tbuckley/cabot-search huggingface dataset:
Abstract 16375: Cardiovascular Risk Factors and Timing of Diagnosis Among Caregivers in the United States
Authors: Tracy T Makuvire, Zara Latif, Haider Warraich
Journal: Circulation (2023)

Introduction: The burden of family caregiving has been increasing in the US. However, caregiver burden may be associated with a higher risk of cardiovascular disease (CVD) among adults. Hypothesis: A higher caregiver burden is associated with an increased risk of CVD. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and March 2020, we conducted a cross-sectional analysis of US adults. We evaluated the prevalence of CVD, age at diagnosis, and treatment rates of caregivers and non-caregivers. The term "caregivers" refers to adults who reported that they had to stay at home to take care of their families. Outcomes included the average age at first diagnosis, rates of treatment, and average levels of hemoglobin A1c, cholesterol, and triglycerides. Descriptive and analytical statistics were generated using STATA. Results: Among the 15,560 US adults, 488 were identified as caregivers. Compared to non-caregivers, caregivers were, on average, older (43 vs. 33 years), more likely to be female (93% vs. 49%), Hispanic (34% vs. 22%), born outside the US (51% vs. 18%), and married (79% vs. 56%) (all p&lt;0.001). While there was no difference in hemoglobin A1c, triglyceride, and LDL-cholesterol levels, caregivers were more likely to self-report CVD risk factors at a younger age: diabetes mellitus (44 vs. 49 years), hypertension (42 vs. 47 years), heart failure (37 vs. 57 years), and stroke (42 vs. 57 years) (all p&lt;0.05). Caregivers were less likely to follow lifestyle modifications such as weight loss or taking cholesterol medications. Caregivers had greater odds of being diagnosed with CAD (3.9 [CI 1.7-8.8]), angina (4.4 [CI 1.4-13]), heart attack (4.8 [CI 2.0-12]), and stroke (2.0 [CI 1.2-3.6]). But this association was not significant after adjusting for age, gender, race, and college education. Conclusion: In this nationally representative sample study, 93% of caregivers were female and had CVD risk factors, such as diabetes and hypertension, detected at younger ages than non-caregivers. A high caregiver burden exposes patients to early CVD risk. As caregiver burden increases, early detection and treatment in this largely female patient population is crucial to reduce sex-related CVD disparities.
Abstract 13154: Impact of Age for Right Atrial Strain in Patients With Submassive Pulmonary Embolism
Authors: Yoshiyuki Orihara, Shunsuke Eguchi, Ayumi Eguchi, Michael Pfeiffer, Brandon Peterson, Mohammed Ruzieh, Zhaohui Gao, John Boehmer, John Gorcsan, Ryan Wilson
Journal: Circulation (2023)

Background: Submassive pulmonary embolisms (sPE) are common and carry significant mortality. Strain imaging presents a novel method of assessing right atrial (RA) function. However, there are less reports focused on the feature of RA strain in patients with sPE. This study examines whether RA strain has different cutoff values according to aging in patients with sPE. Method: We performed a retrospective cohort study of 221 patients with sPE. The primary outcome was 30-day all-cause mortality. RA strain was analyzed retrospectively using TOMTEC ®. All patients were divided into three age groups according to tertiles. Receiver operating characteristic (ROC) curves were performed for evaluation. Result: Median age was 65 years and 31 patients died within 30 days. Of 221 patients, 84 patients (38%) were elder group (70 ≤ age), 66 patients (30%) were middle-aged group (58 ≤ age ≤ 69), and 71 patients (32%) were young group (age &lt; 58). In all patients, statistical difference was observed in RA strain among the three groups (p = 0.042). ROC curve to predict 30-day mortality depicted area under the curve (AUC) and best cutoff value (BCV) were 0.688 and 27.7, respectively. (sensitivity [SE] 0.704, specificity [SP] 0.642) In elder group, ROC demonstrated AUC of 0.656 and BCV of 28.9 (SE 0.480, SP 0.889). In middle-aged group, ROC showed AUC of 0.647 and BCV of 27.7 (SE 0.636, SP 0.694). Interestingly, in young group, ROC demonstrated the lowest BCV of 17.4 with AUC of 0.75 (SE 0.571, SP 0.984) (Figure). Conclusion: RA strain as best cutoff shows different values among different age groups, especially low value in young groups. Further validation is needed to determine the role and utility of strain in patients with submassive PE.
Abstract 18981: Regional Variation in Inpatient Hospital Resources Utilized in Cardiac Surgery Performed in Children
Authors: Devyani Chowdhury, Kimberlee Gauvreau, Mishaal Ather, Darryl T Gray, Kathy J Jenkins
Journal: Circulation (2023)

Introduction: Care for congenital heart disease is highly resource-intensive due to its complexity, and due to patients’ need for surgery and other inpatient care. Understanding regional variation in resource utilization for cardiac surgical care can promote collaborative learning opportunities that could help optimize resources for patient-centered care. Methods: This cross-sectional analysis used the nationally representative 2012 Kids’ Inpatient Database, managed by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Based on International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, we identified hospital discharges of cardiac surgery patients under 18 years of age. We excluded patients undergoing cardiac transplantation and newborns under 31 days of age who only underwent ligation of isolated patent ductus arteriosus. Included cases were aggregated based on the nine US geographic divisions used by the US Census Bureau. Regional variation in observed inpatient billed charges, estimated hospital costs based on cost-to-charge ratios and inpatient length of stay (LOS) were analyzed. The log transformed outcomes were compared unadjusted, and after adjusting for RACHS-1 inpatient surgical mortality risk, admission type, expected primary payer and coded complications (as appropriate). Results: Among 15,350 analyzed discharges, the mean nationwide adjusted in-hospital mortality was 3%. It was highest in East South Central (5%). However, the differences among divisions were not significant for all RACHS-1 categories. Mean adjusted complications frequencies ranged from 21 to 32%.LOS showed only minor variations across divisions. Median billed hospital charges ranged from $93,869 to $226,061. For all RACHS-1 categories, New England (lowest) and East North Central had significantly lower charges than did the Mid-Atlantic division. Estimated costs were significantly lower than charges, ranging from $44,402 to $66,726 across all divisions. Costs were lowest in the Mid-Atlantic division. Conclusions: There is regional variation in resource utilization in cardiac surgical care for CHD with no observed correlation with LOS, case mix or complications.
Abstract 14362: The Columbia Score Predicts Incident Atrial Fibrillation and Flutter in Patients With Transthyretin Cardiac Amyloidosis
Authors: Nicholas Chan, Sergio Teruya, Alfonsina Mirabal, Jeffeny De Los Santos, Samantha Guadalupe, Carlos Rodriguez, Stephen Helmke, Margaret Cuomo, Dia Smiley, Angelo B Biviano, Jose Dizon, Elaine Y Wan, Hirad Yarmohammadi, mathew S Maurer
Journal: Circulation (2023)

Introduction: Atrial fibrillation/flutter (AF) is common in transthyretin cardiac amyloidosis (ATTR-CA). Given the high risk of systemic embolism, there is growing interest in the role of clinical scores for predicting new onset AF in affected patients to potentially guide early prevention of thromboembolic events. The CHARGE-AF scoring system was previously derived from the general population, but has not been validated in ATTR-CA. The Columbia staging system for ATTR-CA is prognostic for survival, but its utility in predicting incident AF is unknown. This study explored the incidence rate and risk scores for AF in ATTR-CA. Methods: This is a retrospective cohort study of 175 patients diagnosed with ATTR-CA who did not have any prior AF upon initial evaluation. We compared the baseline clinical characteristics of individuals with and without incident AF during subsequent follow-up. AF was ascertained based on review of electrocardiograms, continuous monitoring when available, device interrogations if applicable, and charted history. The Columbia score for amyloidosis staging was computed from: Gilmore stage + daily furosemide dose equivalents (0 points: 0 mg/kg, 1 point: between &gt;0 to 0.5 mg/kg, 2 points: &gt;0.5 to 1 mg/kg, 3 points: &gt;1 mg/kg) + NYHA functional class. Time to event analysis was performed via Cox proportional hazard modeling to determine the factors associated with incident AF. Results: New onset AF developed in 41% (n=71) of ATTR-CA patients, with a median follow-up of 2.0 years for the overall population. Compared to those without incident AF, more patients with incident AF were males (93.0% vs 78.8%); self-identified as white race (78.9% vs 61.5%); and reported NYHA II-IV symptoms (91.5% vs 78.8%); but were less frequently of Hispanic ethnicity (2.8% vs 10.6%) or had a genetic variant (25.4% vs 49.0%), all p&lt;0.05. On multivariable analysis, per point increase in Columbia score (HR 1.21, 95% CI 1.03-1.42, p=0.018) was associated with new onset AF, but gender, variant disease, CHARGE-AF, and left atrial volume index were not. Conclusions: About half of ATTR-CM patients developed incident AF during follow-up, which was predicted by the Columbia score, but not the CHARGE-AF score.
Abstract 18578: BMP9 Regulates Endothelial Expression of Mediators of Pulmonary Vascular Remodeling
Authors: Ying Zhong, Luca Troncone, Taylor Convington, Peiran B Yang, Lillian R Worst, Shreyas Rajesh, Ana Zeghibe, Elizabeth Shin, Megan McNeil, Stephanie S Kim, Geoffrey A D Bocobo, Robert Szulcek, Harm J Bogaard, Paul B Yu
Journal: Circulation (2023)

Background: Loss-of-function mutations in GDF2 /BMP9 are found in heritable pulmonary arterial hypertension (PAH), suggesting a protective role, while protective or pathogenic effects are found in experimental PAH studies depending on context. The net contribution of BMP9 in PAH thus remains controversial. Hypothesis: BMP9 regulates the secretome of pulmonary microvascular endothelium (PMVEC) to contribute to pulmonary artery smooth muscle cell (PASMC) phenotype modulation. Methods: We tested recombinant BMP9, BMP9/BMP10 trap ALK1-Fc, and BMP9 neutralizing antibody before and after development of pulmonary hypertension (PH) in distinct experimental models. We analyzed the impact of BMP9 on the PMVEC transcriptome, intersection with human and experimental PAH lung transcriptomes, and tested the impact of EC-derived genes on PASMC phenotype and growth. Results: ALK1-Fc and anti-BMP9 prevented or reversed experimental PH administered before or after onset of experimental PH. Recombinant disulfide-linked BMP9 was not protective in SUGEN/Hypoxia (SU-Hx)- or monocrotaline (MCT)-induced experimental PH, in contrast to previous studies using incompletely disulfide-linked BMP9, suggesting dissociated monomers might function as competitive BMP9 antagonists. Consistent with this interpretation, BMP9 upregulated PMVEC genes associated with pulmonary vascular remodeling in experimental and human PAH including CXCL12, IGFBP4, ET-1, VEGF-A, and PDGF-BB. Stimulation of PMVEC with BMP9 induced a contractile phenotype ( CNN1;TAGLN ) in co-cultured PASMC. Administration of ALK1-Fc or anti-BMP9 attenuated expression of several of these growth factors in SU-Hx PH. In experimental PH ALK1-Fc and ACTRIIA-Fc elicited peripheral edema, a phenotype associated with use of ALK1-Fc in human trials. Conclusions: BMP9 contributes to experimental PH by regulating expression of EC-derived molecules modulating PASMC growth and phenotype. In contrast to broad strategies that inhibit BMP9 and BMP10 associated with HHT mimicry in clinical trials and rodent PH models, treatment with anti-BMP9 was well-tolerated. Selective antagonism of BMP9 represents a potential therapeutic strategy for human PAH.
Abstract 18030: Periprocedural Outcomes of Percutaneous Coronary Interventions in Patients Admitted for Acute Myocardial Infarction and Concomitant COVID-19 Pneumonia: Insight From the National Inpatient Sample
Authors: Ufuk Vardar, Rohan Gajjar, IMRAN AZIZ, Naim Battikh, Aneeza Jamshed, Prajwal Shrestha, Sami J. Shoura, Aviral Vij
Journal: Circulation (2023)

Background: Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement for acute myocardial infarction (MI) is considered standard of care where a culprit lesion is identified. Coronavirus disease - 19 (COVID-19) pneumonia has been associated with a prothrombotic state, however its effects on periprocedural outcomes after PCI are unclear. We analyzed the peri-procedural outcomes in these patients who had concomitant COVID-19 pneumonia in the same hospitalization. Methods: A retrospective cohort study was conducted using the National Inpatient Sample from 2020. 300,840 hospitalizations were identified who underwent PCI and DES for acute MI. These were further stratified based on the presence of COVID-19 using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and analyze the variables. Results: Out of the 300,840 hospitalized patients who underwent PCI for acute MI, 3260 (1.1%) had COVID-19 pneumonia. In-hospital mortality was significantly higher in those with COVID-19 pneumonia (19.1% vs 3.4%; p&lt;0.001). Mean length of stay (LOS) and mean hospital charges (HC) were higher in the presence of COVID-19 (7.83 vs 3.81 days, p&lt;0.001 &amp; $188,533 vs $129,570, p&lt;0.001, respectively). Patients with COVID-19 pneumonia had higher rates of GI bleed (1.53% vs 0.07%, p=0.01), postoperative bleeds (7.0% vs 3.9%, p&lt; 0.001), intracranial hemorrhage (ICH) (0.77% vs 0.12%, p&lt;0.001), cardiac arrest (9.3% vs 3.7%, p&lt;0.001) and cardiogenic shock (12.5% vs 7.3%, p&lt;0.001). Conclusions: Patients who underwent PCI for acute MI and had COVID-19 pneumonia in the same hospitalization had significantly worse outcomes such as mortality, cardiogenic shock, cardiac arrest, postoperative bleeds, intracranial hemorrhage. While severity of COVID pneumonia likely accounts for these worse outcomes, the higher incidence of bleeding (GI, post procedure and intracranial) is concerning and needs further studies to evaluate further.
Abstract 15283: QRS Voltage in Precordial Leads Predicts Survival After Cardiac Resynchronization Therapy in Non-Left Bundle Branch Block Patients
Authors: Csilla-Andrea Apetrei, Teodora Avram, Adriana Daniela Sarb, Iulia Zehan, Madalina Moldovan, Pop Sorin, Gabriel Gusetu, Lorena Mocanu, Giorgia Coseriu, Andrada Burde, Patricia C Schiop-Tentea, Dan Blendea
Journal: Circulation (2023)

Introduction: The QRS complex reflects the summation of all instantaneous electrical forces during ventricular depolarization. In patients with intraventricular conduction abnormalities, whether left bundle branch block (LBBB) or non-LBBB, the propagation of the electrical wavefront is dyssynchronous and unopposed and is thereby associated with an increase in the QRS voltage in the precordial leads. Hypothesis: The aim of this study was to assess the impact of cardiac resynchronization therapy (CRT) on QRS voltage and its ability to predict survival in non-LBBB patients who are known to have lower response rates to conventional CRT. Methods: Twelve-lead EKGs were analyzed in 101 consecutive non-LBBB patients (age 65±12 years, 79 men, LVEF 22±4%, QRS width 154±21ms) who received CRT for a median duration of 43 months. Results: During the follow-up period 39 patients died. Total QRS amplitude in leads V2-V4 decreased significantly with CRT (values preimplant/immediately postimplant, P&lt;0.001 for all changes): lead V2 2.1±0.9mV/0.9±0.7mV, lead V3 2.3±0.8mV/1.4±0.7mV, and lead V4 1.4±0.7mV/0.8±0.6mV. Patients in whom the total QRS amplitude in lead V4 decreased with CRT had significantly better survival than patients in whom it increased or did not change (Figure). Changes in QRS amplitude in lead V4 correlated with changes in LVEF over a period of 6 months post implant (r=-0.439, p=0.017). Total QRS amplitude in lead V4 and its change with CRT independently predicted event free survival in multivariate Cox models that included age, gender, baseline LVEF and the change in QRS duration. Conclusion: A reduction in the QRS voltage in the precordial lead V4 is predictive of response to CRT in non-LBBB patients.
Abstract 14941: Incidence of Cardiac Implantable Electronic Device Infections in End-Stage Kidney Disease Patients on Dialysis
Authors: Suveenkrishna Pothuru, Wan-Chi Chan, Sania Jiwani, Kamal gupta
Journal: Circulation (2023)

Introduction: Hemodialysis potentially increases the risk of cardiac implantable electronic device (CIED) infection due to transient bacteremia. There is limited available data on the incidence of CIED infections in patients with end-stage kidney disease (ESKD) on hemodialysis. The objective of this research was to study the 1-year incidence of device infection after a new CIED implant in hemodialysis patients. Methods: We conducted a retrospective observational analysis using the United States Renal Data System database. We identified patients aged &gt;18 years with ESKD on hemodialysis who underwent first CIED implant between January 2006 and September 2014. ICD-9 codes were used and we excluded patients with a prosthetic valve. The primary outcome of the study was 1-year incidence of CIED infection. We analyzed the association of device infection with the type of CIED. Results: During the study period, a total of 46,209 patients with ESKD on dialysis received a CIED. After applying the exclusion criteria, 15,077 patients were included in the study. The mean age of the population was 69.9 years; majority were male (56.8%) and white patients (68.5%). Common comorbidities included hypertension (97.7%), dysrhythmia (75.7%), diabetes mellitus (71.1%), and congestive heart failure (67.7%). Of the included patients, 66.5% received a pacemaker (PPM), 33.1% received an implantable cardioverter-defibrillator (ICD), and 0.4% received cardiac resynchronization therapy (CRT-P or CRT-D). The overall 1-year incidence of CIED infection was 3.1%. The incidence of CIED infection was highest among patients with ICDs (4.2%), followed by CRT (3.7%), and PPM (2.5%) (p&lt;0.0001). Conclusions: The 1-year incidence of CIED infections in ESKD patients on hemodialysis was 3.1%, which is significantly higher than the incidence reported in the general population. The highest incidence was observed in those with ICDs. These findings underscore the importance of monitoring and managing CIED infections in this population to improve patient outcomes.
Abstract 13420: Nicorandil Suppresses Mitochondria-Associated Ferroptosis to Attenuates Cardiac Microvascular Disorder in Diabetes: Role of Mitochondria-Localized AMPKα1
Authors: Juying Qian, Su Li, Muyin Liu, zhangwei chen, Junbo Ge
Journal: Circulation (2023)

Backgrounds: Common metabolic risk factors, including diabetes, promote cardiac microvascular disorder (CMD), which contributes to ischemia with no obstructive coronary artery disease (INOCA). Recently, our group demonstrated the inhibition of mitochondria-associated ferroptosis in CMD alleviates diabetic cardiomyopathy. Nicorandil (Nic) is recommended as an anti-angina drug for INOCA, whether Nic could inhibit ferroptosis in CMD is not discussed. Aims: To explore the benefits of Nic on diabetes-induced CMD and ferroptosis. Methods: Nic was orally administered to db/db mice for 6 months. Mitochondria-localized AMPKα1 (mitoAMPKα1) was overexpressed in endothelial cells. Ferroptosis and related signaling pathways were assessed by mRNA sequencing assays, fluorescence staining and western blot. Results: Nic significantly alleviated CMD and diabetic cardiomyopathy as evidenced by improved cardiac microvascular perfusion and anatomical structure. mRNA sequencing assays revealed significant enriched pathways related to ferroptosis, mitophagy and AMPK signaling pathway after Nic treatment. Moreover, Nic reversed genes expression involved in ferroptosis and reduced mitochondrial and cellular lipid peroxidation (LPO) formation. Nic increased AMPKα1 phosphorylation and promoted its translocation to mitochondria, in where the phosphorylated AMPKα1 stimulated Parkin-dependent mitophagy and reduced mitochondrial translocation of ACSL4 to inhibit ferroptosis. Endothelium-specific overexpression of an active form of mitoAMPKα1 showed similar benefits as Nic to inhibit cardiac microvascular ferroptosis and improved myocardial dysfunction and pathological remodeling. Conclusions: The present work identified mitoAMPKα1 as the potential target for Nic to alleviate mitochondria-associated ferroptosis in diabetes-induced CMD.
Abstract 14290: Prospective Clinical Validation of the STOPSHOCK Smartphone Application - Artificial Intelligence Model for Prediction of Cardiogenic Shock in Patients With Acute Coronary Syndrome
Authors: Allan Bohm, Nikola Jajcay, Michael Spartalis, Ekaterina Gubareva, Jana Jankova, Amitai Segev, Konstantin Krychtiuk, Guido Tavazzi, Krishnaraj Rathod, Kevin Maurizi, Milana Jarakovic, Federico Guerra, Shlomi Matetzky, Carsten Skurk, Tharusan Thevathasan, Kurt Huber, Patricia Dragunova, Jana Brucknerova, Marta Kollarova, Imrich Berta, Katarina Petrikova, Branislav Bezak
Journal: Circulation (2023)

Background: Cardiogenic shock (CS) complicating acute coronary syndrome (ACS) is a life-threatening condition with mortality reaching 50% despite the use of mechanical circulatory support devices (MCS). It is hypothesized that early implantation of MCS before hemodynamic deterioration could prevent CS. For this purpose, we have developed and externally validated an AI model for CS prediction available as a smartphone application (STOPSHOCK app). Research question: Could the STOPSHOCK app identify ACS patients at high risk of CS development in contemporary clinical practice? Methods: The STOPSHOCK model was derived on a population of 3232 and validated on an external cohort of 5123 patients with high discrimination (c-statistics: 0.84 in external validation). The model was based on variables that were available at first medical contact. A dedicated app was developed to test the performance of the model in the clinical setting. 103 consecutive ACS patients were enrolled in intensive cardiac care units in 8 centers from USA, Europe, and Asia. Results: Heart rate, respiration rate, SpO2, blood glucose level, systolic BP, age, sex, shock index, heart rhythm, type of ACS, history of hypertension, congestive heart failure and hypercholesterolemia were used as input variables. Clinical outcome (presence of CS) was reported at hospital discharge. STOPSHOCK model had a c-statistics of 0.97. Conclusions: Our machine learning model for CS prediction in patients with ACS available at first medical contact showed high discrimination and feasibility in clinical settings as a smartphone app.