tbuckley/cabot-search huggingface dataset:
Abstract 15901: Body Mass Index Threshold for Obesity Should Be Personalized Based on Polygenic Score
Authors: Min Seo Kim, Injeong Shim, Beomsu Kim, Pradeep Natarajan, Ron Do, Woong-Yang Park, Amit V Khera, Patrick T Ellinor, AKL FAHED, Hong-Hee Won
Journal: Circulation (2023)

Background: Current guidelines use body mass index (BMI) ≥30 kg/m 2 to define obesity and indicate obesity management, including lifestyle modification and anti-obesity pharmacotherapy. Hypothesis: The conventional BMI threshold (≥30 kg/m 2 ) may have different clinical significance by the individual’s inherent genetic risk for obesity. Methods: Polygenic score (PGS) for BMI was calculated to quantify inherited susceptibility to obesity for 335,835 European-ancestry UK Biobank participants. We calculated odds ratio (OR) of a composite outcome (type 2 diabetes and cardiovascular outcomes [coronary artery disease, heart failure, atrial fibrillation, pulmonary embolism, venous thromboembolism, hypertension, and aortic valve stenosis]) for people living with obesity (PLwO, BMI ≥30 kg/m 2 ), compared to a reference group (BMI 18.5-24.9 kg/m 2 ). Using a regression model, we assessed the BMI thresholds demonstrating the equivalent OR of composite outcome in each genetic risk stratum, adjusting for clinical, lifestyle, and socio-behavioral covariates. We quantified the extent of reclassification among PLwO by using genetically-inferred BMI. Results: For 335,835 participants (mean age 57.37±7.99 years, 53.6% female), the genetically-inferred BMI thresholds were 29.44 kg/m 2 in the high PGS group (top 20%) and 30.62 kg/m 2 in the low PGS group (bottom 20%) for risk of composite outcome equivalent to the conventional BMI threshold. The genetically-inferred BMI thresholds diverged wider for more extreme genetic groups (i.e., top 5% PGS). With the genetically-inferred BMI threshold, 6.9% of PLwO based on conventional BMI threshold were recalibrated (either excluded or newly ascertained to PLwO). Conclusions: The current one-size-fits-all BMI threshold could benefit from incorporating genetic susceptibility to better define obesity health risks. Accounting for genetic risk to define the obesity BMI threshold could reclassify up to 6.9% of the PLwO.
Abstract 15090: Postural Orthostatic Tachycardia Syndrome After COVID-19 Vaccination
Authors: Debbie L Teodorescu, Anxhela Kote, Jewel Reaso, Carine Rosenberg, Xiao Liu, Alan C Kwan, Susan Cheng, Peng-Sheng Chen
Journal: Circulation (2023)

Background: COVID-19 vaccination may be associated with postural orthostatic tachycardia syndrome (POTS) incidence, but little is known of who is at risk, their autonomic state, or how they respond to therapy. Methods: This prospective cohort study analyzed clinical data of 10 POTS clinic patients with new-onset or worsening POTS after COVID-19 vaccination. We also compared heart rate variability (HRV, via spot and ambulatory electrocardiograms (ECGs)) and skin sympathetic nerve activation (SKNA) with 24 healthy controls. Results: Patient mean age was 41.5±7.9 years with equal gender balance. Ambulatory ECG showed no major arrhythmias. Mean standing norepinephrine level was 638.2±395.3 pg/mL, with 4 patients &gt;600 pg/mL. All patients had conditions that could raise POTS risk: prior COVID-19 infection (N=4); hypermobile Ehlers-Danlos syndrome (N=6); mast cell activation syndrome (N=3 found pre-POTS, N=3 post-POTS); and autoimmune (N=7), cardiac (N=7), neurologic (N=6), or gastrointestinal conditions (4). HRV analysis indicated lower spot (36.09 ms±49.2) and ambulatory root mean square of successive differences (46.19 ms±24, p=0.042) vs control (72.49 ms±40.8). SKNA showed a reduced mean amplitude (0.97uV±0.052, p=0.011) vs control (1.2 uV±0.31) and burst amplitude (1.67 uV±0.16, p=0.018) vs control (4.3 uV±4.3). All patients received guideline-based POTS care. After 417.2±131.4 days of follow-up, 3 patients were on ivabradine, 2 on beta blockers, 2 on midodrine, 5 on antihistamines, 4 on mast cell stabilizers, and 1 on prednisone. All patients reported improvement, although 2 with COVID-19 reinfection and 1 with small fiber neuropathy did have relapses of POTS symptoms. Conclusion: POTS patients with post-vaccine onset or exacerbation had histories of potential predisposing conditions. These suggest a potential screening approach, though referral bias is possible. Elevated standing norepinephrine levels, decreased HRV, and decreased pRR50 support a sympathetic-dominant state. Though only 2/10 patients stayed on beta blockers, 8/10 did at least transiently use them. Reduced average SKNA and burst-to-mean amplitude ratio suggest the presence of peripheral autonomic neuropathy. Patients responded to standard POTS therapy.
Abstract 13128: IGFBP8 as a Novel Biomarker for Hemodynamics and Functional Status in Pulmonary Arterial Hypertension
Authors: Carly Blatt, Jennifer Schramm, Jun Yang, Megan Griffiths, Stephanie Brandal, Rachel L Damico, Dhananjay Vaidya, Catherine Simpson, Todd Kolb, Michael Pauciulo, Bill Nichols, Dunbar D Ivy, Eric D Austin, Paul Hassoun, Allen D Everett
Journal: Circulation (2023)

Background: Previous studies have shown that insulin-like growth factor binding proteins (IGFBPs) are correlated with pulmonary artery hypertension (PAH) disease severity. IGFBP8 has been shown in- vitro to be associated with pulmonary vessel remodeling and PAH in gene deletion experiments. However, no studies have evaluated IGFBP8 levels in adults with PAH. Research Question: This study sought to assess if IGFBP8 concentrations are elevated in patients with PAH and if levels are associated with survival, hemodynamic, and clinical PAH measurements. Methods: Serum IGFBP8 was measured in 2,763 adults with PAH and 92 adult controls. Two PAH cohorts and two control cohorts were used for analysis. A Mann-Whitney U test was used to compare IGFBP8 levels in PAH and controls. Samples were adjusted for age and sex using linear and logistic regression for continuous and categorical variables, respectively. IGFBP8 levels in the PAH cohort were compared to mean right atrial (mRAP), mean pulmonary artery pressures (mPAP), pulmonary vascular resistance (PVR) and functional measures such as six-minute walk distance (6-MWD), and New York Heart Association Functional Class (NYHA FC). Analysis of composite outcome (death or transplant) was conducted using a Cox proportional hazard model. Results: IGFBP8 levels were higher in PAH vs controls patients (Figure 1B, p&lt;0.0001). Among PAH patients, for every natural log unit higher, IGFBP8 was associated with death or transplant with Cox proportional hazard ratio of 1.313 (95% CI 1.034-1.666; p=0.025). Higher IGFBP8 levels were associated with lower 6-MWD (p=0.035) and increased NYHA FC (p=0.026). Hemodynamically, increased IGFBP8 levels were associated with lower cardiac index (p=0.014), increased mRAP (p=0.012) and lower stroke volume (p=0.002) but not mPAP or PVR (Figure 1A). Conclusions: IGFBP8 is a novel biomarker in PAH. Higher levels are associated with worse survival, worse hemodynamics, and poor functional status.
Abstract 16015: The Effect of the 2019 Reduction in Price of PCSK9 Inhibitors on Total Cost, Out-of-Pocket Cost, and Access Among Medicare Part D Beneficiaries
Authors: Benjamin Y Liu, Inmaculada Hernandez, CHIEN-WEN TSENG, Dhruv S Kazi
Journal: Circulation (2023)

Introduction: Uptake of Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9i) among Medicare beneficiaries was initially slow because of coverage restrictions and high out-of-pocket costs. In November 2018, manufacturers announced an unprecedented 60% reduction in the price of PCSK9is. The effect of this price reduction on access and cost has not been previously studied. Hypothesis: Did the large reductions in PCSK9i prices improve coverage and lower out-of-pocket (OOP) costs for Medicare Part D beneficiaries? Methods: Medicare Part D Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information files (2018-2022) were used to evaluate coverage, 30-day OOP and total costs, and formulary restrictions before (2018Q1-2019Q1) and after (2019Q2-2023Q1) the PCSK9i price reduction. Costs were calculated in the coverage phase, not the deductible or coverage gaps. Paired t-tests were used to determine statistical significance with a two-sided alpha of 0.05. Results: We examined Part D plans in the first quarter of each year from 2018 to 2023 (3,127 to 4,543 plans per year, 79% Medicare Advantage plans). Nearly all plans covered at least 1 PCSK9i before and after the price reduction (97% vs 100% of plans). The price reduction was associated with significant reductions in 30-day total costs (from $1,075 to $585; difference = $489; 95% CI $484 - $494; p &lt;0.001) and 30-day out-of-pocket costs ($306 to $75; difference = $231; 95% CI $228 - $233; p&lt;0.001) (Figure 1). The proportion of plans requiring coinsurance as a proportion as opposed to a fixed copayment amount declined from 97% to 15% (p&lt;0.001). Conclusions: The reduction in prices of PCSK9i was associated with significant declines in total Medicare costs and projected OOP costs for Medicare Part D beneficiaries. Nearly all Part D plans cover at least 1 PCSK9i. Future studies should examine the impact of this price reduction on adherence and cost-effectiveness of these therapies.
Abstract 14531: Higher Urban Health Index is Associated With Lower Ambulatory Blood Pressure in People Living in Southeast United States
Authors: Zhidong Wang, Dajun Dai, Hongyan Xu, Christine Stauber, Yanbin Dong, Haidong Zhu
Journal: Circulation (2023)

Introduction: Hypertension is common in the Southeastern (SE) United States (US), which increases the risk of heart attack, stroke and other serious health problems. Ambulatory blood pressure (ABP) monitoring is the gold standard for diagnosing hypertension and provides better information on cardio- and cerebrovascular risk than office blood pressure (BP). However, the role of social determinants of health (SDOH) and their influence on BP elevation has been scarcely examined on a neighborhood level. The Urban Health Index (UHI), developed by the World Health Organization, has the potential to measure disparities in SDOH at the small areal level and examine inequalities in health outcomes. Hypothesis: Higher UHI is associated with lower blood pressure. Methods: We analyzed data using a longitudinal cohort established in 1989 with 724 individuals (age 5-16 in 1989, 50.8% females, 47.1% African Americans) from the Central Savannah River Area. A census tract level UHI was calculated using indicators of employment, income, and educational attainment. The UHI is a unitless and continuous measure (between 0 and 1). The relationship between UHI (2000 and 2010 data) and ABP was examined using a linear regression model, adjusted for age, sex, race, and family socioeconomic status. Results: Higher UHI was associated with lower ABP, with a 3.15 mmHg and 2.72 mmHg drop in 24-hour systolic and diastolic ABP with 1 unit increase in UHI, respectively (2000 data; p=0.010; p=0.020). The 2010 data showed similar trends, with an increase in UHI linked to a 2.66 mmHg decrease in mean 24-hour systolic ABP (P=0.042), with the diastolic ABP reduction (1.74 mmHg) in the same direction though not statistically significant (p=0.088). Conclusions: This is one of the first studies to delineate the correlation of ABP with UHI. Our results show that a higher UHI is associated with lower systolic and diastolic ABP, underscoring the influence of aggregate indicators of SDOH on individual health outcomes. Our results support the utility of the UHI as a tool to inform health policymakers on disparities on a sub-county level thereby informing targeted interventions to address these disparities.
Abstract 335: The Potential of Using Passenger Flow to Guide AED Deployment at Train Stations
Authors: Annam Pervez Sheikh, Anne Juul Grabmayr, Julie S Kjoelbye, Annette Kjær Ersbøll, Carolina Malta Hansen, Fredrik Folke
Journal: Circulation (2023)

Background: According to earlier guidelines, many countries have deployed AEDs at train stations to improve survival after OHCA. However, train stations are heterogeneous in size and traffic, and the association between passenger flow and OHCA incidence remains unexplored. Hypothesis: At train stations, OHCA risk is associated with passenger flow, and patients have better outcomes compared to other public OHCAs. Aims: To guide a strategic deployment of AEDs, we aimed to investigate the incidence of OHCA and its association with passenger flow, as well as outcomes after OHCA at train stations nationwide. Methods: We included non-EMS witnessed OHCAs from the Danish Cardiac Arrest Registry (2016-2020). Data on stations were obtained from The Danish State Railways and Metro Company . Using QGIS stations were geocoded as a 100-meter radius from the center of the station, and stations where buffers were not possible due to size or structure polygons, were drawn. Stations were divided into groups based on the number of passengers/day: 1 (0-500), 2 (500-5,000), 3 (5,000-10,000), and 4 (&gt;10,000), respectively.We used Fisher’s exact test to compare outcomes. We analyzed the incidence rate’s association with passenger flow and the risk ratio using Poisson regression of rates. Results: Train stations accounted for 102 (2.3%) of all 4,467 public OHCAs. The incidence rate (IR) and risk ratio (RR) for OHCA were for group 1: IR = 0.02 OHCA/station/year, RR = 1.0 (ref); group 2: IR = 0.07, RR = 4.1 (95%CI 2.3-7.3); group 3: IR = 0.25, RR = 12.7 (95%CI 6.2-25.9); and group 4: IR = 0.34, RR = 16.3 (95%CI 8.6-30.9).OHCAs at train stations were more likely defibrillated by bystanders (28.4% (95% CI 0.20-0.38) vs. 20.4% (95%CI 0.19-0.22), p-value = 0.063), more patients achieved ROSC (56.8% (95% CI 0.47-0.67) vs. 43.8% (95% CI 0.43-0.46), p-value = 0.011) and had a higher survival (45.1% (95% CI 0.35-0.55) vs. 27.0% (95% CI 0.26 - 0.28), p-value &lt;0.001) compared to other public OHCAs. Conclusion: The incidence of OHCA at trains station was directly associated with passenger flow, with the busiest stations having a 16-fold higher risk of OHCA than the lowest, making passenger flow an important indicator for AED deployment. OHCAs at train stations had better outcomes than other public OHCAs.
Abstract 15714: Racial Disparities in Major Adverse Cardiac and Cerebrovascular Events Among Young Women (Aged 18-44) Admitted in Rural Settings: “A Comprehensive National Inpatient Analysis 2019”
Authors: Chenna reddy Tera, Priyanka Vatsavayi, Sahas Reddy Jitta, Supriya Maramreddy, Shobana Krishnamurthy, Sridevi Tripuraneni, Diksha Sanjana Pasnoor, Saisree Reddy Adla Jala, Medha Reddy, Utheja Dasari, Aisha Farooq, kavya jammula, Rupak Desai
Journal: Circulation (2023)

Background: Limited research has focused on the rising incidence of major adverse cardiac and cerebrovascular events (MACCE) among young women (aged 18-44) with at least one traditional cardiovascular disease risk factor (CVD), especially in rural hospital settings. We aimed to address this research gap by providing insights into the burden of CVD in this population. Methods: Using data from the National Inpatient Sample (2019), we identified young women (aged 18-44) with at least one cardiovascular risk factor admitted to rural hospitals. Baseline demographics, comorbidities, and outcomes were assessed, including MACCE and all-cause mortality. Multivariable logistic regression was performed, adjusting for age, race, income, and comorbidities. Results: Among 179,410 young women, MACCE occurred in 2,455 individuals (1.4%), with varying rates among racial groups: whites (1.2%), blacks (2.4%), Hispanics (1.3%), Asian or Pacific Islanders (API) (2%), Native Americans (NA) (1.6%), and others (1%). All-cause mortality was observed in 385 women (0.2%), with rates of 0.2% for whites and 0.4% for blacks. Blacks had twice the event rates of MACCE, and all-cause mortality compared to whites. Comorbidities and substance abuse were associated with MACCE (P&lt;0.001). In higher-income households, multivariable analysis adjusted for confounders revealed significantly higher odds of MACCE in blacks (OR 1.23, 95% CI 0.11-14.08), API (OR 4.48, 95% CI 1.06-18.93), and NA (OR 10.22, 95% CI 1.03-101.50) compared to whites. In contrast, mortality rates were lower for Hispanics than whites (OR 0.24, 95% CI 0.02-3.80) (all p &lt; 0.001) (Table 1). Conclusion: In higher-income households, greater odds of MACCE were noted among blacks, API, and NA compared to whites. Future research should focus on understanding factors contributing to these disparities and developing interventions to prioritize equitable healthcare access for rural women across diverse ethnic and income classes.
Abstract 13523: Association of Central Arterial Stiffness With Atrial Myopathy: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Lorraine Mascarenhas, Yuekai Ji, Wendy Wang, Riccardo M Inciardi, Romil Parikh, ANNE EATON, Susan Cheng, Alvaro Alonso, Kuni Matsushita, Amil M Shah, Scott D Solomon, Michelle Meyer, Lin Y Chen, Michael J Zhang
Journal: Circulation (2023)

Introduction: Atrial myopathy—defined as abnormal left atrial (LA) size and function— is associated with an increased risk of atrial fibrillation, heart failure, and dementia. Defining risk factors for atrial myopathy is important for identifying preventative therapies. Objective: Examine the cross-sectional association of central arterial stiffness with LA function. Methods: We included 2,825 Atherosclerosis Risk in Communities (ARIC) study participants from Visit 5 (2011-2013) without coronary heart disease, heart failure, sustained arrhythmias, peripheral arterial disease, or morbid obesity (mean age=75 years, 65% female, 20% Black). Central arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV). cfPWV was analyzed continuously per standard deviation (SD) increment and categorically by quartiles. LA strain (function) was measured by speckle-tracking echocardiography. Multivariable linear regression was performed. Results: When analyzed per SD increment, cfPWV was significantly associated with LA reservoir and conduit strain, after adjusting for demographics, clinical characteristics, systolic blood pressure, and left ventricular (LV) function and mass (β=-0.33, 95% CI [-0.60, -0.06] and β=-0.31, 95% CI [-0.52, -0.10], respectively) (Table). When cfPWV was assessed as quartiles, compared to the referent 1 st quartile (lowest), participants in the 4 th quartile (highest) of cfPWV had significantly lower LA reservoir and conduit strain (β=-0.83, 95% [-1.58, -0.08] and β=-0.96, 95% CI [-1.54, -0.38], respectively). There was no significant association between cfPWV and LA contractile strain. Conclusion: Higher central arterial stiffness is cross-sectionally associated with lower LA reservoir and conduit (but not contractile) strain, independent of LV function and mass. Future research examining the prospective association of central arterial stiffness with change in LA function is warranted.
Abstract 18617: Concurrent Postural Orthostatic Tachycardia Syndrome (POTS) and Vasodepressor Syncope: A Unique Case in a Young Female
Authors: Mubariz Hassan, Niyati Grewal, Shervonne Waldron, Muhammad Mohsin Munawar
Journal: Circulation (2023)

Introduction: Rare coexistence of postural orthostatic tachycardia syndrome and vasodepressor disorder in young patient's syncope poses intriguing diagnostic and treatment challenges. We report a case in a healthy young female. Case: A 28-year-old female without prior medical history presented with dizziness, palpitations, and syncope. A tilt table test revealed a significant increase in heart rate upon tilting to 70 degrees, indicative of postural orthostatic tachycardia syndrome (POTS). Later, administration of nitroglycerin resulted in syncope, consistent with vasodepressor disorder. Intravenous fluids alleviated symptoms. The patient was diagnosed with coexisting POTS and vasodepressor syndrome, treated with ivabradine for POTS, and compression stockings for vasodepressor disorder. Follow-up visits showed symptom improvement. Discussion: Autonomic disorders presenting as syncope pose diagnostic and therapeutic challenges due to their varied etiologies. Postural orthostatic tachycardia syndrome (POTS) involves excessive heart rate elevation upon upright posture, while vasodepressor syndrome manifests as orthostatic hypotension. Their coexistence is uncommon. Tilt table testing aids in distinguishing between the two. Treatment focuses on addressing specific pathophysiological mechanisms. Ivabradine and beta blockers target excessive tachycardia in POTS, while hydration and compression stockings mitigate orthostatic hypotension. Refractory cases may benefit from midodrine. A tailored approach is crucial in managing these complex autonomic disorders. Conclusion: Rare coexistence of two autonomic dysfunction syndromes emphasizes the need for tailored treatment. Individualized interventions, guided by underlying pathophysiology, are crucial. Larger studies are required for validation and to optimize diagnostic and therapeutic approaches in patients with coexisting POTS and vasodepressor syndrome.
Abstract 18379: Implementation of a Fully Automated Procedural Reporting System for Cardiology Fellowship
Authors: Howard M Julien, Srinath Adusumalli, Nosheen Reza, Monika Sanghavi, Frank Silvestry, Emeka C Anyanwu
Journal: Circulation (2023)

Introduction: Contemporary cardiovascular fellowship training is based in the principles of competency-based medical education (CBME). Inclusive of CBME, core cardiovascular training statements suggest a minimum number of procedures necessary to achieve levels of training. However, current platforms for procedure logging create an onerous burden on trainees and program leadership which can result in incomplete data capture. There is a paucity of experience with automated case logging tools across training programs. Herein, we present the experience of fully automating trainee case logging within the echo lab at a large cardiovascular fellowship program. Methods: Structured trainee procedure attribution data (patient age, gender, and procedure type) were captured during routine clinical activity within our EHR structured reporting module (Epic Cupid). Attribution was extracted from the EHR reporting warehouse (Epic Clarity) and summarized for trainees weekly via email. Following a weeklong buffer period to allow for corrections, the data were uploaded to the institutional educational reporting platform (MedHub) via a web application programming interface. All stages of this workflow were fully automated. Results: During the post-intervention period (June 2022 to May 2023), 32 cardiovascular fellows participated. Attribution was initially captured for transthoracic and transesophageal echocardiograms and later expanded to include exercise and dobutamine stress echocardiograms. A monthly average of 584 procedures were captured for trainees. There were no attribution errors reported. The intervention was uniformly perceived as helpful by both trainees and leadership with requests for expansion to other cardiovascular procedure types. Conclusion: Fully automated educational experience reporting is feasible in a large cardiovascular training program and can be implemented without change to clinical workflows or administrative burden.