tbuckley/cabot-search huggingface dataset:
Abstract 12341: Cardiometabolic Comorbidity Burden and Risk of Hospitalization in Heart Failure Patients
Authors: Carine Hamo, Xiyue Li, Chiadi E Ndumele, Amrita Mukhopadhyay, Samrachana Adhikari, Saul Blecker
Journal: Circulation (2023)

Background: Cardiometabolic comorbidities, obesity, diabetes, and hypertension, are highly prevalent in heart failure (HF). However, the implications of comorbidity burden on all-cause hospitalization, overall and among HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), are unknown. Hypothesis: Higher cardiometabolic burden is associated with increased hospitalization in individuals with HF. Methods: In a retrospective EHR-based cohort of adults 18 with HF, we categorized individuals based on the number of cardiometabolic comorbidities present prior to 10/1/2021. Specifically, we defined presence of hypertension and/or diabetes mellitus by diagnosis code, and obesity by BMI 30kg/m2. Cox regression models were used to assess the association between number of cardiometabolic comorbidities and time to all-cause hospitalization within 1 year, adjusting for age, sex, race, and insurance status. Separate analyses were also conducted for HFpEF and HFrEF subgroups. Results: There were 26,800 individuals with HF in the study population (mean age 75 13.7, 46% female, 69% White) who experienced 4,284 (16%) hospitalizations over a 1-year period. Compared to those with absent comorbidities (n=3,420), there was an increase in risk for all-cause hospitalization with increasing number of comorbidities, with adjusted hazard ratio (HR) 1.19 (95% CI 1.05-1.34) for 1 comorbidity (n=7,988), HR 1.25 (95% CI 1.11-1.41) for 2 comorbidities (n=9,553), and HR 1.43 (95% CI 1.26-1.62) for 3 comorbidities (n=5,839). ( Figure ) A similar association was also seen for the HFpEF subgroup, but not for the HFrEF subgroup. Conclusions: Greater number of cardiometabolic comorbidities (hypertension, diabetes, and obesity) was associated with increased risk of all-cause hospitalization in HF, especially among patients with HFpEF. This suggests a possible role for targeting cardiometabolic comorbidities to reduce HF morbidity in HFpEF.
Abstract 110: Brain Injury Biomarkers Are Associated With Poor Neurological Outcomes Within 24 Hours After Refractory VT/VF Cardiac Arrest Requiring Extracorporeal Cardiopulmonary Resuscitation
Authors: Nelly Carolina C Rojas-Salvador, Jason Bartos
Journal: Circulation (2023)

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging method that improve survival after refractory VF/VT cardiac arrest. Neuron-specific enolase (NSE) and S-100B are used to predict neurological outcome; however, it is unclear the reliability and earliest time point during ECPR. Methods: Single-center, retrospective cohort study included OHCA patients who underwent ECPR at the University of Minnesota between December 2015 and January 2023. NSE and S100B levels were obtained at admission, at 12 and 24h after ROSC in a total of 361 unconscious patients. The primary outcome was poor neurological outcome (defined as CPC 3-5) at hospital discharge. We evaluated the optimal cut-off levels for NSE and S100B by maximizing the Youden index and ROC analyses for poor clinical results. Finally, NSE and S100B at 12h and 24h were added to a multivariable logistic model (age, sex, bystander and witnessed). Results: Of 361 patients, 170 survived to hospital admission. Of these 85% (145/170) survived neurologically favorable. Mean (SD) NSE (ng/mL) values were significantly higher in the CPC 3-5 group at every time point, 52.3 (53) vs 21.1 (12) on admission; 92.8 (92) vs 20 (10) after 12h; 107.1(94.4) vs 21.5 (12.9) after 24h; p&lt;0.01 at all time points. Again, mean (SD) S100B (ng/L) values were significantly higher in the CPC 3-5 group at every time point 3912 (990) vs 986 (920) on admission; 3975 (4972) vs 272.2 (209) after 12h; 4454 (7300) vs 192 (239) after 24h; p&lt;0.01 at all time points. At 24h, NSE and S100B significantly predicted poor neurological outcome with AUC 0.92; 95%CI:0.87-0.95 (optimal NSE cut-off value of 47) and 0.91; 95%CI: 0.87-0.95 (optimal cut-off S100B value of 354), respectively. High concentrations of both biomarkers at 24h (NSE: odds ratio [OR] 2.4 per 1 ng/mL, p&lt;0.001; S100B: odds ratio [OR] 1.1 per 1 ng/L, p&lt;0.05) were independent for poor outcome in a multivariate analysis. Additionally, the combination of both markers (AUC, 0.94; 95%CI: 0.91-0.97) showed significantly higher predictive performance than when using them individually. Conclusions: By using serial measurements, high NSE and S100B levels may help early predict progression to poor neurological outcome in OHCA survivors requiring ECPR in the first 24h after ROSC.
Abstract 13990: ECG Interpretation Proficiency of Healthcare Professionals
Authors: Anthony H Kashou, Peter A Noseworthy, Thomas Beckman, Nandan S Anavekar, Michael W Cullen, Kurt B Angstman, Benjamin J Sandefur, Brian P Shapiro, Brandon W Wiley, Andrew Kates, david Huneycutt, Andrew Braisted, Stephen W Smith, Adrian Baranchuk, Ken Grauer, Kevin O'Brien, Viren Kaul, Harvir S Gambhir, Stephen J Knohl, David E Albert, Paul KLIGFIELD, Peter W Macfarlane, Adam May
Journal: Circulation (2023)

Background: ECG interpretation is crucial in medical practice, but professionals struggle with achieving and maintaining competency. Identifying proficiency gaps aids in designing educational interventions. Methods: Medical professionals from various disciplines interpreted 30 12-lead ECGs containing commonly taught urgent and non-urgent findings. Performance metrics evaluated were overall adjusted score (% of correctly identified findings using a point-value score based on clinical relevance), unadjusted score (% of correctly identified findings), interpretation time per ECG, and self-reported confidence (rated on an ordinal scale of 0 [not confident], 1 [somewhat confident], or 2 [confident]). Results: Among 1206 participants, there were 72 (6%) primary care physicians (PCPs), 146 (12%) cardiology fellows-in-training (FIT), 353 (29%) resident physicians, 182 (15%) medical students, 84 (7%) advanced practice providers (APPs), 120 (10%) nurses, 249 (21%) allied health professionals, 571 (47%) physicians, and 453 (38%) non-physicians. Participants had a mean adjusted score of 46.9% (± 15.9%), unadjusted score of 56.4% (± 17.2%), interpretation time of 142 seconds (± 67 seconds), and confidence of 0.83 (± 0.53) (Table 1) . Performance varied across groups; cardiology FIT had superior performance in all metrics. Physicians generally outperformed non-physicians, with higher overall adjusted score (52% vs. 43%; p&lt;0.01), unadjusted score (62% vs. 52%; p&lt;0.01), and confidence (0.91 vs. 0.80; p&lt;0.01). Unadjusted score for PCPs was higher than nurses and APPs (58% vs. 47% and 51%; p&lt;0.01) but lower than resident physicians (58% vs. 60%; p&lt;0.01). Allied health professionals outperformed nurses and APPs and closely matched resident physicians and PCPs. Conclusions: Significant gaps in ECG interpretation proficiency exist, emphasizing the need for comprehensive, scalable, and accessible educational tools.
Abstract 12389: Predictors of Elevated High-Sensitivity C-reactive Protein in a US Population With Atherosclerotic Cardiovascular Disease: Results From the National Health and Nutrition Examination Survey
Authors: Kausik K Ray, Mads D Faurby, Gasper Letnar, Søren Lophaven, Julie T Mortensen, Michael G Nanna, Simon B Reuter, Naveed Sattar, Amir A Mohseni Zonoozi, Ann Marie Navar
Journal: Circulation (2023)

Introduction: Evidence suggests that inflammation is causally related to ASCVD. Elevated levels of high-sensitivity C-reactive protein (hsCRP) may identify individuals most likely to benefit from emerging anti-inflammatory therapies but hsCRP is not measured routinely in clinical practice. Aims: To identify potential risk factors indicating elevated hsCRP in patients with ASCVD. Methods: This cross-sectional study using data from the 1999–2010 and 2015–2018 NHANES cycles included adults (≥ 20 years old) with self-reported ASCVD and available hsCRP levels, plus sex and race/ethnicity data. Elevated hsCRP was defined as hsCRP 2–10 mg/L. Following weighting towards the US population, risk factors were assessed using multivariate logistic regression. Results: In total, 3415 individuals with ASCVD were included. In the weighted population (n = 13,008,371), 54.5% had elevated hsCRP. Median hsCRP levels increased with increasing numbers of risk factors ( Figure 1 ). Characteristics of groups with and without elevated hsCRP are shown in Table 1 . Smoking (OR 1.78 [95% CI: 1.11, 2.87]; p = 0.018) and BMI (OR per unit increase: 1.10 [1.06, 1.15]; p &lt; 0.001) were associated with higher odds of elevated hsCRP; receipt of metabolic medication (OR 0.55 [0.39–0.77]; p &lt; 0.001) and male sex (OR 0.60 [0.44–0.83]; p = 0.002) were associated with lower odds of elevated hsCRP. Conclusion: In this analysis of US NHANES data, smoking, BMI and female sex were linked to elevated hsCRP. The greater the number of risk factors, the higher the hsCRP level. Targeted hsCRP screening should be considered to identify those most likely to benefit from emerging anti-inflammatory therapies.
Abstract 14012: The Importance of Right Bundle Branch Block in Suspected ST-Elevation Myocardial Infarction is Independent of ST-T Deviations
Authors: Nils A Soerensen, Yama Fakhri, Alina Gossling, Paul M Haller, Betül Toprak, Jonas Lehmacher, Raphael Twerenbold, Dirk Westermann, Hedvig Andersson, Lisette Okkels Jensen, Lene Holmvang, Johannes T Neumann, Peter Clemmensen
Journal: Circulation (2023)

Background: In patients with suspected acute coronary syndrome (ACS) and bundle branch block (BBB) an emergent invasive strategy is recommended. While left bundle branch block (LBBB) is a well-known high-risk feature in patients with acute myocardial infarction, data supporting this strategy for right bundle branch block (RBBB) are scarce. Hypothesis: RBBB poses a high-risk feature in suspected ST-elevation myocardial infarction (STEMI). Methods: 2,139 patients with suspected STEMI were triaged to acute coronary angiography based on a prehospital, tele-transmitted digital 12-lead ECG. All discharge diagnoses were independently adjudicated. Sensitivity and specificity for STEMI-ECG-criteria were compared in RBBB and non-BBB patients. Adjusted hazard ratios for 1-year overall mortality were computed. Results: STEMI was adjudicated in 1,832/2,139 (85.6%) of all patients and in 102/117 (87.2%) of RBBB patients. ST-segment deviation followed typical patterns in most RBBB patients (n=36 for anterior, n=49 for inferior and n=15 for lateral STEMI) and among these a final diagnosis of STEMI was adjudicated in 88. Out of 17 patients without significant ST-changes, 14 (82%) were adjudicated as STEMI. Diagnostic accuracy of STEMI-criteria was comparable in RBBB and non-RBBB patients for anterior (sensitivity: 51.1% vs 59.1%, p=0.14; specificity: 66.7% vs 52.1%, p=0.33) and inferior STEMI (sensitivity: 35.2% vs 36.6%, p=0.80; specificity: 58.3% vs 49.5%, p=0.55). There was a statistical difference for lateral STEMI (sensitivity: 14.8% vs 4.4%, p=0.001; specificity: 75.0% vs 98.4%, p=0.001). Patients with RBBB had significantly higher1-year mortality compared to non-BBB patients. Adjusted hazard ratio for 1-year mortality comparing RBBB to non-BBB patients was 2.3% (95% CI 1.25-4.21, p=0.007). Conclusion: ECG-criteria for the detection of STEMI show comparable diagnostic accuracy in RBBB and non-BBB patients. However, STEMI was frequently present in RBBB patients not fulfilling diagnostic ECG-criteria. In addition, RBBB-patients showed poorer outcome after 1 year. Our data therefore reinforce current guidelines in designating ACS patients with RBBB, independent of ST-T deviations, high-risk and candidates for acute invasive evaluation.
Abstract 14002: Endovascular Embolization and Coiling for an Intracranial Aneurysm in a 9 - Month Old Infant With Kawasaki Disease- A Unique Case Report
Authors: Noufal Basheer, Aiswarya Raj, Mohammed Rafeeque P K, Midhun K Prakash, Paul J Alapatt
Journal: Circulation (2023)

Introduction: Cerebrovascular involvement is rare in Kawasaki disease.We present a unique case of such an infant who developed intraventricular haemorrhage and was diagnosed with an intracranial aneurysm. Case Report: A 9-month-old female infant was referred to us with 5 days of high-grade intermittent fever &amp; watery diarrhoea that did not respond to routine care. On arrival, she was stable with WBC count 20,000/UL, CRP 111 mg/L &amp; ESR 85 mm/hr.She continued to have fever spikes and Echocardiography revealed dilated left coronaries with a LAD Z score of +2.92. Hence, by pediatric guidelines, she was started on IVIg (2g/kg) for Kawasaki disease. Repeat echocardiography 2 days later showed reduction in coronary prominence. On Day 10, the child developed episodes of abnormal posturing and respiratory failure. MRI brain showed intraventricular haemorrhage in dependent horns of bilateral lateral, 3rd and 4th ventricles and subarachnoid haemorrhage. CT angiography showed a saccular aneurysm at the junction of V4 segment of right vertebral artery &amp; basilar artery (Figure 1). She underwent endovascular embolization, coiling of aneurysm&amp; omaya reservoir insertion(Figure 2). She was weaned off supportive care &amp; recovered well. Conclusion: Unlike fe existing reports, haemorrhage occurred during active phase of the disease and not years after diagnosis. To our knowledge, this is the first report of endovascular management of aneurysmal subarachnoid haemorrhage in KD in an infant. This uncommon presentation in an infant warrants discussion on whether routine screening of all children suspected of Kawasaki disease for extracardiac aneurysms might be potentially life-saving.
Abstract 12390: Differences in the Impact of Use of Contact Force Sensing Catheters on Subsequent Rates of Pulmonary Vein Reconnection Detected Between Men and Women During Repeat Ablation of Atrial Fibrillation
Authors: Ruina Zhang, James Gabriels, Elizabeth Reznik, Han Li, Ari Mandler, Kabir Malkani, Veronica Qu, James E Ip, George Thomas, Christopher F Liu, Steven Markowitz, Bruce B Lerman, Jim W Cheung
Journal: Circulation (2023)

Background: Radiofrequency catheter ablation (CA) is an effective treatment for atrial fibrillation (AF). Contact force (CF) sensing catheters permit tissue contact monitoring that may lead to durable pulmonary vein (PV) isolation. Objective: To assess the impact of CF-sensing catheters on PV reconnection rates at repeat AF ablation and whether there are sex-based differences. Methods: We conducted a retrospective study of patients who underwent repeat AF ablation after index PV isolation between 2010 and 2022. Patients were divided into 2 groups: Group 1 (non-CF sensing catheters) and Group 2 (CF-sensing catheters). Results: One hundred sixty-one patients were included in the study (76 in Group 1 and 85 in Group 2, 32% female, 70 ± 10 years old). Initial use of CF-sensing catheters at index ablation was associated with a lower PV reconnection rate at repeat ablation (60% for Group 2 vs 87% for Group 1; P = 0.001). There were no significant differences in locations of PV reconnection between Group 1 and Group 2. When stratified by sex, there were significantly lower rates of PV reconnection in male patients with use of CF-sensing catheters (92% for Group 1 vs 67% for Group 2; p=0.001) but not for female patients (71% for Group 1 vs 50% for Group 2; p=0.23). On multivariable logistic regression analysis, use of CF-sensing catheters at index ablation (adjusted odds ratio [aOR]: 0.28, 95% CI: 0.12 to 0.65; p=0.003) and female sex (aOR: 0.38, 95% CI: 0.17 to 0.86; p=0.02) were associated with significantly lower rates of PV reconnection found at repeat ablation. Conclusion: Use of CF sensing catheters reduced PV reconnection rate found at repeat AF ablation. Females have lower rates of PV reconnection identified at repeat ablation which suggest that non-PV triggers may be a more common cause of recurrent AF, thereby blunting the impact of CF-sensing catheters on reducing recurrent AF in females.
Abstract 12220: Intracavitary Left Ventricular Flow During Isovolumic Relaxation: Prevalence, Mechanism and Clinical Outcomes
Authors: David Agdashian, Leo Meller, Sachiyo Igata, Anthony N Demaria
Journal: Circulation (2023)

Introduction: Intracavitary flow (IVF) from LV base to apex during isovolumic relaxation (IVR) has been identified in patients with Grade I diastolic dysfunction (G1DD) associated with impaired relaxation. We examined the prevalence, mechanism, and outcomes of this phenomenon. Methods: Echocardiograms and medical records of 113 patients who met ASE criteria for G1DD without other cardiac abnormalities were reviewed. IVR was from relaxation onset to mitral opening. IVF was an apically directed signal with a defined envelope recorded by CW Doppler during IVR (Figure) confirmed by color Doppler. Global longitudinal strain was obtained in standard fashion using commercial equipment and analyzed for apical and basal segments. Results: IVF during IVR was present in 35 patients, absent in 27, and had inconclusive signals not meeting criteria in 51. The magnitude of reduction in apical strain was significantly larger in IVF patients than those without (-14% vs -5%, p = 0.04). This difference was present in both the lateral (-18% vs -7%, p = 0.04) and septal (-11% vs -1%, p = 0.05) segments. The rate of reduction in apical strain was also higher in the IVF group (0.318 strain fractions/sec vs 0.168, p = 0.03). No significant differences between groups existed for proportion of apical relaxation, change in strain between apex/base, proportion/magnitude/rate in basal strain. Patients with IVF during IVR had a non-significant trend for a higher death rate (23 vs 11%). There was no significant difference in hospitalization, heart failure, atrial fibrillation, CAD, or stroke. Conclusions: Apical intracavitary flow during IVR occurred in 31% of G1DD patients. Although mechanism is not fully defined, our data indicates that IVF during IVR is related to the magnitude and rate of apical relaxation. IVF during IVR may be of value in stratifying future risk in Grade I diastolic dysfunction patients but will require larger studies.
Abstract 12312: UBC9 Protects Against Cardiac Hypertrophy and Heart Failure via Regulating FOXO3-LMCD1 Pathway
Authors: Ting Zhou, Hanlin Wu, Chunying Liu, Xiaodong Jia, Dan Liu, Chenghui Yan, haixu song, Yaling Han
Journal: Circulation (2023)

Introduction: Pathological cardiac hypertrophy is a major risk factor for heart failure (HF) and a leading cause of morbidity and mortality worldwide. However, the molecular mechanisms underlying pathological cardiac hypertrophy remain unclear. Hypothesis: In the present study, we investigated the possible underlying effects of UBC9 on cardiac hypertrophy and heart failure. Methods: UBC9 was upregulated in samples of human hypertrophic hearts compared to normal controls using RNA sequencing analysis from the Gene Expression Omnibus (GEO, https://www.ncbi.nlm.nih.gov/geo). Real-time polymerase chain reaction (RT-PCR) and western blotting were used to analyze the expression of UBC9 in samples of human hypertrophic hearts and normal controls. Mice with cardiac-specific over-expression and low-expression of UBC9 by intravenous injection of adeno-associated virus 9 (AAV9)-encoding UBC9 under the control of cardiac troponin T (cTnT) promoter were subjected to transverse aortic construction (TAC). Co-immunoprecipitation assays were performed to determine the mechanism by which UBC9 regulates the expression of forkhead box O3 (FOXO3). Results: UBC9 expression increased in the hearts of patients with hypertrophic cardiomyopathy (HCM) and pressure overload-induced mice, as well as in the Neonatal Mouse Cardiomyocytes (NMCMs) treated with phenylephrine (PE). Cardiac cell-specific UBC9 over-expression alleviates cardiac hypertrophy and dysfunction. Cardiac cell-specific UBC9 knockout aggravates cardiac hypertrophy and heart failure. Mechanistically, UBC9 inhibits LIM and cysteine-rich domain 1 (LMCD1) expression by directly binding to forkhead box O3 (FOXO3), a transcription factor of LMCD1, and promoting FOXO3 dephosphorylation and nuclear translocation, independent of SUMOylation. Conclusions: This study provides a new insight that UBC9, as a potential intervention target in cardiac hypertrophy and HF, may contribute to exploring effective therapeutic strategies for pathological cardiac hypertrophy treatment.
Abstract 13988: Post Stress Test High-Sensitivity Cardiac Troponin I in the Evaluation of Patients With Acute Chest Pain for Enhanced Ischemic Risk Assessment: A Pilot Study
Authors: Viviana Zlochiver, Sara Walczak, James Adefisoye, Phyllis Runningen, Sara Klein, Jodi Kresa, Don Lobacz, Michael Peterson, Joell Salfer, Nataly Stenzel, Suhail Q Allaqaband, M F Jan
Journal: Circulation (2023)

Introduction: High-sensitivity cardiac troponin I (hs-cTnI) assays provide comparable diagnostic information that allow for better detection of myocardial injury. However, hs-cTnI release after cardiac stress testing and its potential utility for identifying inducible myocardial ischemia and risk-stratification are unclear. Aim: This pilot study examined integrating hs-cTnI biomarker testing into cardiac imaging stress testing to improve detection of inducible ischemia and aid in risk-stratification in patients with chest pain being evaluated for acute coronary syndrome (ACS). Methods: We prospectively enrolled 200 consecutive adult patients referred by the Emergency Room for cardiac stress testing for evaluation of possible ACS. A venous blood sample was collected between 0.5 and 2 hours post stress testing; cTnI concentrations were measured in-house by high sensitivity methods. Changes from pre-stress test hs-cTnI concentrations were calculated and association with outcome was explored using a logistic regression model. Results: Patient median age was 62 years, IQR 54-70; 49% were women. ACS known risk factors included hypertension 81.5%, cigarette smoking 49.5% and diabetes 33.5%. Median BMI was 31.63 kg/m 2 , IQR 27.24-35.84. Pre-stress test hs-cTnI median levels were 6 ng/L, IQR 5-9, for women (URL &lt;52 ng/L) and 8 ng/L, IQR 6-12, for men (URL &lt;77 ng/L). A total of 121 patients (60.5%) underwent nuclear stress tests, and 79 (39.5%) received echocardiographic stress tests. Of the 191 samples analyzed, 36% revealed increased hs-cTnI levels from pre-stress test values: 33% in nuclear stress tests (median increase 2 ng/L, IQR 1-5), 41% in echocardiographic stress tests (median increase 2 ng/L, IQR 1-5). In the 155 patients with 6 months of follow-up, changes in post-stress test hs-cTnI levels were not significantly correlated to stress test results, percutaneous coronary interventions or death (p=.85). Conclusion: This study provides insight into the potential of hs-cTnI to aid in identifying inducible myocardial ischemia in a real-world, high-throughput setting. Although a subset of patients exhibited modest increases in hs-cTnI post stress testing, overall, these did not appear to be correlated with inducible myocardial ischemia.