tbuckley/cabot-search huggingface dataset:
Abstract 16290: Lipoprotein (a) as a Predictor of Recurrent Myocardial Infarction/Coronary Revascularization in Patients With Acute Coronary Syndrome Who Underwent PCI: A Meta-Analysis of Observational Studies
Authors: Sandeep Singh, Dyutima Singh, Sashwath Srikanth, Lakshmi Subramanian, Aditi K Bhanushali, Pooja Suchday, Ananth V Guddeti, Hamna Naseem, Ankita Shenoy, srikanth puli, Rupak Desai
Journal: Circulation (2023)

Introduction: Lipoprotein (a) [Lp(a)] has been recognized as an independent predictor of atherosclerotic cardiovascular disease (ASCVD). However, there is limited data on the association between Lp(a) levels and risk of recurrent myocardial infarction (MI)/coronary revascularization in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods: PubMed/Medline, EMBASE, and Scopus were searched for studies evaluating the association of Lp(a) with recurrent ischemic events from the year 2000-2023. Patients with coronary artery disease or ACS with baseline Lp(a) who underwent PCI or coronary stenting and had outcomes as recurrent MI/ coronary revascularization were included. Random effects models and I 2 statistics were used for pooled hazard ratios (HR), odds ratio (OR), and heterogeneity assessment. A leave-one-out sensitivity analysis was also performed. Results: The initial search resulted in 651 articles, of which nine studies with 27964 patients (mean age 58-66 years, 74.79% male) were included. Of the nine studies, six were retrospective and three prospective. Mean±SD/Median (IQ) follow-up duration was four years [range 2-7 years]. There was an increased risk of recurrent MI/coronary revascularization associated with Lp(a) ≥30 mg/dL (OR, 1.44, 95% CI: 1.09-1.89, I 2 = 79.24%, p=0.009) (Fig 1a) and Lp(a) ≥10-30 mg/dL (OR, 1.19, 95% CI: 1.009-1.416, I 2 = 0%, p=0.039) (Fig 1b), but failed to reach significance with Lp(a) as a continuous variable (OR, 1.004, 95% CI: 0.998-1.009, I 2 = 85.02%, p=0.221) (Fig 1c). Leave-one-out sensitivity analysis showed an equivalent result for various Lp(a) cutoffs (Fig 1a, 1b, and 1c). Conclusions: Our meta-analysis suggests an association of raised Lp(a) with increased risk of recurrent MI/coronary revascularization in ACS patients who underwent PCI.
Abstract 18914: Metabolomic Biomarker Profiling Improves Cardiovascular Risk Assessment for Patients on Statins: Evidence From 35000 Individuals From the United Kingdom
Authors: Heli Julkunen, Jeffrey Barrett, Sara Lundgren, Kirsten Schut, Sini Kerminen, Peter Wurtz
Journal: Circulation (2023)

Introduction: Identification of individuals at high cardiovascular risk even when using statins can guide second line therapy for primary prevention. Hypothesis: We addressed whether metabolomic biomarker profiling has utility in predicting onset of major adverse cardiovascular events (MACE) and heart failure among individuals already on statin therapy. Methods: Circulating lipids, fatty acids, amino acids, glycolysis metabolites and inflammation markers were measured by NMR metabolomics in ~275,000 individuals from UK Biobank. The study population was filtered to people using statins at blood sampling, comprising 34,971 individuals. During 10-year follow-up, 2156 first occurrence MACE events and 1753 heart failure hospitalisation events occured. Using multivariable regression modelling, we derived separate 10-year residual risk scores for the first onset of MACE and heart failure. We assessed the predictive improvements of adding the metabolomic biomarkers to established risk factors and routine cholesterol measurements. Results: Adding the metabolomic biomarkers to established risk factors and cholesterol measures improved AUC from 0.67 to 0.70 for 3-point MACE and from 0.68 to 0.71 for heart failure. Using only the metabolomic biomarkers from the low-cost NMR assay, along with age and sex, yielded a performance close to that of the full model, achieving AUC of 0.69 for 3-point MACE and 0.70 for heart failure. Substantial improvements were observed when looking at the high-risk tails of the risk scores. When comparing the highest risk decile to the remaining 90% of study population, adding the metabolomic biomarkers to established risk factors and cholesterols increased the hazard ratio from 2.2 (95% CI 1.9-2.6) to 2.8 (95% CI 2.4-3.3) for 3-point MACE and from 2.7 (95% CI 2.3-3.3) to 3.4 (95% CI 2.8-4.0) for heart failure, i.e. reaching comparable risk elevation as seen in familial hypercholesterolemia. Conclusions: Metabolomic biomarker profiling by a low-cost NMR assay enhanced prediction of incident MACE and heart failure beyond established risk factors for individuals already on statin therapy. This may complement the residual risk assessment in primary prevention settings and guide second line therapy to those with most benefit.
Abstract 16277: Glycoprotein 130 Antagonism Improves Right Ventricle Function in Pulmonary Artery Banded Piglets
Authors: Jenna Mendelson, Jacob Sternbach, Lynn Hartweck, Felipe Kazmirczak, Kurt W Prins
Journal: Circulation (2023)

Introduction: Right ventricular dysfunction (RVD) is a risk factor for death in multiple cardiovascular diseases, but RV-specific therapies are lacking. We recently showed inhibition of glycoprotein 130 (GP130) signaling with the small molecule SC144 improved RV function via modulation of microtubules and mitochondria metabolism in rodent RVD. However, SC144’s efficacy in a translational large animal model of RVD is untested. Methods: Ten 4-week-old castrated male piglets underwent pulmonary artery banding (PAB). After 3 weeks, PAB pigs were randomized into 2 groups (daily injections of SC144 [2 mg/kg, PAB-SC144, n =5] or vehicle control [PAB-Veh, n =5] for 3 weeks). Five pigs of a similar age served as controls. Cardiac MRI evaluated RV function, mass, and volume. Immunoblots of RV extracts quantified microtubule and GP130 pathway protein levels. Quantitative proteomics evaluated RV mitochondrial enrichments. KEGG pathway analysis delineated the biochemical pathways associated with RV ejection fraction. Results: SC144 significantly improved RV ejection fraction ( A , Control: 59.5±4.2, PAB-Veh: 22.6±10.8, PAB-SC144: 37.6±6.4) without changing RV afterload ( B-C ). Molecularly, GP130 antagonism normalized abundances of microtubule proteins and increased levels of suppressor of cytokine signaling 3 (SOCS3), an endogenous GP130 antagonist. Mitochondrial proteomics analysis revealed amino acid metabolism and oxidative phosphorylation suppression was mitigated by SC144 ( D ). Conclusions: SC144 improves RV function in porcine RV failure, potentially by maintaining oxidative phosphorylation, amino acid metabolism, and microtubule regulation.
Abstract 16036: Concomitant Culture-Negative Left-Sided Native Valve Endocarditis With Splenic Emboli and Babesiosis: A Case Report
Authors: Kishen Bulsara, Michael Vaysblat, Suhwoo Bae, Spencer F Weintraub, Bernardo A Acevedo-Mendez, Alex Convissar
Journal: Circulation (2023)

Description of Case: A 76-year-old man with type 2 diabetes and a previously drained hepatic abscess presented with 3 days of fevers and chills associated with dizziness, weakness, and fatigue after hiking at a New York State Park. He denied any shortness of breath, chest pain, abdominal pain, diarrhea, skin rashes, insect bites, IV drug use, recent travel or sick contacts but reported having dental work one month prior to admission. Initial vital signs were notable for a fever of 38.4°C with a blood pressure of 145/76, heart rate of 90, and physical examination was unremarkable. Extensive laboratory studies were drawn, which initially were notable for normocytic anemia, thrombocytopenia, low haptoglobin and elevated lactate dehydrogenase. Empiric antibiotics were initiated as the patient met criteria for systemic inflammatory response syndrome (SIRS). CT abdomen and pelvis was remarkable for right-sided spleen with polysplenia and multiple peripheral wedge-shaped splenic infarcts. A transthoracic echocardiogram (TTE) was inconclusive for infective endocarditis (IE). A subsequent transesophageal echocardiogram (TEE) showed vegetations on the aortic and mitral valves with mild regurgitation respectively. After cardiothoracic surgery evaluation, he was deemed not a surgical candidate. Blood and urine cultures remained negative, but the Babesia antibodies IgM and IgG antibodies, and Babesia microti PCR was detected. He was started on atovaquone 750 mg twice daily and azithromycin 250 mg once daily for 10 days for babesiosis. He was discharged on vancomycin 1g every 12 hours and ceftriaxone 2g every 24 hours for a total of 6 weeks for empiric IE treatment given splenic emboli. Discussion : We describe a rare case of fever caused by culture-negative mitral and aortic valvular endocarditis with splenic emboli and babesiosis. Recent dental work and hiking outdoors in the Northeast United States of America were the key predisposing factors. Given splenic infarcts, pursuing a TEE was pivotal in ascertaining the diagnosis. The patient received empiric IE treatment for gram-positive cocci, HACEK organisms and babesiosis with improvement of symptoms. Identifying and treating unusual causes of fever and SIRS are crucial in reducing mortality and morbidity.
Abstract 16212: Sex-Based Statin Utilization and Cardiovascular Disease Outcomes: A Real World Secondary Prevention Cohort
Authors: Maha Mumtaz, Eli Hay, Jianhui Zhu, Floyd W Thoma, Agnes Koczo, Steven Reis, Anum Saeed, Suresh R Mulukutla
Journal: Circulation (2023)

Introduction: Current guidelines recommend using high-intensity statins in patients with clinical ASCVD.However, real world adherence to GDSI use and recurrent events remains less known. Sex difference in statin use have been previously reported. We evaluated sex-based disparities in GDSI use and recurrent ASCVD outcomes in a large healthcare network. Methods: Using EMR, we assessed statin use and intensity amongst patients with established prior ASCVD events (MI, ischemic stroke/TIA) and PAD from 2010-2022. Statins were categorized into GDSI (high intensity), &lt;gdsi (moderate="" or="" low="" intensity)="" or no statin use. Outcomes of interest included repeat MI, stroke/TIA and all-cause mortality. Incident rates (IR) and Cox regression hazard ratios (HR) of ASCVD outcomes were calculated across statin categories stratified by sex. Results: Amongst 45,949 patients,31% were women. Women had more diabetes (29% vs 24%) and higher LDL-C (94.9 ± 40.8 vs 87.6 ± 37.1 mg/dL) than men. During a follow-up period of 5 years, women were less likely to be started on GDSI (61.6% vs 65.8%, p&lt;0.01) and achieve LDL-C&lt;70mg/dL (41% vs and 49%, p&lt;0.01) as compared to men. GDSI use lowered IRs for all outcomes in both sexes (Table 1). Women on GDSI had higher risk of MI (HR 1.21 [1.12-1.31)],stroke (1.21 [1.08-1.34] and mortality (1.12 [1.05-1.20]), all p&lt;0.01) than men. Conclusions: In a contemporary cohort of secondary prevention patients, women were less likely to be prescribed GDSI than men and less likely to achieve guideline concordant LDL-C&lt;70mg/dL. This was associated with a higher risk of recurrent ASCVD events in women as compared to men. More sex specific interventions are needed to ensure adequate preventive treatment for both sexes. Abbreviations: Atherosclerotic cardiovascular disease (ASCVD), guideline directed statin intensity (GDSI), Electronic medical records (EMR),Myocardial Infarction (MI), Peripheral arterial disease (PAD), Transient Ischemic attack (TIA)
Abstract 15309: Prevalence of Dependent Cannabis Use in Patients Hospitalized With Peripheral Vascular Disease and Concomitant Tobacco Use Disorder and Associated Major Adverse Cardiac Events: National Inpatient Sample Analysis 2019
Authors: Sahas Reddy Jitta, Himaja Dutt Chigurupati, Sivaram Neppala, Sai Prasanna Lekkala, Sai Priyanka Mellacheruvu, Hrushikesh Reddy Pamreddy, Lavanya chowdary Kannekanti, Gurjot Singh, Puneeteshwar Khela, Manali Patel, Mohmed Junaid Hingora, Karanvir Singh Gill, Rupak Desai
Journal: Circulation (2023)

Introduction: Cannabis use disorder (CUD) and tobacco use disorder (TUD) are independent risk factors for patients hospitalized with peripheral vascular disease (PVD) and major adverse cardiac and cerebrovascular events (MACCE). However, the impact of CUD on PVD with concomitant TUD and associated MACCE remains unexplored, despite the increasing prevalence of cannabis use in the USA. Methods: Using the 2019 National Inpatient Sample and relevant ICD-10-CM codes, we identified hospitalizations in patients with PVD and TUD. Baseline demographics, comorbidities, and major adverse cardiac events were compared between CUD+ vs CUD- cohorts. A multivariable regression analysis was conducted, adjusting for confounders to assess the odds of MACCE. Results: Among 363,795 patients admitted with PVD and TUD, 13,440 (3.7%) had CUD+ [median age 57 (48-64)], with a higher proportion of males (70.5% vs 60.8%) and black patients (27.8% vs 14.7%) compared to the CUD-cohort (all p&lt;0.001). The CUD+ cohort exhibited higher rates of alcohol abuse (21.4% vs 11.1%), drug abuse (47% vs 6%), depression (19.2% vs 16.2%), and prior VTE (11% vs 9.2%) (all p&lt;0.001). Overall, MACCE was reported to be high in the CUD+ cohort (18.1% vs. 16.4%). After adjusting for covariates, the CUD+ cohort had significantly higher odds of developing MACCE in the middle-aged (45-64 years) (OR:1.20, 95%CI: 1.04-1.38, p=0.014) and the male subpopulation (OR:1.20, 95%CI: 1.01-1.42, p=0.039). Subgroup analysis revealed that complicated hypertension (OR:1.80, 95%CI:1.28-2.53), hyperlipidemia (OR:1.59, 95%CI: 1.20-2.13), and prior TIA (OR:1.48, 95% CI:1.02-2.16) were significant predictors for the MACCE middle-aged cohort (all p&lt; 0.05) (Table 1). Conclusion: In CUD+TUD cohorts with PAD, men and middle-aged individuals had greater odds of MACCE. Therefore, clinicians should be aware of this high-risk population, and further prospective studies are required for a significant association.
Abstract 14354: The Impact of Riociguat in Pulmonary Arterial Hypertension Patients With Comorbidities Included in Interventional Clinical Trials
Authors: Stephan Rosenkranz, Ardeschir H Ghofrani, Marius Hoeper, Vallerie McLaughlin, Claudia Rahner, David Langleben
Journal: Circulation (2023)

Background: The number of pulmonary arterial hypertension (PAH) patients with comorbidities is increasing, however, there are few published data from these patients in PAH therapy clinical trials meaning that evidence-based treatment recommendations have not been made. Aim: This post-hoc analysis of pooled riociguat clinical trial data assessed the impact of riociguat in patients with PAH and comorbidities. Methods: All interventional studies of riociguat in patients with PAH (PATENT-1, PATENT PLUS, RESPITE, MOTION, REPLACE, and the Phase II study) were included in the pooled analysis. The safety of riociguat and placebo was assessed in patients with ≥3 comorbidities vs &lt;3 comorbidities. Safety was assessed by adverse events (AEs) and serious AEs (SAEs). Comorbidities included: age ≥65 years, body mass index ≥30 kg/m 2 , history of essential hypertension, diabetes mellitus, history of significant coronary artery disease, and atrial fibrillation. Results: The 609 patients who received riociguat and 132 patients who received placebo in the main phase clinical trials of riociguat were included in the analysis. Of these, 113 patients (19%) in the riociguat group and 21 patients (16%) in the placebo group had ≥3 comorbidities. In both treatment groups, AE rates were higher in patients with ≥3 comorbidities vs &lt;3 comorbidities (riociguat 93% vs 86%; placebo 95% vs 84%); with most AEs being mild or moderate. Study drug-related AE rates were similar in both treatment groups and in patients with ≥3 comorbidities vs &lt;3 comorbidities (riociguat 54% vs 56%; placebo 52% vs 52%). SAE rates were higher in riociguat-treated patients with ≥3 comorbidities vs &lt;3 comorbidities (25% vs 12%); of these, 4% and 3% were study drug-related, respectively. In patients with ≥3 comorbidities, study drug-related SAE rates were higher in those receiving placebo vs riociguat (10% vs 4%). AE rates leading to study drug discontinuation were higher in patients with ≥3 comorbidities vs &lt;3 comorbidities (riociguat 6% vs 4%; placebo 10% vs 6%), whereas AE rates leading to death were similar in both groups (riociguat 2% vs 1%; placebo 0% vs 4%). Conclusion: These data suggest that riociguat had an acceptable tolerability profile in PAH patients with comorbidities with most AEs being mild or moderate.
Abstract 14679: Microcirculatory Flow and Resistance at Rest and Hyperemia in Relation to Major Adverse Cardiovascular Events in Chronic Coronary Syndrome
Authors: Shajan Shekarestan, Fadi Jokhaji, Christina Ekenback, Mattias Törnerud, Samantha Lorstad, Petter Ljungman, Nikolaos Östlund-Papadogeorgos, Rickard Linder, Bassem Samad, Jonas Persson
Journal: Circulation (2023)

Background: The prognostic implications of coronary microvascular dysfunction in an all-comer cohort with chronic coronary syndrome (CCS) are not known. Aim: To investigate the association of baseline resistance index (BRI), index of microcirculatory resistance (IMR), and thermodilution-derived resting- and hyperemic flow velocities (RFV and HFV) with the primary composite endpoint consisting of all-cause mortality, incident myocardial infarction (MI) or hospitalization due to congestive heart failure (CHF) in CCS. Methods: CCS patients undergoing elective coronary angiography (CA) were included. Measurements of corrected IMR, BRI and mean transit time at baseline (Tmn base ) and during hyperemia (Tmn hyp ) were obtained in the LAD. RFV and HFV were calculated as 1/Tmn base and 1/Tmn hyp , respectively. Cox-regression was performed and Kaplan-Meier plots were constructed. Results: We included 503 patients before the coronary anatomy was known and thermodilution measurements in the LAD were obtained in 413 patients. Median age was 68 (IQR 61-74), 127 (25%) were women and 151 (37%) had a flow-limiting epicardial lesion in the LAD. Median follow-up was 5.3 years (IQR 3.0-6.6) and there were 57 events. Log 10 BRI was inversely associated with the primary endpoint before and after fractional flow reserve (FFR) adjustments (HR 0.64 [95% CI 0.42 - 0.97]; Figure 1A). Log 10 IMR was not associated with the primary endpoint (HR 0.94 [95% CI 0.61 - 1.5]; Figure 1B). Log 10 RFV was associated with the primary endpoint before and after FFR- adjustment (HR 1.8 [95% CI 1.2 - 2.7]) whereas log 10 HFV was not (HR 1.2 [95% CI 0.75-1.8]). Conclusion: Low microcirculatory resting resistance and high coronary resting flow velocity in the LAD, indicating impaired autoregulation, were associated with all-cause death, MI and/or CHF in CCS whereas hyperemic microcirculatory resistance and flow were not. Resting flow indices can be used for risk evaluation in patients with CCS undergoing CA. .
Abstract 13964: Dynamic Assessment of Shock Severity in Cardiac Intensive Care Unit Patients
Authors: Jacob C Jentzer, Sean Van Diepen, Parag C Patel, Timothy D Henry, David A Morrow, David A Baran, Kianoush B Kashani
Journal: Circulation (2023)

Introduction: A single assessment of the SCAI shock classification robustly predicts mortality, and a repeat assessment may improve prognostication. Hypothesis: We hypothesized that frequent serial assignment of the SCAI shock stage could further improve risk stratification. Methods: Unique AHA Level 1 cardiac intensive care unit (CICU) admissions at a single center from 2015 to 2018 were reviewed retrospectively. Time-stamped electronic health record data were used to assign the SCAI shock stage in each 4-hour block during the first 24 hours of CICU admission. Shock was defined as SCAI shock stage C, D, or E. In-hospital mortality was evaluated using logistic regression. Results: Among 2,918 CICU patients, 1,537 (52.7%) met criteria for shock during &gt;=1 block and 266 (9.1%) died in hospital. The SCAI shock stage on admission was: A, 37.6%; B, 31.5%; C, 25.9%; D, 1.8%; E, 3.3%. Patients with worsening SCAI shock stage after admission (first 4 hours) were at higher risk of mortality ( Figure A ), as were patients who met SCAI criteria for shock (particularly those with shock on admission, Figure B ). The pattern was consistent in patients with acute coronary syndromes, heart failure, or cardiac arrest (who had very high mortality). Each higher admission (aOR 1.36, 95% CI 1.18-1.56, AUC 0.70), maximum (aOR 1.59, 95% CI 1.37-1.85, AUC 0.73) and 24 hour mean (aOR 2.42, 95% CI 1.99-2.95, AUC 0.78) SCAI shock stage were incrementally associated with increasing in-hospital mortality. Discrimination was highest for the mean SCAI shock stage (p &lt;0.05). Each additional 4 hour block meeting SCAI criteria for shock was associated with higher mortality (aOR 1.15, 95% CI 1.07-1.24). Conclusions: Dynamic assessment of shock using serial SCAI shock classification assignment can improve mortality risk stratification in CICU patients. Cumulative time in shock was a strong mortality risk indicator, highlighting the area under the curve of shock severity as an important determinant of outcomes.
Abstract 13662: Novel Morphological Classification of Left Atrial Appendage Using 3-Dimensional Printer -Rock, Paper and Scissors-
Authors: SATOKO RYUZAKI, Yusuke Kondo, Miyo Nakano, Masahiro Nakano, Takatsugu Kajiyama, Ryo Ito, Toshinori Chiba, Yutaka Yoshino, Yuya Komai, Yukiko Takanashi, Yoshio Kobayashi
Journal: Circulation (2023)

Background: Left atrial appendage (LAA) of Asians is generally larger and more complicated than that of non-Asians. Whereas the four classifications from previous reports are widely used in the world, different physicians have different point of views in the real-world practice. Purpose: To identify the relationship between morphological features of LAA and cardioembolic stroke in Japanese patients. Methods: All left atrial appendage closure (LAAC) cases in our institution performed between February 2020 and April 2023 were retrospectively analyzed. The three-dimensional printing of LAA was generated from cardiovascular computed tomography imaging data. The shapes of the LAA were classified into 3 morphological types: (1) The LAA with bi lobe was defined as “Scissors” type; (2) The one with complicated peripheral branches was “Paper” type; (3) The simple one was “Rock” type. We examined the relationship between the risk of cardioembolic stroke and the morphological features of the LAA. Results: The cohort consisted of 93 consecutive patients (age, 75±1 years; male gender, 72%; the size of WATCHMAN device, 29±0 mm). There were 41 (44%) patients who had a history of cardioembolic stroke (27% vs. 41% vs. 58%; Rock vs. Scissors vs. Paper types, p-value = 0.0466). In the multivariate analysis, the Paper type is the potential risk factor of cardioembolic stroke (p-value &lt; 0.01) (Table1.2). Conclusions: The morphological features of LAA by three-dimensional printing was significantly related to cardioembolic stroke in this population. Physicians should pay attention to anticoagulant therapy management and proactively consider LAAC in LAA with complicated peripheral branches.