tbuckley/cabot-search huggingface dataset:
Abstract 18644: Disparities in Inpatients’ Perceptions, Evaluation, and Responses to Worsening Heart Failure Symptoms- Racial and Financial Status
Authors: Muna Hammash, Mohammad Alkawaldeh, Chin-Yen Lin, Debra K Moser
Journal: Circulation (2023)

Background: Most patients with heart failure (HF) exhibit a broad symptom profile, sporadically marked by periods of acute exacerbation and readmission that can be prevented by symptom monitoring and adequate self-care. Yet, patients are frequently unable to adhere to appropriate self-care measures. Reasons for non-adherence are multifactorial including disparities related to race and financial status, and are insufficiently investigated. Thus, a secondary analysis study was conducted to 1) compare HF inpatients’ knowledge, cognitive function and HF self-care based on their race (Black and White), and financial status (higher if they reported having “enough or more than enough to make ends meet” and lower if they “did not have enough to make ends meet”), and 2) investigate disparities in patients’ perception and evaluation of symptoms, and actions taken during HF exacerbation based on their race and financial status. Methods: A total of 185 patients (62 years ±13, 49 % female, 76% white) admitted for acute HF exacerbation completed standardized instruments measuring cognitive function, HF knowledge, HF self-care, perception of, and responses to HF symptoms. Chi-square and independent samples t-test analyses were used. Results: Black patient with HF had lower levels of HF knowledge, cognitive function, and engagement in self-care maintenance behaviors than White patients (p &lt;.05). Black patients believed medication nonadherence, excessive fluid intake, hypertension, and overeating were causes of their worsening symptoms (p &lt;.05). Black patients tended to call an ambulance in response to worsening symptoms while White patients took their water pill (p = 0.03). Patients with lower financial status reported higher body mass index than those with higher financial status (p = .03). Patients with lower financial status linked their symptoms to depression and lung problems (p =.02), but they did nothing to manage symptoms and hoped their symptoms would go away (p &lt; .05). Conclusions: Interventions that take into account culture and financial status are needed to mitigate racial disparities, improve symptom perception, and promote appropriate responses in HF patients.
Abstract 18627: The Relative Contribution of Perfusion vs. Congestion in Predicting Adverse Outcomes in Heart Failure With Preserved Ejection Fraction
Authors: Vivek P Jani, Joban Vaishnav, Soumya Vungarala, Virginia S Hahn, David A Kass, Kavita Sharma
Journal: Circulation (2023)

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) constitutes greater than half of all heart failure (HF) patients with limited therapies. There are limited data on the role of congestion versus perfusion in prognosticating outcomes. Methods: A total of 243 patients seen at the Johns Hopkins HFpEF Clinic between 2011-2023 with HFpEF and RHC were included for analysis. Subjects were stratified into congestion and perfusion groups based on the median PCWP and CI, which were 15 mmHg and 2.44 L/min/m 2 , respectively. Groups were assigned as follows: dry-warm (PCWP &lt; 15 mmHg, CI ≥ 2.44 L/min/m 2 ), wet-warm (PCWP ≥ 15 mmHg, CI ≥2.44 L/min/m 2 ), dry-cold (PCWP &lt; 15 mmHg, CI &lt; 2.44 L/min/m 2 ), and wet-cold (PCWP ≥ 15 mmHg, CI &lt; 2.44 L/min/m 2 ), seen in Figure 1A . Results: Subjects with hypoperfusion (wet-cold and dry-cold) were older (p=0.01), more likely to have atrial fibrillation (p&lt;0.0001), had worse RV function (p=0.002), and had elevated NT-proBNP (p=0.0001) compared to subjects with normal perfusion. Congested patients were more likely female (p=0.002), had higher BMI (p=0.02), higher creatinine (p=0.005), evidence of metabolic syndrome, including elevated fasting glucose (p=0.0008), elevated cholesterol (p=0.01), and LVH on echocardiography (p=0.002). Kaplan-Meier survival analysis of the hemodynamic profiles for a combined end point of all-cause mortality and HF hospitalization revealed that congested profiles exhibited the lowest event free survival compared to the dry profiles (logrank p=0.008; Figure 1B ) and of these, the wet-warm subjects had the lowest event-free survival at 36 months. Conclusion: Unlike in prior HF studies, congestion in HFpEF appears to be concomitant with obesity and metabolic syndrome. Moreover, while consistent with prior studies that congestion drives outcome differences compared to perfusion, wet-warm HFpEF patients appear to have the lowest event free survival as opposed to wet-cold patients as in other forms of HF.
Abstract 17030: Phenome-Wide Mapping of Genetic Effects Distinguishes Etiological Modules Underlying the Phenotypic Spectrum of Heart Failure
Authors: Albert Henry, Tom Lumbers
Journal: Circulation (2023)

Introduction: The heart failure (HF) syndrome has been associated with multiple risk factors of which causal effects on conventional HF subtypes remain unclear. Leveraging insights from human genetics, we characterized the associations of genetic loci associated with susceptibility to HF across a wide range of risk factors and diseases to identify causal risk factors and etiological modules underlying HF subtypes. Methods: Through a genome-wide association meta-analysis in 1.9 million individuals, we identified 66 independent genetic susceptibility loci across HF subtypes. We evaluated the pleiotropic effects of these loci across 294 disease phenotypes in 400,000 UK Biobank participants. Using graph modeling, we constructed a pleiotropy network of HF loci and identified distinct etiological clusters based on the network topology. Finally, we performed cross-trait genetic colocalization, genetic correlation, and Mendelian randomization analyses to investigate the causal effects of 24 HF-related phenotypes across HF subtypes. Results: We identified 207 associations between 49 genetic susceptibility loci of HF and 79 disease phenotypes. Network analysis revealed 18 distinct etiological clusters underlying these associations (Figure A), including clusters of interlinked ischemic phenotypes, cardiac arrhythmia / cardiomyopathies, hypertension, and diabetes / obesity. Through colocalization analysis, we found 105 causal genetic variants that are shared between HF and at least one other trait at 42 loci. We observed differential patterns of genetic correlation and causal associations, for instance, type 2 diabetes were genetically correlated to all HF subtypes but not causally associated with any (Figure B). Conclusions: Genetic analysis identifies distinct etiological modules and causal risk factors underlying different forms of HF, providing insights that may inform approaches to treatment and prevention.
Abstract 16986: Verticalize to Mobilize: A Pilot Study
Authors: Alice T Chan, Meshe Chonde, suzanne seidel, Billy Villao, Bernice L Coleman, Harriet Aronow, Sunny Hsu, Anthony Andreas, Miguel Velazquez
Journal: Circulation (2023)

Introduction: Early mobility in critical illnesses, like acute decompensated heart failure, is essential to preserving muscle strength. However, patients on mechanical support devices such as a femoral-inserted intra-aortic balloon pump (f-IABP) have traditionally had limited mobility due to potential complications. Unfortunately, this commonly leads to prolonged ICU stay and an increased need for rehabilitation. Aim: This study evaluates the safety and feasibility of implementing a nurse-led verticalization protocol for patients with an f-IABP. Methods: A total of 36 patients with f-IABP successfully verticalized utilizing the Kreg Catalyst™ bed between May 1, 2022, to May 4, 2023, for one hour-long session. The cohort selection required patients to be ambulatory before f-IABP placement, hemodynamically stable, and free of arrhythmias within the last 24 hours. The study carefully monitored hemodynamic stability by comparing baseline averages to peak tolerated angle (PTA) data. Results: A total of 322 verticalization sessions were completed without significant complications and only nine minor complications. Minor complications included five sessions (1.55%), resulting in a catheter readjustment of over 3 centimeters. They averaged 9±7 verticalization sessions per patient, averaging 55±13 minutes. Were19/36 patients (53%) achieved a PTA greater than 70 degrees. Mean arterial pressure decreased by 4±7mmHg. Pulmonary artery systolic pressure decreased by 2±3mmHg, the cardiac index fell by 0.1± 0.5L/min/m 2 , and the heart rate increased by 4±5bpm. Of the 36 patients, 29 (81%) received heart transplants during their hospitalization and had an average post-operative ICU stay of 7 days and a total postoperative hospital stay of 18 days. Of the cohort study, 23 patients (64%) were discharged home with home health, ten patients (27%) were transferred to a rehabilitation center, two patients (5%) were transferred to an outside hospital, and one patient transitioned to comfort care. Conclusions: The result of the study indicates that it is safe and feasible to verticalize patients with f-IABP.
Abstract 16721: Concentrations of Troponin I but Not Cardiac Troponin T Are Associated With 7-year Changes in Left Ventricular Structure and Function in Older Adults: The Atherosclerosis Risk in Community (ARIC) Study
Authors: Peder L Myhre, Brian Claggett, Christie M Ballantyne, Elizabeth Selvin, Kuni Matsushita, Dalane W Kitzman, Suma H Konety, Thomas Mosley, Amil M Shah
Journal: Circulation (2023)

Introduction: High-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) are strongly associated with incident heart failure (HF) and left ventricular (LV) remodeling. Their associations with longitudinal changes in cardiac structure and function are less clear. Methods: Among 1,908 participants in the Atherosclerosis Risk in Communities (ARIC) study who were free of coronary disease, HF, or atrial fibrillation and had echocardiography at study Visits 5 (2011-2013) and 7 (2017-2019), we assessed the associations of log-transformed hs-cTnT and hs-cTnI at Visit 5 with absolute changes in LV structure and function between Visit 5 and 7 (median of 6.6 [IQR 6.1-7.0] years) using multivariable linear regression with the exposures modeled as restricted cubic spline models. Models were adjusted for age, sex, race, BMI, diabetes, hypertension and eGFR at Visit 5, blood pressure and heart rate at both visits. Results: At Visit 5, the mean age (years) was 74 (SD 4), 60% were female, 24% reported Black race and the median (p25-p75) concentrations of hs-cTnT and hs-cTnI were 9 (6-13) ng/L and 2.7 (1.9-4.0) ng/L respectively. In adjusted models, higher hs-cTnI concentration was associated with 7-year decline in LV systolic function (ejection fraction, global longitudinal and circumferential strain; Figure ). In contrast, hs-cTnT was not consistently associated with changes in cardiac function. Changes in hs-cTnI, but not hs-cTnT, were also associated with greater increases in left atrial volume. Neither were associated with changes in LV mass or volume. Conclusions: Higher hs-cTnI, but not hs-cTnT, concentrations are associated with greater declines in LV function over ~7 years in late life independent of traditional cardiovascular risk factors. These findings support previous findings of cTnI to be more cardiac specific than cTnT.
Abstract 18362: Endovascular versus Surgical Revascularization for Chronic Limb Threatening Ischemia: A Comparison of Re-Admission Rates From NSQIP Database (2011-2021)
Authors: Syed H Mufarrih, Nada Qureshi, Mohammad Saud Khan, Matthew McCurdy, Sajjad Haider, Muhammad Akbar, Mohammed Kazimuddin, Herbert D Aronow
Journal: Circulation (2023)

Background: Data regarding relative readmission rates following endovascular and surgical revascularization for chronic limb threatening ischemia (CLTI) are conflicting. Understanding comparative readmission rates may inform selection of the most appropriate revascularization modality for these patients. Research Question: What are the differences in 30-day readmission rates between endovascular and surgical interventions for CLTI? Methods: The 2012 to 2021 American College of Surgeons National Surgical Quality Improvement Program's (NSQIP) Targeted Vascular Module was used to identify patients discharged alive after surgical or endovascular revascularization for CLTI. The primary outcome was 30-day readmission following the index procedure; secondary outcomes included survival, major re-intervention of the treated arterial segment, amputation, untreated loss of patency of bypass graft, bleeding requiring transfusion or re-intervention, major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Revascularization modality was related to 30-day readmission using multivariable logistic regression. Results: We identified 30,390 patients (mean age 69±11.5 years, male 62.8%, mean BMI 26.9±8.1 kg/m 2 , 61% Caucasian, 20.2% Black). When compared with endovascular therapy, surgical bypass was associated with higher 30-day readmission (13.3% vs. 8.6%, p = &lt;0.001). After adjusting for demographic, clinical, procedural variables and year of publication, surgical revascularization was independently associated with higher 30-day readmission rates (OR 1.53 95% CI [1.36, 1.71]; p&lt;0.001), mortality and major reintervention rates (Figure). Conclusion: Surgical revascularization was independently associated with higher 30-day readmission rates when compared to endovascular revascularization for patients with CLTI.
Abstract 18259: Overestimation of Major Amputation Risk in Patients Undergoing Peripheral Vascular Intervention for Peripheral Artery Disease When Not Accounting for Mortality Risk
Authors: Gaelle Romain, Kim G Smolderen, Jacob Cleman, Carlos Mena-Hurtado
Journal: Circulation (2023)

Background: Endovascular peripheral vascular intervention (PVI) is intended to improve symptoms and functioning, and avoid limb amputation in patients with chronic limb threatening ischemia (CLTI). CLTI is associated with high mortality risk, which differs across age groups. We aimed to offset mortality vs. amputation risks by age groups in patients with CLTI using competing risk modeling. Methods: Patients with CLTI underwent PVI in 2017-2018 in the Vascular Quality Initiative registry were included. Mortality and major amputation outcomes over 3 years were derived from Medicare data. The cumulative incidence (CIF) of both outcomes in age groups &lt;65 and ≥65 years, was calculated by Aalen-Johansen (AJ), taking mortality into account, and compared with corresponding CIF calculated by Kaplan-Meier (KM). The major amputation risk in &lt;65 vs ≥65 years was estimated using a Fine and Gray competing risk model (sHR) and Cox regression (HR) adjusted for patients’ baseline characteristics. Results: A total of 10,114 patients were included: 22% &lt;65 years; 59% male and 19% Black. The cumulative incidence of death without major amputation increased with age (32% in &lt;65 vs. 46% ≥65 years) and was higher than that of major amputation (26% in &lt;65 vs. 15% in ≥65 years). By ignoring competing risk, both death without major amputation and major amputation was overestimated by a relative difference of 25.4% and 14.3% in &lt;65 years and by 13.8% and 21.2% in ≥65 years. The adjusted major amputation risk in &lt;65 vs. ≥65 years estimated by Cox regression was HR 1.30 95%CI 1.16-1.56 vs. FG model sHR = 1.75 95%CI 1.57-1.95. (Table) Conclusions: Longer term mortality following PVI is high, especially among elderly with CLTI. To derive accurate risk estimates for amputation across age groups, advanced methods that can accommodate the competing risk of mortality are needed to better inform clinicians and patients as they face CLTI treatment decisions.
Abstract 15211: Age and Improvement in Health- Related Quality of Life After Percutaneous Coronary Intervention
Authors: Laura Lappalainen, Piia Lavikainen, Risto Roine, Harri Sintonen, Janne Martikainen, Anna-Maija Tolppanen, Juha Hartikainen
Journal: Circulation (2023)

Background: The purpose of percutaneous coronary intervention (PCI) is to relieve chest pain, improve health-related quality of life (HRQoL), or reduce the risk of cardiac adverse events and death among patients with coronary artery disease. The aim of this study was to investigate whether age is related to HRQoL improvement in patients undergoing PCI and which clinical characteristics explain the changes in HRQoL during 12 months. Methods: Altogether 301 patients undergoing PCI were divided into three age groups: ≤65 (n=94), 66-74 (n=117), and ≥75 (n=90). Patients responded to the generic 15D and disease-specific SAQ-7 HRQoL instruments at baseline and 1 and 12 months after PCI. Results: The median ages in groups were 60, 69, and 79 years, and the proportions of women were 19.1%, 32.5%, and 35.6%, respectively. Baseline instrument scores were lower in the oldest group compared to the youngest groups (15D p &lt;0.001, SAQ-7 p =0.006). 15D and SAQ-7 improved statistically ( p &lt;0.001 for all) and clinically significantly in all groups at 1 month. At 12 months, the 15D score decreased in all groups but remained statistically and clinically higher compared to baseline in the two youngest groups, and in the oldest group, it was statistically ( p =0.005) and nearly clinically higher (threshold 0.015, Δ score 0.013, 95% CI -0.003-0.030). In the oldest group, deterioration in the 15D between 1 and 12 months was due to dimensions “mobility”, “vision”, and “excretion” but not in “cardiac-related” dimensions. Significant improvement in SAQ-7 score at one-year follow-up was observed in all groups ( p &lt;0.001 for all). The improvements in 15D and SAQ-7 scores at 12 months showed no difference between the age groups ( p =0.381). Conclusions: There was no difference in the improvement of generic or disease-specific HRQoL after PCI between the age groups. Importantly, both 15D and SAQ-7 improved equally in the oldest groups as in the younger patients.
Abstract 16692: Early Life Stress Elicits Heart Failure Traits Across Generations in Mice
Authors: Sarah Costantino, Francesca Manuella, Shafeeq Mohammed, Samuele Ambrosini, Chiara Boscardin, Frank Ruschitzka, Nazha Hamdani, Isabelle M Mansuy, Francesco Paneni
Journal: Circulation (2023)

Introduction: Adverse childhood experiences, particularly early life stress (ELS), are associated with cardiovascular disease later in life but the underlying mechanisms remain elusive. Parental life experiences can have effects that are transmitted to the offspring suggesting a possible trans-generational transmission of ELS phenotypic traits. Hypothesis: ELS can impair cardiac function in exposed parents and their offspring. Methods: We used an ELS mouse model based on unpredictable separation of mouse pups (F1) from their mother (F0) each day for 3 hours from postnatal day 1 (PND1) to PND14 combined with dams exposure to an additional unpredictable stressor (forced swim in 18°C water for 5 minutes or 20-minute physical restraint in a tube) during separation. Control litters were raised normally. Echocardiography (Vevo 3100, Visualsonics) was performed at 6, 12 and 18 months in exposed animals (F0), their unexposed offspring (F1) and grand-offspring (F2). Both male and female mice were studied. Heart weight/tibia length was used to assess cardiac mass while Masson's Trichrome was employed to detect fibrosis. Lung congestion was assessed as lung wet/dry weight ratio. Single-cell RNA sequencing (scRNAseq) was performed in MSUS and control hearts. A 6-week environmental enrichment (EE) program (cages containing running wheels, maze) was employed to test the possible rescue of ELS effects in adult males and their offspring. Results: Male and female MSUS mice (F1) displayed a time-dependent deterioration (from 6 to 18 months) of LV hypertrophy, diastolic function, myocardial fibrosis and lung congestion when compared to controls. ScRNAseq revealed dysregulation of genes controlling inflammation and metabolism (Cav1, Fabp4) in cardiomyocyte and endothelial cell clusters. MSUS F1 and F2 females and males had diastolic dysfunction and lung congestion at 12 and 18 months (no change at 6 months). Notably, EE improved diastolic function and lung congestion in MSUS mice. Conclusions: ELS induces heritable cardiac alterations which can be rescued by EE in fathers. These results shed light on the causal role of ELS on heart failure development and potential mitigation strategies.
Abstract 18700: Immune Checkpoint Inhibitor-Related Myocarditis and Overlapping Syndromes
Authors: Shannon Heffernan, Yimin Chen, Babak Tehrani, Steven Ewer, Dustin Hillerson, Peter S Rahko
Journal: Circulation (2023)

Background: Immune checkpoint inhibitor (ICI)-related myocarditis is a rare adverse effect of ICI's. When accompanied by overlapping myasthenia gravis, prognosis is worsened. While established guidelines aid in the treatment of ICI-associated adverse events, management of overlapping syndromes is complex and challenging. Case description: A 66-year-old man with metastatic renal cell carcinoma recently started on ipilimumab and nivolumab presented with dizziness and diplopia. He had high-grade atrioventricular (AV) block with junctional escape. He had elevated troponin, transaminases, and creatinine kinase. Coronary angiogram showed no evidence of obstructive coronary artery disease. A permanent pacemaker was placed. Cardiac MRI showed no specific features of myocarditis, though quality was limited by pacemaker artifact; left ventricular ejection fraction was 29%. MRI of the orbits showed no signs of extraocular myositis. Acetylcholine receptor (AChR) antibody and muscle-specific kinase (MuSK) antibody was negative. Given ongoing suspicion for ICI-associated adverse events, the patient underwent endomyocardial biopsy. This revealed lymphocytic myocarditis, confirming the diagnosis of ICI-related myocarditis. Despite improvement of troponin, transminases, and creatinine kinase, he developed progressive weakness, dysphagia, and respiratory failure, and died one month after initial presentation. Discussion: We highlight a case of ICI-related myocarditis presenting as high-grade AV block with concurrent hepatitis, myositis, and probable serologic-negative myasthenia gravis (MG). Overlapping syndromes are common in patients with exposure to ICI's, and are associated with significantly higher mortality. Although steroids are first-line for treating ICI-associated adverse events including myocarditis, they can initially lead to acute worsening of MG symptoms. While our patient had laboratory and biomarker improvement of his myocarditis, hepatitis, and myositis, he developed progressive weakness and respiratory failure. Our case highlights the complexity and challenges of managing ICI-related myocarditis and overlapping syndromes, including MG, and its poor prognosis despite prompt treatment.