tbuckley/cabot-search huggingface dataset:
Abstract 4147096: Heart Transplantation Trends and Associated Costs: A 12-year Retrospective Analysis on Nationwide Readmission Database (2010-2021)
Authors: Phanidhar Mogga, Karanrajsinh Raol, Dheeraj Pinninty, Ashwin Pillai, prathyusha Mudduluru, Kerry Singh, Zeina Jedeon, Abhishek Jaiswal
Journal: Circulation (2024)

Introduction: Increased prevalence and incidence of heart failure have resulted in a significant rise in the number of patients progressing to advanced heart failure (AHF). Heart transplantation (HT) has been the gold standard treatment for AHF. However, there is limited long-term data on trends in HT procedures and associated costs. Aim: This study aims to perform a comprehensive analysis to ascertain the trends in the number of HTs and the corresponding costs incurred. Methods: Utilizing the National Readmission Database 2010 to 2021, the study population was identified as new recipients of HT, and their median index admission charges were evaluated. We excluded patients aged &lt; 18 with HT and LVAD during the index hospitalization. Results: We identified 36,379 weighted index hospital admissions from January to December 2010 - 2021. The annual HTs increased from 2,905 to 4,046, and the HT numbers increased by 39.28% (Figure 1). From 2010 to 2017, the HT numbers increased by approximately 11.46%; from 2018 to 2021, the increase was about 19.81%. Concurrently, median index admission costs increased from $146,817 in 2010 to $243,079 in 2021 (Figure 2), with a 65.57% cost increase. Considering patient demographics, 47% had private insurance, and Medicare covered 34%. Most patients were discharged home (48%) or to home with health care services (42%). Conclusion: Over the past 12 years, the total number of HT procedures rose by 39.28%. However, associated costs have surged disproportionately by 65.57% since 2010. A significant increase in OHT procedures from 2018 may be linked to policy changes by the United Network for Organ Sharing(Maitra, Dugger et al., 2023). Escalating costs warrant in-depth evaluation and potential policy revisions to curb healthcare expenses for managing advanced end-stage heart failure.
Abstract 4146764: Arrhythmia and Left Ventricular Functional Recovery in Arrhythmic Myocarditis Following Immunosuppressive Therapy
Authors: Nikhila Chelikam, Aashish Katapadi, Douglas Darden, Rakesh Gopinathannair, Rajesh Kabra, Naga Venkata Pothineni, Donita Atkins, Dhanunjaya Lakkireddy
Journal: Circulation (2024)

Introduction: Treatment of myocarditis often revolves around symptomatic management until recovery. Immunosuppressive therapy (IST) is an option in a select group of patients but is poorly understood. Research Questions: Is there a benefit to IST in myocarditis? Goals: To evaluate the role of IST on ventricular arrhythmia burden and left ventricular ejection fraction (LVEF). Methods: The MAVERIC registry is a prospective, single-center, observational study of patients with a high burden of cardiac arrhythmias and suspected myocarditis. All enrolled patients underwent 18-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging. If positive, patients were managed with IST and guideline-directed therapy. IST consisted of 3 months of Methotrexate and Prednisone, and Folic Acid. A repeat FDG-PET was performed after IST. If persistent inflammation was seen, IST was repeated. We analyzed select baseline characteristics and outcomes. Results: Out of 431 total, 31% had evidence of active myocarditis on FDG-PET and underwent at least one cycle of IST. A further 33.8% underwent a second, 18.8% a third, and 12.0% a fourth cycle of IST for persistent symptoms or FDG-PET. Myocarditis resolved in 64% after one cycle, but 31% of all cases had a relapse requiring further IST. Though incidence of ventricular arrhythmias and LVEF was no different, those with four cycles had significantly higher PVC burden (9.5% vs. 7.0%, p&lt;0.001). LVEF recovery was significant in all groups and greatest in those with multiple cycles of IST (Figure 1). There was no difference in arrhythmia recurrence or implantable cardioverter defibrillator (ICD) needs after treatment. Conclusions: Relapses of myocarditis are common. IST is an important adjunctive strategy in treating arrhythmic, FDG-PET-positive myocarditis and assist LVEF recovery and result in no difference in arrhythmias or ICD needs afterward.
Abstract 4147015: Association between Polysocial Risk Score and Cardiovascular Health among Women of Reproductive Age in the American Heart Association’s Research Goes Red
Authors: Faith Metlock, Yaa Kwapong, Dhananjay Vaidya, Crystal Evans, Pamela Ouyang, Yvonne Commodore-Mensah, Garima Sharma
Journal: Circulation (2024)

Introduction: Hypertension (HTN) prevalence is worsening among women of reproductive age (18-44 years), leading to higher maternal morbidity and mortality rates. We sought to evaluate social risks and cardiovascular health (CVH) among women aged 18-44 years, in a national registry. Methods: We conducted a cross-sectional analysis of participants enrolled in the American Heart Association Research Goes Red Registry, who responded to questionnaires on heart health and social risks. Adverse social risks were measured using a polysocial risk score ranging from 0 to 16, with higher scores indicating greater social disadvantage. The polysocial risk score included variables from several domains: sociodemographic information, living situation, food security, transportation, utilities, safety, and financial strain. CVH was assessed by the number of CVH risk factors based on Life’s Essential 8: diet, physical activity, smoking, blood pressure, blood sugar, body mass index, and cholesterol, where a lower number of risk factors indicates more optimal CVH. Linear regression models were used to assess the association between polysocial risk score and CVH. Results: Among the 637 women (mean age range 18-29 years, 30% Non-Hispanic Black), 64% had polysocial risk scores less than 7, while 36% had scores greater than 7. Most participants were married or cohabitating (66%) and had some college education or higher (87%). Financial strain was reported by 51%, with 47% earning less than $50,000 annually. In terms of cardiovascular health, 33% had diabetes, 46% had high cholesterol, 44% had high blood pressure, and 69% had a high body mass index. High polysocial scores (scores &gt; 7) were significantly associated with increased cardiovascular health risk factors (coefficient = 0.4733, p &lt; 0.001), while lower polysocial scores (scores &lt; 7) were not significantly associated with cardiovascular health risk (coefficient = 0.0357, p = 0.229). Additionally, Spearman’s rank correlation showed a moderate positive relationship (Spearman's rho = 0.2395, p = 0.0000), indicating that as polysocial scores increase, the number of CVH risk factors also increases (Figure). Discussion: Women of reproductive age with high number of social risks are at a significantly increased risk of suboptimal cardiovascular health. Screening for social needs and developing public health interventions tailored for women with high social burdens must be prioritized to improve cardiovascular health.
Abstract 4147521: Use of an ETCO <sub>2</sub> -Directed Resuscitation Algorithm in a Pediatric Swine Model of Asphyxial Cardiac Arrest
Authors: Caitlin OBrien, Cameron Javdan, Izabel Powers, Larraine Lage, Christopher Donohue, Raymond Koehler, Donald Shaffner
Journal: Circulation (2024)

Introduction: Current pediatric cardiopulmonary resuscitation (CPR) guidelines provide uniform recommendations for resuscitative efforts, including chest compression rate (CCR), chest compression depth, and epinephrine administration interval (EAI), despite differences in cardiac arrest etiologies or in the patient’s response to resuscitative efforts. Titration of the CCR or the EAI based on the patient’s physiologic response to resuscitation could individualize and optimize resuscitative efforts. Our research group has previously found that use of an end-tidal carbon dioxide (ETCO 2 )-directed algorithm to titrate the CCR and EAI improved intra-arrest hemodynamics and short-term survival in a swine model. Research Question: Here, we investigated whether the use of this ETCO 2 -directed resuscitation algorithm improved long-term survival and neuropathologic outcomes in a similar swine model of cardiac arrest. Methods: We performed 46 resuscitations in 4-5 kg swine. Pigs underwent 7 minutes of asphyxia, 30 seconds of ventricular fibrillation, and 10 minutes of resuscitation prior to the first defibrillation. Pigs were randomized to standard CPR or ETCO 2 -directed algorithm CPR. A sham group was also studied. In the standard group, chest compressions were performed at 100 compressions/minute and epinephrine was administered every 4 minutes per standard pediatric guidelines. In the algorithm group, the CCR was increased by 10 compressions/minute for every minute that the ETCO 2 was &lt;30 torr and the EAI was increased up to every two minutes. Pigs that achieved return of spontaneous circulation (ROSC) were extubated and survived 3 days. Daily neurobehavioral assessments were performed. In blinded fashion, viable and ischemic neurons were counted in the basal ganglia. Results: The rate of ROSC was similar in the standard (10/24, 42%) and algorithm (10/22, 46%, p &gt;0.99) groups. The rate of 3-day survival was also similar between the two groups (4/24 [17%] in the standard group and 6/22 [27%] in the algorithm group, p =0.48). The standard and algorithm groups both had fewer viable neurons and more ischemic neurons in putamen than shams ( p &lt;0.01 for all pairwise comparisons, Figure 1). The number of viable and ischemic neurons were similar between the two CPR groups. Conclusion: In this model of pediatric asphyxial cardiac arrest, use of an ETCO 2 -directed resuscitation algorithm did not improve the rate of ROSC, 3-day survival, or neuropathologic injury in the basal ganglia.
Abstract 4147144: Evaluating a Team-Based Telemedicine Hypertension Management Program to Address Inequities in Hypertension Care Among Black Patients
Authors: Sunit Chhetri, Srista Manandhar, Justin Kramer, Hayden Bosworth, Justin Moore, Clarissa Diamantidis, Yhenneko Taylor, Yashashwi Pokharel
Journal: Circulation (2024)

Background: Although superior to clinic-based care, existing telemedicine programs to manage hypertension are less effective in Black patients. Programs’ insufficient support of Black patients’ self-care skills and social needs may hinder their effectiveness. We piloted a 12-week, team-based telemedicine intervention by pharmacists, nurses, community health workers (CHW), and social workers (SW) emphasizing frequent and tailored self-care support and social support. Methods: We conducted semi-structured interviews with Black patients with hypertension (N=15) and clinic key players (N=16; 5 providers, 1 pharmacist, 4 nurses, 1 nurse manager, 1 administrative manager, 2 CHWs, 2 SWs) from two clinics in North Carolina to evaluate the program’s potential at improving hypertension care among Black patients. The Exploration, Preparation, Implementation, and Sustainment and Health Equity Implementation frameworks guided the interview. We used inductive and deductive coding strategies to identify emergent themes during the thematic analysis. We considered equity-related constructs about culture, social context, medical mistrust, health literacy, and clinic and health system-related factors and comfort using technology for healthcare. Results: At baseline, 12 (80%) patients felt comfortable using technology for healthcare, while 3 (20%) felt somewhat uncomfortable. Eight patients (53.3%) reported feeling confident filling out medical forms, while 7 (46.7%) noted being sometimes or occasionally confident. Medical mistrust score was 2.47 ± 0.62 (range 1-4; higher score, more mistrust with providers and health care system). Five health equity-related themes emerged from the interviews. Both patients and key players expressed (1) satisfaction with program-related clinical encounters and felt that the program (2) may improve trust, (3) is likely to treat Black patients fairly, (4) emphasizes the importance of patient-provider racial concordance, and (5) addresses social needs extending beyond housing (Table). Conclusion: Our team-based telemedicine program may improve equity for hypertension care among Black patients. If shown to be clinically effective, our program has the potential to improve hypertension control in this population.
Abstract 4147106: Maternal Nativity and Adverse Pregnancy Outcomes Stratified by Maternal Race/Ethnicity: Insights from the National Vital Statistics System
Authors: Adhya Mehta, Danish Iltaf Satti, Theresa Boyer, Lisa Yanek, Yaa Kwapong, Rebekah Bhansali, Allison Hays, Anum Minhas
Journal: Circulation (2024)

Background: Adverse pregnancy outcomes (APOs) are a major cause of maternal morbidity and mortality, with significant variations in APOs prevalence among racial and ethnic groups. The US has rising immigration rates. Currently, studies with national representation are limited to detect the association of nativity with APOs. Objective: To determine the association between maternal nativity and APOs across maternal race and ethnicity groups in the US. Methods: We conducted a nationwide, cross-sectional study using data from the National Vital Statistics System natality files, encompassing all live births in the US from 2016 to 2022 among individuals aged 15 - 44 years. Maternal nativity was classified as non–US-born vs US-born. The outcomes of interest (APOs) included gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and pre-term birth (PTB). Multivariable logistic regression was used to determine the association between maternal nativity and APOs, stratified by race and ethnicity, including Asian, Black, Hispanic, White, or other (individuals who selected other race or more than one race). Results: 24,366,281 birthing individuals were included. Non-US-born individuals had lower prevalence odds ratio of HDP (adjusted prevalence odds ratio (aPOR) 0.689 [95% CI 0.686-0.692]) and PTB (aPOR 0.922 [95% CI 0.919-0.925]) compared to US-born individuals, which was consistent across the majority of race and ethnicity groups ( Figure 1, 2 &amp;3 ). However, non-US-born individuals experienced significantly higher POR for GDM (aPOR 1.70 [95% CI 1.69-1.70]) ( Figure 1, 2 &amp;3 ). Conclusions: Individuals born outside the US have higher odds of GDM, but lower odds for HDP and PTB. Findings suggest that APO risk may be environmentally influenced beyond genetic ancestry, with different risk factors geographically across the world.
Abstract 4146997: S-nitrosylation of Aconitase-2 Facilitates Coronary Microembolization-induced Cardiac Injury by Suppressing Iron-sulfur Cluster Assembly
Authors: Ao Chen, Yan Xia, Xinyu Che, Zhangwei Chen, Juying Qian, Junbo Ge
Journal: Circulation (2024)

Background: Coronary microembolization (CME) is a common reason for periprocedural myocardial infarction after coronary interventions. S-nitrosylation (SNO), a prototypic redox-based posttranslational modification, is involved in the pathogenesis of several cardiovascular diseases. Purpose: To explore the role of SNO of aconitase-2 (ACO2) in CME-induced cardiac injury, as well as the mechanism by which SNO-ACO2 modulates myocardial injury in response to CME. Methods: CME models were established in C57BL/6J mice by injecting 300,000 polyethylene microspheres (diameter 9 µm) into the left ventricle chamber with the occlusion of the ascending aorta. S-nitrosylated proteins and SNO sites of ACO2 were identified through LC-MS/MS analysis. De-nitrosylation of ACO2 was achieved by the mutation of SNO site or overexpression of the de-nitrosylation enzyme thioredoxin 1 (TRX1). Interacting effectors of SNO-ACO2 were screened through LC-MS/MS and confirmed by coimmunoprecipitation. Neonatal rat ventricular myocytes (NRVMs) were used for ACO2 enzyme activity analysis, mitochondrial morphology and function. Results: Cardiac injury was exacerbated by CME as demonstrated by impaired cardiac contractile function, increased fibrosis, microinfarct size. We identified 789 S-nitrosylated proteins in CME mouse hearts, and ACO2 is one of the highly S-nitrosylated proteins. The increased level of SNO-ACO2 was verified by immunoblot assay in CME mouse hearts and hypoxia-stimulated NRVMs. SNO site of ACO2 at cysteine 126 was identified by LC-MS/MS and confirmed in NRVMs. De-nitrosylation of ACO2 by the mutation of cysteine 126 or overexpression of TRX1 both greatly improved the activity of ACO2 by 39.7% and 31.4% respectively, further restored the mitochondrial function, and attenuated CME-induced cardiac injury. Mechanistically, SNO-ACO2 at cysteine 126 suppressed the interaction between ACO2 and NFU1, an iron-sulfur (Fe-S) cluster scaffold protein. The dissociation from NFU1 deprived ACO2 of the Fe-S cluster and the enzyme activity, thereby promoting the disruption of the mitochondrial tricarboxylic acid cycle and cardiac injury. Conclusions: Our data defined a previously unrecognized role of SNO-ACO2 in CME-induced cardiac injury. We demonstrated that SNO-ACO2 at cysteine 126 disrupted ACO2/NFU1 interaction to exacerbate myocardial injury after CME. Our results suggested that de-nitrosylation of ACO2 may provide a new therapeutic target for the treatment of CME.
Abstract 4146756: Temporal Trends in Stroke-related Mortality in the United States for the Past 3 Decades
Authors: Zaid Abdulelah, Ahmed Abdulelah, Ahmad Alayyat, Dua' Al-Husni, Lina AlQirem, Ahmad damlakhy, Mansoor Rahman
Journal: Circulation (2024)

Introduction: Stroke is one of the leading causes of morbidity and mortality in the United States resulting in significant health and socioeconomic burden. Accordingly, examining the temporal trends of stroke is essential for the development of effective stroke management strategies and prevention. Research Question: Is there a change in stroke mortality trends in the United States over the past 3 decades? Aim: To investigate trends in stroke mortality in the United States over the past three decades, focusing on gender and age-specific variations. Methods: We analyzed the Global Burden of Diseases 2019 database for stroke mortality trends stratified by age and gender. Trends were expressed using annual percentage change (APC) and average APC (AAPC) calculated via Joinpoint Trend Analysis Software (v5.2.0, NCI). Results: A total of 4,968,927 stroke-related mortality were reported during the time period of 1990-2019. An overall decline in the stroke-related death has been identified, with females displaying a declining mortality from 1990 to 2019 with AAPC of -0.238 (95%CI: -0.291 to -0.183; p&lt;0.001). Additionally. a declining mortality among all age groups has been identified, that is most significantly in the age group of under 50 years of age (AAPC -0.611, 95%CI: -0.655 to -0.565; p&lt;0.001) followed by the 50-74 years of age ((AAPC -0.307, 95%CI: -0.332 to -0.277; p&lt;0.001) and the 75 years and older group (AAPC -0.220, 95%CI: -0.283 to -0.1512; p&lt;0.001). Conclusion: Temporal trends for the past 3 decades in the United States demonstrates a slightly reassuring decline in stroke mortality across the female gender and all age groups. However, more research is warranted to compare to global trends and identify the driving factors behind these trends in the United States.
Abstract 4146935: Ticagrelor Monotherapy in Patients with ACS Undergoing Coronary Stenting: An Updated Meta-Analysis of 3 Month versus 12 Month DAPT
Authors: Mohsin Haseeb, Abdullah Shafiq, sudhir mungee
Journal: Circulation (2024)

Background: Current guidelines recommend DAPT for 12 months in patients with ACS undergoing PCI. However, data on ticagrelor monotherapy after early aspirin discontinuation (&lt;3 months, Short-DAPT) is scarce. We conducted an updated meta-analysis to assess the safety and efficacy of &lt; 3 month of DAPT (aspirin and ticagrelor) in patients with ACS undergoing PCI. Hypothesis: Short-DAPT will be more favorable than Standard-DAPT. Methods: This meta-analysis reviewed literature obtained systematically. Inclusion criteria encompassed randomized controlled trials of ticagrelor comparing &lt; 3 month of DAPT with 12 month of DAPT in ACS patients undergoing coronary stenting with a minimum follow up of one year. The primary endpoint was major adverse cardiovascular events (MACE). Secondary outcomes were net adverse clinical events (NACE), all-cause mortality, and major bleeding. We estimated inverse variance pooled hazard ratios using a random-effects model and DerSimonian-Laird method to calculate between-study variance. Results: Five trials with 21407 patients of ACS undergoing PCI were included (FIGURE). When comparing Short-DAPT with Standard- DAPT, the pooled hazard ratios and corresponding 95% confidence intervals for MACE, NACE, all-cause mortality, and major bleeding were 0.90 (0.77, 1.06), 0.72 (0.57, 0.91), 0.76 (0.59, 0.99), and 0.44 (0.35, 0.56), respectively Conclusion: Patients with ACS undergoing PCI can benefit from superior clinical outcomes, lower bleeding rate and a similar rate of MACE, with aspirin discontinuation at or less than 3 months and maintenance on ticagrelor monotherapy afterwards.
Abstract 4147671: Exosomes from Induced Pluripotent Stem Cell-Derived Cardiomyocytes, miRNA, and siRNA Restore the Porcine Chronic Myocardial Injury Model
Authors: Eileen Tzng, Tsuyoshi Ueyama, Hiroyuki Inoue, Mariko Koike-Ieki, Maithri Kashipathy, Raymond Sierra, Nirmal Vadgama, Soichi Wakatsuki, jennifer lyins, Gentaro Ikeda, Phillip Yang
Journal: Circulation (2024)

Introduction: Heart failure is the leading cause of hospital admission in the U.S. We previously demonstrated that exosomes (Exo) from induced pluripotent stem cell (iPSC)-derived cardiomyocytes (iCMs) significantly restored murine peri-infarct region. Furthermore, we delineated that miR20/92/363 (CORE miRNA) in Exo activated iCM proliferation and restored the injured myocardium by derepressing the Notch3 pathway. However, the optimal pre-clinical method to target the Notch3 pathway effectively through Exo, miRNA, and siRNA remains to be assessed. Hypothesis: Exo are the most effective biologic to target the Notch3 pathway to improve chronic porcine heart failure model by cardiomyocyte proliferation. Methods: iPSCs were differentiated into iCMs. Exo were isolated from the iCM culture media. Yorkshire pigs were subjected to ischemia-reperfusion injury via balloon occlusion of the left descending artery for one hour. One month later, chronic heart failure model was developed, and percutaneous catheter system (Biocardia, Inc) delivered 10 11 Exo, 4200 µg of CORE miRNA, or 4200 µg of siNotch3 into the porcine peri-infarct region. MRI and transcriptomic analyses evaluated the function, morphology and genomic changes in the injured porcine myocardium. Results: Significant improvement in mean absolute change in LVEF when compared to PBS (control, n=6) was achieved in CORE miRNA (n=5), iCM-Exo (n=5), and siNotch 3 (n=4) treatments: 5.89 ± 1.53***, 7.07 ±3.59***, and 4.73 ± 3.17** respectively (PBS -3.55 ± 3.27, mean±SD, **p&lt;0.01, ***p&lt;0.001). LV end systolic volume was significantly reduced in both CORE miRNA and iCM-Exo treatment groups. Transcriptomic analysis of the porcine myocardium was performed to assess cell proliferation and metabolism. Conclusion: All biologics were effective in repairing the porcine myocardium after chronic myocardial injury. iCM-Exo showed the highest functional restoration. Dose-response study is ongoing to optimize the restorative effects.