tbuckley/cabot-search huggingface dataset:
Abstract 12476: QT Prolongation Predicts All-Cause Mortality Above and Beyond a Validated Risk Score
Authors: Selcuk Adabag, Amy Gravely, Sharma Kattel, Melissa Buelt-Gebhardt, Anders Westanmo
Journal: Circulation (2023)

Introduction: QT prolongation is a risk factor for life-threatening arrhythmias and sudden cardiac death. In large cohorts, QT interval was associated with all-cause mortality after adjusting for cardiovascular risk factors, but these analyses may contain residual confounding. Whether the QT interval provides prognostic information above and beyond a validated mortality risk score is unknown. Hypothesis: QT interval on ECG will independently predict mortality after adjustment for the Care Assessment Needs (CAN) score, which was validated to predict mortality nationwide at the Veterans Administration (VA) (c-index 0.86). Methods: Patients receiving primary care at the Minneapolis VA from 2012 to 2016, with at least one ECG were included in this retrospective cohort study. QT intervals were corrected for heart rate (QTc) using the Bazett’s formula. CAN score, calculated within 1-week of the ECG, was obtained from the VA Corporate Data Warehouse. Results: Of the 36,240 patients, 1526 (4.2%) had QTc ≥ 500 ms, 3249 (9.0%) had QTc 470-500 ms, and 31,465 (86.8%) had QTc &lt; 470 ms. A total of 2,189 (6.0%) patients died at 1-year follow-up and 7898 (21.8%) died at 5-year follow-up. Mortality was higher in patients with longer QTc (Table 1). Compared to those with QTc &lt; 470 ms, CAN-adjusted odds of 1-year and 5-year mortality were significantly higher in those with longer QTc (Table 2). C-index for CAN score predicting 1-year and 5-year mortality (0.829 and 0.826, respectively) improved marginally after adding QTc data (0.834 and 0.832, respectively; p &lt;0.0001 for both). Conclusions: QT prolongation predicts all-cause mortality independently of a validated mortality risk prediction score.
Abstract 12421: Guided Advanced Cardiovascular Life Support Mobile App Improves Trainee Experience and Performance During Simulated Cardiac Arrest: A Randomized Controlled Trial
Authors: Michael J Senter-Zapata, Dylan V Neel, Isabella Colocci, Afaf Alblooshi, Faten AlRadani, Brian Quach, Samuel Lyon, Maxwell Coll, Andrew Chu, Katharine Rainer, Beth Waters, Christopher Baugh, Roger Dias, Haipeng Zhang, Andrew J Eyre, Eric Isselbacher, Jared Conley, Narath Calile
Journal: Circulation (2023)

Introduction: Leading hospital code teams is stressful for resident physicians, and variability in training and experience may result in inconsistent care and outcomes. Nearly all bedside aids like AHA advanced cardiovascular life support (ACLS) pocket cards and third-party ACLS mobile apps lack step-by-step guidance or reminders. Our team designed a guided ACLS mobile app to help trainees lead more effective hospital resuscitations and conducted a randomized controlled trial to assess user experience and performance according to 2020 AHA ACLS guidelines. Hypothesis: A guided ACLS app will improve subjective user experience and adherence to AHA ACLS guidelines. Methods: The ACLS mobile app was developed using Swift UIKit. Internal Medicine, Emergency Medicine, Surgery, and Anesthesia residents (N = 46) were randomized to lead a simulated code for cardiac arrest due to massive pulmonary embolism using either AHA pockets cards (N = 22) or the ACLS app (N = 24). User experience was assessed via surveys. Code outcomes, guideline adherence, and errors were analyzed from video recordings. A focus group of 22 residents provided feedback. Statistical analysis was conducted using R software and included two-sided t-tests and Fisher exact tests. Results: App users showed significantly increased confidence (1.0 vs 0.3; p = 0.005), backboard use (96% vs 27%; p &lt;0.001), end-tidal CO2 monitoring (58% vs 27%; p = 0.042), correct thrombolytic administration (54% vs 23%; p = 0.035), and achieving return of spontaneous circulation (50% vs 18%; p = 0.032) compared to controls. Focus group results showed that 100% of the participants would use the app and that 82% preferred the guided app to AHA pocket cards. Conclusions: The guided app improves user confidence and adherence to AHA ACLS guidelines and addresses the need for greater standardization in hospital code management. Validation studies are necessary to confirm its effectiveness in clinical practice.
Abstract 12299: Sex Differences in the Outcomes of Patients With Heart Failure Undergoing Catheter Ablation for Atrial Fibrillation
Authors: Siddharth Agarwal, Bilal Munir, Christopher V Desimone, Abhishek Deshmukh, Zain Ul Abideen U Asad, Stavros Stavrakis
Journal: Circulation (2023)

Introduction: There is a lack of data on the impact of sex on the outcomes of patients with heart failure (HF) undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that outcomes of patients with HF undergoing AF ablation differ between males and females and tested this hypothesis using data from a nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were then divided into two cohorts based on their sex. A multivariable logistic regression model was used to adjust for confounders. Results: A total of 21,439 patients with HF underwent AF ablation between 2016-2019, of which 8,103 had heart failure with preserved ejection fraction (HFpEF) [64.8% were females], and 13,336 had heart failure with reduced ejection fraction (HFrEF) [38.4% were females]. Crude outcomes are shown in Figure 1. After multivariate adjustment, among patients with HFrEF, females had a longer length of stay (adjusted mean difference (aMD): 0.55 (0.16-0.93) days longer, p&lt;0.01) along with lower odds of routine home discharge (adjusted odds ratio (aOR):0.62; 95% confidence interval (CI):0.55-0.70; p&lt;0.01). Females had similar odds of in-hospital mortality, procedural complications, and 30-day/ 180-day all-cause, heart failure, and arrhythmia-related readmissions as compared to males. Among patients with HFpEF, females had higher odds of 30-day (aOR: 1.91; 95% CI: 1.24-2.93; p&lt;0.01) and 180-day heart failure readmissions (aOR: 1.53; 95% CI: 1.04-2.28; p=0.03) along with lower odds of routine home discharge (aOR:0.67; 95% CI: 0.57-0.78; p&lt;0.01), as compared to males. Conclusion: In conclusion, our results show that females with HFrEF undergoing AF ablation have similar odds of in-hospital/30-day/180-day outcomes whereas females with HFpEF have higher odds of 30-day/180-day HF readmissions, as compared to males.
Abstract 13955: Real-World Patients With Obstructive Hypertrophic Cardiomyopathy Treated With Mavacamten: A US Single Center Experience
Authors: Nosheen Reza, Anand Dubey, Thomas Carattini, Juan Maya, Mauricio Ferri, Afraim Botros, Amy Marzolf, Nicole Hornsby, Alejandro de Feria, Anjali T Owens
Journal: Circulation (2023)

Background: Mavacamten, a first-in-class allosteric reversible inhibitor of cardiac myosin ATPase, was approved by the US Food and Drug Administration for the treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM) in April 2022. Purpose: To describe the characteristics of real-world patients initiated on mavacamten at a US HCM center of excellence. Methods: All patients started on mavacamten from May 2022 to February 2023 were included. Baseline demographics, clinical characteristics, and echocardiographic data, including left ventricular ejection fraction (LVEF) and left ventricular outflow tract (LVOT) gradients at rest and with Valsalva, were collected. Descriptive statistics were presented as means (standard deviations) and medians (interquartile ranges [IQRs]) or as counts and percentages as appropriate. Results: Of 45 patients initiated on mavacamten in the study period, 47% were female, 13% were non-White, and median age was 63 years (IQR 48, 70). Two-thirds were privately insured. Hypertension was common (56%), and 27% had an implantable cardioverter defibrillator. Median duration of HCM diagnosis was 6 years (IQR 4, 13), and two patients (4%) had undergone septal reduction therapy. At the time of the baseline echocardiogram prior to drug initiation, 42% had NYHA III symptoms, 56% were on background monotherapy with a beta-blocker, 24% with a nondihydropyridine calcium-channel blocker, and 20% were on both. All patients were in either sinus or an atrial-paced rhythm. Median LVEF was 69% (IQR 65, 75), and median septal wall thickness was 19 mm (IQR 18, 22). Median resting LVOT gradient was 57 mmHg (IQR 35, 80), and median Valsalva LVOT gradient was 78 mmHg (IQR 63, 91) ( Table ). Conclusions: In this single center experience of patients with obstructive HCM initiated on mavacamten, clinical characteristics were largely similar to those of patients enrolled in the phase 3 randomized trials of mavacamten, EXPLORER-HCM and VALOR-HCM.
Abstract 12302: Interleukin-22 Deficiency Exacerbates Right Ventricular Remodeling and Tricuspid Regurgitation During Pressure Overload
Authors: Kodai Shibao, Hideo Yasukawa, Akagaki Daiki, Kota Okabe, Toshiyuki Yanai, Shima Kanako, Yoshihiro Fukumoto
Journal: Circulation (2023)

Introduction: Right ventricle (RV) remodeling is associated with prognosis in patients with RV failure. Interleukin-22 (IL-22) is a member of the IL-10 cytokine family, play roles in tissue protection and wound repair. We have previously shown that IL-22 plays an important role in left ventricular remodeling after acute myocardial infarction; however, the role of IL-22 in the development of RV remodeling remains elusive. Hypothesis: IL-22 would inhibit the development of RV remodeling during pressure overload. Methods: Pulmonary artery banding (PAB) is performed by placing a 6-0 suture around the pulmonary artery over a 24 G needle in wild type mice (C57BL/6J) and IL-22 knockout mice (IL-22 KO). Only mice with moderate pulmonary artery stenosis (peak pressure gradient across the pulmonary band&gt; 25 mmHg at 1 week after surgery by echo Doppler) were included in the study protocol. Four weeks after PAB, RV function was measured by echocardiography, and 2 weeks after PAB, real-time PCR analysis was performed to measure IL-22 receptor subunit alpha 1 (IL-22RA1), and endogenous IL-22 inhibitor IL-22 binding protein (IL-22BP). Results: Four weeks after PAB, IL-22 KO mice showed markedly increased RV weight (IL-22 KO mice vs. wild-type mice; RV/BW: 1.4±0.2% vs 1.7±0.2%, P=0.047). IL-22 KO mice exhibited significant RV enlargement and RV dysfunction 4 weeks safter PAB. Compared with wild type mice, IL-22 KO mice had reduced TAPSE (0.64±0.11mm vs. 0.47±0.06mm, P=0.002) and FAC (30.6±6.6% vs. 23.5±4.4%, P=0.019), whereas RVEDV was increased (12.8±2.2mm 2 vs. 17.1±2.5mm 2 , P=0.019). Four weeks after PAB, the frequency of tricuspid regurgitation (TR) in IL-22 KO mice was significantly higher than that in wild type mice (100% vs 30%, P=0.004). The expression of IL-22, IL-22RA1 and IL-22BP in the RV tended to increase 2 weeks after PAB (wild-type mice with PAB (n=3) vs. wild-type mice with sham; IL-22RA1: 1.489 vs 1.773, P=0.175, IL-22BP: 0.025 vs 0.067, p=0.005). Conclusions: These results suggest that IL-22 may play a preventive role in the development of RV remodeling and TR during pressure overload.
Abstract 12186: A Challenging Case of Acute Superior Mesenteric Artery Embolism Diagnosed by Gastroscopy
Authors: Nobunari Tomura, Takuo Nakagami, Tetsuro Hamaoka, Kuniyoshi Fukai, Shinichiro YAMAGUCHI, Satoaki Matoba
Journal: Circulation (2023)

Introduction: Acute superior mesenteric artery (SMA) occlusion is one of the most lethal causes of acute abdomen that we often experience but mistake for gastrointestinal diseases. The golden time for revascularization in cases of SMA main trunk occlusion is within 5 hours of onset, requiring prompt diagnosis and treatment. We describe a challenging case of acute SMA embolism diagnosed by gastroscopy. Case Summary: A 66-year-old man with a history of hypertension presented to the emergency department for marked epigastric pain after eating raw seafoods. On arrival, electrocardiogram showed atrial flutter with no significant ST-segment changes. Despite the elevation of white blood cell count and lactate dehydrogenase in blood exam, computed tomography (CT) indicated no findings to cause his symptoms. Emergency gastroscopy performed on suspicion of anisakiasis demonstrated pallor findings with hematologic material in the duodenum, suggesting intestinal ischemia (Figure A). Since contrast-enhanced CT revealed an occlusion of SMA (Figure B), we diagnosed acute SMA embolism based on the finding of atrial flutter without anticoagulation. After discussion among cardiologists and gastroenterology surgeons, we selected to perform endovascular treatment. The epigastric pain was improved after reperfusion using a self-expandable stent, but flared up as oral intake progressed. Follow-up CT suggested ischemic enteritis of the proximal jejunum, leading to conduct laparoscopic partial jejunectomy. He was discharged 18 days after the operation with the ability to eat a normal diet. Conclusions: This case highlights that we should keep in mind SMA embolism when examining acute abdomen patients with atrial fibrillation or flutter without anticoagulation.
Abstract 12157: Underutilization of Revascularization Procedures Among Patients Living With HIV Admitted to the US Hospitals With Acute Myocardial Infarction and Factors Associated With Higher Odds of Receiving Revascularization: A Cross-Sectional Study
Authors: Saeed Shoar, Ashok Chaudhary, Sadegh Asadi
Journal: Circulation (2023)

Introduction: Despite significant improvements in the prevention and treatment of infection with the human immunodeficiency virus (HIV), people living with HIV (PLWH) suffer cardiovascular diseases to a more extent than HIV-negative patients. Research Question: Is there a disparity in the demographics and socioeconomic status of hospitalized PLWH with AMI, who undergo revascularization compared to those who do not? Methods: Data pertinent to admission cases with AMI was analyzed from the National Inpatient Sample registry between 2016 and 2019 to determine differences in the frequency and outcomes of revascularization (percutaneous or surgical) between PLWH and HIV-negative counterparts and identify factors associated with higher odds of undergoing revascularization. Results: The frequency of revascularization was significantly lower among PLWH with AMI than HIV-negative patients. The difference was more substantial for PCI than for CABG (Fig.1). Younger age, male gender, White race, residential of a zip code with higher income quartile or smaller metropolitan regions, private insurance or self-paid status, and hospitalization in the Western states were all associated with a higher likelihood of undergoing revascularization (Table1). Although total hospital charges were significantly higher for PLWH and AMI who underwent revascularization compared to those who did not, the length of hospital stay was significantly shorter. Conclusions: There is a significant disparity in revascularization approaches between HIV-positive and HIV-negative patients hospitalized with acute myocardial infarction.
Abstract 12468: One-Year Effects of Randomized High-Intensity Statin versus Placebo on the Bioactive Lipidome: Findings From the JUPITER Trial
Authors: Rosangela Hoshi, Mona Alotaibi, Yanyan Liu, Paul M Ridker, Robert Glynn, Charles N Serhan, Mohit Jain, Olga Demler, Samia Mora
Journal: Circulation (2023)

Introduction: Statin effects extend LDL-C reduction, with the potential to modulate the metabolism of bioactive lipids (BALs), crucial metabolites for biological signaling and inflammation. Hypothesis: Statin allocated participants will have a different BAL profile with cardioprotective properties compared to placebo. Aim: To investigate the impact of high-intensity statin therapy versus placebo on plasma BALs in the JUPITER trial (NCT00239681), a randomized double-blinded primary prevention trial involving individuals with LDL-C &lt;130 mg/dL and high-sensitivity C-reactive protein ≥ 2 mg/L. Methods: Using a non-targeted mass spectrometry approach, over 15500 lipid features were assayed from baseline (BL) and 1-year (Y1) plasma samples from non-CVD cases from 2 nested JUPITER sub-studies: JUPITER discovery (N=589) and JUPITER validation (N=409). The effect of rosuvastatin 20mg vs . placebo on BALs was examined by fitting a linear regression with delta values (ΔBAL=BAL Y1 -BAL BL ) that adjusted for age (years) and baseline BAL level. Significant associations in discovery were carried over for validation. Multiple comparisons were adjusted using a two-stage overall False Discovery Rate (FDR) &lt;.05. Results: We identified 569 associations significantly validated (overall FDR&lt;.05), including 27 BALs with putative annotation. Statins increased levels of 302 BALs, such as specialized pro-resolving mediators (SPMs) and eicosanoids with anti-inflammatory activity in the vasculature (e.g. 5,6-diHETE), arterial vasodilation properties (hepoxilins), and a precursor of leukotrienes (5-HpETE). Among 267 BALs lowered by statins, there were arachidonic acid and inflammation-related lipid mediators (10 HDoHE, 5-HEPE, 11-HETE, 9-HODE, 11d-TXB2) (Fig1 A and B). Conclusions: Statins had pleiotropic effects on BAL metabolites, predominantly increasing anti-inflammatory and pro-resolution BALs and decreasing BALs with pro-inflammatory properties.
Abstract 12275: Neighborhood Deprivation Predicts All-Cause and Cardiovascular Mortality in a Low-Income Population in the Southeastern United States
Authors: Melis Sahinoz, Meng Xu, Kui Deng, Ravi V Shah, Loren Lipworth, Deepak Gupta, Debra Dixon, Martha Shrubsole, Danxia Yu
Journal: Circulation (2023)

Background: Neighborhood disadvantage impacts individuals’ morbidity and mortality and contributes to health disparities, but prospective cohort data from individuals of low socioeconomic status (SES) are limited. Hypothesis: Greater neighborhood deprivation associates with higher all-cause and cardiovascular (CV) mortality beyond individual SES, lifestyle, and clinical factors in a multi-racial, low-income population. Methods: The Southern Community Cohort Study is a population-based cohort of mostly low SES individuals recruited from 12 southeastern US states between 2002-2009. Participant addresses were linked with a census tract-based neighborhood deprivation index (NDI) derived from neighborhood level income, education, employment, housing, and occupation data. Date and cause of death were ascertained via the National Death Index. Cox proportional hazard models were used to test associations between NDI and death adjusted for enrollment age, sex, self-reported race, education, income, insurance, smoking, physical activity, alcohol intake, diet, sleep duration, BMI, and diabetes, hypertension, depression, cancer, heart disease, and stroke. Results: Among 79,631 participants, median age was 51 years (25 th -75 th percentiles: 45-58), 69% were Black, and 60% were female. Over a median 13-year follow-up, 23,356 participants died, of which 7,214 (30.9%) were CV. With adjustment for age, sex, and race, per standard deviation (SD) increase in NDI was associated with a 19% increase in all-cause mortality (HR 1.19, 95% CI 1.18-1.21) and 16% increase in CV mortality (HR 1.16, 95% CI 1.13-1.19). Even with adjustment for individual SES, lifestyle, and clinical factors, NDI was associated with a 6% increased risk in all-cause mortality (HR per SD increase 1.06, 95% CI 1.03-1.08) and 8% increase in CV mortality (HR 1.08, 95% CI 1.05-1.11). NDI showed similar significant associations with all-cause and CV mortality in Black and White participants. Conclusion: Among low-income Americans, greater neighborhood deprivation associates with higher all-cause and CV mortality independent of individual SES, lifestyle, and clinical risk factors. More research is needed to examine factors underlying the health effects of neighborhood deprivation.
Abstract 12340: Association of Liver Enzymes With Incident Cardiovascular Disease Events and All-Cause Mortality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Mario J Trejo, James S Floyd, Daniele Massera, Martha L Daviglus, Olga Garcia-Bedoya, Jianwen Cai, Neil Schneiderman, Gregory A Talavera, Dorathy E Tamayo-Murillo, Daniel L Labovitz, robert kaplan
Journal: Circulation (2023)

Introduction: Metabolic associated fatty liver disease (MAFLD) is a significant contributor to chronic liver disease on a global scale, encompassing a broad range of systemic impacts, including an increased risk of cardiovascular disease (CVD). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are commonly utilized indicators of liver injury in this context. Despite the high prevalence of MAFLD among Hispanic/Latino populations, there is a scarcity of research focusing on this specific demographic. Aim: To investigate the relationship between liver disease, incident CVD, and mortality in a representative Hispanic/Latino population, using non-invasive markers. Methods: A total of 14,149 participants recruited between 2008-2011 in HCHS/SOL aged 18-74 years with no pre-existing CVD at study baseline were included in this study. The outcome of interest was a composite of adjudicated incident CVD and all-cause mortality. Participants who had liver function tests (LFTs) AST &gt; 37 IU/mL or ALT &gt; 40 IU/mL for men, and AST or ALT &gt; 31 IU/mL for women were classified as having elevated LFTs. MAFLD was defined as a fatty liver index score &gt;60 and: type 2 diabetes, body mass index&gt;25 kg/m 2 or at least two metabolic risk abnormalities. Survey-weighted cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for our composite outcome by elevated LFTs. Interaction terms assessed the relationship between elevated LFTs and MAFLD. Results: The study population was 40 years old on average, 53.4% female and had 403 weighted CVD and all-cause mortality events. Elevated LFTs and MAFLD alone were not associated with incident CVD and all-cause mortality (HR: 1.24; CI: 0.89-1.71). MAFLD modified the relationship between elevated LFTs and CVD (P=0.04). Among those with MAFLD, elevated LFTs were not associated with CVD (HR: 1.01; CI:0.70-1.46), but among those without MAFLD, elevated LFTs were associated with CVD (HR: 2.05; CI:1.17-3.58). Conclusions: Among Hispanic/Latinos without MAFLD, elevated LFTs were associated with CVD and all-cause mortality. Additional research is needed to elucidate the relationship between liver disease and CVD in the Hispanic/Latino population.