tbuckley/cabot-search huggingface dataset:
Abstract 155: The Relationship Between Positive Psychology Factors and Quality of Life in Long-Term Cardiac Arrest Survivors
Authors: Courtney J Burns, Mary M Newman, Ana-Maria Vranceau, Sarah M Perman, Alex Presciutti
Journal: Circulation (2023)

Introduction: There is a need to identify factors that can improve quality of life (QoL) post-CA. Long-term CA survivors (i.e., &gt; 1 year) have recommended utilizing positive psychology factors (i.e., psychological strengths that foster well-being) such as mindfulness, existential well-being, and resilient coping to manage survivorship challenges. We explored associations between these factors and QoL. Hypothesis: Higher levels of mindfulness, existential well-being, and resilient coping will be individually associated with better physical, psychological, and social QoL. Goal: Identify factors associated with improved QoL, that may become intervention targets. Methods: Secondary analysis of survey data of long-term CA survivors from the Sudden Cardiac Arrest Foundation. We examined demographic covariates (sex, months since arrest, age, income), self-reported daily memory problems, functional dependence (Lawton Independent Activities of Daily Living Scale), emotional distress (PTSD Checklist-5, Patient Health Questionnaire-4), and positive psychology factors (mindfulness [Cognitive and Affective Mindfulness Scale-Revised], existential well-being [Meaning in Life Questionnaire Presence of Meaning subscale], and resilient coping [Brief Resilient Coping Scale]). We used the WHOQOL-BREF to measure psychological, physical, and social QoL. We conducted 9 multiple regression models to test the individual relationship between each positive psychology factor and each QoL domain, adjusted for demographic covariates, functional dependence, daily memory problems, and emotional distress. Results: We included 129 long-term CA survivors (mean age: 52 years, 52% male, 98% white). In adjusted models, higher mindfulness and resilient coping were associated with better QoL in all domains (βs: 0.19 - 0.56, p &lt; 0.03, R 2 = 0.35 - 0.74); existential well-being was associated with better psychological and social QoL (βs: 0.27- 0.36, p = 0.001, R 2 = 0.4 - 0.72). Conclusion(s): Greater levels of positive psychology factors were associated with better QoL, even after accounting for emotional, cognitive, and functional sequelae. Future interventions should consider teaching these positive psychology factors to CA survivors.
Abstract 16293: Subsequent Pregnancies and Long-Term Cardiac Outcomes Among Patients With Prior Peripartum Cardiomyopathy in Kaiser Permanente Northern California
Authors: Monica S Choo, Alix P Fairman, Richie Houhong Xu, Nikhil Joshi, Megan Stephenson, Erica P Gunderson, Seema Pursnani
Journal: Circulation (2023)

Introduction: Current recommendations for subsequent pregnancies after peripartum cardiomyopathy (PPCM) have been based on previously reported ~30% recurrence rates of PPCM, but evidence has evolved along with clinical practice. Research Questions: What is the incidence of repeat pregnancy in patients with PPCM, and what are cardiac outcomes during and after subsequent pregnancies? Methods: Retrospective study of subsequent pregnancies among 110 pregnant patients identified with a confirmed diagnosis of peripartum cardiomyopathy (PPCM) between 1995-2004 in a Kaiser Permanente Norther California (KPNC) cohort. Results: Among 110 women with a diagnosis of PPCM, there were 58 subsequent pregnancies, including 23 live births in 16 women (15%), and 35 therapeutic or spontaneous abortions in 24 women (21%) over a follow-up period of up to 26 years. The live births included one birth for 11 women, two births for 3 women, and three births for 2 women. Among the 32 women with subsequent pregnancies, there was no maternal mortality or need for advanced mechanical circulatory support. There was 1 woman with relapse of PPCM in subsequent pregnancy, with left ventricular ejection fraction (LVEF) improvement at the latest follow up. There was no significant differences in LVEF at the latest available echocardiogram among those women with and without subsequent live birth pregnancies (Table 1, X 2 -value 0.901, p=0.95). Only 2 women, both with no documented subsequent pregnancy, had persistent severe LV systolic dysfunction at the end of follow-up. Conclusions: In the KPNC cohort, most patients with PPCM recovered LV function and there were no significant differences in LVEF among those women with and without subsequent live birth pregnancy.
Abstract 14177: Alarming Burden and Disparities of MACCE in Postmenopausal Women of a Contemporary Nationwide Cohort, 2020
Authors: Shrikanth Sampath, Archit Srivastava, Pooja Suchday, Aditi K Bhanushali, KAMYA MEHTA, Alkananda Behera, Akhil kumar Eppalapally, Ram Prasanjith Reddy Bollampalli, Rupak Desai
Journal: Circulation (2023)

Background: Cardiovascular disease is the leading cause of death worldwide, with a notable impact on postmenopausal women. However, contemporary large-scale population-based data for the burden and disparities of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in this population remains limited. Methods: The National Inpatient Sample (2020, ICD10 codes, age&gt;55 years) was queried to identify postmenopausal women's hospitalizations. Socio-demographics, racial subgroups, comorbidities, and MACCE rates were retrieved with a more granular comparative analysis in postmenopausal women. A p&lt;0.05 was considered statistically significant. Results: Of the total 8435195 postmenopausal women hospitalizations (median age 75 years), 1021375 (12.1%) were identified with MACCE. MACCE cohort, in comparison to non-MACCE cohort, had significantly higher prevalence of hypertension (77.1% vs 71.3), diabetes (39.8% vs 34.0%), hyperlipidemia (53.7% vs 48.4%), PVD (9.8% vs 7.1%), prior MI (8.3 vs 5.7%), prior TIA/stroke (10.5 vs 9%) and CKD (29.4 vs 23.4%). Significant clinical predictors for all-cause mortality were found to be race Asian/PI vs white ( 1.31 [1.09-1.18]), median household income national quartile (1.16 [1.13-1.20]), hypertension (1.18[1.16-1.20]) diabetes (1.20 [1.19-1.22]), hyperlipidemia (1.12[1.11-1.14]), prior MI (1.37[1.34-1.40]) and prior TIA stroke (1.0 5 [1.03-1.07] (all p&lt;0.05). Conclusion: Among hospitalizations, Asian/Pacific Islanders, patients from the lowermost income quartile with co-existent hypertension, diabetes, hyperlipidemia, CKD, and cardiovascular comorbidities independently revealed the highest MACCE rates. Special emphasis needs to be laid on socio-demographics, comorbidities, and racial differences for CVD disease prevention, and risk factor modification in postmenopausal women.
Abstract 16812: Value of Echocardiographic Variables to Predict Cardiotoxicity in Patients Using Machine Learning
Authors: Helman C MARTINS, Vera M Salemi, Marcelo Melo, Thais Gaudencio, Yann Nobrega, EWERTON MEDEIROS, Ana Caroline P Martins, Helman Fernando P Martins, Elizabeth Monteiro
Journal: Circulation (2023)

Introduction: Early identification of subclinical signs of cardiotoxicity in patients with breast cancer submitted to echocardiographic exam may change the natural history of patients undergoing treatment with anthracyclines. Objectives: The aim of this study was to identify echocardiographic and clinical variables related to cardiotoxicity and death analyzed using machine learning. Methods: The study consisted of a historical cohort of patients with breast cancer, submitted to chemotherapy treatment with anthracyclines, with clinical evaluation, electrocardiogram and echocardiogram performed before the first session,3 ,6 , 12 and 24 months later, with the intention to analyze echocardiographic markers to identify prognostic parameters related to cardiotoxicity.. Among various classifier models, the Extreme Gradient Booster (XGB) model was selected as the best instrument for predicting cardiotoxicity in this study. The SHAP (SHapley Additive exPlanations) approach was employed to assess the importance of each variable in the model. Results: The sample consisted of 58 patients, with a mean age of 50.29 (standard deviation = 13.32), who completed treatment between February 2010 and June 2011. The outcome measure was a composite of death or cardiotoxicity, with 11 patients in the positive group (mean age: 43.73, std: 13.08) and 47 in the negative group (mean age: 51.83, std: 13.05) The XGB model achieved an accuracy of 0.89, recall and precision of 0.67. The Area Under the Receiver Operating Characteristic Curve (ROC AUC) was 0.91 . Notably, echocardiographic variables such as Myocardial Performance Index (MPI), End Systolic Volume (ESV), End Diastolic Volume (EDV) and Systolic Blood Pressure (SBP) emerged as relevant predictors of the outcome figure 1. Conclusions: Echocardiographic indices may predict subclinical cardiotoxicity and which and may be confirmed in larger exploratory studies.
Abstract 16541: Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score-Matched Retrospective Cohort Study
Authors: Kyu Kim, Iksung Cho, Kyu-Yong Ko, Seung-Hyun Lee, Sak Lee, Geu-Ru Hong, Jong-Won Ha, Chi Young Y Shim
Journal: Circulation (2023)

Introduction: Aortic valve replacement (AVR) is a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence of the benefit of early AVR in symptomatic patients with normal-flow, low-gradient (NFLG) severe AS. Hypothesis: Early AVR has benefit in patients with NFLG severe AS Methods: Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥ 35 mL/m 2 , mean transaortic pressure gradient &lt; 40 mmHg, peak transaortic velocity &lt; 4 m/s, and aortic valve area &lt; 1.0 cm 2 ) between January 2010 and December 2020 were retrospectively reviewed. After 1:1 propensity score matching, 121 patients aged 75.1 ± 9.8 years (including 63 women) who underwent early AVR within three months after index echocardiography were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure hospitalization. Results: During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group presented a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29-0.93; P = 0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23-1.16; P = 0.110), although the early AVR group showed a significantly lower incidence of hospitalization for heart failure (HR, 0.43; 95% CI, 0.19-0.95, P = 0.037). Subgroup analyses supported the main findings. Conclusions: An early AVR strategy may benefit guard against a composite outcome of death or hospitalization for heart failure in symptomatic patients with NFLG severe AS. Future randomized studies must confirm our findings.
Abstract 208: Evaluating the Predictive Power of Serum Biomarkers Neuron-Specific Enolase, S-100B Protein, and Neurofilament Light Chain for Neurological Outcomes Following Cardiac Arrest: A Diagnostic Accuracy Meta-Analysis
Authors: Muhammed K Elfaituri, Ala Khaled, Ahmed BenGhatnsh, Hazem Abdelkarem A Faraj, Ahmed Msherghi
Journal: Circulation (2023)

Introduction: The assessment of serum biomarkers, specifically Neuron-Specific Enolase, S-100B protein, and Neurofilament Light Chain, at 24 hours post-cardiac arrest is under investigation for its ability to predict brain injury. Aim: This study aims to evaluate the accuracy of serum biomarkers NSE, S-100B protein, and NFL predicting post-cardiac arrest neurological outcomes. Methods: A systematic search up to December 2022 across PubMed, Embase, and Scopus identified studies examining the association between 24-hour serum levels of NSE, S-100B protein, or NFL and neurological outcomes post-cardiac arrest. Statistical analyses were conducted using R software with mada package to pool sensitivity, specificity, false-positive rates, diagnostic odds ratios, and positive and negative likelihood ratios; each expressed with a 95% Confidence Interval. Results: We incorporated 3 studies, with 759 patients in S-100B protein group, 753 in NSE group, and 799 in NFL group. At 24 hours post-cardiac arrest, NSE showed a pooled sensitivity of 37.7% (95% CI: 24.4-53.2%, I2=85.7%) and specificity of 85.5% (95% CI: 81.6-88.7%, I2=0%). S-100B protein demonstrated a pooled sensitivity of 54.7% (95% CI: 32.1-75.5%, I2=94.8%) and specificity of 81% (95% CI: 66.9-90.1%, I2=82.3%). NFL exhibited a pooled sensitivity of 88.1% (95% CI: 47.7-98.4%, I2=93.8%) and specificity of 93.6% (95% CI: 85.4-97.3%, I2=77.7%). The diagnostic odds ratios were 3.57 (95% CI: 1.79-7.15) for NSE, 5.15 (95% CI: 1.55-17.14) for S-100B protein, and 108.65 (95% CI: 11.02-1071.24) for NFL. The positive Likelihood Ratios were 2.61 (95% CI: 1.64-4.14) for NSE, 2.88 (95% CI: 1.37-6.06) for S-100B protein, and 13.87 (95% CI: 5.64-33.69) for NFL, while the negative Likelihood Ratios were 0.73 (95% CI: 0.57-0.93) for NSE, 0.19 (95% CI: 0.9-0.33) for S-100B protein, and 0.06 (95% CI: 0.03-0.15) for NFL. Conclusion: Brain biomarkers NSE, S-100B protein, and NFL, especially NFL, with its superior sensitivity and specificity, are promising in predicting neurological outcomes post-cardiac arrest, aiding clinicians in patient management and family communication. The limited number of studies and heterogeneity in results necessitate further validation and research of their predictability.
Abstract 17646: Maternal and Neonatal Outcomes in Pregnant Women With Congenital Heart Disease: The Magee Obstetric Maternal and Infant (MOMI) ACHD Substudy
Authors: Anita Saraf, JIl Patel, Morgan Hindes, Kathryn Berlacher, Arvind Hoskoppal, Janet M Catov, Andreas P Kalogeropoulos
Journal: Circulation (2023)

Introduction: Adult patients with congenital heart disease (ACHD) have a life-long burden of cardiovascular morbidity that contributes to increased maternal and neonatal risk during pregnancy and the peripartum period. Hypothesis: Women with ACHD and their neonates have a higher risk of adverse pregnancy and peripartum outcomes as compared to women without ACHD. Methods: We matched 565 deliveries from women with ACHD and 1130 deliveries from women without cardiac disease (1:2 matching), for a delivery year, race and maternal age as a substudy of the Magee Obstetric Maternal and Infant (MOMI) study, of women who received perinatal care at the Magee-Womens Hospital at the University of Pittsburgh Medical Center between 1995-2020. We evaluated for in-hospital maternal and neonatal outcomes. Results: Of the 565 women with ACHD, 24.0% had aortic outflow and mitral valve abnormalities, 19.5% had pulmonary outflow and tricuspid valve abnormalities, 28.1% had isolated atrial or ventricular septal defects, 0.3% had single ventricle physiology, and 1.4% had outflow vessel abnormalities. Maternal and neonatal outcomes are summarized in Table 1. Women with ACHD had a higher rate of pregnancy loss (32.4% vs 26.2% p&lt;0.001), induction of labor, and cesarean section. Neonates from ACHD women were delivered at an earlier gestational age, with a lower birth weight, and had a higher incidence of respiratory distress syndrome. ACHD women had a higher incidence of cardiovascular events (predominantly arrhythmias and pulmonary edema) and required intensive care more frequently (10.5% vs 1.2%, p&lt;0.001) and for longer periods (2.1±1.8 vs. 1.1±0.3 days; P=0.027) after delivery. Conclusion: Women with ACHD are at higher risk for adverse clinical outcomes during pregnancy and delivery. Neonates of ACHD women are delivered slightly earlier by induction of labor and have consequent sequelae after birth.
Abstract 17096: Immune Modulation to Treat Ischemic Heart Failure
Authors: Adrian Grijalva, Daniel R Benson, Jordan Fink, Xiaohong Zhang, Dawn Coletta, Paul Langlais, Amitabh C Pandey, Massimo Mangiola, Jen Koevary, Jordan Lancaster, Steven Goldman
Journal: Circulation (2023)

Introduction: Clinical use of induced pluripotent derived cardiomyocytes (iPSC-CMs) has been slow because their mechanism is not well defined. Our lab developed a cardiac patch composed of iPSC-CMs and human neonatal dermal fibroblast (NDF) seeded on a bioresorbable matrix. Implantation on the epicardium of the infarcted heart in immune competent animal models of ischemic CHF (mice, rats, swine) repaired the damaged heart, improved cardiac function/structure with increased viable myocardium, increased myocardial blood flow, improved left ventricular (LV) contractility, and reversal of maladaptive LV remodeling. Preliminary analysis indicates that the patch created a novel host derived immune response not observed in untreated animals. Hypothesis: The iPSC-CMs and NDFs coordinate an immunomodulatory response that results in reduction of inflammatory cytokine producing M1 macrophages with concomitant polarization to the M2 state. Methods: Spatial transcriptomics and histological analysis was utilized for investigation of patch driven immunomodulatory responses in WT BL6 mice. All animals underwent two procedures; 1) Infarct via left coronary ligation 2) Left lateral sternotomy with patch placement (N=5) (no patch for controls, N=3) 3 weeks post MI. Patch secretions underwent quantitative mass spectroscopy to identify drivers of immunomodulation. Results: Histology demonstrated reduction of left chamber dimension and presence of viable cardiomyocytes in the LV wall. IF demonstrated a novel immune response in the treated group absent in the controls. This response is isolated to the epicardial infarct-patch interface. Cellular deconvolution of the infarct region revealed macrophages and dendritic cells compose this response. Macrophage phenotype was assessed via expression of classical M1(CD68, NOS2, AXL) as well as M2 markers (RETNLA, MRC1, ADGRE1) which were found to be significantly elevated in treated groups. Proteomic analysis of the patch secretome indicates the patch has a role in coordinating this response by upregulation of Il-4/Il-13 signaling and wound healing that stimulates enrichment of pathways associated with reorganization of the ECM.
Abstract 12884: Impact of an Addiction Consult Team on the Management and Outcomes of Patients With Surgically Managed Drug Use Associated Infective Endocarditis
Authors: Lucas X Marinacci, Audrey Li, Annie Tsay, Katherine Kentoffio
Journal: Circulation (2023)

Background: Recurrent injection drug use is a major driver of poor long term outcomes in patients who undergo surgery for drug use associated infective endocarditis (DUA-IE). The effect of an inpatient addiction consult team (ACT) on this population is not well described. Methods: To assess the impact of an ACT on DUA-IE patients, we performed a single center retrospective review of all adults who underwent surgery for active DUA-IE and survived to discharge (DC) between 2012-2022 at a large academic teaching institution. An ACT was established in 9/2017. We compared measures of substance use disorder (SUD) care, readmission, reinfection, and death pre- and post- ACT implementation using logistic regression models. Results: The pre- and post-ACT groups were similar at baseline (Table 1). In a univariate analysis, post-ACT patients were more likely to receive medications for opiate use disorder (MOUD) pre-operatively, to receive MOUD at DC, and to have MOUD follow up appointments scheduled at DC. They were less likely to receive non-MOUD opiates at DC or to be readmitted at 30 or 90 days. Overall rates of SUD follow up care scheduled prior to DC were low. There were no differences in harm reduction measures, recurrent IE, or death. In a multivariate analysis, the association of the ACT with decreased 90 day readmissions remained significant (Table 2). Conclusion: Among surgically managed DUA-IE patients, ACT implementation was associated with improved metrics of SUD care and readmissions at 90 days, but not recurrent IE or death. Future efforts should focus on strengthening harm reduction interventions and ensuring SUD follow up to sustain longitudinal engagement in care.
Abstract 18864: A Novel Technique to Improve Vector Uptake for Cardiac Gene Therapy
Authors: Renata Mazurek, Spyros Archimedes Mavropoulos, Tomoki Sakata, Anjali Ravichandran, Jonas Marx, Kiyotake Ishikawa
Journal: Circulation (2023)

Introduction: Cardiac gene therapy with adeno-associated virus (AAV) has promise. However, clinical trials with intracoronary (IC) delivery have been challenged by low efficacy. Hypothesis: We predicted that AAV uptake could be enhanced using a catheter-based mechanical cardiac support device (MCS) to facilitate IC delivery with brief coronary balloon occlusions in a pig model of myocardial infarction (MI). Aims: We aimed to: 1) confirm that MCS could support hemodynamics during coronary balloon occlusions, and 2) determine whether this technique could improve vector uptake and cardiac gene expression after HF onset. Methods: A week after MI, 12 Yorkshire pigs (36.6±1.45 kg, male n=6) received AAV6 encoding for luciferase by one of four delivery methods (n=3/group) (Figure 1). Tissues were harvested 1 mo later for analysis. A similar experiment was conducted with gold nanoparticles (GNPs) in place of AAV by either continuous or CAO+CSO delivery (n=4) with same-day cardiac harvest. GNP presence was seen by electron microscopy. Results: MCS maintained blood pressure and prevented arrhythmias during coronary balloon occlusions. Application of MCS during continuous infusion did not significantly alter AAV genome uptake (vg) or luciferase expression (luc). CAO+CSO delivery increased both vg and luc across heart regions, with notable significance at the infarct-border region vs continuous delivery (vg: p=0.027; luc: p=0.032). Vg was also positively associated with luc (Figure 2). Improved uptake was further supported by greater GNP presence with CAO+CSO delivery. Conclusion: MCS can be utilized to optimize IC gene delivery in a safe and clinically-applicable way.