tbuckley/cabot-search huggingface dataset:
Abstract 12915: Eye Tracking in the ECG: Exploring the Visual Behavior Patterns of Medical Students
Authors: Steven C Scherping, Samarth Doshi, Elena Parcell, Mira Sridharan, Neeral Shah, William J Brady, Victor Soukoulis
Journal: Circulation (2023)

Introduction: While a universal aspect of medical education, there are few validated teaching methods for ECG interpretation. Eye tracking technology applied to study visual patterns during ECG interpretation suggest that top performers localize the critical leads for diagnosis more effectively. No study, however, has analyzed visual behavior occurring within critical leads. Research Question: How does visual behavior of medical students within critical leads correlate with accuracy of ECG interpretation? Aims: We aimed to characterize the visual behavior of medical students interpreting ECGs to help inform future educational methods. Methods: 36 fourth-year students from one medical school completed 9 cases while visual behavior was tracked via a Tobii Pro Nano eyetracker and analyzed with iMotions software. Cases included a vignette and 12-lead ECG followed by viewing up to three critical leads. We included five morphologic abnormalities (e.g. LBBB) and four arrhythmias (e.g. AVNRT). Accuracy was assessed via multiple choice questions after viewing the 12-lead ECG alone and again after viewing critical leads. Dwell time, the time spent focused on a given lead, and fixation count, the number of discrete focuses &gt; 60 ms, were analyzed via Mann-Whitney U testing. Data: 36.1% of students correctly interpreted all ECGs with morphologic abnormalities compared to 16.7% for arrhythmias. Within critical leads, there was a significant difference in average dwell time (2.62 vs 5.21 seconds (s), p &lt;0.001) and fixation count (9.59 vs 16.5, p&lt;0.001) between morphologic versus arrhythmia ECGs. Higher performers had decreased average dwell time and fixation count in critical leads compared to inaccurate interpreters for morphologic (2.39 vs 3.39 s, p=0.003; 8.92 vs 11.9 fixations, p&lt;0.01) and arrhythmia (4.32 vs 7.04 s, p&lt;0.01; 13.4 vs 22.7 fixations, p&lt;0.01), respectively. Conclusion: Our study demonstrates that learners spend less focused time interpreting morphologic as compared to arrhythmia ECGs. Further, dwell times and fixation counts were lower amongst higher performers. Measurement of discrete visual behavior may provide a novel way to assess students’ pattern recognition skills and interpretation competency while also enhancing ECG didactic methods.
Abstract 14036: Trends, In-Hospital Outcomes and Independent Predictors of Acute Kidney Injury in Patients Admitted for Myocardial Infarction With Percutaneous Coronary Intervention
Authors: Akanimo Antia, Endurance O Evbayekha, Favour Markson, Daniel A Ubokudom, Emmanuel Daniel, Chinwendu Onuegbu, Olanrewaju Adabale, Carlos Gongora
Journal: Circulation (2023)

Introduction: Acute kidney injury (AKI) is an important risk factor associated with adverse outcomes in cardiovascular illnesses; more importantly, myocardial infarction (MI). This study describes the Trends and in-hospital outcomes, and independent predictors of Acute Kidney Injury (AKI) in patients admitted for Myocardial infarction with Percutaneous Coronary Intervention (PCI). Methods: This was a retrospective study using records from the 2016-2020 National In-patient Database (NIS). We identified patients who were admitted for the management of an MI who had a PCI procedure and developed an AKI, evaluated their associated socio-demographic and comorbid factors using ICD-10 codes. We utilized the chi-square test to compare baseline characteristics between our populations with and without AKI and multivariate logistic regression to identify outcomes. Results: 1,551,630 patients admitted for an MI and PCI with 15% having an AKI compared to 85% without AKI. Our population with AKI had a mean age of 69 years on admission and were more likely to be whites. A higher percentage were males. Our subpopulation was more likely to have HF, atrial fibrillation, COPD, prior history of CABG, obesity, CKD, Charlson comorbidity index (CCI) ≥ 3 and anemia. The independent Predictors of developing AKI in our cohort included: CKD, cardiogenic shock, cardiac arrest, CCI of ≥3 and HF. The development of AKI was associated with higher in-hospital mortality rates (aOR: 2.84, CI: 2.7 - 3.02, p&lt;0.001), longer mean Length of Stay (7.1 vs 3.0 days) and higher hospital costs ($183,785.8 vs $101,291.2). We noted an increasing trend in the rates of patients who had an AKI from about 13.5% in 2016 to 16.5% in 2020. Conclusions: AKI is strongly associated with worse hospital outcomes in patients admitted for MI and PCI. A more concise look into preventive measures is recommended to minimize these outcomes.
Abstract 12187: Association Between Ultra-Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age: NHANES 2007-2018
Authors: Zefeng Zhang, Sandra Jackson, Euridice Martinez Steele, Donald K Hayes, Quanhe Yang
Journal: Circulation (2023)

Introduction: Studies have showed that higher intake of ultra-processed foods (UPF) is associated with increased risk of lower cardiovascular health (CVH) among adolescents and adults. As UPF intake is a modifiable risk factor of cardiovascular disease, examining the association of UPF and CVH among women of reproductive age (WRA) may help improve CVH among this population. Hypothesis: A higher percentage of calories (%kcal) from UPF is associated with lower CVH among WRA aged 22-44 years. Methods: We analyzed data on 5,780 WRA from NHANES 2007-2018. UPF was assigned from the Nova classification, which categorizes foods according to the extent and purpose of food processing. CVH was defined by using the Life’s Essential 8 (LE8) on a scale of 0 to 100. Scores of the seven LE8 metrics (excluding diet) were averaged, and the levels of CVH (low, moderate, and high) were defined using tertiles. We estimated the usual %kcal from UPF intake by using up to two 24-hour dietary recalls and the National Cancer Institute’s usual intake method to account for measurement error. We used multivariable linear and multinomial logistic regression to assess the association between UPF and CVH, adjusting for covariates. Results: The mean usual %kcal from UPF was 57.2%, and midpoint of quartiles of intake were 43.8%, 53.5%, 60.9%, and 70.6% for Q1, Q2, Q3, and Q4, respectively. Every 10% increase in calories from UPF was associated with 3.6 points lower CVH score ( P &lt; .001). The adjusted odds ratios and 95% confidence intervals for low CVH were 1.76 (1.52-2.03), 2.70 (2.10-3.47), and 4.72 (3.19-7.04), respectively, comparing Q2, Q3, and Q4 to Q1 of UPF intake. The corresponding adjusted odds ratio and 95% confidence intervals for moderate CVH were 1.17 (1.02-1.34), 1.32 (1.04-1.68), and 1.55 (1.06-2.26). The pattern of association was largely consistent across subgroups, except for non-Hispanic Black women, and was consistent across sensitivity analyses. Conclusions: Among US WRA, UPF represented more than half of total calorie intake and showed a graded inverse association with CVH. Our analyses highlight the importance of limiting the consumption of UPF among WRA to maintain CVH.
Abstract 13528: A Comparison of Five Measures of Accelerated Biological Aging and Their Association With Incident Cardiovascular Disease: The CARDIA Study
Authors: Sarah N Forrester, Jonggyu Baek, Lifang Hou, Veronique L Roger, Catarina I Kiefe
Journal: Circulation (2023)

Background: Accelerated biological aging is an increasingly popular way to track the effects of chronic stress over time. Biological aging is linked to external and internal chronic stressors and has the potential to be used clinically to understand a person’s personalized functioning and to predict future disease. Aims: The primary aim was to investigate the similarities and differences in the association of different measures of biological aging and incident cardiovascular disease (CVD). Hypotheses: Our novel predictor, Clinical Marker-Derived Age Acceleration (CAA), and the Framingham Risk Score (FRS) will be most robustly associated with incident CVD, and the associations will be stronger among Black participants. The latter is based on previous findings that Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study have, on average, more adverse social determinants of health. Methods: We used Multiple Informants Models (MIM) to compare the strength of five measures of accelerated aging (Intrinsic and Extrinsic Epigenetic Age Acceleration, GrimAge Acceleration, PhenoAge Acceleration, CAA (including clinical biomarkers, e.g., CRP, lung function, glucose, etc.), and one established clinical predictor of future CVD, FRS, to predict incident CVD over 11 years (2007 – 2018). Participants were 913 Black or White individuals examined by CARDIA in 2005-2006, when their mean age was 45 years. We also included race-specific analysis. Measures were standardized (M = 0, SD=1) to facilitate comparison. Results: The incidence rate of CVD within our sample was 7.8 per 1,000 person years and the prevalence of CVD was 7.5%. CAA and FRS significantly predicted incident CVD in the fully adjusted model (OR = 1.31, 95% CI: 1.06 – 1.63) and (OR = 1.28, 95% CI: 1.05 – 1.56), respectively. CAA and FRS were the best predictors of CVD, but there was no significant difference in the predictive value of CAA and FRS (Chi2 = 0.05, p = 0.828). In race-stratified models, CAA was the strongest and most consistent predictor in the Black-only models. Conclusions: Our findings support the association of CAA, a multi-system clinical composite, with incident CVD. Further, this composite may account for some of the well-known racial variation in incident CVD.
Abstract 12249: Activation of Prostaglandin E Receptor 4 Ameliorates Perivascular Inflammation and Pulmonary Hypertension in Rats
Authors: Keiji Kimuro, Kohtaro Abe, Misaki Imabayashi, Kohei Masaki, Satomi Imakiire, Kazuya Hosokawa, Shintaro Kinugawa
Journal: Circulation (2023)

Introduction: Perivascular inflammation is involved in the progression of vascular remodeling and pulmonary arterial hypertension (PAH). Activation of prostaglandin E receptor 4 (EP 4 ) has recently been reported to reduce inflammation in ulcerative colitis and osteoarthritis, but there are no reports on perivascular inflammation in PAH. Hypothesis: EP 4 agonist ameliorate perivascular inflammation, vascular remodeling and pulmonary hypertension (PH). Methods and Results: We investigated the effects of EP 4 agonist (KAG-308) on hemodynamics and pulmonary artery remodeling in a monocrotaline (MCT)-exposed rat model of PH. Immunohistochemistry detected predominant expression of EP4 proteins in the macrophages and endothelial layer of pulmonary arteries in the lungs of normal and MCT-exposed rats. Compared to normal rats, MCT-exposed rats had increased nuclear factor kappa B (NFκB) activation and significantly higher interleukin 6 ( IL -6) mRNA levels (1.0±0.4 vs 62.3±39.7, p &lt; 0.05) in the lungs, and showed elevated right ventricular systolic pressure (RVSP; 29.7±1.8 vs 81.0±18.5 mmHg, p &lt; 0.0001), total pulmonary vascular resistance index (TPRI; 91.0±12.1 vs 161.4 ± 37.0 mmHg/mL/min/g, p &lt; 0.001) and RV hypertrophy (0.32±0.02 vs 0.57±0.10, p &lt; 0.0001), together with medial wall thickening and perivascular macrophage accumulation on day 21 after MCT injection. Oral administration of EP 4 agonist KAG-308 (1 mg/kg, twice daily, by gavage, day 0 to 21) significantly reduced NFκB activation and interleukin-6 mRNA levels (6.8 ± 2.5, p &lt; 0.05) in the lungs. Furthermore, KAG-308 prevented the elevated RVSP (53.1 ± 9.3 mmHg, p &lt; 0.01), TPRI (112.0 ± 16.6 mmHg/mL/min/g, p &lt; 0.05) and RV hypertrophy (0.47 ± 0.04, p &lt; 0.05) by inhibiting medical wall thickening and macrophage accumulation. Conclusion: EP 4 agonist ameliorated inflammation, vascular remodeling and PH in MCT-exposed rat. The EP 4 agonist KAG-308 is a potential therapeutic agent for the treatment of PAH.
Abstract 12210: Repeated Systolic Blood Pressure Measures During Intensive Treatment Show a Loss Of Protective Effect Over Time. A Secondary Analysis of the SPRINT Trial
Authors: Lyda M Herrera-Sanchez, Oscar L Rueda-Ochoa
Journal: Circulation (2023)

Introduction: The SPRINT trial showed a 25% reduction in the primary outcome with SBP intensive treatment using Cox proportional risk analysis. A recent secondary analysis by the SPRINT group assessed the post-trial maintenance of this protection by considering repeated SBP measurements and using a mixed linear regression model. They found that the intervention lost its protective effect post-trial, possibly due to the loss of intensive blood pressure control. Could this loss of protective effect also be found during the clinical trial, when considering repeated measurements of systolic blood pressure in the analysis? Methods: Secondary analysis of the SPRINT study database included 9,068 patients with repeated measures of SBP and complete baseline information. Cox proportional hazards and mixed linear models were used to analyze the primary endpoint and repeated SBP measures, respectively. A Cumulative Joint Model Analysis was conducted to combine the direct and indirect effects of the intervention on the primary outcome. R Studio V12.0 software was used for the analyses. Results: The protective effect is lost during the trial, both in the total population (3.4 years) as well as in subgroups such as women (1.1 years), patients with CVD (1.3 years), CKD (1.3 years), black patients (1.8 years), younger than 75 years (2.1 years) and in patients who present serious adverse events (3.4 years) compared to those who do not present SAEs (4.2 years). Beyond the loss of blood pressure control, other factors such as cumulative BP, adverse events, and the increase in SBP variability could be considered. Conclusions: Including repeated measures of SBP revealed a loss of protective effect in the intervention during the trial and generated Simpson's paradox. This highlights the need to consider alternative statistical methods in clinical trial analysis beyond Cox proportional hazard analysis for a comprehensive perspective on intervention efficacy.
Abstract 14032: Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort
Authors: Francesca Sperotto, Nora Lang, Meena Nathan, Aditya K Kaza, David Hoganson, Eleonore Valencia, Catherine K Allan, Eduardo Da Cruz, Pedro J Del Nido, Sitaram Emani, Chris Baird, Nicola Maschietto
Journal: Circulation (2023)

Introduction: Neonates with complex congenital heart disease (CHD) and pulmonary overcirculation have been historically treated surgically. However, sub-cohorts may benefit from less invasive procedures. Data on transcatheter palliation are limited to case reports. Hypothesis: Transcatheter palliation with pulmonary flow restrictors (PFR) may represent an effective palliation strategy in neonates with CHD, especially those at high surgical risk. Methods: We present our experience of PFR palliation in neonates with CHD, including procedural feasibility, technical details, and outcomes. We then compared our sub-cohort of high-risk single ventricle (SV) neonates palliated with PFRs with a historical cohort of high-risk SV neonates palliated with a hybrid Stage 1. Cox regression was used to evaluate the association between palliation strategy and mortality at 6 months. Results: From 2021 to 2023, 17 neonates (median age 4 d [IQR 2-8]; median weight 2.5 kg [IQR 2.1-3.3]) underwent a PFR procedure; 15 (88%) had SV physiology, 15 (88%) were high-risk surgical candidates. All procedures were technically successful. At a median follow-up of 5.2 mo (IQR 2.7-9.9), 13 patients (76%) were either successfully bridged to surgery (n=12, 71%) or are awaiting surgery (n=1, 6%). Patients underwent target surgery at a median of 2.5 mo (IQR 1.1-3.4) since the PFR procedure (median weight 4.6 kg [IQR 3.3-5.6]). Pulmonary arteries were found to have grown adequately for age. All PFR devices were easily removed with no need for arterioplasty. The all-cause mortality rate before target surgery was 24% (n=4). Compared to a historical cohort of high-risk SV neonates palliated with a hybrid Stage 1 (n=23), after adjustment for main confounding (age, weight, intact atrial septum/severely restrictive foramen ovale or left ventricle to coronary fistulae), the PFR procedure was associated with a significantly lower all-cause 6-month mortality risk (adjHR=0.30 [95% CI 0.10-0.93]). Conclusions: Transcatheter PFR palliation in high-risk neonates with CHD is feasible, safe, and may represent an effective alternative strategy to bridge such high-risk neonates to surgical palliation, complete repair, or transplant while allowing for clinical stabilization and somatic growth.
Abstract 12381: De Novo Multiple Myeloma in a Patient With Transthyretin Amyloid Cardiomyopathy
Authors: Andrew Chiou, Rola Khedraki, Rajeev Mohan
Journal: Circulation (2023)

Background: The development of de novo multiple myeloma in a patient with transthyretin amyloid cardiomyopathy (ATTR-CM) is rare and is often associated with poor prognosis. Early and definitive diagnosis is crucial to improve survival. Case: A 63-year-old male was evaluated for heart failure. He had a history of hypertension, sick sinus syndrome status post dual chamber pacemaker, non-sustained ventricular tachycardia requiring ablation in addition to bilateral carpal tunnel syndrome, spontaneous biceps tendon rupture, and lumbar spinal stenosis. Transthoracic echocardiogram showed progressive severe left ventricular hypertrophy with a septal thickness of 2.0cm with a normal left ventricular ejection fraction. Decision-Making: Given his history, an amyloid evaluation was performed. Serum and urine assessment for light chain amyloidosis revealed elevated kappa free light chains with kappa/lambda free light chain ratio of 19.30. Bone marrow biopsy at that time showed normocellular bone marrow with less than 3% plasma cells. An abdominal fat pad biopsy was inconclusive. A cardiac MRI was unobtainable given non-compatible pacemaker leads and a technetium-99m pyrophosphate scintigraphy was deferred given his abnormal light chains. An endomyocardial biopsy was performed and revealed wild-type ATTR deposition by mass spectrometry. Serum genetic test confirmed the absence of TTR gene mutation. The patient was started on Tafamadis. Six months later, he was noted to have progressive elevation in kappa free light chains on serial evaluation and underwent a repeat bone marrow biopsy. This showed plasma cell myeloma with 25-30% marrow cellularity and flow cytometry consistent with kappa light chain multiple myeloma. He was started on Daratumumab, Lenalidomide, and Dexamethasone. This resulted in normalization of his free light chain ratio and morphologic remission on repeat bone marrow biopsy. Conclusion: In patients who are found to have monoclonal gammopathy, an endomyocardial biopsy is crucial to evaluate for amyloid cardiomyopathy. These patients should also be monitored for the progression to multiple myeloma.
Abstract 146: Advanced Age and Neurological Recovery in Elderly Patients With Out-of-Hospital Cardiac Arrest Treated With Targeted Temperature Management: A Nationwide Population-Based Registry Study
Authors: Hyojeong Kwon, Sang-Min Kim, Youn-Jung Kim, Won Young Kim
Journal: Circulation (2023)

Objectives: The chance of neurological recovery after out-of-hospital cardiac arrest (OHCA) can be influenced by advanced age, however further recent evidence will be need in elderly population. The purpose of this study is to evaluate the impact of advanced age on the neurological recovery in elderly OHCA survivors treated with targeted temperature management (TTM). Methods: This retrospective observational study, using a nationwide population-based OHCA registry, was conducted from January 2016 to December 2020. Non-traumatic elderly (≥ 65 years) comatose OHCA survivors treated with TTM were enrolled. The elderly patients were divided into four groups (65-69 years, 70-74 years, 75-79 years, and ≥ 80 years). The primary outcome was good neurological outcome, defined as Cerebral Performance Categories (CPC) of 1 or 2 at hospital discharge. Results: Among 23,336 OHCA patients who admitted to the hospital, 3,398 patients treated with TTM. Excluding 2,033 non-elderly patients, 1,365 patients were analyzed. In four elderly group, the rate of good neurological outcomes were decreased by advanced age (24.2%, 16.1%, 11.4%, and 5.9%). This was also observed after subgroup analysis based on the initial shockable (40.6%, 31.5%, 28.6%, and 14.9%) and non-shockable rhythm (10.6%, 7.2%, 4.1%, and 3.4%). Multivariate analysis showed the adjusted odds ratio (aOR) for good neurological outcome decreased as advanced age (65-69 years: reference, 70-74 years: aOR 0.70, 75-79 years: aOR 0.49, and ≥ 80: aOR 0.25). The optimal age cutoffs for good outcome in elderly OHCA survivors with shockable and non-shockable rhythm were 77 years and 72 years respectively. Conclusions: The neurologic recovery rate in OHCA survivors treated with TTM was gradually decreased with advanced age. However even with ≥ 80 years with shockable rhythm, had a good neurologic outcome of 14.9%, which is higher than 65-69 years of 10.6% in non-shockable rhythm.
Abstract 12844: Weekend Admission is Associated With Higher Renal Complications in Thoracic Endovascular Aneurysm Repair for Stanford Type B Aortic Dissection
Authors: Renxi Li, Qianyun Luo, Derrick L Green, Stephen Huddleston
Journal: Circulation (2023)

Introduction: A weekend effect characterized by worse perioperative outcomes has been demonstrated in some surgery patients admitted on weekends, as opposed to weekdays. This study aims to examine the weekend effect on outcomes after open surgical repair or thoracic endovascular aneurysm repair (TEVAR) in Stanford Type B Aortic Dissection (TBAD). Methods: Patients who underwent TBAD repair were identified in the National Inpatient Sample (NIS) from 2015-2020 by ICD10-CM/PCS. Open surgery and TEVAR were examined separately. Patients were stratified into two cohorts based on weekday or weekend admission. Significant preoperative differences were present between cohorts, so multivariable logistic regressions were performed comparing in-hospital perioperative outcomes. Adjusted preoperative variables included sex, age, race, socioeconomic status, comorbidity, hospital characteristics, length of stay (LOS), days from admission to operation, and total hospital charge were compared. Results: Among patients who underwent open TBAD repair, 1,321 were admitted on weekdays and 340 on weekends. Among patients who underwent TEVAR after TBAD, there were 2,018 admitted on weekdays and 440 admitted on weekends. There was no difference in open repair outcomes between those admitted on weekdays versus weekends. In the TEVAR cohort, weekend admission has associated with higher acute kidney injury (AKI) (aOR=1.69, 95% CI 1.33-2.15, p&lt;0.01), post-procedural kidney failure (aOR=5.65, 95% CI 1.45-22.06, p=0.01), and transfer to another center (aOR=1.54, 95% CI 1.21-1.96, p&lt;0.01). Also in the TEVAR cohort, weekend admission was associated with longer LOS, longer wait to operation, and higher cost (all p&lt;0.01). Conclusion: Weekend admission is an independent risk factor for higher renal complications patients with TBAD who undergo TEVAR. Eliminating delays in treatment associated with the weekend effect may decrease renal complications, decrease LOS, and decrease cost.