tbuckley/cabot-search huggingface dataset:
Abstract 14060: Health Disparities in Exercise Performance in Tetralogy of Fallot
Authors: Andrea L Jones, rui xiao, Paul Stephens, Laura M Mercer-Rosa, PAmela Weiss
Journal: Circulation (2023)

Introduction: Patients with tetralogy of Fallot (TOF) from disadvantaged racial and ethnic groups are reported to have worse outcomes, including worse exercise performance. The underlying mechanisms are not fully understood. Hypothesis: We hypothesize that the association of exercise performance with race is mediated by socioeconomic factors. Methods: We conducted a single center retrospective cohort study of TOF patients aged 8 - 30 years who underwent maximal exercise stress testing (EST) from 2007 - 2020. The primary outcome was percent-predicted maximum oxygen consumption (VO2). Addresses were geocoded. The Childhood Opportunity Index (COI) and its three domains represented neighborhood socioeconomic status. Generalized linear models and mediation analysis were used (Figure). Results: We included 154 subjects who underwent 273 ESTs (Table). Correcting for age at EST, sex, outflow tract repair type, and body mass index, those of non-Hispanic Black race had an 8.6% lower percent-predicted VO2 (95% CI -15.0, -2.2) than those of non-Hispanic white race. Mediation analysis showed that the COI mediates 90% of this relationship. By domain, Education is the strongest mediator and alone can account for 75% of this relationship. Conclusions: Disparities exist in exercise performance after TOF repair. Neighborhood-level factors, in particular related to Education, are significant mediators of the relationship between race and exercise performance in TOF. A detailed understanding of the driving mechanisms underlying health disparities, particularly those that are modifiable, is critical to eliminating those disparities at both the patient and societal levels.
Abstract 18510: Implanting a Novel Active-Fixation Leadless Pacemaker: A Single Center Experience With the Aveir VR
Authors: Nebu Alexander, Huzaifa Ahmad, Binaya Basyal, Rajiv Kabadi, Apostolos Tsimploulis, Malick Islam, Athanasios Thomaides, William S Weintraub, Sarahfaye Dolman, Zayd Eldadah, Cyrus Hadadi
Journal: Circulation (2023)

Background: The new Aveir VR (Abbott Medical, CA) active-fixation leadless pacemaker (LP) is the second LP system to become available in the United States after the Micra (Medtronic, MN) and offers design improvements over its predecessor, the Nanostim. It uses a unique mapping capability to help reduce repositioning attempts prior to fixation and utilizes a helical fixation mechanism for implantation and chronic retrieval. We describe the current largest real world descriptive single center experience with the new Aveir VR LP. Method: We describe characteristics and outcomes of patients who underwent implantation with the single chamber Aveir VR between May 2022 and June 2023. Data was collected from electronic medical records, and procedural logs. Variables collected included demographics (eg age, sex, race), procedural characteristics (e.g., procedure length, fluoroscopic duration), hospital length of stay and time to discharge, pacing parameters and complications. Results: A total of 88 patients underwent implantation with the single chamber Aveir VR. The most common indications were symptomatic bradycardia due to sinus node dysfunction (50%), atrioventricular block (34%), and atrial fibrillation with bradycardia (12.5%). Average age was 73.4 years, 52.3% were male, and 53.4% were African Americans. The median procedure duration was 83 minutes (range 36 - 298) and median fluoroscopy time was 10.3 minutes (range 1.4-41.6). Procedure duration improved from a median of 97.5 minutes in the first 10 cases to a median time of 64.5 minutes in the last 10 cases. The average number of mapping locations was 1.7, implant location was RV Apical Septum in 92% of patients, and 0.1% of patients required repositioning. The average R wave amplitude at implant was 7.3 mV (range 2.5-18 mV), average impedance was 763 Ω (range 310-1800), and average pacing threshold was 0.99V (range 0.25-4.5) at 0.4ms. There were no periprocedural complications with any of the implantations. The median hospital length of stay was 5.75 days (range 0.25-77.5), with median time from implant to discharge in elective patients of 50.5 hours. Conclusion: Our experience demonstrates that implantation of the single chamber Aveir VR LP to be safe and effective, comparable to trial data.
Abstract 362: Multicenter, Retrospective Study of Ventricular Fibrillation Visualized by Echocardiogram With a Non-Shockable Elelctrocardiogram Following Out-of-Hospital Cardiac Arrest
Authors: Robert Lindsay, Monica Kapoor, Timothy Gleeson, Romolo Gaspari
Journal: Circulation (2023)

Introduction: Cardiac rhythm by ECG can be different from cardiac rhythm visualized by echocardiography (echo). Cardiac arrest interventions are largely based on the ECG rhythm and some patients with ventricular fibrillation (vfib) demonstrating a non-shockable ECG may not be rapidly defibrillated. Hypothesis: A significant percentage of out of hospital cardiac arrest (OHCA) with vfib are unrecognized by ECG. Goals - To measure the prevalence and survival outcomes for patients with a non-shockable ECG but vfib by echo. Methods: Analysis of echo images recorded during a previous multi-center, observational study of OHCA patients. ECG and echo during initial pause in CPR at arrival to the Emergency Department (ED) were reviewed. Echo imaging was reviewed for the presence of visible vfib blinded to all patient information. Image interpretation was performed by two experienced physicians with adjudication by a third. ECG interpretation was unblinded to patient information. Primary outcome was survival to hospital admission. Data is presented as mean (95%CI) Results - Vfib was unrecognized by ECG in 31% of patients in vfib at ED arrival (22 of 71). See Figure. Survival to hospital admission for patients with ECG vfib (18.2%, 95%CI 10.2-30.3) and echo vfib (18.2%, 95%CI 6.7-39.1) was similar. All 55 patients who presented in ECG vfib were defibrillated immediately, and 11 of 22 patients with a non-shockable ECG but echo vfib were defibrillated, but during a subsequent pause in CPR. Patients with ECG vfib had no echo before defibrillation. Patients with echo vfib demonstrated ECG PEA (n=9, 41%), asystole (n=7, 32%), or ECG vfib defibrillated to a non-shockable ECG with continued echo vfib that was not subsequently defibrillated (n=6, 11%). Conclusion: A significant percentage of OHCA vfib was not recognized at arrival to the ED, with 31% demonstrating a non-shockable ECG rhythm but vfib on echo. OHCA survival rate for echo vfib is similar to ECG vfib.
Abstract 220: Association Between Initial Defibrillator Pad Position And Outcomes For Out-of-hospital Cardiac Arrest Patients Presenting With Shockable Rhythms
Authors: Joshua Lupton, Craig Newgard, David Dennis, Jack Nuttall, Ritu Sahni, Jonathan Jui, Matthew R Neth, Mohamud R Daya
Journal: Circulation (2023)

Background: Ventricular fibrillation (VF) or ventricular tachycardia (VT) are the most treatable causes of out-of-hospital cardiac arrest (OHCA). Yet, it remains unknown if defibrillator pad position, placement in the anterior-posterior (AP) or anterior-lateral (AL) positions, impacts patient outcomes in VF/VT OHCA. Aim: Evaluate the association between initial defibrillator pad placement (AP vs. AL) and OHCA outcomes for patients presenting with VF/VT. Methods: This was a prospective observational study of non-traumatic OHCA patients with initial VF/VT on EMS rhythm analysis treated by a single EMS agency in the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry) from July 1st, 2019 through October 15th, 2022. Our primary outcome was return of spontaneous circulation (ROSC) at any time and secondary outcomes were ROSC at emergency department (ED) arrival, survival to admission, survival to discharge, and functional survival (cerebral perfusion category score of ≤2). We performed t-tests, chi-squared tests, and multivariable logistic regressions adjusting for age, sex, witness status, bystander interventions, arrest location, 911 call to EMS arrival time, and year of arrest. Results: A total of 243 OHCA patients met inclusion criteria and 232 (95.5%) had initial pad positioning documented (133 AP and 99 AL). Patients with AP placement had higher rates of ROSC at any time (72.2% vs. 47.5%, p&lt;0.001), survival to admission (56.4% vs. 41.4%, p=0.024), survival to discharge (36.1% vs. 24.2%, p=0.050), and functional survival (36.1% vs. 21.2%, p=0.012) compared to AL, with no difference for ROSC at ED arrival (52.6% vs. 40.4%, p=0.065). AP versus AL placement showed higher adjusted odds (aOR [95% CI]) for ROSC at any time (2.76 [1.55-4.93]) and functional survival (2.06 [1.05-4.05]), but not ROSC at ED arrival (1.50, [0.85-2.64]), survival to admission (1.69 [0.96-2.96]) or survival to discharge (1.68 [0.86-3.27]). Among patients with ROSC at ED arrival, patients with AP placement, had shorter times from 911 call to sustained ROSC (21.0 vs. 28.4 min, p=0.013). Conclusions: Initial AP pad placement, compared to AL, was associated with higher ROSC, a reduction in time to sustained ROSC, and higher functional survival for patients with VF/VT OHCA.
Abstract 15442: Street Gang Territories and Hypertension in Chicago
Authors: Bruk Mekonen, Mustafa Agha Al Kola, Corey Tabit
Journal: Circulation (2023)

Hypertension is a major cardiovascular risk factor. Gang violence is an unfortunately common reality in urban communities and violence is associated with worse cardiovascular outcomes. However, the relationship between street gang territories and cardiovascular risk is unknown. We conducted a retrospective cohort study to determine if residence within a street gang territory is associated with higher blood pressure compared with demographically similar patients who resided outside of gang territories within Chicago. A balanced dataset of 1,016 unique-but-demographically-similar patients with at least 3 available pre-pandemic ambulatory blood pressure measurements at our urban, academic tertiary-care center were sampled from over 70,561 available patients. Patients were matched for the number of BP measurements, age, race, sex, and other sociodemographic variables. Patients were geo-coded and mapped, and known street gang territories were similarly geo-coded and mapped using publicly available data from the Chicago Police Department data portal. Out of 66 known street gangs in Chicago, our institution served patients from 28 unique gang territories. Patients residing within a known street gang territory had on average 6.2 mmHg higher BP than those living outside any known street gang territory (median = 133.2 vs 127.0, respectively,p&lt;0.001). SBP control in each unique street gang territory was highly variable with medians ranging between 108.8 to 165.0 mmHg (Figure). In conclusion, we find that residence within a street gang territory is associated with significantly higher systolic blood pressure compared with demographically similar patients who do not live in a gang territory. While poverty and other social determinants of health are known to affect hypertension and cardiovascular risk, residence within a gang territory may represent a new social risk factor for cardiovascular disease.
Abstract 11389: Circulating Aldosterone is an Independent Risk Marker for Left Main Coronary Artery Disease
Authors: Jindong Wan, Sen Liu, Xinquan Wang, Yi Yang, Dan Wang, Peng Zhou, Peijian Wang
Journal: Circulation (2023)

Background: Elevated plasma aldosterone concentrations reflect remodeling of the vascular wall and increased cardiovascular risk, whereas data from the left main coronary artery (LMCA) are lacking. Patients with stenosis of the LMCA present difficult challenges. Therefore, the aim of this study was to investigate the relationship between plasma aldosterone concentrations and LMCA in patients with hypertension. Methods: We recruited hypertensive patients with LMCA with assessed plasma aldosterone concentrations before disease onset from the hospital between 2018 and 2022 and set them as the case group. Simultaneously, an age- and gender-matched cohort with plasma aldosterone concentration measurements but without LMCA was selected as the control group using a ratio of 1:3. Multivariable logistic regression analysis was used to assess the relationship of plasma aldosterone concentrations with LMCA. Angiographically significant LMCA stenosis is defined as luminal diameter stenosis ≥ 50%. Results: A total of 608 hypertensive patients were identified in this study, including 152 cases and 456 controls. The mean age of the patients was 60.8 ± 17.5 years, and 389 (64.0%) were men. Compared with the control group, the case group exhibited significantly higher plasma aldosterone concentrations (15.38 versus 9.68 ng/dL, P =0.009). In logistic regression analysis, higher plasma aldosterone concentrations showed 2.73-fold higher odds (95% confidence interval [CI], 1.35-3.68, P =0.003) for the presence of LMCA, which was significant in the adjusted model (odds ratio, 2.02 [95% CI, 1.18-2.97], P =0.008). In a stratified analysis, males with coronary artery disease and women of all ages showed a relationship between the two. The link between the two was unaffected by sensitivity analysis that excluded those who were exposed to interfering substances during the measurement of plasma aldosterone concentration and those who had primary aldosteronism. Conclusions: This study indicated that higher plasma aldosterone levels were associated with an increased risk of LMCA in patients with hypertension, even in the absence of primary aldosteronism. Interventional studies are needed to elucidate the health effect of treatments to lower aldosterone levels.
Abstract 11433: Elevated Vascular Endothelial Growth Factor A is Associated With Disruption of Default Network Connectivity
Authors: Arunima Kapoor, Jung Yun Jang, Shubir Dutt, John Paul Alitin, Isabel Sible, Anisa Marshall, Fatemah Shenasa, Allie Engstrom, Aimee Gaubert, Amy Nguyen, David Robert Bradford, Kathleen E Rodgers, S. Duke Han, Daniel Nation
Journal: Circulation (2023)

Introduction: Vascular Endothelial Growth Factor A (VEGF-A) is an angiogenic signaling protein involved in the maintenance of the cerebral vasculature. VEGF-A may play a role in the pathogenesis of Alzheimer’s disease and vascular dementia; however, whether elevated VEGF-A levels indicate a pathophysiolocal response or protective mechanism remains unclear. No prior study has explored whether VEGF-A levels may be associated with changes in functional connectivity among brain regions prior to the development of cognitive decline. Hypothesis: Disruption of the default network often precedes the development of cognitive changes. In a sample of older adults, we hypothesized that VEGF-A levels may be associated with default network connectivity, indicating early involvement of VEGF-A in disease processes. Methods: Forty-six independently living older adults (mean age = 72.0 years; SD = 6.4; 34.8% male) free of dementia or clinical stroke underwent venipuncture and brain MRI. Plasma was assayed for VEGF-A. Using resting state functional MRI, blood-oxygen level dependent (BOLD) time series from all voxels in each region of interest (ROI) was averaged to determine mean ROI activity. Medial prefrontal cortex, lateral parietal cortex and precuneus cortex ROIs comprised the default network. Results: Accounting for age and sex, multiple linear regression analysis revealed a significant negative association between VEGF-A levels and default mode network connectivity (B =-.0007, 95% CI (-.0012, -.0002), p = .0096). This association persisted after adjusting for APOE4 carrier status and Framingham score. A significant association was present in both APOE4 carriers (p = .019) and non-carriers (p = .029). Conclusions: Prior studies evaluating the association between VEGF-A levels and cognition have been conflicted. This study is the first to examine whether VEGF-A may be linked to early changes in brain network connectivity which precede cognitive decline. These findings suggest that VEGF-A may be elevated early in the progression of neurocognitive disorders. Whether higher levels of VEGF-A contribute to the pathogenesis of neurocognitive disorders or play a protective role in persevering cognitive function warrants further investigation.
Abstract 16829: Systemic Arterial Pulsatility Index Correlates With Long Term Mortality in Cardiogenic Shock
Authors: ADAM PURVIS, Patrick Stafford, Alicia Rokicki, Kenneth Bilchick, Sula Mazimba
Journal: Circulation (2023)

Introduction: Systemic arterial pulsatility index (SAPi) is a marker for ventriculo-arterial coupling that incorporates the contractile properties of the left ventricle with aortic impedance. Prior studies have demonstrated the association of SAPi with adverse outcomes in advanced heart failure. The association of SAPi in cardiogenic shock has not been studied. We evaluated the association of SAPi with mortality in patients with cardiogenic shock with comparison to cardiac output. Methods: Consecutive patients with cardiogenic shock at University of Virginia from 01/2017 to 09/2021 with right heart catheterization data were included in this analysis. Baseline SAPi [systemic systolic blood pressure-systemic diastolic blood pressure]/pulmonary artery wedge pressure] and cardiac output were calculated on admission. Patients were stratified into high and low SAPi based on median SAPi. Cox proportional hazards regression was used to evaluate the association of SAPi stratas with mortality at 1 year. Receiver-operating characteristic (ROC) analysis was performed. Results: Among 120 patients (mean age 55.9, 34.1% female), 40 patients died (33.3%) within 12 months of admission. The median SAPi was 1.96 (IQR 1.25-2.49).Lower values of SAPi were associated with increased mortality at both 1 month (AUC =0.62, p=0.45) and 12 months (AUC =0.63, p=0.02) 12 months mortality with AUC of 0.63 (p=0.02) (Figure 1). The baseline cardiac output was not associated with this survival. Conclusions: In a contemporary cohort of cardiogenic shock patients, low SAPi was associated with increased mortality at both 1 and 12 months after admission for cardiogenic shock and provided better prediction than the baseline cardiac output. Further studies are needed to evaluate the utility of SAPi in hemodynamic monitoring of cardiogenic shock patients. Figure 1
Abstract 15446: Impact of Patient Demographics on Optimal Beta-Blocker Use After New-Onset Heart Failure: Analysis of the HF-OPT Study (Heart Failure Optimization Study)
Authors: Carsten G Jungbauer, Byron Colley, Michael Döring, David Duncker, Siva Gummadi, Orvar Jonsson, Lars S Maier, Christian Perings, Michael Robertson, Thomas Wittlinger, Christian Veltmann
Journal: Circulation (2023)

Background: While beta-blockers (BB) have helped to improved outcomes in patients with heart failure and a low ejection fraction (HFrEF), the titration to target doses has been suboptimal and it is not clearly understood why. The Heart Failure Optimization Study (HF-OPT) study in newly diagnosed HF patients (pts) collected baseline data, arrhythmias during wearable cardioverter defibrillator (WCD), as well as medications and dosing. Purpose: The objective was to assess which factors were associated with receiving BB at target doses by day 180. Methods: Data from pts with newly diagnosed HFrEF during WCD use was collected from 487 pts (54% from US, 72% male, age 59±13) in the HF-OPT study. Target dose of BB were defined as the lowest maximum dose from either the ESC or ACC/AHA/HFSA guidelines. Supraventricular tachycardia (SVT) was used to label all dysrhythmias originating at or above the atrioventricular node and captured by the WCD. Association between BB and other variables were assessed using logistic regression. Results: 6 months after a new diagnosis of HFrEF, 97% of pts were prescribed BB, but only 25% were on target doses. Univariate analysis showed that only BMI, age, sex, black race, a history of hypertension, and no history of PCI or angina, were associated with receiving target doses of BBs by 180 days. Having episodes of SVT during the first 180 days were also associated with receiving target BB doses (Table). In multivariate analysis, all were significantly associated with target BB dose except BMI, SVT during WCD use and history of PCI. Conclusions: The full beneficial effects of BB may not be achieved in patients with HFrEF if the patients are not recieving target doses. In the HF-OPT study, factors positively associated with reaching target BB doses included younger age, black race, being male, and a history of hypertension. Having a history of angina was associated with not achieving target BB doses. The significance of these differences should be further explored.
Abstract 15459: Statin Twitter: Human and "Bot" Contributions, 2010-2022
Authors: Samuel D Slavin, Adam Berman, Andrew Beam, Ann Marie Navar, Murray A Mittleman
Journal: Circulation (2023)

Background: Half of patients with ASCVD do not take statin medications despite proven efficacy and safety. Misinformation about statins drives skepticism about their use. Social media “bots” are known to proliferate misinformation, but involvement in statin-related discourse is unknown. Objectives: 1) to examine temporal trends in volume and sentiment of statin-related Twitter posts (tweets); 2) to compare statin-related content generated by humans and bots Methods: We queried Twitter for all tweets with statin-related terms from 2010-2022. We used a machine learning-derived classifier to determine tweet authorship as bot, human, or intermediate, and natural language processing to assign a sentiment score to each tweet. Manual qualitative analysis was performed on a randomly selected sample of all tweets and highly influential tweets to quantify statin skepticism. Results: We identified 1,155,735 original tweets (excluding retweets) with statin-related terms, the most common being “statin” (n=832,627, 72%) and “Lipitor” (n=197,015, 17%). Bots produced 333,689 (29%), humans produced 699,876 (61%), and intermediate accounts produced 104,966 (9.1%). Over the study period, the proportion of bot tweets decreased from 48% to 11%, human tweets increased from 44% to 80%, and intermediate tweets decreased from 7.7% to 6.7%. The proportion of negative sentiment tweets increased from 28% to 43% for bots, 31% to 38% for humans, and 29% to 40% for intermediate accounts. Including retweets, negative sentiment increased from 30% to 45% across all tweets. In a qualitative analysis of highly influential tweets, statin skepticism increased from 7% to 29% for bots and 25% to 36% for humans. Conclusions: Since 2010, humans have overtaken bots as generators of statin-related content on Twitter. Negative sentiment and statin skepticism have increased, especially among highly influential tweets. Misinformation interventions should focus on human users and influential bots.