tbuckley/cabot-search huggingface dataset:
Abstract 4147460: Beat Heart failure rehospitalization!
Authors: FNU Riya, Jennifer Sardone-Ponnappan
Journal: Circulation (2024)

Introduction: Heart failure (HF) rehospitalization poses a significant burden on the healthcare system. Multiple factors contribute to multiple HF admissions, such as polypharmacy, non-compliance, and inadequate treatment. Studies have demonstrated a strong association between early follow-up with primary care or a cardiologist within seven days of discharge and reduced 30-day HF rehospitalization. Research Question/Hypothesis: A quality improvement (QI) study was conducted at a community hospital to decrease the HF rehospitalization rate. The study involved enrolling acute in chronic HF exacerbation patients and implementing early follow-up using a checklist for both in-person and telephonic visits. Goals: The study aimed to reduce the HF 30-day readmission rate to 10-12% from the community hospital's 18% average by focusing on early primary care follow-up within seven days of discharge and using a standardized American Heart Association (AHA) Target HF checklist at the time of follow-up. Method: The QI project employed a bundled intervention approach, incorporating patient education, scheduling post-discharge follow-up appointments, and utilizing a standard AHA checklist integrated into EPIC smartphrases for streamlined documentation during follow-up appointments. The project used Tableau to review the 30-day readmission rate. Results: Quality improvement measures were initiated at the community hospital in September 2023 to decrease the 30-day readmission rate. Monthly HF readmission rates from October 2023 to March 2024 in image 1 showed variation with significant peaks due to seasonal periodicity, peaking in January 2024. Despite variation, the project increased HF education resources, achieving 1-2 follow-up HF visits per week at the continuity clinic with increased checklist utilization. Conclusion: With the help of QI, we successfully increased the number of HF education books across all the nursing units on the telemetry floor. We addressed challenges in implementing the approach, focusing on improving education access, increasing staff awareness with interdisciplinary collaboration regarding discharge appointments, and creating awareness posters (as shown in images 2 and 3) in common workplaces. Currently, the project aims to raise awareness among internal residents and familiarize them with the checklist and advanced HF therapy referrals. This is an ongoing QI project tracking the 30-day readmission rate with the implementation of a bundle intervention approach.
Abstract 4146967: The Effects of Physical Activity Levels on Body Composition, Exercise Performance, Single Ventricle Function and Self-Perceived Quality of Life in Children and Adolescents with a Fontan Circulation.
Authors: Li Yen Ng, Colin McMahon, Adam James
Journal: Circulation (2024)

Objectives: Physically active lifestyles are important for patients with congenital heart disease, including Fontan. This study aims to establish the effect of an active lifestyle in paediatric Fontan patients, determine its relationship with body composition, exercise capacity, ventricle function and quality of life. Methods: 30 Fontan patients were recruited. Mean age of 14.8±2 years. Cardiopulmonary exercise tests, bio-impedance analyser, echocardiography and PedsQL questionnaires, generic (V4.0) and cardiac modules (V3.0) were performed. Physical activity level includes structured sports participation, daily stepcounts, and active-zone-minute, AZM (minute spend doing activity ≥ moderate intensity) measured by accelerometer (Fitbit Inspire3). Patients were considered active if they met 2 of the 3 criteria: 1/ Structured sports training ≥ 2 per week (moderate-vigorous intensity &gt;30 minutes) 2/ Daily steps ≥ 10k 3/ AZM ≥ 60 minutes per day Results: 60% of patients were considered active, predominantly male, mean age of 14.1 years old. Overall BMI was normal, however 17% (5 of 30) were overweight or obese (Table 1). The less active Fontan had higher fat% (24.8±8.7 vs 16.6±5.2%; p=0.003), lower percentage appendicular skeletal muscle mass, SMMa%(29.8±3.6 vs 33.7±3.1%; p=0.004), and muscle to fat ratio, MFR (1.4±0.8 vs 2.3±0.9; p=0.015). The less active group had lower peak oxygen consumption, VO 2peak (23.5±7.2mL/kg/min vs 35.1±3.96mL/kg/min; p &lt; 0.001), lower peak oxygen pulse (7.9±1.2 vs 10.01±2.9) ml/beat; (p=0.024). No statistical significant differences observed in the ventricle function. Higher self-report PedQL V4.0 scores noted in the active group, indicated better HRQOL (child’s QOL 88.26±8.6 vs 72.89±17.2%; p=0.003 and parent’s QOL 87.22±10.8 vs 71.6±23.4%; p=0.020). Higher physical activity level is associated with lower body fat% (r=– 0.521, p=0.003), greater SMMA% (r=0.513, p=0.004), higher peak and submaximal VO2, [VO2/kg peak (r=0.787, p &lt; 0.001) VO2 at ventilatory threshold 1, VT1 (r=0.451, p=0.012)], peak O2pulse (r=0.411, p=0.024), and importantly, higher HRQOL reported [child’s QOL V4.0 (r=0.524,p=0.003), parent’s QOL V4.0 (r=0.423, p=0.020)]. Conclusions: Higher physical activity levels in paediatric Fontan patients are associated with normal skeletal muscle mass, higher exercise capacity and better HRQOL. Conversely, lower physical activity levels are associated with skeletal muscle mass deficit, increased adiposity and reduced exercise capacity.
Abstract 4146974: Left Atrial Reservoir Phase Duration: A Novel Marker of Diastolic Function and Successful Cardiac Resynchronization Therapy
Authors: Lars-Egil Hammersboen, John Aalen, Alexis Puvrez, Camilla Larsen, Espen Remme, Erik Kongsgaard, Jurgen Duchenne, Elena Galli, Faraz Khan, Ole Jakob Sletten, Martin Penicka, Erwan Donal, Jens-Uwe Voigt, Otto Smiseth, Marie Stugaard
Journal: Circulation (2024)

Background: During left bundle branch block (LBBB), tachycardia causes marked elevation of left ventricular (LV) filling pressures due to insufficient time for LV relaxation. Cardiac resynchronization therapy (CRT) may reduce pulmonary congestion during exercise by facilitating more time for LV filling, thereby reducing the need for increased left atrial (LA) pressures to accelerate blood into the LV. Purpose: Investigate if successful CRT increases LV filling time and if this is reflected in shorter LA reservoir phase duration. Methods: In a multicenter study of 168 patients, LA and LV global strain was measured by speckle-tracking echocardiography before and 7 ± 1 months after CRT. LA reservoir phase duration was measured from onset shortening in the LV to peak global LA strain, and LV filling time from mitral valve opening to closure. A volumetric response was defined as ≥ 15% decrease in LV end-systolic volume at follow-up. Results: The patient in Figure 1 exemplifies LV/LA mechanical interactions in a volumetric responder. In the LV, resynchronization increases filling time (four areas shaded in gray in Figure 1). This is mirrored in the LA, where resynchronization reduces LA reservoir phase duration (white arrows, upper panels). In all responders, resynchronization was associated with increased LV filling time (p&lt;0.0001) and decreased LA reservoir phase duration (p&lt;0.0001), regardless of heart rate (Figure 2). Reduction in LA reservoir phase duration correlated with a reduction in LV filling time (β=–0.302, p&lt;0.0001 corrected for change in heart rate). These improvements in filling dynamics were not observed in non-responders. Conclusions: LA reservoir phase duration mirrors LV filling time and may be an important diastolic marker of successful CRT.
Abstract 4146853: Factors Associated with Recovery of Right Ventricular Size After Transcatheter Device Closure of Isolated Atrial Septal Defects in Children
Authors: Michael Gritti, Brian McCrindle, Lee Benson
Journal: Circulation (2024)

Introduction: Children with significant left-to-right shunting across an isolated atrial septal defect (ASD) may have important right ventricular (RV) dilation. We sought to determine factors associated with RV recovery after percutaneous device closure. Methods: Children who underwent transcatheter device closure of an isolated ASD were included if they had no underlying genetic defect and echocardiography from prior to, immediately after and at follow-up. General linear regression modeling was used to determine factors associated with time-related RV dimensional recovery. Results: Inclusion criteria were met for 385 children (62% females; mean age 8.9 + 4.3 years) whose procedure occurred from 11/1985 to 11/2012. A single defect was present for 85%, with a mean size indexed to BSA of 14.9 + 6.6 mm/m 2 . A single device (Amplatzer for 80%) was used for 97% of the children, with a mild residual shunt present in 14% at the procedure. Mean BSA-indexed RV end-diastolic dimension (RVEDD) immediately post-closure was 2.20 + 0.66 cm/m 2 and decreased at a median follow-up of 1.8 years (range up to 13 years) to 1.71 + 0.48 cm/m 2 (p&lt;0.001), corresponding to a mean BSA-adjusted Z score of +1.51 at follow-up (&gt;+2 for 47% of children). Significant factors associated with a greater reduction in BSA-indexed RV size ( Figure ) included younger age at closure (p&lt;0.001), larger indexed ASD size (p&lt;0.001), greater RV size at closure (p&lt;0.001) and longer follow-up time (p&lt;0.001). Reduction was not associated with the presence of any residual shunt post-closure. QRS duration on ECG did not change significantly from pre-closure (mean 90 + 12 mmsec) to latest ECG (mean 89 + 12; p=035). Conclusions: Despite progressive reductions in RV size after ASD device closure, some children may continue to have RV enlargement. Earlier closure is associated with greater improvements.
Abstract 4147066: Octacosanol Reduces Lipopolysaccharide Induced Loss of Cellular Integrity of Primary Human Aorta Endothelial Cells
Authors: Jingrong Tang, Diego Lucero, Wenling Li, Huaitian Liu, Hairui Xie, Julia Kun, Denis Sviridov, Zhihong Yang, Yosuke Mukoyama, Alan Remaley
Journal: Circulation (2024)

Atherosclerosis, a complex process involving chronic systemic inflammation, endothelial dysfunction, retention of lipoproteins, plaque formation in large and medium-sized arteries, is one of the most common causes of morbidity and mortality. Octacosanol, a very long chain saturated (C28) aliphatic alcohol is a major active ingredient in the Policosanol, which is extracted from plants like sugar cane and wheat germ. Policosanol has been proposed as dietary supplement for obesity and for lowering serum lipids. Previous animal studies have shown that both Policosanol and Octacosanol can significantly ameliorate formation of atherosclerotic lesions. To further explore the possible mechanism of Octacosanol on the formation of atherosclerosis, we examined the anti-inflammatory effects of Octacosanol on HAEC treated with LPS at 100ng/ml FBS-free cell culture medium. LPS treatment significantly enhanced human monocyte (THP1) adherence to HAEC cells in time-dependent and dose-dependent style, but Octacosanol at 1.25 or 2.5 µM markedly blocked the adhesion of THP1 to HAEC. ELISA showed that LPS can significantly increase the expression of pro-inflammatory cytokines and adhesion molecules by HAEC at 100ng/ml within 4 hours. LPS stimulated more than 3-fold the release of IL-6, IL-8, MCP-1 at 4 hours. By flow cytometry and ELISA, LPS markedly increased the expression of PE-Selectin and VCAM-1. Pretreatment of HAEC with Octacosanol (1.25µM or 2.5µM) significantly reduced the release of inflammatory cytokines, such as MCP-1(p&lt;0.01), IL-6 (p&lt;0.001) and IL-8(P&lt;0.001)&gt; It also inhibited the expression of PE-selectin(p&lt;0.001) and VCAM-1(P&lt;0.001). By QRT-PCR analysis, Octacosanol reduced the transcription of TRAF-6, MYD88 which are associated with LPS triggered TLR-4 involved pro-inflammatory pathway. Confocal imaging analysis of HAEC cells also confirmed Octacosanol the inhibition of the expression of PE-Selectin and VCAM-1 and VE-Cadherin, leading to the maintenance of cell membrane integrity and underlying ECM and the prevention of THP1 cell adherence. A test of HAEC cell membrane permeability using fluorescent intensity of FITC-Dextran (40kD) showed that Octacosanol can significantly improve cell integrity to damage induced by LPS at 100ng/ml for 4 hours. In summary, Octacosanol appears to have multiple potential beneficial functions related to endothelial cell integrity, which could explain its anti-atherogenic properties observed in animal studies.
Abstract 4147105: Risk Factors Associated with Non-Pulmonary Vein Triggers at First-Time Atrial Fibrillation Ablation
Authors: Alireza Oraii, Corentin Chaumont, Oriol Rodriguez-Queralto, Michal Wasiak, Carli Peters, Erica Zado, Matthew Hyman, Timothy Markman, Gustavo Guandalini, Gregory Supple, David Lin, Sanjay Dixit, Saman Nazarian, David Frankel, David Callans, Francis Marchlinski
Journal: Circulation (2024)

Background: The majority of non-pulmonary vein (PV) triggers of atrial fibrillation (AF) require provocative maneuvers for induction during catheter ablation. Identifying a subset of patients with higher likelihood of having non-PV triggers can guide more efficient use of these provocative maneuvers. Objective: This study aims to identify pre-procedural risk factors for the presence of non-PV triggers at first-time AF ablation. Methods: We included patients who underwent first-time AF ablation between 2019 and 2022 at the Hospital of the University of Pennsylvania. Non-PV trigger provocation maneuvers included cardioversion of AF if present at baseline, incremental isoproterenol (ISO) infusion (3-30mcg/min), and atrial burst pacing to induce focal atrial tachycardia (AT) or induce AF followed by cardioversion on 3-6mcg/min ISO or during high dose ISO washout. Non-PV triggers were defined as non-PV ectopic beats initiating AF or sustained focal AT. We used logistic regression analysis to identify pre-procedural risk factors associated with the presence of non-PV triggers. Risk factors with univariable p-value &lt;0.2 were entered in a multivariable model. Results: Of 1805 patients with first-time AF ablation, 1701 (94.2%) patients that received non-PV trigger provocative maneuvers were included. A total of 146 (8.6%) patients were found to have non-PV triggers. The prevalence of non-PV triggers was numerically higher in patients with persistent AF than those with paroxysmal AF (9.7% vs 7.7%, p-value=0.163). In the multivariable model, female sex (OR=2.18, 95% CI: 1.49-3.17), cardiac sarcoidosis/amyloidosis (OR=7.29, 95% CI: 2.90-18.31), prior cardiac surgery (OR=2.30, 95% CI: 1.37-3.85), and moderate to severe left atrial enlargement on echocardiography (OR=2.66, 95% CI: 1.83-3.85) were independent predictors of non-PV triggers during first-time AF ablation. Conclusion: Non-PV triggers are present in approximately 10% of patients undergoing first-time AF ablation. A set of pre-procedural risk factors can risk stratify patients at high risk for non-PV triggers and guide choice of optimal ablation strategy at first procedure.
Abstract 4146844: Characterization of Novel Cardiovascular Medication Use by Clinical Specialty After Admission for Heart Failure or Coronary Artery Disease
Authors: Taufiq Salahuddin, Christine Chow, Annika Hebbe, Carol Simons, Christian Helfrich, Jacob Doll
Journal: Circulation (2024)

Background: Angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have well-established benefit for patients with heart failure (HF) or coronary artery disease with type 2 diabetes (CAD+T2D), but use remains low. We aimed to characterize post-hospitalization use of these novel medications by provider specialty in the Veterans Health Administration (VA). Methods: Using VA health record and administrative data, two patient cohorts were retrospectively identified with hospitalization from 2017-2023 for either HF or CAD+T2D. Provider-level encounter data and outpatient prescriptions within 6 months of discharge were assessed for ARNI and SGLT2i for HF and SGTL2i or GLP-1 RA for CAD+T2D among primary care, cardiology, endocrinology, and nephrology providers. Medication utilization was counted equally for providers seeing the same patient, regardless of which provider initiated the prescription. Descriptive statistics were used to characterize frequency and proportions of novel medication use by specialty in 4 categories with respect to hospital discharge: 1) only before, 2) continued, 3) new start, or 4) untreated. Results: There were 215,816 patient-provider encounters in the HF cohort and 171,540 encounters in the CAD+T2D cohort. Cardiology providers had the highest rate (11.9%) and largest number (n=11,397) of new starts for ARNI. For SGLT2i for HF, endocrinology had the highest rate (12.9%) but the smallest number (n=794) of new starts. For SGTL2i or GLP-1 RA for CAD+T2D, endocrinology had the highest rate (13.8%), but primary care had the highest number (n=7,426) of new starts. In total, 10% of visits had a new start while &gt;70% of patients were untreated with novel medication classes. Conclusion: Most post-hospitalization care for HF and CAD+T2D was provided by primary care and cardiology. Cardiologists and endocrinologists were most likely to use novel cardiovascular medications, but endocrinologists accounted for a small proportion of total HF and CAD care. Future work should focus on implementation strategies to address the large opportunity for improvement in guideline-concordant care across all specialties.
Abstract 4147241: Association of angiogenic biomarkers in the third trimester of pregnancy with future body mass index trajectories
Authors: Maria Pabon, David Cantonwine, Brian Claggett, Tooba Anwer, MARCELO DI CARLI, Scott Solomon, Thomas McElrath, Michael Honigberg
Journal: Circulation (2024)

Background: Prior studies suggest that angiogenic markers measured during pregnancy may be associated with higher future systolic blood pressure. Furthermore, prior work suggests postpartum body mass index (BMI) influences progression to chronic hypertension among women who experience hypertensive disorders of pregnancy. However, no studies to date have investigated the relationship between levels of angiogenic markers during pregnancy and the future development of obesity among non-obese pregnant women. Methods: We included participants in a longitudinal pregnancy biorepository at Brigham and Women’s Hospital (Boston, MA) who had available levels of sFlt-1 (soluble fms-like tyrosine kinase receptor-1) and PlGF (placental growth factor) measured in the third trimester and who continued to follow with primary care in one of the Mass General Brigham institutions up to December 2019, with available covariate and outcome data. We excluded participants with a pre-pregnancy history of obesity (BMI ≥30 kg/m 2 ). The ratio of sFlt-1/PlGF in the third trimester was examined by tertiles. Adjusted mixed effects models were used to test group differences in BMI trends during follow-up. Results: Among 590 participants included, the mean (SD) first-trimester BMI was 24 (3) kg/m 2 , and the mean age at delivery was 32 (6) years. Maternal age at delivery and first-trimester BMI were similar across sFlt-1/PlGF tertiles, but participants in the higher tertiles tended to have a slightly lower gestational age at delivery ( Table 1 ). During a median follow-up of 9 years, 173 participants (29%) developed obesity during follow-up. Participants in the second and third tertiles had steeper increases in BMI (+0.22 and +0.24 kg/m 2 , respectively) compared to those in the first tertile (+0.18 kg/m 2 ; p&lt;0.001 for both comparisons) after adjustment for first trimester BMI, race and parity. Conclusions: Among participants without a history of pre-pregnancy obesity, higher levels of third-trimester sFlt-1/PlGF ratio were associated with higher BMI during follow-up. Angiogenic marker levels during pregnancy, which are now available and used clinically, may enable opportunistic risk stratification for future cardiometabolic disease.
Abstract 4147331: Myeloid-specific Leptin Signaling Links Insulin Resistance to Salt-Sensitive Hypertension
Authors: Treiy Tinich, Ashley Mutchler, Mert Demirci, Annet Kirabo
Journal: Circulation (2024)

Background: Salt-sensitivity of blood pressure (SSBP) has been shown to correlate with insulin resistance, metabolic syndrome, and cardiovascular mortality. Hypertension can often be seen in settings of obesity, leptin resistance, and insulin resistance, though the exact mechanistic interaction of these conditions has yet to be elucidated. Inhibition of the mammalian target of rapamycin (mTOR), a major regulator of both insulin and leptin pathways, promotes symptoms of metabolic syndrome. We have previously shown high sodium environments activate antigen presenting cells (APCs) towards an inflammatory phenotype contributing to the pathogenesis of SSBP. In this study, we investigated whether in vitro and in vivo high sodium exposure affect leptin and insulin signaling in human monocytes. Methods: SSBP was assessed using a modified Weinberger salt-loading and depletion protocol (age was 49.25±1.98, 80% male, screening SBP/DBP was 137.3±4/88.2±2.9). Single cell sequencing was performed on circulating immune cells. In additional experiments, bulk RNA sequencing was performed on monocytes isolated from 11 healthy individuals and were treated i n vitro with either normal sodium (150mM) or high sodium(190mM). We analyzed the RNA sequence data and cross-referenced these results with a comprehensive list of genes associated with insulin and leptin signaling using the NIH Gene database and the Harmonizome 3.0 database from Ma’ayan laboratory at Icahn School of Medicine. Pearson correlation was used to analyze the associations. Salt sensitivity index (SSI) is the difference in SL versus SD systolic blood pressure. Results: We found an overall downregulation of both insulin and leptin signaling genes. Of note, there was a significant downregulation of genes for leptin (log2FC=-2.5; padj&lt;0.0001), leptin receptor (log2FC=-0.53; padj=0.002), insulin receptor (log2FC=-0.36, padj=0.007), and glucose transporter 1 (log2FC=-0.74; padj=0.001). Although mTOR was not significant (log2FC=-0.07; padj=0.69), proline-rich AKT1 substrate 1, a direct inhibitor of mTOR activity, (log2FC=0.71; padj&lt;0.001), was significantly upregulated. Furthermore, we found an inverse correlation between DAKT1S1 and SSI (r=-0.93; p=0.008). Conclusions: Our findings suggest that high salt exposed monocytes have impaired leptin and insulin signaling, which may be a factor to promote insulin and leptin resistance contributing to the development of metabolic syndrome in salt-sensitive hypertension.