tbuckley/cabot-search huggingface dataset:
Abstract 14425: Independent Predictors of ECG Interpretation Proficiency in Healthcare Professionals
Authors: Anthony H Kashou, Peter A Noseworthy, Thomas Beckman, Nandan S Anavekar, Michael W Cullen, Benjamin Sandefur, Christopher L Boswell, Kurt Angstman, Brian P Shapiro, Brandon Wiley, Andrew Kates, david Huneycutt, Andrew Braisted, Scott Kerwin, John Beard, Brian Young, Ian Rowlandson, Adrian Baranchuk, Kevin O'Brien, Stephen Knohl, Adam May
Journal: Circulation (2023)

Background: Accurate ECG interpretation is vital, but variations in skills exist among healthcare professionals. This study aims to identify factors contributing to ECG interpretation proficiency. Methods: Survey data and ECG test scores from participants in the EDUCATE Trial were analyzed. The dependent variable was the test score for interpreting 30 12-lead ECGs. Independent variables included non-modifiable factors (physician status, clinical experience, patient care impact) and modifiable factors (weekly interpretations, training hours, expert supervision frequency). Bivariate and multivariate analyses generated the Comprehensive Model (all factors) and Actionable Model (modifiable factors only). Results: Among 1206 participants, there were 72 (6.0%) primary care physicians, 146 (12.1%) cardiology fellows-in-training, 353 (29.3%) resident physicians, 182 (15.1%) medical students, 84 (7.0%) advanced practice providers, 120 (9.9%) nurses, and 249 (20.7%) allied health professionals. Physicians accounted for 571 (47.3%) of participants, while 453 (37.6%) were non-physicians. Bivariate analysis showed associations between test scores and multiple variables (Table 1) . In the Comprehensive Model, scores were independently associated with weekly interpretations (9.9 score increase; 95% CI 7.9-11.8; P&lt;0.001), physician status (9.0 score increase; 95% CI 7.2-10.8; P&lt;0.001), and training hours (5.7 score increase; 95% CI 3.7-7.6; P&lt;0.001). In the Actionable Model, scores were independently associated with weekly interpretations (12.0 score increase; 95% CI, 10.0-14.0; P&lt;0.001) and training hours (4.7 score increase; 95% CI 2.6-6.7; P&lt;0.001). The Comprehensive and Actionable Models accounted for 18.7% and 12.3% of the variance in test scores, respectively. Conclusions: Being a physician is a non-modifiable predictor, while training and regular practice are modifiable predictors of ECG interpretation performance.
Abstract 13005: Depletion of XCR1+ Conventional Dendritic Cell After Myocardial Infarction Improved Adverse Cardiac Remodeling via CXCR3 Chemokine Signaling
Authors: Hiroyasu Inui, Makoto Nishida, Ayami Saga, Takashi Omatsu, Katsunao Tanaka, Takeshi Okada, Tohru Ohama, Masahiro Koseki, Shizuya Yamashita, Yasushi Sakata
Journal: Circulation (2023)

Introduction: We have demonstrated immune reactions of probucol treatment on cardiac remodeling using SR-BI KO/ApoeR61 h/h (SRBI KO) mice in which ischemic myocardial injury is induced by high fat diet. In the previous study, we identified the role of XCR1 + conventional dendritic cells 1 (cDC1)-activated CD4 + T Helper-1 (Th1) cells after ischemic myocardial injury. Hypothesis: Deletion of XCR1 + cDC1 cells after myocardial infarction (MI) might improve adverse cardiac remodeling through the suppression of Th1 cells. Methods: Using Xcr1 +/DTRvenus mice, which allow the XCR1-expressing cell elimination by treatment with diphtheria toxin (DT), permanent coronary ligation was conducted. DT was injected into Xcr1 +/DTRvenus mice 1 day after MI (XCR1 depleted-MI group). We analyze cDCs and CD4 + T cell subsets by flow cytometry. Results: The XCR1 depleted-MI group showed improvement of EF evaluated by cardiac MRI (p&lt;0.05). In CD4 + T cell subsets, Th1 and Tregs were significantly localized in border and infarcted area, while Th1 cells were decreased in XCR1 depleted-MI group (p&lt;0.001). To elucidate the mechanism of the predominant reduction of Th1 cells, we focused on CXCR3 chemokine receptor and its ligands, CXCL9 and CXCL10. CXCR3 is enriched on Th1 in the heart after MI, while it is not enriched on Tregs. Regarding the precise source of CXCL9 and CXCL10 in the ischemic heart, the percentage of XCR1 + cDC1 cells were most predominant in the cDCs subsets expressing CXCL9 and CXCL10 (p&lt;0.001). These results suggested that XCR1 + cDC1 cell-derived CXCL9 and CXCL10 are significant contributor to the chemotaxis of CXCR3 + Th1 cells after MI. Finally, we analyzed autopsy samples of human MI cases to demonstrate clinical significance. CXCR3 + Th1 and XCR1 + cDC1 cells were detected significantly more in the infarcted area than in marginal zone. Conclusions: The modulation of XCR1+cDC1-activated CXCR3 + Th1 cells could be a novel therapeutic target to reduce post-MI remodeling.
Abstract 13007: Ketone Bodies for Right Ventricular Failure: A Unique Therapeutic Opportunity
Authors: Madelyn Blake, Patricia Puchalska, Felipe Kazmirczak, Thenappan Thenappan, Peter Crawford, Kurt W Prins
Journal: Circulation (2023)

Introduction: Right ventricular failure (RVF) is the leading cause of death in pulmonary arterial hypertension (PAH), but effective therapies for RVF are lacking. Ketones exert therapeutic effects through suppression of the NLRP3 (nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3) inflammasome and exhibit favorable metabolic properties in LVF. However, the relationships among serum ketone bodies, RV inflammasome activation, and RV function in preclinical and human RVF are unexplored. Hypothesis: Serum ketones correlate with RV function and induction of therapeutic ketosis ameliorates RV dysfunction. Methods: 51 PAH patients were dichotomized into preserved or impaired RV function based on a cardiac index of 2.2 L/min/m 2 . Serum ketone bodies acetoacetate (AcAc) and β-hydroxybutyrate (BOHB) were quantified using ultra performance liquid chromatography and mass spectrometry. The relationships between AcAc and BOHB and clinical measures of RV function were evaluated. In rodent studies, male Sprague Dawley rats were assigned to three groups: control (saline injection), monocrotaline (MCT) standard chow diet (MCT-SD), and MCT ketogenic diet (MCT-KD). Immunoblots and confocal microscopy probed macrophage NLRP3 activation in RV extracts and sections. RV fibrosis was determined by Picrosirus Red. Echocardiography evaluated RV function. Results: Human RVF patients lacked a compensatory ketosis as serum AcAc and BOHB levels were not associated with hemodynamic or echocardiographic measures of RV function. In rodent studies, AcAc and BOHB levels were also not elevated in MCT-mediated RVF, but the ketogenic diet significantly increased AcAc and BOHB levels. MCT-KD exhibited suppressed NLRP3 activation with a reduction in NLRP3, ASC (apoptosis-associated speck-like protein), pro-caspase-1, and interleukin-1 beta on immunoblots. Moreover, the number of ASC-positive macrophage in RV sections was reduced, RV fibrosis was blunted, and RV function was augmented in MCT-KD rats. Conclusions: Our preclinical and clinical data suggests therapeutic ketosis could combat RVF, and patients with RVF are uniquely primed for ketogenic interventions due to a lack of effective ketosis.
Abstract 18350: COVID-19 Patients With Pulmonary Hypertension Hospitalized in the United States During the Early Pandemic: Analysis of In-Hospital Mortality, Clinical Outcomes, and Racial Disparities
Authors: Harris Majeed
Journal: Circulation (2023)

Introduction: Coronavirus Disease 2019 (COVID-19) has been associated with adverseoutcomes among hospitalized patients with pulmonary hypertension (PH) based onlimited studies. The objective of our retrospective study was to utilize theNational Inpatient Sample (NIS) database to compare in-hospital mortality andother secondary clinical outcomes between COVID-19 patients with PH andCOVID-19 patients without PH. Hypothesis: We hypothesizedthat there would be a significant increase in inpatient mortality and othercomplications among hospitalized COVID-19 patients with PH. Methods: Patientsages 18 years and older admitted to a hospital in the United States betweenJanuary 1, 2020 and December 31, 2020 with COVID-19 were included in our studyand stratified into two cohorts. Results: Aftermultivariate adjustment, we found that COVID-19 patients with PH hadsignificantly higher in-hospital mortality, increased lengths of stay, andhigher costs of hospitalization when compared to COVID-19 patients without PH.We also noted that COVID-19 with PH had increased dependence on invasive andnon-invasive positive pressure ventilation suggestive of more severerespiratory failure. Furthermore, our data demonstrated that COVID-19 patientswith PH were at risk of pulmonary embolism and myocardial infarction. Also,Hispanic and Native American COVID-19 patients with PH remained at anindependently elevated risk for in-hospital mortality when compared to otherracial groups. Conclusions: To our knowledge this isthe largest study evaluating outcomes among COVID-19 patients with PH.In-hospital complications, especially pulmonary embolism, present a clinicalmechanism for the observed inpatient mortality. Given the significant mortalityand complications associated with COVID-19 infection and pulmonaryhypertension, we recommend vaccination against SARS-CoV-2 and aggressivenon-pharmacologic preventative measures.
Abstract 15726: Large-Scale Plasma Proteomics and Mendelian Randomization of Cardiovascular Performance and Peak Arterio-Venous Oxygen Difference Identify Novel Biology Related to VO <sub>2</sub> max
Authors: Prashant Rao, Jacob L Barber, Michael Y Mi, Usman A Tahir, Shuliang Deng, Laurie A Farrell, Prasun K Dev, Claude Bouchard, Clary B Clish, Mark A Sarzynski, Jeremy M Robbins, Robert E Gerszten
Journal: Circulation (2023)

Introduction: VO 2 max is the product of maximal cardiac output (Q) (maximal stroke volume (SVmax) x heart rate) and peak arterio-venous oxygen content difference (a-vO 2 diff). SVmax and peak a-vO 2 diff have important implications across the spectrum of human health and performance. However, the molecular mechanisms underlying SVmax and peak a-vO 2 diff remain largely unknown. We characterize SVmax and peak a-vO 2 diff using large-scale plasma proteomics and genotyping to identify circulating proteins and putative mediators of these traits. Methods: 763 physically inactive adults without overt cardiovascular disease underwent cardiopulmonary exercise testing with rigorous measurements of Q. High-throughput plasma proteomic profiling was performed to identify proteins associated with SVmax, a-vO 2 diff, and VO 2 max. cis-Mendelian Randomization (MR) analysis was conducted to assess causal relationships between protein markers and cardiovascular performance traits. Results: Proteomic profiling revealed associations between SVmax and several adiposity-related proteins, as well as secretory muscle factors (cathepsin B, α-actinin 2, and troponin I) (Figure). Proteins associated with peak a-vO2diff reflected oxygen-carrying capacity, muscle biology, and glucose metabolism (erythropoietin, myoglobin, fructose-1,6-bisphosphatase). Significant overlap was observed between proteins associated with SVmax, a-vO 2 diff, and VO 2 max. Cis-MR identified myocilin (MYOC) and caspase recruitment domain family member 9 (CARD9) as potential mediators of cardiovascular performance and VO 2 max. Conclusions: This study provides novel insights into the molecular influences of cardiovascular performance and VO 2 max. The identified protein markers associated with SVmax and a-vO 2 diff, along with the possible mediators MYOC and CARD9, merit further investigation into their role in endurance exercise capacity and cardiometabolic health.
Abstract 16663: Psychometric Summary of the Heart Failure Symptom Survey
Authors: Melinda Higgins, Windy Alonso, Brittany Butts, Lucinda J Graven, Carolyn M Reilly, Myra S Schmaderer, Leeza Struwe, Sandra B Dunbar, Bunny J Pozehl
Journal: Circulation (2023)

Introduction: The Heart Failure Symptom Survey (HFSS) was adapted from the Cardiac Symptom Survey to measure common symptoms experienced by heart failure (HF) patients. The HFSS assesses four components (frequency, severity, interference with physical activity and enjoyment of life) for 14 symptoms including shortness of breath at rest, with activity or when lying down or during the night; extremities swelling; bloating; fatigue; chest pressure; irregular heartbeat; worsening cough; dizziness; difficulty sleeping; forgetfulness; and feeling down. To date the formal psychometric analysis and validation of the HFSS has not been published. Hypothesis: Determine reliability and validity of the HFSS using baseline data from multiple HF studies. Methods: Data were merged from several HF studies from four research universities. The HFSS items were summed to compute scores for symptom frequency, severity, interference with physical activity, interference with enjoyment of life, and a total score of all 4 components. Internal consistency was evaluated using Cronbach’s alpha for reliability as well as computing the number of factors from exploratory factor analysis Scree test. Initial external validity was explored by comparing New York Heart Association (NYHA) class to the four component and overall total scores. Results: For the 623 patients in the merged dataset, ages ranged from 22 to 99 with a mean of 65.0 +/- 13.8; 61.0% were male; 69.0% were White, 28.9% were African American; 88.4% had reduced ejection fraction &amp;lt=40%; 41.0% were NYHA class II and 33.3% were class III. Internal reliability estimates for each component were: frequency (Cronbach’s alpha=0.892), severity (alpha=0.913), interference with physical activity (alpha=0.915), and interference with enjoyment of life (alpha=0.921) and overall total (alpha=0.976). For each component and the total scale, a single factor was indicated by the Scree test. The four component and total scores were all correlated moderately with NYHA class (Spearman’s rho, 0.337 to 0.352). Conclusions: The HFSS showed high reliability across multiple HF samples and positive association with NYHA class reflecting validity in relation to heart failure clinical severity useful for tailoring symptom management.
Abstract 13319: The Barostim Baroreflex Activation Therapy System: Safety Insights From FDA MAUDE Database
Authors: Danish Bawa, Adnan Ahmed, Rachad Ghazal, Nicholas Pham, Aakash Sheth, Douglas J Darden, Rajesh Kabra, Rakesh Gopinathannair, Naga Venkata Pothineni, Dhanunjaya R Lakkireddy
Journal: Circulation (2023)

Introduction: BAROSTIM NEO® is a Baroreflex activation therapy (BAT) system which has been approved recently by FDA for patients with refractory heart failure. Post market experience of BAT related complications and performance issues have not been reported. Objective: To analyze the post-approval device failures and patient related adverse events (AE) associated with Barostim NEO® system using Manufacturer and User Facility Device Experience (MAUDE) database. Methods: A MAUDE database search was conducted on December 7, 2022, for reports received between Jan 1, 2019, to November 30, 2022. Manual search of the MAUDE database conducted using the term “Barostim” in the brand name section. The AE were adjudicated to various categories based on the review of the event description for each medical device report (MDR). Results: A total of 22 events were reported which included MDRs reported by physicians or manufacturer or both. Device related malfunction was reported in 45.5% (n=10) whereas patient related AE reported in 77.3% (n=17) cases. Of total device related AE, material split, cut or torn was most commonly reported problem (32%, n=7), followed by high impedance (13.6%, n=3) and low impedance (9.1%, n=2). Of the patient related AE, 32% (n=7) were related to clinical or subclinical infection, 18.2% (n=4) hematoma, 13.6% (n=3) heart failure or myocardial injury, 9.1% (n=2) stroke/CVA, 9.1% and 9.1% (n=2) twiddler’s syndrome. No carotid artery or jugular injury and procedure related death reported in the study period. The report is limited by the lack of information on the total number of BAT devices implanted across the country. Conclusions: This study provides a wide range of device malfunction and patient related post-approval adverse events for Barostim device which have not been reported in any clinical trial/study before. The reported complications seem to be in line with other cardiac implantable electronic devices and no BAT specific complications were noted.
Abstract 299: Predictors of Pediatric Response to Peri-Arrest Bolus Epinephrine
Authors: Jill L Sorcher, Shivani Mehta, Anne V Grossestreuer, Monica E Kleinman, Catherine Ross
Journal: Circulation (2023)

Introduction: Low-dose vasopressor boluses are commonly used for acute hypotension and prevention of cardiac arrest in the ICU. Recent studies have shown an association between SBP response to initial dosing of peri-arrest bolus epinephrine (PBE) and important clinical outcomes in PICU patients. However, reasons for poor response to PBE are not well understood. Aim: To explore clinical characteristics associated with response to initial dosing of PBE. Hypothesis: We hypothesized that more profound hypotension and lower pH would be associated with poor response to PBE. Methods: Cohort study of PICU patients &lt;18 years old who received PBE from April 2022 to March 2023. Change in SBP was measured within 5 minutes before and after PBE. Non-responders were defined as change in SBP ≤10 mmHg. The degree of hypotension was calculated (PALS cutoff for hypotension by age minus lowest SBP prior to PBE). Additional clinical characteristics were abstracted, including pH levels within 2 hours prior to PBE. Given the small subset of patients with pH data, the current dataset was combined with an historical cohort to increase power (Ross, 2018). Results: Of 75 patients who received PBE, 53 (71%) were responders and 22 (29%) were non-responders. Overall, the mean increase in SBP was 31 mmHg (95% CI: 24, 37, p&lt;0.0001). Responders and non-responders were similar ages (median 3.7 years [IQR: 0.4, 10.9] vs. 1.6 years [IQR: 0, 5.4], p=0.11) and received similar initial PBE doses (median 0.26 mcg/kg [IQR: 0.11, 0.43] vs. 0.20 mcg/kg [IQR: 0.17, 0.38], p=0.75). Non-responders had less profound pre-PBE hypotension than non-responders (-15± 10 mmHg vs. –21±12 mmHg, p=0.03). In the combined dataset, 83 responders and 34 non-responders had pH data. Non-responders had lower median pH (7.23; IQR, 7.07, 7.33) than responders (7.32; IQR: 7.23, 7.37; p=0.004). Conclusion: In PICU patients who receive PBE for acute hypotension, poor SBP response was associated with lower pre-event pH, which may reflect known negative effects of acidosis on hemodynamic response to catecholamines. However, contrary to our hypothesis, non-responders had less severe pre-PBE hypotension. Further work is needed to understand factors affecting response to PBE in PICU patients.
Abstract 14744: Driving Distance to a Primary Cardiac Center is Associated With Mortality in Patients With Tetralogy of Fallot Undergoing Neonatal Interventions
Authors: Flora Nunez Gallegos, Shiraz A Maskatia, Jeffrey Zampi, George Nicholson, Yun Zhang, Courtney McCracken, Christopher Mascio, Christopher J Petit, Jennifer Romano, Dominic Zanaboni, Michael L Obyrne, Alekhya Nanduri, Jeannette Wong-Siegel, Mark A Law, Kristal M Hock, Shabana Shahanavaz, Sarosh P Batlivala, Sarah Speed, Jeffery J Meadows, Athar Mahmood Qureshi, Mariam Taleb, Hala Khan, Allen Ligon, Andrew C Glatz, Keila N Lopez
Journal: Circulation (2023)

Introduction: Advances in tetralogy of Fallot care have improved survival, however, associations of sociodemographic disparities and mortality are less well described, particularly among patients with symptomatic tetralogy of Fallot (sTOF) requiring neonatal intervention. Our multicenter Congenital Cardiac Research Collaborative (CCRC) study investigated sociodemographic factors associated with mortality in sTOF patients. Hypothesis: Sociodemographic factors related to a lower socioeconomic status are associated with increased mortality in patients with sTOF. Methods: Retrospective cohort study of neonates with sTOF receiving surgical or catheter-based palliation or primary repair at &lt;30 days old from 1/2005 - 11/2017 at one of nine U.S. centers in the CCRC. Primary outcome variable was mortality at last follow up. Primary predictor variable was childhood opportunity index (COI), a national composite score based on 29 neighborhood-level indicators of poor vs excellent health. Secondary predictor variables included distance to primary cardiac center, race/ethnicity, and maternal insurance type. Sociodemographic factors were evaluated using multivariable Cox proportional hazard models, adjusting for center and patient anatomic and genetic characteristics resulting in hazard ratios (HR) with 95% CI. Results: There were 417 neonates with sTOF, with an overall follow-up mortality of 10% at median follow-up of 4.8 years (25th - 75th %ile: 2.1 - 8.2). Most patients were male (53%), non-Hispanic White (52%), prenatally diagnosed (58%), and had public insurance (54%). On adjusted multivariable analysis, infants &gt;100 miles from a primary heart center had a 3x higher hazard of mortality (HR 2.94; 95% CI, 1.13-7.61; p=0.026) compared to those living &lt;50 miles from a heart center. All other sociodemographic factors (COI, race/ethnicity, and insurance type) were not significantly associated with mortality on multivariable analysis. Conclusions: Proximity to a specialized pediatric cardiac center remains a significant determinant of survival in neonates with sTOF, emphasizing the importance of access to cardiac care. Sociodemographic impact on patient morbidity and lifelong mortality in TOF requires further investigation.
Abstract 136: Does End-Tidal Carbon Dioxide Measured at the Facial Mask Predict Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest?
Authors: MARGOT CASSUTO, Ibtissem Ghouzali, Anna Ozguler, Michel Baer, Thomas Loeb
Journal: Circulation (2023)

Introduction: High value of end-tidal carbon dioxide (EtCO2), measured at the end of a tracheal tube, is closely associated with return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) resuscitation. The aim of this study was to evaluate whether EtCO2 measured at the face mask (FM) before an intubation procedure, may also predict ROSC in OHCA. Material and Methods: This was a prospective non-interventional study. Between May 1 st 2022 and January 30 th 2023, all patients ≥ 18 years with an OHCA on EMS arrival and for whom a laryngoscopy for tracheal intubation was considered, were included. An EtCO2 sensor was directly placed between the valve of the bag-valve-mask and the FM while cardiopulmonary resuscitation was continued. Age, gender, initial rhythm, ROSC on scene and last EtCO2 at the FM (FM-EtCO2) value before laryngoscopy were collected. Patients were assigned to 3 groups: FM-EtCO2 &lt; 10 mmHg ; 10 mmHg &lt; FM-EtCO2 &lt; 30 mmHg and FM-EtCO2 &gt; 30 mmHg. Results: Twenty-three patients were included. Mean age was 64.9 ± 12.2 years and sex ratio was 3.6. Initial rhythm was asystole for 16 (69.6 %) patients, ventricular fibrillation for 5 (21.7 %) and pulseless rhythm for 2 (8.7%). Eight (34.8 %) patients had a ROSC on scene. Five (21,8 %) patients had a FM-EtCO2 &lt; 10 mmHg ; 7 (30,4%) a 10 mmHg &lt; FM-EtCO2 &lt; 30 mmHg and 11 (47,8 %) a FM-EtCO2 &gt; 30 mmHg. Among those with a ROSC, 2 had a FM-EtCO2 &lt; 10 mmHg and 6 a FM-EtCO2 &gt; 30 mmHg (p=0,038). Conclusion: A high value of EtCO2 measured at the face mask (above 30mmHg) was significantly associated with ROSC. This survey proposes a method that would facilitate the knowledge of an EtCO2 value, well known to predict ROSC in OHCA, earlier than with the reference method. Further studies are needed to validate these results.