tbuckley/cabot-search huggingface dataset:
Abstract 17167: Uncontrolled Hypertension Increases Endothelin-1-Induced Contractile Response of Coronary Microvasculature Both Before and After Cardioplegia and Cardiopulmonary Bypass
Authors: Debolina Banerjee, Sharif A Sabe, Jason Machan, Neel Sodha, Afshin Ehsan, Jun Feng, Frank W Sellke
Journal: Circulation (2023)

Introduction: Hypertensive patients undergoing cardiopulmonary bypass (CPB) have worse clinical outcomes, and coronary microvascular dysfunction may play a role. Endothelin-1 (ET-1), a vasoactive biopeptide, is increased in cardiomyocytes during the hypertrophic response to hypertension and in patients following CPB. Differential effects of hypertension on coronary microvascular reactivity and molecular signaling pathways following CPB have yet to be elucidated. Aims: This study investigated the effects of well-controlled and uncontrolled hypertension on CPB-induced changes in coronary microvascular vasoconstriction to ET-1 and associated signaling using unique in vitro microvascular reactivity studies, RNA deep sequencing, and established molecular methods. Methods: Coronary microvessels (&lt;200um) were harvested from atrial samples from patients with no hypertension (NH), well-controlled hypertension (CH), and uncontrolled hypertension (UH) before and after CPB. In vitro contractile response to ET-1 was assessed using video microscopy. Protein expression and receptor localization were measured using immunoblotting and immunohistochemistry, respectively. Enzyme-linked immunosorbent assay was used to quantify plasma concentration of ET-1. Results: Pre-CPB contractile response of coronary microvessels to ET-1 in UH was increased compared to NH or CH (p &lt;0.05). Post-CPB contractile response was impaired overall (p &lt;0.05). Between groups, contractile response in CH and NH was comparable while response in UH was higher (p &lt;0.05). Plasma ET-1 increased post-CPB (p = 0.18). Total protein levels and localization of ET A R and ET B R were unchanged post-CPB. Conclusions: While CPB overall blunted vasomotor contractile response of coronary microvessels to ET-1, UH was associated with relatively increased vasoconstriction compared to CH and NH. Changes in plasma ET-1, ET A R and ET B R levels or localization did not contribute to these effects.
Abstract 17358: Persistent Pericardial Effusion Secondary to Dasatinib Successfully Treated With Colchicine
Authors: Joaquin Espinoza, Paola Lecompte, Juan Quintero Martinez, Mohammed Mustafa, fatemah akbar, Rosario Colombo
Journal: Circulation (2023)

Introduction: Dasatinib is one of the first-line therapies for CML. A large pericardial effusion requiring drainage has rarely been documented among its adverse effects, and its treatment is still a subject of study. Case Presentation: A 44-year-old female with history of chronic myeloid leukemia (CML) in remission on Dasatinib for the past 10 years presented to the emergency with complaints of chest pain and palpitations for 3 weeks. Physical examination was remarkable for muffled heart sounds and tachycardia. No JVD, pulsus paradoxus, or hypotension were noted. A 12-lead EKG showed low voltage QRS in limb leads (A), and transthoracic echo (TTE) reported a moderate to large pericardial effusion with features concerning for early tamponade (B). A pericardiocentesis was performed with 500 mL of hemorrhagic fluid removed with a drain placed. Dasatinib was held but pericardial output remained elevated (&gt;100 mL/day) for the following 12 days. Colchicine 0.6mg twice a day was then initiated. Cardiothoracic surgery recommended against a pericardial window. On day 15, the drain was able to be removed after a marked reduction in fluid output. Patient was discharged to complete 3 weeks of colchicine therapy. Two weeks later, the patient remained asymptomatic with no signs of recurrent pericardial effusion on a repeat TTE. Discussion: Dasatinib is associated with a range of reported side effects including development of pericardial effusions in a limited number of cases. Nonetheless, there is a dearth of information regarding their optimal treatment approach. Our case highlights the use of colchicine as a potential strategy for patients with persistent Dasatinib-related pericardial effusions.
Abstract 17332: Length of Diagnosis, Diagnostic Tests, and Referral Patterns of Transthyretin Amyloid Cardiomyopathy Patients in the United States, United Kingdom, France, Germany, Italy, and Spain
Authors: Niya Melinis, Peter Collins, Wei Yen Chung, Fauziah Hefni, ozan ozbey
Journal: Circulation (2023)

Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a rare disease that typically presents with symptoms like those commonly associated with heart failure and is frequently misdiagnosed. Timely diagnosis and treatment are key to a favorable prognosis. This study aims to investigate and compare the length between suspicion of ATTR-CM and confirmed diagnosis, examine the number of diagnostic tests, and explore the referral dynamics in the US versus EU4+UK (United Kingdom, France, Germany, Italy, and Spain) using real-world data among patients diagnosed in 2022. Methods: A multi-center online medical chart review of patients was fielded in Q4’2022. Cardiologists and cardiology-focused internists from the US and EU4+UK from hospitals and private practices were recruited and screened for ATTR-CM patient management. A total of 239 physicians (US: 109, EU5: 130) who reported on patients diagnosed in 2022 were included, providing data on 759 patients diagnosed during this period (US: 481, EU5: 278). Results: Reported patients in the US experienced a shorter length of time from first suspicion of ATTR-CM to confirmed diagnosis, on average, than those in the EU4+UK (p&lt;0.01); US: 6.3 weeks (n=392), EU4+UK: 9.6 weeks (n=205). The average number of tests ordered to diagnose patients was greater in the EU4+UK than in the US cohort (p&lt;0.01); EU4+UK: 6.8 tests (n=277), US: 5.8 tests. A greater proportion of reported patients in the US (p&lt;0.05) first presented their symptoms prior to diagnosis to the reporting physician (35.1%) than those in EU4+UK (27.3%). In the US, 88.4% of the patients were diagnosed by the reporting physician (n=481), whereas in EU4+UK (n=278) this rate was 78.1% (p&lt;0.01). Conclusions: This study demonstrated that it took significantly less time to diagnose patients in 2022 in the US than in the EU4+UK. Patients in the EU4+UK were more likely to present symptoms to and be diagnosed by a physician other than the reporting physician, with a greater number of diagnostic tests ordered compared to those in the US. Further investigation using comparator cohort and to discover if there is a difference in patient outcomes is warranted.
Abstract 17367: Impact of Cardiac MRI on Myocarditis Management and Patient Outcomes: A Big Data Study
Authors: Aparna Narendrula, Rochell Issa, David Chen, Christopher Nguyen, Wai Hong W Tang, David Kaelber, Deborah H Kwon
Journal: Circulation (2023)

Introduction: The lack of consensus regarding the role of cardiac magnetic resonance (CMR), an essential myocarditis imaging modality, leads to patient care inconsistencies. We investigated the impact of CMR on resource utilization and patient outcomes in myocarditis patients. Methods: Using TriNetX, we conducted a large, retrospective analysis between 1/01/2010 and 6/02/2023. We compared myocarditis patients with and without CMR within 3 months of diagnosis. Matching cohorts (n=7,488 per cohort) were created based on demographic variables and comorbidities including lipidemias, hypertension, diabetes, sarcoidosis, and select heart diseases within 1 month of diagnosis. The analysis yielded risks to compare outcomes, resource utilization, and medication and procedure usage. Results: Patients without CMR had higher mortality rates compared to those who received CMR in the context of higher mortality between 2017-2022 compared to 2010-2016 (Risk 2.728% vs 2.314%, p&lt;0.05). Mortality risk was higher in the non-CMR cohort at 3 months, 1 year and 5 years. Risks of developing cardiomyopathy and heart failure were higher in the non-CMR group. Between 1 and 5 years, the CMR group experienced fewer hospitalizations (Risk 11.6% vs 14.9%, p&lt;0.05). CMR recipients had a higher chance of receiving all GDMT categories within 30 days, and most GDMT categories within 1 year. Conclusions: Myocarditis patients referred for CMR experienced lower hospitalization and mortality rates over 5 years, and were less likely to develop complications and more likely to receive early GDMT. These findings imply potential downstream impacts of CMR on optimal therapeutic management and risk reduction.
Abstract 17353: Health Literacy and Hypertension: A Systematic Review
Authors: Gaither W Horde, Edward Huang, James Hammock, Emily B Levitan, Aowen Zhu, Ross Hansen, Travis Carroll, Mohammed Siddiqui, Elizabeth A Jackson
Journal: Circulation (2023)

Introduction: Low health literacy (HL) is highly prevalent in the United States. Despite the potential for low HL to be a major barrier to effective self-management of blood pressure (BP), data on HL among adults with hypertension (HTN) is scarce. Goals: We conducted a systematic review to examine the prevalence and factors associated with low HL among adults with HTN. Additionally, we examined intervention trials which sought to modify the impact of low HL among participants with HTN. Methods: A comprehensive search of 6 databases was performed to identify studies which measured HL using a validated survey and included adults with HTN. After removing duplicate citations, two authors independently reviewed the references for eligibility, data extraction, and risk of bias assessment. Results: A total of 1,046 studies were identified of which 44 met eligibility criteria. The prevalence of low HL was 33% among the 31,507 participants included across the 44 studies. In the studies that reported associations between social determinants of health factors and HL, lower education levels, non-white race, and lower HTN knowledge were found to be significantly associated with lower HL among adults with HTN. Among the 15 observational studies which examined BP, lower HL was associated with higher BP in 8 studies. Six randomized control trials included an intervention to modify HL and measure its effect on BP control. Two of these trials demonstrated significant reductions in BP among the intervention group compared to control. Conclusion: Among studies which measured HL in adults with HTN, education, HTN knowledge and race were associated with HL; however, interventions to address HL were not consistently associated with improvements in BP control. A more detailed examination of methods to address HL among adults with HTN is warranted.
Abstract 19065: Resource Utilization After Cardiac Surgery in Adults With Congenital Heart Diseases: A Nationwide Analysis
Authors: Carlos E Diaz Castrillon, Ibrahim Sultan, Melita Viegas, Arvind Hoskoppal, Jennifer Nelson, Mario Castro Medina, Luciana da Silva, Nidhi Iyanna, Sarah Yousef, Yisi Wang, Victor Morell
Journal: Circulation (2023)

Objective: This study examined resource utilization following cardiac surgery among ACHD patients.Methods: We used the NIS (2012-2018) to identify &gt;18yo admissions with TOF, Pulmonary valve anomalies/Congenital Pulmonary Stenosis, cTGA, DORV, TGA, HLHS, and Ebstein's anomaly and Open-heart valve or Great Vessels\Conduit replacement procedures. Hospitalization costs were adjusted for inflation to 2022 US dollars using the medical care component of the US Consumer Price Index. A mixed-effect linear regression model was used to identify factors associated with increased costs.Results: Out of 91,565 admissions, 4,578 involved one of the procedures of interest. The median age was 32 (IQR 34 - 46), and 46.6% were females. The median hospitalization cost was $54,400 (IQR 40,990 - 74,520). Valve procedures were the most common (79%). Overall, 19% of admissions had multiple HRU codes, with Blood transfusions (12.5% ) and ICD/pacemakers (7.2% being the most common. The high and low tercile group had a median hospitalization cost of $92,370 (IQR 74,850 - 120,900) and $36,300, IQR 31,180 - 40,930). Hospital-level factors, complications, and the need for HRU services significantly increased hospitalization costs. Notably, in-hospital mortality was associated with a 58% cost increase. Conclusion: Although the proportion of ACHD admissions requiring cardiac surgery is relatively low, the economic burden is significantly high, particularly those with in-hospital mortality. On average, higher hospitalization costs are associated with complications, the utilization of HRU procedures, the type of hospital providing care, and the US region.
Abstract 19080: The Ketogenic Diet Aggravates the Ischemic Response in Mouse Hearts
Authors: Luca Walborn, Noah Coleman, Alexandria Chin, CJ Cunningham, Aiden Tobin, Nicholas DiGiuseppe, Jacob Saadoun, Paige Ponzo, Erica Locke, Stephen C Kolwicz
Journal: Circulation (2023)

Ketone bodies, particularly beta-hydroxybutyrate (B-OHB), have been identified as an important fuel source during physiological and pathological stress. Although controversial, consumption of a ketogenic diet (KD) may be used as a method to increase B-OHB availability. Since the KD is a high-fat, low carbohydrate diet, the diet may have harmful effects on the heart especially during ischemic injury. Therefore, the objective of this study was to investigate the effects of short- term consumption of the KD on cardiac ischemia-reperfusion injury. Male (n=14) and female (n=13) were randomly assigned to KD (90% calories from fat) or normal chow diet. Serum B-OHB and cholesterol were significantly higher in both male and females fed the KD. KD did not increase body weight in male and female mice but significantly increased adipose tissue mass by 2.7 and 1.9 fold, respectively. KD increased hepatic triglyceride content in both males and females and increased cardiac triglycerides only in male mice. Cardiac function was assessed in isolated perfused hearts on a mixed substrate buffer consisting of 0.4mM fatty acids, 5.5mM glucose, 50uU/ml insulin, 1.2mM lactate, and 0.5mM B-OHB. Baseline function was monitored for 15 minutes followed by 18 minutes of global ischemia and 36 minutes of reperfusion. Baseline LV developed pressure (LVDevP) and heart rate (HR) were not affected by the KD in either male or female mice. During ischemia, the end diastolic pressure (EDP) was significantly higher in both male and female KD hearts. Time to peak contracture was accelerated in male and female KD hearts (P&lt;0.05 vs chow), with a delay in female hearts (13.12 ± 1.06 vs. 9.27 ± 0.80 min, P&lt;0.05 vs KD male). At the end of reperfusion, rate pressure product (RPP, the product of LVDevP and HR) was lower in male KD vs male chow (P&lt;0.05) whereas RPP was similar in female KD and female chow. Moreover, RPP in female KD was significantly higher than male KD (6190 ± 929 vs 2133 ± 533 mmHg/min). These findings suggest that the KD may increase vulnerability of the heart to ischemia and may reduce recovery from ischemia, particularly in males. Overall, this study highlights potential sex differences and negative consequences of short-term consumption of the KD.
Abstract 17362: Left Atrial Stiffness is Increased in Pediatric Hypertrophic Cardiomyopathy and May Be of Incremental Value in Predicting Major Adverse Cardiac Events in This Group
Authors: Ryusuke Numata, Daisuke Matsubara, Priyanka Anvekar, Hunter Kauffman, Yan Wang, Renzo C Anyosa, Anirban Banerjee
Journal: Circulation (2023)

Background: Determining risk factors by echocardiography to prevent major adverse cardiac events (MACE) is crucial in pediatric patients with hypertrophic cardiomyopathy (HCM). Recent studies have shown that LA stiffness and strain may serve as surrogate markers in children, to differentiate elevated pulmonary capillary wedge pressure from normal and predict COVID-19 related myocardial injury. Hypothesis: LA stiffness may predict MACE in pediatric patients with HCM. Methods: We retrospectively enrolled 201 pediatric patients with HCM diagnosed by echocardiography. They were divided into two groups: MACE (n=61) and non-MACE (n=140) groups. LV systolic function, and LA strain were evaluated by conventional 2D and speckle tracking echocardiography. Noninvasive LA stiffness was calculated as the ratio of E/e’ to LA strain as depicted in the following equation: LA Stiffness= E/e ' ratio / LA Peak Strain (% -1 ). The primary outcome was a composite endpoint of MACE (including ICD placement, myomectomy, heart transplant or death) during follow-up. Results: The MACE group showed significantly decreased LV global longitudinal strain (GLS) compared to non-MACE group (GLS - 16.76 ± 5.05% vs. - 20.25 ± 3.40%, p &lt; 0.001), even though LV ejection fraction showed no significant difference between the two groups. LA peak strain was significantly reduced (21.96 ± 7.24% vs. 30.80 ± 7.10%, p &lt; 0.001), whereas, noninvasive LA stiffness was significantly increased (0.72 ± 0.48 % -1 vs. 0.34 ± 0.16 % -1 , p &lt; 0.001) in the MACE group. Among the LV diastolic indices, LA stiffness was the superior-most index for predicting MACE (see Table 1, Figure 1) (AUC: 0.814, cut off value: 0.49% -1 ). Also, LA stiffness was independently associated with increased risk of the composite endpoint of MACE (HR: 3.26 [95% CI: 1.77 -5.99]; P &lt; 0.001, see Table 2). Conclusion: LA stiffness is a newly described index in children, that may be of incremental value in predicting risk of MACE in pediatric HCM patients.
Abstract 17390: The Impact of The Covid-19 Pandemic on Perceived Stress in Rural Caregivers Participating in a Cardiovascular Risk Reduction Intervention
Authors: Jennifer L Smith, JungHee Kang, Jennifer Miller, Misook L Chung, Debra K Moser
Journal: Circulation (2023)

Introduction: Interventions to reduce cardiovascular disease (CVD) risk factors are key for improving the health and well-being of rural caregivers who are often referred to as invisible patients. The Rural Intervention for Caregivers’ Heart Health (RICHH), a CVD risk reduction intervention (2017-2022) included a stress management module. The COVID-19 pandemic (2020-2021) had an unknown impact on this intervention on perceived stress. The aim of this study was to determine whether the COVID-19 pandemic moderated the effects of RICHH on perceived stress for rural caregivers. Methods: This was a randomized controlled trial of a CVD risk reduction intervention that promoted self-care. Caregivers were randomized to usual care or the RICHH intervention. Data were collected at baseline, 4 and 12 months. Participants were grouped into two groups by COVID-19 timing: 1) the pre-pandemic group (n=145) completed the study before the pandemic; and 2) the pandemic group (n=114) completed the study during the pandemic. A piecewise linear mixed-effect model was used to evaluate the impact of the intervention and COVID-19 timing on perceived stress (Cohen’s Perceived Stress Scale). Results: The effect of the intervention on perceived stress in 259 participants (mean age = 55 ± 13 years, 78% female, 95% white, and 73 % married) was significant in the pandemic group (β= -.59, SE = .14, P &lt; .001) but not in the pre-pandemic group (β = -.10, SE = .13, P = .45 [Figure1). The differences in perceived stress changes between the pre-COVID and during-COVID groups was significant, indicating a moderating effect of COVID (β = -.50, SE = .19, P = .009). Conclusion: The RICHH intervention helped to mitigate stress during the COVID-19 pandemic among those in the intervention group at the 4 months, however this effect was not sustained at 12 months. It remains unclear if the reduction in perceived stress during the pandemic was due to participation in the intervention or weekly contact with an interventionist.
Abstract 19045: Detection of Left Ventricular Systolic Dysfunction From PDF Outputs of ECGs Obtained on Wearable Devices
Authors: Veer Sangha, Akshay Khunte, Lovedeep S Dhingra, Evangelos K Oikonomou, Rohan Khera
Journal: Circulation (2023)

Background: Left Ventricular Systolic Dysfunction (LVSD) affects 5% of adults with available therapies, but most are diagnosed after the onset of symptoms. AI-ECG tools that detect LVSD from clinical ECGs are not suitable for community screening. Wearable devices offer broad access to ECGs but end users rely on PDF outputs of single-lead data, with limited access to underlying signal data. Methods: We simulated wearable PDF outputs from commercial wearable devices using lead I data from clinical 12-lead ECGs during 2015-2021. We selected the subset with echocardiography within 15 days of the ECG to define LVSD, based on LVEF &lt; 40%. We developed a model to detect LVSD from wearable-adapted PDF outputs using an EfficientNet-B3 convolutional neural network with self-supervised pretraining. The model deployment pipeline was optimized to segment and process PDF outputs across all commercially available devices as inputs to the model (Fig A &amp; B). Results: 385,601 ECGs with paired echocardiograms were used for model development. In a held-out test set of 11,611 ECGs from unique patients (8.2% with LVEF &lt; 40%) the model demonstrated high discrimination power for detection of LVSD with an AUROC of 0.88, AUPRC of 0.45, sensitivity 0.88, and specificity 0.72. An ECG suggestive of LVSD portended over 18-fold higher odds of LVSD in the held-out set (OR 18.3, 95% CI, 15.0-22.4). It also represents a digital biomarker in those with a false positive vs a true negative prediction at baseline, with a false positive assessment being associated with 3.6-fold (95% CI, 2.97-4.34) increased risk of developing incident LV systolic dysfunction in the future (Fig C). Conclusions: We developed and validated a deep learning model that can identify LVSD from PDF image outputs of wearable and handheld single-lead devices. This approach broadens access to screening for LVSD to anyone with access to a wearable device with ECG.