tbuckley/cabot-search huggingface dataset:
Abstract 398: A New Paradigm in Resuscitation Education: “Does Frequency Matter?”
Authors: Kathleen Ward, David Rivera
Journal: Circulation (2019)

Introduction: Survival of in-house cardiac arrests (IHCA) is dependent upon high quality cardiopulmonary resuscitation (CPR). While current BLS and ACLS training occur biannually, studies demonstrate that skills and knowledge diminish over time. Although Self Efficacy (SE) correlates with CPR skills and knowledge, one’s SE can be strengthened through mastery experiences. The RQI training program increases the frequency of training. This study questioned Resuscitation Quality Improvement (RQI), a new quarterly training program, and its influence on self-efficacy and skill decay Methods: The study used a quantitative, quasi-experimental design with a convenience sample derived from 3 medical-surgical (MS) units. Registered nurses (RNs) completed the Basic Resuscitation Skills Self-Efficacy Scale (BRS-SES) survey. Two units were enrolled in traditional life support training, an intervention unit completed the RQI program. Performance data was obtained from program mannequins. Data analysis used Chi-square statistic and ANOVA; p-value 0.05 determined statistical significance. Data sets were inclusive of BRS-SES and performance reports from RQI. Results: SE increased on the intervention unit baseline to 1 year (1512.4±226 to 1600±164, p=0.068); SE improved for safe use of automated external defibrillator (AED)/Defibrillator (627.2±91 to 661.8±71, p=0.034); CPR Skill (350±52 to 374.6±65, p=0.117); recognition (535.2±91 to 563.6±55, p=0.173). RNs &lt; 40 years of age demonstrated an increased SE compared to their peers. Performance was measured by average attempts to pass (ATTP) and mean score with the RQI: compression (2.3 to 1, 79 to 95.4); ventilation (1.6 to 1, 81.1 to 94.9). Conclusions: The RQI training program was associated with increased SE and decreased skill decay. Age appears to influence the degree of success in nurse training using this new methodology. Data suggests an association between RQI and clinical outcomes. Multi-site studies are recommended for future study.
Abstract 17120: Association of Endotoxemia and Endothelin-1 With Development of Cardiac Allograft Vasculopathy After Heart Transplantation
Authors: Lorenzo Braghieri, Bruno Bohn, Giulio Mondellini, Azka Javaid, Andrea J Kim, Hatice D Onat, Farhana Latif, Maryjane Farr, Gabriel T Sayer, Nir Uriel, Koji Takeda, Yoshifumi Naka, Ryan Demmer, Paolo C Colombo, Melana Yuzefpolskaya
Journal: Circulation (2020)

Introduction: Cardiac allograft vasculopathy (CAV) is a leading cause of death after heart transplant (HT). Inflammation is a known cardiovascular risk factor, with gut derived endotoxemia potentially instigating this process, leading to endothelial damage. Our prior work showed that elevation of biomarkers of inflammation (endothelin-1 (ET-1)) and endotoxemia (lipopolysaccharide (LPS)) persists after HT. We investigated the association of LPS and ET-1 with subsequent development of CAV. Methods: Pts who met the following criteria were included: i) blood sampling ≥6 mo post-HT; ii) no evidence of CAV at the time of sampling. Pts were followed up to 2.3y after sampling. Cox-PH was used to regress freedom from CAV on LPS and ET-1 (≤ vs &gt;median), time from HT to sampling (≤ vs &gt;1y), interaction among variables. Results: 33 HT pts enrolled, mean age 57±11y; 70% male; median time post-HT 1.96(0.5-3.7)y. 17(52%) pts developed CAV at 0.7(0.6-1)y following blood collection. Baseline characteristics of pts who developed CAV vs not were similar, except for longer median time post-HT in pts who developed CAV: 2.4(0.7-5.3) vs 1.05(0.5-2.7)y, p=0.1. Median LPS and ET-1 for the entire cohort were 0.34(0.28-0.45) EU/ml and 1.83(1.26-2.72) pg/ml. Pts with &gt;median LPS or ET-1 values trended towards higher risk of developing CAV: HR 1.79(0.66, 4.85), p=0.3 ( Fig.1A ); HR 2.05(0.71, 5.92), p=0.2 ( Fig.1B ). No association was observed between time post-HT and CAV: HR=0.87 comparing ≤ vs. &gt;1y, p=0.8. Pts with both &gt;median LPS and ET-1 levels (n=7) were at significantly higher risk of CAV: HR 2.96(1.06, 8.27), p=0.039, compared to others ( Fig.1C ). When examining pts sampled within the first year of HT (N=14), pts with &gt;median LPS (N=5) were at particularly increased risk of CAV: HR 9.71(0.97, 96.9), p=0.05, while pts with &gt;median ET-1 were not. Conclusions: Elevated LPS and ET-1 synergistically associate with increased CAV risk post-HT. Further studies are warranted to validate these findings.
Abstract 14656: Fusion of Fluoroscopy and Echocardiography During the Mitraclip® Procedure Reduces Time to Transseptal Puncture and Radiation Exposure
Authors: Sarah Slaven, Joseph Burke, Jacob Hammers, Robert A Quaife, Pei-ni Jone, Ernesto E Salcedo, John Carroll, Edward A Gill
Journal: Circulation (2020)

Introduction: Transseptal puncture (TSP) is an essential step in percutaneous structural heart interventions, such as the MitraClip® procedure. Radiation exposure is a hazard for Interventional Cardiologists, Echocardiographers, and patients. Advancements in shielding and radiation equipment have reduced this exposure, but further reduction is desired. EchoNav® (Philips) fuses fluoroscopy and echocardiography resulting in a single multimodal image display. Prior studies demonstrated reduced time to TSP with use of EchoNav® but failed to show significant reduction in radiation. We hypothesized that increased experience using EchoNav® would further decrease TSP time and radiation dose. Methods: Single center, retrospective analysis evaluated 202 patients undergoing MitraClip® procedure pre and post-EchoNav® from 6/2010 to 12/2019: 8 pre and 194 post. We measured time to TSP and radiation exposure by Air Kerma and dose area product (DAP). For the post-EchoNav® cases, we evaluated these variables by 2-year time periods to examine change over time. Results: Comparing pre and post-EchoNav ® procedures, time to TSP was non-significantly reduced overall (40.00±14.95 to 33.63±15.92, p=0.23). However, post-EchoNav ® had a decreasing trend (48.00±28.39, 43.47±15.86, 28.45±11.94, 27.55±10.64; R 2 =0.89, p =0.009) that was significantly less than pre-EchoNav ® by the third time period (40.00±14.95 vs 28.45±11.94, p=0.05) and remained less in the fourth (40.00±14.95 vs 27.55±10.64, p=0.03). Radiation was reduced post-EchoNav ® by both DAP (264.52±150.03 to 109.00±97.68) (p=0.02) and Air Kerma (1472.92±883.50 to 582.49±485.28) (p=0.05). Significant radiation reduction occurred by the third time period for Air Kerma (1472.92±883.50 vs 494.12±413,79, p=0.03) and second time period for DAP (264.52±150.03 to 127.51±110.35, p=0.03). Conclusion: These results suggest that use of EchoNav® has a learning curve, but ultimately reduces time to TSP and radiation.
Abstract 13743: A Tale of Syncope, Prolonged QT and ICD
Authors: Isma N Javed, Nazir AHMAD, Deborah J Lockwood, Karen J J Beckman, Stavros Stavrakis
Journal: Circulation (2020)

Introduction: Long QT syndrome (LQTS) was first described in the 1960s. It manifests clinically as syncope, cardiac arrest or sudden cardiac death. LQTS can be caused by 15 different genes. These mutations lead to action potential prolongation by causing impaired repolarizing currents. Case Discussion: A 29-year-old previously healthy Caucasian woman was admitted after recurrent episodes of syncope that happened within 1-month prior to the presentation. She was hemodynamically stable with normal vitals. Her ECG showed normal sinus rhythm with corrected QT (QTc) of 598ms. In the ED, she suffered an episode of sustained monomorphic ventricular tachycardia (VT) and underwent cardioversion. She was started on amiodarone infusion. Serial ECGs showed prolonged QTc. She had another episode of pulseless VT that terminated without defibrillation. She was transferred to our facility for further care. Her family history was significant for paternal aunt who had died unexpectedly at the age of 39. All her lab work including electrolytes, thyroid panel, cardiac enzymes, inflammatory markers and extended drug screen was unrevealing. Transthoracic echocardiogram showed normal biventricular size and function. Decision making: She was started on propranolol for possible LQTS. Cardiac MR did not show any evidence of structural abnormalities. Genetic panel was sent. Since myocarditis or familial LQTS could not be ruled out, we proceeded with implantable cardioverter defibrillator (ICD) implantation for secondary prevention. She was discharged home on nadolol. Conclusion: In the absence of genetic information, LQTS can be diagnosed in symptomatic patients with QTc &gt;480msec on serial ECGs after excluding secondary causes. Schwartz score comprising of ECG findings, symptoms, clinical &amp; family history is diagnostic when greater than 3.5. Beta-blockers are indicated in all patients with a clinical diagnosis. Patients must avoid any QT prolonging agents and strenuous exercise. An ICD is indicated in patients who suffered cardiac arrest. ICD may also be considered for primary prevention in high risk patients.
Abstract 16148: Serum Gdf-15 Identifies Patients at Risk for Acute Heart Failure but Not Ventricular Arrhythmias and Sudden Death
Authors: M. S Binder, Ananya Pappu, Wanjun Yang, Katherine C Wu, Gordon F TOMASELLI, Andreas S Barth
Journal: Circulation (2020)

Introduction: GDF-15 (Growth Differentiation Factor 15), a member of the transforming growth factor beta superfamily, has been shown to be a biomarker of mitochondrial diseases. Additionally, increased levels of GDF-15 have also been associated with all-cause death and heart failure (HF) in patients with coronary artery disease. Conflicting data exists regarding GDF-15 levels and risk of ventricular arrhythmic events. Hypothesis: In a cohort of patients with reduced left ventricular systolic function, GDF-15 identifies patients at high risk of (1) worsening HF and (2) sudden arrhythmic death. Methods: PROSe-ICD is a multicenter prospective cohort study of 1,189 patients with ischemic and non-ischemic cardiomyopathy who underwent ICD implantation for primary prevention of sudden death, designed to compare patients who sustain an appropriate ICD firing for rapid VT or VF (surrogate for sudden death) to those who do not. Worsening HF was defined as any admission for acute decompensated HF during an average follow up period of 8 years. Blood samples were obtained on average every 6 months and GDF-15 was measured with an ELISA based assay from a subset of PROSe-ICD patients with appropriate ICD shocks (n=58; 228 samples), worsening HF (n=42; 157 samples), both HF and VT/VF (n=12; 46 samples) and 237 samples from 46 controls without ICD shocks and HF, matched for age and ejection fraction. Results: GDF-15 levels were elevated in patients who had acute decompensated heart failure, but not in patients who experienced ICD shocks in the absence of worsening HF (see Figure). Differences in GDF-15 levels were relatively stable over time within individual patients, and did not predict HF events. Conclusions: Future studies need to examine whether patients with the highest GDF-15 levels have underlying mitochondrial or nuclear DNA mutations leading to mitochondrial dysfunction and worsening HF.
Abstract 13317: Acute Pulmonary Embolism in Covid-19 Patients: Presenting Characteristics, Outcomes and Risk Stratification Strategies
Authors: Hai Xu, Angel Martin, Avneet SINGH, Mangala Narasimhan, Joe Lau, Mitchell Weinberg, rajiv jauhar, Gaurav Rao
Journal: Circulation (2020)

Introduction: Pulmonary Embolism in coronavirus disease 2019 (COVID-19) patients have been increasingly reported in observational studies. However, limited knowledge describing their diagnostic features and clinical outcomes exist to date. Our study aims to systemically analyze their clinical characteristics and to investigate strategies for risk stratification. Methods: We retrospectively studied 101 patients with concurrent diagnoses of acute pulmonary embolism and COVID-19 infection, admitted at two tertiary hospitals within the Northwell Health System in New York City area. Clinical features including laboratory and imaging findings, therapeutic interventions, intensive care unit (ICU) admission, mortality and length of stay were recorded. D-dimer values were respectively documented at COVID-19 and PE diagnoses for comparison. Pulmonary Severity Index (PESI) scores were used for risk stratification of clinical outcomes. Results: The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among our study cohort. Baseline D-dimer abnormalities (4647.0 ± 8281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13288.4 ± 14917.9; p&lt;0.05). 5 (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. 31 (31%) patients developed acute kidney injury (AKI) and 1 (1%) patient required renal replacement therapy. Throughout hospitalization, 23 (23%) patients were admitted to intensive care units, of which 20 (20%) patients received invasive mechanical ventilation. The overall mortality rate was 20%. Majority of patients (65%) had Intermediate to high risk PESI scores (&gt;85), which portended a worse prognosis with higher mortality rate and length of stay. Conclusions: This study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. D-dimer levels and PESI scores may be utilized to risk stratify and guide management in this patient population. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection, despite the preliminary and retrospective nature inherent to this study.
Abstract 14098: Comparisons of Advance Directive Attitudes, Perceived Susceptibility, and End-of-life Life-sustaining Treatment Preferences Between Patients With Heart Failure and Cancer Survivors and the Relationships
Authors: Seongkum Heo, JinShil Kim, Jiin Choi, Mi-Seung Shin, Miyeong Kim, EunJu Seo, Minjeong An, Jae Lan Shim
Journal: Circulation (2020)

Introduction: The needs for advanced care planning, including preferences to life-sustaining treatments (LSTs), in patients with heart failure (HF) are comparable to or higher than those in cancer survivors, but they had less access to such care than cancer survivors. Diagnostic context and patients’ attitudes and perceived susceptibility can impact preferences to LSTs, but there is limited evidence on these relationships. Purpose: To compare LST preferences, attitudes, and perceived susceptibility between patients with HF and cancer survivors, and to examine the associations of these variables with their preference for each LST (cardiopulmonary resuscitation [CPR], ventilation support, hemodialysis, and hospice care). Methods: Secondary data on LST preferences (the Korean-Advance Directive), attitudes toward advance directive (Advance Directive Attitude Survey), perceived susceptibility (Perceived Susceptibility subscale of the Advance Care Planning survey), and demographic characteristics were obtained from 36 outpatients with HF (mean age, 65.44 years; male, 69.4%) and 107 cancer survivors (mean age, 67.39 years; male, 32.7%). To compare LST preferences, attitudes, and perceived susceptibility between the wo diagnostic groups, chi-square test, t -test, and Wilcoxon rank sum test were used. To examine the relationships of diagnostic context, attitudes, and perceived susceptibility to preferences for each LST, controlling for sex, marital status, and educational level, multivariable logistic regression analyses were used. Results: More patients with HF preferred CPR than cancer survivors (41.7% and 15.9%, χ 2 = 8.88, P = 0.003). Attitudes and perceived susceptibility were similar between the two diagnostic cohorts ( P = .508 and P = .062, respectively). Patients with HF had greater odds of preferring CPR (odds ratio [OR] = 3.02, confidence interval [CI] = 1.19, 7.70) than cancer survivors. Patients with more positive attitudes had greater odds of preferring hospice care (OR = 1.14, CI = 1.06, 1.23). Conclusions: Diagnostic context and patients’ attitudes were associated with preferences for LSTs. Therefore, diagnostic context and improvement in attitudes need to be considered to facilitate informed decision-making for LSTs.
Abstract 13768: Adoption and Effectiveness of an Mhealth Intervention for Hypertension in Older Adults: A Pilot Clinical Trial
Authors: Matthew F Muldoon, Julian Einhorn, Jonathan Yabes, Danielle Burton, Bruce Rollman, Taya Irizarry, Jeanne Basse, Lora E Burke, Thomas Kamarck, Brian Suffoletto
Journal: Circulation (2020)

Introduction: Hypertension is uncontrolled in 50% of diagnosed adults in the US, and especially in older adults. Home blood pressure monitoring (HBPM) can improve hypertension management by providing clinicians with up-to-date information on BP control and by improving patients’ adherence to prescribed medications and other healthy behaviors. MyBP is a patient-facing HBPM aide that provides video-based education and supports BP self-monitoring with recurring feedback using proactive, bidirectional, automated text messages. Summary reports are routed to primary care providers. Hypothesis: In this proof-of-concept, pragmatic clinical trial, we tested the hypothesis that MyBP will improve hypertension self-efficacy and lower BP in older adults. Methods: Community-dwelling adults ≥55 y/o with uncontrolled hypertension were recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Study BP data were acquired independently of MyBP from all participants by single-blind, phone-supervised home BP measurements. Results: Participants (N=62; 40 women, 33 Blacks, 38 without a college degree, mean age 66, mean office BP 164/91, mean # BP medications 2.6) were randomized to MyBP (41) vs. control (n=21). In the MyBP group, engagement with HBPM averaged over 80%, without notable attrition over the 5-month study period. Regression analyses revealed an interaction between baseline systolic BP and group assignment on change in systolic BP [interaction effect estimate -0.59 (-1.00, -0.19)], such that patients who had a higher baseline systolic BP and were assigned to MyBP showed a greater decline in systolic BP when compared to control patients. Hypertension self-efficacy also improved in the intervention group compared to controls [estimate 0.556 (0.104,1.008)]. Conclusions: In this pragmatic, pilot clinical trial, older adults with hypertension used a novel mHealth technology at high levels, reported improved hypertension self-efficacy, and experienced a decline in BP if home BP was elevated at baseline.
Abstract 16370: Pathology of Coronary Artery After Third-generation Abluminal Biodegradable-polymer Drug-eluting Stent Implantation in Atherosclerotic Porcine Model
Authors: Suguru Migita, Daisuke Kitano, Yuxin Li, Yutaka Koyama, Akira Onishi, Daiichiro Fuchimoto, Shunichi Suzuki, Yoshiyuki Nakamura, Atsushi Hirayama, Yasuo Okumura, Hiroyuki Hao
Journal: Circulation (2020)

Introduction: Third-generation drug-eluting stent (3rd DES) is widely used in percutaneous coronary intervention. Clinical superiority of 3rd DES has been demonstrated, however, pathological response after 3rd DES remains unclear. We aimed to examine the histology after 3rd DESs in low-density lipoprotein receptor knockout (LDLR -/-) minipigs’ coronary arteries. Methods: Using LDLR -/- minipigs, second-generation drug-eluting stents (2nd DESs) and 3rd DESs were deployed in coronary arteries. Two weeks (n = 2) or four weeks (n = 4) after stent implantation, coronary angiography for the follow up was performed. For evaluation of the features of neointima, optical coherence tomography (OCT) examination was performed in all stented vessels. The stent-implanted arteries were dissected immediately after OCT and investigated histologically. Results: OCT analysis for four-week models showed that the thickness of neointima over 3rd DESs was significantly thinner than that over 2nd DESs (3rd DESs; 43.29 ± 3.29 μm vs. 2nd DESs; 61.67 ± 5.51 μm, P = 0.009). In two-week models, numerous inflammatory cells were observed on the luminal side of 2nd DESs’ struts, while this response was absent in 3rd DESs. Fibrin deposition around 3rd DES’s strut was 2347.9 ± 875.6 μm 2 , while that around 2nd DES’s strut was 4738.9 ± 691.0 μm 2 (P = 0.041) in four-week models. Moreover, when defining the density of smooth muscle cells as ratio of hematoxylin-eosin stained area, it was significantly higher in the neointima above 3rd DESs than that above 2nd DESs in four-week models (3rd DESs; 0.373 ± 0.011 vs. 2nd DESs; 0.265 ± 0.030, P = 0.026). Although neointima over 3rd DES was thin, the density of smooth muscle cells that compose the neointima was higher and seemed to be well-matured. Conclusion: Our pathological analysis showed advanced healing process in 3rd DES compared to 2nd DES lesions. This result may attributed to the absence or the presence of polymer applied on the luminal side of struts, which triggers severe inflammation in the early term after stent implantation, leading to formation of fibrin deposition, unnecessary neointimal thickening, and inhibition of neointimal maturation.
Abstract 12651: Fine-Tuning of Lung Thrombosis is a Therapeutic Strategy Against Inflammatory Lung Injury
Authors: Colin E Evans, Xianming Zhang, Narsa Machireddy, You-yang Zhao
Journal: Circulation (2020)

Introduction: Lung thrombosis (LT) and endothelial cell (EC) death are positively associated with mortality in sepsis-induced acute lung injury (ALI) patients, but anti-coagulants have failed in clinical trials of sepsis. Hypothesis: We hypothesized that different levels of LT mediate ALI by regulating lung EC viability. Methods: To assess the impact of different levels of LT on ALI, we used murine models of LT and ALI. To explore how LT level might alter lung EC viability and ALI, we assessed survival gene expression by RNA sequencing. To identify the mechanism(s) responsible for changes in ALI after varying levels of LT, we assessed lung EC viability and ALI in mice with cell-specific knockout of different survival genes. Results: In platelet-depleted mice, LT was reduced while ALI was increased. Intra-venous microbeads were then administered to induce LT in a dose-dependent manner, showing that restoration of LT to the level found in platelet-replete mice protected against thrombocytopenia-induced ALI. We next showed in wild type mice, that while excessive increases in LT worsened ALI, induction of a mild level of LT conversely protected against ALI. The opposing impact of diminished or excessive versus mild LT on ALI was associated with changes in lung EC apoptosis. Subsequent studies showed a panel of candidate survival factors were differentially expressed in the lungs of ALI mice with or without mild or excessive LT. Mechanistically, we found that the protective impact of mild LT on ALI is dependent upon hypoxia-inducible factor (HIF) 1α in Tie2-expressing cells. Remarkably, the same mild level of LT retained its protective impact in platelet-depleted and platelet-replete mice even when induced up to 8 hours after sepsis. Conclusions: ALI is enhanced by diminished or excessive LT but suppressed by mild LT through HIF1α. The control of LT represents a therapeutic strategy for the induction of a pro-survival response that protects against inflammatory lung injury.