tbuckley/cabot-search huggingface dataset:
Abstract 4136145: All-cause and Cause-specific Mortality Disparities in the District of Columbia: Temporal Trends from 2000 to 2020
Authors: Maryam Hashemian, Katherine Conners, Tiffany Powell-Wiley, Rebeka Rafi, Gretell Henriquez Santos, Joe Shearer, Jungnam Joo, Meredith Shiels, Veronique Roger
Journal: Circulation (2024)

Background: A report evaluating all-cause mortality in 30 major U.S. cities documented that inequality between Black and White populations in Washington, D.C. was the greatest. However, little is known about disparities in cause-specific mortality over time or by racial groups. Aims: Evaluate trends in all-cause and cause-specific mortality in D.C. from 2000 to 2020 by race, and concurrently examine trends in cardiovascular (CV) risk factors. Methods: Using the CDC WONDER database, we calculated age-adjusted mortality rates per 100,000 persons (2000-2020) for Non-Hispanic Black and Non-Hispanic White populations in D.C. and corresponding rate ratios. Average Annual Percentage Change (AAPC) was examined with joinpoint regression. We examined the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) using the Behavioral Risk Factor Surveillance System (2000-2020). Results: Among 102,710 deaths that occurred in D.C. (80% Black), cardiovascular diseases (CVD, 32%) and cancer (22%) accounted for over half of the deaths. All-cause mortality declined between 2000-2012 (AAPC: -2.9%, 95% CI: -5.6, 1.0) but stagnated between 2012-2018 (AAPC:-1.1%, 95% CI: -4.6, 0.9) and increased after 2018 (AAPC: 7.7%, 95% CI: 0.6, 11.9). CVD mortality declined between 2000-2011 and plateaued thereafter among Black individuals, contrasting with a monotonous decline (AAPC: -4.7%, 95% CI: -5.3, -4.0) among White individuals, resulting in a magnification of the disparities. Cancer mortality decreased over time for both White and Black individuals (AAPC: -3.4%, 95% CI: -3.9, -2.9 vs. AAPC: -1.8%, 95% CI: -2.1, -1.4, respectively), with a greater magnitude in White individuals. Risk factors were more prevalent among Black individuals over the period. Conclusion: In D.C., the mortality rate is higher in Black vs. White populations, and disparities are increasing over time. While CVD and cancer mortality rates declined overall, profound disparities remain. CVD risk factors are more common in Black populations, with persisting disparities. There is an urgent need for CVD prevention and management, tailored to Black populations in D.C.
Abstract 4135968: Radiomic features of skeletal muscle on prostate T1-Weighted MRI associated with MACE outcomes in prostate cancer patients undergoing hormonal therapy
Authors: Harikrishnan Hyma Kunhiraman, Rakesh Shiradkar, Sandeep Yerraguntla, Gaurav Gopu, Stanley Joseph, Stephanie Jiang, Omar Makram, Neal Weintraub, Pardeep Mittal, Sagar Patel, Gourav Modanwal, Natasha Setiadi, Liping Li, Anant Madabhushi, Avirup Guha
Journal: Circulation (2024)

Background: Patients with high-risk prostate cancer (PC) who undergo hormonal therapy(HT) frequently die of major adverse cardiovascular events (MACE). Skeletal muscle on abdominal T1-weighted MRI (T1W) has been shown to be associated with cardiovascular fitness. Aims: To quantify heterogeneity associated with skeletal muscle tissue composition on prostate MRI patients undergoing HT using computationally derived radiomic features and identify their association with MACE. Methods: Cohort of N=58 men diagnosed with PC who underwent a 3 Tesla pre-treatment multi-parametric MRI followed by HT and followed up for MACE events were identified. MACE is defined as a composite of cardiovascular death, atrial fibrillation, myocardial infarction, ischemic stroke, heart failure, coronary artery disease, and peripheral vascular disease. Regions of interest (ROI) of skeletal muscle, including the obturator externus, pectineus, and the adductor group of muscles, were delineated on axial T1W under the guidance of an experienced radiologist. A set of 120 radiomic features, including gray level statistics, co-occurrence, wavelet, and texture energy-based features, were extracted within the ROI which quantifies underlying subvisual texture-based heterogeneity. Radiomics associated with MACE events were identified using the Wilcoxon rank-sum test and univariate Cox-regression (p&lt;0.05). Results: Of the N=58 patients included in this study, 18 experienced MACE. The most common MACE event was AF (8.6%). Median-time-to-MACE event was 7.3 years (6.2-8.2). 3 radiomic features (Table 1) quantifying the heterogeneity of skeletal muscle on prostate T1W were observed to be associated with MACE. Specifically, we observe that first order features have a lower response and wavelet features have a lower response in MACE patients which suggests a higher degree of local deformations and heterogeneity in skeletal tissue compared to non-MACE patients. Conclusions: Results from our study suggest that radiomics quantified texture characteristics of skeletal muscle tissue may indicate cardiovascular fitness, reflecting the likelihood of experiencing MACE following initiation of HT in PC men. Pre-treatment identification of PC patients at high risk of MACE may allow for alternative treatment options improving cardiovascular outcomes. Future studies will involve exploring larger, multi-site cohorts and machine learning modeling to determine cardiovascular risk.
Abstract 4135745: Prematurity Predicts Neurodevelopmental Outcomes in Congenital Heart Disease
Authors: Jenna Katz, Kimberlee Gauvreau, Samantha Butler, Anjali Sadhwani, Phillip Levy, Aditya Kaza, Meena Nathan, Jane Newburger
Journal: Circulation (2024)

Background: Neurodevelopmental (ND) impairment is common in both prematurity and congenital heart disease (CHD). Preterm infants with CHD may have a “double hit,” with worse ND impairments than seen in prematurity or CHD alone. We analyzed whether gestational age (GA) at delivery predicted ND outcomes in children with CHD. Methods: We performed a single-institution retrospective study of children who underwent infant heart surgery from 2007-2020 and returned for ND evaluation after discharge. Exclusion criteria were 1) trisomy 21 and 2) PDA ligation alone. The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) assessed ND between ages 6-40 months. Patients were stratified into 4 GA groups: very/moderately preterm (≤33 weeks), late-preterm (34-36 weeks), early-term (37-38 weeks) or term/post-term (≥39 weeks). Hierarchical linear regression evaluated potential predictors of Bayley-III composite scores including GA category, demographic, medical, and surgical variables. Results: Among 1350 infants, 513 (38%) had a Bayley-III at median age 28 months [IQR 19, 34]. Of these, 448 (87%) were full-term and 65 (13%) preterm. In univariate analyses, children born preterm vs. full term had lower Bayley-III cognitive, language, and motor scores, explaining from 2.4% (language) to 6.2% (motor) of the variance in Bayley composite scores. In the final models, GA remained a strong independent predictor of motor and cognitive scores. Children with GA ≤33 weeks had the worst outcomes, with age-adjusted cognitive and motor composite scores 11 and 15 points lower, respectively, than those of term infants (Figure). Other significant risk factors included lower primary caregiver education, Black race, longer hospital length of stay, and genetic diagnosis. These models ultimately explained 17-26% of the variance in Bayley scores, with the highest explained variance in the motor domain. Conclusions: Adjusting for other patient and medical factors, preterm infants with CHD have worse cognitive and motor outcomes; risk is highest in those born at ≤33 weeks. Further work is needed to identify potentially modifiable factors to tailor prenatal, postnatal and perioperative care of infants with CHD born prematurely.
Abstract 4137249: Left atrial functional reserve predicts recurrence of atrial arrhythmia following catheter ablation in patients with persistent atrial fibrillation
Authors: Yuriko Yoshida, Koki Nakanishi, Masao Daimon, Kentaro Iwama, Kazutoshi Hirose, Yasuhiro Mukai, Hikari Seki, Yuko Yamamoto, Megumi Hirokawa, Tomoko Nakao, Tsukasa Oshima, Takumi Matsubara, Yu Shimizu, Gaku Oguri, Toshiya Kojima, Eriko Hasumi, Katsuhito Fujiu, Hiroyuki Morita, Makoto Kurano, Norihiko Takeda
Journal: Circulation (2024)

Background: Left atrial (LA) functional remodeling plays an essential role in the pathophysiological mechanisms of atrial fibrillation (AF). LA reservoir strain (LARS) measured by speckle-tracking echocardiography (STE) exhibits acceptable predictive value for recurrent atrial arrhythmia in patients with paroxysmal AF, while its performance in persistent AF remains inconclusive. Recently, LA functional reserve, a novel concept of LA mechanics in response to acute-volume overload, is drawing attention. Research Questions: Are LARS and LA functional reserve associated with recurrent atrial arrhythmia after catheter ablation in patients with persistent AF? Methods: Ninety-two patients who underwent first catheter ablation for persistent AF were included in the study. LARS at rest and LA functional reserve were assessed by STE 1-4 days before catheter ablation. LA functional reserve was calculated as change in LARS after passive leg lifting. Recurrence of arrhythmia was defined as atrial arrhythmia of ≥ 30 seconds duration after a 2-month blanking period. Results: The median values of LARS and LA functional reserve were 14.4 % (interquartile range [IQR] 10.9 to 18.2) and 1.0% (IQR -1.2 to 3.6), respectively. During a mean follow-up of 13.2 ± 9.9 months, 29 (31.5%) patients experienced recurrent AF. When we stratified patients into 2 groups according to LARS and LA functional reserve (below vs. above median values), patients with impaired LA functional reserve (&lt; 1.0%) were at higher risk of AF recurrence (log-rank test p value=0.026), but this was not observed for LARS (Figure). In multivariable Cox proportional hazard analysis, impaired LA functional reserve was associated with recurrent atrial arrhythmia independent of AF risk factors, left ventricular ejection fraction and LARS at rest (adjusted hazard ratio 3.99, p=0.004). Conclusions: Evaluation of LA functional reserve may provide valuable information for optimal patient selection as well as follow-up strategy after catheter ablation in patients with persistent AF.
Abstract 4136016: Higher aircraft noise exposure associates with worse heart structure and function
Authors: Constantin-Cristian Topriceanu, Xiangpu Gong, Mit Shah, Hunain Shiwani, Katie Eminson, Glory O Atilola, Calvin Jephcote, Kathryn Adams, Marta Blangiardo, James Moon, Alun Hughes, John Gulliver, Alex V Rowlands, Nishi Chaturvedi, Declan O'Regan, Anna L Hansell, Gabriella Captur
Journal: Circulation (2024)

Introduction: Aircraft noise is a concern for communities living near airports, but its impact on heart structure and function is unknown. Methods: Night-time (L night ) and weighted 24-hour day (L den ) aircraft noise levels were provided by the UK Civil Aviation Authority for 2011 (Fig.1). Health data came from UK Biobank (UKB) participants living near four UK major airports (Heathrow, Gatwick, Manchester, and Birmingham) who had cardiovascular magnetic resonance (CMR) imaging starting from 2014 and self-reported no hearing difficulties. Generalized linear models investigated the associations between aircraft noise exposure and CMR metrics (derived using a validated convolutional neural network to ensure consistent image segmentations), after adjustment for demographics, socio-economic, lifestyle, and environmental covariates. Mediation by cardiovascular (CV) risk factors was also explored. Downstream associations between CMR metrics and major adverse cardiac events (MACE) were tested in a separate prospective UKB subcohort (n=26,658) to understand the potential clinical impact of noise-associated heart remodeling. Results: Of 3,635 UKB participants included, 3% experienced higher aircraft noise L night (≥45decibels) and 8% higher L den (≥50decibels). Participants exposed to higher L night had 7% [95% confidence interval: 4–10%] higher left ventricular (LV) mass and 4% [2–5%] thicker LV walls with a normal septal:lateral wall thickness ratio (Fig.2 A1). This LV concentric remodeling is relevant since 7% higher LV mass associates with 32% higher odds of MACE. They also had worse LV myocardial dynamics (Fig.2 A2) (e.g., 8% [4–12%] lower global circumferential strain which associates with 37% higher odds of MACE). Overall, a hypothetical individual experiencing the typical CMR abnormalities associated with higher L night exposure may have 5-times higher odds of MACE. Body mass index and hypertension appeared to mediate 20-50% of the observed associations. Findings were similar in those exposed to higher L den (Fig.2 B1-2). Participants who did not move home during follow-up and were continuously exposed to higher aircraft noise levels had the worst CMR phenotype. Conclusion: Higher aircraft noise exposure associates with adverse LV remodeling, potentially due to noise increasing the risk of obesity and hypertension. Findings are consistent with the existing literature on aircraft noise and CV disease, and need to be considered by policymakers and the aviation industry.
Abstract 4135466: Feasibility of Using Existing Infection Surveillance Methods for Percutaneous Coronary Intervention-related Infections
Authors: Makiyo Hashimoto, Akihiko Takahashi, Mitsuko Yokouchi, Aiko Ko
Journal: Circulation (2024)

Background: Percutaneous coronary intervention (PCI) is a treatment that requires attention in terms of infection control, as it necessitates aseptic procedures similar to surgical operations. However, surveillance practices for PCI-related infections are uncommon, and no standardized surveillance program has been established. Purpose: To assess the feasibility of using existing surveillance methods to detect PCI-related infectious diseases. Method: To identify PCI-related bloodstream infections of local access sites, four existing case definitions, namely, laboratory-confirmed bloodstream infections (LCBI), clinical sepsis (CSEP), local access site infection (LASI), and exit site infection (ESI), were retrospectively applied to 1,037 patients who underwent PCI between April 2018 and March 2021. Of these, 167 experienced fever, underwent blood culture testing, and/or received antibiotics within 6 days of PCI. To confirm consistent evaluation, two independent infection control experts evaluated each case record according to the four case definitions. Results: Twenty-three patients (2.2%) were diagnosed with PCI-related infections, including two patients according to LCBI, 21 according to CSEP, and none according to LASI and ESI. Thirteen patients (LCBI: 1, CSEP: 12) received circulatory assist devices such as intra-aortic balloon pumping. Of the remaining 11 patients, 10 underwent emergency PCI, and one underwent elective PCI ( P =0.0001). The average length of hospital stay was 16.1 days for patients with PCI-related infections and 4.7 days for non-infected patients ( P &lt;0.05). Conclusion: The positive diagnosis of PCI-related infections was predominantly based on CSEP. Many of these positive patients underwent emergency PCI and/or received circulatory assist devices. The results of the present study warrant further investigations with larger patient cohorts.
Abstract 4135357: Activation of prostaglandin E receptor 4 attenuates pulmonary vascular remodeling and pulmonary hypertension in monocrotaline-exposed rats via non-inflammatory pathway
Authors: Keiji Kimuro, Keimei Yoshida, Ryo Izumi, Misaki Imabayashi, Kohei Masaki, Kazuya Hosokawa, Kohtaro Abe
Journal: Circulation (2024)

Backgrounds: The prostacyclin pathway plays a pivotal role in the treatment of pulmonary arterial hypertension (PAH). Meanwhile, there is evidence that the expression of IP, the target of prostacyclin, is scant in PAH patients, whereas the prostaglandin E receptor 4 (EP 4 ) remains stable. EP 4 , similar to IP, exerts vasodilative effect via cAMP. In addition, an orally administrable selective EP 4 agonist, KAG-308, has shown to exert anti-inflammatory effect in patients with ulcerative colitis and the mouse with surgically induced osteoarthritis. However, the effect of KAG-308 on pulmonary vasculature of PAH remains unknown. Hypothesis: EP4 agonist ameliorates pulmonary vascular remodeling and pulmonary hypertension (PH). Methods and Results: We investigated the effects of KAG-308 on hemodynamics and pulmonary vascular remodeling in a monocrotaline (MCT)-exposed rat model of PH. Compared to normal rats, MCT-exposed rats had higher right ventricular systolic pressure (RVSP), total pulmonary vascular resistance index (TPRI) and RV hypertrophy, together with medial wall thickening and increased activation of nuclear factor kappa B (NFkB) and inflammatory cytokines in the lungs on day 21 after MCT injection. Chronic oral administration of KAG-308 (1 mg/kg, twice daily, by gavage, day 0 to 21) lowered RVSP (53.1 ± 9.3 vs 81.0±18.5 mmHg, p &lt;0.01), TPRI (112.0 ± 16.6 vs 161.4 ± 37.0 mmHg/mL/min/g, p &lt;0.05) and RV hypertrophy (0.47 ± 0.04 vs 0.57±0.10, p &lt;0.05). Elastica van Gieson staining showed attenuation of medical wall thickening. Furthermore, KAG-308 significantly reduced NFkB activation and inflammatory cytokines such as Il6 , Mcp1 and Il1b in the lungs. In addition, chronic KAG-308 administration didn’t alter the level of cAMP in the lung, suggesting that the reduction of TPRI wasn’t the results of vasodilation. Interestingly, in human pulmonary artery smooth muscle cells (PASMCs) stimulated by TNFα 10ng/ml, pretreatment with KAG-308 significantly upregulated mRNA level of Il6 (5.9±0.1vs 1.0±0.1, p &lt;0.05), whereas downregulated Ki67 (0.4±0.1 vs 1.0±0.2, p &lt;0.05), suggesting anti-proliferative effect via non-inflammatory pathway. Conclusions: KAG-308 ameliorated pulmonary vascular remodeling and PH in MCT-exposed rat, whereas it didn’t show anti-inflammatory effect but anti-proliferative effect in human PASMCs. Although EP 4 agonist KAG-308 could be a potential therapeutic agent for the treatment of PAH, the mechanism of anti-proliferation remains to be elucidated.
Abstract 4135938: Angiopoeitin-2 and Mortality in an End-Stage Renal Disease, Heart Failure Population
Authors: Vanessa Robbin, Vinod Bansal, Fakiha Siddiqui, Jawed Fareed, Mushabbar Syed
Journal: Circulation (2024)

Introduction: Angiopoeitin-2 (Ang2) is a vascular growth factor involved in regulating angiogenesis and endothelial remodeling. Higher Ang2 levels have been associated with mortality in the general population and among male hemodialysis patients, but its effects on concomitant heart failure with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD) are unknown. Methods: Plasma samples from 73 ESRD patients and 40 normal healthy patients (NHP) were analyzed for Ang2 concentrations using ELISA. Patient groups were stratified into those with or without HFrEF (EF &lt; 50%). At two years following sample collection, the medical record was reviewed for mortality. The optimal cut-off value for Ang2 to predict all-cause mortality was 1715 pg/mL (AUC 0.706) based on the regression analysis. Statistical analyses included Mann–Whitney U tests, Cox proportional hazards model, and Log-rank (Mantel-Cox) test. Results: Multiple comorbidities were present; coronary artery disease 46%, diabetes 69%, hypertension 97%, and smoking 49%. Patients with one-year mortality had higher Ang2 (Figure 1). Ang2 levels above the optimal cut-off are associated with mortality, both within the entire ESRD sample and within the group with both ESRD and HFrEF (Figures 2-3). In the Cox proportional hazards analysis, Ang2 levels were associated with mortality within the larger ESRD sample (HR=1.001) but not in the group with ESRD and HFrEF. Discussion: Ang2 has potential as a biomarker for prognostication in patients with chronic disease given its association with mortality. Future research should be conducted with larger samples to evaluate if it has prognostic value in individuals with HFrEF without ESRD.
Abstract 4136566: Primary Pericardial Mesothelioma: Diagnostic dilemma and rapid decline
Authors: Steven Hamilton, Jennifer Ting, Steven Colicci, Rosendo So-rosillo, Paul LaPunzina, Xiushui Ren
Journal: Circulation (2024)

Description of case: A 33-year-old man with no medical history or environment exposures, presented with dyspnea, nausea, and vomiting. He was tachycardic, with jugular venous distension, pulsus paradoxus, low voltage QRS and echocardiogram (TTE) showed a large pericardial effusion with ventricular interdependence. He underwent pericardiocentesis with negative fluid studies, including cytology. Two months later he represented with dyspnea and pleuritic chest pain, was diagnosed with pericarditis, and found to have recurrent pericardial effusion without tamponade. He was treated with aspirin and colchicine and discharged, with surveillance TTE showing a stable pericardial effusion but with significant adhesions and constrictive physiology (confirmed on right heart catheterization). Negative QuantiFERON was obtained and Anakinra started. Two months later he remained symptomatic with new pleural effusions and was sent for positron emission tomography scan which revealed diffuse intensely hypermetabolic pericardial thickening/fluid, up to 3.8 cm in maximal thickness and increased uptake in mediastinal nodes. Next, a cardiac MRI showed extensive circumferential thickening of the pericardial space approximately 2.5 cm in thickness. Both the visceral and parietal pericardium exhibited extensive scattered delayed hyperenhancement. Subsequent pericardial biopsy showed markedly fibrotic pericardium and pathology showed biphasic malignant pericardial mesothelioma. Immunosuppressive medications were stopped, and he underwent thoracentesis. After multidisciplinary discussions, he was started on nivolumab every two weeks and ipilimumab with a plan for surgery based on response to therapy. However, progressive symptoms and worsening constriction physiology led to palliative consultation and comfort care transition, with him dying shortly after. Discussion: Recurrent pericarditis and pericardial effusion, along with negative typical pericardial fluid studies, raised suspicion for a non-benign etiology. Multimodality imaging was employed and led to a pericardial biopsy. Constrictive pericarditis is an uncommon presentation of primary pericardial mesothelioma. Biphasic mesotheliomas from pleural or peritoneal origins are normally treated with systemic therapy with preference for combined immunotherapy. Primary pericardial mesothelioma is associated with a late presentation and high mortality rate, with surgery, if able to be done early appearing to be the recommended approach.