tbuckley/cabot-search huggingface dataset:
Abstract 14142: Life After Left Ventricular Assist Device (LVAD) Implant: A Qualitative Perspective Through Online Focus Groups Of LVAD Caregivers
Authors: Ashley J Xu, Mengchi Li, Samuel Byiringiro, Jennifer Wenzel, Cheryl Dennison
Journal: Circulation (2021)

Introduction: The caregivers’ role is integral for individuals with a left ventricular assist device (LVAD). Caregivers from other chronic diseases (heart failure, stroke, and cancer) experience uncertainty related to caring for their loved ones. However, there is a lack of literature in the LVAD caregiver population. This study explored factors related to uncertainty in LVAD caregivers. Methods: This qualitative study included utilization of synchronous online focus groups through a secure platform. Caregivers (N=20) were recruited through three Facebook LVAD support groups. Participants were assigned based on availability to one of five, 60-min, private, online focus group sessions. Topics explored were guided by the Uncertainty in Illness Theory. NVIVO 12 was used to analyze content into codes and common themes. Results: Focus group results yielded 5 overarching themes: 1) Caregiver perceived positive experiences can lead to hopefulness and a sense of normalcy. 2) Caregiver perceived negative experiences have impact on caregiver health and everyday activities. 3) Coping strategies to the changes (whether perceived negative or positive) are crucial in improving overall experience and regain “sense of control”. 4) Adjusting and adapting can improve quality of life. 5) Caregiver needs are multidimensional and strategies that improving coping are needed to enhance experience. Conclusions: The study found caregivers experience coexistence of ambivalent emotions from positive to negative. They utilize different coping strategies to cope with the changes and uncertainties in the everyday life. However, they still encounter many challenges and have many unmet needs.Access to resources like financial assistance, monitoring of mental health and referral to a professional, constant exchange of information (receiving or sharing) from the centers and keeping caregivers/patient informed and engaged could all enhance the caregiver experience.
Abstract 12457: Atrial Fibrillation is a Cardiovascular Risk Factor for Worse Prognosis in COVID-19
Authors: Michael J Cutler, Heidi T May, Tami L Bair, Brian Crandall, Jeffrey Osborn, Jared D Miller, Charles Mallender, Joseph B Muhlestein, Jeffrey L Anderson, Kirk U Knowlton, Stacey Knight
Journal: Circulation (2021)

Background: In the presence of comorbid conditions, COVID-19 infections are known to require more advanced treatment, poorer outcomes and have longer-term sequelae. New-onset atrial fibrillation (AF) during COVID-19 infection has been associated with worse cardiovascular outcomes but not mortality. However, it remains unclear whether a prior history (hx) of atrial fibrillation is a cardiovascular risk factor predicting a worse outcome in COVID-19 patients. As such, we examined, using propensity matching accounting for possible confounders, the need for advanced treatment and subsequent major cardiovascular events (MACE) in patients with a prior hx of AF with COVID-19 infection. Methods: From March 2020 to May 2021, patients testing positive for SARS-CoV-2 with a prior AF diagnosis (n=3119) were propensity matched for age, gender, race/ethnicity, prior coronary artery disease (CAD), prior heart failure (HF), prior stroke and hypertension to non-AF SARS-CoV-2 positive patients. Cox hazard regression analysis with multivariable adjustment was used to determine risk of subsequent MACE (all-cause death, myocardial infarction, HF and stroke). Results: Baseline characteristics, treatments, and outcomes stratified by AF status are shown in the Table. While the groups had similar baseline characteristics, AF COVID-19 patients were more likely to require hospitalization, ICU care, and ventilator support. Consistent with our hypothesis, composite MACE event rates were higher in the AF patients (HR=1.60, p&lt;0.0001) secondary to increases in heart failure and all-cause mortality rates. Conclusions: These data support AF as a cardiovascular risk factor predicting worse outcomes in COVID-19 patients. Specifically, AF increases the need for advanced treatments such as hospitalization, ICU care and ventilator support resulting in an increase in subsequent heart failure and all-cause mortality.
Abstract P513: Adenylosuccinate Synthase Is A Novel Methylation Target Of Smyd1
Authors: Magnus Creed, Marta Szulik, Ryan Bia, Chris Tracy, Aman Makaju, Sarah Franklin
Journal: Circulation Research (2021)

Among the metabolic shifts in chronic heart failure is a dysregulation of purine metabolism, which has been shown to negatively impact patient outcomes, especially in individuals affected by hypertension, diabetes, and congestive heart failure, via increased serum uric acid levels and cellular oxidative stress. The underlying mechanisms which drive these changes in purine metabolism in the cardiomyocyte and ultimately reactive oxygen species and uric acid accumulation in heart failure patients remain largely unknown. We recently discovered that the methyltransferase Smyd1 interacts with the metabolic enzyme Adss (Adenylosuccinate synthetase), a key component of purine metabolism in the heart involved in AMP synthesis, via co-immunoprecipitation. We confirmed this novel interaction between Smyd1b and Adss in mouse heart and cultured primary cardiomyocytes, which is further enhanced during phenylephrine-induced hypertrophy in the latter. Our hypothesis was that Smyd1b methylates Adss to regulate its activity, therefore, we examined lysine methylation on Adss via western blotting and mass spectrometry and quantified its ability to convert IMP to sAMP in vitro in the presence and absence of Smyd1b. Using a pan-methylation antibody we initially detected di- and tri-methylation on Adss which was increased in the presence of Smyd1b. Then utilizing bottom-up proteomics, we achieved 98% sequence coverage of Adss via mass spectrometry and identified trimethylation on K373 only in the presence of Smyd1b. In addition, utilizing an enzymatic assay in vitro we have shown that Smyd1b enhances the activity of Adss as it converts IMP to s-AMP. While it has been well-established that the activities of metabolic enzymes are modulated via post-translational modifications (e.g. phosphorylation, acetylation), we believe this is the first report of a metabolic enzyme regulated by lysine methylation. These exciting results highlight a novel role for Smyd1b in regulating purine metabolism in the myocyte and begin to lay the groundwork for examining this mechanism in the setting of disease.
Abstract 13212: Chronic Total Occlusion Racial and Income Inequities by Mortality and Cost: Propensity Score and Machine Learning Augmented Nationally Representative Case-Control Study of 30 Million Hospitalizations
Authors: Nikhil Agrawal, Dominique Monlezun, Cullen Grable, Jordan Graham, Konstantinos Marmagkiolis, Siddharth Chauhan, Logan Hostetter, Mehmet Cilingiroglu, Abhijeet Dhoble, Konstantinos Charitakis, Richard W Smalling, Nicolas L Palaskas, Salman A Arain, Cezar Iliescu
Journal: Circulation (2021)

Introduction: We sought to produce the first nationally representative analysis of racial and income inequities by mortality and cost for patients with chronic total occlusion (CTO) of coronary arteries by the presence or absence of active cancer. Methods: Propensity score adjusted and backward propagation neural network machine learning augmented multivariable regression among patients with CTO and stratified by race and income was conducted for the above outcomes in this case-control study of the United States’ largest and most current all-payer hospitalized dataset, the 2016 National Inpatient Sample. Regression models were fully adjusted for age, geographic region, anemia, thrombocytopenia, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), and the likelihood of undergoing PCI (in addition to length of stay [LOS] for cost). To produce nationally representative estimates, analyses were also adjusted for the complex survey design. Results: Of the 30,195,722 adult hospitalized patients, 1,159,994 (3.84%) underwent PCI (of whom 30,624 [2.64%] were in patients with active cancer), and 120,815 (0.40%) had CTO (of whom 3,068 [2.54%] had active cancer). In multivariable regression among patients with CTO, mortality was comparable across races in both PCI and cancer, but significantly increased among the lowest income quartile for patients with cancer (OR 4.09; 95%CI 1.30-12.80; p=0.016). PCI in Hispanic cancer patients unlike other races had significantly increased costs ($207,218.80; 95%CI 76,799.21-337,738.30; p=0.002) as did the lowest income quartile ($26,327.08; 95%CI 21,123.93-31,530.23; p=0.042) unlike other income groups significantly increased costs. Conclusions: This large nationally representative study suggests PCI can safely done in hospitalized patients with CTO and active cancer though its prevalence is far less than in those without cancer despite comparable risk profiles; there also appears to be significant racial and income inequities in both mortality and cost by both race and income.
Outcomes with Chimeric Antigen Receptor T-Cell Therapy in Relapsed or Refractory Acute Myeloid Leukemia: A Systematic Review and Meta-Analysis
Authors: Moazzam Shahzad, Sibgha Gull Chaudhary, Ali Hussain, Fatima Ali, Ayesha Khalid, Ezza Tariq, Muhammad Usman Zafar, Muhammad Arslan, Iqra Anwar, Rajat Bansal, Peiman Hematti, Tara L. Lin, Sunil Abhyankar, Joseph P. McGuirk, Muhammad Umair Mushtaq
Journal: Blood (2021)
Abstract 11979: Activation of Growth Hormone Releasing Hormone Receptor Signaling as Potential Therapeutic Approach to Treat Heart Failure With Preserved Ejection Fraction
Authors: Rosemeire M Kanashiro-takeuchi, Lauro Takeuchi, Wayne Balkan, Renzhi Cai, Andrew Schally, Joshua M Hare
Journal: Circulation (2021)

Introduction: Heart failure (HF) with preserved ejection fraction (HFpEF) represents about 50% of the HF cases and is steadily rising. To date, there no effective therapies for HFpEF. Growth hormone-releasing hormone (GHRH) has shown a broad range of regulatory influences in the cardiovascular system, aging and obesity in preclinical and clinical studies; therefore, we hypothesize that GHRH-agonists (GHRH-A) can attenuate/reverse the HFpEF phenotype. Methods: C57BL6N mice received a high fat diet (HFD) plus L-NAME for 5 weeks (HFD+L-NAME) to induce HFpEF. Cardiac morphology and function was then assessed by echocardiography, and animals were randomized to receive daily injections of GHRH-A (200 μg/Kg) or placebo (vehicle). Control animals received neither HFD+L-NAME nor treatment. Mice were acclimated to treadmill exercise testing and for systolic blood pressure (SBP) measurements. Results: Baseline characteristics following 5 weeks of HFD+L-NAME showed no difference in ejection fraction (EF), but isovolumetric relaxation time (IVRT) and E/A ratio were increased, while E/E’ ratio decreased compared to control (Fig1A-D, *p&lt;0.05, ****p&lt;0.0001 t-test). Running distance (Fig1E) after 1-week of GHRH-A treatment suggests improvement over placebo-treated mice. Similarly, SBP (Fig1F) appears to be returning to normal after 10 days (**p&lt;0.01, Kruskal-Wallis test). Conclusions: Our results corroborate exercise intolerance and hypertension in the HFD+L-NAME placebo and suggest that even short-term GHRH-A treatment produces beneficial effects on exercise tolerance and SBP. Thus, GHRH-A therapy may be a potential therapeutic strategy for treatment of cardiometabolic HFpEF phenotype.
<i>Patient and Physician Perspectives of Unmet Needs in CML - Designing the CML SUN Survey</i>
Authors: Zack Pemberton-Whiteley, Jorge E. Cortes, Joannie Clements, Cristina Ruiz, Delphine Rea, Lisa Machado, Fabian Lang, Naoto Takahashi, Nigel Deekes, Sung-Ho Moon, Andrew Grigg, Merula Steagall, Cornelia Borowczak, Virginia Pilipovic, Pauline Frank, Cristina Constantinescu, Carla Boquimpani
Journal: Blood (2021)
Abstract 10796: Patient and Clinician Perspectives of Decision Quality Surrounding Atrial Fibrillation Ablation: A Mixed-Methods Study
Authors: Meghan Reading Turchioe, Sabrina Mangal, Jessica Ancker, David J Slotwiner
Journal: Circulation (2021)

Introduction: Catheter ablation is a common treatment for atrial fibrillation (AF) with nuanced risks and benefits. Shared decision-making (SDM) could guide the decision to undergo ablation based on patient values and goals of care. Understanding whether and how SDM about ablation is conducted in clinical practice would allow us to determine how to optimize patient decision making and decision quality. The objective of this study was to investigate decision quality and SDM practices surrounding AF ablation. Methods: We conducted a mixed-methods study guided by Sepucha &amp; Scholl’s (2014) SDM framework which specifies decision antecedents, processes, and outcomes. We recruited a convenience sample of AF ablation patients (n=15) and clinicians (n=5; 3 MDs, 1 PA, 1 NP) from a hospital in Queens, New York. Patients completed the AF Symptom Survey (AFSS), Controls-Preferences scale (CPS), and Decisional Conflict scale (DCS), which were summarized using descriptive statistics (median, interquartile range [IQR], and frequency). Patients and clinicians completed semi-structured interviews, which were analyzed using directed content analysis. Participants received $25 as compensation. The Weill Cornell Medicine IRB approved this study. Results: Patients’ median age was 71.0 years (IQR 69.0-78.5), 27% were female, 67% were White, and 73% spoke English. The median AFSS score was 0 (IQR 0-1.0) out of 35 indicating low symptom burden post-ablation. The median DCS score was 7.0 (IQR 0-16.4) out of 100 indicating low levels of conflict. On the CPS 4 patients (27%) preferred to have some control in decision-making; the remainder preferred to share control or relinquish it to clinicians. Qualitative findings underscore low levels of decisional conflict but limited patient agency (Table) . Conclusion: Findings suggest opportunities to improve decision quality surrounding AF ablation by bolstering patient agency, possibly through educational materials and decision aids.
Abstract 13659: Cerebral Small Vessel Disease is a Potent Independent Risk Factor for Alzheimer’s Disease
Authors: Alexa Serino, Emily Coughlin, Rahul Mhaskar, Samuel Wickline, Hua Pan
Journal: Circulation (2021)

Alzheimer’s Disease (AD) is the leading cause of dementia worldwide. Current treatments may slow the progression of the disease but cannot reverse the pathology, thereby confirming the medical need for measures of prevention and early detection. Recent studies established a connection between cardiovascular disease (CVD) risk factors and AD. Small vessel disease, which shares similar risk factors and pathology as CVD, is receiving attention as a potential risk factor for AD as well. We sought to quantify the risk associated with confirmed diagnosis of cerebral small vessel disease (CSVD) for the development of AD as a first step to defining the condition as a treatment target for preventing AD. We hypothesized patients with image-based evidence of CSVD would have a greater risk of having AD.In this retrospective clinical study, we selected patients from the National Alzheimer’s Coordinating Center database with image-based evidence of CSVD including lacunar infarction, microhemorrhage, and white matter hyperintensity (n=3,895). We quantified the risk of each of these conditions for association with clinical AD, elevated β-amyloid, and tau protein accumulation. In addition, we compared the rates of AD development between men and women within these CSVD populations. Using a linear regression analysis, we controlled for shared comorbidities between CSVD and AD. We observed an increased risk as defined by odds ratio (OR) of AD in patients with microhemorrhage (OR=1.32, p=0.04). Patients with white matter hyperintensity also exhibited increased risk of developing AD, which increased with disease severity (Moderate: OR= 1.63, p&lt;0.01; Extensive: OR=2.72, p&lt;0.01). Lacunar infarction did not demonstrate independent risk for developing AD. CSVD did not confer any additional risk for increased tau protein or amyloid based on imaging. The risk of AD was not higher for women as compared to men with confirmed CSVD. Here we elucidate a clear association between CSVD and risk of AD and observe increased risk with the extent of the disease. With a more comprehensive understanding of these relationships, CSVD imaging could be used as an early biomarker for accelerated AD and provide an opportunity to test methods for controlling CSVD as a novel early intervention.
Abstract 13783: Predictors and Prognostic Implications of Stress Cardiomyopathy in Aneurysmal Sub-Arachnoid Hemorrhage: Findings From a 14-year Prospective Registry
Authors: Saarwaani Vallabhajosyula, Renuka Reddy Katta, Hector I Michelena, Alejandro A Rabinstein
Journal: Circulation (2021)

Objective: Stress cardiomyopathy(SCM) occurs between 4-15% in aneurysmal sub-arachnoid hemorrhage(aSAH). Predictors and prognostic implications of SCM in aSAH remains incompletely known. Methods: Adult patients between January 2006-December 2019 with diagnosis of aSAH and echocardiogram during same admission were identified from a prospectively maintained aSAH registry. Presence of SCM was confirmed using the echocardiographic criteria. Severity of aSAH was categorized using the modified Fisher(mFisher) and the World Federation of Neurological Scale(WFNS). Results: Among 570 aSAH patients during study period, 194 aSAH cases had echocardiography and 37(19%) of them had SCM. In comparison to aSAH without SCM, aSAH with SCM were mainly females(76% vs 62%; p= 0.12) and postmenopausal(57±12 vs 59±13 years; p= 0.39). Echocardiographic findings in Table . aSAH with SCM was associated with WFNS grade&gt;3(68% vs 42%; p= 0.005) and mFisher grade&gt;2(87% vs 81%; p= 0.39), intraventricular hemorrhage(IVH)(81% vs 64%; p= 0.04) and larger size of the ruptured aneurysm(8±5 vs 6±4; p= 0.04). Medical management, microsurgical clipping and endovascular coil embolization rates were similar in patients with and without SCM, yet patients with SCM had lower rates of disposition to home(8% vs 27%; p =0.02) and higher in-hospital mortality(41% vs 25%, p= 0.05). On multivariate analysis, ruptured ophthalmic artery aneurysms had 13-times higher odds for formation of SCM(OR 13.43 [1.22-147.8]; p= 0.02). Conclusion: aSAH with SCM predominantly occurred in postmenopausal females with larger aneurysms, and higher severity of bleeds. Ophthalmic artery aneurysms were associated with substantially increased risk of SCM after adjustment for aSAH severity. Despite similar treatment rates, SCM was associated with higher in-hospital mortality. These findings will require further confirmation in a larger subset of aSAH with SCM patients.
Abstract 12125: Baseline Analysis of National Malaysian Heart Failure Registry Indicates Hospitalization as a Key Opportunity to Initiate GDMT in HF Patients
Authors: Wan Azman Wan Ahmad, Muhamad Ali S SK Abdul Kader, Noel Thomas Ross, Ahmad Wazi Ramli, Azmee Mohd Ghazi, Hamat Hamdi Che Hassan, Chuey Yan Lee, Mayuresh Fegade, Hafisyatul Aiza Zainal Abidin, Dharmaraj Karthikesan, Nor Hanim Mohd Amin, Tiong Kiam Ong, Kauthaman A Mahendran, Tamil Selvan Muthusamy, drkahar ghapar
Journal: Circulation (2021)

Introduction: There is scarcity of big data on Heart Failure (HF) in the Asean region in the current era of guideline directed medical therapy (GDMT). Malaysia Heart Failure (MYHF) Registry was set up in 2019 to advance fundamental understanding of the burden, morbidity and mortality among Malaysian patients with HF Objective: This analysis is to determine baseline characteristics, diagnostic work up and treatment pattern of patients admitted with the diagnosis of HF to address the unmet and growing clinical needs of HF patients in Malaysia. Methods: The first ever National HF Registry is planned as a prospective, observational study of HF patients (NYHA II-IV) across 18 tertiary care centers in Malaysia over a period of 3 years starting in 2019. This Registry recruited all patients admitted with a clinical diagnosis of HF by the attending physician with a minimum hospital stay of 24 hours for stabilisation prior to discharge. Primary endpoint is all cause mortality and hospital readmission for acute decompensated heart failure (ADHF) at one year. This paper summarizes baseline and clinical characteristics of patients along with treatment pattern and outcomes of index hospitalization. Results: We evaluated 2673 patients with mean age of 60 years (SD 13.8). De novo HF constituted one third of hospitalizations. Mean left ventricular ejection fraction (LVEF) was 36.4% (SD 15.3) stratified into 65% of HFrEF (LVEF ≤ 40%), 21% of HFpEF (LVEF ≥ 50%); and 11% of HFmrEF (LVEF 41-49%). Prior to index HF hospitalization, proportion of patients on BB, ACEi, ARBs, ARNI, MRA and ivabradine were 57%, 32%, 8%, 6%, 24% &amp; 6% respectively changing to 79%, 36%, 8%, 15%, 43% &amp; 12% at discharge of the patient. Mean length of hospital stay was 7.3 days (SD 8.9). In-hospital mortality was 3% attributed largely to cardiac causes (68%). Conclusions: The registry identifies at-risk patient populations with HF and highlights lesser prevalence of HFpEF compared to other HF registries. The analysis shows increased usage of GDMT post HF hospitalization event remarkably for BB, MRA, ivabradine and ARNI indicating hospitalization as a key opportunity to initiate GDMT in HF patients.