tbuckley/cabot-search huggingface dataset:
Abstract Sa501: Neurological Prognostication in Cardiac Arrest Survivors: Correlation Between Biomarker Molecular Weight and Blood-Brain Barrier Disruption.
Authors: So Young Jeon, Jung Soo Park, Changshin Kang, Yeonho You, Jin Hong Min, Wonjoon Jeong, Hong Joon Ahn
Journal: Circulation (2024)

Aims: This study evaluated the association between blood-brain barrier (BBB) disruption and the molecular weights of biomarkers in predicting neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors who received targeted temperature management (TTM) and lumbar drainage therapy. Methods: This observational study used data from a prospectively collected TTM registry at a tertiary academic hospital.Serum levels of neuron-specific enolase (NSE, 47 kDa) and S100 calcium-binding protein B (S100B, 21 kDa) were measured immediately, 24 h, 48 h, and 72 h after return of spontaneous circulation (ROSC). To assess the extent of BBB disruption, the albumin quotient (Q A ) was calculated at each time point of serum biomarker measurement using the formula: Q A = albumin [cerebrospinal fluid] / albumin [serum]. Degrees of BBB disruption were categorized as follows: a Q A value less than 0.007 was considered normal; a value within 0.007–0.01 indicated mild disruption; a value within 0.01–0.02 indicated moderate disruption; and a value greater than 0.02 indicated severe disruption. Prognostic performances were evaluated using the areas under receiver operating characteristic curves (AUC). The primary outcome was poor neurological outcome 6 months after ROSC defined as Cerebral Performance Category scores of 3–5. Results: A total of 562 serum biomarker levels (371 NSE and 191 S100B) in 106 patients (59% poor neurological outcome) were evaluated. Serum levels of NSE and S100B showed no statistically significant difference in prognostic performance for poor neurological outcomes (AUC 0.85 [0.81–0.88] vs. 0.83 [0.80–0.87], P=0.43). Serum NSE levels showed differences in prognostic performance depending on BBB integrity (AUC 0.65 [intact BBB] vs AUC 0.87 [disrupted BBB]), compared with S100B (AUC 0.83 [intact BBB] vs. 0.79 [disrupted BBB]) (Figure 1). In particular, serum NSE levels had higher predictive performance when the BBB was moderately or severe disrupted compared to when it was intact (Figure 2). Additionally, serum NSE levels demonstrated better predictive performance when BBB is disrupted (P&lt; 0.001), whereas serum S100B levels demonstrated better predictive performance when BBB is intact (P = 0.004) (Figure 3). Conclusions: In this cohort study, the relationship between molecular weights of biomarkers and BBB intact/disruption demonstrated good prognostic performance for OHCA survivors. Prospective multicenter studies are needed to generalize our findings.
Abstract 4147544: Incidence of Heart Failure Among Hispanic/Latino Individuals in the United States: Insights from the Hispanic Community Health Study/Study of Latinos
Authors: Bede Nriagu, Priscilla Duran Luciano, Ambarish Pandey, Martha Daviglus, Gregory Talavera, Robert Kaplan, Sanjiv Shah, Matthew Allison, JORGE KIZER, Barry Hurwitz, Patricia Chavez, Larissa Aviles-Santa, Scott Solomon, Susan Cheng, Bonnie Shook-Sa, Jianwen Cai, Linda Gallo, Carlos Rodriguez
Journal: Circulation (2024)

Introduction: Hispanic/Latino individuals are known to have higher traditional cardiovascular disease (CVD) risk factors compared to non-Hispanic Whites and Asians. However, inconsistencies and variability exist regarding the incidence of heart failure (HF) among Hispanics compared to other race/ethnic groups. We examined the incidence of HF in participants enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: The baseline HCHS/SOL population consisted of 16,415 participants enrolled between 2008 - 2011 and followed up for incident HF events through 2015 (mean follow up period of 5.8 years). A total of 1000 participants with pre-existing HF at baseline, or with missing information/response for baseline HF, socio-economic status (SES), CVD risk factors, and medication use were excluded. Outcome was ascertained via self-report of events at annual follow-up interviews. HF events were adjudicated by trained physicians who reviewed hospital records. HCHS/SOL participants were stratified into seven Hispanic/Latino heritage groups: Mexican, Dominican, Cuban, Puerto Rican, South or Central American, as well as more than one/other. Cox-proportional hazard regression models were used to calculate HRs for incident HF with Mexican Americans as the reference group and controlling for SES, CVD risk factors, and medication use. Results: A total of 15,415 participants [mean age 41 years, 52.2% Female) were included and 114 HF events (69 Males and 45 Females) were identified after 89,751 person-years follow up. The HF incidence rate was 94.6 per 100,000 persons-years. Hispanic/Latino individuals of Cuban background had the highest HF incidence rate (131.4 per 100,000 person-years) while those from Central American backgrounds had the lowest (42.8 per 100,000 person-years). Hispanic/Latino individuals of Cuban background [HR: 1.471 (95% C.I: 0.397,5.447)] and Dominican background [HR: 0.509 (95% C.I: 0.075, 3.429)] had the highest and lowest adjusted HR of incident HF compared to those of Mexican background. Conclusion: Among different Hispanic/Latino heritage groups, the incidence rate for HF was highest among those with Cuban background and lowest among those with a Central American background.
Abstract 4147337: The Aortic Inflammation Affects Long-Term Freedom From Reintervention After Bentall Procedure
Authors: Luca Zanella, Murana Giacomo, Chiara Baldovini, Luca Di Marco, Alessandro Leone, Davide Pacini
Journal: Circulation (2024)

Background: The impact of aortic inflammation on aortic surgery is still unclear. Hypothesis: The aortic inflammation affects the freedom from reintervention in the distal native aorta following the Bentall procedure. Methods: This is a retrospective observational study performed on the aortic histology of patients over 18 years old who underwent a Bentall procedure in a single centre, from 2000 to 2023. Variables included demographics, cardiovascular risk factors and ascending aorta diameter. The follow-up verified death or reintervention on the distal aorta. The relationship between the aortic inflammation and cardiovascular risk factors was tested with Logistic Regression, expressed as odds ratio (OR) and 95% confidence interval (CI95%). The Cox regression evaluated if inflammation was a significant predictor for survival and reintervention, expressed as hazard ratio (HR) and 95%CI. The Kaplan-Meier curves for the freedom from reintervention stratified by inflammation were compared with the Tarone-Ware test. Results: Data concerning 1327 patients was gathered: 61(4.6%) had aortic inflammation. The median follow-up was 4.3 years (Interquartile 1.5-8.1 years). The inflammation was associated with females (OR3.5 CI95% 1.9-6.2 p&lt;0.01), age (OR1.1 CI95% 1.01-1.08 p=0.01), and increased ascending aorta diameter (OR1.1 CI95% 1.05-1.1 p&lt;0.01), but not with aortic dissection (OR0.5 CI95% 0.2-1.1 p=0.08). Inflamed aorta did not increase mortality (HR1.4 CI95% 0.8-2.6 p=0.23). However, inflammation was the strongest risk factor for reintervention on the distal aorta (HR6.8 CI95% 3.1-15.2 p&lt;0.01), independently from aortic dissection (HR3.2 CI95% 1.5-6.6 p&lt;0.01), elevated ascending aorta diameter (HR1.1 CI95% 1.01-1.05 p=0.05), body max index (HR0.9 CI95% 0,84-0,97 p&lt;0.01). The Kaplan-Meier curves confirmed that an inflamed aorta provided lower freedom from reintervention than one without inflammation (Figure 1, Tarone-Ware Test p&lt;0.01). Conclusions: Aortic inflammation in patients treated with the Bentall procedure is associated with age, female, and increased ascending aorta diameter. Inflammation doesn’t affect survival after surgery. However, it strongly increases the risk of reintervention in the distal native aorta.
Abstract Sa1208: Survive and Thrive: Implementing a Post Cardiac Arrest Workflow in a Rural Regional Hospital
Authors: Jacqueline Gibbons, Andrea Nelson, Katelyn Galligan, Ryan Ohnstad, Shawna Ogundeji, Joseph Corser
Journal: Circulation (2024)

Throughout the world, neurologically intact survival to discharge remains low. The Joint Commission (TJC) released post resuscitation requirements in January of 2022. Sanford Bemidji reviewed options that would meet the TJC requirements: Transfer the patient or develop a novel way to meet those needs in the current setting. With the latter, the positive impact on patients is significant in that they receive a high care level of care close to home without delay in care. Sanford Bemidji Medical Center is a rural regional 118-bed hospital in Minnesota with a 14-bed Intensive Care unit. We are unique in that despite our size we serve a large regional footprint of over 100,000 people including three Native American reservations. Our objective was to utilize evidence based guidelines to implement a post cardiac arrest care (PCAC) workflow for adult cardiac arrest patients who obtain return of spontaneous circulation (ROSC) by end of first quarter 2023. The project incorporated low cost equipment and staff training. We used the Plan, Do, Study, Act cycle for our methodology. The outcome metric was neurologically intact survival to hospital discharge. Process metrics included placement and use of the ROSC order set, fever avoidance, rapid EEG completed, MAP over 65, and oxygen saturations of 92-98%. Sixty-one adult patients (both in hospital and out of hospital) suffered cardiac arrest at Sanford Bemidji in the 9 months following project implementation in 2023. Demographics included 3 native americans and 2 caucasians, ages 57-73, 3 males and 2 females. Our overall survival rate remained above the national average. For the few patients who met criteria for ROSC interventions, 4 of 5 (80%) received the ROSC interventions, 2 of 4 (50%) survived hospital to discharge neurologically intact. Results showed an increase in maintaining optimal MAP from 81% in 2022 to 100% in 2023 and achieving oxygen saturation parameters 80% of the time in 2023 compared to 66% in 2022. Real time monitoring and coaching of the order set is needed to increase utilization of the order set in full (fever avoidance was at 20% and rapid EEG completed in 40% of cases with a goal of 100% for both). More data is needed to ascertain the outcomes of a ROSC workflow in like sized hospitals with similar resources. The novelty of this innovative project is in the implementation of an evidence based PCAC workflow in a 118-bed rural hospital giving all cardiac arrest patients a chance for a full recovery.
Abstract Sa903: Adverse effect of Autoimmune Diseases on In-hospital Cardiac Arrest Mortality
Authors: Ruth Pius, Favour Markson, Akanimo Antia, OLUFEMI ODUGBEMI, Enyioma Nwogwugwu, Kenneth Ong
Journal: Circulation (2024)

Introduction: Cardiac arrest (CA) has been linked with worse outcomes in patients with chronic medical conditions such as chronic obstructive pulmonary disease, chronic kidney disease, diabetes mellitus, hypertension, and coronary artery disease. Autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) have been linked to increased risk of cardiovascular diseases, but their effect on the outcome of CA is not well studied. Aim: This study aimed to evaluate the effect of SLE and RA on the outcomes of admitted CA patients. Methodology: We identified all adult CA hospitalizations in the US between 2016 and 2020 using the National Inpatient Sample database and categorized them based on RA and SLE diagnoses. We applied logistic regression analysis to study the effects of SLE or RA diagnosis on CA outcomes, with a p-value threshold of 0.01. Results: A total of 1,099,235 adults were admitted with CA between 2016 to 2020. There were 5745 and 16920 patients with SLE and RA diagnoses among CA hospitalizations, respectively. Among CA patients, the mean age was 54.4 vs. 70.5 years among SLE and RA groups. CA patients with SLE diagnosis had 18% higher odds of in-hospital mortality (OR: 1.18 [1.04-1.34]; p=0.008), similar to those with RA diagnosis (OR:1.16 [1.08-1.24]; p&lt;0.001) when compared to those without SLE or RA. Unlike RA, the SLE effect persisted (AOR:1.44 [1.26-1.64]; p&lt; 0.001) after adjusting for sociodemographic factors (such as age and sex) and other co-morbidities (for RA, AOR: 1.09 [1.01-1.18]; p=0.023). Further analysis to determine if this reported mortality effect of SLE on CA patients is explainable by a general SLE mortality revealed that the interaction of SLE and CA is associated with higher mortality in the broader adult patient population, independent of CA or SLE alone (OR:1.52 [1.34-1.71]; P&lt;0.001). This synergistic effect persisted after controlling for comorbidities and sociodemographic factors (AOR: 1.9 [1.66-2.27]; p&lt; 0.001). RA or SLE diagnosis were not associated with acute heart failure, cardiogenic shock, and acute kidney injury outcomes in CA patients. Conclusion: Our findings suggest an adverse clinical interaction between SLE and CA that is independent of CA or SLE alone, and also independent of other comorbidities and sociodemographic factors. More research is needed to further explore the potential mechanisms involved.
Abstract Sa203: Association between dynamic cerebral perfusion indices by NIRS and cerebral microvascular flow during CPR in a porcine cardiac arrest model
Authors: Takeyuki Kiguchi, Norihiro Nishioka, Wataru Kamo, Kouhei Ninomiya, Yuto Makino, tsuyoshi Kamada, Hideki Maeda, Taku Iwami
Journal: Circulation (2024)

Background: Maintaining cerebral blood flow during cardiopulmonary resuscitation (CPR) significantly impacts the neurological outcome of patients after cardiac arrest. However, dynamic indicator of cerebral blood flow during CPR is not established. Near infrared spectroscopy (NIRS) can continuously detect cerebral blood volume changes in a non-invasive way. The aim of this study is to compare cerebral perfusion during CPR obtained by NIRS-based assessment of continuous cerebral perfusion indices (CPI) with cerebral microvascular flow (CMF) using laser doppler flowmetry (LDF) in a ventricular fibrillation (VF) porcine model with free intracranial pressure (ICP). Methods: CPI and CMF during CPR were measured in 5 swine (40± 3 kg). After craniotomy and head up condition to create free ICP environment, NIRS probe was placed on brain surface directly in the middle of the craniotomy. In the upper left or right corner of the craniotomy, an LDF probe was inserted to measure cortical CMF. Aortic blood pressure (ABP) was measured at same time to assess the quality of chest compression. Following baseline measurements, VF was electrically induced. After the interval of 6 min untreated VF, CPR was continued for 24 min, during which mechanical and manual CPR was alternated at every 4 min intervals. To make a variety of cerebral blood flow by chest compressions, high quality CPR was performed during Mechanical CPR while low quality CPR was purposely performed during manual. CPI, CMF and ABP were measured continuously during CPR. Each median value in 5 sec was regarded as trend. Correlations between CPI and CMF, as well as CPI and ABP, were analyzed by Pearson correlation coefficient and Spearman's rank correlation. Results: Poor data measurements were observed in 2 out of 5 cases for CPI and in 3 cases for CMF. One of 5 cases were eligible for analysis. The followability of CPI to CMF and ABP during CPR was good. CPI and CMF tended to increase during high quality CPR, while both CPI and CMF decreased during low quality CPR (Figure). Pearson's correlation coefficient and Spearman's rank correlation coefficient between CPI and CMF during CPR of analyzable data were 0.71 (p &lt; 0.001) and 0.52 (p &lt; 0.001), respectively. Similarly, CPI and ABP were 0.86 (p&lt;0.001) and 0.67 (p&lt;0.001). Conclusions: It was suggested that CPI by NIRS can reflect the CMF during CPR with free ICP environment.
Abstract 4147522: Myofibroblast transition and loss of UCP2 in a rat model and a human pulmonary hypertension cohort underline right ventricular decompensation: potential value of a loss-of-function UCP2 SNP
Authors: Yongneng Zhang, Alois Haromy, Yongsheng Liu, Yuan Yuan Zhao, Sandra Breuils Bonnet, Sebastien Bonnet, Dawn Bowles, Gopinath Sutendra, Evangelos Michelakis
Journal: Circulation (2024)

Backgrounds: The mechanism driving the transition from compensated (cRVH) to decompensated right ventricular hypertrophy (dRVH) in pulmonary hypertension (PHT) is unknown. We hypothesized that a transition from cardiac fibroblasts (cFB) to cardiac myofibroblasts (cMFB) underlies this mechanism. Decreased mitochondrial calcium (mCa ++ ) promotes cMFB differentiation (from cFB). Methylation of mCa ++ uptake 1 (MICU1) and lack of UCP2 (uncoupling protein 2, a component of the mCa ++ uniporter complex) decrease mCa ++ . Methods/Results: In the monocrotaline-rat PHT model, we separated cRVH from dRVH based on strict catheterization and echo criteria: dRVH had decreased cardiac output, increased right atrial pressure, decreased tricuspid annular plane systolic excursion (TAPSE) and increased RV end-diastolic diameter compared to cRVH. In isolated hearts, RV systolic pressure was lower in dRVH but in isolated cardiomyocytes (CM), contractility (sarcomere shortening) was not, pointing to a non-cardiomyocyte cause. The number of cMFB was not different between cRVH and Control, but dramatically increased in dRVH. Mitochondrial respiration was lower in dRVH cMFB than cRVH cFB. mCa ++ was progressively decreased from Control to cRVH to dRVH c(M)FB, while it was not different in CM. The MICU1 methyltransferase (PRMT1) levels and MICU1 methylation were increased but the expression of UCP2 was decreased from Control to cRVH to dRVH c(M)FB (but not CM). In a cohort of 60 patients with human RV tissues, dRVH (based on clinical criteria) had increased cMFBs compared to Control and cRVH. Cytoplasmic PRMT1 was increased and UCP2 was decreased from Control to cRVH to dRVH c(M)FB. UCP2 protein level correlated negatively with the presence of a loss-of-function SNP (rs659366) and positively with TAPSE. In a subgroup that had Echo and right heart catheterization data within 2 days, carriers of the UCP2 SNP had decreased TAPSE compared to non-carriers with similar mean PA pressure. Conclusion: Our data point to a change of cell identity (cFB to cMFB) in the RV as the basis of RV decompensation. UCP2 SNPs may be promising biomarkers for RV failure in PHT patients.
Abstract 4147279: The Role of Left Atrial Compliance in the Stroke Volume Response to Exercise in HFpEF
Authors: Carlos Tovar, Le Huang, Denis Wakeham, Tiffany Brazile, Christopher Hearon, James Macnamara, Benjamin Levine, Satyam Sarma
Journal: Circulation (2024)

Background: Left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF), but the extent to which LA dysfunction impacts cardiac performance during exercise is unknown. Given the importance of the LA for ventricular filling, we assessed the relationship between LA compliance (LAc) at rest and during exercise and exercise stroke volume (SV) generation. Methods: We studied 50 adults with HFpEF during rest and upright cycle exercise (20W). LA volumes were calculated from two-dimensional, 4-chamber and 2-chamber echocardiographic views during both stages. LA pressures were derived from v-wave maximal amplitudes of corresponding pulmonary capillary wedge pressure tracings. LAc was calculated as LA volume divided by LA pressures (mL/mmHg). Results: LA volume increased by 3.5 + 1.4mL (p&lt;0.01), LA compliance decreased by 4.2 + 5.3 mL/mmHg (p&lt;0.001), and SV increased by 28.9 + 13.4mL (p&lt;0.001) from rest to 20W exercise. Resting LAc was not associated with changes in SV (R 2 =0.01, p=0.47). LAc at 20W was statistically associated, albeit weakly, with changes in SV (p&lt;0.04, R 2 =0.11). Only 2 patients improved/increased LAc and there was no relationships between LA compliance changes and SV changes during rest and exercise (p=0.93). Conclusions: LAc decreased with exercise in patients with HFpEF. LAc measured at 20W had a weak relationship with SV response but changes in LAc did not discriminate for individual SV responses. These findings suggest that LAc does not contribute to SV generation during exercise in patients with HFpEF.
Abstract Su1002: Association of Post-Arrest Mechanical Ventilation Settings on Survival to Hospital Discharge With Favorable Neurologic Outcome in Children with Cardiac Disease
Authors: Rithika Prakash, Lucas Zeida Haar, Sierra Foster, Xilong Li, Priya Bhaskar, Lakshmi Raman, Javier Lasa, Priscilla Yu
Journal: Circulation (2024)

Introduction: There is a lack of evidence on the optimal mechanical ventilation (MV) settings after pediatric cardiac arrest. The purpose of this study is to investigate the impact of MV settings on survival to hospital discharge (SHD) with favorable neurologic outcome (FNO) in the early post cardiac arrest period. Methods: We conducted a retrospective cohort study of children admitted to a single center pediatric CICU from 9/2016 - 4/2023. We divided our cohort into two groups: patients who did and did not utilize extracorporeal membrane oxygenation (ECMO ) during the 48 hours after ROC. We evaluated the association of average values of various MV settings in the 48 hours post - ROSC/ROC: tidal volume (TV, defined as exhaled tidal volume per kg of body weight), peak inspiratory pressure (PIP), peak end expiratory pressure (PEEP), mean airway pressure (MAP), and fraction of inspired oxygen (FiO2) with the association of our primary outcome, SHD with FNO. We defined SHD with FNO as Pediatric Cerebral Performance Category (PCPC) of 1,2, or 3 or no change from admission to discharge. Unfavorable outcome was defined as death or SHD with PCPC of 4,5, or 6. We conducted univariate and multivariate logistic regression analyses, controlling for CPR duration and maximum lactate in the 6 hours post ROSC/ROC. Results: There were 102 index events during the study period. Patients with SHD with FNO compared to those without had lower CPR duration (6.0 [3.0, 18.0] vs. 22.0 [5.0, 43.0] minutes, p=0.0003), incidence of ECPR use (19/57 (33.33%) vs. 24/45 (53.33%), p=0.04), and epinephrine doses used (2.0 [1.0, 6.0] vs. 6.0 [2.0, 8.0], p=0.001). Table 1 shows the MV settings of patients with and without SHD with FNO by PCPC. We found no associations between TV, PIP, PEEP, MAP, and FiO2 with our primary outcome in both ECMO and non-ECMO cohorts. In patients who utilized ECMO, higher TV was associated with lower chances of SHD with FNO. (See Table 2) Conclusions: In this retrospective cohort study of a single center pediatric CICU, early post-arrest TV was associated with SHD with FNO amongst patient supported with ECMO, but not in those who did not utilize ECMO. We did not find an association of PIP, PEEP, MAP, or FiO2 with any outcomes. Future investigations should focus on whether there is a threshold of TV of MV settings that is associated with better outcomes in ECMO patients.