tbuckley/cabot-search huggingface dataset:
Abstract Or104: At What Time Point is Delay to First Bystander Cardiopulmonary Resuscitation Not Associated with Survival for Out-of-Hospital Cardiac Arrest?
Authors: Evan O'Keefe, Dan Nguyen, kevin kennedy, Mohammad Abdel Jawad, Nobuhiro Ikemura, Paul Chan
Journal: Circulation (2024)

Background: Bystander cardiopulmonary resuscitation (CPR) is a critical link in the chain of survival for out-of-hospital cardiac arrest (OHCA). Hypothesis: Although bystander CPR improves survival for OHCA, there may be a time threshold beyond which bystander CPR may no longer be associated with improved OHCA survival. Aims: To determine the time interval for when initiation of bystander CPR may no longer be associated with OHCA survival. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified 198,869 witnessed OHCAs during 2013-2022. Time to initiation of bystander CPR was categorized in 2-minute intervals (0-1, 2-3, 4-5, 6-7, 8-9, 10+ minutes). We used multivariable hierarchical logistic regression to evaluate the association between each time interval for initiation of bystander CPR, as compared with no bystander CPR, for survival to discharge and favorable neurological survival. Results: Mean age was 64.3±15.9 years and 68,085 (34.2%) were women. For those that did not receive bystander CPR, 11.9% survived to discharge and 9.3% had favorable neurological survival (Figure). Individuals receiving CPR within 2 minutes of OHCA had relatively higher rates of survival to discharge (OR: 1.85 [95% CI: 1.79-1.92; p&lt;0.001]) and favorable neurological survival (OR: 1.99 [95% CI: 1.92-2.07; p&lt;0.001]). The survival benefit of bystander CPR, as compared with no bystander CPR, decreased with each subsequent time interval and was no longer associated with improved survival when bystander CPR was initiated 10 or more minutes after the onset of OHCA (Table). Conclusions: Bystander CPR is critical for enhancing survival in OHCA. Under 10 minutes of OHCA, there was a graded inverse relationship between time to bystander CPR and survival outcomes. After 10 minutes there was no longer an association for bystander CPR, underscoring the importance of improving the timeliness of this intervention to improve overall OHCA survival.
Abstract Sa103: Characterizing the Apnea Interval During Endotracheal Intubation and Out-Of-Hospital Cardiac Arrest Resuscitation
Authors: Julia King, Jennifer Blackwood, Heemun Kwok, Sam Sharar, Thomas Rea, David Murphy
Journal: Circulation (2024)

Background: Guidelines for resuscitation of OHCA recommend that advanced airway management be performed without interrupting chest compressions. However, the extent and impact of interrupting ventilation during OHCA resuscitation is unknown. We described the apnea interval that occurs during endotracheal intubation (ETI) and its associated clinical outcomes. Methods: We conducted a cohort investigation of adult ventricular fibrillation (VF)-OHCA patients who underwent attempted paramedic ETI during resuscitation in a metropolitan EMS system from 2017 – 19. We defined apnea interval as the elapsed time from the last breath delivered before an ETI attempt to the first breath delivered after the attempt. We collected patient, care, apnea interval and outcome data from review of OHCA and airway registries linked to digital defibrillator recordings. The defibrillator recording included an audio channel, ECG, transthoracic impedance, and end-tidal carbon dioxide biosignals. Using multivariable logistic regression, we determined the relationship between apnea interval (longest quartile [&gt;120s] vs the shorter 3 quartiles [&lt;120s]) and two outcomes: return of spontaneous circulation (ROSC) and survival to hospital discharge. Results: Among 185 eligible patients, median age was 63 [54 – 74] years, 32 (17%) were female, 181 (98%) had successful prehospital ETI, 106 (57%) achieved ROSC, and 53 (29%) survived to hospital discharge. The median apnea interval during attempted ETI was 89s [65 – 115s]: 16s pre-laryngoscopic, 53s laryngoscopic, and 7s post-laryngoscopic. Median chest compression fraction was 85% [79 – 89%] overall and 90% [76 – 97%] during the apnea interval. Non-airway care during the apnea interval occurred in more than half (94, 51%) of cases, most commonly as medication administration (68, 37%), defibrillation (36, 19%), and multiple laryngoscopic attempts (13, 7%). Apnea interval &gt;120s compared to &lt;120s was associated with a lower likelihood of ROSC (AOR=0.41 [0.20 – 0.83]) but not hospital discharge (AOR=0.84 [0.38 – 1.88]). Conclusions: In this cohort of VF-OHCA patients, the median apnea interval during attempted ETI was 89s, with an interquartile range of 50s. Apnea interval &gt;120s was associated with lower likelihood of ROSC but not hospital discharge. Given its variability and relationship to near-term resuscitation outcomes, the apnea interval may be a modifiable intervention that can affect OHCA survival, supporting the need for further investigation.
Abstract 4146883: Analysis of Near-Infrared Spectroscopy Vascular Occlusion Test as a Complement to Ankle-Brachial Index and 6-Minute Walk Test in Patients Diagnosed with Peripheral Artery Disease
Authors: Cesar Rodriguez, Santh Prakash Lanka, Joshua Maraj, Yaman Alsabbagh, Sam Farres, Carl Ade, Xiuwen Liu, Judy Delp
Journal: Circulation (2024)

Introduction: Peripheral arterial disease (PAD) is caused by a lack of blood flow to the musculature relative to its metabolism which results in pain. PAD impacts up to 20% of patients around the world. PAD involves macrovascular and microvascular dysfunction. Near-infrared spectroscopy (NIRS) measures muscle oxygenation levels and assesses microvascular function. The standard of care for diagnosing PAD is the ankle-brachial index (ABI), which assesses macrovascular disease, and the 6-minute walk test (6MWT), which measures gait speed and claudication. NIRS has the potential to monitor progression of PAD. Hypothesis: NIRS measurement of muscle oxygenation, during a standard test of vascular occlusion and post-occlusive hyperemia, the vascular occlusion test (VOT), is predictive of PAD severity as determined by ABI and 6MWT. Methods: We studied 24 patients diagnosed with PAD. The mean age of the patients was 71.3 years, including 54% (n=13) males and 46% (n=11) females. The VOT consisted of rest, occlusion, and reperfusion phases each lasting 5 min (15 min total). Muscle oxygen saturation levels were recorded at 2 hertz. For every patient, 6 features were extracted from the VOT data using computational methods. The VOT features from 15 patients were used to train function-fitting neural network models to predict ABI and 6MWT Continuous Distance. The models were then used to predict ABI and 6MWT Continuous Distance from the VOT features of 9 test patients not used in the training, Results: For patients in the test set, the ABI and 6MWT Continuous Distance predicted by the models differed from the actual measurements by 14%±13% and 15%±17%, respectively (Figure 1). For patients in the training set, the ABI and 6MWT Continuous Distance predicted by the models differed from the actual measurements by 0±0% and 12%±11%, respectively (Figure 1). Conclusion: The VOT has the potential to predict the ABI and 6MWT Continuous Distance of patients diagnosed with PAD, suggesting that the VOT can be automated and used to monitor the severity of PAD. With more data from both healthy patients and PAD patients, and improvement of the model, we anticipate that the VOT will complement ABI and 6MWT in the diagnosis and monitoring of PAD.
Abstract 4147449: Endothelial microRNAs as New Biomarkers in Patients with Diabetes and INOCA: Insights From a Multicenter Study
Authors: Pasquale Mone, Marco Ferrone, Michele Ciccarelli, Fahimeh Varzideh, Fabio Minicucci, Urna Kansakar, Jessica Gambardella, Tullio Tesorio, Gaetano Santulli
Journal: Circulation (2024)

Background: Diabetes mellitus (DM) and hyperglycemia are known to drive endothelial impairment and coronary microvascular dysfunction. However, currently no established biomarkers of endothelial dysfunction in patients with "Ischemia with non-obstructive coronary artery" (INOCA). We evaluated the expression of circulating microRNAs (miRs) involved in the regulation of endothelial function in individuals with confirmed INOCA, comparing patients with and without DM. Methods: We evaluated consecutive INOCA patients referred for percutaneous coronary intervention (PCI) in a multicenter study. DM was defined according to the American Diabetes Association (ADA) guidelines. INOCA was defined based on symptoms of myocardial ischemia, non-obstructive coronary artery stenosis (&lt;50% diameter reduction or fractional flow reserve &gt;0.80), objective evidence of myocardial ischemia, and impaired coronary microvascular function (coronary flow reserve ≤2.0, abnormal coronary microvascular resistance indices, coronary microvascular spasm, endothelial dysfunction with ≥20% luminal constriction during acetylcholine infusion, or coronary slow flow phenomenon). Circulating miRs were isolated from plasma samples using EDTA-containing tubes and the miRNeasy Serum/Plasma kit. Quality control included using the Agilent Small RNA Kit [33] and the RNA Spike-in kit (Qiagen) with synthetic RNA spike-ins (UniSp2, UniSp4, UniSp5) and UniSp6 spike-in and cel-miR-39-3p for cDNA synthesis control. Relative gene expression was determined using the 2-ΔΔCT method, with miRs miR-125a-5p and miR-19a-5p selected for normalization using bioinformatic algorithms. Hemolysis was assessed by measuring absorbance at 414 nm and ΔCq of miR-16-5p, miR-451a, and miR-23a-3p. Results: 42 patients completed the study (28 without DM, 14 with DM). We measured the expression levels of validated miRs and found that in INOCA patients with DM, there was increased expression of miRs associated with endothelial dysfunction and reduced expression of miRs protective for endothelial function. Specifically, miR-363-5p was significantly downregulated (P&lt;0.001), and miR-92 was significantly upregulated (P&lt;0.001) in individuals with DM. Conclusions: Our results revealed significant dysregulation of miR-363-5p and miR-92a-3p in INOCA patients with DM compared to those without DM, supporting their role as biomarkers for endothelial dysfunction in DM and INOCA.
Abstract 4147146: Mortality Trends Of Peripheral Arterial Disease
Authors: Hussein abdulelah, Zaid Abdulelah, Mohammad Abdulelah, Ahmed Abdulelah, Ahmad Alayyat, Ahmad damlakhy, Mansoor Rahman, Mohammad Al-Dqour, Kais Al Balbissi
Journal: Circulation (2024)

Introduction: Peripheral arterial disease (PAD) carries a high prevalence of around 200 million individuals worldwide, and is known to significantly contribute to mortality, morbidity and healthcare expenditures in the elderly. Co-morbidities such as hyperlipidemia, diabetes, hypertension, and smoking are all risk factors associated with development of PAD. The rising prevalence of such co-morbidities has affected the mortality trends of PAD despite the significant advances in both medical and interventional therapeutic options over the past 30 years. Research Question: Has there been any changes in PAD associated mortality trends in the last 30 years? Methods: Mortality trends of PAD across the USA were evaluated through calculating Annual percentage change (APC) and average APC (AAPC) of mortality via JoinPoint Analysis software. The data was obtained from the Global Burden of Diseases 2019 database. Results: From 1990 to 2019, there have been 268,129 PAD associated deaths in the US. Mortality trends over different age groups revealed an overall statistically significant decrement in those older than 75 (AAPC –0.3953, 95% CI –0.4590 to –0.3336; p&lt;0.001). While a statistically significant increment was observed in those between the age of 15-49 (AAPC 1.1774; 95% CI 1.0923 to 1.2710; p &lt;0.001) and those who were 55-75 years old (AAPC 0.2986; 95% CI 0.1968 to 0.4379; p=0.002). Furthermore, stratification by gender yielded a statistically significant increment in males with an AAPC of 1.2657 (95% CI 1.1641 to 1.3511, P&lt;0.001) while a non-significant increment was noted in females (AAPC 0.9563; 95% CI 0.9078 to 1.0010; P&lt;0.001). The highest decrement in mortality for females was observed between 2004 to 2008, during which an AAPC of -2.3519 (95% CI -2.9828 to -1.8419; p=0.02) was observed. On the other hand, male gender noted its highest decrement in mortality between 2002-2009 (AAPC-1.3020; 95% CI -2.2156 to -0.7734; p=0.03) (Figure 1). Conclusion: Our findings identify variable trends in PAD mortality among age groups. Additionally, male gender appeared to influence mortality trends. Our findings suggest a need for further investigations to define age and gender based therapeutic regimens for PAD.
Abstract 4148154: Sex Outcomes associated with AngioVac Debulking of Tricuspid Valve Endocarditis at an Academic Tertiary Care Hospital
Authors: Leonard Palatnic, John Sheppard, David Zlotnick
Journal: Circulation (2024)

Background: The AngioVac mechanical aspiration system has recently emerged in the literature for its use in the percutaneous debulking of intracardiac vegetations and masses. However, description of gender-related outcomes and analysis has remained sparse. We present our unique experience with the AngioVac system in men compared to women with tricuspid valve infective endocarditis (TVIE) and high or prohibitive operative risk. Methods: We performed a retrospective, in-hospital analysis comparing all men and women who underwent percutaneous AngioVac vegetation debulking in the setting of TVIE from January 2017 to December 2023 at a large academic tertiary care hospital. Results: Of the 62 patients who underwent AngioVac debulking between January 2017 and December 2023, 32 (51.6%) were women with a mean age of 35.921 +/- 9.976 years. The mean length of the vegetation was 19.581 +/- 7.478 mm and time (days) to blood culture clearance was 8.667 +/- 7.799. Of the 62 patients, 30 (48.4%) were men with a mean age of 41.711 +/- 13.627 years. The mean length of the vegetation was 21.759 +/- 7.836 mm, and time (days) to blood culture clearance was 6.188 +/- 3.692. During their index admission, between both men and women, there was no difference in time (days) from procedure to blood culture clearance (P-value: 0.239, 95% CI: -6.717 – 1.758). There was no difference in the risk of stroke (P-value 0.489, 95% CI: 0.00 – 5.852), systemic embolism (P-value: 0.577, 95% CI: 0.124 – 164.863), vascular access bleeding (OR: 0.966, 95% CI: 0.011 – 78.416), or blood transfusion requirement (P-value 0.799, 95% CI: 0.270 – 2.622). There was no difference in risk of recurrent endocarditis (P-value: 0.712, 95% CI: 0.265 – 9.147) or worsening tricuspid regurgitation post-procedure (P-value: 0.470, 95% CI: 0.075 – 3.113). Finally, there was no difference in the length of hospital stay (days) between both groups (P-value: 0.990, 95% CI: -11.748 – 11.605), and there was no difference in in-hospital mortality post-procedure (P-value: 0.354, 95% CI: 0.384 – 218.472). Notably, neither of the two groups required surgical or percutaneous tricuspid valve replacement. Conclusion: This retrospective, comparative analysis adds to the growing literature that Angiovac debulking may be a safe and effective long-term alternative to cardiac surgery in both men and women with TVIE and elevated perioperative risk.
Abstract 4146867: Catheter-Directed Interventions for High-Risk Acute Pulmonary Embolism in patients with Liver Cirrhosis
Authors: Manoj Kumar, Shafaqat Ali, Nso Nso, Aneeza Jamshed, Mukunthan Murthi, Nomesh Kumar, Sanjay Kumar, Rinkle Kumari, M Chadi Alraies, Javier Gomez Valencia, Mark Ricciardi, Qamar Arman
Journal: Circulation (2024)

Background: Catheter-Directed Interventions (CDIs) for Acute Pulmonary Embolism (PE) have been available for years. However, their use and effectiveness in patients with a concomitant diagnosis of liver cirrhosis is uncertain due to a paucity of data in this high-risk population. In this study, we aim to evaluate the safety, efficacy, and current trends in the use of CDIs for high-risk PE (HR-PE) in patients with liver cirrhosis. Methods: Nationwide Readmissions Database (2016-2021) was used to identify patients with liver cirrhosis presenting with HR-PE (shock, pressor or mechanical circulatory support requirement). Patients who received systematic thrombolysis were excluded. Mahalanobis Distance Matching within the Propensity Score Caliper was used to match patients who received CDIs vs those who did not recieve any catheter-directed intervention. Inverse Probability weighting (IPW) was utilized, and Pearson’s chi-squared test was applied to the PSM-2 matched cohorts to compare outcomes. Results: Among 427,802 hospitalizations of patients with HR-PE and concomitant diagnosis of liver cirrhosis, only 1,319 (0.3%) of the patients underwent CDI. After propensity matching (N: 668 in each group), patients receiving CDI had a significantly lower mortality (42.9% vs. 61.7%, aOR:0.44, p &lt;0.001). However, bleeding complications including major bleeding (12.1% vs 5.4%, aOR:1.9, p&lt;0.001), thoraco-respiratory bleeding (8.5% vs 3.3%, aOR:1.9, p &lt;0.001) and intracerebral hemorrhage (5.1% vs 1.8%, aOR:2.3, p:0.001) was higher in patients receiving CDIs. Short-term (30-day) readmission rates were lower in cirrhotic patients receiving CDI (12.4% vs 18.8%, p: 0.024). From 2016-2021, mortality associated with HR-PE in cirrhotic patients has not changed significantly (mean: 61.2%, p &gt;0.05). There has been increasing use of mechanical thrombectomy (MT) over thrombolysis in recent years (0.08% to 0.22%, p-trend &lt;0.001). Conclusion: CDIs for HR-PE in patients with liver cirrhosis are rare and areassociated with significant reduction in mortality at the expense of higher bleeding risk. Despite a slight increase in the utilization of mechanical thrombectomy, mortality has not significantly decreased over the years.
Abstract 4147488: Effects of Influenza Vaccination Among Patients With Myocardial Ischemia and Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Charles Karel Santos, Maria Clara Ramos Miranda, Gabriel Barbosa, Thallys Nogueira, Antonio da Silva Menezes Junior
Journal: Circulation (2024)

Background: Previous studies have shown that influenza vaccination (IV) may reduce the incidence of cardiovascular events in patients with cardiovascular disease. In this meta-analysis, we aimed to clarify the effects of IV in patients with myocardial ischemia (MI) and heart failure (HF). Hypothesis: The influenza vaccine reduces the incidence of major adverse cardiovascular events among patients with MI and HF. Methods: A comprehensive search was performed in PubMed, Cochrane Library, and Embase databases from inception up to march 2024. We included randomized clinical trials (RCTs) that assessed the effects of IV in patients with HF and MI, and reported outcomes of major adverse cardiovascular events (MACE), cardiovascular death, and all-cause death. Analyses were conducted using R software. Heterogeneity was assessed using the I2 statistic. A random-effects model was applied to calculate pooled Relative Risk (RR). A stratified analysis was performed to investigate ST-segment elevation myocardial infarction (STEMI) and non-STEMI subgroups. Sensitivity analysis was performed to explore heterogeneity. Confidence Interval (CI) was set at 95%. Results: We identified six RCTs comprising a total population of 9229 participants. Of these, 4100 were patients with MI, and 5129 were HF patients. Overall, MACE (RR 0.65; 95%CI 0.47-0.89; p=0.007; I2=75%) (Figure 1A) and cardiovascular death (RR 0.60; 95%CI 0.37-0.96; p=0.035; I2=62%) (Figure 1B) were significantly lower in group receiving IV compared to placebo/no treatment. No statistically significant difference was observed for all-cause death. In sensitivity analysis, after excluding HF patients, IV significantly decreased the risk of MACE (RR 0.57; 95%CI 0.43-0.76; p&lt;0.001; I2=21%) (Figure 2A), cardiovascular death (RR 0.49; 95%CI 0.30-0.81; p=0.006; I2=24%) (Figure 2B), and all-cause death (RR 0.56; 95%CI 0.39-0.80; p=0.001; I2=0%). Consistent results were observed, with IV reducing the risk of MACE in the non-STEMI subgroup (RR 0.48; 95%CI 0.30-0.78; p=0.003; I2=24%). However, no significant difference was identified in the STEMI subgroup. Meta-regression showed impact of age and follow-up duration on treatment effect estimates. Conclusion: IV exhibited potential in reducing the risk of major cardiovascular events and cardiovascular mortality in patients with HF and MI. These findings reinforce the importance of the IV as a secondary prevention strategy for these populations.
Abstract 4147650: Right Ventricular Hemodynamics in Patients Screened for HFpEF with a Novel Artificial Intelligence Screening Tool
Authors: Kevin Chang, Ryan Sachar, Maria Latz, Tess Allen, John Blair, Gene Kim, Jonathan Grinstein, gary woodward, Roberto Lang, Mark Belkin
Journal: Circulation (2024)

Background: Invasive hemodynamics are the gold standard for diagnosis of heart failure with preserved ejection fraction (HFpEF). A novel, FDA-approved artificial intelligence (AI) technology that uses a single, 4-chamber transthoracic echocardiogram (TTE) image to screen patients for HFpEF shows promise as a non-invasive tool to assist in diagnosis. Development of right ventricular (RV) dysfunction is a sign of a more advanced HFpEF. Advanced RV hemodynamic parameters, beyond pulmonary arterial pressures (PAP), have not been well studied in HFpEF. We sought to correlate advanced RV hemodynamic parameters in patients screened for HFpEF with this AI screening tool. Method: We retrospectively evaluated two cohorts of patients with suspected HFpEF that underwent TTE and RHC at our institution. The most recent TTE for each patient was screened using the AI-based analysis tool and was reported as either “suggestive” or “non-suggestive” of HFpEF – labeled as “positive” or “negative,” respectively. Mean PAP, pulmonary vascular resistance (PVR), pulmonary artery pulsatility index (PAPI), RV cardiac power output (RV-CPO), RV myocardial performance score (RV-MPS), and right atrial pressure to pulmonary capillary wedge pressure ratio (RA:PCWP) were calculated using invasive hemodynamic parameters at rest, and exercise when available. RV-CPO was calculated as [(mean PAP-RAP) x cardiac output] /451, and RV-MPS was calculated as (RV-CPO x PAP)x1.5. Median values were calculated. AI positive and negative groups were compared using Student’s t-test. Results: A total of 47 patients (82% women, 79% Black, average EF 62%) were included, with 23 undergoing subsequent exercise RHC. There were 18 (38%) that screened positive for HFpEF, and 29 (62%) screened negative by TTE AI software. Positive patients had a significantly higher mean PAP (median 31 vs 23 mmHg, p=0.01), PVR (2.1 vs 1.3 WU, p=0.02), and RV-CPO (0.26 vs. 0.17, p=0.04) than patients who were screened negative. There were no significant differences in PAPI, RV-MPS, and RA:PCWP at rest. There were no significant differences in mean PAP, PVR, PAPI RV-CPO, RV-MPS, or RA:PCWP with exercise. Conclusion: Patients screened positive for HFpEF by a novel AI TTE software had significantly higher PAP and RV-CPO at rest, but no differences in PAPI, RV-MPS, or RA:PCWP ratio. This tool may help identify more advanced HFpEF.