tbuckley/cabot-search huggingface dataset:
Abstract 17880: The Association of Social Determinants of Health at Birth With Cardiovascular Health in Young Adulthood: The Future of Families and Child Wellbeing Study
Authors: Norrina B Allen, Hongyan Ning, Amanda M Marma, Lifang Hou, Yinan Zheng, Linda Van, James H Stein, Daniel Notterman, Donald M Lloyd-Jones, Noreen Goldman
Journal: Circulation (2023)

Background: Social determinants of health (SDoH) are known to influence an individual’s risk for CVD. Childhood is a vulnerable period during which the influences of SDoH may have a stronger impact on future health outcomes. Little is known about early life SDoH and associations with cardiovascular health (CVH) in early adulthood. Methods: In 1998-2000, the Future of Families and Child Wellbeing Study (FFCWS) enrolled 4898 mother-baby dyads from large cities across the US. Births to unmarried mothers were oversampled. When the offspring were 22 yrs, they completed an in-person exam for CVH metrics. SDoH at birth included maternal and paternal education, mother living in a public housing project, having income within the past year from public assistance/welfare/food stamps. Life’s Essential 8 (LE8) Score (without sleep) was assessed at age 22. Linear regression models examined the association of individual SDoH measures with LE8 score adjusting for age, gender and race/ethnicity. Results: This study included 1211 participants, mean age 22 yrs (55% female; 51% Black, 25% Hispanic, 20% White, 4% Other). Adverse SDoH were common with 10% living in a public housing project at birth and 36.7% of mothers having received public assistance within the past year. Adjusted CVH scores were 3.0 (95% CI 1.2-4.8) pts lower for individuals whose mother reported having received public assistance in the past year. Compared to mothers with a college or graduate degree, those with less than high school, high school, and some college had 8.0 (5.0-10.9), 7.1 (4.2-10.0) and 3.2 (0.3-6.1) lower scores CVH scores. Findings were similar for paternal education. No significant associations were observed with living in a public housing project. Conclusion: SDoH at the time of birth have long lasting influence on the CVH of offspring. Interventions to promote CVH within children and families experiencing adverse SDoH are critical to promote health equity and break the inter-generational cycle of CVD.
Abstract 15518: What Monitoring Duration is Needed to Rule Out High Atrial Fibrillation Burden?
Authors: Linda S Johnson, William F McIntyre, Axel Brandes, Jeff S Healey, Emma Svennberg
Journal: Circulation (2023)

Introduction: Atrial fibrillation (AF) burden contributes to stroke risk. AF detection rates increase with monitoring duration, but the relationship between time to the first AF episode and AF burden has not been described. We aimed to identify AF free monitoring durations after which a given AF burden can be ruled out. Methods: We included all subjects without permanent AF (n=13,106, median age 65 years (IQR 51-74 years), 40.1% male) monitored for ≥14 days in 2021 in the USA with PocketECG (MEDICALgorithmics), a full disclosure mobile cardiac telemetry device. We graphed 14-day AF burden (% time in AF/total time) by time in days before detection of prespecified AF durations (&lt;30s (micro-AF), ≥30s-6 minutes, ≥6 minutes-1 hour and ≥1 hour in mutually exclusive strata) and calculated the 95th percentile of 14-day AF burden by time to first AF episode of different durations. Confidence intervals were estimated using bootstrapping with 1000 replications. Results: There were 5,605 patients with micro-AF episodes, 1,788 patients with 30s-6min AF episodes, 748 patients with 6 min-1 hour AF episodes and 227 patients with ≥1 hour AF episodes (Fig 1 a-d). The overall AF burden was higher in subjects with longer episodes, but decreased by time to first episode for all episode durations, Figure 1e-h. After 3 days of monitoring the 95th percentile for overall AF burden was 0.03% (95%CI 0.02-0.03%) in patients without micro-AF, 0.1% (95%CI 0.08-0.11% in patients without ≥30s AF, 0.4% (95%CI 0.3-0.4%) without ≥6-minute AF episodes, and 1.5% (95%CI 1.2-1.8%) without ≥1 hour episodes of AF. Conclusions: The probability of a high AF burden decreases as AF-free monitoring time increases, and AF free monitoring time can be used to inform the need for longer monitoring. When no AF episodes lasting ≥1 hour have been detected after 3 days of monitoring the probability of an AF burden &gt;2% can be effectively ruled out.
Abstract 15904: Hypertension Risk in Adolescent Females With Polycystic Ovary Syndrome
Authors: Sherry Zhang, Jeanne A Darbinian, Louise C Greenspan, sahar naderi, Joan C Lo
Journal: Circulation (2023)

Background: Polycystic ovary syndrome (PCOS) is associated with increased risk of hypertension (HTN) in adult women, but fewer studies have examined PCOS and HTN among adolescents. Characterizing blood pressure (BP) by PCOS status prior to adulthood may inform early cardiovascular risk surveillance efforts. Aim: To examine the prevalence of hypertension-range BP (HTN-BP) in adolescent females with and without PCOS and to characterize the association of PCOS and HTN-BP. Methods: We used data from an existing cohort of 171,855 females aged 13-17y in a US healthcare system with well-child visit (2012-2018) and measured systolic/diastolic BP. The 2017 American Academy of Pediatrics Practice Guideline was used to classify normal BP [&lt;120/&lt;80], elevated BP [120/&lt;80-129/&lt;80], stage 1 HTN [130/80-139/89] and stage 2 HTN [≥140/90 mmHg]. PCOS was based on clinical diagnosis (ICD-9 265.4, ICD-10 E28.2) within 1 year of the visit. Body mass index (BMI) was classified as healthy, overweight, moderate and severe obesity using BMI percentile data; 3062 underweight females were excluded from analyses. Differences by PCOS (N=1142) and no PCOS (N=167,651) status were compared. Multivariable logistic regression examined the association of PCOS and HTN-BP, with adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: The cohort included 168,793 females (33.6% non-Hispanic White, 9.7% Black, 30.5% Hispanic, 19.9% Asian/Pacific Islander, and 6.3% other/unknown race ethnicity), of whom 65.9% had healthy weight, 18.7% overweight, and 15.4% obesity. Based on visit BP data, 75.6% were normotensive, 17.5% had elevated BP, and 7.0% had HTN-BP (6.1% Stage 1, 0.9% Stage 2). HTN-BP prevalence was much higher for PCOS vs no PCOS (18.6% vs 6.9%, p&lt;0.001). After accounting for age, race/ethnicity, and BMI level, PCOS was associated with 1.3-fold greater odds of HTN-BP (aOR 1.3, CI 1.1-1.5). Similar findings were seen among females with obesity (aOR 1.3, CI 1.1-1.6). Conclusions: Prevalence of HTN-BP was 30% higher for those with PCOS after adjusting for BMI, race/ethnicity, and age. Similar findings were evident among those with obesity. Future studies should examine persistent HTN and the independent association of PCOS and HTN severity in this high-risk population.
Abstract 371: Physiological Predictors of Cerebral Oxygenation During Hemorrhage in Swine
Authors: Jeffrey R Gould, Lyra R Clark, Jill Badin, Joshua Harvey, Joshua W Lampe
Journal: Circulation (2023)

Introduction: Measurements of cerebral oxygenation (rSO 2 ) using near-infrared spectroscopy (NIRS) have been used to predict survival in retrospective clinical studies. However, the physiology underlying changes in rSO 2 during critical states such as hemorrhage is not completely understood. This analysis examined the effect of blood pressures, intracranial pressure, and heart rate on rSO 2 . Methods: Eight swine were instrumented with invasive pressure catheters in the aorta, right atrium, and cerebrum and underwent a pressure-targeted arterial hemorrhage protocol. Animals were bled at a rate of 20mL/min to a target diastolic pressure of 35 mmHg. Brief periods of increased baseline airway pressure (15 cm H 2 O) were introduced to cause transient drops in arterial blood pressure. The aortic pressure waveform was used to identify individual heartbeats. The first 100 heartbeats represent baseline data, while heart beats 4900-5000 (time from start of bleed; 40±7 min) capture data late into the bleed for all animals. Data from 53,315 heart beats were entered into a regression model: rSO 2 = mean diastolic aortic pressure + mean diastolic right atrial pressure + intracranial pressure + heart rate + animal. Results: The hemorrhage reduced diastolic aortic pressure from 61.7±9.6 (heart beats 1-100) to 35.0±9.2 mmHg (heart beats 4900-5000), increased right atrial pressure from 4.1±3.6 to 4.9±6.9 mmHg, reduced intracranial pressure from 33.6±23.2 mmHg to 16.3±2.5 mmHg, and increased heart rate from 101±14 to 144±40 beats/min. Output from the regression model (Table 1) shows that mean diastolic aortic pressure, but not right atrial pressure, intracranial pressure or heart rate, is a significant predictor of rSO 2 . Conclusions: rSO 2 values are largely driven by arterial blood pressure and may serve as a useful non-invasive tool as a surrogate for arterial blood pressure during hemorrhage. Further work should investigate the use of this technology to provide real-time feedback.
Abstract 15668: The Incidence and Predictors of Delayed and Late Response to Cardiac Re-Synchronization Therapy
Authors: Matias E Pollevick, Samuel L Bruce, Michael Lavelle, Kenneth Guber, David Majure, Angelo B Biviano, Elaine Y Wan, Hasan Garan, Ioanna Kosmidou, Hirad Yarmohammadi
Journal: Circulation (2023)

Background: The incidence and predictors of delayed response to cardiac resynchronization therapy (CRT) have not been well established. Our study aimed to investigate the incidence and predictors of delayed and late response in CRT patients. Research Question: What patient-specific characteristics are associated with delayed or late response to CRT? Goal/Aim: To investigate the incidence and predictors of delayed and late response in CRT patients. Methods: We conducted a retrospective analysis of 201 patients who underwent CRT implantation with placement of a CS lead. Patients meeting the enrollment criteria were categorized into three groups: Group A comprised conventional responders with a response observed at the 6-month follow-up, Group B consisted of delayed responders with a response seen between 6 months and 1-year follow-up, and Group C included late responders with a response observed after 1 year of follow-up. CRT response was defined as an absolute increase of ≥ 5% in left ventricular ejection fraction. All echocardiograms were performed at the same institution. Only patients who were defined as responders to CRT were included in the analysis. Results: Among the patients analyzed, 59 patients (67.2 ± 12.3 years, 39 male) achieved a conventional response to CRT, while 40 patients (69.6 ± 9.5 years, 30 male) experienced a delayed response, and 29 patients exhibited a late response (66.1 ± 11.4 years, 18 male). The mean follow-up time was 267 days (± 341 days). The incidence of delayed and late responses was 19.9% and 14.43%, respectively. In univariable logistic regression analysis, a history of coronary artery disease (p = 0.047) was associated with delayed and late CRT responses. Conclusions: Our findings demonstrate a significant proportion of patients experiencing delayed and late responses to CRT. This study suggests the need for reconsidering the waiting time for CRT response, particularly in patients with a history of coronary artery disease. Keywords: cardiac resynchronization therapy, delayed response, heart failure
Abstract 16848: Reduced Survival of Patients Treated With Leadless Right Ventricular Pacemakers
Authors: Anne J Wong, Robert G Hauser, Melanie J Kapphahn-Bergs, Susan A Casey, Dawn R Witt, Evan T Walser-Kuntz, Jay D Sengupta
Journal: Circulation (2023)

Introduction: Leadless right ventricular pacemakers (LVP) are particularly valuable for patients who lack venous access for transvenous pacing (TVP) or who are at risk for pocket complications including infection, erosion, or hematoma. Since such patients constitute a unique population, we sought to compare their 2-year survival (SURV) to that of patients paced with traditional TVP or conduction system pacemakers (CSP). Hypothesis: The SURV of patients treated with a LVP for reasons related to venous access or potential pocket complications is different from the SURV of TVP or CSP patients. Methods: We calculated the weighted and unweighted Kaplan-Meier SURV of patients implanted with a LVP, TVP, or CSP at our institution. The Piccini risk score variables (age, BMI, gender, heart failure, CAD, prior MI, pulmonary hypertension, COPD, atrial fibrillation, prior cardiac intervention, and chronic kidney disease) were used to weight patients via the generalized linear model method, which successfully reduced comorbidity variability between the LVP, TVP, and CSP groups. All analyses were conducted in R 4.2.3. Results: The weighted and unweighted SURV of 335 patients who were implanted with a LVP (n=196), CSP (n=89), or traditional TVP (n=50) are shown in the graph. Despite weighting patients using the Piccini risk score, LVP SURV was significantly lower than that of patients paced with TVP or CSP pacemakers (p&lt;0.01). The SURV of CSP and TVP patients were similar (p=0.51). Conclusions: For unclear reasons, the near-term prognosis of these LVP patients appears to be considerably less favorable than those receiving TVP or CSP pacemakers. Importantly, while further study is needed, this finding should be considered when evaluating the survival of leadless pacemaker populations.
Abstract 18178: Should We Screen for S-ICD Vectors in Hypertrophic Cardiomyopathy Post-Myectomy?
Authors: Unnati Bhatia, Nishaki M Mehta
Journal: Circulation (2023)

Case Description: We describe a 40 year old Asian male with hypertrophic cardiomyopathy (HCM) who presented after an inappropriate shock from his subcutaneous ICD (S-ICD) but was otherwise asymptomatic. The device was placed 4 months ago for secondary prevention of sudden cardiac death (SCD). He underwent a septal myectomy 2 months prior to presentation for severe LVOT obstruction. EKG showed sinus rhythm with new post-myectomy LBBB. Troponins were normal. Device interrogation revealed a wide complex rhythm consistent with sinus tachycardia with LBBB and evidence of T-wave oversensing (TWOS). The S-ICD was turned off and no further arrythmias were seen on continuous telemetry. Subsequent vector rescreening reflected ineligibility for S-ICD, most likely due to altered QRS morphology post-myectomy. Accordingly, the S-ICD system was extracted and a dual chamber transvenous ICD was placed. Patient noted to be doing well at 3 months follow up. Discussion: S-ICD is a safe and effective alternate to transvenous ICDs to prevent SCD in patients with HCM, especially those with a long life-expectancy. The pre-implant automated screening tool generates 3 sensing vectors. Screening is done to ensure at least 1 vector with suitable EKG morphology as low amplitude vectors and low R:T ratios increase risk of oversensing. However, post-surgical changes can alter the QRS morphology as seen above. This can significantly impact the screening process. Currently, there are no guidelines for rescreening. We propose rescreening in the setting of significant QRS changes (especially post-operatively) to reduce the risk of oversensing and undersensing in high risk populations.
Abstract 17210: Re-Defining Antibody Mediated Rejection With Donor-Specific Antibodies and Graft Dysfunction, on Behalf of the GRAfT Investigators
Authors: Jason F Goldberg, Yifei Xu, Xin Tian, Eleanor Gerhard, Ruth Brower, Moon Jang, Hyesik Kong, Temesgen Andargie, Woojin Park, Samer S Najjar, Inna Tchoukina, Keyur B Shah, Steven Hsu, Maria Rodrigo, Charles Marboe, Gerald Berry, Hannah Valantine, Palak Shah, Sean Agbor-Enoh
Journal: Circulation (2023)

Introduction: Heart transplant recipients with donor-specific antibodies (DSA) have increased risk for antibody-mediated rejection (AMR). However, many patients with graft dysfunction and DSA do not show AMR by endomyocardial biopsy (EMB). Hypothesis: We hypothesized that, similar to EMB-defined AMR, AMR defined as DSA presence + graft dysfunction on echocardiography is associated with 1) graft injury via elevated donor-derived cell-free DNA (dd-cfDNA) and 2) risk for long-term adverse outcomes. Methods: Adult heart transplant recipients from the Genomic Research Alliance for Transplantation (GRAfT, a prospective, multicenter study from 2015 to 2020) had DSA, echocardiogram, and dd-cfDNA evaluated at time of EMB. AMR was defined by EMB (pAMR ≥ 1), DSA/EF (DSA presence + LVEF drop by ≥ 10% to an LVEF ≤50%), or a composite of EMB or DSA/EF criteria. The composite long-term endpoint was death or long-term EF reduction ≤ 50% for &gt;90 days. Results: 216 patients (29% Female, 39% Black race, mean age 52 ± 12 years) had 1489 EMB, 1959 DSA, 1821 echocardiogram, and 1190 dd-cfDNA evaluations. DSA were present in 71 patients (34%), predominantly class II (69%). AMR was detected by EMB in 16 subjects and by DSA/EF in 10 subjects. Median %dd-cfDNA for subjects with AMR by EMB was 0.63% (IQR 0.23-2.0), by DSA/EF was 0.40% (IQR 0.36-1.24), and for controls was 0.01% (IQR 0.001-0.10). There were 18 deaths and 10 subjects with long term EF reduction. As compared to controls, development of each AMR definition was associated with the composite long-term endpoint: AMR by EMB, HR=3.6, P =0.010; AMR by DSA/EF, HR=23.4, P &lt;0.0001; composite AMR, HR=7.6, P &lt;0.0001, Figure. Conclusions: Heart transplant recipients with EMB and EF/DSA AMR have similar evidence of graft injury via dd-cfDNA as well as risk of long-term adverse outcomes, as compared to those without AMR. Therefore, a composite definition of AMR, including EMB or DSA/EF may better allow for identification of patients at risk for graft failure.
Abstract 18696: Berberine as a Supplement to Guideline-Based Lipid Management of a Patient With Heterozygous Familial Hypercholesterolemia: A Case Presentation
Authors: Elizabeth S Epstein, Kunal Goel, Douglas W Triffon
Journal: Circulation (2023)

Description of Case: A 62-year-old female presented for a lipidology consult. Labs revealed total cholesterol &gt;450 mg/dL, Lp(a) 42 mg/dL, and LDL-P 2938. She was not on any lipid lowering therapy. A clinical diagnosis of heterozygous familial hypercholesterolemia (HeFH) was made. She reported occasional chest pain with both cardiac and noncardiac features. She had no personal history of CAD, and her family history revealed a mother and maternal grandfather with CAD in their 50s. A CCTA was performed, which revealed mild-moderate plaque in the ostial left circumflex (25-49%) and a CAC score of 124 (90-95th percentile). She was started on rosuvastatin 10mg daily and alirocumab with reduction of her LDL-C to 247 mg/dL. Given documented CAD, LDL-C &lt;55 mg/dL was targeted. She had intolerable side effects to combination ezetemibe plus bempadoic acid and lomitapide. Evinacumab or LDL pheresis were offered, and the patient preferred to start evinacumab. Alirocumab was stopped. With rosuvastatin plus evinacumab, her LDL-C improved to 198 mg/dL. Berberine 1000mg was added to her regimen and resulted in further reduction of her LDL-C to 117 mg/dL. Discussion: Long used in Traditional Chinese and Ayurvedic medicine, Berberine is an alkaloid found in plants such as barberry and tree turmeric. Berberine suppresses PCSK9 transcription by regulating hepatocyte nuclear factor 1 alpha, a binding site located upstream from the PCSK9 gene promoter. The role of supplements in lipid management remains unknown. We describe a case of HeFH in which berberine yielded an 81 mg/dL absolute reduction (41% relative reduction) in LDL-C when added to guideline-based therapy. In a dedicated integrative lipidology practice, berberine may be an effective supplement to the pharmaceutical management of severe hyperlipidemia.
Abstract 17986: Impact of Race and Socioeconomic Factors on Hypertensive Emergency
Authors: Affan M Rizwan, Hunter Mace, Arsalan Hamid, Donald Clark, Michael Hall
Journal: Circulation (2023)

Background: Hypertensive emergency, defined as a blood pressure ≥ 180/110mmHg with target organ damage, is a major cause of cardiovascular morbidity and mortality. There is a lack of data on the impact of race and socioeconomic factors on hypertensive emergency incidence and outcomes. Thus, we investigated these associations in a diverse population at a large tertiary-care academic medical center. Methods: Utilizing the Patient Cohort Explorer Epic electronic health records system at the University of Mississippi Medical Center from 1/1/2013 to 7/31/2021, we identified patients diagnosed with hypertensive emergency. Sociodemographic factors related to hypertension and patient status (alive/deceased) were also examined. Descriptive statistics were used to examine differences in means across groups. Results: 2,483 patients diagnosed with hypertensive emergency were included in this analysis. Among these patients, the mean (SD) age was 52 (17) years, 49% were women, and 82.2% were Black. Nearly half (44.4%) of those diagnosed with hypertensive emergency were uninsured, 46.7% had Medicaid or Medicare, and 7.9% had private insurance. Black patients with hypertensive emergency were significantly younger compared with White patients (51 vs 57 years, p&lt;0.001). There was no significant correlation between race and insurance status in this population. Over the 8-year period, 14.1% were deceased at the time of analysis. Conclusions: Among patients admitted to a large academic medical center with hypertensive emergency, most were Black individuals with Medicaid or lacking health insurance. Black individuals present at significantly younger ages compared to White patients. Our findings are much different than data published from the Nationwide Readmissions Database reporting a mean age of 66 years and nearly 90% insured rate in patients with hypertensive emergency. Further, race was not reported in that analysis. Our findings suggest that hypertensive emergency disproportionately affects minority and underserved populations. Further work is needed to characterize risk factors and improve outcomes for this high-risk population.