tbuckley/cabot-search huggingface dataset:
Abstract 4144549: Proof of Concept of a Novel Culinary Medicine Service Line to Address Diet-Related Cardiovascular Disease Risk Factors
Authors: Willis Wong, Amulya Agrawal, Tin Khine, Milette Siler, Jaclyn Albin
Journal: Circulation (2024)

Background: Poor diet has emerged as a top contributor to cardiovascular disease (CVD) in the United States. Evidence-based dietary strategies have been shown to decrease CVD risk by addressing comorbid conditions such as hypertension and diabetes, and there is a growing demand for practical nutrition guidance from health providers. However, implementation of nutrition support in healthcare settings remains limited due to lack of time, expertise, and reimbursement, necessitating creative interprofessional collaboration. Culinary Medicine (CM) combines medical nutrition education with culinary literacy and holds promise to address these challenges. Our study reports on the cascade implementation of a 3-prong CM service line which includes a CM eConsult, 1:1 CM specialty clinic, and shared medical appointment (group visit) in a teaching kitchen at a large, academic medical center from 2021 to 2024. Methods: A CM-specific eConsult was designed and launched on August 1 st 2021 utilizing existing eConsult workflows in the electronic health record. Next, an in-person, interprofessional CM specialty clinic launched at a community-based satellite clinic December 4 th 2022 open to referrals from physicians and patients. In April 2024, established patients in the CM clinic were invited to participate in six, biweekly cooking classes billed as shared medical appointments. A Microsoft PowerBI dashboard was developed to track patient demographics, referrals and participation, associated diagnoses, and billing data for the service line for continuous quality improvement. Results: In the first year of eConsults, 25 eConsults were completed with 19 (76%) reimbursed by insurance. In the first year from launch of the CM specialty clinic, 96 patients completed initial visits with a 100% insurance collections rate. In the recent launch of shared medical appointments, the initial cohort included 17 unique patients with 58% completing at least 4 of 6 classes. Referrals to the CM clinic included hypertension, hyperlipidemia, coronary artery disease, and type 2 diabetes as the top 4 associated diagnoses. Conclusions: We demonstrated proof-of-concept of a novel CM service line as an interprofessional, financially sustainable preventive strategy to target patients with diet-sensitive CVD risk factors such as diabetes, hypertension, and obesity. Future study will investigate the impact on biomarkers of CVD health for patients served by the CM service line.
Abstract 4139176: SUMOylation of TP53INP1 Is Involved in miR-30a-5p-Regulated Heart Senescence
Authors: yixiang hong
Journal: Circulation (2024)

Introduction: During natural aging, physiological remodeling of the heart is a critical for the cardiovascular disease and heart failure. miR-30a-5p is related to kidney injury, cancer, and autoimmune diseases. However, whether miR-30a-5p has an effect in cardiac aging has yet to be explored. Hypothesis: This study aimed to characterize the role and mechanism of action of miR-30a-5p in cardiac senescence. Methods: We established miR-30a-5p knockout/overexpressing mouse model. Natural heart aging (18-months-old) and D-galactose-induced aging mouse model were established. The mechanism was explored in D-galactose- or 10-days-cultured cardiomyocytes. Results: miR-30a-5p was downregulated in aged mouse hearts and neonatal rat cardiomyocytes (NRCMs). In vivo, using a combination of echocardiography and different molecular biological approaches, we investigated the role of miR-30a-5p knockout or overexpressed mice on natural- or D-galactose-induced heart aging. In vitro, using RNA-sequence and a series of molecular biology, the mechanism of miR-30a-5p-regulated cardiac senescence was explored in cardiomyocytes. miR-30a-5p knockout mice showed aggravated natural- or D-galactose-induced heart aging compared to wild-type littermate mice, with significantly decreased heart function, increased number of γH2AX-positive cells, reduced telomere length, and upregulated p21 and p53 expression. Cardiac-specific knockdown of miR-30a-5p using adeno-associated virus 9 in D-galactose-induced senescent wild-type mice showed effects similar to those observed in knockout mice. Notably, overexpression of miR-30a-5p in wild-type murine hearts alleviated D-galactose-induced heart senescence by improving heart function, increasing telomere length, decreasing the number of γH2AX-positive cells, and downregulating p53 and p21 expression. This was confirmed in D-galactose-treated or naturally aged NRCMs. Mechanistically, TP53INP1 was identified as a target of miR-30a-5p by mediating the SUMOylation of TP53INP1 and its translocation from the cytoplasm to the nucleus to interact with p53. Further evidence demonstrated that cardiac-specific TP53INP1 deficiency ameliorates miR-30a-5p knockout-aggravated cardiac dysfunction and heart senescence. Conclusions: This study identified miR-30a-5p as a crucial modulator of heart senescence and revealed that the miR-30a-5p–TP53INP1–p53 axis is essential for heart and cardiomyocyte aging.
Abstract 4136989: Association of alternating PR intervals with paroxysmal atrioventricular block in patients with right bundle branch block following cardiac surgery
Authors: Farah Olleik, Filip Istvanic, Stefano Pacifici, Carlos Ceron, Tong Liu, Chuanyu Gao, Gan-Xin Yan
Journal: Circulation (2024)

Background: We previously observed a positive correlation between QRS duration and the preceding RP interval in sinus rhythm in certain patients experiencing new onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR). This unique phenomenon, termed inverse decremental conduction ( IDC ) or Yan conduction, prompted us to investigate whether IDC in the left bundle could manifest as AV conduction in an IDC pattern in patients with preexisting right bundle branch block (RBBB) and its association with atrioventricular block (AVB). Methods: 12 lead ECGs, available in-patient telemetry and mobile cardiac outpatient telemetry were reviewed in patients with sinus rhythm and preexisting RBBB who developed paroxysmal AVB requiring temporary or permanent pacemaker within 7 days following any types of cardiac surgery from 2014 to 2023 in Lankenau Medical Center. Results: A total of 9 patients (5 males) with a mean age of 71±15 years were identified to exhibit PR interval changes consistent with IDC prior to paroxysmal AVB. Among these patients, 6 had undergone TAVR, while the remaining 3 had undergone surgical aortic valve replacement, mitral valve repair, and ventricular septal defect repair, respectively. Specifically, PR interval alternation in the setting of RBBB occurred during sinus rhythm in a pattern that the longer RP interval is followed by a longer PR interval (Figure 1). This pattern exhibits the following features: 1) 8 of 9 patients had RBBB plus left anterior fascicular block (LAFB); 2) PR alternation occurred at sinus rates from 68 to 91 bpm within 5 days following surgical procedures; 3) proximal AVB occurred within 1 to 12 hours after PR interval alternation began. A positive correlation was established between PR and preceding RP interval in 2 of 9 patients whose telemetry data were available for analysis ( Figure 2A ). In a patient with RBBB who developed paroxysmal AVB without IDC changes in the PR interval post TAVR, intracardiac recording showed a decrease in AH interval but an increase in HV interval with slowing heart rates ( Figure 2B ), indicating that decremental conduction in AV node can mask IDC in Purkinje system. Conclusion: 1) PR alternation with longer PR following longer preceding RP interval in presence of RBBB, likely due to IDC in left bundle, heralds paroxysmal AVB; 2) PR interval changes resulting from IDC in left bundle in the setting of RBBB may be masked by decremental conduction in AV node.
Abstract 4123639: Tumor Endothelial Marker 1 is Upregulated in Atrial Cardiac Fibroblasts in Atrial Fibrillation and Correlates With Atrial Fibrosis
Authors: Yi-Heng Li, YUNING HU, Ting-Chun Huang, Mu-Shiang Huang, Hsing-Chun Chung
Journal: Circulation (2024)

Background: Tumor endothelial marker 1 (TEM1 or CD248) is a transmembrane protein found in activated mesenchymal cells during embryo development. Its expression level becomes very low or undetectable in adult tissue. Re-expression of TEM1 in fibroblasts has been reported in hepatic, renal, and pulmonary fibrosis. We evaluated atrial TEM1 expression in atrial fibrillation (AF) and its relation with atrial fibrosis. Methods and Results: All data were presented as mean±standard error. Left atrial (LA) tissues were collected from 30 patients (pts) (mean age 64.0±1.6 yrs, male 76.7%) with AF underwent cardiac surgery (mitral and/or tricuspid valve surgery 96.7%) and maze procedure with LA appendage excision. Immunofluorescence (IF) staining showed TEM1 expressed in atrial cardiac fibroblasts (CFs) in the LA tissue of AF pts, but not in normal LA tissue (US Biomax). Primary human CFs were directly isolated from the LA tissue. IF staining showed TEM1 expression in the isolated CFs from AF pts but not in normal human CFs (ScienCell). Western blot could detect TEM1 expression in the LA tissues of all 30 AF pts. Sirius Red staining was used to visualize collagen and atrial fibrosis was quantified using a pixel-based method (Adobe Photoshop) by calculating the total numbers of red pixels and the percentage (%) of red pixels to total pixels. Atrial fibrosis was increased in AF pts compared with normal control (total number of red pixels: 160740±13066 vs. 50863±6357, % of red pixels to total pixels: 11.4±0.8 vs. 3.8±0.2%, all p&lt;0.001). There was a positive correlation between the expression level of TEM1 (ratio of TEM1/actin band density in western blot) with the severity of atrial fibrosis, including the total numbers of red pixels (r = 0.47, p = 0.01) and the % of red pixels to total pixels (r = 0.48, p = 0.01). TEM1 and galectin expression levels had positive correlation (r = 0.60, p &lt; 0.01). There were no correlations of atrial TEM1 expression with the LA diameter and CHA2DS2-VASc score. In vitro study showed TEM1 knockdown in cultured CFs with siRNA reduced cell proliferation (scrambled- vs TEM1-siRNA, BrdU absorbance: 1.84±0.05 vs 1.50±0.07, p&lt;0.05), increased starvation-induced cell apoptosis (cell death ELISA absorbance: 0.69±0.11 vs 2.88±0.05, p&lt;0.05) and decreased cell migration. Conclusions: There is increased TEM1 expression in atrial CFs in AF and its expression level is associated with atrial fibrosis. TEM1 expression changes the cell behaviors of CFs.
Abstract 4142765: Plant-based Diet And Risk of Cardiovascular Disease in Patients with Prediabetes And Diabetes
Authors: Pan Zhuang, Xiaohui Liu, Xuzhi Wan, Jingjing Jiao
Journal: Circulation (2024)

Introduction/Background: The role of plant-based dietary patterns in preventing cardiovascular disease (CVD) among individuals with prediabetes and diabetes remains unclear. Research Questions/Hypothesis: We aimed to evaluate the associations of plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) with cardiovascular disease (CVD) risk and explore potential contributing factors among people with prediabetes and diabetes. Methods/Approach: A total of 18,145 participants with prediabetes and 7,922 with diabetes were enrolled from the UK Biobank and followed until the end of 2020. We calculated the PDI, hPDI, and uPDI based on 18 major food groups including plant-based foods and animal-based foods and applied Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD risk related to PDI, hPDI, and uPDI. Results/Data: A positive association was found between uPDI and CVD risk among individuals with prediabetes (HR T3 VS. T1=1.14, 95% CI=1.03–1.27, P trend=0.012) and those with diabetes (HRT3 VS. T1=1.16, 95% CI=1.03–1.31, P trend=0.016), but not for PDI (P trend=0.621) or hPDI (P trend=0.914) (Table 1). High sugar-sweetened beverages (SSB) intake accounted for 16.7% of the uPDI-CVD association, whereas low intake of whole grain accounted for 26.9% of the association among patients with diabetes. Elevated cystatin C levels explained the largest proportion of the association between uPDI and CVD risk among individuals with prediabetes (18.1%, 95% CI=7.1%–39.1%) and diabetes (32.8%, 95% CI=11.5%–64.6%) (Table 2). Conclusions: Adherence to an unhealthy plant-based diet is associated with a higher CVD risk in people with prediabetes or diabetes, which may be partially attributed to low consumption of whole grains, high intake of SSB, and high blood cystatin C level.
Abstract 4142796: Hospital Admission Rates for Peripartum Cardiomyopathy Follow Influenza Seasonal Peaks
Authors: Megan Pattoli, Spandan Desai, Nicholas Roma, Luke Miller, Eluwana Amaratunga, Patrick Field, Jamshid Shirani
Journal: Circulation (2024)

Background: Peripartum cardiomyopathy (PPCM) is defined as a dilated form of cardiomyopathy that occurs within the last month of pregnancy and up to 5 months postpartum. Previous studies have shown that PPCM more often occurs in the Southern United States compared to other geographic locations. Although the etiology of PPCM is likely multifactorial, viral infections may account for up to a third of those cases. We aimed to examine the association of PPCM to active influenza infection in the Southern United States. Methods: National Inpatient Sample 2016-2021 was queried to identify women admitted with PPCM with (group A) and without (group B) concurrent influenza infection in the Southern United States. Results: A total of 13540 women were admitted with PPCM, of whom 3511 (35%) had concurrent influenza infection. Group A PPCM followed a seasonal pattern with peak incidence in winter (62%) followed by spring (25%), fall (13%) and summer (0) [p&lt;0.001]. Group A was older (mean age 33.6 -vs- 31.9), more often obese (16.8% -vs- 11.2%, p=0.011), had a smoking history (38.2% -vs- 26.1%, p&lt;0.001), had higher Charlson comorbidity severity indexes (25.3% -vs- 17.2%, p=0.020), and had longer length of stay (6.1 -vs- 5.5). Group A also had higher rates of preexisting hypertension (15.3% -vs- 13.1%, p=0.011) and depression (18.8% -vs- 8.6%, p&lt;0.001, OR 0.125 p-0.285), but similar rates of preeclampsia. In hospital mortality was not statistically significantly different between the two groups (1.8 -vs- 1.6%, p=0.067). Conclusion: PPCM appears to follow a seasonal trend in incidence similar to influenza in the Southern United States. Influenza infection may account for some cases of PPCM in that region and may be associated with adverse in-hospital outcomes.
Abstract 4140198: Impact of Non-ST-segment elevation Myocardial Infarction on outcomes of Diabetic Ketoacidosis in Hospitalized Patients: A National Inpatient Sample Analysis
Authors: Nishant Patel, Ishwari Iyer, Anusha Kavarthapu, Prahasith Kamani, Sujana Sanka, Bhavyakumar Vachhani, Hnin Nadi Linn, Dhairya Nanavaty, Sohrab Singh, Keerthi Ramireddy, Pradeep Kumar Devarakonda, Cesar Ayala-Rodriguez, Sarath Reddy
Journal: Circulation (2024)

Introduction: Diabetes Mellitus (DM) has a broad spectrum of complications and is one of the leading 5 causes of hospital admissions in the US. Decompensated DM is associated with high mortality in hospitalized patients. Cardiac ischemia and related events are proposed to be increasingly prevalent in hospitalized patients with decompensated diabetes. Numerous studies and reports have suggested that elevation in troponin levels is associated with high mortality in such patients. Notably, there have only been a few studies that assessed the prevalence of NSTEMI (Non-ST segment elevation myocardial infarction) and its effect on outcomes in patients hospitalized with Diabetes ketoacidosis (DKA). Methods: We aimed to compare the outcomes of DKA in hospitalized adults (age &gt;18 years) with NSTMI with those without NSTEMI using the National Inpatient Sample (NIS) database from 2018 to 2020. NIS is the largest publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays. Results: There were a total of 1113295 hospitalizations identified with a diagnosis of DKA. Of these, 9860 (0.88%) patients had NSTEMI. The mean age of this subpopulation was 38.71 years. Among these patients, 48.59% were female, and 58.40% were male. We attempted to assess the impact of NSTEMI on the occurrence of complications such as cardiac arrest, acute renal failure (ARF), Acute liver failure (ALF), Acute heart failure (Acute HF), and acute respiratory failure in patients admitted with DKA. The results of this analysis are depicted in the table below. The cost of hospitalization for DKA with NSTEMI was $35878 higher and the length of stay was 50% longer compared to the patients with DKA without NSTEMI. The Odds ratio for mortality was 2.84 for patients with NSTEMI. Conclusions: Our analysis suggests that the occurrence of NSTEMI negatively impacts outcomes in DKA patients. The occurrence of primary outcomes assessed in this study (Cardiac arrest, ARF, ALF, Acute HF, and Acute respiratory failure) was significantly higher in DKA patients with concomitant diagnosis of NSTEMI. NSTEMI also increased the cost burden on hospitalizations for DKA.
Abstract 4144526: A Case Presentation of Severe Left Ventricular Dysfunction from Focal Myocarditis due to Immune Checkpoint Inhibitor
Authors: Romil Patel, Kifah Hussain, Robert Gordon
Journal: Circulation (2024)

Introduction: Immune checkpoint inhibitors (ICI), such as pembrolizumab, are an effective immunotherapy for several malignancies, however, have been associated with adverse events including myocarditis and accelerated atherosclerosis. ICI myocarditis is associated with a mortality rate of up to 33%. This case reports a patient on pembrolizumab with an atypical presentation. Case presentation: A 75-year-old female with a past medical history significant for lung cancer on pembrolizumab and myasthenia gravis presented to the hospital with dyspnea and mild, intermittent exertional chest discomfort. She denied nausea, radiation of pain, diplopia, weakness in extremities, or dysphagia. Workup revealed a leucocyte count of 13,500 cells/uL, pro-brain natriuretic peptide of 13,458 pg/mL, troponin of 26 ng/L, and a normal erythrocyte sedimentation rate and C reactive protein. A chest computed tomography was performed that showed mild bilateral pleural effusion and no pulmonary embolism. A nuclear stress test showed no evidence of ischemia but showed a severely reduced left ventricular ejection fraction (LVEF) at 29%. An echocardiogram confirmed that the ejection fraction was reduced at 23% (baseline LVEF was 60% from 1 year ago). Cardiac MRI revealed a mildly increased regional T2 signal in the anterolateral wall, mildly elevated extracellular volume fraction, and no late gadolinium enhancement. With ongoing clinical suspicion despite equivocal findings on cardiac MRI, an endomyocardial biopsy was done that revealed a single small aggregate of lymphocytes present in 1 of 6 tissue samples. Ultimately, with the single site of aggregated lymphocytes on biopsy, a diagnosis of ICI myocarditis was determined, and the patient was started on high-dose intravenous glucocorticoids as well as bisoprolol, empagliflozin, spironolactone, and Entresto for heart failure management as she was able to tolerate. Discussion: Myocarditis due to pembrolizumab is a rare, but potentially lethal adverse effect. Patients typically have abnormal electrocardiograms and elevated cardiac biomarkers. Cardiac MRIs have sensitivity and specificity of 68% and 91% respectively for diagnosis, and the gold standard is endomyocardial biopsy however, it is limited due to sampling error. Our patient had an unusual presentation, but with both imaging and biopsy, we found a case of focal myocarditis with severe left ventricular dysfunction, which typically is seen with fulminant myocarditis.
Abstract 4123637: Prevalence of Invasively Diagnosed Coronary Endothelial Dysfunction in Patients with Chest Pain and Normal Coronary Flow Reserve: The Systematically Missed Diagnosis on Non-invasive Testing
Authors: Sharanyah Srinivasan, alvaro altamirano, sai Bhogadi, Saad Kubba, Michel Corban
Journal: Circulation (2024)

Background: Invasive coronary reactivity testing (CRT) is the gold standard for comprehensive assessment of coronary endothelial and microvascular dysfunction in patients with angina and non-obstructive CAD (ANOCA). Non-invasive imaging modalities (PET and CMR) have emerged as potential alternatives. However, due to the inability to systemically administer acetylcholine, patients with normal coronary flow reserve (CFR) but abnormal endothelial function on invasive Ach testing are systemically missed on non-invasive testing. We aimed to assess the prevalence of coronary endothelial dysfunction in ANOCA patients with normal CFR. Methods: Consecutive patients undergoing CRT at our institution were included. Those with normal adenosine-based CFR (&gt;2.5), were further stratified as having normal coronary endothelial function (NEF, &lt;20% epicardial coronary diameter constriction and &gt;50% increase in coronary blood flow in response to ACh) vs abnormal endothelial function (AEF, &gt;20% epicardial coronary diameter constriction and/or &lt;50% increase in coronary blood flow in response to Ach). We then assessed the proportion of AEF patients who would have been otherwise diagnosed with normal coronary physiology based on CFR alone on non-invasive testing. Results: 37 patients underwent CRT. Mean age was 55 years ± 25, 68% were females. 25 out of 37 patients (68%) had normal CFR. Of those patients, 17 (68%) patients had AEF. Distribution of coronary epicardial vs microvascular endothelial dysfunction is represented in Fig. 1. Conclusion: 68% of ANOCA patients with normal CFR had coronary epicardial and/or microvascular endothelial dysfunction and would have otherwise been labeled as ‘normal coronary physiology’ by non-invasive microvascular function testing. Our findings re-enforce the need for comprehensive invasive CRT for accurate comprehensive diagnosis of patients with ANOCA.