tbuckley/cabot-search huggingface dataset:
Abstract 4146928: Inflammation, Adverse Cardiac Remodeling and Post-operative Atrial Fibrillation
Authors: Bernard Ofosuhene, Irina Radu, Taylor Orwig, Bella Vogt, Khanh-Van Tran
Journal: Circulation (2024)

Background: Post-operative atrial fibrillation (POAF) is a common and serious complication following cardiac surgery, leading to increased morbidity and healthcare costs. Inflammation, particularly mediated by cytokines like IL-17A, is believed to play a significant role in the pathogenesis of POAF. We aim to investigate the association between blood IL-17A levels and the incidence of POAF. Hypothesis: We hypothesize that elevated IL-17A levels in the blood are associated with a higher incidence of POAF in patients undergoing cardiac surgery. Methods: Blood samples were collected from 16 patients undergoing open heart surgery. Patients were monitored during the index hospitalization for the surgery. IL-17A levels in the blood were quantified using Olink proteomics, where oligonucleotide-labeled antibodies bind to target proteins, forming a new PCR target sequence by a proximity-dependent DNA polymerization event. Quantitative PCR measured the amplicons, and the Olink NPX Manager Software calculated Normalized Protein Expression Units (NPX) by normalizing the Cq values to interpolate controls. Statistical analysis was performed using Student's t-test to compare clinical variables and IL-17A levels across the two groups. Results: Our cohort had an average age of 63.8 ± 4.7 with 14% female participants, an average weight of 83.9 ± 14.6 kg, and an average BMI of 28.8 ± 4.7. The POAF group was slightly older (64.8 ± 3.8 years vs. 62.7 ± 4.6 years) but had a similar BMI compared to those who did not develop AF. Hypertension and hyperlipidemia were present in all POAF patients (100%) compared to 81.8% in those without AF, while anemia was more common in the POAF group (40% vs. 18.2%). IL-17A levels were significantly elevated in the POAF group (0.75 ± 0.10 NPX) compared to the non-POAF group (0.35 ± 0.05 NPX) with a p-value &lt; 0.05. Cardiac function assessments showed non-significant differences in left atrial volume index (LAVI) (46.2 mL/m^2 vs. 36.3 mL/m^2) and left ventricular mass index (LVMI) (114.4 g/m^2 vs. 89.3 g/m^2) in the POAF group. These findings suggest a significant association between elevated IL-17A levels and POAF, with trends of differences in left atrial remodeling between the two groups. Conclusion: Elevated blood IL-17A levels are associated with an increased risk of developing POAF. This suggests that IL-17A may serve as a critical biomarker and potential therapeutic target for preventing POAF in patients undergoing cardiac surgery.
Abstract 4147221: Surface Engineering Enhances the Therapeutic Potential of Systemically Delivered Extracellular Vesicles Following Acute Myocardial Infarction
Authors: Touba Tarvirdizadeh, Kyle Mentkowski, Cody Manzanero, Lisa Eagler, Gayatri Potekar, Jennifer Lang
Journal: Circulation (2024)

Background: Cardiomyocyte (CM) cell death is a sentinel event in the development of cardiomyopathy. It contributes to additional myocyte dysregulation, generating a positive-feedback loop which potentiates the evolution of heart disease. Accordingly, CMs represent an important therapeutic target in modulating the pathogenesis of cardiac disease. While extracellular vesicles derived from cardiosphere-derived cells (CDC-EVs) have emerged as therapeutic vectors for cardiovascular disease, their potential is limited by their biodistribution and necessity for direct intramyocardial injection. We hypothesized that CDC-derived EVs engineered to express a CM-specific binding peptide (CMP-EVs) with improved cardiac targeting would result in enhanced therapeutic efficacy when administered intravenously post-myocardial infarction (MI). Methods: Mice with acute MI underwent both intramyocardial and intravenous (IV) delivery of unmodified CDC-EVs, CMP-EVs and vehicle control in a double-blind study. Left ventricular ejection fraction (LVEF) was assessed by echo at 2- and 28-days post-MI and tissue samples processed for assessment of EV biodistribution and histological endpoints. Results: Mice treated with IV delivered CMP-EVs demonstrated a significant improvement in LVEF (57% ± 2% vs. 47% ± 3%) and a significant reduction in remote zone cardiomyocyte apoptosis (0.6 ± 0.2% vs. 1.9 ± 0.4%) when compared with IV delivered non-targeted EVs at 28-days post-MI (n=6-8 mice per group, mean± SEM, p&lt;0.05, one-way ANOVA followed by Tukey’s post-hoc test). Conclusions: Systemic administration of CMP-EVs enhances their ability to augment systolic function following acute MI when delivered via systemic route, demonstrating a strategy to optimize therapeutic EV delivery post-MI. This approach also facilitates repeated dosing which may be advantageous as a treatment strategy for several cardiovascular diseases.
Abstract 4146872: Analysis of 30-Day Readmission Rates and Costs Post-Heart Transplant: A 12-Year Retrospective Study Using Nationwide Readmission Database(NRD) : 2010-2021
Authors: Dheeraj Pinninty, Phanidhar Mogga, Karanrajsinh Raol, Ashwin Pillai, prathyusha Mudduluru, Kerry Singh, Zeina Jedeon, Abhishek Jaiswal
Journal: Circulation (2024)

Introduction: Increased prevalence and incidence of heart failure has resulted in a significant rise in the number of patients progressing to advanced heart failure (AHF). Heart transplant improves morbidity and mortality in patients with heart failure refractory to medical therapy. We examined resource utilization as measured in 30-day readmission in a contemporary population utilizing the NRD database. Aim: We conducted a thorough analysis to identify trends in 30-day readmissions of HTs and analyze the associated costs. Methods: Using the National Readmission Database from 2010 to 2021, the study focused on new HT recipients. We evaluated various parameters, including readmission rates and the costs associated with 30-day readmissions. Patients aged &lt;18 and those receiving HT and LVAD during the initial hospitalization were excluded from the study. Results: We identified 36,379 weighted index hospital admissions from January to December 2010 - 2021. The 30-day readmission rate fluctuated between 21% and 26% during this period, p—0.143 (Figure 1). There has been an upward trajectory in 30-day median readmission costs over the past decade, escalating from $13,027 in 2010 to $15,722 in 2021, with the highest readmission costs being $18,190 in 2020 (Figure 2). Conclusion: Over the last decade, 30-day readmissions among heart transplant recipients remain high in the US. Furthermore, associated costs continue to rise, and an unmet need remains to reduce the burden on healthcare resources. Despite some periods of improvement, the costs associated with readmission have increased by 20.69% since 2010. These findings underscore the need for targeted interventions to enhance post-transplant care, reduce readmission rates and manage costs more effectively.
Abstract 4146885: Association of Structural Remodeling and Mitral Annular Disjunction with Significant Premature Ventricular Contraction Burden in Patients with Mitral Valve Prolapse: A Cardiac Magnetic Resonance Imaging Study
Authors: Tess Calcagno, Tom Kai Ming Wang, Vidyasagar Kalahasti, Pasquale Santangeli, Oussama Wazni, Brian Griffin, David Chen, Christopher Nguyen, Jakub Sroubek, Deborah Kwon
Journal: Circulation (2024)

Background: Mitral annular disjunction (MAD) is identified by a displacement of the posterior mitral valve annulus into the left atrial wall and is commonly coexisting with mitral valve prolapse (MVP). MAD and MVP are both associated with a high prevalence of premature ventricular complexes (PVCs); however, the underlying mechanisms of increased PVC burden in these patients are unknown. We sought to determine the association between PVC burden, structural heart changes, and late gadolinium enhancement (LGE) in patients with MVP, with and without MAD. Methods: We analyzed patients with MVP who underwent cardiac magnetic resonance (CMR) imaging and 24-48hr Holter monitoring from 2020 to 2024. Patients with prior myocardial infarction or ischemic pattern LGE were excluded. LGE was characterized dichotomously as present or absent. Multivariate logistic regression was performed to assess significant independent associations with PVC burden &gt; 5%. Results: The study included 107 patients (mean age 53.2 ± 17.6 years old, female (65%), mean LVEDVi 99cc/m 2 , mean LVEF 58±8%, mean mitral regurgitant fraction 23±16%). There were 56 patients with MAD + MVP and 51 with MVP - MAD. PVCs &gt; 5% were noted in 26% of the cohort, and LGE was present in 32%. MAD was present in 52%, and 14% had mitral regurgitant fraction &gt;40%. Multivariate analysis identified MAD and sex-specific LV dilation as independent predictors of significant PVC burden. Mitral regurgitant fraction showed a trend towards significance, while LGE was not significantly associated with PVC burden &gt;5% (Figure 1). Conclusions: PVC burden &gt; 5%, MAD, and LGE were prevalent in patients with MVP referred for CMR evaluation. MAD and left ventricular (LV) dilation were independently associated and more strongly predictive of high PVC burden than LGE. Future studies are needed to investigate further structural mechanisms and potential interactions with myocardial fibrosis impacting electrical activity in patients with MVP.
Abstract 4146799: Medical Applications of Artificial Intelligence: Coronary Artery Segmentation, Lesion Identification and Measurement in X-Ray Angiography
Authors: Abhishek Raval, Karan Padariya, Pranay Soni, Harsh Kapadiya, Niraj Raghvani
Journal: Circulation (2024)

Background: Coronary artery segmentation, Lesion Identification and Measurement (CASLIM) on XRA images on X-ray angiography (XRA) are performed by cardiologists. Aims: The study, CASLIM aims to develop an end-to-end deep learning framework with integrated conventional image processing methods that accurately performs those tasks on XRA images. Methods: In depth analysis and comparisons of the deep learning models UNet, UNet+, Attention UNet, Trans UNet, SwinUNet, and UNet3+ comprising of the training curve and validation curve plotted against the epochs were carried out. The testing scores are obtained from the results of trained models on around 80 full size images. The data is presented for validity of the UNet3+ model as compared to the others. The performance of the proposed CASLIM analysis starts with the training results of the UNet3+ and other models for the coronary pixel segmentation. For UNet3+, patch sizes of 128*128 and 244*244 are studied to define the effect of patch sizes on performance. The model is trained on XRA images for accurate segmentation. (Image-1) Multiple image processing techniques are developed for lesion assessment. A dataset for training, validation and testing of the model is prepared by manual pixel annotation. Image processing algorithms are innovated to develop algorithms for catheter detection, its width measurement; subtract small arteries; thinning and pixel width measurement on binary mask images of arteries; detect, locate and quantify lesions. (Images-2,3) Experiments evaluated this method by comparing the lesion measurement results with the manually performed ones. Results: The dice score, 0.989; Structural Similarity Index Measurement (SSIM), 0.888; SSIM loss, 0.809 and Intersection Over Union, 0.979 of UNet3+ show its excellent performance and proximity to the ground truth in segmentation; overcoming the issues of intensity and position variations, noise and overlapping structures. The numerical testing performance report shows that the UNet3+ with a patch size of 128*128 performs the best. The lesion measurement by CASLIM shows a mean square error (MSE) value- 28.66 and an R squared (R2) value- 0.81 as compared to the manual process. The MSE- 69.91 and R2- 0.99 are obtained with the proposed method for lesion localization as compared to the manual process. Conclusion: The UNet3+ model has exceptional accuracy for precise segmentation. The CASLIM presents a promising solution for automated coronary lesion assessment accurately.
Abstract 4147132: Impact of Cannabis Use Disorder on Major Adverse Cardiovascular Events in Hospitalized Young Female Patients with Established Cardiovascular Disease Risk: A Nationwide Analysis from 2016-2020
Authors: Manaswini Krishnakumar, Monitha Pinnamaneni, Juhi Amin, Shefali Mody, Sai Priyanka Mellacheruvu, Aanchal Sawhney, Rupak Desai
Journal: Circulation (2024)

Introduction: Cannabis use disorder (CUD) has been associated with major adverse cardiac events (MACE). Additionally, preexisting cardiovascular disease (CVD) poses a major threat to young female patients, but the impact of CUD on MACE remains largely unexplored. Methodology: A retrospective cohort study was undertaken, utilizing data from the National Inpatient Sample dataset spanning from 2016 to 2020. Female patients aged 18-45 years with CVD risk factors (Hypertension, Diabetes Mellitus, Hyperlipidemia, Obesity) were divided into two groups: those with cannabis use disorder (CUD+) and those without (CUD-). Demographic characteristics, comorbidities, and MACE (myocardial infarction (MI), atrial fibrillation (AF), venous thromboembolism (VTE), cardiac arrest (CA), stroke, and all-cause mortality) were explored. Multivariable regression analysis was performed for all the outcomes reported under MACE. Results: Of the 7,245,508 hospitalized young females with CVD risk factors, 3.5% had CUD. CUD+ group was younger (31 vs. 33 years), had more Black patients (37.2 vs. 25.1%) and were more likely to be using Medicaid (59.2 vs. 42.4%). Comorbidities such as complicated diabetes (19.6 vs 13%), smoking (29.4 vs 15.7%), chronic pulmonary disease (22.4 vs 15.2%), drug abuse (64.1 vs 3.7%), alcohol use (10.1 vs 1.8%), and cocaine use (9.2 vs 0.7%) had higher prevalence in CUD+ group (p&lt;0.001). Higher prevalence of MI, CA, and stroke in the CUD+ group, and secondary outcomes showed lower cost of hospitalization, similar length of stay, and a higher number of patient transfers to intermediate care facilities. Multivariable analysis showed that CUD was associated with higher odds of stroke (aOR 1.20) and lower odds for VTE, CA and AF. Conclusion: Young female patients with CUD and established CVD risk factors present a unique clinical profile. While CUD seems to lower the odds of certain cardiovascular events, it significantly heightens the risk of stroke. This further increases the necessity for interventions and healthcare policies aimed at this specific population.
Abstract 4146803: Long-term outcomes of Abnormal Global Longitudinal Left Ventricular Strain during Sepsis: A propensity-matched cohort study
Authors: Sadhana Jonna, Lekhya Raavi, ivan huespe, Shahin Isha, Anna Jenkins, Abby Hanson, Anek Jena, Faiz Saleem, Arvind Balavenkataraman, Aysun Tekin, Vikas Bansal, sean caples, Syed Khan, Nitesh Jain, Rodrigo Cartin-Ceba, Bhavesh Patel, Ricardo Diaz Milian, Carla Venegas, Anna Shapiro, Anirban Bhattacharyya, Sanjay Chaudhary, Sean Kiley, Quintin Quinones, Neal Patel, Pramod Guru, Pablo Moreno Franco, Devang Sanghavi
Journal: Circulation (2024)

Introduction/Background: Patients admitted with sepsis are at risk of developing septic cardiomyopathy (SCM), which may elevate their risk of short-term mortality. However, the effect of SCM on long-term outcomes after sepsis is poorly understood. This study explores whether patients with sepsis and SCM have worse long-term outcomes compared to those without SCM. Research Questions/Hypothesis: What are the long-term major adverse cardiovascular events, including death, stroke, and myocardial infarction (MACE) 36 months after ICU discharge for septic patients with abnormal global left ventricular strain (LV GLS)? Methods: We conducted a retrospective study of 396 sepsis patients from August 2018 to September 2022, approved by the Mayo Clinic IRB. Patient demographics, comorbidities, echo parameters, and outcomes were collected. Due to the expected non-linear relation between LV GLS and Hazard Ratio (HR) of MACE we employed Cox regression analysis with Restricted Cubic Splines. Secondly, we divided the population into 2 groups, patients with and without normal LV GLS (between -23 and -16). The effect of non-normal LV GLS on MACE was evaluated using Cox regression weight by inverse probability weighting (IPWT) analysis after propensity score assessment, adjusting for diabetes, hypertension, BMI, history of stroke or myocardial infarction, chronic kidney disease, age, and sex. Results: Demographic variables did not differ significantly based on normal versus abnormal LV GLS. In the restricted cox regression with cubic spline models, we observed that patients with normal values had HR lower than one compared with patients without normal values (Figure 1). Secondly, we found that the HR of MACE in patients with normal LV GLS was significantly lower in the crude analysis (HR 0.66 [CI 95% 0.5, 0.86]; p&lt;0.01) and in the analysis adjusted by IPWT (HR 0.7 [CI 95% 0.53, 0.92]; p=0.01). Conclusion: Sepsis patients with abnormal global left ventricular strain (LV GLS) have a higher risk of major adverse cardiovascular events (MACE) within 36 months post-ICU discharge compared to those with normal strain. LV GLS values outside the range of -23 to -16 are associated with increased risk. Monitoring LV GLS in sepsis patients is important for identifying those at elevated risk for long-term cardiovascular complications.
Abstract 4147143: The value of high coronary artery calcium score (CACS) in prediction of stroke incidence.
Authors: Natale Wasef, Andrii Maryniak, Filip Oleszak, Melissa Pham, Catherine Hajek, Shubhi Bartaria, SHAOPENG GU, Xiuqing Guo, Jerome Rotter, Eric Larson, Adam Stys, Marian Petrasko, Naveen Rajpurohit, Tom Stys
Journal: Circulation (2024)

Introduction: In multiple recent studies, a higher coronary artery calcium score (CACS) has been associated with a higher risk of MACE and all-cause mortality. The relationship between coronary artery calcium (CAC) and the incidence of stroke is poorly defined. Method: Patients were obtained from the Sanford heart screening program from April 25, 2011 through June 23, 2023. The sample was limited to only those who underwent a CACS. A high CACS was deemed as anything greater than or equal to 300, whereas anything lower was identified as non-high CACS. The odds ratio was calculated via multiple logistic regression to analyze the data. Results: A total of 33249 patients with CACS were analyzed in this study. The average age of the patients is 56.19 (SD =9.97) and 46% of them are male. Among all the patients in the study, 3529 had a high CACS, of which 399 of them had stroke (11.3%). Our study shows that there is a positive effect between a high CACS and the incidence of stroke. The odds of having stroke are predicted to be 1.95 times larger in patients with high CACS (P-value &lt; 0.001). In comparison to the patients who smoke frequently, the odds of developing a stroke shrink by a factor of about 0.53 and 0.48 for patients who do not smoke (P-value &lt; 0.001) and patients who smoke occasionally (P-value=0.003), respectively. Furthermore, a five-year increase in age results in a 32% increase in odds of developing a stroke for patients with CACS less than 300 (P-value &lt; 0.001), and a 17% increase in odds of developing a stroke for patients with high CACS (P-value = 0.006). However, for each additional year after CACS testing, the odds of stroke decreased by 18%, for patients with CACS less than 300 (P-value &lt; 0.001), and 27%, for patients with high CACS (P-value &lt; 0.001), likely due to interventions done. Conclusion: Our study showed that a high coronary artery calcium score predicts an increased incidence of stroke in our patient population.
Abstract 4147142: Inhaled Benzene Exacerbates Atherogenesis and Compromises Plaque Composition and Stability
Authors: Igor Zelko, Breandon Taylor, Marina Malovichko, Samantha McFall, Daniel Conklin, Hong Chen, Michelle Barati, Michael Merchant, sanjay srivastava
Journal: Circulation (2024)

Background: Benzene is a ubiquitous environmental pollutant abundant in automobile exhaust, cigarette smoke, forest fires, and present in several household products. It is ranked # 6 on Agency for Toxic Substances and Disease Registry (ATSDR) priority list, however, little is known about its effect on cardiovascular disease, especially atherosclerosis. Hypothesis: Inhaled benzene induces atherogenesis by increasing vascular inflammation in LDL receptor Knockout (LDLR-KO) mice. Methods: Male LDLR-KO or apoE-KO mice were exposed to HEPA-filtered air or benzene (1.0 or 10.0 ppm, 6h/day, 5 days/week) for 24 weeks and maintained on Western diet for the last 12 weeks of exposure. Atherosclerotic lesion composition and nature were determined by liquid chromatography-mass spectrometry (LC-MS), single nuclei RNA sequencing (snRNAseq), and Cytometry by time of flight (CyTOF). Results: Inhaled benzene exposure significantly increased lesions in the aortic valves (&gt;25%, P&lt;0.05). Single cell RNA sequencing of the aortae of benzene-exposed mice revealed 11 major cell types (e.g., vascular smooth muscle cells (VSMCs), endothelial cells, macrophages, T cells, etc.) categorized into 23 sub-populations. snRNAseq and CyTOF analysis showed that benzene exposure robustly increased (P&lt;0.05) CD4 + and CD8 + T-cells, and B-cells in the lesions. Clustering of T cells showed significantly higher expression (P&lt;0.05) of CD4, CD8, and Th17 marker RAR Related Orphan Receptor C (RORc). snRNAseq data also suggested increased cell proliferation and &gt;1.5-fold increase in VSMC number following benzene exposure. LC-MS analysis revealed that benzene exposure differentially regulated the abundance of 930 proteins (at least 2 two unique peptides) in innominate plaque. Importantly, several of the proteins involved in an extracellular matrix organization and elastic fibre formation (e.g. Elastin, Fibronectin , and Latent transforming growth factor beta binding protein 1 ) were downregulated in benzene-exposed mice. These data agree with the snRNAseq data. In vitro , benzene metabolite hydroquinone (HQ, 1 μM) induced ROR-gamma, the transcription factor that regulates Th17, in spleen-derived CD4 + T cells (P&lt;0.05). HQ (0.1 μM) also increased protein kinase C activity and proliferation of human aortic smooth muscle cells (P&lt;0.001). Conclusion: Benzene exposure exacerbates atherosclerosis and compromises plaque cellularity and stability.