tbuckley/cabot-search huggingface dataset:
Abstract 12135: Quality of Life in Early-Stage Hypertrophic Cardiomyopathy: A Secondary Analysis of the VANISH Trial
Authors: Catherine G Ireland, Sharlene Day, Anna Axelsson, Mark W Russell, Kenneth G Zahka, Alexandre Pereira, Charles E Canter, Richard G Bach, Matthew T Wheeler, Joseph W Rossano, Anjali T Owens, Henning Bundgaard, Luisa Mestroni, Matthew R Taylor, Patel R Amit, Ivan Wilmot, Jonathan H Soslow, Jason R Becker, Endel J Orav, Carolyn Y Ho
Journal: Circulation (2023)

Background: The VANISH trial (Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy) showed valsartan improves LV remodeling in early-stage HCM, but its effects on quality of life (QOL) are unknown. A better understanding of QOL may impact patient wellness. Aims: Describe baseline QOL in early-stage HCM. Assess the impact of valsartan on QOL in early-stage HCM. Methods: We evaluated QOL using age-adjusted versions of the Pediatric Quality of Life Inventory in VANISH participants (ages 8-45): 166 with early-stage HCM, 34 with subclinical HCM (sarcomere variant present but normal LV wall thickness/no HCM diagnosis). Demographic, imaging, CPET, and biomarker correlates of baseline QOL were studied. The impact of valsartan on QOL was analyzed in the early-stage HCM cohort. Results: Participants with early-stage HCM reported good baseline QOL, better than an earlier published healthy validation cohort but diminished compared to subclinical participants (mean overall/physical/psychosocial scores 85/87/84 for early-stage, 90/92/89 subclinical, 82/84/81 earlier validation cohort). Race and ethnicity influenced QOL, with non-white and Hispanic participants reporting lower scores (Table 1). Valsartan improved physical QOL (p=0.03), with suggestion of differential effect by sex and pubertal status, but limited power to detect effect modification (Figure 1). Conclusion: Baseline QOL is lower in patients with early-stage HCM compared to subclinical participants despite NYHA I status. Non-white and Hispanic participants and those with lower baseline peak VO 2 may have lower quality of life. Valsartan treatment improved physical QOL.
Abstract 12178: Association Between QT Prolongation and Cardiovascular Mortality in Cancer Patients
Authors: Cheng-Han Chan, Chih-Min Liu, Pei-Fen Chen, I-Chien Wu, Hu Yufeng
Journal: Circulation (2023)

Introduction: The QT interval (QT) is a safeguard criterion to avoid detrimental arrhythmias. Cancer patients are vulnerable to QT prolongation. However, its prognostic impact on cardiovascular (CV) mortality in cancer patients is not clear. Research questions: Which is the best QTc formula to predict CV mortality in cancer patients? Whether a QT interval would be a suitable predictor for CV mortality in cancer patients? Methods: This retrospective observational cohort included adult cancer patients who had an electrocardiogram (ECG) performed in a tertiary hospital in Taiwan. The first performed ECGs after cancer diagnosis (n=59,568) were analyzed. The corrected QT intervals by Bazett (QTcB), Fridericia (QTcFri), and Framingham (QTcFra) formulae were used to predict the 90-day and one-year CV mortality according to the Taiwan death registry. Results: The AUC of QTcB (0.70) for predicting CV mortality at 90 days was better than QTcFri and QTcFra (0.63 and 0.50). The AUC of QTcB (0.68) for predicting CV mortality at one year was also better than QTcFri and QTcFra (0.65 and 0.56).Using the restricted cubic spline regression model adjusted by age and comorbidities, QTcB increased a significant but trivial risk of CV mortality at 90 days (hazard ratio, 1.007, P= 0.02) and one year (1.006, P &lt;0.01). Compared to those with QTcB &lt;500ms, the patients with QTcB ≥500ms were older, had more comorbidities, and higher CV (1.74%), cancer (24.5%), and all-cause mortalities (32.5%) within one year. The incidence of sudden death and ventricular arrhythmias was only 0.2%. After adjusting for comorbidities, QTcB was neither associated with 90-day nor one-year CV mortality. Conclusions: Rather than a long QT interval per se, comorbidities contributed to CV mortality and irreversible outcome in cancer patients.
Abstract 12075: Does Improvement in Food Insecurity Lead to Improvement in Weight and Waist Circumference?
Authors: Tiffany W Ardoin, Donald Mercante
Journal: Circulation (2023)

Purpose: The Food Insecurity and its Sequelae on Health (FISH) Research Study measures the impacts of the Geaux Get Healthy Clinical Program (GGH) on food insecurity and metabolic health. GGH is an 8-week program that provides community members with food insecurity nutrition/cooking education and access to resources. We have already shown that this program improves food security scores from enrollment to completion of the program with continued improvement at 6 months with USDA Adult Food Security Survey Module scores of 6.9 to 4 to 2.7 respectively 1 . We proposed that improvements in food insecurity with GGH would also translate into sustainable improvements in weight and waist circumference. Methods: Eligible participants included patients who qualified for the GGH Program ages 18-65, were English-speaking and without audiovisual deficits. Upon enrollment, participants met with the Health Specialist, again at 8-12 weeks, and again at 6 months. At each visit, participants completed validated surveys which included food security scores and vital signs were obtained. Results: At the time of this analysis, a total of 118 participants were enrolled. Participants’ mean BMI was 34.89 kg/m 2 ( SD =9.20). 66% of enrollees had diabetes (37%) or pre-diabetes (29%) and 56% of enrollees had hypertension. Of those who completed the study (n= 57), the mean weights were 92.2 kg at initial visit; 86.1 kg at 8 weeks; and 91.2 kg at 6 months. The mean waist circumferences were 42.26 in at initial visit; 40.2 in at 8 weeks; and 41.06 in at 6 months. The Wilcoxon Signed Rank Test was used to analyze change in response over 2 timepoints. Significant improvement in means of both weight ( p =0.011) and waist circumference ( p =0.008) occurred from enrollment to program completion at 8 weeks. However, neither of these improvements were sustained. Conclusions: It appears that a program providing access to resources and education improves food security scores along with weight and waist circumference. Although food security score improvements persist, improvements in weight and waist circumference do not. This suggests that intense programs addressing food insecurity may not continue to improve metabolic health once the educational piece is over and only access to community resources remains.
Abstract 12306: CREG1 Attenuates Doxorubicin-Induced Cardiotoxicity via Inhibiting the Ferroptosis of Cardiomyocytes
Authors: Dan Liu, Xiaoli Cheng, haixu song, Chenghui Yan, Yaling Han
Journal: Circulation (2023)

Introduction: Doxorubicin (DOX) is currently one of the most used anthracycline anticancer drugs. However, the cardiotoxicity of DOX limits its application in cancer patients. Cellular repressor of E1A-stimulated genes (CREG1) is an important cardioprotective factor. Hypothesis: We investigated the underlying effects and mechanism of of CREG1 in DOX-induced cardiotoxicity have not been reported. Methods: In vivo, a mouse DOX-induced cardiotoxicity model was established by DOX intraperitoneal injection, the mRNA and protein expression of CREG1 in the myocardium was examined using real-time PCR and western blot. CREG1 transgenic mice and cardiac-specific CREG1 knockout mice were used to establish DOX-induced cardiotoxicity model. HE staining, Masson staining, WGA staining and western blot were applied to examine fibrosis, myocardial hypertrophy and ferroptosis. In vitro, neonatal mouse cardiomyocytes (NMCMs) were stimulated with DOX, CREG1 overexpression adenovirus and small interfering RNA was used to examine the role of CREG1 on the ferroptosis of NMCMs. Results: In vivo, the mRNA and protein expression of CREG1 were significantly reduced in DOX-treated myocardium. CREG1 overexpression alleviated the myocardial damage induced by DOX, and CREG1 deficiency aggravated the DOX-induced cardiotoxicity. The abnormal increase in ferroptosis was shown in the DOX-treated heart tissues. CREG1 overexpression inhibited the ferroptosis, and CREG1 deficiency aggravated the ferroptosis induced by DOX. In vitro, the mRNA and protein of CREG1 was reduced in DOX-treated NMCMs. CREG1 overexpression reduced the ferroptosis of cardiomyocytes, CREG1 knockdown aggravated the ferroptosis of cardiomyocytes induced by DOX. Mechanically, CREG1 inhibited the mRNA and protein expression of pyruvate dehydrogenase kinase 4 (PDK4). The effect of CREG1 overexpression on ferroptosis of cardiomyocytes was reversed by PDK4 overexpression. Conclusion: CREG1 alleviated DOX-induced cardiotoxicity by inhibiting ferroptosis of cardiomyocytes. Our findings might help clarify new roles of CREG1 in the development of DOX-induced cardiotoxicity.
Abstract 11774: Right Ventricular Function and Myocardial Blood Volume Analyses by Convolutional Neural Network in Experimental Pulmonary Hypertension
Authors: Sailun Wang, Nils Kremer, Sofia-Iris Bibli, Alexander Belenkov, Jiong Hu, Ingrid Henneke, Regina Mukhametshina, Ardeschir H Ghofrani, Norbert Weissmann, Soni Savai Pullamsetti, Werner Seeger, Ralph T Schermuly, Khodr Tello, Baktybek Kojonazarov
Journal: Circulation (2023)

Introduction: Survival of patients with pulmonary hypertension (PH) is highly dependent on the right ventricular (RV) function. Despite the association of various factors with adaptive or maladaptive RV phenotypes, the contribution of microvascular density to RV adaptation to pressure overload remains unclear. Hypothesis: This study aimed to evaluate the RV myocardial blood volume and its role in the RV adaptation to pressure overload. Methods: Both the University Animal Care Committee and the federal authorities for animal research of the Regierungsprasidium Giessen (Hessen, Germany) approved the study protocol. The study used adult Wistar-Kyoto rats and Sprague-Dawley rats to induce PH using SuHx and monocrotaline (MCT), respectively. Echocardiography, in vivo contrast-μCT, and invasive hemodynamic measurements were performed. The researchers used an artificial intelligence (AI)-based convolutional neural network (CNN) approach to reconstruct, segment, and analyze the cardiac μCT images. The RV functional reserve was evaluated during mCT acquisition and dobutamine stress test, and metabolomics analysis was performed. Results: The data showed that SuHx rats developed maladaptive cardiac function and RV-PA uncoupling. MCT rats exhibited adaptive RV function at days 14 and 21, but maladaptive function at day 35, which was associated with RV-PA uncoupling and reduced RV functional reserve. Impaired PKA-CREB signaling pathway was also found to be associated with the reduced RV functional reserve in the MCT rats. In both PH models, the absolute RV blood volume significantly increased with the development of RV hypertrophy, but the relative blood volume decreased, which was associated with maladaptive RV function Conclusions: This study is the first to demonstrate the use of AI CNN in post-processing of μCT-derived cardiac images from experimental PH models. Additionally, a single-beat PV loop was established for the first time in a rat model of PH by combining non-invasive and invasive techniques. The findings suggest that RV maladaptive function in rat models of PH is characterized by capillary rarefaction, impaired RV reserve in response to dobutamine infusion, which is associated with impaired PKA-CREB signaling pathway in the RV.
Abstract 11975: The Multi-Ethnic Association of Aortic Valve Calcium and Long-Term Risk of Incident Severe Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis
Authors: Jelani K Grant, Kunal Jha, Natalie Marrero, Alexander C Razavi, Ellen Boakye, Khalil Anchouche, Omar Dzaye, Matthew Budoff, Sanjiv J Shah, Matthew J Czarny, Jerome I Rotter, Xiuqing Guo, Jie Yao, Roger S Blumenthal, George Thanassoulis, Wendy S Post, Michael J Blaha, Seamus P Whelton
Journal: Circulation (2023)

Introduction: Racial/ethnic differences exist in the prevalence and burden of aortic valve calcium (AVC) and in the incidence of aortic stenosis (AS). While AVC is strongly associated with the long-term risk for AS, whether this association differs by race/ethnicity remains uncertain. Hypothesis: There will be a similar absolute event rate for incident moderate to severe AS within AVC categories across race/ethnicity. Methods: 6,812 MESA participants underwent non-contrast EKG gated CT at MESA Visit 1 and AVC was quantified using the Agatston scoring method. Adjudication of incident moderate and severe AS was defined using standard clinical criteria. We assessed the association of AVC with the combined outcome of incident moderate-severe AS stratified by race/ethnicity. We calculated the event rate per 1,000 person-years and multivariate Cox proportional hazards with log-transformed AVC as a continuous variable. Results: The mean age was 62 years old and 47% of participants were women. Over a median follow-up of 16.7 years, there were 140 participants diagnosed with moderate AS (n=56) and severe AS (n=84). The prevalence of AVC &gt;0 by race was 15.8% for White, 13.3% for Hispanic, 12.3% for Black, and 8.3% for Chinese participants. The rate of incident moderate-severe AS was similar across race/ethnicity when stratified by AVC, p for interaction=0.62 (Figure 1). Log-transformed AVC had a similar association with the long-term risk of moderate-severe AS regardless of race/ethnicity: White HR 1.83 (95% CI 1.63-2.05), Hispanic: HR 2.12 (95% CI 1.79-2.51), Black: HR 2.31 (95% CI 1.79-2.98), and Chinese: HR 2.14 (95% CI 1.30-4.41). Conclusions: The association between AVC and moderate-severe AS was similar across race/ethnicity. This suggests that previously observed differences in AS by race/ethnicity may be predominantly due to the differing prevalence of AVC.
Abstract 11895: Efficacy of Maintaining Mean Aortic Pressure by Percutaneous Left Ventricular Assist Device for Hemodynamic Support in Ventricular Tachycardia Ablation - Relation to Cycle Length
Authors: Hannah M Bernstein, Dali Fan, Bilal Munir, Uma N Srivatsa
Journal: Circulation (2023)

Introduction: Percutaneous left ventricular assist device (pLVAD) has been used to maintain mean aortic pressure (MAP) during ventricular tachycardia (VT) ablation (ABL) and is a class II recommendation. We sought to assess the ability of pLVAD to maintain MAP and its relationship to VT cycle length (CL). Methods: All patients who underwent CA for VT with pLVAD support within a 3-year period were included. Type of pLVAD was determined by operator. Insertion of device was performed under fluoroscopy via femoral arterial sheath. Acute ablation success was defined as absence of inducible VT at end of procedure. Results: A total of 9 patients were included. Most patients had ischemic cardiomyopathy (Table 1); pLVAD was inserted prophylactically in 66.67% of patients and for refractory VT/VF storm in 22.2%. One patient was had critical AS and underwent balloon valvuloplasty prior to VT ablation. Impella CP was used in 78%, and Impella 2.5 in 22%, mean cardiac output was 2.9 + 0.5 L at mean P flow rate 7.3 + 1.3. CARTO was used in 89% and ESI Navx in 11% for electroanatomic/activation mapping. There were no instances of electromagnetic interference, despite the use of magnetic mapping system in all cases (CARTO in 8, Stereotaxis in 1). Mean PCWP was 17.88 + 10.12 pre-ablation vs 23.57 + 8.30 post-ablation (p=ns). There were 24 VTs, 42% were sustained, with a mean CL 342 + 80 msec, ranging from 223 to 558 msec. Mean MAP pre-ablation was 67.44 + 12.85 mmHg vs 61.86 + 13.27 post-ablation with absent negative correlation to VT CL (p=ns). There was no difference in MAP between VT Cl &gt; 300 msec vs &lt; 300 msec: 66 + 11 vs 59 + 14 mm Hg, (p=ns). Mean dose of phenylephrine was 452 mcg. pLVAD was removed at the end of procedure, there were no femoral site complications. Conclusions: pLVAD utilization maintains stable MAP even with faster VT cycle length in patients undergoing VT ABL under general anesthesia obviating need for high dose pressor support.
Abstract 12291: Impact of History of Mental Health Disorder on In-Hospital Mortality in Patients With Heart Failure. A Population-Based Cohort Study
Authors: Rami Al-Ayyubi, Laura Gonzalez Reyes, Divya Parepalli, Andres Mata, Muhammad Qudrat Ullah, Raghavendra Sanivarapu, John Garza, Muhammad Jehangir Malik
Journal: Circulation (2023)

Introduction: Mental health disorders are associated with lower life expectancy and patients with mental disorders are at an increased risk of heart failure. Data on the prognostic impact of mental disorders on heart failure outcomes is limited and inconclusive. Hypothesis: Mental health disorders are associated with increased risk of in-hospital mortality in patients with heart failure. Methods: The study population were patients aged ≥18 years in acute care hospitals with heart failure as principal diagnosis in Texas for years 2016 through 2021. Three prespecified models were applied to estimate the association between mental disorders and in-hospital mortality. Multilevel, multivariable logistic regression with propensity adjustment was the primary analysis approach with propensity score matching and multivariable logistic regression without propensity adjustment applied as alternative analyses. Additional analyses were completed for patient subgroups, categories of mental disorders, and classifications of heart failures. Results: Out of 513,565 heart failure hospitalizations, 103,675 (20.2%) had mental disorders. Heart failure hospitalizations with vs without mental disorders were more commonly female (61.3% vs 46.0%), white (55.3% vs 46.9%), and obese (31.6% vs 26.4%), but had less frequent need for mechanical ventilation (1.8% vs 2.1%); p &lt; 0.0001 for each. Unadjusted in-hospital mortality among heart failure hospitalizations with and without mental disorders was 1.7% vs 2.2%. On adjusted analyses, mental disorders remained associated with lower odds of in-hospital mortality (adjusted odds ratio 0.8650 [95% CI 0.8149-0.9183]). The results were similar for the alternative modeling approaches, subgroup analyses, and classifications of heart failure. Conclusion: Mental disorders were associated with substantially lower risk of in-hospital mortality for patients with a principal diagnosis of heart failure.
Abstract 11832: Carotid Sinus Massage Can Obviate the Need for Tilt Table Testing in Patients With Undiagnosed Vasodepressor Syncope
Authors: Julie K Truong, Adeniyi Adelakun, Atul Prakash
Journal: Circulation (2023)

Introduction: Head-up tilt table (HUTT) testing is typically utilized for patients with syncope where the diagnosis is unclear but suspicion of a vasovagal etiology. Carotid sinus massage (CSM) can be used to elicit a vasopressor response though typically used to diagnose carotid sinus hypersensitivity. The usual protocol of HUTT consists of baseline CSM, 30-mins of HUTT, a repeat of CSM, and drug infusion. This is time-consuming and tedious. Hypothesis: CSM has a high predictive value for a vasodepressor response and may prevent the need for the completion of the HUTT protocol. Methods: Consecutive patients with clinical suspicion of vasovagal syncope underwent HUTT. Protocol consisted of baseline CSM in the supine posture, 30-mins of HUTT at 60 degrees, repeat CSM, and infusion of isoproterenol infusion from 1 to 3 mcg/min. Beat-to-beat blood pressure (BP) monitoring was performed non-invasively and standard cuff BP monitoring every minute. Positive tilt was defined as a drop in BP by more than 20 mmHg with reproducible symptoms (correlation to clinical symptoms). Results: 55 consecutive patients with a history of syncopal episode(s) underwent HUTT. 46 were females and 9 were male with a mean age of 54.4 ± 17.4 years old. They presented symptoms suggestive of a vasovagal etiology but were not diagnostic. 12 out of 55 (21.8%) patients had a positive reproducible response with supine CSM. 11 out of 12 of these patients subsequently had a positive result with protocol completion. This provided a positive predictive value (PPV) of 92%. 36 out of 55 (65.5%) patients had a negative response to CSM. All 36 had a negative result on completion of the HUTT protocol. This provided a negative predictive value (NPV) of 100%. 7 out of 55 (12.7%) patients had a “borderline” positive supine CSM. All 7 had a positive result with the completion of the HUTT protocol. Of note, these patients became positive only with isoproterenol infusion. Conclusions: CSM in the supine posture has a high PPV and NPV in eliciting a possible vasodepressor etiology. A full HUTT protocol may be only required in a patient who presents with a “borderline” CSM response in the supine posture. Therefore, CSM may easily be performed at the bedside with a monitor and a BP apparatus obviating the need for the full HUTT protocol.
Abstract 12077: Temporal Trends in the Prevalence of Atrial Fibrillation and Atrial Flutter in Septic Patients From 2010 to 2019
Authors: Muddasir Ashraf, Arshad Jahangir
Journal: Circulation (2023)

Background: Increased awareness of the importance of timely treatment of sepsis has led to improved sepsis care and outcomes over time in the USA. Research question: We evaluated the prevalence of atrial fibrillation (AF) and atrial flutter (AFL) in septic patients over time. Aims: The primary objective was to evaluate temporal trends in the prevalence of AF and AFL in septic patients. The secondary objective was to evaluate these trends stratified by age, sex, and race and ethnicity. Methods: Using the National Inpatient Sample, we studied all adult patients hospitalized with sepsis in the USA from 2010 to 2019. The year 2015 was not included due to changes in ICD coding in the last quarter. Results: Of 18.4 million adult patients admitted with sepsis from 2010 to 2019 in the USA, with a mean age of 65±0.038 years, 50% were female. The risk-adjusted rates of AF and AFL in septic patients showed an increasing trend over time (Panel A) after accounting for differences in age, sex, and comorbidity burden. AF and AFL occurred more frequently in the elderly than the young (Panel B). Sex-stratified analysis showed consistently higher rates of AF and AFL in males than females throughout the study period (Panel C). Finally, the risk-adjusted rates of AF and AFL were consistently highest in White patients, followed by Asian patients, compared with other races and ethnicities throughout the study period (Panel D). Conclusion: Despite improved treatment of sepsis, as evidenced by improving outcomes shown by many studies, the prevalence of AF and AFL in patients with sepsis in the USA has increased over time. This is likely due to sicker patients with sepsis now than in the past or to residual confounding owing to an increase in the elderly and comorbid patient population, which is not captured completely by the comorbidity index. White and Asian patients with sepsis had higher rates of AF than other racial and ethnic groups.