tbuckley/cabot-search huggingface dataset:
Abstract 14087: Physical Activity is Associated With Monocytes and Monocyte Subsets in Low-Resourced Neighborhoods: Data From the Step It Up Physical Activity Intervention
Authors: Abhinav Saurabh, Hannatu Tarfa, Yvonne Baumer, Ayushi Dave, Mario Pita, Manuel Cintron, Lola Ortiz-Whittingham, Sandy Reynolds, Kameswari Potharaju, Andrew Baez, Keitra Thompson, Foster Osei Baah, Colby Ayers, Sam Neally, Kaveri Curlin, Nithya Vijayakumar, Valerie Mitchell, Ayanna Wells, Marie Marah, Billy Collins, Tiffany M Powell-Wiley
Journal: Circulation (2023)

Background: Physical activity (PA) reduces cardiovascular disease (CVD) risk; those living in lower-resourced neighborhoods have higher CVD risk in part due to limited PA access. Monocyte subsets (classical, intermediate, and non-classical) with their platelet aggregates (PlAgg) are key in CVD, but less is known about relationships between PA and monocytes. We investigated associations between PA and monocyte subsets with PlAgg in African American (AA) women at risk for CVD living in resource-limited Washington, DC areas. Methods: Participants were enrolled in Step It Up, a technology-enabled, community-engaged PA intervention. Baseline PA was measured as daily step counts using a FitBit Charge 2. Monocyte subsets and PlAgg were measured in fasting blood samples by flow cytometry. Multivariable linear regression was used to determine relationships between PA and monocytes adjusting for BMI and ASCVD 10-year risk score. We examined neighborhood deprivation index (NDI), a 2018 Census-tract based measure of neighborhood socioeconomic deprivation, as a moderator of associations between PA and monocytes. Results: The study cohort was a sample of AA women with overweight/obesity enrolled in Step It Up (N=106, age=57±12 y, BMI=34.8±6.3kg/m2). Higher baseline PA associated with monocyte subsets, but not overall monocyte presence (Table). Furthermore, higher baseline PA negatively associated with PlAgg on all monocytes. PA and monocyte subsets were most associated among those residing in higher deprivation neighborhoods (Table). Conclusion: Baseline PA was associated with monocyte subsets and lower monocyte-PlAgg formation among AA women living in lower-resourced conditions. Future work should examine the relationship between PA changes and changes in monocyte subsets in community engaged PA interventions like Step It Up, particularly among those residing in limited resource communities.
Abstract 19079: Assessment of Heart Sounds, Physiologic Changes, and Sleep Performance Using Non-Invasive Monitoring in a Volume Depleted Heart Failure Patient
Authors: Alexander Hajduczok, Prashanth Shyam Kumar, Mohammad Ahmed, Carly Maucione, Vijay Varadan, Pratyush Rai, Mouli Ramasamy, John Boehmer
Journal: Circulation (2023)

Case: A 46-year-old male with EF 15% who was co-enrolled in two non-invasive remote monitoring clinical trials, using the WHOOP strap and Nanowear vest to track heart failure (HF) progression at Hershey Medical Center was readmitted for volume depletion. Our patient presented to his PCP’s office complaining of daytime fatigue. Review of systems was negative including no dizziness or light headedness. Blood pressures during this visit was 85/50 and 79/49. He was sent to the emergency department where he had persistent hypotension with a creatinine elevation from 2.4 to 3.71. He was admitted for IV fluid resuscitation and diuretic optimization. Methods: We report cumulative metrics pre- and post-hospitalization showing significant changes in sleep performance and S3 heart sound magnitude. Other measured variables with WHOOP included heart rate (HR), respiratory rate (RR), rapid eye movement (REM) sleep, and heart rate variability (HRV). Results: Following adequate hydration, return to euvolemia, and diuretic adjustment, the patient had statistically significant improvement in sleep metrics (Figure 1, Graph C). Patient’s daily strain, a surrogate of HR elevation over time, was also significantly decreased post discharge (5.19 to 0.73, p &lt;0.01). Patient’s S3 heart sounds were measured during both hospitalizations and showed a decrease in amplitude consistent with volume depletion (Figure 1, Graphs A/B). Conclusion: We report physiologic trends that correlate with clinical status as measured using two novel non-invasive monitoring strategies. Poor sleep secondary to orthopnea and paroxysmal nocturnal dyspnea are considered signs that indicate volume overload. This case, indicates that volume depletion in patients with severely reduced EFs could also contribute to poor sleep performance, indicating a narrow therapeutic window. Further studies may validate these devices as remote monitoring tools for HF management.
Abstract 13479: Impact of ST-Elevation Myocardial Infarction Among Hospitalized Patients With Coronary Artery Dissection: A United States Population-Based Cohort Study
Authors: Bruce Adrian Casipit, Abiodun Idowu, Hussein Al Sudani, Carlo Casipit, Matthew Nguyen, Kevin Bryan U Lo, Ola Khraisha, Aman M Amanullah
Journal: Circulation (2023)

Introduction: ST-Elevation myocardial infarction (STEMI) is a rare but serious complication of coronary artery dissection (CADi). There is paucity of data on the in-hospital outcomes of hospitalized patients with CADi complicated by STEMI. Methods: We queried the National Inpatient Sample to identify patients with CADi who developed STEMI during the index hospitalization using appropriate ICD-10 codes between 2018-2020. We aim to investigate the impact of STEMI among CADi patients based on in-hospital mortality, risk for cardiogenic shock and arrythmias, utilization of coronary intervention, mechanical circulatory support, and mechanical ventilation. A multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest. Results: A total of 20,941 hospitalized patients with CADi were identified, of which 5.42% (1135/20,941) had concomitant STEMI during the index hospitalization. The overall in-hospital mortality rate among hospitalized patients with CADi was 6.45% (1,351/20,930). Among those with concomitant STEMI, the in-hospital mortality was significantly elevated to 18.5% (210/1,135, p= 0.00) compared to those who did not have STEMI. After adjusting for possible confounders, concomitant STEMI in CADi patients was found to be an independent significant predictor of increased risk for cardiogenic shock, development of ventricular tachycardia, ventricular fibrillation, utilization of percutaneous coronary interventions, coronary artery bypass graft, mechanical ventilation, and in-hospital mortality (Table 1). Conclusions: STEMI among CADi patients was independently associated with poorer cardiovascular and in-hospital mortality outcomes. Therefore, prompt recognition and treatment of underlying STEMI in CADi patients is necessary to prevent adverse outcomes.
Abstract 16273: Contemporary Risk Prediction Model for In-Hospital or 30-day Mortality After Percutaneous Coronary Interventions: An NCDR CathPCI Registry Model
Authors: Yulanka Castro Dominguez, Yongfei Wang, Karl E Minges, John Spertus, Gregory J Dehmer, Nestor Mercado, Julie Clary, Anwar D Osborne, Lucy Pereira, Jeptha P Curtis, Matthew Cavender
Journal: Circulation (2023)

Introduction: While the ACC NCDR CathPCI registry has long provided risk-adjusted benchmarking of in-hospital mortality after percutaneous coronary intervention (PCI), extending follow-up to 30 days in those who are discharged can provide a more comprehensive assessment of post-PCI outcomes. Aims: We sought to develop a new model for predicting in-hospital or 30-day mortality after PCI with excellent discrimination to be used for quality improvement efforts. Methods: Data from 472,594 PCIs performed in 2019 at 1,369 sites from the CathPCI registry linked to National Death Index data were used to identify pre-procedural and angiographic predictors of mortality and develop a predictive model of in-hospital or 30-day mortality. A thousand bootstrapped samples of the development cohort were created, and stepwise logistic regression was performed on each sample. The final model included variables that were selected in at least 70% of the bootstrapped samples. Results: The overall in-hospital or 30-day mortality rate after PCI in the entire cohort was 2.8%. In those undergoing elective PCI without shock or clinical instability, mortality was 0.5%, while in those undergoing salvage PCI or for refractory shock it was 60.3% . Cardiovascular instability, level of consciousness after cardiac arrest, frailty, and chronic kidney disease stage were the factors most predictive of mortality (Table 1). The full model performed well with good discrimination in the overall population (C-index= 0.907), and in the cohorts of patients with STEMI (c-index=0.899), and cardiac arrest or shock (c-index=0.828), as well as across the spectrum of procedural risk. Conclusions: This risk model can accurately predict in-hospital or 30-day mortality in those undergoing PCI by incorporating variables that capture cardiovascular instability and clinical status. Extending the mortality follow-up period should enable for a more standardized evaluation of outcomes across hospitals.
Abstract 17879: Assessing the Safety of an Early Repatriation Strategy for Uncomplicated ST-Elevation Myocardial Patients After Primary Percutaneous Intervention
Authors: Shanjot Brar, Razi Khan, Farshad Hosseini, Albert Chan, Jahangir Charania, Roger Philipp, Minh Vo, Tycho Vuurmans, Natasha Kohli
Journal: Circulation (2023)

Introduction: Repatriation of patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) is common in Canadian regional health care programs. However, the safety of early repatriation after PPCI in uncomplicated STEMI patients remains unknown. We aimed to compare the outcomes between uncomplicated STEMI patients repatriated early (transfer to home hospital ≤4hrs of PPCI completion) vs. those who remained at the PPCI-hospital until discharge. Methods: We performed a retrospective, cohort study examining consecutive, uncomplicated STEMI patients treated with PPCI between 2016-2018 in the Fraser Health Authority. Patients were designated as uncomplicated if there was no evidence of cardiogenic shock, prolonged cardiac arrest or congestive heart failure requiring mechanical ventilation. Outcomes of interest included discharge with guideline-based medical therapy (GBMT) and a composite of 1-year major cardiovascular events. Results: A total of 787 patients were included for analysis, with 62% (n=492) being repatriated early. Early repatriated patients were similar in age and baseline characteristics when compared with those discharged from the PPCI-based hospital. Interestingly, early repatriated patients were more likely to be discharged on GBMT (89% vs. 83%, p=0.015) In multivariate analysis, early repatriation was not associated with worsened 1-year cardiovascular outcomes (OR 1.05, 95% CI 0.6782,1.6521, p=0.80). Independent predictors of 1-year major cardiovascular outcomes included hypertension (OR 1.75, 95% CI 1.0918-2.8349, p=0.02) and discharge with GBMT (OR 0.49, 95% CI 0.2831-0.8465, p=0.01). Amongst the subset of early repatriated patients, primary treatment by cardiologist vs internist did not result in differences in 1-year outcomes (10% vs. 8%, p=0.23) or discharge with GBM (87% vs. 83%, p=0.09). Conclusions: Early repatriation of uncomplicated STEMI patients after PPCI was associated with outcomes similar to those having ongoing care at the PPCI-based hospital. Therefore, early repatriation serves as a safe treatment strategy for regional STEMI programs and may be particularly relevant for PPCI centres with limited bed capacity.
Abstract 207: Soluble Urokinase-Type Plasminogen Activator Receptor in Comatose Survivors After Out-of-Hospital Cardiac Arrest Treated With Targeted Temperature Management
Authors: John Bro-Jeppesen, Anders Grejs, Ove Andersen, Anni N Jeppesen, Christophe Henri Valdemar Duez, Hans Kirkegaard
Journal: Circulation (2023)

Introduction: Exposure to whole-body ischemia/reperfusion after out-of-hospital cardiac arrest (OHCA) triggers a systemic inflammatory response where soluble urokinase plasminogen activator receptor (suPAR) is released. Aims: This study investigated serial levels of suPAR in patients treated with differentiated target temperature management (TTM) and the associations with mortality and neurological outcome. Methods: In this single center sub-study of the randomized Targeted Temperature Management for 24 vs 48h (TTH-trial), we included 82 patients and measured serial levels of suPAR at 24, 48 and 72 h. We assessed all-cause mortality and neurological function evaluated by the Cerebral Performance Categories at six months after OHCA. Levels of suPAR between TTH groups were evaluated in repeated measures mixed models. Mortality was assessed by the Kaplan-Meier method. Good neurological outcome at six months was assessed by logistic regression analyses. The predictive value of suPAR was evaluated with the area under the receiver operating characteristic (ROC) curve. Results: Levels of suPAR were significantly different between TTH-groups (p interaction =0.04) with the highest difference at 48h, 4.7 ng/mL (95%CI: 4.1-5.4 ng/mL) in the TTH24 group compared to 2.8 ng/mL (95%CI: 2.2-3.5 ng/mL) in the TTH48 group, p&lt;0.0001. Levels of suPAR above the median value (2.6 ng/mL) was significantly associated with increased all-cause mortality at any timepoint (p log-rank &lt;0.05). The interaction of suPAR levels and TTH group was not significant (p interaction =NS). A two-fold increase in levels of suPAR were significantly associated with a decreased odds ratio of a good neurological outcome in both unadjusted and adjusted analyses without interaction of TTH group (p interaction =NS). AUC at 24h was 0.78 (95%CI: 0.67-88, p&lt;0.0001). The optimal cutoff value for suPAR in predicting 180 mortality was 2.6 ng/mL (sensitivity: 0.75, specificity: 0.63). Conclusion: Prolonged TTM of 48 hours vs. 24 hours was associated with lower levels of suPAR. High levels of suPAR were associated with increased mortality and lower odds for good neurological outcome at six months with no significant interaction of TTH group. The biomarker suPAR was a modest predictor of outcome.
Abstract 12910: Exercise Hemodynamics Unmasks Stage C Heart Failure With Preserved Ejection Fraction and Impaired Peripheral Oxygen Extraction in Stage A/B Patients in a Safety-Net Center
Authors: Garen Kroshian, Joshua Lepson, Stephanie Zombeck, Andy Truong, Shannon Gavin, Reza Nezafat, Gary Balady, Matthew G Nayor, Jessica L Fetterman, Nir Ayalon, Deepa M Gopal
Journal: Circulation (2023)

Introduction: There is a gap in research evaluating hemodynamics and impaired peripheral oxygen extraction in Stage A/B HFpEF in diverse groups. We sought to characterize the prevalence of impaired cardiac/peripheral profiles in Stage A/B HFpEF at Boston Medical Center. Hypothesis: We hypothesize both abnormal cardiac and peripheral profiles will be unmasked in exercising Stage A/B HFpEF patients. Methods: Invasive cardiopulmonary exercise testing (iCPET) was performed in 30 individuals with Stage A/B HFpEF. Significant valvular or pulmonary disease were excluded. Criteria for an impaired cardiac profile, with reclassification to Stage C, included exercise PCWP ≥ 25 mmHg or ΔPCWP/ΔCO slope &gt; 2 mmHg/L/min. An impaired peripheral profile was defined as O 2 extraction ratio (peak arterio-venous oxygen saturation difference)/ (1.34*rest hemoglobin*rest arterial O 2 saturation) &lt; 50%. With an approved IRB, the analysis was conducted in R. Results: Cohort clinical data shown in Table with 47% non-white and 57% female patients. Exercise unmasked Stage C HFpEF in 23 (77%) of cases; 17% had an impaired peripheral profile (O 2 extraction ratio 43 ± 7) and 10% (3 out of 30 patients) had concomitant impaired cardiac and peripheral profiles. Both cardiac and peripheral metrics correlated to metabolic parameters: peak oxygen consumption correlated to PCWP (rho -0.52, p&lt;0.004) and extraction ratio correlated to oxygen-uptake efficiency slope (rho 0.40, p=0.029). Conclusions: In our diverse cohort, a significant proportion of Stage A/B patients reclassified to Stage C HFpEF via invasive exercise testing; abnormal peripheral profiles were also noted. Impaired cardiac and peripheral profile metrics were related to metabolic parameters. Broader implementation of iCPET in early disease stages and attention to both cardiac and peripheral profiles in diverse populations will guide further HFpEF research in novel mechanisms and therapeutics.
Abstract 16287: Predictive Value of High Sensitivity Troponin T for Patients With Suspected Acute Coronary Syndromes Undergoing Invasive Coronary Angiography
Authors: Arshjot Khokhar, Alexander Ambrosini, Fangyong Li, Rohit Sangal, Stephen Possick, Natasha Cigarroa, Nancy Kim, Samit Shah
Journal: Circulation (2023)

Introduction: High sensitivity troponin T (hs-cTnT) assays are used to risk stratify patients with suspected acute coronary syndromes(ACS), but the predictive value of hs-cTnT in patients undergoing invasive coronary angiography (ICA) has not been well described. Hypothesis: Hs-cTnT levels at baseline and the delta change with serial sampling will correlate with the findings of ICA, and the diagnostic performance of hs-cTnT may be affected by patient specific variables. Methods: This is a retrospective study of 1,037 patients that presented to the emergency department with suspected ACS who had hs-cTnT measured and underwent ICA. We collected patient demographics, medical history and results of cardiac testing. Our primary endpoint was a diagnosis of obstructive coronary artery disease (CAD) defined as a stenosis &gt; 70% or &gt; 50% in the left main. We excluded cases of arrhythmias, cardiac arrests, or STEMI. Data analyzed using multivariate regression models. Results: We analyzed data from 728 patients with a mean age of 68 years old, 62.5% were male and 37.5% female. 312 patients were diagnosed with no obstructive CAD and 413 with obstructive CAD, of which 286 underwent PCI, 43 underwent CABG and 84 were medically managed. There were significant (p&lt;0.001) differences in average baseline hs-cTnT levels between no obstructive CAD (78.8 ng/L) and obstructive CAD (201.1 ng/L) patients, but no significant difference in the 1 hour hs-cTnT delta (30.4 ng/L vs 33.3ng/L) or the 3 hour delta (56.4ng/L vs 66.6ng/L). Being male, White race, or having diabetes were independent predictors of obstructive CAD with odd ratios of 2.42 (95% CI 1.75-3.34), 1.64 (95% CI 1.12-2.41), and 1.47 (95% CI 1.05-2.06) respectively. Conclusion: In this study, elevated baseline hs-cTnT was predictive of obstructive CAD but trending hs-cTnT had no additionalpredictive value. Average baseline hs-cTnT for no obstructive CAD was higher than the manufacture suggested cutoff (52 ng/L) to identify myocardial injury. Baseline variables of sex, race and history of diabetes were predictive of obstructive CAD regardless of the hs-cTnT. Future analysis will determine whether specific hs-cTnT thresholds in these populations could improve hs-cTnT performance for the identification of obstructive CAD.
Abstract 12254: The QRS Frontal Plane Axis Changes During Left Bundle Branch Block After Transcatheter Aortic Valve Replacement
Authors: oren yagel, Bernard Belhassen, David Planer, Offer Amir, Gabby Elbaz Greener
Journal: Circulation (2023)

Background: Left bundle branch block (LBBB) is common after transcatheter aortic valve replacement (TAVR) and associated with either a left or normal frontal QRS axis. Research Questions: To assess the QRS frontal plane axis shift changes during LBBB after TAVR and determine if the risk of procedure-related high degree atrioventricular block (AVB) is affected by these QRS axis shift changes. Methods: In a retrospective single-center study of 720 consecutive patients who underwent TAVR, 141 (19.6%) with normal baseline QRS duration developed a new LBBB after TAVR and constituted the study group. Most patients (59.6%) were females, and the mean age of the cohort was 81.2±6 years. About two-thirds of the patients were implanted with a self-expandable valve. The length of hospital stay was 6.6±4.4 days. Results: This study show 3 main findings: 1) As compared with the baseline QRS axis before TAVR, the occurrence of LBBB after TAVR was associated with a leftward QRS axis shift (by 40+28.3°) in 73% of the study patients and a rightward (by 18.6+19.4°) or no change in QRS axis in 25.6% and 1.4% of the study patients, respectively. These results were not affected by the type and size of prosthetic valve used. 2) Although the proportion of patients having a left QRS axis (&lt;-30°) markedly increased after TAVR in the study group (from 14.9% to 38.3%) and in the group displaying a leftward QRS axis shift (from 5.8% to 45.6%), converse results were observed in the group displaying a rightward QRS axis shift (decrease from 38.9% to 16.7%). 3) The group of patients exhibiting a rightward or no QRS axis shift tended to show a greater incidence of high degree AVB than the group of patients exhibiting a leftward QRS axis shift (18.4% vs. 6.8%, P=0.056). Conclusion: Although post TAVR-LBBB was associated with a leftward QRS axis shift in most patients (73%), a non-negligible proportion of patients (27%) exhibited a rightward or no QRS axis shift. The latter group tended to have a higher risk of developing high degree AVB.
Abstract 12357: Investigating Sex-Specific Factors Influencing Atrial Fibrillation Burden in Patients With Persistent Atrial Fibrillation: A DECAAF II Subanalysis
Authors: Hadi Younes, Han Feng, Christian Sohns, Mathias Forkmann, Mario Mekhael, Charbel Noujaim, Nour Chouman, Ala' Assaf, Chanho Lim, Lilas Dagher, chao huang, Abdel Hadi El Hajjar, eoin donnellan, Omar Kreidieh, Amitabh C Pandey, Nassir Marrouche, christian mahnkopf
Journal: Circulation (2023)

Background: Atrial Fibrillation(AF) burden provides insights beyond the common binary classification of AF recurrence after catheter ablation(CA). Objective: We sought to investigate the predictors of AF burden in patients with persistent AF(PeAF) at 1 year post-CA, with a focus on sex-based differences. The analysis was conducted separately for both female and male. Methods: We examined all PeAF patients in the DECAAF II trial and divided them into 2 groups, women and men. Baseline demographics and late gadolinium enhancement magnetic resonance imaging data were reviewed. Patients were instructed to provide single-lead home ECG strips once daily. AF burden was calculated by dividing the total number of days in AF over the total number of days when strips were sent. Univariate and multivariate analysis were performed to predict AF burden beyond the 3-month blanking period. Results: We included 658 patients(20% Female,80% male) who transmitted 215825 ECG strips. The average AF burden across the population was 17%. The mean AF burden was higher in women(21%) than in men(16%)(p&lt;0.01). In women, on univariate analysis, baseline fibrosis(p&lt;0.05), history of stroke(p&lt;0.01) and left atrial(LA) volume(p&lt;0.01) were positively correlated with AF burden. After conducting a multivariate analysis, we found that baseline fibrosis(p&lt;0.05), history of stroke(p&lt;0.05), vascular diseases(p&lt;0.05), and LA volume(p&lt;0.01) were independent predictors of AF burden. In men, on univariate analysis, age(p&lt;0.01), baseline fibrosis(p&lt;0.01), hyperlipidemia(p&lt;0.01) and LA volume(p&lt;0.01) were positively correlated with AF burden. After conducting a multivariate analysis, only LA volume (p&lt;0.01) and age(&lt;0.01) continued to be significantly related(Table 1). Conclusion: Sex-specific management strategies are crucial for addressing AF, as our study demonstrates a significant impact of sex on predicting AF burden monitored by a single-lead handheld smartphone ECG device.