tbuckley/cabot-search huggingface dataset:
Abstract 4141461: Zonal Coating Application System for Left Atrial Appendage Occlusion Devices: A Novel Approach to Reduce Peri-Device Leakage and Device Related Thrombus.
Authors: Mustafa Houmsse, Andrew Muskara, Damaris Pasca, Arnab Roy
Journal: Circulation (2024)

Introduction: Left atrial appendage occlusion (LAAO) is an effective method of stroke prevention in patients with atrial fibrillation (AF). However, peri-device leakage (PDL) and device related thrombus (DRT) are common limitations of LAAO. Notably, PDL is associated with an increased risk of thromboembolic events. In order to minimize DRT, the Watchman FLX Pro is coated with PVDF-HFP. We aim to minimize both DRT and PDL with our novel zonal coating application system (ZCAS). ZCAS integrates a two-part thromboresistant and endothelialization promoting coating onto LAAO devices (Figure 1). In order to determine the optimal coating for the endothelialization promoting zone of ZCAS, we validated coating candidates in an in vitro model of LAAO device endothelialization (Figure 2). Hypothesis: We hypothesized that polyethylene terephthalate (PET) mesh coated with collagen type IV, fibronectin + VEGF, or poly-L-lysine would improve endothelial cell viability and proliferation. Methods: Human umbilical vein endothelial cells (HUVEC) were cultured in DMEM/F12 supplemented with ATCC’s Endothelial Cell Growth Kit and antibiotics. For the cell viability and proliferation assay, HUVEC cells were cultured in DMEM/F12 supplemented with 2% FBS, 10 mM L-glutamine, and antibiotics. A 96 well plate with PET inserts was coated with three coating candidates. Each coating was applied in three concentrations ([1x], [10x], and [100x]) with triplicates for each concentration. The coatings included collagen type IV ([1x]: 1 ug/cm2), fibronectin ([1x]: 1 ug/cm2) + VEGF ([1x]: 10 ng/cm2), and poly-L-lysine ([1x]: 4 ug/cm2). An MTS assay was performed at 48 hours after plating to assess cell viability and proliferation. Results: MTS absorbance relative to the uncoated control (MTS absorbance coated well/MTS absorbance uncoated well) for collagen type IV at [1x], [10x], and [100x] was 0.81, 1.29, and 0.84 respectively (Table 1). Fibronectin + VEGF at [1x], [10x], and [100x] was 1.31, 1.62, and 0.96. Finally, poly-L-lysine at [1x], [10x], and [100x] was 0.69, 0.90, and 0.91 respectively. Conclusion(s): Among the coating candidates, fibronectin (1 ug/cm2) + VEGF (100 ng/cm2) had the greatest increase in cell viability and proliferation compared to the uncoated PET control. The significance of this finding lies in the potential for ZCAS to improve the endothelial seal between the LAAO device and LAA orifice, which may significantly reduce PDL post-implantation.
Abstract 4139117: Epidemiology of Patients Undergoing a Rapid Response within the First 24 Hours of Admission at an Urban Academic Center
Authors: Andrew Cyr, Pushpendra Patel, Jack Jnani, Joshua Chang, Ajay Jassal, Christian Leung, Shuojohn Li, Sai Palati, Saimanoj Guntaka, Shafkat Salam, Aditya Sood, Matthew Capustin, Alexander Smith, Spencer Weintraub, Kishen Bulsara, Jared Honigman, Miguel Alvarez Villela, Matthew Griffin, Matthew Pierce
Journal: Circulation (2024)

Introduction: A Rapid Response Team (RRT) is an inpatient team that aims to resuscitate deteriorating patients in non-critical care settings and reduce inpatient morbidity and mortality. It is not well understood which patients are likely to deteriorate and need a rapid response (RR) within the first 24 hours of admission. Research Question: We sought to identify the most common characteristics for patients who had a RR within 24 hours of admission. Methods: We performed a descriptive analysis evaluating 176 patients who had a RR called within 24 hours of admission to North Shore University Hospital from February 2022 to August 2023. Demographic and clinical variables were assessed, including medical history, admitting diagnosis, and indication for RR. Results: The median age of the population was 73 years; 92 (52.3%) were male, and 91 (51.7%) were white. The most common comorbidities were hypertension (119, 67.6%), coronary artery disease (51, 28.9%), and heart failure (34, 19.3%). Amongst these patients, acute hypoxic respiratory failure (11.6%) was the most common admission diagnosis followed by sepsis (9.7%) (Table 1). The most common reason for the RR was acute mental status change (26.1%) followed by hypotension (25.0%). Average time spent in the ED prior to admission was 6 hours 41 mins. Intensive care unit (ICU) consultation prior to the RRT occurred in 36 patients (20.5%) and 52 patients (29.5%) were transferred to an ICU while 124 (70.5%) remained on the medicine floors. Regarding hospital utilization, 98 (55.7%) patients were admitted within the last year and 47 (26.7%) patients were hospitalized within the last month. 14 (7.9%) patients had an ICU admission in the past year. 38 (21.5%) patients died during the admission post RR. Conclusion: In our cohort of RRs within 24 hours of admission, we observed a high prevalence of cardiac comorbidities and recent hospitalizations, a low prevalence of ICU consults prior to RR, and discordance between admitting diagnoses and reasons for RR. Further studies involving a larger cohort are needed to develop a prediction model for determining patients most at risk of deteriorating after admission and requiring RRs.
Abstract 4145812: Cardiovascular MRI-Derived Cardiac Age Acceleration is Associated with Shortened Leukocyte Telomere Length But Not Clonal Hematopoiesis of Indeterminate Potential
Authors: James Brundage, Joshua Barrios, Geoffrey Tison, James Pirruccello
Journal: Circulation (2024)

Introduction: Cardiac structure and function typically decline with age. Abnormal acceleration of this decline, known as cardiac age acceleration, can be estimated from MRI using deep learning. Both general and cardiac-specific mechanisms may contribute to cardiac aging. Longer telomere length in circulating leukocytes, which indicates greater cellular capacity for replication, has been associated with a lower risk of heart failure and more favorable cardiac structure and function Recent data have also suggested that longer telomeres contribute to risk of clonal hematopoiesis of indeterminate potential (CHIP), which has been linked to increased risk of atherosclerosis, heart failure and arrhythmia. Here we studied whether telomere length or CHIP status are associated with deep learning derived cardiac age acceleration. Methods: We developed a deep learning model to estimate cardiac age acceleration in 70,805 UK Biobank participants from the cardiovascular MRI (four-chamber long axis view). Of these, we identified leukocyte telomere length (LTL) in 61,554 and were able to evaluate CHIP in 61,636. In an additional 372,465 participants unrelated to those with imaging, a genome-wide association study (GWAS) was conducted for LTL, and a GWAS of cardiac age acceleration was conducted in those with imaging; using these, a two-sample Mendelian randomization (MR) was performed to identify putatively causal relationships. Results: In the 61,636 participants with both CHIP and cardiac age acceleration measurements, CHIP was not associated with cardiac age acceleration regardless of driver gene (p=0.79). In contrast, cardiac age acceleration was associated with a shorter LTL (Beta=-0.025 SD, p=5.4E-10). Shorter LTL was causally associated with cardiac age acceleration (Beta=-0.10, p=0.047). Conclusions: These data suggest that general aging mechanisms conferred by shortening telomeres may contribute to the age-associated structural and functional decline of the heart as observed with MRI. In comparison, the relationship between CHIP and cardiovascular risk may not manifest in ways that cause apparent cardiac age acceleration.
Abstract 4119595: Impact of Environmental Noise and Sleep Health on Pediatric Hypertension Incidence: The ABCD Study
Authors: Augusto Cesar Ferreira De Moraes, Marcus Nascimento-Ferreira, Martin Y. Ma, Deanna Hoelscher
Journal: Circulation (2024)

Background: Pediatric hypertension is linked to environmental factors like neighborhood noise disrupting sleep, which is crucial for health. The specific interaction between noise and sleep health in causing hypertension still needs to be explored. Research Question: How does the interaction between neighborhood environmental noise and sleep health affect the incidence of pediatric hypertension? Aims: To estimate the incidence of hypertension in American adolescents and to investigate the individual and joint effects of exposure to neighborhood environmental noise and sleep health on its incidence. Methods: Our analysis involved 3,320 individuals from the Adolescent Brain Cognitive Development (ABCD) study across 21 US cities, followed prospectively from 2018-2020 (T0) to 2020-2022 (T1). We included only those with complete data: Fitbit-tracked sleep, blood pressure, height, neighborhood noise, and relevant covariates (biological sex, ethnicity, pubertal stage, waist circumference). Hypertension was defined as average blood pressure at or above the 95th percentile for age, sex, and height, based on American Academy of Pediatrics guidelines. Sleep health was classified based on daily duration into three categories: healthy (9-12 hours), moderately healthy (1 hour below or above optimal), and low (more than 1-hour deviation). Neighborhood noise exposure was quantified using median anthropogenic noise levels at night, linked to participants’ zip codes. We estimated hypertension incidence and its relative risks (RR, 95% CI), examining the effect (individual and joint) of sleep health and environmental noise on hypertension risk. Results: At Time 1 (T1), the mean age was 13.9 years; 47.6% were girls, and 52.9% were White. Hypertension prevalence in 2018-2020 was 1.7% (CI95% 1.4; 2.1), and the incidence after two years was 2.9% (CI95% 2.4; 3.6). Night noise was 58.4 decibels, 29.9% healthy sleep time (T0); 20.3% healthy sleep time (T1). Adolescents with more favorable healthy sleep showed a lower risk of developing hypertension RR= 0.63 (CI 95% 0.25 to 0.82). We found no association between noisy neighborhoods and no joint effects (neighborhood noise + sleep health) with hypertension incidence. Conclusions: Adequate sleep is associated with a lower risk of hypertension in adolescents. However, no significant link was found between neighborhood noise and pediatric hypertension. This highlights the need for public health efforts to improve sleep quality in youth.
Abstract 4141474: Impact of Serum 5-Hydroxytryptophan Levels on Coronary Artery Calcification Severity in Acute Coronary Syndrome Patients: Insights from the Microbiota-Gut-Brain Axis
Authors: Ching Jung Chen, Chao-Yung Wang
Journal: Circulation (2024)

Background: 5-Hydroxytryptophan (5-HTP) has shown positive clinical effects on various neuropsychiatric and metabolic disorders, particularly depression. While it is known to increase serotonin levels in the brain and gastrointestinal tract, its pharmacology remains largely unexplored. Additionally, 5-HTP influences the mouse gut microbiome, which is closely linked to depression through the "microbiota-gut-brain axis." However, the role of 5-HTP in vascular disease is not well understood. This study aimed to investigate the potential correlation between serum 5-HTP levels and the severity of coronary artery calcification (CAC) in patients with acute coronary syndrome (ACS). Methods and Results: This study included 183 ACS patients who underwent coronary angiography. The severity of coronary calcification was recorded, and serum 5-HTP levels were measured after the coronary event. The study period was from February 4, 2009, to August 9, 2020. The primary exposure variable was 5-HTP levels, and the primary outcome was the severity of coronary calcification assessed through fluoroscopy. Logistic regression was used to determine the association between 5-HTP levels and calcification severity, adjusting for age, gender, smoking status, chronic kidney disease, hyperlipidemia, and diabetes. Odds ratios (OR) and 95% confidence intervals (CI) measured the strength of associations, with statistical significance set at p &lt; 0.05. High 5-HTP levels were significantly associated with more severe calcification (p = 0.04, OR = 3.3, 95% CI = 2.6 to 40686.5). For other factors, the OR for smokers was 0.97 (0.53 to 1.77); dyslipidemia 0.91 (0.5 to 1.63); hypertension 1.57 (0.87 to 2.82); male gender 1.35 (0.45 to 4.01); age 1.07 (1.03 to 1.10); diabetes 1.24 (0.67 to 2.31); chronic kidney disease 1.07 (0.33 to 3.50). After adjusting for conventional risk factors, the association between 5-HTP and calcification remained significant (p &lt; 0.05). Conclusion: Higher 5-HTP levels are positively associated with greater severity of coronary artery calcification. This correlation persists even after adjusting for conventional risk factors.
Abstract 4143225: Carotid Artery Ultrasound Grayscale and Incident Dementia: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Matthew Tattersall, Carol Mitchell, Ronald Gangnon, Claudia Korcarz, Kristin Hansen, ADAM GEPNER, Stephen Rapp, Sterling Johnson, James Stein
Journal: Circulation (2024)

Introduction: Vascular contributions to cognitive impairment and dementia are potentially modifiable. Early detection of reversible arterial injury may improve dementia risk stratification and provide an opportunity for treatment monitoring. We hypothesized that carotid ultrasound grayscale-median (GSM), a novel imaging biomarker of early arterial injury, would predict incident all-cause dementia in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: The MESA enrolled adults aged 45-84 years old who were free of atherosclerotic cardiovascular disease at baseline. Common carotid artery GSM (grayscale units) was measured at baseline. Incident all-cause dementia events were identified by hospital and death records. Adjusted Cox proportional hazards models with natural cubic splines allowing for non-linear effects investigated the associations of baseline GSM and incident all-cause dementia. Results: The 1,788 participants were a mean (standard deviation) 63.1 (10.3) years old (53% female). Over a median of 13.7 years, 157 all-cause dementia events occurred. Lower (worse) carotid GSM independently predicted incident all-cause dementia (Hazard Ratio [HR] 1st to 3rd tertile, 1.39 [95% Confidence Intervals, 1.08-1.80], p =0.04). In models adjusting additionally for carotid IMT there was no attenuation of the association of GSM and incident all-cause dementia (HR 1.63 [95% CI 1.13-2.35], p=0.033) (Figure 1). Conclusions: Lower GSM predicts incident all-cause dementia independent of carotid intima-media thickness, suggesting it may serve as an early marker of dementia risk.
Abstract 4141487: Social Determinants of Health and Outcomes in Patients with Hypertrophic Cardiomyopathy in the Sarcomeric Human Cardiomyopathy Registry (SHaRe)
Authors: Neha Hafeez, Brian Claggett, Anjali Owens, Adam Helms, Sara Saberi, Rachel Lampert, John Stendahl, Euan Ashley, Victoria Parikh, Neal Lakdawala, Jodie Ingles, Iacopo Olivotto, Carolyn Ho, Matthew Taylor, Sadiya Khan, Sharlene Day
Journal: Circulation (2024)

Introduction: Area-based social determinants of health (SDOH) are associated with higher risk for acquired heart disease. However, the impact of area-based SDOH on clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has not been previously studied. Hypothesis: Residing in an area with lower median household income and a higher social deprivation index (SDI) are independently associated with adverse outcomes in patients with HCM. Methods: This study included 4,483 adult patients with HCM from five Sarcomeric Human Cardiomyopathy Registry (a multi-center prospective registry of patients with HCM) sites in the US followed for a median [IQR] of 4.0 [1.0-8.5] years. The patients’ residential address was geocoded at the zip code level to characterize median household income and SDI. SDI is based on various social factors (such as income and education), with a higher score reflecting more deprivation. Multivariate models, adjusting for sex, age, hypertension and body mass index were used to determine the independent association of household income and SDI on ventricular arrhythmias (VA), heart failure (HF), and an overall composite outcome (VA, HF, atrial fibrillation, death, and stroke). Results: Median age at diagnosis was 48.3 [32.0-60.4] years with 42.0% female. Median household income was $90,000 [60,000-110,000] and median SDI was 25 [10-55]. Adjusted hazard ratios per $10,000 higher income were 0.96 (95% CI 0.93-1.00, p=0.03) for VA, 0.91 (95% CI 0.90-0.93, p &lt;0.01) for HF, and 0.95 (95% CI 0.94-0.96, p &lt;0.01) for the composite outcome. Adjusted hazard ratios per 10 units higher SDI (more deprived) were 1.07 (95% CI 1.03-1.12, p&lt;0.01) for VA, 1.06 (95% CI 1.04-1.08, p &lt;0.01) for HF, and 1.05 (95% CI 1.03-1.06, p &lt;0.01) for the composite outcome. The associations of SDI and income on clinical outcomes were similar regardless of sarcomere gene variant status. Conclusions: Residing in an area with lower median household income and higher SDI were independently associated with adverse outcomes in patients with HCM. These findings extend observations from acquired cardiovascular disease and highlight the need to address adverse SDOH to reduce health disparities and improve outcomes in patients with HCM.
Abstract 4141469: Left Ventricular Septum Displacement Implications in the Limited Cardiac Reserve, RV to Pc Uncoupling and Oxygen Uptake During Exercise in Heart Failure
Authors: Violetta Serrantoni, GIULIA CRISCI, Maurizio Losito, Tania Zagarra, Daniele Ginelli, Francesca Bursi, Marco Guazzi
Journal: Circulation (2024)

Background: Dyspnea on exertion is cardinal symptom in heart failure (HF) and may be caused by an unfavorable dynamic of ventricular interaction. This concept has been poorly addressed over time and we hypothesized that a careful study of the interventricular septum adaptations during maximal exercise in HF might be implicated in the limited cardiac reserve and uncoupling of right ventricular (RV) to pulmonary circulation (Pc), both yielding to a limited O2 uptake. Aim: To study the pathophysiology behind biventricular interaction during exercise in HF, evaluating the role of septum displacement during exercise and how and whether it would affect peak exercise oxygen consumption (VO 2 peak) through a limited cardiac output (CO) increase and some degrees of RV to PC uncoupling assessed by TAPSE/PASP. Methods: 22 HF performed a combined cardiopulmonary exercise testing imaging (CPET imaging) with RV 3D-imaging analysis and were compared with a control population. 3D imaging of the RV chamber was examined off-line using the 4D RV TomTec software and obtained 3D mesh of the RV model using custom software to obtain the mean curvature value of IVS in 4 regions of: inflow tract (RVIT), outflow tract (RVOT), apical and body. We acquired measurements of curvature during end-diastole (ED) and at end systole (ES) phases and obtained a parametric curvature map. Results: HF patients (mean age 72±12, 27% female) typically showed an abnormal septal curve, with a more leftward configuration either at rest and under exercise (rest =−0.01±0.007 at ED, and −0.01±0.009 at ES; peak exercise= −0.01±0.006 at ED, and −0.01±0.007 at ES) compared to controls (rest=−0.02±0.002 at ED, and −0.02±0.006 at ES; peak exercise −0.02±0.0.006 at ED, and −0.02±0.01 at ES, Figure). Notably, the degree of the IVS curvature showed a linear correlation with an impaired gas exchange performance as indicated by a lower peak VO 2 , a limited CO and impairment of TAPSE/PASP in HF (respectively, r=0.64, p&lt;0.001, r=0.5, p&lt;0.001, r=0.53, p&lt;0.001 at ED during exercise; r=0.61, p&lt;0.001 at ES during exercise; Figure). Conclusions: In HF, the evidence of right to left IVS displacement appears worth of investigation, by intervening strictly to a reduced CO response, and RV-PA uncoupling during exercise. These findings clearly point to the utility of assessing how new and current therapeutic strategies may modulate the negative septum displacement and overall cardiac mechanics.
Abstract 4141460: Exploring Novel Data-Driven Clustering Methods for Uncovering Patterns in Longitudinal Neonatal Postoperative Temperature Measurements
Authors: Stephanie Helman, Nathan Riek, Susan Sereika, Robert Olsen, J Gaynor, Amy Lisanti, Salah Al-Zaiti
Journal: Circulation (2024)

Introduction: Neonatal hypothermia (&lt; 36.5 o C) after CPB is considered benign despite lack of evidence on its prognostic significance. Question: Are group-based trajectory modeling (GBTM), k-means, and self-organizing map (SOM) clustering approaches clinically useful for evaluating their associations with important outcomes? Aims: Identify distinct postoperative temperature trajectories in neonates after CPB using novel machine learning (ML) clustering methods, corroborate findings, and evaluate prognostic value on outcomes. Methods: Secondary cohort analysis of prospectively collected data. Accessed data from a single pediatric referral center's CardioAccess registry consistent of postoperative neonates with congenital heart defects (CHD). 48-hourly postoperative temperature measurements were extracted from patient records. GBTM, SOM, and k-means clustering identified cluster membership and model fit was optimized for 3 clusters based on existing knowledge. The primary outcome was a complication composite of severe bleeding, illness severity, cardiac arrest, arrhythmia, delayed first successful extubation, prolonged ICU LOS, very poor weight gain, and 30-day mortality. 3 data driven techniques were compared and then associated with outcomes using adjusted multivariable binary logistic regression (LR). Results: 450 neonates ≥ 34 weeks gestation undergoing CPB between 2015 and 2019 met inclusion criteria. GBTM, SOM, and k-means clustering identified temperature group assignment for 3 clusters: 1) persistent hypothermia (n=38, 9% vs. n=49, 11% vs. n=40, 9%), 2) resolving hypothermia (n=233, 51% vs. n=227, 50% vs. n=147, 33%), and 3) normothermia (n=179, 40% vs. n=174, 39% vs. n=263, 58%). Concordance of techniques showed strong agreement between GBTM and SOM (kappa= 0.92). The kappa test comparing GBTM and k-means assignment was 0.41, indicating a weak to moderate agreement. After adjustment in the multivariable binary LR, persistently hypothermic neonates compared to normothermic neonates were associated with higher odds of the complication composite outcome in the GBTM (OR: 2.8 [1.0-7.3], p 0.041) and SOM (OR: 2.3 [1.0-5.4], p 0.045) models, but not the k-means model (OR: 1.4 [0.7-3.1], p 0.38). Conclusion: Exploring concordance between different unsupervised ML techniques, shows that neonatal temperature after CPB follows distinct postoperative trajectories, and those exhibiting a persistent hypothermia trend are at higher risk of adverse outcomes.