tbuckley/cabot-search huggingface dataset:
Abstract 18267: Successful C-Section Delivery at 36 Weeks in a Patient With a Heartmate 3 LVAD
Authors: Cullen Soares, Michael Plazak, Karl Seif, Ryan Brophy, Lynn Dees, Amanda Nevin, Kristin Murphy, SHOBANA BHARADWAJ, Katelyn T Scharf, Aaron Sachs, Lisa Forbess, Stanley Liu, Siamak Dahi, Warren Naselsky, Alison Grazioli, Susan Sankova, Allison Lankford, Manjula Ananthram
Journal: Circulation (2023)

Introduction: Pregnancy in patients with advanced heart failure requiring left ventricular assist device (LVAD) support is risky and discouraged, though there are cases of successful deliveries. Hypothesis: A 29-year-old G3P2002 female with history of embolic cerebrovascular accident, postpartum hemorrhage, peripartum cardiomyopathy status-post HeartMate 3 (HM3) LVAD, became pregnant after intrauterine device dislodgement. She elected to continue the pregnancy against the advice of maternal-fetal medicine (MFM). A multidisciplinary team convened to plan for delivery. Methods: Warfarin and sacubitril-valsartan were stopped due to teratogenicity. Therapeutic anticoagulation with enoxaparin injections was started. Aspirin was continued. Low-dose digoxin was added for right ventricular support. A multidisciplinary team involving anesthesiology, MFM, and advanced heart failure (AHF) was convened. Through patient-centered shared decision-making, cesarean delivery was planned for 36 weeks. She was seen by MFM and AHF every two weeks with LVAD speed optimization under transthoracic echocardiogram (TTE) guidance and anti-Xa monitoring. Results: The patient was electively admitted at 35 weeks for pre-delivery optimization. Enoxaparin was switched to an unfractionated heparin infusion. Betamethasone was administered to facilitate fetal lung maturation. Twice-daily fetal non-stimulation tests were performed. LVAD speed was optimized with TTE guidance. Continuous hemodynamic monitoring was performed perioperatively with a Swan-Ganz catheter and arterial line. Femoral veno-arterial sheaths were placed in case extracorporeal membrane oxygenation was needed. Anesthesia was administered via spinal-epidural approach. LVAD speed was modulated as needed. A healthy neonate was delivered by cesarean section without complication at 36 weeks and 3 days. Conclusions: Pregnancy during LVAD support remains an extremely high-risk clinical situation, though this case demonstrates that it is possible to carry such a pregnancy to near-term.
Abstract 16476: Association Between Atrial Fibrillation and Deep Learning Derived Retinal Features Trained on Electrocardiogram versus Coronary Artery Calcium
Authors: Tyler H Rim, Hyun Goo Kang, Chan Joo J Lee, Sung Soo Kim, Hyeonmin Kim, Geunyoung Lee, Marco Yu, Yih-Chung Tham, Ching-Yu Cheng, Sung Ha Park, Gregory Lip
Journal: Circulation (2023)

Introduction: This study aimed to assess the ability of a deep learning algorithm, Reti-AF, developed from retinal photos, to predict atrial fibrillation (AF) incidence. Its predictive performance was evaluated using the UK Biobank and compared to Reti-CAC, a similar algorithm trained on coronary artery calcium (CAC) scores. Hypothesis: We hypothesised that Reti-AF and Reti-CAC could potentially predict the incidence of AF. Methods: Due to the lack of atrial fibrillation (AF) patients in the UK Biobank, a Masked AutoEncoder method was used with a Vision Transformer (ViT) model. The model was first trained on 636,992 fundus images from a health screening dataset, then fine-tuned with an additional 6,068 retinal images from the UK Biobank. The survival analysis of the UK Biobank's longitudinal data was performed to assess the model's predictive performance for AF, with hazard ratios calculated. Results: In longitudinal validation among participants without baseline AF, Reti-AF was significantly associated with AF incidence (HR=5.50, 95% CI, 1.98-2.57, highest tertile of Reti-AF versus the first tertile) in a univariable model. However, this significance was not maintained in a multivariable model (HR=1.23, 95% CI, 0.93-1.30). When Reti-CAC was applied to predict AF, it showed a significant association with AF incidence in both univariable (HR=9.30, 95% CI, 6.68-12.96, highest tertile of Reti-CAC versus the first tertile) and multivariable (HR=1.84, 95% CI, 1.26-2.70) models after adjustment for age, gender, smoking, diabetes, hyperlipidemia, hypertension, and baseline chronic kidney disease. Conclusions: The study found that combining deep learning with retinal photos and coronary artery calcium (CAC) as a reference, led to more accurate prediction of atrial fibrillation (AF) incidence compared to using AF. Furthermore, Reti-CAC was shown to be capable of predicting both cardiovascular disease onset and AF incidence.
Abstract 16444: Gut Microbiota Derived Metabolite, Ursodeoxycholic Acid, and the Risk of Cardiovascular Disease
Authors: Sahereh Mirzaei, Holli A Devon, Rita M Cantor, Markku Laakso, Aldons J Lusis
Journal: Circulation (2023)

Introduction: Gut microbial metabolites have been recognized as risk factors for cardiometabolic diseases. The associations between plasma levels of the gut microbiota derived metabolites with cardiovascular disease (CVD) have not been comprehensively examined. Our objective was to investigate the association between 6 secondary bile acids including ursodeoxycholic acid and CVD. Ursodeoxycholic acid is used to dissolve cholesterol gall stones to treat cholestatic liver diseases. Hypothesis: Gut microbiota derived metabolites are associated with CVD. Methods: We performed a secondary analysis of data from the cross-sectional Metabolic Syndrome in Men (METSIM) cohort. Our study included 915 men aged 45-73 years (age = 54.94 ± 5.04 years, BMI = 27.31 ± 3.44), randomly selected from the population register of Kuopio, Eastern Finland, from 2005 to 2010. The associations between 6 secondary bile acids (ursodeoxycholic acid, glycoursodeoxycholate, glycolithocholate sulfate, taurocholenate sulfate, taurochenodeoxycholate, and glycocholenate sulfate) and the risk of CVD were investigated. Kaplan-Meier analysis with Cox proportional-hazards regressions were conducted for the time-to-event analysis to determine hazard ratios (HR) and 95% confidence intervals (CI) for CVD. Adjustments were made for traditional cardiovascular risk factors (age, systolic blood pressure, low-density and high-density lipoprotein cholesterol levels, triglyceride levels, smoking status, high-sensitivity C-reactive protein, estimated glomerular filtration rate, and alcohol consumption). Results: Participants were stratified into groups according to quartile metabolites levels and CVD. During a median follow-up of 16 years, n = 62 (7%) of patients experienced CVD. Only ursodeoxycholic acid was significantly associated with CVD risk. Cox regression analyses showed that the adjusted HR for CVD was higher in patients in quartile 4 (HR: 2.8, 95% [CI]: 1.35-4.6; p =0.008) than in quartile 1. The Kaplan-Meier analysis indicated that patients in quartile 4 had a significantly lower event-free survival (p = 0.037) compare to quartile 1. Conclusions: Ursodeoxycholic acid, a secondary bile acid, was positively associated with an increased risk of CVD.
Abstract 14951: Input From Renal Afferent Nerves Contributes to Hypertensive Heart Failure With Preserved Systolic Function Through Baroreflex Impairment and Sympathoexcitation
Authors: Ryosuke Nakashima, Keisuke Shinohara, Soichiro Kashihara, Shota Ikeda, Sho Matsumoto, Daisuke Yoshida, Yoshiyasu Ono, Hiroka Nakashima, Hiroyuki Tsutsui, Shintaro Kinugawa
Journal: Circulation (2023)

Introduction: Activation of renal afferent nerves, which can be caused by hypertensive renal damage, increases sympathetic output. The nucleus tractus solitarius (NTS) receives the inputs from baroreflex afferent nerves as well as renal afferent nerves. Baroreflex dysfunction leads to increased left ventricular (LV) end-diastolic pressure even in the heart with preserved systolic function. The GABAergic inhibitory system in the NTS blunts the signals from baroreflex afferent nerves, resulting in increased sympathetic output. Hypothesis: Input from renal afferent nerves contributes to hypertensive heart failure with preserved systolic function through baroreflex impairment and sympathoexcitation mediated by increased GABAergic inhibition in the NTS. Methods and Results: Male Dahl salt-sensitive rats with 8% high-salt diet from 7 weeks of age develop hypertensive HFpEF at 19 weeks. These rats underwent sham surgery (Sham), selective afferent renal denervation (ARDN), or additionally dissection of baroreflex afferent nerves (ARDN+BAROX) at 9 weeks. As controls, rats underwent sham surgery with a low-salt diet. The rats were evaluated at 19 weeks. Systolic blood pressure was similarly elevated in the three groups on high-salt diet. Impaired LV diastolic function assessed by echocardiography and pressure-volume loop analysis in Sham was recovered in ARDN group, while systolic function was preserved in all the group. Decreased baroreflex sensitivity and increased sympathetic output in Sham were attenuated in ARDN group. Activity of GABAergic neurons in the NTS evaluated by immunostaining was increased in Sham compared to controls, and was attenuated in ARDN group. All of the changes in ARDN were cancelled in ARDN+BAROX group. Conclusion: Input from renal afferent nerves contributes to hypertensive heart failure with preserved systolic function through baroreflex impairment and sympathoexcitation along with increased GABAergic inhibition in the NTS.
Abstract 16432: Screening for Cardiovascular Complications in Pediatric Hematopoietic Stem Cell Transplant Patients
Authors: Zach Hutchinson, Michael Smith, Elizabeth Colglazier, Matt Zinter, Christopher Dvorak, Hythem Nawaytou
Journal: Circulation (2023)

Introduction: Hematopoietic stem cell transplantation (HSCT) carries a risk of cardiovascular morbidity, with reported incidences of pericardial effusion, pulmonary hypertension (PH), and reduced left ventricular ejection fraction (LVEF). Screening for cardiovascular complications in children undergoing HSCT may be essential, but its utility remains unexplored. Hypothesis: Screening HSCT children using echocardiography and brain natriuretic peptide (BNP) can detect cardiovascular complications associated with adverse outcomes in this population. Methods: This prospective single-center cohort study analyzed children undergoing HSCT over a 2-year period. Baseline, 7-day, and 30-day echocardiograms and BNP levels were obtained. Multilevel linear regression assessed changes in echocardiograms and BNP. Logistic regression determined associations between cardiac complications and outcomes. Results: The study included 43 patients, with a median age of 8.6 years (IQR 3.7, 14.6). Echocardiograms were obtained at baseline (n=43), day+7 (n=34), and day+30 (n=25). BNP levels were obtained at baseline (n=41), day+7 (n=34), and day+30 (n=12). Adverse outcomes included TMA (n=7), endothelial dysfunction (n=36), mechanical ventilation (n=8), and death (n=8). Pericardial effusion was the most common finding (n=2(6%) at day+7, n=4(16%) at day+30). Pericardial effusion at either day+7 or day+30 predicted death (OR 15.7, 95% CI 1.8-137, p=0.013) and TMA (OR 13.1, 95% CI 1.7-103, p=0.014). A 10% decrease in LVEF was observed in 6 (17%) of patients at day+7 and 2 (8%) at day+30, and was associated with reduced mortality (OR 0.1, 95% CI 0-0.6, p=0.009). The change in BNP level at day+7 was 7pg/mL (IQR 6, 66) and 5pg/mL (IQR 3, 20) at day+30. A 10 point increase in BNP carried an increased risk of endothelial dysfunction (OR 4.1, 95% CI 1.3-263, p&lt;0.001). No patients developed PH. Conclusions: Cardiovascular complications are common after HSCT in children and carry diagnostic and prognostic significance. Further refinement of the screening protocol is necessary to determine the optimal timing of testing and assess its clinical utility.
Abstract 17939: Predictors of Time in Target Range in a Comprehensive Self-Measured Blood Pressure Program in a Socially and Economically Disadvantaged Primary Care Population
Authors: Samir Shah, Maria Hartley, Jordan Rodriguez, Omar Cantu Martinez, Audry Chacin Suarez, Matthew Behme, Joshua A Copeland
Journal: Circulation (2023)

Introduction: The Community Practice Center (CPC) in North Philadelphia serves a community with significant socioeconomic barriers leading to inability to access care necessary for management of hypertension (HTN). Prior studies have shown the efficacy of SMBP programs in improving blood pressure (BP) control. Methods: All sequential patients presenting to the CPC with stage 2 HTN were screened for eligibility. Upon enrollment, patients received a Bluetooth-enabled BP cuff connected to a mobile health app and HTN education. Patients completed validated social and behavioral assessments including social determinants of health (SD)H) assessment via WellRx screen, depression screening (PHQ-9), and self-efficacy screening ( Self-Efficacy to Manage Chronic Disease Scale ). A behavior change plan was created using Brief Problem Solving Therapy based on the aforementioned assessments. Staff continuously monitored usage, BP, and provided individualized interventions. We conducted a cross-sectional quality improvement study using daily BP data from June 2022 - April 2023 to assess the correlation between baseline sociodemographic characteristics and Time in Target Range (TTR) through multivariable linear regression. We calculated TTR, defined as the percentage of time with systolic BP within 100-130 mmHg, through linear interpolation. Results: A total of 133 patients were enrolled in the program. We analyzed data from 78 patients with ≥3 days of readings (average 33; SD 49) and complete baseline characteristics (Table 1). Female sex and non-smoking status were associated with TTR, while diabetes, positive depression screening, positive SDOH screening, and self-efficacy were not (Table 2). Conclusions: In a socioeconomically disadvantaged population participating in a comprehensive SMBP program, depression, SDOH, and self-efficacy screening at time of enrollment did not predict TTR. Participation in a SMBP program may be valuable in these populations.
Abstract 18284: Inhibition of Sulfatase-1 Prevents Pulmonary Arterial Hypertension in Animal Models of Disease
Authors: Andriy Samokhin, Bradley M Wertheim, George A Alba, Elena Arons, Bradley A Maron
Journal: Circulation (2023)

Introduction: Sulfatase-1 (Sulf1) is an extracellular enzyme that removes 6-O-sulfate groups from heparan sulfate and is implicated in cardiovascular disease. In human pulmonary artery endothelial cells (HPAECs), Sulf1 mRNA and protein levels are regulated by the fibroproliferative protein NEDD9 involved in PAH. Hypothesis: Sulf1 regulates migration and profibrotic potential of HPAECs and its downregulation prevents the development of PAH. Methods: HPAECs were transfected with Sulf1 siRNA or adenovirus expressing Sulf1 and cell migration was analyzed by scratch assay. In a PAH disease prevention treatment protocol, rats received intratracheal injection of Sulf1 siRNA (si-Sulf1) (1mg/kg of body weight, once a week for 3 weeks) beginning one day following the administration of monocrotaline (MCT). In a disease reversal protocol, injection of si-Sulf1 (1mg/kg of body weight, once every 5 days for a total of 3 doses) began 14 days following initiation of SU-5416/Hypoxia (SU/Hypox) PAH model. Results: Overexpression of Sulf1 in HPAECs resulted in a significant reduction in migration compared to empty vector (wound size 506 ± 39 vs 353 ± 19 μm, P&lt;0.01), whereas transfection with si-Sulf1 increased migration significantly compared to si-Scrambled control (wound size 212 ± 30 vs 295 ± 31 μm, P&lt;0.01). Overexpression of Sulf1 also increased extracellular collagen III deposition in cultured HPAECs compared to empty vector (15.4 ± 5 vs. 7 ± 1 arb. units, P&lt;0.01). Immunostaining of HPAECs for Sulf1 showed strong expression at focal adhesions. In both in vivo PAH models, si-Sulf1 treatment significantly decreased right ventricular (RV) systolic pressure compared to si-Scrambled control (MCT: 41 ± 5 vs 58 ± 6 mm Hg, P&lt;0.05; SU/Hypox: 40 ± 5 vs 75 ± 15 mm Hg, P&lt;0.05) and RV mass measured by Fulton index (MCT: 0.33 ± 0.06 vs 0.56 ± 0.06, P&lt;0.01; SU/Hypox: 0.32 ± 0.02 vs 0.41 ± 0.02, P&lt;0.05). Conclusions: These data demonstrate that pulmonary endothelial expression of Sulf1 is increased at focal adhesions and regulates cellular migration. Inhibition of Sulf1 significantly reduced the severity of PAH in vivo, which, taken together, identifies Sulf1 as a potential therapeutic target by which to improve proliferative vascular remodeling and pulmonary hypertension in PAH.
Abstract 18020: An Analysis of Retraction Studies in the Cardiology in Last 2 Decades
Authors: Akash Sharma, Vidusha Karavadi, Harshini Suresh, Priyali Singh, Parteek Walia, Sowntappan Balasubramanian, U Venkatesh
Journal: Circulation (2023)

Background: False information might harm patients and increase medical care costs. For accurate and rapid scientific advancement and clinical care, the integrity of published biomedical literature is essential. Hence, we analyzed the retracted studies in cardiology. Methodology: We adhere to the STROBE checklist. This cross-sectional study utilized PubMed and Embase databases to identify retracted publications from 2002-2022. The articles are retrieved for the detailed analysis of various characteristics, including year of publication, article type, causes of retraction, impact factor, number of citations, and author country. The statistical analysis was done by using R statistical software. Fischer t-test and 2-sample t-test were used to compare the two groups. Mann-Kendall Trend Test was used to know the trend of various variables. P-value &lt;0.05 was considered significant. Results: The search yielded 979 articles. Randomized controlled studies, experimental studies, and case-control studies are major retracted study designs. Authors from China have the highest number of retracted studies (36.1%), followed by the USA (22.4%) and Japan (4%). The most common cause of retraction is mistakes and honest errors (24.51%); and duplicate data (17.78%). From 2002 to 2022, there has been an insignificant increase in the number of retracted studies with a significant decrease in the impact factor of journals, number of citations, and time to retraction. In the first decade(FD, 2003-2012) and second decade (SD, 2013-2023), males (68.2% in the FD and 66.9% in SD) had higher retraction. In the FD, USA's first authors had the highest retractions (32.5%), while in the SD, it was for Chinese authors (46%). In the SD, retracted publications had fewer citations than in the FD (mean difference (MD) -96.37, 95% CI -142.12 to -50.62, p-value &lt;0.001). Also, the SD publications have less time for retractions (MD -9.12, 95%CI -15.52 to -2.71, p-value&lt;0.005). Conclusion: The trend of retracting publications in cardiovascular diseases is increasing. The retracted studies are still cited, but there is a decreasing trend.
Abstract 148: Differential Neuroprotective Effects of Targeted Temperature Management in Adult and Aged Rats Post-Cardiac Arrest
Authors: Binjie Chen, Chenglei Su, Ningjun Zhao, Tie Xu, Xianliang Yan
Journal: Circulation (2023)

Background: Targeted temperature management (TTM) has been recognized as a crucial brain protective method post-cardiac arrest (CA). However, its efficacy has recently been questioned due to several clinical trials. Hypothesis: TTM may not offer significant neuroprotective benefits in older individuals post-CA. Aims: This study aims to evaluate the therapeutic efficacy of TTM on neurological dysfunction in aged rats post-CA. Methods: Fifty-six male Sprague-Dawley (SD) rats were divided into two age groups: adult group (3-4 months, n=28) and aged group (19-22 months, n=28). Each group was then randomized into four subgroups: 1) sham, 2) sham + TTM, 3) control, 4) control + TTM. Control and control + TTM groups underwent 6 minutes of asphyxiation followed by cardiopulmonary resuscitation. TTM was applied at 32-34°C for 2 hour post-return of spontaneous circulation (ROSC). Neurological outcomes were assessed five days post-CA using the Y-maze and the Open field test. Serum IL-17 and IL-6 levels were measured four hours post-CA. Results: TTM significantly enhanced the spontaneous alternation in the Y-maze (p &lt;0.05), increased moter active in Open field test (p&lt;0.05), and reduced serum IL-17 and IL-6 levels in the adult group (p &lt;0.05). Conversely, in the aged group, TTM did not exhibit any significant benefits in Y maze performance, Open field test, IL-17 or IL-6 serum levels reduction (p &gt;0.05). Conclusion(s): TTM demonstrated improvement in post-CA neurological deficits in adult rats, yet it failed to deliver similar benefits in aged rats. IL-6 and IL-17 might play a role in the differential neuroprotective effects of TTM.
Abstract 14820: Is Mitral Annular Disjunction Associated With Atrial Fibrillation?
Authors: Andrew P Cesmat, Abdul M Chaudry, Suhani Gupta, Thelsa T Weickert, Ross J Simpson, Faisal F Syed
Journal: Circulation (2023)

Introduction: Mitral annular disjunction has been associated with increased risk of ventricular arrhythmias. However, its association with atrial fibrillation (AF) in mitral valve prolapse (MVP) is unknown. Hypothesis: Mitral annular disjunction (MAD) is associated with atrial fibrillation in patients with MVP. Methods: We studied all patients aged 18 - 90 years with MVP on echocardiography between 2016-19 at our institution. Echocardiograms were reviewed for ventricular size and function and mitral valve pathology. Comorbidities, including atrial fibrillation, were identified on chart review. Multivariate logistic regression was used to assess the association of mitral morphologic factors and clinical characteristics with AF in MVP. Results: AF was present in 135 (21.2%) of a total 637 MVP patients. AF was present in 5.3% (11/209) under age 60 years, 19.8% (50/253) age 60-75 years, and 43.3% (74/175) over age 75 years. MAD was present in 15.6% (21/135) with AF and 14.7% (74/502) without AF (p=0.79). On multivariate analysis, atrial fibrillation was associated with increased age (OR [95% CI], 1.93 [1.59-2.36] per 10 years, p&lt;0.0001) and heart failure (OR 2.70 [1.62-4.51], p=0.0001), although not moderate or severe mitral regurgitation (OR 1.20 [0.75-1.92], p=0.45). Conclusion: Atrial fibrillation is highly prevalent in mitral valve prolapse and independently associated with older age and presence of heart failure. Mitral annular disjunction is not a risk factor for atrial fibrillation in mitral valve prolapse.