stress testing, although its benefit in patients without such evidence of ischemia is unknown.