tbuckley/cabot-search huggingface dataset:
Abstract 18200: Prognostic Importance of Serial NT-proBNP Measurements Following High-Risk Mi: The PARADISE-MI Trial
Authors: Karola Jering, Brian Claggett, Marc A Pfeffer, Christopher Granger, Lars Kober, Eldrin F Lewis, Aldo Pietro Maggioni, Douglas Mann, John J McMurray, Margaret PRESCOTT, Jean L Rouleau, Scott Solomon, Philippe G Steg, Dirk von Lewinski, Eugene Braunwald
Journal: Circulation (2023)

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a potent predictor of heart failure (HF) and death following myocardial infarction (MI). NT-proBNP levels change post MI. Hypothesis: Serial measurements of NT-proBNP add prognostic information. Aims: To investigate the prognostic importance of NT-proBNP two weeks after MI in PARADISE-MI and to identify predictors of week 2 NT-proBNP. Methods: Patients with MI and LVEF ≤40% and/or pulmonary congestion (n=5661) were randomized to sacubitril/valsartan or ramipril. Patients with NT-proBNP measured at week 2 (n=1057) were analyzed. Associations of week 2 NT-proBNP with subsequent clinical outcomes were evaluated with Cox models adjusted for baseline NT-proBNP, age, sex, atrial fibrillation (AF), LVEF, STEMI presentation, BMI, eGFR, high-sensitivity troponin T (hs-cTnT), time from presentation to randomization and treatment assignment. Results: Median NT-proBNP was 1425 [685, 2598] ng/L at week 2, declining 23% (95% CI, 20-26%) from baseline. Patients in the highest NT-proBNP quartile at week 2 (≥2616 ng/L) were older, had lower LVEF and eGFR, higher Killip class, more AF, and higher baseline NT-proBNP (all p≤0.05). Higher NT-proBNP at week 2 was independently associated with greater risk of CV death or incident HF (adjusted HR [aHR] 1.62 per log2; 95% CI, 1.30-2.03), HF hospitalization (aHR 1.96; 95% CI, 1.46-2.62) and all-cause death (aHR 1.86; 95% CI, 1.40-2.47). Higher baseline NT-proBNP and hs-cTnT, longer interval between presentation and randomization and female sex were associated with higher week 2 NT-proBNP levels while sacubitril/valsartan was associated with lower levels (Table). Conclusions: Patients with elevated NT-proBNP two weeks after high-risk MI are at greater risk of subsequent death or incident HF, even after adjusting for baseline level. Higher baseline NT-proBNP and hs-cTnT are predictive of higher week 2 NT-proBNP while sacubitril/valsartan decreases levels.
Abstract 14702: Roles of Atrial Mass Reduction and Gaps on the Anti-Atrial Fibrillatory Effects of Pulmonary Vein Isolation: A Computational Modeling Study
Authors: Taehyun Hwang, Ze Jin, Daehoon Kim, BYOUNGHYUN LIM, Oh-Seok Kwon, Je Park, Hee Tae Yu, Tae-Hoon Kim, Jae-sun Uhm, BOYOUNG JOUNG, Moon Hyoung LEE, Hui-Nam Pak
Journal: Circulation (2023)

Background: Although pulmonary vein isolation (PVI) is the basis of atrial fibrillation (AF) catheter ablation (AFCA), the conditional changes of an anti-AF effect and the wave-dynamic mechanism are poorly understood. Therefore, we compared the effects of PVI based on the ablation circumference, width, and number or locations of gaps with or without amiodarone at the same condition in realistic computational modeling of human AF. Hypothesis: An anatomical level of PVI and characteristics of the PVI gap would affect the anti-AF effects of the AFCA. Methods: We included 50 patients (76.0% persistent AF) who underwent AFCA. Realistic AF modeling reflecting the computed tomography (CT) and the electroanatomical map was performed on each patient. We compared the AF defragmentation rate (DeFR; change to atrial tachycardia (AT) or termination), termination rate (TnR), and changes in the dominant frequency (DF) and the number of phase singularities (PSs) based on the PVI level (antral vs. ostial), PVI width (single vs. 3х width), number and location of 2-mm PVI gaps with or without amiodarone (10mM). We randomly assigned the number and location of the PVI gaps to the AF models. Results: The antral PVI had a significantly higher DeFR (p for trend &lt;0.001) and TnR (p for trend &lt;0.001) than the ostial PVI, PVI gaps, or baseline AF. However, there was no difference depending on PVI width. Among the PVI gaps, the DeFR (p for trend&lt;0.001) decreased as the gap number increased. Additional amiodarone increased DeFR (p=0.003) and TnR (p=0.034) and reduced DF (p&lt;0.001) and the number of PSs (p&lt;0.001) with PVI-gap, especially with a single PVI-gap. Conclusions: In this realistic computational modeling study with integrated patients’ atrial anatomy and electrophysiology, the atrial mass reduction depending on the anatomical PVI level, number of PVI gaps, and additional antiarrhythmic drug significantly affected the AF maintenance mechanisms.
Abstract 290: Initial Engagement in a Novel Online Support Community for Cardiac Arrest Survivors, Co-Survivors, Lay Rescuers, and Advocates
Authors: Mary M Newman, Alex Presciutti, Joe Farrell, Joshua Lupton, Stephen Sanko, Sarah Perman
Journal: Circulation (2023)

Background: Cardiac arrest survivors often experience physical, cognitive, emotional, and social challenges that can linger for years. Co-survivors and lay rescuers can also experience distress. In 2023, Sudden Cardiac Arrest Foundation (SCAF) created the Cardiac Arrest Survivor Alliance™ (CASA), an online community to support these individuals. CASA offers evidence-based information about common challenges post-arrest, easy connection with peers, access to experts, and pathways to further clinical support. To measure early dissemination, we examined CASA’s community engagement and growth through the first 5 months. Methods: We built CASA using Mighty Networks (MN), assembled a leadership team including researchers and clinicians with expertise in post-resuscitation quality of life, and launched the community in mid-January 2023. We recruited members through SCAF’s Survivor Network and outreach via its website, newsletters, and social media. We obtained analytic reports to evaluate engagement and growth of CASA during the first 5 months of operation. Results: By mid-June 2023, there were 868 members from the U.S. and 21 other countries. Based on preliminary data, approximately 75% of members are survivors. Initial growth resulted from SCAF outreach and is continuing organically through internet searches and member outreach. During the 5-month period, there were: 6,829 contributions (sum of actions taken by hosts, moderators and members including posts, “cheers,” comments, chat messages, direct [private] messages [DMs], and RSVPs), 858 active members (total members who visited during the 5-month period), and 376 unique members providing contributions. Members are not only engaging publicly, but also privately; 344 members (40%) have sent 1,944 DMs. MN considers communities to be successful if 15% or more members send DMs. CASA also provides monthly webinars with guided discussions led by experts. Attendance has ranged from 22 to 47 participants. Conclusion: In the 5 months since its launch, the CASA community is engaged and continually growing. Future plans include providing additional evidence-based content, outreach to hospitals and targeted healthcare professionals, and collaboration with program partners to grow the CASA community.
Abstract 18042: Induction of Cardiac Reprogramming Following Injury Through Delivery of a Single Factor, PHF7
Authors: Glynnis A Garry, Matthieu Dos Santos, Wei Tan, Kenian Chen, Svetlana Bezprozvannaya, Ning Liu, Rhonda S Bassel-Duby, Eric N Olson
Journal: Circulation (2023)

Direct reprogramming of resident cardiac fibroblasts into cardiomyocytes is an attractive strategy to restore cardiac function following myocardial infarction (MI). However, canonical and extensively studied reprogramming factors (e.g. Gata4, Mef2c, Tbx5) have shown to be ineffective in reprogramming adult human fibroblasts. Furthermore, current human cocktails require an excess of factors, limiting the clinical translation and safety of this technology. Recently, we undertook a large screen of gene regulatory factors and identified the epigenetic factor PHF7 as the most potent activating factor of adult human fibroblast reprogramming, and described its ability to bind and modify chromatin accessibility at cardiac super enhancers. In this manuscript, we describe the ability of PHF7 to activate adult reprogramming in vitro in absence of canonical reprogramming factors, with PHF7, MEF2C, and TBX5 (PMT) or PHF7 and TBX5 (PT) alone. These minimalist PHF7 cocktails induced broad and unique cardiac transcriptomes in comparison to canonical cocktails. Importantly, when overexpressed in isolation in fibroblasts, PHF7 strongly activated expression of several cardiac transcription factors, establishing its role as a cardiac master regulator. When delivered to the mouse heart following MI, minimalist PHF7 cocktails were found to significantly recover cardiac function and decrease fibrotic scar formation. Interestingly, delivery of PHF7 alone following MI was sufficient to improve cardiac function and induce remodeling through activation of bona fide reprogramming events in vivo as determined by genetic tracing of the Postn MCM lineage. Here, we report for the first time the ability of a single reprogramming factor, PHF7, to induce fibroblast to cardiomyocyte reprogramming and recover cardiac function following injury in vivo.
Abstract 13914: Development of a High School Mentorship and Scholarship Program to Promote Interest in Healthcare Among Students Underrepresented in Medicine
Authors: Kirsten Shaw, Christine Schmidt, Kate Richards-May, David M Tierney
Journal: Circulation (2023)

Introduction: Despite the rising demand, positive career outlooks, and promising salary in healthcare professions, youth from underrepresented backgrounds continue to be poorly represented in these careers. Mentorship has emerged as a strategy to enhance the involvement of underrepresented youth in healthcare careers, serving as one of the few effective approaches to address this disparity. Aims: The aim of this study was to develop practical recommendations for founding, growing, and sustaining a mentorship and scholarship program between a physician group and a racially, ethnically, and socioeconomically diverse local high school. Methods: Each year, six events were hosted for high school students interested in healthcare. Events included hands-on activities, networking events, career panel discussions, and field trips to our simulation center. Following 2 years of successful program execution, a modified mini-Delphi approach was used to develop formal recommendations for founding, growing, and sustaining such a program. Results: On an observational basis, the mentorship program appeared effective at growing high school student interest in healthcare careers. Utilizing a modified mini-Delphi method, we created recommendations for the development of a healthcare mentorship and scholarship program. These recommendations are shown in Figure 1. Conclusions: These recommendations may serve as a guide for other programs that wish to establish similar programs. All our self-developed curricula, grant proposals, and marketing materials will be freely shared with any group wishing to develop a similar program.
Abstract 13447: Political Orientation of Online Media Sources and Reporting of COVID-19 Vaccine Myocarditis
Authors: Muzna Hussain, Addison Matsumura, Ria Garg, Martin E Matsumura
Journal: Circulation (2023)

Background: Political orientation has played a role in patients' perceptions of risk associated with COVID-19 vaccination, including COVID-19 vaccine myocarditis (CVM). We examined the relationship between political orientation of popular online media outlets and reporting of CVM. Methods: Media sites were classified as “left” or “right" biased using the Allsides media bias rating report. For each site “COVID vaccine myocarditis” was searched in articles posted 5/21-12/22. Each search return was reviewed for the following: 1) Did it contain numerical data or reference the source of numerical data regarding CVM risk? 2) Did it report benefits of covid vaccination? 3) Did it mention covid infection -related myocarditis? Monthly reports of vaccine-related adverse events were obtained directly from the Vaccine Adverse Events Reporting System (VAERS). Correlations of reports of left- vs. right-leaning media were performed using Pearson Product Moment Correlation. Results: A total of 520 unique online reports regarding CVM were reviewed. Comparison of report volumes from left vs. right biased media sources by month during the assessment period demonstrated modest correlation (r=0.546, p=0.013), suggesting that monthly reporting volumes were driven by availability of information regarding CVM rather than media political alignment. Peak reporting across both left and right biased media was temporally proximate to peak volume of VAERS reporting. Left biased media sources were significantly more likely to include numerical data and/or links to source data vs. right biased sources (76.6% vs. 24.3%, p&lt;0.001) and likewise were more likely to include data supporting benefits of covid vaccination (85.1% vs. 21.7%. p&lt;0.001). In contrast, there was no difference regarding mention of COVID-19 infection-related myocarditis (24.5% vs. 24.3%, p=0.957). Conclusion: Political orientation of online news sites was not associated with frequency of CVM reports but was significantly related to report content, most notably whether reports included numerical vs verbal representations of CVM risk. These bias-related reporting characteristics may contribute to the relationship between political orientation and patient understanding of risk of CVM.
Abstract 13226: Young Infants With Symptomatic Tetralogy of Fallot: Superior Survival With Staged Repair
Authors: Xin Tao Ye, Soichiro Henmi, Edward Buratto, Mitchell Haverty, Can Yerebakan, Christian Brizard, Yves d'Udekem, Igor Konstantinov
Journal: Circulation (2023)

Background: The optimal strategy to treat symptomatic young infants with tetralogy of Fallot (TOF) is unclear. Objective: We performed a balanced comparison of staged repair (SR) vs. primary repair (PR) at two institutions that have exclusively adopted each strategy. Methods: Between 1993 and 2021, 143 consecutive infants under 4 months of age underwent systemic-to-pulmonary shunt at the Royal Children’s Hospital, Melbourne, Australia. These were compared with 122 consecutive infants in the same age group who underwent PR between 2004 and 2018 at the Children’s National Hospital, Washington, D.C. The primary outcome was mortality. Secondary outcomes were component and cumulative hospital stay, durations of perioperative support, hospital complications, and early and late reinterventions. Propensity-score matching was performed for risk adjustment. Mean follow-up was 9.3 years. Results: In the unmatched comparison, the SR cohort was younger, more commonly on prostaglandin infusion and mechanical ventilation, more likely to require urgent procedures, and had lower weight and smaller pulmonary annulus size. Hospital mortality after initial procedure (SR: 2.8% [4/143] vs. PR: 2.5% [3/122]; p = 0.86) and 10-year survival (SR: 95% [95% confidence interval (CI): 90 - 98%] vs. PR: 90% [95% CI: 81 - 95%]; p = 0.65) were similar. Hazard of reinterventions favored the PR group during early (&lt;6 months) follow-up (hazard ratio: 0.22; 95% CI: 0.11 - 0.48; p &lt; 0.001) but was similar at late follow-up. Most secondary outcomes cumulatively favored the PR group. Among 57 propensity-score matched pairs, the SR group had superior survival at 10 years (98% [95% CI: 88 - 99.8%] vs. 85% [95% CI: 69 - 93%]; p = 0.02). Conclusions: In this two-institutional, propensity-score matched comparison of SR vs. PR in symptomatic young infants with TOF, the SR strategy was associated with superior long-term survival and equivalent late reinterventions, at a cost of increased early reinterventions.
Abstract 13253: Remotely-Controlled Cantilevered Cardiac Shim Coil (CSS) Corrects Cardiac MRI Magnetic-Field Inhomogeneities Due to Implanted Cardioverter Defibrillators (ICDs): Preclinical Validation
Authors: Mirko Hrovat, Yifan Wang, Anthony Gunderman, Henry R Halperin, Yue Chen, Ehud J Schmidt, Aravindan Kolandaivelu
Journal: Circulation (2023)

Introduction: 1.4M people (US) have implanted ICDs, which reduce risk of sudden death due to ventricular arrhythmias. Cardiac MRI (cMR) is used in patients with ICDs to diagnose conditions that predispose to sudden death and to plan and guide ablation therapy. However, all ICDs contain a ferromagnetic transformer which imposes a large inhomogeneous (&gt;100 parts-per-million, ppm) magnetic field in sections of the heart, creating large image voids that can mask pathology, such as myocardial scar. Wide-band Late Gad. Enhancement (LGE) imaging has improved evaluation of ICD patients, handling &lt; 25ppm artifacts, leaving unreadable voids in ~30% of patients. Hypothesis: ICD artifacts can be reduced with a remotely-displaced cardiac shim system (CSS), allowing clinical CMR imaging. Methods: The CSS system (Fig. 1A- C). A shim coil, placed in the bore, was designed to correct 75ppm fields at 15cm distances, using currents supplied from the MRI operator room (OpRm). The coil is immune to magnetic forces. A cantilevered beam holds the shim coil over the patient’s chest above the cardiac imaging coil allowing unrestricted imaging. MR-conditional motors, remotely-controlled from the OpRm, allow 2mm-resolution 3D shim-coil positioning. Experiments : swine (N=3) with chest-overlaid ICDs, emulating patients, were imaged. Magnetic-field maps were used to estimate shim-coil positioning, and current magnitude &amp; polarity. Fine-tuning of location and current was performed during continuous 2D ECG-gated breath-held GRE/SSFP imaging. 2D/3D LGE cMR was subsequently acquired and evaluated. Results: CSS reduced field inhomogeneities due to implanted ICDs by 30ppm in 2D and 3D cMR sequences, correcting ICD-related image distortions in several heart regions (Fig. 1D, E). Conclusion: An externally-controlled shim-coil localization and drive system reduced artifacts without requiring entry into the scanner room, supporting efficient, higher quality cMR imaging of ICD patients.
Abstract 13525: Plateletcrit: A Novel Risk Predictor of Acute Myocardial Infarction
Authors: Samia P Tasneem
Journal: Circulation (2023)

Introduction: Platelets are crucial in the pathogenesis of acute coronary syndrome (ACS). Naïve platelets are larger in size and have higher thrombotic activity compared to smaller platelets. The plateletcrit (PCT), representing the total platelet mass, may emerge as a marker of prothrombotic state in ACS patient. Hypothesis: Increased PCT is associated with higher risk of acute MI in young patients (≤40 years). Aim: To find out PCT levels in young AMI patients. Methods: A hospital-based case-control study at Dhaka Medical College Hospital, Bangladesh were carried out. 50 young newly diagnosed AMI (both STEMI &amp; NSTEMI) patients presented to CCU and 50 age- and sex-matched healthy controls were studied. Platelet indices i.e., PCT, Mean platelet volume (MPV) and platelet count were measured upon admission. The correlation between PCT, clinical and laboratory parameters were examined with Pearson Spearman analysis. Multivariate logistic regression was used to evaluate the role of PCT in predicting AMI. Receiver operating characteristic (ROC) curve analysis was done to obtain the optimal cut off for significant variables. 95.0% confidence interval and p &lt;0.05 were considered statistically significant. Results: In AMI patients, the mean platelet count, mean PCT and mean MPV were 258 х 10 3 /μl, 0.30% and 11.09fl, respectively. In the control population, the mean platelet count, mean PCT and mean MPV were 245х10 3 /μl, 0.26% and 10.29 fl, respectively. PCT showed the most significant association with AMI with odds ratio 3.89, followed by an OR of 2.38 for MPV. PCT showed higher sensitivity and specificity (84.8% and 67.2%, respectively) in comparison to MPV (66% and 68%, respectively) ( p &lt;0.001 vs 0.003). There was a significant positive correlation between PCT and serum troponin-I level. Conclusion: Patients with higher PCT was at higher risk of AMI and myocardial damage. This routine inexpensive and readily available PCT may be of value as a complementary marker in early AMI.
Abstract 14262: Cancer - A Driver of Heart Failure in People With Diabetes
Authors: Joshua Wong, Dianna J Magliano, Lei Chen, Jedidiah I Morton, Jonathan E Shaw, Thomas H Marwick
Journal: Circulation (2023)

Introduction: Despite the risk of heart failure (HF) in the survivorship phase of some cancers, the risk is not high enough to justify HF screening. However, people with diabetes mellitus (DM) have an increased risk of both HF and cancer. Examining this at-risk population may allow for better understanding of the effect cancer has on the development of HF. Hypothesis: Among people with DM, HF is more common in those with than without prior cancer. Methods: Data from the Australian National Diabetes Services Scheme (NDSS; 1,114,356 DM, types 1 and 2) from 2010 to 2019, was linked with public hospital data, the National Death Index and national Pharmaceutical Benefits Scheme (PBS) database. People with cancer were identified by the prescription of chemotherapy agents on the PBS dataset or a hospital admission with cancer. Incident HF was detected via first hospitalisation with HF as the primary diagnosis or death due to HF. The model was adjusted for age and sex. Results: Of the total cohort (1,114,356 people with DM), 48,014 experienced HF during 6,663,046 person-years of follow up from 2010-2019. Specifically, of 175,656 people with DM and cancer, 8,464 experienced HF during 644,620 person-years of follow up. The HF incidence rate ratio (IRR) of people with DM and cancer was 1.63 (95%CI: 1.59-1.67), compared to people with DM but no cancer. Cancer admission alone had an IRR of 1.97 (1.90-2.05), with an IRR of 1.50 (1.46-1.54) in DM treated with chemotherapy with or without admission. Conclusion: Cancer diagnosis is associated with an increased incidence of HF among people with DM. The higher IRR of people with cancer admission alone supports the association of cancer with HF irrespective of chemotherapy. Further studies controlling for confounders of cardiovascular risk and refinements by age are required to justify grounds for HF screening.
Abstract 13756: The Role of Glucagon Like Peptide-1 Receptor Agonists on Major Adverse Cardiovascular Events in Patients With Type 2 Diabetes Mellitus and Chronic Heart Failure: A Meta-Analysis From Cardiovascular Outcome Trials
Authors: SHARATH KOMMU
Journal: Circulation (2023)

Introduction: Meta-analyses on glucagon-like peptide-1 (GLP-1) receptor agonists have shown beneficial effects in reducing major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus. However, it is unclear if they have similar beneficial effects in patients with type 2 diabetes mellitus and chronic heart failure. Methods: A search was performed on online databases - MEDLINE (via PubMed) and ClinicalTrials.gov, using the search words GLP-1 receptor agonist and cardiovascular outcomes. The references from the search results were also reviewed for potential studies that can be included. We identified four cardiovascular outcome studies with GLP-1 receptor agonists on patients with type 2 diabetes mellitus with data on patients with chronic heart failure, and included them in our meta-analysis. Results: 6189 patients were evaluated in this meta-analysis, with 3053 in the GLP-1 receptor agonist group and 3136 in the placebo group. Among them, 475 (15.56%) major adverse cardiovascular events (i.e., cardiovascular death, stroke, or myocardial infarction) occurred in the GLP-1 receptor agonist group and 536 events (17.09%) in the placebo group with a hazard ratio (HR) of 0.90, 95% confidence interval (CI) of 0.79 to 1.01 and a p-value of 0.08, indicating a favorable effect with GLP1 agonists though statistically not significant. Conclusion: In patients with type 2 diabetes mellitus and chronic heart failure, GLP-1 receptor agonists may have a favorable effect in reducing major adverse cardiovascular events, though statistically not significant.