tbuckley/cabot-search huggingface dataset:
Abstract 12248: Anemia Impacts Mortality, Length of Stay and Resources Utilization on Patients Admitted With Primary Diagnosis of Ventricular Tachycardia: A Nationwide Analysis 2016 - 2020
Authors: Ricardo Carvalhais, Kamran Mahfooz, Kenneth Ong, Syed Ashfaq Najeed
Journal: Circulation (2023)

Introduction: Ventricular Tachycardia is a life threating arrhythmia with large admission amount. In this analysis, authors aim to investigate the impact of anemia in patients admitted due to ventricular tachycardia in terms of mortality, length of stay and total hospital charges. Methods: This is an analysis of the National Inpatient Sample Database of the years 2016-2020. Adult patients admitted non elective with a primary diagnosis of ventricular tachycardia, with or without a secondary diagnosis of anemia were identified using the ICD-CM codes. The primary outcome was mortality. Secondary outcomes were length of stay and resources utilization. Multivariate logistic analysis was performed, and outcomes were adjusted by age, gender, race, Charlson comorbidity index, hospital location, size, region, teaching status and insurance. Data was considered statistically significant with p-value &lt;0.05. Results: Among 221720 patients who had a primary diagnosis of ventricular tachycardia, 17.56% had anemia. Adjusted mortality was significantly different in patients with secondary diagnosis of any anemia with odds ratio 1.95, p value &lt; 0.001, 95% Confidence Interval 1.73 - 2.2. In terms of Length of Stay, patients with anemias of any type stayed 3.09 more days in the hospital when compared to general population, p value &lt; 0.001, 95% Confidence Interval 2.78 - 3.41. Patients with anemia also had an increase on their total hospital charges by 61507.92 dollars, p value &lt; 0.001, 95% Confidence Interval 53771.36 - 69244.48. Conclusions: Patients with anemia had 1.95 higher mortality rate, stayed 3.09 more days in the hospital and had a total hospital cost higher by 61507.92$. Anemia can be a risk marker within patients admitted with ventricular tachycardia, more studies needed to investigate if the treatment of anemia improves the outcome.
Abstract 12710: The Role of Cellular Senescence in Aortic Dissection
Authors: Eichi Nakao, Hiroki Aoki, Ryohei Majima, Youhei Hashimoto, Ryo Shibata, Makiko Hayashi, Satoko Ohno, Aya Furusho, Norifumi Nishida, Saki Hirakata, Yoshihiro Fukumoto
Journal: Circulation (2023)

Background: Aortic dissection (AD) is a catastrophic disease with high mortality and serious complications, and its molecular pathogenesis is largely unknown. The importance of inflammation in AD has been reported. Recently we found that cell proliferation precedes the inflammatory response in AD. Cell proliferation causes cellular senescence that induces inflammatory response, however, role of cellular senescence in AD has not been elucidated. Objective: We investigated if cellular senescence contributes to AD pathogenesis in mouse AD model. Methods and Results: A mouse AD model was created by continuous infusion of beta-aminopropionitrile and angiotensin II (BAPN+AngII) for 14days. BAPN+AngII infusion induced senescence markers from day 3, before AD onset, and persisted until day14. Senescent cells, as demonstrated by the expression of senescence-associated beta-galactosidase, were evident in intimal endothelial cells, medial smooth muscle cells, adventitial macrophages, and fibroblasts. To examine role of cellular senescence in AD, we orally administrated ABT263 known as “senolytics” that eliminates senescent cells. ABT263 treatment reduced the expression of the senescence markers. The AD mortality of ABT263 group was 35%, which was lower than that of vehicle group(66.7%, P &lt; 0.05 by log-rank test). The severity of AD, as assessed by the lesion length in vehicle group was 33.2 ± 3.1mm, whereas that in ABT263 group was 24.6 ± 1.8mm (P &lt; 0.05). Transcriptome analysis revealed that ABT263 treatment suppressed the immune and inflammatory response in the aorta before AD onset. Quantitative RT-PCR confirmed that ABT263 treatment prevented the induction of p21Cip1, interleukin-6 and several chemokines. Bioplex analysis of mice’s serum showed that ABT263 decreased inflammatory molecules in mice’s serum compared to vehicle group. Moreover, aortic smooth muscle cells(SMCs)remained contractile phenotype in ABT263 group, whereas BAPN+AngII reduced the phenotype in vehicle group. Conclusions: Elimination of senescent cells prevented AD progression and death in mice. ABT263 suppressed the inflammatory response and contributed to retain the SMCs phenotype. Cellular senescence represents a potential predictor and a therapeutic target for AD.
Abstract 16204: Scaling Hearts: Exploring the Link Between Psoriasis and Infective Endocarditis in Pacemaker Patients
Authors: Ahmad Mustafa, chapman Wei, Shahkar Khan, Taqi A Rizvi, John Afif, Nawal Mustafa, Radu Grovu, Suzanne Elsayegh, Mitchell Weinberg
Journal: Circulation (2023)

Introduction: Device related infective endocarditis (IE) is associated with high morbidity and mortality resulting in a growing emphasis on identifying and managing comorbidities that increase the risk of IE in these patients. Psoriasis, a chronic inflammatory skin disorder with multifactorial etiology, is increasingly being identified as having multiple cardiovascular manifestations. However, little is known about the impact of psoriasis on IE risk in patients with permanent pacemaker (PPM). Hypothesis: Psoriasis patients with PPM have an increased risk of developing IE. Methods: Patients with a history of PPM implantation were sampled from the National Inpatient Sample Database (2016 - 2018). Comorbidities were identified using ICD-10 codes. Individuals with age &lt; 18, history of endocarditis, immunosuppression, central line associated infections, intravenous drug use, and implantable cardiac defibrillators were excluded. Patients were stratified into two groups based on the presence of psoriasis. A univariate analysis followed by a multivariate analysis adjusting for age, gender valvular disease, dental infections, coronary artery disease, and sixteen other comorbidities was performed. Furthermore, 1:10000 propensity score matching was performed between the psoriasis and non-psoriasis groups and rates of IE were calculated. Results: Out of the 437,728 patients included in the study, 45 (4.4%) had psoriasis. Psoriasis patients were older and had more coronary artery disease. Psoriasis patients had significantly higher rates of endocarditis (4.4% vs 0.6%; p&lt;0.001). On multivariate analysis, psoriasis was linked to a 7.2-fold higher IE risk compared to patients without psoriasis (OR: 7.2 [1.7-30.2]; p=0.007). Post-match analysis showed similar results with 8.3-fold higher rates of IE in psoriasis patients (OR: 8.3 [2.0-34.4]; p&lt;0.001). Conclusions: Psoriasis was independently associated with elevated risk of IE in patients with PPM. The chronic inflammatory state associated with psoriasis likely contributed to this risk. Further large-scale studies are required to corroborate these findings as this will have implications on consideration of IE prophylaxis for these patients.
Abstract 17026: Predictors of Exercise Performance in Pediatric Heart Transplant Recipients
Authors: Tracy Curran, Jennifer Pymm, Suellen M Yin, Yisong Huang, Tajinder P Singh, Naomi Gauthier
Journal: Circulation (2023)

Introduction: Previous studies have shown that peak oxygen consumption (VO 2 ) is impaired in pediatric heart transplant (HT) recipients compared to healthy controls. This impairment in exercise performance is variable among patients, however. Research Question: What are the predictors of exercise performance in pediatric HT recipients? Aim: To assess the association of demographic (age at HT, sex, BMI, diagnosis, duration since HT), echocardiographic (LV volume z-scores, ejection fraction), hemodynamic (cardiac index, filling pressures), hematologic (hematocrit) and pulmonary (FEV1, FVC) factors with percent predicted peak (ppp) VO 2 in pediatric HT recipients. Methods : The first cardiopulmonary exercise test (CPET) performed in each HT recipient at our institution from 2003-2021 was assessed. Imaging, catheterization, and laboratory data closest in time to CPET were used. A multivariable linear regression model was developed to assess independent predictors of pppVO 2 . Results: Of 154 patients studied, 46% were female, age at HT was 9.6 ± 6 years, age at CPET was 15.4 ± 4.9 years, and time since HT was 5.8 ± 4.4 years. LV ejection fraction was 60 ±10%, pulmonary capillary wedge pressure was 12 ±4mmHg, FVC was 81 ±20% predicted, and mean pppVO 2 was 70 ± 18%. Multivariable analysis showed the age at transplant (β=-3.02/year, p&lt;0.001) and duration since HT (β=-2.4/year, p=0.02) were significantly associated with pppVO 2. No other clinical factors were significantly associated with pppVO 2 . Variability in pppVO2 among patients was mostly explained by the variability in ppp O2 pulse (Pearson correlation coefficient, r=0.88) and surprisingly, much less by variation in ppp heart rate (r=0.3). Conclusions: Older age at HT and longer duration since HT are both independently associated with lower pppVO 2 among pediatric HT recipients whereas all other clinical factors were not. Further research is warranted to explore changes in exercise performance in this patient population longitudinally. The stronger mechanistic correlate with ppp O2 pulse (surrogate for stroke volume) rather than with ppp heart rate suggests that interventions such as rehabilitation/exercise training may improve exercise performance in pediatric HT recipients.
Abstract 15862: Risk Prediction Model for Early Detection of Left Bundle Branch Associated Nonischemic Cardiomyopathy: Insights From the UK Biobank
Authors: Jeffrey Kingsley, Prashant Bhave, Raman Mitra
Journal: Circulation (2023)

Introduction: Ventricular dyssynchrony resulting from left bundle branch block (LBBB) can lead to development of nonischemic cardiomyopathy (NICM) in some individuals. Increasing evidence suggests early treatment with cardiac resynchronization therapy yields a greater treatment effect while a delayed diagnosis of LBBB NICM may fail to capture the critical period to reverse the progressive myocardial damage. Early identification of LBBB patients most likely to develop NICM would be valuable to clinical management. Methods: International classification of diseases (ICD) codes from the linked health data in the UK Biobank were used to identify individuals with LBBB NICM along with baseline demographics and comorbidities. Logistic regression models adjusted for covariates in baseline characteristics were used to identify early predictive indicators based on electrocardiogram (ECG) parameters and physical activity data obtained at time of enrollment into the UK Biobank Results: Among 3,766 individuals with LBBB, 481 developed LBBB NICM. The adjusted logistic regression analyses demonstrated a one standard deviation increase in p-axis was associated with a 128% higher incidence of LBBB NICM (OR 2.28, CI 1.10-4.73, p=0.01) and an increase of one day per week of vigorous physical activity was associated with an 8% lower incidence of LBBB NICM (OR 0.92, CI 0.87-0.98, p=0.006). A risk prediction model using the predictive indicators of p-axis and vigorous activity per week yielded an area under the receiver operating characteristic curve of 0.87. Conclusions: A risk prediction model using ECG parameters and physical activity was developed which provides personalized estimation of the likelihood of development of NICM in individuals with LBBB using readily accessible clinical parameters. Further investigations are necessary to refine risk stratification strategies, validate this in a larger population, and optimize patient management based on these findings.
Abstract 251: Approach to Prognostication for Patients Enrolled in a Post-Arrest Clinical Trial
Authors: Alexis M Steinberg, Yanran Yang, Baruch Fischhoff, Clifton W Callaway, Patrick J Coppler, Romergryko Geocadin, Robert Silbergleit, Sharon D Yeatts, William J Meurer, Jonathan Elmer
Journal: Circulation (2023)

Introduction/Background: Neuroprognostication after cardiac arrest is complex and the way clinicians prognosticate is not well understood. Research Question/Hypothesis: How do clinicians describe their approach to post-arrest prognostication in general and in specific patients they have treated? Goals/Aims: Characterize one or more prevailing themes in clinical decision-making about neuroprognostication. Methods/Approach: We surveyed and performed semi-structured interviews with clinicians who had cared for a subject enrolled in the Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (ICECAP) trial (NCT04217551). We performed interviews after trial subject died or was discharged. Our interviews explored clinician’s approach to neuroprognostication. Two authors (AS and YY) independently performed thematic analysis using inductive coding, then discussed any discrepancies and reached a consensus. Early in coding, we identified “clinical gestalt” as a common theme, defined as prognosticating based on patients overall appearance or impression of their history in the absence of any definitive prognostic tests. Each clinician provided their demographic information and local standard practices. We presented emerging themes and discrete responses with descriptive statistics as appropriate. We did not have access to subjects’ clinical identifiers or treatment arm of the trial. Results/Data: We interviewed 30 clinicians, who practiced at 19 US hospitals. Clinicians were primarily attendings (n=20) and most practiced critical care (n=21). Many (21/30) clinicians reported using clinical gestalt to formulate their early impressions. Of these, 9/21 reported high certainty in their initial predictions. Clinical gestalt informed both prediction of good and poor outcomes. Clinicians described different ways of incorporating gestalt into prognostication, including arrest history (17/21), severity of initial shock or multi-system organ failure (13/21), past clinical experience (10/21), comorbidities (10/21), and patient physical appearance (6/21). Conclusion: Clinicians often use gestalt when formulating early impressions of patient’s prognosis, an approach rarely discussed in prognostication literature.
Abstract 17623: Estrogen-Mediated Small GTP-Binding Protein GDP Dissociation Stimulator Induction Contributes to Sex Differences in Resilience to Ferroptosis in Takotsubo Syndrome
Authors: Ti Wang, Ting Xiong, Xuesong Liu, Yuxue Yang, Xiwei Chen, Beibei Zhou, Zhiyong Lin, Daxin Wang
Journal: Circulation (2023)

Introduction: Declining estrogen (E2) has been associated with disproportionate susceptibility to takotsubo syndrome (TTS) in postmenopausal women. Small GTP-binding protein GDP dissociation stimulator (SmgGDS), as a key modulator of cardiovascular disease, plays protective roles in reducing oxidative stress and exerts pleiotropic effects of statins. Whether SmgGDS levels are influenced by E2 status and the effect of SmgGDS on sex differences in TTS are poorly understood. Methods: Clinical data were reviewed from TTS inpatients. Echocardiography, immunofluorescence, and immunohistochemistry were performed together with expression analysis to uncover phenotypic and mechanism changes in sex differences in TTS-like wild-type ( WT ) and SmgGDS +/- mice. HL-1 cardiomyocytes were used to further examine molecular mechanisms. Results: In 14 TTS inpatients, TTS had a higher incidence in postmenopausal women as compared to premenopausal women and men. In murine TTS, female WT mice exhibited higher cardiac SmgGDS levels than male WT mice. Ovariectomy reduced SmgGDS expression in female WT mice, whereas E2 replacement reversed this effect. The physiological importance of this sex-specific E2-mediated SmgGDS response is underscored by the disparity in cardiac adaptation to isoproterenol (ISO) stimulation between both sexes of WT mice. E2-mediated SmgGDS induction conferred female cardioprotection against ferritinophagy-mediated ferroptosis. No such cardioprotection was observed in male WT mice and ovariectomized (OVX) female mice. A causal role for SmgGDS in this sex-specific cardioprotective adaptation was indicated, inasmuch as SmgGDS deficiency abolished E2-modulated cardioprotection against ferritinophagy and aggravated TTS progression in both sexes. Consistently, knockdown of SmgGDS in HL-1 cardiomyocytes exacerbated ferritinophagy and abrogated the protective role of E2 against ferritinophagy. Mechanistically, our findings revealed that SmgGDS deficiency abolished E2-conferred protection against ferritinophagy through activating AMPK/mTOR pathway. Conclusions: These results demonstrate SmgGDS is a central mediator of E2-conferred female cardioprotection against ferritinophagy-mediated ferroptosis in TTS.
Abstract 14129: Identification of Highly Correlated Sub-Networks of Cardiovascular Ageing Imaging Markers With 10-Year Predicted Risk Scores
Authors: Kieran Tan, Gayathri Basker, Keerthana Thangaraja, Fei Gao, Si Yong Yeo, Loon Yee Teo, See H Ewe, Ru S Tan, Angela S Koh
Journal: Circulation (2023)

Introduction: While Framingham 10-year risk scores (FRS) estimates cardiovascular disease (CVD) risk in older adults, few studies have benchmarked these estimates against age-related changes in cardiac structure and function, which are complex and highly inter-related. We investigated associations between cardiovascular (CV) imaging markers and FRS, vascular age, calculated regression, and determined connectivity between them in a network analysis. Methods: Participants recruited from a community-based cohort without CVD completed standardized questionnaires that collected baseline clinical factors, from which FRS, vascular age and calculated regression were derived. Cardiac structural and functional parameters were obtained via echocardiography. Results: 202 participants (46.0% women, mean age 70.2 SD8.8) were included in this analysis. CV imaging markers correlated across a spectrum with FRS, vascular age and calculated regression. Predictive features and their associations by pearson correlation (nodes containing the variables; edges denoting links) (Fig 1) show significant associations. In ageing, this network showed that E/A ratio is inversely linked to FRS, vascular age and calculated regression while LVEF has a weak association with FRS and vascular age, without direct relationship with E/A ratio. While LAVI is associated with FRS and vascular age, LAVI is associated with E/E1 and not E/A ratio nor LVMI. Multivariate regression confirmed independent associations between FRS and vascular age with E/A ratio (b=-7.03, 95% CI -10.55, -3.52, p &lt; 0.001; b= -15.13, 95% CI -19.33, -10.93, p &lt; 0.001) and E/E prime ratio (b= 0.33, 95% CI 0.03 - 0.63, p = 0.033; b=0.66, 95% CI 0.30 - 1.02, p &lt; 0.001). Conclusion: This structural collation of associations depicted different sub networks of cardiovascular imaging features into context. FRS, vascular age and calculated regression were associated with imaging markers of CV ageing at various network levels.
Abstract 17578: Improving Access to Care With a Structural Heart Disease Program in a Metropolitan Public Healthcare System
Authors: Rafael Harari, Samuel Bernard, Binita Shah, Ambika Nayar, Adam Small, Randal Goldberg, Dan Halpern, Michael DiVita, Kenneth Sutin, sara rostanski, Kaitlyn Lillemoe, Jennifer Cruz, Lindsay Elbaum, peter neuburger, Syed Hussain, Mireia Padilla Lopez, Kah-Loon Wan, Nicolette Kroczynski, Sudheer Jain, Carlos L Alviar, Sripal Bangalore, Norma Keller
Journal: Circulation (2023)

Background: Public hospitals face challenges in providing access to structural heart interventions due to limited resources. Our aim is to describe the implementation and outcomes of a comprehensive, multi-disciplinary Structural Heart Disease Program (SHDP) in the largest public healthcare system in the United States, as a strategy to mitigate healthcare disparities and improve access to care. Methods: The SHDP at Bellevue Hospital serves as the referral center for 11 public hospitals in New York. It launched in 2022 and added a hybrid OR in March 2023. We collected clinical, demographic, and socioeconomic data for patients undergoing structural heart interventions. Results: A total of 56 patients were included from January 2022 to June 2023. The median age was 60 years (22-93 years), 59% were women, 41% were Black, 38% Hispanic, 11% White and 9% Asian. Most patients were immigrants (71%), 28.5% were uninsured, 37.5% were undocumented and 41% required an English interpreter. Only 21% of patients completed high school and 9% completed college. The most common procedure was PFO closure (30%) followed by M-TEER and BAV (Figure 1). For TAVRs and M-TEERs combined, the 30-day re-admission rate was 7.1% (n=1) and 30-day mortality was 0%, with no differences by ethnic group. Length of stay varied by procedure and there were low rates of procedural complications (Table 1). Conclusions: Our multidisciplinary SHDP program demonstrates feasibility to provide care to underserved populations in a public healthcare system with excellent outcomes. Further study of strategies aimed at improving access to structural heart interventions is warranted.
Abstract 17400: Effects of Concurrent Extracellular Vesicle and Metformin Therapy in Porcine Model of Chronic Myocardial Ischemia and Metabolic Syndrome
Authors: Sharif A Sabe, Dwight D Harris, Mark Broadwin, Mohamed Sabra, Cynthia Xu, Ruhul Abid, Frank W Sellke
Journal: Circulation (2023)

Introduction: We previously demonstrated using a swine model of chronic myocardial ischemia (CMI) that extracellular vesicle (EV) therapy improves cardiac function, perfusion, and angiogenic signaling, but these benefits were blunted in the setting of metabolic syndrome (MS). Hypothesis: We hypothesized that concurrent treatment with metformin may augment the cardiac effects of EV therapy in a swine model of CMI and MS. Methods: Twenty-nine Yorkshire swine were fed a high fat diet for four weeks to induce MS, then underwent placement of an ameroid constrictor to the left circumflex artery to induce CMI. Two weeks later, pigs receiving either oral placebo or 500mg metformin (MET) BID underwent intramyocardial injection of either vehicle or mesenchymal stem cell-derived EVs. This resulted in four groups: placebo+vehicle (CON, n=6), placebo+EV (EV, n=8), MET+vehicle (MET, n=7), and MET+EV (METEV, n=8). Five weeks after injection, pigs underwent functional measurements and harvest of ischemic myocardium. Perfusion, capillary density, and protein expression were measured by microspheres, immunofluorescence, and immunoblotting respectively. Results: Cardiac function was improved in EV compared to CON (SV p=0.02, SW p=0.01, CO p=0.03), and in MET compared to CON (SV p=0.03, SW p=0.09, CO p=0.2), though there were no differences between MET and METEV groups (p&gt;0.5 for all). Contractility as measured by slope of PRSW relationship was improved with METEV compared to CON (p=0.04), with a trend towards improvement in MET compared to CON (p=0.21), but not with EV alone. During pacing, there was increased perfusion in MET (p=0.04) and METEV (p=0.04) groups compared to CON. At rest, there was increased perfusion in MET (p=0.05) group, with a trend towards increased perfusion in METEV group (p=0.29) compared to CON, without differences between MET and METEV (p&gt;0.5). Capillary density was unchanged in METEV compared to CON (p&gt;0.5). The MET and METEV groups had decreased expression of p-Akt (p=0.01, p=0.06) and p-ERK (p=0.09, p=0.03) compared to CON, without changes in p-eNOS (p&gt;0.5), and all without differences between MET and METEV (p&gt;0.5). Conclusions: In the setting of CMI and MS, the blunted effects of EVs are not augmented by concurrent metformin therapy.