tbuckley/cabot-search huggingface dataset:
Abstract 16276: Complex Corynebacterium Case: Management of Recurrent Corynebacterium Bacteremia in a Patient With Cardiac Implanted Electronic Device and Left Ventricular Assist Device
Authors: Gabriela Narowska, Edward R Horton, Richard Saporito, Eman A Hamad, chethan gangireddy, Isaac R Whitman
Journal: Circulation (2023)

Background Cardiac implantable electronic device (CIED) infections are morbid and costly. Atypical organisms are increasingly recognized as a cause of CIED infections. We present a case of recurrent Corynebacterium striatum bacteremia requiring CIED and left ventricular assist device (LVAD) extraction. Case Presentation A 54-year-old female dialysis patient with diabetes, ischemic cardiomyopathy, primary prevention single chamber transvenous defibrillator (ICD) 8 years prior, and destination LVAD presented with chronic C. striatum driveline site infection and relapsing and remitting bacteremia. Over the prior two years, she suffered from chronic driveline infections requiring wound care, driveline washouts, and antibiotics, although not seen by the electrophysiology (EP) team. After a fourth episode of bacteremia, she underwent ICD extraction and LVAD pump exchange, followed by 6 weeks of vancomycin and 3 months of rifampin. She then remained free of bacteremia for 19 months, though continued to demonstrate evidence of driveline infection despite pump exchange. Ultimately, C. striatum bacteremia recurred. Given unrelenting soft tissue infection and recurrent bacteremia, redo LVAD exchange was deferred and she was treated with lifelong suppressive antibiotics. Discussion Corynebacterium species have historically been considered skin flora, but more recently have been identified as pathogens, both as a cause of endocarditis, and a common organism in LVAD associated soft tissue infections. There are few reports of CIED infection. Source control is difficult in bacteremia patients with both CIED and LVAD. In this case, recurrent bacteremia could be attributed to recurrent driveline-soft tissue infection. However, the prolonged freedom from bacteremia off antibiotics after CIED extraction, despite ongoing soft tissue and driveline infection, argues that her transvenous ICD may have been seeded. This case highlights the growing spectrum of bacteria implicated in CIED-related infection, that early extraction may be a critical intervention regardless of infectious source, and importance of multidisciplinary discussions including heart failure, surgery, infectious disease, and EP to improve outcomes in this complex population.
Abstract 18411: The Causal Association Between Coronary Artery Disease and Atrial Fibrillation in East Asian Ancestry
Authors: Jingyang Wang, Jiangshan Tan, Yanmin Yang
Journal: Circulation (2023)

Background: Previous studies have reported a causal association between coronary artery disease (CAD) and atrial fibrillation (AF) in the European populations. However, it is unclear whether the causal association the exists in East Asian populations. Methods: We assessed the causal relationship between CAD and AF using 2-sample Mendelian randomization (MR) in the East Asian populations. Additionally, we performed multivariable MR, correcting obesity, smoking initiation, alcohol intake frequency, and hypertension to further explore the causality between CAD and AF. Results: The calculated odds ratios (ORs) and 95% confidence intervals (CIs) for CAD using inverse-variance weighted, MR-Egger, and weighted-median analysis were 0.984 (0.955-1.014; P = 0.285), 0.957 (0.899-1.019; P = 0.191), and 0.974 (0.945-1.004; P = 0.088), respectively; for AF, the results were 1.066 (0.944-1.203; P = 0.302), 0.790 (0.546-1.142; P = 0.216), and 1.258 (1.098-1.441; P &lt; 0.001). After adjusting common risk factors, the genetically predicted CAD was also causally associated with an 18.5% increased risk of AF (OR = 1.185; 95% CI = 1.065-1.319; P = 0.002), but no causal effect of AF on the risk of CAD. Conclusions: Our findings suggest that genetically predicted CAD is causally associated with an increased risk of AF in East Asian populations.
Abstract 18298: 10-Year Trends of In-Hospital Outcomes of Patients That Underwent Percutaneous Coronary Intervention for Cardiogenic Shock Complicating Acute Coronary Syndrome
Authors: Takanori Ohata, Shun Kohsaka, Ryo Nakamaru, Yasuyuki Shiraishi, Ikuko Ueda, Toshiki Kuno, Masaki Kodaira, Tomohiko Ono, Yohei Numasawa, Shigetaka Noma, Masaki Ieda
Journal: Circulation (2023)

Background: Cardiogenic shock complicating acute coronary syndrome (CS-ACS) is a life-threatening condition and percutaneous coronary intervention (PCI) remains a fundamental approach in its management. In recent years, notable advancements have emerged, including the utilization of mechanical circulatory support (MCS) devices and an enhanced understanding of patient selection for PCI. This study aims to assess the temporal trends in patient background and outcomes of patients who underwent PCI for CS-ACS. Methods: The Keio interhospital Cardiovascular Studies (KiCS)-PCI registry prospectively collects approximately 200 variables, which were defined in accordance with the National Cardiovascular Data Registry (NCDR), from the major teaching hospitals in Tokyo metropolitan area in Japan. Between 2009 and 2019, 24,671 consecutive cases were registered, 10,053 patients (40.7%) undergoing PCI for ACS, of which 870 patients (8.5%) had CS-ACS. We stratified CS-ACS patients into 4-time frame groups (T1: 2009-2011, T2: 2012-2013, T3: 2014-2016, and T4: 2017-2019), and examined the temporal trends in patient risk profiles using the NCDR score (ranging 0-100, reflecting predicted mortality rates). Additionally, we assessed the incidence and types of employed MCS as well as the in-hospital mortality rate. Results: During the study period, the proportion of CS-ACS remained stable, accounting for 8.0% in T1 to 8.2% in T4 of ACS-related PCI cases. The calculated NCDR risk score demonstrated minimal variation, ranging from 70.6 in T1 to 70.1 in T4. There was a notable decrease in the utilization of MCS (66.5% in T1 to 56.7% in T4), mainly driven by a reduction in the use of intra-aortic balloon pump (70.3% to 55.0%, p for trend&amp;lt;0.001), with a increase in the concomitant use of veno-arterial-extracorporeal membrane oxygenation (27.6% to 36.2%, p for trend&amp;lt;0.001). However, the in-hospital mortality rate for CS-ACS patients remained persistently high at 30%. Conclusion: Over the past decade, there have been notable changes in the peri-procedural management of CS-ACS, albeit no significant improvements in patient outcomes was observed. The result calls for additional efforts to enhance their management.
Abstract 15109: Percutaneous Coronary Intervention During the Global Shortage of Iodinated Contrast
Authors: Brian K Mitchell, Zachary M Gertz, Michael C Kontos, Nicholas Teman, Anthony Norman, Raza Ahmad, Raymond Strobel, Abdulla A Damluji, Alan Speir, Robert Short, Mohammed Quader
Journal: Circulation (2023)

Background: A recent coronavirus-related factory shutdown led to a global shortage of iodinated contrast media. Its impact on percutaneous coronary interventions (PCI), which require contrast, has not been investigated. Research Question: The purpose of the study was twofold: (1) to evaluate the impact of the contrast shortage on PCI procedure volumes, patient and procedure characteristics and (2) to evaluate whether those changes impacted patient outcomes, especially acute kidney injury (AKI). Methods: Using CathPCI registry data from 19 Viriginia hospitals, we evaluated two time periods: pre-shortage (May 2021 - April 2022) and during the contrast shortage (May 2022 - October 2022). We compared procedure volumes, patient and procedure characteristics, and short-term outcomes. Of primary interest was whether a reduction in contrast would reduce the incidence of AKI. Results: There were 8,980 patients in the pre-shortage period and 4,046 during the shortage. Procedure volumes per hospital and patient characteristics remained similar. Multivessel procedures declined during the shortage (45.3% vs. 42.8%, p=0.007). There was a sharp decline in contrast per procedure during the shortage (149.9 ± 68.1 mL per case to 137.5 ± 62.4 mL (p&lt;0.0001) that began at the start of the shortage and then continued throughout. There were no differences in patient outcomes, including AKI (7.9% versus 7.4%, p=0.40), between study periods. When limited to patients at increased risk of AKI, there remained no difference in AKI between the study periods, despite a similar decrease in contrast volume in that cohort. Multivariable analysis showed strong correlation between baseline risk of AKI and subsequent AKI (p&lt;0.0001), but no impact of procedure characteristics or the timing of the PCI. Conclusions: The global shortage of iodinated contrast led to a significant decline in contrast use during PCI, with no impact on patient outcomes.
Abstract 18399: Loss of Myeloid Epigenetic-Metabolic Crosstalk by BAF60a Deficiency Aggravates Atherosclerosis
Authors: Yang Zhao, Yuhao Liu, Guizhen zhao, Eugene Chen, Jifeng Zhang
Journal: Circulation (2023)

Introduction: Atherosclerosis is a primary medical concern, characterized by the involvement of immune cells within atherosclerotic plaques. Notably, the modulation of gene expression through chromatin remodeling and transcription machinery, known to be disrupted in disease conditions, is less studied in macrophages within atherosclerotic plaques. Hypothesis: We propose that BAF60a , a component of the SWItch/Sucrose Non-Fermentable (SWI/SNF) chromatin remodeling complex, might be instrumental in atherosclerosis by modulating disease-specific epigenetic-metabolic crosstalk, offering a potential therapeutic avenue. Methods: To evaluate our hypothesis, we assessed BAF60a expression in macrophages derived from advanced plaques. To decipher its role, myeloid Baf60a was deleted in mice with hypercholesterolemic ApoE deficient backgrounds. Subsequent changes in atherosclerotic lesion size, mitochondrial integrity, cellular adhesion, and apoptosis were characterized. ChIP-seq and ATAC-seq were employed to analyze the function of BAF60 a in maintaining key transcription factor activities. Results: Our results revealed a marked downregulation of BAF60a in macrophages from advanced plaques. Upon myeloid Baf60a deletion, we observed compromised mitochondrial integrity, increased cellular adhesion, enhanced apoptosis, and amplified plaque formation. Importantly, BAF60a was crucial in preserving mitochondrial energy homeostasis in the face of pro-atherogenic stimuli, as it sustained Nuclear Respiratory Factor 1 ( NRF1 ) access to critical genes. BAF60a overexpression rescued these defects in an NRF1-dependent manner. Conclusions: We conclude that the BAF60a-NRF1 axis is a key regulator of mitochondrial function in atherosclerosis. Our study underscores the potential of restoring the disrupted epigenetic-metabolic crosstalk as a promising therapeutic strategy in treating atherosclerosis.
Abstract 14994: A Propensity Score Analysis of Early and Long-Term Outcomes After Ticagrelor or Clopidogrel in Elderly Patients With Acute Myocardial Infarction: The Fast-MI 2015 Registry
Authors: Nicolas Danchin, Yves Cottin, Guillaume Cayla, Gilles Lemesle, Orianne Weizman, Jean Ferrieres, Francois Schiele, Etienne Puymirat, Tabassome Simon
Journal: Circulation (2023)

Introduction: Guidelines recommend ticagrelor (T) over clopidogrel (C) in AMI patients, irrespective of age. Real-world evidence in the very elderly is limited. Question: Whether T is superior to C for elderly patients regarding early and long-term outcomes in real-life conditions. Goal: To analyze in-hospital, one- and 5-year outcomes according to use of T or C in AMI patients ≥80 yo. Methods: FAST-MI 2015 included consecutive AMI patients over 1 month in 204 French centers. Patients ≥80 yo, receiving C or T ≤48 hours of admission were studied. Propensity scores (PS) for receiving T or C was used in multivariable analyses and for PS matching. Results: Of 5291 patients in the registry, 995 (19%) were ≥80 yo, of whom 870 (87%) met the inclusion criteria. Mean age was 85±4 years (86 ± 4 for C-treated; 84±3 for T-treated), 51% were women (50.5% and 53% respectively for C and T), and 40% had STEMI (33% and 49% respectively). PS-adjusted HRs for T vs C were 1.26, 95%CI 0.65-2.44 for 30-day death, 1.09, 95% CI 0.71-1.67 for death at one year and 0.86, 95% CI 0.67-1.11 at 5 years. After PS matching, the two cohorts (N=293 each) were well balanced for all baseline characteristics including medications given at the acute stage. In-hospital complications, including major bleeding, re-MI, stroke and death were similar for T and C. Thirty-day, one-year, and 5-year mortality were similar for the 2 medications, with a trend favouring T over time, suggesting the possibility of undetected confounders (Figure). In hospital survivors, however, T at discharge was associated with improved 5-year survival (PS-adjusted HR 0.64, 95%CI 0.46-0.90), compared with C. Conclusions: In this real-world population of elderly (mean age 85 years) patients with AMI, initial use of ticagrelor was not associated with improved survival, compared with clopidogrel. In hospital survivors, however, ticagrelor at discharge was associated with reduced long-term mortality.
Abstract 18451: Point-of-Care Aid-to-Diagnosis for Heart Failure Using Artificial Intelligence Based on Seismocardiography Acquired With a Smartphone in the Emergency Department
Authors: Tran T Long, Diaa El Ahmadie, Geoffrey Mainil, Amin Hossein, Virginie Meurant, Alexandre Almorad
Journal: Circulation (2023)

BACKGROUND The number of new heart failure (HF) diagnoses in hospitals constantly increases. The associated clinical signs lead to a delay in treatment. Reliable and rapid diagnostic assistance is needed at earlier stages. Kinocardiography (KCG), based on Seismocardiography (SCG), allows the computation of non-invasive cardiac kinetic energy that is used to characterize the cardiac function and could detect HF among patients at risk. PURPOSE In a multi-centric study, test the performance of smartphone-based KCG recording in diagnosing HF in the emergency department (ED). METHODS Adult patients presenting with dyspnea in the ED were recruited. Relevant clinical characteristics were recorded. A blood sample was collected for NT-proBNP measurement, and a 180-sec KCG was acquired with a smartphone. The patient is supine on the back; the smartphone is placed on his chest to acquire the precordial vibrations due to the heartbeats. Cardiac kinetic energy (CKE) metrics are derived from these vibrations, including diastolic gradient kinetic energy ( ΔiK diastolic ). The final HF diagnosis was assessed from the medical record at discharge from the ED. The primary outcome is the performance of an AI-based on CKE metrics at classifying HF, measured using metrics including the area under the receiver operating characteristic curve (AUROC), negative predictive value (NPV), and specificity, with two-sided 95% CIs. RESULTS 375 patients were recruited; among these, 137 patients were diagnosed with HF (78 [70.2;85.7] years, 26.8 [23.4;29.6] kg/m 2 , 45.7% male, 4843.0 [3199;7845] pg/ml, 88 HFpEF, 17 HFmrEF, 37 HFrEF) and 243 without HF (65 [54;74] years, 27.9 [25.3;31.3] kg/m 2 , 50.2% male, 291.0 [71;803] pg/ml). ΔiK diastolic was significantly lower in patients with HF (0.37 [0.11;0.72] vs. 0.06 [-0.05;0.29] %, p&lt;0.005). The AI approach resulted in an AUROC of 0.85 (0.80-0.89), sensitivity of 85.0% (74.2-90.3), and NPV of 79.0% (77·7-82·9). CONCLUSION This study shows that an AI system applied to SCG acquired during a 3-mins examination with a smartphone can detect HF among patients presenting dyspnea. These findings highlight the potential for a non-invasive, workflow-adapted, point-of-care, aid-to-diagnosis for earlier diagnosis.
Abstract 18426: Secreted Frizzled-Related Protein 1 Mediates Adipogenic Differentiation of Vascular Cell Adhesion Protein 1 Fibroadipogenic Progenitors in the Ischemic Limb
Authors: Qunsheng Dai, Changxin Wan, Kaileen Fei, Yueyuan Xu, Derek Peters, Brianna Garrett, James Otto, Christopher D Kontos, Zhicheng Ji, Yarui Diao, Kevin W Southerland
Journal: Circulation (2023)

Introduction: Chronic limb threatening ischemia (CLTI) patients display a skeletal muscle myopathy that is hallmarked by fatty infiltration. The replacement of functional muscle fibers with adipocytes impairs ambulatory function and is associated with poor clinical outcomes. The cell type responsible for fatty infiltration is a mesenchymal stromal cellular population, term fibroadipogenic progenitors (FAPs). We previously demonstrated that Vcam1+ FAPs represent a sub-population with increased adipogenic potential. However, the molecular mechanisms which govern Vcam1+ FAP mediated adipogenesis remain unknown. Herein, we sought to identify the intracellular mechanisms that drive Vcam1+ FAPs into an adipogenic cellular fate. Methods: We used single cell and bulk RNA-sequencing to identify Sfrp1 as an enriched gene in Vcam1+ FAPs. Next, to determine the sufficiency and necessity of Sfrp1, we overexpress Sfrp1 with a recombinant protein and inhibit Sfrp1 with a siRNA and assess adipogenesis. To assess the clinical significance of this FAP subpopulation, we apply single-cell RNA sequencing to CLTI patients. Results: We show in a CLTI murine model that Vcam1+ FAPs are enriched in Sfrp1. Next, we demonstrate that Sfrp1 is both sufficient and necessary for the differentiation of Vcam1+ FAPs into adipocytes. Finally, we demonstrate that human CLTI patients also have a pathologic FAP population that is enriched in Vcam1 and Sfrp1Conclusions: Our results reveal a novel mechanism for fatty infiltration, a histologic hallmark of CLTI patients, in the ischemic limb. We also validate the clinical significance of Vcam1+ Sfrp1+ FAPs by demonstrating the presence of this population in human CLTI patients. This work lays the foundation for future studies aimed at inhibiting fatty infiltration and promoting skeletal muscle regeneration in CLTI patients.
Abstract 18446: Rates and Risk Factors of Pregnancy-Related Ischemic Stroke During Labor Admissions
Authors: Fares Ghanem, Laith Alhuneafat, ahmad jabri, Anas Alameh, Huthaifah Aburumman, Indu G Poornima
Journal: Circulation (2023)

Background: Pregnancy-related stroke is a relatively uncommon yet devastating complication. However, the rates and associated risk factors of stroke in this context remain poorly described. Hypothesis: We aim to evaluate rates and associated risk factors for stroke. Methods: We conducted a population-based retrospective study using national inpatient data from 2016 to 2020 to assess ischemic stroke rates and identify associated risk factors during labor admissions. Regression analysis was performed, adjusting for multiple patient characteristics, to determine significant factors related to stroke occurrence. Results: We examined a total of 19,089,780 labor admissions. The incidence of ischemic stroke during labor admissions was recorded at a rate of 445 per 100,000 cases. Several factors showed significant associations with ischemic stroke in this context. Atrial fibrillation exhibited a strong correlation (odds ratio [OR] 5.98, 95% confidence interval [CI] [1.16-30.92], p=0.033), as did dyslipidemia (OR 9.54, 95% CI [4.38-20.80], p&lt;0.001), heart failure (OR 3.95, 95% CI [1.09-14.34], p=0.037), chronic kidney disease (OR 6.27, 95% CI [1.92-20.47], p=0.002), cesarean section (OR 2.23, 95% CI [1.60-3.13], p&lt;0.001), chronic hypertension (OR 1.67, 95% CI [1.12-2.47], p=0.011), and hypertensive disorders of pregnancy (OR 7.00, 95% CI [4.94-9.44], p&lt;0.001). However, factors such as advanced maternal age, race/ethnicity, income quartile, gestational and non-gestational diabetes mellitus, coronary artery disease, tobacco use, polycystic ovarian syndrome, and peripartum cardiomyopathy did not exhibit significant associations with stroke. Conclusion: Our study highlights an incidence rate of 445 per 100,000 cases for pregnancy-related ischemic stroke during labor admissions and identified certain associated risk factors. These findings provide valuable guidance to healthcare professionals in identifying high-risk individuals.
Abstract 18297: Association Of Maximum Daily Mobility After Open Cardiac Surgery And Clinical Outcomes
Authors: Nancy M Albert, Cristin Phillips, Julie Hoffman, Michelle Levay, James F Bena, Shannon L Morrison, Gina Barley, Mary C Collins, Edward G Soltesz, Kenneth J Bober
Journal: Circulation (2023)

Introduction: Hospital-based mobility after coronary artery bypass graft (CABG) and valve surgery using a mid-sternal incision is valuable and facilitated by use of Phase 1 cardiac rehabilitation. However, rehabilitation services may be limited and patients may not receive the full benefits of early mobility. Further, factors associated with maximum daily mobility and clinical outcomes need to be better understood. Research Questions: What is the degree of maximum daily mobility variability during hospitalization and what factors are associated with higher maximum daily mobility? Methods: This prospective, correlational design used a daily mobility form, surveys and medical records data from 5 hospitals in 5 states. Nurses collected mobility (daily) and psychological status (one time, post intensive care unit [ICU] stay) using valid and reliable tools. Medical record data were retrieved by analysts. Maximum daily mobility scores were categorized into 4 groups; higher levels represented greater mobility. Relationships between mobility category scores and patient factors were described using Spearman correlations (95% confidence intervals. Results: Of 650 participants with a median [25th, 75th percentile] of 4.0 [3.0, 5.0] days of post-ICU daily mobility data, lowest to highest category rates were 9.5% (n=62), 9.8% (n=63), 16.2% (n=105) and 64.5% (n=419). Higher maximum daily mobility was associated with hospital site, younger age, male gender, commercial insurance, lower body mass index, no history of prior myocardial infarction, heart failure, aortic or pulmonic valve disease, cerebrovascular disease or diabetes, higher hemoglobin/hematocrit, lower serum creatinine and lower rates of prolonged ventilation (all p &amp;lt0.05). Higher maximum daily mobility was associated with higher general health perception scores (rho 0.12 (0.04, 0.19), p=0.003, shorter hospital length of stay and an increased likelihood of discharge to home (both p &amp;lt0.01). Conclusions: After CABG/valve surgery, maximal daily mobility varied by multiple factors, many of which were not directly associated with patient’s ability to ambulate. Attention to achieving higher post-ICU daily mobility levels are warranted.